Introducción. Es un concepto generalizado que las infecciones respiratorias son estacionales, pero pocas veces se precisan localmente estos períodos de alta frecuencia en un país con diversidad de climas. Anticipar la temporada de neumonía a nivel local puede proveer de un mejor uso de recursos críticos. Objetivo. Examinar la variabilidad estacional en defunciones mensuales por neumonía en el Perú. Métodos. Estudio observacional retrospectivo de análisis de serie de tiempo para identificar períodos de alta mortalidad por neumonía en siete ciudades del Perú. Se revisaron registros administrativos del Ministerio de Salud sobre defunciones por neumonía durante los años 2003-2017. Se calcularon estadísticas descriptivas y se analizó mediante una serie de tiempo a escala mensual la frecuencia de defunciones por neumonía, precipitación acumulada, y la temperatura ambiental máxima y mínima. Resultados. El 94,4% de las defunciones por neumonía (N = 166 844) reportaron como causa «organismo no especificado», y el 75,6% eran adultos mayores de 65 años. En Tarma, Arequipa y Cusco la temperatura mínima tiene una correlación negativa con las defunciones por neumonía en todas las edades y al menos uno de los grupos de riesgo. En Iquitos la temperatura mínima tiene una correlación positiva con las defunciones en menores de 5 años. Pucallpa y Cajamarca no tuvieron correlaciones significativas. El clima de Lima es un caso particular. La distribución durante el año de las muertes por neumonía sugiere una secuencia norte-sur, mientras que el análisis espaciotemporal del clima sugiere un patrón que va de sur-norte. Conclusión. Existen diferentes patrones estacionales en diferentes ciudades y grupos de riesgo.

IMPORTANCE At least 13 medication-associated diethylene glycol (DEG) mass poisonings have occurred since 1937. To our knowledge, this is the first longitudinal study characterizing long-term health outcomes among survivors beyond the acute poisoning period. OBJECTIVE To characterize renal and neurologic outcomes among survivors of a 2006 DEG mass-poisoning event in Panama for 2 years after exposure. DESIGN, SETTING, AND PARTICIPANTS This prospective longitudinal study used descriptive statistics and mixed-effects repeated-measures analysis to evaluate DEG-poisoned survivors at 4 consecutive 6-month intervals (0, 6, 12, and 18 months). Case patients included outbreak survivors with a history of (1) ingestion of DEG-contaminated medication, (2) hospitalization for DEG poisoning, and (3) an unexplained serum creatinine level of 1.5 mg/dL or higher (to convert to micromoles per liter, multiply by 88.4) during acute illness or unexplained exacerbation of preexisting end-stage renal disease. MAIN OUTCOMES AND MEASURES Demographics, mortality, dialysis dependence, renal function, neurologic signs and symptoms, and nerve conduction studies. RESULTS Of the 32 patients enrolled, 5 (15.6%) died and 1 was lost to follow-up, leaving 26 patients at 18 months. Three (9.4%) missed 1 or more evaluations. The median age was 62 years (range, 15-88 years), and 59.4% were female. Three (9.4%) patients had preexisting renal failure. Enrollment evaluations occurred at a median of 108 days (range, 65-154 days) after acute illness. The median serum creatinine level for the 22 patients who were not dialysis dependent at time 0 was 5.9 mg/dL (range, 1.8-17.1 mg/dL) during acute illness and 1.8 mg/dL (range, 0.9-5.9 mg/dL) at time 0. Among non-dialysis-dependent patients, there were no significant differences in the log of serum creatinine or estimated glomerular filtration rate over time. The number of patients with subjective generalized weakness declined significantly over time (P < .001). A similar finding was observed for any sensory loss (P = .05). The most common deficits at enrollment were bilateral lower extremity numbness in 13 patients (40.6%) and peripheral facial nerve motor deficits in 7 (21.9%). All patients with neurologic deficits at enrollment demonstrated improvement in motor function over time. Among 28 patients (90.3%) with abnormal nerve conduction study findings at enrollment, 10 (35.7%) had motor axonal involvement, the most common primary abnormality. CONCLUSIONS AND RELEVANCE Neurologic findings of survivors tended to improve over time. Renal function generally improved among non-dialysis-dependent patients between acute illness and the first evaluation with little variability thereafter. No evidence of delayed-onset neurologic or renal disease was observed.

Urinary Metal Exposures in an Artisanal Gold Mining Community in Madre De Dios, PeruAbstract Number:2010 Ellen Yard*, Diane Dong, Melissa Halliday, Carlos Sanchez, and Kathleen Caldwell Ellen Yard* U.S. Centers for Disease Control and Prevention, United States, E-mail Address: [email protected] , Diane Dong Emory University, United States, E-mail Address: [email protected] , Melissa Halliday U.S. Centers for Disease Control and Prevention, United States, E-mail Address: [email protected] , Carlos Sanchez N/A, Peru, E-mail Address: [email protected] , and Kathleen Caldwell U.S. Centers for Disease Control and Prevention, United States, E-mail Address: [email protected] AbstractBackground: Worldwide, 10–20 million people practice 'artisanal' gold mining. Artisanal miners use rudimentary processes and risk working under harsh conditions; it is well established that artisanal gold mining can release mercury into the environment and expose communities to health risks. Previously, we reported our findings on mercury exposure among residents of an artisanal mining town along the Amazon River in Peru, where we found that 65% of participants had urinary mercury above the U.S. 95th percentile. Here, we assess exposure to a range of other metals among these same participants.Methods: We collected spot urine samples and questionnaire data from 98 residents of an artisanal gold mining town in July 2010. Urine samples were corrected for creatinine and were analyzed for antimony, arsenic, barium, beryllium, cadmium, cesium, cobalt, iodine, lead, manganese, molybdenum, platinum, strontium, thallium, tin, tungsten, and uranium using ICP-DRC-MS. We described exposure and compared log-transformed concentrations between subgroups using linear regression, and we compared exposure to the U.S. population. We considered p<0.05 to be statistically significant.Results: One-third (35%) of participants were gold miners; 54% were male and average age was 34 years (range: 4–71). Many participants exceeded the U.S. 95th percentile for urinary cesium (100%), thallium (96%), cadmium (39%), iodine (25%), and lead (24%). Cesium and lead concentrations were higher in children compared to adults; thallium concentrations were higher in females than males.Conclusions: Although we cannot determine the source of exposure, members of this artisanal gold mining town in the Peruvian Amazon were exposed to a range of metals, and some urinary metal levels were elevated compared to the United States. Interventions that seek to decrease mercury exposure in artisanal gold mining communities should consider whether controls for additional hazardous metals are also needed.

Exposure to mercury, a toxic metal, occurs primarily from inhaling mercury vapors or consuming methylmercury-contaminated fish. One third of all anthropogenic mercury emissions worldwide are from artisanal gold mining, which uses mercury to extract gold. Although recent reports suggest that the Madre de Dios region in Peru (with >30,000 artisanal miners) has extensive mercury contamination, residents had never been assessed for mercury exposure. Thus, our objective was to quantify mercury exposure among residents of an artisanal mining town in Madre de Dios and to assess risk factors for exposure.

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging1 Apr 2011539 VALIDATION OF PROGNOSTIC MODELS FOR NONMETASTATIC RENAL CELL CARCINOMA AFTER NEPHRECTOMY IN A MEDITERRANEAN CAUCASIAN POPULATION Maria C. Santiago, Carlos Sanchez, Ana M. Palacin, Eva Golmayo, Cristina Fernandez, Antonio Garcia, and Manuel Sanchez-Chapado Maria C. SantiagoMaria C. Santiago Alcala de Henares, Spain More articles by this author , Carlos SanchezCarlos Sanchez Alcala de Henares, Spain More articles by this author , Ana M. PalacinAna M. Palacin Alcala de Henares, Spain More articles by this author , Eva GolmayoEva Golmayo Alcala de Henares, Spain More articles by this author , Cristina FernandezCristina Fernandez Madrid, Spain More articles by this author , Antonio GarciaAntonio Garcia Caceres, Spain More articles by this author , and Manuel Sanchez-ChapadoManuel Sanchez-Chapado Alcala de Henares, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1263AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the applicability of the current prognostic models to predict disease recurrence-free survival (RFS) and cancer-specific survival (CSS) after nephrectomy in nonmetastatic renal cell carcinoma (RCC) in a Mediterranean Caucasian population. METHODS We retrospectively reviewed the clinical and pathological variables of 305 patients treated with nephrectomy (partial or radical) for RCC. Three models were used to predict RFS (Kattan nomogram, Sorbellini model and Leibovich model), and three ones to predict CSS: the University of California at Los Angeles Integrated Staging System (UISS) model, the Stage, Size, Grade and Necrosis (SSIGN) model and the Karakiewicz nomogram. Survival was estimated using the Kaplan-Meier method. The predictive ability of the different scores was evaluated using the Harrell concordance index. RESULTS With a median follow-up of 50.7 months, 41 patients (15.1%) died of RCC and in 54 (19.9%) the disease progressed. The 5-years CSS and RFS rates were 84.9% and 77.5%, respectively. Among the features included in the models, the Eastern Cooperative Oncology Group Performance Score (ECOG PS), pathological T (pT) stage, tumor size in surgical specimen, nuclear grade and pathological necrosis were significantly associated with RFS and CSS on univariate analysis. The ECOG PS, pT stage and nuclear grade also influenced in the multivariate analysis (Table 1). The c-indexes for RFS at 5 years were 0.626 for the Kattan nomogram and 0.696 for the Sorbellini model. The Leibovich nomogram presented c-indexes for RFS at 1, 3 and 5 years of 0.807, 0.728 and 0.721 respectively. The c-indexes for CSS were 0.774, 0.773, 0.772, 0.760 and 0.760 at 1, 2, 3, 4 and 5 years respectively for the UISS model, 0.831, 0.819 and 0.795 at 1, 3 and 5 years respectively for the SSIGN nomogram, and 0.752, 0.753 and 0.767 at 1, 2 and 5 years respectively for the Karakiewicz model. Table 1. Univariate and multivariate Cox regression model for prediction of renal cell carcinoma (RCC). VARIABLE Disease recurrence-free survival (RFS) Cancer-specific survival (CSS) Univariate Multivariate Univariate Multivariate HR pvalue HR pvalue HR pvalue HR p value ECOG PS 3,53 <0,001 3,710 <0,001 3,87 <0,001 3,143 0,001 pT stage 3,67 <0,001 1,839 0,058 4,52 <0,001 1,950 0,065 Tumor size 2,84 0,022 4,70 0,012 Nuclear grade 4,82 <0,001 4,083 <0,001 9,14 8,333 <0,001 Presence of necrosis 2,11 0,001 2,84 <0,001 CONCLUSIONS The current prognostic models are therefore validated in the Mediterranean Caucasian population with nonmetastatic RCC treated by surgery. The Leibovich nomogram was found to be most accurate to predict RFS, and SSIGN model to predict CSS. The most influential features in our population, both in RFS and CSS, were nuclear grade, ECOG PS and pT stage. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e219 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria C. Santiago Alcala de Henares, Spain More articles by this author Carlos Sanchez Alcala de Henares, Spain More articles by this author Ana M. Palacin Alcala de Henares, Spain More articles by this author Eva Golmayo Alcala de Henares, Spain More articles by this author Cristina Fernandez Madrid, Spain More articles by this author Antonio Garcia Caceres, Spain More articles by this author Manuel Sanchez-Chapado Alcala de Henares, Spain More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

ABSTRACT Background: During June 2008, heavy precipitation and 500-year flood events resulted in the displacement of thousands of families throughout eastern Iowa. The objectives of this study were to assess the effectiveness and preferred sources of health messages communicated to the public following the disaster. Methods: Three hundred twenty-seven households were surveyed in 4 counties hit hardest by the flooding. A 48-item questionnaire containing items on demographics, housing, health information sources, and 8 specific health issues was administered. Results: Almost all of the participants (99.0%) received information on at least 1 of the health topics covered by the survey. Most participants received information regarding vaccination (84.1%), mold (79.5%), safe use of well water (62.7%), respirator use (58.7%), or stress (53.8%). Television was the primary (54.7%) and preferred (60.2%) source of health information for most people, followed by the Internet (11.0% and 30.3% as source and preference, respectively). Conclusions: Public health messages were received by a wide audience in the flood-affected communities. Along with more traditional health communication channels such as television, radio, or newspapers, continued emphasis on the development of health information Web sites and other technological alternatives may result in useful and effective health communication in similar situations. (Disaster Med Public Health Preparedness. 2010;4:129-134)

INTRODUCTION:On 13 September 2008, Hurricane Ike made landfall near Galveston, Texas, resulting in an estimated 74 deaths statewide and extensive damage in many counties. The Texas Department of State Health Services, US Public Health Service, and the Centers for Disease Control and Prevention conducted assessments beginning 12 days following hurricane landfall to identify the public health needs of three affected communities. The results of the assessment are presented, and an example of a type of public health epidemiological response to a disaster due to a natural hazard is provided.METHODS:A one-page questionnaire that focused on household public health characteristics was developed. Using a two-stage cluster sampling methodology, 30 census blocks were selected randomly in three communities (Galveston, Liberty, and Manvel, Texas). Seven households were selected randomly from each block to interview.RESULTS:The assessments were conducted on 25, 26, and 30 September 2008. At the time of the interview, 45% percent of the households in Galveston had no electricity, and 26% had no regular garbage collection. Forty-six percent reported feeling that their residence was unsafe to inhabit due to mold, roof, and/or structural damage, and lack of electricity. Sixteen percent of households reported at least one member of the household had an injury since the hurricane. In Liberty, only 7% of the household members interviewed had no access to food, 4% had no working toilet, 2% had no running water, and 2% had no electricity. In Manvel, only 5% of the households did not have access to food, 3% had no running water, 2% had no regular garbage collection, and 3% had no electricity.CONCLUSIONS:Post-Ike household-level surveys conducted identified the immediate needs and associated risks of the affected communities. Despite the response efforts, a high proportion of households in Galveston still were reportedly lacking electricity and regular garbage pickup 17 days post-storm. The proportion of households with self-reported injury in Galveston suggested the need to enhance public education on how to prevent injuries during hurricane cleanup. Galveston public health officials used the assessment to educate local emergency and elected officials of the health hazards related to lack of basic utilities and medical care in the community. This resulted in the provision of an extensive public health outreach education program throughout the island. The Liberty and Manvel assessment findings suggest that most households in both communities were receiving the basic utilities and that the residents felt "safe". The assessments reassured local health officials that there were no substantial acute public health needs and provided objective information that services were being restored.

This study examines health effects resulting from landslides in Chuuk during Tropical Storm Chata'an in July 2002, and suggests strategies to prevent future mortality. In August 2002, we conducted a cross-sectional survey to identify risk factors for mortality during landslides, which included 52 survivors and 40 surrogates for 43 decedents to identify risk factors for death. Findings suggest that 1) females had a higher mortality rate from this event than males, and 2) children aged 5-14 years had a 10-fold increase in mortality when compared with annual mortality rates from all causes. Awareness of landslides occurring elsewhere and knowledge of natural warning signs were significantly associated with lower risks of death; being outside during landslides was not associated with reduced mortality. In Chuuk, improving communication systems during tropical storms and increasing knowledge of natural warnings can reduce the risk for mortality during landslides.

In this paper, we propose a new architecture for diabetes patients. These applications allow the monitoring, patient selfcontrol and communication between patient and doctor. Moreover, as an important study case, we present a mobile monitoring system which allows patients with diabetes to have a constant control of their glucose tendency as well as direct communication with their doctor. We present an application to solve this problem; we share some details of the current implementation, detailing the functionalities achieved so far.

The recent NFC technology is not only valid for payment and ticketing, a new interaction form is also available. With the only action being to put a mobile phone close to another NFC device (reader, tag or mobile phone) it is possible to get a contactless communication supported by a server or not. Some services such as open doors, location, access, presence, and so on, can be performed with a simple touch. In this work we analyze the interaction through the adaptability of two technologies: RFID and NFC. Challenges in models have been considered. In addition, we are trying to put in practice the idea of tagging context and the awareness only with a single interaction by touch. For that, we consider the benefits to adapting NFC technology as a good approach to model contexts.

Interest in multilevel inverters is increasing in recent years, especially in high voltage applications. Traditional pulse width modulation (PWM) techniques can be applied to control this type of switched converter. However, it is necessary to adapt these techniques to the particularities of multilevel operation. As an alternative, other modulation techniques, such as sigma-delta modulation (SDM) can be used. In this case, it is possible to use advanced modulation techniques, such as adaptive modulation, to adapt the SDM to the multilevel operation. This article presents a new adaptive sigma-delta modulator that controls a five levels multilevel inverter. The algorithm that generates the sigma-delta signal is implemented in a field-programmable gate array (FPGA). This allows a very fast operation independent of the overall control circuit operation response. In addition, the FPGA can generate the control signals necessary to drive the power semiconductors in the power stage. The resulting modulator is simpler than the PWM version.

The following is an update on research and activities in which clinical toxicologists are actively involved at CDC/ATSDR.The Journal of Medical Toxicology periodically will highlight some of these activities to illustrate the growing relationship

Martensitic AISI420 stainless steel was plasma nitrided using a DC N2-Hz pulsed discharge, after thermal treatment at two different tempering temperatures. Sliding wear behavior was determined by means of a ball-on-disk tribometer at room temperature and without lubrication. Wear volume was calculated from the information provided by an optical profilometer and wear scars were analyzed by Scanning Electron Microscopy. The results indicated that the nitrided samples exhibited improved wear resistance when compared to the untreated specimens, but corrosion resistance was diminished due to the presence of the outer nitrided layer. However, when this layer was removed mechanically considerable improvement in the corrosion resistance was achieved without impairing the wear resistance of the whole system, which was 200 % higher compared to the wear resistance of the non-nitrided specimens.