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Predictors of one-year mortality after hospitalization for an exacerbation of COPD

Abstract

Background

Hospitalization for a severe exacerbation of COPD (eCOPD) is an important event in the natural history of COPD. Identifying factors related to mortality 1 year after hospitalization could help determine interventions to reduce mortality.

Methods

In a prospective, observational, multicentre study, we evaluated data from two cohorts: the Spanish audit of hospital COPD exacerbation care (our derivation sample) and the Spanish cohort of the European audit of COPD exacerbation care (our validation sample). The endpoint was all-cause mortality. Mortality was determined by local research managers of the participating hospitals and matched the official national index records in Spain.

Results

In the multivariate analysis, factors independently related to an increase in mortality were older age, cardio-cerebro-vascular and/or dementia comorbidities, PaCO2 > 55 mmHg measured at emergency department arrival, hospitalizations for COPD exacerbations in the previous year, and hospital characteristics. The area under the receiver-operating curve for this model was 0.75 in the derivation cohort and 0.76 in the validation cohort.

Conclusion

One-year mortality following the index hospitalization for an exacerbation of COPD was related to clinical characteristics of the patient and of the index event, previous events of similar severity, and characteristics of the hospital where the patient was treated.

Peer Review reports

Background

Hospitalization for a severe exacerbation of chronic obstructive pulmonary disease (eCOPD) is an important event in the natural history of this disease. Approximately half of the patients admitted for an eCOPD die within 4 years [1]. Identifying factors associated with mid-term mortality (1 year) after hospitalization for an eCOPD could provide tools for more targeted evaluation of these patients and interventions to prevent premature death.

Several studies designed for that purpose have yielded variable or conflicting results [2, 3]. These divergent results can largely be attributed to study methodology, such as the patient population (recruited from the medical ward or from intermediate or intensive care), source of the data (prospective studies, retrospective studies, or computerized databases), variables studied, duration of follow-up, and organizational and administrative distribution of hospital resources. Another source of uncertainty is whether indices used among patients with stable COPD have the same prognostic capacity when used in those admitted to the hospital [4, 5].

The aim of this study was to determine predictors of one-year mortality in patients hospitalized for an eCOPD following discharge for the index event.

Methods

The Cohorte Española de EPOC Avanzada (CEPA) is a prospective observational study designed to examine factors associated with one-year mortality among patients hospitalized for an eCOPD.

CEPA includes patients from two separate cohorts. One, defined as the derivation cohort, is a sample of patients from the Spanish COPD Audit [6]. The other, defined as the validation cohort, is from the Spanish sample of the European COPD Audit [7]. The methodology of both studies has been described in detail elsewhere [6, 7].

The Spanish COPD Audit was a cross-sectional study with prospective non-interventional case ascertainment of consecutive eCOPD hospital admissions for the 8-week period from November 1, 2008 to December 31, 2008. Patients were included in the cohort following a two-step process. Reports of all patients admitted to the hospital following an emergency department (ED) visit were reviewed daily to identify one or more of 13 clinical conditions compatible with the diagnosis of eCOPD. These patients were labelled as interim/possible eCOPD cases. They were assessed again at hospital discharge against a list of definite inclusion and exclusion criteria to identify patients with a clinical diagnosis of eCOPD. Those who qualified were labelled as definite eCOPD cases [6]. A total of 32 hospitals completed a one-year follow-up of their patients and were included in our study.

The European Respiratory Society COPD audit was designed as a pilot study to evaluate clinical practice variability as well as clinical and organizational factors associated with outcomes for COPD-related hospital admissions across Europe. This prospective, observational, non-interventional cohort trial was conducted during the 8-week period from January 1, 2011 and February 28, 2011 in 74 hospitals [7].

In both studies, all consecutive cases admitted to the participant hospitals due to an eCOPD were identified and information on clinical practice was gathered. Each patient was included only once in the study.

Comorbidities were standardized recorded from the clinical record of every patient, including any new one diagnosed during the index event. The Charlson index was used as a reference [8].

All the hospitals participating in the studies were asked to complete cross-sectional surveys of the resources and organization they devoted to COPD acute care. The survey included questions related both to the hospital and to the respiratory unit resources.

Mortality was determined by local research managers of the participating hospitals and matched the official national index records in Spain.

The study was approved by Instituto de Salud Carlos III CEI PI 30_2011-v4 and hospital participation in the two cohorts was approved by the ethics committees of the participating hospitals. All participants provided written informed consent. To allow for patient-level analyses, patient data was protected and dissociated.

Statistical analysis

Descriptive statistics of sociodemographic and clinical variables were calculated using means and standard deviations (SD) for quantitative data; frequencies and percentages were used for categorical variables. The Spanish cohort represented our derivation cohort and the European cohort the validation cohort.

A univariate analysis was undertaken in the derivation sample to determine variables that were predictors of one-year mortality (patients who died during the admission were excluded from the analysis). Student’s t test (or the Wilcoxon test if normality was rejected) was used for continuous variables, while Chi-square and Fisher’s exact tests were used for categorical variables. In the multivariate analysis, generalized linear mixed models were used so as to perform a multilevel multivariable analysis adjusted by hospital, with one-year mortality as the dependent dichotomous variable. The predictive accuracy of the model was determined by calculating the area under the receiver-operating curve (AUC).

The model developed in the derivation cohort was tested in the validation cohort to compare the predictive accuracy of the model by means of comparisons of their AUCs.

We also evaluated the independent influence of the hospital setting both models and determined which hospital characteristics were predictors of mortality.

All effects were deemed statistically significant at p < 0.05. All statistical analyses were performed using SAS System, version 9.2 (SAS Institute, Inc., Carey, NC).

Results

A sample of 1420 patients from the Spanish COPD Audit was included in the derivation cohort. Mean patient age was 73 years, 89% were men, 24.6% were current smokers, 43% had a Charlson Comorbidity Index higher than 3, and 74.6% had previously been admitted for an eCOPD (Table 1). The in-hospital mortality for that cohort was 5%.

Full size table

The validation cohort included a sample of 3949 patients from the European COPD Audit. Compared to the derivation cohort, the validation cohort included more women (10.2 vs 14.5%), had a lower Charlson Comorbidity Index, and statistically significant differences were observed in the percentages of cardiovascular, cerebrovascular, and peripheral vascular disease between the two cohorts (Table 1). The in-hospital mortality for that cohort was 4.3%.

In the univariate analysis, statistically significant differences were observed between patients who had died within 1 year of the index hospitalization and those who had not, in age, smoking habit, Charlson Comorbidity Index, and presence of specific comorbidities such as cardiovascular disease, heart failure, peripheral vascular disease, cerebrovascular disease and dementia, previous eCOPD admissions, number of eCOPD admissions in the previous year, level of airway severity obstruction (FEV1% and Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages of obstruction) and PaCO2 level upon ED arrival. At discharge, patients who died within 1 year were more likely to have been prescribed home oxygen therapy than those who did not die, while prescription of home mechanical ventilation support at discharge and length of stay were not different between these groups (Table 2).

Full size table

In the multivariate analysis, independent variables related to one-year mortality were age, comorbidity (making reference to previous presence of cardiac, peripheral vascular or cerebral vascular diseases and dementia), admission for an eCOPD in the previous year, and PaCO2 at emergency department arrival, and the participant hospital. The hospital characteristics that influenced one-year mortality were the size of the hospital and whether they had a respiratory ward (Table 3).

Full size table

The AUC for this model was 0.75 for the derivation cohort and 0.76 for the validation cohort (Tables 4 and 5).

Full size table

Full size table

A score based on the weight of the different variables included in the multivariate model was developed (Table 4). This score was stratified in 4 levels that showed a high rate of mortality at every risk level, especially in those patients having a score higher than 10 (Table 6).

Full size table

Discussion

In this prospective cohort study, four groups of variables were associated with one-year mortality after an eCOPD hospitalization: general condition of the patient (older age, presence of cardiovascular, cerebrovascular, or peripheral vascular disease and dementia); clinical markers of the severity of the index event, (PaCO2 above the normal limit, at ED arrival); previous events of similar severity (hospitalization for an eCOPD in the previous year). The presence of any of these variables, added to the characteristics of the hospital where the patient was treated, were associated with higher mortality.

Patient’s characteristics

Age, as a continuous variable, was an independent predictor of mortality. Age has been included, although controversially, as a variable in other multidimensional indexes for stable COPD [9, 10]. Among patients experiencing severe exacerbations, age is a key predictive factor for in-hospital mortality [11] and long-term post-discharge mortality [12]. Data from 150 hospitals in the United Kingdom indicated that age was the main predictor of 30-day mortality following hospitalization for COPD (OR, 8.5; 95% CI, 7.7–9.4). Other predictive factors included comorbidities, and gender [13]. In other studies, age was an independent predictor of jose luis martinez candial during one-year of follow-up after hospitalization for an eCOPD [14, 15]. It must be noted, however, that age is a stronger predictor of long-term mortality following eCOPD hospitalization than it is as a predictor for in-hospital mortality [16].

Several reasons could explain our previously mentioned results, older COPD patients tend to have a low performance status, higher level of respiratory disability, and more comorbidities. Together with a diminished awareness of the signs of an exacerbation and poorer understanding of medication [17], these factors make older patients extremely vulnerable, with generally worse outcomes and increasing 90-day mortality [17]. Moreover, respiratory specialists usually find it more difficult to control COPD in older patients than in younger ones [17]. In the UK audit, hospital care varied with age, but the lower level of care given to older patients was not associated with mortality [18]. In sum, all of these circumstances could make age a key factor contributing to mortality after hospitalization for an eCOPD.

Although comorbidities are prevalent among hospitalized eCOPD patients [19], there is some controversy over their importance as a prognostic factor for mortality. In one study, non-respiratory organ failure was most closely related to in-hospital mortality while the overall level of respiratory severity was associated with long-term mortality [16].

In another study comorbidities—cor pulmonale, left ventricular failure, neurological conditions, and non-respiratory malignancies—were associated with in-hospital mortality while 90-day mortality was also increased by the presence of lung cancer or arrhythmias [19]. Almagro et al. showed that the Charlson Comorbidity Index score were associated with 90-day mortality [20]. Comorbidities such as cardiac failure [21], ischaemic heart disease [22], stroke, and diabetes [23] have also been identified as predictors of mortality after hospitalization for an eCOPD.

We did not observe an association between comorbidities evaluated by the Charlson index and mortality during the one-year follow-up, as in another study was [24]. In contrast, in our cohort specific comorbidities—cardiac disease (ischaemic heart disease, chronic heart failure), cerebrovascular disease, and peripheral vascular disease—were independently related to mortality. It seems that the impact of the different comorbidities is variable with respect to the outcome analysed [25] and is focused on the cardio-cerebro-vascular comorbidities, because not all the comorbidities have the same importance.

Apart from the cardio-cerebro-vascular comorbidities, it is worth mentioning dementia as a variable associated to mortality in our study. Prevalence of cognitive dysfunction is very variable in COPD patients, (up to 61%), depending on the place where the study was carried out [26].

COPD patients are prone to being affected by deterioration of their level of cognitive function, and there are several mechanisms involved, from the hypoxaemia, usually present in COPD, to smoking and some concurrent comorbidities, as cardiovascular [27].

Cognitive deterioration has been shown to have a great impact on important outcomes. In patients admitted to a general hospital those with dementia had a mortality rate of 48% after 1 year, higher than that of patients without dementia [28]. In COPD, those patients admitted suffering dementia had 38% and 69% higher risk of severe sepsis and hospital mortality respectively [29].

Our study adds that in COPD patients, dementia chase bank fulton street a key point and the strongest variable associated to mortality in the mid term, after one hospitalization.

In sum, what our study showed was the important relationship between comorbidities and mortality, but not comorbidities in general, but some specific comorbidities such as cardio-cerebro-vascular and dementia.

Factors of the index event (hospitalization)

Several variables were registered from the hospitalization, however our study showed that only hypercapnia at the time of hospital admission was associated with one-year mortality.

PaCO2 has been recognized as a key predictor of in-hospital mortality [30] and one-year after admission mortality [14, 22] among eCOPD patients. A study that included COPD patients admitted to the intensive care unit established that the severity of the exacerbation reflected by respiratory physiology influenced one-year mortality but not in-hospital mortality [16]. Patients admitted with a PaCO2 > 50 mmHg—which would indicate the severity of the underlying respiratory disease, like ventilation/ perfusion mismatch or hypoventilation—had higher one-year mortality than those with PaCO2 < 50 mmHg. It is possible that in this study, illiana financial credit union homogeneity of the cohort (ICU patients only) could have diluted the discriminative capacity of the analysis, limiting the possibility of finding any relationship between in-hospital mortality and variables (like PaCO2) that reflect the physiological respiratory impairment during an eCOPD.

We were not able to demonstrate if hypercapnia persisted at discharge, and if its persistence was related to mortality, as has been suggested by others [20]. Neither did we have any information on patient PaCO2 in a stable condition of our cohorts.

Previous hospitalizations

Previous eCOPD hospitalizations have been identified as an independent predictor of mortality in cohorts of stable and hospitalized patients. Soler-Cataluña et al., for example, demonstrated that mortality increases with the frequency of severe exacerbations requiring hospital evaluation [31]. Other researchers have observed that the number of severe eCOPD requiring hospitalization increases the risk of respiratory and all-cause mortality regardless of factors such as age, FEV1, dyspnoea, cumulative pack-year smoking history, and health-related quality of life [32].

Across the lifespan of COPD patients, the addition of every new hospitalization significantly increases the rate of mortality, and the risk of other severe eCOPD peaks during the 3 months after the index event [1].

In cohorts derived from databases, episodes of previous COPD-related hospitalizations were an independent predictor of mortality [21, 33]. In fact, previous hospitalizations and comorbidities have been included as components of a multidimensional score predicting mortality in a cohort of hospitalized patients.

In our study having had one hospitalization the year before the index-event increased the probability of mortality the year after by 60%, which would be in accordance with the results of studies previously mentioned and outline more precisely the profile of the patient that should be carefully monitored after and eCOPD hospitalization.

Hospital characteristics

Hospital characteristics were reported as a predictor of mortality in the UK national audit 2003. Inpatient and 90-day mortality were lower in hospitals with more respiratory staff per 1000 beds. No other associations were found between other hospital resources and mortality.

The European COPD audit team evaluated adherence to 10 key management recommendations set forth by the GOLD standards in 13 European countries. It found great variability between hospitals and across countries, especially connected with the availability of the level of severity of the obstruction and the use of oxygen and non-invasive ventilation. The audit also showed that larger hospitals have more resources but this does not imply a better quality of care.

Walker et al. showed that 30-day mortality after hospitalization for an eCOPD was quite variable from 1 year to the following across various hospitals. Mortality in that period was independent of hospital size and of whether a respiratory specialist was responsible for the discharge of the patient [13].

In our study, hospital size, as measured by bed numbers and population served, was related to one-year mortality. Knowing the potential limitation of using data from one brief time point rather than data collected over several years we could speculate that having more resources provided not only better treatment of the index episode but better follow-up care afterward. We observed a significant influence of the hospital on one-year mortality since the AUC increases from 0.68 to 0.77 after including the variable hospital in the analysis. Nevertheless, we were not able to establish whether this is due exclusively to the hospital, or is also due to the primary care organization, the regional medical or social characteristics involved in the care of these patients, or all of these together. In any case including hospital size seems to be an important point in the final results.

Strengths and limitations

Strengths of our study included are the number of patients we were able to follow, the length of follow-up, and the fact that patients were recruited from multiple centres. The usage of multilevel models provides a better approach than ordinary logistic regression models when patients are clustered in different groups, as in our case, that we have patients clustered in different hospitals. In this way, the correlation effect among patients from the same hospitals is controlled, as we do not consider them independently.

Several limitations must also be noted, primarily related to the design of the study as an audit of care in eCOPD, which implies missing data. We used for the analysis only those variables with less than 15% of missing data. Another limitation is that we were not able to recover the whole cohort of the Spanish audit. Instead, we analysed only those hospitals that conducted a follow-up of 1 year. We checked our sample against the whole cohort and verified that there were no differences in the clinical characteristics of the patients. Patients who died during the admission were not included in this analysis, only discharged patients. We were not able to pinpoint the cause of death because it is not accurately registered in death records, but this was not the objective of this study. As an audit of general practice some variables currently used as part of predictive mortality scores were not collected. Thus, a comparison with others mortality scores was not possible. The low percentage of women in both cohorts of the study limited the possibility of carrying out an analysis about potential differences with respect to men in the main outcomes studied.

Conclusions

In a cohort of patients hospitalized for an eCOPD, predictors of mortality in the year following the index hospitalization were patient characteristic age, characteristics of the disease (admission for an eCOPD in the previous year and specific comorbidities), aspects of the index event (PaCO2), and the characteristics of the hospitals in which the patients were treated. Some of these aspect are potentially adjustable to impact in the care and outcomes of severe eCOPD.

In conclusion our study provides the patient profile with the highest probability of mortality during the year after an eCOPD hospitalization. We should pay attention to a man in his seventies, with cardio-vascular and/or dementia, with a previous eCOPD hospitalization the year before the index event and with hypercapnia > 50 mmHg during the admission. In those patients with these characteristics a more personalized follow-up is mandatory.

Abbreviations

Area under the receiver-operating curve

Chronic obstructive pulmonary disease

Exacerbation of COPD

Emergency department

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Acknowledgements

We are grateful for the support of the participating hospitals.

Grupo AUDIPOC España-CEPA Subproyecto 1

COMITÉ COORDINADOR: ESTEBAN, Cristóbal. Neumología, Hospital de Galdakao. Vizcaya. POZO RODRIGUEZ, Francisco. Neumología, Hospital 12 de Octubre. Madrid. CASTRO ACOSTA, Ady Angélica. Médico Investigador CIBERES Unidad de Epidemiología Clínica, Hospital Universitario 12 de octubre. Madrid. BOUKICHOU ABDELKADER, Nisa Lic. CC y TT. Estadísticas. Investigador CIBERES Unidad de Epidemiología Clínica, Hospital Universitario 12 de octubre. Madrid. ESTEBAN GARCIA-NAVAS, Sara Investigador CIBERES Unidad de Epidemiología Clínica, Hospital Universitario 12 de octubre. Madrid. COMITÉ CIENTÍFICO: POZO RODRÍGUEZ, Francisco. AGUSTÍ, Alvar. Neumología, Instituto Cardiotorácico Hospital Clinic, Barcelona. ÁLVAREZ MARTÍNEZ, Carlos José. Neumología, Hospital 12 de Octubre. Madrid. CAPELASTEGUI SAIZ, Alberto. Neumología, Barakaldo. Bilbao. HERNÁNDEZ CARCERENY, Carme. Neumología, Hospital Clinic. Barcelona. IZQUIERDO ALONSO, José Luis. Neumología, Hospital de Guadalajara. LOPEZ CAMPOS, José Luís. Neumología, Hospital Universitario Virgen del Rocío. Sevilla. MELERO MORENO, Carlos. Neumología, Hospital Universitario 12 de octubre. Madrid. ANDALUCIA: RESPONSABLE REGIONAL: José Luís López Campos. Neumología, Hospital Universitario Virgen del Rocío. RESPONSABLES LOCALES: Almería, Complejo Hospitalario Torrecárdenas: José Calvo Bonachera. Cádiz, Hospital de La Línea de la Concepción: Armando Falces Sierra, Hospital General de Jerez de la Frontera: Gregorio Soto Campos, Hospital Puerta del Mar: Fernando Romero Valero y Isidro Blasco, Hospital Puerto Real: Jesús Sánchez Gómez. Hospital Universitario Reina Sofía: Marisol Arenas de la Riva y María Jesús Cobos Ceballos. Granada: Hospital Universitario San Cecilio: Alicia Conde Valero. Huelva: Hospital Infanta Elena: Rosa Vázquez Oliva y Fernando Hernández Utrera. Hospital Juan Ramón Jiménez: Rut Ayerbe García. Jaén: Centro Hospitalario Ciudad de Jaén: Bernardino Alcázar Navarrete. E.P.H.A.G. Alto Guadalquivir (Andujar): Juan Manuel Bravo Santervás. Málaga: Hospital Costa del Sol: José Fernández Guerra. Hospital Comarcal de Vélez Málaga: Carlos Rueda, Hospital Regional Carlos Haya: José Luís de la Cruz Ríos. Hospital Serranía de Ronda: Francisco José Cabello Rueda. Hospital Virgen de la Victoria: Francisco Marín Sánchez. Sevilla: Hospital de la Merced – Osuna: José Pérez Ronchel. Hospital Universitario Virgen del Rocío: José Luís López Campos. Hospital Universitario Valme: Inmaculada Alfageme Michavila. ARAGÓN: RESPONSABLE REGIONAL: Luis Borderías. Neumología, Hospital San Jorge de Huesca, José Manuel Gascón Pelegrín. Neumología, Hospital Miguel Servert. Zaragoza, Instituto Aragonés de Salud: Anselmo López y Mónica Torrijos RESPONSABLES LOCALES: Hospital Clínico Universitario Lozano Bleza: Joaquín Carlos Costan Galicia. Hospital Miguel Servert: Salvador Bello Dronda, Andrés Sánchez Barón y José Manuel Gascón Pelegrín. Hospital San Jorge de Huesca: Luis Borderías. CANARIAS: RESPONSABLE REGIONAL Ana Velázquez Benítez. H Ntra Señora de la Candelaria. José Gabriel Julia. Neumología, Hospital Dr. Negrín RESPONSABLES LOCALES: Las Palmas: Hospital Dr. Negrín: Carlos Cabrera López. Lanzarote: Hospital Dr. José Molina Orosa, Lanzarote: Javier Navarro Esteva. Santa Cruz de Tenerife: HM Nuestra Señora de Candelaria: Magdalena Alonso, Ruth Pitti, José Batista y Orlando Acosta Fernández. Hospital Universitario de Tenerife: José Antonio Gullón. CANTABRIA: RESPONSABLE REGIONAL Ramón Agüero Balbín. Neumología, Hospital Marqués de Valdecilla. Cantabria: Hospital de Laredo: Miguel Zabaleta Murguiondo. Hospital Marqués de Valdecilla: Beatriz Abascal Bolado y Ramón Agüero Balbín. Hospital Sierrallana: Mar García Pérez. CASTILLA LA MANCHA: RESPONSABLE REGIONAL Jose Celdran Gil. Neumología, Hospital Nuestra Señora del Prado de Talavera. Jesús Fernández Francés. Neumología, Hospital de Guadalajara. RESPONSABLES LOCALES: Albacete: Hospital de Albacete: Ana Isabel Tornero. Ciudad Real: Hospital La Mancha Centro (ALCAZAR): Gloria Francisco. Hospital Manzanares. Fernando Pedraza y Marisi Verdugo. Cuenca: Hospital Virgen de la Luz de Cuenca: María José Peirón. Guadalajara: Hospital de Guadalajara: Jesús Fernández Francés y JL Izquierdo. Soria: Complejo Asistencial de Soria, H Santa Bárbara: José Luis Orcastegui Candial Toledo: Hospital Nuestra Señora del Prado de Talavera: José Celdrán. Hospital Virgen de la Luz de Toledo: Encarnación López Gabaldón. CASTILLA Y LEÓN: RESPONSABLE REGIONAL Jesús Reyes Hernández Hernández. Neumología, Hospital Nuestra señora de Sonsoles. RESPONSABLES LOCALES: Ávila: H Nuestra señora de Sonsoles: José Eugenio Alonso Muñoz y Eugenio Trujillo Santos. Burgos: Complejo Hospitalario de Burgos: Luís Rodríguez Pascual. Hospital Santiago Apóstol de Miranda de Ebro: Esteban Pascual Pablo. Hospital Santos Reyes Aranda de Duero: Pedro Cancelo Suárez. León: Complejo Asistencial de León: Ana José Seco García. Hospital del Bierzo: Juan Ortiz De Saracho y Bobo. Palencia: Complejo Asistencial de Palencia: María Ángeles Fernández Jorge. Salamanca: Complejo hospitalario de Salamanca: Rosa Cordovilla Pérez. Segovia: Hospital General de Segovia: Graciliano Estrada Trigueras. Soria: Complejo Asistencial de Soria, Hospital Santa Bárbara: José Luís Orcastegui Candial. Valladolid: Hospital Clínico Universitario: Carlos Disdier y Enrique Macías Fernández. Hospital Río Hortera: Félix del Campo Matías. Zamora: Complejo Hospitalario de Zamora. Hospital de Benavente: Carmen Fernández García, Cecilia Alonso Medievilla y María Victoria Domínguez Rodríguez. CATALUÑA: RESPONSABLE REGIONAL Carlos Martínez Rivera. Neumología, Hospital Universitari Germans Trias i Pujol. Eduard Monsó Molas. Neumología, Hospital Universitari Germans Trias i Pujol. RESPONSABLES LOCALES: Barcelona: Hospital Clinic Barcelona: Néstor Soler Porcar, Carmen Hernández. Hospital Comarcal de L’alt Penedés,Vilefrance de Penedés: Nuria Rodríguez Lázaro. Hospital del Mar: Joaquim Gea, Roser Pedreny y Sergi Pascual. Hospital General de Vic: Fernando Ruiz Mori. Hospital San Pau: Antonio Antón y Virginia Pajares Ruiz. Virginia Pajares Ruiz. Hospital Universitari Germans Trias i Pujol: Eduard Monsó Molas y Ignasi Garcia Olivé. Hospital Vall d’Hebron: Esther Rodríguez González, Eva Lozano, Eva Tapia Melechon, Mª Angeles Barrio, Mª Antonia Roman, Jose luis martinez candial Guzman Perez, Milagros Gandara Sanz y Xavier Pérez. Hospital Viladecans: Joan Anton Lloret Queraltó, Mercedes Palau Benavent y Nuria Celorrio Jiménez. Gerona (Girona): Hospital Universitario Doctor Josep Trueta: Manuel Haro Estarriol. Lérida (Lleida): Hospital Arnau: Ferrán Barbé. H General Par Sanitari Sant Joan de Déu: Luis Lores Obradors, H Parc Taulí de Sabadell: Eduard Monso, H Joan XXIII de Tarragona: Leonardo Esteban MADRID: RESPONSABLE REGIONAL. Julio Ancoechea Bermúdez. Neumología, Hospital de la Princesa. Carlos Melero Moreno y Carlos José Álvarez Martínez. Neumología, Hospital Universitario 12 de Octubre. RESPONSABLES LOCALES: Madrid. H. 12 OCTUBRE: Virginia Pérez González. Hospital Clínico San Carlos: Gema Rodríguez Trigo. Hospital de la Princesa: Enrique Zamora García. Hospital de Tajo, Aranjuez: José. Fernando González Torralba. Hospital de Valdemoro: Rocío García García. Hospital El Escorial: Francisco Gómez Rico. Hospital Fundación Alcorcón: Barbara Steen. Eva De Higes Martínez. Mercedes Izquierdo Patrón y Ángela Ramos Pinedo. Hospital Gómez Ulla: Javier Jareño, Ignacio Granda Uribe y Sergio Campos Tellez. Hospital Gregorio Marañón: Jorge García, José De Miguel Rodríguez González Moro. Hospital Infanta Cristina, Parla: Beatriz Jara Chinarro, María Teresa Rio. Ramírez. Hospital Infanta Sofía: Raúl Moreno Zabaleta, Maria Teresa Ramirez Prieto y Blas Rojo Moreno Arrones. Hospital La Paz: Francisco García Río y Sergio Alcolea Batres. Hospital Puerta de Hierro: Rosa Malo de Molina Ruíz, Antolin López Viña y Pietat Ussetti. Hospital Ramón y Cajal: Esteban Pérez Rodríguez y Salvador Díaz Lobato. Hospital Infanta Leonor: Carmen Matesanz Ruíz, Maria Jesus Buendia. Hospital Sureste Arganda del Rey: Sergio Salgado Aranda. Fundación Jiménez Díaz: German Peces Barba. Hospital de Getafe: Mª Antonia Juretschke Moragues. Hospital Príncipe de Asturias Alcalá Henares: Soledad Alonso Viteri. Hospital de Móstoles: Dolores Álvaro. Hospital Severo Ochoa de Leganés: Asunción Perpina. Hospital del Henares: Mª Ángeles Ruíz-Cobos. C.F.NAVARRA: RESPONSABLE REGIONAL. Javier Hueto Perez de Heredia. Neumología, Complejo Hospitalario de Navarra. RESPONSABLES LOCALES: Navarra: Complejo hospitalario de Navarra: José Javier Lorza Blasco, José Antonio Cascante Rodrigo, Jalil Abú-Shams, Victor Manuel Eguía Astibia, Idoya Pascal Martínez, Joan Boldú Mitgans y Pilar Cebollero Rivas. Hospital García Orcoyen De Estella: Idoya Pascal Martínez. Hospital Reina Sofía De Tudela: José Antonio Cascante Rodrigo y José Javier Lorza Blasco. Hospital Virgen Del Camino De Pamplona:. C. VALENCIANA: RESPONSABLE REGIONAL Pablo Catalán Serra y Juan José Soler Cataluña. Neumología, Hospital de Requena. RESPONSABLES LOCALES: Alicante: Hospital de Elda: Alejandro Muñoz. Hospital de Orihuela: José Manuel Querol. Hospital de San Joan: Eusebi Chiner Vives y Adaluz Andreu Rodríguez. Hospital de Torrevieja: Esther Pastor. Castellón de la Plana: Hospital de la Magdalena: Khaled Bdeir Egnayem Hospital de La Plana: Luis Miravet. Hospital General de Castellón: Margarita Marín Royo. Valencia: Hospital Clínico Valencia: María Cruz González Villaescusa. Hospital de Requena: Pablo Catalán Serra y Juan José Soler Cataluña. Hospital Dr. Peset: Estrella Fernández Fabrellas, Ángela Cervera Juan, Alberto Herreron Silvestre y Alfonso Martinez Martinez. Hospital Francés de Borja, Gandia: Concha Pellicer Ciscar. Hospital de la Rivera: Elsa Naval Sendra. Hospital Sagunto: Eva Martínez Moragon. Hospital Universitario la Fe: Montserrat Leon Fabregas. EXTREMADURA: RESPONSABLE REGIONAL Juan Antonio Riesco Miranda. Neumología, Hospital de Cáceres. RESPONSABLES LOCALES: Badajoz: Hospital Infanta Cristina de Badajoz: José Antonio Gutierrez Lara, Fernando Fuentes. Cáceres: Hospital de Cáceres: Juan Antonio Riesco Miranda. Hospital de Plasencia: Miguel Ángel Hernández Mezquita. Mérida: Hospital de Mérida: Germán García Vinuesa. GALICIA: RESPONSABLE REGIONAL Alberto Fernández Villar. Neumología, Complejo hospitalario de Vigo. Juan Suárez Antelo. Neumología, Complejo Hospitalario Universitario A Coruña. RESPONSABLES LOCALES: La Coruña (A Coruña): Complejo Hospitalario Universitario A Coruña: Juan Suarez Antelo. FPH Barbanza: Emilio Manuel Padin Paz. Hospital de Conxo - Santiago de Compostela: Jesús Suarez Martinez. Lugo: Hospital Comarcal Burela: Sonia Paredes Vila. Hospital Xeral, Lugo: Rafael Golpe Gomez y Luis Pérez de Llano. Orense (Ourense): CH Ourense: Pedro Marcos, Carlos Vilariño Pombo y Jose Manuel García Pazos. Pontevedra: Hospital provincial de Pontevedra: Adolfo Baloira. Hospital Xeral, Vigo: Alberto Fernández Villar y Cristina Represas Represas. Hospital do Meixoero, Vigo: Manuel Nuñez Delgado. Hospital Povisa: Maria Dolores Corbacho Abelaira. Hospital Xeral, Vigo: Marta Nuñez Fernandez. ISLAS BALEARES: RESPONSABLE REGIONAL Borja García Cosio. Neumología, Hospital Son Espases. RESPONSABLES LOCALES: Palma de Mallorca: Hospital Comarcal de Inca: Elena Laserna Martinez. Hospital de Manacor: Rosa Maria Irigaray Canals. Hospital de San Llatzer: Salvador Pons Vivas. Hospital Son Espases: Borja Garcia Cosio. Menorca: Hospital Mateu Orfila: Jordi Guerrero. Ibiza: Hospital Can Misses, Ibiza: Alvaro De Astorza y Antonio Cascales García. LA RIOJA: RESPONSABLE REGIONAL Manuel Barrón Medrano. Neumología, Hospital de la Rioja. RESPONSABLES LOCALES: La Rioja: Fundación Hospital de Calahorra: Susana Chic Palacin y Manuel Barron Medrano. Hospital De La Rioja: Carlos Ruiz Martínez y Manuel Barron Medrano. PAIS VASCO: RESPONSABLE REGIONAL Cristóbal Esteban. Neumología, Hospital de Galdakao. RESPONSABLES LOCALES: Álava: H de Santiago: Mª Ines Carrascosa. H Txagorritxu: Laura Tomas. Gipuzcoa (Guipuzkoa): H Bidasoa: Jose Antonio Miguel Arce, Mª Asunción Celaya y Silvia Dorronsoro. H Donostia: Mª Rosa Berdejo, Mónica Rayón y Gabriel Zubillaga Garmendia. Hospital de Mendaro: Jose Ignacion Royo, Susana Chic Palacin y Nicolás Gurrutxaga. H de Mondragón: Iñaki Peña y Mikel Temprano Gogenola. H Zumarraga: Silvia Dorronsoro, Cristina Estirado y Raquel Sanchez. Vizcaya (Bizkaia): H Basurto: Miren Begoña Salinas y Igor Iturbe. H Cruces: José Mª Antoñana y Pilar Marin. H Galdakao: Cristóbal Esteban, Mikel Egurrola y Alberto Capelastegui. H San Eloy: Juan Manuel Nuñez, Jesús Caminos y Luis Alberto Ruiz Iturriaga. PRINCIPADO DE ASTURIAS: RESPONSABLE REGIONAL Cristina Martinez. Neumología, Hospital Universitario Central de Asturias. RESPONSABLES LOCALES: Hospital Universitario Central de Asturias: Marta García Clemente, Hospital de Cabueñes Gijón: Teresa Pascual Pascual y Concepción Diaz Sanchez. Hospital del Oriente-Arriondas: Blanca Requejo Mañana. Hospital Fundación Jove: Benigno Del Busto Lorenzo. Hospital San Agustín, Avilés: Fernando Álvarez Navascues y Marta García Clemente. Hospital Universitario Central de Asturias: Aida Quero Martínez y Cristina Martínez. Hospital Valle del Nalón Langreo: Hortencia Canto Argiz. REGION DE MURCIA: RESPONSABLE REGIONAL. Juan Miguel Sánchez Nieto. Neumología, Hospital General Universitario Morales Meseguer. RESPONSABLES LOCALES: Hospital de los Arcos: Damián Melia Alvarado, Jose A Ros Lucas y Nuria Castejon Piña. Hospital General Universitario Morales Meseguer: Roberto Bernabeu Mora, Juan Miguel Sanchez Nieto y Maria Loreto Alemany Frances. Hospital Universitario Santa Lucía: Ines Bernal Belijar, Jose Javier Martinez Garceran, Mercedes Guillamon Sanchez y Pilar Berlinches Acin. Hospital U Reina Sofía: Carlos Orts Arqueros, Maria Jesus Aviles Ingles y Pedro Mendez Martinez.

Funding

This work was supported in part by grants from the Fondo de Investigación Sanitaria PI 06\10.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author information

Affiliations

  1. Pulmonary Service, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain

    Cristóbal Esteban & Alberto Capelastegui

  2. Pulmonary Service and Research Institute, Doce de Octubre University Hospital, Madrid, Spain

    Ady Castro-Acosta, Carlos Jose Alvarez-Martínez & Francisco Pozo-Rodriguez

  3. CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain

    Ady Castro-Acosta, Carlos Jose Alvarez-Martínez & Francisco Pozo-Rodriguez

  4. Hospital Universitario Virgen del Rocío, Medical- Surgical Unit of Respiratory Diseases, Seville, Spain

    José Luis López-Campos

  5. Network and Health Services Research Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain

    Cristóbal Esteban

Contributions

Conception and design: FPR; Analysis and interpretation: CE, ACA, FPR; Drafting the manuscript for important intellectual content: CE, ACA, CJAM, AC, JLLP, FPR. All authors have read and approved the final version of this manuscript.

Corresponding author

Correspondence to Cristóbal Esteban.

Ethics declarations

Ethics approval and consent to participate

The study was approved by Instituto de Salud Carlos III CEI PI 30_2011-v4 and by the Ethics Committees of every hospital involved in the study. All participants provided written informed consent.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Esteban, C., Castro-Acosta, A., Alvarez-Martínez, C.J. et al. Predictors of one-year mortality after hospitalization for an exacerbation of COPD. BMC Pulm Med18, 18 (2018). https://doi.org/10.1186/s12890-018-0574-z

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Keywords

  • Pulmonary disease
  • Chronic obstructive
  • Hospitalization
  • Mortality
Источник: https://link.springer.com/article/10.1186/s12890-018-0574-z;
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NUESTRA CLINICA DEL VALLE (NCDV) has opening for a Custodian for the Roma Clinic. Experience in routine housekeeping, maintenance and operating various janitorial equipment. Apply at Nuestra Clinica del Valle 2891 E. Grant, Roma, TX or mail resume to: P.O. Box 1689, Pharr, TX 78577; phone 787-8915; fax 787-2021. Online: www.nuestraclinicadelvalle.org EOE

City of Rio Grande City Communications Officer

Job Title &amp; Classification

Communications Officer for Rio Grande City Police Department is a full-time permanent hourly position.

Requirements

Graduate from an accredited High School or GED Certificate, experience preferred not required, also a valid Texas Driver’s License. Must be able to work rotating shifts, weekends, and maintain on-call status. Job consists of multi-task duties such as answering phone (administrative and 911 Emergency), dispatching through a 2-way radio (City Police, Fire Department, and RGCISD PD). Applicant must pass a thorough background check (employment &amp; criminal) and a pre-employment drug test.

Salary &amp; Compensation

Salary will be bases on experience. Benefits include retirement, health insurance, holiday, sick and vacation leave.

Deadline

Position open until filled Applications may be picked up at City Hall Valerie Brown-Garza, Personnel Director Rio Grande City Personnel Department 5332 E. Hwy 83 Rio Grande City, TX 78582 956/487-0672 www.cityofrgc.com City of Rio Grande City is an Equal Opportunity Employer

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STARR COUNTY TOWN CRIER, MAY 16, 2018, SECTION II, PAGE 3

TWA College Scholarships Available Roma ISD 70th Anniversary Gala The Texas Wildlife Association Foundation (TWAF) and the San Antonio Livestock Exposition, Inc. (SALE) have joined forces to offer San Antonio Livestock Exposition, Inc. Scholarships. Scholarships in the amount of $10,000 will be awarded to incoming freshmen at all Texas universities and colleges. The scholarship application is available on the Texas Wildlife Association website, www.texaswildlife.org. Applications must be postmarked by July 31st. Winners will be announced by August 15th. “As our population has grown, the strain on our natural resources has grown proportionately,” said TWAF Trustee Charles Davidson. “Our future depends on our ability to manage our natural resources wisely, balancing the needs of man and nature. It just makes sense to identify our future leaders and support them while they are getting their educations. We all will benefit from their expertise in the years to come.”

This is the twelfth year that TWAF and SALE have teamed up to offer scholarships to future natural resource stewards. To date, $500,000 has been awarded through this scholarship program. Selection Criteria: - Participation in activities, internships, and experience related to the field of natural resource conservation in high school and/or college. - Honors, awards, and leadership skills - Degree plan option and academic achievements - Answers to four essay questions - Recommendations - Applications must be postmarked by July 31st. Winners will be announced by August 15th. Eligibility Requirements: Students receiving a San Antonio Livestock Exposition, Inc. Scholarship through the Texas Wildlife Association Foundation, Inc. must comply with the following guidelines:

- Must be a citizen of the United States and provide proof of citizenship. - Must be a Texas high school graduate enrolling in a Texas college within 1 year of high school graduation. - Must attend an accredited Texas college or university; no online degree programs. - Must maintain a minimum GPA of 2.5 per semester on a 4.0 scale each semester (not cumulative) of each academic year to remain eligible. - Must take a minimum of 12 hours per semester. Only one (1) online 3 – 4 hour course, taken at the college or university in which recipient is enrolled full time, will be funded per semester. The online course must be a curriculum requirement. Any additional online courses will not count towards the minimum 12 hours per semester and will not be funded. For more information contact Kassi Scheffer at kscheff[email protected] texas-wildlife.org

OVERLAY WORK IN HIDALGO/BROOKS COUNTY AREA SCHEDULED

The Texas Department of Transportation announces that US 281 will be receiving some scheduled maintenance throughout the summer months. The details are as follow: May 15, 2018 thru August 17, 2018. Day work from 7:00 a.m. to 6:00 p.m., 69 working days, Monday thru Friday. (weather permitting) Foremost Paving, Inc., a TxDOT contractor will be applying stone matrix asphalt overlay, milling, and striping. From: .747 Miles South of FM 755 To: Brooks/Hidalgo County Line. Motorists are advised to observe all posted warning, construction, detour and speed limit signs. Lane closures should be expected throughout the project.

North Grammar Elementary 4th Six Weeks Honor Roll

Ms. Nora Rivera, principal at North Grammar Elementary, proudly announces the honor roll for the 4th six weeks. PRE-KINDER Miss Victoria Trigo “A” Jasmin Garcia, Kaylen Hernandez, Roxann Lara, Joe Mijares, America Morin, Brandon Rios, Cornelio Camacho, Richard Vasquez “A&amp;B” Isaiah Acevedo, Ediel Moreno, Jesus Quiroz, Bryan Salinas, Ryan Gonzalez, Jorge Trevino Mrs. Erika Guerra “A” Andries Aguilera, Felix Briceno, Zaniah Cabrera, Elizabeth Garcia, Kalub Vera, Angel Gonsalez, Everardo Gonzalez, Skylinn Martinez, Dylan Barrera “A&amp;B” Ixael Alvarez, Analia Cruz, Bridgette Rosales, Damian Salinas Ms. S. J. Garcia “A” Daney De la Garza, Eiza Garcia, Fabian Gonzalez Barbosa, Robert Ramirez, Josiel Gonzalez “A&amp;B” Hailey Chapa, Ian Ibarra, Martie Jaramillo, Juan Pablo Pena, Jonathan Reyes, Kaylee Rincon, Maria Luisa Zarate “B” Emmanuel Garcia KINDERGARTEN Mrs. Cinthia Perez “A” Nicole Alonso, Victor Guerra, Ediel Hernandez, Prissila Rocha, Cesar Villarreal, Valerie Villarreal “A&amp;B” Eliseo Garza, Ana l. Ibarra, Jessica Orozco Mrs. Marisol Rios “A” Jacqueline Falcon, Adalyn Galvan, Chanel Gonzalez, Jonathan Perez, Bridget Perez, Aubree Reyes, Kristine Roiz, Christian Zurita, Eric Garcia, Ethan Hernandez “A&amp;B” Julian Cabrera, Drake Cortez, Eden Moreno, Tiana Tamez, Cristian Martinez, Sofia Barrera Mr. Jose F. Garcia “A” Luis Banda, Tristan Gamez, Dylan Garza, Kimberly Lucatero, Madison Marks, Romeo Rodriguez “A&amp;B” Ashley Gonzalez, Tatiana Hinojosa, Emilee Sanchez, Jaylah Sanchez Mrs. Veronica B. de Sanchez “A” Alexa Gomez, Yaima D. Meraz, Delaney M. Lopez, Brittney Trevino, Kimberly Trevino “A&amp;B” Christina Castellanos, Eduardo Gonzalez, Ashley B. Hernandez, Guadalupe Rios FIRST GRADE Mrs. Dayna Trillayes “A” Luis F. Gonzalez, Lynea R. Lara,

Vianney L. Martinez, Adlih Y. Perez, Kaylee Ramirez, Audrey Ruiz A&amp;B” DeeAndra N. Garza. Monica Mendoza, Geronimo A. Salinas, Miss Dayna Rivera “A” Nicolas Dominguez, Yaritza Garcia, Crystal Gonzalez, Sophie Vela “A&amp;B” Eloy Amador, Ashanti Gutierrez, Isamar Perez, Ashley Ramos Ms. Martha Trevino “A” Adanely Blanco-Herrera, Juan Lanas, Carlos Luna, Cesar Luna, Catherine Gonzalez, Eduardo Gonzalez “A&amp;B” Emely Adame, Cynthia Medina, Enrique Perez-Saenz, Robert Hernandez Mrs. Eunice Villarreal “A” Angel Balderas, Kendra Lopez, Valeria Luera, Natasha Mijares, Edgar Pruneda “A&amp;B” Dylan Chapa, Esteban De La Garza, Erika Nunez, Genesses Pompa SECOND GRADE Mrs. Mayra Guerra “A” Kaya Arredondo, Jenna Cabello, Isaac Guerra, Juan Hernandez, Jose Maldonado, Tristan Silva, Marco Trevino, Serapio Trillayes, Nikolai Vera “A&amp;B” Valentina De la Cruz, Dayana Lazos Ms. Anel Lopez “A” Sophie Aleman, Christian Garcia, Alexa Gonzalez, Yael Portillo, Job Hernandez, Daniel Reyez “A&amp;B” Josue Gonzalez, Maddison Gutierrez, Naomi Luna, Destiny Mejia, Ruben Navarro, Efren Ramirez Mrs. Carmela Perez “A” Cesar Garcia, Ashley Gonsalez, Naytza Mireles, Romeo Perez, Eduardo Rios, Alejandro Zapata “A&amp;B” Isaac Garza, Antonio Puente, Alexis Ruiz, Leslie Sanchez, Adaias Tanguma, Andrea Trevino, Hector Vela Mrs. Adriana Lopez “A” Zantiago Dominguez, Elian Gonzalez, Adrian F. Guerra, Jasmine A. Martinez, Miguel A. Mendoza-Duarte, Jose E. Solis, Gilberto Tello, Jr., Kailann E. Valverde, Caridad Villarreal “A&amp;B” Alessandra Briceno, Leslie S. Castillo, Debani Moreno THIRD GRADE Mrs. Rhonda Canales “A” Justin Garcia, Julianne Hernandez, Aztrid Reyes

“A&amp;B” Gabriela Briceno, Robert Cardona, Luis Castro Ramirez, Andrea Covarrubias, Isaiah Farias, Ariana Galvan, Jorge Jaime Garcia Mr. Adrian Garcia “A&amp;B” Graciela Briceno, Aylin Galvan, Sebastian Garcia, Maritza Lucatero, Steven Martinez, George Perez, Dozani Rodriguez Mrs. Sylvia Vela “A” Clarissa Garcia, Kendra Gonzalez, Sophia Ramirez, Abdiel Vazquez “A&amp;B” Ciara Barrera, Karolina Barrera, Daniela Garcia, Gael Garza, Anaiza Guzman, Miguel Martinez, Bryan Moreno, Carlos Reyes, Annette Reyna Mrs. Graciela Garza “A&amp;B” Pedro De La Torre, Oscar Garza, Jatziry Garcia, Audrey Gutierrez, Derick Ramirez FOURTH GRADE Mrs. Armandina Garza “A&amp;B” Nadalee Arredondo, Manuel E. Chapa, Dezaree Martinez, Kristal N. Ortiz, Karla Vargas Mrs. Maria Bravo “A” Nemuel Pena-Rios “A&amp;B” Adan Bazan, Lizbeth Carmona, Ashley Gomez, Gabriela Nunez, Ariana Rangel Mrs. Ana M. Ramirez “A” Noe Mijares, Delilah Mireles, Gerardo Vela “A&amp;B” Alexa Clarke, Ana P. Gomez, Jaylene Gomez, Pedro De La Garza, Alexia Lara, Ruhan Ruiz Mr.Castulo Solis “A” Luis E. Lopez FIFTH GRADE Mr. Ben Benavidez “A” Sadie Cabrera, Ailyn Villarreal “A&amp;B” Joshua Guerra, Vianey Olivares, Vanessa Ramirez, Kimberly Rivera, Diego Rodriguez Miss Jessica Saenz “A” Kira Davenport, Krystal Vargas “A&amp;B” Isabella V. Garza, Jose F. Garza, Tania Moreno Ms. Veronica Perez “A” Jesus Portillo, Juan Villarreal “A&amp;B” Jose Alaffa, Mario Herrera, Armando Martinez, Oscar Trevino, Aaron Villarreal Mrs. Lizel Lopez “A” Irais Barrera “A&amp;B” Eduardo Amezquita, Hugo Yahir Cruz, Jessica de la Cruz, Alieh Martinez, Marco Martinez

Puts Student Excellence on Display

Congratulations to all the wonderful students who put their talents on display for the Roma ISD 70th Anniversary Gala! Student excellence was on display from jose luis martinez candial facets of jose luis martinez candial district. We appreciate everyone who took the opportunity to celebrate this milestone with us.

DPS Reminds Texans to Prepare for Hurricane Season Now With the hurricane season less than one month away, the Texas Department of Public Safety (DPS) urges all Texans to use Hurricane Preparedness Week to learn how to protect themselves and their families from hurricanes and tropical storms. Hurricane season starts June 1 and continues through Nov. 30. “Hurricane season is unpredictable, and as we saw last year with Hurricane Harvey, these powerful storms can cause dangerous conditions and leave behind major devastation,” said Texas Gov. Greg Abbott, who proclaimed this week as Hurricane Preparedness Week in Texas. “By preparing ahead of time, we can help ensure our state is ready when natural disasters strike. I encourage all of my fellow Texans to plan now in advance of hurricane season, and to closely monitor any weather warnings and evacuation orders in the coming months.” All Atlantic and Gulf of Mexico coastal areas are subject to hurricanes and tropical storms. It is possible for a storm to severely impact our state, even prior to or without making direct landfall in Texas. Hurricanes can cause catastrophic damage to coastlines, and winds can vary from 74 to 157 miles per hour (or higher). In addition, hurricanes and tropical storms can also spawn tornadoes, create dangerous coastal water conditions,

including regional acceptance customer service number live person surges, and cause extensive flooding damage. Also, the rainfall associated with a tropical system can have an extremely wide reach, so monitoring changing weather conditions during hurricane season is critically important for all Texans. “As Texans know all too well, the damage caused by a hurricane can be catastrophic, and the impact these storms have on our lives does not go away when the storm warning expires,” said DPS Director Steven McCraw. “Our neighbors along the coast are still recovering from Hurricane Harvey. Hurricane Preparedness Week offers an important reminder for everyone to be diligent, and by taking a few simple steps — like developing a hurricane plan and assembling an emergency disaster kit — we can ensure we are ready when a storm hits. It can mean the difference between life and death.” Here are several measures residents can take now to prepare for potential storms: •Assemble an emergency kit that includes essential documents, supplies and provisions. •Review hurricane evacuation maps, and select a route for you and your family. •Plan how all family members and pets will evacuate safely. •Consider any special needs for individuals with disabilities or the elderly.

•Stay informed about changing weather conditions in and around your area. •Follow the instructions of local officials if a storm develops. Residents are also encouraged to review their property’s flood risk and current insurance coverage, and to consider whether a separate flood policy should be part of their home protection plan. (Remember most flood policies have a 30-day waiting period before taking effect.) For more information, visit the Texas Department of Insurance website. If you or someone you know might need assistance during a disaster, register now with the State of Texas Emergency Assistance Registry (STEAR) — a free registry that provides local emergency planners and responders with additional information about the needs in their communities. To register, contact 2-1-1 Texas, the state’s free 24-hour helpline. No matter where you live in Texas, you can dial 2-1-1 or 877-541-7905 for community resources. For more information about hurricanes and how to prepare for the 2018 hurricane season, visit the DPS website and www. texasprepares.org. You can also find out more about hurricane preparedness at the National Weather Service website.


STARR COUNTY TOWN CRIER, MAY 16, 2018, SECTION II, PAGE 4

You should be a conservationist!

many ways to contribute to the effort. As with most important If you believe as I do that we causes, success should preserve much of our results from the natural environment, there are accumulation of lots of little contributions. I’d like to suggest a few. One of the major factors leading Application has been made to the decline of some species, with the Texas Alcoholic such as the ocelot, is road kill. You B e v e r a g e C o m m i s s i o n can make a difference by driving our backroads carefully and, when for a B E E R R E TA I L you see wild things on the road, D E A L E R ’ S O F F - give them, literally, the brake. I’ve P R E M I S E L I C E N S E, seen a few drivers deliberately run P A C K A G E S T O R E over snakes. That’s despicable behavior. PERMITAND PACKAGE Poachers are far down on my S T O R E T A S T I N G list of what constitutes a civil P E R M I T by: L O YA L human being. They are not only I N V E S T M E N T S &amp; thieves but deplete the numbers CONSTRUCTION, LLC of already threatened species. Any time you see poachers stealing, dba: LOYAL LIQUORS call the game warden or police. to be located at 605 W Get their car license number if MAIN ST. SUITE 4, RIO you can. We all have trash to dispose GRANDE CITY, STARR of including batteries, used oil C O U N T Y, T E X A S. and electronics. Such polluting Officers of said LLC are materials should be handled LARISSA LEAL. differently than ordinary trash. Call your commissioner or

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mayor’s office to find a proper disposal site in your area. Our periodic droughts create tough times for some wildlife. You can help them survive by offering food and water and, as an extra benefit, also provide some wonderful viewing opportunities for yourself. A bird feeding area can be very entertaining. Just a birdbath can be a delight. Also, during dry times, be extra careful with fire. Cigarets and untended campfires can inflame many acres and decimate the wildlife. We’re fortunate to have many conservation oriented organizations and they’re making significant progress but they need financial support. One, whose strategies I admire, is The Nature Conservancy. If an area deserves to be conserved, they simply buy it. If that’s not possible, they try to negotiate conservation easements. Support any of the conservation groups that you can. Donations do make a difference. One of the most important things any of us can do is to provide young people with opportunities to enjoy wildlife first-hand. Get them away from the computer

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STARR COUNTY TOWN CRIER, MAY 16, 2018, PAGE 6

Starr County Staff working on Procedural Plan for Emergency and Hazardous Situations

Y.B. Escobar Celebrates Dr. Seuss

The Y.B. Escobar Buckaroos had a great time celebrating Dr. Seuss Week in March. The school hosted a Vocabulary Parade, which was a wonderful experience both for students and teachers. Librarian Anna Guillen extends her thanks to the school’s Yvonne Garza from the Texas Department of Public Safety Division of Emergency Management Office parents, students and staff for and Mr. Jose Alejandro-District Coordinator for TDEM provided a training for Starr County Personnel their participation in the activities on Emergency Management Plans, disaster declarations and the importance of being prepared in case of because without them, none of the awesome things the school a disaster. (Not pictured; Mr. Jose Alejandro and Captain Lenard Fuentes) did this year would not have been possible or as successful. (Photo courtesy Anna Guillen.)

STC

Continued from Front Page

Cantu says she’s excited to begin her journey with South Texas College. “I plan to serve as a public advocate and ambassador for the college,” said Cantu. “Meanwhile I’ll also be advocating for the best interest of our students.” Rene Guajardo was elected to be STC’s District 6 representative that encompasses Donna, South Alamo, South San Juan, Southwestern Pharr, South Weslaco, and Progresso. Guajardo took 57 percent of votes. “My goal is to continue to break the barriers that hold back our students from achieving their ultimate goal of obtaining a higher education in the Rio Grande Valley,” said Guajardo. “In essence, it is all about helping all students across the RGV achieve a post-secondary education.” STC board members will serve the college community and participate in monthly public meetings ensuring the voices of their constituents are represented and addressed.

50th Class Reunion 1968 Class of RGC

The 1968 Class of Rio Grande City High School will celebrate its 50th class reunion on June 2nd, 2018, from 6:00 p.m. to 10:00 p.m., at The Party Place located at 1960 West U.S. Hwy 83, Rio Grande City, Texas. We are still searching for the following class members: Suzanne Benoit, Aida Cantu, Maria Del Rosario Espinoza, Elma Lydia Gonzalez, Herlinda R. Lopez, Maria Aurora Olivarez, Rosa Idalia Ramirez, Linda Kathleen Russell, Diana Smith, Virginia Solis, Juanita Ybanez, Miguel Espinoza, Jose Francisco Gomez, Jesus Guzman, Jr., Steve Jesurun, Ray Dan Kenmotsu, Rodolfo Perez, Alvaro Omar Solis, Eleazar Solis, Ricardo Solis, Jose Rene Venecia, Juan Ybarra, Jr., Jaime Ramiro Flores, and Yolanda Solis. Please contact any of the following Steering Committee members if you have any information on the whereabouts of the above-named and unaccounted for class members: Romeo Garcia: 956-4872035 (home); Maria Imelda Saenz: 956-735-3275 (cell); Juan Remigio Lara: 956-3171713(cell); Maria Elena Sanchez: 956-648-2328 (cell); Margil Sanchez, Jr.: 956-739-6117 (cell) and 956-487-7575 (office).


STARR COUNTY TOWN CRIER, MAY 16, 2018, PAGE 7

Alto Bonito Elementary Rewarded Students with Gift Certificates Roma Middle School Hosts Career Day

Kudos to Roma Middle School for hosting a wonderful Career Day featuring a variety of career paths for students to pursue. Students learned how they can chart bright futures by starting on the path to their chosen careers through career trainings and academic classes in high school. Some basic entry career training classes are also offered at both Roma Middle School and Ramiro Barrera Middle School. Way to go Gladiators! Alto Bonito Elementary Principal, Mrs. Yvette Pena, awarded all students present with a certificate that could be used for a “Free Day” at Incredibowl. This certificate, donated to the school, gives access to unlimited free bowling, batting cages, arcades, kiddie train rides, and a free lunch. These kids were super excited! Way to go Roadrunners! (Pictured with these certificates, are 3rd graders, from Mrs. Sandra Sanchez’s class).

Wednesday May 16, 2018 Where: South Texas College Starr County Campus D1-116 Workforce Room Time: 3:30 Ð 4:00 P.M. Registration v Door Prizes v Recipes v Exhibits v Tasting

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STC announces 2018 Board Election outcomes Grulla Middle School Mariachi Juvenil Grulla Three S o u t h Te x a s College Board of Trustee seats were up for election t h i s spring. Board members are elected by constituents in the districts they represent and serve a six-year

term. Those elected in May 2018 will serve through 2024. The outcomes were as follows: Rose Benavidez will remain the STC representative for Starr County. Benavidez took nearly 70 percent of the vote and will begin her second full term. Benavidez thanks the constituents of District 1 for their efforts. “The election is over but our campaign to strengthen and improve our community

continues,” said Benavidez. “We are humbled with the steadfast support and enduring trust you have granted us and we are eager to continue to work for you and with you.” Victoria “Vicky” Cantu was elected to represent District 2. Cantu won the election with 70 percent of the vote and now serves the areas of La Joya, Western Mission, Palmview, Sullivan City, Penitas, and Western Alton. STC, page 6

I.C.S. Students PSIA State Finalists

I.C.S. Is very proud of all of our P. S. I. A. (Private School Interscholastic Association) students who made it to STATE in Fort Worth, Tx. Five out of nine students who participated at State won top 10 in Texas. Immaculate Conception School PSIA State Finalists Winners are: (Top 10) - 8th Grade Art Smart Graciela Perez -10th Place, Coach: Ms. D. Garza (Top 6) Medal Winners - 4th Grade Poetry - Jaime Castillo - 4th Place Bronze Medal, Coach: Miss A. Solis; 4th Grade - Spelling - Jose Jara - 4th Place Bronze Medal, Coach: Mrs. A. Congrats to all our students &amp; Rodriguez; 3rd Grade - Spelling- 2nd Grade - Story Telling - Ryan Ryan Vazquez - 2nd Place Silver Rios - 5th place Bronze Medal, teachers for their hard work and dedication. Medal, Coach: Mrs. A. Rodriguez; Coach: Mrs. F. Landes.

Roque Guerra, Jr. Elementary Colt Cheerleaders Participated in the Fun Cheer Spirit Splash

de Plata Earned 1st Place at Competition

Grulla Middle School Mariachi Juvenil Grulla de Plata earned 1st Place and won all section awards at the 2018 Feria del Mariachi. The competition was held in San Marcos-Texas State University. They are under the direction of Jose Rangel.

La Union Elementary Congratulates Student Basketball Champions

La Union Elementary would like to recognize the following 3rd-grade boys for being this year’s Rio Grande City Park and Recreational basketball champions. A big “THANK YOU” to Mr. Omar Perales and the Rio Grande City Parks and Recreation Department for working with our students. Congratulations: Johnny Bazan, Diego Garcia, Rylee Gutierrez, Gilberto Ortiz, Gilberto Rodriguez and Arnold Trevino.

Roma High School Boys Track Teams Advance to Area Competition

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The Roque Guerra, Jr. Elementary Colt Cheerleaders, under the direction of Mrs. Myra Toscano, Ms. Tiffany Alaniz and Ms. Melanie Zamora, participated in the Fun Cheer Spirit Splash at the South Padre Island Convention Center. The Colts brought home the 2nd Place Team Award and earned the Fun Cheer Spirit Award for 2018! The Colt team also enjoyed a fun filled day with their families at Schlitterbahn the day before Congratulations to the Roma High School Boys Track 4X1 Relay Team, the competition. Congratulations to the RGE Colt Cheerleaders! Your hard work and dedication throughout who are district champions and advance to area competition in the 4x1 and the 4x2 relays. Way to go Gladiators! the year was on full display during the competition! OPEN MON-SUN 7AM-7PM

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STARR COUNTY TOWN CRIER, MAY 16, 2018, PAGE 2

WEDNESDAY MAY 16TH - I.C.C. 6:00 P.M. †KENNIE ALANIZ by Parents †AGAPITO &amp; EMMA GLORIA by Juan &amp; Angie Guerra THURSDAY MAY 17TH - I.C.C. 6:30 A.M. PRO POPULO - MASS SAID FOR THE PEOPLE FRIDAY MAY 18TH - I.C.C. 8:20 A.M. ICS STUDENTS &amp; STAFF 6:00 P.M. †LUZ MARIA GARZA (6TH AN.) by Family SATURDAY MAY 19TH - I.C.C. 5:00 P.M. †HERBERT BROWN (AN.) by Brown Family †LOLITA &amp; PEDRITO FERNANDEZ by Fernandez Family

†JOSE ANGEL PEÑA by Su Esposa y Familia †MARIA DEL REFUGIO TREVIÑO by Vela Perpetua Altar Society †ALFONSO O. MASCORRO (10TH AN.) by Su Esposa e Hijos

†XOCHITL O. ACEVEDO by Daughters Mayte &amp; Mary SPECIAL INTENTION FOR MR. &amp; MRS. JOSE R. ESCOBAR, JR. &amp; FAMILY by Family

†LUIS MANUEL PEÑA (2ND AN.) by Family INTENCION ESPECIAL POR LUIS ALBERTO ANDRADE TANGUMA by Tios Raudel &amp; Lina

SUNDAY MAY 20TH- I.C.C. 7:00 A.M. †FELIPE GOMEZ, JR. (1ST AN.) by Family

1:00 P.M. †NOE OLIVAREZ by Wife &amp; Family †ALFREDO GARCIA by Wife Zoila Garcia &amp; Family †GEORGE XAVIER DURAN by Wife &amp; Daughters †SIXTO FLORES, JR. by Wife &amp; Family †MARIA J. GUERRERO (1ST AN.) by Nietas 3:00 P.M. SENIOR’S MASS 5:00 P.M. †MAXIMO PEÑA by Familia Peña †ABEL S. SAENZ by Mr. &amp; Mrs. Derly Ramirez †MARIA CELIA LOPEZ by Ninfa Longoria &amp; Family

MONDAY MAY 21ST – I.C.C. 6:00 P.M. †DANIEL ALBERTO GOMEZ, JR. by Mom &amp; Dad †ELOISA BERMUDEZ by Family †ROGELIO RAMOS by Juan &amp; Angie Guerra †HOMERO DOMINGO ZAMORA (1ST AN.) by His Wife Melba Zamora †DOLORES PEREZ by Children

SUNDAY SACRED HEART/LOS GARCIA 9:00 A.M. PRO POPULO - MASS SAID FOR THE PEOPLE SUNDAY MAY 20TH - I.C.C. 11:00 A.M. †LAZARO &amp; ALEJANDRA R. GARCIA by Letty &amp; Valerie †JOEL F. SALINAS by Family †JOSE S. HINOJOSA (28TH AN.) by Mr. &amp; Mrs. J.O. Hinojosa †JOSE ORTIZ (1ST AN.) by Family

Card of Thanks

TUESDAY MAY 22ND - I.C.C. 6:30 A.M. PRO POPULO - MASS SAID FOR THE PEOPLE

Starr County Preparing for Hurricane Season

In Loving Memory of

Ramiro Rocha October 14, 1969 † May 5, 2018

The Broken Chain We little knew that morning that God was going to call your name. In life we loved you dearly, in death we do the same. It broke our hearts to lose you, you did not go alone for part of us went with you, the day that God called you home. You left us beautiful memories, your love is still our guide, and though we cannot see you, you are always by our side. Our family chain is broken and nothing seems the same; but as God calls us one by one, the chain will link again.

Captain Lenard Fuentes-Starr County Sheriff’s Office and Ms. Maricela Ibarra-Coordinator Federal Programs are working with all precinct personnel to prepare for any emergencies that may arise during hurricane season. Pictured; Maricela Ibarra, Chief Bernabe Benavidez-Pct. 4 Fire Dept. (San Isidro), Vicente Gómez-Supervisor Pct. 2., Anibal Rodriguez-La Rosita Fire Dept., Captain Lenard Fuentes, Adalberto Garza-Supervisor Pct. 1, Luis Carlos Guerra-Supervisor Pct. 4, and Heraldo Rosa-La Rosita Fire Dept.

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We wish to express our deepest appreciation to all of our relatives and friends for their presence, food, flowers, cards, gifts, and condolences during our time of grief for the loss of our beloved one. May God bless you and we will always remember your presence and comforting words.

Rocha Family

Primer Aniversario En Memoria de

Ruben Vasquez Jr.

Junio 1, 1970 † Mayo 22, 2017 Dios miró alrededor de su jardín y encontró un lugar vacío. Entonces bajo su mirada hacia la tierra y vio su rostro cansado. El puso sus brazos alrededor de su cuerpo y lo llevo a descansar. El Jardín de Dios tiene que ser un lugar muy hermoso, porque El únicamente se lleva lo mejor. El sabía que estaba sufriendo, El sabía que tenia dolor. El vio que su camino se estaba haciendo muy difícil, así que cerró sus cansados ojos y susurró: ‘‘Que la paz sea tuya’’. Nuestros corazones se destrozaron al perderte pero no te as ido solo, parte de nosotros se fue contigo el día que Dios te llevo a casa con El.

Con amor su Esposa, Hijos, Padres Y Hermanos Always in our heart, El Borrado &amp; yours truly short legged

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Pida a los 3 Ángeles San Miguel, Rafael y Gabriel. Prenda 3 velas blancas en un plato con agua y azúcar, haga su petición. A los tres días publique esta oración. Aunque no crea mire que pasa el cuarto día.


Main Street Hosts Business Networking Mixer

Several Main Street and Rio Grande City businesses gathered for Mixers on Main Business Social The Rio Grande City Main The Rio Grande City Main The Rio Grande City Main Street Program held a business- Street Program provides several Street Program provides many networking mixer at the historic services and assistance available opportunities to get involved in Lopez-Tijerina Courtyard. Local to Main Street businesses downtown revitalization efforts. businesses gathered for a fun, including: Design Assistance Anyone interested in casual evening of networking from the Texas Historical volunteering is encouraged to and gave them an opportunity to Commission and much more. visit the Rio Grande City Main connect with each other, generate Rio Grande City Main Street also referrals and learn from the hosts a variety of special events Street office at 408 E. Main Street or call (956) 488-0047. success of others. throughout the year.

STARR COUNTY TOWN CRIER, MAY 16, 2018, PAGE 3

Alexis Sandoval receives certificate of appreciation

Alexis Sandoval 9 1 1 Addressing Coordinator for County of Starr was presented with a certificate of appreciation at a The South Texas 9-1-1 Regional Administration Office Award ceremony in Laredo, Texas. Congratulations!

Pan American Observance Day

This year, the Pan American Round Table from the Upper Valley Alamo-San Juan-Pharr, Edinburg, McAllen and Rio Grande City-Roma have come together to celebrate the 2018 Pan American Observance Day. In attendance were special guests State Director Dee Moore, Immediate Past State Director Lana Harper and other dignitaries.

Pan American Day, was established by presidential proclamation on April 14, 1931, is observed wherever a Pan American Table exists. This year’s Pan American Observance Day took place at the McAllen Country Club. This event included a luncheon, guest speaker Dr. Esperanza Zendejas, entertainment, raffle and door prizes.

Pictured are: Left to Right Seated - Iliana Peña, Nydia Benitez, Dalinda Peña, Maria Dee Cavazos, Corrine Guerra, Alma Gloria Gonzalez. 2nd row - Teresa Perez, Hortadelia Barrera, Ramonsita Guerra, Elvia Guerrero, Yolanda Gonzalez, Leticia Pena Garza, Deborah L. Delano, Nelda Laurel, Maria Elia Ramos, Soila Perez.

Juan Garcia Manager

Alejandra Tello Manager

Jocelyn Rodriguez CSR


STARR COUNTY TOWN CRIER, MAY 16, 2018, PAGE 4

Roma ISD Students Participate AC2E Elementary Held 7th Annual Starr Psych in UT-RGV Cello Fest Their McTeacher Night Club Scholarship Recipient

The AC2E Elementary held their McTeacher Night Kudos to all the Roma ISD students who participated in the 3-day UT- at McDonalds where admins, RGV Cello Fest! The students participated in three days of intensive teachers, and support staff cello workshops that culminated in a concert. The students enjoyed cooked, served, and had a blast taking orders for our community! learning from professional cellists from across the United States.

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Students had fun seeing their teachers behind the counter. Teachers also had fun face painting activities for the kids and we had a special appearances by our very own Rio High School Mariachi Cascabel come and entertain us with their talent!! A BIG thank you to all of our parents, students, and community for such a successful event!

Cecilia Garza – South Texas College student and Starr County Campus Psychology Club Communications Coordinator (Officer) – was presented with a Certificate of Recognition for being the 7th Annual Starr County Campus Psychology Club Scholarship Recipient. Cecilia will graduate this May from STC with an Associate’s Degree in Psychology. She has obtained an A in all of her psychological science courses.

Cecilia has great social and leadership skills that were enhanced throughout the 20172018 academic year via the Starr Psych Club that she was actively involved in with community service, fundraisers, conferences, events, etc, at the same time as balancing employment duties at the local Rio Grande City Dairy Queen. Cecilia will transfer to the University of Texas-Rio Grande Valley (UTRGV) to pursue a Bachelor’s Degree followed by a Master’s Degree in the field of Psychology. Cecilia would like to one day teach psychology at the college or university level and / or become a school psychologist. Pictured with Cecilia are Dr. Arturo Montiel (STC Starr County Campus Administrator), Ms. Rose Benavidez (STC Board of Trustees), and Eli and Alex Sarabia (STC Psychological Science Faculty &amp; Starr Psych Club Advisors). Cecilia stated, “It’s such an overwhelming experience to actually getting the opportunity to receive such an amazing scholarship. I’m really grateful for it. It shows hard work does pay off. I will continue to work hard and move forward.”


STARR COUNTY TOWN CRIER, MAY 16, 2018, PAGE 5

In a Matter of Minutes Leave stroke and neurological care to the experts

Wondwossen Tekle, MD

Ameer Hassan, DO

McAllen Medical Center’s new comprehensive neuroscience program includes neurointerventional treatment and neurocritical care. Advanced, minimally invasive, and comprehensive stroke care features 24/7 endovascular stroke treatment that may expand the time window of stroke treatment up to 24 hours after stroke symptoms begin.*

McAllen Medical Center has Level II stroke certification from the Texas Department of State Health Services and is certified as an Advanced Primary Stroke Center by The Joint Commission.

Alexandros Georgiadis, MD

The following specialty neurological services are available: • mechanical thrombectomy (clot retrieval) for acute stroke • cerebral aneurysm repair • carotid artery stenting and angioplasty • cerebral angiography, intra-arterial t-PA (tissue plasminogen activator, a.k.a. clot buster drug) for acute stroke • carotid endarterectomy • cerebral and spinal arteriovenous malformation embolization

For more information about our services, visit mcallenmedicalcenter.com

301 W. Expressway 83

The Zaragoza Fair began its activity in 1941 in the Aragonese capital, with the celebration of a general hall.

Over the years it has focused on the organization of events of a high technical level, specializing in various professional sectors, thus achieving the celebration of monographic fairs, which to date have the recognition and support of the different sectors, becoming reference in the national and international scene.

The Zaragoza Fair site has a total area of ​​360,000 m², making it the largest fair in Spain, it has 11 pavilions of various sizes, large outdoor areas, equipped with all the necessary services for holding any type of eventboth professional and playful. It is located 6 km from Zaragoza airport and 9 km from the city center.

History

Zaragoza 1 Sample Fair Tower

In the lands near the Parque Primo de Rivera acquired by the Zaragoza Chamber of Commerce and in what was known as the Zaragoza Trade Fair, the first Fair was held after the civil war in 1941, 127 exhibitors participated and the The contest was repeated in the following years throughout the month of October. At the age of four, the neo-Mudejar tower that presides over the old Fair building was erected within the small enclosure, in 1945 it reached the rank of official fair, thus becoming definitively institutionalized.

The remarkable growth unleashed in successive years by the two main competitions held at the Zaragoza Trade Fair ( International Fair of Agricultural Machinery FIMA and the Official and National Fair of Samples General Fair leads to the executive committee of the fair institution, chaired by José Luis Martinez Candial to initiate proceedings for the construction of a new enclosure capacity all exhibitors and trade firms. [ 1 ]

In 1986 the current Feria de Zaragoza site was inaugurated, on the Madrid highway, km 311.5, which solves the problems derived from the lack of space in the old headquarters. [ 2 ] The Kings of Spain, Don Juan Carlos and Doña Sofía, accompanied by the Minister of Industry, Carlos Croissier, and the first Aragonese authorities, inaugurated the new Palace of the Zaragoza trade fair. The works lasted 18 months and 3,000 million pesetas were invested. The Chamber of Commerce and Industry contributed 1,200 million and the rest the Zaragoza City Council, the Zaragoza Provincial Council, the Government of Aragon and the Savings Bank of Zaragoza, Aragon and Rioja (Ibercaja). [ 3 ]

References

Bibliography

-VÁZQUEZ ASTORGA, Mónica, "The building of the old Zaragoza Trade Fair: the Phoenix rising from the ashes?", ArtigramaDepartment of Art History of the University of Zaragoza, no. 21, 2006, pp. 597-631 ( http://www.unizar.es/artigrama/pdf/21/3varia/12.pdf )

Источник: https://second.wiki/wiki/feria_de_zaragoza

Clinical audit of COPD patients requiring hospital admissions in Spain: AUDIPOC study

AUDIPOC Study Group:

Francisco Pozo Rodriguez, Ady Angélica Castro Acosta, Nisa Lic Boukichou Abdelkader, Sara Esteban Garcia-Navas, Francisco Pozo Rodríguez, Alvar Agustí, Carlos José Álvarez Martínez, Alberto Capelastegui Saiz, Cristóbal Esteban González, Carme Hernández Carcereny, José Luis Izquierdo Alonso, José Luis Lopez Campos, Carlos Melero Moreno, José Luis López Campos, José Calvo Bonachera, Armando Falces Sierra, Gregorio Soto Campos, Fernando Romero Valero, Isidro Blanco Sáez, Jesús Sánchez Gómez, Marisol Arenas de la Riva, María Jesús Cobos Ceballos, Alicia Conde Valero, Rosa V Vázquez Oliva, Fernando Hernández Utrera, Rut Ayerbe García, Bernardino Alcázar Navarrete, Juan Manuel Bravo Santervás, José Fernández Guerra, Carlos Rueda, José Luis de la Cruz Ríos, Francisco José Cabello Rueda, Francisco Marín Sánchez, José Pérez Ronchel, José Luis López Campos, Inmaculada Alfageme Michavila, Luis Borderías, José Manuel Gascón Pelegrín, Anselmo López, Mónica Torrijos, Joaquín Carlos Costán Galicia, Salvador Bello Dronda, Andrés Sánchez Barón, José Manuel Gascón Pelegrín, Luis Borderías, Ana Velázquez Benítez, José Gabriel Julia, Carlos Cabrera López, Javier Navarro Esteva, Magdalena Alonso, Ruth Pitti, José Batista, Orlando Acosta Fernández, José Antonio Gullón, Ramón Agüero Balbín, Miguel Zabaleta Murguiondo, Beatriz Abascal Bolado, Ramón Agüero Balbín, Mar García Pérez, Jose Celdran Gil, Jesús Fernández Francés, Ana Isabel Tornero, Gloria Francisco, Fernando Pedraza, Marisi Verdugo, María José Peirón, Jesús Fernández Francés, José Luis Izquierdo, José Luis Orcastegui Candial Toledo, José Celdrán, Encarnación López Gabaldón, Jesús Reyes Hernández Hernández, José Eugenio Alonso Muñoz, Eugenio Trujillo Santos, Luis Rodríguez Pascual, Esteban Pascual Pablo, Pedro Camcelo Suárez, Ana José Seco García, Juan Ortiz de Saracho y Bobo, María Ángeles Fernández Jorge, Rosa Cordovilla Pérez, Graciliano Estrada Trigueras, José Luis Orcastegui Candial, Carlos Disdier, Enrique Macías Fernández, Félix del Campo Matías, Carmen Fernández García, Cecilia Alonso Medievilla, María Victoria Domínguez Rodríguez, Carlos Martínez Rivera, Eduard Monsó Molas, Néstor Soler Porcar, Carmen Hernández, Nuria Rodríguez Lázaro, Joaquim Gea, Roser Pedreny, Sergi Pascual, Fernando Ruiz Mori, Antonio Antón, Virginia Pajares Ruiz, Virginia Pajares Ruiz, Eduard Monsó Molas, Ignasi García Olivé, Esther Rodríguez Fernández, Joan Anton Lloret Queraltó, Mercedes Palau Benavent, Nuria Celorrio Jiménez, Manuel Haro Estarriol, Ferrán Barbé, Luis Lores Obradors, Eduard Monso, Leonardo Esteban, Julio Ancochea Bermúdez, Carlos Melero Moreno, Carlos José Álvarez Martínez, Virginia Pérez González, Gema Rodríguez Trigo, Enrique Zamora García, Fernando González Torralba, Rocío García García, Francisco Gómez Rico, Bárbara Steen, Eva De Higes Martínez, Mercedes Izquierdo Patrón, Ángela Ramos Pinedo, Javier Jareño, Ignacio Granda Uribe, Sergio Campos Téllez, José de Miguel Rodríguez González Moro, Jorge García, Beatriz Jara Chinarro, María Teresa Río Ramírez, Raúl Moreno Zabaleta, Maria Teresa Ramírez Prieto, Blas Rojo Moreno Arrones, Francisco García Río, Sergio Alcolea Batres, Rosa Malo de Molina Ruíz, Antolín López Viña, Pietat Ussetti, Esteban Pérez Rodríguez, Salvador Díaz Lobato, Carmen Matesanz Ruíz, Maria Jesus Buendia, Sergio Salgado Aranda, Germán Peces-Barba, Ma Antonia Juretschke Moragues, Soledad Alonso Viteri, Dolores Álvaro, Asunción Perpina, Ma Ángeles Ruíz-Cobos, Javier Hueto Perez de Heredia, Pilar Cebollero Rivas, Joan Boldú Mitjans, Jalil Abú-Shams, Victor Manuel Eguía Astibia, Idoya Pascal Martínez, José Antonio Cascante Rodrigo, José Javier Lorza Blasco, Pablo Catalán Serra, Juan José Soler Cataluña, Alejandro Muñoz, José Manuel Querol, Eusebi Chiner Vives, Adaluz Andreu Rodríguez, Esther Pastor, Luis Miravet, Margarita Marín Royo, María Cruz González Villaescusa, Pablo Catalán Serra, Juan José Soler Cataluña, Estrella Fernández Fabrellas, Ángela Cervera Juan, Alberto Herrerón Silvestre, Alfonso Martinez Martínez, Concha Pellicer Ciscar, Elsa Naval Sendra, Eva Martínez Moragón, Montserrat León Fábregas, Juan Antonio Riesco Miranda, José Antonio Gutierrez Lara, Fernando Fuentes, Juan Antonio Riesco Miranda, Miguel Ángel Hernández Mezquita, Germán García Vinuesa, Alberto Fernández Villar, Juan Suárez Antelo, Juan Suarez Antelo, Emilio Manuel Padin Paz, Jesús Suarez Martinez, Sonia Paredes Vila, Rafael Golpe Gómez, Luis Pérez de Llano, Pedro Marcos, Carlos Vilariño Pombo, Jose Manuel García Pazos, Adolfo Baloira, Alberto Fernández Villar, Cristina Represas Represas, Manuel Nuñez Delgado, Maria Dolores Corbacho Abelaira, Marta Núñez Fernandez, Borja García-Cosío, Elena Jose luis martinez candial Martinez, Rosa Maria Irigaray Canals, Salvador Pons Vivas, Borja Garcia Cosio, Jordi Guerrero, Alvaro De Astorza, Antonio Cascales García, Manuel Barrón Medrano, Susana Chic Palacin, Manuel Barron Medrano, Carlos Ruiz Martínez, Manuel Barron 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Источник: https://pubmed.ncbi.nlm.nih.gov/22911875/

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