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ABSTRACT The etiology of nosocomial pneumonia (NP) in non-mechanically ventilated patients [hospital-acquired pneumonia (HAP)] is poorly understood because of difficulties in obtaining reliable respiratory samples. While it is thought to resemble that of mechanically ventilated patients [ventilator-associated pneumonia (VAP)], few studies compare etiology in both groups. We compared the etiology of bacteremic NP (bNP) episodes in HAP and VAP over 10 years in our institution. We defined NP in adults according to the American Thoracic Society criteria. bNP episodes were defined as significant isolates in ≥1 blood culture concordant with ≥1 respiratory pathogen isolated with 40%. IMPORTANCE This study on bacteremic nosocomial pneumonia (bNP) demonstrates the importance of this condition both in patients undergoing and not undergoing mechanical ventilation. Staphylococcus aureus, Enterobacterales, and non-fermenting Gram-negative bacilli are all causative agents in ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP), with a predominance of S. aureus in HAP and of Pseudomonas aeruginosa in VAP. Mortality in this condition is very high. Therefore, new therapeutic and preventive approaches should be sought.

Background: Vulvovaginal candidiasis (VVC) is caused by biofilm formation and epithelial invasion. In addition, Escherichia coli (EC) can establish a vaginal intracellular reservoir modulating Candida spp. biofilm production. We aimed to analyze the behavior of Candida albicans (CA) and EC biofilm both in single cultures and in co-cultures. Methods: We prospectively collected CA and EC isolates from vaginal swabs over 6 months. We selected positive cultures with both CA and EC (cases) and a comparator group with either CA or EC (controls). We analyzed overall biomass production and metabolic activity in single cultures and in co-cultures based on staining assays, confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) to assess biofilm occupation. We also analyzed clinical manifestations. Results: We cultured 455 samples, 16 (3.5%) of which had CA and EC (cases); only CA or EC (controls) was detected, respectively, in 72 (15.8%) and 98 (21.5%). Biomass production and metabolic activity were significantly more pronounced in co-cultures in both groups. CLSM and SEM, on the other hand, showed the biofilm of each species to be significantly reduced when they were cultured together, with higher values in CA (percentage biofilm reduction: CA, 95.8% vs. EC, 36.2%, p

Osteoarthritis merupakan penyakit dengan terapi jangka panjang dan memiliki beban biaya yang besar. Penelitian farmakoekonomi ini bertujuan untuk melihat efektivitas biaya dari jamu santifik dalam pengobatan osteoarthritis menggunakan perspektif pasien. Analisis efektivitas biaya dipresentasikan dalam bentuk Incremental Cost Effectiveness Ratio (ICER). Efektivitas terapi dileporkan berdasarkan nilai keberhasilan terapi dan dan Quality Adjusted Life Year (QALY). Komponen biaya yang diukur meliputi biaya langsung medis maupun non-medis. Analisis sensitivitas univariat dilakukan untuk melihat pengaruh dari variable penelitian terhadap nilai ICER. Pasien berjumlah 50 orang yang berpartisipasi dalam penelitian ini dimasukkan ke dalam terapi jamu saintifik (40%) dan terapi konvensional osteoarthritis (60%). Biaya pada kelompok yang menggunakan jamu saintifik lebih tinggi jika dibandingkan dengan terapi konvensional osteoarthritis (38.993±2.873 vs 31.511±1.833). Efektivitas terapi jamu saintifik lebih tinggi jika dibandingkan terapi konvensional osteoarthritis namun perbedaan tersebut tidak bermakna secara statistik (95,0% vs 93,3%; p value 0,808), begitu juga dengan utility index jamu saintifik yang lebih besar dibandingkan terapi konvensional osteoarthritis (0,88±0,07 vs 0,77±0,15; p value 0,093). Nilai ICER untuk 1 unit penambahan efektivitas terapi bernilai Rp 437.765, sedangkan ICER untuk penambahan 1 unit kualitas hidup bernilai Rp 67.654. Faktor yang paling mempengaruhi nilai ICER adalah biaya jamu. Terapi jamu saintifik osteoarthritis merupakan terapi yang cost-effective dibandingkan terapi konvensional osteoarthritis.

IntroductionInfections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018.MethodsA national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.ResultsA total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017–2018 compared to 2014–2016.DiscussionData from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms.

El objetivo de este artículo es construir un diagnóstico del proyecto político de la élite de Chile, a través del prisma de la teoría de la hegemonía de Antonio Gramsci (1891-1937). Este enfoque permite interpretar los lineamientos del Estado y la sociedad chilena desde la transición hasta el 18 de octubre de 2019. Las bases del proyecto hegemónico previo al estallido social que se había reconstruido a partir de retazos de la caída de la dictadura se enfrentan a una crisis de autoridad que abre un tiempo político nuevo y todavía en desarrollo. El artículo aporta una lectura desde la teoría política gramsciana para entender qué elementos de dicho proyecto han dejado de ser creíbles en la sociedad chilena.

El objetivo de este artículo es proponer una reflexión y análisis respecto de los desafíos epistemológicos, éticos y políticos del trabajo social a la luz del proceso constituyente que vive Chile, tomando como referencia de esta discusión los aportes teóricos de Antonio Gramsci. En términos metodológicos, este trabajo se sustenta desde una perspectiva hermenéutica crítica, que articula la revisión y el análisis documental con las experiencias históricas concretas. Se sostiene que, en este proceso constituyente, se pone en juego un proyecto de carácter contra-hegemónico, y, por tanto, la disciplina debería experimentar rupturas con los anclajes conservadores heredados de la dictadura y el largo período de transición a la democracia. El proceso constituyente se configura como una posibilidad no solo de profundización de la democracia, sino que permitiría generar las condiciones para avanzar en una reforma cultural y moral.

Rootstock election is one of the key decisions when designing a vineyard. Although the research performed to determine the effect they induce in the behaviour of scion varieties is not scarce, it is not easy to have a global idea, as results are usually published scattered. In this work, we re-examine previous research conducted in Spain on rootstock implications on vine agronomic performance through the performance of a meta-analysis (MA). As a result, we were able to integrate the information reported in 20 articles that included rootstock experimentation conducted with 36 different varieties and 47 different rootstocks, totalling 764 individual records. However, when the information was filtered before the meta-analysis, this number decreased to 312 records, for which rootstock Response Ratios (RR) were calculated. The characteristics conferred by the rootstock were more closely related to the rootstock itself, rather than to the characteristics of the Vitis sp. crossing used to create the rootstock. Several rootstocks were identified as more suitable for adapting to future climate change conditions, as far as they were able to moderate sugar accumulation and pH (161-49 C, 41-B MGt and 420A MGt). Meanwhile, 140 Ru and 5-BB were observed to provide high pH and sugar contents despite their high yield. In conclusion, despite being based on data from a single country, the meta-analysis was shown to be a useful tool for enhancing the value of previous research on rootstocks. Combining articles from both peer-reviewed and technical journals helped in the assessment of the implications of different rootstocks, although further steps should be taken to facilitate data integration (harmonisation of measurement and reporting procedures, open data repositories, etc).

Semantic segmentation of remote sensing images has many practical applications such as urban planning or disaster assessment. Deep learning-based approaches have shown their usefulness in automatically segmenting large remote sensing images, helping to automatize these tasks. However, deep learning models require large amounts of labeled data to generalize well to unseen scenarios. The generation of global-scale remote sensing datasets with high intraclass variability presents a major challenge. For this reason, data augmentation techniques have been widely applied to artificially increase the size of the datasets. Among them, photometric data augmentation techniques such as random brightness, contrast, saturation, and hue have been traditionally applied aiming at improving the generalization against color spectrum variations, but they can have a negative effect on the model due to their synthetic nature. To solve this issue, sensors with high revisit times such as Sentinel-1 and Sentinel-2 can be exploited to realistically augment the dataset. Accordingly, this paper sets out a novel realistic multi-temporal color data augmentation technique. The proposed methodology has been evaluated in the building and road semantic segmentation tasks, considering a dataset composed of 38 Spanish cities. As a result, the experimental study shows the usefulness of the proposed multi-temporal data augmentation technique, which can be further improved with traditional photometric transformations.