O pastor, o doutor e o Big Data

The rise of the Internet as a space for global interaction makes the political subjectivation of automated surveillance especially important for understanding the mechanisms of social control in our current culture. This essay approaches mass electronic surveillance from the perspective of the processes of production of subjectivities among users of the Net. It will briefly outline a history of the production of subjects as related to the necessity of expressing a certain truth about themselves, of confessing and conforming to a normality regulated by the strategic frameworks of power. At the same time, it will attempt to associate the logic of that history with the rise of Big Data as a device for the tracking, discrimination and management of personal data. Finally, the paper will provide some reflections on the significance of resistance to the loss of privacy in digital culture.La consolidación de Internet como espacio de relación global implica que la subjetivación política de la vigilancia automatizada adquiera especial relevancia a la hora de comprender los mecanismos de control social en nuestra cultura. Este ensayo pretende ser una aproximación a la cuestión de la vigilancia masiva desde la perspectiva de los procesos de configuración de subjetividades de los usuarios de la red. Es por ello que se procurará trazar sucintamente un recorrido histórico de producción de sujetos en torno a la necesidad de expresar cierto tipo de verdad sobre sí mismos, de confesar y de conformar con una normalidad reglada por los marcos estratégicos del poder. Al mismo tiempo, se tratará de poner en relación la lógica de ese recorrido con el advenimiento del Big Data como dispositivo de rastreo, discriminación y tratamiento de información personal; para, finalmente, reflexionar sobre el sentido de la resistencia a la pérdida de privacidad en la cultura digital.A consolidação da Internet como espaço de relação global resulta na subjetivação políticade vigilância automatizada que vai adquirindo especial relevância na hora de compreender os mecanismos de controle social em nossa cultura. Este ensaio pretende aproximar-se à questão da vigilância massiva desde a perspectiva dos processos configuradores de subjetividades que incidem sobre os usuários da rede. Para isso será delimitado um período histórico de produção de sujeitos ao redor da necessidade de expressar um certo tipo de verdade sobre si mesmo, de confessar e de adequar-se a uma normalidade regrada por marcos estratégicos depoder. Simultaneamente, esta lógica será relacionada ao surgimento do Big Data como dispositivo de rastreio, registro e tratamento de informação pessoal para, finalmente, refletir sobre o sentido da resistência à perda de privacidade na cultura digital

O pastor, o doutor e o Big Data

The rise of the Internet as a space for global interaction makes the political subjectivation of automated surveillance especially important for understanding the mechanisms of social control in our current culture. This essay approaches mass electronic surveillance from the perspective of the processes of production of subjectivities among users of the Net. It will briefly outline a history of the production of subjects as related to the necessity of expressing a certain truth about themselves, of confessing and conforming to a normality regulated by the strategic frameworks of power. At the same time, it will attempt to associate the logic of that history with the rise of Big Data as a device for the tracking, discrimination and management of personal data. Finally, the paper will provide some reflections on the significance of resistance to the loss of privacy in digital culture.La consolidación de Internet como espacio de relación global implica que la subjetivación política de la vigilancia automatizada adquiera especial relevancia a la hora de comprender los mecanismos de control social en nuestra cultura. Este ensayo pretende ser una aproximación a la cuestión de la vigilancia masiva desde la perspectiva de los procesos de configuración de subjetividades de los usuarios de la red. Es por ello que se procurará trazar sucintamente un recorrido histórico de producción de sujetos en torno a la necesidad de expresar cierto tipo de verdad sobre sí mismos, de confesar y de conformar con una normalidad reglada por los marcos estratégicos del poder. Al mismo tiempo, se tratará de poner en relación la lógica de ese recorrido con el advenimiento del Big Data como dispositivo de rastreo, discriminación y tratamiento de información personal; para, finalmente, reflexionar sobre el sentido de la resistencia a la pérdida de privacidad en la cultura digital.A consolidação da Internet como espaço de relação global resulta na subjetivação políticade vigilância automatizada que vai adquirindo especial relevância na hora de compreender os mecanismos de controle social em nossa cultura. Este ensaio pretende aproximar-se à questão da vigilância massiva desde a perspectiva dos processos configuradores de subjetividades que incidem sobre os usuários da rede. Para isso será delimitado um período histórico de produção de sujeitos ao redor da necessidade de expressar um certo tipo de verdade sobre si mesmo, de confessar e de adequar-se a uma normalidade regrada por marcos estratégicos depoder. Simultaneamente, esta lógica será relacionada ao surgimento do Big Data como dispositivo de rastreio, registro e tratamento de informação pessoal para, finalmente, refletir sobre o sentido da resistência à perda de privacidade na cultura digital

USO DE BORTEZOMIB, TALIDOMIDA Y DEXAMETASONA, COMO TERAPIA DE PRIMERA LÍNEA EN PACIENTES CON MIELOMA MÚLTIPLE DE RECIENTE DIAGNÓSTICO. CENTRO MÉDICO ISSEMYM. ARTURO MONTIEL ROJAS

El Mieloma Múltiple (MM) es una neoplasia maligna hematológica caracterizada por una proliferación clonal no controlada de células plasmáticas, las cuales producen una paraproteína monoclonal. El Mieloma Múltiple puede condicionar lesiones líticas, falla renal, hipercalcemia, Síndrome de Hiperviscosidad y una inmunodeficiencia, la cual es agravada por los esquemas terapéuticos ofrecidos en esta enfermedad. Según las escalas pronosticas más utilizadas a nivel mundial, la sobrevida global esperada en el mejor de los casos es de 4 años, la cual puede ser menor en los casos de estadios avanzados de la enfermedad. En la mayoría de las ocasiones, esta enfermedad es incurable y los pacientes terminan complicándose con procesos infecciosos que condicionan la muerte al enfermo

Projecte de programa d’atenció al pacient crònic complex

Programa d’atenció al pacient crònic complex; Atenció sanitària; PlanificacióPrograma de atención al paciente crónico complejo; Atención sanitaria; PlanificaciónComplex chronic patient care program; Health care; PlanningAquest document presenta el Programa d’atenció al pacient crònic complex mitjançant estratègies orientades perquè els pacients rebin una atenció proactiva, resolutiva, adequada, eficient i satisfactòria en qualsevol moment i amb la intensitat que calgui

Relevance of gastrointestinal manifestations in a large Spanish cohort of patients with systemic lupus erythematosus: what do we know?

SLE can affect any part of the gastrointestinal (GI) tract. GI symptoms are reported to occur in >50% of SLE patients. To describe the GI manifestations of SLE in the RELESSER (Registry of SLE Patients of the Spanish Society of Rheumatology) cohort and to determine whether these are associated with a more severe disease, damage accrual and a worse prognosis. METHODS: We conducted a nationwide, retrospective, multicentre, cross-sectional cohort study of 3658 SLE patients who fulfil =4 ACR-97 criteria. Data on demographics, disease characteristics, activity (SLEDAI-2K or BILAG), damage (SLICC/ACR/DI) and therapies were collected. Demographic and clinical characteristics were compared between lupus patients with and without GI damage to establish whether GI damage is associated with a more severe disease. RESULTS: From 3654 lupus patients, 3.7% developed GI damage. Patients in this group (group 1) were older, they had longer disease duration, and were more likely to have vasculitis, renal disease and serositis than patients without GI damage (group 2). Hospitalizations and mortality were significantly higher in group 1. Patients in group 1 had higher modified SDI (SLICC Damage Index). The presence of oral ulcers reduced the risk of developing damage in 33% of patients. CONCLUSION: Having GI damage is associated with a worse prognosis. Patients on a high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids. Oral ulcers appear to decrease the risk of GI damage. © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

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

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Innovación en las enseñanzas universitarias: experiencias presentadas en las III Jornadas de Innovación Educativa de la ULL

En este libro se recoge un conjunto de experiencias de innovación educativa desarrolladas en la ULL en el curso 2011-12. Se abordan distintos ámbitos y ramas del conocimiento, y ocupan temáticas variadas que han sido desarrolladas con rigor, y con un claro potencial para su extrapolación a efectos de la mejora educativa en el ámbito universitario. Esta publicación constituye una primera edición de una serie que irá recogiendo las experiencias de innovación educativa de la ULL. Este es un paso relevante para su impulso en nuestra institución, como lo es el de su vinculación con la investigación educativa, para potenciar su publicación en las revistas científicas en este ámbito cada vez más pujante y relevante para las universidades. Sobre todo representan el deseo y el compromiso del profesorado de la ULL para la mejora del proceso educativo mediante la investigación, la evaluación y la reflexión compartida de nuestras prácticas y planteamientos docentes