Elevated inflammatory markers combined with positive pneumococcal urinary antigen are a good predictor of pneumococcal community-acquired pneumonia in children.

BACKGROUND: Our objective was to evaluate procalcitonin (PCT) and C-reactive protein (CRP) as predictors of a pneumococcal etiology in community-acquired pneumonia (CAP) in hospitalized children. METHODS: Children requiring hospitalization for CAP were prospectively enrolled. The following indices were determined: antibodies against pneumococcal surface proteins (anti-PLY, pneumococcal histidine triad D, pneumococcal histidine triad E, LytB and pneumococcal choline-binding protein A), viral serology, nasopharyngeal cultures and polymerase chain reaction for 13 respiratory viruses, blood pneumococcal polymerase chain reaction, pneumococcal urinary antigen, PCT and CRP. Presumed pneumococcal CAP (P-CAP) was defined as a positive blood culture or polymerase chain reaction for Streptococcus pneumoniae or as a pneumococcal surface protein seroresponse (≥2-fold increase). RESULTS: Seventy-five patients were included from which 37 (49%) met the criteria of P-CAP. Elevated PCT and CRP values were strongly associated with P-CAP with odds ratios of 23 (95% confidence interval: 5-117) for PCT and 19 (95% confidence interval: 5-75) for CRP in multivariate analysis. The sensitivity was 94.4% for PCT (cutoff: 1.5 ng/mL) and 91.9% for CRP (cutoff: 100 mg/L). A value≤0.5 ng/mL of PCT ruled out P-CAP in >90% of cases (negative likelihood ratio: 0.08). Conversely, a PCT value≥1.5 ng/mL associated with a positive pneumococcal urinary antigen had a diagnostic probability for P-CAP of almost 80% (positive likelihood ratio: 4.59). CONCLUSIONS: PCT and CRP are reliable predictors of P-CAP. Low cutoff values of PCT allow identification of children at low risk of P-CAP. The association of elevated PCT or CRP with a positive pneumococcal urinary antigen is a strong predictor of P-CAP.

Dealing with clients' diversity in test situations: Client categorisations in psychologists' accounts of their practices

Reducing a test administration to standardised procedures reflects the test designers' standpoint. However, from the practitioners' standpoint, each client is unique. How do psychologists deal with both standardised test administration and clients' diversity? To answer this question, we interviewed 17 psychologists working in three public services for children and adolescents about their assessment practices. We analysed the numerous "client categorisations" they produced in their accounts. We found that they had shared perceptions about their clients' diversity, and reported various non-standard practices that complemented standardised test administration, but also differed from them or were even forbidden. They seem to experience a dilemma between: (a) prescribed and situated practices; (b) scientific and situated reliability; (c) commutative and distributive justice. For practitioners, dealing with clients' diversity this is a practical problem, halfway between a problem-solving task and a moral dilemma.

"Vinci Cosmetics" Fabricación y comercialización de productos cosméticos

Contexto: La idea principal es la creación de una empresa para la fabricación y comercialización de productos cosméticos de alta gama. A pesar del contexto de crisis económica en el que estamos envueltos estos últimos años y del que no parece que acabamos de salir, el sector de la cosmética está resistiendo la situación de forma envidiable. De la crisis, como dicen los economistas, “se saldrá y se volverá, todo es cíclico” y viendo la fortaleza que éste sector está mostrando unido a la necesidad de que nuestra economía abandone sectores muy deteriorados y sin una previsión positiva de futuro, la cosmética se postula con un futuro prometedor dentro del contexto económico español y europeo. “Vinci Cosmetics” es el nombre inicialmente pensado para que la nueva compañía inicie su andadura. Nombre con tintes latinos de la lejana época del imperio romano como homenaje a la rica herencia histórica de la ciudad del autor del proyecto - Tarragona. La cultura por cuidarse y sentirse bien, muy arraigada en la mentalidad latina y mediterránea, es un factor cultural clave para el desarrollo y futura evolución de esta industria. El slogan de la empresa, “Dieta Mediterránea para tu piel”, clarifica en buena medida la idea a desarrollar y los objetivos pretendidos por la estrategia empresarial. Objetivos: El objetivo esencial del TFC es elaborar un estudio detallado para la creación de una empresa de fabricación y comercialización de productos cosméticos de alta gama que abarque el management y la gestión por procesos de la empresa, la función de marketing, el tipo de operaciones y procesos a realizar, la gestión del factor humano y el presupuesto necesario para cubrir este ambicioso proyecto. En detalle, un completo plan de empresa que marque las directrices de la organización industrial que se pretende crear compuesto a su vez por cinco planes: plan de gerencia, plan de marketing, plan de operaciones, plan de recursos humanos y plan económico – financiero. Procedimientos: El proyecto tiene un alto componente de estudio de mercados y de marketing pero pretende también abarcar el management, los procesos de operación, el factor humano y el aspecto económico y financiero de las inversiones y presupuesto necesario. El estudio inicial centrará su esfuerzo en un análisis del mercado de la península ibérica, y, en función del avance y del progreso esperado por la empresa, la compañía podría extender su campo de acción a Europa aunque no antes de un medio plazo. “Vinci Cosmetics” ha adoptado referenciales de sistemas de gestión integrados en toda la organización. Así tenemos principalmente, por un lado, la norma internacional ISO 9001:2008 y, por otro, el Modelo EFQM de Excelencia en la gestión; ambos plasmados a partir de un enfoque basado en procesos que nos garantiza el control continuo y la gestión excelente. Conclusiones: Tras evaluar la situación actual del mercado de la cosmética, las previsiones futuras de éste y las necesidades que una organización industrial necesita, se puede crear - con plenas garantías de éxito como organización empresarial y desde el punto de vista económico - una empresa de cosméticos de alta gama para cubrir las necesidades de una parte de mercado que lo requiere.

Medical demography and intergenerational inequalities in general practitioners' earnings

This article examines the link between restrictions on the number of physicians and general practitioners' (GPs) earnings. Using a representative panel of 6016 French self-employed GPs over the years 1983-2004, we estimate an earnings function to identify experience, time and cohort effects. The estimated gap in earnings between 'good' and 'bad' cohorts can be as large as 25%. GPs who began their practices during the eighties have the lowest permanent earnings: they belong to the large cohorts of the baby-boom and face the consequences of an unlimited number of places in medical schools. Conversely, the decrease in the number of places in medical schools led to an increase in permanent earnings of GPs who began their practices in the mid-nineties. A stochastic dominance analysis shows that unobserved heterogeneity does not compensate for average differences in earnings between cohorts. These findings suggest that the first years of practice are decisive for a GP. If competition between physicians is too intense at the beginning of their careers, they will suffer from permanently lower earnings. To conclude, our results show that the policies aimed at reducing the number of medical students succeeded in buoying up physicians' permanent earnings. [Ed.]

Cohesió social, alimentació i immigració

El projecte té com a objectiu general descriure accions comunitàries relacionades amb el menjar i la cohesió social. L’objectiu específic del projecte és recollir bones pràctiques d’entitats de Barcelona que treballin sobre la cohesió social i els espais alimentaris amb l’objectiu de dinamitzar l’intercanvi d’elements culturals, entre d’altres. La metodologia emprada en aquest treball ha estat un estudi descriptiu transversal de tipus qualitatiu, tenint en compte les tècniques emprades: anàlisi documental, observació participant i entrevistes a professionals. Les experiències analitzades per a la realització del treball resulten experiències d’èxit que basen la seva activitat en la utilització de l’alimentació com a eina per treballar la cohesió social, a partir de la creació d’espais comunitaris que permeten l’intercanvi d’elements culturals entre els participants

Good practice in authoring manuscripts on geomorphology

This article aims to help potential authors of geomorphological articles to get their work published. It identifies the basic characteristics of a good manuscript in geomorphology in terms of: (a) originality and significance; and (b) rigour. It uses these characteristics to define how an author should structure a conventional' manuscript in geomorphology by successfully identifying and justifying the motivation for the research; clearly and fully explaining the methods used; and presenting and discussing the results obtained. The article considers the importance of published literature in sustaining all elements of a manuscript in geomorphology. It also presents the natural symmetry that should exist between parts of a manuscript. These practical elements regarding the form and content of a manuscript are then developed through: (a) flagging some of the common mistakes made by authors drawing upon my experience as Managing Editor of the journal Earth Surface Processes and Landforms; (b) discussing the ethical and legal issues, including plagiarism, that relate to manuscript submission; (c) exploring the review process from the perspective of an author, including guidance on how best to respond to review comments in revising a manuscript. Copyright (c) 2013 John Wiley & Sons, Ltd.

Mortality among 24,865 workers exposed to polychlorinated biphenyls (PCBs) in three electrical capacitor manufacturing plants: a ten-year update.

The objective of this analysis was to evaluate mortality among a cohort of 24,865 capacitor-manufacturing workers exposed to polychlorinated biphenyls (PCBs) at plants in Indiana, Massachusetts, and New York and followed for mortality through 2008. Cumulative PCB exposure was estimated using plant-specific job-exposure matrices. External comparisons to US and state-specific populations used standardized mortality ratios, adjusted for gender, race, age and calendar year. Among long-term workers employed 3 months or longer, within-cohort comparisons used standardized rate ratios and multivariable Poisson regression modeling. Through 2008, more than one million person-years at risk and 8749 deaths were accrued. Among long-term employees, all-cause and all-cancer mortality were not elevated; of the a priori outcomes assessed only melanoma mortality was elevated. Mortality was elevated for some outcomes of a priori interest among subgroups of long-term workers: all cancer, intestinal cancer and amyotrophic lateral sclerosis (women); melanoma (men); melanoma and brain and nervous system cancer (Indiana plant); and melanoma and multiple myeloma (New York plant). Standardized rates of stomach and uterine cancer and multiple myeloma mortality increased with estimated cumulative PCB exposure. Poisson regression modeling showed significant associations with estimated cumulative PCB exposure for prostate and stomach cancer mortality. For other outcomes of a priori interest--rectal, liver, ovarian, breast, and thyroid cancer, non-Hodgkin lymphoma, Alzheimer disease, and Parkinson disease--neither elevated mortality nor positive associations with PCB exposure were observed. Associations between estimated cumulative PCB exposure and stomach, uterine, and prostate cancer and myeloma mortality confirmed our previous positive findings.

Daily smoking as a marker of weight control practices among female adolescents

Purpose: There is evidence indicating that adolescent females smoke as a way to control weight. The aim of our research is to assess whether daily smoking is a marker for weight control practices among adolescent females. Methods: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health (SMASH02) data base, a survey including 7,548 [3,838 females] in-school adolescents aged 16-20 years in Switzerland. Among females self-reporting BMI (N _ 3,761), two groups were drawn: daily smokers (DS, N _ 1,273) included all those smoking at least 1 cigarette/day and never smokers (NS, N _ 1,888) included all those having never smoked. Former (N _ 177) and occasional (N _ 423) smokers were not included. Groups were compared on weight control practices (being on a diet, self-induced vomiting, use of doctor-prescribed or over-the-counter appetite suppressors) controlling for possible confounding variables (age, BMI, feeling fat, body image, use of other substances, depression, sport practice, academic track and perceived advanced puberty). Analyses were performed with STATA 9. Bivariate analyses are presented as point-prevalence and multivariate analysis (using logistic regression) are presented as adjusted odds ratio (AOR) and [95% confidence interval]. Results: In the bivariate analysis, DS females were significantly more likely (p _ 0.001) than NS to be on a diet (DS: 33.2%, NS: 22.2%), to self-induce vomiting (DS: 9.0%, NS: 3.3%), and to use doctor prescribed (DS: 2.3%, NS: 0.9%) or over-the-counter (DS: 3.2%, NS: 1.2%) appetite suppressors. In the multivariate analysis, DS females were more likely than NS to be on a diet (AOR: 1.40 [1.17/1.68]), to self-induce vomiting (AOR: 2.07 [1.45/2.97]), and to use doctor-prescribed appetite suppressors (AOR: 1.99 [1.00/ 3.96]). Conclusions: Weight control practices are more frequent among female daily smokers than among never smokers. This finding seems to confirm cigarette smoking as a way to control weight among adolescent females. Health professionals should inquire adolescent female smokers about weight control practices, and this association must be kept in mind when discussing tobacco cessation options with adolescent females. Sources of Support: The SMASH02 survey was funded by the Swiss Federal Office of Public Health and the participating cantons.

Escriure (correctament) per al web

The article presents the requirements of written text to be read on the web, as well as the general recommendations for editing text aimed at facilitating its reading. After introducing the overview of reading of written text, techniques, and strategies, the author turns to factors that condition reading on the web, as well as other specifics. Based on these elements, a series of recommendations is offered for good practices for writing correctly for the web, organised by the three basic components of written text: style or tone, structure, and presentation (orthographic and typographic corrections). Also introduced are tools that can be useful for improving text editing in a corporate environment