When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: an observational study.

BACKGROUND: Most clinical guidelines recommend that AIDS-free, HIV-infected persons with CD4 cell counts below 0.350 × 10(9) cells/L initiate combined antiretroviral therapy (cART), but the optimal CD4 cell count at which cART should be initiated remains a matter of debate. OBJECTIVE: To identify the optimal CD4 cell count at which cART should be initiated. DESIGN: Prospective observational data from the HIV-CAUSAL Collaboration and dynamic marginal structural models were used to compare cART initiation strategies for CD4 thresholds between 0.200 and 0.500 × 10(9) cells/L. SETTING: HIV clinics in Europe and the Veterans Health Administration system in the United States. PATIENTS: 20, 971 HIV-infected, therapy-naive persons with baseline CD4 cell counts at or above 0.500 × 10(9) cells/L and no previous AIDS-defining illnesses, of whom 8392 had a CD4 cell count that decreased into the range of 0.200 to 0.499 × 10(9) cells/L and were included in the analysis. MEASUREMENTS: Hazard ratios and survival proportions for all-cause mortality and a combined end point of AIDS-defining illness or death. RESULTS: Compared with initiating cART at the CD4 cell count threshold of 0.500 × 10(9) cells/L, the mortality hazard ratio was 1.01 (95% CI, 0.84 to 1.22) for the 0.350 threshold and 1.20 (CI, 0.97 to 1.48) for the 0.200 threshold. The corresponding hazard ratios were 1.38 (CI, 1.23 to 1.56) and 1.90 (CI, 1.67 to 2.15), respectively, for the combined end point of AIDS-defining illness or death. Limitations: CD4 cell count at cART initiation was not randomized. Residual confounding may exist. CONCLUSION: Initiation of cART at a threshold CD4 count of 0.500 × 10(9) cells/L increases AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 0.300 and 0.500 × 10(9) cells/L.

Eina per a generar l'assignació docent d'un centre

Aquest projecte de final de carrera està basat en la problemàtica que suposa l'assignació de professors sobre un horari docent ja definit. Donat que hi ha diferents limitacions tant per disponibilitat, nombre de crèdits a impartir o perfil docent de la persona, s'ha treballat en una aplicació que permeti la introducció de dades d'una manera simple i intuitiva i l'utilització de diferents resoledors per calcular solucions a partir de les dades inicials

Projecte de reorientació productiva de la finca Horta de les Flors de Canet de Mar (Barcelona)

Estudi de la reorientació productiva d’una finca amb espècies hortícoles i aromàtiques autòctones de la zona del Maresme. Per a obtenir les condicions òptimes de producció s’instal•laran tots els equips i mitjans auxiliars necessaris. La finalitat del projecte és produir espècies autòctones de la comarca del Maresme que a posteriori s’intentaran comercialitzar al detall dins la mateixa finca. Les espècies que no es venguin directament a la finca es vendran a minoristes que les portaran principalment al mercat local beneficiant-nos així, del valor afegit que poden tenir les espècies autòctones. No es descarta comercialitzar el producte, que aniria al minorista local, a alguna empresa del sector alimentari

Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study.

BACKGROUND: Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. AIMS: We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients. METHODS: We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. RESULTS: The EPIC II database includes 13,796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P < 0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P < 0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05). CONCLUSIONS: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.

La piscicultura: una alternativa per a las comarques gironines

La piscicultura com una alternativa per a las comarques gironines

Implantación de POS DM en una cadena de tiendas de ropa

En este documento queremos reflejar la situación inicial de la empresa en cuanto a su forma de recopilar la información de ventas de las tiendas e integrarla en el sistema ERP, así como establecer las modificaciones necesarias en el flujo actual para realizar este proceso mediante el uso de POSDM.

Estudi dels fenòmens de contacte de llengües en el lèxic d'escolars de primera llengua castellana i la seva l'evolució lingüística (de 6è de primària a 1r d'ESO)

Aquest treball estudia els fenòmens de contacte de llengües que apareixen a la llengua oral catalana d'una mostra d'adolescents de primera llengua castellana de Manlleu en dos punts temporals (6è de primària i 1r d'ESO) i compara els resultats obtinguts amb dos estudis precedents (Vila, 1996; Galindo, 2006)

The Building Blocks of International Ecological Footprint inequality: A Regression-Base Decomposition

This paper performs an empirical Decomposition of International Inequality in Ecological Footprint in order to quantify to what extent explanatory variables such as a country’s affluence, economic structure, demographic characteristics, climate and technology contributed to international differences in terms of natural resource consumption during the period 1993-2007. We use a Regression- Based Inequality Decomposition approach. As a result, the methodology extends qualitatively the results obtained in standard environmental impact regressions as it comprehends further social dimensions of the Sustainable Development concept, i.e. equity within generations. The results obtained point to prioritizing policies that take into account both future and present generations. Keywords: Ecological Footprint Inequality, Regression-Based Inequality Decomposition, Intragenerational equity, Sustainable development.