Search

BACKGROUND Invasive pneumococcal disease (IPD) is the most important bacterial infection in young children, and the introduction of pneumococcal conjugate vaccines has changed its presentation. This study compared the incidence, characteristics and serotype distribution of IPD before and after the introduction of the pneumococcal conjugate vaccine (PCV13). METHODS Prospective enrolment of patients with IPD aged less than 60 months and admitted to either of 2 tertiary care hospitals between January 2007 and December 2009 (pre-PCV13 period) and January 2012 and June-2016 (PCV13 period). RESULTS We identified 493 cases, 319 in the pre-PCV13 period and 174 in the PCV13 period. The incidence of IPD decreased from 89.7 to 34.4 casos per 100 000 habitantes ( -62%; P

Objective After the introduction of 13-valent pneumococcal conjugate vaccine (PCV13), a decrease of serotype-3 invasive pneumococcal disease (IPD) has not been homogenously observed around Europe. The aim of the study is to analyze the incidence of serotype-3 IPD in our area (Catalonia, Spain) and describe what microbiological and clinical characteristics distinguish serotype-3 IPD from nonserotype-3 IPD. Methods This study is a prospective observational study performed in three hospitals of Barcelona (Spain), from January 2012 to June 2016. Patients younger than 18 years with a diagnosis of IPD were included. Epidemiological, clinical, and microbiological data were collected. Results A total of 253 cases of IPD were included; of these, 53 were caused by serotype 3. The incidence rate of serotype-3 IPD remained stable over the study years (risk ratio [RR] = 0.64; 95% confidence interval [CI]: 0.3–1.38). In 92.5% (49/53) of the cases of serotype-3 IPD, the diagnosis was pneumonia and 89.8% (44/49) of them reported a complicated pneumonia. Also, 98.1% (52/53) were detected by positive real-time polymerase chain reaction (PCR) in blood or pleural effusion. Seventeen patients were properly vaccinated with PCV13 before the infection. Conclusion After the introduction of PCV13 a global decline of invasive pneumococcal disease has been reported, specially, due to a decrease of serotypes 1 and 19A cases. Serotype-3 Streptococcus pneumoniae IPD remained stable throughout the years of study, being currently the main serotype causing IPD in our area. Serotype 3 causes mostly pneumonia and physicians must be aware of possible complications. Real-time PCR have a significantly higher diagnostic yield for serotype 3 compared with culture. Some vaccination failures were observed.

Background: The impact of antimicrobials generic entry (GE) is controversial. Their introduction could provide an economic benefit yet may also increase their consumption, leading to a higher risk of resistance. Our aim was to analyze the impact of GE on trends of antimicrobial consumption in an acute-care hospital. Methods: A retrospective quasi-experimental interrupted time series analysis was conducted at a 400-bed tertiary hospital in Barcelona, Spain. All antimicrobials for systemic use for which a generic product entered the hospital from January 2000 to December 2019 were included. Antimicrobial consumption was expressed as DDD/100 bed days. Results: After GE, the consumption of cefotaxime (0.09, p &lt, 0.001), meropenem (0.54, p &lt, 0.001), and piperacillin-tazobactam (0.13, p &lt, 0.001) increased, whereas the use of clindamycin (−0.03, p &lt, 0.001) and itraconazole (−0.02, p = 0.01) was reduced. An alarming rise in cefepime (0.004), daptomycin (1.02), and cloxacillin (0.05) prescriptions was observed, despite not achieving statistical significance. On the contrary, the use of amoxicillin (−0.07), ampicillin (−0.02), cefixime (−0.06), fluconazole (−0.13), imipenem–cilastatin (−0.50) and levofloxacin (−0.35) decreased. These effects were noticed beyond the first year post GE. Conclusions: GE led to an increase in the consumption of broad-spectrum molecules. The potential economic benefit of generic antibiotics could be diluted by an increase in resistance. Antimicrobial stewardship should continue to monitor these molecules despite GE.

In this work we present the results obtained on the simulation and nanofabrication of photonic crystals based on silicon nanopillars. The simulations show the formation of photonic band gaps within 1.31 and 1.89μm, with a gap-to-midgap ratio approaching 40%. The introduction of waveguides and cavities prove the adaptability of these structures to tune the wavelengths allowed to be transmitted through the system within the photonic band gaps. On the other hand, thanks to the use of advanced nanofabrication techniques, the modelled structures have been successfully fabricated.

Background: Invasive meningococcal disease (IMD) is an urgent notifiable disease and its early notification is essential to prevent cases. The objective of the study was to assess the sensitivity of two independent surveillance systems, the statutory disease reporting system (SDR) and the microbiological reporting system (MRS), and to estimate the incidence of IMD.Methods: The study was performed in Catalonia, Spain, between 2011 and 2015. The variables collected were age, sex, year of report, size of municipality (< 10,000 and ≥ 10,000), clinical form, death, serogroup, country of birth and type of reporting centre (private and public). The capture-recapture analysis and 95% confidence intervals were calculated using the Chapman formula. Multinomial logistic regression was performed for adjusted estimation.Results: The sensitivity of the two combined surveillance systems was 88.5% (85.0-92.0). SDR had greater sensitivity than the MRS (67.9%; 62.7-73.1 vs. 64.7%; 59.4-70.0). In 2014-2015, the sensitivity of both systems was higher (80.6%; 73.2–87.9 vs. 73.4%; 65.2–81.6) than in 2011-2013 (59.3%; 52.6–66.0 vs. 58.3%; 51.6–65.1). In private centres, the sensitivity was higher for SDR than for MRS (100%; 100–100 vs. 4.8%; -4.4–13.9). The adjusted estimate of cases was lower than that obtained using the Chapman formula (279; 266–296 vs. 313; 295–330). The estimated adjusted incidence of IMD was 0.7/100,000 persons-year.Conclusions: The sensitivity of enhanced surveillance through the combination of two complementary sources was higher than for the sources individually. Factors associated with under-reporting in different systems should be analysed to improve IMD surveillance.

AIM The aim was to analyze the epidemiological, microbiological and clinical characteristics of patients with complicated pneumococcal pneumonia with pleural effusion (PE) or empyema. METHOD Prospective study in three Catalan hospitals in persons aged

BACKGROUND We studied the impact of 13-valent pneumococcal conjugate vaccine (PCV13) on the incidence of invasive pneumococcal disease (IPD) and serotype distribution in a region with intermediate levels of vaccination (around 64% in children aged

Volume 57, no. 8, e00363-19, 2019, [https://doi.org/10.1128/JCM.00363-19][1]. This article was published on 26 July 2019 with the title “Invasive Pneumococcal Disease and Influenza Activity in a Pediatric Population: Impact of PCV13 Vaccination in Pandemic and Nonpandemic Influenza Periods.” The

By using ZnO thin films doped with Ce, Tb or Eu, deposited via radiofrequency magnetron sputtering, we have developed monochromatic (blue, green and red, respectively) light emitting devices (LEDs). The rare earth ions introduced with doping rates lower than 2% exhibit narrow and intense emission peaks due to electronic transitions in relaxation processes induced after electrical excitation. This study proves zinc oxide to be a good host for these elements, its high conductivity and optical transparency in the visible range being as well exploited as top transparent electrode. After structural characterization of the different doped layers, a device structure with intense electroluminescence is presented, modeled, and electrically and optically characterized. The different emission spectra obtained are compared in a chromatic diagram, providing a reference for future works with similar devices. The results hereby presented demonstrate three operating monochromatic LEDs, as well as a combination of the three species into another one, with a simply-designed structure compatible with current Si technology and demonstrating an integrated red-green-blue emission.

Resumen La infeccion causada por el nuevo coronavirus SARS-CoV-2 (COVID-19) representa actualmente una de las mayores emergencias sanitarias a nivel mundial. La aparicion de una nueva infeccion potencialmente grave y la situacion de pandemia actual ha implicado importantes ajustes en la practica clinica en medicina materno-fetal. Aunque no parece existir una mayor afectacion o susceptibilidad al virus de las mujeres embarazadas respecto la poblacion general, existen aspectos especificos ligados a la gestacion que deben tenerse en cuenta de cara al diagnostico y manejo de la COVID-19 en pacientes embarazadas. En el siguiente documento se exponen las recomendaciones y el protocolo de actuacion ante la infeccion por COVID-19 durante el embarazo desarrollado en nuestro centro, basado en la evidencia cientifica disponible hasta la fecha y las principales recomendaciones internacionales.

Vaccination with the 13-valent conjugated pneumococcal disease (PCV13) has reduced invasive pneumococcal disease (IPD), but there have been reports of vaccine failures. We performed a prospective study in children aged 2-59 months who received diagnoses of IPD during January 2012-June 2016 in 3 pediatric hospitals in Catalonia, Spain, a region with a PCV13 vaccination coverage of 63%. We analyzed patients who had been age-appropriately vaccinated but who developed IPD caused by PCV13 serotypes. We detected 24 vaccine failure cases. The serotypes involved were 3 (16 cases); 19A (5 cases); and 1, 6B, and 14 (1 case each). Cases were associated with children without underlying conditions, with complicated pneumonia (OR 6.65, 95% CI 1.91-23.21), and with diagnosis by PCR (OR 5.18, 95% CI 1.84-14.59). Vaccination coverage should be increased to reduce the circulation of vaccine serotypes. Continuous surveillance of cases of IPD using both culture and PCR to characterize vaccine failures is necessary.

Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain).A prospective observational study was conducted in patients18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%.35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13.Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.

The lack of invasive pneumococcal disease (IPD) cost studies may underestimate the eect of pneumococcal polysaccharide conjugated vaccines (PCV). The objective of this study was to estimate the direct costs of hospitalized IPD cases. A prospective study was made in children aged

The increasing need for efficient memories with integrated functionalities in a single device has led the electronics community to investigate and develop different materials for resistive switching (RS) applications. Among these materials, the well-known Si nanocrystals (NCs) have demonstrated to exhibit RS properties, which add to the wealth of phenomena that have been studied on this model material platform. In this work, we present ZnO/Si NCs/p-Si resistive switching devices whose resistance state can be electrically read at 0 V under the application of low-power monochromatic illumination. The presented effect is studied in terms of the inner structural processes and electronic physics of the device. In particular, the creation of conductive filaments through the Si NC multilayers induces a low-resistance path for photogenerated carriers to get extracted from the device, whereas in the pristine state charge extraction is strongly quenched due to the insulating nature of the NC-embedding SiO2 matrix. In addition, spectral inspection of the generated photocurrent allowed unveiling the role of Si NCs in the reported effect. Overall, the hereby shown results pave the way to obtain memories whose RS state can be read under low-power conditions.

In this paper, we report on the photoresponse properties of a SiO2/Si/SiO2 multilayer (ML) system deposited at 500 °C and integrated into a metal-oxide-semiconductor structure (Al/ML/p-Si) without any further thermal annealing. High contents of elemental Si (Si0) revealed by the XPS measurements suggests the formation of amorphous Si-nanoclusters (a-Si ncls) within the ML. Dark and illuminated I–V curves of the device indicate its sensitivity to ultraviolet, visible and near infrared light under applied bias and at 0 V. In addition, we observed variation of the spectral response and the external quantum efficiency as a function of the electrode size. At 0 V, the device illuminated with a wavelength at 550 nm exhibits a maximum external quantum efficiency of 0.95% and a spectral response of 4.1 mA/W. This photoresponse has been ascribed to photon absorption in SiO2 sub-band states created by the a-Si ncls and defects formed by the excess Si inside the SiO2/Si/SiO2 multilayers.

In this work, the relation between the photovoltaic and resistive switching (RS) properties of metal-oxide-semiconductor devices containing Si nanocrystal (Si NC) superlattices is investigated. A first approximation concludes that the low resistance state achieved by the RS process allows for enhanced photogenerated carrier extraction when compared to the high resistance state and pristine devices. By using different current compliance values during the electroforming process, the low resistance state is further modified, improving its conductivity and the collection probability of photogenerated carriers. Conversion efficiency is enhanced by at least one and up to five orders of magnitude by applying different electroforming processes. In addition to promoting the RS properties in these devices, spectral response measurements demonstrate that Si NCs are partially responsible for the optical absorption, and that their contribution is maintained after electroforming. We thus conclude that the proposed methodology can improve the conversion efficiency of this and other multijunction solar cells or structures that also exhibit RS properties. Through RS, a dense network of conductive filaments is promoted in the insulating region, which reduces the travel distance of photocarriers for their collection., This work was financially supported by the Spanish Ministry of Economy, Industry and Competitiveness (TEC2016-76849-C2-1-R) and the German Research Foundation (ZA191/27-3 and ZA191/33-1). J.L.F. acknowledges financial support from the subprogram “Ayudas para la Formación de Profesorado Universitario” (FPU16/06257) from the Spanish Ministry of Education, Culture and Sports.

Background: Hospital-acquired Clostridioides difficile infection (HA-CDI) is a major infection control challenge. Using whole-genome sequencing, 500 beds), 9 hospitals; group 2 (500–200 beds), 15 hospitals; and group 3 (P < .001) and a lack of association with HA-MRSA (IRR, 0.83; 95% CI, 0.46–1.48; P = .52). Conclusions: The HA-CDI incidence rate grew annually by 5% for an increase of 1 DDD in annual antibiotic consumption. No association HA-MRSA rates was detected, suggesting that antimicrobial stewardship programs are urgently needed to improve the control of HA-CDI in Catalonia, a geographical area with a low prevalence of epidemic ribotypes.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini and speaker honoraria from MSD, Pfizer, and Zambon.

Background: Antimicrobial resistance is a disturbing problem in the health system. A relationship between the use of certain antimicrobials and a resistance increase has been proposed. Since this phenomenon is not usually attributed to specific uses of antimicrobials but preferably to its evolution over the years, the analysis of the antimicrobial consumption over time can justify the epidemiological situation of a given region in terms of resistance and possible increases and decreases for specific microorganisms. The objective of this study was to analyze the evolution of the use of antimicrobials in Catalonia during 2008–2018 through the VINCat program (Infection Control and Antimicrobial Stewardship Catalonian Program). Methods: The number of hospitals participating in the VINCat increased from 46 in 2008 to 63 in 2018 (ie, 68.8% and 85.7% of all adult acute-care hospital beds in Catalonia, respectively). Hospitalization days recorded at the participating hospitals increased from 2,991,053 in 2008 to 3,714,938 in 2018. The Anatomical Therapeutic Chemical Classification (ATC) defined daily dose (DDD) index was used for monitoring antimicrobial consumption. Simple linear regressions were performed, the linear relationship was checked by ANOVA tests, and the Pearson correlation (Pc) coefficients were obtained. Values of P ≤ .05 were considered statistically significant. Results: From 2008 to 2018, there was a statistically significant increase of global antibacterial consumption (65.50 vs 71.73 DDD per 100 bed days; P = .001) and antimycotic consumption (3.09 vs 3.45 DDD per 100 bed days, P = .012) due to an increase of consumption in the surgical units. At the same time, there was a decrease in the consumption of antimycotics in the medical units (4.35 vs 3.90 DDD per 100 bed days; P =.029). Cephalosporins and carbapenem consumption increased both globally (10.88 vs 13.86 DDD per 100 bed days; P < .001) and in medical and surgical units (3.26 vs 5.38 DDD per 100 bed days; P < .001). This increase was mainly associated with ceftriaxone (3.45 vs 5.46 DDD per 100 bed days; P < .001) and meropenem (1.12 vs 3.08 DDD per 100 bed days; P < .001). There was a global decrease in the consumption of penicillins (26.10 vs 24.24 DDD per 100 bed days; P = .012) and quinolones (11.63 vs 9.61 DDD per 100 bed days; P = .004). This trend was observed also in ICUs and medical units but not in surgical units, for which only quinolones showed a significant decrease. Decreases in the use of amoxicillin/clavulanate acid (17.80 vs 14.24 DDD per 100 bed days; P < .001) and ciprofloxacin (5.68 vs 4.01 DDD per 100 bed days; P < .001) were observed. Conclusions: The increase in the use of antimicrobials in Catalonia is concerning. This increase is attributable to the use of these drugs in surgical units. Antibiotic stewardship measures should be aimed primarily at these units. The increasing use of carbapenems should be analyzed.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini as well as speaker honoraria from MSD, Pfizer, and Zambon.

Background: The aim of this study was to analyse the serotypes causing invasive pneumococcal disease (IPD) according to the clinical presentation, and antimicrobial susceptibility in children aged ≤17 years before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in the official paediatric schedule. Methods: We conducted a prospective study in children ≤17 years with IPD attended in three Catalan hospitals between January 2012 and June 2016. IPD cases were diagnosed by culture or RT-PCR. Demographic, microbiological, and clinical data were analysed. Associations were assessed using the odds ratio (OR) and 95% confidence intervals (CI). Results: Of the 253 cases included, 34.4% were aged < 2 years, 38.7% 2-4 years and 26.9% 5-17 years. Over 64% of cases were PCV13 serotypes. Cases with PCV13 serotypes were associated with overall pneumonia (OR:7.47[4.0-13.96]) and complicated pneumonia (OR:7.2[4.04-12.75]), overall and in each age group (p4 years, respectively. Forty-four cases (36.1%) were non-susceptible to penicillin and 16.4% were also non-susceptible to cefotaxime. There were no significant differences between PCV13 and non-PCV13 cases with non-susceptible penicillin strains (36.1% and 36.0%, respectively), while PCV13 cases showed more frequently non-susceptible cefotaxime strains (23.6%; p=0.010). Serotypes 19A and 14 were associated with non-susceptibility to both penicillin and cefotaxime strains (p=0.003 and p

The objective of this study was to analyze the incidence, clinical presentation, and severity of invasive pneumococcal disease (IPD)-causing serotypes and the impact of the 13-valent pneumococcal conjugate vaccination during epidemic and nonepidemic influenza periods in Catalonia, Spain. This was a prospective study in persons aged

In the last few years, the emergence of studies concerning the resistive switching (RS) phenomenon has resulted in the finding of a large amount of materials being capable of acting as an active layer in such devices, i.e., the layer where the change in resistance takes place. Whereas the normal operation consists of the electrical readout of the modified resistance state of the device after electrical writing, electro-photonic approaches seek the involvement of light in these devices, be it either for the active Set or Reset operations or the readout. We propose in this work silicon nanocrystal multilayers (Si NC MLs) as an active material for being used in RS devices, taking advantage of their outstanding optical properties. The resistance states of Si NC MLs were obtained by electrical excitation, whose readout is carried out by electrical and electro-optical means, thanks to a distinguishable electroluminescence emission under each state. To achieve this, we report on an adequate design that combines both the Si NC MLs with ZnO as a transparent conductive oxide, whose material properties ensure the device RS performance while allowing the electro-optical characterization. Overall, such an occurrence states the demonstration of a Si NCs-based electroluminescent RS device, which paves the way for their future integration into photonic integrated circuits.

OBJECTIVES: The aim of this study was to assess the indirect effect of paediatric 13-valent pneumococcal conjugate vaccine (PCV13) vaccination on people ≥65 years of age with invasive pneumococcal disease (IPD) in Catalonia and to determine factors predictive of mortality. METHODS: During 2014-2016, 1285 IPD cases were reported to the Public Health Agency of Catalonia. The indirect effect of paediatric PCV13 vaccination was calculated by comparing the incidence rate (IR) in 2016 (PCV13 year) with that in 2009 (pre-PCV13). Predictors of mortality were determined using multivariate logistic regression. RESULTS: Comparing 2016 and 2009, IPD decreased by 19% (IR 40.1 and 32.5 per 100 000 person-years, respectively). PCV13 serotypes decreased by 57% (IR 23.7 and 10.1), while non-PCV13 serotypes increased by 36% (IR 16.4 and 22.4). During 2014-2016, the mortality rate was 17.5%, and mortality was associated with age ≥85 years (adjusted odds ratio (aOR) 2.91, 95% confidence interval (CI) 1.89, 4.48), meningitis (aOR 2.29, 95% CI 1.25, 4.19), non-focal bacteraemia (aOR 3.73, 95% CI 2.00, 6.94), and ≥1 high-risk condition (aOR 1.89, 95% CI 1.08, 3.32). PPV23non13 serotypes were associated with lower mortality than PCV13 serotypes (aOR 0.54, 95% CI 0.34, 0.86). CONCLUSIONS: The incidence of IPD in people ≥65 years of age decreased after the introduction of paediatric PCV13, and this was due to a reduction in PCV13 serotypes, although an increase in non-PCV13 serotypes was observed. Mortality was associated with age, meningitis, non-focal bacteraemia, ≥1 high-risk condition, and PCV13 serotypes. This study was partially supported by SpIDnet (Assessing the impact of vaccination with conjugate vaccines on the epidemiology of invasive pneumococcal disease in Europe), a network funded by the European Centre for Disease Prevention and Control ( ECDC/2015/031 ); the Catalan Agency for the Management of Grants for University Research ( AGAUR Grant number 2017/SGR 1342 and 2017/SGR 0742 ); the Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública ( CIBERESP CB06/02/0076 and CB15/00067 ); and the Centro de Investigación Biomédica en Red de Enfermedades Respiratorias ( CIBERES CB06/06/0037 ). Sí

Background The frequency of mild forms of hepatitis A, especially in children, could lead to underreporting. The objective of the study was to investigate the sensitivity of two surveillance systems, mandatory Statutory Disease Reports and the Microbiological Reporting System of Catalonia, using capture-recapture techniques. Methods The study was conducted in Catalonia between 2011 and 2015. Hepatitis A cases reported to two independent surveillance systems were included: Statutory Disease Reports (SDR) and Microbiological Reporting System of Catalonia (MRS). The variables collected were: age, sex, year of declaration, size of municipality ( 15 years (25.5%; 22.8–28.3 vs. 12.1%; 10–14.2). For those born in Spain, the sensitivity was 57.2% (49.6–67.4) in the SDR and 27.1% (23.5–31.9) in the MRS, lower than that for foreign-born patients (58%; 51.2–66.8 vs. 49.1%; 43.4–56.6). In electronically-reported cases, the sensitivity was much higher in the SDR than in the MRS (47.2%; 42.3–52.1 vs. 9.4%; 6.5–12.3). No differences were observed according to sex, size of municipality, and year of declaration or reporting centre. The estimated total number of cases using the Chapman formula was very similar to the adjusted estimate (1121; 985–1258 vs. 1120; 876–1525), indicating the robustness of the results. Conclusions The sensitivity of the SDR was greater than that of MRS, especially in patients aged

Background: The antibiotic use optimization program (PROA) in Catalonia (Spain) is part of the surveillance program for nosocomial infections in hospitals in Catalonia (VINCat). Despite the existence of guidelines for the treatment of urinary tract infections in hospitals, adherence to them is not guaranteed. Objective: Our objective was to evaluate the adequacy of empirical antimicrobial therapy to local guidelines in bacteremia caused by Escherichia coli of urinary source within the PROA-VINCat program during a 3-year period. The impact of a voluntary survey asking for evaluating local results and implementing correction measures was also analyzed. Methods: Multicentric prospective observational study including all episodes of E. coli bacteremia of urinary source between May 2017 and September 2019, in adult hospitalized patients in 45 Catalan hospitals. Adequacy of the empirical therapy to local guidelines was one of the prospectively recorded items. A survey evaluating local results of 2017–2018 and asking for possible correcting measures was sent to the participating centers at the end of 2018. Percentages of adequacy of empirical antimicrobial therapy in 2017, 2018, and 2019 were compared by means of χ2 test. Results: Overall, 3,804 episodes of bacteremia were recorded: 845 in 2017, 1,861 in 2018 and 1,098 until September 30, 2019. Globally, adequacy of empirical therapy to guidelines increased from 73.7% in 2017 to 78.2% in 2019 (P = .06). Interestingly, in the 24 hospitals that responded to the voluntary survey, the adequacy of empirical therapy increased significantly from 72.9% in 2017 to 79.9% in 2019 (P = .009). In hospitals that did not respond, adequacy remained the same over the years (76.7% in 2017, 75.1% in 2019; P = .90). Correction measures applied were: meeting with the antimicrobial stewardship team to evaluate the results (100%), review of local resistance rates (62%), review of local guidelines (58.3%), improving guidelines dissemination (75%), sessions for improving guidelines adherence (58%), and analysis of adherence to guidelines after education (65%). Conclusions: In the empirical treatment of E. coli bacteremia of urinary source, adequacy to local antimicrobial therapy guidelines improved from 2017 to 2019, but only in hospitals answering a voluntary survey regarding correcting measures for improving adequacy. Adherence to antimicrobial stewardship proposals improves indicators at local and regional level.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini and speaker honoraria from MSD, Pfizer, and Zambon.

The achievement of an efficient all-Si electrically-pumped light emitter is a major milestone in present optoelectronics still to be fulfilled. Silicon nanocrystals (Si NCs) are an attractive material which, by means of the quantum confinement effect, allow attaining engineered bandgap visible emission from Si by controlling the NC size. In this work, SiO2-embedded Si NCs are employed as an active layer within a light-emitting device structure. It is demonstrated that the use of an additional thin Si3N4 interlayer within the metal-insulator-semiconductor device design induces an enhanced minority carrier injection from the substrate, which in turn increases the efficiency of sequential carrier injection under pulsed electrical excitation. This results in a substantial increase in the electroluminescence efficiency of the device. Here, the effect of this Si3N4 interlayer on the structural, optical, electrical, and electro-optical properties of a Si NC-based light emitter is reported, and the physics underlying these results is discussed.

The resistive switching properties of silicon-aluminium oxynitride (SiAlON) based devices have been studied. Electrical transport mechanisms in both resistance states were determined, exhibiting an ohmic behaviour at low resistance and a defect-related Poole−Frenkel mechanism at high resistance. Nevertheless, some features of the Al top-electrode are generated during the initial electroforming, suggesting some material modifications. An in-depth microscopic study at the nanoscale has been performed after the electroforming process, by acquiring scanning electron microscopy and transmission electron microscopy images. The direct observation of the devices confirmed features on the top electrode with bubble-like appearance, as well as some precipitates within the SiAlON. Chemical analysis by electron energy loss spectroscopy has demonstrated that there is an out-diffusion of oxygen and nitrogen ions from the SiAlON layer towards the electrode, thus forming silicon-rich paths within the dielectric layer and indicating vacancy change to be the main mechanism in the resistive switching.

Asymmetric (CuGaO2/ZnO/ZnMgO) and symmetric (ZnMgO/ZnO/ZnMgO) multiple quantum well (MQW) structures were successfully fabricated using pulsed laser deposition (PLD) and their comparison were made. Efficient room temperature photoluminescent (PL) emission was observed from these MQWs and temperature dependent luminescence of asymmetric and symmetric MQWs can be explained using the existing theories. A systematic blue shift was observed in both MQWs with decrease in the confinement layer thickness which could be attributed to the quantum confinement effects. The PL emission from asymmetric and symmetric MQW structures were blue shifted compared to 150 nm thick ZnO thin film grown by PLD due to quantum confinement effects.

IEEE OCEANS 2017 ABERDEEN conference and workshop, Aberdeen, Scotland,19th - 22nd June 2017. -- http://www.nexosproject.eu/node/180, Measurement of the seawater temperature at different depths to get a vertical temperature profile on the water column is presented in this paper: The acquisition system based on optical fiber Bragg gratings (FBGs) and the subsequent data processed is also presented. The temperature measurements are taken in distributed points along the fiber where the Bragg gratings are located. The paper reports on the robustness of the new technique.

In this work, the fabrication and the structural, optical and electrical properties of Al-Tb/SiO2 nanomultilayers have been studied. The nanomultilayers were deposited by means of electron beam evaporation on top of p-type Si substrates. Optical characterization shows a narrow and strong emission in the green spectral range, indicating the optical activation of Tb3+ ions. The electrical characterization revealed conduction limited by the electrode, although trapped-assisted mechanisms can also contribute to transport. The electroluminescence analysis revealed also emission from Tb3+ ions, a promising result to include this material in future optoelectronics applications as integrated light-emitting devices. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim., This work was financially supported by the Spanish Ministry of Economy and Competitiveness (TEC2016-76849-C2-1-R and MAT2015-71035-R). O.B. also acknowledges the subprogram “Ayudas para Contratos Predoctorales para la Formaci on de Doctores” from the Spanish Ministry of Economy and Competitiveness for economical support.

In this work, the electroluminescence (EL) emission of zinc oxide (ZnO)/Si nanocrystals (NCs)-based light-emitting devices was studied under pulsed electrical excitation. Both Si NCs and deep-level ZnO defects were found to contribute to the observed EL. Symmetric square voltage pulses (50-μs period) were found to notably enhance EL emission by about one order of magnitude. In addition, the control of the pulse parameters (accumulation and inversion times) was found to modify the emission lineshape, long inversion times (i.e., short accumulation times) suppressing ZnO defects contribution. The EL results were discussed in terms of the recombination dynamics taking place within the ZnO/Si NCs heterostructure, suggesting the excitation mechanism of the luminescent centers via a combination of electron impact, bipolar injection, and sequential carrier injection within their respective conduction regimes.

A transparent and conducting ZnO:Er:Yb thin film with upconversion properties has been achieved after being annealed with continuous laser radiation just before the ablation point of the material. This work demonstrates that the laser energy preserves the conductivity of the film and at the same time creates an adequate surrounding for Er and Yb to produce visible upconversion at 660, 560, 520, and 480 nm under 980 nm laser excitation. The relation between the structural, electrical and upconversion properties is discussed. It is observed that the laser energy melts part of the material, which recrystallizes creating rare earth oxides and two different wurtzite structures, one with substitutional rare earths and oxygen vacancies (responsible for the conductivity) and the other without substitutional rare earth ions (responsible for the upconversion emission). (C) 2017 Elsevier B.V. All rights reserved.

The purpose of this investigation was to study the risk of intrauterine growth restriction in human immunodeficiency virus (HIV)-infected women and to describe the associated risk factors. A cohort study was performed among HIV-infected women who delivered in a single tertiary centre in Barcelona, Spain, from January 2006 to December 2011. Consecutive singleton pregnancies delivered beyond 22 weeks of pregnancy were included. Intrauterine growth restriction (IUGR) was defined as a birth weight below the 10th customised centile for gestational age and IUGR babies were compared to non-IUGR newborns. Intrauterine Doppler findings were described among IUGR foetuses. Baseline characteristics, HIV infection data and perinatal outcome were compared between groups. The results were adjusted for potential confounders. A total of 156 singleton pregnancies were included. IUGR occurred in 23.4 % of cases (38/156). In two-thirds of the cases detected before birth, Doppler abnormalities compatible with placental insufficiency were observed. IUGR pregnancies presented a worse perinatal outcome, mainly due to a higher risk of iatrogenic preterm delivery [adjusted odds ratio 6.9, 95 % confidence interval (CI) 1.4-33.5]. IUGR foetuses also had a higher risk of emergent Caesarean section and neonatal intensive care unit admission. No cases of intrauterine foetal death occurred. A high rate of IUGR was observed among HIV pregnancies, and it was associated with adverse perinatal outcomes, mainly iatrogenic preterm and very preterm birth due to placental insufficiency. Our results support that ultrasound detection and follow-up of IUGR foetuses should be part of routine antenatal care in this high-risk population to improve antenatal management.

The optical, electrical and electro-optical properties of metal-insulator-semiconductor (MIS) devices containing Si-rich silicon nitride (SRN) films are reported. The photoluminescence and optical absorption characterization evidences that optically active centers present a defective nature. As a consequence, a Poole-Frenkel type transport mechanism is considered, which is in agreement with the electrical results. The electro-optical performance of the devices has been found to be strongly modulated by the poly-Si electrode transmittance. After taking into account this contribution, EL emission has been studied, being the obtained spectra in accordance to the PL ones, which proofs that the same luminescent centers are also being excited electrically. The electrical response of the devices has been investigated under light excitation, showing induced photocurrent and photoconductivity, which makes SRN a good candidate material for photovoltaic applications.

The electro-optical properties of devices containing Si-rich silicon nitride (SRN) thin films, deposited by means of low-pressure chemical-vapor deposition (LPCVD), are studied. After optically evidencing the presence of defects in our films, a Poole-Frenkel conduction mechanism has been considered, which is in agreement with electrical experiments. We found that the poly-Si layer strongly modulates the electroluminescence and light absorption of the devices. In addition, they showed photocurrent and photoconductivity under illumination, SRN becoming a promising material for photovoltaic applications.

We investigated the incidence and distribution of cases of invasive pneumococcal disease (IPD), invasive meningococcal disease (IMD) and invasive Hemophilus influenzae disease (IHiD) notified by hospital laboratories to the Microbiological Reporting System of Catalonia between 2005 and 2009. Incidence rates were compared using the rate ratio (RR) and 95% CI were calculated. A value of p < 0.05 was considered statistically significant. Of the 6,661 cases, 6,012 were IPD, 436 IMD and 213 IHiD. The global annual incidence per 10 ( 5) inhabitants was 16.62 (95% CI 16.20-17.04) for IPD, 1.21 (95% CI 1.09-1.32) for IMD and 0.59 (95% CI 0.51-0.67) for IHiD. IPD increased in 2009 compared with 2005 (RR:1.55, 95%CI: 1.43-1.70) and IMD and IHiD remained stable. Pneumonia was the most-frequent clinical manifestation of IPD (75.6%) and IHiD (44.1%) and meningoencephalitis with or without sepsis for IMD (70.6%). The male:female ratio was 1.37 for IPD, 1.0 for IMD and 1.15 for IHiD. The age groups with the highest incidence were the ≤ 2 y and 2-4 y groups for IPD (66.40 and 50.66/100,000 persons-year) and IMD (14.88 and 7.26/100,000 persons-year) and the ≤ 2 y and ≥ 65 y groups for IHiD (1.88 and 1.89/100,000 persons-year). The most-frequent serotypes were serotype 1 (19.0%) in IPD and untypeable serotypes (60.8%) in IHiD. Serogroup B (78.3%) was the most frequent in IMD. S. pneumoniae is the most-frequent agent causing invasive disease in Catalonia. The main clinical manifestations were pneumonia in IPD and IHiD and meningitis in IMD. The main causative agent of meningitis was N. meningitidis in people aged < 20 y and S. pneumoniae in people aged ≥ 20 y. Vaccination with conjugate vaccines may reduce the risk of infectious disease in our setting.

The aim of this study was to investigate factors associated with vaccination with 7-pneumococcal conjugate vaccine (PCV7) and risk factors for invasive pneumococcal disease (IPD) and for penicillin-nonsusceptible strains in a community with intermediate vaccination coverage. We conducted a prospective, matched case-control study in children aged 3-59 months with IPD admitted to two hospitals in Catalonia. Three controls matched by hospital, age, sex, date of hospitalization and risk medical conditions were selected for each case. We calculated odds ratios for potential risk factors using logistic regression. Of the 1075 children included, 46.6% were considered fully vaccinated by age. 91.1% of cases were caused by non-PCV7 serotypes. Vaccination with PCV7 was positively associated with attending day care or school and negatively associated with age 24-59 months,4 cohabitants and low social class. Attending day care or school and4 cohabitants were risk factors for IPD. Previous antibiotic treatment in children aged 24-59 months was a protective factor for IPD; however, antibiotic use in the previous month and age24 months were associated with penicillin-nonsusceptible IPD. In a community where IPD in children aged5 years is caused mainly by non-PCV7 Streptococcus pneumoniae serotypes and where vaccine coverage is only intermediate, attending day care or school, age24 months,4 cohabitants and social class were associated with vaccination. Attending day care or school was a strong risk factor for IPD, while vaccination was protective in children aged24 months. Age and antibiotic use in the previous month were associated with penicillin-nonsusceptible IPD.

Silicon nanocrystals (Si NCs) are a promising candidate for the top cell of an all-Si tandem solar cell with a band gap from 1.3-1.7 eV, tuneable by adjusting NC size. They are readily produced within a Si-based dielectric matrix by precipitation from the Si excess in multilayers of alternating stoichiometric and silicon-rich layers. Here we examined the luminescence and transport of Si NCs embedded in SiC. We observed luminescence that redshifts from 2.0 to 1.5 eV with increasing nominal NC size. Upon further investigation, we found that this redshift is to a large extent due to Fabry-Pérot interference. Correction for this effect allows an analysis of the spectrum emitted from within the sample. We also produced p-i-n solar cells and found that the observed I-V curves under illumination could be well-fitted by typical thin-film solar cell models including finite series and parallel resistances, and a voltage-dependent current collection function. A minority carrier mobility-lifetime product on the order of 10-10 cm2/V was deduced, and a maximum open-circuit voltage of 370 mV achieved.

The optical and photovoltaic properties of Si NCs/SiC multilayers (MLs) are investigated using a membrane-based solar cell structure. By removing the Si substrate in the active cell area, the MLs are studied without any bulk Si substrate contribution. The occurrence is confirmed by scanning electron microscopy and light-beam induced current mapping. Optical characterization combined with simulations allows us to determine the absorption within the ML absorber layer, isolated from the other cell stack layers. The results indicate that the absorption at wavelengths longer than 800 nm is only due to the SiC matrix. The measured short-circuit current is significantly lower than that theoretically obtained from absorption within the ML absorber, which is ascribed to losses that limit carrier extraction. The origin of these losses is discussed in terms of the material regions where recombination takes place. Our results indicate that carrier extraction is most efficient from the Si NCs themselves, whereas recombination is strongest in SiC and residual a-Si domains. Together with the observed onset of the external quantum efficiency at 700–800 nm, this fact is an evidence of quantum confinement in Si NCs embedded in SiC on device level.

The purpose of this study was to describe the variation in listeriosis infection incidence during pregnancy over a 25-year period based on salient clinical and laboratory features compiled in a tertiary referral hospital and to depict the clinical characteristics of these cases. A cohort was created of all cases of listeriosis in pregnant women or their neonates (early-onset form) diagnosed between 1985 and 2010. Forty-three cases of perinatal listeriosis were diagnosed among the 82,320 hospitalised pregnant women (incidence 0.5‰). Whereas the incidence remained almost constant at 0.24‰ until 2000, an increasing incidence was observed from then on, reaching 0.86‰ during the last years of the study period. A four-fold increase in listeriosis rate during pregnancy has occurred in recent years, with poorer outcome for those cases occurring before 28 weeks and for those in which early antibiotic treatment was not provided. These results should raise the awareness of the agencies and professionals involved in prenatal care.

Vaccine failures occurring with 13-valent pneumococcal conjugate vaccine (PCV13) in 3 pediatric hospitals in Barcelona (2012-2013) are described. PCV13 vaccine failure was defined as the occurrence of an invasive pneumococcal infection in children properly vaccinated by PCV13. Among 84 patients with invasive pneumococcal infection, 32 had received at least one dose of PCV13. Seventeen of them had invasive pneumococcal infection produced by a PCV13 serotype. Among those, 9 patients were considered to have a PCV13 vaccine failure. Serotype 3 was isolated in 6 patients, serotype 19A in 2 and serotype 6B in 1.

The aim of this study was to evaluate the effectiveness of the administration of the 7-valent pneumococcal conjugate vaccine in a region with an intermediate vaccination coverage. A matched case-control study was carried out in children aged 7–59 months with invasive pneumococcal disease (IPD) admitted to two university hospitals in Catalonia. Three controls matched for hospital, age, sex, date of hospitalization and underlying disease were selected for each case. Information on the vaccination status of cases and controls was obtained from the vaccination card, the child's health card, the hospital medical record or the vaccination register of the primary healthcare center where the child was attended for non-severe conditions. A conditional logistic regression analysis was made to control for the effect of possible confounding variables. The adjusted vaccination effectiveness of the complete vaccination schedule (3 doses at 2, 4 and 6 months and a fourth dose at 15 months, 2 doses at least two months apart in children aged 12–23 months or a single dose in children aged >24 months) in preventing IPD caused by vaccine serotypes was 93.7% (95% CI 51.8–99.2). It was not effective in preventing cases caused by non-vaccine serotypes. The results of this study carried out in a population with intermediate vaccination coverage confirm those of other observational studies showing high levels of effectiveness of routine 7-valent pneumococcal conjugate vaccination.

We present a systematic z -scan study of the nonlinear absorption coefficient β of Si-nanocrystals embedded in SiO 2 (Si-nc/SiO 2 ) excited in the nanosecond regime. Two different wavelengths of a Nd:YAG laser have been used, λ = 1064 and 532 nm. The samples under study were deposited on silica substrates by plasma-enhanced chemical-vapor deposition technique and subsequently annealed up to 1250 ∘ C . We have observed an increase in β as the Si content in the Si-nc/SiO 2 films rises, indicating that the nonlinear behavior strongly depends on the amount of Si. Typical values of β around 1 cm/MW were obtained at 1064 nm, while they are one order of magnitude higher exciting at 532 nm, following the same trend as bulk Si with respect to the excitation energy. Large Si-nc present an energy of high-symmetry transitions ( E og , E 2 ) that approaches the system to a resonant condition with the excitation energy. On the other hand, we observed an increase of β with the annealing temperature that can be associated to an additional absorption from free carriers, as the crystalline degree scales with the thermal budget.

Transparent and conducting ZnO:Er:Yb thin films with visible up-conversion (660-nm emission under 980-nm excitation) were fabricated by RF magnetron sputtering. The as-deposited films were found to be transparent and conducting and the activation of the Er ions in these films to produce up-conversion luminescence was achieved by different post-deposition annealing treatments in air, vacuum or by laser annealing using a Nd:YVO4 laser. The structural, electrical and optical properties and the up-conversion efficiency of these films were found to be strongly influenced by the annealing method, and a detailed study is reported in this paper. It has been demonstrated that, although the air annealing was the most efficient in terms of up-conversion, laser annealing was the only method capable of activating Er ions while preserving the electrical conductivity of the doped films. It has been shown that a minimum energy was needed in laser annealing to optically activate the rare earth ions in the ZnO host material to produce up-conversion. Up-converting and transparent conducting ZnO:Er:Yb films with an electrical resistivity of 5 x 10(-2) cm and transparency 80% in the visible wavelength range has been achieved by laser annealing. (C) 2015 Elsevier B.V. All rights reserved.

In this work we apply low-loss electron energy loss spectroscopy (EELS) to probe the structural and electronic properties of single silicon nanocrystals (NCs) embedded in three different dielectric matrices (SiO2, SiC and Si(3)N(4)). A monochromated and aberration corrected transmission electron microscope has been operated at 80 kV to avoid sample damage and to reduce the impact of radiative losses. We present a novel approach to disentangle the electronic features corresponding to pure Si-NCs from the surrounding dielectric material contribution through an appropriate computational treatment of hyperspectral datasets. First, the different material phases have been identified by measuring the plasmon energy. Due to the overlapping of Si-NCs and dielectric matrix information, the variable shape and position of mixed plasmonic features increases the difficulty of non-linear fitting methods to identify and separate the components in the EELS signal. We have managed to solve this problem for silicon oxide and nitride systems by applying multivariate analysis methods that can factorize the hyperspectral datacubes in selected regions. By doing so, the EELS spectra are re-expressed as a function of abundance of Si-NC-like and dielectric-like factors. EELS contributions from the embedded nanoparticles as well as their dielectric surroundings are thus studied in a new light, and compared with the dielectric material and crystalline silicon from the substrate. Electronic properties such as band gaps and plasmon shifts can be obtained by a straightforward examination. Finally, we have calculated the complex dielectric functions and the related electron effective mass and density of valence electrons.

Light confinement strategies play a crucial role in the performance of thin-film (TF) silicon solar cells. One way to reduce the optical losses is the texturing of the transparent conductive oxide (TCO) that acts as the front contact. Other losses arise from the mismatch between the incident light spectrum and the spectral properties of the absorbent material that imply that low energy photons (below the bandgap value) are not absorbed, and therefore can not generate photocurrent. Up-conversion techniques, in which two sub-bandgap photons are combined to give one photon with a better matching with the bandgap, were proposed to overcome this problem. In particular, this work studies two strategies to improve light management in thin film silicon solar cells using laser technology. The first one addresses the problem of TCO surface texturing using fully commercial fast and ultrafast solid state laser sources. Aluminum doped Zinc Oxide (AZO) samples were laser processed and the results were optically evaluated by measuring the haze factor of the treated samples. As a second strategy, laser annealing experiments of TCOs doped with rare earth ions are presented as a potential process to produce layers with up-conversion properties, opening the possibility of its potential use in high efficiency solar cells. Refereed/Peer-reviewed

The electrical and electroluminescence (EL) properties of Si-rich oxynitride (SRON)/SiO 2 superlattices are studied for different silicon excess and layer thicknesses. The precipitation and crystallization of the Si excess present within the SRON layers is induced by a post-deposition annealing treatment, in order to form Si nanocrystals (Si-NCs). The electrical characterization performed in dark conditions allowed for deducing the charge transport mechanism through the superlattice structure, found to follow the Poole-Frenkel law. In addition, the EL investigation revealed the correlation between EL excitation and transport mechanisms, suggesting that impact ionization of high-energy conduction electrons dominates the whole frame. The reduction of the SiO 2 barrier thickness and the increase in the Si excess were found to enhance the carrier transport through the superlattices due to the reduction of the electrons mean free path, which, in turn, modifies the EL properties.

Rubella is usually a mild disease with nonspecific symptoms, but can cause congenital rubella syndrome (CRS) when infection occurs during pregnancy. The objective of this study was to evaluate the sensitivity and positive predictive value of different data sources used for surveillance purposes in the Rubella Elimination Program of Catalonia between 2002 and 2011. The Urgent Notification to the Statutory Disease Reporting System, the Individualized Disease Reporting System, screening for other viruses included in the Measles Elimination Program, the Microbiological Reporting System and the Minimum Hospital Discharge Data were evaluated. 100 suspected cases of postnatal rubella and 6 suspected cases of CRS were detected. For postnatal rubella, Urgent Notification had the highest sensitivity (32.5%; 95%CI 18.6–49.1), followed by the Virus screening in Measles Elimination Program (25%; 95%CI 12.7-41.2). Virus screening in the Measles Elimination Program had the highest PPV (76.9%; 95%CI 46.1–94.9), followed by the Individualized Disease Reporting System (57.1%; 95%CI 28.9–82.3). For CRS cases, the Individualized Disease Reporting System had the highest sensitivity (100%, 95%CI 29.2–100) and the highest PPV (60%; 95%CI 14.7–100). Most confirmed postnatal cases (25 cases, 48.1%) were in the 25–44 y age group followed by the 15–24 y age group (11 cases, 21.2%). The highest values of sensitivity and PPV for the detection of confirmed cases corresponded to activities that were specifically introduced in the measles and rubella elimination programs.