Desempeño del personal del área de farmacia de la Clínica Médica san Juan de Dios

En esta investigación se detalla el diseño del parámetro de evaluación que utilizan los jefes para medir el desempeño de cada trabajador/a, así mismo la opinión de los/as asegurados en cuanto a la atención que reciben de esta importante área, el análisis de las fortalezas, oportunidades debilidades y amenazas (FODA), permitió proponer alternativas que pueden ser implementadas para una mayor eficiencia. Esta es una investigación cualitativa. Se aplicaron entrevistas a directores y trabajadores, y se aplicó una encuesta a los usuarios. Entre los resultados se muestra que los/as trabajadores/as presentan un déficit en su desempeño laboral, se planifica incorrectamente, los objetivos institucionales no están claros, existe un clima desagradable de trabajo: negatividad, egoísmo, desmotivación, y desconfianza. Esta situación repercute en la atención a los usuarios. Se recomienda la creación de estándares de servicio para una atención a sus clientes, capacitación a empleados, y crear un sistema formal de quejas y sugerencias para conocer la opinión del usuario. Palabras Claves: Evaluación, Desempeño, Trabajadores, Usuario

Estrategia para el aprendizajes de la lecto-escritura con el uso de las tic en el grado segundo en la institución educativa Jhon f-Kennedy sede n° 2

Con la elaboración de este proyecto se busca que sirva como material didáctico para fortalecer el desarrollo de las competencias lectora en los estudiantes de segundo grado de la de la Institución Educativa John F. Kennedy del municipio de Luruaco Sede No. 2, Atlántico mediante el uso de las herramientas que nos facilita la Web 2.0. Para el desarrollo del proyecto se soportó en estrategias pedagógicas con el fin de apoyar los procesos de enseñanza aprendizaje, de tal forma que se constituya en un instrumento educacional del estudiante. Finalmente, las herramientas que nos facilitan las Tic, se pueden considerar como el conjunto de recursos informáticos diseñados con la intención de ser utilizados en el contexto del proceso de enseñanza – aprendizaje

Worldwide prevalence of small ruminant lentiviruses in sheep: A systematic review and meta-analysis

Small Ruminant Lentiviruses (SRLV) are highly prevalent retroviruses with significant genetic diversity and antigenic heterogeneity that cause a progressive wasting disease of sheep called Maedi-visna. This work provides a systematic review and meta-analysis of the last 40 years (1981–2020) of scientific publications on SRLV individual and flock prevalence. Fifty-eight publications and 314 studies were included. Most articles used a single diagnostic test to estimate prevalence (77.6%), whereas articles using three or more tests were scarce (6.9%). Serological tests are more frequently used than direct methods and ELISA has progressively replaced AGID over the last decades. SRLV infection in sheep is widespread across the world, with Europe showing the highest individual prevalence (40.9%) and being the geographical area in which most studies have been performed. Africa, Asia, and North America show values between 16.7% to 21.8% at the individual level. South and Central America show the lowest individual SRLV prevalence (1.7%). There was a strong positive correlation between individual and flock prevalence (¿ = 0.728; p = 0.001). Despite the global importance of small ruminants, the coverage of knowledge on SRLV prevalence is patchy and inconsistent. There is a lack of a gold standard method and a defined sampling strategy among countries and continents

Apego, duelo y continuidad de lazos en el afrontamiento de la pérdida

Esta revisión sistemática ha considerado la literatura publicada en los últimos 30 años sobre las relaciones existentes entre el apego, el proceso de duelo y el afrontamiento de la pérdida. El apego es el vínculo que se establece en el momento del nacimiento, principalmente con los cuidadores pri-marios. El proceso de duelo es la reacción que se produce ante la pérdida de una relación cercana. La continuidad de lazos es una herramienta que utilizan los dolientes para mantenerse unidos al fallecido. El trabajo se fundamenta principalmente en estudios empíricos con muestras de sujetos donde, en su mayoría, se tomaban medidas de apego, de duelo y de continuidad de lazos. Los resultados de dichos estudios arrojan relaciones entre las tres variables, sin embargo, no se pueden establecer relaciones causales, por lo que se necesita más investigación que pueda esclarecer la relación existente entre dichas variables. En términos generales, el apego seguro se relaciona con un proceso de duelo más adaptativo y el apego ansioso y evitativo dificultan el proceso de duelo. Por otro lado, la continuidad de lazos con el fallecido resultará adaptativa o desadaptativa en función de si se ajustan o no al sistema de significado dominante de la personaThis systematic review has considered the literature published over the last 30 years on the rela-tionships between attachment, the grieving process and coping with loss. Attachment is the bond that is established at birth, primarily with primary caregivers. The grieving process is the reaction to the loss of a close relationship. Continuity of attachment is a tool that mourners use to stay attached to the deceased. The work is mainly based on empirical studies with samples of subjects where, for the most part, measures of attachment, grief and continuity of ties were taken. The results of these studies show relationships between the three variables however, causal relationships cannot be established and more research is needed to clarify the relationship between these variables. In general terms, se-cure attachment is related to a more adaptive grieving process and anxious and avoidant attachment hinders the grieving process. On the other hand, continued attachment to the deceased will be adaptive or maladaptive depending on whether or not it conforms to the person’s dominant meaning syste

Mid and late Holocene forest fires and deforestation in the subalpine belt of the Iberian range, northern Spain

26 Pags.- 6 Figs.- 2 Tabls. The definitive version is available at: http://link.springer.com/journal/11629The conversion of subalpine forests into grasslands for pastoral use is a well-known phenomenon, although for most mountain areas the timing of deforestation has not been determined. The presence of charcoal fragments in soil profiles affected by shallow landsliding enabled us to date the occurrence of fires and the periods of conversion of subalpine forest into grasslands in the Urbión Mountains, Iberian Range, Spain. We found that the treeline in the highest parts of the northwestern massifs of the Iberian Range (the Urbión, Demanda, Neila, and Cebollera massifs) is currently between 1500 and 1600 m a.s.l., probably because of pastoral use of the subalpine belt, whereas in the past it would have reached almost the highest divides (at approximately 2100–2200 m a.s.l.). The radiocarbon dates obtained indicate that the transformation of the subalpine belt occurred during the Late Neolithic, Chalcolithic, Bronze Age, Iron Age, and Middle Ages. Forest clearing was probably moderate during fires prior to the Middle Ages, as the small size of the sheep herds and the local character of the markets only required small clearings, and therefore more limited fires. Thus, it is likely that the forest recovered burnt areas in a few decades; this suggests the management of the forest and grasslands following a slash-and-burn system. During the Middle and Modern Ages deforestation and grassland expansion affected most of the subalpine belt and coincided with the increasing prevalence of transhumance, as occurred in other mountains in the Iberian Peninsula (particularly the Pyrenees). Although the occurrence of shallow landslides following deforestation between the Neolithic and the Roman Period cannot be ruled out, the most extensive shallow landsliding processes would have occurred from the Middle Ages until recent times.Support for this research was provided by the projects INDICA (CGL2011- 27753-C02-01 and -02) and DINAMO2 (CGL2012-33063), funded by the Spanish Ministry of Economy and Competitiveness.Peer reviewe

Specific patterns of brain alterations underlie distinct clinical profiles in Huntington's disease

Huntington's disease (HD) is a genetic neurodegenerative disease which involves a triad of motor, cognitive and psychiatric disturbances. However, there is great variability in the prominence of each type of symptom across individuals. The neurobiological basis of such variability remains poorly understood but would be crucial for better tailored treatments. Multivariate multimodal neuroimaging approaches have been successful in disentangling these profiles in other disorders. Thus we applied for the first time such approach to HD. We studied the relationship between HD symptom domains and multimodal measures sensitive to grey and white matter structural alterations. Forty-three HD gene carriers (23 manifest and 20 premanifest individuals) were scanned and underwent behavioural assessments evaluating motor, cognitive and psychiatric domains. We conducted a multimodal analysis integrating different structural neuroimaging modalities measuring grey matter volume, cortical thickness and white matter diffusion indices - fractional anisotropy and radial diffusivity. All neuroimaging measures were entered into a linked independent component analysis in order to obtain multimodal components reflecting common inter-subject variation across imaging modalities. The relationship between multimodal neuroimaging independent components and behavioural measures was analysed using multiple linear regression. We found that cognitive and motor symptoms shared a common neurobiological basis, whereas the psychiatric domain presented a differentiated neural signature. Behavioural measures of different symptom domains correlated with different neuroimaging components, both the brain regions involved and the neuroimaging modalities most prominently associated with each type of symptom showing differences. More severe cognitive and motor signs together were associated with a multimodal component consisting in a pattern of reduced grey matter, cortical thickness and white matter integrity in cognitive and motor related networks. In contrast, depressive symptoms were associated with a component mainly characterised by reduced cortical thickness pattern in limbic and paralimbic regions. In conclusion, using a multivariate multimodal approach we were able to disentangle the neurobiological substrates of two distinct symptom profiles in HD: one characterised by cognitive and motor features dissociated from a psychiatric profile. These results open a new view on a disease classically considered as a uniform entity and initiates a new avenue for further research considering these qualitative individual differences

Specific patterns of brain alterations underlie distinct clinical profiles in Huntington's disease

Huntington's disease (HD) is a genetic neurodegenerative disease which involves a triad of motor, cognitive and psychiatric disturbances. However, there is great variability in the prominence of each type of symptom across individuals. The neurobiological basis of such variability remains poorly understood but would be crucial for better tailored treatments. Multivariate multimodal neuroimaging approaches have been successful in disentangling these profiles in other disorders. Thus we applied for the first time such approach to HD. We studied the relationship between HD symptom domains and multimodal measures sensitive to grey and white matter structural alterations. Forty-three HD gene carriers (23 manifest and 20 premanifest individuals) were scanned and underwent behavioural assessments evaluating motor, cognitive and psychiatric domains. We conducted a multimodal analysis integrating different structural neuroimaging modalities measuring grey matter volume, cortical thickness and white matter diffusion indices - fractional anisotropy and radial diffusivity. All neuroimaging measures were entered into a linked independent component analysis in order to obtain multimodal components reflecting common inter-subject variation across imaging modalities. The relationship between multimodal neuroimaging independent components and behavioural measures was analysed using multiple linear regression. We found that cognitive and motor symptoms shared a common neurobiological basis, whereas the psychiatric domain presented a differentiated neural signature. Behavioural measures of different symptom domains correlated with different neuroimaging components, both the brain regions involved and the neuroimaging modalities most prominently associated with each type of symptom showing differences. More severe cognitive and motor signs together were associated with a multimodal component consisting in a pattern of reduced grey matter, cortical thickness and white matter integrity in cognitive and motor related networks. In contrast, depressive symptoms were associated with a component mainly characterised by reduced cortical thickness pattern in limbic and paralimbic regions. In conclusion, using a multivariate multimodal approach we were able to disentangle the neurobiological substrates of two distinct symptom profiles in HD: one characterised by cognitive and motor features dissociated from a psychiatric profile. These results open a new view on a disease classically considered as a uniform entity and initiates a new avenue for further research considering these qualitative individual differences

White matter cortico-striatal tracts predict apathy subtypes in Huntington's disease

BACKGROUND: Apathy is the neuropsychiatric syndrome that correlates most highly with Huntington's disease progression, and, like early patterns of neurodegeneration, is associated with lesions to cortico-striatal connections. However, due to its multidimensional nature and elusive etiology, treatment options are limited. OBJECTIVES: To disentangle underlying white matter microstructural correlates across the apathy spectrum in Huntington's disease. METHODS: Forty-six Huntington's disease individuals (premanifest (N = 22) and manifest (N = 24)) and 35 healthy controls were scanned at 3-tesla and underwent apathy evaluation using the short-Problem Behavior Assessment and short-Lille Apathy Rating Scale, with the latter being characterized into three apathy domains, namely emotional, cognitive, and auto-activation deficit. Diffusion tensor imaging was used to study whether individual differences in specific cortico-striatal tracts predicted global apathy and its subdomains. RESULTS: We elucidate that apathy profiles may develop along differential timelines, with the auto-activation deficit domain manifesting prior to motor onset. Furthermore, diffusion tensor imaging revealed that inter-individual variability in the disruption of discrete cortico-striatal tracts might explain the heterogeneous severity of apathy profiles. Specifically, higher levels of auto-activation deficit symptoms significantly correlated with increased mean diffusivity in the right uncinate fasciculus. Conversely, those with severe cognitive apathy demonstrated increased mean diffusivity in the right frontostriatal tract and left dorsolateral prefrontal cortex to caudate nucleus tract. CONCLUSIONS: The current study provides evidence that white matter correlates associated with emotional, cognitive, and auto-activation subtypes may elucidate the heterogeneous nature of apathy in Huntington's disease, as such opening a door for individualized pharmacological management of apathy as a multidimensional syndrome in other neurodegenerative disorders

Multidisciplinary Prehabilitation and Postoperative Rehabilitation for Avoiding Complications in Patients Undergoing Resection of Colon Cancer: Rationale, Design, and Methodology of the ONCOFIT Study

ONCOFIT is a randomized clinical trial with a two-arm parallel design aimed at determining the influence of a multidisciplinary Prehabilitation and Postoperative Program (PPP) on post-surgery complications in patients undergoing resection of colon cancer. This intervention will include supervised physical exercise, dietary behavior change, and psychological support comparing its influence to the standard care. Primary and secondary endpoints will be assessed at baseline, at preoperative conditions, at the end of the PPP intervention (after 12 weeks) and 1-year post-surgery, and will include: post-surgery complications (primary endpoint); prolonged hospital length of stay; readmissions and emergency department call within 1-year after surgery; functional capacity; patient reported outcome measures targeted; anthropometry and body composition; clinical/tumor parameters; physical activity levels and sedentariness; dietary habits; other unhealthy habits; sleep quality; and fecal microbiota diversity and composition. Considering the feasibility of the present intervention in a real-life scenario, ONCOFIT will contribute to the standardization of a cost-effective strategy for preventing and improving health-related consequences in patients undergoing resection of colon cancer with an important clinical and economic impact, not only in the scientific community, but also in clinical practice.This study was funded by the University of Granada, Plan Propio de Investigación 2016-Excellence actions: Unit of Excellence on Exercise and Health (UCEES). P.C. was supported by the Margarita Salas postdoctoral grant, convened by de University of the Basque Country (UPV/EHU), funded by the Ministry of Universities of Spain and the European Union-Next Generation EU

An analysis and proposal for the work of social workers in psychopedagogical services in schools in the Valencian Autonomous Community

Los Trabajadores Sociales de Educación de la provincia de Alicante nos planteamos la necesidad de actualizar las funciones que la normativa de la, denominada en su día, Conselleria de Educación y Ciencia nos marca, dentro de los Servicios Psicopedagógicos Escolares (SPE) y Gabinetes Psicopedagógicos Municipales (GPM) de la Comunidad Autónoma Valenciana. Los motivos vienen determinados por considerar una normativa obsoleta (Orden 10 de marzo de 1995), una realidad social y educativa cambiante que determinan nuevas demandas hacia el trabajador social de educación, y la configuración de un perfil profesional que nos diferencie de otros profesionales que también intervienen en el ámbito socio-educativo. Este documento es el resultado del trabajo realizado inicialmente por un grupo de trabajadores sociales de educación (a partir de ahora TRASO) de la Provincia de Alicante y consensuado, finalmente, en el I Encuentro de Trabajadores Sociales de Educación de la Comunidad Autónoma Valenciana en diciembre de 2016.As social workers in education in the province of Alicante we consider it necessary to update our roles as described in the regulations of the Regional Council of Education and Science, within the School Psychopedagogical Services and the Municipal Educational Psychopedagogical Services of the Autonomous Community of Valencia. We propose these changes because the regulations are outdated (1995), and because of the need to reflect the changing educational and social reality. In addition, the work of social workers in the educational field has changed, and social workers need their own professional profile that is differentiated from that of other professionals who work in the field of education. This document is the result of the work of a group of social workers in the educational field in the province of Alicante. It was approved by the first meeting of social workers in the educational field in the Autonomous Community of Valencia in December of 2016