Hypoxie transitoire en relation avec les activités rythmiques des muscles de la mastication chez les patients atteints du bruxisme du sommeil

Study Objectives: Sleep bruxism (SB) is a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible occurring during sleep. SB is scored, from electromyographic traces, as rhythmic masticatory muscle activity (RMMA). Most RMMA occurred during sleep in association with sleep arousal. Since not all RMMA episodes were associated with sleep arousal we hypothesized that some event could be observed in relation to small fluctuations of the oxygen level resulting in mild desaturation/hypoxia. Methods: Sleep laboratory or home recordings from 22 SB (teeth grinding) patients were analyzed from our data bank. A total of 143 RMMA/SB episodes were classified in 4 categories: (i) no arousal & no body movement; (ii) arousal + & no body movement; (iii) no arousal & body movement +; (iv) arousal + & body movement +. Minimum blood oxygen levels were assessed from finger oxymetry signal: 1) during the baseline period before RMMA, i.e., an average of 7 s before RMMA onset (-20 s to -14 s); 2) during RMMA, i.e. a window of 15 s corresponding to -5 s before the onset until +10 s after the episode. For all episodes, the minimum oximetry values were compared for each patient. Results: There was a significant variation of blood oxygen level over time (p=0.001) with a statistically significant transient hypoxia during RMMA at time (+7),(+8) and (+9) s. The variation over time was similar among the 4 groups (non significant group*time interaction p=0.10) and no overall difference was observed between groups (p=0.91). Of the 22 subjects, 6 subjects (27%) remained equal or had a slight increase in SaO2 (+8) s after the RMMA/SB onset compared to baseline (-20 s to -14) s, 10 subjects (45%) showed a small decrease in SaO2 (>0 to <1%) and 6 others (27%) had a decrease of 1-1.8%. Conclusions: These preliminary findings suggest that in some SB patients, RMMA episodes are potentially triggered by minor transient hypoxia. Key words: sleep bruxism, oximetry, desaturation, hypoxia, rhythmic masticatory muscle activity

Impacto de una intervención de precauciones de contacto sobre la infección intrahospitalaria en una unidad neonatal

Introducción : las infecciones intrahospitalarias llevan alta morbilidad y mortalidad en pacientes críticamente enfermos en unidades neonatales. Materiales y métodos : después de un período de observación de 5 meses, se realizó una intervención educativa en una unidad neonatal de referencia en Bogotá sobre adecuadas técnicas de aislamiento y precauciones de contacto, basados en la toma de cultivos de piel para evaluar la colonización microbiológica. Se evaluó la tasa de infecciones intrahospitalarias (IIH) de los dos períodos y se realizó un ajuste teniendo en cuenta variables confusoras que afectan el riesgo de infección intrahospitalaria a través de un modelo de regresión logística incondicional. Resultados : se evaluaron 450 neonatos. 78 pacientes tuvieron IIH, siendo mayor en el primer grupo (45 de 247; 18,2%), que en el de intervención educativa: (33 de 203; 16,2%). La IIH se presentó en 17 de 25 pacientes colonizados (66,7%), 15 de 44 pacientes no colonizados (34%) y uno de los 134 pacientes a los que no se les tomó muestra (0,75%; p<0,01). El modelo mostró que el riesgo de IIH fue mayor en el grupo no intervenido, (O.R. 1,99, I.C. 95%: 1,39-12,30); otros factores de riesgo identificados fueron el uso de nutrición parenteral, la presencia de cardiopatía congénita y una mayor estancia hospitalaria. Discusión : una intervención educativa sobre adecuadas técnicas de aislamiento y precauciones de contacto en neonatos, basados en la toma de cultivos de piel para evaluar la colonización microbiológica, se asoció con una menor tasa de IIH en el grupo intervenido en una UCIN.

A segurança estrutural na reabilitação de património habitacional composto por elementos pré-fabricados

Pretende-se no presente artigo analisar a segurança estrutural do tipo de edificações referido, durante o seu processo de reabilitação. Considerando a existência de três momentos diferentes – o período antecedente ao início dos trabalhos, o intervalo de tempo correspondente ao decurso dos trabalhos de reabilitação e o período posterior, correspondente à futura utilização do património, é sobre o segundo que incidirá a nossa análise, por ser aquele em que a estrutura se encontra mais fragilizada, implicando uma menor segurança estrutural, que tende a ser desvalorizada, por ter uma natureza temporária. Numa primeira fase descreve-se o existente, assim como as alterações arquitetónicas propostas. Posteriormente indicam-se os potenciais danos estruturais resultantes das alterações pretendidas e as principais medidas a considerar para os evitar. Numa fase posterior propõe-se a sequenciação dos trabalhos de modo a evitar um colapso parcial ou global e, por último, apresentam-se conclusões e sugerem-se desenvolvimentos futuros. / The present work seeks to present an analysis related to the structural safety of prefabricated buildings, referred above, associated it’s rehabilitation process. Considering the existence of three different moments – a first period before the beginning of the works, a second one correspondent to the rehabilitation procedures and a last one related with the future utilization of the patrimony, this article will focus on the second period, because during that gap of time, the structure is usually weakened, which implies a lower structural safety that tends to be ignored, due to its temporary nature. In a first moment, the existing construction is described, as well as the architectonical proposals. Afterwards, are referred the potential structural damages resultant of the architectonical proposals and the measures to implemented to prevent them. In the posterior phase we propose the work sequence, in order to avoid a partial or global collapse and, finally, we reach some conclusions and suggest other works to be developed in the future.

A segurança estrutural relacionada com a escavação sob fundações de edifícios pré-existentes

Pretende-se no presente artigo analisar a segurança estrutural de edificações condicionadas por escavações a um nível inferior ao das suas fundações. Considerando a existência de três momentos diferentes – o período antecedente ao início dos trabalhos, o intervalo de tempo correspondente ao decurso dos trabalhos de reabilitação e o período posterior, correspondente à futura utilização do património, é sobre o segundo que incidirá a nossa análise, por ser aquele em que a estrutura se encontra mais fragilizada, implicando uma menor segurança estrutural, que tende a ser desvalorizada, por ter uma natureza temporária. Numa primeira fase descreve-se o existente, assim como as intervenções propostas. Posteriormente indicam-se os potenciais danos estruturais resultantes das alterações pretendidas e as principais medidas a considerar para os evitar. Numa fase posterior propõe-se a sequenciação dos trabalhos de modo a evitar um colapso parcial ou global e, por último, apresentam-se conclusões e sugerem-se desenvolvimentos futuros. / The present work seeks to present an analysis related to the structural safety of buildings that are object of excavations at a lower level than their foundations. Considering the existence of three different moments – a first period before the beginning of the works, a second one correspondent to the rehabilitation procedures and a last one related with the future utilization of the patrimony, this article will focus on the second period, because during that gap of time, the structure is usually weakened, which implies a lower structural safety that tends to be ignored, due to its temporary nature. In the first phase, the existing construction is described, as well as the proposed interventions. Afterwards, are referred the potential structural damages resultant of the architectonical proposals and the measures to implemented to prevent them. In the posterior phase we propose the work sequence, in order to avoid a partial or global collapse and, finally, we reach some conclusions and suggest other works to be developed in the future.

Las relaciones Ecuador-Colombia en perspectiva comparada (Tema Central)

Este artículo pasa revista a los principales aspectos que han afectado a las relaciones entre Ecuador y Colombia desde fines de los años noventa, poniendo énfasis en la etapa previa y posterior al incidente de Angostura, que llevó al rompimiento de relaciones diplomáticas. Paralelamente, se analizan los principales temas de interés tanto de Colombia como de Ecuador, que deberían tomarse en cuenta al momento de definir una agenda de política exterior.

Estimating soil water fluxes from soil water records obtained using dielectric sensors

Accurate estimation of the soil water balance (SWB) is important for a number of applications (e.g. environmental, meteorological, agronomical and hydrological). The objective of this study was to develop and test techniques for the estimation of soil water fluxes and SWB components (particularly infiltration, evaporation and drainage below the root zone) from soil water records. The work presented here is based on profile soil moisture data measured using dielectric methods, at 30-min resolution, at an experimental site with different vegetation covers (barley, sunflower and bare soil). Estimates of infiltration were derived by assuming that observed gains in the soil profile water content during rainfall were due to infiltration. Inaccuracies related to diurnal fluctuations present in the dielectric-based soil water records are resolved by filtering the data with adequate threshold values. Inconsistencies caused by the redistribution of water after rain events were corrected by allowing for a redistribution period before computing water gains. Estimates of evaporation and drainage were derived from water losses above and below the deepest zero flux plane (ZFP), respectively. The evaporation estimates for the sunflower field were compared to evaporation data obtained with an eddy covariance (EC) system located elsewhere in the field. The EC estimate of total evaporation for the growing season was about 25% larger than that derived from the soil water records. This was consistent with differences in crop growth (based on direct measurements of biomass, and field mapping of vegetation using laser altimetry) between the EC footprint and the area of the field used for soil moisture monitoring. Copyright (c) 2007 John Wiley & Sons, Ltd.

Incorporation of in situ and biomarker assays in higher-tier assessment of the aquatic toxicity of insecticides

This study was designed to test the feasibility of integrating in situ, single species exposures and biomarker analysis into microcosm studies. Experimental ponds were dosed with pirimiphos methyl (PM) and lindane. C. riparius fourth instar larvae were deployed for 48 h on nine separate occasions during the study period before and after treatment. Surviving larvae were analysed for acetylcholinesterase activity (AChE). Survival and biomarker data were compared to chironomid assemblage analysis by monitoring insects emerging from the microcosms. Survival of chironomids within the in situ systems commenced on day + 16 after treatment with 31.6% and 53.3% survival in the lindane and PM treated ponds, respectively. In contrast, the first emergence from the microcosms occurred on days + 27, in respect to lindane, and + 59 for the PM treated ponds. Thus the in situ bioassay was able to demonstrate gradual reduction in toxicity within the sediment before this was evident from macroinvertebrate monitoring. Significant ACNE inhibition was only detected on exposure to PM. Levels decreased from 75% on day + 16 to 26% by day +29. The biomarker analysis confirmed that, by the end of the study, the insecticide was no longer exerting an effect. We discuss how the use of in situ bioassays could also aid comparison of microcosm studies by adding a standardized dimension. (C) 2003 Elsevier Ltd. All rights reserved.

Modulation of the fecal microflora profile and immune function by a novel trans-galactooligosaccharide mixture (B-GOS) in healthy elderly volunteers

Background: Aging is associated with reduced numbers of beneficial colonic bifidobacteria and impaired immunity. Galactooligosaccharides (GOSs) stimulate the growth of bifidobacteria in younger adults, but little is known about their effects in the elderly and their immunomodulatory capacity. Objective: We assessed the effect of a prebiotic GOS mixture (B-GOS) on immune function and fecal microflora composition in healthy elderly subjects. Design: In a double-blind, placebo-controlled, crossover study, 44 elderly subjects were randomly assigned to receive either a placebo or the B-GOS treatment (5.5 g/d). Subjects consumed the treatments for 10 wk, and then went through a 4-wk washout period, before switching to the other treatment for the final 10 wk. Blood and fecal samples were collected at the beginning, middle (5 wk), and end of the test period. Predominant bacterial groups were quantified, and phagocytosis, natural killer (NK) cell activity, cytokine production, plasma cholesterol, and HDL cholesterol were measured. Results: B-GOS significantly increased the numbers of beneficial bacteria, especially bifidobacteria, at the expense of less beneficial groups compared with the baseline and placebo. Significant increases in phagocytosis, NK cell activity, and the production of antiinflammatory cytokine interleukin-10 (IL-10) and significant reduction in the production of proinflammatory cytokines (IL-6, IL-1 beta , and tumor necrosis factor-alpha) were also observed. B-GOS exerted no effects on total cholesterol or HDL-cholesterol production, however. Conclusions: B-GOS administration to healthy elderly persons resulted in positive effects on both the microflora composition and the immune response. Therefore, B-GOS may be a useful dietary candidate for the enhancement of gastrointestinal health and immune function in elderly persons. Am J Clin Nutr 2008; 88: 1438-46.

Prebiotic evaluation of cocoa-derived flavanols in healthy humans by using a randomized, controlled, double-blind, crossover intervention study

BACKGROUND: The absorption of cocoa flavanols in the small intestine is limited, and the majority of the flavanols reach the large intestine where they may be metabolized by resident microbiota. OBJECTIVE: We assessed the prebiotic potential of cocoa flavanols in a randomized, double-blind, crossover, controlled intervention study. DESIGN: Twenty-two healthy human volunteers were randomly assigned to either a high-cocoa flavanol (HCF) group (494 mg cocoa flavanols/d) or a low-cocoa flavanol (LCF) group (23 mg cocoa flavanols/d) for 4 wk. This was followed by a 4-wk washout period before volunteers crossed to the alternant arm. Fecal samples were recovered before and after each intervention, and bacterial numbers were measured by fluorescence in situ hybridization. A number of other biochemical and physiologic markers were measured. RESULTS: Compared with the consumption of the LCF drink, the daily consumption of the HCF drink for 4 wk significantly increased the bifidobacterial (P < 0.01) and lactobacilli (P < 0.001) populations but significantly decreased clostridia counts (P < 0.001). These microbial changes were paralleled by significant reductions in plasma triacylglycerol (P < 0.05) and C-reactive protein (P < 0.05) concentrations. Furthermore, changes in C-reactive protein concentrations were linked to changes in lactobacilli counts (P < 0.05, R(2) = -0.33 for the model). These in vivo changes were closely paralleled by cocoa flavanol-induced bacterial changes in mixed-batch culture experiments. CONCLUSION: This study shows, for the first time to our knowledge, that consumption of cocoa flavanols can significantly affect the growth of select gut microflora in humans, which suggests the potential prebiotic benefits associated with the dietary inclusion of flavanol-rich foods. This trial was registered at clinicaltrials.gov as NCT01091922.

The basis of valuations for secured commercial property lending in the UK

In the context of the financial crash and the commercial property market downturn, this paper examines the basis of valuation used in the UK commercial property lending process. Post-crisis there is discussion of countercyclical measures including the monitoring of asset prices; however there is no consideration of a different approach to property valuation. This paper questions this omission, given the role that valuations play in the bank regulatory process. The different bases of valuation available to lenders within International Valuation Standards are identified as Market Value (MV), Mortgage Lending Value (MLV) and Investment Value (IV), with MV being the most used in the UK. Using the different bases in the period before the financial crisis, the UK property market is modelled at a national office, retail and industrial/warehouse sector level to determine the performance of each alternative valuation basis within the context of counter-cyclical pressures on lending. Both MLV and IV would have produced lower valuations and could have provided lenders with tools for more informed and prudent lending. The paper concludes by recognising some of the practical issues involved in adopting the different bases for the bank lending role but recommends a change to IV.

Bacillus coagulans GBI-30, 6086 modulates Faecalibacterium prausnitzii in older men and women

Abstract Background: Advancing age is linked to a decrease in beneficial bacteria such as Bifidobacterium spp. and reduced aspects of innate immune function. Objectives: We investigated whether daily consumption of a probiotic [Bacillus coagulans GBI-30, 6086 (BC30); GanedenBC30] could improve immune function and gut function in men and women aged 65–80 y, using a double-blind, placebo-controlled crossover design. Method: Thirty-six volunteers were recruited and randomly assigned to receive either a placebo (microcrystalline cellulose) or the probiotic BC30 (1 3 109 colony-forming units/capsule). Volunteers consumed 1 treatment capsule per day for 28 d, followed by a 21-d washout period before switching to the other treatment. Blood and fecal samples were collected at the beginning and end of each treatment period. Fecal samples were used to enumerate bacterial groups and concentrations of calprotectin. Peripheral blood mononuclear cells (PBMCs) were extracted from whole blood to assess natural killer cell activity and lipopolysaccharide (LPS)-stimulated cytokine production. C-reactive protein concentrations were measured in plasma. Results: Consumption of BC30 significantly increased populations of Faecalibacterium prausnitzii by 0.1 log10 cells/mL more than during consumption of the placebo (P = 0.03), whereas populations of Bacillus spp. increased significantly by 0.5 log10 cells/mL from baseline in volunteers who consumed BC30 (P = 0.007). LPS-stimulated PBMCs showed a 0.2 ng/mL increase in the anti-inflammatory cytokine IL-10 28 d after consumption of BC30 (P < 0.05), whereas the placebo did not affect IL-10, and no overall difference was found in the effect of the treatments. Conclusions: Daily consumption of BC30 by adults aged 65–80 y can increase beneficial groups of bacteria in the human gut and potentially increase production of anti-inflammatory cytokines. This study shows the potential benefits of a probiotic to improve dysbiosis via modulation of the microbiota in older persons. J Nutr doi: 10.3945/jn.114.199802.

Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality : cluster-randomized controlled trial

BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44599712. Please see later in the article for the Editors' Summary.

Method for determining reaction rate of mild steel containers during melting of magnesium-aluminium alloys and effect of aluminium content on directionally solidified microstructures

A magnesium alloy of eutectic composition (33 wt-'%Al) was directionally solidified in mild steel tubes at two growth rates, 32 and 580 mum s(-1,) in a temperature gradient between 10 and 20 K mm(-1). After directional solidification, the composition of each specimen varied dramatically, from 32'%Al in the region that had remained solid to 18%Al (32 mum s(-1) specimen) and 13%Al (580 mum s(-1) specimen) at the plane that had been quenched from the eutectic temperature. As the aluminium content decreased, the microstructure contained an increasing volume fraction of primary magnesium dendrites and the eutectic morphology gradually changed from lamellar to partially divorced. The reduction in aluminium content was caused by the growth of an Al-Fe phase ahead of the Mg-Al growth front. Most of the growth of the Al-Fe phase occurred during the remelting period before directional solidification. The thickness of the Al-Fe phase increased with increased temperature and time of contact with the molten Mg-Al alloy. (C) 2003 Maney Publishing.

An interventional study to improve paramedic diagnosis of stroke

Objective: The aim of the Faster Access to Stroke Therapy (FAST) study was to determine the effect of educational intervention andthe use of a prehospital stroke tool on the paramedic diagnosis of stroke.

Methods: Paramedics in emergency medical service units servicing a university teaching hospital were divided into two groups: FAST study paramedics (n = 18) and non-FAST study paramedics (n = 43). The FAST study paramedics received stroke education and instruction in the use of a prehospital stroke assessment tool [Melbourne Ambulance Stroke Screen (MASS)] to assist in stroke diagnosis. Based on final hospital diagnosis, the sensitivities of paramedic stroke diagnosis in the two groups were compared for a 12-month period before andafter the intervention.

Results: The sensitivity for the FAST study paramedics in identifying stroke improved from 78% (95% confidence interval [CI]: 63% to 88%) to 94% (95% CI: 86% to 98%) (p = 0.006) after receiving the stroke education session and with use of the MASS tool. There was no change in stroke diagnosis for the non-study paramedics 78% (95% CI: 71% to 84%) to 80% (95% CI: 72% to 87%) (p = 0.695). Prenotification of impending arrival to the emergency department was associated with higher-priority triage in the emergency department, and subsequent shorter times for door to medical review (15 min vs. 31 min, p < 0.001) and door to computed tomography (CT) scanning (94 min vs. 144 min, p < 0.001).

Conclusions: Targeted stroke education and the use of a simple clinical tool can significantly improve the diagnostic sensitivity of stroke by paramedics in the prehospital setting. Accurate diagnosis combined with prenotification of the pending arrival of stroke patients will allow for the focused and timely application of resources for the management of acute stroke.

Implied volatility smiles, option mispricing and net buying pressure : evidence around the global financial crisis

Using the recent global financial crisis as an exogenous setting, we examine the presence and source of implied volatility smile phenomena in Australian S&P ASX 200 index options. We find a pronounced implied volatility smile for index puts in both bull and bear markets and a smile for index calls in the bear but not bull market. Implied volatilities of out-of-the money puts tend to be upwards biased whilst those of calls tend to be downwards biased. We also find that the bias in implied volatilities yields excess returns based on unhedged and delta-neutral trading strategies, suggesting that implied volatilities are related to option mispricing. Net buying pressure from market participants appears to be a source of mispricing in the case of out-of-the-money index puts with excess demand particularly pronounced during the bull period before the global financial crisis unfolded.