Pulsioximetría de pacientes en hemodiálisis, de la unidad de terapia renal – fundación cardioinfantil, análisis para establecer recomendaciones

Introducción. En Colombia, el 80% de los pacientes con enfermedad renal crónica en hemodiálisis tienen fístula arteriovenosa periférica (FAV) que asegura el flujo de sangre durante la hemodiálisis (1), la variabilidad en el flujo de sangre en el brazo de la FAV hacia la parte distal, puede afectar la lectura de la oximetría de pulso (SpO2) (2), llevando a la toma de decisiones equivocadas por el personal de salud. El objetivo de este estudio es aclarar si existe diferencia entre la SpO2 del brazo de la FAV y el brazo contralateral. Materiales y métodos. Se realizó un estudio de correlación entre los valores de SpO2 del brazo con FAV contra el brazo sin FAV, de 40 pacientes que asistieron a hemodiálisis. La recolección de los datos se llevó a cabo, con un formato que incluyó el resultado de la pulsioximetria y variables asociadas, antes, durante y después de la hemodiálisis. Se comparó la mediana de los deltas de las diferencias con pruebas estadísticas T Student – Mann Whitney, aceptando un valor significativo de p < 0,05. Resultados. No se encontraron diferencias estadísticamente significativas de la SpO2 entre el brazo con FAV y el brazo sin FAV, antes, durante y después de la diálisis, sin embargo si se apreció una correlación positiva estadísticamente significativa. Conclusiones. Se encontró correlación positiva estadísticamente significativa, donde no hubo diferencias en el resultado la pulsioximetría entre el brazo con FAV y brazo sin FAV, por lo tanto es válido tomar la pulsioximetría en cualquiera de los brazos.

Panorama de la música a Mallorca des del final del segle XIX fins al XXI.

Aquest article pretén mostrar d’una manera general la situació musical a la Mallorca de final del segle XIX i durant el segle XX. Analitzarem, de manera general, el panorama de la música a Mallorca en els diversos aspectes: agrupacions musicals, músics i compositors, l’educació musical… i tendrem una visió de la situació musical en què es trobava Mallorca en aquest període analitzat, perquè serveixi de pauta en els diversos treballs de recerca que a partir d’aquest estudi puguin sorgir. No pretenem fer-ne una anàlisi exhaustiva, això ho deixam per a futures investigacions, sinó donar a conèixer la situació musical a Mallorca abans esmentada.

Building the Directorate General for Urban Affairs in European Union. A proposal for the European Commission

The present documents get together reflection elements that allow sustaining the irreversibility of the process that leads to the creation of a Directorate General for Urban AffairsThe irreversibility of this process results of the assumed necessity to implement the cooperation between Member-States in respect to the urban and territorial development policy. It is time, with vision, to assume the urgency to create, as well, in this area an European joint policy and which are the necessary structures for its definition and implementation within the EU framework. O Directorate General for Urban Affairs deverá articular-se em particular com o Comité Económico e Social e com o Comité das RegiõesThe present text is based essentially on political documents on urban and territorial affairs elaborated in the extent of the EU and in the general guideline documents produced by the EU, which favor social, economic and territorial integration.

A gestão do risco nas empresas : comparação das práticas de gestão do risco, no setor da construção em Portugal e no Reino Unido

O risco faz parte do dia a dia das organizações e atualmente mais do que nunca deve ser gerido de uma forma consciente. As organizações como forma de transparência na divulgação da informação para os investidores e outras partes interessadas, devem expor as suas políticas de risco e a forma como pretendem alcançar os objetivos que se propõem numa ótica de continuidade e sustentabilidade. Os mercados globais com grande complexidade e forte concorrência levam a que as empresas se afirmem pela sua capacidade de organização. No setor da construção a dispersão geográfica das obras e a correspondente dispersão dos ativos de produção, os concursos públicos e a apresentação de preço assumem especial relevância em termos de análise de risco. Atualmente na matéria da gestão do risco existem várias recomendações ao nível do governo das sociedades e vários modelos que servem de guião para as empresas implementarem na sua gestão do risco. A estrutura conceptual mais atual e considerada o ‘state of the art’ na matéria de gestão do risco é a ISO 31000 Risk management – Principles and Guidelines. Esta norma pretende definir princípios que permitam a cada organização desenvolver um modelo feito à medida, ajustado aos seus processos e alinhado com a sua estratégia.

Educação como política social de prevenção ao cometimento de crimes dolosos contra a vida e reincidência criminal

Esta dissertação teve como diretriz principal percecionar até que ponto a educação se torna eficaz como política pública capaz de ajudar a enfrentar a criminalidade. Tal enfrentamento ocorre por dois vieses distintos; O primeiro tem caráter mais preventivo, de modo que a educação tem sua atuação voltada à prevenção da criminalidade; enquanto o segundo viés consiste em prevenir a reincidência criminal com a aplicação de políticas educativas a apenados. Neste trabalho de investigação realizou-se uma breve revisão bibliográfica, abrangendo alguns autores teóricos que enfatizaram como se dá o processo de aquisição e desenvolvimento do conhecimento no indivíduo, dentre os quais constam: Descartes, Rousseau, Kant, além de Piaget e Vygotsky. A pesquisa consistiu em levantamento nos processos julgados pela comarca de João Pessoa do Tribunal do Júri no ano de 2011, a fim de verificar o grau de escolaridade dos réus, bem como no Estabelecimento Prisional, com vistas a levantamentos sobre a reincidência criminal. Os resultados da pesquisa demonstraram que é latente a eficácia da educação como política pública de combate a criminalidade. Foi apurada também, a enorme economia financeira que produziria uma maior concentração de investimentos educativos em detrimento de investimentos em segurança pública.

Potassium leaching in undisturbed soil cores following surface applications of gypsum

Displacement studies on leaching of potassium (K+) were conducted under unsaturated steady state flow conditions in nine undisturbed soil columns (15.5 cm in diameter and 25 cm long). Pulses of K+ applied to columns of undisturbed soil were leached with distilled water or calcium chloride (CaCl2) at a rate of 18 mm h(-1). The movement of K+ in gypsum treated soil leached with distilled water was at a similar rate to that of the untreated soil leached with 15 mM CaCl2. The Ca2+ concentrations in the leachates were about 15 mM, the expected values for the dissolution of the gypsum. When applied K+ was displaced with the distilled water, K+ was retained in the top 10-12.5 cm depth of soil. In the undisturbed soil cores there is possibility of preferential flow and lack of K+ sorption. The application of gypsum and CaCl2 in the reclamation of sodic soils would be expected to leach K+ from soils. It can also be concluded that the use of sources of water for irrigation which have a high Ca2+ concentration can also lead to leaching of K+ from soil. Average effluent concentration of K+ during leaching period was 30.2 and 28.6 mg l(-1) for the gypsum and CaCl2 treated soils, respectively. These concentrations are greater than the recommended guideline of the World Health Organisation (12 mg K+ l(-1)).

Discarding Like Pieces

The guideline of ‘discarding like men’ to estimate the merit of a chess position is well known. This note compares it with some statistics.

Provision of information about drug side-effects to patients

To make informed decisions about taking medicinal drugs, people need accurate information about side-effects. A European Union guideline now recommends use of qualitative descriptions for five bands of risk, ranging from very rare (affecting < 0·01% of the population), to very common (>10%). We did four studies of more than 750 people, whom we asked to estimate the probability of having a side-effect on the basis of qualitative and quantitative descriptions. Our results showed that qualitative descriptions led to gross overestimation of risk. Until further work is done on how patients taking the drugs interpret these terms, the terms should not be used in drug information leaflets.

Is 15 per cent very common? Informing people about the risks of medication side effects

Objectives - To assess the general public's interpretation of the verbal descriptors for side effect frequency recommended for use in medicine information leaflets by a European Union (EU) guideline, and to examine the extent to which differences in interpretation affect people's perception of risk and their judgments of intention to comply with the prescribed treatment. Method - Two studies used a controlled empirical methodology in which people were presented with a hypothetical, but realistic, scenario about visiting their general practitioner and being prescribed medication. They were given an explanation that focused on the side effects of the medicine, together with information about the probability of occurrence using either numerical percentages or the corresponding EU verbal descriptors. Interpretation of the descriptors was assessed. In study 2, participants were also required to make various judgments, including risk to health and intention to comply. Key findings - In both studies, use of the EU recommended descriptors led to significant overestimations of the likelihood of particular side effects occurring. Study 2 further showed that the "overestimation" resulted in significantly increased ratings of perceived severity of side effects and risk to health, as well as significantly reduced ratings of intention to comply, compared with those for people who received the probability information in numerical form. Conclusion - While it is recognised that the current findings require replication in a clinical setting, the European and national authorities should suspend the use of the EU recommended terms until further research is available to allow the use of an evidence-based approach.

An assessment of the fine sediment dynamics in an upland river system: INCA-Sed modifications and implications for fisheries

There is a need for better links between hydrology and ecology, specifically between landscapes and riverscapes to understand how processes and factors controlling the transport and storage of environmental pollution have affected or will affect the freshwater biota. Here we show how the INCA modelling framework, specifically INCA-Sed (the Integrated Catchments model for Sediments) can be used to link sediment delivery from the landscape to sediment changes in-stream. INCA-Sed is a dynamic, process-based, daily time step model. The first complete description of the equations used in the INCA-Sed software (version 1.9.11) is presented. This is followed by an application of INCA-Sed made to the River Lugg (1077 km2) in Wales. Excess suspended sediment can negatively affect salmonid health. The Lugg has a large and potentially threatened population of both Atlantic salmon (Salmo salar) and Brown Trout (Salmo trutta). With the exception of the extreme sediment transport processes, the model satisfactorily simulated both the hydrology and the sediment dynamics in the catchment. Model results indicate that diffuse soil loss is the most important sediment generation process in the catchment. In the River Lugg, the mean annual Guideline Standard for suspended sediment concentration, proposed by UKTAG, of 25 mg l− 1 is only slightly exceeded during the simulation period (1995–2000), indicating only minimal effect on the Atlantic salmon population. However, the daily time step simulation of INCA-Sed also allows the investigation of the critical spawning period. It shows that the sediment may have a significant negative effect on the fish population in years with high sediment runoff. It is proposed that the fine settled particles probably do not affect the salmonid egg incubation process, though suspended particles may damage the gills of fish and make the area unfavourable for spawning if the conditions do not improve.

Opportunities for reduction in acute toxicity testing via improved design

The conventional method for assessing acute oral toxicity (OECD Test Guideline 401) was designed to identify the median lethal dose (LD50), using the death of animals as an endpoint. Introduced as an alternative method (OECD Test Guideline 420), the Fixed Dose Procedure (FDP) relies on the observation of clear signs of toxicity, uses fewer animals and causes less suffering. More recently, the Acute Toxic Class method and the Up-and-Down Procedure have also been adopted as OECD test guidelines. Both of these methods also use fewer animals than the conventional method, although they still use death as an endpoint. Each of the three new methods incorporates a sequential dosing procedure, which results in increased efficiency. In 1999, with a view to replacing OECD Test Guideline 401, the OECD requested that the three new test guidelines be updated. This was to bring them in line with the regulatory needs of all OECD Member Countries, provide further reductions in the number of animals used, and introduce refinements to reduce the pain and distress experienced by the animals. This paper describes a statistical modelling approach for the evaluation of acute oral toxicity tests, by using the revised FDP for illustration. Opportunities for further design improvements are discussed.

Statistical evaluation of an acute dermal toxicity test using the dermal fixed dose procedure

The conventional method for the assessment of acute dermal toxicity (OECD Test Guideline 402, 1987) uses death of animals as an endpoint to identify the median lethal dose (LD50). A new OECD Testing Guideline called the dermal fixed dose procedure (dermal FDP) is being prepared to provide an alternative to Test Guideline 402. In contrast to Test Guideline 402, the dermal FDP does not provide a point estimate of the LD50, but aims to identify that dose of the substance under investigation that causes clear signs of nonlethal toxicity. This is then used to assign classification according to the new Globally Harmonised System of Classification and Labelling scheme (GHS). The dermal FDP has been validated using statistical modelling rather than by in vivo testing. The statistical modelling approach enables calculation of the probability of each GHS classification and the expected numbers of deaths and animals used in the test for imaginary substances with a range of LD50 values and dose-response curve slopes. This paper describes the dermal FDP and reports the results from the statistical evaluation. It is shown that the procedure will be completed with considerably less death and suffering than guideline 402, and will classify substances either in the same or a more stringent GHS class than that assigned on the basis of the LD50 value.

Statistical evaluation of the fixed concentration procedure for acute inhalation toxicity assessment

The conventional method for the assessment of acute inhalation toxicity (OECD Test Guideline 403, 1981) uses death of animals as an endpoint to identify the median lethal concentration (LC50). A new OECD Testing Guideline called the Fixed Concentration Procedure (FCP) is being prepared to provide an alternative to Test Guideline 403. Unlike Test Guideline 403, the FCP does not provide a point estimate of the LC50, but aims to identify an airborne exposure level that causes clear signs of nonlethal toxicity. This is then used to assign classification according to the new Globally Harmonized System of Classification and Labelling scheme (GHS). The FCP has been validated using statistical simulation rather than byin vivo testing. The statistical simulation approach predicts the GHS classification outcome and the numbers of deaths and animals used in the test for imaginary substances with a range of LC50 values and dose response curve slopes. This paper describes the FCP and reports the results from the statistical simulation study assessing its properties. It is shown that the procedure will be completed with considerably less death and suffering than Test Guideline 403, and will classify substances either in the same or a more stringent GHS class than that assigned on the basis of the LC50 value.

A statistical evaluation of the fixed dose procedure

The fixed-dose procedure (FDP) was introduced as OECD Test Guideline 420 in 1992, as an alternative to the conventional median lethal dose (LD50) test for the assessment of acute oral toxicity (OECD Test Guideline 401). The FDP uses fewer animals and causes less suffering than the conventional test, while providing information on the acute toxicity to allow substances to be ranked according to the EU hazard classification system. Recently the FDP has been revised, with the aim of providing further reductions and refinements, and classification according to the criteria of the Globally Harmonized Hazard Classification and Labelling scheme (GHS). This paper describes the revised FDP and analyses its properties, as determined by a statistical modelling approach. The analysis shows that the revised FDP classifies substances for acute oral toxicity generally in the same, or a more stringent, hazard class as that based on the LD50 value, according to either the GHS or the EU classification scheme. The likelihood of achieving the same classification is greatest for substances with a steep dose-response curve and median toxic dose (TD50) close to the LD50. The revised FDP usually requires five or six animals with two or fewer dying as a result of treatment in most cases.

Assessing the natural ventilation cooling potential of office buildings in different climate zones in China

This paper presents an investigation of the natural ventilation cooling potential (NVCP) of office buildings in the five generally recognised climate zones in China using the Thermal Resistance Ventilation (TRV) model, which is a simplified, coupled, thermal and airflow model. The acceptable operative temperature for naturally conditioned space supplied by the ASHARE Standard 55-2004 has been used for the comfort temperature setting. Dynamic simulations for a typical office room in the five representative cities, which are Harbin, Beijing, Shanghai, Kunming and Guangzhou, have been carried out. The study demonstrates that the NVCP depends on the multiple impacts of climate, the building's thermal characteristics, internal gains, ventilation profiles and regimes. The work shows how the simplified method can be used to generate detailed, indoor, operative temperature data based on the various building conditions and control profiles which are used to investigate the NVCP at the strategic design stage. The simulation results presented in this paper can be used as a reference guideline for natural ventilation design in China.