Caricias digitales en reproducción automática: un cuento de géneros

La globalización representada en la internet, como plataforma, es el nuevo espacio de encuentro y horizontalidad en las redes que ha garantizado a los ciudadanos del mundo globalizado para encontrarse desde la diversidad se debe precisar que las TIC no transforman sociedades, mucho menos ciudadanos, porque son ellos quienes actúan realmente en el ciberespacio. Abordar la violencia simbólica que subyace en las redes sociales como formas de discriminación de género y las repercusiones que estos hechos tienen dentro de la sociedad digitalizada, en especial con el derecho como forma de garantizar la dignidad humana. Se abordan en esta perspectiva autores como: Castells, Manuel); Simon, Nora y Minc, Alain; Salazar, Robinson; Natansohn) entre otros quienes reconocen el poder del derecho y las convenciones jurídicas aplicadas para la vigilancia y el castigo social en el espacio digital, las divergencias de la práctica se enfrentan a situaciones similares a la de la realidad material; hay derecho a la libertad de expresión, por ejemplo, pero los ciudadanos son vigilados por las instancias de poder, también, por otros que establecen sus propias normas en esta dinámica

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Caracterizando las elecciones venezolanas a través de Twitter: caso: #26S

This paper is aimed to discover the characteristic routines established by Twitter users along September 26th 2010, an Asamblea Nacional election day in Venezuela. It is based on previous studies by Boyd (2005), Masten and Plowman (2003) and FAO (2011) on digital ethnography and passive observation as the appropriate methods and techniques for modeling and characterizing the behavior of a digital community. The data acquisition was achieved using The Archivist, while the software CAVAnaTuit was developed by the authors for the corresponding analysis. Among the results, it is clear that Venezuelans have developed a series of practices, behaviors and games that they execute systematically along the Election Day; the users behave as digital journalists for covering the vote�s instauration, execution and counting. The whole process being started at 9am and finished on September 27th, the analysis revealed that the maximum amounts of tweets were written at 6 pm, while the minimum was detected to occur at 4 pm. Even when the data acquisition was designed to include the hashtag #26S, among the other most frequent hashtags were: #Venezuela, #Cuba, #ElNacional, cosasquepasaranantesdelboletín y #fuerafocas. During the early morning of September 27th were positioned into the Trending Topics 8 hashtags related to Venezuela and the elections results.Etereos Esta investigación tuvo como objetivo describir las rutinas que establecen los usuarios de la plataforma Twitter durante el día 26 de Septiembre de 2010, día de las elecciones de diputados a la Asamblea Nacional en Venezuela. Se basa en los aportes de boyd (2005), Masten y Plowman (2003) y la FAO (2011) relacionados a con la etnografía digital y observación pasiva como métodos y técnicas de estudio más apropiados para los trabajos que buscan modelar y caracterizar a los participantes de una comunidad digital. La recolección de datos se realizó con la herramienta The Archivist y para el procesamiento de los mismos se desarrolló el software CAVAnaTuit versión v0.9. Entre los primeros resultados se puede destacar que los venezolanos han desarrollado una serie de rutinas, prácticas y juegos que ejecutan durante el día del evento electoral de forma sistemática; asimismo se detectó que los usuarios se convierten en reporteros digitales durante el día cubriendo desde el establecimiento de los centros electorales hasta el ejercicio y conteo de los votos. La hora que registró la mayor cantidad de tuits fueron las 6 de la tarde mientras que el valor mínimo se tuvo a las 4pm (hay que tomar como punto de referencia que estas son las horas en las cuales comienza el cierre de mesas). La descarga de datos se estableció con la etiqueta #26S pero las más comunes, según su frecuencia de uso, fueron: #Venezuela, #Cuba, #ElNacional, #cosasquepasaranantesdelboletín y #fuerafocas. En la madrugada del 27S se posicionaron en las Tendencias del Momento Mundial de Twitter 8 de 10 etiquetas

Caracterizando las elecciones venezolanas a través de Twitter. Caso: #26s

This paper is aimed to discover the characteristic routines established by Twitter users along September 26th 2010, an Asamblea Nacional election day in Venezuela. It is based on previous studies by Boyd (2005), Masten and Plowman (2003) and FAO (2011) on digital ethnography and passive observation as the appropriate methods and techniques for modeling and characterizing the behavior of a digital community. The data acquisition was achieved using The Archivist, while the software CAVAnaTuit was developed by the authors for the corresponding analysis. Among the results, it is clear that Venezuelans have developed a series of practices, behaviors and games that they execute systematically along the Election Day; the users behave as digital journalists for covering the vote’s instauration, execution and counting. The whole process being started at 9am and finished on September 27th, the analysis revealed that the maximum amounts of tweets were written at 6 pm, while the minimum was detected to occur at 4 pm. Even when the data acquisition was designed to include the hashtag #26S, among the other most frequent hashtags were: #Venezuela, #Cuba, #ElNacional, cosasquepasaranantesdelboletín y #fuerafocas. During the early morning of September 27th were positioned into the Trending Topics 8 hashtags related to Venezuela and the elections results.Esta investigación tuvo como objetivo describir las rutinas que establecen los usuarios de la plataforma Twitter durante el día 26 de Septiembre de 2010, día de las elecciones de diputados a la Asamblea Nacional en Venezuela. Se basa en los aportes de boyd (2005), Masten y Plowman (2003) y la FAO (2011) relacionados a con la etnografía digital y observación pasiva como métodos y técnicas de estudio más apropiados para los trabajos que buscan modelar y caracterizar a los participantes de una comunidad digital. La recolección de datos se realizó con la herramienta The Archivist y para el procesamiento de los mismos se desarrolló el software CAVAnaTuit versión v0.9. Entre los primeros resultados se puede destacar que los venezolanos han desarrollado una serie de rutinas, prácticas y juegos que ejecutan durante el día del evento electoral de forma sistemática; asimismo se detectó que los usuarios se convierten en reporteros digitales durante el día cubriendo desde el establecimiento de los centros electorales hasta el ejercicio y conteo de los votos. La hora que registró la mayor cantidad de tuits fueron las 6 de la tarde mientras que el valor mínimo se tuvo a las 4pm (hay que tomar como punto de referencia que estas son las horas en las cuales comienza el cierre de mesas). La descarga de datos se estableció con la etiqueta #26S pero las más comunes, según su frecuencia de uso, fueron: #Venezuela, #Cuba, #ElNacional, #cosasquepasaranantesdelboletín y #fuerafocas. En la madrugada del 27S se posicionaron en las Tendencias del Momento Mundial de Twitter 8 de 10 etiquetas.

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

International audienceBackground: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/ hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH 2 O, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmH 2 O, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury

Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study

Background: Current incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in the intensive care unit (ICU) are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS). Methods: An international, multicentre, prospective cohort study of patients presenting with hypoxaemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with arterial oxygen tension/inspiratory oxygen fraction ratio ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure of ≥5 cmH2O. ICU prevalence, causes of hypoxaemia, hospital survival and factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared. Findings: 12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (CHF; 8.2%). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1% versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality, but similar adjusted mortality compared to those with ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only two quadrants involved. Interpretation: More than one-third of patients receiving mechanical ventilation have hypoxaemia and new infiltrates with a hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

Background: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p &lt; 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH2O, p &lt; 0.001), plateau (20 [15-23] vs 22 [19-26] cmH2O, p &lt; 0.001) and peak (21 [17-27] vs 26 [20-32] cmH2O, p &lt; 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p &lt; 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073

Validation and utility of ARDS subphenotypes identified by machine-learning models using clinical data: an observational, multicohort, retrospective analysis

International audienceTwo acute respiratory distress syndrome (ARDS) subphenotypes (hyperinflammatory and hypoinflammatory) with distinct clinical and biological features and differential treatment responses have been identified using latent class analysis (LCA) in seven individual cohorts. To facilitate bedside identification of subphenotypes, clinical classifier models using readily available clinical variables have been described in four randomised controlled trials. We aimed to assess the performance of these models in observational cohorts of ARDS. Methods: In this observational, multicohort, retrospective study, we validated two machine-learning clinical classifier models for assigning ARDS subphenotypes in two observational cohorts of patients with ARDS: Early Assessment of Renal and Lung Injury (EARLI; n=335) and Validating Acute Lung Injury Markers for Diagnosis (VALID; n=452), with LCA-derived subphenotypes as the gold standard. The primary model comprised only vital signs and laboratory variables, and the secondary model comprised all predictors in the primary model, with the addition of ventilatory variables and demographics. Model performance was assessed by calculating the area under the receiver operating characteristic curve (AUC) and calibration plots, and assigning subphenotypes using a probability cutoff value of 0·5 to determine sensitivity, specificity, and accuracy of the assignments. We also assessed the performance of the primary model in EARLI using data automatically extracted from an electronic health record (EHR; EHR-derived EARLI cohort). In Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE; n=2813), a multinational, observational ARDS cohort, we applied a custom classifier model (with fewer variables than the primary model) to determine the prognostic value of the subphenotypes and tested their interaction with the positive end-expiratory pressure (PEEP) strategy, with 90-day mortality as the dependent variable. Findings: The primary clinical classifier model had an area under receiver operating characteristic curve (AUC) of 0·92 (95% CI 0·90–0·95) in EARLI and 0·88 (0·84–0·91) in VALID. Performance of the primary model was similar when using exclusively EHR-derived predictors compared with manually curated predictors (AUC=0·88 [95% CI 0·81–0·94] vs 0·92 [0·88–0·97]). In LUNG SAFE, 90-day mortality was higher in patients assigned the hyperinflammatory subphenotype than in those with the hypoinflammatory phenotype (414 [57%] of 725 vs 694 [33%] of 2088; p<0·0001). There was a significant treatment interaction with PEEP strategy and ARDS subphenotype (p=0·041), with lower 90-day mortality in the high PEEP group of patients with the hyperinflammatory subphenotype (hyperinflammatory subphenotype: 169 [54%] of 313 patients in the high PEEP group vs 127 [62%] of 205 patients in the low PEEP group; hypoinflammatory subphenotype: 231 [34%] of 675 patients in the high PEEP group vs 233 [32%] of 734 patients in the low PEEP group). Interpretation: Classifier models using clinical variables alone can accurately assign ARDS subphenotypes in observational cohorts. Application of these models can provide valuable prognostic information and could inform management strategies for personalised treatment, including application of PEEP, once prospectively validated. Funding: US National Institutes of Health and European Society of Intensive Care Medicine