Impact of the Use of Non-Pharmacological Care Tools in Building the Perception of Dignity in Ailing People at the End-of-Life

Objective This paper examines the link between non-pharmacological care tools carried out by volunteers in a hospice and the development of the perception of dignity in people with end-of-life terminal illnesses. Materials and Methods We interviewed volunteers from a hospice institution in Argentina, who carried out non-pharmacological care activities aimed at people at the end-of-life. The results of these interviews were analyzed with the Atlas Ti software, using the grounded theory as a form of qualitative codification. Results From the codification of the interviews, we obtained the following analysis categories: 1. Caring after the caregivers (mentioned 14 times), 2. Caretaking into account the temporal needs of others (mentioned 7 times), 3. Active listening (mentioned 11 times), 4. Environmental aesthetic factors (mentioned 18 times) and 5. Enhancement of autonomy and selfhood (mentioned 22 times). Discussion We examined ways in which volunteers associated with the care of people with end-of-life terminal illnesses understand their work from the explanation of the non-pharmacological care activities developed within the institution, as well as the link that these have with the different dimensions of the human sense. Conclusion The non-pharmacological care tools, as they alleviate existential/spiritual suffering, impact positively in the possibility of a terminal person’s capacity to perceive herself/himself as worthy.Fil: Radosta Rosas, Darío Iván. Hospice San Camilo; Argentina. Universidad Nacional de San Martín. Instituto de Altos Estudios Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ham, Socorro. Hospice San Camilo; ArgentinaFil: Alvarado, Cynthia. Hospice San Camilo; ArgentinaFil: Fernández, Irupé. Asociación Argentina de Medicina y Cuidados Paliativos; ArgentinaFil: Pincemín, Isabel. Hospice San Camilo; Argentin

Elaboración de un programa de mantenimiento preventivo en un centro de entretenimiento de juegos mecánicos

El presente trabajo tiene como finalidad la elaboración de un programa de mantenimiento preventivo para un centro de entretenimiento de juegos mecánicos. Con este programa de mantenimiento preventivo se busca que los juegos mecánicos estén disponibles y en operación, además reducir posibles fallas que generen paradas imprevistas dado que, estos juegos mecánicos son la principal fuente de ingresos para la empresa. Para elaborar la investigación, se definió conceptos básicos de mantenimiento preventivo que abarcan la secuencia de pasos para elaborar el programa de mantenimiento. Por ello, nos basamos en fuentes confiables para poder realizar la investigación. Para el desarrollo del programa, se debe tener en cuenta las fichas técnicas de los equipos, hojas de vida, instructivos de trabajo, manuales de los equipos, entre otros factores. Con el propósito de elaborar el cronograma de actividades, en donde se detallan que actividades de mantenimiento deben seguir los técnicos especializados y cada cuanto tiempo hacerlo. Todo esto con el fin de mantener los equipos disponibles y operativos, además de reducir las posibles fallas y evitar posibles accidentes e incidentes. En la parte final indicamos las conclusiones de la elaboración del trabajo.Campus Lima Centr

Talleres de inglés con perspectiva intercultural como estrategia didáctica para mejorar el aprendizaje del inglés en estudiantes indígenas

The purpose of this study was to identify the current situation of our indigenous students in relation to low performance and the impact that motivation causes in learning the English language at the Faculty of Business Administration and Accounting (FAECO) and at the Faculty of Humanities. It is a descriptive cross-sectional study. A diagnosis and a survey were applied to a sample of 24 indigenous students between these Gunas and Embera.  English workshops were organized from an intercultural context in order to know the attitude and perception of students in regular English classes and the causes of the high percentages of failures, dropouts and learning problems that interrupt the process that indigenous students have with respect to their mother tongue, forcing them to read and write in a language that they often do not know, they do not speak or write it, leading them to reject or neglecting their own language to acquire a second language resulting in the loss of the first. It was observed that it is possible that FAECO indigenous students feel excluded from learning activities in a traditional classroom. They can even become marginalized and demoralized, if teachers ignore the development of intercultural competence in their lessons.  Therefore, we can conclude that the teaching of English from an intercultural perspective reinforces values, beliefs, and identity, as integrating elements in the development of a foreign language and that the modality of workshops provides an excellent opportunity to design dynamic and inclusive classes for Low-performing indigenous students in English classes.Este estudio tuvo como propósito identificar la situación actual de nuestros estudiantes indígenas con relación al bajo rendimiento y el impacto que la motivación causa en el aprendizaje del idioma inglés en la Facultad de Administración de Empresas y Contabilidad (FAECO) y en la Facultad de Humanidades. El mismo es un estudio transversal descriptivo. Se aplicó un diagnóstico y una encuesta a una muestra de 24 estudiantes indígenas entre estos Gunas y Embera  Se organizaron talleres de inglés desde un contexto intercultural con el fin de conocer la actitud y la percepción de los estudiantes en las clases regulares de inglés  y las causas de los altos porcentajes de fracasos, deserción y problemas de aprendizaje  que  interrumpen  el proceso que tiene  el estudiante indígena con respecto a su lengua materna obligándole a leer y a escribir  en una lengua que muchas veces desconoce, no lo habla ni lo escribe llevándole a rechazar o descuidar su propia lengua  para adquirir una segunda lengua resultando en la pérdida de la primera. Se observó que es posible que los estudiantes indígenas de FAECO se sientan excluidos de las actividades de aprendizaje en un aula tradicional, inclusive pueden llegar a ser marginados y desmoralizados, si los docentes obvian el desarrollo de la competencia intercultural en sus lecciones.Por lo que podemos concluir que la enseñanza del inglés desde una perspectiva intercultural refuerza valores, creencias e identidad, como elementos integradores en el desarrollo de una lengua extranjera y que la modalidad de talleres brinda una excelente oportunidad para que se diseñen clases dinámicas e integradoras para estudiantes indígenas con bajo rendimiento en las clases de inglés

Estudio del Programa Nacional para la Promoción de Oportunidades Laborales Impulsa Perú, y su impacto en la promoción del empleo en Lima Metropolitana en el período 2011-2019

La crisis mundial del 2008 trajo como consecuencia la desaceleración en los mercados internacionales de créditos y problemas de liquidez en todos aquellos países latinoamericanos que dependían del crédito externo. Con este panorama, el nivel de desempleo aumentó debido al impacto negativo de la crisis en la expansión económica de los países. En el marco de lo expuesto, la presente tesis tiene como objetivo determinar los factores que han reducido el impacto del Programa Nacional para la promoción de Oportunidades laborales IMPULSA PERU de Lima Metropolitana en el periodo 2011 – 2019

An Iterative Process for Training Design and Implementation Increased Health Workers\u27 Knowledge for Taking Nutrition Behavior Change to Scale

The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. Results: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers\u27 routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. Conclusions: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions

A tale of two community networks program centers: Operationalizing and assessing CBPR principles and evaluating partnership outcomes

BACKGROUND: Community Networks Program (CNP) centers are required to use a community-based participatory research (CBPR) approach within their specific priority communities. Not all communities are the same and unique contextual factors and collaborators’ priorities shape each CBPR partnership. There are also established CBPR and community engagement (CE) principles shown to lead to quality CBPR in any community. However, operationalizing and assessing CBPR principles and partnership outcomes to understand the conditions and processes in CBPR that lead to achieving program and project level goals is relatively new in the science of CBPR. OBJECTIVES: We sought to describe the development of surveys on adherence to and implementation of CBPR/CE principles at two CNP centers and examine commonalities and differences in program- versus project-level CBPR evaluation. METHODS: A case study about the development and application of CBPR/CE principles for the Missouri CNP, Program for the Elimination of Cancer Disparities, and Minnesota CNP, Padres Informados/Jovenes Preparados, surveys was conducted to compare project versus program operationalization of principles. Survey participant demographics were provided by CNP. Specific domains found in CBPR/CE principles were identified and organized under an existing framework to establish a common ground. Operational definitions and the number of survey items were provided for each domain by CNP. CONCLUSION: There are distinct differences in operational definitions of CBPR/CE principles at the program and project levels of evaluation. However, commonalities support further research to develop standards for CBPR evaluation across partnerships and at the program and project levels

iHIVARNA phase IIa, a randomized, placebo-controlled, double-blinded trial to evaluate the safety and immunogenicity of iHIVARNA-01 in chronically HIV-infected patients under stable combined antiretroviral therapy

Background: HIV therapeutic vaccination aims to improve the immune responses against HIV in order to control viral replication without the need for combined antiretroviral therapy (cART). iHIVARNA-01 is a novel vaccine combining mRNA delivery and T-cell immunogen (HTI) based on conserved targets of effective antiviral T-cell responses. In addition, it holds adequate stimuli required for activating antigen presenting cells (APC)s and co-activating specific T-cells (TriMix), including human CD40L, constitutively active TLR4 (caTLR4) and CD70. We propose that in-vivo targeting of dendritic cells (DCs) by direct administration of a HIV mRNA encoding these immune modulating proteins might be an attractive alternative to target DCs in vitro. Methods/design: This is a phase-IIa, randomized, double-blinded, placebo-controlled, multicenter study in chronically HIV-1 infected patients under stable cART. One of the three study arms is randomly allocated to subjects. Three vaccinations with either HIVACAT T-cell immunogen (HTI)-TriMix (iHIVARNA-01), TriMix or water for injection (WFI) (weeks 0, 2 and 4) are administered by intranodal injection in the inguinal region. Two weeks after the last immunization (week 6) cART is stopped for 12 weeks. The two primary endpoints are: (1) safety and tolerability of intranodal iHIVARNA-01 vaccination compared with TriMix or WFI and (2) induced immunogenicity, i.e., increase in the frequency of HIV-specific T-cell responses between baseline, week 6 and 12 weeks after treatment interruption in iHIVARNA-01-treated patients as compared to the control groups, immunized with TriMix-mRNA or WFI measured by an IFNγ ELISPOT assay. Secondary endpoints include the evaluation of time to viral rebound, plasma viral load (pVL) at w18, the proportion of patients with control of viral load, induction of T-cell responses to new HIV epitopes, polyfunctionality of HIV-specific T-cells, CD8+ T-cell in-vitro HIV suppressive capacity, the effect on viral reservoir (measured by proviral DNA and cell-associated RNA), assessment of viral immune escape by mutation and mRNA expression profiles of host immune genes. Discussion: This trial aims to direct target DC in situ with mRNA encoding HTI and TriMix for co-stimulation. Intranodal injection circumvents laborious DC isolation and handling in the laboratory. The trial extends on the safety results of a phase-I dose-escalating trial. This candidate vaccine could complement or even replace cART for chronic HIV infection and could be applicable to improve the care and cost of HIV infection

A collaboratively derived environmental research agenda for Galapagos

Galápagos is one of the most pristine archipelagos in the world and its conservation relies upon research and sensible management. In recent decades both the interest in, and the needs of, the islands have increased, yet the funds and capacity for necessary research have remained limited. It has become, therefore, increasingly important to identify areas of priority research to assist decision-making in Galápagos conservation. This study identified 50 questions considered priorities for future research and management. The exercise involved the collaboration of policy makers, practitioners and researchers from more than 30 different organisations. Initially, 360 people were consulted to generate 781 questions. An established process of preworkshop voting and three rounds to reduce and reword the questions, followed by a two-day workshop, was used to produce the final 50 questions. The most common issues raised by this list of questions were human population growth, climate change and the impact of invasive alien species. These results have already been used by a range of organisations and politicians and are expected to provide the basis for future research on the islands so that its sustainability may be enhanced. </jats:p

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years