An index-based method for evaluating seismic retrofitting techniques. Application to a reinforced concrete primary school in Huelva

A project named PERSISTAH (Projetos de Escolas Resilientes aos SISmos no Território do Algarve e de Huelva, in Portuguese) is being developed. It aims to cooperatively assess and improve the seismic vulnerability of primary schools in the Algarve (Portugal) and Huelva (Spain). A large number of schools have to be analysed. In order to determine which seismic retrofitting technique is optimal, an index-based method is presented in this paper. It considers three parameters: first, the efficiency of the seismic retrofitting technique in relation to the structural improvement obtained; second, the cost of the implementation of the retrofitting technique; and third, the architectural impact. It should be mentioned that a specific measurement for each solution according to its geometry has been performed. Also, coefficients to consider the singularities of each analysis and the importance of the parameters (number of buildings, typology, available funds, etc.) in the study are considered. The most representative primary school of Huelva has been chosen to test the index-based method. The most suitable retrofitting techniques for this type of buildings have been tested. The retrofitting technique which most increased the seismic performance has been the addition of X and V bracings within the building's bays. Furthermore, the analyses have revealed that adding the retrofitting elements in the most vulnerable direction of the building provides a high efficiency. The results have also shown that implementing techniques of lower architectural impact gives acceptable results. The analysis of the mean damage level index has shown that the building would experiment a severe damage. All the retrofitting techniques applied have reduced it, at least, up to moderate damage. Finally, it should be noted that the position of the retrofitting elements is also paramount for providing an optimal retrofitting.info:eu-repo/semantics/publishedVersio

Incidence and Cost of Acute Kidney Injury in Hospitalized Patients with Infective Endocarditis

Acute kidney injury (AKI) is a frequent complication of hospitalized patients with infective endocarditis (IE). Further, AKI in the setting of IE is associated with high morbidity and mortality. We aimed to examine the incidence, clinical parameters, and hospital costs associated with AKI in hospitalized patients with IE in an endemic area with an increasing prevalence of opioid use. This retrospective cohort study included 269 patients admitted to a major referral center in Kentucky with a primary diagnosis of IE from January 2013 to December 2015. Of these, 178 (66.2%) patients had AKI by Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria: 74 (41.6%) had AKI stage 1 and 104 (58.4%) had AKI stage ≥ 2. In multivariable analysis, higher comorbidity scores and the need for diuretics were independently associated with AKI, while the involvement of the tricuspid valve and the need for vasopressor/inotrope support were independently associated with severe AKI (stage ≥ 2). The median total direct cost of hospitalization was progressively higher according to each stage of AKI ($17,069 for no AKI;$37,111 for AKI stage 1; and $61,357 for AKI stage ≥ 2; p \u3c 0.001). In conclusion, two-thirds of patients admitted to the hospital due to IE had incident AKI. The occurrence of AKI significantly increased healthcare costs. The higher level of comorbidity, the affection of the tricuspid valve, and the need for diuretics and/or vasoactive drugs were associated with severe AKI in this susceptible population

Global Perspectives in AKI: Peru

Peru is a middle-income Latin American country with an estimated population of more than 31 million inhabitants.1 Although our country has experienced significant improvements in some social determinants of health, the main causes of death are still related to socioeconomic status, which means people with lower incomes have higher mortality rates because of less access to health care, education, basic services, and employment, among other aspects.1 There are other challenges in the Peruvian health system, such as its fragmented nature which makes it one of the most dysfunctional and unequal health systems in Latin America. For example, the Peruvian Ministry of Health (MINSA) covers 50% of the population through the Government health insurance, whereas approximately 20% of Peruvians have access to the Social Health Insurance (EsSalud).2 However, although the health system has improved in terms of health insurance outreach, it continues to be centralized and precarious and has structural and organizational problems that have an effect not only on health care coverage but also on its delivery and quality.2–5 In this context, along with the barriers to access basic health care services6 and the effects of climate change, the incidence of AKI is increasing in Peru and in other low- and middle-income countries.7 Despite the fact that AKI constitutes a public health burden of growing repercussion in Peru and surroundings, there are lack of public health data and policy, as well as suboptimal patient and provider education and clinical care. Herein, we describe important challenges and provide perspectives and possible solutions to improve AKI care in Peru

Pneumocystis primary infection in non-immunosuppressed infants in Lima, Peru

Objectives: To provide original data on Pneumocystis primary infection in non-immunosuppressed infants from Peru. / Methods: A cross sectional study was performed. Infants less than seven months old, without any underlying medical conditions attending the “well baby” outpatient clinic at one hospital in Lima, Peru were prospectively enrolled during a 15-month period from November 2016 to February 2018. All had a nasopharyngeal aspirate (NPA) for detection of P. jirovecii DNA using a PCR assay, regardless of respiratory symptoms. P. jirovecii DNA detection was considered to represent pulmonary colonization contemporaneous with Pneumocystis primary infection. Associations between infants’ clinical and demographic characteristics and results of P. jirovecii DNA detection were analyzed. / Results: P. jirovecii DNA was detected in 45 of 146 infants (30.8%) and detection was not associated with concurrent respiratory symptoms in 40 of 45 infants. Infants with P. jirovecii had a lower mean age when compared to infants not colonized (p <0.05). The highest frequency of P. jirovecii was observed in 2-3-month-old infants (p < 0.01) and in the cooler winter and spring seasons (p <0.01). Multivariable analysis showed that infants living in a home with ≤ 1 bedroom were more likely to be colonized; Odds Ratio =3.03 (95%CI 1.31-7.00; p =0.01). / Conclusion: Pneumocystis primary infection in this single site in Lima, Peru, was most frequently observed in 2-3-month-old infants, in winter and spring seasons, and with higher detection rates being associated with household conditions favoring close inter-individual contacts and potential transmission of P. jirovecii

Safety, Feasibility, and Efficacy of Early Rehabilitation in Patients Requiring Continuous Renal Replacement: A Quality Improvement Study

Introduction: Early rehabilitation in critically ill patients is associated with improved outcomes. Recent research demonstrates that patients requiring continuous renal replacement therapy (CRRT) can safely engage in mobility. The purpose of this study was to assess safety and feasibility of early rehabilitation with focus on mobility in patients requiring CRRT. Methods: Study design was a mixed methods analysis of a quality improvement protocol. The setting was an intensive care unit (ICU) at a tertiary medical center. Safety was prospectively recorded by incidence of major adverse events including dislodgement of CRRT catheter, accidental extubation, bleeding, and hemodynamic emergency; and minor adverse events such as transient oxygen desaturation \u3e 10% of resting. Limited efficacy testing was performed to determine if rehabilitation parameters were associated with clinical outcomes. Results: A total of 67 patients (54.0 ± 15.6 years old, 44% women, body mass index 29.2 ± 9.3 kg/m2) received early rehabilitation under this protocol. The median days of CRRT were 6.0 (interquartile range [IQR], 2–11) and 72% of patients were on mechanical ventilation concomitantly with CRRT at the time of rehabilitation. A total of 112 rehabilitation sessions were performed of 152 attempts (74% completion rate). No major adverse events occurred. Patients achieving higher levels of mobility were more likely to be alive at discharge (P = 0.076). Conclusions: The provision of early rehabilitation in critically ill patients requiring CRRT is safe and feasible. Further, these preliminary results suggest that early rehabilitation with focus on mobility may improve patient outcomes in this susceptible population

Multidrug-resistant and methicillin-resistant Staphylococcus aureus (MRSA) in hog slaughter and processing plant workers and their community in North Carolina (USA)

Background: Use of antimicrobials in industrial food-animal production is associated with the presence of antimicrobial resistant Staphylococcus aureus among animals and humans. Hog slaughter/processing plants process large numbers of animals from industrial animal operations, and are environments conducive to the exchange of bacteria between animals and workers. Objectives: To compare the prevalence of methicillin-resistant S. aureus (MRSA) and multidrug resistant S. aureus(MDRSA) carriage between processing plant workers, their household members, and community residents. Methods: We conducted a cross-sectional study of hog slaughter/processing plant workers, their household members, and community residents in North Carolina. Participants responded to a questionnaire and provided a nasal swab. Swabs were tested for S. aureus, and isolates tested for antimicrobial susceptibility and subjected to multilocus sequence typing. Results: The prevalence of S. aureus was 21.6%, 30.2%, and 22.5% among 162 workers, 63 household members, and 111 community residents, respectively. The overall prevalence of MRSA and MDRSA tested by disk diffusion was 4.8% and 6.9%, respectively. The adjusted prevalence of MDRSA among workers was 1.96 times (95% CI: 0.71, 5.45) the prevalence in community residents. The adjusted average number of antimicrobial classes to which S. aureus isolates from workers were resistant was 2.54 times (95% CI: 1.16, 5.56) the number among isolates from community residents. One MRSA isolate and two MDRSA isolates from workers were identified as sequence type 398, a type associated with exposure to livestock. Conclusions: Although the prevalence of S. aureus and MRSA was similar in hog slaughter/processing plant workers and their household and community members, S. aureus isolates from workers were resistant to a greater number of antimicrobial classes. These findings may be related to the non-therapeutic use of antimicrobials in food-animal production

Success rates of zygomatic implants for the rehabilitation of severely atrophic maxilla: a systematic review

Zygomatic implants are a treatment solution for patients with severe maxillary atrophy. This treatment option allows delivering immediate fixed teeth within 24 h. Numerous peer-reviewed publications have reported different success rates, resulting in a disagreement on the topic. Therefore, the overall efficacy and predictability of this rehabilitation is still a matter of discussion. With this study, we aimed to identify the published literature on the use of zygomatic implants for the reconstruction of the severely atrophic maxilla and report the cumulative success rate (CSR) as a function of follow-up time. A systematic review of the literature on zygomatic implant for the treatment of severe maxillary atrophy was performed and 196 publications were included in the study. The cumulative success rate of zygomatic implants for the treatment of severe maxillary atrophy was 98.5% at less than 1 year, 97.5% between 1 and 3 years, 96.8% between 3 and 5 years and 96.1% after more than 5 years. The most commonly reported complications were soft tissue dehiscence, rhinosinusitis and prosthetic failures. The treatment of severe lack of bone in the upper maxilla with zygomatic implants is a safe procedure, reaching a cumulative success rate of 96.1% after more than 5 years