El libro comprende 222 preguntas que atañen a los diversos e importantes asuntos a los que los profesores universitarios (experimentados y novatos) suelen enfrentarse antes, durante y después de la ...clase. Las respuestas que se ofrecen -algunas de ellas complementadas con ilustrativas figuras- son claras, concisas y, sobre todo, útiles.Estoy seguro de que el lector sabrá valorar el coraje y la honestidad que exhiben los autores cuando, a manera de conclusión, responden a la pregunta: “¿Qué no debe hacer el profesor universitario si pretende ser un buen profesor?". El listado de acciones que se deben evitar es amplio y abarca temas muy relevantes, muchos de ellos con indudable trasfondo ético. Germán Ramírez GarcíaEd D., Universidad de Harvard
Abstract Aims Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify ...predictors of in-hospital mortality. Methods Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals. Results Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p = 0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex female, EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score > 3. Conclusions The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.
Ceftobiprole is a fifth-generation cephalosporin that has been approved in Europe solely for the treatment of community-acquired and nosocomial pneumonia. The objective was to analyze the use of ...ceftobiprole medocaril (Cefto-M) in Spanish clinical practice in patients with infections in hospital or outpatient parenteral antimicrobial therapy (OPAT).
This retrospective, observational, multicenter study included patients treated from 1 September 2021 to 31 December 2022.
A total of 249 individuals were enrolled, aged 66.6 ± 15.4 years, of whom 59.4% were male with a Charlson index of four (IQR 2-6), 13.7% had COVID-19, and 4.8% were in an intensive care unit (ICU). The most frequent type of infection was respiratory (55.8%), followed by skin and soft tissue infection (21.7%). Cefto-M was administered to 67.9% of the patients as an empirical treatment, in which was administered as monotherapy for 7 days (5-10) in 53.8% of cases. The infection-related mortality was 11.2%. The highest mortality rates were identified for ventilator-associated pneumonia (40%) and infections due to methicillin-resistant
(20.8%) and
(16.1%). The mortality-related factors were age (OR: 1.1, 95%CI (1.04-1.16)), ICU admission (OR: 42.02, 95%CI (4.49-393.4)), and sepsis/septic shock (OR: 2.94, 95%CI (1.01-8.54)).
In real life, Cefto-M is a safe antibiotic, comprising only half of prescriptions for respiratory infections, that is mainly administered as rescue therapy in pluripathological patients with severe infectious diseases.
Mediterranean vineyards are subjected to drastic changes due to socio-economic, physical and environmental drivers. Whereas global trends affecting the evolution of Mediterranean land cover are ...well-known, their descriptions at a fine spatial scale, i.e., a plot level of several decametres, and over long time periods are still underexplored. This lack of exploration persists despite the increase in multitemporal imagery at fine resolutions. As scale and stakeholders are often correlated, we hypothesize that monitoring land cover at fine spatial and temporal scale would help understanding the local drivers shaping landscapes. To that end, we exploited a database of aerial pictures to obtain classified and vectorized land uses at the field level during the past five decades of a large watershed. The land uses were analyzed to detect changes at the field level considering the evolution of vineyard management. Changes in land management were synthesized in transition matrices expressing gains, losses and swaps for each land use category and illustrated using chord and Sankey diagrams. The results showed both a change in land management through a severe transformation of vineyards areas, from goblet to trellised vineyards, during the 1980s and a progressive evolution of land uses from vineyards to urban areas, arboriculture areas and arable lands. This transformation resulted from the local policies on vineyard replanting and the arrival of mechanization.
•Exploitation of multitemporal imagery at high spatial resolution.•Detection of a severe change in land management of vineyards.•First attempt to link the change in land management to geomorphology of the zone.
Este trabajo evalúa la influencia de las variables macroeconómicas e institucionales en la tasa de desempleo de 14 países de la Unión Europea. Se recurre a un modelo de datos de panel para el período ...1985-201 1. El mismo permite concluir sobre qué variables macroeconómicas e institucionales puede resultar más adecuado actuar para mejorar la respuesta del mercado de trabajo a los problemas económicos. Del análisis se concluye que la protección excesiva a los trabajadores, el salario mínimo interprofesional, la centralización en la negociación salarial y las elevadas cotizaciones empresariales a la Seguridad Social, así como la escasa competencia en el mercado de productos, pueden explicar, en parte, las mayores tasas de desempleo que presentan algunos países de la Unión Europea. Este trabalho avalia a influência das variáveis macroeconômicas e institucionais na taxa de desemprego de 14 países da União Europeia. Se recorre a um modelo de dados de painel para o período 1985-201 1. O mesmo permite concluir sobre que variáveis macroeconômicas e institucionais pode resultar mais adequado atuar para melhorar a resposta do mercado de trabalho aos problemas econômicos. Da análise se conclui que a proteção excessiva aos trabalhadores, o salário mínimo inter-profissional, a centralização na negociação salarial e as elevadas cotizações empresariais à Segurança Social, assim como a escassa competência no mercado de produtos, podem explicar em parte as maiores taxas de desemprego que apresentam alguns países da União Europeia.
A young male presented with a right parasternal stab wound. The chest radiography was normal and transthoracic echocardiography ruled out pericardial tamponade. He remained hemodynamically stable ...until three hours later when signs of progressive anemia were observed. Chest computed tomography showed massive right-sided hemothorax. The patient underwent surgery, which revealed an active bleeding atriopleural fistula connecting the right atrium and draining into the right pleura resulting from the negative pressure generated during respiration. This mechanism prevented cardiac tamponade and maintained initial hemodynamically stability.
Um jovem foi transferido para o serviço de emergência da nossa instituição com uma facada paraesternal direita. A radiografia de tórax foi normal. A ecocardiografia transtorácica descartou a presença de derrame pericárdico. Manteve-se hemodinamicamente estável até ao fim de três horas, após o que o paciente começou a apresentar sinais de anemia progressiva. Foi realizada tomografia computadorizada de tórax que mostrou hemotórax maciço. O paciente foi encaminhado urgentemente para cirurgia cardíaca. Observou-se hemorragia ativa através de uma fístula corte pleural ligando o átrio direito/a aurícula direita e drenagem pleural direita, resultado da pressão negativa da pleura durante a respiração. Este mecanismo impediu o tamponamento cardíaco e explica a estabilidade hemodinâmica inicial.
The economic crisis has revived the old myths about the Spanish labour market. It has shot our unemployment rate, which, in 2013, reached one of the highest levels of the European Union, after ...Greece. Thus, the cyclical behaviour of employment, labour market rigidity, difficulties in access to employment for youth and women, wage disparities and temporary employment, are some of the most criticized aspects. The article gives an overview of Spanish labour market compared to the neighbouring countries, and at the same time, it analyses the behaviour of labour market variables that have been most criticized.
Plant⁻pest relationships involve complex processes encompassing a network of molecules, signals, and regulators for overcoming defenses they develop against each other. Phytophagous arthropods ...identify plants mainly as a source of food. In turn, plants develop a variety of strategies to avoid damage and survive. The success of plant defenses depends on rapid and specific recognition of the phytophagous threat. Subsequently, plants trigger a cascade of short-term responses that eventually result in the production of a wide range of compounds with defense properties. This review deals with the main features involved in the interaction between plants and phytophagous insects and acari, focusing on early responses from the plant side. A general landscape of the diverse strategies employed by plants within the first hours after pest perception to block the capability of phytophagous insects to develop mechanisms of resistance is presented, with the potential of providing alternatives for pest control.
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