Comparación del tiempo de despertar y tiempo de descarga entre dos técnicas de anestesia total intravenosa manual : Remifentanil vs Fentanil.

Introducción: A pesar de que las combinaciones de Propofol y opioides son ampliamente usadas para inducir y mantener una adecuada anestesia y analgesia, disminuir la dosis del inductor, incrementar la estabilidad hemodinámica y suprimir la respuesta a la laringoscopia y la intubación; no existen estudios que comparen el uso de Anestesia Total Intravenosa manual con Remifentanil - Propofol versus Fentanil - Propofol. Objetivo: Comparar el tiempo de despertar y el tiempo de descarga entre dos técnicas de Anestesia Total Intravenosa manual empleadas en el Hospital Occidente de Kennedy, una basada en Propofol y Remifentanil y otra basada en Propofol y Fentanil controlado por Stangraf. Metodología: Estudio de corte transversal, en 43 pacientes llevados a cirugía bajo Anestesia Total Intravenosa en el Hospital Occidente de Kennedy. Se analizó la información mediante las pruebas de Shapiro-Wilks, t de Student y U de Mann Withney y los coeficientes de correlación de Spearman y de Pearson, usando SPSS versión 20 para Windows. Un valor de p < 0.05 fue aceptado como estadísticamente significativo. Resultados: Al comparar las dos técnicas, no se encontraron diferencias estadísticamente significativas en los tiempos evaluados. El tiempo de despertar promedio fue 10,1 minutos para Fentanil y 10,2 minutos para Remifentanil. El tiempo de descarga para Fentanil fue 11,9 minutos y para Remifentanil fue 11,5 minutos. Conclusiones: El uso de Fentanil - Propofol guiado por Stangraf es equivalente al uso de Remifentanil – Propofol en cuanto a los tiempos de despertar y de descarga. Se requieren nuevos estudios para corroborar estos hallazgos.

The great awakening : a history of the revival of religion in the time of Edwards and Whitefield /

Includes bibliographical references.

Assessment of the cortisol awakening response: Real-time analysis and curvilinear effects of sample timing inaccuracy

The cortisol awakening response (CAR) is typically measured in the domestic setting. Moderate sample timing inaccuracy has been shown to result in erroneous CAR estimates and such inaccuracy has been shown partially to explain inconsistency in the CAR literature. The need for more reliable measurement of the CAR has recently been highlighted in expert consensus guidelines where it was pointed out that less than 6% of published studies provided electronic-monitoring of saliva sampling time in the post-awakening period. Analyses of a merged data-set of published studies from our laboratory are presented. To qualify for selection, both time of awakening and collection of the first sample must have been verified by electronic-monitoring and sampling commenced within 15 min of awakening. Participants (n = 128) were young (median age of 20 years) and healthy. Cortisol values were determined in the 45 min post-awakening period on 215 sampling days. On 127 days, delay between verified awakening and collection of the first sample was less than 3 min (‘no delay’ group); on 45 days there was a delay of 4–6 min (‘short delay’ group); on 43 days the delay was 7–15 min (‘moderate delay’ group). Cortisol values for verified sampling times accurately mapped on to the typical post-awakening cortisol growth curve, regardless of whether sampling deviated from desired protocol timings. This provides support for incorporating rather than excluding delayed data (up to 15 min) in CAR analyses. For this population the fitted cortisol growth curve equation predicted a mean cortisol awakening level of 6 nmols/l (±1 for 95% CI) and a mean CAR rise of 6 nmols/l (±2 for 95% CI). We also modelled the relationship between real delay and CAR magnitude, when the CAR is calculated erroneously by incorrectly assuming adherence to protocol time. Findings supported a curvilinear hypothesis in relation to effects of sample delay on the CAR. Short delays of 4–6 min between awakening and commencement of saliva sampling resulted an overestimated CAR. Moderate delays of 7–15 min were associated with an underestimated CAR. Findings emphasize the need to employ electronic-monitoring of sampling accuracy when measuring the CAR in the domestic setting.

Good Morning, America! The explosive U.S. awakening to the need for adaptation

Since the early years of the 21st century, and in particular since 2007, the U.S. has been awakening rapidly to the fact that climate change is underway and that even if stringent efforts are undertaken to mitigate greenhouse gas emissions, adaptation to the unavoidable impacts from the existing commitment to climate change is still needed and needs to be begun now. This report provides an historical overview of the public, political, and scientific concern with adaptation in the United States. It begins by briefly distinguishing ongoing, historical adaptation to environmental circumstances from deliberate adaptation to human‐induced climate change. It then describes the shift from the early concerns with climate change and adaptation to the more recent awakening to the need for a comprehensive approach to managing the risks from climate change. Ranging from the treatment of the topic in the news media to the drafting of bills in Congress, to state and local government activities with considerable engagement of NGOs, scientists and consultants, it is apparent that adaptation has finally, and explosively, emerged on the political agenda as a legitimate and needed subject for debate. At the same time, the current policy rush is not underlain by widespread public engagement and mobilization nor does it rest on a solid research foundation. Funding for vulnerability and adaptation research, establishing adequate decision support institutions, as well as the building of the necessary capacity in science, the consulting world, and in government agencies, lags far behind the need. (PDF contains 42 pages)

Awakening a sleeping giant: The riddle of Latino political participation

For some time now, the Latino voice has been gradually gaining strength in American politics, particularly in such states as California, Florida, Illinois, New York, and Texas, where large numbers of Latino immigrants have settled and large numbers of electoral votes are at stake. Yet the issues public officials in these states espouse and the laws they enact often do not coincide with the interests and preferences of Latinos. The fact that Latinos in California and elsewhere have not been able to influence the political agenda in a way that is commensurate with their numbers may reflect their failure to participate fully in the political process by first registering to vote and then consistently turning out on election day to cast their ballots.

To understand Latino voting behavior, I first examine Latino political participation in California during the ten general elections of the 1980s and 1990s, seeking to understand what percentage of the eligible Latino population registers to vote, with what political party they register, how many registered Latinos to go the polls on election day, and what factors might increase their participation in politics. To ensure that my findings are not unique to California, I also consider Latino voter registration and turnout in Texas for the five general elections of the 1990s and compare these results with my California findings.

I offer a new approach to studying Latino political participation in which I rely on county-level aggregate data, rather than on individual survey data, and employ the ecological inference method of generalized bounds. I calculate and compare Latino and white voting-age populations, registration rates, turnout rates, and party affiliation rates for California's fifty-eight counties. Then, in a secondary grouped logit analysis, I consider the factors that influence these Latino and white registration, turnout, and party affiliation rates.

I find that California Latinos register and turn out at substantially lower rates than do whites and that these rates are more volatile than those of whites. I find that Latino registration is motivated predominantly by age and education, with older and more educated Latinos being more likely to register. Motor voter legislation, which was passed to ease and simplify the registration process, has not encouraged Latino registration . I find that turnout among California's Latino voters is influenced primarily by issues, income, educational attainment, and the size of the Spanish-speaking communities in which they reside. Although language skills may be an obstacle to political participation for an individual, the number of Spanish-speaking households in a community does not encourage or discourage registration but may encourage turnout, suggesting that cultural and linguistic assimilation may not be the entire answer.

With regard to party identification, I find that Democrats can expect a steady Latino political identification rate between 50 and 60 percent, while Republicans attract 20 to 30 percent of Latino registrants. I find that education and income are the dominant factors in determining Latino political party identification, which appears to be no more volatile than that of the larger electorate.

Next, when I consider registration and turnout in Texas, I find that Latino registration rates are nearly equal to those of whites but that Texas Latino turnout rates are volatile and substantially lower than those of whites.

Low turnout rates among Latinos and the volatility of these rates may explain why Latinos in California and Texas have had little influence on the political agenda even though their numbers are large and increasing. Simply put, the voices of Latinos are little heard in the halls of government because they do not turn out consistently to cast their votes on election day.

While these findings suggest that there may not be any short-term or quick fixes to Latino participation, they also suggest that Latinos should be encouraged to participate more fully in the political process and that additional education may be one means of achieving this goal. Candidates should speak more directly to the issues that concern Latinos. Political parties should view Latinos as crossover voters rather than as potential converts. In other words, if Latinos were "a sleeping giant," they may now be a still-drowsy leviathan waiting to be wooed by either party's persuasive political messages and relevant issues.

Post awakening salivary cortisol secretion and trait well-being: The importance of sample timing accuracy

Indices of post awakening cortisol secretion (PACS), include the rise in cortisol(cortisol awakening response: CAR) and overall cortisol concentrations (e.g. area under the curve with reference to ground: AUCg) in the first 30—45 min. Both are commonly investigated in relation to psychosocial variables. Although sampling within the domestic setting is ecologically valid, participant non-adherence to the required timing protocol results in erroneous measurement of PACS and this may explain discrepancies in the literature linking these measures to trait well-being (TWB). We have previously shown that delays of little over 5 min(between awakening and the start of sampling) to result in erroneous CAR estimates. In this study, we report for the first time on the negative impact of sample timing inaccuracy (verified by electronic-monitoring) on the efficacy to detect significant relationships between PACS and TWB when measured in the domestic setting.Healthy females (N = 49, 20.5 ± 2.8 years) selected for differences in TWB collected saliva samples (S1—4) on 4 days at 0, 15, 30, 45 min post awakening, to determine PACS. Adherence to the sampling protocol was objectively monitored using a combination of electronic estimates of awakening (actigraphy) and sampling times (track caps).Relationships between PACS and TWB were found to depend on sample timing accuracy. Lower TWB was associated with higher post awakening cortisol AUCg in proportion to the mean sample timing accuracy (p < .005). There was no association between TWB and the CAR even taking into account sample timing accuracy. These results highlight the importance of careful electronic monitoring of participant adherence for measurement of PACS in the domestic setting. Mean sample timing inaccuracy, mainly associated with delays of >5 min between awakening and collection of sample 1 (median = 8 min delay), negatively impacts on the sensitivity of analysis to detect associations between PACS and TWB.

Subjective, behavioural and electrophysiological measurements of the time-course and intensity of sleep inertia after a full night of sleep /

Several recent studies have described the period of impaired alertness and performance known as sleep inertia that occurs upon awakening from a full night of sleep. They report that sleep inertia dissipates in a saturating exponential manner, the exact time course being task dependent, but generally persisting for one to two hours. A number of factors, including sleep architecture, sleep depth and circadian variables are also thought to affect the duration and intensity. The present study sought to replicate their findings for subjective alertness and reaction time and also to examine electrophysiological changes through the use of event-related potentials (ERPs). Secondly, several sleep parameters were examined for potential effects on the initial intensity of sleep inertia. Ten participants spent two consecutive nights and subsequent mornings in the sleep lab. Sleep architecture was recorded for a fiiU nocturnal episode of sleep based on participants' habitual sleep patterns. Subjective alertness and performance was measured for a 90-minute period after awakening. Alertness was measured every five minutes using the Stanford Sleepiness Scale (SSS) and a visual analogue scale (VAS) of sleepiness. An auditory tone also served as the target stimulus for an oddball task designed to examine the NlOO and P300 components ofthe ERP waveform. The five-minute oddball task was presented at 15-minute intervals over the initial 90-minutes after awakening to obtain six measures of average RT and amplitude and latency for NlOO and P300. Standard polysomnographic recording were used to obtain digital EEG and describe the night of sleep. Power spectral analyses (FFT) were used to calculate slow wave activity (SWA) as a measure of sleep depth for the whole night, 90-minutes before awakening and five minutes before awakening.

A desarticulação do universo patriarcal em The awakening, de Kate Chopin

Pós-graduação em Estudos Literários - FCLAR

Acute physical exercise under hypoxia improves sleep, mood and reaction time

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Safety of endovascular treatment beyond the 6-h time window in 205 patients

Background and purpose Intra-arterial treatment (IAT) is effective when performed within 6 h of symptom onset in selected stroke patients (‘T < 6H’). Its safety and efficacy is unclear when the patient has had symptoms for more than 6 h (‘T > 6H’) or for an unknown time (unclear-onset stroke, UOS), or woke up with a stroke (wake-up stroke, WUS). In this study we compared the safety of IAT in these four patient groups. Methods Eight-hundred and fifty-nine patients treated with IAT were enrolled. The main outcome parameters were clinical outcome [excellent: modified Rankin Scale (mRS) 0 or 1; or favorable: mRS 0–2] or mortality 3 months after treatment. Further outcome parameters were the rates of vessel recanalization, and cerebral and systemic hemorrhage. Results Six-hundred and fifty-four patients were treated before (T < 6H) and 205 after 6 h or an unknown time (128 T > 6H, 55 WUS and 22 UOS). NIHSS scores were higher in UOS patients than in T < 6H patients, vertebrobasilar occlusion was more common in T > 6H and UOS patients, and middle cerebral artery occlusions less common in T > 6H than in T < 6H patients. Other baseline characteristics were similar. There was no significant difference in clinical outcome and the rate of hemorrhage in multivariable regression analysis. Conclusions Clinical outcome of our four groups of patients was similar with no increase of hemorrhage rates in patients treated after awakening, after an unknown time or more than 6 h. Our preliminary data suggest that treatment of such patients may be performed safely. If confirmed in randomized trials, this would have major clinical implications.

Beyond the Spanish classics - The ephemeral awakening of the history of international law in pre-democratic Spain

Cuadernos para el Diálogo (1963-1978) played a key-role in nurturing the intellectual soil for the Spanish Transition to democracy and it has spawned an extensive amount of literature among historians. This work links for the first time the course of this emblematic monthly journal with the short-lived period of methodological and historiographical innovation of Revista Española de Derecho Internacional under the direction of the international jurist Mariano Aguilar Navarro.

Detailed analysis of a conservative difference approximation for the time fractional diffusion equation

Diffusion equations that use time fractional derivatives are attractive because they describe a wealth of problems involving non-Markovian Random walks. The time fractional diffusion equation (TFDE) is obtained from the standard diffusion equation by replacing the first-order time derivative with a fractional derivative of order α ∈ (0, 1). Developing numerical methods for solving fractional partial differential equations is a new research field and the theoretical analysis of the numerical methods associated with them is not fully developed. In this paper an explicit conservative difference approximation (ECDA) for TFDE is proposed. We give a detailed analysis for this ECDA and generate discrete models of random walk suitable for simulating random variables whose spatial probability density evolves in time according to this fractional diffusion equation. The stability and convergence of the ECDA for TFDE in a bounded domain are discussed. Finally, some numerical examples are presented to show the application of the present technique.

Determination of preventive maintenance lead time using hybrid analysis

The time for conducting Preventive Maintenance (PM) on an asset is often determined using a predefined alarm limit based on trends of a hazard function. In this paper, the authors propose using both hazard and reliability functions to improve the accuracy of the prediction particularly when the failure characteristic of the asset whole life is modelled using different failure distributions for the different stages of the life of the asset. The proposed method is validated using simulations and case studies.