Is it really worth the effort to renounce to 5 mm trocars?

Objective: Single port laparoscopy andNOTES aim at decreasing the number¦of trocars, at a price of increased technical difficulty and cost, without until now¦any proof of benefit for the patient.Morbidity related to 5 mm trocar sites (TS)¦is claimed to be low, but there are no good quality data on this topic. The aim¦of the present prospective study is to measure the morbidity and overall specific¦impact related to the 5 mm TS and compare them to larger TS.¦Methods:Wecollected prospectively data on 300 consecutive patients operated¦by laparoscopy in our institution between 2009 and 2010. Pain, morbidity,¦cosmetic, and overall patient discomfort were assessed specifically for each¦TS, using standardized questionnaires, at 3 time points: at discharge from¦the hospital, at 1 month and at 6 months after surgery. Results were compared¦between 5 mmand larger TS (10 mm, 12 mmand 15 mm).Trocar sites replaced¦by a minilaparotomy or a stoma were excluded from analysis. In this study we¦present the short-term results.¦Results: Three-hundred patients (mean age 47·5, women 55%) were operated¦with 1074 TS of which 477(44%) were 5 mm TS. Indication to laparoscopy was¦cholecystectomy (31·3%), appendectomy (26·6%), upper GI surgery (16·3%),¦colon resection (13·3%) or other (12·3%). Follow-up at 1 month was completed¦in 90%.¦The 5 mm TS had an infection rate of 0·2%, and a hematoma rate of 1·7%.¦VAS pain scores at the 5mm TS were ≤3 in 91·6% at rest and in 75·9% upon¦effort at discharge, and in 97% at 1 month. Median patient scar assessment¦score (PSAS) of the 5 mm TS at 1 month was 6 (IQR: 2-9) out of 60 (0 =¦best score). Overall discomfort of the 5 mm TS in a VAS scale was 0 in 77%¦and ≤3 in 95% of patients at 1 month. Morbidity, pain assessments, PSAS, and¦overall discomfort scores were all significantly better for 5 mm TS compared to¦larger TS.¦Conclusion: Morbidity, pain, cosmetic impact and overall patient's discomfort¦related to a 5 mm trocar site is extremely low. For this reason, any potential¦advantage related to omitting 5 mm trocars to perform the same type of surgery¦will be difficult to demonstrate.

Asociaciones de peces demersales en el norte del mar peruano durante el verano 2001

Analiza las asociaciones de peces demersales frente a la costa norte del Perú mediante las técnicas estadísticas multivariadas de clasificación de dos vías y de ordenamiento.

Efectos del tamaño de anzuelo sobre capturas y tallas del perico Coryphaena hippurus

Se evidenció alta selección interespecífica del espinel superficial experimental, al capturar 130 ejemplares de perico Coryphaena hippurus (87,8%) del total de 148 especímenes que incluyeron 8 especies entre peces, tortugas y cefalópodos; como pesca incidental se registró 1 enganche por lance de tortugas (verde Chelonia mydas y amarilla Caretta caretta). El anzuelo más eficiente para la captura de esta especie, fue el de menor calibre (Nº 6) que capturó 24,6%, el menos eficiente fue el Nº 5 (16,9%); sin embargo, mediante el ANOVA de dos vías se estableció que no existía efecto del tamaño de anzuelo sobre el número de ejemplares capturados (p= 0,963). Los anzuelos no evidenciaron una selección de tallas, al no establecerse diferencias significativas entre distribución de tallas (p= 0,538), excepto para los anzuelos Nº 2 y 6 (p= 0,084), al identificarse diferencia por efecto del tamaño de anzuelo. Las longitudes medias estimadas fueron 119,7 cm, 116,8 cm, 118,3 cm, 115,0 cm y 113,7 cm, para los anzuelos Nº 2, 3, 4, 5 y 6, respectivamente. El tamaño de anzuelo mostró un fuerte efecto sobre el tipo de enganche (p= 0,002), presentándose con mayor frecuencia los enganches en la agalla (53,1%) y boca (44,6%). Generalmente los enganches en la agalla son ocasionados por los anzuelos grandes (Nº 2 y 3), mientras que los de boca son realizados por los anzuelos más pequeños (Nº 5 y 6). La captura por unidad de esfuerzo (CPUE) global del longline experimental fue 1,2 ejemplares de perico para un esfuerzo de 1000 anzuelos por hora, lo que representa la tercera parte de la CPUE estimada para la flota comercial.

Equipamento para extração de amostras indeformadas de solo

O presente trabalho teve como objetivo desenvolver um equipamento para coletar amostras indeformadas de solo de 75 mm de diâmetro a uma profundidade de até 0,60 m, bem como avaliar a qualidade das amostras retiradas. O amostrador foi constituído por um tubo de PVC, acondicionado dentro de um tubo cravador de alumínio equipado com uma ponteira de aço, formando um conjunto sem movimento rotativo. Envolveu este conjunto uma rosca-sem-fim, equipada com três lâminas de corte na sua extremidade. O conjunto foi adaptado a um veículo especificamente projetado para o tráfego no campo (VAS - Veículo Amostrador de Solo). As amostras obtidas pelo VAS foram comparadas com as testemunhas, obtidas pelo método do bloco da parafina, por meio de testes laboratoriais, para verificar a ocorrência de alterações estruturais. Os testes foram: inspeção visual, densidade do solo, ensaio de compressão triaxial rápido e ensaio de adensamento. As amostras obtidas pelo VAS em solo argiloso (Latossolo Roxo) apresentaram confiabiliade (95%) dos valores de densidade do solo, características de resistência à compressão e adensamento iguais à testemunha. O equipamento mostrou-se prático, versátil e adequado para retirar amostras de solos argilosos, sendo a qualidade das amostras semelhante à obtida pelos métodos tradicionais de extração do anel volumétrico e de bloco de solos. O equipamento desenvolvido pode ser útil na coleta de dados para mapeamento de solos, com o auxílio de uma antena de GPS.

Una Interpretación de la psicología cultural: aplicaciones prácticas y principios teóricos

En el siguiente trabajo se exponen las bases teóricas y se ilustran algunas aplicaciones de una visión de la psicología cultural alrededor del concepto de “vivencia” y “geografía vital”. Según esta perspectiva, el desarrollo humano es el resultado de la participación en prácticas educativas a través de las cuales nos apropiamos de los “signos”, “tecnología cultural” o formas explícitas e implícitas de vida compartida. Se postulan dos supuestos y tres características. Los supuestos son que la experiencia psicológica se debe estudiar en el contexto o situación donde ésta se expresa y construye, siendo la “dieta cultural” el alimento de nuestra mente (nuestros recuerdos, temores, percepciones, sentimientos, pensamientos). Las características nos remiten a considerar la vivencia humana como unidad de análisis, en tanto realidad dinámica situada y distribuida y, finalmente, en tanto producto o resultado de la participación en particulares geografías o contextos de vida. Se esbozan aplicaciones en el campo de la psicología clínica y la rehabilitación, en el terreno socioeducativo y en el ámbito de las organizaciones o psicología del trabajo, como ejemplos de prácticas acordes a una psicología orientada culturalmente. Finalmente, se concluye considerando la necesidad de vertebrar la dimensión subjetiva, social y política de la cultura con el objetivo de ofrecer vías de comprensión ecológicas de la mente y conducta humana

Kako =to uspje=nije plasirati va=e poslovne talente, December 2001

|elite posao. I osje]ate da negdje, neki poslodavac nudi upravo onakav posao kakav vi \elite -posao na kojem va=e znanje i vje=tine mogu do]i do punog izra\aja, a koji, u isto vrijeme, predstavlja izazov i daje mogu]nost napretka. Da biste ostvarili ovaj korak morate se pripremiti na dobro planiranu potragu za poslom. Imate proizvod koji \elite prodati - va=e znanje, vje=tinu i iskustvo-vas same. Ono =to treba da nau[ite je kako da =to uspje=nije predstavite sebe na tr\i=tu. Neke od informacija datih u ovoj bro=uri mogu vam u tome pomo]i bez obzira da li ste tek zavr=ili =kolu spremni da otpo[nete poslovnu karijeru, ili tra\ite novi posao nakon 20 godina rada. NOTE: BOSNIAN

Kako =to uspje=nije plasirati va=e poslovne talente, December 2001

|elite posao. I osje]ate da negdje, neki poslodavac nudi upravo onakav posao kakav vi \elite -posao na kojem va=e znanje i vje=tine mogu do]i do punog izra\aja, a koji, u isto vrijeme, predstavlja izazov i daje mogu]nost napretka. Da biste ostvarili ovaj korak morate se pripremiti na dobro planiranu potragu za poslom. Imate proizvod koji \elite prodati - va=e znanje, vje=tinu i iskustvo-vas same. Ono =to treba da nau[ite je kako da =to uspje=nije predstavite sebe na tr\i=tu. Neke od informacija datih u ovoj bro=uri mogu vam u tome pomo]i bez obzira da li ste tek zavr=ili =kolu spremni da otpo[nete poslovnu karijeru, ili tra\ite novi posao nakon 20 godina rada. NOTE: BOSNIAN

Consolidando la calidad en las bibliotecas universitarias: evaluaciones, sellos, diplomas y certificaciones

La construcción efectiva del Espacio europeo de educación superior se ha convertido en un dinamizador de muchas actividades relacionadas con la calidad y la adopción de sistemas de garantía de la calidad en el seno de las universidades y, por ende de sus bibliotecas; es una decisión inaplazable. Un tercio de las bibliotecas universitarias españolas dispone de algún tipo de reconocimiento público de la calidad de su gestión. Se presentan las diversas vías que han seguido las bibliotecas universitarias para disponer de este reconocimiento: certificaciones, diplomas y sellos de calidad y se constata la existencia de una cierta tendencia a la multicertificación.

Precipitacion de plata en efluentes electroliticos

La recuperación de plata contenida en efluentes electrolíticos es atractiva por su alto valor económico. Estos efluentes son catalogados como residuos tóxicos y no pueden ser evacuados a cauces públicos sin un tratamiento previo de detoxificación. Una de las vías propuestas para recuperar plata de este tipo de efluentes es la precipitación química utilizando ditionito de sodio, borohidruro de sodio o monohidrato de hidracina. En este trabajo, se discuten los aspectos más signifícativos de la utilización de estos reactivos para el citado objetivo. Se presentan resultados de la precipitación de plata con ditionito de sodio en efluentes base tiosulfato, sin eliminación de otras especies presentes. Se pone de maniflesto la capacidad de este reactivo de cumplir los objetivos de alcanzar una precipitación, prácticamente total, de la plata, dejando el metal en el efluente a niveles de menos de 1 ppm, sin introducir substancias extrañas al sistema.

Psychometric characteristics of the Spanish version of instruments to measure neck pain disability

Background: The NDI, COM and NPQ are evaluation instruments for disability due to NP. There was no Spanish version of NDI or COM for which psychometric characteristics were known. The objectives of this study were to translate and culturally adapt the Spanish version of the Neck Disability Index Questionnaire (NDI), and the Core Outcome Measure (COM), to validate its use in Spanish speaking patients with non-specific neck pain (NP), and to compare their psychometric characteristics with those of the Spanish version of the Northwick Pain Questionnaire (NPQ).Methods: Translation/re-translation of the English versions of the NDI and the COM was done blindly and independently by a multidisciplinary team. The study was done in 9 primary care Centers and 12 specialty services from 9 regions in Spain, with 221 acute, subacute and chronic patients who visited their physician for NP: 54 in the pilot phase and 167 in the validation phase. Neck pain (VAS), referred pain (VAS), disability (NDI, COM and NPQ), catastrophizing (CSQ) and quality of life (SF-12) were measured on their first visit and 14 days later. Patients' self-assessment was used as the external criterion for pain and disability. In the pilot phase, patients' understanding of each item in the NDI and COM was assessed, and on day 1 test-retest reliability was estimated by giving a second NDI and COM in which the name of the questionnaires and the order of the items had been changed.Results: Comprehensibility of NDI and COM were good. Minutes needed to fill out the questionnaires [median, (P25, P75)]: NDI. 4 (2.2, 10.0), COM: 2.1 (1.0, 4.9). Reliability: [ICC, (95%CI)]: NDI: 0.88 (0.80, 0.93). COM: 0.85 (0.75,0.91). Sensitivity to change: Effect size for patients having worsened, not changed and improved between days 1 and 15, according to the external criterion for disability: NDI: -0.24, 0.15, 0.66; NPQ: -0.14, 0.06, 0.67; COM: 0.05, 0.19, 0.92. Validity: Results of NDI, NPQ and COM were consistent with the external criterion for disability, whereas only those from NDI were consistent with the one for pain. Correlations with VAS, CSQ and SF-12 were similar for NDI and NPQ (absolute values between 0.36 and 0.50 on day 1, between 0.38 and 0.70 on day 15), and slightly lower for COM (between 0.36 and 0.48 on day 1, and between 0.33 and 0.61 on day 15). Correlation between NDI and NPQ: r = 0.84 on day 1, r = 0.91 on day 15. Correlation between COM and NPQ: r = 0.63 on day 1, r = 0.71 on day 15.Conclusion: Although most psychometric characteristics of NDI, NPQ and COM are similar, those from the latter one are worse and its use may lead to patients' evolution seeming more positive than it actually is. NDI seems to be the best instrument for measuring NP-related disability, since its results are the most consistent with patient's assessment of their own clinical status and evolution. It takes two more minutes to answer the NDI than to answer the COM, but it can be reliably filled out by the patient without assistance.

Comparison of two oral probiotic preparations in a randomized crossover trial highlights a potentially beneficial effect of Lactobacillus paracasei NCC2461 in patients with allergic rhinitis.

BACKGROUND: There is promising but conflicting evidence to recommend the addition of probiotics to foods for prevention and treatment of allergy. Based on previous studies with fermented milk containing Lactobacillus paracasei NCC2461, we aimed to compare the effect of a powder form of the latter probiotic with the effect of a blend of Lactobacillus acidophilus ATCC SD5221 and Bifidobacterium lactis ATCC SD5219 in patients with allergic rhinitis. METHODS: A double-blind, randomized, cross-over study, involving 31 adults with allergic rhinitis to grass pollen, was performed outside the grass pollen season (registration number: NCT01233154). Subjects received each product for 4-weeks in two phases separated by a wash-out period of 6 to 8 weeks. A nasal provocation test was performed before and after each 4-week product intake period, and outcome parameters (objective and subjective clinical symptoms; immune parameters) were measured during and/or 24 hours after the test. RESULTS: Out of the 31 subject enrolled, 28 completed the study. While no effect was observed on nasal congestion (primary outcome), treatment with NCC2461 significantly decreased nasal pruritus (determined by VAS), and leukocytes in nasal fluid samples, enhanced IL-5, IL-13 and IL-10 production by peripheral blood mononuclear cells in an allergen specific manner and tended to decrease IL-5 secretion in nasal fluid, in contrast to treatment with the blend of L. acidophilus and B. lactis. CONCLUSIONS: Despite short-term consumption, NCC2461 was able to reduce subjective nasal pruritus while not affecting nasal congestion in adults suffering from grass pollen allergic rhinitis. The associated decrease in nasal fluid leukocytes and IL-5 secretion, and the enhanced IL-10 secretion in an allergen specific manner may partly explain the decrease in nasal pruritus. However, somewhat unexpected systemic immune changes were also noted. These data support the study of NCC2461 consumption in a seasonal clinical trial to further demonstrate its potentially beneficial effect.

A territorial model of commuting in Catalonia, 1986-1996

Commuting consists in the fact that an important fraction of workers in developed countries do not reside close to their workplaces but at long distances from them, so they have to travel to their jobs and then back home daily. Although most workers hold a job in the same municipality where they live or in a neighbouring one, an important fraction of workers face long daily trips to get to their workplace and then back home.Even if we divide Catalonia (Spain) in small aggregations of municipalities, trying to make them as close to local labour markets as possible, we will find out that some of them have a positive commuting balance, attracting many workers from other areas and providing local jobs for almost all their resident workers. On the other side, other zones seem to be mostly residential, so an important fraction of their resident workers hold jobs in different local labour markets. Which variables influence an area¿s role as an attraction pole or a residential zone? In previous papers (Artís et al, 1998a, 2000; Romaní, 1999) we have brought out the main individual variables that influence commuting by analysing a sample of Catalan workers and their commuting decisions. In this paper we perform an analysis of the territorial variables that influence commuting, using data for aggregate commuting flows in Catalonia from the 1991 and 1996 Spanish Population Censuses.These variables influence commuting in two different ways: a zone with a dense, welldeveloped economical structure will have a high density of jobs. Work demand cannot be fulfilled with resident workers, so it spills over local boundaries. On the other side, this economical activity has a series of side-effects like pollution, congestion or high land prices which make these areas less desirable to live in. Workers who can afford it may prefer to live in less populated, less congested zones, where they can find cheaper land, larger homes and a better quality of life. The penalty of this decision is an increased commuting time. Our aim in this paper is to highlight the influence of local economical structure and amenities endowment in the workplace-residence location decision. A place-to-place logit commuting models is estimated for 1991 and 1996 in order to find the economical and amenities variables with higher influence in commuting decisions. From these models, we can outline a first approximation to the evolution of these variables in the 1986-1996 period. Data have been obtained from aggregate flow travel-matrix from the 1986, 1991 and 1996 Spanish Population Censuses

A territorial model of commuting in Catalonia, 1986-1996

Commuting consists in the fact that an important fraction of workers in developed countries do not reside close to their workplaces but at long distances from them, so they have to travel to their jobs and then back home daily. Although most workers hold a job in the same municipality where they live or in a neighbouring one, an important fraction of workers face long daily trips to get to their workplace and then back home.Even if we divide Catalonia (Spain) in small aggregations of municipalities, trying to make them as close to local labour markets as possible, we will find out that some of them have a positive commuting balance, attracting many workers from other areas and providing local jobs for almost all their resident workers. On the other side, other zones seem to be mostly residential, so an important fraction of their resident workers hold jobs in different local labour markets. Which variables influence an area¿s role as an attraction pole or a residential zone? In previous papers (Artís et al, 1998a, 2000; Romaní, 1999) we have brought out the main individual variables that influence commuting by analysing a sample of Catalan workers and their commuting decisions. In this paper we perform an analysis of the territorial variables that influence commuting, using data for aggregate commuting flows in Catalonia from the 1991 and 1996 Spanish Population Censuses.These variables influence commuting in two different ways: a zone with a dense, welldeveloped economical structure will have a high density of jobs. Work demand cannot be fulfilled with resident workers, so it spills over local boundaries. On the other side, this economical activity has a series of side-effects like pollution, congestion or high land prices which make these areas less desirable to live in. Workers who can afford it may prefer to live in less populated, less congested zones, where they can find cheaper land, larger homes and a better quality of life. The penalty of this decision is an increased commuting time. Our aim in this paper is to highlight the influence of local economical structure and amenities endowment in the workplace-residence location decision. A place-to-place logit commuting models is estimated for 1991 and 1996 in order to find the economical and amenities variables with higher influence in commuting decisions. From these models, we can outline a first approximation to the evolution of these variables in the 1986-1996 period. Data have been obtained from aggregate flow travel-matrix from the 1986, 1991 and 1996 Spanish Population Censuses

Objetivo: cuantificar la reproducción

Se estudian en este trabajo algunas magnitudes relacionadas con el enfoque de la reproducción social. Ante todo se hace hincapié en tres ideas fundamentales, las nociones de: a) Salidas menos entradas; b) Salidas dividido por entradas; c) Subsistemas. A continuación se subrayan los obstáculos para la cuantificación directa de estos conceptos, y se repasan las vías sugeridas para sortear las dificultades (por medio de constructos teóricos propuestos por Leontief, von Neumann y Sraffa). Luego se examinan dos nuevos indicadores: la ¿tasaespecífica de excedente¿, que se refiere a los bienes autorreproducibles, y el ¿coeficiente neto de reproducción¿, que se predica de todos los bienes básicos. De pasada se apuntan algunas pistas para establecer indicadores del mismogénero en campos como la economía ecológica y la economía feminista. Por último, se anotan algunas conjeturas relacionadas con la dirección adecuada del cambio técnico

Pain and beliefs after musuloskeletal trauma: Complex relationships during the first year of rehabilitation

Introduction.- Pain and beliefs have an influence on the patient's course in rehabilitation and their relationships are complex. The aim of this study was to understand the relationships between pain at admission and the evolution of beliefs during rehabilitation as well as the relationships between pain and beliefs one year after rehabilitation.Patients and methods.- Six hundred and thirty-one consecutive patients admitted in rehabilitation after musculoskeletal trauma, were included and assessed at admission, at discharge and one year after discharge. Pain was measured by VAS (Visual Analogical Scale) and beliefs by judgement on Lickert scales. Four kinds of beliefs were evaluated: fear of a severe origin of pain, fear of movement, fear of pain and feeling of distress (loss of control). The association between pain and beliefs was assessed by logistic regressions, adjusted for gender, age, native language, education and bio-psycho-social complexity.Results.- At discharge, 44% of patients felt less distressed by pain, 34% are reinsured with regard to their fear of a severe origin of pain, 38% have less fear of pain and 33% have less fear of movement. The higher the pain at admission, the higher the probability that the distress diminished, this being true up to a threshold (70 mm/100) beyond which there was a plateau. At one year, the higher the pain, the more dysfunctional the fears.Discussion.- The relationships between pain and beliefs are complex and may change all along rehabilitation. During hospitalization, one could hope that the patient would be reinsured and would gain self-control again, if pain does not exceed a certain threshold. After one year, high pain increases the risk of dysfunctional beliefs. For clinical practice, these data suggest to think in terms of the more accessible "entrance door", act against pain and/or against beliefs, adpated to each patient.