Feasibility study to inform the design of a UK multi-centre randomised controlled trial of prophylactic antibiotics for the prevention of recurrent cellulitis of the leg

Background: This paper describes the results of a feasibility study for a randomised controlled trial (RCT). Methods: Twenty-nine members of the UK Dermatology Clinical Trials Network (UK DCTN) expressed an interest in recruiting for this study. Of these, 17 obtained full ethics and Research & Development (R&D) approval, and 15 successfully recruited patients into the study. A total of 70 participants with a diagnosis of cellulitis of the leg were enrolled over a 5-month period. These participants were largely recruited from medical admissions wards, although some were identified from dermatology, orthopaedic, geriatric and general surgery wards. Data were collected on patient demographics, clinical features and willingness to take part in a future RCT. Results: Despite being a relatively common condition, cellulitis patients were difficult to locate through our network of UK DCTN clinicians. This was largely because patients were rarely seen by dermatologists, and admissions were not co-ordinated centrally. In addition, the impact of the proposed exclusion criteria was high; only 26 (37%) of those enrolled in the study fulfilled all of the inclusion criteria for the subsequent RCT, and were willing to be randomised to treatment. Of the 70 participants identified during the study as having cellulitis of the leg (as confirmed by a dermatologist), only 59 (84%) had all 3 of the defining features of: i) erythema, ii) oedema, and iii) warmth with acute pain/tenderness upon examination. Twenty-two (32%) patients experienced a previous episode of cellulitis within the last 3 years. The median time to recurrence (estimated as the time since the most recent previous attack) was 205 days (95% CI 102 to 308). Service users were generally supportive of the trial, although several expressed concerns about taking antibiotics for lengthy periods, and felt that multiple morbidity/old age would limit entry into a 3-year study. Conclusion: This pilot study has been crucial in highlighting some key issues for the conduct of a future RCT. As a result of these findings, changes have been made to i) the planned recruitment strategy, ii) the proposed inclusion criteria and ii) the definition of cellulitis for use in the future trial.

Adaptivity and a posteriori error control for bifurcation problems I: the Bratu problem

This article is concerned with the numerical detection of bifurcation points of nonlinear partial differential equations as some parameter of interest is varied. In particular, we study in detail the numerical approximation of the Bratu problem, based on exploiting the symmetric version of the interior penalty discontinuous Galerkin finite element method. A framework for a posteriori control of the discretization error in the computed critical parameter value is developed based upon the application of the dual weighted residual (DWR) approach. Numerical experiments are presented to highlight the practical performance of the proposed a posteriori error estimator.

Immigration experience of Latin American working women in Alicante, Spain: an ethnographic study

Objective: to describe the experience of Latin American working women regarding immigration, taking into account the expectations and conditions in which this process takes place. Method: ethnographic qualitative study. Data collection was performed by means of semi-structured interviews with 24 Latin American immigrant women in Spain. The information collected was triangulated through two focal groups. Results: the expectations of migrant women focus on improving family living conditions. Social support is essential for their settling and to perform daily life activities. They declare they have adapted to the settlement country, although they live with stress. They perceive they have greater sexual freedom and power with their partners but keep greater responsibility in childcare, combining that with the role of working woman. Conclusions: migrant women play a key role in the survival of households, they build and create new meanings about being a woman, their understanding of life, their social and couple relationships. Such importance is shaped by their expectations and the conditions in which the migration process takes place, as well as their work integration.

Cost-effectiveness analysis of apixaban compared to low-molecular-weight heparins and vitamin k antagonists for treatment and secondary prevention of venous thromboembolism

Objective: Cost-effectiveness analysis of a 6-month treatment of apixaban (10 mg/12h, first 7 days; 5 mg/12h afterwards) for the treatment of the first event of venous thromboembolism (VTE) and prevention of recurrences, versus low-molecular-weight heparins/vitamin K antagonists treatment (LMWH/VKA). Material and methods: A lifetime Markov model with 13 health states was used for describing the course of the disease. Efficacy and safety data were obtained from AMPLIFY and AMPLIFY-EXT clinical trials; health outcomes were measured as life years gained (LYG) and quality-adjusted life years (QALY). The chosen perspective of this analysis has been the Spanish National Health System (NHS). Drugs, management of VTE and complications costs were obtained from several Spanish data sources (€, 2014). A 3% discount rate was applied to health outcomes and costs. Univariate and probabilistic sensitivity analyses (SA) were performed in order to assess the robustness of the results. Results: Apixaban was the most effective therapy with 7.182 LYG and 5.865 QALY, versus 7.160 LYG and 5.838 QALYs with LMWH/VKA. Furthermore, apixaban had a lower total cost (€13,374.70 vs €13,738.30). Probabilistic SA confirmed dominance of apixaban (led to better health outcomes with less associated costs) in 89% of the simulations. Conclusions: Apixaban 5 mg/12h versus LMWH/VKA was an efficient therapeutic strategy for the treatment and prevention of recurrences of VTE from the NHS perspective.

Bioethics, culture and infanticide in brazilian indigenous communities : the Zuruahá case

O artigo analisa a prática do infanticídio em comunidades indígenas brasileiras. Tomando como referência um caso específico envolvendo duas crianças do povo Zuruahá, focaliza o tema sob uma abordagem mais abrangente e discute como o infanticídio é interpretado em outros povos indígenas. Foram considerados, na discussão, os debates ocorridos durante a Audiência Pública realizada no Congresso Nacional Brasileiro, em dezembro de 2005, que analisou o tema, além de revisão bibliográfica. Diante dos posicionamentos assumidos naquela audiência, procurou-se identificar os problemas éticos e os dilemas morais, contextualizando-os e analisando-os à luz do respeito ao pluralismo cultural. A fim de contribuir com o debate, os autores analisam as possibilidades de intervenção nas práticas tradicionais de infanticídio, recusando qualquer opção que não esteja ancorada numa atitude de profundo respeito pela cultura de outros povos ou que não apresente condição de dialogar com indivíduos ou grupos com diferentes moralidades. ______________________________________________________________________________ ABSTRACT

Automated morphometry provides accurate and reproducible virtual staging of liver fibrosis in chronic hepatitis C

International audience

Transcription-Coupled DNA Supercoiling in Escherichia Coli: Mechanisms and Biological Functions

Transcription by RNA polymerase can induce the formation of hypernegatively supercoiled DNA both in vivo and in vitro. This phenomenon has been explained by a “twin-supercoiled-domain” model of transcription where a positively supercoiled domain is generated ahead of the RNA polymerase and a negatively supercoiled domain behind it. In E. coli cells, transcription-induced topological change of chromosomal DNA is expected to actively remodel chromosomal structure and greatly influence DNA transactions such as transcription, DNA replication, and recombination. In this study, an IPTG-inducible, two-plasmid system was established to study transcription-coupled DNA supercoiling (TCDS) in E. coli topA strains. By performing topology assays, biological studies, and RT-PCR experiments, TCDS in E. coli topA strains was found to be dependent on promoter strength. Expression of a membrane-insertion protein was not needed for strong promoters, although co-transcriptional synthesis of a polypeptide may be required. More importantly, it was demonstrated that the expression of a membrane-insertion tet gene was not sufficient for the production of hypernegatively supercoiled DNA. These phenomenon can be explained by the “twin-supercoiled-domain” model of transcription where the friction force applied to E. coli RNA polymerase plays a critical role in the generation of hypernegatively supercoiled DNA. Additionally, in order to explore whether TCDS is able to greatly influence a coupled DNA transaction, such as activating a divergently-coupled promoter, an in vivo system was set up to study TCDS and its effects on the supercoiling-sensitive leu-500 promoter. The leu-500 mutation is a single A-to-G point mutation in the -10 region of the promoter controlling the leu operon, and the AT to GC mutation is expected to increase the energy barrier for the formation of a functional transcription open complex. Using luciferase assays and RT-PCR experiments, it was demonstrated that transient TCDS, “confined” within promoter regions, is responsible for activation of the coupled transcription initiation of the leu-500 promoter. Taken together, these results demonstrate that transcription is a major chromosomal remodeling force in E. coli cells.

Evaluación de bancos naturales de concha de abanico (Argopecten purpuratus) y de pulpo (Octopus mimus). Isla Lobos de Tierra (Noviembre 2009)

Se efectuó la evaluación de bancos naturales de concha de abanico y pulpo del 7 al 16 de noviembre del 2009. La concha de abanico se distribuyó entre 06°21’07,8’’ y 06°26’04,4’’S al noreste de Cabo Cruz y sur de Peña Negra, con densidades absolutas de 1 a 178 ejem.m-2, en profundidades de 12 a 27 m; las tallas variaron entre 2 y 100 mm de altura valvar, media 41 mm, presentando moda principal en 37 mm y dos modas secundarias en 4 y 79 mm; predominaron ejemplares desovantes (37%) y madurantes (29%), se detectó el 26% de inmaduros. La biomasa de concha de abanico fue estimada en 8.877 t y la población en 865 millones de individuos. El stock de juveniles (<25 mm) fue 96 millones de ejemplares (11% de la población) y 36 t, el stock explotable (≥65 mm) fue 83 millones de individuos y 4.376 t. El pulpo se encontró pobremente distribuido en los alrededores de la isla; la talla varió entre 85 y 150 mm de longitud del manto. El 100% de lo capturado tuvo peso inferior al mínimo legal de extracción (1 kg). Hembras y machos estuvieron en estadios en desarrollo y maduros (66,67%).

Asfixia perinatal y proteína S100B

La asfixia perinatal es la principal causa de muerte en la primera semana de vida la nivel mundial, los niños que sufren esta complicación y sobreviven pueden presentar trastornos neurológicos de diferente nivel de compromiso que inciden en su desarrollo personal y social. Las cifras de muerte por este problema de salud han disminuido de manera importante, sin embargo en el reporte de la Organización Mundial de Salud (OPS) del 2010, la asfixia perinatal es causa del 29% de muertes infantiles en los países de América Latina y el Caribe 2. Es necesario conocer además la extensión del daño neurológico que sufren estos niños, con este fin se desarrolló un estudio piloto en el Hospital Universitario Mayor Mederi de Bogotá, en el cual se determinó la concentración de un marcador metabólico de daño cerebral, la proteína S100B en suero de 60 recién nacidos sanos, con el objetivo de analizar la asociación del mismo con el peso al nacer, la edad gestacional y el diagnóstico. Los resultados no mostraron diferencias significativas entre este marcador y las variables analizadas que puede asociarse al pequeño número de pacientes, sin embargo han sentado las bases para el desarrollo de un estudio que incluya varios hospitales de Bogotá y sobre todo la determinación del mismo en recién nacidos con diagnóstico de hipoxia en el período perinatal, lo cual aportará información del grado de la alteración que puedan tener a nivel cerebral y contribuya al mejor manejo evolutivo con la aplicación de medidas de intervención en estadios tempranos de la vida.

Ideación suicida y desesperanza en pacientes con cáncer

El objetivo de la presente investigación fue identificar la relación entre ideación suicida y desesperanza en 160 pacientes con cáncer. La ideación suicida se midió a través de dos ítems de una entrevista semiestructurada, la escala de ideación suicida (ISS), el ítem 9 del inventario de depresión de Beck (BDI-IA). La desesperanza se midió con la escala de desesperanza de Beck (BHS). Los resultados obtenidos indicaron una relación significativa (p=.000) entre ideación suicida y desesperanza; una prevalencia de ideación suicida en los pacientes con cáncer entre 4.4% y 13.8% y de riesgo de suicidio entre 5.6% y 30.6%; y algún grado de desesperanza en 31.9 % de los participantes. De acuerdo con lo anterior, se confirma que existe relación entre la desesperanza y la ideación suicida en pacientes oncológicos adultos. Adicionalmente, que estas variables están presentes en los pacientes y que ameritan atención en la intervención interdisciplinaria.

Curva de aprendizaje para ecografía cardiaca en residentes de primer y segundo año de medicina crítica de la universidad del rosario en el año 2016

La ecografía básica cardiaca (ECB) es una herramienta útil en la Unidad de Cuidados intensivos al facilitar la realización de ciertas intervenciones. No se ha definido el número de repeticiones necesarias para obtener un nivel de competencia adecuado. La evidencia encontrada indica un número mínimo de cincuenta repeticiones, para alcanzar cierto grado de habilidad.

La semilla de la discordia: un estudio de la influencia del Régimen Alimentario Corporativo en la construcción de políticas públicas alimentarias en Colombia

El hambre es un tema fundamental dentro de la agenda política internacional en la actualidad. Diariamente, según la FAO, mueren alrededor de 24.000 personas a causa de no ingerir alimentos. Las estrategias planteadas por parte de las empresas y los gobiernos están enfocadas a generar una mayor producción de alimentos para disminuir el hambre y garantizar la seguridad alimentaria. Este artículo explica cómo el significado del alimento se transformó para ser entendido como mercancía, a partir del establecimiento del régimen alimentario corporativo. Las normas aquí creadas influyen en la construcción de las políticas públicas nacionales. Este estudio de caso evidencia la relación entre ambas en Colombia a partir del 2008 y el nivel de dependencia alimentaria y de insumos químicos del país hacia actores internacionales, analizado a partir de la importación y producción de alimentos. Finalmente, este trabajo investigativo permitirá determinar el estado de la soberanía alimentaria en Colombia.

Adaptation and validation of HIV Antibody Testing Attitude Scale in Portuguese

Introduction; The awareness of HIV positiveness is important for health of the individual and of the comunity. The identicatio of HIV antibodies is possible both using conventional lab tests and quick result tests. In the bibliography it was made clear that there are no instruments in Portuguese to assert the reactions to the HIV quick tests and it was therefore considered it would be useful to adapt and validate a scale in Portuguese, since the language is the official language of 7 different countries and spoken by more than 250 milion people, Objectives: the purpose is to validate a version in European Portuguese of the HIV Antibody Testing Attitude Scale. Methods: the study refers to methodological research for the adaptation and validation of an instrument of attitude measurement. A translation and back-translation was prepared and a trial test was then carried out. A total of 317 students, lectures and co-workers of a Portuguese University was interviewes. Ethical principles were taken into consideration. the pool was obtained in the seven components of the University campus. Results: 3 trials of factorial testing of the main components of 5, 4 and 3 factors. It ended up a solution of 3 factors that explains 50.82% of the variability. In the analysis of the inter-items correlation values of between 0.018 and 0.749 were observed. The internal consistency reveals an alpha Cronbach coefficient of 0.860 as a whole, and in between 0,865 and 0.659 in the 3 factors. Conclusions: this version of the instrument shows that the psychometric properties allow its use in the Portuguese speaking countries.

Serum concentrations of acute phase proteins and immunoglobulins of calves with rotavirus diarrhea.

2016

Maturity index and cold storage effects on postharvest quality of 'Packham's Triumph' and 'Rocha' pears.

Pears have been grown in the south region of Brazil, where the climatic conditions are favourable. The aim of this work was to determine the harvest maturity index as well as maximum storage period of 'Packham's Triumph? and 'Rocha' pears to maintain quality attributes. The ?Packham?s Triumph? fruit were harvested from a commercial orchard at 7 days intervals and flesh firmness was used as a maturity index (MI1=76, MI2=67 and MI3=58 N). ?Rocha? pears were harvested twice and they were considered as MI1 and MI3 because of the firmness values. The fruit were stored at 1±1C and 90-95% RH for 15, 30, 45 and 60 days and evaluated at the end of each storage period and after five days at room temperature (24±1C), simulating a helflife period. Flesh firmness, water loss, peduncle dehydration, epidermis colour, soluble solids, titratable acidity were measured. ?Packham?s? pears harvested at MI1 and MI2 showed firmness loss after 30 days of cold storage, whereas fruit harvested at MI3 retained the initial values, resulting in firmer fruit after 60 days (P<0.001). Fruit harvested in MI3 had less firmness loss after 5 days at room temperature following 45 and 60 days of cold storage. ?Rocha? pears harvested in MI1 and MI3 showed firmness reduction during cold storage, which was intensified at room temperature. Maximum values of water loss approached 6%. Fruit peduncles of both cultivars dehydrated after 60 days of cold storage, but their colour remained green, independent of harvest maturity index. ?Packham?s Triumph? and ?Rocha? pears harvested at MI3 showed better quality attributes after 60 days of cold storage plus 5 days of shelf-life than fruit harvested at other maturity stages.