Óxido nitroso como sedoanalgesia para reducción de fracturas en un servicio de urgencias pediátricas

33 páginas.Trabajo Fin de Máster Universitario en Urgencias y Emergencias Pediátricas (2016/17). Directora: María Teresa Alonso Salas ; Tutora: Macarena Taguas-Casaño Corriente. El dolor y la angustia durante los procedimientos hospitalarios menores es un problema familiar para muchos niños. Existe una gran variedad de agentes farmacológicos disponibles para la sedoanalgesia en procedimientos en Urgencias pediátricas, sin embargo, clásicamente los pacientes pediátricos han recibido una medicación insuficiente o inadecuada frente al dolor asociado a los mismos. En los últimos años, la mezcla de óxido nitroso + oxigeno ha cobrado un interés creciente por sus propiedades como fármaco sedoanalgésico, aportando según algunos estudios ventajas frente a otras medidas utilizadas clásicamente, como son un tiempo de inducción, procedimiento y recuperación significativamente más cortos. Los efectos adversos registrados son escasos, leves y conocidos. Nuestro objetivo es comprobar la seguridad y eficacia del óxido nitroso como sedoanalgésico en comparación con la asociación de Ketamina y Midazolam iv para la reducción de fracturas en un Servicio de Urgencias Pediátricas y estandarizar el fármaco de primera elección. Para ello se realizará un ensayo clínico aleatorizado y controlado, a triple ciego. Se recogerán variables epidemiológicas, clínicas y de resultado, como la puntuación en la escala FLACC (valorada por el profesional que lleva a cabo el procedimiento), la escala de caras de Wong-Baker o escala numérica del dolor según la edad (valoradas por el propio paciente o sus padres), antes, durante y después de la reducción.Pain and anguish during minor hospital procedures is a family problem for many children. There is a wide variety of pharmacological agents available for sedoanalgesia in procedures in pediatric emergencies, however, pediatric patients have traditionally received insufficient or inadequate medication against the pain associated with them. In recent years, the mixture of nitrous oxide + oxygen has gained increasing interest due to its properties as a sedoanalgesic drug, providing, according to some studies, advantages over other measures used classically, such as a significantly shorter induction, procedure and recovery time. The adverse effects recorded are scarce, mild and known. Our objective is to verify the safety and efficacy of nitrous oxide as sedoanalgesic in comparison with the combination of Ketamine and Midazolam iv for the reduction of fractures in a Pediatric Emergency Service and to standardize the drug of first choice. For this, a randomized controlled trial, triple-blind, will be carried out. Epidemiological, clinical and outcome variables will be collected, such as the score on the FLACC scale (assessed by the professional who carries out the procedure), the Wong-Baker face scale or the numerical scale of pain according to age (assessed by the own patient or parents), before, during and after the reduction

La deshumanización del trabajo en la producción de bienes culturales en la industria musical

En el presente trabajo se analizará una producción cultural audiovisual realizada por CAPIF (Cámara Argentina de Productores de Fonogramas) en soporte DVD que tiene como objetivo mostrar e instruir acerca del modo de producción de un CD de música en Argentina.Facultad de Humanidades y Ciencias de la Educació

A Finite Element‑Based Methodology for the Thermo‑mechanical Analysis of Early Age Behavior in Concrete Structures

This paper presents a general procedure based on fracture mechanics models in order to analyze the level of cracking and structural safety in reinforced concrete elements at early ages, depending on the stripping time. Our procedure involves the development of a thermo-mechanical numerical model based on the finite element method that accounts for the change in the mechanical properties of concrete with time. Moreover, fracture mechanisms are analyzed by means of a material damage model, which is characterized via specific experimental results obtained for standard specimens and notched beams under three-point bending testing. The loading conditions are both thermal and mechanical, and are obtained from the hydration process for a given concrete dosage. The presented methodology allows for the determination of the optimal stripping time, whereas it helps assessing the analysis of the cracking and the stress states of the elements under consideration. A practical application, namely the analysis of a retaining wall, is used to validate our methodology, showing its suitability in engineering practice.Ministerio de Economía y Competitividad BIA2016-75431-

Functional diversity of motoneurons in the oculomotor system

Extraocular muscles contain two types of muscle fibers according to their innervation pattern: singly innervated muscle fibers (SIFs), similar to most skeletal muscle fibers, and multiply innervated muscle fibers (MIFs). Morphological studies have revealed that SIF and MIF motoneurons are segregated anatomically and receive different proportions of certain afferents, suggesting that while SIF motoneurons would participate in the whole repertoire of eye movements, MIF motoneurons would contribute only to slow eye movements and fixations. We have tested that proposal by performing single-unit recordings, in alert behaving cats, of electrophysiologically identified MIF and SIF motoneurons in the abducens nucleus. Our results show that both types of motoneuron discharge in relation to eye position and velocity, displaying a tonic–phasic firing pattern for different types of eye movement (saccades, vestibulo-ocular reflex, vergence) and gaze-holding. However, MIF motoneurons presented an overall reduced firing rate compared with SIF motoneurons, and had significantly lower recruitment threshold and also lower eye position and velocity sensitivities. Accordingly, MIF motoneurons could control mainly gaze in the off-direction, when less force is needed, whereas SIF motoneurons would contribute to increase muscle tension progressively toward the on-direction as more force is required. Anatomically, MIF and SIF motoneurons distributed intermingled within the abducens nucleus, with MIF motoneurons being smaller and having a lesser somatic synaptic coverage. Our data demonstrate the functional participation of both MIF and SIF motoneurons in fixations and slow and phasic eye movements, although their discharge properties indicate a functional segregation.Ministerio de Ciencia, Innovación y Universidades – Fondo Europeo de Desarrollo Regional (BFU2015-64515-P)Junta de Andalucía (BIO-297

Thin Capitalization Rules in the Conext of the CCCTB

In the context of the proposed European CCCTB there is clearly a perceived need for the introduction of a common thin capitalization rule. This rule would be aimed at dealing with inbound investment emerging from both third countries, and from Member States opting out of the CCCTB. The principal aim of this paper is to establish whether such a need does indeed exist, and if so, which considerations should guide the design of a thin capitalization rule for the CCCTB. The paper starts by providing a broad summary of the varying approaches of Member States to thin capitalization. It then makes the case for the introduction of a thin capitalization rule in the context of the CCCTB, from both an economic and a legal perspective, and sets out the general principles which should guide the design of such a rule

Modified SEIR model for COVID-19 outbreak in Spain

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has been ongoing for over 5 months now and has spread to nearly every country in the world from its initial outbreak in Wuhan, China. Europe, specially Italy and Spain, has been one of the most affected areas by the virus, although there are now many other epicenters surging in other areas, such as North and South America. In this project we will try to model the disease spread in our home country Spain and try to find some useful parameters to analyze and characterize the outbreak. We have thus tried to implement a modified SEIR model that includes the effects of the lockdown imposed on March 14th by the Spanish government. Creating and estimating the model parameters has proven to be a rather difficult task for us, since the data involving this disease is often unreliable and under continuous modification of criteria. That's the reason why we have only achieved to model the outbreak up to a point and, given time and difficulty constraints, we have been forced to settle for the results obtained. The algorithm for the fitting of the model and estimation of the parameters was initially implemented in R language, but due to complications and the authors' familiarity with the MATLAB environment, the latter was chosen in the end.2019/202

Detection and assessment of victims of illtreatment and torture in Primary Health Care.: Quick guide including developments in the 2022 updated version of the Istanbul Protocol.

Editorial to the 2023(1) issue published in 17.03.202

Cork boiling wastewater anaerobic digestion process leads to biogas and valuable enzymes production

Cork is the outer bark of the cork-tree (Quercus suber L.) and it is a very important industrial sector in western Mediterranean region, being Portugal the world-leading producer and exporter (1). The anaerobic digestion has never been applied to the treatment and valorization of the industrial cork effluents (cork boiling wastewater, CBW). The goal of the present work is evaluate the role of this biological process in providing valuable biomolecules, i.e. enzymes, during the conversion of CBW. Anaerobic experiments were conducted under mesophilic conditions of temperature and the obtained results suggest that CBW is an interesting substrate to be treated and valorised through the anaerobic digestion. Besides the energy recovery through biogas production by anaerobic digestion of CBW, the increase in the reactor effluent of valuable biomolecules is an aspect of great industrial interest. The identification and characterization of such products of high added value creates a supplementary prospect of effluent valorisation, contributing to the cork sector profits. During the CBW anaerobic digestion process several important alterations on the enzymatic capacity of the digested flow were observed. For instance, the laccase activity contained in the CBW was implemented by anaerobiosis and the xilanase was formed during the process. Laccases exhibit low substrate specificity and can be used in different industrial sectors (i.e. paper manufacturing, wine stabilization and wastewater treatment) (2). Xylanases are enzymes involved in the hydrolyse carbohydrates and are used in the pulp, paper and food industries (3). The production of enzymes with commercial interest offers an additional opportunity for the biotechnological valorisation of the CBW, contributing to make the process more interesting and cheaper