Clinical pathway intervention compliance and effectiveness when used in the treatment of patients with severe sepsis and septic shock at an Intensive Care Unit in Spain

The purpose of this quasi-experimental study was to assess levels of compliance with the intervention bundles contained in a clinical pathway used in the treatment of patients with severe sepsis and septic shock, and to analyze the pathway’s impact on survival and duration of hospital stays. We used data on 125 patients in an Intensive Care Unit, divided into a control group (N=84) and an intervention group (N=41). Levels of compliance increased from 13.1% to 29.3% in 5 resuscitation bundle interventions and from 14.3% to 22% in 3 monitoring bundle interventions. In-hospital mortality at 28 days decreased by 11.2% and the duration of hospital stay was reduced by 5 days. Although compliance was low, the intervention enhanced adherence to the instructions given in the clinical pathway and we observed a decline in mortality at 28 days and shorter hospital stays.

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.

Validation of a mobility item bank for older patients in primary care

Background: To develop and validate an item bank to measure mobility in older people in primary care and to analyse differential item functioning (DIF) and differential bundle functioning (DBF) by sex. Methods: A pool of 48 mobility items was administered by interview to 593 older people attending primary health care practices. The pool contained four domains based on the International Classification of Functioning: changing and maintaining body position, carrying, lifting and pushing, walking and going up and down stairs. Results: The Late Life Mobility item bank consisted of 35 items, and measured with a reliability of 0.90 or more across the full spectrum of mobility, except at the higher end of better functioning. No evidence was found of non-uniform DIF but uniform DIF was observed, mainly for items in the changing and maintaining body position and carrying, lifting and pushing domains. The walking domain did not display DBF, but the other three domains did, principally the carrying, lifting and pushing items. Conclusions: During the design and validation of an item bank to measure mobility in older people, we found that strength (carrying, lifting and pushing) items formed a secondary dimension that produced DBF. More research is needed to determine how best to include strength items in a mobility measure, or whether it would be more appropriate to design separate measures for each construct.

El papel del Marqués de Vadillo como propagador de la vacuna en Soria (1801)

El método desarrollado por Edward Jenner para prevenir la viruela en 1798 se difundió con extraordinaria rapidez por Europa. Las primeras vacunaciones en diciembre de 1800 marcan en España el inicio de una práctica que fue promovida por la iniciativa particular de médicos y cirujanos en distintos núcleos del país. Ignacio María Ruiz de Luzuriaga, secretario de la Real Academia de Medicina de Madrid, fue una figura central en la propagación del método al establecer una red espontánea de corresponsales a los que remitía vacuna e información sobre cómo utilizarla. Esta correspondencia, conservada en un legajo de la Academia con el título de Papeles de la vacuna, muestra la relación mantenida no solo con otros facultativos, sino también con miembros de la nobleza y burguesía peninsular que contribuyeron a impulsar la práctica. Este estudio analiza las cartas remitidas por Francisco González de Castejón, Marqués de Vadillo, interesado inicialmente por preservar de la viruela a su hija, y que junto al médico Josef Ubis propagó la vacuna en la provincia de Soria y algunas localidades de Navarra entre los meses de agosto y diciembre de 1801.

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.

Differentiated effect of advertising: Joint vs. separate consumption

In a context of intense competition, cooperative advertising between firms is critical. Accordingly, the objective of this article is to analyze the potential differentiated effect of advertising on two basic consumption patterns: individual products (i.e. hotel, restaurant) vs. bundle (i.e. hotel + restaurant). This research adds to the extant literature in that, for the first time, this potential differentiated effect is examined through a hierarchical modelling framework that reflects the way people make their decisions: first, they decide whether to visit or not a region; second, whether to purchase an advertised product in that region; and third, whether to buy products together or separately at the region. The empirical analysis, applied to a sample of 11,288 individuals, shows that the influence of advertising is positive for the decisions to visit and to purchase; however, when it comes to the joint or separate consumption, advertising has a differentiated effect: its impact is much greater on the joint alternative (“hotel + restaurant”) than the separate options (“hotel” and “restaurant”). Also, the variable distance moderates the advertising effect.