Determinación del volumen gástrico residual: en busca de la mejor evidencia

Introducción: La determinación del volumen gástrico residual es una práctica frecuente en pacientes críticos, pero hay falta de consenso acerca de la conveniencia de reintroducir o desechar el contenido gástrico aspirado (CGA). Objetivo: Determinar el grado de evidencia científica acerca de la eficacia de 2 intervenciones-reintroducción/rechazo- del CGA en pacientes críticos. Material y métodos: Revisión sistemática de la evidencia disponible acerca de la conveniencia de reintroducir o desechar el CGA. Proceso: a) establecimiento de los criterios de inclusión/exclusión; b) determinación de la estrategia de búsqueda (palabras clave e itinerarios); c) vaciado de las bases de datos: MEDLINE, CINAHL, CUIDEN, IME, SCIELO y COCHRANE. Búsqueda por método indirecto y vaciado manual de índices; d) lectura crítica independiente y contrastada, utilizando la plantilla CASPe, y e) contraste de resultados del análisis crítico. Resultados: Los itinerarios de búsqueda generan más de 800 referencias que, una vez depuradas, permiten seleccionar 54. Después de su lectura, sólo 4 se centran realmente en cuestiones relacionadas con la reintroducción/rechazo del CGA: 2 revisiones, un estudio observacional y un ECA de muestra pequeña. La heterogeneidad de estos estudios no permite emplear técnicas de metaanálisis. Por ello se analizan por separado los resultados de cada estudio. Mediante este proceso se obtiene un resultado final que demuestra un bajo grado de evidencia científica. Conclusiones: Hay escasa evidencia científica acerca de la conveniencia, la seguridad y los beneficios de ambas intervenciones. Es difícil establecer un protocolo de cuidados, por lo que se planteó realizar un estudio experimental para establecer las indicaciones y contraindicaciones de ambas intervenciones.

O perfil Brasileiro de propriedade intelectual em radiologia e diagnóstico por imagem em um contexto internacional, nos anos 2000-2009

OBJETIVO: Analisar a inovação tecnológica brasileira na área de radiologia e diagnóstico por imagem, em termos de indicadores de patentes. MATERIAIS E MÉTODOS: Este é um estudo analítico-exploratório de informações recuperadas por meio de consultas cruzadas nas bases de dados dos escritórios de propriedade intelectual do Brasil (Instituto Nacional da Propriedade Industrial - INPI), dos Estados Unidos (United States Patent and Trademark Office - USPTO) e da Europa (European Patent Office - EPO). RESULTADOS: Foram encontradas 277.057 patentes. Desse total, 7.800 foram registradas no INPI (3%), 65.428 (24%) registradas no EPO e 203.829 (73%) emitidas no USPTO. O Brasil é o país signatário em 1.732 patentes publicadas no INPI, 80 no EPO e 26 no escritório USPTO. Globalmente, 219.993 (79%) patentes referiam-se a dispositivos eletrônicos ligados a informática em saúde, ultrassonografia, ressonância magnética, tomografia computadorizada e procedimentos de geração, comunicação e arquivamento de imagens, e 57.064 (21%) das patentes tratavam das tecnologias relacionadas a radioproteção e dosimetria, física nuclear, eletroterapia, terapia magnética e radioterapia. CONCLUSÃO: Os resultados obtidos apontam para a fragilidade da produção nacional de inovação tecnológica registrada em patentes, no campo de radiologia e diagnóstico por Imagem.

The HIV care cascade in Switzerland: reaching the UNAIDS/WHO targets for patients diagnosed with HIV.

OBJECTIVES: To describe the HIV care cascade for Switzerland in the year 2012. DESIGN/METHODS: Six levels were defined: (i) HIV-infected, (ii) HIV-diagnosed, (iii) linked to care, (iv) retained in care, (v) on antiretroviral treatment (ART), and (vi) with suppressed viral load. We used data from the Swiss HIV Cohort Study (SHCS) complemented by a nationwide survey among SHCS physicians to estimate the number of HIV-patients not registered in the cohort. We also used Swiss ART sales data to estimate the number of patients treated outside the SHCS network. Based on the number of patients retained in care, we inferred the estimates for levels (i) to (iii) from previously published data. RESULTS: We estimate that (i) 15 200 HIV-infected individuals lived in Switzerland in 2012 (margins of uncertainty, 13 400-19 300). Of those, (ii) 12 300 (81%) were diagnosed, (iii) 12 200 (80%) linked, and (iv) 11 900 (79%) retained in care. Broadly based on SHCS network data, (v) 10 800 (71%) patients were receiving ART, and (vi) 10 400 (68%) had suppressed (<200 copies/ml) viral loads. The vast majority (95%) of patients retained in care were followed within the SHCS network, with 76% registered in the cohort. CONCLUSION: Our estimate for HIV-infected individuals in Switzerland is substantially lower than previously reported, halving previous national HIV prevalence estimates to 0.2%. In Switzerland in 2012, 91% of patients in care were receiving ART, and 96% of patients on ART had suppressed viral load, meeting recent UNAIDS/WHO targets.

Hydrological evidence for a North Atlantic oscillation during the Little Ice Age outside its range observed since 1850.

An annual-resolved precipitation reconstruction for the last 800 yr in Southern Spain has been performed using stable carbon isotope (δ13C) of Pinus nigra tree rings. The reconstruction exhibits high- to low-frequency variability and distinguishes a Little Ice Age (LIA, AD 13501850) characterized by lower averaged rainfall than both in the transition from the Medieval Climate Anomaly to the LIA and in the 20th century. The driest conditions are recorded during the Maunder solar Minimum (mid 17thearly 18th centuries), in good agreement with the Spanish documentary archive. Similar linkage between solar activity (maximum/minimum) and precipitation (increase/decrease) is observed throughout the entire LIA. Additionally, the relationship between the hydrological pattern in the Iberian Peninsula and Morocco during the LIA suggests different spatial distribution of precipitation in the south-eastern sector of the North Atlantic region such as it is known currently. Whereas in the instrumental record the precipitation evolves similarly in both regions and opposite to the North Atlantic oscillation (NAO) index, the coldest periods of the LIA shows a contrasting pattern with drier conditions in the South of Spain and wetter in Northern Africa. We suggest an extreme negative NAO conditions, accompanied by a southward excursion of the winter rainfall band beyond that observed in the last century, can explain this contrast. The sustained NAO conditions could have been triggered by solar minima and higher volcanic activity during the LIA.

Autoevaluación en Enfermería: Educación sanitaria del paciente con isquemia de las extremidades inferiores

Juan L.R., jubilado de 72 años de edad, acude al médico por presentar dolor en ambas pantorrillas al caminar aproximadamente 800 metros. Hace 5 años se le diagnosticó diabetes mellitus e hiperlipidemia, que controla adecuadamente con antidiabéticos orales y dieta. La exploración física está dentro de la normalidad, si se exceptúa la disminución del latido en las arterias pedias. El médico diagnostica una arteriosclerosis...

CO2 utilization in the perspective of industrial ecology, an overview

Carbon dioxide emissions from anthropic activities have accumulated in the atmosphere in excess of 800 Gigatons since preindustrial times, and are continuously increasing. Among other strategies, CO2 capture and storage is one option to mitigate the emissions from large point sources. In addition, carbon dioxide extraction from ambient air is assessed to reduce the atmospheric concentration of CO2. Both direct and indirect (through photosynthesis) pathways are possible. Geological sequestration has significant disadvantages (high cost, low public acceptance, long term uncertainty) whereas carbon dioxide recycling (or utilization) is more consistent with the basic principle of industrial ecology, almost closing material cycles. In this article, a series of technologies for CO2 capture and valorization is described as integrated and optimized pathways. This integration increases the environmental and economic benefits of each technology. Depending on the source of carbon dioxide, appropriate capture and valorization processes are evaluated based on material and energy constraints.

Prevalence and sonographic changes compatible with fatty liver disease in patients referred for abdominal ultrasound examination in Aracaju, SE

Abstract Objective: To estimate the prevalence and evaluate sonographic findings compatible with changes consistent with hepatic steatosis in patients referred for abdominal ultrasonography at four reference centers in Aracaju, SE, Brazil. Materials and Methods: Prospective, descriptive survey, with analytical and quantitative approach, comprising abdominal ultrasonography scans performed with a convex, dynamic 3.75 MHz transducer. Liver dimensions and parenchymal echotexture were evaluated, classifying hepatic steatosis into grades (1, 2 or 3). The SPSS® 22.0 software was used for statistical analysis, adopting p < 0.05 as significance level. Results: A total of 800 individuals (561 women and 239 men) were evaluated. The prevalence of steatosis was 29.1%, and the male patients were most affected, presenting with more advanced grades of disease (p = 0.021), as follows: 119 grade 1 (51.0%); 94 grade 2 (40.4%); and 20 grade 3 (8.6%). The median age patients' was 46 years. Conclusion: In the present study sample, the prevalence of hepatic steatosis was high, particularly in the male patients. Ultrasonography is suggested as a first choice for the diagnosis of this condition, considering its wide availability, low cost and absence of side effects or risks to the patient.

Fischer-Tropsch Slurry Bubble Column Reactor Modeling

The literature part of the work reviews overall Fischer-Tropsch process, Fischer-Tropsch reactors and catalysts. Fundamentals of Fischer-Tropsch modeling are also presented. The emphasis is on the reactor unit. Comparison of the reactors and the catalysts is carried out to choose the suitable reactor setup for the modeling work. The effects of the operation conditions are also investigated. Slurry bubble column reactor model operating with cobalt catalyst is developed by taking into account the mass transfer of the reacting components (CO and H2) and the consumption of the reactants in the liquid phase. The effect of hydrostatic pressure and the change in total mole flow rate in gas phase are taken into account in calculation of the solubilities. The hydrodynamics, reaction kinetics and product composition are determined according to literature. The cooling system and furthermore the required heat transfer area and number of cooling tubes are also determined. The model is implemented in Matlab software. Commercial scale reactor setup is modeled and the behavior of the model is investigated. The possible inaccuraries are evaluated and the suggestions for the future work are presented. The model is also integrated to Aspen Plus process simulation software, which enables the usage of the model in more extensive Fischer-Tropsch process simulations. Commercial scale reactor of diameter of 7 m and height of 30 m was modeled. The capacity of the reactor was calculated to be about 9 800 barrels/day with CO conversion of 75 %. The behavior of the model was realistic and results were in the right range. The highest uncertainty to model was estimated to be caused by the determination of the kinetic rate.

La força pot predir el rendiment i la lesionabilitat al bàsquet professional?

Amb l’objectiu de conèixer les relacions existents entre la força, el rendiment esportiu i la lesionabilitat en un equip masculí de bàsquet professional, es realitza un estudi prospectiu, observacional i descriptiu d’anàlisis d’estadístiques (71 partits), test de mig esquat (n = 7) i patologia lesional, monitoritzant la temporada 09/10, on es relacionen les dades obtingudes de cada jugador referents al rendiment esportiu per partit (valoració estadística), les mitjanes de força, velocitat i potència de cada mesocicle i la lesionabilitat. La tècnica estadística utilitzada ha estat la correlació a partir del paràmetre rho de Spearman. Aquestes correlacions entre força i lesionabilitat mostren que a valors de força més elevats hi ha més lesions: amb 80 kg són molt significatives per a lesions totals (LT) i potència (rho = 0,898; p = 0,006), i significatives per força (rho = 0,823; p = 0,023) i velocitat (rho = 0,774; p = 0,041); la velocitat amb 90 kg es relaciona amb lesions time loss (TL) (rho = 0,878; p = 0,009), i la potència amb 100 kg, amb lesions totals (LT) (rho = 0,805; p = 0,029) i V100 (rho = 0,898; p = 0,006) molt significativament. I la relació entre força i rendiment és significativament negativa en 5 dels 7 mesocicles, és a dir, a menys força, més rendiment. En conclusió, durant l’execució del mig esquat, hi ha valors de força adients per rendir millor i lesionar-se menys: de 800 N a 1.050 N i amb càrregues de 80 kg a 90 kg.

Secure logarithmic audio watermarking scheme based on the human auditory system

Peer-reviewed

Determinação direta de selênio em água de coco e em leite de coco utilizando espectrometria de absorção atômica com atomização eletrotérmica em forno de grafite

Selenium is both essential and toxic to man and animals, depending on the concentration and the ingested form. Most fruits and vegetables are poor sources of selenium, but coconut can be a good selenium source. Samples were suspended (1 + 4 v/v) in a mixture of tertiary amines soluble in water (10% v/v CFA-C). This simple sample treatment avoided contamination and decreased the analysis time. The standard additions method was adopted for quantification. The action of the autosampler was improved by the presence of the amines mixture in the suspension. A Varian model AA-800 atomic absorption spectrometer equipped with a graphite furnace and a GTA 100 autosampler was used for selenium determination in coconut water and coconut milk. Background correction was performed by means of the Zeeman effect. Pyrolytically coated graphite tubes were employed. Using Pd as chemical modifier, the pyrolysis and the atomization temperatures were set at 1400 and 2200ºC, respectively. For six samples, the selenium concentration in coconut water varied from 6.5 to 21.0 mug L-1 and in coconut milk from 24.2 to 25.1 mug L-1. The accuracy of the proposed method was evaluated by an addition-recovery experiment and all recovered values are in the 99.5-102.3% range. The main advantage of the proposed method is that it can be directly applied without sample decomposition.

Skönlitteratur – en specialsamling rikssvensk skönlitteratur

Samlingen med signum HB IVb2 finns vid huvudbiblioteket och innehåller rikssvensk skönlitteratur förutom barnlitteratur. Samlingen tillväxer kontinuerligt. Barnlitteraturen ingår Barnbokssamlingen. Grunden för specialsamlingen rikssvensk skönlitteratur lades vid akademins invigning år 1919. Riksföreningen för svenskhetens bevarande i utlandet gjorde ett upprop i hela Sverige att det nygrundade svenskspråkiga universitetet i grannlandet behövde litteratur. Strömmen bokdonationer fortsatte sedan genom åren att komma från Sverige, men betydande bokdonationer kom också från hemlandet. Det kom bokdonationer från enskilda personer, från sterbhus, från institutioner och från föreningar. Bland föreningar i Sverige kan förutom ovannämnda riksförening nämnas Föreningen Svensk-Finlands Vänner i Stockholm, Riksföreningen Sverigekontakt och Föreningen Konung Oscar II:s vandringsbibliotek. Bland stora donationer från institutioner kan nämnas de 400 volymer som Göteborgs stadsbibliotek donerade i mitten av 40-talet och de 800 volymer som Kungliga biblioteket i Stockholm donerade i slutet av 50-talet. Bland donationer från hemlandet kan speciellt nämnas vicehäradshövding Arvid Souranders samling böcker skrivna av Strindberg samt hans samling böcker skrivna av Almqvist. En annan speciellt värdefull specialsamling som biblioteket erhållit består av äldre svensk dramatisk litteratur. Samlingen är kronologiskt ordnad men okatalogiserad. Beståndet finns förprickat i ett exemplar av G.E. Klemmings Sveriges dramatiska litteratur till och med 1875. Med anledning av att Åbo Akademi fyllde 50 år förband sig över femtio rikssvenska förlag i januari 1968 att till biblioteket ställa till förfogande ett exemplar av varje bok som förlagen utgav. Denna s.k. förlagsgåva har med åren minskat i omfång och betydelse, dels har förlagsvärlden ändrats så att flertalet förlag har upphört att existera och dels har bibliotekets resurser blivit bättre och biblioteket kompletterar samlingen genom inköp. Den rikssvenska skönlitteraturen söks i Alma med sökfunktionen Signum och söktermen HB IVb2. En del litteratur tryckt före 1980 skall sökas manuellt i huvudbibliotekets systematiska kortkatalog, men retroaktiv inmatning i Alma av litteratur tryckt mellan 1830 och 1979 pågår.

Musiikin kehittämis- ja opetussuunnitelma Seinäjoen Kansalaisopistoon

Tämän opinnäytetyön lähtökohtana on ollut musiikinopetuksen kehittämis- ja opetussuunnitelman puuttuminen Seinäjoen Kansalaisopistosta. Työn alkuosassa käydään läpi pääpiirteittäin vapaan sivistystyön historia ja Laki vapaasta sivistystyöstä. Seinäjoen Kansalaisopiston musiikin opetusta tarkastellaan elinikäisen oppimisen, eettisyyden ja indoktrinaation näkökulmista. Musiikin opetus- ja oppimiskäsitykset sekä opettajan kompetenssi ovat myös keskeisiä asioita kehitettäessä Seinäjoen Kansalaisopiston musiikin opetusta. Seinäjoen Kansalaisopistossa musiikkiaineissa opiskeli lukuvuonna 2006-2007 yli 800 opiskelijaa. Solistista opetusta annettiin pianossa, laulussa, viulussa ja huilussa. Ryhmäopetusta annettiin harmonikan ja pelimanniharmonikan soitossa, kitaran soitossa, rummuissa, viulun soitossa, kuorolaulussa sekä vauva-äiti/vanhempi - ja erityismusiikkiryhmille (erityislapset, ikäihmiset, erityisaikuiset), kansanmusiikki- ja pelimanniyhtyeille. Seinäjoen Kansalaisopistossa musiikin kehittämis- ja opetussuunnitelmaa varten tehtiin kaksi kyselytutkimusta: erikseen musiikin opiskelijoille ja musiikin opettajille. Niissä selvitettiin opiskelijoiden ja opettajien toiveita ja tarpeita kansalaisopiston musiikin opetuksessa. Tutkimus on määrällinen, ja tulokset antoivat Seinäjoen kansalaisopiston musiikin opetuksen kehittämiselle tietoa, jonka pohjalta opetussuunnitelma on mahdollista laatia. Opettajille suunnattu kysely tuotti keskeisiä tuloksia: kansalaisopiston hallinnolliset palvelut opettajille koettiin tasokkaiksi, mutta opetustuntien toivottiin olevan pidempiä; lisäksi täydennyskoulutustarvetta oli yli puolella vastanneista. Hyvän opettajuuden tärkeimmiksi elementeiksi opettajat kokivat kannustavuuden, hyvät vuorovaikutustaidot, ohjaavan ja rakentavan suhtautumisen sekä hyvän tilannetajun. Opiskelijoille suunnattu kysely osoitti, että heidän mielestään opetus on tasokasta ja opettajat ammattitaitoisia sekä innostavia. Opiskelijat kokivat solististen aineiden oppitunnit liian lyhyiksi. Opiskelun kannustimiksi opiskelijat totesivat musiikista saadun ilon, itsensä kehittämisen ja uuden oppimisen halun sekä musiikin sopivuuden vapaa-ajan harrastukseksi. Musiikkikurssien yleisarvio oli hyvä, hinta-laatu-suhde erinomainen ja opiskelijat kokivat saavansa myös tarpeeksi palautetta. Opetussuunnitelma voi palvella musiikinopettajia opetuksen kehittämisessä, suunnittelussa ja toteuttamisessa ilman, että sen tarvitsee viedä opettajien itsenäisyyttä. Opiskelijoita halutaan tukea musiikin opiskelussa siten, että heille luodaan hyvä oppimisympäristö ja tarvittaessa heille laaditaan henkilökohtainen opetussuunnitelma yhteistyössä opettajan kanssa. Seinäjoen Kansalaisopisto pyrkii tulevaisuudessa tarjoamaan aiempaa paremmin kysyntää vastaavaa musiikinopetusta niin aikuisille harrastajille kuin myös nuorille ja lapsille.

Geographic patterns of genetic variation in a broadly distributed marine vertebrate: new insights into loggerhead turtle stock structure from expanded mitochondrial DNA sequences

Previous genetic studies have demonstrated that natal homing shapes the stock structure of marine turtle nesting populations. However, widespread sharing of common haplotypes based on short segments of the mitochondrial control region often limits resolution of the demographic connectivity of populations. Recent studies employing longer control region sequences to resolve haplotype sharing have focused on regional assessments of genetic structure and phylogeography. Here we synthesize available control region sequences for loggerhead turtles from the Mediterranean Sea, Atlantic, and western Indian Ocean basins. These data represent six of the nine globally significant regional management units (RMUs) for the species and include novel sequence data from Brazil, Cape Verde, South Africa and Oman. Genetic tests of differentiation among 42 rookeries represented by short sequences (380 bp haplotypes from 3,486 samples) and 40 rookeries represented by long sequences (~800 bp haplotypes from 3,434 samples) supported the distinction of the six RMUs analyzed as well as recognition of at least 18 demographically independent management units (MUs) with respect to female natal homing. A total of 59 haplotypes were resolved. These haplotypes belonged to two highly divergent global lineages, with haplogroup I represented primarily by CC-A1, CC-A4, and CC-A11 variants and haplogroup II represented by CC-A2 and derived variants. Geographic distribution patterns of haplogroup II haplotypes and the nested position of CC-A11.6 from Oman among the Atlantic haplotypes invoke recent colonization of the Indian Ocean from the Atlantic for both global lineages. The haplotypes we confirmed for western Indian Ocean RMUs allow reinterpretation of previous mixed stock analysis and further suggest that contemporary migratory connectivity between the Indian and Atlantic Oceans occurs on a broader scale than previously hypothesized. This study represents a valuable model for conducting comprehensive international cooperative data management and research in marine ecology.

Garvey-Kelson relations for nuclear charge radii

The Garvey-Kelson relations (GKRs) are algebraic expressions originally developed to predict nuclear masses. In this letter we show that the GKRs provide a fruitful framework for the prediction of other physical observables that also display a slowly-varying dynamics. Based on this concept, we extend the GKRs to the study of nuclear charge radii. The GKRs are tested on 455 out of the approximately 800 nuclei whose charge radius is experimentally known. We find a rms deviation between the GK predictions and the experimental values of only 0.01 fm. This should be contrasted against some of the most successful microscopic models that yield rms deviations almost three times as large. Predictions -with reliable uncertainties- are provided for 116 nuclei whose charge radius is presently unknown.