Abstract We report high angular resolution observations, made with the Atacama Large Millimeter Array in band 6, of high excitation molecular lines of CH 3 CN and SO 2 and of the H29 α radio ...recombination line toward the G345.0061+01.794 B HC H ii region in order to investigate the physical and kinematical characteristics of its surroundings. Emission was detected in all observed components of the J = 14 →13 rotational ladder of CH 3 CN and in the 30 4,26 –30 3,27 , and 32 4,28 –32 3,29 lines of SO 2 . The peak of the velocity-integrated molecular emission is located ∼0.″4 northwest of the peak of the continuum emission. The first-order moment images and channel maps show a velocity gradient of 1.1 km s −1 arcsec −1 across the source and a distinctive spot of blueshifted emission toward the peak of the zero-order moment. The rotational temperature is found to decrease from 252±24 K at the peak position to 166±16 K at its edge, indicating that our molecular observations are probing a hot molecular core that is internally excited. The emission in the H29 α line arises from a region of 0.″65 in size, where its peak coincides with that of the dust continuum. We model the kinematical characteristics of the “central blue spot” feature as due to infalling motions, suggesting a central mass of 172.8±8.8 M ⊙ . Our observations indicate that this HC H ii region is surrounded by a compact structure of hot molecular gas, which is rotating and infalling toward a central mass, that is most likely confining the ionized region. The observed scenario is reminiscent of a “butterfly pattern” with an approximately edge-on torus and ionized gas roughly parallel to its rotation axis.
Background and Objectives
Accurate and readily available biomarkers to predict the clinical course of bronchiolitis would enable enhanced decision‐making in this setting. We explored the relationship ...of several biochemical parameters available at the pediatric emergency care setting with the need of advanced respiratory support (ARS): continuous positive airway pressure (CPAP), biphasic positive airway pressure (BiPAP), or invasive mechanical ventilation (MV) in bronchiolitis.
Methods
Single‐center, prospective, observational, including infants aged less than 12 months diagnosed with acute bronchiolitis at the Pediatric Emergency Department. Determination of plasmatic values of several laboratory tests was performed at the time of hospital admission. Multivariate logistic analysis identified independent predictors for need of ARS.
Results
From October 1, 2018 to May 1, 2020, we recruited 149 infants (58% males; median age of 1 0.5–2.5 month). Thirty‐seven (25%) cases required ARS. After adjusting by age, bacterial superinfection, and comorbidities in the multivariate analysis, only higher levels of glycemia (p = 0.001), C‐reactive protein (CRP) (p = 0.028), CRP/albumin ratio (p = 0.032), and NT‐proBNP (p = 0.001) remained independently associated with ARS. These biomarkers reached moderate prediction accuracy with area under the curve of receiver operator curve curves ranging from 0.701 to 0.830 (p = 0.001). All they presented relatively high specificity (0.75–0.84) and negative predictive values (0.77–0.89) with low sensitivity and positive predictive values. They also correlated significantly with length of stay hospitalization (p = 0.001).
Conclusion
Increased plasmatic levels of CRP, CRP/albumin ratio, glycemia, and NT‐proBNP at hospital admission are associated with the need for ARS in infants with acute bronchiolitis.
At the international level, the enormous demand to manage the COVID-19 pandemic has posed a challenge both in the provision of personnel and in supplies and sanitary material. There is no precedent ...or publication related to the management and leadership of nursing services in Spain within the emergency plan for the COVID-19 pandemic. This article describes the experience of the Hospital Clinico de Barcelona in the current extraordinary circumstances that undoubtedly constitute a nursing management of enormous magnitude and unprecedented due to the high number of people affected and the extraordinary risk of healthcare personnel. Following national and international guidelines to alleviate the pandemic, protect health and prevent the spread of the outbreak. The ability to work as a team, emotional management and respect for organizational decisions have made it possible to face the challenges that the pandemic has put in place and that the Nursing Department can lead in a calm and orderly manner the different actions to perform. Lastly, it will be necessary to continue with an in-depth analysis of the situation and of the actions carried out in order to identify the areas for improvement as well as to evaluate the overall nature of the process.
In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to ...Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.
In order to shed light on the main physical processes controlling fragmentation of massive dense cores, we present a uniform study of the density structure of 19 massive dense cores, selected to be ...at similar evolutionary stages, for which their relative fragmentation level was assessed in a previous work. We inferred the density structure of the 19 cores through a simultaneous fit of the radial intensity profiles at 450 and 850 mu m (or 1.2 mm in two cases) and the spectral energy distribution, assuming spherical symmetry and that the density and temperature of the cores decrease with radius following power-laws. Even though the estimated fragmentation level is strictly speaking a lower limit, its relative value is significant and several trends could be explored with our data. We find a weak (inverse) trend of fragmentation level and density power-law index, with steeper density profiles tending to show lower fragmentation, and vice versa. In addition, we find a trend of fragmentation increasing with density within a given radius, which arises from a combination of flat density profile and high central density and is consistent with Jeans fragmentation. We considered the effects of rotational-to-gravitational energy ratio, non-thermal velocity dispersion, and turbulence mode on the density structure of the cores, and found that compressive turbulence seems to yield higher central densities. Finally, a possible explanation for the origin of cores with concentrated density profiles, which are the cores showing no fragmentation, could be related with a strong magnetic field, consistent with the outcome of radiation magnetohydrodynamic simulations.
An important feature of e-research is the increased mediation of research practices, which changes not only the objects and tools of research, but also the relation between researcher and object, ...between researchers, and between researchers and their constituencies and stakeholders. This article focuses on the ethical aspects of e-research by analysing the implications of these changing relationships in the case of ethnography in mediated settings. It makes a specific contribution to the discussions about research ethics that are currently pursued and that tend to be catalysed by institutional review boards. The authors aim to link ethical discussions with the actual practices and conditions of qualitative social research. To do so, they review how researchers have used principles and ethical guides of traditional disciplines in ethnography, and show that several of concepts and categories on which these guidelines rely (personhood, privacy, harm, alienation, power) are otherwise enacted in mediated settings. The authors also analyze the ethical issues that have arisen in our own research. On the basis of these discussions, they specify two of the underlying dynamics of research in mediated settings, contiguity and traceability, in order to understand why traditional research ethics are challenged by these settings. The article specifies how mediated contexts can shape ethical issues; it provides a concise yet illustrative elaboration of a number of these issues; and proposes a vocabulary to further discuss this aspect of ethnographic work. Together, these elements amount to a contribution for the elaboration of new ethical research practices for social research in mediated settings.
Background
Intensive care unit (ICU) patients can experience emotional distress and post‐traumatic stress disorder when they leave the ICU, also referred to as post‐intensive care syndrome. A deeper ...understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient‐centred care and, ultimately, contribute to a positive experience.
Aim
To describe the patients' experience while transitioning from the ICU to a general ward.
Design
A descriptive qualitative study.
Method
Data were gathered through in‐depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.
Findings
Forty‐eight interviews were conducted. Impact on emotional well‐being emerged as a main theme, comprising four categories with six subcategories.
Conclusion
Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well‐being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward.
Relevance to clinical practice
It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow‐up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge.
Aim
To describe the impact of the COVID‐19 pandemic on stress, resilience and depression in health professionals from a public hospital in Barcelona, Spain after the first peak of pandemic.
...Background
The COVID‐19 pandemic in Spain has pushed boundaries in health systems and, especially, for health professionals. Analysis of resilience as an individual resource and it is essential to understand the mechanisms that make staff react unfavourably to stressors caused by the pandemic.
Design
A descriptive cross‐sectional study was designed.
Participants
Health professionals supervised by the nursing department, including registered nurses, health care assistants, health technicians, final year nurse student nurses, foreign nurses, and other nurse‐related health workers.
Methods
The study complies with the STROBE checklist for cross‐sectional studies. An online survey was administered to all health professionals supervised by the nursing department between 6 and 27 May 2020. The survey included the ER‐14 Resilience Scale, the widely‐used PHQ‐9 depression scale, the Spanish version of the Nursing Stress Scale, and an ad‐hoc questionnaire to obtain sociodemographic and occupational variables.
Results
A total of 686 participants answered the survey. Resilience was high or very high in health professionals, with an inverse correlation with stress and depression scores. Personal on fixed shifts showed better resilience. The most stressed health professionals were full‐time registered nurses, followed by health care assistants. Up to 25% of nursing professionals had depression.
Conclusion
Our study showed a high degree of resilience among nurse professionals despite the overwhelming nature of the COVID‐19 pandemic. Relevant signs of depression and stress were detected among participants. Occupational factors heavily influenced nurses’ resilience, stress and depression.
Implications for Nursing & Health Policy
Government policy shifts are needed in Spain to improve nurses’ workforce conditions, enhance the ratio of nurses to patient numbers, and avoid workforce losses. Maintaining the resilience of health professionals would assist in improving their health and their capacity to possible future emergency situations.
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