Incidencia de enfermedad metabólica ósea en neonatos

Introduction. Metabolic bone disease of premature infants is a rare complication, established due to lower mineral content in bone tissue. Objective. To establish the incidence of metabolic bone disease in premature infants and associated risk factors. Materials and method. A descriptive prospective cohort study was carried out for one year in all newborns under 32 weeks or 1500 g at the Hospital Universitario de Santander, to determine the incidence of metabolic bone disease. In the selected patients, demographic data and prenatal history were established, later a measurement of serum alkaline phosphatase and serum phosphorus was performed at the third week of birth, having reference values for diagnosis <5.6mg/dl and alkaline phosphatase >500IU/ L. For the analysis of the information, statistical tools were applied such as average proportions, dispersion measures, distribution measures, association measures, and binomial regression. Results. A total of 58 patients were, of which 7 had a diagnosis of metabolic bone disease, with an incidence of 12%. The weight was reported as an independent variable for the development of the disease, being significant in children under 1160g, as well as prolonged parenteral nutrition >24 days. When performing the multivariate analysis, weight and time of parenteral nutrition are described as risk factors, but also maternal age below <22 years and birth weight under 1160g are characterized by having a higher relative risk than weight <1160g. Conclusion. The importance of early intervention in patients with metabolic bone disease-enhancing risk factors, such as weight and prolonged parenteral nutrition, is established to prevent severe complications.Introducción. La enfermedad metabólica ósea del prematuro es una complicación poco común, establecida por menor contenido mineral en el hueso. Objetivo. Establecer la incidencia de la enfermedad metabólica ósea en prematuros y factores de riesgo asociados. Materiales y métodos. Se realizó un estudio de cohorte prospectivo descriptivo durante un año a todos los recién nacidos menores de 32 semanas o <1500 g en el Hospital Universitario de Santander. En los pacientes seleccionados se establecieron datos demográficos y antecedentes prenatales, posteriormente se realizó una medición de fosfatasa alcalina y fósforo séricos a la tercera semana de nacimiento, con valores de referencia diagnóstica < 5,6mg/dl y fosfatasa alcalina > 500UI/L. Para el análisis de la información se aplicaron herramientas estadísticas como proporciones de promedio, medidas de dispersión, distribución, y asociación; y regresión binomial. Resultados. Se obtuvieron un total de 58 pacientes, de los cuales 7 tuvieron diagnóstico de enfermedad metabólica ósea, con una incidencia del 12%. De las variables estudiadas, el peso se reportó como variable independiente para el desarrollo de la enfermedad, siendo significativa en menores de 1160g, igualmente la nutrición parenteral prolongada >24 días. Al realizar el análisis multivariado se describen el peso y tiempo de nutrición parenteral como factores de riesgo, además la edad materna <22 años presentó un riesgo relativo mayor, a comparación del peso <1160 g. Conclusión. Se establece la importancia de intervención temprana de pacientes con factores de riesgo potenciadores de enfermedad metabólica ósea, como el peso y nutrición parenteral prolongada mayor a 24 días, con el fin de prevenir complicaciones severas

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamentos de Cundinamarca y Chocó.

Este trabajo se aborda desde una perspectiva psicosocial de como la violencia ha transformado las sociedades en el marco del conflicto armado en Colombia. En la primera parte se realiza un análisis del caso de Shimaia, identificando los emergentes psicosociales de la historia, el tipo de violencia, como se lograron afrontar las diferentes adversidades y por último el planteamiento de unas preguntas circulares, reflexivas y estratégicas. Posteriormente, en la segunda parte se aborda del caso de la masacre del Salado, en el que se estudian los emergentes psicosociales del caso, un relato de la vida de la comunidad y los procesos sociohistóricos los impactos, las experiencias de violencia, resiliencia y transformación que vivieron como parte de la historia para finalizar con unas estrategias psicosociales. Y, para terminar, en la tercera y última parte, en el informe analítico, se encuentra una reflexión acerca de la identificación y visibilización de los problemas sociales a través de la fotografía, en los territorios de Fontibón, el Monumento a las Banderas, la fundación infantil, el Municipio de Sutatausa y Quibdó, de cómo el arte, la acción psicosocial y comunitaria se entrelazan para generar un impacto significativo en la sociedad. Así mismo, la resiliencia, la capacidad de adaptación y la búsqueda de formas de construir comunidad son aspectos fundamentales para afrontar situaciones difíciles para superar adversidades en cualquier contexto social, darle voz a quienes han sido marginados y vulnerados, promoviendo la construcción de memorias colectivas más inclusivas y diversas.This work is approached from a psychosocial perspective of how violence has transformed societies in the framework of the armed conflict in Colombia. In the first part, an analysis of the case of Shimaia is carried out, identifying the psychosocial emergents of the story, the type of violence, how they managed to face the different adversities and finally the approach of circular, reflective and strategic questions. Subsequently, in the secondpart, the case of the Salado massacre is addressed, in which the psychosocial emergents of the caseare studied, an account of the life of the community and the socio-historical processes, the impacts,the experiences of violence, resilience and transformation. who lived as part of history to end withsome psychosocial strategies. And finally, in the third and last part, in the analytical report, there is a reflection on the identification and visibility of social problems through photography, in the territories of Fontibón, the Monument to the Flags, the Foundation children, the Municipality of Sutatausa and Quibdó, of how art, psychosocial and community action are intertwined to generate a significant impact on society. Likewise, resilience, the ability to adapt and the search for ways to build community are fundamental aspects to face difficult situations to overcome adversities in any social context, give voice to those who have been marginalized and violated, promoting the construction of collective memories more inclusive and diverse

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

La Dorada, Caldas : un lugar mágico lleno de paz y emociones mil ¡Que viva mi terruño que tanto amo! : recopilación de cuentos folclóricos

En el libro recupera cuentos folclóricos, versos, canciones, juegos y mitos producto de la tradición oral difundida en La Dorada Caldas y le da reconocimiento a los narradores de la cultura oral del poblado.In the book, he recovers folk tales, verses, songs, games and myths that are the product of the oral tradition spread in La Dorada Caldas and gives recognition to the narrators of the oral culture of the town.El fantasma -- Anécdota de la patasola -- Historia del mohán -- El pollito pio -- Nos ayudamos -- La emboscada -- Toño un amigo con diversidad -- El horripilante olvido en medio de un temblor -- Valoremos -- Mito de un arriero -- El juego de la candela -- Canción el capitán de un buque -- Versos -- Multiplicadores de la cultura oral.na66 página

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

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI