Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 10

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 10, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Systemic Violence and International Foreign Investment Law

El tiempo en el cual vivimos está marcado por una existencia constante de confictos armados (regulares e irregulares), falta de acceso a servicios básicos, desigualdad y un gran número de personas que viven en la pobreza. En este contexto, cobra especial importancia abordar el concepto de violencia sistémica, haciendo un análisis sobre lo que se entiende por esta y sus alcances en la realidad latinoamericana. Hannah Arendt señala que los individuos son renuentes a realizar análisis sobre la violencia y sus consecuentes problemas, lo cual genera que la violencia sea un concepto que no se analice e investigue a profundidad.1 2 Teniendo en cuenta lo anterior, este capítulo hace una primera aproximación de la relación existente entre el derecho internacional para la protección y promoción de la inversión extranjer

Racionalidad del mercado neoliberal: el motor del derecho internacional de inversiones

Neoliberalism is an ideological project characterised as being pro-market, pro-investor, and based on an instrumental rationality, which has re-shaped the relationship between societies, governments and the market, leading to standardising conducts and practices.1 In this form, neoliberal ideology has permeated throughout all of global society, ensuring that everything is seen through the lens of economic rationality. Accordingly, in this paper I will argue that neoliberalism is an ideological project that has played an essential part in shaping international investment law and creating a proinvestor regime with strong protection of property rights and contractual relationships, limiting the ability of host states to regulate in matters of public interest

BIT e a Constituição colombiana de 1991: internacionalização da economia dentro de um Estado social de dereito

Hablar de los veinte años de la Constitución desde la perspectiva de hoy, implica necesariamente detenerse a analizar  la apertura,  internacionalización e inserción de la economía Colombiana con el mundo y sus efectos en la economía nacional y per se en la sociedad. El presente artículo presenta una aproximación al desarrollo  de los Acuerdos de Promoción y Protección de la Inversión extranjera (APPRI) o Bilateral Investment Treaties (BITs) como son mundialmente conocidos, en la constitución de 1991 y la importancia dada por el estado Colombiano a estos tratados como herramientas para el desarrollo económico, tecnológico y científico. En este sentido, el artículo parte del análisis de estos tratados y su desarrollo en el ámbito internacional, para después centrarse en el estudio de los BITs en Colombia a la luz de la jurisprudencia de la Corte Constitucional sobre la materia. Del  análisis se destaca el estudio de la expropiación de inversiones extranjeras en Colombia bajo la Constitución de 1991, la contradicción existente entre los BITs y la solución dada por el legislador frente a la controversia. Finalmente el artículo realiza una crítica  desde un punto de vista teórico sobre la efectividad y necesidad de estos tratados para  la sociedad Colombiana.A discussion of the twenty years of the Constitution from today’s perspective necessarily implies an analysis of the opening, internationalization and insertion of the Colombian economy in the global markets and its effects on the nation’s economy and on society. This article discusses the development of Bilateral Investment Agreements (BITs, or APPRI by its acronym in Spanish), within the framework of the Colombian Constitution of 1991 and the importance given by the Colombian government to these treaties as a tool for economic, technological and scientific development. In this sense, this paper begins by analyzing the treaties and their development in the international scene. Then it focuses on the BITs in Colombia in the light of Constitutional Court jurisprudence and rulings on the matter. Special emphasis is made on the issue of expropriation of foreign investments in Colombia under the Constitution of 1991, the contradiction between the Constitution and the BITs, and the solution given to the controversy by Colombian Congress. Lastly, the article makes a theoretical critique on the effectiveness and necessity of these treaties for Colombian society.Falar dos vinte anos da Constituição desde a perspectiva de hoje implica necessariamente parar a analisar a apertura, internacionalização e inserção da economia colombiana com o mundo e seus efeitos na economia nacional e per se na sociedade. O presente artigo expõe uma aproximação ao desenvolvimento dos Acordos de Proteção e Promoção Recíproca de Investimento (APPRI) ou Bilateral Investment Treaties (BIT) como são mundialmente conhecidos, na Constituição do ano 1991, e a importância dada pelo Estado colombiano a estes tratados como ferramentas para o desenvolvimento econômico, tecnológico e cientifico. Neste sentido, o artigo parte da análise destes tratados e seu desenvolvimento no âmbito internacional, para depois centrar-se no estudo dos BIT na Colômbia à luz da jurisprudência da Corte Constitucional sobre a matéria. Da análise, destaca-se o estudo da expropriação de investimentos estrangeiros na Colômbia sob a Constituição do ano 1991, a contradição existente entre os BIT e a solução dada pelo legislador frente à controvérsia. Finalmente, o artigo realiza uma crítica desde um ponto de vista teórico sobre a efetividade e necessidade destes tratados para a sociedade colombiana

BITs y la Constitución Colombiana de 1991: Internacionalización de la Economía dentro de un Estado Social de Derecho

Hablar de los veinte años de la Constitución desde la perspectiva de hoy, implica necesariamente detenerse a analizar  la apertura,  internacionalización e inserción de la economía Colombiana con el mundo y sus efectos en la economía nacional y per se en la sociedad. El presente artículo presenta una aproximación al desarrollo  de los Acuerdos de Promoción y Protección de la Inversión extranjera (APPRI) o Bilateral Investment Treaties (BITs) como son mundialmente conocidos, en la constitución de 1991 y la importancia dada por el estado Colombiano a estos tratados como herramientas para el desarrollo económico, tecnológico y científico. En este sentido, el artículo parte del análisis de estos tratados y su desarrollo en el ámbito internacional, para después centrarse en el estudio de los BITs en Colombia a la luz de la jurisprudencia de la Corte Constitucional sobre la materia. Del  análisis se destaca el estudio de la expropiación de inversiones extranjeras en Colombia bajo la Constitución de 1991, la contradicción existente entre los BITs y la solución dada por el legislador frente a la controversia. Finalmente el artículo realiza una crítica  desde un punto de vista teórico sobre la efectividad y necesidad de estos tratados para  la sociedad Colombiana

El concepto de “Expropiación Indirecta”, su aparición en el sistema internacional y sus efectos en la actividad regulatoria de los gobiernos

The protection of an alien’s property in a host country against direct expropriation has long existed in the international arena. Examples of direct expropriation include nationalization, physical seizure of assets or legislated transfer of assets to the state. However such physical takings are no longer common practice. Nowadays, expropriation comes mainly in the form of “indirect expropriation”: acts and steps taken by governments which interfere with the right to the property or diminish the value of the property. This paper explores the most relevant antecedents of the concept of indirect expropriation, its appearance in the international system, the inclusion in BITs and Investment Chapters of FTAs, and the effect that the concept is having on the regulatory activity of governments

Descolonizando las epistemologías, politizando los derechos: una entrevista con Eduardo Mandieta

Interview to Eduardo Mendiet

The teaching of International Law in Bogotá: A preliminary diagnosis, departing from the analysis of syllabuses and its relationship with the epistemologies of not-knowing

Resumen Este artículo presenta los resultados de un diagnóstico inicial realizado en 24 programas de cursos de derecho internacional (DI) de 10 universidades bogotanas para analizar y problematizar la educación del derecho internacional, a la luz de las epistemologías de la ignorancia (agnotología). Este primer estudio sobre el tema busca sentar las bases para discusiones futuras que lo complementen o contradigan y que resulten en, por ejemplo, trabajos que hagan propuestas para repensar los alcances de la enseñanza en derecho internacional en Bogotá. El estudio preliminar muestra que la forma actual de educación del DI en Bogotá se caracteriza por una línea eurocéntrica clásica, no interdisciplinaria y donde la relación de la educación del DI con las problemáticas locales es limitada. El artículo muestra cómo la enseñanza del DI en Bogotá crea pun-tos ciegos epistemológicos o epistemologías de ignorancia. La creación de estas epistemologías de ignorancia limita la percepción y problematización para que los estudiantes y abogados, mediante la práctica de DI, puedan ver alternativas de conceptualización, reflexionando sobre los orígenes del DI, su relación con los proyectos coloniales e imperiales y su conexión con el contexto local.Abstract This paper presents the results of a preliminary empirical study analysing 24 syllabuses of International Law related subjects from 10 Universities in Bogotá. This empirical study is analysed using the theoretical framework of epistemologies of ignorance (agnotology). This preliminary and limited empirical study seeks to be the starting point for future discussions with colleagues in Colombia and in the region about the teaching and learning of IL in the region. In pursuing this empirical research, the paper shows that the teaching of IL in Bogotá tent to take an orthodox and Eurocentric approach, not pursuing an interdisciplinary approach and not focusing on local problems. In this sense, the paper argues that the way how IL is taught in Bogotá creates epistemological blind spots, that we refer as epistemologies of ignorance. The creation of this epistemologies of ignorance limits the perception and problematisation that the students and IL lawyers may have in reflecting on the origins of the IL, its relationship with colonial and imperial projects and its relationship with the local context