Necesidad y tipo de tratamiento en cirugía bucomaxilofacial durante la pandemia por COVID-19 en un servicio de urgencias odontológicas del AMBA / Need and type of treatment in maxillofacial surgery during the COVID-19 pandemic in a dental emergency department in the AMBA

Objetivo: Analizar y describir los requerimientos de atención quirúrgica bucomaxilofacial de urgencia en el Servicio de Urgencias Odontológicas y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires durante el aislamiento social preventivo y obligatorio por la pandemia de COVID-19. Materiales y métodos: Se realizó un estudio observacional descriptivo de análisis retrospectivo durante el período de aislamiento social preventivo y obligatorio inicial de 93 días, comprendido entre el 20 de marzo y el 20 de junio de 2020. Se evaluó la totalidad de historias clínicas de los pacientes que acudieron al Servicio de Urgencias Odontológicas y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires y se caracterizó a aquellos que requerían distintos tipos de tratamiento quirúrgico bucal y maxilofacial. Resultados: Durante el período estudiado, se atendieron 4564 pacientes, de los cuales 1337 (29,3%) requirieron tratamientos quirúrgicos como terapéutica para la resolución de la urgencia. De estos, el 93,2% fueron exodoncias de piezas erupcionadas o retenidas; el 1,7%, biopsias quirúrgicas; el 2,4%, tratamientos agudos de infecciones que involucran espacios anatómicos vecinos; el 0,8%, resolución de traumatismos en los maxilares, y el 1,9%, tratamientos de complicaciones posquirúrgicas. Conclusión: Los resultados ponen de relieve la necesidad de disponer de servicios de guardia odontológica en el ámbito del AMBA que cuenten con recursos humanos calificados y entrenados para resolver urgencias de tipo quirúrgico

Aim: The objective of this study was to analyze and describe the requirements for the emergency care of oral and maxillofacial surgical treatment in the emergency dental department of the School of Dentistry of the University of Buenos Aires during the Preventive and Mandatory Social Isolation. Materials and methods: We conducted a retrospective analysis of a descriptive observational study during the initial period of 93 days of Preventive and Compulsory Social Isolation, from March 20, 2020 to June 20, 2020. All the medical records of the patients who attended the emergency dental department of the School of Dentistry of the University of Buenos Aires were evaluated and those who required different types of oral and maxillofacial surgical treatment were characterized. Results: A total of 4564 patients were attended during the period studied, of which 1337 (29.3%) required surgical treatment as a therapy for the resolution of their emergencies. Of these, 93.2% were exodontia of erupted or retained teeth, 1.7% surgical biopsies, 2.4% acute treatment of infections involving neighboring anatomical spaces, 0.8% resolution of maxillary alveolar trauma and 1.9% treatment of post-surgical complications. Conclusion: The results highlight the need to have dental emergency services in the AMBA area that have qualified and trained human resources to solve the surgical type emergencies that may arise (AU)

[Spanish tools of cognitive and behavior assessment of alzheimer´s disease in severe state.] / Escalas de valoración cognitiva y conductual en español para la demencia severa.

BACKGROUND: There are different scales in Spanish for cognitive and behavioral assessment of patients with severe dementia. The objective of this study was to select those scales that are more accessible, useful and with better psychometric properties, both for clinical practice and for research. METHODS: Literature review, by experts in the field, of scales of cognitive and behavioral assessment in dementia in the main scientific databases. Published in Spanish or English, excluding those not validated in Spanish. RESULTS: 11 bibliographical references were selected. Cognitive scales: Severe Impairment Battery was the one with the most cognitive areas, its abbreviated version (SIB-s) had the best internal consistency (α=0.96), Baylor Profound Mental Status Examination had very good psychometric properties with 0.99 reliability and excellent concurrent validity with Mini-Mental State Examination (r=-0.91). Severe Cognitive Impairment Profile was the only one that allowed establishing subgroups of cognitive impairment. Behavioral scales: Neuropsychiatric Inventory was the gold standard in dementias, but there was only one specific scale for severe Alzheimer's disease, the Baylor Profound Mental Status Examination behavioral subscale. CONCLUSIONS: In Spanish severe dementia, Severe Cognitive Impairment Profile and the Neuropsychiatric Inventory are the gold standard tool for cognitive assessment for research studies, and the Baylor Profound Mental Status Examination is the most useful for daily clinical practice.

OBJETIVO: Existen diferentes escalas en español para la valoración cognitiva y conductual de los pacientes con demencia severa. El objetivo de este estudio fue seleccionar aquellas escalas más accesibles, útiles y con mejores propiedades psicométricas, tanto para la práctica clínica como para fines investigadores. METODOS: Se realizó una revisión bibliográfica, por expertos en la materia, de escalas de valoración cognitiva y conductual sobre demencia en las principales bases de datos científicas. Debían estar publicadas en español o inglés, excluyendo aquellas no validadas al español. RESULTADOS: Se seleccionaron 11 referencias bibliográficas. En cuanto a escalas cognitivas: la Severe Impairment Battery era la que más áreas cognitivas en-globaba; su versión abreviada (SIB-s) presentaba la mejor consistencia interna (α=0,96); el Baylor Profound Mental Status Examination presentaba muy buenas propiedades psicométricas, con fiabilidad 0,99 y excelente validez concurrente con el Mini-Mental State Examination (r=-0,91); el Severe Cognitive Impairment Profile era la única que permitía establecer subgrupos de deterioro cognitivo. En cuanto a escalas conductuales: el Neuropsychiatric Inventory era el gold standard en demencias. Solo había una escala específica para la enfermedad de Alzheimer, el Baylor Profound Mental Status Examination subescala conductual. CONCLUSIONES: En demencias severas, el Severe Cognitive Impairment Profile y el Neuropsychiatric Inventory son las herramientas más completas para estudios de investigación, y el Baylor Profound Mental Status Examination la más útil para la práctica clínica.

[Comprehensive Care Home Unit: reduction of hospital resources during influenza outbreaks]. / Unidad domiciliaria de atención integral: Reducción de recursos hospitalarios durante brotes de gripe.

OBJECTIVE: The Comprehensive Care Home Unit of the General Hospital of Villarrobledo is a unit formed by a geriatrician who sees people in nursing homes to improve their quality of care. The activity of the Unit has been analyzed, mainly with the objective of avoiding referral to the emergency room, avoiding hospital admissions, avoiding hospital readmissions and reducing the number of hospital admission days. METHODS: We retrospectively described the clinical activity of the Unit during the influenza outbreak of 2017 and 2018. We selected sociodemographical variables, functional assessment scales (Katz index, Barthel index and the Functional Ambulation Classification), and the Global Deterioration Scale. We registered mortality, type of treatment, oncological patients and patients with supplementary tests. The population was divided into four subgroups: hospital admission avoided, hospital re-admission avoided, referral to the emergency department avoided and reduction of admission days. The demographic characteristics were described, including the mode or mean of the variables. An economic report was made, and an analysis of cost per process according to the subgroups, means of Related Groups for the Diagnosis and degree of dependency measured by the Barthel index. RESULTS: We selected 112 patients, they had a mean age of 82.2 years, Katz G (34.8%), IB 28.8 (DE 34.9), FAC 0 (63.4%) and GDS 7 (22.3%). The most frequent disease seen was respiratory infection (63.2%), 71.4% received active treatment, 10.7% complementary tests were performed, 17.9% oncological and 17% mortality. Cost analysis: hospital readmission avoided (€ 4,128 per patient) and patients with total disability (BI 0-20, € 3,623 per patient) presented more economic saving. The economic savings were more than € 230,000. CONCLUSIONS: The contribution of the Unit during periods of influenza outbreak is cost saving because of reduced numbers of admissions, numbers of readmissions, days of admission and emergency room visits.

OBJETIVO: La Unidad Domiciliaria de Atención Integral (UDAI) del Hospital General de Villarrobledo está formada por un geriatra que atiende a las personas institucionalizadas para mejorar su calidad asistencial. Se analizó la actividad de la UDAI, principalmente en el objetivo de evitar ingresos y reingresos hospitalarios, evitar visitas a urgencias y facilitar el alta hospitalaria prematura. METODOS: Describimos de forma retrospectiva la actividad de la UDAI durante los brotes de gripe del 2017 y 2018. Aportamos variables sociodemográficas, escalas de valoración funcional (índice de Katz, índice de Barthel y la Escala de Valoración Funcional de la Marcha), y la Escala de Deterioro Global. Registramos mortalidad, tipo de tratamiento, pacientes oncológicos y pruebas complementarias. Se dividió la población en cuatro subgrupos: ingreso hospitalario evitado, reingreso hospitalario evitado, derivación a urgencias evitada y reducción días de ingreso. Se describieron las características demográficas, incluido la moda o media de las variables. Se realizó una memoria económica, y un análisis de coste por proceso según los subgrupos, medias de Grupos Relacionados por el Diagnóstico y grado de dependencia medido por el Índice de Barthel. RESULTADOS: Se seleccionaron 112 pacientes, presentaban una edad media de 82,2 años, Katz G (34,8%), IB 28,8 (DE 34,9), FAC 0 (63,4%) y GDS 7 (22,3%). La enfermedad más frecuente fue la infección respiratoria (63,4%), recibieron tratamiento activo un 71,4%, se realizaron pruebas complementarias en un 10,7%, oncológico 17,9% y exitus 17%. Análisis de costes: el reingreso hospitalario evitado (4.128 € por paciente) y los pacientes con discapacidad total (IB 0 ­ 20, 3.623 € por paciente) presentaron un mayor ahorro de costes. El ahorro económico fue de más de 230.000€. CONCLUSIONES: La contribución de la UDAI durante los periodos de brote de gripe supone un ahorro de costes basado en disminuciones de hospitalizaciones, disminución de reingresos, acortamiento de estancias hospitalarias y reducción de derivaciones a urgencias.

Clasificación de instituciones prestadores de servicios de salud según el sistema de cuentas de la salud de la Organización para la Cooperación y el Desarrollo Económico: el caso de Colombia / Classification of Health Services Providing Institutions According to the System of Health Accounts of the Organization for Economic Cooperation and Development: the Colombia Case / Classificação de instituições prestadoras de serviços de saúde de acordo ao sistema de contas da saúde da Organização para a Cooperação e o Desenvolvimento Económico: o caso da Colômbia

Resumen En Colombia las instituciones prestadoras de servicios de salud (IPS) públicas tienen una clasificación según tres niveles de complejidad: bajo, medio y alto. Esto no sucede con las IPS privadas. Esta carencia dificulta los análisis comparativos entre prestadores privados. Para suplir esta necesidad se desarrolló un algoritmo de clasificación de IPS de acuerdo con la metodología del Sistema de Cuentas de la Salud utilizado en los países de la Organización para la Cooperación y el Desarrollo Económico. Se utilizó como fuente de información la base de datos de servicios habilitados del Registro Especial de Prestadores para 2015. Los resultados muestran que en el país el 66 % de las IPS son de atención ambulatoria, el 17 % hospitales, el 11 % centros de promoción y prevención y el 6 % prestadores de servicios auxiliares. La concentración de activos es opuesta, pues se encontró que los hospitales tienen el 90.5 % de los activos.

Abstract In Colombia, public health service providers (IPS) are classified according to three complexity levels: low, medium, and high. Such is not the case with private IPS. This lack hinders comparative analyzes between private providers. To meet this need, an IPS classification algorithm was developed according to the methodology of the System of Health Accounts used in the member countries of the Organization for Economic Cooperation and Development. The database of qualified services of the Special Registry of Providers for 2015 was used as a source of information. The results show that 66% of the IPS in the country work in ambulatory care, 17% are hospitals, 11% are promotion and prevention centers, and 6% are ancillary service providers. The concentration of assets follows the opposite distribution, as it was found that hospitals have 90.5% of assets.

Resumo Na Colômbia as instituições prestadoras de serviços de saúde (IPS) públicas tem classificação segundo três níveis de complexidade: baixo, meio e alto. Isso não acontece com as IPS privadas. Esta carência dificulta as análises comparativas entre prestadores privados. Para suprir tal necessidade desenvolveu-se um algoritmo de classificação de IPS de acordo com a metodologia do Sistema de Contas da Saúde utilizado nos países da Organização para a Cooperação e o Desenvolvimento Económico. Utilizou-se como fonte de informação a base de dados de serviços habilitados do Registro Especial de Prestadores para 2015. Os resultados mostram que no país 66 % das IPS são de atenção ambulatorial, 17% hospitais, o 11% centros de promoção e prevenção e 6% prestadores de serviços auxiliares. A concentração de ativos é oposta, pois se encontrou que os hospitais têm o 90.5 % dos ativos.

Microalgae-based biodiesel: economic analysis of downstream process realistic scenarios.

Microalgae oil has been identified as a reliable resource for biodiesel production due to its high lipid productivity and potential cultivation in non-fertile locations. However, high scale production of microalgae based biodiesel depends on the optimization of the entire process to be economically feasible. The selected strain, medium, harvesting methods, etc., sorely affects the ash content in the dry biomass which have a direct effect in the lipid content. Moreover, the suitable lipids for biodiesel production, some of the neutral/saponifiable, are only a fraction of the total ones (around 30% dry base biomass in the best case). The present work uses computational tools for the modeling of different scenarios of the harvesting, oil extraction and transesterification. This rigorous modeling approach detects process bottlenecks that could have led to an overestimation of the potentiality of the microalgae lipids as a resource for the biodiesel production.

Cost of mental set reconfiguration between digits and their photisms in synaesthesia.

In this study we present an experiment investigating the reconfiguration process elicited by the task switching paradigm in synaesthesia. We study the time course of the operations involved in the activation of photisms. In the experimental Group, four digit-color synaesthetes alternated between an odd-even task and a color task (to indicate the photism elicited by each digit). In both tasks, the target stimuli were numbers between 1 and 9 written in white. One of the control groups ran the same tasks but this time with colored numbers (Naive Control Group). The results of these studies showed the expected pattern for the control group in the case of regular shift: a significant task switch cost with an abrupt offset and a cost reduction in long RSI. However for the experimental group, we found switch cost asymmetry in the short RSI and non-significant cost in the long RSI. A second control group performed exactly the same tasks as the experimental group (with white numbers as targets and a second imaginary color task) -Trained Control Group-. We found no cost for this second control group. This means that the cost of mental set reconfiguration between numbers (inducers) and their photisms (concurrent sensations) occurs, that there is a specific cost asymmetry (from photisms to inducers) and that this cost cannot be explained by associative learning. The results are discussed in terms of exogenous and endogenous components of mental set reconfiguration.

Mental representations of obligatory and prohibitory traffic signs.

Every traffic sign conveys a single proposition about traffic conditions. Drivers must integrate this proposition with their goals and other known facts to decide on an appropriate action in what amounts to a deduction task. For example, imagine that you are driving a car and you want to turn right at an intersection but there is a 'no right turn' sign. You have to assess the options and make a decision (reach a conclusion). Theoretical accounts from research about reasoning can be applied to how we understand traffic signs and make inferences from them. This study includes two experiments that analysed how people decide whether a situation is allowed or not, taking into account the information provided by one sign--obligatory or prohibitory--or two signs--two obligatory or two prohibitory signs. The number of signs, that is, the complexity of the driving scene, was a key factor in this study. The two experiments differ in the presentation format of the two-sign experimental condition. In the first experiment, the signs were presented as two isolated signs. In the second experiment, the two signs were embedded in one. Equivalent results were found whether two isolated signs or two embedded signs were shown. When an obligatory sign was used at the junction, faster responses were obtained for allowed manoeuvres than for those not allowed. When a prohibitory sign was used, the results were the opposite. However, the advantage of prohibitory signs in the not-allowed situation was not replicated when people had to collect information from two prohibitory signs. Results showed that people integrate two obligatory sign messages--informing where one can go--more easily than two prohibitory sign messages--informing where not to go. Therefore, it could be said that each traffic sign elicits an internal mental model elaboration in which forbidden actions are explicitly labelled by means of attached "mental footnotes" indicating the epistemic status of "prohibitory information."