Pulmonary Infiltrates and Eosinophilia in a 25-Year-Old Traveler

A 25-year-old Spanish male travelled to Senegal in September 2009, where he swam near the Dindefelo fresh-water falls. Five weeks later, he presented with fever, myalgia, and dry cough. His complete blood count showed a hemoglobin level of 157 g/L, platelet count of 123.000 platelets/µL, and a leukocyte count of 8.670 cells/µL, with 9% eosinophils. Malaria smear, blood cultures, and serologies for common viral and bacterial infections were negative. Titers of an indirect hemagglutination test for Schistosoma mansoni were 1∶80. The patient was treated with a single dose of praziquantel (40 mg/kg) and prednisone (30 mg) for three days. After treatment, the dry cough increased and he developed moderate dyspnea, with increasing malaise and myalgia. A second blood sample revealed eosinophilia of 1.200 cells/µL. A chest X-ray showed patchy infiltrates in both lungs (Figure 1), and a CT scan showed multiple peripheral bilateral pseudonodular lesions with surrounding ground-glass-opacity halo

Sparse ellipsometry: portable acquisition of polarimetric SVBRDF and shape with unstructured flash photography

Ellipsometry techniques allow to measure polarization information of materials, requiring precise rotations of optical components with different configurations of lights and sensors. This results in cumbersome capture devices, carefully calibrated in lab conditions, and in very long acquisition times, usually in the order of a few days per object. Recent techniques allow to capture polarimetric spatially-varying reflectance information, but limited to a single view, or to cover all view directions, but limited to spherical objects made of a single homogeneous material. We present sparse ellipsometry, a portable polarimetric acquisition method that captures both polarimetric SVBRDF and 3D shape simultaneously. Our handheld device consists of off-the-shelf, fixed optical components. Instead of days, the total acquisition time varies between twenty and thirty minutes per object. We develop a complete polarimetric SVBRDF model that includes diffuse and specular components, as well as single scattering, and devise a novel polarimetric inverse rendering algorithm with data augmentation of specular reflection samples via generative modeling. Our results show a strong agreement with a recent ground-truth dataset of captured polarimetric BRDFs of real-world objects

State-space modelling for heater induced thermal effects on LISA pathfinder's test masses

The OSE (Offline Simulations Environment) simulator of the LPF (LISA Pathfinder) mission is intended to simulate the different experiments to be carried out in flight. Amongst these, the thermal diagnostics experiments are intended to relate thermal disturbances and interferometer readouts, thereby allowing the subtraction of thermally induced interferences from the interferometer channels. In this paper we report on the modelling of these simulated experiments, including the parametrisation of different thermal effects (radiation pressure effect, radiometer effect) that will appear in the Inertial Sensor environment of the LTP (LISA Technology Package). We report as well how these experiments are going to be implemented in the LTPDA toolbox, which is a dedicated tool for LPF data analysis that will allow full traceability and reproducibility of the analysis thanks to complete recording of the processes.Postprint (published version

Care dependency in patients with heart failure: A cross-sectional study in Spain

Background: Heart failure (HF) is a progressive and debilitating condition that represents an ever-growing problem for health systems worldwide. HF patients feel that they are a burden on their families, they feel socially isolated and have a low perception of their health. Accordingly, the objectives of this study were to: (1) to explore the profile of care dependency in a representative sample of Spanish HF patients through the Care Dependency Scale (CDS), and (2) to identify correlates of care dependency in this population. Material and Methods: We performed a cross-sectional study of 187 patients admitted for HF decompensation to the Hospital Clínico of Zaragoza (Spain). Results: Only 15% of our sample was highly or completely dependent on care from others. More specifically, our results indicate that HF patients felt a greater level of dependency on care from others when it comes to moving, getting dressed and undressed, maintaining good personal hygiene, participating in daily and recreational activities and being continent. Conclusions: We find association between the CDS categories that present a low score for care dependency in HF patients and the patients’ physical deterioration

Cost-effectiveness of Different Strategies for Screening and Treatment of Strongyloides stercoralis in Migrants From Endemic Countries to the European Union

Background: The best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions. Methods: We developed a stochastic Markov chain model. The target population was adult migrants from endemic countries to the European Union; the time horizon, a lifetime and the perspective, that of the health system. Average and incremental cost-effectiveness ratios (ACER and ICER) were calculated as 2016 EUR/life-year gained (LYG). Health interventions compared were: base case (no programme), primary care-based presumptive treatment (PCPresTr), primary care-based serological screening and treatment (PCSerTr), hospital-based presumptive treatment (HospPresTr), hospital-based serological screening and treatment (HospSerTr), hospital-based presumptive treatment of immunosuppressed (HospPresTrim) and hospital-based serological screening and treatment of the immunosuppressed (HospSerTrim). The willingness to pay threshold (WTP) was ¿32 126.95/LYG. Results: The base case model yielded a loss of 2 486 708.24 life-years and cost EUR 3 238 393. Other interventions showed the following: PCPresTr: 2 488 095.47 life-years (Δ1 387.23LYG), cost: EUR 8 194 563; ACER: EUR 3573/LYG; PCSerTr: 2 488 085.8 life-years (Δ1377.57LYG), cost: EUR 207 679 077, ACER: EUR 148 407/LYG; HospPresTr: 2 488 046.17 life-years (Δ1337.92LYG), cost: EUR 14 559 575; ACER: EUR 8462/LYG; HospSerTr: 2 488 024.33 life-years (Δ1316.08LYG); cost: EUR 207 734 073; ACER: EUR 155 382/LYG; HospPresTrim: 2 488 093.93 life-years, cost: EUR 1 105 483; ACER: EUR -1539/LYG (cost savings); HospSerTrim: 2 488 073.8 life-years (Δ1365.55LYG), cost: EUR 4 274 239; ACER: EUR 759/LYG. One-way and probabilistic sensitivity analyses were undertaken; HospPresTrim remained below WTP for all parameters' ranges and iterations. Conclusion: Presumptively treating all immunosuppressed migrants from areas with endemic Strongyloides would generate cost savings to the health system

El Estatuto de la responsabilidad penal de las personas jurídicas: aspectos de Derecho material

Descripció del recurs: 20 setembre 2016El principio "societas delinquere non potest" ya no constituye un principio vertebrador del Derecho penal; el referido aforismo ya quedó relativizado en el texto originario del Código Penal de 1995 (artículo 129 CP). Posteriormente, el Proyecto de Ley Orgánica de Reforma del CP de 2007 y los sucesivos textos prelegislativos posteriores (Anteproyecto de Reforma del Código Penal de 2008) acogieron propuestas que suponían su erradicación. Con la Reforma del CP de 22 de junio del 2010, se introdujo en el Código Penal el estatuto de responsabilidad penal de las personas jurídicas en el artículo 31 bis CP, cuyas controvertidas particularidades evidenciaron, a ojos de la doctrina, un más que cuestionable modelo normativo elegido por el legislador. Finalmente, con la Reforma del CP de 2015 se incorporaron modificaciones parciales al referido estatuto, que a pesar de haberse concebido para superar las carencias verificadas en la anterior regulación, comportaron la inserción de novedosos elementos hasta entonces desconocidos por el Ordenamiento jurídico penal, lo que trajo como causa que el modelo de responsabilidad de los entes continuara en entredicho. En definitiva, la responsabilidad penal ya no sólo se concibe con respecto a las personas físicas, sino que a partir de la Reforma del CP de 2010, se puede hablar de una responsabilidad directa e independiente de las personas jurídicas. A lo largo de este trabajo, se tratn de explicar las novedades legislativas en cuanto a la regulación de la responsabilidad penal de las personas jurídicas y se analizan los efectos que puedan derivarse de esta nueva regulación, haciendo especial referencia a los fundamentos de la atribución de la responsabilidad penal y a la materia del Compliance Penal como eje central sobre el que versarán las circunstancias modificativas de la responsabilidad penal. Asimismo, se formulan valoraciones político-criminales a la vista de posibles inconvenientes e incongruencias suscitados por las últimas Reformas penales. Por consiguiente, el presente trabajo aborda tanto cuestiones que se ubican en el plano dogmático como en el que es propio de la política criminal.The aphorism "societas delinquere non potest" is not constituted as a guiding principle of criminal Law. The aforementioned aphorism was relativized in the original text of the Penal Code of 1995 (Article 129 CP). Subsequently, the draft Organic Law on Penal Code reform and the successive pre-legislative texts (draft reform of the Penal Code of 2008), welcomed proposals that assumed its eradication. With the reform of the Penal Code of 2010, it was introduced into the Penal Code the statute of criminal liability of legal persons, at article 31 CP, whose controversial peculiarities evidenced, from the doctrine point of view, a more than a questionable model chosen by the legislature. Finally, the reform of the Penal Code of 2015, partial modifications were incorporated intro de aforementioned statute, which despite of being designed to overcome the shortcomings verified in the previous regulation, inserted new elements that were unknown for criminal Law until then, which meant that the model of criminal liability of the entities continue into question. In conclusion, criminal liability is not only referring to individuals, but also to legal persons. Throughout this research, we try to explain the legislative developments regarding regulation of criminal liability of legal persons, and we will analyze the effects that may result from this new regulation, with particular reference to the fundamentals of criminal liability attribution and to the criminal compliance, as a central axis of modifying circumstances of criminal responsibility. This thesis analyzes the inconsistencies and incongruities of recent penal reforms and undertakes both dogmatic issues as political-criminals

Immunosuppression and Chagas disease: a management challenge

Immunosuppression, which has become an increasingly relevant clinical condition in the last 50 years, modifies the natural history of Trypanosoma cruzi infection in most patients with Chagas disease. The main goal in this setting is to prevent the consequences of reactivation of T. cruzi infection by close monitoring. We analyze the relationship between Chagas disease and three immunosuppressant conditions, including a description of clinical cases seen at our center, a brief review of the literature, and recommendations for the management of these patients based on our experience and on the data in the literature. T. cruzi infection is considered an opportunistic parasitic infection indicative of AIDS, and clinical manifestations of reactivation are more severe than in acute Chagas disease. Parasitemia is the most important defining feature of reactivation. Treatment with benznidazole and/or nifurtimox is strongly recommended in such cases. It seems reasonable to administer trypanocidal treatment only to asymptomatic immunosuppressed patients with detectable parasitemia, and/or patients with clinically defined reactivation. Specific treatment for Chagas disease does not appear to be related to a higher incidence of neoplasms, and a direct role of T. cruzi in the etiology of neoplastic disease has not been confirmed. Systemic immunosuppressive diseases or immunosuppressants can modify the natural course of T. cruzi infection. Immunosuppressive doses of corticosteroids have not been associated with higher rates of reactivation of Chagas disease. Despite a lack of evidence-based data, treatment with benznidazole or nifurtimox should be initiated before immunosuppression where possible to reduce the risk of reactivation. Timely antiparasitic treatment with benznidazole and nifurtimox (or with posaconazole in cases of therapeutic failure) has proven to be highly effective in preventing Chagas disease reactivation, even if such treatment has not been formally incorporated into management protocols for immunosuppressed patients. International consensus guidelines based on expert opinion would greatly contribute to standardizing the management of immunosuppressed patients with Chagas disease