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Agriculture has progressively decreased in its proportion of the value of international trade flows, being largely surpassed by extractive industries and, above all, manufacturing. Latin America, and especially South America, however, is one of the regions where the highest percentage of total trade comes from agricultural trade. China has become a preferred destination for Latin American agricultural exports, with China seeing Latin America as a strategic partner in guaranteeing its food security. The objective of this chapter is to analyze the agricultural trade and investment relationship between China and Latin America, starting with an overview of the recent evolution of agricultural export and import flows between China and Latin America and its implications, followed by an analysis of the agricultural investment strategies that China has developed in Latin America and the agricultural trade agreements China has made with Latin American countries, and finishing with an exploration of the effects of COVID-19 on Sino-Latin American agricultural trade and some adaptation strategies that have been implemented. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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The aim of this paper is to describe a teaching proposal that promotes algebraic thinking through the expression and justification of mathematical ideas when solving tasks related to three different approaches to algebraic thinking. We designed a classroom teaching experiment implemented during the COVID pandemic in Chile. We analyze the oral discussions and the written productions of children in fourth grade (9-10 years old). The results show that the children expressed and justified increasingly sophisticated algebraic ideas. That is, they gradually adopted a more precise and mathematical language. We conclude that this modality of work, in which the algebraic character of arithmetic is highlighted through various instances of discussion, is a contribution for teachers, by guiding them in addressing current teaching challenges. © 2023 Universitat Autonoma de Barcelona. All rights reserved.
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Objective: Analyze the relationship between experiences in enjoyment activities, self-concept clarity and the perception of a significant future in young people who are pursuing higher education during the covid-19 pandemic. Method: Participants: students (n = 228), of both sexes who were studying different higher-level careers in Buenos Aires. Instruments: Sociodemographic questionnaire. Possible Selves Questionnaire. Purpose in Life Scale for College Students. Self-concept clarity Scale. Scale of Enjoyment in Activity, Scale of Personal Achievement. Scale of Physical and Psychoemotional Indicators of Stress. Results: More than a half of the students (65,8 %) perceive great changes in their enjoyment activity during the quarantine, but these are not related to the perception of a significant future. Self-concept clarity predicts the probability of attaining possible desired selves and the pursuit of purpose in life. Clarity, positive affect, and self-actualization predict purpose in life identification. The variables studied are associated with fewer stress symptoms. Conclusion: The results show the need to favor these experiences, as well as the exploration of self-knowledge, values and interests, which promote the identification of goals, as a protective factor against the effects and consequences of the current context. © 2023, Universidad Simon Bolivar. All rights reserved.
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Today, many consumers seek to stay in environmentally sustainable hotels. Moreover, the tourism industry is one of the most impacted by the COVID-19 outbreak. In this increasingly competitive environment, companies in general, and hotels in particular, must offer unique experiences through value co-creation. The purpose of this work is to analyze the impact of "green” practices and value co-creation on brand equity, evaluating the moderating role of the consumer's nationality in the setting of hospitality companies. From a personal survey of 309 hotel guests in Valencia (Spain) and 302 guests in Bogotá (Colombia), evidence is obtained on the existence of some differences depending on the guest's country of origin, thus allowing hotel managers to have a better knowledge when designing their corporate strategies. © 2023 Taylor & Francis Group, LLC.
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Background: Interruption of GM-CSF signaling leads to Pulmonary Alveolar Proteinosis (PAP), occasionally to lung infections and relates to the impaired ability of lung macrophages to catabolize phagocytized surfactant and handle microbes. COVID-19 is associated with worse prognosis in lung disorders. We hypothesized that PAP patients would be at increased risk for COVID-19 and poor outcome. Aim and objectives: This multi-center, retrospective, European study aimed to investigate prevalence and clinical consequences of COVID-19 in PAP and the impact of iGM-CSF treatment on hospitalization or death. Method(s): All patients with PAP and COVID-19 diagnosed and followed-up in 11 referral European centers from January 24th 2020 to August 31st 2021 were included. Prevalence, clinical course and outcome were investigated. Result(s): COVID-19 developed in 34/255 (13.3%) of patients, mostly adults (91.2%), all with autoimmune (a)PAP;all patients were infected before the preventive option of vaccination was available;11 (35.5%) were hospitalized, of whom almost half were in the ICU;3 (27%) of hospitalized patients either died or underwent lung-transplant;these three patients had worse DLCO% predicted (p=0.019) and had more often arterial hypertension (AH) (p=0.012), and a smoking history (p=0.002). All patients with mild disease treated at home survived. Among children, 3 developed COVID-19 with good outcome. Conclusion(s): PAP patients experienced similar rates of COVID-19 with the general population but increased rates of hospitalizations and deaths, underscoring the vulnerability of this population and the necessity of preventive measures to avoid infection. If infected, secondary prophylaxis with monoclonal antibodies and the impact of iGM-CSF must be considered.
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Background: Hydroxychloroquine (HCQ) may be an effective, safe, and affordable treatment for Covid-19 that can be used in selected patients. However, more evidence on its association when it is used in different stages of the disease with clinical outcomes is required. This observational study investigates the association between treatment with HCQ and mortality in patients with Covid-19. Method(s): The data from 6217 patients who died or were discharged from 24 Spanish hospitals were analyzed. Propensity matching scores (PMS) were used. Result(s): 5094 patients received HCQ. Death was recorded for 17.5% of those who had HCQ and 34.1% of those who did not have it. Mortality was lower for those who had HCQ, OR=0.41 (95% CI=0.34-0.48). The PMS analysis also showed that mortality was lower for those receiving HCQ, OR=0.47 (95%CI=0.36-0.62). PMS analysis for categories revealed an association between HCQ and lowered mortality for patients over 65 years of age, with a past medical history of hypertension, for those who were diagnosed during admission with sepsis related organ failure or pneumonia, and for those with lymphocytopenia, raised troponin, LDH, ferritin and D-dimer. No increase in mortality associated with HCQ was observed in any category of any of the variables investigated. Conclusion(s): HCQ could be associated with lower mortality for older patients, those with more severe disease and raised inflammatory markers. Further RCTs, observational studies, and summaries of both types of evidence on this topic are necessary to select the precise profile of patients that may benefit from HCQ.Copyright © 2023 Bentham Science Publishers.
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Background: Some patients present persistent ground glass opacities (GGO) and/or consolidations after an acute episode of SARS-CoV-2 pneumonia (COVID19). Risk factors for persistent pneumonitis (PPN) and potential response to corticosteroids remain unclear. Objective(s): To evaluate the clinical characteristics of patients with PPN, as well as to detect possible risk factors and the role of corticosteroids. Method(s): We conducted a prospective, controlled, multicenter analysis of patients hospitalized because of COVID19 with (n=152) or without (n=140) PPN. PPN was defined by the persistence of pulmonary opacities in a chest CT scan >14 days after admission. Characteristics of participants were obtained from their medical records. A CT score was used to quantify parenchymal abnormalities when PPN was suspected. Result(s): Compared to controls, patients with PPN were older and suffered more comorbidities, also D-dimer and Creactive protein levels were higher. The most frequent features observed in CT scans were GGO (97%), consolidation (95%), bronchial dilatation (93%) and reticular pattern (92%) with a CT score of 16.12+/-4.26. Multivariate logistic regression identified age and C-reactive protein levels on admission as independent risk factors for PPN. No significant differences were observed in thoracic CT scan one-month after discharge in patients treated with higher corticosteroids doses (>50 mg/day after discharge) compared to lower doses. Conclusion(s): Age and raised C-reactive protein levels on admission are significant risk factors of PPN after COVID19. Treatment with high doses of corticosteroids does not seem to add benefit.
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Introduction: Rehabilitation in subjects with severe coronavirus disease 2019 (COVID-19) pneumonia has been widely recommended. However, data regarding the starting time of rehabilitation, subjects and healthcare workers safety are limited. We aimed to assess the safety and characterize the effect of early and non-early physiotherapy on severe COVID-19 pneumonia subjects. Method(s): Retrospective cohort study including a consecutive sample of surviving subjects admitted to an acute care hospital due to severe COVID-19 pneumonia from March 13th to May 15th of 2020. Subjects were separated into three groups: non-physical therapy, early physiotherapy (onset <7 days of admission), and non-early physiotherapy. Subject and therapist safety, and length of hospital stay were the main evaluated outcomes. Result(s): A total of 159 subjects were included (72% male;median age 62 years). Rehabilitation was performed on 108 subjects (32 early and 76 non-early physiotherapy). The length of hospital stay was 19 (IQR 36.25) and 34 days (IQR 27.25) (p=0.001) for early and non-early physiotherapy groups, respectively. No physiotherapist was infected and no subject adverse effect was identified. Multivariate analysis of subjects receiving physiotherapy during admission identified obesity (Odds ratio [OR] 3.21;p-value 0.028), invasive mechanical ventilation (OR 6.25;p-value <0.001) and non-early physiotherapy (OR 3.54;p-value 0.017) as independent factors associated with a higher risk of prolonged hospital stay. Conclusion(s): Rehabilitation in acute severe COVID-19 pneumonia is safe for subjects and healthcare workers, and could reduce the length of hospitalization stay, especially in those that may start early.
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Background. Antibiotic stewardship programs (ASP) are relatively new in Mexico. It was until May 2018 that it was established as a public health policy in the country. Few hospitals have acknowledged the mandate and started an ASP despite the efforts. Besides, little has been done to evaluate the efficacy of the program in terms of antibiotic expenditure and the incidence of associated infections. Therefore, the main objective was to evaluate antibiotic expenditure before and after the ASP in a third-level hospital in Mexico. As a secondary analysis, the relationship with Clostridioides difficile infections was explored. Methods. This is a retrospective and descriptive study from January 2017 to February 2020 (pre-COVID-19 pandemic). First, the mean antibiotic expenditure (adjusting for DDD/patient days-costs in USD) was evaluated before and after (June 2018 as the first month of implementation) the ASP. Statistical difference of the means was evaluated. It was also performed an exploratory analysis between the prescription of Clindamycin and Levofloxacin with the number of cases and deaths related to C. difficile infection. Results. The average antibiotic expenditure before ASP was US$13,468 +/- 3,267, and US$8,193 +/- 2,574 (p< 0.001) after. Graph 1 presents the changes in trend. Specifically, caspofungin, ciprofloxacin, clindamycin, fluconazole, levofloxacin, linezolid, piperacillin/tazobactam, and tigecycline showed statistically significant reduction after June 2018. Graph 2 displays the descriptive relationship between the prescription of levofloxacin and clindamycin, the cases of C. difficile infection, and the elimination of all associated mortality. Graph 1. Antibiotic expenditure. Before and after AMS Graph 2. Relationship between monthly consumption of clindamycin and levofloxacin and the number of cases/deaths secondary to Clostridioides difficile infections, before and after ASP. Conclusion. The ASP has significantly reduced the antibiotic expenditure in the hospital. Besides reducing the prescription of associated antibiotics, a possible reduction in C. difficile infections and associated deaths were observed.
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Background The COVID-19 pandemic has severely impacted older people. The disease and the measures to combat it have had a differential impact according to gender, with higher mortality rates in men and worse psychological and social consequences in women. The objective of this work is to analyze the changes in perceived health of older people in Europe during the first months of the pandemic and to assess the combined role of age and gender. Methods Wave 8 data of SHARE-corona (Survey of Health, Aging and Retirement in Europe) (n = 51,695, aged≥50) collected between Jun-Aug 2020 were used. Perceived health status was explored with a question on whether there has been a change compared with the health status before the COVID-19 outbreak (response options: worse, the same and better). Two-way ANOVA with interaction and Student's t-test with Bonferroni correction were used to compare the effects of gender and age group (50-59 years, 60-69 years, 70-79 years, and ≥80) in changes in perceived health. Results Differences in perceived health were observed by age, as well as by gender in participants aged ≥70 years (F = 91.94;p < 0.001). These differences were significant both by gender (F = 19.39;p < 0.001) and age (F = 191.79;p < 0.001). No interaction was detected between both factors (p = 0.170), which allowed their effect to be studied individually. Among the people who reported a worsening in their perceived health, women aged 70 to 79 years predominated (11.1%), followed by men aged 80 and over (15.3%) and women of the same age group (16.4%). Conclusions The results suggest an association between the change in perceived health during the pandemic and age. Women have a slightly worse health status than men in all age groups. Therefore, gender can be considered as an influential factor in perceived health in old age, which in turn can have a potential impact in the quality of life of older people. Funding Projects Ref. H2019/HUM-5698 and Ref. 202010E158. Key messages Older people have been severely impacted by COVID-19 pandemic. The combined effect of age and gender on the change in perceived health status during the pandemic have been analyzed.
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This research article describes the importance of the English language as a foreign language within a inquiry, gamification, autonomous learning and digital reading process. The main objective was about developing a digital proposal that would promote the use of technical English applied to the reading plan in some courses of the civil engineering program through a virtual environment, it was based on interactive and digital magazines. They worked about the civil engineering discipline and they were focused on the ESP methodology. It was framed within the reading plan established through the syllabus of the four disciplinary courses. The mandatory quarantine situation generated by Covid-19 made part of the methodological process and fieldwork research. Just because it was 100% virtual. The research was carried out using a correlational quantitative methodological. The intervened sample was 161 students. Talking about the results obtained, it is highlighted that the reading plan proposed from the digital magazines enhanced the level of English to the civil engineering students, it was according to statistical facts used to measure different aspects from the type of research selected. The situation of virtualized education was used to strengthen disciplinary themes about civil engineering program and foreign language skills. © 2021 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.
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Purpose: The evidence regarding the clinical effectiveness of COVID-19 vaccination in kidney transplant (KT) recipients is limited so far. Our purpose is to analyze the characteristics and outcomes of a large series of KT with COVID-19 breakthrough infection and compare them with unvaccinated patients. As a secondary objective, we analyzed the evolution according to the type of mRNA vaccine administered. Method(s): From April to October 2021, KT recipients with COVID-19, included in the COVID-19 registry of the Spanish Society of Nephrology, were analyzed. Data regarding vaccination status and type of vaccine were collected and outcomes of unvaccinated or partially vaccinated patients were compared with fully vaccinated patients. Result(s): Clinical picture was similar and survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated or partially vaccinated died (p=.776). In multivariable analysis age and pneumonia were independent risk factors for death, while vaccination status was not related to mortality. These results remained similar when we excluded patients with partial vaccination as well as when we analyzed exclusively hospitalized patients. Patients vaccinated with mRNA-1273 (Moderna) (n=213) showed a significantly lower mortality than those who received BNT162b2 (Pfizer-BioNTech) vaccine (n=121) (16.4% vs. 28.8%, p=.002) (HR: 0.52, CI 95% 0.31-0.85, p=.010). Conclusion(s): COVID-19 severity in KT patients has remained high and has not improved despite receiving 2 doses of an mRNA vaccine, but the mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infection, so it could be considered as the first option in these patients.
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This research article describes the importance of the English language as a foreign language within a inquiry, gamification, autonomous learning and digital reading process. The main objective was about developing a digital proposal that would promote the use of technical English applied to the reading plan in some courses of the civil engineering program through a virtual environment, it was based on interactive and digital magazines. They worked about the civil engineering discipline and they were focused on the ESP methodology. It was framed within the reading plan established through the syllabus of the four disciplinary courses. The mandatory quarantine situation generated by Covid-19 made part of the methodological process and fieldwork research. Just because it was 100% virtual. The research was carried out using a correlational quantitative methodological. The intervened sample was 161 students. Talking about the results obtained, it is highlighted that the reading plan proposed from the digital magazines enhanced the level of English to the civil engineering students, it was according to statistical facts used to measure different aspects from the type of research selected. The situation of virtualized education was used to strengthen disciplinary themes about civil engineering program and foreign language skills. © 2021 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.
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Purpose/Objectives: Patients with Limited English proficiency (LEP) are at greater risk for hospital admissions and representations to the emergency department (ED) in comparison to patients with English proficiency (EP). Improved communication with language services has been shown to decrease these health disparities. In our free-standing Children's Hospital yearly ED representation rates for patients with LEP (4.6%) are over 20% higher than for our patients with EP (3.7%). We aimed to decrease the 7-day representation rate for patients with LEP in the emergency department by 20% over 18 months using the Plan Do Study Act (PDSA) method for quality improvement. Design/Methods: Our first cycle was the deployment of video remote interpretation (VRI). Second and third cycles included focused teaching for Faculty, House staff and staff on VRI use. PDSA cycles were interrupted with the unexpected event of Covid-19 and issues obtaining Cerner data. We evaluated outcomes quantitatively based on data from our language service provider and electronic medical record (EMR). We also conducted an electronic survey of Faculty and Staff to evaluate quantitatively over time VRI reception and frequency of obtaining preferred language. Results: LEP representation rates initially increased followed by a decreasing trend with the Covid19 pandemic and opening of an ED observation unit but this trend was not sustained and average representation rates after PDSA cycles increased to 6.1%. EP representation rates overall remained unchanged at 3.7%. Utilization of interpretation carts increased from 0 to >250 total calls made per month over the course of 18 months. The monthly average number of identified patients with LEP decreased after changes were made to the recording system in the EMR. Monthly rates of interpretation carts used for un-identified patients with LEP were found to range from 27% to 78%, signifying significant under identification in the EMR. 75% of ED Faculty and staff reported that they only ask preferred language or offer interpretation services for medical discussions infrequently when patients appear to speak English well but is clearly not their native language. Total ED visit numbers decreased after March of 2020 to 30-50% of expected due to Covid-19 pandemic. Conclusion/Discussion: ED Patients with LEP had an unexpectedly high rate of un-identification in addition to ED faculty and staff reporting not asking preferred language if the patient seems to speak English well. This has likely led to an underestimation of our LEP representation rate and lack of representative change during our PDSA cycles. Without identifying this vulnerable population, we will always be lacking in providing care in the preferred language which is critical for improving outcomes for our patients with LEP. Our next steps are to develop interventions to increase the identification of patients with LEP to provide safe and comprehensive care for this vulnerable population.
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Purpose/Background: Perioperative COVID-19 infection is associated with an increase in morbidity and mortality, in addition to the consequences on surgical pathologies due to delays in diagnosis and treatment. Hypothesis/Aim: The aim of this study it is to describe and evaluate the effects of the pandemic on patients undergoing colorectal cancer surgery in the UC-Christus Healthcare Network. Methods/Interventions: A retrospective observational cross-sectional cohort study was made. It was based on the review of the admissions and surgical protocols of patients operated due to colon and rectal cancer diagnosis between 03/18/2019 - 03/17/2021 in the UC-Christus Healthcare Network. Patients with incomplete records and follow-ups, recurrences, or endoscopic treatments were excluded. The results of patients who were operated before the sanitary restrictions were compared with those who were operated afterwards (03/18/2020). The variables of sex, age, date of surgery, procedure, approach, tumor location, TNM, biopsy, pathological stage, presence of neoadjuvant and/or adjuvant, cause of mortality, emergency admission, and ostomy requirement were recorded in a database. The descriptive and analytic statistics of the results were analyzed using the Microsoft SPSS-Statistics21 program. Proportions were compared with the Chi2 test and Fisher's exact test in variables whose frequency was less than 5. Results/Outcome(s): One hundred seven records were included in the first period (79 colon and 28 rectal tumors) and 134 in the second (100 colon and 34 rectal tumors), with no significant differences between the number of patients nor the distribution by sex in both periods. In the colon tumors group, there were no significant differences between the groups of patients with early-stage (17), locally advanced (118), and metastatic (44) tumors between both periods. Nineteen patients (10.6%) underwent emergency surgery, 36 patients (20.1%) required an ostomy to be performed without significant differences in both periods. At the rectum tumor group, there were no significant differences concerning sex, nor pathological stage, where 17 (26.9%) were in the initial stages, 29 (46%) locally advanced, and 17 (26.9%) were metastatic. The laparoscopic approach was preferred in all tumor groups, requiring conversion in 6 (4.65%) colon tumor and 1 (2.17%) rectal tumor cases. No mortalities were recorded 30, 60, nor 90 days after Limitations: Among the limitations of our study is a selection bias, since it was carried out only in one institution, so the results obtained here are not necessarily extrapolated to the general population. Conclusions/Discussion: In patients operated in the oncology program of the Healthcare Network, there were no significant differences regarding the number of operated patients, their pathological stage, mortality, or approach in the compared periods.