Percepción de pacientes mayores de 65 años o cuidadores sobre el posoperatorio de fractura de cadera y su recuperación funcional

Introducción: La fractura de cadera se presenta predominantemente en población mayor; se espera que para el año 2050 se presenten alrededor de 6 millones de fracturas de cadera a nivel global. Parkkari et al (1). Dado que el sistema de salud colombiano dificulta el seguimiento adecuado de los pacientes y su manejo posoperatorio integral, desconocen las estadísticas reales de los desenlaces funcionales, mortalidad y complicaciones asociadas a la fractura de cadera. Método: Estudio observacional descriptivo de corte transversal. Mediante una encuesta telefónica cuyo objetivo fue determinar el manejo intra y extra hospitalario por los servicios de rehabilitación y ortopedia, describir la mortalidad y la recuperación funcional percibidos por los encuestados. Resultados: De 286 pacientes intervenidos, 116 aceptaron participar (24% hombres y 76% mujeres). Edades entre 65 y 99 años (media: 81.3 años). En el primer año después de la cirugía, el 29% de los pacientes presento al menos un reingreso hospitalario; la mortalidad en el grupo femenino fue de 23% frente a un 43% en el grupo masculino. El 98% de los pacientes deambulaba previo a la cirugía, frente a un 78% de los pacientes a un año del procedimiento, 83 pacientes refirieron complicaciones pos-operatorias. En el grupo entre 65 y 74 años la capacidad de deambular posterior al procedimiento fue de 84%, para las edades entre 75 a 84 años fue del 82% y en los mayores de 85 años del 75%. Conclusiones: La recuperación funcional de los pacientes intervenidos por fractura de cadera, difícilmente llegan a alcanzar el estado funcional previo a la fractura, lo cual se traduce en situaciones de dependencia, riesgo de caída y complicaciones médicas.

Engagement y productividad en las empresas

El presente trabajo pretende mostrar algunos avances en el término “engagement”, y como puede ser implementado en las organizaciones, teniendo en cuenta los diferentes factores que intervienen, para que los trabajadores se sientan “engaged” dentro de la organización. Además busca relacionar las diferentes habilidades y tipos de liderazgo que los altos mandos utilizan con sus empleados y como éste afecta la productividad de los trabajadores en las organizaciones. Para esto, se realizó una investigación de las clases de liderazgo y los comportamientos de los altos mandos, que pueden afectar positiva y negativamente el vínculo y sentido de pertenencia que tienen los trabajadores con la empresa en la que trabajan. Considerando importante las habilidades del liderazgo transformacional, para lograr desarrollar algún grado de engagement en los trabajadores, lo cual genera a su vez, un alza en la productividad de sus resultados dentro de la organización.

Osteomielitis esternal: utilidad de las pruebas de diagnóstico por imágenes con enfoque en medicina nuclear

Introducción: El diagnóstico de osteomielitis esternal post-esternotomía resulta difícil empleando síntomas clínicos o de laboratorio y las imágenes morfológicas orientan a sospecha más que al diagnóstico. Un diagnóstico precoz ofrece calidad de vida y el mejor tratamiento para reducir una mortalidad que oscila entre 14% y 47%. La gammagrafía con leucocitos marcados ofrece el mejor rendimiento diagnóstico para infecciones y se destaca como el patrón de oro diagnóstico. Objetivo: Identificar el desempeño y utilidad de la gammagrafía con leucocitos autólogos marcados con 99mTc-HMPAO en los estudios realizados para la evaluación de osteomielitis esternal. Materiales y métodos: Se realizó un estudio descriptivo, retrospectivo de prueba diagnóstica en la Fundación Cardioinfantil de Bogotá entre enero/2010 y mayo/2015 evaluando gammagrafías con leucocitos marcados ante la sospecha de osteomielitis posterior a esternotomía. Resultados: Se evaluaron 52 pacientes, en los que la gammagrafía con leucocitos mostró 23 pacientes (44,2%) con osteomielitis esternal, logrando una sensibilidad y especificidad del 88,46% y 100% respectivamente. El valor predictivo positivo fue de 100%, y el valor predictivo negativo fue de 89,66%. El impacto de una prueba negativa no modificó el manejo médico inicial en el 93% de los casos mientras que una prueba positiva lo modificó en el 83%. Conclusiones: La gammagrafía con leucocitos autólogos radiomarcados con 99mTc-HMPAO continúa siendo el patrón de oro de referencia no invasiva para el diagnóstico de osteomielitis, y en el caso de osteomielitis esternal se convierte en la prueba de elección pertinente en la selección de pacientes que ameritan una re-intervención quirúrgica.

Resonancia magnética cardiaca: medidas lineales y volumétricas en adultos sanos

Introducción: La gran mayoría de las medidas de normalidad utilizadas para la interpretación de resonancia cardiaca son extrapoladas de las medidas de ecocardiografía. Los limitados registros de medidas de normalidad se encuentran ajustados en poblaciones extranjeras, no hay registros en latinoamericanos. Objetivo: Determinar las dimensiones cardiacas utilizando resonancia magnética en una población de personas sin antecedente médicos con repercusión cardiaca para lograr una muestra de valores que permitan ajustar las medidas de normalidad utilizadas por nuestro servicio. Materiales y métodos: se analizaron 45 sujetos sanos con edad comprendida entre los 21 y 45 años, las adquisiciones se realizaron utilizando un equipo de RM de 1,5 teslas, el análisis de las imágenes se realizó mediante el programa Cardiac Volume Vx. Se evaluaron múltiples parámetros morfofuncionales a través de análisis estadístico por medio del sistema SPSS versión 23. Resultados: Mediciones obtenidas de ventrículo izquierdo principales fueron volumen diastólico en mujeres de 62 ml +/- 7.1 y en hombres de 65 ml +/- 11.2 y fracción de eyección de 60 % +/- 5 en mujeres y de 62 % +/- 9 en hombres. En ventrículo derecho el volumen diastólico final se encontró 81.8 ml +/- 14.6 en mujeres y 100 ml +/- 24.8 en hombres y fracción de eyección de 53 % +/- 17 en mujeres y de 45 % +/- 12 en hombres. Volumen de fin de diástole de 50 +/- 12.7 ml en mujeres y de 49 ml +/- 19 ml en hombres y fracción de eyección de aurícula izquierda de 55 % +/- 0.08 en mujeres y de 50 % +/- 0.07 en hombres. Volumen de fin de diástole de 44.1 ml +/- 18.5 en mujeres y de 49.2 ml +/- 22.9 en hombres y fracción de eyección de aurícula derecha de 50 % +/- 11 en mujeres y de 45 % +/- 8 en hombres. Se obtuvieron otras medidas lineales y volumétricas adicionales de cavidades cardiacas y de grandes vasos supracardiacos. Conclusiones: se describen los valores de referencia de los parámetros morfofuncionales de las cavidades cardiacas y de vasos supracardiacos. El sexo fue tenido en cuenta como covariable relacionada con la modificación de los parámetros evaluados. Se sugieren variaciones en las medidas de cavidades cardiacas para la población estudiada relacionada con aclimatación crónica a la altitud de la ciudad de Bogotá.

The impact of an intelligent classroom on pupils' interactive behaviour

Purpose – The purpose of this research is to determine whether new intelligent classrooms will affect the behaviour of children in their new learning environments. Design/methodology/approach – A multi-method study approach was used to carry out the research. Behavioural mapping was used to observe and monitor the classroom environment and analyse usage. Two new classrooms designed by INTEGER (Intelligent and Green) in two different UK schools provided the case studies to determine whether intelligent buildings (learning environments) can enhance learning experiences. Findings – Several factors were observed in the learning environments: mobility, flexibility, use of technology, interactions. Relationships among them were found indicating that the new environments have positive impact on pupils' behaviour. Practical implications – A very useful feedback for the Classrooms of the Future initiative will be provided, which can be used as basis for the School of the Future initiative. Originality/value – The behavioural analysis method described in this study will enable an evaluation of the “Schools of the Future” concept, under children's perspective. Using a real life laboratory gives contribution to the education field by rethinking the classroom environment and the way of teaching.

A high resolution late Holocene palaeo environmental record from the central Adriatic Sea

A multi-proxy study of a Holocene sediment core (RF 93-30) from the western flank of the central Adriatic, in 77 m of water, reveals a sequence of changes in terrestrial vegetation, terrigenous sediment input and benthic fauna, as well as evidence for variations in sea surface temperature spanning most of the last 7000 yr. The chronology of sedimentation is based on several lines of evidence, including AMS 14C dates of foraminifera extracted from the core, palaeomagnetic secular variation, pollen indicators and dated tephra. The temporal resolution increases towards the surface and, for some of the properties measured, is sub-decadal for the last few centuries. The main changes recorded in vegetation, sedimentation and benthic foraminiferal assemblages appear to be directly related to human activity in the sediment source area, which includes the Po valley and the eastern flanks of the central and northern Appenines. The most striking episodes of deforestation and expanding human impact begin around 3600 BP (Late Bronze Age) and 700 BP (Medieval) and each leads to an acceleration in mass sedimentation and an increase in the proportion of terrigenous material, reflecting the response of surface processes to widespread forest clearance and cultivation. Although human impact appears to be the proximal cause of these changes, climatic effects may also have been important. During these periods, signs of stress are detectable in the benthic foram morphotype assemblages. Between these two periods of increased terrigeneous sedimentation there is smaller peak in sedimentation rate around 2400BP which is not associated with evidence for deforestation, shifts in the balance between terrigenous and authigenic sedimentation, or changes in benthic foraminifera. The mineral magnetic record provides a sensitive indicator of changing sediment sources: during forested periods of reduced terrigenous input it is dominated by authigenic bacterial magnetite, whereas during periods of increased erosion, anti-ferromagetic minerals (haematite and/or goethite) become more important, as well as both paramagnetic minerals and super-paramagnetic magnetite. Analysis of the alkenone, U37k′, record provides an indication of possible changes in sea surface temperature during the period, but it is premature to place too much reliance on these inferred changes until the indirect effects of past changes in the depth of the halocline and in circulation have been more fully evaluated. The combination of methods used and the results obtained illustrate the potential value of such high resolution near-shore marine sedimentary sequences for recording wide-scale human impact, documenting the effects of this on marine sedimentation and fauna and, potentially, disentangling evidence for human activities from that for past changes in climate.

Sustainable construction: exploring the capabilities of Nigerian construction firms

As the built environment accounts for much of the world's emissions, resource consumption and waste, concerns remain as to how sustainable the sector is. Understanding how such concerns can be better managed is complex, with a range of competing agendas and institutional forces at play. This is especially the case in Nigeria where there are often differing priorities, weak regulations and institutions to deal with this challenge. Construction firms are in competition with each other in a market that is growing in size and sophistication yearly. The business case for sustainability has been argued severally in literature. However, the capability of construction firms with respect to sustainability in Nigeria has not been studied. This paper presents the preliminary findings of an exploratory multi-case study carried out to understand the firm's views on sustainability as a source of competitive advantage. A international firm and a lower medium-sized indigenous firm were selected for this purpose. Qualitative interviews were conducted with top-level management of both firms, with key themes from the sustainable construction and dynamic capabilities literature informing the case study protocol. The interviews were transcribed and analysed with the use of NVivo software. The findings suggest that the multinational firm is better grounded in sustainability knowledge. Although the level of awareness and demand for sustainable construction is generally very poor, few international clients are beginning to stimulate interest in sustainable buildings. This has triggered both firms to build their capabilities in that regard, albeit in an unhurried manner. Both firms agree on the potentials of market-driven sustainability in the long term. Nonetheless, more drastic actions are required to accelerate the sustainable construction agenda in Nigeria.

Statistical characterisation of the growth and spatial scales of the substorm onset arc

We present the first multi-event study of the spatial and temporal structuring of the aurora to provide statistical evidence of the near-Earth plasma instability which causes the substorm onset arc. Using data from ground-based auroral imagers, we study repeatable signatures of along-arc auroral beads, which are thought to represent the ionospheric projection of magnetospheric instability in the near-Earth plasma sheet. We show that the growth and spatial scales of these wave-like fluctuations are similar across multiple events, indicating that each sudden auroral brightening has a common explanation. We find statistically that growth rates for auroral beads peak at low wavenumber with the most unstable spatial scales mapping to an azimuthal wavelength λ≈1700 − 2500 km in the equatorial magnetosphere at around 9-12 RE. We compare growth rates and spatial scales with a range of theoretical predictions of magnetotail instabilities, including the cross-field current instability and the shear-flow ballooning instability. We conclude that, although the cross-field current instability can generate similar magnitude of growth rates, the range of unstable wavenumbers indicates that the shear-flow ballooning instability is the most likely explanation for our observations.

Examining the predictability of the Stratospheric Sudden Warming of January 2013 using multiple NWP systems

The first multi-model study to estimate the predictability of a boreal Sudden Stratospheric Warming (SSW) is performed using five NWP systems. During the 2012-2013 boreal winter, anomalous upward propagating planetary wave activity was observed towards the end of December, which followed by a rapid deceleration of the westerly circulation around 2 January 2013, and on 7 January 2013 the zonal mean zonal wind at 60°N and 10 hPa reversed to easterly. This stratospheric dynamical activity was followed by an equatorward shift of the tropospheric jet stream and by a high pressure anomaly over the North Atlantic, which resulted in severe cold conditions in the UK and Northern Europe. In most of the five models, the SSW event was predicted 10 days in advance. However, only some ensemble members in most of the models predicted weakening of westerly wind when the models were initialized 15 days in advance of the SSW. Further dynamical analysis of the SSW shows that this event was characterized by the anomalous planetary wave-1 amplification followed by the anomalous wave-2 amplification in the stratosphere, which resulted in a split vortex occurring between 6 January 2013 and 8 January 2013. The models have some success in reproducing wave-1 activity when initialized 15 days in advance, they but generally failed to produce the wave-2 activity during the final days of the event. Detailed analysis shows that models have reasonably good skill in forecasting tropospheric blocking features that stimulate wave-2 amplification in the troposphere, but they have limited skill in reproducing wave-2 amplification in the stratosphere.

Riparian shading controls instream spring phytoplankton and benthic diatom growth

Dissolved oxygen (DO) concentrations showed a striking pattern in a multi-year study of the River Enborne, a small river in SE England. In each of three years (2010-2012), maximum DO concentrations were attained in mid-April, preceded by a period of steadily increasing diurnal amplitudes, followed by a steady reduction in both amplitude and concentration. Flow events during the reduction period reduce DO to low concentrations until the following spring. Evidence is presented that this pattern is mainly due to benthic algal growth which is eventually supressed by the growth of the riparian tree canopy. Nitrate and silicate concentrations are too high to inhibit the growth of either benthic algae or phytoplankton, but phosphate concentrations might have started to reduce growth if the tree canopy development had been delayed. This interpretation is supported by evidence from weekly flow cytometry measurements and analysis of the diurnal, seasonal and annual patterns of nutrient concentrations. As the tree canopy develops, the river switches from an autotrophic to a heterotrophic state. The results support the use of riparian shading to help control algal growth, and highlight the risks of reducing riparian shade.

Estratégia internacional e relações gerenciais de negócios internacionais

Esta pesquisa procura avaliar a estratégia de negócios internacionais de indústrias brasileiras e a forma como se conduzem suas parcerias com indústrias estrangeiras. Seu objetivo é conseguir uma melhor conceituação teórica sobre tópicos como: (1) forma como as empresas conduzem suas relações com empresas de outros países; (2) determinação dos fatores de sucesso dessas alianças de negócios internacionais; (3) implementação de uma estratégia internacional bem-sucedida. Este projeto é parte de um estudo multinacional, desenvolvido com o patrocínio de algumas das mais importantes universidades do Brasil, Canadá, Chile, México e Estados Unidos, e empresas de cada um desses países. A primeira parte se refere à relação da empresa brasileira com seus parceiros estrangeiros. A segunda analisa a estratégia internacional seguida pela empresa brasileira.

Atitude socialmente responsável ou estratégia comercial: o caso do pacto global

The discussion about corporate obligations toward the various stakeholders began in the postindustrial era and developed to culminate in the creation of rules, regulations, programs and projects focusing on the dissemination and promotion of what we know today as corporate social responsibility (CSR). In this context, satisfying this new demand and adopting social policies emerge as a determining factor in defining organizational strategies. Nevertheless, some questions are raised when we examine the subject, such as: To what extent should organizations intervene in society? Is the decision for the organizations to adopt a socially responsible attitude really linked to promoting social well being, or is it only a commercial strategy? How does social marketing relate to CSR projects? The study herein, based on the concept and understanding of CSR theories, stakeholders and social marketing, has sought to find evidence of this relationship, in the light of the Global Compact (GC). It was decided to use the multi-case study methodology, considering the possibility of explaining the reasons why the decisions were taken, how they were implemented and what was the outcome. Interviews, supported by previously prepared scripts, were held with CSR managers, employees from other areas of the organizations, and specialists on the subject. Complementary research studies were made in various sources, such as the website of companies under analysis, their sustainability reports, and the GC websites in Brazil and the United Nations (UN). The results obtained show that the organizations have worked increasingly with CSR projects, but the efforts have not been focused. Special mention is given to the programs that create major impact on the company¿s image and reputation, such as projects competing for prizes and participating in the formation of rankings or socially responsible organizations. From the view of Carroll¿s Pyramid (1991) for CSR, it is found that the projects are predominantly focusing on ethical and philanthropic issues. The driving power of the GC, action based on learning, dialogue and partnership, is not to be found. This factor contributes to the statement that social marketing tools are used to build an ethical and socially responsible image, in detriment to effective action by the organizations to meet the social requirements of their stakeholders. The social marketing has as an objective to transform the way a specific public sees a social question and promotes behavior changes, but what has been seen is the use of marketing tools exclusively to promote the company's image.

Divergência entre prática e recomendações para modelos de atuação do PMO : o caso de uma empresa de grande porte do setor industrial

Neste trabalho, o objetivo é identificar, a partir da análise de um estudo de caso, quais são as principais divergências encontradas quando se compara o que a teoria preconiza como o escopo e a abordagem dos Project Management Offices - PMOs e o que acontece na prática, no que diz respeito à real atuação destas estruturas. O tema pode ser considerado relevante devido ao fato de fornecer uma melhor compreensão sobre como as estruturas de PMO realmente atuam, principalmente no que diz respeito ao escopo, isto é, se o PMO é um Programa-Projeto, um PMO Departamental ou um PMO Corporativo e relativamente a sua amplitude, ou seja, se sua atuação é operacional, tática ou estratégica. Para este estudo foi utilizada a metodologia qualitativa, por meio da abordagem de estudo de caso. Foi selecionada uma empresa de grande porte do setor de manufatura não estruturada por projeto para avaliação. A empresa do estudo de caso possui uma estrutura organizacional complexa que possibilita um estudo abrangente. A atuação dos PMOs do estudo de caso foi discutida à luz da revisão de literatura e levando-se em conta, também, as informações colhidas a partir da observação participante. Os resultados deste trabalho permitem concluir que o pressuposto defendido, que é a existência de divergências entre o que a teoria preconiza como escopo e abordagem do PMO e a real atuação dos PMOs, foi confirmado através do estudo de caso; além disso, não existe relação de causalidade clara entre o escopo de atuação dos PMOs e sua posição hierárquica dentro da empresa; e não existe uma atuação padrão destas estruturas, quando comparadas às funções que elas exercem. Por fim, são apresentadas recomendações relativas ao estudo de caso realizado, ou seja, é importante realizar um estudo multicasos entre ao menos uma empresa não estruturada por projeto e outra estruturada por projeto e comparar a atuação dos seus PMOs para melhor compreensão do tema, incluir mais stakeholders no grupo de entrevistados dentro do estudo de caso, realizar um survey com várias empresas de vários segmentos dentro do território nacional e um possível estudo onde seja verificado se tipologias diferentes de estruturas organizacionais podem afetar a atuação práticas dos PMOs.

Morte como desafio afetivo para o profissional da saúde: ansiedade e sentimentos de quem lida com o paciente terminal com câncer

It is a Cross-sectional and multi-disciplinary study whose population selection was made by department of human resources (composed by a Manager, an Oncologist and a Psychologist) from the hospital where this research was realized. They also collaborated with important information about the work of that professionals in the hospital. We also counted on a Statistic who made study design calculating the sample and analyzing data. This research issued Evaluating health professionals anxiety levels who care for cancer terminally ill and their feelings about that work as well as identifying the factors which have influence on it. 100 health professionals from the Hospital which is a reference on cancer caring in Brazil situated in the city of Natal, state of Rio Grande do Norte, participated of this research. There was a sample loss of 21%. Data were collected through a questionnaire and State-Trait Anxiety Inventory (STAI). Results showed that 15% of the professionals have low State Anxiety levels, 70% Medium State Anxiety levels and 15% high State anxiety levels. The Number of Patients and Working in another Institution have interfered in the anxiety levels. Doctors and Nursing Assistants and Technicians have got the highest high State Anxiety percentage (25%). 73% of them declare to feel some sort of different behavior and/or feelings in caring for terminally ill. The most remarkable professionals feelings were Suffering and Sadness, and Terminally ill Children was the most difficult age group to care for. We conclude that work overload and having more than one job can interfere in professional stress levels and anxiety. Dealing with terminally ill, specially children one, can cause on the professionals psychological suffering. It s recommended the development of supporting and training strategies to reduce and/or to prevent Stress and Anxiety high levels

A eficácia do milnaciprano em pacientes ambulatoriais com transtorno depressivo maior não respondedores ao tratamento com ISRSs: um estudo aberto de 12 semanas

CONTEXTO: O objetivo deste estudo é avaliar a eficácia do milnaciprano em pacientes ambulatoriais com depressão maior grave que não respondem em tempo e em dosagem adequados à terapia com ISRSs. MÉTODOS: Um estudo aberto multicêntrico com a duração de 12 semanas foi elaborado para avaliar a eficácia do milnaciprano após falha em um experimento com ISRS. Remissão completa (HAMD-17 < 8) foi o desfecho principal. Os desfechos secundários foram resposta (HAM > 50%), CGI e avaliação da qualidade de vida (WHOQOL-Bref). RESULTADOS: O escore HAMD-17 médio da amostra foi de 27 (7,2). As taxas de remissão com o milnaciprano foram de 17,5%, e as de resposta, 61,3%. Na linha de base, 70,9% dos pacientes foram classificados como gravemente sintomáticos. Ao final do tratamento, 48,1% dos pacientes foram classificados como normais assintomáticos ou sintomáticos limítrofes e 20,2% eram moderadamente sintomáticos. Além disso, os quatro domínios do WHOQOL-Bref, um instrumento genérico de mensuração de qualidade de vida, apresentou diferenças clínicas e estatísticas: CONCLUSÃO: Nossos resultados sugerem que o milnaciprano é uma possível opção para pacientes que não respondem a ISRSs. Uma vez que não há evidências na literatura de um antidepressivo que seja a melhor opção quando um ISRS falha, o uso do milnaciprano deveria ser considerado em casos de pacientes com depressão severa.