Resiliencia del sistema de drenaje pluvial ante inundaciones: caso de estudio Chetumal, Quintana Roo, México

Floods are one of the effects of hurricanes that have been more evident on coastal areas causing human deaths and economical loss. This tests the response capacity of drain system infrastructure. The objective of this research was to determine resilience of drain system infrastructure facing floods, produced by hurricanes, in the city of Chetumal,  Quintana Roo, México. Five components were considered, each one with a variable number of indicators, which are shown in parenthesis: sturdiness (8), redundancy (7), resources (2), speed (2) and adaptive capacity (13). Each value was standardized, then weighted through experts’ enquiry and finally resilience rate was defined, 0.2982 was found for the city of Chetumal. This demonstrates a low rate for resilience, which was mainly associated to resources and redundancy components. Based on this, both components should be strengthened in order to increase resilience rate stressing normative and territorial planning instruments application, emergency plans in case of floods, maintenance service plans of drain system infrastructure as well as investment in prevention programs.Las inundaciones son uno de los efectos de los huracanes que se han evidenciado más en las zonas costeras, ocasionando pérdidas de vidas humanas y económicas. Esta situación ha puesto a prueba la capacidad de respuesta de los sistemas de infraestructura de drenaje pluvial. El objetivo de la investigación que precedió a este trabajo fue determinar la resiliencia ante inundaciones asociadas a huracanes del sistema de drenaje pluvial de la ciudad de Chetumal, Quintana Roo, México. Se consideraron cinco componentes, cada uno con un número variable de indicadores mostrados entre paréntesis: robustez (8), redundancia (7), recursos (2), rapidez (2) y capacidad adaptativa (13). El valor de cada indicador se normalizó; luego, se ponderó mediante la consulta de expertos; y, por último, se integró el índice de resiliencia, obteniéndose un valor de 0.2982 para la ciudad de Chetumal. Este valor indica una resiliencia baja, asociada principalmente a los componentes recursos y redundancia. Con base en lo anterior, se deben reforzar ambos componentes para elevar la resiliencia con énfasis en la aplicación de normativas e instrumentos de planeación territorial, planes de emergenciaen caso de inundaciones, planes de mantenimiento de la infraestructura pluvial, así como  inversión enprogramas de prevención

Profundización en metodologías y espacios docentes innovadores

Fac. de FilologíaFALSEsubmitte

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

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

Las Izquierdas Latinoamericanas

Este libro recoge lo más sobresaliente del Seminario Internacional Las izquierdas latinoamericanas: sus trayectorias nacionales y relaciones internacionales durante el siglo XX, actividad convocada por la Cátedra Antonio Gramsci del Instituto Cubano de Investigación Cultural Juan Marinello (La Habana, 14 al 16 de noviembre de 2016), concurriendo a la cita participantes del Instituto de Historia de Cuba, la Universidad de Santiago de Chile, la Universidad Nacional Autónoma de México, del Instituto de Ciencias Sociales de la Universidad Federal de Uberlandia (Brasil), y de la Red Iberoamericana de Historiadores del siglo XX. En las cuatro partes de esta entrega, se pasa revista a los elementos principales de la exposición y los debates acaecidos, reflejándose en todo momento la necesidad de replanteamientos y de nuevos desarrollos que, a la luz de su pasado reciente, desafían hoy a nuestras Izquierdas en toda la regiónA mi compañero Elías, Vencido por la muerte, en los mismos momentos en que mis colegas debatían sobre las izquierdas Por su ayuda y apoyo de siempre a todos mis proyectos Por su recuerdo en mi corazón y en el de nuestros hijos

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