23-Valent Pneumococcal Vaccine. Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society. February 2010

The article summarizes the scientific evidence related with protection conferred by the 23 valent polysacchar-die vaccine against invasive pneumococcal disease, non bacteriemic pneumococcal pneumonia, and probable pneumococal pneumonia in the elderly. Eider patients with and without risk factors are considered. The impact of herd immunitty conferred by vaccination of children with conjugated pneumococcal vaccine in reduction of penumonia in adults is discussed. Based on this analysis, the Advisory Committee on Immunizations of the Chilean Infectious Disease Society makes recommendations on the most efficient vaccine strategy for reduction of pneumococcal pneumonia in the elderly

Géneros híbridos y libros mixtos en el Siglo de Oro

Este dossier pretende reflexionar sobre algunas obras que hoy percibimos a medio camino entre dos formas de expresión artística, como la prosa y el verso ; o entre dos disciplinas, como la historia y la literatura, o entre ésta, la filosofía y la política. Es posible que en el Siglo de Oro los diversos asedios a los géneros clásicos —épica, lírica, dramática— obedezcan a la creatividad de los grandes autores y al espíritu polémico con que recibían determinadas innovaciones. Pero también lo es que el mundo de la imprenta, denominada hoy industria editorial, intuyera la rentabilidad de mezclar poesía e imagen, o escritura y grabado, para ofrecer un producto híbrido, más atractivo a los lectores ; o de lanzar folletos de circunstancias, como los libelos políticos, que no estaban entre los géneros canónicos. Los siete artículos de la monografía analizan algunos de dichos fenómenos a partir de obras mixtas, y como contrapunto se formula una nueva hipótesis sobre el género (o géneros) y los propósitos del Criticón de Baltasar Gracián. Ce dossier propose une réflexion autour de certaines œuvres, perçues actuellement à mi-chemin entre deux genres artistiques, comme la prose et le vers, ou bien entre deux disciplines : histoire et littérature, littérature et philosophie, ou encore littérature et politique. Il est probable qu’au Siècle d’or, les divers assauts faits aux genres classiques — épique, lyrique, dramatique — soient dus à la créativité des grands auteurs de l’époque et à l’esprit de polémique dans lequel certaines nouveautés étaient reçues. Mais il est vraisemblable aussi que le monde de l’imprimerie, que nous appelerions aujourd’hui édition, a pu entrevoir l’intérêt de mélanger la poésie et l’image, ou l’écriture et la gravure, pour proposer un produit hybride, plus attirant pour les lecteurs ; ou bien de lancer des brochures de circonstance, tels que les libelles politiques, qui ne faisaient pas partie des genres canoniques. Les sept articles de notre monographie analysent certains desdits phénomènes, à partir de certaines œuvres mêlées, tandis que le contrepoint propose une nouvelle hypothèse sur le genre (les genres) et les intentions du Criticón de Baltasar Gracián. This dossier looks at some works that today are viewed as falling somewhere between two forms of artistic expression such as prose and verse, or between two disciplines such as history and literature, or again between literature, philosophy and politics. In the Golden Age the various assaults on the classic genres—epic, lyric, dramatic— may have been a product of the creativity of great writers and the argumentative spirit in which they received certain innovations. But it is also possible that the generality of printers—which today we call the publishing industry—anticipated the profits to be derived from mixing poetry and image, or writing and engraving, to offer a hybrid product, more attractive o readers; or of putting out gossip sheets,such as political libels, which were not among the standard genres. The seven articles in this monograph analyse these phenomena in the light of some mixed works; in counterpoint it offers a new hypothesis regarding the genre (or genres) and the intent behind Baltasar Criticón

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society