Recientes resultados de la investigación en el sitio arqueológico Puchini, Atavillos Alto, Valle de Chancay

Atavillos Alto, con el objetivo de determinar los tipos de arquitectura que se desarrollaron en el lugar denominado como Puchuni. Asimismo, tuvo como finalidad establecer la secuencia de ocupación de que fue objeto en su devenir histórico, para lo cual se aprovechó, además de los tipos arquitectónicos del lugar, los restos decerámica superficial encontrados. Finalmente, se trató de comprobar la presencia inca en Puchuni a partir de los vestigios arquitectónicos presentes.Palabras clave: Atavillos Alto, Puchuni.DOI: http://dx.doi.org/10.21503/CienciayDesarrollo.2008.v9.0

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Logro de control metabólico temprano en adultos con diabetes mellitus tipo 2 en Perú

Objetivo: Estimar la proporción de sujetos con diabetes mellitus tipo 2 (DMT2) que alcanzan la meta terapéutica para HbA1C un año después del diagnóstico. Métodos: Revisión retrospectiva de historias clínicas de adultos atendidos en nueve ciudades peruanas.  Se incluyeron pacientes que recibieron un diagnóstico inicial de DMT2 y tuvieron al menos un año de seguimiento. Resultados:  Se incluyeron 457 sujetos (53,03% mujeres). Cuando fueron diagnosticados, la edad media fue de 55,75 años (DE ± 12,92), la media de HbA1C fue de 9,10% (DE ± 2,28). Hubo diagnóstico concomitante de hipertensión arterial o de dislipidemia en 27,13% y 52,40%, respectivamente. Al año de seguimiento, 57,76% de los sujetos alcanzó la meta de HbA1C ( 40 mg / dL), 24.31% para HDL-c en mujeres (>50 mg/dL), 48.24% para triglicéridos (<150 mg/dL), y 89,23% para presión arterial (<140/90 mmHg).       Conclusiones: En este estudio en condiciones de la vida real, en adultos con DMT2 con un año de seguimiento, el logro de la meta de HbA1c (<7%) se alcanzó en el 58% de los pacientes. Si bien estos resultados son compatibles con los reportados en otros estudios de la región, se evidencia la oportunidad de mejorar el logro temprano de metas con el objetivo de optimizar los resultados a largo plazo

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

TVII - Taller de Integración - AR324 - 202101

Descripción: El curso TVII Taller de Integración es un curso perteneciente al séptimo nivel de los talleres de diseño arquitectónico que constituyen la columna vertebral de la carrera. en el que el estudiante Desarrollará propuestas arquitectónicas en las que las consideraciones específicas que fueron materia principal de los anteriores talleres estén satisfactoriamente atendidas. En los niveles precedentes, cada taller ha tenido un tema de inflexión (explicitado en el propio nombre del taller) Introducción al diseño de la Arquitectura, Arquitectura y Arte, Arquitectura y Entorno, Arquitectura y Función, Arquitectura y Medio Ambiente y Arquitectura y Construcción) En este nivel se pretende hacer que el estudiante adquiera una experiencia en la que aplique de manera integral los 06 temas anteriores en un proyecto arquitectónico. Este curso permite comprender la importancia que tiene cada una de las inflexiones en el Proceso de Diseño. En este nivel se trabajan proyectos con mayor envergadura y complejidad como Edificaciones Hospitalarias, Edificios Híbridos, Teatros de gran escala, entre otros. El curso de taller se basa en la búsqueda y ensayo de una metodología de diseño, mediante la rigurosidad y compromiso, que le permite al estudiante transitar por los distintos niveles de un método y acercarse al logro de los objetivos. Propósito: El curso Taller VII ¿Taller de integración tiene como propósito que el estudiante trabaje y desarrolle las herramientas necesarias para su desenvolvimiento en el campo profesional. En él se concientiza, refuerza y consolida en el estudiante, la importancia de las ideas detrás de un proyecto arquitectónico, una arquitectura pensada y no arbitraria, la importancia del desarrollo de un buen lenguaje, en el caso de la arquitectura, planos profesionales bien dibujados y expresados, imágenes en 03 dimensiones, esquemas. Por ello, se puede afirmar que los temas a trabajar son una excusa para desarrollar estas habilidades que finalmente aseguran el logro del nivel de las competencias. La asignatura contribuye al desarrollo de la competencia general Pensamiento innovador y la competencia específica de la carrera: Diseño Fundamentado que corresponde a los criterios NAAB : PC2, PC3, PC8, PC5, SC3, SC5 , ambas en el nivel de logro A2. Tiene como pre requisito la asignatura de AR313 Taller VI - Arquitectura y Construcció

TVII - Taller de Integración - AR324 - 202102

Descripción: El curso TVII Taller de Integración es un curso perteneciente al séptimo nivel de los talleres de diseño arquitectónico que constituyen la columna vertebral de la carrera. en el que el estudiante Desarrollará propuestas arquitectónicas en las que las consideraciones específicas que fueron materia principal de los anteriores talleres estén satisfactoriamente atendidas. En los niveles precedentes, cada taller ha tenido un tema de inflexión (explicitado en el propio nombre del taller) Introducción al diseño de la Arquitectura, Arquitectura y Arte, Arquitectura y Entorno, Arquitectura y Función, Arquitectura y Medio Ambiente y Arquitectura y Construcción) En este nivel se pretende hacer que el estudiante adquiera una experiencia en la que aplique de manera integral los 06 temas anteriores en un proyecto arquitectónico. Este curso permite comprender la importancia que tiene cada una de las inflexiones en el Proceso de Diseño. En este nivel se trabajan proyectos con mayor envergadura y complejidad como Edificaciones Hospitalarias, Edificios Híbridos, Teatros de gran escala, entre otros. El curso de taller se basa en la búsqueda y ensayo de una metodología de diseño, mediante la rigurosidad y compromiso, que le permite al estudiante transitar por los distintos niveles de un método y acercarse al logro de los objetivos. Propósito: El curso Taller VII ¿Taller de integración tiene como propósito que el estudiante trabaje y desarrolle las herramientas necesarias para su desenvolvimiento en el campo profesional. En él se concientiza, refuerza y consolida en el estudiante, la importancia de las ideas detrás de un proyecto arquitectónico, una arquitectura pensada y no arbitraria, la importancia del desarrollo de un buen lenguaje, en el caso de la arquitectura, planos profesionales bien dibujados y expresados, imágenes en 03 dimensiones, esquemas. Por ello, se puede afirmar que los temas a trabajar son una excusa para desarrollar estas habilidades que finalmente aseguran el logro del nivel de las competencias. La asignatura contribuye al desarrollo de la competencia general Pensamiento innovador y la competencia específica de la carrera: Diseño Fundamentado que corresponde a los criterios NAAB : PC2, PC3, PC8, PC5, SC3, SC5 , ambas en el nivel de logro A2. Tiene como pre requisito la asignatura de AR313 Taller VI - Arquitectura y Construcció

Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Background: Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons' knowledge and perception of using AI-based tools in clinical decision-making processes. Methods: An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society's website and Twitter profile. Results: 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion: The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI