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International audience; Background - Staphylococcus aureus (SA) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on SA IE after transcatheter aortic valve replacement (TAVR). Methods - Data were obtained from the Infectious Endocarditis After TAVR International Registry, including patients with definite IE after TAVR from 59 centres in 11 countries. Patients were divided into 2 groups according to microbiologic etiology: non-SA IE vs SA IE. Results - SA IE was identified in 141 patients out of 573 (24.6%), methicillin-sensitive SA in most cases (115/141, 81.6%). Self-expanding valves were more common than balloon-expandable valves in patients presenting with early SA IE. Major bleeding and sepsis complicating TAVR, neurologic symptoms or systemic embolism at admission, and IE with cardiac device involvement (other than the TAVR prosthesis) were associated with SA IE (P < 0.05 for all). Among patients with IE after TAVR, the likelihood of SA IE increased from 19% in the absence of those risk factors to 84.6% if ≥ 3 risk factors were present. In-hospital (47.8% vs 26.9%; P < 0.001) and 2-year (71.5% vs 49.6%; P < 0.001) mortality rates were higher among patients with SA IE vs non-SA IE. Surgery at the time of index SA IE episode was associated with lower mortality at follow-up compared with medical therapy alone (adjusted hazard ratio 0.46, 95% CI 0.22-0.96; P = 0.038). Conclusions - SA IE represented approximately 25% of IE cases after TAVR and was associated with very high in-hospital and late mortality. The presence of some features determined a higher likelihood of SA IE and could help to orientate early antibiotic regimen selection. Surgery at index SA IE was associated with improved outcomes, and its role should be evaluated in future studies.

Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation >= 2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p < 0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p < 0.001) and septic shock (adjusted p < 0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation >= 2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up. (C) 2022 Elsevier Inc. All rights reserved.

Background Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients. Methods This multicenter study included 579 patients who had the diagnosis of definite IE at a median of 171 (53–421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm, or fistula. Results A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (adjusted odds ratio [ORadj], 2.08; 95% confidence interval [CI]: 1.27–3.41; P = .003) and IE secondary to coagulase-negative staphylococci (ORadj, 2.71; 95% CI: 1.57–4.69; P Conclusions PEE occurred in about one-fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.

BACKGROUND The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain. OBJECTIVES The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB). METHODS Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry. RESULTS Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock. CONCLUSIONS In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients' characteristics, pathogen, and IE-related complications. (C) 2022 by the American College of Cardiology Foundation.

BACKGROUND Stroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR). OBJECTIVES The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization. METHODS Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]). RESULTS A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation >= moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47). CONCLUSIONS Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes. (C) 2021 by the American College of Cardiology Foundation.

BackgroundProcedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR.MethodsObservational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014).ResultsOverall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P ConclusionsAlthough overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.

Background: No data exist about the characteristics of infective endocarditis (IE) post-transcatheter aortic valve replacement (TAVR) according to transcatheter valve type. We aimed to determine the incidence, clinical characteristics, and outcomes of patients with IE post-TAVR treated with balloon-expandable valve (BEV) versus self-expanding valve (SEV) systems. Methods: Data from the multicenter Infectious Endocarditis After TAVR International Registry was used to compare IE patients with BEV versus SEV. Results: A total of 245 patients with IE post-TAVR were included (SEV, 47%; BEV, 53%). The timing between TAVR and IE was similar between groups (SEV, 5.5 [1.2–15] months versus BEV, 5.3 [1.7–11.4] months; P =0.89). Enterococcal IE was more frequent in the SEV group (36.5% versus 15.4%; P P =0.01; valve leaflet, SEV, 23.9%; BEV, 38.5%; P =0.01). BEV recipients had a higher rate of stroke/systemic embolism (20.0% versus 8.7%, adjusted OR: 2.46, 95% CI: 1.04–5.82, P =0.04). Surgical explant of the transcatheter valve (SEV, 8.7%; BEV, 13.8%; P =0.21), and in-hospital death at the time of IE episode (SEV, 35.6%; BEV, 37.7%; P =0.74) were similar between groups. After a mean follow-up of 13±12 months, 59.1% and 54.6% of the SEV and BEV recipients, respectively, had died ( P =0.66). Conclusions: The characteristics of IE post-TAVR, including microorganism type, vegetation location, and embolic complications but not early or late mortality, differed according to valve type. These results may help to guide the diagnosis and management of IE and inform future research studies in the field.

La presente monografía analizo la efectiva implementación de la negociación colectiva en la empresa éxito de la ciudad de Valledupar entre los periodos 2012-2016, arrojando como resultados que dicha empresa está conformada por un sindicato acorde a derecho , puesto que cumple con el objetivo fundamental del derecho sindical, que es velar por el cumplimiento de las leyes del trabajo o de la seguridad social de todos los trabajadores, utilizando así el mecanismo del diálogo social, en cada sección sindical. Por eso el interés por abordar esta problemática surge también debido a conocer cuál es el impacto de efectividad que tiene la ley en las diferentes negociaciones colectivas firmadas respectivamente por los participantes (empleados que pertenecen al grupo sindical) y empleadores; a su vez analizar la efectividad de la ley colombiana por medio de encuestas realizadas a los empleados del Grupo éxito y otros métodos de investigación , con el fin de probar si en las diferentes secciones colectivas que se dieron durante los periodos 2012-2016 de almacenes éxito en la ciudad de Valledupar hubo efectividad de la ley sindical. Por otro lado, la enorme importancia que tiene la negociación colectiva y el papel central que ocupan los factores de eficacia o ineficacia de la ley sindical en la actividad de los sindicatos, ya que es otro de los objetivos de nuestra investigación, constituyéndose este descuido en un factor que debilita la posición de los sindicatos y que afecta sus resultados., This monograph analyzing the effective implementation of collective bargaining in the company success in the city of Valledupar between 2012-2016, yielding results that the undertaking contains a well formed Union, since it complies with the main objective of the Trade Union law, which is to ensure compliance with the laws of work and social security for all workers, so using the mechanism of social dialogue, in every trade union section., Pregrado, Abogado(a), Ej. 1, DEDICATORIA ………………………………………………………………………. 3 AGRADECIMIENTO…………………………………………………………………….. 4 ÍNDICE GENERAL …………………………………………………………………6 INDICE DE CUADROS…………………………………………………………………..10 INDICE DE TABLAS……………………………………………………………………..12 RESUMEN ………………………………………………………………………….13 ABSTRACT …………………………………………………………………………14 GLOSARIO………………………………………………………………..........................15 INTRODUCCIÓN………………………………………………………………………...17 CAPÍTULO I. EL PROBLEMA 1.1 PLANTEAMIENTO DEL PROBLEMA……………………………………………. 19 1.2 FORMULACIÓN DEL PROBLEMA………………………………………………..26 1.3 OBJETIVOS DE LA INVESTIGACIÓN …………………………………………27 1.3.1 OBJETIVO GENERAL……………………………………………………………..27 1.3.2 OBJETIVOS ESPECÍFICO………………………………………………………... 27 1.4 JUSTIFICACIÓN DE LA INVESTIGACIÓN……………………………………… 28 1.5 DELIMITACIÓN DE LA INVESTIGACIÓN…………………………………….....30 CAPÍTULO II. MARCO TEÓRICO 2.1 ESTADO DEL ARTE …………………………………………………………… 31 2.2 MARCO DE REFERENCIA ……………………………………………………. 35 2.3 MARCO SOCIAL…………………………………………………………………38 2.3.1 Negociación colectiva en Colombia……………………………………………... 39 2.3.1.2 Características de la negociación colectiva……...………………………………40 2.3.1.3 Conductas que vulneran la negociación colectiva………………………………41 2.3.1.3.1 Retención ilegal de cuotas…………………………………………………….41 2.3.1.3.2 Permisos sindicales…………………………………………………………….43 2.4 MARCO HISTORICO…………………………………………………………….. 44 2.4.1 Parte directiva de la empresa éxito……………………………………………….. 47 2.5 MARCO LEGAL……………………………………………………………………50 2.5.1 Nudo gordiano………………………………………………………………….….51 2.6 SISTEMA DE VARIABLE…………………………………………………………52 2.6.1 Definición de derecho……………………………………………………………...52 2.6.1.2 Definición derecho laboral……………………………………………………….53 CAPITULO III. MARCO METODOLOGICO 3.1 PROPUESTA METODOLOGICA……………………………………………….. 54 3.2 APLICACIÓN Y ANÁLISIS DE RESULTADOS…………………………………56 3.2.1 Tipo de investigación………………………………………………………………56 3.2.2 Enfoque de investigación………………………………………………………….57 3.2.3 Método de investigación…………………………………………………………. 57 3.2.4 Instrumento………………………………………………………………………..58 3.2.5 Técnica e instrumento de recolección de datos……………………………………58 3.2.6 Población………………………………………………………………………….58 CAPITULO IV. RESULTADOS DE LA INVESTIGACION 4.1 ANALISIS E INTERPRETACION DE LOS RESULTADOS……………………….59 4.2 RESULTADOS DE LAS ENCUESTAS REALIZADAS…………………………….61 4.3 FACTORES CONSIDERA USTED QUE INFLUYE EN LA PARTICIPACIÓN SINDICAL DE LOS TRABAJADORES……………………………………………………...65 4.4 ANALISIS E INTERPRETACION DE LOS RESULTADOS………………………68 CAPITULO V 5.1 CONCLUSIONES………………………………………………………………………70 5.2 RECOMENDACIONES…………………………………………………………………73 REFERENCIAS BIBLIOGRÁFICAS………………………………………………………74

El presente trabajo se enfoca en describir los aprendizajes generados a partir de la sistematización de la muestra pedagógica “déjate ver” de la Corporación Universitaria Minuto de Dios, en este evento se divulgan y socializan diversas propuestas que se circunscriben en los ámbitos pedagógicos, didácticos, investigativos, artísticos y culturales; mediante los cuales los estudiantes de licenciatura en Pedagogía Infantil y Lengua Castellana de esta entidad educativa dan cuenta de su proceso de práctica pedagógica, este último dada su importancia para la formación integral docente requiere otra mirada que permita enriquecer no solo el estudiante en formación quien la realiza sino otros actores, los cuales desde la experiencia presentada en las muestras pedagógicas y su sistematización a la luz del modelo praxeológico puedan contemplarlas desde una perspectiva holística y reflexionada y de esta manera este proceso investigativo puede contribuir como herramienta no solo de análisis de proceso de las practicas pedagógicas sino también como herramienta de mejoramiento de este proceso. Corporación Universitaria Minuto de Dios

O queijo é um alimento de grande importância nos hábitos de consumo dos brasileiros devido à questões nutricionais, gastronômicas e culturais. O queijo tipo parmesão ralado está entre os mais consumidos e também entre os mais fraudados do país, uma vez que a ralagem facilita a incorporação de adulterantes. Este estudo teve como objetivo avaliar a adição de amido em diferentes marcas de queijo tipo parmesão ralado comercializados no estado do Paraná, além de sua adequação aos padrões de umidade exigidos pelo seu regulamento técnico de identidade e qualidade para o produto. Foram obtidas 45 amostras nas regiões de Curitiba e Paranavaí. Os teores de umidade encontrados variaram entre 12 e 26%, sendo que 11% das amostras avaliadas não atendiam o limite máximo previsto pela legislação. Não foi detectada a adição de amido em nenhuma das amostras. Os resultados deste estudo indicam que queijo tipo parmesão ralado estão, em sua maioria, em adequação com a legislação brasileira. Contudo, a presença de elevados teores de umidade representa um risco de desenvolvimento de micro-organismos deteriorantes e/ou patogênicos, além de se caracterizar como fraude.

International audience; IMPORTANCE Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR. DESIGN, SETTING, AND PARTICIPANTS The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. EXPOSURE Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. MAIN OUTCOMES AND MEASURES Infective endocarditis and in-hospital mortality after infective endocarditis. RESULTS A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% Cl, 1.1%44%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% C1,1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% Cl, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% Cl, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% Cl, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% Cl, 19.1%-30.1% and 23.3%; 95% Cl, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% Cl, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% Cl, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% C1,1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% Cl, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% C1,1.42-5.11). The 2-year mortality rate was 66.7% (95% Cl, 59.0%-74.2%; 132 deaths; 115 survivors). CONCLUSIONS AND RELEVANCE Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.

Adriano Caixeta, J Eduardo Sousa, Luiz Antonio Carvalho, Jose A. Mangione, Rogerio Sarmento-Leite, Alexandre S. Colafranceschi, Pedro Lemos, Paulo Caramori, Julio Andrea, Maria C. Ferreira, Valter Lima, Dimytri Siqueira, Fabio Brito Jr, Hospital Israelita Albert Einstein, Sao Paulo, Brazil, Dante Pazzanese, Sao Paulo, Brazil, Pro-Cardiaco, Rio de Janeiro, Brazil, Beneficencia Portuguesa de Sao Paulo, SAo Paulo, SP, Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Porto Alegre, Brazil, Instituto Nacional de Cardiologia Laranjeiras, Rio de Janeiro, Brazil, Heart Institute InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil, Hospital Sao Lucas da PUCRS, Porto Alegre, RS, Clinica Sao Vicente, Rio de Janeiro, Brazil, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil