To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
In recent years, the use of drones in health emergencies has increased. Among their main benefits are avoiding endangering rescuers, travelling long distances in a short time, or contacting victims in risky situations; but despite their multiple advantages, their use has not been fully demonstrated.
This study aims to identify the available evidence on the use of drones in emergency health care compared to traditional health care.
Systematic review of the literature was conducted. Search protocols were developed to locate studies that met the established selection criteria. Six experimental or quasi-experimental studies with high methodological quality published from the beginning of indexing until 2020 were included.
Drones covered a significantly larger area than other traditional tracking methods and were very useful for performing preliminary triage, determining needs, and knowing the scene prior to the arrival of rescuers. In addition, drones reduced the time required to locate the victim.
Drones are an element to be taken into account when attending health emergencies as they significantly improve the distance travelled to locate accident victims, have the possibility of performing triage prior to the arrival of the health care units, and improve the time and quality of the care provided.
The objective of this study was to identify the perceived problems by medical and nursing professionals that have arisen in the Spanish Emergency Medical Services (EMS) as a consequence of the first wave of the severe acute respiratory syndrome-coronavirus-2/SARS-CoV-2 pandemic, as well as the measures or solutions adopted to manage those problems and improve response.
This was a cross-sectional study of quantitative and qualitative methodology (“mixed methods”) using a self-administered questionnaire in 23 key informants of EMS of Spain selected by purposeful sampling, followed by the statistical analysis of both types of variables and an integration of the results in the discussion.
Common problems had been identified in many EMS, as well as similar solutions in some of them. Among the former, the following had been found: lack of leadership and support from managers, initial shortage of personal protective equipment (PPE), lack of participation in decision making, initial lack of clinical protocols, and slowness and/or lack of adaptability of the system, among others. Among the solutions adopted: reinforcement of emergency call centers, development of specific coronavirus disease 2019 (COVID-19) telephone lines and new resources, personal effort of professionals, new functions of EMS, support to other structures, and reinforcement of the role of nursing.
The general perception among the respondents was that there was a lack of support and communication with health care managers and that the staff expertise was not used by policy makers to make decisions adapted to reality, also expressing the need to improve the capacity for analysis of the EMS response. Few respondents reported good overall satisfaction with their EMS response. The EMS adopted different types of measures to adapt to the COVID-19 pandemic.
Acacia dealbata Link is one of the main invasive species in southwestern Europe and a resource with potential value for agriculture. Our objective was to assess the value of A. dealbata vegetative aerial biomass used as green manure and as a tool for weed control in maize crops through three sequential experiments. In 2017, an experiment was carried out with acacia green manure vs inorganic fertilization of pots sown with a field corn and a sweet corn hybrid with strong and weak nutrient demand, respectively. Nutrients were not released from acacia green manure at an appropriate timing, and maize suffered nutrient deficit. In 2018, a pot experiment was made outdoors incorporating acacia green manure at different times before maize sowing, and we found that a 4-month period was required for maximum nutrient release from acacia green manure. In 2019, an early and a late-field experiments were performed by incorporating acacia green manure 4 months before maize sowing. Physiological and agronomic data were recorded in maize, along with soil data, for all years, and weed data the last year. Altogether, most effects and interactions between genotype or environment and fertilization treatment were not significant, and some deficiencies caused by acacia green manure fertilization depend on genotype and environment. Incorporation of acacia green manure 4 months before maize sowing partially controlled weeds and replaced inorganic fertilization. However, deficiencies should be corrected with additional weed control practices and fertilization treatments, according to the nutrient demand of the crop and the soil environment.
The PapSEEK test is an emerging minimally invasive technique in which samples are collected from the endocervical or intrauterine cavity with the Papanicolaou (Pap) brush or the Tao brush to detect somatic mutations or aneuploidies indicating the presence of endometrial or ovarian cancer.
We systematically searched for articles published up to October 2020 in the following electronic databases: Medline, Embase, the Cochrane Library, and the Centre for Reviews and Dissemination. We included experimental studies, observational primary studies, and cost-effectiveness studies evaluating the safety, effectiveness, and cost effectiveness of the PapSEEK test for the early detection of ovarian or endometrial cancer. Relevant outcomes included sensitivity, specificity, the coefficient of variation, re-test rates, the incremental cost-effectiveness ratio, the incremental cost-utility ratio, and the cost of each alternative.
A single relevant retrospective study was identified. In this study, samples from women with endometrial cancer (n = 656) and ovarian cancer (n = 254) were collected with the Pap brush and Tao brush and compared with samples from healthy women (n = 1,002). The diagnostic validity for somatic mutation or aneuploidies obtained with a Pap brush had a sensitivity of 81% for endometrial cancer and 33% for ovarian cancer, and a specificity of 99% for both conditions. When samples were collected from the intrauterine cavity with a Tao brush, the sensitivity increased to 93% for endometrial cancer and to 45% for ovarian cancer. The sensitivity of the PapSEEK test increased only for ovarian cancer when plasma samples to detect circulating tumor DNA were collected in addition to Pap smear samples. This strategy provided a diagnostic validity of 43%, which was higher in late-stage ovarian cancer (56% versus 35%), and a specificity of 100%.
Prospectively designed studies are required to assess the safety and effectiveness of the PapSEEK test in screening settings, as well as studies comparing the technology with conventional screening methods. No cost-effectiveness studies have been conducted for the PapSEEK test.
About 70 percent of metastatic breast, lung, and prostate cancers affect the bones. When this phase of the disease affects the spine, the mobility and quality of life of patients are severely impaired. Radiofrequency ablation (RFA) has become a feasible option in the palliative treatment of vertebral metastases due to its minimal invasiveness and short procedure time. This health technology assessment report aimed to identify, evaluate, and synthesize evidence on the safety, effectiveness, and cost effectiveness of RFA for vertebral metastases.
A systematic search was conducted to identify literature published from December 2016 to July 2019 in the following databases: Medline, Embase, the Cochrane Library, and the Centre for Reviews and Dissemination. Systematic reviews, randomized and non-randomized controlled trials, and case series studies evaluating the efficacy and safety of RFA in patients with vertebral metastases were included.
Sixteen studies were included: two systematic reviews, 13 case series studies, and one comparative study. None of the systematic reviews identified any randomized controlled trials. Of the 14 included primary studies, 10 evaluated RFA in combination with vertebroplasty, three evaluated RFA in combination with kyphoplasty, and one study evaluated a combination of RFA and radiation therapy. In all cases, the evaluated patients had different types of cancer (e.g., breast, lung, or liver). The follow-up periods varied between the studies from one day to 12 months. The most commonly used RFA devices were the STAR™ Tumour Ablation System (Merit Medical Systems) and the OsteoCool™ Radiofrequency Ablation System (Medtronic).
RFA reduces pain, improves functional capacity, and provides greater local control of disease, potentially giving patients a higher quality of life, even in the context of metastatic disease. Although there is evidence on the safety and efficacy of this technology for the palliative treatment of vertebral metastases, more studies with higher methodological quality are needed. There were no studies available on the cost effectiveness of RFA for this indication.
The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.
This paper aims to describe the development of a flowchart to guide the decisions of researchers in the Spanish Network for Health Technology Assessment of the National Health System (RedETS) regarding patient involvement (PI) in Health Technology Assessment (HTA). By doing so, it reflects on current methodological challenges in PI in the HTA field: how best to combine PI methods and what is the role of patient-based evidence.
A decisional flowchart for PI in HTA was developed between March and April 2019 following an iterative process, reviewed by the members of the PI Interest Group and other RedETS members and validated during an online deliberative meeting. The development of the flowchart was based on a previous methodological framework assessed in a pilot study.
The guidelines on how to involve patients in HTA in the RedETS were graphically represented in a flowchart. PI must be included in all HTA reports, except those that assess technologies with no relevant impact on patients’ experiences, values, and preferences. Patient organizations or expert patients related to the topic of the HTA report must be identified and invited. These patients can participate in protocol development, outcomes' identification, assessment process, and report review. When the technology assessed affects in a relevant way patient experiences, values, and preferences, patient-based evidence should be included through a systematic literature review or a primary study.
The decisional flowchart for PI in HTA contributes to the current methodological challenges by proposing a combination of direct involvement and patient-based evidence.
Human embryos generated in vitro have a high incidence of chromosomal abnormalities that negatively affect pregnancy rate. Embryos generated in vitro secrete extracellular vesicles (EVs) into the culture medium that could be used potentially as indicators of embryo competence. This research aimed to evaluate the concentration and size of EVs and their gDNA content as an indicator of developmental competence in human embryos. Human embryos generated by intracytoplasmic sperm injection (ICSI) were classified morphologically as of either TOP, FAIR or POOR quality. Culture medium and developmentally arrested embryos (which were not able to be used for embryo transfer) were collected. Microvesicles, exosomes (MV/Exo) and apoptotic bodies (ABs) were isolated from culture medium. Nanoparticle tracking analysis (NTA) and array comparative genomic hybridization (aCGH) analysis were performed to evaluate EVs and their gDNA content. From NTA, the diameter (mean) of MVs/Exo from TOP quality embryos was higher (112.17 nm) compared with that of FAIR (108.02) and POOR quality embryos (102.78 nm) (P < 0.05). aCGH analysis indicated that MVs/Exo and ABs carried gDNA with the presence of 23 chromosome pairs. However, when arrested embryos were compared with their respective MVs/Exo and ABs, the latter had an increased rate of chromosomal abnormalities (24.9%) compared with embryos (8.7%) (P < 0.05). In conclusion, the size of EVs from culture medium might be an alternative for evaluating competence of human embryos, however more studies are needed to validate the use of gDNA from EVs as an indicator of embryo competence.
This study was carried out on sediment cores collected with a gravity corer from Laguna Cháltel, an almost circular crater lake located in Patagonia, Argentina (49.9°S, 71°W). The main magnetic carrier was Ti-magnetite in the pseudo–single domain range. A model using magnetic grain size and concentration, previously applied to Laguna Potrok Aike to infer lake-level changes, was used for Laguna Cháltel. The main requirement to apply the model is uniform magnetic mineralogy, which is the case for Laguna Cháltel. After magnetic data were compared with previously studied lake levels, it was found that the magnetic proxies that best follow hydrologic changes are ARM/SIRM (anhysteretic remanent magnetisation/saturation of isothermal remanent magnetisation) and ARM. The concentration proxy (ARM measured with a 100 mT alternating field and 0.05 mT direct field) was also used as wind indicator. High wind strength was found at around 3650 cal yr BP, and low wind strength for the last century. ARM/SIRM and ARM were used to infer the strength of fluvial runoff into the lake for a core collected close to the shore and near a tributary. The results show that the magnetic model is promising for inferring lake-level variations, particularly in Patagonian lakes.
Parkinson's disease and Alzheimer's disease are progressive nervous system disorders that affect physical and cognitive capacities of individuals, including memory loss, motion impairment, or problem-solving dysfunctions. Leisure activities are associated with reducing the risk of dementia and are preventive policies for delaying the cognitive impairment in later stages of those neurodegenerative diseases. Electronic games related to cognitive abilities are an easy and inexpensive alternative for stimulating brain activity in this kind of patients. The previous research demonstrated the acceptance of these activities in the environment of Connected TV when playing at home and in daily care centers. Interaction in Connected TV applications has its own particularities that influence the design of the interface, including the viewing distance, the type of interaction through a remote control or other techniques, the size of the screen, or the collectiveness of consumption. Iterative testing with patients of these groups revealed how the physical characteristics and cognitive impairment of these concrete end-users affect the human–computer interaction, offering guidelines and recommendations in good practices for the Smart TV interface design. On the other hand, data analytics extracted from the interaction and evolution of the game offer important information enabling the creation of estimation prediction models about the cognitive state of the patient.
Conventional tests with written information used for the evaluation of sign language (SL) comprehension introduce distortions due to the translation process. This fact affects the results and conclusions drawn and, for that reason, it is necessary to design and implement the same language interpreter-independent evaluation tools. Novel web technologies facilitate the design of web interfaces that support online, multiple-choice questionnaires, while exploiting the storage of tracking data as a source of information about user interaction. This paper proposes an online, multiple-choice sign language questionnaire based on an intuitive methodology. It helps users to complete tests and automatically generates accurate, statistical results using the information and data obtained in the process. The proposed system presents SL videos and enables user interaction, fulfilling the requirements that SL interpretation is not able to cover. The questionnaire feeds a remote database with the user answers and powers the automatic creation of data for analytics. Several metrics, including time elapsed, are used to assess the usability of the SL questionnaire, defining the goals of the predictive models. These predictions are based on machine learning models, with the demographic data of the user as features for estimating the usability of the system. This questionnaire reduces costs and time in terms of interpreter dedication, as well as widening the amount of data collected while employing user native language. The validity of this tool was demonstrated in two different use cases.
Universal access on equal terms to audiovisual content is a key point for the full inclusion of people with disabilities in activities of daily life. As a real challenge for the current Information Society, it has been detected but not achieved in an efficient way, due to the fact that current access solutions are mainly based in the traditional television standard and other not automated high-cost solutions. The arrival of new technologies within the hybrid television environment together with the application of different artificial intelligence techniques over the content will assure the deployment of innovative solutions for enhancing the user experience for all. In this paper, a set of different tools for image enhancement based on the combination between deep learning and computer vision algorithms will be presented. These tools will provide automatic descriptive information of the media content based on face detection for magnification and character identification. The fusion of this information will be finally used to provide a customizable description of the visual information with the aim of improving the accessibility level of the content, allowing an efficient and reduced cost solution for all.
We present the main results from the analysis of the Hα-[NII] emission lines with integral field spectroscopy observations gathered with MEGARA at the GTC of the nearby Seyfert 1.5 galaxy NGC7469. We obtained maps of the ionised gas in the inner 12.5 arcsec × 11.3 arcsec, at spatial scales of 0.62 arcsec, with an unprecedented spectral resolution (R ˜ 20 000). We characterized the kinematics and ionisation mechanism of the distinct kinematic components (Cazzoli et al.2019).
Within out-of-hospital emergencies, primary health care (PHC) nurses must face life-threatening emergencies (LTEs), which are defined as “a situation associated with an imminent life risk that entails the start-up of resources and special means to resolve the situation.”
The objectives of this study were to know the training received for out-of-hospital LTEs by PHC nurses of Asturias, Spain and the perception they have about their theoretical knowledge and practical skills in a series of emergency procedures or techniques used in LTE emergencies; as well as to analyze the differences according to the geographical area of their work.
Cross-sectional, descriptive, and observational study was conducted in 2018 of a sample of PHC service nurses of Asturias, Spain.
A total of 236 nurses from PHC service centers of Asturias, Spain, from among the total of 730 nurses who make up the staff of nurses of the PHC service of Asturias, between April and May 2018, were surveyed. The survey was designed ad hoc using the Doctrinal Body of Emergency Nursing (DBEN) proposed by the Spanish Society of Emergency Medicine (SEMES; Madrid, Spain), which indicates the theoretical and practical procedures that must be acquired by the PHC nurses. It is composed of 37 procedures or techniques employed in LTEs using an 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to ten (“Maximum”).
There were significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
All PHC nurses must be perfectly trained to provide initial quality assistance to the LTE, with both theoretical and practical knowledge of the different techniques, so that it can continue to be attended by the corresponding Emergency Service.
To study the impact of duration of mechanical ventilation, hospitalization and multiple ventilation episodes on the development of pneumonia while accounting for extubation as a competing event.
A multicenter data base from a Spanish surveillance network was used to conduct a retrospective analysis of prospectively collected intensive care patients followed from admission to discharge.
Spanish intensive care units (ICUs).
Mechanically ventilated adult patients from 158 ICUs with 45,486 admissions, 48,705 ventilation episodes, and 314,196 ventilator days.
Competing-risk models were applied to account for extubation plus 48 hours as a competing event for acquiring ventilator-associated pneumonia (VAP).
Time in the ICU before mechanical ventilation was associated with an increased VAP hazard rate and with longer intubation time. This indirect prolongation of intubation increased the cumulative risk to eventually acquire VAP. For instance, comparing 3–4 versus 0 days, the adjusted VAP hazard ratio was 1.40 (95% confidence interval [CI], 1.19–1.64) and the adjusted extubation hazard ratio was 0.64 (95% CI, 0.61–0.68), which leads to an adjusted VAP subdistribution hazard ratio (sHR) of 2.13 (95% CI, 1.83–2.50). Similarly, due to prolonged intubation, multiple ventilation episodes increase the risk for VAP; the adjusted sHR is 1.52 (95% CI, 1.35–1.72) for the second episode compared to the first episode, and the adjusted sHR is 1.54 (95% CI, 1.03–2.30) for the third episode compared to the first episode. The Kaplan-Meier method produced an upward biased estimated cumulative risk for VAP.
A competing-risk analysis is necessary to receive unbiased risk estimates and to quantify the indirect effect of intubation time on the cumulative VAP risk. Our findings may guide physicians to improve medical decisions related to the harms and benefits of the duration of ventilation.