Percepción de los profesionales de enfermería y auxiliares de enfermería sobre cultura de seguridad del paciente en el área quirúrgica

Objetivos: Evaluar las percepciones, opiniones y conductas que tienen enfermeros y auxiliares de enfermería sobre seguridad del paciente en el servicio quirúrgico de un hospital público del Sistema Nacional de Salud español. Describir fortalezas y debilidades/oportunidades de mejora según criterios de la Agency for Healthcare Research and Quality y conocer el número de incidentes de seguridad notificados. Método: Estudio observacional, transversal, llevado a cabo utilizando la versión española del cuestionario Hospital Survey on Patient Safety Culture. La muestra estuvo constituida por profesionales de enfermería que aceptaron participar en el estudio voluntariamente y cumplían los criterios de selección. Se realizó un análisis descriptivo e inferencial en función de la naturaleza de las variables y las condiciones de aplicación de los test estadísticos. Significación p < 0,05. Resultados: Respondieron 74 profesionales de enfermería (63,2%). No se encontró ninguna fortaleza en el servicio quirúrgico, y las áreas principales que necesitan mejora corresponden a «Dotación de personal» (64,0%) y «Apoyo de la gerencia del hospital en materia de seguridad del paciente» (52,9%). El 52,3% (n = 65) califica el grado de seguridad del paciente entre 7 y 8,99 (en una escala de 10); el 79,7% (n = 72) no notificó ningún incidente durante el último año. La varianza total explicada por el modelo de regresión fue 0,56 para «Frecuencia de eventos notificados» y 0,26 para «Percepción de seguridad». Conclusiones: Percepción más positiva sobre cultura de seguridad del paciente a nivel de unidad/servicio. Las debilidades identificadas pueden servir para diseñar actividades concretas de intervención para mejorar la cultura de seguridad del paciente en otros servicios quirúrgicos del entorno.

Construction of Structures I in Moodle: a new teaching methodology in the Degree of Building Engineer

The subject of Construction of Structures I studies, from a constructive point of view and taking into account current legislation, reinforced concrete structures used in buildings, through the acquisition of knowledge and construction criteria required in the profession of a Technical Architect. The contents acquired in this course are essential for further professional development of technicians and are closely related to many of the subjects taught in the same or other courses of the Degree in Technical Architecture at the University of Alicante. The aim of this paper is to present, analyze and discuss the development of a new methodology proposed in the mentioned subject, as it supposed an important change in the traditional way of teaching Construction and Structures I. In order to incorporate new teaching tools in 2013-2014, the course has been implemented by using a Moodle software tool to promote blended learning with online exercises. Our Moodle community allows collaborative work within an open-source platform where teachers and students share a new and personalized learning environment. Students are easily used to the interface and the platform, value the constant connection with teachers or other fellows and completely agree with the possibility of making questions or share documents 24 hours a day. The proposed methodology consists of lectures and practical classes. In the lectures, the basics of each topic are discussed; class attendance, daily study and conducting scheduled exercises are indispensable. Practical classes allow to consolidate the knowledge gained in theory classes by solving professional exercises and actual construction problems related to structures, that shall be compulsorily delivered online. So, after the correction of the teacher and the subsequent feedback of students, practical exercises ensure lifelong learning of the student, who can download any kind of material at any time (constructive details, practical exercises and even corrected exams). Regarding the general evaluation system, goals achievement is assessed on an ongoing basis (65% of the final mark) along the course through written and graphic evidences in person and online, as well as a individual development of a workbook. In all cases, the acquisition of skills, the ability to synthesize, the capacity of logical and critical thinking are assessed. The other 35 % of the mark is evaluated by a complementary graphic exam. Participation in the computing platform is essential and the student is required to do and present, at least 90% of the practices proposed. Those who do not comply with the practices in each specific date could not be assessed continuously and may only choose the final exam. In conclusion, the subject of Construction of Structures I is essential in the development of the regulated profession of Technical Architect as they are considered, among other professional profiles, as specialists in construction of building structures. The use of a new communication platform and online teaching allows the acquisition of knowledge and constructive approaches in a continuous way, with a more direct and personal monitoring by the teacher that has been highly appreciated by almost 100% of the students. Ultimately, it is important to say that the use of Moodle in this subject is a very interesting tool, which was really well welcome by students in one of the densest and important subjects of the Degree of Technical Architecture.

How to measure healthiness in buildings: Experiences in teaching with BIM tools

Introducing teaching about healthy solutions in buildings and BIM has been a challenge for the University of Alicante. Teaching attached to very tighten study plans conditioned the types of methods that could be used in the past. The worldwide situation of crisis that especially reached Spain and the bursting of the housing bubble generated a lack of employment that reached universities where careers related to construction, Architecture and Architectural Technologist, suffered a huge reduction in the number of students enrolled. In the case of the University of Alicante, students’ enrolment for Architectural Technology reached an 80% reduction. The necessity of a reaction against this situation made the teachers be innovative and use the new Bologna adapted study plans to develop new teaching experiences introducing new concepts: people wellbeing in buildings and BIM. Working with healthy solutions in buildings provided new approaches for building design and construction as an alternative to sustainability. For many years sustainability was the concept that applied to housing gave buildings an added value and the possibility of having viability in a very complex scenario. But after lots of experiences, the approved methodologies for obtaining sustainable housing were ambiguous and at the end, investors, designers, constructors and purchasers cannot find real and validated criteria for obtaining an effective sustainable house. It was the moment to work with new ideas and concepts and start facing buildings from the users’ point of view. At the same time the development of new tools, BIM, has opened a wide range of opportunities, innovative and suggestive, that allows simulation and evaluation of many building factors. This paper describes the research in teaching developed by the University of Alicante to adapt the current study plans, introducing work with healthy solutions in buildings and the use of BIM, with the aim of attracting students by improving their future employability. Pilot experiences have been carried out in different subjects based on the work with projects and case studies under an international frame with the cooperation of different European partner universities. The use of BIM tools, introduced in 2014, solved the problems that appeared in some subjects, mainly building construction, and helped with the evaluation of some healthy concepts that presented difficulties until this moment as knowledge acquired by the students was hard to be evaluated. The introduction of BIM tools: Vasari, FormIt, Revit and Light Control among others, allowed the study of precise healthy concepts and provided the students a real understand of how these different parameters can condition a healthy architectural space. The analysis of the results showed a clear acceptance by the students and gave teachers the possibility of opening new research lines. At the same time, working with BIM tools to obtain healthy solutions in building has been a good option to improve students’ employability as building market in Spain is increasing the number of specialists in BIM with a wider knowledge.

Characterization of residual soil used for infiltration of reclaimed water

The effects of climate change and the growing demand for water for domestic, industrial, agricultural and recreational activities have been led the use of treated wastewater (reclaimed water) for such applications. The artificial recharge of aquifers with treated wastewater can be an alternative way for restoring underground water volumes that can be used for satisfying some activities, particularly in water shortage areas or where their quality is not suitable for use. After a two-year monitoring period in the Vila Fernando WWTP (Guarda, Portugal), the characteristics of the treated effluent suggest that it could be used for infiltration for aquifer recharge. A multi-criteria analysis based on GIS was developed for site location of infiltration sites. The procedure has involved the combination of six thematic maps and environmental, technical and economic criteria, over an area of 6687.1 ha. About 6.4 ha were selected for suitable sites for infiltration and one of these sites (Quinta de Gonçalo Martins, Guarda) was selected for collecting soil samples. The characterization of the soil indicates that is favorable to the infiltration of treated wastewater for artificial recharge of aquifers.

Insuficiência hepática aguda provocada por Amanita phalloides

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Displasia broncopulmonar : revisão teórica, a propósito de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Carbon leakage: an overview. CEPS Special Report No. 79, 6 December 2013

Carbon leakage is central to the discussion on climate policy, given the confluence of issues that are currently being debated, including the 2030 Energy and Climate Framework and the review of the EU carbon leakage list by 2014. Carbon leakage is the result of asymmetrical carbon policies, especially carbon pricing, and the resulting carbon cost, which affects the international competitive position of some EU industry and could displace production and/or investment, and the emissions of the activities displaced. This paper identifies the difference between carbon price and carbon cost to leakage exposed industry as one of two fundamental issues to be understood and addressed; lack of visibility on future climate policies and anti-leakage provisions is the other key issue. While this is a global issue, most of the experience has been accumulated in the EU. Carbon leakage is only one of the factors that could affect the competitive position of sectors, but it is difficult to attribute the impact of carbon costs versus other variables such as energy costs, labour, etc. Studies have predicted the risk of a significant amount of production leakage in a number of energy-intensive industries. To address the danger, they were included in the EU ETS carbon leakage list, which gave them access to free allowances. However, a limited number of studies undertaken after the end of the second trading period (2012) show little evidence of production leakage and asks the question whether the issue has not been blown out of proportion. The paper argues that the past may not be a good representation of the future, as it was heavily influenced by a high level of free allocation, the exceptional economic downturn, CO2 prices significantly below what was anticipated, as well as the potential for changes in some fundamental variables such as the shrinking pool of allowances available for free allocation. It emphasises the need for a well-informed debate in the EU on measures to address carbon leakage post-2020, underpinned by a number of options, and objective criteria to evaluate those options. It emphasises that the debate should cover both investment and production leakage, caused by both direct and indirect carbon costs.

Identity Construction in Europe: A Discursive Approach. IES WORKING PAPER 2/2010

Proposing a discursive approach to studying identity, this paper presents Positioning Theory as a theoretical framework for conceptualizing the construction of identity in discourse. The Positioning Diamond is employed to analyse the discourse surrounding the Danish Euro referendum. The analysis reveals how identities are constructed in discourse that promotes a ‘yes’ or ‘no’ vote in the referendum, highlighting the generally implicit allocation of rights and duties to actors within a specific narrative context. The penultimate section discusses appropriate criteria for evaluating discursive accounts, distinguishing between cases in which truth, normative and ethical criteria are applicable. Finally, the paper concludes with a discussion of policy considerations and recommendations.

Can group exercise programs improve health outcomes in pregnant women? A systematic review

Current scientific evidence supports the recommendation to initiate or continue the practice of physical exercise in healthy pregnant women. Group exercise programs have positive effects in improving health and well-being, as well as social support. In order to understand the scientific evidence in this field, and the outcomes in maternal health, it has generated wide interest in exploring the studies carried out with more relevant group exercise programs. The aim of this systematic review was to evaluate the available evidence on the effectiveness of group exercise programs in improving women’s and newborns health outcomes during pregnancy. Three databases were used to conduct literature searches and strict inclusion and exclusion criteria were employed. Seventeen studies were selected for analysis. All studies were randomized control trials conducted with pregnant women that evaluated the effect of group exercise programs on the health outcomes of mother and newborn. Most studies followed a supervised structured exercise program including a main aerobic part, resistance training, pelvic floor training and stretching and relaxation sections. The significant effects of the programs are related with improved maternal perception of health status, lower maternal weight gain, improved levels of maternal glucose tolerance, improved aerobic fitness and muscular strength, lower frequency of urinary incontinence, improved sick leave due to lumbopelvic pain, fewer cesarean and instrumental deliveries, higher newborn Apgar score and faster postpartum recovery. Exercise and health professionals should advise pregnant women that aerobic group exercise during pregnancy improves a wide range of health outcomes for the women and newborn

Screening for Language Disorders in Stroke: German Validation of the Language Screening Test (LAST)

BACKGROUND Screening of aphasia in acute stroke is crucial for directing patients to early language therapy. The Language Screening Test (LAST), originally developed in French, is a validated language screening test that allows detection of a language deficit within a few minutes. The aim of the present study was to develop and validate two parallel German versions of the LAST. METHODS The LAST includes subtests for naming, repetition, automatic speech, and comprehension. For the translation into German, task constructs and psycholinguistic criteria for item selection were identical to the French LAST. A cohort of 101 stroke patients were tested, all of whom were native German speakers. Validation of the LAST was based on (1) analysis of equivalence of the German versions, which was established by administering both versions successively in a subset of patients, (2) internal validity by means of internal consistency analysis, and (3) external validity by comparison with the short version of the Token Test in another subset of patients. RESULTS The two German versions were equivalent as demonstrated by a high intraclass correlation coefficient of 0.91. Furthermore, an acceptable internal structure of the LAST was found (Cronbach's α = 0.74). A highly significant correlation (r = 0.74, p < 0.0001) between the LAST and the short version of the Token Test indicated good external validity of the scale. CONCLUSION The German version of the LAST, available in two parallel versions, is a new and valid language screening test in stroke.

Développement d’une lentille cornéenne médicamentée

L’utilisation de lentilles cornéennes peut servir à améliorer le profil d’administration d’un principe actif dans les yeux. Avec une efficacité d’administration de 5% par l’utilisation de gouttes, on comprend rapidement que l’administration oculaire doit être améliorée. Cette faible administration a donné naissance à plusieurs tentatives visant à fabriquer des lentilles cornéennes médicamentées. Cependant, à cause de multiples raisons, aucune de ces tentatives n’a actuellement été mise sur le marché. Nous proposons dans cette étude, une possible amélioration des systèmes établis par le développement d’une lentille cornéenne à base de 2-(hydroxyéthyle)méthacrylate (HEMA), dans laquelle des microgels, à base de poly N-isopropylacrylamide (pNIPAM) thermosensible encapsulant un principe actif, seront incorporé. Nous avons donc débuté par développer une méthode analytique sensible par HPCL-MS/MS capable de quantifier plusieurs molécules à la fois. La méthode résultante a été validée selon les différents critères de la FDA et l’ICH en démontrant des limites de quantifications et de détections suffisamment basses, autant dans des fluides simulés que dans les tissus d’yeux de lapins. La méthode a été validée pour sept médicaments ophtalmiques : Pilocarpine, lidocaïne, proparacaïne, atropine, acétonide de triamcinolone, timolol et prednisolone. Nous avons ensuite fait la synthèse des microgels chargés négativement à base de NIPAM et d’acide méthacrylique (MAA). Nous avons encapsulé une molécule modèle dans des particules ayant une taille entre 200 et 600 nm dépendant de la composition ainsi qu’un potentiel zêta variant en fonction de la température. L’encapsulation de la rhodamine 6G (R6G) dans les microgels a été possible jusqu’à un chargement (DL%) de 38%. L’utilisation des isothermes de Langmuir a permis de montrer que l’encapsulation était principalement le résultat d’interactions électrostatiques entre les MAA et la R6G. Des cinétiques de libérations ont été effectuées à partir d’hydrogels d’acrylamide chargés en microgels encapsulant la R6G. Il a été trouvé que la libération des hydrogels chargés en microgels s’effectuait majoritairement selon l’affinité au microgel et sur une période d’environ 4-24 heures. La libération à partir de ces systèmes a été comparée à des formules d’hydrogels contenant des liposomes ou des nanogels de chitosan. Ces trois derniers (liposomes, microgels et nanogels) ont présenté des résultats prometteurs pour différentes applications avec différents profils de libérations. Enfin, nous avons transposé le modèle développé avec les gels d’acrylamide pour fabriquer des lentilles de contact de 260 à 340 µm d’épaisseur à base de pHEMA contenant les microgels avec une molécule encapsulée devant être administrée dans les yeux. Nous avons modifié la composition de l’hydrogel en incorporant un polymère linéaire, la polyvinylpyrrolidone (PVP). L’obtention d’hydrogels partiellement interpénétrés améliore la rétention d’eau dans les lentilles cornéennes. L’encapsulation dans les microgels chargés négativement a donné de meilleurs rendements avec la lidocaïne et cette dernière a été libérée de la lentille de pHEMA en totalité en approximativement 2 heures qu’elle soit ou non encapsulée dans des microgels. Ainsi dans cette étude pilote, l’impact des microgels n’a pas pu être déterminé et, de ce fait, nécessitera des études approfondies sur la structure et les propriétés de la lentille qui a été développée. En utilisant des modèles de libération plus représentatifs de la physiologie de l’œil, nous pourrions conclure avec plus de certitude concernant l’efficacité d’un tel système d’administration et s’il est possible de l’optimiser.

(Table 2) Age determination of sediments from lake basins near Polyarny, Russia

A relative sea-level curve for the Holocene is constructed for Polyarny on the Kola Peninsula, northwest Russia. The curve is based on 18 radiocarbon dates of isolation contacts, identified from lithological and diatomological criteria, in nine lake basins situated between 12 and 57 m a.s.l. Most of the lakes show a conformable, regressive I-II-III (marine-transitional-freshwater) facies succession, indicating a postglacial history comprising an early (10,000-9000 radiocarbon years BP) phase of rapid, glacio-isostatically induced emergence (~5 cm/year) and a later phase (after 7000 years BP,) having a moderate rate of emergence (<0.5 cm/year). Three lakes together record a phase of very low rate of emergence or slight sea-level rise at a level of ~27 m a.s.l., between 8500 and 7000 years BP, which correlates with the regional Tapes transgression. Pollen stratigraphy in the highest lake shows that the area was deglaciated before the Younger Dryas and that previously reconstructed Younger Dryas glacier margins along the north Kola coast lie too far north

Evaluation of aeration/circulation as a lake restoration technique /

Mode of access: Internet.

Sediment removal as a lake restoration technique /

Mode of access: Internet.

Clean Lakes Program strategy /

Mode of access: Internet.