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To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017.
This prospective, pre–post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate.
During the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34–0.6; P<.001).
Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina.
An integrated climate policy has been lacking in Spain, at least until 2004 when the National Climate Change Strategy was approved. Several scattered, sector-specific measures indirectly leading to CO2 emissions have been applied or recently approved, but they were mostly implemented to reach other goals (e.g. to improve employment and regional development opportunities, to reduce foreign energy dependency or to increase the competitiveness of national industry by raising its energy efficiency). The following two are worth mentioning:
RES-E Promotion. The National Plan for the Promotion of Renewable Energy Sources (NPPES) sets a 12% energy consumption target coming from renewables in 2010 (29% of renewable electricity). This Plan aims to reduce emissions by 28 Mt CO2e annually up to 2010 by substituting renewable energy for conventional energy sources with several measures (particularly the granting of feed-in tariffs to renewable generators).
Energy Efficiency and Energy Savings Strategy (2004–2012) aiming at the control of energy-related CO2 emissions by partly subsidising energy-efficient technological change in industrial firms. With the Strategy, CO2 emissions would increase by 58% in 2012 compared to 1990 (instead of a 78% increase). This represents an accumulated reduction of 190 Mt CO2 in 2004–2012.
These policies mainly focus on the industry and energy sectors. Measures tackling emissions from other sectors are even more limited. In general, fiscal deductions and exemptions, tax relief, direct subsidies and, to a lesser extent, voluntary agreements are applied in all sectors.
The Zone of Proximal Development (ZPD) has drawn attention from psychologists and educators and has oriented their research, diagnosis, and educational work toward new grounds. We hold that, rather than a term to be added to conventional psychology and pedagogy, the ZPD provides us with an instrument whose use will inevitably lead to a reappraisal and renewal of theory.
We suggest that this concept also operated as a Zone of Proximal Development in its own right for Vygotsky's theoretical thought. He focused his endeavors on the areas of conflict where his contemporaries ran into difficulties by exploring three theoretical frontiers:
The evolutionary and historical frontier (change and evolution of the child and individual, of the species, of cultures).
The identity frontier (the view of the functional system as shared, of functions as socially distributed).
The ecological frontier between the internal and external, the mental and the material, the organism and the medium.
A large part of the literature on Vygotsky and the research carried out on the basis of his ideas have developed his proposals with regard to the first two frontiers. Although the third frontier has received scant attention, it is in our opinion essential to a full understanding of Vygotsky's thought, especially the concept of ZPD. We will therefore pay special attention to this third frontier. Taking the ecofunctionalist influences on his thought as a framework, we will analyze the internal and external context of the ZPD and the internal and external mediation processes and conclude with a reflection on the possible future projection for Vygotskian approaches.
Sociocultural Studies of Mind addresses the primary question: how is mental functioning related to the cultural, historical, and institutional settings in which it exists? Although the contributors speak from different perspectives, there is a clear set of unifying themes that run through the volume: 1. One of the basic ways that sociocultural setting shapes mental functioning is through the cultural tools employed. 2. Mediation provides a formulation of how this shaping occurs. 3. In order to specify how cultural tools exist and have their effects, it is essential to focus on human action as a unit of analysis. This landmark volume defines a general approach to sociocultural psychology, one that we hope will be debated and redefined as the field moves forward. Sociocultural Studies of Mind is crucial reading for researchers and graduate students in cognitive science, philosophy, and cultural anthropology.
Perhaps it is the fate of every generation to believe it experiences a period of crisis, or at least rapid social change. In the twentieth century alone, several events have been nominated as major crises with their attendant cultural and psychological dimensions. For example, Fussell (1975) has eloquently shown how World War I fundamentally changed poetry and literature along with the general worldview of the English, and Elder (1974) has documented the lasting psychological impact of the Great Depression on Americans. In both cases the focus is on the cultural and psychological dimensions of great social crises, and the assumption is that these dimensions are as central to understanding such events as are economic, political, or other dimensions.
Although armed conflict and economic deprivation remain an all too familiar part of the news today, we are fortunately not in the midst of a world war or a world depression. However, we are in the midst of other major social changes and crises. For example, instead of bringing the prosperity and tranquility expected by many, the end of the Cold War has unleashed a host of major social and political forces that are changing our lives in ways few had anticipated: The forces of globalization have accelerated in a variety of arenas such as finance, economic production, and communication, while simultaneously and somewhat paradoxically, new forces of localism, especially in the form of nationalism, have emerged with their attendant and often brutal consequences.
“E pur, se muove!” (“In spite of everything, it moves!”)
Quotation attributed to Galileo, who whispered it immediately after he had declared that he accepted the immobility of the earth before a panel of inquisitors
Those of us who try to understand humankind have become entangled in a tension between the illusions of modernity and progress, the legacy of the past two centuries, and the ironic caution of postmodernism, offered as a bridge into the next century. Located between these two positions is what Alvin Toffler (1970) referred to more than 20 years ago as “the furious storm of change.” No one questions the inevitability of change, but in the scientific community it seems that there is little consensus about whether it is prudent to allow it to go beyond the “defense belt” of paradigms, and if so, there is little consensus about how to deal with it.
Neither among scientists nor among citizens is there unanimity on the perception of change. In general, it could be said that a state of uneasiness has arisen over a whole series of events occurring in societies throughout the world. It seems that there is no easy way to respond to this state of affairs. There is the increasingly rapid disappearance of relatively stable traditional societies and long-standing contexts that have been essential for humans' well-being. And the new conditions replacing these contexts bring their own set of problems.