Nuevos paradigmas de diseño urbano en la ciudad de México. Dinámica urbano-inmobiliaria bajo el modelo neoliberal

El auge urbano-inmobiliario actual en la ciudad de México, iniciado en la administración 2000-2006 y continuado en las siguientes, ha dado como resultado un nuevo diseño urbano en diversos puntos de la metrópoli, el cual coexiste sin embargo, con la ciudad tradicional. En este trabajo se parte del reconocimiento a la necesidad de más y mejor actividad económica y, en este sentido, el sector construcción es altamente generador de empleos; no obstante, desde nuestra perspectiva, la mayor parte de los proyectos desarrollados en la ciudad, de alto nivel económico y tecnológico-constructivo, responden más a intereses del capital inmobiliario privado, nacional o extranjero, que a tratar de mejorar las necesidades de mejores servicios, infraestructura, para las mayorías. Estas prácticas, planteamos, responden al modelo económico neoliberal predominante en el mundo y generador de grandes transformaciones urbanoarquitectónicas en las ciudades de México y del mundo. En esta aportación buscamos demostrar porqué cuestionamos esta dinámica y cuáles son los grupos sociales más favorecidos y cuáles los más afectados.The urban-real estate’s best moment in México City, starting the government 2000-2006 and progressing along the next ones, has given a new urban design in diff erent places of the metropolis as a result, which, nevertheless co - exists with the traditional city. In this writing we are starting from the acknowledging of the existing need of better and more ef ective economical activities. In this sense, the construction and real estate sectors are very high sources of jobs for citizens. From our point of view the most of the projects developed in the city (both highly economic and technologicalconstructive) respond more to the interests of the private real state business, national or foreign, than the need to improve the quality of services and infrastructure for the majority. We believe this practices answer to the economical-neoliberal predominant model. This model is also the generator to most of the urban and architectural transformations in the cities of Mexico and around the world. In our contribution we look forward to show the reasons why we question this dynamic and which are the most bene ciary groups and vulnerable groups, sociably speaking

Nuevos paradigmas de diseño urbano en la Ciudad de México

El auge inmobiliario actual en la Ciudad de México, comenzado en la administración 2000-2006 y continuado en las siguientes, ha dado como resultado un nuevo diseño urbano en diversos puntos de la metrópoli que coexiste con la ciudad tradicional. Este trabajo parte del reconocimiento de la necesidad de contar con más y mejor actividad económica y, en este sentido, el sector de la construcción es un importante generador de empleos. No obstante, planteamos que la mayoría de los proyectos desarrollados, de alto nivel económico y tecnológico-constructivo, responden más a intereses del capital inmobiliario privado, nacional o extranjero, que a la mejora en las necesidades de servicios e infraestructura para las mayorías. De esta forma, buscamos demostrar por qué cuestionamos esta dinámica y cuáles son los grupos sociales más afectados

Discursos sobre el diseño, la relación con el entorno natural y la sustentabilidad

107 páginas. División de Ciencias y Artes para el Diseño. Departamento de Investigación y Conocimiento para el Diseño. Área de Hábitat y Diseño. D.R. Isaac Acosta Fuentes.El texto está estructurado en cuatro partes. En la primera de éstas se aborda el recuento y análisis de la definición de sustentabilidad con el objetivo de fundamentar las preocupaciones centrales de los planteamientos del desarrollo sustentable. En la siguiente sección se plantea un análisis general de la relación del diseño con la temática referida. En tercer término se diserta sobre la aproximación de las disciplinas de la Arquitectura, el Diseño de la Comunicación Gráfica y el Diseño Industrial al desarrollo sustentable. Para cerrar el texto se presentan algunas reflexiones que buscan señalar puntualmente tareas pendientes en cuanto a la discusión propuesta por el trabajo.Universidad Autónoma Metropolitana (México). Unidad Azcapotzalco.Coordinación editorial y cuidado de la edición: Ivonne Murillo. Diseño de gráficas y diseño y formación de interiores: Eunice Viridiana Suárez Rosales, Lenny Daniel Nuñez Maya (alumnos de servicio social: núm. ic24 proyecto de apoyo para la transformación del departamento de investigación y conocimiento)

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research