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In recent years, several researchers have attempted to identify COPD phenotypes using different cluster analysis. This study aimed to determine the most optimal cluster analysis (supervised vs unsupervised) to robustly identify clinical phenotypes. 2,968 COPD patients have been included from January 2014 until February 2020. General information (age, BMI, smoking, comorbidities), lung function, exacerbations and symptoms were collected. After 5 years of follow-up, vital status was recorded. A hierarchical classification on the principal components (HCPC) was performed, followed by two unsupervised classification algorithms: k-means and PAM (Partition Around Medoids). Robustness was defined according to three different indices of validation (Connectivity, Dunn and silhouette). The mean age was 70 years, 63.7% of males, current smokers: 38.7%, mean FEV1: 61.3% predicted, ≥2 exacerbations: 43.6%, mMRC dyspnea grade≥2: 56.3%, chronic cough: 58%. The 5-year mortality rate was 11.3%. Based on our hypothesis, four phenotypes were described, using the PAM method. The phenotype A (24.2%) consisted of elderly patients with severe airflow limitation, low symptoms, cardiovascular comorbidities, diabetes and a higher mortality. The phenotype B (23.9%) contained more female patients, young patients with moderate airflow limitation and a high rate of current smokers. The phenotype C (25.5%) contained patients with very severe airflow limitation, more symptoms and low BMI. The Phenotype D (26.2%) was composed of patients with mild airflow limitation and low dyspnoea. These results showed the superiority of PAM classification compared with two other algorithms (k-means and HCPC) in terms of the robustness.

Objectives:Serologic techniques can serve as a complement to diagnose SARS-CoV-2 infection. The objective of our study was to compare the diagnostic performance of six immunoassays to detect antibodies against SARS-CoV-2: three lateral flow immunoassays (LFAs), one ELISA and two chemiluminescence assays (CLIAs).Methods:We evaluated three LFAs (Alltest, One Step and SeroFlash), one ELISA (Dia.Pro) and 34 two CLIAs (Elecsys and COV2T). To assess the specificity, 60 pre-pandemic sera were 35 used. To evaluate the sensitivity, we used 80 serum samples from patients with 36 positive PCR for SARS-CoV-2. Agreement between techniques was evaluated using the kappa score (k).ResultsAll immunoassays showed a specificity of 100% except for SeroFlash (96.7%). Overall sensitivity was 61.3%, 73.8%, 67.5%, 85.9%, 88.0% and 92.0% for Alltest, One Step, SeroFlash, Dia.Pro, Elecsys and COV2T, respectively. Sensitivity increased throughout the first two weeks from the onset of symptoms, reaching sensitivities over 85% from 14 days for all LFAs, being One Step the most sensitive (97.6%), followed by SeroFlash (95.1%). Dia.Pro, Elecsys and COV2T showed sensitivities over 97% from 14 days, being 100% for COV2T. One Step showed the best agreement results among LFAs, showing excellent agreement with Dia.Pro (agreement=94.2%, k=0.884), COV2T (99.1%, k=0.981) and Elecsys (97.3%, k=0.943). Dia.Pro, COV2T and Elecsys also showed excellent agreement between them.ConclusionOne Step, Dia.Pro, Elecsys and COV2T obtained the best diagnostic performanc e results. All these techniques showed a specificity of 100% and sensitivities over 97% from 14 days after the onset of symptoms, as well as excellent levels of agreement.

The main factors that increase the mortality risk of COPD patients are age, comorbidities and the severity of airflow obstruction. This study aimed to validate the clinically relevant COPD phenotypes found by Burgel P-R et al [1] and analyzed their impact on 5-year mortality in the PALOMB cohort. COPD patients (post-BD FEV1/FVC 2,653 patients (66 years old, 64.27% males) were included. Application of the CART-based algorithm to Palomb cohort confirmed that it identified 5 COPD phenotypes with different clinical characteristics. In addition: The high proportion of FEV1 decline (≥100 ml/yr) belongs to phenotype 1 and 4; the majority of patients in these phenotypes were under oxygen therapy and they were associated with higher rates of exacerbation, lung cancer, anxiety and depression. These results confirmed the identification of five clinically relevant COPD phenotypes. A novel finding of this study is that FEV1 decline, frequency of exacerbations and other comorbidities were associated with the more severe phenotypes. Fundings: Bordeaux Univ Foundation, Novartis, Isis Medical, GSK, BI, Chiesi.

Introduction L’identification de sous-groupes de patients atteints de BPCO et partageant des caracteristiques cliniques et/ou paracliniques communes est a l’origine du concept de phenotypes dans cette pathologie. De nombreuses etudes de cohortes observationnelles sont en cours, pour tenter d’identifier de nouveaux phenotypes de patients BPCO. L’objectif de cette etude est de determiner l’analyse en cluster la plus optimale (supervise vs non-supervise) pour identifier de facon robuste les phenotypes cliniques dans le cadre de la cohorte PALOMB. Methodes Les patients BPCO (VEMS/CVF Resultats 2968 patients (70 ans, 63,7 % d’hommes, 38,7 % de fumeurs actuels) ont ete inclus ( Tableau 1 ). Parmi eux, 43,6 % ont eu au moins deux exacerbations au cours des 12 derniers mois, 58 % avaient de la toux chronique et 56,3 % avaient une dyspnee plus severe. Selon GOLD 2007, la severite de la BPCO etait representee par le stade I (18,2 %), le stade II (51,7 %), le stade III (24,1 %) et le stade IV (6 %). Le taux de la mortalite a 5 ans est de 11,3 %. Sur la base de notre hypothese, nous avons pu determiner quatre phenotypes, a l’issu de la methode PAM (k-medoides: partition Around Medoids): le phenotype A (24,2 %), B (23,9 %), C (25,5 %), et D (26,2 %). Le phenotype (A) etait constitue de patients âges, comorbides (cardiovasculaire et de diabete), peu symptomatiques, severe sur le VEMS. Le phenotype (B) etait tres severe, plus symptomatique, avec un IMC faible, plus de comorbidite metabolique, osteo-articulaire et neuropsychiatrique. Conclusion Ces Resultats illustrent l’aspect plurifactoriel des differents phenotypes identifies chez les patients BPCO. Parmi toutes les mesures de classification, la methode PAM (Machine Learning) apparait la plus valide.

Highlights • The six immunoassays are reliable to detect antibodies against SARS-CoV-2. • LFAs using S and N protein as antigens achieved the highest sensitivity. • One Step LFA, Dia.Pro ELISA, Elecsys and COV2T CLIAs showed 100 % specificity. • These four assays showed sensitivity over 97 % from 14 days after the onset of symptoms. • These four assays showed excellent agreement with kappa scores (k) > 0.9., Objectives Serologic techniques can serve as a complement to diagnose SARS-CoV-2 infection. The objective of our study was to compare the diagnostic performance of six immunoassays to detect antibodies against SARS-CoV-2: three lateral flow immunoassays (LFAs), one ELISA and two chemiluminescence assays (CLIAs). Methods We evaluated three LFAs (Alltest, One Step and SeroFlash), one ELISA (Dia.Pro) and two CLIAs (Elecsys and COV2T). To assess the specificity, 60 pre-pandemic sera were used. To evaluate the sensitivity, we used 80 serum samples from patients with positive PCR for SARS-CoV-2. Agreement between techniques was evaluated using the kappa score (k). Results All immunoassays showed a specificity of 100 % except for SeroFlash (96.7 %). Overall sensitivity was 61.3 %, 73.8 %, 67.5 %, 85.9 %, 88.0 % and 92.0 % for Alltest, One Step, SeroFlash, Dia.Pro, Elecsys and COV2T, respectively. Sensitivity increased throughout the first two weeks from the onset of symptoms, reaching sensitivities over 85 % from 14 days for all LFAs, being One Step the most sensitive (97.6 %), followed by SeroFlash (95.1 %). Dia.Pro, Elecsys and COV2T showed sensitivities over 97 % from 14 days, being 100 % for COV2T. One Step showed the best agreement results among LFAs, showing excellent agreement with Dia.Pro (agreement = 94.2 %, k = 0.884), COV2T (99.1 %, k = 0.981) and Elecsys (97.3 %, k = 0.943). Dia.Pro, COV2T and Elecsys also showed excellent agreement between them. Conclusions One Step, Dia.Pro, Elecsys and COV2T obtained the best diagnostic performance results. All these techniques showed a specificity of 100 % and sensitivities over 97 % from 14 days after the onset of symptoms, as well as excellent levels of agreement.

As a result of the opinion given by the European Food Safety Authority about the safety of chia seed (Salvia hispanica L) and whole ground chia seed as food ingredients, they may be placed on the market in the European Community as novel food ingredients to be used in bread products. The objective of the present investigation was to develop new cereal-based products with increased nutritional quality by using chia and ground chia seeds (whole chia flour, semi-defatted chia flour and low-fat chia flour) in order to evaluate its potential as a bread-making ingredient. The samples with chia addition significantly increased the levels of proteins, lipids, ash and dietary fibre in the final product compared to the control sample. Breads with seeds or ground seeds showed similar technological quality to the control bread, except for the increase in specific bread volume, decrease in crumb firmness and change in crumb colour. Sensory analysis showed that the inclusion of chia increased overall acceptability by consumers. The thermal properties of the starch did not alter substantially with the inclusion of chia. However, the incorporation of chia inhibited the kinetics of amylopectin retrogradation during storage, which would be directly related to the delay in bread staling., This work was financially supported by the Grants AGL2011-22669 and Consolider Fun-C-Food CSD2007-00063 from the Ministry of Economy and Competitiveness (MINECO) and PROMETEO/2012/064 from the Generalitat Valenciana, Spain. The contract of E. Iglesias-Puig from the Consolider Fun-C-Food Project is gratefully acknowledged.

Magnetic particles covered by gold are very important in many biological applications. However, there are not simple methods to produce small (< 5–10 nm) nanoparticles. One of the main reasons for that is the general use of iron oxides as magnetic cores, which have a large crystalline mismatch with gold. The use of Fe would be more appropriate, but its high tendency to oxidation has largely precluded it from being used as a core. Here, we will show that using a simple “one-pot” successive reaction method in microemulsions, can avoid such problems and is able to produce very stable core-shell Fe@Au nanoparticles. With this procedure, nanoparticles of ∼6 nm with a Fe core of 3 nm can easily be obtained. These Fe@Au nanoparticles, with a saturation magnetization of 1.13 emu/g, are very stable even in air after magnetic separation from the solution, which shows the good covering of the Fe core by the Au shell. In this contribution we will report the key parameters, which have to be taken into account, to prepare such stable Fe@Au dispersions and analyze their optical and magnetic properties, as well as their possible applications as biosensors, targeted magnetic separation, etc.

A partir de una entrevista recopilada in situ en 1966 se evoca el quehacer, logros y proyectos de una familia migrante de origen español, de la región de Navarra, y que llegó a Argentina en la última década del siglo XIX. Se instaló en el sudoeste pampeano, en una zona de suelos salitrosos con climas alternantes entre extrema aridez y en los últimos decenios con pluviometrías desbordantes que dificultan temporalmente cualquier producción agrícola o animal. El relato oral funge como testimonio de la presencia de estos pobladores que forjaron los primeros frutos para una agricultura agroexportadora en unidades de explotación o ‘chacras’ cuyas superficies oscilaban entre 200 y 400 hectáreas. La mayoría de estos chacareros empezaron como arrendatarios de tierras que las grandes estancias de la zona les alquilaban para realizar sus cultivos. Muchos de ellos, como en el caso que ejemplificamos aquí, se convirtieron posteriormente en propietarios: la familia nuclear les había favorecido con un número de hijos varones que desarrollaron en conjunto la empresa familiar. La tercera generación de estas familias, en su mayoría, migran del espacio rural. From an interview collected in situ in 1966, in this work, the achievements and projects of a migrant family of Spanish origin, from the region of Navarre, which evolved in Argentina in the last decade of the nineteenth century, is evoked. It was installed in the southwest of Pampa, in an area of ​​salty soil with climates alternating between extreme aridity and in recent decades with overflowing rainfall that temporarily hinder any agricultural or animal production. The oral history serves as a testimony of the presence of these people who forged the first fruits for an agro-export agriculture in units of exploitation or 'chacras' whose surfaces oscillated between 200 and 400 hectares. Most of these chacareros began as land tenants that the great estancias of the zone were renting them to realize their crops. Many of them, as in the case exemplified here, later became proprietors: the nuclear family had favoured them with a number of sons who jointly developed the family business. The third generation of these families, mostly, migrate from rural areas.

Se realizó un estudio observacional descriptivo transversal en el Policlínico “Augusto Ramón Fraga Coloma”, asentamiento poblacional El Cangre municipio Güines, provincia Mayabeque, durante el período comprendido entre noviembre de 2007 hasta marzo de 2008, para determinar la prevalencia, gravedad y factores de riesgos asociados a la enfermedad periodontal. Se evaluó el estado periodontal de 202 individuos de uno y otro sexo, de 19 a 35 años y se utilizó el Índice Periodontal de Russell, forma revisada por la Organización Mundial de Salud. La Higiene Bucal se determinó por el índice de Greene y Vermillión. El examen bucal se realizó por los investigadores en los hogares de los individuos encuestados. La información se procesó en una tabla de Excel. En el procesamiento se aplicó la dócima X2 y la comparación múltiple de Duncan. La prevalencia de la enfermedad periodontal fue de 71,8% y predominó la no formación de bolsas.

Se presenta un tema de actualidad para fundamentar la utilización de los escasos recursos para ofertar servicios de salud, según normas establecidas por el Ministerio de Salud Pública. Se establece la relación economía y salud como binomio inseparable en la toma de decisiones para el logro de un mayor desempeño de la oferta de los servicios de salud, en aras de una buena calidad de vida poblacional e institucional. Para este trabajo se utilizaron las bases de datos de Infomed, Google, MEDLINE y textos de maestrías de Economía dela Saludofrecidos porla Escuela Nacionalde Salud Pública, así como otros libros de interés.

Seit der BGH im Jahr 2001 die Rechtsfähigkeit der (Außen-)Gesellschaft bürgerlichen Rechts (GbR) anerkannt hat, stellen sich Folgefragen zur Haftung ihrer Gesellschafter. Diese beschäftigen Rechtsprechung und Lehre seitdem in besonderem Maße. Eine Haftung der Gesellschafter analog § 128 S. 1 sowie der eingetretenen Gesellschafter analog § 130 ist inzwischen höchstrichterlich anerkannt. In diesem Beitrag soll die Möglichkeit der analogen Anwendung des § 28 auf die GbR, also die Haftung der neu entstehenden Gesellschaft für die Altverbindlichkeiten des vorher einzeln Tätigen, untersucht werden. Dies soll anhand eines Falles unter dem Gesichtspunkt der Haftung des in die Einzelkanzlei eintretenden Sozius erfolgen. Dieser Beitrag möchte das Für und Wider einer solchen Analogie aufzeigen und den Umgang hiermit in der Klausur verdeutlichen.

Este artículo plantea repensar las desigualdades y vulnerabilidades en diferentes territoriosy en las diversas coyunturas que adquiere el desarrollo de Latinoamérica en el período1990-2015. Se despliega un análisis de tipo teórico sobre la temática y posteriormente seimplementa el estudio a partir de ciertos indicadores aplicados para algunos territorios deAmérica Latina. El tema se organiza en tres partes. La primera de ellas trata los problemasde desigualdad, desarrollo, vulnerabilidad y democracia a nivel teórico. En la segunda parteanalizamos las temáticas de crecimiento y desempleo en la región latinoamericana duranteel período de análisis. Por último, las vulnerabilidades generadas por la desigualdad son contempladasa partir de los conceptos de crecimiento económico y desarrollo. Las reflexionesfinales cierran este análisis y plantean nuevas interrogantes sobre el tema.

Objective: To evaluate the opinions of intensive care unit staff and family members about family participation in decisions about patients in intensive care units in France, a country where the approach of physicians to patients and families has been described as paternalistic. Design: Prospective multiple-center survey of intensive care unit staff and family members. Setting: Seventy-eight intensive care units in university-affiliated hospitals in France. Patients: We studied 357 consecutive patients hospitalized in the 78 intensive care units and included in the study starting on May 1, 2001, with five patients included per intensive care unit. Interventions: We recorded opinions and experience about family participation in medical decision making. Comprehension, satisfaction, and Hospital Anxiety and Depression Scale scores were determined in family members. Measurements and Main Results: Poor comprehension was noted in 35% of family members. Satisfaction was good but anxiety was noted in 73% and depression in 35% of family members. Among intensive care unit staff members, 91% of physicians and 83% of nonphysicians believed that participation in decision making should be offered to families; however, only 39% had actually involved family members in decisions. A desire to share in decision making was expressed by only 47% of family members. Only 15% of family members actually shared in decision making. Effectiveness of information influenced this desire. Conclusion: Intensive care unit staff should seek to determine how much autonomy families want. Staff members must strive to identify practical and psychological obstacles that may limit their ability to promote autonomy. Finally, they must develop interventions and attitudes capable of empowering families.

The purpose of the present work was to provide further information on how replacing wheat flour by whole quinoa flour (at 25 and 50g/100g of flour) affects bread performance and to assess its potential as a nutritious ingredient. Bread with quinoa resulted in a depreciation in quality in terms of loaf specific volume (from 4.48 to 3.46/2.63 cm3/g), crumb firmness (from 0.77 to 1.55/2.64 N) and acceptability (from 7.94 to 7.58/5.94). Quinoa increased the bread nutritional value, raising fibre (from 5.5 to 7.2 g/100g) and minerals (Ca from 0.35 to 1.28 mg/g, Fe from 17 to 34 ¿g/g, and Zn from 23 to 48 ¿g/g). The phytates were controlled by bifidobacterial phytase treatment during breadmaking (from 4.7 ¿mol/g to below the detection limit), which decreased phytate/mineral molar ratios to values lower than the threshold for inhibition of Fe and Zn absorption. Quinoa could partially replace wheat flour in bread, increasing its nutritional value in terms of dietary fibre, minerals, proteins of high biological value and healthy fats, with only a small depreciation in bread quality at 25g/100g of flour substitution. The high phytate contents were efficiently removed by phytase treatment and the breads were accepted by consumers., This work was financially supported by grants Consolider Fun-C-Food CSD2007-00063 and AGL2011-22669 from the Ministry of Economy and Competitiveness (MINECO) and PROMETEO/2012/064 from the Generalitat Valenciana, Spain.

En este artículo se señalan los momentos de quiebre en la conformación del constructo epistemológico a partir de los cuales la historia, la historia económica y las fuentes orales comienzan a deslindar fronteras. Se analizan algunos aspectos metodológicos de la historia oral para dejar de lado la validación del testimonio oral como tal y jerarquizar su utilización para diferentes espacios y tiempos que hacen al quehacer histórico. Después se despliegan los temas que conforman el sustrato entre memoria, relato oral e historia económica, al estudiar por un lado las relaciones entre historia económica e investigación histórica y por el otro la historia económica y la fuente oral dentro del contexto de la memoria. En amplios considerandos se da lugar a un importante número de reflexiones que cierran etapas y plantean nuevos escenarios y ropajes en y con los cuales debiera transitar la historia económica.

El presente trabajo pretende demostrar la presencia –en la historia– de actores silenciados. Para ello nos proponemos presentar los beneficios en el uso del relato oral como herramienta complementaria en la elaboración de la investigación en historia económica y social. Proponemos al relato oral como una herramienta de búsqueda de los nuevos sujetos de la historia, las voces silenciadas detrás de instituciones o gobernantes. Discurrimos entre la historia y la memoria, justificaremos las intenciones de esos sujetos silenciados en un nuevo escenario que hasta mediados del siglo pasado se reconocía geográficamente, pero no tenía voz propia en un corpus teórico-histórico. En tanto que el relato oral no da voz sólo a los silenciados sino que despliega la cotidianidad de aquellos espacios que la historia económica ha manejado marcando sus ciclos y ritmos sistémicos, devela la parte complementaria de este escenario, es decir, el contexto en el que intervienen nuevos actores con un discurso alterno y/o complementario para poder articular posteriormente el dominio objetual de una investigación. A partir de nuestro trabajo de campo en el espacio agrario henequenero de Yucatán en los años setenta, presentaremos datos con el fin de ilustrar los alcances y riqueza del relato oral como herramienta metodológica.

"La migración internacional es un fenómeno relativamente reciente en el estado de Yucatán; sin embargo, durante la última década, la región se ha convertido en receptora de un importante monto de remesas. Aunque los montos de estos envíos han aumentado significativamente y han servido para mitigar la pobreza, es evidente que no se puede considerar un modelo de desarrollo basado en las remesas; con estas se cubren necesidades de sobrevivencia y es sólo en algunos casos que puede hablarse de un aumento en la calidad de vida, manifestado mediante una acumulación de salarios. La actual documentación para el análisis de algunos de los indicadores es aún incipiente; sin embargo, con el trabajo de campo de corte histórico que aquí se presenta -en el que se analiza cómo ha influido en la experiencia de los inmigrantes el proceso de migración interna detonado por el desarrollo del complejo turístico cancunense-, así como con una revisión de las condiciones en los nuevos territorios expulsores -especialmente los de la región henequenera-, se complementan algunas de las interrogantes planteadas."

1. LAS INDUSTRIAS DEL CUERO Y DEL CALZADO EN MÉXICO: FORTALEZAS Y DEBILIDADES. Las industrias mexicanas del cuero y del calzado, espacio tradicional de capitales nacionales se sacudieron muy fuertemente, como muchos otros sectores manufactureros, después de la entrada de México al Acuerdo General de Aranceles y Comercio (GATT), en 1986, las transformaciones sufridas entonces ilustran sobre este problema. ...

Iglesias Esther. Les crises agraires des années 1930 dans la pampa argentine vues à travers la presse quotidienne. In: Cahiers du monde hispanique et luso-brésilien, n°19, 1972. pp. 35-58.