Patients with moderate-severe systolic dysfunction undergoing coronary artery bypass graft have a higher incidence of postoperative low cardiac output. Preconditioning with levosimendan may be a ...useful strategy to prevent this complication. In this context, design cost-effective strategies like preconditioning with levosimendan may become necessary.
In a sequential assignment of patients with Left Ventricle Ejection Fraction less than 40%, two strategies were compared in terms of cost-effectiveness: standard care (n = 41) versus preconditioning with Levosimendan (n = 13). The adverse effects studied included: postoperative new-onset atrial fibrillation, low cardiac output, renal failure and prolonged mechanical ventilation. The costs were evaluated using deterministic and probabilistic sensitivity analysis, and Monte Carlo simulations were performed.
Preconditioning with levosimendan in moderate to severe systolic dysfunction (Left Ventricle Ejection Fraction < 40%), was associated with a lower incidence of postoperative low cardiac output in elective coronary artery bypass graft surgery 2(15.4%) vs 25(61%) (P < 0.01) and lesser intensive care unit length of stay 2(1-4) vs 4(3-6) days (P = 0.03). Average cost on levosimendan group was 14,792€ while the average cost per patient without levosimendan was 17,007€. Patients with no complications represented 53.8% of the total in the levosimendan arm, as compared to 31.7% in the non-levosimendan arm. In all Montecarlo simulations for sensitivity analysis, use of levosimendan was less expensive and more effective.
Preconditioning with levosimendan, is a cost-effective strategy preventing postoperative low cardiac output in patients with moderate-severe left ventricular systolic dysfunction undergoing elective coronary artery bypass graft surgery.
Superabsorbent materials, showing water absorption higher than 1000 wt%, are traditionally formulated on acrylic derivatives, which are expensive and with low biodegradability. The massive use of ...non-biodegradable plastic materials has caused a serious environmental impact which especially affects oceans and seas. Thus, their replacement by bioplastics results interesting, for which one of the main challenges is the achievement of adequate mechanical properties. This work aims to improve those properties for a superabsorbent bioplastic based on porcine plasma protein, and different amounts of glutaraldehyde as cross-linking agent. When glutaraldehyde is added either directly in the protein-plasticizer blend (0.1–0.2 wt%) or through immersion of the injection-molded material in an aqueous solution of the cross-linker (0.005 wt%) resulted in superabsorbent materials that maintain their integrity after swelling. Soluble material loss decreases in a greater extent when glutaraldehyde was added through immersion. These results highlight the potential of a by-product of the meat industry as raw material of biodegradable superabsorbent materials with improved mechanical properties, which could find applications in agriculture or horticulture.
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•Glutaraldehyde enhances the viscoelastic properties of protein plasma-based plastics.•An increment of glutaraldehyde produce protein plasma-based plastics more fragile.•Glutaraldehyde hinders the porosity and water absorption of plasma-based plastics.•Plasma protein-based materials are reinforced through chemical cross-linking.•Plasma superabsorbent materials were obtained using up to 0.2% of glutaraldehyde.
Rationale and objectives
Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health ...published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies.
Methods
We performed a quasi‐experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients.
Results
Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk‐based strategy, P‐value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies.
Conclusion
Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.
The corn and chile jalapeño crops in Mexico are essential, culturally, and economically. The production of corn and chile jalapeño is the main economic source for many peasants in the country. Many ...producers develop conventional agriculture to carry out the production of their crops; these practices are based on the use of chemical inputs for fertilization and pest control. Therefore they need massive investments to be able to produce; in another context, some producers implement an alternative management of production, that is to say, they use organic fertilizers to improve the fertility of the soils of their crop fields and also make use of
some chemical products from the market to complete the fertilization required by the crops. In this sense, the present investigation was carried out, with visits to fields with corn and chile crops in the Autlán de Navarro agricultural valley, Jalisco, each with two managements (alternative and conventional) with three probabilistic samplings directed for each handling. The analysis of Net Present Value (NPV), the benefit/cost ratio (B/C), and the Internal Rate of Return (IRR) were implemented. These three parameters were interpreted as obtaining higher productivity and profitability in alternative management with a better relationship cost/ benefit and lower investment.
Los cultivos de maíz y chile jalapeño en México son muy importantes tanto cultural como económicamente. La producción de maíz y chile jalapeño es la principal fuente económica para muchos campesinos del país. Muchos desarrollan agricultura convencional para la producción de sus cultivos. Estas prácticas se basan en la utilización de insumos químicos para la fertilización y control de plagas y, por ende, necesitan fuertes inversiones para poder producir. Algunos agricultores implementan un manejo alternativo de producción, es decir, utilizan abonos orgánicos para mejorar la fertilidad de los suelos de sus campos de cultivo. Además usan algunos productos químicos del mercado para completar la fertilización requerida por los cultivos. Esta investigación se llevó a cabo con recorridos en campos con cultivos de maíz y chile jalapeño en el valle agrícola de Autlán de Navarro, Jalisco, cada uno con dos manejos (alternativo y convencional) y con tres muestreos probabilísticos dirigidos para cada manejo. Se aplicaron los análisis de Valor Actual Neto (VAN), la relación Beneficio/Costo (B/C) y la Tasa Interna de Retorno (TIR), y la mayor productividad y rentabilidad se obtuvo en el manejo alternativo con una mejor relación costo/beneficio y una menor inversión
Tanto en Europa como en otras regiones se está generalizando una cultura de la formación del profesorado universitario en competencias docentes específicas. Una de las metodologías activas a la que ...se viene prestando interés durante los últimos años, tanto en la literatura pedagógica como en las prácticas de formación, es el aprendizaje-servicio. Con la intención de cuantificar y caracterizar su oferta formativa en las universidades españolas, se llevó a cabo un estudio ex post facto de carácter transversal, basado en el registro de información publicada en las webs institucionales, así como en una encuesta no estructurada. La evidencia pone de manifiesto la tendencia ascendente en la oferta formativa de la metodología docente de ApS, al tiempo que progresa la institucionalización de la misma. No obstante, se identifican también importantes limitaciones, que alejan la orientación práctica del ámbito de la formación y no favorecen la planificación coordinada de las ecologías del aprendizaje, lo que reduce considerablemente el impacto reflexivo, cooperativo y transformador que se le presume a esta metodología. A partir de este diagnóstico, se sugiere la inserción de las actividades formativas en planes plurianuales, la combinación de las orientaciones sociocrítica y práctica, y la potenciación del trabajo conjunto entre las universidades y las agencias comunitarias. A culture of training teaching staff in specific teaching skills is spreading throughout higher education in Europe and other regions. In recent years, service-learning has been one of the active methodologies that has attracted the most attention in educational literature and in training practices. This piece uses an ex post facto cross-sectional study to quantify and describe service learning training provision in Spanish universities, using an information recording sheet to gather evidence from institutional websites and an unstructured questionnaire as a complementary data source. Our results support the claim that teaching training activities are growing and that there are some advances in the consolidation of this trend. However, significant limitations were identified, such as a lack of a practice-based orientation in teacher training and the lack of a coordinated plan to facilitate learning ecologies, something that is hindering the reflective, cooperative, and transformative impact that is attributed to the service learning method. Based on this diagnosis, we suggest that training activities be incorporated into multi-year plans, and note that sociocritical and practical orientations would work better together, and that collaborative work between universities and community services should be strengthened.
We describe the inquiries regarding Ebola virus disease (EVD) received by the Department of Public Health Alerts of the Community of Madrid between April and December 2014. A total of 242 inquiries ...were received. Consultations were initiated most frequently by hospital clinicians (59 inquiries, 24%), private citizens (57 inquiries, 24%) and primary care physicians (53 inquiries, 22%). The most frequent topic of inquiry was possible EVD in a patient (215 inquiries, 89%). Among these, 31 persons (14%) presented both EVD-compatible symptoms and epidemiological risk factors, and 11 persons (5%) fulfilled the criteria for a person under investigation. Recent travel abroad was reported in 96 persons (45%), but only 32 (15%) had travelled to an EVD-affected area. Two high-risk and one low-risk contact were identified through these inquiries. Low specificity of the EVD symptoms led to many difficulties in protocol application. Ineffective communication with healthcare professionals and unfamiliarity with the EVD protocols caused many case classification errors. A rapid consultation service by telephone is essential for providing qualified advice during emergencies. Our experience may help other countries dimension their activities and resources for managing similar exceptional outbreaks in the future.
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