RESUMEN
OBJECTIVES: To create a bedside peripherally inserted central catheter service to increase placement of bedside peripherally inserted central catheter in PICU patients. DESIGN: Two-phase observational, pre-post design. SETTING: Single-center quaternary noncardiac PICU. PATIENTS: All patients admitted to the PICU. INTERVENTIONS: From June 1, 2015, to May 31, 2017, a bedside peripherally inserted central catheter service team was created (phase I) and expanded (phase II) as part of a quality improvement initiative. A multidisciplinary team developed a PICU peripherally inserted central catheter evaluation tool to identify amenable patients and to suggest location and provider for procedure performance. Outcome, process, and balancing metrics were evaluated. MEASUREMENTS AND MAIN RESULTS: Bedside peripherally inserted central catheter service placed 130 of 493 peripherally inserted central catheter (26%) resulting in 2,447 hospital central catheter days. A shift in bedside peripherally inserted central catheter centerline proportion occurred during both phases. Median time from order to catheter placement was reduced for peripherally inserted central catheters placed by bedside peripherally inserted central catheter service compared with placement in interventional radiology (6 hr [interquartile range, 2-23 hr] vs 34 hr [interquartile range, 19-61 hr]; p < 0.001). Successful access was achieved by bedside peripherally inserted central catheter service providers in 96% of patients with central tip position in 97%. Bedside peripherally inserted central catheter service central line-associated bloodstream infection and venous thromboembolism rates were similar to rates for peripherally inserted central catheters placed in interventional radiology (all central line-associated bloodstream infection, 1.23 vs 2.18; p = 0.37 and venous thromboembolism, 1.63 vs 1.57; p = 0.91). Peripherally inserted central catheters in PICU patients had reduced in-hospital venous thromboembolism rate compared with PICU temporary catheter in PICU rate (1.59 vs 5.36; p < 0.001). CONCLUSIONS: Bedside peripherally inserted central catheter service implementation increased bedside peripherally inserted central catheter placement and employed a patient-centered and timely process. Balancing metrics including central line-associated bloodstream infection and venous thromboembolism rates were not significantly different between peripherally inserted central catheters placed by bedside peripherally inserted central catheter service and those placed in interventional radiology.
Asunto(s)
Cateterismo Periférico/métodos , Unidades de Cuidado Intensivo Pediátrico/organización & administración , Sistemas de Atención de Punto/organización & administración , Adolescente , Infecciones Relacionadas con Catéteres/epidemiología , Niño , Preescolar , Femenino , Humanos , Masculino , Mejoramiento de la Calidad , Factores de Tiempo , Ultrasonografía Intervencional , Tromboembolia Venosa/epidemiologíaRESUMEN
OBJECTIVES: referrals between health care facilities are important in low-resource settings, particularly in maternal and child health, to transfer pregnant patients to the appropriate level of obstetric care. Our aim was to characterise the obstetrical referrals from a rural clinic to a community referral hospital in Honduras, to identify barriers in effective transport/referral, and to describe subsequent patient outcomes. METHODS: we performed a descriptive retrospective study of patients referred during a 9-month period. We reviewed patient charts to review diagnosis, referral, and treatment times at both sites to understand the continuity of care. RESULTS: ninety-two pregnant patients were referred from the rural clinic to the community hospital. Twenty six pregnant patients (28%) did not have complete and accurate medical records and were excluded from the study. The remaining 66 patients were our study population. Of the 66 patients, 54 (82%) received antenatal care with an average of 5.5±2.4 visits. The most common diagnoses requiring referral were non-reassuring fetal status, hypertensive disorders of pregnancy, and preterm labour. The time spent in the rural clinic until transfer was 7.35±8.60 hours, and transport times were 4.42±1.07 hours. Of the 66 women transferred, 24 (36%) had different primary diagnoses and 16 (24%) had additional diagnoses after evaluation in the community hospital, whereas the remaining 26 (40%) had diagnoses that remained the same. No system was in place to give feedback to the referring clinic doctors regarding their primary diagnoses. CONCLUSIONS: our results demonstrate challenges seen in obstetric transport from a rural clinic to a community hospital in Honduras. Further research is needed for reform of emergency obstetric care management, targeting both healthcare personnel and medical referral infrastructure. The example of Honduras can be taken to motivate change in other resource-limited areas.
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Servicios de Salud Materno-Infantil/estadística & datos numéricos , Complicaciones del Embarazo/epidemiología , Derivación y Consulta/estadística & datos numéricos , Servicios de Salud Rural/provisión & distribución , Continuidad de la Atención al Paciente , Atención a la Salud , Países en Desarrollo , Femenino , Honduras/epidemiología , Hospitales Comunitarios/estadística & datos numéricos , Humanos , Recién Nacido , Servicios de Salud Materno-Infantil/normas , Transferencia de Pacientes , Embarazo , Complicaciones del Embarazo/terapia , Atención Prenatal , Estudios Retrospectivos , Servicios de Salud Rural/estadística & datos numéricosRESUMEN
BACKGROUND AND PURPOSE: The Near Needle Holder (NNH) (Near Manufacturing, Camrose, Alberta, Canada) is a reusable tool to introduce a standard hollow needle for pediatric intraosseous (IO) infusion. We compared the NNH to the Cook Dieckmann (Cook Critical Care, Bloomington, IN) manual IO needle in a simulation setting. METHODS: Study subjects were 32 physicians, nurses, and medical students participating in a trauma course in Guyana. After watching a training video and practicing under supervision, subjects were observed inserting each device into a pediatric leg model using a randomized crossover design. Outcome measures were time to successful insertion, technical complications, ease of use, and safety of each device. RESULTS: The mean time for IO insertion (32 ± 13 seconds) was similar for both devices (P = .92). Subjects rated the NNH device equivalent in ease of use to the Cook IO needle but slightly lower in perceived safety to the user. CONCLUSIONS: After training, all subjects successfully inserted the NNH IO device in a simulation environment, and most rated it as easy to use and safe. The NNH is a significant advance because IO needles are often not available in emergency departments in developing countries. Further studies are needed to evaluate clinical effectiveness of the NNH.
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Infusiones Intraóseas/instrumentación , Agujas , Pediatría/instrumentación , Actitud del Personal de Salud , Niño , Estudios Cruzados , Países en Desarrollo , Equipo Reutilizado , Guyana , Humanos , Modelos Anatómicos , Pediatría/educación , Grabación de Cinta de VideoRESUMEN
Sex-biased dispersal (SBD) is common in many vertebrates, including primates. However, dispersal patterns in New World primates may vary among closely related taxa or populations in different local environments. Here, we test for SBD in an endangered New World primate, the Central American Squirrel Monkey (Saimiri oerstedii citrinellus). Previous studies of behavioral ecology suggest predominantly female dispersal in S.o. oerstedii in the Southern Pacific region of Costa Rica. However, our genetic data do not support strongly female-biased dispersal in S.o. citrinellus in the Central Pacific region. Our tests for SBD using microsatellite data including comparisons of isolation-by-distance, AI(c) , and F(ST) values between males and females were not significant. Also, we found greater population genetic structure in mitochondrial markers than in microsatellite markers, indicative of predominantly male dispersal. We conclude that both sexes disperse in S.o. citrinellus, and that males probably disperse over longer distances. We discuss how spatial and temporal variation among local populations should be taken into account when studying dispersal patterns and especially sex bias.
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Conducta Animal , ADN Mitocondrial , Saimiri/genética , Animales , Costa Rica , Femenino , Masculino , Repeticiones de Microsatélite , Panamá , Dinámica Poblacional , Saimiri/fisiología , Análisis de Secuencia de ADN , Factores SexualesRESUMEN
Nutritionally enhanced beans (NEB) with more Fe and Zn than conventional beans (CB) and nutritionally enhanced maize (NEM) with more tryptophan and lysine than conventional maize (CM) were developed as part of a crop-biofortification strategy to improve human nutrition. Proxy measures were used to assess Fe and Zn bioavailability and protein digestibility of a bean recipe (fríjol sancochado) and a maize-milk recipe (mazamorra) prepared with enhanced or conventional crops in Colombia. Fe concentration was similar in the cooked NEB and CB and in NEM and CM (P> or = 0.05); in vitro Fe dialyzability was similar in cooked NEB (9.52%) and CB (9.72%) and greater for NEM (37.01%) than CM (32.24%). Zn concentration was higher in the uncooked and cooked NEB than in the CB (P < 0.05); phytate: Zn molar ratios were high in cooked NEB (36: 1) and CB (47: 1), suggesting low Zn bioavailability, and not different from each other (P = 0.07). There were no differences in Zn concentration or phytate: Zn molar ratio in the maize recipes. Nitrogen, tryptophan, and lysine concentrations were higher in the cooked NEM than CM; nitrogen was higher in the cooked NEB than CB (P < 0.05). In vitro protein digestibility was comparable (82% to 83%) for NEM and CM and higher for NEB (84%) than for CB (82%). The higher nutrient concentrations + similar bioavailability (protein in NEM, Zn in NEB), same nutrient concentrations + higher bioavailability (Fe in NEM) or higher nutrient concentrations + higher bioavailability (protein in NEB) can translate into more nutrients absorbed and utilized by the body.
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Proteínas en la Dieta/farmacocinética , Fabaceae/metabolismo , Alimentos Fortificados , Hierro de la Dieta/farmacocinética , Zea mays/metabolismo , Zinc/farmacocinética , Disponibilidad Biológica , Preescolar , Colombia , Colorimetría , Dieta/métodos , Humanos , Lisina/metabolismo , Nitrógeno/metabolismo , Estado Nutricional/fisiología , Valor Nutritivo , Ácido Fítico/metabolismo , Espectrofotometría Atómica , Triptófano/metabolismoRESUMEN
The present study describes a new set of 61 polymorphic microsatellite markers for beans and the construction of a genetic map using the BAT93 x Jalo EEP558 (BJ) population for the purpose of developing a reference linkage map for common bean (Phaseolus vulgaris). The main objectives were to integrate new microsatellites on the existing framework map of the BJ population, and to develop the first linkage map for the BJ population based exclusively on microsatellites. Of the total of 264 microsatellites evaluated for polymorphism, 42.8% showed polymorphism between the genitors. An integrated map was created totaling 199 mapped markers in 13 linkage groups, with an observed length of 1358 cM and a mean distance between markers of 7.23 cM. For the map constructed exclusively with microsatellites, 106 markers were placed in 12 groups with a total length of 606.8 cM and average distance of 6.8 cM. Linkage group designation and marker order for BM microsatellites generally agreed with previous mapping, while the new microsatellites were well distributed across the genome, corroborating the utility of the BJ population for a reference map. The extensive use of the microsatellites and the availability of a reference map can help in the development of other genetic maps for common bean through the transfer of information of marker order and linkage, which will allow comparative analysis and map integration, especially for future quantitative trait loci and association mapping studies.
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Mapeo Cromosómico , Hibridación Genética , Repeticiones de Microsatélite/genética , Phaseolus/genética , Segregación Cromosómica , Cromosomas de las Plantas/metabolismo , Ligamiento Genético , Marcadores Genéticos , Repeticiones de Minisatélite , Polimorfismo GenéticoRESUMEN
The Andean gene pool of common bean (Phaseolus vulgaris L.) has high levels of morphological diversity in terms of seed color and size, growth habit and agro-ecological adaptation, but previously was characterized by low levels of molecular marker diversity. Three races have been described within the Andean gene pool: Chile, Nueva Granada and Peru. The objective of this study was to characterize a collection of 123 genotypes representing Andean bean diversity with 33 microsatellite markers that have been useful for characterizing race structure in common beans. The genotypes were from both the primary center of origin as well as secondary centers of diversity to which Andean beans spread and represented all three races of the gene pool. In addition we evaluated a collection of landraces from Colombia to determine if the Nueva Granada and Peru races could be distinguished in genotypes from the northern range of the primary center. Multiple correspondence analyses of the Andean race representatives identified two predominant groups corresponding to the Nueva Granada and Peru races. Some of the Chile race representatives formed a separate group but several that had been defined previously as from this race grouped with the other races. Gene flow was more notable between Nueva Granada and Peru races than between these races and the Chile race. Among the Colombian genotypes, the Nueva Granada and Peru races were identified and introgression between these two races was especially notable. The genetic diversity within the Colombian genotypes was high, reaffirming the importance of this region as an important source of germplasm. Results of this study suggest that the morphological classification of all climbing beans as Peru race genotypes and all bush beans as Nueva Granada race genotypes is erroneous and that growth habit traits have been mixed in both races, requiring a re-adjustment in the concept of morphological races in Andean beans.
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Genes de Plantas , Variación Genética , Repeticiones de Microsatélite/genética , Phaseolus/clasificación , Phaseolus/genética , ADN de Plantas , Pool de Genes , Genética de Población , Genotipo , Phaseolus/crecimiento & desarrollo , Filogenia , Polimorfismo GenéticoRESUMEN
The present study describes a new set of 61 polymorphic microsatellite markers for beans and the construction of a genetic map using the BAT93 x Jalo EEP558 (BJ) population for the purpose of developing a reference linkage map for common bean (Phaseolus vulgaris). The main objectives were to integrate new microsatellites on the existing framework map of the BJ population, and to develop the first linkage map for the BJ population based exclusively on microsatellites. Of the total of 264 microsatellites evaluated for polymorphism, 42.8% showed polymorphism between the genitors. An integrated map was created totaling 199 mapped markers in 13 linkage groups, with an observed length of 1358 cM and a mean distance between markers of 7.23 cM. For the map constructed exclusively with microsatellites, 106 markers were placed in 12 groups with a total length of 606.8 cM and average distance of 6.8 cM. Linkage group designation and marker order for BM microsatellites generally agreed with previous mapping, while the new microsatellites were well distributed across the genome, corroborating the utility of the BJ population for a reference map. The extensive use of the microsatellites and the availability of a reference map can help in the development of other genetic maps for common bean through the transfer of information of marker order and linkage, which will allow comparative analysis and map integration, especially for future quantitative trait loci and association mapping studies.
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Mapeo Cromosómico , Hibridación Genética , Phaseolus/genética , Repeticiones de Microsatélite/genética , Segregación Cromosómica , Cromosomas de las Plantas/metabolismo , Ligamiento Genético , Marcadores Genéticos , Repeticiones de Minisatélite , Polimorfismo GenéticoRESUMEN
The bean pod weevil (Apion godmani Wagner) is a serious insect pest of common beans (Phaseolus vulgaris L.) grown in Mexico and Central America that is best controlled by host-plant resistance available in Durango or Jalisco genotypes such as J-117. Given unreliable infestation by the insect, the use of marker-assisted selection is desirable. In the present study, we developed a set of nine molecular markers for Apion resistance and mapped them to loci on chromosomes 2, 3, 4 and 6 (linkage groups b01, b08, b07 and b11, respectively) based on genetic analysis of an F (5:10) susceptible x resistant recombinant inbred line population (Jamapa x J-117) and two reference mapping populations (DOR364 x G19833 and BAT93 x JaloEEP558) for which chromosome and linkage group designations are known. All the markers were derived from randomly amplified polymorphic DNA (RAPD) bands that were identified through bulked segregant analysis and cloned for conversion to sequence tagged site (STS) markers. One of the markers was dominant while four detected polymorphism upon digestion with restriction enzymes. The other markers were mapped as RAPD fragments. Phenotypic data for the population was based on the evaluation of percentage seed damage in replicated trials conducted over four seasons in Mexico. In single point regression analysis, individual markers explained from 3.5 to 22.5% of the variance for the resistance trait with the most significant markers overall being F10-500S, U1-1400R, R20-1200S, W9-1300S and Z4-800S, all markers that mapped to chromosome 2 (b01). Two additional significant markers, B1-1400R and W6-800R, were mapped to chromosome 6 (b11) and explained from 4.3 to 10.2% of variance depending on the season. The latter of these markers was a dominant STS marker that may find immediate utility in marker-assisted selection. The association of these two loci with the Agr and Agm genes is discussed as well as the possibility of additional resistance genes on chromosome 4 (b07) and chromosome 3 (b08). These are among the first specific markers developed for tagging insect resistance in common bean and are expected to be useful for evaluating the mechanism of resistance to A. godmani.
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Mapeo Cromosómico , Phaseolus , Gorgojos/patogenicidad , Animales , América Central , Cruzamientos Genéticos , Femenino , Ligamiento Genético , Marcadores Genéticos , México , Phaseolus/genética , Phaseolus/parasitología , Polimorfismo Genético , Técnica del ADN Polimorfo Amplificado AleatorioRESUMEN
Advanced backcross QTL analysis was used to identify quantitative trait loci (QTL) for agronomic performance in a population of BC2F(3:5) introgression lines created from the cross of a Colombian large red-seeded commercial cultivar, ICA Cerinza, and a wild common bean accession, G24404. A total of 157 lines were evaluated for phenological traits, plant architecture, seed weight, yield and yield components in replicated trials in three environments in Colombia and genotyped with microsatellite, SCAR, and phaseolin markers that were used to create a genetic map that covered all 11 linkage groups of the common bean genome with markers spaced at an average distance of every 10.4 cM. Segregation distortion was most significant in regions orthologous for a seed coat color locus (R-C) on linkage group b08 and two domestication syndrome genes, one on linkage group b01 at the determinacy (fin) locus and the other on linkage group b02 at the seed-shattering (st) locus. Composite interval mapping analysis identified a total of 41 significant QTL for the eight traits measured of which five for seed weight, two for days to flowering, and one for yield were consistent across two or more environments. QTL were located on every linkage group with b06 showing the greatest number of independent loci. A total of 13 QTL for plant height, yield and yield components along with a single QTL for seed size showed positive alleles from the wild parent while the remaining QTL showed positive alleles from the cultivated parent. Some QTL co-localized with regions that had previously been described to be important for these traits. Compensation was observed between greater pod and seed production and smaller seed size and may have resulted from QTL for these traits being linked or pleiotropic. Although wild beans have been used before to transfer biotic stress resistance traits, this study is the first to attempt to simultaneously obtain a higher yield potential from wild beans and to analyze this trait with single-copy markers. The wild accession was notable for being from a unique center of diversity and for contributing positive alleles for yield and other traits to the introgression lines showing the potential that advanced backcrossing has in common bean improvement.
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Cruzamientos Genéticos , Ligamiento Genético , Phaseolus/genética , Fenotipo , Sitios de Carácter Cuantitativo/genética , Carácter Cuantitativo Heredable , Mapeo Cromosómico , Cromosomas de las Plantas , Genoma de Planta , Phaseolus/crecimiento & desarrolloRESUMEN
PIP: The problem-posing methodology of Brazilian educator Paulo Freire, using the reading circle approach previously deployed in successful literacy campaigns in developing countries, is introduced for application in AIDS information programs. The basis of this educational process is the dialogue where those to be educated resolve their problems by evaluating information critically, capturing concepts by codification and decodification, and transmitting information by creating relevant educational materials. Health circles are organized with women as educators to impart knowledge about AIDS and HIV: definitions, epidemiological components (sex, age, and risk behavior), means of transmission, stages of the progression of AIDS, prevention of HIV infection, and tests for detecting HIV antibodies. The dialogue explores knowledge and feelings about AIDS and how it affects life in the community reveals personal experiences and accounts of knowing someone who was HIV-positive, and develops action plans to minimize AIDS cases in the community. The Latin population of California, mainly of Mexican origin, with low levels of education, income, and acculturation and a high incidence of AIDS, is an appropriate target of such intervention. In 1980, there were 12.3 million people of Hispanic origin in the US. In August 1990, there were 143,280 persons diagnoses with AIDS according to the Centers for Disease Control. 78,878 of these (55%) were Anglos, and 21,752 (15%) were Hispanics. Among the Anglos, the incidence was 300/million inhabitants, while among Hispanics, it was 1059/million, a 3-field higher rate.^ieng