Validación clínica de la maniobra de compresión de Gaenslen estandarizada en pacientes con artropatía inflamatoria activa.

La estandarización y validación de maniobras clínicas en medicina no es una práctica habitual. La reumatología es una especialidad en donde la clínica es de gran relevancia para la clasificación de las enfermedades, en especial en la detección de la artritis y su posterior clasificación. La maniobra de compresión de Gaenslen (MCG), consiste en la presión de las articulaciones metacarpofalángicas (MCF) para despertar dolor en el paciente con presencia de sinovitis activa. La fuerza, forma y tiempo de la presión se describen como un “apretón de manos”. No se especifica tiempo o alguna forma en particular. A pesar de que la MCG ha sido utilizada en otros ámbitos clínicos, no ha sido estandarizada. Recht la utilizó como una prueba de tamizaje para problemas relacionados con la mano. Rigby, Eberhardt, Visser, El Mediany, Emery y van der Van Mill la utilizaron como tamizaje y herramienta de clasificación. Por su parte de Jong y Weisenger demostraron que la MCG es una maniobra clínica útil en un ámbito clínico ocupado. Se presenta un abordaje sistemático de validación de una maniobra clínica ampliamente utilizada. Posterior a la elaboración de un dispositivo biomecánico de sensado, se determinó que el abordaje superior con la mano derecha fue la manera más común de realizarla y la mediana de la fuerza fue de 299 gr en 1 segundo. El rango de fuerza ejercida por los participantes fue de los 150 a los 741 gramos, de mostrando la falta de consistencia de la maniobra utilizada en los diferentes ámbitos clínicos. El ensayo de caracterización realizado muestra que los resultados del sensor del actuador electromecánico se encuentran a una relación de 1.325 respecto a las muestras obtenidas con el sensor de la prótesis. Basado en lo anterior la mediana de la fuerza que se registró en el sensor de 299 gr, pasa a 396.17 (RIQ 192.12), con un rango de 198.75 a 993.75.Por lo que se construyó un sistema compresor electrónico y se probó en pacientes con Artritis Reumatoide (AR) y sanos. La maniobra de compresión de Gaenslen con al menos 1.5 kilogramos de fuerza detecta al 100% de los pacientes con artropatía inflamatoria activa en las articulaciones metacarpofalángicas, en pacientes con AR. Además existe un gradiente de aproximadamente 1.5 kg entre pacientes enfermos con AR y pacientes sanos, que permite su discriminación

Diseño de herramienta digital (software educativo "Edusoft comunal") para fortalecer las dinámicas de enseñanza en la formación legal de la Junta de Acción Comunal "El Terminal"

La educación de hoy en día está caracterizada por la implementación de diversos recursos tecnológicos que permiten una mayor accesibilidad a la información, nuevos escenarios y modalidades educativos; en directa proporción, las exigencias para el docente aumentan, ya que las estrategias didácticas deben responder a las nuevas motivaciones de los estudiantes y así facilitar el proceso de aprendizaje. En consecuencia se habla de tecnología educativa1 la cual posibilita ampliar los encuentros educomunicativos2 enriqueciendo así las interacciones humanas, direccionando los procesos forma y brindando herramientas esenciales para la adquisición de conocimientos. En un escenario particular como las juntas de acción comunal no es la excepción, ya que es indispensable establecer metodologías didácticas para las educaciones legales que se le ha de impartir a estas organizaciones sociales. Este trabajo se fundamenta en el diseño de una herramienta digital para fortalecer las dinámicas de enseñanza de las capacitaciones legales de la junta de acción comunal "El Terminal". Para empezar se llevo a cabo un diagnostico situacional, el cual determinó las principales características y necesidades de la población objeto, por otra parte se evidencio la insuficiencia de herramientas y estrategias didácticas para dicha formación y la necesidad de conceptos claros acerca de organización y apropiación de los fundamentos legislativos propios de las juntas de acción comunal.Education today it is characterized by the implementation of several technologic advices to allow a bigger accessibility to the information, new scenarios and educative modalities; in direct proportion, the requirements to the teaching grows, now that the didactical strategies must to respond to the new motivations of the students and that way be able to make easier the learning process. By consequence it´s talking about educative technology which is possible to enlarge the educomunicative encounters getting richer that way human interaction, directing the shape process and giving essential tools to the acquirement of knowledge. In a particular stage like community action boards it´s not the exception, now that it is indispensable to establish didactic methodologies to the legal education who given to providing to this social organizations . This work is based on the design of a digital tool to strength the dynamics of teaching of the legal capacitating of the community action boards “El Terminal”. To start it took place a situational diagnosis, which determined the principal characteristics and needs of the object people. By other hand evidenced the lack of tools and didactical strategies in order to that formation and the needs of clear concepts about the organization and approaching of the own legislative foundations to the community action boards

Desarrollo de una aplicación móvil para sistemas operativos android utilizando técnicas de gamificación para el aprendizaje de inecuaciones y números complejos dirigido a los estudiantes de secundaria

En este proyecto se ha desarrollado un juego para mejorar el aprendizaje de los alumnos de secundaria sobre los números complejos y las desigualdades, a través de unos procesos de gamificación que se centran en esto, ya que al ser un juego educativo debe ser atractivo, intuitivo e interesante, para poder captar la atención de los jugadores. El desarrollo de la aplicación se basó en una metodología ágil conocida como SUM, que desarrolla el software a través de las fases: concepto, planificación, desarrollo, pruebas y cierre, logrando una aplicación amigable para los estudiantes. El objetivo de este proyecto fue motivar a los estudiantes a aprender los temas de desigualdades y números complejos, de paso, mejorar su atención mientras juegan el juego, ya que ganan recompensas dadas por completar exitosamente los niveles del mismo. Esto hace que el aprendizaje sea más divertido y se consiga una mejor comprensión de los alumnos en estos temas. Los alumnos, tras la evaluación del juego, respondieron a la pregunta 2 que el 93,3% lo encontraron divertido, y a la pregunta 4 respondieron el 53,3% que les ayudó mucho a aprender estos temas.This project developed a game to improve the learning of high school students about the complex numbers and inequalities, through some gamification processes that focuses on this, since it is an educational game should be attractive, intuitive and interesting, in order to capture the attention of players. The development of the application was based on an agile methodology known as SUM, that developing the software through the phases: concept, planning, development, testing and closure, achieving a user-friendly application for students. The goal of this project was to motivate students to learn the topics of inequalities and complex numbers, by the mean, improve their atention while play the game, because they win rewards given for successfully completing the levels of it. This does learning more fun and get a better understanding of the students in these topics. The students, after the evaluation of the game, answered the question 2 that 93.3% were found fun, and with the question 4 answered 53.3% that was helpful a lot to learn these topics

Logística y competitividad: El entorno empresarial norteamericano como referencia de estudio

Misión académica internacionalSíntesis de la experiencia vivida en la Misión Académica Internacional realizada en los Estados Unidos del 23 al 30 de noviembre de 2019, oportunidad de conocer ese país desde una mirada tanto académica como también cultural y empresarial, pero con mayor enfoque en el aspecto empresarial mediante la observación de los aspectos logísticos que desarrollan las empresas, esenciales para agregar valor y ser competitivas en el mercado actual.Introducción Planteamiento del problema - pregunta orientadora Objetivo Revisión de la Literatura Informes Conclusiones Recomendaciones ReferenciasEspecializaciónEspecialista en Análisis y Administración Financier

Prokaryotic picoplankton distribution within the oxygen minimum zone of the central Mexican Pacific across environmental gradients

O picophytoplankton marinho tornou-se uma questão importante para compreender a ecologia global das formas fototróficas, devido à sua ampla distribuição e contribuição para a biomassa e a produtividade. Estudamos os pigmentos de abundância, distribuição e assinatura do picofitoplâncton procarionte Prochlorococcus e Synechococcus durante um cruzeiro oceanográfico no Pacífico central mexicano, uma zona mínima de oxigênio relativamente poco conhecida (OMZ) e o efeito de três gradientes ambientais. As abundâncias de Prochlorococcus e Synechococcus foram comparáveis às encontradas em outras áreas tropicais (0.17 to 30.37 X 104 células mL1, e 0.9 to 30.97 X 104 células mL-1, respectivamente). As abundâncias de Prochlorococcus atingiram o maior número em águas mais profundas, coincidindo frequentemente com a segunda intensidade de fluorescência in situ profunda (e clorofila a), em estações oceânicas, abaixo da nitratoclina, enquanto as abundâncias de Synechococcus foram maiores nas águas de subsuperficie e sua concentração máxima geralmente coincidiu com os máximos de subsuperficie de fluorescência in situ, com abundâncias ligeiramente mais altas nas estações costeiras. As análises estatísticas suportam significativamente esses resultados. A distribuição da divinil-clorofila a foi errática ao longo da coluna de água e coincidiu ocasionalmente com os máximos de fluorescência in situ profundos, enquanto que a distribuição da zeaxantina seguiu geralmente a da clorofila a e as abundâncias de Synechococcus e atingiu o pico. Estes resultados são semelhantes aos encontrados anteriormente na área de estudo e em zonas mais temperadas, e também à tendência geral na OMZ, mas confirmam que a clorofila profunda a maxima é atribuída a altas densidades de Prochlorococcus. Além disso, encontramos a abundância e distribuição de Prochlorococcus e Synechococcus fortemente conduzida pelos gradientes ambientais observados.Marine picophytoplankton has become an important issue to understand the global ecology of phototrophic forms, due to its wide distribution and contribution to biomass and productivity. We studied the abundance, distribution and signature pigments of the prokaryote picophytoplankters Prochlorococcus and Synechococcus during an oceanographic cruise (26 April to 7 May, 2011) in the central Mexican Pacific, a relatively poorlyknown oxygen minimum zone (OMZ), and the effect of three environmental gradients. Prochlorococcus and Synechococcus abundances were comparable with those found in other tropical areas (0.17 to 30.37 X 104 cells mL-1, and 0.9 to 30.97 X 104 cells mL-1, respectively). Prochlorococcus abundances reached highest numbers in deeper waters, often coinciding with the second deep in situ fluorescence (and chlorophyll α) maxima, at oceanic stations, below the nitratecline, whereas Synechococcus abundances were higher at subsurface waters and its concentration maxima usually coincided with the subsurface in situ fluorescence maxima, with slightly higher abundances in coastal stations. Statistical analyses support significantly these results. Distribution of divinyl-chlorophyll α was erratic along the water column and occasionally coincided with the deep in situ fluorescence maxima, whereas the distribution of zeaxanthin usually followed that of chlorophyll α and the abundances of Synechococcus, and peaked together. These results are similar to those previously found in the study area and in more temperate zones, and also to the general trend in OMZ, but confirm that the second deep chlorophyll α maxima are attributed to high Prochlorococcus densities. We additionally found the abundance and distribution of Prochlorococcus and Synechococcus strongly driven by the environmental gradients observed

Joint Distribution of Distance and Angles in Finite Wireless Networks

Directional beamforming will play a paramount role in 5G and beyond networks in order to combat the higher path losses incurred at millimeter wave bands. Appropriate modeling and analysis of the angles and distances between transmitters and receivers in these networks are thus essential to understand performance and limiting factors. Most existing literature considers either infinite and uniform networks, where nodes are drawn according to a Poisson point process, or finite networks with the reference receiver placed at the origin of a disk. Under either of these assumptions, the distance and azimuth angle between transmitter and receiver are independent, and the angle follows a uniform distribution between $0$ and $2\pi$. Here, we consider a more realistic case of finite networks where the reference node is placed at any arbitrary location. We obtain the joint distribution between the distance and azimuth angle and demonstrate that these random variables do exhibit certain correlation, which depends on the shape of the region and the location of the reference node. To conduct the analysis, we present a general mathematical framework which is specialized to exemplify the case of a rectangular region. We then also derive the statistics for the 3D case where, considering antenna heights, the joint distribution of distance, azimuth and zenith angles is obtained. Finally, we describe some immediate applications of the present work, including the analysis of directional beamforming, the design of analog codebooks and wireless routing algorithms.Comment: 14 pages, 14 figure

Estrategia pedagógica basada en simuladores para potenciar las competencias de solución de problemas de física

This document presents the results to apply a pedagogical strategy based on software simulator, this project has as objective to improve the solution competences in Physic problems. The research has a qualitative approach, it is descriptive type, the data collection was through a diagnostic test at the beginning and other one at the end. The sample was seventy students from eleven grade, they were from a Colombian institution. When was applied the pedagogical strategy with the PHET simulator, the average result was 60,97 over 100, the difference was 43,02 that was obtained at the beginning. The majority of students (45), had at the beginning a basic achievement, while in the final, test the highest frequency was obtained with a high achievement, with 45 students. The difference in data results is significant, this project showed that pedagogical strategy with digital technologies generated positive results. As conclusion the simulation about Physical phenomenons help students to be involve on a real scientific activity, and this event impacts as a positive way in their formative process.En este documento se presentan los resultados de aplicar una estrategia pedagógica basada en software de simulación, orientada a mejorar las competencias de solución de problemas de física. La investigación tiene un enfoque cuantitativo, de tipo descriptivo, y la información se recolectó a través de una prueba diagnóstica y otra final. La muestra fue de 70 estudiantes de grado undécimo, de una institución educativa colombiana. Luego de aplicar la estrategia pedagógica con el simulador PHET, el puntaje promedio fue de 60,97 sobre 100, a diferencia del 43,02 obtenido inicialmente. La mayoría de estudiantes (45), se encontraba inicialmente en desempeño básico, mientras que en la prueba final, la mayor frecuencia se da en el desempeño alto, con 45 estudiantes. La diferencia en el desempeño es significativa, indicando que la estrategia pedagógica con tecnologías digitales generó resultados favorables. Se concluye que la simulación de fenómenos físicos permite a los estudiantes situarse en una actividad científica real, impactando positivamente en su proceso formativo

Body mass index and treatment survival in patients with RA starting treatment with TNFalpha-inhibitors: long-term follow-up in the real-life METEOR registry

OBJECTIVES: To study whether there is an association between body mass index (BMI) category and survival of various tumour necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA) patients in a real-life longitudinal international registry. METHODS: Data from 5230 patients with RA starting treatment with any TNFi were selected from the METEOR registry. Patients were divided into six BMI categories: 3.7% underweight, BMI \u3c 18.5 kg/m(2); 46% normal weight, BMI 18.5-25 kg/m(2); 32% pre-obesity, BMI 25-30 kg/m(2); 13% obesity class I, BMI 30-35 kg/m(2); 3.4% obesity class II, BMI 35-40 kg/m(2); and 1.6% obesity class III, BMI \u3e 40 kg/m(2). Time on treatment in the different BMI categories was compared for all TNFi combined and for the infliximab, adalimumab and etanercept separately, using Kaplan-Meier curves and Cox regression analyses. Cox regression analyses were adjusted for potential confounders, with follow-up censored at 5000 days. RESULTS: Patients in obesity class II (HR 1.28, 95% CI 1.06 to 1.54) and III (HR 1.67, 95% CI 1.29 to 2.18) and underweight patients (HR 1.30, 95% CI 1.07 to 1.58) showed statistically significantly shorter TNFi survival than normal weight patients. The effect in underweight patients was strongest for infliximab (HR 1.82, 95% CI 1.20 to 2.76), the effect in overweight patients was strongest for infliximab (category II (HR 1.49, 95% CI 0.98 to 2.26); category III (HR 1.46, 95% CI 0.79 to 2.71)) and etanercept (category II (HR 1.27 95% CI 0.98 to 1.65); category III (HR 1.79, 95% CI 1.25 to 2.55)). No significant effect modification from reported pain was found. CONCLUSION: Both underweight and overweight patients discontinued TNFi treatment earlier than normal weight patients, without evidence of reported pain as the main determinant. It remains uncertain what determines TNFi survival in individual patients

Stimuli Characteristics and Psychophysical Requirements for Visual Training in Amblyopia: A Narrative Review

Active vision therapy using perceptual learning and/or dichoptic or binocular environments has shown its potential effectiveness in amblyopia, but some doubts remain about the type of stimuli and the mode and sequence of presentation that should be used. A search was performed in PubMed, obtaining 143 articles with information related to the stimuli used in amblyopia rehabilitation, as well as to the neural mechanisms implied in such therapeutic process. Visual deficits in amblyopia and their neural mechanisms associated are revised, including visual acuity loss, contrast sensitivity reduction and stereopsis impairment. Likewise, the most appropriate stimuli according to the literature that should be used for an efficient rehabilitation of the amblyopic eye are described in detail, including optotypes, Gabor’s patches, random-dot stimuli and Vernier’s stimuli. Finally, the properties of these stimuli that can be modified during the visual training are discussed, as well as the psychophysical method of their presentation and the type of environment used (perceptual learning, dichoptic stimulation or virtual reality). Vision therapy using all these revised concepts can be an effective option for treating amblyopia or accelerating the treatment period when combining with patching. It is essential to adapt the stimuli to the patient’s individual features in both monocular and binocular training.The authors C.J.H.-R., D.P.P., A.M.-M., D.d.F., L.L.-V., M.B.C.-M. have been funded by CDTI (Centro para el Desarrollo Tecnológico Industrial, Ministry of Economy and Competitiveness of Spain) and FEDER (Fondos Europeos de Desarrollo Regional) funds by means of the program PID (“Proyectos de Investigación y Desarrollo”) in the context of the Project NEIVATECH (“Neuroplasticity through virtual reality for amblyopia”, application number 111705). The author León Morales-Quezada is supported by funding from the Spaulding Research Catalyst award. The author David P Piñero has been also supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471