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Background The E-FAST (Extended Focused Assessment with Sonography in Trauma) protocol is an essential diagnostic tool in emergency medicine. Its structured format and diagnostic relevance make it ideal for early clinical training. The aim of this study was to assess the feasibility of teaching E-FAST ultrasound skills to medical students starting in their second academic year and to compare the educational effectiveness of portable versus conventional ultrasound devices. Methods A structured mixed-learning program was implemented across four academic years at the University of Granada. Students participated in online modules and hands-on workshops supervised by experienced clinicians. Performance was evaluated across five E-FAST windows, assessing probe selection, image acquisition, and anatomical identification. Comparative analysis examined outcomes by year and device type. Results Of 317 participants, even second-year students achieved elevated levels of competency in probe handling, image acquisition, and structure recognition. Conventional ultrasound systems were significantly more effective than portable devices in producing interpretable images and aiding anatomical identification ( p  < 0.001). Conclusions E-FAST training is feasible from the early years of medical education. Conventional systems remain superior for instructional purposes despite the convenience of portable devices.

Background A head-to-head study demonstrated the superiority of once-daily umeclidinium bromide/vilanterol (UMEC/VI) 62.5/25 mcg on trough forced expiratory volume in 1 s (FEV 1 ) versus once-daily tiotropium/olodaterol (TIO/OLO) 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease (COPD). This analysis evaluated the cost effectiveness of UMEC/VI versus TIO/OLO from a Spanish National Healthcare System perspective, using data from this study and Spanish literature. Methods This analysis was conducted from the perspective of the Spanish National Healthcare System with a 3-year horizon as base case. A disease progression model using a linked risk equation approach was used to estimate disease progression and associated healthcare costs, and quality-adjusted life years (QALYs). The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was used to develop the statistical risk equations for clinical endpoints, and costs were calculated using a health state approach (by dyspnea severity). Utilities for QALY calculation were estimated using patient baseline characteristics within a regression fit to Spanish observational data. Treatment effect, expressed as change from baseline in FEV 1 was obtained from the head-to-head study and used in the model (UMEC/VI minus TIO/OLO difference: + 52 mL [95% confidence interval: 28, 77]). Baseline patient characteristics were sourced from Spanish literature or the head-to-head study if unavailable. A scenario analysis using only the intent-to-treat (ITT) population from the head-to-head study, and sensitivity analyses (including probabilistic sensitivity analyses), were conducted. Direct healthcare costs (2017 Euro) were obtained from Spanish sources and costs and benefits were discounted at 3% per annum. Results UMEC/VI was associated with small improvements in QALYs (+ 0.029) over a 3-year time horizon, compared with TIO/OLO, alongside cost savings of €393/patient. The ITT scenario analysis and sensitivity analyses had similar results. All probabilistic simulations resulted in UMEC/VI being less costly and more effective than TIO/OLO. Conclusion UMEC/VI dominated TIO/OLO (more effective and less expensive). These results may aid payers and decision-makers in Spain when making judgements on which long-acting muscarinic antagonist/long-acting β 2 -agonist (LAMA/LABA) treatments can be considered cost effective in Spain.

This cross-sectional multicenter study was performed aimed at describing the clinical characteristics of women with COPD attended in routine daily practice in Spain. Of a total of 1610 consecutive patients diagnosed with COPD recruited in primary care centers and pneumology services throughout Spain over a 90-day period, 17.9% (n=286) were women, with a median age of 62 years. Differences in COPD phenotypes by sex were statistically significant ( = 0.002). Males as compared with females showed a higher prevalence of non-exacerbator (47.9% vs 42.2%) and exacerbator with chronic bronchitis (22.9% vs 18.8%) phenotypes, whereas the ACOS phenotype was more common among females (21.7% vs 12.9%). The mean (SD) CAT score was similar in men than in women (20.8 [9.0] vs 21.2 [8.7], = 0.481), as well as the impact of the disease on the quality of life according to CAT scores of <5 (no impact), 5-9 (low), 10-20 (medium), >20 (high), and >30 (very high). Sex-related differences according to smoking status were statistically significant ( < 0.001), with a higher percentage of men as compared with women in the groups of current smokers and ex-smokers; never-smokers were higher in women (9.1%) than in men (0.6%). The mean number of comorbidities was 2.01 (1.43) (95% CI 1.93-2.09) in males and 1.99 (1.42) (95% CI 1.83-2.16) ( = 0.930) in females, but cardiovascular diseases (hypertension, ischemic heart disease, chronic heart failure) were more frequent in men, whereas metabolic disorders (osteoporosis) were more frequent in women. This study highlights the impact of COPD in women and the importance of continuing sex-based research in tobacco-related respiratory diseases.

Crowdsourcing provides an opportunity for SMEs to exploit collective knowledge that is located outside the organisation. Crowdsourcing allows organisations to keep pace with a fast-changing environment by solving business problems, supporting R&D activities, and fostering innovation cheaply, flexibly, and dynamically. Nevertheless, managing crowdsourcing is difficult, and positive outcomes are not guaranteed. Drawing on the Resource-based View, we study transformational leadership and organisational learning capability as complementary assets to help SMEs deploy crowdsourcing. An empirical study of Spanish telecommunications and biotechnology companies confirmed the moderating effect of organisational learning on the relationship between crowdsourcing and organisational performance.

The inclusion of membrane-based oxygen-fired combustion in power plants is considered an emerging technology that could reduce carbon emissions in a more efficient way than cryogenic oxygen-fired processes. In this paper, a techno-economic assessment was developed for a 863 MWel,net power plant to demonstrate whether this CCS technique results in a reduction in efficiency losses and economic demand. Four configurations based on oxygen transport membranes were considered, while the benchmark cases were the air combustion process without CO2 capture and a cryogenic oxygen-fired process. The type of driving force through the membrane (3-end or 4-end), the point of integration into the oxy-fuel combustion process, the heating system, and the pollutant control system were aspects considered in this work. In comparison, the efficiency losses for membrane-based alternatives were lower than those in the cryogenic oxygen-fired process, reaching savings of up to 14% net efficiency. Regarding the specific energy consumption for CO2 capture, the configuration based on the oxygen transport membrane unit with 4-end mode and hot filtration presented 1.01 kWel,net,·h/kgCO2 captured with 100% CO2 recovery, which is an improvement of 11% compared with the cases using cryogenic oxygen. Comparing economic aspects, the specific investment costs for cases based on the oxygen transport membrane unit varied between 2520 and 2942 $/kWel,net·h. This was between 39.6 and 48.2% above the investment for the reference case without carbon capture. However, its hypothetical implantation could suppose a savings of 10.7% in terms of investment cost compared with cryogenic oxygen-based case. In terms of the levelized cost of electricity and the cost of CO2 avoidance, the oxygen transport membrane configurations achieved more favorable results compared with the cryogenic route, reaching savings up to 14 and 38%, respectively. Although oxygen transport membrane units are currently not mature for commercial-scale applications, the results indicated that its application within carbon capture and storage technologies can be strongly competitive.

Chronic obstructive pulmonary disease (COPD) outpatients account for a large burden of usual care by respirologists. EPOCONSUL is the first national clinical audit conducted in Spain on the medical care for COPD patients delivered in outpatient respiratory clinics. We aimed to evaluate the clinical interventions and the degree of adherence to recommendations in outpatients of current COPD clinical practice guidelines. This is an observational study with prospective recruitment (May 2014-May 2015) of patients with a COPD diagnosis as seen in outpatient respiratory clinics. The information collected was historical in nature as for the clinical data of the last and previous consultations, and the information concerning hospital resources was concurrent. A total of 17,893 clinical records of COPD patients in outpatient respiratory clinics from 59 Spanish hospitals were evaluated. Of the 5,726 patients selected, 4,508 (78.7%) were eligible. Overall, 12.1% of COPD patients did not fulfill a diagnostic spirometry criteria. Considerable variability existed in the available resources and work organization of the hospitals, although the majority were university hospitals with respiratory inpatient units. There was insufficient implementation of clinical guidelines in preventive and educational matters. In contrast, quantitative evaluation of dyspnea grade (81.9%) and exacerbation history (70.9%) were more frequently performed. Only 12.4% had COPD severity calculated according to the Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) index. Phenotype characteristics according to Spanish National Guideline for COPD were determined in 46.3% of the audited patients, and the risk evaluation according to Global initiative for chronic Obstructive Lung Disease was estimated only in 21.9%. The EPOCONSUL study reports the current situation of medical care for COPD patients in outpatient clinics in Spain, revealing its variability, strengths, and weaknesses. This information has to be accounted for by health managers to define corrective strategies and maximize good clinical practice.

Veno-veno extracorporeal membrane oxygenation (VV ECMO) is used as a bridge to recovery in acute respiratory distress syndrome (ARDS) patients who have reversible lung failure. We present a complication of ECMO cannula placement/position resulting in hemodynamic and oxygenation alterations. These demonstrate principles related to the interaction of the VV ECMO circuit and patient cardio-pulmonary physiology. Consideration and comprehension of pulmonary shunt fraction, ECMO cannula recirculation ratio and ECMO blood flow to cardiac output (CO) ratio are central to continuous assessment and diagnosis of cardio-pulmonary changes encountered during management of VV ECMO. •Unrecognized peri-cannulation pneumothorax may cause ECMO cannula malposition.•Pulmonary shunt fraction often worsens after initiation of VV ECMO.•Without working lungs, arterial oxygenation is governed by ECMO blood flow to CO ratio.

In this work, we report the preparation of TiO2 nanoparticles with a high surface area, from 120 to 168 m2 g−1 by the hydrothermal-microemulsion route and hydrothermal temperature effect over particle size, porosity, and photovoltaic parameter. The TiO2 samples were characterized by Raman, BET, TEM, SEM-FE, I–V curves, and EIS. The increase of hydrothermal temperature correlates with particle and pore size. Although when the synthesis temperature was 250 °C, the surface area presents an unexpected decrease of c.a. 28%. TiO2 samples were employed as thin-film photo-anodes for dye-sensitized solar cell (DSSC) solar cells. Photovoltaic results showed that the sample prepared at 250 °C presented the more suitable textural properties for the DSSC application. The prepared TiO2 materials with a particle size of 6.93 ± 0.59 nm and anatase crystalline phase favor electron transport and diffusion of electrolyte species, which directly impact in solar cell efficiency.

Background: The cost of chronic obstructive pulmonary disease (COPD) in Spain has been studied from different perspectives, but parameters such as the patient's phenotype have seldom been considered. Our aim was to describe the disease burden of COPD patients with frequent exacerbator phenotype, treated with triple therapy. Methods: An observational, multicenter study was carried out from December 2017 to November 2018 in pulmonology services among patients [greater than or equal to] 40 years with COPD confirmed diagnosis receiving triple therapy (ICS/LAMA/LABA) and history of [greater than or equal to] 2 moderate or [greater than or equal to] 1 severe exacerbation in the 12 months prior to the inclusion visit. COPD-related healthcare resources were collected over a 12-months period prior to the inclusion visit: pharmacological and non-pharmacological treatments, medical and ER visits, hospitalizations, tests and productivity loss. Costs were updated to 2019 [euro]. Patients were classified according to blood eosinophil levels: <150 cells/[micro]L and [greater than or equal to] 150 cells/[micro]L. Results: A total of 306 patients were included (77.1% men), with mean age of 69.9 years. Mean COPD exacerbation rate was 2.5/patient/year and 51.3% of patients had [greater than or equal to] 150 cells/[micro]L eosinophil level. On average, for the total population, COPD-related visits/patients/year were 6.2. Resource use in moderate exacerbation was higher in patients with eosinophils [greater than or equal to] 150 cells/[micro]L, whereas in severe exacerbation was higher in patients with eosinophils <150 cells/ [micro]L. According to eosinophil levels, total annual mean (SD) costs/patient accounted for 8382 [euro] (9863) and 5144 [euro] (5444) for patients with eosinophils <150 cells/[micro]L and [greater than or equal to] 150 cells/[micro]L, respectively. Conclusion: The impact of exacerbating COPD patients treated with triple therapy in Spain is large, especially among those with eosinophils <150 cells/[micro]L. Keywords: frequent exacerbation, triple therapy, cost, eosinophil, health care resources, COPD

Immediate postoperative extubation (IPE) can reduce perioperative complications and length of stay (LOS), however it is performed variably after liver transplant across institutions and has historically excluded high-risk recipients from consideration. In late 2012, we planned and implemented a single academic institution structured quality improvement (QI) initiative to standardize perioperative care of liver transplant recipients without exceptions. We hypothesized that such an approach would lead to a sustained increase in IPE after primary (PAC) and delayed abdominal closure (DAC). We retrospectively studied 591 patients from 2013 to 2018 who underwent liver transplant after initiative implementation. We evaluated trends in incidence of IPE versus delayed extubation (DE), and reintubation, LOS, and mortality. Overall, 476/591 (80.5%) recipients underwent PAC (278 IPE, 198 DE) and 115/591 (19.5%) experienced DAC (39 IPE, 76 DE). When comparing data from 2013 to data from 2018, the incidence of IPE increased from 9/67 (13.4%) to 78/90 (86.7%) after PAC and from 1/12 (8.3%) to 16/23 (69.6%) after DAC. For the same years, the incidence of IPE after PAC for recipients with MELD scores ≥30 increased from 0/19 (0%) to 12/17 (70.6%), for recipients who underwent simultaneous liver-kidney transplant increased from 1/8 (12.5%) to 4/5 (80.0%), and for recipients who received massive transfusion (>10 units of packed red blood cells) increased from 0/17 (0%) to 10/13 (76.9%). Reintubation for respiratory considerations <48 h after IPE occurred in 3/278 (1.1%) after PAC and 1/39 (2.6%) after DAC. IPE was associated with decreased intensive care unit (HR of discharge: 1.92; 95% CI: 1.58, 2.33; P < 0.001) and hospital LOS (HR of discharge: 1.45; 95% CI: 1.20, 1.76; P < 0.001) but demonstrated no association with mortality. A structured QI initiative led to sustained high rates of IPE and reduced LOS in all liver transplant recipients, including those classified as high risk. •Evidence based structured quality initiative leads to immediate postoperative extubation of liver transplant recipients.•Consistent with prior literature, immediate postoperative extubation of liver transplant patients is a safe practice.•Immediate postoperative extubation is feasible even in patients who have undergone delayed abdominal closure.