Aplicación de óxido nitroso inhalado para la administración de toxina botulínica en niños con parálisis cerebral infantil

39 páginas.Trabajo Fin de Máster Universitario en Urgencias y Emergencias Pediátricas (2016/17). Director: José Domingo López Castilla. El procedimiento de inyección de la toxina botulínica utilizado en la rehabilitación de la espasticidad de niños afectos de parálisis cerebral infantil (PCI) es doloroso, haciendo necesaria la adminsitración de sedoanalgesia al paciente, que puede variar desde la anestesia general hasta la sedación superficial con óxido nitroso inhalado (ONi), la cual es una técnica de sedación rápida y no invasiva. Objetivo: El objetivo principal de nuestro estudio será determinar la utilidad del oxido nitroso inhalado para la sedoanalgesia de pacientes afectos de PCI durante la administración de toxina botulínica. Material y método: Estudio observacional descriptivo prospectivo. Se realizará en la Unidad ó Servicio de Urgencias Pediátricas del Hospital Materno-Infantil de Málaga durante el periodo de enero de 2018 a diciembre de 2019, con un mínimo de 50 pacientes afectos de PCI a los que se suministrará óxido nitroso inhalado (ONi) durante la administración de toxina botulínica. Para valorar el grado de analgesia utilizamos las escalas FLACC, EVA o de dibujos faciales según la colaboración del paciente, y objetivamos la sedación conseguida con la escala de RAMSAY. Se realizará un análisis de la sedoanalgesia conseguida, así como de características generales del paciente (edad, sexo, enfermedades concomitantes). Se pedirá consentimiento informado y el promotor e investigadores se comprometen a aplicar las normas de la buena práctica clínica y legislación vigentes. Se garantizará la confidencialidad de los datos. Análisis estadístico con el programa SPSS 18.0, estableciendo la significación estadística en p<0,05.The procedure of injecting botulinic toxin in the rehabilitation of spasticity in PCI affected children is painful, requiring sedation and analgesia which can ranges from general anaesthesia to superficial sedation with inhaled nitrous oxide (ONi), which is a quick and non-invasive sedation procedure. Ojective: Our main goal is to establish if ONi is useful towards sedation in the injection of botulinic toxins. Method: Descriptive observational prospective study from January 2018 to December 2019 that will be carried out in the Paediatric Emergency Unit of the Child and Mother Hospital of Málaga, recruiting a minimum of 50 patients affected by PCI, who will receive ONi during the administration of botulinum toxin. To asses the analgesy degree achieved we will use the FLACC, EVA or facial drawing scale according to the patient’s collaboration, while sedation is measured with RAMSAY scale. An analysis of the achieved sedoanalgesy will be carried out, together with general characteristic of the patient (sex, gender, accompanying diseases). Informed content shall be required, and the promotor and investigators comply to applying good clinical practice norms and legality. Confidentiality of provided data is assured. Statistical analysis will be carried out with SPSS 18.0 program, establishing statistical significance in p<0.05

Individual differences in dominance-related traits drive dispersal and settlement in hatchery-reared juvenile brown trout

Effective management of exploited populations is based on an understanding of population dynamics and evolutionary processes. In spatially structured populations, dispersal is a central process that ultimately can affect population growth and viability. It can be influenced by environmental conditions, individual phenotypes, and stochastic factors. However, we have a limited knowledge of the relative contribution of these components and its interactions, and which traits can be used as reliable predictors of the dispersal ability. Here, we conducted a longitudinal field experiment aimed to identify traits which can be used as proxy for dispersal in juvenile brown trout (Salmo trutta L.). We measured body size and standard metabolic rates, and estimated body shapes for 212 hatchery-reared juvenile fish that were marked with individual codes and released in a small coastal stream in northwest Spain. We registered fish positions and distances to the releasing point after 19, 41, 60 and 158 days in the stream. We detected a high autocorrelation of dispersal distances, demonstrating that most individuals settle down relatively soon and then hold stable positions over the study period. Body size and fish shape were reliable predictors of dispersal, with bigger and more robust-set individuals being more likely to settle closer to the release site than smaller and more elongated fish. In addition, the analysis of spacing and spatial patterns indicated that the dispersal of introduced fish could affect the distribution of resident conspecifics. All together, these results suggest that stocking programs aimed to the enhancement of overexploited populations at fine spatial scales can be optimized by adjusting the size and shape of the introduced fish to specific management targets and environmental conditions.This study was supported by grants CN-07-164 (Principality of Asturias), MEC-CGL2004-03239/BOS and MMA/86-2003-1 to A.G. Nicieza, and a FICYT PhD fellowship (BP04-147) to J.R. Sánchez-González

Kink dynamics in spatially inhomogeneous media: the role of internal modes

The phenomenon of length-scale competition in soliton-bearing equations perturbed by spatially dependent terms A. Sánchez and A. R. Bishop, SIAM Rev. 40, 579 1998 is analyzed from a general viewpoint. We show that the perturbation gives rise to an effective potential for solitons, which consists of wells and barriers. We calculate the effect of these potential features on the solitons, establishing a direct relationship between the maxima, minima, and curvature of the potential with soliton deformations. When the typical wavelength of the perturbation is of the order of the soliton width, these deformations are seen to correspond to the excitation of shape modes and can lead to the dissipation of the soliton kinetic energy and, further, to the impossibility of soliton propagation. Thus, we demonstrate that the mechanism for length-scale competition is related to changes in the dynamics of the internal modes. We study different examples where the perturbation is introduced parametrically and nonparametrically to make it clear that our results apply to a wide class of equations.This work was supported by MEC Spain under Grants MOSAICO and No. NAN2004-9087-C03-03 and by the Comunidad Autónoma de Madrid (Spain) under Grants No. UC3M-FI-05-007 and SIMUMAT-CM. The work by J.G. was done in part during a stay at Universidad Carlos III de Madrid, whose financial support is acknowledged, and S.C. is supported by the Consejería de Educación de la Comunidad Autónoma de Madrid and the Fondo Social Europeo.Publicad

Security scheme under opensource software for accessing wireless local area networks at the university campus

Wireless networks provide flexibility, increase in productivity, and savings in infrastructure and are useful in organizations with high volume of mobile device users. The services in wireless networks require mechanisms that guarantee their efficient, secure, and reliable use. A security scheme is designed for accessing wireless local area networks (WLAN) at the campus of a Venezuelan university. The confidentiality, integrity, availability (CIA) information security principles are applied, as well as control objectives specified in ISO 27001. The proposed access security scheme mitigates threats, monitors the use of services, and establishes security parameters for reducing attacks to the network, complying with national laws and internal regulations of the university under study respecting to the use of opensource software based on the National Institute of Standards and Technology

Security scheme under opensource software for accessing wireless local area networks at the university campus

Wireless networks provide flexibility, increase in productivity, and savings in infrastructure and are useful in organizations with high volume of mobile device users. The services in wireless networks require mechanisms that guarantee their efficient, secure, and reliable use. A security scheme is designed for accessing wireless local area networks (WLAN) at the campus of a Venezuelan university. The confidentiality, integrity, availability (CIA) information security principles are applied, as well as control objectives specified in ISO 27001. The proposed access security scheme mitigates threats, monitors the use of services, and establishes security parameters for reducing attacks to the network, complying with national laws and internal regulations of the university under study respecting to the use of opensource software based on the National Institute of Standards and Technolog

The valuation of life contingencies: A symmetrical triangular fuzzy approximation

This paper extends the framework for the valuation of life insurance policies and annuities by Andrés- Sánchez and González-Vila (2012, 2014) in two ways. First we allow various uncertain magnitudes to be estimated by means of fuzzy numbers. This applies not only to interest rates but also to the amounts to be paid out by the insurance company. Second, the use of symmetrical triangular fuzzy numbers allows us to obtain expressions for the pricing of life contingencies and their variability that are closely linked to standard financial and actuarial mathematics. Moreover, they are relatively straightforward to compute and understand from a standard actuarial point of view

Pricing Endowments with Soft Computing

This paper develops life insurance pricing with different representation of its two sources of uncertainty: stochastic behaviour of mortality of the insured and fuzzy quantification of interest rates within the time horizon. Concretely we analyse endowment contracts, which are present in several financial real - world contexts as residential mortgage loans or retirement plans. We show that modelling the present value of these contracts with fuzzy random variables allows a well - founded quantification of their fair price and the risk resulting from the uncertainty of mortality and discounting rates. To do this, we firstly describe fuzzy random variables and some associated measures (mathematical expectation, variance, distribution function and quantiles) are defined. Subsequently the present value of a endowment contract (pure and mixed) is modelled with fuzzy random variables. Finally we show how the price and risk measures for endowment portfolios can be obtaine