Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Las competencias b?sicas, una herramienta para enriquecer la dimensi?n socio-afectiva en los estudiantes de ciclo 2 jornada tarde, de la Instituci?n Educativa Distrital Jos? Joaqu?n Castro Mart?nez localidad cuarta de San Crist?bal Sur

122 p. Recurso Electr?nicoLa intervenci?n pedag?gica, ?Las competencias b?sicas, una herramienta para enriquecer la dimensi?n socio-afectiva en los estudiantes de ciclo dos jornada tarde, de la Instituci?n Educativa Distrital Jos? Joaqu?n castro Mart?nez localidad cuarta de san Crist?bal sur?, se llev? a cabo con el fin de fortalecer la dimensi?n socio-afectiva a partir de las competencias b?sicas (Interpretar, Argumentar y proponer). La recolecci?n de datos e identificaci?n de la problem?tica, se pudo obtener mediante la t?cnica de Investigaci?n Acci?n Participativa (IAP) y el empleo de herramientas como: la observaci?n, el diario de campo, la entrevista, el estudio de casos, grupos focales y elaboraci?n de una matriz Dofa; donde se evidenci? una problem?tica en la dimensi?n socio-afectiva, en cuanto al mal comportamiento, dificultad en la forma de relacionarse con los dem?s, situaciones de conflicto social, falta de comprensi?n y tolerancia para trabajar en grupo. Se tom? como muestra 15 estudiantes del grado tercero y 15 estudiantes del grado cuarto entre hombres y mujeres, en edades de 8 y 9 a?os; a quienes se les aplicaron 14 talleres organizados en 3 fases, la primera fase de observaci?n y diagn?stico ; la segunda fase de intervenci?n y una ?ltima fase de evaluaci?n. En conclusi?n, se obtuvieron resultados significativos donde se observ? el trabajo en grupo y la participaci?n activa, por lo cual fue satisfactorio haber participado en este proyecto, estimulando y fortaleciendo la dimensi?n socio afectiva desde las competencias b?sicas.The pedagogical intervention, "Core competencies, a tool to enrich the socio-affective dimension in students in cycle, two, afternoon shift, from the District Educational Institution ?Jose Joaquin Castro Martinez?, fourth town San Cristobal south" was held with the goal of strengthening the socio-affective dimension from basic skills (interpret, argue and propose). Data collection and identification of the problem, could be obtained by the technique of Participatory Action Research (IAP) and the use of tools such as observation, field diary, interviews, case studies, focus groups and development of a SWOT matrix; where a problem was evident in the socio-affective dimension, based on bad behavior, difficulty in the way of relating to others, social conflict, lack of understanding and tolerance for group work. 15 students of the third grade and 15 fourth graders between men and women, ages 8 and 9 years were sampled; they were applied with 14 workshops in three phases, the first phase of observation and diagnosis; the second phase of intervention and a final evaluation phase In conclusion, significant results where teamwork and active participation were obtained was observed, so it was satisfying to have participated in this project, encouraging and strengthening the socio affective dimension from basic skills. Keywords: socio-affective dimension, core competencies, interpret, argue, propose human values, integration and participation

Open borders in the nineteenth century : constructing the national, the citizen and the foreigner in South America

This working paper describes and explains the historical origins of the division between the national and the foreigner in South America. In the early nineteenth century, all the previously Spanish possessions in South America as well as Brazil achieved independence. With this new freedom, countries turned their attention to asserting their statehood through the delineation of three constitutive elements: government, territory and population. The new governments had to define who were going to be considered as nationals, citizens and foreigners, and the rights that pertained to each of these categories. These countries were all concerned with attracting new settlers and very early on introduced constitutional provisions on open borders and equal treatment for foreigners. White, male Europeans were the principal addresses of open borders provisions in an effort to entice them to settle in territories presented as empty to the exclusion of indigenous groups, bring new industries, and contribute to the whitening of mixed race populations. Whilst weak statehood came with independence, forming nations was a much longer process and States used migration and citizenship policies as tools to define nationhood