Úlcera de Martorell. Diferencias en el diagnóstico y tratamiento entre estudiantes y profesionales de Enfermería

Objetivo. Averiguar las diferencias en el nivel de conocimiento de los estudiantes y profesionales de Enfermería sobre el diagnóstico y tratamiento de la úlcera hipertensiva o de Martorell. Introducción. Las úlceras de extremidad inferior (UEI) son lesiones que no cicatrizan en el tiempo esperado. Causan gran deterioro social, así como un gran gasto económico. La úlcera de Martorell es una complicación de la HTA sistémica de larga evolución. Su prevalencia es del 0,5 al 1%, pero este tipo de lesiones están infradiagnosticadas por el personal sanitario. Material y métodos. Se diseñó un cuestionario con un caso clínico a resolver. Se administró a estudiantes de Enfermería de 3º y 4º de la Universidad de Alicante y a profesionales de Enfermería del Hospital G. U. de Alicante, obteniéndose una muestra de 207 participantes. Se registraron varias variables como la edad, sexo, curso o conocimientos previos entre otras. Resultados. Un 60,9% de la muestra refirió tener conocimientos sobre heridas crónicas, un 43,7% de estudiantes frente a un 56,3% de profesionales. Un 20,8% diagnosticó correctamente la úlcera de Martorell, siendo un 90,7% estudiantes y tan solo un 9,3% enfermeras tituladas. Solo 1 de cada 4 enfermeras indicó el tratamiento correctamente, mientras que los estudiantes acertaron en un 62,1%. Por otro lado, los estudiantes que cursaron la optativa de “Atención Integral al paciente con Heridas Crónicas” tuvieron casi 6 veces más probabilidad de acertar que los que no la cursaron. Conclusiones. La formación universitaria sobre las UEI resulta imprescindible para desarrollar una buena labor profesional en el futuro, mientras que la formación post-universitaria es un reto en la actualidad. Hay una necesidad en la actualización de conocimientos sobre el diagnóstico y tratamiento por parte de los profesionales de Enfermería.

Unifying the observational diversity of isolated neutron stars via magneto-thermal evolution models

Observations of magnetars and some of the high magnetic field pulsars have shown that their thermal luminosity is systematically higher than that of classical radio-pulsars, thus confirming the idea that magnetic fields are involved in their X-ray emission. Here we present the results of 2D simulations of the fully coupled evolution of temperature and magnetic field in neutron stars, including the state-of-the-art kinetic coefficients and, for the first time, the important effect of the Hall term. After gathering and thoroughly re-analysing in a consistent way all the best available data on isolated, thermally emitting neutron stars, we compare our theoretical models to a data sample of 40 sources. We find that our evolutionary models can explain the phenomenological diversity of magnetars, high-B radio-pulsars, and isolated nearby neutron stars by only varying their initial magnetic field, mass and envelope composition. Nearly all sources appear to follow the expectations of the standard theoretical models. Finally, we discuss the expected outburst rates and the evolutionary links between different classes. Our results constitute a major step towards the grand unification of the isolated neutron star zoo.

The outburst decay of the low magnetic field magnetar SGR 0418+5729

We report on the long-term X-ray monitoring of the outburst decay of the low magnetic field magnetar SGR 0418+5729 using all the available X-ray data obtained with RXTE, Swift, Chandra, and XMM-Newton observations from the discovery of the source in 2009 June up to 2012 August. The timing analysis allowed us to obtain the first measurement of the period derivative of SGR 0418+5729: ˙ P = 4(1) × 10−15 s s−1, significant at a ∼3.5σ confidence level. This leads to a surface dipolar magnetic field of Bdip 6 × 1012 G. This measurement confirms SGR 0418+5729 as the lowest magnetic field magnetar. Following the flux and spectral evolution from the beginning of the outburst up to ∼1200 days, we observe a gradual cooling of the tiny hot spot responsible for the X-ray emission, from a temperature of ∼0.9 to 0.3 keV. Simultaneously, the X-ray flux decreased by about three orders of magnitude: from about 1.4 × 10−11 to 1.2 × 10−14 erg s−1 cm−2. Deep radio, millimeter, optical, and gamma-ray observations did not detect the source counterpart, implying stringent limits on its multi-band emission, as well as constraints on the presence of a fossil disk. By modeling the magneto-thermal secular evolution of SGR 0418+5729, we infer a realistic age of ∼550 kyr, and a dipolar magnetic field at birth of ∼1014 G. The outburst characteristics suggest the presence of a thin twisted bundle with a small heated spot at its base. The bundle untwisted in the first few months following the outburst, while the hot spot decreases in temperature and size. We estimate the outburst rate of low magnetic field magnetars to be about one per year per galaxy, and we briefly discuss the consequences of such a result in several other astrophysical contexts.

A strongly magnetized pulsar within the grasp of the milky way’s supermassive black hole

The center of our Galaxy hosts a supermassive black hole, Sagittarius (Sgr) A∗. Young, massive stars within 0.5 pc of Sgr A∗ are evidence of an episode of intense star formation near the black hole a few million years ago, which might have left behind a young neutron star traveling deep into Sgr A∗’s gravitational potential. On 2013 April 25, a short X-ray burst was observed from the direction of the Galactic center. With a series of observations with the Chandra and the Swift satellites, we pinpoint the associated magnetar at an angular distance of 2.4±0.3 arcsec from Sgr A∗, and refine the source spin period and its derivative (P = 3.7635537(2) s and ˙ P = 6.61(4) × 10−12 s s−1), confirmed by quasi simultaneous radio observations performed with the Green Bank Telescope and Parkes Radio Telescope, which also constrain a dispersion measure of DM = 1750 ± 50 pc cm−3, the highest ever observed for a radio pulsar. We have found that this X-ray source is a young magnetar at ≈0.07–2 pc from Sgr A∗. Simulations of its possible motion around Sgr A∗ show that it is likely (∼90% probability) in a bound orbit around the black hole. The radiation front produced by the past activity from the magnetar passing through the molecular clouds surrounding the Galactic center region might be responsible for a large fraction of the light echoes observed in the Fe fluorescence features.

The imprint of the crustal magnetic field on the thermal spectra and pulse profiles of isolated neutron stars

Isolated neutron stars (NSs) show a bewildering variety of astrophysical manifestations, presumably shaped by the magnetic field strength and topology at birth. Here, using state-of-the-art calculations of the coupled magnetic and thermal evolution of NSs, we compute the thermal spectra and pulse profiles expected for a variety of initial magnetic field configurations. In particular, we contrast models with purely poloidal magnetic fields to models dominated by a strong internal toroidal component. We find that, while the former displays double-peaked profiles and very low pulsed fractions, in the latter, the anisotropy in the surface temperature produced by the toroidal field often results in a single pulse profile, with pulsed fractions that can exceed the 50–60 per cent level even for perfectly isotropic local emission. We further use our theoretical results to generate simulated ‘observed’ spectra, and show that blackbody (BB) fits result in inferred radii that can be significantly smaller than the actual NS radius, even as low as ∼1–2 km for old NSs with strong internal toroidal fields and a high absorption column density along their line of sight. We compute the size of the inferred BB radius for a few representative magnetic field configurations, NS ages and magnitudes of the column density. Our theoretical results are of direct relevance to the interpretation of X-ray observations of isolated NSs, as well as to the constraints on the equation of state of dense matter through radius measurements.

A new low magnetic field magnetar: the 2011 outburst of Swift J1822.3–1606

We report on the long-term X-ray monitoring with Swift, RXTE, Suzaku, Chandra, and XMM-Newton of the outburst of the newly discovered magnetar Swift J1822.3–1606 (SGR 1822–1606), from the first observations soon after the detection of the short X-ray bursts which led to its discovery, through the first stages of its outburst decay (covering the time span from 2011 July until the end of 2012 April). We also report on archival ROSAT observations which detected the source during its likely quiescent state, and on upper limits on Swift J1822.3–1606's radio-pulsed and optical emission during outburst, with the Green Bank Telescope and the Gran Telescopio Canarias, respectively. Our X-ray timing analysis finds the source rotating with a period of P = 8.43772016(2) s and a period derivative P = 8.3(2)×10−14 s s−1, which implies an inferred dipolar surface magnetic field of B sime 2.7 × 1013 G at the equator. This measurement makes Swift J1822.3–1606 the second lowest magnetic field magnetar (after SGR 0418+5729). Following the flux and spectral evolution from the beginning of the outburst, we find that the flux decreased by about an order of magnitude, with a subtle softening of the spectrum, both typical of the outburst decay of magnetars. By modeling the secular thermal evolution of Swift J1822.3–1606, we find that the observed timing properties of the source, as well as its quiescent X-ray luminosity, can be reproduced if it was born with a poloidal and crustal toroidal fields of Bp ~ 1.5 × 1014 G and B tor ~ 7 × 1014 G, respectively, and if its current age is ~550 kyr.

Spectral features in isolated neutron stars induced by inhomogeneous surface temperatures

The thermal X-ray spectra of several isolated neutron stars display deviations from a pure blackbody. The accurate physical interpretation of these spectral features bears profound implications for our understanding of the atmospheric composition, magnetic field strength and topology, and equation of state of dense matter. With specific details varying from source to source, common explanations for the features have ranged from atomic transitions in the magnetized atmospheres or condensed surface, to cyclotron lines generated in a hot ionized layer near the surface. Here, we quantitatively evaluate the X-ray spectral distortions induced by inhomogeneous temperature distributions of the neutron star surface. To this aim, we explore several surface temperature distributions, we simulate their corresponding general relativistic X-ray spectra (assuming an isotropic, blackbody emission), and fit the latter with a single blackbody model. We find that, in some cases, the presence of a spurious ‘spectral line’ is required at a high significance level in order to obtain statistically acceptable fits, with central energy and equivalent width similar to the values typically observed. We also perform a fit to a specific object, RX J0806.4−4123, finding several surface temperature distributions able to model the observed spectrum. The explored effect is unlikely to work in all sources with detected lines, but in some cases it can indeed be responsible for the appearance of such lines. Our results enforce the idea that surface temperature anisotropy can be an important factor that should be considered and explored also in combination with more sophisticated emission models like atmospheres.

The many lives of magnetized neutron stars

The magnetic field strength at birth is arguably one of the most important properties to determine the evolutionary path of a neutron star. Objects with very high fields, collectively known as magnetars, are characterized by high X-ray quiescent luminosities, occurrence of outbursts, and, for some of them, sporadic giant flares. While the magnetic field strength is believed to drive their collective behaviour, however, the diversity of their properties, and, especially, the observation of magnetar-like bursts from “low-field” pulsars, has been a theoretical puzzle. In this review, we discuss results of long-term simulations following the coupled evolution of the X-ray luminosity and the timing properties for a large, homogeneous sample of X-ray emitting isolated neutron stars, accounting for a range of initial magnetic field strengths, envelope compositions, and neutron star masses. In addition, by following the evolution of magnetic stresses within the neutron star crust, we can also relate the observed magnetar phenomenology to the physical properties of neutron stars, and in particular to their age and magnetic field strength and topology. The dichotomy of “high-B” field pulsars versus magnetars is naturally explained, and occasional outbursts from old, low B-field neutron stars are predicted. We conclude by speculating on the fate of old magnetars, and by presenting observational diagnostics of the neutron star crustal field topology.

The X-ray outburst of the Galactic Centre magnetar SGR J1745−2900 during the first 1.5 year

In 2013 April a new magnetar, SGR 1745−2900, was discovered as it entered an outburst, at only 2.4 arcsec angular distance from the supermassive black hole at the centre of the Milky Way, Sagittarius A*. SGR 1745−2900 has a surface dipolar magnetic field of ∼2 × 1014 G, and it is the neutron star closest to a black hole ever observed. The new source was detected both in the radio and X-ray bands, with a peak X-ray luminosity LX ∼ 5 × 1035 erg s−1. Here we report on the long-term Chandra (25 observations) and XMM–Newton (eight observations) X-ray monitoring campaign of SGR 1745−2900 from the onset of the outburst in 2013 April until 2014 September. This unprecedented data set allows us to refine the timing properties of the source, as well as to study the outburst spectral evolution as a function of time and rotational phase. Our timing analysis confirms the increase in the spin period derivative by a factor of ∼2 around 2013 June, and reveals that a further increase occurred between 2013 October 30 and 2014 February 21. We find that the period derivative changed from 6.6 × 10−12 to 3.3 × 10−11 s s−1 in 1.5 yr. On the other hand, this magnetar shows a slow flux decay compared to other magnetars and a rather inefficient surface cooling. In particular, starquake-induced crustal cooling models alone have difficulty in explaining the high luminosity of the source for the first ∼200 d of its outburst, and additional heating of the star surface from currents flowing in a twisted magnetic bundle is probably playing an important role in the outburst evolution.

Modelling of the surface emission of the low magnetic field magnetar SGR 0418+5729

We perform a detailed modelling of the post-outburst surface emission of the low magnetic field magnetar SGR 0418+5729. The dipolar magnetic field of this source, B=6×1012G estimated from its spin-down rate, is in the observed range of magnetic fields for normal pulsars. The source is further characterized by a high pulse fraction and a single-peak profile. Using synthetic temperature distribution profiles, and fully accounting for the general-relativistic effects of light deflection and gravitational redshift, we generate synthetic X-ray spectra and pulse profiles that we fit to the observations. We find that asymmetric and symmetric surface temperature distributions can reproduce equally well the observed pulse profiles and spectra of SGR 0418. None the less, the modelling allows us to place constraints on the system geometry (i.e. the angles ψ and ξ that the rotation axis makes with the line of sight and the dipolar axis, respectively), as well as on the spot size and temperature contrast on the neutron star surface. After performing an analysis iterating between the pulse profile and spectra, as done in similar previous works, we further employed, for the first time in this context, a Markov-Chain Monte Carlo approach to extract constraints on the model parameters from the pulse profiles and spectra, simultaneously. We find that, to reproduce the observed spectrum and flux modulation: (a) the angles must be restricted to 65° ≲ ψ + ξ ≲ 125° or 235° ≲ ψ + ξ ≲ 295°; (b) the temperature contrast between the poles and the equator must be at least a factor of ∼6, and (c) the size of the hottest region ranges between 0.2 and 0.7 km (including uncertainties on the source distance). Lastly, we interpret our findings within the context of internal and external heating models.

Constraining the GRB-Magnetar Model by Means of the Galactic Pulsar Population

A large fraction of Gamma-ray bursts (GRBs) displays an X-ray plateau phase within <105 s from the prompt emission, proposed to be powered by the spin-down energy of a rapidly spinning newly born magnetar. In this work we use the properties of the Galactic neutron star population to constrain the GRB-magnetar scenario. We re-analyze the X-ray plateaus of all Swift GRBs with known redshift, between 2005 January and 2014 August. From the derived initial magnetic field distribution for the possible magnetars left behind by the GRBs, we study the evolution and properties of a simulated GRB-magnetar population using numerical simulations of magnetic field evolution, coupled with Monte Carlo simulations of Pulsar Population Synthesis in our Galaxy. We find that if the GRB X-ray plateaus are powered by the rotational energy of a newly formed magnetar, the current observational properties of the Galactic magnetar population are not compatible with being formed within the GRB scenario (regardless of the GRB type or rate at z = 0). Direct consequences would be that we should allow the existence of magnetars and "super-magnetars" having different progenitors, and that Type Ib/c SNe related to Long GRBs form systematically neutron stars with higher initial magnetic fields. We put an upper limit of ≤16 "super-magnetars" formed by a GRB in our Galaxy in the past Myr (at 99% c.l.). This limit is somewhat smaller than what is roughly expected from Long GRB rates, although the very large uncertainties do not allow us to draw strong conclusion in this respect.

Population synthesis of isolated neutron stars with magneto-rotational evolution – II. From radio-pulsars to magnetars

Population synthesis studies constitute a powerful method to reconstruct the birth distribution of periods and magnetic fields of the pulsar population. When this method is applied to populations in different wavelengths, it can break the degeneracy in the inferred properties of initial distributions that arises from single-band studies. In this context, we extend previous works to include X-ray thermal emitting pulsars within the same evolutionary model as radio-pulsars. We find that the cumulative distribution of the number of X-ray pulsars can be well reproduced by several models that, simultaneously, reproduce the characteristics of the radio-pulsar distribution. However, even considering the most favourable magneto-thermal evolution models with fast field decay, lognormal distributions of the initial magnetic field overpredict the number of visible sources with periods longer than 12 s. We then show that the problem can be solved with different distributions of magnetic field, such as a truncated lognormal distribution, or a binormal distribution with two distinct populations. We use the observational lack of isolated neutron stars (NSs) with spin periods P > 12 s to establish an upper limit to the fraction of magnetars born with B > 1015 G (less than 1 per cent). As future detections keep increasing the magnetar and high-B pulsar statistics, our approach can be used to establish a severe constraint on the maximum magnetic field at birth of NSs.

Adaptación cultural y validación de la escala de valoración de riesgo de desarrollar úlceras por presión en neonatos hospitalizados (Neonatal Skin Risk Assessment Scale)

Los estudios epidemiológicos realizados hasta la fecha en neonatos hospitalizados son escasos. En España en las unidades neonatales las cifras de prevalencia se mueven entre un 50% en unidades de cuidados intensivos (UCIN) y un 12,5% en unidades de hospitalización. Desde todas las organizaciones de salud, nacionales (GNEAUPP) e internacionales (EPUAP, EWMA, NPUAP) relacionadas con las heridas, se promociona y potencia la seguridad del paciente mediante la prevención de los efectos adversos hospitalarios. Para conseguirlo es necesario dotar a los profesionales sanitarios de herramientas validadas y adaptadas a la edad neonatal que permitan valorar el riesgo de la población hospitalizada. De esta forma los profesionales sanitarios podrán gestionar de forma eficiente los recursos preventivos y trazar planes de cuidados centrados en el neonato. En la actualidad, en España no existe ninguna escala validada específicamente para neonatos. Por tanto, el objetivo principal de nuestro equipo de investigación fue adaptar transculturalmente al contexto español la escala NSRAS original y evaluar la validez y la fiabilidad de la versión en español. En esta ponencia se presentarán los resultados preliminares de la tesis. Método. El estudio se subdividió en tres fases. En la primera fase se realizó la adaptación transcultural de la escala NSRAS original mediante el método de traducción con retrotraducción. Posteriormente entre un grupo de expertos se calculó la validez de contenido mediante el IVC. La versión de la escala adaptada fue evaluada mediante dos fases de estudio multicéntrico observacional analítico en las unidades neonatales de 10 hospitales públicos del Sistema Nacional de Salud. Se evaluó la fiabilidad interobservadores e intraobservadores, la validez de constructo en la segunda fase y en una tercera fase se evaluó la capacidad predictiva y el punto de corte de la versión en español de la escala NSRAS. Resultados. En la primera fase la validez de contenido evaluada obtuvo un IVC de 0,926 [IC95%0,777-0,978]. En la segunda fase, la muestra evaluada fue de 336 neonatos. La consistencia interna mostró un Alfa de Cronbach de 0,794. Y la fiabilidad intraobservadores fue de 0,932 y la fiabilidad interobservadores fue de 0,969. En la tercera fase la muestra evaluada fue de 268 neonatos. El análisis multivariante de la relación entre los factores de riesgo, las medidas preventivas y la presencia de UPP mostró que 3 variables eran significativas: la puntuación NSRAS, la duración del ingreso y el uso de VMNI. Siendo de esta forma la puntuación NSRAS (debido a que activa las medidas preventivas) un factor protector frente a UPP. Es decir, a mayor puntuación de NSRAS, menor riesgo de UPP. La valoración clinicométrica de la puntuación 17 mostró una sensibilidad del 91,18%, una especificidad de 76,5%, un VPN de 36,05% y un VPP de 98,35%. El área bajo la curva ROC fue de 0,8384 en la puntuación 17. Conclusiones. La versión en español de la escala NSRAS es una herramienta válida y fiable para medir el riesgo de UPP en la población neonatal hospitalizada en el contexto español. Los neonatos hospitalizados con una puntuación igual o menor a 17 están en riesgo desarrollar UPP.

The outburst decay of the low magnetic field magnetar SWIFT J1822.3−1606: phase-resolved analysis and evidence for a variable cyclotron feature

We study the timing and spectral properties of the low-magnetic field, transient magnetar SWIFT J1822.3−1606 as it approached quiescence. We coherently phase-connect the observations over a time-span of ∼500 d since the discovery of SWIFT J1822.3−1606 following the Swift-Burst Alert Telescope (BAT) trigger on 2011 July 14, and carried out a detailed pulse phase spectroscopy along the outburst decay. We follow the spectral evolution of different pulse phase intervals and find a phase and energy-variable spectral feature, which we interpret as proton cyclotron resonant scattering of soft photon from currents circulating in a strong (≳1014 G) small-scale component of the magnetic field near the neutron star surface, superimposed to the much weaker (∼3 × 1013 G) magnetic field. We discuss also the implications of the pulse-resolved spectral analysis for the emission regions on the surface of the cooling magnetar.

The discovery, monitoring and environment of SGR J1935+2154

We report on the discovery of a new member of the magnetar class, SGR J1935+2154, and on its timing and spectral properties measured by an extensive observational campaign carried out between 2014 July and 2015 March with Chandra and XMM–Newton (11 pointings). We discovered the spin period of SGR J1935+2154 through the detection of coherent pulsations at a period of about 3.24 s. The magnetar is slowing down at a rate of P˙=1.43(1)×10−11 s s−1 and with a decreasing trend due to a negative P¨ of −3.5(7) × 10−19 s s−2. This implies a surface dipolar magnetic field strength of ∼2.2 × 1014 G, a characteristic age of about 3.6 kyr and a spin-down luminosity Lsd ∼1.7 × 1034 erg s−1. The source spectrum is well modelled by a blackbody with temperature of about 500 eV plus a power-law component with photon index of about 2. The source showed a moderate long-term variability, with a flux decay of about 25 per cent during the first four months since its discovery, and a re-brightening of the same amount during the second four months. The X-ray data were also used to study the source environment. In particular, we discovered a diffuse emission extending on spatial scales from about 1 arcsec up to at least 1 arcmin around SGR J1935+2154 both in Chandra and XMM–Newton data. This component is constant in flux (at least within uncertainties) and its spectrum is well modelled by a power-law spectrum steeper than that of the pulsar. Though a scattering halo origin seems to be more probable we cannot exclude that part, or all, of the diffuse emission is due to a pulsar wind nebula.