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

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Low-Skilled Immigration and the Labor Supply of Highly Skilled Women

Low-skilled immigrants represent a significant fraction of employment in services that are close substitutes of household production. This paper studies whether the increased supply of low-skilled immigrants has led high-skilled women, who have the highest opportunity cost of time, to change their time-use decisions. Exploiting cross-city variation in immigrant concentration, we find that low-skilled immigration increases average hours of market work and the probability of working long hours of women at the top quartile of the wage distribution. Consistently, we find that women in this group decrease the time they spend in household work and increase expenditures on housekeeping services. (JEL J16, J22, J24, J61)

Deserci?n en el programa de Licenciatura en Lengua Castellana de la Universidad del Tolima desde el a?o 2012-a al 2018-A

63 p.El prop?sito del presente proyecto de investigaci?n realizar un estudio de la deserci?n en el programa de pregrado de la Licenciatura en Lengua Castellana de la universidad del Tolima 2012A ? 2018A de la Facultad de Educaci?n de la Universidad del Tolima. En el estudio se toma como referentes los trabajos realizados en este mismo campo a nivel regional, Nacional e internacional. La propuesta busca identificar los m?ltiples factores, sus causas y efectos que influyen como determinantes sociales, culturales y acad?micos que son determinantes directos e indirectos de la deserci?n. La deserci?n acad?mica tiene incidencia en el orden institucional, familiar y econ?mico que genera p?rdidas de costos de oportunidad social, as? la deserci?n afecta la productividad laboral calificada e incide en los retornos educativos de los estudiantes desertores y por ende del capital humano que son motor del desarrollo de las comunidades modernas. El prop?sito es determinar, caracterizar y sistematizar una estrategia institucional que permita la conformaci?n de l?nea base y la implementaci?n de metodolog?a para identificar y trazar estrategias para evaluar los m?ltiples factores, causas y efectos que influyen en la deserci?n escolar. Factores sociales, culturales y acad?micos que pueden ser determinantes directos e indirectos de la deserci?n en el programa de pregrado de Licenciatura en Lengua Castellana. Esto con el prop?sito de generar alertas tempranas sobre el potencial de deserci?n, trazar e implementar pol?ticas y materializar en el corto, mediano y largo plazo, las directrices mediante estrategias de contingencia que mitiguen este problema social en busca de la optimizaci?n de los indicadores de retenci?n escolar que impactan la calidad de vida en beneficio del colectivo social. Palabras clave: An?lisis de datos, deserci?n, pedagog?a.The purpose of this research project carried out a study of desertion in the undergraduate program of the bachelor's degree in Spanish language of the University of Tolima 2012A ? 2018A of the Faculty of Education of the University of Tolima. The study takes as a reference the work carried out in this same field at a regional, national and international level. The proposal seeks to identify the multiple factors, their causes and effects that influence as social, cultural and academic determinants that are direct and indirect determinants of desertion. Academic dropout has an impact on the institutional, family and economic order that generates losses in social opportunity costs, thus dropout affects qualified labor productivity and affects the educational returns of dropout students and therefore the human capital that are the driving force behind the development of modern communities. The purpose is to determine, characterize and systematize an institutional strategy that allows the establishment of a baseline and the implementation of a methodology to identify and draw up strategies to evaluate the multiple factors, causes and effects that influence school dropout. Social, cultural and academic factors that can be direct and indirect determinants of dropout from the undergraduate degree program in Spanish language. This with the purpose of alerting early alerts about the potential for desertion, drawing up and implementing policies and materializing in the short, medium and long term, the guidelines through contingency strategies that mitigate this social problem in search of the optimization of retention indicators. school that impacts the quality of life for the benefit of the social group. Keywords: Data analysis, desertion, pedagogy

La narraci?n hiperbreve para el fortalecimiento de la expresi?n y creaci?n oral en los estudiantes de ciclo dos de la Instituci?n Educativa Gimnasio Sabidur?a del Futuro de la localidad s?ptima Bosa el Recreo

142 p. Recurso Electr?nicoEl presente proyecto de intervenci?n pedag?gica ?La narraci?n hiperbreve para el fortalecimiento de la expresi?n y creaci?n oral en los estudiantes de ciclo dos de la instituci?n educativa Gimnasio Sabidur?a del Futuro de la localidad s?ptima Bosa el Recreo? es una propuesta innovadora aplicada en los grados tercero y cuarto, que adopt? como m?todo de investigaci?n la IAP usando diferentes herramientas etnogr?ficas, evidenciando una poblaci?nafectada en su expresi?n oral que a la hora de interactuar presentan actitudes de timidez, dificultades de dicci?n y respiraci?n, que conllevan al aislamiento y la poca interacci?n verbal. Partiendo del an?lisis se procedi? a intervenir directamente a los estudiantes, con narraciones orales hiperbreves desde la teor?a de Garz?n C?spedes, complementado con los ejercicios de expresi?n y creaci?n oral en el aula de los profesores Ca?as y Rodari. Se realiz? en tres talleres o fases implementadas desde la pedagog?a afectiva, cada uno con dos momentos realizados en 20 sesiones. Siendo el primero, un taller afectivo; ?Despertando o?dos sordos? de sensibilizaci?nsaber, con cinco sesiones divididas en dos momentos de exploraci?n y narraci?n, un segundo taller cognitivo; ?Acariciando la palabra? aplicaci?n-saber-hacer, con 11 sesiones, divididas en dos momentos uno cognitivo y otro practico-cognitivo y un tercer taller expresivo ?Futuristas en acci?n? producci?n-hacer y ser, con 4 sesiones, divididas en dos momentos, uno de creaci?n oral y otro de expresi?n oral narrativa. Para concluir es de gran satisfacci?n haber participado estimulando el inter?s en los estudiantes por interactuar social y verbalmente en diferentes contextos fortaleciendo su expresi?n oral. Palabras Clave: Narraci?n hiperbreve, expresi?n oral, dicci?n, timidez, respiraci?n diafragm?tica.This pedagogical intervention "The hiperbreve narrative for strengthening oral expression and creation on the second-cycle students of the educational institution Gimnasio Sabidur?a del Futuro, location seventh Bosa el Recreo " it is an innovative approach applied for the third and fourth grades, its principal resource was based on the IAP research method through the use of different ethnographic tools, it shown an affected population on their speech at the time to interact because they presented attitudes of shyness, diction and breathing difficulties, which lead to isolation and lesser verbal interaction . Based on the analysis proceeded to intervene to students directly with Hiperbreves oral narratives from the Garz?n C?spedes theory, supplemented with oral expression and creation exercises in the classroom of the Ca?as and Rodari teachers. It Was performed in three phases or activities implemented since affective pedagogy, each one with two different spots made in 20 sessions. Being the first, an effective activity; "Awakening deaf ears" awareness-Knowing, through five sessions divided into two spots of exploration and narration, a second cognitive activity; "Stroking the word" application-know-how, with 11 sessions, divided in two spots: cognitive, practical-cognitive and the third expressive activity "Futuristic in action" production-be and do, with 4 sessions, divided in two spots, the first one oral creation and the second one oral narrative expression. To conclude is of great satisfaction have participated by stimulating interest in students for social interaction and verbally in different contexts through strengthening their oral expression. Keywords: Hiperbreve narrative, speech, diction, shyness, diaphragmatic breathing.INTRODUCCI?N 15 1 PLANTEAMIENTO DEL PROBLEMA 17 2 OBJETIVOS 20 2.1 GENERAL 20 2.2 OBJETIVOS ESPEC?FICOS 20 3 HIP?TESIS 21 4 JUSTIFICACI?N 22 5 MARCO REFERENCIAL 24 5.1 ANTECEDENTES 24 5.1.1 Internacionales 24 5.1.2 Nacionales 25 5.1.3 Locales 27 5.2 MARCO LEGAL 27 5.3 MARCO EPISTEMOL?GICO 29 5.4 MARCO PSICOL?GICO 32 5.5 MARCO PEDAG?GICO 33 5.6 MARCO CONCEPTUAL 34 6 DISE?O METODOL?GICO 38 6.1 TIPOS DE INVESTIGACI?N 38 6.2 POBLACI?N 38 6.2.1 Muestra 39 6.3 ETAPAS 39 6.3.1 Etapa uno:Observaci?n 40 6.3.1.1 Fase uno 41 6.3.1.2 Fase dos: Diario de campo 40 6.3.1.3 Fase tres:Estudio de casos 41 6.3.1.4 Fase cuatro: Entrevistas 41 6.3.1.5 Fase quinta: Grupos focales 41 6.3.1.6 Fase sexta: Matriz Dofa 41 6.3.2 Etapa dos:Intervenci?n 43 6.3.2.1 Fase uno: taller de sensibilizaci?n:?Despertando o?dos sordos? 43 6.3.2.2 Fase dos: Aplicaci?n; ?Acariciando la palabra? 46 6.3.2.3 Fase tres: Producci?n; ?Futuristas en acci?n? 53 6.3.3 Etapa tres: Evaluaci?n y sistematizaci?n 56 7 AN?LISIS DE RESULTADOS 57 7.1 T?CNICA DE EVALUACI?N 57 7.2 RESULTADOS OBTENIDOS 58 7.2.1 Observaci?n 58 7.2.2 Intervenci?n 59 7.2.2.1 Fase 1: Despertando o?dos sordos 59 7.2.2.2 Fase 2: Acariciando la Palabra 74 7.2.2.3 Fase tres: Futuristas en acci?n 92 8 CONCLUSIONES 101 RECOMENDACIONES 103 REFERENCIAS 10