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An extraordinary flash-flood event occurred the 9th October 2018 in the north-eastern part of Mallorca Island. The spatial distribution of main geomorphic changes were accurately mapped through field and aerial UAV campaigns in two contrasted small headwater catchments (i.e., < 2 km2) of the Begura de Saumà River. The first one was massively covered by step terraces over Lias limestone, whilst the second one was only covered by check-dam terraces over Miocene marls.Two weeks after the event, a UAV was used to record aerial photographs and build high-resolution digital elevation models (HR-DEM; i.e., 5 cm). Geomorphic changes were assessed comparing this HR-DEM with LiDAR-derived DEM (i.e., 25 cm resolution) obtained in 2014. The Borselli index of connectivity (IC; version of Cavalli et al., 2013) was calculated from the LiDAR-derived DEM to compare the geomorphic changes triggered by the flash-flood with the structural sediment connectivity distribution.At hillslope scale, the HR-DEM allowed the identification of geomorphic changes, such as the initiation of rills and the wall collapse of old agricultural terraces in the terraced limestone catchment. In the main headwater valley axis of the marls catchment, where natural streams had been historically reduced and deviated with the construction of check-dam terraces, huge geomorphic changes enabled the recovering of natural streams.The spatial distribution of the observed geomorphic changes on hillslopes was compared with the spatial patterns of sediment connectivity. Geomorphic changes elucidated a good concordance with structural connectivity, both in the location and magnitude. The analysis of these concordances and some discordances allows the identification of hydrogeomorphological factors triggering the erosional response of hillslopes.This work was supported by the research project CGL2017-88200-R “Functional hydrological and sediment connectivity at Mediterranean catchments: global change scenarios –MEDhyCON2” funded by the Spanish Ministry of Science, Innovation and Universities, the Spanish Agency of Research (AEI) and the European Regional Development Funds (ERDF).

A flash-flood event hit in the 9th October 2018 the northeastern part of Mallorca Island, causing 13 casualties. As global change may exacerbate devastating flash floods, comprehensive analyses of catastrophic events are crucial to support effective prevention and mitigation measures. Field-based, remote-sense and modelling techniques were used to evaluate rainfall-runoff processes at catchment scale linked to hydrological modelling. Continuous streamflow monitoring data revealed a peak discharge 442 m3 s−1 with an unprecedented runoff response (lag time, 15’). This very flashy behaviour triggered the natural disaster as a combination of heavy rainfall (246 mm in 10 h), karstic features and land cover disturbances in the Begura de Saumà River catchment (i.e., 23 km2). Topography-based connectivity index and geomorphic change detection were used as a rapid post-catastrophe decision-making tool, playing a key role during the rescue searching tasks. These hydrogeomorphological precision techniques were also applied in combination with Copernicus EMS and ground-based damage assessment illustrating with high accuracy the damage driving factors in the village of Sant Llorenç des Cardassar. The incorporation of hydrogeomorphological precision tools during Emergency post-catastrophe operational has been revealed as a powerful tool. Then, the simple application of a geomorphometric index from easy-access LiDAR-based topographic data resulted in a rapid identification of deposition zones in the different compartments of a catchment helping in the search and rescue of missing persons. In addition, the evaluation of landforms signature by using UAVs effectively quantified the sediment deposits generated by the flash-flood and/or mobilised by the Emergency operational during the rescue searching tasks.This work was supported by the research project CGL2017-88200-R “Functional hydrological and sediment connectivity at Mediterranean catchments: global change scenarios –MEDhyCON2” funded by the Spanish Ministry of Science, Innovation and Universities, the Spanish Agency of Research (AEI) and the European Regional Development Funds (ERDF)

Objective To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. Methods A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. Variables knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire. Results Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses' knowledge and the application of preventive measures or between workload and the application of preventive measures. Conclusions Nurses' knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors.

espanolObjetivo Analizar si el cumplimiento de las medidas no farmacologicas para la prevencion de la neumonia asociada a la ventilacion mecanica (NAV) se asocia a la carga de trabajo de las enfermeras. Metodo Estudio observacional prospectivo llevado a cabo en una UCI medico-quirurgica. Se evaluo a las enfermeras a cargo de pacientes con soporte ventilatorio. Variables: cuestionario de conocimiento, aplicacion de las medidas no farmacologicas de prevencion de la NAV, carga de trabajo medida mediante el Nine Equivalents of Nursing Manpower Use Score. Fases: 1) las enfermeras realizaron un programa educativo, basado en conferencias de 60 min sobre medidas no farmacologicas para la prevencion de NAV, completando al finalizar un cuestionario de conocimiento; 2) periodo de observaciones; 3) cuestionario de conocimiento. Resultados De un total de 67 enfermeras de UCI, 54 completaron el programa formativo y fueron incluidos en el estudio. Se llevaron a cabo un total de 160 observaciones de 49 enfermeros/as. El correcto conocimiento de las medidas de prevencion se confirmo tanto en el cuestionario inicial como final. La aplicacion de las medidas de prevencion vario desde el 11% para el lavado de manos preaspiracion hasta el 97% para el uso de sonda de aspiracion esteril. La puntuacion del Nine Equivalents of Nursing Manpower Use Score fue de 50±13. No se observaron asociaciones significativas entre el grado de conocimiento y la aplicacion de medidas de prevencion, ni entre la carga de trabajo y la aplicacion de dichas medidas. Conclusiones El conocimiento de las enfermeras de las medidas de prevencion de la NAV no se traslada necesariamente a la practica diaria. En la poblacion estudiada, la falta de aplicacion de estas medidas no esta sujeta a la falta de conocimiento ni a la carga de trabajo, sino probablemente a los factores contextuales EnglishObjective To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. Methods A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. Variables: knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire. Results Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses’ knowledge and the application of preventive measures or between workload and the application of preventive measures. Conclusions Nurses’ knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors

A flash-flood event hit in the 9th October 2018 the northeastern part of Mallorca Island, causing 13 casualties. This island is prone to catastrophic flash floods acting on a scenario that illustrates the deep landscape transformation of Mediterranean tourist resorts. As global change may exacerbate devastating flash floods, comprehensive analyses of catastrophic events are crucial to support effective prevention and mitigation measures. Field-based, remote-sense and modelling techniques were used in this study to evaluate rainfall-runoff processes at catchment scale linked to hydrological modelling. Continuous streamflow monitoring data revealed a peak discharge 442 m3 s−1 with an unprecedented runoff response (lag time, 15’). This very flashy behaviour triggered the natural disaster as a combination of heavy rainfall (246 mm in 10 h), karstic features and land cover disturbances in the Begura de Saumà River catchment (i.e., 23 km2). Topography-based connectivity index and geomorphic change detection were used as a rapid post-catastrophe decision-making tool, playing a key role during the rescue searching tasks. These hydrogeomorphological precision techniques were also applied in combination with Copernicus EMS and ground-based damage assessment illustrating with high accuracy the damage driving factors in the village of Sant Llorenç des Cardassar. The main challenges in the future are to readapt hydrological modelling to global change scenarios, implement an early flash flood warning system and apply adaptive and resilient measures at catchment scale.

Objective To evaluate the anesthetic block provided by contact topical anesthesia (CTA) in strabismus surgery in adult patients. To analyze postoperative pain and surgical outcome obtained by CTA compared with general anesthesia (GA). Methodology Prospective longitudinal cohort study of adult patients undergoing strabismus surgery by CTA or GA. The intensity of pain perceived by patients during the course of surgery and in the postoperative period was measured using Numerical Pain Scale. The success of the surgical outcome, considered as a residual ocular deviation Results Twenty-three patients were operated using CTA and 26 using AG. During the course of surgery, pain intensity experienced by patients in ATC group was 3.17 ± 2.44. There were no differences between CTA group and AG group in the intensity of pain in the immediate postoperative period (2.13 ± 2.39 vs. 2.77 ± 2.18, respectively; p = .510) and during the first postoperative day (3.22 ± 2.84 vs. 3.17 ± 2.73; p = .923). Surgical success was significantly higher in the CTA group than in the GA group (78.3% vs. 73.1%; p = .019). Conclusions CTA provides adequate sensory block to perform strabismus surgery. The control of postoperative pain is similar to that obtained with AG. Conservation of ocular motility providing CTA enables better surgical outcome.

Resumen Objetivo Evaluar el bloqueo anestesico proporcionado por la anestesia topica de contacto (ATC) en cirugia de estrabismo en pacientes adultos. Analizar el dolor postoperatorio y el resultado quirurgico obtenido mediante ATC y compararlo con la anestesia general (AG). Metodologia Estudio de cohortes longitudinal prospectivo en pacientes adultos intervenidos de estrabismo mediante ATC o AG. Se midio la intensidad del dolor percibido por los pacientes durante el desarrollo de la intervencion y en el periodo postoperatorio mediante la Escala Numerica del Dolor (END). Se evaluo el exito del resultado quirurgico, considerado como una desviacion ocular residual Resultados Se intervino a un total de 23 pacientes con ATC y a 26 con AG. Durante el desarrollo de la intervencion quirurgica, la intensidad del dolor padecido por los pacientes del grupo ATC fue de 3,17 ± 2,44. No hubo diferencias entre el grupo ATC y el grupo AG en la intensidad de dolor en el postoperatorio inmediato (2,13 ± 2,39 vs. 2,77 ± 2,18 respectivamente; p = 0,510) ni durante el primer dia postoperatorio (3,22 ± 2,84 vs. 3,17 ± 2,73; p = 0,923). El exito quirurgico fue significativamente mayor en el grupo ATC que en el grupo AG (78,3 vs. 73,1%; p = 0,019). Conclusiones La ATC proporciona un adecuado bloqueo sensitivo para poder llevar a cabo la cirugia de estrabismo, logrando un control del dolor postoperatorio similar al obtenido con la AG. La conservacion de la motilidad ocular que proporciona la ATC permite obtener un mejor resultado quirurgico.

Resumen Objetivo Analizar la eficacia y utilidad de la anestesia topica de contacto en cirugia de estrabismo en pacientes adultos. Material y metodo Estudio prospectivo de 20 pacientes intervenidos de estrabismo utilizando anestesia topica de contacto mas sedacion con remifentanilo. Mediante la escala numerica del dolor se registro la intensidad de este en el momento de la aplicacion de la anestesia, durante la intervencion quirurgica, a los 30 min y durante el primer dia posoperatorio. Se valoro la aparicion de reflejo oculocardiaco durante la intervencion, la incidencia de nauseas y vomitos posoperatorios, la presencia de ulceras corneales, la satisfaccion de los pacientes de forma numerica del 0 al 10, y el grado de desviacion ocular residual. Resultados La intervencion quirurgica se realizo de forma satisfactoria en todos los pacientes. La intensidad del dolor fue de 1,40 ± 1,73 en el momento de la aplicacion de la anestesia; 4,20 ± 2,57 durante el desarrollo de la intervencion; 2,50 ± 2,54 a los 30 min, y 3,55 ± 2,89 durante el primer dia posoperatorio. Se observo aparicion de reflejo oculocardiaco en 7 pacientes (35%), nauseas y vomitos posoperatorios en 4 (20%), y ulcera corneal en 4 (20%). La satisfaccion de los pacientes alcanzo un valor promedio de 9,53 ± 2,51. El 70% de los pacientes presentaban una desviacion ocular residual menor a 10 dioptrias prismaticas. Conclusiones La anestesia topica de contacto es una alternativa segura y eficaz para la cirugia del estrabismo en pacientes adultos. Permite un adecuado control del dolor, ofrece una baja incidencia de reflejo oculocardiaco y nauseas y vomitos posoperatorios, y proporciona un ajuste optimo de la alineacion ocular.

Resumen Mujer de 36 anos que fue sometida a una reseccion de timoma gigante que ocupaba gran parte del hemitorax izquierdo. Tras la reseccion del tumor y la insuflacion del pulmon izquierdo aparecio un edema pulmonar por reexpansion precoz. Se trato con diureticos, corticoides y se mantuvo la ventilacion mecanica. La paciente evoluciono favorablemente. El edema pulmonar por reexpansion es una complicacion poco frecuente, pero con una alta mortalidad. Es fundamental conocer los factores implicados en su etiopatogenia. El diagnostico y tratamiento se deben realizar de forma inmediata.

To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload.A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed.knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire.Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses' knowledge and the application of preventive measures or between workload and the application of preventive measures.Nurses' knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors.

An experimental long–term hepatotoxicity study of cyanamide in Sprague–Dawley and Wistar rats has been carried out. After six months oral administration of cyanamide (2,7 and 25 mg/kg/day) no significant histological changes have been observed in the liver. Similarly, a one year intraperitoneal administration of 8 and 16 mg/kg/day has not induced any hepatic change. Specifically, no inclusion bodies in any cyanamide treated rat have been detected. Moreover, hepatic biochemical parameters have shown no significant impairment of hepatic function at doses used in human therapy (0.5–1 mg/kg)

To evaluate the anesthetic block provided by contact topical anesthesia (CTA) in strabismus surgery in adult patients. To analyze postoperative pain and surgical outcome obtained by CTA compared with general anesthesia (GA).Prospective longitudinal cohort study of adult patients undergoing strabismus surgery by CTA or GA. The intensity of pain perceived by patients during the course of surgery and in the postoperative period was measured using Numerical Pain Scale. The success of the surgical outcome, considered as a residual ocular deviation10 prism diopters, was evaluated.Twenty-three patients were operated using CTA and 26 using AG. During the course of surgery, pain intensity experienced by patients in ATC group was 3.17±2.44. There were no differences between CTA group and AG group in the intensity of pain in the immediate postoperative period (2.13±2.39 vs. 2.77±2.18, respectively; P=.510) and during the first postoperative day (3.22±2.84 vs. 3.17±2.73; P=.923). Surgical success was significantly higher in the CTA group than in the GA group (78.3 vs. 73.1%; P=.019).CTA provides adequate sensory block to perform strabismus surgery. The control of postoperative pain is similar to that obtained with AG. Conservation of ocular motility providing CTA enables better surgical outcome.

To analyze the effectiveness and usefulness of contact topical anesthesia in strabismus surgery in adult patients.A prospective study was conducted on 20 patients undergoing strabismus surgery using contact topical anesthesia and sedation with remifentanil. The intensity of pain was recorded using a numeric pain rating scale at the time of anesthesia implementation, during the surgical procedure, 30 min afterwards, and during the first postoperative day. The incidence of oculocardiac reflex, postoperative nausea and vomiting, corneal ulcers, patient satisfaction (numerically from 0 to 10) and the degree of residual ocular deviation were also assessed.The operation was performed successfully in all patients. Average pain intensity was 1.40 ± 1.73 during anesthesia implementation, 4.20 ± 2.57 during the surgical procedure, 2.50 ± 2.54 30 min after surgery, and 3.55 ± 2.89 during the first postoperative day. Oculocardiac reflex was observed in 7 patients (35%), postoperative nausea and vomiting in 4 (20%), and corneal ulcer in 4 (20%). The patient satisfaction was 9.53 ± 2.51. More than two-thirds (70%) of patients had a residual ocular deviation less than 10 prism diopters.Contact topical anesthesia is a safe and effective alternative for strabismus surgery in adult patients. Contact topical anesthesia provides adequate pain control, lower incidence of postoperative nausea and vomiting and oculocardiac reflex, and optimal setting of ocular alignment.

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome. © 2014 Hanberger et al.; licensee BioMed Central Ltd.

Adverse events significantly impact upon mortality rates and healthcare costs.To design a checklist of safety measures based on relevant scientific literature, apply random checklist measures to critically ill patients in real time (safety audits), and determine its utility and feasibility.A list of safety measures based on scientific literature was drawn up by investigators. Subsequently, a group of selected experts evaluated these measures using the Delphi methodology. Audits were carried out on 14 days over a period of one month. Each day, 50% of the measures were randomly selected and measured in 50% of the randomized patients. Utility was assessed by measuring the changes in clinical performance after audits, using the variable improvement proportion related to audits. Feasibility was determined by the successful completion of auditing on each of the days on which audits were attempted.The final verified checklist comprised 37 measures distributed into 10 blocks. The improvement proportion related to audits was reported in 83.78% of the measures. This proportion was over 25% in the following measures: assessment of the alveolar pressure limit, checking of mechanical ventilation alarms, checking of monitor alarms, correct prescription of the daily treatment orders, daily evaluation of the need for catheters, enteral nutrition monitoring, assessment of semi-recumbent position, and checking that patient clinical information is properly organized in the clinical history. Feasibility: rounds were completed on the 14 proposed days.Audits in real time are a useful and feasible tool for modifying clinical actions and minimizing errors.

The diagnosis of influenza A/H1N1 is mainly clinical, particularly during peak or seasonal flu outbreaks. A diagnostic test should be performed in all patients with fever and flu symptoms that require hospitalization. The respiratory sample (nasal or pharyngeal exudate or deeper sample in intubated patients) should be obtained as soon as possible, with the immediate start of empirical antiviral treatment. Molecular methods based on nucleic acid amplification techniques (RT-PCR) are the gold standard for the diagnosis of influenza A/H1N1. Immunochromatographic methods have low sensitivity; a negative result therefore does not rule out active infection. Classical culture is slow and has low sensitivity. Direct immunofluorescence offers a sensitivity of 90%, but requires a sample of high quality. Indirect methods for detecting antibodies are only of epidemiological interest. Patients with A/H1N1 flu may have relative leukopenia and elevated serum levels of LDH, CPK and CRP, but none of these variables are independently associated to the prognosis. However, plasma LDH1500 IU/L, and the presence of thrombocytopenia150 x 10(9)/L, could define a patient population at risk of suffering serious complications. Antiviral administration (oseltamivir) should start early (48 h from the onset of symptoms), with a dose of 75 mg every 12h, and with a duration of at least 7 days or until clinical improvement is observed. Early antiviral administration is associated to improved survival in critically ill patients. New antiviral drugs, especially those formulated for intravenous administration, may be the best choice in future epidemics. Patients with a high suspicion of influenza A/H1N1 infection must continue with antiviral treatment, regardless of the negative results of initial tests, unless an alternative diagnosis can be established or clinical criteria suggest a low probability of influenza. In patients with influenza A/H1N1 pneumonia, empirical antibiotic therapy should be provided due to the possibility of bacterial coinfection. A beta-lactam plus a macrolide should be administered as soon as possible. The microbiological findings and clinical or laboratory test variables may decide withdrawal or not of antibiotic treatment. Pneumococcal vaccination is recommended as a preventive measure in the population at risk of suffering severe complications. Although the use of moderate- or low-dose corticosteroids has been proposed for the treatment of influenza A/H1N1 pneumonia, the existing scientific evidence is not sufficient to recommend the use of corticosteroids in these patients. The treatment of acute respiratory distress syndrome in patients with influenza A/H1N1 must be based on the use of a protective ventilatory strategy (tidal volume10 ml / kg and plateau pressure35 mmHg) and positive end-expiratory pressure set to high patient lung mechanics, combined with the use of prone ventilation, muscle relaxation and recruitment maneuvers. Noninvasive mechanical ventilation cannot be considered a technique of choice in patients with acute respiratory distress syndrome, though it may be useful in experienced centers and in cases of respiratory failure associated with chronic obstructive pulmonary disease exacerbation or heart failure. Extracorporeal membrane oxygenation is a rescue technique in refractory acute respiratory distress syndrome due to influenza A/H1N1 infection. The scientific evidence is weak, however, and extracorporeal membrane oxygenation is not the technique of choice. Extracorporeal membrane oxygenation will be advisable if all other options have failed to improve oxygenation. The centralization of extracorporeal membrane oxygenation in referral hospitals is recommended. Clinical findings show 50-60% survival rates in patients treated with this technique. Cardiovascular complications of influenza A/H1N1 are common. Such problems may appear due to the deterioration of pre-existing cardiomyopathy, myocarditis, ischemic heart disease and right ventricular dysfunction. Early diagnosis and adequate monitoring allow the start of effective treatment, and in severe cases help decide the use of circulatory support systems. Influenza vaccination is recommended for all patients at risk. This indication in turn could be extended to all subjects over 6 months of age, unless contraindicated. Children should receive two doses (one per month). Immunocompromised patients and the population at risk should receive one dose and another dose annually. The frequency of adverse effects of the vaccine against A/H1N1 flu is similar to that of seasonal flu. Chemoprophylaxis must always be considered a supplement to vaccination, and is indicated in people at high risk of complications, as well in healthcare personnel who have been exposed.

A 36 year-old woman was subjected to resection of a giant thymoma that occupied a large area of the left hemithorax. After resection of the tumour and insufflation of the left lung there was pulmonary oedema due to early re-expansion. She was treated with diuretics and corticoids and was kept on mechanical ventilation. The patient progressed favourably. Although pulmonary oedema due to re-expansion is an uncommon complication it has a high mortality. It is essential to be aware of the factors involved in its aetiopathogenesis. It should be diagnosed and treated immediately.

Pandemic Influenza A (H1N1)v infection is the first pandemic in which intensive care units (ICU) play a fundamental role. It has spread very rapidly since the first cases were diagnosed in Mexico with the subsequent spread of the virus throughout the Southern Cone and Europe during the summer season.This study has aimed to compare the clinical presentation and outcome among the critical patients admitted to the ICU until July 31, 2009 in Spain with some series from Latin America.Six series of critically ill patients admitted to the ICU were considered. Clinical characteristics, complications and outcome were compared between series.Young patients (35-45 years) with viral pneumonia as a predominant ICU admission cause with severe respiratory failure and a high need of mechanical ventilation (60-100%) were affected. Obesity, pregnancy and chronic lung disease were risk factors associated with a worse outcome, however there was a high number of patients without comorbidities (40-50%). Mortality rate was between 25-50% and higher in the Latin America series, demonstrating the specific potential pathogenesis of the new virus. The use of antiviral treatment was delayed (between 3 and 6 days) and not generalized, with greater delay in Latin America in regards to Spain.These data suggest that a more aggressive treatment strategy, with earlier and easier access to the antiviral treatment might reduce the number of ICU admissions and mortality.

The acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are part of a devastating syndrome characterized by acute onset, hypoxemia, and bilateral infiltrates on chest x-rays. ALI/ARDS is the response of the lung to a local or systemic aggression, resulting in local inflammation and coagulation disorders, which lead to increased inflammatory pulmonary edema. ARDS is a major cause of morbidity, death, and cost in intensive care units. The most common cause is sepsis. We present a case of ARDS secondary to infection with the influenza A (H1N1) virus. The influenza A (H1N1) virus caused a global pandemia 91 years ago, with sporadic outbreaks afterward. The new influenza A pandemia was transmitted from swine to humans. Infection by the influenza A (H1N1) virus can cause severe respiratory illness, the acute respiratory distress syndrome, and secondary infections among healthcare workers.

To describe the clinical characteristics and outcomes of patients with community-acquired pneumonia (CAP) admitted to the Intensive Care Unit (ICU). To evaluate new ATS/IDSA criteria to identify patients with CAP who required admission to ICU.Retrospective analysis of prospective collected data in a 7-year period (2000-2007).Medical-surgical ICU with 16 beds.All patients with severe CAP admitted to the ICU (n=147). PRIMARY ENDPOINTS: Clinical and microbiological characteristics. Prognostic factors. Comparison of patients admitted in the ICU and ATS/IDSA criteria (group 1:or = 1 major criterion, group 2:or = 3 minor criteria and group 3: no criterion).None.Admission to the ICU is required for patients with acute respiratory failure (60.5%) and with septic shock (28.5%). A total of 71.4%, had an identifiable microbial etiology, S. pneumoniae being the most frequently isolated. Mean time to antibiotic therapy was 4.3+/-4.2h, this being adequate in 97.1%. ICU global mortality rate was 32%. Prognostic factors associated with higher mortality were acute renal failure (OR:4.7), mechanical ventilation (OR:3.4), non-identifiable etiology (OR:4.2) and non-S. pneumonia etiology (OR:3.5). Sixty-eight percent of the patients were included in the first group of the ATS/IDSA criteria and 21% in the second group.CAP mortality is still high despite early antibiotic therapy, especially in those patients with a non-S. pneumonia etiology or who require mechanical ventilation. Almost 90% of the ICU admissions were identified by the new criteria from ATS/IDSA.

A scale invariant 3D object detection method based on phase Fourier transform (PhFT) is addressed. Three-dimensionality is expressed in terms of range images. The PhFT of a range image gives information about the orientations of the surfaces in the 3D object. When the object is scaled, the PhFT becomes a distribution multiplied by a constant factor which is related to the scale factor. Then 3D scale invariant detection can be solved as illumination invariant detection process. Several correlation operations based on vector space representation are applied. Results show the tolerance of detection method to scale besides discrimination against false objects.

In this paper a unique map or signature of three dimensional objects is defined. The map is obtained locally, for every possible rotation of the object, by the Fourier transform of the phase-encoded range-image at each specific rotation. From these local maps, a global map of orientations is built that contains the information about the surface normals of the object. The map is defined on a unit radius sphere and permits, by correlation techniques, the detection and orientation evaluation of three dimensional objects with three axis translation invariance from a single range image.

Bloodstream infection, together with ventilator-associated pneumonia, is the most frequent nosocomial infection in critically ill patients; it is associated with significant morbidity and mortality. As bloodstream infections in critical patients are usually due to intravascular catheters, they can be caused by both gram-positive and gram-negative microorganisms. Furthermore, infection with multiresistant organisms is becoming more common, and this makes the choice of empirical antibiotic treatment more difficult. Patients with severe community-acquired infections account for a large percentage of patients who require admission to intensive care units for hemodynamic instability or organ dysfunction. Many of these also have bacterial bloodstream infections; about 30% of all bacterial bloodstream infections in critical patients occur in this group of patients. Among this group, 70% develop severe sepsis or septic shock, both of which have high mortality. Recently, another classification scheme included a distinct group comprising patients with community-acquired bloodstream infections after recent or intermittent contact with healthcare facilities. When choosing the empirical antibiotic treatment, it is important to bear in mind that this group has specific characteristics that are often comparable to nosocomial infections. We describe the characteristics, origins, causes, and most common complications of nosocomial, community-acquired, and healthcare-related bacterial bloodstream infections in critical patients to make it easier to recognize them early and initiate efficacious empirical antibiotic therapy and thus improve the prognosis of these patients.

Three-dimensional object recognition with scale and rotation changes is addressed. The recognition method is described in terms of correlations between spherical surfaces. Tridimensionality is codified into range images. We used the phase Fourier transform of a range image which gives information about the orientation of the 3D object surfaces. A 3D object orientation map containing information about all possible rotations of the object is obtained. This map distribution is calculated using the amplitude of the phase Fourier transform for different views of the object. From that 3D object description it is possible to achieve detection and rotation estimation by performing a correlation between unit spheres even when only partial information is presented. In addition, a scale change of a rotated 3D object implies a change of the intensity in the unit sphere. We define correlations between the reference unit sphere and a certain target-patch placed on the surface of the unit sphere. Various experiments are carried out to confirm the correct detection. We also validate the method when other false targets were used. In addition to tolerance to scale and rotation, high discrimination against false targets is also achieved.

Invariant optical correlation method for 3D target detection is addressed. Tridimensionality is expressed in terms of range images. The recognition model is based on a vector space representation using an orthonormal image basis. The recognition method proposed is based on the calculation of the angle between the vector associated with a certain 3D object and a vector subspace. Scale and rotation invariant 3D target detection are obtained using the phase Fourier transform (PhFT) of the range images. In fact, when the 3D object is scaled, the PhFT becomes a distribution multiplied by a constant factor. On the other hand a rotation of the 3D object around the z axis, implies a shift in the PhFT. So, changes of scale and rotation of 3D objects are replaced by changes of intensity and position of PhFT distributions. We applied intensity invariant correlation methods for recognition. In addition to tolerance to scale and rotation, high discrimination against false targets is also achieved.

We present an approach for scale invariant 3D object detection based on phase Fourier transform (PhFT). Three‐dimensionality is expressed in terms of range images. The PhFT of a range image gives information about the orientations of the surfaces in the 3D object. When the 3D object is scaled, the PhFT becomes a distribution multiplied by a constant factor. So, scale invariant 3D pattern recognition is converted into illumination invariant 2D pattern recognition.

We present a novel method of three‐dimensional object recognition independent of illumination conditions. The recognition model is based on a vector space representation using an orthonormal basis generated by the Lambertian reflectance functions obtained with distant light sources. The recognition method proposed is based on the calculation of the angle between the vector associated with a certain illuminated three‐dimensional object and a vector subspace. We define the angle in terms of linear correlations in order to get shift and illumination‐invariant detection.

The sludge water obtained from the dewatering processes following anaerobic sludge digestion contains high levels of ammonia. This sludge water is generally returned to the beginning of the waste water treatment plant process, thereby significantly increasing the nitrogen load on the biological process. In this project, the start-up of a full-scale sequencing batch reactor (SBR) process to separately treat the aforementioned sludge water is studied. Two parallel SBRs were operated over 8 hour cycles. The duration of the start-up was approximately 100 days until a hydraulic load of 225 m3/d was reached for each SBR. This paper presents the results of the start-up, highlighting the change in nitrogen concentration with time and the effect of other parameters such as temperature and suspended solids in that period. Following the project period of operation, the ammonium concentration was reduced by more than 95% on average.

We present a method for coding the information of a 3D object into a representation on a unit sphere. The coding is based on mapping the phase Fourier transform of the range images of the object onto the sphere. This procedure creates a unique object signature that we call three-dimensional object orientation map (3DOOM). The correlation between 3DOOM of different objects is discussed and defined. The maps permit to obtain detection as well as the orientation of an object from a range image, using only partial object information.

Congenital midline nasal masses are rare and therefore easily misdiagnosed, but due to their possible complications, they require prompt diagnosis and management. In this article we review the three most common: dermoid cyst, glioma and encephalocele. Their tendency to have a similar presentation requires very good skills in taking the history and performing the physical exam as well as an adequate radiologic diagnosis including CT, MRI or both. It is very important that we always consider them to avoid taking a biopsy.

The problem of three-dimensional (3-D) object recognition is addressed. Range images permit the description of 3-D surfaces with a significant reduction of the complexity of the processing. The encoding of range images as phase gives a simple and straightforward method for parallel processing of these images. In this contribution we propose the use of range images encoded as phase to deal with the detection of three dimensional objects. The use of Fourier transform profilometry can serve for real time optical implementation of correlators based on this encoding, using a joint transform correlator or a VanderLugt one. The extension to scale and in-plane rotation invariant detection is discussed and implemented in a simple optoelectronic system. Furthermore, a method for full 3-D rotation invariant detection is presented. A simplified approach allowing only rotation around an axis perpendicular point of view permits the implementation with a conventional correlator.

In color pattern recognition, color channels are normally processed separately and afterward the correlation outputs are combined. This is the definition of multichannel processing. We combine a single-channel method with nonlinear filtering based on nonlinear correlations. These nonlinear correlations yield better discrimination than common matched filtering. The method codes color information as amplitude and phase distributions and is followed by correlations related to binary decompositions. The technique is based on binary decompositions of the red, green, and blue and the hue, saturation, and intensity monochromatic channels of the reference and of the input scene, after which the binary information on the red, green, and blue channels and that of the hue, saturation, and intensity channels are encoded as different angles of a phase distribution. We have applied the method to images degraded by high levels of substitutive noise. Results show that the sliced orthogonal nonlinear generalized correlation detects the target with a high degree of discrimination when other methods fail.

In the present article are shown the results of a work of investigation centered in fixing the main factors that condition the design of the buildings dedicated lo lodgings of mi/k goals livestock in Almería province, and considering the conceptual principles of the planning of industrial facilities. For that, it has been carried out the characterization of the lodgings of mi/k goats ' livestock of the A1mería province in an integral way. by a sampling of the referred explotations. For that, a questionnaire has been made which includes all the parameters 01' variables of design that can characterize this explitatíons, and later on it has been carried out an multivariate statistical analysis that has allowed lOreduce the number of original variables by a Factorial Analysis, and that it has borne lo establish groups of exploitations with homogeneous characteristics together with the realization of a cluster analysis. By means of this methodology five grollps of f arms with homogeneous characteristics have been obtained. andfive descriptive axes that summarize the entirety of the original quantitative variables have been determined, and that they represent the main design fa ctors that condition the construction of the lodgings. Finally a mathematical model has been formulated that allows discriminating against among each one of the homogeneous groups of farms . allowing to classify any new farm of mi/k goats 'Livestock, and thus lo know which are the design parameters that characterize it and those on which is neccessary to act. En el 'presente artículo se presentan los resultados de un trabajo de investigación centrado en fijar los factores principales más significativos que condicionan el diseño de los edificios destinados a alojamientos de caprino de leche de la provincia de A1mería. considerando los principios conceptuales de la planificación de instalaciones industriales. Para conseguir este objetivo se ha realizado la caracterización de los alojamientos de ganado caprino de leche de la provincia de Almería de una forma integral. mediante muestreo de las referidas explotaciones. Para ello. se ha confeccionado un cuestionario que engloba todos los parámetros o variables de diseño que pueden caracterizar dichas explotaciones. y posteriormente se ha realizado un análisis estadístico multivariante, que ha permitido reducir el número de variables originales mediante un análisis factorial. y que ha conllevado a establecer grupos de explotaciones con características homogéneas junto con la realización de un análisis cluster. Mediante dicha metodología se han obtenido cinco grupos de granjas con características homogéneas. y se han determinado cinco e es descriptivos que resumen la totalidad de las variables cuantitativas originales. y que representan los factores de diseño principales que condicionan la construcción de los alojamientos. Finalmente se ha formulado un modelo matemático que permite discriminar entre cada lino de los grupos homogéneos de granjas. permitiendo clasificar cualquier nueva granja de caprino de leche. y conocer, así, cuales son los parámetros de diseño que la caracteriza y sobre los que hay que actuar.