113 research outputs found

    Acute fetal anemia diagnosed by middle cerebral artery Doppler velocimetry in stage v twin-twin transfusion syndrome.

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    In stage V twin-twin transfusion syndrome (TTTS), up to 50% of surviving twins die or experience permanent disabilities, likely due to acute intertwin hemorrhage resulting in sudden severe anemia of the survivor. Although fetal middle cerebral artery (MCA) Doppler studies demonstrate strong correlation with fetal hemoglobin values, acute hemorrhagic events are more difficult to diagnose, and optimal timing of delivery of the survivor poses an obstetric dilemma. We report a case of newly diagnosed stage V TTTS at 28 weeks gestation, complicated by acute severe anemia diagnosed by significantly abnormal fetal MCA Doppler studies. The anemic twin was urgently delivered and is doing well without significant sequelae

    Over-The-Counter Availability of Levonorgestrel Emergency Contraception in Pharmacies on Oahu

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    Since the United States Food and Drug Administration’s approval of over-the-counter levonorgestrel emergency contraception, access to this time-sensitive medication has improved. However, multiple barriers, including the cost of the medication and pharmacy availability, still exist. The objective of this study was to determine the over-the-counter availability of levonorgestrel emergency contraception in pharmacies on Oahu, Hawaii. We conducted a cross-sectional population-based study using in-person simulated patient encounters at all pharmacies on Oahu. Out of 109 chain pharmacies and 13 independent pharmacies, 102 (84%) pharmacies had levonorgestrel emergency contraception available over the counter. Of pharmacies in which it was available, 12.7% required an employee to unlock the medication, 37.3% required the medication to be unlocked at the register, 29.4% were packaged in a large plastic box, and 3.9% were packaged in a blister pack. Levonorgestrel emergency contraception is widely available as an over-the-counter medication in pharmacies on Oahu, yet there are packaging and display practices that make it less accessible. Many of these practices could be improved with pharmacy education or changes in store policies. Systems-based interventions are needed to improve the access to levonorgestrel emergency contraception as an over-the-counter medication

    Immediate Versus Delayed Insertion of the Levonorgestrel Intrauterine Device in Postpartum Adolescents: A Randomized Pilot Study.

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    This pilot study assessed the feasibility of conducting a larger randomized controlled trial comparing the proportion of adolescents using a levonorgestrel intrauterine device (LNG IUD) at six months postpartum when it is inserted immediately after vaginal delivery (within 10 minutes after placental expulsion) compared to insertion four to six weeks postpartum. Pregnant adolescents (14 to 19 years) who desired a LNG IUD for postpartum contraception were randomized to insertion of the LNG IUD either within 10 minutes of delivery of the placenta or at 4-6 weeks postpartum. Study follow-up visits were conducted at 4-6 weeks postpartum, 10 weeks postpartum, and 6 months postpartum. From November 2013 to June 2015, eleven adolescents were randomized - six participants to the immediate postpartum LNG IUD insertion group, and five to the delayed insertion group. All six women in the immediate insertion group had successful immediate postpartum insertion; two of five women in the delayed insertion group had an IUD inserted. At six months postpartum, four of six women in the immediate insertion group had a LNG IUD in place; of the five women in the delayed group, three did not have a LNG IUD in place and two were pregnant. The study was discontinued after 19 months because of suboptimal enrollment. Though insertion of a LNG IUD immediately after delivery is an appropriate option for some adolescents, a larger prospective study comparing immediate to delayed LNG IUD insertion is unlikely to be feasible at our institution

    Travesías por los pliegues de lo virtual. Una lectura del atlas de Michel Serres

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    El Atlas de Michel Serres le proporciona al habitante del umbral del nuevo milenio una colecci√≥n de mapas flotantes que esbozan c√≥mo acontece el espacio, tanto en la intersecci√≥n de relaciones m√≥viles como en sus pliegues y fluctuaciones. Esbozando cuadros animados, el fil√≥sofo da cuenta del modo en el que una materialidad vol√°til emana de la megal√≥polis de acero y cristal. All√≠, le ofrece al individuo una omnipresencia velada en sus traves√≠as por las infinitas corrientes que nutren la Red mundial de informaci√≥n. La meditaci√≥n de Serres sobre el espacio contempor√°neo manifiesta que el denominado 'espacio virtual' es tan novedoso como arcaico, pues si bien las nuevas tecnolog√≠as le permiten al individuo morar en un espacio l√≥gico, no hacen otra cosa que duplicar y reforzar lo que de suyo es virtual en el espacio. Tanto la filosof√≠a de Leibniz como la de Lucrecio, ense√Īan a ver el espacio en su car√°cter intermedio, haz de potencialidades a punto de actualizarse, juego entre presencia y ausencia. Precisamente, entre los pliegues de lo org√°nico y de lo inerte, el individuo se gesta en su intimidad protegida, constituy√©ndose como pura posibilidad. En este sentido, nos preguntamos si la geograf√≠a vol√°til de las redes de informaci√≥n le brindan la posibilidad de resguardo al internauta o, si por el contrario, lo somete a una vida p√ļblica en una suerte de omnipresencia trasparente en la que deshace su singularidad. Nuestro problema es, por tanto, el de la fundaci√≥n de pliegues en el nuevo espacio virtual.Michael Semes‚Äô Atlas provides to inhabitants of the new millennium's threshold a collection of floating maps outlining how space occurs, both at the mobile relationships' intersections as well as in their foldings and fluctuations. By outlining animated pictures, the french philosopher shed light on the way volatile materiality emanates from steel and crystal megalopolis. In doing so, Serres offers to individuals a veiled omnipresence by its journeys into the infinite currents that nourish the Global Network of Information. Serres' meditation on contemporary space states that the so-called 'virtual space' is as novel as it is archaic: although new technologies allow individuals to dwell in a logical space, they do nothing but duplicate and reinforce what it is virtual in itself within space. Both Leibniz and Lucretius' philosophy teaches to consider space in its intermediate character; bundle of possibilities about to be actualized, an interplay between presence and absence. Precisely, within the folds of the organic and of the inert, individuals loom in their protected intimacy and constitute themselves as pure possibility. In this sense, we raise the question about whether the volatile geography of the information networks provide the internaut with the possibility of safeguarding, or if, on the contrary, such geography submits the individual to a public life in some sort of transparent omnipresence in which individual's singularity comes away. Therefore, ours is the problem about the foundation of folds in the new virtual space.Mag√≠ster en Filosof√≠aMaestr√≠

    La gestión del conocimiento en el proceso de producción de aguardiente

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    Ilustraciones, gr√°ficosEl conocimiento y su gesti√≥n se han convertido en una opci√≥n estrat√©gica de la organizaci√≥n para alcanzar los objetivos y metas, es por ello que, en el contexto de la globalizaci√≥n y las transformaciones, la gesti√≥n del potencial del conocimiento es una herramienta imprescindible para aumentar la eficacia de las organizaciones. Consecuentemente, el conocimiento como activo intangible de una organizaci√≥n impulsa la mejora organizacional. Asimismo, e inconscientemente, el conocimiento organizacional contin√ļa creciendo junto con las experiencias individuales y organizacionales. Es por esta necesidad detectada en el proceso de producci√≥n de aguardiente, que el presente informe de investigaci√≥n busca estrategias para identificar, registrar, almacenar, socializar y transferir el conocimiento. Los resultados obtenidos est√°n basados en el diagn√≥stico exhaustivo de la informaci√≥n, el conocimiento y las tecnolog√≠as de informaci√≥n dentro del proceso productivo del aguardiente, a trav√©s de un estudio que integra la descripci√≥n del producto seleccionado, la identificaci√≥n, esquematizaci√≥n y modelaci√≥n de los flujos de proceso entre las √°reas participantes. Estos elementos permiten la concepci√≥n de una propuesta pr√°ctica y de investigaci√≥n que integra los procesos informacionales y de conocimiento en la producci√≥n de aguardiente, a trav√©s de la miner√≠a de datos.Knowledge and its management have become a strategic option for the organization to achieve the objectives and goals. In the context of globalization and transformations, knowledge potential management is an essential tool to increase the effectiveness of organizations. Knowledge as an intangible asset of an organization drives organizational improvement. Unconsciously, organizational knowledge continues to grow along with individual and organizational experiences. It is for this need detected in the process of brandy production, that this research report seeks strategies to identify, register, store, socialize and transfer knowledge. The results obtained are based on the exhaustive diagnosis of the information, knowledge and information technologies within the brandy production process through a study that integrates the description of the selected producto, the identification, schematization and modeling of process flows between the participating √°reas. These elements allow the conception of a practical and research proposal that integrates the informational and knowledge processes in the production of brandy, through data mining.Mag√≠ster en Gerencia Estrat√©gica de Tecnolog√≠as de Informaci√≥nMaestr√≠

    Una mirada filosófica a la felicidad y al perdón. Una conversación con el profesor Diego Sebastián Garrocho Salcedo

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    Las siguientes páginas presentan una reflexión en torno a cuestiones como el perdón, la felicidad, el papel de la Filosofía y las humanidades en la educación, así como el rol de la Filosofía en el análisis y cuestionamiento de las condiciones socio-políticas en las que se debe ejercer la ciudadanía actualmente
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