Fabricación y caracterización de pozos cuánticos para el estudio de la interacción luz-materia / Fabrication and characterization of quantum wells for the study of light-matter interaction

RESUMEN Los pozos cuánticos representan la base de una gran variedad de dispositivos electrónicos, entre ellos los ledes, láseres, fotodetectores y moduladores. Las propiedades optoelectrónicas de estos sistemas dependen de su composición química y del espesor de las capas crecidas. Por dicha razón, es necesario tener un control preciso durante su crecimiento. El presente trabajo tuvo como objetivo inducir el crecimiento epitaxial de pozos cuánticos intrínsecos (sin ningún dopaje) asimétricos acoplados y desacoplados de AlGaAs/ GaAs/AlGaAs, así como, establecer su caracterización mediante técnicas de espectroscopía óptica, como lo son la reflectancia diferencial, también conocida como espectroscopía de reflectancia anisotrópica (RAS) y la fotoluminiscencia (PL). Se realizó un estudio experimental de las interacciones entre niveles de energía en los pozos cuánticos asimétricos acoplados. Este tipo de estructuras son especialmente interesantes por permitir la formación y observación, no solo de excitones directos, dentro del mismo pozo, sino también, de excitones y triones indirectos, que se forman entre electrones de un pozo y huecos de otro pozo vecino (Transiciones intra-QW). Se hicieron crecer tres pozos intrínsecos, basados en arseniuro de galio (GaAs): un pozo individual (desacoplado) y un par de pozos asimétricos acoplados, a través de epitaxia por haces moleculares (MBE). Se observó el efecto del rompimiento de simetría (de D2d a C2v) en las propiedades espintrónicas de la estructura, a través de PL y RAS, a una temperatura de ~ 30 K. Se lograron establecer las técnicas y métodos necesarios para el crecimiento de pozos cuánticos intrínsecos, que constituyen la base para la creación de dispositivos y estructuras más complejas. El uso de técnicas espectroscópicas permitió demostrar la presencia de anisotropías ópticas, que repercuten en el comportamiento del espín de los excitones en pozos cuánticos.

ABSTRACT Quantum Wells are the basis for a great variety of electronic devices such as leds, lasers, photodetectors and modulators. Their optoelectronic properties depend on their chemical composition and the thickness of each layer. Therefore, a precise control during their growth is needed. This work has the objective of presenting the epitaxial growth of coupled and uncoupled asymmetric AlGaAs/GaAs/AlGaAs quantum wells and their characterization using optical techniques such as reflectance anisotropy spectroscopy (RAS) and photoluminescence (PL). An experimental study of the different interactions between the confined levels of energy in coupled quantum wells was carried on. This kind of structures is of special interest because they allow the formation and observation not only of direct excitons and trions inside a single quantum well, but of indirect excitons and trions, which are only formed by electrons of one quantum well and holes of the neighbor quantum well (IntraQW transitions). Three intrinsic quantum wells based on gallium arsenide (GaAs) were grown by molecular beam epitaxy (MBE), one single QW and a pair of coupled asymmetric QWs. The effect of breaking symmetry (from de D2d a C2v) on the spintronic properties of the structure was observed by RAS and PL measurements at ~ 30 K. The main techniques and methods for the growth of intrinsic quantum wells were established, which are the basis for the creation of devices with more complex structures. The use of spectroscopic techniques for the study of quantum wells allowed the demonstration of the presence of optical anisotropies that influence the behavior of exciton's spins at quantum wells.

Characteristics of dual carbapenemase-producing Klebsiella pneumoniae strains from an outbreak in Venezuela: a retrospective study.

OBJECTIVE: To characterize carbapenemase-producing Klebsiella pneumoniae isolated from patients treated at a hospital in Cumaná, Sucre, Venezuela. METHODS: This was a retrospective study conducted at the general hospital in Cumaná where 58 K. pneumoniae strains were analyzed for resistance to antimicrobials, specifically carbapenems, in January - June 2015. Production of metallo-ß-lactamases and serine carbapenemases was determined by the double-disc synergy test, using EDTA-sodium mercaptoacetic acid and 3-aminophenyl boronic acid discs, respectively. Multiplex-PCR was used to detect genes coding for carbapenemases. Molecular typing using ERIC-PCR determined the presence of clones. RESULTS: Four strains of K. pneumoniae resistant to carbapenems were identified. Phenotypic methods for detection of metallo-ß-lactamases and serine carbapenemases were positive, and PCR demonstrated the co-presence of bla NDM and bla KPC genes in all four strains. ERIC-PCR identified two clones circulating in the hospital. CONCLUSIONS: Infection control strategies are needed at the central hospital in Cumaná and its surrounding areas to prevent the spread of these pathogens, especially given the high levels of migration from Venezuela to other countries in South America.

Characteristics of dual carbapenemase-producing Klebsiella pneumoniae strains from an outbreak in Venezuela: a retrospective study

[ABSTRACT]. Objective. To characterize carbapenemase-producing Klebsiella pneumoniae isolated from patients treated at a hospital in Cumaná, Sucre, Venezuela. Methods. This was a retrospective study conducted at the general hospital in Cumaná where 58 K. pneumoniae strains were analyzed for resistance to antimicrobials, specifically carbapenems, in January – June 2015. Production of metallo-β-lactamases and serine carbapenemases was determined by the double-disc synergy test, using EDTA-sodium mercaptoacetic acid and 3-aminophenyl boronic acid discs, respectively. Multiplex-PCR was used to detect genes coding for carbapenemases. Molecular typing using ERIC-PCR determined the presence of clones. Results. Four strains of K. pneumoniae resistant to carbapenems were identified. Phenotypic methods for detection of metallo-β-lactamases and serine carbapenemases were positive, and PCR demonstrated the co-presence of blaNDM and blaKPC genes in all four strains. ERIC-PCR identified two clones circulating in the hospital. Conclusions. Infection control strategies are needed at the central hospital in Cumaná and its surrounding areas to prevent the spread of these pathogens, especially given the high levels of migration from Venezuela to other countries in South America.

[RESUMEN]. Objetivo. Caracterizar la Klebsiella pneumoniae productora de carbapenemasa aislada de pacientes tratados en un hospital de Cumaná (Sucre, Venezuela). Métodos. Se hizo un estudio retrospectivo en el hospital central de Cumaná, donde se analizaron 58 cepas de k. pneumoniae para estudiar la resistencia a los antimicrobianos, específicamente a los fármacos carbapenémicos, entre enero y junio del 2015. La producción de metalo-β-lactamasas y carbapenemasas de serina se determinó mediante la prueba de sinergia de doble disco, usando discos de EDTA SMA de sodio y de ácido borónico 3 aminofenil, respectivamente. Se usó la PCR múltiple para detectar la codificación de genes correspondiente a las carbapenemasas. Se determinó la presencia de clones por tipificación molecular mediante la técnica de ERIC PCR. Resultados. Se detectaron cuatro cepas de K. pneumoniae resistentes a los fármacos carbapenémicos. Los métodos fenotípicos para la detección de metalo-β-lactamasas y carbapenemasas de serina fueron positivos y se demostró mediante la PCR la copresencia de los genes blaNDM y blaKPC en las cuatro cepas. Por medio de la técnica ERIC-PCR se detectaron dos clones que circulaban en el hospital. Conclusiones. Es necesario adoptar estrategias de control de infecciones en el hospital central en Cumaná y las zonas circundantes para prevenir la propagación de estos agentes patógenos, especialmente dados los niveles altos de migración de Venezuela a otros países de América del Sur.

[RESUMO]. Objetivo. Caracterizar cepas de Klebsiella pneumoniae produtoras de carbapenemases isoladas de pacientes tratados em um hospital em Cumaná, Sucre, na Venezuela. Métodos. Realizamos um estudo retrospectivo no hospital geral de Cumaná, onde 58 cepas de K. pneumoniae foram analisadas para verificar a resistência a antimicrobianos, especificamente carbapenens, entre janeiro e junho de 2015. A produção de metalo-β-lactamases e serino-carbapenemases foi determinada pelo teste de sinergia de disco duplo, usando discos de EDTA sódico-ácido mercaptoacético e ácido 3-aminofenil borônico, respectivamente. Utilizamos a PCR multiplex para detectar os genes codificadores de carbapenemases. A tipagem molecular por ERIC-PCR determinou a presença de clones. Resultados. Foram identificadas quatro cepas de K. pneumoniae resistentes a carbapenens. Os métodos fenotípicos para a detecção de metalo-β-lactamases e serino-carbapenemases foram positivos, e a PCR demonstrou a co-presença dos genes blaNDM e blaKPC em todas as quatro cepas. A ERIC-PCR identificou dois clones que circulavam no hospital. Conclusões. São necessárias estratégias de controle de infecções no hospital central de Cumaná e seus arredores para prevenir a disseminação destes patógenos, especialmente devido aos altos níveis de migração da Venezuela para outros países da América do Sul.

Prácticas de cuidado cultural de mujeres con morbilidad materna extrema / Cultural care practices of women with extreme maternal morbidity / Práticas de cuidados culturais de mulheres com morte materna extrema

El presente artículo se genera a partir de los resultados de la investigación: Creencias y prácticas de cuidado cultural de mujeres con morbilidad materna extrema (Hoyos & Muñoz, 2017). OBJETIVO: Describir las creencias y prácticas de cuidado cultural de mujeres que tuvieron morbilidad materna extrema, inasistentes al control prenatal y atendidas en un Hospital de la ciudad de Medellín-Colombia. MÉTODO: Cualitativo, etnográfico, utilizando la etnoenfermería propuesto por Leininger y la entrevista etnográfica de Spradley. Muestra: 17 mujeres con morbilidad materna extrema, inasistentes a control prenatal. RESULTADOS: Se encontró 3 temas generales y 2 taxonomías. CONCLUSIONES: El estudio concluyó que la mujer con morbilidad materna extrema, inasistente al control prenatal tiene sus propios modos de cuidado a sí misma y al hijo por nacer cuando está enferma, porque el acceso a los servicios en salud materna es deficiente. Palabras clave: Enfermería, etnoenfermería, cuidado cultural, salud, morbilidad materna extrema

The present article is generated from the results of the research: Beliefs and cultural care practices of women with extreme maternal morbidity (Hoyos & Muñoz, 2017). OBJECTIVE: To describe the cultural care beliefs and practices of women who had extreme maternal morbidity, who were not in control of prenatal care and who were treated at hospital in the city of Medellín, Colombia. Sample: 17 women with extreme maternal morbidity, not in control of prenatal care. METHOD: Qualitative, ethnographic, using ethno-nursing proposed by Leininger and Spradley's ethnographic interview. RESULTS: 3 general topics and 2 taxonomies were found. CONCLUSIONS: The study concluded that women with extreme maternal morbidity, who do not have prenatal care, have their own ways of caring for themselves and their unborn child when they are sick, because access to maternal health services is poor

Este artigo tem sua origen no projeto da pesquisa: Crenças e práticas de cuidados culturais de mulheres com extrema morbidade materna (Hoyos & Muñoz, 2017). OBJETIVO: Descrever as crenças e práticas de atenção cultural de mulheres que tiveram morbidade materna extrema, que não controlavam o pré-natal e que foram atendidas em um hospital da cidade de Medellín, na Colômbia. MÉTODO: Qualitativo, etnográfico, utilizando a etno-enfermagem proposto pela entrevista etnográfica de Leininger e Spradley. Amostra:17 mulheres com extrema morbidade materna, não controlando o pré-natal. RESULTADOS: Foram encontrados 3 tópicos gerais e 2 taxonomias. CONCLUSÕES: O estudo concluiu que as mulheres com morbidade materna extrema, que não controlam o pré-natal, têm suas próprias formas de cuidar de si mesmas e do nascituro quando estão doentes, porque o acesso aos serviços de saúde materna é fraco

Amplification of nonlinear polariton pulses in waveguides.

Using a sub-millimeter exciton-polariton waveguide suitable for integrated photonics, we experimentally demonstrate nonlinear modulation of pico-Joule pulses at the same time as amplification sufficient to compensate the system losses. By comparison with a numerical model we explain the observed interplay of gain and nonlinearity as amplification of the interacting polariton field by stimulated scattering from an incoherent continuous-wave reservoir that is depleted by the pulses. This combination of gain and giant ultrafast nonlinearity operating on picosecond pulses has the potential to open up new directions in low-power all-optical information processing and nonlinear photonic simulation of conservative and driven-dissipative systems.

Care from the Cultural Perspective in Women with Physiological Pregnancy: a Meta-Ethnography.

OBJECTIVES: This work sought to conduct an interpretative synthesis of qualitative studies on the phenomenon of care from the cultural perspective in women with physiological pregnancy. METHODS: The Meta-ethnography method was used with the seven traditional phases by Noblit and Hare to describe the knowledge derived from the results of qualitative studies with relation to the study phenomenon. A bibliographic search was carried out in seven databases. Twenty-nine qualitative studies were pre-selected of which 23 complied with the quality criteria of the Critical Appraisal Skills Program. RESULTS: Upon synthesizing the studies selected, 12 thematic categories emerged: pregnancy: a natural phenomenon in the woman's life; spirituality and family support; the midwife; positive and negative feelings; physical exercise; comfort and rest; feeding; avoid consumption of non-beneficial substances; intrauterine stimulation; heat and cold; sexuality during pregnancy; and traditional beliefs and myths. CONCLUSIONS: Synthesis of the studies permitted developing a line of argument, which reveals that the care practices of pregnant women have a cultural legacy of beliefs, values, myths, and customs that are aimed at guaranteeing the protection of the mother and of her unborn child.

Barreras de acceso a controles prenatales en mujeres con morbilidad materna extrema en Antioquia, Colombia / Barriers to antenatal women with severe maternal morbidity in Antioquia, Colombia

RESUMEN Objetivo El presente estudio busca describir las barreras de acceso a controles prenatales en mujeres que tuvieron morbilidad materna extrema, atendidas en un Hospital de la ciudad de Medellín-Colombia 2017. Método Cualitativo; etnográfico; utilizando la etnoenfermería propuesto por Leininger y la entrevista etnográfica de Spradley. Resultados Se encontró un tema relacionado con la apreciación de la atención en salud que tiene la mujer con morbilidad materna extrema, la cual considera que el sistema de salud no le garantiza un acceso en salud para ella y para su hijo por nacer. Conclusiones Se concluye que el sistema sanitario al que tienen derecho las mujeres del estudio, no es asequible lo que condiciona la inasistencia a los programas de atención prenatal.(AU)

ABSTRACT Objective This study seeks to describe the barriers to access to antenatal care in women with severe maternal morbidity, treated at a hospital in the city of Medellin, Colombia in 2017. Methods Qualitative, ethnographic study using the ethnonursing approach proposed by Leininger, and Spradley's ethnographic interview. Results Women with severe maternal morbidity consider that the health system does not guarantee access to health for them and their unborn children. Conclusions It is concluded that the health system, to which the women included in the study are entitled, is not available, which conditions non-attendance to prenatal care programs.(AU)

Care from the Cultural Perspective in Women with Physiological Pregnancy: a Meta-Ethnography

Objective. This work sought to conduct an interpretative synthesis of qualitative studies on the phenomenon of care from the cultural perspective in women with physiological pregnancy. Methods. The Meta-ethnography method was used with the seven traditional phases by Noblit and Hare to describe the knowledge derived from the results of qualitative studies with relation to the study phenomenon. A bibliographic search was carried out in seven databases. Twenty-nine qualitative studies were pre-selected of which 23 complied with the quality criteria of the Critical Appraisal Skills Program. Results. Upon synthesizing the studies selected, 12 thematic categories emerged: pregnancy: a natural phenomenon in the woman's life; spirituality and family support; the midwife; positive and negative feelings; physical exercise; comfort and rest; feeding; avoid consumption of non-beneficial substances; intrauterine stimulation; heat and cold; sexuality during pregnancy; and traditional beliefs and myths. Conclusion. Synthesis of the studies permitted developing a line of argument, which reveals that the care practices of pregnant women have a cultural legacy of beliefs, values, myths, and customs that are aimed at guaranteeing the protection of the mother and of her unborn child.

Objetivo. Realizar una síntesis interpretativa de los estudios cualitativos sobre el fenómeno del cuidado desde la perspectiva cultural en mujeres con embarazo fisiológico. Métodos. Se empleó el método Metaetnográfico con las siete fases tradicionales de Noblit y Hare, para describir el conocimiento derivado de los resultados de estudios cualitativos con relación al fenómeno de estudio. Se realizó una búsqueda bibliográfica en siete bases de datos. Se preseleccionaron 29 estudios cualitativos, de los cuales 23 cumplieron con los criterios de calidad del Critical Appraisal Skills Programme. Resultados. Al sintetizar los estudios seleccionados, surgieron doce categorías temáticas: El embarazo: fenómeno natural en la vida de la mujer, la espiritualidad y el apoyo familiar, la comadrona, sentimientos positivos y negativos, el ejercicio físico, la comodidad y el descanso, la alimentación, evitar el consumo de sustancias no beneficiosas, la estimulación intrauterina, el calor y frío, la sexualidad en el embarazo y, las creencias tradicionales y los mitos. Conclusión. La síntesis de los estudios permitió el desarrollo de una línea de argumentación la cual revela que las prácticas de cuidado de la mujer gestante cuentan con un legado cultural de creencias, valores, mitos y costumbres que están orientadas a garantizar la protección de la madre y del niño por nacer.

Objetivo. Realizar uma síntese interpretativa de estudos qualitativos sobre o fenômeno do cuidado a partir da perspectiva cultural em mulheres com gestação fisiológica. Métodos. O método Meta-etnografia foi utilizado com as sete fases tradicionais de Noblit e Hare, para descrever o conhecimento derivado a partir dos resultados de estudos qualitativos em relação ao fenômeno de estudo. Uma busca bibliográfica foi realizada em sete bases de dados. Vinte e nove estudos qualitativos foram pré-selecionados, dos quais 23 preencheram os critérios de qualidade do Critical Appraisal Skills Program. Resultados. Ao sintetizar os estudos selecionados, emergiram doze categorias temáticas: Gravidez: um fenômeno natural na vida das mulheres; espiritualidade e apoio familiar; a parteira; sentimentos positivos e negativos; exercício físico; conforto e descanso; a alimentação; evitar o consumo de substâncias não benéficas; estimulação intra-uterina; o calor e o frio; sexualidade na gravidez; e, crenças e mitos tradicionais. Conclusão. A síntese dos estudos permitiu o desenvolvimento de uma linha de argumentação, o que revela que as práticas de cuidados das mulheres grávidas, têm um legado cultural de crenças, valores, mitos e costumes que são destinadas a assegurar a proteção da mãe e seu feto.

[Barriers to antenatal women with severe maternal morbidity in Antioquia, Colombia]. / Barreras de acceso a controles prenatales en mujeres con morbilidad materna extrema en Antioquia, Colombia.

OBJECTIVE: This study seeks to describe the barriers to access to antenatal care in women with severe maternal morbidity, treated at a hospital in the city of Medellin, Colombia in 2017. METHODS: Qualitative, ethnographic study using the ethnonursing approach proposed by Leininger, and Spradley's ethnographic interview. RESULTS: Women with severe maternal morbidity consider that the health system does not guarantee access to health for them and their unborn children. CONCLUSIONS: It is concluded that the health system, to which the women included in the study are entitled, is not available, which conditions non-attendance to prenatal care programs.

OBJETIVO: El presente estudio busca describir las barreras de acceso a controles prenatales en mujeres que tuvieron morbilidad materna extrema, atendidas en un Hospital de la ciudad de Medellín-Colombia 2017. MÉTODO: Cualitativo; etnográfico; utilizando la etnoenfermería propuesto por Leininger y la entrevista etnográfica de Spradley. RESULTADOS: Se encontró un tema relacionado con la apreciación de la atención en salud que tiene la mujer con morbilidad materna extrema, la cual considera que el sistema de salud no le garantiza un acceso en salud para ella y para su hijo por nacer. CONCLUSIONES: Se concluye que el sistema sanitario al que tienen derecho las mujeres del estudio, no es asequible lo que condiciona la inasistencia a los programas de atención prenatal.

Valoración del cuidado de enfermería por parte de adolescentes gestantes antes de una intervención en atención prenatal y después de esta / Evaluation of Nursing by Pregnant Adolescents before and after an Intervention in Prenatal Care / Avaliação de enfermagem por adolescentes grávidas antes e após uma intervenção no pré-natal

Introducción: Investigaciones sobre gestación en mujeres adolescentes han detectado ciertas necesidades, como sentirse escuchadas o apoyadas y recibir trato humanizado. Objetivo: Determinar cómo adolescentes gestantes valoraron el cuidado proporcionado por el servicio de enfermería antes de una intervención y después de esta, en una institución de salud de Bucaramanga, en 2015. Método: Estudio cuasi experimental pretest y postest en 39 adolescentes asistentes a atención prenatal. Para la valoración del cuidado se utilizó la Escala Profesional de Cuidado, organizada en las subescalas: sanador compasivo y competente. La valoración pretest se realizó después del control prenatal convencional, por enfermería, y la postest, después de la intervención de cuidado, fundamentada en la teoría de Swanson. Resultados: Aunque las valoraciones del cuidado fueron excelentes antes de la intervención, mejoraron posteriormente, lo que muestra un aumento de puntajes mínimos de 48 antes, a 57 después de la intervención, y en disminución de las desviaciones estándar 2,6704 y 0,6863, respectivamente. Estos cambios son notorios en el sanador compasivo referido a la relación afectuosa y de confianza que establece el enfermero(a) en la interacción de cuidado. Conclusiones: La teoría de Swanson permitió abordar a la adolescente en la atención prenatal, supliendo necesidades de escucha, trato humanizado y apoyo. Ello se evidencia en la valoración posterior.

Introduction: Research on pregnancy in adolescent women has detected certain needs, such as feeling heard or supported and receiving humane treatment. Objective: To determine how pregnant adolescents evaluated the care provided by the nursing service before and after an intervention at a health institution in Bucaramanga in 2015. Method: Quasi-experimental pretest and posttest study in 39 adolescents attending antenatal care. For the assessment of care, the Professional Care Scale was used, organized in the subscales: compassionate and competent healer. The pretest evaluation was carried out after the conventional prenatal control, by nursing, and the posttest, after the care intervention, based on Swanson's theory. Results: Although the values of the care were excellent before the intervention, they improved later, which shows an increase of minimum scores of 48 before, to 57 after the intervention, and in decrease of the standard deviations 2.6704 and 0.6863, respectively. These changes are notorious in the compassionate healer referred to the affectionate and trusting relationship established by the nurse in the care interaction. Conclusions: Swanson's theory allowed to approach the adolescent in prenatal care, supplying listening needs, humanized treatment and support. This is evidenced in the subsequent assessment.

Introdução: Pesquisas sobre gravidez em adolescentes detectaram certas necessidades, como sentir-se ouvido ou apoiado e receber tratamento humanizado. Objetivo: Determinar como adolescentes grávidas apreciado o atendimento prestado pelo serviço de enfermagem antes da cirurgia e depois disso, em uma instituição de saúde de Bucaramanga, em 2015. Método: Pré-teste quasi-experimental e estudo pós-teste em 39 adolescentes freqüentando pré-natal. Para a avaliação do atendimento, utilizou-se a Escala de Cuidados Profissionais, organizada nas subescalas: curador compassivo e competente. A avaliação do pré-teste foi realizada após o controle pré-natal convencional, pela enfermagem, e o pós-teste, após a intervenção assistencial, com base na teoria de Swanson. Resultados: Embora as avaliações foram excelente cuidado antes de cirurgia, posteriormente melhorados, que mostra um aumento na pontuação mínima de 48 antes de 57 após a intervenção, e diminuíram os desvios padrão e 0,6863 e 2,6704, respectivamente. Essas mudanças são notórias no curandeiro compassivo referente à relação afetiva e de confiança estabelecida pelo enfermeiro na interação do cuidado. Conclusões: A teoria de Swanson permitiu abordar o adolescente no pré-natal, suprindo necessidades de escuta, tratamento humanizado e apoio. Isto é evidenciado na avaliação subsequente.

[qnr genes in Enterobacteriaceae isolated from at a hospital in Venezuela]. / Genes qnr en Enterobacteriaceae aisladas en un hospital de Venezuela.

BACKGROUND: Enterobacteria resistant to quinolones is increasing worldwide, including Venezuela. The mechanism for this resistance could be due to genes included in the chromosome or in transmissible plasmids. AIM: To evaluate the resistance to quinolones, coded by qnr genes present in enterobacteria species, isolated in the University Hospital of Cumana, Venezuela. METHODS: Antimicrobial susceptibility tests to quinolones, beta-lactams and aminoglycosides were carried out to all the isolates. The presence of qnr genes were determined by PCR. The isolates carrying the qnr genes were used for bacterial conjugation tests to determine the presence of transferable plasmids. Antimicrobial susceptibility tests and PCR were carried out in the transconjugants to verify the transfer of the genes. RESULTS: High levels of antimicrobial resistance to quinolones and beta-lactams were found among the isolates. We found that 33.6% of the isolates carry the qnrB gene and 0.9% qnr A gene. Of the 23 transconjugants, 20 showed to have qnrB gene, but none qnrA. DISCUSSION: We concluded that the high frequency of qnr genes found in the enterobacteria isolates and their presence on transferable plasmids, complicate the use of quinolones for the treatment of bacterial infections, thus, a treatment plan should be designed with the rational use and the rotation of different types of antimicrobials, in order to avoid the selection of increasingly resistant strains.

Evaluation of the Nursing Care Offered during the Parturition Process. Controlled Clinical Trial of an Intervention based on Swanson's Theory of Caring versus Conventional Care.

OBJECTIVES: This work sought to compare the evaluation of the nursing care provided during the parturition process in the intervention group based on Swanson's theory of caring versus that of the control group that received conventional care. METHODS: Preventive-type controlled clinical trial conducted in a tier II hospital in San Gil, Santander (Colombia). During the parturition process, the intervention group received care based on Swanson's theory of caring (n=20) and the control group received conventional care (n=23). During immediate postpartum, the mothers were applied the Professional care rating scale by Swanson, validated into Spanish in Colombia. RESULTS: Assessment of professional care in the intervention group was Excellent with an average for the scale total of 59.8 points of a possible maximum of 60 points, while in the control group it was Good with 50.2 (p<0.0001). In the 15 items that make up the scale and in both subscales (Compassionate Healer and Competent Healer) higher scores were also observed in the intervention group compared to those of the control group. Conclusion. The intervention derived from Swanson's theory of caring was associated to a better evaluation of professional nursing care by women during the parturition process.

Genes qnr en Enterobacteriaceae aisladas en un hospital de Venezuela / qnr genes in Enterobacteriaceae isolated from at a hospital in Venezuela

Resumen Introducción: La resistencia de enterobacterias a quinolonas se ha difundido por el mundo, fenómeno presente también en Venezuela. El mecanismo de esta resistencia pudiera estar mediado por genes incluidos en el cromosoma bacteriano o transmitirse en el interior de plásmidos. Objetivo: Evaluar la resistencia a quino-lonas, codificada por genes qnr, presentes en cepas de enterobacterias, aisladas en el Hospital Universitario de Cumaná, Venezuela. Métodos: A las cepas obtenidas se les realizaron pruebas de susceptibilidad antimicrobiana a quinolonas, β-lactámicos y aminoglucósidos. La presencia del gen qnr se determinó por RPC. Las enterobacterias portadoras del gen qnr fueron sometidas al proceso de conjugación bacteriana para comprobar su capacidad de transferencia. A las transconjugantes obtenidas se les realizó pruebas de susceptibilidad antimicrobiana y RPC para comprobar la transferencia de los genes. Resultados: Se encontraron elevados porcentajes de resistencia antimicrobiana a quinolonas y betalactámicos. El 33,6% de las cepas eran portadoras del gen qnrB, y 0,9% del gen qnrA. Se obtuvieron 23 cepas transconjugantes; de éstas, 20 portaban el gen qnrB, no se observó la presencia de qnrA. Discusión: En conclusión, el elevado porcentaje de genes qnr encontrado en las enterobacterias aisladas, y comprobada la presencia de éstos en plásmidos transferibles, complica la aplicación de tratamientos basados en quinolonas y fluoroquinolonas, por lo que es recomendable el uso racional de estos antimicrobianos, y proponer la rotación de la terapia antimicrobiana, a fin de evitar la selección de cepas resistentes.

Background: Enterobacteria resistant to quinolones is increasing worldwide, including Venezuela. The mechanism for this resistance could be due to genes included in the chromosome or in transmissible plasmids. Aim: To evaluate the resistance to quinolones, coded by qnr genes present in enterobacteria species, isolated in the University Hospital of Cumana, Venezuela. Methods: Antimicrobial susceptibility tests to quinolones, beta-lactams and aminoglycosides were carried out to all the isolates. The presence of qnr genes were determined by PCR. The isolates carrying the qnr genes were used for bacterial conjugation tests to determine the presence of transferable plasmids. Antimicrobial susceptibility tests and PCR were carried out in the transconjugants to verify the transfer of the genes. Results: High levels of antimicrobial resistance to quinolones and beta-lactams were found among the isolates. We found that 33.6% of the isolates carry the qnrB gene and 0.9% qnr A gene. Of the 23 transconjugants, 20 showed to have qnrB gene, but none qnrA. Discussion: We concluded that the high frequency of qnr genes found in the enterobacteria isolates and their presence on transferable plasmids, complicate the use of quinolones for the treatment of bacterial infections, thus, a treatment plan should be designed with the rational use and the rotation of different types of antimicrobials, in order to avoid the selection of increasingly resistant strains.

Valoración del cuidado de Enfermería brindado durante el proceso de parto. Ensayo clínico controlado de una intervención basada en la Teoría de Swanson versus cuidado convencional / Valorização do cuidado de Enfermagem brindado durante o processo de parto. Ensaio clínico controlado de uma intervenção baseada na Teoria de Swanson versus cuidado convencional / Evaluation of the Nursing Care Offered during the Parturition Process. Controlled Clinical Trial of an Intervention based on Swanson's Theory of Caring versus Conventional Care

Objective. This work sought to compare the evaluation of the nursing care provided during the parturition process in the intervention group based on Swanson's theory of caring versus that of the control group that received conventional care. Methods. Preventive-type controlled clinical trial conducted in a tier II hospital in San Gil, Santander (Colombia). During the parturition process, the intervention group received care based on Swanson's theory of caring (n=20) and the control group received conventional care (n=23). During immediate postpartum, the mothers were applied the Professional care rating scale by Swanson, validated into Spanish in Colombia. Results. Assessment of professional care in the intervention group was Excellent with an average for the scale total of 59.8 points of a possible maximum of 60 points, while in the control group it was Good with 50.2 (p<0.0001). In the 15 items that make up the scale and in both subscales (Compassionate Healer and Competent Healer) higher scores were also observed in the intervention group compared to those of the control group. Conclusion. The intervention derived from Swanson's theory of caring was associated to a better evaluation of professional nursing care by women during the parturition process.(AU)

Objetivo. Comparar la valoración del cuidado de enfermería brindado durante el proceso de parto en el grupo de Intervención basada en la Teoría de Swanson versus la del grupo de Control que recibió cuidado convencional. Métodos. Ensayo clínico controlado de tipo preventivo realizado en un hospital de segundo nivel de atención en San Gil, Santander (Colombia). Durante el proceso de parto el grupo de Intervención recibió cuidado basado en la Teoría de Swanson (n=20) y al grupo de Control se le practicó el cuidado convencional (n=23). En el postparto inmediato se aplicó a las madres la Escala de Valoración del cuidado profesional de Swanson, validada al español en Colombia. Resultados. La valoración del cuidado profesional en el grupo de Intervención fue Excelente con un promedio para el total de la escala de 59.8 puntos de un máximo posible de 60, mientras que en el grupo de Control fue Bueno con 50.2 (p<0.0001). En los 15 ítems que conforman la escala y en las dos subescalas (Sanador Compasivo y Sanador Competente) también se observaron mayores puntajes en el grupo de Intervención comparados con los del grupo de Control. Conclusión. La intervención derivada de la teoría de Swanson se asoció a una mejor valoración del cuidado profesional de enfermería por parte de las mujeres durante el proceso de parto. (AU)

Objetivo. Comparar a valorização do cuidado de enfermagem brindado durante o processo de parto no grupo de Intervenção baseada na Teoria de Swanson versus a do grupo de Controle que recebeu cuidado convencional. Métodos. Ensaio clínico controlado de tipo preventivo realizado num hospital de segundo nível de atenção em San Gil, Santander (Colômbia). Durante o processo de parto o grupo de Intervenção recebeu cuidado baseado na Teoria de Swanson (n=20) e ao grupo de Controle se lhe praticou o cuidado convencional (n=23). No pós-parto imediato se aplicou às mães a Escala de Valorização do cuidado profissional de Swanson, validada ao espanhol na Colômbia. Resultados. A valorização do cuidado profissional no grupo de Intervenção foi Excelente com uma média para o total da escala de 59.8 pontos de um máximo possível de 60, enquanto que no grupo de Controle foi Bom com 50.2 (p<0.0001). Nos 15 itens que conformam a escala e nas duas sub-escalas (Curador Compassivo e Curador Competente) também se observaram maiores pontuações no grupo de Intervenção comparados com os do grupo de Controle. Conclusão. A intervenção derivada da teoria de Swanson se associou a uma melhor valorização do cuidado profissional de enfermagem por parte das mulheres durante o processo de parto.(AU)

Evolución del proceso de afrontamiento y adaptación en adultos hospitalizados que experimentaron un trauma músculo esquelético por accidentes de tránsito / The evolution of coping and adaptation in hospitalised adults who have suffered traffic accident-related musculoskeletal trauma

Objetivo: Explorar la evolución del proceso de afrontamiento y adaptación de 11 casos de adultos que experimentaron un trauma músculo esquelético, por accidentes de tránsito, durante la estancia hospitalaria en la Clínica Universidad de la Sabana en 2015. Método: Estudio de casos que permitió describir y comparar el proceso de afrontamiento y adaptación en 11 personas. Se aplicó la Escala de medición del proceso de afrontamiento y adaptación versión abreviada en español, al ingreso y al egreso hospitalario. En esta investigación se tuvo en cuenta los principios éticos correspondientes, se obtuvo el consentimiento informado de los participantes y las autorizaciones de la Subcomisión de Investigación de la Facultad de Enfermería y Rehabilitación de la Universidad de la Sabana y de la Clínica donde se llevó a cabo el estudio. Resultado: Los hallazgos de este estudio muestran para ocho de los once casos una tendencia a mantenerse en nivel alto de afrontamiento o a pasar de nivel medio a alto desde el ingreso hasta el egreso hospitalario. Conclusión: La mayoría de los casos tuvo un proceso de afrontamiento y adaptación dirigido al problema, donde se encontró interés por resolver dudas relacionadas con la situación antes de actuar, utilización de experiencias pasadas consideradas como útiles, adopción de nuevas habilidades para afrontar las situaciones difíciles y el uso de soluciones alternativas y recursos (AU)

Objective: Exploring the evolution of coping and adaptation strategies by 11 cases of adults who had suffered traffic accident-related musculoskeletal trauma during their stay in hospital at Clínica Universidad de la Sabana during 2015. Methods: Studying the aforementioned cases enabled describing and comparing the 11 patients' coping and adaptation strategies. The abridged Spanish version of Roy's Coping Adaptation Processing Scale (CAPS) was used for measuring such strategies; it was used on patient admission to and discharge from hospital. This research took the relevant ethical principles into account; the patients gave their written informed consent and the Universidad de la Sabana and its hospital where the study was carried out authorised the study (i.e. the Faculty of Nursing and Rehabilitation's Research Subcommittee). Results: This study's findings showed that eight of the eleven cases maintained a high coping ability, or improved from moderate (on admission to hospital) to high level ability (on discharge). Conclusion: Problem-centred coping and adaptation strategies were involved in most cases. Patients approached this through resolving situation-related questions before acting, using past experiences considered useful, adopting new skills to cope with difficult situations and using alternative solutions and resources (AU)

The Importance of Spiritual Care in Nursing Practice.

PURPOSE: Explore what spiritual care means to nurses who work in emergency care units. DESIGN AND METHOD: Nine nursing professionals from an emergency care unit at a private health institution affiliated with the Universidad de La Sabana participated in this descriptive qualitative study. Nonparticipant observation, field notes, and in-depth interviews with a question guide were used to collect the data, which were analyzed by means of content analysis. RESULTS: Three themes and their corresponding subthemes were identified with respect to the significance of spiritual care: (1) interpretation of spiritual care, (2) the patient and the family in spiritual care, and (3) the role of the nurse in spiritual care. CONCLUSIONS: These findings provide a deeper understanding of spiritual care in terms of its significance. They also acknowledge its importance to nursing practice in emergency care units. The significance of spiritual care is based on theoretical, scientific, and humanistic points of reference (the discipline of nursing) that strengthen the therapeutic relationship between the patient/family-nurse dyad. The study also offers evidence for holistic nursing practice that requires theoretical-academic, administrative, and assistance support.

Relación clonal y detección del gen blaKPC en cepas de Klebsiella pneumoniae resistentes a carbapenémicos, en un hospital de Venezuela / Clonal relationship and detection of blaKPC gene in strains of Klebsiella pneumoniae resistant to carbapenems, at a hospital in Venezuela

In order to study the clonal relationship and blaKPC gene detection in clinical isolates of Klebsiella pneumoniae resistant to carbapenems, we analyzed 22 clinical isolates of K. pneumoniae with resistance to imipenem and/ or meropenem, isolated in the laboratory of bacteriology at the University Hospital "Antonio Patricio de Alcalá" (HUAPA) from the Cumana city, Sucre state, Venezuela, for a period of five consecutive years. Susceptibility to different antimicrobials was determined, and the presence of carbapenemases was detected by modified Hodge method, phenyl boronic acid synergy and combination discs. blaKPC gene detection was conducted by polymerase chain reaction and the clonal relationship was determined by pulsed field electrophoresis. High rates of antimicrobial resistance were found, five strains were negative, at least one phenotypic method, and all carried the blaKPC gene. Clonal spread was observed only in the intensive care unit (ICU), while in other services, polyclonality was found. We concluded that blaKPC gene is present in K. pneumoniae strains resistant to carbapenems isolated in the HUAPA and clonal spread it was only in the ICU.

Con el objetivo de estudiar la relación clonal y detección del gen blaKPC en aislados clínicos de Klebsiella pneumoniae resistentes a carbapenémicos, se analizaron 22 cepas clínicas de K. pneumoniae con resistencia a imipenem y/o meropenem, aisladas en el laboratorio de bacteriología del Hospital Universitario "Antonio patricio de Alcalá" (HUAPA) de la ciudad de cumaná, Estado Sucre, Venezuela, durante un período de cinco años continuos. Se determinó la susceptibilidad a diversos antimicrobianos, y se detectó la presencia de carbapenemasas por los métodos de Hodge modificado, sinergia con ácido fenil borónico y combinación de discos. La detección del gen blaKPC se llevó a cabo mediante la técnica de reacción de polimerasa en cadena y la determinación de la relación clonal se realizó por electroforesis de campo pulsado. Se encontraron elevados porcentajes de resistencia antimicrobiana, cinco cepas resultaron negativas, al menos, a un método fenotípico y todas portaban el gen blaKPC. Se observó diseminación de clones únicamente en la Unidad de cuidados Intensivos (UCI), mientras que, en otros servicios, se halló policlonalidad. Se concluye que el gen blaKPC se encuentra presente en cepas de K. pneumoniae resistentes a carbapenémicos aisladas en el HUAPA y que hubo diseminación clonal sólo en UCI.

Experiencias de cuidado cultural en personas con diabetes y el contexto familiar, con enfoque Leininger / Experiências culturais em cuidados com diabetes e contexto familiar, com foco Leininger Cultural / Experiences in diabetes care and family context, focusing Leininger

Objetivo: Describir experiencias de cuidado desde lo cultural de personas con diabetes Mellitus tipo II en su contexto familiar atendidos en un Hospital de III nivel durante 2013 y 2014. Metodología: Enfoque cualitativo tipo etnográfico, etnoenfermería, derivada de la Teoría de enfermería de Madeleine Leininger. Muestreo no probabilístico a conveniencia con 10 informantes clave, 6 informantes generales. Recolección de información mediante entrevistas abiertas a profundidad en el hogar, notas de campo. Análisis de información a través de las fases de la etnoenfermería: codificación, categorización, identificación de patrones recurrentes, temas. Resultados: se identificaron cinco tema principales: Reacción a su situación de enfermedad, la participación de la familia, experiencias producidas desde el servicio de salud y otros actores sociales, efectos percibidos y conocidos por sí mismo, construcción del cuidado. Conclusión: La experiencia de cuidado en las personas con diabetes en el contexto familiar determina patrones de cuidado que inciden culturalmente y reflejan su cuidado en el hogar. La investigación desde lo cultural, fortalece la práctica de enfermería porque potencia un campo natural de cuidado para brindar cuidado culturalmente congruente (AU)

To describe experience of care from culture of people with type II diabetes mellitus in the family context treated at a hospital in Ibague III level during 2013 and 2014. Methodology: qualitative ethnographic approach, ethnonursing derived from the Theory of nursing Madeleine Leininger. Non-probability convenience with 10 key informants, informants 6 general sampling. Gathering information through open deep in the home, field notes and observation interviews. Analysis of information through the phases of the ethnonursing: coding, categorizing, identifying recurring patterns, themes. Results: Reaction to the disease situation, the involvement of family, experiences produced from the health service and other social actors, perceived and known by itself effects, construction of care: five major topic were identified. Conclusion: The experience of diabetes care in the family context determines patterns of care that reflect their influence culturally and home care. Research from the cultural, strengthens nursing practice because it enhances a natural field of care to provide culturally congruent care (AU)

Para descrever a experiência dos cuidados de cultura de pessoas com diabetes mellitus tipo II no contexto familiar tratados em um hospital de nível III Ibague durante 2013 e 2014. Metodologia: abordagem etnográfica qualitativa, etnoenfermagem derivado da Teoria de enfermagem Madeleine Leininger. Conveniência não probabilística com 10 informantes-chave, os informantes 6 de amostragem geral. Coleta de informações por meio de profundidade aberto em casa, notas de campo de observação e entrevistas. Análise de informações através das fases do etnoenfermagem: codificação, categorização, identificação de padrões recorrentes, temas. Resultados: A reação à situação da doença, o envolvimento dos familiares, as experiências produzidas a partir do serviço de saúde e outros atores sociais, percebido e conhecido por si só, efeitos, construção do cuidado: cinco dos principais tópicos foram identificados. Conclusão: A experiência de cuidados com diabetes no contexto familiar determina padrões de cuidados que afetam cultural e reflectem os seus cuidados em casa. Pesquisa da cultural, fortalece a prática de enfermagem porque melhora um campo natural de cuidado para prover um cuidado culturalmente congruente (AU)

Needs of Parents in Caring for Their Children in a Pediatric Intensive Care Unit / Necesidades de los padres para cuidar a sus hijos en una Unidad de Cuidados Intensivos Pediátrica / Necessidades dos padres para cuidar aos seus filhos numa Unidade de Tratamento Intensivos Pediátrica

Objective.This work sought to describe the needs of parents to participate in caring for their children hospitalized in a pediatric intensive care unit (PICU). Methods. This is a qualitative study based on the ethno-nursing research method proposed by Leininger. For data collection and analysis, in-depth open interviews were used, along with field notes and enabler guidelines proposed by Leininger: stranger-friend, observation, participation, reflexion, and the Sunrise model. Parents of children hospitalized in a PICU in the city of Tunja (Boyacá, Colombia) participated between February 2012 and October 2013. Results. The needs of parents to care for their children were described in the following themes: clear and timely communication, familiarization with technology, the value of the family, favoring the parent-children interaction during visits, and valuing and respecting generic (folk) knowledge. Conclusion. The study provides knowledge, from the cultural perspective of parents with children hospitalized in PICU, as input to plan and develop care actions with them, according to their own needs.

Objetivo.Describir las necesidades de padres para participar del cuidado de sus hijos hospitalizados en la Unidad de Cuidado Intensivo Pediátrico (UCIP). Métodos. Investigación cualitativa basada en el método de la etnoenfermería propuesto por Leininger. Para la recolección y análisis de la información se utilizaron la entrevista abierta a profundidad, las notas de campo y guías facilitadoras propuestas por Leininger: Extraño amigo, Observación, Participación Reflexión y el modelo del sol naciente. Participaron los padres de niños hospitalizados en una UCIP de Tunja (Boyacá, Colombia) entre febrero de 2012 y Octubre de 2013. Resultados. Se describen las necesidades de los padres para cuidar a sus hijos en los siguientes temas: Comunicación clara y oportuna, Familiarización con la Tecnología, El valor de la familia, Favorecer la interacción de padres-hijos durante la visita y Valorar y respetar el conocimiento genérico. Conclusión. Se describieron las necesidades de los padres en el cuidado de sus hijos internados en una UCIP. La enfermera debe tener en cuenta el conocimiento genérico de las personas y respetar las creencias que ellas tengan, con el fin de fortalecer su desempeño como profesional mediante la aplicación de teorías en enfermería.

Objetivo.Descrever as necessidades de pais para participar do cuidado dos seus filhos hospitalizados na Unidade de Tratamento Intensivo Pediátrico (UTIP). Métodos. Investigação qualitativa baseada no método da etnoenfermagem proposto por Leininger. Para a recolecção e análise da informação se utilizaram a entrevista aberta a profundidade, as notas de campo e guias facilitadoras propostas por Leininger: Estranho amigo, Observação, Participação Reflexão e o modelo do sol nascente. Participaram os pais de crianças hospitalizadas numa UTIP de Tunja (Boyacá, Colômbia) entre fevereiro de 2012 e Outubro de 2013. Resultados. Se descrevem as necessidades dos pais para cuidar aos seus filhos nos seguintes assuntos: Comunicação clara e oportuna, Familiarização com a Tecnologia, O valor da família, Favorecer a interação de pais-filhos durante a visita e Valorar e respeitar o conhecimento genérico. Conclusão. Se descreveram as necessidades dos pais no cuidado dos seus filhos internados numa UTIP. A enfermeira deve ter em conta o conhecimento genérico das personas e respeitar as crenças que elas tenham, com o fim de fortalecer seu desempenho como profissional mediante a aplicação de teorias em enfermagem.

[Clonal relationship and detection of blaKPC gene in strains of Klebsiella pneumoniae resistant to carbapenems, at a hospital in Venezuela]. / Relación clonal y detección del gen blaKPC en cepas de Klebsiella pneumoniae resistentes a carbapenémicos, en un hospital de Venezuela.

In order to study the clonal relationship and blaKPC gene detection in clinical isolates of Klebsiella pneumoniae resistant to carbapenems, we analyzed 22 clinical isolates of K. pneumoniae with resistance to imipenem and/ or meropenem, isolated in the laboratory of bacteriology at the University Hospital "Antonio Patricio de Alcalá" (HUAPA) from the Cumana city, Sucre state, Venezuela, for a period of five consecutive years. Susceptibility to different antimicrobials was determined, and the presence of carbapenemases was detected by modified Hodge method, phenyl boronic acid synergy and combination discs. blaKPC gene detection was conducted by polymerase chain reaction and the clonal relationship was determined by pulsed field electrophoresis. High rates of antimicrobial resistance were found, five strains were negative, at least one phenotypic method, and all carried the blaKPC gene. Clonal spread was observed only in the intensive care unit (ICU), while in other services, polyclonality was found. We concluded that blaKPC gene is present in K. pneumoniae strains resistant to carbapenems isolated in the HUAPA and clonal spread it was only in the ICU.