Consensus of Spanish Society of Hospital Pharmacy on optimal medication therapy management of atopic dermatitis.

Atopic Dermatitis; Hospital Pharmacy; Multidisciplinary approachDermatitis atòpica; Farmàcia hospitalària; Enfocament multidisciplinariDermatitis atópica; Farmacia hospitalaria; Enfoque multidisciplinarioAim: This study's aims are: 1) To use the Delphi method to determine the level of consensus among hospital pharmacists (HPs) as regards the factors involved in the current approach to patients with atopic dermatitis (AD); 2) To identify potential areas for improvement in hospital pharmacy in terms of dealing with patients with severe AD; and 3) To contribute to adequate pharmaceutical care for patients with AD by drawing up recommendations. Methods: A two-round Delphi survey with participation from HPs from all over Spain. Three theme-based blocks were set out: 1) AD; 2) Management of patients with severe AD in the Hospital Pharmacy setting; and 3) Unmet needs (pathology, patient, treatment and management). Results: The 42 HPs participating reached a consensus in recognising the impact of severe AD on the patients suffering from it, the need to encourage adherence and the recommendations to use scales that take into account the patient's quality of life and indicators of the patient's experience. It has also been demonstrated that it is worthwhile evaluating the results in real clinical practice in consensus with other specialists from the multidisciplinary team. Finally, it is advisable to use drugs that have demonstrated long-term effectiveness and safety for patients with severe AD, given the disease's chronic nature. Conclusions: This Delphi consensus highlights the impact of severe AD on patients, the importance of a multidisciplinary and holistic approach, in which HP play a major role. It also highlights the importance of increased access to new drugs to improve health outcomes

Generalized Wavelet Fisher’s Information of 1

This paper defines the generalized wavelet Fisher information of parameter q. This information measure is obtained by generalizing the time-domain definition of Fisher’s information of Furuichi to the wavelet domain and allows to quantify smoothness and correlation, among other signals characteristics. Closed-form expressions of generalized wavelet Fisher information for 1/fα signals are determined and a detailed discussion of their properties, characteristics and their relationship with wavelet q-Fisher information are given. Information planes of 1/f signals Fisher information are obtained and, based on these, potential applications are highlighted. Finally, generalized wavelet Fisher information is applied to the problem of detecting and locating weak structural breaks in stationary 1/f signals, particularly for fractional Gaussian noise series. It is shown that by using a joint Fisher/F-Statistic procedure, significant improvements in time and accuracy are achieved in comparison with the sole application of the F-statistic

Fire behavior modeling for operational decision-making

Simulation frameworks are necessary to facilitate decision-making to many fire agencies. An accurate estimation of fire behavior is required to analyze potential impact and risk. Applied research and technology together have improved the implementation of fire modeling, and decision-making in operational environments.Dr Cardil acknowledges the support of Technosylva USA and Wageningen University in his research stays in the USA and the Netherlands to develop this work. The authors of this paper acknowledges the support of the EUfunded PYROLIFE project (Reference: 860787; https://pyrolife.lessonsonfire.eu/), a project in which a new generation of experts will be trained in integrated wildfire management

Technical, tactical and spatial indicators related to goal scoring in European elite soccer

The aim of this study was to describe the technical, tactical and spatial indicators related to goal scoring in elite European soccer, considering the type of defence and the positioning of the opponent. For the analysis, 8 tactical dimensions related to the final actions in 380 sequences that led to goal during the UEFA Champions League were evaluated by observational methodology. 75.9% of the goals were scored from open play and 24.1% were scored from set pieces. Collective actions produced 51.6% of the total goals while individual actions produced 10.5% of goals. Regarding the penultimate action, crosses were more frequent against organized defences, while passes in behind the defence, or actions as dribbling or running with the ball had a greater percentage of goals against circumstantial defences (X2=37.027; p>0.001). Besides, greater utilization of wide invasive spaces (70.2%) was observed to assist against organized defences, while this percentage was 53.1% (X2=5.501; p=0.015) against circumstantial defences. For the last action, 70.1% of the goals were scored by using only one contact to the ball in organized defences but 46.6% in circumstantial defences (X2=26.521; p>0.001). The technical and tactical actions that achieve goal and their spatial characteristics are related to the type of defence used by the opposing team

Mame-Look

Nuestra iniciativa de iniciar este proyecto se debe a la actual crisis de salud que atraviesan el Perú y el mundo. Por ello, hemos desarrollado un proyecto de investigación, con el fin de poder implementar y colocar en el mercado del sector textil perteneciente a la categoría de artículos de protección personal, una prenda denominada "mameluco" confeccionada con materiales que garanticen una buena protección y comodidad para los clientes, también queremos que este proyecto sea escalable y rentable en el tiempo. Mamelook está dirigido a hombres y mujeres entre 18 y 60 años que necesiten salir a buscar una actividad que se encuentren en un nivel socioeconómico A, B y C y vivan en Lima. Nuestra propuesta de valor es poder ofrecer la variedad de diseños en cuanto a colores y diseños creados por costureras independientes que trabajan desde casa con la oportunidad de que puedan ganar dinero en esta difícil situación que venimos atravesando. Adicionalmente, Asimismo, el canal de contacto directo con el cliente empleado para este proyecto son las redes sociales. Para iniciar el proyecto se requerirá invertir S / 75,463 (setenta y cinco mil cuatrocientos sesenta y tres soles), estos tendrán la estructura de capital con aporte de los accionistas y un préstamo de microfinanzas. El proyecto genera una Tasa Interna de Retorno (TIR) de 31.06% y un Valor Actual Neto de S / 44,977.39. Antes mencionado, se puede concluir que el proyecto es viable.Our initiative to start this project is because of the current health crisis that Peru and the world are facing. For this reason, we have developed a research project, in order to be able to implement and place in the market of the textile sector belonging to the category of personal protection items, a garment called "mameluco" made with materials that guarantee good protection and comfort to the customers, also we want this project be scalable and profitable over time . Mamelook is aimed at men and women between the ages of 18 and 60 who need to go out and look for an activity those are in a socioeconomic level A, B and C and live in Lima. Our value proposal is to be able to offer the variety of designs in terms of colors and designs created by independent seamstresses who work from home with the opportunity that they can make money in this hard situation that we have been facing. In addition, the way of selling our product to the costumers for this project is the social. To start the project, it will be required to invest S / 75,463 (Seventy-five thousand four hundred and sixty-three soles), these will have the capital structure with contribution from the stockholders and a microfinance loan. The project generates an Internal Rate of Return (IRR) of 31.06% and a Net Present Value of S / 44,977.39. Above mentioned, it can be concluded that the project is viable.Trabajo de investigació

High levels of anti-tuberculin (IgG) antibodies correlate with the blocking of T-cell proliferation in individuals with high exposure to Mycobacterium tuberculosis

SummaryObjectivesTo determine the effect of anti-tuberculin antibodies in the T-cell proliferation in response to tuberculin and Candida antigens in individuals with different levels of tuberculosis (TB) risk.MethodsSixteen high-risk TB individuals, 30 with an intermediate TB risk (group A), and 45 with a low TB risk (group B), as well as 49 control individuals, were studied. Tuberculin skin test (TST) results were analyzed and serum levels of antibodies (IgG and IgM) against purified protein derivative (PPD) were measured by ELISA. Tuberculin and Candida antigens were used to stimulate T-cell proliferation in the presence of human AB serum or autologous serum.ResultsHigh levels of anti-tuberculin IgG antibodies were found to be significantly associated with the blocking of T-cell proliferation responses in cultures stimulated with tuberculin but not with Candida antigens in the presence of autologous serum. This phenomenon was particularly frequent in high-risk individuals with high levels of anti-tuberculin IgG antibodies in the autologous serum when compared to the other risk groups, which exhibited lower levels of anti-tuberculin antibodies.ConclusionsAlthough cellular immunity plays a central role in the protection against TB, humoral immunity is critical in the control of Mycobacterium tuberculosis infection in high-risk individuals with latent TB infection

Variants in toll-like receptor 9 gene influence susceptibility to tuberculosis in a Mexican population

Background: The control of Mycobacterium tuberculosis (Mtb) infection begins with the recognition of mycobacterial structural components by toll like receptors (TLRs) and other pattern recognition receptors. Our objective was to determine the influence of TLRs polymorphisms in the susceptibility to develop tuberculosis (TB) in Amerindian individuals from a rural area of Oaxaca, Mexico with high TB incidence. Methods: We carried out a case–control association community based study, genotyping 12 polymorphisms of TLR2, TLR4, TLR6 and TLR9 genes in 90 patients with confirmed pulmonary TB and 90 unrelated exposed but asymptomatic household contacts. Results: We found a significant increase in the frequency of the allele A of the TLR9 gene polymorphism rs352139 (A>G) in the group of TB patients (g.f. = 0.522) when compared with controls (g.f. = 0.383), (Pcorr = 0.01, OR = 1.75). Under the recessive model (A/G + A/A vs G/G) this polymorphism was also significantly associated with TB (Pcorr = 0.01, OR= 2.37). The association of the SNP rs352139 was statistically significant after adjustment by age, gender and comorbidities by regression logistic analysis (Dominant model: p value = 0.016, OR = 2.31; Additive model: p value = 0.023, OR = 1.68). The haplotype GAA of TLR9 SNPs was also associated with TB susceptibility (Pcorr = 0.02). Differences in the genotype or allele frequencies of TLR2, TLR4 and TLR6 polymorphisms between TB patients and healthy contacts were not detected. Conclusions: Our study suggests that the allele A of the intronic polymorphism rs352139 on TLR9 gene might contribute to the risk of developing TB in Mexican Amerindians

Blanqueo de la fibra de celulosa de paja de caña de azúcar (Saccharum spp.) con peróxido de hidrógeno

Objective: Optimize the treatment of cellulose bleaching, replacing the use of sodium hypochlorite with hydrogen peroxide. Design/methodology/approach: A completely randomized design was used, the treatments were six processes of cellulose bleaching, which were carried out with 18 repetitions. To extract the cellulose, the artisanal method and 40 g of straw were used per treatment. The extraction and yield of cellulose and cellulose fiber, whiteness, crystallinity, granule size, purity of the cellulose and an economic analysis of the cost of the bleaching process were evaluated. Results: The average cellulose fiber extracted was 14 g, meaning that the yield of cellulose fiber was 35%. The average cellulose was 8 g, which represents a yield of 39.9% cellulose. The whiteness with sodium hypochlorite was 86.6 %, with a crystallinity of 65.9% and the cellulose granule size was 2.6 nm, and with hydrogen peroxide whiteness was 83%, the crystallinity was 68 % and the average granule size was 2.7 nm, according to the XRD method. This means similarity in both bleaching process. According to the FTIR analysis, the cellulose bleached in both processes is similar to the cellulose structure. Limitations on study/implications: Cellulose bleaching is more expensive with hydrogen peroxide process. Findings/conclusions: The cellulose extracted from the sugar cane straw, bleached with hydrogen peroxide presents acceptable characteristics to produce artisanal paperObjetivo: Optimizar el tratamiento de blanqueo de celulosa, sustituyendo el uso de hipoclorito de sodio por peróxido de hidrógeno. Diseño/metodología/aproximación: Se utilizó un diseño completamente al azar, donde los tratamientos fueron seis procesos de blanqueo de celulosa, que se realizaron con 18 repeticiones. Para extraer la celulosa se usó el método artesanal y 40 g de paja por tratamiento. Se evaluó la extracción y rendimiento de fibra de celulosa y celulosa, blancura, cristalinidad, tamaño de gránulo, pureza de la celulosa y un análisis económico del costo del proceso de blanqueo. Resultados: El promedio de fibra de celulosa extraída fue de 14 g, esto significa que el rendimiento de fibra de celulosa fue 35 %. El promedio de celulosa fue de 8 g que representa un rendimiento de 39.9 % de celulosa. La blancura con hipoclorito de sodio fue del 86.6%, la cristalinidad de 65.9 % y un tamaño de granulo de celulosa de 2.6 nm, y con peróxido de hidrógeno fue del 83 %, la cristalinidad del 68% y el tamaño de granulo promedio fue 2.7 nm, según el método de XRD, indicando resultados similares. De acuerdo al análisis de FTIR, la celulosa blanqueada en ambos procesos, es similar a la estructura de celulosa reportada en la literatura. Limitaciones del estudio/implicaciones: Se observó un costo más elevado en el blanqueo de la celulosa con el peróxido de hidrógeno. Hallazgos/conclusiones: La celulosa de la paja de caña de azúcar blanqueada con peróxido de hidrógeno presenta características adecuadas para elaborar papel artesanal

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio