La historia de la educaci?n en Am?rica Latina : contribuci?n y aportes de la Sociedad de Historia de la Educaci?n Latinoamericana - SHELA (1994-2015).

Este texto evidencia las conclusiones de la investigaci?n, sobre la historia de la educaci?n latinoamericana, bajo la perspectiva de una red acad?mica internacional, que centra su trabajo en la Sociedad de Historia de la Educaci?n Latinoamericana (Shela, 1994). De las premisas a las conclusiones, la investigaci?n expresa el objetivo expl?cito de avanzar hacia una comprensi?n de la disciplina en tiempos de transdisciplinariedad y presentando la prospectiva de la misma. Nos interes? destacar c?mo se construy? el campo intelectual de Shela, mostrando los resultados de esas investigaciones vinculadas con las redes locales, regionales, nacionales e internacionales con el impacto que han representado en cada pa?s. Se constat? que en su actividad internacional viene aportando elementos te?ricos, metodol?gicos y estrat?gicos para pensar en una nueva perspectiva historiogr?fica de la historia de la educaci?n en Am?rica Latina y el Caribe. Es as? que se han renovado las categor?as metodol?gicas e incorporado temas invisibilizados por la historiograf?a tradicional, en los nuevos contextos latinoamericanos. El m?todo se centr? en la historia social de la educaci?n, incursionando en las mentalidades, con la metodolog?a comparada que se ha interiorizado en las investigaciones de Shela. Las fuentes se establecen desde el archivo de SHELA, grupos de investigaci?n y entrevistas. Palabras-clave: Shela, Revista Historia de la Educaci?n Latinoamericana, historiograf?a, comunidad acad?mica, historia de la educaci?n latinoamericana.Este texto evidencia as conclus?es da pesquisa sobre a hist?ria da educa??o latino-americana a partir da perspectiva de uma rede acad?mica internacional, que centra o seu trabalho na Sociedad de Historia de la Educaci?n Latinoamericana (Shela, 1994). Das premissas ?s conclus?es a pesquisa expressa o objetivo expl?cito de avan?ar para uma compreens?o da disciplina em tempos de transdisciplinaridade e apresentando a sua prospectiva. Interessou-nos destacar como o campo intelectual da Shela foi constru?do, evidenciando os resultados dessas pesquisas ligadas ?s redes locais, regionais, nacionais e internacionais e o impacto representado em cada pa?s. Verificou-se que, em sua atividade internacional, se tem aportados elementos te?ricos, metodol?gicos e estrat?gicos para pensar em uma nova perspectiva historiogr?fica da hist?ria da educa??o na Am?rica Latina e no Caribe. Assim, as categorias metodol?gicas t?m sido renovadas e se incorporam temas, at? ent?o, tornados invis?veis pela historiografia tradicional, nos novos contextos latino-americanos. O m?todo situa-se na hist?ria social da educa??o, adentrando nas mentalidades, com a metodologia comparativa que tem sido internalizada nas pesquisas de Shela. As fontes s?o estabelecidas a partir do arquivo de Shela, grupos de pesquisa e entrevistas

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Forma??o de docentes e o modelo pedag?gico da Universidade Pedag?gica e Tecnol?gica da Col?mbia.

El modelo pedag?gico de la Facultad de Ciencias de la Educaci?n de la Universidad Pedag?gica y Tecnol?gica de Colombia se concibe a partir del enfoque human?stico, propuesto por la Universidad desde sus inicios con el antecedente directo de la Escuela Normal Superior en Colombia. La aproximaci?n al enfoque educativo y a los modelos pedag?gicos que subyacen en la facultad se establece desde el m?todo de la historia social de la educaci?n, los imaginarios, y el an?lisis cualitativo. Se concluye que el enfoque educativo human?stico cambi? de cat?lico a cr?tico y se mantiene bajo el principio de la integralidad del ser humano, se evidencia una aproximaci?n a la tendencia cognoscitiva actual, que se ubica en la escuela del pensamiento epistemol?gico y se inclina hacia modelos cr?ticos sociales dentro de un c?digo ?tico de principios, enmarcados en la identidad del desempe?o profesional del educador. Se propone, en la aproximaci?n al modelo pedag?gico cr?tico, una tr?ada equilibrada en la cual se llega desde el educador y el educando al centro focal del acto del conocimiento, esto bajo el principio de la dialogicidad y mediado por la responsabilidad social, la pedagog?a emancipatoria y la felicidad del ser humano en la construcci?n de la paz de Colombia.O modelo pedag?gico da Faculdade de Ci?ncias da Educa??o da Universidade Pedag?gica e Tecnol?gica da Col?mbia ? concebido a partir do enfoque human?stico, proposto pela universidade desde seu in?cio, com o antecedente direto da Escola Normal Superior na Col?mbia. A abordagem do enfoque educativo e dos modelos pedag?gicos subjacentes na faculdade foi estabelecida a partir do m?todo da hist?ria social da educa??o, dos imagin?rios e da an?lise qualitativa. Conclui-se que o enfoque educativo human?stico mudou do cat?lico ao cr?tico e se mant?m sob o princ?pio da integridade do ser humano; ? evidente uma aproxima??o ? tend?ncia cognoscitiva atual, que ? embasada na escola do pensamento epistemol?gico e se inclina na dire??o de modelos cr?ticos sociais dentro de um c?digo ?tico de princ?pios, fundamentados na identidade do desempenho profissional do educador. Prop?e-se, na aproxima??o ao modelo pedag?gico cr?tico, uma tr?ade equilibrada por meio da qual se chega, a partir do educador e do educando, ao centro focal do ato do conhecimento, isto sob o princ?pio da dialogicidade e mediado pela responsabilidade social, ? pedagogia emancipat?ria e a felicidade do ser humano na constru??o da paz da Col?mbia

A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae

Objective To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). Patients and Methods A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. Results The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. Conclusion A validated score predictive of early mortality in patients with BSIs due to CPE was developed. Trial Registration clinicaltrials.gov Identifier: NCT01 764490

Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): a retrospective cohort study

Background The best available treatment against carbapenemase-producing Enterobacteriaceae (CPE) is unknown. The objective of this study was to investigate the effect of appropriate therapy and of appropriate combination therapy on mortality of patients with bloodstream infections (BSIs) due to CPE. Methods In this retrospective cohort study, we included patients with clinically significant monomicrobial BSIs due to CPE from the INCREMENT cohort, recruited from 26 tertiary hospitals in ten countries. Exclusion criteria were missing key data, death sooner than 24 h after the index date, therapy with an active antibiotic for at least 2 days when blood cultures were taken, and subsequent episodes in the same patient. We compared 30 day all-cause mortality between patients receiving appropriate (including an active drug against the blood isolate and started in the first 5 days after infection) or inappropriate therapy, and for patients receiving appropriate therapy, between those receiving active monotherapy (only one active drug) or combination therapy (more than one). We used a propensity score for receiving combination therapy and a validated mortality score (INCREMENT-CPE mortality score) to control for confounders in Cox regression analyses. We stratified analyses of combination therapy according to INCREMENT-CPE mortality score (0\ue2\u80\u937 [low mortality score] vs 8\ue2\u80\u9315 [high mortality score]). INCREMENT is registered with ClinicalTrials.gov, number NCT01764490. Findings Between Jan 1, 2004, and Dec 31, 2013, 480 patients with BSIs due to CPE were enrolled in the INCREMENT cohort, of whom we included 437 (91%) in this study. 343 (78%) patients received appropriate therapy compared with 94 (22%) who received inappropriate therapy. The most frequent organism was Klebsiella pneumoniae (375 [86%] of 437; 291 [85%] of 343 patients receiving appropriate therapy vs 84 [89%] of 94 receiving inappropriate therapy) and the most frequent carbapenemase was K pneumoniae carbapenemase (329 [75%]; 253 [74%] vs 76 [81%]). Appropriate therapy was associated with lower mortality than was inappropriate therapy (132 [38\uc2\ub75%] of 343 patients died vs 57 [60\uc2\ub76%] of 94; absolute difference 22\uc2\ub71% [95% CI 11\uc2\ub70\ue2\u80\u9333\uc2\ub73]; adjusted hazard ratio [HR] 0\uc2\ub745 [95% CI 0\uc2\ub733\ue2\u80\u930\uc2\ub762]; p<0\uc2\ub70001). Among those receiving appropriate therapy, 135 (39%) received combination therapy and 208 (61%) received monotherapy. Overall mortality was not different between those receiving combination therapy or monotherapy (47 [35%] of 135 vs 85 [41%] of 208; adjusted HR 1\uc2\ub763 [95% CI 0\uc2\ub767\ue2\u80\u933\uc2\ub791]; p=0\uc2\ub728). However, combination therapy was associated with lower mortality than was monotherapy in the high-mortality-score stratum (30 [48%] of 63 vs 64 [62%] of 103; adjusted HR 0\uc2\ub756 [0\uc2\ub734\ue2\u80\u930\uc2\ub791]; p=0\uc2\ub702), but not in the low-mortality-score stratum (17 [24%] of 72 vs 21 [20%] of 105; adjusted odds ratio 1\uc2\ub721 [0\uc2\ub756\ue2\u80\u932\uc2\ub756]; p=0\uc2\ub762). Interpretation Appropriate therapy was associated with a protective effect on mortality among patients with BSIs due to CPE. Combination therapy was associated with improved survival only in patients with a high mortality score. Patients with BSIs due to CPE should receive active therapy as soon as they are diagnosed, and monotherapy should be considered for those in the low-mortality-score stratum. Funding Spanish Network for Research in Infectious Diseases, European Development Regional Fund, Instituto de Salud Carlos III, and Innovative Medicines Initiative

A Multinational, Preregistered Cohort Study of beta-Lactam/beta-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-beta-Lactamase-Producing Enterobacteriaceae

The spread of extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether beta-lactam/beta-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.