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An eight-year multicenter study on short-term peripheral intravenous catheter–related bloodstream infection rates in 100 intensive care units of 9 countries in Latin America: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Venezuela. Findings of the International Nosocomial Infection Control Consortium (INICC)
Victor Daniel Rosenthal, Gustavo Jorge Chaparro, Eduardo Alexandrino Servolo-Medeiros, Dayana Souza-Fram, Daniela Vieira da Silva Escudero, Sandra Milena Gualtero-Trujillo, Rayo Morfin-Otero, Esteban Gonzalez-Diaz, Eduardo Rodriguez-Noriega, Miguel Angel Altuzar-Figueroa, Guadalupe Aguirre-Avalos, Julio César Mijangos-Méndez, Federico Corona-Jiménez, Blanca Estela Hernandez-Chena, Mohamed Rajab Abu-Jarad, Evelia Maria Diaz-Hernandez, María Guadalupe Miranda-Novales, José Guillermo Vázquez-Rosales, Daisy Aguilar-De-Morós, Elizabeth Castaño-Guerra, Gabriel Munoz-Gutierrez, Nepomuceno Mejia, Jenia Johana Acebo-Arcentales, Gabriela Di-Silvestre
Journal: Infection Control & Hospital Epidemiology , First View
Published online by Cambridge University Press: 14 January 2021, pp. 1-7
Data on short-term peripheral intravenous catheter–related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied.
International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used.
In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635–2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975–1.6351; P = .040).
The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%.
Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.
Transient time-delay focusing of shock waves in thin liquids
Ulisses J. Gutiérrez-Hernández, Fabio De Colle, Claus-Dieter Ohl, Pedro A. Quinto-Su
Journal: Journal of Fluid Mechanics / Volume 910 / 10 March 2021
Published online by Cambridge University Press: 13 January 2021, A27
Print publication: 10 March 2021
In this work we propose and demonstrate a Fresnel-lens-inspired method to focus multiple laser-induced shock waves through time-delay superposition at arbitrary locations. While the principle works for any geometry, we demonstrate that this method already achieves focusing with two pairs of photoacoustic shock wave emitters located on a line centred around the acoustic axis ( $z$) in a quasi-two-dimensional liquid geometry. Each emitter pair is created by focusing one laser pulse simultaneously at two spots with a spatial light modulator at $z=0\ \mathrm {\mu }$m with $y=\pm 145\ \mathrm {\mu }$m and $y=\pm 75\ \mathrm {\mu }$m. The delays between the emitters necessary to vary the location of the focus from $z\approx 0$ to ${\sim }206\ \mathrm {\mu }$m are $35$ and $0$ ns, respectively. We find that the location of constructive superposition is significantly closer to the origin than what would be expected for linear waves in homogeneous media. This is confirmed with simulations using an Euler solver that shows the importance of finite-amplitude effects. The simulated dynamics are in reasonable agreement with our measurements. Finally, pressure gains at various locations along the acoustic axis are tested with the response of gaseous microbubbles acting as pressure probes. The measurements agree with calculated pressure ratios at different positions.
Choroidal metastases: case report and review
Victor Duque, Carolina de la Pinta, Ciriaco Corral, Carmen Vallejo, Margarita Martin, Raul Hernanz, Elsa Margarita Mezherane, Lira Pelari, Antonio Hernandez, Mireia Valero, Sonsoles Sancho
Journal: Journal of Radiotherapy in Practice , First View
Published online by Cambridge University Press: 29 December 2020, pp. 1-7
Choroidal metastases are the most frequent intraocular secondary tumours, with a prevalence of 2–7% according to the literature. Our aim was to review a clinical case of choroidal metastasis.
We present a case of a 63-year-old male patient diagnosed in 2018 with lung adenocarcinoma cT4N0M1. The patient had three metastases in the brain, which were successfully treated with radiosurgery (RS). The patient was treated with chemotherapy with pemetrexed–cisplatin schedule. Five months after diagnosis, the patient presented with decreased vision in the right eye. After ophthalmologic evaluation, he was diagnosed with a right choroidal metastasis, which was treated with external beam radiotherapy with 20 Gy in five fractions, resulting in improved visual acuity and a complete clinical and radiological response.
The patient took part in a clinical trial that continued with systemic chemotherapy. Twenty-two months after radiotherapy to the eye, the patient has good visual acuity without any side effects.
Choroidal metastasis treated with radiotherapy achieves good local control, with limited side effects, allowing an improvement in visual acuity and consequently, an improvement in the patient´s quality of life.
Autistic traits and mental health in women with the fragile-X premutation: maternal status versus genetic risk
Sarah J. White, Denise Gerber, Romina D. Sanchez Hernandez, Anthonia Efiannayi, Ishita Chowdhury, Hannah Partington, Joanna F. Moss
Journal: The British Journal of Psychiatry / Volume 218 / Issue 1 / January 2021
Published online by Cambridge University Press: 28 December 2020, pp. 28-34
Print publication: January 2021
Research on women with the fragile-X premutation (FX-p) has been underrepresented within the field of behavioural phenotypes.
To understand whether the FX-p confers risk for autistic traits, depression and anxiety, independent of maternal status.
In study 1, mothers of children with fragile-X syndrome (M-FXp; n = 51, mean age 43 years (s.d. = 5.80)) were compared with mothers of autistic children (M-ASD; n = 59, mean age 42 (s.d. = 5.80)), mothers of children with Smith-Magenis syndrome (M-SMS; n = 27, mean age 39 (s.d. = 7.20)) and mothers of typically developing children (M-TD; n = 44, mean age 40 (s.d. = 4.90)). In study 2, the M-FXp group were compared with non-mothers with the FX-p (NM-FXp; n = 17, mean age 32 (s.d. = 9.20)), typically developed non-mothers (NM-TD; n = 28, mean age 31 (s.d. = 6.80)) and the M-TD group. All participants completed an online survey, including measures of IQ, autistic traits, anxiety, depression and positive affect.
In study 1: the M-FXp group reported more autistic traits than the M-TD group (P < 0.05, η2 = 0.046). Anxiety and parental stress were elevated in the M-FXp, M-SMS and M-ASD groups relative to the M-TD group (all P ≤ 0.003, η2 = 0.079–0.322). In study 2: a main effect of premutation status indicated that women with the FX-p report elevated autistic traits and anxiety (P ≤ 0.007, η2 = 0.055–0.060); this did not interact with maternal status.
The findings indicate that women with the FX-p show an increased risk for autistic traits and anxiety. This risk is specific to the presence of the FX-p and is not fully accounted for by maternal status or the stress of caring for children with neurodevelopmental disorders.
Five-year outcome of peripherally inserted central catheters in adults: a separated infectious and thrombotic complications analysis
Samuel González, Pedro Jiménez, Pedro Saavedra, Desiré Macías, Ana Loza, Cristóbal León, Magdalena López, Elena Pallejá, Carmen Rosa Hernández-Socorro, Sergio Ruiz-Santana
To assess infectious and thrombotic complications of peripherally inserted central catheters (PICCs) in adults.
A 5-year prospective cohort study.
Tertiary-care teaching hospital in Seville, Spain.
Patients:
Adult patients undergoing PICC insertion.
Catheter-associated bloodstream infection (CABSI) including catheter-related bloodstream infection (CRBSI), primary bacteremia (PB), and upper extremity deep vein thrombosis (UEDVT) were recorded. Independent predictors of complications were assessed by multivariate analysis.
In total, 1,142 PICCs were inserted, with 153,191 catheter days (median, 79). Complications included 66 cases of CABSI (5.78%; 0.43‰ catheter days), 38 cases of CRBSI (3.33%; 0.25‰ catheter days), 28 cases of PB (2.45%; 0.18‰ catheter days), and 23 cases of UEDVT (2.01%; 0.15‰ catheter days). The median times to infection were 24, 41, and 60 days for CRBSI, PB, and UEDVT, respectively. Parenteral nutrition (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.77–6.52) and admission to the hematology ward (OR, 4.90; 95% CI, 2.25–10.71) were independently associated with CRBSI and PB, respectively. Admission to the hematology ward (OR, 12.46; 95% CI, 2.49–62.50) or to the oncology ward (OR, 7.89; 95% CI, 1.77–35.16) was independently associated with UEDVT. The crude mortality rate was 24.8%. Only 2 patients died of complications.
PICCs showed a low rate of thrombotic and infectious complications. Compared to PB, CRBSI showed significantly different risk factors, a higher incidence density per catheter days, and a shorter median time to infection. Separate analyses of CRBSI and PB are more specific and clinically useful when analyzing infectious complications.
A HIGH-RESOLUTION CHRONOLOGY FOR THE PALATIAL COMPLEX OF XALLA IN TEOTIHUACAN, MEXICO, COMBINING RADIOCARBON AGES AND ARCHAEOMAGNETIC DATES IN A BAYESIAN MODEL
Laura E Beramendi-Orosco, Galia Gonzalez-Hernandez, Ana M Soler-Arechalde, Linda R Manzanilla
Journal: Radiocarbon , First View
Teotihuacan is one of the most studied archaeological sites in Mesoamerica because of its exceptional size and urban planning; however, its last years of occupation and abandonment are still under debate. We report a high-resolution chronology for the Xalla complex integrating archaeomagnetic dates, radiocarbon (14C) ages, and detailed archaeological information about sample type and context in a Bayesian model. The model includes 42 14C ages and 7 archaeomagnetic dates grouped in 6 phases, including samples from collapsed roofs with 14C ages earlier than expected, suggesting a problem of inbuilt age. The archaeomagnetic dates on lime plasters were classified in unburned samples, related to the time of construction, and burned samples, related to the Big Fire associated to the abandonment of Teotihuacan. The modeled 14C ages resulted in shorter intervals, with the possibility of differentiating the construction phases, confirming that big beams had inbuilt age. Further, combining the two dating methods and classifying lime plaster samples in burned and unburned, it was possible to date different events within the same archaeological context. It is concluded that by combining these two dating methods and understanding the moment that each sample is dating, it is possible to obtain solid and precise chronologies.
Lorena Pérez-Hernández
Book: Speech Acts in English
Print publication: 03 December 2020, pp vii-viii
5 - A Cognitive Pedagogical Grammar of Directive Speech Acts II: Activities and Practice Materials
Print publication: 03 December 2020, pp 183-217
Chapter 5 draws on the description of the meaning and form of directive speech acts reported in Chapter 4 in order to offer a collection of practical activities for their teaching. Activities will be grouped attending to the semantic, formal, or contrastive aspects that need to be taught. Some of them will be designed to improve the students recognition and production of those illocutionary constructions and linguistic realisation procedures which allow the communication of the different illocutionary forces.
Others will be devoted to help teachers and textbook developers show students (1) the motivation of the form of directive speech acts in their underlying semantics and force dynamics, (2) the role of conceptual metonymy in the production of directive speech acts, and (3) the existence of families of speech act base constructions whose illocutionary force can be further modulated by means of linguistic realisation procedures.
Print publication: 03 December 2020, pp xvi-xvi
2 - What Contemporary Research Tells Us about Speech Acts
Print publication: 03 December 2020, pp 16-68
Chapter 2 provides an accessible outlook on contemporary research on speech acts, explaining and illustrating the latest pragmatic, functional, conversational, and cognitive/constructional contributions to the understanding of illocutionary acts. The chapter advocates a contrastive, cognitive/constructional theory of speech acts, showing how this approach is capable of integrating pragmatic, semantic, and formal aspects of speech acts into a unified and comprehensive account that is compatible with current psycholinguistic knowledge on speech acts production and understanding. This chapter sets the theoretical foundations for Chapters 4 and 5, offering a fully-fledged theoretical proposal on the semantic and formal features of directive speech acts in terms of illocutionary constructions and metonymic operations. The semantic side of the constructions is captured in the form of illocutionary ICMs, and the formal side takes the form of inventories of base constructions and linguistic realisation procedures. It is further argued that speakers can modulate the explicitness of their directive speech acts through (multiple-source)-in-target metonymies.
Print publication: 03 December 2020, pp xii-xii
The final chapter summarises the main contributions made in each of the chapters of this book, connects them to current trends, and specifies the needs for future research. Among the latter, it is suggested that the findings of the present investigation could be extended to the analysis of non-directive speech acts (e.g. commissive, expressive, representative, etc.). Additionally, it is argued that empirical validation from other disciplines and from experimental analyses, both in the fields of psycholinguistics and foreign language learning/teaching, will also be needed to lend a stronger support to the claims presented in this book.
3 - Critical Assessment of the Representation of Speech Acts in Advanced EFL Textbooks
Chapter 3 reports the results of a study which looks into a collection of ten textbooks for advanced EFL students in order to assess their treatment of directive speech acts. This chapter considers aspects related to (1) the quantitative representation of directive speech acts in the textbooks (i.e. determining if there is a balanced portrayal of the most frequent categories of directive speech acts), and (2) the qualitative treatment of directive speech acts (i.e. assessing if the depiction of directive speech acts in EFL textbooks has incorporated the main research advancements described in ). In particular, this chapter offers an account of the treatment of constructional, conversational, and contrastive aspects of directive speech acts in EFL textbooks for advanced EFL Spanish students.
4 - A Cognitive Pedagogical Grammar of Directive Speech Acts I: Know-What and Know-How of Directives
Print publication: 03 December 2020, pp 88-182
Chapter 4 applies the cognitive-constructional theoretical model of speech acts proposed in Chapter 2 to the task of providing an exhaustive description of the meaning and form of the six directive speech acts under consideration (i.e. orders, requests, beggings, suggestions, advice acts, and warnings). The ensuing portrayal of directive speech acts also includes contrastive considerations about their linguistic realisations in Spanish (L1) and English (L2). The description of the form-meaning constructional nature of the aforementioned directive speech acts takes the form of a Cognitive Pedagogical Grammar. Information is, thus, presented in an accessible, largely jargon-free manner, so that it can be used by teachers and textbook developers for the explicit teaching of the workings of directive illocutions to advanced Spanish EFL students. For each directive category, this chapter offers relevant information about its semantics (i.e. know-what) and its formal configurations (i.e. know-how).
Print publication: 03 December 2020, pp xv-xv
Print publication: 03 December 2020, pp 1-15
This chapter offers an introduction to the topic of the book. It includes some reflections on the relevance of mastering the use of directive speech acts for EFL learners. It describes the objectives of the investigation, the methodological decisions taken for the study, and the corpus of data used for the analysis. Finally, it offers a summary of chapter contents.
Print publication: 03 December 2020, pp ix-xi
Print publication: 03 December 2020, pp xiii-xiv