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The aim of this study was to assess the performance of the National Early Warning Score 2 (NEWS2) in predicting a short-term complicated outcome in stable patients with acute symptomatic pulmonary embolism (PE). We also studied the ability of the NEWS2 score compared with the simplified Pulmonary Embolism Severity Index (sPESI) for identifying low-risk patients with acute PE.We performed a retrospective analysis of a prospective cohort composed of 848 patients with acute PE. The NEWS2 and the sPESI were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for a 30-day complicated outcome using the C statistic, which was obtained by logistic regression models and ROC curves. We also assessed the test and performance characteristics of the low-risk versus high-risk categories of each prediction rule.Overall, 63 out of 848 patients died (7.4%; 95% confidence interval, 5.7%-9.2%) during the first month of follow-up. Both scores showed a similarly poor predictive value for 30-day complicated outcome (C statistic, 0.68 and 0.62). The sPESI classified fewer patients as low-risk (36.9% versus 44.5%; P0.01). Compared with the NEWS2 score, the sPESI showed significantly higher sensitivity (92.1% versus 66.7%) and a better negative predictive value (98.4% versus 94.4%).Both scores provide similar information for stratifying the risk of a complicated outcome in stable patients with PE. The sPESI identified low-risk patients with PE better than the NEWS2 score.

Penetrating aortic ulcer (AU) is defined as localized disruption of the intimal layer of the aortic wall, resulting in a crater-like lesion outpouching from the vessel contour. AU is a generic term which encompasses a constellation of entities with different etiologies and prognoses and may be a complication of infective, inflammatory, traumatic, iatrogenic, atherosclerotic processes or intramural hematoma. One of the most challenging scenarios of AU for a differential diagnosis, but also for treatment implications, is when they are associated with acute aortic syndrome. Despite advances in the field of aortic disease, lack of consensus defining these lesions and the significant semantic confusion in the medical literature of the acronym PAU (for penetrating aortic ulcer but also for penetrating atherosclerotic ulcer) have given rise to controversy in guidelines and expert consensus, leading to the same treatment being recommended for entities with different etiology and prognosis. Moreover, in the medical literature, most diagnoses were mainly based on imaging techniques which identified AU regardless of clinical symptoms, surrounding imaging findings or dynamic morphologic changes. In this Review, we provide the latest insight into the differential diagnosis between AU, also called penetrating aortic ulcers, based on clinical context and the newest imaging characteristics to aid treatment decision-making.

This study tests the positive effects of empowering leadership (ELSH) under boundary conditions in the hospitality industry. We propose the existence of an interactive process through which ELSH behaviors interact with employees’ personality type to condition their engagement, which in turn influences their extra-role service behavior. We use data from 294 employees and structural equation modeling. The results show that the interaction of ELSH with employees’ independent and interdependent personality is negatively related to their engagement. This decrease in engagement is then reflected in decreased extra-role service behaviors due to the positive relationship between engagement and extra-role service. These findings suggest that self-construal is a significant boundary condition capable of changing the positive relationship between ELSH and engagement to a negative one. Not considering this relationship when establishing a leadership strategy such as ELSH in the hospitality context could render efforts to achieve the goal of high-quality service ineffective., European Regional Development Fund (European Union), Spanish Government ECO2017-84138-P, Junta de Andalucia A-SEJ-154-UGR18, University of Granada/CBUA

This study examines the impact of information technology (IT)-enabled knowledge ambidexterity on innovation performance, and the potential moderator role of social media capability on a sample composed of 100 small U.S. firms. The empirical analysis suggests that IT infrastructure enables the firm to explore new knowledge and exploit existing/new knowledge to innovate more and better. We also find that social media capability has a positive moderator role in this equation: IT infrastructure and social media capabilities work together to enable knowledge ambidexterity.

Summary Background The use of peripheral venous catheters (PVCs) has increased outside the intensive care unit, as have rates of peripheral venous catheter associated-bloodstream infection (PVC-BSI). The internal medicine department (IMD) is one of the main wards where PVCs are widely used. However, data on the incidence of PVC-BSI and its characteristics in the IMD are scarce. Aim Our objective was to assess the incidence of PVC-BSI episodes detected in IMDs in Spain. Methods We performed a 1-year multicenter prospective observational cohort study in 14 Spanish IMDs. We included adult patients admitted with at least one PVC and bacteremia. Demographic and clinical data were provided by local coordinators. Findings We recorded 70 episodes of PVC-BSI, representing an overall rate of 1.64 PVC-BSI episodes/1,000 IMD admissions. Patients had a mean (SD) age of 67.44 (16.72) years. It was estimated that 25.7% of PVCs were no longer necessary. Staphylococcus aureus was the most frequently isolated microorganism (41.7%). Phlebitis was clinically evident in 44 (62.9%) episodes and proved to be an independent predictor of catheter insertion in emergency departments (OR=5.44). The crude and attributable mortality rates were 12.9% and 5.7%, respectively. Conclusion Our study shows that PVCs carry a significant risk for bacteremia in Spanish IMDs. Phlebitis is not always clinically evident in patients with bacteremia in this population. Our findings support the need for educational and interventional preventive measures both in IMDs and in emergency departments to reduce the rate of PVC-BSI and associated comorbidities and costs.

Introduction Critically ill patients may suffer varying degrees of temporary myocardial dysfunction during respiratory weaning that could play an important role in weaning failure. Objectives In this study, we tried to assess the existence of temporary diastolic dysfunction during respiratory weaning. Methods Inclusion period is from 2006 to 2015. In this study, we included 181 ventilated patients with cardiogenic shock that were being weaned from mechanical ventilation. Twenty of those patients were successfully weaned from mechanical ventilation, and the rest (161) experienced complications in their weaning process. All patients had a left ventricular ejection fraction >0.45 and E/E′ ratio ≤ 8, did not require vasoactive drugs at that time, and did not have remaining significant ischemic disease. We divided our patients into 3 groups, as follows: A, patients who could not tolerate a T-tube and required pressure-support ventilation (82); B, patients who successfully tolerated a T-tube period (20); and C, patients who could not tolerate spontaneous breathing modes of mechanical ventilation and remained on assisted mechanical ventilation. We performed stress echocardiography for the last two groups; using dobutamine to assess diastolic function and using ephedrine to evaluate functional mitral regurgitation (MR). We estimated pulmonary capillary wedge pressure through the E/E′ ratio and the flow in the pulmonary veins. Results In group A (ie, those patients who could not tolerate a T-tube trial), we observed an increase in the E/E′ ratio (6.32 ± 0.77 vs 15.2 ± 6.65; P = .0001) and a worsening of strain (S) and strain rate (SR) (−13.6 ± 1.80 vs −11.88 ± 5.6, P = .0001; and −1.3 ± 1.28 vs −0.95 ± 0.38, P = .0001; respectively). We did not observe a change in the E/E′ ratio during stress echocardiogram on those patients with successful weaning from mechanical ventilation (7.41 ± 0.43 vs 8.38 ± 4.57, P = .001). However, we did see in this group an increased peak velocity of the S wave and of SR (−16.11 ± 08.72 vs −19.89 ± 5.62 and −1.48 ± 0.23 vs −1.59 ± 0.21, P = .001; respectively). In 42 weaning failure patients, the dobutamine echocardiography showed an increased E/E′ ratio (7.41 ± 0.43 vs 15.98 ± 7.98; P = .0001) and deterioration of S (−15.41 ± 09.56 vs −12.72 ± 6.55; P = .0001) and SR (−1.41 ± 0.78 vs −1.22 ± 0.65; P = .0001). In 37 patients without systolic or diastolic impairment and functional MR grade >2, ephedrine echocardiography showed an increase of effective regurgitant volume (29.56 ± 11.32 mL vs 46.56 ± 0.13 mL, P = .0001) and effective regurgitant orifice area (0.19 ± 0.09 cm2 vs 0.31 ± 0.09 cm2, P = .0001). Conclusions Stress echocardiography may be helpful in detecting silent diastolic and systolic dysfunction or severe MR that could have a major impact on respiratory weaning.

Definition of skills, occupations, professional profiles and similar concepts have been explored in the ICT area since long ago. It has been only recently in Europe when new frameworks and standards have strived in getting a real systematic conceptual map to this challenging and fast evolving field. More precisely, three are the most important references which provide different aspects and approaches to the challenge of creating a common language in the area: e-Competence Framework e-CF (EN 16234-1:2016), ESCO (European Skills, Competences and Occupations classification) and the European ICT BOK. This paper addresses the challenge of studying them with the goal of providing a consistent model covering the different views of the area. This is an essential step to integrate ICT profiles, competences, skill, knowledges and qualifications, keeping both an interlink to the different already existing systems and the capability to acknowledge and integrate emerging areas in ICT profession in the future. The resulting framework, named as eSkills Match, will allow development of future support systems which may provide self-assessment functions for job candidates, recommender modules to guide their training to target occupations and the possibility of knowledge validation options aligned to the specific set of skills, knowledges and competences used as basic elements of the model. The proposed framework provides a useful system for job candidates and employers.It integrates the ICT related reference schemes and standards: ESCO, e-CF and BOK.It includes ICT profiles, competences, skill, knowledges and qualifications.

Can social media-driven customer engagement help movie producers to increase movie sales? Movie producers use social media to boost customer engagement; however, our understanding of whether there is a relationship between pre-consumption customer engagement and movie sales is limited. This research explores what drives the success of movies on the opening-weekend. We examine the relationship between pre-consumption customer engagement driven by social media (i.e., personal and interactive engagement) and movie performance (i.e., opening-weekend box office revenues). Driven by the debate about the potential capacity of social media-driven customer engagement to improve movie performance and the limited understanding of the association of pre-consumption customer engagement and movie performance, this research suggests that social media-enabled customer engagement (i.e., personal and interactive engagement) has the potential to improve movie performance, and these two types of engagement can interact to make this effect stronger. We analyze these relationships drawing from the uses and gratifications theory and the social media affordances perspective that motivate customers to interact in social media. The theoretical model evaluation was tested on a unique and original dataset composed of 966 movies released in the U.K. and Spain. The empirical analysis suggests that personal and interactive engagement are positively related to movie performance, and the positive effects of personal and interactive engagement on movie performance are mutually reinforcing. This research contributes to Information Systems (IS) research by theorizing and empirically showing how customer engagement driven by social media creates business value by improving movie performance.

This paper presents an effort to improve the quality of processes and products by the definition of the foundations of Maintenance Management Systems based on ISO standards that could help companies to strength the organization of work. We applied the Design Science Research methodology. Finally developing two prototypes which were implanted in different companies. With information gathered along the process, we can offer a system's design which can be adopted by companies to help om maintenance management tasks and serves as a base to carry out internal audit tasks.

Resumen Objetivo Conocer la incidencia de complicaciones asociadas a los cateteres venosos centrales (tunelizados, reservorios y PICC), en pacientes con patologia oncohematologica, ingresados en Unidades de Hematologia o Trasplantes de Progenitores Hematopoyeticos, en dos hospitales terciarios. Metodologia Se desarrollo un estudio descriptivo transversal donde se recogieron datos sociodemograficos, clinicos, complicaciones y seguimiento del protocolo de cuidados. A cada cateter se le asigno un numero de identificacion correlativo. Se recogio informacion de 366 cateteres: 185 en el Hospital Universitario Ramon y Cajal (HURYC): 80 tunelizados, 40 reservorios y 65 PICC; 181 en el Hospital Universitario Gregorio Maranon (HUGM): 101 tunelizados y 80 reservorios. Resultados Las principales complicaciones en los tunelizados fueron las infecciones (13,7% en el HURYC vs. 6,8% en el HUGM; p Conclusiones La diferencia entre hospitales respecto a la infeccion y oclusion, puede asociarse a las distintas pautas de cuidados. Destaca la alta incidencia de flebitis y trombosis en PICC.

Resumen Objetivos Evaluar el efecto de la administracion precoz de estatinas durante la fase aguda del infarto de miocardio (IM). Diseno Estudio de cohortes retrospectivo. Ambito Nacional. Pacientes o participantes Pacientes incluidos en el registro ARIAM desde enero de 1999 hasta diciembre de 2008 con diagnostico de IM. Intervenciones Ninguna. Variables de interes principales Se utilizaron analisis de regresion logistica y de propension para determinar si la administracion de estatinas, durante las primeras 24 h del IM, se comportaba como un factor protector frente a: 1) la mortalidad, 2) la incidencia de arritmias letales o 3) el shock cardiogenico. Resultados Se incluyeron 36.842 pacientes en el estudio. En un 50,2% de los pacientes las estatinas se administraron de forma precoz. Su administracion se asocio a pacientes mas jovenes, con dislipidemia previa conocida, obesidad, antecedentes personales de cardiopatia isquemica, insuficiencia cardiaca, presencia de taquicardia sinusal, uso de betabloqueantes, inhibidores de la enzima convertidora de angiotensina, trombolisis e intervencionismo coronario percutaneo. La mortalidad fue del 8,2% (13,2% sin estatinas vs. 3% con estatinas; p Conclusiones Estos resultados sugieren que el tratamiento precoz con estatinas en los pacientes con IM se asocia con una reduccion de la mortalidad.

Fundamento y objetivo El proposito de este trabajo es investigar los factores predictores de mortalidad y la estancia media de los pacientes diagnosticados de angina inestable (AI) durante su ingreso en las unidades de cuidados intensivos o unidades de cuidados coronarios (UCI/UCC). Pacientes y metodo Estudio de cohorte retrospectivo que incluyo a los pacientes del registro espanol ARIAM (Analisis del Retraso en el Infarto Agudo de Miocardio). El periodo de estudio comprendio de junio de 1996 a diciembre de 2003. Su seguimiento se limito a UCI/UCC. Se realizo un analisis univariante entre los pacientes fallecidos y los vivos y otro entre los pacientes con estancia prolongada y no prolongada. Se realizaron ademas 3 analisis multivariantes con el objetivo de evaluar los factores relacionados con la mortalidad, las variables asociadas a la realizacion de intervencion coronaria percutanea (ICP) y los factores asociados a la estancia media prolongada en UCI/UCC. Resultados Se incluyo a 14.096 pacientes con AI. La mortalidad fue del 1,1% y se asocio a la clase Killip, edad, necesidad de reanimacion cardiopulmonar y presencia de shock cardiogenico,arritmias y diabetes; mientras que los pacientes fumadores se asociaron a una menor mortalidad. Se realizo ICP solo a 1.226 (8,9%) pacientes, aunque su realizacion se incremento con los anos. La ICP se asocio a edad, traslado interhospitalario, tabaquismo, infarto de miocardio previo, shock cardiogenico o ante el bloqueo auriculoventricular de alto grado (BAVAG) y tratamiento con bloqueadores beta. La estancia media (desviacion estandar) fue de 3,15 (18,65) dias. La estancia media prolongada dependio de la edad, haber sido sometido a una coronariografia o ICP, clase Killip,ecocardiografia o ventilacion mecanica y presentar complicaciones graves. Conclusiones La mortalidad se explica por la comorbilidad y la gravedad de la isquemia. Los pacientes a los que se realiza ICP son una poblacion menos grave, y su realizacion con el tiempo se incrementa. La estancia media prolongada se asocia a la mayor gravedad de la isquemia miocardica y a la ICP.

The growth curve interference (GCI) induced by different antibiotics was studied using reference strains of oral streptococci. This parameter may prove to be useful in preventing subacute endocarditis of odontological origin in high-risk patients. The growth curves using different concentrations of antibiotics and with an initial optical density (OD) of 0.05 +/- 0.01 were observed until an OD of 0.9-1.0 was reached. The GCI was defined as the lowest concentration of antibiotic that modified the growth curve with respect to a control without antibiotic. The GCI values were then compared with the minimum inhibitory concentration (MIC) values. In all cases, interference in the growth curves was at least one concentration lower than the MIC in a time ranging from 4-6 h.

Objective To describe a series of patients treated with intrapericardial glue. Design Case reports. Descriptive study. Patients We describe the results obtained using the injection of a surgical intrapericardial adhesive in 19 patients who presented cardiac tamponade and shock after cardiac rupture. The technique was done using puncture and echocardiographic subxiphoid control. At the one-year follow-up, 5 patients had survived, with neither pseudoaneurysms nor constriction. One patient was injected with said adhesive in the right ventricular cavity. Conclusions Pericardial drainage, followed by the administration of intrapericardial glue may be an attractive technique. This technique should be studied for its possible utility when faced with surgical impossibility.

The antibacterial action of bonding systems Gluma 2000, Syntac, Prisma Universal Bond 3, Scotchbond Multipurpose and Prime-Bond was tested against 32 strains of the caries-producing bacteria Streptococcus spp., Lactobacillus spp., Actinomyces spp., Porphyromonas spp. and Clostridium spp. An agar plate diffusion method was used with chlorhexidine as the positive control. Assays were performed in triplicate for each component (primer and adhesive) of the bonding systems. All the adhesives were found to inhibit bacterial growth but with differences in their spectra of action. The sum action of the Scotchbond Multipurpose components were most inhibitory and Prime-Bond was found to be the least effective system.

OBJECTIVE: To test a new system for the biotyping of Streptococcus mutans, based on the measurement of enzyme activity, and to investigate the relationship between biotype and in vitro susceptibility to seven clinically useful antibiotics. METHODS: In total, 160 oral isolates of S. mutans were classified into different biotypes with the APIZYM test for enzyme activity, excluding results that were positive or negative in >80% of the strains. The susceptibility of all 160 strains to amoxycillin, cefazolin, erythromycin, clindamycin, vancomycin, teicoplanin and imipenem was tested by dilution in a solid medium. Statistical analysis of susceptibility (mean minimum inhibitory concentrations (MICs)) was based on chi-squared tests. RESULTS: Eight different biotypes (1-8) were identified on the basis of three kinds of enzyme activity: valine aryl amidase, acid phosphatase and alpha-galactosidase. Biotype 5 was found to be the most common. The mean MIC values showed strains belonging to biotype 4 to be the most susceptible to amoxycillin, cefazolin and erythromycin, whereas biotype 1 was the least susceptible to teicoplanin. CONCLUSIONS: The proposed biotyping method, which is relatively fast and simple to perform, provided reproducible results, and may contribute to clinically effective treatment of S. mutans infections.

We have studied the ontogenic development of immunoglobulin M (IgM) and of IgM-bearing cells in the rainbow trout, Oncorhynchus mykiss. Lymphocytes showing cytoplasmic IgM were first observed in embryos at 12 days before hatch (14 degrees C). At this stage, no cells positive for surface IgM were present. Lymphocytes bearing surface IgM were observed at 8 days before hatch (14 degrees C). Unfertilized trout eggs contained detectable amounts of IgM (11.2 +/- 2.6 micrograms/g of egg weight), indicating that transfer of IgM from mother to embryo can occur in salmonids. The levels of IgM from whole fish increase slowly after the appearance of intraembryonic cells that express surface IgM. The amount of IgM/g of tissue peaks around hatch, but this parameter shows lower values up to 2 months after hatch.