Les admissions hospitalières pour les infections urinaires: tendances temporelles, fardeau économique et facteurs prédicateurs de mauvaise évolution des patients

Résumé Introduction: Les infections urinaires (IU) sont les infections bactériennes les plus fréquentes chez les patients hospitalisés. Cette étude décrit les tendances temporelles d'admission et de mortalité liées aux hospitalisations pour les IU, ainsi que le fardeau économique associé. Les prédicteurs de mauvaise évolution clinique et de mortalité sont examinés par la suite. Méthodes: Les données ont été extraites à partir de la base de données du NIS entre le 1er janvier 1998 et le 31 décembre 2010. 1,717,181 hospitalisations liées aux IU ont été retenues. L'incidence et la mortalité ont été calculées et stratifiées selon le sexe, l'âge et la présence de sepsis. Les frais médians et totaux pour les hospitalisations sont calculés et ajustés pour l'inflation. Finalement, les prédicteurs d'avoir un sepsis induit par les IU et de mortalité sont examinés avec une analyse par régression logistique multivariée. Résultats: L'incidence globale d'hospitalisation et la mortalité associées aux IU voit une croissance annuel estimé (EAPC) de +4.764 et +4.610 respectivement (p<0.0001). L'augmentation d'incidence est le plus marquée pour les patients âgés de 55 à 64 ans (EAPC = +7.805; p<0.0001). Les frais médians par hospitalisation ont augmenté de $10 313 en 1998 à $21 049 en 2010 (EAPC +9.405; p<0.0001). Les frais globaux pour les hospitalisations des IU ont augmenté de $8.9 milliard en 1998 à $33.7 milliard en 2010 (EAPC +0.251; p<0.0001). Les patients âgés, de sexe masculin, de race afro-américaine, ainsi que les patients assurés par Medicaid ou ceux sans assurance, et les patients soignés à des centres non-académiques sont à risque plus important de mortalité (p<0.0001). Conclusion: L'incidence et la mortalité associées aux IU ont augmenté au cours de la dernière décennie. Les frais médians ajustés pour l'inflation ainsi que les frais globaux ont augmenté progressivement au cours de la période d'étude. Dans la cohorte étudiée, les patients âgés, de sexe masculin, de race afro-américaine, ainsi que les patients assurés par Medicaid ou ceux sans assurance, et les patients soignés à des centres non-académiques sont à risque plus important de mortalité. Ces données représentent des indicateurs de qualité de soins qui pourraient permettre d'adapter certaines politiques de soins de santé aux besoins des sous-populations plus vulnérables.

Organic field-effect transistors and phototransistors based on amorphous materials

A comparison between the charge transport properties in low molecular amorphous thin films of spiro-linked compound and their corresponding parent compound has been demonstrated. The field-effect transistor method is used for extracting physical parameters such as field-effect mobility of charge carriers, ON/OFF ratios, and stability. In addition, phototransistors have been fabricated and demonstrated for the first time by using organic materials. In this case, asymmetrically spiro-linked compounds are used as active materials. The active materials used in this study can be divided into three classes, namely Spiro-linked compounds (symmetrically spiro-linked compounds), the corresponding parent-compounds, and photosensitive spiro-linked compounds (asymmetrically spiro-linked com-pounds). Some of symmetrically spiro-linked compounds used in this study were 2,2',7,7'-Tetrakis-(di-phenylamino)-9,9'-spirobifluorene (Spiro-TAD),2,2',7,7'-Tetrakis-(N,N'-di-p-methylphenylamino)-9,9'-spirobifluorene (Spiro-TTB), 2,2',7,7'-Tetra-(m-tolyl-phenylamino)-9,9'-spirobifluorene (Spiro-TPD), and 2,2Ž,7,7Ž-Tetra-(N-phenyl-1-naphtylamine)-9,9Ž-spirobifluorene (Spiro alpha-NPB). Related parent compounds of the symmetrically spiro-linked compound used in this study were N,N,N',N'-Tetraphenylbenzidine (TAD), N,N,N',N'-Tetrakis(4-methylphenyl)benzidine (TTB), N,N'-Bis(3-methylphenyl)-(1,1'-biphenyl)-4,4'-diamine (TPD), and N,N'-Diphenyl-N,N'-bis(1-naphthyl)-1,1'-biphenyl-4,4'-diamine (alpha-NPB). The photosensitive asymmetrically spiro-linked compounds used in this study were 2,7-bis-(N,N'-diphenylamino)-2',7'-bis(biphenyl-4-yl)-9,9'-spirobifluorene (Spiro-DPSP), and 2,7-bis-(N,N'-diphenylamino)-2',7'-bis(spirobifluorene-2-yl)-9,9'-spirobifluorene (Spiro-DPSP^2). It was found that the field-effect mobilities of charge carriers in thin films of symmetrically spiro-linked compounds and their corresponding parent compounds are in the same order of magnitude (~10^-5 cm^2/Vs). However, the thin films of the parent compounds were easily crystallized after the samples have been exposed in ambient atmosphere and at room temperature for three days. In contrast, the thin films and the transistor characteristics of symmetrically spiro-linked compound did not change significantly after the samples have been stored in ambient atmosphere and at room temperature for several months. Furthermore, temperature dependence of the mobility was analyzed in two models, namely the Arrhenius model and the Gaussian Disorder model. The Arrhenius model tends to give a high value of the prefactor mobility. However, it is difficult to distinguish whether the temperature behaviors of the material under consideration follows the Arrhenius model or the Gaussian Disorder model due to the narrow accessible range of the temperatures. For the first time, phototransistors have been fabricated and demonstrated by using organic materials. In this case, asymmetrically spiro-linked compounds are used as active materials. Intramolecular charge transfer between a bis(diphenylamino)biphenyl unit and a sexiphenyl unit leads to an increase in charge carrier density, providing the amplification effect. The operational responsivity of better than 1 A/W can be obtained for ultraviolet light at 370 nm, making the device interesting for sensor applications. This result offers a new potential application of organic thin film phototransistors as low-light level and low-cost visible blind ultraviolet photodetectors.

Pepoles juega con conceptos y formas.

Imágenes animadas. - Aplicación creada con el programa Neobook. - Para niñós de 3 a 6 años

El trastorn per dèficit d'atenció amb o sense hiperactivitat (TDA-H) : guia per a docents. El trastorno por déficit de atención con o sin hiperactividad (TDA-H) : guía para docentes'.

STILL es la asociación balear de niños con TDA-H, es una asociación sin ánimo de lucro integrada por padres de niños afectados, profesionales de la salud y la educación, y personas sensibilizadas con los objetivos de la asociación

La relación entre los conceptos de relación estratégica comunitaria de las organizaciones con las comunidades y la responsabilidad social

Para maximizar los beneficios, una compañía fundamenta sus acciones en ciertas estrategias que ayudan a cumplir su objetivo de generar utilidades. Entre las diferentes acciones que una organización puede utilizar, están las de responsabilidad social y las de relaciones estratégicas con la comunidad. Partiendo de la definición de comunidad, pasando por una descripción de responsabilidad social y sus diferentes formas de aplicabilidad dentro de una empresa, hasta la definición de relación estratégica con la comunidad; esta investigación dirige sus esfuerzos a determinar el vínculo que existe entre los conceptos de responsabilidad social y relación estratégica comunitaria. Adicionalmente, se plantea que otras estrategias de relacionamiento con clientes, como el mercadeo relacional o el CRM, las cuales enfocan sus esfuerzos en conocer a cada uno de los clientes de una compañía para plantear una oferta acorde a sus necesidades, no son muy efectivas a la hora de crear un vínculo emocional con la comunidad.

La construcción de la política exterior de Rusia hacia Serbia: entre el pragmatismo y el Eurasianismo (2007-2015)

Esta monografía defenderá que la Rusia contemporánea cuenta con una ideología formada a partir de los elementos imperiales y religiosos previos a la Unión Soviética además de elementos políticos propios de la URSS como la colectividad y la oposición a occidente. La Rusia de Putin ha recobrado sus capacidades para defender sus intereses en el mundo frente a la injerencia de occidente, y en el caso de Serbia esto se hará evidente a través de la importancia de los lazos culturales e históricos reforzados por los vínculos económicos y estratégicos que representa la presencia de Rusia en Serbia. Los principales autores sobre los que se trabajará son Alexander Dugin y Alexander Panarin.

Situation assessment through multi-modal sensing of dynamic environments to support cognitive robot control

Awareness of emerging situations in a dynamic operational environment of a robotic assistive device is an essential capability of such a cognitive system, based on its effective and efficient assessment of the prevailing situation. This allows the system to interact with the environment in a sensible (semi)autonomous / pro-active manner without the need for frequent interventions from a supervisor. In this paper, we report a novel generic Situation Assessment Architecture for robotic systems directly assisting humans as developed in the CORBYS project. This paper presents the overall architecture for situation assessment and its application in proof-of-concept Demonstrators as developed and validated within the CORBYS project. These include a robotic human follower and a mobile gait rehabilitation robotic system. We present an overview of the structure and functionality of the Situation Assessment Architecture for robotic systems with results and observations as collected from initial validation on the two CORBYS Demonstrators.

Iodide Transport Defect: Functional Characterization of a Novel Mutation in the Na(+)/I(-) Symporter 5 `-Untranslated Region in a Patient with Congenital Hypothyroidism

Context: Iodide transport defect (ITD) is an autosomal recessive disorder caused by impaired Na(+)/I(-) symporter (NIS)-mediated active iodide accumulation into thyroid follicular cells. Clinical manifestations comprise a variable degree of congenital hypothyroidism and goiter, and low to absent radioiodide uptake, as determined by thyroid scintigraphy. Hereditary molecular defects in NIS have been shown to cause ITD. Objective: Our objective was to perform molecular studies on NIS in a patient with congenital hypothyroidism presenting a clinical ITD phenotype. Design: The genomic DNA encoding NIS was sequenced, and an in vitro functional study of a newly identified NIS mutation was performed. Results: The analysis revealed the presence of an undescribed homozygous C to T transition at nucleotide -54 (-54C>T) located in the 5`-untranslated region in the NIS sequence. Functional studies in vitro demonstrated that the mutation was associated with a substantial decrease in iodide uptake when transfected into Cos-7 cells. The mutation severely impaired NIS protein expression, although NIS mRNA levels remained similar to those in cells transfected with wild-type NIS, suggesting a translational deficiency elicited by the mutation. Polysome profile analysis demonstrated reduced levels of polyribosomes-associated mutant NIS mRNA, consistent with reduced translation efficiency. Conclusions: We described a novel mutation in the 5`-untranslated region of the NIS gene in a newborn with congenital hypothyroidism bearing a clinical ITD phenotype. Functional evaluation of the molecular mechanism responsible for impaired NIS-mediated iodide concentration in thyroid cells indicated that the identified mutation reduces NIS translation efficiency with a subsequent decrease in protein expression and function. (J Clin Endocrinol Metab 96: E1100-E1107, 2011)

Posttranscriptional regulation of sodium-iodide symporter mRNA expression in the rat thyroid gland by acute iodide administration

Serrano-Nascimento C, Calil-Silveira J, Nunes MT. Posttranscriptional regulation of sodium-iodide symporter mRNA expression in the rat thyroid gland by acute iodide administration. Am J Physiol Cell Physiol 298: C893-C899, 2010. First published January 27, 2010; doi:10.1152/ajpcell.00224.2009.-Iodide is an important regulator of thyroid activity. Its excess elicits the Wolff-Chaikoff effect, characterized by an acute suppression of thyroid hormone synthesis, which has been ascribed to serum TSH reduction or TGF-beta increase and production of iodolipids in the thyroid. These alterations take hours/days to occur, contrasting with the promptness of Wolff-Chaikoff effect. We investigated whether acute iodide administration could trigger events that precede those changes, such as reduction of sodium-iodide symporter (NIS) mRNA abundance and adenylation, and if perchlorate treatment could counteract them. Rats subjected or not to methylmercaptoimidazole treatment (0.03%) received NaI (2,000 mu g/0.5 ml saline) or saline intraperitoneally and were killed 30 min up to 24 h later. Another set of animals was treated with iodide and perchlorate, in equimolar doses. NIS mRNA content was evaluated by Northern blotting and real-time PCR, and NIS mRNA poly(A) tail length by rapid amplification of cDNA ends-poly(A) test (RACE-PAT). We observed that NIS mRNA abundance and poly(A) tail length were significantly reduced in all periods of iodide treatment. Perchlorate reversed these effects, indicating that iodide was the agent that triggered the modifications observed. Since the poly(A) tail length of mRNAs is directly associated with their stability and translation efficiency, we can assume that the rapid decay of NIS mRNA abundance observed was due to a reduction of its stability, a condition in which its translation could be impaired. Our data show for the first time that iodide regulates NIS mRNA expression at posttranscriptional level, providing a new mechanism by which iodide exerts its autoregulatory effect on thyroid.

Differential gene expression analysis of iodide-treated rat thyroid follicular cell line PCCl3

The inhibitory effect of supraphysiological iodide concentrations on thyroid hormone synthesis (Wolff - Chaikoff effect) and on thyrocyte proliferation is largely known as iodine autoregulation. However, the molecular mechanisms by which iodide modulates thyroid function remain unclear. In this paper, we analyze the transcriptome profile of the rat follicular cell lineage PCCl3 under untreated and treated conditions with 10 (- 3) M sodium iodide (NaI). Serial analysis of gene expression (SAGE) revealed 84 transcripts differentially expressed in response to iodide (p <= 0.001). We also showed that iodide excess inhibits the expression of essential genes for thyroid differentiation: Tshr, Nis, Tg, and Tpo. Relative expression of 14 of 20 transcripts selected by SAGE was confirmed by real-time PCR. Considering the key role of iodide organification in thyroid physiology, we also observed that both the oxidized form of iodide and iodide per se are responsible for gene expression modulation in response to iodide excess. (c) 2008 Elsevier Inc. All rights reserved.

Syntheses, crystal structure and theoretical investigation of novel heteroleptic complexes of nickel(II) with N-R-sulfonyldithiocarbimate and phosphine ligands

Five new complexes of general formula: [Ni(RSO(2)N=CS(2))(dppe)], where R = C(6)H(5) (1), 4-ClC(6)H(4) (2), 4-BrC(6)H(4) (3), 4-IC(6)H(4) (4) and dppe = 1,2-bis(diphenylphosphino) ethane and [Ni(4-IC(6)H(4)SO(2)N=CS(2))(PPh(3))(2)] (5), where PPh3 = triphenylphosphine, were obtained in crystalline form by the reaction of the appropriate potassium N-R-sulfonyldithiocarbimate K(2)(RSO(2)N=CS(2)) and dppe or PPh(3) with nickel(II) chloride in ethanol/water. The elemental analyses and the IR, (1)H NMR, (13)C NMR and (31)P NMR spectra are consistent with the formation of the square planar nickel(II) complexes with mixed ligands. All complexes were also characterized by X-ray diffraction techniques and present a distorted cis-NiS(2)P(2) square-planar configuration around the Ni atom. Quantum chemical calculations reproduced the crystallographic structures and are in accord with the spectroscopic data. Rare C-H center dot center dot center dot Ni intramolecular short contact interactions were observed in the complexes 1-5. (C) 2011 Elsevier B. V. All rights reserved.

Produktion av marknadsförings- och korrespondensmaterial för DUCIS

The report describes the production of graphic correspondence and marketing material for DUCIS(Dalarna University Centre for Irish Studies).A logotype symbol is created on the basis of an element from the Celtic art, and a graphic material thatharmonies with this ideal of style is built around the symbol. A unique visiting card, correspondence cardand letterhead is produced to strengthen the identity of DUCIS outwards.The work proceeds with an international education folder which is an important element in the marketingwork for the MA-education which starts in the autumn of 2003. Two posters, one for the opening ofDUCIS in may 2003 and one for a conference in 2004, are produced. Finally, a redesign of the book coverfor NIS, Nordic Irish Studies, is carried out.The report describes the working process consisting of meetings, practical work and other elementswithin the process. The conclusion is that the work has been quite successful and that this, to a largeextent, depended on an engaged and supporting commissioner. The commissioner also is very satisfi edwith the results.The in-depth studies of the project is about the art and design of the Celtic culture throughout history.The text gives an account for the history and expressions of Celtic art from its birth, 2800 years ago, untilits death in 13th century Ireland and Scotland. Special attention is payed to the golden age of ChristianCeltic art on the british islands, the era from which the pattern of the DUCIS logotype originates.

Educação em Goiás de 1964 a 1978: a política que não é a do ensino

A política educacional de Goiás no período de 1964 a 1978 foi profundamente determinada pelo conjunto de medi das do Estado brasileiro após 1964. Estas medidas visaram criar as condições jurídico-institucionais que garantissem a continuidade e o aprofundamento da "estrutura de corte mo nopolístico da economia brasileira". Para tanto,mudanças de ordem política que redimensionaram as relações entre os Poderes governamentais (executivo, legislativo e judiciário), entre os níveis de governo (federal, estadual e municipal) e principalmente entre o poder de Estado e a participação PQ pular foram necessárias. Neste conjunto se inserem as refor mas educacionais. Estas reformas procuraram ajustar a educa çao aos parâmetros do modelo econômico e às necessidades de Segurança Nacional, aparato ideológico do regime. Relegada a posições inferiores dentro do jogo econômico do país, a política nacional de educação tem provocado um declínio do nível de qualidade do ensino, assim como um descomprometimento do Poder Público para com a educação das classes popula res. A análise da expansao do ensino de 1 9 e 29 graus em Goiás evidencia o caráter discriminatório e elitista desta expansão. Estas características levam não só a deterioração da qualidade do ensino, mas também à frustração da própria política expansionista que se mostra incapaz tanto de absorver a demanda por ensino de 1 9 grau, primário, principalmete, como de modificar o caráter de seletividade interno do sistema.Entretanto, tanto a an~lise da expans~o como da or ganizaç~o administrativa do sistema de ensino goiano eviden ciam a utilizaç~o da pr~tica clientelística como caracterí~ tica administrativa principal, se bem que dissimulada por um discurso técnico racional. Esta pr~tica clientelÍstica é resultado do processo histórico de "submissão" da economia goiana aos centros hegem6nicos do Sudeste do Brasil. Sobre a base da economia agropecuaria se estruturam as forças políticas locais, em torno das oligarquias familiocraticas que exercem o poder na fiel cartilha da "política de coro néis". Assim, sob a intermediaç~o destas pr~ticas sio efeti vadas as medidas da política nacional de educaç~o em Goiis. E é esta relação, política nacional-política clientelÍstica, que conferE especificidade i política de Educaç~o no Estado de Goiás, tornando mais fácil atribuir ao clientelismo o fracasso da educação.

POLONORDESTE: proposta educativa do "Projeto de Desenvolvimento Rural Integrado da Ibiapaba": Ceará

Este trabalho pretende mostrar que o setor educação inserido no "Projeto de Desenvolvimento Rural Integrado da Ibiapaba" (Ceará) - que se constitui em um sub-projeto do POLONORDESTE - serve quase apenas para justificar a caE tação de recursos financeiros. A educação formal alI transmi tida pelo "aparelho e~. colar", assim o como os demais segmentos que compoem o social, como a safid~ as várias modalidades de cultura, saneamento básico, etc, sao pouco relevantes, não sendo considerados em si, mas enquanto meio para que o setor econômico cresça cada vez mais. A "educação" que a "filosofia" daquele projeto prJ:. vilegia é aquela que inserida no seu conjunto como um todo, está voltada para a formação Ode novos hábitos de consumo e uma nova mentalidade onde o.capitalismo possa ter o seu res peIdo e conseqüentemente se acumular. of; uma educação que visa urbanisar o homem, "moder nisá-Io". Esta educação objetiva formar o homem não para o meio rural e sim para a cidade em coerência com o capitali~ mo brasileiro onde o setor industrial-urbano tem sido o ele menta propulsor de seu desenvolvimento.