No abstract

System-related issues, not severity of illness, prolong hospital stay excessively. Cost-reduction efforts should target operational bottlenecks between acute and postacute care.

Hookworms remain major agents of global morbidity, and vaccination against these bloodfeeding parasites may be an attractive complement to conventional control methods. Here we describe the cloning of Ancylostoma ceylanicum excretory-secretory protein 2 (AceES-2), a novel immunoreactive protein produced by adult worms. Native AceES-2 was purified from excretory-secretory (ES) products by reverse-phase high-pressure liquid chromatography, subjected to amino-terminal sequencing, and cloned from adult worm RNA by using reverse transcription-PCR. The translated AceES-2 cDNA predicts that the mature protein consists of 102 amino acids and has a molecular mass of 11.66 kDa. Western immunoblot and enzyme-linked immunosorbent assay analyses demonstrated that recombinant AceES-2 (rAceES-2) reacted strongly with antibodies from A. ceylanicum-infected hamsters. Immunization of hamsters with native ES products adsorbed to alum induced antibodies that recognized rAceES-2, while rAceES-2-alum vaccination resulted in antibodies that reacted with a single protein band in ES products that closely approximated the size predicted for the native molecule. Infected hamsters that were passively immunized with hyperimmune rabbit anti-rAceES-2 serum exhibited more rapid and complete recovery from anemia than controls that received normal serum. Oral immunization with rAceES-2 was associated with significantly reduced anemia upon challenge, an outcome similar to the outcome observed in hamsters that were orally vaccinated with soluble hookworm extract (the latter animals were also resistant to weight loss). These data suggest that AceES-2 plays an important role in the hostparasite interaction and that vaccination against this protein may represent a useful strategy for controlling hookworm anemia.

Surgical capacity varies by hospital type, with primary hospitals having the least surgical capacity and surgical volume. Departmental, regional, and national referral hospitals have adequate surgical capacity. Surgical subspecialty care appears to be insufficient, as evidenced by the large presence of NGOs and other surgical brigade teams filling this gap.

In this paper, solar photodegradation of caffeine in aqueous solution was studied, this organic compound is the most consumed stimulant around the world. The degradation experiments were carried outdoors in a solar reactor and Evonik-Degussa P25 TiO2was used as catalyst. The photochemical and photocatalytic effect were tested in aqueous solutions of caffeine. Experimental results indicate that the organic compound is easily degraded over a very short period of time using 0.5 g L-1of catalyst. The kinetic analysis indicates that the initial reaction rate of caffeine is described by the LH-HW model. However, the original compound cannot be mineralized very fast, caffeine is converted to other organic compounds with a longer lifetime before the mineralization, converting caffeine CO2and water.

Training programs should consider adopting simulation training for CVC insertion to improve the real patient procedural success of trainees.

Context:Standard teaching is that patients with pneumoperitoneum on plain X-ray and clinical signs of abdominal pathology should undergo urgent surgery. It is unknown if abdominal computed tomography (CT) provides additional useful information in this scenario.Aims:The aim of this study is to determine whether or not CT scanning after identification of pneumoperitoneum on plain X-ray changes clinical management or outcomes.Settings and Design:Retrospective study carried out over 4 years at a tertiary care academic medical center. All patients in our acute care surgery database with pneumoperitoneum on plain X-ray were included. Patients who underwent subsequent CT scanning (CT group) were compared with patients who did not (non-CT group).Statistical Analysis Used:The Wilcoxon rank-sum test, t-test and Fisher's exact test were used as appropriate to compare the groups.Results:There were 25 patients in the non-CT group and 18 patients in the CT group. There were no differences between the groups at presentation. All patients in the non-CT group underwent surgery, compared with 83% (n = 15) of patients in the CT group (P = 0.066). 16 patients in the non-CT and 11 patients in the CT group presented with peritonitis and all underwent surgery regardless of group. For patients undergoing surgery, there were no differences in outcomes between the groups. After X-ray, patients undergoing CT required 328.0 min to arrive in the operating room compared with 136.0 min in the non-CT group (P = 0.007).Conclusions:In patients with pneumoperitoneum on X-ray and peritonitis on physical exam, CT delays surgery without providing any measurable benefit.

Este artículo expone el contexto y los antecedentes que fundamentan el proceso de diseño e instalación de un marco de cualificaciones para la formación laboral y la certificación de competencias en Chile. En una primera parte se presentan las carencias y desafíos del mercado del trabajo en el país y el sentido que tienen las políticas públicas que posibilitan la intervención en los sistemas de formación laboral y certificación de competencias laborales, relevando a continuación la utilidad que un marco de cualificaciones puede prestar para contribuir a articular y focalizar ambos sistemas. Posteriormente se realiza una revisión de la situación actual de los marcos de cualificaciones en diversos países y la experiencia al respecto en Chile, para luego presentar una síntesis de la opinión de diversos actores relevantes respecto de la factibilidad y condiciones de operación de un marco de cualificaciones para los sistemas mencionados. Finalmente, se formulan los principios y criterios considerados necesarios para enmarcar su operación y las proyecciones que podría tener la puesta en marcha de este instrumento.