Nuevo centro Las Cruces: renovación urbana, capacitación y emprendimiento en la ciudad de Bogotá

Trabajo de gradoEl proyecto nuevo Centro Las Cruces es una propuesta urbana y arquitectónica que presenta un cambio en la imagen de un sector tradicional del centro de Bogotá. Teniendo de base conceptos como el hábitat y la sostenibilidad el modelo de ciudad incorpora nuevos elementos arquitectónicos que delimitan un borde pretendiendo de esta manera cambiar la percepción de inseguridad, inequidad y pobreza no sólo de sus habitantes sino también del resto de la ciudad.PregradoArquitect

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

. 38. Arqueología

Por razones de política editorial tratamos de equilibrar cada número en cuanto a regiones y temporalidades, pero en esta ocasión ha resultado difícil porque hay un sesgo muy fuerte hacia el periodo Posclásico en el Altiplano. Sin embargo, esta pequeña trasgresión a nuestras reglas tiene por contraparte el interés de los artículos que conjuntan especialistas en arqueología y otros ámbitos de la antropología y la historia, con temáticas que se entrecruzan, comparten y enriquecen para ofrecer la posibilidad de lecturas aleccionadoras Encabezan el número Óscar Basante y Juan Sebastián Gómez, en cuyo trabajo preliminar se describe una colección de materiales procedentes de Zacatecas y se proporciona información sobre sitios con arquitectura y pintura rupestre de Monte Escobedo, relacionados con la cultura Bolaños. En el siguiente artículo se ofrecen algunos resultados de las excavaciones en el Cerro de los Magueyes en Metepec, Estado de México, donde Carmen Carvajal y Alfonso González, a partir del análisis de un entierro en urna del Posclásico tardío, elaboran una propuesta de identificación física e interpretación simbólica. A su vez, Denisse L. Argote y colaboradores nos ofrecen los resultados iniciales de la prospección en el sitio Los Teteles de Ocotitla, Tlaxcala, ubicado temporalmente en el Clásico y donde por medio de radar de penetración detectan anomalías en las terrazas que interpretan como posibles estructuras, tumbas u otros elementos soterrados, impulsando el uso de los llamados métodos geofísicos. En una línea de descripción iconográfica, María Teresa Muñoz y José Carlos Castañeda analizan una figurilla de barro perteneciente al acervo del Museo Histórico de la Sierra Gorda de Querétaro; con ello intentan establecer la relación de esta pieza con la deidad de la fertilidad Tlazolteotl-Ixcuina, asociándola también con la diosa pame Cachum mediante un análisis comparativo e interpretación simbólica. En el trabajo de Verónica Ortega y Víctor Álvarez, dos estructuras subterráneas del Posclásico tardío, encontradas en la zona urbana de Teotihuacan, se interpretan como temascales por medio de un análisis comparativo con otras localizadas en San Francisco Mazapa. A continuación, un salvamento en la ciudad de México proporciona información sobre la traza prehispánica de Tlatelolco y el barrio de Atezcapan. Los autores, Alberto Mena, Janis Rojas y María de Jesús Sánchez Vázquez, muestran amplio conocimiento sobre la ciudad y aportan datos para la reconfiguración del límite sur y la separación de las islas. A partir de la arqueología histórica del periodo colonial, Patricia Murrieta informa sobre el proceso productivo del azúcar en la hacienda de Tecoyutla, Guerrero, y ofrece una descripción de las labores realizadas alrededor de este monumento histórico, por las que también plantea propuestas de uso del espacio. A su vez, Carmen Aguilera diserta sobre Tlaltecuhtli, una deidad poco conocida que conjuga orígenes y para ello se discute su procedencia y género, además de plantear propuestas interpretativas y rutas de investigación iconográfica. El artículo de Ángel García Cook y Yadira Martínez Calleja es de corte técnico y descriptivo, pues detalla de manera precisa las características principales de las vías de circulación interna en Cantona, y a partir de ahí se elabora una completa tipología. Además de proporcionar hipótesis y propuestas para la interpretación, se aplica un análisis comparativo entre Cantona y otras ciudades prehispánicas en las que se han identificado calles y caminos. A partir de los hallazgos en el salvamento de La Plaza Juárez, Fernando Guerrero y colaboradores dibujan rasgos del paleopaisaje en la zona de La Alameda Central. Además, el conjunto de los contextos y el análisis iconográfico les permiten proponer usos del espacio y la posible localización del barrio de Tzapotlán, componente de México-Tenochtitlan. Por último, Francisca Ramírez parte del análisis documental, la información arqueológica y etnográfica para ofrecer un panorama que asocia los cambios climáticos y las fluctuaciones demográficas en el valle de Tehuacan para el Posclásico tardío y la primera parte de la Colonia. No podemos concluir la presentación de este número sin llamar la atención del lector a nuestras ya acostumbradas secciones Archivo Técnico y Noticia, igualmente enriquecedoras y no menos importantes; en esta ocasión ofrecemos un texto de Florencia Jacobs Muller sobre Teotihuacan, y un reporte de Rodolfo Cid y Liliana Torres a propósito del deterioro de materiales óseos. Fieles al compromiso de mantener y mejorar la calidad de este espacio de difusión y comunicación académica, esperamos que este material les sea de utilidad y los estimule a enviar sus contribuciones.</p

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care