Utilización de fotografías aéreas negativo-positivo en la viticultura de precisión

En San Juan la viticultura de precisión no está difundida, pero es una alternativa que no debe dejarse de lado ante la heterogeneidad de las parcelas y su alta variabilidad en cuanto a calidad y rendimientos. Si bien los materiales para este tipo de práctica no son económicos, la viticultura de precisión permite cuantificar la variabilidad - lo que representa una base útil para la toma de decisiones - y uniformar la producción y/o calidad. El artículo aborda una experiencia desarrollada por la EEA San Juan en el sur del valle de Tulum.EEA San JuanFil: Battistella, Maximiliano. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria San Juan; ArgentinaFil: Silva, Sonia Marisa. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria San Juan; Argentin

Terapia de ultrassom e estimulaçao elétrica transcutânea neuromuscular para a tratamento do linfedema de membro superior pós-mastectomia

Objective: This article aims to assess the effect of transcutaneous electrical stimulation or ultrasound therapy in the treatment of post-mastectomy upper limb lymphedema. Method: A systematic literature review was performed from 1980 to 2012 from the MedLine, Cochrane Library, LILACS and SciELO databases. The terms used in the search were (breast neoplasm OR breast cancer OR lymphedema) and (hyperthermia, induced OR diathermy OR ultrasonic therapy OR ultrasound OR transcutaneous electrical nerve stimulation OR TENS). The selections of the studies concerned female patients with post-mastectomy upper limb lymphedema who underwent diathermy by ultrasound therapy and transcutaneous electric nerve stimulation. Only randomized (RCT) and quasi-randomized study designs were included (both Narrow and Broad Therapy). Only studies published in the full paper format were included. After reviewing the 2,158 abstracts resulting from the search, only two papers were selected. Two researchers analyzed the two articles, using the Van Tulder and JADAD scales for quality assessment. Results: Both papers evaluated the use of ultrasound therapy and electric stimulation for treatment of post-mastectomy lymphedema. A total of 132 subjects were included in these two studies, and little improvement was observed in pain reduction or quality of life. Only the study using ultrasound therapy identified a small reduction in lymphedema symptoms; however, evidence supporting the application of this method is lacking. Conclusion: Further studies are needed to evaluate the use of ultrasound therapy or electrotherapy for treatment of post-mastectomy lymphedema and to evaluate the potential effect of these therapies on later development of metastatic disease.Objetivo: Avaliar o efeito da estimulaçao elétrica transcutânea ou terapia de ultra-som no tratamento de pós-mastectomia linfedema do membro superior. Método: revisao sistemática da literatura foi realizada 1980-2012 do MedLine, Cochrane Library, LILACS e SciELO. Os termos utilizados na pesquisa foram (neoplasia de mama ou câncer de mama ou de linfedema) e (hipertermia, induzido ou diatermia ou terapia de ultra-som ou ultra-som ou a estimulaçao elétrica nervosa transcutânea ou dezenas). As seleçoes dos estudos eram de pacientes mulheres com linfedema pós-mastectomia membro superior que foram submetidos a diatermia por terapia de ultra-som e estimulaçao elétrica nervosa transcutânea. Só randomizado (RCT) e projetos quase randomizados do estudo foram incluídos (ambos estreita e Broad Therapy). Somente estudos publicados no formato de artigo completo foram incluídos. Depois de analisar os 2.158 resumos resultantes da pesquisa, foram selecionados apenas dois artigos. Dois pesquisadores analisaram os dois artigos, usando o Van Tulder e JADAD escalas para avaliaçao da qualidade. Resultados: Ambos os trabalhos avaliaram o uso da terapia de ultra-som e estimulaçao elétrica para o tratamento do linfedema pós-mastectomia. Um total de 132 indivíduos foram incluídos em ambos os estudos, e pouca melhora foi observada em reduçao ou a qualidade de vida da dor. Somente o estudo usando a terapia de ultra-som identificada uma pequena reduçao nos sintomas de linfedema. No entanto evidências que suportam a aplicaçao deste método está faltando. Conclusao: Mais estudos sao necessários para avaliar o uso da terapia de ultra-som ou eletroterapia para o tratamento de linfedema pós-mastectomia e para avaliar o efeito potencial dessas terapias no desenvolvimento posterior da doença metastática

Multi-level strategies to improve equitable timely person-centred osteoarthritis care for diverse women: qualitative interviews with women and healthcare professionals

Abstract Background Women are more likely to develop osteoarthritis (OA), and have greater OA pain and disability compared with men, but are less likely to receive guideline-recommended management, particularly racialized women. OA care of diverse women, and strategies to improve the quality of their OA care is understudied. The purpose of this study was to explore strategies to overcome barriers of access to OA care for diverse women. Methods We conducted qualitative interviews with key informants and used content analysis to identify themes regarding what constitutes person-centred OA care, barriers of OA care, and strategies to support equitable timely access to person-centred OA care. Results We interviewed 27 women who varied by ethno-cultural group (e.g. African or Caribbean Black, Chinese, Filipino, Indian, Pakistani, Caucasian), age, region of Canada, level of education, location of OA and years with OA; and 31 healthcare professionals who varied by profession (e.g. family physician, nurse practitioner, community pharmacist, physio- and occupational therapists, chiropractors, healthcare executives, policy-makers), career stage, region of Canada and type of organization. Participants within and across groups largely agreed on approaches for person-centred OA care across six domains: foster a healing relationship, exchange information, address emotions, manage uncertainty, share decisions and enable self-management. Participants identified 22 barriers of access and 18 strategies to overcome barriers at the patient- (e.g. educational sessions and materials that accommodate cultural norms offered in different languages and formats for persons affected by OA), healthcare professional- (e.g. medical and continuing education on OA and on providing OA care tailored to intersectional factors) and system- (e.g. public health campaigns to raise awareness of OA, and how to prevent and manage it; self-referral to and public funding for therapy, greater number and ethno-cultural diversity of healthcare professionals, healthcare policies that address the needs of diverse women, dedicated inter-professional OA clinics, and a national strategy to coordinate OA care) levels. Conclusions This research contributes to a gap in knowledge of how to optimize OA care for disadvantaged groups including diverse women. Ongoing efforts are needed to examine how best to implement these strategies, which will require multi-sector collaboration and must engage diverse women

Uma proposta para o ensino dos quadriláteros utilizando o software GeoGebra

O presente trabalho relata a importância do uso dos recursos tecnológicos em sala de aula nos dias atuais. É também, o relato de uma experiência realizada em uma escola pública, da cidade de Casca, RS, para trabalhar com os conceitos dos Quadriláteros, mais especificamente do retângulo e do quadrado. Este trabalho foi realizado com um grupo de alunos do 6º ano do Ensino Fundamental, utilizando o software de geometria dinâmica chamado Geogebra. O Geogebra permite a busca de soluções por tentativas, assim como, permite analisar as relações entre as propriedades dos quadriláteros, através da manipulação das figuras

Principles of Drug Dosing in Sustained Low Efficiency Dialysis (SLED) and Review of Antimicrobial Dosing Literature

The use of sustained low-efficiency dialysis (SLED) as a renal replacement modality has increased in critically ill patients with both acute kidney injury (AKI) and hemodynamic instability. Unfortunately, there is a paucity of data regarding the appropriate dosing of medications for patients undergoing SLED. Dose adjustment in SLED often requires interpretation of pharmacodynamics and pharmacokinetic factors and extrapolation based on dosing recommendations from other modes of renal replacement therapy (RRT). This review summarizes published trials of antimicrobial dose adjustment in SLED and discusses pharmacokinetic considerations specific to medication dosing in SLED. Preliminary recommendation is provided on selection of appropriate dosing for medications where published literature is unavailable

Domperidone-Associated Sudden Cardiac Death in the General Population and Implications for Use in Patients Undergoing Hemodialysis: A Literature Review

ABSTRACTBackground: Domperidone, an effective prokinetic agent, is commonly used to manage symptoms of gastroparesis. Health regulatory agencies have issued warnings about an increased risk of sudden cardiac death associated with use of this drug.Objective: To evaluate the evidence for domperidone-associated sudden cardiac death and to determine whether this drug can be safely used for gastroparesis in patients undergoing dialysis.Data Sources: Two databases (MEDLINE [1965 to September 2014] and Embase [1980 to September 2014]) were searched using the Medical Subject Headings “domperidone”, “sudden cardiac death”, and “cardiac arrhythmia”. The search was limited to studies conducted in humans and published in English. Advisories from health regulatory agencies (Health Canada, the European Medicines Agency, and the US Food and Drug Administration) were identified and reviewed.Study Selection: Studies eligible for inclusion in this narrative review were randomized controlled trials and cohort, case–control, crosssectional, and other epidemiological studies comparing use and non-use of domperidone for the outcome of sudden cardiac death in adults. Abstracts of eligible case reports and case series were also included.Data Synthesis: Despite inconsistencies in their decisions, the various drug regulatory authorities have acknowledged the potential safety concern of increased risk of sudden cardiac death associated with domperidone. To date, no randomized controlled studies have shown an increased risk of this outcome secondary to domperidone use. Current regulatory recommendations and approval decisions are based on 2 large observational epidemiological studies that generated a signal of increased risk. The strengths and limitations of these studies were evaluated in detail. No direct evidence applicable to patients with end-stage renal disease was found. In vitro evidence suggests that the risk of sudden cardiac death is dose-related.Conclusions: Given gaps in the literature, use of domperidone for patients undergoing dialysis should be assessed on a case-by-case basis. Extreme caution should be used for patients taking more than 30 mg/day of this drug.RÉSUMÉContexte : La dompéridone, un agent procinétique efficace, est couramment utilisée pour traiter les symptômes de la gastroparésie. Les organismes de réglementation en santé ont émis des mises en garde à propos du risque accru de mort subite d’origine cardiaque associée à l’utilisation de ce médicament.Objectif : Évaluer les données probantes portant sur la mort subite cardiaque associée à la dompéridone et déterminer si ce médicament peut être utilisé en toute sécurité pour traiter les patients sous dialyse atteints de gastroparésie.Sources des données : Deux bases de données (MEDLINE [1965 à septembre 2014] et Embase [1980 à septembre 2014]) ont été interrogées en utilisant les mots clés des Medical Subject Headings suivants : « domperidone » (dompéridone), « sudden cardiac death » (mort subite cardiaque) et « cardiac arrhythmia » (arythmie cardiaque). La recherche se limitait aux études effectuées chez l’humain et publiées en anglais. Les avis émis par les organismes de réglementation en santé (Santé Canada, l’Agence européenne des médicaments et la Food and Drug Administration des États-Unis) ont été relevés et examinés.Sélection des études : Les études admissibles à cette analyse narrative étaient les essais cliniques à répartition aléatoire, les études de cohorte et cas-témoins, les études transversales et autres études épidémiologiques dans lesquelles étaient comparées l’utilisation et la non-utilisation de la dompéridone quant à la mort subite cardiaque chez les adultes. Les résumés des études de cas et des séries de cas admissibles ont aussi été inclus.Synthèse des données : Malgré des divergences dans leurs décisions, les différents organismes de réglementation des médicaments reconnaissent qu’un risque accru de mort subite cardiaque soit un éventuel problème de sécurité associé à l’utilisation de la dompéridone. À ce jour, aucun essai clinique à répartition aléatoire n’a montré qu’une augmentation du risque de cet effet est secondaire à l’administration de la dompéridone. Les recommandations réglementaires actuelles et les décisions en matière d’approbation sont fondées sur deux importantes études épidémiologiques d’observation qui ont sonné l’alarme à propos d’une augmentation du risque. Les forces et les faiblesses de ces études ont été examinées en détail. Il n’y a pas de preuve directe applicable à la population atteinte d’insuffisance rénale terminale. D’après les données in vitro, le risque de mort subite cardiaque est lié à la dose administrée.Conclusions : Étant donné les lacunes dans la littérature, il est recommandé que l’utilisation de dompéridone chez les patients sous dialyse soit évaluée au cas par cas. Il faut faire preuve d’énormément de prudence chez les patients qui prennent quotidiennement plus de 30 mg de ce médicament

Stability of Trisodium Citrate and Gentamicin Solution for Catheter Locks after Storage in Plastic Syringes at Room Temperature

ABSTRACTBackground: Catheter-related infections are a major problem for hemodialysis patients with central venous catheters for vascular access. Catheter lock solutions containing an anticoagulant are used to maintain the patency of the catheter between hemodialysis sessions. There is evidence that the use of lock solutions containing an antibiotic is associated with lower rates of infection but also that these solutions can kill microbes in colonized catheters and thus avoid the risks and costs associated with replacing the catheter.Objective: This stability study was conducted to determine whether an extemporaneously prepared gentamicin-citrate catheter lock solution would retain its potency over time, thus allowing for advance preparation of the solution.Methods: Catheter lock solutions containing gentamicin alone, citrate alone, and the combination of gentamicin and citrate were prepared aseptically and packaged in polyethylene syringes. The syringes were stored at room temperature. At timed intervals over 112 days, samples were withdrawn for analysis by means of validated high performance liquid chromatography.Results: None of the 3 lock solutions showed any evidence of degradation during the 112-day observation period. In the formulation containing both gentamicin 2.5 mg/mL and sodium citrate 40 mg/mL (4%), there was no change in the concentration of either gentamicin (p = 0.34) or citrate (p = 0.55). Linear regression analysis of the concentration- time data for the combined formulation showed that 99.97% of the labelled amount of gentamicin and 101.30% of the labelled amount of citrate remained at day 112. The lower limit of the 95% confidence intervals indicated that more than 98.17% of the gentamicin and more than 99.57% of the citrate remained on day 112.Conclusion: The results of this study will allow pharmacies to extemporaneously compound the combined gentamicin-citrate catheter lock solution in advance of use. The method described here will yield a stable product for use in clinical applications.RÉSUMÉContexte : Les infections liées aux cathéters sont un problème important chez les patients hémodialysés dont l'abord vasculaire est réalisé à l'aide de cathéters veineux centraux. On a recours à des solutions pour verrou de cathéter contenant un anticoagulant afin de maintenir la perméabilité du cathéter entre les séances d'hémodialyse. Des données montrent que des solutions pour verrou renfermant un antibiotique sont associées à des taux d'infections inférieurs et que ces solutions peuvent tuer les microbes colonisant les cathéters, ce qui permet donc d'éviter les risques et les coûts associés au remplacement des cathéters.Objectif : Cette étude de stabilité a été menée pour déterminer si une solution extemporanée de gentamicine et de citrate pour verrou de cathéter pouvait conserver sa puissance dans le temps, ce qui permettrait ainsi de préparer la solution à l'avance.Méthodes : Des solutions pour verrou de cathéter contenant de la gentamicine seule, du citrate seul et l'association gentamicine-citrate ont été préparées selon une méthode aseptique, puis conditionnées dans des seringues de polyéthylène. Les seringues ont été conservées à la température ambiante. À différents points dans le temps sur une période de 112 jours, des échantillons ont été prélevés à des fins d'analyse à l'aide d'une épreuve validée par chromatographie liquide haute performance.Résultats : Aucune des trois solutions pour verrou n'a montré de signes de dégradation durant les 112 jours de la période d'observation. La préparation contenant la gentamicine à 2,5 mg/mL et le citrate de sodium à 40 mg/mL (4 %) n'a montré aucun changement dans la concentration de gentamicine (p = 0,34) et de citrate (p = 0,55). Une analyse de régression linéaire des concentrations en fonction du temps de la préparation associant la gentamicine et le citrate a révélé que cette préparation avait retenu 99,97 % de sa concentration initiale de gentamicine et 101,30 % de sa concentration initiale de citrate au jour 112. La limite inférieure de l'intervalle de confiance à 95% a également révélé que la préparation avait retenu plus de 98,17 % de la gentamicine et plus de 99,57 % du citrate au jour 112.Conclusion : Les résultats de cette étude permettront aux pharmacies de préparer à l'avance la solution extemporanée pour verrou de catheter renfermant l'association gentamicine-citrate. La méthode décrite ici donnera un produit stable pour une utilisation dans des applications cliniques