Compatibilidades en las multiplicidades: El uso de dispositivos médicos en la sala de operaciones

Un dispositivo médico (DM) no es solo tecnología en sí mismo. Cuando un DM es usado, éste interactúa con otros DM, usuarios, espacios físicos, instituciones, entre otros, volviéndose parte de una tecnología más compleja que emerge de la ejecución de procedimientos médicos concretos o del desarrollo de actividades asociadas al equipo, tales como su instalación, mantenimiento, etc. Cuando de las interacciones entre esta red se obtienen resultados positivos se denomina que hay compatibilidad, mientras que cuando se generan dificultades, incidentes o eventos adversos se habla de incompatibilidad. Esta tesis doctoral da cuenta de los resultados de la investigación realizada alrededor del uso de dispositivos médicos en cirugías ortopédicas y traumatología en un hospital de segundo nivel en Bogotá, durante el primer semestre de 2015. El objetivo general fue comprender la compatibilidad e incompatibilidad en el uso de los dispositivos médicos como parte de la tecnología de la sala de operaciones, como sistemas sociotécnicos y como prácticas sociomateriales. Es un estudio cualitativo-interpretativo que parte conceptualmente desde la ergonomía con aportes de la Teoría del Actor Red y de la teoría de las prácticas, abordado metodológicamente desde el enfoque sistémico y la praxiografía (etnografía de la práctica). El estudio presenta la compatibilidad e incompatibilidad en el uso de los dispositivos médicos, como resultado de interacciones entre elementos de los sistemas así como de la deducción de rutinas. La frase “hacer lo mejor con lo que hay” resume el sentir, hacer y resolver tanto del personal de salud involucrado en las cirugías observadas como del personal administrativo, develándose una “zona gris” en donde varían las prácticas sociomateriales que repercuten en el esfuerzo y desgaste de los profesionales en salud, el pronóstico de recuperación y sanación del paciente, el estado de los DM así como en la sostenibilidad tecnológica de la institución.Abstract. A medical device (MD) is not, in itself, just technology. When an MD is used, it interacts with other MDs, users, physical spaces, institutions, etc. and becomes part of a more complex technology that emerges from the carrying out of concrete medical procedures or the performing of activities associated with the equipment, such as installing or maintaining it. When positive results are obtained from the interactions in this network, there is said to be compatibility, whereas when problems arise or adverse events or damage occur, we talk of incompatibility. This doctoral thesis gives an account of the results of research into the use of medical devices in orthopaedic and traumatology surgery at a second-level hospital in Bogotá during the first half of 2015. The general objective was to gain an understanding of compatibility and incompatibility in the use of medical devices as part of operating theatre technology and as socio-technical systems and socio-material practices. It is a qualitative-interpretative study that is based, conceptually, on ergonomics, with contributions from Actor-Network Theory (ANT) and theory of practices, applied methodologically using the systemic approach and praxiography (ethnography of practice). The study details compatibility and incompatibility in the use of medical devices as a result of interactions between elements of systems and as a deduction of routines. The phrase “do the best with what there is” sums up the feelings, actions and decisions not only of the health staff involved in the operations observed but also of the administrative personnel, and reveals a “grey zone” where variations occur in socio-material practices that have repercussions on the efforts and tiredness of health professionals, the patient recuperation and cure prognosis and the status of the MDs, as well as the technological sustainability of the institution.Doctorad

Towards strategic design: the experience of two Colombian MSMEs

This qualitative-interpretive study reflects on the experience of two MSMEs that adapted rapidly to meet the need for protection products and maintain their production in the midst of confinement decreed by the city and country authorities, as a containment measure for the pandemic caused by the Covid-19, and where design was a key factor. The different experiences are organized taken the Product sociotechnical Cycles (PstC) model as a conceptual basis, analyzing the case studies from the organizational capabilities of industrial design, as well as from design-driven innovation. The article ends by summarizing the learnings, emphasizing the value of design with a strategic focus, in these processes of change

Conformal sulfated zirconia monolayer catalysts for the one-pot synthesis of ethyl levulinate from glucose

Here we describe a simple route to creating conformal sulphated zirconia monolayers throughout an SBA-15 architecture that confers efficient acid-catalysed one-pot conversion of glucose to ethyl levulinate

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Tendencias en diseño y desarrollo de productos desde el factor humano: una aproximación a la responsabilidad social

Este artículo presenta una reflexión sobre la responsabilidad social (RS) asociada a las tendencias que han surgido desde la ergonomía y los factores humanos en el proceso de diseño y desarrollo de productos. Inicia con la introducción del concepto de responsabilidad social y su relación con el proceso de diseño y desarrollo de productos desde la perspectiva del trabajo con, por y para las personas. Luego presenta una reseña histórica, una descripción conceptual y los principios fundamentales del diseño colaborativo, el diseño centrado en el usuario, el diseño centrado en el cliente, la usabilidad, el diseño universal, el diseño basado en la experiencia y el diseño transcultural, estableciendo paralelamente una relación entre cada tendencia y los principios de la RS. El artículo concluye con algunos retos que se plantean desde la ergonomía y los factores humanos, resaltando la necesidad de una reflexión por parte de los responsables del diseño y desarrollo de productos acerca de las implicaciones de su quehacer, al considerar su contexto específico y su rol particular