Eficacia de la limpieza corporal con clorhexidina en prevenir la sepsis neonatal en cuidado intensivo revisión sistemática

ANTECEDENTES. La mortalidad neonatal se debe principalmente a procesos infecciosos y a prematurez. Se ha sugerido que el lavado corporal total con clorhexidina podría reducir la mortalidad neonatal relacionada con infección. No existen revisiones sistemáticas que exploren la eficacia de esta intervención. Objetivo. Evaluar la eficacia y seguridad de la limpieza corporal total con clorhexidina en la prevención de las infecciones asociadas al cuidado de la salud en neonatos de alto riesgo hospitalizados en cuidado intensivo neonatal. Metodología. Se realizó una revisión sistemática de la literatura. La búsqueda se hizo a través de las bases de datos Medline, Embase, LilaCS, Cochrane library y el registro de ensayos clínicos del Instituto Nacional de Salud de Estados Unidos. Se incluyeron ensayos clínicos publicados en los últimos 15 años hasta el 30 de enero del 2015. Las variables cualitativas se estimaron mediante OR o RR con sus IC95%. Las variables cuantitativas mediante diferencias de promedios o diferencias estandarizadas de promedios con sus IC95%. Resultados: Se incluyeron 3 estudios en el análisis cualitativo y cuantitativo. No se encontró evidencia concluyente que permita recomendar el uso de la limpieza corporal total con clorhexidina en los recién nacidos hospitalizados en cuidado intensivo neonatal. Conclusión: No existe evidencia que permita concluir que la limpieza corporal total con clorhexidina al 0.25% es mejor respecto a otras intervenciones en la prevención de sepsis neonatal asociada al cuidado de la salud . Es una intervención segura sin efectos adversos significativos.

Evaluación de la validez de la escala llanto para el dolor en neonatos y menores de cinco años

Introducción: La escala LLANTO para dolor es una escala que hasta la fecha ha sido solo validada en población infantil española, actualmente no se conocen datos en población colombiana. Se pretende validar la escala de dolor LLANTO en pacientes neonatos y menores de 5 años, a través de su aplicación en pacientes atendidos en una de tres instituciones, además comparándola con las escalas FLACC y PIPP dependiendo de edad del paciente. Metodología: Se incluyeron niños con cualquier tipo de dolor, clasificándolos en dos grupos por edad: 1) neonatos y 2) niños entre 1 mes y 5 años de edad, que asistieron a la Fundación Cardioinfantil, Clínica Infantil Colsubsidio o al Hospital Universitario Mayor. Las escalas fueron aplicadas por dos residentes de pediatría y una enfermera especializada en el cuidado de población infantil. Para la prueba piloto se diseñó un cuestionario determinar dificultades en la aplicación de la escala LLANTO. Una vez corregidos los problemas identificados se procederá a la validación de la escala. Resultados: Se presentan los datos de la prueba piloto. Se incluyeron 8 neonatos y 8 niños entre 1 mes y 5 años, esta muestra fue obtenida en un periodo de un mes, con la encuesta se evaluó la aceptación y entendimiento de la escala LLANTO por parte de los evaluadores. La prueba piloto mostró resultados favorables en el 100% de los encuestados. Discusión: Se considera que la escala LLANTO no requiere cambios para continuar con su validación.

Network externalities across financial institutions

We propose and estimate a financial distress model that explicitly accounts for the interactions or spill-over effects between financial institutions, through the use of a spatial continuity matrix that is build from financial network data of inter bank transactions. Such setup of the financial distress model allows for the empirical validation of the importance of network externalities in determining financial distress, in addition to institution specific and macroeconomic covariates. The relevance of such specification is that it incorporates simultaneously micro-prudential factors (Basel 2) as well as macro-prudential and systemic factors (Basel 3) as determinants of financial distress. Results indicate network externalities are an important determinant of financial health of a financial institutions. The parameter that measures the effect of network externalities is both economically and statistical significant and its inclusion as a risk factor reduces the importance of the firm specific variables such as the size or degree of leverage of the financial institution. In addition we analyze the policy implications of the network factor model for capital requirements and deposit insurance pricing.

Sentencia de la Corte Constitucional del Ecuador sobre la constitucionalidad de la obligación del afianzamiento tributario (Jurisprudencia)

Los sujetos pasivos que impugnen ante la vía judicial un acto administrativo mediante el cual se pretenda determinar o recaudar tributos, deben rendir una caución equivalente al 10% de la cuantía de su demanda, de no presentársela en el término de quince días, el acto impugnado queda ejecutoriado y los jueces deben ordenar el archivo del proceso. Nuestra Corte Constitucional para el Período de Transición considera que no se vulnera derecho alguno en ese caso, siempre y cuando se exija rendir la caución después de calificada la demanda. Estudiaremos los fundamentos que tuvo la Corte Constitucional para llegar a esa conclusión. Pretenderemos analizarlos y cuestionarlos objetivamente, para así demostrar por qué su falta de coherencia y de sustento permite concluir que su análisis pecó por falto de imparcialidad, y por qué es razonable suponer que sus móviles no fueron jurídicos en lo absoluto, sin perjuicio de que, a la par, demos nuestro parecer al respecto. Independientemente de la trascendencia jurídica que puedan o no tener en nuestro ordenamiento, esperamos se entienda por qué creemos que estos precedentes deben ser considerados como un capítulo funesto en la historia de la jurisprudencia constitucional ecuatoriana.

What kind of European Banking Union? Bruegel Policy Contribution [2012/12?]June 25, 2012

This paper discusses the creation of a European Banking Union. First, we discuss questions of design. We highlight seven fundamental choices that decision makers will need to make: Which EU countries should participate in the banking union? To which categories of banks should it apply? Which institution should be tasked with supervision? Which one should deal with resolution? How centralised should the deposit insurance system be? What kind of fiscal backing would be required? What governance framework and political institutions would be needed? In terms of geographical scope, we see the coverage of the banking union of the euro area as necessary and of additional countries as desirable, even though this would entail important additional economic difficulties. The system should ideally cover all banks within the countries included, in order to prevent major competitive and distributional distortions. Supervisory authority should be granted either to both the ECB and a new agency, or to a new agency alone. National supervisors, acting under the authority of the European supervisor, would be tasked with the supervision of smaller banks in accordance with the subsidiarity principle. A European resolution authority should be established, with the possibility of drawing on ESM resources. A fully centralized deposit insurance system would eventually be desirable, but a system of partial reinsurance may also be envisaged at least in a first phase. A banking union would require at least implicit European fiscal backing, with significant political authority and legitimacy. Thus, banking union cannot be considered entirely separately from fiscal union and political union. The most difficult challenge of creating a European banking union lies with the short-term steps towards its eventual implementation. Many banks in the euro area, and especially in the crisis countries, are currently under stress and the move towards banking union almost certainly has significant distributional implications. Yet it is precisely because banks are under such stress that early and concrete action is needed. An overarching principle for such action is to minimize the cost to the tax payers. The first step should be to create a European supervisor that will anchor the development of the future banking union. In parallel, a capability to quickly assess the true capital position of the system’s most important banks should be created, for which we suggest establishing a temporary European Banking Sector Task Force working together with the European supervisor and other authorities. Ideally, problems identified by this process should be resolved by national authorities; in case fiscal capacities would prove insufficient, the European level would take over in the country concerned with some national financial participation, or in an even less likely adverse scenario, in all participating countries at once. This approach would require the passing of emergency legislation in the concerned countries that would give the Task Force the required access to information and, if necessary, further intervention rights. Thus, the principle of fiscal responsibility of respective member states for legacy costs would be preserved to the maximum extent possible, and at the same time, market participants and the public would be reassured that adequate tools are in place to address any eventuality.

Banking Union in three steps. CEPS Commentary, 12 June 2012

As the banking crisis in the eurozone becomes even more acute, CEPS Chief Executive Karel Lannoo exhorts the EU to not lose further precious time in creating a fully functional bank union, which would entail three main steps: creating a single supervisory authority, a common deposit protection and a harmonised bank resolution and liquidation system.

The challenges of Europe's fourfold union. Bruegel Policy Contribution 2012/13, 16 August 2012

Five years after the first tremors in Europe’s banking system, what makes the crisis unique is the absence of a democratically accountable decision-making framework; there is an 'executive deficit' that compounds Europe’s democratic deficit. The author argues that the only way to resolve the crisis successfully is a sustained effort to achieve a 'fourfold union' agenda: banking union, fiscal union, competitiveness union and political union. Progress must be made in parallel on each of the four components. In particular, successful progress towards banking union requires a combination of short term action, including the establishment of a temporary resolution authority to identify undercapitalised banks and to restructure them, and longer-term measures, including the creation of permanent authorities for supervision, resolution and deposit insurance.

Banking Union: A Federal Model for the European Union with Prompt Corrective Action. CEPS Policy Brief No. 282, 18 September 2012

The European Commission has published its proposals for the transfer of supervisory responsibilities to the European Central Bank (ECB),1 under Article 127(6) of the TFEU, providing a comprehensive and courageous ‘first step’ towards a European banking Union, the other steps being European deposit insurance and resolution procedures. However, on a number of issues the Commission’s chosen path raises questions that should be brought out in the open and fully recognized before final deliberation by the Council.

Effects of contrasting forage diets on phosphorus utilisation in lactating dairy cows

The effects of different forage mixtures on duodenal flow and faecal output of phosphorus (P) were measured in lactating dairy cows in two experiments. The forages comprised grass silage (GS) alone or mixtures of GS and urea-treated whole crop wheat (WCW). Replacement of GS by high levels of WCW resulted in a significant decrease in total P (TP), water-soluble P (WSP) and acid-soluble P (ASP) intakes, but increased phytate P (PP) and acid-insoluble P (AIP) intakes. Duodenal flows of all P fractions were unaffected by dietary treatments. However, the amounts of all fractions flowing to the intestine were much higher than the amounts consumed-with the exception of AIP, which was unchanged, and PP, which was considerably reduced. Diets did not significantly affect faecal outputs of TP, ASP, PP and AIP; however, faecal outputs of WSP were significantly higher on WCW than GS diets. Inclusion of WCW significantly decreased TP and WSP availabilities in the total tract but did not affect PP and AIP availabilities. A new fraction of P, which was not present in the feeds, was found in significant amounts in the intestines and proved to be soluble in dilute acid but insoluble in water. Estimated annual excretions for a herd of 100 cows ranged from 1550 to 1721 kg for total P of which 337-786 kg was WSP. The results suggest that GS based diets deposit more P in the environment. However, the potential to cause P pollution depends not only on the quantity but also on the nature of faecal P and on soil parameters. © 2004 Elsevier B.V. All rights reserved.

Microgemma vivaresi n. sp (Microsporidia, Tetramicridae), infecting liver and skeletal muscle of sea scorpions, Taurulus bubalis (Euphrasen 1786) (Osteichthyes, Cottidae), an inshore, littoral fish

The ultrastructure of a new microsporidian species Microgemmia vivaresi n. sp. causing liver cell xenoma formation in sea scorpions, Taurulus bubalis, is described. Stages of merogony, sporogony, and sporogenesis are mixed in the central cytoplasm of developing xenomas. All stages have unpaired nuclei. Uninucleate and multinucleate meronts lie within vacuoles formed from host endoplasmic reticulum and divide by binary or multiple fission. Sporonts, no longer in vacuoles, deposit plaques of surface coat on the plasma membrane that cause the surface to pucker. Division occurs at the Puckered stage into sporoblast mother cells, on which plaques join up to complete the surface coat. A final binary fission gives rise to sporoblasts. A dense globule, thought to be involved in polar tube synthesis, is gradually dispersed during spore maturation. Spores are broadly ovoid, have a large posterior vacuole, and measure 3.6 mu m x 2.1 pint (fresh). The polar tube has a short wide anterior section that constricts abruptly, then runs posteriad to coil about eight times around the posterior vacuole with granular contents. The polaroplast has up to 40 membranes arranged in pairs mostly attached to the wide region of the polar tube and directed posteriorty around a cytoplasm of a coarsely granular appearance. The species is placed alongside the type species Microgemmia hepaticus Ralphs and Matthews 1986 within the family Tetramicridae, which is transferred from the class Dihaplophasea to the class Haplophasea, as there is no evidence for the occurrence of a diplokaryotic phase.

Joint effects of population density and toxicant exposure on population dynamics of Capitella sp I

Very few studies have analyzed the dependence of population growth rate on population density, and even fewer have considered interaction effects of density and other stresses, such as exposure to toxic chemicals. Yet without such studies we cannot know whether chemicals harmful at low density have effects on carrying capacity or, conversely, whether chemicals reducing carrying capacity are also harmful at low density, impeding a population's capacity to recover from disturbance. This study examines the combined effects of population density and a toxicant (fluoranthene) on population growth rate (pgr) and carrying capacity using the deposit-feeding polychaete Capitella sp. I as a test organism. Populations were initiated with a stable age distribution, and population density and age/size distribution were followed during a period of 28 wk. Fluoranthene (FLU), population density, and their interaction influenced population growth rate. Population growth rate declined linearly with the logarithm of population biomass, but the slope of the relationship was steeper for the control populations than for populations exposed to 50 mug FLU/(g sediment dry mass). Populations exposed to 150 mug FLU/(g sediment dry mass) went extinct after 8 wk of exposure. Despite concerns that toxicant effects would be exacerbated at high density, we found the reverse to be the case, and effects of fluoranthene on population growth rate were much reduced in the region of carrying capacity. Fluoranthene did. reduce carrying capacity by 46%, and this could haven important implications for interacting species and/or sediment biogeochemical processes.

Electrochemical characterisation and anodic stripping voltammetry at mesoporous platinum rotating disc electrodes

Using the technique of liquid crystal templating a rotating disc electrode (RDE) was modified with a high surface area mesoporous platinum film. The surface area of the electrode was characterised by acid voltammetry, and found to be very high (ca. 86 cm(2)). Acid characterisation of the electrode produced distorted voltammograms was interpreted as being due to the extremely large surface area which produced a combination of effects such as localised pH change within the pore environment and also ohmic drop effects. Acid voltammetry in the presence of two different types of surfactant, namely Tween 20 and Triton X-100, suggested antifouling properties associated with the mesoporous deposit. Further analysis of the modified electrode using a redox couple in solution showed typical RDE behaviour although extra capacitive currents were observed due to the large surface area of the electrode. The phenomenon of underpotential deposition was exploited for the purpose of anodic stripping voltammetry and results were compared with data collected for microelectrodes. Underpotential deposition of metal ions at the mesoporous RDE was found to be similar to that at conventional platinum electrodes and mesoporous microelectrodes although the rate of surface coverage was found to be slower at a mesoporous RDE. It was found that a mesoporous RDE forms a suitable system for quantification of silver ions in solution.

Comparative study of Barium Fluoride thin films produced by ion-beam sputtering and thermal evaporation

Coatings and filters for spaceflight far-infrared components require a robust, non-absorptive low-index thin film material to contrast with the typically higher refractive index infrared materials. Barium fluoride is one such material for the 10 to 20µm wavelength infrared region, however its optical and mechanical properties vary depending on the process used to deposit it in thin film form. Thin films of dielectric produced by thermal evaporation are well documented as having a lower packing density and refractive index than bulk material. The porous and columnar micro structure of these films causes possible deterioration of their performance in varied environmental conditions, primarily because of the moisture absorption. Dielectric thin films produced by the more novel technique of ion-beam sputtering are denser with no columnar micro structure and have a packing density and refractive index similar to the bulk material. A comparative study of Barium Fluoride (BaF2) thin films made by conventional thermal evaporation and ion-beam sputtering is reported. Films of similar thicknesses are deposited on Cadmium Telluride and Germanium substrates. The optical and mechanical properties of these films are then examined. The refractive index n of the films is obtained from applying the modified Manifacier's evvelope method to the spectral measurements made on a Perkin Elmer 580 spectrophotometer. An estimate is also made of the value of the extinction coefficient k in the infrared wavelength transparent region of the thin film. In order to study the mechanical properties of the BaF2 films, and evaluate their usefulness in spaceflight infrared filters and coatings, the thin film samples are subjected to MIL-F-48616 environmental tests. Comparisons are made of their performance under these tests.

Estimating the volume of tephra deposits: a new simple strategy

Volume determination of tephra deposits is necessary for the assessment of the dynamics and hazards of explosive volcanoes. Several methods have been proposed during the past 40 years that include the analysis of crystal concentration of large pumices, integrations of various thinning relationships, and the inversion of field observations using analytical and computational models. Regardless of their strong dependence on tephra-deposit exposure and distribution of isomass/isopach contours, empirical integrations of deposit thinning trends still represent the most widely adopted strategy due to their practical and fast application. The most recent methods involve the best fitting of thinning data using various exponential seg- ments or a power-law curve on semilog plots of thickness (or mass/area) versus square root of isopach area. The exponential method is mainly sensitive to the number and the choice of straight segments, whereas the power-law method can better reproduce the natural thinning of tephra deposits but is strongly sensitive to the proximal or distal extreme of integration. We analyze a large data set of tephra deposits and propose a new empirical method for the deter- mination of tephra-deposit volumes that is based on the integration of the Weibull function. The new method shows a better agreement with observed data, reconciling the debate on the use of the exponential versus power-law method. In fact, the Weibull best fitting only depends on three free parameters, can well reproduce the gradual thinning of tephra deposits, and does not depend on the choice of arbitrary segments or of arbitrary extremes of integration.

Brief communication. Rain effect on the load of tephra deposits

Accumulation of tephra fallout produced during explosive eruptions can cause roof collapses in areas near the volcano, when the weight of the deposit exceeds some threshold value that depends on the quality of buildings. The additional loading of water that remains trapped in the tephra deposits due to rainfall can contribute to increasing the loading of the deposits on the roofs. Here we propose a simple approach to estimate an upper bound for the contribution of rain to the load of pyroclastic deposits that is useful for hazard assessment purposes. As case study we present an application of the method in the area of Naples, Italy, for a reference eruption from Vesuvius volcano.