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Tesis-Universidad de Murcia., MEDICINA ESPINARDO. DEPOSITO. MU-Tesis 262., Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M.-614.

Tesis-Universidad de Murcia., Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M. 3099.

Tesis-Universidad de Murcia., Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M.-616.

This article presents the Schumann resonance (SR) variations, obtained in the extreme low frequency (ELF) signal observatory of Sierra de Filabres belonging to the University of Almeria Spain, in operation since 2011. This station has two large and sensitive orthogonal sensors operating between 1 and 100 Hz. A 24 bit low-noise, high-resolution system processes the signal. The Sierra de Filabres ELF station is operating to offer valuable information on SRs’ activity in this area. This system allows us to have a broader range of comparison patterns to study correlations with other phenomena. The information presented in this work deals with the diurnal and seasonal variations of the first six modes of the SRs in 2016 and 2017. The graphs have been obtained through Lorentzian functions. We explain the diurnal variation based on the position and distance to the most important lightning hotspots and demonstrate its relation with the first mode captured in our observatory. We introduce a new yearly evolution method based on the resonance frequency through the most representative lightning activity hours in one year. This article is supported by the comparison between our signals and the global thunderstorm center’s activity.

Background: To analyze the long-term outcomes for advanced cancer patients admitted to an intermediate care unit (ImCU), an analysis of a do not resuscitate orders (DNR) subgroup was made. Methods: A retrospective observational study was conducted from 2006 to January 2019 in a single academic medical center of cancer patients with stage IV disease who suffered acute severe complications. The Simplified Acute Physiology Score 3 (SAPS 3) was used as a prognostic and severity score. In-hospital mortality, 30-day mortality and survival after hospital discharge were calculated. Results: Two hundred and forty patients with stage IV cancer who attended at an ImCU were included. In total, 47.5% of the cohort had DNR orders. The two most frequent reasons for admission were sepsis (32.1%) and acute respiratory failure (excluding sepsis) (38.7%). Mortality in the ImCU was 10.8%. The mean predicted in-hospital mortality according to SAPS 3 was 51.9%. The observed in-hospital mortality was 37.5% (standard mortality ratio of 0.72). Patients discharged from hospital had a median survival of 81 (30.75–391.25) days (patients with DNR orders 46 days (19.5–92.25), patients without DNR orders 162 days (39.5–632)). The observed mortality was higher in patients with DNR orders: 52.6% vs. 23.8%, p 0 < 0.001. By multivariate logistic regression, a worse ECOG performance status (3–4 vs. 0–2), a higher SAPS 3 Score and DNR orders were associated with a higher in-hospital mortality. By multivariate analysis, non-invasive mechanical ventilation, higher bilirubin levels and DNR orders were significantly associated with 30-day mortality. Conclusion: For patients with advanced cancer disease, even those with DNR orders, who suffer from acute complications or require continuous monitoring, an ImCU-centered multidisciplinary management shows encouraging results in terms of observed-to-expected mortality ratios.

Seven decades have passed since the Schumann resonances (SRs) were identified. Since then, their research interest has increased, currently being a topic of significance. Nonetheless, the papers that study their nature from the frequency perspective are in clear majority regarding those who focus on the time domain. To fill this gap in the literature and further characterize the SRs, a method to perform statistical analysis on the SRs signal in the time domain has been developed. For any given segment of data, the analysis performs a maximum likelihood estimation (MLE) of the statistical parameters from a group of previously selected distributions. After that, the best fit among the target distributions is selected through the application of Akaike information criterion (AIC). The method is tested by analyzing a month’s worth of data, showing the general analysis’ results and discussing the relationship between the chosen target distributions and common aspects between the time segments fitted to them. The reliability of the method’s results is also discussed by looking at different aspects of the analysis. Special emphasis is put over the results being correlated with lightning activity. This correlation highlights the usefulness of the method, given the well-established relationship between lightning and SRs.

Crowd monitoring was an essential measure to deal with over-tourism problems in urban destinations in the pre-COVID era. It will play a crucial role in the pandemic scenario when restarting tourism and making destinations safer. Notably, a Destination Management Organisation (DMO) of a smart destination needs to deploy a technological layer for crowd monitoring that allows data gathering in order to count visitors and distinguish them from residents. The correct identification of visitors versus residents by a DMO, while privacy rights (e.g., Regulation EU 2016/679, also known as GDPR) are ensured, is an ongoing problem that has not been fully solved. In this paper, we describe a novel approach to gathering crowd data by processing (i) massive scanning of WiFi access points of the smart destination to find SSIDs (Service Set Identifier), as well as (ii) the exposed Preferred Network List (PNL) containing the SSIDs of WiFi access points to which WiFi-enabled mobile devices are likely to connect. These data enable us to provide the number of visitors and residents of a crowd at a given point of interest of a tourism destination. A pilot study has been conducted in the city of Alcoi (Spain), comparing data from our approach with data provided by manually filled surveys from the Alcoi Tourist Info office, with an average accuracy of 83%, thus showing the feasibility of our policy to enrich the information system of a smart destination. This research was carried out within the research Project Alcoi Tourist Lab framework, co-funded by the Alcoi City Council & the Valencian Innovation Agency. The research was also partially funded by project UAPOSTCOVID19-10 from the University of Alicante. Finally, this research was partly supported by the EU CEF project GreenMov, CARM HORECOV-21 project (https://horecovid.com/ (accessed on 12 January 2022)). is financed through the Call for Public Aid destined to finance the Strategic projects contemplated in the Research and Innovation Strategy for Smart Specialization - RIS3MUR Strategy by the Autonomous Community of the Region of Murcia, through the Ministry of Economic Development, Tourism and Employment within the framework of the FEDER Region of Murcia Operational Program 2014–2020 within the framework Thematic Objective 1. Strengthen research, technological development and innovation by 80% and with CARM’s own funds in 20%, and finally the EU project H2020 NIoVE (833742).

International audience; Background: Streptococcus equi subspecies equi (S.equi) is the cause of the highly contagious equine respiratory disease ‘strangles’. Approximately 10% of recovered animals can persistently carry the bacteria and transmit it to naïve animals. The global movement of horses is an ideal mechanism for widespread transmission to geographically distant locations.Objectives: Utilise whole-genome sequence data to disentangle the transmission of S. equi and subsequent outbreaks of strangles.Study design: In vitro analysis of micro-organisms.Methods: Isolates (n = 670) of S. equi were recovered from clinical samples submitted to multiple collaborating clinics and institutions globally. Following species confirmation, isolates underwent whole-genome sequencing using Illumina technology. Sequence reads passing quality control measures were assembled and uploaded to Pathogenwatch, which assigned a phylogeny based upon sequences of core genome alleles. Population structure was inferred using the population mixture analysis in BAPS.Results: BAPS clustered the isolates into six different clusters (BAPS 1-6) and showed dominant lineages in different geographical areas but also global transmission within the clusters. Sub-groups within the clusters highlighted multiple outbreaks at local, national and international scales and highlighted population structures and transmission dynamics within single locations. For example, four different strains collected over just seven months were identified in a single location. Sequence data also identified a statistically significant decline in BAPS-5 since 2010.Main limitations: Pathogenwatch has shown its utility in investigating S. equi transmission and population structure. However, it is based upon a curated set of 1286 core genome loci. Further investigations will need to be conducted using the full spectrum of data available from whole-genome sequencing.Conclusions: Pathogenwatch was used as a tool to rapidly identify and visualise the whole-genome sequence data of a large S. equi dataset. The data demonstrate widespread transmission of multiple S. equi lineages and provide strong evidence that asymptomatic carrier horses are perpetuating this dissemination.

Sustainability is becoming of vital importance in project management, and a life cycle assessment (LCA) can ensure a body of knowledge to bear in mind the environmental burdens the project involves. In this study, two different ways of supplying energy to a sensor network are analyzed. Firstly, we analyze the environmental impact of the devices connected to the public grid. Secondly, we analyze the completely full off-grid system, with the sensor connected to a photovoltaic (PV) panel. Our findings show that the off-grid option has a greater number of benefits than the grid-connected option in terms of environmental impacts, although it is less economically advantageous. In a detailed analysis of the off-grid scenario, it can be observed that the battery is the component with the highest impact, so actions to try to reduce consumption, and, therefore, the battery size and its negative impact are taken. After reducing the battery size, the break-even point was reached, providing a net economic benefit of EUR 0.23 sensor/year. However, this analysis refers to a single sensor, and although the environmental and economic benefits seem low, in an economy of scale, this could result in large savings if these types of sensors are massively installed.

The equine disease strangles, which is characterized by the formation of abscesses in the lymph nodes of the head and neck, is one of the most frequently diagnosed infectious diseases of horses around the world. The causal agent, Streptococcus equi subspecies equi , establishes a persistent infection in approximately 10 % of animals that recover from the acute disease. Such ‘carrier’ animals appear healthy and are rarely identified during routine veterinary examinations pre-purchase or transit, but can transmit S. equi to naïve animals initiating new episodes of disease. Here, we report the analysis and visualization of phylogenomic and epidemiological data for 670 isolates of S. equi recovered from 19 different countries using a new core-genome multilocus sequence typing (cgMLST) web bioresource. Genetic relationships among all 670 S. equi isolates were determined at high resolution, revealing national and international transmission events that drive this endemic disease in horse populations throughout the world. Our data argue for the recognition of the international importance of strangles by the Office International des Épizooties to highlight the health, welfare and economic cost of this disease. The Pathogenwatch cgMLST web bioresource described herein is available for tailored genomic analysis of populations of S. equi and its close relative S. equi subspecies zooepidemicus that are recovered from horses and other animals, including humans, throughout the world. This article contains data hosted by Microreact.

Intermediate care units (ImCUs) have been shown as appropriate units for the management of selected septic patients. Developing specific protocols for residents in training may be useful for their medical performance. The objective of this study was to analyze whether a simulation-based learning bundle is useful for residents while acquiring competencies in the management of sepsis during their internship in an ImCU. A prospective study, set in a tertiary-care academic medical center was performed enrolling residents who performed their internship in an ImCU from 2014 to 2017. The pillars of the simulation-based learning bundle were sepsis scenario in the simulation center, instructional material, and sepsis lecture, and management of septic patients admitted in the ImCU. Each resident was evaluated in the beginning and at the end of their internship displaying a sepsis-case scenario in the simulation center. The authors developed a sepsis-checklist that residents must fulfill during their performance which included 5 areas: hemodynamics (0–10), oxygenation (0–5), antibiotic therapy (0–9), organic injury (0–5), and miscellaneous (0–4). Thirty-four residents from different years of residency and specialties were evaluated. The total median score (interquartile range) increased significantly after training: 12 (25) vs 23 (16), P = .001. First-year residents scored significantly lower than older residents at baseline: 10 (14) vs 14.5 (19), P = .024. However, the performance at the end of the training period was similar in both groups: 21.5 (11) vs 23 (16), P = 1.000. Internal Medicine residents scored significantly higher than residents from other specialties: 18 (17) vs 10.5 (21), P = .007. Nonetheless, the performance at the end of the training period was similar in both groups: 24.5 (9) vs 22 (13), P = 1.000. Combining medical simulation with didactic lectures and a rotation in an ImCU staffed by hospitalists seems to be useful in acquiring competencies to manage critically ill patients with sepsis. We designed a checklist to assure an objective evaluation of the performance of the residents and to identify those aspects that could be potentially improved.

This paper describes the characteristics of contributions made by researchers worldwide in the field of ELF (extremely low frequency) waves from 1957 to 2019. The data were collected through the Scopus database and processed with analytical and bibliometric techniques. The selection of the keywords is an essential step, because ELF has a very different meaning in some areas of medicine, where it is associated with a gene. A total of 12,436 documents were worked on in 12 thematic communities according to their collaborative relationships between authors and documents. Studies included authors publishing in the different thematic areas and the country where the USA stands first with more researchers in this theme than China and Japan. Documents were analyzed from the temporal perspective, their overall contribution, means of publication, and the language of the publication. Research requires extra effort and multidisciplinary collaboration to improve the knowledge, the application, and influence of these fields

This paper describes the characteristics of contributions made by researchers worldwide in the field of ELF (extremely low frequency) waves from 1957 to 2019. The data were collected through the Scopus database and processed with analytical and bibliometric techniques. The selection of the keywords is an essential step, because ELF has a very different meaning in some areas of medicine, where it is associated with a gene. A total of 12,436 documents were worked on in 12 thematic communities according to their collaborative relationships between authors and documents. Studies included authors publishing in the different thematic areas and the country where the USA stands first with more researchers in this theme than China and Japan. Documents were analyzed from the temporal perspective, their overall contribution, means of publication, and the language of the publication. Research requires extra effort and multidisciplinary collaboration to improve the knowledge, the application, and influence of these fields.

Sorafenib is a multi-kinase inhibitor and a vascular endothelial growth factor (VEGF) inhibitor approved to treat patients with advanced hepatocellular carcinoma, renal cell carcinoma and differentiated thyroid carcinoma. Its most common side effects are asthenia/fatigue, skin toxicity, diarrhea and arterial hypertension. Reported respiratory adverse reactions include dyspnea, cough, pleural effusion and hoarseness. The aim of this report is to describe for the first time the occurrence of pneumatocele in two patients treated with Sorafenib. Patients had no respiratory symptoms and alternative diagnoses were ruled out. Primary tumors were different (liver metastases from a pancreatic neuroendocrine tumor and hepatocellular carcinoma) but both patients had been treated with yttrium 90 radioembolization 9 and 17 months before starting on Sorafenib, respectively. No complications occurred and Sorafenib withdrawal was followed by radiologic improvement.

In this paper, a real-time monitoring system is presented to be used for environmental parameters measurement in tourist caves that can be employed for getting a sustainable tourism. The system allows the registration of a lot of metadata (temperature, relative humidity, wind speed and direction, CO2, atmospheric pressure, rain, presence and visitor count) and it shows them via the Internet in real time anywhere. The system reports the data registered and stored as metadata in a database online. In the ”El Soplao” Cave in the North of Spain, this system, permits a high level of control and security of the influence of visitors on a day to day and the temporal evolution to medium and long term. These measurements allow developing a sustainable and profitable system where heritage management and tourism exploitation acquire a subordinate commitment to the welfare of the natural asset (Cave-Mine “El Soplao”); the alteration of the fragile microclimate inside the cave can damage or destroy the specific geologic formations that make the touristic cave. After the visits, the company managing the cave takes in charge monitoring the environmental parameters of the cave to regulate future visits. The temperature in the cave has ranges between 11 and 13.5 °C, a seasonal quasi-periodic maximum variation of ± 0.5 °C and depending on the temperature outside the cave and number of visitors; it is difficult to associate one with another because both happen in the same month. The relative humidity is around 70–95%, it has no correlation with the number of visitors accessing the cavity. The CO2 concentration in air is around 400–1000 ppm; it has a clear correlation with the number of visitors and cave area (the deepest present's higher level CO2). In conclusion, a cave is visited as long as its microclimate is maintained, thus the real-time system developed has been conceptualized for monitoring over time the relationship between the cave environment and a sustainable tourism. Monitoring can help to preserve the specific geologic formation and therefore to keep the touristic interest of the cave.

Deception Island (South Shetland Islands) is one of the most active volcanoes in Antarctica. In the 1988–1989 austral summer, after the most recent eruptive process on the island (1967–1970), monitoring of volcanic activity through geophysical and geodetic techniques was resumed by Spanish and Argentinean scientists. In order to monitor the island's tectonic and volcanic behavior, a geodetic network was deployed. Currently, this network consists of 15 geodetic benchmarks located around Port Foster, Deception's inner bay open to the sea. Two additional geodetic benchmarks were installed outside Deception Island to be used as reference benchmarks for the differential positioning strategy. Since 1991–1992, geodetic ground-displacement velocities between the successive austral summer Antarctic campaigns have been computed and analyzed. The overall geodynamic behavior of Deception Island within the South Shetland Islands, Antarctic Peninsula and Bransfield Basin regional environment has been analyzed from geodetic ground-displacements. Results obtained demonstrate that Deception and Livingston island have a similar behavior derived from the Bransfield Basin extension and the Phoenix micro-plate subsidence processes. However, Deception Island is also highly influenced by its volcanic activity. Deception Island's volcanic behavior between 1991 and 2018 is shown by the velocity field, strain tensors and pressure source evolution obtained from the ground-displacements at the geodetic benchmarks. During this time period, it is possible to identify different inflation and deflation phases separated by transitional (or mixed) stages of extension without uplift and compression without subsidence. The most representative inflation and deflation periods were analyzed in detail, to show how they correlate with high and low seismic activity, respectively. The transitional or mixed stages, seem to be the precursors of the next inflation or deflation phase being the Bransfield basin rifting and NW-SE extension the potential related process. Finally, we have analyzed the processes that occurred prior to the volcanic unrests of 1999–2000 and 2012–2013. In both cases, an increase in detected seismic activity and/or soil and seawater temperature was observed and a mixed phase of extension without uplift seems to be precursory to the volcanic unrest. The correlation between the inflation processes, identified by ground-displacement of the network geodetic benchmarks, the increase in seismicity and the increment of soil and seawater temperature makes these transitional mixed phases potential precursors of Deception Island's volcanic unrest periods. © 2019 Elsevier B.V.

The implantation of the Implantable Cardioverter Defibrillator (ICD) influences the psychological adjustment and the degree of subjective discomfort. The objective of this work was to analyze differences in psychological adjustment, fear of shocks and the degree of subjective discomfort derived from the illness depending on the reasons for implantation (primary vs secondary).A sample of 82 patients with an ICD, for primary (58.5%) or secondary (41.5%) prevention indications was studied. A sociodemographic and clinical questionnaire and List of Brief Symptoms (LBS-50) was used. Descriptive univariate and bivariate analysis, t-tests on mean differences for independent samples and z-tests on proportion differences were performed.Regarding psychological adjustment, 43.9% of the patients reported to have sleeping disorder, regardless the type of prevention. A greater percentage of patients of primary prevention had scored higher in clinical scales. The 29.4% of patients with secondary prevention reported to be afraid of experiencing some shock. The 25% of patients whose type of prevention was primary showed severe or moderate level of subjective discomfort derived from the illness compared with the 14.7% of the secondary prevention patients (p=0.7).The patients with an ICD show symptoms clinically significant in Psychoactivity, Obsession-Compulsion, Anxiety, Somatization, Sleeping disorders and Psychopathology Risk Index. Both groups, regardless the type of prevention showed a similar psychological adjustment. Regarding the fear of shocks and the degree of subjective discomfort derived from the illness, no statistically significant differences between the groups were found.La implantación del Desfibrilador Automático Implantado (DAI) influye en el ajuste psicológico y en el grado de malestar de los pacientes. El objetivo de este trabajo fue analizar las diferencias en el ajuste psicológico, el miedo a las descargas y el grado de malestar subjetivo derivado de la enfermedad en función del motivo de implantación (primaria frente a secundaria).La muestra fue de 82 pacientes portadores de un DAI, tanto por prevención primaria (58,5%) como secundaria (41,5%). Se utilizó un cuestionario sociodemográfico y clínico, así como el Listado de Síntomas Breves (LSB–50). Se realizaron análisis descriptivos univariados y bivariados, pruebas t de diferencias entre medias y pruebas z de diferencias entre proporciones.Respecto al ajuste psicológico, el 43,9% de los pacientes refirió tener alteraciones del sueño, independientemente del tipo de prevención. Un mayor porcentaje de pacientes de prevención primaria mostraron puntuaciones altas en escalas clínicas. El 29,4% de los pacientes de prevención secundaria mostró miedo a sufrir alguna descarga. El 25% de los pacientes cuyo motivo de implantación fue primario indicó un nivel moderado o intenso en cuanto al malestar subjetivo derivado de la enfermedad, comparado con el 14,7% de los pacientes de prevención secundaria (p=0,7).Los pacientes con DAI presentan síntomas clínicamente relevantes en Psicoreactividad, Obsesión-compulsión, Ansiedad, Somatización, Alteraciones del sueño y el Índice de riesgo psicopatológico. Independientemente del tipo de prevención ambos grupos muestran un ajuste psicológico similar. No se encuentran diferencias entre los grupos ni en el miedo a las descargas ni en el grado de malestar subjetivo.