Diferencias microbiológicas en pacientes con exacerbación severa de EPOC con o sin consolidación neumónica

La EPOC es una causa importante de morbilidad y mortalidad en el mundo y su prevalencia en Bogotá alcanza hasta 8,5%. Las exacerbaciones están asociadas a deterioro funcional y de la calidad de vida por lo que se consideran un factor cardinal de la enfermedad. En la literatura se ha descrito que las infecciones por bacterias y/o virus son las responsables del 78% de las exacerbaciones. Estos datos han sido descritos en poblaciones diferentes y no hay datos en la literatura que muestren cual es la epidemiología local de las exacerbaciones de EPOC y menos aún de aquellas que se asocian a consolidaciones neumónicas. Objetivo: Comparar la microbiología de las exacerbaciones severas de la EPOC que requieren ingreso a UCI con y sin infiltrados alveolares. Materiales y métodos: Estudio de corte transversal en el que se estudiaron pacientes con EPOC que ingresaron a la UCI Médica de la FCI-IC por exacerbación severa, asociada o no a infiltrados alveolares. Se tomaron muestras de microbiología, serológicas y radiografía de tórax para evaluar la etiología de la exacerbación, si se asocia a coinfección viral y a consolidación neumónica o no. Resultados: No se encontró una diferencia estadísticamente significativa en la microbiología de los diferentes grupos evaluados. Se encontró un resistencia global del 24% y llama la atención que hay una alta prevalencia de Serratia Marcescens AMPc entre los 2 grupos, germen que no está descrito como patógeno común en la literatura. Se encontraron diferencias en cuanto a factores de riesgo para presentar neumonía asociada como lo son un mayor índice de paquetes/año (55.1.6 vs. 36.3 paq/año, sig.=0.021). Así mismo se demostró que los pacientes con neumonía asociada presentan mayor necesidad de IOT (48.9 vs. 23.9, sig.=0.013). No hay diferencia significativa en desenlaces como mortalidad (20.5 vs. 13.0, sig.=0.346). Conclusiones: A pesar de no haber diferencia microbiológica entre los 2 grupos se encontraron variables como factores de riesgo y variables clínicas que pueden ayudar a proponer planes de manejo en los dos escenarios. El hecho de encontrar un paciente con neumonía asociada al cuadro de exacerbación no debe afectar en la toma de decisiones en relación al tratamiento antibiótico.

Pseudomonas aeruginosa PA14 cupD transcription is activated by the RcsB response regulator, but repressed by its putative cognate sensor RcsC

The opportunistic pathogen Pseudomonas aeruginosa PA14 possesses four fimbrial cup clusters, which may confer the ability to adapt to different environments. cupD lies in the pathogenicity island PAPI-1 next to genes coding for a putative phosphorelay system composed of the hybrid histidine kinase RcsC and the response regulator RcsB. The main focus of this work was the regulation of cupD at the mRNA level. It was found that the HN-S-like protein MvaT does not exert a strong influence on cupD transcript levels, as it does for cupA. cupD transcription is higher in cultures grown at 28 degrees C, which agrees with a cupD mutant presenting attenuated virulence only in a plant model, but not in a mouse model of infection. Whereas an rcsC in-frame deletion mutant presented higher levels of cupD mRNA, rcsB deletion had the opposite effect. Accordingly, overexpression of RcsB increased the levels of cupD transcription, and promoted biofilm formation and the appearance of fimbriae. A single transcription start site was determined for cupD and transcription from this site was induced by RcsB. A motif similar to the enterobacterial RcsB/RcsA-binding site was detected adjacent to the -35 region, suggesting that this could be the RcsB-binding site. Comparison of P. aeruginosa and Escherichia coli Rcs may provide insights into how similar systems can be used by different bacteria to control gene expression and to adapt to various environmental conditions.

Adsorption of caffeic acid on titanium dioxide: A spectroscopic study

Caffeic acid is an ortho-phenol found in vegetable tissues presenting important properties such as carcinogenesis inhibitor, anti-oxidant, anti-viral, anti-inflammatory and anti-rheumatic actions. It was observed that caffeic acid was not degraded in daylight during the adsorption on TiO2 at pH 4.8. The adsorption fit very well to a Brunauer-Emmett-Teller isotherm equation with a monolayer coverage of 68.15 mg(CA) g(TiO2)(-1) and saturation coverage of 195.4 mg(CA) g(TiO2)(-1). A strong adsorption of caffeic acid was verified on TiO2 for the dry solid obtained from the mixture. The Raman and IR spectroscopies revealed that the adsorption should occur through the interaction of the diphenol oxygens with contribution of CC double bond of the acrylic group, however, the carboxylic acid group did not have participation in the adsorption. (C) 2012 Elsevier B.V. All rights reserved.

Un percorso fra natura e storia. Il museo della citta' di Cesena lungo il fiume Savio

“Il museo sta cambiando. In passato, era un luogo di certezze assolute, fonte di definizioni, di valori e di dottrina in materia d'arte, a tutto campo; era il luogo in cui non ci si ponevano interrogativi ma si davano autorevoli risposte.[...]“ 1 Il collezionismo d'arte comincia con il Rinascimento italiano, che sviluppa un particolare senso della storia, un entusiasmo per i prodotti dell'Antichità classica e per tutti i generi dell'arte contemporanea, pensati per la residenza privata, e in realtà, per esse fabbricati: dipinti di soggetto mitologico, quadri di artisti fiamminghi, piccoli bronzi e, al nord arte grafica. Il collezionismo in senso stretto fu agli inizi del secolo connesso solo con le antichità. Verso la fine del Cinquecento, vanno manifestandosi parecchie innovazioni. Per la prima volta compare la parola museo, che era già stata adottata in Alessandria durante il periodo Ellenistico per designare tutto l'ambito degli edifici per la cultura in cui era compresa la biblioteca. Inizialmente tutte le collezioni erano private, ma potevano essere visitate dalle élite sociali. L‟istituzione del museo che noi oggi conosciamo, nasce dall‟ Europa illuminista del XVIII secolo: infatti in questo periodo fu deliberatamente progettato uno spazio architettonico appropriato che desse forma universalmente riconoscibile all‟idea di museo. Poniamo gli esempi del Museo di Villa Albani nel 1746 e il Museo Pio Clementino in Vaticano nel 1775, che per primi si pongono il problema della progettazione architettonica, dell‟allestimento e ordinamento adeguati a un museo aperto al pubblico. Mentre per Villa Albani si trattava pur sempre di una raccolta privata visitabile, il museo voluto dai papi Clemente XIV e Pio VI per le collezioni archeologiche era già pensato come un‟istituzione di interesse pubblico. Gli ultimi tre secoli del secondo millennio hanno visto la crescita dell‟istituzione del museo, diventata esponenziale negli ultimi decenni del XX secolo. I tempi hanno coinciso con la nascita, l‟affermazione rivoluzionaria, il trionfo e il consolidamento della cultura nell‟età della borghesia. 2 “Mentre prima il museo non era che un luogo pieno di oggetti, oggi è diventato un luogo pieno di idee, che vengono suggerite dalle indicazioni e dalle descrizioni accompagnanti gli oggetti esposti, dato che il museo è come un libro aperto che si offre allo studioso e a chi desidera formarsi una coltura.[...]3 1 Karsten Schubert, Museo. Storia di un'idea - dalla Rivoluzione francese ad oggi, il Saggiatore, Milano 2004, p.17. 2 Alessandra Mottola Molfino, Il libro dei musei, Umberto Alemandi & C., Torino 1991, pp. 11-22 3 Daniele Donghi, Manuale dell'architetto Volume II, Unione Tipografico Editrice Torinese, Torino 1935, p. 11. 8 Un museo non è definito solo in base all'importanza e alla qualità delle sue raccolte, ma soprattutto da come vengono recepite da chi le esamina, sia per motivi di studio che per interesse personale. Per questo motivo si deve mettere in grado le diverse categorie di fruitori, di accedere al museo con il minor spreco di tempo possibile e con il maggior profitto. L'effetto che si vuole ottenere deriva sia dal metodo di esposizione degli oggetti, sia da una buona soluzione tecnica relativa alle dimensioni, alla forma, alla distribuzione, riscaldamento e ventilazione dei locali, all'illuminazione degli oggetti e ai mezzi di loro conservazione e sicurezza. Il museo moderno dovrà coniugare al suo interno museografia e museologia. Dove“[...]per museografia si intende l'insieme delle azioni progettuali, scientifiche e tecniche, tendenti alla sistemazione organizzativa del museo (distributiva, impiantistica, tecnica, architettonica, allestitiva, informatica); appartiene in genere all'opera dell'architetto, con la collaborazione di strutturisti, impiantisti e informatici. Al contrario per museologia si intende l'insieme delle azioni di ricerca storica, filologica, di comparazione critica che presiede all'ordinamento dell'esposizione delle opere; generalmente appartiene allo storico dell'arte, allo storico della scienza, all'archeologo, all'antropologo [...].”4 Confrontando progetti museografici e museali dei primi musei con esempi moderni e contemporanei, si intendono ricavare i caratteri fondamentali che permettano di presentare un progetto per museo coerente all'area di studio, e che riesca a rivelare la vera natura degli oggetti che andrà a ospitare attraverso uno studio specifico dei percorsi e degli allestimenti.

Applicazioni cliniche e sperimentali dell’ecografia toracica in pneumologia: la diagnostica precoce delle patologie pleuropolmonari

Lung ultrasound use is increasing in respiratory medicine thanks to its development in the latest years. Actually it allows to study diseases of the chest wall (traumas, infections, neoplasms), diaphragm (paralysis, ipokinesis), pleura (effusions, pneumothorax, thickenings, neoplasms) and lung parenchyma (consolidations, interstitial syndromes, peripheral lesions). One of the most useful application of chest ultrasound is the evaluation of effusions. However, no standardized approach for ultrasound-guided thoracenthesis is available. Our study showed that our usual ultrasonographic landmark (“V-point”) could be a standard site to perform thoracenthesis: in 45 thoracenthesis no pneumothorax occurred, drainage was always successful at first attempt. Values of maximum thickness at V-point and drained fluid volume showed a significative correlation. Proteins concentration of ultrasound patterns of effusions (anechoic, ipoechoic, moving echoic spots, dense moving spots, hyperechoic) were compared to those of the macroscopic features of fluids showing connection between light-yellow fluid and echoic moving spots pattern and between ipoechoic/dense moving spots and cloudy-yellow/serum-haematic fluids. These observations suggest that ultrasound could predict chemical-physical features of effusions. Lung ultrasound provides useful information about many disease of the lung, but actually there is not useful in obstructive bronchial diseases. Analysing diaphragmatic kinetics using M-mode through transhepatic scan we described a similarity between diaphragm excursion during an expiratory forced maneuver and the volume/time curve of spirometry. This allowed us to identify the M-mode Index of Obstruction (MIO), an ultrasound-analogue of FEV1/VC. We observed MIO values of normal subjects (9) and obstructed patients (9) comparing the two groups. FEV1/VC and MIO showed a significant correlation suggesting that MIO may be affected by airways obstruction; MIO values were significatively different between normal and obstructed so that it could identify an obstructive syndrome. The data show that it is possible to suspect the presence of obstructive syndrome of the airways using ultrasonography of the diaphragm.

Biomarkers in chronic obstructive pulmonary diseases. Clinical and functional correlations.

Asthma and chronic obstructive pulmonary disease (COPD) are two distinct lung diseases with distinctive clinical and inflammatory features. A proportion of asthmatic patients experience a fixed airflow obstruction that persists despite optimal pharmacologic treatment for reasons that are still largely unknown. We found that patients with asthma and COPD sharing a similar fixed airflow obstruction have an increased lung function decline and frequency of exacerbations. Nevertheless, the decline in lung function is associated with specific features of the underlying inflammation. Airway inflammation increases during asthma exacerbation and disease severity. Less is known about the correlations between symptoms and airway inflammation in COPD patients. We found that there is no correlation between symptoms and lung function in COPD patients. Nevertheless symptoms changes are associated with specific inflammatory changes: cough is associated with an increase of sputum neutrophils in COPD, dyspnoea is associated with an increase of eosinophils. The mechanisms of this correlation remain unknown. Neutrophils inflammation is associated with bacterial colonization in stable COPD. Is not known whether inhaled corticosteroids might facilitate bacterial colonization in COPD patients. We found that the use of inhaled corticosteroids in COPD patients is associated with an increase of airway bacterial load and with an increase of airway pathogen detection. Bacterial and viral infections are the main causes of COPD and asthma exacerbations. Impaired innate immune responses to rhinovirus infections have been described in adult patients with atopic asthma. Whether this impaired immune condition is present early in life and whether is modulated by a concomitant atopic condition is currently unknown. We found that deficient innate immune responses to rhinovirus infection are already present early in life in atopic patients without asthma and in asthmatic subjects. These findings generalize the scenario of increased susceptibility to viral infections to other Th2 oriented conditions.

Meta-analysis identifies 29 additional ulcerative colitis risk loci, increasing the number of confirmed associations to 47

Genome-wide association studies and candidate gene studies in ulcerative colitis have identified 18 susceptibility loci. We conducted a meta-analysis of six ulcerative colitis genome-wide association study datasets, comprising 6,687 cases and 19,718 controls, and followed up the top association signals in 9,628 cases and 12,917 controls. We identified 29 additional risk loci (P < 5 × 10(-8)), increasing the number of ulcerative colitis-associated loci to 47. After annotating associated regions using GRAIL, expression quantitative trait loci data and correlations with non-synonymous SNPs, we identified many candidate genes that provide potentially important insights into disease pathogenesis, including IL1R2, IL8RA-IL8RB, IL7R, IL12B, DAP, PRDM1, JAK2, IRF5, GNA12 and LSP1. The total number of confirmed inflammatory bowel disease risk loci is now 99, including a minimum of 28 shared association signals between Crohn's disease and ulcerative colitis.

Energy/power consumption model for an embedded processor board

This dissertation, whose research has been conducted at the Group of Electronic and Microelectronic Design (GDEM) within the framework of the project Power Consumption Control in Multimedia Terminals (PCCMUTE), focuses on the development of an energy estimation model for the battery-powered embedded processor board. The main objectives and contributions of the work are summarized as follows: A model is proposed to obtain the accurate energy estimation results based on the linear correlation between the performance monitoring counters (PMCs) and energy consumption. the uniqueness of the appropriate PMCs for each different system, the modeling methodology is improved to obtain stable accuracies with slight variations among multiple scenarios and to be repeatable in other systems. It includes two steps: the former, the PMC-filter, to identify the most proper set among the available PMCs of a system and the latter, the k-fold cross validation method, to avoid the bias during the model training stage. The methodology is implemented on a commercial embedded board running the 2.6.34 Linux kernel and the PAPI, a cross-platform interface to configure and access PMCs. The results show that the methodology is able to keep a good stability in different scenarios and provide robust estimation results with the average relative error being less than 5%. Este trabajo fin de máster, cuya investigación se ha desarrollado en el Grupo de Diseño Electrónico y Microelectrónico (GDEM) en el marco del proyecto PccMuTe, se centra en el desarrollo de un modelo de estimación de energía para un sistema empotrado alimentado por batería. Los objetivos principales y las contribuciones de esta tesis se resumen como sigue: Se propone un modelo para obtener estimaciones precisas del consumo de energía de un sistema empotrado. El modelo se basa en la correlación lineal entre los valores de los contadores de prestaciones y el consumo de energía. Considerando la particularidad de los contadores de prestaciones en cada sistema, la metodología de modelado se ha mejorado para obtener precisiones estables, con ligeras variaciones entre escenarios múltiples y para replicar los resultados en diferentes sistemas. La metodología incluye dos etapas: la primera, filtrado-PMC, que consiste en identificar el conjunto más apropiado de contadores de prestaciones de entre los disponibles en un sistema y la segunda, el método de validación cruzada de K iteraciones, cuyo fin es evitar los sesgos durante la fase de entrenamiento. La metodología se implementa en un sistema empotrado que ejecuta el kernel 2.6.34 de Linux y PAPI, un interfaz multiplataforma para configurar y acceder a los contadores. Los resultados muestran que esta metodología consigue una buena estabilidad en diferentes escenarios y proporciona unos resultados robustos de estimación con un error medio relativo inferior al 5%.

Herramienta de medida y visualización de prestaciones basada en eventos para especificaciones RVC-CAL

Este proyecto fin de grado presenta dos herramientas, Papify y Papify-Viewer, para medir y visualizar, respectivamente, las prestaciones a bajo nivel de especificaciones RVC-CAL basándose en eventos hardware. RVC-CAL es un lenguaje de flujo de datos estandarizado por MPEG y utilizado para definir herramientas relacionadas con la codificación de vídeo. La estructura de los programas descritos en RVC-CAL se basa en unidades funcionales llamadas actores, que a su vez se subdividen en funciones o procedimientos llamados acciones. ORCC (Open RVC-CAL Compiler) es un compilador de código abierto que utiliza como entrada descripciones RVC-CAL y genera a partir de ellas código fuente en un lenguaje dado, como por ejemplo C. Internamente, el compilador ORCC se divide en tres etapas distinguibles: front-end, middle-end y back-end. La implementación de Papify consiste en modificar la etapa del back-end del compilador, encargada de la generación de código, de modo tal que los actores, al ser traducidos a lenguaje C, queden instrumentados con PAPI (Performance Application Programing Interface), una herramienta utilizada como interfaz a los registros contadores de rendimiento (PMC) de los procesadores. Además, también se modifica el front-end para permitir identificar cierto tipo de anotaciones en las descripciones RVC-CAL, utilizadas para que el diseñador pueda indicar qué actores o acciones en particular se desean analizar. Los actores instrumentados, además de conservar su funcionalidad original, generan una serie de ficheros que contienen datos sobre los distintos eventos hardware que suceden a lo largo de su ejecución. Los eventos incluidos en estos ficheros son configurables dentro de las anotaciones previamente mencionadas. La segunda herramienta, Papify-Viewer, utiliza los datos generados por Papify y los procesa, obteniendo una representación visual de la información a dos niveles: por un lado, representa cronológicamente la ejecución de la aplicación, distinguiendo cada uno de los actores a lo largo de la misma. Por otro lado, genera estadísticas sobre la cantidad de eventos disparados por acción, actor o núcleo de ejecución y las representa mediante gráficos de barra. Ambas herramientas pueden ser utilizadas en conjunto para verificar el funcionamiento del programa, balancear la carga de los actores o la distribución por núcleos de los mismos, mejorar el rendimiento y diagnosticar problemas. ABSTRACT. This diploma project presents two tools, Papify and Papify-Viewer, used to measure and visualize the low level performance of RVC-CAL specifications based on hardware events. RVC-CAL is a dataflow language standardized by MPEG which is used to define video codec tools. The structure of the applications described in RVC-CAL is based on functional units called actors, which are in turn divided into smaller procedures called actions. ORCC (Open RVC-CAL Compiler) is an open-source compiler capable of transforming RVC-CAL descriptions into source code in a given language, such as C. Internally, the compiler is divided into three distinguishable stages: front-end, middle-end and back-end. Papify’s implementation consists of modifying the compiler’s back-end stage, which is responsible for generating the final source code, so that translated actors in C code are now instrumented with PAPI (Performance Application Programming Interface), a tool that provides an interface to the microprocessor’s performance monitoring counters (PMC). In addition, the front-end is also modified in such a way that allows identification of a certain type of annotations in the RVC-CAL descriptions, allowing the designer to set the actors or actions to be included in the measurement. Besides preserving their initial behavior, the instrumented actors will also generate a set of files containing data about the different events triggered throughout the program’s execution. The events included in these files can be configured inside the previously mentioned annotations. The second tool, Papify-Viewer, makes use of the files generated by Papify to process them and provide a visual representation of the information in two different ways: on one hand, a chronological representation of the application’s execution where each actor has its own timeline. On the other hand, statistical information is generated about the amount of triggered events per action, actor or core. Both tools can be used together to assert the normal functioning of the program, balance the load between actors or cores, improve performance and identify problems.

Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting

Acknowledgements The iHARP database was funded by unrestricted grants from Mundipharma International Ltd and Research in Real-Life Ltd; these analyses were funded by an unrestricted grant from Teva Pharmaceuticals. Mundipharma and Teva played no role in study conduct or analysis and did not modify or approve the manuscript. The authors wish to direct a special appreciation to all the participants of the iHARP group who contributed data to this study and to Mundipharma, sponsors of the iHARP group. In addition, we thank Julie von Ziegenweidt for assistance with data extraction and Anna Gilchrist and Valerie L. Ashton, PhD, for editorial assistance. Elizabeth V. Hillyer, DVM, provided editorial and writing support, funded by Research in Real-Life, Ltd.

La comunicación institucional con fines políticos: el caso de las campañas de igualdad de género

La sociedad española aún no es igualitaria y, en materia de corresponsabilidad, queda mucho por hacer. Las campañas de sensibilización pueden y deben contribuir a mejorar la situación. El estudio describe y evalúa el esfuerzo publicitario de la Administración pública en campañas institucionales de igualdad de género entre 1999 y 2007. Este periodo es relevante en la promoción de la conciliación y corresponsabilidad por parte de los dos partidos que gobernaron durante estos años en legislaturas distintas (PP y PSOE). Se plantea un análisis diacrónico del esfuerzo publicitario realizado por la Administración en dichas campañas. El esfuerzo se observa mediante las inversiones publicitarias, proporcionadas por InfoAdex. Estos datos son comparados con la curva del esfuerzo de la categoría en la que se encuentran tales campañas (de interés público) y con la inversión que debía haberse realizado para mantenerlo, ambas curvas calculadas atendiendo a criterios de comunicación. Los resultados apuntan a que las campañas de igualdad de género se ubican en posiciones intermedias en la inversión en comparación con otro tipo de campañas institucionales. Sin embargo, la curva del esfuerzo de las campañas de igualdad de género es irregular y desvela intenciones políticas de las inversiones que, a priori, se realizaron con supuesta pretensión informativa o de sensibilización social.

Wysoké Mýto, Králowské wěnné město w Čechách.

Bibliographical footnotes.

Istoria dell'origine del sagratissimo luogo di Monteuergine /

Contiene según consta en port.: Dou'è la Vita e di S. Guglielmo, capo, e fondatore di quel monasterio, e su'ordine; e di S. Amato, vescouo di Nusco, e gia suo discepolo; e di S.Donato, monaco dell'ordine stesso. Con vn compendio delle Vite de gli abati da S. Guglielmo in qua: descrizzione del luogo, suo reliquiario, miracoli successiui, indulgenze e priuilegi conceduti e da Papi, e da imperadori, e da re alla detta religione. ...

Biblioteka inostrannykh pisateleĭ o Rossīi : otdi︠e︡lenīe pervoe.

V.2, pt. 1 published in Tip. K. Vingebera.