domingo, 27 de febrero de 2011

The Inside Story on Outsiderness


Artist Glenn Ligon
Fred R. Conrad/The New York Times
Artist Glenn Ligon
Coming to the Whitney Museum: Glenn Ligon’s art made from a word suspended in air, or a phrase repeated over and over.
Scenes from the red-carpet season: Jesse Eisenberg, an Oscar nominee for best actor, at the New York Film Festival.

Best Movie Query? You Win

A. O. Scott and Manohla Dargis answer readers’ questions about the Oscars and the motion picture industry’s awards season in general.
Elisabeth Moss, left, and Keira Knightley in “The Children’s Hour” by Lillian Hellman, at the Comedy Theater in London.

All Over London, Love Hurts

Keira Knightley, Elisabeth Moss and Rebecca Hall have taken to the London stage and audiences are lining up.
“Rango,” an animated western featuring the voice of Johnny Depp.

Where the Deer and the Chameleon Play

Gore Verbinski, who directed three “Pirates of the Caribbean” movies, directs his first animated film, “Rango,” whose hero is voiced by Johnny Depp.
The brothers Winchester (Jared Padalecki, left, and Jensen Ackles) and their trusty ally in fighting dark forces, a 1967 Chevy Impala, in “Supernatural.”

Heaven, Hell, Brothers and an Impala

The CW series “Supernatural” has survived for six seasons thanks to its combination of religious imagery, fantasy, humor and clever pop-culture-savvy writing.

Indicaciones en ventilación mecánica no invasiva. ¿Evidencias en la bibliografía médica?

Revision
Indicaciones en ventilación mecánica no invasiva. ¿Evidencias en la bibliografía médica?
Med Clin (Barc). 2011;136:116-20.


La ventilación mecánica no invasiva(VMNI)ha demostrado reducir la necesidad de intubación traqueal y ventilación invasiva y las complicaciones derivadas de ésta, en diversas circunstancias asociadas a insuficiencia respiratoria. Actualmente existe un grado de recomendación A para aplicación de VMNI en dos circunstancias: edema de pulmón cardiogénico y exacerbación de EPOC. Existen otras muchas circunstancias en las que se está ampliando la utilización de VMNI, con diversos niveles de evidencia que son analizados en esta revisión elaborada por expertos.
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Enrojecimiento de la piel (flushing) después de la inyección epidural lumbar interlaminar de esteroides con la dexametasona




Enrojecimiento de la piel (flushing) después de la inyección epidural lumbar interlaminar de esteroides con la dexametasona
Flushing following interlaminar lumbar epidural steroid injection with dexamethasone.
Kim CH, Issa MA, Vaglienti RM.
West Virginia University, Morgantown, WV, USA. wp34@hotmail.com
Pain Physician. 2010 Sep-Oct;13(5):481-4.
Abstract
BACKGROUND: Epidural steroid injections are commonly used in managing radicular pain. Most complications related to epidural injections are minor and self-limited. Flushing is considered as one such minor side effect. Flushing has been studied using various steroid preparations including methylprednisone, triamcinolone, and betamethasone but its frequency has never been studied using dexamethasone. OBJECTIVE: This study evaluates the frequency of flushing associated with fluoroscopy-guided lumbar epidural steroid injections using dexamethasone. STUDY DESIGN: Retrospective cohort design study. Patients presenting with low back pain were evaluated and offered a fluoroscopically guided lumbar epidural steroid injection using dexamethasone via an interlaminar approach as part of a conservative care treatment plan. SETTING: University-based Pain Management Center. INTERVENTION: All injections were performed consecutively over a 2-month period by one staff member using 16 mg (4 mg/mL) of dexamethasone. A staff physician specifically asked each participant about the presence of flushing following the procedure prior to discharge on the day of injection and again on follow-up within 48 hours after the injections. The answers were documented as "YES" or "NO." RESULTS: A total of 150 participants received fluoroscopically guided interlaminar epidural steroid injection. All participants received 16 mg (4 mg/mL) of dexamethasone with 2 mL of 0.2% ropiviciane. Overall incidence of flushing was 42 out of 150 cases (28%). Of the 42 participants who experienced flushing, 12 (28%) experienced the symptom prior to discharge following the procedure. Twenty-seven of the 42 (64%) were female (P < 0.05). All the participants who experienced flushing noted resolution by 48 hours. No other major side effects or complications were noted. LIMITATIONS: Follow-up data were solely based on subjective reports by patients via telecommunication. Follow-up time was limited to only 48 hours, which overlooks the possibility that more participants might have noted flushing after the 48 hour limit. CONCLUSIONS: Flushing is commonly reported following epidural steroid injections. With an incidence of 28%, injections using dexamethasone 16 mg by interlaminar epidural route appear to be associated with more flushing reaction than previously reported with other steroid preparations. Additionally, female participants are more likely to experience flushing though the reactions seem to be self-limiting with resolution by 48 hours.

Baje el artículo en PDF en este enlace

Atentamente
Anestesiología y Medicina del Dolor

Utilidad de la resonancia magnética en el cáncer de próstata

Actualizacion
Utilidad de la resonancia magnética en el cáncer de próstata 
Radiologia. 2010;52:513-24.

El cáncer de próstata(CP) es la neoplasia más frecuente en el varón y su diagnóstico viene marcado por el tacto rectal y niveles sospechosos de PSA que obligan a biopsia prostática. Hasta fechas recientes los métodos de imagen disponibles no eran capaces de definir el CP. Actualmente la RM prostática ofrece información anatómica y funcional de primera magnitud con alto grado de especificidad y posibilidad de estadificación locorregional y a distancia. En esta revisión se realiza una puesta al día de las indicaciones y el papel de la RM en el diagnóstico del CP.

Can Scientists Learn from Science Journalists?


February 26, 2011, 2:22 PM

Can Scientists Learn from Science Journalists?

Maggie Koerth-Baker, science editor of BoingBoing.net, gave a really good talk at the University of Wisconsin aiming to encourage scientists to communicate effectively with other human beings. A starting point: listening. Another: Start a blog.
Here’s a summary of the main points that I got from David Isenberg, who alerted me to the lecture:
Show, don’t tell.
Don’t just talk, ask.
Lay people know more (and less) than you think.
Not everything is news.
Be critical of your own work.
Mistakes last, but pedantry kills.
There are deep divisions between the cultures and norms of science and journalism.
One example: For scientists, peer review occurs before publication, for journalists, afterward.
Another: All lines in a newspaper story or broadcast, in theory at least, have to stand on their own as accurate; in a research paper, the inaccuracies produced by the compression in an abstract are seen as normal and acceptable by many scientists, with the nuance conveyed in the body of a paper.
In a recent conversation I had with Gavin Schmidt, a climate scientist and communicator, it was clear we had utterly different norms for interpreting summaries of a research paper.
Some of the differences were touched on in my recent coverage of new analysis attributing some changes in extreme precipitation in the Northern Hemisphere to human-driven global warming.
I would add that scientists (and science journalists) would do well to review the talk given by Thomas Lessl of the University of Georgia at the annual conference of the American Association for the Advancement of Science, on the limited role of science, even if communicated clearly, in shaping policy and human choices.
There’s a link and excerpt in my recent post “Do Fights Over Climate Communication Reflect the End of ‘Scientism’?
The take-home thought:
As scientists and science journalists spar over who’s failing in climate communication, an outside says they’re missing the point.

Best Practice in Systematic Reviews: The Importance of Protocols and Registration


Best Practice in Systematic Reviews: The Importance of Protocols and Registration


The PLoS Medicine Editors*
It is now just over six years [1] since many medical journals began requiring that trials be registered before considering the trial report for publication. Such a policy was set up explicitly to reduce what was considered to be widespread bias in favor of publication of “positive” trials and to ensure that all clinical trials be made public prior to participant enrollment. Given the importance of clinical trials for estimating the efficacy and safety of interventions, and their role in approval of new drugs and devices, such a policy seemed uncontroversial. Although it is known that some trials still go unregistered, there are strong incentives (such as journal publication) and, in some countries legally enforceable mandates, for authors to register these studies before enrolling patients. The existence and widespread uptake of trial registration helps researchers, patients, and funders understand how many trials are being undertaken and which interventions are being evaluated. It also allows studies to be traced from inception through to completion and publication [2].
However, well-conducted systematic reviews—overviews of health care interventions that use a predefined, explicit methodology to find and synthesize all the relevant evidence—are generally considered higher-caliber evidence than are individual trials in decision-making for clinical practice and health policy. The superiority given to such reviews derives from key aspects inherent to the process of carrying out a systematic review. This study type, if done properly, allows the review to come closer to estimating the true effect of an intervention than any single study can, for two main reasons. First, such reviews collect and synthesize all relevant studies; second, reviews appraise each included study for risk of bias.
However, there is increasing evidence of the existence of publication bias for systematic reviews. A recent survey [3] indicates that nonpublication of completed studies may be as much of a problem for systematic reviews as it is for trials. Other analyses [4],[5] point to the existence of discrepancies between systematic review protocols and the published report, with one study [5] showing that the outcomes included in published systematic reviews may be biased toward “positive” findings. It is crucially important, therefore, that if the evidence from these studies is to be incorporated into clinical practice, the review is as rigorous and as fully reported as possible. For example, it should be obvious to readers whether there was a prespecified protocol for the review, that deviations are noted, and whether outcomes from the review are reported according to the original study plan. Increased clarity surrounding systematic review conduct and reporting would be possible if the protocols for systematic reviews, just like those for trials, were registered [6],[7].
Systematic reviews conducted under the auspices of the Cochrane Collaboration are registered early, at the protocol development stage. This registration helps minimize bias in the conduct and reporting of the review, reduce duplication of effort between groups, and keep systematic reviews updated. However, until now no overarching registry open to all researchers, worldwide, has existed for recording the existence and development of systematic reviews from inception through to completion.
This month, the Centre for Reviews and Dissemination (University of York, UK), supported by the UK National Institutes of Health Research and in collaboration with an international advisory group, announces PROSPERO, its international Prospective Register of Ongoing Systematic Reviews. Following months of public consultation, with many hundreds of respondents from 34 countries providing input on the proposed registration process and minimum dataset, PROSPERO is now open for business [8]. Registration is free, is available to anyone around the world, and generates a unique identifying number for each registered systematic review, which can (and should) be reported in any publications that arise from the study. Investigators should use the registry to record the existence of the protocol for a planned or ongoing systematic review of health care interventions even before screening studies for inclusion in the systematic review. A minimum dataset specifies the key items that are required for a systematic review to be meaningfully registered. Key data items include a statement of the research question, patients and population, study intervention(s) and outcomes; criteria for inclusion and exclusion of studies in the systematic review; outline of search strategy; and methods to assess risk of bias and for analysis of studies included in the systematic review.
With a clear system in place for registration of new and ongoing systematic reviews, PLoS Medicineannounces its support for this initiative. The journal wishes to promote best practice in the conduct and reporting of systematic reviews. Best practice includes registration during the protocol phase in PROSPERO or other appropriate registry, conduct of the review in accordance with a fully developed protocol, and reporting in line with the PRISMA guidelines [9]PLoS Medicine and other PLoS journals will now start asking authors on submission whether registered their systematic review, and if so, to provide us with the registry number, which will be included in the final published article if the study is accepted for publication in the journal. We will also encourage authors to submit copies of their protocols, which will be available for reviewers and editors as part of the review process, and then published as supporting information alongside the full report of the systematic review.
We recognize that it is still early days for registration of systematic reviews. As a result, the PLoS Medicine editors are keen to hear from our readers and authors about this new initiative. We recognize that efforts such as this cannot alone eliminate bias in the conduct and reporting of research. We also appreciate that an additional burden is posed to prospective authors; as such we will reassess the PLoS policy on systematic review registration within a year. The research community is still in the process of learning what the publication outcomes are of cohorts of trials registered in the main registries, such as ClinicalTrials.gov and ISRCTN, since these sites were set up and widely supported by medical journals [2]. It will be some time before the uptake and outcomes of systematic review registration are known. We hope, however, that the future success of this initiative will contribute toward increased rigor and transparency of the systematic review literature.

Acknowledgments Top

The editors would like to thank David Moher and Lesley Stewart, both members of the international advisory board of PROSPERO, for their comments on an earlier draft of this editorial. David Moher is also a PLoS Medicine editorial board member.

Author Contributions Top

Wrote the first draft of the paper: EV. Contributed to the writing of the paper: VB JC SJ MN.

References Top

  1. De Angelis C, Drazen JM, Frizelle FA, Haug C, Hoey J, et al. (2004) Clinical trial registration: A statement from the International Committee of Medical Journal Editors. Ann Intern Med 141: 477–478. FIND THIS ARTICLE ONLINE
  2. Ross JS, Mulvey GK, Hines EM, Nissen SE, Krumholz HM (2009) Trial publication after registration in ClinicalTrials.Gov: A cross-sectional analysis. PLoS Med 6: e1000144. doi:10.1371/journal.pmed.1000144.
  3. Tricco AC, Pham B, Brehaut J, Tetroe J, Cappelli M (2009) An international survey indicated that unpublished systematic reviews exist. J Clin Epidemiol 62: 617–623. FIND THIS ARTICLE ONLINE
  4. Kirkham JJ, Altman DG, Williamson PR (2010) Bias due to changes in specified outcomes during the systematic review process. PLoS One 5: e9810. doi:10.1371/journal.pone.0009810.
  5. Silagy CA, Middleton P, Hopewell S (2002) Publishing protocols of systematic reviews: Comparing what was done to what was planned. JAMA 287: 2831–2834. FIND THIS ARTICLE ONLINE
  6. Straus S, Moher D (2010) Registering systematic reviews. CMAJ 182: 13–14. FIND THIS ARTICLE ONLINE
  7. Booth A, Clarke M, Ghersi D, Moher D, Petticrew M, Stewart L (2011) An international registry of systematic-review protocols. Lancet 377: 108–109. FIND THIS ARTICLE ONLINE
  8. PROSPERO Register of Ongoing Systematic Reviews. Available:http://www.crd.york.ac.uk/PROSPERO.
  9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration PLoS Med 6: e1000100. doi:10.1371/journal.pmed.1000100.

Enabling a new icon


Enabling a new icon

Artist’s street campaign promotes an updating of the wheelchair symbol

Cambridge artist Sara Hendren is sticking her modified handicapped symbol over the standard sign image.Cambridge artist Sara Hendren is sticking her modified handicapped symbol over the standard sign image. (Jonathan Wiggs/Globe Staff)
By Billy Baker
Globe Staff / February 21, 2011
Text size  +
The wheelchair symbol is everywhere, one of the most recognizable icons in the world. Everyone has seen the image, but Sara Hendren believes most people have never really looked at it.
“It’s so familiar, it has the invisibility of the obvious,’’ said Hendren, who is trying to change that with a street art project that is popping up — illegally — throughout the area.
In an era when even the most mundane objects are given obsessive attention from designers, Hendren said she believes the International Symbol of Access, as it is formally known, is long overdue for a makeover. The design, which is more than 40 years old, represents dated views of persons with disabilities, she said, and lacks the life of even the most basic stick-figure pictograms, such as the pedestrian walk signal.
“The figure is static, wooden, with the squared-off geometry of machinery. The body is synonymous with the chair,’’ and creates the impression of someone who needs a push to get through the world, said the 37-year-old artist and mother of three small children who lives in Cambridge. “It is almost completely unexamined, yet it is a design with human values at stake.’’
Hendren has created stickers that feature her own design — the symbol looks more like a person in a wheelchair race — and she is placing that sticker over the current symbol. Her goal is not to replace the symbol but to evolve it, she said. Her stickers are intentionally transparent so that they call attention not just to themselves, but also the old image underneath.
Hendren, who began focusing her attention on issues of accessibility five years ago after giving birth to a son with Down syndrome, is not the first artist to make a case for a redesign. The most successful challenge to the image came courtesy of Brendan Murphy, who as a graduate student in Cincinnati in 1994 updated the image by pushing the figure’s posture forward and putting the arm behind the body, as if he or she had just pushed off on the wheel.
Murphy, who is from Ireland, was inspired in part by Christy Brown, a childhood neighbor of his father’s in Dublin whose story of life with cerebral palsy was made into the Oscar-winning film “My Left Foot.’’
His updated pictogram, seen by many as more progressive in its view of people who use wheelchairs, has been adopted by the city of San Antonio and Williams College, and such retailers as REI and Wal-Mart Stores Inc. A slight variation of it is used by the Museum of Modern Art in New York.
Murphy has always faced a problem getting his symbol adopted because many worry that using anything but the original will violate the Americans with Disabilities Act. But state and federal officials who work on disability issues say that slight variations on the symbol are generally permissible, as long as it is still recognizable as the wheelchair symbol

There are others who question why the image, which has become a universal symbol for so many disabilities, features a wheelchair at all. Until recently, it was used to denote computer programs that had accessibility options for people with hearing and vision problems. Microsoft now uses the “Ease of Access’’ icon, which looks like a wheel; Apple’s “Universal Access’’ icon looks like Leonardo da Vinci’s Vitruvian Man. Murphy proposed changing it to an open door.
Hendren said she is not a designer or a policy maker, but an artist, and the real goal of her guerrilla campaign is to raise questions about the symbol, not propose answers.
“There’s a much bigger question to ask about who is abled and who is disabled and what we think about dependence and need,’’ she said. “I’m just trying to start a discussion where we reevaluate our assumptions and our attitudes.’’
The recognized legal design was commissioned by Rehab International, a global advocacy group for persons with disabilities, to standardize the designation of accessible facilities at a time when many countries had their own symbol. The original sketch was done in 1968 by a Danish graphic design student, then “humanized’’ by Rehab International, which added a circle to the top of the seated figure, giving it a head, according to Rehab International’s website.
The image soon gained global acceptance, backed by the United Nations and written into the standards of the Americans with Disabilities Act, and has played no small part in the giant leap human rights have taken for persons with disabilities over recent decades.
Rehab International did not appreciate the news of Hendren’s campaign to change its iconic image, and said it was very subjective of her to criticize its design.
“There will always be people who wish to redesign [images] to satisfy their creative urges,’’ Joseph Kwan, the global chairman of Rehab International’s commission on technology and accessibility, wrote in an e-mail to the Globe. “The case of your Boston woman is nothing new.’’
Indeed, Hendren credited Murphy’s design, as well as one in use at area Marshall’s stores, for inspiring her. But she also pointed to other stick-figure pictograms that manage to convey a sense of life and action, everything from the pedestrian walk signal to the “operatic drama’’ of the person being electrocuted by the third rail.
Hendren said she knows what she is doing is technically illegal. According to Cambridge police, her unauthorized stickers would be considered a form of tagging, and she could be charged with a misdemeanor and subject to a small fine. But she said that is part of the power of street art — which includes everything from graffiti to flash mobs — where the art is in your face in a public space.
“If she were to make this thing domesticated, it wouldn’t have that social power,’’ said Brian Glenney, an assistant professor of philosophy at Gordon College and a former graffiti artist who collaborated with Hendren on the project. “What she is doing is capturing the social power of the urban street.’’
According to Pedro Alonzo, a curator at the Institute of Contemporary Art who specializes in street art, Hendren’s campaign is the essence of street art: defiant, audacious, in-your-face art that’s accessible to all.
“One of the core issues of street art is taking back public space,’’ Alonzo said. “And in many cases, it’s for a social agenda, which you have here.’’
Hendren calls her campaign an urban edit, and she is sending out stickers to others who want to pick up her campaign around the country. In a world that is continually built up and filled in, she said, there is room for people who think they have a better idea to step in and offer a tiny tweak, even if it is just to begin a discussion.
And there is a successful precedent in guerrilla public signs.
In 2001, an artist named Richard Ankrom thought an interchange on a Los Angeles freeway was poorly marked, so he machined his own sign according to state specifications, and mounted it above the freeway.
When it was discovered after nine months, officials acknowledged he was right and left the sign up.
Billy Baker can be reached at billybaker@globe.com