Healthcare-associated pneumonia (HCAP) is actually considered a subgroup of hospital-acquired pneumonia due to the reported high risk of multidrug-resistant pathogens in the USA. Therefore, current ...American Thoracic Society/Infectious Diseases Society of America guidelines suggest a nosocomial antibiotic treatment for HCAP. Unfortunately, the scientific evidence supporting this is contradictory.
We conducted a prospective multicentre case-control study in Spain, comparing clinical presentation, outcomes and microbial aetiology of HCAP and community-acquired pneumonia (CAP) patients matched by age (±10 years), gender and period of admission (±10 weeks).
476 patients (238 cases, 238 controls) were recruited for 2 years from June 2008. HCAP cases showed significantly more comorbidities (including dysphagia), higher frequency of previous antibiotic use in the preceding month, higher pneumonia severity score and worse clinical status (Charslon and Barthel scores). While microbial aetiology did not differ between the two groups (HCAP and CAP: Streptococcus pneumoniae: 51% vs 55%; viruses: 22% vs 12%; Legionella: 4% vs 9%; Gram-negative bacilli: 5% vs 4%; Pseudomonas aeruginosa: 4% vs 1%), HCAP patients showed worse mortality rates (1-month: HCAP, 12%; CAP 5%; 1-year: HCAP, 24%; CAP, 9%), length of hospital stay (9 vs 7 days), 1-month treatment failure (5.5% vs 1.5%) and readmission rate (18% vs 11%) (p<0.05, each).
Despite a similar clinical presentation, HCAP was more severe due to patients' conditions (comorbidities) and showed worse clinical outcomes. Microbial aetiology of HCAP did not differ from CAP indicating that it is not related to increased mortality and in Spain most HCAP patients do not need nosocomial antibiotic coverage.
Dexamethasone and tocilizumab have been associated with reduction in mortality, however, the beneficial effect is not for all patients and the impact on viral replication is not well defined. We ...hypostatized that C-reactive protein (CRP) could help in the identification of patients requiring anti-inflammatory therapy. Patients admitted for > 48 h in our hospital for a confirmed or suspected infection by SARS-CoV-2 from February 2020 to February 2021 were retrospectively evaluated. The primary outcome was mortality at 30 days. Demographics and the most relevant variables related with the outcome were included. CRP was stratified by percentiles. Univariate and multivariate analysis were performed. A total of 3218 patients were included with a median (IQR) age of 66 (74-78) years and 58.9% were males. The rate of intensive care unit admission was 24.4% and the 30-day mortality rate was 11.8%. Within the first 5 days from admission, 1018 (31.7%) patients received dexamethasone and 549 tocilizumab (17.1%). The crude analysis showed a mortality reduction in patients receiving dexamethasone when CRP was > 13.75 mg/dL and > 3.5 mg/dL for those receiving tocilizumab. Multivariate analysis identified the interaction of CRP > 13.75 mg/dL with dexamethasone (OR 0.57; CI 95% 0.37-0.89, P = 0014) and CRP > 3.5 mg/dL with tocilizumab (0.65; CI95%:0.44-0.95, P = 0.029) as independent predictors of mortality. Our results suggest that dexamethasone and tocilizumab are associated with a reduction in mortality when prescribed to patients with a certain inflammatory activity assessed by C-reactive protein.
•In fetal CMV, thrombocytopenia and high GGT are related to severe brain damage.•GGT is the only parameter associated with brain damage at any gestational age.•Thrombocytopenia seems to be a marker ...of the acute phase of fetal CMV infection.•With the exception of GGT, blood parameters are not useful in the third trimester.
Cytomegalovirus (CMV) remains a major cause of congenital infection and disease. During pregnancy, symptomatic cases can be detected through ultrasound (US) features, nevertheless, prognostic assessment is difficult. The aim of this study was to assess the predictive value of specific blood parameters in CMV infected fetuses.
Twenty-eight CMV-infected fetuses in which a cordocentesis had been performed were included. Fetuses were considered severely or mildly affected according to prenatal US/MRI brain damage. Fetal blood parameters were assessed for the prediction of severe brain abnormalities, and compared according to the trimester of pregnancy. Logistic regression and receiver operating curve analysis were performed.
Thrombocytopenia (≤100,000/mm3; p:0.03) and high levels of gamma-glutamyl transpeptidase (GGT) (≥151 IU/L; p:0.02) signaled severity. For the prediction of brain damage, GGT levels ≥ 183 UI/l achieved 71% sensitivity, 83% specificity (AUC: 0.78), and OR of 2.05 (95% CI: 1.22–3.43) per 100 IU/l increase, adjusted for gestational age. However, thrombocytopenia (91% vs 50%; p: 0.04), β2 microglobulin >10.4 mg/l (60% vs 0% p: 0.03), CMV-DNA >50,000 copies/ml (80% vs 25%; p: 0.02), and positive IgM (70% vs 17%; p: 0.04) were observed significantly more often in severely damaged fetuses sampled ≤28 weeks than thereafter.
In CMV infected fetuses, thrombocytopenia and high levels of GGT are associated with severe US/MRI brain abnormalities. Nevertheless, among severely affected fetuses, blood parameters, with exception of GGT, change according to gestational age. Fetal blood could be less predictive of brain damage in the third trimester.
This manuscript provides a novel approach to reputational management as a driver of entrepreneurial sustainability, using game theory to integrate three dimensions of reputation. First, if the ...entrepreneur perceives reputation as a risk source, the analysis is framed as a prisoner's dilemma schema that is solved by protecting against reputational threats from entrepreneurial sustainability. Second, if the entrepreneur perceives reputation as a competitive advantage, the analysis is framed as an innovator's dilemma that is solved by getting reputational opportunities from entrepreneurial sustainability. Third, if reputation is perceived as a strategic asset, the analysis is framed as a coordination game schema that results in the development of a reputational intelligence skill that has the potential to become crucial for success in entrepreneurial sustainability. Consequently, this manuscript provides an original multidisciplinary analysis of reputational management by relating well-known theoretical results from game theory to organizational realities.
Understanding the responses of insects to ecological variables provides information that is fundamental for their conservation. The present study took place in three different landscapes (three plots ...of 10 × 10 km each) in a typical Mediterranean ecosystem of a Spanish national park. Each landscape included three vegetation types, grasslands, scrublands, and woodlands, and was characterised by a dominant vegetation type. Our objectives were: (1) to assess how important the influence of the dominant vegetation type and the vegetation type of sites are on hoverfly (Diptera: Syrphidae) diversity at landscape scale; (2) to assess whether scrublands are contributing to the loss of hoverfly diversity in an ecosystem with a long history of human use. In order to achieve these goals, we compared hoverfly diversity among sampling sites by prospecting all three diversity levels, alpha, beta and gamma, at each landscape. We sampled adult hoverflies at 18 sites located in different vegetation types within the three landscapes. No evidence was found that demonstrated an effect of the dominant vegetation type on alpha or beta diversity of sites, but the vegetation type of sites did have an affect. The highest species richness was found in woodland sites, particularly in the grassland-dominated landscape. At each landscape, beta diversity among sampling sites contributed more to gamma diversity than alpha diversity did. Our results highlight the need to focus on the conservation of woodland remnants of grassland-dominated landscape and scrubland-dominated landscape in order to preserve a large proportion of the biodiversity of Cabañeros hoverflies, as well as on the maintenance of the mosaic landscape, which is linked to high beta diversity, typical in many Mediterranean ecosystems. We emphasise the importance of open clearings in the vast mass of scrubland in the scrubland-dominated landscape in order to provide extra resources for the hoverflies.
Although the gender composition of corporate boards and the contribution of female directors to corporate governance have been previously analysed, few studies have investigated the factors that may ...help contribute to increasing the still scarce presence of women on boards. Therefore, using three-stage least squares (3SLS) estimation on a data panel comprising the 100 largest companies in the world according to the 2019 Fortune Global 500 ranking, including data on (re)election proposals for corporate board members, this research aims to analyse the influence of the number of men's nominations, board interlocks, director tenure, geographical area, the sector to which the firms belong, and the relevance of firms on women's nominations for boards of directors. The results show the factors that facilitate the presence of women on boards. In addition, the different influences that remain in the election of female and male directors when considering factors related to the experience, expertise, and networks of directors or the visibility of firms can also be observed. This study contributes to the knowledge of gender diversity on boards, shedding light on the factors that might lead to gender-balanced boards. It could also help companies and policymakers design strategies to build more egalitarian boards.
•The appointment of members of corporate boards is not gender neutral.•Female proposals depend on the number of men's nominations.•The presence on several corporate boards penalizes female proposals.•Greater visibility of firms Fortune Global 500 list promote board gender diversity.•Females' tenure does not justify their election as board member.
Comprising nearly 500 species worldwide, Cheilosia Meigen is the largest genus of Syrphidae in the Palaearctic region. Within Cheilosia, phenotypic diversity has been assessed in different species ...groups, including the group of Cheilosia longula (Zetterstedt, 1838). However, the phenotypic variability of Cheilosia soror (Zetterstedt, 1843), a highly variable member of the C. longula group, has never been assessed in western Europe. In the present work, morphological and molecular analyses were conducted to assess the phenotypic variability found in 300+ specimens of C. soror from the Iberian Peninsula. A total of 16 variable characters were identified and defined for the C. soror morphology, with the highest variation found in the colour of the mesonotum pilosity and the metatibia colour. Morphological variation was assessed against molecular variation based on two molecular markers, one mitochondrial, the 5′ end of the cytochrome c oxidase subunit I (COI-5′), and one nuclear, the large subunit ribosomal DNA (28S). Phylogenetic analyses rendered trees with topologies in disagreement with the defined morphological variation. Two haplotypes were identified amongst the analysed specimens of C. soror, together with a haplotypic variant exclusive to the Iberian region. Potential distributions were used to identify unexplored areas of occurrence of C. soror and other species of the C. longula group in the Iberian Peninsula. Unassessed areas of occurrence of C. soror should be surveyed in the future to confirm the absence of hidden taxonomic diversity within the range of phenotypic variation for this species. Phenotypic variation of the other two Iberian species of the C. longula group, C. longula and C. scutellata (Fallén, 1817), was also assessed to find that they are species with less-variable morphology than C. soror and with molecular characters in accordance with other conspecific populations in Europe. New distributional data are provided for C. soror and C. scutellata from Spain, and a leg abnormality is identified for the first time in C. soror.
Amoebic gill disease (AGD), caused by the protozoan parasite Neoparamoeba perurans, is one of the most significant infectious diseases for Atlantic salmon (Salmo salar L.) mariculture. The present ...study investigated the humoral immune response (both local in gill mucus and systemic in serum) of farmed Atlantic salmon naturally infected with N. perurans in commercial sea pens, at two different stages of the disease and after freshwater treatment. Parameters analysed included activity of immune related enzymes (i.e. lysozyme, peroxidase, protease, anti-protease, esterase, alkaline phosphatase), IgM levels, and the terminal carbohydrate profile in the gill mucus. Overall, greater variations between groups were noted in the immune parameters determined in gill mucus than the equivalent in the serum. In gill mucus, IgM levels and peroxidase, lysozyme, esterase and protease activities were decreased in fish showing longer exposure time to the infection and higher disease severity, then showed a sequential increase after treatment. Results obtained highlight the capacity of gills to elicit a local response to the infection, indicate an impaired immune response at the later stages of the disease, and show partial reestablishment of the host immune status after freshwater treatment. In addition to providing data on the humoral response to AGD, this study increases knowledge on gill mucosal humoral immunity, since some of the parameters were analysed for the first time in gill mucus.
•Longitudinal field case study undertaken in a commercial Atlantic salmon farm.•Humoral immunity in gill mucus and serum during amoebic gill disease outbreak.•Local response to the infection in gill mucus.•Decreased response in gill mucus at the later stages of the infection.•Partial restoration of the immune response in gill mucus post freshwater treatment.
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