Artroplastia de cadera y dolor postoperatorio. Asociación de fármacos en función de diferentes mecanismos de dolor: Rasmussen ML, Mathiesen O, Dierking G, Christensen BV, Hilsted KL, Larsen TK, Dahl JB. Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: a preliminary study. Eur J Anaesthesiol 2010; 27 : 324-330

Un artículo firmado por Jorgen B Dahl (colaborador de Henrik Kehlet) sobre dolor postoperatorio, es siempre una garantía. En el presente estudio realizado entre 2 hospitales Daneses, y con la honestidad de reconocer que tuvieron que parar de reclutar pacientes por cambios organizativos, se comparan dos modalidades de tratamiento del dolor post-artroplastia de cadera, en base a "atacar" distintos mecanismos fisiopatológicos de dolor. En un grupo (Control) se administró analgesia con paracetamol + ketorolaco + 3 placebos, y en el otro grupo (Activo) paracetamol + ketorolaco + gabapentina + ketamina + dexametasona. La hipótesis de trabajo es que si actuamos sobre distintos mecanismos tendríamos, a priori, menos intensidad de dolor o lo podríamos prevenir de algún modo. La gabapentina es antihiperalgésica y la ketamina es un antagonista del receptor NMDA conla misma acción que se emplean en dolor crónico y, ahora, en dolor agudo postoperatorio. Ambos tienen efecto analgésico, "ahorran" y disminuyen consumo de opiáceos. Los glucocorticoides tienen efecto antiinflamatorio y disminuyen la incidencia de náuseas y vómitos postoperatorios (NVPO). También, se sabe que la dexametasona posee un efecto analgésico postoperatorio prolongado

Bloqueo nervioso periférico continuo y dolor: ¿de qué depende su efecto? Ilfeld BM, Moeller LK, Mariano ER, Loland VJ, Stevens-Lapsley JE, Fleisher AS, et al. Continuous Peripherals nerve blocks. Is local anesthetic dose the Orly factor, or do concentration and volumen influence infusión effects as well? Anesthesiology 2010;112:347-354 (

El factor determinante principal del efecto del bloqueo nervioso periférico en infusión continua; concentración y volumen, o simplemente dosis total en mg de Anestésico Local (AL) es aún desconocido. En este estudio los autores comparan dos concentraciones y volúmenes de infusión distintos de ropivacaína, a dosis totales en mg equivalentes, en bloqueo continuo de plexo lumbar posterior tras artroplastia de cadera. En el preoperatorio, se coloca un catéter perineural en el compartimento del psoas. En el postoperatorio, los pacientes se asignaron aleatoriamente a dos grupos de tratamiento

Towards next generation coordination infrastructures

Coordination infrastructures play a central role in the engineering of multiagent systems. Since the advent of agent technology, research on coordination infrastructures has produced a significant number of infrastructures with varying features. In this paper, we review the the state-of-the-art coordination infrastructures with the purpose of identifying open research challenges that next generation coordination infrastructures should address. Our analysis concludes that next generation coordination infrastructures must address a number of challenges: (i) to become socially aware, by facilitating human interaction within a MAS; (ii) to assist agents in their decision making by providing decision support that helps them reduce the scope of reasoning and facilitates the achievement of their goals; and (iii) to increase openness to support on-line, fully decentralised design and execution. Furthermore, we identify some promising approaches in the literature, together with the research issues worth investigating, to cope with such challenges

Lessons learned from supplementing archaeological museum exhibitions with virtual reality

Archaeological excavations provide us with important clues about the past. Excavated artefacts represent an important connection to civilisations that no longer exist and help us understand some of their customs, traditions and common practices. With the help of academics and practitioners from various disciplines the results of archaeological excavations can be analysed and a body of knowledge about the corresponding society can be created and shared with members of the general public. Museums have traditionally served the purpose of communicating this knowledge and backing it up with the help of the excavated artefacts. Many museum visitors, however, find it difficult to develop a coherent understanding of the corresponding society only based on the artefacts and annotations showed in museums. Effective modern techniques that have high potential in helping museum visitors with better understanding of the past are 3D reconstruction and Virtual Reality. 3D reconstruction offers a cost effective way of recreating historical settlements in a computer-generated virtual environment, while Virtual Reality helps with immersing people into such environments and reaching a high degree of realism. With the help of these technologies it becomes possible to relive history, imagine yourself being a part of the reconstructed society and learn about its culture firsthand. The combination of 3D reconstruction and Virtual Reality \anton{represents} a very powerful learning tool, however this tool has been rarely used in a museum setting and its correct use has not been properly investigated. In this paper we present a study into using Virtual Reality in itinerant archaeological exhibitions. We discuss the lessons we have learned from developing an interactive Virtual Reality simulation of the Neolithic settlement of La Draga. These lessons feature our analysis of qualitative and quantitative feedback of museum visitors, as well as what we have learned from analysing their navigation and interaction patterns

1 Using Evolutive Summary Counters for Efficient Cooperative Caching in Search Engines

Abstract—We propose and analyze a distributed cooperative caching strategy based on the Evolutive Summary Counters (ESC), a new data structure that stores an approximated record of the data accesses in each computing node of a search engine. The ESC capture the frequency of accesses to the elements of a data collection, and the evolution of the access patterns for each node in a network of computers. The ESC can be efficiently summarized into what we call ESC-summaries to obtain approximate statistics of the document entries accessed by each computing node. We use the ESC-summaries to introduce two algorithms that manage our distributed caching strategy, one for the distribution of the cache contents, ESC-placement, and another one for the search of documents in the distributed cache, ESC-search. While the former improves the hit rate of the system and keeps a large ratio of data accesses local, the latter reduces the network traffic by restricting the number of nodes queried to find a document. We show that our cooperative caching approach outperforms state of the art models in both hit rate, throughput, and location recall for multiple scenarios, i.e., different query distributions and systems with varying degrees of complexity

Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study

<div><p>The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): <i>Haemophilus influenzae</i> [24.2%], both <i>Streptococcus pneumoniae</i> and <i>H</i>. <i>influenzae</i> [24.0%], <i>S</i>. <i>pneumoniae</i> [15.9%], <i>Streptococcus pyogenes</i> [13.6%], and <i>Staphylococcus aureus</i> [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (<i>S</i>. <i>pneumoniae</i>), 30.2% (<i>H</i>. <i>influenzae</i>) and 89.6% (mixed <i>S</i>. <i>pneumoniae/H</i>. <i>influenzae</i> infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by <i>S</i>. <i>pneumoniae</i> and by <i>H</i>. <i>influenzae</i>, but no decreases for mixed <i>S</i>. <i>pneumoniae/H</i>. <i>influenzae</i> infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for <i>S</i>. <i>pyogenes</i> (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by <i>S</i>. <i>pneumoniae</i> as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences.</p></div

Previous history of otitis and clinical data of children included in the study distributed by isolates from middle ear fluid.

<p>Previous history of otitis and clinical data of children included in the study distributed by isolates from middle ear fluid.</p