Os eventos adversos. Objetivos ou consensos?

An adverse event is not an objective problem, since its measure or quantification does not constitute the problem as a field with explanations and statements, but the application of shared validation criteria of causal explanations by a community of observers in their experience. We propose that an adverse event is a problem only if we can distinguish it by consensus, therefore, it is a social construction. The critical question is not where to trace the limit, but who can do it. Different interpretations of the same incident are always possible. In fact, when putting objectivity in hold we realize that reality is specified by an operation of distinction and that there are so many reality fields as types of operation of distinction. As a result, the objective facts disappear and we cannot pretend that we have a privilege access to an objective reality that we can use to validate our statements, being liberated to build a culture that does not look behind trying to find who is right, but rather to look ahead such as changing towards acting based on an ethics of responsibility.Un evento adverso no es un problema objetivo, ya que no es la medición ni su cuantificación lo que constituye a un problema como un dominio de explicaciones y afirmaciones, sino que la aplicación de criterios compartidos de validación de las explicaciones causales por una comunidad de observadores en sus experiencias. Proponemos que un evento adverso es un problema solo si podemos distinguirlo consensuadamente como tal, por tanto se trata de una construcción social. La pregunta crítica no es dónde trazar la línea, sino quién la puede trazar. Diferentes interpretaciones de un mismo incidente son siempre posibles. En efecto, al poner la objetividad entre paréntesis nos damos cuenta de que lo real está especificado por una operación de distinción y que existen tantos dominios de realidad como tipos de operaciones de distinción. Como resultado, los hechos objetivos desaparecen y no podemos pretender que tenemos un acceso privilegiado a una realidad objetiva que podemos usar para validar nuestras afirmaciones, siendo liberados para construir una cultura que no mire hacia atrás buscando encontrar quién tiene la razón, sino que busque en una mirada hacia adelante cómo producir un cambio hacia un actuar basado en una ética de la responsabilidad.Um evento adverso não é um problema objetivo, já que não é a medição nem sua quantificação o que constitui um problema como um domínio de explicações e afirmações, senão que a aplicação de critérios compartilhados de validação das explicações causais por uma comunidade de observadores em suas experiências. Propomos que um evento adverso seja um problema somente se pudermos distinguí-lo consensualmente como tal, portanto se trata de uma construção social. A pergunta crítica não é onde traçar a linha, senão quem a pode traçar. Diferentes interpretações de um mesmo incidente são sempre possível. Com efeito, ao colocar a objetividade entre parênteses nos damos conta de que o real está especificado por uma operação de distinção e que existem tantos domínios de realidade como tipos de operação de distinção. Como resultado, os fatos objetivos desaparecem e não podemos pretender que temos um acesso privilegiado a uma realidade objetiva que podemos usar para validar nossas afirmações, sendo liberados para construir uma cultura que não olhe para trás buscando encontrar quem tem a razão, senão que busque numa mirada para adiante como produzir um câmbio para um atuar baseado numa ética da responsabilidade

Rapid Syphilis Tests as Catalysts for Health Systems Strengthening: A Case Study from Peru.

OBJECTIVES: Untreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT) offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening. METHODS: The study was implemented from September 2009-November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability. RESULTS: Before the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the "two for one strategy", offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%. CONCLUSIONS: Implementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1) engaging the authorities; (2) dissipating tensions between providers and identifying champions; (3) training according to the needs; (4) providing monitoring, supervision, support and recognition; (5) sharing results and discussing actions together; (6) consulting and obtaining feedback from users; and (7) integrating with other services such as with rapid HIV testing

Validez de la evaluación del consumo de alcohol establecido en la norma técnica de atención integral del adulto con infección por el VIH

Objectives: To determine the validity of the evaluation of alcohol consumption established by the national strategy to prevent and control STI-HIV-AIDS (ESNITSS) of HIV-infected adults that started anti-retroviral treatment (ART). Methods: Diagnostic study of HIV patients in a single hospital in Lima from September 2017 to January 2018 using data from a phase one study “Effectiveness of nursing counseling in improving adherence to ART among patient with alcohol consumption”. Three hundred and fifty patients were randomly selected among 4000 participants. Two gold standards evaluated alcohol consumption: 1. Last month alcohol consumption and ii; alcohol consumption identified by the Alcohol Use Disorders Identification Test (AUDIT). Sensitivity, specificity, safety of the evaluation and probability rates. Results: sensitivity and specificity were moderate for last month alcohol consumption (s=0.64; e=0.57); specificity was low for evaluation of consumption risk (e=0.48). Positive validity rates demonstrated that the evaluation is not useful (<2). Conclusions: The evaluation of alcohol consumption followed by the ESNITSS has no diagnostic utility.Objetivos: Determinar la validez de la evaluación de consumo de alcohol realizado en la Estrategia Nacional de Salud para la Prevención y Control de ITS-VIH / SIDA (ESNITSS) a pacientes con VIH que iniciaron tratamiento antirretroviral (TARV). Material y métodos: El tipo de estudio fue de evaluación de prueba diagnóstica en pacientes en TARV de un hospital del Ministerio de Salud (MINSA), entre septiembre de 2017 y enero de 2018; en base al análisis de datos de la Fase I del estudio “Efectividad de la Consejería en Enfermería en la Mejora de la Adherencia al TARV en pacientes con VIH y Conducta de Consumo de Alcohol”. 4000 pacientes conformaron la población de estudio y 350 pacientes fueron seleccionados aleatoriamente. Se procedió a la validación de la evaluación del consumo de alcohol realizado por la ESNITSS con dos Gold estándar: i. la evaluación del consumo de alcohol en el último mes y ii. el consumo de riesgo identificado con el Alcohol Use Disorders Identification Test (AUDIT). Se calculó sensibilidad, especificidad, seguridad de la evaluación y razones de probabilidad. Resultados: La sensibilidad y especificidad fue regular para la evaluación de consumo de alcohol en el último mes (S=0,64, E=0,57), la especificidad fue mala para la evaluación de consumo de riesgo (E=0,48). Las razones de verosimilitud positivas demuestraron que la evaluación no tiene utilidad diagnóstica para ninguno de los casos (<2). Conclusiones: La evaluación de “consumo actual de alcohol” realizada por la ESNITSS no mostró utilidad diagnóstica

Tracking kelp-type seaweed fuel in the archaeological record through Raman spectroscopy of charred particles: examples from the Atacama Desert coast

The use of seaweed as fuel has been mentioned in ethnographic and historical sources of different coastal regions. Nevertheless, the archaeological record of seaweed burning is still limited to contexts where preservation is exceptional and macroscopic discrimination of charred remains is possible. Here, we evaluate the effectiveness of Raman spectroscopy in discriminating seaweed vs. plant/wood char. Our dataset (N = 92) consists of modern and archaeological seaweed and plant/wood charred remains, including specimens of unknown origin from the Atacama Desert coast, Northern Chile. The charred samples were processed to obtain 13 parameters which were then fed into five supervised machine learning models. The models, built on samples of known origin (seaweed and plant/wood), performed remarkably well in terms of accuracy, kappa, sensitivity, and specificity. The models were used for final predictions on 10 non-identified archaeological charcoals. Our results suggest that Raman spectroscopy combined with machine learning techniques is a robust methodology for discriminating seaweed and plant/wood charred remains in the archaeological record. The predictions on unknown samples confirm that seaweed was used as fuel in a specific funerary ritual in the southern Atacama Desert coast around 5000 cal BP. Furthermore, charred specimens of Lessonia spp. recovered from combustion features in other northern Chile coastal settlements, suggest that seaweed pyrotechnology developed by Atacama Desert coast people is likely a long-term process. As for coastal archaeology, this work encourages new research on seaweed as an alternative/main fuel in coastal deserts and evaluates possible bias for chronologies from coastal archaeological settlements around the globe.The present study was supported by the Universidad de Tarapacá (Chile) through the research grants UTA MAYOR 3754 (2021–2022) – “Uso de algas como combustible en sitios arqueológicos de la costa desértica de Atacama: una aproximación arqueomética” and UTA MAYOR 367122 (2022–2024) – “Estudio multiproxy para el reconocimiento de algas en rasgos de combustión arqueológicos de la costa del Desierto de Atacama” (Universidad de Tarapacá, Chile). D.Z. received financial support from the Arqueología, desiertos costeros y visibilización de recursos naturales Project (PIE 190405, CSIC) and ARVCODA – Arqueología de los Recursos Vegetales en la Costa del Desierto de Atacama project (Fundación PALARQ, CSIC). The studied samples were obtained during archaeological excavations or samplings performed in the following projects: FONDECYT 1151203; FONDECYT POSTDOC 3150664; and Quebrada Blanca Phase 2 (QB2) project – Compañía Minera Teck Quebrada Blanca S.A

Gestión del conocimiento: perspectiva multidisciplinaria. Volumen 11

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 11, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro cuenta con el apoyo de los grupos de investigación: Universidad Sur del Lago “Jesús María Semprúm” (UNESUR), Zulia – Venezuela; Universidad Politécnica Territorial de Falcón Alonso Gamero (UPTAG), Falcón – Venezuela; Universidad Politécnica Territorial de Mérida Kleber Ramírez (UPTM), Mérida – Venezuela; Universidad Guanajuato (UG) - Campus Celaya - Salvatierra - Cuerpo Académico de Biodesarrollo y Bioeconomía en las Organizaciones y Políticas Públicas (C.A.B.B.O.P.P), Guanajuato – México; Centro de Altos Estudios de Venezuela (CEALEVE), Zulia – Venezuela, Centro Integral de Formación Educativa Especializada del Sur (CIFE - SUR) - Zulia - Venezuela, Centro de Investigaciones Internacionales SAS (CIN), Antioquia - Colombia.y diferentes grupos de investigación del ámbito nacional e internacional que hoy se unen para estrechar vínculos investigativos, para que sus aportes científicos formen parte de los libros que se publiquen en formatos digital e impreso

Verdade científica, poder e obediência

Physicians belief in objectivity without parenthesis, which assumes, in one side, the real existence of scientific truth and, in the other, confers the possibility of knowing such truth leaving aside subjectivity, which determines that certain physician-patient relations are of power and obedience, in which obedience is justified by promises of means and results, promises based in the belief of having access to an objective truth independent from actions taken. Based in the theory of knowledge of Humberto Maturana, we question this paradigm and, under biological insight, we propose a new look to objective knowledge. La creencia por parte de los médicos de una objetividad sin paréntesis, que asume, por un lado, una existencia real de la verdad científica y, por otro, les confiere la posibilidad de conocer dicha verdad prescindiendo de su subjetividad, determina que ciertas relaciones médico-paciente sean relaciones de poder y obediencia, en las cuales la obediencia se justifica por promesas de medios y resultados, promesas fundadas a su vez en la creencia de que poseen acceso a una verdad objetiva con independencia de lo que hacen. Basados en la teoría del conocimiento de Humberto Maturana, cuestionamos ese paradigma y, a la luz de la biología, proponemos una nueva mirada al conocimiento objetivo.A crença por parte dos médicos de uma objetividade sem parênteses, que assume, por um lado, uma existência real da verdade científica e, por outro, lhes confere a possibilidade de conhecer a dita verdade prescindindo de sua subjetividade, determina que certas relações médico-paciente sejam relações de poder e obediência, nas quais a obediência se justifica por promessas de meios e resultados, promessas fundadas, por sua vez, na crença de que possuem acesso a uma verdade objetiva com independência do que fazem. Baseados na teoria do conhecimento de Humberto Maturana, questionamos esse paradig- ma e, à luz da biologia, propomos um novo olhar sobre o conhecimento objetivo