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Forecasting vineyard yield with accuracy is one of the most important trends of research in viticulture today. Conventional methods for yield forecasting are manual, require a lot of labour and resources and are often destructive. Recently, image-analysis approaches have been explored to address this issue. Many of these approaches encompass cameras deployed on ground platforms that collect images in proximal range, on-the-go. As the platform moves, yield components and other image-based indicators are detected and counted to perform yield estimations. However, in most situations, when image acquisition is done in non-disturbed canopies, a high fraction of yield components is occluded. The present work’s goal is twofold. Firstly, to evaluate yield components’ visibility in natural conditions throughout the grapevine’s phenological stages. Secondly, to explore single bunch images taken in lab conditions to obtain the best visible bunch attributes to use as yield indicators. In three vineyard plots of red (Syrah) and white varieties (Arinto and Encruzado), several canopy 1 m segments were imaged using the robotic platform Vinbot. Images were collected from winter bud stage until harvest and yield components were counted in the images as well as in the field. At pea-sized berries, veraison and full maturation stages, a bunch sample was collected and brought to lab conditions for detailed assessments at a bunch scale. At early stages, all varieties showed good visibility of spurs and shoots, however, the number of shoots was only highly and significantly correlated with the yield for the variety Syrah. Inflorescence and bunch occlusion reached high percentages, above 50 %. In lab conditions, among the several bunch attributes studied, bunch volume and bunch projected area showed the highest correlation coefficients with yield. In field conditions, using non-defoliated vines, the bunch projected area of visible bunches presented high and significant correlation coefficients with yield, regardless of the fruit’s occlusion. Our results show that counting yield components with image analysis in non-defoliated vines may be insufficient for accurate yield estimation. On the other hand, using bunch projected area as a predictor can be the best option to achieve that goal, even with high levels of occlusion.

In a historical retrospective, although the existing literature calls the management consulting industry an extraordinary sector and a unique phenomenon in the business context, in fact these statements are not accompanied by a number of academic studies that emphasize the importance of the effective management consultant’s work. To battle the lack of studies in this emerging area, this article aims to understand the most important factors from the perspective of consultants and managers to build successful relationships in management consulting projects. Semi-structured interviews and questionnaires were conducted to management consultants and SME managers. Our findings suggests competence and experience of consultants, their ability to understand clients, their professionalism and credibility, the transparency of the processes, values and goals they can put in the performance of their work are the five key factors for building successful relationships.

Background Global Asthma Network (GAN) was established in 2012 as a development to the International Study of Asthma and Allergies in Childhood to improve asthma care globally.Objective To survey asthma, allergic rhinitis and atopic dermatitis in primary and secondary school children and to investigate and evaluate its prevalence, severity, management and risk factors in Mexico.Methods GAN Phase I is a cross-sectional, multicentre survey carried out in 15 centres corresponding to 14 Mexican cities throughout 2016–2019 using the validated Spanish language version of the GAN Phase I questionnaires. The questionnaires were completed by parents of 6–7-year-old primary school pupils (school children) and by 13–14-year-old adolescents.Results A total of 35 780 school children and 41 399 adolescents participated. Wheezing ever prevalence was 26.2% (95% CI 25.8% to 26.7%) in school children and 23.9% (95% CI 23.4% to 24.3%) in adolescents. The corresponding frequencies for current wheeze were 10.2% (95% CI 9.9% to 10.5%) and 11.6% (95% CI 11.2% to 11.9%). In school children, the risk factors for current wheeze were rhinitis (OR 4.484; 95% CI 3.915% to 5.134%) and rash symptoms (OR 1.735; 95% CI 1.461% to 2.059%). For adolescents, rhinitis symptoms (OR 3.492; 95% CI 3.188% to 3.825%) and allergic rhinitis diagnosis (OR 2.144; 95% CI 1.787% to 2.572%) were the most significant. For both groups, there was a negative relation with centres’ sea level altitude higher than 1500 m above mean sea level (p

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.

Los centros de detención y tortura de la dictadura chilena han desaparecido o están desapareciendo. Con ello, las memorias de dichos lugares parecen asimismo perderse. Sostendremos aquí, no obstante, que la desaparición física de los lugares no implica la pérdida de todo rastro, puesto que su recuerdo subsiste a través de otros medios, como la tradición oral. Exploramos, en particular, la posibilidad de que sean los relatos de actividad sobrenatural, los así llamados “cuentos de fantasmas”, los que sirvan de escenario público de la memoria social, permitiendo que esta sea convocada.

3D objects (artifacts) are made to fulfill functions. Designing an object often starts with defining a list of functionalities or affordances (action possibilities) that it should provide, known as functional requirements. Today, designing 3D object models is still a slow and difficult activity, with few Computer-Aided Design (CAD) tools capable to explore the design solution space. The purpose of this study is to explore shape generation conditioned on desired affordances. We introduce an algorithm for generating voxelgrid object shapes which afford the desired functionalities. We follow the principle form follows function, and assume that object forms are related to affordances they provide (their functions). First, we use an artificial neural network to learn a function-to-form mapping from a dataset of affordance-labeled objects. Then, we combine forms providing one or more desired affordances, generating an object shape expected to provide all of them. Finally, we verify in simulation whether the generated object indeed possesses the desired affordances, by defining and executing affordance tests on it. Examples are provided using the affordances contain-ability, sit-ability, and support-ability.

Wave energy is one of the most powerful sources of energy on our planet, but its exploitation is difficult. Much current research on renewable energy is focused on how to harness ocean energy. However, wave energy converter (WEC) technology is still immature and how to reach high levels of efficiency is still unknown. In coming years, this field is likely to reach a high level of development, so it is important to continue research on the improvement of the performance of these devices. One of the most important wave energy converters is the oscillating water column (OWC). The main difficulty of OWCs is that they have to provide good rates of hydrodynamic efficiency for many different types of sea states (different periods, heights, wavelengths, etc.). The other big concern is the optimization of the geometric parameters of the device. This research paper is focused on these two big concerns: how oceanographic parameters affect the hydrodynamic behavior of an OWC and its geometric optimization. Different studies about how wave and geometric characteristics affect the performance of an OWC are reviewed and relationships between these and the hydrodynamic performance of an OWC are finally outlined and summed up.

This article seeks to define the basic concepts and levels of analysis must be, from an organizational perspective, the study of the processes of governance at the local level. The operation is explained on the assumption that results from the actions of members of various public organizations in the three levels of government. This process of interaction is the product of social transformations, greater electoral competition locally, and the decentralization of federal government spending.

Resumo: Introdução: Fatores comportamentais e emocionais são desencadeantes de eventos cardiovasculares (ECV). Permanece incerto se espetadores de jogos de futebol, em particular indivíduos com doença arterial coronária (DAC), estão expostos a maior risco de ECV. Objetivos: Avaliar o efeito da assistência a jogos de futebol em doentes com DAC na incidência de ECV de acordo com o resultado obtido pela equipa de apoio. Métodos: Avaliados prospetivamente 82 adeptos de futebol do sexo masculino com antecedentes de síndrome coronária aguda, durante 23 jogos de futebol da época 2015/2016. Cada indivíduo foi monitorado com Holter no dia do jogo da sua equipa e em dia controlo em período homólogo à hora do jogo. Avaliado como endpoint primário o composto de morte, acidente vascular cerebral, re‐enfarte, angor ou arritmias mantidas. Avaliados ainda como endpoints secundários, episódios de disritmia supraventricular ou ventricular não mantida e frequência cardíaca média. Resultados: A idade média foi 61 ± 10 anos. Comparado com o dia controlo, apesar do aumento significativo da frequência cardíaca na hora de jogo (p < 0,001) que foi independente do resultado (p > 0,97), o número de eventos cardiovasculares não foi diferente tendo em conta o resultado (p > 0,05). Também o número de episódios de disritmia supraventricular e ventricular não mantida não foi diferente estratificando de acordo com o resultado (p > 0,05). Conclusão: O resultado do jogo não se associou a diferente incidência de eventos cardiovasculares em doentes com substrato isquémico e arrítmico por antecedentes de DAC que assistiram a jogos de futebol na televisão. Abstract: Introduction: Behavioral and emotional factors are triggers of cardiovascular events (CVEs). It is uncertain whether soccer fans, particularly individuals with coronary artery disease (CAD), are at increased risk for CVEs. Objectives: To assess the effect of watching soccer matches in patients with known CAD on the incidence of CVEs according to the match result. Methods: We prospectively assessed 82 male soccer fans with a history of acute coronary syndrome during 23 matches of the 2015/2016 season. Each individual was assessed by Holter monitoring on the day of their team's match and on the control day. The primary endpoint was the composite of death, stroke, reinfarction, angina or sustained arrhythmia. Secondary endpoints assessed were episodes of non‐sustained supraventricular or ventricular arrhythmia and mean heart rate (HR). Results: Participants’ mean age was 61 ± 10 years. Compared with the control day, despite a significant increase in HR (p 0.97), the number of CVEs did not differ according to the result (p > 0.05). Moreover, the number of non‐sustained episodes of supraventricular and ventricular arrhythmia did not differ when stratified according to the match result (p > 0.05). Conclusions: The match result was not associated with a difference in incidence of CVEs in patients with a past history of CAD, with ischemic and arrhythmic substrate, who watched soccer matches on television. Palavras‐chave: Eventos cardiovasculares, Futebol, Stresse, Keywords: Cardiovascular events, Soccer, Stress

Introduction: Renal insufficiency, as evidenced by an increase in creatinine, is associated with higher mortality in patients with acute heart failure (AHF). Conversely, hemoconcentration (HC) in AHF is associated with lower mortality, but can also cause an increase in creatinine. Our aim was to assess the prognosis of HC in patients hospitalized for AHF presenting with or without worsening renal function (WRF). Methods: A total of 618 consecutive patients admitted for AHF were included. WRF was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria and HC was defined as an elevation of hemoglobin during hospitalization compared to the admission value. Six-month all-cause mortality was analyzed. Results: The patients’ mean age was 79±11 years; 58% were women. Mortality at six months was 38% and 49% of patients had WRF. HC occurred in 38.9% of patients with WRF and was associated with improved survival (HR 1.6, 95% CI 1.10-2.34; p=0.02) compared to WRF without HC. HC was associated with better survival in KDIGO stages 1 and 2 (HR 1.8; 95% CI 1.1-2.8; p=0.01). For patients without chronic kidney disease (CKD) with WRF in stages 1 and 2, HC was associated with significantly better survival (HR 2.3; 95% CI 1.2-4.2; p=0.01). Conclusion: In patients admitted for AHF without renal failure or CKD, WRF with HC is associated with a better prognosis, similar to that of patients without WRF, and should therefore be reclassified as ‘pseudo-WRF’. Resumo: Introdução: Alterações na função renal com aumento da creatinina têm sido associadas a maior mortalidade em doentes com insuficiência cardíaca aguda (ICA). Já a hemoconcentração na ICA tem-se associado a redução da mortalidade, é também uma causa de elevação da creatinina. Avaliar o prognóstico da hemoconcentração (HC) em doentes hospitalizados por ICA com e sem agravamento da função renal (AFR). Métodos: Analisados 618 doentes consecutivos admitidos por ICA. Definido agravamento da função renal de acordo com os critérios KDIGO e HC como elevação da hemoglobina durante a hospitalização comparativamente à admissão. Avaliada morte por qualquer causa aos seis meses. Resultados: A idade média foi 79 ± 11 anos; 58% mulheres. A mortalidade aos seis meses foi de 38%; 49% dos doentes tiveram AFR. HC ocorreu em 38,9% dos doentes com AFR e associou-se a maior sobrevivência após ajuste de fatores demográficos e comorbilidades (HR 1,6; IC95%: 1,06–2,33; p=0,026), comparativamente a AFR sem HC. Na avaliação por estádios KDIGO, HC associou-se a maior sobrevivência nos estádios 1 e 2 (HR 1,8; IC95%: 1,1–2,8; p=0,01). Nos doentes com doença renal crónica (DRC) com AFR nos estádios 1 e 2, a HC esteve associada a maior sobrevivência (HR 2,3, IC95%: 1,2-4,2, p=0,01). Conclusão: Em doentes admitidos por ICA sem falência renal ou DRC, o AFR com HC está associada a bom prognóstico. O seu prognóstico é similar a doentes sem AFR e deverá assim ser reclassificado como «pseudo-AFR». Keywords: Cardiorenal syndrome, Worsening renal function, Hemoconcentration, Palavras-chave: Síndrome cardiorrenal, Agravamento da função renal, Hemoconcentração

Background: A urethral diverticulum (UD) constitutes a localised saccular dilation that forms out of any point in the urethra’s length, contiguous with the true urethral lumen through an orifice with a variable size neck. Disturbance of urine drainage from this outpouching leads to urinary stasis, recurrent urinary tract infections, lithiasis formation, an increase in UD size, urinary leakage or fistulas, incontinence, or even a palpable penoscrotal mass. UD occurs far more frequently in women and is very rare in men, with the incidence and prevalence in males remaining largely unknown. Objective: The purpose of this paper is to present an updated review of acquired male UD, according to clinical presentation, diagnostic imaging findings, management, complications, and outcomes. Material and Methods: Literature searches were conducted using Medline, Embase, and Cochrane databases in June 2015 to identify papers related to acquired male UD, concerning type, aetiology, presentation, radiologic and/or surgical intervention, and outcomes. Discussion: The most common symptoms are obstructive lower urinary tract symptoms along with haematuria. Additionally, both congenital and acquired diverticula at the penoscrotal angle are frequent. Diagnosis alternates between physical examination and specific imaging, with individualised treatment now being standard practice varying with the location and size of the diverticulum. Besides conservative and observational follow-up, endoscopic and open surgical techniques are the selected definitive management options. Conclusion: An acquired male UD is rare and must be considered in the differential diagnosis of suspicious penile and scrotal masses. If there is significant urinary stasis, recurrent urinary tract infections, or urethral calculi, a rigorous and thorough clinical examination followed by surgical correction is most often standard procedure, allowing for treatment of symptoms and aetiology simultaneously. Reconstructive urethral surgical corrections are very complex and require a specialised approach, often found only in high-volume surgical centres.

El objetivo del presente ensayo es reflexionar sobre la evolución del concepto de Educación Intercultural y su posible inserción en los ambientes escolares latinoamericanos. Para tal fin, se contrastan y comparan los conceptos esbozados por autores representativos del pluralismo cultural con el fin de establecer las similitudes y divergencias entre las diferentes perspectivas del debate. Se inicia analizando el paso de la idea de multiculturalismo a la interculturalidad. Luego se abordan perspectivas en torno ala Educación InterculturalLatinoamericana. Finalmente se reflexiona sobre los Enfoques Decoloniales dela Educación Interculturalen Latinoamérica. Se concluye que la interculturalidad apuesta por la recuperación de cosmovisiones marginadas por la modernidad y la creación de metarrelatos con otros significados y percepciones de la realidad. Por esa razón, es una perspectiva fundamental para combatir dinámicas escolares excluyentes que contribuyen al mantenimiento de estructuras sociales inequitativas.

Abstract Background The canonical code, although prevailing in complex genomes, is not universal. It was shown the canonical genetic code superior robustness compared to random codes, but it is not clearly determined how it evolved towards its current form. The error minimization theory considers the minimization of point mutation adverse effect as the main selection factor in the evolution of the code. We have used simulated evolution in a computer to search for optimized codes, which helps to obtain information about the optimization level of the canonical code in its evolution. A genetic algorithm searches for efficient codes in a fitness landscape that corresponds with the adaptability of possible hypothetical genetic codes. The lower the effects of errors or mutations in the codon bases of a hypothetical code, the more efficient or optimal is that code. The inclusion of the fitness sharing technique in the evolutionary algorithm allows the extent to which the canonical genetic code is in an area corresponding to a deep local minimum to be easily determined, even in the high dimensional spaces considered. Results The analyses show that the canonical code is not in a deep local minimum and that the fitness landscape is not a multimodal fitness landscape with deep and separated peaks. Moreover, the canonical code is clearly far away from the areas of higher fitness in the landscape. Conclusions Given the non-presence of deep local minima in the landscape, although the code could evolve and different forces could shape its structure, the fitness landscape nature considered in the error minimization theory does not explain why the canonical code ended its evolution in a location which is not an area of a localized deep minimum of the huge fitness landscape.

El objetivo del presente artículo es analizar el Programa Nacional para Áreas Naturales Protegidas en México del periodo 2014-2018, debido a que en éste se establecen los objetivos, acciones y metas que se pretendían alcanzar en materia de manejo y conservación de estos espacios. Para ello, se limitó el estudio al análisis de dos objetivos específicos del programa: “manejo integrado del paisaje” y “conservación y manejo de la biodiversidad”, así como los indicadores propuestos para este fin. Se encontró que el instrumento de política pública en su inicio eliminó, modificó y omitió diversos indicadores, los cuales son fundamentales para poder medir de manera imparcial estos dos objetivos. Con la exclusión de ellos, el programa eliminó información fundamental que podría ayudar a comprender el nivel de conservación de las Áreas Naturales Protegidas. Principalmente se dejaron fuera indicadores para calcular los cambios en la cubierta vegetal, representatividad de los ecosistemas, riesgos generados por las actividades humanas y pérdida de biodiversidad.

The focus of research in biped locomotion has moved toward real-life scenario applications, like walking on uneven terrain, passing through doors, climbing stairs and ladders. As a result, we are witnessing significant advances in the locomotion of biped robots, enabling them to move in hazardous environments while simultaneously accomplishing complex manipulation tasks. Yet, considering walking in an unknown environment, the efficiency of humanoid robots is still far from being comparable with the human. Currently, bipeds are very sensitive to external changes and they have severe constraints for adaptation of walk to conditions from such a complex environment. Promising approaches for efficient generation and realization of walking in a complex environment are based on biological solutions that have been developed for many years of evolution. This work presents one such human-inspired methodology for path planning and realization of biped walk appropriate for motion in a complex unfamiliar environment. Path planning results in calculating clothoid curves that represent well the human-like walking path. The robot walk is realized by the composition of parametric motion primitives. Such an approach enables on-line modification of planned path and walk parameters at any moment, instantly. To establish the relationship between high-level path planner and the low-level joint motion realization, we had to find a way to extract the parameters of the clothoid paths that can be linked with the parameters of the walk and consequently to motion primitive parameters. This enabled the robot to adopt its walking for avoiding the obstacles and for a smooth transition between different paths. In this paper we provide a complete framework that integrates the following components: (i) bio-inspired online path planning, (ii) path-dependent automatic calculation of high-level gait parameters (step length, walking speed, direction, and the height of the foot sole), and (iii) automatic calculation of low-level joint movements and corresponding control terms (driving motor voltage) through the adaptation of motion primitives which realize walking pattern and preserves the dynamic balance of the robot.

El presente escrito parte propone que el modo en que se constituyen los centros de detención y/o tortura de la dictadura militar chilena es el de la reconfiguración. Por “reconfiguración” se entenderá el proceso por el cual a un inmueble se le altera, por una parte, su finalidad y sentido, y por otra, se interviene su infraestructura. Es así como estadios, universidades, liceos y colegios, hospitales, etc., pasaron a ser parte del enorme contingente de 1.168 centros de detención y/o tortura que operaron durante la dictadura. A la luz de los testimonios de los prisioneros que fueron encerrados en dichos lugares, se intenta establecer la forma en que se les involucró en dichos procesos de reconfiguración y la manera en que esto los afectó, dando lugar a otra forma de suplicio.

Biofilms on food-contact surfaces can lead to recurrent contamination. This work aimed to study the biofilm formation process on stainless steel plates used in the dairy industry: 304 surface finish 2B and electropolished; and the effect of a cleaning and disinfection process using alkaline (AEW) and neutral (NEW) electrolyzed water. Milk fouling during heat processing can lead to type A or B deposits, which were analyzed for composition, surface energy, thickness, and roughness, while the role of raw milk microbiota on biofilm development was investigated. Bacteria, yeasts, and lactic acid bacteria were detected using EUB-338, PF2, and Str-493 probes, respectively, whereas Lis-637 probe detected Listeria sp. The genetic complexity and diversity of biofilms varied according to biofilm maturation day, as evaluated by 16S rRNA gene sequence, denaturing gradient gel electrophoresis, and fluorescence in situ hybridization microscopy. From analysis of the experimental designs, a cleaning stage of 50 mg/L NaOH of AEW at 30 °C for 10 min, followed by disinfection using 50 mg/L total available chlorine of NEW at 20 °C for 5 min is a sustainable alternative process to prevent biofilm formation. Fluorescence microscopy was used to visualize the effectiveness of this process.

This paper describes how we tackled the development of Amaia, a conversational agent for Portuguese entrepreneurs. After introducing the domain corpus used as Amaia’s Knowledge Base (KB), we make an extensive comparison of approaches for automatically matching user requests with Frequently Asked Questions (FAQs) in the KB, covering Information Retrieval (IR), approaches based on static and contextual word embeddings, and a model of Semantic Textual Similarity (STS) trained for Portuguese, which achieved the best performance. We further describe how we decreased the model’s complexity and improved scalability, with minimal impact on performance. In the end, Amaia combines an IR library and an STS model with reduced features. Towards a more human-like behavior, Amaia can also answer out-of-domain questions, based on a second corpus integrated in the KB. Such interactions are identified with a text classifier, also described in the paper.

During the economic and financial crisis, private and public organizations were subject to a constant reduction in costs and resources. Public shared service models felt compelled to adopt the Lean methodology with the aim of reducing costs, reducing waste and increasing employee satisfaction with the provision of quality services. Against this background, this article aims to evaluate the impact of the implementation of Shared Services and the inherent benefits of lean management in the Military Store, Contact Center, Post Office and Internal Portal used by the Portuguese Air Force. Using a case study methodology, this study portrays the elimination of waste and the optimization of existing human and financial resources. After the implementation in 2015, it is still possible now to verify that there is some resistance to change, and the fact that we are dealing with a hierarchical organization justifies this disadvantage. The implementation and operation of all services in their entirety allowed the optimization of resources and the simplification of processes, resulting in the elimination of duplicate tasks.

Object: Leptomeningeal Carcinomatosis (LCM) represents a state of systemic malignant disease with poor prognosis. The purpose of this study is to compare overall survival (OS) between intraventricular chemotherapy through Ommaya reservoir (OR) and chemotherapy through lumbar puncture (LP) in LCM.Patients and Methods: Forty adult patients with LCM were included. All patients underwent lumbar puncture and Magnetic resonance imaging (MRI). Thirty patients received chemotherapy through LP and 10 undergone colocation of Ommaya reservoir for intraventricular chemotherapy.Results: The most common symptom was headache (Present in 50%). The cranial nerves most affected were VI and VII. Leptomeningeal enhancement was the most frequent finding in MRI. The OS in the LP group was 4 months and Ommaya group was 9.2 months (p = 0.0006; CI:1.8-3), with statistical differences in favor to Intraventricular treatment. Proportional hazard regression showed that receiving chemotherapy through Ommaya reservoir was a protective factor (Hazard ratio = 0.258, Standard Error = 0.112, p = 0.002 and 95% CI 0.110-0.606). Using KPS as a factor did not affect the hazard ratio of Ommaya reservoir itself.Conclusions: OS was significantly higher in patients with Ommaya reservoir in spite of Karnofsky Performance Status (KPS) previous to chemotherapy. Therefore, intraventricular chemotherapy should be preferred over lumbar puncture chemotherapy administration if there are resources available.

Abstract Background: There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). Objectives: To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR. Methods: We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. We conducted a pooled relative risk meta-analysis of four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial infarction (MI) and target-vessel revascularization (TVR). Results: We identified 7 studies that included a total of 5,107 patients. A pooled meta-analysis showed no significant difference in mortality (relative risk [RR] = 1.44; 95% CI, 0.9-2.4), CV mortality (RR = 1.29; 95% CI = 0.4-4.3) and TVR (RR = 1.46; 95% CI = 0.9-2.3) after deferral of revascularization based on FFR between ACS and non-ACS patients. Such deferral was associated with significant additional risk of MI (RR = 1.83; 95% CI = 1.4-2.4) in ACS patients. Conclusion: The prognostic value of FFR in ACS setting is not as good as in stable patients. The results demonstrate an increased risk of MI but not of mortality, CV mortality, and TVR in ACS patients.

En el presente trabajo se presenta, de forma breve, la construcción de una pantalla vertical con micropilotes, ejecutada a fin de poder realizar una excavación de 20 m de altura para la edificación de un Hospital en Granada. Dicha pantalla fue instrumentada con inclinómetros y el trabajo presenta la interpretación de los resultados y diversas hipótesis sobre las propiedades geotécnicas, la rigidez de la pantalla y de los anclajes, etc., a fin de ajustar los resultados a los cálculos derivados de esas hipótesis. Finalmente se propone una ley de empujes para otros casos futuros y similares.

This study focuses on the effect on wood strength and natural durability of Eucalyptus globulus and Eucalyptus botryoides when subjected to heat treatments with low energy consumption. The objective was to improve the wood durability, without negatively impacting the strength properties. Six-year-old trees from Eucalyptus globulus and Eucalyptus botryoides were used. The samples were heat treated for 4 h conditioned to very low oxygen availability. A field test for assessing the resistance to termites and fungal degradation was conducted according to EN 252:1989/AC1:1989 Inspections were made every six months for 3 years. All the samples of Eucalyptus globulus showed signs of termite and microorganisms attack, most showing extensive galleries. Eucalyptus botryoides wood showed no sign of termite attack and only few traces of microrganisms presence. The wood bending strength was smaller upon thermal treatment for both species, decreasing 3.8% and 4.8% for Eucalyptus globulus and Eucalyptus botryoides, respectively. Overall the results are promising regarding some common utilizations, mainly floor coverings, decks, doors and door and window frames, fences (only for Eucalyptus botryoides), decorative arbors and pergolas (only for Eucalyptus botryoides), but excluding structural beams for building roofs or bridges due to the fragility of the wood treated thermally towards impacts.

Resumo: A pericardite purulenta é uma entidade rara, definida como a presença de derrame pericárdico neutrofílico infetado por um agente bacteriano, fungo ou parasita. O diagnóstico pode ser desafiante, especialmente se os doentes fizeram antibioterapia previamente; por outro lado, o reconhecimento dessa patologia é feito, muitas vezes, tardiamente, quando do aparecimento de sintomas graves ou sinais de tamponamento ou mesmo apenas na autópsia. Os autores descrevem o caso de uma mulher, 82 anos, com antecedentes de laceração extensa do membro inferior direito por mordedura de cão em julho de 2016, internada no Serviço de Cardiologia um mês depois por suspeita de pericardite aguda. Durante o internamento manteve picos febris recorrentes apesar da terapêutica com anti‐inflamatórios não esteroides e colchicina. Colheu rastreio sético e repetiu ecocardiograma, que revelou aumento do derrame pericárdico, sem sinais de compromisso hemodinâmico, e as hemoculturas revelaram a presença de Pasteurella multocida. Por suspeita clínica de pericardite purulenta fez pericardiocentese com drenagem de líquido compatível com exsudado e foi apresentada ao Serviço de Cirurgia Cardiotorácica para pericardiotomia e drenagem adequada do líquido purulento. O exame histológico confirmou o diagnóstico de pericardite aguda. De salientar que a Pasteurella é um agente muito frequente (50‐90%) no trato gastrointestinal e nasofaringe de muitos animais domésticos, nomeadamente cães.Os autores realçam a necessidade de tratar agressivamente essa patologia, uma vez que se não tratada a morte é inevitável. Abstract: Purulent pericarditis is a rare entity, defined as the presence of neutrophilic pericardial effusion which is infected by a bacterial, fungus or parasite agent. The diagnosis can be challenging, especially if patients have taken previous antibiotic therapy; on the other hand the recognition of this pathology is often made late, with the onset of severe symptoms or signs of cardiac tamponade or even only at the autopsy. The authors describe the case of a 82‐year‐old woman with history of extensive laceration of the right lower limb from a dog bite in July 2016, admitted to the Cardiology Department one month later for Acute Pericarditis. During hospitalization she maintained recurrent fever peaks despite the treatment with non‐steroidal anti‐inflammatory drugs and colchicine. She collected blood cultures and repeated echocardiogram showed increased pericardial effusion with no signs of hemodynamic compromise. Blood cultures revealed the presence of Pasteurella multocida. Due to clinical suspicion of purulent pericarditis, pericardiocentesis was performed with drainage of liquid compatible with exudate and the patient was presented to the Cardiothoracic Surgery Department for pericardiotomy and adequate drainage of the liquid. Histological examination confirmed the diagnosis of Acute Pericarditis. It should be noted that Pasteurella is a very frequent agent (50‐90%) in the gastrointestinal tract and nasopharynx of many domestic animals, namely dogs.The authors emphasize the need to aggressively treat this pathology, since untreated death is inevitable. Palavras‐chave: Pericardite purulenta, Pasteurella multocida, Keywords: Purulent pericarditis, Pasteurella multocida

Bos indicus (n = 67) and crossbred Bos taurus × Bos indicus (n = 67) bulls were finished in extensive or intensive conditions to evaluate the effect of genetic differences and finishing system on the fatty acid (FA) composition of intramuscular fat. Finishing system had a more pronounced effect on FA profiles than the genetic group, but the two factors often interacted for both individual and groups of FA. When compared with animals finished intensively, those finished on pasture produced meat with higher concentration of CLA and polyunsaturated n-3 FA, in particular of 18:3, 20:5 and 22:5. Meat from animals finished intensively had higher amounts of 14:0, 16:0, 18:1 trans-10, 18:1 trans-11, monounsaturated trans FA and 18:2. When the two genetic groups were compared under intensive finishing, B. indicus animals showed lower amounts of 20:4 (synthesised from 18:2) and 20:5 (synthesised from 18:3), suggesting that they may have a lower ability in biochemical pathways involved in the metabolism of n-6 and n-3 long chain fatty acids. Overall, meat from animals finished on pasture had a higher amount of the FA considered desirable for human health.

La importancia de la detección y de la intervención precoz en los trastornos del espectro autista (TEA) ha adquirido gran interés tanto para las sociedades profesionales como por la administración sanitaria. Con el propósito de facilitar la puesta en marcha de dispositivos de detección y de atención e intervención a edades tempranas de estos niños, es necesaria una información actualizada y sintetizada sobre los procedimientos de cribado y las técnicas de atención temprana para niños con TEA, reflejando los aspectos más relevantes que se deduzcan de las experiencias y estudios llevados a cabo hasta el momento. Tras la revisión realizada en nuestro estudio sobre las experiencias de detección precoz de autismo, se obtiene un grupo de consideraciones importantes, para realizar análisis críticos de programas de cribado en marcha así como recomendaciones para experiencias futuras. Así mismo, la revisión de los estudios sobre la eficacia de los programas de atención temprana nos proporciona una visión esperanzadora, indicando que éstos son cada vez más frecuentes, sistemáticos y metodológicamente más apropiados. Llevamos mucho camino recorrido, pero aún queda mucho por hacer.

En este texto se intenta una aproximación al tema de la tortura desde la perspectiva del cuerpo. De hecho, éste es un elemento central de la tortura, al punto de que se podría decir que en ella todo es cuerpo. Es un arma para los torturadores; el saber acerca del cuerpo es una herramienta tecnológica que puede ser usada para torturar, una suerte de traidor que hace vulnerables a las víctimas. El cuerpo de la víctima es lo dañado, aunque el daño se extiende también a su familia y al cuerpo social, a la comunidad de las víctimas. Palabras clave: tortura, cuerpo, dictadura, víctima, torturador

Entrevista a José Santos Herceg por Martín Ríos López

El presente texto busca poner en evidencia que en el último tiempo ha tenido lugar un desplazamiento en lo referente al modo de trabajo académico, en el sentido de que se ha instalado una concepción productiva del conocimiento que tiene consecuencias evidentes sobre el tipo de textos que se escriben y publican. Los académicos nos hemos ido convirtiendo —las instituciones nos han ido forzando a convertirnos— en productores, en el sentido de producir escritos de cierto tipo que deben publicarse en determinados medios. Los textos, por su parte, son concebidos como productos, con todo lo sorprendente que ello pueda parecer. Este artículo busca poner de manifiesto algunas consecuencias que ha tenido este cambio para la escritura académica y el trabajo intelectual en general.

We present an approach for quantitative assessment of the arm/hand movements in patients with Parkinson’s disease (PD), from sensor data acquired with a wearable, wireless armband device (Myo sensor). We propose new Movement Performance Indicators that can be adopted by practitioners for the quantitative evaluation of motor performance and support their clinical evaluations. In addition, specific Movement Performance Indicators can indicate the presence of the bradykinesia symptom. The study includes seventeen PD patients and sixteen age-matched controls. A set of representative arm/hand movements is defined under the supervision of movement disorder specialist. In order to assist the evaluations, and for progress monitoring purposes, as well as for assessing the amount of bradykinesia in PD, a total set of 84 Movement Performance Indicators are computed from the sensor readings. Subsequently, we investigate whether wireless armband device, with the use of the proposed Movement Performance Indicators can be utilized: (1) for objective and precise quantitative evaluation of the arm/hand movements of Parkinson’s patients, (2) for assessment of the bradykinesia motor symptom, and (3) as an adequate low-cost alternative for the sensor glove. We conducted extensive analysis of proposed Movement Performance Indicators and results are indicating following clinically relevant characteristics: (i) adequate reliability as measured by ICC; (ii) high accuracy in discrimination between the patients and controls, and between the disease stages (support to disease diagnosis and progress monitoring, respectively); (iii) substantial difference in comparison between the left-hand and the right-hand movements across controls and patients, as well as between disease stage groups; (iv) statistically significant correlation with clinical scales (tapping test and UPDRS-III Motor Score); and (v) quantitative evaluation of bradykinesia symptom. Results suggest that the proposed approach has a potential to be adopted by physicians, to afford them with quantitative, objective and precise methods and data during clinical evaluations and support the assessment of bradykinesia.

O Programa Mais Médicos foi criado em 2013 para enfrentar desafios que condicionavam a expansão e o desenvolvimento da Atenção Básica (AB), sobretudo, a insuficiência e má distribuição de médicos e o perfil de formação inadequado às necessidades da população. O programa é composto por três eixos: provimento emergencial, qualificação da infraestrutura e mudança da formação. Neste artigo realizamos análise documental, análise de bancos de dados oficiais e revisão de literatura, com o objetivo de avaliar resultados do provimento de médicos alcançados até 2015. Identificamos avanços importantes na alocação dos médicos com equidade; na ampliação da cobertura da AB; na ampliação do acesso da população às ações de AB; no impacto nos indicadores de saúde; e na avaliação positiva que usuários, médicos e gestores têm do programa. Na conclusão, são apontados desafios enfrentados pelo programa para alcançar efetivamente seus objetivos.

Background: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. Methods: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. Results: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. Conclusion: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Copper sulfide is a promising p-type inorganic semiconductor for optoelectronic devices such as solar cells, due its small band gap energy and its electrical properties. In this work nanocrystalline copper sulfide (CuxS), with two stoichiometric ratios (x = 2, 1.8) was obtained by one-pot synthesis at 220, 230, 240 and 260 °C in an organic solvent and amorphous CuxS was obtained in aqueous solution. Nanoparticle-like nucleation centers are formed at lower temperatures (220 °C), mixtures of morphologies (nanorods, nanodisks and nanoprisms) are seen at 230 and 240 °C, in which the nanodisks are predominant, while big hexagonal/prismatic crystals are obtained at 260 °C according to TEM results. A mixture of chalcocite and digenite phases was found at 230 and 240 °C, while a clear transition to a pure digenite phase was seen at 260 °C. The evolution of morphology and transition of phases is consistent to the electrical, optical, and morphological properties of the copper sulfide. In fact, digenite Cu1.8S is less resistive (346 Ω/sq) and has a lower energy band gap (1.6 eV) than chalcocite Cu2S (5.72 × 105 Ω/sq, 1.87 eV). Low resistivity was also obtained in CuxS synthesized in aqueous solution, despite its amorphous structure. All CuxS products could be promising for optoelectronic applications.

The Internet-of-Things (IoT) and Smart Cities continue to expand at enormous rates. Centralized Cloud architectures cannot sustain the requirements imposed by IoT services. Enormous traffic demands and low latency constraints are among the strictest requirements, making cloud solutions impractical. As an answer, Fog Computing has been introduced to tackle this trend. However, only theoretical foundations have been established and the acceptance of its concepts is still in its early stages. Intelligent allocation decisions would provide proper resource provisioning in Fog environments. In this article, a Fog architecture based on Kubernetes, an open source container orchestration platform, is proposed to solve this challenge. Additionally, a network-aware scheduling approach for container-based applications in Smart City deployments has been implemented as an extension to the default scheduling mechanism available in Kubernetes. Last but not least, an optimization formulation for the IoT service problem has been validated as a container-based application in Kubernetes showing the full applicability of theoretical approaches in practical service deployments. Evaluations have been performed to compare the proposed approaches with the Kubernetes standard scheduling feature. Results show that the proposed approaches achieve reductions of 70% in terms of network latency when compared to the default scheduling mechanism.

Estimation of wave run-up has been of increasing concern for offshore wind structures and a critical aspect for designers. The highly nonlinear phenomenon makes the study difficult. That is the reason for the very few design rules and experimental data available to estimate it. Actual wave run-up is greater than commonly predicted. The goal of this research is to benchmark the theoretical formulations with the results of the physical model tests performed by Deltares in the field of crest elevation, run-up, forces and pressures. The laboratory reproduced in a wave tank (75 m length; 8.7 m width; 1 m depth; and a 1:60 scale, with Froude similarity) an offshore power converter platform located at intermediate water depths (25⁻43.80 m) in the Southern North Sea, designed by the Norwegian company Aibel. The purpose of this research is to offer a preliminary design guide for wave run⁻up using theoretical expressions both for cylinders and gravity based structures (GBS), leaning on the cited laboratory tests to validate the results obtained by such theoretical models.

PURPOSE: To describe topographic and endoscopic anatomy of guinea pig ear for development of surgical approaches in experimental studies. METHODS: Experimental study. Eight adult guinea pigs (Cavia porcellus) were used in this study. Four animals were described through endoscopic view and four animals were used to describe topographic anatomy. RESULTS: The main structures of middle ear were well identified through endoscopy view: oval and round window, ossicles and vascular structures. Temporal bone position, landmarks and its relations to skull are perceived with topographic description. CONCLUSION: Topographic anatomic description allowed exposition of temporal bone relations for external surgical approaches. Alternatively, grooves and middle ear structures were identified and may be used to transcanal accesses.

PURPOSE: Initial study of the pig`s temporal bone anatomy in order to enable a new experimental model in ear surgery. METHODS: Dissection of five temporal bones of Sus scrofa pigs obtained from UNIFESP - Surgical Skills Laboratory, removed with hole saw to avoid any injury and stored in formaldehyde 10% for better conservation. The microdissection in all five temporal bone had the following steps: inspection of the outer part, external canal and tympanic membrane microscopy, mastoidectomy, removal of external ear canal and tympanic membrane, inspection of ossicular chain and middle ear. RESULTS: Anatomically it is located at the same position than in humans. Some landmarks usually found in humans are missing. The tympanic membrane of the pig showed to be very similar to the human, separating the external and the middle ear. The middle ear`s appearance is very similar than in humans. The ossicular chain is almost exactly the same, as well as the facial nerve, showing the same relationship with the lateral semicircular canal. CONCLUSION: The temporal bone of the pigs can be used as an alternative for training in ear surgery, especially due the facility to find it and its similarity with temporal bone of the humans.

A presença de corpo estranho (CE) nas orelhas, nariz ou garganta é uma queixa muito comum. Seu devido reconhecimento, estudo e manejo são necessários para que complicações sejam prevenidas. OBJETIVO: Analisar o perfil dos atendimentos a CE realizados em um pronto-socorro (PS) de Otorrinolaringologia (ORL) de referência, no período de fevereiro de 2010 a janeiro de 2011. MÉTODO: Estudo retrospectivo de coorte histórica com corte transversal, baseado na análise de fichas de pronto-atendimento digitalizadas. RESULTADOS: Foram realizados atendimentos a 827 casos de CE no período, representando 5,3% de todos os casos atendidos no PS-ORL. CE foi mais comumente encontrado em crianças, principalmente em ≤ 8 anos. Não houve diferença significativa entre gêneros. CE se localizaram mais frequentemente nas orelhas (64,4%), nas fossas nasais (19,5%) e na orofaringe (8,9%). A taxa geral de complicações foi 4,5% e a necessidade de anestesia geral para retirada do CE, 4,4%. CONCLUSÃO: CE em ORL é uma queixa comum, sendo mais comumente encontrados nas orelhas, principalmente em crianças. Baixas taxas de complicação e necessidade de anestesia geral foram registradas nos atendimentos realizados pelo otorrinolaringologista. Salienta-se, novamente, a importância do correto manejo de CE em ORL para a prevenção de complicações.

En este artículo se recuerdan algunas actividades y nombramientos del benedictino Martín Sarmiento. Conoceremos detalles sobre su elección en 1748 para la abadía del monasterio de San Martín de Madrid, su casa de profesión. Indagaremos las razones que le llevaron a no querer cobrar los sueldos inherentes al título de cronista general de Indias, que le fue concedido por Fernando VI en 1750. Y averiguaremos cómo fue designado por el Rey abad de Ripoll en 1755 y por qué renunció al año siguiente.

As urgências/emergências em Otorrinolaringologia são desordens comuns e de baixa morbimortalidade, em sua maioria. Existem poucos estudos que abordam a epidemiologia desses atendimentos. OBJETIVO: Avaliar as características epidemiológicas dos atendimentos em pronto-socorro de Otorrinolaringologia em um hospital de alta complexidade no período de 12 meses. MÉTODO: Estudo epidemiológico, tipo corte transversal, retrospectivo com coleta de dados realizada a partir das fichas de atendimento do pronto-socorro de Otorrinolaringologia de um hospital de alta complexidade do estado de São Paulo, pelo período de 12 meses. Foram levantados os dados: idade, sexo, diagnóstico clínico e conduta. Os atendimentos foram divididos em subespecialidades: otologia, rinologia, faringolaringoestomatologia e cirurgia de cabeça e pescoço. Nível de urgência/emergência, etiologia e distribuição mensal dos atendimentos foram avaliados. RESULTADOS: Obtidas 17.503 fichas de atendimento, foram excluídas 1.863. Das 15.640 fichas incluídas, a média de idade foi 36,3 anos. 9.818 (62,77%) corresponderam a atendimentos considerados como urgência/emergência. Entre os atendimentos urgência/emergência, 6.422 (65,41%) foram por diagnósticos em otologia e entre os 10 diagnósticos mais prevalentes, sete foram da subespecialidade de otologia. CONCLUSÃO: Dentre os atendimentos em pronto-socorro de Otorrinolaringologia avaliados, 62,77% correspondem a casos de urgência/emergência, com predomínio na subespecialidade de otologia.Urgent and emergency care are common happenings in ENT practice and most carry low morbidity and mortality. There are but few studies that address the epidemiology of these situations. OBJECTIVE: To evaluate the epidemiological characteristics of care in the emergency department of otorhinolaryngology at a high complexity hospital. METHOD: Epidemiological, cross-sectional study, retrospective with data collection carried out from medical records from the emergency department of otorhinolaryngology of a high complexity hospital in São Paulo, for a period of 12 months. Data collected: age, gender, clinical diagnosis and management. The cases were divided by subspecialty: otology, rhinology, pharyngolaryngeal-stomatology and head and neck surgery. We evaluated the level of urgency/emergency, etiology and monthly distribution of visits. RESULTS: 17,503 medical records were obtained; 1,863 were excluded. Of the 15,640 cases included, the average age was 36.3 years. 9,818 (62.77%) corresponded to cases considered as emergency/urgency. Among the urgency/emergency cases, 6,422 (65.41%) were diagnosed in the ear and among the 10 most prevalent diagnostics, 7 were in the subspecialty of otology. CONCLUSION: Among the patients seen in the emergency department of otolaryngology evaluated in this study, 62.77% corresponded to cases of urgency/emergency, predominantly in the otology subspecialty.

Otite média (OM) é considerada doença potencialmente grave em razão dos riscos de complicações que podem ocorrer em sua evolução. OBJETIVO: Estabelecer a incidência anual de complicações intratemporais de OM e avaliar prospectivamente os pacientes por meio da análise dos aspectos epidemiológicos e clínicos. MÉTODO: Estudo de coorte contemporânea. Durante o período de um ano, os pacientes admitidos em um Hospital Universitário, com diagnóstico de OM e de complicação intratemporal (CIT) de OM foram incluídos no estudo. Os dados avaliados foram: idade, sexo, tipo de complicação intratemporal, tratamento e desfecho clínico. A incidência geral das complicações e de cada complicação foi determinada. RESULTADOS: 1.816 pacientes foram diagnosticados com OM. Em 592 (33%) indivíduos, o diagnóstico foi de otite média crônica; em 1224 (67%) o diagnóstico foi de otite média aguda. CIT de OM foi diagnosticada em 15 pacientes, perfazendo uma incidência anual de CIT 0,8%. Foram identificados 19 diagnósticos de CIT em 15 pacientes. Fístula labiríntica foi diagnosticada em sete (36,8%) indivíduos, mastoidite em cinco (26,3%), paralisia facial periférica em quatro (21,1%) e labirintite em três (15,8%). CONCLUSÃO: A incidência das complicações intratemporais permanece significativa quando comparada à de países desenvolvidos. A otite média crônica colesteatomatosa é a etiologia mais frequente das complicações intratemporais. A fístula labiríntica é a complicação intratemporal mais comum.Otitis media (OM) is considered a potentially severe disease due to the risk of complications. OBJECTIVE: To establish the annual incidence of intratemporal complications (ITC) resulting from OM and to prospectively assess patients for epidemiological and clinical factors. METHOD: This prospective cohort study included patients admitted during one year at a university hospital diagnosed with intratemporal complications of OM. Patients were analyzed for age, gender, type of intratemporal complication, treatment, and clinical outcome. The overall incidence of complications and the specific incidence rates of each type of complication were determined. RESULTS: 1,816 patients were diagnosed with OM; 592 (33%) had chronic OM; 1224 (67%) had acute OM. Fifteen patients were diagnosed with OM ITC, adding up to an annual incidence of 0.8%. Nineteen diagnoses of ITC were made in 15 patients. Seven (36.8%) patients were diagnosed with labyrinthine fistula, five (26.3%) with mastoiditis, four (21.1%) with peripheral facial palsy, and three (15.8%) with labyrinthitis. CONCLUSION: The incidence of intratemporal complications remains significant when compared to the rates seen in developed countries. Chronic cholesteatomatous otitis media is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.

Resumo: A existência de cardiopatia estrutural, a história de cirurgia cardíaca prévia (frequentemente envolvendo a aurícula esquerda) e a ablação percutânea da fibrilhação auricular conduziram a um aumento da incidência de taquicardias auriculares regulares, frequentemente apresentando‐se como flutters atípicos. Este tipo de flutter é particularmente frequente após isolamento das veias pulmonares, especialmente após extensa ablação auricular, incluindo lesões e/ou desfragmentação lineares.Os autores descrevem o caso de um homem, 51 anos de idade, sem antecedentes patológicos conhecidos, encaminhado para a consulta de cardiologia, em 2009, por fibrilhação auricular paroxística. Após insucesso da terapêutica antiarrítmica, foi referenciado para ablação percutânea, com critérios de sucesso agudo. Três anos depois, reiniciou queixas de palpitações e foi documentado flutter auricular atípico. O estudo eletrofisiológico confirmou o diagnóstico de flutter atípico esquerdo e reaparecimento de atividade elétrica na veia pulmonar inferior direita. Fez re‐ablação da veia recanalizada com sucesso, sem qualquer recorrência arrítmica até ao momento.Na era da ablação percutânea, é essencial perceber o mecanismo da arritmia e reconhecer a existência destes flutters atípicos. Abstract: Cardiac surgery for structural heart disease (often involving the left atrium) and radiofrequency catheter ablation of atrial fibrillation have led to an increased incidence of regular atrial tachycardias, often presenting as atypical flutters. This type of flutter is particularly common after pulmonary vein isolation, especially after extensive atrial ablation including linear lesions and/or defragmentation.The authors describe the case of a 51‐year‐old man, with no relevant medical history, referred for a cardiology consultation in 2009 for paroxysmal atrial fibrillation. After failure of antiarrhythmic therapy, he underwent catheter ablation, with criteria of acute success. Three years later he again suffered palpitations and atypical atrial flutter was documented. The electrophysiology study confirmed the diagnosis of atypical left flutter and reappearance of electrical activity in the right inferior pulmonary vein. This vein was again ablated successfully and there has been no arrhythmia recurrence to date.In an era of frequent catheter ablation it is essential to understand the mechanism of this arrhythmia and to recognize such atypical flutters. Palavras‐chave: Flutter auricular atípico, Ablação percutânea de fibrilhação auricular, Re-ablação, Keywords: Atypical atrial flutter, Catheter ablation of atrial fibrillation, Re-ablation

Se plantea que existe un ordenamiento real del territorio en el Sur-occidente del país, la región Pacífico, compuesta por indígenas, comunidades afrodescendientes y campesinos. Estos pobladores son los llamados a materializar el camino indicado por la Constitución Política de 1991, es decir, a construir una territorialidad intercultural con base en los principios de autonomía y autodeterminación. Sin embargo, frente a este ordenamiento real, los preacuerdos de La Habana amenazan con imponer un ordenamiento ajeno y excluyente, que podría desconocer los avances y logros alcanzados por los grupos étnicos.

Introduction: Peyronie’s disease, a fibrotic disorder of the tunica albuginea of the penis, has been associated with penile shortening and some degree of erectile dysfunction. It affects patient’s quality of life, leading to severe psychological, mental, and physical stress. Penile deformation hampers sexual life leading to depression, lack of sexual confidence, loss of sexual function and performance anxiety. Peyronie’s disease etiology is yet to be known. Material and Methods: Literature search was conducted in Medline, Embase, and Cochrane databases in January 2015 in order to identify papers related to Peyronie’s disease, concerning evolving surgical management, technique, outcomes as well as ancillary treatments. Publications not concerning humans were not considered. We identified original articles, review articles, and editorials addressing the subject. All articles published in the English language were selected for screening. The eligibility criteria for inclusion were based on relevance concerning the subject. Results: The variety of penile deformities associated with Peyronie’s disease still doesn’t have an effective and reliable non-surgical therapy. We summarize the updated surgical techniques and management algorithm described for Peyronie’s disease. Discussion: Surgical management shares similar goals: correcting the curvature, preserving erectile function and penile length, and minimizing morbidity. Conclusion: To date there is no high level of evidence-based data to determine the best surgical treatment of Peyronie’s disease. After proper diagnosis, surgical reconstruction should be based on giving a functional penis, that is, rectifying the penis with rigidity enough to enable sexual intercourse.

Este trabajo busca analizar la irrupción de paper como un modo de escritura que en el último tiempo está siendo impuesto en el ámbito de las Humanidades con el apoyo de una serie de instituciones que lo ha hecho posible. El objetivo de este escrito será, por un lado, estudiar sus características principales a partir de la información contenida en los manuales e instructivos para escribir papers y, por otro lado, poner en evidencia sus implicancias para el trabajo intelectual en general y el latinoamericano en particular.This paper analyzes the emergence of the paper as a kind of writing in the area of the Humanities that, in recent times, and with institutional support, has been imposed as the nearly unique and acceptable kind of academic discourse. The aim of this paper is, first, to study the main characteristics of this kind of writing, based on information in the manuals and instructions for paper writing and, secondly, to signal its implications for the intellectual work in general and for the work in Latin America in particular.

Por Josetxo Sagarra. Barcelona: Alas, 2009. 92 páginas. 23’5x1775 cm. I.S.B.N.: 978-84-203-0467-0.

No English abstract available