Incidencia de fibrilación auricular en las primeras 72 horas del post operatorio de revascularización miocárdica

Determinar la incidencia de fibrilación auricular en las primeras 72 horas del post operatorio en pacientes llevados a revascularización miocárdica utilizando dos técnicas de anestésia una convencional (AC) con anestésicos inhalados y opioides y otra con dexmedetomidina (AD.). cohorte retrospectivo, en donde se seleccionarán dos grupos de estudio, un grupo de expuestos, pacientes llevados a revascularización miocárdica con utilización técnica anestésica convencional y un grupo de no expuestos pacientes llevados a revascularización miocárdica con uso de dexmedetomidina como técnica de anestesia; A estos grupos se les hizo seguimiento por 72 horas para determinar la presencia de fibrilación auricular y la terapéutica instaurada.

Diabetes relacionada a la fibrosis quística (DRFQ)

Importancia: el paciente con fibrosis quística después de las complicaciones gastrointestinales y pulmonares debe enfrentar otras comorbilidades como la diabetes relacionada a su condición . Dado el aumento en la esperanza de vida y el hecho de que virtualmente todas los pacientes con esta enfermedad pueden desarrollar alteración en el metabolismo de los carbohidratos, se requiere una sensibilización frente al tema que posibilite una detección temprana de esta entidad y un tratamiento óptimo que evite las complicaciones microvasculares e impacte entre otros el crecimiento pondo-estatural en pacientes en desarrollo y la función pulmonar. Objetivo : realizar una revisión actualizada de la literatura sobre la diabetes relacionada a la fibrosis quística, destacando las indicaciones de tamización y tratamiento. Conclusión : la FQ dentro de su abordaje requiere la detección temprana de la alteración del metabolismo de los carbohidratos con una prueba de tolerancia a la glucosa , el daño del islote pancreático , la disfunción inmune, la resistencia a la insulina, el estrés oxidativo entre otros elementos fisiopatológicos conllevan a un estado de depleción de insulina que producirán un efecto negativo microvascular así como a una reducción marcada de la función pulmonar, mayores tasa de infección e incremento de la mortalidad. La piedra angular del tratamiento en pacientes con o sin hiperglicemia es la insulina que mejora tanto el estado nutricional como la función pulmonar ; nuevos antidiabéticos orales con efecto incretinas y fármacos modificadores de la enfermedad se vislumbran como alternativas al corto plazo

Phosphorus dynamics in the ditch system of a restored peat wetland

The restoration of wetlands as bird habitats often involves the maintenance of a fluctuating water regime by careful, localised ditch water management using pumps and sluices. However, there is evidence in the literature to Suggest that alternate flood/drainage cycles can accelerate nutrient cycling and transport within the soil and, therefore, pose a threat to water quality through the process of eutrophication. This study focused on the dynamics and losses of soil P in a recently re-wetted, eutrophic fen peat developed on alluvium ill South west England. During the 2-year Study (2001 and 2002), soil water tensiometry revealed that the field water table (fluctuating annually between +20 and 60 cm relative to ground level) was extensively influenced across most of the 8.4 ha field site by the management of the adjacent ditch water levels. This conservation-led, prescribed water balance was facilitated by the high hydraulic conductivity (1.1 x 10(-s) ms(-1)) of the lower (70-140 cm), degraded layer of peat. However, only during a 7-day period of water table drawdown by intermittent pump drainage, approximately 45 g ha(-1) of dissolved reactive P (DRP) entered the pumped ditch from the field via this degraded layer. Summer rainfall events >35 mm d(-1) also coincided with significant peaks ill ditch water P concentration (up to 200 mu g L-1 DRP). Even larger peaks (Up to 700 mu g L-1 DRP) Occurred With the annual onset of autumn reflooding. These episodic P loss events pose a serious potential threat to biological water quality. (C) 2009 Elsevier B.V. All rights reserved.

Wetland restoration within agricultural watersheds: Balancing water quality protection with habitat conservation

Peat wetlands that have been restored from agricultural Land have the potential to act as Long term sources of phosphorus (P) and, therefore have to potenital to accelerate freshwater eutrophication. During a two-year study the water table in a eutrophic fen peat that was managed by pump drainage fluctuated annually between +20 cm and -60 cm relative to ground Level. This precise management was facilitated by the high hydraulic conductivity (K) of the humified peat (1.1 x 10(-5) m s(-1)) below around 60 cm depth. However, during one week of intermittent pumping, as much as 50 g ha(-1) dissolved P entered the pumped ditch. Summer. rainfall events and autumn reflooding also triggered P losses. The P Losses were attributed to the low P sorption capacity (217 mg kg(-1)) of the saturated peat below 60 cm, combined with its high K and the reductive dissolution of Fe bound P.

Antibacterials and modulators of bacterial resistance from the immature cones of Chamaecyparis lawsoniana

As part of an on-going project to characterize compounds from immature conifer cones with antibacterial or modulatory activity against multidrug-resistant (MDR) strains of Staphylococcus aureus, eight compounds were isolated from the cones of Chatnaecyparis lawsoniana. The active compounds were mainly diterpenes, with minimum inhibitory concentrations ranging from 4 to 128 mu g/ml against MDR effluxing S. aureus strains and two epidemic methicillin-resistant (EMRSA) clinical isolates. The compounds extracted were the diterpenes ferruginol, pisiferol and its epimer 5-epipisiferol, formosanoxide, trans-communic acid and torulosal, the sesquiterpene oplopanonyl acetate and the germacrane 4 beta-hydroxygermacra-1(10)-5-diene. Some of these compounds also exhibited modulatory activity in potentiating antibiotic activity against effluxing strains and ferruginol, used at a sub-inhibitory concentration, resulted in an 80-fold potentiation of oxacillin activity against strain EMRSA-15. An efflux inhibition assay using an S. aureus strain possessing the MDR NorA efflux pump resulted in 40% inhibition of ethidium bromide efflux at 10 mu M ferruginol (2.86 mu g/ml). We report the H-1 and C-13 NMR data for the cis A/B ring junction epimer of pisiferol which we have named 5-epipisiferol. We also unambiguously assign all H-1 and C-13 NMR resonances for trans-communic acid. (c) 2006 Elsevier Ltd. All rights reserved.

Isopimaric acid from Pinus nigra shows activity against multidrug-resistant and EMRSA strains of Staphylococcus aureus

The diterpene isopimaric acid was extracted from the immature cones of Pinus nigra (Arnold) using bioassay. guided fractionation of a crude hexane extract. Isopimaric acid was assayed against multidrug-resistant (MDR) and methicillin-resistant Staphylococcus aureus (MRSA). The minimum inhibitory concentrations (MIC) were 32-64 mu g/mL and compared with a commercially obtained resin acid, abietic acid, with MICs of 64 mu g/mL. Resin acids are known to have antibacterial activity and are valued in traditional medicine for their antiseptic properties: These results show that isopimaric acid is active against MDR an MRSA strains of S. aureus which are becoming, increasingly resistant to antibiotics. Both compounds were evaluated for modulation activity in combination with antibiotics, but did not potentiate the activity of the antibiotics tested. However, the compounds were also assayed in combination with the efflux pump inhibitor reserpine, to ice if inhibition of the TetK or NorA efflux pump increased their activity. Interestingly, rather than a potentiation of activity by a reduction in MIC, a two to four-fold increase in MIC was seen. It may he that isopimaric acid and abietic acid are not substrates for these efflux pumps, but it is also possible that an antagonistic interaction with reserpine may render the antibiotics inactive. H-1-NMR of abietic acid and reserpine taken individually and in combination, revealed a shift in resonance of some peaks for both compounds when mixed together compared with the spectra of the compounds on their own. It is proposed that this may he due to complex formation between abietic acid and reserpine and that this complex formation is responsible for a reduction in activity and elevation of MIC. Copyright (c) 2005 John Wiley & Sons, Ltd.

Arresting developments in the cardiac myocyte cell cycle: Role of cyclin-dependent kinase inhibitors

Like most other cells in the body, foetal and neonatal cardiac myocytes are able to divide and proliferate. However, the ability of these cells to undergo cell division decreases progressively during development such that adult myocytes are unable to divide. A major problem arising from this inability of adult cardiac myocytes to proliferate is that the mature heart is unable to regenerate new myocardial tissue following severe injury, e.g. infarction, which can lead to compromised cardiac pump function and even death. Studies in proliferating cells have identified a group of genes and proteins that controls cell division. These proteins include cyclins, cyclin-dependent kinases (CDKs) and CDK inhibitors (CDKIs), which interact with each other to form complexes that are essential for controlling normal cell cycle progression. A variety of other proteins, e.g. the retinoblastoma protein (pRb) and members of the E2F family of transcription factors, also can interact with, and modulate the activities of, these complexes. Despite the major role that these proteins play in other cell types, little was known until recently about their existence and activities in immature (proliferating) or mature (non-proliferating) cardiac myocytes. The reason(s) why cardiac myocytes lose their ability to divide during development remains unknown, but if strategies were developed to understand the mechanisms underlying cardiac myocyte growth, it could open up new avenues for the treatment of cardiovascular disease. In this article, we shall review the function of the cell cycle machinery and outline some of our recent findings pertaining to the involvement of the cell cycle in modulating cardiac myocyte growth and hypertrophy.

Experimental measurement and numerical simulation of horizontal-coupled slinky ground source heat exchangers

Results from both experimental measurements and 3D numerical simulations of Ground Source Heat Pump systems (GSHP) at a UK climate are presented. Experimental measurements of a horizontal-coupled slinky GSHP were undertaken in Talbot Cottage at Drayton St Leonard site, Oxfordshire, UK. The measured thermophysical properties of in situ soil were used in the CFD model. The thermal performance of slinky heat exchangers for the horizontal-coupled GSHP system for different coil diameters and slinky interval distances was investigated using a validated 3D model. Results from a two month period of monitoring the performance of the GSHP system showed that the COP decreased with the running time. The average COP of the horizontal-coupled GSHP was 2.5. The numerical prediction showed that there was no significant difference in the specific heat extraction of the slinky heat exchanger at different coil diameters. However, the larger the diameter of coil, the higher the heat extraction per meter length of soil. The specific heat extraction also increased, but the heat extraction per meter length of soil decreased with the increase of coil central interval distance.

Do in vivo terahertz imaging systems comply with safety guidelines?

Techniques for the coherent generation and detection of electromagnetic radiation in the far infrared, or terahertz, region of the electromagnetic spectrum have recently developed rapidly and may soon be applied for in vivo medical imaging. Both continuous wave and pulsed imaging systems are under development, with terahertz pulsed imaging being the more common method. Typically a pump and probe technique is used, with picosecond pulses of terahertz radiation generated from femtosecond infrared laser pulses, using an antenna or nonlinear crystal. After interaction with the subject either by transmission or reflection, coherent detection is achieved when the terahertz beam is combined with the probe laser beam. Raster scanning of the subject leads to an image data set comprising a time series representing the pulse at each pixel. A set of parametric images may be calculated, mapping the values of various parameters calculated from the shape of the pulses. A safety analysis has been performed, based on current guidelines for skin exposure to radiation of wavelengths 2.6 µm–20 mm (15 GHz–115 THz), to determine the maximum permissible exposure (MPE) for such a terahertz imaging system. The international guidelines for this range of wavelengths are drawn from two U.S. standards documents. The method for this analysis was taken from the American National Standard for the Safe Use of Lasers (ANSI Z136.1), and to ensure a conservative analysis, parameters were drawn from both this standard and from the IEEE Standard for Safety Levels with Respect to Human Exposure to Radio Frequency Electromagnetic Fields (C95.1). The calculated maximum permissible average beam power was 3 mW, indicating that typical terahertz imaging systems are safe according to the current guidelines. Further developments may however result in systems that will exceed the calculated limit. Furthermore, the published MPEs for pulsed exposures are based on measurements at shorter wavelengths and with pulses of longer duration than those used in terahertz pulsed imaging systems, so the results should be treated with caution.

PINCER trial: a cluster randomised trial comparing the effectiveness and cost-effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors in general practice are an important source of potentially preventable morbidity and mortality. Building on previous descriptive, qualitative and pilot work, we sought to investigate the effectiveness, cost-effectiveness and likely generalisability of a complex pharm acist-led IT-based intervention aiming to improve prescribing safety in general practice. Objectives: We sought to: • Test the hypothesis that a pharmacist-led IT-based complex intervention using educational outreach and practical support is more effective than simple feedback in reducing the proportion of patients at risk from errors in prescribing and medicines management in general practice. • Conduct an economic evaluation of the cost per error avoided, from the perspective of the National Health Service (NHS). • Analyse data recorded by pharmacists, summarising the proportions of patients judged to be at clinical risk, the actions recommended by pharmacists, and actions completed in the practices. • Explore the views and experiences of healthcare professionals and NHS managers concerning the intervention; investigate potential explanations for the observed effects, and inform decisions on the future roll-out of the pharmacist-led intervention • Examine secular trends in the outcome measures of interest allowing for informal comparison between trial practices and practices that did not participate in the trial contributing to the QRESEARCH database. Methods Two-arm cluster randomised controlled trial of 72 English general practices with embedded economic analysis and longitudinal descriptive and qualitative analysis. Informal comparison of the trial findings with a national descriptive study investigating secular trends undertaken using data from practices contributing to the QRESEARCH database. The main outcomes of interest were prescribing errors and medication monitoring errors at six- and 12-months following the intervention. Results: Participants in the pharmacist intervention arm practices were significantly less likely to have been prescribed a non-selective NSAID without a proton pump inhibitor (PPI) if they had a history of peptic ulcer (OR 0.58, 95%CI 0.38, 0.89), to have been prescribed a beta-blocker if they had asthma (OR 0.73, 95% CI 0.58, 0.91) or (in those aged 75 years and older) to have been prescribed an ACE inhibitor or diuretic without a measurement of urea and electrolytes in the last 15 months (OR 0.51, 95% CI 0.34, 0.78). The economic analysis suggests that the PINCER pharmacist intervention has 95% probability of being cost effective if the decision-maker’s ceiling willingness to pay reaches £75 (6 months) or £85 (12 months) per error avoided. The intervention addressed an issue that was important to professionals and their teams and was delivered in a way that was acceptable to practices with minimum disruption of normal work processes. Comparison of the trial findings with changes seen in QRESEARCH practices indicated that any reductions achieved in the simple feedback arm were likely, in the main, to have been related to secular trends rather than the intervention. Conclusions Compared with simple feedback, the pharmacist-led intervention resulted in reductions in proportions of patients at risk of prescribing and monitoring errors for the primary outcome measures and the composite secondary outcome measures at six-months and (with the exception of the NSAID/peptic ulcer outcome measure) 12-months post-intervention. The intervention is acceptable to pharmacists and practices, and is likely to be seen as costeffective by decision makers.

Prediction of the thermal performance of horizontal-coupled ground source heat exchangers

The thermal performance of a horizontal-coupled ground-source heat pump system has been assessed both experimentally and numerically in a UK climate. A numerical simulation of thermal behaviour of the horizontal-coupled heat exchanger for combinations of different ambient air temperatures, wind speeds, refrigerant temperature and soil thermal properties was studied using a validated 2D transient model. The specific heat extraction by the heat exchanger increased with ambient temperature and soil thermal conductivity, however it decreased with increasing refrigerant temperature. The effect of wind speed was negligible.

The Institute of Psychoplasmics

ABSTRACT: The Institute of Psychoplasmics is a group exhibition dealing with cults, rituals and the metaphor of the body politic. A key interest of the project is the way in which cultic groupings challenge the integrity of the social body by producing another within it. The exhibition, book and events explore parallels between the operations of new religious movements in the context of neo-liberalism and the forms of collectivity posited by contemporary art. These issues were addressed through a gallery display, academic essays, discussion, adult and children focused workshops and live performance event. The exhibition design, which considered the gallery as a research institute, itself investigated strategies of collaboration and psycho-social manipulation. The show was curated by Pil and Galia Kollectiv and commissioned by the Pump House Gallery in London and supported by Outset, Arts Council England and the Henry Moore Foundation. The exhibition included work by a.a.s., Insectoid, Diann Bauer, Amanda Beech, Mikko Canini, Seth Coston, Rod Dickinson, Pil and Galia Kollectiv, Tai Shani, Francis Upritchard and Roman Vasseur. A publication edited by the curators, features writing by Suhail Malik, Amanda Beech, Pil and Galia Kollectiv, Gilad Elbom, Tom McCarthy, Emily McMehen and Travis Jeppesen.

Asparagus: a horticultural ballet

Asparagus: A Horticultural Ballet was a live performance and film narrating the rise of capital in the medium of asparagus. The project stemmed from an obscure reference to an art piece of the same name by Waw Pierogi of the band xex. However, the its re-enactment had little to do with the original exploration of the growth and branching patterns of the asparagus plant. Instead, a rigid choreography inspired by Oskar Schlemmer's Triadic Ballet and based on Karl Marx's Capital dictated the movements of six performers in asparagus costumes. Bringing together the organic and the geometric, the ballet investigated the transition from the Fordist assembly line to immaterial labour through a reanimation of modernist abstraction. Being itself the story of abstraction, Capital shows how human relationships are replaced by those between commodities in the joyless grind of endless accumulation. This process results in the transcendent mythical figure of capital, which frames, transfigures and even produces the natural world. Asparagus: A Horticultural Ballet was produced in collaboration with Montreal based band Les Georges Leningrad and commissioned by The Showroom Gallery, London. It was presented live at Conway Hall in London on 6.3.07 and at the Montreal Biennale at SAT on 12.5.07. The performance was accompanied by a film at the Showroom gallery and preceded by a production residency at the Pump House Gallery. The film has subsequently been shown at The Golden Thread Gallery, Bluecoat Liverpool and as part of A-Lot-Ment in Portsmouth. Props from Asparagus: A Horticultural Ballet, were included in The Eagle Document at the Stephen Lawrence Gallery, London.

A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis

Background: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. Methods: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-eff ectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. Findings: 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months’ follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0∙58, 95% CI 0∙38–0∙89); a β blocker if they had asthma (0∙73, 0∙58–0∙91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0∙51, 0∙34–0∙78). PINCER has a 95% probability of being cost eff ective if the decision-maker’s ceiling willingness to pay reaches £75 per error avoided at 6 months. Interpretation: The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. Funding: Patient Safety Research Portfolio, Department of Health, England.

Temperature optimization of optical-phase conjugation in dye doped polymer-films

Experimental results of the temperature dependence of the nonlinear optical response of methyl red doped polymethylmethacrylate films in the range 20°C to 170°C are reported. It is found that the intensity of the phase conjugate signal resulting from degenerate four-wave mixing using pump and probe beams with parallel polarisation states increases dramatically on heating by a factor of ∼ 10, reaching a maximum at ∼ 100°C. The intensity of the phase conjugate signal for the case with crossed polarisation states of the pump and probe beams drops monotonically with increasing temperature. For both configurations the response time shortens with increasing temperature. The particular role of the polymer matrix in this temperature variation of the nonlinear optical response is discussed.