Propuesta didáctica para el desarrollo del sistema de clases de electrocardiografía en la asignatura Propedéutica Clínica

In spite of the multiple strategies designed for the teaching of the contents about the Electrocardiographic Propedeutic program, the students do not get properly the knowledge and they do not apply them systematically. Besides, the subject program does not have methodological guidelines for the topic. This situation has brought about insufficiencies in the development of the skills in third year medical students, for the diagnostic of the main electrocardiographic alterations, we propose to elaborate a didactic proposal for the development of the system of electrocardiographic lessons in the Clinical Propedeutic Subject. This proposal is based on the application of the didactic principles to the teaching learning process, in the solution of the difficulties identified by the teachers during the development of this system of lessons and in the different problems to be solved in the Primary Health Care. It is proposed the system of objectives, knowledge and skills for the different electrocardiographic lessons. It was established like a general objective, the diagnostic of the main electrocardiographic alterations. The proposal emphasizes in the education at work like an ideal way to develop the skills and form the values in the students.  The proposal can be useful for the teachers in order to develop the system of electrocardiographic lessons and to obtain in the students the necessary skills for the diagnostic of the main electrocardiographic alterations.A pesar de las múltiples estrategias diseñadas para la impartición de los contenidos sobre electrocardiografía del programa de Propedéutica, los estudiantes no siempre se apropian de los conocimientos ni los aplican sistemáticamente. Además, el programa de la asignatura no cuenta con orientaciones metodológicas para el desarrollo tema. Esta situación ha propiciado insuficiencias en el desarrollo de habilidades en los estudiantes del tercer año de la carrera de Medicina, para el diagnóstico de las principales alteraciones electrocardiográficas Objetivo: elaborar una propuesta didáctica para el desarrollo del sistema de clases de electrocardiografía en la asignatura de Propedéutica Clínica.  Método: Dicha propuesta se basa en la aplicación de los principios didácticos al proceso docente educativo, en la solución de las   dificultades identificadas por los docentes durante el desarrollo de este sistema de clases y en los diferentes problemas a resolver en la Atención Primaria de Salud. Resultados: Se propone el sistema de objetivos, de conocimientos y habilidades para las diferentes de clases de electrocardiografía. Se establece como objetivo general a lograr, el diagnóstico de las principales alteraciones electrocardiográficas. La propuesta enfatiza en la educación en el trabajo como vía idónea para desarrollar las habilidades y formar los valores en los estudiantes.  Conclusiones: La propuesta puede ser de utilidad para que los docentes desarrollen el sistema de clase de electrocardiografía y logren en los estudiantes habilidades en el diagnóstico de las principales alteraciones electrocardiográficas

Increase in the Erosion Rate Due to the Impact of Climate Change on Sea Level Rise: Victoria Beach, a Case Study

This article provides a general methodology for calculating the retreat of the coastline and the volume of sand necessary to renourish a beach due to sea level rise (SLR) in the medium-long term. An example is presented, Victoria Beach, and a projection is made for the years 2030, 2040, 2050, and 2100. The results obtained take into account global sea level rise (GSLR), which is worldwide, and local sea level rise (LSLR), which considers climate variability and vertical land movements. Regarding GSLR, data were provided by the projections from IPCC (Intergovernmental Panel on Climate Change) scenarios and empirical models, such as Rahmstorf and Pfeffer. The LSLR data came from the tide gauge station located in Cadiz. Finally, the results obtained showed that global warming impacts erosive effects and the subsequent volume of sand required to renourish beaches. The total sea level rise (TSLR) projections indicated for Victoria Beach are relatively higher than the GSLR projections. Even in the best IPCC scenario (RCP 2.6), Victoria Beach presents a significant erosion of 52 m, requiring a volume of sand of 1.0 Mm3 to supply renourishment.14 página

Prognostic value of clinical, humoral and tomographic abnormalities in patients with severe traumatic brain injury

Se realizó un estudio observacional, analítico, de cohortes con el objetivo de identificar el valor pronóstico de las alteraciones clínicas, humorales y tomográficas en pacientes con traumatismo craneoencefálico grave (TCEG). Se seleccionaron 100 enfermos ingresados en la unidad de cuidados intensivos (UCI), del Hospital general universitario “Carlos Manuel de Céspedes” de Bayamo, Granma, Cuba, en el periodo comprendido desde 1º de enero del 2007 hasta el 31 de diciembre del 2011 y que tuvieron escala de coma de Glasgow (ECG) menor de 8 puntos. Las variables estudiadas fueron: la edad, el sexo, los hábitos tóxicos (alcoholismo y tabaquismo), la comorbilidad, los traumas asociados, la temperatura, el valor de los leucocitos, la presión arterial media (PAM), la ECG, la presencia de infección nosocomial, los valores de hemoglobina y los hallazgos tomográficos (desplazamiento  de la línea media y signos de herniación cerebral). La variable pronóstica fue la muerte en la UCI. El análisis estadístico multivariado, a través de la regresión logística, demostró que la hipoxemia (OR ajustado 23 IC 95% 2,5-208,6), la escala de coma del Glasgow (OR ajustado 4,9 IC 95% 1,7-11,8), el desplazamiento de la línea media (OR ajustado 2,4-68,9) y los signos de herniación cerebral (OR ajustado 6,7 IC 95% 1,6-70,1) tuvieron una relación significativa con la muerte, de ahí su valor pronóstico.It was performed an observational, analytical, cohort study with the aim of identifying the prognostic value of the clinical, humoral and tomographic abnormalities in patients with severe craniocerebral trauma (SCCT). There were selected 100 patients admitted to the Intensive Care Unit (ICU) at "Carlos Manuel de Céspedes" General University Hospital in Bayamo, Granma, Cuba, since January 1rst, 2007 to December 31rst, 2011 and they had Glasgow Coma Scale (GCS) under 8 points. The variables studied were: age, sex, toxic habits (alcohol and tobacco), comorbidity, associated trauma, the temperature, the value of leukocytes, mean blood pressure (MBP), the ECG, nosocomial infection, hemoglobin values and tomographic findings (displacement of the midline) and signs of brain herniation. The prognostic variable was the death in the ICU. The multivariate statistical analysis through logistic regression showed that hypoxemia (OR set 23; 95% CI 2, 5-208, 6), the Glasgow Coma Scale (OR adjusted 4.9; 95% CI 1, 7-11, 8), the displacement of the middle line (set OR 2, 4-68, 9 and signs of brain herniation (6.7 set OR 95% CI 6-70, 1, 1) had a significant relationship with death, favouring its prognostic value

Relación de la economía personal con el perfil de felicidad y satisfacción de vida y el perfil de preocupaciones personales en Andalucía (España) / Relationship of the personal economy with the profile of happiness and life satisfaction and the profile of personal concerns in Andalusia (Spain)

Desde hace unos años, se ha intensificado la necesidad de evaluar la sociedad colocando en el centro a las personas y considerando como objetivos la felicidad, la satisfacción de vida y sus preocupaciones personales. En este trabajo, se analiza la relación de la valoración de la situación económica personal con la satisfacción con la vida (en general y diversos aspectos como trabajo, formación, familia, etc.), con el índice de felicidad y con los grados de preocupación con diversos aspectos personales y del entorno cercano a partir de una encuesta realizada en Andalucía en 2018.  Para ello, además del análisis de las correlaciones bivariadas, se procede a aplicar modelos de regresión logística ordinal que permitan explicar las relaciones de los distintos indicadores personales de satisfacción, felicidad y preocupaciones con la valoración de la situación económica personal en la actualidad y las perspectivas futuras, ambas diseñadas como variables ordinales

Relationship of the personal economy with the profile of happiness and life satisfaction and the profile of personal concerns in Andalusia (Spain)

Desde hace unos años, se ha intensificado la necesidad de evaluar la sociedad colocando en el centro a las personas y considerando como objetivos la felicidad, la satisfacción de vida y sus preocupaciones personales. En este trabajo, se analiza la relación de la valoración de la situación económica personal con la satisfacción con la vida (en general y diversos aspectos como trabajo, formación, familia, etc.), con el índice de felicidad y con los grados de preocupación con diversos aspectos personales y del entorno cercano a partir de una encuesta realizada en Andalucía en 2018. Para ello, además del análisis de las correlaciones bivariadas, se procede a aplicar modelos de regresión logística ordinal que permitan explicar las relaciones de los distintos indicadores personales de satisfacción, felicidad y preocupaciones con la valoración de la situación económica personal en la actualidad y las perspectivas futuras, ambas diseñadas como variables ordinales.In recent years, the need to evaluate society has intensified, placing people at the center and considering happiness, life satisfaction and their personal concerns as objectives. In this work, the influence of life satisfaction (in general and various aspects such as work, training, family, etc.), the happiness index and the degrees of personal concern on the assessment of the personal economic situation are analyzed. The analysis has been developed using data from a survey conducted in Andalusia in 2018. In addition to the analysis of the bivariate correlations, ordinal logistic regression models are applied to explain the relationships of the different personal indicators of satisfaction, happiness and concerns with the assessment of the personal economic situation at present and future perspectives, both designed as ordinal variables

Safeguard plan management for heritage buildings: development of a spatial information system

This paper explains the methodology and criteria used in the development of a new tool for the management of a safeguard plan for historic buildings in Avila, which is a Spanish World Heritage City. As a result of a first approximation, there are many requirements to take into account: completeness, interactivity, ease of use, modularity, and low costs. Due to the characteristics of the information (spatially located, heterogenic, and provided in different formats) we consider it indispensable to create a spatial information system that is qualifiedfor organizing all available multimedia digital information (2-D images, panoramas, graphics, text documents, and music). While the mainobjective of this study is to provide a simple tool for the management of historic and artistic heritage in the form of a safeguard plan, the features of the tool created here open up new possibilities for other uses in the future

Phosphorus restriction does not prevent the increase in fibroblast growth factor 23 elicited by high fat diet

This study was designed to evaluate the influence of phosphorus (P) restriction on the dele- terious effects of high fat diets on mineral metabolism. Twenty-four rats were allotted to 3 groups (n = 8 each) that were fed different diets for 7 months. Rats in group 1 were fed nor- mal fat-normal P (0.6%) diet (NF-NP), rats in group 2 were fed high fat- normal P diet (HF- NP) and rats in group 3 were fed high fat-low P (0.2%) diet (HF-LP). Blood, urine and tissues were collected at the end of the experiments. When compared with the control group (NF- NP), rats fed HF diets showed increases in body weight, and in plasma concentrations of tri- glycerides and leptin, and decreased plasma calcitriol concentrations. In rats fed HF-NP plasma fibroblast growth factor 23 (FGF23) was higher (279.6 ± 39.4 pg/ml vs 160.6 ± 25.0 pg/ml, p = 0.018) and renal klotho (ratio klotho/GAPDH) was lower (0.75 ± 0.06 vs 1.06 ± 0.08, p < 0.01) than in rats fed NF-NP. Phosphorus restriction did not normalize plasma FGF23 or renal klotho; in fact, rats fed HF-LP, that only ingested an average of 22.9 mg/day of P, had higher FGF23 (214.7 ± 32.4 pg/ml) concentratio ns than rats fed NF-NP (160.6 ± 25. 0 pg/ml), that ingested and average of 74.4 mg/day of P over a 7 month period. In conclusion, our results demonstrate that severe P restriction over a prolonged period of time (7 months) does not normalize the increase in circulating FGF23 induced by HF diets. These data indi- cate that the deleterious effects of high fat diet on the FGF23/klotho axis are not eliminated by reduced P intake

Increase in the erosion rate due to the impact of climate change on sea level rise: Victoria Beach, a case study

This article provides a general methodology for calculating the retreat of the coastline and the volume of sand necessary to renourish a beach due to sea level rise (SLR) in the medium-long term. An example is presented, Victoria Beach, and a projection is made for the years 2030, 2040, 2050, and 2100. The results obtained take into account global sea level rise (GSLR), which is worldwide, and local sea level rise (LSLR), which considers climate variability and vertical land movements. Regarding GSLR, data were provided by the projections from IPCC (Intergovernmental Panel on Climate Change) scenarios and empirical models, such as Rahmstorf and Pfeffer. The LSLR data came from the tide gauge station located in Cadiz. Finally, the results obtained showed that global warming impacts erosive effects and the subsequent volume of sand required to renourish beaches. The total sea level rise (TSLR) projections indicated for Victoria Beach are relatively higher than the GSLR projections. Even in the best IPCC scenario (RCP 2.6), Victoria Beach presents a significant erosion of 52 m, requiring a volume of sand of 1.0 Mm3 to supply renourishmentPostprint (published version

Oral Acid Load Down-Regulates Fibroblast Growth Factor 23

Increased dietary acid load has a negative impact on health, particularly when renal function is compromised. Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that is elevated during renal failure. The relationship between metabolic acidosis and FGF23 remains unclear. To investigate the effect of dietary acid load on circulating levels of FGF23, rats with normal renal function and with a graded reduction in renal mass (1/2 Nx and 5/6 Nx) received oral NH4Cl for 1 month. Acid intake resulted in a consistent decrease of plasma FGF23 concentrations in all study groups when compared with their non-acidotic control: 239.3 ± 13.5 vs. 295.0 ± 15.8 pg/mL (intact), 346.4 ± 19.7 vs. 522.6 ± 29.3 pg/mL (1/2 Nx) and 988.0 ± 125.5 vs. 2549.4 ± 469.7 pg/mL (5/6 Nx). Acidosis also decreased plasma PTH in all groups, 96.5 ± 22.3 vs. 107.3 ± 19.1 pg/mL, 113.1 ± 17.3 vs. 185.8 ± 22.2 pg/mL and 504.9 ± 75.7 vs. 1255.4 ± 181.1 pg/mL. FGF23 showed a strong positive correlation with PTH (r = 0.877, p < 0.0001) and further studies demonstrated that acidosis did not influence plasma FGF23 concentrations in parathyroidectomized rats, 190.0 ± 31.6 vs. 215 ± 25.6 pg/mL. In conclusion, plasma concentrations of FGF23 are consistently decreased in rats with metabolic acidosis secondary to increased acid intake, both in animals with intact renal function and with decreased renal function. The in vivo effect of metabolic acidosis on FGF23 appears to be related to the simultaneous decrease in PTH