Patient Blood Management in Liver Transplant-A Concise Review.

Transfusion of blood products in orthotopic liver transplantation (OLT) significantly increases post-transplant morbidity and mortality and is associated with reduced graft survival. Based on these results, an active effort to prevent and minimize blood transfusion is required. Patient blood management is a revolutionary approach defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood while promoting patient safety and empowerment. This approach is based on three pillars of treatment: (1) detecting and correcting anemia and thrombocytopenia, (2) minimizing iatrogenic blood loss, detecting, and correcting coagulopathy, and (3) harnessing and increasing anemia tolerance. This review emphasizes the importance of the three-pillar nine-field matrix of patient blood management to improve patient outcomes in liver transplant recipients.

Eye Movements of Deaf Students in Expository Versus Narrative Texts.

Text comprehension, a daily academic activity in primary and secondary school, is especially challenging for deaf or hard of hearing (DHH) students. The present study analyzed the effect of text genre (narrative vs. expository) on accuracy and eye-movement patterns during text comprehension by DHH students (ages 9-15 years) when compared to a typically hearing (TH) control group matched for chronological age. Comprehension accuracy was found to be similar across text genres for both groups, though TH participants outperformed DHH participants. Regarding eye movements, both groups spent more time and made more regressive fixations in the expository text than in the narrative text, but DHH participants showed longer saccade amplitude in the expository than in the narrative, which could be interpreted as indicating better self-regulation of DHH readers in the easiest and more familiar narrative text structure.

Enhancing Joint Attention Skills in Children on the Autism Spectrum through an Augmented Reality Technology-Mediated Intervention.

In the present study, the effects of an intervention based on an augmented reality technology called Pictogram Room were examined. The objective of the intervention was to improve the responding to joint attention (RJA) skills of gaze following and pointing in six children on the autism spectrum between 3 and 8 years old. A multiple baseline single-subject experimental design was conducted for 12 weeks in a school setting. Results indicated that all of the participant children improved performance in RJA following the intervention. Improvements were maintained over time and generalised to real-world situations. These findings demonstrate that autistic children can improve their RJA skills with a targeted and engaging intervention based on an accessible augmented reality technology tool.

Did the three little pigs frighten the wolf? How deaf readers use lexical and syntactic cues to comprehend sentences.

BACKGROUND: The ways in which students with deafness process syntactic and semantic cues while reading sentences are unclear. While some studies have supported the preference for semantic cues, others have not. AIM: To examine differences in the processing of syntactic versus semantic cues during sentence reading among students who are deaf or hard of hearing (DHH). METHOD: Twenty DHH students (mean age = 12.48 years) and 20 chronologically age-matched students with typical hearing (TH) were asked to read sentences written in Spanish with different grammatical structures and to choose the picture that best matched the sentences' meaning while their eye movements were being registered. The picture options were manipulated so that, in addition to the correct ones, there were lexical distractors and syntactic distractors. RESULTS: The TH participants outperformed the DHH participants in reading complex sentences but not simple sentences in the active voice. In the correctly answered trials, both groups fixated longer and made more fixations on the target than on the syntactic distractor than on the lexical distractor. DHH participants made significantly longer fixations on the lexical distractions. CONCLUSIONS: Our results did not support a strict preference for either lexical or semantic cues in the DHH participants.

Revisiting the relationship between traffic accidents, real economic activity and other factors in Spain.

This paper analyzes the relationship between road traffic accidents and real economic activity in Spain, using data on accidents, fatalities and injuries from January 1975 to December 2016. Our results show the historical asymmetric cyclical behavior of traffic accidents variables. This relationship is more evident for accidents and injuries, while fatalities have shown a different pattern since 2002. Besides using aggregate data, we have analyzed urban and nonurban accidents separately. We analyze the effect of economic variables, public policy interventions and other potential factors affecting traffic series. Regarding policy interventions, we confirm a permanent reduction in all accident rates associated with the mandatory use of seatbelts on car passengers since 1992. However, the penalty points system introduced in July 2006 has only had temporary effects. We have also shown the effect of economic variables such as Industrial Production Index, gasoline and diesel consumption and registration of new vehicles and, as a novelty, the benefits of using the composite coincident and leading indicators of the Spanish economy.

Time-Course of Grammatical Processing in Deaf Readers: An Eye-Movement Study.

Twenty participants who were deaf and 20 chronological age-matched participants with typical hearing (TH) (mean age: 12 years) were asked to judge the correctness of written sentences with or without a grammatically incongruent word while their eye movements were registered. TH participants outperformed deaf participants in grammaticality judgment accuracy. For both groups, First Pass and Total Fixation Times of target words in correct trials were significantly longer in the incongruent condition than in the congruent one. However, whereas TH students showed longer First Pass in the target area than deaf students across congruity conditions, deaf students made more fixations than their TH controls. Syntactic skills, vocabulary, and word reading speeds (measured with additional tests) were significantly lower in deaf students but only syntactic skills were systematically associated to the time-course of congruity processing. These results suggest that syntactic skills could have a cascading effect in sentence processing for deaf readers.

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management.

Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management ('theranostic' approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration.

Bedside Breath-Wise Visualization of Bronchospasm by Electrical Impedance Tomography Could Improve Perioperative Patient Safety: A Case Report.

Bronchospasm appears in up to 4% of patients with obstructive lung disease or respiratory infection undergoing general anesthesia. Clinical examination alone may miss bronchospasm. As a consequence, subsequent (mis)treatment and ventilator settings could lead to pulmonary hyperinflation, hypoxia, hypercapnia, hypotension, patient-ventilator asynchrony, volutrauma, or barotrauma. Electrical impedance tomography (EIT), a new noninvasive technique, can potentially identify bronchospasms by determining regional expiratory time constants (τ) for each one of the pixels of a functional EIT image. We present the first clinical case that highlights the potential of breath-wise EIT-based τ images of the lung to quickly identify bronchospasm at the bedside, which could improve perioperative patient management and safety.

Evaluation of a Mapleson D CPAP system for weaning of mechanical ventilation in pediatric patients.

BACKGROUND: Over the last years, we have used a flow-inflating bag circuit with a nasotracheal or nasopharyngeal tube as an interface to deliver effective CPAP support in infants ("Mapleson D CPAP system"). The primary goal of this study was to assess the usefulness of the "Mapleson D CPAP system" for weaning of mechanical ventilation (MV) in infants who received MV over 24 h. MATERIALS AND METHODS: All infants who received MV for more than 24 h in the last year were enrolled in the study. Demographic data included age, gender, weight, and admission diagnosis. Heart rate, respiratory rate, blood pressure, and oxygen saturation were measured during MV, 2 h after the nasotracheal Mapleson D CPAP system and 2 h after extubation. Patients were classified into two groups: patients MV more than 48 h, and patients with MV fewer than 48 h. P < 0.05 was considered statistically significant. RESULTS: A total of 50 children were enrolled in the study, with a median age was 34 ± 45 months (range, 1-59 months) and median weight was 11.98 ± 9.31 kg (range, 1-48 kg). Median duration of MV was 480 h (range, 2-570). There were no significant differences in PaO2, PaCO2, and pH among MV, 2 h after the nasotracheal Mapleson D CPAP system and 2 h after extubation and spontaneous ventilation with the nasopharyngeal Mapleson D CPAP system or with nasal prongs. The overall extubation failure rate was 26% (n = 13). Weight and age were significantly associated with extubation failure (P < 0.05). CONCLUSIONS: The Mapleson D CPAP system, in our opinion, is a useful and safe alternative to more complex and expensive noninvasive CPAP and BiPAP weaning from MV in infants.

In vitro thromboelastometric evaluation of the efficacy of frozen platelet transfusion.

BACKGROUND: Although frozen platelets are extensively used in remote locations and military environments, scientific evidence of their efficacy is scarce. The objective of this study was to evaluate the in vitro hemostatic efficacy of frozen versus fresh platelet transfusions by rotational thromboelastometry (ROTEM) to ascertain whether the freezing and thawing process impaired platelet contribution to clot strength. METHODS: An experimental study was performed using platelet in vitro transfusions. Blood samples were collected from 12 patients with non-autoimmune thrombocytopenia. The samples were each transfused with one of 6 pairs of fresh platelet concentrates and platelet concentrates frozen with dimethylsulfoxyde. Optical platelet counts, coagulation studies and ROTEM (EXTEM and FIBTEM) were performed for the baseline and the post-transfusion samples. RESULTS: Only fresh platelet transfusions significantly increased the EXTEM maximum clot firmness (MCF) and maximum clot elasticity (MCE) over baseline (p<0.001), achieving values within the normal range. The frozen platelet contribution to MCE was negligible. However, the EXTEM clotting time (CT) was significantly (p<0.001) shorter after the frozen platelet transfusion compared with the fresh platelet transfusion. The EXTEM clot formation time (CFT) was significantly shortened after the transfusion of fresh platelets (p=0.002). CONCLUSION: The ROTEM analysis assessment indicates a dual effect in frozen platelet transfusion: it produces a hypercoagulable state (shortening of CT), and a second, more predominant effect of frozen platelets' functionality impairment compared with fresh platelets (shorter MCF/MCE and longer CFT).

Who do you refer to? How young students with mild intellectual disability confront anaphoric ambiguities in texts and sentences.

Along 2 experiments we tested the anaphoric pronoun resolution abilities of readers with intellectual disability in comparison with chronological and reading age-matched groups. In Experiment 1, the anaphor test of Elosúa, Carriedo, and García-Madruga (2009) confirmed that readers with intellectual disability (ID) are slower than control readers resolving clitic anaphoric pronouns, especially when the use of morphological cues (e.g. gender) is necessary. In order to test if the poor performance could be due to low levels of metacognitive skills during reading, an inconsistency detection task combined with eye tracking was designed in Experiment 2. Participants read short texts with an anaphoric pronoun in the fifth sentence, either morphologically (gender) consistent or not with the information provided in the second sentence. The scores in the anaphor comprehension questions presented after the text confirmed that readers with ID are affected by the gender inconsistency but they are unable to explicitly report it and recover from it, as the number of re-fixations after reading the critical sentence suggests. As their answers to the explicit detection questions showed, the adults control group did not show any preference for morphosyntax or semantics in spite of being aware of the inconsistency. In sum, both groups of readers with and without ID are affected by inconsistencies, but ID readers do not have appropriate metacognitive skills to explicitly identify the source of the inconsistency and fix it.

Easy-to-read texts for students with intellectual disability: linguistic factors affecting comprehension.

BACKGROUND: The use of 'easy-to-read' materials for people with intellectual disabilities has become very widespread but their effectiveness has scarcely been evaluated. In this study, the framework provided by Kintsch's Construction-Integration Model (1988) is used to examine (i) the reading comprehension levels of different passages of the Spanish text that have been designed following easy-to-read guidelines and (ii) the relationships between reading comprehension (literal and inferential) and various linguistic features of these texts. METHOD: Sixteen students with mild intellectual disability and low levels of reading skills were asked to read easy-to-read texts and then complete a reading comprehension test. The corpus of texts was composed of a set of forty-eight pieces of news selected from www.noticiasfacil.es, a Spanish digital newspaper that publishes daily journalistic texts following international guidelines for the design of easy-to-read documents (IFLA, Tronbacke B. (1997) Guidelines for Easy-to-read Materials. IFLA, The Hague). RESULTS: Participants correctly answered 80% of the comprehension questions, showing significantly higher scores for literal questions than for inferential questions. The analyses of the texts' linguistic features revealed that the number of coreferences was the variable that best predicted literal comprehension, but contrary to what the previous literature seemed to indicate, the relationship between the two variables was inverse. In the case of inferential comprehension, the number of sentences was a significant negative predictor; that is, the higher the sentence density, the lower the ability of these students to find relationships between them. The effects of the rest of linguistic variables, such as word frequency and word length, on comprehension were null. CONCLUSIONS: These results provide preliminary empirical support for the use of easy-to-read texts but bring into question the validity of some popular design guidelines (e.g. augmenting word frequency) to optimally match texts and reading levels of students with intellectual disability. Two factors are suggested as contributing to the effect of sentence density on inferential comprehension: (i) long texts present higher conceptual density, so there are more ideas to store, retrieve and integrate, which increases the demand on inferential reasoning and (ii) long texts are perceived as difficult, which affects reading motivation and, consequently, induces passive reading strategies. The need for further research to elucidate the origin of our main findings with a larger and more heterogeneous sample of students with intellectual disability is highlighted.

Towards text simplification for poor readers with intellectual disability: when do connectives enhance text cohesion?

Cohesive elements of texts such as connectives (e.g., but, in contrast) are expected to facilitate inferential comprehension in poor readers. Two experiments tested this prediction in poor readers with intellectual disability (ID) by: (a) comparing literal and inferential text comprehension of texts with and without connectives and/or high frequency content words (Experiment 1) and (b) exploring the effects of type and familiarity of connectives on two-clause text comprehension by means of a cloze task (Experiment 2). Neither the addition of high frequency content words nor connectives in general produced inferential comprehension improvements. However, although readers with ID were less likely to select the target connective in the cloze task than chronologically age-matched readers (mean age=21 years) in general, their performance was affected by the type of connective and its familiarity. Familiarity had a facilitative effect for additive and contrastive connectives, but interfered in the case of temporal and causal connectives. The average performance of a reading level-matched control group (typically developing children) was similar to the group of readers with ID although the pattern of interaction between familiarity and type of connectives varied between groups. The implications of these findings for the adaptation of texts in special education contexts are discussed.

La mediación en los procesos de separación y/o divorcio / No disponible

En una serie de ciudades de nuestra geografía existen desde hace años Juzgados de Familia que se ocupan, con carácter exclusivo, de las cuestiones relacionadas con el Derecho de Familia. Dada la corta experiencia que tenemos en relación con la problemática que generan la separación y el divorcio, este artículo pretende despertar el interés de los profesionales en la búsqueda de alternativas a los procedimientos litigiosos. Es un campo de trabajo para el psicólogo en el que, en España, está casi todo por hacer (AU)

Técnicas de ahorro sanguíneo en cirugía: [revisión] / Blood-saving techniques in surgery: [review]

Introducción. Las transfusiones sanguíneas son un trasplante tisular con morbimortalidad y costos. Metodología. Se describen estrategias acordes a la literatura vigente con una revisión narrativa de los últimos diez años.Resultados y Conclusiones. Nos enfrentamos a pacientes añosos, con comorbilidades y para procedimientos complejos. Se deben racionalizar las transfusiones, protocolizando técnicas, mejorando las condiciones del paciente, disminuyendo las pérdidas sanguíneas operatorias, recuperando la sangre perdida y estableciendo la autodonación con un programa institucional.

Introduction. Blood transfusions are tissue transplants with morbimortality and costs involved. Methodology. A description of the strategies consistent with the current literature that offers a review of de last decade. Results and Conclusions. We have to deal with elderly patients with comorbidities who will undergo complex procedures. Blood transfusions must be streamlined, thorugh the development of technical protocols, improving the patient’s condition, decreasing operative blood loss, recovering any blood losses and establishing an institutional program for autologous blood donation.

C-reactive protein in the diagnosis of postoperative infection in pediatric patients: a prospective observational study of 103 patients.

BACKGROUND: Surgical stress elicits a systemic inflammatory response syndrome that contributes to the development of septic complications. C-reactive protein (CRP) is an acute phase protein released in inflammatory states. To analyze the usefulness of CRP as a marker of infection in surgical pediatric patients, we analyzed its kinetics in these patients in comparison with usual markers, such temperature, leukocytes, or fibrinogen. METHODS: One hundred three pediatric patients undergoing major surgery were enrolled consecutively in this observational study. C-reactive protein, leukocytes, neutrophils, platelets, fibrinogen, glycemia, and temperature were determined daily after surgery. Patients were classified as infected or not infected. Sensitivity, specificity, positive predictive value, negative predictive value, efficiency, precocity, positive likelihood ratio, and number of subjects to be treated were calculated. RESULTS: Peak in CRP was detected at 48 ± 24 hours. C-reactive protein was higher in the infected group from the first day, with significant differences between groups from the second day. Best cutoff for detecting infection was increases in CRP of 11 mg/dL in 48 hours, with a sensitivity of 87%, specificity of 89%, precocity of 1.7 days (0.82-2.54), number of subjects to be treated of 1.7 (1.4-2.6), and positive likelihood ratio of 7.9. Application of other markers alone or in combination did not surpass the sensitivity, specificity, or precocity for increases in CRP of 11 mg/dL in 48 hours. CONCLUSIONS: Increases of CRP constitute an easy and cheap prognostic alert system and may be used to establish strategies aimed to detect infection in surgical pediatric patients.