Uso de la hipotermia en el síndrome posparada cardíaca

Antecedentes: La parada cardiorrespiratoria es uno de los principalesproblemas sanitarios en los países desarrollados, además de por la mortalidadproducida, por las importantes repercusiones neurológicas posteriores quepresentan las personas que sobreviven. Hasta un 64% de los supervivientespuede presentar secuelas de gravedad, y tan solo un 1,4% queda exento dealgún tipo de alteración neurológica. Distintos ensayos clínicos, muestran quela hipotermia inducida ligera, es decir, el descenso controlado de latemperatura corporal mejora la supervivencia y los daños neurológicos en lospacientes adultos inconscientes tras una resucitación cardiopulmonar. Sinembargo, no está del todo claro cuáles son los pacientes más indicados pararecibir la terapia, la técnica de inducción ideal, la temperatura objetivo, suduración y la tasa idónea de recalentamiento.Objetivos: El objetivo del estudio es conocer la técnica de hipotermiaterapéutica como cuidado posresucitación tras sufrir una parada cardíaca.Metodología: Para ello, se realizó una búsqueda bibliográfica a través de lassiguientes bases de datos: CSIC, Medline PubMed, CINAHL, BibliotecaCochrane, Cuiden Plus, Dialnet, Scopus y ScienceDirect. Finalmente, seaceptaron 8 artículos que pertenecían a los criterios de inclusión: revisionessistemáticas, ensayos clínicos, revisiones bibliográficas y documentos deconsenso tras consejo de expertos, en español o inglés, publicados desde elaño 2005 hasta el año 2013 cuyos sujetos de estudio son adultos.Resultados: en la actualidad, se recomienda que los pacientes adultosinconscientes, con recuperación de la circulación espontánea tras una paradacardíaca extrahospitalaria, deben ser enfriados a 32-34ºC durante un periodode 12-24 horas cuando el ritmo inicial sea fibrilación ventricular. Se establecen4 periodos de tratamiento: inducción (desde el ingreso en la unidad hasta quese alcanzan los 33ºC), mantenimiento (desde el logro de los 33ºC hasta 24horas después), recalentamiento (12 horas de incremento de la temperatura,hasta alcanzar los 37ºC) y estabilización térmica (12 horas posteriores aalcanzar los 37ºC). Los métodos de inducción y mantenimiento de la hipotermiason diversos y se establecen dos grupos: técnicas invasivas y no invasivas.Palabras clave: hipotermia inducida, parada cardíaca, técnicas enfriamiento

Exchange rate predictability

The main goal of this article is to provide an answer to the question: "Does anything forecast exchange rates, and if so, which variables?". It is well known thatexchange rate fluctuations are very difficult to predict using economic models, andthat a random walk forecasts exchange rates better than any economic model (theMeese and Rogoff puzzle). However, the recent literature has identified a series of fundamentals/methodologies that claim to have resolved the puzzle. This article providesa critical review of the recent literature on exchange rate forecasting and illustratesthe new methodologies and fundamentals that have been recently proposed in an up-to-date, thorough empirical analysis. Overall, our analysis of the literature and thedata suggests that the answer to the question: "Are exchange rates predictable?" is,"It depends" -on the choice of predictor, forecast horizon, sample period, model, andforecast evaluation method. Predictability is most apparent when one or more of thefollowing hold: the predictors are Taylor rule or net foreign assets, the model is linear, and a small number of parameters are estimated. The toughest benchmark is therandom walk without drift.

Long diagnostic delay in Crohn's disease is associated with complicated disease course and increased operation rate

Background and Aims: The impact of d iagnostic delay ( a period from appearance of f irst s ymptoms t o diagnosis) o n the clinical c ourse o f Crohn's disease (CD) i s unknown. W e examined whether length of d iagnostic delay a ffects d isease outcome. Methods: Data from the Swiss IBD cohort study were analyzed. T he frequencies of o ccurrence of b owel s tenoses, internal fistulas, perianal f istulas, and CD-related surgery at distinct i ntervals a fter C D diagnosis (0 - < 2 , 2 - < 6,  6 years) were c ompared f or g roups o f patients w ith different length of d iagnostic delay. Results: T he data from a g roup o f 200 CD patients with long diagnostic delay (> 24 months, 76th - 100th p ercentile) were c ompared to t hose from a group of 4 61 patients with a short diagnostic delay ( within 9 months, 1st - 50th p ercentile). T reatment r egimens d id n ot d iffer between t he two groups. Two years following diagnosis, p atients with long diagnostic delay presented more frequently with bowel stenoses (25% vs. 13.1%, p = 0.044), internal fistulas (10% vs. 2%, p = 0.018), perianal f istulas ( 20% vs. 8 .1%, p = 0.023) a nd more frequently underwent intestinal surgery (15% vs. 5 .1%, p = 0.024) t han patients with short diagnostic delay. Intestinal surgery was a lso m ore frequently p erformed  6 y ears after diagnosis in t he group with long d iagnostic delay ( 56.2% vs. 42.3%, p = 0.005) w hen compared to t he g roup with short diagnostic delay. Conclusions: L ong diagnostic delay i s associated with worse o utcome c haracterized by t he development o f increased bowel damage, n ecessitating more frequently operations in t he years following CD d iagnosis. Efforts should be undertaken to shorten the diagnostic delay.

Understanding the gains from wage flexibility: The exchange rate connection

We study the gains from increased wage flexibility and their dependence on exchange rate policy, using a small open economy model with staggered price andwage setting. Two results stand out: (i) the impact of wage adjustments on employment is smaller the more the central bank seeks to stabilize the exchange rate,and (ii) an increase in wage flexibility often reduces welfare, and more likely so ineconomies under an exchange rate peg or an exchange rate-focused monetary policy.Our findings call into question the common view that wage flexibility is particularlydesirable in a currency union.

Avaluació de la futura gestió i utilització de la biomassa forestal mitjançant un district heating a Bellver de Cerdanya

En aquest article es pretén explicar breument la viabilitat de la futura gestió i utilització de la biomassa forestal de Bellver de Cerdanya mitjançant un district heating al futur barri del Pla de Tomet. Les particularitats per les quals aquest poble és ideal per a aquest projecte són que l'ajuntament és propietari de gairebé un 90% dels boscos situats en aquest municipi; i que alhora ja ha realitzat diverses instal·lacions que utilitzen la biomassa forestal per a calefacció i ACS. La situació econòmica de la comarca és bastant complicada, ja que s'ha basat en el sector turístic i la construcció, però ambdós no passen pel millor moment. El projecte serviria per donar un valor a la biomassa forestal que fins ara no s'ha donat, i alhora s'intenta buscar nous inputs econòmics per a la Cerdanya. En aquest treball també s'analitza quins haurien de ser els futurs tractaments que s'haurien d'aplicar a la forest, tenint en compte les activitats que es realitzen actualment, i evitant en tot moment possibles efectes negatius, com podria ser la sobreexplotació. També es dedica una part del projecte a explicar els sistemes per obtenir i gestionar de forma correcta la biomassa. A continuació es tracta la part més tècnica, realitzant una estimació del possible futur consum energètic del barri del Pla de Tomet, encara no construït; i decidint quins sistema de calderes seria el més adequat, el tipus d’emmagatzematge més apropiat i els passos a seguir per millorar el rendiment del procés de la gestió i extracció de la biomassa. Seguint tots aquests passos s'arriba a la conclusió que aprofitar la biomassa forestal és millor solució que utilitzar combustibles fòssils. A part dels obvis beneficis medi ambientals, també és millor a nivell econòmic, tant pels futurs veïns com per l'ajuntament.

Is it appropriate to index glomerular filtration rate for body surface area

Purpose: Obesity is an established independent risk factor for chronic kidney disease. Thus, measurement of glomerular filtration rate (GFR) is important in this population. Traditionally, GFR has been indexed for body surface area (BSA), but this indexation may not be appropriate in obese individuals. Therefore, the objective of the study was to compare absolute GFR with GFR indexed for BSA and with GFR indexed for height. Methods and materials: The study was conducted in 66 families from the Seychelles islands that included several members with hypertension. GFR and effective renal plasma flow (ERPF) were measured using inulin and PAH clearances, respectively. Antihypertensive treatment, if used, was withheld 2 weeks before conducting the clearances. Participants with diabetes mellitus were excluded from the analysis. BSA was calculated using the Dubois formula. We assessed trend across BMI categories using a non parametric test. Results: Participants included 174 women and 127 men. The prevalence of hypertension was 61%, of which 68% were treated. The table shows that absolute GFR, GFR indexed for height, ERPF, filtration fraction were significantly higher across BMI categories. When GFR was indexed for BSA, the association between GFR and BMI categories was lost. Conclusion: Indexing GFR for BSA in overweight and obese individuals leads to a substantial underestimation of GFR. Filtration fraction, which does not depend on BSA, is higher in obese individuals, which suggests glomerular hyperfiltration. Indexing GFR for BSA therefore would mask the underlying glomerular hyperfiltration. As the number of nephrons does not increase with weight gain, absolute GFR represents a better marker of single nephron GFR and is more appropriate.

Issue review : impact on the insurance premium tax rate reduction .

In 2002, Senate File 2318, Insurance Premium Tax Reduction Act, the Iowa General Assembly approved a reduction in the insurance premium tax rate from 2 percent to 1 percent. The reduction was phased in at the rate of 1/4 percent annual increments over a five-year period, beginning with life and health insurance policy payments made on or after January 1st, 2003. Calendar year 2007 was the first year all premiums were taxed at 1 percent and fiscal year 2008 was the first full fiscal year at the 1 percent rate. Insurance premiums tax is paid only by insurance companies. The companies that benefit from the tax reduction are uniquely identified in government employment statistics. This allows for a unique opportunity to evaluate both the revenue impact and the employment impact of the tax rate reduction in Senate File 2318. This issue review focuses on the General Fund revenue impact of the rate reduction and the Iowa employment trends for the insurance industry since the rate reduction legislation was approved.

Estimation of a maximum Lu diffusion rate in a natural eclogite garnet

Lutetium zoning in garnet within eclogites from the Zermatt-Saas Fee zone, Western Alps, reveal sharp, exponentially decreasing central peaks. They can be used to constrain maximum Lu volume diffusion in garnets. A prograde garnet growth temperature interval of 450-600 A degrees C has been estimated based on pseudosection calculations and garnet-clinopyroxene thermometry. The maximum pre-exponential diffusion coefficient which fits the measured central peak is in the order of D-0= 5.7*10(-6) m(2)/s, taking an estimated activation energy of 270 kJ/mol based on diffusion experiments for other rare earth elements in garnet. This corresponds to a maximum diffusion rate of D (600 A degrees C) = 4.0*10(-22) m(2)/s. The diffusion estimate of Lu can be used to estimate the minimum closure temperature, T-c, for Sm-Nd and Lu-Hf age data that have been obtained in eclogites of the Western Alps, postulating, based on a literature review, that D (Hf) < D (Nd) < D (Sm) a parts per thousand currency sign D (Lu). T-c calculations, using the Dodson equation, yielded minimum closure temperatures of about 630 A degrees C, assuming a rapid initial exhumation rate of 50A degrees/m.y., and an average crystal size of garnets (r = 1 mm). This suggests that Sm/Nd and Lu/Hf isochron age differences in eclogites from the Western Alps, where peak temperatures did rarely exceed 600 A degrees C must be interpreted in terms of prograde metamorphism.

The effect of obesity, age, puberty and gender on resting metabolic rate in children and adolescents.

During puberty fat-free mass (FFM) and fat mass (FM) change quickly and these changes are influenced by sex and obesity. Since it is not completely known how these changes affect resting metabolic rate (RMR), the aim of the present study was to investigate the effect of body composition, age, sex and pubertal development of postabsorptive RMR in 9.5- to 16.5- year-old obese and non-obese children. Postabsorptive RMR was measured in a sample of 371 pre- and postpubertal children comprising 193 males (116 non-obese and 77 obese) and 178 females (119 non-obese and 59 obese). RMR was assessed by indirect calorimetry using a ventilated hood system for 45 min after an overnight fast. Body composition (FFM and FM) was estimated from skinfold measurements. The mean (+/- SD) RMR was significantly (P < 0.001) lower in non-obese (males: 5600 +/- 972 kJ/24 h; females: 5112 +/- 632 kJ/24 h) than in obese (males: 7223 +/- 1220 kJ/24 h; females: 6665 +/- 1106 kJ/24 h) children. This difference became non-significant when RMR was adjusted for body composition (FFM+FM). However, the difference between the genders still remained significant (control male: 6118 +/- 507, control female: 5652 +/- 507, P < 0.001; obese male: 6256 +/- 507, obese female: 5818 +/- 507 kJ/24 h, P < 0.001). The main determinant of RMR was FFM. In the whole cohort. FFM explained 79.8% of the variation in RMR, followed by age, gender and FM adding further 3.8%, 1.1% and 0.8% to the predictability of RMR, respectively. No significant contribution for study group (obese, non-obese), pubertal stage, or fat distribution was found in the regression for RMR. The adjusted value of RMR (for FFM and FM) slightly, but significantly (P < 0.01) decreased between the age of 10-16 years, demonstrating the important effect of age on RMR. CONCLUSIONS: The resting metabolic rate of obese and control children is not different when adjusted for body composition. The main determinant of RMR is the fat-free mass, however, age, gender and fat mass are also significant factors. Pubertal development and fat distribution do not influence RMR independently from the changes in body composition.

Factors affecting the attack rate of Bemisia tabaci on cucumber

The objective of this work was to determine the effects of rainfall, temperature, predators, parasitoids, plant age, leaf chemical composition, levels of leaf nitrogen and potassium, besides density of leaf trichomes, on attack intensity of Bemisia tabaci biotype B on the Cucumis sativus. An increase in the number of whitefly adults and nymphs per leaf was observed with plant aging. A higher number of whitefly adults per leaf and eggs cm-2 was verified in the apical part than in the middle and bottom part of the plants canopy. However, the higher number of whitefly nymphs was observed in the mid-part than in the apical and bottom part of the plant canopy. The incidence of whitefly nymphs was negatively affected with foliar nitrogen. Pentacosane and octacosane positively affected whitefly adults and the first compound also affected the nymphs of this pest species.

Investigation of Plastic Pipes for Highway Applications, HR-373A, Phase II, 1997

It is generally accepted that high density polyethylene pipe (HDPE) performs well under live loads with shallow cover, provided the backfill is well compacted. Although industry standards require carefully compacted backfill, poor inspection and/or faulty construction may result in soils that provide inadequate restraint at the springlines of the pipes thereby causing failure. The objectives of this study were: 1) to experimentally define a lower limit of compaction under which the pipes perform satisfactorily, 2) to quantify the increase in soil support as compaction effort increases, 3) to evaluate pipe response for loads applied near the ends of the buried pipes, 4) to determine minimum depths of cover for a variety of pipes and soil conditions by analytically expanding the experimental results through the use of the finite element program CANDE. The test procedures used here are conservative especially for low-density fills loaded to high contact stresses. The failures observed in these tests were the combined effect of soil bearing capacity at the soil surface and localized wall bending of the pipes. Under a pavement system, the pipes' performance would be expected to be considerably better. With those caveats, the following conclusions are drawn from this study. Glacial till compacted to 50% and 80% provides insufficient support; pipe failureoccurs at surface contact stresses lower than those induced by highway trucks. On the other hand, sand backfill compacted to more than 110 pcf (17.3 kN/m3) is satisfactory. The failure mode for all pipes with all backfills is localized wall bending. At moderate tire pressures, i.e. contact stresses, deflections are reduced significantly when backfill density is increased from about 50 pcf (7.9 kN/m^3) to 90 pcf (14.1 kN/m^3). Above that unit weight, little improvement in the soil-pipe system is observed. Although pipe stiffness may vary as much as 16%, analyses show that backfill density is more important than pipe stiffness in controlling both deflections at low pipe stresses and at the ultimate capacity of the soil-pipe system. The rate of increase in ultimate strength of the system increases nearly linearly with increasing backfill density. When loads equivalent to moderate tire pressures are applied near the ends of the pipes, pipe deflections are slighly higher than when loaded at the center. Except for low density glacial till, the deflections near the ends are not excessive and the pipes perform satisfactorily. For contact stresses near the upper limit of truck tire pressures and when loaded near the end, pipes fail with localized wall bending. For flowable fill backfill, the ultimate capacity of the pipes is nearly doubled and at the upper limit of highway truck tire pressures, deflections are negligible. All pipe specimens tested at ambient laboratory room temperatures satisfied AASHTO minimum pipe stiffness requirements at 5% deflection. However, nearly all specimens tested at elevated pipe surface temperatures, approximately 122°F (50°C), failed to meet these requirements. Some HDPE pipe installations may not meet AASHTO minimum pipe stiffness requirements when installed in the summer months (i.e. if pipe surface temperatures are allowed to attain temperatures similar to those tested here). Heating of any portion of the pipe circumference reduced the load carrying capacity of specimens. The minimum soil cover depths, determined from the CANOE analysis, are controlled by the 5% deflection criterion. The minimum soil cover height is 12 in. (305 mm). Pipes with the poor silt and clay backfills with less than 85% compaction require a minimum soil cover height of 24 in. (610 mm). For the sand at 80% compaction, the A36 HDPE pipe with the lowest moment of inertia requires a minimum of 24 in. (610 mm) soil cover. The C48 HDPE pipe with the largest moment of inertia and all other pipes require a 12 in. (305 mm) minimum soil cover.

Effect of Oven Heating Time of Asphaltic Concrete on Marshall Stability, MLR-82-02, 1982

It has been observed in the Laboratory that an increase in oven heating time of relatively short duration between mixing and compaction of asphaltic concrete hot mixes can have an effect on the Marshall stability results obtained. The purpose of this short investigation is to determine the effect of oven heating time on the density and stability of hot mixes.

Improving Portland Cement Concrete Mix Consistency and Production Rate through Two-Stage Mixing, TR-505, 2007

A two-stage mixing process for concrete involves mixing a slurry of cementitious materials and water, then adding the slurry to coarse and fine aggregate to form concrete. Some research has indicated that this process might facilitate dispersion of cementitious materials and improve cement hydration, the characteristics of the interfacial transition zone (ITZ) between aggregate and paste, and concrete homogeneity. The goal of the study was to find optimal mixing procedures for production of a homogeneous and workable mixture and quality concrete using a two-stage mixing operation. The specific objectives of the study are as follows: (1) To achieve optimal mixing energy and time for a homogeneous cementitious material, (2) To characterize the homogeneity and flow property of the pastes, (3) To investigate effective methods for coating aggregate particles with cement slurry, (4) To study the effect of the two-stage mixing procedure on concrete properties, (5) To obtain the improved production rates. Parameters measured for Phase I included: heat of hydration, maturity, and rheology tests were performed on the fresh paste samples, and compressive strength, degree of hydration, and scanning electron microscope (SEM) imaging tests were conducted on the cured specimens. For Phases II and III tests included slump and air content on fresh concrete and compressive and tensile strengths, rapid air void analysis, and rapid chloride permeability on hardened concrete.