Búsqueda de caso y diagnóstico temprano en sujetos con sospecha de la EPOC

La enfermedad pulmonar obstructiva crónica es una patología comúnmente sub-diagnosticada. A la fecha no existe ninguna revisión sistemática publicada que evalué la búsqueda de caso (sujetos mayores de 40 años con factores de riesgo sin síntomas) y el diagnóstico temprano (factor de riesgo y síntomas) de la enfermedad. Métodos: Se condujo una revisión sistemática en tres bases de datos (Pubmed, CINAHL, EMBASE) para identificar estudios observacionales que reportaran la prevalencia de la EPOC en diferentes poblaciones expuestas a factores de riesgo (búsqueda de caso) o con factores de riesgo y síntomas (diagnóstico temprano), posteriormente con dichos estudios se calculó una prevalencia ponderada para cada grupo y esta se comparó con la prevalencia reportada en la población general en estudios locales. Así mismo se identificaron estudios para determinar la precisión de estrategias de búsqueda de caso (cuestionarios y el pico flujo espiratorio portátil PiKo 6®) usando la espirometría como patrón de oro para el diagnóstico de la EPOC. Dos autores seleccionaron de forma independiente los estudios que cumplían con los criterios de inclusión y exclusión y se evaluó la calidad metodológica por medio de la estrategia GRADE. El número necesario a tamizar (1/ prevalencia) para diagnosticar un caso de EPOC con espirometría fue calculado para los dos grupos de interés y comparado con el valor conocido de la prevalencia nacional. A los cuestionarios y estudios de Piko 6® se les evaluó las características operativas (VPP, VPN) y se calcularon las probabilidades pos test negativas y positivas teniendo en cuenta la prevalencia ponderada. Resultados Para la estrategia de búsqueda de caso, once estudios cumplieron los criterios de inclusión y la prevalencia ponderada en este grupo fue de 22% con un número necesario a tamizar (NNS) con espirometría de 5, comparado con un NNS de 11 obtenido de la prevalencia de la EPOC en Colombia 8.9% ( IC 95% 8.2-9.7). Posterior a la evaluación critica de varios cuestionarios y estudios de piko 6®, seleccionamos el cuestionario desarrollado por Mullernová y cols y el estudio de Frith y cols respectivamente. El cuestionario validado mostro una probabilidad postest positiva del 56% y postest negativa del 3% con un NNS de 2; para piko 6® los valores correspondientes fueron de 44%, 7% y 2 respectivamente. Para el diagnóstico temprano la prevalencia ponderada fue del 33.9% con un NNS de 3. Conclusiones El número necesario a tamizar para la estrategia de búsqueda de caso con cuestionarios y piko 6® es substancialmente menor que el número necesario a tamizar en la población general. El uso de cuestionarios o de piko 6® disminuye a 2 el NNS en el grupo de búsqueda de caso y a 3 para el grupo de diagnóstico temprano.

Exercise and Training at Altitudes: Physiological Effects and Protocols

An increase in altitude leads to a proportional fall in the barometric pressure, and a decrease in atmospheric oxygen pressure, producing hypobaric hypoxia that affects, in different degrees, all body organs, systems and functions. The chronically reduced partial pressure of oxygen causes that individuals adapt and adjust to physiological stress. These adaptations are modulated by many factors, including the degree of hypoxia related to altitude, time of exposure, exercise intensity and individual conditions. It has been established that exposure to high altitude is an environmental stressor that elicits a response that contributes to many adjustments and adaptations that influence exercise capacity and endurance performance. These adaptations include in crease in hemoglobin concentration, ventilation, capillary density and tissue myoglobin concentration. However, a negative effect in strength and power is related to a decrease in muscle fiber size and body mass due to the decrease in the training intensity. Many researches aim at establishing how training or living at high altitudes affects performance in athletes. Training methods, such as living in high altitudes training low, and training high-living in low altitudes have been used to research the changes in the physical condition in athletes and how the physiological adaptations to hypoxia can enhanceperformance at sea level. This review analyzes the literature related to altitude training focused on how physiological adaptations to hypoxic environments influence performance, and which protocols are most frequently used to train in high altitudes.

Alteración del centro de gravedad y riesgo de caída en pacientes con trastornos neurológicos. Bogotá. 2014

Introducción: el objetivo de la rehabilitación en los pacientes neurológicos es reducir su discapacidad, potencializar su funcionalidad y promover su independencia para así permitirle desempeñar un rol activo en la comunidad. Por esta razón, es de gran importancia prevenir la aparición de eventos adversos en esta población mediante la detección temprana de factores de riesgo que conllevan a pacientes con enfermedad cerebro vascular a presentar caídas y a su vez le permita a los profesionales de la salud generar estrategias para minimizar su incidencia, complicaciones y/o secuelas. Objetivo: determinar los factores relacionados con la alteración del centro de gravedad y riesgos de caída en paciente con trastornos neurológicos Metodología: se realizó un estudio cuantitativo descriptivo exploratorio retrospectivo donde se tuvieron en cuenta pacientes diagnóstico de enfermedades neurológicas que presentaron o no antecedentes de caídas junto con otros criterios de inclusión y exclusión, tomados de las bases de datos de la institución Mobility Group. Resultados: Se evaluaron en total 19 sujetos (52,6 % hombres) con edad media de 48,37 años. Se clasificaron en dos grupos (alto y bajo riesgo de caída ) de pacientes según la aplicación de la escala de riesgo de caída de J.H. Downton a los cuales se aplicó estadística descriptiva para describir su comportamiento en referencia a factores como diagnóstico clínico, presencia de dolor, fuerza y tono de miembros inferiores en los principales grupos musculares , clasificación de espasticidad y finalmente con la alteración de la trayectoria del centro de gravedad según la valoración realizada con el dispositivo THERA-TRAINER BALANCE.

The influence of the atmospheric boundary layer on nocturnal layers of noctuids and other moths migrating over southern Britain

Insects migrating at high altitude over southern Britain have been continuously monitored by automatically-operating, vertical-looking radars over a period of several years. During some occasions in the summer months, the migrants were observed to form well-defined layer concentrations, typically at heights of 200-400 m, in the stable night-time atmosphere. Under these conditions, insects are likely to have control over their vertical movements and are selecting flight heights which are favourable for long-range migration. We therefore investigated the factors influencing the formation of these insect layers by comparing radar measurements of the vertical distribution of insect density with meteorological profiles generated by the UK Met. Office’s Unified Model (UM). Radar-derived measurements of mass and displacement speed, along with data from Rothamsted Insect Survey light traps provided information on the identity of the migrants. We present here three case studies where noctuid and pyralid moths contributed substantially to the observed layers. The major meteorological factors influencing the layer concentrations appeared to be: (a) the altitude of the warmest air, (b) heights corresponding to temperature preferences or thresholds for sustained migration and (c), on nights when air temperatures are relatively high, wind-speed maxima associated with the nocturnal jet. Back-trajectories indicated that layer duration may have been determined by the distance to the coast. Overall, the unique combination of meteorological data from the UM and insect data from entomological radar described here show considerable promise for systematic studies of high-altitude insect layering.

Climate change, glacier retreat, and water availability in the Caucasus region

The paper discusses the observed and projected warming in the Caucasus region and its implications for glacier melt, water availability and potential hazards. A strong positive trend in summer air temperatures of 0.05 degrees C year(-1) is observed in the high-altitude areas (above 2000 m) providing for a strong glacier melt. A widespread glacier retreat has also been reported between 1985 and 2000, with an average rate of 8 m year(-1). A warming of 5-7 degrees C is projected for the Sum mer months in the 2071-2100 period under the A2 emission group of scenarios, Suggesting that enhanced glacier melt and a changing water balance can be expected.

An Assessment of the Recent Past and Future Climate Change, Glacier Retreat, and Runoff in the Caucasus Region Using Dynamical and Statistical Downscaling and HBV-ETH Hydrological Model

The paper discusses the observed and projected warming in the Caucasus region and its implications for glacier melt and runoff. A strong positive trend in summer air temperatures of 0.05 degrees C a(-1) is observed in the high-altitude areas providing for a strong glacier melt and continuous decline in glacier mass balance. A warming of 4-7 degrees C and 3-5 degrees C is projected for the summer months in 2071-2100 under the A2 and B2 emission scenarios respectively, suggesting that enhanced glacier melt can be expected. The expected changes in winter precipitation will not compensate for the summer melt and glacier retreat is likely to continue. However, a projected small increase in both winter and summer precipitation combined with the enhanced glacier melt will result in increased summer runoff in the currently glaciated region of the Caucasus (independent of whether the region is glaciated at the end of the twenty-first century) by more than 50% compared with the baseline period.

Mid-infrared filters for astronomical and remote sensing instrumentation

As improvements to the optical design of spectrometer and radiometer instruments evolve with advances in detector sensitivity, use of focal plane detector arrays and innovations in adaptive optics for large high altitude telescopes, interest in mid-infrared astronomy and remote sensing applications have been areas of progressive research in recent years. This research has promoted a number of developments in infrared coating performance, particularly by placing increased demands on the spectral imaging requirements of filters to precisely isolate radiation between discrete wavebands and improve photometric accuracy. The spectral design and construction of multilayer filters to accommodate these developments has subsequently been an area of challenging thin-film research, to achieve high spectral positioning accuracy, environmental durability and aging stability at cryogenic temperatures, whilst maximizing the far-infrared performance. In this paper we examine the design and fabrication of interference filters in instruments that utilize the mid-infrared N-band (6-15 µm) and Q-band (16-28 µm) atmospheric windows, together with a rationale for the selection of materials, deposition process, spectral measurements and assessment of environmental durability performance.

Turbulent flow at 190 m height above London during 2006-2008: A climatology and the applicability of similarity theory

Flow and turbulence above urban terrain is more complex than above rural terrain, due to the different momentum and heat transfer characteristics that are affected by the presence of buildings (e.g. pressure variations around buildings). The applicability of similarity theory (as developed over rural terrain) is tested using observations of flow from a sonic anemometer located at 190.3 m height in London, U.K. using about 6500 h of data. Turbulence statistics—dimensionless wind speed and temperature, standard deviations and correlation coefficients for momentum and heat transfer—were analysed in three ways. First, turbulence statistics were plotted as a function only of a local stability parameter z/Λ (where Λ is the local Obukhov length and z is the height above ground); the σ_i/u_* values (i = u, v, w) for neutral conditions are 2.3, 1.85 and 1.35 respectively, similar to canonical values. Second, analysis of urban mixed-layer formulations during daytime convective conditions over London was undertaken, showing that atmospheric turbulence at high altitude over large cities might not behave dissimilarly from that over rural terrain. Third, correlation coefficients for heat and momentum were analyzed with respect to local stability. The results give confidence in using the framework of local similarity for turbulence measured over London, and perhaps other cities. However, the following caveats for our data are worth noting: (i) the terrain is reasonably flat, (ii) building heights vary little over a large area, and (iii) the sensor height is above the mean roughness sublayer depth.

Cusp observations during a sequence of fast IMF B-Z reversals

In recent years, a large number of papers have reported the response of the cusp to solar wind variations under conditions of northward or southward Interplanetary Magnetic Field (IMF) Z-component (BZ). These studies have shown the importance of both temporal and spatial factors in determining the extent and morphology of the cusp and the changes in its location, connected to variations in the reconnection geometry. Here we present a comparative study of the cusp, focusing on an interval characterised by a series of rapid reversals in the BZ-dominated IMF, based on observations from space-borne and ground-based instrumentation. During this interval, from 08:00 to 12:00 UT on 12 February 2003, the IMF BZ component underwent four reversals, remaining for around 30 min in each orientation. The Cluster spacecraft were, at the time, on an outbound trajectory through the Northern Hemisphere magnetosphere, whilst the mainland VHF and Svalbard (ESR) radars of the EISCAT facility were operating in support of the Cluster mission. Both Cluster and the EISCAT were, on occasion during the interval, observing the cusp region. The series of IMF reversal resulted in a sequence of poleward and equatorward motions of the cusp; consequently Cluster crossed the high altitude cusp twice before finally exiting the dayside magnetopause, both times under conditions of northward IMF BZ. The first magnetospheric cusp encounter, by all four Cluster spacecraft, showed reverse ion dispersion typical of lobe reconnection; subsequently, Cluster spacecraft 1 and 3 (only) crossed the cusp for a second time. We suggest that, during this second cusp crossing, these two spacecraft were likely to have been on newly closed field lines, which were first reconnected (opened) at low latitudes and later reconnected again (re-closed) poleward of the northern cusp.

Assessment of the consistency of H2O line intensities over the near-infrared using sun-pointing ground-based Fourier transform spectroscopy

We report on the consistency of water vapour line intensities in selected spectral regions between 800–12,000 cm−1 under atmospheric conditions using sun-pointing Fourier transform infrared spectroscopy. Measurements were made across a number of days at both a low and high altitude field site, sampling a relatively moist and relatively dry atmosphere. Our data suggests that across most of the 800–12,000 cm−1 spectral region water vapour line intensities in recent spectral line databases are generally consistent with what was observed. However, we find that HITRAN-2008 water vapour line intensities are systematically lower by up to 20% in the 8000–9200 cm−1 spectral interval relative to other spectral regions. This discrepancy is essentially removed when two new linelists (UCL08, a compilation of linelists and ab-initio calculations, and one based on recent laboratory measurements by Oudot et al. (2010) [10] in the 8000–9200 cm−1 spectral region) are used. This strongly suggests that the H2O line strengths in the HITRAN-2008 database are indeed underestimated in this spectral region and in need of revision. The calculated global-mean clear-sky absorption of solar radiation is increased by about 0.3 W m−2 when using either the UCL08 or Oudot line parameters in the 8000–9200 cm−1 region, instead of HITRAN-2008. We also found that the effect of isotopic fractionation of HDO is evident in the 2500–2900 cm−1 region in the observations.

Inter-hemispheric mesospheric coupling in a comprehensive middle atmosphere model

Observations of noctilucent clouds have revealed a surprising coupling between the winter stratosphere and the summer polar mesopause region. In spite of the great distance involved, this inter-hemispheric link has been suggested to be the principal reason for both the year-to-year variability and the hemispheric differences in the frequency of occurrence of these high-altitude clouds. In this study, we investigate the dynamical influence of the winter stratosphere on the summer mesosphere using simulations from the vertically extended version of the Canadian Middle Atmosphere Model (CMAM). We find that for both Northern and Southern Hemispheres, variability in the summer polar mesopause region from one year to another can be traced back to the planetary-wave flux entering the winter stratosphere. The teleconnection pattern is the same for both positive and negative wave-flux anomalies. Using a composite analysis to isolate the events, it is argued that the mechanism for interhemispheric coupling is a feedback between summer mesosphere gravity-wave drag (GWD) and zonal wind, which is induced by an anomaly in mesospheric cross-equatorial flow, the latter arising from the anomaly in winter hemisphere GWD induced by the anomaly in stratospheric conditions.

Climatology and predictability of the late summer stratospheric zonal wind turnaround over Vanscoy, Saskatchewan

A climatology of the late summer stratospheric zonal wind turnaround phenomenon is presented, with a particular focus on the behaviour over the Meteorological Service of Canada’s balloon-launching site at Vanscoy, Saskatchewan (52°N, 107°W). Turnaround refers to the change in sign of the zonal wind velocity and occurs twice each year at stratospheric mid-latitudes, in early spring and in late summer. The late summer turnaround is of particular interest to the high-altitude ballooning community because it offers the ideal conditions for launch, but it is also an interesting dynamical phenomenon in its own right. It is studied here using both the National Centers for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR) reanalysis and the United Kingdom Meteorological Office (MetO) analysis products as well as climate simulation data from the Canadian Middle Atmosphere Model (CMAM). The phenomenon and its interannual variability are documented. The predictability of the late summer turnaround over Vanscoy is investigated using both statistical averages and autocorrelation analysis. From the statistical averages, it is found that during every year since 1993, the period from 26 August to 5 September has contained appropriate launch dates. From the autocorrelation analysis, it is found that stratospheric zonal wind anomalies can persist for a month or more during most of the summer, but there is a predictability horizon at the end of the summer — just before turnaround

Pollen-based biome reconstructions for Latin America at 0, 6000 and 18000 radiocarbon years

The biomisation method is used to reconstruct Latin American vegetation at 6000±500 and 18 000±1000 radiocarbon years before present (14C yr BP) from pollen data. Tests using modern pollen data from 381 samples derived from 287 locations broadly reproduce potential natural vegetation. The strong temperature gradient associated with the Andes is recorded by a transition from high altitude cool grass/shrubland and cool mixed forest to mid-altitude cool temperate rain forest, to tropical dry, seasonal and rain forest at low altitudes. Reconstructed biomes from a number of sites do not match the potential vegetation due to local factors such as human impact, methodological artefacts and mechanisms of pollen representivity of the parent vegetation.

The effect of non-uniform radiative damping on the zonal-mean dynamics of the extratropical middle atmosphere

The effect of spatial and temporal variations in the radiative damping rate on the response to an imposed forcing or diabatic heating is examined in a zonal-mean model of the middle atmosphere. Attention is restricted to the extratropics, where a linear approach is viable. It is found that regions with weak radiative damping rates are more sensitive in terms of temperature to the remote influence of the diabatic circulation. The delay in the response in such regions can mean that ‘downward’ control is not achieved on seasonal time-scales. A seasonal variation in the radiative damping rate modulates the evolution of the response and leaves a transient-like signature in the annual mean temperature field. Several idealized examples are considered, motivated by topical questions. It is found that wave drag outside the polar vortex can significantly affect the temperatures in its interior, so that high-latitude, high-altitude gravity-wave drag is not the only mechanism for warming the southern hemisphere polar vortex. Diabatic mass transport through the 100 hPa surface is found to lag the seasonal evolution of the wave drag that drives the transport, and thus cannot be considered to be in the downward control regime. On the other hand, the seasonal variation of the radiative damping rate is found to make only a weak contribution to the annual mean temperature increase that has been observed above the ozone hole. Copyright © 2002 Royal Meteorological Society.

Jet characterization in the upper troposphere/lower stratosphere (UTLS): applications to climatology and transport studies

A method of classifying the upper tropospheric/lower stratospheric (UTLS) jets has been developed that allows satellite and aircraft trace gas data and meteorological fields to be efficiently mapped in a jet coordinate view. A detailed characterization of multiple tropopauses accompanies the jet characterization. Jet climatologies show the well-known high altitude subtropical and lower altitude polar jets in the upper troposphere, as well as a pattern of concentric polar and subtropical jets in the Southern Hemisphere, and shifts of the primary jet to high latitudes associated with blocking ridges in Northern Hemisphere winter. The jet-coordinate view segregates air masses differently than the commonly-used equivalent latitude (EqL) coordinate throughout the lowermost stratosphere and in the upper troposphere. Mapping O3 data from the Aura Microwave Limb Sounder (MLS) satellite and the Winter Storms aircraft datasets in jet coordinates thus emphasizes different aspects of the circulation compared to an EqL-coordinate framework: the jet coordinate reorders the data geometrically, thus highlighting the strong PV, tropopause height and trace gas gradients across the subtropical jet, whereas EqL is a dynamical coordinate that may blur these spatial relationships but provides information on irreversible transport. The jet coordinate view identifies the concentration of stratospheric ozone well below the tropopause in the region poleward of and below the jet core, as well as other transport features associated with the upper tropospheric jets. Using the jet information in EqL coordinates allows us to study trace gas distributions in regions of weak versus strong jets, and demonstrates weaker transport barriers in regions with less jet influence. MLS and Atmospheric Chemistry Experiment-Fourier Transform Spectrometer trace gas fields for spring 2008 in jet coordinates show very strong, closely correlated, PV, tropopause height and trace gas gradients across the jet, and evidence of intrusions of stratospheric air below the tropopause below and poleward of the subtropical jet; these features are consistent between instruments and among multiple trace gases. Our characterization of the jets is facilitating studies that will improve our understanding of upper tropospheric trace gas evolution.