The Impact of Red Light Cameras on Injury Crashes within Miami-Dade County, Florida

Previous red light camera (RLC) studies have shown reductions in violations and overall and right angle collisions, however, they may also result in increases in rear-end crashes (Retting & Kyrychenko, 2002; Retting & Ferguson, 2003). Despite their apparent effectiveness, many RLC studies have produced imprecise findings due to inappropriate study designs and/or statistical techniques to control for biases (Retting & Kyrychenko, 2002), therefore, a more comprehensive approach is needed to accurately assess whether they reduce motor vehicle injury collisions. The objective of this proposal is to assess whether RLC’s improve safety at signalized intersections within Miami-Dade County, Florida. Twenty signalized intersections with RLC’s initiating enforcement on January 1st, 2011 were matched to two comparison sites located at least two miles from camera sites to minimize spillover effect. An Empirical Bayes analysis was used to account for regression to the mean. Incidences of all injury, red light running related injury, right-angle/turning, and rear-end collisions were examined. An index of effectiveness along with 95% CI’s were calculated. During the first year of camera enforcement, RLC sites experienced a marginal decrease in right-angle/turn collisions, a significant increase in rear-end collisions, and significant decreases in all-injury and red light running-related injury collisions. An increase in right-angle/turning and rear-end collisions at the RLC sites was observed after two years despite camera enforcement. A significant reduction in red light running-related injury crashes, however, was still observed after two years. A non-significant decline in all injury collisions was also noted. Findings of this research indicate RLC’s reduced red light running-related injury collisions at camera sites, yet its tradeoff was a large increase in rear-end collisions. Further, there was inconclusive evidence whether RLC’s affected right-angle/turning and all injury collisions. Statutory changes in crash reporting during the second year of camera enforcement affected the incidence of right-angle and rear-end collisions, nevertheless, a novelty effect could not be ruled out. A limitation of this study was the small number of injury crashes at each site. In conclusion, future research should consider events such as low frequencies of severe injury/fatal collisions and changes in crash reporting requirements when conducting RLC analyses

Perioperative Management of Antiplatelet-Drugs in Cardiac Surgery

The management of coronary patients scheduled for a coronary artery bypass grafting (CABG), who are receiving one or more antiplatelet drugs, is plenty of controversies. It has been shown that withdrawal of antiplatelet drugs is associated with an increased risk of a thrombotic event, but surgery under an altered platelet function also means an increased risk of bleeding in the perioperative period. Because of the conflict recommendations, this review article tries to evaluate the outcome of different perioperative antiplatelet protocols in patients with coronary artery disease undergoing CABG

Análisis del tratamiento del colectivo homosexual en la prensa digital española (2005-2018). El País, El Mundo, Las Provincias y La Vanguardia

Treball Final de Grau en Periodisme. Codi: PE0932. Curs acadèmic: 2018/2019El colectivo homosexual en España concibe el año 2005 como el año en el que pudo gozar de igualdad frente a la comunidad heterosexual al aprobarse el matrimonio igualitario. Desde ese momento, se vivió un período de pérdida de activismo ante la sensación de conformismo. Es ahora, en la actualidad, cuando la lucha LGTB vuelve a aflorar y a ser reivindicativa. Este estudio pretende hacer un análisis longitudinal que recoja el tratamiento que recibe el colectivo homosexual en la prensa digital desde el año 2005 hasta el año 2018. Para hacerlo, se realizará un análisis cuantitativo de 186 noticias de cuatro de los principales periódicos españoles en su versión digital: El País, El Mundo, La Vanguardia y Las Provincias. Las noticias se han recogido a través de las herramientas de búsqueda de Google. Este análisis tendrá en cuenta qué temas aparecen en las noticias sobre el colectivo homosexual, qué actores protagonizan dichas noticias y qué fuentes informativas se utilizan para redactar las piezas informativas. También se estudiará una vertiente deontológica del tratamiento de estas noticias. Los resultados indican que el número de noticias sobre el colectivo homosexual es cada vez mayor y que dentro del colectivo, los hombres gais gozan de mayor visibilidad y presencia en los medios de comunicación que las mujeres lesbianas. Además, es la comunidad homosexual la que protagoniza la mayor parte de las noticias y, también, la que se utiliza con mayor frecuencia como fuente informativa.The homosexual community in Spain conceives 2005 as a year in which they could enjoy the same rights as straight people, given that gay marriage was approved in Congress that year. Since then, homosexual people stopped making activism because of the feeling that the community had achieved all their rights. Currently, the gay fight turns out to be back to claim their rights again. This study aims to analyze the treatment they gay community receives in the digital press in Spain between 2005 and 2018. To do so, a quantitative analysis will be done over 186 pieces of news from four of the most important Spanish newspapers in their digital version: El País, El Mundo, La Vanguardia y Las Provincias. These articles have been picked up by menas of using the searching tools that Google provides. The analysis will take into account which topics are the ones that newspapers mostly talk about when it comes to the gay people, which kind of protagonists do these articles have and which sources of information do they use in order to construct their stories. This study will also investigates if the newspapers follow the ethical recommendations when writing about gay people in these articles. The results show that the number of news stories has increased during the last years and that gay men are much more visible in the press than lesbian women. Besides, gay people are the ones that have the leading role in the articles and the ones that are mostly used as sources of information

Alert System to Detect Possible School-based Outbreaks of Influenza-like Illness

To evaluate the usefulness of school absentee data in identifying outbreaks as part of syndromic surveillance, we examined data collected from public schools in Miami-Dade County, Florida, USA. An innovative automated alert system captured information about school-specific absenteeism to detect and provide real-time notification of possible outbreaks of influenza-like illness

Técnicas de ahorro de sangre en cirugía ortopédica

La cirugía ortopédica está asociada con frecuencia a la necesidad de transfusión de sangre homóloga, con los consiguientes riesgos que ello conlleva. En la actualidad se resalta la importancia de la disminución tanto de la transfusión como de la sobretransfusión en este tipo de cirugía. Dicho objetivo se puede alcanzar con el empleo de diversas técnicas de ahorro de sangre, que incluyan la potenciación del uso de sangre antóloga de métodos para disminuir el sangrado perioperatorio. La máxima eficacia para disminuir la necesidad de transfusión de sangre homóloga se deriva de la combinación de varias técnicas de ahorro, como son los programas de autotransfusión, la hipotensión controlada y el empleo de nuevos fármacos como eritropoyetina o aprotinina; todo ello sin olvidar la importancia de establecer unos criterios restrictivos, en consonancia con las directrices más actuales en este sentido, en el momento de indicar la necesidad de una transfusión sanguínea.Technique in orthopaedic surgery requires frequently transfusion of homologous blood which entails several risks. Nowadays, the importance of the decrease of both transfusion and overtransfusion has been proposed for this type of surgery. This aim can be reached by using different blood saving techniques including either the use of antologous blood or methods to minimize perioperative bleeding. The highest efficacy in order to diminish homologous blood transfusion combines several savings techniques as autotransfusion programs, controlled hypotension, and the use of new drugs such as erytropoyetin and aproinin. Restrictive criteria have to be established according to the more recent guidelines for blood transfusion

Perioperative use of prothrombin complex concentrates

Prothrombin complex concentrates (PCCs) are purified drug products with hemostatic activity derived from a plasma pool. Today, PCCs contain a given and proportional amount of four non-activated vitamin K-dependent coagulation factors (II, VII, IX, and X), a variable amount of anticoagulant proteins (proteins C and S, and in some antithrombin) and low-dose heparin. In some countries PCC products contained only three clotting factors, II, IX, and X. Dosage recommendations are based on IU of F-IX, so that one IU of F-IX represents the activity of F-IX in 1 mL of plasma. Reversion of the anticoagulant effect of vitamin K antagonists (VKAs) in cases of symptomatic overdose, active bleeding episodes, or need for emergency surgery is the most important indication for PCCs and this effect of PCCs appears to be more complete and rapid than that caused by administration of fresh frozen plasma. They may be considered as safe preparations if they are used for their approved indications at the recommended dosage with adequate precautions for administration, and have been shown to be effective for reversing the effect of VKAs. Their adequate use based on decision algorithms in the perioperative setting allows a rapid normalization of International Normalized Ratio (INR) for performing emergency surgery, minimizing bleeding risk. This review aims to propose two algorithms for the use of PCCs in the perioperative setting, one to calculate the PCCs dose to be administered in a bleeding patient and/or immediately before urgent surgery, based on patient's clinical status, prior INR and INR target and another for reversing the action of oral anticoagulants depending on urgency of surgery

Observational study on fluid therapy management in surgical adult patients

Background: Perioperative fluid therapy management is changing due to the incorporation of different fluids, surgical techniques, and minimally invasive monitoring systems. The objective of this study was to explore fluid therapy management during the perioperative period in our country. Methods: We designed the Fluid Day study as a cross-sectional, multicentre, observational study. The study was performed in 131 Spanish hospitals in February 2019. We included adult patients undergoing general anaesthesia for either elective or non-elective surgery. Demographic variables were recorded, as well as the type and total volume of fluid administered during the perioperative period and the monitorization used. To perform the analysis, patients were categorized by risk group. Results: We recruited 7291 patients, 6314 of which were included in the analysis; 1541 (24.4%) patients underwent high-risk surgery, 1497 (23. 7%) were high risk patients, and 554 (8.7%) were high-risk patients and underwent high-risk surgery; 98% patients received crystalloids (80% balanced solutions); intraoperative colloids were used in 466 patients (7.51%). The hourly intraoperative volume in mL/kg/h and the median [Q1; Q3] administered volume (mL/kg) were, respectively, 6.67 [3.83; 8.17] ml/Kg/h and 13.9 [9.52;5.20] ml/Kg in low-risk patients undergoing low- or intermediate-risk surgery, 6 [4.04; 9.08] ml/Kg/h and 15.7 [10.4;24.5] ml/Kg in high- risk patients undergoing low or intermediate-risk surgery, 6.41 [4.36; 9.33] ml/Kg/h and 20.2 [13.3;32.4] ml/Kg in low-risk patients undergoing high-risk surgery, and 5.46 [3.83; 8.17] ml/Kg/h and 22.7[14.1;40.9] ml/Kg in high-risk patients undergoing high- risk surgery . We used advanced fluid monitoring strategies in 5% of patients in the intraoperative period and in 10% in the postoperative period. Conclusions: The most widely used fluid was balanced crystalloids. Colloids were used in a small number of patients. Hourly surgery volume tended to be more restrictive in high-risk patients but confirms a high degree of variation in the perioperatively administered volume. Scarce monitorization was observed in fluid therapy management

Intraoperative transfusion practices in Europe

Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger-mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)-based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (SD)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Guía de práctica clínica para la elección del fluido de restauración volémica perioperatoria en los pacientes adultos intervenidos de cirugía no cardiaca

Esta Guía de Práctica Clínica responde a preguntas clínicas sobre seguridad en la elección de fluido (cristaloide, coloide o Hidroxietilalmidón 130) en pacientes que precisan restauración volémica en el periodo perioperatorio de cirugía no cardiaca. A partir del resumen de la evidencia, se elaboraron las recomendaciones siguiendo la metodología GRADE. En esta población se sugiere la fluidoterapia basada en la administración de cristaloides, (recomendación débil, calidad de la evidencia baja). En las situaciones en las que la restauración volémica no se alcance sólo con cristaloides, se sugiere utilizar coloides sintéticos (Hidroxietilalmidón 130 o gelatina fluida modificada) en lugar de Albúmina 5% (recomendación débil, calidad de la evidencia baja). La elección y dosificación de coloide deberán basarse en las características del producto, comorbilidad del paciente y experiencia del anestesiólogo