Desarrollo de un nuevo protocolo de cirugía general, que disminuya las devoluciones de medicamentos e insumos al almacén de cirugía del Hospital Méderi

Esta tesis surge como una oportunidad de mejora en el almacén de cirugías del Hospital MÉDERI, debido a la recurrente devolución de medicamentos e insumos solicitados por las auxiliares de enfermería para las cirugías generales, lo cual repercute directamente en pérdidas de productividad laboral por los re-procesos, un aumento en los errores humanos y posibles pérdidas de medicamentos e insumos. Tras esta clara oportunidad de mejora, se toma la decisión de evaluar el proceso interno del almacén de cirugías con el fin de conocer el punto crítico que genera esta situación; dando como resultado los protocolos de cirugías, los cuales al haber sido diseñados varios años atrás basados en una demanda presentada en ese momento, no están acorde con la realidad que se vive actualmente el almacén de cirugía. Por lo tanto se decidió implementar un pronóstico de promedio móvil, para identificar la demanda real que se presentan en el Hospital MÉDERI, esto seguido de una identificación gráfica comparativa que permitiera definir el nuevo protocolo de cirugía general, lo cual permite disminuir la cantidad de material solicitado, con lo cual se generan disminuciones significativas en el inventario, perdidas y un aumento en la productividad.

Global Acceleration and Dispossesion: Regression in the Right to Life and Public Health during Ecuador’s Neoliberal Decades

The present essay’s central argument or hypothesis is, consequently, that the mechanisms accelerating a wealth concentrating and exclusionary economy centred on the benefit and overprotection of big business—with a corresponding plundering of resources that are vital for life—generated forms of loss and regression in the right to healthcare and the dismantling of institutional protections. These are all expressed in indicators from 1990-2005, which point not only to the deterioration of healthcare programs and services but also to the undermining of the general conditions of life (social reproduction) and, in contrast to the reports and predictions of the era’s governments, a stagnation or deterioration in health indicators, especially for those most sensitive to the crisis. The present study’s argument is linked together across distinct chapters. First, we undertake the necessary clarification of the categories central to the understanding of a complex issue; clarifying the concept of health itself and its determinants, emphasizing the necessity of taking on an integral understanding as a fundamental prerequisite to unravelling what documents and reports from this era either leave unsaid or distort. Based on that analysis, we will explain the harmful effects of global economic acceleration, the monopolization and pillaging of strategic healthcare goods; not only those which directly place obstacles on the access to health services, but also those like the destructuration of small economies, linked to the impoverishment and worsening of living modes. Thinking epidemiologically, we intend to show signs of the deterioration of broad collectivities’ ways of life as a result of the mechanisms of acceleration and pillage. We will then collect disparate evidence of the deterioration of human health and ecosystems to, finally, establish the most urgent conclusions about this unfortunate period of our social and medical history.

Hydrogen-bonded interpolymer complexes. Formation, structure and applications

Noncovalent interactions play key roles in many natural processes leading to the self-assembly of molecules with the formation of supramolecular structures. One of the most important forces responsible for self-assembly is hydrogen bonding, which also plays an important role in the self-assembly of synthetic polymers in aqueous solutions. Proton-accepting polymers can associate with proton-donating polymers via hydrogen bonding in aqueous solutions and form polymer-polymer or interpolymer complexes. There has been an increased interest among researchers in hydrogen-bonded interpolymer complexes since the first pioneering papers were published in the early 1960s. Several hundred research papers have been published on various aspects of complex formation reactions in solutions and interfaces, properties of interpolymer complexes and their potential applications. This book focuses on the latest developments in the area of interpolymer complexation via hydrogen bonding. It represents a collection of original and review articles written by recognized experts from Germany, Greece, Kazakhstan, Poland, Romania, Russia, UK, Ukraine, and the USA. It highlights many important applications of interpolymer complexes, including the stabilization of colloidal systems, pharmaceuticals, and nanomaterials.

Interaction of pesticides with p-glycoprotein and other ABC proteins: A survey of the possible importance to insecticide, herbicide and fungicide resistance

P-glycoproteins (p-gps) are ubiquitous membrane proteins from the ABC (ATP-binding cassette) family. They have been found in many animals, bacteria, plants and fungi and are extremely important in regulating a wide range of xenobiotics including pesticides. P-gps have been linked to xenobiotic resistance, most famously in resistance to cancer drug treatments. Their wide substrate range has led to what is known as "multidrug resistance", where resistance developed to one type of xenobiotic gives resistance to a different classes of xenobiotic. P-gps are a major contributor to drug resistance in mammalian tumours and infections of protozoan parasites such as Plasmodium and Leishmania. There is a growing body of literature suggesting that p-gps, and other ABC proteins, are important in regulating pesticide toxicity and represent potential control failure through the development of pesticide resistance, in both agricultural and medical pests. At the same time, aspects of their biochemistry offer new hope in pest control, in particular in furthering our understanding of toxicity and offering insights into how we can improve control without recourse to new chemical discovery. (c) 2008 Elsevier Inc. All rights reserved.

Host-symbiont interactions of the primary endosymbiont of human head and body lice

The first mycetome was discovered more than 340 yr ago in the human louse. Despite the remarkable biology and medical and social importance of human lice, its primary endosymbiont has eluded identification and characterization. Here, we report the host-symbiont interaction of the mycetomic bacterium of the head louse Pediculus humanus capitis and the body louse P. h. humanus. The endosymbiont represents a new bacterial lineage in the -Proteobacteria. Its closest sequenced relative is Arsenophonus nasoniae, from which it differs by more than 10%. A. nasoniae is a male-killing endosymbiont of jewel wasps. Using microdissection and multiphoton confocal microscopy, we show the remarkable interaction of this bacterium with its host. This endosymbiont is unique because it occupies sequentially four different mycetomes during the development of its host, undergoes three cycles of proliferation, changes in length from 2–4 µm to more than 100 µm, and has two extracellular migrations, during one of which the endosymbionts have to outrun its host’s immune cells. The host and its symbiont have evolved one of the most complex interactions: two provisional or transitory mycetomes, a main mycetome and a paired filial mycetome. Despite the close relatedness of body and head lice, differences are present in the mycetomic provisioning and the immunological response.—Perotti, M. A., Allen, J. M., Reed, D. L., Braig, H. R. Host-symbiont interactions of the primary endosymbiont of human head and body lice.

A decade of research and development in disability, virtual reality and associated technologies: review of ICDVRAT 1996−2006

The International Conference (series) on Disability, Virtual Reality and Associated Technologies (ICDVRAT) this year held its sixth biennial conference, celebrating ten years of research and development in this field. A total of 220 papers have been presented at the first six conferences, addressing potential, development, exploration and examination of how these technologies can be applied in disabilities research and practice. The research community is broad and multi-disciplined, comprising a variety of scientific and medical researchers, rehabilitation therapists, educators and practitioners. Likewise, technologies, their applications and target user populations are also broad, ranging from sensors positioned on real world objects to fully immersive interactive simulated environments. A common factor is the desire to identify what the technologies have to offer and how they can provide added value to existing methods of assessment, rehabilitation and support for individuals with disabilities. This paper presents a brief review of the first decade of research and development in the ICDVRAT community, defining technologies, applications and target user populations served.

Incorporating climate change into water resources planning in England and Wales

Public water supplies in England and Wales are provided by around 25 private-sector companies, regulated by an economic regulator (Ofwat) and and environmental regulator (Environment Agency). As part of the regulatory process, companies are required periodically to review their investment needs to maintain safe and secure supplies, and this involves an assessment of the future balance between water supply and demand. The water industry and regulators have developed an agreed set of procedures for this assessment. Climate change has been incorporated into these procedures since the late 1990s, although has been included increasingly seriously over time and it has been an effective legal requirement to consider climate change since the 2003 Water Act. In the most recent assessment in 2009, companies were required explicitly to plan for a defined amount of climate change, taking into account climate change uncertainty. A “medium” climate change scenario was defined, together with “wet” and “dry” extremes, based on scenarios developed from a number of climate models. The water industry and its regulators are now gearing up to exploit the new UKCP09 probabilistic climate change projections – but these pose significant practical and conceptual challenges. This paper outlines how the procedures for incorporating climate change information into water resources planning have evolved, and explores the issues currently facing the industry in adapting to climate change.

Science and medicine

This is the first ‘Science and Medicine’ chapter in The Year’s Work in Critical and Cultural Theory. It is synchronised with the journal’s other chapters in its reviewing of works published in 2010, while it also reads these works in the broader context of rapidly expanding interdisciplinary areas of research. Scientific and medical vocabularies are (to use a scientific metaphor) cross-pollinating within many areas of scholarship in the humanities, and this current period is bringing many exciting developments. This chapter concentrates on literary studies, while forthcoming chapters will also look more squarely at cultural studies.

Poetry on Pre-Raphaelite principles: science, nature and knowledge in William Michael Rossetti’s 'Fancies at Leisure' and 'Mrs. Holmes Grey'

This article demonstrates how early Pre-Raphaelite poetry worked according to the principle that art should be modelled on science theorised by the Pre-Raphaelites in their early essays. As the main theorists (rather than practitioners) of Pre-Raphaelite art, F. G. Stephens and William Michael Rossetti defined the Pre-Raphaelite project in terms of observation, investigation, experiment, the “adherence to fact” and the “search after truth”. In the hands of the early Pre-Raphaelite poets, and particularly Rossetti himself, poetry too becomes a mode of scientific enquiry into the natural world, the nature of observation, human psychology and medical practice.

Structural changes in the epithelium of the small intestine and immune cell infiltration of enteric ganglia following acute mucosal damage and local inflammation

An acute enteritis is commonly followed by intestinal neuromuscular dysfunction, including prolonged hyperexcitability of enteric neurons. Such motility disorders are associated with maintained increases in immune cells adjacent to enteric ganglia and in the mucosa. However, whether the commonly used animal model, trinitrobenzene sulphonate (TNBS)-induced enteritis, causes histological and immune cell changes similar to human enteric neuropathies is not clear. We have made a detailed study of the mucosal damage and repair and immune cell invasion following intralumenal administration of TNBS. Intestines from untreated, sham-operated and TNBS-treated animals were examined at 3 h to 56 days. At 3 h, the mucosal surface was completely ablated, by 6 h an epithelial covering was substantially restored and by 1 day there was full re-epithelialisation. The lumenal epithelium developed from a squamous cell covering to a fully differentiated columnar epithelium with mature villi at about 7 days. Prominent phagocytic activity of enterocytes occurred at 1-7 days. A surge of eosinophils and T lymphocytes associated with the enteric nerve ganglia occurred at 3 h to 3 days. However, elevated immune cell numbers occurred in the lamina propria of the mucosa until 56 days, when eosinophils were still three times normal. We conclude that the disruption of the mucosal surface that causes TNBS-induced ileitis is brief, a little more than 6 h, and causes a transient immune cell surge adjacent to enteric ganglia. This is much briefer than the enteric neuropathy that ensues. Ongoing mucosal inflammatory reaction may contribute to the persistence of enteric neuropathy.

Effects of cyclooxygenase inhibitors on parasite burden, anemia and oxidative stress in murine Trypanosoma cruzi infection

Prostaglandins are known to be produced by macrophages when challenged with Trypanosoma cruzi, the etiological agent of Chagas` disease. It is not known whether these lipid mediators play a role in oxidative stress in host defenses against this important protozoan parasite. In this study, we demonstrated that inducible cyclooxygenase-mediated prostaglandin production is a key chemical mediator in the control of parasite burden and erythrocyte oxidative stress during T. cruzi infection in C57BL/6 and BALB/c mice, prototype hosts for the study of resistance and susceptibility in murine Chagas` disease. The results suggested the existence of at least two mechanisms of oxidative stress, dependent or independent with regard to the nitric oxide and cyclooxygenase pathway, where one or the other is more evident depending on the mouse strain.

Functional and immunological characterization of a natural polymorphic variant of a heat-labile toxin (LT-I) produced by enterotoxigenic Escherichia coli (ETEC)

Heat-labile toxins (LT) encompass at least 16 natural polymorphic toxin variants expressed by wild-type enterotoxigenic Escherichia coli (ETEC) strains isolated from human beings, but only one specific form, produced by the reference ETEC H10407 strain (LT1), has been intensively studied either as a virulence-associated factor or as a mucosal/transcutaneous adjuvant. In the present study, we carried out a biological/immunological characterization of a natural LT variant (LT2) with four polymorphic sites at the A subunit (S190L, G196D, K213E, and S224T) and one at the B subunit (T75A). The results indicated that purified LT2, in comparison with LT1, displayed similar in vitro toxic activities (adenosine 3`,5`-cyclic monophosphate accumulation) on mammalian cells and in vivo immunogenicity following delivery via the oral route. Nonetheless, the LT2 variant showed increased adjuvant action to ovalbumin when delivered to mice via the transcutaneous route while antibodies raised in mice immunized with LT2 displayed enhanced affinity and neutralization activity to LT1 and LT2. Taken together, the results indicate that the two most frequent LT polymorphic forms expressed by wild ETEC strains share similar biological features, but differ with regard to their immunological properties.