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Rationale: In primary ciliary dyskinesia, factors leading to disease heterogeneity are poorly understood. Objectives: To describe early lung disease progression in primary ciliary dyskinesia and identify associations between ultrastructural defects and genotypes with clinical phenotype. Methods: This was a prospective, longitudinal (5 yr), multicenter, observational study. Inclusion criteria were less than 19 years at enrollment and greater than or equal to two annual study visits. Linear mixed effects models including random slope and random intercept were used to evaluate longitudinal associations between the ciliary defect group (or genotype group) and clinical features (percent predicted FEV 1 and weight and height z-scores). Measurements and Main Results: A total of 137 participants completed 732 visits. The group with absent inner dynein arm, central apparatus defects, and microtubular disorganization (IDA/CA/MTD) (n = 41) were significantly younger at diagnosis and in mixed effects models had significantly lower percent predicted FEV 1 and weight and height z-scores than the isolated outer dynein arm defect (n = 55) group. Participants with CCDC39 or CCDC40 mutations (n = 34) had lower percent predicted FEV 1 and weight and height z-scores than those with DNAH5 mutations (n = 36). For the entire cohort, percent predicted FEV 1 decline was heterogeneous with a mean (SE) decline of 0.57 (0.25) percent predicted/yr. Rate of decline was different from zero only in the IDA/MTD/CA group (mean [SE], 21.11 [0.48] percent predicted/yr; P = 0.02). Conclusions: Participants with IDA/MTD/CA defects, which included individuals with CCDC39 or CCDC40 mutations, had worse lung function and growth indices compared with those with outer dynein arm defects and DNAH5 mutations, respectively. The only group with a significant lung function decline over time were participants with IDA/MTD/CA defects.

OBJECTIVES: The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed. METHODS: This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included. RESULTS: A total of 1,055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn's disease and ulcerative colitis patients, respectively. In both Crohn's disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confi dence interval (CI)= 1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI= 1.07-3.37) or discontinuation because of adverse events (HR= 2.33; 95% CI= 1.27-2.02) vs. a top-down strategy, colonic localization (HR= 1.51; 95% CI= 1.13-2.02) vs. ileal, and stricturing behavior (HR= 1.5; 95% CI= 1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn's disease patients, whereas treatment with immunomodulators after discontinuation (HR= 0.67; 95% CI= 0.51-0.87) and age (HR= 0.98; 95% CI= 0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe. CONCLUSIONS: The incidence rate of infl ammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identifi ed. Retreatment with the same anti-TNF drug was effective and safe.

As one of the few small liberal arts colleges in a city, Trinity College in Hartford, Connecticut, has developed a simple educational creed: Life and learning are inseparable. The “real world” is not something you brace yourself to enter at the end of your education. That world is with you -- politically, economically, socially, culturally -- even as you prepare to take the responsibility for running it. There is much talk about the need to educate students to become citizens of the world. Capitalizing on our location in a small exemplary multi-ethnic city, Trinity College gives meaning to this clichéd rhetorical notion. We train our students for a world that is complex, multi-ethnic, globalized, and cross-culturally connected in a way that no previous society could have imagined. Conceptualizing the learning experience in terms of a set of concentric circles, our education begins with the small inner circle of the campus, expands to the broader surround of Hartford, and then building on the local foundation, extends to study abroad with an urban focus. In this article, two of our study abroad programs exemplify our presumption that the city is your classroom: the full semester Trinity-in-Trinidad Global Learning Site and Trinity’s faculty-led summer program “Connections: Boomtowns of the Yangtze River” that links an immersion experience in the city of Hartford with four emerging megacities in China. In distinctive and complementary ways, the Trinidad and China programs illustrate how Trinity College through its urban and global educational mission is broadening and deepening the use of the city (in Hartford and globally) to better prepare our students for our urbanized and globalized world. The Trinidad program, centered on urban culture, is more a study in the city, while the China program, revolving around the triangle of urban history, urban sociology, and environmental science, is more overtly a study of the city. Both programs link the academic domain with experiential learning. Recognizing that the modern city is “no longer local” (Orum and Chen, p. 55), we believe that urban, global experience is the best way to give students insights into their own home cities, whether these are in the United States or elsewhere. We take them abroad not to give them a romantic student overseas junket, but to teach them about themselves in the context of the world in which they must live, over which they must be trained to take control.

Rationale: The relationship between clinical phenotype of childhood primary ciliary dyskinesia (PCD) and ultrastructural defects and genotype is poorly defined. Objectives: To delineate clinical features of childhood PCD and their associations with ultrastructural defects and genotype. Methods: A total of 118 participants younger than 19 years old with PCD were evaluated prospectively at six centers in North America using standardized procedures for diagnostic testing, spirometry, chest computed tomography, respiratory cultures, and clinical phenotyping. Measurements and Main Results: Clinical features included neonatal respiratory distress (82%), chronic cough (99%), and chronic nasal congestion (97%). There were no differences in clinical features or respiratory pathogens in subjects with outer dynein arm (ODA) defects (ODA alone; n = 54) and ODA plus inner dynein arm (IDA) defects (ODA 1 IDA; n = 18) versus subjects with IDA and central apparatus defects with microtubular disorganization (IDA/ CA/MTD; n = 40). Median FEV 1 was worse in the IDA/CA/MTD group (72% predicted) versus the combined ODA groups (92% predicted; P = 0.003). Median body mass index was lower in the IDA/ CA/MTD group (46th percentile) versus the ODA groups (70th percentile; P = 0.003). For all 118 subjects, median number of lobes with bronchiectasis was three and alveolar consolidation was two. However, the 5- to 11-year-old IDA/CA/MTD group had more lobes of bronchiectasis (median, 5; P = 0.0008) and consolidation (median, 3; P = 0.0001) compared with the ODA groups (median, 3 and 2, respectively). Similar findings were observed when limited to participants with biallelic mutations. Conclusions: Lung disease was heterogeneous across all ultrastructural and genotype groups, but worse in those with IDA/ CA/MTD ultrastructural defects, most of whom had biallelic mutations in CCDC39 or CCDC40.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:19Z No. of bitstreams: 1 S0004-27302012000800018.pdf: 138617 bytes, checksum: 6272e3edefd445c844169dd6dec96675 (MD5) Made available in DSpace on 2013-08-22T19:03:19Z (GMT). No. of bitstreams: 1 S0004-27302012000800018.pdf: 138617 bytes, checksum: 6272e3edefd445c844169dd6dec96675 (MD5) Previous issue date: 2012-11-01 Made available in DSpace on 2013-09-30T20:05:05Z (GMT). No. of bitstreams: 2 S0004-27302012000800018.pdf: 138617 bytes, checksum: 6272e3edefd445c844169dd6dec96675 (MD5) S0004-27302012000800018.pdf.txt: 14858 bytes, checksum: f0c885a3c1b012752d54dfd77f638c28 (MD5) Previous issue date: 2012-11-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:16:41Z No. of bitstreams: 2 S0004-27302012000800018.pdf: 138617 bytes, checksum: 6272e3edefd445c844169dd6dec96675 (MD5) S0004-27302012000800018.pdf.txt: 14858 bytes, checksum: f0c885a3c1b012752d54dfd77f638c28 (MD5) Made available in DSpace on 2014-05-20T15:16:41Z (GMT). No. of bitstreams: 2 S0004-27302012000800018.pdf: 138617 bytes, checksum: 6272e3edefd445c844169dd6dec96675 (MD5) S0004-27302012000800018.pdf.txt: 14858 bytes, checksum: f0c885a3c1b012752d54dfd77f638c28 (MD5) Previous issue date: 2012-11-01 A osteomalacia oncogênica é um diagnóstico clínico desafiador, caracterizado pela perda renal de fosfato e baixos níveis de 1,25-di-hidroxivitamina D3, ocorrendo na presença de um tumor produtor de altos níveis de fator de crescimento de fibroblasto 23. No entanto, é possível que se trate muito mais de uma falha de diagnóstico clínico do que propriamente uma doença rara. Os autores relatam o caso de um homem de 42 anos com histórico de fraqueza muscular progressiva por cinco anos e restrição à cadeira de rodas, sem diagnóstico. Seus exames laboratoriais evidenciavam baixos níveis de fósforo. A remoção cirúrgica de um hemangiopericitoma detectado previamente em cavidade nasal levou à resolução completa dos sintomas. Os autores enfatizam que, mesmo com a etiologia já evidenciada, o paciente consultou diversos clínicos no decorrer dos cinco anos até que fossem instituídos o diagnóstico e o tratamento adequados. Arq Bras Endocrinol Metab. 2012;56(8):570-3 Diagnosing oncogenic osteomalacia is still a challenge. The disorder is characterized by osteomalacia caused by renal phosphate wasting and low serum concentration of 1,25-dihydroxyvitamin D3 occurring in the presence of a tumor that produces high levels of fibroblast growth factor 23. However, it is possible that the disease is much more misdiagnosed than rare. We present the case of a 42-year-old man with a long-term history of undiagnosed progressive muscle weakness. His laboratory results mainly showed low serum phosphate. Surgical removal of a nasal hemangiopericytoma that had been diagnosed five years earlier, brought him to a symptom-free condition. Even though knowing the underlying etiology would explain his osteomalacia, the patient sought medical help from countless physicians for five consecutive years, and only after adequate treatment a rewarding outcome was achieved. Arq Bras Endocrinol Metab. 2012;56(8):570-3 Universidade Estadual de São Paulo Faculdade de Medicina de Botucatu Department of Medicine Universidade Federal de São Paulo (UNIFESP) Department of Neurology and Neurosurgery Metabolism and Molecular Medicine Northwestern University Division of Endocrinology

Art history has provided an invaluable resource for modern directors of medieval plays. As an encyclopedia of style, medieval paintings, woodcuts, and doorway sculpture have helped to establish the historic credibility of recent medieval drama productions, for instance, at Bristol, Toronto, Leeds, Indiana, Michigan, and Western Michigan Universities. By verifying that clothing details shoe styles (blunted or pointed), headgear, length and fullness of sleeves or mantles accord with a specific date and a particular place, a costumer may avoid the unintended comedy of placing an Elizabethan courtier side-byside with a Chaucerian peasant, thus helping to dispel the lingering notion that history ceased to function during several medieval centuries. 1 Or a director of mystery plays can select historically appropriate anachronisms for instance, costuming a fifteenth-century Caesar Augustus as a medieval king rather than a Roman emperor. However, being aware of the ways in which art history can influence the staging of medieval drama means more than knowing whether Caesar should wear a Roman toga or an ermine robe. By visually representing the verbal symbols and allegorical figures of a morality or mystery play, props and costumes can serve iconographie functions similar to those of the medieval wall paintings and doorway sculpture to which they have been compared.2 Like verifying historically accurate costuming styles, drawing on art history as a source for specific iconographie portraits is one way of establishing a credible link between contemporary

Contribución al estudio de suelos desarrollados sobre roca caliza, por A. Hoyos de Castro, A. Mª Moreno García y J. González Parra.-- Génesis y evolución de un suelo desarrollado sobre material calizo (Sierra deAralar), por A. Hoyo, A. M. Moreno y J. González Parra.-- Características del humus a lo largo de una toposecuencia de andoso es en la lsla de Tenerife, por A. Polo, C. Gª Milla y F. Velasco.-- Relationship between organic carbon, nitrogen, phoophorus, sulphur and organic matter in some soils of Rajasthau, por L. L. Somani and S. N. Saxena.-- Meteorización experimental de sedimentos aluviales ácidos del valle del Guadalquivir, por Juan de Olmedo Pujoly Angelines Hernández.-- Predicting cation exchange capacity of soils from relative amount of clay and organic matter content, por L. L. Souzani.-- Influencia de la época de siembra de Triticum vulgare L. y grado de infección de Avena sterilis L. en la competencia de ambas especies, por R.González Ponce y V. Hernando Fernandez.-- Estudio de la capacidad competitiva de Avena sterilis L. contra Triticum vulgare L. en comparación a la de este ultimo consigo mismo, por R. González Ponce y V. H ernando Fernández.-- Estudio previo sobre la nutrición del Aguacate por análisis foliar, por S. Jaime Palacios, A. Aguilar Villalvilla y E. Esteban Velasco.-- Influencia del clururo sódico sobre la germinación de semillas de pimiemo (Capsicum annuum), por N. Caro, F. G. Fernández y A. Cerda.-- Aclareo químico de frutos en el olivar manzanillo de Sevilla, por A. Troncoso, I. Prieto y J. Liñan.-- Estudio de un sistema de drenaje a nivel parcelario en pasto Nariño (Colombia), por A. Alvarez López, A. Arias Henández y L. Legarda Burbano.-- Utilización digestiva de dietas con pesticidas, por Ciara Mª Rueda, J. F. Aguilar y J. Boza.—Trabajos recapitulativos.-- Genética de khizobium y de la fijación de nitrógeno, por J. Casadesús y J. Olivares.—Notas previa.-- Aplicaciones de la informática en el reconocimiento y evaluación de suelos, por D. de la Rosa, F. Cardona. J. Naranjo y J. Almorza.-- Notas.-- Asociación Internacional de Ciencias del Suelo.-- Mapa mundial de Suelos a escala 1:5.000.000.-- C. S. l. C. Normativa sobre constitución de las comisiones científica y económica: Real Decreto 3450/77.-- Nota informativa de la Comisión Científica (núm. 1) C. S. l. C.-- Nota informativa de la Comisión Científica (núm. 2) C. S. l. C.-- Comisión Económica (Circular núm. 1) 29-JX-1978. C. S. l. C.-- VII Reunión Nacional de Suelos.-- Sociedad Española de Ciencia del Suelo.-- Los profesores Hoyos y García Vicente visitan Polonia.-- XXth International Horticultural Congress y 8th International Colloquium Plant Analysis and Fertilizer Problema.-- Asamblea de la Sociedad Española de Ciencia del Suelo.-- Reunión de la sección VII de la Sociedad Española de Ciencia del Suelo y Estudio de los suelos del Campo de Cartagena.-- VII Curso Internacional de fertilidad de suelos y nutrición vegetal.-- Becas de estudios científicos y técnicos de la Fundación Juan March para 1979.--IV Simposio Nacional de Bioclimatología.-- III Reunión del Grupo Humus (junio de 1979).-- Premio Agrícola Aedos (Convocatoria 1979).--Bibliografía, 2019-08.- CopyBook.- Libnova.- Biblioteca ICA.

Equips de protecció individual; EPI; Mesures d'optimització; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV Equipos de protección individual; EPI; Medidas de optimización; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV Personal protective equipment; EPI; Optimization measures; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV El propòsit d’aquest document és recomanar accions per a l’optimització dels equips de protecció individual (EPI), segures per als professionals i els pacients, en el context present de pandèmia per la COVID-19 i per actuar davant de possibles desabastiments d’aquests equipaments.

Higiene de mans; Mesures de prevenció; Antisèpsia de mans; Infeccions Higiene de manos; Medidas de prevención; Antisepsia de manos; Infecciones Hand hygiene; Prevention measures; Hand antisepsis; Infections L’objectiu d'aquest document és fer un treball de revisió, actualització i consens de diversos documents sobre la higiene de mans en l'àmbit hospitalari i a l'atenció primària, per crear-ne un de sol que faciliti la informació i la consulta als professionals, amb la finalitat de millorar el seu compliment de la higiene de mans.