Catalytic activity and accessibility of acidic ion-exchange resins in liquid phase etherification reactions

Abstract Although macroreticular acidic ion-exchange resins have been widely used as catalysts in the industrial world for decades, their catalytic behavior is still far from being completely understood at a molecular level. Several characterization techniques coexist, which provide information about their properties. Only few of these techniques give an actual picture of their working-state features when swollen in anhydrous polar reactive media such as in etherification processes, where they are extensively used. The inverse steric exclusion chromatography technique, based on modeling the micropores structure, or gel-phase, as a set of discrete volume fractions with a characteristic polymer chain density, constitutes an appropriate procedure to assess the morphology of ion-exchangers in the swollen state. Present work proposes an empirical model to correlate the properties of the volume fractions with their catalytic activity in the etherification reaction rates of isobutene by addition of C1 to C4 linear primary alcohols. Sixteen different macroreticular acidic ion-exchange catalysts, both commercial and lab-made, have been used, which differ in acid capacity, sulfonation type, cross-linking degree and swollen-phase volume fractions distribution. Experimental reaction rates have been expressed as a sum of contributions of each individual volume fraction. The contribution of each polymer volume fraction corresponds to the product of the catalyst acidity, the characteristic volume fraction within the gel-phase of the catalyst, and a specific turnover frequency (TOF) of that fraction. Accessibility of the reacting alcohol, expressed in terms of the Ogston coefficient, has been also included in the empirical dependency equation presented in this work

Comparación entre dos tipos de gastrostomías quirúrgicas, abierta y laparoscópica, en nutrición enteral domiciliaria

Objetivo: Exponer las complicaciones de las gastrostomías quirúrgicas utilizadas como vía de soporte nutricional enteral domiciliario (SNED) y detectar si existen diferencias entre las dos técnicas usadas en nuestro medio: Cirugía abierta vs laparoscópica. Material y métodos: Estudio observacional descriptivo de carácter retrospectivo de las gastrostomías quirúrgicas realizadas entre los años 1994 y 2009 seguidas por nuestra unidad. Se han analizado las complicaciones detectadas en consulta durante el seguimiento de pacientes con SNED a través de gastrostomía quirúrgica realizada con técnica laparotómica abierta vs laparoscópica, valorando: fuga del contenido gástrico al exterior, irritación de la pared abdominal, presencia de exudado, presencia de exudado con cultivo positivo que requirió tratamiento antibiótico, quemadura o pérdida de sustancia de la zona periostomía, rotura de balón, úlcera de decúbito por la sonda y formación de granuloma. Resultados: Durante los años 1994-2009 se realizaron 57 gastrostomías quirúrgicas: 47 por técnica laparótomica (abierta) convencional y 10 por vía laparoscópica. La edad media de los pacientes fue de 57,51 ± 17,29 años. La causa más frecuente que motivó la realización de la gastrostomía quirúrgica fue el cáncer de esófago (38,6%) seguido de alteraciones neurológicas (26,3%) y tumores de cabeza y cuello (26,3%). El 97,9% de los pacientes a los que se realizó una gastrostomía quirúrgica abierta presentaron al menos una complicación, es decir que solo el 2,1% estuvieron libres de complicaciones; mientras que el 50% de los que se sometieron a una gastrostomía laparoscópica no tuvo ninguna. Las complicaciones más frecuentes fueron la presencia de fuga del contenido gástrico y la irritación de la pared abdominal que se presentaron en el 89,4% y 83% respectivamente de las gastrostomías laparotómicas frente a la aparición de solo el 30% de ambas complicaciones en las gastrostomías laparoscópicas siendo la diferencia estadísticamente significativa (p Aim: Exposing the complications of surgical gastrostomies used as way of home enteral nutritional support (HEN) and detecting the differences between the two techniques used in our environment: Open Surgery vs Laparoscopic Surgery. Material and methods: Retrospective descriptive observational study of the surgical gastrostomies performed between 1994 and 2009 followed up by our unit. Have been analyzed the complications detected in our practice during the follow-up of patients with HEN performed via open laparotomy vs. laparoscopic tecniques, assessing: leaks of gastric fluid to the exterior, abdominal wall irritation, presence of exudate, presence of exudate with positive culture that required antibiotical treatment, burning or loss of substance of the periostomic zone, breach of balloon, decubitus ulcer caused by the tube and formation of granuloma. Results: Between 1994 and 2009, 57 surgical gastrostomies were performed: 47 using the conventional laparotomic (open) tecnique and 10 laparoscopies. The average age of the patients was 57.51 ± 17.29 years old. The most common cause for the performance of surgical gastrostomy was esophageal cancer (38.6%) followed by neurologic alterations (26.3%) and head and neck tumors (26.3%). 97.9% of the patients who underwent to surgical gastrostomy presented at least one complication, meaning that only 2.1% were free of complications; meanwhile, 50% of the patients were laparoscopic gastrostomy was performed had none of these complications. The most common complications were the presence of leaks of gastric fluid and abdominal wall irritation that appeared on 89.4% and 83% respectively of the laparotomic gastrostomies versus the presence of only 30% of both complications in laparoscopic gastrostomies being the difference statistically significant (p < 0.01). Conclusions: After the introduction of the laparoscopic technique in the performance of surgical gastrostomies has been observed a decrease of the complications occured during the home enteral nutritional support related to surgical gastrostomies

Consensus statement on the diagnosis, management, and treatment of angioedema mediated by Bradykinin. Part. II: treatment, follow-up, and special situations

Background: There are no previous Spanish guidelines or consensus statements on bradykinin-induced angioedema. Aim: To draft a consensus statement on the management and treatment of angioedema mediated by bradykinin in light of currently available scientifi c evidence and the experience of experts. This statement will serve as a guideline to health professionals. Methods: The consensus was led by the Spanish Study Group on Bradykinin-Induced Angioedema, a working group of the Spanish Society of Allergology and Clinical Immunology. A review was conducted of scientifi c papers on different types of bradykinin-induced angioedema (hereditary and acquired angioedema due to C1 inhibitor defi ciency, hereditary angioedema related to estrogens, angioedema induced by angiotensin-converting enzyme inhibitors). Several discussion meetings were held to reach the consensus. Results: Treatment approaches are discussed, and the consensus reached is described. Specifi c situations are addressed, namely, pregnancy, contraception, travelling, blood donation, and organ transplantation. Conclusions: A review of and consensus on treatment of bradykinin-induced angioedema is presentedIntroducción: No existen guías previas españolas sobre el manejo del angioedema mediado por bradicinina. Objetivos: Alcanzar un consenso sobre el manejo y tratamiento del angioedema mediado por bradicinina a la luz de la evidencia científi ca disponible y la experiencia de los expertos, que sirva como guía para los profesionales de la salud. Métodos: SGBA/GEAB, un grupo de trabajo de la SEAIC dirigió el consenso. Se realizó una revisión de los documentos científi cos publicados sobre los diferentes tipos de angioedema mediado por bradicinina [angioedema hereditario o adquirido por defi ciencia de inhibidor de la C1 esterasa, angioedema hereditario relacionado con estrógenos (AEH tipo III, AEH-FXII), angioedema inducido por IECA (inhibidores del enzima convertidor de angiotensina]. Hubo varias reuniones del SGBA/GEAB para alcanzar el consenso. Resultados: Se revisan y discuten los diferentes tratamientos disponibles y se describe el consenso alcanzado. Se abordan situaciones específi cas (embarazo, anticoncepción, viajes, hemodonación, trasplante de órganos). Conclusiones: Se presenta una revisión del tratamiento del angioedema mediado por bradicinina y un consenso sobre su tratamiento en EspañaDr. Teresa Caballero is a researcher with the Hospital La Paz Health Research Institute (IdiPaz) program for promoting research activities (2009

International consensus on (ICON) anaphylaxis

ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction. They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice. For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences. ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available. ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research. In addition to confirming the alignment of major anaphylaxis guidelines, ICON: Anaphylaxis adds value by including summary tables and citing 130 key references. It is published as an information resource about anaphylaxis for worldwide use by healthcare professionals, academics, policy-makers, patients, caregivers, and the public

Desafios da integração nos novos arranjos institucionais de políticas públicas no Brasil

Resumo O Governo Federal brasileiro tem experimentado arranjos institucionais que tem como objetivo construir políticas públicas efetivas em um contexto territorial complexo. Neles há dois eixos centrais: (i) a tentativa de articular temáticas intersetoriais e (ii) a construção de modelos de gestão de políticas públicas com coordenação entre os entes federativos e a sociedade civil. Este artigo analisa como novos arranjos institucionais consideram o papel dos territórios. A análise está estruturada em duas questões centrais: (a) qual a centralidade dada à concepção de território e em que medida ele desempenha papel ativo ou passivo no desenho do arranjo; (b) que fatores poderiam explicar contornos do arranjo institucional e como a dimensão territorial se materializa neles. O artigo analisa três arranjos: Plano Brasil Sem Miséria; Programa de Aceleração do Crescimento; Programa Territórios da Cidadania. As análises baseadas em documentos oficiais dos programas visam compreender, a partir de sua estrutura de funcionamento, como se dão questões como intersetorialidade, relações federativas e concepção de território. Analisando os programas, percebe-se que, ainda que em graus variados, há mais justaposição do que integração de políticas públicas, e que neles os territórios – entendido como os lócus de implementação das políticas e as forças sociais nele presentes – não ocupam uma posição ativa, revelando-se meros repositórios de investimentos. Como consequência, essa fragilidade, observada tanto na dupla integração desejada como na articulação territorial, é algo que resulta em perda de eficiência dos investimentos e em comprometimento dos resultados. Esses limites se devem, em grande medida, ao peso da cultura setorial que permeia os gestores e o comportamento das forças sociais, associado a uma cultura institucional de privilégio dos resultados alcançáveis em curto prazo. Esses aspectos, por sua vez, concretizam-se tanto nas normas que regulamentam os arranjos como no leque de agentes envolvidos. Em termos teóricos essa hipótese se afasta das análises que tomam os arranjos meramente sob o ângulo administrativo ou de gestão e se aproxima das abordagens institucionalistas, para as quais não se pode analisar os arranjos institucionais isolados do ambiente institucional do qual são, a um só tempo, parte e expressão

Determinants and Differences in Satisfaction with the Inhaler Among Patients with Asthma or COPD

Satisfaction with the inhaler is an important determinant of treatment adherence in patients with asthma and chronic obstructive pulmonary disease (COPD). However, few studies have compared these 2 groups to identify the factors associated with satisfaction with the inhaler. To assess and compare satisfaction with the inhaler in patients with asthma or COPD and to determine the variables associated with high inhaler satisfaction. A multicenter, cross-sectional study of 816 patients (406 with asthma and 410 with COPD) was conducted. Satisfaction was assessed with the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire. All participants completed the Test of Adherence to Inhalers and either the Asthma Control Test (ACT) or the COPD Assessment Test (CAT). Overall, the asthma group was significantly more satisfied with the inhaler (mean [standard deviation] FSI-10 scores: 44.1 [6.5] vs 42.0 [7.7]; P <.001) and more satisfied on most (7 of 10; 70%) items. Patients with asthma were significantly more satisfied with the inhaler regardless of the adherence level or the type of nonadherence pattern. Younger age, good disease control (ACT ≥20 or CAT ≤10), previous inhaler training, and absence of unwitting nonadherence were all independently and significantly associated with high inhaler satisfaction. Age, disease control, and training in inhalation technique all play a more significant role than the specific diagnosis in explaining satisfaction with the device in patients with asthma and COPD. These findings underscore the need to provide better training and more active monitoring of the inhalation technique to improve patient satisfaction, treatment adherence, and clinical outcomes

History of fires and vegetation since the Neolithic in the Cantabrian Mountains (Spain)

Fire has been one of the main causes of disturbance of vegetation over time, and since the Neolithic has become an irreplaceable tool for the opening of forest spaces and maintenance of pastures. Previous studies showed that the intensity and effects of wildfires are related to the biomass and controlled by climate factors. However, in regions such as Cantabria, where agriculture and livestock have spread throughout the territory since prehistory, fires should also be closely related to human land uses. The aim of this paper was to investigate the history of fires and vegetation since the Neolithic in the Cantabrian Mountains, using sedimentary charcoal and pollen data to study the role of human activities in the processes that have shaped ecosystems throughout the Holocene. The asynchrony and quantitative differences in the results obtained at different sites indicate significant variations in fire patterns at regional scale since the Neolithic, although the type and size of each basin also had a strong influence on charcoal accumulation. Maximum values for charcoal accumulation rate at La Molina were observed between the Neolithic and the Bronze Age but occurred after about 3500 cal years BP at El Cueto de la Avellanosa. At El Sertal, low charcoal accumulation rate values were observed, probably because the sequence begins in a space that already had been cleared; the maximum values occurred during the most recent millennium. These data provide evidence that fire has been a key factor in forest retreat and in maintaining open landscapes since the Neolithic.This article was made possible by two Coordinated Project grants from Spain's Ministry of Economics and Competitiveness (MEC), “El uso del fuego y la conformación de los paisajes en la Montaña cantábrica y el Pirineo oriental: estudio comparado de su evolución histórica y tendencias actuales” (CSO2012-39680-C02-01) awarded to the Department of Geography, Urban studies and Land Planning, Universidad de Cantabria and “Geohistoria ambiental del fuego en el Holoceno. Patrones culturales y gestión territorial desde el inicio de la ganadería y la agricultura en la montaña Cantábrica y Pirineo “awarded to the Department of Geography, Universitat Autónoma de Barcelona (CSO2012-39680-C02-02). In addition, the project was funded by the Catalan government's Applied Geography program, “Grup de Geografia Aplicada” (AGAUR, Generalitat de Catalunya, 2014 SGR 1090)

Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder

Children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD) experience functional impairment and poor health-related quality of life (HRQoL) in addition to symptoms of inattention/hyperactivity-impulsivity. To synthesize qualitatively the published evidence from randomized, double-blind, placebo-controlled trials of the effectiveness of pharmacotherapy on functional impairment or HRQoL in patients with ADHD, a systematic PubMed searching and screening strategy was designed to identify journal articles meeting pre-specified criteria. Post hoc analyses and meta-analyses were excluded. HRQoL outcomes, functional outcomes and the principal ADHD symptom-based outcome were extracted from included studies. An effect size of 0.5 versus placebo was used as a threshold for potential clinical relevance (unreported effect sizes were calculated when possible). Of 291 records screened, 35 articles describing 34 studies were included. HRQoL/functioning was usually self-rated in adults and proxy-rated in children/adolescents. Baseline data indicated substantial HRQoL deficits in children/adolescents. Placebo-adjusted effects of medication on ADHD symptoms, HRQoL and functioning, respectively, were statistically or nominally significant in 18/18, 10/12 and 7/9 studies in children/adolescents and 14/16, 9/11 and 9/10 studies in adults. Effect sizes were ≥0.5 versus placebo for symptoms, HRQoL and functioning, respectively, in 14/16, 7/9 and 4/8 studies in children/adolescents; and 6/12, 1/6 and 1/8 studies in adults. Effect sizes were typically larger for stimulants than for non-stimulants, for symptoms than for HRQoL/functioning, and for children/adolescents than for adults. The efficacy of ADHD medication extends beyond symptom control and may help reduce the related but distinct functional impairments and HRQoL deficits in patients with ADHD

Human resources: the Cinderella of health sector reform in Latin America

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside

Landscape dynamics and fire activity since 6740 cal yr BP in the Cantabrian region (La Molina peat bog, Puente Viesgo, Spain)

A lack of paleobotanic studies with adequate resolution and multiproxy approaches has limited proper discussion of vegetation dynamics in Cantabria and of the role of fires in the configuration of the plant landscape during the Holocene in the northwest part of the Iberian peninsula. The pollen diagram of La Molina peat bog in Puente Viesgo (43 ‹15 Œ38 N.3 ‹58 Œ37 W; ETRS89), located at 484 m.a.s.l., and the study of its sedimentary charcoals allowed the acquisition of a continuous and thorough fire sequence for the last 6 700 cal yr BP and an understanding of its relationship to the forest. The results show the importance of human influence on the incidence and characteristics of fire activity during the different phases studied: the Neolithic, Bronze Age, Iron Age, Roman period, and Middle Ages. A synergy seems to exist between dry climate periods (especially during Bond events 3 and 4) and a greater presence of biomass. As the Holocene advances, vegetation coverage clearly tends to decrease. This study provides key elements for understanding the role of fire activity in the forest dynamics of deciduous and evergreen Quercus, Corylus, Pinus, Fagus, and Alnus and demonstrates the strongly artificialized character of the present landscape