Herniorrafia inguinal por laparoscopia, experiencia en hospital universitario mayor de febrero 2013 a febrero 2014

Los defectos herniarios inguinales son una condición con alta prevalencia en nuestra población. En los últimos años la introducción de la cirugía laparoscopia para la corrección de esta patología ha tomado fuerza gradualmente. El propósito del presente trabajo es describir la experiencia en el uso de esta técnica quirúrgica en una institución hospitalaria. Materiales y métodos: estudio descriptivo de corte trasversal en el cual se revisaron las historias clínica de cada uno de los sujetos llevados a herniorrafia inguinal laparoscópica, donde se evaluaron las características pre y postoperatorias de los casos, así como las complicaciones derivadas del procedimiento. Resultados: Se evaluaron un total de 250 pacientes para un total de 334 Herniorrafias. El promedio de edad fue 58,3 años. La relación hombre mujer fue 3,7: 1. Del total de procedimientos 168 correspondieron a defectos bilaterales. 32 pacientes tenían antecedentes de herniorrafia previa. Se presentaron un total de tres complicaciones. El promedio general de tiempo quirúrgico fue de 69,3 minutos. El seguimiento post operatorio evidencio al dolor inguinal agudo como el principal proceso patológico derivado. El promedio de tiempo de incapacidad en total fue 8,3 días. Se encontró reproducción de la hernia comprobado por ecografía en 10 pacientes. No se produjo ninguna mortalidad en los pacientes del estudio. Conclusiones: La corrección laparoscopia se ha convertido en una alternativa segura y eficiente en el tratamiento definitivo de los defectos herniarios inguinales y debe ser tenida en cuenta en el momento de seleccionar la vía de acceso.

La medicina anatomoclínica y su llegada y consolidación en Chile: 1833-1843

El presente trabajo trata de dar cuenta de explicar el proceso por el cual la medicina anatomoclínica configurada en Francia durante el siglo XVIII llega y se consolida en Chile durante 1833 a 1843. Par el desarrollo de este objetivo el trabajo consta de dos partes principales. En la primera parte se hace un estudio a profundidad sobre la configuración de la medicina anatomoclínica en Francia durante la Revolución Francesa. Esto nos permite entender que la constitución de esta medicina se da de la mano con la construcción del Estado Nacional francés y, así mismo, que este proceso se caracteriza por un cambio en la mentalidad de lo que significa la enfermedad y la manera en la que el oficio médico es entendido. La segunda parte es un estudio sobre cómo esta medicina llega a Chile y se consolida durante un periodo político particular en el que a la vez se institucionaliza la educación médica, se constituye un Estado Nación Chileno y se evidencia un cambio de los fundamentos de la medicina.

Trauma craneoencefálico severo en la UCIP del Hospital de la Misericordia, 2010-2013

El Trauma Craneoencefálico (TCE) infantil constituye un motivo frecuente de consulta en Urgencias y supone la primera causa de muerte en niños, llegando a ser hasta del 50% en trauma severo. En Colombia se conocen cifras de TCE por algunos estudios descriptivos, pero no existen reportes en Bogotá ni específicamente en TCE severo. Objetivo: Caracterizar el trauma craneoencefálico severo pediátrico en la Unidad de Cuidado intensivo del Hospital de la Misericordia entre los años 2010 y 2013. Materiales y métodos: Un estudio descriptivo retrospectivo fue realizado en el Hospital de la Misericordia mediante revisión de las historias clínicas de los pacientes que ingresaron a la Unidad de Cuidado Intensivo pediátrico con diagnóstico de trauma craneoencefálico severo entre el año 2010 al 2013. Resultados: Se incluyeron 63 pacientes (71,4% hombres) con una edad mediana de 4 años (RIQ 2-8). La mayoría de los traumas fueron originados por caída o accidente de tránsito (79,4%). La principal lesión fue fractura de cráneo (79%). Casi la mitad de los pacientes sufrieron algún tipo de secuela neurológica al egreso (47,1%). La mayoría de los pacientes que murieron (19%) sufrieron choque hipovolémico (83,3%) y presentaron trauma asociado (66,7%). Conclusión: Las características y epidemiología del trauma craneoencefálico en nuestra población muestran claras similitudes con lo reportados en otras series de la literatura mundial y de Colombia, excepto por la mortalidad, que se esperaba más alta al estudiar solo pacientes con TCE severo.

I don't want to go to hospital.

Princesita tiene algo en su nariz y el médico le dice que tiene que ir al hospital para que se lo quiten pero ella se niega a ir. La Reina y el Primer Ministro tratar de persuadirla, ella corre y va escondiéndose de los funcionarios que la buscan. Cuando el rey finalmente la encuentra, ella tiene que ir. Una vez que el grano sale la Princesita vuelve a palacio, pero quiere regresar al hospital. Allí fue tratada como una princesa.

Reinserci??n social del enfermo en el Hospital Psiqui??trico de C??rdoba

Se estudia la progresiva desaparici??n del antiguo sistema de asistencia, en especial de los Hospitales Psiqui??tricos y el desarrollo de los nuevos dispositivos mediante las tareas de adecuaci??n. Analizar la formaci??n de los profesionales y trabajo en equipo. Recopilar los datos, proyectos, y planes elaborados durante el ??ltimo quinquenio dentro de la Psiquiatr??a, a nivel de Junta de Andaluc??a. Desmantelar progresivamente el Hospital Psiqui??trico de C??rdoba, desarrollando al mismo tiempo unas estructuras de atenci??n que est??n centradas e integradas dentro del dispositivo sanitario general. Se trata de un proceso complejo y lleno de dificultades que va a exigir una capacidad t??cnica y voluntad pol??tica capaz de asumir las tensiones y dificultades. La transformaci??n de las estructuras de Atenci??n en Salud Mental exige contar desde el principio con una clara pol??tica de formaci??n de los distintos profesionales implicados y su trabajo en equipo, y hacer posible el correcto desarrollo de las nuevas tareas y la adaptaci??n al nuevo marco organizativo y funcional de los servicios.

The liberal state and education in Portugal : social integration, freedom of teaching and secularization (1840-1880)

Resumen tomado de la publicaci??n

How Millennials are changing the way we learn : the state of the art of ICT integration in education

Resumen basado en el de la publicaci??n

Reintroduction of the Eurasian otter (Lutra lutra) in Muga and Fluvià basins (north-eastern Spain): viability, development, monitoring and trends of the new population

Aquesta tesi es basa en el programa de reintroducció de la llúdriga eurasiàtica (Lutra lutra) a les conques dels rius Muga i Fluvià (Catalunya) durant la segona meitat dels 1990s. Els objectius de la tesi foren demostrar la viabilitat de la reintroducció, demostrar l'èxit de la mateixa, estudiar aspectes ecològics i etològics de l'espècie, aprofitant l'oportunitat única de gaudir d'una població "de disseny" i determinar les probabilitats de supervivència de la població a llarg termini. La reintroducció de la llúdriga a les conques dels rius Muga i Fluvià va reeixir, doncs l'àrea geogràfica ocupada efectivament es va incrementar fins a un 64% d'estacions positives a l'hivern 2001-02. La troballa de tres exemplars adults nascuts a l'àrea de reintroducció és una altra prova que valida l'èxit del programa. La densitat d'exemplars calculada a través dels censos visuals ha resultat baixa (0.04-0.11 llúdrigues/km), però s'aproxima al que hom pot esperar en els primers estadis d'una població reintroduïda, encara poc nombrosa però distribuïda en una gran àrea. La mortalitat post-alliberament va ser del 22% un any després de l'alliberament, similar o inferior a la d'altres programes de reintroducció de llúdrigues reeixits. La mortalitat va ser deguda principalment a atropellaments (56%). El patró d'activitat de les llúdrigues reintroduïdes va esdevenir principalment nocturn i crepuscular, amb una escassa activitat diürna. Les seves àrees vitals van ser del mateix ordre (34,2 km) que les calculades en d'altres estudis realitzats a Europa. La longitud mitjana de riu recorreguda per una llúdriga durant 24 hores va ser de 4,2 km per les femelles i 7,6 km pels mascles. Durant el període de radioseguiment dues femelles van criar i els seus moviments van poder ser estudiats amb deteniment. La resposta de la nova població de llúdrigues a les fluctuacions estacionals en la disponibilitat d'aigua, habitual a les regions mediterrànies, va consistir en la concentració en una àrea menor durant el període de sequera estival, a causa de l'increment de trams secs, inhabitables per la llúdriga per la manca d'aliment, fet que va provocar expansions i contraccions periòdiques en l'àrea de distribució. La persistència a llarg termini de la població reintroduïda va ser estudiada mitjançant una Anàlisi de Viabilitat Poblacional (PVA). El resultat va ser un baix risc d'extinció de la població en els propers 100 anys i la majoria dels escenaris simulats (65%) van assolir el criteri d'un mínim de 90% de probabilitat de supervivència. Del model poblacional construït es dedueix que un punt clau per assegurar la viabilitat de la població reintroduïda és la reducció de la mortalitat accidental. A l'àrea d'estudi, els atropellaments causen més del 50% de la mortalitat i aquesta pot ser reduïda mitjançant la construcció de passos de fauna, el tancament lateral d'alguns trams de carretera perillosos i el control de la velocitat en algunes vies. El projecte de reintroducció ha posat a punt un protocol per a la captura, maneig i alliberament de llúdrigues salvatges, que pot contenir informació útil per a programes similars. També ha suposat una oportunitat única d'estudiar una població dissenyada artificialment i poder comparar diversos mètodes per estimar la distribució i la densitat de poblacions de llúdrigues. Per últim, la reintroducció portada a terme a les conques dels rius Muga i Fluvià ha aconseguit crear una nova població de llúdrigues, que persisteix en el temps, que es reprodueix regularment i que es dispersa progressivament, fins i tot a noves conques fluvials.

Motiva��ão no trabalho: um estudo de caso na gestão administrativa do Hospital Divina Providência

A motiva��ão organizacional é assunto que vem sendo estudado mais profundamente com o passar do tempo, buscando entender o que realmente faz com que o colaborador se sinta motivado para desenvolver suas atividades laborais. A fim de atingir o objetivo proposto nesta pesquisa foram estudados os aspectos motivacionais no ambiente de trabalho da área administrativa do hospital filantrópico Divina Providência, localizado no município de Marituba integrante da área metropolitana do Estado do Pará e, qual a percepção dos clientes em relação aos serviços prestados por estes profissionais. Para tanto, a primeira parte do estudo, apresenta uma pesquisa bibliográfica, com o objetivo de coletar contribuições de diversos autores sobre o tema motiva��ão Estes aspectos foram estudados sob a égide de estudiosos como Maslow, Herzberg, McGregor, Aldefer e Adams. O estudo justifica-se pela necessidade de serem obtidos dados que dizem respeito a aspectos objetivos e subjetivos que podem ser captados ou não na correlação entre os fatores motivacionais e o êxito dos serviços realizados. Face à natureza do problema, este estudo de caso tem como procedimento metodológico a aplicação e a análise de três questionários em três amostragens: colaboradores da área administrativa sem cargo de chefia, colaboradores que possuem cargo de chefia na área administrativa em dados sobre motiva��ão laboral, clientes sobre a qualidade de serviços prestados pelo hospital. Por um lado, os dados evidenciaram uma visão realista em relação a motiva��ão dos colaboradores. Mostrando ainda uma visão positiva em relação à qualidade dos serviços prestados. Os resultados expostos conseguiram demonstrar quais os principais fatores que representam a motiva��ão dos colaboradores no trabalho além de visualizar a satisfação dos usuários com os serviços prestados.

Contested institutions? Traditional leaders and land access and control in communal areas of Eastern Cape Province, South Africa

The South African government has endeavoured to strengthen property rights in communal areas and develop civil society institutions for community-led development and natural resource management. However, the effectiveness of this remains unclear as the emergence and operation of civil society institutions in these areas is potentially constrained by the persistence of traditional authorities. Focusing on the former Transkei region of Eastern Cape Province, three case study communities are used examine the extent to which local institutions overlap in issues of land access and control. Within these communities, traditional leaders (chiefs and headmen) continue to exercise complete and sole authority over land allocation and use this to entrench their own positions. However, in the absence of effective state support, traditional authorities have only limited power over how land is used and in enforcing land rights, particularly over communal resources such as rangeland. This diminishes their local legitimacy and encourages some groups to contest their authority by cutting fences, ignoring collective grazing decisions and refusing to pay ‘fees’ levied on them. They are encouraged in such activities by the presence of democratically elected local civil society institutions such as ward councillors and farmers’ organisations, which have broad appeal and are increasingly responsible for much of the agrarian development that takes place, despite having no direct mandate over land. Where it occurs at all, interaction between these different institutions is generally restricted to approval being required from traditional leaders for land allocated to development projects. On this basis it is argued that a more radical approach to land reform in communal areas is required, which transfers all powers over land to elected and accountable local institutions and integrates land allocation, land management and agrarian development more effectively.

[Global climate] global aerosols [in state of the climate in 2008]

The global mean temperature in 2008 was slightly cooler than that in 2007; however, it still ranks within the 10 warmest years on record. Annual mean temperatures were generally well above average in South America, northern and southern Africa, Iceland, Europe, Russia, South Asia, and Australia. In contrast, an exceptional cold outbreak occurred during January across Eurasia and over southern European Russia and southern western Siberia. There has been a general increase in land-surface temperatures and in permafrost temperatures during the last several decades throughout the Arctic region, including increases of 1° to 2°C in the last 30 to 35 years in Russia. Record setting warm summer (JJA) air temperatures were observed throughout Greenland. The year 2008 was also characterized by heavy precipitation in a number of regions of northern South America, Africa, and South Asia. In contrast, a prolonged and intense drought occurred during most of 2008 in northern Argentina, Paraguay, Uruguay, and southern Brazil, causing severe impacts to agriculture and affecting many communities. The year began with a strong La Niña episode that ended in June. Eastward surface current anomalies in the tropical Pacific Ocean in early 2008 played a major role in adjusting the basin from strong La Niña conditions to ENSO-neutral conditions by July–August, followed by a return to La Niña conditions late in December. The La Niña conditions resulted in far-reaching anomalies such as a cooling in the central tropical Pacific, Arctic Ocean, and the regions extending from the Gulf of Alaska to the west coast of North America; changes in the sea surface salinity and heat content anomalies in the tropics; and total column water vapor, cloud cover, tropospheric temperature, and precipitation patterns typical of a La Niña. Anomalously salty ocean surface salinity values in climatologically drier locations and anomalously fresh values in rainier locations observed in recent years generally persisted in 2008, suggesting an increase in the hydrological cycle. The 2008 Atlantic hurricane season was the 14th busiest on record and the only season ever recorded with major hurricanes each month from July through November. Conversely, activity in the northwest Pacific was considerably below normal during 2008. While activity in the north Indian Ocean was only slightly above average, the season was punctuated by Cyclone Nargis, which killed over 145,000 people; in addition, it was the seventh-strongest cyclone ever in the basin and the most devastating to hit Asia since 1991. Greenhouse gas concentrations continued to rise, increasing by more than expected based on with CO2 the 1979 to 2007 trend. In the oceans, the global mean uptake for 2007 is estimated to be 1.67 Pg-C, about CO2 0.07 Pg-C lower than the long-term average, making it the third-largest anomaly determined with this method since 1983, with the largest uptake of carbon over the past decade coming from the eastern Indian Ocean. Global phytoplankton chlorophyll concentrations were slightly elevated in 2008 relative to 2007, but regional changes were substantial (ranging to about 50%) and followed long-term patterns of net decreases in chlorophyll with increasing sea surface temperature. Ozone-depleting gas concentrations continued to fall globally to about 4% below the peak levels of the 2000–02 period. Total column ozone concentrations remain well below pre-1980, levels and the 2008 ozone hole was unusually large (sixth worst on record) and persistent, with low ozone values extending into the late December period. In fact the polar vortex in 2008 persisted longer than for any previous year since 1979. Northern Hemisphere snow cover extent for the year was well below average due in large part to the record-low ice extent in March and despite the record-maximum coverage in January and the shortest snow cover duration on record (which started in 1966) in the North American Arctic. Limited preliminary data imply that in 2008 glaciers continued to lose mass, and full data for 2007 show it was the 17th consecutive year of loss. The northern region of Greenland and adjacent areas of Arctic Canada experienced a particularly intense melt season, even though there was an abnormally cold winter across Greenland's southern half. One of the most dramatic signals of the general warming trend was the continued significant reduction in the extent of the summer sea-ice cover and, importantly, the decrease in the amount of relatively older, thicker ice. The extent of the 2008 summer sea-ice cover was the second-lowest value of the satellite record (which started in 1979) and 36% below the 1979–2000 average. Significant losses in the mass of ice sheets and the area of ice shelves continued, with several fjords on the northern coast of Ellesmere Island being ice free for the first time in 3,000–5,500 years. In Antarctica, the positive phase of the SAM led to record-high total sea ice extent for much of early 2008 through enhanced equatorward Ekman transport. With colder continental temperatures at this time, the 2007–08 austral summer snowmelt season was dramatically weakened, making it the second shortest melt season since 1978 (when the record began). There was strong warming and increased precipitation along the Antarctic Peninsula and west Antarctica in 2008, and also pockets of warming along coastal east Antarctica, in concert with continued declines in sea-ice concentration in the Amundsen/Bellingshausen Seas. One significant event indicative of this warming was the disintegration and retreat of the Wilkins Ice Shelf in the southwest peninsula area of Antarctica.

Industrial relations in South-Eastern Europe: disaggregating the contexts

This study critically evaluates industrial relations (IR) in South-Eastern Europe and points towards future practical and research-oriented opportunities in the region. A survey of organizational policies and practices has been used to explore the state of IR in both private and public organizations in this region. Specifically, the data, collected in 2009–2010 (including the latest changes due to the economic crisis), cover 840 different organizations located in Slovenia, Serbia, Bulgaria, Greece and Cyprus. We discuss the development of ‘regional-specific’ IR policies, the ‘importing’ of varieties of capitalism models, the diffusion of the European Union social model and the role of foreign MNCs in changing IR in the region.

Palaeoenvironmental evidence for the impact of the crusades on the local and regional environment of medieval (13th–16th century) northern Latvia, eastern Baltic

This paper evaluates the impact of the crusades on the landscape and environment of northern Latvia between the 13th–16th centuries (medieval Livonia). The crusades replaced tribal societies in the eastern Baltic with a religious state (Ordenstaat) run by the military orders and their allies, accompanied by significant social, cultural and economic developments. These changes have previously received little consideration in palaeoenvironmental studies of past land use in the eastern Baltic region, but are fundamental to understanding the development and expansion of a European Christian identity. Sediment cores from Lake Trikāta, located adjacent to a medieval castle and settlement, were studied using pollen, macrofossils, loss-on-ignition and magnetic susceptibility. Our results show that despite continuous agricultural land use from 500 BC, the local landscape was still densely wooded until the start of the crusades in AD 1198 when a diversified pattern of pasture, meadow and arable land use was established. Colonisation followed the crusades, although in Livonia this occurred on a much smaller scale than in the rest of the Ordenstaat; Trikāta is atypical showing significant impact following the crusades with many other palaeoenvironmental studies only revealing more limited impact from the 14th century and later. Subsequent wars and changes in political control in the post-medieval period had little apparent effect on agricultural land use.

The impact of westerly wind bursts and ocean initial state on the development, and diversity of El Niño events

Westerly wind bursts (WWBs) that occur in the western tropical Pacific are believed to play an important role in the development of El Niño events. Here, following the study of Lengaigne et al. (Clim Dyn 23(6):601–620, 2004), we conduct numerical simulations in which we reexamine the response of the climate system to an observed wind burst added to a coupled general circulation model. Two sets of twin ensemble experiments are conducted (each set has control and perturbed experiments). In the first set, the initial ocean heat content of the system is higher than the model climatology (recharged), while in the second set it is nearly normal (neutral). For the recharged state, in the absence of WWBs, a moderate El Niño with a maximum warming in the central Pacific (CP) develops in about a year. In contrast, for the neutral state, there develops a weak La Niña. However, when the WWB is imposed, the situation dramatically changes: the recharged state slides into an El Niño with a maximum warming in the eastern Pacific, while the neutral set produces a weak CP El Niño instead of previous La Niña conditions. The different response of the system to the exact same perturbations is controlled by the initial state of the ocean and the subsequent ocean–atmosphere interactions involving the interplay between the eastward shift of the warm pool and the warming of the eastern equatorial Pacific. Consequently, the observed diversity of El Niño, including the occurrence of extreme events, may depend on stochastic atmospheric processes, modulating El Niño properties within a broad continuum.

Ecological aspects of mosquitoes (Diptera: Culicidae) in an Atlantic forest area on the north coast of Rio Grande do Sul State, Brazil

Mosquito diversity was determined in an area located on the southern limit of the Atlantic Forest on the north coast of Rio Grande of Sul State. Our major objective was to verify the composition, diversity, and temporal distribution of the mosquito fauna, and the influence of temperature and rainfall. Samplings were performed monthly between December, 2006 and December, 2008, in three biotopes: forest, urban area, and transition area, using CDC light traps and a Nasci vacuum. A total of 2,376 specimens was collected, from which 1,766 (74.32%) were identified as 55 different species belonging to ten genera. Culex lygrus, Aedes serratus, and Aedes nubilus were dominant (eudominant) and constant throughout samplings. The forest environment presented the highest species dominance (D(S) = 0.20), while the transition area showed the highest values of diversity (H` = 2.55) and evenness (J` = 0.85). These two environments were the most similar, according to the Morisita-Horn Index (I(M-H) = 0.35). Bootstrap estimates showed that 87.3% of the species occurring in the region were detected. The seasonal pattern showed a greater abundance of mosquitoes between May and October, indicating the period to intensify entomological surveillance in that area. Journal of Vector Ecology 36 (1): 175-186. 2011.