Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention

Background and Purpose: Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplate- let therapy: aspirin plus clopidogrel) in patients > 75 years of age with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). Methods: A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT) was analyzed. All outcomes were evaluated at 1- year of follow-up. Results: Five hundred and eighty-five patients, 289 (49%) of whom were > 75 years of age (79.6 ± 3.4 years; 33% women) were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA 2 DS 2 VASc score: 4.23 ± 1.51 vs 3.76 ± 1.40, p = 0.007 and a higher bleeding risk (HAS-BLED > 3: 88.6% vs 79.2%, p = 0.02) than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01 - 0.70, p = 0.004). Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53 - 17.57, p = 0.008). The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38); however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12 - 0.86, p = 0.02). Conclusions In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associ- ated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding

Intención emprendedora en estudiantes universitarios: un análisis desde la teoría del comportamiento planificado en Colombia

JEL: L26, I23[EN] Studies on entrepreneurship have used several approaches, among which, research on entrepreneurial intention (EI) can be highlighted. Studies on EI help researchers better understand entrepreneurial behavior. In this sense, one of the most relevant frameworks in EI studies is the Theory of Planned Behavior (TPB), which stands out for its predictive capacity, mainly in a university context. The aim of this research was to determine the relationship between the variables of Personal Attitudes (PAs), Subjective Norms (SNs), and Perceived Behavioral Control (PBC) with respect to the EI of university students in Colombia. For this purpose, we constructed a model that integrates the elements of the TPB with EI with reference to the validated instrument of the Global University Entrepreneurial Spirit Student's Survey (GUESSS) project applied to a sample of 12,383 students. The estimation of the model uses structural equations (SEMs) by means of Partial Least Squares-Path Modelling (PLS-PM). The findings show that PAs and PBC are determinants of EI, while SNs have no direct influence; however, their effects are indirect. These results have implications for how to promote entrepreneurship in emerging economies through the university environment. The results indicate that the development of students' capabilities is essential for entrepreneurship and its incorporation into the university's knowledge transfer model.[ES] Los estudios sobre el espíritu empresarial han tenido varios enfoques, entre los que destaca la investigación sobre la intención emprendedora (IE). Los estudios sobre la IE permiten explicar y comprender el comportamiento emprendedor. En este sentido, uno de los marcos más relevantes en los estudios de IE es la Teoría del Comportamiento Planificado (TCP), que ha destacado por su capacidad predictiva principalmente en el contexto universitario. El objetivo de esta investigación es determinar la relación entre las variables Actitudes Personales (AP), Normas Subjetivas (NS) y Control Conductual Percibido (CCP) con respecto a la IE de estudiantes universitarios en Colombia. Para ello se construye un modelo que integra los elementos de la TCP con la IE tomando como referencia el instrumento validado del proyecto Global University Entrepreneurial Spirit Student's Survey (GUESSS) aplicado a una muestra de 12.383 estudiantes. La estimación del modelo se realiza a través de ecuaciones estructurales (SEM) mediante Partial Least Squares - Path Modelling (PLS-PM). Los resultados muestran que las AP y el CCP son determinantes de la IE, mientras que las NS no tienen influencia directa; sin embargo, sus efectos son indirectos. Estos resultados tienen implicaciones sobre cómo promover el espíritu empresarial en las economías emergentes desde el ámbito universitario. Por lo tanto, es evidente que el desarrollo de las capacidades de los estudiantes es esencial para el emprendimiento y su incorporación al modelo de transferencia de conocimiento de la universidad.We thank the GUESSS Project (Global University Entrepreneurial Spirit Student's Survey) 2018-2019 edition of the University of St. Gallen (KMU-HSG/CFB-HSG) (GUESSS Project, 2021), and the GUESSS Colombia network led by the university e EAFIT (GUESSS-Colombia Project, 2021) that surveyed 12.383 students from 57 Higher Education Institutions. The data belong to Global University Entrepreneurial Spirit Student's Survey) 2018-2019 edition of the University of St. Gallen (KMU-HSG/CFB-HSG) and are used by members of the GUESSS Colombia network led by the university e EAFIT. These data are copyrighted. This research was funded by the Universidad Pedagógica y Tecnológica de Colombia, grant number SGI 3134 and SGI 3066

Evaluación de la actividad docente para lograr la calidad del profesorado en el proceso de acreditación internacional del CEP la Inmaculada Concepción, del Consorcio de Centros Educativos Católicos en el distrito de Surco – Lima, durante el año 2014

Publicación a texto completo no autorizada por el autorAnaliza la influencia de la evaluación de la actividad docente para lograr la calidad del profesorado en el proceso de acreditación internacional del Centro Educativo Privado La Inmaculada Concepción, del Consorcio de Centros Educativos Católicos en el distrito de Surco – Lima, durante el año 2014. La población objeto de estudio está constituida por un total de 478 alumnos de educación secundaria de menores desde el primer año al quinto año de educación secundaria, distribuidos en 16 secciones y una población total de 36 Docentes. Sumando un total de 514 sujetos de investigación. Respecto a la técnica básica de recolección de datos que se utilizó en el estudio es una encuesta, que fue aplicado en estudiantes de educación secundaria, para determinar el nivel de satisfacción frente a la actividad docente, así mismo una autoevaluación docente, ambos instrumentos permitirán recabar información respecto a la influencia de la evaluación de la actividad docente para el logro de la calidad del profesorado en el proceso de acreditación internacional del CEP La Inmaculada Concepción. En el empeño por perfeccionar el sistema educativo y mejorar la calidad del impacto de éste, se ha determinado como elemento importante el desempeño profesional del docente que contribuirá al cambio en el proceso educacional. El éxito de cualquier sistema educativo dependerá en gran medida del nivel de desarrollo profesional alcanzado por los docentes lo que repercutirá en la calidad de los resultados del aprendizaje.Tesi

Implementación de un plan de mantenimiento preventivo para incrementar la disponibilidad de los Reach Stacker en la empresa Fargoline S. A., Callao 2022

El objetivo de la actual investigación es establecer en qué medida un plan de mantenimiento preventivo incrementa la disponibilidad de los reach stacker en la empresa Fargoline S.A., Callao 2022. Para lograr este objetivo se realizó un plan de mantenimiento preventivo de acuerdo a la cantidad de horas de trabajo de las máquinas. Mediante la implementación del plan de mantenimiento preventivo se consiguió incrementar la disponibilidad del 65.03% al 78.13%, asimismo, se logró incrementar la mantenibilidad del 66.26% al 69.60% y se obtuvo un aumento en la confiabilidad de las grúas reach stacker del 88.38% al 93.32%. Con la implementación de un plan de mantenimiento preventivo se logró reducir los tiempos de paradas por mantenimientos de 549 horas a 428 horas, obteniendo una reducción de 121 horas. Se logró un ahorro económico de 3,630 dólares después de la implementación durante los meses de estudio, el cual nos indica un aspecto positivo en la implementación del plan de mantenimiento preventivo para las grúas reach stacker. En conclusión, la implementación de un plan de mantenimiento preventivo incrementa la disponibilidad de las grúas reach stacker en la empresa Fargoline S.A., reduciendo los tiempos de paradas por mantenimiento, minimizando los costos de los mantenimientos correctivos y optimizando las operaciones de la empresa

A Survey of Speech-language Pathologists: Long-term Speech Therapy Needs for Patients within Three Neurological Conditions

Forty-seven speech-language pathologists (SLPs) completed a written survey designed to obtain their opinions regarding the speech-language pathology needs of patients presenting with communication deficits following traumatic brain injury, cerebrovascular accident and cerebral palsy. Results indicated that over one-half of the SLPs in the study cited the most common reason that speech therapy is stopped is due to lack of insurance coverage, not because the patient reached maximum improvement. After discharge from services, 78-92% of SLPs affirmed that their patients would have benefitted from ongoing speech-language treatment if insurance limitations were not a consideration. In many instances, therapy was recommended for several years up to lifetime follow-up. Study results demonstrate that a common reason for termination of therapy was due to insurance limits, The implications of this pilot study for life care planners pertain to consulting with SLPs regarding what the evaluation and long term speech-language pathology needs may be for patients with these three neurological disorders, without considering insurance limits

Mikroskopska građa mišićnih vlakana nakon izlaganja bisfenolu-A te mogućnost njihova oporavka primjenom plazme obogaćene trombocitima.

Bisphenol-A (BPA) is one of the chemical products most produced in large volumes world-wide. Among other items, it forms part of plastics and food containers, from which there is a migration of BPA into food, thus it enters our organism via the digestive tract, which in fact is one of the main sources of exposure in humans. In this study, BPA action has been investigated: at a muscular level with continuous exposure; after its withdrawal in order to evaluate the possible recovery of the muscle; and the potential effect of platelet-rich plasma (PRP) on a muscle previously modified by the action of BPA. For this purpose, and as a fundamental tool, histopathology was used, from which it was observed that muscle modifications were produced. These were compatible with the action of hormones administered exogenously to animals to fatten them up. It was also noted that, after the withdrawal of BPA, there was some muscle structure recovery, and, after treatment with PRP, this was practically total. Further research should investigate the mechanisms through which BPA affects muscle tissue and PRP succeeds in restoring this type of muscular lesion.Bisfenol-A (BPA) je kemijska tvar koja se u velikim količinama proizvodi širom svijeta. Između ostaloga, bisfenol-A je sastavni dio plastike i ambalaže za prehrambene proizvode, odakle se otpušta u hranu te tako dospijeva u probavni sustav čovjeka pa hrana time postaje jedan od glavnih izvora izloženosti ljudi toj supstanciji. U ovom istraživanju učinci BPA promatrani su u mišićju nakon trajne izloženosti, u mišićju nakon prestanka davanja BPA kako bi se procijenio njihov mogući oporavak, te u mišićju s primijenjenom plazmom obogaćenom trombocitima (PRP) kako bi se utvrdio njezin utjecaj na BPA uzrokovana oštećenja. Opažene patohistološke promjene u mišićima bile se slične onima kod djelovanja hormona rabljenih za bolji prirast tovnih životinja. Nakon prestanka davanja BPA uočen je određeni oporavak mišićne građe, a nakon primjene PRP oporavak je bio potpun. Daljnjim istraživanjima treba utvrditi kojim mehanizmima BPA utječe na mišićno tkivo i kako PRP uspijeva oporaviti nastala mišićna oštećenja

Propuesta de intervención: creación de hábitos deportivos y grupo de apoyo en personas con Discapacidad Intelectual.

Las personas con discapacidad intelectual a menudo no tienen los recursos suficientes para llevar a cabo una actividad física continuada en el tiempo. A través de esta intervención, lo que se busca es reducir los efectos negativos del sedentarismo a través de la creación de hábitos deportivos, los cuales puedan ser mantenidos gracias a la creación de un grupo de apoyo. Para ello, se facilitará a los participantes de una serie de recursos para que puedan acceder al programa sin complicaciones, de manera que los cuidadores principales también se vean beneficiados indirectamente de los resultados del programa. <br /

Ecosystem services of tropical dry forests : insights from longterm ecological and social research on the Pacific coast of Mexico

In the search for an integrated understanding of the relationships among productive activities, human well-being, and ecosystem functioning, we evaluated the services delivered by a tropical dry forest (TDF) ecosystem in the Chamela Region, on the Pacific Coast of Mexico. We synthesized information gathered for the past two decades as part of a long-term ecosystem research study and included social data collected in the past four years using the Millennium Ecosystem Assessment (MA) conceptual framework as a guide. Here we identify the four nested spatial scales at which information has been obtained and emphasize one of them through a basin conceptual model. We then articulate the biophysical and socio-economic constraints and drivers determining the delivery of ecosystem services in the Region. We describe the nine most important services, the stakeholders who benefit from those services, and their degree of awareness of such services. We characterize spatial and temporal patterns of the services&rsquo; delivery as well as trade-offs among services and stakeholders. Finally, we contrast three alternative future scenarios on the delivery of ecosystem services and human well-being. Biophysical and socioeconomic features of the study site strongly influence human&minus;ecosystem interactions, the ecosystem services delivered, the possible future trajectories of the ecosystem, and the effect on human well-being. We discuss future research approaches that will set the basis for an integrated understanding of human&minus;ecosystem interactions and for constructing sustainable management strategies for the TDF.<br /

Procjene strukture i ultrastrukture ovarija vrste Danio rerionakon izlaganja 2, 3, 7, 8 – tetraklorodibenzo-p-dioksinu (TCDD)

The morphological consequences of long-term exposure to low doses of 2, 3, 7, 8-tetrachlo rodibenzo-p-dioxin in the ovaries were nvestigated in 50 adult female zebrafish at structural and ultrastructural levels. Animals were exposed to graded concentrations of 2, 3, 7, 8-tetrachlorodiben zo-p-dioxin (10, 40, 100 and 270 ppb) for 21 days, then zebrafish were sacrificed by an overdose of anaesthetic solution tricaine methanesulfonate, and immediately samples were taken for morphological evaluation. At lower concentrations of exposure there was no evidence of morphological modifications, while at higher concentrations (100 and 270 ppb) we frequently observed degeneration and inflammation. Significant increases in follicular atresia were observed among all groups (p<0.05). These results indicate that long-term exposure to low doses of 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin are able to induce morphological damage on the ovaries, which could then produce adverse effects on fish reproductive health.Morfološke konsekvence ovarija po dugotrajnijem izlaganju niskim dozama 2, 3, 7, 8-tetra klorodibenzo-p-dioksina su utvrđene na 50 odraslih jedinki vrste Danio rerio i to na strukturnoj i ultrastrukturnoj razini. Jedinke su bile izložene stupnjevanim koncentracijama 2, 3, 7, 8-tetraklorodi benzo-p-dioksina (10, 40, 100 i 270 ppb) tijekom 21 dana, i tada su jedinke bile žrtvovane uporabom letalne doze anestetske solucije tricain metansulfonata, i odmah su jedinke uzete za morfološku procjenu. Utvrđeno je da pri nižim koncentracijama izloženosti nema morfoloških modifikacija, dok su pri višim koncentracijama (100 i 270 ppb) utvrđene učestale degeneracije i upale. Značajan porast folikularne atrezije je utvrđen unutar svih grupa (p0.05). Ovi rezultati ukazuju na to se da po dugom izlaganju ovarija niskim dozama 2, 3, 7, 8-tetraklorodibenzo-p-dioksina mogu inducirati morfološkepromjene ovarija, koje tada mogu imati negativni utjecaj na normalnu reprodukciju vrste