Medio ambiente, sociedad, ética, auditoría y educación. La Investigación Contable en UNIMINUTO Virtual y a Distancia: Contexto y Oportunidades.

En los últimos años la educación a distancia ha mostrado ser capaz de reducir la brecha de inequidad social, de capacitar personas en lugares remotos, de brindar la posibilidad a la comunidad discapacitada y de permitirle a quienes no cuentan con suficientes recursos económicos acceder a la educación superior, la presente investigación da cuenta de los aspectos clave asociados a la decisión de matricularse en el programa de Contaduría Pública en la modalidad distancia tradicional. Se realizó un análisis de las narrativas basado en los resultados de un instrumento aplicado a 150 estudiantes. Para el análisis de datos se empleó la herramienta SenseMaker®. Los resultados evidencian aspectos personales, sociales y culturales que posicionan la oferta de educación en la modalidad a distancia como la institución que permite resignificar la vida de las persona

Medio ambiente, sociedad, ética, auditoría y educación. La Investigación Contable en UNIMINUTO Virtual y a Distancia: Contexto y Oportunidades.

En los últimos años la educación a distancia ha mostrado ser capaz de reducir la brecha de inequidad social, de capacitar personas en lugares remotos, de brindar la posibilidad a la comunidad discapacitada y de permitirle a quienes no cuentan con suficientes recursos económicos acceder a la educación superior, la presente investigación da cuenta de los aspectos clave asociados a la decisión de matricularse en el programa de Contaduría Pública en la modalidad distancia tradicional. Se realizó un análisis de las narrativas basado en los resultados de un instrumento aplicado a 150 estudiantes. Para el análisis de datos se empleó la herramienta SenseMaker®. Los resultados evidencian aspectos personales, sociales y culturales que posicionan la oferta de educación en la modalidad a distancia como la institución que permite resignificar la vida de las persona

A geological and biostratigraphic study of the Paleozoic of the Malaguide Complex in the Cogollos Vega Zone (Granada) using conodonts

ACP agradece de un modo especial a Alejandro Ruiz Fuentes, por su apoyo incondicional y ayuda durante muchísimas de las jornadas de campo realizadas, y también a los profesores Antonio Sánchez-Navas y Alberto Pérez-López, de los departamentos de Mineralogía y Petrología y de Estratigrafía y Paleontología de la Universidad de Granada, por haber permitido la realización de este trabajo con fondos del proyecto CGL2016–75679P (Ministerio de Economía y Competitividad) y del Grupo de investigación RNM- 208 (Junta de Andalucía). Agradecemos a los Dres. Silvia Blanco-Ferrera y Sergio Rodríguez García sus cuidadosas revisiones, las cuales nos han ayudado a mejorar este trabajo.La integración de datos cartográficos, litoestratigráficos y estructurales con el estudio de la fauna de conodontos hallada ha permitido detallar diversos aspectos de la geología del Complejo Maláguide en la Zona de Cogollos Vega. La Formación Falcoña constituye un importante nivel-guía para la correlación de distintas secciones estratigráficas presentes en el área. Su presencia ha permitido diferenciar las sucesiones pre-Falcoña y post-Falcoña, con facies y edades diferentes: la primera del Devónico (Emsiense, Frasniense y Fameniense) y la segunda del Carbonífero (Viseense superior-Serpukhoviense inferior). La estructura Alpina de la zona está determinada por la existencia de retrocabalgamientos que producen repeticiones de la serie estratigráfica general y pliegues asociados vergentes al sur que organizan el Complejo Maláguide en tres unidades tectónicas. Las estructuras están sistemáticamente cortadas y desplazadas por fallas normales y de salto en dirección dextrorsas, orientadas predominantemente según NW-SE. Un análisis preliminar del Índice de Alteración del Color (CAI) y de las microtexturas de los elementos conodontales ha revelado interesantes diferencias entre las unidades tectónicas presentes en la zona, lo que deberá ser objeto de estudio más detallado.A detailed geological characterization of the Malaguide Complex in the Cogollos Vega Zone has been made by integrating geological mapping, lithostratigraphy and structural analysis with conodont studies. The Falcoña Formation constitutes an important guide-horizon to correlate different stratigraphic sections and to distinguish pre-Falcoña and post-Falcoña successions with slightly different facies and different ages: the first one is Devonian (Emsian, Frasnian and Famennian) and the second one Carboniferous (upper Visean-lower Serpukhovian). The Alpine structure of the area is determined by the presence of backthrusts associated with south-vergent folds that repeat the general stratigraphy and divide the Malaguide Complex into three tectonic units. These structures are systematically cut by (mainly NW-SE oriented) normal and dextral strike-slip faults. Preliminary Colour Alteration Index (CAI) and micro-textural studies of conodontal elements have revealed interesting differences between the tectonic units present in the area, which should be the subject of a more detailed study.CGL2016–75679P (Ministerio de Economía y Competitividad)Grupo de investigación RNM- 208 (Junta de Andalucía

Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER); Agencia Española del Medicamento; Consejería de Salud de Andalucía.Background & Aims: Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period. Methods: Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected. Results: A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974-0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994-0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged ≥65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy's law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%). Conclusions: AST elevation at onset is a strong predictor of poor outcome and should be routinely assessed in DILI evaluation. Mortality is higher in older patients with hepatocellular damage and patients with underlying hepatic conditions. The Spanish DILI Registry is a valuable tool in the identification of causative drugs, clinical signatures and prognostic risk factors in DILI and can aid physicians in DILI characterisation and management. Lay summary: Clinical information on drug-induced liver injury (DILI) collected from enrolled patients in the Spanish DILI Registry can guide physicians in the decision-making process. We have found that older patients with hepatocellular type liver injury and patients with additional liver conditions are at a higher risk of mortality. The type of liver injury, patient sex and analytical values of aspartate aminotransferase and total bilirubin can also help predict clinical outcomes

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society