Variación de volumen sistólico como predictor de hipovolemia en pacientes pediátricos con choque séptico

El compromiso del sistema cardiovascular es frecuente en los pacientes en estado crítico, por tanto la monitorización hemodinámica es esencial para un tratamiento apropiado dirigido a objetivos terapéuticos en este grupo de pacientes. La monitorización hemodinámica del gasto cardíaco y la estimación del volumen intravascular son fundamentales para el manejo de los pacientes pediátricos en estado crítico, la medición del gasto cardíaco es uno de los principales elementos para evaluar la situación hemodinámica y la perfusión tisular de un paciente ayudando a dirigir el tratamiento y a monitorizar la respuesta clínica en pacientes con choque séptico. La hipovolemia es una causa común para la falla circulatoria en pacientes en condición crítica, el encontrar un método confiable para medición de precarga es importante para guiar la administración de líquidos. Tradicionalmente se han utilizado medidas de la volemia asociadas como la presión venosa central (PVC), frecuencia cardiaca (FC), presión arterial (PA) y el gasto urinario. Estos indicadores tienen grandes factores de distracción que hacen que su valor sea limitado y por tanto se tengan que buscar alternativas más confiables. En años recientes se han postulado parámetros dinámicos para la evaluación de la precarga, entre ellos uno de los mas ampliamente estudiado es la medición de la variabilidad de Volumen sistólico (VVS); Este valor se basa en el concepto de que durante la inspiración, la disminución del retorno venoso produce una disminución del Volumen sistólico, lo cual se manifiesta como una disminución en la onda de pulso; Por tanto en una situación de hipovolemia esta diferencia será mayor, dado que será más evidente la disminución del volumen al final de la diástole. En adultos este parámetro se ha convertido en una herramienta útil para evaluar estado de volumen de los pacientes que se encuentran en estado crítico y ha demostrado su utilidad para predecir respuesta a administración de fluidos en diferentes poblaciones de pacientes. En la actualidad no hay estudios en niños que comparen la medición de VVS contra dichas medidas tradicionales de volemia.

Diferencia venoarterial de Pco2 como predictor de disfunción miocárdica en niños con sepsis severa y choque séptico.

Introducción: La sepsis es una de las principales causas de morbilidad y mortalidad en la población pediátrica a nivel mundial, siendo la disminución del gasto cardiaco uno de los principales factores asociados a mortalidad. Se ha planteado la diferencia venoarterial de pCO2 como predictor de la función miocárdica en pacientes con sepsis, sin embargo hasta el momento no hay estudios en la población pediátrica que lo evalúen. Objetivo: Determinar la capacidad predictora y las características operativas de la diferencia venoarterial de pCO2, como predictor de disfunción miocárdica en pacientes pediátricos con sepsis severa y choque séptico. Métodos: Para alcanzar los objetivos del estudio, se llevo a cabo un estudio prospectivo de pruebas diagnósticas. Se realizó ecocardiograma y diferencia venoarterial de pCO2 en cada paciente, posteriormente se calculó las características operativas de la diferencia venoarterial de pCO2 para determinar su utilidad. Resultados: Se incluyeron 71 pacientes. La mediana de la diferencia venoarterial de pCO2 no fue significativamente mayor en los pacientes que tuvieron disfunción cardiaca en el ecocardiograma en comparación con los que no tuvieron disfunción. Se encontró una relación estadísticamente significativa de valores de 1,5 a 2,1 mmHg, como predictor negativo de disfunción miocárdica con una sensibilidad de 100% y una especificidad de 88%. Conclusiones: La diferencia venoarterial de pCO2 requiere de estudios mas extensos para determinar la probabilidad como predictor de disfunción miocárdica en pacientes pediátricos con sepsis severa y choque séptico, incluso cuando otros biomarcadores se encuentran dentro de límites normales.

Developing a desertification indicator system for a small Mediterranean catchment: a case study from the Serra de Rodes, Alt Empordà, Catalunya, NE Spain

La desertificació és un problema de degradació de sòls de gran importància en regions àrides, semi-àrides i sub-humides, amb serioses conseqüències ambientals, socials i econòmiques com a resultat de l'impacte d'activitats humanes en combinació amb condicions físiques i medi ambientals desfavorables (UNEP, 1994). L'objectiu principal d'aquesta tesi va ser el desenvolupament d'una metodologia simple per tal de poder avaluar de forma precisa l'estat i l'evolució de la desertificació a escala local, a través de la creació d'un model anomenat sistema d'indicators de desertificació (DIS). En aquest mateix context, un dels dos objectius específics d'aquesta recerca es va centrar en l'estudi dels factors més importants de degradació de sòls a escala de parcel.la, comportant un extens treball de camp, analisi de laboratori i la corresponent interpretació i discussió dels resultats obtinguts. El segon objectiu específic es va basar en el desenvolupament i aplicació del DIS. L'àrea d'estudi seleccionada va ser la conca de la Serra de Rodes, un ambient típic Mediterràni inclòs en el Parc Natural del Cap de Creus, NE Espanya, el qual ha estat progressivament abandonat pels agricultors durant el segle passat. Actualment, els incendis forestals així com el canvi d'ús del sòl i especialment l'abandonament de terres són considerats els problemes ambientals més importants a l'àrea d'estudi (Dunjó et al., 2003). En primer lloc, es va realitzar l'estudi dels processos i causes de la degradació dels sòls a l'àrea d'interés. En base a aquest coneixement, es va dur a terme la identificació i selecció dels indicadors de desertificació més rellevants. Finalment, els indicadors de desertificació seleccionats a escala de conca, incloent l'erosió del sòl i l'escolament superficial, es van integrar en un model espaial de procés. Ja que el sòl és considerat el principal indicador dels processos d'erosió, segons la FAO/UNEP/UNESCO (1979), tant el paisatge original així com els dos escenaris d'ús del sòl desenvolupats, un centrat en el cas hipotétic del pas d'un incendi forestal, i l'altre un paisatge completament cultivat, poden ser ambients classificats sota baixa o moderada degradació. En comparació amb l'escenari original, els dos escenaris creats van revelar uns valors més elevats d'erosió i escolament superficial, i en particular l'escenari cultivat. Per tant, aquests dos hipotètic escenaris no semblen ser una alternativa sostenible vàlida als processos de degradació que es donen a l'àrea d'estudi. No obstant, un ampli ventall d'escenaris alternatius poden ser desenvolupats amb el DIS, tinguent en compte les polítiques d'especial interés per la regió de manera que puguin contribuir a determinar les conseqüències potencials de desertificació derivades d'aquestes polítiques aplicades en aquest escenari tan complexe espaialment. En conclusió, el model desenvolupat sembla ser un sistema força acurat per la identificació de riscs presents i futurs, així com per programar efectivament mesures per combatre la desertificació a escala de conca. No obstant, aquesta primera versió del model presenta varies limitacions i la necessitat de realitzar més recerca en cas de voler desenvolupar una versió futura i millor del DIS.

The stapedial reflex as an early indicator of cis-platinum ototoxicity

This paper discusses a study to determine whether changes in stapedial reflex thresholds can be utilized as an early indicator of cochlear damage with ongoing cid-platinum therapy.

The construction of a thyratron inflection indicator, its behaviour with certain vowels, and its use in instructing deaf children

This paper discusses the construction of an apparatus, Thyratron Inflection Indicator, to help hearing impaired children learn speech.

The analysis of ranked observations of soil structure using indicator geostatistics

Structure is an important physical feature of the soil that is associated with water movement, the soil atmosphere, microorganism activity and nutrient uptake. A soil without any obvious organisation of its components is known as apedal and this state can have marked effects on several soil processes. Accurate maps of topsoil and subsoil structure are desirable for a wide range of models that aim to predict erosion, solute transport, or flow of water through the soil. Also such maps would be useful to precision farmers when deciding how to apply nutrients and pesticides in a site-specific way, and to target subsoiling and soil structure stabilization procedures. Typically, soil structure is inferred from bulk density or penetrometer resistance measurements and more recently from soil resistivity and conductivity surveys. To measure the former is both time-consuming and costly, whereas observations made by the latter methods can be made automatically and swiftly using a vehicle-mounted penetrometer or resistivity and conductivity sensors. The results of each of these methods, however, are affected by other soil properties, in particular moisture content at the time of sampling, texture, and the presence of stones. Traditional methods of observing soil structure identify the type of ped and its degree of development. Methods of ranking such observations from good to poor for different soil textures have been developed. Indicator variograms can be computed for each category or rank of structure and these can be summed to give the sum of indicator variograms (SIV). Observations of the topsoil and subsoil structure were made at four field sites where the soil had developed on different parent materials. The observations were ranked by four methods and indicator and the sum of indicator variograms were computed and modelled for each method of ranking. The individual indicators were then kriged with the parameters of the appropriate indicator variogram model to map the probability of encountering soil with the structure represented by that indicator. The model parameters of the SIVs for each ranking system were used with the data to krige the soil structure classes, and the results are compared with those for the individual indicators. The relations between maps of soil structure and selected wavebands from aerial photographs are examined as basis for planning surveys of soil structure. (C) 2007 Elsevier B.V. All rights reserved.

Localization of eIF4A-III in the nucleolus and splicing speckles is an indicator of plant stress

The mechanisms of long-term adaptation to low oxygen environment are quite well studied, but little is known about the sensing of oxygen shortage, the signal transduction and the short-term effects of hypoxia in plant cells. We have found that an RNA helicase eIF4A-III, a putative component of the Exon Junction Complex, rapidly changes its pattern of localisation in the plant nucleus under hypoxic conditions. In normal cell growth conditions GFP- eIF4A-III was mainly nucleoplasmic, but in hypoxia stress conditions it moved to the nucleolus and splicing speckles. This transition occurred within 15-20 min in Arabidopsis culture cells and seedling root cells, but took more than 2 h in tobacco BY-2 culture cells. Inhibition of respiration, transcription or phosphorylation in cells and ethanol treatment had similar effects to hypoxia. The most likely consequence is that a certain mRNA population will remain bound to the eIF4A-III and other mRNA processing proteins, rather than being transported from the nucleus to the cytoplasm, and thus its translation will be suspended.

Characteristics and variability of storm tracks in the north Pacific, Bering Sea, and Alaska

The North Pacific and Bering Sea regions represent loci of cyclogenesis and storm track activity. In this paper climatological properties of extratropical storms in the North Pacific/Bering Sea are presented based upon aggregate statistics of individual storm tracks calculated by means of a feature-tracking algorithm run using NCEP–NCAR reanalysis data from 1948/49 to 2008, provided by the NOAA/Earth System Research Laboratory and the Cooperative Institute for Research in Environmental Sciences, Climate Diagnostics Center. Storm identification is based on the 850-hPa relative vorticity field (ζ) instead of the often-used mean sea level pressure; ζ is a prognostic field, a good indicator of synoptic-scale dynamics, and is directly related to the wind speed. Emphasis extends beyond winter to provide detailed consideration of all seasons. Results show that the interseasonal variability is not as large during the spring and autumn seasons. Most of the storm variables—genesis, intensity, track density—exhibited a maxima pattern that was oriented along a zonal axis. From season to season this axis underwent a north–south shift and, in some cases, a rotation to the northeast. This was determined to be a result of zonal heating variations and midtropospheric moisture patterns. Barotropic processes have an influence in shaping the downstream end of storm tracks and, together with the blocking influence of the coastal orography of northwest North America, result in high lysis concentrations, effectively making the Gulf of Alaska the “graveyard” of Pacific storms. Summer storms tended to be longest in duration. Temporal trends tended to be weak over the study area. SST did not emerge as a major cyclogenesis control in the Gulf of Alaska.

GISQ, a multifunctional indicator of soil quality

We present here an indicator of soil quality that evaluates soil ecosystem services through a set of 5 subindicators, and further combines them into a single general Indicator of Soil Quality (GISQ). We used information derived from 54 properties commonly used to describe the multifaceted aspects of soil quality. The design and calculation of the indicators were based on sequences of multivariate analyses. Subindicators evaluated the physical quality, chemical fertility, organic matter stocks, aggregation and morphology of the upper 5 cm of soil and the biodiversity of soil macrofauna. A GISQ combined the different subindicators providing a global assessment of soil quality. Research was conducted in two hillside regions of Colombia and Nicaragua, with similar types of land use and socio-economic context. However, soil and climatic conditions differed significantly. In Nicaragua, soil quality was assessed at 61 points regularly distributed 200 m apart on a regular grid across the landscape. In Colombia, 8 plots representing different types of land use were arbitrarily chosen in the landscape and intensively sampled. Indicators that were designed in the Nicaragua site were further applied to the Colombian site to test for their applicability. In Nicaragua, coffee plantations, fallows, pastures and forest had the highest values of GISQ (1.00; 0.80; 0.78 and 0.77, respectively) while maize crops and eroded soils (0.19 and 0.10) had the lowest values. Examination of subindicator values allowed the separate evaluation of different aspects of soil quality: subindicators of organic matter, aggregation and morphology and biodiversity of macrofauna had the maximum values in coffee plantations (0.89; 0.72 and 0.56, respectively on average) while eroded soils had the lowest values for these indicators (0.10; 0.31 and 0.33, respectively). Indicator formulae derived from information gained at the Nicaraguan sites were not applicable to the Colombian situation and site-specific constants were calculated. This indicator allows the evaluation of soil quality and facilitates the identification of problem areas through the individual values of each subindicator. It allows monitoring of change through time and can guide the implementation of soil restoration technologies. Although GISQ formulae computed on a set of data were only valid at a regional scale, the methodology used to create these indices can be applied everywhere.

The air distribution index as an indicator for energy consumption and performance of ventilation systems

This paper deals with the energy consumption and the evaluation of the performance of air supply systems for a ventilated room involving high- and low-level supplies. The energy performance assessment is based on the airflow rate, which is related to the fan power consumption by achieving the same environmental quality performance for each case. Four different ventilation systems are considered: wall displacement ventilation, confluent jets ventilation, impinging jet ventilation and a high level mixing ventilation system. The ventilation performance of these systems will be examined by means of achieving the same Air Distribution Index (ADI) for different cases. The widely used high-level supplies require much more fan power than those for low-level supplies for achieving the same value of ADI. In addition, the supply velocity, hence the supply dynamic pressure, for a high-level supply is much larger than for low-level supplies. This further increases the power consumption for high-level supply systems. The paper considers these factors and attempts to provide some guidelines on the difference in the energy consumption associated with high and low level air supply systems. This will be useful information for designers and to the authors' knowledge there is a lack of information available in the literature on this area of room air distribution. The energy performance of the above-mentioned ventilation systems has been evaluated on the basis of the fan power consumed which is related to the airflow rate required to provide equivalent indoor environment. The Air Distribution Index (ADI) is used to evaluate the indoor environment produced in the room by the ventilation strategy being used. The results reveal that mixing ventilation requires the highest fan power and the confluent jets ventilation needs the lowest fan power in order to achieve nearly the same value of ADI.

Considering the normative, systemic and procedural dimensions in indicator-based sustainability assessments in agriculture

This paper develops a framework for evaluating sustainability assessment methods by separately analyzing their normative, systemic and procedural dimensions as suggested by Wiek and Binder [Wiek, A, Binder, C. Solution spaces for decision-making – a sustainability assessment tool for city-regions. Environ Impact Asses Rev 2005, 25: 589-608.]. The framework is then used to characterize indicator-based sustainability assessment methods in agriculture. For a long time, sustainability assessment in agriculture has focused mostly on environmental and technical issues, thus neglecting the economic and, above all, the social aspects of sustainability, the multifunctionality of agriculture and the applicability of the results. In response to these shortcomings, several integrative sustainability assessment methods have been developed for the agricultural sector. This paper reviews seven of these that represent the diversity of tools developed in this area. The reviewed assessment methods can be categorized into three types: (i) top-down farm assessment methods; (ii) top-down regional assessment methods with some stakeholder participation; (iii) bottom-up, integrated participatory or transdisciplinary methods with stakeholder participation throughout the process. The results readily show the trade-offs encountered when selecting an assessment method. A clear, standardized, top-down procedure allows for potentially benchmarking and comparing results across regions and sites. However, this comes at the cost of system specificity. As the top-down methods often have low stakeholder involvement, the application and implementation of the results might be difficult. Our analysis suggests that to include the aspects mentioned above in agricultural sustainability assessment, the bottomup, integrated participatory or transdisciplinary methods are the most suitable ones.

Normative, systemic and procedural aspects: a review of indicator‐based sustainability assessments in agriculture

Several methods for assessing the sustainability of agricultural systems have been developed. These methods do not fully: (i) take into account the multi‐functionality of agriculture; (ii) include multidimensionality; (iii) utilize and implement the assessment knowledge; and (iv) identify conflicting goals and trade‐offs. This paper reviews seven recently developed multidisciplinary indicator‐based assessment methods with respect to their contribution to these shortcomings. All approaches include (1) normative aspects such as goal setting, (2) systemic aspects such as a specification of scale of analysis, (3) a reproducible structure of the approach. The approaches can be categorized into three typologies. The top‐down farm assessments focus on field or farm assessment. They have a clear procedure for measuring the indicators and assessing the sustainability of the system, which allows for benchmarking across farms. The degree of participation is low, potentially affecting the implementation of the results negatively. The top‐down regional assessment assesses the on‐farm and the regional effects. They include some participation to increase acceptance of the results. However, they miss the analysis of potential trade‐offs. The bottom‐up, integrated participatory or transdisciplinary approaches focus on a regional scale. Stakeholders are included throughout the whole process assuring the acceptance of the results and increasing the probability of implementation of developed measures. As they include the interaction between the indicators in their system representation, they allow for performing a trade‐off analysis. The bottom‐up, integrated participatory or transdisciplinary approaches seem to better overcome the four shortcomings mentioned above.