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Medellin, Colombia

The University of Antioquia , also called UdeA, is a public, departmental, coeducational, research university based primarily in the city of Medellín, Antioquia, Colombia with regional campuses in Amalfi, Andes, Caucasia, Carmen de Viboral, Envigado, Puerto Berrío, Santa Fe de Antioquia, Segovia, Sonsón, Turbo and Yarumal. It is the oldest departmental university in Colombia, founded in 1803 by a Royal Decree issued by the King Charles IV of Spain under the name Franciscan College . It is considered one of Colombia's best universities, receiving a high quality accreditation from the Ministry of Education for 9 years. Along with the University of the Andes, the two universities hold the second longest term, behind the National University of Colombia. UdeA and the Tecnológico de Antioquia have the largest number of seats in the department of Antioquia. It is also renowned for its prestigious Faculty of Medicine, which is acknowledged as the top medical school in Colombia.The university is a member of the Association of Colombian Universities , the Iberoamerican Association of Postgraduate Universities , and the network Universia. Wikipedia.

Ethnicity is a biological and a social construct which encompasses ancestral genes, cultural, geographic and socioeconomic characteristics shared within a population. It is clear that no homogeneous racial groups exist within the human race as demonstrated when examining ancestry informative markers. Both the genetic and non-genetic components of ethnicity exert influence in the expression and outcome of systemic lupus erythematosus (SLE), including disease activity, damage accrual, work disability and mortality. Although it is difficult to determine the extent to which the differences observed in these parameters are caused by genetic or non-genetic factors, early in the disease genetic factors seem to play a more important role as determinants of the differences observed between SLE patients from various ethnic groups. Over the course of the disease, non-genetic factors seem to play a more important role. By and large, SLE is more frequent and more severe with higher disease activity and more damage accrual in non-Caucasian populations (Hispanics, African descendants and Asians) than in Caucasians. To overcome these differences it is necessary to optimize health care access to disadvantaged populations and use innovative tools to increase disease awareness and improve treatment adherence. Source

Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997-2011). A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen's conceptual framework of access and use of health services and by incorporating other emergent categories. We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed. Source

Barrera L.M.,University of Antioquia
The Cochrane database of systematic reviews

Trauma is a leading causes of death and disability in young people. Venous thromboembolism (VTE) is a principal cause of death. Trauma patients are at high risk of deep vein thrombosis (DVT). The incidence varies according to the method used to measure the DVT and the location of the thrombosis. Due to prolonged rest and coagulation abnormalities, trauma patients are at increased risk of thrombus formation. Thromboprohylaxis, either mechanical or pharmacological, may decrease mortality and morbidity in trauma patients who survive beyond the first day in hospital, by decreasing the risk of VTE in this population.A previous systematic review did not find evidence of effectiveness for either pharmacological or mechanical interventions. However, this systematic review was conducted 10 years ago and most of the included studies were of poor quality. Since then new trials have been conducted. Although current guidelines recommend the use of thromboprophylaxis in trauma patients, there has not been a comprehensive and updated systematic review since the one published. To assess the effects of thromboprophylaxis in trauma patients on mortality and incidence of deep vein thrombosis and pulmonary embolism. To compare the effects of different thromboprophylaxis interventions and their effects according to the type of trauma. We searched The Cochrane Injuries Group Specialised Register (searched April 30 2009), Cochrane Central Register of Controlled Trials 2009, issue 2 (The Cochrane Library), MEDLINE (Ovid) 1950 to April (week 3) 2009, EMBASE (Ovid) 1980 to (week 17) April 2009, PubMed (searched 29 April 2009), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) (1970 to April 2009), ISI Web of Science: Conference Proceedings Citation Index-Science (CPCI-S) (1990 to April 2009). Randomized controlled clinical trials involving people of any age with major trauma defined by one or more of the following criteria: physiological: penetrating or blunt trauma with more than two organs and unstable vital signs, anatomical: people with an Injury Severity Score (ISS) higher than 9, mechanism: people who are involved in a 'high energy' event with a risk for severe injury despite stable or normal vital signs. We excluded trials that only recruited outpatients, trials that recruited people with hip fractures only, or people with acute spinal injuries. Four authors, in pairs (LB and CM, EF and RC), independently examined the titles and the abstracts, extracted data, assessed the risk of bias of the trials and analysed the data. PP resolved any disagreement between the authors. Sixteen studies were included (n=3005). Four trials compared the effect of any type (mechanical and/or pharmacological) of prophylaxis versus no prophylaxis. Prophylaxis reduced the risk of DVT in people with trauma (RR 0.52; 95% CI 0.32 to 0.84). Mechanical prophylaxis reduced the risk of DVT (RR = 0.43; 95% CI 0.25 to 0.73). Pharmacological prophylaxis was more effective than mechanical methods at reducing the risk of DVT (RR 0.48; 95% CI 0.25 to 0.95). LMWH appeared to reduce the risk of DVT compared to UH (RR 0.68; 95% CI 0.50 to 0.94). People who received both mechanical and pharmacological prophylaxis had a lower risk of DVT (RR 0.34; 95% CI 0.19 to 0.60) We did not find evidence that thromboprophylaxis reduces mortality or PE in any of the comparisons assessed. However, we found some evidence that thromboprophylaxis prevents DVT. Although the strength of the evidence was not high, taking into account existing information from other related conditions such as surgery, we recommend the use of any DVT prophylactic method for people with severe trauma. Source

Perez-Velez C.M.,University of Antioquia
Current Opinion in Pediatrics

Purpose of Review: To discuss the recommendations pertaining to infants, children, and adolescents in new and updated tuberculosis (TB) guidelines that have been published since 2010 - with emphasis on those from supranational organizations. Recent Findings: The main developments in the guidelines covered in this article are related to: novel diagnostics for TB infection, disease, and drug resistance; updated treatment regimens for childhood and drug-resistant TB (DR-TB); and primary and secondary prevention of TB disease in HIV-infected children and adolescents. Summary: These new guidelines have significant implications for improving pediatric TB care. Regarding diagnosis, current interferon-gamma release assays should not replace tuberculin skin testing, but may be complementary; a polymerase chain reaction assay has been validated for detecting Mycobacterium tuberculosis and rifampicin resistance in microscopy-negative samples, especially in HIV-infected and DR-TB suspects; and a molecular line probe assay has been validated for detecting DR-TB in microscopy-positive samples and culture isolates in DR-TB suspects. With respect to treatment, there have been certain changes in the recent World Health Organization recommendations for certain clinical syndromes, for multidrug-resistant TB disease, and for HIV/TB disease. Concerning prevention, there are new screening algorithms for case finding, and new recommendations for treating HIV-infected children with presumed TB infection and with TB disease with treatment completed (i.e., secondary prophylaxis). © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Saxena S.,Lawrence Berkeley National Laboratory | Bedoya I.D.,University of Antioquia
Progress in Energy and Combustion Science

Low temperature combustion (LTC) engines are an emerging engine technology that offers an alternative to spark-ignited and diesel engines. One type of LTC engine, the homogeneous charge compression ignition (HCCI) engine, uses a well-mixed fuel-air charge like spark-ignited engines and relies on compression ignition like diesel engines. Similar to diesel engines, the use of high compression ratios and removal of the throttling valve in HCCI allow for high efficiency operation, thereby allowing lower CO2 emissions per unit of work delivered by the engine. The use of a highly diluted well-mixed fuel-air charge allows for low emissions of nitrogen oxides, soot and particulate matters, and the use of oxidation catalysts can allow low emissions of unburned hydrocarbons and carbon monoxide. As a result, HCCI offers the ability to achieve high efficiencies comparable with diesel while also allowing clean emissions while using relatively inexpensive aftertreatment technologies. HCCI is not, however, without its challenges. Traditionally, two important problems prohibiting market penetration of HCCI are 1) inability to achieve high load, and 2) difficulty in controlling combustion timing. Recent research has significantly mitigated these challenges, and thus HCCI has a promising future for automotive and power generation applications. This article begins by providing a comprehensive review of the physical phenomena governing HCCI operation, with particular emphasis on high load conditions. Emissions characteristics are then discussed, with suggestions on how to inexpensively enable low emissions of all regulated emissions. The operating limits that govern the high load conditions are discussed in detail, and finally a review of recent research which expands the high load limits of HCCI is discussed. Although this article focuses on the fundamental phenomena governing HCCI operation, it is also useful for understanding the fundamental phenomena in reactivity controlled compression ignition (RCCI), partial fuel stratification (PFS), partially premixed compression ignition, spark-assisted HCCI, and all forms of low temperature combustion (LTC). Source

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