Safety and effectiveness of propranolol in severely burned patients: systematic review and meta-analysis

Background The objective of this systematic review was to determine the effectiveness and safety of propranolol compared to placebo or usual care for improving clinical relevant outcomes in severely burned patients (TBSA \u3e20%). Methods Relevant articles from randomized controlled trials were identified by a literature search in MEDLINE, EMBASE, and CENTRAL. We included trials involving patients with a severe burn (\u3e20% of total body surface area affected). Trials were eligible if they evaluated propranolol and compared to usual care or placebo. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for the final analysis. We conducted a meta-analysis using a random-effects model. Results We included ten studies in our systematic review. These studies randomized a total of 1236 participants. There were no significant differences between propranolol and placebo with respect to mortality (RD −0.02 [95% CI −0.06 to 0.02]), sepsis (RD −0.03 [95% CI −0.09 to 0.04]), and the overall hospital stay (MD −0.37 [−4.52 to 3.78]). Propranolol-treated adults had a decrease in requirements of blood transfusions (MD −185.64 [95% CI −331.06 to −40.43]) and a decreased heart rate (MD −26.85 [95% CI −39.95 to −13.75]). Conclusions Our analysis indicates that there were no differences in mortality or sepsis in severely burned patients treated with propranolol compared with those who had usual care or placebo. However, the use of propranolol in these patients resulted in lower requirements of blood transfusion and lower values of heart rate. The evidence synthesized in this systematic review is limited to conclude that propranolol reduces the length of hospital stay among severely burned patients. Future trials should assess the impact of propranolol on clinically relevant outcomes such as mortality and adverse events

La entrada de un supermercado de descuento duro: efecto sobre precios

In this paper we study how an incumbent supermarket reacts when entry by a new operator is announced but does not know the product variety that the entrant will offer. We use a database obtained from a special survey for supermarkets in Gran Canaria to estimate how incumbents reacted to entry in the products sold and not sold by the new entrant (LIDL). We show that there is evidence that prices for all goods prior to entry were initially lower in supermarkets close to the future entrant compared to supermarkets further away. However, after entry incumbents' prices for products not sold by the entrant actually rose near the entrant's new stores, compared to a suitable control group of supermarkets farther away.En este trabajo analizamos cómo reacciona un incumbente ante la entrada de un nuevo operador del que desconoce la variedad de productos que éste ofrecerá. Para ello utilizamos una base de datos proveniente de un trabajo de campo propio de supermercados en Gran Canaria en orden a estimar dicha reacción en términos de precios, tanto para productos vendidos como no vendidos por el entrante (LIDL). Nuestros resultados apuntan a una bajada generalizada de precios antes de la entrada por parte de los incumbentes afectados por dicha entrada. Sin embargo, dichos supermercados afectados aumentaron los precios de aquellos productos que finalmente no fueron vendidos por el entrante

Diseño dela automatización del proceso productivo para la máquina mezclo procesadora en la empresa Cocodelicia

El presente proyecto realiza una descripción detallada que permite obtener el diseño para automatizar el proceso realizado por la máquina mezclo procesadora de la empresa COCODELICIAS. Como metodología para llegar a tal fin, se ha escogido el diseño concurrente ya que permite integrar sistemáticamente y en forma simultánea el diseño de productos y procesos, para que sean considerados desde un principio todos los elementos del ciclo de vida de un producto, desde la concepción inicial hasta su disposición final. Considerando la voz del cliente como estrategia para llegar al mejor diseño . La automatización del proceso realizado por la máquina comprende controlar 3 etapas (Sistema de dosificación, control de temperatura, control en la velocidad de mezclado)PregradoIngeniero(a) en Electrónica y Telecomunicacione

A multi-physics ensemble of regional climate change projections over the Iberian Peninsula

©. This manuscript version is made available under the CC-BY-NC 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the, Accepted, version of a Published Work that appeared in final form in Climate Dynamics. To access the final edited and published work see: https://doi.org/10.1007/s00382-012-1551-5This study illustrates the sensitivity of regional climate change projections to the model physics. A single-model (MM5) multi-physics ensemble of regional climate simulations over the Iberian Peninsula for present (1970–1999) and future (2070–2099 under the A2 scenario) periods is assessed. The ensemble comprises eight members resulting from the combination of two options of parameterization schemes for the planetary boundary layer, cumulus and microphysics. All the considered combinations were previously evaluated by comparing hindcasted simulations to observations, none of them providing clearly outlying climates. Thus, the differences among the various ensemble members (spread) in the future projections could be considered as a matter of uncertainty in the change signals (as similarly assumed in multi-model studies). The results highlight the great dependence of the spread on the synoptic conditions driving the regional model. In particular, the spread generally amplifies under the future scenario leading to a large spread accompanying the mean change signals, as large as the magnitude of the mean projected changes and analogous to the spread obtained in multi-model ensembles. Moreover, the sign of the projected change varies depending on the choice of the model physics in many cases. This, together with the fact that the key mechanisms identified for the simulation of the climatology of a given period (either present or future) and those introducing the largest spread in the projected changes differ significantly, make further claims for efforts to better understand and model the parameterized subgrid processes

Edge detection algorithm based on fuzzy logic theory for a local vision system of robocup humanoid league

Este artículo presenta el desarrollo de un algoritmo para la extracción de bordes basado en la teoría de lógica difusa, mediante el cual es posible reconocer las marcas de un campo de juego para la liga humanoide de RoboCup. El algoritmo propuesto describe la creación de un sistema de inferencia difuso que permite evaluar la relación existente entre los pixeles de una imagen, encontrando así las variaciones en los niveles de gris para una vecindad de pixeles específica. Posteriormente se plantea la implementación del método OTSU para binarizar la imagen obtenida en el proceso difuso y así generar una imagen que contiene solo los bordes extraídos, validando el algoritmo en imágenes de la liga humanoide. Luego se analizan los resultados obtenidos evidenciando el buen desempeño del algoritmo, considerando que el tiempo de procesamiento de la propuesta es tan solo el 35% más del tiempo necesario en métodos tradicionales, mientras que los bordes extraídos son unos 52% menos susceptibles al ruido.At this paper we shown the development of an algorithm to perform edges extraction based on fuzzy logic theory. This method allows recognizing landmarks on the game field for Humanoid League of RoboCup. The proposed algorithm describes the creation of a fuzzy inference system that permit evaluate the existent relationship between image pixels, finding variations on grey levels of related neighbor pixels. Subsequently, it shows an implementation of OTSU method to binarize an image that was obtained from fuzzy process and so generate an imagecontaining only extracted edges, validating the algorithm with Humanoid League images. Later, we analyze obtained results that evidence a good performance of algorithm, considering that this proposal only takes an extra 35% processing time that will be required by traditional methods, whereas extracted edges are 52% less noise susceptible

A cost-effectiveness analysis of a 10-valent pneumococcal conjugate vaccine in children in six Latin American countries.

BACKGROUND: A recently developed 10-valent pneumococcal non-typeable H influenzae protein D-conjugate vaccine (PHiD-CV) is expected to afford protection against more than two thirds of isolates causing IPD in children in Latin America, and also against acute otitis media caused by both Spn and NTHi. The objective of this study is to assess the cost-effectiveness of PHiD-CV in comparison to non-vaccination in children under 10 years of age in Argentina, Brazil, Chile, Colombia, Mexico and Peru. METHODS: We used a static, deterministic, compartmental simulation model. The dosing regimen considered included three vaccine doses (at 2 months, 4 months and 6 months) and a booster dose (at 13 months) (3 + 1 schedule). Model outcomes included number of cases prevented, deaths averted, quality-adjusted life-years (QALYs) gained and costs. Discount for costs and benefits of long term sequelae was done at 3.5%, and currency reported in 2008-2009 U$S varying between countries. RESULTS: The largest effect in case prevention was observed in pneumococcal meningitis (from 27$ Dollars per QALY gained. Results were robust in the sensitivity analysis, and scenarios with indirect costs affected results more than those with herd immunity. CONCLUSIONS: The incorporation of the 10-valent pneumococcal conjugate vaccine into routine infant immunization programs in Latin American countries could be a cost-effective strategy to improve infant population health in the region

Propiedades psicométricas de la Escala de Resiliencia de Connor y Davidson (CD-RISC) en población española.

Although the number of studies in the literature on the psychometric properties of the CD-RISC measures is remarkably high, there is still a great lack of consensus about its internal structure among the general population. Therefore, the aim of this study has been threefold: to analyze the psychometric properties, explore the factorial structure and calculate percentiles of the Connor-Davidson Resilience Scale (CD-RISC) for a sample of the Spanish population. For this purpose, the study sample consisted of 1119 participants consisting of 324 males and 795 females and they completed the following scales: CD-RISC, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, General Self-Efficacy Scale, Stress Vulnerability Inventory, Personality Hardiness Questionnaire and the anxiety and depression subscales of the SCL-90-R. In terms of reliability, an adequate Cronbach's coefficient alpha value of .86 was obtained. The evidence for the validity of the internal structure supports the unidimensionality of the CD-RISC measurements, as well as confirming the expected theoretical relationships and correlating with the described measures in the expected direction. Satisfactory results are obtained in the present study that reinforce the usefulness and precision of this scale for its application using the Spanish population, presenting percentiles that can provide guidance in the interpretation and use of the scores with respect to its application in both research and clinical practice.Aunque el número de estudios sobre las propiedades psicométricas de la CD-RISC es notablemente amplio, aún hay gran falta de consenso sobre su estructura interna en población general. Por ello, el objetivo de este estudio ha sido triple, verificar sus  propiedades psicométricas, explorar la estructura factorial y calcular baremos de la escala de resiliencia CD-RISC para una muestra de población española. Para ello participaron 1119 personas, 324 hombres y 795 mujeres, cumplimentando las siguientes escalas: CD-RISC, Escala de Estrés Percibido, Escala de Apoyo Social Percibido, Escala de Autoeficacia, Escala de Vulnerabilidad al Estrés, Cuestionario de Personalidad Resistente y subescalas de ansiedad y depresión del SCL-90. Las evidencias de validez confirmaron las relaciones teóricas esperadas correlacionándose con las medidas descritas. El análisis factorial encontró un apoyo razonable a la hipótesis de unidimensionalidad. En cuanto a la fiabilidad se obtuvieron valores aceptables con un alfa de 0.866 y una omega de 0.862. Se obtienen resultados satisfactorios que refuerzan la utilidad y precisión de esta escala para su uso en población española, apoyando la hipótesis de unidimensionalidad y aportando baremos que permiten interpretar las puntuaciones para su aplicación tanto en investigación como en la práctica clínica. &nbsp

Using quality risk management in the plantibody HB-01 manufacturing by transgenic tobacco Plants for vaccine production

The production of biopharmaceuticals by transgenic plants is a promising choice to achieve the multi-kilogram amount of products needed to treat many human diseases. However, this scientific field is still lacking of approved specific guidelines regarding points to consider for manufacturing and application of these products. In such sense, the implementation of new manufacturing processes and quality systems using the quality risks management is recognized as something of prime importance in the current pharmaceutical industry. In this work, we summarize the application of the FMEA method to design the manufacturing process of a plantibody, employed in the hepatitis B vaccine production to ensure the vaccine high quality.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Using quality risk management in the plantibody HB-01 manufacturing by transgenic tobacco Plants for vaccine production

The production of biopharmaceuticals by transgenic plants is a promising choice to achieve the multi-kilogram amount of products needed to treat many human diseases. However, this scientific field is still lacking of approved specific guidelines regarding points to consider for manufacturing and application of these products. In such sense, the implementation of new manufacturing processes and quality systems using the quality risks management is recognized as something of prime importance in the current pharmaceutical industry. In this work, we summarize the application of the FMEA method to design the manufacturing process of a plantibody, employed in the hepatitis B vaccine production to ensure the vaccine high quality.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Health economic evaluation of Human Papillomavirus vaccines in women from Venezuela by a lifetime Markov cohort model

Abstract Background Cervical cancer (CC) and genital warts (GW) are a significant public health issue in Venezuela. Our objective was to assess the cost-effectiveness of the two available vaccines, bivalent and quadrivalent, against Human Papillomavirus (HPV) in Venezuelan girls in order to inform decision-makers. Methods A previously published Markov cohort model, informed by the best available evidence, was adapted to the Venezuelan context to evaluate the effects of vaccination on health and healthcare costs from the perspective of the healthcare payer in an 11-year-old girls cohort of 264,489. Costs and quality-adjusted life years (QALYs) were discounted at 5%. Eight scenarios were analyzed to depict the cost-effectiveness under alternative vaccine prices, exchange rates and dosing schemes. Deterministic and probabilistic sensitivity analyses were performed. Results Compared to screening only, the bivalent and quadrivalent vaccines were cost-saving in all scenarios, avoiding 2,310 and 2,143 deaths, 4,781 and 4,431 CCs up to 18,459 GW for the quadrivalent vaccine and gaining 4,486 and 4,395 discounted QALYs respectively. For both vaccines, the main determinants of variations in the incremental costs-effectiveness ratio after running deterministic and probabilistic sensitivity analyses were transition probabilities, vaccine and cancer-treatment costs and HPV 16 and 18 distribution in CC cases. When comparing vaccines, none of them was consistently more cost-effective than the other. In sensitivity analyses, for these comparisons, the main determinants were GW incidence, the level of cross-protection and, for some scenarios, vaccines costs. Conclusions Immunization with the bivalent or quadrivalent HPV vaccines showed to be cost-saving or cost-effective in Venezuela, falling below the threshold of one Gross Domestic Product (GDP) per capita (104,404 VEF) per QALY gained. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these results