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Despite proximity and cultural similarities, Peru and Bolivia provide contrasting examples of elite power as opposed to that of popular movements. Peru in recent years has seen the consolidation of business power at the expense of a politically active civil society; opposition to neoliberal policies has been fragmented and weak. Bolivia has a history of strong social movements that underpinned successive administrations by the Movimiento al Socialismo (MAS). However, these trajectories are not fixed and the ability of civil society and elites to control the state fluctuates. The November 2019 coup in Bolivia is a reminder of this. This article compares the two countries over different time periods: that of state-led development prior to 1980, the neoliberal period in the 1980s and 1990s, and that of post-neoliberalism period after 2000.

Laparoscopy is an underused modality for peritoneal dialysis access procedures. The strengths of laparoscopy are that it can both prevent and resolve the common mechanical problems that adversely effect dialysis catheter outcomes. Laparoscopically enabled catheter implantation and rescue procedures included rectus sheath catheter tunneling, omentopexy, adhesiolysis, resection of epiploic appendices, colopexy, salpingectomy, and appendectomy. Using these techniques, the outcomes of 428 laparoscopically implanted catheters were studied. During a mean follow-up of 21.6 months, mechanical obstruction complicated 3.7% of implantation procedures. The incidence of pericatheter leak was 2.6%. There were no occurrences of pericatheter hernia or subcutaneous cuff extrusion. Laparoscopic salvage procedures limited losses from mechanical catheter problems to .9%. Cumulative revision-free and assisted catheter survival probabilities for loss from mechanical complications at 5 years were .96 and .99, respectively. Because it is enabled by techniques not available to other catheter-placement methods, laparoscopy produces superior outcomes.

Crabtree and Durand explore how the Peruvian elite and foreign mining interests have been able to entrench their position and marginalise the left, even as leftist governments have risen to power elsewhere on the continent.

Peritoneal dialysis catheter embedment consists of implanting the catheter far in advance of anticipated need, with the external tubing buried under the skin. The catheter is externalized when initiation of dialysis is required. Details of the surgical procedure and management of associated complications are generally lacking. A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period. Factors influencing duration of embedment, functionality upon externalization, and long-term outcomes were analyzed. Mean duration of embedment was 13.9 months (median 9.4; range .5 to 68.5). Immediate function was exhibited in 85.7% of catheters. Employing laparoscopic revision, 98.8% of embedded catheters were successfully used for peritoneal dialysis. Extended catheters and duration of embedment were important determinants of catheter functionality. Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed. Complications are few and easily managed.

Both medical benefits to the patient and financial incentives to the health care system exist to increase the use of peritoneal dialysis as renal replacement therapy. Providing long-term peritoneal access free of mechanical dysfunction continues to represent a major challenge to the success of this modality. Variable outcomes result from the lack of standard implantation methodology and failure to address persistent problems associated with current implantation techniques. This prospective case study compared noninfectious procedural complications of three approaches to establish peritoneal dialysis access. The groups consisted of 63 catheters implanted by traditional open dissection, 78 catheters implanted by basic laparoscopy without associated interventions, and 200 catheters implanted by advanced laparoscopic methods including rectus sheath tunneling, selective prophylactic omentopexy, and selective adhesiolysis. Mechanical flow obstruction, the major outcome indicator, followed only 1 of 200 (0.5%) implantation procedures in the advanced group and was significantly better ( P < 0.0001) than the open dissection (17.5%) and basic laparoscopic (12.5%) groups. A low rate of pericannular leaks (1.3–2%) was not different for the three groups. One pericannular hernia occurred in the open group. Catheter mechanical dysfunction attributable to the surgical technique can nearly be eliminated through adjunctive procedures made possible only by a laparoscopic approach.

A solid foundation in computer programming is critical for students to succeed in advanced computing courses, but teaching such an introductory course is challenging. Therefore, it is important to develop better approaches in order to improve teaching effectiveness and enhance student learning. In this paper, we present 26 tips for teaching introductory programming drawn from the experiences of four well-qualified college professors. It is our hope that our peers can pick up some tips from this paper, apply them in their own classroom, improve their teaching effectiveness, and ultimately enhance student learning.

Adhesions from previous surgery and peritonitis can lead to peritoneal dialysis catheter insertion failure, visceral injury, and poor dialysis function. Employing a laparoscopic approach, the effect of adhesiolysis on mechanical catheter complications and long-term catheter survival was prospectively examined in 436 catheter placement procedures having a 57.8 per cent prevalence rate of previous surgery. Adhesiolysis was required in 31.8 per cent of cases with prior surgery and in 3.3 per cent of procedures without previous operations. The incidence of adhesiolysis was directly related to the number of prior surgeries ( P < 0.0001). The incidence of catheter insertion failure from extensive adhesions was 1.8 per cent. Survival probability free from catheter obstruction was lower in patients requiring adhesiolysis compared with subjects with prior surgery not requiring adhesiolysis ( P = 0.01). Laparoscopic rescue procedures limited catheter losses from flow obstruction to only 0.7 per cent. As a result, long-term catheter survival was not different among patients regardless of prior surgery and/or adhesion status ( P = 0.2). Scars on the abdomen and prior peritonitis do not predict the extent of adhesions and should not be used to judge eligibility for peritoneal dialysis. Presently, laparoscopy is the only practical way to provide optimal peritoneal access in patients with a history of surgery and peritonitis.

Teaching advanced programming can be a challenge, especially when the students are pursuing different majors with diverse analytical and problem-solving capabilities. The purpose of this paper is to explore the efficacy of using a particular problem as a vehicle for imparting a broad set of programming concepts and problem-solving techniques. We present a classic brain teaser that is used to communicate and demonstrate advanced software development concepts and techniques. Our results show that students with varied academic experiences and goals, assuming at least one procedural/structured programming pre-requisite, can benefit from and also be challenged by such an exercise. Although this problem has been used by others in the classroom, we believe that our use of this problem in imparting such a broad range of topics to a diverse student population is unique.