Prevalencia de Desnutrición en los pacientes de Hospitalización a Domicilio

Objective: To estimate the prevalence of malnutrition in patients admitted to the UHD of the General University Hospital of Alicante.Material and methods: Prospective longitudinal study of a sample of 386 patients admitted to UHD randomly selected. Patients were evaluated with the HEN Nutritional Assessment Tool [https://www.evalnut.com/]. During the years 2016-2017.Results: The 386 selected patients had an average age of 72.87 years. 51.7 percent of them were male and 42.1 percent had a level of illness “acute mild / chronic stable” (Fig. 1). 24 of the patients (9.2 percent) were gastrostomy carriers. 42.1 percent of patients did not cover 75 percent of daily energy requirements. 69.7 percent of patients lost weight before admission in the HaD [mean 10.1 ± 6.1 percent of their usual weight], independent of sex (p = 0.343) and age (p = 0.712), presenting higher lost weight those who had done for more than a month (p <0.001), as well as those in whom the severity of the disease had increased (p <0.001) and not related to the decrease in reported intake (p = 0.395). 21.5 percent of patients had difficulty chewing and 18.4 percent of them had dysphagia (Fig2) of which 91.3 percent was from liquids. 91.6 percent of patients had some type of malnutrition, of which 54.4 percent were mild, highlighting that 71.3 percent of cases were mixed malnutrition (Fig 3). No relationship was found between the weight loss and the type of malnutrition (p = 0.054). However a relationship between the severity level of the disease and the type and degree of malnutrition (p = 0.005, p = 0.034) was found.Conclusions: Patients admitted to HaD have a very high prevalence of malnutrition, mostly of mixed type, which is more severe as the severity of the disease increases. The relationship between the degree and type of malnutrition with the severity of the disease suggests that it has been established for a long period of time.Objetivo: Estimar la prevalencia de desnutrición en los pacientes ingresados en la UHD del Hospital General Universitario de Alicante.Material y Métodos: Estudio longitudinal prospectivo de una muestra de 386 pacientes ingresados en UHD incluidos aleatoriamente. Los pacientes fueron evaluados con la Herramienta de Evaluación Nutricional HEN [https://www.evalnut.com/]. Durante el año 2016-2017.Resultados: Los 386 pacientes tenían una media de edad de 72,87años y 51,7% eran varones. El 42,1% de los pacientes tenían un nivel de enfermedad “agudo leve / crónico estable” (Fig1). Eran portadores de gastrostomía 24(9,2%). No cubría el 75% de los requerimientos energéticos diarios el 42,1%. Habían perdido peso antes de su ingreso en HaD el 69,7% de los pacientes [media 10,1±6,1% de su peso habitual] independiente del sexo (p=0,343) y la edad (p=0,712) presentando mayor pérdida los que lo habían hecho en más de 1 mes (p<0,001), también según se incrementa la gravedad de la enfermedad (p<0,001) y sin relación con la disminución de la ingesta declarada (p=0,395). Tenían dificultades para masticar 21,5%, presentaban disfagia 18,4% (Fig2) de los que 91,3% era a líquidos. El 91,6% de los pacientes tenía algún tipo de desnutrición, siendo leve el 54,4% y destacando la desnutrición mixta en el 71,3% de los casos (Fig3). No se encontró relación entre la pérdida de peso y el tipo de desnutrición (p=0,054) y sí entre el nivel de gravedad de la enfermedad y con el tipo de desnutrición y grado de desnutrición (p=0,005; p=0,034).Conclusiones: Los pacientes ingresados en HaD presentan una altísima prevalencia de desnutrición, mayoritariamente de tipo mixta, siendo ésta más severa a medida que se incrementa la gravedad de la enfermedad.La relación entre el grado y tipo de desnutrición con la gravedad de la enfermedad hace pensar que se ha ido instaurando durante un largo periodo de tiempo

Influencia de los suplementos nutricionales en la evolución de las heridas quirúrgicas abdominales complicadas de pacientes en hospitalización a domicilio

Objective: To evaluate the impact of nutritional supplements in patients admitted to the Home Hospitalization Unit with complicated abdominal surgical wounds.Material and methods: We have performed a retrospective study of 67 patients which presented complicated abdominal surgical wounds upon admission to the Home Hospitalization Unit. We have studied the type and amount of the supplement received, the body mass index (BMI), the albumin, and the time and cycles of antibiotic therapy.Results: The median age of the 67 patients was 69.2 ± 5.6. All patients had open abdominal wounds and 53.7% had infection with intravenous antibiotics. All patients received some type of nutritional supplement (62.7% standard, 25.4% immunomodulatory (Atempero®), 11.9% others). After one month of follow-up, the albumin mean value had increased in all patients p = 0.032, although the greatest difference was in patients who received immunomodulatory nutrition p = 0.001. The median follow-up was 84.05 ± 17.48 days until discharge. In the immunomodulatory supplement group it was 77.18 ± 13.72 days (p = 0.001).Conclusions: The data support a benefit of oral supplementation in this type of patients improving their nutritional status. The group that was supplemented with Atempero®, stood out both in the recovery of albumin levels and in a better evolution, which translates into a significantly earlier discharge.Objetivo: Evaluar el impacto de los suplementos nutricionales en pacientes ingresados en la Unidad de Hospitalización a Domicilio con heridas quirúrgicas abdominales complicadas.Material y Métodos: Estudio retrospectivo de 67 pacientes que a su ingreso en la Unidad de Hospitalización a Domicilio presentaban heridas quirúrgicas abdominales complicadas. Se estudió el tipo y cantidad de suplemento recibido, Índice de Masa Corporal (IMC), albumina, tiempo y ciclos de antibioterapia.Resultados: La edad media de los 67 pacientes fue de 69,2 ±5,6. Todos los pacientes presentaban heridas abdominales abiertas y el 53,7% presentaban infección con antibioterapia intravenosa. Todos los pacientes recibieron algún tipo de suplemento nutricional (estándar 62,7%; inmunomodulador (Atempero®) 25,4% y otros 11,9%). Al mes de seguimiento el valor medio de albumina se había incrementado en todos los pacientes p=0,032 aunque la mayor diferencia la presentaron los pacientes que recibieron nutrición inmunomoduladora p=0,001. La estancia media fue de 84,05±17,48 días hasta el alta, en el grupo del suplemento inmunomodulador fue de 77,18±13,72 días (p=0,001).Conclusiones: Los datos apoyan un beneficio de la suplementación oral en este tipo de pacientes mejorando su estado nutricional. El grupo que se suplementó con Atempero®, destacó tanto en la recuperación de los niveles de albumina como en una mejor evolución, lo que se traduce en un alta significativamente más precoz

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Search for heavy resonances decaying to two Higgs bosons in final states containing four b quarks

A search is presented for narrow heavy resonances X decaying into pairs of Higgs bosons (H) in proton-proton collisions collected by the CMS experiment at the LHC at root s = 8 TeV. The data correspond to an integrated luminosity of 19.7 fb(-1). The search considers HH resonances with masses between 1 and 3 TeV, having final states of two b quark pairs. Each Higgs boson is produced with large momentum, and the hadronization products of the pair of b quarks can usually be reconstructed as single large jets. The background from multijet and t (t) over bar events is significantly reduced by applying requirements related to the flavor of the jet, its mass, and its substructure. The signal would be identified as a peak on top of the dijet invariant mass spectrum of the remaining background events. No evidence is observed for such a signal. Upper limits obtained at 95 confidence level for the product of the production cross section and branching fraction sigma(gg -> X) B(X -> HH -> b (b) over barb (b) over bar) range from 10 to 1.5 fb for the mass of X from 1.15 to 2.0 TeV, significantly extending previous searches. For a warped extra dimension theory with amass scale Lambda(R) = 1 TeV, the data exclude radion scalar masses between 1.15 and 1.55 TeV

Measurement of the top quark mass using charged particles in pp collisions at root s=8 TeV

Peer reviewe