The dynamics around the collinear point L3 of the RTBP

We consider the Restricted Three Body Problem (RTBP), and we restrict our attention to the equilibrium point L3. Our aim is centered in the description, as global as possible, of the dynamics around this equilibrium point. In this communication, we initially consider small values of µ, for which homoclinic connections to the equilibrium point L3 are horseshoe-shaped, and then, other values of µ are considered. We compute the objects in the center manifold of L3, including the invariant manifolds associated with them. They are computed by purely numerical procedures, in order to avoid the convergence restrictions of the semi-analytical ones (typically used around L1 or L2). We deal with homoclinic connections of periodic orbits and develop some numerical tools in order to compute them. These tools can be extended to compute also homoclinic connections to invariant tori

Meta-analysis of individual patient data of albumin dialysis in acute-on-chronic liver failure:focus on treatment intensity

Background: Acute-on-chronic liver failure (ACLF) is a common complication of cirrhosis characterized by single or multiple organ failures and high short-term mortality. Treatment of ACLF consists of standard medical care (SMC) and organ(s) support. Whether the efficacy of artificial liver support (ALS) depends on the severity of ACLF or on the intensity of this treatment, or both, is unclear. This study aimed to further assess these issues. Methods: We performed an individual patient data meta-analysis assessing the efficacy of Molecular Adsorbent Recirculating System (MARS) in ACLF patients enrolled in prior randomized control trials (RCTs). The meta-analysis was designed to assess the effect of patient severity (ACLF grade) and treatment intensity [low-intensity therapy (LIT), SMC alone or SMC plus ⩽ 4 MARS sessions, high-intensity therapy (HIT), SMC plus > 4 MARS sessions] on mortality. Results: Three RCTs suitable for the meta-analysis (n=285, ACLF patients=165) were identified in a systematic review. SMC plus MARS (irrespective of the number of sessions) did not improve survival compared with SMC alone, neither in the complete population nor in the ACLF patients. Survival, however, was significantly improved in the subgroup of patients receiving HIT both in the entire cohort (10-day survival: 98.6% versus 82.8%, p=0.001; 30-day survival: 73.9% versus 64.3%, p=0.032) and within the ACLF patients (10-day survival: 97.8% versus 78.6%, p=0.001; 30-day survival: 73.3% versus 58.5%, p=0.041). Remarkably, HIT increased survival independently of ACLF grade. Independent predictors of survival were age, Model for End-Stage Liver Disease (MELD), ACLF grade, number of MARS sessions received, and intensity of MARS therapy. Conclusion: HIT with albumin dialysis may improve survival in patients with ACLF. Appropriate treatment schedules should be determined in future clinical trials

La diplomacia de Smart Cities: el caso de la ciudad de Barcelona, 2011-2015

El trabajo se fundamenta en torno a la diplomacia de la ciudad de Barcelona y a la configuración de un discurso hegemónico sobre Smart City, con repercusiones a nivel local y global. El énfasis se hace en relación con las interacciones y coaliciones en red con otras ciudades, se establece que Barcelona, como Smart City, proyecta una imagen de ciudad líder, dinámica, en construcción y crecimiento continuo, que ejerce un liderazgo relacional y apunta a la conformación de redes y estructuras donde las ciudades y sus actores están conectados al aprendizaje e intercambio de experiencia, al posicionamiento internacional, a la actividad económica y a la concreción de acuerdos como reflejo de una narrativa sostenida en la apertura, la flexibilidad y la inclusión.This research is based on the diplomacy of Barcelona City and the configuration of a hegemonic discourse on Smart City, with repercussions at a local and global level. The emphasis is on interactions and coalitions in network with other cities, establishing that Barcelona, as Smart City, projects an image of a leading and dynamic city, under construction and continuous growth that exerts a relational leadership, besides aims conformation of networks and structures where cities and their actors are connected learning and exchanging experience, reaching international positioning, economic activity, and agreements, as a reflection of a narrative sustained in openness, flexibility and inclusion, that precisely justifies the participation and political action of Barcelona as a city in global multilevel governance

Definitive diagnosis in suspected Middle East Respiratory Syndrome Coronavirus cases

We evaluated the microbiological diagnosis in 14 patients with epidemiological and clinical suspicion of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) attended in a non-endemic area between June 2015 and January 2017. While no MERS-CoV was detected, other respiratory viruses were identified in 12 cases and Mycoplasma pneumoniae in 1 case

Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain

Background: Noroviruses are one of the principal biological agents associated with the consumption of contaminated food. The objective of this study was to analyse the size and epidemiological characteristics of foodborne outbreaks of gastroenteritis in Catalonia, a region in the northeast of Spain. Methods: In all reported outbreaks of gastroenteritis associated with food consumption, faecal samples of persons affected were analysed for bacteria and viruses and selectively for parasites. Study variables included the setting, the number of people exposed, age, sex, clinical signs and hospital admissions. The study was carried out from October 2004 to October 2005. Results: Of the 181 outbreaks reported during the study period, 72 were caused by Salmonella and 30 by norovirus (NoV); the incidence rates were 14.5 and 9.9 per 100,000 person-years, respectively. In 50% of the NoV outbreaks and 27% of the bacterial outbreaks (p = 0.03) the number of persons affected was ¿10; 66.7% of NoV outbreaks occurred in restaurants; no differences in the attack rates were observed according to the etiology. Hospitalizations were more common (p = 0.03) in bacterial outbreaks (8.6%) than in NoV outbreaks (0.15%). Secondary cases accounted for 4% of cases in NoV outbreaks compared with 0.3% of cases in bacterial outbreaks (p < 0.001) Conclusion: Norovirus outbreaks were larger but less frequent than bacterial outbreaks, suggesting that underreporting is greater for NoV outbreaks. Food handlers should receive training on the transmission of infections in diverse situations. Very strict control measures on handwashing and environmental disinfection should be adopted in closed or partially-closed institutions

Annual Epidemiological Report: Measles and Rubella Surveillance in Spain, 2019

Centro Nacional de Epidemiología (CNE). Centro Nacional de Microbiología (CNM). Instituto de Salud Carlos III (ISCIII), CIBERESP. Plan Nacional de Eliminación del Sarampión y de la Rubeola. Informe anual 2019. Madrid, España.[ES] En España en 2019 el sarampión presentó el perfil de la fase post-eliminación: importado, casos en adultos y asociado a los entornos sanitarios. Se notificaron 287 casos de sarampión-incidencia 6,1 casos por millón de habitantes- ligeramente superior a la de años anteriores. La incidencia de rubeola fue extremadamente baja, solo tres casos confirmados incidencia de 0,06 casos por millón de habitantes. No se notificó ningún Síndrome de Rubeola Congénita. El sarampión ocurrió en personas no vacunadas –niños menores de un año y adultos mayores de 30 años. Se registraron casos en adultos que habían recibido dos dosis de vacuna, la última dosis una media de 10 años antes de contagiarse de sarampión. La falta de refuerzos naturales de la inmunidad por ausencia de circulación del virus en la población facilita la evanescencia de la inmunidad, particularmente evidente en las personas más expuestas, sobre todo trabajadores del ámbito sanitario. En 2019 el sarampión en España fue importado. Las importaciones llegaron de diferentes zonas del mundo, pero sobre todo de países europeos que estaban registrando brotes y epidemias sostenidas de sarampión. El sarampión tuvo escasa difusión en la población generando brotes de pequeño tamaño <10 casos; solo dos brotes registraron en torno a los 100 casos y en estos la transmisión en el entorno sanitario mantuvo la circulación del sarampión. Se notificaron tres casos de rubeola en personas no vacunadas que se contagiaron en el seno de un brote importado -notificado a finales de 2018– ocurrido entre personas adultas que no habían nacido en España. El sistema de vigilancia es adecuado para investigar los casos sospechosos de sarampión o rubeola una vez que se notifican; sin embargo para mantener los estándares de calidad que requiere el proceso de verificación de la eliminación tienen que mejorarse la sensibilidad en la identificación de sospechas clínicas y la oportunidad de su notificación a los servicios de vigilancia epidemiológica. El sarampión sigue siendo una amenaza trasfronteriza y solo una fuerte inmunidad de la población evitará la aparición de epidemias. La rubeola es rara y ocurre en personas susceptibles nacidas fuera de España. Las claves para mantener interrumpida la transmisión del sarampión y rubeola en España: son: mantener altas coberturas con dos dosis de vacunación infantil, promover la vacunación oportunista de adultos, viajeros y personas nacidas en otros países y zonas del mundo, asegurar la inmunidad de los profesionales del ámbito sanitario, establecer medidas de aislamiento que reduzcan la transmisión en los entornos asistenciales y mantener la calidad del sistema de vigilancia y de los laboratorios. La pandemia de COVID-19 y las medidas de control establecidas han reducido drásticamente la importación y la transmisión de sarampión en España con los últimos casos notificados en marzo 2020. Algunas incertidumbres asociadas a la situación epidémica: las restricciones en la asistencia sanitaria durante las primeras semanas de confinamiento podrían haber afectado las coberturas de vacunación, particularmente con la segunda dosis de vacuna triple vírica. La sobrecarga generada en el sistema de salud podría afectar a la vigilancia, notificación e investigación de las sospechas de sarampión o rubeola. [EN] In Spain in 2019 measles presented the profile of the post-elimination phase: imported, cases in adults and transmission associated with health environments. 287 confirmed cases of measles were reported along the year 2019, incidence of 6.1 cases per million population - slightly higher than in previous years. The incidence of rubella was extremely low, with only three confirmed cases; the incidence was 0.06 cases per million population. None Congenital Rubella Syndrome was reported. Measles occured in unvaccinated persons - children under one year and adults over 30 years of age. Cases were reported in adults who had received two doses of vaccine, the last dose on average 10 years before getting measles. The lasted lack of virus circulation in the population reduces the natural booster of immunity and consequently facilitates the evanescence of immunity, what is is particularly evident in those most exposed, especially among health care workers. In 2019 measles in Spain was imported. Importations came from different areas of the world, mostly from some European countries experiencing sustained measles outbreaks and epidemics. In general measles spread little in the population generating small size outbreaks <10 cases; In the two outbreaks that recorded about 100 cases, transmission was documented in health care facilities and among health care workers, which likely sustained transmission longer. The surveillance system is adequate to investigate suspected cases of measles or rubella once they are reported,; however, in order to maintain the quality standards required by the WHO-Europe elimination verification process, the sensitivity in the identification of clinical suspicions and the timeliness of their notification to epidemiological surveillance services must be improved. Measles remains a transboundary threat and only strong immunity of the population will prevent epidemics. Rubella is rare and occurs in susceptible persons born outside Spain. The keys to maintaining interrupted transmission of measles and rubella in Spain are: maintaining high coverage with two doses of childhood vaccination, promoting opportunistic vaccination of adults, travelers and people born in other countries, ensuring the immunity of healthcare professionals, establishing isolation measures that reduce transmission in healthcare settings and maintaining the quality of the surveillance system and laboratories. The pandemic of COVID-19 and the control measures established have drastically reduced the importation and transmission of measles in Spain with the last cases reported in March 2020. Some uncertainties associated with the epidemic situation are: restrictions on health care during the first weeks of lockdown could have affected vaccination coverage, particularly with the second dose of MMR vaccine. The overload generated in the health system could affect surveillance, notification and investigation of suspected measles or rubella.1. Introducción. Planes de la OMS y su traslado a España. Estrategias para alcanzar la eliminación. 2. Evolución de las incidencia del sarampión y rubeola y las coberturas de vacunación. 3. Resultados de la vigilancia del sarampión y la rubeola en España, 2019. 4. Hospitalizaciones y complicaciones relacionadas con sarampión y rubeola. España, 2019. 5. Estudio de laboratorio de los casos sospechosos de sarampión y rubeola. España, 2019. 6. Brotes de sarampión y rubeola. España, 2019. 7. Sarampión en Europa y en el mundo, año 2019. 8. Clasificación de los casos sospechosos de sarampión y rubeola: incidencia y genotipos identificados en fase de post-eliminación. España 2013-2019. 9. Verificación de la eliminación del sarampión y la rubeola en OMS-Europa, 2019. 10. Informe Anual del Comité Regional para la Verificación (CRV) de la Eliminación del Sarampión y la Rubeola en OMS-Europa, 2018. 11. Indicadores de calidad de la vigilancia establecidos por la OMS-Europa, España, 2014-2019. 12. Conclusiones. ANEXO I. Modelo de notificación de los brotes de sarampión. Formato OMS-Europa.N