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Introduction: Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. Methods: The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. Results: We identified 36,044 patients with ischaemic stroke (mean age, 74.7 +/- 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was euro 3,230 the year before stroke, euro 11,060 for year one after stroke, euro 4,104 for year 2, and euro 3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. Conclusion: After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services. (C) 2019 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia.

Background: Pituitary adenomas (PA) associated with pheochromocytomas/paragangliomas (Pheo/PGL), also known as "the three P association" or "3PAs" could be the results of coincidence, but new evidence supports a common pathogenic mechanism in some patients. Our aim is to report the clinical data, surgical outcome, genetic findings of a large case series and review the current knowledge on this topic. Methods and results: In a retrospective multicentre study, we compiled 10 patients with PAs (6 new unreported cases). Six patients were female with mean age of 51.6 +/- 18.0 years. PA were: 6 acromegaly, 3 prolactinoma and 1 non-functioning PA (NFPA). Among the Pheo/PGL, 7 patients had a single tumour (4 Pheo and 3 PGL) and 3 patients had multiple or bilateral disease (2 PGL and 1 Pheo). Patients with GH-secreting PA and NFPA underwent surgery, while patients with prolactinoma received medical treatment (one patient required surgery). Unilateral adrenalectomy was carried out in all single Pheo and a bilateral procedure was performed in the patient with bilateral tumour. A single tumour was resected in two patients with multiple PGL. We found 3 germline pathogenic mutations: 2 in SDHB (c.166-170delCCTCA and a gross deletion involving exon 1) and 1 SDHD (p.P81L exon 3). Two variants of uncertain significance: 1 in MEN1 (c.1618C > T; p.Pro540Ser) and 1 in RET (c.2556C > G, p.Ile852Met), and finally a RETM918T somatic mutation in a Pheo tissue. Conclusion: We actively suggest considering the possibility of hereditary disease in all cases with 3PA and performing a complete genetic study.

Background: To evaluate the associations between individual income, all-cause mortality and use of healthcare resources in a very large population of chronic heart failure (CHF) patients living in Catalonia (Spain), where access to public healthcare is granted by law. Methods and results: We used 2016 data from the Catalan Health Surveillance System, a large, exhaustive, administrative healthcare database which includes information on medical diagnoses, healthcare resource use, and individual income for all Catalan residents (N = 7,638,524). Individual annual income was categorized as high (>100,000€), medium (18,000–100,000€), low (

This work is the continuation of Part 1, published in 2015, and comprises the reconstruction of the original collections of new taxa described by R. Pampanini and other botanists and, where possible, typification of the new names and taxonomical updating. The material studied for the most part concerns Libyan specimens held in the FI and FI-W herbaria but in some case also K, LD, MPU, P, PAD, PAL, ULT. Other material, which Pampanini studied in Florence was subsequently conserved in other herbaria. Specimens belonging to 21 families have been examined, from the Najadaceae to Zygophyllaceae. As well as typification, bibliographical data have been provided for those already typified. In this second part, a total of 113 names have been indexed and 91 typified, taking the names validly published in the entire work to 353, of which 286 are typified. Also on this occasion, we have provided taxonomic updates for each taxon. The Conclusions present a synthetic sum of the taxa still recognised taxonomically (entirely, in new combinations, or with a new status) in recent works on the Flora of N. Africa, in general revisions of various systematic groups, or reconsidered by the authors of this present work. We have also investigated the phyto-geographic origins of the taxa [according to the dominions proposed by Quézel (1978) for N. Africa]. Finally we have very briefly indicated the presence of material of the R. Pampanini collections (for Cyrenaica, together with R. E. G. Pichi Sermolli in 1934) in the most important herbaria. The paragraph "Addenda et Corrigenda" has been added to the final part of the treatise and relates chiefly to taxa omitted from the first part, either on account of new information or as a result of errors which came to light after publication.

BACKGROUND AND OBJECTIVES To determine which factors are associated with a functional gain above 19 on Barthel's index (CSFG) and also factors associated with a new post-discharge institutionalisation (NPDI) in patients who a underwent rehabilitation intervention whilst admitted to a medium long term care unit. PATIENTS AND METHODS Prospective study of patients admitted between 2000 and 2005 who underwent a rehabilitation intervention. Demographic, mind-body and laboratory data were collected. RESULTS 153 patients were selected for the first aim and 148 for the second. 53.3% of the patients achieved a CSFG. The incidence of NPDI was of 23.7%. The following factors were associated with a CSFG in the multivariate analysis: age (OR: 0.95), female gender (OR: 0.35), rehabilitation objective at admission (OR: 7.43), infectious disease as primary diagnosis (OR: 10.35), mild dependence at admission (OR: 0.09), absence of malnutrition (OR: 3.12), high comorbidity (OR: 0.31), need of wound care (OR: 0.36) and ansiolitic intake at admission (OR: 9.11). Likewise, the following factors were associated with the occurrence of a NPDI: age (OR: 1.12), long-term care objective at admission (OR: 7.84), chronic lung disease (OR: 0.29), number of drug prescriptions at admission (OR: 0.82), neuroleptic intake at admission (OR: 7.42), living with relatives (OR: 0.29) and nosocomial infection during the hospital stay (OR: 2.99). CONCLUSIONS Several factors have been associated to CSFG and NPDI and they would be useful to optimise rehabilitation resources and to plan post-discharge institutional transfer.

Objetivos: Describir en un Hospital de Media y Larga Estancia (HMLE) los resultados iniciales tras la implantación de un programa de valoración e intervención sobre la disfagia y conocer que variables mostraban diferencias significativas entre los enfermos con y sin disfagia así detectados. Métodos: Estudio descriptivo retrospectivo de la valoración realizada a los pacientes con sospecha de disfagia y de la intervención posterior en los que esta se confirmó. Se usó para dicha valoración un método clínico estandarizado que utiliza diferentes viscosidades y volúmenes. Tras su confirmación se llevaron a cabo cuidados dietéticos, posturales y formativos. Se recogieron variables demográficas, clínicas y de laboratorio. Resultados: Se incluyó a 146 pacientes, describiéndose sus correspondientes valoraciones y las intervenciones en los 110 que presentaron disfagia. Esto representó una prevalencia de disfagia del 14,8% de los pacientes ingresados. En el análisis univariante entre los pacientes con y sin disfagia, los primeros presentan al ingreso mayor presencia de sonda de alimentación (p 0,011) y menor proporción de deterioro cognitivo leve (p 0,048); y al alta menor recuperación funcional (p < 0,01) y mayor presencia de sonda de alimentación (p 0,028), de desnutrición (p < 0,01) y de mortalidad (p 0,02). Conclusiones: Para mejorar la calidad asistencial en HMLE es recomendable la implantación de un programa de atención a la disfagia, dada su frecuente presencia e importantes repercusiones clínicas. La disfagia detectada se relacionó con la presencia de sonda de alimentación y tuvo claras implicaciones evolutivas a nivel funcional, nutricional y de pronóstico vital.

We have micromachined and tested the first paraffin–PDMS composite thermal microactuator having multi shot large vertical displacement capabilities ( 160 um for 1 mm diameter device). A solid to liquid phase change of trapped paraffin into the PDMS is used to create a large volume dilatation of the composite (18%, for a temperature varied from 20 to 80 °C). The elasticity of the PDMS ensures the reversibility of the actuation. The paraffin-PDMS composite also facilitates fabrication and confines the melted paraffin when the device is actuated. This actuator has large force capabilities illustrated in our demonstrator by lifting a heavy mass for microsystems (60 mg). The actuator consists of a glass cavity filled with a paraffin-PDMS composite, a micro hotplate at the bottom of the cavity, and a nozzle-like silicon structure sealing the top of the cavity. The polyimide-aluminium micro-hotplate bonded to the bottom of the cavity heats (160 mW @ 2 V) the composite to obtain up to 160 um out of plane vertical displacement. Keywords: thermal actuator, paraffin, PDMS, composite, micro-hotplate, reversible, phase change

Background The incidence of sepsis can be estimated between 250 and 500 cases/100.000 people per year and is responsible for up to 6% of total hospital admissions. Identified as one of the most relevant global health problems, sepsis is the condition that generates the highest costs in the healthcare system. Important changes in the management of septic patients have been included in recent years; however, there is no information about how changes in the management of sepsis-associated organ failure have contributed to reduce mortality. Methods A retrospective analysis was conducted from hospital discharge records from the Minimum Basic Data Set Acute-Care Hospitals (CMBD-HA in Catalan language) for the Catalan Health System (CatSalut). CMBD-HA is a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia. Sepsis was defined by the presence of infection and at least one organ dysfunction. Patients hospitalized with sepsis were detected, according ICD-9-CM (since 2005 to 2017) and ICD-10-CM (2018 and 2019) codes used to identify acute organ dysfunction and infectious processes. Results Of 11.916.974 discharges from all acute-care hospitals during the study period (2005–2019), 296.554 had sepsis (2.49%). The mean annual sepsis incidence in the population was 264.1 per 100.000 inhabitants/year, and it increased every year, going from 144.5 in 2005 to 410.1 in 2019. Multiorgan failure was present in 21.9% and bacteremia in 26.3% of cases. Renal was the most frequent organ failure (56.8%), followed by cardiovascular (24.2%). Hospital mortality during the study period was 19.5%, but decreases continuously from 25.7% in 2005 to 17.9% in 2019 (p p p Conclusions The incidence of sepsis has been increasing in recent years in our country. However, hospital mortality has been significantly reduced. In septic patients, all organ failures except liver have shown a statistically significant reduction on associated mortality, with cardiovascular failure as the most relevant.

[Background] Most cost of illness studies are based on models where information on exposure is combined with risk information from meta-analyses, and the resulting attributable fractions are applied to the number of cases. [Methods] This study presents data on alcohol and tobacco use for 2011 and 2012 obtained from a routine medical practice in Catalonia of 606 947 patients, 18 years of age and older, as compared with health care costs for 2013 (all costs from the public health care system: primary health care visits, hospital admissions, laboratory and medical tests, outpatient visits to specialists, emergency department visits and pharmacy expenses). Quasi-Poisson regressions were used to assess the association between alcohol consumption and smoking status and health care costs (adjusted for age and socio-economic status). [Results] Resulting health care costs per person per year amounted to 1290 Euros in 2013, and were 20.1% higher for men than for women. Sex, alcohol consumption, tobacco use and socio-economic status were all associated with health care costs. In particular, alcohol consumption had a positive dose–response association with health care costs. Similarly, both smokers and former smokers had higher health care costs than did people who never smoked. [Conclusions] Alcohol and tobacco use had modest and large impacts respectively on health care costs, confirming the results of previous ecological modelling analyses. Reductions of alcohol consumption and smoking through public policies and via early identification and brief interventions would likely be associated with reductions in health care costs., This work was supported by a grant from Lundbeck Denmark received by A.G. (CP041374). This work also received funding from the RD12/0028/0016 project, Plan Nacional de I + D+I and was financed jointly with ISCII-Subdireccio´n General de Evaluacio´n y Fondo Europeo de Desarrollo Regional (FEDER). This grant was received by AG. http://www.redrta.es/.

[EN] The paper aims at stressing the discussion about the significant and topical issues that are evaluation and self-assessment in educational contexts, from teachers’ initial tertiary education and training to in-service and lifelong one. Finally, we will point out the strategic functions derived from building an organic evaluation system, which may allow a systemic and overall look about the whole scope of evaluation, as well as promote and improve a monitoring network. It will be useful primarily for teachers to know about their professional activities and have thus the opportunity to improve. Moreover, we will illustrate some results of a first experience on the investigation into the knowledge and ideas of the students attending the Primary Education degree course at the University of Macerata (Italy). Such survey is included within a broader research project about outcomes of future teachers. The methodologies used are both quantitative (most used statistical methods) and qualitative (a method autonomously adapted from Grounded Theory by Glaser and Strauss). A first data analysis shows that, as written by the students of the pilot sample, the characteristic that must not fail the teacher to be a good evaluator is objectivity, an aspect also much discussed within the scientific community.

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Característiques sociodemogràfiques; Característiques clíniques; Factors pronòstics; Pacients Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Características sociodemográficas; Características clínicas; Factores pronósticos; Pacientes Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Sociodemographic characteristics; Clinical features; Prognostic factors; Patients Informe que descriu quines són les característiques de les persones afectades per la COVID-19 i quins són els factors que condicionen el seu pitjor pronòstic. Aquests factors són importants actualment, per exemple, per a definir el grup considerat vulnerable i al que s’ha de protegir amb l’ús de les mesures de confinament/distanciament físic que s’estan implementant per part dels governs.

Fibrilación Atrial; Insuficiencia Cardíaca; Estudio longitudinal Fibril·lació atrial; Insuficiència cardíaca; Estudi longitudinal Atrial Fibrillation; Heart Failure; Longitudinal study BACKGROUND Heart failure (HF) is frequent and its prevalence is increasing. We aimed to evaluate the epidemiologic features of HF patients, the 1-year follow-up outcomes and the independent predictors of those outcomes at a population level. METHODS AND RESULTS Population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on December 31st, 2012. Patients were divided in 3 groups: patients without a previous HF hospitalization, patients with a remote (>1 year) HF hospitalization and patients with a recent (