Tómese unos minutos para revisar sus conocimientos sobre Transmisión de infecciones. Autoprotección del personal sanitario

En la transmisión de infecciones se mezclan las evidencias científicas, los miedos y las valoraciones personales del riesgo de contagio, en ocasiones inadecuadas, dado que el concepto"riesgo" es siempre subjetivo y difícil de definir. Todo ello puede generar conceptos erróneos o no totalmente ciertos. Esta autoevaluación es una pequeña contribución para separar"los mitos y/o leyendas sanitarias" de las realidades en relación con los riesgos de transmisión de algunas infecciones al personal sanitario.

Impact of body tilt on the central aortic pressure pulse.

The present work was undertaken to investigate, in young healthy volunteers, the relationships between the forward propagation times of arterial pressure waves and the timing of reflected waves observable on the aortic pulse, in the course of rapid changes in body position. 20 young healthy subjects, 10 men, and 10 women, were examined on a tilt table at two different tilt angles, -10° (Head-down) and + 45° (Head-up). In each position, carotid-femoral (Tcf) and carotid-tibial forward propagation times (Tct) were measured with the Complior device. In each position also, the central aortic pressure pulse was recorded with radial tonometry, using the SphygmoCor device and a generalized transfer function, so as to evaluate the timing of reflected waves reaching the aorta in systole (onset of systolic reflected wave, sT1r) and diastole (mean transit time of diastolic reflected wave, dMTT). The position shift from Head-up to Head-down caused a massive increase in both Tct (women from 130 ± 10 to 185 ± 18 msec P < 0.001, men from 136 ± 9 to 204 ± 18 msec P < 0.001) and dMTT (women from 364 ± 35 to 499 ± 33 msec P < 0.001, men from 406 ± 22 to 553 ± 21 msec P < 0.001). Mixed model regression showed that the changes in Tct and dMTT observed between Head-up and Head-down were tightly coupled (regression coefficient 2.1, 95% confidence interval 1.9-2.3, P < 0.001). These results strongly suggest that the diastolic waves observed on central aortic pulses reconstructed from radial tonometric correspond at least in part to reflections generated in the lower limbs.

Tómese unos minutos para revisar sus conocimientos sobre Transmisión de infecciones. Autoprotección del personal sanitario

En la transmisión de infecciones se mezclan las evidencias científicas, los miedos y las valoraciones personales del riesgo de contagio, en ocasiones inadecuadas, dado que el concepto"riesgo" es siempre subjetivo y difícil de definir. Todo ello puede generar conceptos erróneos o no totalmente ciertos. Esta autoevaluación es una pequeña contribución para separar"los mitos y/o leyendas sanitarias" de las realidades en relación con los riesgos de transmisión de algunas infecciones al personal sanitario.

Stress, coping and personal strengths and difficulties in internationally adopted children in spain

This study analyses the types of coping strategies used by internationally adopted children, and explores the relation between these strategies and personal strengths and difficulties. The Kidcope checklist (Spirito, Stark, & Williams, 1998) and the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) were administered to a sample of 35 Spanish adoptees (25.7% boys and 74.3% girls, aged 8-12 years) and their parents. Self-reported problems were categorised and their relation with coping strategies and psychological adjustment was explored. Results indicated that adopted children report problems of interpersonal nature. The content of the problems mainly refers to relationships and health, illness, or accidents. Parents reported that children were generally well-adjusted and they had no problems outside the normal range. International adoptees used mainly control-oriented coping strategies. Escape-oriented coping was linked to parents' ratings of total difficulties, with self-criticism accounting for the highest percentage of the variance.

Aortic Annulus Stabilization Technique for Rapid Deployment Aortic Valve Replacement.

NlmCategory="UNASSIGNED">Rapid deployment aortic valve replacement (RDAVR) with the use of rapid deployment valve systems represents a smart alternative to the use of standard aortic bioprosthesis for aortic valve replacement. Nevertheless, its use is still debatable in patients with pure aortic valve regurgitation or true bicuspid aortic valve because of the risk of postoperative paravalvular leak. To address this issue, an optimal annulus-valve size match seems to be the ideal surgical strategy. This article describes a new technique developed to stabilize the aortic annulus and prevent paravalvular leak after RDAVR. To confirm the feasibility, this technique was performed in six patients with severe symptomatic aortic stenosis who were scheduled to undergo aortic valve replacement at our center. All patients survived surgery and were discharged from the hospital. There were no new intracardiac conduction system disturbances observed, and a permanent pacemaker implantation was not required in any of the patients. The intraoperative and postoperative echocardiogram confirmed successful positioning of the valve, and no paravalvular leak was observed. In this preliminary experience, RDAVR through a full sternotomy or an upper hemisternotomy approach with the use of aortic annulus stabilization technique was safe, and no leak was observed. Future studies on large series of patients are necessary to confirm the safety and effectiveness of this technique in preventing paravalvular leak in patients with true bicuspid aortic valves or pure aortic regurgitation.

Servicios avanzados de seguridad para un sistema de emergencias

La recuperación de un desastre requiere la coordinación e interacción oportuna de todos los servicios de emergencias para poder hacer una valoración conjunta de los datos obtenidos y elaborar una respuesta rápida y efectiva. En el presente trabajo se propone un sistema que permite el acceso, manipulación y transferencia de información sensible y urgente entre el personal de los organismos implicados. Los privilegios sobre los recursos están regulados mediante políticas de seguridad que permiten definir el comportamiento del servicio en función de la sesión o contexto temporal del solicitante. La arquitectura propuesta está basada en tecnología de redes ad hoc para el campo de operaciones, y una plataforma orientadaa servicios en las sedes corporativas.

El desarrollo personal y profesional mediante el aprendizaje reflexivo : una experiencia en el grado de Educación Social

In the last years, an increase of the interest to develop educational practices in higher education, based on the approach of the reflective learning, is observed. Nevertheless, we scarcely find in our context researches or experiences that allow knowing students’ perceptions about this teaching and learning approach. We have developed an experience in the bachelor of Social Education at the University of Girona with the aim to contribute to the personal and professional development of future social educators in their initial training, using reflective learning methodology. In this article we present an evaluation of the experience based on students’ perceptions. They assessed the usefulness they think the module has for their training, the methodology and the activities. This evaluation has been carried out through in-depth interviews to 17 students who participated in the module in 2010-11 academic year. The results show that students assess positively the experience, either its general usefulness or the methodology of reflective learning, although they acknowledge some difficulties to carry out such a process which involves a high degree of introspection and a difficulty to set the boundaries in the narration of personal questions. The study also shows some challenges related on the need, but also the difficulty, to include personal and professional development as a powerful axis in the higher education curriculum, as well as elements linked to reflective learning assessment

High Altitude Increases Alteration in Maximal Torque but Not in Rapid Torque Development in Knee Extensors after Repeated Treadmill Sprinting.

We assessed knee extensor neuromuscular adjustments following repeated treadmill sprints in different normobaric hypoxia conditions, with special reference to rapid muscle torque production capacity. Thirteen team- and racquet-sport athletes undertook 8 × 5-s "all-out" sprints (passive recovery = 25 s) on a non-motorized treadmill in normoxia (NM; FiO2 = 20.9%), at low (LA; FiO2 = 16.8%) and high (HA; FiO2 = 13.3%) normobaric hypoxia (simulated altitudes of ~1800 m and ~3600 m, respectively). Explosive (~1 s; "fast" instruction) and maximal (~5 s; "hard" instruction) voluntary isometric contractions (MVC) of the knee extensors (KE), with concurrent electromyographic (EMG) activity recordings of the vastus lateralis (VL) and rectus femoris (RF) muscles, were performed before and 1-min post-exercise. Rate of torque development (RTD) and EMG (i.e., Root Mean Square or RMS) rise from 0 to 30, -50, -100, and -200 ms were recorded, and were also normalized to maximal torque and EMG values, respectively. Distance covered during the first 5-s sprint was similar (P > 0.05) in all conditions. A larger (P < 0.05) sprint decrement score and a shorter (P < 0.05) cumulated distance covered over the eight sprints occurred in HA (-8 ± 4% and 178 ± 11 m) but not in LA (-7 ± 3% and 181 ± 10 m) compared to NM (-5 ± 2% and 183 ± 9 m). Compared to NM (-9 ± 7%), a larger (P < 0.05) reduction in MVC torque occurred post-exercise in HA (-14 ± 9%) but not in LA (-12 ± 7%), with no difference between NM and LA (P > 0.05). Irrespectively of condition (P > 0.05), peak RTD (-6 ± 11%; P < 0.05), and normalized peak RMS activity for VL (-8 ± 11%; P = 0.07) and RF (-14 ± 11%; P < 0.01) muscles were reduced post-exercise, whereas reductions (P < 0.05) in absolute RTD occurred within the 0-100 (-8 ± 9%) and 0-200 ms (-10 ± 8%) epochs after contraction onset. After normalization to MVC torque, there was no difference in RTD values. Additionally, the EMG rise for VL muscle was similar (P > 0.05), whereas it increased (P < 0.05) for RF muscle during all epochs post-exercise, independently of the conditions. In summary, alteration in repeated-sprint ability and post-exercise MVC decrease were greater at high altitude than in normoxia or at low altitude. However, the post-exercise alterations in RTD were similar between normoxia and low-to-high hypoxia.

Preparation of a blood culture pellet for rapid bacterial identification and antibiotic susceptibility testing.

Bloodstream infections and sepsis are a major cause of morbidity and mortality. The successful outcome of patients suffering from bacteremia depends on a rapid identification of the infectious agent to guide optimal antibiotic treatment. The analysis of Gram stains from positive blood culture can be rapidly conducted and already significantly impact the antibiotic regimen. However, the accurate identification of the infectious agent is still required to establish the optimal targeted treatment. We present here a simple and fast bacterial pellet preparation from a positive blood culture that can be used as a sample for several essential downstream applications such as identification by MALDI-TOF MS, antibiotic susceptibility testing (AST) by disc diffusion assay or automated AST systems and by automated PCR-based diagnostic testing. The performance of these different identification and AST systems applied directly on the blood culture bacterial pellets is very similar to the performance normally obtained from isolated colonies grown on agar plates. Compared to conventional approaches, the rapid acquisition of a bacterial pellet significantly reduces the time to report both identification and AST. Thus, following blood culture positivity, identification by MALDI-TOF can be reported within less than 1 hr whereas results of AST by automated AST systems or disc diffusion assays within 8 to 18 hr, respectively. Similarly, the results of a rapid PCR-based assay can be communicated to the clinicians less than 2 hr following the report of a bacteremia. Together, these results demonstrate that the rapid preparation of a blood culture bacterial pellet has a significant impact on the identification and AST turnaround time and thus on the successful outcome of patients suffering from bloodstream infections.

The personal research portal : web 2.0 driven individual commitment with open access for development

Peer-reviewed

Los estilos y estrategias de afrontamiento y su relación con el bienestar personal en una muestra de adolescentes

Several studies have linked coping with personal wellbeing. However, there is no research evidence analyzing this relationship in theSpanish population using Cummins’ model (1997). The aim of this study was to know the level of personal wellbeing of a sample of adolescents and to analyze the relationship between coping strategies and styles and personal well-being. With that purpose in mind, the Personal Well Being Index (PWI) and the Adolescent Coping Scale (ACS) have been administered to a sample of 656 adolescents aged between 11 and 17. The results allow identifying the effect of age and gender on personal wellbeing. Those coping strategies centered on focusing on the positive, physical recreation, working hard and achieving are associated to higher personal wellbeing while self-blaming and keeping to self are with lower personal wellbeing