Pescadores cucapá contemporáneos

Los pescadores indígenas cucapá defienden su derecho a pescar en su territorio ancestral incluso en contra de las normatividades de la Reserva de la Biósfera del Alto Golfo y Delta del Río Colorado que se creó hace 20 años en el mismo lugar en donde realizan esta actividad. Las mujeres cucapá tienen un rol predominante en la organización política de la defensa de sus derechos, incluyendo el derecho al trabajo de la pesca como forma de subsistencia. En este artículo se ofrece información sobre el trabajo de pesca de los cucapá, sus restricciones, y el proyecto de investigación colaborativo del que se desprende la información presentada.Cocopah fishermen struggle to defend their right to fish in their historic territory. Against them, environmental laws –including the creation of a Biosphere Reserve– have restricted their right to exploit resources in their territory since 1993. Cocopah women play an important role in organizing and leading the cocopah movement that reclaim the recognition of their rights, including their right fish as an activity for survival for contemporary Cocopah families. Here I describe the Cocopah fishing practice, the restrictions imposed to it, and a general overview about the collaborative research that has generated the information that is presented in the following pages

Cuadernos del CONEICC

Esta obra recupera el punto de vista de Investigadores y autoridades, tanto de Estados Unidos como de México, que hablan sobre los orígenes, las causas y las consecuencias de la migración mexicana hacia el vecino país del norte. A lo largo del texto se analizan diversas perspectivas, incluyendo el de un migrante que busca mejores condiciones de vida.ITESO, A.C.CONEIC

La organización y atención a la diversidad en centros de educación secundaria de Iberoamérica. Reflexiones y experiencias

La organización y atención a la diversidad en centros de educación secundaria de Iberoamérica. Reflexiones y experiencias" es el nuevo título de la Serie Informes de RedAGE. La misma recoge la visión de 41 especialistas de 13 países iberoamericanos sobre la realidad y perspectivas de la atencion a la diversidad en centros de educación secundaria. La focalización, en esta etapa educativa, tiene que ver con la consideración de que, actualmente, es el momento de la escolarización donde se producen más abandonos y donde se abren o limitan posibilidades para el posible acceso a estudios superiores de los más capacitados. La orientación de los escritos tiene que ver con las finalidades y objetivos de la Red de Apoyo a la Gestion Educativa (RedAGE); también con el convencimiento, por parte de los que escriben, de que el contexto organizativo actúa como un amplificador o limitador de las actuaciones dirigidas a la formación de los escolares

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Elicitation of broadly protective sarbecovirus immunity by receptor-binding domain nanoparticle vaccines

Understanding vaccine-elicited protection against SARS-CoV-2 variants and other sarbecoviruses is key for guiding public health policies. We show that a clinical stage multivalent SARS-CoV-2 spike receptor-binding domain nanoparticle vaccine (RBD-NP) protects mice from SARS-CoV-2 challenge after a single immunization, indicating a potential dose-sparing strategy. We benchmarked serum neutralizing activity elicited by RBD-NP in non-human primates against a lead prefusion-stabilized SARS-CoV-2 spike (HexaPro) using a panel of circulating mutants. Polyclonal antibodies elicited by both vaccines are similarly resilient to many RBD residue substitutions tested although mutations at and surrounding position 484 have negative consequences for neutralization. Mosaic and cocktail nanoparticle immunogens displaying multiple sarbecovirus RBDs elicit broad neutralizing activity in mice and protect mice against SARS-CoV challenge even in the absence of SARS-CoV RBD in the vaccine. This study provides proof of principle that multivalent sarbecovirus RBD-NPs induce heterotypic protection and motivates advancing such broadly protective sarbecovirus vaccines to the clinic

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Precarización laboral y corrupción

This article analyses the protection of marine species in the context of precarious labour, corruption and the growing transnational black markets in the Colorado delta and the Upper Gulf of California. I analyze these phenomena as constitutive elements of a globalized system of violences favoured by extractivist practices. All the former is put in perspective from the viewpoint of Cocopah fishers that get organized to try tostop the negative impacts of assimilation, dispossession and invisibilization produced in this context. Therefore I engage in trying to understand the role that national institutions play in the precarization of rural employment and in the empowerment of illicit structures of transnational black markets in this region. This case help to think on how laws and practices to evade them are interconnected phenomena that shouldbe studied together as part of the same processes of globalized States, just as Heyman and Smart have suggested (1999).Este artículo analiza la conservación de especies marinas en un escenario de violencias sistémicas que incluyen la precarización del empleo, la corrupción y el fortalecimiento de mercados negros trasnacionales que extienden sus redes en las zonas rurales de la frontera norte de México. Lo anterior se analiza con base en la experiencia de los pescadores cucapá, que se organizan para contener procesos de asimilación, despojo e invisibilización en el Alto Golfo de California. Se reflexiona sobre el papel que desempeñan las instituciones nacionales en la configuración de la precarización del empleo rural y de las estructuras ilícitas de mercados negros trasnacionales. Este caso nos sirve para pensar cómo las leyes y su evasión son fenómenos que están necesariamente interconectados y deben estudiarse juntos porque son parte de la operación de los Estados en un contexto de globalización e intenso intercambio comercial, tal y como lohan sugerido Heyman y Smart (1999)