A collaboration between adult protective services and forensic accounting examiners to investigate complex financial exploitation: formative evaluation findings.

Financial exploitation (FE) is one of the most common reports to Adult Protective Services (APS) and the cases are often complex. Consequently, APS caseworkers report FE investigations to be among the most difficult while simultaneously reporting low confidence in productive outcomes for these investigations. This necessitates finding ways to support APS FE investigations. This paper describes the structure, process, and formative findings of a collaboration between forensic accounting examiners and APS workers to investigate complex cases of FE. Among the 77 FE cases completed, forensic examiners reviewed multiple years of financial records which included over 101,000 transactions, totaling over $213,000,000.00 in finances, and identified over $8,000,000 in questionable activity. Scores on the 8-item Client Satisfaction Questionnaire were high indicating high program satisfaction by APS workers, subject matter experts, and forensic examiners. These findings support the feasibility and acceptability of forensic accounting and APS collaborations to investigate complex cases of FE.

Speech-language pathologists' perceptions of childhood bilingualism.

The value of learning multiple languages has increased in the past 20 years. Despite this, some professionals continue to provide misinformation about bilingualism to many families around the United States, resulting in recommendations of implementing a monolingual approach for children. This study investigated the perceptions held by speech-language pathologists (SLPs) regarding childhood bilingualism. A total of 320 SLPs completed a survey stating their perceptions on childhood bilingualism for typically developing children and children with disabilities. Based on the number of responses, 292 participants were analysed quantitatively utilising a binary logistic regression to identify whether SLPs thought childhood bilingualism was advantageous or neutral, while incorporating the predictors of bilingual status and bilingualism education received. Additionally, a qualitative content analysis was conducted on 173 participants' responses to an open-ended question about their perceptions on childhood bilingualism. Results revealed that SLPs' bilingual status did not predict the probability of an advantageous perception for typically developing children, but it did for children with disabilities; however, SLPs who had received bilingualism education had a higher probability of having advantageous perceptions in both populations. Qualitative results revealed the use of appraisals related to multiple themes. This study served to understand the thoughts of SLPs in relation to the education they are providing to parents and the services they are providing to different populations - whether it be typically developing children or children with disabilities. There are implications for bilingual and cultural-linguistic education to be implemented across graduate programmes to ensure that optimal services are provided to the diverse groups in our case loads.

Preliminary Perceptual Findings of Singing After Flow Phonation Voice Exercises for Singers in Training.

INTRODUCTION: Goals of voice therapy and vocal pedagogy share similar principles and therefore, therapy approaches designed to improve the disordered voice may be equally effective when used to enhance healthy voice and vice versa. The purpose of this study was to investigate the effects of flow phonation voice exercises on vocal characteristics of students in undergraduate vocal music training programs and examine their potential use in vocal pedagogy. METHODS: A total of 10 cis females were recruited and were randomized into two groups: an experimental group (group 1, n = 6) receiving five sessions of flow phonation intervention across 5 weeks; and a control group (group 2, n = 4) that did not receive any direct intervention other than vocal hygiene education. Participants provided data pertaining to auditory perception, subjective respiratory measures, voice-related quality of life, and vocal fatigue before and after 5 weeks. Flow phonation exercises consisted of cup bubble blowing, gargling, and stretch and flow. Wilcoxon signed ranks test was administered to compare outcomes across time points and between groups. RESULTS: Data indicate statistically significant changes in auditory perception of the singing voice, and voice-related quality of life for the group that received flow phonation exercises alone. No other measures showed statistical significance. DISCUSSION AND CONCLUSION: Overall, this study indicates that the use of flow phonation voice exercises has the potential to improve voice instruction within the voice studio. While our target enrollments were not met to achieve optimal statistical power, our hypotheses were at least partially supported. In particular, positive intervention-related changes were observed in self-perceived voice handicap, and auditory perception of singing which were not observed in the control group.

Development and validation of a paediatric version of the Khalfa Hyperacusis Questionnaire for children with and without autism.

OBJECTIVE: Hyperacusis is reported to occur in 3.2-17.1% of the general paediatric population with higher rates in clinical populations such as autism spectrum disorders (ASD). Although hyperacusis is a relatively common form of decreased sound tolerance (DST), no valid paediatric hyperacusis measures are currently available. The purpose of the present study was to develop and validate a paediatric version of the Khalfa Hyperacusis Questionnaire (HQ) as a first step towards filling this measurement gap. DESIGN: A cross-sectional design was used to evaluate therapist opinions of the paediatric version (P-HQ) and to field test the P-HQ in parents of children with and without ASD. Total scores were compared between ASD and non-ASD groups. STUDY SAMPLE: Eleven paediatric occupational and speech therapists with expertise in ASD, 64 parents of children with ASD and 37 parents of children without ASD completed online questionnaires. Psychometric analyses were conducted. RESULTS: A unidimensional construct was found underlying P-HQ and all items displayed sufficient theoretical relevance to hyperacusis and adequate psychometric properties. CONCLUSIONS: The P-HQ demonstrates good internal consistency and shows promise as a potential screening tool for identifying DST in ASD. Further research is warranted to establish normative data and validate cut-off scores.

The growth and metabolome of Saccharomyces uvarum in wine fermentations are strongly influenced by the route of nitrogen assimilation.

Nitrogen is a critical nutrient in beverage fermentations, influencing fermentation performance and formation of compounds that affect organoleptic properties of the product. Traditionally, most commercial wine fermentations rely on Saccharomyces cerevisiae but the potential of alternative yeasts is increasingly recognised because of the possibility to deliver innovative products and process improvements. In this regard, Saccharomyces uvarum is an attractive non-traditional yeast that, while quite closely related to S. cerevisiae, displays a different fermentative and aromatic profile. Although S. uvarum is used in cider-making and in some winemaking, better knowledge of its physiology and metabolism is required if its full potential is to be realised. To address this gap, we performed a comparative analysis of the response of S. uvarum and S. cerevisiae to 13 different sources of nitrogen, assessing key parameters such as growth, fermentation performance, the production of central carbon metabolites and aroma volatile compounds. We observed that the two species differ in the production of acetate, succinate, medium-chain fatty acids, phenylethanol, phenylethyl acetate, and fusel/branched acids in ways that reflect different distribution of fluxes in the metabolic network. The integrated analysis revealed different patterns of yeast performance and activity linked to whether growth was on amino acids metabolised via the Ehrlich pathway or on amino acids and compounds assimilated through the central nitrogen core. This study highlights differences between the two yeasts and the importance that nitrogen metabolism can play in modulating the sensory profile of wine when using S. uvarum as the fermentative yeast.

Beyond Saccharomyces pastorianus for modern lager brews: Exploring non-cerevisiae Saccharomyces hybrids with heterotic maltotriose consumption and novel aroma profile.

Non-domesticated, wild Saccharomyces yeasts have promising characteristics for beer diversification, particularly when used in the generation of de novo interspecific hybrids. A major motivation for the current work was the question whether attractive novel Saccharomyces interspecific hybrids can be created for the production of exotic lager beers without using the genomic resources of the ale yeast Saccharomyces cerevisiae. Importantly, maltotriose utilization is an essential characteristic typically associated with domesticated ale/lager brewing strains. A high-throughput screening on nearly 200 strains representing all eight species of the Saccharomyces genus was conducted. Three Saccharomyces mikatae strains were able to aerobically grow on maltotriose as the sole carbon source, a trait until recently unidentified for this species. Our screening also confirmed the recently reported maltotriose utilization of the S. jurei strain D5095T. Remarkably, de novo hybrids between a maltotriose-utilizing S. mikatae or S. jurei strain and the maltotriose-negative Saccharomyces eubayanus strain CBS 12357T displayed heterosis and outperformed both parents with regard to aerobically utilizing maltotriose as the sole source of carbon. Indeed, the maximum specific growth rates on this sugar were comparable to the well-known industrial strain, Saccharomyces pastorianus CBS 1513. In lager brewing settings (oxygen-limited), the new hybrids were able to ferment maltose, while maltotriose was not metabolized. Favorable fruity esters were produced, demonstrating that the novel hybrids have the potential to add to the diversity of lager brewing.

The evolution and role of the periplasmic asparaginase Asp3 in yeast.

The study of nitrogen assimilation in yeast is of interest from genetic, evolutionary, and biotechnological perspectives. Over the course of evolution, yeasts have developed sophisticated control mechanisms to regulate nitrogen metabolism, with domesticated lineages sometimes displaying particular specialisation. The focus of this study was on assimilation of asparagine, which is a significant nutritional source for some alcoholic fermentations. We were particularly interested in ASP3, which encodes a periplasmic asparaginase and that was proposed to have been acquired relatively recently in S. cerevisiae by horizontal gene transfer. We examined 1680 S. cerevisiae genome assemblies to evaluate the distribution and evolutionary trajectory of ASP3. Our findings suggest an alternative hypothesis that ASP3 is an ancient Saccharomyces gene that has generally been lost over the course of evolution but has been retained in certain fermentative environments. As asparagine is the major nitrogen source in apple juice, we explored whether the presence of ASP3 would confer a growth advantage. Interestingly, we found that although ASP3 enhances growth when asparagine is the sole nitrogen source, the same effect is not seen in apple juice. These data indicate that growth in pure culture may not reflect the original selective environment for ASP3+ strains and highlight the role that complex regulation may play in optimising nitrogen assimilation in yeasts.

Considerations for Addressing the Needs of Culturally and Linguistically Diverse Speech-Language Pathology Praxis Test Takers.

PURPOSE: The primary purpose of this article is to explore the speech-language pathology (SLP) Praxis test, a barrier to culturally and linguistically diverse (CLD) individuals entering the profession, by investigating first-time pass rates and mean scores by test taker race/ethnicity. Other potential barriers to licensure and certification, as well as solutions for mitigating these barriers, will also be addressed. METHOD: SLP Praxis test data from two windows of time, 2008-2011 and 2014-2020, were compared for the following: (a) proportions of test taker race/ethnicity relative to U.S. demographic estimates of racial/ethnic group proportions overall, (b) proportions of racial/ethnic groups, and (c) trends in test-taker mean scores by race/ethnicity. First-attempt pass rates by racial/ethnic groups were also calculated for the 2014-2020 testing window. RESULTS: The percentage of some CLD SLP Praxis test-taker groups increased since the 2008-2011 testing window but is still not representative of U.S. racial/ethnic demographics. The first-attempt pass rates and overall mean scores of CLD test-taker groups remained substantially lower than White non-Hispanic/Latinx test takers. CONCLUSIONS: Despite the encouraging trends in SLP Praxis test-taker racial/ethnic diversity, disparities persist between the racial/ethnic makeup of SLP Praxis test takers and the demographic makeup of the United States. Consequently, these disparities have implications for the continued lack of cultural representativeness seen in our workforce.

Domestication-induced reduction in eye size revealed in multiple common garden experiments: The case of Atlantic salmon (Salmo salar L.).

Domestication leads to changes in traits that are under directional selection in breeding programmes, though unintentional changes in nonproduction traits can also arise. In offspring of escaping fish and any hybrid progeny, such unintentionally altered traits may reduce fitness in the wild. Atlantic salmon breeding programmes were established in the early 1970s, resulting in genetic changes in multiple traits. However, the impact of domestication on eye size has not been studied. We measured body size corrected eye size in 4000 salmon from six common garden experiments conducted under artificial and natural conditions, in freshwater and saltwater environments, in two countries. Within these common gardens, offspring of domesticated and wild parents were crossed to produce 11 strains, with varying genetic backgrounds (wild, domesticated, F1 hybrids, F2 hybrids and backcrosses). Size-adjusted eye size was influenced by both genetic and environmental factors. Domesticated fish reared under artificial conditions had smaller adjusted eye size when compared to wild fish reared under identical conditions, in both the freshwater and marine environments, and in both Irish and Norwegian experiments. However, in parr that had been introduced into a river environment shortly after hatching and sampled at the end of their first summer, differences in adjusted eye size observed among genetic groups were of a reduced magnitude and were nonsignificant in 2-year-old sea migrating smolts sampled in the river immediately prior to sea entry. Collectively, our findings could suggest that where natural selection is present, individuals with reduced eye size are maladapted and consequently have reduced fitness, building on our understanding of the mechanisms that underlie a well-documented reduction in the fitness of the progeny of domesticated salmon, including hybrid progeny, in the wild.

New approaches and therapeutic options for post-dural puncture headache treatment / Nuevos abordajes y alternativas terapéuticas en el tratamiento de la cefalea pospunción dural

Abstract Post-dural puncture headache is a frequent complication in neuraxial approaches. It may result in disability, healthcare dissatisfaction and potentially serious complications. The traditional initial management includes general and analgesia measures with poor evidence. The treatment approach best supported by the literature is the epidural blood patch for which rates of up 70% improvement have been reported. Regional techniques have been recently described that may be helpful because they are less invasive than the epidural blood patch, under certain clinical circumstances. This article suggests an algorithm that uses such techniques for the management of this complication.

Resumen La cefalea pospunción dural es una complicación frecuente del abordaje del neuroeje. Puede producir incapacidad, insatisfacción con la atención en salud y complicaciones potencialmente graves. Tradicionalmente su manejo inicial incluye medidas generales y de analgesia las cuales tienen baja evidencia. La medida para su tratamiento, con mejor soporte en la literatura, es la realización de parche hemático, el cual informa tazas de mejoría hasta del 70 %. Recientemente se han descrito técnicas regionales, que pueden resultar útiles por ser menos invasivas que el parche hemático, en ciertos contextos clínicos. En este artículo se propone un algoritmo que permite incorporar dichas técnicas al manejo de esta complicación.

Stigma and the Hispanic stuttering experience: A qualitative study.

The stigmatization of stuttering has profound effects on the education, employment, and mental health of people who stutter. While there is a large body of research into the impact of stuttering stigma, few studies have considered the effects of cultural differences. The purpose of this study is to provide an in-depth analysis of how Hispanic adults who stutter experience stigma. To do so, seven Hispanic/Latino adults who stutter were interviewed using ethnographic interviewing techniques. A thematic analysis of participants' narrative responses gave rise to four major themes: Family, Stigma in Society, Stuttering Experiences in Cultural and Linguistic Contexts, and Stigma's Impact on Identity. Findings indicate that Hispanic adults who stutter experience stigma in unique ways that affect their language use, cultural participation, and identity. An understanding of these cultural and linguistic factors will allow clinicians to develop a more nuanced and effective approach when treating Hispanic adults who stutter.

Disentangling the effects of sex, life history and genetic background in Atlantic salmon: growth, heart and liver under common garden conditions.

Livestock domestication has long been a part of agriculture, estimated to have first occurred approximately 10 000 years ago. Despite the plethora of traits studied, there is little understanding of the possible impacts domestication has had on internal organs, which are key determinants of survival. Moreover, the genetic basis of observed associated changes in artificial environments is still puzzling. Here we examine impacts of captivity on two organs in Atlantic salmon (Salar salar) that have been domesticated for approximately 50 years: heart and liver, in addition to growth. We studied multiple families of wild, domesticated, F1 and F2 hybrid, and backcrossed strains of S. salar in replicated common garden tanks during the freshwater and marine stages of development. Heart and liver weight were investigated, along with heart morphology metrics examined in just the wild, domesticated and F1 hybrid strains (heart height and width). Growth was positively linked with the proportion of the domesticated strain, and recombination in F2 hybrids (and the potential disruption of co-adapted gene complexes) did not influence growth. Despite the influence of domestication on growth, we found no evidence for domestication-driven divergence in heart or liver morphology. However, sexual dimorphism was detected in heart morphology, and after controlling for body size, females exhibited significantly larger heart weight and heart width when compared with males. Wild females also had an increased heart height when compared with wild males, and this was not observed in any other strain. Females sampled in saltwater showed significantly larger heart height with rounder hearts, than saltwater males. Collectively, these results demonstrate an additive basis of growth and, despite a strong influence of domestication on growth, no clear evidence of changes in heart or liver morphology associated with domestication was identified.

Severe pediculosis capitis in a nursery school girl / Pediculosis capitis grave en una niña inscrita en una guardería

Pediculosis capitis is the most frequent ectoparasitosis around the world. The infestation is caused by Pediculus humanus capitis (head louse), which affects hair, scalp, and skin. It rarely presents with more symptoms and in the majority of the cases, it shows a benign course if treated properly. We present the case of a nursery school girl with head lice infestation for 18 months. She did not improve after the shampoo treatment. This case was associated with furunculosis, skin lesions, multiple adenopathies, and anemia. Initially, the presence of boils, alopecia, and lymphadenopathy was evident. The persistence of pediculosis capitis and intense scratching induced changes on skin integrity, facilitating opportunistic bacterial superinfection that led to impetiginization, furunculosis, excoriations, hematic scabs, anemia, alopecia, and lymphadenopathies. Pediculosis capitis affected the patient triggering psychological, economic, social, and other health problems. The patient presented uncommon symptoms (furunculosis, anemia, fever, alopecia, and adenopathies) resulting from the persistence of risk factors and the absence of head inspection and mechanical removal of insects. The education about the risk factors, as well as sanitary controls, are essential to contain the infestation.

La pediculosis capitis es la ectoparasitosis más frecuente a nivel mundial. La infestación es causada por Pediculus humanus capitis (piojo de la cabeza) y afecta el cabello, el cuero cabelludo y la piel. Rara vez se manifiesta con otro tipo de sintomatología y, por lo general, su curso es benigno si se trata adecuadamente. Se presenta el caso de una menor con pediculosis capitis de 18 meses de evolución, asociada con forúnculos, lesiones cutáneas, múltiples adenopatías y anemia, que no mejoró tras la aplicación del champú. Inicialmente, llamó la atención la presencia de forúnculos, alopecia y adenopatías. La persistencia de la pediculosis capitis y el rascado intenso alteraron la integridad de la epidermis y facilitaron las infecciones secundarias por bacterias patógenas y oportunistas que produjeron impétigo, forunculosis, excoriaciones, costras hemáticas, anemia, alopecia y linfadenopatías. La pediculosis capitis afectó notoriamente a la paciente al causarle problemas psicológicos y de salud, agudizados por su condición económica y social. La paciente presentó manifestaciones clínicas poco frecuentes (forunculosis, anemia, fiebre, alopecia y adenopatías), lo cual se vio facilitado por la persistencia de los factores de riesgo y el hecho de que no se le inspeccionaba la cabeza ni se removían los insectos. La educación sobre los factores de riesgo y el control sanitario es indispensable para controlar la infestación.

Pediculosis capitis grave en una niña inscrita en una guardería / Severe pediculosis capitis in a nursery school girl

La pediculosis capitis es la ectoparasitosis más frecuente a nivel mundial. La infestación es causada por Pediculus humanus capitis (piojo de la cabeza) y afecta el cabello, el cuero cabelludo y la piel. Rara vez se manifiesta con otro tipo de sintomatología y, por lo general, su curso es benigno si se trata adecuadamente. Se presenta el caso de una menor con pediculosis capitis de 18 meses de evolución, asociada con forúnculos, lesiones cutáneas, múltiples adenopatías y anemia, que no mejoró tras la aplicación del champú. Inicialmente, llamó la atención la presencia de forúnculos, alopecia y adenopatías. La persistencia de la pediculosis capitis y el rascado intenso alteraron la integridad de la epidermis y facilitaron las infecciones secundarias por bacterias patógenas y oportunistas que produjeron impétigo, forunculosis, excoriaciones, costras hemáticas, anemia, alopecia y linfadenopatías. La pediculosis capitis afectó notoriamente a la paciente al causarle problemas psicológicos y de salud, agudizados por su condición económica y social. La paciente presentó manifestaciones clínicas poco frecuentes (forunculosis, anemia, fiebre, alopecia y adenopatías), lo cual se vio facilitado por la persistencia de los factores de riesgo y el hecho de que no se le inspeccionaba la cabeza ni se removían los insectos. La educación sobre los factores de riesgo y el control sanitario es indispensable para controlar la infestación.

Pediculosis capitis is the most frequent ectoparasitosis around the world. The infestation is caused by Pediculus humanus capitis (head louse), which affects hair, scalp, and skin. It rarely presents with more symptoms and in the majority of the cases, it shows a benign course if treated properly. We present the case of a nursery school girl with head lice infestation for 18 months. She did not improve after the shampoo treatment. This case was associated with furunculosis, skin lesions, multiple adenopathies, and anemia. Initially, the presence of boils, alopecia, and lymphadenopathy was evident. The persistence of pediculosis capitis and intense scratching induced changes on skin integrity, facilitating opportunistic bacterial superinfection that led to impetiginization, furunculosis, excoriations, hematic scabs, anemia, alopecia, and lymphadenopathies. Pediculosis capitis affected the patient triggering psychological, economic, social, and other health problems. The patient presented uncommon symptoms (furunculosis, anemia, fever, alopecia, and adenopathies) resulting from the persistence of risk factors and the absence of head inspection and mechanical removal of insects. The education about the risk factors, as well as sanitary controls, are essential to contain the infestation.

Cumulative Risks of Multiple Criminal Justice Outcomes in New York City.

Previous research has provided estimates of the cumulative risk of felony conviction and imprisonment in the United States. These experiences are, however, also the rarest; most of what happens in the criminal justice system occurs at the level of the misdemeanor rather than the felony. This article addresses our limited understanding of the scope of subfelony justice by providing estimates of the cumulative risk of several lower-level arrest outcomes for one jurisdiction: New York City. Because of excess life table events contributed by nonresidents of New York City, estimates are likely upwardly biased relative to the true values. Nonetheless, they allow us to (1) assess the cumulative risk of misdemeanor conviction and jail sentences and (2) determine to what extent those who enter the world of subfelony justice are distinct from those with felony or imprisonment records.

Chitosan spray-dried microcapsule and microsphere as fertilizer host for swellable - controlled release materials.

A fertilizer delivery system based on chitosan (Ch) or chitosan/montmorillonite clay (Ch/MMt) was developed by spray drying technique using 2-fluid (2FN) and 3-fluid (3FN) nozzles. 2FN provided solid microspheres and 3FN formed microcapsules structures. Morphology is dependent upon formulation and the type of nozzle used. As higher the number of the components (polymer, clay and sodium tripolyphosphate (TPP)) in the microparticles more collapsed and non-shaped spheres are generated. Different structures provided distinct nutrient releasing profiles. Higher swelling values (∼500%) and slower fertilizer releasing process (under 70% in the firsts measurements) are observed for microcapsules. This phenomenon occurs due to entrapped nutrient by an extra chitosan outer layer. The swelling-controlled release mechanism was observed for both microcapsules and microspheres instead of diffusion-controlled. Swelling characteristic was confirmed in soil medium since after water irrigation higher fertilizer releases were observed.

A Hispanic mother's beliefs about stuttering aetiology: A systemic functional linguistic analysis.

The aim of this study was to identify the linguistic resources a Hispanic mother used to convey her beliefs about the aetiology of her adult son's stuttering. A qualitative research paradigm was adopted for data collection and analysis. An Ecuadorian mother and her adult son who stutters recorded a conversation in Spanish about the son's stuttering. Tools derived from systemic functional linguistic (SFL) theory were used to analyse conversation transcripts and to describe the word choices and sentence structures the mother used to talk about her son's stuttering. The mother deflected community-assigned blame for causing her son's stuttering by configuring her 'strong' temperament as a separate, uncontrollable entity. She structured the pervasiveness of stigma, lack of resources and misinformation within the community as causes for her inability to identify and seek help for her son's stuttering, which also served as a means for deflecting blame. SFL-based analyses were appropriate tools for the investigation of how a Hispanic mother construes her views, attitudes and experiences relative to her son's stuttering. Clinical implications of findings regarding parent education and the utility of SFL-based tools in the speech-language therapy setting are discussed.

Bloqueo del plano transverso del abdomen en herniorrafia inguinal. Ensayo clínico controlado / TAP block in inguinal hernia repair. Randomized controlled trial

Abstract Introduction: Around the world, inguinal hernia repair is one of the most frequent surgical interventions and is associated with moderate to severe postoperative pain. TAP (Transver-sus Abdominis Plane) block appears to be a useful tool to reduce the morbidity associated with pain in inguinal hernia repair. Objective: To evaluate the analgesic effect of a TAP block in patients scheduled for primary inguinal hernia repair, 1 h and 24-h post-surgery. Materials and methods : Randomized controlled trial. 45 patients were randomized to receive placebo vs. TAP block. Clinical, surgical and anesthetic variables were analyzed. The primary outcome was pain in the first hour and the secondary outcome was pain during the first 24 h, opiate use and side effects. Results: The acute postoperative pain score during the first hour in the control group was 6 with maximum values of 9 in 22% of patients, whereas in the intervention group the pain score was 2 (SD: 1) (p: 0.03). Likewise, pain 24 h postop and opiate consumption was lower in the intervention group than in the control group. Conclusions: TAP block helps to reduce acute postoperative pain and the use of opiates in inguinal hernia repair.

Resumen Introducción: La herniorrafia inguinal es una de las cirugías más realizadas en el mundo, y está asociada con dolor postoperatorio de moderado a severo. El bloqueo del plano transverso del abdomen (transversus abdominus plane [TAP]) parece ser una técnica útil para disminuir la morbilidad asociada con el dolor en herniorrafia inguinal. Objetivo: Evaluar el efecto analgésico del bloqueo TAP a la hora y a las 24 h postoperatorias en herniorrafia inguinal. Materiales y métodos: Se realizó un estudio doble ciego donde se aleatorizaron 45 pacientes para recibir bloqueo TAP vs placebo, se analizaron variables clínicas, quirúrgicas y anestésicas, y se evaluó como resultado primario la intensidad de dolor agudo postoperatorio (pop) una hora después de la cirugía y, como resultados secundarios, el dolor a las 24 h, el consumo de opiáceos y la presencia de reacciones adversas. Resultados: El dolor agudo postoperatorio a la primera hora en el grupo control fue de 6, con valores máximos de 9 en el 22% de los pacientes, mientras que el dolor en la primera hora en el grupo intervención fue de 2 (DE: 1) (p = 0,03). De igual forma, el dolor a las 24h pop y el consumo de opiáceos fue menor en el grupo intervención que en el grupo control. Conclusiones: El bloqueo TAP es útil en la reducción del dolor agudo pop y del consumo de opiáceos en herniorrafia inguinal.

Ergonomía en los bloqueos nerviosos guiados por ultrasonografía / Ergonomics in ultrasound-guided nerve blocks

Introduction: Performing ultrasound-guided nerve blocks has proven to be safe, but ergonomic considerations are essential. Methods: A non-systematic literature search was conducted in the Medline/Pubmed and Embase databases. Objective: To describe the influence of operator position, monitor location, and hand position in performing ultrasound-guided nerve blocks. Results: Poor ergonomics is a key factor of error when performing nerve blocks under ultrasound guidance. "In-plane" needle insertion increases success. An inappropriate position may be a cause of muscle-skeletal disorders. Based on these results, we propose specific element location and operator position for the performance of certain nerve blocks. Conclusion:Performing ultrasound-guided nerve blocks requires an ergonomic work area allowing for greater comfort and effectiveness, thus reducing the occurrence of muscle-skeletal disorders.

Introducción: Los bloqueos guiados por ultrasonografía han demostrado ser eficaces, pero requieren considerar aspectos como la ergonomía. Objetivo: Describir influencia de la postura del operador, ubicación del monitor y posición de las manos, al realizar bloqueos con ultrasonografía. Métodos: Se realizó una búsqueda no sistemática de literatura en Medline/Pubmed y Embase. Resultados: Una mala ergonomía es un factor de error al realizar bloqueos con ultrasonido. La inserción de la aguja "en plano" aumenta el éxito. Una posición inapropiada puede producir trastornosmusculo-esqueléticos en el operador. Basados en esto, se propone una ubicación de elementos y posición del operador para realizar algunos bloqueos. Conclusión: Realizar bloqueos con ultrasonido requiere un área de trabajo ergonómica para lograr mayor eficacia, y disminuir aparición de trastornos músculo-esqueléticos.