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Evaluación de la calidad de la atención a pacientes con cáncer de pulmón: análisis integrado de datos para la mejora continua en servicios de Oncología Médica
No full textTesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de Lectura: 30-06-2025El creciente conocimiento y complejidad del abordaje del cáncer de pulmón hace necesario la planificación y análisis de la atención oncológica para lograr el más alto nivel de calidad en el sistema sanitario. Sin embargo, la selección y medición de indicadores de calidad continúa siendo un reto para los servicios médicos, superados por el rápido avance de la ciencia y lastrados por la carga administrativa asociada a su evaluación.
El objetivo de la presente tesis doctoral es crear un método de evaluación y monitorización de la calidad de atención prestada a pacientes con cáncer de pulmón utilizando datos contenidos en los sistemas de información del hospital. Debe permitir la retroalimentación a partir de los sistemas de información de forma cíclica para establecer un sistema de mejora continua.
Material y métodos: estudio observacional retrospectivo de cohortes realizado en el Hospital Universitario Puerta de Hierro Majadahonda, incluyendo de forma consecutiva a todos los pacientes con cáncer de pulmón atendidos en el Servicio de Oncología Médica entre el 1 de enero de 2016 y el 31 de diciembre de 2020.
Utilizando el marco metodológico Cross-Industry Standard Process for Data Mining, creamos un algoritmo de análisis, basado en las recomendaciones de las guías clínicas para, una vez integrados los datos de actividad y administrativos extraídos de la historia clínica electrónica junto con los datos de los registros de cáncer del hospital, reconstruir el itinerario terapéutico de los pacientes, en función de cada subgrupo histológico y estadio, y evaluar la calidad de la práctica clínica mediante el cálculo indicadores de proceso, oportunidad de cuidados y resultado.
Resultados: a través de los datos generados en la práctica habitual (1.223.245 registros), ha sido posible reconstruir la trayectoria terapéutica de 821 pacientes con cáncer de pulmón atendidos por el Servicio de Oncología Médica, describir sus características, la atención prestada, y calcular automáticamente 56 indicadores de calidad para evaluar el proceso de atención, la oportunidad de cuidados y los resultados.
Se obtuvieron 26 indicadores de proceso, observando una alta adherencia a las guías clínicas para la realización de tratamientos curativos y sistémico adyuvante en la enfermedad precoz, tratamiento multimodal de la enfermedad localmente avanzada y tratamiento sistémico en la enfermedad avanzada. Permitió también evaluar la incorporación de nuevas terapias como la inmunoterapia durante el periodo de estudio, así como evaluar tratamientos fútiles como la administración de quimioterapia en los últimos días de vida. Posteriormente se calcularon 10 indicadores de oportunidad de cuidados y 14 indicadores de resultado, observando mejor supervivencia para cada subgrupo de población respecto a la descrita en la literatura.
Se evaluó también la atención no planificada observando que es un evento muy frecuente y precoz, con una incidencia acumulada a 1 año del 71,3% y del 56,7% para la consulta en urgencias y para la hospitalización respectivamente, calculando adicionalmente 6 indicadores de calidad, clave para comprender las necesidades de los pacientes a lo largo del proceso de atención del cáncer de pulmón.
Conclusiones: la presente tesis doctoral demuestra que es posible evaluar y monitorizar la calidad de atención prestada a pacientes con cáncer de pulmón mediante la extracción de datos de la historia clínica electrónica y, a partir de éstos, obtener indicadores de forma automática utilizando un algoritmo creado en base a las recomendaciones de guías de práctica clínica. El enfoque del trabajo demuestra la aplicabilidad de la ciencia de datos a las ciencias de la salud, confirmando la necesidad de integrar tanto conocimientos y habilidades para extraer información como un entendimiento clínico de los procesos de atención para manipular los datos de manera adecuad
Agency mobilization applying an ethnography-based questionnaire of critical sociolinguistic incidents
No full textIn the context of an action-research project in Madrid focusing on sociolinguistic
inequalities, this paper presents one of the tools used to prompt critical reflection
and discussion on sociolinguistic inequalities and agency amongst higher education students: The questionnaire of critical sociolinguistic incidents. The questionnaire presents experiences drawn from previous ethnographic work that cover situations of misrecognition and unequal distribution of linguistic resources among speakers of minority languages, varieties of Spanish, and the presence of English at Spanish universities. For each critical incident, participant students were presented with multiple-choice answers that suggested possible reactions or opinions, offering different alternatives of agency. The questionnaire of sociolinguistic critical incidents served three main goals: To ask participants to react to lived situations of inequality, to trigger reflection on the agency of speakers, and to assess the impact of the project’s interventions. To assess this impact, the students answered the questionnaire twice, at the beginning and at the end of the semester, in intervention and control groupsOpen Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature.
Ministerio de Ciencia e Innovación, PID2019-105676RB-C41/AEI/10.13039/50110001103
The role of the hydroid Eudendrium racemosum (Cavolini, 1785) (Cnidaria: Hydrozoa) as basibiont for exotic species in marinas
No full textEffective management of non-indigenous species (NIS) in marinas requires accurate knowledge of their biodiversity. A temporal study of macrofaunal assemblages associated to the native arborescent hydroid Eudendrium racemosum was conducted in two marinas with intense maritime traffic on the Spanish Atlantic and Mediterranean coasts. While only 7 (all peracarid crustaceans) of the 52 species were NIS, they frequently dominated macrofaunal assemblages in abundance. Factors affecting these assemblages were primarily hydroid density and water turbidity, and secondarily water salinity and temperature. The relative contribution of NIS to the community, both in number of species and abundance, was significantly higher in Palma (Mediterranean) than in Cádiz (Atlantic) during the entire year. The structure of the total and NIS community also differed between marinas, highlighting the local singularity of these human-made environments. Despite the lack of basibiont specificity of most exotic epibionts, E. racemosum seems to facilitate the proliferation of the exotic amphipod Paracaprella pusilla compared with other hosts, probably due to mutualistic relationshipsFinancial support for this study was provided by the Spanish ‘Ministerio de Economía y Competitividad’ (Project CGL2017-82739-P) co-financed by the ERDF, European Union. We acknowledge all the staff who granted permission for conducting the sampling and observational field studies in marinas. We are very grateful to three anonymous reviewers for valuable comments that helped to improve the manuscrip
Enhanced CO₂ affinity in a metal-organic framework through green incorporation of a dual-functional amino acid
No full textPost-synthetic incorporation of amino acids into the Zr-based metalorganic framework DUT-67 via relatively green methods yields materials with enhanced CO2 affinity. Structural and sorption studies reveal high affinity for DUT-67-Trp, exploiting its dual functionality to achieve an adsorption enthalpy level comparable to those of highperforming frameworks. The findings provide a promising pathway towards developing sustainable amino-functionalized CO2 sorbentsThis project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 101034324. This work was supported by the grants PID2021-123839OB-I00, PID2023-147972OB-I00, RYC2018-024328-I and CNS2022-135261 funded by MICIU/AEI/ 10.13039/501100011033 and the NextGenerationEU/PRTR. The authors acknowledge the financial support from the Spanish Ministry of Science and Innovation, through the “María de Maeztu” Programme for Units of Excellence in R&D (CEX2018000805-M and CEX2023-001316-M
The Social Network of a Group of White‑Fronted Lemurs (Eulemur albifrons) in Managed Care
No full textOur understanding of animal social structures, and primate groups in particular, has been greatly enhanced by the use of social network analysis (SNA). However, strepsirrhine species remain underrepresented in such studies. Existing SNA studies have primarily focused on species with strong female dominance, leaving a gap in our knowledge of species with more flexible dominance hierarchies. We investigated the social networks of one such species: the white-fronted lemur (Eulemur albifrons). We analyzed affiliative (proximity, huddling, grooming) and agonistic (chasing) behaviors in a captive group of 11 individuals: seven adult males, three adult females, and one juvenile male. We found a female-centered structure in affiliative networks, while one adult male was socially isolated and the primary target of aggression. Affiliative networks exhibited high-density behavior and no evidence of subgroups, indicating strong overall group cohesion. Grooming and huddling networks correlated weakly and positively, suggesting that grooming behavior may involve deeper affiliative bonds among individuals than huddling behavior. These findings show that E. albifrons females can occupy central social positions even in the absence of strict female dominance. Beyond contributing to our understanding of lemur sociality, this study provides valuable insights into group dynamics that may support improved management practices in captivity—especially given the limited knowledge available for this speciesOpen Access funding provided thanks to the CRUE-CSIC agreement with Springer Natur
A novel in situ microwave-assisted biomimetic route to modified TiO2 photocatalysts for efficient hydrogen generation under solar irradiation
No full textHydrogen (H2) is widely recognized as a clean and sustainable energy carrier, capable of supporting the global transition toward carbon-neutral energy systems. Among the various production strategies, photocatalytic hydrogen generation from aqueous media using solar energy stands out as a green and low-impact alternative to conventional reforming methods. In particular, the photoreforming of organic compounds, such as alcohols, has emerged as an attractive approach, enabling both H2 production and the valorization of organic substrates. In this work, a series of TiO2-based photocatalysts were synthesized through a novel in situ microwave-assisted biomimetic method, incorporating a marine sponge as a bio-template to modulate the textural and chemical properties of the materials. Several sponge-containing composites (TiO2_Sx) were prepared and characterized, with platinum added as a cocatalyst to promote charge separation and enhance H2 evolution activity. The photocatalytic performance of the materials was evaluated under simulated solar light using four alcohols, methanol, ethanol, ethylene glycol, and 1,2-propanediol, as sacrificial agents. Among the tested photocatalysts, the TiO2_S5 sample exhibited the highest H2 production rate. Ethylene glycol was identified as the most effective sacrificial agent, yielding a maximum H2 generation rate of 1196 μmol⋅gcat 1⋅h 1 and concurrent CO2 evolution of 1156 μmol⋅gcat 1⋅h 1, indicating efficient photoreforming. The superior performance of ethylene glycol is attributed to its vicinal diol structure, which promotes effective hole scavenging. These findings demonstrate that the combination of sponge-assisted TiO2 structuring and polyhydric alcohols as sacrificial agents provides a promising platform for improving solar-driven H2 production through photoreformingThis work was supported by the National Science Centre, Poland (grant no. 2023/51/D/ST8/00206), and by the Spanish State Research Agency and FSE+ (PID2022-141056OB-I00/MCIN/AEI/10.13039/ 501100011033). L. Gudiño acknowledges support from the Spanish Ministry of Science and Innovation through the FPI fellowship (grant no. PRE2020-093998
Competences in Historical Thinking in the Spanish History University Entrance Exam in the Community of Madrid
No full textEl objetivo de esta investigación es evaluar la presencia de las competencias de pensamiento histórico y sus niveles cognitivos en las Pruebas de Acceso a la Universidad, en la asignatura de Historia de España de Bachillerato, realizadas en la Comunidad de Madrid entre 2012 y 2022. Para ello, se ha utilizado una rúbrica de evaluación de competencias de pensamiento histórico (RECH), que incluye tres niveles de concreción, lo que permite evaluar la presencia de las ocho competencias históricas a través del análisis de 404 preguntas. Además, se ha realizado un análisis comparativo entre las preguntas de los exámenes correspondientes al periodo 2012-2016 (LOE) y las del periodo 2017-2022 (LOMCE). Los resultados muestran que más del 50% de las preguntas no incluyen competencias históricas. De las ocho competencias, solo se identificaron cinco: perspectiva histórica, relevancia histórica, evidencias históricas, cambio y continuidad, y causas y consecuencias. En definitiva, no se observan aspectos vinculados a la dimensión ética de la historia, la conciencia histórica ni la formación cívica. Esto permite concluir que la inclusión de estas áreas en las pruebas de acceso a la universidad en la Comunidad de Madrid es limitada e insuficienteThis study aims to evaluate the presence of historical thinking skills and their cognitive level in the Spanish history baccalaureate university entrance exams in the Community of Madrid between 2012 and 2022. For this purpose, we used a rubric for the assessment of historical thinking skills (RECH), which includes three levels of specificity, allowing us to assess the presence of the eight historical skills through the analysis of 404 questions. In addition, a comparative analysis was carried out between the examination questions corresponding to 2012-2016 (LOE) and those corresponding to 2017-2022 (LOMCE). The results show that more than 50% of the questions do not include historical competencies. Only five of the eight skills were identified: historical perspective, historical significance, historical evidence, change and continuity, and causes and effects. In short, no aspects are related to the ethical dimension of history, historical awareness, or civic education. This leads to the conclusion that the inclusion of these areas in university entrance examinations in the Community of Madrid is limited and insufficien
The decurions and their civil liability in the public management of municipalities in the 4th-6th AD
No full textEn el artículo se abordan los requisitos de acceso, el nombramiento y la vinculación de por vida a la curia de los decuriones, encargados del gobierno y de la administración de los municipios en época imperial, los cuales eran los responsables de la recaudación directa de los tributos ante los gobernadores provinciales. Asimismo, se trata, a través de las fuentes jurídicas, la responsabilidad civil de estos magistrados, por ejemplo, cuando realizan negocios jurídicos con terceras personas en representación de sus municipiosThis article addresses the requirements for access, appointment, and lifetime tenure of the decurions, who were in charge of the government and administration of municipalities during the imperial period and were responsible for the direct collection of taxes from the provincial governors. It also examines, through legal sources, the civil liability of these magistrates, for example, when they conduct legal transactions with third parties on behalf of their municipalitie
Pensar con Manuel Sacristán: ecosocialismos para el siglo de la Gran Prueba
No full textManuel Sacristán (1925-1985) fue uno de los escasos
intelectuales de la izquierda europea que, sobre todo desde 1972
en adelante, vio con lucidez que Occidente se adentraba en una
crisis de civilización y que era necesario repensar profundamente
los idearios socialistas (en sentido amplio: socialistas, comunistas,
anarquistas) para hacer frente a los «problemas posleninianos
» (entre ellos, señaladamente, la debacle ecológica que iba
desplegándose). Trabajando en el seno de las redacciones de las
revistas Materiales y después mientras tanto, Sacristán desarrolló
posiciones ecomarxistas que aún hoy se muestran fecundas.
Con este texto intentaré sintetizar estos aportes con la mirada
puesta en los problemas del presente y el futuro: ¿qué pueden
ofrecer los análisis y la práctica de Manuel Sacristán, a cien años
de su nacimiento y cuarenta de su muerte, para los ecosocialismos
del siglo de la Gran Prueba
Computationally guided structural modification of centaureidin: a novel approach for enhancing antioxidant and antitumor activities for drug development
No full textThe development of novel therapeutic drugs with enhanced efficacy has gained significant attention in recent years. In this study, we aimed to enhance the radical scavenging and antitumor activities of centaureidin through computationally guided structural modifications. Centaureidin was initially isolated through extensive phytochemical fractionation from Centaurea scoparia. We employed Density Functional Theory (DFT) and multitarget molecular modeling to explore how modifying the carbon-8 (C-8) position influences bond dissociation enthalpies, radical scavenging mechanisms, and the structure-antitumor activity relationships.
Guided by computational analysis, we then modified the core skeleton of centaureidin using a facile multicomponent Mannich-type synthesis, resulting in two newly substituted centaureidin analogues. The radical scavenging properties of centaureidin and its analogues CA1 and CA4 were investigated using DPPH and ABTS assays. CA1 and CA4 revealed more potent radical scavenging activities. In addition, both analogues were more effective in inhibiting the proliferation of the MCF-7 cancer cell line. All tested compounds exhibited binding affinity towards caspase-3 and the receptors EGFR, HER2 and VEGFR. In conclusion, structural modification of centaureidin resulted in enhanced antioxidant and cytotoxic activities. This comprehensive approach offers a streamlined and cost-effective
pathway for drug design and development, providing valuable insights for
researchers in the field of therapeutic drug productionThis work was carried out with the support from the project PID2023-150717NB
-00 of the Ministerio de Ciencia, Innovacion y Universidades of Spain. The
authors would like to thank the Centro de Computacion Cientifica of
the UAM (CCC-UAM) for the generous allocation of computer time and
continued technical support and the suppor