Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Logros del yo durante el desarrollo psicoafectivo en la etapa de latencia

This article is the result of the review of references of psycho development in the latency stage. The achievements of the self in early latency are related to impulse control, repression of sexual impulses, leading to reaction formation and sublimation that is geared towards the development of goals and achievements of the self in late latency are given on the development of a process of autonomy, increased secondary thought process and closer towards relationships with peers. Activities in the latency stage, head towards the end of intellectual, allowing the development of social skills and the collective construction of new learning that provides schooling. Unfortunately the children of Colombia faced with the negligence of educational institutions, which do not adequately address the demands that are required for proper training, for which it is important, individual and group processes that need to be taken into account development of self-criticism and thought.  Este artículo es el producto de la revisión de referencias del desarrollo psicoafectivo en la etapa de latencia. Los logros del yo en la latencia temprana se encuentran  relacionados con el control de los impulsos, la represión de los impulsos sexuales, dando paso a la formación reactiva y la sublimación que se orienta hacia el desarrollo de metas y,  los logros del yo en la latencia tardía se dan en torno al desarrollo de un proceso de autonomía, incremento del proceso secundario de pensamiento y mayor acercamiento hacia las relaciones con pares. Las actividades en la etapa de latencia, se dirigen hacia fines de tipo intelectual, que permiten el desarrollo de habilidades sociales y la construcción colectiva de nuevos aprendizajes que proporciona la escolarización.    Infortunadamente los niños de Colombia se enfrentan a la  negligencia de parte de las instituciones educativas, que no atienden adecuadamente las demandas que se requieren para una apropiada formación, para lo cual es importante, se tengan en cuenta los procesos individuales y grupales que se necesitan para el desarrollo de la autocrítica y  del pensamiento.

Logros del yo durante el desarrollo psicoafectivo en la etapa de latencia. Achievements of the self during the psychoaffective development in the latency stage.

Achievements of the self during the psychoaffective development       in the latency stage. Resumen Este artículo es el producto de la revisión de referencias del desarrollo psicoafectivo en la etapa de latencia. Los logros del yo en la latencia temprana se encuentran  relacionados con el control de los impulsos, la represión de los impulsos sexuales, dando paso a la formación reactiva y la sublimación que se orienta hacia el desarrollo de metas y,  los logros del yo en la latencia tardía se dan en torno al desarrollo de un proceso de autonomía, incremento del proceso secundario de pensamiento y mayor acercamiento hacia las relaciones con pares. Las actividades en la etapa de latencia, se dirigen hacia fines de tipo intelectual, que permiten el desarrollo de habilidades sociales y la construcción colectiva de nuevos aprendizajes que proporciona la escolarización.    Infortunadamente los niños de Colombia se enfrentan a la  negligencia de parte de las instituciones educativas, que no atienden adecuadamente las demandas que se requieren para una apropiada formación, para lo cual es importante, se tengan en cuenta los procesos individuales y grupales que se necesitan para el desarrollo de la autocrítica y  del pensamiento.   Palabras claves: Desarrollo psicoafectivo, etapa de latencia, relaciones con pares   Summary   This article is the result of the review of references of psycho development in the latency stage. The achievements of the self in early latency are related to impulse control, repression of sexual impulses, leading to reaction formation and sublimation that is geared towards the development of goals and achievements of the self in late latency are given on the development of a process of autonomy, increased secondary thought process and closer towards relationships with peers. Activities in the latency stage, head towards the end of intellectual, allowing the development of social skills and the collective construction of new learning that provides schooling. Unfortunately the children of Colombia faced with the negligence of educational institutions, which do not adequately address the demands that are required for proper training, for which it is important, individual and group processes that need to be taken into account development of self-criticism and thought.   Keywords: Developing psycho, latency stage, peer group.

Impact of a Social-emotional Skills-Building Program (Pisotón) on Early Development of Children in Colombia: A Pilot Effectiveness Study

Quality early childhood development (ECD) settings that address children's needs holistically provide safe and nurturing opportunities for children to thrive. We evaluated, through a quasi-experimental design, the impact of a social-emotional skills-building program (Pisotón) across ECD centers in Colombia. Developmental outcomes of children participating in Pisotón (n = 37) for 12 weeks were compared to those of children who did not participate in the program (n = 37) using the International Development and Early Learning Assessment (IDELA) measure and the Child Behavior Checklist (CBCL). The results show that participation in Pisotón significantly increased children's social-emotional development score by 0.37 standard deviation units as assessed by IDELA. Study implications are discussed

A Modified Holder Pasteurization Method for Donor Human Milk: Preliminary Data

Background: Holder pasteurization (HoP) is the recommended method of pasteurization for donor human milk (DHM). The aim of the present study was to compare nutritional and microbiological impact on DHM of a new technique of pasteurization based on technical changes of HoP. Methods: We analyzed milk samples from 25 donors. Each sample, derived from one breast milk expression, was subdivided into three aliquots according to pasteurization: The first was not pasteurized, the second pasteurized by HoP, and the third was pasteurized by modified HoP (MHoP). Each aliquot was assessed as to its microbiological and nutritional profile. Nutritional profile included calcium and triglycerides concentrations detected by spectrophotometry and amino acid levels assessed by high-performance liquid chromatography (HPLC). Results: Triglycerides were significantly lower in pasteurized, by both methods, than in not pasteurized aliquots, while calcium and amino acids concentration were similar. Microbiological profile did not differ between HoP and MHoP aliquots. Conclusions: HoP and MHoP seem to have similar efficacy in preserving some nutritional characteristics of DHM and to confer similar microbiological safety. MHoP is time-saving and potentially costs-effective when compared to HoP, and it is; therefore, potentially of more interest from a practical point of view. Further studies are needed to confirm these findings

The 19q12 bladder cancer GWAS signal: Association with cyclin E function and aggressive disease

A genome-wide association study (GWAS) of bladder cancer identified a genetic marker rs8102137 within the 19q12 region as a novel susceptibility variant. This marker is located upstream of the CCNE1 gene, which encodes cyclin E, a cell-cycle protein. We performed genetic fine-mapping analysis of the CCNE1 region using data from two bladder cancer GWAS (5,942 cases and 10,857 controls). We found that the original GWAS marker rs8102137 represents a group of 47 linked SNPs (with r(2) ≥ 0.7) associated with increased bladder cancer risk. From this group, we selected a functional promoter variant rs7257330, which showed strong allele-specific binding of nuclear proteins in several cell lines. In both GWASs, rs7257330 was associated only with aggressive bladder cancer, with a combined per-allele OR = 1.18 [95% confidence interval (CI), 1.09-1.27, P = 4.67 × 10(-5)] versus OR = 1.01 (95% CI, 0.93-1.10, P = 0.79) for nonaggressive disease, with P = 0.0015 for case-only analysis. Cyclin E protein expression analyzed in 265 bladder tumors was increased in aggressive tumors (P = 0.013) and, independently, with each rs7257330-A risk allele (P(trend) = 0.024). Overexpression of recombinant cyclin E in cell lines caused significant acceleration of cell cycle. In conclusion, we defined the 19q12 signal as the first GWAS signal specific for aggressive bladder cancer. Molecular mechanisms of this genetic association may be related to cyclin E overexpression and alteration of cell cycle in carriers of CCNE1 risk variants. In combination with established bladder cancer risk factors and other somatic and germline genetic markers, the CCNE1 variants could be useful for inclusion into bladder cancer risk prediction models

Association of maternal hypertension and chorioamnionitis with preterm outcomes

OBJECTIVES: We compared the relative effect of hypertensive disorders of pregnancy and chorioamnionitis on adverse neonatal outcomes in very preterm neonates, and studied whether gestational age (GA) modulates these effects. METHODS: A cohort of neonates 23 to 30 weeks' GA, born in 2008 to 2011 in 82 hospitals adhering to the Italian Neonatal Network, was analyzed. Infants born from mothers who had hypertensive disorders (N = 2096) were compared with those born after chorioamnionitis (N = 1510). Statistical analysis employed logistic models, adjusting for GA, hospital, and potential confounders. RESULTS: Overall mortality was higher after hypertension than after chorioamnionitis (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.08-1.80), but this relationship changed across GA weeks; the OR for hypertension was highest at low GA, whereas from 28 weeks' GA onward, mortality was higher for chorioamnionitis. For other outcomes, the relative risks were constant across GA; infants born after hypertension had an increased risk for bronchopulmonary dysplasia (OR, 2.20; 95% CI, 1.68-2.88) and severe retinopathy of prematurity (OR, 1.48; 95% CI, 1.02-2.15), whereas there was a lower risk for early-onset sepsis (OR, 0.25; 95% CI, 0.19-0.34), severe intraventricular hemorrhage (OR, 0.65; 95% CI, 0.48-0.88), periventricular leukomalacia (OR, 0.70; 95% CI, 0.48-1.01), and surgical necrotizing enterocolitis or gastrointestinal perforation (OR, 0.47; 95% CI, 0.31-0.72). CONCLUSIONS: Mortality and other adverse outcomes in very preterm infants depend on antecedents of preterm birth. Hypertension and chorioamnionitis are associated with different patterns of outcomes; for mortality, the effect changes across GA weeks. Copyright \uc2\ua9 2014 by the American Academy of Pediatrics