8 research outputs found

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low‚Äďmiddle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‚Äėsingle-use‚Äô consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low‚Äďmiddle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high‚Äď and low‚Äďmiddle‚Äďincome countries

    Model tridimensional de la Casa Macaya

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    Aquest treball es basa en la Casa Macaya, edifici situat a Barcelona i constru√Įt durant l‚Äô√®poca modernista per l‚Äôarquitecte Josep Puig i Cadafalch. Per tant, farem una introducci√≥ sobre el Modernisme, l‚Äôautor, la hist√≤ria de la casa i la localitzaci√≥ de l‚Äôedifici per donar a con√®ixer al lector les circumst√†ncies que envolten l‚Äôobra

    Model tridimensional de la Casa Macaya

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    Aquest treball es basa en la Casa Macaya, edifici situat a Barcelona i constru√Įt durant l‚Äô√®poca modernista per l‚Äôarquitecte Josep Puig i Cadafalch. Per tant, farem una introducci√≥ sobre el Modernisme, l‚Äôautor, la hist√≤ria de la casa i la localitzaci√≥ de l‚Äôedifici per donar a con√®ixer al lector les circumst√†ncies que envolten l‚Äôobra

    Combination of late gadolinium enhancement and genotype improves prediction of prognosis in non-ischaemic dilated cardiomyopathy

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    Aims: Genotype and left ventricular scar on cardiac magnetic resonance (CMR) are increasingly recognized as risk markers for adverse outcomes in non-ischaemic dilated cardiomyopathy (DCM). We investigated the combined influence of genotype and late gadolinium enhancement (LGE) in assessing prognosis in a large cohort of patients with DCM. Methods and results: Outcomes of 600 patients with DCM (53.3 ¬Ī 14.1 years, 66% male) who underwent clinical CMR and genetic testing were retrospectively analysed. The primary endpoints were end-stage heart failure (ESHF) and malignant ventricular arrhythmias (MVA). During a median follow-up of 2.7 years (interquartile range 1.3‚Äď4.9), 24 (4.00%) and 48 (8.00%) patients had ESHF and MVA, respectively. In total, 242 (40.3%) patients had pathogenic/likely pathogenic variants (positive genotype) and 151 (25.2%) had LGE. In survival analysis, positive LGE was associated with MVA and ESHF (both, p < 0.001) while positive genotype was associated with ESHF (p = 0.034) but not with MVA (p = 0.102). Classification of patients according to genotype (G+/G‚ąí) and LGE presence (L+/L‚ąí) revealed progressively increasing events across L‚ąí/G‚ąí, L‚ąí/G+, L+/G‚ąí and L+/G+ groups and resulted in optimized MVA and ESHF prediction (p < 0.001 and p = 0.001, respectively). Hazard ratios for MVA and ESHF in patients with either L+ or G+ compared with those with L‚ąí/G‚ąí were 4.71 (95% confidence interval: 2.11‚Äď10.50, p < 0.001) and 7.92 (95% confidence interval: 1.86‚Äď33.78, p < 0.001), respectively. Conclusion: Classification of patients with DCM according to genotype and LGE improves MVA and ESHF prediction. Scar assessment with CMR and genotyping should be considered to select patients for primary prevention implantable cardioverter-defibrillator placementThis work was supported by grants from the Instituto de Salud Carlos III (ISCIII) (PI18/0004, PI19/01283, PI20/0320). (Co-funded by European Regional Development Fund/European Social Fund ‚ÄėA way to make Europe‚Äô/‚ÄėInvesting in your future‚Äô). The Hospital Universitario Puerta de Hierro Majadahonda, the Hospital Clinic, the Hospital Vall d‚ÄôHebron, the Hospital General Universitario Gregorio Mara√Ī√≥n and the Hospital Universitario Virgen de la Arrixaca are members of the European Reference Network for rare, low-prevalence, and complex diseases of the heart (ERN GUARD-Heart). The CNIC is supported by the ISCIII, MCIN, the Pro-CNIC Foundation, and the Severo Ochoa Centers of Excellence program (CEX2020-001041-S). Conflict of interest: none declare

    Proyecto Djehuty

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    Web tem√°tica.-- Prop√≥sito: divulgativoEl ‚ÄúProyecto Djehuty‚ÄĚ tiene como objetivo la excavaci√≥n, restauraci√≥n, publicaci√≥n cient√≠fica y divulgaci√≥n de un conjunto de monumentos funerarios y enterramientos de individuos de clase media y alta, en la colina de Dra Abu el-Naga, en el extremo norte de la necr√≥polis de la antigua ciudad de Tebas, hoy Luxor, Egipto. Destacan las capillas-tumbas de Djehuty y de Hery, altos funcionarios al servicio de la administraci√≥n real en torno al a√Īo 1500 a. C.Peer reviewe

    Legume consumption is inversely associated with type 2 diabetes incidence in adults: A prospective assessment from the PREDIMED study

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    Background & aims: Legumes, a low-energy, nutrient-dense and low glycemic index food, have shown beneficial effects on glycemic control and adiposity. As such, legumes are widely recommended in diabetic diets, even though there is little evidence that their consumption protects against type 2 diabetes. Therefore the aim of the present study was to examine the associations between consumption of total legumes and specific subtypes, and type 2 diabetes risk. We also investigated the effect of theoretically substituting legumes for other protein- or carbohydrate-rich foods. Methods: Prospective assessment of 3349 participants in the PREvenci√≥n con DIeta MEDiterr√°nea (PREDIMED) study without type 2 diabetes at baseline. Dietary information was assessed at baseline and yearly during follow-up. We used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for type-2 diabetes incidence according to quartiles of cumulative average consumption of total legumes, lentils, chickpeas, dry beans and fresh peas. Results: During a median follow-up of 4.3 years, 266 new cases of type 2 diabetes occurred. Individuals in the highest quartile of total legume and lentil consumption had a lower risk of diabetes than those in the lowest quartile (HR: 0.65; 95% CI: 0.43, 0.96; P-trend = 0.04; and HR: 0.67; 95% CI: 0.46‚Äď0.98; P-trend = 0.05, respectively). A borderline significant association was also observed for chickpeas consumption (HR 0.68; 95% CI: 0.46, 1.00; P-trend = 0.06). Substitutions of half a serving/day of legumes for similar servings of eggs, bread, rice or baked potato was associated with lower risk of diabetes incidence. Conclusions: A frequent consumption of legumes, particularly lentils, in the context of a Mediterranean diet, may provide benefits on type 2 diabetes prevention in older adults at high cardiovascular risk. Trial registration: The trial is registered at http://www.controlled-trials.com (ISRCTN35739639). Registration date: 5th October 2005.The authors disclose no conflict of interest related with the article. Centro de Investigaci√≥n Biom√©dica en Red Fisiopatolog√≠a de la Obesidad y Nutrici√≥n (CIBEROBN) is an initiative of the Instituto de Salud Carlos III (ISCIII) of Spain which is supported by FEDER funds (CB06/03). Supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through grants provided to research networks specifically developed for the trial (RTIC G03/140 and RD 06/0045) through CIBEROBN, and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigaci√≥n Sanitaria‚ÄďFondoEuropeo de Desarrollo Regional (PI04‚Äď2239, PI05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, and PI11/02505; PI13/00462), Ministerio de Ciencia e Innovaci√≥n (AGL-2009‚Äď13906-C02 and AGL2010‚Äď22319-C03), Fundaci√≥n Mapfre 2010, Consejer√≠a de Salud de la Junta de Andaluc√≠a (PI0105/2007), Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (ACOMP06109, GVA-COMP2010‚Äď181, GVACOMP2011‚Äď151, CS2010-AP-111, and CS2011-AP-042), and the Navarra Regional Government (27/2011). The Fundaci√≥n Patrimonio Comunal Olivarero and Hojiblanca SA (M√°laga, Spain), California Walnut Commission (Sacramento, CA), Borges SA (Reus, Spain), and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds, and hazelnuts, respectively, used in the study. None of the funding sources played a role in the design, collection, analysis or interpretation of the data or in the decision to submit the manuscript for publication. Acknowledgements: The authors thank all the participants for their collaboration, all the PREDIMED personnel for their assistance and all the personnel of affiliated primary care centers for making the study possible. CIBEROBN is an initiative of ISCIII, Spain.Peer Reviewe

    Mural Endocarditis: The GAMES Registry Series and Review of the Literature

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    Legume consumption is inversely associated with type 2 diabetes incidence in adults: A prospective assessment from the PREDIMED study

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