viernes, 18 de mayo de 2012

May 18, 2012 Books Update


The New York Times

May 18, 2012

Books Update

On the Cover of Sunday's Book Review
Illustration of Toni Morrison by Tina Berning
‘Home’
By TONI MORRISON
Reviewed by LEAH HAGER COHEN
In Toni Morrison's novel, a traumatized soldier returns from the Korean War to his segregated hometown in Georgia.

Also in the Book Review

Let's Go Reading in the Car

By JUDITH SHULEVITZ
Audiobooks and road trips offer a chance to reacquaint children, and their parents, with the joy of listening to stories.

The Voice

By JOHN SCHWARTZ
A great audiobook experience depends on the reader as much as the text.

'This Will Be Difficult to Explain'

By JOHANNA SKIBSRUD
Reviewed by JESSICA LOUDIS
Whether in Paris or the Great Plains, failures to communicate fray the relationships in these tales.

'The Lower River'

By PAUL THEROUX
Reviewed by PATRICK McGRATH
In Paul Theroux's novel, an American seeks a fresh start in Africa after a 40-year absence.

'The Cause'

By ERIC ALTERMAN and KEVIN MATTSON
Reviewed by JEFF SHESOL
Eric Alterman's history of liberalism from the New Deal to the present concentrates on the men and women who have defined it.

'The Tyranny of Clichés'

By JONAH GOLDBERG
Reviewed by JOE KLEIN
Jonah Goldberg accuses liberals of lazy thinking and worse.
Survivor: Fossil remains of the horseshoe crab, which isn't a crab at all, date from 450 million years ago.

'Horseshoe Crabs and Velvet Worms'

By RICHARD FORTEY
Reviewed by CONSTANCE CASEY
The paleontologist Richard Fortey searches out species that have endured hundreds of millions of years of planetary turmoil.

'Wichita'

By THAD ZIOLKOWSKI
Reviewed by NATALIE BAKOPOULOS
Fleeing the pressures of academia, Thad Ziolkowski's Midwestern hero is sucked into his family's schemes and strife.
Jonathan Franzen

'Farther Away'

By JONATHAN FRANZEN
Reviewed by PHILLIP LOPATE
Jonathan Franzen's essays express his love of birds and of writers, especially his friend David Foster Wallace.

'Billy Lynn's Long Halftime Walk'

By BEN FOUNTAIN
Reviewed by GEOFF DYER
A firefight with Iraqi insurgents is caught on tape and turns a band of soldiers into media heroes in Ben Fountain's satire.

'Chasing Venus'

By ANDREA WULF
Reviewed by JoANN C. GUTIN
With a Venusian transit imminent, 18th-century astronomers risked their lives for a chance to measure the solar system.
The author and his father, whose intelligence

'Oblivion: A Memoir'

By HECTOR ABAD. Translated by ANNE McLEAN and ROSALIND HARVEY
Reviewed by MICHAEL GREENBERG
Héctor Abad creates a sociopolitical portrait of Colombia through the telling of his family's story.
Lucia Perillo

Silver Linings

By ADAM PLUNKETT
Lucia Perillo's two collections, poems and stories, draw upon her experiences in a world that often hurts her.
Hugh Dancy

Hugh Dancy: By the Book

Hugh Dancy, currently on Broadway in "Venus in Fur" and in the film "Hysteria," wishes David Mitchell would match Philip Roth's output.

Back Page

Books With 140 Characters

By JEFF HOWE
At 64,000 members and counting, the Twitter-based reading group 1book140 is a global concern.
Toni Morrison

Inside the List

By GREGORY COWLES
Toni Morrison, whose novel "Home" enters the hardcover fiction list at No. 9 this week, remembers being confronted by a stark image of race relations as a freshman at Howard University.

Editors' Choice

Recently reviewed books of particular interest.

Paperback Row

By IHSAN TAYLOR
Paperback books of particular interest.

Book Review Podcast

This week, Joe Klein talks about Jonah Goldberg's "The Tyranny of Clichés"; Jeff Shesol discusses Eric Alterman's history of liberalism from the New Deal to the present; Julie Bosman has notes from the field; and Gregory Cowles has best-seller news. Sam Tanenhaus is the host.
ArtsBeat

Editor's Note

Thanks for taking the time to read this e-mail. Feel free to send feedback; I enjoy hearing your opinions and will do my best to respond.
John Williams
Books Producer
The New York Times on the 


Nadezhda Konstantinovna Krupskaya (1869-1939): Feminista y bibliotecaria


Nadezhda Konstantinovna Krupskaya, feminista, pedagoga, dirigente bolchevique y figura principal en la Revolución Rusa, creó el nuevo sistema educativo soviético y puso en pie las bibliotecas del estado obrero impulsando el sistema bibliotecario soviético, impartió conferencias y escribió extensamente sobre la importancia de las bibliotecas y la lectura en la sociedad socialista. 
 
Referencia bibliográfica:
MUÑOZ-MUÑOZ, Ana Mª. Nadezhda Konstantinovna Krupskaya (1869-1939): Feminista y bibliotecaria. En: MUÑOZ-MUÑOZ, Ana Mª y BALLARÍN DOMINGO, Pilar (edas.). Mujeres y libros. Homenaje a la profesora a Ia profesora Dña. Isabel de Torres Ramírez. Granada: Universidad de Granada, Servicio de Publicaciones, 2010, pp. 143-156. ISBN: 978-84-338-5153-6.

Texto completo en:

jueves, 17 de mayo de 2012

Duración optima de la anticoagulación en pacientes con tromboembolismo venoso


Duración optima de la anticoagulación en pacientes con tromboembolismo venoso
Optimal duration of anticoagulation in patients with venous thromboembolism.
Prandoni P, Piovella C, Spiezia L, Valle FD, Pesavento R.
Indian J Med Res [serial online] 2011 [cited 2012 May 3];134:15-21.

The risk of recurrent venous thromboembolism (VTE) approaches 40 per cent of all patients after 10 yr of follow up. This risk is higher in patients with permanent risk factors of thrombosis such as active cancer, prolonged immobilization from medical diseases, and antiphospholipid syndrome; in carriers of several thrombophilic abnormalities, including deficiencies of natural anticoagulants; and in patients with unprovoked presentation. Patients with permanent risk factors of thrombosis should receive indefinite anticoagulation, consisting of subtherapeutic doses of low molecular weight heparin in cancer patients, and oral anticoagulants in all other conditions. Patients whose VTE is triggered by major surgery or trauma should be offered three months of anticoagulation. Patients with unprovoked VTE, including carriers of thrombophilia, and those whose thrombotic event is associated with minor risk factors (such as hormonal treatment, minor injuries, long travel) should receive at least three months of anticoagulation. The decision as to go on or discontinue anticoagulation after this period should be individually tailored and balanced against the haemorrhagic risk. Post-baseline variables, such as the D-dimer determination and the ultrasound assessment of residual thrombosis can help identify those patients in whom anticoagulation can be safely discontinued. As a few emerging anti-Xa and anti-IIa compounds seem to induce fewer haemorrhagic complications than conventional anticoagulation, while preserving at least the same effectiveness, these have the potential to open new scenarios for decisions regarding the duration of anticoagulation in patients with VTE.
Keywords: Anticoagulation - deep venous thrombosis - pulmonary embolism - thrombophilia - venous thromboembolism
http://www.ijmr.org.in/text.asp?2011/134/1/15/83319 
Atentamente
Anestesiología y Medicina del Dolor

Novedades en la Ortografìa


Reglas de Ortografía

         

Boletín n.º 41

http://www.reglasdeortografia.com Morón de la Frontera, 17 de mayo de 2012

Examen polémico
 
En reglasdeortografia.com tienes la posibilidad de hacer la prueba: Si bien, el planteamiento es distinto, toda vez, que el enmarque es totalmente educativo y podrás realizar el ejercicio las veces que quieras con la particularidad, eso sí, de que no verás ninguna pista de las palabras con errores a la hora de comprobar el ejercicio corregido y, en su lugar, las respuestas solo señalarán en rojo las frases que contengan palabras mal escritas.
¿Aprobarías el examen en el que suspendieron 138 policías grancanarios? Sería bueno que conocieras tu nivel:

El hombre séptico... sin ninguna duda


Cover Image: June 2012 Scientific American MagazineSee Inside

http://www.scientificamerican.com/article.cfm?id=ultimate-social-network-bacteria-protects-health

Bacteria in Our Bodies Protect Our Health [Preview]

Researchers who study the friendly bacteria that live inside all of us are starting to sort out who is in charge—microbes or people?
Image: Bryan Christie


In Brief

  • Bacterial cells in the body outnumber human cells by a factor of 10 to 1. Yet only recently have researchers begun to elucidate the beneficial roles these microbes play in fostering health.
  • Some of these bacteria possess genes that encode for beneficial compounds that the body cannot make on its own. Other bacteria seem to train the body not to overreact to outside threats.
  • Advances in computing and gene sequencing are allowing investigators to create a detailed catalogue of all the bacterial genes that make up this so-called microbiome.
  • Unfortunately, the inadvertent destruction of beneficial microbes by the use of antibiotics, among other things,  may be leading to an increase in autoimmune disorders and obesity.


Biologists once thought that human beings were phys­iological islands, entirely capable of regulating their own internal workings. Our bodies made all the enzymes needed for breaking down food and using its nutrients to power and repair our tissues and organs. Signals from our own tissues dictated body states such as hunger or satiety. The specialized cells of our immune system taught themselves how to recognize and attack dangerous microbes—pathogens—while at the same time sparing our own tissues.
Over the past 10 years or so, however, researchers have demonstrated that the human body is not such a neatly self-sufficient island after all. It is more like a complex ecosystem—a social network—containing trillions of bacteria and other microorganisms that inhabit our skin, genital areas, mouth and especially intestines. In fact, most of the cells in the human body are not human at all. Bacterial cells in the human body outnumber human cells 10 to one. Moreover, this mixed community of microbial cells and the genes they contain, collectively known as the microbiome, does not threaten us but offers vital help with basic physiological processes—from digestion to growth to self-defense.


http://www.scientificamerican.com/article.cfm?id=microbiome-graphic-explore-human-microbiome

Explore the Human Microbiome [Interactive]

Learn about the bacteria, fungi and other micro-organisms that maintain human health.

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The body contains 10 times more bacteria, fungi and other micro-organisms than human cells. Most of these species are harmless—although they can still cause illness if they wind up in the wrong place. In addition, researchers are beginning to learn exactly how some microbial species in the body help digestion and contribute to regulation of appetite and the immune system.  
Illustration by Bryan Christie

Cover Image: December 2011 Scientific American MagazineSee Inside

Swapping Germs: Should Fecal Transplants Become Routine for Debilitating Diarrhea?

A potentially beneficial but unusual treatment for serious intestinal ailments may fall victim to regulatory difficulties


STRAIGHT POOPBacteria shed from the intestine (some of which are colored purple here) make up much of human feces.Image: Tony Brain/Photo Researchers, Inc.


Marion Browning of North Providence, R.I., was at her wit’s end. The 79-year-old retired nurse had suffered from chronic diarrhea for almost a year. It began after doctors prescribed antibiotics to treat her diverticulitis, a painful infection of small pouches in the wall of the colon. The regimen also killed friendly bacteria that lived in Browning’s intestines, allowing a toxin-producing organism known as Clostridium difficile to take over and begin eating away at the entire lining of her gut.
For months Browning was in and out of her doctor’s office, getting big-gun antibiotics to suppress the C. difficile infection. Each time a course of treatment ended she would feel better for a while. But her strain of C. difficile was stubborn: a few of the destructive bacteria always survived. Within a few days they would begin multiplying, and the racking diarrhea would recur. After four rounds of antibiotics, her gastroenterologist told her that he had done all he could think of. He recommended that she see Colleen Kelly, a clinical faculty member at Brown University’s medical school, who was trying something new.
Kelly proposed a treatment that sounded both logical and strangely unmedical. Normally, she told Browning, the friendly bacteria that reside in the human intestine maintain a seesawing balance that keeps pathogenic bacteria in check. That equilibrium can be temporarily disrupted—as with standard antibiotic treatment—but it nearly always returns to stability. Browning’s own bacterial community had lost that ability, probably for good. Still, there was a way to restore normality, Kelly said. She could replace Browning’s bacteria completely, by inserting into her colon a diluted sample of stool from someone whose intestinal health was good. If the good bacteria in the donated stool took hold and recolonized her intestine, the C. difficile would be crowded out, and she would be cured.
Browning had never heard of such a procedure—variously called fecal transplant, fecal bacteriotherapy or fecal flora reconstitution—but she was ready to try anything. Kelly asked her to recruit a healthy donor. Browning chose her 49-year-old son. In the fall of 2009 Browning performed the bowel-cleansing routine that precedes a colonoscopy, while her son took an overnight laxative. Kelly diluted the donation, then used colonoscopy instruments to squirt the solution high up in Browning’s large intestine. The diarrhea resolved in two days and has never recurred.
“I can’t understand why more doctors aren’t doing this,” says Browning, now 80. Yet a complex combination of federal regulations and research rules—along with just plain squeamishness—could keep the procedure from helping potentially thousands of people who might benefit.
A Growing Threat 
Browning is not alone in being a success story. In medical journals, about a dozen clinicians in the U.S., Europe and Australia have described performing fecal transplants on about 300 C. difficile patients so far. More than 90 percent of those patients recovered completely, an unheard-of proportion. “There is no drug, for anything, that gets to 95 percent,” Kelly says. Plus, “it is cheap and it is safe,” says Lawrence Brandt, a professor of medicine and surgery at the Albert Einstein College of Medicine, who has been performing the procedure since 1999.
So far, though, fecal transplants remain a niche therapy, practiced only by gastroenterologists who work for broad-minded institutions and who have overcome the ick factor. To become widely accepted, recommended by professional societies and reimbursed by insurers, the transplants will need to be rigorously studied in a randomized clinical trial, in which people taking a treatment are assessed alongside people who are not. Kelly and several others have drafted a trial design to submit to the National Institutes of Health for grant funding. Yet an unexpected obstacle stands in their way: before the NIH approves any trial, the substance being studied must be granted “investigational” status by the Food and Drug Administration. The main categories under which the FDA considers things to be investigated are drugs, devices, and biological products such as vaccines and tissues. Feces simply do not fit into any of those categories.

The physicians performing the transplants decry the regulatory bottleneck because new treatments for C. difficile infection are critically needed. C. diff, to use the common medical shorthand, has risen in the past 30 years from a recognized but tolerated consequence of antibiotic treatment to a serious health threat. Since 2000, when a virulent new strain emerged, cases have become much more common, occurring not only in the elderly but in children, pregnant women and people with no obvious health risks. One study estimated that the number of hospitalized adults withC. diff more than doubled from about 134,000 patients in 2000 to 291,000 patients in 2005. A second study showed that the overall death rate from C. diff had jumped fourfold, from 5.7 deaths per million in the general population in 1999 to 23.7 deaths per million in 2004.
C. diff has also become harder to cure. Thanks to increasing antibiotic resistance, standard treatment now relies on two drugs: metronidazole (Flagyl) and vancomycin. Both medications are so-called broad-spectrum antibiotics, meaning that they work against a wide variety of bacteria. Thus, when they are given to kill C. diff infection, they kill most of the gut’s friendly bacteria as well. The living space that those bacteria once occupied then becomes available for any C. diff organisms that survive the drugs’ attack. As a result, roughly 20 percent of patients who have had one episode of C. diffinfection will have a recurrence; 40 percent of those with one recurrence will have another; and 60 percent of those who experience a second bout are likely to suffer several more. Some victims with no other options must have their colon removed. (A new drug, fidaxomicin, which was approved for C. diff infection by the FDA in late May, may lead to fewer relapses because it is a narrow-spectrum antibiotic.)
A Simple Procedure
The details of how the transplantation of microbes eliminates C. diff infection have not been well studied, but Alex Khoruts, a gastroenterologist and immunologist at the University of Minnesota who has performed two dozen fecal transplants over the past two years, has demonstrated that the transplanted bacteria do take over the gut, replacing the absent friendly bacteria and outcompeting C. diff. In 2010 he analyzed the genetic makeup of the gut flora of a 61-year-old woman so disabled by recurrentC. diff that she was wearing diapers and was confined to a wheelchair. His results showed that before the procedure, in which the woman received a fecal sample from her husband, she harbored none of the bacteria whose presence would signal a healthy intestinal environment. After the transplant—and her complete recovery—the bacterial contents of her gut were not only normal but were identical to that of her husband.
Most clinicians who perform fecal transplants ask their patients to find their own donors and prefer that they be a child, sibling, parent or spouse. “For me, it’s aesthetic,” says Christina Surawicz, a professor of medicine at the University of Washington, who has done transplants on two dozen patients and published an account of the first 19. “There’s something very intimate about putting someone else’s stool in your colon, and you are already intimate with a spouse.”
To ensure safety, the physicians performing the procedure require that donors have no digestive diseases and put them through the same level of screening that blood donation would require. That process imposes a cost in time and logistics because standard rules for medical confidentiality require a donor to be interviewed separately from the potential recipient. It also carries inherent financial penalties. The donor’s lab work most likely will not be covered by insurance; the transplant procedure may or may not be covered by the patient’s insurance.
Proponents have come up with work-arounds for those possible barriers. Khoruts no longer uses related donors—which requires finding a different individual for every case—but instead has recruited a cadre of “universal donors” from among local health care workers. (He has seen no change in how often the transplants “take.”) Last year Michael Silverman of the University of Toronto boldly proposed a yet more streamlined solution: having patients perform the transplants at home with a drugstore enema kit. A drawback, he cautioned in Clinical Gastroenterology and Hepatology, is that too much of the stool solution might leak out for the transplant to take. Nevertheless, seven patients with recurrent C. diff have safely performed the home version, he wrote, with a 100 percent recovery rate.
Next Steps
Even without large-scale rigorous investigations of fecal transplants, the medical community appears to be coming around to the practice. The Journal of Clinical Gastroenterology editorialized in September 2010 that “it is clear from all of these reports that fecal bacteriotherapy using donor stool has arrived as a successful therapy.” Albert Einstein’s Brandt recently suggested in the same journal that fecal transplants should be the first treatment tried for serious C. diff infection rather than a last resort. Increasing research interest in the influence of gut flora on the rest of the body—and on conditions as varied as obesity, anxiety and depression—will likely bring pressure for transplants to be adopted more widely.
Currently three clinical trials of fecal transplants have begun in Canada. In the U.S., however, the research logjam persists. An FDA spokesperson said in an interview that there is no way to determine how the agency might rule on an investigational application until the application is brought. That tosses the initiative back to Kelly and her collaborators, who include Khoruts and Brandt. They hope to file with the FDA before much longer, but Kelly admits to being apprehensive over the possible outcome.
“We hope they will not ask things that we cannot answer,” she says. Medical centers need to be able to study the procedure, Kelly argues, “because people are trying it on their own.”

ABOUT THE AUTHOR(S)

Maryn McKenna is a journalist, a blogger and author of two books about public health. She writes about infectious diseases, global health and food policy.