The sepsis syndrome and the "one size fits all" construct: the emperor has not clothes!!

Background: Sepsis, a syndrome characterized by a systemic, (often overwhelming) inflammatory response to infection is an under recognized, potentially lethal, public health problem in developed and developing countries. Furthermore, is unlikely that it will improve, as other than standard critical care support, there are no effective specific treatment strategies. Most of the therapeutic trials conducted in the last four decades, other than the lack of benefit, have consistently shown that subgroups of septic patients respond differently to the same treatment. This has lead to the thought that sepsis may not be a unique syndrome only differentiated by grades of severity, but rather a syndrome that encompasses diverse phenotypes that behave differently and thus may respond different not only to injury but also to treatment. Thus, the aim of this study is to explore if distinct phenotypes exist in a cohort of critically ill patients with suspected sepsis, and if these can be identified through clinical available data. This is highly relevant to the public health aspect of Sepsis, as it challenges the current paradigm, and provides the basis to develop a new approach that may lead finally to an effective reduction of morbidity and mortality. Methods: We used a large database of critically ill patients (HiDenIC-8). We selected a population of patients with “suspected sepsis” defined as having blood cultures sent or being started on antibiotics within 24 hours of admission to the ICU. We defined demographic, clinical and available laboratory variables to include in the clustering algorithm, and selected them on the basis of availability, and absence of redundancy. We used hierarchical clustering to evaluate the possible number of clusters according to the data structure, and then ran K-means method to determine the actual cluster schedule. Results: We found 13 clusters, 8 of which included more than 70 subjects (~2.5% of entire population). We found important differences in demographic, clinical and laboratory data at admission, and also, different clinical trajectories in terms of patterns of organ dysfunction and mortality. Conclusion: The present study has demonstrated that an unsupervised clustering technique based on frequently collected demographic, clinical and physiologic data can be used to derive distinct, biologically sound clusters of patients who clinically behave differently from each other

BINORMAL MOTION OF CURVES AND SURFACES IN A MANIFOLD

In the present work we consider a curve embedded in a three-dimensional Riemannian manifolf moving in the binormal direction proportional to its curvature. We study how an appropiate orthonormal frame, the Frenet-Serret frame, along the curve evolves in order to deduce that a nonlinear Schrodinger-type equation rules the motion of the curve. Although there exist no conserved quantities, we establish. as one of our main results, local and global existence of solutions for the derived Cauchy problem on a unit circle (corresponding to closed curves ) and on the real line (corresponding to open curves). We also study the motion by mean curvature of a surface embedded in the four-dimensional Euclidean space. Introducing the language of gauge fields as an appropriate framework for presenting the structural properties of the surface and the evolution equations of its geometric quantities, we derive that the complex mean curvature of the evolving surface satisfies a nonlinear Schrodinger-type equation

Differential distribution patterns in cerebellar irrigation. A study with autopsy material

Aim: The aim of this investigation was characterize morphologically the cerebellar artery and its branches in a specimen of autopsy material. Methods: This descriptive cross-sectional study evaluated the anatomical characteristics of the cerebellar arteries and their branches in 93 brain stem and cerebellum blocks obtained from fresh cadavers. The specimens were perfused bilaterally channeling the proximal segments of the internal carotid and vertebral arteries with a semi-synthetic resin (Palatal GP40L 85%; styrene 15%) impregnated with mineral red dye. We evaluated the distribution patterns of the cerebellar artery and its branches. Results: The calibers of the superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) were 1.46 ± 0.2 mm, 1.02 ± 0.35 mm and 1.45 ± 0.37 mm, respectively. Agenesis of the SCA was observed in six specimens (3.2%), AICA in 30 (16.1%), and PICA in 14 (7.5%) specimens. Usual irrigation was observed in 44 (47.3%) cerebellar blocks, whereas 49 (52.7%) specimens showed irrigation variants, 23 (46.9%) of which appeared bilaterally. The dominant distribution of the cerebellar arteries corresponded to SCA in 9 (12.5%) cases, AICA in 46 (63.9%) and PICA in 7 (9.7%) specimens; shared dominance was found in 10 (13.9%) specimens. Conclusion: The high variability of the cerebellar arteries observed in the present study is consistent with previous reports. The diverse anatomic expressions of the cerebellar arteries were typified in relation to their dominance and territories irrigated, useful for the diagnosis and clinical-surgical management of the cerebellum blood supply

Diferencias de género en los estilos de vida de los adolescentes

En este estudio se analizan las diferencias de género que se observan en la adolescencia con respecto a di-ferentes aspectos de los estilos de vida relacionados con la práctica de actividades físicas y deportivas, im-plicación en actividades extraescolares, utilización de las TIC, tiempo destinado a estar con los amigos y a estudiar, consumo de sustancias y rutinas relacionadas con el sueño. Para ello se han estudiado las diferen-cias por curso y sexo, en una muestra de 2400 adolescentes, 55.5% de chicas y 44.5% de chicos, con edades comprendidas entre los 12 y 17 años (media de 14.73 y deviación típica de 1.24) pertenecientes a 20 cen-tros educativos de Andalucía. Los resultados obtenidos, mediante la realización de análisis de correlaciones, ANOVA y prueba de Tukey, confirman que existen correlaciones significativas entre la mayoría de las varia-bles que conforman los estilos de vida, casi todas de tipo positivo a excepción de las relacionadas con con-sumo de sustancias en donde la mayoría fueron negativas. También se encontraron grandes diferencias de género en los estilos de vida ya que de las 15 variables analizadas 10 de ellas presentan diferencias signifi-cativas con respecto al género y una disminución significativa, con el aumento de la edad, en una serie de variables que conforman los estilos de vida saludables: práctica de la actividad física y deportiva, participa-ción en actividades extraescolares y horas de sueñoThis research analyzes gender differences observed in different aspects of adolescent lifestyles, such as physical activities and sports, involvement in extracurricular activities, use of ICT’s, time spent with friends and time spent studying, substance use, and sleep-related routines. Bearing this in mind, we analyzed differences by year and gender in a sample of 2400 adolescents, 55.5 percent girls and 44.5 percent of boys, aged between 12 and 17 (mean age =14.73 and SD = 1.24) in 20 schools from Andalusia. The results from correlation analysis, ANOVA, and Tukey test confirm significant correlations between most variables making up lifestyle, most of them positive except those related to substance use (most correlations were negative). We also found significant gender differences in lifestyles: 10 out of the 15 variables analyzed have significant gender differences. A significant negative correlation with age was found in a number of variables making up healthy lifestyles, such as the practice of sport and physical activity, participation in extracurricular activities and slee

Prehospital induction of mild hypothermia with cold normal saline for cardiac arrest: more harm than good?

Background\ud Hospital cooling improves outcome after cardiac arrest, but prehospital cooling immediately after return of spontaneous circulation may result in better outcomes.\ud \ud Methods\ud Objective: To determine whether prehospital cooling improves outcomes after resuscitation from cardiac arrest in patients with ventricular fibrillation (VF) and without VF.\ud \ud Design: A randomized clinical trial that assigned adults with prehospital cardiac arrest to standard care with or without prehospital cooling. Patient follow-up was completed by May 1, 2013. Nearly all of the patients resuscitated from VF and admitted to the hospital received hospital cooling regardless of their randomization.\ud \ud Setting: King County, Washington.\ud \ud Subjects: Adults with prehospital cardiac arrest and resuscitated by paramedics were eligible and 1359 patients (583 with VF and 776 without VF) were randomized between December 15, 2007, and December 7, 2012.\ud \ud Intervention: Infusing up to 2 L of 4°C normal saline to patients with prehospital cardiac arrest as soon as possible following return of spontaneous circulation.\ud \ud Outcomes: The primary outcomes were survival to hospital discharge and neurological status at discharge.\ud \ud Results\ud The intervention decreased mean core temperature by 1.20°C (95% CI, −1.33°C to −1.07°C) in patients with VF and by 1.30°C (95% CI, −1.40°C to −1.20°C) in patients without VF by hospital arrival and reduced the time to achieve a temperature of less than 34°C by about 1 hour compared with the control group. However, survival to hospital discharge was similar among the intervention and control groups among patients with VF (62.7% [95% CI, 57.0%-68.0%] vs 64.3% [95% CI, 58.6%-69.5%], respectively; P = 0.69) and among patients without VF (19.2% [95% CI, 15.6%-23.4%] vs 16.3% [95% CI, 12.9%-20.4%], respectively; P = 0.30). The intervention was also not associated with improved neurological status of full recovery or mild impairment at discharge for either patients with VF (57.5% [95% CI, 51.8%-63.1%] of cases had full recovery or mild impairment vs 61.9% [95% CI, 56.2%-67.2%] of controls; P = 0.69) or those without VF (14.4% [95% CI, 11.3%-18.2%] of cases vs 13.4% [95% CI,10.4%-17.2%] of controls; P = 0.30). Overall, the intervention group experienced rearrest in the field more than the control group (26% [95% CI, 22%-29%] vs 21% [95% CI, 18%-24%], respectively; P = 0.008), as well as increased diuretic use and pulmonary edema on first chest x-ray, which resolved within 24 hours after admission.\ud \ud Conclusions\ud Although use of prehospital cooling reduced core temperature by hospital arrival and reduced the time to reach a temperature of 34°C, it did not improve survival or neurological status among patients resuscitated from prehospital VF or those without VF

Desarrollo de un marcador electronico para cambios de futbol

Cuando buscamos un tema para el proyecto nos enfocamos al desarrollar un equipo que ayude a nuestro querido colegio y a su vez debía abarcar los conocimientos adquiridos en el bachillerato de tres áreas técnicas como son: Aplicaciones Informáticas (Informática), Instalación de Equipos y Maquinas Eléctricas (electricidad), y Mecatrónica. El proyecto consistía en desarrollar un Marcador electrónico que permitiera la visualización de los cambios que se realicen en un partido de futbol, además del tiempo extra; el mismo que deberá ser de fácil manejo para cualquier usuario, que se pueda visualizar a largas distancias independientemente del clima, que cumpla estándares generales para este tipo de artefactos y que sea de un tamaño y peso adecuados para que el usuario pueda manipularlo con facilidad. El uso de los materiales apropiados fue un tema controversial ya que de estos no solo dependía el funcionamiento del equipo, si no también la durabilidad. Además de buscar un costo cómodo para el desarrollo del marcador de manera que resultara más sustentable para el colegio financiar el proyecto

Comparative charts among countries of people infected with COVID-19

Debido a la afectación sufrida en el mundo a causa de la pandemia por el covid-19, se surge la idea de hacer un comparativo entre los países con mayor número de contagios para lo cual se utilizan algunas de las herramientas de control calidad. Se inicia descargando información de nueve sitios web, donde se encontró la información necesaria para la aplicación de dichas herramientas, las cuales, facilitaron la identificación del número de contagios en 17 países en el primer cuatrimestre del año 2020, y las posibles causas que generaron la propagación del virus en la población, así mismo, identificar el mayor número de contagios en las ciudades de los países de Colombia y Ecuador. De igual forma, se identificó los países más afectados. Finalmente, se obtuvo que los diagramas utilizados fueron asertivos, ya que cumplieron con la función de corroborar la información recopilada a través de la investigación que se realizó, lo cual se reflejó en las gráficas realizadas, facilitando de esta manera el reconocimiento de los contagios para poder posteriormente ejecutar otros métodos de prevención.Due to affectation suffered around the world caused by the pandemic caused by covid-19, arises idea to make a comparison between the countries with the highest number of infections, which, some of the quality control tools are used. Begins by download information from nine websites, where it was found the necessary information for application of these tools, which facilitated identification number of infected in 17 countries in the first four months of 2020, and the possible causes that generated the spread of the virus, likewise, it was identify the highest number of people infections in the cities of the countries of Colombia and Ecuador. Similarly, the most affected countries were identified. Finally, it was obtained that the diagrams used were assertive, since it was fulfilled the function of corroborating the information collected through the research that was carried out, which was reflected in the graphs made, thus facilitating the recognition of infections in order to subsequently execute other prevention method

Saúde e bem-estar nos adolescentes imigrantes em Espanha e Portugal: um estudo comparativo

The terms on which the integration of new generations of immigrants into Portuguese and Spanish societies happens will have a decisive influence in the future of both countries. Therefore, promoting their health, well-being, and psychosocial adaptation is a matter of strategic interest. This paper analyses psychosocial factors associated with well-being and psychological adjustment on a sample of 108 adolescents (55 males and 53 females), children of immigrants from Huelva (Spain) and Algarve (Portugal), aged between 10 and 17 years. Adolescents were assessed for demographic characteristics and perceived well-being. We used the “KIDSCREEN-5”, a self-report questionnaire that yields detailed profile information for children aged 8 to 18 years for the following ten dimensions: Physical well-being, Psychological well-being, Moods and emotions, Self-perception, Autonomy, Parental relationships and home life, Financial resources, Social support and peers, School environment, and Social acceptance(Bullying). Overall, significant differences were found between the Spanish and Portuguese samples on physical well-being, psychological well-being, mood, financial resources and social acceptance (bullying). Boys perceived themselves as having a better physical well-being than girls. Mothers’ educational level was associated with psychological well-being and mood. Also, results suggested that residence location and other socio-demographical variables were not associated with the adolescents’ well-being and psychological adjustment.O modo como as novas gerações de imigrantes se irão integrar nas sociedades espanhola e portuguesa terá uma influência decisiva no futuro de ambos os países. Promover a sua saúde, bem-estar e adaptação psicológica é por isso uma questão de interesse estratégico. Este trabalho analisa os factores em jogo no bem-estar e adaptação psicológica numa amostra de 108 adolescentes (55 rapazes e 53 raparigas), filhos de imigrantes em Huelva (Espanha) e no Algarve (Portugal), com idades compreendidas entre os 10 e os 17 anos. Foram recolhidos dados sobre as características sócio-demográficas e o bem-estar percebido dos adolescentes. Utilizámos o KIDSCREEN-52, questionário que avalia a percepção dos adolescentes sobre a sua saúde e bem-estar em dez dimensões: Bem-estar físico, Bem-estar psicológico, Estado de ânimo, Auto-percepção, Autonomia, Relações com os pais e vida familiar, Recursos económicos, Apoio social e dos pares, Ambiente escolar e Aceitação social (Bullying-rejeição). Entre os principais resultados destacamos as diferenças significativas entre as pontuações obtidas na amostra de Espanha e Portugal no Bem-estar físico, Bem-estar psicológico, Estado de ânimo, Recursos económicos e Aceitação social (Bullying-rejeição) respectivamente. Os rapazes percebem-se com melhor bem-estar físico. O nível de escolaridade da mãe está relacionado com o bem-estar psicológico e o estado de ânimo. Não encontrámos efeitos do tempo de residência nem de outras variáveis sociodemográficas estudadas no bem-estar e adaptação psicológica dos adolescentes

The role of teacher support in the acquisition of digital skills associated with technology-based learning activities: the moderation of the educational level

The presence of the technology in the lives of young students does not guarantee that they know how to use it as a learning resource. Likewise, doubts remain about the role of teacher support in the digital literacy of their students. Assuming the moderating capacity of educational level, the aim of this study was to understand to what extent teacher support can determine students’ ability to use technology as a learning resource. In order to respond to this objective, the Model for Developing Effective e-Learners (MDEeL) was used. A multigroup analysis with structural equations and a simple quota sample of secondary education (N = 300) and higher education (N = 300) students in Spain were used. The results showed that the influence of teaching support on basic digital skills associated with the use of the Internet as a learning resource was moderated by educational level. The study provides an approach that allows teacher support for digital literacy to be evaluated in the context of student learning practices