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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.
We examined annual outpatient antibiotic dispensings within a health insurance plan covering ∼970,000 members per year during 2000–2016. The proportion of members with antibiotic dispensings decreased from 33.3% in 2000 to 25.9% in 2016. This trend was consistent in all stratifications of age, race/ethnicity, sex, and comorbidities.
In this work, we present an oxygen-releasing insole to treat diabetic foot ulcers. The insole consists of two layers of polydimethylsiloxane: the top layer has selective laser-machined areas (to tune oxygen permeability) targeting the ulcerated foot region, while the bottom layer provides structural support and incorporates a chamber for oxygen storage. When loaded with a pressure of 150 kPa (average value for standing/walking), the insole is able to release oxygen at a rate of 1.8 mmHg/min/cm2. At lower sitting pressures, the delivery rate persists at 0.092 mmHg/min/cm2, raising the oxygen level to an optimal healing value (50 mmHg) for a 2 × 2 cm2 wound within 150 min.
The citrus leafminer (CLM), Phyllocnistis citrella Stainton causes injury to citrus and related species in the Rutaceae family. The damage that the CLM larvae can cause is significant in citrus plantations. We tested two citrus cultivars — ‘Kinnow’ (Citrus reticulata Blanco) and ‘Fairchild’ (a hybrid of Citrus reticulata Clementine x Orlando Tangelo) — to quantify CLM larvae infestation and effect on the physiology of the citrus cultivars. We then compared the CLM larval weight with its associated damage. To calculate infestation level, mine area and total leaf area, we used the image analysis technique. The infestation level of CLM was higher in ‘Fairchild’ than in ‘Kinnow’ cultivar of citrus. For both cultivars, larval weight of CLM was directly proportional to the amount of mines generated. Taken together, the results of this study suggest that the mines that CLM larvae generate pose significant effect on the net photosynthetic rates and water use efficiency of citrus nursery plants. These results will help improve our understanding of the interaction between CLM and citrus nursery plants and effect of the pest on the yield potential of the crop.
Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome.
A multicenter, randomized, controlled clinical trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive biases and social cognition.
Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p = 0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p = 0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions (JTC) improved more in the MCT group than the psycho-educational group (p = 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in the MCT group but not the psycho-educational group (p < 0.001–0.032).
MCT could be an effective psychological intervention for people with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve symptoms, ToM, and personalizing bias.
A latent tuberculosis infection (LTBI) prevalence survey was conducted using tuberculin skin test (TST) and Quantiferon test (QFT) in 1218 healthcare workers (HCWs) in Medellín, Colombia. In order to improve the prevalence estimates, a latent class model was built using a Bayesian approach with informative priors on the sensitivity and specificity of the TST. The proportion of concordant results (TST+,QFT+) was 41% and the discordant results contributed 27%. The marginal estimate of the prevalence P(LTBI+) was 62·1% [95% credible interval (CrI) 53·0–68·2]. The probability of LTBI+ given positive results for both tests was 99·6% (95% CrI 98·1–99·9). Sensitivity was 88·5 for TST and 74·3 for QFT, and specificity was 87·8 for TST and 97·6 for QFT. A high LTBI prevalence was found in HCWs with time-accumulated exposure in hospitals that lack control plans. In a context of intermediate tuberculosis (TB) incidence it is recommended to use only one test (either QFT or TST) in prevalence surveys or as pre-employment tests. Results will be useful to help implement TB infection control plans in hospitals where HCWs may be repeatedly exposed to unnoticed TB patients, and to inform the design of TB control policies.
Using Finite Element Method (FEM) simulations is possible to study the homogeneity of deformation in the Equal Channel Angular Pressing (ECAP) process. In this work an investigation about the influence of a modified die on strain distribution in an ecaped Al6060 alloy was carried out. Due to that, tensile stress occurs in the vicinity of upper surface of the specimen in the severe plastic deformation zone, which increases the cracking and fracture tendency of the specimen and impedes further ECAP processing, the conventional ECAP die was modified to eliminate the tensile stress and enhance the compressive stress in the severe plastic deformation zone and reducing the cracking and fracture tendency of the specimen. Finite element analysis demonstrated that the stress state changes from tensile to strongly compressive when using the modified die. The aim of this study is to evaluate the advantages/disadvantages of the modified ECAP die and processing conditions.
Powders of BaSnO3 were synthesized to obtain gas sensor thick films (using the screen printing technique) for the detection of O2 and CO. Impedance spectroscopy was used at different atmospheres and temperatures. In the presence of O2, the films showed a maximum value of sensitivity at 300 °C, with the powders formed by Pechini presenting greater reproducibility and sensitivity (with an order of magnitude greater than that for the powders formed by precipitation). Results showed that the films formed with powders obtained using the Pechini method presented a better response to CO, with a maximum sensitivity at 450 °C. In addition, in the presence of CO and for T > 250 °C, these films showed an anomalous behavior regarding their sensitivity as a function of time when platinum electrodes were used: a great increase in the electrical resistance value for exposure times greater than 10 min.
We simulated the frequency of tuberculosis infection in healthcare workers in order to classify the risk of TB transmission for nine hospitals in Medellín, Colombia. We used a risk assessment approach to estimate the average number of infections in three risk groups of a cohort of 1082 workers exposed to potentially infectious patients over 10- and 20-day periods. The risk level of the hospitals was classified according to TB prevalence: two of the hospitals were ranked as being of very high priority, six as high priority and one as low priority. Consistent results were obtained when the simulation was validated in two hospitals by studying 408 healthcare workers using interferon gamma release assays and tuberculin skin testing. The latent infection prevalence using laboratory tests was 41% [95% confidence interval (CI) 34·3–47·7] and 44% (95% CI 36·4–51·0) in those hospitals, and in the simulation, it was 40·7% (95% CI 32·3–49·0) and 36% (95% CI 27·9–44·0), respectively. Simulation of risk may be useful as a tool to classify local and regional hospitals according to their risk of nosocomial TB transmission, and to facilitate the design of hospital infection control plans.
In this work, the synthesis of new hybrid material based on a poly (buthyl acrylate –co- vinyl formamide) copolymer using the emulsion polymerization and doped with Pd, is discussed. The copolymer structure was confirmed by FT-IR. Afterwards, Pd nanocrystals previously synthesized, resulting on a spherical shape of ~ 5 nm, as measured by High-resolution transmission electron microscopy (HR-TEM), were deposited on the structure of the organic material. The films were analyzed using AFM and Scanning electron microscopy (SEM), giving rise to a hybrid material that could be applied in areas such as nanolithography, catalysis, and sensors.