Cafeina vs aminofilina para la apnea del prematuro: estudio randomizado

La apnea del prematuro es una patología frecuente que se presenta en el 85% de los recién nacidos menores de 34 semanas de edad gestacional y en el 95-100% de los menores de 28 semanas. Con respecto al peso al nacer, se manifiesta en el 92% de los de peso menor a 1250 gramos y en el 50% de los de peso menor a 1500 gramos. Desde 2003, se aprobó en Colombia el uso de citrato de cafeína para la prevención y el tratamiento de la apnea del prematuro, basados en la evidencia. Metodología: Se realizó un estudio de interención simple comparando el citrato de cafeína con la aminofilina para la prevención y manejo de la apnea en pretérminos menores de 35 semanas de edad. Resultados: Se incluyeron 118 recién nacidos pretérminos de los cuales 18,6% fueron menores de 28 semanas, 79,7% de 34 semanas y dos 1,7% mayores o iguales a 34,1 semanas. 56 neonatos recibieron citrato de cafeína. De éstos, 33,9% de forma profiláctica y 66,1%, terapéutica; 28 (23,7%) recibieron aminofilina y 34 (28,8%) no recibieron ninguno de los dos medicamentos. El citrato de cafeína mostró menos efectos secundarios comparado con aminofilina (p <0,01). Discusión: El citrato de cafeína, administrado en forma profiláctica o terapéutica, mostró resultados superiores, estadísticamente significativos, en comparación con aminofilina y con los controles sin tratamiento, para la prevención y el tratamiento de la apnea del prematuro, presentando, además, menores efectos secundarios.

Comparación entre analgesia epidural continua vs bloqueo nervio periférico en niños llevados a cirugía múltiple de miembros inferiores

Las cirugías reconstructivas múltiples de miembros inferiores son intervenciones quirúrgicas que implican un difícil manejo analgésico en el postoperatorio, actualmente la técnica analgésica usada es la analgesia peridural; sin embargo los efectos adversos asociados a esta no la hacen una técnica ideal para manejo de dolor. Los bloqueos de nervio periférico han aparecido como una alternativa para el manejo del dolor; pero no se ha difundido ampliamente su uso. Se pretende evaluar la disminución de efectos adversos con el uso de bloqueos de nervio periférico sobre la analgesia epidural. Este estudio piloto inicial se realizo para verificar efectividad técnicas a usar y problemas que se pudieran presentar. Se aplico el protocolo en 23 pacientes que fueron llevados a cirugía de miembros inferiores, se dividieron en 2 grupos 11 recibieron bloqueos de nervio periférico y 12 analgesia epidural. Se les realizo seguimiento por 48 horas y se evaluó el control del dolor, consumo de opioides y efectos adversos. El tiempo de colocación del bloqueo fue similar en ambos grupos, el grupo de bloqueos presento menos episodios de dolor y menos episodios de dolor severo. No se presento retención urinaria en ningún paciente pero en el grupo de epidural se presento mayor incidencia de nausea y vomito (60% vs 45%). Se encontró que los bloqueos de nervio periférico son una adecuada opción para el manejo del dolor en este tipo de cirugías; y al parecer disminuye la incidencia de eventos adversos asociados a la analgesia epidural.

Corticosteroides vs dosis bajas de adrenocorticotropina en el tratamiento de espasmos infantiles. Revisión sistemática de la literatura

Antecedentes: El tratamiento de los espasmos infantiles generalmente se realiza con ACTH a pesar de perfil de efectos secundarios y el alto costo financiero. Se ha propuesto el uso de los corticoides como primera línea de tratamiento para la enfermedad, no obstante no existe certeza sobre la eficacia de este esquema. Objetivos: Evaluar la eficacia del uso de los corticoides comparados con la ACTH como primera línea de tratamiento en el manejo de pacientes con espasmos infantiles. Metodología: Se realizó una revisión sistemática de la literatura. La búsqueda se efectuó en las bases de datos Pubmed, Embase, Ovid, LiLaCs y en el registro de ensayos clínicos de Estados Unidos. Se incluyeron estudios en portugués, ingles y español, no se fijo límite de tiempo para la publicación. Se realizó un análisis de riesgo de sesgo y de calidad de la evidencia utilizando el programa GRADEPRO. Se estimaron OR y sus respectivos intervalos de confianza al 95%. Resultados: Se incluyeron 4 estudios, un ensayo clínico y tres estudios de cohorte retrospectiva. Dos estudios aportaron evidencia de calidad moderada y alta. No se encontraron diferencias en la eficacia a corto plazo entre el uso de los corticoides y la ACTH sobre desenlaces clínicos o electroencefalográficos. No se encontraron estudios de seguridad a largo plazo. La seguridad a corto plazo no mostró diferencias. Conclusiones: Es muy probable que el uso de los corticoides como primera línea de tratamiento puedan reemplazar el uso de la ACTH, se requiere estudios de seguridad a largo plazo. La decisión de su uso rutinario debería estar basada en un análisis de costo efectividad y bajo la mirada del balance riesgo/beneficio.

Gel vs aceite mineral en el tratamiento del fotoenvejecimiento de manos con luz pulsada intensa

Introducción: En el tratamiento con Luz Pulsada Intensa (LPI) para el fotoenvejecimiento de las manos no se encuentran estudios que evidencien si existe alguna diferencia estadísticamente significativa en el grado de efectividad y seguridad al utilizar gel o aceite mineral como medios de acople. Objetivo: Determinar la efectividad y seguridad terapéutica en el uso de gel vs aceite mineral. Materiales y Métodos: Estudio observacional analítico de cohorte retrospectivo que involucró 29 pacientes. Realizado en tres fases; selección y recolección de las historias clínicas, evaluación fotográfica de registros pre tratamiento y pos tratamiento con determinación del grado de mejoría global en el fotoenvejecimiento de las manos por parte de tres evaluadores cegados, y análisis estadístico de los datos obtenidos por medio de las pruebas de Mann Whitney y Wilcoxon. Resultados: Se encontró mejoría dada por disminución en un grado del fotoenvejecimiento para los dos medios de acople con la misma significancia estadística. La percepción subjetiva mostró mejoría en todos los pacientes evaluados. La seguridad es similar en los dos grupos pero se evidenció mayor severidad en los efectos secundarios con el uso de aceite, con diferencias estadísticamente significativas en los efectos moderados y severos. Conclusión: La efectividad es la misma independiente del medio de acople que se use. La seguridad a pesar de evidenciar un perfil similar es mayor con el uso de gel en cuanto a la menor severidad de los efectos presentados. Se requieren más estudios de tipo ensayos clínicos controlados que permitan determinar una mayor evidencia.

Determinismo vs probabilidad en la enseñanza de la Física.

Incluye resumen en inglés. Este artículo pertenece al Monográfico: La Ciencia a las puertas del Tercer Milenio (II)

Use of Large Clear-Cuts by Wilson’s Warbler in an Eastern Canadian Boreal Forest

Wilson’s Warbler (Cardellina pusilla; WIWA) has been declining for several decades, possibly because of habitat loss. We compared occupancy of territorial males in two habitat types of Québec’s boreal forest, alder (Alnus spp.) scrubland and recent clear-cuts. Singing males occurred in clusters, their occupancy was similar in both habitats, but increased with the amount of alder or clear-cut within 400 m of point-count stations. A despotic distribution of males between habitats appeared unlikely, because there were no differences in morphology between males captured in clear-cuts vs. alder. Those results contrast with the prevailing view, mostly based on western populations, that WIWA are wetland or riparian specialists, and provide the first evidence for a preference for large tracts of habitat in this species. Clear-cuts in the boreal forest may benefit WIWA by supplying alternative nesting habitat. However, the role of clear-cuts as source or sink habitats needs to be addressed with data on reproduction.

Students’ perception of the safety and value of a herbal vs. a conventional medicine for treating insomnia

University students suffer from variable sleep patterns including insomnia;[1] furthermore, the highest incidence of herbal use appears to be among college graduates.[2] Our objective was to test the perception of safety and value of herbal against conventional medicine for the treatment of insomnia in a non-pharmacy student population. We used an experimental design and bespoke vignettes that relayed the same effectiveness information to test our hypothesis that students would give higher ratings of safety and value to herbal product compared to conventional medicine. We tested another hypothesis that the addition of side-effect information would lower people’s perception of the safety and value of the herbal product to a greater extent than it would with the conventional medicine.

Modelling the lava dome extruded at Soufrière Hills Volcano, Montserrat, August 2005–May 2006. Part I: Dome shape and internal structure

Lava domes comprise core, carapace, and clastic talus components. They can grow endogenously by inflation of a core and/or exogenously with the extrusion of shear bounded lobes and whaleback lobes at the surface. Internal structure is paramount in determining the extent to which lava dome growth evolves stably, or conversely the propensity for collapse. The more core lava that exists within a dome, in both relative and absolute terms, the more explosive energy is available, both for large pyroclastic flows following collapse and in particular for lateral blast events following very rapid removal of lateral support to the dome. Knowledge of the location of the core lava within the dome is also relevant for hazard assessment purposes. A spreading toe, or lobe of core lava, over a talus substrate may be both relatively unstable and likely to accelerate to more violent activity during the early phases of a retrogressive collapse. Soufrière Hills Volcano, Montserrat has been erupting since 1995 and has produced numerous lava domes that have undergone repeated collapse events. We consider one continuous dome growth period, from August 2005 to May 2006 that resulted in a dome collapse event on 20th May 2006. The collapse event lasted 3 h, removing the whole dome plus dome remnants from a previous growth period in an unusually violent and rapid collapse event. We use an axisymmetrical computational Finite Element Method model for the growth and evolution of a lava dome. Our model comprises evolving core, carapace and talus components based on axisymmetrical endogenous dome growth, which permits us to model the interface between talus and core. Despite explicitly only modelling axisymmetrical endogenous dome growth our core–talus model simulates many of the observed growth characteristics of the 2005–2006 SHV lava dome well. Further, it is possible for our simulations to replicate large-scale exogenous characteristics when a considerable volume of talus has accumulated around the lower flanks of the dome. Model results suggest that dome core can override talus within a growing dome, potentially generating a region of significant weakness and a potential locus for collapse initiation.

Synthesis, crystal structure and hydrolysis of a dinuclear copper(II) complex constructed by N2O donor Schiff base and 4,4 '-bipyridine: discrete supra-molecular ensembles vs. oligomers

The tridentate Schiff base ligand, 7-amino-4-methyl-5-aza-3-hepten-2-one (HAMAH), prepared by the mono-condensation of 1,2diaminoethane and acetylacetone, reacts with Cu(BF4)(2) center dot 6H(2)O to produce initially a dinuclear Cu(II) complex, [{Cu(AMAH)}(2) (mu-4,4'-bipyJ](BF4)(2) (1) which undergoes hydrolysis in the reaction mixture and finally produces a linear polymeric chain compound, [Cu(acac)(2)(mu-4,4'-bipy)](n) (2). The geometry around the copper atom in compound 1 is distorted square planar while that in compound 2 is essentially an elongated octahedron. On the other hand, the ligand HAMAH reacts with Cu(ClO4)(2) center dot 6H(2)O to yield a polymeric zigzag chain, [{Cu(acac)(CH3OH)(mu-4,4'-bipy)}(ClO4)](n) (3). The geometry of the copper atom in 3 is square pyramidal with the two bipyridine molecules in the cis equatorial positions. All three complexes have been characterized by elemental analysis, IR and UV-Vis spectroscopy and single crystal X-ray diffraction studies. A probable explanation for the different size and shape of the reported polynuclear complexes formed by copper(II) and 4,4'-bipyridine has been put forward by taking into account the denticity and crystal field strength of the blocking ligand as well as the Jahn-Teller effect in copper(II). (c) 2007 Elsevier Ltd. All rights reserved.

Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery

Aims and objectives. To examine the impact of written and verbal education on bed-making practices, in an attempt to reduce the prevalence of pressure ulcers. Background. The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco-elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress. Design. A prospective randomized pre/post-test experimental design. Methods. Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re-examined one month later. One researcher was blinded to the educational delivery received by the wards. Results. Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (chi(2) = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (chi(2) = 0, P 0.987). Conclusions. Clear, concise written instruction improved practice but verbal education was not additionally beneficial. Relevance to clinical practice. Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.

Codification vs personalisation: A study of the information evaluation practice between aerospace and construction industries

In the emerging digital economy, the management of information in aerospace and construction organisations is facing a particular challenge due to the ever-increasing volume of information and the extensive use of information and communication technologies (ICTs). This paper addresses the problems of information overload and the value of information in both industries by providing some cross-disciplinary insights. In particular it identifies major issues and challenges in the current information evaluation practice in these two industries. Interviews were conducted to get a spectrum of industrial perspectives (director/strategic, project management and ICT/document management) on these issues in particular to information storage and retrieval strategies and the contrasting approaches to knowledge and information management of personalisation and codification. Industry feedback was collected by a follow-up workshop to strengthen the findings of the research. An information-handling agenda is outlined for the development of a future Information Evaluation Methodology (IEM) which could facilitate the practice of the codification of high-value information in order to support through-life knowledge and information management (K&IM) practice.

Use of Megasphaera elsdenii NCIMB41125 as a probiotic for early-lactation dairy cows: effects on rumen pH and fermentation patterns

Multiparous rumen-fistulated Holstein cows were fed, from d 1 to 28 post-calving, an ad libitum TMR containing (g/kg DM) grass silage (196), corn silage (196), wheat (277), soybean meal (100), and other feeds (231) with CP, NDF, starch and water soluble carbohydrate concentrations of 176, 260, 299 and 39 g/kg DM respectively and ME of 12.2 MJ/kg DM. Treatments consisting of a minimum of 1010 cfu Megasphaera elsdenii NCIMB 41125 in 250 ml solution (MEGA) or 250 ml of autoclaved M. elsdenii (CONT) were administered via the rumen cannula on d 3 and 12 of lactation (n=7 per treatment). Mid-rumen pH was measured every 15 minutes and eating and ruminating behavior was recorded for 24 h on d 2, 4, 6, 8, 11, 13, 15, 17, 22 and 28. Rumen fluid for VFA and lactic acid (LA) analysis was collected at 11 timepoints on each of d 2, 4, 6, 13 and 15. Data were analysed as repeated measures using the Glimmix (LA data) or Mixed (all other data) procedures of SAS with previous 305 d milk yield and d 2 measurements as covariates where appropriate. Milk yield was higher (CONT 43.0 vs MEGA 45.4 ±0.75 kg/d, P=0.051) and fat concentration was lower (CONT 45.6 vs MEGA 40.4 ±1.05 g/kg, P=0.005) in cows that received MEGA. Time spent eating (263 ±15 min/d) and ruminating (571 ±13 min/d), DM intake (18.4 ±0.74 kg/d), proportion of each 24 h period with rumen pH below 5.6 (3.69 ±0.94 h) and LA concentrations (2.00 mM) were similar (P>0.327) across treatments. Ruminal total VFA concentration (104 ±3 mM) was similar (P=0.404) across treatments, but a shift from acetate (CONT 551 vs MEGA 524 ±14 mmol/mol VFA, P=0.161) to propionate production (CONT 249 vs MEGA 275 ±11 mmol/mol VFA, P=0.099) meant that the acetate:propionate ratio (CONT 2.33 vs MEGA 1.94 ±0.15) was reduced (P=0.072) in cows that received MEGA. This study provides evidence that supplementation of early lactation dairy cows with MEGA alters rumen fermentation patterns in favour of propionate, with potential benefits for animal health and productivity.

Land re-use, complexity and actor-networks: a framework for research

This paper will present a conceptual framework for the examination of land redevelopment based on a complex systems/networks approach. As Alvin Toffler insightfully noted, modern scientific enquiry has become exceptionally good at splitting problems into pieces but has forgotten how to put the pieces back together. Twenty-five years after his remarks, governments and corporations faced with the requirements of sustainability are struggling to promote an ‘integrated’ or ‘holistic’ approach to tackling problems. Despite the talk, both practice and research provide few platforms that allow for ‘joined up’ thinking and action. With socio-economic phenomena, such as land redevelopment, promising prospects open up when we assume that their constituents can make up complex systems whose emergent properties are more than the sum of the parts and whose behaviour is inherently difficult to predict. A review of previous research shows that it has mainly focused on idealised, ‘mechanical’ views of property development processes that fail to recognise in full the relationships between actors, the structures created and their emergent qualities. When reality failed to live up to the expectations of these theoretical constructs then somebody had to be blamed for it: planners, developers, politicians. However, from a ‘synthetic’ point of view the agents and networks involved in property development can be seen as constituents of structures that perform complex processes. These structures interact, forming new more complex structures and networks. Redevelopment then can be conceptualised as a process of transformation: a complex system, a ‘dissipative’ structure involving developers, planners, landowners, state agencies etc., unlocks the potential of previously used sites, transforms space towards a higher order of complexity and ‘consumes’ but also ‘creates’ different forms of capital in the process. Analysis of network relations point toward the ‘dualism’ of structure and agency in these processes of system transformation and change. Insights from actor network theory can be conjoined with notions of complexity and chaos to build an understanding of the ways in which actors actively seek to shape these structures and systems, whilst at the same time are recursively shaped by them in their strategies and actions. This approach transcends the blame game and allows for inter-disciplinary inputs to be placed within a broader explanatory framework that does away with many past dichotomies. Better understanding of the interactions between actors and the emergent qualities of the networks they form can improve our comprehension of the complex socio-spatial phenomena that redevelopment comprises. The insights that this framework provides when applied in UK institutional investment into redevelopment are considered to be significant.

House in the Shape of a Stretcher

In an essay from 1910 the architect and critic Adolf Loos distinguishes between buildings that are for everyday practical use and buildings made for contemplation. The latter type he asserts may be considered as both architecture and works of art. He refers to only two types of contemplative architecture namely the tomb and the monument. There are certain paintings made in the early part of the twentieth century that do not observe this separation such as certain works by Hopper and de Chirico. Here the commonplace is simultaneously experienced in the way a tomb might be. This mortifying gaze condemns building by inducing a sense that space has become inhospitable and alienating. It could be argued that these and other paintings made around this time such as Carlo Carra The Abandoned House 1916 are like premonitions of what will occur when building observes the prescription laid down by Loos and omit an aesthetic dimension. However it might also suggest that buildings need their tombs or at least some space that is not completely assimilable by the daily, practical and functional needs of an inhabitant.

The shape and tempo of language evolution

There are approximately 7000 languages spoken in the world today. This diversity reflects the legacy of thousands of years of cultural evolution. How far back we can trace this history depends largely on the rate at which the different components of language evolve. Rates of lexical evolution are widely thought to impose an upper limit of 6000-10,000 years on reliably identifying language relationships. In contrast, it has been argued that certain structural elements of language are much more stable. Just as biologists use highly conserved genes to uncover the deepest branches in the tree of life, highly stable linguistic features hold the promise of identifying deep relationships between the world's languages. Here, we present the first global network of languages based on this typological information. We evaluate the relative evolutionary rates of both typological and lexical features in the Austronesian and Indo-European language families. The first indications are that typological features evolve at similar rates to basic vocabulary but their evolution is substantially less tree-like. Our results suggest that, while rates of vocabulary change are correlated between the two language families, the rates of evolution of typological features and structural subtypes show no consistent relationship across families.