Escala de Fisher como factor predictor de hidrocefalia en hemorragia subaracnoidea espontanea

Objetivo. Determinar si la cantidad de sangre y su localización es el espacio subaracnoideo, medible con la escala de Fisher en las primeras 24 horas de ocurrido el ictus hemorrágico, es un factor predictor para el desarrollo de hidrocefalia en pacientes con diagnóstico de hemorragia subaracnoidea (HSA) espontánea, vistos en el Hospital Universitario Clínica San Rafael (HUCSR) con seguimiento de 12 meses. Métodos. 251 pacientes fueron incluidos en una cohorte retrospectiva. La asociación entre la escala de Fisher y el desarrollo de hidrocefalia en pacientes con HSA espontánea fue analizada a través de un análisis bivariado y multivariado. Resultados. La edad promedio de los pacientes fue de 55,5 ± 15 años; con predominancia en el sexo femenino 65,7%. La prevalencia de hidrocefalia fue de 27,1% en la cohorte y la etiología de la HSA fue en su mayoría por ruptura de aneurismas de arterias cerebrales; 78,5%. La sobrevida a 12 meses fue de 65,7%. Tanto el grado 4 en la escala de Fisher como Hunt-Hess III se asocian con el desarrollo de hidrocefalia: ORA; 2.93 IC 95%: 1.51-5.65, P <0.001, ORA 2.83 IC 95%: 1.31-6.17 P=0.008 respectivamente. Conclusión. La presencia de sangrado Intraventricular o intraparenquimatoso ( Fisher 4) en las primeras 24 horas, asociado a un deterioro neurológico al ingreso Hunt-Hess III están asociados con el desarrollo de hidrocefalia en los 251 pacientes evaluados con diagnóstico de HSA espontánea; hallazgos consistentes con lo reportado en la literatura mundial.

Concentração sérica da proteína C reativa como indicador preditivo do prognóstico clínico em indivíduos com hemorragia subaracnóidea aneurísmática

Pós-graduação em Bases Gerais da Cirurgia - FMB

Grados altos en la Escala de Fisher predicen el desarrollo de hidrocefalia en pacientes con hemorragia subaracnoidea espontanea

Objetive. To determine if high grades of Fisher scale are useful to predict the development of hydrocephalus in consecutive Colombian patients with spontaneous subarachnoid hemorrhage (SAH) assessed from January 2005 to April 2012 with 12 month follow-up. Methods. 251 patients were included in a restrospective manner. The association between Fisher scale and hydrocephalus was analyzed bivariate and multivariate analysis. In addition, a systematic literature review (SLR) was done. Results. In our cohort of patients, the etiology of SAH was due to aneurysms; 78,5%. The prevalence of hydrocephalus was found to be of 27,1%. Overall survival with a 12 month follow-up was of 65,7%. Average age of included patients was 55,5 ± 15 years, and most of them were women; 65,7%. Having Fisher 4 and Hunt-Hess III are significantly associated with hydrocephalus: adjusted OR: 2.93 95% CI: 1.51-5.65, P <0.001, adjusted OR: 2.83 95% CI: 1.31-6.17 P=0.008 respectively. The SRL showed an overall prevalence of hydrocephalus between 17 and 68% and mortality varied between 3.0% and 33%. 50% of the included studies significantly associated intraventricular hemorrhage ( Fisher 4) with hydrocephalus. Conclusion. Our results confirm current concepts on post-SAH hydrocephalus and the fact that is obstructive and secondary to Fisher 4 and having neurological impairment on admission (Hunt and Hess III).

Distal anterior cerebral artery aneurysms

Objective: Distal anterior cerebral artery (DACA) aneurysms represent about 6% of all intracranial aneurysms. So far, only small series on treatment of these aneurysms have been published. Our aim is to evaluate the anatomic features, microneurosurgical techniques, treatment results, and long-term outcome in patients treated for DACA aneurysms. Patients and methods: We analyzed the clinical and radiological data on 517 consecutive patients diagnosed with DACA aneurysm at two neurosurgical centers serving solely the Southern (Helsinki) and Eastern (Kuopio) Finland in 1936–2007, and used a defined subgroup of the whole study population in each part of the study. Detailed anatomic analysis was performed in 101 consecutive patients from 1998 to 2007. Treatment results were analyzed in 427 patients treated between 1980 to 2005, the era of CT imaging and microneurosurgery. Long-term treatment outcome of ruptured DACA aneurysm(s) was evaluated in 280 patients with a median follow-up of 10 years; no patients were lost to follow-up. Results: DACA aneurysms, found most often (83%) at the A3 segment of the anterior cerebral artery (ACA), were smaller (median 6 mm vs. 8 mm), more frequently associated with multiple aneurysms (35% vs. 18%), and presented more often with intracerebral hematomas (ICHs) (53% vs. 26%) than ruptured aneurysms in general. They were associated with anomalies of the ACA in 23% of the patients. Microsurgical treatment showed similar complication rates (treatment morbidity 15%, treatment mortality 0.4%) as for other ruptured aneurysms. At one year after subarachnoid hemorrhage (SAH), DACA aneurysms had equally favorable outcome (GOS≥4) as other ruptured aneurysms (74% vs. 69%) but their mortality was lower (13% vs. 24%). Factors predicting unfavorable outcome for ruptured DACA aneurysms were advanced age, Hunt&Hess≥3, rebleeding before treatment, ICH, intraventricular hemorrhage, and severe preoperative hydrocephalus. The cumulative relative survival ratio showed 16% excess mortality in patients with ruptured DACA aneurysm during the first three years after SAH compared to the matched general population. From the fourth year onwards, there was no excess mortality during the follow-up. There were four episodes of recurrent SAH, only one due to treated DACA aneurysm, with a 10-year cumulative risk of 1.4%. Conclusions: The special neurovascular features and frequent association with anterior cerebral artery anomalies must be taken into account when planning occlusive treatment of DACA aneurysms. Clipping of DACA aneurysms provides a long-lasting result, with very small rates of rebleeding. After surviving three years from rupture of DACA aneurysm, the long-term survival of these patients becomes similar to that of the matched general population.

Estudio teórico-empírico sobre la validez del modelo de la contingencia de Fiedler en el campo educativo.

Validar el modelo de Fiedler y utilizarlo para comprender a través de la relación existente entre liderazgo y educación. Se miden una serie de variables relevantes para la educación y la satisfacción grupal. 220 alumnos y 20 profesores. Son seleccionados entre 860, bajo criterios de sexo, edad, nivel académico y nivel social; todos pertenecientes a 6 colegios de EGB de Granada. Se utiliza un diseño factorial mixto con tres variables, la última de ellas con medidas repetidas. Las variables han sido: favorabilidad situacional, estilo motivación del lider y estructuración de la tarea. Las variables dependientes ha sido el rendimiento escolar del grupo experimental. Escala LPC de Fiedler (1967), escala de Hunt, test sociométrico de Moreno, 3 tests de pruebas estructurados sobre rendimiento en Ciencias Sociales, Naturaleza y Filología, 2 tests de pruebas sin estructurar, en Naturaleza y Filología. Media aritmética, desviación típica, asimetría, curtasis, correlacion lineal de Pearson, coeficiente de correlación múltiple, coeficiente de correlación parcial, ANOVA. La teoría de Fiedler es demasiado ambiciosa, por lo que presenta problemas metodológicos y teóricos. Nuestras hipótesis son positivas, el modelo de contingencia sigue siendo útil para comprender el proceso de liderazgo, aunque debe ser matizado en las circunstancias concretas del grupo y área investigada. El modelo necesita ser perfeccionado, introduciendo las variables relevantes en nuestro trabajo y otras características psicológicas y ambientales; tampoco debemos olvidar las variables cognitivas. No existe un estilo directivo que sea el mejor, ya que no hay ninguno apropiado a todas las situaciones. La experiencia es favorable en profesores motivados por las relaciones interpersonales, no por la tarea. Instruir a los profesores para que modifiquen su grupo de trabajo para que se adecúe a su estilo de dirección. Es necesario que los programas escolares incluyan aspectos del ambiente donde se va a desarrollar la educación, y que las Escuelas de Magisterio formen profesores en relación al lugar donde van a desarrollar su actividad profesional. El rendimiento depende de factores situacionales, motivacionales del director, profesor, y de características de los alumnos, familiares, sociales, etc..

Development and/or change of the notion of permanent object and operative causality: empirical evidence in the first year of life

This study examines the notion of permanent object during the first year of life, taking into account the controversy of two approaches about the nature of change: developmental change and cognitive change. Using a longitudinal/cross-sectional design, tasks adapted of the subscale of permanent object and operative causality of the Uzgiris-Hunt Scale (Uzgiris and Hunt, 1975) (Uzgiris & Hunt, 1975) were presented to 110 infants of 0, 3, 6 and 9 months-old, which reside in three cities of Colombia. The results showed three types of strategies: (a) Not resolution; (b) Exploratory and (c) Resolution, which follow different trajectories in children’s performance. This allows affirming that adaptive conquests of the cognitive development stay together with the variety of strategies. Using strategies reveals adjustments and transformations of action programs that consolidate the notion of permanent object not necessarily with age, but with self-regulatory processes. Empirical evidence contributes to the understanding of the relations between the emergence of novelty in the development and performance variability

Baremación de una escala para la orientación heurística VS algorítmica con una muestra de adultos no universitarios.

Este trabajo se encuadra, desde el punto de vista teórico, en el contexto de razonamiento humano, y dentro de él en el campo del llamado razonamiento heurístico, entendido como una dimensión del estilo cognitivo para la población canaria de la 'escala de razonamiento heurístico', elaborada por Groner y Groner (1991), como instrumento de medida de tal dimensión. Participaron 148 personas no universitarias, de un gran abanico de profesiones, mayores de 25 años. La primera parte del trabajo presenta una reflexión teórica en torno a la concepción del razonamiento heurístico, a fin de realizar un intento de operacionalizar tal concepto-constructo, como paso previo para su medida. En el segundo capítulo se describe un instrumento de medida surgido en 1991, elaborado por el suizo, Groner que tiene como finalidad diferenciar entre sujetos cuyo razonamiento siga una pauta de carácter heurístico frente a aquella cuya estrategia es algorítmica. Se expone cuál ha sido el desarrollo de la escala original suiza y sus características estadísticas. Los siguientes capítulos se dedican al método empleado en este estudio, para la posible estandarización de la escala en Lengua Castellana. 'Escala de razonamiento heurístico' de Groner y Groner (1991). 1. La réplica de la metodología utilizada por Groner y Groner genera en nuestro estudio la reproducción de los resultados obtenidos en Suiza. 2. Esta adaptación no logra apresar el factor bipolar del tipo de razonamiento humano propuesto por ellos (al igual que la escala original). La versión reducida de 30 ítems tampoco consigue apresar dicho factor. 3. La utilización de una metodología diferente mejora el modelo de Groner a nivel explicativo, pero mantiene las incongruencias teóricas detectadas en su metodología. 4. La estructura factorial de la primera fase de esta investigación responde a los dos tipos de razonamiento propuestos por Groner, pero sin producirse la dicotomización del factor. 5. La versión reducida resultante del replanteamiento metodológico de la investigación, consigue apresar el constructo surgido en la investigación suiza, a nivel empírico. 6. El constructo de razonamiento humano obtenido con la nueva versión de la escala consta de tres factores, uno de razonamiento heurístico general y dos algorítmicos, en vez de un único factor bipolar que los recoja. 7. El instrumento de medida propuesto en este trabajo, no permite diferenciar entre sujetos con modos de razonamiento diferenciales. No existen estilos cognitivos definidos que puedan englobarse en las definiciones propuestas de razonamiento heurístico VS algorítmico. Los datos derivados de las distintas depuraciones a que sometimos la escala parecen indicar dicha afirmación, si bien hay que hacer la salvedad de que la escala debería ser rechazada totalmente si se quiere verificar un nuevo modelo, por ejemplo el modelo de Evans (1984) o Kauswisher (1989) que contempla la interacción 'conocimiento previo x características impuestas por la tarea'.

Adaptación del sector turístico al cambio climático en España. La importancia de las acciones a escala local y en empresas turísticas

El 5º Informe del IPCC (Panel Intergubernamental de Cambio Climático, 2014) señala que el turismo será una de las actividades económicas que mayores efectos negativos experimentará en las próximas décadas debido al calentamiento térmico del planeta. En España, el turismo es una fuente principal de ingresos y de creación de puestos de trabajo en su economía. De ahí que sea necesaria la puesta en marcha de medidas de adaptación a la nueva realidad climática que, en nuestro país, va a suponer cambios en el confort climático de los destinos e incremento de extremos atmosféricos. Frente a los planes de adaptación al cambio climático en la actividad turística, elaborados por los gobiernos estatal y regional, que apenas se han desarrollado en España, la escala local muestra interesantes ejemplos de acciones de adaptación al cambio climático, desarrolladas tanto por los municipios (energía, transporte, vivienda, planificación urbanística) como por la propia empresa turística (hoteles, campings, apartamentos). Medidas de ahorro de agua y luz, fomento del transporte público y de las energías limpias, creación de zonas verdes urbanas y adaptación a los extremos atmosféricos destacan como acciones de mitigación del cambio climático en los destinos turísticos principales de nuestro país.

Crocodile Hunt

'Crocodile Hunt' is a short story, based on archival research, that emerged from my practice-led PhD thesis.

The hunt

"Information Thru Play: In 2010, responding to the success of The Threshold, Juxt Interactive again asked No Mimes Media, to partner in creating a transmedia experience to entertain and inform Cisco's Global Sales Force. The Hunt put employees at the center of a thriller where characters sent and responded to their emails, left phone messages, communicated through Facebook and Twitter, even asked them to retrieve items from a dead drop and to send them photographs and information. And while helping fictional characters Isabel and Keith escape an ancient secret organization, the sales force also learned about new Cisco technologies coming to market. Cisco had new demands for the 2010 experience. A geographically and culturally dispersed sales force raises challenges when it comes to introducing dozens of new products and technologies each year. Cisco wanted The Hunt to have global reach, to educate, to build collaboration, and to be fun. This demanded new ways of storytelling and new ways of thinking. The Hunt was quick and intense, unfolding in real time in just two weeks. Many experienced players were poised to participate and expectations were high. Many of the mechanics of the previous year's experience were repeated, and the audience ripped through the opening, discovering video clips and websites in minutes. The surprise was discovering Facebook and Twitter accounts, where characters responded to player postings and comments in real time. The Hunt involved audience members from countries around the world, including China, India, Netherlands, Germany, Norway, Pakistan, Japan, the United Kingdom, and the United States. It highlighted new Cisco technologies like Pulse and Mediator, painlessly engaging the audience in what those technologies do and how they work. Players collaborated across silos, creating networks of cross-disciplinary experts. The Hunt pushed the boundaries of storytelling, with events unfolding on Twitter and Facebook, and in the real world where the audience had to use social engineering to find and secure a package with vital information. With thousands of players highly engaged around the world, The Hunt once again proved that transmedia experiences can effectively be used to not only meet the goals of a brand, but entertain their audience as well."

Cardiovascular disease is increased prior to onset of rheumatoid arthritis but not osteoarthritis: The population-based Nord-Trøndelag health study (HUNT)

Introduction: Patients with rheumatoid arthritis (RA) have increased risk of cardiovascular (CV) events. We sought to test the hypothesis that due to increased inflammation, CV disease and risk factors are associated with increased risk of future RA development. Methods: The population-based Nord-Trøndelag health surveys (HUNT) were conducted among the entire adult population of Nord-Trøndelag, Norway. All inhabitants 20 years or older were invited, and information was collected through comprehensive questionnaires, a clinical examination, and blood samples. In a cohort design, data from HUNT2 (1995-1997, baseline) and HUNT3 (2006-2008, follow-up) were obtained to study participants with RA (n = 786) or osteoarthritis (n = 3,586) at HUNT3 alone, in comparison with individuals without RA or osteoarthritis at both times (n = 33,567). Results: Female gender, age, smoking, body mass index, and history of previous CV disease were associated with self-reported incident RA (previous CV disease: odds ratio 1.52 (95% confidence interval 1.11-2.07). The findings regarding previous CV disease were confirmed in sensitivity analyses excluding participants with psoriasis (odds ratio (OR) 1.70 (1.23-2.36)) or restricting the analysis to cases with a hospital diagnosis of RA (OR 1.90 (1.10-3.27)) or carriers of the shared epitope (OR 1.76 (1.13-2.74)). History of previous CV disease was not associated with increased risk of osteoarthritis (OR 1.04 (0.86-1.27)). Conclusion: A history of previous CV disease was associated with increased risk of incident RA but not osteoarthritis.

Kissing fish: Rex Hunt, popular culture, sustainability and fishing practices

Natural resource managers and scientists focus on the behaviour of individual recreational fishers to understand environmental problems associated with this leisure activity. They do this in an effort to identify ways to change attitudes in order to facilitate environmentally friendly choices. This applied use of ABC psychology (attitude, behaviour, choice) has not delivered the expected results. This article offers a different approach by investigating an emergent practice in diverse fishing communities, rather than looking to the responsibility of the individual recreational fisher. Using practice theory, I trace the change from take-all to catch-and-release fishing in Australia by analysing the texts of celebrity fisher Rex Hunt, who is an advocate for releasing fish. I combine this with oral history testimony from a sample of recreational fishers from the broader Australian community to show how change happened. The practice of catch-and-release fishing emerged through the combination of sociotechnical and historically specific elements present in popular culture, including the media. Paying attention to the way different elements catalyse provides a rich account of the changing modes of sustainability in recreational fishing communities.

The hunt for disability: The new eugenics and the normalization of school children

Examines issues of sameness, difference, equality, and democracy in present public school systems, focusing on the question of (dis)ability and implications of rethinking (dis)ability as an ontological issue before its inscription as an educational one concerning the politics of inclusion. The paper analyzes old and new discourses of eugenics as quality control of national populations. (Contains references.) (SM)

Patterns in the distribution and abundance of female eastern king prawns, Melicertus plebejus (Hess, 1865), capable of spawning and reproductive potential in waters off

Linear mixed models were used to test the null hypothesis that there were no differences between seasons and locations in the reproductive potential of female eastern king prawns, Melicertus plebejus along the east coast of Australia. Three samples were collected in each season between autumn 1991 and winter 1992 (inclusive). Females capable of spawning were found at all locations but proportions were greater in lower than higher latitudes. Females capable of spawning were not found at the southern (highest latitude) most location in all seasons. There was a significant interaction in reproductive potential between seasons and locations suggesting that patterns among seasons differed between locations and vice versa. Reproductive potential was greatest amongst the northern (lower latitudes) most locations and was greatest in autumn at these locations. Seasonal patterns were less pronounced further south (higher latitudes). The length composition of females in catches differed between locations with more larger prawns found in samples from northern locations. The challenge that remains is to quantify the oceanic sources of larvae that contribute to recruitment in each nursery area and the estuarine sources of juveniles that contribute adults back to the effective spawning stock. Maintaining the effective spawning stock and important nursery areas are crucial to the sustainability of this resource.