Valoración subjetiva de la onda de pletismografia como predictor en la administración de líquidos endovenosos.

Introducción: Determinar el balance de líquidos en pacientes quirúrgicos es un factor de suma importancia, la variabilidad de la onda de pletismografía puede ser un soporte para ayudar a superar este objetivo. La interpretación subjetiva por parte del anestesiólogo de la variabilidad de la onda de pletismografía, puede inferirse como una herramienta confiable para predecir y guiar la administración de líquidos en pacientes que no requieran monitoria invasiva. Metodología: Estudio exploratorio desarrollado por método de observación con la colaboración de 90 médicos anestesiólogos, mediante observación de la variabilidad de la onda de pletismografía en 5 videos aleatorizados. El porcentaje de decisiones correctas se analizó mediante IC del 95% para proporciones. Para evaluar la homogeneidad en la fracción de respuestas correctas se realizan pruebas chi-cuadrado de homogeneidad con un nivel de significancia de 0.05. Resultados: El 75% de la población encuestada con (IC) 95% de la proporción acertó en la estimación del IVP. La conducta de administrar o no líquidos y/o vasopresores fue correcta en el 80% de la población para 4 videos, con una tasa de error de 8,2% por video. El video 4 obtuvo un 32% de acierto y una tasa de error de 10,6%. Conclusiones: El estudio permitió de manera subjetiva, determinar que el uso de la variabilidad de la onda de pletismografía es una herramienta de fácil lectura que ayuda a la administración de líquidos durante el intraoperatorio en el paciente sometido a ventilación mecánica en procedimientos quirúrgicos de baja a intermedia complejidad.

African easterly wave variability and its relationship to Atlantic tropical cyclone activity

Automatic tracking of vorticity centers in European Centre for Medium-Range Weather Forecasts analyses has been used to develop a 20-yr climatology of African easterly wave activity. The tracking statistics at 600 and 850 mb confirm the complicated easterly wave structures present over the African continent. The rainy zone equatorward of 15 degreesN is dominated by 600-mb activity, and the much drier Saharan region poleward of 15 degreesN is more dominated by 850-mb activity. Over the Atlantic Ocean there is just one storm track with the 600- and 850-mb wave activity collocated. Based on growth/decay and genesis statistics, it appears that the 850-mb waves poleward of 15 degreesN over land generally do not get involved with the equatorward storm track over the ocean. Instead, there appears to be significant development of 850-mb activity at the West African coast in the rainy zone around (10 degreesN, 10 degreesW), which, it is proposed, is associated with latent heat release. Based on the tracking statistics, it has been shown that there is marked interannual variability in African easterly wave (AEW) activity. It is especially marked at the 850-mb level at the West African coast between about 10 degrees and 15 degreesN, where the coefficient of variation is 0.29. For the period between 1985 and 1998, a notable positive correlation is seen between this AEW activity and Atlantic tropical cyclone activity. This correlation is particularly strong for the postreanalysis period between 1994 and 1998. This result suggests that Atlantic tropical cyclone activity may be influenced by the number of AEWs leaving the West African coast, which have significant low-level amplitudes, and not simply by the total number of AEWs.

La onda de pletismografía y su correlación con la reposición de líquidos intraoperatorios en pacientes sometidos a anestesia general

Introducción: Se ha conocido la necesidad de la monitoria del estado hemodinámico de los pacientes quirúrgicos de forma dinámica, que permita realizar una valoración rápida, menos invasiva y confiable para un diagnóstico acertado y evaluar la respuesta a las conductas tomadas. El delta de pletismografía es una herramienta confiable, no invasiva y dinámica que logra cumplir con las características antes mencionadas y que además puede llegar a tener un papel preponderante en la terapia hídrica dirigida. Metodología: Estudio de correlación, se realizaron evaluaciones sistemáticas de la onda de pletismografía y las variables del paciente desde la inducción anestésica hasta el inicio del procedimiento quirúrgico, se determinó la correlación entre la variabilidad de la onda de pletismografía, el delta de pletismografía y el requerimiento de líquidos intraoperatorios. Se incluyeron pacientes adultos en el rango de 18 a 80 años, que cumplían los criterios de inclusión, programados para cirugía bajo anestesia general en la Fundación Cardioinfantil Instituto de Cardiología, hasta lograr la muestra calculada de 31 pacientes. Siguiendo los principios éticos de la declaración de Helsinki y la normatividad colombiana, este estudio no consideró la realización de ningún tipo de intervención en los pacientes lo que lo cataloga de bajo riesgo. Resultados: El 80.6% presentó variabilidad aumentada, con correlación entre la variabilidad de la onda del pulso, el delta POP y la cantidad de líquidos intraoperatorios (0.245 IC 95%). Disminución del delta POP en T3, sugiriendo respuesta a líquidos, correlación entre uso de vasopresores, analgesia y náuseas y vómito postoperatorio. Conclusión: Existe correlación entre la variabilidad de la onda de pletismografía, el delta de pletismografía y la reposición de líquidos endovenosos en los pacientes ventilados mecánicamente durante anestesia general. Además se encuentra asociación entre uso de vasopresores, analgesia y náuseas y vómito postoperatorio.

Flow structure and variability in the subtropical Indian Ocean: Instability of the South Indian Ocean Countercurrent

The origin of the eddy variability around the 25°S band in the Indian Ocean is investigated. We have found that the surface circulation east of Madagascar shows an anticyclonic subgyre bounded to the south by eastward flow from southwest Madagascar, and to the north by the westward flowing South Equatorial Current (SEC) between 15° and 20°S. The shallow, eastward flowing South Indian Ocean Countercurrent (SICC) extends above the deep reaching, westward flowing SEC to 95°E around the latitude of the high variability band. Applying a two-layer model reveals that regions of large vertical shear along the SICC-SEC system are baroclinically unstable. Estimates of the frequencies (3.5–6 times/year) and wavelengths (290–470 km) of the unstable modes are close to observations of the mesoscale variability derived from altimetry data. It is likely then that Rossby wave variability locally generated in the subtropical South Indian Ocean by baroclinic instability is the origin of the eddy variability around 25°S as seen, for example, in satellite altimetry.

The relationship between the radio and gamma-ray emission of blazars

Blazars are active galaxies with a jet closely oriented to our line of sight. They are powerful, variable emitters from radio to gamma-ray wavelengths. Although the general picture of synchrotron emission at low energies and inverse Compton at high energies is well established, important aspects of blazars are not well understood. In particular, the location of the gamma-ray emission region is not clearly established, with some theories favoring a location close to the central engine, while others place it at parsec scales in the radio jet.

We developed a program to locate the gamma-ray emission site in blazars, through the study of correlated variations between their gamma-ray and radio-wave emission. Correlated variations are expected when there is a relation between emission processes at both bands, while delays tell us about the relative location of their energy generation zones. Monitoring at 15 GHz using the Owens Valley Radio Observatory 40 meter telescope started in mid-2007. The program monitors 1593 blazars twice per week, including all blazars detected by the Fermi Gamma-ray Space Telescope (Fermi) north of -20 degrees declination. This program complements the continuous monitoring of gamma-rays by Fermi.

Three year long gamma-ray light curves for bright Fermi blazars are cross-correlated with four years of radio monitoring. The significance of cross-correlation peaks is investigated using simulations that account for the uneven sampling and noise properties of the light curves, which are modeled as red-noise processes with a simple power-law power spectral density. We found that out of 86 sources with high quality data, only three show significant correlations (AO 0235+164, B2 2308+34 and PKS 1502+106). Additionally, we find a significant correlation for Mrk 421 when including the strong gamma-ray/radio flare of late 2012. In all four cases radio variations lag gamma-ray variations, suggesting that the gamma-ray emission originates upstream of the radio emission. For PKS 1502+106 we locate the gamma-ray emission site parsecs away from the central engine, thus disfavoring the model of Blandford and Levinson (1995), while other cases are inconclusive. These findings show that continuous monitoring over long time periods is required to understand the cross-correlation between gamma-ray and radio-wave variability in most blazars.

Ensaios não-destrutivos de propagação de ondas em toras e madeira serrada de Pinus. taeda L.

In this paper it was evaluated the influence of the relative position of logs on the trees, the type of wood (juvenile and mature wood and pith) and the dimension of sawed wood elements on the velocity of propagation of stress waves into the material on condition. P. taeda L wood (43 years old trees) from Horto Florestal of Manduri (latitude 230 00’ south, longitude 400 19’ west and altitude de 700 m) São Paulo State, Brazil were used, considering its easy growth rings visualization and the better ju regions definition. Six trees were randomly chosen in the plantation. Trees were sawed into 4 logs (2,5 m long each. In each log it was delimited the central board (80mm tick) region and the lateral boards (25mm tick) regions, cons right hand. It were evaluated relation between velocity of stress waves on logs and the correspondent lumber (central and lateral boards), on green condition, on the three main region of the elements (mature wood results obtained revealed the concordance between velocities of stress waves in the material before and after the its mechanical processing. It was also revealed statistical differences between the velocity of stress waves at juvenile wood, mature wood and pith regions. Keywords: stress wave method, velocity 17 destrutivos de propagação da propagação de ondas de tensão em toras e madeira serrada de taeda L. Hernando Alfonso Lara Palma - Universidade Estadual Paulista Faculdade de Ciências Agronômicas – FCA/UNESP – Botucatu - SP, e-mail: awballarin@fca.unesp.br Luiz Antonio Vasques Hellmeister - Universidade Estadual Paulista - Faculdade de Arquitetura, FAAC/UNESP – Bauru - SP, e-mail: hellmeister@faac.unesp.br Este trabalho teve como objetivo analisar a influência do tipo de lenho, da posição da tora ao longo do fuste e das dimensões das peças desdobradas, na velocidade de as de tensão (Stress wave method), na condição de madeira verde. P. taeda L., originária de árvores de plantio do Horto Florestal de SP., com idade aproximada de 43 anos, pela facilidade de identificação dos anéis imento e demarcação das regiões de madeira adulta e madeira juvenil. Foram amostradas 6 árvores distintas, escolhidas ao acaso do talhão selecionado. De cada árvore foram retiradas 4 toras com comprimento de 2,5 m cada. Foram demarcadas nas toras a ha central (8 cm de espessura) e 4 tábuas laterais (espessura comercial de 2,5 cm), sendo duas à esquerda e duas à direita da prancha central. Foram avaliadas as relações existentes entre as velocidades de propagação das ondas de tensão na madeira íntegra (toras) e desdobrada (pranchas e tábuas), na condição de madeira verde, nas três regiões distintas do lenho: medula, madeira adulta e madeira juvenil. A análise comparativa dos resultados revelou a concordância entre as velocidades antes e após o desdobr madeira. Houve diferenciação estatisticamente significativa entre as velocidades de propagação das ondas de tensão nos lenhos adulto, juvenil e na medula. -destrutivos, método das ondas de tensão, Pinus taeda stress wave tests on green logs and lumber of Pinus taeda In this paper it was evaluated the influence of the relative position of logs on the trees, the type of wood (juvenile and mature wood and pith) and the dimension of sawed wood elements on the velocity of propagation of stress waves into the material on L wood (43 years old trees) from Horto Florestal of Manduri (latitude 19’ west and altitude de 700 m) São Paulo State, Brazil were used, considering its easy growth rings visualization and the better juvenile and mature wood regions definition. Six trees were randomly chosen in the plantation. Trees were sawed into 4 logs (2,5 m long each. In each log it was delimited the central board (80mm tick) region and the lateral boards (25mm tick) regions, considering 2 boards on the left and 2 at the right hand. It were evaluated relation between velocity of stress waves on logs and the correspondent lumber (central and lateral boards), on green condition, on the three main region of the elements (mature wood, juvenile wood and pith). Comparative analyses of results obtained revealed the concordance between velocities of stress waves in the material before and after the its mechanical processing. It was also revealed statistical differences ty of stress waves at juvenile wood, mature wood and pith regions

Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation

BACKGROUND: Hypnotic depth but not haemodynamic response to painful stimulation can be measured with various EEG-based anaesthesia monitors. We evaluated the variation of pulse plethysmography amplitude induced by an electrical tetanic stimulus (PPG variation) as a potential measure for analgesia and predictor of haemodynamic responsiveness during general anaesthesia. METHODS: Ninety-five patients, ASA I or II, were randomly assigned to five groups [Group 1: bispectral index (BIS) (range) 40-50, effect site remifentanil concentration 1 ng ml(-1);Group 2: BIS 40-50, remifentanil 2 ng ml(-1); Group 3: BIS 40-50, remifentanil 4 ng ml(-1); Group 4: BIS 25-35, remifentanil 2 ng ml(-1); Group 5: BIS 55-65, remifentanil 2 ng ml(-1)]. A 60 mA tetanic stimulus was applied for 5 s on the ulnar nerve. From the digitized pulse oximeter wave recorded on a laptop computer, linear and non-linear parameters of PPG variation during the 60 s period after stimulation were computed. The haemodynamic response to subsequent orotracheal intubation was recorded. The PPG variation was compared between groups and between responders and non-responders to intubation (anova). Variables independently predicting the response were determined by logistic regression. RESULTS: The probability of a response to tracheal intubation was 0.77, 0.47, 0.05, 0.18 and 0.52 in Groups 1-5, respectively (P<0.03). The PPG variability was significantly higher in responders than in non-responders but it did not improve the prediction of the response to tracheal intubation based on BIS level and effect site remifentanil concentration. CONCLUSION: Tetanic stimulation induced PPG variation does not reflect the analgesic state in a wide clinical range of surgical anaesthesia.

Non-invasive clinical measurement of the viscoelastic properties of tendon using acoustic wave transmission

Background. In isotropic materials, the speed of acoustic wave propagation is governed by the bulk modulus and density. For tendon, which is a structural composite of fluid and collagen, however, there is some anisotropy requiring an adjustment for Poisson's ratio. This paper explores these relationships using data collected, in vivo, on human Achilles tendon and then compares estimates of elastic modulus and hysteresis against published values from in vitro mechanical tests. Methods. Measurements using conventional B-model ultrasound imaging, inverse dynamics and acoustic transmission techniques were used to determine dimensions, loading conditions and longitudinal speed of sound in the Achilles tendon during a series of isometric plantar flexion exercises against body weight. Upper and lower bounds for speed of sound versus tensile stress in the tendon were then modelled and estimates of the elastic modulus and hysteresis of the Achilles tendon derived. Results. Axial speed of sound varied between 1850 and 2090 ms-1 with a non-linear, asymptotic dependency on the level of tensile stress (5-35 MPa) in the tendon. Estimates derived for the elastic modulus of the Achilles tendon ranged between 1-2 GPa. Hysteresis derived from models of the stress-strain relationship, ranged from 3-11%. Discussion. Estimates of elastic modulus agree closely with those previously reported from direct measurements obtained via mechanical tensile tests on major weight bearing tendons in vitro [1,2]. Hysteresis derived from models of the stress-strain relationship is consistent with direct measures from various mamalian tendon (7-10%) but is lower than previous estimates in human tendon (17-26%) [3]. This non-invasive method would appear suitable for monitoring changes in tendon properties during dynamic sporting activities.

Spatial Variability of the Depth of Weathered and Engineering Bedrock using Multichannel Analysis of Surface Wave Method

In this paper an attempt has been made to evaluate the spatial variability of the depth of weathered and engineering bedrock in Bangalore, south India using Multichannel Analysis of Surface Wave (MASW) survey. One-dimensional MASW survey has been carried out at 58 locations and shear-wave velocities are measured. Using velocity profiles, the depth of weathered rock and engineering rock surface levels has been determined. Based on the literature, shear-wave velocity of 330 ± 30 m/s for weathered rock or soft rock and 760 ± 60 m/s for engineering rock or hard rock has been considered. Depths corresponding to these velocity ranges are evaluated with respect to ground contour levels and top surface levels have been mapped with an interpolation technique using natural neighborhood. The depth of weathered rock varies from 1 m to about 21 m. In 58 testing locations, only 42 locations reached the depths which have a shear-wave velocity of more than 760 ± 60 m/s. The depth of engineering rock is evaluated from these data and it varies from 1 m to about 50 m. Further, these rock depths have been compared with a subsurface profile obtained from a two-dimensional (2-D) MASW survey at 20 locations and a few selected available bore logs from the deep geotechnical boreholes.

Sensitivity of GCM tropical middle atmosphere variability and climate to ozone and parametrized gravity wave changes

This paper describes the impact of changing the current imposed ozone climatology upon the tropical Quasi-Biennial Oscillation (QBO) in a high top climate configuration of the Met Office U.K. general circulation model. The aim is to help distinguish between QBO changes in chemistry climate models that result from temperature-ozone feedbacks and those that might be forced by differences in climatology between previously fixed and newly interactive ozone distributions. Different representations of zonal mean ozone climatology under present-day conditions are taken to represent the level of change expected between acceptable model realizations of the global ozone distribution and thus indicate whether more detailed investigation of such climatology issues might be required when assessing ozone feedbacks. Tropical stratospheric ozone concentrations are enhanced relative to the control climatology between 20–30 km, reduced from 30–40 km and enhanced above, impacting the model profile of clear-sky radiative heating, in particular warming the tropical stratosphere between 15–35 km. The outcome is consistent with a localized equilibrium response in the tropical stratosphere that generates increased upwelling between 100 and 4 hPa, sufficient to account for a 12 month increase of modeled mean QBO period. This response has implications for analysis of the tropical circulation in models with interactive ozone chemistry because it highlights the possibility that plausible changes in the ozone climatology could have a sizable impact upon the tropical upwelling and QBO period that ought to be distinguished from other dynamical responses such as ozone-temperature feedbacks.

Response of the North Atlantic wave climate to atmospheric modes of variability

This study investigates the relationship between the wind wave climate and the main climate modes of atmospheric variability in the North Atlantic Ocean. The modes considered are the North Atlantic Oscillation (NAO), the East Atlantic (EA) pattern, the East Atlantic Western Russian (EA/WR) pattern and the Scandinavian (SCAN) pattern. The wave dataset consists of buoys records, remote sensing altimetry observations and a numerical hindcast providing significant wave height (SWH), mean wave period (MWP) and mean wave direction (MWD) for the period 1989–2009. After evaluating the reliability of the hindcast, we focus on the impact of each mode on seasonal wave parameters and on the relative importance of wind-sea and swell components. Results demonstrate that the NAO and EA patterns are the most relevant, whereas EA/WR and SCAN patterns have a weaker impact on the North Atlantic wave climate variability. During their positive phases, both NAO and EA patterns are related to winter SWH at a rate that reaches 1 m per unit index along the Scottish coast (NAO) and Iberian coast (EA) patterns. In terms of winter MWD, the two modes induce a counterclockwise shift of up to 65° per negative NAO (positive EA) unit over west European coasts. They also increase the winter MWP in the North Sea and in the Bay of Biscay (up to 1 s per unit NAO) and along the western coasts of Europe and North Africa (1 s per unit EA). The impact of winter EA pattern on all wave parameters is mostly caused through the swell wave component.

On the ability of statistical wind-wave models to capture the variability and long-term trends of the North Atlantic winter wave climate

A dynamical wind-wave climate simulation covering the North Atlantic Ocean and spanning the whole 21st century under the A1B scenario has been compared with a set of statistical projections using atmospheric variables or large scale climate indices as predictors. As a first step, the performance of all statistical models has been evaluated for the present-day climate; namely they have been compared with a dynamical wind-wave hindcast in terms of winter Significant Wave Height (SWH) trends and variance as well as with altimetry data. For the projections, it has been found that statistical models that use wind speed as independent variable predictor are able to capture a larger fraction of the winter SWH inter-annual variability (68% on average) and of the long term changes projected by the dynamical simulation. Conversely, regression models using climate indices, sea level pressure and/or pressure gradient as predictors, account for a smaller SWH variance (from 2.8% to 33%) and do not reproduce the dynamically projected long term trends over the North Atlantic. Investigating the wind-sea and swell components separately, we have found that the combination of two regression models, one for wind-sea waves and another one for the swell component, can improve significantly the wave field projections obtained from single regression models over the North Atlantic.

Chronic obstructive pulmonary disease and heart rate variability: a literature update

Background: The literature indicates that chronic obstructive pulmonary disease (COPD) affects cardiac autonomic control. In this study, we conducted a literature review in order to investigate the heart rate variability (HRV) in COPD subjects. Methods: A search was performed in Medline database, using the link between the keywords: “autonomic nervous system”, “cardiovascular system”, “COPD” and “heart rate variability”. Results: The search resulted in a total of 40 references. Amongst these references, the first exclusion resulted in the barring of 29 titles and abstracts, which were not clearly related to the purpose of review. This resulted in a total of 11 articles that were then read and utilized in the review. The selected studies indicated that there is significant reduction of HRV in patients with COPD, characterized by reduction of indices that assess parasympathetic activity in addition to dealing with the global autonomic modulation. We also established that supervised exercise can reduce these harmful effects in COPD patients. Also, it was reported that the use of non-invasive ventilation in these patients may contribute to the improvement of respiratory symptoms, with no impairing, and may even induce positive responses in cardiac autonomic regulation. Conclusion: The studies indicate a need for further investigations to guide future therapies to improve the treatment of cardiovascular system in the respiratory diseases.