Real-time parameter estimation of Zika outbreaks using model averaging.

Early prediction of the final size of any epidemic and in particular for Zika disease outbreaks can be useful for health authorities in order to plan the response to the outbreak. The Richards model is often been used to estimate epidemiological parameters for arboviral diseases based on the reported cumulative cases in single- and multi-wave outbreaks. However, other non-linear models can also fit the data as well. Typically, one follows the so called post selection estimation procedure, i.e., selects the best fitting model out of the set of candidate models and ignores the model uncertainty in both estimation and inference since these procedures are based on a single model. In this paper we focus on the estimation of the final size and the turning point of the epidemic and conduct a real-time prediction for the final size of the outbreak using several non-linear models in which these parameters are estimated via model averaging. The proposed method is applied to Zika outbreak data in four cities from Colombia, during the outbreak ocurred in 2015-2016.

[Access for starting kidney replacement therapy: vascular and peritoneal temporal access in pre-dialysis]. / Accesos para comenzar depuracion extrarrenal: vascular y peritoneal. acceso temporal en pre-dialisis.

UNLABELLED: PATIENT EVALUATION AND PREPARATION PRIOR TO VASCULAR ACCESS (VA) PLACEMENT: 1. Early referral of patients with advanced chronic kidney disease (ACKD: GFR

[Informed consent]. / Consentimiento informado.

- Basic law 41/2002 on patient autonomy regulates the rights and obligations of patients, users and professionals, as well as those of public and private health care centers and services. This regulation refers to patient autonomy, the right to information and essential clinical documentation. - This law establishes the minimum requirements for the information the patient should receive and the decision making in which the patient should take part. Diagnostic tests are performed and therapeutic decisions are taken in the ACKD unit in which patient information is an essential and mandatory requirement according to this law.

[Comparison of different methods in order to identify Proteus spp]. / Comparación de diferentes métodos para identificar las especies del género Proteus.

Comparison of different methods in order to identify Proteus spp. The objectives were: (a) to identify Proteus strains to species level, following Farmer's and O'Hara's conventional biochemical reactions; b) to evaluate the sensitivity and specificity of both the API 20E method and a schema of reduced reactions (TSI and MIO agar: motility, indole and ornithine) comparing them with conventional methodology, and c) to evaluate the utility of SDS-PAGE (total proteins) in order to identify Proteus strains to species level. Two hundred and five Proteus spp. clinical isolates, were collected between January 1998 and September 2004, from inpatients and outpatients at Hospital de Clinicas. Strains were identified by means of conventional methodology, the API 20E method, and a schema of reduced reactions. SDS-PAGE (total proteins) was used in 48 out of the 205 strains. The API 20E method identified 79 out of 87 (90.8%) strains of P. mirabilis, 103 out of 103 P. vulgaris complex, and 15 out of 15 P. penneri. Eight strains of P. mirabilis were identified as Proteus spp., the acid production from maltose being necessary to identify them to species level. The schema of reduced reactions identified 205 out of 205 (100%) strains, that is, this schema of reduced reactions identified all the strains to species level without any additional tests, in marked contrast to the API 20E method. The SDS-PAGE (total proteins) identified the three species of the genus, even if the strains of P. mirabilis showed different biochemical reactions.

Comparación de diferentes métodos para identificar las especies del género Proteus / Comparison of different methods in order to identify Proteus spp

Los objetivos de este trabajo fueron: a) identificar a nivel de especie aislamientos de Proteus siguiendo la combinación de los esquemas de Farmer y O'Hara; b) determinar la utilidad del sistema comercial API 20E y de un esquema reducido de pruebas (agar TSI y agar MIO: movilidad, indol y ornitina), comparar estos procedimientos con la metodología convencional y evaluar su sensibilidad y especificidad, y c) evaluar la utilidad del perfil proteico en la identificación de las distintas especies. Se estudiaron 205 aislamientos de Proteus spp. aislados en el período comprendido entre enero de 1998 y setiembre de 2004, recuperados de distintos materiales clínicos correspondientes a pacientes hospitalizados y ambulatorios atendidos en el Hospital de Clínicas. Los organismos fueron identificados mediante la metodología convencional, por el sistema API 20E y con un esquema reducido de pruebas; 48 de ellos fueron sometidos a un SDS-PAGE. API 20E identificó 79 de 87 aislamientos de P. mirabilis (90,8%), 103/103 del complejo P. vulgaris y 15/15 de P. penneri. Ocho aislamientos identificados como Proteus spp. resultaron ser P. mirabilis, al incluir una prueba adicional (maltosa). En la identificación, el esquema reducido coincidió en un 100% con la metodología convencional. A diferencia del sistema API 20E, el esquema reducido alcanza la correcta identificación de todas las especies en laboratorios de baja complejidad, sin la necesidad de pruebas adicionales. El perfil proteico permitió la correcta diferenciación de las tres especies, independientemente de las diferentes atipias de P. mirabilis.

The objectives were: a) to identify Proteus strains to species level, following Farmer's and O'Hara's conventional biochemical reactions; b) to evaluate the sensitivity and specificity of both the API 20E method and a schema of reduced reactions (TSI and MIO agar: motility, indole and ornithine) comparing them with conventional methodology, and c) to evaluate the utility of SDS-PAGE (total proteins) in order to identify Proteus strains to species level. Two hundred and five Proteus spp. clinical isolates, were collected between January 1998 and September 2004, from inpatients and outpatients at Hospital de Clínicas. Strains were identified by means of conventional methodology, the API 20E method, and a schema of reduced reactions. SDS-PAGE (total proteins) was used in 48 out of the 205 strains. The API 20E method identified 79 out of 87 (90.8%) strains of P. mirabilis, 103 out of 103 P. vulgaris complex, and 15 out of 15 P. penneri. Eight strains of P. mirabilis were identified as Proteus spp., the acid production from maltose being necessary to identify them to species level. The schema of reduced reactions identified 205 out of 205 (100%) strains, that is, this schema of reduced reactions identified all the strains to species level without any additional tests, in marked contrast to the API 20E method. The SDS-PAGE (total proteins) identified the three species of the genus, even if the strains of P. mirabilis showed different biochemical reactions.

[Evaluation of API Coryne System, version 2.0, for diphteroid gram-positive rods identification with clinical relevance]. / Evaluación del sistema API coryne, versión 2.0, para la identificación de bacilos gram-positivos difteroides de importancia clínica.

The ability of the API Coryne system, version 2.0, to identify 178 strains of gram-positive rods was evaluated. Seventy eight isolates belonged to genus Corynebacterium and one hundred to related genera, all strains were isolated from clinical samples at the Laboratory of Bacteriology, Hospital de Clínicas José de San Martin (UBA) between 1995 and 2004. The isolates were identified according to von Graevenitz and Funke's scheme. One hundred and sixty two out of 178 strains (91%) were correctly identified at genus and species level (IC95 = 85.6-94.6), in 44 of them (24.7%) additional tests were needed to final identification. Sixteen strains (9%) were not correctly identified (IC95 = 5.4-14.4); none of the 178 strains remained unidentified. The API Coryne system, version 2.0, is useful to identify the majority of Cory-nebacterium species with clinical relevance: Corynebacterium jeikeium, Corynebacterium urealyticum, Corynebacterium striatum, Corynebacterium pseudodiphtheriticum, Corynebacterium amycolatum and related species such as Arcanobacterium haemolyticum, Dermabacter hominis, Listeria monocytogenes, among others. Nevertheless for yellow-pigmented diphteroid gram-positive rods (Aureobacterium spp., Leifsonia aquatica, Microbacterium spp. and Cellulomonas spp.) and for acid fast gram-positive rods (Rhodococcus, Gordonia, Tsukamurella and Nocardia) the identification usefulness the system is limited.

Micellar anisometry in lyotropic uniaxial nematic phases studied by transversal NMR relaxation dispersion.

A new method, based on the measurement of the (23 )( )Na nuclei spin-spin NMR relaxation times ( T2 ), is proposed to investigate the shape of micelles in lyotropic nematic phases. We investigate the ternary lyotropic mixture of sodium dodecyl sulfate, 1-decanol, and water by using the NMR technique, measuring T2 in the two lyotropic uniaxial nematic phases. The characteristic relaxation time curves of each particular phase are analyzed by considering that they are constituted by a superposition of exponential decays with typical characteristic times: in a sense, a T2 spectroscopy. The analysis of the T2 dispersion profiles in both the uniaxial nematic calamitic and discotic phases indicates that our results can be interpreted in terms of the model of intrinsically biaxial micelles in all the nematic phases.

Slow molecular dynamics of water in a lyotropic complex fluid studied by deuterium conventional and spin-lattice relaxometry NMR.

A nuclear magnetic resonance study of protons and deuterons in the mesomorphic phases of the micellar lyotropic mixture potassium laurate/1-decanol/heavy water is reported. The slow dynamical behavior of water molecules has been investigated with deuterons spin-lattice relaxation dispersion in the Larmor frequency range 10(3)

Kin28, the TFIIH-associated carboxy-terminal domain kinase, facilitates the recruitment of mRNA processing machinery to RNA polymerase II.

The cotranscriptional placement of the 7-methylguanosine cap on pre-mRNA is mediated by recruitment of capping enzyme to the phosphorylated carboxy-terminal domain (CTD) of RNA polymerase II. Immunoblotting suggests that the capping enzyme guanylyltransferase (Ceg1) is stabilized in vivo by its interaction with the CTD and that serine 5, the major site of phosphorylation within the CTD heptamer consensus YSPTSPS, is particularly important. We sought to identify the CTD kinase responsible for capping enzyme targeting. The candidate kinases Kin28-Ccl1, CTDK1, and Srb10-Srb11 can each phosphorylate a glutathione S-transferase-CTD fusion protein such that capping enzyme can bind in vitro. However, kin28 mutant alleles cause reduced Ceg1 levels in vivo and exhibit genetic interactions with a mutant ceg1 allele, while srb10 or ctk1 deletions do not. Therefore, only the TFIIH-associated CTD kinase Kin28 appears necessary for proper capping enzyme targeting in vivo. Interestingly, levels of the polyadenylation factor Pta1 are also reduced in kin28 mutants, while several other polyadenylation factors remain stable. Pta1 in yeast extracts binds specifically to the phosphorylated CTD, suggesting that this interaction may mediate coupling of polyadenylation and transcription.

A Saccharomyces cerevisiae RNA 5'-triphosphatase related to mRNA capping enzyme.

The Saccharomyces cerevisiae mRNA capping enzyme consists of two subunits: the RNA 5'-triphosphatase (Cet1) and the mRNA guanylyltransferase (Ceg1). Using computer homology searching, a S. cerevisiae gene was identified that encodes a protein resembling the C-terminal region of Cet1. Accordingly, we designated this gene CTL1 (capping enzyme RNAtriphosphatase-like 1). CTL1 is not essential for cell viability and no genetic or physical interactions with the capping enzyme genes were observed. The protein is found in both the nucleus and cytoplasm. Recombinant Ctl1 protein releases gamma-phosphate from the 5'-end of RNA to produce a diphosphate terminus. The enzyme is specific for polynucleotide RNA in the presence of magnesium, but becomes specific for nucleotide triphosphates in the presence of manganese. Ctl1 is the second member of the yeast RNA triphosphatase family, but is probably involved in an RNA processing event other than mRNA capping.

Allosteric interactions between capping enzyme subunits and the RNA polymerase II carboxy-terminal domain.

mRNA capping is a cotranscriptional event mediated by the association of capping enzyme with the phosphorylated carboxy-terminal domain (CTD) of RNA polymerase II. In the yeast Saccharomyces cerevisiae, capping enzyme is composed of two subunits, the mRNA 5'-triphosphatase (Cet1) and the mRNA guanylyltransferase (Ceg1). Here we map interactions between Ceg1, Cet1, and the CTD. Although the guanylyltransferase subunit can bind alone to the CTD, it cannot be guanylylated unless the triphosphatase subunit is also present. Therefore, the yeast mRNA guanylyltransferase is regulated by allosteric interactions with both the triphosphatase and CTD.

A sensitive fluorometric enzyme-linked immunosorbent assay that measures vascular endothelial growth factor165 in human plasma.

A specific and sensitive fluorometric enzyme-linked immunosorbent assay (ELISA) was developed to measure endogenous levels of vascular endothelial growth factor (VEGF165) in human plasma. The ELISA can be performed in 10% human EDTA plasma, yielding a neat plasma sensitivity of 10 pg/ml or 0.2 pM. The recovery of recombinant human VEGF (rhVEGF) added to human plasma ranges from 89 to 100%. The capture antibody depletes the endogenous signal in normal human plasma, suggesting that the signal is specific for VEGF. The inter-assay and intra-assay coefficients of variation (CV) for the ELISA ranges from 5 to 14% and 8 to 18%, respectively. Characterization of the ELISA using plasmin derived VEGF variants suggests the assay is specific for the VEGF165 isoform. The heterodimer, VEGF(165/110) quantitates similar to that of the intact VEGF165 homodimer, however, the homodimers VEGF121, VEGF110 and the carboxy terminal domain (residues 111-165) are not detected in the assay. Circulating endogenous VEGF levels measured in 50 normal healthy individuals range from 20 to 141 pg/ml, with a mean of 42 +/- 22 pg/ml. There were no significant differences in VEGF levels between males and females. Circulating endogenous VEGF levels in cancer patients ranged from 32 to 418 pg/ml, averaging 129 +/- 17 pg/ml.

Carotid artery puncture, airway obstruction and the laryngeal mask airway in a preeclamptic patient.

We report a case of a preeclamptic patient with a difficult airway in whom attempted central venous cannulation led to inadvertent carotid artery puncture and dilatation causing immediate life threatening upper airway obstruction. The use of the laryngeal mask airway was life-saving on two occasions when other techniques of airway management had failed. We discuss the series of events that led to this critical incident and suggest areas in which management might have been improved.

Lipoprotein(a) and coronary heart disease.

Elevated plasma or serum lipoprotein(a) (Lp(a)) levels have been associated with premature coronary heart disease (CHD). Lp(a) levels can be assessed quantitatively by electrophoresis and quantitatively by immunoassays determining either total Lp(a) mass, apo(a) mass on Lp(a) protein mass, or by precipitation methods followed by measurement of Lp(a) cholesterol. We prefer the latter method because it can be standardized. Electrophoretic methods can detect total Lp(a) values > or = 30 mg/dl. These values correspond to Lp(a) cholesterol values > or = 10 mg/dl. Such values are above the 75th percentile and represent high risk values for CHD. Values above the 90th percentile for middle aged men and women in Framingham (n = 2678) are > or = 38 mg/dl for total Lp(a). About 16% of patients with premature CHD (n = 321) have such values and have familial Lp(a) excess. Lp(a) is atherogenic because it can be deposited in the arterial wall, and it also can interfere with fibrinolysis. Multiple apo(a) isoforms have been found and are due to a variable number of kringle 4 like repeats. Lower molecular weight apo(a) isoforms forms are associated with elevated Lp(a) values and are more frequent in CHD kindreds. Both Lp(a) levels and apo(a) isoforms are highly heritable in this Caucasian population. Lp(a) values can be decreased with niacin, and such therapy should be strongly considered in CHD patients with elevated Lp(a) levels (> or = 30 mg/dl) since niacin treatment has been shown to decrease CHD morbidity and mortality in unselected CHD patients.

Vaccine against group B Neisseria meningitidis: protection trial and mass vaccination results in Cuba.

The Cuban vaccine, first in the world with proven efficacy against group B-caused disease, is based on outer membrane proteins from B meningococci capable of inducing long-lasting and high-titered bactericidal antibodies in humans. This bactericidal activity has a wide spectrum against all pathogenic group B Neisseria meningitidis tested. A randomized, double-blind controlled trial of the vaccine efficacy was performed during 1987-1989 with 106,000 10-14 years old students from 197 boarding schools in seven provinces. The efficacy obtained was 83% (chi 2, p less than 0.002; Fischer exact, p less than 0.001). In a second field trial including 133,600 persons from 5 months to 24 years of age in Ciego de Avila province (30 cases/10(5) inhabitants, the highest incidence rate in Cuba) by comparing vaccinated and non-vaccinated population after 2.5 years of observation and careful follow-up, the efficacy and safety was confirmed. Because of these results and because of the very low reactogenicity of the vaccine, the Ministry of Public Health took the advice of the Scientific Council to vaccinate all children between 3 months and 6 years of age in the most affected provinces. No severe or long lasting reactions to the vaccine were observed after the millions of doses administered. The efficacy of vaccination varied in the provinces between 83% and 94%, among age groups ranging from 3 months and 20 years. After 3 years of massive application no severe reactions occurred and one of the most severe epidemics has been practically eradicated.

Criteria for mucus transport in the airways by two-phase gas-liquid flow mechanism.

The critical conditions for mucous layer transport in the respiratory airways by two-phase gas-liquid flow mechanism were investigated by using 0.5- and 1.0-cm-ID tube models. Several test liquids with rheological properties comparable to human sputum were supplied continuously into the vertically positioned tube models in such a way that the liquid could form a uniform layer while traveling upward through the tube with a continuous upward airflow. The critical airflow rate and critical liquid layer thickness required for the upward transport of the liquids were determined. The critical airflow rate was in the Reynolds number (Re) range of 142-1,132 in the 0.5-cm-ID tube model and 708-2,830 in the 1.0-cm-ID tube model depending on the types of liquids tested. In both models, the critical airflow rate was lower with viscoelastic liquids than with viscous oils. The critical liquid layer thickness ranged from 0.2 to 0.5 mm in the 0.5-cm-ID tube model and 0.8 to 1.4 mm in the 1.0-cm-ID tube model at Re of 2,800. These values decreased rapidly with increasing airflow rate. The critical thickness relative to the tube diameter ranged from 3 to 15% of the respective tube diameter and was lower by approximately 30-50% in the 0.5-cm-ID tube model than in the 1.0-cm-ID tube model over the entire Re range tested. The results indicate that the critical conditions for the mucus transport by two-phase gas-liquid flow mechanism are within the range that can be achieved in patients with bronchial hypersecretions during normal breathing.