7 research outputs found
Enfrentando los riesgos socionaturales
Get PDFEl objetivo del libro es comprender la magnitud de los Riesgos Socionaturales en MĂ©xico y LatinoamĂ©rica, para comprender el peligro que existe por algĂșn tipo de desastre, ya sea inundaciones, sismos, remociĂłn en masa, entre otros, ademĂĄs conocer quĂ© medidas preventivas, correctivas y de contingencias existen para estar atentos ante alguna señal que la naturaleza estĂ© enviando y asĂ evitar alguna catĂĄstrofe. El libro se enfoca en los aspectos bĂĄsicos de anĂĄlisis de los peligros, escenarios de riesgo, vulnerabilidad y resiliencia, importantes para la gestiĂłn prospectiva o preventiva
Dementia in Latin America : paving the way towards a regional action plan
Get PDFRegional challenges faced by Latin American and Caribbean countries (LACs) to fight dementia, such as heterogeneity, diversity, political instabilities, and socioeconomic disparities, can be addressed more effectively grounded in a collaborative setting based on the open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking and translational research) and align them to current global strategies to translate regional knowledge into actions with transformative power. Then, by characterizing genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions and mapping these to the above challenges, we provide the basic mosaics of knowledge that will pave the way towards a KtAF. We describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF
Characterising the novel activation of wt1b in the notochord damage response of zebrafish larvae
Get PDFThe
notochord
is
the
defining
structure
of
all
chordates.
A
semi-Ââflexible
elongated
tube
of
cells,
it
forms
along
the
central
axis
of
the
embryo
and
provides
axial
support
during
development.
It
also
acts
as
a
signalling
centre
during
early
embryogenesis,
controlling
the
patterning
of
a
number
of
tissues
and
establishing
the
early
body
axis
of
the
embryo.
In
vertebrates,
the
function
of
the
notochord
expands
beyond
early
development.
It
creates
morphogenic
gradients
for
the
patterned
formation
of
the
vertebral
bodies
and,
in
adults,
the
remnants
of
the
notochord
form
the
nucleus
pulposus,
a
gel-Ââlike
structure
with
an
integral
role
in
the
distribution
of
vertebral
pressure
in
the
intervertebral
disc.
Little
is
known
about
how
the
notochord
copes
with
damage
during
embryogenesis,
but
degeneration
of
the
nucleus
pulposus
can
lead
to
debilitating
spinal
disorders.
In
this
thesis,
I
use
a
zebrafish
model
system
to
present
new
data
that
describes
the
cellular
behaviours
associated
with
how
the
notochord
copes
with
external
damage
and
how
this
damage
can
influence
the
future
development
of
the
vertebrae.
I
have
uncovered
a
novel
damage
response
in
the
notochord
of
zebrafish
larvae
and
characterised
the
morphogenetic
changes
involved
in
the
process
using
transgenic
fluorescent
lines.
I
have
explored
the
damage
in
the
context
of
the
Wilmsâ
Tumour
1
(Wt1)
gene,
a
vertebrate-Ââconserved
transcription
factor,
which
has
recently
been
associated
with
several
regenerative
responses,
and
discovered
that
one
of
its
zebrafish
orthologues,
wt1b,
becomes
upregulated
in
the
notochord
damage
response.
I
have
used
fluorescent
confocal
imaging
and
immunohistochemistry
to
present
new
evidence
that
shows
that
upon
injury,
the
outer
notochord
sheath
cells
upregulate
the
expression
of
wt1b.
Additionally,
I
have
used
time-Ââlapse
microscopy
to
show
that
damage
to
the
notochord
induces
novel
morphological
changes
in
the
injured
organ,
which
include
the
loss
of
cellularity
of
the
inner
vacuolated
cells
and
the
movement
of
the
wt1b-Ââpositive
outer
sheath
cells
into
the
injured
lumen.
Long-Ââterm
imaging
experiments
have
also
demonstrated
the
capacity
of
the
notochord
to
heal
the
damage
over
time,
which
ultimately
leads
to
the
formation
of
an
extra,
smaller
vertebra
in
the
wounded
area.
Skeletal
staining
of
these
fish
has
revealed
a
previously
unknown
putative
cartilage
switch
at
the
site
of
damage,
which
leads
to
the
formation
of
the
new
vertebral
body.
This
finding
has
been
supported
by
the
microarray
analysis
of
the
injured
area,
which
shows
the
unexpected
de-Âânovo
expression
of
cartilage
markers
at
the
site
of
damage
The
work
in
this
thesis
identifies
for
the
first
time
an
endogenous
repair
mechanism
in
the
notochord
of
zebrafish
larvae
and
describes
the
cellular,
genetic
and
molecular
processes
cotrolling
this
novel
wt1b-Ââassociated
damage
response
GESITRA-SEIMC/REIPI recommendations for the management of cytomegalovirus infection in solid-organ transplant patients
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Dementia in Latin America: Paving the way toward a regional action plan.
No full textAcross Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking, and translational research) and align them to current global strategies to translate regional knowledge into transformative actions. Then we characterize key sources of complexity (genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions), map them to the above challenges, and provide the basic mosaics of knowledge toward a KtAF. Finally, we describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
No full textBackground
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)
