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Background: Carbapenemase-producing Enterobacteriaceae (CPE) causes infections associated with high mortality rates among hospitalized patients. CPE transmission occurs frequently, and prevention of patient-to-patient transmission is a priority. However, transmission pathways are not yet completely understood. The colonization of the respiratory tract with a CPE may lead to a higher risk of contamination of the patient’s environment increasing the spread of CPE. Objective: We estimated the rate of CPE spread when respiratory tract infection or colonization is present. Methods: We studied CPE dissemination analyzing a cohort of patients admitted between January 2013 and December 2018 at the university hospital complex of A Corua, a tertiary-care hospital. All patients who were hospitalized in the same room as a patient colonized or infected with a CPE (index case) for at least 24 hours were screened for CPE carriage. The microbiological screening was performed with conventional culture or polymerase chain reaction (PCR) to identified possible CPE patient-to-patient transmission. The screening test included several samples: rectal swab, perineal swab, wound or drainage swab, and low respiratory tract sample. Results: Active screening for CPE carriage was performed in 84 contact patients. Men represent 57.1% of the sample, and the mean age was 78.5 years (men, 68.0 years and women, 80.8 years), with significant differences between sexes (12.9; 95% CI, 19.6 to 6.1). The major group of cases (86.9%) were hospitalized in medical wards. Transmission confirmed by PCR occurred in 13 (15.5%) of 84 contact patients, after a mean exposure to the index case of 13.3 days. No significant differences were detected in terms of mean exposure to index cases between those contact patients who result negative and those who result positive. The 35 index cases (41.7%) tested positive for CPE on the respiratory sample, and exposure to them led to 8 positive contact patients (61.5%). Conclusions: CPE transmission in a tertiary-care hospital occurred frequently. The spread rate is even higher when CPE is present at the respiratory level. Understanding the mode of spread is important for designing effective control measures and adding a respiratory sample to CPE screening could be a key consideration.
The objective was to evaluate maternal Mediterranean diet (MD) pattern adherence during pregnancy and its association with small for gestational age (SGA) and preterm birth. A secondary objective of the current study was to describe the sociodemographic, lifestyle and obstetric profile of the mothers studied as well as the most relevant paternal and newborn characteristics.
The current study is a two-phase retrospective population-based study of maternal dietary habits during pregnancy and their effect on newborn size and prematurity. The descriptive first phase examined maternal dietary habits during pregnancy along with the maternal sociodemographic, lifestyle and obstetric profile in a cross-sectional period study. In the second phase, newborn outcomes were evaluated in a nested case–control study. Adherence to MD during pregnancy was measured with the Spanish version of Kidmed index.
Obstetrics ward of the La Fe Hospital in Valencia.
All mother–child pairs admitted after delivery during a 12-month period starting from January 2018 were assessed for eligibility. A total of 1118 provided complete outcome data after signing informed consent.
14·5 % met the criteria of poor adherence (PA); 34·8 %, medium adherence (MA); and 50·7 %, optimal adherence (OA). Medium adherence to MD was associated in the adjusted scenarios with a higher risk of giving birth to a preterm newborn. No association was found between MD adherence and SGA.
Early intervention programmes geared towards pregnant women, where women were aided in reaching OA to MD, might reduce the risk of preterm newborn.
The food habits of the South Pacific hake (Merluccius gayi) from Ecuadorian waters were studied by analysing 232 stomachs of specimens ranging from 23.4–83.1 cm in total length (TL). Fish was the most important prey group (Alimentary Index, %AI = 94), Ctenosciaena peruviana being the most represented prey species (%AI = 62.17). PERMANOVA analysis showed dietary differences between the smallest individuals (class I < 30 cm TL) and the largest (class IV 40–45 cm TL; class V ≥ 45 cm TL). In addition, spatial differences in dietary composition were found between the three sampled regions (Manabí, Santa Elena and Guayas). The results of this study indicate that the South Pacific hake is an opportunistic predator feeding on a wide variety of vertebrate and invertebrate organisms.
En las sociedades andinas actuales las relaciones de parentesco determinan el tipo de matrimonio y el patrón de residencia posmarital que garantizan el manejo de los recursos, la supervivencia y la estabilidad reproductiva de la población. Sin embargo, es escasa la información disponible en el Área Andina Centro-Sur (AACS) para explicar los sistemas de parentesco durante el poblamiento original del territorio y su impacto en la estructura de las poblaciones locales posteriores a la conquista y colonización europea. En el presente trabajo se investiga el patrón residencial en dos sectores del AACS a partir de datos bioarqueológicos disponibles para el Noroeste Argentino y Norte de Chile. La información necesaria pudo ser recuperada a partir de la arqueología y de la antropología física regional. La muestra proviene de 8 localidades y 44 sitios con fechados que cubren el intervalo cronológico desde 3000 aC hasta 1450 dC, desde grupos arcaicos tempranos hasta comunidades agroalfareras tardías. Se emplearon 1.897 observaciones y 27 variables craneométricas. El análisis se realizó con técnicas estadísticas multivariadas: el cálculo de la varianza generalizada (determinante de la matriz de varianzas y covarianzas) para cada sexo y la estimación de los estadísticos de distancia (D2) y divergencia fenotípica (Fst) entre grupos y sexos. Los resultados revelan el efecto de distintos flujos migratorios que determinaron la estructura de las poblaciones. En todos los casos la varianza generalizada masculina es mayor que la femenina indicando una mayor variabilidad entre sitios y una mayor actividad migratoria. Los valores de D2 y Fst femeninos son mayores entre regiones y localidades con una menor tasa migratoria. Estos resultados indican, en general, la prevalencia de una estrategia de supervivencia basada en un sistema de parentesco que favoreció un modelo de residencia matrilocal.
In the past decades the community-based participatory research method known as PhotoVoice has gained relevance, but there are few published studies on its application in the field of health technology assessment (HTA) and clinical practice guidelines (CPGs). The aim of this presentation was to describe a PhotoVoice project linked to a CPG on major depression in children and adolescents.
The design of the study was adapted to the main objective, which was to enhance the understanding of major depression and improve clinical practice with the contributions of clinicians, methodologists, and patients. Seven adolescents and ten of their family members participated in the study through PhotoVoice sessions and focus groups. The audio recordings of all sessions were transcribed verbatim and coded, and a thematic analysis was undertaken.
Six themes emerged: (i) a lack of understanding and information about depression in childhood and adolescence; (ii) the importance of support groups; (iii) the need to favor early care and access to services; (iv) the adaptation of therapeutic strategies tailored to individual needs; (v) the sensitivity of professionals; and (vi) fostering interaction between the health and education systems. Photographic exhibitions were planned to share the main results. These exhibitions were promoted to increase public awareness and reduce stigmatization, and to reach clinicians and policy makers. From a methodological point of view, the use of PhotoVoice in this study helped to effectively incorporate the lived experiences, concerns, and preferences of patients and their relatives into the CPG. The study also confirmed the value of photographs and participatory methods. The main limitations and strengths of the study, as well as suggestions for future research, are also outlined.
PhotoVoice is a flexible, effective, and innovative method of obtaining information about patients’ perspectives and experiences, and it offers the added value of being able to reach the main stakeholders, including policymakers and the public.
The specificities of non-pharmaceuticals can require adapting classical health technology assessment (HTA) methodologies and developing additional regional approaches to support decision-making processes. However, little information exists regarding the explicit approaches used in different countries. The aim of this work is to provide an overview of the role and activities of the Galician HTA agency (avalia-t, Spain) regarding assessment, appraisal and continued evaluation across the whole life cycle of non-pharmaceutical technologies.
In depth review and analysis of the activities undertaken by avalia-t during the past five years to support the introduction and appropriate use of non-pharmaceutical health care technologies at the regional level.
A multidisciplinary Commission judges the added value of new non-pharmaceuticals and establishes the indications and conditions for use. HTAs, which are mandatory for all relevant technologies, rely on the best available evidence on safety and effectiveness but also provide fit for purpose contextualized information based on organizational data and administrative registers. Interaction with multidisciplinary stakeholders is commonly needed to complement the evidence base (ad hoc working groups, face to face discussions), and post-launch studies can be implemented to analyze the utilization and results in real world practice. Performance indicators and other HTA based products can also be required to ensure the quality of health care (e.g., appropriate use indications, quality indicators, evidence based patient information). In addition, technical and scientific advice/support can be provided at different decision levels of the health organization to promote the quality of care and appropriate use of technologies (e.g., regional mental health program, suicide management strategy, bariatric surgery surveillance registry).
Rigorous, comprehensive and systematic processes for supporting non-pharmaceutical technology adoption and implementation are required. Although it is acknowledged that core information does not differ substantially within countries, contextualized information is recognized as essential for establishing the conditions for use at the regional level.
Decision making regarding national population-based prenatal and newborn screening policies is recognized to be highly challenging. This paper aims to describe the formalized collaboration that has been established between the Spanish National Public Health Screening Advisory Committee (PHSAC) and the Spanish Network of Health Technology Assessment (HTA) agencies to support the development of evidence- and consensus-based recommendations to support this process.
In-depth description and analysis of the strategic and methodological processes that have been implemented within the Spanish National Health System prenatal and newborn screening frameworks, with special emphasis on the role, actions, and responsibilities of HTA agencies.
The role of HTA agencies is threefold: (i) support the PHSAC by providing evidence on safety, effectiveness and cost/effectiveness of the screening tests/strategies, as well as contextualized information regarding costs, organizational, social, legal and ethical issues; (ii) collaborate with the PHSAC in the development of formal evidence- and consensus-based recommendations for defining population screening programs, when required; (iii) analyze real-world data that is generated by piloted programs. This paper will provide real-life examples of how these processes were implemented in practice, with a special focus on the development of the non-invasive prenatal testing (NIPT) policy. Recommendations for NIPT were developed by a multidisciplinary group based on the European network for Health Technology Assessment (EUnetHTA) rapid assessment report and the predictive models that were built using national statistics and other contextualized data.
The current work represents an innovative approach for prenatal and newborn screening policymaking, which are commonly difficult to evaluate due to the low quality of evidence and the confounding public health issues. The paper raises awareness regarding the importance of joint collaborations in areas where evidence is commonly insufficient for decision making.
Early awareness and alert systems (EAAS) try to anticipate the impact of new technologies in the healthcare systems. Spain, which has a decentralized health system with public provision and universal health coverage, has been a pioneer in establishing EAAS activities. From 2006 a network of regional agencies coordinated EAAS activities. Taking into account the individual agencies scarce resources and in order to improve efficiency, this collaboration decided to distribute tasks when identifying and early assessment of new and emerging health technologies. The aim was to inform the common benefit package of the Spanish public health system.
Four out of eight Spanish Health Technology Assessment (HTA) agencies had EAAS in Spain (AETS-Carlos III Institute; AETSA-Andalusia; Avalia-t-Galicia; Osteba-Basque Country). Each agency has taken care of different sources for the identification of new and emerging non-drug health technologies: industry and innovator contacts, health expert networks, mass media and EAAS databases. Members of the network used the same filtration criteria to reach the final list. The system will run in parallel to a biannual identification process in major databases.
In 2016, the network identified and filtered sixty-three technologies: ten by mass media; five by health experts; thirty-five other EAAS and thirteen by direct contact with industry and innovators. Main represented specialties were: endocrinology (seven); gynecology and obstetrics (six); cardiology and cardiac surgery (five); emergency medicine (four); dermatology (three) and pneumology (three). Technologies were grouped by specialty in order to inform the different commissions that discuss inclusion in the Spanish Benefit Package. Specialty monographs will be published to inform stakeholders.
The approach is feasible, and increases the capacity of individual agencies to address the needs of the national and regional systems by improving their efficiency. There is a need to previously define the methods and the criteria that will be used for the identification and filtration.
The diet and the feeding habits of the common dolphinfish (Coryphaena hippurus) in the Pacific coast of Ecuador was assessed by examining 320 stomachs of individuals ranging from 51 to 149 cm in total length. Fish was the predominant prey group in the diet (Alimentary Index, %AI = 95.39) followed by cephalopods (%AI = 4.13) and crustaceans (%AI = 0.48). Among the 17 prey items that make up the dolphinfish diet, the Exocoetidae family was the most important prey (%AI = 57.13), Dosidicus gigas being the most abundant invertebrate species (%AI = 7.65). Feeding patterns were evaluated using the graphing method of Amundsen, which suggested that this species shows a varying degree of specialization on different prey taxa. Thus, while some species were unimportant and rare (Hippocampus hippocampus, Lagocephalus lagocephalus, Gobiidae and Argonauta sp.), several dolphinfishes showed a high degree of specialization on Scombridae, Pleuroncodes planipes, Portunus xantusii and Opisthonema libertate. Size-related and temporal shifts in dietary composition were investigated by PERMANOVA analysis, which showed wide variations among size classes and periods of capture. The results of this study indicate that the common dolphinfish is an opportunistic feeder, which is capable of consuming a wide variety of schooling epipelagic organisms.
Polymer-clay nanocomposites are compounds in which nanoclay particles are distributed in a polymer matrix. Epoxy-clay nanocomposites have become a very interesting topic among researchers in the past two decades because nanoclays have a positive effect on the mechanical, thermal and especially barrier anticorrosive performance of the polymers. In this study, epoxy-montmorillonite organoclay (OMMT) nanocomposite coatings were prepared and deposited on carbon steel substrates. The coatings were prepared through in situ polymerization and by UV-curing technique. The OMMT was added to epoxy resin at loadings between 0 wt.% and 5 wt.%, the particles of OMMT were dispersed using forced agitation-sonication and deposited on carbon steel coupons. The nanocomposite coatings obtained have been characterized by scanning electron microscopy (SEM), spectroscopy Fourier transform infrared (FTIR), X-ray diffraction (XRD), thermogravimetric analysis (TGA), and evaluated their corrosion protection effect on cold rolled carbon steel coupons by performing visual analysis. The X-ray analysis showed that exfoliation occurred for the OMMT in the polymer matrix, the SEM analysis showed that OMMT was homogenous dispersed in the polymer matrix and the coatings were uniform. The FTIR analysis showed the characteristic bands of epoxy resin and OMMT in the composite. The results showed that 1 wt.% OMMT coating exhibit better anticorrosive properties than pure epoxy.
Quantitative analysis of macroecological patterns for late Pleistocene assemblages can be useful for disentangling the causes of late Quaternary extinctions (LQE). However, previous analyses have usually assumed linear relationships between macroecological traits, such as body size and range size/range shift, that may have led to erroneous interpretations. Here, we analyzed mammalian datasets to show how macroecological patterns support climate change as an important driver of the LQE, which is contrary to previous analyses that did not account for more complex relationships among traits. We employed quantile regression methods that allow a detailed and fine-tuned quantitative analysis of complex macroecological patterns revealed as polygonal relationships (i.e., constraint envelopes). We showed that these triangular-shaped envelopes that describe the macroecological relationship between body size and geographical range shift reflect nonrandom extinction processes under which the large-bodied species are more prone to extinction during events of severe habitat loss, such as glacial/interglacial transitions. Hence, we provide both a theoretical background and methodological framework to better understand how climate change induces body size-biased species sorting and shapes complex macroecological patterns.
The diet of young Atlantic bluefin tuna (Thunnus thynnus) in the Bay of Biscay foraging ground was assessed using stomach-content analysis (SCA) and stable-isotope analysis coupled with isotope mixing model. Whereas SCA showed that the young tuna fed mainly on horse mackerel (Trachurus trachurus), the estimation of liver and muscle mixing model analyses indicated that northern krill (Meganyctiphanes norvegica) was the most important food resource. These contrasting observations are probably due to the different time scales spanned by the different methods. The present results suggest that young bluefin tuna prey at different trophic levels of the Bay of Biscay pelagic food web, thus behaving as an opportunist and generalist predator.
In the present work, we report the synthesis and characterization of NaNbO3 particles obtained by microwave-assisted hydrothermal method from Nb2O5 and NaOH. The synthesis was made at different periods at 180 °C and 300W. The crystallization of NaNbO3 structures produced Na2Nb2O6.H2O in the intermediate phase with fiber-like morphology, and this is associated with the synthesis time. Pure orthorhombic NaNbO3 with cube-like morphology originates after synthesizing for 240 minutes. To verify the remnant polarization of particles, films were obtained by electrophoresis process and sintered at 800°C for 10 minutes in a microwave furnace. The films characterization indicated that films of niobate with fiber-like morphology present remaining polarization, and the morphology of cubes did not show remaining polarization. Considering these results, it can be concluded that the morphology implemented ferroelectric property of NaNbO3.
A number of systems based on synthetic molecules, among them cationic liposomes and poly(ethylene imine)-based polymers, have been proposed as delivery vehicles for nucleic acids. Some of these systems have even reached the market, ensuring efficient and transient transfection levels in a variety of cell types. However, toxicity issues have limited their application in vivo. In this context, chitosan, a biocompatible and biodegradable polysaccharide, has been proposed as a promising alternative for the delivery of nucleic acid-based molecules. Here we present an overview of the state of the art of chitosan-based vectors for nucleic acid delivery and the most recent data on the in vivo testing of the proposed systems. We additionally express our view on the barriers that might be hampering the translation of this knowledge into clinical practice and the challenges that need to be fulfilled for these promising vehicles to reach patients.
This research shows the influence of the synthesis route in the structural and morphological characteristics as well as in the luminescent properties of doped with europium and pure SrTiO3 (STO) powders prepared by microwave assisted hydrothermal synthesis, MWH, and by the polymeric precursor method, PPM. The XRD at room temperature of the STO powders nominally pure obtained by PPM at 700°C for 3 hours, as well as by the MWH at 190°C by 30 minutes present all the reflection peaks for the cubic perovskite structure (JCPDS-ICDD 35-734). The morphology varies according to the synthesis route. The particles of pure STO obtained by PPM presents morphology in the form of plates and the morphology of the particles synthesized by MWH is spherical with approximately 150 nm. The photoluminescent analysis shows for pure STO wide bands associated with the transition of charge transfer from the titanates group (TiO3)2- that are centered on 450 nm. In both preparation methods the emission bands obtained in the composites spectra were found to be asymmetric and low intense. However, in the case of the STO prepared by the PPM a bigger FWHM of the band can be observed. The excitation of the samples was done using a laser (Coherent Innova) with wavelength of 350 nm.
Scanning probe microscopy (SPM) was used to probe piezoelectric vibrations and local conductivity in CaCu3Ti4O12(CCTO) ceramics at room temperature. Piezoelectric contrast was observed on the polished surfaces of CCTO in both vertical (out-of-plane) and lateral (in-plane) modes and depended on the grain orientation varying in sign and amplitude. The piezoelectric contrast is shown to be controlled by the electrical bias (local poling) and displayed a ferroelectric-like reversible hysteresis accompanied with a change of the phase of piezoelectric signal. Flexoelectric effect (strain-gradient-induced polarization) due to surface relaxation was invoked to explain the observed contrast inside the grains.