91 research outputs found
Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: Impact of a Multidimensional Strategy to Reduce Ventilator-Associated Pneumonia in Neonatal Intensive Care Units in 10 Developing Countries
No full textRodriguez Ferrer, Marena Luz/0000-0002-8053-8454WOS: 000304998300009PubMed: 22669232DESIGN. Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP). SETTING. Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and Turkey. PATIENTS. NICU inpatients. METHODS. VAP rates were determined during a first period of active surveillance without the implementation of the multidimensional approach (phase 1) to be then compared with VAP rates after implementation of the INICC multidimensional infection control program (phase 2), which included the following practices: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback on VAP rates, and performance feedback on infection control practices. This study was conducted by infection control professionals who applied National Health Safety Network (NHSN) definitions for healthcare-associated infections and INICC surveillance methodology. RESULTS. During phase 1, we recorded 3,153 mechanical ventilation (MV)-days, and during phase 2, after the implementation of the bundle of interventions, we recorded 15,981 MV-days. The VAP rate was 17.8 cases per 1,000 MV-days during phase 1 and 12.0 cases per 1,000 MV-days during phase 2 (relative risk, 0.67 [95% confidence interval, 0.50-0.91]; P = .001), indicating a 33% reduction in VAP rate. CONCLUSIONS. Our results demonstrate that an implementation of the INICC multidimensional infection control program was associated with a significant reduction in VAP rate in NICUs in developing countries. Infect Control Hosp Epidemiol 2012;33(7):704-710Foundation to Fight against Nosocomial InfectionsFinancial support. The funding for the activities performed at INICC headquarters were provided by V.D.R. and the Foundation to Fight against Nosocomial Infections
Theoretical investigation considering manufacturing errors of a high concentrating photovoltaic of Cassegrain design and its experimental validation
No full textThis is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.A compact high concentrating photovoltaic module based on cassegrain optics is presented; consisting of a primary parabolic reflector, secondary inverse parabolic reflector and a third stage homogeniser. The effect of parabolic curvatures, reflector separation distance and the homogeniser’s height and width on the acceptance angle has been investigated for optimization. Simulated optical efficiencies of 84.82 – 81.89 % over a range of ±1 degree tracking error and 55.49% at a tracking error of ±1.5 degrees were obtained. The final singular module measures 169mm in height and 230mm in width (not including structural components such as cover glass).The primary reflector dish has a focal length of 200mm and is afocal with the secondary inverse reflector which has a focal length of 70mm. The transparent homogenising optic has a height of 70mm, an entry aperture of 30 x 30mm and an output aperture of 10 x 10mm to match the solar cell. This study includes an analysis of the optical efficiency, acceptance angle, irradiance distribution and component errors for this type of concentrator. In particular material stability and the surface error of the homogeniser proved to be detrimental in theoretical and experimental testing – reducing the optical efficiency to ~40%. This study proves the importance of material choice and simulating optical surface quality, not simply assuming ideal conditions. In the experimental testing, the acceptance angle followed simulation results as did the optical efficiency of the primary and secondary reflectors. The optical efficiency of the system against increasing solar misalignment angles is given for the theoretical and experimental work carried out.This work has been carried out as a part of BioCPV project jointly funded by DST, India (Ref No: DST/SEED/INDO-UK/002/2011) and EPSRC, UK, (Ref No: EP/J000345/1). J.P. Ferrer-Rodriguez is supported by the Spanish Economy Ministry and the European Regional Development Fund / Fondo Europeo de Desarrollo Regional (ERDF / FEDER) under the project ENE2013-45242-R. Authors acknowledge the funding agencies for the support
Asociación entre el crecimiento bacteriano de la flora intestinal y la presión arterial de hombres adultos mayores hipertensos después de cinco semanas de consumo de soya (Glicine máx)
No full textObjetivo: Objetivo: Determinar la asociación entre el crecimiento bacteriano de la flora intestinal y la presión arterial de hombres adultos mayores hipertensos después de cinco semanas de consumo de soya (Glicine máx). Materiales y métodos: Estudio cuasiexperimental para evaluar la asociación entre cambios en la presión arterial y el crecimiento bacteriano en 24 hombres hipertensos con edades entre 61 y 82 años residentes en el barrio Las Malvinas (suroccidente de Barranquilla), quienes adicionaron a su dieta habitual “leche de soya” de grano entero sin lactosa (18 gramos de proteína de soya por día) durante 6 semanas. En el análisis microbiológico de las heces se determinaron los géneros y la cantidad de bacterias mediante técnicas tradicionales. Se midió la presión arterial al inicio y final del tratamiento. Resultados: Los recuentos de bacterias aeróbicas al inicio fueron 10 5 a 10 9 y al final 10 6 a 10 9 UFC/gramo de muestra; en bacterias anaeróbicas se encontraron los recuentos más altos: 10 5 a 10 9 antes y 10 6 a 1010 UFC/g al final. Después del tratamiento con soya la presión sistólica disminuyó en 37.5 % de los participantes, la diastólica en 16.67 %, la media en 45.83 % y la de pulso en 45.83 %; sin embargo, no hubo significancia estadística en ningún caso. El coeficiente de correlación de Pearson entre presión arterial y crecimiento bacteriano fue 0.14. Conclusiones: Se observó una asociación débil e inversa entre el incremento de la microbiota intestinal y la disminución de la presión arterial
Asociación entre el crecimiento bacteriano de la flora intestinal y la presión arterial de hombres adultos mayores hipertensos después de cinco semanas de consumo de Soya (Glicine máx)
No full textObjetivo: Determinar la asociación entre el crecimiento bacteriano de la flora intestinal y la presión arterial de hombres adultos mayores hipertensos después de cinco semanas de consumo de Soya (Glicine máx).Materiales y métodos: estudio cuasi-experimental para evaluar la asociación entre cambios en la presión arterial y el crecimiento bacteriano en 24 hombres hipertensos con edades entre 61 y 82 años residentes en “Las Malvinas”, suroccidente de Barranquilla, quienes adicionaron a la dieta habitual “Leche de soya” de grano entero sin lactosa (18 g. de proteína de soya por día) durante 6 semanas. En el análisis microbiológico de las heces fecales se determinaron los géneros y la cantidad de bacterias mediante técnicas tradicionales. Se midió la presión arterial al inicio y final del tratamiento.Resultados: Los recuentos de bacterias aeróbicas al inicio fueron 10⁵ a 10⁹ y al final, 10⁶ a 10⁹ UFC/gramo de muestra; en bacterias anaeróbicas se encontraron los recuentos más altos: 10⁵ a 10⁹ antes y 10⁶ a 1010 UFC/g, al final. Después del tratamiento con soya la presión sistólica disminuyó en 37.5% de los participantes, la diastólica en 16.67%, la media en 45.83% y la de pulso en 45.83%; sin embargo, no hubo significancia estadística en ningún caso. El coeficiente de correlación de Pearson entre presión arterial y crecimiento bacteriano fue ̵ 0.14.Conclusiones: se observó una asociación débil e inversa entre el incremento de la microbiota intestinal y la disminución de la presión arterial
IMPORTANCIA DE LA VIGILANCIA EPIDEMIOLÓGICA EN EL CONTROL DE LAS INFECCIONES ASOCIADAS A LA ATENCIÓN EN SALUD
No full textBackground: The infections associated to the Attention in health (IAAS) they are an I lash that it whips to the institutions prestored of service of health to World scale, it is considered one of the biggest problems for patient safety, directly affecting the quality in the provision of services. Objective: To deepen the knowledge in the main aspects of the IAAS, analysis of the factors of risk, mechanisms of prevention and the importance of the hospital epidemic surveillance as one of the measures for their control. Methodology: The present document is the result of a bibliographical revision of scientific articles consulted in the databases PubMed, Scielo, ProQuest, Ovid, Academic Google, of the last 10 years, published in Spanish and in English. For the selection of the bibliography it was considered the following group of key words: infection Associated to the attention of the health; infection intrahospital; control of infections, epidemic surveillance, national system of hospital surveillance. Conclusion: With the current review it was shown that the prevalence of IAAS is maintained over the years, and has even increased in intermediate level health care institutions, highlighting the importance of increasing the reporting units of IAAS and bacterial resistance, as well as the creation of epidemiological surveillance programs or a more efficient National Information System for these events, considered a key component of any health system to improve the indicators of quality in the services provided for the benefit of the patient. The Epidemiological Surveillance is important not only for contributing in a significant way in the control and prevention of the IAAS, but also in determining the steps to be taken at the time of registering and disseminating, to the authorities in charge of the analysis of said problem in its different spheres of activity. action, supporting in this way the decision making, execution and evaluation of these diseases.Antecedentes: Las infecciones asociadas a la Atención en salud (IAAS) son un flagelo que azota a las instituciones prestadoras de servicio de salud a escala Mundial, se considera uno de los mayores problemas para la seguridad del paciente, afectando directamente la calidad en la prestación de servicios. Objetivo: Profundizar en los principales aspectos epidemiológicos de la IAAS, los factores de riesgo relacionados, el impacto que tiene este problema a nivel mundial y local y la importancia de un programa de vigilancia epidemiológica hospitalaria como una de las medidas para su prevención y control. Metodología: El presente documento es el resultado de una revisión bibliográfica de artículos científicos consultados en bases de datos Pubmed, Scielo, Proquest, Ovid, Google Académico, de los últimos 10 años, publicados en español y en inglés. Para la selección de la bibliografía se consideró el siguiente grupo de palabras claves: infección Asociada a la atención de la salud; infección intrahospitalaria; control de infecciones, vigilancia epidemiológica, sistema nacional de vigilancia hospitalaria. Conclusión: Con la revisión actual se evidenció que la prevalencia de IAAS se mantiene a través de los años, e incluso ha aumentado en instituciones de nivel intermedio de atención en salud, resaltando la importancia de incrementar las unidades notificadoras de IAAS y resistencia bacteriana, así como la creación de programas de vigilancia epidemiológica o Sistema Nacional de información de estos eventos de manera más eficiente, considerándose un componente clave de cualquier sistema de salud para mejorar los indicadores de la calidad en los servicios prestados en beneficio del paciente. La Vigilancia Epidemiológica es importante no solo por contribuir de manera significativa en el control y prevención de las IAAS sino para determinar los pasos a seguir en el momento de registrar y difundir debidamente, a las autoridades encargadas del análisis de dicha problemática en sus diferentes esferas de acción, apoyando de esta manera la toma de decisiones, la ejecución y evaluación de dichas enfermedades
A > 3000 suns high concentrator photovoltaic design based on multiple Fresnel lens primaries focusing to one central solar cell
No full textThis is the final version of the article. Available from Elsevier via the DOI in this record.A high concentrator photovoltaic design is proposed of 5800x geometrical concentration ratio based on multiple primary Fresnel lenses focusing to one central solar cell. The final stage optic is of a novel design, made of a high refractive index (n = ∼1.76), to accept light fr om four different directions but very easily manufactured. The high geometrical concentration of 5800x was chosen in anticipation of the losses accompanied due to alignment difficulties. Two scenarios are however simulated, one with state of the art optics (achromatic Fresnel lenses and 98% reflective mirrors) and one of standard, relatively cheap optics. An optical efficiency of ∼75% is achieved in simulations if high quality optics are utilised, which gives an optical concentration ratio of just over 4300x. Simulating standard optical constraints with less accurate optics results in an optical efficiency of ∼55% which translates to an optical concentration ratio of ∼3000x. In this way the quality of the optics can be chosen depending on the trade of between cost and efficiency with room for future advanced optics to be incorporated at a later date. The optical efficiency of each component is simulated as well as experimentally measured to ensure the accuracy of the simulations. A theoretical acceptance angle of 0.4° was achieved in ray trace simulations for this design which is considered good for such a high concentration level. The need for achromatic Fresnel lenses is apparent from this study to reach optimum performance and concentration but even 55% optical efficiency results in a > 3000x concentration not yet experimentally tested. The solar cells irradiance distribution of the design is also presented along with performance and rough cost comparisons to other systems in the literature. The cost of the optics compared to more complex shaped optics is also given.This research is funded by EPSRC (EP/P003605/1) through the Joint UK-India Clean Energy Centre (JUICE)
Current concepts on oxidative/carbonyl stress, inflammation and epigenetics in pathogenesis of chronic obstructive pulmonary disease
No full textChronic obstructive pulmonary disease (COPD) is a global health problem. The current therapies for COPD are poorly effective and the mainstays of pharmacotherapy are bronchodilators. A better understanding of the pathobiology of COPD is critical for the development of novel therapies. In the present review, we have discussed the roles of oxidative/aldehyde stress, inflammation/immunity, and chromatin remodeling in the pathogenesis of COPD. An imbalance of oxidants/antioxidants caused by cigarette smoke and other pollutants/biomass fuels plays an important role in the pathogenesis of COPD by regulating redox-sensitive transcription factors (e.g., NF-κB), autophagy and unfolded protein response leading to chronic lung inflammatory response. Cigarette smoke also activates canonical/alternative NF-κB pathways and their upstream kinases leading to sustained inflammatory response in lungs. Recently, epigenetic regulation has been shown to be critical for the development of COPD because the expression/activity of enzymes that regulate these epigenetic modifications have been reported to be abnormal in airways of COPD patients. Hence, the significant advances made in understanding the pathophysiology of COPD as described herein will identify novel therapeutic targets for intervention in COPD
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Validation study of genetic biomarkers of response to TNF inhibitors in rheumatoid arthritis
No full textGenetic biomarkers are sought to personalize treatment of patients with rheumatoid arthritis (RA), given their variable response to TNF inhibitors (TNFi). However, no genetic biomaker is yet sufficiently validated. Here, we report a validation study of 18 previously reported genetic biomarkers, including 11 from GWAS of response to TNFi. The validation was attempted in 581 patients with RA that had not been treated with biologic antirheumatic drugs previously. Their response to TNFi was evaluated at 3, 6 and 12 months in two ways: change in the DAS28 measure of disease activity, and according to the EULAR criteria for response to antirheumatic drugs. Association of these parameters with the genotypes, obtained by PCR amplification followed by single-base extension, was tested with regression analysis. These analyses were adjusted for baseline DAS28, sex, and the specific TNFi. However, none of the proposed biomarkers was validated, as none showed association with response to TNFi in our study, even at the time of assessment and with the outcome that showed the most significant result in previous studies. These negative results are notable because this was the first independent validation study for 12 of the biomarkers, and because they indicate that prudence is needed in the interpretation of the proposed biomarkers of response to TNFi even when they are supported by very low p values. The results also emphasize the requirement of independent replication for validation, and the need to search protocols that could increase reproducibility of the biomarkers of response to TNFi. © 2018 Lopez-Rodriguez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
The myth of minority : cultural change in Valencia in the thirteenth century at the time of the conquests of James I of Aragon
No full textThe history of the Iberian Peninsula is intricate and complex. Like most regions of
Western Europe in the Middle Ages, it suffered invasion, occupation, political change and an almost constant re–alignment of social alliances. Yet the thirteenth century saw one of the most massive shifts in the balance of power recorded in western history. In the space of fifty years, Islamic rule within the peninsula was ended for good, with the last vestiges of Muslim territory erased from the southern peninsula by the fifteenth century. Christian ascendancy heralded the arrival of a mixed policy of tolerance, as questions began to be asked about the nature of living together with other cultures and religions and whether this new rule – this new Christian rule – needed to tolerate the existence of others in its midst.
The most dramatic shift in policy occurred in the middle of the thirteenth century, as the campaigns of the two great northern kingdoms of Leon–Castile and Aragon–Catalonia moved southwards. The most dramatic outcome – due to the size of the Muslim population – was the relatively swift conquest of, in the case of Ferdinand III, the main towns of Andalucia and, in the case of James I, king of Aragon, the region of Valencia by 1245. Yet it is important when examining the campaigns of these great warrior kings not
to be overwhelmed by the idea of the religious ethos for the conquest. Some historians have chosen to interpret the thirteenth–century conquests as the Christian reaction for the centuries of subjugation under Muslim rule. The reasoning behind the conquests was far more complex than that of a mere idealistic crusade. In the case of thirteenth–century Christian expansion, desire for territory, sovereignty, inheritance, taxation and inter-territorial rivalry had just as much of a part to play as a desire to overcome the Muslim ‘infidel.’ It is the conquest of Valencia which will form the major focal point of this paper, examining the historical precedent for conquest, the nature of Muslim rule, the ulterior motives of the Christians, the
position of Muslims and Jews in existing Christian society (as well as under the
conquerors) and the role of James I in both consolidating and changing that culture.
The programme of this thesis is divided into two main parts. In the first part, the paper will explore the impact of historical events up to the birth of James; how these events both shaped him as a king and as a warrior; and how domestic concerns may have provided a greater incentive than religious missionaries spreading Crusading fever amongst Western kingdoms. It will review the impact of those close to the king; on the nature of his conquest; on his ideology; and how his attitude towards his conquered subjects was shaped. External political and geographical pressures impacted both upon the king’s campaigning and, ultimately, how complete the conquest was.
In the second part, the thesis will focus on the communities themselves and the changes that occurred as the conquests progressed further and further southwards. It will
contrast the circumstances and fortunes of those conquered with the lives of minority
cultures who were already subjects in the Christian realms. It will examine the idea of
hierarchy within minority culture and the social mores that had an even more direct
impact upon community life than the military campaigning. Most important of all, it will
question the idea of convivencia and the concept of tolerance and ‘living together.
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