Efeméride en los treinta años de fundación del Barrio el Caimito, municipio de Palmira, Valle del Cauca : Una historia del tiempo presente (1990 - 2020).

Esta investigación formativa resignifica la efeméride del barrio El Caimito, municipio de Palmira, mediante la reconstrucción de sus treinta años de historia del tiempo presente donde se privilegia la memoria de sus habitantes como fuente oral, para coadyuvar a fortalecer el arraigo y sentido de pertenencia por el barrio como lugar. Para ello emplea la metodología cualitativa, el diseño etnográfico y aplica dos estrategias de muestreo: en cadena y de participantes voluntarios, con técnicas como la observación en campo, entrevistas no estructuradas y semiestructuradas, trianguladas con la revisión documental, diarios y fotografías. Lo anterior permite reconstruir una historia socio espacial en la cual se evidencia cómo el fenómeno de la delincuencia produce un vaciamiento social del barrio que, posteriormente, es resignificado con el habitar culturalmente distinto de otras poblaciones, quienes llegan a transformar esos espacios atribuyéndole otros sentidos de lugar, toda vez que despliegan la espacialidad de sus prácticas cotidianas a modo de hologramas socio-espaciales. Se concluye finalmente, y entre otras razones, que la falta de una Junta de Acción Comunal sólida ha impedido la integración entre sus habitantes y, en consecuencia, el reconocimiento de estas prácticas como parte fundamental de la construcción socio espacial, cultural y emocional del lugar-barrio El Caimito.PregradoLICENCIADO(A) EN EDUCACIÓN BÁSICA CON ÉNFASIS EN CIENCIAS SOCIALE

New Insights Into the Pharmacological Management of Postoperative Pain: A Narrative Review

Postoperative pain is prevalent and often undertreated. There is a risk that untreated or suboptimally treated postoperative pain may transition into chronic postoperative pain, which can be challenging to treat. Clinical guidelines recommend the use of multimodal analgesia, including non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and, in some cases, opioids. NSAIDs are a broad class of drugs with different attributes such as cyclo-oxygenase (COX)-1 or COX-2 selectivity, onset of action, and analgesic potency. NSAIDs are associated with gastrointestinal and cardiovascular side effects and should be administered at the lowest effective dose for the shortest effective duration but can be effective in postoperative pain. The role of opioids in postoperative analgesia is long-standing but has recently come under scrutiny. Opioids are often used in multimodal analgesic combinations in such a way as to minimize the total consumption of opioids without sacrificing analgesic benefit. Special clinical considerations are required for surgical patients already on opioid regimens or with opioid use disorder. A particularly useful fixed-dose combination product for postoperative analgesia is dexketoprofen-tramadol, which confers safe and effective postoperative pain control and reduces the risk of persistent postoperative pain

Iatrogenic Side Effects of Pain Therapies

Pain regimens, particularly for chronic cancer and noncancer pain, must balance the important analgesic benefits against potential risks. Many effective and frequently used pain control regimens are associated with iatrogenic adverse events. Interventional procedures can be associated with nerve injuries, vascular injuries, trauma to the spinal cord, and epidural abscesses. Although rare, these adverse events are potentially catastrophic. Pharmacologic remedies for pain must also consider potential side effects that can occur even at therapeutic doses of over-the-counter remedies such as paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs. Opioids are effective pain relievers but are associated with many side effects, some of which can be treatment limiting. A prevalent and distressing side effect of opioid therapy is constipation. Opioid-induced constipation is caused by binding to opioid receptors in the gastrointestinal system, making conventional laxatives ineffective. Peripherally acting mu-opioid receptor antagonists are a new drug class that offers the benefits of preserving opioid analgesia without side effects in the gastrointestinal system. An important safety concern, particularly among geriatric patients is the increasingly prevalent condition of polypharmacy. Many senior patients take five or more medications, including some that may be contraindicated in geriatric patients, duplicative of other drugs, have potential pharmacokinetic drug-drug interactions, or may not be the optimal choice for the patient's age and condition. Careful assessment of medications in the elderly, including possibly deprescribing with tapering of certain drugs, may be warranted but should be done systematically and under clinical supervision.</p

Interacciones de fertilizantes y sales del suelo

Se hizo la investigación por medio de un experimento de umbráculo usando suelo de la granja de la Universidad Tecnológica del Magdalena franco arcillo arenoso, para determinar los efectos en el desarrollo y composición del algodonero (Gossypium hirsutum L.) de las distintas combinaciones de sales y fertilizantes. En casos de niveles bajos a moderados de salinidad, las aplicaciones de nitrógeno, fósforo y potasio, redujeron los efectos nocivos de la salinidad del suelo en los rendimientos. En el caso de los altos niveles de salinidad, no se encontró ninguna mejora en el rendimiento. Los rendimientos fueron más afectados por el cloruro de sodio que por el cloruro de potasio, a igual concentración de sal en el suelo y en presencia de un fertilizante NP, El pH del suelo bajó tanto en la parte saturada como en la dilución 1:2,5 al aumentar la salinidad. El contenido canónico del algodonero (Gossypium hirsutum L.), varió directa mente en la salinidad del suelo, bajó la asimilación del potasio por las plantas, pero al aumentar el potasio en el suelo, no tuvo ningún efecto consistente sobre la absorción de sodio. Cuando se aplicaron cantidades equivalentes de sodio y potasio, el complejo de intercambio catiónico absorbió mas potasi

Future projections of Mediterranean cyclone characteristics using the Med-CORDEX ensemble of coupled regional climate system models

Here, we analyze future projections of cyclone activity in the Mediterranean region at the end of the twenty-first century based on an ensemble of state-of-the-art fully-coupled Regional Climate System Models (RCSMs) from the Med-CORDEX initiative under the Representative Concentration Pathway (RCP) 8.5. Despite some noticeable biases, all the RCSMs capture spatial patterns and cyclone activity key characteristics in the region and thus all of them can be considered as plausible representations of the future evolution of Mediterranean cyclones. In general, the RCSMs show at the end of the twenty-first century a decrease in the number and an overall weakening of cyclones moving across the Mediterranean. Five out of seven RCSMs simulate also a decrease of the mean size of the systems. Moreover, in agreement with what already observed in CMIP5 projections for the area, the models suggest an increase in the Central part of the Mediterranean region and a decrease in the South-eastern part of the region in the cyclone-related wind speed and precipitation rate. These rather two opposite tendencies observed in the precipitation should compensate and amplify, respectively, the effect of the overall reduction of the frequency of cyclones on the water budget over the Central and South-eastern part of the region. A pronounced inter-model spread among the RCSMs emerges for the projected changes in the cyclone adjusted deepening rate, seasonal cycle occurrence and associated precipitation and wind patterns over some areas of the basin such as Ionian Sea and Iberian Peninsula. The differences observed appear to be determined by the driving Global Circulation Model (GCM) and influenced by the RCSM physics and internal variability. These results point to the importance of (1) better characterizing the range of plausible futures by relying on ensembles of models that explore well the existing diversity of GCMs and RCSMs as well as the climate natural variability and (2) better understanding the driving mechanisms of the future evolution of Mediterranean cyclones properties

Molecular typing of ST239-MRSA-III from diverse geographic locations and the evolution of the SCCmec III element during its intercontinental spread

ST239-MRSA-III is probably the oldest truly pandemic MRSA strain, circulating in many countries since the 1970s. It is still frequently isolated in some parts of the world although it has been replaced by other MRSA strains in, e.g., most of Europe. Previous genotyping work (Harris et al., 2010; Castillo-Ramírez et al., 2012) suggested a split in geographically defined clades. In the present study, a collection of 184 ST239-MRSA-III isolates, mainly from countries not covered by the previous studies were characterized using two DNA microarrays (i) targeting an extensive range of typing markers, virulence and resistance genes and (ii) a SCCmec subtyping array. Thirty additional isolates underwent whole-genome sequencing (WGS) and, together with published WGS data for 215 ST239-MRSA-III isolates, were analyzed using in-silico analysis for comparison with the microarray data and with special regard to variation within SCCmec elements. This permitted the assignment of isolates and sequences to 39 different SCCmec III subtypes, and to three major and several minor clades. One clade, characterized by the integration of a transposon into nsaB and by the loss of fnbB and splE was detected among isolates from Turkey, Romania and other Eastern European countries, Russia, Pakistan, and (mainly Northern) China. Another clade, harboring sasX/sesI is widespread in South-East Asia including China/Hong Kong, and surprisingly also in Trinidad & Tobago. A third, related, but sasX/sesI-negative clade occurs not only in Latin America but also in Russia and in the Middle East from where it apparently originated and from where it also was transferred to Ireland. Minor clades exist or existed in Western Europe and Greece, in Portugal, in Australia and New Zealand as well as in the Middle East. Isolates from countries where this strain is not epidemic (such as Germany) frequently are associated with foreign travel and/or hospitalization abroad. The wide dissemination of this strain and the fact that it was able to cause a hospital-borne pandemic that lasted nearly 50 years emphasizes the need for stringent infection prevention and control and admission screening

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries