Anestesia regional y periférica guiada por ultrasonido en el paciente critico

El presente trabajo es un capítulo de libro titulado “Anestesia Regional y Periférica Guiada por Ultrasonido en el Paciente Crítico” que será incluido en la última edición del libro “Manual de Ultrasonido en Terapia Intensiva y Emergencias” cuyo editor es el Doctor José de Jesús Rincón Salas y que será publicado por la Editorial Prado de México para distribución latinoamericana desde dicho país. Por solicitud del editor y teniendo en cuenta el enfoque del libro, el presente trabajo está dirigido a estudiantes de formación, médicos graduados y especialistas en las áreas de cuidado intensivo, anestesiología, dolor, medicina interna y medicina de urgencias. Tiene como propósito empapar de conocimientos necesarios y prácticos en anestesia regional a personas que usualmente no han tenido contacto con la anestesia regional, pues desafortunadamente sólo en los últimos años ha sido posible que la anestesia regional haya comenzado a salir de las salas de cirugía, ámbito donde ha estado confinada tradicionalmente. El lenguaje utilizado es sencillo y el capítulo ha sido escrito para que sea fácil de leer y consultar, dejando así mensajes muy claros sobre la utilidad, viabilidad e implicaciones que tiene el uso de anestesia regional guiada por ultrasonido en cuidado intensivo. Los autores esperamos que de esta manera, el presente capítulo permita continuar superando los obstáculos que se interponen entre los invaluables beneficios de la anestesia regional y los pacientes de cuidado intensivo que necesitan de ella.

Amanhecer para uma nova realidade : uma experiência de educação de todos, com todos e para todos, no 1º ciclo do ensino básico

A educação Inclusiva pressupõe proporcionar a todos os alunos as condições para que possam aprender e interagir de forma cooperativa e solidária e, assim, desenvolver competências tanto ao nível social como académico (Leitão, 2006). Foi neste seguimento que surgiu o presente Trabalho de Projecto, tendo como enfoque uma turma do 4º ano, onde se encontra incluída uma criança com Paralisia Cerebral. O principal objectivo foi o de criar raízes de um espírito de trabalho cooperativo na turma em questão, para que se alcance no seu seio uma verdadeira situação de inclusão educativa, em que não haja distinção entre os diferentes alunos da turma, e onde se consiga promover valores e princípios como da equidade e respeito mútuo, de justiça, de dignidade, em que os alunos possam aprender uns com os outros, vivendo experiências enriquecedoras e assimilando atitudes e valores que levem a um efectivo respeito pela diversidade e diferença. Por termos como base os princípios de uma de investigação-acção, foi um projecto onde nos envolvemos activamente, para conseguirmos provocar uma mudança na situação problemática por nós diagnosticada no início do desenvolvimento do projecto e que nos levou a desencadear a acção. Para tal, e como característico deste tipo de modalidade de investigação, foi privilegiada a adopção de técnicas qualitativas para a recolha de dados, como a observação naturalista, a entrevista, a sociometria e a pesquisa documental, através dos quais alicerçámos o nosso projecto. Assim, podemos referir que o nosso projecto se caracterizou como uma investigação interactiva, em espiral e focada num problema, sobre o qual agimos, sustentada por um quadro teórico a partir do qual elaborámos todo o enquadramento metodológico do nosso projecto, bem como o plano de acção, que se baseou em todo um sistema de planificação/acção/reflexão. Como resultados, podemos afirmar que, partindo do facto do J. ser um aluno bem aceite pelos colegas e da grande motivação que toda a turma sempre demonstrou em trabalhar em grupo, conseguiu desenvolver-se uma socialização de aprendizagens, gerando inclusão educativa, beneficiando o J. e outros colegas que, a partir desta experiência, conseguiram libertar-se de constangimentos e fazer emergir potencialidades, capacidades e competências nunca antes vivenciadas.

A utilização de transformadas de wavelet e de detrended fluctuation analysis no estudo da microcirculação da pele humana

A Fluxometria por Laser Doppler (LDF) é uma técnica não invasiva usada para medir o fluxo microvascular da pele humana. No fluxo é possível isolar componentes oscilatórias em gamas de frequências características que se encontram relacionadas com as actividades cardíaca, respiratória, miogénica, simpática e metabólica. A LDF permite assim estudar a fisiologia do fluxo sanguíneo. Neste trabalho foram realizadas medições de LDF nos tornozelos de 9 mulheres saudáveis numa situação de restrição à perfusão, usando uma braçadeira nos tornozelos. Os dados foram analisados com Transformada de Wavelet e Detrended Fluctuation Analysis (DFA) de modo a estudar os rácios das amplitudes das componentes de Wavelet e os respectivos expoentes . Estes parâmetros foram comparados nas situações de repouso, de restrição à perfusão e de recuperação após remoção da braçadeira. Observou-se que durante a restrição à perfusão houve um aumento significativo dos rácios de amplitude e dos expoentes a para as componentes cardíaca, respiratória e miogénica, o que pode reflectir vasoconstrição. Os parâmetros da componente metabólica apresentaram uma diminuição que se pode relacionar com variações na libertação de NO por parte do endotélio. Após a libertação da braçadeira, os parâmetros das componentes respiratória, miogénica e metabólica retornaram aos valores iniciais. Aanálise combinada de Wavelet com DFAoferece uma nova visão sobre a regulação do fluxo microvascular.

Relação entre factores ambientais causadores de stress e doença renal felina

A Doença Renal Crónica (DRC) é de natureza insidiosa, progressiva e irreversível e uma grande causa de morbilidade e mortalidade em gatos. O comportamento natural da espécie felina fica comprometido no meio doméstico, originando situações de stress que desempenham um papel importante na patogénese da doença crónica. A literatura sugere que a activação contínua do sistema nervoso simpático desencadeia uma série de processos fisiológicos que se traduzem por último no aparecimento de fibrose renal, contribuindo assim para a progressão da DRC. Esta dissertação pretende avaliar essa relação. Para tal, foram analisados questionários que permitissem avaliar as condições em que viviam uma amostra de 139 gatos e realizados painéis hematológicos e bioquímicos a uma sub-amostra para verificar as correlações existentes. Ainda que não tenha sido possível concluir que a presença de um parâmetro individual possa ser apontada como causa directa do desenvolvimento de DRC, podemos identificar um conjunto de factores ambientais causadores de stress como prováveis factores de risco para a degradação desta doença e a sua transição para fases mais avançadas. Desta forma, a implementação de estratégias de enriquecimento ambiental MEMO (Multimodal Environmental Modification) não só visa melhorar a qualidade de vida destes animais como se pode revelar uma chave de sucesso na prevenção e maneio de doenças crónicas.

Evaluation of the Met Office global forecast model using Geostationary Earth Radiation Budget (GERB) data

Simulations of the top-of-atmosphere radiative-energy budget from the Met Office global numerical weather-prediction model are evaluated using new data from the Geostationary Earth Radiation Budget (GERB) instrument on board the Meteosat-8 satellite. Systematic discrepancies between the model simulations and GERB measurements greater than 20 Wm-2 in outgoing long-wave radiation (OLR) and greater than 60 Wm-2 in reflected short-wave radiation (RSR) are identified over the period April-September 2006 using 12 UTC data. Convective cloud over equatorial Africa is spatially less organized and less reflective than in the GERB data. This bias depends strongly on convective-cloud cover, which is highly sensitive to changes in the model convective parametrization. Underestimates in model OLR over the Gulf of Guinea coincide with unrealistic southerly cloud outflow from convective centres to the north. Large overestimates in model RSR over the subtropical ocean, greater than 50 Wm-2 at 12 UTC, are explained by unrealistic radiative properties of low-level cloud relating to overestimation of cloud liquid water compared with independent satellite measurements. The results of this analysis contribute to the development and improvement of parametrizations in the global forecast model.

Chemical composition observed over the mid-Atlantic and the detection of pollution signatures far from source regions

The atmospheric composition of the central North Atlantic region has been sampled using the FAAM BAe146 instrumented aircraft during the Intercontinental Transport of Ozone and Precursors (ITOP) campaign, part of the wider International Consortium for Atmospheric Research on Transport and Transformation (ICARTT). This paper presents an overview of the ITOP campaign. Between late July and early August 2004, twelve flights comprising 72 hours of measurement were made in a region from approximately 20 to 40°W and 33 to 47°N centered on Faial Island, Azores, ranging in altitude from 50 to 9000 m. The vertical profiles of O3 and CO are consistent with previous observations made in this region during 1997 and our knowledge of the seasonal cycles within the region. A cluster analysis technique is used to partition the data set into air mass types with distinct chemical signatures. Six clusters provide a suitable balance between cluster generality and specificity. The clusters are labeled as biomass burning, low level outflow, upper level outflow, moist lower troposphere, marine and upper troposphere. During this summer, boreal forest fire emissions from Alaska and northern Canada were found to provide a major perturbation of tropospheric composition in CO, PAN, organic compounds and aerosol. Anthropogenic influenced air from the continental boundary layer of the USA was clearly observed running above the marine boundary layer right across the mid-Atlantic, retaining high pollution levels in VOCs and sulfate aerosol. Upper level outflow events were found to have far lower sulfate aerosol, resulting from washout on ascent, but much higher PAN associated with the colder temperatures. Lagrangian links with flights of other aircraft over the USA and Europe show that such signatures are maintained many days downwind of emission regions. Some other features of the data set are highlighted, including the strong perturbations to many VOCs and OVOCs in this remote region.

A case study of boundary layer ventilation by convection and coastal processes

It is often assumed that ventilation of the atmospheric boundary layer is weak in the absence of fronts, but is this always true? In this paper we investigate the processes responsible for ventilation of the atmospheric boundary layer during a nonfrontal day that occurred on 9 May 2005 using the UK Met Office Unified Model. Pollution sources are represented by the constant emission of a passive tracer everywhere over land. The ventilation processes observed include shallow convection, turbulent mixing followed by large-scale ascent, a sea breeze circulation and coastal outflow. Vertical distributions of tracer are validated qualitatively with AMPEP (Aircraft Measurement of chemical Processing Export fluxes of Pollutants over the UK) CO aircraft measurements and are shown to agree impressively well. Budget calculations of tracers are performed in order to determine the relative importance of these ventilation processes. Coastal outflow and the sea breeze circulation were found to ventilate 26% of the boundary layer tracer by sunset of which 2% was above 2 km. A combination of coastal outflow, the sea breeze circulation, turbulent mixing and large-scale ascent ventilated 46% of the boundary layer tracer, of which 10% was above 2 km. Finally, coastal outflow, the sea breeze circulation, turbulent mixing, large-scale ascent and shallow convection together ventilated 52% of the tracer into the free troposphere, of which 26% was above 2 km. Hence this study shows that significant ventilation of the boundary layer can occur in the absence of fronts (and thus during high-pressure events). Turbulent mixing and convection processes can double the amount of pollution ventilated from the boundary layer.

Estimating surface CO2 fluxes from space-borne dry air mole fraction observations using an Ensemble Kalman filter

We have developed an ensemble Kalman Filter (EnKF) to estimate 8-day regional surface fluxes of CO2 from space-borne CO2 dry-air mole fraction observations (XCO2) and evaluate the approach using a series of synthetic experiments, in preparation for data from the NASA Orbiting Carbon Observatory (OCO). The 32-day duty cycle of OCO alternates every 16 days between nadir and glint measurements of backscattered solar radiation at short-wave infrared wavelengths. The EnKF uses an ensemble of states to represent the error covariances to estimate 8-day CO2 surface fluxes over 144 geographical regions. We use a 12×8-day lag window, recognising that XCO2 measurements include surface flux information from prior time windows. The observation operator that relates surface CO2 fluxes to atmospheric distributions of XCO2 includes: a) the GEOS-Chem transport model that relates surface fluxes to global 3-D distributions of CO2 concentrations, which are sampled at the time and location of OCO measurements that are cloud-free and have aerosol optical depths <0.3; and b) scene-dependent averaging kernels that relate the CO2 profiles to XCO2, accounting for differences between nadir and glint measurements, and the associated scene-dependent observation errors. We show that OCO XCO2 measurements significantly reduce the uncertainties of surface CO2 flux estimates. Glint measurements are generally better at constraining ocean CO2 flux estimates. Nadir XCO2 measurements over the terrestrial tropics are sparse throughout the year because of either clouds or smoke. Glint measurements provide the most effective constraint for estimating tropical terrestrial CO2 fluxes by accurately sampling fresh continental outflow over neighbouring oceans. We also present results from sensitivity experiments that investigate how flux estimates change with 1) bias and unbiased errors, 2) alternative duty cycles, 3) measurement density and correlations, 4) the spatial resolution of estimated flux estimates, and 5) reducing the length of the lag window and the size of the ensemble. At the revision stage of this manuscript, the OCO instrument failed to reach its orbit after it was launched on 24 February 2009. The EnKF formulation presented here is also applicable to GOSAT measurements of CO2 and CH4.

The effects of difficulty and gain versus loss on vocal physiology and acoustics

To examine the basis of emotional changes to the voice, physiological and electroglottal measures were combined with acoustic speech analysis of 30 men performing a computer task in which they lost or gained points under two levels of difficulty. Predictions of the main effects of difficulty and reward on the voice were not borne out by the data. Instead, vocal changes depended largely on interactions between gain versus loss and difficulty. The rate at which the vocal folds open and close (fundamental frequency; f0) was higher for loss than for gain when difficulty was high, but not when difficulty was low. Electroglottal measures revealed that f0 changes corresponded to shorter glottal open times for the loss conditions. Longer closed and shorter open phases were consistent with raised laryngeal tension in difficult loss conditions. Similarly, skin conductance indicated higher sympathetic arousal in loss than gain conditions, particularly when difficulty was high. The results provide evidence of the physiological basis of affective vocal responses, confirming the utility of measuring physiology and voice in the study of emotion.

Formation and circulation of the cold intermediate layer in the Gulf of Saint Lawrence

[ 1] The local heat content and formation rate of the cold intermediate layer (CIL) in the Gulf of Saint Lawrence are examined using a combination of new in situ wintertime observations and a three-dimensional numerical model. The field observations consist of five moorings located throughout the gulf over the period of November 2002 to June 2003. The observations demonstrate a substantially deeper surface mixed layer in the central and northeast gulf than in regions downstream of the buoyant surface outflow from the Saint Lawrence Estuary. The mixed-layer depth in the estuary remains shallow (< 60 m) throughout winter, with the arrival of a layer of near-freezing waters between 40 and 100 m depth in April. An eddy-permitting ice-ocean model with realistic forcing is used to hindcast the period of observation. The model simulates well the seasonal evolution of mixed-layer depth and CIL heat content. Although the greatest heat losses occur in the northeast, the most significant change in CIL heat content over winter occurs in the Anticosti Trough. The observed renewal of CIL in the estuary in spring is captured by the model. The simulation highlights the role of the northwest gulf, and in particular, the separation of the Gaspe Current, in controlling the exchange of CIL between the estuary and the gulf. In order to isolate the effects of inflow through the Strait of Belle Isle on the CIL heat content, we examine a sensitivity experiment in which the strait is closed. This simulation shows that the inflow has a less important effect on the CIL than was suggested by previous studies.

The development of a new dust uplift scheme in the Met Office Unified Model

Aeolian mineral dust aerosol is an important consideration in the Earth's radiation budget as well as a source of nutrients to oceanic and land biota. The modelling of aeolian mineral dust has been improving consistently despite the relatively sparse observations to constrain them. This study documents the development of a new dust emissions scheme in the Met Office Unified ModelTM (MetUM) based on the Dust Entrainment and Deposition (DEAD) module. Four separate case studies are used to test and constrain the model output. Initial testing was undertaken on a large dust event over North Africa in March 2006 with the model constrained using AERONET data. The second case study involved testing the capability of the model to represent dust events in the Middle East without being re-tuned from the March 2006 case in the Sahara. While the model is unable to capture some of the daytime variation in AERONET AOD there is good agreement between the model and observed dust events. In the final two case studies new observations from in situ aircraft data during the Dust Outflow and Deposition to the Ocean (DODO) campaigns in February and August 2006 were used. These recent observations provided further data on dust size distributions and vertical profiles to constrain the model. The modelled DODO cases were also compared to AERONET data to make sure the radiative properties of the dust were comparable to observations. Copyright © 2009 Royal Meteorological Society and Crown Copyright

Airborne measurements of the spatial distribution of aerosol chemical composition across Europe and evolution of the organic fraction

The spatial distribution of aerosol chemical composition and the evolution of the Organic Aerosol (OA) fraction is investigated based upon airborne measurements of aerosol chemical composition in the planetary boundary layer across Europe. Sub-micron aerosol chemical composition was measured using a compact Time-of-Flight Aerosol Mass Spectrometer (cToF-AMS). A range of sampling conditions were evaluated, including relatively clean background conditions, polluted conditions in North-Western Europe and the near-field to far-field outflow from such conditions. Ammonium nitrate and OA were found to be the dominant chemical components of the sub-micron aerosol burden, with mass fractions ranging from 20--50% each. Ammonium nitrate was found to dominate in North-Western Europe during episodes of high pollution, reflecting the enhanced NO_x and ammonia sources in this region. OA was ubiquitous across Europe and concentrations generally exceeded sulphate by 30--160%. A factor analysis of the OA burden was performed in order to probe the evolution across this large range of spatial and temporal scales. Two separate Oxygenated Organic Aerosol (OOA) components were identified; one representing an aged-OOA, termed Low Volatility-OOA and another representing fresher-OOA, termed Semi Volatile-OOA on the basis of their mass spectral similarity to previous studies. The factors derived from different flights were not chemically the same but rather reflect the range of OA composition sampled during a particular flight. Significant chemical processing of the OA was observed downwind of major sources in North-Western Europe, with the LV-OOA component becoming increasingly dominant as the distance from source and photochemical processing increased. The measurements suggest that the aging of OA can be viewed as a continuum, with a progression from a less oxidised, semi-volatile component to a highly oxidised, less-volatile component. Substantial amounts of pollution were observed far downwind of continental Europe, with OA and ammonium nitrate being the major constituents of the sub-micron aerosol burden. Such anthropogenically perturbed air masses can significantly perturb regional climate far downwind of major source regions.

Early women law students at Cambridge and Oxford

This article examines the hitherto neglected history of the twelve women who studied law at Cambridge and Oxford in the years up to 1900. It concludes that the reason why so little has been written about them is, first, because women's experience has been routinely ignored in accounts of legal education ( and in history generally) and, second, because their entry to the university law schools was accomplished with very little fuss or opposition. This in turn was due not only to the fact that the law professors were generally sympathetic to higher education for women but also because the women themselves did not challenge university traditions or the men's curriculum.

Medusa, Antaeus, and Caesar Libycus

Although it is well known that Lucan’s Libya is a wild and threatening place, its threat is not restricted to indigenous people, places and things, such as Hannibal, Cleopatra, the Syrtes, or the desert with its catalogue of horrifying snakes. He also associates Libya with anti-Republican Romans, above all Julius Caesar, who endangers the Republic with his excessive, animalistic energy and resembles the continent where he is trapped in the final book. Although the gods as characters are removed from the world of the Bellum Civile, Lucan allows supernatural traces to linger in particular locations such as the Gallic grove in Book 3 or Thessaly in Book 6. Libya is by far the greatest of these reservoirs of frightening myth and fantasy, which do violence to the historical credibility of the narrative, just as Libya itself is presented as the origin or conduit of a number of historical characters who assault Italy and Europe. Lucan’s two mythic narratives (Antaeus in Book 4 and Medusa in Book 9) are essential parts of the hostile Libyan landscape, but in very different ways. The male Antaeus, associated with lions, is connected with a region of solid rock where he was destroyed. The female Medusa, associated with snakes, is connected with a region of shifting sands where she left a deadly, everlasting legacy. To complicate matters further, even though Medusa’s snakes represent the annihilation of the Republican self, the logic of the narrative is undermined and there is even a sympathetic subtext. As part of Libya’s historical and mythical legacy, these stories reveal that for Lucan, historical epic is linked with Republicanism, but mythical epic is in the service of dictatorship.

Intermittent release of transients in the slow solar wind: 2. In situ evidence

In paper 1, we showed that the Heliospheric Imager (HI) instruments on the pair of NASA STEREO spacecraft can be used to image the streamer belt and, in particular, the variability of the slow solar wind which originates near helmet streamers. The observation of intense intermittent transient outflow by HI implies that the corresponding in situ observations of the slow solar wind and corotating interaction regions (CIRs) should contain many signatures of transients. In the present paper, we compare the HI observations with in situ measurements from the STEREO and ACE spacecraft. Analysis of the solar wind ion, magnetic field, and suprathermal electron flux measurements from the STEREO spacecraft reveals the presence of both closed and partially disconnected interplanetary magnetic field lines permeating the slow solar wind. We predict that one of the transients embedded within the second CIR (CIR‐D in paper 1) should impact the near‐Earth ACE spacecraft. ACE measurements confirm the presence of a transient at the time of CIR passage; the transient signature includes helical magnetic fields and bidirectional suprathermal electrons. On the same day, a strahl electron dropout is observed at STEREO‐B, correlated with the passage of a high plasma beta structure. Unlike ACE, STEREO‐B observes the transient a few hours ahead of the CIR. STEREO‐A, STEREO‐B, and ACE spacecraft observe very different slow solar wind properties ahead of and during the CIR analyzed in this paper, which we associate with the intermittent release of transients.