In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis.

IMPORTANCE: There are limited prospective, controlled data evaluating survival in patients receiving early surgery vs medical therapy for prosthetic valve endocarditis (PVE). OBJECTIVE: To determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias. DESIGN, SETTING, AND PARTICIPANTS: Participants were enrolled between June 2000 and December 2006 in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a prospective, multinational, observational cohort of patients with infective endocarditis. Patients hospitalized with definite right- or left-sided PVE were included in the analysis. We evaluated the effect of treatment assignment on mortality, after adjusting for biases using a Cox proportional hazards model that included inverse probability of treatment weighting and surgery as a time-dependent covariate. The cohort was stratified by probability (propensity) for surgery, and outcomes were compared between the treatment groups within each stratum. INTERVENTIONS: Valve replacement during index hospitalization (early surgery) vs medical therapy. MAIN OUTCOMES AND MEASURES: In-hospital and 1-year mortality. RESULTS: Of the 1025 patients with PVE, 490 patients (47.8%) underwent early surgery and 535 individuals (52.2%) received medical therapy alone. Compared with medical therapy, early surgery was associated with lower in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias (in-hospital mortality: hazard ratio [HR], 0.44 [95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57 [95% CI, 0.49-0.67]). The lower mortality associated with surgery did not persist after adjustment for survivor bias (in-hospital mortality: HR, 0.90 [95% CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI, 0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality with early surgery in the highest surgical propensity quintile (21.2% vs 37.5%; P = .03). At 1-year follow-up, the reduced mortality with surgery was observed in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs 50.0%; P = .007) quintiles of surgical propensity. CONCLUSIONS AND RELEVANCE: Prosthetic valve endocarditis remains associated with a high 1-year mortality rate. After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared with medical therapy in the overall cohort. Further studies are needed to define the effect and timing of surgery in patients with PVE who have indications for surgery.

Impact of duration of untreated psychosis on pre-treatment, baseline, and outcome characteristics in an epidemiological first-episode psychosis cohort.

INTRODUCTION: To assess the impact of duration of untreated psychosis (DUP) on baseline and 18-month follow-up characteristics controlling for relevant confounders in an epidemiological first-episode psychosis (FEP) cohort. METHOD: The Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia admitted 786 FEP patients from January 1998 to December 2000. Data were collected from medical files using a standardized questionnaire. Data from 636 patients were analyzed. RESULTS: Median DUP was 8.7 weeks. Longer DUP was associated with worse premorbid functioning (p<0.001), higher rate of schizophrenia-spectrum disorders (p<0.001), and younger age at onset of psychosis (p=0.004). Longer DUP was not associated with baseline variables but with a lower rate of remission of positive symptoms (p<0.001) and employment/occupation (p<0.001), a higher rate of persistent substance use (p=0.015), worse illness severity (p<0.001) and global functioning (p<0.001) at follow-up after controlling for relevant confounders, explaining approximately 5% of variance of remission of positive symptoms (p<0.001) in the total sample and 3% in schizophrenia-spectrum disorders excluding bipolar I disorder (p=0.002). Outcome was significantly worse when DUP exceeded 1-3 months. CONCLUSION: Avoiding pitfalls of non-epidemiological studies, DUP appears to be a modest independent predictor of prognosis in the medium-term. Results support the need for assertive early detection strategies.

The psychometric properties of the WAI in a career counseling setting: Comparison with a personal counseling sample

This study investigated the psychometric properties of the Working Alliance Inventory-Client version (WAI-C) and Working Alliance Inventory-Short and revised (WAI-SR) in a career counseling setting. Moreover, it compared the impact of career versus personal counseling settings based on results obtained using the WAI-SR. Subjects were 188 French-speaking career counseling clients and 95 French-speaking personal counseling clients, mainly students. For the career counseling sample, total reliability was .87 for the WAI-C and .76 for the WAI-SR. The shape of the distribution was normal but the variance was significantly lower for the career counseling sample. Exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs) confirmed the presence of an overall working alliance factor but indicated a clearer hierarchical structure for the WAI- SR than for the WAI-C. The psychometric properties seemed only slightly affected by the counseling setting, suggesting that this inventory is also relevant for career counseling, especially the WAI-SR, which has a more robust factorial structure.

Clinical and laboratory predictors of imported malaria in an outpatient setting: an aid to medical decision making in returning travellers with fever

Si le tableau clinique évoque une malaria et que le résultat des examens parasitologiques n?est pas disponible ou est négatif, le praticien n?a pas d?information basée sur l?évidence pour savoir s?il doit donner ou non un traitement présomptif. Afin d?identifier les facteurs cliniques et paracliniques prédictifs d?une parasitémie à Plasmodium, nous avons mené une étude prospective chez les voyageurs ou migrants en provenance d?une zone tropicale ou subtropicale et qui consultaient pour de la fièvre. Le questionnaire comprenait 49 items explorant les données démographiques, les caractéristiques du voyage, les éléments de l?anamnèse et de l?examen clinique ainsi que les résultats de laboratoire. 336 sujets avec données complètes ont été recrutés (97 patients atteints de malaria et 239 contrôles avec fièvre et examen parasitologique négatif). L?analyse de régression multivariée a permis d?identifier les facteurs prédictifs de maiaria suivants : prophylaxie inadéquate, sudations, absence de douleur abdominale, température )38"C, mauvais état général, splénomégalie, compte leucocytaire (1 O x 1 03/L, plaquettes ~ 1 5 0 x l 03/L, taux d?hémoglobine <12 g/dL et éosinophiles (5%. La présence d?une splénomégalie avait le coefficient de probabilité positif pour un diagnostic de malaria le plus élevé (1 3.6) ; venait ensuite la présence d?une thrombopénie (1 1 .O). Dans le contexte de la consultation ambulatoire de la Policlinique Médicale Universitaire (prévalence de malaria de 29%), la probabilité post- test d?avoir un examen parasitologique positif était de 85% pour la splénomégalie et de 82% pour la thrombopénie. Même si le seuil thérapeutique n?est pas absolument défini, il semble raisonnable d?envisager un traitement présomptif lorsque la probabilité post- test est >80%. Si le médecin est réticent à administrer un traitement sans documentation parasitologique, il devrait au moins se retenir d?entreprendre d?autres investigations coûteuses, et plutôt répéter l?examen parasitologique après 12-24 heures.

Comparative study of the mandarin hybrid fruit characteristics: Nova, Murcott and Ortanique in Capão Bonito SP, Brazil

The Murcott tangor represent 20% of the tangerines trees in São Paulo State being the second more grown. Their fruits have good acceptance in the market cause of the good characteristics presented as: size, attractive internal and external color, transport resistance, high juice rate and industry potential. It is necessary to study the behavior of others varieties, in order to amplify the diversity of tangerine industry, which show suitable characteristics to the fresh fruit market and that make possible different harvest season. Many tangerine varieties, selected from the Citrus Germplasm Bank of the do Centro Avançado de Pesquisa Tecnológica do Agronegócio de Citros "Sylvio Moreira"/IAC, belong to trials carried out in 15 places in São Paulo State. The Capão Bonito area, south-west of the state, is one of this places where the Nova tangelo, the Ortanique and the Murcott tangors are showing quite good results about their fruit qualities. This paper had as an objective to compare the fruit characteristics of the Nova tangelo, the Murcott and the Ortanique tangors grafted on two rootstocks: Rangpur lime and Cleopatra mandarin. Accordingly to the gotten results, is possible to conclude that Nova and Ortanique had shown weight, width, fruit shape and juice percent, similar to the Murcott. In compliance with the harvest season, the Nova present suitable conditions to fresh fruit market in May and June. By the other hand the Murcott fruits can be harvested in July to August and the Ortanique in August to September. For this reason, is possible extend the harvest season of this mandarin-like, from two to five month, occurring inclusive in a period out of the crop at the north hemisphere.

Overweight in Swiss children and associations with children's and parents' characteristics et Worldwide trends in childhood obesity

(1) Surpoids chez les enfants suisses et associations avec certaines caractéristiques chez les enfants et leurs parents Le but de cette étude était de mesurer la prévalence du surpoids et de l?obésité chez les enfants de sixième année du canton de Vaud (âge moyen de 12 ans) et les facteurs associés au surpoids. Les données ont été récoltées lors d?une étude menée par l?Institut universitaire de médecine sociale et préventive. Tous les enfants scolarisés en 6ème année à l?école publique du canton de Vaud entre septembre 2005 et mai 2006 étaient éligibles à participer à cette étude. Le taux de participation a atteint 76% (soit 5207 enfants de 12,3 ans en moyenne). Le poids et la taille des enfants ont été mesurés à l?école par des assistants de recherche et les enfants ont rempli, en classe, un questionnaire structuré sur leur mode de vie (notamment : temps quotidien passé à regarder la télévision, à jouer à des jeux sur écran; fréquence de la pratique de diverses activités physiques; fréquence de la consommation de fruits ou de légumes). Des informations sur les parents (niveau d?éducation, nationalité, poids et taille) ont été récoltées au moyen d?un questionnaire structuré envoyé par courrier à ceux-ci. Nous avons utilisé les critères de l?International Obesity Task Force, qui définit les valeurs-seuils de l'indice de masse corporelle pour le surpoids et pour l?obésité, par age et par sexe. La prévalence du surpoids (obésité incluse) dans la population était de 15% chez les garçons et de 12% chez les filles, et la prévalence de l?obésité était de 2% dans les deux sexes. Nous avons trouvé que le surpoids était associé de façon indépendante avec le temps passé à regarder la télévision, ainsi qu?avec certaines caractéristiques des parents, comme le surpoids, un bas niveau d?éducation et une nationalité étrangère. En conclusion, un enfant sur sept est en surpoids ou obèse dans le canton de Vaud. Ces chiffres indiquent un important défi de santé publique, même si cette prévalence dans le canton de Vaud est, actuellement, moindre que dans beaucoup d?autres pays d?Europe, et bien moindre qu?en Amérique du Nord. Les associations entre le surpoids infantile et le temps passé à regarder la télévision, ainsi que les associations avec des variables liées au milieu socio-culturel des parents indiquent plusieurs pistes d?intervention pour prévenir le surpoids chez les enfants. Il est probable que les mesures de prévention ne devraient pas se limiter aux approches individuelles, mais devraient aussi inclure des mesures structurelles sur l?environnement social, physique et économique visant à réduire les facteurs obésogènes dans la société.<br/><br/>Objective: The objective was to assess the prevalence of overweight and obesity in children in a canton of Switzerland and the association with various characteristics of the parents and the children. Research Methods and Procedures: A cross-sectional survey was conducted in all children of the sixth school grade of the canton of Vaud, Switzerland. Weight and height were measured, and selected lifestyle variables were assessed with a self-administered semiquantitative questionnaire. Information on children?s parents was gathered through a mailed structured questionnaire. Overweight and obesity were based on the International Obesity Task Force criteria. Results: Of 6873 eligible children, 5207 (76%) participated (2621 boys, 2586 girls; mean age, 12.3 years; standard deviation, 0.5 year). The prevalence of overweight (including obesity) was 15.0% (95% confidence interval, 13.7% to 16.4%) in boys and 12.4% (11.1% to 13.7%) in girls, and the prevalence of obesity was 1.8% (1.3% to 2.3%) and 1.7% (1.2% to 2.2%), respectively. In both univariate and multivariate analyses, overweight was strongly associated with high television viewing time and selected characteristics of the parents (overweight, low educational level, and foreign nationality). Discussion: The prevalence of pediatric overweight and obesity was lower in this region of Switzerland than in several European countries. The correlates of overweight found in this region suggest areas for potential interventions.

Improving Dynamic Characteristics of Open-loop Controlled Log Crane

The improvement of the dynamics of flexible manipulators like log cranes often requires advanced control methods. This thesis discusses the vibration problems in the cranes used in commercial forestry machines. Two control methods, adaptive filtering and semi-active damping, are presented. The adaptive filter uses a part of the lowest natural frequency of the crane as a filtering frequency. The payload estimation algorithm, filtering of control signal and algorithm for calculation of the lowest natural frequency of the crane are presented. The semi-active damping method is basedon pressure feedback. The pressure vibration, scaled with suitable gain, is added to the control signal of the valve of the lift cylinder to suppress vibrations. The adaptive filter cuts off high frequency impulses coming from the operatorand semi-active damping suppresses the crane?s oscillation, which is often caused by some external disturbance. In field tests performed on the crane, a correctly tuned (25 % tuning) adaptive filter reduced pressure vibration by 14-17 % and semi-active damping correspondingly by 21-43%. Applying of these methods require auxiliary transducers, installed in specific points in the crane, and electronically controlled directional control valves.

Agronomic characteristics of 'Prata-anã' and 'Maçã' bananas micropropagated

The experiment evaluated the agronomic characteristics of 'Prata-anã' and 'Maçã' banana plants, in the São Manuel region of São Paulo state. In the first crop cycle, the number of days from planting to inflorescence and from inflorescence to harvest; the number of shoots until the appearance of inflorescence and during the harvest period; active leaves number at inflorescence appearance and during the harvest period. Were evaluated yield parameters: like average weight of bunch, hand, rachis and fruit; average fruit number per hand and bunch; average fruit diameter and length. Incidences of plague diseases, as well as their severity were also evaluated. Delineation was totally at random, with 2 treatments, 15 replications and 5 useful plants per experimental plot. Both cultivars were characterized by values of descriptive average statistics and standard deviation, for characteristic interests. Number of days from planting to harvest was similar for both 'Prata-anã' and 'Maçã', 574 and 567 days respectively. Banana plants showed good phytosanitary quality throughout the whole cycle.

Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain

Background: Noroviruses are one of the principal biological agents associated with the consumption of contaminated food. The objective of this study was to analyse the size and epidemiological characteristics of foodborne outbreaks of gastroenteritis in Catalonia, a region in the northeast of Spain. Methods: In all reported outbreaks of gastroenteritis associated with food consumption, faecal samples of persons affected were analysed for bacteria and viruses and selectively for parasites. Study variables included the setting, the number of people exposed, age, sex, clinical signs and hospital admissions. The study was carried out from October 2004 to October 2005. Results: Of the 181 outbreaks reported during the study period, 72 were caused by Salmonella and 30 by norovirus (NoV); the incidence rates were 14.5 and 9.9 per 100,000 person-years, respectively. In 50% of the NoV outbreaks and 27% of the bacterial outbreaks (p = 0.03) the number of persons affected was ≥10; 66.7% of NoV outbreaks occurred in restaurants; no differences in the attack rates were observed according to the etiology. Hospitalizations were more common (p = 0.03) in bacterial outbreaks (8.6%) than in NoV outbreaks (0.15%). Secondary cases accounted for 4% of cases in NoV outbreaks compared with 0.3% of cases in bacterial outbreaks (p < 0.001) Conclusion: Norovirus outbreaks were larger but less frequent than bacterial outbreaks, suggesting that underreporting is greater for NoV outbreaks. Food handlers should receive training on the transmission of infections in diverse situations. Very strict control measures on handwashing and environmental disinfection should be adopted in closed or partially-closed institutions.

Estudio de algunas características de las plantas en variedad de peral y su relación con la incidencia de la psila (Cacopsylla Pyri (L.) Hemiptera: Psyllidae)

Se estudian algunas de las características varietales del peral que pueden influir sobre la instalación y desarrollo de las poblaciones de Cacopsylla pyri (L.). El estudio se realizó en una finca de la Estación Experimental de Lleida en Gimenells, para las variedades Blanquilla y Conference. Los parámetros medidos en la planta fueron: el incremento del perímetro del tronco, la densidad de lamburdas, la superficie foliar, el contenido en clorofila, el contenido en agua y el grosor de la hoja. Para estimar la densidad de poblacion del insecto, se realizaron recuentos de los estados inmaduros de C. pyri en lamburdas durante el invierno y en brotes tiernos durante el periodo vegetativo en los años 2000 y 2001. Se han observado diferencias significativas entre las dos variedades en cuanto a las características de la planta estudiadas y la incidencia de C. pyri. La incidencia de la psila es mayor en la variedad Blanquilla, variedad más vigorosa, con mayor superficie foliar, hojas más delgadas y con menor contenido en clorofila que la variedad Conference.

Relación Cacopsylla pyri (L.) (Homoptera: Psyllidae) - Peral. Influencia de la variedad

Se estudian algunas de las características morfológicas y fisiológicas de diferentes variedades de peral que pueden influir sobre la instalación y desarrollo de las poblaciones de Cacopsylla pyri. Se realizaron recuentos de puesta, ninfas, adultos y enemigos naturales de C. pyri en lamburdas y posteriormente en hojas de brotes del año en una colección de selección de variedades de peral de la "Estació Experimental de Lleida". El año 1997 se muestrearon 40 variedades. Los resultados obtenidos pusieron de manifiesto que existian diferencias significativas debidas a la variedad en los niveles de ocupación por el fitófago. Las variedades se agruparon en 3 categorias en función de la presencia de psylla: elevada, media y baja. De las plantadas los años 1994 y 1995 se muestrearon las 16 variedades correspondientes a los grupos anteriores. Las características de la planta estudiadas fueron: altura, diámetro del tronco, peso de la madera de poda, contenido en clorofila, macro y micronutrientes. Se han observado diferencias significativas entre las distintas variedades en las características de la planta estudiadas, relacionadas con las diferencias en los niveles de ocupación.

Meat characteristics of chickens from an F1 cross of two improved Spanish breeds depending on slaughter age

The present study analysed the meat characteristics of i) improved Castellana Negra chickens slaughtered at 18 weeks (CN-18) and ii) F1 crossbred chickens from improved Castellana Negra hens and improved Penedesenca Negra cocks (CNPN) slaughtered at 12 weeks and 18 weeks of age (young and adult animals, respectively). Purebred and crossbred specimens were compared at similar weights (CN-18 and CNPN-12) and ages (CN-18 and CNPN-18). The protein content of the meat was similar for the three types of animals; heavier animals (CNPN-18) had more fat than those slaughtered at lower weights (CNPN-12 and CN-18). Adults had a higher saturated fatty acid content and the young CNPN chickens had more monounsaturated fatty acids than CN chickens. In the CNPN adults, less water was lost during cooking, which is directly related to the juiciness of the meat. With regard to sensory analysis, a darker colour was observed in the meat as much as the internal fat of adult animals, in addition to greater colour uniformity. The meat of young CNPN birds was juicier, whereas that of the CN chickens was more fibrous. Therefore, we conclude that meat from CNPN chickens presents chemical, physical, and sensorial characteristics that make these animals a genetic base for alternative poultry production.

Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis.

BACKGROUND: Pneumonia is the biggest cause of deaths in young children in developing countries, but early diagnosis and intervention can effectively reduce mortality. We aimed to assess the diagnostic value of clinical signs and symptoms to identify radiological pneumonia in children younger than 5 years and to review the accuracy of WHO criteria for diagnosis of clinical pneumonia. METHODS: We searched Medline (PubMed), Embase (Ovid), the Cochrane Database of Systematic Reviews, and reference lists of relevant studies, without date restrictions, to identify articles assessing clinical predictors of radiological pneumonia in children. Selection was based on: design (diagnostic accuracy studies), target disease (pneumonia), participants (children aged <5 years), setting (ambulatory or hospital care), index test (clinical features), and reference standard (chest radiography). Quality assessment was based on the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. For each index test, we calculated sensitivity and specificity and, when the tests were assessed in four or more studies, calculated pooled estimates with use of bivariate model and hierarchical summary receiver operation characteristics plots for meta-analysis. FINDINGS: We included 18 articles in our analysis. WHO-approved signs age-related fast breathing (six studies; pooled sensitivity 0·62, 95% CI 0·26-0·89; specificity 0·59, 0·29-0·84) and lower chest wall indrawing (four studies; 0·48, 0·16-0·82; 0·72, 0·47-0·89) showed poor diagnostic performance in the meta-analysis. Features with the highest pooled positive likelihood ratios were respiratory rate higher than 50 breaths per min (1·90, 1·45-2·48), grunting (1·78, 1·10-2·88), chest indrawing (1·76, 0·86-3·58), and nasal flaring (1·75, 1·20-2·56). Features with the lowest pooled negative likelihood ratio were cough (0·30, 0·09-0·96), history of fever (0·53, 0·41-0·69), and respiratory rate higher than 40 breaths per min (0·43, 0·23-0·83). INTERPRETATION: Not one clinical feature was sufficient to diagnose pneumonia definitively. Combination of clinical features in a decision tree might improve diagnostic performance, but the addition of new point-of-care tests for diagnosis of bacterial pneumonia would help to attain an acceptable level of accuracy. FUNDING: Swiss National Science Foundation.

Gender inequalities in the response to combination antiretroviral therapy over time: the Swiss HIV Cohort Study.

OBJECTIVES: Gender-specific data on the outcome of combination antiretroviral therapy (cART) are a subject of controversy. We aimed to compare treatment responses between genders in a setting of equal access to cART over a 14-year period. METHODS: Analyses included treatment-naïve participants in the Swiss HIV Cohort Study starting cART between 1998 and 2011 and were restricted to patients infected by heterosexual contacts or injecting drug use, excluding men who have sex with men. RESULTS: A total of 3925 patients (1984 men and 1941 women) were included in the analysis. Women were younger and had higher CD4 cell counts and lower HIV RNA at baseline than men. Women were less likely to achieve virological suppression < 50 HIV-1 RNA copies/mL at 1 year (75.2% versus 78.1% of men; P = 0.029) and at 2 years (77.5% versus 81.1%, respectively; P = 0.008), whereas no difference between sexes was observed at 5 years (81.3% versus 80.5%, respectively; P = 0.635). The probability of virological suppression increased in both genders over time (test for trend, P < 0.001). The median increase in CD4 cell count at 1, 2 and 5 years was generally higher in women during the whole study period, but it gradually improved over time in both sexes (P < 0.001). Women also were more likely to switch or stop treatment during the first year of cART, and stops were only partly driven by pregnancy. In multivariate analysis, after adjustment for sociodemographic factors, HIV-related factors, cART and calendar period, female gender was no longer associated with lower odds of virological suppression. CONCLUSIONS: Gender inequalities in the response to cART are mainly explained by the different prevalence of socioeconomic characteristics in women compared with men.

Formalizing argumentative reasoning in a possibilistic logic programming setting with fuzzy unification

Possibilistic Defeasible Logic Programming (P-DeLP) is a logic programming language which combines features from argumentation theory and logic programming, incorporating the treatment of possibilistic uncertainty at the object-language level. In spite of its expressive power, an important limitation in P-DeLP is that imprecise, fuzzy information cannot be expressed in the object language. One interesting alternative for solving this limitation is the use of PGL+, a possibilistic logic over Gödel logic extended with fuzzy constants. Fuzzy constants in PGL+ allow expressing disjunctive information about the unknown value of a variable, in the sense of a magnitude, modelled as a (unary) predicate. The aim of this article is twofold: firstly, we formalize DePGL+, a possibilistic defeasible logic programming language that extends P-DeLP through the use of PGL+ in order to incorporate fuzzy constants and a fuzzy unification mechanism for them. Secondly, we propose a way to handle conflicting arguments in the context of the extended framework.