IntroductionInfections caused by carbapenem-resistant Enterobacteriaceae are a public health problem associated with higher mortality rates, longer hospitalization and increased healthcare costs. We carried out a study to describe the characteristics of patients with carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE bloodstream infection (BSI) from Latin American hospitals and to determine the clinical impact in terms of mortality and antibiotic therapy.MethodsBetween July 2013 and November 2014, we conducted a multicenter observational study in 11 hospitals from 7 Latin American countries (Argentina, Colombia, Ecuador, Guatemala, Mexico, Peru, Venezuela). Patients with BSI caused by Enterobacteriaceae were included and classified either as CPE or non-CPE based on detection of blaKPC, blaVIM, blaIMP, blaNDM and blaOXA-48 by polymerase chain reaction.Enrolled subjects were followed until discharge or death. Demographic, microbiological and clinical characteristics were collected from medical records. Both descriptive and inferential statistics were used to analyze the information.ResultsA total of 255 patients with Enterobacteriaceae BSI were included; CPE were identified in 53 of them. In vitro non-susceptibility to all screened antibiotics was higher in the patients with CPE BSI, remaining colistin, tigecycline and amikacin as the most active drugs. Combination therapy was significantly more frequent in the CPE BSI group (p < 0.001). The most common regimen was carbapenem + colistin or polymyxin B. The overall mortality was 37% (94/255). Overall and attributable mortality were significantly higher in patients with CPE BSI (p < 0.001); however, we found that patients with CPE BSI who received combination therapy and those who received monotherapy had similar mortality. After multivariate adjustment, CPE BSI (adjusted odds ratio [aOR] 4; 95% confidence interval [CI] 1.7–9.5; p = 0.002) and critical illness (aOR 6.5; 95% CI 3.1–13.7; p < 0.001) were independently associated with in-hospital mortality.ConclusionsThis study provides valuable data on the clinical characteristics and mortality risk factors in patients with CPE BSI. We determined that CPE infection is an independent mortality predictor and thus Latin American hospitals should perform campaigns on prevention and control of CPE BSI.
OmpSs is a programming model that provides a simple and powerful way of annotating sequential programs to exploit heterogeneity and task parallelism based on runtime data dependency analysis, dataflow scheduling and out-of-order task execution; it has greatly influenced Version 4.0 of the OpenMP standard. The current implementation of OmpSs achieves those capabilities with a puresoftware runtime library: Nanos++. Therefore, although powerful and easy to use, the performance benefits of exploiting finegrained (pico) task parallelism are limited by the software runtime overheads. To overcome this handicap we propose Picos, an implementation of the Task Superscalar (TSS) architecture that provides hardware support to the OmpSs programming model. Picos is a novel hardware dataflow-based task scheduler that dynamically analyses inter-task dependencies and identifies task-level parallelism at run-time. In this paper, we describe the Picos Hardware Design and the latencies of the main functionality of its components, based on the synthesis of their VHDL design. We have implemented a full cycle-accurate simulator based on those latencies to perform a design exploration of the characteristics and number of its components in a reasonable amount of time.Finally, we present a comparison of the Picos and Nanos++ runtime performance scalability with a set of real benchmarks. With Picos, a programmer can achieve ideal scalability using aggressive parallel strategies with a large number of fine granularity tasks.
The LEGaTO project leverages task-based programming models to provide a software ecosystem for Made in-Europe heterogeneous hardware composed of CPUs, GPUs, FPGAs and dataflow engines. The aim is to attain one order of magnitude energy savings from the edge to the converged cloud/HPC, balanced with the security and resilience challenges. LEGaTO is an ongoing three-year EU H2020 project started in December 2017.
COVID-19, the new pandemic is associated to SARS-CoV-2 virus infection. Social distancing and the testing have been the principal measures that have shown to be effective for the reduction of critical cases. Although the gold standard for diagnosis of COVID-19 is the RT-PCR, rapid serological tests could also be used for prevalence studies, and for epidemiological monitoring. In order to characterize the humoral immune response, we analyzed eight immuno-chromatographic test and one ELISA test, as a verification or secondary validation analysis used positive and negative control serum samples. Sera from negative and positive individuals [asymptomatic or symptomatic individuals, outpatient or inpatientor (intensive care unit)] were analyzed, and the following results were found: of all these rapid tests, only 4 exhibit clear banding patterns for IgG and two of these also showed results for IgM (only in a few symptomatic patients). Instead, with an ELISA test a preferential recognition was observed for symptomatic patients who were critically ill, whereas in asymptomatic individuals it did not show more than 25% of positivity. Understanding and validating molecular and serological tests are an essential component for the design of public health measures to response to the pandemic. Hacia la construcción de criterios para la selección de pruebas serológicas rápidas para COVID-19Resumen COVID-19 la nueva pandemia está asociada con la infección por el virus SARS-CoV-2. La distancia social y el análisis masivo de muestras son las principales medidas que se han mostrado efectivas para la reducción de los casos críticos. Aunque el estándar de oro para el diagnóstico de COVID-19 es la RT-PCR, las pruebas serológicas rápidas podrían también ser usadas en estudios de prevalencia, así como en la vigilancia epidemiológica. Con el fin de caracterizar la respuesta inmune humoral, analizamos ocho pruebas inmunocromatográficas y una prueba de ELISA, en un proceso de verificación de desempeño o validación secundaria, usando sueros control positivos y negativos. Los sueros de pacientes positivos y negativos [individuos asintomáticos o sintomáticos, pacientes ambulatorios u hospitalizados (en cuidados intensivos)] fueron analizados, encontrando los siguientes resultados: de todas las pruebas rápidas examinadas solamente 4 mostraron un claro patrón de bandas para IgG, de éstas, dos de ellas también mostraron resultados para IgM (solamente en pocos pacientes sintomáticos). En cambio, con la prueba de ELISA un reconocimiento preferencial fue observado en pacientes sintomáticos con enfermedad crítica, mientras que los individuos asintomáticos no mostraron más de un 25 % de positividad. Comprender y validar las pruebas serológicas son componentes esenciales en el diseño de las medidas de políticas públicas como respuesta a esta pandemia.
Los pacientes con infección por VIH tienen una mayor incidencia de eventos cardiovasculares en comparación con la población general; los factores que contribuyen al incremento del riesgo de eventos cardiovasculares son la prevalencia de factores de riesgo cardiovascular tradicionales (FRCV), la infección por VIH que condiciona tanto un proceso de inflamación crónica como alteración de la función endotelial y la exposición a los antirretrovirales. Los factores que deben ser objeto de intervención son los FRCV tradicionales, en especial la alta tasa de fumadores entre este grupo de pacientes, la tamización y tratamiento de HTA, el síndrome metabólico y el acceso temprano a la terapia antirretroviral con medicamentos con mayor perfil de seguridad. Esta guía pretende proveer información y recomendaciones en el ámbito nacional acerca de la relación entre la infección por VIH/SIDA (Síndrome de Inmunodeficiencia Adquirida), uso de antirretrovirales y riesgo cardiovascular.
This paper presents the new features of the OmpSs@FPGA framework. OmpSs is a data-flow programming model that supports task nesting and dependencies to target asynchronous parallelism and heterogeneity. OmpSs@FPGA is the extension of the programming model addressed specifically to FPGAs. OmpSs environment is built on top of Mercurium source to source compiler and Nanos++ runtime system. To address FPGA specifics Mercurium compiler implements several FPGA related features as local variable caching, wide memory accesses or accelerator replication. In addition, part of the Nanos++ runtime has been ported to hardware. Driven by the compiler this new hardware runtime adds new features to FPGA codes, such as task creation and dependence management, providing both performance increases and ease of programming. To demonstrate these new capabilities, different high performance benchmarks have been evaluated over different FPGA platforms using the OmpSs programming model. The results demonstrate that programs that use the OmpSs programming model achieve very competitive performance with low to moderate porting effort compared to other FPGA implementations.
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