Incorporating diverse values of nature in decision-making-theory and practice.

Values play a significant role in decision-making, especially regarding nature. Decisions impact people and nature in complex ways and understanding which values are prioritised, and which are left out is an important task for improving the equity and effectiveness of decision-making. Based on work done for the IPBES Values Assessment, this paper develops a framework to support analyses of how decision-making influences nature as well as whose values get prioritised. The framework is used to analyse key areas of environmental policy: a) the present model for nature protection in market economies, b) the role of valuation in bringing nature values into decisions, and c) values embedded in environmental policy instruments, exemplified by protected areas for nature conservation and payments for ecosystem services. The analyses show that environmental policies have been established as mere additions to decision-making structures that foster economic expansion, which undermines a wide range of nature's values. Moreover, environmental policies themselves are also focused on a limited set of nature's diverse values. This article is part of the theme issue 'Bringing nature into decision-making'.

Turbulent heating in galaxy clusters brightest in X-rays.

The hot (10(7) to 10(8) kelvin), X-ray-emitting intracluster medium (ICM) is the dominant baryonic constituent of clusters of galaxies. In the cores of many clusters, radiative energy losses from the ICM occur on timescales much shorter than the age of the system. Unchecked, this cooling would lead to massive accumulations of cold gas and vigorous star formation, in contradiction to observations. Various sources of energy capable of compensating for these cooling losses have been proposed, the most promising being heating by the supermassive black holes in the central galaxies, through inflation of bubbles of relativistic plasma. Regardless of the original source of energy, the question of how this energy is transferred to the ICM remains open. Here we present a plausible solution to this question based on deep X-ray data and a new data analysis method that enable us to evaluate directly the ICM heating rate from the dissipation of turbulence. We find that turbulent heating is sufficient to offset radiative cooling and indeed appears to balance it locally at each radius-it may therefore be the key element in resolving the gas cooling problem in cluster cores and, more universally, in the atmospheres of X-ray-emitting, gas-rich systems on scales from galaxy clusters to groups and elliptical galaxies.

Ecocardiografía funcional en cuidados intensivos neonatales: experiencia en una unidad española a lo largo de un año / Functional echocardiography in neonatal intensive care: 1 year experience in a unit in Spain

INTRODUCCIÓN: Numerosas publicaciones destacan la utilidad de la ecocardiografía funcional (EcoFn) en neonatología. No existen datos sobre su uso en unidades españolas. OBJETIVO: Evaluar la frecuencia de uso, pacientes, indicaciones, mediciones y repercusión sobre el tratamiento de la EcoFn en un año en una unidad de cuidados intensivos neonatales (UCIN) española. MÉTODOS: Estudio descriptivo retrospectivo en pacientes ingresados en UCIN en un año. VARIABLES: edad gestacional, peso, diagnóstico principal, días de vida en el momento del estudio, indicación, parámetros medidos y modificaciones del tratamiento. RESULTADOS: Se realizaron 168 ecografías en 50 pacientes, con una media ± desviación estándar de 3,4 ± 2,83 por paciente. Las indicaciones más frecuentes fueron la valoración del ductus (58,3%) seguida de la inestabilidad hemodinámica (22,2%). El resultado de la ecografía modificó el tratamiento en 62 casos (36,9%). En un 17,4% se inició tratamiento con ibuprofeno y en un 1,2% de los casos se adelantó el fin de este. En un 10,8% de los casos, la ecografía modificó el soporte hemodinámico. Los parámetros principales valorados fueron: valoración de presencia/repercusión del ductus 100%; función miocárdica: fracción de eyección/acortamiento 23,8%, gasto ventrículo del izquierdo 24,4%, gasto del ventrículo derecho 21,4%; flujo sistémico 42,3%; signos de hipertensión pulmonar 7,7%. CONCLUSIONES: La EcoFn es utilizada frecuentemente en UCIN y en muchos casos guía el tratamiento de los pacientes. La valoración del ductus y de la inestabilidad hemodinámica son las indicaciones más frecuentes. Queda por determinar si el uso de la EcoFn modifica la evolución de los pacientes de UCIN

INTRODUCTION: Several publications highlight the usefulness of functional echocardiography (FnECHO) in neonatal intensive care. Data is lacking on its use in units neonatal in Spain. OBJECTIVES: To evaluate frequency of use, patient characteristics, indications, measurements, and impact on patient management of FnECHO in a neonatal intensive care unit (NICU) in Spain over a 1 year period. METHODS: A retrospective study conducted in NICU patients during 1 year. VARIABLES: gestational age, birthweight, admission criteria, days of life at examination, indication for FnECHO, parameters assessed, and treatment modifications. RESULTS: 168 echocardiographic studies were performed in 50 patients (mean 3,4. SD 2,83). The most frequent indication was patent ductus (PDA) assessment (58.3%), followed by hemodynamic instability (22.2%). The results of FnECHO modified treatment in 62 cases (36.9%). In 17.4% of them treatment with ibuprofen was initiated, and in 1.2% it was discontinued. In 10.8% of the cases, the results of FnECHO modified hemodynamic support. Echocardiographic evaluation included: assessment of presence/hemodynamic significance of PDA (100%); myocardiac function: ejection fraction/shortening fraction (EF/SF) 23.8%, left ventricular output 24.4%, right ventricular output 21.4%, systemic blood flow 42.3%; and signs of pulmonary hypertension 7.7%. CONCLUSIONS: FnECHO is frequently used in the NICU, and in many cases it guides treatment. PDA assessment and hemodynamic instability are the most frequent indications. It still needs to be elucidated if the use of FnECHO modifies patient outcomes

Factores de riesgo de la luxación congénitade cadera en niños/as de 0 a 9 años del centro provincial de neurodesarrollo integral. Cuenca, 2012 / Risk factors of the congenital hip dysplasia in children from 0 to 9 years of the centro provincial de neurodesarrollo integral. Cuenca, 2012

OBJETIVO: Determinar los factores de riesgo asociados de la luxación congénita de cadera en niños/as de 0 a 9 años que asisten al Centro Provincial de Neurodesarrollo Integral (CEPRONDI). MÉTODOS: Se realizó un estudio de casos y controles, el universo estuvo conformado por 1.200 niños/as de 0 a 9 años con luxación congénita de cadera (LCC), que asisten al Centro Provincial de Neurodesarrollo Integral (CEPRONDI). El tamaño total de la muestra fue de 310 niños (155 con luxación congénita de cadera y 155 sin luxación congénita de cadera), calculado con los criterios de intervalo de confianza del 95% y nivel de significación del 0,05%. Se identificó la luxación congénita de cadera en niños/ as según antecedentes familiares, presentación podálica y desproporción pélvico ­ fetal. Los datos se analizaron mediante SPSS v.20, Excel y Minitab v.15. Para la descripción de variables cualitativas se calculó frecuencias y porcentajes y para el análisis inferencial se utilizó prueba de chi cuadrado para diferencia de proporciones y regresión múltiple para identificar las principales causas que influyen mayormente en este problema. RESULTADOS: La incidencia de LCC en niños/ as con trastornos del desarrollo en el CEPRONDI es del 18,10%; se demostró que los factores de riesgo relacionados con la LCC son antecedentes familiares, peso al nacer y embarazo múltiple porque tuvieron mayor significancia estadística con un p_valor de 0,000 los dos primeros y 0,003 el último; en cambio se demostró que la desproporción pélvico ­ fetal y sexo tienen menor significancia estadística. CONCLUSIONES: El porcentaje (18,10%) de LCC que se encontró en el CEPRONDI es alarmante pues supera las cifras con respecto a otros países e inclusive con la prevalencia mundial que es del 3%.

OBJECTIVE: To determine the risk factors associated with congenital hip dislocation in children from 0 to 9 years who are attending to the Provincial Center for Integrative Neurodevelopment (CEPRONDI). METHODS: A case-control study was made; the universe consisted of 1200 children from 0 to 9 years of congenital hip dislocation (LCC), who are attending to the Provincial Center for Integrative Neurodevelopment (CEPRONDI). The total sample size was 310 children (155 with congenital hip dislocation and 155 without congenital hip dislocation); they were calculated with confidence interval criteria of 95% and significance level of 0.05 %. We identified the congenital hip dislocation in children according to the family history, breech presentation and pelvic-fetal disproportion. Data were analyzed using SPSS v.20, Excel and Minitab v.15. For the description of qualitative variables, frequencies and percentages were calculated, and for the inferential analysis we used chi -square test to contrast and also multiple proportions to identify the main causes of this problem. RESULTS: The incidence of LCC in children with developmental disorders in the CEPRONDI is about 18.10%; we showed that the risk factors are related to the LCC family history, birth weight and multiple pregnancy because they had higher statistical significance with a p_value of 0,000 the first two and 0,003 the last; however it was shown that the pelvic disproportion - fetal and sex have a lower statistical significance. CONCLUSIONS: The percentage (18.10%) of LCC which was found in CEPRONDI is very alarming because it exceeds the figures in comparison with other countries and even with the global prevalence that is 3%.

[Functional echocardiography in neonatal intensive care: 1 year experience in a unit in Spain]. / Ecocardiografía funcional en cuidados intensivos neonatales: experiencia en una unidad española a lo largo de un año.

INTRODUCTION: Several publications highlight the usefulness of functional echocardiography (FnECHO) in neonatal intensive care. Data is lacking on its use in units neonatal in Spain. OBJECTIVES: To evaluate frequency of use, patient characteristics, indications, measurements, and impact on patient management of FnECHO in a neonatal intensive care unit (NICU) in Spain over a 1 year period. METHODS: A retrospective study conducted in NICU patients during 1 year. VARIABLES: gestational age, birthweight, admission criteria, days of life at examination, indication for FnECHO, parameters assessed, and treatment modifications. RESULTS: 168 echocardiographic studies were performed in 50 patients (mean 3,4. SD 2,83). The most frequent indication was patent ductus (PDA) assessment (58.3%), followed by hemodynamic instability (22.2%). The results of FnECHO modified treatment in 62 cases (36.9%). In 17.4% of them treatment with ibuprofen was initiated, and in 1.2% it was discontinued. In 10.8% of the cases, the results of FnECHO modified hemodynamic support. Echocardiographic evaluation included: assessment of presence/hemodynamic significance of PDA (100%); myocardiac function: ejection fraction/shortening fraction (EF/SF) 23.8%, left ventricular output 24.4%, right ventricular output 21.4%, systemic blood flow 42.3%; and signs of pulmonary hypertension 7.7%. CONCLUSIONS: FnECHO is frequently used in the NICU, and in many cases it guides treatment. PDA assessment and hemodynamic instability are the most frequent indications. It still needs to be elucidated if the use of FnECHO modifies patient outcomes.

[Bacterial colonization in areas of burnt skin and healthy children younger than 15 years, seen COANIQUEM, Santiago, Chile]. / Colonización bacteriana de piel sana versus quemada de niños bajo 15 años tratados en COANIQUEM, Santiago de Chile.

UNLABELLED: Bacterial colonization in patients with burns skin without infection and outpatient management has been poorly studied. OBJECTIVE: To quantify and identify the type of bacteria that colonize healthy body areas homologous location of the skin in children from 1 to 15 years, seen COANIQUEM, Santiago, Chile. Per patient, we studied 204 samples from each zone. The isolated microorganisms were S. epidermidis 35, 3%; others Staphylococcus coagulase negative, 25.8%; S. aureus, 4.4%; and S. viridans group 1.4%. In the subgroup of children who had a count between 1 and 1000 cfu, there was a higher proportion of cfu in burned skin healthy skin (p = 0.0359). The association between depth of the lesion and the bacterial count obtained p = 0.034. CONCLUSION: In outpatient treatment, the microorganisms are expected in healthy skin, burned skin is evident in lower counts probably associated with epithelial damage.

Colonización bacteriana de piel sana versus quemada de niños bajo 15 años tratados en COANIQUEM, Santiago de Chile / Bacterial colonization in areas of burnt skin and healthy children younger than 15 years, seen COANIQUEM, Santiago, Chile

Bacterial colonization in patients with burns skin without infection and outpatient management has been poorly studied. Objective: To quantify and identify the type of bacteria that colonize healthy body areas homologous location of the skin in children from 1 to 15 years, seen COANIQUEM, Santiago, Chile. Per patient, we studied 204 samples from each zone. The isolated microorganisms were S. epidermidis 35, 3%; others Staphylococcus coagulase negative, 25.8%; S. aureus, 4.4%; and S. viridans group 1.4%. In the subgroup of children who had a count between 1 and 1000 cfu, there was a higher proportion of cfu in burned skin healthy skin (p = 0.0359). The association between depth of the lesion and the bacterial count obtained p = 0.034. Conclusion: In outpatient treatment, the microorganisms are expected in healthy skin, burned skin is evident in lower counts probably associated with epithelial damage.

La colonización bacteriana de la piel de pacientes quemados, sin infección y de manejo ambulatorio, ha sido escasamente estudiada. Objetivo: Cuantificar e identificar el tipo de bacterias que colonizan las zonas cruentas y las zonas sanas de localización homóloga de la piel, en niños entre uno y 15 años de edad que son tratados de forma ambulatoria en la Corporación de Ayuda al Niño Quemado (COANIQUEM) en Santiago de Chile. Pacientes y Métodos: Se estudiaron 204 pacientes quemados en los que se tomó una muestra para cultivo desde la zona de la quemadura y otra desde el sitio homólogo sin quemadura. Resultados: Las especies bacterianas aisladas desde ambos tipos de muestra fueron similares: Staphylococcus epidermidis; otras especies de Staphylococcus coagulasa negativa; Staphylococcus aureus, y Streptococcus grupo viridans. El recuento bacteriano de uno a 999 ufc/ 10,5 cm² fue significativamente superior en las muestras de piel sana (p = 0,0359). La asociación entre mayor profundidad de la lesión y el menor recuento bacteriano obtuvo un p = 0,034. Conclusión: En niños quemados de entre uno y 15 años, de manejo ambulatorio, los microorganismos que colonizan la zona quemada fueron los mismos que colonizan la piel sana, pero en recuento inferior.

[Sydenham's chorea: report of a case treated with carbamazepine with excellent clinical response]. / Corea de Sydenham: presentación de un caso tratado con carbamazepina con excelente respuesta clínica.

Sydenham's chorea is the most common cause of acquired chorea in childhood. This disorder is secondary to an autoimmune response against basal ganglia in the brain, induced by prior streptococcal infection. Chorea is a major criterion for the diagnosis of rheumatic fever and can also be the presenting feature of the disease. The incidence of rheumatic fever has been markedly decreased by improved socioeconomic conditions and increased antibiotic prescription. In the last two decades, however, this disease has reappeared and should be taken into account in the evaluation of children with movement disorders. Chorea is characterized by acute exacerbations that can cause substantial functional impairment and may warrant drug treatment. Carbamazepine has proven to be both efficacious and safe in the treatment of this condition. We present a case of rheumatic chorea, in which carbamazepine therapy produced excellent clinical response.

Corea de Sydenham: presentación de un caso tratado con carbamazepina con excelente respuesta clínica / Sydenham’s chorea: report of a case treated with carbamazepine with excellent clinical response

La corea de Sydenham es la causa más frecuente de corea adquirida en el niño. Se presenta por la existencia de una respuesta autoinmunitaria contra los núcleos de la base del cerebro, inducida tras una infección estreptocócica. La corea es uno de los criterios mayores de diagnóstico de fiebre reumática y puede ser la forma de presentación de esta entidad. La mejoría de las condiciones socioeconómicas y el tratamiento antibiótico han condicionado un descenso importante de la incidencia de fiebre reumática. En los últimos 20 años se ha producido un repunte de la enfermedad, que se ha de tener en cuenta en el diagnóstico diferencial de los trastornos del movimiento en la edad pediátrica. La corea evoluciona generalmente de forma subaguda con episodios de exacerbación que generan una importante repercusión funcional planteando la necesidad de un tratamiento farmacológico. Una de las posibilidades terapéuticas es la carbamazepina que se ha mostrado eficaz y segura en el tratamiento de esta entidad. Presentamos un caso de corea reumática que se trató con carbamazepina con una excelente respuesta clínica

Sydenham's chorea is the most common cause of acquired chorea in childhood. This disorder is secondary to an autoimmune response against basal ganglia in the brain, induced by prior streptococcal infection. Chorea is a major criterion for the diagnosis of rheumatic fever and can also be the presenting feature of the disease. The incidence of rheumatic fever has been markedly decreased by improved socioeconomic conditions and increased antibiotic prescription. In the last two decades, however, this disease has reappeared and should be taken into account in the evaluation of children with movement disorders. Chorea is characterized by acute exacerbations that can cause substantial functional impairment and may warrant drug treatment. Carbamazepine has proven to be both efficacious and safe in the treatment of this condition. We present a case of rheumatic chorea, in which carbamazepine therapy produced excellent clinical response

Performance of Bacticard Candida compared with the germ tube test for the presumptive identification of Candida albicans.

Bacticard Candida was compared with the germ tube test for the rapid, presumptive identification of Candida albicans. This test kit detects the enzymatic activities l-proline aminopeptidase and beta-galactosaminidase in yeast colonies grown on culture media. Candida albicans produces both enzymes whereas other yeasts produce only one or neither of the enzymes. We evaluated 536 isolates including eight genera and 33 species of medically important yeasts, including 228 C. albicans and 36 C. dubliniensis. Both tests did not discriminate between C. albicans and C. dubliniensis isolates. The sensitivity and specificity for the Bacticard Candida test were 97.8 and 96.5%, respectively. Bacticard Candida and germ tube tests detected 246 (93.2%), and 256 (97%) C. albicans plus C. dubliniensis isolates. There were eight false-positive results with BactiCard Candida kit and four false-positive results with the germ tube test. Positive and negative predictive values for Bacticard Candida enzymatic test were 95.3 and 98.4%, respectively, while 97.4 and 98.1% for the germ tube test, its specificity being 98.1% and efficiency 97% (97.7% for germ tube). We have observed slightly lower values of sensitivity and specificity than those reported by others using the BactiCard test kit. Bacticard Candida provides a rapid and accurate alternative to the germ tube test for the presumptive identification of C. albicans.

[Evaluation of Chromalbicans Agar for presumptive identification of Candida albicans]. / Evaluación del medio Chromalbicans Agar para la identificación presuntiva de Candida albicans.

The utility of Chromalbicans Agar (Biolife Italiana, Milano, Italy) was evaluated with 723 clinical isolates and type culture collection strains from different genera including Candida, Cryptococcus, Pichia, Rhodotorula, Saccharomyces, Trichosporon y Zygosaccharomyces. Presumptive identification was confirmed by germ tube test and carbohydrate assimilation on API-ATB ID 32C (bioMerieux, France). Growth on Chromalbicans Agar was very useful for the presumptive identification of C. albicans isolates, and sensitivity and specificity values were significantly high (>97%), since a very low number of isolates were found to be false negative or false positive.

Cutaneous primary paracoccidioidomycosis.

Paracoccidioidomycosis is a common fungal infection in Latin America. Few cases have been described in non-endemic countries and their diagnosis without the correct suspicion, bearing in mind that the latency period might be up to 60 years, may not be easy. We report the case of a 59-year-old man who worked as a taxi driver for 25 years in Venezuela. Cutaneous paracoccidioidomycosis was diagnosed one year after he returned to Spain. No internal signs or symptoms of the disease were found and cell-mediated immunity showed no depression. Our case suggested us to consider direct cutaneous infection, although respiratory tract is believed to be the most frequent portal of entry for this infection.

[Determination of the in vitro antifungal susceptibility of clinically important yeasts using the Sensititre system]. / Determinación mediante el sistema Sensititre de la sensibilidad in vitro a los antifúngicos de levaduras de interés médico.

Using Sensititre (AccuMed, USA) we studied the in vitro antifungal activity of amphotericin B, fluconazole, itraconazole, ketoconazole and 5-fluorocytosine against 250 clinical yeast isolates taken from different hospitals, including Candida (151 C. albicans, 15 C. krusei, 14 C. parapsilosis, 11 C. tropicalis, 10 C. glabrata, 4 C. guilliermondii, 3 C. rugosa, 2 C. viswanathii, 2 C. famata and 2 C. kefyr), Cryptococcus (32 C. neoformans and 1 C. laurentii), Trichosporon (2 isolates) and Rhodotorula rubra (1 isolate). All the strains were susceptible to amphotericin B and showed an MIC <1 mg/l. The susceptibility of C. albicans (MIC(90) <256 mg/l), C. krusei (MIC(90) <64 mg/l), C. glabrata (MIC(90) <64 mg/l) and C. neoformans (MIC(90) 32 mg/l) to fluconazole was lower (14% isolates being resistant and 16.8% susceptible depending on the dose). The largest number of strains resistant to itraconazole was observed in C. albicans and C. glabrata (17.2% resistant and 24% susceptible and susceptible depending on the dose, respectively). Ketoconazole and 5-fluorocytosine were not effective in vitro against 12.8% and 2%, respectively, of all the isolates studied. Nine C. krusei and seven C. neoformans (12.9%) showed dose-dependent susceptibility to 5-fluorocytosine.

Comparative study of the in vitro antifungal activity of bifonazole, naftifine and sertaconazole against yeasts.

The in vitro activity of three antifungal agents was tested and compared against 151 yeast strains, including ten Candida species, Cryptococcus neoformans, Rhodotorula rubra, and Trichosporon cutaneum. Minimum inhibitory concentrations (MICs) were determined by a microdilution technique in Shadomy modified liquid medium. The mean MICs of sertaconazole (0.34 mg/L) were lower than those of naftifine (16.3 mg/L) and bifonazole (13.2 mg/L). These results suggest that sertaconazole is more active against Candida spp than other topical agents such as bifonazole and naftifine.

Multicenter evaluation of Neo-Sensitabs, a standardized diffusion method for yeast susceptibility testing.

The agar diffusion method Neo-Sensitabs for sensitivity testing, was evaluated with 33 reference strains by fourteen laboratories. Tablets with 5-fluorocytosine, amphotericin B, nystatin, fluconazole, itraconazole, ketoconazole and tioconazole were used on Shadomy modified medium. These tests classify each strain as susceptible, intermediate or resistant to all tested antifungals by measuring the inhibition zone diameters. Intra and interlaboratory reproducibility was studied. Neo-Sensitabs sensitivity for fungi was easy to perform and reliable method with a reproducibility of 97.1% and superior to other commercialized methods, being specially interesting for antifungal susceptibility in vitro testing of triazole derivatives fluconazole and itraconazole.

Potential salmon sperm origin of the E3 region insert of the adenovirus 5 dl309 mutant.

The plasmid pJM17 is a commonly used adenoviral backbone derived from the dl309 mutant virus. It contains unknown sequences inserted in the E3 region during construction of the dl309 mutant. Complete description of the backbone sequence is required for interpretation of potential vector effects and for regulatory approval of a vector to be used in clinical trials. The anonymous E3 insert was sequenced and analyzed. The insert fragment is 646 base pairs (bp) long and is 100 bp shorter than the vector sequences it replaces. It interrupts the expression of the E3B 10.4K, 14.6K, and 14.7K genes, but not the E3A glycoprotein (gp) 19K gene. Sequence analysis and Southern blotting suggest that the insert might originate from salmon sperm DNA used as carrier during the construction of dl309. Transcription from the insert was not detected by Northern blot analysis of vector-transduced cells but was detected by reverse transcriptase polymerase chain reaction.