ResumenEn nuestro tiempo, el derecho administrativo es también una herramienta fundamental para alinear los intereses privados con el interés público. Cumplir con este objetivo exige reducir la intervención estatal en la economía y presupone introducir en el diseño de las regulaciones elementos que permitan reemplazar la coacción por la persuasión. El Estado (y dentro de él, especialmente, el Poder Ejecutivo) se enfrenta con el desafío de regular para convencer. Es en este sentido el fomento, como técnica de la actividad administrativa, el medio que encierra mayor potencial. Este trabajo propone revisar la figura clásica del fomento para contribuir a que sea considerado como una alternativa de reducción de la intervención estatal directa en las actividades privadas, sin por ello dejar de lado objetivos de interés general. Acudiendo a la ayuda de las ciencias del comportamiento, y particularmente a la figura del nudge, se demostrará que el Estado, además de imponer costos o sanciones para alentar o desalentar conductas, tiene la posibilidad de motivar a las personas a hacer lo conveniente para el bien común. Muchos Gobiernos en todo el mundo están implementando exitosamente este tipo de regulaciones que buscan persuadir sin coartar la libertad personal. Argentina no debe ser una excepción.Palabras clave: fomento, actividad administrativa de fomento, intervención estatal, nudges, regulación económica, economía del comportamiento.
BackgroundIt is estimated that 1.5 million people are infected with T. cruzi in Argentina (4%). Chagas reactivation rate (R) in patients with solid organ transplantation (SOT) is around 33%, being higher in cardiac transplantation (Tx). ObjectiveTo describe the clinical characteristics, evolution, mortality, to evaluate reactivation risk factors and to analyze the usefulness of molecular tests in patients undergoing at SOT with Chagas’ disease risk (ChR) (R or Donor-derived transmission, -DT-), in a hospital in our country.MethodsRetrospective cohort from all the patients who received an SOT in our hospital from January 1988 to March 2017. All patients with ChR: either R or DT were analyzed. Inclusion: survival more 30 days and 6 months of follow-up or until death. We performed post-Tx monitoring with parasitaemia (Strout), and serial whole blood polymerase chain reaction (PCR) testing, weekly until 2 months, every 2 weeks until the sixth month and monthly until the year, later annual. PCR monitoring is done since 2006.ResultsWe performed 1932 SOT in 29 years: 54 SOT in patients with ChR, 46 chagasic recipients (CR) and 8 chagasic donors (CD) to negative recipient 24/46 (52%) presented R, (see Table 1), 4 had more than one episode. Time to first R was 67 days (r = 3–296, median 30 days). At the time of the R Strout was performed in 19 episode 13 were negative, PCR was positive in 10/10 of perfcormed test, 32% vs. 100% (P = 0.001). Clinical R: 5 episode in 4 patients (panniculitis 3, 1 with myocarditis, 1 myocarditis). Strout was negative in 2 of these, in the other episode monitoring had not been performed. Immunosuppression (IS): there were no differences in the IS, (induction and treatment of rejections). Reactivation: 21/24 responded to treatment, 2 spontaneously PCR-negative, 1 died. Mortality: 6/24 (25%) in pt. R and 2/17 (12%) in pt no R (P = ns), not related mortality. DT occurred in 1/ 3 liver and in 0/5 renal recipients.Type of TxAllReactivationClinicLiver (L)7867/26 (27%)1/7 (14%)Heart24113/23 (56%)2/13 (15%)Kidney (K)6132/5 (40%)1/2 (50%)Lung1051/2 (50%)0LK261/1 (100%0Others16100ConclusionPCR was more sensitive than Strout for detection of R or transmission. There was no clinical R in pt monitored by PCR. Also PCR sensitivity allow safe acceptance of Chagasic organs.Disclosures All authors: No reported disclosures.
Intensive Care Unit with pneumonia and progressive respiratory Insufficiency. She was intubated and ventilated by pressure regulated volume controlled ventilation (Servo 300C, Siemens, Solna, Sweden). Maximum conditions were Inspiratory Minute Volume 3.2 I, PEEP 10 cm H 2 O and 100% 0,. Chest X-ray showed bilateral interstitial Consolidation. Material obtained by broncho-alveolar lavage showed Pneumocystls Carinii. HIV-serology (Elisa and Western blott) and p24-antigen were positive, confirming the diagnosis Of pediatric AIDS. She was then treated with high dose Co-trimoxazole, Penthamidine, zidovudlne and steroids iv. Because of chest X-ray features, high need for 0, (100%, pao, 56 mm Hg), not responding to elevation of PEEP (max 10 Cm H 2 O) and Pao,/FiO, <200 (56)."' Acute Respiratory Distress Syndrome (ARDS) was diagnosed. Because conventional ventilation (CV) failure, HFO -V (3100A, Sensor Medics,Yorba Linda, Ca) was Initiated. Starting Mean Airway Pressure (MAP) of 19 cm H,0 was based on MAP of the cv, oscillatory pressure amplitude (dP) of 47 was, at initial frequency of 7.5 Hz, adjusted until chest wall vibrations were visible. It was required to raise MAP to 26 Cm H,0 and OP to 66 before optimal lung volume and ventilation were achieved and need for 0, reduced within hours. This was monitored by frequent blood-gas analysis and chest X-rays. MAP and dP could slowly be reduced. After a good response the first day, gradually 0,demand reduced and the patient could be weaned from the ventilation. MAP, OP, Fi0, and Oxygenation Index (MAP x PaO,/FiO,I are shown in table 1. Chest X-ray follow-up showed gradually Improving lung features, with marked improvement of aereatlon. After 10 days HFO-V she Could be succesfully detubated when a MAP Of 10 Cm H,0 was achieved.
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