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In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.
The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.
This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.
From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).
Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).
The objective was to compare the performance of the updated Charlson comorbidity index (uCCI) and classical CCI (cCCI) in predicting 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB). All cases of SAB in patients aged ⩾14 years identified at the Microbiology Unit were included prospectively and followed. Comorbidity was evaluated using the cCCI and uCCI. Relevant variables associated with SAB-related mortality, along with cCCI or uCCI scores, were entered into multivariate logistic regression models. Global model fit, model calibration and predictive validity of each model were evaluated and compared. In total, 257 episodes of SAB in 239 patients were included (mean age 74 years; 65% were male). The mean cCCI and uCCI scores were 3.6 (standard deviation, 2.4) and 2.9 (2.3), respectively; 161 (63%) cases had cCCI score ⩾3 and 89 (35%) cases had uCCI score ⩾4. Sixty-five (25%) patients died within 30 days. The cCCI score was not related to mortality in any model, but uCCI score ⩾4 was an independent factor of 30-day mortality (odds ratio, 1.98; 95% confidence interval, 1.05–3.74). The uCCI is a more up-to-date, refined and parsimonious prognostic mortality score than the cCCI; it may thus serve better than the latter in the identification of patients with SAB with worse prognoses.
We aimed to quantify the proportion of people receiving care for HIV-infection that are 50 years or older (older HIV patients) in Latin America and the Caribbean between 2000 and 2015 and to estimate the contribution to the growth of this population of people enrolled before (<50yo) and after 50 years old (yo) (⩾50yo). We used a series of repeated, cross-sectional measurements over time in the Caribbean, Central and South American network (CCASAnet) cohort. We estimated the percentage of patients retained in care each year that were older HIV patients. For every calendar year, we divided patients into two groups: those who enrolled before age 50 and after age 50. We used logistic regression models to estimate the change in the proportion of older HIV patients between 2000 and 2015. The percentage of CCASAnet HIV patients over 50 years had a threefold increase (8% to 24%) between 2000 and 2015. Most of the growth of this population can be explained by the increasing proportion of people that enrolled before 50 years and aged in care. These changes will impact needs of care for people living with HIV, due to multiple comorbidities and high risk of disability associated with aging.
The aim of this study was to assess the effect of infection with the nematode whipworm Trichuris muris on the course of chemically induced acute ulcerative colitis in CBA/J mice, a strain proven to be highly resistant to infection with T. muris. Each mouse was infected with 50 embryonated eggs of T. muris by oral gavage. Acute colitis was triggered by administering 4% dextran sulphate sodium (DSS) in the drinking water for nine consecutive days at different times after infection. Concurrent infection and DSS administration exacerbate the severity of the colitis while favouring the permanence of parasites in the intestine. The induction of ulcerative colitis from days 54 to 62 post-infection (p.i.), when all worms had been expelled, ameliorated the course of the inflammatory disease. When ulcerative colitis was triggered earlier on, from days 27 to 35 p.i., the beneficial effects on inflammatory events were clearly shown with signs of mucosal epithelization and regeneration as early as day 1 after DSS administration. Previous infections by T. muris therefore accelerate recovery from subsequently induced inflammatory bowel disease and such an effect assists the nematode to persist in the intestinal niche.
Has been a tradition of the Mexican Social Security Institute (IMSS) have a great spirit of solidarity with any type of disaster. That is why the early hours of the earthquake in Haiti was appointed to a group of specialists trained in emergency care who participated in the first acts of rescue and stabilization of multiple victims. The first group of six specialists arrived Port au Prince on January 15 fieldwork being allocated in coordination with the rest of the Mexican aid mission in the sector 8 of the city, preferably at the University of Saint Gerard. Among the actions taken by this group were:
•Application of 300 doses of immunization.
•Tracking and signaling a radius of 3 km in search of survivors and bodies.
•Working in conjunction with the group of Topos, the Federal Police and the Navy in the initial care, resuscitation and transfer of 9 people rescued from the rubble.
•More than 60 dressings and sutures.
•Monitoring and maintenance of health of mission personnel.
The second group, consisting of specialists in trauma, reconstructive surgery, anesthesiology, surgical and intensive care nurses, was part of a Field Hospital was established in conjunction with the United States at the place called “Killi Point”, involving a network trauma care in which our doctors surgically intervened the hospital ship “Comfort”. Were to a large number of cases of traumatic amputation, children and adults burned, fractures, crushing limbs and carrying large infections for obvious reasons IMSS staff recognizes the professionalism and capacity of the entire Mexican mission of humanitarian aid to Haiti and the opportunity offered to us to help a sister nation, we reiterate that we are engaged, if required again to respond with the same promptly and sense of humanity shown so far.
El programa se estableció en el año 2006 dentro de la Coordinación General de Protección Civil de la Secretaría de Gobernación e incluye un Comité Nacional de Evaluación, Diagnóstico y Certificación integrado por todas las instituciones del Sector Salud Público, Privado y Social Se han acreditado cerca de 700 evaluadores de más de 2,700 que han tomado el curso. Se han realizado más de 1,700 autoevaluaciones y se han evaluado de 205 hospitales. En el marco legal se ha integrado el Programa Hospital Seguro en la Ley General de Protección Civil, se ha incluido en la Norma Oficial Mexicana que tiene relación con instalaciones de salud, se ha logrado el acceso al Fondo de Prevención de Desastres que maneja la Secretaría de Gobernación y se ha establecido que previo a la Certificación de Calidad del Consejo de Salubridad General (que incluye los criterios internacionales de la Joint Commission) sea evaluada como Hospital Seguro. De los hospitales calificados como no seguros ya se han evacuado dos (que serán demolidos) con alternativa de construir nuevos con alto nivel de seguridad. En un gran número de hospitales se han mejorado los sistemas de detección de incendios, rutas de evacuación y escaleras de emergencias, entre otros
Safe Hospital Program and Safe Medical Unit in Mexico. The program was established in 2006 within the General Coordination of Civil Protection of the Department of Government and includes a National Evaluation, Diagnosis and Certification integrated of all the institutions of the Public Health Sector, Private and Social. They have about 700 accredited assessors more than 2,700 who have taken the training. There have been more than 1,700 self-assessments and have been assessed in 205 hospitals. The legal framework has been integrated the Safe Hospital Program in the Civil Protection General Law, is included in the Official Mexican Standard that relates to health facilities, has gained access to the Disaster Prevention Fund that manages the Interior Secretary and has established that prior to the Certification of Quality Health Council General (including international standards of the Joint Commission) is evaluated as Safe Hospital. Of the hospitals classified as unsafe have been evacuated two (which will be demolished) with alternative of building new high level of security. In a large number of hospitals have improved fire detection systems, evacuation routes and emergency stairs, as others.
Organic materials from the Huitzilapa shaft tomb (calibrated and
averaged to date around a.d. 74 [Ramos and López
1996]) were examined for clues to identify
the contents of food (or other types of) offerings and determine the
constituents of burial accoutrements found on and around the six
inhumations found in the two tomb chambers. These materials have been
examined by light microscopy and scanning electron microscopy. The food
offerings have proven difficult to identify. Only class (fish, insect) or
kingdom level identifications (plant, animal) have been possible with
available technology. Nevertheless, both the diversity of offering
constituents and the quantity offered provide clues about the social
status of the individuals interred in the tomb. The fibers of burial
accoutrements have been less difficult to identify. Cotton and agave
fibers and at least two other tentatively identified fiber types are
associated with the interments and represent clothing, burial shrouds, and
personal accoutrements. A crumpled piece of amate paper is associated with
the high-status individual in the south chamber. This piece of paper is
the earliest organic evidence of paper in Mesoamerica. The presence of
cotton in the north chamber also suggests that cotton was a high-status
item that had limited availability in the Jaliscan altiplano and was
restricted to individuals that had achieved recognized social status. The
predominance of agave fibers associated with all but one of the interments
indicates the preeminence of maguey as the utilitarian fiber in western
Mexico during the Late Formative. The association of paper with a male
individual suggests that the Late Formative inhabitants of Huitzilapa
recognized status differences and observed class differentiation and craft
specialization. In addition to these organic, presumably food offerings,
textiles, and fiber, a new species of bacterium—Bacillus
tequilensis—was discovered in the decomposing material
associated with the interments.
Nanocapsules of Bi2S3 with diameters between 5 and 10 nm and shells with an amorphous atomic distribution were synthesized at room temperature, with bismuth nitrate and thiourea as precursors. Aging the solution for several days a black powder precipitated made of a mixture of one amorphous phase and crystalline Bi2S3. When two capsules interacted between each other, the capsule regions in contact crystallized into bismuth sulfide, which explains the origin of the crystalline phase observed in the X-ray diffraction pattern. At this temperature, aggregation of the small nanocapsules also gave rise to necklaces of capsules, which eventually gave rise to nanotubes; these necklaces ordered forming bundles parallel to their largest dimension. When the solution was annealed at temperatures lower than 100 °C, aggregation gave rise to capsules as large as 1 μm in diameter, and tubes with similar diameters; in this case aggregation occurred between small and large nanocapsules. Because of the monomers aggregating had an external spherical symmetry and the low annealing temperatures, which were not high enough to produce sintering, all capsules and tubes formed during aggregation had porous walls, making these materials interesting for many applications.
This paper presents a portable condition monitoring system named MAPREX which was
developed as result of the cooperation between the University of Oviedo and Aceralia
inside of a research project funded by the ECSC - Steel RTD Program. The system integrates
powerful monitoring and data visualization techniques based on the Self Organizing Map
(SOM) algorithm. In this paper is described in detail the system architecture
and performances, visualization techniques implemented and an example displaying real
data from a 6,000 kW DC motor of a hot strip mill rolling stand.
Four species of the genus Rhagoletis are native to Chile: R. nova (Schiner), R. conversa, (Brèthes), R. penela Foote and R. tomatis Foote. Currently, identification of these species is based on morphological criteria, but their strong similarity makes precise recognition difficult. To clarify species separation for quarantine purposes, a reliable method based on a PCR–RFLP procedure is reported. A DNA region containing mitochondrial NADH dehydrogenase genes was selected as a target sequence for the analysis. The amplification products (c. 1 kb) were digested with either SspI or DdeI, yielding specific patterns that differentiated each of the endemic species. Complete nucleotide sequences were determined, confirming empirical restriction maps. This report updates information on the geographical distribution of Rhagoletis species in Chile.
An estimated 5–10% of all breast and ovarian cancers are due to an inherited predisposition, representing a rather large number of patients. In Spain 1/13–1/14 women will be diagnosed with breast cancer during their lifetime. Two major breast cancer genes, BRCA1 and BRCA2, have been identified. To date, several hundred pathogenic mutations in these two genes have been published or reported to the Breast Cancer Information Core, BIC database (http://www.nhgri.nih.gov/Intramural_research_Lab transfer/Bic/index.html). In the present study, 30 Spanish breast and breast/ovarian cancer families (29 from Galicia, NW Spain, and 1 from Catalonia, NE Spain) were screened for mutations in the BRCA1 and BRCA2 genes. The analysis of these genes was carried out by SSCP for shorter exons and direct sequencing in the case of longer ones. Mutations were found in 8 of the 30 families studied (26.66%). It is important to note that all mutations were detected within the BRCA1 gene: 330 A>G, 910_913delGTTC, 2121 C>T, 3958_3962delCTCAGinsAGGC, and 5530 T>A. The BRCA1 330 A>G mutation was found in four unrelated families and accounted for 50% of all identified mutations.
In human disease and rodent models, immune responses in the intestinal mucosa can be damaging. Damage is characterised by villus atrophy, crypt hyperplasia and reduced ability to digest and absorb nutrients. In normal individuals active responses to harmless environmental antigens associated with food and commensal bacteria are controlled by the development of immunological tolerance. Similar pathological changes occur in piglets weaned early from their mothers. Active immune responses to food antigens are observed in these piglets, and we and others have hypothesised that the changes occur as a result of transient allergic immune responses to novel food or bacteria antigens. The normal mechanism for producing tolerance to food antigens may operate at induction (Peyer’s patches and mesenteric lymph nodes) or at the effector stage (intestinal lamina propria). In our piglet studies immunological tolerance occurs despite the initial active response. Together with evidence from rodents, this observation suggests that active responses are likely to be controlled at the effector stage, within the intestinal lamina propria. Support for this mechanism comes from the observation that human and pig intestinal T-cells are susceptible to apoptosis, and that this process is accelerated by antigen. We suggest that the role of the normal mature intestinal lamina propria is a balance between immunological effector and regulatory function. In neonatal animals this balance develops slowly and is dependant on contact with antigen. Immunological insults such as weaning may tip the balance of the developing mucosal immune system into excessive effector or regulatory function resulting in transient or chronic allergy or disease susceptibility.
During recent years the HRAS1 minisatellite has been analysed by several authors because of its
putative association with cancer susceptibility. The aim of this report is to test the usefulness of this
minisatellite in investigating human population relationships. We have studied 370 chromosomes
from two well-differentiated populations: Galicia (North-west Iberia) and South-east Africa, as well
as available data on allele length gene frequencies. The fragment analysis results show a strong
tendency to differentiate between non-African and African populations. In spite of the usefulness of
fragment analysis, the minisatellite variant repeat (MVR) approach of the HRAS1 minisatellite
appears to be a more powerful method for use in human population studies, due to the high level of
diversity of its interspersion pattern structures. In addition, this approach has allowed us to define
some new structural characteristics of this minisatellite. Four different major groups of human
HRAS1 minisatellite alleles could be distinguished following a structural criterion based on the MVR
code. Furthermore, the characterisation of the HRAS1 minisatellite in chimpanzees revealed clear
differences when compared to humans, not only with respect to the allele size but also to the internal
F. Bertola, Dipartimento di Astronomià, Università di Padova, Vicolo dell'Osservatorio 5, I-35122 Padova, Italy,
E.M. Corsini, Dipartimento di Astronomià, Università di Padova, Vicolo dell'Osservatorio 5, I-35122 Padova, Italy,
M. Cappellari, Dipartimento di Astronomià, Università di Padova, Vicolo dell'Osservatorio 5, I-35122 Padova, Italy,
J.C. Vega Beltrán, Telescopio Nazionale Galileo, Osservatorio Astronomico di Padova, Vicolo dell'Osservatorio 5, I-35122 Padova, Italy,
A. Pizzella, European Southern Observatory, Alonso de Cordova 3107, Casilla 19001, Santiago 10, Chile,
M. Sarzi, Dipartimento di Astronomià, Università di Padova, Vicolo dell'Osservatorio 5, I-35122 Padova, Italy,
J.G. Funes, Dipartimento di Astronomià, Università di Padova, Vicolo dell'Osservatorio 5, I-35122 Padova, Italy
We report the case of the geometrical and kinematical decoupling between the bulge and the disk of the Sa galaxy NGC 4698. The R–band isophotal map of this spiral shows that the bulge structure is elongated perpendicularly to the major axis of the disk. At the same time a central stellar velocity gradient is found along the major axis of the bulge. We also present the Sa galaxy NGC 4672 as being a good candidate for a spiral hosting a bulge and a disk that are orthogonally decoupled with respect to one other. This decoupling of the two fundamental stellar components suggests that the disk could represent a second event in the history of early-type spirals.
NGC 4698 is classified Sa by Sandage & Tammann (1981) and Sab(s) by de Vaucouleurs et al. (1991; RC3). Sandage & Bedke (1994; CAG) present NGC 4698 as an example of the early-to-intermediate Sa type since it is characterized by a large central bulge and tightly wound spiral arms. In addition to a remarkable geometrical decoupling between the bulge and the disk (whose apparent major axes appear oriented in an orthogonal way upon simple visual inspection of galaxy plates; see Panels 78, 79 and 87 in CAG), a spectrum taken along the minor axis of the disk shows the presence of a stellar velocity gradient which could be ascribed to the bulge.