martes, 11 de enero de 2011

An Assault on Everyone’s Safety

EDITORIAL

An Assault on Everyone’s Safety

The Glock 19 is a semiautomatic pistol so reliable that it is used by thousands of law enforcement agencies around the world, including the New York Police Department, to protect the police and the public. On Saturday, in Tucson, it became an instrument of carnage for two preventable reasons: It had an oversize ammunition clip that was once restricted by federal law and still should be; and it was fired by a disturbed man who should never have been able to purchase it legally.

The ludicrously thin membrane that now passes for gun control in this country almost certainly made the Tucson tragedy worse. Members of Congress are legitimately concerned about their own safety now, but they should be no less worried about the effect of their inaction on the safety of all Americans.
As lawmakers in Washington engage this week in moments of silence and tributes to Representative Gabrielle Giffords and the other casualties, they should realize that they have the power to reduce the number of these sorts of horrors, and their lethality.
To do so, they will need to stand up to the National Rifle Association and its allies, whose lobbying power continues to grow despite the visceral evidence that the groups have made the country a far more dangerous place. Having won a Supreme Court ruling establishing a right to keep a firearm in the home, the gun lobby is striving for new heights of lunacy, waging a campaign to legalize the possession of a gun in schools, bars, parks, offices, and churches, even by teenagers.
It reflexively opposes even mild, sensible restrictions — but if there is any reason left in this debate, the latest mass shooting should force a retreat. Is there anyone, even the most die-hard gun lobbyist, who wants to argue that a disturbed man should be able to easily and legally buy a Glock to shoot a congresswoman, a judge, a 9-year-old girl?
One of the first things Congress can do is to take up a bill proposed by Representative Carolyn McCarthy, a Democrat of Long Island, that would ban the extended ammunition clip used by the Arizona shooter, Jared Loughner. A Glock 19 usually holds 15 bullets. Mr. Loughner used an oversize clip allowing him to fire as many as 33 bullets before pausing to reload. It was at that point that he was tackled and restrained.
Between 1994 and 2004, it was illegal to manufacture or import the extended clips as part of the ban on assault weapons. But the ban was never renewed because of the fierce opposition of the N.R.A. At least six states, including California and New York, ban extended clips, which serve absolutely no legitimate purpose outside of military or law enforcement use. At a minimum, that ban should be extended nationwide, and should prohibit possession, not just manufacture.
The gun itself was purchased by Mr. Loughner at a sporting goods store that followed the bare-minimum federal background check, which only flags felons, people found to be a danger to themselves or others, or those under a restraining order.
Mr. Loughner was rejected by the military for failing a drug test, and had five run-ins with the Pima Community College police before being suspended for disruptive activity. Why can’t Congress require a background check — without loopholes for gun shows or private sales — that would detect this sort of history? If the military didn’t want someone like Mr. Loughner to be given a firearm, neither should the public at large.
At least two members of Congress say they will start to carry weapons to district meetings, the worst possible response. If lawmakers want to enhance their safety, and that of their constituents, they should recognize that the true public menace is the well-dressed gun lobbyist hanging out just outside their chamber door
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The Politicized Mind

OP-ED COLUMNIST

The Politicized Mind

Before he allegedly went off on his shooting rampage in Tucson, Jared Loughner listed some of his favorite books on his YouTube page. These included: “Animal Farm,” “Brave New World,” “Alice in Wonderland,” “One Flew Over the Cuckoo’s Nest,” “Through the Looking Glass” and “The Communist Manifesto.” Many of these books share a common theme: individuals trying to control their own thoughts and government or some other force trying to take that control away.
Josh Haner/The New York Times
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Loughner also made a series of videos. These, too, suggest that he was struggling to control his own mind. Just before his killing spree, Loughner made one called “My Final Thoughts.” In it he writes about different levels of consciousness and dreaming. He tries to build a rigid structure to organize his thinking. He uses the word “currency” as a metaphor for an inner language to make sense of the world.
“You create and distribute your new currency, listener?” the video asks. “You don’t allow the government to control your grammar structure, listener?”
All of this evidence, which is easily accessible on the Internet, points to the possibility that Loughner may be suffering from a mental illness like schizophrenia. The vast majority of schizophrenics are not violent, and those that receive treatment are not violent. But as Dr. E. Fuller Torrey, a research psychiatrist, writes in his book, “The Insanity Offense,” about 1 percent of the seriously mentally ill (or about 40,000 individuals) are violent. They account for about half the rampage murders in the United States.
Other themes from Loughner’s life fit the rampage-killer profile. He saw himself in world historical terms. He appeared to have a poor sense of his own illness (part of a condition known as anosognosia). He had increasingly frequent run-ins with the police. In short, the evidence before us suggests that Loughner was locked in a world far removed from politics as we normally understand it.
Yet the early coverage and commentary of the Tucson massacre suppressed this evidence. The coverage and commentary shifted to an entirely different explanation: Loughner unleashed his rampage because he was incited by the violent rhetoric of the Tea Party, the anti-immigrant movement and Sarah Palin.
Mainstream news organizations linked the attack to an offensive target map issued by Sarah Palin’s political action committee. The Huffington Post erupted, with former Senator Gary Hart flatly stating that the killings were the result of angry political rhetoric. Keith Olbermann demanded a Palin repudiation and the founder of the Daily Kos wrote on Twitter: “Mission Accomplished, Sarah Palin.” Others argued that the killing was fostered by a political climate of hate.
These accusations — that political actors contributed to the murder of 6 people, including a 9-year-old girl — are extremely grave. They were made despite the fact that there was, and is, no evidence that Loughner was part of these movements or a consumer of their literature. They were made despite the fact that the link between political rhetoric and actual violence is extremely murky. They were vicious charges made by people who claimed to be criticizing viciousness.
Yet such is the state of things. We have a news media that is psychologically ill informed but politically inflamed, so it naturally leans toward political explanations. We have a news media with a strong distaste for Sarah Palin and the Tea Party movement, and this seemed like a golden opportunity to tarnish them. We have a segmented news media, so there is nobody in most newsrooms to stand apart from the prevailing assumptions. We have a news media market in which the rewards go to anybody who can stroke the audience’s pleasure buttons.
I have no love for Sarah Palin, and I like to think I’m committed to civil discourse. But the political opportunism occasioned by this tragedy has ranged from the completely irrelevant to the shamelessly irresponsible.
The good news is that there were a few skeptics, even during the height of the mania:Howard Kurtz of The Daily BeastJames Fallows of The Atlantic and Jonathan Chait of The New Republic. The other good news is that the mainstream media usually recovers from its hysterias and tries belatedly to get the story right.
If the evidence continues as it has, the obvious questions are these: How can we more aggressively treat mentally ill people who are becoming increasingly disruptive? How can we prevent them from getting guns? Do we need to make involuntary treatment easier for authorities to invoke?
Torrey’s book describes a nation that has been unable to come up with a humane mental health policy — one that protects the ill from their own demons and society from their rare but deadly outbursts. The other problem is this: contemporary punditry lives in the world of superficial tactics and interests. It is unprepared when an event opens the door to a deeper realm of disorder, cruelty and horror.

En este día...

On This Day in HistoryTuesday, January 11th
The 011th day of 2011.
There are 354 days left in the year.
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Today's Highlights in History
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NYT Front PageSee a larger version of this front page.
On Jan. 11, 1935, aviator Amelia Earhart began a trip from Honolulu to Oakland, Calif., becoming the first woman to fly solo across the Pacific Ocean. (Go to article.)On Jan. 111842William Jamesthe American psychologist and exponent of pragmatism, was born. Followinghis death on Aug. 261910, his obituary appeared in The Times.(Go to obit. | Other Birthdays)
Editorial Cartoon of the Day

On January 11, 1868Harper's Weekly featured a cartoon about tobacco use. (See the cartoon and read an explanation.)

On this date in:
1757American founding father Alexander Hamilton was born in the West Indies.
1805The Michigan Territory was created.
1861Alabama seceded from the Union.
1964U.S. Surgeon General Luther Terry issued the first government report saying smoking may be hazardous to one's health.
1973Owners of American League baseball teams voted to adopt the designated-hitter rule.
1977France set off an international uproar by releasing Abu Daoud, a Palestinian suspected of involvement in the massacre of Israeli athletes at the 1972 Munich Olympics.
2001The Army acknowledged that U.S. soldiers killed an "unknown number" of South Korean refugees early in the Korean War at No Gun Ri.
2003Calling the death penalty process "arbitrary and capricious, and therefore immoral," Illinois Gov. George Ryan commuted the sentences of 167 condemned inmates, clearing his state's death row two days before leaving office.
2007English soccer player David Beckham announced a five-year deal to play for the Los Angeles Galaxy.
2008Sir Edmund Hillary, the first person to conquer Mount Everest, died at age 88.
2010Mark McGwire admitted to The Associated Press that he'd used steroids and human growth hormone when he broke baseball's home run record in 1998.
2010Miep Gies, who helped hide Anne Frank and her family from the Nazis for two years and saved the teenager's diary, died in Amsterdam at age 100.

Current Birthdays
Mary J. Blige turns 40 years old today.

AP Photo/Evan Agostini R&B singer Mary J. Blige turns 40 years old today.

81Rod Taylor
Actor
77Jean Chretien
Former Canadian prime minister
69Clarence Clemons
Saxophonist (The E Street Band)
65Naomi Judd
Country singer
59Ben Crenshaw
Golfer
55Robert Earl Keen
Rock singer
53Vicki Peterson
Rock musician (The Bangles)
49Kim Coles
Actress
43Tom Dumont
Rock musician (No Doubt)
40Tom Rowlands
Rock musician (The Chemical Brothers)
39Amanda Peet
Actress
Historic Birthdays
William James
 
1/11/1842 - 8/26/1910
American philosopher/psychologist 

(Go to obit.)

37Parmigianino
1/11/1503 - 8/24/1540
Italian painter

49Alexander Hamilton
1/11/1757 - 7/12/1804
American secretary of the treasury and founding father

67Ezra Cornell
1/11/1807 - 12/9/1874
American university founder

85Sir James Paget
1/11/1814 - 12/30/1899
English surgeon/physiologist

82Thomas Dixon
1/11/1864 - 4/3/1946
American dramatist/legislator

72Alice H. Rice
1/11/1870 - 2/10/1942
American novelist

92Alice Paul
1/11/1885 - 7/9/1977
American Women's Rights activist

78Laurens Hammond
1/11/1895 - 7/1/1973
American inventor/businessman

92Eva Le Gallienne
1/11/1899 - 6/3/1991
English/Am. actress/producer

85Alan Paton
1/11/1903 - 4/12/1988
South African writer

75Pierre Mendes-France
1/11/1907 - 10/18/1982
French Premier

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SOURCE: The Associated Press
Front Page Image Provided by UMI

lunes, 10 de enero de 2011

Patrones de temperatura tras la reanimación en la parada cardiaca intrahospitalaria en niños


REMI envía todos sus contenidos gratuitamente por correo electrónico a más de 8.700 suscriptores. [Suscripción]
Artículo nº 1587. Vol 11 nº 1, enero 2011.
Autor: Jesús López-Herce Cid

Patrones de temperatura tras la reanimación en la parada cardiaca intrahospitalaria en niños
Artículo original: Temperature patterns in the early postresuscitation period after pediatric inhospital cardiac arrest. Bembea MM, Nadkarni VM, Diener-West M, Venugopal V, Carey SM, Berg RA, Hunt EA. Pediatr Crit Care Med 2010; 11(6): 723-730. [Resumen] [Artículos relacionados]
Introducción: Varios estudios en adultos han mostrado la asociación de la aparición de hipertermia tras recuperación de la circulación espontánea de una parada cardiaca (PC) con un mal pronóstico. Por otra parte estudios en adultos y neonatos han encontrado que el tratamiento con hipotermia tras la recuperación de una PC o un episodio hipóxico mejora el pronóstico neurológico. Aunque no existen estudios en niños que hayan demostrado este efecto, las recomendaciones ILCOR recomiendan evitar la hipertermia y sugieren que la hipotermia precoz puede ser eficaz. No existen estudios en niños que hayan relacionado la hipertemia tras recuperación de la PC con el pronóstico.

Resumen: Este estudio se realizó con los datos de un registro prospectivo multicéntrico norteamericano en el que se analizaron los 547 niños con PC que recuperaron la circulación  espontánea (RCE) y que tuvieron un registro de la temperatura máxima y mínima en las primeras 24 horas tras la RCE. Un 43,5 % de los pacientes presentó al menos un registro con temperatura > 38º C y un 5,5 % tuvieron hipertermia persistente, definida como una temperatura mínima por encima de 38º C. La presencia de hipertermia persistente se asoció con un mal pronóstico neurológico definido como una puntuación 4 a 6 en la escala cerebral pediátrica PCPC (que incluye alteración cerebral grave, coma o estado vegetativo persistente y muerte cerebral) (OR ajustada 2,7; IC 95% 1,1-6,7). Sin embargo, la hipertermia persistente no se relacionó con la mortalidad. La hipertermia aislada no se relacionó ni con el pronóstico neurológico ni con la mortalidad. Los autores concluyen que la hipertermia es frecuente en el periodo postresucitación inmediato, aunque sólo la hipertermia persistente se asocia con mal pronóstico neurológico. Sólo 86 pacientes, un 15,7%, fueron tratados con hipotermia activa.

Comentario: Este estudio muestra que la frecuencia de hipertermia tras la RCE es elevada y sobre todo que la hipotermia terapéutica es todavía poco utilizada en niños. Aunque en el estudio se encontró que la hipertermia persistente se asociaba con un mal pronóstico neurológico, este estudio no fue diseñado específicamente para analizar la relación entre la temperatura y el pronóstico, y de hecho una de las limitaciones del mismo es que solo se registró la temperatura máxima y la mínima durante las primeras 24 horas. Es por tanto necesario diseñar protocolos terapéuticos específicos de hipotermia activa tras la RCE de una PC en niños que faciliten su implantación y realizar estudios multicéntricos que analicen su efecto sobre la evolución neurológica.
Jesús López-Herce Cid
Hospital General Universitario Gregorio Marañón, Madrid
©REMI, http://remi.uninet.edu. Enero 2011.

Búsqueda en PubMed:
  • Enunciado: Hipotermia en el paro cardiaco pediátrico
  • Sintaxis: pediatric heart arrest AND hypothermia
  • [Resultados]
Palabras clave: Paro cardiaco, Resucitación cardiopulmonar, Hipotermia inducida, Pediatría.

Vomito después de adenotonsilectomía en niños: comparación entre inducción con propofol y mantenimiento con sevofluorano-óxido nitroso y TIVA con propofol-remifentanil

Vomito después de adenotonsilectomía en niños: comparación entre inducción con propofol y mantenimiento con sevofluorano-óxido nitroso y TIVA con propofol-remifentanil
Vomiting after a pediatric adenotonsillectomy: comparison between propofol induced sevoflurane-nitrous oxide maintained anesthesia and TIVA with propofol-remifentanil.
Chung JH, Kim YH, Ko YK, Lee SY, Nam YT, Yoon SH.
Department of Anesthesiology and Pain Medicine, Eulji University School of Medicine, Daejeon, Korea.
Korean J Anesthesiol. 2010 Sep;59(3):185-9. Epub 2010 Sep 20
Abstract
BACKGROUND: Anesthesia methods and drugs affect postoperative nausea and vomiting. Propofol is known to have antiemetic effects. We compared the incidence of postoperative vomiting (POV) in children undergoing an adenotonsillectomy; anesthesia in one group was induced with propofol and maintained with sevoflurane and nitrous oxide, and the other group received total intravenous anesthesia (TIVA) with propofol-remifentanil. METHODS: Ninety children, ASA physical status I, were assigned randomly to one of two groups. In the PSN group, anesthesia was maintained with 2-3 vol% sevoflurane and 50% nitrous oxide. In the PR group, anesthesia was maintained with 10 mg/kg/h propofol and 0.25 µg/kg/min remifentanil. In both groups, anesthesia was induced with 0.5 µg /kg remifentanil and 2 mg/kg propofol. The incidence of POV and the need for rescue antiemetics were assessed in the postanesthesia care unit at 6, 12, and 24 hours postoperatively. RESULTS: The total incidence of POV was not significantly different between the groups; POV occurred in eight (17.7%) and three (6.7%) children in the PSN and PR groups, respectively. Postoperative frequency of retching in the recovery room was significantly higher in the PSN group, with four children (8.9%) in the PSN group compared to none (0%) in the PR group (P = 0.041). The frequency of POV 24 hrs after exiting the recovery room tended to be higher in the PSN group than the PR group, but no statistically significant difference was observed. CONCLUSIONS: If the development of POV in the early anesthetic recovery phase of children undergoing adenotonsillectomy is adequately prevented, propofol-induced anesthesia maintained with sevoflurane-nitrous oxide is as safe as TIVA with propofol-remifentanil
 
Estudio prospectivo de vomito postoperatorio en niños sometidos a diferentes procedimientos operatorios bajo anestesia general 
A Prospective Study of Postoperative Vomiting in Children Undergoing Different Surgical Procedures under General Anaesthesia
Jaya Choudhary1, S Bano2, Mohib Ahmed3, M N Zaidi4
Indian Journal of Anaesthesia 2008; 52 (2): 159-163
Summary
To identify the risk factors associated with postoperative vomiting (POV) in paediatric population undergoing common surgeries. The risk factors studied for association with POV were age >5 years, female gender, previous history of POV/motion sickness, type of surgery and duration of anaesthesia >45 min. A total of 100 ASA grade I and II patients of either sex aged
between 2-12 years undergoing elective surgical procedures were screened for the study. All patients underwent similar anaesthesia protocol and received two antiemetic agents (ondansetron 0.05mg.kg-1 and dexamethasone 0.15mg.kg-1) in premedication. The patients were observed for 24 hours postoperatively for the incidence of vomiting, number of times rescue antiemetic given and any adverse reaction to antiemetic. Overall 34% patients (34/100) developed POV of which 26 had only one episode and 8 patients had 2 episodes during first 24 h. Incidence of POV was 13% (13/100) in first 4 h whereas it was 29% (29/100) in late postoperative period. In early post operative period, POV was not associated significantly with any predicted risk factors. However, age>5years, duration of anaesthesia>45 minutes and history of motion sickness/POV were significantly associated in late postoperative period(4-24h). Female gender and type of surgery were not associated with increased POV. The combination antiemetic effectively prevented POV in early postoperative period (0-4h) only but not in late postoperative period (0-24h).

Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor

La Fabrique du Théâtre

10 janvier 2011
Ces jours-ci, le Conservatoire National Supérieur d’Art Dramatique (Paris 9ème) invite le public à venir voir jouer ses élèves de troisième et dernière année. Quelques mois avant les « journées de Juin », qui dévoilent chaque été les travaux des étudiants guidés par de prestigieux metteurs en scène, voici donc déjà l’occasion de rencontrer cette nouvelle génération d’acteurs, parfois fragiles, au niveau inégal, mais ni plus ni moins, en somme, que certains professionnels. Ce qu’ils ont d’exceptionnel, ces futurs « diplômés » du Conservatoire, c’est une ferveur intacte, une attention minutieuse portée à chaque mot qu’ils prononcent ; un souci presque angoissé d’être à la hauteur de leur personnage… Ces qualités s’imposent d’autant plus qu’ils jouent Les Trois Sœurs , ce drame de Tchekhov (1860-1904) où les êtres, bouleversés et bouleversants, ne laissent qu’entrevoir la souffrance qui les traverse. L’autre jour, j’ai vu ces jeunes gens répéter l’acte IV de la pièce dans la ravissante petite salle Louis Jouvet, où ils travaillent sous la direction d’un camarade de promotion : Julien Oliveri.
j-388.1294653964.jpg
Copyright : Anne Gayan
Le jour de ma visite, un spot venait de prendre feu, c’était un peu la pagaille, et les comédiens avaient du mal à retrouver leurs rôles après deux semaines de vacances. Mais ce fut un pur délice, et un vrai moment de théâtre, de contempler l’apprenti metteur en scène et ses condisciples faire face à toutes sortes de problèmes à la fois élémentaires et cruciaux. Par exemple lorsque Irina (Flore Babled), la plus jeune sœur, annonce dans une tirade qui mêle espoir et résignation, sa décision d’épouser le Baron. Son beau-frère Fedor Ilitch (Martin Loizillon) et le docteur Ivan Romanovitch (Mathurin Voltz) qui sont alors sur scène, doivent la soutenir de leur présence, ne pas la laisser trop seule, mais tout en prenant garde à ne pas se « figer dans l’écoute ». C’est une question de dosage, un peu comme pour le piano, qui accompagne la scène sur l’air hautement symbolique de « la prière d’une vierge » : la musique doit être présente, distincte, proche, mais tout en venant d’ailleurs, et sans résonner trop fort… Autre nuance tchekhovienne : le personnage de Macha, la sœur cadette (Claire Chastel), qui renonce à voir son amant pour toujours. Elle a perdu le bonheur comme elle l’avait connu, « par bribes », et traîne au quatrième acte une souffrance à hurler, mais toujours avec une glorieuse pudeur…
« T’excuser, ça ne sert à rien », répond Julien Oliveri, à la fois tendre et pragmatique, lorsqu’une comédienne lui dit « pardon », parce qu’elle ne trouve pas le ton juste, et recommence en vain le début de sa scène. Le jeune homme rêvait de monter Les Trois Sœurs depuis l’âge de vingt ans. Il en a aujourd’hui vingt-cinq, et dirige ses camarades avec autant de douceur que de précision. Je n’ai vu la petite troupe qu’en répétition, mais il me semble que c’est bon signe, d’interpréter Tchekhov avec une angoisse pleine de tendresse; et c’est bon signe, de travailler les rôles d’Irina, de Macha ou d’Olga comme si le destin de ces personnages dépendait de leur interprétation. N’est-ce pas déjà un peu rendre justice aux trois héroïnes ? Voilà pourquoi je recommande d’aller les découvrir un soir, entre le mardi 11 et le samedi 15 janvier, dans la petite salle Louis Jouvet du Conservatoire National Supérieur d’Art Dramatique.
PS : Jusqu’au 12 janvier, à 19h30, dans la grande salle du Conservatoire, on peut voir également Opus Magnum, pièce écrite par Olivier Py qui dirige l’autre partie de la classe des élèves de troisième année.