13 research outputs found

    Imaginación y violencia en América

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    Las despedidas

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

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    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

    Novela e ideología en « Sobre héroes y tumbas » de Ernesto Sábato

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    Partiendo del análisis de los personajes como organizaciones significantes, este artículo trata de develar el entramado ideológico de Sobre héroes y tumbas como medio de acercamiento a la totalidad de sus elementos. El personaje Bruno posee, además de una función estructural, la de ser una especie de comentador teorético dentro de la obra. Su pensamiento sustancialista, tanto en lo ontológico como en lo epistemológico, adquiere una derivación antropológico-social : la búsqueda de una condición humana y de una condición nacional. Cuando analiza a esta última, efectúa una dicotomía en que lo pasado (lo incorrupto) se enfrenta a lo presente (lo corrupto), y en que el embellecimiento de un patriciado en decadencia insinúa la propuesta ideológica de un esquema de reconstrucción que emana de la creencia en una indebida ruptura axiológica y en un rescate de valores que debe ser realizado. Tal propuesta, hecha desde una perspectiva esencialista y transhis- tórica, termina por invadir toda la novela. El análisis de los restantes personajes (fundamentalmente Martín, Alejandra y Fernando, pero también los rostros secundarios) y la exploración de otros desarrollos literarios, permite percibir la homogeneidad de la obra en tal sentido, a pesar de la oscuridad aparente de muchos de sus elementos. Esta verificación, y también la de la existencia de diversos rasgos y modelos tradicionales bajo la superficie de las novedades técnicas empleadas, revela el contexto ideológico de la novela conectándola con una etapa más de cierre que de apertura dentro del actual panorama de la narrativa hispanoamericana.Avellaneda Andrés O. Novela e ideología en « Sobre héroes y tumbas » de Ernesto Sábato. In: Bulletin Hispanique, tome 74, n°1-2, 1972. pp. 92-115

    Daniel E. Salazar, La evolución de las ideas de Domingo F. Sarmiento

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    Avellaneda Andrés. Daniel E. Salazar, La evolución de las ideas de Domingo F. Sarmiento . In: Caravelle, n°50, 1988. 25 ans d'Amérique latine. pp. 218-221

    Daniel E. Salazar, La evolución de las ideas de Domingo F. Sarmiento

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    Avellaneda Andrés. Daniel E. Salazar, La evolución de las ideas de Domingo F. Sarmiento . In: Caravelle, n°50, 1988. 25 ans d'Amérique latine. pp. 218-221

    Memorias del primer Simposio Nacional de Ciencias Agronómicas

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    Primer simposio nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano

    Memorias del primer Simposio Nacional de Ciencias Agronómicas

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    Primer simposio nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano

    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)
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