Cirugía Abierta Versus Cirugía Endovascular en el Tratamiento de la Patología de la Aorta Torácica Descendente

El reparo endovascular de la aorta torácica (REVAT), se ha incrementado en el mundo en los últimos años con relación al abierto. Los resultados de la intervención son controversiales. La información en Colombia es insuficiente. Objetivo: Comparar los resultados clínicos del REVAT frente al reparo abierto en la Fundación Cardio Infantil (Bogotá, Col) entre 2002 y 2011. Metodología: Análisis retrospectivo de la cohorte de pacientes sometidos a reparo abierto (Grupo 1) en comparación de REVAT (grupo 2). En cada uno de los grupos se evaluó el tiempo quirúrgico, tasa de morbilidad (infección, hemo-rragia, isquemia medular, evento cerebrovascular [ECV] y falla renal postoperatoria), mortalidad, reintervención y estancia hospitalaria. Para las comparaciones se realizó un análisis univariado considerando un valor p<0.05 estadísticamente significativo. Resultados: Fueron incluidos 57 pacientes en el análisis (26% reparo abierto; 74% REVAT). Se reintervinieron 2 pacientes por endofugas tipo 1 en el Grupo 2 y un caso por sangrado en el Grupo 1. La mortalidad operatoria fue (Grupo1: 20%; Grupo 2: 2.3%). El tiempo quirúrgico fue de 398 ± 180 min Grupo 1 versus 85.5 ± 35 min en el Grupo 2 (p:0.0001) y el tiempo de estancia hospitalaria promedio fue de 9.8 días:Grupo 1 y 5,3 días Grupo 2 [p:0.01]). El tiempo promedio de seguimiento fue 4,8± 3,1 años. Conclusiones: El REVAT parece ofrecer menor morbilidad, mortalidad, tiempo quirúrgico y estancia hospitalaria respecto al reparo abierto, aunque las pobla-ciones de pacientes incluidos no fueron estrictamente comparables. Se requieren nuevos análisis en un diseño prospectivo, idealmente aleatorizado para documentar los beneficios a largo plazo de este tipo de reparo.

System Design: Alternative Individual Assessment Scenario

This is the scenario used in the course when individuals are unable to participate in group work. It includes a written case study of a diary farm, and several news articles that describe various views on the business of dairy farming.

Representaciones sociales hegemónicas y polémicas en el contexto de identidad rural [TC]

El objetivo de este estudio es conocer las representaciones de lo rural y lo urbano con el intento de comprender cómo miembros de una comunidad rural se posicionan frente a la estructura social y simbólica hegemónicamente urbana. Se obtuvo el conjunto de datos a través de entrevistas a 200 integrantes de una comunidad rural, contemplando los siguientes núcleos de información: motivaciones para éxodo/permanencia en el territorio, experiencia de prejuicios, estereotipos atribuidos al grupo rural, y valores endo/exo-grupales. Los resultados referentes a las motivaciones para el éxodo o permanencia en el campo revelaron el predominio del proyecto de vida vinculado a lo rural. Los clásicos estereotipos de roceiros, bobos y caipiras fueran identificados como la imagen social del hombre del campo, elementos que producen el escenario conflictivo estratégico a la elaboración de representaciones defensivas, siendo el endogrupo rural asociado a valores positivos, y la ciudad, a significados negativamente valorizados. Se discute el imaginario grupal como campo de fuerzas en el que se elaboran representaciones polémicas en respuesta a la hegemonía urbana.

Publicness of goods and violent conflict : evidence from Colombia

How the degree of publicness of goods affect violent conflict? Based on the theoretical model in Esteban and Ray (2001) we find that the effect of the degree of publicness depends on the group size. When the group is small (large), the degree of publicness increases (decreases) the likelihood of conflict. This opens an empirical question that we tackle using microdata from the Colombian conflict at the municipality level. We use three goods with different publicness degree to identify the sign of the effect of publicness on conflict. These goods are coca crops (private good), road density (public good subject to congestion) and average education quality (a purer public good). After dealing with endogeneity issues using an IV approach, we find that the degree of publicness reduces the likelihood of both paramilitary and guerrilla attacks. Moreover, coca production exacerbates conflict and the provision of both public goods mitigates conflict. These results are robust to size, geographical, and welfare controls. Policies that improve public goods provision will help to fight the onset of conflict.

Las prácticas de recursos humanos y su incidencia en el bienestar laboral de los empleados

El objetivo del presente trabajo es formular, mediante una profunda revisión documental, bibliográfica y empírica, una fundamentación teórica sobre si existe o no incidencia de las prácticas de recursos humanos sobre el bienestar laboral de los empleados, y el que grado en que esta se presenta sobre aspecto como el engagement y la satisfacción laboral. Se realizó la revisión de múltiples estudios empíricos que aportaran evidencia sobre la relación que se presenta entre las principales prácticas de recursos humanos – provisión de personal, formación y desarrollo, promoción de personal, evaluación de desempeño, compensación y pago, y balance trabajo-familia – y el bienestar laboral, representado en el engagement y satisfacción en el trabajo de los empleados. Los resultados de este trabajo indican la existencia de una relación e incidencia de las prácticas de recursos humanos, el bienestar laboral, el engagement y la satisfacción laboral. De igual forma se encontró que estas relaciones son principalmente de carácter positivo, lo cual indica que las organizaciones que desarrollan este tipo de prácticas en su interior, fomentan tanto el desarrollo y la presencia de bienestar laboral en sus empleados, como su perdurabilidad.

Exposición laboral de agentes químicos carcinógenos presentes en las empresas afiliadas a una ARL en Colombia 2011-2014

Objetivo: Caracterizar los sectores económicos con mayor susceptibilidad de exposición a agentes químicos carcinógenos, categorizados en el grupo 1 por la Agencia Internacional para la Investigación del Cáncer IARC (formaldehído, polvo de madera, benceno y sílice cristalina) afiliadas a una Administradora de riesgos Laborales (ARL) en Colombia entre el periodo 2011 a 2014. Método: Estudio de tipo descriptivo retrospectivo con datos históricos obtenidos desde 2011 hasta 2014. De acuerdo con el número de mediciones que se realizó en cada área y cargo de las empresas objeto de estudio, se utilizó la medición basal para determinar el estado inicial y evaluar de manera concurrente la exposición de estos cuatro agentes químicos. Resultados: En total se obtuvieron 201 mediciones de higiene industrial para cuatro agentes químicos carcinógenos. Los resultados mostraron que índice de riesgo de la exposición a agentes químicos carcinógenos en diferentes empresas, se encuentra en algunos casos en niveles altos o críticos dado que superar los valores máximos permisibles definidos por la Conferencia Americana de Higienistas Industriales de Gobierno (ACGIH). Conclusión: Los trabajadores de diferentes empresas en Colombia están expuestas a diferentes tipos de concentraciones por agentes químicos cancerígenos. Las concentraciones ambientales obtenidas en el ambiente laboral en algunos casos excedieron las concentraciones máximas permitidas, por lo que se recomienda que las empresas e instituciones del país fortalezcan las medidas de prevención, vigilancia y control para minimizar los riegos a que pueden estar expuestos sus trabajadores.

Radzenie sobie z zagrożeniem tożsamości społecznej i osobistej – moderująca rola konstruktu Ja

Wydział Nauk Społecznych: Instytut Psychologiii

Reflections of geography and gender, then and now

Women and Geography Study Group Publication on the anniversary of Geography and Gender. The Women and Geography Study Group's publication "Geography and Gender Reconsidered" (ISBN 0 -902447 - 26 - 2) can now be purchased in UK, USA and Canada. This self-publication on CD-Rom was produced to celebrate and reflect upon the 20 years since the groundbreaking "Geography and Gender" published by the WGSG in 1984, and to coincide with a session at the IGU conference in Glasgow in Aug 2004. The self-publication format allowed a more flexible approach to writing, in addition to minimising the price of the final produce while maximising return for the study group (to support student conference attendance, reading weekends and other activities).

Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery

Aims and objectives. To examine the impact of written and verbal education on bed-making practices, in an attempt to reduce the prevalence of pressure ulcers. Background. The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco-elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress. Design. A prospective randomized pre/post-test experimental design. Methods. Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re-examined one month later. One researcher was blinded to the educational delivery received by the wards. Results. Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (chi(2) = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (chi(2) = 0, P 0.987). Conclusions. Clear, concise written instruction improved practice but verbal education was not additionally beneficial. Relevance to clinical practice. Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.

Survival analysis statistics applied to threshold data obtained from the ascending forced-choice method of limits

Sensory thresholds are often collected through ascending forced-choice methods. Group thresholds are important for comparing stimuli or populations; yet, the method has two problems. An individual may correctly guess the correct answer at any concentration step and might detect correctly at low concentrations but become adapted or fatigued at higher concentrations. The survival analysis method deals with both issues. Individual sequences of incorrect and correct answers are adjusted, taking into account the group performance at each concentration. The technique reduces the chance probability where there are consecutive correct answers. Adjusted sequences are submitted to survival analysis to determine group thresholds. The technique was applied to an aroma threshold and a taste threshold study. It resulted in group thresholds similar to ASTM or logarithmic regression procedures. Significant differences in taste thresholds between younger and older adults were determined. The approach provides a more robust technique over previous estimation methods.

Intermittent antegrade cardioplegia: isolated heart preservation with the Asporto heart preservation device

Background—A major problem in procurement of donor hearts is the limited time a donor heart remains viable. After cardiectomy, ischemic hypoxia is the main cause of donor heart degradation. The global myocardial ischemia causes a cascade of oxygen radical formation that cumulates in an elevation in hydrogen ions (decrease in pH), irreversible cellular injury, and potential microvascular changes in perfusion. Objective—To determine the changes of prolonged storage times on donor heart microvasculature and the effects of intermittent antegrade perfusion. Materials and Methods—Using porcine hearts flushed with a Ribosol-based cardioplegic solution, we examined how storage time affects microvascular myocardial perfusion by using contrast-enhanced magnetic resonance imaging at a mean (SD) of 6.1 (0.6) hours (n=13) or 15.6 (0.6) hours (n=11) after cardiectomy. Finally, to determine if administration of cardioplegic solution affects pH and microvascular perfusion, isolated hearts (group 1, n=9) given a single antegrade dose, were compared with hearts (group 2, n=8) given intermittent antegrade cardioplegia (150 mL, every 30 min, 150 mL/min) by a heart preservation device. Khuri pH probes in left and right ventricular tissue continuously measured hydrogen ion levels, and perfusion intensity on magnetic resonance images was plotted against time. Results—Myocardial perfusion measured via magnetic resonance imaging at 6.1 hours was significantly greater than at 15.6 hours (67% vs 30%, P= .00008). In group 1 hearts, the mean (SD) for pH at the end of 6 hours decreased to 6.2 (0.2). In group 2, hearts that received intermittent antegrade cardioplegia, pH at the end of 6 hours was higher at 6.7 (0.3) (P=.0005). Magnetic resonance imaging showed no significant differences between the 2 groups in contrast enhancement (group 1, 62%; group 2, 40%) or in the wet/dry weight ratio. Conclusion—Intermittent perfusion maintains a significantly higher myocardial pH than does a conventional single antegrade dose. This difference may translate into an improved quality of donor hearts procured for transplantation, allowing longer distance procurement, tissue matching, improved outcomes for transplant recipients, and ideally a decrease in transplant-related costs.

Outcome Analysis of Immediate and Delayed Conservative Breast Surgery Reconstruction With Mastopexy and Reduction Mammaplasty Techniques

Background: Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. Method: Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. Results: There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval - 1.01-7.00; P = 0.049). Conclusions: On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.

Comparison of agar gel immunodiffusion test, rapid slide agglutination test, microbiological culture and PCR for the diagnosis of canine brucellosis

The performance of the rapid slide agglutination test, with and without 2-mercaptoethanol (RSAT and 2ME-RSAT) and agar gel immunodiffusion test (AGID) was evaluated for the diagnosis of brucellosis in naturally infected dogs. The microbiological culture, PCR and clinical parameters were used as reference. A total of 167 dogs were clinically examined and tested by blood culture, culture of semen/vaginal swab and PCR in blood and semen/vaginal swab. According to the results observed the 167 dogs were divided into three groups: Brucella canis infected dogs (Group 1). B. canis non-infected dogs (Group 2) and dogs with suspected brucellosis (Group 3). The dogs were then tested by RSAT, 2ME-RSAT and AGID. Groups 1 and 2 were used to calculate the diagnostic sensitivity and specificity of the serological tests and the results observed in Group 3 were also discussed. The diagnostic sensitivity of RSAT, 2ME-RSAT and AGID was respectively 70.58%, 31.76%, and 52.94%. The diagnostic specificity of RSAT, 2ME-RSAT and AGID was respectively 83.34%, 100%, and 100%. In dogs with suspected brucellosis 15% were RSAT positive, none was 2ME-RSAT positive and 5% were AGID positive. Although the serological tests are the most commonly used methods for brucellosis diagnosis, a significant proportion of false-negative results were observed highlighting the importance of the direct methods of diagnosis, like blood culture and PCR to improve the diagnosis of canine brucellosis. (c) 2008 Elsevier Ltd. All rights reserved.

Comparative Histopathological Analysis of Human Pulps after Class I Cavity Preparation with a High-Speed Air-Turbine Handpiece or Er:YAG Laser

The purpose of this study was to comparatively evaluate the response of human pulps after cavity preparation with different devices. Deep class I cavities were prepared in sound mandibular premolars using either a high-speed air-turbine handpiece (Group 1) or an Er: YAG laser (Group 2). Following total acid etching and the application of an adhesive system, all cavities were restored with composite resin. Fifteen days after the clinical procedure, the teeth were extracted and processed for analysis under optical microscopy. In Group 1 in which the average for the remaining dentin thickness (RDT) between the cavity floor and the coronal pulp was 909.5 mu m, a discrete inflammatory response occurred in only one specimen with an RDT of 214 mu m. However, tissue disorganization occurred in most specimens. In Group 2 (average RDT = 935.2 mu m), the discrete inflammatory pulp response was observed in only one specimen (average RDT = 413 mu m). It may be concluded that the high-speed air-turbine handpiece caused greater structural alterations in the pulp, although without inducing inflammatory processes.

Elitidrottsproblem? : En kvalitativ studie om elitidrottares karriäravslutning

This paper used a qualitative technique from a social scientific perspective, a model based on Hewitt and his theory of the self-concept. The purpose of this study was to investigate why some elite athletes experience troublesome periods after their career ending. Interviews were performed with five elite athletes with varying experiences after career ending. The length of the elite athlete careers vary between 7 to 17 years. Two groups were made based upon experiences after career ending. Group 1 had experienced problems, for example suicide tendency, and group 2 had not. The result shows that a troublesome period can come up independently of career ending. The self-concept was investigated during the career and further different kind of variables which could affect the self as training and competition, social relations both before and after termination from sport. Result indicates that an individual in group 2 who has a high complexity in the self-concept based upon significant others outside the elite sport during the career copes with the new situation after career ending much better than group 1 who have not. To build up the self based only upon significant others in the elite sport seems to give expression in a strengthen self. Intensity in training and competition did not have a connection with a troublesome period after retirement from sport but it could prevent establishing contact with others outside the elite sport and reduce a high complexity in the self-concept. The result further shows that elite athletes who practise an individual sport trains in to a greater extent than elite athletes in a seasonal sport. Result also shows that practising a sport with one day off a week, contributes to better opportunities for developing a higher complexity in the self-concept. Suspicions has also rouse that practising an elite sport on the highest level can lead to extensive focusing that further leads to social isolation from individuals outside elite sport. To build up the self upon significant others outside elite sport during the career and keep in touch with significant others from elite sport after the career seems to be the key to avoid problems after the career ending. Suggestions about further investigations are made to see if medial exposure and status can affect the self.