Curricular Training in Design for All in Nursing

Esta publicación nace de la necesidad de tener en cuenta la diversidad de las personas desde el momento en que se concibe y diseña un producto, bien o servicio. Pensar en la generalidad excluye a quienes son diferentes. Una sociedad de iguales necesita de concepciones que tengan en cuenta sus diferencias. Los profesionales del mañana necesitan tener formación específica en Diseño para Todas las Personas para hacer de la práctica de su desarrollo profesional una oportunidad y no otra barrera.This publication is the result of the need to take into account people’s diversity from the very first moment we envisage and design a product, good or service. By thinking about the general picture, we exclude different people. A society of equals needs concepts that take into account the differences among people. Future professionals need to receive specific training in Design for All to make their practical professional development an opportunity and not another barrier

Temporal patterns of active fire density and its relationship with a satellite fuel greenness index by vegetation type and region in Mexico during 2003-2014

Background: Understanding the temporal patterns of fire occurrence and their relationships with fuel dryness is key to sound fire management, especially under increasing global warming. At present, no system for prediction of fire occurrence risk based on fuel dryness conditions is available in Mexico. As part of an ongoing national-scale project, we developed an operational fire risk mapping tool based on satellite and weather information. Results: We demonstrated how differing monthly temporal trends in a fuel greenness index, dead ratio (DR), and fire density (FDI) can be clearly differentiated by vegetation type and region for the whole country, using MODIS satellite observations for the period 2003 to 2014. We tested linear and non-linear models, including temporal autocorrelation terms, for prediction of FDI from DR for a total of 28 combinations of vegetation types and regions. In addition, we developed seasonal autoregressive integrated moving average (ARIMA) models for forecasting DR values based on the last observed values. Most ARIMA models showed values of the adjusted coefficient of determination (R2 adj) above 0.7 to 0.8, suggesting potential to forecast fuel dryness and fire occurrence risk conditions. The best fitted models explained more than 70% of the observed FDI variation in the relation between monthly DR and fire density. Conclusion: These results suggest that there is potential for the DR index to be incorporated in future fire risk operational tools. However, some vegetation types and regions show lower correlations between DR and observed fire density, suggesting that other variables, such as distance and timing of agricultural burn, deserve attention in future studiesAntecedentes: Una adecuada planificación del manejo del fuego requiere de la comprensión de los patrones temporales de humedad del combustible y su influencia en el riesgo de incendio, particularmente bajo un escenario de calentamiento global. En la actualidad en México no existe ningún sistema operacional para la predicción del riesgo de incendio en base al grado de estrés hídrico de los combustibles. Un proyecto de investigación nacional actualmente en funcionamiento, tiene como objetivo el desarrollo de un sistema operacional de riesgo y peligro de incendio en base a información meteorológica y de satélite para México. Este estudio pertenece al citado proyecto Resultados: Se observaron en el país distintas tendencias temporales en un índice de estrés hídrico de los combustibles basado en imágenes MODIS, el índice “dead ratio” (DR), y en las tendencias temporales de un ìndice de densidad de incendios (FDI), en distintos tipos de vegetación y regiones del país. Se evaluaron varios modelos lineales y potenciales, incluyendo términos para la consideración de la autocorrelación temporal, para la predicción de la densidad de incendios a partir del índice DR para un total de 28 tipos de vegetación y regiones. Se desarrollaron además modelos estacionales autoregresivos de media móvil (ARIMA en inglés) para el pronóstico del índice DR a partir de los últimos valores observados. La mayoría de los modelos ARIMA desarrollados mostraron valores del coeficiente de determinación ajustado (R2 adj) por encima de 0.7 to 0.8, sugiriendo potencial para ser empleados para un pronóstico del estrés hídrico de los combustibles y las condiciones de riesgo de ocurrencia de incendio. Con respecto a los modelos que relacionan los valores mensuales de DR con FDI, la mayoría de ellos explicaron más del 70% de la variabilidad observada en FDI. Conclusiones: Los resultados sugirieron potencial del índice DR para ser incluido en futuras herramientas operacionales para determinar el riesgo de incendio. En algunos tipos de vegetación y regiones se obtuvieron correlaciones más reducidas entre el índice DR y los valores observados de densidad de incendios, sugiriendo que el papel de otras variables tales como la distancia y el patrón temporal de quemas agrícolas debería ser explorado en futuros estudiosFunding for this work was provided by CONAFOR-CONACYT Project 252620 “Development of a Fire Danger System for Mexico.” This work was also cofinanced by the Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria and European Social Fund (Dr. E. Jiménez grant)S

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Ciencia Odontológica 2.0

Libro que muestra avances de la Investigación Odontológica en MéxicoEs para los integrantes de la Red de Investigación en Estomatología (RIE) una enorme alegría presentar el segundo de una serie de 6 libros sobre casos clínicos, revisiones de la literatura e investigaciones. La RIE está integrada por cuerpos académicos de la UAEH, UAEM, UAC y UdeG

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Actualidad y prospectiva de la investigación científica en el Centro Universitario Amecameca de la Universidad Autónoma del Estado de México

Con responsabilidad, se organizó un programa cuya finalidad fuera publicitar con transparencia dichos avances, a través de un esfuerzo de rendición de cuentas a la comunidad inmediata, la universitaria, y a la comunidad abierta, la sociedad que la principal referencia para tal efecto. El programa se concretiza a través del presente libro, conformado con una inspiración de investigación multidisciplinaria; sin embargo, para llegar a tal fin, el reto es realizar el proceso de búsqueda y generación de conocimiento transitando hacia la colaboración de los cuerpos académicos, que puedan construir nuevos conocimientos fortalecidos por la convergencia de diferentes campos del saber. En consecuencia, la primera etapa de esta estrategia es la publicidad de los trabajos investigativos ejercidos, para hacer un balance al día, pero también proyectar el futuro de cada campo y área del conocimiento. La organización explicativa está organizada por tres bloques representativos del quehacer en la generación de conocimiento del Centro Universitario, un primer bloque centra el interés en las humanidades, educación y sustentabilidad; el segundo bloque lo integra la reflexión científica sobre la construcción democrática, derechos humanos y equidad de género; en el tercer segmento se destina a la seguridad alimentaria, salud pública y sistemas agropecuarios. La actualidad de la investigación eleva la producción lograda y lo que en el momento se encuentra en construcción y los alcances que produce para la docencia, la investigación misma, y para la sociedad en general. La prospectiva es un área que todos los capítulos desarrollan con el propósito de delinear los alcances innovadores por andar en teoría, metodología e incluso en los saberes mismo

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Análisis de la estrategia MasAgro-maíz

This paper discusses the objectives and strategies of the MasAgro-maize program starting from the initial conditions of the traditional agricultural subsector of Mexico that produces maize under rainfed conditions. These initial conditions show that the trend of the past 30 years has been to increase the domestic production of rainfed maize by 1.20 million tons per year (MTY) and the yield in 0.22 Mg ha-1, each 10. Therefore, the MasAgro objectives should be corrected in consequence. Global experience on the adoption of conservation agriculture (CA) by small producers is analyzed. For the CA with biannual rotation adoption case examined, it is estimated that the program has directly or indirectly to treat 3.164 million hectares (M ha) managed by more than 800 000 small production units, (categories<5 ha and 5-20 ha) and achieve average yields of 3.92 Mg ha-1. Despite the recognized positive effect on sustainability, the strategy of irreversible adoption of CA may be poor due to a low shortterm economic incentive involved, to the lack of access to credit, marketing support, and several inconsistencies with the objectives and requirements of the small UP wellness. The strategy of replacing 25 to 50% of the area occupied by both native maize races and creolized varieties are deemed inappropriate for Mexico, by its character as the center of origin of maize and important reservoir of biodiversity of this speciesEn este ensayo se examinan los objetivos y estrategias del programa MasAgro-maíz, partiendo de las condiciones iniciales del subsector agrícola tradicional de México que produce maíz de temporal. Estas condiciones iniciales muestran que la tendencia de los últimos 30 años ha sido de incrementar la producción nacional de maíz de temporal en 1.20 millones de toneladas anuales (MTA) y el rendimiento en 0.22 Mg ha-1 , cada 10. Por lo tanto los objetivos de MasAgro habrán de ser corregidos en consecuencia. Se analiza la experiencia mundial sobre la adopción de la agricultura de conservación (AC) por parte de los productores en pequeño. Para el caso examinado de adopción de la AC con rotación bianual, se calcula que el programa ha de tratar directa o indirectamente 3.164 millones de hectáreas (M ha) manejadas por más de 800 000 unidades de producción (UP) pequeñas (categorías < 5 ha y 5-20 ha) y lograr rendimientos promedio de 3.92 Mg ha-1. No obstante el reconocido efecto positivo sobre la sostenibilidad, la estrategia de adopción irreversible de la AC podrá ser pobre debido al bajo incentivo económico de plazo corto involucrado, a la falta de acceso al crédito, a apoyos a la comercialización, y varias incompatibilidades con los objetivos y demandas de bienestar de las pequeñas UP. La estrategia de sustituir entre 25 y 50%, de la superficie ocupada por los maíces nativos y las variedades acriolladas se considera inadecuada para México, por su carácter de centro de origen del maíz y de importante reservorio de biodiversidad de la especi

Efecto del portainjerto por aproximación en el estatus nutrimental del manzano ‘Brookfield Gala’

In high-density apple orchards, dwarfing rootstocks play a key role, since they promote or stimulate early production, increase the yield and quality of the fruit per unit area. However, its horticultural performance depends on the ability of the soil to supply water and nutrients for the root system. Under limiting conditions of shallow soils some dwarfing rootstocks are not able to satisfy the water and nutrient requirements for the variety. In Aquixtla, Puebla, growth and development in ‘Brookfield Gala’ / Bud.9 apple trees are weak, with symptoms of mineral deficiencies, in contrast to trees grafted in Emla7, which are producing fruits normally. In this work, the nutritional status of ‘Brookfield Gala’ / Bud.9 trees, supported by the rootstock Emla7, is reported. The foliar analysis in 2018 showed a higher concentration of Mn and B in ‘Brookfield Gala’ / Bud.9 trees with approximation grafting carried out in 2016 and 2017 respectively. In 2019 the concentration of Cu and B was higher in the ‘trees with approximation grafting carried out in 2017. In all trees the concentration of Zn and K was low and the concentration of Ca and B was high. The effect of the approximation graft with the Emla7 rootstock was incipient in the development and growth of the ‘Brookfield Gala’ / Bud.9 apple tree.En huertos de manzana de alta densidad, los portainjertos enanizantes juegan un papel clave, puesto que ellos promueven o estimulan la producción temprana, incrementan el rendimiento y calidad del fruto por unidad de superficie. Sin embargo, su desempeño hortícola depende de la capacidad del suelo para suministrar agua y nutrientes para el sistema radical. Bajo condiciones limitantes de suelos someros algunos portainjertos enanizantes no son capaces de satisfacer los requerimientos de agua y nutrientes para la variedad. En Aquixtla, Puebla, el crecimiento y desarrollo en árboles de manzano ‘Brookfield Gala’/Bud.9 son débiles, con sintomatología de deficiencias minerales, en contraste a los árboles injertados en Emla7, los cuales están produciendo frutos normalmente. En este trabajo se reporta el estatus nutrimental de árboles ‘Brookfield Gala’/Bud.9, apoyados por el portainjerto Emla7. El análisis foliar en 2018 demostró una concentración más alta de Mn y B en arboles ‘Brookfield Gala’/Bud.9 con injerto de aproximación realizado en 2016 y 2017 respectivamente. En 2019 la concentración de Cu y B fue más alta en los ‘arboles con injerto de aproximación realizado en 2017. En todos los árboles la concentración de Zn y K fue baja y la concentración de Ca y B fue alta. El efecto del injerto de aproximación con el portainjerto Emla7 fue incipiente en el desarrollo y crecimiento del manzano ‘Brookfield Gala’/Bud.9