Enfoque del paciente con trastornos del sueño

La importancia del sueño y las patologías relacionadas con el mismo son ampliamente reconocidas en el campo de la medicina y la neurología, sin embargo la mayoría de neurólogos dedican muy poco tiempo al estudio de estas entidades y muy raramente durante la valoración de los pacientes se indaga acerca de la presencia de trastornos relacionados con el sueño. Esto es sorprendente si tenemos en cuenta que pasamos casi un tercio de la vida durmiendo, además de la alta incidencia de trastornos de sueño en la población general. A continuación revisaremos los principales trastornos del sueño, su diagnóstico y tratamiento.

Eficacia de la melatonina en insomnio primario en el adulto mayor: revisión sistemática de la literatura

Introducción: La melatonina, una sustancia cronobiótica endógena, es cada vez más empleada para el manejo de los problemas del sueño en adultos mayores por su aparente eficacia y buen perfil de eventos adversos. En este sentido, se intentó evaluar la eficacia de la melatonina en el tratamiento del insomnio primario en el adulto mayor (≥55 años) comparado con benzodiacepinas, zopiclona y placebo a la luz de la evidencia disponible en los últimos cinco años. Métodos: Revisión sistemática de la literatura. Resultados: En comparación con placebo, al parecer la melatonina mejora la calidad y los hábitos de sueño, no así la latencia de inicio de sueño en mediciones subjetivas ni objetivas (polisomnografía); a diferencia de otros medicamentos hipnóticos, no altera la arquitectura del sueño ni genera síntomas diurnos. Conclusiones: No se encontró evidencia que soporte el uso de melatonina en adultos mayores de 55 años para la reducción de la latencia de sueño, aumento del tiempo total de sueño, mejoría de la eficiencia del sueño, disminución de despertares nocturnos o mejoría de la calidad de sueño. Es necesario adelantar más estudios en comparación con placebo y otros medicamentos.

Eficacia y seguridad de la melatonina para el manejo de los trastornos del sueño en el autismo: meta-análisis

INTRODUCCIÓN: El 80% de los niños y adolescentes con trastornos del espectro autista (TEA) presenta algún trastorno del sueño, en cuya génesis al parecer intervienen alteraciones en la regulación de la melatonina. El objetivo de este metaanálisis fue determinar la eficacia y seguridad de la melatonina para el manejo de ciertos trastornos del sueño en niños con TEA. MÉTODOS: Tres revisores extrajeron los datos relevantes de los ensayos clínicos aleatorizados doble ciego de alta calidad publicados en bases de datos primarias, de ensayos clínicos, de revisiones sistemáticas y de literatura gris; además se realizó búsqueda en bola de nieve. Se analizaron los datos con RevMan 5.3. Se realizó un análisis del inverso de la varianza por un modelo de efectos aleatorios para las diferencias de medias de los desenlaces propuestos: duración del tiempo total, latencia de sueño y número de despertares nocturnos. Se evaluó la heterogeneidad interestudios con el parámetro I2 RESULTADOS: La búsqueda inicial arrojó 355 resultados, de los cuales tres cumplieron los criterios de selección. La melatonina resultó ser un medicamento seguro y eficaz para aumentar la duración total del sueño y disminuir la latencia de sueño en niños y adolescentes con TEA; hasta el momento la evidencia sobre el número de despertares nocturnos no es estadísticamente significativa. DISCUSIÓN: A la luz de la evidencia disponible, la melatonina es una elección segura y eficaz para el manejo de ciertos problemas del sueño en niños y adolescentes con TEA. Es necesario realizar estudios con mayores tamaños muestrales y comparados con otros medicamentos disponibles en el mercado.

Superphonics book 3 : the simplest, fastest way to teach your child to read.

Forma parte de una serie de cinco libros basada en la consideración de que la fonética es una forma muy eficaz de enseñar la lectura y la escritura a los niños de primaria. Se basa en la relación existente entre letras y sonidos, es decir, entra la unidad de sonido que se llama fonema y la unidad escrita, grafema. En este tercer libro, el niño aprende palabras con cuatro o más letras y lee y deletrea palabras como: hand, clock y splash.

Filogenia y genética poblacional del género Androcymbium (Colchiceae)

En este trabajo se ha estudiado el género Androcymbium (Colchicaceae) a dos niveles: macro- y micro- evolutivo. A nivel microevolutivo se ha obtenido que para las especies de Sudáfrica oriental la componente interpoblacional es muy importante para explicar la distribución de la variabilidad genética, igual que en Sudáfrica occidental. Para las especies de Namibia, la componente mas importante es la intrapoblacional, igual que en el norte de África. A nivel macroevolutivo se ha obtenido que el origen del género se sitúa en Sudáfrica occidental, datándose en 11,22 ma. Este género ha resultado ser parafilético, dada la aparición conjunta en un mismo clado de especies de Androcymbium y Colchicum, y las especies del norte de África derivan de un taxa de Namibia que llegó a la cuenca Mediterránea a principios del Plioceno gracias a la formación de un corredor árido entre las zonas áridas del suroeste y este de África.

Statistical inference of OH concentrations and air mass dilution rates from successive observations of non-methane hydrocarbons in single air masses

Bayesian inference has been used to determine rigorous estimates of hydroxyl radical concentrations () and air mass dilution rates (K) averaged following air masses between linked observations of nonmethane hydrocarbons (NMHCs) spanning the North Atlantic during the Intercontinental Transport and Chemical Transformation (ITCT)-Lagrangian-2K4 experiment. The Bayesian technique obtains a refined (posterior) distribution of a parameter given data related to the parameter through a model and prior beliefs about the parameter distribution. Here, the model describes hydrocarbon loss through OH reaction and mixing with a background concentration at rate K. The Lagrangian experiment provides direct observations of hydrocarbons at two time points, removing assumptions regarding composition or sources upstream of a single observation. The estimates are sharpened by using many hydrocarbons with different reactivities and accounting for their variability and measurement uncertainty. A novel technique is used to construct prior background distributions of many species, described by variation of a single parameter . This exploits the high correlation of species, related by the first principal component of many NMHC samples. The Bayesian method obtains posterior estimates of , K and following each air mass. Median values are typically between 0.5 and 2.0 × 106 molecules cm−3, but are elevated to between 2.5 and 3.5 × 106 molecules cm−3, in low-level pollution. A comparison of estimates from absolute NMHC concentrations and NMHC ratios assuming zero background (the “photochemical clock” method) shows similar distributions but reveals systematic high bias in the estimates from ratios. Estimates of K are ∼0.1 day−1 but show more sensitivity to the prior distribution assumed.

Correlating Bayesian date estimates with climatic events and domestication using a bovine case study

The tribe Bovini contains a number of commercially and culturally important species, such as cattle. Understanding their evolutionary time scale is important for distinguishing between post-glacial and domestication-associated population expansions, but estimates of bovine divergence times have been hindered by a lack of reliable calibration points. We present a Bayesian phylogenetic analysis of 481 mitochondrial D-loop sequences, including 228 radiocarbon-dated ancient DNA sequences, using a multi-demographic coalescent model. By employing the radiocarbon dates as internal calibrations, we co-estimate the bovine phylogeny and divergence times in a relaxed-clock framework. The analysis yields evidence for significant population expansions in both taurine and zebu cattle, European aurochs and yak clades. The divergence age estimates support domestication-associated expansion times (less than 12 kyr) for the major haplogroups of cattle. We compare the molecular and palaeontological estimates for the Bison-Bos divergence.

A double data rate (DDR) architecture for OFDM based wireless consumer devices

The creation of OFDM based Wireless Personal Area Networks (WPANs) has allowed the development of high bit-rate wireless communication devices suitable for streaming High Definition video between consumer products, as demonstrated in Wireless-USB and Wireless-HDMI. However, these devices need high frequency clock rates, particularly for the OFDM, FFT and symbol processing sections resulting in high silicon cost and high electrical power. The high clock rates make hardware prototyping difficult and verification is therefore very important but costly. Acknowledging that electrical power in wireless consumer devices is more critical than the number of implemented logic gates, this paper presents a Double Data Rate (DDR) architecture for implementation inside a OFDM baseband codec in order to reduce the high frequency clock rates by a complete factor of 2. The presented architecture has been implemented and tested for ECMA-368 (Wireless- USB context) resulting in a maximum clock rate of 264MHz instead of the expected 528MHz clock rate existing anywhere on the baseband codec die.

A double data rate (DDR) architecture for OFDM based wireless consumer devices

The creation of OFDM based Wireless Personal Area Networks (WPANs) has allowed high bit-rate wireless communication devices suitable for streaming High Definition video between consumer products as demonstrated in Wireless- USB. However, these devices need high clock rates, particularly for the OFDM sections resulting in high silicon cost and high electrical power. Acknowledging that electrical power in wireless consumer devices is more critical than the number of implemented logic gates, this paper presents a Double Data Rate (DDR) architecture to reduce the OFDM input and output clock rate by a factor of 2. The architecture has been implemented and tested for Wireless-USB (ECMA-368) resulting in a maximum clock of 264MHz instead of 528MHz existing anywhere on the die.

Changes in light intensity can influence age at sexual maturity in domestic pullets

1. Shaver White and ISA Brown pullets were reared to 140 d in groups of 8 in cages on a 10-h photoperiod of incandescent light and maintained at an illuminance of 3 or 25 lux, or transferred from 3 to 25 lux or from 25 to 3 lux at 63 or 112 d of age. 2. There was no significant difference in sexual maturity, measured as eggs per 100 bird.d at 139 and 140 d, for ISA Brown maintained on 3 or 25 lux, but Shaver White pullets exposed to constant 3 lux matured significantly later than those maintained on 25 lux. 3. In Shaver Whites, sexual maturity was significantly delayed by an increase from 3 to 25 lux at 63 and 112 d, and advanced by a decrease from 25 to 3 lux at 112 d. Sexual maturity of ISA Browns was not significantly affected by a change in illuminance at 63 or 112 d, though responses were in the same direction as for Shaver Whites. 4. In both breeds, total feed consumed to 112 d was higher for birds on 3 lux than 25 lux, but lower between 112 d and 140 d when birds on 25 lux underwent rapid sexual development. In both breeds, body weight at 63 d was higher for birds exposed to 3 lux than 25 lux, but body weight gain thereafter was similar for the two light intensities. 5. In both breeds, plasma luteinising hormone (LH) concentration at 63 and 112 d was lower in birds maintained on 3 lux than 25 lux. At 63 and 112 d, transfers from 25 to 3 lux depressed, whereas transfers from 3 to 25 lux at 63 d, but not at 112 d, increased plasma LH. 6. Advances or delays in sexual maturity induced by changes in illuminance were not correlated with differences in feed intake, body weight gain, or with changes in plasma LH. 7. One possible explanation for the inverse relationship between the direction of change in illuminance at 63 and 112 d in pullets exposed to a 10-h photoperiod and the age at which they became sexually mature is that changes in light intensity and/or spectral composition affect the entrainment of the circadian rhythm of photoinducibility, to effect a phase shift in the photoinducible phase and/or the responsiveness of phototransduction pathways.

Environmental control for layers

Light patterns have less effect on numbers of eggs laid by current stocks than on those of forty years ago, but the principles have not changed. Ovarian activity is stimulated by increasing photoperiods and suppressed by decreasing photoperiods. The light pattern used during rearing can still have large effects on age at 50% lay, even for modern stocks. Early sexual maturity maximises egg numbers but gives smaller eggs. Late maturity maximises egg size at the expense of numbers. The relationship between egg output (g/hen d) and age at first egg is curvilinear, with maximum yield occurring in flocks maturing in about the centre of their potential range. Fancy patterns of increasing daylength after maturity are probably not justified. A flock held on a constant 14h day will lay as many eggs as one given step up lighting. Intermittent lighting saves about 5% of feed consumption with no loss of output, provided that the feed has adequate amino acid content to allow for the reduced feed intake. Producers with light-proof laying houses should be taking advantage of intermittent lighting. The recommended light intensity for laying houses is still 10 lx, although the physiological threshold for response to changes in photoperiod is closer to 2 lx. Very dim (0.05 lx) light filtering into blacked out houses will not stimulate the hypothalamic receptors responsible for photo-sexual responses, but may affect the bird's biological clock, which can alter its response to a constant short photoperiod. Feed intake shows a curvilinear dependence on environmental temperature. At temperatures below the panting threshold, performance can be maintained by adjusting the feed so as to maintain an adequate intake of critical amino acids. Above the panting threshold, the hen is unable to take in enough energy to maintain normal output. There is no dietary modification which can effectively offset this problem. Diurnally cycling temperatures result in feed intake and egg production equivalent to that observed under a constant temperature equal to the mean of the cycle. When the poultry house is cooler at night than by day, it helps to provide light so that the birds can feed during the cooler part of the cycle.

Large punctuational contribution of speciation to evolutionary divergence at the molecular level

A long-standing debate in evolutionary biology concerns whether species diverge gradually through time or by punctuational episodes at the time of speciation. We found that approximately 22% of substitutional changes at the DNA level can be attributed to punctuational evolution, and the remainder accumulates from background gradual divergence. Punctuational effects occur at more than twice the rate in plants and fungi than in animals, but the proportion of total divergence attributable to punctuational change does not vary among these groups. Punctuational changes cause departures from a clock-like tempo of evolution, suggesting that they should be accounted for in deriving dates from phylogenies. Punctuational episodes of evolution may play a larger role in promoting evolutionary divergence than has previously been appreciated.

Detecting the node-density artifact in phylogeny reconstruction

The node-density effect is an artifact of phylogeny reconstruction that can cause branch lengths to be underestimated in areas of the tree with fewer taxa. Webster, Payne, and Pagel (2003, Science 301:478) introduced a statistical procedure (the "delta" test) to detect this artifact, and here we report the results of computer simulations that examine the test's performance. In a sample of 50,000 random data sets, we find that the delta test detects the artifact in 94.4% of cases in which it is present. When the artifact is not present (n = 10,000 simulated data sets) the test showed a type I error rate of approximately 1.69%, incorrectly reporting the artifact in 169 data sets. Three measures of tree shape or "balance" failed to predict the size of the node-density effect. This may reflect the relative homogeneity of our randomly generated topologies, but emphasizes that nearly any topology can suffer from the artifact, the effect not being confined only to highly unevenly sampled or otherwise imbalanced trees. The ability to screen phylogenies for the node-density artifact is important for phylogenetic inference and for researchers using phylogenetic trees to infer evolutionary processes, including their use in molecular clock dating. [Delta test; molecular clock; molecular evolution; node-density effect; phylogenetic reconstruction; speciation; simulation.]

The effect of Parkinson's disease on time estimation as a function of stimulus duration range and modality

The present research sought to investigate the role of the basal ganglia in timing of sub- and supra-second intervals via an examination of the ability of people with Parkinson's disease (PD) to make temporal judgments in two ranges, 100-500 ms, and 1-5 s. Eighteen nondemented medicated patients with PD were compared with 14 matched controls on a duration-bisection task in which participants were required to discriminate auditory and visual signal durations within each time range. Results showed that patients with PD exhibited more variable duration judgments across both signal modality and duration range than controls, although closer analyses confirmed a timing deficit in the longer duration range only. The findings presented here suggest the bisection procedure may be a useful tool in identifying timing impairments in PD and, more generally, reaffirm the hypothesised role of the basal ganglia in temporal perception at the level of the attentionally mediated internal clock as well as memory retrieval and/or decision-making processes. (c) 2007 Elsevier Inc. All rights reserved.

Investigation into low power of a 2D Inverse Discrete CosineTransform (IDCT) in FPGAs

Design for low power in FPGA is rather limited since technology factors affecting power are either fixed or limited for FPGA families. This paper investigates opportunities for power savings of a pipelined 2D IDCT design at the architecture and logic level. We report power consumption savings of over 25% achieved in FPGA circuits obtained from clock gating implementation of optimizations made at the algorithmic level(1).