Defining barriers in caring for seriously-ill children in a resource-limited setting: An observational study of 2 children's hospitals in Haiti

Background. According to the WHO 2007 country report, Haiti lags behind the Millennium Development Goal of reducing child mortality and maintains the highest under-5 mortality rate in the Western hemisphere. 3 Overall, few studies exist that seek to better grasp barriers in caring for a seriously ill child in a resource-limited setting and only a handful propose sustainable, effective interventions. ^ Objectives. The objectives of this study are to describe the prevalence of serious illnesses among children hospitalized at 2 children's hospitals in Port au Prince, to determine the barriers faced when caring for seriously ill children, and to report hospital outcomes of children admitted with serious illnesses. ^ Methods. Data were gathered from 2 major children's hospitals in Port au Prince, Haiti (Grace Children's Hospital [GCH] and Hopital d l'Universite d'Etat d'Haiti [HUEH]) using a triangulated approach of focus group discussions, physician questionnaires, and retrospective chart review. 23 pediatric physicians participated in focus group discussions and completed a self-administered questionnaire evaluating healthcare provider knowledge, self-efficacy, and perceived barriers relating to the care of seriously ill children in a resource-limited setting. A sample of 240 patient charts meeting eligibility criteria was abstracted for pertinent elements including sociodemographics, documentation, treatment strategies, and outcomes. Factors associated with mortality were analyzed using χ2 test and Fisher exact test [Minitab v.15]. ^ Results. The most common primary diagnoses at admission were gastroenteritis with moderate dehydration (35.5%), severe malnutrition (25.8%), and pneumonia (19.3%) for GCH, and severe malnutrition (32.6%), sepsis (24.7%), and severe respiratory distress (18%) for HUEH. Overall, 12.9% and 27% of seriously ill patients presented with shock to GCH and HUEH, respectively. ^ Shortage of necessary materials and equipment represented the most commonly reported limitation (18/23 respondents). According to chart data, 9.4% of children presenting with shock did not receive a fluid bolus, and only 8% of patients presenting with altered mental status or seizures received a glucose check. 65% of patients with meningitis did not receive a lumbar puncture due to lack of materials. ^ Hospital mortality rates did not differ by gender or by institution. Children who died were more likely to have a history of prematurity (OR 4.97 [95% CI 1.32-18.80]), an incomplete vaccination record (OR 4.05 [95% CI 1.68-9.74]), or a weight for age ≤3rd percentile (OR 6.1 [95% CI 2.49-14.93]. Case-fatality rates were significantly higher among those who presented with signs of shock compared with those who did not (23.1% vs. 10.7%, RR=2.16, p=0.03). Caregivers did not achieve shock reversal in 21% of patients and did not document shock reversal in 50% of patients. ^ Conclusions. Many challenges face those who seek to optimize care for seriously ill children in resource-limited settings. Specifically, in Haiti, qualitative and quantitative data suggest major issues with lack of supplies, pre-hospital factors, including malnutrition as a comorbidity, and early recognition and management of shock. A tailored intervention designed to address these issues is needed in order to prospectively evaluate improvements in child mortality in a high-risk population.^

Household risk factors and the health and nutritional status of children in rural Honduras

During this cross-sectional study, both quantitative and qualitative research methods were used to elucidate the role that household environment and sanitation play in the nutritional status of children in a rural Honduran community. Anthropometric measurements were taken as measures of nutritional status among children under five years of age, while interviews regarding the household environment were conducted with their primary caregivers. Community participatory activities were conducted with primary caregivers, and results from water quality testing were analyzed for E. coli contamination. Anthropometric results were compared using the 1977 NCHS Growth Charts and the 2006 WHO Child Growth Standard to examine the implications of using the new WHO standard. The references showed generally good or excellent agreement between z-score categories, except among height-for-age classifications for males 24-35.9 months and weight-for-age classifications for males older than 24 months. Comparing the proportion of stunted, underweight, and wasted children, using the WHO standard generally resulted in higher proportions of stunting, lower underweight proportions, and higher overweight proportions. Logistic regression was used to determine which household and sanitation factors most influenced the growth of children. Results suggest only having water from a spring, stream, or other type of surface water as the primary source of drinking water is a significant risk factor for stunting. A protective association was seen between the household wealth index and stunting. Through participatory activities, the community provided insight on health issues important for improving child health. These activities yielded findings to be harnessed as a powerful resource to unify efforts for change. The qualitative findings were triangulated with the quantitative interview and water testing results to provide intervention recommendations for the community and its primary health care clinic. Recommendations include educating the community on best water consumption practices and encouraging the completion of at least some primary education for primary caregivers to improve child health. It is recommended that a community health worker program be developed to support and implement community interventions to improve water use and household sanitation behaviors and to encourage the involvement of the community in targeting and guiding successful interventions. ^

HIV-associated malignancies among children attending the Baylor Clinic in Kampala, Uganda

Introduction: HIV-associated malignancies such as Kaposi’s sarcoma and Non-Hodgkin’s lymphoma occur in children and usually lead to significant morbidity and mortality. No studies have been done to establish prevalence and outcome of these malignancies in children in a hospital setting in Uganda. ^ Research question: What proportion of children attending the Baylor-Uganda COE present with HIV-associated malignancies and what are the characteristics and outcome of these malignancies? The objective was to determine the prevalence, associated factors and outcome of HIV-associated malignancies among children attending the Baylor-Uganda Clinic in Kampala, Uganda. Study Design: This was a retrospective case series involving records review of patients who presented to the Baylor-Clinic between January 2004 and December 2008. Study Setting: The Baylor-Uganda Clinic, where I worked as a physician before coming to Houston, is a well funded, well staffed; Pediatric HIV clinic located in Mulago Hospital, Kampala, Uganda and is affiliated to Makerere University Medical School. Study Participants: Medical charts of patients aged 6 weeks to 18 years who enrolled for care at the clinic during the years 2004 to 2008 were retrieved for data abstraction. Selection Criteria: Study participants had to be patients of Baylor-Uganda seen during the study period; they had to be aged 6 weeks to 18 years; and had to be HIV positive. Patients with incomplete data or whose malignancies were not confirmed by histology were excluded. Study Variables: Data on patient’s age, sex, diagnosis, type of malignancy, anatomic location of the malignancy; pathology report, baseline laboratory results and outcome of treatment, were abstracted. Data Analysis: Cross tabulation to determine associations between variables using Pearson’s chi square at 95% level of significance was done. Proportions of malignancies among different groups were determined. In addition, Kaplan Meier survival analysis and comparison of survival distributions using the log-rank test was done. Change in CD4 percentages from baseline was assessed with the Wilcoxon signed rank test. Results: The proportion of children with malignancies during the study period was found to be 1.65%. Only 2 malignancies: Kaposi’s sarcoma and Non-Hodgkin’s lymphoma were found. 90% of the malignancies were Kaposi’s sarcoma. Lymph node involvement in children with Kaposi’s sarcoma was common, but the worst prognosis was seen with visceral involvement. Deaths during follow-up were seen in the first few weeks to months. Upon starting treatment the CD4 cell percentage increased significantly from a baseline median of 6% to 14% at 6 months and 15.8% at 12 months of follow-up.^

Does diabetes mellitus contribute to the disease burden of vascular dementia?

Background. Vascular dementia (VaD) is the second most common of dementia. Multiple risk factors are associated with VaD, but the individual contribution of each to disease onset and progression is unclear. We examined the relationship between diabetes mellitus type 2 (DM) and the clinical variables of VaD.^ Methods. Data from 593 patients evaluated between June, 2003 and June, 2008 for cognitive impairment were prospectively entered into a database. We retrospectively reviewed the charts of 63 patients who fit the NINDS-AIREN criteria of VaD. The patients were divided into those with DM (VaD-DM, n=29) and those without DM (VaD, n=34). The groups were compared with regard to multiple variables.^ Results. Patients with DM had a significantly earlier onset of VaD (71.9±6.54 vs. 77.2±6.03, p<0.001), a faster rate of decline per year on the mini mental state examination (MMSE; 3.60±1.82 vs. 2.54±1.60 points, p=0.02), and a greater prevalence of neuropsychiatric symptoms (62% vs. 21%, p=0.02) at the time of diagnosis.^ Conclusions. This study shows that a history of pre-morbid DM is associated with an early onset and faster cognitive deterioration in VaD. Moreover, the presence of DM predicts the presence of neuropsychiatric symptoms in patients with VaD. A larger study is needed to verify these associations. It will be important to investigate whether better glycemic control will mitigate the potential effects of DM on VaD.^

Effect of parental weight status on the food packed in preschool children's lunches

Problem. Recent statistics show that over a fifth of children aged 2-5 years in 2006-2008 were overweight, with 7% above the 97 th percentile of the BMI-for-age growth charts (extreme obesity). Because poor diet is an important environmental determinant of obesity and the preschool years are crucial developmentally, examination of factors related to diet in the pre-school years is important for obesity prevention efforts. ^ Objective. The goals of this study were to determine the association between BMI of the parents and the number of servings of fruits, vegetables, and whole grains (FVWG) packed; the nutrient content of preschool children’s lunches; and norms and expectations about FVWG intake.^ Methods. This study was a cross sectional analysis of parents enrolled in the Lunch is in the Bag program at baseline. The independent measure was weight status of the parents/caregivers, which was determined using body mass index (BMI) calculated from self-reported height and weight. BMI was classified as healthy weight (BMI <25) or overweight/obese (BMI ≥25). Outcomes for the study included the number of servings of fruits, vegetables and whole grains (FVWG) in sack lunches, as well as the nutrient content of the lunches, and psychosocial constructs related to FVWG consumption. Linear regression analysis was conducted and adjusted for confounders to examine the associations of these outcomes with parental weight status, the main predictor. ^ Results. A total of 132 parent/child dyads were enrolled in the study; 59.09% (n=78) of the parents/caregivers were healthy weight and 39.01% (n=54) of the parents/caregivers were overweight/obese. Parents/caregivers in the study were predominantly white (68%, n=87) and had at least some college education (98%, n=128). No significant associations were found between the weight status of the parents and the servings of fruits, vegetables and whole grain packed in preschool children’s lunchboxes. The results were similar for the association of parental weight status and the nutrient contents of the packed lunches. Both healthy weight and overweight/obese parents packed less than the recommended amounts of vegetables (mean servings = 0.49 and 0.534, respectively) and whole grains (mean servings = 0.58 and 0.511, respectively). However, the intentions of the obese/overweight parents were higher compare to the healthy for vegetables and whole grains.^ Conclusion. Results from this study indicate that there are few differences in the servings of fruits, vegetables and whole grains packed by healthy weight parents/caregivers compared to overweight/obese parents/caregivers in a high income, well-educated population, although neither group met the recommended number of servings of vegetables or whole grains. Thus, results indicate the need for behaviorally-based health promotion programs for parents, regardless of their weight status; however, this study should be replicated with larger and more diverse populations to determine if these results are similar with less homogenous populations.^

Lifetime changes in body mass index and risk of breast cancer in minority women

Introduction: Obesity is an epidemic in the United States, especially among Hispanics and African-Americans. Studies of obesity and breast cancer risk and subtype have been conducted primarily in non-Hispanic whites. Obesity is inversely associated with premenopausal breast cancer, but both obesity and weight gain increase the risk of postmenopausal disease. Obesity has been associated with breast cancer subtype in many studies. Methods: To assess the association between changes in body mass index (BMI) over the lifetime, weight gain, and breast cancer in Mexican-American women, we conducted a case-control study using 149 cases and 330 age-matched controls. In a second study, we identified 212 African-American and 167 Mexican-American women with breast cancer in the ongoing ELLA Bi-National Breast Cancer Study, abstracted medical charts to classify tumors as ER+/PR+, HER2+, or ER-/PR-/HER2-, and assessed the association between lifetime changes in body mass index, weight gain, and breast cancer subtype. In both studies, growth mixture modeling was use to identify trajectories of change in BMI over the lifetime, and these trajectories were used as exposures in a logistic regression model to calculate odds ratios (OR). Results: There was no association between trajectories of change in BMI and breast cancer risk in Mexican-American women. In addition, BMI at ages 15 and 30 and at diagnosis was not associated with breast cancer. However, adult weight gain was inversely associated with breast cancer risk (per 5kg, OR=0.92, 95% CI: 0.85-0.99). The case-only analysis found no association between obesity at ages 15 and 30 and at diagnosis and breast cancer subtype. Further, there was no association between adult weight gain (defined as weight change from age 15 to time of diagnosis) and breast cancer subtype. Conclusions: Obesity was not associated with breast cancer risk in Mexican-American women, while adult weight gain reduced the risk independently of menopausal status. These results are contradictory of those in non-Hispanic white women and suggest that the etiology of breast cancer may differ by race/ethnicity. Further, obesity was not associated with breast cancer subtype in African-American and Mexican-American women, contrary to results in non-Hispanic white women. ^

BIOCHEMICAL CHARACTERIZATION AND CLINICAL SIGNIFICANCE OF COAGULASE-NEGATIVE STAPHYLOCOCCI

Although coagulase-negative staphylococci (C-NS) have been implicated in certain human infections, they are generally regarded as contaminants and their clinical significance is questioned. To assess their role as pathogens, 205 isolates of C-NS from wounds, and body fluids (blood, urine, pleural and peritoneal fluids, etc.) were studied. Patient's charts were reviewed and using strict criteria a determination was made regarding the clinical significance of these isolates. The organisms were then identified using the scheme of Kloos and Schleifer to determine if certain species of C-NS were associated with specific infections. S. epidermidis sensu stricto accounted for 81% of the C-NS isolated; the frequency of other species was S. haemolyticus (6%), S. hominis (5%), S. capitis (4%), S. warneri (3%), and others (1%). Only two isolates were novobiocin resistant; neither was identified as S. saprophyticus. Using these criteria, 22% of C-NS were considered to be clinically significant and the majority of these (93%) were due to S. epidermidis. The most common source of the clinically relevant C-NS isolates was from wounds. These data suggest that identifying C-NS species other than S. epidermidis may be of limited value in predicting clinical significance.^ In addition, selected pathogenic and non-pathogenic strains of C-NS were compared for their ability to adhere to human cells in vitro. Although the results were not conclusive, it appeared that pathogenic C-NS adhered more avidly than non-pathogenic C-NS to buccal cells. Experiments with HeLa cells showed no difference between pathogenic and non-pathogenic C-NS in adherence abilities. ^

The Hospital Study of the City of Houston and Harris County

In 1941 the Texas Legislature appropriated $500,000 to the Board of Regents of the University of Texas to establish a cancer research hospital. The M. D. Anderson Foundation offered to match the appropriation with a grant of an equal sum and to provide a permanent site in Houston. In August, 1942 the Board of Regent of the University and the Trustees of the Foundation signed an agreement to embark on this project. This institution was to be the first one in the medical center, which was incorporated in October, 1945. The Board of Trustees of the Texas Medical Center commissioned a hospital survey to: - Define the needed hospital facilities in the area - Outline an integrated program to meet these needs - Define the facilities to be constructed - Prepare general recommendations for efficient progress The Hospital Study included information about population, hospitals, and other health care and education facilities in Houston and Harris County at that time. It included projected health care needs for future populations, education needs, and facility needs. It also included detailed information on needs for chronic illnesses, a school of public health, and nursing education. This study provides valuable information about the general population and the state of medicine in Houston and Harris County in the 1940s. It gives a unique perspective on the anticipated future as civic leaders looked forward in building the city and region. This document is critical to an understanding of the Texas Medical Center, Houston and medicine as they are today. SECTIONS INCLUDE: Abstract The Abstract was a summary of the 400 page document including general information about the survey area, community medical assets, and current and projected medical needs which the Texas Medical Center should meet. The 123 recommendations were both general (e.g., 12. “That in future planning, the present auxiliary department of the larger hospitals be considered inadequate to carry an added teaching research program of any sizable scope.”) and specific (e.g., 22. That 14.3% of the total acute bed requirement be allotted for obstetric care, reflecting a bed requirement of 522 by 1950, increasing to 1,173 by 1970.”) Section I: Survey Area This section basically addressed the first objective of the survey: “define the needed hospital facilities in the area.” Based on the admission statistics of hospitals, Harris County was included in the survey, with the recognition that growth from out-lying regional areas could occur. Population characteristics and vital statistics were included, with future trends discussed. Each of the hospitals in the area and government and private health organizations, such as the City-County Welfare Board, were documented. Statistics on the facilities use and capacity were given. Eighteen recommendations and observations on the survey area were given. Section II: Community Program This section basically addressed the second objective of the survey: “outline an integrated program to meet these needs.” The information from the Survey Area section formed the basis of the plans for development of the Texas Medical Center. In this section, specific needs, such as what medical specialties were needed, the location and general organization of a medical center, and the academic aspects were outlined. Seventy-four recommendations for these plans were provided. Section III: The Texas Medical Center The third and fourth objectives are addressed. The specific facilities were listed and recommendations were made. Section IV: Special Studies: Chronic Illness The five leading causes of death (heart disease, cancer, “apoplexy”, nephritis, and tuberculosis) were identified and statistics for morbidity and mortality provided. Diagnostic, prevention and care needs were discussed. Recommendations on facilities and other solutions were made. Section IV: Special Studies: School of Public Health An overview of the state of schools of public health in the US was provided. Information on the direction and need of this special school was also provided. Recommendations on development and organization of the proposed school were made. Section IV: Special Studies: Needs and Education Facilities for Nurses Nursing education was connected with hospitals, but the changes to academic nursing programs were discussed. The needs for well-trained nurses in an expanded medical environment were anticipated to result in significant increased demands of these professionals. An overview of the current situation in the survey area and recommendations were provided. Appendix A Maps, tables and charts provide background and statistical information for the previous sections. Appendix B Detailed census data for specific areas of the survey area in the report were included. Sketches of each of the fifteen hospitals and five other health institutions showed historical information, accreditations, staff, available facilities (beds, x-ray, etc.), academic capabilities and financial information.

Los recursos visuales en el ordenamiento territorial : I- Potrerillos (Mendoza, Argentina)

Se presenta la primera etapa del relevamiento de los recursos paisajísticos de la provincia de Mendoza, con el ajuste metodológico efectuado mediante una prueba piloto desarrollada sobre la Ruta Nac. N° 7, desde el Acceso sur en Luján de Cuyo (límite este) hasta Potrerillos inclusive (límite oeste). Los límites norte y sur están abarcados por el horizonte observable desde la ruta que atraviesa el área en sentido este-oeste. Se seleccionaron los puntos representativos mediante dos tipos de muestreo: sistemático y discrecional. En base a la catalogación de los recursos visuales se diseña una zonificación referencial general con miras al ordenamiento territorial y uso del suelo en distintas actividades de desarrollo futuro: turístico, reservas, residencial, agrícola, industrial. Se valora la calidad estética del paisaje aplicando, además, índices valorativos de la vulnerabilidad de los espacios a las actividades humanas (Índice de Naturalidad e Índice de Fragilidad), para obtener valores de la Calidad Visual Vulnerable del paisaje. Estos valores se grafican en planos que representan las distintas calidades alcanzadas y se complementa con una descripción de los puntos analizados, recomendaciones para el mejoramiento paisajístico a través de introducción o conducción de vegetación y fotografías documentales de las vistas analizadas.

Upper Triassic nannofossils from Wombat Plateau, Northwest Australia

A taxonomic and biostratigraphic investigation has been carried out on Upper Triassic (Carnian-Rhaetian) nannofossils from Sites 759, 760, 761 and 764 drilled on the Wombat Plateau during ODP Leg 122. The recovery of continuous sequences containing well preserved nannofossils has enabled us to refine the previous taxonomy and biostratigraphy of this interval. Fossil assemblages are of two major types: (1) previously described calcareous taxa were recovered at Sites 761 and 764; and (2) sideritic forms, which may represent diagenetic replacement of calcareous nannofossils, were observed in material from Sites 759 and 760. The sideritic forms proved difficult to study taxonomically due to inadequate optical properties. Calcareous nannofossil assemblages in the Upper Triassic are dominated by Prinsiosphaera triassica. We show that the multitude of identities of this species in the light microscope are the result of selective etching on a layered structure. We propose an evolutionary lineage for the earliest known coccoliths, with Crucirhabdus primulus as the ancestor. This species gave rise to C. minutus and Archaeozygodiscus koessenensis. The Upper Triassic can be subdivided based on the sequential first occurrences of C. primulus and Eoconusphaera zlambachensis in the upper Norian. The late Norian and Rhaetian were times of slow evolution of calcareous nannofossils. However, we noted three morphometric changes in this time-interval which possess biostratigraphic utility: (1) P. triassica increases in diameter from an average of 6 µm to over 9 µm; (2) E. zlambachensis evolves from a stubby to an elongated shape; and (3) C. primulus increases in size. Upper Triassic assemblages from the Wombat Plateau are similar in composition and diversity to those which have been described in detail from the Alps. In both areas, nannofossiliferous sediments interfinger with massive limestones deposited in reef and peri-platform environments. Stable isotopic analyses of Wombat Plateau nannofossil assemblages indicate that they thrived in open ocean conditions. Biostratigraphy allows sequence chronostratigraphic interpretation of ODP Site 761 and supports the chronostratigraphic cycle charts of Haq et al. (1987).

Documentation of sediment cores during SONNE Expedition SO228 from the western tropical Pacific

The core descriptions (chapter 7) summarize the most important results of the analysis of each sediment core following procedures applied during ODP/IODP expeditions. All cores were opened, described, and color-scanned. In the core descriptions the first column displays the lithological data that are based on visual analysis of the core and are supplemented by information from binocular and smear slide analyses. The sediment classification largely follows ODP/IODP convention. Lithological names consist of a principal name based on composition, degree of lithification, and/or texture as determined from visual description and microscopic observations. In the structure column the intensity of bioturbation together with individual or special features (turbidites, volcanic ash layers, plant debris, shell fragments, etc.) is shown. The hue and chroma attributes of color were determined by comparison with the Munsell soil color charts and are given in the color column in the Munsell notation. A GretagMacbethTM Spectrolino spectrophotometer was used to measure percent reflectance values of sediment color at 36 wavelength channels over the visible light range (380-730 nm) on all of the cores. The digital reflectance data of the spectrophotometer readings were routinely obtained from the surface (measured in 1 cm steps) of the split cores (archive half). The Spectrolino is equipped with a measuring aperture with folding mechanism allowing an exact positioning on the split core and is connected to a portable computer. The data are directly displayed within the software package Excel and can be controlled simultaneously. From all the color measurements, for each core the red/blue ratio (700 nm/450 nm) and the lightness are shown together with the visual core description. The reflectance of individual wavelengths is often significantly affected by the presence of minor amounts of oxyhydroxides or sulphides. To eliminate these effects, we used the red/blue ratio and lightness.

Deep drilling of glaciers: Russian projects in the Arctic (1975-1995)

The data collection "Deep Drilling of Glaciers: Soviet-Russian projects in Arctic, 1975-1995" was collected by the following basic considerations: - compilation of deep (>100 m) drilling projects on Arctic glaciers, using data of (a) publications; (b) archives of IGRAN; (c) personal communication of project participants; - documentation of parameters, references. Accuracy of data and techniques applied to determine different parameters are not evaluated. The accuracy of some geochemical parameters (up to 1984 and heavy metalls) is uncertain. Most reconstructions of ice core age and of annual layer thickness are discussed; - digitizing of published diagrams (in case, when original numerical data were lost) and subsequent data conversion to equal range series and adjustment to the common units. Therefore, the equal-range series were calculated from original data or converted from digitized chart values as indicated in the metadata. For the methodological purpose, the equal-range series obtained from original and reconstructed data were compared repeatedly; the systematic difference was less then 5-7%. Special attention should be given to the fact, that the data for individual ice core parameters varies, because some parameters were originally measured or registered. Parameters were converted in equal-range series using 2 m steps; - two or more parameter values were determined, then the mean-weighted (i.e. accounting the sample length) value is assigned to the entire interval; - one parameter value was determined, measured or registered independently from the parameter values in depth intervals which over- and underlie it, then the value is assigned to the entire interval; - one parameter value was determined, measured or registered for two adjoining depth intervals, then the specific value is assigned to the depth interval, which represents >75% of sample length ; if each of adjoining depth intervals represents <75% of sample length, then the correspondent parameter value is assigned to both intervals of depth. This collection of ice core data (version 2000) was made available through the EU funded QUEEN project by S.M. Arkhipov, Moscow.

Estado, Justicia y Sociedad : la Administración de Justicia en la provincia de Buenos Aires, 1853-1881

Esta ponencia es la presentación del proyecto de tesis, que tiene por objetivo estudiar el proceso de constitución y consolidación del poder judicial, responsable de la administración de justicia, como integrante del Estado provincial, legitimador de su accionar político y mediador con la sociedad civil. La investigación se ubica en la provincia de Buenos Aires, entre 1853 y 1881, que sancionó su propia Constitución en 1854, en la que declaraba en su artículo 118 que el poder judicial sería independiente de todo otro en el ejercicio de sus funciones. Es decir que en esta provincia la consagración de la teoría de los poderes del Estado y la ley como definidora de lo que era justo, requirieron de la organización del poder judicial. El sistema judicial de la provincia de Buenos Aires comenzó su formación como poder del Estado a partir de la reforma rivadaviana y el proceso alcanzó su madurez entre 1853 y 1881, como parte fundamental del proyecto liberal, asentado sobre la autoridad de la ley. El poder judicial garantizaba la legitimidad del sistema político republicano de matriz liberal, pero la dependencia con el poder ejecutivo se mantuvo en parte, representada en el presupuesto, los nombramientos y los jurys. La organización judicial en formación incluyó al ámbito rural con una fisonomía institucional que tendía a consolidar la relación entre Estado y sociedad civil; ésta manifestaba sus necesidades a través de la opinión pública y el poder las interpretaba con el fin de legitimar su acción política. En este proceso de legitimación, el poder judicial era funcional al Estado, lo que se consolidó con el tiempo. La Constitución de 1873, a pesar de ser ideal en algunas de sus propuestas, dio protagonismo y efectividad a las instituciones judiciales que se formaron y pusieron en funcionamiento con una nueva concepción de justicia, que sin dejar de lado el derecho natural se consolidaba en una función más positiva, atenta a los derechos individuales y de propiedad. Para comprender el rol que jugó el sistema de justicia en la formación del Estado es necesario desenmarañar la compleja trama de relaciones entre el poder político y los magistrados, y a su vez entre ellos y la sociedad. Pero esto no se puede realizar sin conocer y comprender que entendían por justicia, y definir de qué forma organizaron su administración. En la realización de esta investigación atenderé a las soluciones que el ordenamiento jurídico debía brindar a una determinada sociedad, las instituciones que lo formaron y las ideas de quienes lo gestaron. El uso de la fuente judicial será fundamental para observar si la letra de la ley fue cumplida en la administración de justicia y de qué manera. Pero esa fuente judicial confirmará o no la aplicación de las leyes dictadas por el poder legislativo y los decretos emanados del ejecutivo, por ello será necesario reconstruir los organigramas del Poder Judicial a partir del estudio de los Registros Oficiales y los debates legislativos de la provincia.

Control estadístico de calidad en bibliotecología : Aplicación de gráficos de control en los procesos técnicos

A partir de la aceptación de la biblioteca como parte del ciclo de creación, organización y diseminación del conocimiento cambió el concepto de la misma de una entidad cerrada hacia un sistema dinámico en constante interacción con su entorno. Así se la reconoció como una institución social más que como una colección de documentos. Desde entonces se percibió a la biblioteca como una entidad en la que se podía aplicar los principios de gestión. Desde entonces se utilizaron distintas herramientas de gestión para la toma de decisiones en el ámbito de las bibliotecas. Entre estas herramientas son de gran importancia en el control estadístico de procesos los gráficos de control, utilizados para medir la estabilidad de un proceso a través del tiempo. Han tenido amplia aplicación en el control estadístico de la calidad, comenzando en el ámbito industrial. Hoy su aplicación se ha extendido a una gran variedad de disciplinas incluyen empresas de servicios y unidades administrativas. Aquí se presentan a los gráficos de control como una importante herramienta de gestión aplicada a los procesos técnicos permitiendo su evaluación y el monitoreo de su desempeño a partir de la utilización de indicadores y otros datos de carácter diagnóstico