Voces del tiempo

“Voces del tiempo” es un proyecto que reflexiona, a lo largo de tres capítulos, sobre nuestra conciencia de ser y estar en el tiempo. El primer capítulo es un diálogo conceptual y cinematográfico en el que exploro las tensiones de la temporalidad, una que parece desbordarse en la actualidad. El segundo es un diario de campo que contiene mis impresiones en bruto sobre la experiencia del tiempo, que viene de películas, obras literarias y referentes que me sirven para la exploración de un universo diegético en construcción. En el tercer capítulo, diseño y escribo el guion para un largometraje con la idea de que si contemplamos y entendemos que hay un presente único y pleno, indiferenciado de la espacialidad, podemos ver la permanencia de las cosas en el tiempo.Permanence“Voices of time” is a project that reflects, over the course of three chapters, about our consciousness of being and existing in time. The first chapter is a conceptual and cinematic dialogue, where I explore the tensions of temporality, which seems to slip away nowadays. The second is a journal with my raw impressions about the experience of time, which comes from films, literary works and references that allow me to explore the diegetic universe I’m constructing. Thirdly, I design and write the screenplay for a feature film, with the idea that if we contemplate and understand that there is only one time, the present, whole in itself and undifferentiated from spatiality, we can see the permanence of things in timeComunicador (a) SocialPregrad

Laparoscopic choledochal cyst resection with simplified common bile duct reconstruction in an adult population: A case series

Introducción: Los quistes de colédoco (CC) son una patología congénita poco frecuente en la población adulta. Desde 1995, el manejo laparoscópico ha sido descrito para esta entidad. Sin embargo, su manejo se considera un tema controvertido debido al aumento del riesgo de colangiocarcinoma. Materiales y métodos: se realizó un estudio retrospectivo, observacional y descriptivo considerando pacientes diagnosticados de CC que fueron operados en un centro de referencia de cirugía hepatobiliar desde enero de 2013 hasta junio de 2018. Los pacientes fueron llevados a laparoscopia simplificada hepaticoyeyunostomía con reconstrucción en Y de Roux. Se presenta un análisis retrospectivo de los datos obtenidos. Resultados: Diez pacientes adultos con CC fueron sometidos a reconstrucción biliar quirúrgica a una edad media de 34,5 años; 75% tenía CC Todani tipo I y 25% Todani tipo IV-B CC. Aproximadamente el 50% de los pacientes fueron diagnosticados mediante colangiopancreatografía retrógrada endoscópica (CPRE) y el 50% de ellos mediante colangiopancreatografía por resonancia magnética. Ninguno requirió reintervención, no se informó mortalidad; y la estancia media en el hospital fue 5 días, ningún paciente tuvo fuga biliar posoperatoria, ninguno se convirtió a cirugía abierta y todos los pacientes tuvieron una tolerancia adecuada a la alimentación oral 2 días postoperatorios. El seguimiento a largo plazo no mostró incidencia de colangiocarcinoma después de un seguimiento de 2 años. Conclusión: Los quistes de colédoco en adultos son una patología poco frecuente que tiene una alta probabilidad de desarrollar malignidad cuando no se realiza de forma adecuada quirúrgicamente manejado y debido al reflujo biliar secundario. Estos factores hacen que el manejo quirúrgico sea una decisión crítica. El abordaje laparoscópico simplificado presentado en este trabajo parece ser una alternativa eficaz y segura a la cirugía reconstructiva de la vía biliar.Introduction: Choledochal cysts (CC) are rare congenital pathology in adult population. Since 1995, laparoscopic management has been described for this entity. Nevertheless, its management is considered to be a controversial matter due to the augmented risk of associated cholangiocarcinoma. Materials and methods: A retrospective, observational, and descriptive study was conducted considering patients diagnosed with CC who were operated at a hepatobiliary surgery referral center from January 2013 to June 2018. Patients were taken to simplified laparoscopic hepaticojejunostomy with a Roux-en-Y reconstruction. A retrospective analysis of the data obtained is presented. Results: Ten adult patients with CC underwent surgical biliary reconstruction at a mean age of 34.5 years; 75% had Todani type I CC and 25% Todani type IV-B CC. About 50% of the patients were diagnosed via endoscopic retrograde holangiopancreatography (ERCP) and 50% of them via magnetic resonance cholangiopancreatography. None required re-intervention, no mortality was reported; and the mean hospital stay was 5 days, no patient had postoperative biliary leakage, none was converted to open surgery, and all patients had adequate oral feeding tolerance 2 days postoperative. Long-term follow-up showed no incidence of cholangiocarcinoma after 2-year follow-up. Conclusion: Choledochal cysts in adults is a rare pathology that has a high probability of developing malignancy when not adequately surgically managed and because of secondary bile reflux. These factors make surgical management a critical decision. The simplified laparoscopic approach presented in this paper seems to be an effective and safe alternative to biliary duct reconstructive surgery

Financial Stability Report - September 2015

From this edition, the Financial Stability Report will have fewer pages with some changes in its structure. The purpose of this change is to present the most relevant facts of the financial system and their implications on the financial stability. This allows displaying the analysis more concisely and clearly, as it will focus on describing the evolution of the variables that have the greatest impact on the performance of the financial system, for estimating then the effect of a possible materialization of these risks on the financial health of the institutions. The changing dynamics of the risks faced by the financial system implies that the content of the Report adopts this new structure; therefore, some analyses and series that were regularly included will not necessarily be in each issue. However, the statistical annex that accompanies the publication of the Report will continue to present the series that were traditionally included, regardless of whether or not they are part of the content of the Report. In this way we expect to contribute in a more comprehensive way to the study and analysis of the stability of the Colombian financial system. Executive Summary During the first half of 2015, the main advanced economies showed a slow recovery on their growth, while emerging economies continued with their slowdown trend. Domestic demand in the United States allowed for stabilization on its average growth for the first half of the year, while other developed economies such as the United Kingdom, the euro zone, and Japan showed a more gradual recovery. On the other hand, the Chinese economy exhibited the lowest growth rate in five years, which has resulted in lower global dynamism. This has led to a fall in prices of the main export goods of some Latin American economies, especially oil, whose price has also responded to a larger global supply. The decrease in the terms of trade of the Latin American economies has had an impact on national income, domestic demand, and growth. This scenario has been reflected in increases in sovereign risk spreads, devaluations of stock indices, and depreciation of the exchange rates of most countries in the region. For Colombia, the fall in oil prices has also led to a decline in the terms of trade, resulting in pressure on the dynamics of national income. Additionally, the lower demand for exports helped to widen the current account deficit. This affected the prospects and economic growth of the country during the first half of 2015. This economic context could have an impact on the payment capacity of debtors and on the valuation of investments, affecting the soundness of the financial system. However, the results of the analysis featured in this edition of the Report show that, facing an adverse scenario, the vulnerability of the financial system in terms of solvency and liquidity is low. The analysis of the current situation of credit institutions (CI) shows that growth of the gross loan portfolio remained relatively stable, as well as the loan portfolio quality indicators, except for microcredit, which showed a decrease in these indicators. Regarding liabilities, traditional sources of funding have lost market share versus non-traditional ones (bonds, money market operations and in the interbank market), but still represent more than 70%. Moreover, the solvency indicator remained relatively stable. As for non-banking financial institutions (NBFI), the slowdown observed during the first six months of 2015 in the real annual growth of the assets total, both in the proprietary and third party position, stands out. The analysis of the main debtors of the financial system shows that indebtedness of the private corporate sector has increased in the last year, mostly driven by an increase in the debt balance with domestic and foreign financial institutions. However, the increase in this latter source of funding has been influenced by the depreciation of the Colombian peso vis-à-vis the US dollar since mid-2014. The financial indicators reflected a favorable behavior with respect to the historical average, except for the profitability indicators; although they were below the average, they have shown improvement in the last year. By economic sector, it is noted that the firms focused on farming, mining and transportation activities recorded the highest levels of risk perception by credit institutions, and the largest increases in default levels with respect to those observed in December 2014. Meanwhile, households have shown an increase in the financial burden, mainly due to growth in the consumer loan portfolio, in which the modalities of credit card, payroll deductible loan, revolving and vehicle loan are those that have reported greater increases in risk indicators. On the side of investments that could be affected by the devaluation in the portfolio of credit institutions and non-banking financial institutions (NBFI), the largest share of public debt securities, variable-yield securities and domestic private debt securities is highlighted. The value of these portfolios fell between February and August 2015, driven by the devaluation in the market of these investments throughout the year. Furthermore, the analysis of the liquidity risk indicator (LRI) shows that all intermediaries showed adequate levels and exhibit a stable behavior. Likewise, the fragility analysis of the financial system associated with the increase in the use of non-traditional funding sources does not evidence a greater exposure to liquidity risk. Stress tests assess the impact of the possible joint materialization of credit and market risks, and reveal that neither the aggregate solvency indicator, nor the liquidity risk indicator (LRI) of the system would be below the established legal limits. The entities that result more individually affected have a low share in the total assets of the credit institutions; therefore, a risk to the financial system as a whole is not observed. José Darío Uribe Governo

Estudios de propiedad intelectual

Transcurrida la primera década del siglo XXI, uno de los principales retos que continúa afrontando el derecho es determinar los mecanismos más adecuados para proteger la expresión de las ideas. Mientras algunos opinan que no deberían existir regulaciones que impidan acceder al conocimiento, otros afirman que se trata de un derecho que les asiste a los creadores y a quienes participan en el proceso creativo, razón por la cual las normas deben ser cada vez más protectoras e, incluso, sancionatorias. Son múltiples los tópicos que suscita la mencionada controversia, aplicados a diferentes aspectos de la cotidianeidad, enmarcados principalmente en temas relacionados con la investigación y el desarrollo, el comercio, la cultura y la industria del entretenimiento. Transcurrida la primera década del siglo XXI, uno de los principales retos que continúa afrontando el derecho es determinar los mecanismos más adecuados para proteger la expresión de las ideas

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

La magia de tus pensamientos : poesías & cuentos

Recopilación de poesías y cuentos realizados por aprendices del SENA de los programas de Mantenimiento de Motores Diesel, Técnico en Sistemas, Automatización Industrial, Electricidad Industrial, Diseño e Integración de Automatismos Mecatrónicos, Mantenimiento de Equipo Biomédico, Animación 3D, Manejo Ambiental, Diseño e integración de Automatismos Mecatrónicos y Mantenimiento mecatrónico automotriz, entre 2015 y 2017.Poesías 2018 -- Dándome tu vida / Brayan Orlando Jaimes Chaparro -- Tierra infinita / Christian Ricardo Caballero Villamizar -- Lamento a la tierra / Jeferson Alexis Montoya Moreno -- Conciencia por favor / Daniel Rincón -- Salvar un hogar llamado tierra / William Gamboa Arguello -- Planeta tierra / Iván Arley jurado -- Salvemos nuestro planeta / Jonathan David Silva -- Tierra bella / Martin Santiago -- Mi planeta / Fabián Moreno -- Generando conciencia / José Alberto Lizarazo -- Añoranza / Javier Casanova -- Sin tierra… / Gustavo Andrés Rodríguez Mendoza -- Planeta vivo y limpio / Yesid Serrano -- Palabras del destino / Osneider David Hernández Otalvaro -- Planeta tierra / Luis Fernando Isidro -- Medio ambiente / Yorgin David Hernández -- Prevenir / Brayan Mauricio Sanmiguel Luengas -- Nada será cómo antes / Jaime Andres Rodriguez Parrado -- Yo…Sol / Jonathan Bautista -- Lamento / Héctor Mauricio Parra Cuesta -- Nuestro hogar / Juan José Amaya -- Te agradecemos / Edwin Andrés Navarro Rozo, Anderson Cardozo Villamizar -- HErmoso milagro / Jhonatan Jaimes Solano -- El creador / Ana Rosa Hernández Santana -- Cuentos 2015 -- Juventud en la zona azul / Jeniffer Solano Ardila -- Los Ucayali y los Cubeo / Oscar Ivan Rueda Quintero -- Vientos de armonía / Ever Edinson Monsalve Salcedo -- El nacimiento de una nueva era / Carlos Leonardo Ardila Alvarado -- Luz de sueños / Hugo Andrés Álvarez -- Sol de medio día / Claudia Ramírez Guarín -- Cuentos 2016 -- Mucha verraquera mano / Héctor Josué Amado Sandoval -- El viaje de irse y nunca volver / Dayana Marcela Fuentes Duran -- “Santander es hermosa” / Kelly Tatiana Pabón Blanco -- Los valores del SENA / Ana Rosa Hernandez Santana -- La fuerza del espiritu y el deseo de cambiar / Pablo Andrés Capera Rodríguez -- SENA, paz y reconciliación / Adrián Benítez R., Rubén Darío Martínez -- Cuentos 2017 -- Cartas a un pasado / Angelita Delgado Pérez -- ¿Por qué así? ¿por qué tan blanco? ¿por qué no de otra manera? / Cristian Felipe Vargas Buenahora -- El gato pacho pacho, el gato más pacho de todos los pachos / Edwin Matajira García -- Freeland “el paraíso perdido” / Dámaso Antonio Morales Palacin -- Un mundo al revés / Fabio Eduardo Contreras Piñeresna91 página

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception