Cofradías de esclavos negros, morenos y mulatos libres en la Catedral de Santo Domingo, Primada de América

The evangelization of the indigenous and spiritual assistance to the colonizers and Creoles, was a priority in the conquest and colonization of the Indies. The black slave was also evangelized but with different strategies, one of them was the brotherhood, which was installed in the churches and fulfilled an essential function giving the slave participation in religious and social events. For this reason, the objective of this research is to describe the brotherhoods of blacks, brunettes and mulattos that existed in the Cathedral of Santo Domingo, its composition and religious syncretism.La evangelización del indígena y la asistencia espiritual a los colonizadores y criollos fue prioridad en la conquista y colonización, de las Indias. El esclavo negro, también fue evangelizado, pero con estrategias diferentes, siendo una de ellas las cofradías, que se instalaron en las iglesias y cumplieron una función esencial dándole participación al esclavo en eventos religiosos y sociales. Por tal motivo, el objetivo de esta investigación es describir las cofradías de negros, morenos y mulatos que existieron en la Catedral de Santo Domingo, su composición y el sincretismo religioso

Thermal Behavior Assessment of Two Types of Roofs of the Dominican Vernacular Housing

The Dominican vernacular architecture, based on the indigenous bohio with Spanish influence, is built with natural materials, such as the royal palm (Roystonea Hispaniolana) and the cana palm (Sabal Dominguensis). This model of housing has remained practically unchanged for five centuries, responding adequately to the Caribbean tropical climate. In the twentieth century, start to replace the traditional palm leaf roof by a corrugated sheet zinc, significantly affecting the temperature inside these houses and altering the conditions of living comfort. For this reason, the aim of this research is to evaluate the thermal behavior of two roof types of vernacular housing. One type is a cana palm leaf roof and the other is a corrugated sheet zinc roof. The houses are in the towns of Villa Sombrero and Sabana Buey, Peravia Province, in the southwest of the Dominican Republic, a region with a Tropical savanna climate (Aw) according to the Köppen-Geiger climate classification. The climate is characterized by temperatures from 20°C to 38°C, with rainfall below 500 mm per year. The technique and tools used for this research are: Infrared Thermography (IRT) and digital thermometer for measure of thermal properties of roof materials, a thermometer and hygrometer to measure the relative humidity and temperature inside and outside of the houses, and carbon monoxide (CO) and carbon dioxide (CO2) meter. Passive IRT is used to measures the temperature differences of a structure that are generated under normal conditions. The results indicate that there is a difference in temperature between one type of roofing material and the other. Finding that houses with palm leaf roofs have lower temperature than corrugated sheet zinc roof and present a temperature difference between the interior and exterio

Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Cofradías de esclavos negros, morenos y mulatos libres en la Catedral de Santo Domingo, Primada de América

The evangelization of the indigenous and spiritual assistance to the colonizers and Creoles, was a priority in the conquest and colonization of the Indies. The black slave was also evangelized but with different strategies, one of them was the brotherhood, which was installed in the churches and fulfilled an essential function giving the slave participation in religious and social events. For this reason, the objective of this research is to describe the brotherhoods of blacks, brunettes and mulattos that existed in the Cathedral of Santo Domingo, its composition and religious syncretism.La evangelización del indígena y la asistencia espiritual a los colonizadores y criollos fue prioridad en la conquista y colonización, de las Indias. El esclavo negro, también fue evangelizado, pero con estrategias diferentes, siendo una de ellas las cofradías, que se instalaron en las iglesias y cumplieron una función esencial dándole participación al esclavo en eventos religiosos y sociales. Por tal motivo, el objetivo de esta investigación es describir las cofradías de negros, morenos y mulatos que existieron en la Catedral de Santo Domingo, su composición y el sincretismo religioso

Application of Geophysical Prospecting Methods for Soil Structure Characterization of the Cathedral of Santo Domingo, Dominican Republic

Hispaniola is in the edge of interaction between the North American and Caribbean plates. In this zone, the occurrence of earthquakes greater than 5.0, Mw is frequent, characterizing it as a seismically active zone. These earthquakes cause considerable material damage and can provoke loss of human lives. The Cathedral of Santo Domingo, Primate of the Americas, is in the Colonial City of Santo Domingo. It is the most important colonial building in Dominican Republic, was built between 1521-1541, and is a masonry building made with stone ashlars and covered with stone ribbed vault. However, it is essential to know about the possible seismic behavior that the ground could have in case of a relevant earthquake to try to avoid possible damage to this heritage. For this reason, the aim of this research is to apply geophysical prospecting methods for the seismic site characterization of the Cathedral of Santo Domingo. For this study, the geophysical methods applied were: MASW (Multichannel Analysis of Surface Wave), H/V Spectral Ratio and Georadar. The characterization of site conditions was determined with the values of the average shear wave velocity for the top 30 m of soil (Vs30) obtained with the MASW method. As a main result it was found that the site seismic class determined with the MASW method was type C- very dense soil and soft rock (360-760 m/s), according to the NEHRP classification. In addition, the Georadar tests allowed confirming that there are no unknown caverns in the basement of the Cathedral in the first 5 m, thus it is accepted as valid the seismic classification of the soil obtained by the MASW method