Techo de cristal inquebrantable

El fin de este trabajo es conocer la evolución de las mujeres en el mundo laboral, todo lo que a día de hoy se ha conseguido y cómo se ha conseguido, así como todos los aspectos laborales en los cuales sigue existiendo desigualdad, analizando las posibles causas. Como veremos a lo largo del documento, hay diversos motivos que crean estas desigualdades y trataremos de ofrecer distintas opciones para enfrentarlos, colectiva e individualmente. <br /

Utilidad diagnóstica de los marcadores de estrés oxidativo en artritis reumatoide precoz en pacientes no fumadores y anti-CCP negativos

Fundamento. A pesar del desarrollo de nuevos marcadores y cri- terios diagnósticos para la artritis reumatoide (AR), todavía mu- chos pacientes son diagnosticados tras varios años de síntomas. Los marcadores de estrés oxidativo se incrementan ya en una fase temprana de la enfermedad. El objetivo del presente estudio fue evaluar el valor diagnóstico adicional de estos marcadores. Método. Se realizó un estudio de casos y controles. Los pacien- tes reclutados para el estudio cumplían los criterios para AR de la ACR 1987, todos ellos tenían menos de 2 años de síntomas y sin tratamiento previo con fármacos modificadores de la enfer- medad antirreumática (DMARD), esteroides o vitamina E. Los controles fueron seleccionados de los familiares del paciente y pareados (1:1) por sexo, edad, hábito tabáquico actual. Los marcadores de daño oxidativo que se midieron fueron malo- nildialdehído (MDA), hidroperóxidos lipídicos (LOOH) y pro- teínas carboniladas (CP). El Análisis estadístico se realizó de acuerdo con la STARD. resultados. Se incluyeron sesenta y cinco pacientes con AR sin tratamiento y 65 controles sanos. LOOH, CP, los anticuerpos con péctidos citrulinados (anti-CCP) y el factor reumatoide (FR) fueron significativamente mayores en los pacientes, y MDA fue mayor en los controles. Los mismos resultados se obtuvieron en los subgrupos de pacientes que fuman o no, y en anti-CCP positivos o negativos. El valor diagnóstico de los marcadores tradicionales mostró una buena especificidad pero una baja sensibilidad. La construcción de los modelos logísti- cos con la adicción de LOOH y CP aumenta la sensibilidad y el área bajo la curva ROC, especialmente en los no fumadores (66%) y los pacientes negativos ante-CCP (51%). conclusiones. Al incorporar LOOH o CP a los marcadores de la enfermedad tradicionales en AR, bien por separado o ambos conjuntamente, mejoró el diagnóstico de AR, especialmente en los pacientes no fumadores o aquellos con anticuerpos anti- CCP negativos.background. Besides the development of new markers and di- agnostic criteria for rheumatoid arthritis (RA), many patients are still diagnosed after several years of symptoms. Oxidative stress markers are already increased at an early stage of RA. Our aim was to evaluate the additional diagnostic value of these markers. Methods. A case-control study was performed. Patients met the 1987 RA ACR criteria, less than 2 years of symptoms and no previous treatment with disease-modifying anti-rheumatic drugs (DMARD), steroids or vitamin E. Controls were select- ed from patient’s relatives and matched (1:1) by gender, age, and current smoking habit. Oxidative damage markers were malonyldialdehyde (MDA), Lipid hydroperoxides (LOOH) and Carbonyl proteins (CP). Statistical analysis was performed in agreement with the STARD initiative. results. Sixty-five RA patients without treatment and 65 healthy controls were included. LOOH, CP, antibodies against citrullinated peptides (anti-CCP) and rheumatoid factor (RF) were significantly higher in patients, and MDA higher in con- trols. The same results were obtained in the subgroups of pa- tients who smoke or not, and in anti-CCP positive or negative. The diagnosis performance of traditional markers showed good specificity but low sensitivity. The addition of LOOH and CP increased the sensitivity and the area under the receiving operating characteristic (ROC) curve especially in non-smok- ing (66%) and negative anti-CCP (51%) patients. conclusions. The separate or combined addition of LOOH or CP to the traditional disease markers improved the diag- nosis of RA, especially in non-smoking or negative anti-CCP patients

A new HVAC ductwork steady-state flow analysis method: The Minimum Energy Dissipation Principle applied to flow networks including the effects of branched junctions

The fact that the popular head loss coefficient concept, may become negative in branched junctions, is a symptom that something is not correctly managed. The paper makes a review of recent works which have sought new models based on physical concepts, as a way to avoid speaking about “negative losses”. Herwing and Schmandt [1], showed that the origin of the negative sign was a diffusive shear work exchange between the two streams of a branched junction. Traditionally, the head losses at the branched junctions are neglected, but definitely it cannot be done in HVAC air-duct networks. Firstly, the paper illustrates how, by ignoring this “negative loss” contradiction, traditional duct network analysis may encounter unexpected numerical difficulties. Secondly, it shows that the Minimum Energy Dissipation Principle (MinEDP) can be successfully applied to analyze the steady-state of any flow network (not necessarily HVAC ductworks), with or without shear work at junctions. Moreover, the new method does not need to know the latter, beforehand, although the nature of the solution is very different in either case. Finally, the paper includes a practical example of an HVAC ductwork to illustrate the outcomes. The new method works smoothly and quickly and does not need any ad hoc modification to cope with an eventual “negative” head loss

The Role of Aerosol Concentration on Precipitation in a Winter Extreme Mixed-Phase System: The Case of Storm Filomena

Aerosol concentration, size and composition are fundamental in hydrometeor formation processes. Meteorological models often use prescribed aerosol concentrations and a single substance. In this study, we analyze the role of aerosol concentration, acting both as CCN and IN, in the development of precipitation in a mixed phase system in numerical weather simulations. To this end, Storm Filomena was selected as the case study. In such a mixed-phase system, the coexistence of supercooled water with ice crystals, as well as the particular existence of a thermal inversion, led to the formation of precipitation in the form of rain, snow and graupel. Several high resolution experiments varying the fixed background aerosol concentration as well as a simulation with an interactive aerosol calculation were performed by means of the WRF-Chem model, using the same physics suite, domain and driving conditions. Results show that the total precipitation remains basically unaltered, with maximum changes of 5%; however, the production of snow is heavily modified. The simulation with maximum prescribed aerosol concentration produced 27% more snow than the interactive aerosol simulation, and diminished the graupel (74%) and rain production (28%). This redistribution of precipitation is mainly linked to the fact that under fixed ice crystal population the variation of aerosol concentration translates into changes in the liquid water content and droplet size and number concentration, thus altering the efficiency of precipitation production. In addition, while modifying the prescribed aerosol concentration produces the same precipitation pattern with the concentration modulating the precipitation amount, interactive aerosol calculation leads to a different precipitation pattern due to the spatial and temporal variability induced in the dynamical aerosol distribution

Biloma secondary to blunt liver trauma in a pediatric patient: case report

Liver is the organ most frequently injured after blunt or penetrating abdominal trauma, being in pediatrics a pathology that has an increasing incidence; Non-operative management is the hallmark of treatment, however cases of secondary biliary leakage have been described, which may affect the intrahepatic or extrahepatic track. A male 8 years old, with blunt trauma in the right hypochondrium, presenting acute abdomen and hemodynamic instability, requiring exploratory laparotomy with a grade III liver injury in VI and VII hepatic segments. Four weeks after discharge, he presented as a complication a giant biloma in VII and VIII hepatic segments, performing percutaneous drainage guided by ultrasound. The incidence of biliary complications related to hepatic trauma is low, 4% in pediatric patients, dividing into bilomas or biliary fistulas; the presentation of biliary leakage is very non-specific and early diagnosis difficult; in the bilomas, the tomography allows to define precisely its size, nature, distribution and regional anatomy in relation to adjacent structures, as well as underlying cause. The approach of choice is percutaneous or endoscopic drainage, with surgical management being the last option

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamentos del Cesar y Bolívar

Durante más de 5 décadas de violencia, el territorio Colombiano fue sometido a la voluntad de los grupos armados al margen de la ley, en este periodo se conformaron diferentes ideologías y movimientos en todo el territorio Colombiano. Hemos vivido una situación de violencia que parece nunca acabar, muchas son las familias que han quedado desamparadas, olvidadas, asesinadas, desplazadas y violentadas a tal punto que son sujetas a muchos pensares subjetivos. A pesar de los sucesos ocurridos, son re victimizados sufriendo constantemente el fuerte golpe de la violencia. Es importante adentrarnos en el abordaje de los escenarios de violencia a través del cortometraje, que nos da una clara idea de todos los sucesos a los que fueron sometidas todas estas familias indígenas, que tuvieron que dejar a un lado sus costumbres, creencias y decisiones para someterse a otra cultura con el fin de no ser masacrados, vulnerados y violentados. Este espacio académico, nos brindó un escenario concreto que nos permitió llegar más a fondo acerca de los sucesos que afectan a las poblaciones más vulnerables de nuestro territorio nacional. Este espacio nos permite a través de imágenes, reflexiones y cuestionamientos acerca del conflicto armado en Colombia, determinar la importancia de esta problemática en nuestra sociedad y así mismo, se dan a conocer las estrategias de abordaje psicosocial para el Caso de Masacre en El Salado: relatos de resiliencia después de 20 años.During more than 5 decades of violence, the Colombian territory was subdued by the will of illegal armed groups. During this period, different ideologies and movements were formed throughout the territory. We have experienced a situation of violence that seems to never end. Many families have been left helpless, forgotten, killed, displaced, and assaulted to such an extent that they are subject to many subjective thoughts. Despite the events that have occurred, they are revictimized, constantly suffering the heavy strike of violence. It is important to dig into the approach to the scenes of violence through the short film figure; which gives us a clear idea of all the events to which all these indigenous families were subdued, who had to put aside their customs, beliefs, and decisions to be subjected to another culture in order not to be massacred, harmed and assaulted. This academic space provided us with a specific scenario that allowed us to go deeper into the events that affect the most vulnerable populations in our national territory. Through images, reflections, and questions about the armed conflict in Colombia, this space allows us to determine the importance of this problem in our society and, on the other hand, to make known the psychosocial approach strategies for the Case of the Massacre in El Salado: stories of resilience after 20 years

sFlt-1/PlGF for prediction of early-onset pre-eclampsia: STEPS (Study of early pre-eclampsia in Spain)

Objective: A high ratio of soluble fms‐like tyrosine kinase‐1 (sFlt‐1) to placental growth factor (PlGF) has been linked to pre‐eclampsia (PE). We evaluated the sFlt‐1/PlGF ratio as a predictive marker for early‐onset PE in women at risk of PE. Methods: This prospective, Spanish, multicenter study included pregnant women with a risk factor for PE, including intrauterine growth restriction, PE, eclampsia or hemolysis, elevated liver enzymes and low platelet count syndrome in previous pregnancy, pregestational diabetes or abnormal uterine artery Doppler. The primary objective was to show that the sFlt‐1/PlGF ratio at 20, 24 and 28 weeks' gestation was predictive of early‐onset PE (< 34 + 0 weeks). Serum sFlt‐1 and PlGF were measured at 20, 24 and 28 weeks. Multivariate logistic regression was used to develop a predictive model. Results: A total of 819 women were enrolled, of which 729 were suitable for analysis. Of these, 78 (10.7%) women developed PE (24 early onset and 54 late onset). Median sFlt‐1/PlGF ratio at 20, 24 and 28 weeks was 6.3 (interquartile range (IQR), 4.1–9.3), 4.0 (IQR, 2.6–6.3) and 3.3 (IQR, 2.0–5.9), respectively, for women who did not develop PE (controls); 14.5 (IQR, 5.5–43.7), 18.4 (IQR, 8.2–57.9) and 51.9 (IQR, 11.5–145.6) for women with early‐onset PE; and 6.7 (IQR, 4.6–9.9), 4.7 (IQR, 2.8–7.2) and 6.0 (IQR, 3.8–10.5) for women with late‐onset PE. Compared with early‐onset PE, the sFlt‐1/PlGF ratio was significantly lower in controls (P < 0.001 at each timepoint) and in women with chronic hypertension (P < 0.001 at each timepoint), gestational hypertension (P < 0.001 at each timepoint) and late‐onset PE (P < 0.001 at each timepoint). A prediction model for early‐onset PE was developed, which included the sFlt‐1/PlGF ratio plus mean arterial pressure, being parous and previous PE, with areas under the receiver–operating characteristics curves of 0.86 (95% CI, 0.77–0.95), 0.91 (95% CI, 0.85–0.97) and 0.93 (95% CI, 0.86–0.99) at 20, 24 and 28 weeks, respectively, and was superior to models using the sFlt‐1/PlGF ratio alone or uterine artery mean pulsatility index. Conclusions: The sFlt‐1/PlGF ratio can improve prediction of early‐onset PE for women at risk of this condition