SIDUR: development of an information system, using controlled vocabulary designed to the characterization and sample of population with and without disability, attended by Rehabilitation programs, University of Rosario

Introduction: the statistical record used in the Field Academic Programs (PAC for it’s initials in Spanish) of Rehabilitation denotes generalities in the data conceptualization, which complicates the reliable guidance in making decisions and provides a low support for research in rehabilitation and disability. In response, the Research Group in Rehabilitation and Social Integration of Persons with Disabilities has worked on the creation of a registry to characterize the population seen by Rehabilitation PAC. This registry includes the use of the International Classification of Functioning, Disability and Health (ICF) of the WHO. Methodology: the proposed methodology includes two phases: the first one is a descriptive study and the second one involves performing methodology Methontology, which integrates the identification and development of ontology knowledge. This article contextualizes the progress made in the second phase. Results: the development of the registry in 2008, as an information system, included documentary review and the analysis of possible use scenarios to help guide the design and development of the SIDUR system. The system uses the ICF given that it is a terminology standardization that allows the reduction of ambiguity and that makes easier the transformation of health facts into data translatable to information systems. The record raises three categories and a total of 129 variables Conclusions: SIDUR facilitates accessibility to accurate and updated information, useful for decision making and research.

La ventilazione non-invasiva a pressione positiva nell’insufficienza respiratoria acuta ipercapnica: 10 anni di esperienza clinica di una Unità di Terapia Semi-Intensiva Respiratoria

PremessaSebbene numerosi studi prospettici, controllati e randomizzati abbiano dimostrato il successo della ventilazione non-invasiva a pressione positiva (NIV) in casi selezionati di insufficienza respiratoria acuta ipercapnica (IRA) in setting con intensità di cura differenti, i dati di pratica clinica relativi all’uso della NIV nel “mondo reale” sono limitati. Scopo Riportare i risultati della nostra esperienza clinica sulla NIV nell’IRA applicata nell’Unità di Terapia Semi-Intensiva Respiratoria (UTSIR) allocata all’interno dell’Unità Operativa di Pneumologia di Arezzo negli anni 1996-2006 in termini di: tollerabilità, effetti sui gas ematici, tasso di successo e fattori predittivi del fallimento.MetodiTrecentocinquanta dei 1484 pazienti (23.6%) consecutivamente ammessi per IRA nella nostra Unità Operativa di Pneumologia durante il periodo di studio hanno ricevuto la NIV in aggiunta alla terapia standard, in seguito al raggiungimento di criteri predefiniti impiegati di routine.RisultatiOtto pazienti (2.3%) non hanno tollerato la NIV per discomfort alla maschera, mentre i rimanenti 342 (M: 240, F: 102; età: mediana (interquartili) 74.0 (68.0-79.3) anni; BPCO: 69.3%) sono stati ventilati per >1 ora. I gas ematici sono significativamente migliorati dopo 2 ore di NIV (media (deviazione standard) pH: 7.33 (0.07) versus 7.28 (7.25-7.31), p<0.0001; PaCO2: 71.4 (15.3) mmHg versus 80.8 (16.6) mmHg, p<0.0001; PaO2/FiO2: 205 (61) versus 183 (150-222), p<0.0001). La NIV ha evitato l’intubazione in 285/342 pazienti (83.3%) con una mortalità ospedaliera del 14.0%. Il fallimento della NIV è risultato essere predetto in modo indipendente dall’Apache III (Acute Physiology and Chronic Health Evaluation III) score, dall’indice di massa corporea e dal fallimento tardivo della NIV (> 48 ore di ventilazione) dopo iniziale risposta positiva.ConclusioniSecondo la nostra esperienza clinica di dieci anni realizzata in una UTSIR, la NIV si conferma essere ben tollerata, efficace nel migliorare i gas ematici e utile nell’evitare l’intubazione in molti episodi di IRA non-responsivi alla terapia standard.

La ventilación no invasiva con presión positiva en la insuficiencia respiratoria aguda hipercápnica: diez años de experiencia clínica de una unidad de terapia semiintensiva respiratoria

Premisa: Si bien numerosos estudios prospectivos, controlados y aleatorizados han demostrado el éxito de la ventilación no invasiva con presión positiva (VNI) en casos seleccionados de insuficiencia respiratoria aguda (IRA) hipercápnica, en contexto con intensidad de cuidado diferente, los datos de práctica clínica relativos al uso de la VNI en escenarios reales son limitados.Objetivo: Reportar los resultados de nuestra experiencia clínica sobre la VNI en la IRA aplicada en la Unidad de Terapia Semiintensiva Respiratoria (UTSIR), de la Unidad Operativa de Neumología de Arezzo, entre 1996-2006, en términos de tolerabilidad, efectos sobre los gases arteriales, tasa de éxito y factores predictivos del fracaso.Métodos: Trescientos cincuenta de los 1.484 pacientes (23,6%) ingresados consecutivamente por IRA en nuestra Unidad Operativa de Neumología, durante el periodo de estudio, recibieronla VNI asociada a la terapia estándar, posterior al cumplimiento de criterios predefinidos, empleados de rutina.Resultados: Ocho pacientes (2,3%) no toleraron la VNI por incomodidad producida por la máscara, mientras los 342 restantes (M: 240; F: 102; edad: mediana [intercuartiles] 74,0 años [68,0-79,3]; enfermedad pulmonar obstructiva crónica (EPOC) [69,3%]) fueron ventilados por más de una hora. Los parámetros de ventilación (y su efecto sobre el pH) y de oxigenación mejoraron significativamente después de dos horas de VNI (media [desviación estándar] pH: 7,33 [0,07] contra 7,28 [7,25-7,31 ], p < 0,0001; PaCO2: 71,4 mmHg [15,3] contra 80,8 mmHg [16,6], p < 0,0001; PaO2/FiO2: 205 [61] contra 183 [150-222 ], p < 0,0001). La VNI evitó la intubación en 285/342 pacientes (83,3%), con una mortalidad hospitalaria del 14,0%. El fracaso de la VNI resultó ser predicho de modo independiente por el puntaje acute physiology and chronic health evaluation III (Apache III), por el índice de masa corporal y por el fracaso tardío de la VNI (mayor a 48 horas de ventilación), después de una respuesta positiva inicial.Conclusiones: Según nuestra experiencia clínica de diez años en una UTSIR, la VNI confirma ser bien tolerada, eficaz en el mejoramiento de los gases arteriales y útil en evitar la intubación en muchos episodios de IRA que no responden a la terapia estándar.

The Role of Kinaesthetic Motor Imagery in Promoting Activation of the Lumbrical Muscles in the Hemiparetic Hand: a Randomised Controlled Study

The objective of the investigation who gave as result this work was to investigate the effectiveness of kinaesthetic motor imagery in the activation of the hemiplegic hand muscles following stroke. The experiment consisted of two random groups. Movements were measured after treatment. The participants were ten patients with hemiplegic hands (men who mean age was 74.4 years; mean time since stroke 3.05 months). All patients received three sessions of physical treatment based on an identical treatment protocol. Five patients were randomly assigned to an experimental group practising kinaesthetic motor imagery of a grasp using the 'lumbrical action' (experimental group). The others five (control group) followed a relaxation script. All the patients were then asked to grasp an object using the 'lumbrical action'. The grasps were recorded using an optoelectronic motion capture system. The magnitude of the extension of the index finger and the correlation of the angular displacement of the proximal phalangeal joints and the metacarpophalangeal joints were calculated. The movement time for the whole grip was calculated. The experimental group demonstrated higher extension in the index finger (p = < 0.01) and they had a higher correlation coefficient (0.99) than the control group (0.77) for the displacement of the proximal interphalangeal joint and the metacarpophalangeal joints. The movement time for the experimental group was faster, although the difference was not significant.

Variación en la resistencia al flujo de los tubos endotraqueales pediátricos modificando su longitud

Introducción: Se conocen los beneficios del uso de los tubos endotraqueales con neumotaponador, aunque dicha práctica tiene un impacto sobre el trabajo respiratorio durante el acto anestésico sin embargo se propone estudiar las consecuencias físicas de la variación en la longitud de los tubos para compensar dicha perdida de flujo, con base en la ley de Hagen-Poiseuille. Metodología: Se realizó un estudio experimental in vitro, en el cual se realizaron mediciones repetidas de flujo, variando la longitud y diámetro de diferentes tubos endotraqueales pediátricos (desde calibre 3.5mm hasta 6.5mm), con longitudes de 20cm, 15 cm, 10 cm y manteniendo su longitud original. Se analizaron los datos con el fin de medir el impacto sobre el flujo. Resultados: A pesar que los resultados muestran diferencias estadísticamente significativas (p0,000), la variación en la longitud de los tubos endotraqueales pediátricos tiene mucho menor impacto sobre la variación en el flujo, que la modificación del diámetro. Discusión: Si bien la práctica de acortar la longitud de un tubo endotraqueal pediátrico puede ayudar a reducir el espacio muerto y la retención de CO2, el impacto que tiene sobre el flujo es poco. Cuando se trata de disminuir el trabajo respiratorio de un niño en ventilación espontánea durante el acto anestésico, se debe escoger de forma apropiada el calibre de tubo correspondiente para la edad.

Empowering IDP with SMS: a randomized controlled trial in Bogotá

We carried out a randomized controlled trial in Bogotá, the recipient of Colombia´s highest number of internally displaced people (IDP), to assess whether the use of SMS to communicate eligibility to social benefits fosters the welfare of victimized internal refugees. Only a fraction of IDP are elegible to benefits. We inform eligibility via SMS to a random half of IDP-households who are, and estimate the Local Average Treatment Effect of the text message on the knowledge of the benefits available tothe displaced population. We show that while on the average treated households know their rights better than controls, a more disaggregate analysis suggest that there is variation of awareness across benefits. The intervention was overall successful in empowering IDP and the use of SMS should be widened as a social policy instrument. However our results suggest that text messages should be complemented with other communication strategies, yet to be evaluated.

Fatiga del reanimador y calidad de las compresiones torácicas en niños con y sin vía aérea asegurada

Introducción: La calidad de las compresiones torácicas tiene importancia durante la reanimación pediátrica y se ve afectada por diversos factores como la fatiga del reanimador, esta puede verse condicionada por las características de las compresiones establecidas según la presencia o ausencia de un dispositivo avanzado en la vía aérea determinando la interrupción continuidad de las mismas. En este estudio se realizó una simulación clínica, evaluando la presencia de fatiga del reanimador frente a pacientes con y sin dispositivo avanzado de la vía aérea. Metodología: Se incluyeron 12 participantes, quienes realizaron compresiones torácicas a un simulador clínico, tanto para el caso de la maniobra 1 correspondiente a ciclos interrumpidos con el fin de proporcionar ventilaciones, como para el caso de la maniobra 2 en la que la actividad fue continua. Se midieron calidad de compresiones, VO2 max y fatiga mediante escala de Borg RPE 6-20. Resultados: La calidad de las compresiones disminuyó en ambos grupos después del minuto 2 y más rápidamente cuando fueron ininterrumpidas. La fatiga se incrementó cuando las compresiones fueron continuas. Discusión: Se evidencia una relación directamente proporcional del aumento de la fatiga en relación al tiempo de reanimación e inversamente proporcional entre la calidad de las compresiones y la sensación de cansancio, en especial después del minuto 2. Un tiempo de 2 minutos podría ser el tiempo ideal para lograr compresiones de calidad y para realizar el reemplazo de la persona que realiza las compresiones.

Evaluating lexically controlled word lists for open set speech perception testing in profoundly hearing impaired children

This paper evaluates speech perception testing in pediatric cochlear implant users. Using pre-recorded stimulus presentation, the author replicated an earlier experiment comparing the Lexical Neighborhood List (LNT) test to the Phonetically Balanced Kindergarten (PB-K) test in estimating speech perception abilities in hearing impaired children.

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.

Wind-tunnel modelling of dispersion from a scalar area source in urban-like roughness

A wind-tunnel study was conducted to investigate ventilation of scalars from urban-like geometries at neighbourhood scale by exploring two different geometries a uniform height roughness and a non-uniform height roughness, both with an equal plan and frontal density of λ p = λ f = 25%. In both configurations a sub-unit of the idealized urban surface was coated with a thin layer of naphthalene to represent area sources. The naphthalene sublimation method was used to measure directly total area-averaged transport of scalars out of the complex geometries. At the same time, naphthalene vapour concentrations controlled by the turbulent fluxes were detected using a fast Flame Ionisation Detection (FID) technique. This paper describes the novel use of a naphthalene coated surface as an area source in dispersion studies. Particular emphasis was also given to testing whether the concentration measurements were independent of Reynolds number. For low wind speeds, transfer from the naphthalene surface is determined by a combination of forced and natural convection. Compared with a propane point source release, a 25% higher free stream velocity was needed for the naphthalene area source to yield Reynolds-number-independent concentration fields. Ventilation transfer coefficients w T /U derived from the naphthalene sublimation method showed that, whilst there was enhanced vertical momentum exchange due to obstacle height variability, advection was reduced and dispersion from the source area was not enhanced. Thus, the height variability of a canopy is an important parameter when generalising urban dispersion. Fine resolution concentration measurements in the canopy showed the effect of height variability on dispersion at street scale. Rapid vertical transport in the wake of individual high-rise obstacles was found to generate elevated point-like sources. A Gaussian plume model was used to analyse differences in the downstream plumes. Intensified lateral and vertical plume spread and plume dilution with height was found for the non-uniform height roughness

Boundary-layer ventilation by baroclinic lifecycles

Ventilation of the boundary layer has an important effect on local and regional air quality and is a prerequisite for long-range pollution transport. Once in the free troposphere, pollutants can alter the chemical composition of the troposphere and impact on the Earth's radiative forcing. Idealised baroclinic life cycles, LC1 and LC2, have been simulated in a three-dimensional dry hemispheric model in the presence of boundary-layer turbulent fluxes. A passive tracer is added to the simulations to represent pollution emitted at, or near, the surface. A simple conveyor-belt diagnostic is developed to objectively identify regions of the boundary layer that can be ventilated by either warm or cold conveyor belts. Transport of pollutants within and above the boundary layer is examined on synoptic scales. Three different physical mechanisms are found to interact with each other to ventilate pollutants out of the boundary layer. These mechanisms are turbulent mixing within the boundary layer, horizontal advection due to Ekman convergence and divergence within the boundary layer, and advection by the warm conveyor belt. The mass of tracer ventilated by the two life cycles is remarkably similar given the differences in frontal structure, suggesting that the large-scale baroclinicity is an effective constraint on ventilation.

Electronic structure of point defects in controlled self-doping of the TiO2 (110) surface: Combined photoemission spectroscopy and density functional theory study

Point defects in metal oxides such as TiO2 are key to their applications in numerous technologies. The investigation of thermally induced nonstoichiometry in TiO2 is complicated by the difficulties in preparing and determining a desired degree of nonstoichiometry. We study controlled self-doping of TiO2 by adsorption of 1/8 and 1/16 monolayer Ti at the (110) surface using a combination of experimental and computational approaches to unravel the details of the adsorption process and the oxidation state of Ti. Upon adsorption of Ti, x-ray and ultraviolet photoemission spectroscopy (XPS and UPS) show formation of reduced Ti. Comparison of pure density functional theory (DFT) with experiment shows that pure DFT provides an inconsistent description of the electronic structure. To surmount this difficulty, we apply DFT corrected for on-site Coulomb interaction (DFT+U) to describe reduced Ti ions. The optimal value of U is 3 eV, determined from comparison of the computed Ti 3d electronic density of states with the UPS data. DFT+U and UPS show the appearance of a Ti 3d adsorbate-induced state at 1.3 eV above the valence band and 1.0 eV below the conduction band. The computations show that the adsorbed Ti atom is oxidized to Ti2+ and a fivefold coordinated surface Ti atom is reduced to Ti3+, while the remaining electron is distributed among other surface Ti atoms. The UPS data are best fitted with reduced Ti2+ and Ti3+ ions. These results demonstrate that the complexity of doped metal oxides is best understood with a combination of experiment and appropriate computations.