Ventilación mecánica en posición prona en pacientes con síndrome de dificultad respiratoria aguda

Introducción La ventilación en posición prona ha demostrado mejorar la oxigenación y la mecánica ventilatoria en pacientes con síndrome de dificultad respiratoria aguda (SDRA). Nosotros evaluamos si la posición prona disminuye el riesgo de mortalidad en pacientes adultos con SDRA vs. ventilación en posición supino. Metodología. Se realizó un metanálisis de ensayos clínicos controlados aleatorizados (ECAs) que compararon pacientes en posición prono vs supino. Se realizó una búsqueda en Pubmed, Embase, Cochrane Library y LILACS. Se evaluó mortalidad, estancia hospitalaria, días de ventilación mecánica y efectos adversos. Resultados. Siete ECAs (2119 pacientes) fueron incluidos en el análisis. La posición prona mostró una tendencia no significativa a disminuir la mortalidad (OR 0.76; IC 95% 0.54–1.06; p=0.11). Al estratificar por subgrupos se encontró una disminución significativa en el riesgo de mortalidad en los pacientes ventilados con volumen corriente bajo (OR 0.58; IC 95%: 0.38-0.87; p=0.009), pronación prolongada (OR 0.6; IC 95% 0.43–0,83, p=0,002), instauración antes de 48h de evolución de la enfermedad (OR 0.49; IC 95% 0.35–0.68; p=0.0001) e hipoxemia severa (OR 0,51; IC 95% 0.36–1.25; p=0.0001). Los efectos adversos relacionados con la pronación fueron el desarrollo de ulceras por presión y obstrucción del tubo orotraqueal.

Analysis of the alveolar recruitment maneuvers applied at seven intensive care units

Introduction: During the past years, alveolar recruitment maneuvers (RM) have produced growing interest due to their beneficial potential in pulmonary protection, and have been introduced in clinical practice. Objective: To describe and analyze the knowledge of MR and its application at seven intensive care units in the city of Cali, Colombia. Methods and materials: Descriptive Cross-Sectional Study with an intentional sample of 64 professionals working in seven intensive care units and who apply MR. The self-completed survey was made up of thirteen questions, and the application period was two months. Results: Out of 64 professionals surveyed, 77.8% of them follow a protocol guide; 54.7% employes during RM the ideal Positive end-expiratory pressure (PEEP), which maintains a saturation > 90% and a PaO2 > 60 mmHg; 42.1% tolerates airway pressures between 35 and 50 cmH2O; 48.4% perform RM with a progressive increase of the PEEP and a low tidal volume. Conclusions: Regarding the knowledge related to RM, heterogeneity was found in the answers. There is currently no consensus about which is the most effective and secure way to implement an MR. This study can be the starting point to create awareness towards the revision of knowledge, capacities and abilities that are required to perform RM.

Caracterización de las variables nutricionales en pacientes incidentes de diálisis peritoneal rts 2011-2012

Los pacientes con enfermedad renal crónica (ERC) terminal se caracterizan por presentar alteraciones nutricionales que se perpetúan independiente de la modalidad de la Terapia de Reemplazo Renal (TRR). En la diálisis peritoneal, tanto APD (automated peritoneal dialysis) como la CAPD (continuous ambulatory peritoneal dialysis) existe un alto riesgo de pérdida de albúmina por el filtrado peritoneal, sin diferencias claras en el estatus nutricional. El presente estudio caracteriza el estado nutricional de los pacientes incidentes en diálisis peritoneal de RTS Bogotá Regional 1, con un seguimiento de un año, para conocer los cambios en las variables nutricionales. Se realizó un estudio de cohortes retrospectivo, analizando 2 grupos según el tipo de diálisis peritoneal escogida (APD o CAPD), con un análisis análisis descriptivo trimestral de las características nutricionales y posteriormente una comparación entre las 2 modalidades de TRR. Encontrando un promedio de edad de 60,8 años, la mayoría hombres y etiología principal nefropatía diabética. La mayoría de las variables nutricionales permanecieron sin cambios durante seguimiento. El Test de equilibrio peritoneal para glucosa y creatinina mostró valores promedio bajo y promedio alto y la mayoría de pacientes un rango nutricional normal. Al comparar APD y CAPD, solo se encontraron de forma aislada, diferencias significativas en algunas variables aisladas. Este es el primer estudio en Colombia que evalúa diferentes aspectos nutricionales en diálisis peritoneal. Aunque con limitaciones metodológicas, es un punto de partida para la realización de estudios más robustos que del estado nutricional de los pacientes en diálisis peritoneal

Aerosorgailu palen aplikazioetarako pvc espumaren degradazio termiko eta propietate mekanikoen karakterizazioa

[EU]Energia berriztagarria iturri naturaletatik sortzen den energia mota da. Energia lortzeko erabiltzen diren baliabide naturalak asko dira, eguzki-energia, haizea, ura… Energia berriztagarrien artean, eolikoa da zabalkunde handien lortu duena; batez ere ingurumen-inpaktu urriagatik eta bere kostuak gero eta txikiagoak izateagatik. Honen ondorioz, energia garbi, lehiakor eta ekonomikoki bideragarria da gaur egun. Hala ere, aerosorgailu hauen ekoizpen prozesuak desabantaila nabaria aurkezten du palen ontze prozesuan. Tenperatura igoeraren ondorioz material konkretu baten degradazioa dela eta. Ikerketa lan honetan, aerosorgailu palen karakterizazioa egingo da eta ontze prozesuan, “polikloruro de binilo” (PVC)-ak jasaten duen degradazioaren azterketa.

California's Endangered Belding’s Savannah Sparrow (Passerculus sandwichensis beldingi): Tolerance of Pedestrian Disturbance

Salt marshes constitute habitat islands for many endemic animal species, particularly along the California coast, where urban sprawl has fragmented this habitat. Recreational activities in salt marshes have increased recently, posing an interesting problem: how do endemic species lacking alternative habitat modify their tolerance to humans? We assessed seasonal and site variations in three tolerance parameters (distances at which animals became alert, fled, and moved after fleeing) of California's endangered Belding’s Savannah Sparrow ((Passerculus sandwichensis beldingi). We approached individuals on trails in three salt marshes with different levels of vehicle and pedestrian traffic. Belding’s Savannah Sparrows became aware and fled at shorter distances in the salt marsh coincident with greater levels of recreational activity as a result of habituation or visual obstruction effects. Seasonal effects in tolerance varied between sites. Alert and flight initiation distances were higher in the pre-nesting than in the non-breeding season in the site with the highest levels of recreational use likely due to greater exposure of breeding individuals; however, the opposite seasonal trend was found in each of the two sites with relatively lower human use, probably because individuals were less spatially attached in the non-breeding season when they foraged in aggregations. Distance fled was greater in the non-breeding than in the breeding season. Our findings call for dynamic management of recreational activities in different salt marshes depending on the degree of exposure to humans and seasonal variations in tolerance. We recommend a minimum approaching distance of 63 m and buffer areas of 1.3 ha around Belding's Savannah Sparrows.

Flight Paths of Migrating Golden Eagles and the Risk Associated with Wind Energy Development in the Rocky Mountains

In recent years, the eastern foothills of the Rocky Mountains in northeastern British Columbia have received interest as a site of industrial wind energy development but, simultaneously, have been the subject of concern about wind development coinciding with a known migratory corridor of Golden Eagles (Aquila chrysaetos). We tracked and quantified eagle flights that crossed or followed ridgelines slated for one such wind development. We found that hourly passage rates during fall migration peaked at midday and increased by 17% with each 1 km/h increase in wind speed and by 11% with each 1°C increase in temperature. The propensity to cross the ridge tops where turbines would be situated differed between age classes, with juvenile eagles almost twice as likely to traverse the ridge-top area as adults or subadults. During fall migration, Golden Eagles were more likely to cross ridges at turbine heights (risk zone, < 150 m above ground) under headwinds or tailwinds, but this likelihood decreased with increasing temperature. Conversely, during spring migration, eagles were more likely to move within the ridge-top area under eastern crosswinds. Identifying Golden Eagle flight routes and altitudes with respect to major weather systems and local topography in the Rockies may help identify scenarios in which the potential for collisions is greatest at this and other installations.

Data assimilation for a coastal area morphodynamic model: Morecambe Bay

This paper investigates the use of data assimilation in coastal area morphodynamic modelling using Morecambe Bay as a study site. A simple model of the bay has been enhanced with a data assimilation scheme to better predict large-scale changes in bathymetry observed in the bay over a 3-year period. The 2DH decoupled morphodynamic model developed for the work is described, as is the optimal interpolation scheme used to assimilate waterline observations into the model run. Each waterline was acquired from a SAR satellite image and is essentially a contour of the bathymetry at some level within the inter-tidal zone of the bay. For model parameters calibrated against validation observations, model performance is good, even without data assimilation. However the use of data assimilation successfully compensates for a particular failing of the model, and helps to keep the model bathymetry on track. It also improves the ability of the model to predict future bathymetry. Although the benefits of data assimilation are demonstrated using waterline observations, any observations of morphology could potentially be used. These results suggest that data assimilation should be considered for use in future coastal area morphodynamic models.

An eclectic morphostratigraphic model for the sedimentary response to Holocene sea-level rise in northwest Europe

The improved empirical understanding of silt facies in Holocene coastal sequences provided by such as diatom, foraminifera, ostracode and testate amoebae analysis, combined with insights from quantitative stratigraphic and hydraulic simulations, has led to an inclusive, integrated model for the palaeogeomorphology, stratigraphy, lithofacies and biofacies of northwest European Holocene coastal lowlands in relation to sea-level behaviour. The model covers two general circumstances and is empirically supported by a range of field studies in the Holocene deposits of a number of British estuaries, particularly, the Severn. Where deposition was continuous over periods of centuries to millennia, and sea level fluctuated about a rising trend, the succession consists of repeated cycles of silt and peat lithofacies and biofacies in which series of transgressive overlaps (submergence sequences) alternate with series of regressive overlaps (emergence sequences) in association with the waxing and waning of tidal creek networks. Environmental and sea-level change are closely coupled, and equilibrium and secular pattern is of the kind represented ideally by a closed limit cycle. In the second circumstance, characteristic of unstable wetland shores and generally affecting smaller areas, coastal erosion ensures that episodes of deposition in the high intertidal zone last no more than a few centuries. The typical response is a series of regressive overlaps (emergence sequence) in erosively based high mudflat and salt-marsh silts that record, commonly as annual banding, exceptionally high deposition rates and a state of strong disequilibrium. Environmental change, including creek development, and sea-level movement are uncoupled. Only if deposition proceeds for a sufficiently long period, so that marshes mature, are equilibrium and close coupling regained. (C) 2002 Elsevier Science B.V. All rights reserved.

Seasonality of modern pollen and sediment deposition in an estuarine context: the Severn Estuary Levels, southwest England

Recent sedimentological and palynological research on subfossil Holocene banded sediments from the Severn Estuary Levels suggested seasonality of deposition, registered by variations in mineral grain-size and pollen assemblages between different parts of the bands. Here we provide data that strengthen this interpretation from sampling of modern sediments and pollen deposition on an active mudflat and saltmarsh on the margin of the Severn Estuary, and comparison with a vegetation survey and contemporary records of climate, river and tidal regimes. The results of grain-size analysis indicate deposition of comparatively coarse-grained silts during the relatively cool and windy conditions of winter and comparatively fine-grained sediments during relatively warm and calm summer months. Pollen analysis demonstrates the significance of long-term storage of pollen grains and fern spores in the estuarine waterbody, superimposed on which seasonal variations in pollen inputs from local and regional vegetation remain detectable. Copyright (C) 2007 John Wiley & Sons, Ltd.

Granulometric characterization and evaluation of annually banded mid-Holocene estuarine silts, Welsh Severn Estuary (UK): coastal change, sea level and climate

Holocene silts (salt marshes) and highest intertidal-supratidal peats are superbly exposed on a 15 kin coastal transect which reveals two laterally extensive units of annually banded silts (Beds 3, 7) associated with three transgressive-regressive silt-peat cycles (early sixth-early fourth millennium BC). Bed 3 in places is concordantly and gradationally related to peats above and below, but in others transgresses older strata. Bed 7 also grades up into peat, but everywhere overlies a discordance. The banding in Bed 3 at three main and two minor sites was resolved and characterized texturally at high-resolution (2.5/5 mm contiguous slices) using laser granulometry (LS230 with PIDS) and a comprehensive scheme of data-assessment. Most of Bed 3 formed very rapidly, at peak values of several tens of millimetres annually, in accordance with modelled effects of sea-level fluctuations on mature marshes (bed concordant and gradational) and on marshes growing up after coastal erosion and retreat (bed with discordant base). Using data from the modern Severn Estuary, the textural contrast within bands, and its variation between bands, points to a variable but overall milder mid-Holocene climate than today. The inter-annual variability affected marsh dynamics, as shown by the behaviour of the finely divided plant tissues present. Given local calibration, the methodology is applicable to other tidal systems with banded silts in Britain and mainland northwest Europe. (c) 2006 Elsevier Ltd. All rights reserved.

An ichnofabric approach to the depositional interpretation of the intensely burrowed Bateig Limestone, Miocene, SE Spain

The foraminiferal-rich pelagic Bateig Limestone forms several varieties of the important building stones quarried at Bateig Hill in southeastern Spain. Three principal ichnofabrics (Bichordites, mottled-Palaeophycus and mottled-Ophiomorpha) are recognized, which are present in at least two (possibly up to four) repeated successions (cycles). Each succession begins with an erosional event. The Bichordites ichnofabric represents a new type of facies, formed as thin turbidity/grain flow, stratiform units derived from sediment slips off a fault into deep water. Each slipped unit became almost completely bioturbated by infaunal echinoids, colonizing by lateral migration. Because of the thinness of the units, successive colonizations tended to truncate the underlying burrows giving rise to a pseudo-stratification. As the Bichordites ichnofabric accumulated on the fault apron, thus reducing the effective height of the fault scarp, the substrate gradually came under the influence of currents traversing the shelf. This led to a change in hydraulic regime, and to the mottled-Palaeophycus and mottled-Ophiomorpha ichnofabrics in sediment deposited under bed load transport, and associated with laminar and cross-stratified beds and local muddy intervals. Reactivation of the fault triggered erosion and channeling and a return to grain flow sedimentation, and to the Bichordites ichnofabric of the succeeding cycle. The highest unit of the Bateig Limestone is formed entirely of cross-stratified calcarenites with occasional Ophiomorpha (Ophiomorpha-primary lamination ichnofabric) and is similar to many shallow marine facies but they still bear a significant content of pelagic foraminifera. The sedimentary setting bears resemblance with that described for the Pleistocene Monte Torre Paleostrait and the modem Strait of Messina (Italy), where the narrow morphology of the depositional area enhanced tidal currents and allowed for high-energy sandy deposition in relatively deep areas. More data on the Miocene paleogeography of the Bateig area should provide further testing for this hypothesis. The ichnofacies and stacking of the Bateig Limestone differ from the classic Seilacherian model in that they reflect changes in hydraulic process and are associated with faulting and subsidence and changes in sediment supply. Recognition of the unusual ichnofabrics and their relationships provides a clear indication of the overall dynamic setting. (c) 2006 Elsevier B.V. All rights reserved.

Remote sensing of intertidal morphological change in Morecambe Bay, U.K., between 1991 and 2007

Tidal Flats are important examples of extensive areas of natural environment that remain relatively unaffected by man. Monitoring of tidal flats is required for a variety of purposes. Remote sensing has become an established technique for the measurement of topography over tidal flats. A further requirement is to measure topographic changes in order to measure sediment budgets. To date there have been few attempts to make quantitative estimates of morphological change over tidal flat areas. This paper illustrates the use of remote sensing to measure quantitative and qualitative changes in the tidal flats of Morecambe Bay during the relatively long period 1991–2007. An understanding of the patterns of sediment transport within the Bay is of considerable interest for coastal management and defence purposes. Tidal asymmetry is considered to be the dominant cause of morphological change in the Bay, with the higher currents associated with the flood tide being the main agency moulding the channel system. Quantitative changes were measured by comparing a Digital Elevation Model (DEM) of the intertidal zone formed using the waterline technique applied to satellite Synthetic Aperture Radar (SAR) images from 1991–1994, to a second DEM constructed from airborne laser altimetry data acquired in 2005. Qualitative changes were studied using additional SAR images acquired since 2003. A significant movement of sediment from below Mean Sea Level (MSL) to above MSL was detected by comparing the two Digital Elevation Models, though the proportion of this change that could be ascribed to seasonal effects was not clear. Between 1991 and 2004 there was a migration of the Ulverston channel of the river Leven north-east by about 5 km, followed by the development of a straighter channel to the west, leaving the previous channel decoupled from the river. This is thought to be due to independent tidal and fluvial forcing mechanisms acting on the channel. The results demonstrate the effectiveness of remote sensing for measurement of long-term morphological change in tidal flat areas. An alternative use of waterlines as partial bathymetry for assimilation into a morphodynamic model of the coastal zone is also discussed.

Response of the lower St. Lawrence Estuary to external forcing in winter

Mostly because of a lack of observations, fundamental aspects of the St. Lawrence Estuary's wintertime response to forcing remain poorly understood. The results of a field campaign over the winter of 2002/03 in the estuary are presented. The response of the system to tidal forcing is assessed through the use of harmonic analyses of temperature, salinity, sea level, and current observations. The analyses confirm previous evidence for the presence of semidiurnal internal tides, albeit at greater depths than previously observed for ice-free months. The low-frequency tidal streams were found to be mostly baroclinic in character and to produce an important neap tide intensification of the estuarine circulation. Despite stronger atmospheric momentum forcing in winter, the response is found to be less coherent with the winds than seen in previous studies of ice-free months. The tidal residuals show the cold intermediate layer in the estuary is renewed rapidly ( 14 days) in late March by the advection of a wedge of near-freezing waters from the Gulf of St. Lawrence. In situ processes appeared to play a lesser role in the renewal of this layer. In particular, significant wintertime deepening of the estuarine surface mixed layer was prevented by surface stability, which remained high throughout the winter. The observations also suggest that the bottom circulation was intensified during winter, with the intrusion in the deep layer of relatively warm Atlantic waters, such that the 3 C isotherm rose from below 150 m to near 60 m.

High-resolution, unstructured meshes for hydrodynamic models of the Great Barrier Reef, Australia

Accuracy and mesh generation are key issues for the high-resolution hydrodynamic modelling of the whole Great Barrier Reef. Our objective is to generate suitable unstructured grids that can resolve topological and dynamical features like tidal jets and recirculation eddies in the wake of islands. A new strategy is suggested to refine the mesh in areas of interest taking into account the bathymetric field and an approximated distance to islands and reefs. Such a distance is obtained by solving an elliptic differential operator, with specific boundary conditions. Meshes produced illustrate both the validity and the efficiency of the adaptive strategy. Selection of refinement and geometrical parameters is discussed. (c) 2006 Elsevier Ltd. All rights reserved.