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.

Implementación de la política de seguridad en Cali durante las alcaldías de Jorge Iván Ospina y Rodrigo Guerrero

El presente estudio de caso tiene como objetivo evaluar la implementación de las políticas públicas de seguridad ciudadana en Cali durante las administraciones de Jorge Iván Ospina (2008 – 2011) y Rodrigo Guerrero (2012 – 2013). Se buscó determinar cuáles han sido los errores que se han cometido durante la fase de ejecución de las políticas públicas ya que, aunque muestran un diseño y una comprensión de la problemática desde una perspectiva multidimensional, no arrojan resultados satisfactorios. Para esto, se hizo un análisis documental y se revisaron los conceptos de política pública, seguridad ciudadana y criminalidad y violencia, además de las políticas de seguridad de cada uno de los alcaldes y las políticas que, en cada uno de esos momentos, se ejecutaban a nivel nacional. Al final de la investigación se podrán encontrar los errores descubiertos y una serie de recomendaciones formuladas de acuerdo a los hallazgos de la investigación.

Relação das actividades desportivas não lectivas e a aptidão física nos alunos do Ensino Secundário (estudo efectuado em 4 escolas da rede de Estágios da ULHT 2010/211)

RESUMO: Actividade Física, é qualquer movimento corporal produzido pelos músculos esqueléticos que resultam em energia despendida, acima do nível de repouso (Caspersen et al1985; Baranowski et al 1992). Um indivíduo sedentário que comece uma Actividade Física regular desencadeia um conjunto de adaptações ao esforço, em que algumas destas adaptações serão benéficas em termos de saúde, ajudando na prevenção inicial de várias doenças (Haskell et al 1965; Barata et al 1997). A Aptidão Física é um conjunto de atributos que as pessoas têm ou alcançam, que estão relacionados com os movimentos que as pessoas desempenham (Caspersen et al 1985; Baranowski et al 1992). O objectivo central do presente estudo consistiu em verificar se existem diferenças significativas entre os Praticantes e Não Praticantes de ADEC e a Aptidão Física dos alunos. A amostra foi constituída por 310 sujeitos, 165 rapazes e 145 raparigas pertencentes ao Ensino Secundário de 4 escolas da rede de estágios da ULHT 2010/2011. As Capacidades Físicas foram avaliadas através dos testes do Fitnessgram, a Prática de ADEC e o Índice de Actividade Física foram obtidos através do Questionário de Actividade Desportiva. Conclusões: Os alunos que praticam ADEC são mais aptos do que os alunos que não praticam ADEC. Estes Praticantes apresentam valores mais elevados na Aptidão Aeróbia e no VO2máx., quando comparados com os Não Praticantes. Nas restantes Capacidades Físicas analisadas (Força de Braços, Força Abdominal e Flexibilidade) não foram encontradas diferenças significativas. Não foram encontradas diferenças significativas entre a Prática de ADEC e o IMC. Os Praticantes de ADEC demonstraram ter um IAF superior aos Não Praticantes de ADEC. O Género Feminino apresenta melhores resultados do que o Género Masculino para a Força de Braços. Nas restantes Capacidades Físicas não foram encontradas diferenças significativas entre Géneros. Quando analisado o IMC, o Género Feminino apresenta percentagens superiores de Peso Normal relativamente ao Género Masculino. Não foram encontradas diferenças significativas entre o Género e a Aptidão Física. Verificou-se que existe diferenças significativas na relação entre o Género e o IAF, o Género Masculino tem um IAF superior ao Género Feminino. Os alunos mais aptos fisicamente são os alunos com maior IAF. Não foram encontradas diferenças significativas entre as Modalidades praticadas pelos alunos e o desenvolvimento qualquer das Capacidades Físicas estudadas. ABSTRACT: Physical Activity is any body movement produced by skeletal muscles resulting in energy expenditure above the resting level (Caspersen et al1985; Baranowski et al 1992). A sedentary individual, who starts a regular Physical Activity, triggers a set of adaptations to stress, in which some of these changes will be helpful in terms of health, aiding in primary prevention of several diseases (Haskell et al 1965; Barata et al 1997). Physical Fitness is a set of attributes that people have or achieve, and are related with the movements that people perform (Caspersen et al 1985; Baranowski et al 1992). The main purpose of this study was to determine whether there are significant differences between Practicing and Non-practitioners of ADEC and Physical Fitness of students. The sample consisted of 310 subjects, 165 boys and 145 girls belonging to high school students of 4 schools integrated in the ULHT 2010/2011. The Physical Abilities were assessed through Fitnessgram tests, ADEC practice and the Index of Physical Activity were obtained through the Physical Activity Questionnaire. Conclusions: Students that practice ADEC are more able than students who do not practice ADEC. These students that practice ADEC have higher values in Aerobic Fitness and VO2max when compared to non-practicing students. In the remaining Physical Abilities analyzed (Arm Strength, Abdominal Strength and Flexibility) were not considered significant differences. No significant differences were found between ADEC practice and the BMI. The students that practice ADEC showed higher Physical Activity levels than students who do not practice. Female gender presents better results than the male gender in Arms strength. In the remaining components of Physical Fitness were not found significant differences between genders. When analyzed BMI, female gender has higher percentages of normal weight compared to male gender. No significant differences were found between Gender and Physical Fitness. It was verified that there are significant differences in the relation between gender and Physical Activity levels, the male gender have a higher level of Physical Activity than female gender. The most able students are the ones with higher levels of Physical Activity. There were no significant differences between the sports practiced by students and the development of the studied components of physical fitness.

Desenvolvimento da força nas aulas de Educação Física : aplicação de exercícios específicos

Com os avanços da tecnologia as crianças e jovens passam demasiado tempo sem realizar atividade física (Rodrigues, 2000), exceto a que é proporcionada na escola. É nas aulas de Educação Física que se notam as dificuldades sentidas pelos alunos na realização de exercícios devido à sua fraca aptidão física, sendo a força uma das capacidades motoras com maior défice. O presente trabalho pretende analisar as possibilidades de melhorias da força através da realização de exercícios específicos nas aulas de Educação Física. Para tal, realizámos um estudo experimental com dois grupos: GE (grupo experimental), onde foi aplicado um programa de treino de desenvolvimento da força superior e média, durante seis semanas, em três sessões semanais e GC (grupo de controlo) onde não foi aplicado o programa de treino. A amostra foi constituída por trinta e quatro alunos, de ambos os géneros, pertencentes a três turmas do 9º ano de escolaridade, com idades compreendidas entre os catorze e os dezasseis anos, da Escola EB 2,3 António Gedeão em Odivelas. Após a análise estatística (Teste T-Pares) constatámos que existiram melhorias nos dois testes, nos dois géneros, em ambos os grupos, com as seguintes exceções: extensões de braços nas raparigas do GC (decréscimo não significativo); abdominais das raparigas do GC (valor manteve-se); extensões de braços das raparigas no GE (melhoria significativa). Concluímos que a aplicação de alguns exercícios específicos, devidamente integrados no normal funcionamento das aulas, provocou melhorias na força. O estudo sugere a possibilidade de alcançar melhores resultados ao nível da aptidão física mediante a inclusão de exercícios específicos no plano de aulas.

Riscos profissionais e lesões musculosqueléticas : na Indústria dos Moldes da Marinha Grande

As Lesões Musculosqueléticas Relacionadas com o Trabalho (LMERT) são patologias inflamatórias e degenerativas do sistema musculosquelético desenvolvidas pelos trabalhadores quando sujeitos a determinados riscos profissionais. O crescente número de trabalhadores tem vindo a aumentar com lesões musculosqueléticas, embora não tenhamos encontrado estudos que analisem as LMERT na indústria dos moldes. Este estudo teve como finalidade avaliar o grau de incidência das lesões musculosqueléticas bem como as localizações mais relatadas. A amostra constituiu-se por 196 trabalhadores masculinos inquiridos por questionário. Os dados permitiram caracterizar a amostra quanto a hábitos de vida, condições de trabalho, ambiente de trabalho, posturas adotadas nas tarefas laborais bem como retirar informações quanto a queixas relativas às LMERT, as causas, a localização, a frequência da dor. Os resultados revelam que os trabalhadores desempenham tarefas de caráter repetitivo, fundamentalmente de pé e com poucas pausas. Os sintomas musculosqueléticos mais frequentes situam-se na zona lombar, nos joelhos, nos braços e na cabeça, sendo nos trabalhadores com mais idade que se registam mais sintomas, assim como dores mais intensas e permanentes. O trabalho termina com algumas recomendações para trabalhos futuros.

Monetary policy and banking supervision: coordination instead of separation. CEPS Policy Brief No. 286, 12 December 2012

Introduction. Following the June 2012 European Council decision to place the ‘Single Supervisory Mechanism’ (SSM) within the European Central Bank, the general presumption in the policy discussions has been that there should be ‘Chinese walls’ between the supervisory and monetary policy arms of the ECB. The current legislative proposal, in fact, is explicit on this account. On the contrary, however, this paper finds that there is no need to impose a strict separation between these two functions. The authors argue, in fact, that a strict separation of supervision and monetary policy is not even desirable during a financial crisis when the systemic stability of the financial system represents the biggest threat to a monetary policy that aims at price stability. In their view, the key problem hampering the ECB today is that it lacks detailed information on the state of health of the banking system, which is often highly confidential. Chinese walls would not solve this problem. Moreover, in light of the fact that the new, proposed Supervisory Board will be composed to a large extent of representatives of the same institutions that also dominate the Governing Council, the paper finds that it does not make sense to have Chinese walls between two boards with largely overlapping memberships. In addition, it recommends that some members of the Supervisory Boards should be “independents” in order to reduce the tendency of supervisors to unduly delay the recognition of losses.

Gene conversion and evolution of Xq28 duplicons involved in recurring inversions causing severe hemophilia A

Inversions breaking the 1041 bp int1h-1 or the 9.5-kb int22h-1 sequence of the F8 gene cause hemophilia A in 1/30,000 males. These inversions are due to homologous recombination between the above sequences and their inverted copies on the same DNA molecule, respectively, int1h-2 and int22h-2 or int22h-3. We find that (1) int1h and int22h duplicated more than 25 million years ago; (2) the identity of the copies (>99%) of these sequences in humans and other primates is due to gene conversion; (3) gene conversion is most frequent in the internal regions of int22h; (4) breakpoints of int22h-related inversions also tend to involve the internal regions of int22h; (5) sequence variations in a sample of human X chromosomes defined eight haplotypes of int22h-1 and 27 of int22h-2 plus int22h-3; (6) the latter two sequences, which lie, respectively, 500 and 600 kb telomeric to int22h-1 are five-fold more identical when in cis than when in trans, thus suggesting that gene conversion may be predominantly intrachromosomal; (7) int1h, int22h, and flanking sequences evolved at a rate of about 0.1% substitutions per million years during the divergence between humans and other primates, except for int1h during the human-chimpanzee divergence, when its rate of evolution was significantly lower. This is reminiscent of the slower evolution of palindrome arms in the male specific regions of the Y chromosome and we propose, as an explanation, that intrachromosomal gene conversion and cosegregation of the duplicated regions favors retention of the ancestral sequence and thus reduces the evolution rate.

Tolerance traits and the stability of mutualism

Identifying factors which allow the evolution and persistence of cooperative interactions between species is a fundamental issue in evolutionary ecology. Various hypotheses have been suggested which generally focus on mechanisms that allow cooperative genotypes in different species to maintain interactions over space and time. Here, we emphasise the fact that even within mutualisms (interactions with net positive fitness effects for both partners), there may still be inherent costs, such as the occasional predation by ants upon aphids. Individuals engaged in mutualisms benefit from minimising these costs as long as it is not at the expense of breaking the interspecific interaction, which offers a net positive benefit. The most common and obvious defence traits to minimise interspecific interaction costs are resistance traits, which act to reduce encounter rate between two organisms. Tolerance traits, in contrast, minimise fitness costs to the actor, but without reducing encounter rate. Given that, by definition, it is beneficial to remain in mutualistic interactions, the only viable traits to minimise costs are tolerance-based 'defence' strategies. Thus, we propose that tolerance traits are an important factor promoting stability in mutualisms. Furthermore, because resistance traits tend to propagate coevolutionary arms races between antagonists, whilst tolerance traits do not, we also suggest that tolerance-based defence strategies may be important in facilitating the transition from antagonistic interactions into mutualisms. For example, the mutualism between ants and aphids has been suggested to have evolved from parasitism. We describe how phenotypic plasticity in honeydew production may be a tolerance trait that has prevented escalation into an antagonistic arms race and instead led to mutualistic coevolution.

Using historical lesion volume data in the design of a new phase II clinical trial in acute stroke

Background and Purpose-Clinical research into the treatment of acute stroke is complicated, is costly, and has often been unsuccessful. Developments in imaging technology based on computed tomography and magnetic resonance imaging scans offer opportunities for screening experimental therapies during phase II testing so as to deliver only the most promising interventions to phase III. We discuss the design and the appropriate sample size for phase II studies in stroke based on lesion volume. Methods-Determination of the relation between analyses of lesion volumes and of neurologic outcomes is illustrated using data from placebo trial patients from the Virtual International Stroke Trials Archive. The size of an effect on lesion volume that would lead to a clinically relevant treatment effect in terms of a measure, such as modified Rankin score (mRS), is found. The sample size to detect that magnitude of effect on lesion volume is then calculated. Simulation is used to evaluate different criteria for proceeding from phase II to phase III. Results-The odds ratios for mRS correspond roughly to the square root of odds ratios for lesion volume, implying that for equivalent power specifications, sample sizes based on lesion volumes should be about one fourth of those based on mRS. Relaxation of power requirements, appropriate for phase II, lead to further sample size reductions. For example, a phase III trial comparing a novel treatment with placebo with a total sample size of 1518 patients might be motivated from a phase II trial of 126 patients comparing the same 2 treatment arms. Discussion-Definitive phase III trials in stroke should aim to demonstrate significant effects of treatment on clinical outcomes. However, more direct outcomes such as lesion volume can be useful in phase II for determining whether such phase III trials should be undertaken in the first place. (Stroke. 2009;40:1347-1352.)

Expression profiles in the progression of ductal carcinoma in the breast

An understanding of the multi-step nature of cancer as it is in the breast, as a series of pivotal genetic/epigenetic modifications is irrefutably a milestone in diagnostics, prognostics and eventually providing a cure. Here we have utilised a variant of analysis of variance (ANOVA) as a model for the identification and tracking of specific mRNA species whose transcription has been significantly altered at each grade in the progression of ductal carcinoma, making it possible to correlate histological progression with the genetic events underlying breast cancer. We show that in the progression of ductal carcinomas, from grade 1 to 3, there is a reduction in the actual number of mRNA species, which are significantly over or under expressed. We also show that this technique can be employed to generate differential gene expression patterns, whereby the combined expression profile of the tailored spectra of genes in the comparison of each ductal grade is sufficient to render them on clearly separate arms of an array-wise hierarchical cluster dendrogram.

Recognition of sequence-information in synthetic copolymer chains by a conformationally-constrained tweezer molecule

A novel type of tweezer molecule containing electron-rich 2-pyrenyloxy arms has been designed to exploit intramolecular hydrogen bonding in stabilising a preferred conformation for supramolecular complexation to complementary sequences in aromatic copolyimides. This tweezer-conformation is demonstrated by single-crystal X-ray analyses of the tweezer molecule itself and of its complex with an aromatic diimide model-compound. In terms of its ability to bind selectively to polyimide chains, the new tweezer molecule shows very high sensitivity to sequence effects. Thus, even low concentrations of tweezer relative to diimide units (<2.5 mol%) are sufficient to produce dramatic, sequence-related splittings of the pyromellitimide proton NMR resonances. These induced resonance-shifts arise from ring-current shielding of pyromellitimide protons by the pyrenyloxy arms of the tweezer-molecule, and the magnitude of such shielding is a function of the tweezer-binding constant for any particular monomer sequence. Recognition of both short-range and long-range sequences is observed, the latter arising from cumulative ring-current shielding of diimide protons by tweezer molecules binding at multiple adjacent sites on the copolymer chain.

Synthesis and evaluation of a solid supported molecular tweezer type receptor for cholesterol

A new macroporous stationary phase bearing 'tweezer' receptors that exhibit specificity for cholesterol has been constructed from rigid multifunctional vinylic monomers derived from 3,5-dibromobenzoic acid, propargyl alcohol and cholesterol. The synthesis of the novel tweezer monomer that contains two cholesterol receptor arms using palladium mediated Sonogashira methodologies and carbonate couplings is reported. The subsequent co-polymerisation of this tweezer monomer with a range of cross-linking agents via a 'pseudo' molecular imprinting approach afforded a diverse set of macroporous materials. The selectivity and efficacy of these materials for cholesterol binding was assessed using a chromatographic screening process. The optimum macroporous stationary phase material composition was subsequently used to construct monolithic solid phase extraction columns for use in the selective extraction of cholesterol from multi-component mixtures of structurally related steroids.

Metal complexes of cyclen and cyclam derivatives useful for medical applications: a discussion based on thermodynamic stability constants and structural data

A series of the most common chelators used in magnetic resonance imaging ( MRI) and in radiopharmaceuticals for medical diagnosis and tumour therapy, H(4)dota, H(4)teta, H(8)dotp and H(8)tetp, is examined from a chemical point of view. Differences between 12- and 14-membered tetraazamacrocyclic derivatives with methylcarboxylate and methylphosphonate pendant arms and their chelates with divalent first-series transition metal and trivalent lanthanide ions are discussed on the basis of their thermodynamic stability constants, X- ray structures and theoretical studies.

Bis- and tris-(3-aminopropyl) derivatives of 14-membered tetraazamacrocycles containing pyridine: synthesis, protonation and complexation studies

New N-(3-aminopropyl) (L-1, L-2) and (2-cyanoethyl) (L-3, L-4) derivatives of a 14-membered tetraazamacrocycle containing pyridine have been synthesized. The protonation constants of L-1 and L-2 and the stability constants of their complexes with Ni2+, Cu2+, Zn2+ and Cd2+ metal ions were determined in aqueous solutions by potentiometry, at 298.2 K and ionic strength 0.10 mol dm(-3) in KNO3. Both compounds have high overall basicity due to the presence of the aminopropyl arms. Their copper(II) complexes exhibit very high stability constants, which sharply decrease for the complexes of the other studied metal ions, as usually happens with polyamine ligands. Mono- and dinuclear complexes are formed with L-2 as well as with L-1, but the latter exhibits mononuclear complexes with slightly higher K-ML values while the dinuclear complexes of L-2 are thermodynamically more stable. The presence of these species in solution was supported by UV-VIS-NIR and EPR spectroscopic data. The single crystal structures of [Cu(H2L2)(ClO4)](3+) and [(CoLCl)-Cl-3](+) revealed that the metal centres are surrounded by the four nitrogen atoms of the macrocycle and one monodentate ligand, adopting distorted square pyramidal geometries. In the [(CoLCl)-Cl-3](+) complex, the macrocycle adopts a folded arrangement with the nitrogen atom opposite to the pyridine at the axial position while in the [Cu(H2L2)(ClO4)](3+) complex, the macrocycle adopts a planar conformation with the three aminopropyl arms located at the same side of the macrocyclic plane.

Bis- and tris-(methylphosphonic) acid derivatives of a 14-membered tetraazamacrocycle containing pyridine: synthesis, protonation and complexation studies

Two N-methylphosphonic acid derivatives of a 14-membered tetraazamacrocycle containing pyridine have been synthesized, H4L1 and H6L2. The protonation constants of these compounds and the stability constants of complexes of both ligands with Ni2+, Cu2+ and Zn2+ were determined by potentiometric methods at 298 K and ionic strength 0.10 mol dm(-3) in NMe4NO3. The high overall basicity of both compounds is ascribed to the presence of the phosphonate arms. H-1 and P-31 NMR spectroscopic titrations were performed to elucidate the sequence of protonation, which were complemented by conformational analysis studies. The complexes of these ligands have stability constants of the order of or higher than those formed with ligands having the same macrocyclic backbone but acetate arms. At pH = 7 the highest pM values were found for solutions containing the compound with three acetate groups, followed immediately by those of H6L2, however, as expected, the increasing pH favours the complexes of ligands containing phosphonate groups. The single-crystal structure of Na-2[Cu(HL1)]NO3.8H(2)O has shown that the coordination geometry around the copper atom is a distorted square pyramid. Three nitrogen atoms of the macrocyclic backbone and one oxygen atom from one methylphosphonate arm define the basal plane, and the apical coordination is accomplished via the nitrogen atom trans to the pyridine ring of the macrocycle. To achieve this geometric arrangement, the macrocycle adopts a folded conformation. This structure seems consistent with Uv-vis-NIR spectroscopy for the Ni2+ and the Cu2+ complexes and with the EPR for the latter.