La distopía andina. El papel de la Comisión de la Verdad y Reconciliación (CVR) en la construcción de un relato sobre el Perú de 1980 al 2000

"El ensayo empieza describiendo brevemente el trabajo de la CVR; yo no lo tenía claro y creo que, con excepción de los especialistas en el tema, se sabe poco sobre lo que hizo y lo que no. Para tenerlos a la mano, he resumido también algunos de los datos sobre las víctimas de la violencia producidos por la CVR. La segunda parte del ensayo resume el relato de esta con un cambio que me pareció útil y revelador: la CVR utiliza una periodización ad hoc que no coincide con los periodos de gobierno. Yo he intentado describir lo que hicieron los Gobiernos de Belaunde, García y Fujimori pensando en su responsabilidad política, por lo que resumo el relato de la CVR usando esa óptica. La tercera parte del ensayo es un breve recuento de la crisis económica de aquellos años destacando el rol de los tres Gobiernos en enfrentarla." -- Introducción

Sugarcane juice extraction and preservation, and long-term lime pretreatment of bagasse

New technologies, such as an efficient vapor-compression evaporator, a stationary lime kiln (SLK), and the MixAlco process, compelled us to re-evaluate methods for producing sugar from cane. These technologies allow more water and lime to be used, and they add more value to bagasse. Extracting and preserving the sugars, and lime pretreating the bagasse to enhance biodigestibility, all at the same time in a pile, was demonstrated to be unfeasible; therefore, sugar extraction must occur before lime treating the bagasse. Sugar extraction should occur countercurrently by lixiviation, where liquid moves in stages opposite to the soaked bagasse (megasse), which is conveyed by screw-press conveyors that gently squeeze the fiber in each stage, improving extraction. The performance of a pilot-scale screw-press conveyor was tested for dewatering capabilities and power consumption. The unoptimized equipment decreased megasse moisture from 96 to 89%. Simulation of the process suggested that eight stages are necessary to achieve 98% recovery from typical sugarcane. The cumulative power for the screw-press conveyor system was 17.0±2.1 hph/ton dry fiber. Thin raw juice preserved with lime for several months showed no sucrose degradation and no quality deterioration, except for reducing sugar destruction. The lime loading needed for 1-year preservation is 0.20 g Ca(OH)2/g sucrose. Shorter times require less lime. After preservation, the juice was carbonated and filtered, and the resulting sludge pelletized. Due to their high organic content, the pellets were too weak for calcination temperatures used in the SLK. The organics must be decreased prior to pelletization and sodium must be supplemented as a binding agent. Long-term lime pretreatment of bagasse showed two delignification phases: bulk (rapid) and residual (slow). These were modeled by two simultaneous first-order reactions. Treatments with air purging and higher temperatures (50 57oC) delignified more effectively, especially during the residual phase, thus yielding higher cellulase-enzyme digestibilities after 2 8 weeks of treatment. At temperatures > 60oC, pure oxygen purging is preferred. Fresh bagasse was of better quality than old bagasse. Treatment with NaOH yielded a larger bulk delignification phase than Ca(OH)2. Long-term lime pulping of bagasse was unsuitable for copy-quality paper, but it was appropriate for strawboard and other filler applications

La incidencia del patrimonio histórico inmueble en la identidad cultural de los pobladores de Paita, 2021

La presente investigación tiene como objetivo general determinar la incidencia del patrimonio histórico inmueble en la identidad cultural de los pobladores de la Paita, 2021. De tipo básica, no experimental con enfoque cuantitativo y diseño transversal correlacional – causal; muestra estratificada de 63 pobladores, a quienes se les aplicó la técnica de la encuesta con dos cuestionarios tipo escala Likert; a diferencia de las fichas de observación resueltas por la investigadora. Los resultados se dieron a través de los valores encontrados, afirmando que se muestra incidencia significativa (p < 0.05) del patrimonio histórico inmueble en la identidad cultural (r2=6.9%). Sin embargo, no existe incidencia significativa de la conservación, restauración y puesta en valor en la identidad cultural (p > 0.05). Las conclusiones determinaron que acerca de la conservación y puesta en valor, existe un buen nivel de conocimiento por parte de la población, 50.8% y 97.7% respectivamente. Asimismo, la identidad cultural de los pobladores en las dimensiones memoria cultural e identidad cultural, es buena: 88.9% y 58.7% respectivamente. La importancia de esta investigación radica en otorgar aportes y lineamientos para la solución de la problemática actual ante el abandono y falta de difusión que presentan los monumentos en Paita

Using Cost-Effectiveness Analysis to Address Health Equity Concerns

This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health-the objective underpinning conventional CEA-and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and-crucially-who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs

Destrezas y habilidades en alumnos del último año de medicina para interpretar electrocardiogramas de emergencias cardiológicas

Es importante para los estudiantes de medicina adquirir habilidades y destrezas para la interpretación de electrocardiogramas de emergencias cardiológicas, pero se desconoce el nivel de este conocimiento en nuestro medio. Objetivo: Evaluar las destrezas y habilidades de los alumnos del último año de medicina de cuatro universidades de Lima en el periodo 2016, que realizaron sus prácticas en dos Hospitales Nacionales docentes de alta complejidad nivel III-1, para interpretar los Electrocardiogramas de emergencias cardiológicas. Materiales y Métodos: Estudio observacional, descriptivo y transversal. Se incluyeron 120 alumnos del último año de medicina, a los que les pidió interpretar 11 electrocardiogramas (ECG) de emergencias cardiológicas por medio de una evaluación de respuesta abierta, bajo una escala de calificación de 0 a 100. Resultados: 120 alumnos de último año de medicina participaron en el estudio. El promedio de la nota general fue del 33.94±22.04. 18,3% de los participantes realizaron algún curso extracurricular en cardiología y ECG. La realización de un curso estuvo significativamente relacionada con la obtención de una mejor calificación (p<0,0001). Las patologías con mayor potencial de mortalidad fueron identificadas de manera subóptima en comparación con estudios internacionales. Conclusiones: Los alumnos participantes del último año de medicina, demostraron tener un nivel subóptimo en la interpretación de ECG de emergencias cardiológicas. La realización de un curso extracurricular en el tema, mejoró significativamente sus promedios

Outcomes associated with SARS-CoV-2 reinfection in individuals with natural and hybrid immunity

BACKGROUND: Studies comparing SARS-CoV-2 reinfection outcomes among individuals with previous infection (natural immunity) and previous infection plus vaccination (hybrid immunity) are limited. METHODS: Retrospective cohort study comparing SARS-CoV-2 reinfection among patients with hybrid immunity (cases) and natural immunity (controls) from March 2020 to February 2022. Reinfection was defined as positive PCR\u3e 90 days after initial laboratory-confirmed SARS-CoV-2 infection. Outcomes included time to reinfection, symptom severity, COVID-19-related hospitalization, critical COVID-19 illness (need for intensive care unit, invasive mechanical ventilation, or death), length of stay (LOS). RESULTS: A total of 773 (42%) vaccinated and 1073 (58%) unvaccinated patients with reinfection were included. Most patients (62.7%) were asymptomatic. Median time to reinfection was longer with hybrid immunity (391 [311-440] vs 294 [229-406] days, p \u3c 0.001). Cases were less likely to be symptomatic (34.1% vs 39.6%, p = 0.001) or develop critical COVID-19 (2.3% vs 4.3%, p = 0.023). However, there was no significant difference in rates of COVID-19-related hospitalization (2.6% vs 3.8%, p = 0.142) or LOS (5 [2-9] vs 5 [3-10] days, p = 0.446). Boosted patients had longer time to reinfection (439 [IQR 372-467] vs 324 [IQR 256-414] days, p \u3c 0.001) and were less likely to be symptomatic (26.8% vs 38%, p = 0.002) compared to unboosted patients. Rates of hospitalization, progression to critical illness and LOS were not significantly different between the two groups. CONCLUSIONS: Natural and hybrid immunity provided protection against SARS-CoV-2 reinfection and hospitalization. However, hybrid immunity conferred stronger protection against symptomatic disease and progression to critical illness and was associated with longer time to reinfection. The stronger protection conferred by hybrid immunity against severe outcomes due to COVID-19 should be emphasized with the public to further the vaccination effort, especially in high-risk individuals

Effects of Self-Rated Health and Self-Rated Economic Situation on Depressed Mood Via Life Satisfaction Among Older Adults in Costa Rica

Objective: The study examined the relationship of self-rated health and self-rated economic situation with depressed mood, and life satisfaction as mediator of this relationship among older adults in Costa Rica. Method: A longitudinal study was conducted with a subsample (N = 1,618) from the Costa Rican Longevity and Healthy Aging Study (CRELES). Self-rated health, self-rated economic situation, depressed mood, and life satisfaction were measured at baseline, and depressed mood was reassessed 18 months later. Putative mechanisms for changes in depressed mood were examined by means of conditional process analysis. Results: Self-rated health was negatively associated to depressed mood. This effect took place via life satisfaction. An interaction showed that better economic situation compensated the effect of a low self-rated health on life satisfaction. Discussion: This study suggests that subjective variables such as self-rated health, economic situation, and life satisfaction should be considered when addressing the onset of depressed mood.Wellcome Trust/[072406/Z/03/Z]//Estados UnidosUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro Centroamericano de Población (CCP

Professionalism and Occupational Well-Being: Similarities and Differences Among Latin American Health Professionals

Context: Empathy, teamwork, and lifelong learning are described as key elements of professionalism. The first recipients of their benefits are professionals themselves. Paradoxically, scarce studies have reported association between professionalism and occupational well-being. The main purpose of this study was to characterize the influence that empathy, teamwork, and lifelong learning, play in the occupational well-being of physicians and nurses working in Latin American healthcare institutions.Materials and Methods: The Jefferson Scale of Empathy, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, the Jefferson Scale of Physicians Lifelong Learning, and the Scale of Collateral Effects (somatization, exhaustion, and work alienation), were administered to 522 physicians and nurses working in institutions of Mexico, Colombia, Ecuador, and Argentina. Internal reliability was calculated. Gender and discipline were used as explanatory variables in comparison analysis. Two-way analysis of variance was performed to examine differences due to the main effects of the gender, and discipline, and to determine possible combined effects. Correlation analysis was performed to measure associations between collateral effects and age, and between collateral effects and professionalism.Results: A total of 353 (68%) surveys were returned fully completed. Adequate reliability was confirmed in all instruments. No differences were found among countries for collateral effects. Correlation analysis confirmed in physicians an inverse association between empathy and collateral effects (P = -0.16; p < 0.05), and between collateral effects and lifelong learning (P = -0.18; p < 0.01). In nurses, this association was confirmed only for empathy (P = -0.19; p < 0.05). Important differences in the development of professionalism and in its effects on occupational well-being appeared associated to inter-professional collaboration and work roles. An inverse correlation between age and collateral effects was confirmed in physicians (P = -0.22; p < 0.001) and in nurses (P = -28; p < 0.001). Comparison by gender confirmed higher somatization in women physicians and nurses than in men groups (p < 0.001). On the other hand, comparison by discipline confirmed higher exhaustion and alienation in physicians than in nurses (p < 0.01).Conclusion: The findings support the importance that empathy, teamwork, and lifelong learning have in practitioners’ health and welfare, and the role that cultural behaviors, associated to work professional models and social stereotypes, play in the interaction between professionalism and occupational well-being.This study was supported by the Rioja Salud Foundation (FRS), Spain