Morbimortalidad asociada a transfusiones de glóbulos rojos. Unidad de Cuidados Intensivos, Clínica Infantil Colsubsidio

Objetivos: Determinar si las transfusiones de glóbulos rojos en niños en cuidados intensivos se asocian a aumento de la morbimortalidad. Materiales y Métodos: Estudio observacional analítico de cohorte. Se incluyeron niños con anemia de 1 mes a 18 años de edad en un periodo de 13 meses. Resultados: 156 niños con anemia fueron incluidos. En el 51.5% la anemia se desarrolló posterior a su ingreso. De éstos, 77 niños recibieron una transfusión de glóbulos rojos y la mediana de hemoglobina pretransfusión fue de 7.5 g/dl. El 6.5% de los pacientes transfundidos presentó una Reacción adversa. Entre el grupo de pacientes expuesto a transfusión y los no expuestos existió diferencia significativa en la hemoglobina de ingreso, cantidad de sangre extraída y edad en el análisis bivariado. Los pacientes transfundidos tuvieron mayor mortalidad (12.9% vs. 2.5%, p =0.014). El desarrollo de falla multiorgánica también fue más frecuente en el grupo transfundido (57.1% vs. 13.9%, p < 0.001). La mediana de los días de estancia en la UCI y el tiempo de ventilación mecánica fue mayor en los niños transfundidos que en los no transfundidos, 8 vs. 4 días p< 0.001, y 6 vs. 3 días p<0.001 respectivamente. Un análisis multivariado mostró asociación de transfusión de glóbulos rojos con mortalidad y falla multiorgánica. Conclusión: Las transfusiones de glóbulos rojos se asocian con un aumento en la Mortalidad y en el desarrollo de falla multiorgánica. La estancia en la UCI y el tiempo de ventilación mecánica fue mayor en los niños transfundidos.

Incidencia de la política "desarrollo pacífico" en las relaciones de china y la ASEAN. Una aproximación desde la soberanía de las islas Spratly, 2004 – 2012

El interés de este trabajo es el de analizar la Política Exterior de la Republica Popular China, más específicamente la conocida como Desarrollo Pacífico, y su incidencia en las disputas territoriales del Sudeste Asiático. El trabajo se dividirá en 3 partes, donde cada una tratara distintos aspectos del Desarrollo Pacífico, y través del mismo se explicará como por medio de distintos conceptos se pueden entender las múltiples posiciones chinas, así como las preocupaciones de los países que conforman el bloque ASEAN. El propósito de este documento será demostrar que a pesar de que dicha política ha ayudado de forma sustancial a mejorar las relaciones entre ambos bandos y ha traído bastantes beneficios políticos, no ha sido suficiente para eliminar la tensión en la zona y dar una solución a las disputas que se viven.

Las adicciones a la luz del psicoanálisis, una revisión de literatura

El presente trabajo de grado es una revisión de la literatura que permite hacer un recorrido desde el psicoanálisis acerca de la compleja problemática de las adicciones. Para ello, se revisaron las bases de datos PepWeb, Ebsco, y Jstor, revisando las posiciones del psicoanálisis freudiano, lacaniano y otras corrientes psicoanalíticas respondiendo a las siguientes preguntas de investigación: (a) ¿Cómo se comprenden las adicciones desde un marco de referencia psicoanalítico? (b) ¿Cómo –desde la teoría freudiana y la teoría lacaniana - se aborda la comprensión de la adicción? (c) ¿Qué dice el psicoanálisis contemporáneo sobre ésta problemática? Se abordan temas como la concepción de una adicción desde la perspectiva de Freud y Lacan hasta psicoanalistas contemporáneos, el rol que juega el goce en la adicción y, finalmente, el complejo debate incipiente sobre la legalidad del tóxico. Se encontró que es un campo de constante publicación y es necesario que los clínicos y los psicoanalistas aborden este campo de estudio clínico permanentemente y sigan produciendo investigaciones sobre el fenómeno.

Análisis de las estrategias de comunicación política del movimiento 19 de Abril M-19 (1974-1994)

La presente tesis examina las diferentes estrategias de comunicación política del M-19 en tres etapas a lo largo de su historia; la etapa de surgimiento y consolidación como movimiento alzado en armas (1974-82); la etapa del proceso de paz (1982-90); y la etapa partidista de la ADM-19 (1990-94).

De la planificación a la gestión: Implementación de modelos de ocupación en el territorio. Caso de estudio: Zona norte de Bogotá

Las políticas públicas de ordenamiento territorial contienen múltiples implicaciones. Por un lado, definen visiones de ocupación sobre el territorio y, por el otro, establecen mecanismos para su consecución. La zona norte de Bogotá permanece a la espera de un modelo que permita su ocupación con fines urbanos. La presente investigación presenta las implicaciones y caminos desde los cuáles se ha buscado sustentar las posiciones sobre la ocupación de la zona, como las contraposiciones existentes sobre el modelo de ciudad con el que se asocia. La expansión de la ciudad pone de relieve las discusiones sobre lo que debe ser una ciudad, y cambian en el tiempo de la mano con los discursos, intereses e ideologías dominantes.

Aztecs and incas : AD 1300-1532.

Los pueblos azteca e inca crearon grandes imperios en Centroamérica y Sudamérica, respectivamente.Los aztecas, procedentes de Asia, se instalaron primero en Alaska y después en el norte y centro de México, donde fundaron Tenochtitlán y, se expandieron hasta la costa del Golfo de México, en el reinado de Montezuma.Por su parte,los incas se extendieron por los territorios que actualmente corresponden a Perú, Bolivia, Ecuador y parte de Chile y fundaron Cuzco. Aunque ambas civilizaciones fueron destruidas en el siglo XVI por los españoles,conocemos bastante de ellas por las descripciones de los conquistadores y también por la gran cantidad de restos conservados.

A2 media studies : the essential introduction for AQA.

Libro para estudiantes de los niveles AS a A2 (enseñanza secundaria de segundo ciclo, bachillerato) orientado a superar la certificación AQA (Assessment and Qualifications Alliance) en la materia de medios de información y comunicación. Está estructurado en seis capítulos que cubren las siguientes materias: desarrollo del análisis de texto, marco de referencia histórico para el análisis, temas y casos de estudio para debatir (MEST3 y MEST4), habilidades de investigación y presentación. Incluye ejercicios, conceptos básicos y ejemplos de preguntas de examen.

Errors associated with the preparation of aseptic products in UK hospital pharmacies: lessons from the national aseptic error reporting scheme

Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.

Errors associated with preparation of adult and paediatric parenteral nutrition in UK hospital pharmacies

Rationale: In UK hospitals, the preparation of all total parenteral nutrition (TPN) products must be made in the pharmacy as TPNs are categorised as high-risk injectables (NPSA/2007/20). The National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors in the UK since August 2003. This study reports on types of error associated with the preparation of TPNs, including the stage at which these were identified and potential and actual patient outcomes. Methods: Reports of compounding errors for the period 1/2004 - 3/2007 were analysed on an Excel spreadsheet. Results: Of a total of 3691 compounding error reports, 674 (18%) related to TPN products; 548 adult vs. 126 paediatric. A significantly higher proportion of adult TPNs (28% vs. 13% paediatric) were associated with labelling errors and a significantly higher proportion of paediatric TPNs (25% vs. 15% adult) were associated with incorrect transcriptions (Chi-Square Test; p<0.005). Labelling errors were identified equally by pharmacists (42%) and technicians (48%) with technicians detecting mainly at first check and pharmacists at final check. Transcription errors were identified mainly by technicians (65% vs. 27% pharmacist) at first check. Incorrect drug selection (13%) and calculation errors (9%) were associated with adult and paediatric TPN preparations in the same ratio. One paediatric TPN error detected at first check was considered potentially catastrophic; 31 (5%) errors were considered of major and 38 (6%) of moderate potential consequence. Five errors (2 moderate, 1 minor) were identified during or after administration. Conclusions: While recent UK patient safety initiatives are aimed at improving the safety of injectable medicines in clinical areas, the current study highlights safety problems that exist within pharmacy production units. This could be used in the creation of an error management tool for TPN compounding processes within hospital pharmacies.

Dietary fatty acids and chylomicron synthesis and secretion

There is currently considerable interest in potential atherogenic and thrombogenic consequences of elevated concentrations of triacylglycerols, especially in the post-prandial state. Despite this, there is limited information on the effects of dietary fatty acids on the synthesis, secretion and metabolism of chylomicrons, the large triacylglycerol-rich lipoproteins synthesized in the enterocyte following the digestion and absorption of dietary fat. This brief review considers current approaches to the investigation of chylomicron synthesis and summarizes some of the human, cell and animal studies that have investigated effects of different fatty acids on these pathways. Potential sites for modulatory effects of dietary fatty acids on the molecular events of chylomicron synthesis are proposed in the light of the recent model that has been developed from cell and animal studies and observations based on abnormalities in chylomicron formation in human inherited autosomal recessive diseases.

Effect of feeding supplemental fibrolytic enzymes or soluble sugars with malic acid on milk production

Two trials were conducted to evaluate effects of feeding supplemental fibrolytic enzymes or soluble sugars and malic acid on milk production. In trial 1, 257 cows at four sites were fed a basal diet consisting of no more than 60% of forage DM as corn silage and less than 40% as alfalfa hay. Cows were assigned randomly within site, parity, and two stages of lactation to: 1) control; 2) enzyme A; 3) enzyme B; and 4) soluble sugars and malic acid. There was a 14-d pretreatment and an 84-d treatment period. Enzyme solutions were sprayed on either the forage component or the TMR each day while mixing feed. Trial 2 was similar, except 122 cows at one site in the United Kingdom were fed diets containing forage that was 75% corn silage and 25% grass silage, and all cows began the study between 25 to 31 DIM. Mean milk productions for 233 cows that completed trial 1 were 32.9, 32.5, 32.4, and 32.9 kg/d for control, enzyme A, enzyme B, and soluble sugars and malic acid, respectively. Mean milk productions for 116 cows that completed trial 2 were 28.2, 27.9, 28.8, and 28.4 kg/d, respectively. In vitro analyses of the activities of enzyme solutions indicated that all major cellulose and hemicellulose degrading activities were present; however, the pH optima (approximate pH = 4 to 5) were more acidic, and the temperature optimum (approximately 50 C) was greater than normal pH and temperature in the rumen. If fibrolytic activity in the rumen is a major mechanism of action of supplemental fibrolytic enzymes, it appears that considerable activity of these preparations was lost due to conditions in the rumen. In conclusion, feeding supplemental fibrolytic enzymes or malic acid with soluble sugars had no effect on milk production under the conditions used in this study.

Comparative micromorphology of nectariferous and nectarless labellar spurs in selected clades of subtribe Orchidinae (Orchidaceae)

Floral nectar spurs are widely considered to influence pollinator behaviour in orchids. Spurs of 21 orchid species selected from within four molecularly circumscribed clades of subtribe Orchidinae (based on Platanthera s.l., Gymnadenia-Dactylorhiza s.l., Anacamptis s.l., Orchis s.s.) were examined under light and scanning electron microscopes in order to estimate correlations between nectar production (categorized as absent, trace, reservoir), interior epidermal papillae (categorized as absent, short, medium, long) and epidermal cell striations (categorized as apparently absent, weak, moderate, strong). Closely related congeneric species scored similarly, but more divergent species showed less evidence of phylogenetic constraints. Nectar secretion was negatively correlated with striations and positively correlated with papillae, which were especially frequent and large in species producing substantial reservoirs of nectar. We speculate that the primary function of the papillae is conserving energy through nectar resorption and explain the presence of large papillae in a minority of deceit-pollinated species by arguing that the papillae improve pollination because they are a tactile expectation of pollinating insects. In contrast, the prominence of striations may be a 'spandrel', simply reflecting the thickness of the overlying cuticle. Developmentally, the spur is an invagination of the labellum; it is primarily vascularized by a single 'U'-shaped primary strand, with smaller strands present in some species. Several suggestions are made for developing further, more targeted research programmes. (C) 2009 The Linnean Society of London, Botanical Journal of the Linnean Society, 2009, 160, 369-387.

Genetic structure and systematic relationships within the Ophrys fuciflora aggregate (Orchidaceae: Orchidinae): high diversity in Kent and a wind-induced discontinuity bisecting the Adriatic

A recent phylogenetic study based on multiple datasets is used as the framework for a more detailed examination of one of the ten molecularly circumscribed groups identified, the Ophrys fuciflora aggregate. The group is highly morphologically variable, prone to phenotypic convergence, shows low levels of sequence divergence and contains an unusually large proportion of threatened taxa, including the rarest Ophrys species in the UK. The aims of this study were to (a) circumscribe minimum resolvable genetically distinct entities within the O. fuciflora aggregate, and (b) assess the likelihood of gene flow between genetically and geographically distinct entities at the species and population levels. Fifty-five accessions sampled in Europe and Asia Minor from the O. fuciflora aggregate were studied using the AFLP genetic fingerprinting technique to evaluate levels of infraspecific and interspecific genetic variation and to assess genetic relationships between UK populations of O. fuciflora s.s. in Kent and in their continental European and Mediterranean counterparts. The two genetically and geographically distinct groups recovered, one located in England and central Europe and one in south-eastern Europe, are incongruent with current species delimitation within the aggregate as a whole and also within O. fuciflora s.s. Genetic diversity is higher in Kent than in the rest of western and central Europe. Gene flow is more likely to occur between populations in closer geographical proximity than those that are morphologically more similar. Little if any gene flow occurs between populations located in the south-eastern Mediterranean and those dispersed throughout the remainder of the distribution, revealing a genetic discontinuity that runs north-south through the Adriatic. This discontinuity is also evident in other clades of Ophrys and is tentatively attributed to the long-term influence of prevailing winds on the long-distance distribution of pollinia and especially seeds. A cline of gene flow connects populations from Kent and central and southern Europe; these individuals should therefore be considered part of an extensive meta-population. Gene flow is also evident among populations from Kent, which appear to constitute a single metapopulation. They show some evidence of hybridization, and possibly also introgression, with O. apifera.

Friends or relatives? Phylogenetics and species delimitation in the controversial European orchid Genus ophrys

Background and Aims Highly variable, yet possibly convergent, morphology and lack of sequence variation have severely hindered production of a robust phylogenetic framework for the genus Ophrys. The aim of this study is to produce this framework as a basis for more rigorous species delimitation and conservation recommendations. Methods Nuclear and plastid DNA sequencing and amplified fragment length polymorphism (AFLP) were performed on 85 accessions of Ophrys, spanning the full range of species aggregates currently recognized. Data were analysed using a combination of parsimony and Bayesian tree-building techniques and by principal coordinates analysis. Key Results Complementary phylogenetic analyses and ordinations using nuclear, plastid and AFLP datasets identify ten genetically distinct groups (six robust) within the genus that may in turn be grouped into three sections (treated as subgenera by some authors). Additionally, genetic evidence is provided for a close relationship between the O. tenthredinifera, O. bombyliflora and O. speculum groups. The combination of these analytical techniques provides new insights into Ophrys systematics, notably recognition of the novel O. umbilicata group. Conclusions Heterogeneous copies of the nuclear ITS region show that some putative Ophrys species arose through hybridization rather than divergent speciation. The supposedly highly specific pseudocopulatory pollination syndrome of Ophrys is demonstrably 'leaky', suggesting that the genus has been substantially over-divided at the species level.