Development and Validation of Nosocomial Bacterial Infection Prediction Models for Patients With Systemic Lupus Erythematosus.

BACKGROUND: Hospital-acquired bacterial infections are associated with high morbidity and mortality rates in patients with systemic lupus erythematosus (SLE). This study aimed to develop and validate predictive models for the risk of hospital-acquired bacterial infections in patients with SLE. METHODS: A historical cohort study was designed for development, and another bidirectional cohort study was used for external validation. The risk of bacterial infection was assessed upon admission and after 5 days of hospitalization. Predictor selection employed the least absolute shrinkage and selection operator (LASSO) techniques. Multiple imputations were used to handle missing data. Logistic regression models were applied, and the properties of discrimination, calibration, and decision curve analysis were evaluated. RESULTS: The development cohort comprised 1686 patients and 237 events (14.1%) from 3 tertiary hospitals. The external validation cohort included 531 patients and 84 infection outcomes (15.8%) from 10 hospital centers in Colombia (secondary and tertiary level). The models applied at admission and after 120 hours of stay exhibited good discrimination (AUC > 0.74). External validation demonstrated good performance among patients from the same tertiary institutions where the models were developed. However, geographic validation at other institutions has been suboptimal. CONCLUSIONS: Two predictive models for nosocomial bacterial infections in patients with SLE are presented. All infection prevention recommendations should be maximized in patients at moderate/high risk. Further validation studies in diverse contexts, as well as clinical impact trials, are necessary before potential applications in research and clinical care.

Evaluation of air pollution tolerance index and anticipated performance index of six plant species, in an urban tropical valley: Medellin, Colombia.

High atmospheric pollution levels in urban areas have become a global problem that threatens both human health and urban ecosystems. Trees that grow near areas with vehicular and industrial emissions can be highly affected, since they constitute the main barrier for emitted pollutants, with trees being either tolerant or sensitive to them. Different methodologies worldwide have been implemented to evaluate the tolerance and sensitivity of tree species to atmospheric pollutants. In this research, the air pollution tolerance index (APTI) and the anticipated performance index (API) are evaluated in order to determine both the degree of tolerance or sensitivity of trees to pollutants in the air and their performance in urban areas. To this end, six tree species found in four biomonitoring zones in the city of Medellín, Colombia, were selected: Mangifera indica, Tabebuia chrysantha-rosea, Erythrina fusca, Jacaranda mimosifolia, Fraxinus uhdei, and Spathodea campanulata. A total of 54 individual trees were evaluated by means of the APTI and API, and it was determined that the species with the highest tolerance (APTI≥16) and the best performance (81

Management Control Systems and Clinical Experience of Managers in Public Hospitals.

Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.

M/F changes after T-loop upper horizontal bending in segmented arch mechanics / Cambios en relación M/F después del doblaje horizontal superior en ansas en T para mecánicas de arco segmentado

bTi T-type loops are a frictionless, efficient alternative for extraction space closure. Changes in the upper horizontal portion of T-type loops to improve their mechanical behavior have been proposed, but differences in their biomechanical characteristics have not been well described. This stu dy analyzed the biomechanical differences among three T-type loops with differential bends in their upper horizontal portion. Ninety loops (0.017"x0.025" bTi) were bent and randomly divided in 3 groups according to the form of their upper horizontal portion (Tstraight, M convex, and C-loops concave), to evaluate force characteristics up to 6 mm of activation. Stiffness, maximum horizontal loads, total loop moments, and moment-to-force ratios were obtained. Nonparametric statistical analyses were used to test differences among groups. M-loops demonstrated lower force than T- and C-loops, and higher total loop moment than T-loops. A significant increase in M-loop moment-to-force ratio compared with T- or C-loops was obtained. C- and T-loops did not demonstrate significant differences in moment-to-force ratio between them. The convex upper bend in M-loops produced an increased total loop moment compared with T-loops. M-loops demonstrated moment-to-force values slightly higher than translation values, while the other loops reported only controlled inclination values at 6 mm of activation. M-loops are ideal when a higher control of root movement is indicated since the beginning of dental retraction in segmented arch mechanics.

Las ansas tipo T de bTi son una alternativa eficiente para el cierre de espacios de extracción. Cambios en la porción horizontal de las ansas tipo T se han propuesto para mejorar su comportamiento mecánico, pero sus diferencias con relación a las características biomecánicas no han sido bien descritas. Este estudio analizo las diferencias biomecánicas entre tres ansas tipo T con dobleces diferenciales en su porción horizontal superior. Noventa ansas (0,017"x0,025" bTi) fueron dobladas y divididas en tres grupos aleatoriamente, de acuerdo a la forma de su porción horizontal superior (ansas en T recta, M convexa, y C cóncava), para evaluar características de fuerza hasta 6 mm de activación. Rigidez, cargas horizontales máximas, momentos totales del ansa, y razones momento-fuerza fueron obtenidas. Análisis estadísticos no paramétricos se utilizaron para comprobar diferencias entre los grupos. Las ansas en M demostraron una menor fuerza que las ansas en T y C, y momentos totales del ansa mas altos que las ansas en T. Se obtuvo un incremento significativo en la razón momento-fuerza de las ansas en M comparado con las ansas en T o en C. Las ansas en C y T no demostraron diferencias significativas en la razón momento-fuerza entre si. El doblez convexo superior en las ansas en M produjo un momento del ansa total incrementado comparado con las ansas en T. Las ansas en M mostraron valores de momento-fuerza ligeramente mas altos que los valores para translación, mientras que las otras ansas solo reportaron valores para inclinación controlada a 6 mm de activación. Las ansas en M son ideales cuando un control alto de movimiento radicular esta indicado desde en comienzo de la retracción dental en mecánicas de arco segmentado.

Antihypertensive role of polyphenols.

Hypertension is considered the most important risk factor in the development of cardiovascular disease. Considerable evidence suggests that oxidative stress, which results in an excessive generation of reactive oxygen species (ROS), plays a key role in the pathogenesis of hypertension. This phenomenon leads to endothelial dysfunction, an imbalance between endothelium-derived relaxing factors, such as nitric oxide (NO), and contracting factors, such as angiotensin-II and endothelin (ET)-1, favoring the latter. Vascular remodeling also takes place; both processes lead to hypertension establishment. Antioxidant therapies have been evaluated in order to decrease ROS production or increase their scavenging. In this line, polyphenols, widespread antioxidants in fruits, vegetables, and wine, have demonstrated their beneficial role in prevention and therapy of hypertension, by acting as free radical scavengers, metal chelators, and in enzyme modulation and expression. Polyphenols activate and enhance endothelial nitric oxide synthase (eNOS) expression by several signaling pathways, increase glutathione (GSH), and inhibit ROS-producing enzymes such as NADPH and xanthine oxidases. These pathways lead to improved endothelial function, subsequent normalization of vascular tone, and an overall antihypertensive effect. In practice, diets as Mediterranean and the "French paradox" phenomenon, the light and moderate red wine consumption, supplementation with polyphenols as resveratrol or quercetin, and also experimental and clinical trials applying the mentioned have coincided in the antihypertensive effect of polyphenols, either in prevention or in therapy. However, further trials are yet needed to fully assess the molecular mechanisms of action and the appearance of adverse reactions, if a more extensive recommendation of polyphenol introduction in diet wants to be made.