Comparison of the Laryngeal View during Tracheal Intubation Using Airtraq and Macintosh Laryngoscopes by Unskillful Anesthesiology Residents: A Clinical Study

Background and Objective. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) is a novel tracheal intubation device. Studies, performed until now, have compared the Airtraq with the Macintosh laryngoscope, concluding that it reduces the intubation times and increase the success rate at first intubation attempt, decreasing the Cormack-Lehane score. The aim of the study was to evaluate if, in unskillful anesthesiology residents during the laryngoscopy, the Airtraq compared with the Macintosh laryngoscope improves the laryngeal view, decreasing the Cormack-Lehane score. Methods. A prospective, randomized, crossed-over trial was carried out on 60 patients. Each one of the patients were intubated using both devices by unskillful (less than two hundred intubations with the Macintosh laryngoscope and 10 intubations using the Airtraq) anesthesiology residents. The Cormack-Lehane score, the success rate at first intubation attempt, and the laryngoscopy and intubation times were compared. Results. The Airtraq significantly decreased the Cormack-Lehane score (P = 0.04). On the other hand, there were no differences in times of laryngoscopy (P = 0.645; IC 95% 3.1, +4.8) and intubation (P = 0.62; C95%  −6.1, +10.0) between the two devices. No relevant complications were found during the maneuvers of intubation using both devices. Conclusions. The Airtraq is a useful laryngoscope in unskillful anesthesiology residents improving the laryngeal view and, therefore, facilitating the tracheal intubation

Codesa: strategy formulation for the National Industrial Development Corporation in Costa Rica

The present thesis »«barks on the study of three distinct aspects of the Costa Rican Development Corporations operations. The first section presents the Ethos under which the organization was created in 1972, and follows the enterprise’s development until the present day in order to analyze how well it has adhered to its fundamental precepts, as well as how significant its contribution has been to the national economy. The following chapters cover in detail the present state of the four major areas of investment: cament factories, sugar cane based sugar and ethanol production, aluminium semi-processing, and fertilizers. Alternative strategies are discussed for each of the sectors involved, in an attempt to determine their potential to continue as independent on-going concerns. In the analysis of the Costa Rican Cement industry, national consumption/installed capacity forecasts until the end of the century are included. Also, the comparative competitive position of the Codesa plants (quality, quantity, price, distribution) both nationally and internationally, is discussed. Finally, the impact of new massive construction programs on demand (dams, public housing, etc.), as well as the potential such programs could provide to enhance the expert possibilities by the sale of similar package deals (design, construction, materials (cement), skilled labour, etc.) abroad is presented. The use of alcohol as combustion fuel, both as a complement to petrol (gasohol), and as an independent combustible, represents the main theme of the sugar cane chapter. A dynamic impact study of the implementation of different oil substitution programs in Costa Rica (land use, alternative energy crops, cost competitiveness with respect to fluctuations in the price of oil, etc.). New technological developments in the production of alcohol from biomass are also presented. In the Aluminium section, an analysis of the World aluminium industry scene is made, in an attempt to determine the subsidiary company's strategic outlook (currently the company has important limitations in the acquisition of raw materials. The potential for integration: Establishment of backward linkages to secure the flow of raw materials into the process (from national bauxite deposits), as well as forward linkages to establish the production and marketing of end products (and recycling) to improve value-added position are discussed. In relation to the fertilizers plant, the effort has been focused on two main areas; raw materials and the study of energy usage (including steps for an energy audit, and the establishment of an energy management system). Finally the review of chronic working capital problems of the past and the development of more adequate performance evaluation criteria and pricing policies are suggested. The final section is devoted to organizational structure. Different organizational set-ups for the company, provided by management throughout the years, are reviewed and a revised structure, more adequate to fulfill the company’s raison d'etre is proposed

Assessing the Left Ventricular Systolic Function at the Bedside: The Role of Transpulmonary Thermodilution-Derived Indices

Evaluating the systolic function of the left ventricle (LV) is important in the hemodynamic management of the critically ill patients with circulatory failure. Echocardiography is considered the standard monitor for estimating the LV function at the bedside in the intensive care unit. However, it requires a trained operator and is not a real-time monitoring tool. For monitoring of the systolic function, the pulmonary artery catheter has been the gold standard for a long time. However, now there are alternatives to this device, with transpulmonary thermodilution being one of them. This paper provides an overview of the usefulness of the transpulmonary thermodilution-derived indices for assessing systolic function at the bedside

Decomposition and nitrogen mineralisation of two wild lupins (Leguminosae) species with potential as green manures

The amount of biomass produced by various native species of genus Lupinus (L.) growing in Mexico ranges from 2.9- 8.2 Mg/ha of dry matter, which can add up to 200 kg/ha of N to soil as green manure. However, information is scarce on the decomposition and mineralisation this biomass in the soil. The above-ground decomposition and N mineralisation of Lupinus mexicanus Cerv. ex Lag. and Lupinus rotundiflorus M.E. Jones species from Mexico using fine-mesh litter bags was evaluated. Litter bags containing 5 g of above-ground air-dried biomass at the vegetative and flowering stages were buried at a depth of 20 cm. Were dug up every 3 weeks over the course of 4 months, dried and re-weighed to determine the lost mass and total N by the Kjeldahl method. The largest decrease in residue mass occurred during the first 3 weeks of incubation. However, the lost mass was higher in younger green manure (75 days old) than in older plants (85 days old) after 18 weeks of exposure in the field. It was found that 60-75% of the total N in the plant material was released in the first 6 weeks. In L. rotundiflorus green manure, it was found that 79.14% of the initial N in the vegetative stage and 77.6% of N in the flowering stage was released 18 weeks after litter bag installation, whereas L. mexicanus were 74.6% and 74.7%, respectively. It was found that both decomposition and N mineralisation occurred quickly in the green manures evaluated

Optical Characterization of a New Young Stellar Population in the Serpens Molecular Cloud

We report on the results of an optical spectroscopic survey designed to confirm the youth and determine the spectral types among a sample of young stellar object (YSO) candidates in the Serpens Molecular Cloud. We observed 150 infrared excess objects, previously discovered by the Spitzer Legacy Program "From Molecular Cores to Planet-Forming Disks" (c2d), bright enough for subsequent Spitzer/IRS spectroscopy. We obtained 78 optical spectra of sufficient S/N for analysis. Extinctions, effective temperatures and luminosities are estimated for this sample, and used to construct H-R diagrams for the population. We identified 20 background giants contaminating the sample, based on their relatively high extinction, position in the H-R diagram, the lack of Halpha emission and relatively low infrared excess. Such strong background contamination (25%) is consistent with the location of Serpens being close to the Galactic plane (5degrees Galactic latitude). The remaining 58 stars (75%) were all confirmed to be young, mostly K and M-type stars that are presumed to belong to the cloud. Individual ages and masses for the YSOs are inferred based on theoretical evolutionary models. The models indicate a spread in stellar ages from 1 to 15 Myr, peaking at 2 - 6 Myr, and a mass distribution of 0.2 to 1.2 Msun with median value around 0.8 Msun. Strong H emission lines (EW[Halpha] > 3 A) have been detected in more than half of the sample (35 stars). The mass accretion rates as derived from the H line widths span a broad distribution over 4 orders of magnitude with median accretion rate of 10^-8 Msun/yr. Our analysis shows that the majority of the infrared excess objects detected in Serpens are actively accreting, young T-Tauri stars.Comment: ApJ in pres

Schwinger mechanism for gluons from lattice QCD

Continuum and lattice analyses have revealed the existence of a mass-scale in the gluon two-point Schwinger function. It has long been conjectured that this expresses the action of a Schwinger mechanism for gauge boson mass generation in quantum chromodynamics (QCD). For such to be true, it is necessary and sufficient that a dynamically-generated, massless, colour-carrying, scalar gluon+gluon correlation emerges as a feature of the dressed three-gluon vertex. Working with results on elementary Schwinger functions obtained via the numerical simulation of lattice-regularised QCD, we establish with an extremely high level of confidence that just such a feature appears; hence, confirm the conjectured origin of the gluon mass scale

What doesn't kill you makes you stranger: Dipeptidyl peptidase-4 (CD26) proteolysis differentially modulates the activity of many peptide hormones and cytokines generating novel cryptic bioactive ligands

Dipeptidyl peptidase 4 (DPP4) is an exopeptidase found either on cell surfaces where it is highly regulated in terms of its expression and surface availability (CD26) or in a free/circulating soluble constitutively available and intrinsically active form. It is responsible for proteolytic cleavage of many peptide substrates. In this review we discuss the idea that DPP4-cleaved peptides are not necessarily inactivated, but rather can possess either a modified receptor selectivity, modified bioactivity, new antagonistic activity, or even a novel activity relative to the intact parent ligand. We examine in detail five different major DPP4 substrates: glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), peptide tyrosine-tyrosine (PYY), and neuropeptide Y (NPY), and stromal derived factor 1 (SDF-1 aka CXCL12). We note that discussion of the cleaved forms of these five peptides are underrepresented in the research literature, and are both poorly investigated and poorly understood, representing a serious research literature gap. We believe they are understudied and misinterpreted as inactive due to several factors. This includes lack of accurate and specific quantification methods, sample collection techniques that are inherently inaccurate and inappropriate, and a general perception that DPP4 cleavage inactivates its ligand substrates. Increasing evidence points towards many DPP4-cleaved ligands having their own bioactivity. For example, GLP-1 can work through a different receptor than GLP-1R, DPP4-cleaved GIP can function as a GIP receptor antagonist at high doses, and DPP4-cleaved PYY, NPY, and CXCL12 can have different receptor selectivity, or can bind novel, previously unrecognized receptors to their intact ligands, resulting in altered signaling and functionality. We believe that more rigorous research in this area could lead to a better understanding of DPP4’s role and the biological importance of the generation of novel cryptic ligands. This will also significantly impact our understanding of the clinical effects and side effects of DPP4-inhibitors as a class of anti-diabetic drugs that potentially have an expanding clinical relevance. This will be specifically relevant in targeting DPP4 substrate ligands involved in a variety of other major clinical acute and chronic injury/disease areas including inflammation, immunology, cardiology, stroke, musculoskeletal disease and injury, as well as cancer biology and tissue maintenance in aging

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Modified Brans-Dicke theory of gravity from five-dimensional vacuum

We investigate, in the context of five-dimensional (5D) Brans-Dicke theory of gravity, the idea that macroscopic matter configurations can be generated from pure vacuum in five dimensions, an approach first proposed in the framework of general relativity. We show that the 5D Brans-Dicke vacuum equations when reduced to four dimensions lead to a modified version of Brans-Dicke theory in four dimensions (4D). As an application of the formalism, we obtain two five-dimensional extensions of four-dimensional O'Hanlon and Tupper vacuum solution and show that they lead two different cosmological scenarios in 4D.Comment: 9 page

Geographic variations in cervical cancer risk in San Luis Potosí state, Mexico: A spatial statistical approach

El trabajo es una investigación orientada al uso de herramientas de análisis espacial para analizar la distribución del cáncer cervicouterino en el Estado de San Luis Potosí. Se consideran aspectos como el lugar de residencia de la población usuaria de los servicios de detección-tratamiento y los lugares donde se ogrecen los servicos. se aplica un modelo de accesibilidad potencial a los servicios a fin de diferenciar las ventajas y desventajas que tiene la población