Late Major Hemoptysis After Lung Volume Reduction With Coils Induced by Dual Antiaggregation Therapy.

Lung-volume reduction using coils is an effective and safe treatment for selected patients presenting severe emphysema and hyperinflation. Most complications occur during the first 30 days after the procedure. Although frequent, hemoptysis is usually transient and minor. Antiaggregation therapy is common in patients with emphysema who, very often, have additional tobacco-associated comorbidities. Aspirin is considered safe for most major interventions; however, clopidogrel is mainly contraindicated and considered an exclusion criterion. We present a case of life-threatening hemoptysis caused by dual antiaggregation therapy "accidentally" introduced 3 months after the procedure. So far no recommendations exist on the optimal therapeutic strategy after lung-volume reduction with coils.

Anà lisi d'estratègies d'identificació i prevenció dels trastorns de conducta a l'aula

Aquest treball, vol exemplificar la importància que té actualment l’aplicació de diverses estratègies d’intervenció per identificar i disminuir la presència de trastorns de conducta a les aules. Des d’un punt de vista inclusiu, la detecció i el tractament d’aquests problemes s’ha convertit en un dels reptes més importants en l’educació i per aquest motiu volem oferir al professorat un seguit de metodologies i tècniques amb les quals puguin reconèixer en cursos inicials a tots aquells alumnes susceptibles a la realització d’una intervenció preventiva.

Estudi de l'ensenyament-aprenentatge de la multiplicació de fraccions

Aquest treball és una investigació de com cal ensenyar la multiplicació de fraccions a l’Educació Primària. S’han recollit les dades a través d’entrevistes per conèixer com 6 mestres ensenyaven aquest coneixement matemàtic per comparar-ho amb el que diuen diferents autors com Van de Walle, Tipps, Tucker i Bruner. L’ensenyamentaprenentatge de la multiplicació de fraccions és un procés difícil i complex. Per adquirir aquest coneixement, els infants necessiten tenir experiències amb diferents situacions que es plantegi el producte de fraccions i deduir ells mateixos estratègies i algorismes propis per resoldre-les. Si se’ls dóna directament l’algorisme tradicional sense comprensió, tindran dificultats per identificar si el resultat és coherent o no.

HIV-1 Transmission During Recent Infection and During Treatment Interruptions as Major Drivers of New Infections in the Swiss HIV Cohort Study.

BACKGROUND: Reducing the fraction of transmissions during recent human immunodeficiency virus (HIV) infection is essential for the population-level success of "treatment as prevention". METHODS: A phylogenetic tree was constructed with 19 604 Swiss sequences and 90 994 non-Swiss background sequences. Swiss transmission pairs were identified using 104 combinations of genetic distance (1%-2.5%) and bootstrap (50%-100%) thresholds, to examine the effect of those criteria. Monophyletic pairs were classified as recent or chronic transmission based on the time interval between estimated seroconversion dates. Logistic regression with adjustment for clinical and demographic characteristics was used to identify risk factors associated with transmission during recent or chronic infection. FINDINGS: Seroconversion dates were estimated for 4079 patients on the phylogeny, and comprised between 71 (distance, 1%; bootstrap, 100%) to 378 transmission pairs (distance, 2.5%; bootstrap, 50%). We found that 43.7% (range, 41%-56%) of the transmissions occurred during the first year of infection. Stricter phylogenetic definition of transmission pairs was associated with higher recent-phase transmission fraction. Chronic-phase viral load area under the curve (adjusted odds ratio, 3; 95% confidence interval, 1.64-5.48) and time to antiretroviral therapy (ART) start (adjusted odds ratio 1.4/y; 1.11-1.77) were associated with chronic-phase transmission as opposed to recent transmission. Importantly, at least 14% of the chronic-phase transmission events occurred after the transmitter had interrupted ART. CONCLUSIONS: We demonstrate a high fraction of transmission during recent HIV infection but also chronic transmissions after interruption of ART in Switzerland. Both represent key issues for treatment as prevention and underline the importance of early diagnosis and of early and continuous treatment.