Factores de Riesgo Asociados a la Conducta Homicida de un Niño hacia un Par

Los casos de niños homicidas son escasos, pero tienen gran impacto social y legislativo, llevando al estudio de factores de riesgo y protectores de la actividad delictiva temprana. Dado el único registro en Chile de un homicidio por parte de un niño, el objetivo de este estudio fue analizar los factores de riesgo individuales y contextuales asociados a dicha conducta homicida de un niño menor de 10 años hacia un par. Se utilizó un diseño de caso único con diagnóstico multidisciplinar, con evaluaciones clínica individual y familiar, neuropsicológica y psiquiátrica. Los principales hallazgos son escasa flexibilidad cognitiva del niño y retroalimentación emocional en sus relaciones familiares, que se asociarían a los factores de riesgo: pautas educativas familiares, características de personalidad y uso del tiempo (jugar videojuegos violentos) y podrían explicar la conducta homicida, donde al niño le sería difícil detener la conducta violenta una vez iniciada, en un contexto demandante emocionalmente

Impact of operatoŕs experience on peri-procedural outcomes with Watchman FLX: Insights from the FLX-SPA registry

Background: The Watchman FLX is a device upgrade of the Watchman 2.5 that incorporates several design enhancements intended to simplify left atrial appendage occlusion (LAAO) and improve procedural outcomes. This study compares peri-procedural results of LAAO with Watchman FLX (Boston Scientific, Marlborough, Massachusetts) in centers with varying degrees of experience with the Watchman 2.5 and Watchman FLX. Methods: Prospective, multicenter, 'real-world' registry including consecutive patients undergoing LAAO with the Watchman FLX at 26 Spanish sites (FLX-SPA registry). Implanting centers were classified according to the center's prior experience with the Watchman 2.5. A further division of centers according to whether or not they had performed ≤ 10 or > 10Watchman FLX implants was prespecified at the beginning of the study. Procedural outcomes of institutions stratified according to their experience with the Watchman 2.5 and FLX devices were compared. Results: 359 patients [mean age 75.5 (SD8.1), CHA2DS2-VASc 4.4 (SD1.4), HAS-BLED 3.8(SD0.9)] were included. Global success rate was 98.6%, successful LAAO with the first selected device size was achieved in 95.5% patients and the device was implanted at first attempt in 78.6% cases. There were only 9(2.5%) major peri-procedural complications. No differences in efficacy or safety results according to the centeŕs previous experience with Watchman 2.5 and procedural volume with Watchman FLX existed. Conclusions: The Watchman FLX attains high procedural success rates with complete LAA sealing in unselected, real-world patients, along with a low incidence of peri-procedural complications, regardless of operatoŕs experience with its previous device iteration or the number of Watchman FLX devices implanted

Expedición cangrejo negro : informe técnico

El huracán Iota que pasó por las islas de providencia y Santa catalina el 16 de noviembre de 2020 produjo efectos importantes en los ecosistemas de las islas, así como en los servicios que estos ofrecen a las comunidades locales y que dan lugar a un atractivo turístico que se constituye en la principal actividad económica de las islas. Este trabajo corresponde a un esfuerzo por identificar áreas importantes para la prestación de los servicios ecosistémicos (SSE) en especial aquellas que pudieron haber resultado especialmente afectadas como resultado de Iota, para tal fin se aborda un enfoque basado en el análisis de datos geoespaciales, apoyado por la consulta de información secundaria. La revisión de la información secundaria permitió identificar SSE relevantes en la isla fundamentalmente relacionados con protección frente a desastres naturales y servicios de provisión y regulación hídrica, mientras que los análisis espaciales permitieron identificar cuencas importantes frente a estos servicios como Freshwater, Bailey, Bowden y Santa Catalina Sur, los análisis de imágenes satelitales por su parte permitieron identificar áreas afectadas por la pérdida de vegetación y acumulación de biomasa.Bogot

Sostenibilidad y desarrollo humano integral

282 páginasEl Centro de Estudios para el Desarrollo Humano Integral (Cedhin) de la Universidad de La Sabana viene estudiando los desafíos del desarrollo global y la necesidad de un compromiso universal con el futuro del planeta. En este caso, ha reunido expertos en distintas áreas para proponer proyectos sociales, políticos, económicos y culturales, orientados a mejorar el modo de vida de muchas personas. En medio de la pandemia de la covid-19, vimos conveniente aportar ideas para la nueva sociedad que estamos llamados a construir entre todos después de la compleja situación que afrontamos. De ahí la convocatoria a esta reflexión interdisciplinaria, resultado de las investigaciones de los profesores invitados desde diversas áreas geográficas y epistemológicas. Esperamos que este libro, fruto de un trabajo mancomunado como aporte a la regeneración que exige la pandemia de la covid-19, estimule el compromiso generoso y solidario para promover un verdadero desarrollo humano integral.1. Desarrollo, desafíos, decisiones||2. El desarrollo humano integral en la doctrina social de la Iglesia||3. Contornos del bien común: derechos humanos, desarrollo y paz||4. La ecología de Francisco: de la “ecología integral” hacia el “pacto educativo global” ||5. Los negocios en la doctrina social de la Iglesia||6. Pilares de la perspectiva cristiana sobre la empresa y la acción directiva||7. La gerencia centrada en las capacidades humanas, condición necesaria para el desarrollo sostenible||8. La construcción de bienes públicos pospandemia: la renta básica universal||9. Las políticas de garantía pública de empleo: alternativa de dignificación del trabajo humano||10. Pensar las relaciones políticas, económicas y sociales desde el bien común, para lograr un desarrollo socioeconómico integral||11. La cooperación internacional como herramienta del desarrollo sostenible: una lectura desde las Agencias de Desarrollo Económico Local en Colombia||12. Programa de Desarrollo con Enfoque Territorial (PDET) de la subregión Chocó: aproximaciones desde las encíclicas sobre desarrollo humano integral||13. Epílogo. Experiencias internacionales para mejorar el desarrollo humano y la sostenibilida

TALLER: PRÁCTICAS DE LABORATORIO SUSTENTABLES; UN DIÁLOGO DESDE EL CUIDADO DEL AMBIENTE Y LA ENSEÑANZA DE LA FÍSICA. UNA PROPUESTA DESDE LAS MÁQUINAS DE GOLDBERG

Este taller pretende mostrar la importancia de las máquinas de Goldberg como herramienta de dialogo entre las tensiones en la enseñanza de la Física y el problema generalizado de desperdicio de elementos reciclables en las diversas escuelas de básica y media. Que se devele una solución dialógica enmarcada en la creación de prácticas de laboratorio de física, accesible para los estudiantes, entendiendo la accesibilidad a las cuestiones prácticas y por supuesto cognitivas, asociadas a los montajes de laboratorio. Esta propuesta surge de la preocupación generalizada de los estudiantes del seminario de enseñanza de la física, del departamento de Física, apropósito de vislumbrar nuevas formas para la enseñanza de la física en la escuela, que trascienda lo tradicional y se posibiliten como punto de encuentro de las necesidades particulares de la comunidad educativa, para este caso, encontramos dos particularidades de preocupación colectiva, la primera, mostrar la física como una ciencia al alcance de todos y segundo decantar las consecuencias de generar una lógica del cuidado del entorno.Esta apuesta surge en el marco de las discusiones del seminario de enseñanza de la física (licenciatura en física) a propósito del papel que tiene la física en la escuela frente a su enseñabilidad

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Twenty-three unsolved problems in hydrology (UPH) – a community perspective

This paper is the outcome of a community initiative to identify major unsolved scientific problems in hydrology motivated by a need for stronger harmonisation of research efforts. The procedure involved a public consultation through on-line media, followed by two workshops through which a large number of potential science questions were collated, prioritised, and synthesised. In spite of the diversity of the participants (230 scientists in total), the process revealed much about community priorities and the state of our science: a preference for continuity in research questions rather than radical departures or redirections from past and current work. Questions remain focussed on process-based understanding of hydrological variability and causality at all space and time scales. Increased attention to environmental change drives a new emphasis on understanding how change propagates across interfaces within the hydrological system and across disciplinary boundaries. In particular, the expansion of the human footprint raises a new set of questions related to human interactions with nature and water cycle feedbacks in the context of complex water management problems. We hope that this reflection and synthesis of the 23 unsolved problems in hydrology will help guide research efforts for some years to come

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups