Riesgo asociado a la cirugía cardíaca mayor en pacientes octogenarios : una revisión sistemática de la literatura.

Introducción: La enfermedad cardiovascular es la principal causa de muerte a nivel mundial, afectando principalmente la salud pública de países pobres con economías emergentes. La transición epidemiológica en Colombia ha incrementado la proporción de pacientes ancianos con enfermedad cardiovascular y que requieren cirugía cardíaca. Sin embargo, no existe consenso sobre la conducta para la selección de pacientes añosos para este tipo de intervenciones. El objetivo de este estudio fue definir el riesgo mortalidad asociado a cirugía cardíaca en este grupo de pacientes, basados en una revisión sistemática de la literatura. Materiales y Métodos: Se diseñó una revisión sistemática empleando las plataformas PubMed (Medline), EBSCO Discovery Service, Ovid SP-EBMR, Sciverse y MDConsult. Los términos de búsqueda fueron “Aged”, “Cardiac surgery” and “Mortality”, conjugados de acuerdo con el lenguaje de cada buscador. Las publicaciones fueron seleccionadas por consenso. Los resultados se analizaron en un modelo de Mantel-Haenszel. Resultados: La búsqueda arrojó un total de 8.565 publicaciones. Los datos analizados en el modelo incluyeron 81.547 pacientes (7.855 octogenarios y 73.692 más jóvenes). El riesgo de mortalidad asociado a cirugía cardíaca en octogenarios fue de 125% (OR=2,35, IC 95% [2,15 - 2,57]). Discusión: El sometimiento de pacientes octogenarios a cirugías cardíacas mayores es una decisión que requiere un juicio clínico minucioso en el que es importante destacar que la probabilidad de un resultado francamente desfavorable es alta. Se necesitan más estudios diseñados que permitan aumentar la solidez de la evidencia actual en cuanto al riesgo aquí encontrado.

La valoración de la prueba testimonial; el paradigmático caso del Coronel Luis Alfonso Plazas Vega

De acuerdo a la coyuntura social por la que atraviesa actualmente la administración de justicia colombiana, en cuanto a la proliferación de injusticias y errores judiciales causados por la valoración probatoria positiva de los falsos testigos, nace nuestro estudio y la respectiva crítica a la estimación superficial que se realiza a la prueba testimonial por parte de algunos de nuestros jueces, y la aceptación sin mayor control que efectúa la Fiscalía General de la Nación. En ese sentido, se realiza una exhaustiva pero concisa investigación al respecto de todos y cada uno de los factores relevantes a la hora de valorar al deponente y su testimonio como medio probatorio, de suerte que establece los diferentes requisitos formales y sustanciales de los cuales debe gozar, tanto el testigo como su declaración, para que puedan ser tomados en cuenta a la hora de tomar una decisión judicial en materia penal. Con base en lo anterior, nuestra monografía consta de una parte teórica y una parte teóricopractica, en la cual se tomó como ejemplo principal, el paradigmático caso del Coronel ® Luis Alfonso Plazas Vega, toda vez que es un proceso que actualmente se encuentra en sede de casación, y aun no tiene un pronunciamiento definitivo por parte de la honorable Corte Suprema de Justicia, por lo cual es posible realizar una crítica constructiva y propia en lo que concierne a la valoración de la prueba testimonial, en el entendido en que no existe una decisión inequívoca. Finalmente, lo que se pretende con este trabajo es explicar de una manera sencilla y de fácil entendimiento la labor que deben realizar los jueces de la República y la Fiscalía, que aunque no es la que toma la decisión, también debería realizar un mínima valoración, o por lo menos una verificación al momento de aportar y darle credibilidad a testigos que son favorables a su teoría del caso. De forma tal que, la administración de justicia debe llevar a cabo una valoración probatoria, específicamente encaminada al estándar probatorio que se le debe atribuir al testimonio, teniendo en cuenta los factores externos e internos que afecten la declaración, y por los cuales se vea influenciada la misma; todo esto, con el fin de evitar los errores judiciales que se han generado a lo largo de nuestra historia, los cuales han conllevado a innumerables injusticias creando gran polémica y un desasosiego por parte de la sociedad civil.

Análisis de la Revista Interuniversitaria de formación del profesorado (1993-2002) : una contribución a los estudios de educación para la docencia.

Resumen tomado de la publicación

Aplicación del modelo CAIT en el Colegio Sagrada Familia (Valladolid).

Analiza la aplicación del modelo CAIT en el Colegio Sagrada Familia de Valladolid por el cual ha obtenido el Premio Nacional de Innovación Pedagógica 2004, Este modelo proporciona unas herramientas y metodología interesante con alumnos que presentan dificultades de aprendizaje o que manifiestan escasa motivación ante las actividades de aprendizaje normales de secundaria. No se detectan diferencias sustanciales respecto a la evaluación más tradicional si se utiliza la metodología CAIT y asegura que los alumnos realicen una serie de operaciones mentales que constituyen la base del aprendizaje. Su aplicación dejó una buena impresión de todos los profesores, a los cuales exige una formación específica tanto en el modelo como en el uso de la herramienta informática necesaria: el ordenador.

Coordinación de los sistemas de protección social y protocolo de intervención : del Libro Blanco a la Ley de Dependencia.

Se plantean y analizan los servicios de atención a la dependencia en Europa para compararlos con los servicios existentes en España y poder aportar valoraciones y estrategias de futuro que logren un mejor servicio de atención a las personas dependientes. Se pretende analizar el marco normativo en el que se sustenta el Libro Blanco de la Dependencia y la ley que lo regula. Se estudia la Dependencia y el perfil de las personas afectadas para erradicar el nexo entre dependencia y envejecimiento a la vez que se analizan loa sistemas de atención formal e informal. Finalmente se compara la atención a la dependencia en otros países, así como las escalas y baremos que permiten evaluar la situación de los beneficiarios. Se trabaja con la siguiente hipótesis: la Ley de Autonomía de las Personas Dependientes deberá dar respuesta social, económica y sanitaria suficiente a las necesidades reales de las personas dependientes y sus familias mediante la creación de servicios innovadores, abriendo opciones de respuesta a asociaciones y empresas de carácter privado en los sectores socio-sanitarios, de acogida, jurídicos y de envejecimiento activo, siempre que se cuenten con los recursos económicos y humanos necesarios. Se lleva a cabo una investigación sistemática en la que se utiliza en método hipotético-deductivo. Para realizar el estudio ha sido imprescindible someter a análisis exhaustivo las fuentes de información. El trabajo se estructura en cuatro capítulos: en el primer capítulo se presenta el concepto de dependencia, la prevalencia de las situaciones de dependencia en España y las características de las personas afectadas, con especial énfasis en no confundir dependencia con vejez o envejecimiento; en el segundo capítulo se presenta el marco normativo en el que discurre la regulación de la dependencia en España; en el tercer capítulo se realiza una aproximación a los trabajos formales e informales con los que cuentan las personas dependientes para afrontar su situación; en el último capítulo se abordan los aspectos más instrumentales con una aproximación a la medida concreta de la dependencia, a través de escalas susceptibles de traducirse en baremos administrativo, que permitan evaluar la situación concreta de los posibles beneficiarios de las prestaciones y conseguir la mayor adecuación entre necesidades y prestaciones. Tras el proceso de investigación se confirma la hipótesis de trabajo establecida, al igual que se ha logrado la consecución de los objetivos propuestos. La preocupación por la atención de las personas dependientes no es algo nuevo en España, ya que desde el área de los servicios sociales, las respuestas a este problema se han abordado desde el Plan Gerontológico Nacional. Una de las bondades de la Ley de la Dependencia es el reconocimiento del derecho subjetivo de las personas dependientes a disfrutar de las prestaciones y servicios que establece dicha Ley.

On the evolution of monopoly pricing in Internet-assisted search markets

This study examines the evolution of prices in markets with Internet price-comparison search engines. The empirical study analyzes laboratory data of prices available to informed consumers, for two industry sizes and two conditions on the sample (complete and incomplete). Distributions are typically bimodal. One of the two modes of distribution, corresponding to monopoly pricing, tends to attract such pricing strategies increasingly over time. The second one, corresponding to interior pricing, follows a decreasing trend. Monopoly pricing can serve as a means of insurance against more competitive (but riskier) behavior. In fact, experimental subjects who initially earn low profits due to interior pricing are more likely to switch to monopoly pricing than subjects who experience good returns from the start.

Fatty acid composition of intramuscular fat from Nellore steers fed dry or high moisture corn and calcium salts of fatty acids

The purpose of this work was to evaluate the fatty acid composition of the Longissimus muscle from carcasses of Nellore steers fed diets with calcium salts of fatty acids (CSFA) and high moisture corn. Forty eight steers were fed during 70 days four diets containing dry corn (DC), high moisture corn (HM). dry corn plus CSFA (DC-CSFA) or high moisture corn plus CSFA (HM-CSFA). Fatty acid composition of the Longissimus muscle was determined by gas chromatography. Corn type had no effect on the ether extract percentage and in the content of the majority of the fatty acids, although steers fed HMC showed higher levels of polyunsaturated fatty acids and polyunsaturated/saturated ratio. Feeding CSFA increased ether extract percentage but had no effect on total of saturated, unsaturated and saturated: unsaturated ratio. Both high moisture corn and calcium salts of fatty acids increased CIA (cis9, trans11) and total CIA concentrations in intramuscular fat (C) 2008 Elsevier B.V. All rights reserved.

Response of black oats (Avena strigosa Schreb) on the aspersion irrigation and nitrogen fertilization

The objective of the study was assessing the effect of the nitrogen and the aspersion irrigation on the growth and dry matter yield of black oats (Avena strigosa Schreb). The experiment was conducted in the Campus of USP in Pirassununga, Sao Paulo State. In the study were evaluated four nitrogen levels (0, 50, 100 and 150 kg of N ha(-1)) and also the presence or absence of the irrigation. The plant variables evaluated were: mean height, dry matter percentage, yield and growth rate. The results had disclosed to greater height of plant in the irrigated condition, reflecting in the higher production of dry matter. In dry land area, percentage of DM was 24.7% and in irrigated area 18.7%. The nitrogen was significantly only for plant mean height that showed linear fit when carried through the irrigation. The effect of the irrigation was better for the production of black oats than nitrogen.

The numbers of sample design for evaluation of the soil fertility

The determination of the amount of sample units that will compose the sample express the optimization of the workforce, and reduce errors inherent in the report of recommendation and evaluation of soil fertility. This study aimed to determine in three systems use and soil management, the numbers of units samples design, needed to form the composed sample, for evaluation of soil fertility. It was concluded that the number of sample units needed to compose the composed sample to determination the attributes of organic matter, pH, P, K, Ca, Mg, Al and H+Al and base saturation of soil vary by use and soil management and error acceptable to the mean estimate. For the same depth of collected, increasing the number of sample units, reduced the percentage error in estimating the average, allowing the recommendation of 14, 14 and 11 sample in management with native vegetation, pasture cultivation and corn, respectively, for a error 20% on the mean estimate.

Reactivity of Nellore steers in two feedlot housing systems and its relationship with plasmatic cortisol

To evaluate reactivity to assess the temperament of Nellore steers in two feedlot housing systems (group pen or individual pen) and its relationship with plasmatic cortisol, 36 experimental units were observed five times at 28-day intervals of weight management during a 112-day feedlot confinement. A reactivity score scale ranging from 1 to 5 was applied when an animal was in the chute system. To the calmest animal, a reactivity score of 1 was ascribed and to the most agitated, 5. Blood samples were collected for cortisol analysis. No differences were found in reactivity and feedlot system. There was a relationship noted between reactivity and feedlot time in both housing systems (P < 0.01). There was a relation between reactivity and cortisol levels for group animals (P = 0.0616) and for individual ones (P < 0.01). Cortisol levels varied among housing systems (P < 0.01). Feedlot time influenced the cortisol levels (P < 0.09 individual; P < 0.01 group) and when variable time was included, these levels changed, decreasing in the group pen and increasing in individual pens. The continuous handling reduces reactivity and plasmatic cortisol, and group pen system seems to be less stressfully than individual pens. (C) 2010 Elsevier B.V. All rights reserved.

Cloud condensation nuclei from biomass burning during the Amazonian dry-to-wet transition season

Aircraft measurements of cloud condensation nuclei (CCN) during the Large-Scale Biosphere-Atmosphere Experiment in Amazonia (LBA) were conducted over the Southwestern Amazon region in September-October 2002, to emphasize the dry-to-wet transition season. The CCN concentrations were measured for values within the range 0.1-1.0% of supersaturation. The CCN concentration inside the boundary layer revealed a general decreasing trend during the transition from the end of the dry season to the onset of the wet season. Clean and polluted areas showed large differences. The differences were not so strong at high levels in the troposphere and there was evidence supporting the semi-direct aerosol effect in suppressing convection through the evaporation of clouds by aerosol absorption. The measurements also showed a diurnal cycle following biomass burning activity. Although biomass burning was the most important source of CCN, it was seen as a source of relatively efficient CCN, since the increase was significant only at high supersaturations.

Home range and habitat use by the roadside hawk, Rupornis magnirostris (Gmelin, 1788) (Aves: Falcaniformes) in southeastern Brazil

Although most raptor species are found mainly in the tropics, information on their home range and spatial requirements in the Neotropics is still scarce. In this study, we used radio telemetry to evaluate the home range and the habitat use and selection of five Roadside hawks, Rupornis magnirostris (Gmelin, 1788) in a heterogeneous landscape in southeastern Brazil. The average home range size calculated using the adaptive kernel method (95% isopleth) was 126.1ha (47.4-266.7ha), but using the minimum convex polygon method (95% isopleth) it was 143.54ha (32.6-382.3ha). The roadside hawk explored a wide variety of habitats, most of them opportunistically, as suggested in the literature. Despite this, habitat quality could influence home range size and promote habitat selection. The observation of habitat use as expected, as well as the relatively small home range size, could be related to the generalist/opportunistic behaviour of the roadside hawk.

Consequences of Simulated Loss of Open Cerrado Areas to Bird Functional Diversity

Over the past 35 years, more than two thirds of the Cerrado`s original expanse has been taken by agriculture. Even if some attempts have been made to conserve closed cerrado physiognomies, open cerrado physiognomies, richer in species and more fragile, have been systematically ignored. These open physiognomies are used by almost half of the Cerrado bird species, many of which being endemics. Using data from 11 surveys carried out in Cerrado landscapes, we asked what would happen to bird functional diversity if open cerrado species became extinct. Open cerrado birds would be able to keep on average 59% of the functional diversity. If they became extinct, on average 27% of the functional diversity would be lost. In this case, the remaining functional diversity would be lower than what would be expected by chance in five sites. Although many functions were shared by both open cerrado and forest species, there was some degree of complementarity between them, highlighted by the decrease in functional diversity when the former became extinct. Destruction of open cerrado physiognomies would lead to a habitat simplification, decrease in bird functional diversity, and, ultimately, to a considerable impact on community functioning. Thus, open cerrado physiognomies must receive much more conservation attention than they are currently receiving, because they maintain a high bird functional diversity that would otherwise be considerably diminished Were open cerrado species to become extinct.

Observations on the Breeding Biology of the Collared Crescentchest (Melanopareia torquata)

The Collared Crescentchest (Melanopareia torquata) is an endemic bird of the Cerrado (Family: Melanopareiidae), and is listed in the State of Sao Paulo, Brazil as ""endangered"". We studied the breeding biology of Collared Crescentchest at two nests in the State of sao Paulo, southeast Brazil. Males were identified genetically and equipped with radio-transmitters. The incubation period was 12-16 days and the nestling period was 12-14 days. Nestling body mass was measured every second day for the first 10 days. Males participated in incubation and helped with nesting care. Measurements of eggs and nests are compared to those from the single previously known nest. These data are the first for any member of the Family Melanopareiidae. Received 27 March 2009. Accepted 28 August 2009.

Behavioural and morphological observations of the Collared Crescentchest (Melanopareia torquata) in a Cerrado area of south-eastern Brazil

The Collared Crescentchest (Melanopareia torquata) is endemic to the Cerrado Biome, and distributed mainly in Brazil, but extending to Bolivia and Paraguay. Although considered of least concern globally, it is threatened in the state of Sao Paulo in south-eastern Brazil. In this study we examined the morphology and some aspects of behaviour of the Collared Crescentchest. Birds were captured with mist-nets using playback in September-December 2006 and October-November 2007. For each captured bird, we took a range of morphological measurements, looked for brood-patches and moult, and took a blood sample for genetic determination of sex. Of the 35 individuals captured, only five were female, probably as a result of behavioural differences between sexes, with males apparently responding more readily to the playback. Furthermore, birds with white dorsal patches exhibited more aggression or risk taking behaviour than birds without patches. However, there was no sexual dimorphism in any of the morphological or colour traits measured ( although the female sample was small). Brood-patches were present mainly in October and November, but we did not detect any cloacal protuberance. Among the four species that comprise the family Melanopareiidae, this is the first record of brood-patches in males.