Predictors for mortality due to acute exacerbation of COPD in primary care: Derivation of a clinical prediction rule in a multicentre cohort study.

BACKGROUND: In primary care (PC), 80% of the acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are treated. However, no predictive model has been derived or validated for use in PC to help general practitioners make decisions about these patients. OBJECTIVES: To derive a clinical prediction rule for mortality from any cause 30 days after the last PC visit. METHODS: Between December 2013 and November 2014, we performed a cohort study with people aged 40 and over who were treated for AECOPD in 148 health centres in Spain. We recorded demographic variables, past medical history, signs, and symptoms of the patients and derived a logistic regression model. RESULTS: In the analysis, 1,696 cases of AECOPD were included and 17 patients (1%) died during follow-up. A clinical prediction rule was derived based on the exacerbations suffered in the last 12 months, age, and heart rate, displaying an area under the receiver operating characteristic curve of 0.792 (95% confidence interval, 0.692-0.891) and good calibration. CONCLUSION: This rule stratifies patients into three categories of risk and suggests to the physician a different action for each category: managing low-risk patients in PC, referring high-risk patients to hospitals and taking other criteria into account for decision-making in patients with moderate risk. These findings suggest that it is possible to accurately estimate the risk of death due to AECOPD without complex devices. Future studies on external validation and impact assessment are needed before this prediction rule may be used in clinical practice.

Violencia del hombre contra una mujer. Dos modalidades diversas / Violence of a man against a woman. Two different modalities

Este artículo se inscribe dentro del trabajo que se viene desarrollando en el marco de un proyecto de investigación UBACyT sobre la función psíquica del crimen en de la economía libidinal. A partir de allí describe al menos dos perfiles de agresores diversos al interior de lo que se denomina violencia de género, especificando la misma en torno de la violencia que un hombre ejerce contra una mujer con la que mantiene un vínculo de pareja (mediare o no la convivencia entre ambos). El trabajo identifica dos perfiles distintos de ofensores, correspondiéndose cada uno con una forma específica de ejercicio de la violencia del hombre contra una mujer. Se verá que cada uno implica una distinta forma de lazo vincular y muchas veces, un desenlace también diverso. A partir de allí sitúa también el lugar diferencial en el que queda situado el partenaire mujer respecto de ese hombre: como soporte narcisista en un caso, como objeto denigrado en el otro. La relevancia del planteo radica en situar el fenómeno de la llamada violencia de género desde una perspectiva clínica que permita identificar el tipo particular de lazo entre los miembros de la pareja para poder pensar a partir de allí la intervención posible

This article is part of the work being carried out within the framework of an UBACyT research project which is about the psychic function of crime in the libidinal economy. It describes at least two profiles of different aggressors within what is called gender violence, specifying the same around the violence that a man exercises against a woman with whom he maintains a relationship (whether or not they live together Between both). The work identifies two different profiles of offenders, each corresponding to a specific form of violence by men against women. It will be seen that each implies a different form of bonding and many times, a different outcome as well. From there, he also locates the differential place in which the female partner is situated with respect to that man: as a narcissistic support in one case, as a denigrated object in the other. The relevance of the proposal lies in locating the phenomenon of so-called gender violence from a clinical perspective that allows us to identify the particular type of bond between the members of the couple in order to be able to think about the possible intervention from there

Room temperature sintering of polar ZnO nanosheets: II-mechanism.

In a previous work by the authors (A. Fernández-Pérez el al., Room temperature sintering of polar ZnO nanosheets: I-evidence, 2017, DOI: 10.1039/C7CP02306E), polar ZnO nanosheets were stored at room temperature under different atmospheres and the evolution of their textural and crystal properties during storage was followed. It was found that the specific surface area of the nanosheets drastically decreased during storage, with a loss of up to 75%. The ZnO crystals increased in size mainly through the partial merging of their polar surfaces at the expense of narrow mesoporosity, in a process triggered by the action of moisture, oxygen and, in their absence, by light. In the present work, a set of spectroscopic techniques (FTIR, Raman and XPS) has been used in an attempt to unravel the mechanism behind this spontaneous sintering process. The mechanism starts with the molecular adsorption of water, which takes place on Zn atoms close to oxygen vacancies on the (100) surface, where H2O dissociates to form two hydroxyl groups and to heal one oxygen vacancy. This process triggers the room temperature migration of Zn interstitials towards the outer surface of the polar region. What were previously interstitial Zn atoms now gradually occupy the mesopores, with interstitial oxygen being used to build up the O sublattice until total occupancy of the narrow mesoporosity is achieved.

Room temperature sintering of polar ZnO nanosheets: I-evidence.

Polar ZnO nanosheets of a high specific surface area (∼120 m2 g-1) were subjected to storage under different atmospheres at room temperature and analyzed for changes in their textural and crystal properties. During their storage under laboratory conditions (in closed transparent polypropylene vials kept under the light of the laboratory on worktop tables) the nanosheets lost up to 75% of their specific surface area in approximately two months, with most of the loss occurring during the first two weeks. The narrow mesoporosity (∼5 nm pore size) became filled with ZnO during the process. No loss or gain in weight was detected. The loss of specific surface area took place under all of the atmospheres assayed, in the following order: moist air (with or without light) > moist CO2-free atmosphere (with or without light and/or oxygen) > dry CO2-free oxygen-containing atmosphere (with or without light) > dry inert atmosphere (with light) > dry inert atmosphere (in the dark). During storage the ZnO crystals grew mainly by the partial merging of their polar surfaces in a process triggered by the action of moisture, oxygen and, in the absence of these two agents, light. The mechanism of this intriguing phenomenon will be analyzed in detail in the second part of this work.

Screening for Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus, and Treponema pallidum by Blood Testing Using a Bio-Flash Technology-Based Algorithm before Gastrointestinal Endoscopy.

Currently, conventional enzyme immunoassays which use manual gold immunoassays and colloidal tests (GICTs) are used as screening tools to detect Treponema pallidum (syphilis), hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus type 1 (HIV-1), and HIV-2 in patients undergoing surgery. The present observational, cross-sectional study compared the sensitivity, specificity, and work flow characteristics of the conventional algorithm with manual GICTs with those of a newly proposed algorithm that uses the automated Bio-Flash technology as a screening tool in patients undergoing gastrointestinal (GI) endoscopy. A total of 956 patients were examined for the presence of serological markers of infection with HIV-1/2, HCV, HBV, and T. pallidum The proposed algorithm with the Bio-Flash technology was superior for the detection of all markers (100.0% sensitivity and specificity for detection of anti-HIV and anti-HCV antibodies, HBV surface antigen [HBsAg], and T. pallidum) compared with the conventional algorithm based on the manual method (80.0% sensitivity and 98.6% specificity for the detection of anti-HIV, 75.0% sensitivity for the detection of anti-HCV, 94.7% sensitivity for the detection of HBsAg, and 100% specificity for the detection of anti-HCV and HBsAg) in these patients. The automated Bio-Flash technology-based screening algorithm also reduced the operation time by 85.0% (205 min) per day, saving up to 24 h/week. In conclusion, the use of the newly proposed screening algorithm based on the automated Bio-Flash technology can provide an advantage over the use of conventional algorithms based on manual methods for screening for HIV, HBV, HCV, and syphilis before GI endoscopy.

Responsabilidad en la psicosis. Psicoanálisis y derecho penal / Responsibility in psychosis. Psychoanalysis and criminal law

Esta publicación dará cuenta de los resultados de la investigación desarrollada en el marco del Doctorado en Psicología de la UBA, cuya tesis se titula "Responsabilidad y Psicosis. Aportes del Psicoanálisis al Derecho Penal", y que ha centrado su pregunta en torno de la noción de responsabilidad en el punto en que ésta permite un cruce paradojal entre el campo del Derecho penal y el del Psicoanálisis. De esta manera, el escrito enumera las distintas variantes de la responsabilidad en la psicosis con relación a un crimen realizado bajo la modalidad del forzamiento a la acción al tiempo que menciona los ejes sobre los cuales la investigación planteara la revisión de los criterios de comprensión de la criminalidad y dirección de la acción con los que el artículo 34 inc.1° del Código Penal cierne el punto de exceptuación de la culpabilidad jurídica. Asimismo formula la concepción de responsabilidad que se desprende de la investigación y que permite a partir de allí repensar la dogmática de la culpabilidad jurídica.

This publication will report on the results of research carried out under the Doctorate in Psychology from the UBA, whose thesis is titled "Responsibility and psychosis. Contributions of psychoanalysis to the Criminal Law", and has focused its question around the notion of responsibility at the point where it allows paradoxical cross between the field of criminal law and Psychoanalysis. Thus, the letter lists the different variants of responsibility in psychosis in relation to a crime done in the form of the forcing action while mentions the axis on which the research raised the revised criteria comprehension crime and direction of action with Article 34 of the Penal Code Inc.1 hovering point exceptuación of legal guilt. Also formulated the concept of responsibility that emerges from research and from there allows rethink dogmatic legal culpability.

Laryngeal measurements and diagnostic tools for diagnosis of chronic obstructive pulmonary disease.

PURPOSE: The purpose of this study was to evaluate sensitivity, specificity, and positive and negative likelihood ratios of laryngeal height, lung function, and diagnostic questionnaires for screening and diagnosis of chronic obstructive pulmonary disease (COPD). METHODS: We undertook a cross-sectional study of 233 people aged between 40 and 75 years. Measured variables were age, sex, weight, height, body mass index, tobacco use, maximum laryngeal height, and spirometry, and we administered a COPD questionnaire and the Lung Function Questionnaire. RESULTS: For laryngeal height, we found a positive likelihood ratio of 5.21, and for the Lung Function Questionnaire, we found a negative likelihood ratio of 0.10. Combining a maximum laryngeal height of ≤4 cm with Lung Function Questionnaire findings of ≤18 yielded a positive likelihood ratio of 29.06, and a negative likelihood ratio of 0.26. CONCLUSIONS: The intrinsic validity of the lung function questionnaire makes it useful for screening. Combining Lung Function Questionnaire results and laryngeal height can help confirm or dismiss COPD.

Complejo de castración y Edipo en la niña: lógica de las operaciones respecto de la falta / Castration complex and Oedipus in the girl: logic operations over the lack

El recorrido del texto intenta retomar algunos de los lugares en los que tanto Freud como Lacan interrogan y responden respecto del devenir mujer de la niña. A tal efecto el desarrollo del artículo retoma como ejes centrales los desarrollos de la conferencia freudiana sobre la femineidad tanto como los aportes lacanianos sobre las categorías de la falta de objeto en relación con los tres tiempos lógicos del Edipo del lado de la niña. Los aportes del texto intentan pensar una lógica que permita ubicar la secuencia de la subjetivación por parte de la niña de su relación con la falta. En tal sentido, la secuencia lógica que el texto ubica es la siguiente: privación de la madre –castración en la niña –castración en la madre- privación de la niña. Por último el trabajo del duelo por el falo viene a situar los dos desasimientos libidinales necesarios –la madre y el padre- reubicándolos en el campo de la significación fálica.

Estudio preliminar: lo real de la responsabilidad / Preliminary estudy: The real thing of liability

El escrito realiza un recorrido por el texto de Nietzsche sobre la genealogía de la moral con miras a encontrar alguna punta para pensar la responsabilidad en Freud. Así el artículo sigue en su formulación la lógica del contrapunto. Toma la formulación nietzscheana sobre la responsabilidad como capacidad para hacer promesas rescatando la dimensión simbólica de la misma hasta ubicar su núcleo más real. De ese modo sigue los lineamientos que el filósofo traza en torno al dolor y su relación con la voluntad hasta conducir a la idea de voluptuosidad vinculada a la culpa. Ubica finalmente la vertiente real de la responsabilidad ubicada directamente por Freud al interrogarse por la posición que el sujeto puede asumir respecto a la oscura y enigmática satisfacción de la pulsión de muerte que lo habita.

The brief takes a journey through the text of Nietzsche on the genealogy of morality in order to find some point to think about responsibility in Freud.Nietzschean formulation takes on the responsibility and ability to make promises rescuing the symbolic dimension of it to locate your actual nucleus. Just follow the guidelines that the philosopher draws about pain and its relation to the will to lead to the idea of pleasure linked to guilt.Finally locates the real side of the responsibility placed directly by Freud to interrogate the position that the subject can take on the dark and mysterious satisfaction of the death drive that inhabits it.