Caracterización epidemiológica de la artritis idiopática juvenil y refractariedad a dmard en una institución en Bogotá

La artritis idiopática juvenil (AIJ) es la enfermedad reumatológica crónica más común de la infancia con repercusiones importantes en la calidad de vida del paciente y su familia; las alteraciones físicas presentadas pueden ocasionar ausentismo escolar. Los tratamientos de uso crónico utilizados hacen que la adherencia al mismo en la población infantil y adolescente sea todo un reto. A esto se adiciona la refractariedad a DMARDs (Disease – Modifying – Antirheumatic – Drugs) que conlleva al inicio de terapia biológica y a cambios en el pronóstico de la enfermedad. Materiales y métodos: Estudio observacional retrospectivo mediante la revisión de las historias clínicas de pacientes con diagnóstico de artritis idiopática juvenil que consultaron a la Fundación Cardioinfantil desde enero del 2008 a septiembre de 2015. Se obtuvieron datos como edad, sexo, edad de diagnóstico, manejo actual, remisión, seguimiento, tratamiento, cambios realizados en el mismo y refractariedad a DMARD. Resultados: De 108 registros clínicos evaluados, 90 cumplieron los criterios de elegibilidad. Se diagnosticó con mayor frecuencia en el sexo femenino con un 57.8%, media de edad de 7.88 años. El subtipo poliarticular con Factor Reumatoideo negativo se presentó con una frecuencia con 31,1 %. El tiempo transcurrido entre el inicio de la sintomatología en meses, previo a realizar el diagnóstico, osciló entre 1 y 60 meses con una media de 10,6 meses. Se usaron con mayor frecuencia: AINES (61,1%), metotrexate (47,8%) y corticoides (42,2%). De los 90 pacientes, solo un 11.1% de la población presentó complicaciones, siendo la más frecuente la obesidad en un 3,3 % y la menos frecuente la uveítis con un 1,1%. Discusión: Es importante el entendimiento de la Artritis idiopática juvenil como una entidad de carácter sistémica, lo cual hace necesario el conocimiento de la epidemiología para establecer estrategias de manejo y seguimiento adecuadas. El género femenino continúa siendo afectado en mayor porcentaje. Se observaron leves cambios respecto al subtipo de mayor frecuencia comparado con estudios previos. Se necesitan más estudios de caracterización epidemiológica en la población Colombiana para realización de políticas de salud pública

Análisis de supervivencia en pacientes con prótesis valvular biológica, Fundación Cardioinfantil-Instituto de Cardiología, Colombia, 2005-2013

Introducción: A partir de la década de los cincuenta el manejo de la enfermedad valvular presenta cambios significativos cuando se incorporan los reemplazos valvulares tanto mecánicos como biológicos dentro de las opciones de tratamiento quirúrgico (1). Las válvulas biológicas se desarrollaron como una alternativa que buscaba evitar los problemas relacionados con la anticoagulación y con la idea de utilizar un tejido que se comportara hemodinámicamente como el nativo. Este estudio está enfocado en establecer la sobrevida global y la libertad de reoperación de la válvula de los pacientes sometidos a reemplazo valvular aórtico y mitral biológicos en la Fundación Cardioinfantil - IC a 1, 3, 5 y 10 años. Materiales y métodos: Estudio de cohorte retrospectiva de supervivencia de pacientes sometidos a reemplazo valvular aórtico y/o mitral biológico intervenidos en la Fundación Cardioinfantil entre 2005 y 2013. Resultados: Se obtuvieron 919 pacientes incluidos en el análisis general y 876 (95,3%) pacientes con seguimiento efectivo para el análisis de sobrevida. La edad promedio fue 64años. La sobrevida a 1, 3, 5 y 10 años fue 95%,90%,85% y 69% respectivamente. El seguimiento efectivo para el desenlace reoperación fue del 55% y se encontró una libertad de reoperación del 99%, 96%, 93% y 81% a los 1, 3, 5 y 10 años. No hubo diferencias significativas entre la localización de la válvula ni en el tipo de válvula aortica empleada. Conclusiones: La sobrevida de los pacientes que son llevados a reemplazo valvular biológico en este estudio es comparable a grandes cohortes internacionales. La sobrevida de los pacientes llevados a reemplazo valvular con prótesis biológicas en posición mitral y aortica fue similar a 1, 3, 5 y 10 años.

Eficacia y seguridad de la melatonina para el manejo de los trastornos del sueño en el autismo: meta-análisis

INTRODUCCIÓN: El 80% de los niños y adolescentes con trastornos del espectro autista (TEA) presenta algún trastorno del sueño, en cuya génesis al parecer intervienen alteraciones en la regulación de la melatonina. El objetivo de este metaanálisis fue determinar la eficacia y seguridad de la melatonina para el manejo de ciertos trastornos del sueño en niños con TEA. MÉTODOS: Tres revisores extrajeron los datos relevantes de los ensayos clínicos aleatorizados doble ciego de alta calidad publicados en bases de datos primarias, de ensayos clínicos, de revisiones sistemáticas y de literatura gris; además se realizó búsqueda en bola de nieve. Se analizaron los datos con RevMan 5.3. Se realizó un análisis del inverso de la varianza por un modelo de efectos aleatorios para las diferencias de medias de los desenlaces propuestos: duración del tiempo total, latencia de sueño y número de despertares nocturnos. Se evaluó la heterogeneidad interestudios con el parámetro I2 RESULTADOS: La búsqueda inicial arrojó 355 resultados, de los cuales tres cumplieron los criterios de selección. La melatonina resultó ser un medicamento seguro y eficaz para aumentar la duración total del sueño y disminuir la latencia de sueño en niños y adolescentes con TEA; hasta el momento la evidencia sobre el número de despertares nocturnos no es estadísticamente significativa. DISCUSIÓN: A la luz de la evidencia disponible, la melatonina es una elección segura y eficaz para el manejo de ciertos problemas del sueño en niños y adolescentes con TEA. Es necesario realizar estudios con mayores tamaños muestrales y comparados con otros medicamentos disponibles en el mercado.

Noves tècniques de gestió per a l'empresa promotora constructora

En el sector de la promoció construcció, i en especial, en el subsector de la promoció construcció d'habitatges, l'empresari ha de tenir un bon coneixement de les variables d'entorn ja que la consideració de les mateixes seran fonamentals a l'hora de prendre decisions sobre planificació estratègica. En l'actualitat vivim una fase de canvis socioeconòmics que dificulten la previsió del comportament futur de les variables d'entorn. Per tant, el subjecte decisor es troba en un ambient d'incertesa que s'aguditza per la majoritària presència de factors qualitatius difícils de quantificar. Llavors, l'empresari promotor constructor haurà de recórrer a tècniques operatives de gestió que tinguin present aquesta situació i això serà possible a partir de les eines que ens ofereix la lògica borrosa. Aquesta tesi s'ha estructurat en tres parts: En la primera part, exposem les característiques específiques i l'evolució del sector. En la segona part, expliquem la metodologia i, en la tercera part, exposem diverses aplicacions de la metodologia borrosa per l'establiment de noves estratègies de gestió aplicades al sector objecte d'estudi.

Strategic airline alliances

Airline alliances: overview - Alliances goals - Impact of airline alliances on customers - Types of alliance Marketing agreements Codesharing Franchising Global alliances Equity alliance - The Future

Africa aviation growth : Boeing

- Market Outlook Global Observations Regulatory Environment Product Strategies Africa Regional Perspective - Strategy vs. Tactics - Final Thoughts

Linking Canadian Harvested Juvenile American Black Ducks to Their Natal Areas Using Stable Isotope (δD, δ13C, and δ15N) Methods

Understanding source-sink dynamics of game birds is essential to harvest and habitat management but acquiring this information is often logistically and financially challenging using traditional methods of population surveys and banding studies. This is especially true for species such as the American Black Duck (Anas rubripes), which have low breeding densities and extensive breeding ranges that necessitate extensive surveys and banding programs across eastern North America. Despite this effort, the contribution of birds fledged from various landscapes and habitat types within specific breeding ranges to regional harvest is largely unknown but remains an important consideration in adaptive harvest management and targeted habitat conservation strategies. We investigated if stable isotope (δD, δ13C, δ15N) could augment our present understanding of connectivity between breeding and harvest areas and so provide information relevant to the two main management strategies for black ducks, harvest and habitat management. We obtained specimens from 200 hatch-year Black Duck wings submitted to the Canadian Wildlife Service Species Composition Survey. Samples were obtained from birds harvested in Western, Central, and Eastern breeding/harvest subregions to provide a sample representative of the range and harvest rate of birds harvested in Canada. We sampled only hatch-year birds to provide an unambiguous and direct link between production and harvest areas. Marine origins were assigned to 12%, 7%, and 5% of birds harvested in the Eastern, Central, and Western subregions, respectively. In contrast, 32%, 9%, and 5% of birds were assigned, respectively, to agricultural origins. All remaining birds were assigned to nonagricultural origins. We portrayed probability of origin using a combination of Bayesian statistical and GIS methods. Placement of most eastern birds was western Nova Scotia, eastern New Brunswick, Prince Edward Island, and southern Newfoundland. Agricultural birds from the Central region were consistent with the Saguenay region of Québec and the eastern claybelt with nonagricultural birds originating in the boreal. Western nonagricultural birds were associated with broad boreal origins from southern James Bay to Lake of the Woods and east to Cochrane, Ontario. Our work shows that the geographic origins, landscape, and habitat associations of hatch-year Black Ducks can be inferred using this technique and we recommend that a broad-scale isotopic study using a large sample of Canadian and US harvested birds be implemented to provide a continental perspective of source-sink population dynamics.

Establishing Winter Origins of Migrating Lesser Snow Geese Using Stable Isotopes

Increases in Snow Goose (Chen caerulescens) populations and large-scale habitat changes in North America have contributed to the concentration of migratory waterfowl on fewer wetlands, reducing resource availability, and enhancing risks of disease transmission. Predicting wintering locations of migratory individuals is critical to guide wildlife population management and habitat restoration. We used stable carbon (δ13C), nitrogen (δ15N), and hydrogen (δ2H) isotope ratios in muscle tissue of wintering Snow Geese to discriminate four major wintering areas, the Playa Lake Region, Texas Gulf Coast, Louisiana Gulf Coast, and Arkansas, and infer the wintering locations of individuals collected later during the 2007 and 2008 spring migrations in the Rainwater Basin (RWB) of Nebraska. We predicted the wintering ground derivation of migrating Snow Geese using a likelihood-based approach. Our three-isotope analysis provided an efficient discrimination of the four wintering areas. The assignment model predicted that 53% [95% CI: 37-69] of our sample of Snow Geese from the RWB in 2007 had most likely originated in Louisiana, 38% [23-54] had wintered on Texas Gulf Coast, and 9% [0-20] in Arkansas; the assessment suggested that 89% [73-100] of our 2008 sample had most likely come from Texas Gulf Coast, 9% [0-27] from Louisiana Gulf Coast, and 2% [0-9] from Arkansas. Further segregation of wintering grounds and additional sampling of spring migrating Snow Geese would refine overall assignment and help explain interannual variations in migratory connectivity. The ability to distinguish origins of northbound geese can support the development of spatially-adaptive management strategies for the midcontinent Snow Goose population. Establishing migratory connectivity using isotope assignment techniques can be extended to other waterfowl species to determine critical habitat, evaluate population energy requirements, and inform waterfowl conservation and management strategies.

Influence of vegetation on the nocturnal foraging behaviors and vertebrate prey capture by endangered Burrowing Owls

Restrictions in technology have limited past habitat selection studies for many species to the home-range level, as a finer-scale understanding was often not possible. Consequently, these studies may not identify the true mechanism driving habitat selection patterns, which may influence how such results are applied in conservation. We used GPS dataloggers with digital video recorders to identify foraging modes and locations in which endangered Burrowing Owls (Athene cunicularia) captured prey. We measured the coarse and fine-scale characteristics of vegetation at locations in which owls searched for, versus where they caught, vertebrate prey. Most prey items were caught using hover-hunting. Burrowing Owls searched for, and caught, vertebrate prey in all cover types, but were more likely to kill prey in areas with sparse and less dense vegetative cover. Management strategies designed to increase Burrowing Owl foraging success in the Canadian prairies should try to ensure a mosaic of vegetation heights across cover types.

Variables associated with nest survival of Golden-winged Warblers (Vermivora chrysoptera) among vegetation communities commonly used for nesting

Among shrubland- and young forest-nesting bird species in North America, Golden-winged Warblers (Vermivora chrysoptera) are one of the most rapidly declining partly because of limited nesting habitat. Creation and management of high quality vegetation communities used for nesting are needed to reduce declines. Thus, we examined whether common characteristics could be managed across much of the Golden-winged Warbler’s breeding range to increase daily survival rate (DSR) of nests. We monitored 388 nests on 62 sites throughout Minnesota, Wisconsin, New York, North Carolina, Pennsylvania, Tennessee, and West Virginia. We evaluated competing DSR models in spatial-temporal (dominant vegetation type, population segment, state, and year), intraseasonal (nest stage and time-within-season), and vegetation model suites. The best-supported DSR models among the three model suites suggested potential associations between daily survival rate of nests and state, time-within-season, percent grass and Rubus cover within 1 m of the nest, and distance to later successional forest edge. Overall, grass cover (negative association with DSR above 50%) and Rubus cover (DSR lowest at about 30%) within 1 m of the nest and distance to later successional forest edge (negative association with DSR) may represent common management targets across our states for increasing Golden-winged Warbler DSR, particularly in the Appalachian Mountains population segment. Context-specific adjustments to management strategies, such as in wetlands or areas of overlap with Blue-winged Warblers (Vermivora cyanoptera), may be necessary to increase DSR for Golden-winged Warblers.

Predicted soil organic carbon stocks and changes in the Brazilian Amazon between 2000 and 2030

Currently we have little understanding of the impacts of land use change on soil C stocks in the Brazilian Amazon. Such information is needed to determine impacts'6n the global C cycle and the sustainability of agricultural systems that are replacing native forest. The aim of this study was to predict soil carbon stocks and changes in the Brazilian Amazon during the period between 2000 and 2030, using the GEFSOC soil carbon (C) modelling system. In order to do so, we devised current and future land use scenarios for the Brazilian Amazon, taking into account: (i) deforestation, rates from the past three decades, (ii) census data on land use from 1940 to 2000, including the expansion and intensification of agriculture in the region, (iii) available information on management practices, primarily related to well managed pasture versus degraded pasture and conventional systems versus no-tillage systems for soybean (Glycine max) and (iv) FAO predictions on agricultural land use and land use changes for the years 2015 and 2030. The land use scenarios were integrated with spatially explicit soils data (SOTER database), climate, potential natural vegetation and land management units using the recently developed GEFSOC soil C modelling system. Results are presented in map, table and graph form for the entire Brazilian Amazon for the current situation (1990 and 2000) and the future (2015 and 2030). Results include soil organic C (SOC) stocks and SOC stock change rates estimated by three methods: (i) the Century ecosystem model, (ii) the Rothamsted C model and (iii) the intergovernmental panel on climate change (IPCC) method for assessing soil C at regional scale. In addition, we show estimated values of above and belowground biomass for native vegetation, pasture and soybean. The results on regional SOC stocks compare reasonably well with those based on mapping approaches. The GEFSOC system provided a means of efficiently handling complex interactions among biotic-edapho-climatic conditions (> 363,000 combinations) in a very large area (similar to 500 Mha) such as the Brazilian Amazon. All of the methods used showed a decline in SOC stock for the period studied; Century and RothC simulated values for 2030 being about 7% lower than those in 1990. Values from Century and RothC (30,430 and 25,000 Tg for the 0-20 cm layer for the Brazilian Amazon region were higher than those obtained from the IPCC system (23,400 Tg in the 0-30 cm layer). Finally; our results can help understand the major biogeochemical cycles that influence soil fertility and help devise management strategies that enhance the sustainability of these areas and thus slow further deforestation. (C) 2007 Elsevier B.V. All rights reserved.

The taxonomic status of pest species of Coptotermes in Southeast Asia: Resolving the paradox in the pest status of the termites, Coptotermes gestroi, C-havilandi and C-travians (Isoptera : Rhinotermitidae)

The taxonomic status of Coptotermes gestroi (Wasmann), C. havilandi Holmgren, C. travians (Haviland) and C. borneensis Oshima (Isoptera: Rhinotermitidae) is revised. The apparent discrepancy between the reported importance of C. havitandi in countries to which it has been introduced and the region from which it originated is shown to be due to misidentification and taxonomic confusion between C. travians, C. havilandi and C. gestroi. Based on an examination of specimens from Southeast Asia, two species are recognized, namely C. gestroi and C. travians. Coptotermes havilandi, described from imagos, is shown to be the same species as C. gestro described earlier from the soldier caste, and is designated a junior synonym. Coptotermes gestroi occurs from Assam through Burma and Thailand to Malaysia and the Indonesian archipelago, and has been introduced into other geographic regions, including parts of North and South America and the Caribbean. It is frequently found damaging wood in buildings, and is often intercepted outside its range in cargo onboard ships and sailing vessels, which is a likely mechanism for its spread to new geographical areas. Coptotermes gestroi has been misidentified in much literature as C. travians. Conversely, C. travians has been misidentified in recent literature in Peninsular Malaysia as C. havilandi and was redescribed from Borneo as C. borneensis, which is here designated a junior synonym of C. travians. It has a known distribution from Peninsular Malaysia to Borneo, and has not been found infesting wood in buildings. It is envisaged that the resolution of this taxonomic problem will enable the deployment of common pest management strategies for C. gestro the primary pest species of Coptotermes originating from Southeast Asia.

Conservation ecology of bees: populations, species and communities

Recent concerns regarding the decline of plant and pollinator species, and the impact on ecosystem functioning, has focused attention on the local and global threats to bee diversity. As evidence for bee declines is now accumulating from over broad taxonomic and geographic scales, we review the role of ecology in bee conservation at the levels of species, populations and communities. Bee populations and communities are typified by considerable spatiotemporal variation; whereby autecological traits, population size and growth rate, and plant-pollinator network architecture all play a role in their vulnerability to extinction. As contemporary insect conservation management is broadly based on species- and habitat-targeted approaches, ecological data will be central to integrating management strategies into a broader, landscape scale of dynamic, interconnected habitats capable of delivering bee conservation in the context of global environmental change.

Enhancing pollinator biodiversity in intensive grasslands

Increased agricultural intensification has led to well-documented declines in the fauna and flora associated with intensive grasslands in the UK. We aimed to quantify the effectiveness of different field margin management strategies for putting bumblebee and butterfly biodiversity back into intensive grasslands. Using four intensive livestock farms in south-west England, we manipulated conventional management practices (addition of inorganic fertilizer, cutting frequency and height, and aftermath grazing) to generate seven grass-based treatments along a gradient of decreasing management intensity. We also tested two more interventionist treatments which introduced sown components into the sward: (i) a cereal, grass and legume mix, and (ii) a diverse conservation mix with kale, mixed cereals, linseed and legumes. These crop mixtures were intended to provide forage and structural resources for pollinators but were not intended to have agronomic value as livestock feed. Using a replicated block design, we monitored bumblebee and butterfly responses in 27 plots (10 x 50 m) in each farm from 2003 to 2006. Bumblebees were most abundant, species-rich and diverse in the sown treatments and virtually absent from the grass-based treatments. The diverse conservation mix treatment supported larger and more diverse bumblebee assemblages than the cereal, grass and legume mix treatment. The sown treatments, and the most extensively managed grass-based treatments, had the highest abundance, species richness and diversity of adult butterflies, whereas butterfly larvae were only found in the grass-based treatments. Bumblebee and butterfly assemblage structure was driven by floral abundance, floral richness, the availability of nectar resources, and sward structure. Only vegetation cover was correlated with butterfly larval abundance. Synthesis and applications. This study has identified management options in the margins of intensive grasslands which can enhance bumblebee and butterfly biodiversity. Extensification of conventional grass management by stopping fertilization, reducing cutting frequency and not grazing, benefits butterflies. However, to enhance bumblebees requires a more interventionist approach in the form of sowing flower-rich habitat. Both approaches are potentially suitable for adoption in agri-environment schemes in the UK and Europe.

The relationship between multi-species catch and effort: among fishery comparisons

The control of fishing mortality via fishing effort remains fundamental to most fisheries management strategies even at the local community or co-management level. Decisions to support such strategies require knowledge of the underlying response of the catch to changes in effort. Even under adaptive management strategies, imprecise knowledge of the response is likely to help accelerate the adaptive learning process. Data and institutional capacity requirements to employ multi-species biomass dynamics and age-structured models invariably render their use impractical particularly in less developed regions of the world. Surplus production models fitted to catch and effort data aggregated across all species offer viable alternatives. The current paper seeks models of this type that best describe the multi-species catch–effort responses in floodplain-rivers, lakes and reservoirs and reef-based fisheries based upon among fishery comparisons, building on earlier work. Three alternative surplus production models were fitted to estimates of catch per unit area (CPUA) and fisher density for 258 fisheries in Africa, Asia and South America. In all cases examined, the best or equal best fitting model was the Fox type, explaining up to 90% of the variation in CPUA. For lake and reservoir fisheries in Africa and Asia, the Schaefer and an asymptotic model fitted equally well. The Fox model estimates of fisher density (fishers km−2) at maximum yield (iMY) for floodplain-rivers, African lakes and reservoirs and reef-based fisheries are 13.7 (95% CI [11.8, 16.4]); 27.8 (95% CI [17.5, 66.7]) and 643 (95% CI [459,1075]), respectively and compare well with earlier estimates. Corresponding estimates of maximum yield are also given. The significantly higher value of iMY for reef-based fisheries compared to estimates for rivers and lakes reflects the use of a different measure of fisher density based upon human population size estimates. The models predict that maximum yield is achieved at a higher fishing intensity in Asian lakes compared to those in Africa. This may reflect the common practice in Asia of stocking lakes to augment natural recruitment. Because of the equilibrium assumptions underlying the models, all the estimates of maximum yield and corresponding levels of effort should be treated with caution.