Modelling human choices: MADeM and decision‑making

Research supported by FAPESP 2015/50122-0 and DFG-GRTK 1740/2. RP and AR are also part of the Research, Innovation and Dissemination Center for Neuromathematics FAPESP grant (2013/07699-0). RP is supported by a FAPESP scholarship (2013/25667-8). ACR is partially supported by a CNPq fellowship (grant 306251/2014-0)

Gestión ambiental y desarrollo agropecuario sostenible

Este libro reúne las principales investigaciones desarrolladas por estudiantes, docentes y egresados de la Escuela de Ciencias Agrícolas, Pecuarias y del Medio Ambiente (ECAPMA) de la Universidad Nacional Abierta y a Distancia UNAD y su Grupo de Investigación INYUMACIZO, categorizado en A por Minciencias, el cual desde hace más de una década viene desarrollando investigación científica y aplicada de alto impacto en la región surcolombiana,especialmente en los departamentos de Tolima, Huila, Caquetá y Putumayo.Se deriva a partir de un riguroso trabajo interdisciplinar y de aliados estratégicos (autoridades ambientales, alcaldías municipales, empresas de servicios públicos domiciliarios, sector productivo, entre otros), para convertirse en una valiosa herramienta de gestión, planificación y toma de decisiones para el sector ambiental y agropecuario de la región surcolombiana.El libro está dividido en dos capítulos. Un primer capítulo denominado Gestión ambiental y un segundo capítulo denominado Desarrollo agropecuario sostenible. Los resultados obtenidos en cada capítulo, así como el marco metodológico propuesto en cada una de las investigaciones brindan alternativas de gestión y desarrollo agropecuario sostenible, permitiendo conocer las potencialidades de cada sistema analizado, y sirviendo como línea base para mejorar la productividad y competitividad del sector.En este contexto, el libro presentado se constituye en un recurso valioso de consulta con el fin de brindar herramientas de análisis, soporte, planificación y gestión de los recursos naturales y el territorio a profesionales, técnicos, consultores, estudiantes de ciencias agropecuarias, ambientales, ingenierías, entre otros, interesados en temas de gestión ambiental y desarrollo agropecuario sostenible

Intraoperative transfusion practices in Europe

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended