Estudio sobre las buenas prácticas de las IFIS en función a la normativa de suficiencia patrimonial de Basilea I

Incluye Bibliografía

Síndrome de “Floppy Iris" y Tamsulosina. Un llamado de atención (IFIS Síndrome).

El uso de alfabloqueantes para el tratamiento de la hiperplasia prostática benigna, es hoy válido y de muy buenos resultados. Pero, si bien la TAMSULOSINA tiene una vida media de 48 a 72 hs su ingesta debe ser siempre interrogada en los pacientes que van a ser operados de cataratas a fin de tomar los recaudos necesarios. Hay autores que prefieren suspender la medicación alfabloqueante al menos 2 a 3 semanas antes, utilizando un régimen de dilatación máxima para aumentar el diámetro quirúrgico de la pupila. La Miosis intraoperatoria que se produce en el IFIS, aumenta el número de complicaciones intraoperatorias.

Validity and reliability of the international fItness scale (IFIS) in a population-based sample of schoolchildren in Bogota, Colombia: The FUPRECOL study

The International FItness Scale (IFIS) is a self-reported measure of physical fitness that could easily. This scale has been validated in children, adolescents, and young adults; however, it is unknown whether the IFIS represents a valid and reliable estimate of physical fitness in Latino-American youth population. In the present study we aimed to examine the validity and reliability of the IFIS on a population-based sample of schoolchildren in Bogota, Colombia. Participants were 1,875 Colombian youth (56.2% girls) aged 9 to 17.9 years old. We measured adiposity markers (body fat, waist-to-height ratio, skinfold thicknesses and BMI), blood pressure, lipids profile, fasting glucose, and physical fitness level (self reported and measured). Also, a validated cardiometabolic risk index was used. An age- and sex-matched sample of 229 Schoolchildren originally not included in the study sample fulfilled IFIS twice for reliability purposes. Our data suggest that both measured and self-reported overall fitness were associated inversely with adiposity indicators and a cardiometabolic risk score. Overall, schoolchildren who self-reported “good” and “very good” fitness had better measured fitness than those who reported “very poor” and “poor” fitness (all p<0.001). Test–retest reliability of IFIS items was also good, with an average weighted Kappa of 0.811. Therefore, our findings suggest that self-reported fitness, as assessed by IFIS, is a valid, reliable, and health-related measure, and it can be a good alternative for future use in large studies with Latin-schoolchildren from Colombia.

Representation of evidence: An approach to uncertainty handling in knowledge-based systems

Many knowledge based systems (KBS) transform a situation information into an appropriate decision using an in built knowledge base. As the knowledge in real world situation is often uncertain, the degree of truth of a proposition provides a measure of uncertainty in the underlying knowledge. This uncertainty can be evaluated by collecting `evidence' about the truth or falsehood of the proposition from multiple sources. In this paper we propose a simple framework for representing uncertainty in using the notion of an evidence space.

Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET).

BACKGROUND: Invasive fungal infections (IFIs) are a major cause of morbidity and mortality among organ transplant recipients. Multicenter prospective surveillance data to determine disease burden and secular trends are lacking. METHODS: The Transplant-Associated Infection Surveillance Network (TRANSNET) is a consortium of 23 US transplant centers, including 15 that contributed to the organ transplant recipient dataset. We prospectively identified IFIs among organ transplant recipients from March, 2001 through March, 2006 at these sites. To explore trends, we calculated the 12-month cumulative incidence among 9 sequential cohorts. RESULTS: During the surveillance period, 1208 IFIs were identified among 1063 organ transplant recipients. The most common IFIs were invasive candidiasis (53%), invasive aspergillosis (19%), cryptococcosis (8%), non-Aspergillus molds (8%), endemic fungi (5%), and zygomycosis (2%). Median time to onset of candidiasis, aspergillosis, and cryptococcosis was 103, 184, and 575 days, respectively. Among a cohort of 16,808 patients who underwent transplantation between March 2001 and September 2005 and were followed through March 2006, a total of 729 IFIs were reported among 633 persons. One-year cumulative incidences of the first IFI were 11.6%, 8.6%, 4.7%, 4.0%, 3.4%, and 1.3% for small bowel, lung, liver, heart, pancreas, and kidney transplant recipients, respectively. One-year incidence was highest for invasive candidiasis (1.95%) and aspergillosis (0.65%). Trend analysis showed a slight increase in cumulative incidence from 2002 to 2005. CONCLUSIONS: We detected a slight increase in IFIs during the surveillance period. These data provide important insights into the timing and incidence of IFIs among organ transplant recipients, which can help to focus effective prevention and treatment strategies.

Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database.

BACKGROUND: The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies. METHODS: The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts. RESULTS: We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT. CONCLUSIONS: In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.

Public-public partnerships (PUPs) in water

Water operators need to be efficient, accountable, honest public institutions providing a universal service. Many water services however lack the institutional strength, the human resources, the technical expertise and equipment, or the financial or managerial capacity to provide these services. They need support to develop these capacities. The vast majority of water operators in the world are in the public sector – 90% of all major cities are served by such bodies. This means that the largest pool of experience and expertise, and the great majority of examples of good practice and sound institutions, are to be found in existing public sector water operators. Because they are public sector, however, they do not have any natural commercial incentive to provide international support. Their incentive stems from solidarity, not profit. Since 1990, however, the policies of donors and development banks have focussed on the private companies and their incentives. The vast resources of the public sector have been overlooked, even blocked by pro-private policies. Out of sight of these global policy-makers, however, a growing number of public sector water companies have been engaged, in a great variety of ways, in helping others develop the capacity to be effective and accountable public services. These supportive arrangements are now called 'public-public partnerships' (PUPs). A public-public partnership (PUP) is simply a collaboration between two or more public authorities or organisations, based on solidarity, to improve the capacity and effectiveness of one partner in providing public water or sanitation services. They have been described as: “a peer relationship forged around common values and objectives, which exclude profit-seeking”.1 Neither partner expects a commercial profit, directly or indirectly. This makes PUPs very different from the public–private partnerships (PPPs) which have been promoted by the international financial institutions (IFIs) like the World Bank. The problems of PPPs have been examined in a number of reports. A great advantage of PUPs is that they avoid the risks of such partnerships: transaction costs, contract failure, renegotiation, the complexities of regulation, commercial opportunism, monopoly pricing, commercial secrecy, currency risk, and lack of public legitimacy.2 PUPs are not merely an abstract concept. The list in the annexe to this paper includes over 130 PUPs in around 70 countries. This means that far more countries have hosted PUPs than host PPPs in water – according to a report from PPIAF in December 2008, there are only 44 countries with private participation in water. These PUPs cover a period of over 20 years, and been used in all regions of the world. The earliest date to the 1980s, when the Yokohama Waterworks Bureau first started partnerships to help train staff in other Asian countries. Many of the PUP projects have been initiated in the last few years, a result of the growing recognition of PUPs as a tool for achieving improvements in public water management. This paper attempts to provide an overview of the typical objectives of PUPs; the different forms of PUPs and partners involved; a series of case studies of actual PUPs; and an examination of the recent WOPs initiative. It then offers recommendations for future development of PUPs.

Polymerase Chain Reaction Screening for Fungemia and/or Invasive Fungal Infections in Patients with Hematologic Malignancies

INTRODUCTION: Invasive fungal infections (IFIs) are a life-threatening complication in patients with hematologic malignancies, mainly in acute leukemia patients, following chemotherapy. IFI incidence is increasing, and associated mortality remains high due to unreliable diagnosis. Antifungal drugs are often limited by inadequate antimicrobial spectrum and side effects. Thus, the detection of circulating fungal DNA has been advocated as a rapid, more sensitive diagnostic tool. PATIENTS AND METHODS: Between June 01 and January 03, weekly blood samples (1,311) were screened from 193 patients undergoing intensive myelosuppressive or immunosuppressive therapy. IFI cases were classified according to European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Fungal DNA was extracted from whole blood and amplified using polymerase chain reaction (PCR) published primers that bind to the conserved regions of the fungal 18S rRNA gene sequence. In our study, two or more consecutive positive samples were always associated with fungal disease. RESULTS: PCR screening predicted the development of IFI to be 17 days (median). This test had a specificity of 91.1% and a sensitivity of 75%. IFI incidence was 7.8%. DISCUSSION: Therefore, our results confirm the potential usefulness of PCR serial screening and the clinical applicability in everyday routine. PCR screening offers a noninvasive repeatable aid to the diagnosis of IFI.

A Tangled Web? Asking the Gender Question in the Multilateral Development Banks’ Law and Justice Policies in India

Over the course of the last two decades, IFIs (most prominently the World Bank) have begun acknowledging the centrality of human development as an essential element of the economic development process if the growth aimed at is to be holistic and sustainable. Strikingly, there is no agreement on the manner in which this approach is to be achieved, especially in the field of gender and development. This paper focuses on the issue of whether the Multilateral Development Banks’ policies have truly attempted at implementing their stated model of gender mainstreaming through their programmes and projects in India, with a specific focus on the legal sector, since that sector has both instrumental and intrinsic value for gender rights advocates. This article will aim at reviewing their approach towards rule of law projects and the manner in which gender equality norms have or have not been addressed within that framework; it will end with recommendations as to the necessary issues which gender programmes must address within the rule of law framework in order to achieve the Millennium Development Goal of gender equity.

Identificación y cuantificación de las desviaciones metodológicas en la gestión del oficial de microcrédito como evento de riesgo operativo en las cooperativas de ahorro y crédito de la ciudad de Quito

Para las IFI´s, sean estas organizaciones sociales que han ido formalizándose o entidades reguladas por los organismos de control, una decisión puede ser incursionar o no en microfinanciamiento. Esta decisión debe considerar factores como entorno, variables y lineamientos acerca del sector, a fin de apostar a la decisión más acertada. La administración de riesgos tiene diferentes significados para diferentes personas. Para los reguladores, la administración del riesgo significa control; para los operadores, es una cuestión de cobertura, mientras que para los administradores de riesgos, significa asignar el capital necesario para obtener el máximo rendimiento con relación al riesgo. En muchas instituciones, la tradición en materia de administración del riesgo se circunscribe a un proceso donde ciertos profesionales buscan solamente minimizar las pérdidas. Desde un punto de vista organizacional, en esos casos, la responsabilidad de administrar el riesgo se delega a especialistas y ni siquiera se considera el riesgo desde el punto de vista de los accionistas, ni mucho menos como un arma competitiva El riesgo operativo se refiere a las pérdidas potenciales resultantes de fallas en los factores: procesos, personas, tecnología y eventos externos. Estas fallas pueden derivarse por sistemas inadecuados, fallas administrativas, controles defectuosos, fraude, o error humano, esto incluye riesgo de ejecución, que abarca situaciones donde se falla en la ejecución de las operaciones, algunas veces conduciendo a retrasos o penalizaciones costosas. Incluye el riesgo legal pero excluye los riesgos sistémico y de reputación. Esta tesis pretende determinar aquellas deficiencias en el factor personas dentro de la gestión del oficial de Microcredito.

El aporte de la cooperación internacional en el proceso de reforma de la justicia del Ecuador

La presente investigación examina cuáles son los aportes de la Cooperación Internacional (CI) en el proceso de reforma de la justicia en Ecuador desde los años 90 y en este contexto describe sus dinámicas y orientaciones, en diferentes períodos. Fue central comprender por qué instituciones de gran influencia como el Banco Mundial (BM) y el Banco Interamericano de Desarrollo (BID), se volcaron a impulsar la reforma de los estados y del sector justicia. Por ello, este proceso se sitúa en una temporalidad extensa que abarca dos dimensiones: la reforma de las estructuras del Estado y las transformaciones de los sistemas específicos de justicia. En esta perspectiva central, que reenvía al objeto de esta tesis, el referéndum y la consulta popular del Ecuador del 2011, sobre la reforma de la justicia, no es sino uno de los hitos de una reforma del sector más amplia que debe remontarse a los procesos explícitos diseñados por el “Consenso de Washington”, en la décadas de los 90 y 2000 y que hablan, entonces, ya de una intervención programada de muchos actores y entre ellos, protagónicamente de las Instituciones Financieras Internacionales (IFIS), con sus iniciativas judiciales de promoción de las economías de mercado y en paralelo el reforzamiento de un modelo de desarrollo neoliberal. En otro período posterior de la reforma del sector, los organismos de CI disminuyen su incidencia, ante un Estado que reasume un protagonismo que había perdido. La metodología empleada privilegia el mapeo de las intervenciones de la CI y evidencia cómo las cuantificaciones de sus aportes son solo indicadores parciales, que miden la importancia de su influencia en el proceso de estas reformas. Como conclusión, se llega a valorar el peso del aporte de la CI en la reforma de la justicia; se encuentra la variación en el protagonismo de su intervención frente al otro actor central, el Estado. Por otra parte, se develan las modalidades de intervención de la CI en el proceso de reforma de la justicia en el Ecuador. Las reformas se tomaron aquí como principal objeto de investigación empírica y por ello se buscó identificar las agendas de los organismos internacionales; con este aporte se abre el paso a que otras investigaciones indaguen más allá las implicaciones políticas y sociales de tales reformas en el campo nacional y global.

Dietary-based gut flora modulation against Clostridium difficile onset

Clostridium difficile infection is a frequent complication of antibiotic therapy in hospitalised patients, which today is attracting more attention than ever and has led to its classification as a 'superbug'. Disruption of the composition of the intestinal microflora following antibiotic treatment is an important prerequisite for overgrowth of C. difficile and the subsequent development of an infection. Treatment options for antibiotic-associated diarrhoea and C. difficile-induced colitis include administration of specific antibiotics (e.g. vancomycin), which often leads to high relapse rates. More importantly, both the rate and severity of C. difficile-associated diseases are increasing, with new epidemic strains of C. difficile often implicated. For the prevention and treatment of antibiotic-associated diarrhoea and C. difficile infection, several probiotic bacteria such as selected strains of lactobacilli (especially Lactobacillus rhamnosus GG), Bifidobacterium longum, and Enterococcus faecium and the non-pathogenic yeast Saccharomyces boulardii have been used. Controlled trials indicate a benefit of S. boulardii and L. rhamnosus GG as therapeutic agents when used as adjuncts to antibiotics. However, the need for more well designed controlled trials with probiotics is explicit.

Prebiotics and probiotics: potential strategies for reducing travellers' diarrhoea in athletes competing abroad

Travellers’ diarrhoea (TD) is the most common gastrointestinal illness to affect athletes competing abroad. Consequences of this debilitating condition include difficulties with training and/or participating in competitions which the athlete may have spent several years preparing for. Currently, there are no targeted strategies to reduce TD incidence in athletes. General methods used to reduce TD risk, such as avoidance of contaminated foods, chemoprophylactics and immunoprophylactics, have disadvantages. Since most causative agents of TD are microbial, strategies to minimise TD risks may be better focused on the gut microbiota. Prebiotics and probiotics can fortify the gut microbial balance, thus potentially aiding the fight against TD-associated microorganisms. Specific probiotics have shown promising actions against TD-associated microorganisms through antimicrobial activities. Use of prebiotics has led to an improved intestinal microbial balance which may be better equipped to combat TD-associated microorganisms. Both approaches have shown promising results in general travelling populations; therefore, a targeted approach for athletes has the potential to provide a competitive advantage.

The potential of probiotics as in-feed growth enhancers for swine

Probiotics have enjoyed a surge of popularity in recent years, with many novel applications being proposed. One of the foremost for the agricultural industry is their potential for livestock growth promotion, a subject of special interest since the 2006 EU-wide ban on sub therapeutic levels of in-feed antibiotic growth enhancers. Probiotics work through a number of differing mechanisms, most of which are not, as yet, fully understood. The probiotics interact with the host’s natural gut flora in a complex and varying array of mechanisms, but ultimately work to improve nutrient digestibility and gut health and to suppress the actions of pathogenic bacteria. In conclusion, probiotics can be a useful replacement for in-feed antibiotic growth enhancers. However, care should be taken due to the variability of the size of the effect and the inconsistency of the results in the published literature.

Dietary prebiotics: current status and new definition

In November 2008, a group of scientists met at the 6th Meeting of the International Scientific Association of Probiotics and Prebiotics (ISAPP) in London, Ontario, Canada, to discuss the functionality of prebiotics. As a result of this, it was concluded that the prebiotic field is currently dominated by gastrointestinal events. However, in the future, it may be the case that other mixed microbial ecosystems may be modulated by a prebiotic approach, such as the oral cavity, skin and the urogenital tract. Therefore, a decision was taken to build upon the current prebiotic status and define a niche for ‘dietary prebiotics’. This review is co-authored by the working group of ISAPP scientists and sets the background for defining a dietary prebiotic as ‘‘a selectively fermented ingredient that results in specific changes in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefit(s) upon host health’’.