Terapias no farmacológicas en el manejo del dolor en neonatos pretérmino. revisión sistemática de la literatura

Antecedentes El dolor en neonatos ha sido un problema poco explorado. Se ha propuesto el uso de las terapias no farmacológicas para su tratamiento, sin embargo existen pocas aproximaciones sistemáticas para la evaluación de su eficacia. Objetivos Determinar la eficacia de las terapias no farmacológicas en el manejo del dolor en neonatos pretérmino a través de una revisión sistemática. Metodología Se realizó una revisión sistemática de la literatura para evaluar la eficacia de las terapias no farmacológicas en el manejo del dolor en el recién nacido petérmino. La búsqueda se realizó a través de las bases de datos Embase, Cochrane, Bireme y Embase. Se identificaron estudios publicados inglés y español. Se realizó un análisis cualitativo y cuantitativo. Resultados Se incluyeron 10 ensayos clínicos. La solución de sacarosa administrada por vía oral mostró reducir la intensidad del dolor en el recién nacido. La intubación y toma de muestras facilitada por el cuidador mostró también reducir la intensidad del dolor. Conclusión Se recomienda la administración solución de sacarosa y acompañamiento del cuidador durante los procedimientos como medidas para reducir el dolor en el recién nacido pretérmino.

Prevalencia de alteraciones audiométricas y su relación con exposición a ruido ocupacional y extra ocupacional, en una cohorte de trabajadores de Santander, Colombia, Años 2014-2015

La hipoacusia neurosensorial inducida por ruido (HNIR) definida como la pérdida de la capacidad auditiva secundaria a la exposición ocupacional continua o intermitente a ruido en el lugar de trabajo, es la cuarta enfermedad ocupacional en prevalencia en Colombia. Objetivo: Determinar la prevalencia de alteraciones audiométricas y su relación con exposición a ruido ocupacional y extra ocupacional, en un grupo de trabajadores que asistieron a una IPS de la ciudad de Bucaramanga en el periodo comprendido entre agosto de 2014 y agosto de 2015. Diseño: Se realizó un estudio de corte transversal con 2725 registros de las historias clínicas de fonoaudiología realizadas a los trabajadores con audiometría tonal como parte de los exámenes ocupacionales, entre el 1 de agosto de 2014 al 31 de agosto de 2015, en una Institución Prestadora de Salud (IPS) ocupacional, en la ciudad de Bucaramanga, Santander. Resultados: El 17.2% de los trabajadores presentaron alteraciones audiométricas, de estos el 33,1%, cumplió con los criterios definidos en el estudio para ser calificados como casos probables de hipoacusia neurosensorial inducida por ruido, de estos el 87,8% fueron clasificados como leves, 10,8% como moderados y el 1,2% como moderado severo, no se registraron casos de HNIR severa o profunda. El 62,7% se clasificaron como no HNIR y el 4% correspondió a hipoacusias con afectación de frecuencias conversacionales. Conclusiones: Al aplicar un modelo de regresión logística para controlar las variables de confusión, no se encontró asociación con ninguna de las variables anteriormente descritas. A pesar de esto, existe suficiente evidencia de la relación entre algunas ocupaciones y la HNIR.

Informe final creación y evaluación de campo de un instrumento para la medición de las competencias clínicas en Fisioterapia

La evaluación de los procesos formativos en el área clínica, basados en competencias, es fundamental para la Fisioterapia. Este proceso articula la teoría con la práctica, orienta la organización de los procesos académicos, promueve la formación integral y establece mecanismos de retroalimentación permanentes y rigurosos, basados en la evaluación del desempeño del profesional en formación ante situaciones del día a día que dan cuenta de su toma de decisiones profesional. Se espera que los estudiantes se formen y puedan actuar como profesionales competitivos a nivel nacional e internacional, de manera integral, con sólidos compromisos éticos y sociales para responder a las necesidades del entorno social en el que se desenvuelven (PEP, Universidad del Rosario). Los esfuerzos actuales en investigación de la evaluación educativa se encuentran orientados a la integración de la adquisición del conocimiento y al desarrollo de estrategias de medición y cuantificación de capacidades técnico-científicas dentro de cada disciplina. En este sentido, hasta el momento, en Colombia no se encuentra evidencia alrededor de la validación de instrumentos de medición de las competencias clínicas, ni se cuenta con estándares para la evaluación en práctica clínica en el proceso de formación del recurso humano en Fisioterapia. En el proyecto se desarrolló y fueron evaluadas las propiedades psicométricas de un instrumento que mide las competencias clínicas del estudiante de fisioterapia en la práctica clínica. Este proceso involucró a Fisioterapeutas que con experiencia en el área de docencia y clínica, contribuyen con la formación de fisioterapeutas en Colombia.

Miopatia atípica: análise de casos clínicos

A Miopatia atípica é uma doença emergente em alguns países europeus, que afecta cavalos de pasto, caracterizada por fraquez súbita, decúbito prolongado e degeneração muscular aguda. Tem-se verificado recentemente um aumento do número de surtos, incluindo em países em que a doença nunca fora diagnosticada anteriormente, o que justifica o presente estudo, que tem como objectivo a contribuição para a descrição do perfil epidemológico da MA, com base na descrição de dados geográficos, demográficos e clínicos de casos confirmados e suspeitos de MA, observados num Hospital Equino de referência, na Bélgica, durante o Outono de 2010. Foram incluídos na análise retrospectiva da série de casos clínicos estudados tanto a identificação fenotípica de cada indivíduo, assim como as respectivas práticas de maneio, incluindo condições de pastoreio, história clínica e achados bioquímicos e, sempre que possível, histopatológicos. Os sinais clínicos ocorreram em condições climáticas desfavoráveis. Os sintomas mais frequentes incluíram fraqueza e recusa em mover-se. As concentrações de creatinina quinase, CK, variaram entre 20360 UI/L a 213350 UI/L nos casos confirmados, CC e casos de elevada probabilidade, CEP para miopatia atípica, MA. A associação de MA com as condições climáticas sugere que o maneio das pastagens é de extrema importância na prevenção da condição.

International evidence on the predictability of returns to securitized real estate assets: econometric models versus neural networks

The performance of various statistical models and commonly used financial indicators for forecasting securitised real estate returns are examined for five European countries: the UK, Belgium, the Netherlands, France and Italy. Within a VAR framework, it is demonstrated that the gilt-equity yield ratio is in most cases a better predictor of securitized returns than the term structure or the dividend yield. In particular, investors should consider in their real estate return models the predictability of the gilt-equity yield ratio in Belgium, the Netherlands and France, and the term structure of interest rates in France. Predictions obtained from the VAR and univariate time-series models are compared with the predictions of an artificial neural network model. It is found that, whilst no single model is universally superior across all series, accuracy measures and horizons considered, the neural network model is generally able to offer the most accurate predictions for 1-month horizons. For quarterly and half-yearly forecasts, the random walk with a drift is the most successful for the UK, Belgian and Dutch returns and the neural network for French and Italian returns. Although this study underscores market context and forecast horizon as parameters relevant to the choice of the forecast model, it strongly indicates that analysts should exploit the potential of neural networks and assess more fully their forecast performance against more traditional models.

Carbon and nitrogen stable isotope ratio analysis of freshwater, brackish and marine fish from Belgian archaeological sites (1st and 2nd millennium AD)

Carbon and nitrogen stable isotope ratios were measured in 157 fish bone collagen samples from 15 different archaeological sites in Belgium which ranged in ages from the 3rd to the 18th c. AD. Due to diagenetic contamination of the burial environment, only 63 specimens produced results with suitable C:N ratios (2.9–3.6). The selected bones encompass a wide spectrum of freshwater, brackish, and marine taxa (N = 18), and this is reflected in the δ13C results (−28.2‰ to −12.9%). The freshwater fish have δ13C values that range from −28.2‰ to −20.2‰, while the marine fish cluster between −15.4‰ and −13.0‰. Eel, a catadromous species (mostly living in freshwater but migrating into the sea to spawn), plots between −24.1‰ and −17.7‰, and the anadromous fish (living in marine environments but migrating into freshwater to spawn) show a mix of freshwater and marine isotopic signatures. The δ15N results also have a large range (7.2‰ to 16.7‰) indicating that these fish were feeding at many different trophic levels in these diverse aquatic environments. The aim of this research is the isotopic characterization of archaeological fish species (ecology, trophic level, migration patterns) and to determine intra-species variation within and between fish populations differing in time and location. Due to the previous lack of archaeological fish isotope data from Northern Europe and Belgium in particular, these results serve as an important ecological backdrop for the future isotopic reconstruction of the diet of human populations dating from the historical period (1st and 2nd millennium AD), where there is zooarchaeological and historical evidence for an increased consumption of marine fish.

Holocene alluvial environments at Barking, Lower Thames Valley (London, UK)

Deposit modelling based on archived borehole logs supplemented by a small number of dedicated boreholes is used to reconstruct the main boundary surfaces and the thickness of the main sediment units within the succession of Holocene alluvial deposits underlying the floodplain in the Barking Reach of the Lower Thames Valley. The basis of the modelling exercise is discussed and the models are used to assess the significance of floodplain relief in determining patterns of sedimentation. This evidence is combined with the results of biostratigraphical and geochronological investigations to reconstruct the environmental conditions associated with each successive stage of floodplain aggradation. The two main factors affecting the history and spatial pattern of Holocene sedimentation are shown to be the regional behaviour of relative sea level and the pattern of relief on the surface of the sub-alluvial, Late Devensian Shepperton Gravel. As is generally the case in the Lower Thames Valley, three main stratigraphic units are recognised, the Lower Alluvium, a peat bed broadly equivalent to the Tilbury III peat of Devoy (1979) and an Upper Alluvium. There is no evidence to suggest that the floodplain was substantially re-shaped by erosion during the Holocene. Instead, the relief inherited from the Shepperton Gravel surface was gradually buried either by the accumulation of peat or by deposition of fine-grained sediment from suspension in standing or slow-moving water. The palaeoenvironmental record from Barking confirms important details of the Holocene record observed elsewhere in the Lower Thames Valley, including the presence of Taxus in the valley-floor fen carr woodland between about 5000 and 4000 cal BP, and the subsequent growth of Ulmus on the peat surface.

Configurations institutionnelles de la protection de l’enfance: regards croisés de l’Afrique, de l’Europe et de l’Amérique du Nord

Cet article porte sur l’analyse de trois configurations institutionnelles de la protection de l’enfance : celle en place au Burkina Faso, en Belgique et au Québec. Pour chaque configuration, le texte explore les transformations qui ont marqué le passage de la prise en charge exclusive de l’enfant par la famille vers la présence accrue de l’État et la manière dont la Convention internationale des droits de l’enfant de 1989 a influencé ce passage. Il montre, au travers d’une lecture historique, que l’implication de l’État dans la protection des enfants a connu des formes et des modalités variables selon le temps et l’espace. L’approche actuelle en matière de protection de l’enfance au Nord et au Sud, approche largement inspirée de la perspective des droits, représente un défi tant pour les intervenants que pour les familles, car son application dépend à fois des ressources disponibles pour aider les enfants et les familles en difficulté, de la capacité d’action des institutions publiques et de l’efficacité des interventions. This article deals with the analysis of three institutional configurations of child protection: those in Burkina Faso, in Belgium, and in Québec. With respect to each configuration, the text explores the changes from situations in which the family had sole control of the child to those where the State played a greater role, and the manner in which the 1989 International Convention on the Rights of the Child has affected such changes. It shows, through a reading of history, that the involvement of the State in child protection has gone through different forms and stages over time and space. The current strategies as regards child protection in the North and in the South—an approach that is largely subject to a legal perspective—represent a challenge both for intervenors and for families, since their application depends on the resources available for helping children and families in difficulty, on the ability of the public institutions to intervene, and on the efficiency of such interventions.

Social citizenship, housing wealth and the cost of social care: is the Care Act 2014 'Fair'?

This article assesses the extent to which it is ‘fair’ for the government to require owner-occupiers to draw on the equity accumulated in their home to fund their social care costs. The question is stimulated by the report of the Commission on Funding of Care and Support, Fairer Care Funding (the Dilnot Commission) and the subsequent Care Act 2014. The enquiry is located within the framework of social citizenship and the new social contract. It argues that the individualistic, contractarian approach, exemplified by the Dilnot Commission and reflected in the Act, raises questions when considered from the perspective of intergenerational fairness. We argue that our concerns with the Act could be addressed by inculcating an expectation of drawing on housing wealth to fund older age: a policy of asset-based welfare.

Contractual restrictions on lawful use of information: sole-source databases protected by the back door?

This article is concerned with the risks associated with the monopolisation of information that is available from a single source only. Although there is a longstanding consensus that sole-source databases should not receive protection under the EU Database Directive, and there are legislative provisions to ensure that lawful users have access to a database’s contents, Ryanair v PR Aviation challenges this assumption by affirming that the use of non-protected databases can be restricted by contract. Owners of non-protected databases can contractually exclude lawful users from taking the benefit of statutorily permitted uses, because such databases are not covered from the legislation that declares this kind of contract null and void. We argue that this judgment is not consistent with the legislative history and can have a profound impact on the functioning of the digital single market, where new information services, such as meta-search engines or price-comparison websites, base their operation on the systematic extraction and re-utilisation of materials available from online sources. This is an issue that the Commission should address in a forthcoming evaluation of the Database Directive.

Denudation history of the Bocaina Plateau, Serra do Mar, southeastern Brazil: Relationships to Gondwana breakup and passive margin development

The Bocaina Plateau, which is situated on the eastern flank of the continental rift of southeastern Brazil, is the highest part of the Serra do Mar. Topographic relief in this area is suggested to be closely related to its complex tectono-magmatic evolution since the breakup of Western Gondwana and opening of the South Atlantic Ocean. Apatite fission track ages and track length distributions from 27 basement outcrops were determined to assess these hypotheses and reconstruct the denudation history of the Bocaina Plateau. The ages range between 303 +/- 32 and 46 +/- 5 Ma, and are significantly younger than the stratigraphic ages. Mean track lengths vary from 13.44 +/- 1.51 to 11.1 +/- 1.48 mu m, with standard deviations between 1.16 and 1.83 mu m. Contrasting ages within a single plateau and similar ages at different altitudes indicate a complex regional tectonothermal evolution. The thermal histories inferred from these data imply three periods of accelerated cooling related to the Early Cretaceous continental breakup, Early Cretaceous alkaline magmatism, and the Paleogene evolution of the continental rift of southeastern Brazil. The oldest fission track ages (>200 Ma) were obtained in the Serra do Mar region, suggesting that these areas were a long-lived source of sediments for the Parana, Bauru, and Santos basins. (C) 2010 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

O controle externo sobre as agências reguladoras de Estado : limites e (im)possibilidades

Com a criação das primeiras entidades reguladoras de infraestrutura, década de 90, surgiu uma nova maneira estratégica de o Estado atuar com intuito de melhorar a governança pública. O Estado brasileiro, que era responsável direto pelo desenvolvimento econômico e social, buscou se redefinir frente ao modelo de entidades reguladoras que emergia. Em decorrência dessa nova fisionomia estatal, a descentralização funcional ganhou ênfase resultando no aparecimento de estruturas mais flexíveis e autônomas sob a natureza de direito público com a finalidade de atuar em setores típicos de Estado. Assim, foram criadas as primeiras agências reguladoras brasileiras com objetivo de normatizar, incentivar e regular setores essenciais à sociedade. Por consequência de tais inovações, diversas áreas administrativas tiveram de serem adaptadas, sobretudo as relacionadas à atividade de controle no âmbito administrativo. Para tanto, tornou-se necessário conciliar, dentro de um escopo sistematizado, mecanismos capazes de atender as demandas oriundas do recente Estado regulador brasileiro. Com efeito, a função controle adquire relevo no sentido de evitar que tais agências reguladoras apartem-se de limites impostos por lei ou de que divirjam de suas missões institucionais. Assim, o presente trabalho investiga a atuação do controle externo exercido pelo Tribunal de Contas da União (TCU) no desempenho das agências reguladoras de Estado. Diante de o assunto permear várias áreas epistemológicas, entende-se que abordá-lo sob o enfoque interdisciplinar pode estender em contribuições sobre o objeto investigado. Nesse contexto, esta dissertação visa incorporar, também, outras áreas de conhecimento. Longe de defender um isomorfismo para o arranjo regulatório brasileiro ou de promover uma saída paradigmática, esta pesquisa busca, com amparo na metodologia qualitativa e sob os enfoques exploratórios e descritivos, reunir conhecimentos e constatações no sentido de propiciar maior aproximação acerca do assunto e concorrer para o delineamento de diretrizes futuras do controle externo sobre a regulação brasileira. Destaca-se que tanto a regulação como o controle sobre o ambiente regulatório são assuntos que se encontram em desenvolvimento no contexto brasileiro, o que enseja a pertinência desta pesquisa. Em face do exposto, esta dissertação visa investigar o estado atual do controle exercido pelo TCU sobre o desempenho nas agências reguladoras de Estado – infraestrutura - com intuito de analisar e promover um debate sobre limites e (im)possibilidades dessa atuação.

Avaliação de características morfométricas na relação solo-superfície da Bacia Hidrográfica do Córrego Rico, Jaboticabal (SP)

Com a análise das características morfométricas procura-se entender a relação solo-superfície, em decorrência dos processos erosivos sobre estruturas e litologias variadas. Neste trabalho, objetivou-se avaliar as características morfométricas do padrão de drenagem e do relevo em microbacias hidrográficas de 2ª ordem de magnitude, em Latossolo Vermelho-Escuro e Argissolo Vermelho-Amarelo, com vistas ao planejamento agroambiental da Bacia Hidrográfica do Córrego Rico, município de Jaboticabal, SP. O estudo foi baseado em fotografias aéreas, pancromáticas, verticais na escala 1:35.000 da região administrativa de Ribeirão Preto. Com técnicas de fotointerpretação, foram traçadas a rede de drenagem e respectivas microbacias hidrográficas, onde as variáveis selecionadas foram determinadas. As classes de risco de degradação, resultando no uso potencial do solo, foram determinadas de acordo com o coeficiente de rugosidade. As características do padrão de drenagem e do relevo repercutiram no comportamento hidrológico e litológico das microbacias hidrográficas, possibilitando a diferenciação entre as unidades de solos. A densidade de drenagem e a amplitude altimétrica foram as características que mais contribuíram para o poder discriminatório na relação solo-superfície. Na análise conjunta do potencial de uso do solo, verificou-se, principalmente, adequação para agricultura nos Latossolos e pecuária e, ou, reflorestamento nos Argissolos.

Modelagem e medições de ondas de rádio para predição de perda de propagação em ambientes urbanos

In this dissertation new models of propagation path loss predictions are proposed by from techniques of optimization recent and measures of power levels for the urban and suburban areas of Natal, city of Brazilian northeast. These new proposed models are: (i) a statistical model that was implemented based in the addition of second-order statistics for the power and the altimetry of the relief in model of linear losses; (ii) a artificial neural networks model used the training of the algorithm backpropagation, in order to get the equation of propagation losses; (iii) a model based on the technique of the random walker, that considers the random of the absorption and the chaos of the environment and than its unknown parameters for the equation of propagation losses are determined through of a neural network. The digitalization of the relief for the urban and suburban areas of Natal were carried through of the development of specific computational programs and had been used available maps in the Statistics and Geography Brazilian Institute. The validations of the proposed propagation models had been carried through comparisons with measures and propagation classic models, and numerical good agreements were observed. These new considered models could be applied to any urban and suburban scenes with characteristic similar architectural to the city of Natal

Estimativa da profundidade do embasamento na bacia potiguar usando inversão gravimétrica

The gravity inversion method is a mathematic process that can be used to estimate the basement relief of a sedimentary basin. However, the inverse problem in potential-field methods has neither a unique nor a stable solution, so additional information (other than gravity measurements) must be supplied by the interpreter to transform this problem into a well-posed one. This dissertation presents the application of a gravity inversion method to estimate the basement relief of the onshore Potiguar Basin. The density contrast between sediments and basament is assumed to be known and constant. The proposed methodology consists of discretizing the sedimentary layer into a grid of rectangular juxtaposed prisms whose thicknesses correspond to the depth to basement which is the parameter to be estimated. To stabilize the inversion I introduce constraints in accordance with the known geologic information. The method minimizes an objective function of the model that requires not only the model to be smooth and close to the seismic-derived model, which is used as a reference model, but also to honor well-log constraints. The latter are introduced through the use of logarithmic barrier terms in the objective function. The inversion process was applied in order to simulate different phases during the exploration development of a basin. The methodology consisted in applying the gravity inversion in distinct scenarios: the first one used only gravity data and a plain reference model; the second scenario was divided in two cases, we incorporated either borehole logs information or seismic model into the process. Finally I incorporated the basement depth generated by seismic interpretation into the inversion as a reference model and imposed depth constraint from boreholes using the primal logarithmic barrier method. As a result, the estimation of the basement relief in every scenario has satisfactorily reproduced the basin framework, and the incorporation of the constraints led to improve depth basement definition. The joint use of surface gravity data, seismic imaging and borehole logging information makes the process more robust and allows an improvement in the estimate, providing a result closer to the actual basement relief. In addition, I would like to remark that the result obtained in the first scenario already has provided a very coherent basement relief when compared to the known basin framework. This is significant information, when comparing the differences in the costs and environment impact related to gravimetric and seismic surveys and also the well drillings