Photocatalytic degradation of acid yellow 36 with calcined titania-hydroxyapatite-cuo xerogels.

Advanced oxidation processes (AOP), using semiconductor (SC) and hydroxyapatite (HA) composites, are promising due to the synergy of photocatalytic and adsorption properties. Still, dye removal efficiency of composites based on HA-SC remains low, because most of the research reported consider single SC materials. In this work, nanocrystalline xerogels of titanium oxide (TiO2) with copper oxide (CuO) and HA were synthesized by the sol-gel process. HA was obtained by the precipitation method without heat treatment and calcined in the range of 200-1000 °C. TiO2 and copper precursors were added to a sol containing HA in a 12:1 mol ratio, obtaining HA-TiO2 and HA-CuO-TiO2 nanomaterials. The xerogels were characterized by X-ray diffraction, scanning electron microscopy, emission field scanning electron microscopy and photoresponse. Their performance in the photocatalytic discoloration of an aqueous solution acid yellow dye 36 (AY36) was evaluated, using visible and UV light. The best discoloration was achieved with HA-CuO-TiO2 xerogels with HA calcined at 600 °C, showing a degradation kinetic constant of 0.24 min-1. In contrast, HA-TiO2 materials showed little or no photocatalytic activity, but strong dye adsorption/desorption. The thermal treatment of HA determines the filament-like morphology and degree of compaction of the nanomaterials, which are relevant in the crystallite size and sensitization of the SC matrix. Further studies must address the surface chemistry and rectifying properties of the best SC composite to have a more complete understanding of the mechanisms involved.

Síndrome visual informático en universitarios en tiempos de pandemia / Computer visual syndrome in university students in times of pandemic

Introducción Una de las consecuencias del uso prolongado de pantallas luminosas como las del ordenador o las del teléfono móvil es el síndrome visual informático (SVI), donde se presentan síntomas característicos que normalmente desaparecen después de un par de horas de haber dejado de usar los aparatos electrónicos. La prevalencia es alta debido a múltiples factores de riesgo. Objetivo Determinar la prevalencia de SVI en estudiantes de Medicina en tiempos de pandemia. Metodología Estudio observacional descriptivo y de corte transversal. La población a estudio fueron estudiantes de Medicina de la Universidad de Boyacá y los datos fueron recogidos en septiembre y octubre del año 2021 a través de una encuesta electrónica. Resultados Un total de 300 personas participaron en el estudio. El 78% (234) de los estudiantes participantes presentan SVI. El 67,09% (157) de los participantes que refirieron presentar SVI pertenecían al sexo femenino y el 32,91% (77) eran del sexo masculino. Conclusiones El SVI es muy común entre los estudiantes de Medicina de la Universidad de Boyacá. Este estudio ha demostrado que la presencia del SVI se ha asociado significativamente a factores exposicionales que se desencadenaron durante el período de pandemia, en donde las clases virtuales frecuentes y durante horarios prolongados conllevaban a una alta exposición a pantallas. Además, en la era de virtualidad la comunicación mediante redes sociales aumentó el uso de teléfonos móviles, lo cual aumenta la posibilidad de aparición de este síndrome. (AU)

Introduction One of the consequences of prolonged use of bright screens such as those of the computer or cell phone is the computer visual syndrome (CVS), where characteristic symptoms are presented that normally disappear after a couple of hours when you stop using electronic devices. The prevalence is high due to multiple risk factors. Objective To determine the prevalence of CVS in medical students at the University of Boyacá in times of pandemic. Methodology Descriptive and cross-sectional observational study. The study population were medical students, the data were collected in September and October of the year 2021, and an electronic survey was carried out for data collection. Results A total of 300 participants were invited to participate in the study. A percentage of 78 (234) of participating students suffer from CVS. A percentage of 67.09 (157) of the participants who reported suffering from CVS were female and 32.91% (77) were male. ConclusionsCVS is very common among medical students at the University of Boyacá. This study has shown that the presence of CVS has been significantly associated with exposure factors that were triggered during the pandemic period, where frequent virtual classes and long hours led to high exposure to screens. In addition, in the era of virtuality, communication through social networks increased the use of cell phones, which increases the possibility of the appearance of this syndrome. (AU)

Computer visual syndrome in university students in times of pandemic.

INTRODUCTION: One of the consequences of prolonged use of bright screens such as those of the computer or cell phone, is the computer visual syndrome where characteristic symptoms are presented that normally disappear after a couple of hours when you stop using electronic devices. The prevalence is high due to multiple risk factors. OBJECTIVE: To determine the prevalence of computer vision syndrome in medical students at the University of Boyacá in times of pandemic. METHODOLOGY: Descriptive and cross-sectional observational study. The study population were medical students, the data were collected in September and October of the year, an electronic survey was carried out for data collection. RESULTS: A total of 300 participants were invited to participate in the study. 78% (234) of participating students suffer from SVI. 67.09% (157) of the participants who reported suffering from SVI were female and 32.91% (77) were male. CONCLUSIONS: Computer visual syndrome is very common among medical students at the University of Boyacá. This study has shown that the presence of SVI has been significantly associated with exposure factors that were triggered during the pandemic period, where frequent virtual classes and long hours led to high exposure to screens. In addition, in the era of virtuality, communication through social networks increased the use of cell phones, which increases the possibility of the appearance of this syndrome.

Rol de la enfermera en el cuidado al final de la vida del paciente crítico / The role of the nurse at the end of the life of a critically ill patient

Objetivo: Analizar el rol de la enfermera en el cuidado al final de la vida del paciente crítico. Método: Revisión bibliográfica a partir de la búsqueda en bases de datos de ciencias de la salud: PubMed, CINAHL, Cuiden, Scopus, Cochrane Plus, y en plataformas especializadas, buscadores generales y temáticos. Los límites establecidos fueron el idioma (español e inglés) y la fecha de publicación (2005-2015). Resultados: Ciento ochenta artículos cumplieron los criterios de inclusión, seleccionándose 16 para su análisis. Los principales resultados se agruparon en tres categorías de análisis: el cuidado directo al paciente, la atención centrada en la familia y el rol dentro del equipo multidisciplinar. Conclusiones: Los roles descritos sitúan a la enfermera como un elemento clave para humanizar la muerte en las UCI, por ello las enfermeras pueden y deben liderar el cambio desempeñando un papel activo en la creación de estrategias que hagan realidad la integración del enfoque de cuidados paliativos en las UCI

Objective: Analyze the role of the nurse at the end of the life of a critically ill patient. Method: Bibliographic review from a search of the health science databases such as PubMed, CINAHL, Cuiden, Scopus, Cochrane, as well as specialized platforms, general and thematic browsers. The limits were language (English or Spanish) and publication date (2005-2015). Results: 180 articles met the inclusion criteria, and 16 of them were selected for analysis. The main results were grouped into three categories of analysis: direct patient care, family-focussed care and the nurse's role within the team. Conclusions: the described roles place the nurse as a key element in humanising death in the ICU and so nurses can and must lead change, playing an active role in creating strategies that really promote the integration of a palliative care approach in ICU

Experimental infection of conventional newly-weaned piglets with porcine astrovirus.

The presence of porcine astroviruses in diarrheic and healthy pigs has been reported, however, the consequences of the astrovirus infection during the weaning process have not been described. In this study, eight healthy conventional newly-weaned piglets were used to evaluate effects of astrovirus infection during the first five days. Four piglets were infected with the porcine astrovirus PoAstV/PUJP5 strain and the other four represented the control group. Body weight, rectal temperature, diarrhea and other clinical signs were monitored every 24 hours. The results showed that all animals gained body weight, the occurrence of mild diarrhea on the 3rd day post-infection, and the astroviral presence in diarrheic samples. On the 5th day post-infection all the piglets were euthanized and then intestinal and extra-intestinal tissues were analyzed for the presence of PoAstV/PUJP5. The cytoplasmic antigen of PoAstV/PUJP5 was observed in the enterocytes of infected piglets from jejunum, ileum, colon and in inflammatory cells from mesenteric lymph nodes. In addition, villi atrophy, fusion, epithelial hyperplasia and incipient virus detection in mesenteric lymph were observed. RNAemia could not be proved. This study shows for the first time the effects of porcine astrovirus infection on conventional newly-weaning piglets. Keywords: porcine astrovirus; newly-weaned piglets.

Next-generation muscle-directed gene therapy by in silico vector design.

There is an urgent need to develop the next-generation vectors for gene therapy of muscle disorders, given the relatively modest advances in clinical trials. These vectors should express substantially higher levels of the therapeutic transgene, enabling the use of lower and safer vector doses. In the current study, we identify potent muscle-specific transcriptional cis-regulatory modules (CRMs), containing clusters of transcription factor binding sites, using a genome-wide data-mining strategy. These novel muscle-specific CRMs result in a substantial increase in muscle-specific gene transcription (up to 400-fold) when delivered using adeno-associated viral vectors in mice. Significantly higher and sustained human micro-dystrophin and follistatin expression levels are attained than when conventional promoters are used. This results in robust phenotypic correction in dystrophic mice, without triggering apoptosis or evoking an immune response. This multidisciplinary approach has potentially broad implications for augmenting the efficacy and safety of muscle-directed gene therapy.

The role of the nurse at the end of the life of a critically ill patient. / Rol de la enfermera en el cuidado al final de la vida del paciente crítico.

OBJECTIVE: Analyze the role of the nurse at the end of the life of a critically ill patient. METHOD: Bibliographic review from a search of the health science databases such as PubMed, CINAHL, Cuiden, Scopus, Cochrane, as well as specialized platforms, general and thematic browsers. The limits were language (English or Spanish) and publication date (2005-2015). RESULTS: 180 articles met the inclusion criteria, and 16 of them were selected for analysis. The main results were grouped into three categories of analysis: direct patient care, family-focussed care and the nurse's role within the team. CONCLUSIONS: the described roles place the nurse as a key element in humanising death in the ICU and so nurses can and must lead change, playing an active role in creating strategies that really promote the integration of a palliative care approach in ICU.

Differential evolution of cerebral and cerebellar fossae in recent Homo: A new methodological approach.

The endocranium shows the influence of the shape and development of brain tissues and overall brain modifications. During the late Upper Pleistocene and Holocene smaller brains appeared and the higher position of endinion relative to inion might indicate changes in cerebellar and occipital lobes. In previous studies, the depths of the cerebral and cerebellar fossae were not specifically considered; new tools for quantitatively measuring these irregular, problematic curved areas need to be developed. This paper's main objective is to investigate to what degree changes in the fossae's depths of extant humans have occurred with respect to fossil anatomically modern humans (AMH) and older Homo species. The proportions of the occipital and nuchal planes are compared measuring the inner and outer surfaces of the bone. Additionally, this paper proposes a quantitative geometric methodology based on endocranial landmarks that create a plane with which to measure the position of the deepest part of the fossa: it represents a curvature maxima - concavity - associated with local structures. The four points thus obtained could be framed in Bookstein's Type II landmarks but without biomechanical implication. Through univariate, bivariate and multivariate analyses (principal components analysis) of raw and size-corrected data we study the differential evolution in recent Homo species, which presents a more vertical occipital area than ancient fossils. Our results corroborate this derived trait; additionally, we have observed a tendency towards a relative decrease in the depth of the cerebral fossae and maintenance of the cerebellar fossae.

Contrasting catastrophic eruptions predicted by different intrusion and collapse scenarios.

Catastrophic volcanic eruptions triggered by landslide collapses can jet upwards or blast sideways. Magma intrusion is related to both landslide-triggered eruptive scenarios (lateral or vertical), but it is not clear how such different responses are produced, nor if any precursor can be used for forecasting them. We approach this problem with physical analogue modelling enhanced with X-ray Multiple Detector Computed Tomography scanning, used to track evolution of internal intrusion, and its related faulting and surface deformation. We find that intrusions produce three different volcano deformation patterns, one of them involving asymmetric intrusion and deformation, with the early development of a listric slump fault producing pronounced slippage of one sector. This previously undescribed early deep potential slip surface provides a unified explanation for the two different eruptive scenarios (lateral vs. vertical). Lateral blast only occurs in flank collapse when the intrusion has risen into the sliding block. Otherwise, vertical rather than lateral expansion of magma is promoted by summit dilatation and flank buttressing. The distinctive surface deformation evolution detected opens the possibility to forecast the possible eruptive scenarios: laterally directed blast should only be expected when surface deformation begins to develop oblique to the first major fault.

Differential induction of polar and non-polar metabolism during wound-induced suberization in potato (Solanum tuberosum L.) tubers.

Wound-induced suberin deposition involves the temporal and spatial coordination of phenolic and fatty acid metabolism. Phenolic metabolism leads to both soluble metabolites that accumulate as defense compounds as well as hydroxycinnamoyl derivatives that form the basis of the poly(phenolic) domain found in suberized tissue. Fatty acid metabolism involves the biosynthesis of very-long-chain fatty acids, 1-alkanols, ω-hydroxy fatty acids and α,ω-dioic acids that form a poly(aliphatic) domain, commonly referred to as suberin. Using the abscisic acid (ABA) biosynthesis inhibitor fluridone (FD), we reduced wound-induced de novo biosynthesis of ABA in potato tubers, and measured the impact on the expression of genes involved in phenolic metabolism (StPAL1, StC4H, StCCR, StTHT), aliphatic metabolism (StCYP86A33, StCYP86B12, StFAR3, StKCS6), metabolism linking phenolics and aliphatics (StFHT) or acyl chains and glycerol (StGPAT5, StGPAT6), and in the delivery of aliphatic monomers to the site of suberization (StABCG1). In FD-treated tissue, both aliphatic gene expression and accumulation of aliphatic suberin monomers were delayed. Exogenous ABA restored normal aliphatic suberin deposition in FD-treated tissue, and enhanced aliphatic gene expression and poly(aliphatic) domain deposition when applied alone. By contrast, phenolic metabolism genes were not affected by FD treatment, while FD + ABA and ABA treatments slightly enhanced the accumulation of polar metabolites. These data support a role for ABA in the differential induction of phenolic and aliphatic metabolism during wound-induced suberization in potato.

Skeletal muscle IL-15/IL-15Rα and myofibrillar protein synthesis after resistance exercise.

In vitro and in vivo studies described the myokine IL-15 and its receptor IL-15Rα as anabolic/anti-atrophy agents, however, the protein expression of IL-15Rα has not been measured in human skeletal muscle and data regarding IL-15 expression remain inconclusive. The purpose of the study was to determine serum and skeletal muscle IL-15 and IL-15Rα responses to resistance exercise session and to analyze their association with myofibrillar protein synthesis (MPS). Fourteen participants performed a bilateral leg resistance exercise composed of four sets of leg press and four sets of knee extension at 75% 1RM to task failure. Muscle biopsies were obtained at rest, 0, 4 and 24 hours post-exercise and blood samples at rest, mid-exercise, 0, 0.3, 1, 2, 4 and 24 hours post-exercise. Serum IL-15 was increased by ~5.3-fold immediately post-exercise, while serum IL-15Rα decreased ~75% over 1 hour post-exercise (P<.001). Skeletal muscle IL-15Rα mRNA and protein expression were increased at 4 hours post-exercise by ~2-fold (P<.001) and ~1.3-fold above rest (P=.020), respectively. At 24 hours post-exercise, IL-15 (P=.003) and IL-15Rα mRNAs increased by ~2-fold (P=.002). Myofibrillar fractional synthetic rate between 0-4 hours was associated with IL-15Rα mRNA at rest (r=.662, P=.019), 4 hours (r=.612, P=.029), and 24 hours post-exercise (r=.627, P=.029). Finally, the muscle IL-15Rα protein up-regulation was related to Leg press 1RM (r=.688, P=.003) and total weight lifted (r=.628, P=.009). In conclusion, IL-15/IL-15Rα signaling pathway is activated in skeletal muscle in response to a session of resistance exercise.

Exercise-mediated modulation of autophagy in skeletal muscle.

Although exercise exerts multiple beneficial health effects, it may also damage cellular structures. Damaged elements are continuously degraded and its constituents recycled to produce renovated structures through a process called autophagy, which is essential for the adaptation to training. Autophagy is particularly active in skeletal muscle, where it can be evaluated using specific molecular markers of activation (unc-51-like kinase 1 [ULK1] phosphorylation) and specific proteins indicating increased autophagosome content (increased total LC3, LC3-II, LC3-II/LC3-I ratio). Studies in humans are technically limited but have provided evidence suggesting the activation of autophagy in skeletal muscle through AMP-activated protein kinase (AMPK) and its downstream target ULK1. Autophagy activation is more likely when the intensity is elevated and the exercise performed in the fasted state. The autophagy-gene program and autophagosome content are upregulated after ultraendurance running competitions. However, autophagosome content is reduced after endurance exercise at moderate intensities (50% and 70% of VO2 max) for 60-120 minutes. Autophagosome content is decreased within the first few hours after resistance training. The effects of regular endurance and strength training on basal autophagy remain to be established in humans. One study has reported that acute severe hypoxia increases autophagosome content in human skeletal muscle, which is reverted by 20 minutes of low-intensity exercise. Experiments with transgenic mice have shown that autophagy is necessary for skeletal muscle adaptation to training. Little is known on how genetic factors, environment, nutrition, drugs and diseases may interact with exercise to modulate autophagy at rest and during exercise in humans.

Improved Automatic Segmentation of White Matter Hyperintensities in MRI Based on Multilevel Lesion Features.

Brain white matter hyperintensities (WMHs) are linked to increased risk of cerebrovascular and neurodegenerative diseases among the elderly. Consequently, detection and characterization of WMHs are of significant clinical importance. We propose a novel approach for WMH segmentation from multi-contrast MRI where both voxel-based and lesion-based information are used to improve overall performance in both volume-oriented and object-oriented metrics. Our segmentation method (AMOS-2D) consists of four stages following a "generate-and-test" approach: pre-processing, Gaussian white matter (WM) modelling, hierarchical multi-threshold WMH segmentation and object-based WMH filtering using support vector machines. Data from 28 subjects was used in this study covering a wide range of lesion loads. Volumetric T1-weighted images and 2D fluid attenuated inversion recovery (FLAIR) images were used as basis for the WM model and lesion masks defined manually in each subject by experts were used for training and evaluating the proposed method. The method obtained an average agreement (in terms of the Dice similarity coefficient, DSC) with experts equivalent to inter-expert agreement both in terms of WMH number (DSC = 0.637 vs. 0.651) and volume (DSC = 0.743 vs. 0.781). It allowed higher accuracy in detecting WMH compared to alternative methods tested and was further found to be insensitive to WMH lesion burden. Good agreement with expert annotations combined with stable performance largely independent of lesion burden suggests that AMOS-2D will be a valuable tool for fully automated WMH segmentation in patients with cerebrovascular and neurodegenerative pathologies.

Diagnosis of Cognitive Impairment Compatible with Early Diagnosis of Alzheimer's Disease. A Bayesian Network Model based on the Analysis of Oral Definitions of Semantic Categories.

BACKGROUND: Early detection of Alzheimer's disease (AD) has become one of the principal focuses of research in medicine, particularly when the disease is incipient or even prodromic, because treatments are more effective in these stages. Lexical-semantic-conceptual deficit (LSCD) in the oral definitions of semantic categories for basic objects is an important early indicator in the evaluation of the cognitive state of patients. OBJECTIVES: The objective of this research is to define an economic procedure for cognitive impairment (CI) diagnosis, which may be associated with early stages of AD, by analysing cognitive alterations affecting declarative semantic memory. Because of its low cost, it could be used for routine clinical evaluations or screenings, leading to more expensive and selective tests that confirm or rule out the disease accurately. It should necessarily be an explanatory procedure, which would allow us to study the evolution of the disease in relation to CI, the irregularities in different semantic categories, and other neurodegenerative diseases. On the basis of these requirements, we hypothesise that Bayesian networks (BNs) are the most appropriate tool for this purpose. METHODS: We have developed a BN for CI diagnosis in mild and moderate AD patients by analysing the oral production of semantic features. The BN causal model represents LSCD in certain semantic categories, both of living things (dog, pine, and apple) and non-living things (chair, car, and trousers), as symptoms of CI. The model structure, the qualitative part of the model, uses domain knowledge obtained from psychology experts and epidemiological studies. Further, the model parameters, the quantitative part of the model, are learnt automatically from epidemiological studies and Peraita and Grasso's linguistic corpus of oral definitions. This corpus was prepared with an incidental sampling and included the analysis of the oral linguistic production of 81 participants (42 cognitively healthy elderly people and 39 mild and moderate AD patients) from Madrid region's hospitals. Experienced neurologists diagnosed these cases following the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA)'s Alzheimer's criteria, performing, among other explorations and tests, a minimum neuropsychological exploration that included the Mini-Mental State Examination test. RESULTS: BN's classification performance is remarkable compared with other machine learning methods, achieving 91% accuracy and 94% precision in mild and moderate AD patients. Apart from this, the BN model facilitates the explanation of the reasoning process and the validation of the conclusions and allows the study of uncommon declarative semantic memory impairments. CONCLUSIONS: Our method is able to analyse LSCD in a wide set of semantic categories throughout the progression of CI, being a valuable first screening method in AD diagnosis in its early stages. Because of its low cost, it can be used for routine clinical evaluations or screenings to detect AD in its early stages. Besides, due to its knowledge-based structure, it can be easily extended to provide an explanation of the diagnosis and to the study of other neurodegenerative diseases. Further, this is a key advantage of BNs over other machine learning methods with similar performance: it is a recognisable and explanatory model that allows one to study irregularities in different semantic categories.

A GOOD TREATMENT OPTION FOR PATIENTS WITH CHARCOT OSTEOARTHROPATHY OF THE FOOT.

Abstract BACKGROUND: METHODS: RESULTS: CONCLUSIONS:

[Assessment of the patient satisfaction with a Nuclear Medicine Service]. / Evaluación del grado de satisfacción de los pacientes atendidos en un servicio de Medicina Nuclear.

GOAL: To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). METHODS: A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance." The validity of the questionnaire was measured using Cronbach's alpha and determination (R(2)) indexes. The authors used the χ(2), Student's T, ANOVA and linear regression analysis statistical tests. RESULTS: A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. CONCLUSION: This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user's perspective.

Evaluación del grado de satisfacción de los pacientes atendidos en un servicio de Medicina Nuclear / Assessment of the Patient Satisfaction with a Nuclear Medicine Service

Objetivo. Conocer la calidad percibida y el grado de satisfacción de los pacientes con el servicio de Medicina Nuclear (MN). Metodología. Estudio descriptivo transversal. Se diseñó un cuestionario, adaptando un cuestionario elaborado por el National Health Service. Se analizaron las respuestas de 32 ítems, incluyendo 4 preguntas socio-demográficas y una abierta. Las variables relacionadas con la calidad de servicio se recodificaron en conformidad y no conformidad. Se midió la validez del cuestionario a través de los coeficientes alfa de Cronbach y de determinación (R2). Se utilizaron los test estadísticos χ2, t de Student, ANOVA y análisis de regresión lineal. Resultados. Fueron analizados 179 cuestionarios (tasa de respuesta: 36,6%, error muestral: 5,8%). La valoración de la satisfacción general y la recomendación del servicio de MN obtuvieron una puntuación media de 8,96 y 9,20 puntos respectivamente (escala 1-10). La variable que más influyó en la satisfacción general fue la impresión de la organización del servicio. Los principales puntos fuertes del servicio fueron la cortesía, la impresión de la organización del servicio y la limpieza; y las principales áreas de mejora, el cambio de cita y la lista de espera. No hubo diferencias significativas en la satisfacción en función de las variables sociodemográficas excepto para la edad. Conclusiones. La encuesta de satisfacción realizada nos ha permitido conocer que los pacientes están satisfechos con el Servicio de MN y, al mismo tiempo, constituye un instrumento útil para poder detectar los puntos fuertes y áreas de mejora del servicio desde la óptica del usuario(AU)

Goal. To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). Methods. A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance". The validity of the questionnaire was measured using Cronbach's alpha and determination (R2) indexes. The authors used the χ2, Student's T, ANOVA and linear regression analysis statistical tests. Results. A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. Conclusion. This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user‘s perspective(AU)

[Usefulness of multilevel analysis of satisfaction questionnaires on clinical units and medical specialties]. / Utilidad del análisis multinivel en las encuestas de satisfacción para evaluar las unidades clínicas y las especialidades médicas.

OBJECTIVES: Evaluate the usefulness of multilevel analysis applied to satisfaction surveys to assess the ambulatory care offered by the Clinical Units and Medical Specialties. METHODS: Telephone surveys were conducted on 6,922 patients seen in outpatient visits in the Navarra Health System in order to assess 94 Clinical Units and 37 Medical Specialties. A hierarchical analysis was then performed at 3 levels (patients, Clinical Units and Medical Specialties). RESULTS: The patient explained between 91.7% and 99.3% of the variability in the satisfaction survey scores. The patient perception of service quality also depends of the clinical unit, in 18 out of 20 items analysed, the variance related to the Clinical Unit was statistically significant, and ranged from 0.9% and 8.3%. The Medical Specialty explained 4.2% of the variability in only one item. Patients aged under 65 years, patients seen in first visit, and those who were seen at tertiary hospitals gave the lowest scores. CONCLUSIONS: Multilevel analysis is a useful tool to analyse and compare satisfaction survey results, as it can correctly distinguish the different Clinical Units of a health service, and this is a key element in the management of these Units. Moreover, it gives the percentage of variability due to each level and which variables predict the quality of service obtained.

Essential role of IL-6 in protection against H1N1 influenza virus by promoting neutrophil survival in the lung.

Influenza virus infection is considered a major worldwide public health problem. Seasonal infections with the most common influenza virus strains (e.g., H1N1) can usually be resolved, but they still cause a high rate of mortality. The factors that influence the outcome of the infection remain unclear. Here, we show that deficiency of interleukin (IL)-6 or IL-6 receptor is sufficient for normally sublethal doses of H1N1 influenza A virus to cause death in mice. IL-6 is necessary for resolution of influenza infection by protecting neutrophils from virus-induced death in the lung and by promoting neutrophil-mediated viral clearance. Loss of IL-6 results in persistence of the influenza virus in the lung leading to pronounced lung damage and, ultimately, death. Thus, we demonstrate that IL-6 is a vital innate immune cytokine in providing protection against influenza A infection. Genetic or environmental factors that impair IL-6 production or signaling could increase mortality to influenza virus infection.