Factores de riesgo para mortalidad y bajo gasto cardiaco en el posoperatorio de Switch arterial en pacientes con transposición de grandes arterias

El Switch arterial se ha convertido en la primera opción quirúrgica en pacientes con Transposición de grandes arterias (DTGA). El objetivo de este estudio es presentar la experiencia de la Fundación Cardioinfantil desde el año 2003 hasta julio del 2011, y determinar los factores de riesgo asociados a bajo gasto y mortalidad. Materiales y métodos: Estudio de caso - cohorte. Se revisaron las historias clínicas de los pacientes para obtener la información de las variables. El análisis se realizó mediante métodos estándar para variables continuas y variables categóricas. Los casos y sus controles se compararon y solo las variables con valores de p < 0.05 se analizaron como factores de riesgo. Resultados: 58 pacientes operados. Mediana de edad 12 días (RIQ 7 - 34), El 70.7% (41/58) de los pacientes fueron hombres. La DTGA con septum integro fue la anomalía más frecuente 53,5% (31/58). La mortalidad fue 15,2% (9/58) y la frecuencia de bajo gasto fue 55,2% (32/58). Entre el grupo de controles y casos no hubo diferencias estadísticamente significativas entre las variables preoperatorias y la presencia de bajo gasto y muerte, excepto el tiempo prolongado de circulación extracorpórea que fue factor de riesgo independiente para mortalidad OR 1.1 IC 95% (1 – 1,2) p de 0.002, y para bajo gasto cardiaco el score de vasoactivos-inotrópicos elevado OR 1.2 IC 95% (1.1 – 1,4) p de 0.001. Conclusiones: La frecuencia de las características de los pacientes operados en nuestra población es similar a lo reportado en la literatura mundial, sin embargo los factores de riesgo para mortalidad y bajo gasto no tuvieron el mismo impacto en nuestra población excepto por el tiempo de circulación extracorpórea y el uso de inotrópicos.

Educació ambiental: un enfocament metodològic en formació inicial del professorat d'Educació Primària

Aquesta tesi se situa en una perspectiva de l'Educació Ambiental adreçada a la Sostenibilitat i com a nucli catalitzador d'una Educació per al Canvi. Amb la investigació que es presenta es pretén, a més, contribuir a reduir el buit existent entre el marc teòric de l'Educació Ambiental i la seva transposició didàctica en la formació inicial del professorat, i al mateix temps poder fer aportacions significatives en el camp dels enfocaments pedagògics i estratègies metodològiques d'aquest àmbit de l'educació. En primer lloc, es presenta una anàlisi del marc teòric que ha informat el desenvolupament de l'Educació Ambiental, la seva reorientació i reconceptualització en la dècada dels anys noranta, i s'exposen el debat i les tendències actuals. A continuació es presenta l'anàlisi del nivell d'incorporació de l'Educació Ambiental, així com dels factors que en limiten o dificulten una plena integració, tant a nivell de l'etapa d'educació primària, com en la formació inicial del professorat. Es porta també a terme una revisió i una anàlisi exhaustiva de l'estat actual de la investigació en Educació Ambiental, a nivell nacional i internacional, i a partir d'ella es revela el dèficit que existeix, particularment, en la investigació educativa en Educació Ambiental en la formació inicial del professorat, i sobretot en el camp dels enfocaments pedagògics i estratègies metodològiques. El propòsit concret de la investigació se centra en: (i) analitzar l'impacte d'un enfocament metodològic (metodologia triaxial) aplicat en un curs d'Educació Ambiental en formació inicial del professorat; (ii) explorar el procés de formació en Educació Ambiental des del propi pensament dels estudiants. Aquest propòsit general ha portat la definició dels objectius d'investigació següents: (a) dissenyar i aplicar un enfocament metodològic triaxial en la formació en Educació Ambiental del professorat; (b) dissenyar i aplicar els instruments que promouen el procés de reflexió, individual i col·lectiu, en els estudiants; (c) explorar el procés de formació en Educació Ambiental des del pensament dels estudiants i a través dels instruments utilitzats per a la reflexió; (d) valorar la metodologia triaxial en la formació en Educació Ambiental de futurs i futures mestres d'Educació Primària. Cal destacar que la metodologia triaxial elaborada i aplicada es basa en la integració de tres eixos processals: procés d'investigació, procés de reflexió i procés de treball cooperatiu, i és consistent amb el model teòric que s'exposa i es defensa en la investigació (el capítol 5 tracta, concretament, del disseny, estructuració i desenvolupament del curs fonamentat en aquesta metodologia) La investigació se situa en el paradigma interpretatiu d'investigació educativa i en una metodologia d'anàlisi qualitativa. La mostra l'ha constituïda un grup classe, 42 estudiants, del 3r curs dels estudis de Magisteri, curs 1998/99, de la Universitat de Girona. Els instruments d'anàlisi han estat els instruments de reflexió, individual i col·lectiva, utilitzats en el curs. Destaquem l'ús d'un diari de grup, especialment dissenyat i estructurat per a promoure la reflexió col·lectiva, com l'aportació més rellevant en relació als instruments per a la reflexió. El diari de grup ha estat l'instrument vertebrador de la metodologia d'anàlisi qualitativa, i, tal com s'ha aplicat en aquesta investigació, s'ha validat com a un instrument nuclear i eficaç per a la reflexió de grup, i per explorar i analitzar el procés de formació en Educació Ambiental i de la formació professional general del grup d'estudiants. La resta d'instruments han estat, bàsicament, qüestionaris individuals, en diferents moments del curs; els documents produïts pels estudiants (propostes didàctiques en Educació Ambiental) i la memòria de la investigadora. La triangulació s'ha realitzat a través de tots els instruments. En la investigació es presenta, de manera detallada, com s'ha dut a terme el procés d'anàlisi de cadascun dels instruments i els resultats extrets. L'anàlisi dels resultats ha permès dibuixar l'evolució del pensament dels estudiants al llarg del curs i realitzar una anàlisi holística i multidimensional del seu procés de formació en Educació Ambiental. S'ha produït un canvi substancial en relació a la comprensió i assumpció dels components de l'Educació Ambiental: rellevància, holisme, educació crítica, educació en valors, capacitat de responsabilitat, d'acció i d'atendre diferents punts de vista i perspectives. Al llarg del curs i del procés hi ha una clara potenciació de qualitats dinàmiques. Al mateix temps, l'anàlisi revela la interdependència real i efectiva dels tres processos que configuren la metodologia triaxial i la seva clara influència en la formació en Educació Ambiental del grup d'estudiants i en la construcció dels seus models didàctics. En la investigació es conclou, entre altres aspectes, que l'enfocament metodològic, basat en un procés triaxial, aplicat en la formació inicial del grup de futurs i futures mestres, ha resultat de gran eficàcia i rellevància en la seva formació en Educació Ambiental i, també, en la seva formació com a professionals investigadors, crítico- reflexius, amb capacitat d'innovació i amb un grau més alt d' "empowerment". Cal dir que la metodologia triaxial es revela amb altes possibilitats de transferència i adaptabilitat a altres estudis. La transferibilitat d'aquesta metodologia serà objecte de seguiment investigatiu amb el propòsit de trobar les orientacions pedagògiques més adequades a cada àmbit i situació, ja que pot oferir aportacions valuoses en el camp de l'Ambientalització Curricular dels estudis universitaris.

Urbanismo ambiental y evaluación estratégica

La tesis doctoral "Urbanismo Ambiental y Evaluación Estratégica" investiga y propone un renovado papel del urbanismo y muy especialmente de la ordenación del territorio como instrumentos no tan sólo de valor para la protección del medio ambiente sino también para la consecución de las políticas hacia un desarrollo sostenible. Con tal fín se reflexiona y potencia la visión/función del suelo como recurso ambiental, también en su función urbanística, y de su mano las consecuencias e interacciones que tal conceptuación puede tener en la Comunidad Europea desde su competencia compartida con los Estados Miembros en materia de medio ambiente, concretamente en su capacidad para incidir, mediante técnicas normativas y no normativas en el urbanismo y la ordenación del territorio en cuanto instrumentos de regulación y ordenación del recurso ambiental suelo. En esta nueva andadura del urbanismo ambientalizado o, si se prefiere, en la carrera hacia el desarrollo urbanístico sostenible, la técnica de evaluación ambiental estratégica de determinados planes y programas se revela como fundamental, especialmente si se consigue que su transposición a los ordenamientos internos de los Estados Miembros se lleve a cabo con pleno respeto a las notas insosyalables defendidas en la tesis de técnica preventiva y no reparativa, dinámica, con capacidad de incidencia en la elección misma del modelo de plan y con miras finalistas a la sostenibilidad. Con ella podrá generalizarse el urbanismo ambiental y acelerarse el proceso de revisión que tienen pendiente las materias de urbanismo y ordenación del territorio desde la nueva concepción del suelo como recurso ambiental y mediante la recepción e integración de los principios ambientalistas.

The evolution of mobile DNAs: when will transposons create phylogenies that look as if there is a master gene?

Some families of mammalian interspersed repetitive DNA, such as the Alu SINE sequence, appear to have evolved by the serial replacement of one active sequence with another, consistent with there being a single source of transposition: the "master gene." Alternative models, in which multiple source sequences are simultaneously active, have been called "transposon models." Transposon models differ in the proportion of elements that are active and in whether inactivation occurs at the moment of transposition or later. Here we examine the predictions of various types of transposon model regarding the patterns of sequence variation expected at an equilibrium between transposition, inactivation, and deletion. Under the master gene model, all bifurcations in the true tree of elements occur in a single lineage. We show that this property will also hold approximately for transposon models in which most elements are inactive and where at least some of the inactivation events occur after transposition. Such tree shapes are therefore not conclusive evidence for a single source of transposition.

The impact of genome defense on mobile elements in Microbotryum

Repeat induced point mutation (RIP), a mechanism causing hypermutation of repetitive DNA sequences in fungi, has been described as a ‘genome defense’ which functions to inactivate mobile elements and inhibit their deleterious effects on genome stability. Here we address the interactions between RIP and transposable elements in the Microbotryum violaceum species complex. Ten strains of M. violaceum, most of which belong to different species of the fungus, were all found to contain intragenomic populations of copia-like retrotransposons. Intragenomic DNA sequence variation among the copia-like elements was analyzed for evidence of RIP. Among species with RIP, there was no significant correlation between the frequency of RIP-induced mutations and inferred transposition rate based on diversity. Two strains of M. violaceum, from two different plant species but belonging to the same fungal lineage, contained copia-like elements with very low diversity, as would result from a high transposition rate, and these were also unique in showing no evidence of the hypermutation patterns indicative of the RIP genome defense. In this species, evidence of RIP was also absent from a Class II helitron-like transposable element. However, unexpectedly the absolute repetitive element load was lower than in other strains.

Miniature transposable sequences are frequently mobilized in the bacterial plant pathogen Pseudomonas syringae pv. phaseolicola

Mobile genetic elements are widespread in Pseudomonas syringae, and often associate with virulence genes. Genome reannotation of the model bean pathogen P. syringae pv. phaseolicola 1448A identified seventeen types of insertion sequences and two miniature inverted-repeat transposable elements (MITEs) with a biased distribution, representing 2.8% of the chromosome, 25.8% of the 132-kb virulence plasmid and 2.7% of the 52-kb plasmid. Employing an entrapment vector containing sacB, we estimated that transposition frequency oscillated between 2.661025 and 1.161026, depending on the clone, although it was stable for each clone after consecutive transfers in culture media. Transposition frequency was similar for bacteria grown in rich or minimal media, and from cells recovered from compatible and incompatible plant hosts, indicating that growth conditions do not influence transposition in strain 1448A. Most of the entrapped insertions contained a full-length IS801 element, with the remaining insertions corresponding to sequences smaller than any transposable element identified in strain 1448A, and collectively identified as miniature sequences. From these, fragments of 229, 360 and 679-nt of the right end of IS801 ended in a consensus tetranucleotide and likely resulted from one-ended transposition of IS801. An average 0.7% of the insertions analyzed consisted of IS801 carrying a fragment of variable size from gene PSPPH_0008/PSPPH_0017, showing that IS801 can mobilize DNA in vivo. Retrospective analysis of complete plasmids and genomes of P. syringae suggests, however, that most fragments of IS801 are likely the result of reorganizations rather than one-ended transpositions, and that this element might preferentially contribute to genome flexibility by generating homologous regions of recombination. A further miniature sequence previously found to affect host range specificity and virulence, designated MITEPsy1 (100-nt), represented an average 2.4% of the total number of insertions entrapped in sacB, demonstrating for the first time the mobilization of a MITE in bacteria.

Haptic interfaces: the live and the recorded body in Beckett's Eh Joe on stage and screen

Beckett’s sparse and minimalist pieces have continuously addressed the nature and characteristics of the media for which they were written. What does it mean when a work written specifically for television is transposed to the stage, as film director Atom Egoyan did in his 2006 version of Beckett’s Eh Joe? This article will focus on the implications of such a transposition and discuss how Egoyan’s version reveals the haptic interface present in the original piece, between body and technology, between the flesh and “spirit made light” of the electronic broadcast.

The Tnt1 family member Retrosol copy number and structure disclose retrotransposon diversification in different Solanum species

Eukaryotic genome expansion/retraction caused by LTR-retrotransposon activity is dependent on the expression of full length copies to trigger efficient transposition and recombination-driven events. The Tnt1 family of retrotransposons has served as a model to evaluate the diversity among closely related elements within Solanaceae species and found that members of the family vary mainly in their U3 region of the long terminal repeats (LTRs). Recovery of a full length genomic copy of Retrosol was performed through a PCR-based approach from wild potato, Solanum oplocense. Further characterization focusing on both LTR sequences of the amplified copy allowed estimating an approximate insertion time at 2 million years ago thus supporting the occurrence of transposition cycles after genus divergence. Copy number of Tnt1-like elements in Solanum species were determined through genomic quantitative PCR whereby results sustain that Retrosol in Solanum species is a low copy number retrotransposon (1-4 copies) while Retrolyc1 has an intermediate copy number (38 copies) in S. peruvianum. Comparative analysis of retrotransposon content revealed no correlation between genome size or ploidy level and Retrosol copy number. The tetraploid cultivated potato with a cellular genome size of 1,715 Mbp harbours similar copy number per monoploid genome than other diploid Solanum species (613-884 Mbp). Conversely, S. peruvianum genome (1,125 Mbp) has a higher copy number. These results point towards a lineage specific dynamic flux regarding the history of amplification/activity of Tnt1-like elements in the genome of Solanum species.

A light and scanning electron microscopy study of bone healing following inferior alveolar nerve lateralization: An experimental study in rabbits

Purpose: The purpose of this study was to evaluate the bone healing kinetics around commercially pure titanium implants following inferior alveolar nerve (IAN) lateralization in a rabbit model. Materials and Methods: Inferior alveolar nerve lateralization was performed in 16 adult female rabbits (Oryctolagus cuniculus). During the nerve lateralization procedure, 1 implant was placed through the mandibular canal, and the IAN was replaced in direct contact with the implant. During the 8-week healing period, various bone labels were administered for fluorescent microscopy analysis. The animals were euthanized by anesthesia overdose, and the mandibular blocks were exposed by sharp dissection. Nondecalcified samples were prepared for optical light and scanning electron microscopy (SEM) evaluation. Results: SEM evaluation showed bone modeling/remodeling between the IAN and implant surface. Fluorochrome area fraction labeling at different times during the healing period showed that bone apposition mainly occurred during the first 2 weeks after implantation. Conclusions: The results obtained showed that bone healing/deposition occurred between the alveolar nerves in contact with a commercially pure titanium implant. No interaction between the nerve and the implant was detected after the 8-week healing period. Appositional bone healing occurred around the nerve bundle structure, restoring the mandibular canal integrity and morphology.

Entanglement degree measure and a criterion for sudden death as a phase transition in bipartite systems

We propose a method to compute the entanglement degree E of bipartite systems having dimension 2 x 2 and demonstrate that the partial transposition of density matrix, the Peres criterion, arise as a consequence Of Our method. Differently from other existing measures of entanglement, the one presented here makes possible the derivation of a criterion to verify if an arbitrary bipartite entanglement will suffers sudden death (SD) based only on the initial-state parameters. Our method also makes possible to characterize the SD as a dynamical quantum phase transition, with order parameter epsilon. having a universal critical exponent -1/2. (C) 2009 Elsevier Inc. All rights reserved.

A Broad-spectrum mer Operon in a Multi-drug Resistant Strain of the Fish Pathogen, Aeromonas salmonicida.

Aeromonas salmonicida AS03, a potential fish pathogen, was isolated from Atlantic salmon, Salmo salar, in 2003. This strain was found to be resistant to ≥1000 mM HgCl2 and ≥32 mM phenylmercuric acetate as well as multiple antimicrobials. Mercury (Hg) and antibiotic resistance genes are often located on the same mobile genetic elements, so the genetic determinants of both resistances and the possibility of horizontal gene transfer were examined. Specific PCR primers were used to amplify and sequence distinctive regions of the mer operon. A. salmonicida AS03 was found to have a pDU1358-like broad-spectrum mer operon, containing merB as well as merA, merD, merP, merR and merT, most similar to Klebsiella pneumonaie plasmid pRMH760. To our knowledge, the mer operon has never before been documented in Aeromonas spp. PCR and gene sequencing were used to identify class 1 integron associated antibiotic resistance determinants and the Tet A tetracycline resistance gene. The transposase and resolvase genes of Tn1696 were identified through PCR and sequencing with Tn21 specific PCR primers. We provide phenotypic and genotypic evidence that the mer operon, the aforementioned antibiotic resistances, and the Tn1696 transposition module are located on a single plasmid or conjugative transposon that can be transferred to E. coli DH5α through conjugation in the presence of low level Hg and absence of any antibiotic selective pressure. Additionally, the presence of low-level Hg or chloramphenicol in the mating media was found to stimulate conjugation, significantly increasing the transfer frequency of conjugation above the transfer frequency measured with mating media lacking both antibiotics and Hg. This research demonstrates that mercury indirectly selects for the dissemination of the antibiotic resistance genes of A. salmonicida AS03.

A broad-spectrum mer operon in a multi-drug resistant strain of the fish pathogen, Aeromonas salmonicida

Aeromonas salmonicida AS03, a potential fish pathogen, was isolated from Atlantic salmon, Salmo salar, in 2003. This strain was found to be resistant to ≥1000 mM HgCl2 and ≥32 mM phenylmercuric acetate as well as multiple antimicrobials. Mercury (Hg) and antibiotic resistance genes are often located on the same mobile genetic elements, so the genetic determinants of both resistances and the possibility of horizontal gene transfer were examined. Specific PCR primers were used to amplify and sequence distinctive regions of the mer operon. A. salmonicida AS03 was found to have a pDU1358-like broad-spectrum mer operon, containing merB as well as merA, merD, merP, merR and merT, most similar to Klebsiella pneumonaie plasmid pRMH760. To our knowledge, the mer operon has never before been documented in Aeromonas spp. PCR and gene sequencing were used to identify class 1 integron associated antibiotic resistance determinants and the Tet A tetracycline resistance gene. The transposase and resolvase genes of Tn1696 were identified through PCR and sequencing with Tn21 specific PCR primers. We provide phenotypic and genotypic evidence that the mer operon, the aforementioned antibiotic resistances, and the Tn1696 transposition module are located on a single plasmid or conjugative transposon that can be transferred to E. coli DH5α through conjugation in the presence of low level Hg and absence of any antibiotic selective pressure. Additionally, the presence of low-level Hg or chloramphenicol in the mating media was found to stimulate conjugation, significantly increasing the transfer frequency of conjugation above the transfer frequency measured with mating media lacking both antibiotics and Hg. This research demonstrates that mercury indirectly selects for the dissemination of the antibiotic resistance genes of A. salmonicida AS03.

Análise sociológica do romance "Terras do sem fim"

Este trabalho consiste na análise sociológica do romance "Terras do Sem Fim", de Jorge Amado. Partimos da idéia de que a obra de arte não é apenas um reflexo da realidade mas que ela é capaz de reproduzir um determinado momento desta realidade, apreendendo-o em toda sua complexidade, embora através de sua própria especificidade. Procuramos portanto ao analisar esta obra captar o princípio estrutural que ordena o mundo ficcional e mostrar de que forma se faz a transposição do plano real ao plano romanesco. Em "Terras do Sem Fim" nos parece que as relações entre as personagens assim como sua trajetória são de terminadas pelo princípio do autoritarismo e da "malandragem”. Nesta sociedade cacaueira do princípio do século transposta para o romance, os coronéis, fazendeiros de cacau, dominam por meio da violência e da fraude, mas para dar livre curso à sua ambição ou para se realizarem no pleno individual, necessitam do concurso dos representantes dos grupos médios (advogados, médicos, funcionários públicos, jornalistas, etc.). Estes de melhor nível educacional, de origem urbana, detentores do "saber" utilizam-se desses trunfos para obterem dinheiro, prestígio social ou fama que os compensem pela sua submissão e lealdade aos coronéis. Em plano secundário, como na vida real, estão os trabalhadores e pessoas humildes que vivem sob a bota dos coronéis, não tendo maior peso político ou influência os acontecimentos. Para compreender essa estrutura social baseada na realidade baiana, partimos da análise da sociedade brasileira no, período estudado (Primeira República), analisando-a do ponto de vista econômico, político e social. Procuramos também mostrar como a formação e a vivência do escritor contribuem para a apreensão dessa realidade mas não seriam por si sós garantia dessa fidelidade que e, em última instância, determinada pela sensibilidade e pelo trabalho criador do artista.

Uma interpretação da psicogênese e da sociogênese do desenvolvimento moral

O objetivo deste estudo volta-se para uma análise a nível teórico,da construção de normas. constitutivas do sistema moral aptas a direcionarem a conduta humana. Três referenciais básicos foram estabelecidos como pla taformas para o estudo: A Crítica da Razão Prática de I. Kant e a avaliação do caráter neces5ário da norma. bem como a dificuldade de transpor para o plano histórico e empírico. critérios de universalidade inerentes ao "imperativo categórico". A categorização dos valores de E. Spranger forneceu elementos para proceder a uma análise da sociogênese das normas, partindo de critérios valorativos. culturalmente estabelecidos, aptos a quantificar conteúdos para a moral. Finalmente. a perspectiva piagetiana ofereceu as bases para uma avaliação da psicogênese como construção formal dos sistemas de regras, que compõem a moral humana. O estudo aqui realizado estabelece seus próprios limites dentro dos três contextos acima selecionados por constituirem uma interpretação prefixada que viza harmonizar tais posiçoes. Estas fronteiras. assim definidas. justificam portanto o caráter circunscrito. e sem pretensões de ser exaustivo na matéria que o presente trabalho se propõe evidenciar.

Projeto de transposição de águas do Rio São Francisco: uma análise à luz do processo de agenda-setting

Quais condições permitiram que o Projeto de Transposição de Águas do Rio São Francisco deixasse de figurar no imaginário daqueles que o defendiam, como o vinha sendo desde os idos do período imperial, e, começasse a ser efetivamente implementado somente em 2007? Responder a esta questão corresponde ao objetivo principal deste estudo. Para tal, o Projeto São Francisco, como também é conhecido, foi analisado à luz do modelo de multiple streams, concebido por John Kingdon (2003), orientado para a compreensão sobre como algumas questões passam a fazer parte da agenda de governo, recebendo atenção dos formuladores de políticas públicas, enquanto outras são ignoradas. Por meio do modelo de multiple streams, foi possível apontar os principais diagnósticos e alternativas historicamente apresentados para a região do semiárido brasileiro, frente à questão dramática das secas recorrentes. Além disso, foi estruturado o complexo jogo político da transposição, caracterizado pelo conflito entre coalizões atuantes em múltiplas arenas decisórias. A partir do mapeamento da forma como os atores políticos se apropriaram dos diagnósticos e alternativas apresentados para a região, com o intuito de impor aos demais as suas crenças sobre qual deve ser o melhor caminho para o desenvolvimento do semiárido, foram identificadas as janelas de oportunidades (policy windows) que tornaram viáveis a execução do projeto de transposição.