Neonatal Respiratory Depression and Intrathecal Fentanyl

Objetivo Establecer la prevalencia de depresión respiratoria neonatal en pacientes expuestas a fentanil intratecal durante cesárea. Métodos Estudio Observacional Retrospectivo Analítico Tipo Corte Transversal realizado en la Clínica Materno-Infantil de la Corporación Saludcoop en pacientes llevadas a cesárea y que recibieron Fentanil intratecal para anestesia regional en los años 2007 y 2008. Desenlaces primarios: APGAR Bajo (APGAR<7) y APGAR Severo (APGAR<4). Resultados 2165 Registros de cesáreas y fentanil intratecal con dosis media de 19,21mcg (DE=0,206mcg). Prevalencia de APGAR Bajo al nacer al minuto 01=1,77% (DE=0,63%), al minuto 05=0,11% (DE 0,163%), al minuto 10=0%; siendo estos dos últimos valores diferentes al valor del minuto 01 (ANOVA Test Scheffé p=0,031) y sin diferenciarse entre ellos (minutos 5 y 10) (ANOVA p=0,861). APGAR Severamente disminuido al nacer al minuto 1=0,059% (DE 0,058), a los minutos 5 y 10=0%. Los tres valores severamente disminuidos no presentaron diferencias estadísticamente significativas entre sí (ANOVA p=0,861). Conclusiones La prevalencia de Depresión Respiratoria medido con el test de APGAR al nacer es baja; el compromiso severo del APGAR presenta una tendencia a 0 en todos los minutos de su valoración; aun así es cuestionable la fiabilidad de la herramienta diagnóstica (APGAR) al existir discrepancias en el análisis con una escala mucho más sensible para el diagnóstico (Test de Silverman). La importancia de este estudio solo radica como evaluación de prevalencia y fuente de hipótesis de investigación, no como estudio de asociación o predicción.Objective To establish the prevalence of neonatal respiratory depression in patients exposed to intrathecal fentanyl during Cesarean section. Methods Cross-sectional Analytical Observational Retrospective Study conducted at the Mother and Child Clinic of the Saludcoop Corporation in patients undergoing C-section who received intrathecal fentanyl for regional anesthesia in 2007 and 2008. Primary endpoints: low APGAR score (APGAR<7) and severe APGAR (APGAR<4). Results 2165 records of C-sections and intrathecal fentanyl with a mean dose of 19.21mcg (SD=0.206mcg). Prevalence of low APGAR at 1, 5 and 10 minutes was 1.77% (SD=0.63%), 0.11% (SD 0.163%), and 0%, respectively. The latter two values were different from the 1-minute value (ANOVA Scheffé Test, p=0.031) and there was no difference between them (minutes 5 and 10) (ANOVA p=0.861). Severely diminished APGAR results were, 0.059% (SD 0.058) 1 minute after birth and 0% at 5 and 10 minutes. There were no statistically significant differences between the three severely diminished values (ANOVA p=0.861). Conclusions The prevalence of respiratory depression measured with the APGAR test at birth is low; severely compromised APGAR shows a trend towards 0 in the different minutes of assessment. However, the reliability of the diagnostic tool (APGAR) is questionable, considering discrepancies when the analysis is done with a far more sensitive diagnostic tool (Silverman test). The importance of this study relates only to the assessment of prevalence and its use as a source of a research hypothesis, and not as an association or prediction study

Feeding Habits of Dwarf Goatfish (Upeneus parvus: Mullidae) on the Continental Shelf in the Gulf of Mexico

Feeding habits of dwarf goatfish on the continental shelf off Alvarado, Veracruz, Mexico, were analyzed to determine seasonal variation and size-class changes in diet composition and trophic overlap between size classes. Food was found in 63% of the 1,437 dwarf goatfish guts analyzed. The 52 dietary items identified consisted mainly of crustaceans, with Solenocera vioscai being the most important prey. Dwarf goatfish exhibited seasonal and size-class changes in prey consumption. Despite the high number of prey items, low values of diversity and diet breadth were found in the trophic spectrum. A high trophic overlap between size classes was observed in the north-winds season between length classes (92-111 vs 112-130 mm) (λ = 0.81) and (92-111 vs 131-150 mm) (λ = 0.80), and (112-131 vs 131-150 mm) (λ = 0.67). In the rainy season high overlaps were obtained between (92-111 vs 112-131 min) (λ = 0.73) and (112-131 vs 131-150 mm) (λ = 0.84) length classes. Dwarf goatfish appear to be opportunistic carnivorous predators that impact benthic and epibenthic invertebrates

Inflation and late time acceleration in braneworld cosmological models with varying brane tension

Braneworld models with variable brane tension $\lambda$ introduce a new degree of freedom that allows for evolving gravitational and cosmological constants, the latter being a natural candidate for dark energy. We consider a thermodynamic interpretation of the varying brane tension models, by showing that the field equations with variable $\lambda$ can be interpreted as describing matter creation in a cosmological framework. The particle creation rate is determined by the variation rate of the brane tension, as well as by the brane-bulk energy-matter transfer rate. We investigate the effect of a variable brane tension on the cosmological evolution of the Universe, in the framework of a particular model in which the brane tension is an exponentially dependent function of the scale factor. The resulting cosmology shows the presence of an initial inflationary expansion, followed by a decelerating phase, and by a smooth transition towards a late accelerated de Sitter type expansion. The varying brane tension is also responsible for the generation of the matter in the Universe (reheating period). The physical constraints on the model parameters, resulted from the observational cosmological data, are also investigated.Comment: 25 pages, 8 figures, accepted for publication in European Physical Journal

The exposure of the hybrid detector of the Pierre Auger Observatory

The Pierre Auger Observatory is a detector for ultra-high energy cosmic rays. It consists of a surface array to measure secondary particles at ground level and a fluorescence detector to measure the development of air showers in the atmosphere above the array. The "hybrid" detection mode combines the information from the two subsystems. We describe the determination of the hybrid exposure for events observed by the fluorescence telescopes in coincidence with at least one water-Cherenkov detector of the surface array. A detailed knowledge of the time dependence of the detection operations is crucial for an accurate evaluation of the exposure. We discuss the relevance of monitoring data collected during operations, such as the status of the fluorescence detector, background light and atmospheric conditions, that are used in both simulation and reconstruction.Comment: Paper accepted by Astroparticle Physic

Ultrahigh energy neutrinos at the pierre auger observatory

The observation of ultrahigh energy neutrinos (UHEs) has become a priority in experimental astroparticle physics. UHEs can be detected with a variety of techniques. In particular, neutrinos can interact in the atmosphere (downward-going ) or in the Earth crust (Earth-skimming ), producing air showers that can be observed with arrays of detectors at the ground. With the surface detector array of the Pierre Auger Observatory we can detect these types of cascades. The distinguishing signature for neutrino events is the presence of very inclined showers produced close to the ground (i.e., after having traversed a large amount of atmosphere). In this work we review the procedure and criteria established to search for UHEs in the data collected with the ground array of the Pierre Auger Observatory.This includes Earth-skimming as well as downward-going neutrinos. No neutrino candidates have been found, which allows us to place competitive limits to the diffuse flux of UHEs in the EeV range and above

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Challenging matter creation models in the phantom divide

© 2020 American Physical Society. We perform a study both statistical and theoretical for cosmological models of matter creation and their ability to describe effective phantom models of dark energy. Such models are beyond the ΛCDM model since the resulting cosmic expansion is not adiabatic. In fact, we show that this approach exhibits transient phantom/quintessence scenarios at present time and tends to the standard cosmological model at some stage of the cosmic evolution. We discuss some generalities of the thermodynamics properties for this type of cosmological model; we emphasize on the behavior of the temperature associated to dark matter, which keeps positive along cosmic evolution together with the entropy. The enrichment of this type of model by means of the incorporation of cosmological constant and dissipative effects in the fluid description to explore their cosmological consequences in the expansion of the Universe is considered. Finally, a generalization for the matter production rate as an inhomogeneous expression of the Hubble parameter and its derivatives is discussed; as in all the cases examined, such election leads to an effective phantom/quintessence behavior

The nature and origin of ultra high-energy cosmic rays

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