Revista Jurídica Digital UANDES
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Intermittent prophylactic antibiotics for bronchiectasis
No full textBackground: Bronchiectasis is a common but under-diagnosed chronic disorder characterised by permanent dilation of the airways arising from a cycle of recurrent infection and inflammation. Symptoms including chronic, persistent cough and productive phlegm are a significant burden for people with bronchiectasis, and the main aim of treatment is to reduce exacerbation frequency and improve quality of life.Prophylactic antibiotic therapy aims to break this infection cycle and is recommended by clinical guidelines for adults with three or more exacerbations a year, based on limited evidence. It is important to weigh the evidence for bacterial suppression against the prevention of antibiotic resistance and further evidence is required on the safety and efficacy of different regimens of intermittently administered antibiotic treatments for people with bronchiectasis.ObjectivesTo evaluate the safety and efficacy of intermittent prophylactic antibiotics in the treatment of adults and children with bronchiectasis.Search methodsWe identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted searches on 6 September 2021, with no restriction on language of publication.Selection criteriaWe included randomised controlled trials (RCTs) of at least three months' duration comparing an intermittent regime of prophylactic antibiotics with placebo, usual care or an alternate intermittentregimen. Intermittent prophylactic administration was defined as repeated courses of antibiotics with on-treatment and off-treatment intervals of at least 14 days' duration. We included adults and childrenwith a clinical diagnosis of bronchiectasis confirmed by high resolution computed tomography (HRCT), plain film chest radiograph, or bronchography and a documented history of recurrent chest infections. We excluded studies where participants received high dose antibiotics immediately prior to enrolment or those with a diagnosis of cystic fibrosis, allergic bronchopulmonary aspergillosis(ABPA), primary ciliary dyskinesia, hypogammaglobulinaemia, sarcoidosis, or a primary diagnosis of COPD. Our primary outcomes were exacerbation frequency and serious adverse events. We did not exclude studies on the basis of review outcomes.Data collection and analysisWe analysed dichotomous data as odds ratios (ORs) or relative risk (RRs) and continuous data as mean differences (MDs) or standardised mean differences (SMDs). We used standard methodological procedures expected by Cochrane. We conducted GRADE assessments for the following primary outcomes: exacerbation frequency; serious adverse events and secondary outcomes: antibiotic resistance; hospital admissions; health-related quality of life.Main resultsWe includedeightRCTs,with interventions ranging from16 to 48weeks, involving 2180 adults. All evaluatedone ofthree types of antibiotics over two to six cycles of 28 days on/o@ treatment: aminoglycosides, ß-lactams or fluoroquinolones. Two studies also included 12 cycles of 14 days on/off treatment with fluoroquinolones. Participants had a mean age of 63.6 years, 65% were women and approximately 85% Caucasian. Baseline FEV1 ranged from 55.5% to 62.6% predicted. None of the studies included children. Generally, there was a low risk of bias in the included studies.Antibiotic versus placebo: cycle of 14 days on/o . Ciprofloxacin reduced the frequency of exacerbations compared to placebo (RR 0.75, 95% CI 0.61 to 0.93; I² = 65%; 2 studies, 469 participants; moderate-certainty evidence), with eight people (95% CI 6 to 28) needed to treat for an additional beneficial outcome. The intervention increased the risk of antibiotic resistance more than twofold (OR 2.14, 95% CI 1.36 to 3.35; I² = 0%; 2 studies, 624 participants; high-certainty evidence). Serious adverse events, lung function (FEV1), health-related quality of life, and adverse ffects did not differ between groups.Antibiotic versus placebo: cycle of 28 days on/o . Antibiotics did not reduce overall exacerbation frequency (RR 0.92, 95% CI 0.82 to 1.02; I²=0%; 8 studies, 1695 participants; high-certainty evidence) butthere were fewer severe exacerbations (OR 0.59, 95% CI 0.37 to 0.93; I²= 54%; 3 studies, 624 participants),though this should be interpretedwith caution due to loweventrates. The risk of antibiotic resistancewas more than twofold higher based on a pooled analysis (OR 2.20, 95% CI 1.42 to 3.42; I² = 0%; 3 studies, 685 participants; high-certainty evidence)and consistent with unpooled data from four further studies. Serious adverse events, time to first exacerbation, duration of exacerbation, respiratory-related hospital admissions, lung function, health-related quality of life and adverse effects did not differ between study groups.Antibiotic versus usual care. We did not find any studies that compared intermittent antibiotic regimens with usual care.Cycle of 14 days on/o versus cycle of 28 days on/o . Exacerbation frequency did not differ between the two treatment regimens (RR 1.02, 95% CI 0.84 to 1.24; I² = 71%; 2 studies, 625 participants; moderate-certainty evidence) However, inconsistencies in the results from the two trials in this comparison indicate that the apparent aggregated similarities may not be reliable. There was no evidence of a difference in antibiotic resistance between groups (OR 1.00, 95% CI 0.68 to 1.48; I² = 60%; 2 studies, 624 participants; moderate-certainty evidence).Serious adverse events, adverse effects, lung function and health-related quality of life did not differ between the two antibiotic regimens.Authors' conclusionsOverall, in adults who have frequent chest infections, long-term antibiotics given at 14-day on/off intervals slightly reduces the frequency of those infections and increases antibiotic resistance. Intermittent antibiotic regimens result in little to no difference in serious adverse events. The impact ofintermittent antibiotic therapy on childrenwithbronchiectasis is unknowndue to an absence of evidence, and further research is needed to establish the potential risks and benefits
Found childhood as a practice of child as method
No full textThis article presents the rationale for ‘found childhood’, a crossdisciplinary project mobilising the art practice of ‘found objects’ to attend specifically to found objects concerning childhood. Found childhood reflects an emerging approach, child as method [Burman, E. 2019. Fanon, Education, Action: Child as Method. Abingdon: BrunnerRoutledge], that interrogates both contemporary modalities of childhood and wider social relations disclosed by the prism of childhood. Narratives of visual records of a discarded/found childhood-related artefacts encountered in public space are presented and reflected upon, conceptually and methodologically. The approach combines debates on contemporary relationships constellated around childhood with social geographies of urban space, and its non-places, alongside narrative and walking methodologies as embodied practices giving rise to new modes of remembering. Framed around a specific example, its potential as a practical socio-spatial pedagogy is discussed as opening up forms and meanings of childhood in contemporary culture, and its material practice, helping expose normative assumptions and invite new modes of engagement.</p
Advanced Beam Shaping for Ultrafast Laser Micro-processing
No full textThis paper details the use of novel beam shaping methods to improve the flexibility and speed of ultrafast laser micro-processes. The vector fields of a picosecond-pulse laser beam are shaped using a Spatial Light Modulator (SLM) and polarization optics, so that both the amplitude and direction of the electric field vectors are controlled with a high spatial resolution. This allows to shape the focal field landscapes obtained by focusing the beam with a low Numerical Aperture (NA) lens. A number of shaped vector beams are produced, including radially or azimuthally polarized vortex beams. All these beams are then used for surface ablation of titanium alloy substrates at low fluence to imprint Laser Induced Periodic Surface Structures (LIPSS). Thanks to their polarization dependent properties, LIPSS help to analyse the vector fields in the focal region. This analysis reveals for the first time how the orbital angular momentum associated with a vortex vector field induces complex focal field landscapes which fluctuate along the optical axis of the focusing lens. The produced shaped focal fields are also used for helical micro-drilling stainless steel and silicon substrates. The results are compared in terms of quality and efficiency, illustrating how the distinct machining properties associated with each beam make it best suited for specific processes or materials
Transhumanismo, discurso transgénero y digitalismo. Una réplica al profesor Vicente Bellver
No full textEl centralismo como imperativo categórico en el modelo de organización territorial de España
No full textThe present paper is an approach to a critical reading of the Spanish model of territorial organization, apparently strongly decentralized through Autonomous Communities. This model aims to explain the causal bonds, from history to present times, of the centrifugal movements’ strength in a State that never achieved the completion of its identity construction, its state-building and least of all, its nation-building. Not even with the extreme violence exerted against the national minorities in different non-democratic historical periods. The inability of the predominant political culture in Spain to assume this plurality or plurinationality, especially its elites, involves a radical anti-federalism that seems to be catalyzing powerful political and social independentism movements in some of its territorial peripheries. The data show a substantial increase of independentism in Catalonia or almost the virtual disappearance of one of the great Spanish parties (the People’s Party) in Euskadi and also in Catalonia.Aproximación a una lectura crítica del modelo de organización territorial español, en apariencia fuertemente descentralizado mediante Comunidades Autónomas, que pretende explicar los vínculos causales, desde la historia al presente, para la persistente fortaleza de los movimientos centrífugos existentes en un Estado que nunca logró completar su construcción identitaria, su state-building y, mucho menos, su nation-building, ni siquiera con la extrema violencia ejercida contra las minorías nacionales en distintos períodos históricos no democráticos. La incapacidad de la cultura política mayoritaria en España, singularmente de sus élites, de asumir esta pluralidad o esta plurinacionalidad, conlleva un radical antifederalismo que parece estar actuando como catalizador de poderosos movimientos políticos y sociales independentistas en varias de sus periferias territoriales, como demuestran los datos aportados de incremento sustancial, en escaso tiempo, del independentismo en Cataluña o la práctica desaparición de uno de los grandes partidos españoles (el Partido Popular) en el País Vasco y también en Cataluña
El alcance del deber de sinceridad en el seguro de daños al momento de notificar el siniestro y de declarar las circunstancias y consecuencias de este
No full textThe article reviews the national doctrine and the scarce jurisprudence related to numbers 7 and 8 of article 524 of the Commercial Code, which each provide for the duties of sincerity. Faced with the absence of an express rule that determines when the company can legitimately reject coverage for transgression of these duties, it proposes some guidelines that address the duty whose fulfillment is weighed, the purpose it pursues and whether the inaccuracies or errors in them influences or not the duty to compensate and the amount of compensation, avoiding two extremes: that the insurer exacerbates the importance of any inaccuracies in the notification of the claim or in the subsequent information and that the insured does not make the minimum effort that allows the company to know in a timely manner the occurrence of the claim, its circumstances and consequences.El artículo revisa la doctrina nacional y la escasa jurisprudencia relativa a los números 7 y 8 del artículo 524 del Código de Comercio que contemplan sendos deberes de sinceridad. Frente a la ausencia de norma expresa que determine cuándo la compañía puede legítimamente rechazar la cobertura por transgresión de estos deberes, propone algunas pautas que atienden a cuál sea el deber cuyo cumplimiento se pondera, la finalidad que este persigue y si las inexactitudes o errores en el cumplimiento de los deberes influyen o no en el deber de indemnizar y en el monto de la indemnización, debiendo evitarse dos extremos: que el asegurador exacerbe la importancia de cualquier imprecisión en la notificación del siniestro o en las informaciones posteriores y que el asegurado no haga el esfuerzo mínimo que le permita a la compañía conocer oportunamente la ocurrencia del siniestro, sus circunstancias y consecuencias
Chemical Species Tomography
No full textThe tomographic imaging of chemical species distributions has undergone rapid development in the last 20 years, driven by the combination of key scientific and technological challenges, the emergence of new optoelectronic hardware, and fundamental progress in inverse problems. We describe here the state of the art in Chemical Species Tomography using transmission-based spectroscopic absorption. The treatment ranges from the infrared spectroscopy of target species and associated spectroscopic techniques, through hardware implementation in optical and electronic systems, to image reconstruction methods. In this second edition, we have taken the opportunity to include a greater variety of case studies in order to illustrate central advances in the field, including landmark applications to engineering processes
Determinación de la sanción administrativa en materia de educación
No full textThis investigation analyzes how the criteria for administrative sanction in education matters must be applied. The educational regulation when referring to the economic benefit, nature and gravity of the infringement makes a clear reference of the principals or proportionality, reasonableness, and measurability. Despite this, jurisprudence still does not consolidate the idea that the courts can control and review the sanction imposed by the Administration.Esta investigación analiza cómo se deben aplicar los criterios de determinación de la sanción administrativa en materia de educación. La normativa educacional al referirse al beneficio económico y la naturaleza y gravedad de la infracción como criterios de determinación de la sanción, hace una remisión clara a los principios de proporcionalidad, razonabilidad y mensurabilidad. A pesar de eso, aún la jurisprudencia no consolida la idea de que los tribunales pueden controlar y revisar la sanción que impone la Administración