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Menopause is a biological stage associated with increased cardiovascular morbidity and mortality due to changes in sex hormone levels.This systematic review aimed to investigate the benefits and harms of RT in menopausal and postmenopausal women.We searched PubMed, Embase, CENTRAL, Scopus, and Web of Science from inception to 2021, and clinical trial registries. Randomized controlled trials (RCT) in menopausal and postmenopausal women that compared women undergoing RT programs with a control group were included. The primary outcomes were C-reactive protein level and adverse events; and, the secondary outcomes were lipid profile and waist circumference. Two reviewers independently selected the studies, extracted data, and assessed the completeness of RT programs, risk of bias, and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). A random-effects model was used. Statistical significance was set at P0.05.Twelve RCTs published from 2012 to 2020 met the inclusion criteria (n = 482). Four follow-up periods were assessed. RT caused reductions in C-reactive protein levels compared to those in the control group in postmenopausal women in the short- to long-term follow-up (mean difference, -0.47 mg/dL; 95% confidence interval, -0.66 to -0.29; P0.00001). Furthermore, RT may reduce C-reactive protein levels even at moderate and moderate-to-high intensity ( P0.0001 and P = 0.0005, respectively). Similar findings were found for lipid profiles in the short- to long-term follow-up ( P0.05). RT may have had little to no effect on waist circumference. The certainty of the body of evidence was assessed as very low and downgraded owing to serious study limitations, inconsistency, imprecision, and publication bias.There was very low-quality evidence supporting the benefits of RT compared with control for C-reactive protein levels and lipid profile. No benefits were found for the outcome of waist circumference in postmenopausal women with different comorbidities or risk factors. Safety data were scarce. We have little confidence in the results, and the true effect is likely to be substantially different. Further well-conducted and well-reported RCTs are warranted to strengthen the evidence.PROSPERO CRD42020213125.

The ankle plays a key role in balance, but ankle range of motion decreases with ageing.To establish whether a talus mobilization-based manual therapy intervention may be effective for increasing range of motion and balance in older adults with limited ankle mobility due to the ageing process.Randomized clinical trial in which 42 community-dwelling older adults with limited ankle mobility were allocated to an experimental or a control group. The experimental intervention consisted of six sessions of anteroposterior talus mobilization, whereas the control intervention was a sham treatment. Baseline change in weight and non-weight bearing ankle range of motion (ROM), balance outcome in terms of the Timed up and go (mobility and dynamic balance), Single-leg stand (static balance and stability), Functional reach (margins of stability) and Romberg tests (static balance) were assessed. Analysis of variance based on a mixed-linear model of repeated measures looked for group interactions.Forty participants completed the study. Participants who received six sessions of manual therapy showed greater improvements in the Timed up and go, Functional reach and Single-leg stand tests than participants who received a sham intervention (p 0.001). Both groups presented similar performance in post-treatment static balance measures (p 0.05).An anteroposterior talus mobilization-based manual therapy intervention is effective for increasing ankle ROM, with a positive effect on dynamic balance, mobility and stability in community-dwelling older adults with limited ankle mobility.

Objective To determine the effectiveness of mechanical diagnosis and therapy (MDT) in patients with chronic low back pain (CLBP) compared to other traditional physical therapy interventions. Methods Randomized controlled trials investigating the effect of MDT compared to other traditional physical therapy interventions in individuals with CLBP were considered eligible. For the purpose of this review, MDT was compared to active and passive physical therapy interventions. Independent reviewers assessed the eligibility of studies, extracted data, and assessed the risk of bias. The primary outcomes investigated were pain and disability. Results Fourteen studies were included in the review. Of these, 11 provided data to be included in the meta-analyses. Our findings showed that MDT was no more effective in decreasing pain (standardized mean difference [SMD] = 0.01, 95% confidence interval [CI]: −0.44, 0.46) and disability (SMD = 0.08, 95% CI: −0.53, 0.68) than other active treatments. Similar results were found when comparing MDT to other passive treatments for pain (SMD = −0.39, 95% CI: −0.90, 0.11) and disability (SMD = −0.13, 95% CI: −0.29, 0.03). Conclusion There is low to moderate quality evidence that MDT is not superior than other traditional physical therapy interventions in improving pain and disability in people with CLBP.

Background Loss of knee extensor strength in individuals with knee osteoarthritis (KOA) may induce inter-limb strength asymmetries and alter functionality. The aims were to analyse whether the condition of the uninvolved knee (advanced to severe KOA or no affection) may induce different degrees of knee extensor strength asymmetry in individuals with KOA and to study whether functionality may differ in cases of unilateral or bilateral KOA. Methods Sixty-eight subjects with advance-to-severe KOA were categorized into two groups (unilateral or bilateral KOA). The knee extensor strength ratio (KESR), and self-reported and performance-based functionality were analysed and compared. Sex and age were independent factors. One- and two-way analysis of variance assessed for significant between-group differences (95% confidence interval (CI)). Results Participants with unilateral KOA presented with 20% knee extensor strength asymmetry. The mean difference with the bilateral KOA group in terms of Knee Extensors Strength Ratio was 0.2 (95% CI 0–0.3; P = 0.021), of the Oxford Knee Scale score was 4.2 (95% CI 3.4–5.1; P = 0.037), and of the Timed Up and Go was 1.3 s (95% CI 0.5–2.2; P > 0.05). There were significant sex and age interactions (P Conclusions Individuals with unilateral or bilateral KOA present with different degrees of knee extensor strength asymmetry. The non-affected knee seems to help to better develop functional tasks in cases of unilateral condition. The findings may help the design of tailored strengthening interventions in which each knee condition in individuals with KOA should be considered.

The intracellular pathogens of the genus Brucella are phylogenetically close to Ochrobac-trum, a diverse group of free-living bacteria with a few species occasionally infecting medically compromised patients. A group of taxonomists recently included all Ochrobactrum organisms in the genus Brucella based on global genome analyses and alleged equivalences with genera such as Mycobacterium. Here, we demonstrate that such equivalencies are incorrect because they overlook the complexities of pathogenicity. By summarizing Brucella and Ochrobactrum divergences in lifestyle, structure, physiology, population, closed versus open pangenomes, genomic traits, and pathogenicity, we show that when they are adequately understood, they are highly relevant in taxonomy and not unidimensional quantitative characters. Thus, the Ochrobactrum and Brucella differences are not limited to their assignments to different “risk-groups”, a biologically (and hence, taxonomically) oversimplified description that, moreover, does not support ignoring the nomen periculosum rule, as proposed. Since the epidemiology, prophylaxis, diagnosis, and treatment are thoroughly unrelated, merging free-living Ochrobactrum organisms with highly pathogenic Brucella organisms brings evi-dent risks for veterinarians, medical doctors, and public health authorities who confront brucellosis, a significant zoonosis worldwide. Therefore, from taxonomical and practical standpoints, the Brucella and Ochrobactrum genera must be maintained apart. Consequently, we urge researchers, culture collections, and databases to keep their canonical nomenclature. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

This is a retrospective cohort study based on data from five nursing homes which aims to appraise how physical and cognitive characteristics of nursing home residents were associated with the use of restraints, and to provide information on their prevalence in Spain. The goal was to assess, in a visual way, the possible interactions between the nursing homes residents’ characteristics and their association with the use of restraints. Motivation, risk factors, characteristics of the residents analysed by validated rating systems that assess mobility, level of dependence, cognitive condition and nutritional status, and their association with the use of restraints, were described by means of linear and non-linear multivariate approaches in the form of self-organised maps. Findings showed that the prevalence of restraints was high when compared to other developed countries. The visual analysis reinforced the knowledge that a greater impairment was associated with the use of restraints and vice versa. However, the residents’ characteristics were not always associated with the use of restraints. Subjective factors seem to play a relevant role in decision-making, so it is important to assess risk factors continuously and determine the actual need for the use of restraints from an individual perspective by basing the criteria on specific objectives, and on consistent, reproducible and reliable methods. Initiatives to minimise these subjective factors should be promoted. Likewise, a clear definition of physical restraints should be offered at each centre. In addition, effective legislation that clearly states the need, alternatives and motivation for the use of restraints is needed.

Background: Balance limitations and foot and ankle problems are common in older adults. Objective: To determine the impact of augmented balance training with foot and ankle mobilizations (FAMs) on ...

Bovine brucellosis induces abortion in cows, produces important economic losses, and causes a widely distributed zoonosis. Its eradication was achieved in several countries after sustained vaccination with the live attenuated Brucella abortus S19 vaccine, in combination with the slaughtering of serologically positive animals. S19 induces antibodies against the smooth lipopolysaccharide (S-LPS), making difficult the differentiation of infected from vaccinated bovines. We developed an S19 strain constitutively expressing the green fluorescent protein (S19-GFP) coded in chromosome II. The S19-GFP displays similar biological characteristics and immunogenic and protective efficacies in mice to the parental S19 strain. S19-GFP can be distinguished from S19 and B. abortus field strains by fluorescence and multiplex PCR. Twenty-five heifers were vaccinated withS19-GFP (5×10 CFU) by the subcutaneous or conjunctival routes and some boosted with GFP seven weeks thereafter. Immunized animals were followed up for over three years and tested for anti-S-LPS antibodies by both the Rose Bengal test and a competitive ELISA. Anti-GFP antibodies were detected by an indirect ELISA and Western blotting. In most cases, anti-S-LPS antibodies preceded for several weeks those against GFP. The anti-GFP antibody response was higher in the GFP boosted than in the non-boosted animals. In all cases, the anti-GFP antibodies persisted longer, or at least as long, as those against S-LPS. The drawbacks and potential advantages of using the S19-GFP vaccine for identifying vaccinated animals in infected environments are discussed., This work was partially supported by the FES-CONARE of Costa Rica (www.conare.ac.cr), projects UNA 0009-12, 0248-13, 0504-13, 0505-13 from Universidad Nacional (www.investigacion.una.ac.cr). Grant 803-C0-456, 803-B3-761 Red Temática de brucelosis, Vicerrectoría de Investigación of the University of Costa Rica (www.vinv.ucr.ac.cr). Grant B8762 from Espacio Estudios Avanzados (UCREA) from the University of Costa Rica (www.ucrea.ucr.ac.cr). Bilateral cooperation CSIC-CRUSA Foundation (ref. 2010CR0005)(www.crusa.cr); grants from the Spanish Minister of Economy and Competitiveness (MINECO refs. AGL2010-20247, AGL2011-30453-C04-00, AGL2014-58795-C4-2-R and RTC-2015-3618-1). Fellowship support for The doctoral contract of Ana Zabalza was funded by Public University of Navarra, and the postdoctoral contract of Beatriz San Román was funded by JAE-DOC program of CSIC co-funded by European Social Fund (FSE, European Commission) and MINECO (AGL2011-30453-C04-00) of Spain (www.mineco.gob.es). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Background and purpose Ankle function declines with age. The objective of this study was to investigate the association between ankle function and balance in older adults, with a focus on range of motion (ROM) and strength. Methods This was a cross-sectional study that included 88 healthy community-dwelling older adults. Ankle mobility was measured while bearing weight (lunge test) and not bearing weight. The plantar-flexor muscle strength was assessed using a hand-held dynamometer. Balance was measured in terms of dynamic balance and mobility (timed up and go test), monopodal and bipodal static balance with open and closed eyes (single-leg stand test and platform measures), and margins of stability (functional reach test). Linear correlation and multiple regression analyses were conducted with a 95% CI. Results and discussion Most participants had limited ankle mobility (n = 75, 86%). Weight-bearing ankle dorsiflexion ROM was the strongest predictor of dynamic balance and included general mobility and stability (Radj2 = [0.34]; β = [-0.50]). In contrast, plantar-flexor muscle strength was a significant predictor of static standing balance with open eyes (Radj2 = [0.16–0.2]; β = [0.29–0.34]). Overall, weight-bearing ankle dorsiflexion ROM was a more representative measure of balance and functional performance; however, a non-weight-bearing mobility assessment provides complementary information. Therefore, both measures can be used in clinical practice. Conclusion This study supports the concept that ankle mobility contributes to the performance of dynamic tasks, while the plantar-flexor muscle strength helps to develop a standing static balance. Identification of alterations in ankle function is warranted and may assist in the design of tailored interventions. These interventions can be used in isolation or to augment conventional balance training in order to improve balance performance in community-dwelling older adults.

Background Altered muscle activation patterns and proprioception, loss of strength, and weight bearing asymmetries are common limitations after total knee arthroplasty, which can also affect balance. Therefore, preoperative sensorimotor training has been proposed to enhance surgical outcome. Research question Is preoperative sensorimotor training effective in improving functional outcome in patients undergoing total knee arthroplasty? Does preoperative sensorimotor training affect secondary outcomes such as balance, pain, and quality of life? Methods A systematic review and meta-analysis were conducted by searching PEDro, MEDLINE, Embase, Cochrane Library, and Scopus databases from inception to May 2020. Studies were eligible if participants underwent total knee arthroplasty after two or more weeks of preoperative sensorimotor training. A meta-analysis compared the effects of such interventions with standard care before and after surgery using standardized mean differences (SMD) with 95 % confidence interval (CI). Functional outcome was the primary measure. Balance, pain, and quality of life were also outcomes of interest. Results Of the 384 items identified, 7 met the inclusion criteria, and 332 participants were assessed. There was limited evidence suggesting that preoperative sensorimotor training enhanced self-reported function (SMD, 0.89; 95 % CI, 0.16–1.62), functional performance (SMD, 0.56; 95 % CI, 0.19 to 0.93), or knee function (SMD = 0.22–1.05) compared with conventional care. Moderate quality evidence suggested that benefits were only maintained in terms of functional performance up to 3 months after surgery (SMD = 0.37; 95 % CI, 0.13 to 0.62). The outcome was similar after one year. Significance Compared with conventional care, preoperative sensorimotor training may enhance early postoperative functional recovery, with no additional benefits on balance, knee function, or pain. The outcome is the same one year after surgery, regardless of whether such training is implemented. Further investigation is needed to determine whether sensorimotor training may be a feasible conservative treatment for severe knee osteoarthritis.

El objetivo principal del proyecto ha sido el uso de metodologías de enseñanza activa para crear conciencia sobre la importancia de la higiene de manos en la atención médica. Metodología: El proyecto de innovación docente ha puesto en práctica el aprendizaje compartido de conocimientos y habilidades entre iguales. 11 estudiantes de Grado de Enfermería, con un trabajo cooperativo e individual previo, participan en un proceso de enseñanza-aprendizaje sobre higiene de manos con 82 estudiantes de Grado de Fisioterapia, utilizando Tics, talleres sobre desinfección de manos con autoevaluación, evaluación de conocimiento previo y posterior y evaluación de La satisfacción con la actividad. Resultados: La evaluación de los cuestionarios previos y posteriores revela un aumento en la cantidad de respuestas correctas. El 98.8% de los estudiantes considera que podrán aplicar los conocimientos adquiridos en su práctica profesional. La metodología aplicada se considera adecuada en un 95.1%. Los estudiantes han mostrado una gran satisfacción con la actividad. Conclusiones: los estudiantes de fisioterapia han considerado que la experiencia es muy satisfactoria y útil para la práctica profesional. El uso de la metodología de enseñanza-aprendizaje ha demostrado ser una opción válida para adquirir conocimientos y habilidades sobre higiene de manos.

Brucellosis is a worldwide zoonosis causing important economic loss and a public health problem. Small ruminants are the preferred hosts of Brucella melitensis and thus the main source of human infections. Effective control of sheep and goat brucellosis has been achieved in several countries through vaccination with the live‐attenuated B. melitensis Rev1 vaccine. However, Rev1 induces a long‐lasting serological response that hinders the differentiation between infected and vaccinated animals. A Rev1::gfp strain expressing constitutively the Green Fluorescent Protein (GFP) was built by stable insertion of a mini‐Tn7‐gfp in the glmS‐recG non‐codifying chromosomal region. An associated indirect ELISA‐GFP was developed to identify anti‐GFP antibodies in vaccinated animals. The resulting Rev1::gfp kept the biological properties of the Rev1 reference strain, including residual virulence and efficacy in mice, and was readily distinguished from Rev1 and other Brucella field strains by direct visualization under ultraviolet illumination, fluorescence microscopy and a multiplex PCR‐GFP. The Rev1::gfp strain did not elicit anti‐GFP antibodies itself in lambs but when applied in combination with recombinant GFP induced an intense and long‐lasting (>9 months) anti‐GFP serological response readily detectable by the ELISA‐GFP. Overall, our results confirm that Rev1 GFP‐tagging can be a suitable alternative for identifying vaccinated sheep in infected contexts., Secretaría de Estado de Investigación,Desarrollo e Innovación, Grant/AwardNumber: AGL2011-30453-C04-01,AGL2014-58795-C04, RTC-2015-3618-1;CSIC-CRUSA Foundation bilateral project,Grant/Award Number: 2010CR0005

Epidemiological studies on pressure ulcers (PUs) in hospitalised infants are scarce. Spain lacks comprehensive research studies providing data on the prevalence or incidence in this population. This work was developed to determine the incidence of PUs in hospitalised infants admitted to intensive and intermediate care units, along with relevant risk factors and preventive measures. A prospective study appraising the incidence of PUs in infants was performed. The risk factors and preventive measures were evaluated using a multivariate logistic regression model. A sample of 268 infants was included. The cumulative incidence of PUs was 12.70% (95% confidence interval, CI(95%) = [8.95%‐17.28%]). The cumulative incidence in the intermediate care units was 1.90% (CI(95%) = [0.39%‐5.45%]), while it was 28.18% (CI(95%) = [20.02%‐37.56%]) in the intensive care units. The PUs were categorised as stage I, 57.10%; stage II, 31.70%; and stage III, 11.10%. The multivariate analysis found the following to be risk factors: low scores in the Spanish version of the Neonatal Skin Risk Assessment Scale (e‐NSRAS) (Relative Risk (RR) 0.80; CI(95%) = [0.66‐0.97]), the use of non‐invasive mechanical ventilation (RR 12.24; CI(95%) = [4.02‐37.32]), and the length of stay (RR 1.08; CI(95%) = [1.02‐1.15]), suggesting a direct impact of these factors on PU development in infants. Kangaroo care influenced the prevention of PUs (RR 0.26; CI(95%) = [0.09‐0.71]). The infants admitted in intermediate care units suffered PUs. In the case of intensive care units, the incidence is even higher. The risk increases with the length of stay, while the presence of medical devices, particularly non‐invasive mechanical ventilation, is the main causal relationship. Kangaroo care has been shown to be an important preventive measure.

Exercising with the Pilates method may be a beneficial treatment to improve balance and decrease the number of falls. To ascertain this, our search in 7 databases included 15 randomized controlled trials in which Pilates was the primary intervention. Participants were over 60 years of age; the outcomes were related to balance and falls. The Cochrane tool and PEDro scale were used to assess risk of bias and quality of individual studies. Current evidence supported the view that exercising with the Pilates method improves the balance of older adults with a high practical effect in terms of the dynamic (SMD = 0.75 [0.17;1.32]), static (SMD = 1.33 [0.53;2.13]), and overall balance (SMD = 0.96[0.00;1.91]). Pilates also produced greater improvements with a moderate effect in terms of the dynamic (SMD = 0.37[-0.36;1.11]) and overall balance (SMD = 0.58[0.19;0.96]) compared to other training approaches oriented to the same end. Literature evaluating the effects on falls is scarce, and results were not conclusive.

Background:More than one billion of peripheral venous catheters are inserted into hospitalized patients every year. This study sought to identify the status of nursing care in vascular accesses in different hospitals and to evaluate the impact of a series of informative and formative interventions aimed at their care.Methods:Quasi-experimental, multicenter study. A total of 54 nursing professionals of 19 hospitals participated. The intervention consisted of informative talk and three training sessions related to the care and maintenance of vascular accesses and intravenous therapy in the hospital-admitted adult population. This was delivered in four years, with eight periodic cross-sectional assessments conducted before and after each intervention. To assess quality of nursing care in vascular accesses and intravenous therapy, a quality indicator called Standard Variable (VES), was developed and validated with the Delphi methodology.Results:A total of 21,108 patients, aged 64.0 years (SD 18.3), were assessed, of which 78.3% (16,516) had some type of vascular access inserted. An average of 22.1% (95% CI: 21.4–22.7) were classified as optimal. In total, 3218 nursing care professionals took part in the training activities. The VES indicator grew steadily throughout the study, raising from 7.8% to 37.6%. Changes were statistically significant between those time points in which one of the described interventions was delivered; however, there were no significant changes between time points with no intervention.Conclusions:This study supports that continuous training interventions can produce improvements in the quality of nursing care and reduce complications in patients with vascular accesses. In addition, the VES indicator was a useful and simple tool to measure quality, but the experience with its use suggests continuous research in the search for standardized indicators that objectify the evaluation and evolution of care.

Objective: To assess the effects of preoperative balance training on the early postoperative balance and functional outcomes after total knee replacement surgery and to test whether an outpatient intervention may be as effective as a domiciliary intervention. Design: This is a three-arm randomized controlled trial. Setting: University hospital. Subjects: Eighty-six individuals were recruited. Seventy-seven were analysed, aged 72.1 (SD 7.6) years, of which 68% were women. Outcome measures: Overall state of balance, as measured with the Berg Balance Scale, and patient-perceived functionality, as measured with the Knee Injury and Osteoarthritis Outcome Score Function in Activities in Daily Living (KOOS-ADL) questionnaire, were the primary outcomes. Secondary assessments targeted knee function, balance and mobility, quality of life, and self-reported outcomes. The primary end-point was six weeks after surgery. Intervention: The hospital group implemented a four-week preoperative outpatient balance-oriented intervention. The home group implemented similar training, but this was domiciliary. The control group was instructed to keep performing their normal activities. Results: Home and hospital groups presented a moderate effect against the control group ( dhospital-control = 0.54; dhome-control = 0.63), both being similarly effective in improving the overall state of balance at six weeks after surgery ( P = 0.013). KOOS-ADL scores showed no between-group differences and a small effect size ( d < 0.5; P = 0.937). Secondary assessments suggested non-significant between-group differences. Conclusion: Preoperative balance training, conducted either as domiciliary or as an outpatient, is an effective approach to enhance early postoperative balance outcome but not the perceived functionality of individuals undergoing total knee replacement.

[EN] The objective of this proposal for educational innovation is to facilitate the learning of complex concepts and their relationship with reality, through peer-to-peer training, in where two scenarios will be shared: university and professional training. We propose an experience in which University students in the area of Electronic Technology and Health, specifically from the degrees of Industrial Electronics Engineering, Physiotherapy and Nursing, previously trained in the concepts of radiation and its types, infrared radiation, its use in health in both treatment and diagnosis, thermoregulation and thermography with the visual thinking tool, can transversally share a teaching scenario with students of professional training in the technological areas and health in particular to the Superior Technicians in Clinical Electromedicine. The execution of the project will be conducted during the month of February of 2019. This proposal of training acquired between equals will produce greater efficiency in the results, generating a better adhesion in the teaching scenarios and a posteriori in the work environment., [ES] El objetivo de esta propuesta de innovación educativa es facilitar el aprendizaje de conceptos complejos y su relación con la realidad, a través de la capacitación entre pares, en la que se compartirán dos escenarios: la universidad y la capacitación profesional. Proponemos una experiencia en la que los estudiantes universitarios en el área de Tecnología Electrónica y Salud, específicamente de los grados de Ingeniería Electrónica Industrial, Fisioterapia y Enfermería, previamente capacitados en los conceptos de radiación y sus tipos, la radiación infrarroja, su uso en la salud en ambos. El tratamiento y diagnóstico, la termorregulación y la termografía con la herramienta de pensamiento visual, pueden compartir de manera transversal un escenario de enseñanza con estudiantes de capacitación profesional en áreas tecnológicas y de salud en particular con los Técnicos Superiores en Electromedicina Clínica. La ejecución del proyecto se llevará a cabo durante el mes de febrero de 2019. Esta propuesta de formación adquirida entre iguales producirá una mayor eficiencia en los resultados, generando una mejor adhesión en los escenarios de enseñanza y posteriormente en el entorno laboral.

[EN] Introduction: Nowadays, clinical simulation could be a key link in the teaching and learning of different procedures. Methodology: It is a quasi-experimental study, using three evaluation questionnaires as a method to collect the respective information to the acquisition of competences and satisfaction of the students regarding a theoretical-practical training on pediatric and neonatal CPR for students of 2nd year Nursing the University of Valencia. To this end, 17 RCP laboratories formed by 228 students were carried out. Results: The students gave a great reception to this project, giving it a score of 8.82 (SD 0.42) out of 10. The most valued item (by the students) was that in which other students were recommended to do the Pediatric CPR laboratory with a 9.53 out of 10. Student knowledge improved in 7 of the 11 questions and worsened in 4 of them. The one that improved the most was the one referred to the intubation time. Conclusions: After the simulation, most students said that despite having lived a stressful time they would like to be able to perform more simulations to be able to better fix the theoretical knowledge., [ES] Introducción: Hoy en día, la simulación clínica podría ser un eslabón clave en la enseñanza y el aprendizaje de diferentes procedimientos. Metodología: Este es un estudio cuasi-experimental, que utiliza un cuestionario de evaluación como un método para recopilar la información sobre el respeto de la adquisición de las competencias y la satisfacción de los estudiantes. Neonatal para estudiantes del 2º año de Enfermería de la Universidad de Valencia, para ello se capacitaron en 17 laboratorios de RCP, conformados por 228 alumnos. Resultados: Los estudiantes dieron una gran acogida a este proyecto, otorgando una puntuación de 8.82 (SD 0.42) sobre 10. El elemento más valorado (por los estudiantes) fue aquel en el que se recomendó a otros estudiantes que realizarán el laboratorio de RCP pediátrica con a 9.53 de 10. El conocimiento de los estudiantes mejoró en 7 de las 11 preguntas y empeoró en 4 de ellas. El mejor resultado fue el resultado de la intubación. Conclusiones: los estudiantes en general, después de la simulación, después de que se tiene que mantener el tiempo, el poder de los aspirantes se puede realizar con más simulaciones para poder mejorar los conocimientos teóricos.

Brucellosis is a highly contagious zoonosis of significance for public health and economic performance in both endemic and non-endemic countries. Historically, brucellosis was recognised for the first time in the Mediterranean region and it is hypothesised that it subsequently spread worldwide. It is associated in humans with poor food hygiene, is transmitted by direct and indirect contact with animals and crosses international boundaries with relative ease. In resource-limited nations, brucellosis is often a very common but neglected disease. Diagnosis and control of brucellosis is still a challenge. This review focuses on the historical and current status of the disease in the 23 countries with coastlines along the Mediterranean. This work is mainly based on information collected and provided by local authorities, governmental bodies and National Reference Laboratories for Brucellosis, as well as national experts in each country. National and international studies from each country were reviewed and scientific output published in peerreviewed journals was included. Moreover, data published in local languages and not internationally available have also been included.

Background: Most human movements are executed while in a state of postural instability. For this reason, instability training is a highly-specific method that is intended to improve balance and postural control. This research aimed to determine the effect of instability training on the balance of individuals with similar baseline abilities, who initiated training within different stability conditions. Research question: Does the level of difficulty with which instability training is performed determine improvements in balance? Method: A two-arm randomized trial was undertaken, for which 22 and 21 participants were included in the experimental and control groups, respectively. The experimental group performed balance training on unstable surfaces and the control group implemented the same training on stable ground. The primary outcome was the Y-Balance Test (YBT); the Emery test, Functional Reach test, and platform measures were the secondary outcomes. Confidence intervals were set at 95% and Cohen's f statistic was used to estimate effect size. Results: Dynamic balance, as measured by the YBT, showed significant Time improvements in both groups for right (p < 0.001, f = 0.53) and left (p = 0.005, f =0.33) limbs. Similar results were found in the Emery test and Functional Reach test. No statistical Group and Time*Group interactions were found. None of the proposals modified the center of pressure excursions. Significance: Instability training is a safe and effective approach to enhance balance. However, the findings deduced that the level of difficulty (instability) with which participants with similar abilities initiate the training is not a determining factor in the balance improvements achieved. It follows that instability training may be either used as an alternative or as an additional method to train for balance on a stable ground.

Members of the genus Brucella cluster in two phylogenetic groups: classical and non-classical species. The former group is composed of Brucella species that cause disease in mammals, including humans. A Brucella species, labeled as Brucella sp. BCCN84.3, was isolated from the testes of a Saint Bernard dog suffering orchiepididymitis, in Costa Rica. Following standard microbiological methods, the bacterium was first defined as “Brucella melitensis biovar 2.” Further molecular typing, identified the strain as an atypical “Brucella suis.” Distinctive Brucella sp. BCCN84.3 markers, absent in other Brucella species and strains, were revealed by fatty acid methyl ester analysis, high resolution melting PCR and omp25 and omp2a/omp2b gene diversity. Analysis of multiple loci variable number of tandem repeats and whole genome sequencing demonstrated that this isolate was different from the currently described Brucella species. The smooth Brucella sp. BCCN84.3 clusters together with the classical Brucella clade and displays all the genes required for virulence. Brucella sp. BCCN84.3 is a species nova taxonomical entity displaying pathogenicity; therefore, relevant for differential diagnoses in the context of brucellosis. Considering the debate on the Brucella species concept, there is a need to describe the extant taxonomical entities of these pathogens in order to understand the dispersion and evolution. Los miembros del género Brucella se agrupan en dos grupos filogenéticos: el clásico y el especies no clásicas. El primer grupo está compuesto por especies de Brucella que causan enfermedad en los mamíferos, incluyendo a los humanos. Una especie de Brucella, etiquetada como Brucella sp. BCCN84.3, fue aislado de los testículos de un perro de San Bernardo que sufría orquiepididimitis, en Costa Rica. Siguiendo los métodos microbiológicos estándar, la La bacteria fue definida por primera vez como "Brucella melitensis biovar 2". Más tipificación molecular, identificó la cepa como una "Brucella suis" atípica. Distintivo Brucella sp. BCCN84.3 los marcadores, ausentes en otras especies y cepas de Brucella, fueron revelados por el ácido graso análisis de éster de metilo, PCR de fusión de alta resolución y gen omp25 y omp2a/omp2b diversidad. Análisis de múltiples loci número variable de repeticiones en tándem y genoma completo La secuenciación demostró que este aislado era diferente del actualmente descrito La especie Brucella. La suave Brucella sp. BCCN84.3 se agrupa junto con la clásica Brucella clona y muestra todos los genes necesarios para la virulencia. Brucella sp. BCCN84.3 es una entidad taxonómica de la especie nova que muestra patogenicidad; por lo tanto, relevante para diagnósticos diferenciales en el contexto de la brucelosis. Considerando el debate sobre la Brucella concepto de especie, es necesario describir las entidades taxonómicas existentes de estas patógenos para entender la dispersión y la evolución. Universidad Nacional, Costa Rica Escuela de Medicina Veterinaria

Background and objective One of the main causes of emergency medical consultations done by children are musculoskeletal injures. In such cases, radiological tests are a common practice to diagnose the gravity of the trauma and determine the likely existence of a fracture. In order to avoid, or at least to reduce, the use of ionizing radiations with children, the infrared thermographic technique was studied as an alternative solution, since it is a non-harmful, non-invasive and non-contact technique, without excessive technical complications and moderate cost when compared to other types of imaging tools. Methodology When an infrared thermographic diagnostic test is performed, and once the pictures of the studied limb are taken accordingly to the established methodology, an imaging post-processing protocol becomes necessary to make a correct interpretation and diagnosis. Aimed at performing the analysis in situ and in real time, in this work we present a software tool based on a Matlab interface. The software programming is based on the results obtained in clinical tests, where several variables were took into consideration. The program is able to determine the probability of fracture basing the diagnosis on a non-linear cataloguing approach, using decision trees. Results The tool implemented allows to diagnose musculoskeletal injures in children shortly after taking the infrared thermographic picture. Conclusions The diagnosis tool provides the means for the interpretation of the IT pictures, allows to obtain a diagnosis in a fast way, and may help to decrease the radiation doses in children.

Las fuentes de información son una herramienta clave en la evolución social y tecnológica actual. Si bien es cierto que no todos son beneficios. Del mismo modo, la sobreinformación es evidente y puede conducir a la extracción de conclusiones que, en muchos casos, se vuelven confusas, difusas o incluso erróneas. En este contexto, el uso de la pirámide 6S puede ayudar a encontrar la mejor evidencia de investigación con la menor cantidad de tiempo y esfuerzo. Esta propuesta de trabajo expone los métodos y el desarrollo de un programa de apoyo y capacitación para la búsqueda en la salud. Para hacerlo, los recursos de aprendizaje se han convertido a través de un servidor de acceso libre, del Centro Nacional de Servicios y Herramientas (NCCMT) de la Universidad McMaster.Más tarde, se realizó la evaluación de las competencias.

Aim The primary goal of this study was to estimate the prevalence of pressure ulcers in the paediatric population cared for in primary health care. Materials The data of this epidemiological study were extracted from the records of the 24 departments that attended to an approximate population of 1 million inhabitants between 0 and 18 years old from 2012 to 2015. The study included children requiring assistance to reduce pressure ulcer incidence. The paediatric population was categorised into neonates and infants (0–2 years), young child (3–6 years), child (7–12 years) and adolescents (13–18 years). The primary outcome was information on the prevalence of pressure ulcers. Secondary outcomes were classification of ulcers in terms of location and category. Other outcomes included the total number of consultations owing to pressure ulcers. Results The sample included 65,359 children who attended 813 centres of primary health care. The prevalence of pressure ulcers was 1.72%. A higher prevalence was observed in children younger than 3 years (2.89%), with children at age 1 year showing the most prevalence (4.77%). The highest number of diagnosed ulcers was located in the lower back and heels, regardless of the age range. Conclusion Overall, the prevalence of pressure ulcers in the paediatric population attended to in primary health care is low when compared to that of hospitalised and acutely ill children. The figures advise that special attention should be paid to the care of the population younger than 3 years, because this population shows the highest prevalence.

This work presents the study and simulation of a high-resolution charged particle detection device for beam positioning, monitoring and calibration, together with its read-out proposal. To provide the precise positional information of the beam, the detection system has been based on Plastic Scintillating Fibers (PSF), while the read-out on a Silicon-PhotoDiode (Si-PD) array. To carry out the study, a PSF prototype with one detection plane has been experimentally tested with a β particle source. Besides, Monte Carlo simulations of the complete system have also been conducted. Both simulations and experimental tests give consistency to the results obtained. The work presented in this article show the usefulness of this proposal for high-precision charged particle positioning, achieving resolutions up to 100 µm.

Backgound Balance and proprioceptive deficits are frequently persistent after total joint replacement, limiting functionality and involving altered movement patterns and difficulties in walking and maintaining postural control among patients. Research question The goal of this systematic review was to evaluate the short- and mid-term effects of proprioceptive and balance training for patients undergoing total knee and hip replacement. Methods This is a systematic review of literature. MEDLINE, Embase, Cochrane Library, PEDro, and Scopus were the databases searched. The review included randomized clinical trials in which the experimental groups underwent a training aimed at improving balance and proprioception, in addition to conventional care. The studies had to assess at least one of the following outcomes: self-reported functionality or balance (primary outcomes), knee function, pain, falls, or quality of life. Results Eight trials were included, involving 567 participants. The quantitative synthesis found a moderate to high significant effect of balance and proprioceptive trainings on self-reported functionality and balance after total knee replacement. The effects were maintained at mid-term in terms of balance alone. Conversely, preoperative training did not enhance outcomes after total hip arthroplasty. Significance The synthesis showed that, in clinical terms, balance trainings are a convenient complement to conventional physiotherapy care to produce an impact on balance and functionality after knee replacement. If outcomes such as improvement in pain, knee range of movement, or patient quality of life are to be promoted, it would be advisable to explore alternative proposals specifically targeting these goals. Further research is needed to confirm or discard the current evidence ultimately, predominantly in terms of the effects on the hips and those yielded by preoperative interventions.

Background and Purpose: Sensorimotor training has proven to be an efficient approach for recovering balance control following total knee replacement (TKR). The purpose of this trial was to evaluate the influence of specific balance-targeted training using a dynamometric platform on the overall state of balance in older adults undergoing TKR. Methods: This was a randomized controlled clinical trial conducted at a university hospital rehabilitation unit. Patients meeting the inclusion criteria were randomly assigned to a control group or an experimental group. Both groups participated in the same 4-week postoperative rehabilitation training protocol. Participants in the experimental group performed additional balance training with a dynamometric platform consisting of tests related to stability challenges, weight-shifting, and moving to the limits of stability. The primary outcome measure was the overall state of balance rated according to the Berg Balance Scale. Secondary outcomes in terms of balance were the Timed Up and Go Test, Functional Reach Test, and Romberg open and closed-eyes tests. Data processing included between-group analysis of covariance, minimal detectable change assessment for the primary outcome measure, and effect size estimation. Confidence intervals (CIs) were set at 95%. Results: Forty-three participants meeting the inclusion criteria and having signed the informed consent were randomly assigned to 2 groups. Thirty-seven completed the training (86.1%). Significant between-group differences in balance performance were found as measured with the Berg Balance Scale (P = .03) and Functional Reach Test (P = .04) with a CI = 95%. Significant differences were not recorded for the Timed Up and Go Test or Romberg open and closed-eyes tests (P > .05). Furthermore, Cohen's effect size resulted in a value of d = 0.97, suggesting a high practical significance of the trial. Discussion and Conclusions: According to the Berg Balance Scale and Functional Reach Test, participants with TKR who have followed a 4-week training program using a dynamometric platform improved balance performance to a higher extent than a control group training without such a device. The inclusion of this instrument in the functional training protocol may be beneficial for recovering balance following TKR.

In experimental nuclear physics, HPGe segmented detectors are used to provide high energy resolution of the gamma rays. Besides, 4pi configuration is common to get a full coverage of the interaction point and detection of all the products of the collisions. In this type of experiments, the number of electronic channels can be high (>100) and also the sampling frequency of the digitizing system (>100 Msps). This results in a high data rate per channel (> 2 Gbps) and thus a high aggregated bandwidth to process. In principle, this problem can be solved using a parallel data acquisition system where the input channels (commonly arriving through optical fibers) are read and processed accordingly to its bandwidth capacity. As a result of this limitation a high number of replicated electronics must be used that incur in high costs. However, Ethernet switch technology provides a way to compress the number of input channels taking profit of the high-performance FPGA devices presently available which can manage input link of up to 10 Gbps. So, data aggregation may increase the compactness of the processing system and reduce the number of replicated electronics. This paper presents the design of an input data mezzanine with four SNAP12 optic links receiving 38 2Gbps channels. Inside the mezzanine, 1 to 4 multiplexing aggregation is implemented reducing the 38 input channels to ten 8Gbps output lines through a FMC connector. The FMC Mezzanine can be controlled from a FMC master by SPI with an internal low cost and low power FPGA. This FPGA is seen by the FMC master as a standalone intelligent device without the need of an active slow control.

The electronics of AGATA HPGe segmented gamma ray detector faces a new challenge in the search of a bigger integration and cost reduction for the phase 2 of the experiment going beyond 45 crystals. This opportunity can be used to introduce a new architecture based on commercial standards while keeping backward compatibility with current electronics. In this sense, new FPGA devices and fast Ethernet links can be used to ease the preprocessing and control task and allowing for processor farms to distribute the processing load. At the same time, modularity should be a key feature of the design in the aim to make it upgradable in time and technology. This paper presents the design of a new preprocessing and control board that could fulfill with the experiment requirements having in mind that it should not be only a new system but also should serve as replacement of the current electronics. The design is intended to process the data coming from 3 crystals (114 channels) in the same board, with a total aggregate bandwidth of 216 Gpbs using 2 Gbps input optical fiber links in SNAP12 format and with a data readout done through Ethernet fiber optics. It is expected that, with this new system, the level of integration will raise up to 3 times while cost will scale down a 30% with respect to the current electronics.

Introduction No cases of human brucellosis caused by Brucella suis has been reported in Spain. Methods This study involved interviews with the case and his co-workers, inspection of their workplace, checking infection control measures, and typing the Brucella strain isolated in the blood culture. Results Brucella suis biovar 1 strain 1330 was isolated from a patient who worked in a waste treatment plant. Food borne transmission, contact with animals, and risk jobs were ruled out. An accidental inoculation with a contaminated needle from a research laboratory waste container was identified as the most probable mode of transmission. Conclusion There should be controls to ensure that waste containers are sealed.

Compton Cameras have been proposed as an alternative to SPECT imaging with Gamma Camera, mainly due to factors such as the electronic collimation, which allows a bigger field of view and provides further information from the acquired events if compared to devices with mechanical collimation. By contrast, this involves a higher amount of data to be processed. In medical devices this leads to waiting times that are generally higher than desirable by the health-care professionals. In this work we have assessed the reconstruction of Compton images by making use of iterative and non-iterative techniques, and also evaluated its performances as a SPECT imaging technique.

Evidence of risk of pressure ulcers in neonates pro is related to the type of bearing surface on which the neonate lays. To prevent pressure ulcers is necessary to know which of the available commercial surfaces is the most convenient. The goal of this work is to evaluate the interface and redistribution pressure of five constant low pressure devices (special surfaces for pressure management [SEMP] both static and mixed) for neonates. Next step will be the study of the properties of the new support surface with healthy subjects under clinical conditions.

ressure ulcers (PU) category I are defined by intact skin with non-blanchable erythema of a localized area, usually over a bony prominence. Although they are often underdiagnosed, they may indicate “at risk” persons. There are available different procedures to diagnose pressure ulcers category I, such as but these methods can produce a misdiagnosis. Infrared thermal imaging may be helpful to resolve his conflict. We propose a protocol to observational and prospective study for the diagnosis of PU category I using thermography. Sin financiación No data (2016) UEV

Geant4 Application for Tomography Emission (GATE) is a simulation platform based on GEANT4. It is designed to perform numerical simulations in medical imaging and radiotherapy. It is also used to simulate Emission Tomography (Positron Emission Tomography, PET and Single Photon Emission Computed Tomography, SPECT), Computed Tomography (CT) and Radiotherapy experiments. The purpose of this study is to validate a GATE model of the commercial PET/CT Siemens Biograph, the latest acquisition of the Clinical Hospital of Salamanca. The geometry of the system has been implemented in GATE, including the detector ring, the crystal blocks, the PMTs etc. Radionuclides for all measurements shall be \(^{18}\)F and a cylindrical source type twogamma (which has no attenuation). The GATE simulated results are directly compared to experimental data obtained using a number of NEMA NU-2-2007 performance protocols, including sensitivity and scatter fraction. The PET data generated using GATE can be reconstructed using STIR (Software for Tomographic Imagen Reconstruction). STIR is an open source software, written in C++, consisting of classes, functions and utilities for 3D PET image reconstruction, although it is general enough to accommodate other imaging modalities. Finally we will compare our simulated model with experimental values of the scanner they have at the hospital in Salamanca.