Un guide pour l'établissement du statut du personnel des administrations publiques
In: Progress in Public Administration, Band 17, Heft 3, S. 532-535
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In: Progress in Public Administration, Band 17, Heft 3, S. 532-535
In: Ecotoxicology and environmental safety: EES ; official journal of the International Society of Ecotoxicology and Environmental safety, Band 134, S. 433-439
ISSN: 1090-2414
In: Ecotoxicology and environmental safety: EES ; official journal of the International Society of Ecotoxicology and Environmental safety, Band 134, S. 336-343
ISSN: 1090-2414
Background: Executive functions and attention play a key role to achieve academic goals in scholars. However, research have shown multiple social factors that might impact educational outcomes in typically developed children. Colombia faces one major issue in its border with Venezuela due to historical, social, cultural and economic conditions that have contributed to low quality of education - among others problems. This situation is far worse in rural areas where government assistance programs are limited, and teaching methodologies vary considerably. The aim of this study was to explore children's performances in attention and executive functions tasks according to teaching methodology used in urban (regular) and rural (multigrade) areas in the northeast of Colombia and close to the border with Venezuela. Methods: data were collected in two types of settings: 26 children from one local school (in Cucuta- Norte de Santander) and 29 children from three rural schools. All of them were 6 years old and enrolled in the first grade of primary school. Participants were tested using attentional (visual and auditory) and executive function tasks (planning, inhibitory control, and working memory). Results: lower performance was found in visual attention tasks for both groups in comparison with the reference group (children from other regions in Colombia). Moreover, there was a significant difference between the two conditions according to the teaching methodology: children from multigrade methodologies showed better performance in inhibitory control tasks, meanwhile children from regular methodologies showed better results in planning and attentional tasks. Conclusions: this study has identified differences in executive functions and attention of children depending on social contexts (urban-rural) and teaching methodologies. Findings are discussed in order to highlight social variables such as physical environment, limited cognitive stimulation, parenting, and some habits that impact Latin American contexts and have a strong relationship with children's scholar outcomes. ; Introducción: La frontera colombo-venezolana enfrenta dinámicas sociales particulares que han contribuido en los bajos indicadores de calidad educativa, presente también en contextos rurales donde problemas como la migración y la violencia, dificultan la calidad y cobertura. Este estudio tuvo como objetivo analizar las diferencias en el desarrollo de habilidades de atención y funciones ejecutivas según el contexto (urbano -rural) y la metodología escolar recibida (urbana regular y rural multigrado). Métodos: Se empleó un diseño no experimental, de alcance comparativo y corte transversal, evaluando una muestra intencional de 55 niños emparejados por edad, sin dificultades académicas y matriculados en diferentes instituciones de Norte de Santander- Colombia, en zona de frontera con Venezuela. Los estudiantes fueron evaluados con tareas neuropsicológicas de atención visual, planificación, inhibición y memoria de trabajo de la Evaluación neuropsicológica Infantil (ENI y Neuro psi). Los resultados fueron analizados mediante estadística no-paramétrica dadas las características de los datos recolectados. Resultados: Se encontraron desempeños inferiores en tareas de atencional visual en los participantes de ambas metodologías en comparación con el grupo de referencia. Así mismo, se encontraron diferencias según el tipo de metodología escolar recibida, siendo destacados en control inhibitorio los participantes de metodología multigrado, mientras que los niños escolarizados en metodología regular mostraron mejores resultados en capacidad de atención visual, atención auditiva y planeación. Conclusiones: Se encontraron diferencias en funciones ejecutivas de control inhibitorio, atención y planeación de acuerdo con el contexto escolar urbano-rural. Los hallazgos se discuten con el fin de argumentar la importancia de variables intervinientes asociadas a contextos rurales latinoamericanos, donde se destaca el entorno físico, la limitada estimulación cognitiva, prácticas particulares de crianza y cuidado y algunos hábitos que han mostrado una relación con el desempeño cognitivo.
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Hospitals must have a major haemorrhage protocol in place and this should include clinical, laboratory and logistic responses.Immediate control of obvious bleeding is of paramount importance (pressure, tourniquet, haemostatic dressings).The major haemorrhage protocol must be mobilised immediately when a massive haemorrhage situation is declared.A fibrinogen 1.5 times normal represents established haemostatic failure and is predictive of microvascular bleeding. Early infusion of fresh frozen plasma (FFP; 15 ml.kg−1) should be used to prevent this occurring if a senior clinician anticipates a massive haemorrhage.Established coagulopathy will require more than 15 ml.kg−1 of FFP to correct. The most effective way to achieve fibrinogen replacement rapidly is by giving fibrinogen concentrate or cryoprecipitate if fibrinogen is unavailable.1:1:1 red cell:FFP:platelet regimens, as used by the military, are reserved for the most severely traumatised patients.A minimum target platelet count of 75 × 109.l−1 is appropriate in this clinical situation.Group-specific blood can be issued without performing an antibody screen because patients will have minimal circulating antibodies. O negative blood should only be used if blood is needed immediately.In hospitals where the need to treat massive haemorrhage is frequent, the use of locally developed shock packs may be helpful.Standard venous thromboprophylaxis should be commenced as soon as possible after haemostasis has been secured as patients develop a prothrombotic state following massive haemorrhage.
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Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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