Modelo de gestión urbana sostenible

Este libro tiene como propósito brindar al lector un compendio de opiniones y puntos de vista generados por expertos desde diferentes áreas del conocimiento, que le permitan tener una visión global de los elementos que se deben considerar cuando se busca entender y generar soluciones a problemas que emergen de sistemas urbanos. Vale mencionar que lo presentado aquí no contiene todos los puntos de vista y opiniones posibles, y que en muchos casos es factible aportar desde algún tópico no incluido aquí. Este libro está dirigido a todas aquellas personas que tengan algún interés en el análisis de problemas urbanos, así como a un público más amplio que pueda encontrar aquí ideas y opiniones que le permitan formarse las suyas propias sobre estos asuntos

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

Educación intercultural en el aula

El proyecto consiste en desarrollar actividades interdisciplinares que sirvan para resolver situaciones de descompensación curricular, dificultades de comunicación y problemas de convivencia, dado el aumento de la situación multicultural en el centro. Los objetivos son preparar al alumno para desenvolverse en entornos multiculturales, desarrollando habilidades sociales específicas; elaborar materiales didácticos y de evaluación de la práctica sobre educación intercultural. La metodología es dinámica, se desarrolla a través de tutorías, programaciones, actividades complementarias y materiales de evaluación. Las actividades son interdisciplinares y de ámbito amplio, desarrolladas en fechas clave, el 19 de diciembre -Día de la Convivencia-, el 30 de enero -Día de la Paz-, el 21 de marzo - Día de la no Discriminación- y el 9 de mayo -la Jornada Intercultural-. La evaluación valora la superación del etnocentrismo, la curiosidad, la empatía y la apertura, esto es la capacidad de emitir juicios utilizando otros parámetros culturales y la apropiación selectiva de nuevos valores. ontiene: una relación de hojas de evaluación y valoración de las actividades clasificadas por materia (original y copia) ; dos cuestionarios, uno para el alumnado y otro para el profesorado; una encuesta sobre interculturalidad; y un análisis de los resultados de esta encuesta .- 2 videos con imágenes del desarrollo de las actividades .- dos carpetas, 1 y 1a, que contienen fichas de cada actividad, fotocopia de los artículos publicados en el diario escolar y fotografías que ilustran las actividades .- y otras dos carpetas, 2 y 2a, que contienen la programación de actividades de educación intercultural, más anexos, en los áreas de educación plástica y visual, tecnología, geografía e historia, francés, música, en las tutorías.Madrid (Comunidad Autónoma). Consejería de EducaciónMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Avances en Informática y Automática. Undécimo Workshop

Actas de los trabajos de TFM del Máster Universitario en Sistemas Inteligentes[ES]El Máster Oficial en Sistemas Inteligentes de la Universidad de Salamanca tiene como principal objetivo promover la iniciación de los estudiantes en el ámbito de la investigación. El congreso organizado por el Departamento de Informática y Automática que se celebra dentro del Máster en Sistemas Inteligentes de la Universidad de Salamanca proporciona la oportunidad ideal para que sus estudiantes presenten los principales resultados de sus Trabajos de Fin de Máster y obtengan una realimentación del interés de los mismos. La undécima edición del workshop Avances en Informática y Automática , correspondiente al curso 2016 - 2017, ha sido un encuentro interdisciplinar donde se han presentado trabajos pertenecientes a un amplio abanico de líneas de investigación, desde los sistemas biométricos y la visualización de la información hasta la minería de datos pasando por otros campos relacionados. Todos los trabajos han sido supervisados por investigadores de reconocido prestigio pertenecientes a la Universidad de Salamanca, proporcionando el marco idóneo para sentar las bases de una futura tesis doctoral. Entre los principales objetivos del congreso se encuentran: Ofrecer a los estudiantes un marco donde exponer sus primeros trabajos de investigación. Proporcionar a los participantes un foro donde discutir ideas y encontrar nuevas sugerencias de compañeros, investigadores y otros asistentes a la reunión. Permitir a cada estudiante una realimentación de los participantes sobre su trabajo y una orientación sobre las futuras direcciones de investigación. Contribuir al desarrollo del espíritu de colaboración en la investigación

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN