Epidemiology and susceptibility to antimicrobial agents of the main Nocardia species in Spain.

Objectives: The aims of this study were to explore the clinical distribution, by species, of the genus Nocardia and to assess the antimicrobial susceptibilities of the 10 most prevalent species identified in Spain. Methods: Over a 10 year period (2005-14), 1119 Nocardia strains were molecularly identified and subjected to the Etest. The distribution and resistance trends over the sub-periods 2005-09 and 2010-14 were also examined. Results: Of the strains examined, 82.9% belonged to the following species: Nocardia cyriacigeorgica (25.3%), Nocardia nova (15.0%), Nocardia abscessus (12.7%), Nocardia farcinica (11.4%), Nocardia carnea (4.3%), Nocardia brasiliensis (3.5%), Nocardia otitidiscaviarum (3.1%), Nocardia flavorosea (2.6%), Nocardia rhamnosiphila (2.6%) and Nocardia transvalensis (2.4%). Their prevalence values were similar during 2005-09 and 2010-14, except for those of N. abscessus , N. farcinica and N. transvalensis , which fell significantly in the second sub-period ( P ≤ 0.05). The major location of isolation was the respiratory tract (∼86%). Half (13/27) of all strains from the CNS were N. farcinica . Significant differences in MIC results were recorded for some species between the two sub-periods. According to the CLSI's breakpoints, low resistance rates (≤15%) were recorded for seven species with respect to cefotaxime, imipenem and tobramycin; five species showed similar rates with respect to trimethoprim/sulfamethoxazole. Linezolid and amikacin were the most frequently active agents. Conclusion: The accurate identification of the infecting species and the determination of its susceptibility to antimicrobial agents, given the large number of strains with atypical patterns, are crucial if patients with nocardiosis are to be successfully treated.

Unequal effect of ethanol-water on the stability of ct-DNA, poly[(dA-dT)]2 and poly(rA)·poly(rU). Thermophysical properties.

Ethanol affects unequally the thermal stability of DNA and RNA. It stabilizes RNA, while destabilizing DNA. The variation of the relative viscosity (η/η0) of [poly(dA-dT)]2 with temperature unveils transitions close to the respective denaturation temperature, calculated spectrophotometrically and calorimetrically. From the raw data densities and speeds of sound, the volumetric observables were calculated. In all cases studied, a change in sign from low to high ethanol content occurred for both partial molar volume (ϕV) and partial molar adiabatic compressibility (ϕK(S)). The minima, close to 10%, should correspond to the highest solvation and the maxima, close to 30%, to the lowest solvation. For 40-50% ethanol, the solvation increases again. The complex structure of ethanol-water, for which changes are observed in regions close to such critical concentrations, justifies the observed behaviour. The variation of ϕV and ϕK(S) was sharper for RNA compared with respect to DNA, indicating that the solvation sequence is poly(rA)·poly(rU) < ct-DNA < [poly(dA-dT)]2.

The reach and rationale for community health fairs.

Latinos living in the USA account for one third of the uninsured population and face numerous cultural, linguistic, and financial barriers to accessing healthcare services. Community health fairs have developed to address the unmet need for no- and low-cost services that target prevention and education among underserved communities. The current research describes an ongoing effort in a community in Southern California and examines the barriers to health care among participants registering to receive free breast health screenings, one of the major services offered at a 2010 health fair. A total of 186 adult Latina women completed a brief questionnaire assessing their healthcare utilization and self-reported barriers to engaging in preventive and screening services. Approximately two thirds of the participants reported never receiving or having more than 2 years passing since receiving a preventive health check-up. Participants identified cost (64.5%) and knowledge of locations for services (52.3%) as the primary barriers to engaging in routine healthcare services. Engaging with health professionals represents a leading way in which adults obtain health information; health fairs offering cancer health screenings represent a culturally appropriate venue for increased cancer health equity. Implications of the current research for future health fairs and their role in community cancer education are discussed.

Focus group discussions in community-based participatory research to inform the development of a human papillomavirus (HPV) educational intervention for Latinas in San Diego.

The purpose of this paper is to demonstrate the usefulness of formative focus groups as a community-based participatory research (CBPR) method in developing cancer education programs. Two focus groups were conducted according to CBPR principles, in order to develop a community-competent human papillomavirus (HPV)/cervical cancer educational program for Latinas living in the USA/Mexico border region. Focus group participants were 18 female Mexican American community health advisors. Participants reported that there is limited information and many myths about HPV and the vaccine in the Latino/Latina community, along with many barriers to acceptance of HPV/cervical cancer-related information. Furthermore, participants discussed their recommendations for the development of a culturally appropriate HPV educational program. From these data, we have a better understanding of the HPV/cervical cancer educational approach that will be most accepted in the community and what key information needs to be provided to women who participate in the program, which reinforces the importance of the CBPR approach to the formative phase of cancer education program development.

The impact of allergic rhinitis on symptoms, and quality of life using the new criterion of ARIA severity classification.

INTRODUCTION: Allergic rhinitis (AR) is a common disease with major socieconomic burden and a significant impact on quality of life. OBJECTIVE: The objective of the study was to assess the impact of AR severity, using the modified ARIA (m-ARIA) severity criterion in order to discriminate among moderate and severe AR, in symptoms and quality of life assessed with the questionnaire ESPRINT-15. METHODS: The specific quality of life questionnaire (ESPRINT-15) was applied in over thousand untreated RA patients. Severity was evaluated by the m-ARIA classification, which categorizes AR as mild, moderate, and severe. Nasal symptoms were evaluated by using categorized (none, low, middle, and high) Total Four Symptom Score (T4SS). RESULTS: Using the m-ARIA severity classification, significant differences in quality of life, both global score and specific domains, and categorized T4SS were found among the AR severity groups. CONCLUSION: Modified ARIA severity classification in mild, moderate, and severe allergic rhinitis clearly discriminates the impact of AR in all domains of quality of life and categorized symptom`s score.

The Effect of a Learning Partner Model-Based Program on Spreading Cancer Prevention Knowledge Using Community Health Volunteers in Japan.

OBJECTIVES: This study examines the implementation and short-term effects of a Learning Partner Model (LPM)-based educational program on cancer prevention and control information for community health volunteers in Japan. METHODS: The program was undertaken by 3 local governments in collaboration with a government initiative and offered a 90-min group workshop to community health volunteers. Community health volunteers (primary participants) recruited in turn friend or family members (secondary participants) with whom they were prepared to share the content of the workshop with the help of printed materials received in the workshop. We conducted self-administered paper and pencil questionnaire surveys before, immediately after, and 3 months after the workshop. The t-test, Fisher's exact test, paired t-test, and McNemar test were used to compare the 2 groups' demographic characteristics and healthy habits at pretest. Repeated measures ANOVA was used to compare cancer prevention knowledge between groups and over time. RESULTS: Of 142 participants, 107 pairs of learning partners (primary and corresponding secondary participant) completed all questionnaires. All primary participants and 37.4% of the secondary participants were women, and 57.9% of the learning partners were spouses. The results showed significantly higher correct answers on the cancer-prevention knowledge questions in the post-workshop and follow-up surveys compared to the pre-workshop survey (P < .001). The increase in knowledge was observed in all learning-partner groups in all 3 sites. CONCLUSION: The study demonstrates a promising strategy that can be adapted to the health needs of the community beyond cancer prevention and control, building on the efforts of local governments and government health initiatives.

Morphological rational operator for contrast enhancement.

Contrast enhancement is an important task in image processing that is commonly used as a preprocessing step to improve the images for other tasks such as segmentation. However, some methods for contrast improvement that work well in low-contrast regions affect good contrast regions as well. This occurs due to the fact that some elements may vanish. A method focused on images with different luminance conditions is introduced in the present work. The proposed method is based on morphological transformations by reconstruction and rational operations, which, altogether, allow a more accurate contrast enhancement resulting in regions that are in harmony with their environment. Furthermore, due to the properties of these morphological transformations, the creation of new elements on the image is avoided. The processing is carried out on luminance values in the u'v'Y color space, which avoids the creation of new colors. As a result of the previous considerations, the proposed method keeps the natural color appearance of the image.

Diagnosis and treatment of grass pollen-induced allergic rhinitis in specialized current clinical practice in Spain.

Allergic rhinitis (AR) is the leading cause of consultation at the allergy specialist's office, but detailed, reliable, and validated clinical data on this condition are limited. This study was designed to define the clinical features, diagnostic methods, and therapeutic approaches of patients with AR induced by grass pollen in Spain. Two hundred twelve specialists participated in a multicenter, observational, epidemiologic, questionnaire-based study. Each investigator had to recruit at least two patients consulting for the first time and with a diagnosis of AR induced by grass pollen. Five hundred twenty-four patients (52% men; mean age, 29.3 years) with grass pollen-induced rhinitis (mean disease duration, 8.7 years) were recruited. Just 18.4% of patients reported that their symptom status had improved since the beginning of the condition, 89.4% had moderate-severe rhinitis (Allergic Rhinitis and Its Impact on Asthma classification) and 35.1% had concomitant bronchial asthma. For 52.1% of patients, control of symptoms with previous drug treatment was poor. Most of the patients were polysensitized to other pollens (sensitization to olive tree pollen, 57.1%). Oral antihistamines (97.3%) and nasal corticosteroids (82.3%) were the most frequently prescribed drugs and 43.1% of patients received specific immunotherapy. The clinical profile for the majority of Spanish patients consulting an allergy specialist for AR induced by grass pollen corresponds to a young adult with a lengthy moderate-severe rhinitis, often accompanied by bronchial asthma. Their symptoms progressively worsen and rhinitis is poorly controlled by symptomatic treatment. Oral antihistamines and nasal corticosteroids are the most frequently used therapeutic approaches and less than one-half receive specific immunotherapy.

Validation of the DECA criteria for allergic conjunctivitis severity and control.

BACKGROUND: Allergic conjunctivitis (AC) is usually associated to allergic rhinitis (AR), but the severity and control of ocular symptoms should be assessed independently to improve diagnosis and treatment. The criteria from the Spanish consensus document on allergic conjunctivitis (DECA) aimed to be used as a patient-reported instrument for AC management. Here we validate these criteria for classifying AC severity and defining its control following COSMIN guidelines recommendations. METHODS: Patients with moderate or severe AR [reflective total nasal symptom score (rTNSS) score ≥ 8] and concomitant AC were recruited from hospitals in Spain. Patients were classified according to the severity of ocular symptoms as mild, moderate, or severe, and classified with respect to control as controlled and non-controlled, using the DECA criteria. To validate these criteria, comparisons with the validated modified allergic rhinitis and its impact on asthma (mARIA), reflective total ocular symptom score (rTOSS), rhinitis control assessment test (RCAT), ESPRINT-15 questionnaires, a conjunctival hyperemia scale and a visual analogue scale (VAS) for ocular symptoms were performed. RESULTS: A total of 128 patients participated in the validation. Mean age was 34.4 ± 12.1 years; 72.7% were women. The DECA criteria showed a good discriminant validity, reflecting a high capacity to differentiate between mild, moderate, and severe patients, and controlled from uncontrolled patients. A strong association between AC and AR was reflected in the comparison between the DECA and the mARIA criteria (p < 0.0001). The DECA criteria for severity and control presented satisfactory properties for longitudinal validity and responsiveness. CONCLUSIONS: Validation of the DECA criteria for severity and control of AC suggested that it can be useful in the evaluation of eye symptoms and follow-up of therapies.

Allergic respiratory disease (ARD), setting forth the basics: proposals of an expert consensus report.

BACKGROUND: The variability of symptoms observed in patients with respiratory allergy often hampers classification based on the criteria proposed in guidelines on rhinitis and asthma. OBJECTIVES: We assessed specific aspects of allergic respiratory disease (ARD) that are not explicitly addressed in the guidelines in order to issue specific recommendations and thus optimize clinical practice. METHODS: Using the Delphi technique, 40 Spanish allergists were surveyed to reach consensus on 71 items related to ARD. RESULTS: Consensus was achieved for 95.7% of the items. These included the following: the clinical manifestations of ARD are heterogeneous and individual airborne allergens can be related to specific clinical profiles; the optimal approach in patients with ARD is based on the global assessment of rhinoconjunctivitis and asthma; aeroallergens are largely responsible for the clinical features and severity of the disease; and clinical expression is associated with the period of environmental exposure to the allergen. Pharmacological treatment of ARD is often based on the intensity of symptoms recorded during previous allergen exposures and cannot always be administered following a step-up approach, as recommended in clinical practice guidelines. Allergen immunotherapy (AIT) is the only option for overall treatment of respiratory symptoms using an etiological approach. AIT can modify the prognosis of ARD and should therefore be considered a valuable first-line treatment. CONCLUSIONS: The present study highlights gaps in current asthma and rhinitis guidelines and addresses specific aspects of ARD, such as global assessment of both asthma and rhinitis or the specific role of variable allergen exposure in the clinical expression of the disease.

Detection and measurement of the intracellular calcium variation in follicular cells.

This work presents a new method for measuring the variation of intracellular calcium in follicular cells. The proposal consists in two stages: (i) the detection of the cell's nuclei and (ii) the analysis of the fluorescence variations. The first stage is performed via watershed modified transformation, where the process of labeling is controlled. The detection process uses the contours of the cells as descriptors, where they are enhanced with a morphological filter that homogenizes the luminance variation of the image. In the second stage, the fluorescence variations are modeled as an exponential decreasing function, where the fluorescence variations are highly correlated with the changes of intracellular free Ca(2+). Additionally, it is introduced a new morphological called medium reconstruction process, which helps to enhance the data for the modeling process. This filter exploits the undermodeling and overmodeling properties of reconstruction operators, such that it preserves the structure of the original signal. Finally, an experimental process shows evidence of the capabilities of the proposal.

Is the physician's behavior in dyslipidemia diagnosis in accordance with guidelines? Cross-sectional ESCARVAL study.

BACKGROUND: Clinical inertia has been defined as mistakes by the physician in starting or intensifying treatment when indicated. Inertia, therefore, can affect other stages in the healthcare process, like diagnosis. The diagnosis of dyslipidemia requires ≥2 high lipid values, but inappropriate behavior in the diagnosis of dyslipidemia has only previously been analyzed using just total cholesterol (TC). OBJECTIVES: To determine clinical inertia in the dyslipidemia diagnosis using both TC and high-density lipoprotein cholesterol (HDL-c) and its associated factors. DESIGN: Cross-sectional. SETTING: All health center visits in the second half of 2010 in the Valencian Community (Spain). PATIENTS: 11,386 nondyslipidemic individuals aged ≥20 years with ≥2 lipid determinations. MEASUREMENT VARIABLES: Gender, atrial fibrillation, hypertension, diabetes, cardiovascular disease, age, and ESCARVAL training course. Lipid groups: normal (TC<5.17 mmol/L and normal HDL-c [≥1.03 mmol/L in men and ≥1.29 mmol/L in women], TC inertia (TC≥5.17 mmol/L and normal HDL-c), HDL-c inertia (TC<5.17 mmol/L and low HDL-c), and combined inertia (TC≥5.17 mmol/L and low HDL-c). RESULTS: TC inertia: 38.0% (95% CI: 37.2-38.9%); HDL-c inertia: 17.7% (95% CI: 17.0-18.4%); and combined inertia: 9.6% (95% CI: 9.1-10.2%). The profile associated with TC inertia was: female, no cardiovascular risk factors, no cardiovascular disease, middle or advanced age; for HDL-c inertia: female, cardiovascular risk factors and cardiovascular disease; and for combined inertia: female, hypertension and middle age. LIMITATIONS: Cross-sectional study, under-reporting, no analysis of some cardiovascular risk factors or other lipid parameters. CONCLUSIONS: A more proactive attitude should be adopted, focusing on the full diagnosis of dyslipidemia in clinical practice. Special emphasis should be placed on patients with low HDL-c levels and an increased cardiovascular risk.

Microwave dielectric relaxation spectroscopy study of alkan-1-ol/alkylbenzoate binary solvents.

The structure and dynamics of alkan-1-ol/alkylbenzoate binary mixtures have been studied by microwave dielectric relaxation spectroscopy in the 200 MHz to 20 GHz frequency range. The binary mixtures of methanol, ethanol, propan-1-ol, butan-1-ol, and pentan-1-ol with methyl, ethyl, propyl, and butyl benzoates were studied at 298.15 K. The relaxational response of the pure alcohols, pure esters, and their binary mixtures over the full composition range is properly described by the Havriliak-Negami model. The alcohol content, alcohol length, and alkyl side-chain effects on the relaxational properties have been studied for these mixtures over the whole composition range. From the experimental readings, the effective and the corrective Kirkwood and Bruggeman correlation factors have been calculated. The data gathered have been interpreted in terms of the alkyl side-chain effect and their reliance on the mixture composition.

Heat capacity behavior and structure of alkan-1-ol/alkylbenzoate binary solvents.

Heat capacities for the binary mixtures of methanol with (C(1)-C(4)) alkylbenzoates and methylbenzoate with (C(1)-C(11)) alkan-1-ols have been measured over the whole composition range at 298.15 K under atmospheric pressure. From the experimental measurements, the derived excess molar heat capacities and partial excess molar heat capacities at infinite dilution have been calculated. A Redlich-Kister-type equation was fitted to these data, and the fitting parameters and standard deviations have been evaluated. Likewise, the IR spectra for the same systems have been recorded as a function of composition. The sets of experimental data gathered contribute to shed light onto the solvent structure and the underlying molecular interactions between the mixture constituents. The conclusions drawn have been established in terms of solute-solvent and solvent-solvent interactions and the ensuing structural effects between the solvent constituents.

Preferential solvation in alkan-1-ol/alkylbenzoate binary mixtures by solvatochromic probes.

The binary mixtures of methanol with (C(1)-C(4)) alkylbenzoates and of (C(1), C(3), C(5), C(7), C(9), C(11)) alkan-1-ols with methylbenzoate were used as solvents to look into the preferential solvation and intermolecular interactions of the solvatochromic indicators 2-nitroanisole, 4-nitroaniline, 4-nitrophenol, and Reichardt's dye by UV-vis measurements. The experimental data at 298.15 K have served to deduce the corresponding Reichardt and Kamlet-Taft parameters of the mixed solvents. The solvation effects exerted on the solvatochromic probes by the solvents used, either pure or binary mixed, were analyzed by means of the preferential solvation model. Likewise, the (1)H NMR, (13)C NMR, and IR spectroscopic parameters measured for the mixed solvents corroborate the structural effects. The sets of experimental data gathered shed abundant light on the underlying solute-solvent and solvent-solvent interactions. The alkanol/methylbenzoate mixtures display stronger solvation ability than the pure solvents.

Epidemiology of allergic rhinitis caused by grass pollen or house-dust mites in Spain.

BACKGROUND: Although the prevalence of allergic rhinitis (AR) is increasing, relatively little is known about patient characteristics in Spain. The aim of this study was to investigate the clinical profile and therapeutic strategies in patients attending Spanish specialists for AR caused by grass pollen or house-dust mites (HDMs). METHODS: This was a multicenter cross-sectional epidemiological study of consecutive patients aged ≥5 years with confirmed diagnosis of AR caused by grass pollen or HDMs attending allergy specialists throughout Spain. Demographic and clinical data and information on treatment were collected. RESULTS: Data from 1043 patients were analyzed (524 with grass pollen allergy and 519 with HDM allergy; mean age, 27.1 years). Three-quarters had persistent AR as per the Allergic Rhinitis and Its Impact on Asthma (ARIA) definition, with disease duration of >2 years in 94.3% of those with pollen allergy and 85.5% of those with HDM allergy. Approximately 38% had concurrent asthma. Over one-half of the patients were considered to have gotten worse since the first onset of symptoms. In total, 51.5% did not achieve good disease control with pharmacotherapy and 47.7% were treated with immunotherapy (52.2% of HDM allergic patients and 43.2% of grass pollen-allergic patients). CONCLUSION: The duration of AR in patients attended for the first time by specialists is long and, in general, the disease does not improve over time and is often not well controlled with pharmacologic interventions. Less than one-half of patients receive allergen-specific immunotherapy that is more often prescribed in HDM allergy.

Evaluation of proton activity in microemulsions by a kinetic probe.

The decomposition reaction of the purple dye murexide in acidic media is used as a probe indicator for protons in nonionic microemulsions. The reaction kinetics primarily rely on the proton concentration and permit assessment of the proton activity in the nonionic microemulsions of water/cyclohexane/Igepal and water/heptane/Igepal. The experiments performed in the two microemulsions covered a wide range of water-to-oil mass fraction for the two systems. The kinetic runs were monitored under pseudo-first order conditions by the stopped-flow technique. The equilibrium constants for the formation of purpuric acid and the kinetic constants for the ensuing decomposition reaction fulfill a trend consistent with the micro compartmentalized nature of the multicomponent medium, and support the use of murexide as an indicator of the proton activity in microemulsions.

Phosphine and thiophene cyclopalladated complexes: hydrolysis reactions in strong acidic media.

The mechanisms for the hydrolysis of organopalladium complexes [Pd(CNN)R]BF(4) (R=P(OPh)(3), PPh(3), and SC(4)H(8)) were investigated at 25 °C by using UV/Vis absorbance measurements in 10 % v/v ethanol/water mixtures containing different sulphuric acid concentrations in the 1.3-11.7 M range. In all cases, a biphasic behavior was observed with rate constants k(1obs), which corresponds to the initial step of the hydrolysis reaction, and k(2obs), where k(1obs)>k(2obs). The plots of k(1obs) and k(2obs) versus sulfuric acid concentration suggest a change in the reaction mechanism. The change with respect to the k(1obs) value corresponds to 35 %, 2 %, and 99 % of the protonated complexes for R=PPh(3), P(OPh)(3), and SC(4)H(8), respectively. Regarding k(2obs), the change occurred in all cases at about 6.5 M H(2)SO(4) and matched up with the results reported for the hydrolysis of the 2-acetylpyridinephenylhydrazone (CNN) ligand. By using the excess acidity method, the mechanisms were elucidated by carefully looking at the variation of k(i),(obs) (i=1,2) versus cH+. The rate-determining constants, k(0,A-1), k(0,A-2), and k(0,A-SE2) were evaluated in all cases. The R=P(OPh)(3) complex was most reactive due to its π-acid character, which favors the rupture of the trans nitrogen-palladium bond in the A-2 mechanism and also that of the pyridine nitrogen-palladium bond in the A-1 mechanism. The organometallic bond exerts no effect on the relative basicity of the complexes, which are strongly reliant on the substituent.