RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Apoyo en la formulación y estructuración del proyecto “Implementación del esquema de pagos por servicios ambientales como estrategia para la preservación, conservación y restauración ecológica de 500 hectáreas de ecosistemas estratégicos en la Cuchilla de Cispatá, Córdoba”

1. INTRODUCCIÓN ..................................................................................................... 102. PLATAFORMA ESTRATÉGICA DE LA EMPRESA. ........................................ 123. MARCO TEÓRICO O CONCEPTUAL. ................................................................ 144. DIAGNÓSTICO ESPECÍFICO DE LA EMPRESA .............................................. 165. OBJETIVOS. .............................................................................................................. 185.1. Objetivo General. .................................................................................................................. 185.2. Objetivos Específico. ........................................................................................................... 186. ACTIVIDADES PROGRAMADAS. ........................................................................ 196.1. FASE N° 1: REALIZAR UNA REVISIÓN BIBLIOGRÁFICA RELACIONADA CON LA TEMÁTICA DE PAGOS POR SERVICIOS AMBIENTALES (PSA) PARA LA RESTAURACIÓN Y PRESERVACIÓN AMBIENTAL DE ECOSISTEMAS ESTRATÉGICOS EN LA CUCHILLA DE CISPATÁ. ........................................................... 196.1.1. Revisión de la información secundaria relacionada con la temática de Pagos por Servicios Ambientales (PSA) del proyecto. ......................................................................... 196.1.2 Revisión del Geoportal Registro Único de Ecosistemas y Áreas Ambientales- REAA................................................ 196.2. FASE N° 2: APLICAR LA METODOLOGÍA PARA EL ESQUEMA DE PAGOS POR SERVICIOS AMBIENTALES (PSA) ESTABLECIDA POR EL MINESTERIO DE AMBIENTE Y DESARROLLO SOSTENIBLE. ...................................................................... 196.2.1 Visita de campo en la zona de la Cuchilla de Cispatá para la Aplicación de PSA. 196.2.2 Procesamiento y análisis de la información recolectada en campo. ............................... 206.2.3 Revisión con el equipo técnico del proyecto sobre la temática de Pagos por Servicios Ambientales-PSA. ......................................................................................................................... 206.2.4 Socialización de la Propuesta de Pagos por Servicios Ambientales con la Comunidad.......................................206.3 FASE N° 3: APLICAR LA METODOLOGÍA MGA DEL DNP PARA LA PRESENTACIÓN DE PROYECTOS CON FINES DE FINANCIACIÓN. .......................... 206.3.1 Registro y Cargue de proyecto bajo el enfoque marco lógico. ........................... 206.3.2 Apoyo en la elaboración de la cadena de valor. ................................................... 207 ACTIVIDADES DESARROLLADAS ..................................................................... 217.1 FASE N° 1: REALIZAR UNA REVISIÓN BIBLIOGRÁFICA RELACIONADA CON LA TEMÁTICA DE PAGOS POR SERVICIOS AMBIENTALES PARA LA RESTAURACIÓN Y PRESERVACIÓN AMBIENTAL DE ECOSISTEMAS ESTRATÉGICOS EN LA CUCHILLA DE CISPATÁ ............................................................ 217.1.1 Revisión de la Información Secundaria relacionada a la temática PSA del proyecto. 217.1.1.2 Revisión de información secundaria del estado actual de la cuchilla de Cispatá................................237.1.2 Revisión del Geoportal Registro de Ecosistemas y Áreas Ambientales-REAA.....................................267.2 FASE N° 2: APLICAR LA METODOLOGÍA PARA EL ESQUEMA DE PAGOS POR SERVICIOS AMBIENTALES (PSA) ESTABLECIDA POR EL MINESTERIO DE AMBIENTE Y DESARROLLO SOSTENIBLE. ...................................................................... 287.2.1 Visita de Campo en la zona de la Cuchilla de Cispatá para la aplicación (PSA).....................................287.2.2 Procesamiento y análisis de la información recolectada en campo. .................. 327.2.2.1 Análisis de las Condiciones Actuales de los Ecosistemas Estratégicos. ............. 367.2.2.2 Análisis de los Usos y Cobertura de Suelo de la Cuchilla de Cispatá. ............... 387.2.2.3 Características Preliminares de La Cuchilla Cispatá. ........................................ 417.2.2.4 Selección de las especies nativas para la restauración ecológica. ....................... 427.2.3 Revisión con el equipo técnico del proyecto sobre la temática de Pagos por Servicios Ambientales-PSA. ........................................................................................................ 437.2.4 Socialización de la Propuesta del Proyecto con la Comunidad. ...................................... 477.3 FASE N° 3: APLICAR LA METODOLOGÍA MGA DEL DNP PARA LA PRESENTACIÓN DE PROYECTOS CON FINES DE FINANCIACIÓN. .......................... 507.3.1. Registro y Cargue de Proyecto Bajo el Enfoque Marco Lógico. ........................ 507.3.2 Apoyo en la Elaboración de la Cadena de Valor. ............................................................. 538. PROPUESTA DE MEJORAMIENTO. ................................................................... 549. APORTES DEL ESTUDIANTE ............................................................................... 5510. CONCLUSIONES ...................................................................................................... 5611. RECOMENDACIONES ............................................................................................ 5812. BIBLIOGRAFÍA ........................................................................................................ 5913. ANEXOS ..................................................................................................................... 62PregradoIngeniero(a) AmbientalPráctica Empresaria

Prácticas en sistemas de generación, transporte y distribución de energía eléctrica

Este libro presenta cuatro casos de aplicación a través de los cuales el lector podrá poner en práctica conceptos relacionados con la generación, el transporte, la distribución y la operación de sistemas eléctricos. Dichos casos incluyen tanto prácticas de laboratorio con máquinas eléctricas como con programas informáticos de simulación. En el caso de las prácticas de laboratorio,el libro describe el material necesario para realizar las pruebas propuestas, así como un procedimiento detallado con los pasos a seguir.Para las prácticas con programas informáticos, el libro describe los simuladores utilizados y detalla igualmente el procedimiento a seguir para llevar a cabo con éxito los casos propuestos.Todas las prácticas terminan con unas fichas donde, de forma sistemática, se pueden anotar las medidas tomadas durante la sesión práctica, que son necesarias para contestar las cuestiones de que ésta es objeto. El libro está orientado hacia estudiantes de ingeniería que ya han recibido formación específica en el campo de la ingeniería eléctrica. Para ellos,estos casos de aplicación supondrán un complemento esencial para comprender cómo se produce la electricidad y cómo se operan y gestionan los sistemas eléctricos.Cañas Peñuelas, CS.; Vargas Salgado, CA.; Roldán Blay, C.; Alcázar Ortega, M.; Fuster Roig, VL.; Benlloch Ramos, V.; Escrivá Escrivá, G. (2020). Prácticas en sistemas de generación, transporte y distribución de energía eléctrica. Editorial Universitat Politècnica de València. http://hdl.handle.net/10251/146829EDITORIA

Promoción turística sostenible de la reserva de la biosfera Tajo-Tejo Internacional

Convocatoria proyectos de innovación de Extremadura 2020/2021Se describe un proyecto llevado acabo por varios centros educativos ubicados en la zona de la Reserva de la Biosfera Tajo-Tejo Internacional (RBTTI) que pretendía contribuir a la transformación sostenible del entorno mediante su conocimiento y promoción, implementando las competencias digital, social y ciudadana y la cultura emprendedora mediante metodologías activas como el aprendizaje servicio. Entre los objetivos principales del proyecto destacan: dar a conocer las implicaciones de la RBTTI; diseñar una campaña de promoción de la RBTTI mediante trípticos y vídeos promocionales; conocer la Reserva a través de las principales vías pecuarias y caminos que comunican los pueblos; descubrir los principales elementos socioculturales, históricos y tradicionales de la Reserva; valorar la importancia del territorio para conservar la biodiversidad: paisajes, ecosistemas, fauna y flora representativa; relacionar la trashumancia y las vías pecuarias como rasgos identificativos de la Reserva, vinculándolo con la historia y rasgos culturales de los pueblos y valorar el emprendimiento y la iniciativa personal, el asosiacionismo y creación de redes de cooperación en y entre pueblos como motor de desarrolloExtremaduraES

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Item does not contain fulltextOBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status