Epidemiology of mechanical ventilation in Argentina. The EpVAr multicenter observational study

OBJETIVE

To describe mechanical ventilation (MV) practices in Argentina, and to explore factors associated with ICU mortality in this population.

DESIGN

A prospective, multicenter, observational study was carried out.

SETTING

Intensive Care.

PATIENTS

We enrolled patients above 18 years old admitted to any of the participating ICUs requiring invasive MV for at least 12 h since the admission to the healthcare institution, including MV initiation in emergency department, operating room or other hospitals.

INTERVENTIONS

None.

VARIABLES

All variables were classified into three categories: variables related to demographic and clinical factors before the MV, factors related to the first day on MV, and factors related to events happening during the MV (complications and weaning from MV). Mechanical ventilation weaning and mortality were classified according to WIND.

RESULTS

The primary analysis included 950 patients. The main indication for MV was acute respiratory failure (58% of patients). Initial ventilation mode was volume control-continuous mandatory ventilation in 75% of cases. ICU and hospital mortality were 44.6% and 47.9% respectively. The variables identified as independent predictors of mortality in ICU were age (OR 3.48 IC 95% 1.22-11.66; p = 0.028), failure to implement NIV before MV (OR 2.76 IC 95% 1.02-7.10; p = 0.038), diagnosis of sepsis (OR 2.46 IC 95% 1.09-5.47; p = 0.027) and extubation failure (OR 4.50 IC 95% 2.05-9.90; p < 0.001).

CONCLUSIONS

The present study allowed us to describe the characteristics and clinical course of the patients who received mechanical ventilation in Argentina, finding as the main result that mortality was higher than that reported in international studies.

[Respiratory and physical recovery in cervical spinal cord injury. Seventeen years' experience in a weaning and rehabilitation center: An observational study]

INTRODUCTION AND OBJECTIVES

Spinal cord injury (SCI) is a devastating entity that generates substantial disability. The outcome of respiratory and motor features has an impact in human and social well-being. We analyzed demographic characteristics, motor and respiratory outcomes, and determined equipment needs at discharge in a weaning and rehabilitation center.

MATERIAL AND METHOD

Observational, descriptive and retrospective study of medical records between January 2002 and December 2018. Tracheostomised cervical SCI patients with invasive mechanical ventilation were included. Forced vital capacity (upright and supine), maximal inspiratory and expiratory pressures, ASIA and Spinal Cord Independence MeasureIII (SCIMIII) were obtained.

RESULTS

Of 1603 patients, 3.5% had SCI, and 28 met the inclusion criteria. The most frequent level of injury was C4-C5 (17/28), 21/28 had ASIAA classification, and 19 showed no change in either the ASIA or the SCIM score. In all, 22/28 patients were weaned, while 15/28 were decannulated. Twenty four patients were discharged to home. The most relevant change in SCIMIII was in the 5th component of respiration and sphincter subscale, related to weaning and tracheostomy. At discharge, 23/24 patients needed both respiratory and motor aids.

CONCLUSIONS

The admission rate of SCI patients was low in our weaning and rehabilitation center, with almost all being admitted for traumatic causes. Severity remained unchanged in most ASIAA patients. Respiratory recovery was more clinically significant than recovery of motor function. Upon discharge, most of our patients had to be equipped with both respiratory and motor aids.

[Gastrointestinal manifestations of cystic fibrosis in children]

INTRODUCTION

Cystic fibrosis (CF) is a multisystemic disease, with high morbidity and mortality, and its early diag nosis improves results. Lung conditions are the main cause of morbidity and mortality and are clo sely related to nutritional status and survival. There is little national information about the liver and gastrointestinal characteristics in pediatric patients with CF.

OBJECTIVE

to describe at a gastrointes tinal level, the general, nutritional, and genetic characteristics and the evolution of CF carriers with/ without neonatal screening.

PATIENTS AND METHOD

Retrospective study carried out in 4 public referral hospitals in the Metropolitan Region. The diagnosis of CF confirmed with two positive sweat tests (Gibson and Cooke method) was considered as an inclusion criterion. Those patients with unconfir med neonatal screening tests through Immunoreactive Trypsinogen (IRT) or with only one positive sweat test were excluded. Sex, age, nutritional status, date of diagnosis, clinical presentation at the onset, evolution, and therapies received were recorded as clinical variables, and as laboratory ones, genetic study by means of a diagnostic panel with 36 mutations. The STATA 12 software was used for statistical analysis.

RESULTS

127 patients were included. Respiratory manifestations (recurrent obstructive bronchial syndrome and pneumonia) were present in >60% and gastrointestinal ones (mainly malabsorption and malnutrition syndrome) in >80% of patients. On average, diagnostic confirmation took 4 months. The diagnosis guided by IRT was associated with better nutritional outcomes in the evolution of the patient. In 81.1% of the patients, the genetic study was performed. The most frequent mutations were those associated with DF508 (deletion of phenylalanine 508). 5.8% of the patients presented mutations not included in the gene panel used.

CONCLUSIONS

Gas trointestinal CF appears with pancreatic, intestinal, and hepatic pathology throughout life. Malnutri tion is a frequently present factor, which worsens the prognosis. The management of gastrointestinal manifestations and malnutrition are relevant to improve the morbidity and mortality of CF patients.

The Age-Related Cryptosporidium Species Distribution in Asymptomatic Cattle from North-Western SPAIN

Simple Summary

An age-related distribution of Cryptosporidium species has been reported in cattle, with the pathogenic and zoonotic C. parvum being predominant in suckling calves, C. bovis and C. ryanae being predominant in post-weaned calves and C. andersoni being predominant in adults. However, variants to this pattern have recently been reported. Unravelling the age-related species distribution pattern in cattle from a particular region will allow determining those age classes posing a higher risk to public and animal health. Thus, fecal samples from asymptomatic cattle were collected in north-western Spain. Cryptosporidium detection and species identification was performed by molecular methods. Cryptosporidium prevalence was 16.7%; it significantly decreased with age. Cryptosporidium andersoni, C. bovis, C. occultus, C. parvum, C. ryanae and C. xiaoi were identified. Cryptosporidium parvum was predominant in calves younger than 1 month and C. bovis was predominant in the rest of the age groups. The presence of C. parvum in all age groups implies animal and public health concerns. The predominance of C. bovis in cattle older than 1 month supports the idea that the age-related pattern of Cryptosporidium species described in cattle is not fully consistent, and thus further studies are needed to identify those factors determining the species distribution.

Abstract

An age-related distribution of Cryptosporidium species has been reported in cattle, with C. parvum being predominant in suckling calves, C. bovis and C. ryanae being predominant in post-weaned calves and C. andersoni being predominant in adults. However, variants to this pattern have recently been reported. Thus, fecal samples (n = 594) from asymptomatic cattle were collected in north-western Spain. Animals were classified as <1 month (G1), 1–2 months (G2), 2–12 months (G3), 12–24 months (G4) and >2 years (G5). Cryptosporidium detection and species identification were performed by SSU rRNA PCR. Individual Cryptosporidium prevalence was 16.7%; it significantly decreased with age. Cryptosporidium parvum was predominant in G1 and C. bovis was predominant in the rest of the age classes; C. bovis and C. ryanae were especially prevalent in G2 and G3. Cryptosporidium occultus was not found in suckling calves. Finally, C. andersoni and C. xiaoi were occasionally detected in G5. The presence of C. parvum in all age classes implies significant animal and public health concerns. The predominance of C. bovis in cattle older than 1 month supports the idea that the age-related pattern of Cryptosporidium species described in cattle is not fully consistent, and thus further studies are still needed to identify those factors determining the species distribution.

Sleep assessment devices: types, market analysis, and a critical view on accuracy and validation

Introduction: Sleep assessment devices are essential for the detection, diagnosis, and monitoring of sleep disorders. This paper provides a state-of-the-art review and comparison of sleep assessment devices and a market analysis.Areas covered: Hardware devices are classified into contact and contactless devices. For each group, the underlying technologies are presented, paying special attention to their limitations. A systematic literature review has been carried out by comparing the most important validation studies of sleep tracking devices in terms of sensitivity and specificity. A market analysis has also been carried out in order to list the most used, best-selling, and most highly-valued devices. Software apps have also been compared with regards to the market.Expert opinion: Thanks to technological advances, the reliability and accuracy of sensors has been significantly increased in recent years. According to validation studies, some actigraphs present a sensibility higher than 90%. However, the market analysis reveals that many hardware devices have not been validated, and especially software devices should be studied before their clinical use.

Mytilus galloprovincialis fast growing phenotypes under different restrictive feeding conditions: Fast feeders and energy savers

The present study aims to test if the environmental conditions prevailing during the growing period can determine the physiological profiles of specimens differentiated as fast (F) or slow (S) growers in the mussel Mytilus galloprovincialis. We reared mussel spats in the laboratory under two different conditions. In Treatment I (continuous feeding during discontinuous immersion), two mussel groups were submitted to a daily air exposure of 8 h and fed continuously during immersion-time, with either high-quality food dosed below the pseudofaeces threshold (BP group) or low organic content food dosed above the pseudofaeces threshold (AP group). In Treatment II (discontinuous feeding during continuous immersion), mussels were continuously immersed but fed only 1 day per week (RC group). Mussels were reared for 7 and 11 months (time required for size-differentiation) in Treatments I and II, respectively, and the smallest and largest individuals from each group were selected as S and F specimens. A series of feeding experiments (with different food quality, food ration and under continuous food supply) were performed to analyse the physiological performance of selected F and S mussels. In Treatment I, no significant differences were found in the metabolic rates between F and S mussels, and the faster growth rate of F-mussels resulted from their capacity to display higher clearance-ingestion rates and pre-ingestive selections. The physiological basis of growth rate differences between F and S mussels were found to be the same in mussels reared with diets below or above a pseudofaeces threshold (F_BP, F_AP, S_BP and S_AP). In contrast, the mussels from Treatment II had no significant differences in the feeding rates between F_RC and S_RC mussels. However, F individuals were found to have a 33% lower standard metabolic rate, indicating that fast growth under severe feeding restriction stemmed from a higher capacity of F-mussels to save energy during long periods of starvation. Despite the differences in the physiological basis explaining fast growth between the two treatments, F-mussels were found to possess significantly higher gill-surface area in both cases. It is thus concluded that endogenous factors affecting the gill-surface area play a major role in determining inter-individual growth rate differences in the mussel, Mytilus galloprovincialis.

Assessment of Metal Immission in Urban Environments Using Elemental Concentrations and Zinc Isotope Signatures in Leaves of Nerium oleander

A thorough understanding of spatial and temporal emission and immission patterns of air pollutants in urban areas is challenged by the low number of air-quality monitoring stations available. Plants are promising low-cost biomonitoring tools. However, source identification of the trace metals incorporated in plant tissues (i.e., natural vs anthropogenic) and the identification of the best plant to use remain fundamental challenges. To this end, Nerium oleander L. collected in the city of Zaragoza (NE Spain) has been investigated as a biomonitoring tool for assessing the spatial immission patterns of airborne metals (Pb, Cu, Cr, Ni, Ce, and Zn). N. oleander leaves were sampled at 118 locations across the city, including the city center, industrial hotspots, ring-roads, and outskirts. Metal concentrations were generally higher within a 4 km radius around the city center. Calculated enrichment factors relative to upper continental crust suggest an anthropogenic origin for Cr, Cu, Ni, Pb, and Zn. Zinc isotopes showed significant variability that likely reflects different pollution sources. Plants closer to industrial hotspots showed heavier isotopic compositions (δ⁶⁶Zn_Lyon up to +0.70‰), indicating significant contributions of fly ash particles, while those far away were isotopically light (up to -0.95‰), indicating significant contributions from exhaust emissions and flue gas. We suggest that this information is applied for improving the environmental and human risk assessment related to the exposure to air pollution in urban areas.

Data on genotypic distribution and linkage disequilibrium of several ANRIL polymorphisms in hemodialysis patients

A long non-coding RNA called ANRIL located on chromosome 9p21.3 has been identified as a novel genetic factor associated with cardiovascular disease. Investigation of several single nucleotide polymorphisms (SNPs) of Noncoding Antisense RNA in the INK4 Locus (ANRIL) gene are of particular interest. This article reports data related to the research article entitled: “Association of ANRIL gene polymorphisms with major adverse cardiovascular events in hemodialysis patients” (Arbiol-Roca et al. [1]). Data presented show the genotypic distribution of four selected ANRIL SNPs: rs10757278, rs4977574, rs10757274 and rs6475606 in a cohort constituted by 284 hemodialysis patients. This article analyzes the Hardy-Weinberg disequilibrium of each studied SNP, and the linkage disequilibrium between them.

Metal uptake of Nerium oleander from aerial and underground organs and its use as a biomonitoring tool for airborne metallic pollution in cities

The analysis of the airborne particulate matter-PM-incorporated to plant leaves may be informative of the air pollution in the surroundings, allowing their use as biomonitoring tools. Regarding metals, their accumulation in leaves can be the result of both atmospheric incorporation of metallic PM on aboveground plant organs and root uptake of soluble metals. In this study, the use of Nerium oleander leaves as a biomonitoring tool for metallic airborne pollution has been assessed. The metal uptake in N. oleander was assessed as follows: (a) for radicular uptake by irrigation with airborne metals as Pb, Cd, Cr, Ni, As, Ce and Zn (alone and in mixture) and (b) for direct leave exposure to urban PM. Plants showed a high resistance against the toxicity of metals under both single and multiple metal exposures. Except for Zn, the low values of translocation and bioaccumulation factors confirmed the excluder behaviour of N. oleander with respect to the metals provided by the irrigation. For metal uptake from airborne pollution, young plants grown under controlled conditions were deployed during 42 days in locations of the city of Zaragoza (700,000 h, NE Spain), differing in their level of traffic density. Samples of PM2.5 particles and the leaves of N. oleander were simultaneously collected weekly. High correlations in Pb concentrations were found between leaves and PM2.5; in a lesser extent, correlations were also found for Fe, Zn and Ti. Scanning electron microscopy showed the capture of airborne pollution particles in the large and abundant substomatal chambers of N. oleander leaves. Altogether, results indicate that N. Oleander, as a metal resistant plant by metal exclusion, is a suitable candidate as a biomonitoring tool for airborne metal pollution in urban areas.

Cryptosporidium species and subtype analysis in diarrhoeic pre-weaned lambs and goat kids from north-western Spain

Faecal specimens from diarrhoeic pre-weaned lambs (n = 171) and goat kids (n = 118) were collected in 37 sheep and 23 goat flocks, respectively, from NW Spain and microscopically examined for the presence of Cryptosporidium oocysts. Positive specimens were selected for molecular characterization. Presence of Cryptosporidium oocysts were significantly higher in specimens from goat kids (62.7%) than from lambs (31.6%). PCR products of the SSU rRNA locus were obtained for 108 isolates, and three Cryptosporidium species were identified. Cryptosporidium parvum was the most common species identified from both lambs (74.4%) and goat kids (93.8%). The remaining PCR products from lambs (25.6%) and goat kids (7.7%) were identified as Cryptosporidium Ubiquitum and Cryptosporidium xiaoi, respectively. Five C. parvum subtypes were identified; IIaA13G1R1, IIaA14G2R1, IIaA15G2R1 and IIaA16G3R1 were found in both host species, and IIdA17G1 was only detected in goat kids. Subtype IIaA15G2R1 was the most common and widely distributed. The present study provides the first description of subtypes IIaA13G1R1 in both small ruminant species, IIaA14G2R1 in sheep and IIaA16G3R1 in goats. Our results also reveal that diarrhoeic pre-weaned lambs and goat kids must be considered important reservoirs of Cryptosporidium species with zoonotic potential, such as C. parvum and C. ubiquitum.

Real-time PCR detection chemistry

Real-time PCR is the method of choice in many laboratories for diagnostic and food applications. This technology merges the polymerase chain reaction chemistry with the use of fluorescent reporter molecules in order to monitor the production of amplification products during each cycle of the PCR reaction. Thus, the combination of excellent sensitivity and specificity, reproducible data, low contamination risk and reduced hand-on time, which make it a post-PCR analysis unnecessary, has made real-time PCR technology an appealing alternative to conventional PCR. The present paper attempts to provide a rigorous overview of fluorescent-based methods for nucleic acid analysis in real-time PCR described in the literature so far. Herein, different real-time PCR chemistries have been classified into two main groups; the first group comprises double-stranded DNA intercalating molecules, such as SYBR Green I and EvaGreen, whereas the second includes fluorophore-labeled oligonucleotides. The latter, in turn, has been divided into three subgroups according to the type of fluorescent molecules used in the PCR reaction: (i) primer-probes (Scorpions, Amplifluor, LUX, Cyclicons, Angler); (ii) probes; hydrolysis (TaqMan, MGB-TaqMan, Snake assay) and hybridization (Hybprobe or FRET, Molecular Beacons, HyBeacon, MGB-Pleiades, MGB-Eclipse, ResonSense, Yin-Yang or displacing); and (iii) analogues of nucleic acids (PNA, LNA, ZNA, non-natural bases: Plexor primer, Tiny-Molecular Beacon). In addition, structures, mechanisms of action, advantages and applications of such real-time PCR probes and analogues are depicted in this review.

Study of a measles outbreak in Granada with preventive measures applied by the courts, Spain, 2010 to 2011

Binary file ES_Abstracts_Final_ECDC.txt matches

Training-induced changes in drag-flick technique in female field hockey players

The penalty corner is one of the most important goal plays in field hockey. The drag-flick is used less by women than men in a penalty corner. The aim of this study was to describe training-induced changes in the drag-flick technique in female field hockey players. Four female players participated in the study. The VICON optoelectronic system (Oxford Metrics, Oxford, UK) measured the kinematic parameters of the drag-flick with six cameras sampling at 250 Hz, prior to and after training. Fifteen shots were captured for each subject. A Wilcoxon test assessed the differences between pre-training and post-training parameters. Two players received specific training twice a week for 8 weeks; the other two players did not train. The proposed drills improved the position of the stick at the beginning of the shot (p < 0.05), the total distance of the shot (p < 0.05) and the rotation radius at ball release (p < 0.01). It was noted that all players had lost speed of the previous run. Further studies should include a larger sample, in order to provide more information on field hockey performance.

Restoration of quality of life of patients with inflammatory bowel disease after one year with antiTNFα treatment

BACKGROUND

Inflammatory bowel disease impairs patients' health related quality of life (HRQOL). AntiTNFα agents control disease activity effectively. An ambitious goal of treatment is to achieve the normalization of health. This can be assessed by using a cut-off scoring threshold of the IBDQ-36 questionnaire. It has not been established if antiTNFα treatment is able to restore to normal patients' HRQOL.

AIMS

To determine whether patients with Crohn's disease (CD) and ulcerative colitis (UC) in clinical remission after one year treatment with antiTNFα agents achieve normalization of their HRQOL.

METHODS

Observational and cross-sectional study in patients treated with antiTNFα for one year and in sustained clinical remission. Patients completed the specific questionnaire IBDQ-36. Complete restoration of health was considered achieved when global score of IBDQ-36 was higher than 209 points.

RESULTS

54 patients (43 with CD and 11 with UC) were included. Thirty patients received adalimumab and 24 infliximab. Median global score of the IBDQ-36 was 231, without differences between CD and UC (228 vs 235 respectively, p=ns). Normalization of HRQOL was achieved in all 11 UC patients and in 29 out of 43 CD patients (67%). In our sample population, restoration of health was significantly more frequent in UC than in CD (p<0.05).

CONCLUSIONS

One-year clinical remission induced by antiTNFα treatment restores perception of health to normal in most patients with IBD.

Protein kinase A regulatory subunit isoforms regulate growth and differentiation in Mucor circinelloides: essential role of PKAR4

The protein kinase A (PKA) signaling pathway plays a role in regulating growth and differentiation in the dimorphic fungus Mucor circinelloides. PKA holoenzyme is comprised of two catalytic (C) and two regulatory (R) subunits. In M. circinelloides, four genes encode the PKAR1, PKAR2, PKAR3, and PKAR4 isoforms of R subunits. We have constructed null mutants and demonstrate that each isoform has a different role in growth and differentiation. The most striking finding is that pkaR4 is an essential gene, because only heterokaryons were obtained in knockout experiments. Heterokaryons with low levels of wild-type nuclei showed an impediment in the emission of the germ tube, suggesting a pivotal role of this gene in germ tube emergence. The remaining null strains showed different alterations in germ tube emergence, sporulation, and volume of the mother cell. The pkaR2 null mutant showed an accelerated germ tube emission and was the only mutant that germinated under anaerobic conditions when glycine was used as a nitrogen source, suggesting that pkaR2 participates in germ tube emergence by repressing it. From the measurement of the mRNA and protein levels of each isoform in the wild-type and knockout strains, it can be concluded that the expression of each subunit has its own mechanism of differential regulation. The PKAR1 and PKAR2 isoforms are posttranslationally modified by ubiquitylation, suggesting another regulation point in the specificity of the signal transduction. The results indicate that each R isoform has a different role in M. circinelloides physiology, controlling the dimorphism and contributing to the specificity of cyclic AMP (cAMP)-PKA pathway.

Kinematic analysis of kicking in young top-class soccer players

AIM

The aim of this study was to describe the kinematic pattern of the kicking movement of young top-class soccer players focusing in examining the linear joint markers velocity of the leg kick and the segments angular position.

METHODS

Maximal in step kicks performed by 21 young top-class soccer players (16.1 ± 0.2 years) were analyzed using a three dimensional motion capture system.

RESULTS

The ball was released at a mean velocity of 30.6 ± 1.54 m/s. The maximum linear velocity of the hip (5.49 ± 0.53 m/s), knee (10.89 ± 0.63 m/s), ankle (19.36 ± 0.96 m/s) and toe (24.59 ± 1.33 m/s) joint markers were achieved consecutively during the kick, representing a typical proximal to distal kinetic chain. Significant (P<0.01) differences in the arms, trunk, thigh, shank and foot segments angular positions were found among the instant times in which the key events took place, determined by the maximum velocity of the hip (T1), knee (T2), ankle (T3) and toe (T4) joint markers (except between T3 and T4). This fact indicates that the instant time when each joint marker reached its maximum velocity implied different positions of the body segments.

CONCLUSION

The results of this study provide additional data about the kicking biomechanics of young top-class soccer players. This information should be taken in consideration by coaches that train young soccer players.

Prediction of preterm birth using the cervical consistency index

OBJECTIVES

To assess the diagnostic power of a new cervical consistency index (CCI) obtained using transvaginal sonography for the prediction of spontaneous preterm birth (PTB) and to establish reference ranges for this new variable.

METHODS

Included in this prospective cross-sectional study were 1115 singleton pregnancies at 5-36 weeks of gestation. Anteroposterior cervical diameter was measured before (AP) and after (AP') application of pressure on the cervix using the transvaginal probe. The index was calculated using the formula: CCI=((AP'/AP) × 100). Cervical length was also measured. The outcomes evaluated were spontaneous PTB before 32, 34 and 37 weeks. Logistic regression and analysis of receiver-operating characteristics (ROC) curves were performed to evaluate the diagnostic power of CCI and cervical length (adjusted for gestational age). Intraclass correlation coefficients (ICCs) and Bland-Altman analysis were used to evaluate intra- and interobserver variability.

RESULTS

In the 1031 women with follow-up, the rate of spontaneous PTB before 32 weeks was 0.87%, before 34 weeks was 2.13% and before 37 weeks was 7.76% (n=80). There were 31 (3.01%) iatrogenic PTBs before 37 weeks. An inverse linear correlation between gestational age and CCI was observed, with regression equation: CCI (in %)=89.8 - 1.35 × (GA in weeks); r(2)=0.66, P<0.001. Cervical length showed an inverse quadratic, though non-significant, relationship with gestational age: CL (in mm)=31.084 - 0.0278× (GA in weeks)(2) + 1.0772× (GA in weeks); r(2)=0.076, P<0.14. The intra- and interobserver ICCs for CCI were 0.99 (95% CI, 0.988-0.994) and 0.98 (95% CI, 0.973-0.987), respectively. The area under the ROC curve for CCI in the prediction of spontaneous PTB before 32 weeks was 0.947, for spontaneous PTB before 34 weeks it was 0.943 and for spontaneous PTB before 37 weeks it was 0.907. For a 5% screen-positive rate, CCI had a sensitivity of 67%, 64% and 45% for prediction of spontaneous PTB before 32, 34 and 37 weeks, respectively, with equivalent values of 11%, 9% and 11% for cervical length.

CONCLUSIONS

CCI shows a clear inverse linear relationship with GA. Assessment of CCI is reproducible and is effective in the prediction of spontaneous PTB. This new variable appears to provide better prediction of spontaneous PTB than does cervical length.

Morphology Analysis of Si Island Arrays on Si(001)

The formation of nanometer-scale islands is an important issue for bottom-up-based schemes in novel electronic, optoelectronic and magnetoelectronic devices technology. In this work, we present a detailed atomic force microscopy analysis of Si island arrays grown by molecular beam epitaxy. Recent reports have shown that self-assembled distributions of fourfold pyramid-like islands develop in 5-nm thick Si layers grown at substrate temperatures of 650 and 750°C on HF-prepared Si(001) substrates. Looking for wielding control and understanding the phenomena involved in this surface nanostructuring, we develop and apply a formalism that allows for processing large area AFM topographic images in a shot, obtaining surface orientation maps with specific information on facets population. The procedure reveals some noticeable features of these Si island arrays, e.g. a clear anisotropy of the in-plane local slope distributions. Total island volume analysis also indicates mass transport from the substrate surface to the 3D islands, a process presumably related to the presence of trenches around some of the pyramids. Results are discussed within the framework of similar island arrays in homoepitaxial and heteroepitaxial semiconductor systems.

[Spanish version of the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit). Pilot study of validation]

OBJECTIVE

To validate the Spanish version of the CAM-ICU.

DESIGN

Validation study. The inter-rater reliability and validity were evaluated using a blind comparison with the DSM-IVTR criteria (reference standard) in a group of patients hospitalized in an Intensive Care Unit (ICU).

SETTING

Medical-surgical ICU.

PATIENTS

129 adults with RASS >-4 score, within the 24-48 h of ICU admission. Independent application of the CAM-ICU by two intensive care specialists and evaluation by a psychiatrist using the DSM-IVTR criteria for delirium.

RESULTS

Prevalence of delirium in the sample was 26.4%, this being and 48.3% in the 29 patients who received mechanical ventilation. Inter-rater reliability in the whole sample according to the Kappa index was 0.792 (95% CI 0.662-0.922, p<0.001) and in those who received mechanical ventilation was 0.726 (95% CI 0.487-0.965, p<0.001). The sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were 79.4% (95% CI 63.2-89.7%); 97.9% (95% CI 92.6-99.4%); 93.1% (95% CI 78.0-98.1%); 93.0% (95% CI 86.3-96.6%); 37.72 (95% CI 9.47-150.20) and 0.21(95% CI 0.11-0.41), respectively, in the whole sample. In mechanically-ventilated patients, sensitivity, specificity, PPV, NPV, +LR and -LR were 92.9% (95% CI 68.5-98.7%); 86.7% (95% CI 62.1-96.3%); 86.7% (95% CI 62.1-96.3%); 92.9% (95% CI 68.5-98.7%); 6.96(95% CI 1.90-25.51) and 0.08 (95% CI 0.01-0.55), respectively.

CONCLUSION

The Spanish version of the CAM-ICU is reliable. Its sensitivity, specificity and predictive values should be considered good.

Previous cycling does not affect running efficiency during a triathlon world cup competition

AIM

The most strategic part of a triathlon is the cycle-run transition. However, all the studies about this situation have been carried out in laboratory conditions and there is a need to perform this kind of study during competition, when the triathletes are highly motivated and the effort is maximum.1 Therefore, the aims of the present study were: 1) to determine the effect of prior 40-km cycling on the 10-km running kinematics during a Triathlon World Cup competition, and 2) to examine the possible differences between males and females.

METHODS

Ten men and ten women, selected among the first ten competitors at the end of the cycling part at Madrid 2006 BG Triathlon World Cup, were enrolled in the study. The kinematic analysis was carried out using a photogrammetric technique (DLT algorithms) in the saggital plane (2D).

RESULTS

There are significant differences (P<0.05) in men's stride length and velocity between the first and the last lap. Also, significant differences (P<0.05) were found between men and women in many of the variables analyzed.

CONCLUSIONS

The previous cycling does not affect the subsequent running efficiency during a elite triathlon competition. On the other hand, the running technique profile during a triathlon competition is very different between men and women.

[Quality of neurological care in the emergency services: a study from the community-hospital]

INTRODUCTION

The medical conditions shared by hospital emergency services and community-hospital neurology clinics (CHNC) have not been described, and the quality of the medical care received in these conditions has not been evaluated in our environment.

METHODS

Over a 2 month period, those patients presenting at any of the seven CHNC in a Health Care Area 1 of Madrid due to previously attended medical conditions in the emergency services were systematically registered. The area neurologists of the CHNC collected administrative and clinical variables and made a judgment on the medical care (primary outcome measure) and diagnoses (secondary outcome measure) received.

RESULTS

A total of 181 patients were included (mean age: 58 years; 60% women). The inclusion rate was one patient per working day, and 31% of patients were visited out of the established quota number of patients for the clinic. The most frequent reasons for visiting the emergency room were: headache (20%), focal neurological syndrome (16%) and loss of consciousness (14%). The most frequent diagnoses at the CHNC were: primary headache (19 %), stroke (11%) and epilepsy (9 %). Emergency care was deemed correct in 56 % of patients. When the patients with intervention were compared to those with no intervention, participation of the neurology service in the emergency room was associated to a greater percentage of correct diagnoses (59% vs. 41%; p=0.019) and care (69% vs. 47%; p=0.003).

CONCLUSIONS

The medical conditions shared with the emergency services represent a small but relevant proportion of the patients assisted in the CHNC. Some of these conditions (primary headaches, syncopes) should be canalized into primary health care. Others (epilepsy) require a circuit between emergency room and CNNC, but the appointment system should be adapted. The intervention of a neurologist in the emergency room raises the quality of the care.

Physical demands of top-class soccer assistant refereeing during high-standard matches

This study examined the physical demands experienced by top-class assistant referees during high-standard football matches. Computerized match analyses and heart rate recordings were performed on 18 international assistant referees during the FIFA Confederations Cup 2005. Total distance covered averaged 5752+/-554 m, of which 34% was covered at a high-intensity (>13 km.h (-1)). Sidewards movements represented 30% of total match distance. Both total distance (r=0.67; P<0.01) and high-intensity activities (r=0.52; P<0.05) were related to the displacements of the ball in the same match. The distance covered by high-speed running in this tournament was 255% greater (P<0.001) than that covered during the under-17 World Championship 2003. Mean heart rate during the game was 140+/-11 b.min (-1) (78+/-4% HR (max)). Mean heart rate during a 5-min interval of the match was related in part (r=0.31; P<0.001) to the amount of high-intensity activities performed within the same match-period. The results of this study show that the physical demands imposed on assistant referees are influenced by the movements of the ball and the standard of the competition.

Physical load imposed on soccer players during small-sided training games

AIM

The aim of this study was to examine the kinematical, physiological and technical load imposed on soccer players during three typical small-sided 3-a-side training games carried out in an artificial grass 33x20 m surface.

METHODS

Kinematic analysis was carried out with a bidimensional photogrammetric video system. Heart rate was recorded at 5 s intervals using Polar Accurex Plus heart rate monitors and expressed in relation to individual maximal heart rate (HR(max)). Technical parameters were registered using a specifically designed notation sheet.

RESULTS

The overall intensity of these three small-sided games was superior than the experienced during competitive matches. Distance covered (747-749 vs 638 m) and mean heart rate (173 vs 166 b x min(-1)) were higher (P<0.05) in the drills without goalkeepers. The inclusion of goalkeepers reduced the tempo of the game as players performed less (P<0.05) high-intensity running and increased (P<0.05) low-intensity activities. Time spent exercising at intensities between 76-85% HR(max) was lower (P<0.05) in the game without goals, whereas the presence of goalkeepers reduced (P<0.05) activities performed exceeding 86% HR(max).

CONCLUSION

The results of this study suggest that small-sided games can be used effectively to develop the specific endurance capacity of football players. The integration of these drills by coaches during the regular training schedule can help replicating the demands experienced during real match-play.