Análisis de supervivencia en pacientes con prótesis valvular biológica, Fundación Cardioinfantil-Instituto de Cardiología, Colombia, 2005-2013

Introducción: A partir de la década de los cincuenta el manejo de la enfermedad valvular presenta cambios significativos cuando se incorporan los reemplazos valvulares tanto mecánicos como biológicos dentro de las opciones de tratamiento quirúrgico (1). Las válvulas biológicas se desarrollaron como una alternativa que buscaba evitar los problemas relacionados con la anticoagulación y con la idea de utilizar un tejido que se comportara hemodinámicamente como el nativo. Este estudio está enfocado en establecer la sobrevida global y la libertad de reoperación de la válvula de los pacientes sometidos a reemplazo valvular aórtico y mitral biológicos en la Fundación Cardioinfantil - IC a 1, 3, 5 y 10 años. Materiales y métodos: Estudio de cohorte retrospectiva de supervivencia de pacientes sometidos a reemplazo valvular aórtico y/o mitral biológico intervenidos en la Fundación Cardioinfantil entre 2005 y 2013. Resultados: Se obtuvieron 919 pacientes incluidos en el análisis general y 876 (95,3%) pacientes con seguimiento efectivo para el análisis de sobrevida. La edad promedio fue 64años. La sobrevida a 1, 3, 5 y 10 años fue 95%,90%,85% y 69% respectivamente. El seguimiento efectivo para el desenlace reoperación fue del 55% y se encontró una libertad de reoperación del 99%, 96%, 93% y 81% a los 1, 3, 5 y 10 años. No hubo diferencias significativas entre la localización de la válvula ni en el tipo de válvula aortica empleada. Conclusiones: La sobrevida de los pacientes que son llevados a reemplazo valvular biológico en este estudio es comparable a grandes cohortes internacionales. La sobrevida de los pacientes llevados a reemplazo valvular con prótesis biológicas en posición mitral y aortica fue similar a 1, 3, 5 y 10 años.

De un modelo tradicional de concesión a un esquema renovado de app para el desarrollo de proyectos de infraestructura vial en Colombia

En la presente investigación se contrasta el Modelo Tradicional de Concesión con el Renovado Esquema de Asociación Público Privada propuesto por la Ley 1508 de 2011 y sus decretos reglamentarios, para establecer, a partir de puntos de contacto y fuga entre una y otra institución, que existe una verdadera transformación del paradigma; y que, este modelo mejorado de participación privada que cuenta con sus propios rasgos definitorios, se erige en principio, como una solución a las exigencias actuales de los proyectos viales de la Cuarta Generación de Concesiones en Colombia, pero a la vez da apertura al debate para la construcción académica del conocimiento, por su reciente implementación.

Epidemiología y perdurabilidad empresarial en Colombia: Grupo Éxito

La muerte empresarial es un proceso que se ha venido presentando en compañías de las diferentes industrias a nivel nacional. La causa son los diferentes factores externos que impactan directamente las operaciones y estructura de estas. Con base en lo anterior es importante resaltar que existen diferentes tipos de muerte empresarial que para efectos de este trabajo se encontraron importante referenciar, pues son el marco del análisis de caso sobre Almacenes Éxito S.A. perteneciente al sector retail, donde se buscaba determinar cuál fue el tipo de cesión que tuvo, como consecuencia de la venta de acciones a la Compañía Francesa Casino Guichard-Perrachon S.A. Además del marco teórico empleado, se encontró importante realizar una reseña histórica de las diferentes empresas que han integrado el sector con el fin de entender posibles generalidades que se han venido replicando y que han llevado a la muerte empresarial de importantes compañías. Este trabajo permite la comprensión de las diferentes transformaciones que pueden tener los entes económicos a lo largo de su vida empresarial, no solo con lo que puede entenderse como el cese de operaciones sino también como apertura a nuevas estrategias de crecimiento y expansión.

Educación legal clínica y litigio estratégico en Iberoamérica.

Esta obra es resultado de investigación sobre dos conceptos de enorme importancia para la educación jurídica en Iberoamérica: la educación legal clínica como modelo pedagógico en construcción y el litigio estratégico como herramienta de incidencia social y política. Se considera que el proceso de construcción de las clínicas en la región es un hito en la educación jurídica iberoamericana y existen evidencias que permiten afirmarlo, ya que se trata de historias paralelas que se fortalecieron por los intercambios de aprendizajes y experiencias a través de las redes. De igual manera se desarrolla el concepto de litigio estratégico o estructural y se examina la forma como inciden en dicha propuesta las alianzas estratégicas. Se pasa luego a una profundización sobre la agenda de las clínicas y los temas prioritarios de Derechos Humanos en Iberoamérica. Examen que se realiza a partir de casos reales que se han trabajado las clínicas. Se concluye en la necesidad del surgimiento de nuevas clínicas y de más proyectos de investigación.

Tests básicos de comprensión escrita en euskera.

Colaborar desde la Psicología empírica al esfuerzo por conseguir una normalización de la lengua euskera. Determinar la dificultad de los elementos y la homogeneidad de los mismos con vistas a una estructuración. En el estudio exploratorio: 6 alumnas de séptimo de EGB de 12 años de la Ikastola Aranzadi de Bergara. Estudio piloto: 244 alumnas de sexto y séptimo de EGB. Estudio experimental: 371 alumnos de quinto y sexto de EGB que pertenecen al Liceo 'Santo Tomás' de San Sebastián y a la Ikastola 'Lore-Berri' de Lasarte. El trabajo es una descripción del proceso de elaboración y depuración de unas pruebas originales y su sucesiva depuración, a base de criterios psicométricos y lingüísticos, a través de los datos obtenidos en un primer ensayo piloto y otro segundo experimental. Variable dependiente: euskera. Variables independientes: comprensión, expresión, condiciones, automatismos, aptitudes del lenguaje (es la puntuación total en comprensión, expresión y automatismos). Variables intervinientes: edad, sexo. Para la comprensión escrita: prueba HI (Harrera Idatzia), prueba TART (Tarteka). Usos del lenguaje: prueba EH1 (Esaldiaren Hutsa), prueba EH2. Vocabulario: prueba HD (Hitz Desberdina). Prueba LEX (Lexikoa). Cuestionario GET (Galdera Erantzun Testa), dividido en factor lingüístico y factor socio-económico. Índices de tendencia central: media, desviación típica. Análisis de varianza. Análisis de correlación entre los diferentes tests, entre factores de GET y entre los tests y GER -condiciones y aptitudes del lenguaje. Análisis factorial Varimax. Las pruebas pueden ser aplicadas y funcionan bien. Mantienen el nivel básico para el que fueron creadas. Todas, excepto LEX, miden el mismo factor: comprensión escrita, en sus aspectos sintáctico y semántico. Es necesario que sean cortas ya que requieren mucha atención, sobre todo EH1 y EH2 y TART. El nivel de conocimiento, en general es alto. En la población escolar, el curso y el sexo de la población se manifiestan como variables importantes. Prospectiva: las pruebas han sido experimentadas y demuestran valer. Es posible, sugerir ajustes en favor de una mayor precisión. Se podría incrementar la longitud de las pruebas para hacerlas más fiables, pero resultarían gravosas para una población joven. Se podrían ajustar los tiempos y así descendería el nivel y la distribución sería más homogénea.

Depth by The Rule

This note corrects a previous treatment of algorithms for the metric DTR, Depth by the Rule.

Evidence of trends in daily climate extremes over southern and west Africa

[ 1] There has been a paucity of information on trends in daily climate and climate extremes, especially from developing countries. We report the results of the analysis of daily temperature ( maximum and minimum) and precipitation data from 14 south and west African countries over the period 1961 - 2000. Data were subject to quality control and processing into indices of climate extremes for release to the global community. Temperature extremes show patterns consistent with warming over most of the regions analyzed, with a large proportion of stations showing statistically significant trends for all temperature indices. Over 1961 to 2000, the regionally averaged occurrence of extreme cold ( fifth percentile) days and nights has decreased by - 3.7 and - 6.0 days/decade, respectively. Over the same period, the occurrence of extreme hot (95th percentile) days and nights has increased by 8.2 and 8.6 days/decade, respectively. The average duration of warm ( cold) has increased ( decreased) by 2.4 (0.5) days/decade and warm spells. Overall, it appears that the hot tails of the distributions of daily maximum temperature have changed more than the cold tails; for minimum temperatures, hot tails show greater changes in the NW of the region, while cold tails have changed more in the SE and east. The diurnal temperature range (DTR) does not exhibit a consistent trend across the region, with many neighboring stations showing opposite trends. However, the DTR shows consistent increases in a zone across Namibia, Botswana, Zambia, and Mozambique, coinciding with more rapid increases in maximum temperature than minimum temperature extremes. Most precipitation indices do not exhibit consistent or statistically significant trends across the region. Regionally averaged total precipitation has decreased but is not statistically significant. At the same time, there has been a statistically significant increase in regionally averaged daily rainfall intensity and dry spell duration. While the majority of stations also show increasing trends for these two indices, only a few of these are statistically significant. There are increasing trends in regionally averaged rainfall on extreme precipitation days and in maximum annual 5-day and 1-day rainfall, but only trends for the latter are statistically significant.

Hydrogen adsorption in a copper ZSM5 zeolite: an inelastic neutron scattering study

Currently microporous oxidic materials including zeolites are attracting interest as potential hydrogen storage materials. Understanding how molecular hydrogen interacts with these materials is important in the rational development of hydrogen storage materials and is also challenging theoretically. In this paper, we present an incoherent inelastic neutron scattering (INS) study of the adsorption of molecular hydrogen and hydrogen deuteride (HD) in a copper substituted ZSM5 zeolite varying the hydrogen dosage and temperature. We have demonstrated how inelastic neutron scattering can help us understand the interaction of H-2 molecules with a binding site in a particular microporous material, Cu ZSM5, and by implication of other similar materials. The H-2 molecule is bound as a single species lying parallel with the surface. As H-2 dosing increases, lateral interactions between the adsorbed H-2 molecules become apparent. With rising temperature of measurement up to 70 K (the limit of our experiments), H-2 molecules remain bound to the surface equivalent to a liquid or solid H-2 phase. The implication is that hydrogen is bound rather strongly in Cu ZSM5. Using the simple model for the anisotropic interaction to calculate the energy levels splitting, we found that the measured rotational constant of the hydrogen molecule is reduced as a consequence of adsorption by the Cu ZSM5. From the decrease in total signal intensity with increasing temperature, we were able to observe the conversion of para-hydrogen into ortho-hydrogen at paramagnetic centres and so determine the fraction of paramagnetic sites occupied by hydrogen molecules, ca. 60%. (c) 2006 Elsevier B.V. All rights reserved.

Microglial activation correlates with severity in Huntington disease: a clinical and PET study

Background: Huntington disease ( HD) is characterized by the progressive death of medium spiny dopamine receptor bearing striatal GABAergic neurons. In addition, microglial activation in the areas of neuronal loss has recently been described in postmortem studies. Activated microglia are known to release neurotoxic cytokines, and these may contribute to the pathologic process. Methods: To evaluate in vivo the involvement of microglia activation in HD, the authors studied patients at different stages of the disease using [ C-11]( R)-PK11195 PET, a marker of microglia activation, and [ C-11] raclopride PET, a marker of dopamine D2 receptor binding and hence striatal GABAergic cell function. Results: In HD patients, a significant increase in striatal [ C-11]( R)-PK11195 binding was observed, which significantly correlated with disease severity as reflected by the striatal reduction in [ C-11] raclopride binding, the Unified Huntington's Disease Rating Scale score, and the patients' CAG index. Also detected were significant increases in microglia activation in cortical regions including prefrontal cortex and anterior cingulate. Conclusions: These [ C-11]( R)-PK11195 PET findings show that the level of microglial activation correlates with Huntington disease ( HD) severity. They lend support to the view that microglia contribute to the ongoing neuronal degeneration in HD and indicate that [ C-11]( R)-PK11195 PET provides a valuable marker when monitoring the efficacy of putative neuroprotecting agents in this relentlessly progressive genetic disorder.

Health-related quality of life in Huntington's disease: a comparison of two generic instruments, SF-36 and SIP

Whereas several clinical endpoints in monitoring the response to treatment in patients with Huntington's disease (HD) have been explored, there has been a paucity of research in the quality of life in such patients. The aim of this study was to validate the use of two generic health-related quality of life instruments (the Short Form 36 health survey questionnaire [SF-36] and the Sickness Impact Profile [SIP]) and to evaluate their psychometric properties. We found that both instruments demonstrated acceptable convergent validity and reliability for patients and carers. However, there was an advantage in using the SF-36 because of its more robust construct validity and test-retest reliability; furthermore, motor symptoms appeared to influence some strictly nonmotor dimensions of the SIP. On a pragmatic level, the SF-36 is shorter and quicker to administer and, therefore, easier for patients at various stages of the disease to complete. Thus, the SF-36 would appear to be the recommended instrument of choice for patients with HD and their carers, although further work needs to be done to investigate the sensitivity of this instrument longitudinally. (C) 2004 Movement Disorder Society.

Huntington's disease patients have selective problems with insight

The objective of this study was to determine insight in patients with Huntington's disease (HD) by contrasting patients' ability to rate their own behavior with their ability to rate a person other than themselves. HD patients and carers completed the Dysexecutive Questionnaire (DEX), rating themselves and each other at two time points. The temporal stability of these ratings was initially examined using these two time points since there is no published test-retest reliability of the DEX with this Population to date. This was followed by a comparison of patients' self-ratings and carer's independent ratings of patients by performing correlations with patients' disease variables, and in exploratory factor analysis was conducted on both sets of ratings. The DEX showed good test-retest reliability, with patients consistently and persistently underestimating the degree of their dysexecutive behavior, but not that of their carers. Patients' self-ratings and caters' ratings of patients both showed that dysexecutive behavior in HD can be fractionated into three underlying components (Cognition, Self-regulation, Insight), and the relative ranking of these factors was similar for both data sets. HD patients consistently underestimated the extent of only their own dysexecutive behaviors relative to carers' ratings by 26%, but were similar in ascribing ranks to the components of dysexecutive behavior. (c) 2005 Movement Disorder Society.

A Packet/Frame sync detector based on statistical mode with application to wireless-USB

Wireless Personal Area Networks (WPANs) are offering high data rates suitable for interconnecting high bandwidth personal consumer devices (Wireless HD streaming, Wireless-USB and Bluetooth EDR). ECMA-368 is the Physical (PHY) and Media Access Control (MAC) backbone of many of these wireless devices. WPAN devices tend to operate in an ad-hoc based network and therefore it is important to successfully latch onto the network and become part of one of the available piconets. This paper presents a new algorithm for detecting the Packet/Fame Sync (PFS) signal in ECMA-368 to identify piconets and aid symbol timing. The algorithm is based on correlating the received PFS symbols with the expected locally stored symbols over the 24 or 12 PFS symbols, but selecting the likely TFC based on the highest statistical mode from the 24 or 12 best correlation results. The results are very favorable showing an improvement margin in the order of 11.5dB in reference sensitivity tests between the required performance using this algorithm and the performance of comparable systems.

Suck. Swallow. Breathe.

Video, Dur: 7 min, HD DVC Pro 2009 Based on the principle of assembling a series of improvised acts, the performance is driven by a concern for the image, sound and gesture and the staging of both contemplative and active human presences. Featuring a woman and child duo the video performs the élan vital within a fairytale scenery.

Suck. Swallow. Breathe.

Video and Performance, Dur: 7 min s HD DVC Pro, 2 performers 2009 deals

Assessment of cognitive symptoms in prodromal and early Huntington disease

The Functional Rating Scale Taskforce for pre-Huntington Disease (FuRST-pHD) is a multinational, multidisciplinary initiative with the goal of developing a data-driven, comprehensive, psychometrically sound, rating scale for assessing symptoms and functional ability in prodromal and early Huntington disease (HD) gene expansion carriers. The process involves input from numerous sources to identify relevant symptom domains, including HD individuals, caregivers, and experts from a variety of fields, as well as knowledge gained from the analysis of data from ongoing large-scale studies in HD using existing clinical scales. This is an iterative process in which an ongoing series of field tests in prodromal (prHD) and early HD individuals provides the team with data on which to make decisions regarding which questions should undergo further development or testing and which should be excluded. We report here the development and assessment of the first iteration of interview questions aimed to assess cognitive symptoms in prHD and early HD individuals.