Existen diferencias farmacocinéticas y tiempos de despertar entre mujeres y hombres con anestesia total intravenosa

Introducción: La anestesia total intravenosa (TIVA) es ampliamente usada y reportada en la literatura como técnica para disminuir la respuesta a la laringoscopia e intubación, en la inducción y mantenimiento de una adecuada anestesia, además de una mejor estabilidad hemodinámica y recuperación pos anestésica; sin embargo no existen un gran número de estudios que comparen el uso de TIVA, determinando si existen diferencias en el perfil farmacocinético según el género del paciente. Objetivo: Describir diferencias farmacocinéticas y de los tiempos de despertar y salida a la unidad de cuidados pos anestésicos (descarga), según el género; en pacientes que reciben TIVA, con remifentanil y propofol, orientado por Stangraf. Metodología: Estudio observacional analítico de corte transversal, en pacientes llevados a cirugía bajo TIVA en el Hospital Occidente de Kennedy en el periodo de junio de 2013 a Enero de 2014.Usando SPSS versión 20 Windows, se analizaron los datos mediante pruebas Kolmogorov-Smirnov y Shapiro-Wilk y U de Mann Withney. Un valor de p menor 0.05 fue aceptado como estadísticamente significativo. Resultados: Se aplicaron pruebas de normalidad y no se encontraron diferencias estadísticamente significativas entre género. El tiempo de despertar fue 9.36 minutos para mujeres y 11.26 minutos para hombres. Los tiempos de descarga fueron 10.71 minutos para mujeres y 12.82 minutos para hombres. Discusión. El tiempo de despertar y descarga no es diferente entre mujeres y hombres en los pacientes analizados. Se requieren estudios adicionales entre grupos poblacionales de diversas condiciones farmacocineticas para corroborar los datos.

Medical Student’s Use of Time During Clinical Clerkships and the Credits Based System

Introduction: Comprehensive undergraduate education in clinical sciences is grounded on activities developed during clerkships. To implement the credits system we must know how these experiences take place. Objectives: to describe how students spend time in clerkships, how they assess the educative value of activities and the enjoyment it provides. Method: We distributed a form to a random clustered sample of a 100 students coursing clinical sciences, designed to record the time spent, and to assess the educative value and the grade of enjoyment of the activities in clerkship during a week. Data were registered and analyzed on Excel® 98 and SPSS. Results: mean time spent by students in clerkship activities on a day were 10.8 hours. Of those, 7.3 hours (69%) were spent in formal education activities. Patient care activities with teachers occupied the major proportion of time (15.4%). Of the teaching and learning activities in a week, 28 hours (56%) were spent in patient care activities and 22.4 hours (44.5%) were used in independent academic work. The time spent in teaching and learning activities correspond to 19 credits of a semester of 18 weeks. The activities assessed as having the major educational value were homework activities (4.6) and formal education activities (4.5). The graded as most enjoyable were extracurricular activities, formal educational activities and independent academic work. Conclusion: our students spend more time in activities with patients than the reported in literature. The attending workload of our students is greater than the one reported in similar studies.

Prevalencia de delirium en población adulta en cuidado intensivo.

Introducción: El delirium es un trastorno de conciencia de inicio agudo asociado a confusión o disfunción cognitiva, se puede presentar hasta en 42% de pacientes, de los cuales hasta el 80% ocurren en UCI. El delirium aumenta la estancia hospitalaria, el tiempo de ventilación mecánica y la morbimortalidad. Se pretendió evaluar la prevalencia de periodo de delirium en adultos que ingresaron a la UCI en un hospital de cuarto nivel durante 2012 y los factores asociados a su desarrollo. Metodología Se realizó un estudio transversal con corte analítico, se incluyeron pacientes hospitalizados en UCI médica y UCI quirúrgica. Se aplicó la escala de CAM-ICU y el Examen Mínimo del Estado Mental para evaluar el estado mental. Las asociaciones significativas se ajustaron con análisis multivariado. Resultados: Se incluyeron 110 pacientes, el promedio de estancia fue 5 días; la prevalencia de periodo de delirium fue de 19.9%, la mediana de edad fue 64.5 años. Se encontró una asociación estadísticamente significativa entre el delirium y la alteración cognitiva de base, depresión, administración de anticolinérgicos y sepsis (p< 0,05). Discusión Hasta la fecha este es el primer estudio en la institución. La asociación entre delirium en la UCI y sepsis, uso de anticolinérgicos, y alteración cognitiva de base son consistentes y comparables con factores de riesgo descritos en la literatura mundial.

Sobrepeso y obesidad como causas de óbito fetal: revisión sistemática de literatura

La obesidad es una de las causas de óbito fetal documentadas en la literatura, pero actualmente no hay datos conclusivos sobre el efecto del sobrepeso como causa de óbito. Con la presente revisión sistemática se pretendió evaluar la evidencia relacionada con las alteraciones de peso como causa de óbito fetal. Se realizó una revisión sistemática de la literatura en múltiples bases de datos incluyendo la mejor evidencia relacionada con el tema en un periodo de cinco años. El sobrepeso/obesidad es un factor de riesgo modificable en toda mujer que planea una gestación; la intervención oportuna durante la valoración preconcepcional puede modificar todos los factores en cuanto a patrones de alimentación, ejercicio y hábitos de vida saludable.

The story behind Charles Dickens' Oliver Twist.

Esta obra literaria se utiliza como base para mostrar,las tendencias sociales, el contexto social, los acontecimientos históricos de Londres en la época victoriana: cómo se vivía, la actitud hacia la pobreza, el tipo de educación que recibían los niños, las condiciones en las fábricas, etc., y expone cómo la literatura refleja la historia. Tiene cronología, glosario y bibliografía.

El risc dinàmic: concepte, mesura i determinants econòmics

Aquesta tesi té la intenció de realitzar una contribució metodològica en el camp de la direcció estratègica, per mitjà de tres objectius: la revisió del concepte de risc ex post o realitzat per l'àmbit de la direcció estratègica; la concreció d'aquest concepte en una mesura de risc vàlida; i l'exploració de les possibilitats i l'interès de la descomposició del risc en diferents determinants que puguin explicar-ne la seva naturalesa. El primer objectiu es du a terme prenent com a base el concepte intuïtiu de risc i revisant la literatura en els camps més afins, especialment en la teoria comportamental de la decisió i la direcció estratègica. L'anàlisi porta a formular el risc ex post d'una activitat com el grau en què no s'han assolit els objectius per a aquesta activitat. La concreció d'aquesta definició al camp de la direcció estratègica implica que els objectius han de portar a l'obtenció de l'avantatge competitiu sostenible, el que descobreix l'interès de realitzar la mesura del risc a curt termini, és a dir, estàticament, i a llarg termini, és a dir, dinàmicament, pel que es defineix una mesura de Risc Estàtic i una altra de Risc dinàmic, respectivament. En l'anàlisi apareixen quatre dimensions conceptuals bàsiques a incorporar en les mesures: sign dependence, relativa, longitudinal i path dependence. Addicionalment, la consideració de que els resultats puguin ser cardinals o ordinals justifica que es formulin les dues mesures anteriors per a resultats cardinals i, en segon lloc, per a resultats ordinals. Les mesures de risc que es proposen sintetitzen els resultats ex post obtinguts en una mesura de centralitat relativa dels resultats, el Risc Estàtic, i una mesura de la tendència temporal dels resultats, el Risc Dinàmic. Aquesta proposta contrasta amb el plantejament tradicional dels models esperança-variància. Les mesures desenvolupades s'avaluen amb un sistema de propietats conceptuals i tècniques que s'elaboren expressament en la tesi i que permeten demostrar el seu gra de validesa i el de les mesures existents en la literatura, destacant els problemes de validesa d'aquestes darreres. També es proporciona un exemple teòric il·lustratiu de les mesures proposades que dóna suport a l'avaluació realitzada amb el sistema de propietats. Una contribució destacada d'aquesta tesi és la demostració de que les mesures de risc proposades permeten la descomposició additiva del risc si els resultats o diferencials de resultats es descomponen additivament. Finalment, la tesi inclou una aplicació de les mesures de Risc Estàtic i Dinàmic cardinals, així com de la seva descomposició, a l'anàlisi de la rendibilitat del sector bancari espanyol, en el període 1987-1999. L'aplicació il·lustra la capacitat de les mesures proposades per a analitzar la manifestació de l'avantatge competitiu, la seva evolució i naturalesa econòmica. En les conclusions es formulen possibles línees d'investigació futures.

Entrepreneurship, ties and relational networks: the case of a public-private cross-border tourism product

The thesis aims to understand the processes of entrepreneurship that try to create businesses or products with a high degree of complexity. This complexity comes from the fact that these products or initiatives can only be viable with the concurrence of a large number of heterogeneous actors (public, private, from different regions, etc..) which interact in a relational context. A case with these characteristics is the Camí dels Bons Homes. The thesis analyzes the evolution of the relational network from the point of view of its structure and content of its links. The results show and explain the observed changes in the network structure and the changes in the ties content. This analysis of the content of ties contributes to a new systematization and operationalization of ties’ content. Moreover this analysis takes in account negative ties, a less discussed issue in literature.

«Às portas da lei»(?): reflexos do diálogo divergente entre West e Posner sobre as possíveis leituras de Kafka na perspetivação do homem perante o direito

Considerando duas diferentes perspetivas acerca da relevância do Movimento Law and Literature na sua configuração Law in Literature, a de Robin WEST e a de Richard POSNER, especificamente confrontando as suas divergentes leituras de Franz KAFKA, o presente artigo propõe uma leitura crítica das consequências das correspondentemente conflituantes compreensões antropológicas para os problemas do sentido do direito e da posição do homem perante o direito.

Práticas de liderança para uma escola inclusiva

Pensar numa escola de todos e para todos é pensar e reconhecer a heterogeneidade dos alunos que a frequentam e responder a cada um deles segundo as suas necessidades. Assim, uma liderança forte é absolutamente vital para o desenvolvimento de ofertas educativas orientadas para a diversidade, incentivando todos os intervenientes a construir uma cultura de colaboração e reflexão. A escolha do problema a ser investigado, tendo como pergunta de partida, que práticas de liderança levar a cabo num projeto educativo para uma escola efetivamente inclusiva, surgiu da reflexão autobiográfica, das atuais funções da investigadora, enquanto elemento da Direção de uma escola, e da caracterização do agrupamento de escolas ao qual pertence. Com base na revisão de literatura, procurou-se clarificar e definir conceitos, aprofundar conhecimentos, de forma a reconhecer o que já foi feito, através de uma reflexão sobre o desenvolvimento do agrupamento em estudo, e propor ações/práticas de liderança a melhorar ou outras ainda não realizadas, com o objetivo que o mesmo seja efetivamente inclusivo.

Potential of Brassic rapa, Cannabis sativa, Helianthus annuus and Zea mays for phytoextraction of heavy metals from calcareous dredged sediment derived soils

Remediation of soil pollution is one of the many current environmental challenges. Anthropogenic activity has resulted in the contamination of extended areas of land, the remediation of which is both invasive and expensive by conventional means. Phytoextraction of heavy metals from contaminated soils has the prospect of being a more economic in situ alternative. In addition, phytoextraction targets ecotoxicologically the most relevant soil fraction of these metals, i.e. the bioavailable fraction. Greenhouse experiments were carried out to evaluate the potential of four high biomass crop species in their potential for phytoextraction of heavy metals, with or without with the use of soil amendments (EDTA or EDDS). A calcareous dredged sediment derived surface soil, with high organic matter and clay content and moderate levels of heavy metal pollution, was used in the experiments. No growth depression was observed in EDTA or EDDS treated pots in comparison to untreated controls. Metal accumulation was considered to be low for phytoextraction purposes, despite the use of chelating agents. The low observed shoot concentrations of heavy metals were attributed to the low phytoavailability of heavy metals in this particular soil substrate. The mobilising effects induced by EDTA in the soil were found to be too long-lived for application as a soil amendment in phytoextraction. Although EDDS was found to be more biodegradable, higher effect half lives were observed than reported in literature or observed in previous experiments. These findings caution against the use of any amendment, biodegradable or otherwise, without proper investigation of its effects and the longevity thereof. (C) 2005 Elsevier Ltd. All rights reserved.

Use of a crop model ensemble to quantify CO2 stimulation of water-stressed and well-watered crops

Increased atmospheric concentrations of carbon dioxide (CO2) will benefit the yield of most crops. Two free air CO2 enrichment (FACE) meta-analyses have shown increases in yield of between 0 and 73% for C3 crops. Despite this large range, few crop modelling studies quantify the uncertainty inherent in the parameterisation of crop growth and development. We present a novel perturbed-parameter method of crop model simulation, which uses some constraints from observations, that does this. The model used is the groundnut (i.e. peanut; Arachis hypogaea L.) version of the general large-area model for annual crops (GLAM). The conclusions are of relevance to C3 crops in general. The increases in yield simulated by GLAM for doubled CO2 were between 16 and 62%. The difference in mean percentage increase between well-watered and water-stressed simulations was 6.8. These results were compared to FACE and controlled environment studies, and to sensitivity tests on two other crop models of differing levels of complexity: CROPGRO, and the groundnut model of Hammer et al. [Hammer, G.L., Sinclair, T.R., Boote, K.J., Wright, G.C., Meinke, H., Bell, M.J., 1995. A peanut simulation model. I. Model development and testing. Agron. J. 87, 1085-1093]. The relationship between CO2 and water stress in the experiments and in the models was examined. From a physiological perspective, water-stressed crops are expected to show greater CO2 stimulation than well-watered crops. This expectation has been cited in literature. However, this result is not seen consistently in either the FACE studies or in the crop models. In contrast, leaf-level models of assimilation do consistently show this result. An analysis of the evidence from these models and from the data suggests that scale (canopy versus leaf), model calibration, and model complexity are factors in determining the sign and magnitude of the interaction between CO2 and water stress. We conclude from our study that the statement that 'water-stressed crops show greater CO2 stimulation than well-watered crops' cannot be held to be universally true. We also conclude, preliminarily, that the relationship between water stress and assimilation varies with scale. Accordingly, we provide some suggestions on how studies of a similar nature, using crop models of a range of complexity, could contribute further to understanding the roles of model calibration, model complexity and scale. (C) 2008 Elsevier B.V. All rights reserved.

A study on intelligent building models

Mathematical models devoted to different aspects of building studies and brought about a significant shift in the way we view buildings. From this background a new definition of building has emerged known as intelligent building that requires integration of a variety of computer-based complex systems. Research relevant to intelligent continues to grow at a much faster pace. This paper is a review of different mathematical models described in literature, which make use of different mathematical methodologies, and are intended for intelligent building studies without complex mathematical details. Models are discussed under a wide classification. Mathematical abstract level of the applied models is detailed and integrated with its literature. The goal of this paper is to present a comprehensive account of the achievements and status of mathematical models in intelligent building research. and to suggest future directions in models.

Multiplexed quantitative proteomics using differential metabolic 15N-labeling

There are several advantages of using metabolic labeling in quantitative proteomics. The early pooling of samples compared to post-labeling methods eliminates errors from different sample processing, protein extraction and enzymatic digestion. Metabolic labeling is also highly efficient and relatively inexpensive compared to commercial labeling reagents. However, methods for multiplexed quantitation in the MS-domain (or ‘non-isobaric’ methods), suffer from signal dilution at higher degrees of multiplexing, as the MS/MS signal for peptide identification is lower given the same amount of peptide loaded onto the column or injected into the mass spectrometer. This may partly be overcome by mixing the samples at non-uniform ratios, for instance by increasing the fraction of unlabeled proteins. We have developed an algorithm for arbitrary degrees of nonisobaric multiplexing for relative protein abundance measurements. We have used metabolic labeling with different levels of 15N, but the algorithm is in principle applicable to any isotope or combination of isotopes. Ion trap mass spectrometers are fast and suitable for LC-MS/MS and peptide identification. However, they cannot resolve overlapping isotopic envelopes from different peptides, which makes them less suitable for MS-based quantitation. Fourier-transform ion cyclotron resonance (FTICR) mass spectrometry is less suitable for LC-MS/MS, but provides the resolving power required to resolve overlapping isotopic envelopes. We therefore combined ion trap LC-MS/MS for peptide identification with FTICR LC-MS for quantitation using chromatographic alignment. We applied the method in a heat shock study in a plant model system (A. thaliana) and compared the results with gene expression data from similar experiments in literature.