Wetting a superomniphobic porous system.

While important research has been focused on developing surfaces that do not wet, some textures with high-wetting resistance are familiar in other applications in which the opposite is needed. A multivalued surface, common in most fabrics or meshes, allows the invading gas-liquid interface to support relatively high imposed pressures and plays a key role in producing topographic elements that avoid wetting. Here we study experimentally and theoretically the critical pressure needed to move a liquid through a network of pores and show that, for small aperture size, wetting and leaking are typical first-order transitions, with a singular behavior at the omniphobic/omniphilic limit (θc = π/2).

Social support for elderly people over 65 years in Spain.

AIMS: To determine what social support is available in Spain to people over 65 who also dedicate hours of their time to the care of others who are older. BACKGROUND: Demographic and social changes are leading to growth of the population. The social support available to older people in the final stage of life affects their health. METHODS: A cross-sectional study was conducted involving the records of older, non-institutionalized individuals residing in Spain, obtained from the European Health Survey of 2014. The method of collecting information used in the European Survey was personal interviews assisted by a computer. RESULTS: The records of 6520 older people were studied; 40.1% of the participants studied had expressed the possibility of having three to five people available in case of a serious problem, and 83.6% reported that the rest of the people around them were very interested in what happens to them. With respect to care, only 7% of the older people studied mentioned performing care tasks. CONCLUSIONS: Social support is beneficial to older people, regardless of whether they perform care tasks, because it acts as a protective factor against problems such as loneliness, stress and depression. The profile of a primary caregiver in this age range is a married, middle-class woman with primary schooling who is caring for a first-degree relative. IMPLICATIONS FOR NURSING AND HEALTH POLICY: These data suggest that it is necessary for nurses to know about the needs of older people to implement societal measures of health promotion, prevention and education that favour social cohort. In addition, health policymakers should establish programmes that improve the social support of non-institutionalized older people.

Amino acid profiles of young adults differ by sex, body mass index and insulin resistance.

BACKGROUND AND AIMS: An increase in plasma branched-chain amino acids is associated with a higher risk of developing type 2 diabetes and cardiovascular diseases. However, little is known about the basal plasma amino acid concentrations in young adults. Our aim was to determine the plasma amino acid profiles of young adults and to evaluate how these profiles were modified by sex, body mass index (BMI) and insulin resistance (IR). METHODS AND RESULTS: We performed a transversal study with 608 Mexican young adults aged 19.9 ± 2.4 years who were applicants to the Universidad Autónoma de San Luis Potosí. The subjects underwent a physical examination and provided a clinical history and a blood sample for biochemical, hormonal and amino acid analyses. The women had higher levels of arginine, aspartate and serine and lower levels of α-aminoadipic acid, cysteine, isoleucine, leucine, methionine, proline, tryptophan, tyrosine, urea and valine than the men. The obese subjects had higher levels of alanine, aspartate, cysteine, ornithine, phenylalanine, proline and tyrosine and lower levels of glycine, ornithine and serine than the normal weight subjects. Subjects with IR (defined as HOMA > 2.5) had higher levels of arginine, alanine, aspartate, isoleucine, leucine, phenylalanine, proline, tyrosine, taurine and valine than the subjects without IR. Furthermore, we identified two main groups in the subjects with obesity and/or IR; one group was composed of amino acids that positively correlated with the clinical, biochemical and hormonal parameters, whereas the second group exhibited negative correlations. CONCLUSION: This study demonstrates that young adults with obesity or IR have altered amino acid profiles characterized by an increase in alanine, aspartate, proline and tyrosine and a decrease in glycine.

Good clinical practice recommendations for the diagnosis and treatment of gastroesophageal reflux disease. An expert review from the Asociación Mexicana de Gastroenterología.

INTRODUCTION: Gastroesophageal reflux disease (GERD) is very prevalent in the general population, with a broad spectrum of clinical manifestations, requiring accurate diagnosis and treatment. AIM: The aim of this expert review is to establish good clinical practice recommendations for the diagnosis and personalized treatment of GERD. METHODS: The good clinical practice recommendations were produced by a group of experts in GERD, members of the Asociación Mexicana de Gastroenterología (AMG), after carrying out an extensive review of the published literature and discussing each recommendation at a face-to-face meeting. This document does not aim to be a clinical practice guideline with the methodology such a document requires. RESULTS: Fifteen experts on GERD formulated 27 good clinical practice recommendations for recognizing the symptoms and complications of GERD, the rational use of diagnostic tests and medical treatment, the identification and management of refractory GERD, the overlap with functional disorders, endoscopic and surgical treatment, and GERD in the pregnant woman, older adult, and the obese patient. CONCLUSIONS: An accurate diagnosis of GERD is currently possible, enabling the prescription of a personalized treatment in patients with this condition. The goal of the good clinical practice recommendations by the group of experts from the AMG presented in this document is to aid both the general practitioner and specialist in the process of accurate diagnosis and treatment, in the patient with GERD.

Capillary deformations of bendable films.

We address the partial wetting of liquid drops on ultrathin solid sheets resting on a deformable foundation. Considering the membrane limit of sheets that can relax compression through wrinkling at negligible energetic cost, we revisit the classical theory for the contact of liquid drops on solids. Our calculations and experiments show that the liquid-solid-vapor contact angle is modified from the Young angle, even though the elastic bulk modulus (E) of the sheet is so large that the ratio between the surface tension γ and E is of molecular size. This finding indicates a new elastocapillary phenomenon that stems from the high bendability of very thin elastic sheets rather than from material softness. We also show that the size of the wrinkle pattern that emerges in the sheet is fully predictable, thus resolving a puzzle in modeling "drop-on-a-floating-sheet" experiments and enabling a quantitative, calibration-free use of this setup for the metrology of ultrathin films.

The Mexican consensus on fecal incontinence.

Fecal incontinence is the involuntary passage or the incapacity to control the release of fecal matter through the anus. It is a condition that significantly impairs quality of life in those that suffer from it, given that it affects body image, self-esteem, and interferes with everyday activities, in turn, favoring social isolation. There are no guidelines or consensus in Mexico on the topic, and so the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, neurogastroenterologists, and surgeons) to carry out the «Mexican consensus on fecal incontinence¼ and establish useful recommendations for the medical community. The present document presents the formulated recommendations in 35 statements. Fecal incontinence is known to be a frequent entity whose incidence increases as individuals age, but one that is under-recognized. The pathophysiology of incontinence is complex and multifactorial, and in most cases, there is more than one associated risk factor. Even though there is no diagnostic gold standard, the combination of tests that evaluate structure (endoanal ultrasound) and function (anorectal manometry) should be recommended in all cases. Treatment should also be multidisciplinary and general measures and drugs (lidamidine, loperamide) are recommended, as well as non-pharmacologic interventions, such as biofeedback therapy, in selected cases. Likewise, surgical treatment should be offered to selected patients and performed by experts.

One-year follow-up changes in weight are associated with changes in blood pressure in young Mexican adults.

OBJECTIVE: Increasing overweight and obesity rates in Mexico have been associated with increases in mortality from cardiovascular disease (CVD). This study assessed changes in body mass index (BMI) and body weight over 1 year, and explored whether these were associated with changes in CVD risk factors of blood pressure and fasting glucose in a cohort of young Mexican adults. STUDY DESIGN: Longitudinal data were obtained from a cohort of young Mexican adults applying to college. METHODS: Data were collected from college applicants for the 2008 academic year who re-applied in 2009. In total, 795 college applicants aged 18-20 years, of both sexes (48% males and 52% females), were included in the study. The screen included height, weight, and systolic (SBP) and diastolic (DBP) blood pressure measurements plus a blood draw following an overnight fast for fasting glucose. RESULTS: At baseline, 31.8% of the participants were overweight or obese. The mean 1-year change in body weight and BMI were 0.80 kg and 0.35 kg/m(2), respectively. One-year changes in body weight and BMI were associated with increased SBP and DBP for both men and women (P < 0.05), independent of baseline BMI. A weight gain of 5% or more was positively associated with increases in blood pressure among women (P < 0.05), but not among men. A weight loss of 5% or more was associated with reductions in SBP among women. CONCLUSIONS: One-year changes in weight were associated with changes in blood pressure.

Inertial lubrication theory.

Thin fluid films can have surprising behavior depending on the boundary conditions enforced, the energy input and the specific Reynolds number of the fluid motion. Here we study the equations of motion for a thin fluid film with a free boundary and its other interface in contact with a solid wall. Although shear dissipation increases for thinner layers and the motion can generally be described in the limit as viscous, inertial modes can always be excited for a sufficiently high input of energy. We derive the minimal set of equations containing inertial effects in this strongly dissipative regime.

Effect of interactions on vortices in a nonequilibrium polariton condensate.

We demonstrate the creation of vortices in a macroscopically occupied polariton state formed in a semiconductor microcavity. A weak external laser beam carrying orbital angular momentum (OAM) is used to imprint a vortex on the condensate arising from the polariton optical parametric oscillator (OPO). The vortex core radius is found to decrease with increasing pump power, and is determined by polariton-polariton interactions. As a result of OAM conservation in the parametric scattering process, the excitation consists of a vortex in the signal and a corresponding antivortex in the idler of the OPO. The experimental results are in good agreement with a theoretical model of a vortex in the polariton OPO.

Extrahepatic complications of non-alcoholic fatty liver disease: Its impact beyond the liver. / Complicaciones extrahepáticas de la enfermedad por hígado graso no alcohólico: impacto más allá del hígado.

Non-alcoholic fatty liver disease (NAFLD) is currently one of the main causes of chronic liver disease in Western countries, with a 25% prevalence reported in the general population worldwide. Visceral adiposity and liver fat promote a state of systemic inflammation, predisposing individuals with NAFLD to the extrahepatic pathologies of cardiovascular disease (the most common cause of death in patients with NAFLD), diabetes mellitus, chronic kidney disease, hypothyroidism, polycystic ovary syndrome, obstructive sleep apnea, and an increased risk for presenting with gastrointestinal and extraintestinal neoplasias. Different mechanisms between NAFLD and its association with extrahepatic diseases have been reported, and lipotoxicity is the main cause of inflammatory pathway activation that results in extrahepatic tissue damage.

Porous Nanogold/Polyurethane Scaffolds with Improved Antibiofilm, Mechanical, and Thermal Properties and with Reduced Effects on Cell Viability: A Suitable Material for Soft Tissue Applications.

The use of implants carries on a series of problems, among them infections, poor biocompatibility, high levels of cytotoxicity, and significant mechanical differences between implants and host organs that promote stress shielding effects. These problems indicate that the materials used to make implants must meet essential requirements and high standards for implantations to be successful. In this work, we present the synthesis, characterization and evaluation of the antibiofilm, mechanical, and thermal properties, and cytotoxic effect of a nanocomposite-based scaffold on polyurethane (PU) and gold nanoparticles (AuNPs) for soft tissue applications. The effect of the quantity of AuNPs on the antibacterial activity of nanocomposite scaffolds was evaluated against Staphylococcus epidermidis and Klebsiella spp., with a resulting 99.99% inhibition of both bacteria using a small quantity of nanoparticles. Cytotoxicity was evaluated with the T10 1/2 test against fibroblast cells. The results demonstrated that porous nanogold/PU scaffolds have no toxic effects on fibroblast cells to the 5 day exposition. With respect to mechanical properties, stress-strain curves showed that the compressive modulus and yield strength of PU scaffolds were significantly enhanced by AuNPs (by at least 10 times). This is due to changes in the arrangement of hard segments of PU, which increase the stiffness of the polymer. Thermogravimetric analysis showed that the degradation onset temperature rises with an increase in the quantity of AuNPs. These properties and characteristics demonstrate that porous nanogold/PU scaffolds are suitable material for use in soft tissue implants.

Universal and nonuniversal features in a model of city traffic.

The complex behavior that occurs when traffic lights are synchronized is studied. Two strategies are considered: all lights in phase, and a "green wave" with a propagating green signal. It is found that traffic variables such as traveling time, velocity, and fuel consumption, near resonance, follow critical scaling laws. For the green wave, it is shown that time and velocity scaling laws hold even for random separation between traffic lights. These results suggest the concept of transient resonances, which can be induced by adaptively changing the phase of traffic lights. This may be important to consider when designing strategies for traffic control in cities, where short trajectories, and thus transient solutions, are likely to be relevant.

[Summary of the GEIPC-SEIMC and GTEI-SEMICYUC recommendations for the treatment of infections caused by gram positive cocci in critical patients]. / Resumen de las recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos gram positivos en la paciente crítico

OBJECTIVE: In recent years there has been an increase in infections caused by gram-positive cocci in critical patients, together with a rapid development of resistance to the antibiotics which are normally used to treat them. The objective is to prepare an antibiotic treatment guide for the most common infections caused by gram positive cocci in critical patients. This guide will help in the decision-making process regarding the care of such patients. METHOD: Experts from two scientific societies worked together to prepare a consensus document. They were members of the Study Group on Infections in Critical Patients (GEIPC), which is part of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and the Infectious Diseases Working Group (GTEI), belonging to the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). There was a systematic review of the literature published up to September 2006 regarding this type of infections and the antibiotic treatments marketed to that date. An evidence grading system was applied according to the strength of the recommendation (categories A, B or C) and the level of evidence (categories I, II or III). Recommendations were given if there was consensus among the experts from both societies. RESULTS: The antibiotic regimens recommended for treating infections caused by gram-positive cocci were presented in the form of tables, showing the recommendation grade. Alternatives were given for allergic patients. The scientific basis supporting the aforementioned recommendations is explained within the text and the references upon which they are based are cited. CONCLUSIONS: A summary of an evidence-based practical guide for the treatment of infections caused by gram-positive cocci in critical patients is presented.

Mechanics of scars.

When a wound heals, as everyone has observed, it contracts, thickens and wrinkles the neighbouring skin, forming a scar. The morphology of the scar depends on the type of wound; an urgent tracheotomy leads to a very different scar than a carefully planned face lift. The surgical challenges of intrusive procedures such as removal of skin lesions, skin transplantation or grafting, and scar removal are complicated by the complex geometry and stress states in different parts of the body. We show that, for relatively general conditions, the nature of the localisation of the scar is determined by the background tension of the skin which can arrest the formation of wrinkles around a scar. Our physical experiments to simulate this procedure indicate that the region deformed by the defect has a characteristic length scale r* approximately 1 square root of tau, where tau is the natural tension of the skin.

Transition from isometric to stretching ridges in thin elastic films.

Isometric deformations in thin elastic films easily form ridges to connect large flat regions or facets. Depending on the forces applied or the boundary conditions imposed, these ridges can be isometric, with no stretching or "stretching ridges" when bending and stretching are required to relax the elastic energy. Here we study a simple configuration to observe the transition between an isometric ridge to the well-known stretching ridge observed in crumpled films, and obtain the parameters that determine the ridge type. Specifically, we show that the transversal size of a stretching ridge acts as a cutoff length scale: a ridge is isometric if its width is greater than this characteristic length.

Hemodynamic effects of oxygen therapy in patients with acute exacerbations of chronic obstructive pulmonary disease.

The effects of oxygen therapy in patients with stable COPD have been previously reported; however, the hemodynamic changes induced by oxygen therapy in patients during acute exacerbations of COPD are less well known. To investigate the hemodynamic effects of controlled oxygen therapy in patients with acute exacerbations of COPD shortly after arriving at the hospital, we studied 15 consecutive patients who came to the emergency room with acutely decompensated COPD that did not require mechanical ventilation. Patients were monitored with a pulmonary artery catheter and a radial artery catheter. Oxygen uptake was calculated by the modified Fick equation. Arterial and venous blood gas levels and hemodynamic parameters were measured while breathing room air (baseline) and after 30 min on oxygen therapy via face mask. Measurements were repeated after 24 and 48 h. The fractional concentration of oxygen in the inspired gas (FIO2) administered was adjusted to keep the PaO2 above 55 mm Hg. All patients had a PaO2 below 45 mm Hg at the beginning of the study. After 30 min of oxygen therapy, there was a significant (p < 0.05) increase in arterial oxygen saturation (from 62 +/- 16 to 87 +/- 9 percent), mixed-venous oxygen pressure (from 25 +/- 5 to 43 +/- 11 mm Hg), and oxygen delivery (from 11.1 +/- 3.7 to 19.3 +/- 8.9 ml/kg.min). Oxygen uptake did not change significantly (from 4.1 +/- 1.2 to 4.3 +/- 1.6 ml/kg.min). The oxygen extraction ratio decreased from 37.5 +/- 10.1 to 25.3 +/- 9.6 percent. These changes were maintained during the following 48 h. There were no significant changes in cardiac output and systemic vascular resistance. A trend toward lower values of pulmonary vascular resistance did not reach statistical significance. We conclude that oxygen therapy in patients with acute exacerbations of COPD that do not require mechanical ventilation increases oxygen delivery without changes in cardiac output or oxygen uptake.

Pneumonia in patients with severe burns : a classification according to the concept of the carrier state.

OBJECTIVE: To establish baseline values of pneumonia incidence and mortality and to distinguish primary endogenous from secondary endogenous and exogenous pneumonias in a homogeneous patient population with severe burns. DESIGN: Cohort study. SETTING: A six-bed burn ICU. PATIENTS: All patients of > or = 14 years admitted to the ICU between January 1995 and June 1996 with a total body surface area burn of > or = 20%. INTERVENTION: Collection of data on surveillance samples from throat and rectum on admission and twice weekly afterward, and pneumonias during the ICU stay. MEASUREMENTS AND RESULTS: Fifty-six patients fulfilled the criteria of the study. Mean age was 43 +/- 19.8 years; total body surface area burn, 41 +/- 18.2%; the area of full-thickness burn was 24 +/- 17.7%. Forty-one patients required mechanical ventilation. Twenty-seven patients (48%) experienced 37 episodes of pneumonia. Twenty-one pneumonias were of primary endogenous development, ie, caused by potential pathogens carried in the admission flora. There were 14 secondary endogenous and 2 exogenous infections caused by microorganisms acquired on the burn unit. Inhalation injury was identified in 26 patients. The pneumonia rate was two times higher in the subset of patients with inhalation injury compared with the group of patients without inhalation injury (p < 0.001). Overall mortality was 25%. CONCLUSIONS: This study shows that pneumonia in burn patients is mainly an endogenous problem. Interventions that prevent the development of endogenous infections deserve prospective evaluation in patients with severe burns.

Effectiveness and safety of enteral vancomycin to control endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit.

A prospective trial was undertaken to assess the effectiveness and safety of enteral vancomycin in controlling methicillin-resistant Staphylococcus aureus (MRSA) in an endemic setting. Over the 49 month period patients aged >14 years were enrolled, following admission to a medical/surgical intensive care unit (ICU) and expected to require ventilation for three days or more. A total of 799 patients were included in the trial. Period one, 1 July 1996-30 April 1997, (N=140), was observational. During period two, 1 May 1997-30 September 1998, (N=258), surveillance samples were obtained. MRSA carriers were isolated and received enteral vancomycin. During period three, 1 October 1998-31 July 2000, (N=400), all ventilated patients were given selective digestive decontamination (SDD) with polymyxin E, tobramycin, amphotericin B and vancomycin and four days of intravenous cefotaxime. The primary endpoints were: (1) incidence of patients with diagnostic samples positive for MRSA acquired on the ICU; (2) incidence of patients with vancomycin-resistant enterococci (VRE) in surveillance or diagnostic samples; (3) incidence of patients with samples positive for S. aureus with intermediate sensitivity to glycopeptides (GISA). The incidence of patients with MRSA in diagnostic samples were 31%, 14%, and 2% in periods one, two and three, respectively (P<0.001). There was a VRE outbreak involving 13 patients during period three. VRE disappeared with no change in policy. GISA was not detected. These findings support the effectiveness and safety of enteral vancomycin in the control of MRSA.

[Prevalence of HIV infection among drug users in Zuid-Limburg]. / Prevalentie van HIV-infectie onder druggebruikers in Zuid-Limburg.

OBJECTIVES: To assess the prevalence of HIV infection among intravenous (IDU) and non-intravenous drug users in Heerlen and Maastricht (Southern Netherlands), to detect subgroups of IDU with a higher risk of HIV infection, and to assess the risk of further spread of HIV. DESIGN: Cross-sectional study. SETTING: Heerlen, Kerkrade, Brunssum and Maastricht, the Netherlands. METHODS: Between August 15 and November 25, 1994, a saliva specimen and a short questionnaire were obtained from 449 drug users (340 IDU) in Heerlen (and environs) and Maastricht. Participants were recruited through methadone care (54%), syringe exchange (16%), a street prostitution project (3%), street recruitment (23%) and other drug users (4%). RESULTS: Of the 340 IDU 33 were infected (prevalence: 10% (95% confidence interval: 7-13)), among the 109 non-IDU no infections were found (0% (0-3)). IDU making use of the syringe exchange had a higher prevalence (odds ratio 3.13 (1.37-7.61)). In logistic regression analysis, this finding could not be explained by selection on more risky injecting. One in five currently injecting IDU reported having used someone else's used needle or syringe in the last 6 months. One in five IDU had a non-drug user as steady sexual partner. In sexual contacts between steady partners condom use was low. On the basis of self-reported serostatus it appeared that some infections have taken place in the last two years. CONCLUSIONS: The prevalence of HIV infections among IDU in Heerlen and Maastricht is about 10%. IDU using the syringe exchange have a higher prevalence. This means this prevention reaches the high-risk group, but probably can not avoid all infections. The risk of further spread among IDU is high. The risk of spread to non-IDU and non-drug users is present.