58 research outputs found
La participation de la communauté et institutionnelle des enseignants et des étudiants: discours et pratique
No full textThe goal of this article is to identify the social representation of “participating”, by highlighting the opinions of teachers and students at the high school and college levels, about their interest in participating and their actual involvement in communitarian and institutional matters. The coexistence of two types of representation was found: A traditional one, which is usually institutionalized and requested, and another one, socially unavoidable, which is not hierarchical, and is connected to knowledge.How to reference this article: Sagastizábal, María de los Ángeles y María Amelia Pidello, “La participación comunitaria e institucional de docentes y alumnos: discurso y práctica”, Revista Educación y Pedagogía, Medellín, Universidad de Antioquia, Facultad de Educación, vol. 22, núm. 58, septiembre-diciembre, 2010, pp. 177-189.Received:december 2009Accepted: march 2010El objetivo de este artículo es conocer la representación social del “participar”, relevando las opiniones de docentes y alumnos del nivel secundario y superior acerca de su interés en dicho acto y su efectiva participación en cuestiones comunitarias e institucionales. Se evidenció la coexistencia de dos tipos de representación: una tradicional institucionalizada y demandada, y otra, socialmente ineludible, no jerarquizada y vinculada al conocimiento.Cómo citar este artículo: Sagastizábal, María de los Ángeles y María Amelia Pidello, “La participación comunitaria e institucional de docentes y alumnos: discurso y práctica”, Revista Educación y Pedagogía, Medellín, Universidad de Antioquia, Facultad de Educación, vol. 22, núm. 58, septiembre-diciembre, 2010, pp. 177-189.Recibido: diciembre 2009Aceptado: marzo 2010L’objectif de cet article est de connaître la représentation sociale de « participer », en soulignant les opinions des enseignants et des étudiants du niveau secondaire et supérieur au sujet de leur intérêt dans cet acte et leur participation efficace dans les questions de communauté et institutionnelles. La coexistence de deux types de représentation a étémise en évidence: l’une traditionnelle institutionnalisée et demandée et l’autre socialement inévitable, non hiérarchisée mais liée à la connaissance.
Extracorporeal membrane oxygenation after lung transplantation: risk factors and outcomes analysis
No full textBackground: Lung transplantation is the treatment of choice for end-stage pulmonary disease in selected patients. However, severe primary graft dysfunction is a significant complication of transplant and requires the implantation of an extracorporeal support. The aim of the study is to evaluate the impact of extracorporeal membrane oxygenation (ECMO) after transplant in our center. Methods: From January 2008 till June 2018, 195 consecutive unselected patients receiving a lung transplant were considered. Mean age was 49±15 years. Main indications for transplant were idiopathic pulmonary fibrosis in 72 patients, chronic obstructive pulmonary disease in 60 patients, and cystic fibrosis in 40 patients. Prior to transplant, 18 patients were on mechanical ventilation and 14 were on ECMO. Results: Twenty-five patients required venous-venous ECMO after transplant. Vascular disease as cause of transplant [relative risk (RR) 7.8, 95% CI: 1.5-41, P=0.02], donor age (RR 1.6, 95% CI: 1.03-2.3, P=0.03) and need for cardiopulmonary by-pass during transplant (RR 3.1, 95% CI: 1.02-9, P=0.04) were associated with ECMO implantation. Patients requiring post-transplant ECMO received more transfusions (P < 0.01), had a longer mechanical ventilation (P < 0.01) and ICU stay (P < 0.01) and had a higher hospital mortality (P < 0.01). Post-transplant ECMO significantly influenced one- and five-year survival [hazard ratio (HR) 5.5, 95% CI: 3-10, P < 0.001 and HR 3.5, 95% CI: 2-6, P < 0.001, respectively]. However, conditional survival after t months is similar for patients with or without post-transplant ECMO. Conclusions: In our experience, although ECMO is a reliable and effective strategy to support pulmonary function, severe graft dysfunction after lung transplantation still has a significant impact on early and late results
Pretransplant Right Ventricular Dysfunction Is Associated With Increased Mortality After Heart Transplantation: A Hard Inheritance to Overcome
No full textBackground: Right ventricular dysfunction (RVD) is a major issue in patients with advanced heart failure because it precludes the implantation of left ventricular assist device, usually leaving heart transplantation (HTx) as the only available treatment option. The pulmonary artery pulsatility index (PAPi) is a hemodynamic parameter integrating information of right ventricular function and of pulmonary circulation. Our aim is to evaluate the association of preoperative RVD, hemodynamically defined as a low PAPi, with post-HTx survival. Methods and Results: Consecutive adult HTx recipient at 2 Italian transplant centers between 2000 and 2018 with available data on pre-HTx right heart catheterization were included retrospectively. RVD was defined as a value of PAPi lower than the 25th percentile of the study population. The association of RVD with the 1-year post-HTx mortality and other secondary end points were evaluated. Multivariate logistic regression was used to adjust for clinical and hemodynamic variables. Analyses stratified by pulmonary vascular resistance (PVR) status (≥3 Woods units vs <3 Woods units) were also performed. Among 657 HTx recipients (female 31.1%, age 53 ± 11 years), patients with pre-HTx RVD (PAPi of <1.68) had significantly lower 1-year survival rates (77.8% vs 87.1%, P = .005), also after adjusting for estimated glomerular filtration rate, total bilirubin, PVR, serum sodium, inotropes, and mechanical circulatory support at HTx (hazard ratio 2.0, 95% confidence interval, 1.3–3.1). RVD was also associated with post-HTx renal replacement therapy (hazard ratio 2.0, 95% confidence interval 1.05–3.30) and primary graft dysfunction (hazard ratio 1.7, 95% confidence interval 1.02–3.30). When stratifying patients by estimated PVR status, RVD was associated with worse 1-year survival among patients with normal PVR (76.9% vs 88.3%, P = .003), but not in those with increased PVR (78.6% vs 83.2%, P = .49). Conclusions: Preoperative RVD, evaluated through PAPi, is associated with mortality and morbidity after HTx, providing incremental prognostic value over traditional clinical and hemodynamic parameters
G-CSF for Extensive STEMI
No full textRationale: In the exploratory Phase II STEM-AMI (Stem Cells Mobilization in Acute Myocardial Infarction) trial, we reported that early administration of G-CSF (granulocyte colony-stimulating factor), in patients with anterior ST-segment-elevation myocardial infarction and left ventricular (LV) dysfunction after successful percutaneous coronary intervention, had the potential to significantly attenuate LV adverse remodeling in the long-Term. Objective: The STEM-AMI OUTCOME CMR (Stem Cells Mobilization in Acute Myocardial Infarction Outcome Cardiac Magnetic Resonance) Substudy was adequately powered to evaluate, in a population showing LV ejection fraction ≤45% after percutaneous coronary intervention for extensive ST-segment-elevation myocardial infarction, the effects of early administration of G-CSF in terms of LV remodeling and function, infarct size assessed by late gadolinium enhancement, and myocardial strain. Methods and Results: Within the Italian, multicenter, prospective, randomized, Phase III STEM-AMI OUTCOME trial, 161 ST-segment-elevation myocardial infarction patients were enrolled in the CMR Substudy and assigned to standard of care (SOC) plus G-CSF or SOC alone. In 119 patients (61 G-CSF and 58 SOC, respectively), CMR was available at baseline and 6-month follow-up. Paired imaging data were independently analyzed by 2 blinded experts in a core CMR lab. The 2 groups were similar for clinical characteristics, cardiovascular risk factors, and pharmacological treatment, except for a trend towards a larger infarct size and longer symptom-To-balloon time in G-CSF patients. ANCOVA showed that the improvement of LV ejection fraction from baseline to 6 months was 5.1% higher in G-CSF patients versus SOC (P=0.01); concurrently, there was a significant between-group difference of 6.7 mL/m2 in the change of indexed LV end-systolic volume in favor of G-CSF group (P=0.02). Indexed late gadolinium enhancement significantly decreased in G-CSF group only (P=0.04). Moreover, over time improvement of global longitudinal strain was 2.4% higher in G-CSF patients versus SOC (P=0.04). Global circumferential strain significantly improved in G-CSF group only (P=0.006). Conclusions: Early administration of G-CSF exerted a beneficial effect on top of SOC in patients with LV dysfunction after extensive ST-segment-elevation myocardial infarction in terms of global systolic function, adverse remodeling, scar size, and myocardial strain. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01969890
Prognostic implications of pulmonary artery catheter monitoring in patients with cardiogenic shock: A systematic review and meta-analysis of observational studies
No full textPurpose: To investigate the impact of pulmonary artery catheter (PAC) monitoring on survival of cardiogenic shock(CS), in the light of the controversies in available evidence. Materials and methods: MEDLINE, EMBASE, Cochrane library and Web of Science were systematically screened to identify most relevant studies on patients with CS comparing PAC use to non-use during hospital stay. Short-term mortality was the primary endpoint and the use of Mechanical Circulatory Support (MCS) devices was the secondary one. Results: Six observational studies including 1,166,762 patients were selected. The most frequent etiology of CS was post-myocardial infarction (75% [95% CI 55–89%] in PAC-group and 81%[95% CI 47–95%] in non-PAC group). Overall, PAC was used in 33%(95% CI 24–44%) of cases. Pooling data adjusted for confounders, a significant association between the PAC-group and a reduction in short-term mortality emerged when compared to the non-PAC group (36%[95% CI 27–45%] vs 47%[95% CI 35–59%];AdjustedOR 0.71, 95% CI 0.59–0.87, p < 0.01). MCS use was significantly higher in PAC vs non-PAC group (59% [95% CI 54–65%]) vs 48% [95% CI 43–53%]);OR 1.60 [95% CI 1.27–2.02, p < 0.01]). Conclusions: PAC was associated with lower incidence of short-term mortality in CS pooling adjusted observational studies. Prospective studies are needed to confirm our hypothesis and better clarify the mechanisms of this potential prognostic benefit
Echo and Hemodynamic-Guided Ramp Test in a Left Ventricular Assist Device Carrier With Right Ventricular Failure and Aortic Regurgitation.
No full textThe clinical outcomes of patients with left ventricular assist devices (LVAD) have steadily improved, unveiling late right ventricular failure (RVF) and aortic regurgitation (AR) as drivers of long-term mortality. The continuous-flow LVAD physiology and the patient's pre-existing features predispose to these complications, recently labeled hemodynamic-related events (HDREs). We present the case of an LVAD carrier complicated by both late RVF and AR, in which a comprehensive hemodynamic and echo-guided ramp test was carried out. A step-by-step standardized ramp test protocol is described with a focus on the interpretation of longitudinal changes in hemodynamic and echocardiographic parameters at different LVAD speeds. We emphasize the clinical relevance of a dynamic evaluation to stage these complex hemodynamic scenarios and to guide individualized management. The ramp test was instrumental to unmask the relative contribution of several morphofunctional components as limiting factors to optimal hemodynamics at different LVAD speeds and identified RVF as the prevailing limiting factor, suggesting the futility of aortic valve replacement. We highlight the coexistence of AR and RVF as a hard conundrum to face, with an ominous clinical impact. An in-depth characterization of HDRE's natural history will be pivotal to build preventive and mitigation strategies to improve the durability of pump-patient continuum
P227 DOES NITROPRUSSIDE TEST BEHAVE AD AN INCREMENTAL PROGNOSTIC FACTOR IN SELECTION OF PATIENTS CANDIDATE TO LVAD IMPLANTATION?
No full textDie Führungsrolle von FPT Industrial im Bereich Erdgastechnologien für Industriemotoren /FPT Industrial’s Leadership in Natural Gas Technologies for Industrial Engines
No full textLas competencias: apuntes para su representación
No full textEste trabajo aborda la cuestión de las competencias integrando diferentes contribuciones teóricas que posibilitensu actualización en una diversidad de contextos. La orientación principal en los estudios actuales en torno alas competencias no limita su concepción a componentes agregados –conocimientos, habilidades o actitudes– sino que estas se presentan como procesos que movilizan e integran tales recursos con relación a situacionesparticulares. La perspectiva que se asume en este trabajo propone un análisis de las competencias comoconfiguraciones de carácter estructural y funcional constitutivas y constituyentes de la subjetividad individual ysocial de un sujeto activo e interactivo situado. En contextos de ambigüedad e incertidumbre, la necesidad deldesarrollo de aprendizajes significativos y significantes abiertos al cambio, a la creación y a la experimentacióndemanda una formación profesional por competencias planteada como proceso constructivo–interpretativoen permanente “diálogo” con una realidad histórica y cambiante producto y productora de nuevas formas desubjetividad
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