Low loss optical waveguides fabricated in LiTaO3 by swift heavy ion irradiation.

Optical waveguides are fabricated by irradiation of LiTaO3 with a variety of swift heavy ions that provide increasing levels of both nuclear and electronic damage rates, including C, F and Si ions, in the energy range of 15-40 MeV. A systematic study of the role of the ion fluence has been carried out in the broad range of 1e13-2e15 at/cm2. The kinetics of damage is initially of nuclear origin for the lowest fluences and stopping powers and, then, is enhanced by the electronic excitation (for F and Si ions) in synergy with the nuclear damage. Applying suitable annealing treatments, optical propagation losses values as low as 0.1 dB have been achieved. The damage rates found in LiTaO3 have been compared with those known for the reference LiNbO3 and discussed in the context of the thermal spike model.

Synergy between pyroelectric and photovoltaic effects for optoelectronic nanoparticle manipulation.

The combined action of the pyroelectric (PY) and photovoltaic (PV) effects, exhibited by z-cut LiNbO3:Fe substrates, has been investigated for particle trapping and patterning applications. The novel hybrid procedure provides new possibilities and versatility to optoelectronic manipulation on LiNbO3 substrates. It has allowed obtaining periodic and arbitrary 2D patterns whose particle density distribution is correlated with the light intensity profile but can be tuned through ΔT according to the relative strength of the PV and PY effects. A relevant result is that the PY and PV contributions compete for a ΔT range of 1-20 °C, very accessible for experiments. Moreover, the synergy of the PY and PV has provided two additional remarkable applications: i) A method to measure the PV field, key magnitude for photovoltaic optoelectronic tweezers. Using this method, the minimum field needed to obtain a particle pattern has been determined, resulting relatively high, E~60 kV/cm, and so, requiring highly doped crystals when only using the PV effect. ii) An strategy combining the PY and PV to get particle patterning in samples inactive for PV trapping when the PV field value is under that threshold.

Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case-Control Study.

Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case-control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.

Diffractive optical devices produced by light-assisted trapping of nanoparticles.

One- and two-dimensional diffractive optical devices have been fabricated by light-assisted trapping and patterning of nanoparticles. The method is based on the dielectrophoretic forces appearing in the vicinity of a photovoltaic crystal, such as Fe:LiNbO3, during or after illumination. By illumination with the appropriate light distribution, the nanoparticles are organized along patterns designed at will. One- and two-dimensional diffractive components have been achieved on X- and Z-cut Fe:LiNbO3 crystals, with their polar axes parallel and perpendicular to the crystal surface, respectively. Diffraction gratings with periods down to around a few micrometers have been produced using metal (Al, Ag) nanoparticles with radii in the range of 70-100 nm. Moreover, several 2D devices, such as Fresnel zone plates, have been also produced showing the potential of the method. The diffractive particle patterns remain stable when light is removed. A method to transfer the diffractive patterns to other nonphotovoltaic substrates, such as silica glass, has been also reported.

Particle trapping and structuring on the surface of LiNbO3:Fe optical waveguides using photovoltaic fields.

We report on the successful trapping and patterning of micro- and nanometric particles on the surface of LiNbO3 optical waveguides via photovoltaic tweezers. A waveguide configuration is used for the first time combined with this recently proposed technique. The electric field pattern is generated by light propagating in the waveguide, allowing us to separate the light channel with the region in which particles are deposited. Results on micro- and nanoparticle trapping, by two different deposition methods on two types of planar waveguides (by soft proton exchanged and by swift heavy ion irradiation), and using single-beam and two-beam interferometric configuration, are presented and discussed.

Five-year economic evaluation of non-melanoma skin cancer surgery at the Costa del Sol Hospital (2006-2010).

BACKGROUND: The cost associated with treatment of non-melanoma skin cancer is expected to rise considerably over the coming decades. This important public health problem is therefore expected to have an enormous economic impact for the various public health services. OBJECTIVES: To estimate the cost of the surgical-care process of non-melanoma skin cancer at the Costa del Sol Hospital and seek areas to improve its efficiency, using the activity-based costing (ABC) method and the tools designed for decision analysis. SECONDARY OBJECTIVE: To compare the costs for hospitalized patients obtained using the ABC method with the data published by the Spanish Ministry of Health, using the diagnosis-related groups (DRG) classification system. MATERIAL AND METHODS: Retrospective analysis of the cost of non-melanoma skin cancer surgery at the Costa del Sol Hospital. RESULTS: The total estimated cost from 2006 to 2010 was 3 398 540€. Most of the episodes (47.3%) corresponded to minor outpatient surgery. The costs of the episodes varied greatly according to the type of admission: 423€ (minor outpatient surgery), 1267€ (major outpatient surgery), and 1832€ (inpatient surgery). The average cost of an inpatient episode varied significantly depending on the calculation system used (ABC: 2328€ vs. DRG: 5674€). CONCLUSIONS: The ABC cost analysis system favours standardization of the care process for these tumours and the detection of areas to improve efficiency. This would enable more reliable economic studies than those obtained using traditional methods, such as the DRG.

Unlocking room-temperature bistable spin transition at the nanoscale: the synthesis of core@shell [Fe(NH2trz)3(NO3)2]@SiO2 nanoparticles.

In this work, we address the synthesis of stable spin-crossover nanoparticles capable of undergoing a hysteretic spin transition at room temperature. For this purpose, we use the reverse-micelle protocol to prepare naked [Fe(NH2trz)3](NO3)2 and core@shell [Fe(NH2trz)3](NO3)2@SiO2 nanoparticles. Through meticulous adjustment of synthetic parameters, we achieved nanoparticle sizes ranging from approximately 40 nm to 60 nm. Our findings highlight that [Fe(NH2trz)3](NO3)2 presents a modest thermal hysteresis of 7 K, which decreases by downsizing. Conversely, silica-coated nanoparticles with sizes of ca. 60 and 40 nm demonstrate a remarkable hysteretic response of approximately 30 K, switching their spin state around room temperature. Moreover, the presence of a SiO2 shell substantially enhances the nanoparticles' stability against oxidation. In this context, the larger 60 nm [Fe(NH2trz)3](NO3)2@SiO2 hybrid remains stable in water for up to two hours, enabling the observation of an unreported water-induced spin transition after 30 min. Therefore, this work also introduces an intriguing avenue for inducing spin transitions through solvent exchange, underscoring the versatility and potential of these nanoparticles.

Diagnostic-therapeutic algorithm for thrombotic microangiopathy. A report of two cases.

Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).

Diagnostic-therapeutic algorithm for thrombotic microangiopathy. A report of two cases. / Algoritmo diagnóstico-terapéutico de las microangiopatías trombóticas. A propósito de 2 casos.

Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).

Practical recommendations for the management of the patient with chronic pain during the pandemic of COVID-19.

SARS-CoV-2 infection has evolved into a pandemic and a Public Health Emergency of International Importance that has forced health organizations at the global, regional and local levels to adopt a series of measures to address to COVID-19 and try to reduce its impact, not only in the social sphere but also in the health sphere, modifying the guidelines for action in the health services. Within these recommendations that include the Pain Treatment Units, patients with suspected or confirmed SARS-CoV-2 infection may be waiting for medical consult or interventional procedures for the management of chronic pain refractory to other therapies. A series of guidelines aimed at reducing the risk of infection of health personnel, other patients and the community are included in this manuscript.

Analysis of photorefractive optical damage in lithium niobate: application to planar waveguides.

Photorefractive optical damage of single beams in LiNbO(3) crystals is analyzed within a framework of two photoactive centres (Fe(2+)/Fe(3+) and Nb(Li) (4+)/Nb(Li) (5+)). It compares model simulations and significant experimental measurements in LiNbO(3) waveguides. A good agreement is found in the performed comparisons: photovoltaic currents, refractive index changes and, especially relevant, in degraded beam-profiles. The progress of the degraded wavefront has been simulated by implementing a finite-difference beam-propagating method which includes the model equations. These results, together with previous ones on grating recording, provide a comprehensive, satisfactory explanation of most important questions on photorefractive optical damage.

Practical recommendations for the management of the patient with chronic pain during the pandemic of COVID-19. / Recomendaciones prácticas para el manejo del paciente con dolor crónico durante la pandemia de COVID-19.

SARS-CoV-2 infection has evolved into a pandemic and a Public Health Emergency of International Importance that has forced health organizations at the global, regional and local levels to adopt a series of measures to address to COVID-19 and try to reduce its impact, not only in the social sphere but also in the health sphere, modifying the guidelines for action in the health services. Within these recommendations that include the Pain Treatment Units, patients with suspected or confirmed SARS-CoV-2 infection may be waiting for medical consult or interventional procedures for the management of chronic pain refractory to other therapies. A series of guidelines aimed at reducing the risk of infection of health personnel, other patients and the community are included in this manuscript.

Correlation between photorefractive index changes and optical damage thresholds in z-cut proton-exchanged-LiNbO(3) waveguides.

An interferometric Mach-Zehnder technique very recently developed has been applied to measure photorefractive index changes in different types of z-cut proton-exchanged planar waveguides in LiNbO(3). These measurements are complemented by determining the intensitythreshold for the onset of optical damage with a standard single-beam setup. In the intensity region just below the threshold-intensity obtained in the single-beam experiment the refractive index change is found to saturate at values around1x10(-4). Furthermore, we measure the dark conductivities of proton-exchanged waveguides by monitoring the decay of the light-induced index changes. Via the time constant of the decay we obtain dark conductivities of the order of about 5x10(-16) Omega (-1) cm (-1), that are negligible compared with the photoconductivity within the light intensity range used. The results of the measurements compare well with the predictions of a recent work, that uses a two-center model to explain the optical damage.

Understanding light intensity thresholds for catastrophic optical damage in LiNbO3.

The appearance of light intensity thresholds for catastrophic optical damage in LiNbO3 is satisfactorily explained by using a photorefractive model based on the Fe(2+)?Fe(3+) and NbLi(4+)?NbLi(5+) defect pairs. Model simulations of the photorefractive amplification gain as a function of the light intensity present sharp threshold behavior. A similar behavior is shown by the saturating refractive index change. In agreement with experiments, predicted thresholds appear shifted towards higher intensities (up to a 10(4) factor) when the Nb(Li) concentration is decreased or the temperature is increased. The model also explains very recent data on the threshold enhancement with the Fe(2+)/Fe(3+) ratio in optical waveguides.

Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation.

OBJECTIVES: To assess the risk factors for development of late-onset invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT). METHODS: We performed a multinational case-control study that retrospectively recruited 112 KT recipients diagnosed with IPA between 2000 and 2013. Controls were matched (1:1 ratio) by centre and date of transplantation. Immunosuppression-related events (IREs) included the occurrence of non-ventilator-associated pneumonia, tuberculosis, cytomegalovirus disease, and/or de novo malignancy. RESULTS: We identified 61 cases of late (>180 days after transplantation) IPA from 24 participating centres (accounting for 54.5% (61/112) of all cases included in the overall study). Most diagnoses (54.1% (33/61)) were established within the first 36 post-transplant months, although five cases occurred more than 10 years after transplantation. Overall mortality among cases was 47.5% (29/61). Compared with controls, cases were significantly older (p 0.010) and more likely to have pre-transplant chronic obstructive pulmonary disease (p 0.001) and a diagnosis of bloodstream infection (p 0.016) and IRE (p <0.001) within the 6 months prior to the onset of late IPA. After multivariate adjustment, previous occurrence of IRE (OR 19.26; 95% CI 2.07-179.46; p 0.009) was identified as an independent risk factor for late IPA. CONCLUSION: More than half of IPA cases after KT occur beyond the sixth month, with some of them presenting very late. Late IPA entails a poor prognosis. We identified some risk factors that could help the clinician to delimit the subgroup of KT recipients at the highest risk for late IPA.

Algoritmo diagnóstico-terapéutico de las microangiopatías trombóticas. A propósito de 2 casos / Diagnostic-therapeutic algorithm for thrombotic microangiopathy. A report of two cases

Las microangiopatías trombóticas (MAT) son un conjunto de síndromes clínicos que asocian anemia hemolítica, trombocitopenia y disfunción orgánica, principalmente renal o neurológica. Están asociados a una morbimortalidad significativa, por lo que su diagnóstico y tratamiento precoz son esenciales. En este artículo detallamos 2 casos de MAT; una paciente con una púrpura trombocitopénica trombótica (PTT) y otra paciente con un síndrome hemolítico urémico atípico (SHUa).(AU)

Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).(AU)

[Questionnaire to evaluate the importance of the family in nursing care. Validation of the Spanish version (FINC-NA)]. / Cuestionario para evaluar la importancia de la familia en los cuidados de enfermería. Validación de la versión española (FINC-NA).

BACKGROUND: The nursing profession is focused on patient care, without forgetting that patients are part of a social group, the family. The aim of this study was the adaptation of the "Families' Importance in Nursing Care-Nurses' Attitudes" (FINC-NA) scale to the Spanish language and its validation. METHODS: A descriptive cross-sectional study was carried out, using the bidirectional translation method for linguistic-cultural adaptation. It was applied to the nursing staff in the Paediatric Department of a University Hospital in Madrid. To evaluate the psychometric properties of the Spanish version, reliability, internal consistence and construct validity were calculated. RESULTS: The sample consisted of 274 professionals. Cronbach´s Alpha coefficient for the total scale was 0.864, oscillating between 0.888 and 0.769 in the subscales. The principal components factor analysis identified 4 factors, which explained 54.22% of total variance. CONCLUSIONS: The new instrument makes it possible to determine the importance nurses give to participation by family members and their attitude to involving the latter in patient care, and the possibility of involving them in planning. It has been adapted to the Spanish population with good psychometrics results and enough evidence for its use in this context.

[Recommendations for respiratory support in the newborn (iii). Surfactant and nitric oxide]. / Recomendaciones para la asistencia respiratoria en el recién nacido (iii). Surfactante y óxido nítrico.

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group.

Proximal partial 5p trisomy resulting from a maternal (19;5) insertion.

We present a case with a partial duplication 5p11-->5p13.3 resulting from a maternal ins (19,5)(p11;p11-p13.3). The diagnosis was confirmed by FISH and complement component determinations. The clinical picture was similar to those described in patients with complete duplication of the short arm and in some patients with partial 5p duplications, affecting at least band 5p13. A special significance of band 5p13 in the clinical severity of 5p duplications is discussed.