Anaesthetic induction with etomidate in cardiac surgery: A randomised controlled trial.

BACKGROUND Etomidate is perceived as preserving haemodynamic stability during induction of anaesthesia. It is also associated with adrenocortical dysfunction. The risk/benefit relationship is controversial. OBJECTIVES We tested the hypotheses that single-dose etomidate increases cumulative vasopressor requirement, time to extubation and length of stay in the ICU. DESIGN Double-blind randomised controlled trial. SETTING Bern University Hospital, Switzerland, from November 2006 to December 2009. PATIENTS There were 90 patients undergoing coronary artery bypass grafts (CABG) and 40 patients undergoing mitral valve surgery (MVS). Reasons for noninclusion were known adrenocortical insufficiency, use of etomidate or propofol within 1 week preoperatively, use of glucocorticoids within 6 months preoperatively, severe renal or liver dysfunction, or carotid stenosis. INTERVENTIONS CABG patients were allocated randomly to receive either etomidate 0.15 mg kg with placebo, propofol 1.5 mg kg with placebo or etomidate 0.15 mg kg with hydrocortisone (n = 30 in each arm). Risk stratification (low vs. high) was achieved by block randomisation. MVS patients received either etomidate 0.15 mg kg or propofol 1.5 mg kg (n = 20 in each arm). MAIN OUTCOME MEASURES Cumulative vasopressor requirements, incidence of adrenocortical insufficiency, length of time to extubation and length of stay in ICU. RESULTS Cumulative vasopressor requirements 24 h after induction did not differ between treatments in patients who underwent CABG, whereas more noradrenaline was used in MVS patients following propofol induction (absolute mean difference 5.86 μg kg over 24 h P = 0.047). The incidence of relative adrenocortical insufficiency was higher after etomidate alone than propofol (CABG 83 vs. 37%, P < 0.001; MVS: 95 vs. 35%, P < 0.001). The time to extubation, length of stay in ICU and 30-day mortality did not differ among treatments. Within low and high-risk subgroups, no differences in vasopressor use or outcomes were found. CONCLUSION In elective cardiac surgery, laboratory indicators of etomidate-induced adrenal insufficiency do not translate into increased vasopressor requirement or inferior early outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT 00415701.

Evaluation of therapist and client language in Motivational Interviewing (MI) sessions: A secondary analysis of data from the Southern Methodist Alcohol Research Trial (SMART) study

In the United States, “binge” drinking among college students is an emerging public health concern due to the significant physical and psychological effects on young adults. The focus is on identifying interventions that can help decrease high-risk drinking behavior among this group of drinkers. One such intervention is Motivational interviewing (MI), a client-centered therapy that aims at resolving client ambivalence by developing discrepancy and engaging the client in change talk. Of late, there is a growing interest in determining the active ingredients that influence the alliance between the therapist and the client. This study is a secondary analysis of the data obtained from the Southern Methodist Alcohol Research Trial (SMART) project, a dismantling trial of MI and feedback among heavy drinking college students. The present project examines the relationship between therapist and client language in MI sessions on a sample of “binge” drinking college students. Of the 126 SMART tapes, 30 tapes (‘MI with feedback’ group = 15, ‘MI only’ group = 15) were randomly selected for this study. MISC 2.1, a mutually exclusive and exhaustive coding system, was used to code the audio/videotaped MI sessions. Therapist and client language were analyzed for communication characteristics. Overall, therapists adopted a MI consistent style and clients were found to engage in change talk. Counselor acceptance, empathy, spirit, and complex reflections were all significantly related to client change talk (p-values ranged from 0.001 to 0.047). Additionally, therapist ‘advice without permission’ and MI Inconsistent therapist behaviors were strongly correlated with client sustain talk (p-values ranged from 0.006 to 0.048). Simple linear regression models showed a significant correlation between MI consistent (MICO) therapist language (independent variable) and change talk (dependent variable) and MI inconsistent (MIIN) therapist language (independent variable) and sustain talk (dependent variable). The study has several limitations such as small sample size, self-selection bias, poor inter-rater reliability for the global scales and the lack of a temporal measure of therapist and client language. Future studies might consider a larger sample size to obtain more statistical power. In addition the correlation between therapist language, client language and drinking outcome needs to be explored.^

Survival of gastrointestinal and stromal tumor patients at UT M.D. Anderson Cancer Center

Objective. Gastrointestinal Stromal Tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal (GI) tract with spindled cell, epithelioid, or occasionally pleomorphic morphology. The primary objective of this paper is to describe the demographic and clinical characteristics and survival among GIST patients registered at the University of Texas M.D. Anderson Cancer Center (MDACC). ^ Methods. This cohort study includes 783 consecutive patients diagnosed with GIST from 1995 to 2007. Demographic, clinical and survival information were obtained from the MDACC cancer registry. ^ Statistical Analysis. Kaplan-Meier survival curves, univariate and multivariate Cox proportional hazards analysis were conducted to estimate survival and identify prognostic clinical factors associated with survival. Results. The age at diagnosis of MDACC GIST cases ranged from 17 to 91 with a mean of 57 years and a male-to-female ratio of 1.3:1. The racial distribution was whites 77%, African-Americans 9.5%, Hispanics 9.3% and other races 4.2%. Fifty per cent of the GISTs arose from stomach, 35% small intestine, 7% retroperitoneal space, 6% colorectal and 2% were omentum and mesentery. About half of the tumors were less than 10 cm in size. Fifty eight per cent of the tumors were localized whereas 36% were metastatic. MDACC GIST patients were generally comparable to SEER patients, but, on the average, were 7 years younger than SEER patients and were predominantly whites. ^ Stratification of 783 GIST cases by year of diagnosis based on the introduction of imatinib treatment in 2000 revealed that 60% of the GIST cases were first diagnosed between 2000 and 2007 whereas, 40% were first diagnosed between 1995 and 1999. There was a significant difference between the two cohorts in the distribution of race, GIST symptom, tumor size, tumor site, and stage of the tumor at diagnosis. The 1- and 5-year survival was 93% and 59% in the 1995–2007 cohort. Multivariate Cox regression analysis identified age at diagnosis (p<0.001), female sex (p=0.047), tumor size (p=0.07), multiple cancers (p=0.002), and GIST diagnosed between 2000 and 2007 (p<0.001) were significantly associated with survival. Approximately, 58% of the cases were treated with imatinib whereas 42% did not receive imatinib in 2000–2005 cohort. There was a significant difference in survival between imatinib and non-imatinib groups and in the distribution of tumor size categories, stage of the tumor at diagnosis and cancers before the diagnosis of GIST. The 1- and 5-year survival for imatinib patients was 99% and 73% and was 91% and 63% for non-imatinib patients. Multivariate Cox regression analysis of the 2000–2007 cohort identified, age at diagnosis and tumor stage as possible prognostic factors associated with survival.^

A DESCRIPTIVE STUDY OF ANIMAL BITES TO HUMANS IN HOUSTON, TEXAS, JANUARY 1, 1982 - JULY 30, 1982 (RABIES)

This study describes animal bites which occurred within the city of Houston, Texas from January 1, 1982, through July 30, 1982. The Rabies Investigation Branch (RIB) recorded 2,047 bite cases. The study has as its foundation a data base management system that was developed to improve the planning and evaluation of the activities of the Rabies Investigation Branch of the Animal Control Center of the City of Houston Health Department. The study provides information which will allow for the development of a more effective animal bite program to meet the needs of the citizens of Houston. ^

Granulometry of two sediment cores from Maxwell Bay, South Shetland Islands, West Antarctica

The climate evolution of the South Shetland Islands during the last c. 2000 years is inferred from the multiproxy analyses of a long (928 cm) sediment core retrieved from Maxwell Bay off King George Island. The vertical sediment flux at the core location is controlled by summer melting processes that cause sediment-laden meltwater plumes to form. These leave a characteristic signature in the sediments of NE Maxwell Bay. We use this signature to distinguish summer and winter-dominated periods. During the Medieval Warm Period, sediments are generally finer which indicates summer-type conditions. In contrast, during the Little Ice Age (LIA) sediments are generally coarser and are indicative of winter-dominated conditions. Comparison with Northern and Southern Hemisphere, Antarctic, and global temperature reconstructions reveals that the mean grain-size curve from Maxwell Bay closely resembles the curve of the global temperature reconstruction. We show that the medieval warming occurred earlier in the Southern than in the Northern Hemisphere, which might indicate that the warming was driven by processes occurring in the south. The beginning of the LIA appears to be almost synchronous in both hemispheres. The warming after the LIA closely resembles the Northern Hemisphere record which might indicate this phase of cooling was driven by processes occurring in the north. Although the recent rapid regional warming is clearly visible, the Maxwell Bay record does not show the dominance of summer-type sediments until the 1970s. Continued warming in this area will likely affect the marine ecosystem through meltwater induced turbidity of the surface waters as well as an extension of the vegetation period due to the predicted decrease of sea ice in this area.

Magnetic properties, grain sizes, XRF Scanner Data of sediment core GeoB9307-3

Geochemical and mineralogical proxies for paleoenvironmental conditions have the underlying assumption that climate variations have an impact on terrestrial weathering conditions. Varying properties of terrigenous sediments deposited at sea are therefore often interpreted in terms of paleoenvironmental change. Also in gravity core GeoB9307-3 (18° 33.99' S, 37° 22.89' E), located off the Zambezi River, environmental changes during Heinrich Stadial 1 (HS 1) and the Younger Dryas (YD) are accompanied by changing properties of the terrigenous sediment fraction. Our study focuses on the relationship of variability in the hydrological system and changes in the magnetic properties, major element geochemistry and granulometry of the sediments. We propose that changes in bulk sedimentary properties concur with environmental change, although not as a direct response of climate driven pedogenic processes. Spatial varying rainfall intensities on a sub-basin scale modify sediment export from different parts of the Zambezi River basin. During humid phases, such as HS 1 and the YD, sediment was mainly exported from the coastal areas, while during more arid phases sediments mirror the hinterland soil and lithological properties and are likely derived from the northern Shire sub-basin. We propose that a de-coupling of sedimentological and organic signals with variable discharge and erosional activity can occur.

Movilidad de trabajadores y construcción social del territorio en el Alto Valle de Río Negro. En: Avá, nº 15

En el norte de la Patagonia Argentina, el tradicional espacio del Alto Valle de Río Negro, se orientó desde sus inicios a actividades vinculadas a la exportación de fruta fresca, asimismo, ha sido punto de confluencia de circulación no sólo de capital y mercancías sino también de mano de obra. Al consolidarse la fruticultura entre 1940 y 1950, migrantes de orígen chileno y del interior de las provincias de Neuquén y Río Negro llegaron a la zona para emplearse en las chacras. Algunos de ellos, junto a sus familias, optaron por conformar pequeños núcleos de población próximos a las exportaciones agrícolas, constituyendo territorios con características particulares. En este trabajo presentaremos algunas aproximaciones a la construcción social de territorios de trabajadores y a la movilidad espacial de esta fuerza de trabajo, relacionadas con las transformaciones en la producción de peras y manzanas en el Alto Valle de Río Negro.

Mujeres, violencia doméstica y protección de derechos. Un estudio sobre la accesibilidad a los servicios de atención en la Provincia de Misiones. 16H335

El proyecto se fundamenta en experiencias de investigación, extensión y profesionales. Toma como tema la violencia de género (s), particularmente la que acontece en el ámbito denominado doméstico (“puertas adentro de la familia”1). Se circunscribe a este tema en tanto, las mujeres constituyen un grupo históricamente vulnerable y la violencia de género en el espacio doméstico es de las más recurrentes en las estadísticas oficiales. Esta problemática social y su abordaje desde el espacio público, el ámbito jurídico y las políticas públicas, no es nueva pero su comprensión debe ser ubicada en las coordenadas de época y espacio. Coordenadas que muestran importantes avances en la protección de los derechos de las mujeres y las familias como también múltiples acciones para su atención (desde instituciones públicas y organizaciones sociales que convergen en su abordaje). Sin embargo, la puesta en acto de las mismas y su efectividad muestran resultados contradictorios que desfavorecen las posibilidades de acceso y equidad. Desde la producción de conocimientos se trata de aportar a la comprensión del proceso2 en el cual se inscriben las respuestas al problema y las medidas de protección que las normas vigentes procuran, ubicando las brechas existentes entre los derechos formalizados y su efectivización en la vida cotidiana; específicamente en la Provincia de Misiones.

Comunicación, arte, ciudad : de la gestión cultural. 16H270

Actividades desarrolladas durante el período: se realizó un análisis inicial de los cruces entre arte y comunicación a partir de los proyectos culturales detectados y gestionados en Posadas: se exploraron y describieron experiencias específicas a partir de historias de vida realizadas a “practicantes culturales”. Se indagó en sus formulaciones y discursos, sus relaciones con la realidad pública de la ciudad, sus retóricas y relatos. Se inició así la descripción de formas de comunicación y prácticas culturales que se establecen en relación a dominios del arte y a espacios concretos en la ciudad.

Grain-size analysis and geochemistry of sediment core GeoB13602-1

Grain-size, terrigenous element and rock magnetic remanence data of Quaternary marine sediments retrieved at the NW African continental margin off Gambia (gravity core GeoB 13602-1, 13°32.71' N, 17°50.96'W) were jointly analyzed by end-member (EM) unmixing methods to distinguish and budget past terrigenous fluxes. We compare and cross-validate the identified single-parameter EM systems and develop a numerical strategy to calculate associated multi-parameter EM properties. One aeolian and two fluvial EMs were found. The aeolian EM is much coarser than the fluvial EMs and is associated with a lower goethite/hematite ratio, a higher relative concentration of magnetite and lower Al/Si and Fe/K ratios. Accumulation rates and grain sizes of the fluvial sediment appear to be primarily constrained by shore distance (i.e., sea-level fluctuations) and to a lesser extent by changes in hinterland precipitation. High dust fluxes occurred during the Last Glacial Maximum (LGM) and during Heinrich Stadials (HS) while the fluvial input remained unchanged. Our approach reveals that the LGM dust fluxes were ~7 times higher than today's. However, by far the highest dust accumulation occurred during HS 1 (~300 g m**-2 yr** -1), when dust fluxes were ~80 fold higher than today. Such numbers have not yet been reported for NW Africa, and emphasize strikingly different environmental conditions during HSs. They suggest that deflation rate and areal extent of HSs dust sources were much larger due to retreating vegetation covers. Beyond its regional and temporal scope, this study develops new, in principle, generally applicable strategies for multi-method end-member interpretation, validation and flux budgeting calibration.

Grain-size analyses and bulk chemistry determined in surface sediment samples along the Chilean continental margin in the Southeast Pacific Ocean

Physical, chemical, and mineralogical properties of a set of surface sediment samples collected along the Chilean continental slope (21-44°S) are used to characterise present-day sedimentation patterns and sediment provenance on the Chilean margin. Despite the presence of several exceptional latitudinal gradients in relief, oceanography, tectonic evolution, volcanic activity and onshore geology, the present-day input of terrigenous sediments to the Chilean continental margin appears to be mainly controlled by precipitation gradients, and source-rock composition in the hinterland. General trends in grain size denote a southward decrease in median grain-size of the terrigenous (Corganic, CaCO3 and Opal-free) fraction, which is interpreted as a shift from aeolian to fluvial sedimentation. This interpretation is supported by previous observations of southward increasing bulk sedimentation rates. North-south trends in sediment bulk chemistry are best recognised in the iron (Fe) and titanium (Ti) vs. potassium (K) and aluminium (Al) ratios of the sediments that most likely reflect the contribution of source rocks from the Andean volcanic arc. These ratios are high in the northernmost part, abruptly decrease at 25°S, and then more or less constantly increase southwards to a maximum at ~40°S.

Stable oxygen isotope ratios and grain size analyses of sediment cores from the Propeller Mound, Northeast Atlantic

The first detailed stratigraphic record from a deep-water carbonate mound in the Northeast Atlantic based on absolute datings (U/Th and AMS 14C) and stable oxygen isotope records reveals that its top sediment sequences are condensed by numerous hiatuses. According to stable isotope data, mainly sediments with an intermediate signal are preserved on the mound, while almost all fully glacial and interglacial sediments have either not been deposited or have been eroded later. The resulting hiatuses reduce the Late Pleistocene sediment accumulation at Propeller Mound to amounts smaller than the background sedimentation. The hiatuses most likely result due to the sweeping of the mound in turn with the re-establishment of vigour interglacial circulation patterns after sluggish current regimes during glacials. Thus, within the discussion if internal, fluid-driven or external environmentally driven processes control the evolution of such carbonate mounds, our findings for Propeller Mound clearly point to environmental forcing as the dominant mechanism shaping deep-water carbonate mounds in the NE Atlantic during the Late Pleistocene and Holocene.