Pharmacological treatment and impairment of pulmonary function in patients with type 2 diabetes: a cross-sectional study

Introducción. La relación de la diabetes mellitus de tipo 2 con el deterioro de la función pulmonar no es clara, como tampoco si el tipo de tratamiento modifica los parámetros espirométricos e inflamatorios. Objetivo. Comparar la función pulmonar de pacientes con diabetes mellitus de tipo 2 tratados con un agente de sensibilización a la insulina (metformina) y de los tratados con secretagogos, así como de estos combinados con insulinas, y evaluar las diferencias en los biomarcadores de inflamación de los grupos. Materiales y métodos. Se hizo un estudio analítico de corte transversal en 196 pacientes con diabetes mellitus de tipo 2. Se midieron las variables espirométricas y la concentración sanguínea de biomarcadores de inflamación (ferritina, fibrinógeno, proteína C reactiva, interleucina 6 y factor de necrosis tumoral alfa). Se analizaron los valores residuales (valores observados menos valores predichos) para la capacidad vital forzada y el volumen espiratorio forzado en los diferentes tipos de tratamiento. También, se compararon las diferencias en las medianas de las concentraciones de los biomarcadores, según los tipos de tratamiento. Resultados. Después de ajustar según los factores determinantes de la función pulmonar y el control y la duración de la diabetes mellitus de tipo 2, los valores esperados de la capacidad vital forzada de los pacientes tratados con agentes de sensibilización a la insulina fue menor que los de aquellos tratados con secretagogos (-212,1 ml Vs. -270,2 ml; p=0,039), y lo mismo se registró en el volumen espiratorio forzado durante el primer segundo (-133,2 ml Vs. -174,8 ml; p>0,05), aunque dichas diferencias no fueron estadísticamente significativas. En el grupo de pacientes tratados con agentes de sensibilización a la insulina, las concentraciones de ferritina y del factor de necrosis tumoral alfa fueron menores (p<0,01). Conclusión. Los resultados de este estudio respaldan la hipótesis de que los agentes de sensibilización a la insulina estarían asociados con un menor deterioro de la función pulmonar y una menor inflamación sistémica en los pacientes diabéticos. Asimismo, sirve como base para la formulación de nuevas hipótesis y trabajos de investigación.Q4276-284Introduction: There is no clear relationship between type 2 diabetes mellitus and lung function decline; it is also unclear whether the type of treatment can modify spirometric variables and levels of inflammatory biomarkers. Objectives: To compare pulmonary function in patients with type 2 diabetes treated with an insulin-sensitizing agent (metformin) and in those treated with secretagogues, as well as combined with insulin, and to evaluate differences in inflammatory biomarkers between treatment groups. Material and methods: We conducted a cross-sectional analytic study in 196 diabetic patients with type 2 diabetic mellitus. Spirometric variables and levels of inflammatory biomarkers (ferritin, fibrinogen, C-reactive protein, interleukin 6, tumor necrosis factor-alpha), were obtained. Residual values (observed minus expected) for forced vital capacity and for forced expiratory volume were calculated and compared between treatment types. Differences in median levels of biomarkers were also compared. Results: After adjustment by known determinants of lung function, and by the control and duration of type 2 diabetes, patients treated with the insulin-sensitizing agent had statistically significant lower differences against expected values for forced vital capacity compared with secretagogues (-212.1 ml vs 270.2 ml, p=0.039), as well as for forced expiratory volume , but without statistical significance (-133.2 mL vs -174.8 mL, p>0.05). In the group of patients treated with the insulin-sensitizing agent, ferritin and tumor necrosis factor-alpha levels were lower (p<0.01). Conclusion: This study supports the hypothesis that insulin-sensitizing agents appear to be associated with less deterioration of lung function and less systemic inflammation in type 2 diabetes. The present study serves to formulate new hypothesis and research projects

Planeamiento estratégico de las entidades promotoras e instituciones prestadoras de salud en Colombia

En Colombia, las Entidades Promotoras de Salud (EPS) y las Instituciones Prestadoras de Salud (IPS) se encuentran reglamentadas para ofrecer la afiliación, administración, y prestación de servicios de salud bajo la supervisión, regulación, y apoyo del Estado. Al 2016 estas instituciones se caracterizan por tener importante prestigio debido al aumento de la cobertura en medio de grandes desafíos, como: (a) incrementar el acceso a los servicios de salud, (b) mejorar el porcentaje de la población afiliada, (c) establecer un modelo de financiamiento óptimo, e (d) incrementar la confianza de los usuarios a través de una prestación de servicios de salud basada en principios de eficiencia en el uso de los recursos, calidad en la prestación de los servicios, equidad y universalidad en el acceso, solidaridad hacia los regímenes de seguridad, integralidad en la cobertura de las contingencias, y participación activa de la comunidad, entre otros principios que logren dotar de ventajas competitivas a estas instituciones de la salud. Es por ello que se elabora un planeamiento estratégico, en el cual las EPS e IPS se proponen reorientar la oferta de los servicios de salud y la prestación de los mismos, utilizando sus instalaciones y capacidades existentes en materia de idoneidad de profesionales de la salud, tiempos de atención y de espera, acceso a atención y cobertura universal, y el prestigio de algunas clínicas y hospitales que atraen un amplio mercado internacional de la salud. A lo largo de este planeamiento, se describieron los antecedentes del sistema de salud y la situación general en el ámbito nacional para detallar el estado actual de las EPS e IPS en Colombia. Además, se conoció la estructura general y financiera de la salud en el país, identificando las fortalezas y debilidades del sistema, destacándose las entradas en el ámbito internacional, provenientes del turismo de la salud. Este último factor hace que las expectativas en el sector sean altamente favorables para mejorar la prestación de servicios de salud. Las ventajas competitivas que tienen que desarrollar las EPS e IPS para ser competitivas en el sector de la salud son las siguientes: equipamiento médico tecnológico, capacidad e infraestructura hospitalaria, recursos humanos calificados, solvencia financiera, tiempos de hospitalización, servicios médicos ofrecidos, niveles de complejidad dentro de los hospitales, inversión en investigación y desarrollo, acreditación de los sistemas de salud, entre otras. Por esta razón, se exponen estrategias que permitan aprovechar las fortalezas existentes y desarrollar nuevas, con lo cual para 2026 se espera que las EPS e IPS logren destacarse dentro del sistema de salud nacional y se posicionen como entidades de la salud líderes en Latinoamérica. Para el desarrollo de estas ventajas competitivas, se han planteado cinco objetivos a largo plazo: (a) Al 2026, aumentar la cobertura en el acceso al 100%; (b) al 2026, certificar al 70% de las 2,500 IPS por organismos de acreditación de calidad en salud, calificando su alto desempeño; (c) al 2026, incrementar a 25 la cantidad de IPS dentro del ranking de las mejores clínicas y hospitales de Latinoamérica; (d) al 2026, mejorar la tasa de satisfacción global en 10% para las EPS e IPS; y (e) al 2026, el 70% de las EPS calificadas con un desempeño medio en 2015 por el Ministerio de Salud y Protección Social obtendrán la calificación de desempeño alto, al prestar servicios de salud de forma óptima, generando un alto valor agregado. La manera en que se lograrán estos objetivos a largo plazo es mediante la implementación de las estrategias elaboradas en el presente planIn Colombia, the EPS and IPS are regulated to offer the affiliation, administration, and provision of health services under the supervision and support of the State. Currently, these health institutions enjoy good prestige, due to: (a) increase coverage amidst major challenges such as increase access to health services, (b) improve the percentage of the affiliated population, (c) establish an optimal financing model, and (d) increase trust of users through the provision of health services based on principles of efficiency in the use of resources, quality in service provision, equity and universality of access, solidarity towards security regimes, integrality of coverage of the contingencies, and active participation of the community, among other principles, that manage to give competitive advantages to these health institutions. It is for this reason, that based on this strategic planning, the EPS and IPS intend to reorient the provision of health services, using their existing facilities and capacities regarding the suitability of health professionals, times of care and waiting, access to universal care and coverage, and the prestige of some clinics and hospitals that attract a large international health market. Throughout the document the background of the health system and the general situation at the national level are reflected to detail the current state of the promoting entities and the institutions that provide health services. In addition, was identified the general and financial structure of health in Colombia, identifying the strengths and weaknesses of the health system, highlighting the entries at the international level, coming from health tourism. This last factor makes expectations in the health sector are favorable to improve the delivery of health services. Competitive advantages must develop EPS and IPS to be competitive in the health sector are: technological medical equipment, hospital capacity and infrastructure, qualified human resources, financial solvency, hospitalization times, medical services offered, levels of complexity within hospitals, investment in research and development, accreditation of health systems, among others. For this reason, strategies are presented that allow take advantage existing strengths and developing new ones. So, in the year 2026, the EPS and IPS are expected to excel within the national health system and position themselves as leading health entities in Latin America. For the development of these competitive advantages, have been raised five goals long-term: (a) By 2026, will be increase coverage in access to 100%; (b) by 2026, accreditation bodies of quality in health will be certify to 70% of the 2,500 IPS , qualifying it's high performance; (c) by 2026, will be increase to 25 the number of IPS within the ranking of the best clinics and hospitals in Latin America; (d) by 2026, will be improved the overall satisfaction rate by 10% for EPS and IPS; (e) by 2026, 70% of the EPS rated with an average performance in 2015 by the Ministry of Health and Social Protection, will obtain the high performance rating, providing optimal health services, which generate a high added value. The way these long-term objectives will be achieved is by implementing strategies developed in this studyTesi

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Azimuthal anisotropy of charged jet production in root s(NN)=2.76 TeV Pb-Pb collisions

We present measurements of the azimuthal dependence of charged jet production in central and semi-central root s(NN) = 2.76 TeV Pb-Pb collisions with respect to the second harmonic event plane, quantified as nu(ch)(2) (jet). Jet finding is performed employing the anti-k(T) algorithm with a resolution parameter R = 0.2 using charged tracks from the ALICE tracking system. The contribution of the azimuthal anisotropy of the underlying event is taken into account event-by-event. The remaining (statistical) region-to-region fluctuations are removed on an ensemble basis by unfolding the jet spectra for different event plane orientations independently. Significant non-zero nu(ch)(2) (jet) is observed in semi-central collisions (30-50% centrality) for 20 <p(T)(ch) (jet) <90 GeV/c. The azimuthal dependence of the charged jet production is similar to the dependence observed for jets comprising both charged and neutral fragments, and compatible with measurements of the nu(2) of single charged particles at high p(T). Good agreement between the data and predictions from JEWEL, an event generator simulating parton shower evolution in the presence of a dense QCD medium, is found in semi-central collisions. (C) 2015 CERN for the benefit of the ALICE Collaboration. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Forward-central two-particle correlations in p-Pb collisions at root s(NN)=5.02 TeV

Two-particle angular correlations between trigger particles in the forward pseudorapidity range (2.5 2GeV/c. (C) 2015 CERN for the benefit of the ALICE Collaboration. Published by Elsevier B. V.Peer reviewe

Event-shape engineering for inclusive spectra and elliptic flow in Pb-Pb collisions at root(NN)-N-S=2.76 TeV

Peer reviewe