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Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico.
We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period.
The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category.
The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.
The objective of this study was to determine the serotype distribution and antibiotic resistance of invasive pneumococcal disease (IPD) strains in children from Lima, Peru, before and after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7), which was introduced in the national immunisation program on 2009. We conducted a prospective, multicentre, passive surveillance IPD study during 2006–2008 and 2009–2011, before and right after the introduction of PCV7 in Peru. The study was performed in 11 hospitals and five private laboratories in Lima, Peru, in patients <18 years old, with sterile site cultures yielding Streptococcus pneumoniae. In total 159 S. pneumoniae isolates were recovered. There was a decrease in the incidence of IPD in children <2 years old after the introduction of PCV7 (18.4/100 000 vs. 5.1/100 000, P = 0.004). Meningitis cases decreased significantly in the second period (P = 0.036) as well as the overall case fatality rate (P = 0.025), including a decreased case fatality rate of pneumonia (16.3% to 0%, P = 0.04). PCV7 serotypes showed a downward trend. Vaccine-preventable serotypes caused 78.9% of IPD cases, mainly 14, 6B, 5, 19F and 23F. A non-significant increase in erythromycin resistance was reported. Our findings suggest that the introduction of PCV7 led to a significant decrease of IPD in children under 2 years old and in the overall case fatality rate.
The welding heat input has been pointed out as a main limiting factor for TWinnig Induced Plasticity (TWIP) steel weldability. Scarce research works have been focused on the study of application and effects of the Gas Tungsten Arc Welding (GTAW) process in the TWIP steel, especially in higher thickness plate. In this research work was conducted a detailed analysis of a butt weld joint performed in plates of TWIP steel microalloyed with titanium (TWIP-Ti) of 6.3 mm thickness. The autogenous GTAW process with low heat input was applied. The analysis considered grain size measurements, second phases identification, post-weld mechanical properties (microhardness) and the welding thermal field. A Finite Element Model (FEM), validated through experimental results, allowed correlating metallurgical results with the thermal field. Likewise, the phases prediction carried out by means of JMatPro 9.0 software during solidification process as well as the estimation of particle precipitation were in good agreement with the experimental results. These predictive diagrams were calculated taking into account the TWIP-Ti steel chemical composition, the grain size measured in critical weld regions and experimental cooling rates. The low heat input improved the microstructural conditions in the heat affected zone (HAZ) whose average grain size and precipitate particles, like (C, N)Ti, promoted good mechanical properties as compared to the base material (as-solution condition). Some particles like Al2O3 y MnS produced microporosities in the HAZ. Despite this, the weld joint did not present hot cracking in the FZ-HAZ interface.