The impact of outdoor pollution and extreme temperatures on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma.

Air pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma-related outcomes of short-term exposure to outdoor air pollutants (PM2.5, PM10, NO2, SO2, O3, and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS-E tools and the certainty of the evidence by using GRADE. Short-term exposure to PM2.5, PM10, and NO2 probably increases the risk of asthma-related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new-onset asthma in agricultural workers, while exposure to 1,3-dichloropropene may increase the risk of asthma-related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma-related ED visits and HA and asthma mortality (low certainty evidence).

Left-Right Symmetry and Leading Contributions to Neutrinoless Double Beta Decay.

We study the impact of the mixing (LR mixing) between the standard model W boson and its hypothetical, heavier right-handed parter W_{R} on the neutrinoless double beta decay (0νßß decay) rate. Our study is done in the minimal left-right symmetric model assuming a type-II dominance scenario with charge conjugation as the left-right symmetry. We then show that the 0νßß decay rate may be dominated by the contribution proportional to this LR mixing, which at the hadronic level induces the leading-order contribution to the interaction between two pions and two charged leptons. The resulting long-range pion exchange contribution can significantly enhance the decay rate compared to previously considered short-range contributions. Finally, we find that even if future cosmological experiments rule out the inverted hierarchy for neutrino masses, there are still good prospects for a positive signal in the next generation of 0νßß decay experiments.

Fewer gastrojejunostomy strictures and marginal ulcers with absorbable suture.

BACKGROUND: The upsurge of gastric bypass procedures has been accompanied by an increase in anastomotic strictures and marginal ulcers. According to the reported literature, the gastrojejunostomy strictures in 3-31% and ulcerates in 1-16% of cases. Several anastomotic techniques are used, however no study has specifically addressed whether choice of reinforcing suture affects rates of stricture or ulcer. We reviewed our case series to determine if a protocol change in suture choice altered the incidence of anastomotic strictures and marginal ulcers. METHODS: We performed a retrospective review of a prospectively collected database for 315 primary Roux-en-Y gastric bypass patients (7/2008 to 3/2008). Nearly all patients had a 25-mm circular stapled anastomosis with an outer suture layer for reinforcement. Before 5/31/06, interrupted permanent suture was used in 231 patients, and after 6/1/06 interrupted absorbable suture was used in 84 patients. We compared overall rates of stricture, marginal ulceration, and aggregate gastrojejunostomy complications between the two suture groups using a proportional hazards model and log-rank statistic. A p-value < 0.05 was used to assign statistical significance. RESULTS: We found statistically fewer gastrojejunostomy complications in the absorbable suture group (4.7%) than the permanent suture group (19.9%). Subgroup analysis showed that anastomotic strictures were less common in the absorbable suture group, but the difference was short of statistical confirmation. Use of absorbable suture did result in statistically fewer marginal ulcers (2.3%) compared with absorbable suture (13.4%). CONCLUSIONS: Use of absorbable reinforcing sutures is associated with fewer gastrojejunostomy complications. We recommend absorbable sutures for the outer layer of stapled gastrojejunal anastomoses when performing isolated Roux-en-Y gastric bypass.

The Influence of Culture on Teamwork and Communication in a Simulation-Based Resuscitation Training at a Community Hospital in Honduras.

STATEMENT: Communication and teamwork are important aspects of medicine and have been a recent focus of resuscitation. Culture can influence communication and teamwork, and these effects have not been studied in low-resource settings. Using a case study and the TEAM scale, we evaluated how culture influences teamwork and communication during resuscitation simulations, in addition to examining other challenges of simulation research in low-resource settings. We observed lower scores in leadership and communication skills than have been seen in other studies using the TEAM scale, which led us to evaluate the possible role of culture in influencing these skills. The high power distance and collectivism in Latin America can make communication difficult, especially during debriefing. Furthermore, in a male-biased medical hierarchy, female nurses may be less likely to voice concerns. Ultimately, this commentary provides advice for taking the influences of culture into account when planning future simulation training in low-resource settings.

Medellín, lecciones de un cambio en seguridad ciudadana / Medellín, lessons of a change in citizen security / Medellín, lições de uma mudança na segurança cidadã

Medellín fue considerada la ciudad más violenta del mundo durante los años noventa con una tasa de homicidios superior a 370 por cada 100 000 habitantes. En las últimas tres décadas, los asesinatos en la ciudad disminuyeron en un 90 %. Esta transformación ha sido celebrada internacionalmente como un ejemplo de gobernanza local exitosa de centros urbanos que sufren altos índices criminales. Ahora bien, este artículo sostiene que dicha recuperación ­catalogada por algunos como "milagro"­ no fue sólo producto de acciones exitosas del gobierno local, sino también el resultado de dos factores más: primero, la política del Estado colombiano a nivel nacional para fortalecer su aparato de seguridad y desmantelar grupos ilegales armados; y segundo, los acuerdos informales entre las autoridades y las bandas locales, así como la decisión de estas últimas de evitar confrontaciones violentas para facilitar la extracción de sus rentas ilegales.

Medellín was considered the most violent city in the world during the 1990s with a homicide rate of over 370 per 100 000 inhabitants. In the last three decades, murders in the city have decreased by 90 %. This transformation has been celebrated internationally as an example of successful local governance of urban centres suffering from high crime rates. However, this article argues that this recovery - labelled by some as a "miracle" - was not only the product of successful local government actions, but also the result of two other factors: first, the Colombian state's policy at the national level to strengthen its security apparatus and dismantle illegal armed groups; and second, the informal agreements between the authorities and local gangs, as well as the latter's decision to avoid violent confrontations in order to facilitate the extraction of their illegal rents.

Medellín foi considerada a cidade mais violenta do mundo durante a década de 1990, com uma taxa de homicídios superior a 370 por 100 000 habitantes. Nas últimas três décadas, os assassinatos na cidade diminuíram 90 %. Esta transformação tem sido celebrada internacionalmente como um exemplo de governação local bem-sucedida de centros urbanos que sofrem de elevadas taxas de criminalidade. Ora, este artigo sustenta que esta recuperação ­ catalogada por alguns como um "milagre" ­ não foi apenas o produto de ações bem-sucedidas do governo local, mas também o resultado de mais dois fatores: primeiro, a política do Estado colombiano no a nível nacional para reforçar o seu aparelho de segurança e desmantelar grupos armados ilegais; e em segundo lugar, os acordos informais entre as autoridades e os gangues locais, bem como a decisão destes últimos de evitar confrontos violentos para facilitar a extracção das suas rendas ilegais.

Breaking Down the Objective Structured Clinical Examination: An Evaluation of the Helping Babies Breathe OSCEs.

INTRODUCTION: Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation curriculum designed for low-resource settings. At the completion of the workshop, learners complete the following four assessments: a multiple-choice question (MCQ) test, bag-mask ventilation (BMV) checklist, and two objective structured clinical examinations (OSCEs). Objective structured clinical examinations are clinical performance assessments that evaluate learners' skills in simulated scenarios. The aims of this study were (1) to evaluate the validity and reliability of the OSCEs used in the HBB curriculum, (2) to conduct an itemized analysis of the OSCEs to identify specific deficits in knowledge and performance, and to identify areas of improvement for future versions of HBB. METHODS: Seventy physicians and nurses completed an HBB workshop conducted in Spanish at a Honduran community hospital. Validity and reliability were examined using an item analysis of item difficulty, discrimination, correlation, and internal consistency/reliability. RESULTS: Posttest scores were higher for all assessments. Most items on the OSCEs were of low difficulty and low discrimination. Item agreement was lowest for multistep items. CONCLUSIONS: As summative and formative assessments of performance in simulated neonatal resuscitation, the HBB OSCEs are effective because most learners were able to perform the skills correctly after an HBB workshop. On the basis of our results, we recommend changes to future editions of HBB, including the following: simplification of multistep items to single tasks, use of a global rating scale, provision of additional scenarios, and specific instructions to raters on how to grade OSCEs and promote self-reflection to enhance debriefings/feedback. Further validation and study of the OSCEs in the second edition of HBB would enhance their quality and translation into clinical performance.

Educational outcomes of Helping Babies Breathe training at a community hospital in Honduras.

OBJECTIVES: Helping Babies Breathe is an evidence-based curriculum designed to teach basic neonatal resuscitation in low-resource countries. The purpose of this study was to evaluate the acquisition of knowledge and skills following this training and correlation of learner characteristics to performance in a Spanish-speaking setting. METHODS: Thirty-one physicians and 39 nurses completed Helping Babies Breathe training at a Honduran community hospital. Trainee knowledge and skills were evaluated before and after the training using a multiple-choice questionnaire, bag-mask ventilation skills test, and two objective structured clinical exams (OSCEs). Linear mixed-effects models were used to analyze assessment scores pre- and post-training by profession (physician or nurse) while controlling for covariates. RESULTS: Helping Babies Breathe training resulted in significant increases in mean scores for the multiple-choice question test, bag-mask ventilation skills test, and OSCE B. Time to initiation of effective bag-mask ventilation decreased from a mean of 74.8 to 68.4 s. Despite this improvement in bag-mask ventilation, only 42 % of participants were able to initiate effective bag-mask ventilation within the Golden Minute. Although physicians scored higher on the pre-test multiple-choice questions and bag-mask ventilation, nurses demonstrated a greater mean difference in scores after training. OSCE B scores pre- and post-training increased similarly between professions. Nurses' and physicians' performance in simulation was not significantly different after the training. Assessment scores and course feedback indicated a need for more skills practice, particularly with bag-mask ventilation. CONCLUSIONS: When evaluated immediately after an initial workshop, Helping Babies Breathe training resulted in significant gains in neonatal resuscitation knowledge and skills. Following training, nurses, who commonly do not perform these skills in real-life situations, were able to perform at a similar level to physicians. Further studies are necessary to determine how to sustain this knowledge and skills over time, tailor the course to learner characteristics, and whether this training translates into improvements in clinical practice.

Relación entre percepción de poder y prácticas de consumo en la categoría de diversión de personas LGBT / Relationship between the perception of power and consumer practices in the leisure category of LGBT people

Las investigaciones sobre el poder social y su influencia en las prácticas de consumo ponen de manifiesto la disposición a pagar más por un producto de alto estatus en función de la sensación de poder percibido por el consumidor. Así, cuando se experimenta una pérdida de poder, cuando se percibe que otros regulan las consecuencias y los resultados propios, la compra estatutaria se convierte en restauradora de poder, lo que se explica por la hipótesis de la restauración. El poder tiene efectos además sobrela conducta, el afecto y la cognición, por lo que se ha estudiado su relación en el proceso de toma de decisión y en los comportamientos de riesgo. Así, la presente investigación tiene como soporte que si la compra estatutaria serelaciona con la obtención de bienestar y el tener o no poder afecta los comportamientos de compra, puede existir una relación entre la sensación de poder, la compra de tipo hedónico o experiencial y los comportamientos de aproximación e inhibición en un sector específico de consumidores. Se llevó a cabo un estudio correlacional, con un muestreo no probabilístico en el que se encuestaron 135 personas de los sectores LGBT, con el propósito de identificar la relación entre las categorías de consumo de diversión y la sensación de poder. Los resultados muestran que el sexo como actividad se puede considerar como restaurador de poder, y la percepción alta de poder es un activador de la aproximación al consumo de viajes y fiestas como una variable contextual donde se gesta el consumo experiencial.

Research into social power and its influence on consumer practices demonstrates the willingness to pay more for a high status product in accordance with the sense of power perceived by the consumer. Thus, when loss of power is experienced, when it is perceived that others regulate the consequences and the results, statutory purchasing becomes a restorer of power, which is explained by the hypothesis of restoration. Power also has effects on behaviour, affection and cognition, and their relationship has been studied in the decision making process and risk behaviours. Thus, this study is based on the assumption that, if the statutory purchase itself is related to obtaining benefits, and having power or not affects purchasing behaviours, there may be a relationship between the sense of power, hedonic or experiential purchasing, and behaviours of approach and inhibition in a specific sector of consumers. This study was conducted using a correlational design, in which 135 people from the LGBT sector were surveyed by non-probability sampling, in order to identify the relationship between leisure consumption categories and the feeling of power. The results show that sex as an activity can be considered as a restorer of power, and a high perception of power is an activator of the approach to the consumption of trips and parties as a contextual variable where experiential consumption is created.

Broncoscopía diagnóstica en el adulto mayor con sospecha de cáncer de pulmón / Diagnostic Bronchoscopy in the Elderly with Suspected Lung Cancer

Antecedentes: el cáncer del pulmón es una enfermedad muy frecuente en el adulto mayor, y generalmente esta población presenta muchas enfermedades asociadas. La broncoscopía es un estudio imprescindible en el diagnóstico de esta entidad. Objetivo: describir los resultados de la broncoscopía diagnóstica en los adultos mayores con sospecha de cáncer pulmonar. Métodos: se realizó un estudio descriptivo, de corte transversal, con carácter retrospectivo y prospectivo, en 125 pacientes adultos de 60 años o más, a los que se les realizó broncoscopía diagnóstica en el servicio de Neumología del Hospital Clinicoquirúrgico Hermanos Ameijeiras, durante el periodo de enero a diciembre de 2015. Resultados: el 62,4 por ciento de los pacientes estaban en el rango de 60-69 años; eran fumadores o exfumadores el 68,8 por ciento, y las principales enfermedades asociadas fueron: hipertensión arterial y enfermedad pulmonar obstructiva crónica. La presencia de masa tumoral y nódulo (52,8 por ciento) predominaron para la indicación de la broncoscopía. Se logró el diagnóstico definitivo por esta vía en el 82,8 por ciento de los pacientes con lesiones visibles endoscópicamente. La tasa de complicaciones fue de solo 8,8 por ciento, con mortalidad 0. Conclusiones: la broncoscopía tiene una alta rentabilidad diagnóstica con un mínimo de complicaciones en el estudio del cáncer del pulmón en el adulto mayor(AU)

Background: Lung cancer is a very common disease in the elderly, and this population usually has many associated diseases. Bronchoscopy is an essential study in the diagnosis of this entity. Objective: Describe the results of diagnostic bronchoscopy in the elderly with suspected lung cancer. Methods: A retrospective and prospective cross-sectional study was carried out on 125 adult patients aged 60 years or older, who underwent diagnostic bronchoscopy at the Pulmonology Service of Hermanos Ameijeiras Clinical and Surgical Hospital from January to December 2015. Results: 62.4 percent of the patients were in the range of 60-69 years; 68.8 percent were smokers or ex-smokers, and the main associated diseases were: arterial hypertension and chronic obstructive pulmonary disease. The presence of tumor mass and nodule (52.8 percent) predominated for indicating bronchoscopy. The definitive diagnosis was achieved this way in 82.8 percent of the patients with endoscopically visible lesions. The complication rate was only 8.8 percent, with 0 mortality. Conclusions: Bronchoscopy has a high diagnostic yield with a minimum of complications for the study of lung cancer in the elderly(AU)

Creencias y normas subjetivas como predictores de intención de comportamiento proambiental / Beliefs and subjective norms as predictors of pro-environmental intention

El propósito de esta investigación fue describir y establecer la relación que hay entre las creencias y normas subjetivas con la intención de conducta proambiental en una institución universitaria privada de la ciudad de Bogotá (Colombia). Se contó con la participación de 346 estudiantes seleccionados mediante un muestreo no probabilístico según la proporción de programas de pregrado y posgrado. Se administró la Escala de Comportamiento Proambiental (67 ítems), que evalúa creencias, normas subjetivas e intención de conducta proambiental. Se identificó que las normas subjetivas pro y antiambientales pueden ser predictores consistentes de la intención de conducta pro y antiambiental.

The purpose of this study was to describe and establish the relationship between beliefs and subjective norms with the pro-environmental intention of a private university in the city of Bogota (Colombia). A total of 346 students participated in the study, and they were selected using non-probability sampling according to the proportion of undergraduate and graduate programs. The pro-environmental behaviour scale (67 items) was administered in order to evaluate beliefs, subjective norms, and intention of pro-environmental behaviour. It was found that pro-and anti-environmental subjective rules may be consistent predictors of pro-and anti-environmental intent.

Estrategias metddológicas para el análisis de dtos textuales: aplicaciones en psicología del consumidor / Methodoogical sttrategies for textual data analysis: aplications in pssychology of consumer

Este trabajo presenta una propuesta de clasificación metodológica para los estudios realizados con datos textuales. Esta clasificación se fundamenta en las dos metodologías predominantes en ciencias sociales para realizar en investigación: cualitativa y cuantitativa. El supuesto de base es que el proceso de investigación se realiza en tres momentos esenciales: 1) Estructuración de la Investigación, 2) Recolección de la Información y, 3) Análisis e Interpretación de los Datos. En cada uno de ellos, se presentan los lineamientos generales para estudios textuales.

This paper presents a classification methodology for studies of textual data. This classification is based on the two predominant methodologies for social science research: qualitative and quantitative. The basic assumption is that the research process involves three main features: 1) Structure Research, 2) Collection of information and, 3) Analysis and Interpretation of Data. In each, there are general guidelines for textual studies.

Patrones de elección de marca en función de los cambios en los niveles de refuerzo utilitario e informacional en categorías de productos de consumo masivo / Choice brand patterns as a function of changes in utilitarian and informational reinforcement levels in consume massive product categories

El presente estudio buscó la relación existente entre la conformación de los patrones de compra de los consumidores y los cambios que se presentan en el nivel de refuerzo tanto utilitario como informacional que obtienen los consumidores a partir del consumo de las marcas escogidas. Se aplicó una metodología de panel con un total de 40 hogares de estratos 2 y 3 enla ciudad de Bogotá, rastreando de manera periódica durante un período de cinco meses todas las ocasionesde compra realizadas para siete categorías de productos de consumo masivo. Los resultados demuestran que se replicaron las medidas de desempeño de las marcas con respecto a las obtenidas en estudios previos. En segundo lugar, y como resultado de una nueva propuesta de operacionalización de los niveles de refuerzo entregadospor las marcas, se obtuvieron dos factores significativos en algunas categorías de producto, los cuales permiten establecer de manera preliminar la existencia de una elasticidad de “evaluación de la marca” y una elasticidad de “evaluación situacional”. Finalmente, se presenta unmodelo estadístico para pesar la influencia de los factores demográficos, situacionales y del conjunto de elecciónsobre las cantidades adquiridas por los consumidores.

The present study search for the existing relation between the conformation of the consumer patterns purchase and the changes in the utilitarian and informationalreinforcement levels that the consumers obtain from the consumption of the chosen brands. It was used a panelmethodology with a total of 40 homes of socioeconomic layers 2 and 3 in the city of Bogota, raking of periodic wayduring a period of five months all purchase occasions for seven product categories of massive consumption. Theresults demonstrate that the measures of performance of the brands are similar to the obtained ones in previous studies. Secondly, and as a result of a new proposal of operationalization of the levels of reinforcement givenby the brands, two significant factors in some product categories were obtained, which allow establishing of preliminary way the existence of an elasticity of “brand evaluation” and an elasticity of “situational evaluation”. Finally, we propose a statistical model to weigh theinfluence of the demographic factors, situational factors and choice set on the amounts acquired by the consumers.

Abordaje diagnóstico del dolor precordial en sala de emergencia Hospital Doctor Roberto Calderón Gutiérrez julio-diciembre 2008 / Diagnostic approach of chest pain in emergency room Doctor Roberto Calderon Gutierrez Hospital July-December 2008

El presente estudio tiene como objetivo general conocer el abordaje diagnostico del dolor precordial de los pacientes atendidos en la emergencia del hospital Dr. Roberto Calderón Gutiérrez en el periodo de julio a diciembre del 2008, a través de un estudio descriptivo y retrospectivo, haciendo uso de tablas y gráficos para reflejar porcentaje y frecuencias. Dentro de los resultados relevantes se encontró lo siguiente: -En relación a las principales características socio demográficas de los pacientes que fueron atendidos por dolor precordial se observó un predominio de los grupos de edades menor de 40 años con un 33.2 % seguido del grupo de 40 a 50 años con un 22.6 %.(Gráfico 1) - En cuanto al tiempo de duración del dolor es importante destacar la ausencia de información sobre este aspecto en el 83.4 % de los casos, predominando en los reportados el mayor de 10 minutos en un 14,1 % de los mismos. (Gráfico 6) - En cuanto a los principales síntomas asociados al dolor en el 65,3 % de los casos no estaba reportado este aspecto, mientras que de los reportados predominó la disnea en un 22,1 % seguido de la diaforesis en un 7,5 % de los mismos. (Gráfico 7). -En relación a los medios diagnósticos utilizados no se hizo uso de electrocardiograma en el 22,1 % de los casos, en cambio en un 77.9% se realizó electrocardiograma. (Grafico 11) - Al analizar los pacientes con dolor precordial según el tiempo de realización del Electrocardiograma se observa que se realizó en los primeros 10 minutos en un 75,9% de los casos y la realización en un nuevo electrocardiograma posterior a los 10 minutos en un 7 % de los casos. (Grafico 11) -En relación a la realización de CPK-MB no fue realizada en el 60,8 % de los casos encontrándose elevado en el 12,6 % y normal en el 26,6 % de los mismos. (Gráfico 12)...

El manejo de las lesiones penetrantes del tórax en la práctica civil: experiencia clínica / Management of penetrating wound of thorax on civil practice: clinical experience

En base a 253 casos de trauma torácicos los autores recomiendan la colocación de dos tubos de drenaje torácico 36 a 40 Frenh. La toracotomía precoz con la utilización de máquinas autosuturadoras, en los casos en los cuales está indicada, se considera como de gran beneficio