Juventud y control social : Acerca de las nuevas estrategias de prevención del delito y la definición de grupos juveniles en riesgo

Con el objetivo de presentar los primeros avances del abordaje del “Programa de Prevención Socio-comunitaria para jóvenes” vigente actualmente en la Ciudad de Buenos Aires (Ministerio de Justicia y Seguridad, Subsecretaría de Seguridad urbana, Dirección de Políticas de Seguridad y Prevención del Delito) partimos de un abordaje anclado en una perspectiva donde “la categoría control social no individualiza procesos particulares, no recorta un área específica de objetos sociales, sino que, (…) [considera]- potencialmente de cada proceso, de cada objeto- los aspectos que contribuyen a la producción de lo bueno y lo malo, de lo normal y lo patológico: qué procesos y qué objetos deben ser analizados en modo privilegiado según esta clave dependerá de la interacción entre los intereses culturales y políticos del observador, la dislocación de los conflictos y el surgimiento de nuevos actores sociales” (Pitch, 1996:59). Ahora bien, ya hemos dado cuenta del impacto que ha tenido la imposición del modelo neoliberal a escala global específicamente en nuestras latitudes: muy sintéticamente, solamente diremos aquí que, anclando particularmente en las estructuras productivas de los estados nación (Daroqui, 2003) ha implicado la retracción de estos últimos en su calidad de reductores de riesgos (Castel, 2004). En este marco, algunos autores como De Giorgi (2000) se han preguntado si la caída de los Estados de Bienestar ha implicado estrictamente la caída del modelo disciplinario de control social, cuya descripción más acabada podemos encontrar en los escritos de Foucault (1989).Jornadas realizadas junto con el I Encuentro Latinoamericano de Metodología de las Ciencias Sociales.Facultad de Humanidades y Ciencias de la Educació

A survey on the use of intra-aortic balloon pump in cardiac surgery

Intra-aortic balloon pump (IABP) is an established tool in the management of cardiac dysfunction in cardiac surgery. The best timing for IABP weaning is unknown and varies greatly among cardiac centers. The authors investigated the differences in IABP management among 66 cardiac surgery centers performing 40,675 cardiac surgery procedures in the 12-month study period. The centers were contacted through email, telephone, or in person interview. IABP management was very heterogeneous in this survey: In 43% centers it was routinely removed on the first postoperative day, and in 34% on the second postoperative day. In 50% centers, it was routinely removed after extubation of the patients whereas in 15% centers it was removed while the patients were sedated and mechanically ventilated. In 66% centers, patients were routinely receiving pharmacological inotropic support at the time of removal of IABP. The practice of decreasing IABP support was also heterogeneous: 57% centers weaned by reducing the ratio of beat assistance whereas 34% centers weaned by reducing balloon volume. We conclude that the management of IABP is heterogeneous and there is a need for large prospective studies on the management of IABP in cardiac surgery

Decreasing mortality with drotrecogin alfa in high risk septic patients A meta-analysis of randomized trials in adult patients with multiple organ failure and mortality >40%

Objective. Sepsis is a complex inflammatory disease, rising in response to infection. Drotrecogin alfa, approved in 2001 for severe sepsis, has been withdrawn from the market. The aim of this study was to assess if drotrecogin alfa-activated can reduce mortality in the more severe septic patients. Methods. We searched PubMed, Embase, Scopus, BioMedCentral, and in Clinicaltrials. gov databases to identify every randomized study performed on drotrecogin alfa-activated in any clinical setting in humans, without restrictions on dose or time of administration. Our primary end-point was mortality rate in high risk patients. Secondary endpoints were mortality in all patients, in patients with an Acute Physiology and Chronic Health Evaluation (APACHE) 2 score ≥ 25 and in those with an APACHE 2 score ≤25. Results. Five trials were identified and included in the analysis. They randomized 3196 patients to drotrecogin alfa and 3111 to the control group. Drotrecogin alfa was associated with a reduction in mortality (99/263 [37.6%] vs 115/244 [47.1%], risk ratios (RR) = 0.80[0.65; 0.98], p = 0.03) in patients with multiple organ failure and a mortality risk in the control group of >40%, but not in the overall population or in lower risk populations. Conclusions. In high risk populations of patients with multiple organ failure and a mortality of >40% in the control group, Drotrecogin alfa may still have a role as a lifesaving treatment. No beneficial effect in low risk patients was found. An individual patient meta-analysis including all randomized controlled trial on sepsis is warranted, along with new studies on similar drugs such as protein C zymogen

Adaptive protocols based on predictions from a mechanistic model of the effect of IL7 on CD4 counts

International audienc

Use of mathematical modeling for optimizing and adapting immunotherapy protocols in HIV-infected patients

International audienc

Non-adrenergic vasopressors in patients with or at risk for vasodilatory shock. A systematic review and meta-analysis of randomized trials

Introduction: Hypotensive state is frequently observed in several critical conditions. If an adequate mean arterial pressure is not promptly restored, insufficient tissue perfusion and organ dysfunction may develop. Fluids and catecholamines are the cornerstone of critical hypotensive states management. Catecholamines side effects such as increased myocardial oxygen consumption and development of arrhythmias are well known. Thus, in recent years, interest in catecholamine-sparing agents such as vasopressin, terlipressin and methylene blue has increased; however, few randomized trials, mostly with small sample sizes, have been performed. We therefore conducted a meta-analysis of randomized trials to investigate the effect of non-catecholaminergic vasopressors on mortality. Methods: PubMed, BioMed Central and Embase were searched (update December 31st, 2014) by two independent investigators. Inclusion criteria were: random allocation to treatment, at least one group receiving a non-catecholaminergic vasopressor, patients with or at risk for vasodilatory shock. Exclusion criteria were: crossover studies, pediatric population, nonhuman studies, studies published as abstract only, lack of data on mortality. Studied drugs were vasopressin, terlipressin and methylene blue. Primary endpoint was mortality at the longest follow-up available. Results: A total of 1,608 patients from 20 studies were included in our analysis. The studied settings were sepsis (10/20 studies [50%]), cardiac surgery (7/20 [35%]), vasodilatory shock due to any cause (2/20 [19%]), and acute traumatic injury (1/20 [5%]). Overall, pooled estimates showed that treatment with non-catecholaminergic agents improves survival (278/810 [34.3%] versus 309/798 [38.7%], risk ratio = 0.88, 95%confidence interval = 0.79 to 0.98, p = 0.02). None of the drugs was associated with significant reduction inmortality when analyzed independently. Results were not confirmed when analyzing studies with a low risk of bias. Conclusions: Catecholamine-sparing agents in patients with or at risk for vasodilatory shock may improve survival. Further researches on this topic are needed to confirm the finding

La violencia detrás de los muros: Una reflexión crítica sobre las prácticas de las agencias de control penal

Este artículo presenta y analiza los resultados de una investigación sobre violencia institucional intramuros desarrollada en unidades penales de la provincia de Buenos Aires (Argentina) durante el año 2008. En particular, se analizan los resultados obtenidos para el subconjunto de los jóvenes detenidos, dando cuenta de la agudización de la violencia institucional aplicada sobre este grupo etario, que se constituye -a través de la visibilización de las prácticas institucionales- como un grupo sobrevulnerado al interior de la población penal.This paper presents and analyzes results of a research project on institutional violence inside Buenos Aires (Argentina) state prisons during 2008. Specifically, the analysis focuses on general findings for the sub group of young inmates, revealing the deepening of institutional violence imposed over this age group, which appears - through the visibilization of institutional practices- as the most repressed group within penal population.Fil: Graziano, María Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Guemureman, Silvia Teresa. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Jorolinsky, Karen. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Lopez, Ana Laura. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Pasin, Julia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study

The efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. Current literature mainly examined efficacy, safety and potential predictors of NIV failure provided out of the intensive care unit (ICU). On the contrary, the outcomes of ICU patients, intubated after NIV failure, remain to be explored. The aims of the present study are: (1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and (2) assessing whether the length of NIV application affects patient survival. This observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February-April 2020), who underwent endotracheal intubation after NIV failure. Among the 704 patients admitted to ICU during the study period, 280 (40%) presented the inclusion criteria and were enrolled. The median age was 69 [60-76] years; 219 patients (78%) were male. In-hospital mortality was 43%. Only the length of NIV application before ICU admission (OR 2.03 (95% CI 1.06-4.98), p = 0.03) and age (OR 1.18 (95% CI 1.04-1.33), p < 0.01) were identified as independent risk factors of in-hospital mortality; whilst the length of NIV after ICU admission did not affect patient outcome. In-hospital mortality of ICU patients intubated after NIV failure was 43%. Days on NIV before ICU admission and age were assessed to be potential risk factors of greater in-hospital mortality

Rol de los medios de comunicación en el despliegue de los mecanismos de control social, proactivos y reactivos : Legitimación de la violencia estatal contra los jóvenes pobres y su vinculación discursiva con la "delincuencia"

El objetivo de este trabajo es aportar en el debate sobre el rol de los medios masivos de comunicación en la generación de consensos sociales, enmarcados dentro de las políticas de control social proactivas, y su vinculación con la legitimación de mecanismos de control social represivos sobre jóvenes-pobres, asociados discursivamente con “la delincuencia”.Facultad de Humanidades y Ciencias de la Educació

Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS

Background Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS. Methods Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th-April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. Results A total of 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality (p value for nonlinearity = 0.01), with a greater risk of death for values < 48 ml/cmH(2)O; (2) the association between DP and ICU mortality was linear (p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH(2)O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06-1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55-1.52). Multivariable analysis confirmed these findings. Conclusions Crs < 48 ml/cmH(2)O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death