Caracterizacion de nódulos tiroideos: concordancia entre estudio citopatologico y ecografia en la detección de nódulos malignos

: Los métodos imagenológicos para evaluar los nódulos tiroideos han sido motivo de estudio en las últimas décadas, especialmente la ecografía sobresale sobre las otras modalidades diagnósticas por su accesibilidad, portabilidad, y seguridad. A pesar de ello, las características ecográficas de cada nódulo han sido objeto de controversia en cuanto a su potencial detección de malignidad o benignidad. Se presenta un estudio de concordancia entre el estudio citopatológico y la ecografía para la caracterización nódulos tiroideos de naturaleza maligna y benigna, y su análisis de pruebas diagnósticas. Metodología: Se realizó un estudio descriptivo de concordancia con estudio de pruebas diagnósticas anidado. Se escogieron todos los pacientes con nódulos tiroideos a quienes se les realizó ecografía y estudio citopatológico de la lesión y se estudiaron los hallazgos ecográficos para evaluar su potencial diagnóstico para malignidad. Se incluyeron un total de 100 pacientes con nódulos tiroideos potencialmente malignos. La concordancia entre la ecografía en modo B y el estudio citopatológico fue moderada (índice kappa 0.55). La característica con mayor potencial para detectar malignidad fue la presencia de Microcalcificaciones (sensibilidad 75%, especificidad 92%).

Evidencia actual sobre características demográficas en mastitis granulomatosa idiopática

Introducción: La mastitis granulomatosa idiopática es una enfermedad crónica benigna, rara y de etiología desconocida; tiende a confundirse con otras enfermedades debido a síntomas similares. Este estudio pretende identificar y cuantificar las características demográficas, los antecedentes ginecoobstétricos relevantes y las manifestaciones clínicas prediagnósticas de esta enfermedad Metodología: Se realizó una revisión sistemática con análisis agrupado de datos tipo meta análisis. Se utilizó una estrategia de búsqueda en PubMed. Todos los estudios relacionados con la definición, manifestaciones clínicas, diagnóstico, tratamiento y pronóstico de la mastitis granulomatosa idiopática fueron elegibles. Las variables de interés fueron edad, país, antecedente de contracepción hormonal, tiempo de evolución, tiempo desde el último embarazo, diagnóstico inicial, y manifestaciones clínicas previas a la consulta. No hubo restricción en fechas de publicación. Resultados: Fueron incluidas 641 mujeres con diagnóstico de MGI reportadas en 68 publicaciones que cumplieron los criterios de selección. La edad media fue 35.9 años, 14.1% de ellas estaba embarazada o lactando, el antecedente de consumo de anticonceptivos hormonales fue 21% y el tiempo promedio desde el último parto fue de 3.9 años. La afectación ocurre principalmente en mama izquierda y en cuadrante superoexterno. El cáncer de mama y el absceso mamario son diagnósticos diferenciales en la consulta. Discusión: El diagnóstico de MGI es un reto para el ginecólogo desde la consulta inicial. Debido a que sus manifestaciones clínicas no son específicas, su diagnóstico parece apuntar a la necesidad de un proceso de descarte de otras patologías más frecuentes e incluso de peor pronóstico. Palabras clave mastitis granulomatosa idiopática

Hallazgos radiológicos de la enfermedad pulmonar en pacientes Colombianos con esclerodermia

La esclerosis sistémica (ES) es una enfermedad autoinmune multisistémica que afecta principalmente la piel, los pulmones, el tracto gastrointestinal, el corazón y los riñones. La enfermedad pulmonar, presente en casi el 100% de los casos, es el factor con mayor influencia en la mortalidad. El propósito de este estudio es realizar un análisis detallado de la enfermedad pulmonar por tomografía computarizada de alta resolución(TCAR) en pacientes Colombianos con ES, para lo cual se realizó un estudio de prevalencia analítica en 44 pacientes con ES valorados en el Hospital Universitario Mayor Méderi en los últimos 7 años. Los resultados mostraron características demográficas y clínicas similares a las previamente descritas. La prevalencia de enfermedad pulmonar intersticial fue alta, y los hallazgos de fibrosis pulmonar como vidrio esmerilado y panal de abejas se asociaron con la presencia del autoanticuerpo antiSCL70. La medida del diámetro esofágico por TCAR fue mayor en los pacientes con disfagia, antiSCL 70 y linfopenia, los cuales son marcadores de mal pronóstico.

Los nuevos saberes en el constitucionalismo ecuatoriano (Tema Central)

Para evitar una transformación formal y conducir un cambio constitucional sustancial se hace indispensable generar una construcción teórica en la que se sustenten los valores estructurales del constitucionalismo ecuatoriano como son el Sumak Kawsay y la justicia. Los nuevos saberes constitucionales son una motivación para transformar la práctica del derecho en el sistema de justicia ecuatoriano, porque no es suficiente el ejercicio tradicional del derecho para las exigencias del sistema constitucional actual. Es importante identificar que el cambio a lo nuevo ofrece resistencia en la práctica y exige creatividad para la transformación, circunstancia que se apega a la reparación integral que involucra el ejercicio de la justicia no como un ideal reservado para la teorización, sino que exige materialización.

The practice of sustainable facilities management: Design sentiments and the knowledge chasm

The construction industry with its nature of project delivery is very fragmented in terms of the various processes that encompass design, construction, facilities and assets management. Facilities managers are in the forefront of delivering sustainable assets management and hence further the venture for mitigation and adaptation to climate change. A questionnaire survey was conducted to establish perceptions, level of commitment and knowledge chasm in practising sustainable facilities management (FM). This has significant implications for sustainable design management, especially in a fragmented industry. The majority of questionnaire respondents indicated the importance of sustainability for their organization. Many of them stated that they reported on sustainability as part of their organization annual reporting with energy efficiency, recycling and waste reduction as the main concern for them. The overwhelming barrier for implementing sound, sustainable FM is the lack of consensual understanding and focus of individuals and organizations about sustainability. There is a knowledge chasm regarding practical information on delivering sustainable FM. Sustainability information asymmetry in design, construction and FM processes render any sustainable design as a sentiment and mere design aspiration. Skills and training provision, traditionally offered separately to designers and facilities managers, needs to be re-evaluated. Sustainability education and training should be developed to provide effective structures and processes to apply sustainability throughout the construction and FM industries coherently and as common practice.

The incidence of oral Gram-negative bacteria in patients with Parkinson's disease

Background: Parkinson's disease is a common neurodegenerative disorder that affects an increasing number of older people every year. Dysphagia is not only a common feature, but one that results in poor nutrition and an increased risk of bronchopneumonia. Previous work has suggested that the oral flora is altered in patients with oral pathology. Methods: Fifty patients were assessed to quantify the incidence of oral Gram-negative bacteria. Results: Sixteen of the patients with Parkinson's disease were found to have six different Gram-negative bacilli in their oral cavities. The 20 different Gram-negative bacteria present were Escherichia coli (n=7), Klebsiella spp. (n=3), Kluyvera spp. (n=3), Serratia spp. (n=3), Proteus spp. (n=2) and Enterobacter spp. (n=2). We found that the oral cavity of 16 (32%) of the patients with Parkinson's disease was abnormally colonised with Gram-negative bacteria and that Gram-negative bacteria were more likely to occur in those patients in whom oromuscular dysfunction was present (88% vs. 21%; p<0.05). Conclusion: Further work is required to determine the association between oral flora and the pathogenic organisms found in aspiration pneumonia as well as work on innovative treatments to reduce oral Gram-negative bacteria in those patients at particular risk of aspiration pneumonia.

Don't we care?: the ethics and emotional labour of early years professionalism

This paper argues that early childhood education and care (ECEC) has a legitimate aspiration to be a 'caring profession' like others such as nursing or social work, defined by a moral purpose. For example, practitioners often draw on an ethic of care as evidence of their professionalism. However, the discourse of professionalism in England completely excludes the ethical vocabulary of care. Nevertheless, it necessarily depends on gendered dispositions towards emotional labour, often promoted by training programmes as 'professional' demeanours. Taking control of the professionalisation agenda therefore requires practitioners to demonstrate a critical understanding of their practice as 'emotion work'. At the same time, reconceptualising practice within a political ethic of care may allow the workforce, and new trainees in particular, to champion 'caring' as a sustainable element of professional work, expressed not only in maternal, dyadic key-working but in advocacy for care as a social principle.

New governance approaches to environmental regulation: an example of the Code for Sustainable Homes (CSH)

Environmental policy in the United Kingdom (UK) is witnessing a shift from command-and-control approaches towards more innovation-orientated environmental governance arrangements. These governance approaches are required which create institutions which support actors within a domain for learning not only about policy options, but also about their own interests and preferences. The need for construction actors to understand, engage and influence this process is critical to establishing policies which support innovation that satisfies each constituent’s needs. This capacity is particularly salient in an era where the expanding raft of environmental regulation is ushering in system-wide innovation in the construction sector. In this paper, the Code for Sustainable Homes (the Code) in the UK is used to demonstrate the emergence and operation of these new governance arrangements. The Code sets out a significant innovation challenge for the house-building sector with, for example, a requirement that all new houses must be zero-carbon by 2016. Drawing upon boundary organisation theory, the journey from the Code as a government aspiration, to the Code as a catalyst for the formation of the Zero Carbon Hub, a new institution, is traced and discussed. The case study reveals that the ZCH has demonstrated boundary organisation properties in its ability to be flexible to the needs and constraints of its constituent actors, yet robust enough to maintain and promote a common identity across regulation and industry boundaries.

Pianos for the people: the manufacture, marketing and sale of pianos as consumer durables, 1850-1914

During the second half of the nineteenth century, British society experienced a rise in real incomes and a change in its composition, with the expansion of the middle classes. These two factors led to a consumer revolution, with a growing, but still segmented, demand for household goods that could express status and aspiration. At the same time technological changes and new ways of marketing and selling goods made these goods more affordable. This paper analyzes these themes and the process of mediation that took place between producers, retailers, and consumers, by looking at the most culturally symbolic of nineteenth century consumer goods, the piano.

Public sector applications of the system dynamics approach

The article discusses various reports published within the issue, including one by Carmine Bianchi on understanding public sector from different levels and perspectives, one by Mauro Lo Tennero on the aspiration and structure of Sicily to enforce public policy, and one by Nuno Videira and colleagues on the use of group model building in the public sector to concur sustainable policies.

Além da diferença: a mulher no Cinema da Retomada

This paper analyses the female participation in the Brazilian Film Revival of the 1990s beyond differences of sex, race, class, age and ethnicity. Its main contention is that the most decisive contribution brought about by the rise of women in recent Brazilian cinema has been the spread of team work and shared authorship, as opposed to a mere aspiration to the auteur pantheon, as determined by a notoriously male-oriented tradition.

Beyond difference: female participation in the Brazilian film revival of the 1990s

In this chapter, I will focus on the female participation in what became known as ‘The Retomada do Cinema Brasileiro’, or the Brazilian Film Revival, by thinking beyond differences of gender, class, age and ethnicity. I will first re-consider the Retomada phenomenon against the backdrop of its historical time, so as to evaluate whether the production boom of the period translated into a creative peak, and, if so, how much of this carried onto the present day. I will then look at the female participation in this phenomenon not just in terms of numerical growth of women film directors, admittedly impressive, but only partially reflective of the drastic changes in the modes of production and address effected by the neoliberal policies introduced in the country in the mid 1990s. I will argue that the most decisive contribution brought about by the rise of women in Brazilian filmmaking has been the spread of team work and shared authorship, as opposed to a mere aspiration to the auteur pantheon, as determined by a notoriously male-oriented tradition. Granted, films focusing on female victimisation were rife during the Retomada period and persist to this day, and they have been, and continue to be, invaluable for the understanding of women’s struggles in the country. However, rather than resorting to feminist readings of representational strategies in these films, I will draw attention to other, presentational aesthetic experiments, open to the documentary contingent and the unpredictable real, which, I argue, suspend the pedagogical character of representational narratives. In order to demonstrate that new theoretical tools are needed to understand the gender powers at play in contemporary world cinema, I will, to conclude, analyse an excerpt of the film, Delicate Crime (Crime delicado, Beto Brant, 2006), where team work comes out as a particularly effective female, and feminist, procedure.

Tracing client interests in the course of a project: why are some client interests incorporated whereas others are not?

Many construction professionals and policy-makers would agree that client expectations should be accommodated during a building project. However, this aspiration is not easy to deal with as there may be conflicting interests within a client organization and these may change over time in the course of a project. This research asks why some client interests, and not others, are incorporated into the development of a building project. Actor-Network Theory (ANT) is used to study a single building project on a University campus. The building project is analysed as a number of discussions and negotiations, in which actors persuade each other to choose one solution over another. The analysis traces dynamic client engagement in decision-making processes as available options became increasingly constrained. However, this relative loss of control was countered by clients who continued the control over the timing of participants' involvement, and thus the way to impose their interests even at the later stage of the project.

Mosquito (Diptera: Culicidae) Diversity of a Forest-Fragment Mosaic in the Amazon Rain Forest

To study the impact of Amazonian forest fragmentation on the mosquito fauna, an inventory of Culicidae was conducted in the upland forest research areas of the Biological Dynamics of Forest Fragments Project located 60 km north of Manaus, Amazonas, Brazil. The culicid community was sampled monthly between February 2002 and May 2003. CDC light traps, flight interception traps, manual aspiration, and net sweeping were used to capture adult specimens along the edges and within forest fragments of different sizes (1, 10, and 100 ha), in second-growth areas surrounding the fragments and around camps. We collected 5,204 specimens, distributed in 18 genera and 160 species level taxa. A list of mosquito taxa is presented with 145 species found in the survey, including seven new records for Brazil, 16 new records for the state of Amazonas, along with the 15 morphotypes that probably represent undescribed species. No exotic species [Aedes aegypti (L.) and Aedes albopictus (Skuse)] were found within the sampled areas. Several species collected are potential vectors of Plasmodium causing human malaria and of various arboviruses. The epidemiological and ecological implications of mosquito species found are discussed, and the results are compared with other mosquito inventories from the Amazon region.

Dissonant Voices : Philosophy, Children's Literature, and Perfectionist Education

Dissonant Voices has a twofold aspiration. First, it is a philosophical treatment of everyday pedagogical interactions between children and their elders, between teachers and pupils. More specifically it is an exploration of the possibilities to go on with dissonant voices that interrupt established practices – our attunement – in behaviour, practice and thinking. Voices that are incomprehensible or expressions that are unacceptable, morally or otherwise. The text works on a tension between two inclinations: an inclination to wave off, discourage, or change an expression that is unacceptable or unintelligible; and an inclination to be tolerant and accept the dissonant expression as doing something worthwhile, but different. The second aspiration is a philosophical engagement with children’s literature. Reading children’s literature becomes a form of philosophising, a way to explore the complexity of a range of philosophical issues. This turn to literature marks a dissatisfaction with what philosophy can accomplish through argumentation and what philosophy can do with a particular and limited set of concepts for a subject, such as ethics. It is a way to go beyond philosophising as the founding of theories that justify particular responses. The philosophy of dissonance and children’s literature becomes a way to destabilise justifications of our established practices and ways of interacting. The philosophical investigations of dissonance are meant to make manifest the possibilities and risks of engaging in interactions beyond established agreement or attunements. Thinking of the dissonant voice as an expression beyond established practices calls for improvisation. Such improvisations become a perfectionist education where both the child and the elder, the teacher and the student, search for as yet unattained forms of interaction and take responsibility for every word and action of the interaction. The investigation goes through a number of picture books and novels for children such as Harry Potter, Garmann’s Summer, and books by Shaun Tan, Astrid Lindgren and Dr. Seuss as well narratives by J.R.R. Tolkien, Henrik Ibsen, Jane Austen and Henry David Thoreau. These works of fiction are read in conversation with philosophical works of, and inspired by, Ludwig Wittgenstein and Stanley Cavell, their moral perfectionism and ordinary language philosophy.