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Perioperative Patient Blood Management and Outcomes in Major Elective Orthopaedic Surgery
No full textAntecedents: Les estratègies de Patient Blood Management (PBM) són considerades una bona pràctica en cirurgies amb alt risc de sagnat; no obstant això, el coneixement sobre la pràctica clínica actual i el seu impacte en els resultats en els pacients és limitat. Mètodes: Es va seguir un disseny de cohort retrospectiu multicèntric, combinant l’anàlisi a nivell d’hospital i de pacient. L’estudi va incloure pacients intervinguts d’artroplàstia primària de genoll o maluc entre el gener de 2016 i el desembre de 2022 en 47 hospitals d’Espanya. La via clínica de PBM en el procés perioperatori va comprendre nou intervencions basades en les recomanacions de les guies, i el seu compliment es va analitzar amb un indicador compost de qualitat. Es van avaluar les complicacions postoperatòries als 30 dies, l’estada hospitalària i l’ús de transfusió sanguínia. L’associació entre el nivell de compliment i els resultats es va estimar mitjançant models de regressió multivariable multinivell. Resultats: Els hospitals van aplicar el 62% de les recomanacions en PBM, i només el 12% dels pacients van rebre l’atenció de manera íntegra. Les intervencions amb més variabilitat van ser el cribratge preoperatori del metabolisme del ferro i la transfusió d’una sola unitat. Un major compliment es va associar amb un 57% menys de probabilitat de tenir complicacions postoperatòries als 30 dies, estades hospitalàries més curtes i menor necessitat de transfusions. Conclusions: El seguiment de les recomanacions en PBM va ser subòptim, amb una elevada variació entre hospitals. Un major grau d’adequació es va associar amb millors resultats en pacients sotmesos a artroplàsties de genoll i maluc.Background: Patient Blood Management (PBM) strategies are considered the best practice for high-risk bleeding surgeries; however, knowledge of current practices and their impact on patient outcomes is limited. Methods: This research followed a retrospective multicentre cohort design combining hospital- and patient-level analyses. The study included patients who underwent elective primary total knee or hip arthroplasty between 1 January 2016 and 31 December 2022 across 47 hospitals in Spain. The PBM clinical pathway consisted of nine major guideline-recommended interventions, with adherence measured using a composite quality indicator. Endpoints included 30-day postoperative complications, length of hospital stay, and red blood cell utilisation. Multilevel multivariable regression models were used to assess the association between PBM adherence and the outcomes. Results: Hospitals provided 62% of the recommended PBM care, with only 12% of patients receiving the complete PBM clinical pathway. The greatest variability occurred in preoperative iron screening and single-unit transfusion. Higher per-patient adherence to the PBM pathway was associated with 57% lower odds of 30-day postoperative complications, shorter hospital stays, and reduced transfusion requirements. Conclusions: Adherence to perioperative recommended PBM care was suboptimal, with considerable variation across hospitals. Higher adherence was associated with improved outcomes in patients undergoing total knee and hip arthroplasties.Universitat Pompeu Fabra. Doctorat en Biomedicin
Revolver el tiempo: nuevas historicidades para nuevos futuros en la investigación artística
No full textReferential communication in heterogeneous communities of pre-trained visual deep networks
No full textData de publicació electrònica: 25-04-2025As large pre-trained image-processing neural networks are being embedded in autonomous agents such as self-driving cars or robots, the question arises of how such systems can communicate with each other about the surrounding world, despite their different architectures and training regimes. As a first step in this direction, we systematically explore the task of referential communication in a community of heterogeneous state-of-the-art pre-trained visual networks, showing that they can develop, in a self-supervised way, a shared protocol to refer to a target object among a set of candidates. This shared protocol can also be used, to some extent, to communicate about previously unseen object categories of different granularity. Moreover, a visual network that was not initially part of an existing community can learn the community's protocol with remarkable ease. Finally, we study, both qualitatively and quantitatively, the properties of the emergent protocol, providing some evidence that it is capturing high-level semantic features of objects.We thank Agnieszka Słowik for early contributions to this work. We are also grateful to Thomas Brochhagen, Dan Dediu, Rahma Chaabouni, Emily Cheng, Valentino Maiorca, Luca Moschella, Clément Moulin Frier, the members of the COLT group and the TMLR editor and reviewers for useful feedback. This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 101019291). We also received funding from the Catalan government (AGAUR grant SGR 2021 00470). This paper reflects the authors’ view only, and the funding agencies are not responsible for any use that may be made of the information it contains
From perception to action: implementing in-context imitation learning on a franka robot for pick-and-place tasks
No full textTreball fi de màster de: Erasmus Mundus joint Master in Artificial Intelligence (EMAI)Supervisor: Alessandro De Luca
Co-Supervisor: Magí Dalmau MorenoThis thesis presents a practical implementation of Instant Policy, an In-Context Imitation Learning (ICIL) model characterized by the rapid learning of new tasks, after processing a few number of demonstrations at inference time. The research evaluates how demonstration context modifications affect the model ability to understand and generalize manipulation behaviors using a Franka Emika Panda arm and Intel RealSense D435 camera integrated with Instant Policy, a state-of-the-art one-shot learning model. The core research systematically modifies demonstration buffers to analyze the model contextual reasoning capabilities across different pick-and-place scenarios. Besides, we deploy a modular pipeline that transforms RGB-D input into structured point clouds through YOLOv11-based segmentation, enabling object identification, demonstration extraction and model deployment at test time. To address gripper annotation challenges, we introduce an automated dataset creation methodology combining LangSAM for text-prompt-based segmentation and XMem++ for video mask propagation. The control architecture employs Instant Policy as a Denoising Diffusion Implicit Model, generating action sequences through graph-based reasoning over point clouds and demonstration context. Experimental results demonstrate successful adaptation of pick-and-place behaviors based on different demonstration contexts, with generalization across object pose and background variations. Performance analysis reveals critical dependencies on segmentation quality, highlighting robust perception requirements for real-world deployment. This work validates ICIL viability for robotic pick-and-place tasks, contributing insights into context understanding, automated dataset creation, and empirical validation of ICIL performance in unstructured manipulation scenarios
Preguntas comunes y respuestas razonadas sobre el síndrome del sobrecrecimiento bacteriano intestinal (SIBO)
No full textLa identificación y el tratamiento del síndrome de sobrecrecimiento bacteriano intestinal son materias sujetas a controversia. Los síntomas que han orientado la búsqueda del trastorno adolecen de falta de especificidad, especialmente en ausencia de factores predisponentes bien definidos. La precisión de los procedimientos diagnósticos ha sido cuestionada y las terapias propuestas alcanzan cifras de efectividad en general bajas, con grandes diferencias entre los estudios disponibles. También se desconoce si la normalización de los test es realmente garantía de curación. En este marco de incertidumbre, y con la intención de contribuir a orientar y a homogeneizar la praxis médica, un grupo de expertos de la AEG y la ASENEM han formulado las preguntas fundamentales sobre el manejo de la patología y les han dado respuesta, de acuerdo a la evidencia científica disponible. Además, han elaborado declaraciones basadas en las conclusiones de la revisión realizada, y las han sometido a votación individual para reflejar el grado de consenso correspondiente a cada una de las mismas
Paisajes y ficciones sonoras en formato de podcast una alternativa para reducir la ansiedad en pacientes odontológicos
No full textEn el manejo de la ansiedad dental se han utilizado métodos alternativos a la farmacoterapia, entre ellos, la musicoterapia cuya efectividad es controversial. El objetivo principal de esta investigación fue analizar la efectividad de otro tipo de intervenciones sonoras (paisaje y ficción) en la reducción de la ansiedad dental. Para ello, se midieron las respuestas psicofisiológicas y autoperceptivas, junto con la observación conductual, en 60 pacientes divididos aleatoriamente en dos grupos experimentales y uno de control. Los resultados evidenciaron efectos significativos en la creación de imágenes mentales, en la atención y en la percepción del tiempo. Las respuestas psicofisiológicas mostraron una disminución de la frecuencia cardíaca (grupo intervención vs. grupo control) y del nivel de conductancia (ficción sonora vs. paisaje sonoro). Estos hallazgos sugieren que tanto los paisajes como las ficciones sonoras fueron eficaces para disminuir la ansiedad durante los procedimientos dentales.In the management of dental anxiety, alternative methods to pharmacotherapy have been used, including music therapy, whose effectiveness remains controversial. The main objective of this research was to analyze the effectiveness of other types of sound interventions (soundscapes and audio fiction) in reducing dental anxiety. To achieve this, psychophysiological and self-perceptive responses were measured, along with behavioral observation, in 60 patients randomly divided into two experimental groups and one control group. The results showed significant effects on mental imagery, attention, and time perception. Psychophysiological responses demonstrated a decrease in heart rate (intervention group vs. control group) and conductance levels (audio fiction vs. soundscape). These findings suggest that both soundscapes and audio fiction were effective in reducing anxiety during dental procedures.Programa de Doctorat en Comunicaci
A single-cell resolved genotype-phenotype map using genome-wide genetic and environmental perturbations
No full textHeterogeneity is inherent to living organisms and it determines cell fate and phenotypic variability. Despite its ubiquity, the underlying molecular mechanisms and the genetic basis linking genotype to-phenotype heterogeneity remain a central challenge. Here we construct a yeast knockout library with a clone and genotype RNA barcoding structure suitable for genome-scale analyses to generate a high-resolution single-cell yeast transcriptome atlas of 3500 mutants under control and stress conditions. We find that transcriptional heterogeneity reflects the coordinated expression of specific gene programs, generating a continuous of cell states that can be responsive to external insults. Cell state plasticity can be genetically modulated with mutants that act as state attractors and disruption of state homeostasis results in decreased adaptive fitness. Leveraging on intra-genetic variability, we establish that regulators of transcriptional heterogeneity are functionally diverse and influenced by the environment. Our multimodal perturbation-based single-cell Genotype-to-Transcriptome Atlas in yeast provides insights into organism-level responses.This work was founded by MICIU/AEI /10.13039/501100011033 and ERDF/EU to FP and EdN (PID2021-124723NB-C21/C22). Funding from the Ministry of Science, Innovation and Universities through the Centres of Excellence Severo Ochoa Award, and from the CERCA Programme of the Government of Catalonia and the Unidad de Excelencia María de Maeztu, funded by the AEI (CEX2018-000792-M). The Ramon y Cajal Program (Spanish Ministry of Science, RYC2021-033520-I) and La Caixa Junior (LCF/BQ/PR20/11770001) awarded to MNR. FP and EdeN are recipients of an ICREA Acadèmia award (Government of Catalonia)
Pharmacodynamic interaction of apotransferrin and anti-pseudomonal antibiotics against extensively drug-resistant Pseudomonas aeruginosa in a dynamic PK/PD model
No full textObjectives: The rise of antibiotic resistance in clinical settings poses a major challenge. Apotransferrin has emerged as a potential non-traditional therapy for combating infections, potentially preventing resistance development while enhancing bactericidal effects. This study evaluated the efficacy of apotransferrin combined with antipseudomonal antibiotics against extensively drug-resistant (XDR) Pseudomonas aeruginosa isolates. Methods: Twenty XDR P. aeruginosa clinical isolates were evaluated. Different apotransferrin concentrations were tested to determine the optimal in vitro concentration. Time-kill assays assessed the combined effects of apotransferrin with meropenem or ceftolozane/tazobactam (C/T). A chemostat model using four selected isolates validated the most effective combinations and monitored resistance emergence. Results: Apotransferrin monotherapy did not reduce bacterial load, but its combination with antipseudomonal antibiotics enhanced efficacy. Meropenem activity improved in 10/20 isolates, and C/T activity in 13/20 compared to antibiotic monotherapy. The chemostat model confirmed synergistic interactions between apotransferrin and C/T in two isolates, with additive effects in two others. This combination outperformed the most effective monotherapy in all isolates, with no emergence of new C/T-resistant strains. Conclusions: In conclusion, the combination of apotransferrin with C/T demonstrated superior in vitro efficacy against XDR P. aeruginosa isolates compared to either treatment alone. These findings suggest that apotransferrin could be a valuable adjunctive therapy, enhancing the antimicrobial effects of existing antibiotics and potentially extending their clinical utility
La productividad del fracaso
No full textEn nuestra sociedad neoliberal e hiperproductiva, el éxito individual se ha convertido en uno de los valores más importantes y codiciados. Los gurús del éxito enseñan que incluso el error y el fracaso se deben emplear como medios para éxitos futuros. Contra esta máquina de subjetividades presuntamente perfectas, cada vez más voces críticas defienden una liberación lúdica y queer en la que el fracaso pueda recobrar sus sentidos propios. Tras el error, el tropiezo y la caída se abre todo un universo en que elementos como lo absurdo, lo inútil y lo contradictorio florecen en todo su esplendor. Hoy en día, algunas prácticas artísticas nos permiten tomar conciencia de los aspectos fundamentales del fracaso. Recorreré a diferentes artistas contemporáneos para describir los diferentes estadios de la reflexión existencial que emerge en condiciones de fracaso. Sus diferentes momentos pasan por la crisis del yo, la recuperación de la dignidad en el reintento, la reflexión sobre la formación de hábitos y normas sociales y la experiencia del estado elemental de la existencia
Strengthening resilience to emerging vector-borne diseases in Europe: lessons learnt from countries facing endemic transmission
No full textEmerging vector-borne diseases (VBDs) are a major public health concern worldwide. Climate change, environmental degradation and globalisation have led to an expansion in the range of many vectors and an erosion of transmission barriers, increasing human exposure to new pathogens and the risk for emerging VBD outbreaks. Europe is potentially underprepared for the increasing threat of VBDs, due to attention and funding being diverted to other public health priorities. Proactive, rather than reactive, prevention and control approaches can greatly reduce the socio-economic toll of VBDs. Endemic countries globally have decades of experience in controlling VBDs, and Europe has much to learn from this knowledge. Here, we advocate for the expansion of transdisciplinary knowledge-sharing partnerships, to co-create proactive measures against VBDs. We present the experiences and expertise of our diverse international team and explore how an array of interventions can be applied and adapted to the European context.We acknowledge Adrià San José Plana, Bruno Moreira de Carvalho and Danielle Andreza da Cruz Ferreira for providing Spanish and Portuguese translations of the abstract. RL and CTC acknowledge support from the Wellcome Trust (HARMONIZE 224694/Z/21/Z and IDExtremes 226069/Z/22/Z). FC acknowledges support from the Wellcome Trust (Mosqlimate 218987/Z/19/Z). RL, JRBP, FB and TM acknowledge EU's Horizon Europe research and innovation programme (E4Warning; grant agreement 101086640 and IDAlert; grant agreement 101057554) and RL acknowledges a Royal Society Dorothy Hodgkin Fellowship. GECC acknowledges joint Centre funding from the UK Medical Research Council and the Department for International Development [MR/R0156600/1]. GECC acknowledges a BSC AI4Science Fellowship funded by the European Union Recovery and Resilience Mechanism-Next Generation as part of the Spanish Ministry Recovery, Transformation and Resilience Plan. GSR acknowledges support from the Brazilian National Council for Scientific and Technological Development (311365/2021-3); the Coordination for the Improvement of Higher Education Personnel, Brazilian Ministry of Education; the Research Support Foundation of the State of Bahia (PET0022/2016); and the Department of Science and Technology, Secretariat of Science, Technology and Strategic Inputs, Brazilian Ministry of Health. CA acknowledges the collaboration and financial support of the International Atomic Energy Agency. AM acknowledges the "Research project for the entomological surveillance of mosquitoes in Attica Region, Greece" (funded by the Attica Region). The ISGlobal authors acknowledge support from the grant CEX2023-0001290-S funded by MCIN/AEI/10.13039/501100011033, the CIBER-Consorcio Centro de Investigación Biomédica en Red-(Grant ID:CB21/13/00112), and the Generalitat de Catalunya through the CERCA Program and AGAUR programme (2021 SGR 01558)