International consensus for a dissection room quality system (DRQS): A Delphi panel study.

Dissection Rooms (DRs) are key facilities that allow teaching and research on human anatomy, where students and researchers work with human bodies to acquire, increase, or create new knowledge. Usually, DRs work with a Body Donation Program (BDP), where living donors bequeath their bodies for use in teaching and research after they expire. Despite DRs being part of universities worldwide, no common guidelines, regulations, or quality management systems (QMS) exist that could be applied to different countries. With that purpose in mind, we aimed to develop a QMS that could be applied to DRs globally, using a Delphi panel to achieve consensus about the items that should constitute the QMS. The panel was constituted by 20 anatomy professors from 20 different countries, and the 167 standards to create the rules or guidelines that constitute the QMS were divided in five categories: direction, body donation, students, instructors, and research. After two rounds of revisions, 150 standards were considered "essential" or "important" by more than 70% of the participants, thus being incorporated to the Dissection Room Quality System (DRQS). The results of this panel represent a minimum list of items of the DRQS for improving the functioning of DRs globally.

Treatment of calcific tendinopathy of the rotator cuff with ultrasound-guided puncture and aspiration.

OBJECTIVE: Calcific tendinopathy of the rotator cuff is a common condition caused by the deposition of calcium crystals in the tendons of the rotator cuff. This study aimed to analyze the effectiveness of ultrasound-guided puncture and aspiration in calcific tendinopathy of the should in 86 patients treated at our center and to determine the factors associated with poor prognosis after this treatment. MATERIAL AND METHODS: This retrospective descriptive study included 86 patients with calcific tendinopathy of the rotator cuff treated with ultrasound-guided puncture and aspiration between 2015 and 2019 for whom clinical and radiological variables were collected 1, 3, 6, and 12 months after the procedure. RESULTS: One year after treatment, 81.4% patients showed clinical improvement and 96.5% showed radiological improvement. Complications were observed in 34.9%; all complications were mild. CONCLUSIONS: Ultrasound-guided puncture and aspiration is an effective treatment for calcific tendinopathy of the shoulder, resulting in a high rate of clinical and radiological improvement and a low rate of minor complications. This technique has additional advantages, such as interaction with the patient and the lack of ionizing radiation.

Time series forecasting methods in emergency contexts.

The key issues in any fire emergency are recognising fire hotspots, locating the emergency intervention team (EI), following the evolution of the fire, and selecting the evacuation path. This leads to the study and development of HelpResponder, a solution capable of detecting the focus of interest in hostile spaces derived from fire due to high temperatures without visibility. A study is conducted to determine which model best predicts measured [Formula: see text] levels. The variables used are temperature, humidity, and air quality, obtained from sensors installed in a fire tower. The statistical methods applied, namely ARIMAX, KNN, SVM, and TBATS, allow the adjustment and modelling of the variables. Explanatory variables with temporal structure are incorporated into SVM, a new improvement proposal. Moreover, combining different models showed the best efficiency in forecasting. In fact, another contribution of our work lies in offering a small-scale prediction system that is specifically designed to save batteries. The system has been tested and validated in a hostile environment (building), simulating real emergency situations. The system has been tested and validated in several hostile environments, simulating real emergency situations. It can help firefighters respond faster in an emergency. This reduces the risks associated with the lack of information and improves the time for tactical operations, which could save lives.

Motor imagery EEG signal classification with a multivariate time series approach.

BACKGROUND: Electroencephalogram (EEG) signals record electrical activity on the scalp. Measured signals, especially EEG motor imagery signals, are often inconsistent or distorted, which compromises their classification accuracy. Achieving a reliable classification of motor imagery EEG signals opens the door to possibilities such as the assessment of consciousness, brain computer interfaces or diagnostic tools. We seek a method that works with a reduced number of variables, in order to avoid overfitting and to improve interpretability. This work aims to enhance EEG signal classification accuracy by using methods based on time series analysis. Previous work on this line, usually took a univariate approach, thus losing the possibility to take advantage of the correlation information existing within the time series provided by the different electrodes. To overcome this problem, we propose a multivariate approach that can fully capture the relationships among the different time series included in the EEG data. To perform the multivariate time series analysis, we use a multi-resolution analysis approach based on the discrete wavelet transform, together with a stepwise discriminant that selects the most discriminant variables provided by the discrete wavelet transform analysis RESULTS: Applying this methodology to EEG data to differentiate between the motor imagery tasks of moving either hands or feet has yielded very good classification results, achieving in some cases up to 100% of accuracy for this 2-class pre-processed dataset. Besides, the fact that these results were achieved using a reduced number of variables (55 out of 22,176) can shed light on the relevance and impact of those variables. CONCLUSIONS: This work has a potentially large impact, as it enables classification of EEG data based on multivariate time series analysis in an interpretable way with high accuracy. The method allows a model with a reduced number of features, facilitating its interpretability and improving overfitting. Future work will extend the application of this classification method to help in diagnosis procedures for detecting brain pathologies and for its use in brain computer interfaces. In addition, the results presented here suggest that this method could be applied to other fields for the successful analysis of multivariate temporal data.

Hippo signaling instructs ectopic but not normal organ growth.

The Hippo signaling pathway is widely considered a master regulator of organ growth because of the prominent overgrowth phenotypes caused by experimental manipulation of its activity. Contrary to this model, we show here that removing Hippo transcriptional output did not impair the ability of the mouse liver and Drosophila eyes to grow to their normal size. Moreover, the transcriptional activity of the Hippo pathway effectors Yap/Taz/Yki did not correlate with cell proliferation, and hyperactivation of these effectors induced gene expression programs that did not recapitulate normal development. Concordantly, a functional screen in Drosophila identified several Hippo pathway target genes that were required for ectopic overgrowth but not normal growth. Thus, Hippo signaling does not instruct normal growth, and the Hippo-induced overgrowth phenotypes are caused by the activation of abnormal genetic programs.

Atheromatosis of the brain-supplying arteries: Circle of Willis, basilar, vertebral and their branches.

PURPOSE: Atherosclerotic plaques in the brain-supplying arteries are slowly-developing alterations of vascular structures that can lead to neurological impairment due to stenosis and insufficient oxygenation of eloquent brain areas. The aim of this study is to provide detailed demographic information related to the incidence of atherosclerotic plaques in the cerebral arteries. MATERIAL AND METHODS: Forty-eight circles of Willis (21 men, 21 women, mean age: 70.26, six samples unknown) were macroscopically analyzed for length, diameter, and presence of atherosclerotic plaques. Statistical analysis was used to identify potential differences in the locations and frequencies of atherosclerotic plaques in relation to age and sex. RESULTS: The study sample revealed 261 atherosclerotic plaques. The key findings were significant correlations between plaque development and age and between plaque location and age; however, there was no significant sex difference. CONCLUSION: The upper and lower branches of the middle cerebral artery (MCA) were novel locations predisposing to plaque development. A cut-off value at 60 years revealed a significant difference in plaque development and distribution. There were no significant sex differences in the occurrence of atherosclerotic plaques.

Treatment of calcific tendinopathy of the rotator cuff with ultrasound-guided puncture and aspiration. / Tratamiento de la tendinopatía calcificante del manguito de los rotadores mediante punción-aspiración ecoguiada.

OBJECTIVE: Calcific tendinopathy of the rotator cuff is a common condition caused by the deposition of calcium crystals in the tendons of the rotator cuff. This study aimed to analyze the effectiveness of ultrasound-guided puncture and aspiration in calcific tendinopathy of the should in 86 patients treated at our center and to determine the factors associated with poor prognosis after this treatment. MATERIAL AND METHODS: This retrospective descriptive study included 86 patients with calcific tendinopathy of the rotator cuff treated with ultrasound-guided puncture and aspiration between 2015 and 2019 for whom clinical and radiological variables were collected 1, 3, 6, and 12 months after the procedure. RESULTS: One year after treatment, 81.4% patients showed clinical improvement and 96.5% showed radiological improvement. Complications were observed in 34.9%; all complications were mild. CONCLUSIONS: Ultrasound-guided puncture and aspiration is an effective treatment for calcific tendinopathy of the shoulder, resulting in a high rate of clinical and radiological improvement and a low rate of minor complications. This technique has additional advantages, such as interaction with the patient and the lack of ionizing radiation.

Partially defatted olive cake in finishing pig diets: implications on performance, faecal microbiota, carcass quality, slurry composition and gas emission.

One of the key factors to improve swine production sustainability is the use of agro-industrial by-products in feeds, such as olive by-products. However, it is necessary to assess its effects on the overall production process, including the animal and the environment. With this aim, an experiment was conducted to determine the effects of including a partially defatted olive cake (PDOC) in pig diets on growth performance, faecal microbiota, carcass quality and gas emission from the slurry. Two finishing diets were formulated, a control (C) diet and a diet with PDOC included at 120 g/kg. Eighty finishing male pigs Duroc-Danbred × (Landrace × Large White) of 60.4 ± 7.00 kg BW were divided between these two treatments. During the finishing period (60 to 110 kg BW, 55 days) average daily gain, average daily feed intake and feed conversion ratio were recorded. Faecal samples from the rectum of 16 animals per treatment were incubated for bacteria enumeration. At the end of finishing period, backfat thickness and loin depth (LD) were measured. Animals were slaughtered to obtain carcass weight and carcass composition parameters, and subcutaneous fat was sampled to analyse the fatty acid (FA) profile. In addition greenhouse gas and ammonia emissions were measured during pig slurry storage using the methodology of dynamic flux chambers. An initial slurry characterisation and biochemical methane potential (B0) were also determined. No significant differences between treatments were found in performance, carcass quality and microbial counts with the exception of LD, which was lower in PDOC compared with C animals (45.5 v. 47.5 mm, SEM: 0.62; P = 0.020). The FA profile of the subcutaneous fat did not differ between treatments, but the monounsaturated FA (MUFA) concentration was higher and the polyunsaturated FA was lower in the animals fed PDOC (50.9 v. 48.3, SEM: 0.48, P < 0.001; 17.6 v. 19.3, SEM: 0.30, P < 0.001 in mg/100 g of Total FA, for PDOC and C animals, respectively). The initial pig slurry characterisation only showed differences in ADF concentration that was higher (P < 0.05) in the slurry from PDOC treatment. Regarding gas emission, slurries from both treatments emitted similar amounts of ammonia (NH3), carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O), as well as B0 values. The results obtained suggest that PDOC may be included in balanced pig diets at rates of up to 120 g/kg without negative effects on performance, carcass quality, gut microflora and slurry gas emission, while improving the MUFA concentration of subcutaneous fat.

Crystal phase competition by addition of a second metal cation in solid solution metal-organic frameworks.

Herein we report a synthetic study focused on the preparation of solid-solution metal-organic frameworks, MOFs, with the use of two kinds of linkers. In particular, we have explored the system composed by zinc, cobalt, 1,2,4-triazole and 4,4'-hexafluoroisopropylidenebisbenzoic acid (H2hfipbb). During this study, four new MOFs have been isolated, denoted TMPF-88 [M3(hfipbb)2(triazole)2(H2O)], TMPF-90 [M2(triazole)3(OCH2CH3)], TMPF-91 [M2(hfipbb)(triazole)2(H2O)] and TMPF-95 [M5(hfipbb)4(triazole)2(H2O)] (TMPF = transition metal polymeric framework, M = Zn, Co, or mixture of them). The study demonstrates that the addition of a second metal element during the MOF synthesis has a major effect in the formation of new phases, even at very high Zn/Co metal ratios. Furthermore, we show that during the MOF formation reaction, there is a competition among different crystal phases, where kinetically favoured phases of various compositions crystallize in short reaction times, precluding the formation of the pure solid-solution phases of other energetically more stable MOFs.

Effects of chronic dietary exposure to monosodium glutamate on feeding behavior, adiposity, gastrointestinal motility, and cardiovascular function in healthy adult rats.

BACKGROUND: Monosodium glutamate (MSG) is a flavor-enhancer widely used as a food additive. However, its safe dietary concentration and its toxicity, including its possible implication in the recent metabolic syndrome pandemia, is still a controversial issue. Therefore, a deep knowledge of its effects upon regular dietary use is needed. Our aim was to evaluate the effects of chronic exposure to MSG on feeding behavior, abdominal fat, gastrointestinal motility, and cardiovascular function in rats. METHODS: Two groups of adult male Wistar rats were used: control and treated with MSG (4 g/L in drinking water) for 6 weeks. Different functional parameters were determined and the histological structure was analyzed in tissues of interest. KEY RESULTS: Compared to control animals, chronic MSG increased water intake but did not modify food ingestion or body weight gain. Neither the abdominal fat volume nor the fat fraction, measured by magnetic resonance imaging, was modified by MSG. Monosodium glutamate did not alter general gastrointestinal motility, but significantly increased the colonic response to mechanical stimulation. It slightly reduced endothelium-dependent relaxation in aorta, without significantly modifying any other cardiovascular parameters. No significant histological alterations were detected in salivary glands, intestinal wall, aorta, heart, and kidney. CONCLUSIONS & INFERENCES: Chronic treatment with MSG in the adult rat increased water intake. This supports its potential to improve acceptance of low-fat regimens and to increase hydration in the elderly and sportspeople, often at risk of dehydration. Changes in colonic contractility and cardiovascular function could have some long-term repercussions warranting further research.

Management factors affecting mortality, feed intake and feed conversion ratio of grow-finishing pigs.

The aim of this study was to determine the effect of animal management and farm facilities on total feed intake (TFI), feed conversion ratio (FCR) and mortality rate (MORT) of grower-finishing pigs. In total, 310 batches from 244 grower-finishing farms, consisting of 454 855 Pietrain sired pigs in six Spanish pig companies were used. Data collection consisted of a survey on management practices (season of placement, split-sex by pens, number of pig origins, water source in the farm, initial or final BW) and facilities (floor, feeder, ventilation or number of animals placed) during 2008 and 2009. Results indicated that batches of pigs placed between January and March had higher TFI (P=0.006), FCR (P=0.005) and MORT (P=0.03) than those placed between July and September. Moreover, batches of pigs placed between April and June had lower MORT (P=0.003) than those placed between January and March. Batches which had split-sex pens had lower TFI (P=0.001) and better FCR (P<0.001) than those with mixed-sex in pens; pigs fed with a single-space feeder with incorporated drinker also had the lowest TFI (P<0.001) and best FCR (P<0.001) in comparison to single and multi-space feeders without a drinker. Pigs placed in pens with <50% slatted floors presented an improvement in FCR (P<0.05) than pens with 50% or more slatted floors. Batches filled with pigs from multiple origins had higher MORT (P<0.001) than those from a single origin. Pigs housed in barns that performed manual ventilation control presented higher MORT (P<0.001) in comparison to automatic ventilation. The regression analysis also indicated that pigs which entered to grower-finisher facilities with higher initial BW had lower MORT (P<0.05) and finally pigs which were sent to slaughterhouse with a higher final BW presented higher TFI (P<0.001). The variables selected for each dependent variable explained 61.9%, 24.8% and 20.4% of the total variability for TFI, FCR and MORT, respectively. This study indicates that farms can increase growth performance and reduce mortality by improving farm facilities and/or modifying management practices.

Lethal liquorice lollies (liquorice abuse causing pseudohyperaldosteronism).

A 47-year-old woman was admitted to the emergency department with a history of asthenia, periorbital and lower limbs oedema, associated with hypokalaemia and increased blood pressure levels. Metabolic and renal causes were initially investigated as thyroid disease, Cushing syndrome and tubulopathies were excluded during the first week of admission. However, further questioning of the patient, revealed that she had been consuming several sachets of raw liquorice lollies (ignored amount) obtained from a herbalist a month ago. Based on the history and clinical findings, liquorice poisoning was highly suspected; an apparent mineralocorticoid excess secondary to ingestion of liquorice. Afterwards, levels of aldosterone and plasma renin activity were measured and found low 3 weeks later; therefore, our clinical suspicion was established. During the patient's stay at the hospital, liquorice was stopped and potassium supplements were started. Subsequently, a week after, the patient fully recovered without any significant sequelae.

Miocardiopatía inducida por estrés o síndrome de takotsubo / Stress-induced cardiomyopathy, or Takotsubo syndrome: a condition that mimics acute coronary syndrome

El síndrome de takotsubo o miocardiopatía inducida por estrés es un síndrome relativamente nuevo en la literatura. Afecta fundamentalmente a mujeres postmenopáusicas y frecuentemente es precedido por un episodio estresante como desencadenante del cuadro. Clínicamente se manifiesta de manera indistinguible a un síndrome coronario agudo (SCA); con alteraciones electrocardiográficas similares (elevación del ST, alargamiento QTc, inversión de la onda T) y con elevación de biomarcadores de daño miocárdico(aunque de forma más moderada). Todo ello sin que se objetiven estenosis significativas en la coronariografía. Se caracteriza por una disfunción sistólica transitoria, con alteración de la contractilidad en los segmentos medio y apical del ventrículo y con hipercinesis compensadora de los segmentos basales, lo que le da una morfología típica que también da nombre al síndrome (apical ballooning). Su mecanismo etiopatogénico sigue siendo una incógnita, aunque la hipótesis más aceptada achaca el síndrome a una descarga masiva catecolaminérgica. Otra teoría en boga lo atribuye a la ruptura de una placa ateromatosa en el seno de la arteria coronaria descendente anterior, con lisis espontánea del trombo que se forma sobre dicha placa. Sin embargo, a diferencia del SCA, este síndrome tiene un pronóstico excelente con una mortalidad intrahospitalaria muy baja (AU)

Takotsubo syndrome, or stress-induced cardiomyopathy, is a relatively new diagnosis. This syndrome mainly affects postmenopausal women and is often preceded by a stressful event that triggers a clinical picture that is indistinguishable from acute coronary syndrome. Both have similar electrocardiographic findings (ST-segment elevation, corrected QT interval prolongation, T-wave inversion) and raised levels of markers of myocardial damage (although the elevation is less marked in Takotsubo syndrome). Coronary angiography fails to demonstrate significant obstruction. Takotsubo syndrome is characterized by transient systolic dysfunction, with contractile abnormalities in the apical and middle sections of the ventricle wall and compensatory hyperkines is of the base of the heart. The resulting morphology typifies the syndrome and gives rise to another name for the syndrome: apical ballooning. The etiology and pathogenesis of this syndrome are poorly understood, although the most widely accepted hypothesis is that massive release of catecholamines is the culprit. Another popular theory blames the rupture of an atheromatous plaque in the anterior descending coronary artery, with spontaneous lysis of the thrombus covering the plaque. Prognosis is excellent intakotsubo syndrome, differentiating it from acute coronary syndrome. Associated in-hospital mortality is very low (AU)

Aportaciones e inconvenientes de la incorporación de metodología cualitativa en la evaluación de servicios sanitarios. Un caso práctico: la evaluación de una consulta de alta resolución / Advantages and disadvantages of incorporating qualitative methodology in the evaluation of health services. A practical case: evaluation of a high-resolution clinic

Objetivo. En el marco de una evaluación sobre la calidad asistencial en una Unidad de Cardiología de Alta Resolución (UCAR) realizada con técnicas cuantitativas, se analizó la utilidad de incorporar una fase cualitativa a la investigación. Material y métodos. Se realizó una investigación cuantitativa con cuestionario estructurado y selección de sujetos por muestreo aleatorio sistemático (n=320) y una investigación cualitativa mediante entrevistas semiestructuradas a pacientes seleccionados por criterios de conveniencia (n=11), observaciones en el circuito asistencial y una entrevista en grupo con los profesionales de la UCAR. Posteriormente, el equipo de investigación, multidisciplinar, analizó individualmente la información recabada en las fases cuantitativa y cualitativa, evaluando los diferentes resultados obtenidos en ambas fases y los posibles sesgos derivados del uso de métodos cualitativos. Se realizaron tres reuniones siguiendo la técnica «brainstorming», para identificar las diversas aportaciones de cada una de las metodologías empleadas, utilizando diagramas de afinidades. Resultados. La investigación cualitativa permitió profundizar en algunos aspectos concretos del servicio que habían sido recogidos en la fase cuantitativa, matizando los resultados obtenidos en la fase previa, ahondando en las razones de insatisfacción con aspectos específicos, como los tiempos de espera y las infraestructuras disponibles, e identificando cuestiones emergentes del servicio, no evaluadas anteriormente. Conclusiones. Globalmente, la fase cualitativa enriqueció de forma sustantiva los resultados de la investigación. Es adecuado y recomendable incorporar este enfoque metodológico en investigaciones encaminadas a evaluar la calidad del servicio en un determinado contexto sanitario puesto que aporta, de primera mano, la voz del cliente(AU)

Objective. We examined the usefulness of incorporating a qualitative phase in the evaluation of the quality of care in a high-resolution medical service carried out with quantitative methods. Design and methods. A quantitative research was performed using a structured questionnaire and selecting interviewees by systematic randomized sampling methods (n=320). In addition, a qualitative research was carried on through semi-structured interviews with patients selected by convenience criteria (n=11), observations in the care assistance circuit, and a group interview with health professionals working in the service. A multidisciplinary research team conducted an individual analysis of the information collected in both quantitative and qualitative phases. Subsequently, three meetings based on group brainstorming techniques were held to identify the diverse contributions of each of the methodologies employed to the research, using affinity graphs to analyse the different results obtained in both phases and evaluate possible bias arising from the use of qualitative methods. Results. Qualitative research allowed examining specific aspects of the health care service that had been collected in the quantitative phase, harmonizing the results obtained in the previous phase, giving in-depth data on the reasons for patient dissatisfaction with specific aspects, such as waiting times and available infrastructures, and identifying emerging issues of the service which had not been previously assessed. Conclusions. Overall, the qualitative phase enriched the results of the research. It is appropriate and recommendable to incorporate this methodological approach in research aimed at evaluating the quality of the service in specific health care settings, since it is provided first hand, by the voice of the customer(AU)

[Advantages and disadvantages of incorporating qualitative methodology in the evaluation of health services. A practical case: evaluation of a high-resolution clinic]. / Aportaciones e inconvenientes de la incorporación de metodología cualitativa en la evaluación de servicios sanitarios. Un caso práctico: la evaluación de una consulta de alta resolución.

OBJECTIVE: We examined the usefulness of incorporating a qualitative phase in the evaluation of the quality of care in a high-resolution medical service carried out with quantitative methods. DESIGN AND METHODS: A quantitative research was performed using a structured questionnaire and selecting interviewees by systematic randomized sampling methods (n=320). In addition, a qualitative research was carried on through semi-structured interviews with patients selected by convenience criteria (n=11), observations in the care assistance circuit, and a group interview with health professionals working in the service. A multidisciplinary research team conducted an individual analysis of the information collected in both quantitative and qualitative phases. Subsequently, three meetings based on group brainstorming techniques were held to identify the diverse contributions of each of the methodologies employed to the research, using affinity graphs to analyse the different results obtained in both phases and evaluate possible bias arising from the use of qualitative methods. RESULTS: Qualitative research allowed examining specific aspects of the health care service that had been collected in the quantitative phase, harmonizing the results obtained in the previous phase, giving in-depth data on the reasons for patient dissatisfaction with specific aspects, such as waiting times and available infrastructures, and identifying emerging issues of the service which had not been previously assessed. CONCLUSIONS: Overall, the qualitative phase enriched the results of the research. It is appropriate and recommendable to incorporate this methodological approach in research aimed at evaluating the quality of the service in specific health care settings, since it is provided first hand, by the voice of the customer.

Muerte súbita cardiaca causada por commotio cordis / Commotio cordis as a cause of sudden cardiac death

Los eventos de muerte súbita cardiaca (MSC) en corazones estructuralmente normales causados por impactos de escasa entidad en la región precordial se denominan commotio cordis. Las víctimas suelen ser muy jóvenes, habitualmente se produce en el contexto de prácticas deportivas, aunque también se ha descrito su aparición durante actividades cotidianas. La patogenia parece estar relacionada con un fenómeno de “Rs obre T” en un instante particularmente vulnerable de la repolarización cardiaca, que desencadena una parada cardiorrespiratoria (PCR) por fibrilación ventricular. Recientemente, la aparición de registros específicos de casos ha permitido indagar sobre las características epidemiológicas y ensayar medios físicos de prevención de la commotio cordis. Sin embargo, aunque se produzca una instauración precoz del soporte vital básico y la activación de la cadena de supervivencia, las tasas de recuperación de PCR causadas por commotio cordis son bastante inferiores a lo esperable por la edad y el estado de salud de las víctimas; y con un desenlace, generalmente fatal (AU)

Commotio cordis is responsible for the sudden cardiac death of an individual with an anatomically normal heart after moderate precordial impact with a blunt object. Victims are usually young and typically players of contact sports,although cases have also occurred during normal daily activities. The pathogenesis seems to be related to occurrence ofthe R-on-T phenomenon at a moment when the heart is particularly vulnerable to repolarization; ventricular fibrillation then triggers cardiorespiratory arrest. Recently, patient registries have been established to allow study of theepidemiologic characteristics and test physical medicine approaches to preventing commotio cordis. However, even if basic life support and chain-of-survival measures have taken place promptly, the rates of recovery from cardiorespiratory arrest due to commotio cordis are markedly lower than might be expected from the age and health status of the victims.The condition is generally fatal (AU)

Effect of type of grinding of barley and dehydrated alfalfa on performance, digestion, and crude mucin ileal concentration in growing rabbits.

The effects of type of grinding of barley and dehydrated alfalfa (DA) were tested in rabbits weaned at 35 d of age with an average BW of 846 ± 93 g. Four nonmedicated diets were arranged in a 2 × 2 factorial structure, with type of grinding (coarse grinding with a 4.5-mm screen or fine grinding with a 1.5-mm screen) of barley (TGB) and DA (TGDA) as the main factors. A total of 1,056 mixed-sex rabbits (264 per diet) were fattened until d 63. Most of these rabbits (216 per diet) were housed in pairs and were used only to record mortality rate. Mortality was also recorded for the remaining 192 rabbits, which were housed individually and used to determine growth performance. From this group, 100 rabbits were used to determine digestive traits. Apart from those rabbits, a different group of 88 rabbits (44 housed individually and the remaining 44 housed in pairs) was used in the digestibility trial. All rabbits in this group were used to determine ileal digestibility (13 pools of ileal digesta per diet) and ileal mucin concentration (6 pools of ileal digesta per diet), whereas only the 44 individually housed rabbits were used to assess the fecal digestibility coefficients (11 rabbits per diet). Last, a jejunal sample was excised from 32 of the 44 individually housed rabbits to determine mucosal histology. Treatments did not affect ADG, ADFI, or G:F in the entire fattening period, but in the 49- to 63-d period, the diet containing both finely ground barley and DA reduced ADFI (P=0.08) compared with the other treatments (130 vs. 137 g). Moreover, this diet increased total digestive tract (4.76%, P=0.08) and cecal content (11.3%, P=0.08) weights compared with the other 3 treatments. Pylorus (P=0.09) and mixed digesta (P=0.06) pH, respectively, were reduced from 1.53 and 1.59 to 1.37 and 1.44 when both barley and DA were finely instead of coarsely ground. Grinding both barley and DA coarsely reduced the ileal digestibility of starch (0.899 vs. 0.936, P=0.06), increased (P < 0.01) its ileal flow and content in the feces to 1.66 g/d and 7.42 g/kg of DM, respectively, and led to decreased fecal digestibility (0.932 vs. 0.951, P < 0.01) compared with fine grinding. Coarse DA shortened villi (612 vs. 704 µm, P=0.02), increased crypt depth (121 vs. 92.1 µm, P=0.01), and reduced the villus:crypt ratio (5.08 vs. 7.66, P < 0.01) compared with finely ground DA. Furthermore, the greatest ileal crude mucin (148 vs. 107 g/kg of DMI, P=0.02) and sialic acid (71.7 vs. 61.7 mg/kg of DMI, P=0.04) concentrations were reported in rabbits receiving the diet with both coarsely ground barley and DA. Finally, mortality rate was not influenced by treatments, with an average of 9.64%. In conclusion, the diet containing finely ground barley and coarsely ground DA did not increase the weight of cecal contents, resulting in increased feed intake and leading to increased ileal digestibility and reduced ileal flow of starch.

Sistemática para la protocolización de los cuidados de enfermería / A program to protocolize nursing care

Objetivo. Disminuir la variabilidad de la práctica clínica y homogeneizar y sistematizar los cuidados que prestan los profesionales mediante la protocolización de los cuidados de enfermería. Material y métodos. La dirección de enfermería del Hospital Gregorio Marañón en 2004 decidió desarrollar una sistemática para la protocolización de los cuidados de enfermería en 5 fases temporales: preparación, elaboración, difusión, evaluación y actualización, y que adquiriera el carácter de actividad continuada basada en la metodología del ciclo de mejora continua (PDCA). Se presta especial atención a la fase de la evaluación y a los tres tipos de herramientas utilizadas: evaluación de los indicadores de proceso, evaluación de los indicadores de resultados y encuesta sobre la percepción de los profesionales. Resultados. Elaboración de 30 protocolos y 80 procedimientos basados en la evidencia, accesibles, actualizables y con indicadores de evaluación. Discusión. La protocolización de los cuidados de enfermería disminuye la variabilidad de la práctica clínica, homogeneiza los cuidados y aumenta la implicación de los profesionales. La evaluación de proceso, de resultados y de adhesión de los profesionales es una parte imprescindible para la mejora continua(AU)

Objective. To decrease variability in clinical practice and to standardise and develop a systematic care programusing nursing care protocols. Materials and methods. The Directorate of Nursing of the Gregorio Marañón Hospital decided to develop a systematic program to produce nursing care protocols in 2004. It followed 5 phases: preparation, processing, dissemination, evaluation and updating. The program was based on the methodology for continuous improvement cycle (PDCA). Particular attention was paid to the evaluation phase, and to the three types of tools used: evaluation of the process and performance indicators and a survey on the perception of professionals. Results. A total of 30 protocols and 80 procedures were developed. They were evidence based, accessible, available for updating and with evaluation indicators. Discussion. Nursing care protocols decrease the variability of clinical practice. They homogenize care and increase the involvement of professionals. The evaluation of the process, outcomes and adherence of professionals is imperative for continuous improvement(AU)

[A program to protocolize nursing care]. / Sistemática para la protocolización de los cuidados de enfermería.

OBJECTIVE: To decrease variability in clinical practice and to standardise and develop a systematic care programusing nursing care protocols. MATERIALS AND METHODS: The Directorate of Nursing of the Gregorio Marañón Hospital decided to develop a systematic program to produce nursing care protocols in 2004. It followed 5 phases: preparation, processing, dissemination, evaluation and updating. The program was based on the methodology for continuous improvement cycle (PDCA). Particular attention was paid to the evaluation phase, and to the three types of tools used: evaluation of the process and performance indicators and a survey on the perception of professionals. RESULTS: A total of 30 protocols and 80 procedures were developed. They were evidence based, accessible, available for updating and with evaluation indicators. DISCUSSION: Nursing care protocols decrease the variability of clinical practice. They homogenize care and increase the involvement of professionals. The evaluation of the process, outcomes and adherence of professionals is imperative for continuous improvement.

Effect of dietary supplementation with glutamine and a combination of glutamine-arginine on intestinal health in twenty-five-day-old weaned rabbits.

The effect of dietary supplementation with 1% l-glutamine and a combination of 1% l-glutamine and 0.5% l-arginine on intestinal health was examined in weaned rabbits. A basal diet was formulated to meet nutrient recommendations. Another 2 diets were formulated by adding 1% (as-fed basis) Gln or a mixture of 1% (as-fed basis) Gln + 0.5% (as-fed basis) Arg (Gln-Arg) to the basal diet. In Exp. 1, a total of 357 rabbits were blocked by litter and assigned at random to the experimental diet to determine mortality (119 per diet) and growth performance (35 per diet; from weaning at 25 to 56 d of age). Rabbits were fed the experimental diets for a 2-wk period and thereafter received a commercial diet. Rabbits weaned at 25 d (blocked by litter and assigned at random to diets) were slaughtered at 35 d and used to determine apparent ileal digestibility of DM, CP, and AA (Exp. 2, a total of 60 rabbits), intestinal morphology, N-aminopeptidase and myeloperoxidase intestinal activity, the expression of PPARgamma at the ileum and kidney, serum immunoglobulin in healthy and sick rabbits (Exp. 3, a total of 24 rabbits), and ileal and cecal microbial composition by PCR-RFLP (Exp. 4, a total of 45 rabbits). Dietary treatment did not affect ADG, ADFI, or G:F, during the entire fattening period. Supplementation with Gln reduced mortality during the first 2 wk and the whole fattening period from 18.5 to 8.4% (P = 0.023) and from 31.9 to 20.2% (P = 0.039), respectively, whereas no effect was detected for Arg supplementation. Among all the variables studied, the reduction on mortality due to Gln was related to a reduced intestinal colonization (Eimeria lesions) and changes on microbial ecosystem in the ileum and cecum, reducing the frequency of detection of Clostridium spp. (from 86.7 to 33.3%, P = 0.003) at the ileum, and Helicobacter spp. at the ileum (from 86.7 to 46.7%, P = 0.003) and at the cecum (from 86.7 to 46.7, P = 0.028), whereas no effect was detected for Arg supplementation. In conclusion, 1% l-Gln supplementation to postweaned rabbit diets decreased fattening mortality and modified the intestinal microbiota (although no consistent effects were observed on mucosal histology or inflammatory and systemic immune response). Diets containing a combination of 1% Gln and 0.5% Arg were of little additional benefit.