Jesús Patrón Recio

Bacterial flora in the sputum and comorbidity in patients with acute exacerbations of COPD

Objective To determine in patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) the association between the isolation of potential pathogens in a conventional sputum culture and comorbidities. Patients and methods The ESMI study is a multicenter observational study. Patients with AE-COPD admitted to the Internal Medicine departments of 70 hospitals were included. The clinical characteristics, treatments, and comorbidities were gathered. The results of conventional sputum cultures were recorded. Results A total of 536 patients were included, of which 161 produced valid sputum and a potentially pathogenic microorganism was isolated from 88 subjects (16.4%). The isolation of Pseudomonas aeruginosa (30.7%) was associated with a greater severity of the lung disease (previous admissions [P= 0.026], dyspnea scale [P=0.047], post-broncodilator forced expiratory volume in 1 second (FEV1) [P=0.005], and the BODEx index [P=0.009]); also with higher prevalence of cor pulmonale (P=0.017), heart failure (P=0.048), and cerebrovascular disease (P=0.026). Streptococcus pneumoniae (26.1%) was associated with more comorbidity according to number of diseases (P=0.018); notably, peripheral artery disease (P=0.033), hypertension (P=0.029), dyslipidemia (P=0.039), osteoporosis (P=0.0001), and depression (P=0.005). Conclusion Patients with AE-COPD and P. aeruginosa present higher severity of COPD, while those with S. pneumoniae present greater comorbidity. The potentially pathogenic microorganism obtained in the sputum culture depends on the associated comorbidities.

Características clínicas y tratamiento de los pacientes ancianos hospitalizados por descompensación de enfermedad pulmonar obstructiva crónica en los servicios de Medicina Interna españoles. Estudio ECCO

BACKGROUND AND OBJECTIVE Hospitalizations for chronic obstructive pulmonary disease (COPD) occur mostly in elderly patients. We describe the characteristics and treatment of elderly patients hospitalized for COPD in Internal Medicine Services, compared with the younger age group. PATIENTS AND METHODS Observational, prospective, multicenter study. We compared the differences between patients older than 80 years and the rest regarding comorbidity, severity of COPD, previous admissions, length of stay and treatment prescribed. Comorbidity was assessed by the Charlson index and a questionnaire was designed for this purpose. RESULTS We included 398 subjects, 353 men (89%) with a mean age of 73.7 years (SD 8.8), of whom about 107 (26.9%) were older than 80 years. These patients had less severe COPD according to the GOLD classification (P<.02). Although the overall morbidity was similar in both groups, elderly patients had greater presence of arrhythmias (P<.01), left ventricular hypertrophy (P<.01) and received more diuretics (P<.05). Dyspnoea, length of stay and mortality were similar between both populations. Home oxygen therapy prior to and use of inhaled corticosteroids and oxygen therapy was lower in older patients, even when they were clinically indicated. CONCLUSIONS A quarter of patients hospitalized for COPD in Internal Medicine Services are over 80 years. Although they present less obstruction, they have a similar degree of dyspnea, increased cardiac morbidity and their treatment is less consistent with the recommendations of the guidelines.

FRIDA: the software architecture to execute and coordinate observing sequences

The instrument FRIDA (inFRared Imager and Dissector for Adaptive optics) is an integral field spectrograph (near infrared) with imaging capability for being used at the Nasmyth B platform of the Gran Telescopio de Canarias (GTC), behind the Adaptive Optics (AO) system. FRIDA is the first GTC instrument to use the telescope AO system. FRIDA is a collaborative project between institutions from México, Spain and the USA. In image mode, FRIDA provides scales of 0.010, 0.020 and 0.040 arcsec/pixel and, in integral-field spectroscopy (IFS) mode, spectral resolutions R 1000, 4.500 and 30.000. FRIDA has a set of different mechanisms (such as the focal plane wheel, the filters and pupil wheels, the cameras wheel, the calibration unit, the grating carousel) that are controlled and coordinated by the FRIDA Instrument Library (IL). In this paper, we present the IL, which provides the implementation of a Device that represents the instrument FRIDA as a whole. More specifically, the IL implements the commands for setting-up and coordinating the different mechanisms of FRIDA for an observation. It moves the mechanisms, exposes the detector, and reduces and stores the data image. In addition, we also present the Observation Manager (OM) component, responsible for the execution of the science observing sequences in close coordination with the IL and GTC AO system.

Software architecture of the high-level control of FRIDA

The instrument FRIDA (inFRared Imager and Dissector for Adaptive optics) is an integral field spectrograph (near infrared) operating at the wavelength range of 0.9 to 2.5um with imaging capability for being used at the Nasmyth B platform of the Gran Telescopio de Canarias (GTC). FRIDA is a collaborative project led by the Instituto de Astronomía Universidad Nacional Autónoma de México (IA-UNAM, México) with the collaboration of the Instituto de Astrofísica de Canarias (IAC, Spain), Centro de Ingeniería y Desarrollo Industrial (CIDESI, México), the University of Florida (UF, USA), and the Universidad Complutense de Madrid (UCM, Spain). In imaging mode, FRIDA will provide scales of 0.010, 0.020 and 0.040 arcsec/pixel and, in IFS mode, spectral resolutions of R 1000, 4.500 and 30.000. FRIDA is the first GTC instrument to use the telescope Adaptive Optic (AO) system and it is rescheduled to be delivered to GTC shortly in 2020. Since FRIDA is a GTC instrument, the high-level control software of FRIDA is embedded within the distributed architecture of the System Control of GTC (GCS) and must fulfill the GCS software and hardware standards to control the telescope and the AO system. This paper shows an overview of the high-level control software components of FRIDA inside the GCS architecture. The main components are the Mechanisms Control System whose primary task is to control the mechanisms of FRIDA, the Data Acquisition System that interacts with the detector to take image, the Data Factory Agent whose task is to provide quality control for both engineering and scientific data, the Instrument Library component responsible for operating the devices associated to FRIDA and the Observation Manager component responsible for the execution of the observing sequences in close coordination with the GTC AO system.

EMCCD in-situ periodic characterization in Shack-Hartmann wavefront sensor for GTCAO

The Gran Telescopio Canarias Adaptive Optics (GTCAO) will measure the wavefront with a Shack-Hartmann sensor. This wavefront sensor (WFS) is based on the CCD220, an electron-multiplying CCD (EMCCD) that achieves sub-electron readout noise, increasing the signal to noise ratio when weak natural guide stars (NGS) are used as reference. GTCAO will start its operation in telescope with NGS, using only one wavefront sensor, and later it will incorporate a Laser Guide Star (LGS) and consequently a second WFS, also based on an EMCCD. Both EMCCDs and a third one used as spare, have been characterized and compared including the system gain, electron- multiplication gain, readout noise vs gain, excess noise and linearity. The EM gain calibration is important to keep all EMCCD channels in the linear regime and the camera manufacturer carries it out, but it is reported that the multiplication gain may suffer ageing and degradation even if the camera is not in use. This suggests the need to monitor this ageing. In this paper it is proposed and tested a procedure for predictive maintenance that re-characterize the system gain, electron- multiplication gain and linearity periodically in order to predict the eventual ageing of the EMCCD multiplying registers. This procedure can be carried out quickly while the detector is installed in the WFS and in operational status. In order to provide the required illumination, the GTCAO calibration system is used.

Servo control simulations and preliminary laboratory results for GTC adaptive optics with NGS

The Gran Telescopio Canarias Adaptive Optics (GTCAO) is a single-conjugated post-focal system with a Shack Hartmann wavefront sensor, and one Deformable Mirror (DM) conjugated to the pupil. The optical design for tip-tilt correction includes two different mirrors, DM and the telescope M2, being M2 also used for off-loading the DM to avoid reaching its stroke limits. This optical configuration is open to different control strategies that have been simulated with Matlab. Later it has also been simulated using Durham Adaptive optics Real-time Controller (DARC) and its AO simulator, DASP. Finally some preliminary laboratory results are presented.

GTCAO real time AO closed loop software implementation and initial computer performance analysis

The Gran Telescopio Canarias Adaptive Optics (GTCAO) is a single-conjugated post-focal system with a Shack Hartmann wavefront sensor working at visible wavelength and one Deformable Mirror (DM) conjugated to the pupil. GTCAO does not include a fast tip-tilt mirror in its optical bench so it relies on the telescope secondary mirror (M2) to correct low frequency tip-tilt and offload the DM. This paper describes specific details of the software implementation of the mirror control for GTCAO, analyses its computational needs, presents the series of tests performed on the newly designed AO closed loop, and summarises software optimizations and operating system configurations set in order to optimise computer performance in the available hardware architecture

GTC adaptive optics first performance tests in laboratory

The GTC AO system designed and developed during the last years is based on a single deformable mirror with 21 x 21 actuators, conjugated to the telescope pupil, and a Shack-Hartmann wavefront sensor with 20 x 20 subapertures, using an OCAM2 camera. The GTCAO system will provide a corrected beam with a Strehl Ratio (SR) of 0.65 in K-band with bright natural guide stars. This paper reports the updated status of the integration of GTCAO in the IAC laboratory, and the results obtained in the first tests carried out to evaluate the performance of the system, before the complete characterization and the verification of the requirements. The wavefront sensor verification has been completed, and it has been integrated in the optical bench together with the corrector optics including the CILAS deformable mirror. The calibration system, also mounted on the optical bench, includes light sources used to tune, characterise and calibrate the whole system. It also simulates the atmospheric turbulence and the telescope, delivering an aberrated wavefront used to debug the whole control system, and to test the real time control software, the servo loop and different servo control strategies. Finally the Test Camera has been also integrated at the science focus to evaluate the performance.

FRIDA: diffraction-limited imaging and integral-field spectroscopy for the GTC

FRIDA is a diffraction-limited imager and integral-field spectrometer that is being built for the adaptive-optics focus of the Gran Telescopio Canarias. In imaging mode FRIDA will provide scales of 0.010, 0.020 and 0.040 arcsec/pixel and in IFS mode spectral resolutions of 1500, 4000 and 30,000. FRIDA is starting systems integration and is scheduled to complete fully integrated system tests at the laboratory by the end of 2017 and to be delivered to GTC shortly thereafter. In this contribution we present a summary of its design, fabrication, current status and potential scientific applications.

Automatisms in EMIR instrument to improve operation, safety and maintenance

EMIR is the NIR imager and multiobject spectrograph being built as a common user instrument for the 10-m class GTC. Big cryogenic instruments demand a reliable design and a specific hardware and software to increase its safety and productivity. EMIR vacuum, cooling and heating systems are monitored and partially controlled by a Programmable Logic Controller (PLC) in industrial format with a touch screen. The PLC aids the instrument operator in the maintenance tasks recovering autonomously vacuum if required or proposing preventive maintenance actions. The PLC and its associated hardware improve EMIR safety having immediate reactions against eventual failure modes in the instrument or in external supplies, including hardware failures during the heating procedure or failure in the PLC itself. EMIR PLC provides detailed information periodically about status and alarms of vacuum and cooling components or external supplies.EMIR is the NIR imager and multiobject spectrograph being built as a common user instrument for the 10-m class GTC. Big cryogenic instruments demand a reliable design and a specific hardware and software to increase its safety and productivity. EMIR vacuum, cooling and heating systems are monitored and partially controlled by a Programmable Logic Controller (PLC) in industrial format with a touch screen. The PLC aids the instrument operator in the maintenance tasks recovering autonomously vacuum if required or proposing preventive maintenance actions. The PLC and its associated hardware improve EMIR safety having immediate reactions against eventual failure modes in the instrument or in external supplies, including hardware failures during the heating procedure or failure in the PLC itself. EMIR PLC provides detailed information periodically about status and alarms of vacuum and cooling components or external supplies.