Indicadores de competencias y su efecto en la gestión de los programas ENT- CPSM. DSRS Jaén, 2018

El trabajo de investigación tuvo por objetivo general: “Determinar el efecto de los indicadores de las competencias en la gestión de los programas de Enfermedades No Transmisibles – Control y Prevención de Salud Mental. Dirección Sub Regional de Salud Jaén, 2018”. Se realizó una investigación de tipo correlacional con diseño no experimental. Para la recolección de datos se usó la técnica de la encuesta y la técnica del reporte técnico, operativizadas con un cuestionario sobre los indicadores de competencias aplicado a los 30 trabajadores incluidos en la muestra, además, una ficha de reporte técnico para evaluar la gestión de los programas presupuestales investigados. Los datos recogidos fueron analizados mediante la estadística descriptiva para identificar el nivel alcanzado por las variables y la estadística inferencial para determinar el índice de correlación. Al término de la investigación, los resultados obtenidos indican que el valor de correlación de Rh Spearman tiene un índice de 0,872, concluyéndose que hay relación directa alta entre variables, además, la correlación es directa y positiva, es decir, si mejora el nivel de los indicadores de competencia, también mejorará el nivel de gestión de los programa

The effect of high dose antibiotic impregnated cement on rate of surgical site infection after hip hemiarthroplasty for fractured neck of femur : a protocol for a double-blind quasi randomised controlled trial

Background: Mortality following hip hemiarthroplasty is in the range of 10-40% in the first year, with much attributed to post-operative complications. One such complication is surgical site infection (SSI), which at the start of this trial affected 4.68% of patients in the UK having this operation. Compared to SSI rates of elective hip surgery, at less than 1%, this figure is elevated. The aim of this quasi randomised controlled trial (RCT) is to determine if high dose antibiotic impregnated cement can reduce the SSI in patients at 12-months after hemiarthroplasty for intracapsular fractured neck of femur. Methods: 848 patients with an intracapsular fractured neck of femur requiring a hip hemiarthroplasty are been recruited into this two-centre double-blind quasi RCT. Participants were recruited before surgery and quasi randomised to standard care or intervention group. Participants, statistician and outcome assessors were blind to treatment allocation throughout the study. The intervention consisted of high dose antibiotic impregnated cement consisting of 1 gram Clindamycin and 1 gram of Gentamicin. The primary outcome is Health Protection Agency (HPA) defined deep surgical site infection at 12 months. Secondary outcomes include HPA defined superficial surgical site infection at 30 days, 30 and 90-day mortality, length of hospital stay, critical care stay, and complications. Discussion: Large randomised controlled trials assessing the effectiveness of a surgical intervention are uncommon, particularly in the speciality of orthopaedics. The results from this trial will inform evidence-based recommendations for antibiotic impregnated cement in the management of patients with a fractured neck of femur undergoing a hip hemiarthroplasty. If high dose antibiotic impregnated cement is found to be an effective intervention, implementation into clinical practice could improve long-term outcomes for patients undergoing hip hemiarthroplasty

Muscle loss following a single high-dose intramuscular injection of corticosteroids to treat disease flare in patients with rheumatoid arthritis.

OBJECTIVE: Adverse changes in body composition, specifically decreased muscle mass (MM) and increased fat mass, characterize rheumatoid arthritis (RA). These changes, termed rheumatoid cachexia (RC), are important contributors to the disability and elevated co-morbidity risk of RA. Recently, we observed substantial muscle loss (~2 kg) in a patient with RA following a single intramuscular (IM) corticosteroid (CS) injection to treat a disease flare. The aim of the current study is to determine whether this apparent iatrogenic effect of IM CS is typical, i.e., does this routine, recommended treatment contribute to RC? METHODS: Body composition was assessed by dual-energy X-ray absorptiometry (DXA) in eight patients with established RA who received a 120 mg IM methylprednisolone injection to treat a disease flare. DXA scans estimated appendicular lean mass (ALM; a surrogate measure of MM), total lean mass (LM), and total and regional adiposity at baseline (injection day) and 4 weeks and 6-9 months post-injection. Statistical analysis was performed using one-way ANOVA. RESULTS: There was significant loss of ALM (-0.93 kg, p=0.001, 95% CI [-0.49, -1.36]) and a trend toward reduced LM (-1.10 kg, p=0.165, 95% CI [0.58, -2.79]) at 4 weeks relative to baseline. At 6-9 months despite control of inflammation and disease activity, these losses remained. CONCLUSION: Substantial muscle loss occurred in patients with RA following IM CS injection to treat a disease flare. Thus, this recommended treatment appears to exacerbate RC, thereby potentially increasing disability and co-morbidity risk. If this effect is confirmed by larger studies, the role of one-off high-dose CS in the treatment of RA should be reviewed

A influência neoliberal nas políticas educacionais na Colômbia

This article aims to show that the design of educational policies in Colombia in recent decades has been the product of a permanent tension between the Colombian State and the Colombian federation of FECODE educators, conceived within the framework of a political confrontation resulting from two visions of education, a state vision that advocates for a neoliberalization, commodification and privatization of education and a defense of the welfare state by FECODE, a vision that strives to guarantee the constitutional right to a free and high quality education .El presente artículo   pretende mostrar  que  el diseño de las políticas  educativas  en  Colombia en las  últimas décadas ha sido producto de una tensión permanente  entre  el Estado Colombiano  y la  federación Colombiana  de  educadores  FECODE,  concebidas   en el marco  de una confrontación política producto de  dos visiones de la educación,  una visión estatal  que propugna por una neoliberalización, mercantilización y privatización de  la educación y  una  defensa  del estado  garantista de bienestar social  por parte de  FECODE, visión que lucha por que se  garantice el derecho constitucional a una educación gratuita y de alta calidad.Este artigo tem como objetivo mostrar que o desenho das políticas educacionais na Colômbia, nas últimas décadas, tem sido o produto de uma tensão permanente entre o Estado colombiano e a Federação Colombiana de Educadores Fecode, concebida no âmbito de um confronto político produzido por dois visões de educação, uma visão estatal que defende a neoliberalização, a mercantilização e a privatização da educação e a defesa do Estado de bem-estar pela Fecode, visão que  luta para ser garantido o direito constitucional à educação gratuita e alta qualidade

Point-of-care ultrasound in general practice: an exploratory study in rural South Australia

Introduction: Access to ultrasound imaging services is limited in rural areas and point-of-care ultrasound (POCUS) has the potential to address this gap. We aimed to examine how POCUS is utilised by doctors in contemporary Australian rural general practice. Methods: A portable ultrasound machine and access to a training course were provided to four general practices in rural South Australia, and the type and frequency of POCUS scans were recorded, along with user information, between July 2020 and June 2021. Participating general practitioners (GPs) completed a survey at the commencement of the study regarding their previous experience and confidence in using POCUS for specific assessments and procedures. Results: Of the 472 scans recorded, most (95%) were for clinical indications, 3% for teaching activities and 2% for self-learning. Overall, 69% were obstetric scans, followed by abdominal (12%), gynaecological procedures (10%), other procedural (7%) and thoracic exams (1.5%). Users reported higher confidence for lower complexity POCUS. Conclusion: Although POCUS has diverse potential applications in rural practice, GPs reported limited confidence for certain scans and used POCUS predominantly for obstetric indications. Further studies should examine the barriers to POCUS utilisation, with particular attention to training requirements, reimbursement for use and access to machines

Seeing environmental violence in deep time: perspectives from contemporary Mongolian literature and music

What does it mean to do violence in deep time? How is deep time evoked in our understanding of environmental harm? Environmental transformations have figured prominently in the recent history of Mongolia. Shifts in land use have been associated with severe pasture degradation, and the precarity of herding livelihoods has been a factor accelerating urbanization. Most recently, the intensification of mining activity has been a particular source of social and economic change. These contexts have led to a political and religious reevaluation of human relationships with the land. This article focuses on literary and musical interventions (particularly rap music in the first part of the article and the literary work of G. Mend-Ooyo in the later part) that draw attention to this changing relationship with the environment, which the article portrays as a potential rupture. We explore how these works domesticate deep time, nesting personal histories within the temporal depth of the landscape and crosshatching biographical, mythological, and geologic understandings of time. Yet we then see how this domestication comes to be threatened by developments that sever the relationship between people and land, leading to the disturbing prospect of being left stranded in the face of an inhospitable deep time

International lease accounting reform and economic consequences: the views of UK users and preparers

In response to perceived difficulties with extant lease-accounting standards in operation worldwide, the G4+1 issued a discussion paper which proposes that all leases should be recognized on the balance sheet [ASB (1999). Leases: Implementation of a new approach, discussion paper. London: Accounting Standards Board]. Leasing is now on the active agenda of the IASB. A major difficulty faced by standard setters lies in overcoming the preparer/user lobbying imbalance and obtaining ex ante evidence on the likely impact of regulatory reform. This paper contributes to the ongoing international debate by conducting a questionnaire survey of U.K. users and preparers to assess their views on proposals for lease-accounting reform and on the potential economic consequences of their adoption. The results, based on 132 responses, indicate that both groups accept that there are deficiencies in the current rules, but they do not agree on the way forward and believe that the proposals would lead to significant economic consequences for key parties. The impact on respondents' views of familiarity with the proposals, level of lease usage, and company size, is also examined

Antiviral Efficacy of Metal and Metal Oxide Nanoparticles against the Porcine Reproductive and Respiratory Syndrome Virus

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Porcine reproductive and respiratory syndrome viruses (PRRSV) are responsible for one of the most economically important diseases affecting the global pig industry. On-farm high-efficiency particulate air (HEPA) filtration systems can effectively reduce airborne transmission of PRRSV and the incidence of PRRS, but they are costly, and their adoption is limited. Therefore, there is a need for low-cost alternatives, such as antimicrobial filters impregnated with antiviral nanoparticles (AVNP). During the past 10 years, tailored intermetallic/multi-elemental AVNP compositions have demonstrated effective performance against human viruses. In this study, a panel of five AVNP was evaluated for viricidal activity against PRRSV. Three AVNP materials: AVNP2, copper nanoparticles (CuNP), and copper oxide nanoparticles (CuONP), were shown to exert a significant reduction (>99.99%) in virus titers at 1.0% (w/v) concentration. Among the three, CuNP was the most effective at lower concentrations. Further experiments revealed that AVNP generated significant reductions in viral titers within just 1.5 min. For an optimal reduction in viral titers, direct contact between viruses and AVNP was required. This was further explained by the inert nature of these AVNP, where only negligible leaching concentrations of Ag/Cu ions (0.06–4.06 ppm) were detected in AVNP supernatants. Real-time dynamic light scatting (DLS) and transmission electron microscopic (TEM) analyses suggested that the mono-dispersive hydrodynamic behavior of AVNPs may have enhanced their antiviral activity against PRRSV. Collectively, these data support the further evaluation of these AVNP as candidate nanoparticles for incorporation into antimicrobial air-filtration systems to reduce transmission of PRRSV and other airborne pathogens.Peer reviewe

Localisation and interactions of the Vipp1 protein in cyanobacteria

Biotechnology and Biological Sciences Research Council. Grant Number: BB/G021856. Deutsche Forschungsgemeinschaft. Grant Number: FOR 929, SCHN 690/3-1. European Commission. Grant Number: FP7-PEOPLE-2009-IEF 254575. NFR. Grant Numbers: 192436, 197119. OCISB. Royal Society and Engineering and Physical Sciences Research Council. Grant Number: EP/G0061009/

Multimessenger astronomy with pulsar timing and X-ray observations of massive black hole binaries

We demonstrate that very massive (>10^8\msun), cosmologically nearby (z<1) black hole binaries (MBHBs), which are primary targets for ongoing and upcoming pulsar timing arrays (PTAs), are particularly appealing multimessenger carriers. According to current models for massive black hole formation and evolution, the planned Square Kilometer Array (SKA) will collect gravitational wave signals from thousands of such massive systems, being able to individually resolve and locate in the sky several of them (maybe up to a hundred). By employing a standard model for the evolution of MBHBs in circumbinary discs, with the aid of dedicated numerical simulations, we characterize the gas-binary interplay, identifying possible electromagnetic signatures of the PTA sources. We concentrate our investigation on two particularly promising scenarios in the high energy domain, namely, the detection of X-ray periodic variability and of double broad K\alpha iron lines. Up to several hundreds of periodic X-ray sources with a flux >10^-13 erg s^-1 cm^-2 will be in the reach of upcoming X-ray observatories. Double relativistic K\alpha lines may be observable in a handful of low redshift (z<0.3) sources by proposed deep X-ray probes, such as Athena. (Abridged)Comment: 19 pages, 11 figures, submitted to MNRAS, minor revision of the reference lis