La imagen en el discurso multimodal cortazariano, una poética en movimiento

The selection and proposed cortazarian image in multimodal speech, a poetic moving as a doctoral thesis title, is the result of a process that forms several progressive stages. more than satisfy our curiosity and literary artistic concerns, the questions multiply increases our desire to bring more creative Cortazarian the colossus, that not only ruins a way of making literature , but in its revolutionary labyrinth gives a turn of the screw to the already tangled world of artistic writing , breaking in 1967 with the first of four hybrids books, La vuelta al día en ochenta mundos through which converts the traditional plastic unitextual and unimodal space in a palempsesto inexhaustible generator senses and meanings. Far from appeasing the wrath of conservative critics, caused by his narrative masterpiece, Hopscotch (1963), sparked the debate to denounce the regression of the classic molds of writing, proposing the imagination as the setting for creative freedom, it is not as arbitrary and nonsense, but as a process of higher state of consciousness in which it operates an underlying logic. Hence, our objective is to crawl into the underworld and plastics other multisígnicas border spaces, fleeting and ephemeral alliances that relate not just as complementary and similar texts which may be the same speech and can transmit the same, but quite the contrary, the oft-repeated notion of analogy is the first victim, fortunately, this kind of creative-artistic operations that raise the creative act to a sublime state capable of converting the inexhaustible multitextuales constellations in different ways: opposition, confrontation, invasion, dialogue, shadow, duplication, theft, etc. However this multiple transgression pushed to the limit by Julio Cortazar and his friend Julio Silva through four books proposed for analysis often does not translate into jobs and research in literature departments of the universities of the world, nor the critics are echoes the striking abundance and clarity of expression multimodal phenomenon as is the case with other works of Cortazar unimodal type, which makes it impassable fences mysterious worlds...

Valoración del dolor en el paciente con trauma grave y ventilación mecánica no comunicativo

Pain is defined since 1979 by the International Association for the Study of Pain (IASP) as "unpleasant subjective, sensory and emotional experience associated with actual or potential damage of tissue", with the concept more acceptable in our days. The Intensive Care Unit (ICU) is a complex environment to assess pain, where the difficulty in communication with the patient is the biggest barrier to getting your "selfreport", which is considered the gold standard in pain assessment. Many factors alter communication with critically ill patients, as the low level of consciousness, mechanical ventilation, sedation, and the patient's own pathology, besides, there are other limitations such as excessive technology or devices that can divert professional attention to the patient's pain behavior, and lack of training and guidance for management. The multicenter study SUPPORT, it showed that 50-65% of critical patients included suffered pain, and 15% of them reported moderate to severe intensity for more than half the period of hospitalization. Critically ill patients experience pain due to high volume of potentially painful techniques applied to them during their ICU admission, emphasizing nursing care and tracheal suctioning, mobilization, wound healing and channeling of catheters and others. The underestimation of pain involves physiological and hemodynamic effects such as increased blood pressure and/or heart rate, altered breathing pattern, and psychological and anxiety. Also an increase of sedation and mechanical ventilation time and ICU stay of increasing the morbidity and mortality of critically ill patients...