What is new in the prevention of ventilator-associated pneumonia?

Purpose of review: Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in endotracheally intubated patients. Strict adherence to preventive measures reduces the risk of VAP. The objective of this paper is to review what has come forward in recent years in the nonpharmacological prevention of VAP. Recent findings: It seems advantageous to implement care bundles rather than single prevention measures. A solid basis of knowledge seems necessary to facilitate implementation and maintain a high adherence level. Continuous educational efforts have a beneficial effect on attitude toward VAP. Intermittent subglottic secretions drainage, continuous lateral rotation therapy, and polyurethane cuffed endotracheal tubes decrease the risk of pneumonia. In an in-vitro setting, an endotracheal tube with a taper-shaped cuff appears to better prevent fluid leakage compared to cylindrical polyurethane or polyvinylchloride cuffed tubes. Cuff pressure control by means of an automatic device and multimodality chest physiotherapy need further investigation, as do some aspects of oral hygiene. Summary: New devices and strategies have been developed to prevent VAP. Some of these are promising but need further study. In addition, more attention is being given to factors that might facilitate the implementation process and the challenge of achieving high adherence rates

Demographics, guidelines, and clinical experience in severe community-acquired pneumonia

Mortality in patients with community-acquired pneumonia (CAP) who require intubation or support with inotropes in an intensive care unit setting remains extremely high (up to 50%). Systematic use of objective severity-of-illness criteria, such as the Pneumonia Severity Index (PSI), British Thoracic Society CURB-65 (an acronym meaning Confusion, Urea, Respiratory rate, Blood pressure, age ≥65 years), or criteria developed by the Infectious Diseases Society of America/American Thoracic Society, to aid site-of-care decisions for pneumonia patients is emerging as a step forward in patient management. Experience with the Predisposition, Infection, Response, and Organ dysfunction (PIRO) score, which incorporates key signs and symptoms of sepsis and important CAP risk factors, may represent an improvement in staging severe CAP. In addition, it has been suggested that implementing a simple care bundle in the emergency department will improve management of CAP, using five evidence-based variables, with immediate pulse oxymetry and oxygen assessment as the cornerstone and initial step of treatment

Creating and refining parameters to investigate compression, asymmetry, and space medium interactions of magnetic obstacles

Un cable de flux és una estructura en l'atmosfera del Sol, composta per línies de camp magnètic recargolades que envolten plasma que viatja a través del sistema solar. S'han desenvolupat múltiples models per intentar determinar el comportament del camp magnètic d'aquest tipus d'esdeveniments. La majoria d'ells representen la secció transversal del cable de flux com a cercles o el·lipses concèntriques. L'objectiu d'aquesta recerca és determinar la rellevància de la distorsió en aquests models. També es desenvoluparà un mètode per poder quantificar la compressió i l'asimetria de cada esdeveniment i poder detectar automàticament esdeveniments amb certs valors de distorsió, per exemple, esdeveniments no distorsionats. Finalment, s'analitzarà la distorsió dels esdeveniments per determinar si hi ha dependències entre la magnitud i la freqüència de la distorsió i paràmetres com el cicle solar o la distància al Sol.Un cable de flujo es una estructura en la atmósfera del Sol, compuesta por líneas de campo magnético retorcidas que envuelven plasma que viaja a través del sistema solar. Se han desarrollado múltiples modelos para intentar determinar el comportamiento del campo magnético de este tipo de eventos. La mayoría de ellos representan la sección transversal del cable de flujo como círculos o elipses concéntricos. El objetivo de esta investigación es determinar la relevancia de la distorsión en estos modelos. También se desarrollará un método para poder cuantificar la compresión y asimetría de cada evento y poder detectar automáticamente eventos con ciertos valores de distorsión, por ejemplo, eventos no distorsionados. Finalmente, se analizará la distorsión de los eventos para determinar si existen dependencias entre la magnitud y la frecuencia de distorsión y parámetros como el ciclo solar o la distancia al Sol.A flux rope is a structure in the Sun's atmosphere, comprising twisted magnetic field lines enveloping plasma that travels through the solar system. Multiple models have been developed to try to determine the behaviour of the magnetic field of this type of events. Most of them represent the cross-section of the flux rope as concentric circles or ellipses. The goal of this research is to determine the relevance of the distortion on this models. A method will also be developed to be able to quantify the compression and asymmetry of each event and to be able to automatically detect events with certain values of distortion, for example, non-distorted events. Finally, the distortion of the events will be analyzed to determine if there are dependencies between the magnitude and frequency of distortion and parameters such as the solar cycle or the distance to the Sun.Outgoin

A Computer-Based Method to Improve the Spelling of Children with Dyslexia

In this paper we present a method which aims to improve the spelling of children with dyslexia through playful and targeted exercises. In contrast to previous approaches, our method does not use correct words or positive examples to follow, but presents the child a misspelled word as an exercise to solve. We created these training exercises on the basis of the linguistic knowledge extracted from the errors found in texts written by children with dyslexia. To test the effectiveness of this method in Spanish, we integrated the exercises in a game for iPad, DysEggxia (Piruletras in Spanish), and carried out a within-subject experiment. During eight weeks, 48 children played either DysEggxia or Word Search, which is another word game. We conducted tests and questionnaires at the beginning of the study, after four weeks when the games were switched, and at the end of the study. The children who played DysEggxia for four weeks in a row had significantly less writing errors in the tests that after playing Word Search for the same time. This provides evidence that error-based exercises presented in a tablet help children with dyslexia improve their spelling skills.Comment: 8 pages, ASSETS'14, October 20-22, 2014, Rochester, NY, US

La interfaz entre prosodia y discurso en la resolución de la anáfora pronominal en español

El estudio de la interfaz entre la prosodia y el discurso oral en español se ha centrado en aspectos como la caracterización prosódica de los marcadores discursivos, el análisis de las funciones de la entonación en la conversación coloquial o la descripción de los correlatos prosódicos de la cortesía y de la ironía, por mencionar únicamente algunos de los temas que han merecido más atención entre los investigadores. Sin embargo, el papel de la información prosódica en la resolución de la anáfora pronominal en el discurso oral en español no parece que se haya abordado todavía en profundidad, pese a que los problemas relacionados con la interpretación de los elementos anafóricos ocupan un lugar prominente en el ámbito de la investigación sobre el discurso, tanto desde la perspectiva de la teoría lingüística como desde el punto de vista de la lingüística computacional (Rello 2010: 5-19). Por otra parte, para el desarrollo de los sistemas de diálogo ―una de las principales aplicaciones de las tecnologías del habla en la actualidad- es fundamental realizar un trata-miento adecuado de la anáfora, combinando los métodos propios del procesamiento del lenguaje natural con la extracción, mediante técnicas de reconocimiento automático del habla, de los parámetros acústicos relacionados con la prosodia

Correlatos prosódicos de la desambiguación pronominal en español

One of the major challenges in pronominal anaphora resolution occurs when the anaphor is ambiguous. This paper explores the interplay between prosodic features and pronominal anaphora in ambiguous discourse in Spanish. The results for duration, fundamental frequency and amplitude of the segment in the speech signal corresponding to the pronoun, complemented by data on pause occurrence and pause duration, suggest the potential role of prosody in anaphora resolution.La ambigüedad del antecedente es uno de los mayores retos que se plantean en la resolución de la anáfora pronominal. Este trabajo explora la interrelación entre los rasgos prosódicos y la anáfora pronominal ambigua en el discurso en español. Los resultados obtenidos en lo que respecta a la duración, la frecuencia fundamental y la amplitud del segmento de la señal sonora que contiene el pronombre anafórico, junto con los datos sobre la presencia de pausa y la duración de la misma, sugieren que los rasgos prosódicos podrían jugar un papel en la resolución de la anáfora

The simple and the simpler in pneumonia diagnosis

In the absence of a perfect 'gold standard' for diagnosing pneumonia, comparing diagnostic performance between techniques remains controversial. El Solh and coworkers present a study evaluating use of quantitative endotracheal aspirate culture to enhance diagnostic accuracy in pneumonia patients admitted from nursing homes. We discuss the use of quantitative cultures and thresholds to differentiate between colonization and infection in pneumonia patients; we also consider the inaccuracy of diagnostic studies, which compromises the reproducibility of these data in clinical practice