Análisis de la gestión del programa vaso de leche del distrito de Santiago de Surco, provincia de Lima desde la perspectiva de gerencia social, en el período comprendido entre 2015-2016

La presente investigación tiene como objetivo principal analizar la gestión del Programa Vaso de Leche en el distrito de Santiago de Surco, con miras a determinar su eficacia, los alcances obtenidos; así como proponer mejoras para renovar el Programa y sensibilizar a sus actores. El Vaso de Leche es un programa nacional asistencial dirigido a mejorar la calidad de vida de la población con más alto riesgo nutricional, grupos empobrecidos asentados en las áreas rurales y urbano-marginales. Este Programa está a cargo de los gobiernos locales, en relación a su organización, administración de recursos y ejecución. El desarrollo de la investigación busca respuestas a varias interrogantes en relación al análisis de la gestión del servicio para obtener alcances sobre la percepción de la calidad del producto y el servicio recibido por los beneficiarios; la identificación de los actores clave y de cumplimiento de sus roles; la verificación de los mecanismos empleados para la selección de los beneficiarios; así como el análisis de los factores que facilitan o limitan la gestión administrativa, operativa y financiera del programa. Siguiendo estos objetivos, la forma de investigación aplicada es el estudio de caso, que logra esclarecer la gestión del Programa a través de sus principales actores del gobierno central, local y sociedad civil. Estos resultados permitirán obtener propuestas que contribuyan a fortalecer el Programa de la gestión municipal. Esta tesis se ha desarrollado de acuerdo a las pautas de la estrategia metodológica mixta, es decir, de tipo cualitativa y cuantitativa. En el extremo cualitativo, la principal fuente de información primaria son las entrevistas en profundidad a los principales actores y los conocimientos adquiridos por observación directa en los diferentes momentos del proceso de investigación. De otro lado, se aplicó la estrategia cuantitativa, mediante la realización de encuestas para determinar el perfil del beneficiario surcano, entre otros aspectos. Los principales hallazgos son los siguientes: a) un porcentaje representativo de beneficiarios se encuentra dentro de la línea de pobreza, b) existe escasa capacitación a las madres preparadoras respecto a la calidad de servicio y pasividad del beneficiario frente al Programa, c) la Municipalidad se muestra como el eje articulador del Programa, d) el registro y depuración de beneficiarios es irregular y está politizado. Además, se detectó la escasez de recursos humanos y presupuestales, la ausencia de un flujograma, la escasa vocación de servicio de los trabajadores; así como el incumplimiento de las actividades programadas. Todo ello permite concluir que el Programa se distancia de un desarrollo de gestión eficaz. Finalmente, la presente tesis sugiere el fortalecimiento de las capacidades en los diferentes roles desde una perspectiva de Gerencia Social, proponiendo estrategias que permitan alcanzar un desarrollo eficaz y sostenible del Programa.The main objective of the present research is to analyze the management of the Vaso de Leche Program in Santiago de Surco district, with the purpose to determine its effectiveness and the results obtained; as well as proposing improvements to renovate it with a sensitization of its actors. The Vaso de Leche was created as a priority poverty - alleviation program to improve the life quality of some population with a high malnutrition risk, a poor sector that settled in rural areas and others who were marginalized on the outskirts of the urban center. The local governments through Peru are in charge of this program, in relation to its organization, resource management and execution. This research looks for responses to several questions about this program, regarding the analysis the service management about the perceptions of the product quality that is gave to the beneficiaries, the description and duties of every actor that is involved in this program. Likewise, examine the mechanisms that are used by the local government in the beneficiaries’ selection process and the analysis of the factors about the institutional – operational management, including its strength and weakness. In this context, the research method applied is the Case Study that helped to understand the program management involving the main actors such as the central and local government including the women organization. These results allow obtaining recommendations that would contribute to enforce the Program of the local management. This thesis has been developed by the guidelines of the mixed methodological strategy, which means both qualitative and quantitative. On the qualitative extreme, the main source of information was the in-depth interviews with the main actors and the knowledge acquired by direct observation at the different moments of the research process. On the other hand, the quantitative strategy was applied, by conducting 361 surveys during the beneficiaries’ census to determine the district beneficiary profile, among other aspects. The main findings infer that a representative percentage of beneficiaries is within the poverty line, there is partial training on women regarding quality of service, the Santiago de Surco Municipality is shown as the main articulation actor of the Program, registration and elimination of the beneficiaries is irregular and politicized. In addition, the shortage of human and budgetary resources, the absence of a flow chart, the non-relevant vocation, as well as the nonfulfilled of the programmed activities, allow this research to conclude that the Vaso de Leche program distances itself from an effective management. Finally, this thesis recommends the strengthening of the capacities in the different actor’s roles from a social management perspective, proposing strategies that allow reaching an effective and sustainable development of this Program.Tesi

The Influence of Acitretin on Brain Lipidomics in Adolescent Mice : Implications for Pediatric and Adolescent Dermatological Therapy

Administration of systemic retinoids such as acitretin has not been approved yet for pediatric patients. An adverse event of retinoid-therapy that occurs with lower prevalence in children than in adults is hyperlipidemia. This might be based on the lack of comorbidities in young patients, but must not be neglected. Especially for the development of the human brain up to young adulthood, dysbalance of lipids might be deleterious. Here, we provide for the first time an in-depth analysis of the influence of subchronic acitretin-administration on lipid composition of brain parenchyma of young wild type mice. For comparison and to evaluate the systemic effect of the treatment, liver lipids were analogously investigated. As expected, triglycerides increased in liver as well as in brain and a non-significant increase in cholesterol was observed. However, specifically brain showed an increase in lyso-phosphatidylcholine and carnitine as well as in sphingomyelin. Group analysis of lipid classes revealed no statistical effects, while single species were tissue-dependently changed: effects in brain were in general more subtly as compared to those in liver regarding the mere number of changed lipid species. Thus, while the overall impact of acitretin seems comparably small regarding brain, the change in individual species and their role in brain development and maturation has to be considered

The development of self-regulated learning during the pre-clinical stage of medical school: a comparison between a lecture-based and a problem based curriculum

Society expects physicians to always improve their competencies and to be up to date with developments in their field. Therefore, an important aim of medical schools is to educate future medical doctors to become self-regulated, lifelong learners. However, it is unclear if medical students become better self-regulated learners during the pre-clinical stage of medical school, and whether students develop self-regulated learning skills differently, dependent on the educational approach of their medical school. In a cross-sectional design, we investigated the development of 384 medical students’ self-regulated learning skills with the use of the Self-Regulation of Learning Self-Report Scale. Next, we compared this development in students who enrolled in two distinct medical curricula: a problem-based curriculum and a lectured-based curriculum. Analysis showed that more skills decreased than increased during the pre-clinical stage of medical school, and that the difference between the curricula was mainly caused by a decrease in the skill evaluation in the lecture-based curriculum. These findings seem to suggest that, irrespective of the curriculum, self-regulated learning skills do not develop during medical school

CERKL-associated retinal dystrophy: Genetics, Phenotype and Natural History

PURPOSE: To analyze the clinical characteristics, natural history, and genetics of CERKL-associated retinal dystrophy in the largest series to date. DESIGN: Multicenter retrospective cohort study. SUBJECTS: 47 patients (37 families) with likely disease-causing CERKL variants METHODS: Review of clinical notes, ophthalmic images, and molecular diagnosis from two international centres. MAIN OUTCOME MEASURES: Visual function, retinal imaging and characteristics were evaluated and correlated. RESULTS: The mean age at the first visit was 29.6 + 13.9 years and the mean follow-up time was 9.1 + 7.4 years. The most frequent initial symptom was central vision loss (40%) and the most common retinal feature was well-demarcated areas of macular atrophy (57%). Seventy percent of the participants had double-null genotypes and 64% had electrophysiological assessment. Amongst the latter, 53% showed similar severity of rod and cone dysfunction, 27% revealed a rod-cone, 10% a cone-rod, and 10% a macular dystrophy dysfunction pattern. Patients without double-null genotypes tended to have fewer pigment deposits and included a higher proportion of older patients with a relatively mild electrophysiological phenotype. Longitudinal analysis showed that over half of the cohort lost 15 ETDRS letters or more in at least one eye during the first 5 years of follow up. CONCLUSIONS: The phenotype of CERKL-retinal dystrophy is broad, encompassing isolated macular disease to severe retina-wide involvement, with a range of functional phenotypes, generally not fitting in the rod-cone/cone-rod dichotomy. Disease onset is often earlier, with more severe retinal degenerative changes and photoreceptor dysfunction, in nullizygous cases

Shotgun lipidomics of liver and brain tissue of Alzheimer's disease model mice treated with acitretin

Alzheimer’s disease (AD) is a very frequent neurodegenerative disorder characterized by an accumulation of amyloid-β (Aβ). Acitretin, a retinoid-derivative and approved treatment for Psoriasis vulgaris, increases non-amyloidogenic Amyloid-Precursor-Protein-(APP)-processing, prevents Aβ-production and elicits cognitive improvement in AD mouse models. As an unintended side effect, acitretin could result in hyperlipidemia. Here, we analyzed the impact of acitretin on the lipidome in brain and liver tissue in the 5xFAD mouse-model. In line with literature, triglycerides were increased in liver accompanied by increased PCaa, plasmalogens and acyl-carnitines, whereas SM-species were decreased. In brain, these effects were partially enhanced or similar but also inverted. While for SM and plasmalogens similar effects were found, PCaa, TAG and acyl-carnitines showed an inverse effect in both tissues. Our findings emphasize, that potential pharmaceuticals to treat AD should be carefully monitored with respect to lipid-homeostasis because APP-processing itself modulates lipid-metabolism and medication might result in further and unexpected changes. Moreover, deducing effects of brain lipid-homeostasis from results obtained for other tissues should be considered cautiously. With respect to acitretin, the increase in brain plasmalogens might display a further positive probability in AD-treatment, while other results, such as decreased SM, indicate the need of medical surveillance for treated patients

Spectral Stacking of Radio-Interferometric Data

Mapping molecular line emission beyond the bright low-J CO transitions is still challenging in extragalactic studies, even with the latest generation of (sub-)mm interferometers, such as ALMA and NOEMA. We summarise and test a spectral stacking method that has been used in the literature to recover low-intensity molecular line emission, such as HCN(1-0), HCO+(1-0), and even fainter lines in external galaxies. The goal is to study the capabilities and limitations of the stacking technique when applied to imaged interferometric observations. The core idea of spectral stacking is to align spectra of the low S/N spectral lines to a known velocity field calculated from a higher S/N line expected to share the kinematics of the fainter line, e.g., CO(1-0) or 21-cm emission. Then these aligned spectra can be coherently averaged to produce potentially high S/N spectral stacks. Here, we use imaged simulated interferometric and total power observations at different signal-to-noise levels, based on real CO observations. For the combined interferometric and total power data, we find that the spectral stacking technique is capable of recovering the integrated intensities even at low S/N levels across most of the region where the high S/N prior is detected. However, when stacking interferometer-only data for low S/N emission, the stacks can miss up to 50% of the emission from the fainter line. A key result of this analysis is that the spectral stacking method is able to recover the true mean line intensities in low S/N cubes and to accurately measure the statistical significance of the recovered lines. To facilitate the application of this technique we provide a public Python package, called PyStacker.Comment: 10 pages, 10 figures, accepted for pub in A&A, Apr 28, 202

The Transformation of Teaching Habits in Relation to the Introduction of Grading and National Testing in Science Education in Sweden

In Sweden, a new curriculum and new methods of assessment (grading of students and national tests) in science education were introduced in grade 6 in 2012/2013. We have investigated what implications these reforms have for teachers’ teaching and assessment practices in order to explore the question of how teachers transform their teaching habits in relation to policy reforms. Interviews with 16 teachers teaching science in grade 6 (Y6), over 3 years after the reforms were introduced, were analysed. Building on the ideas of John Dewey, we consider teachers’ talk about their everyday practice as expressions of their habits of teaching. Habits of teaching are related both to individual experiences as well as institutional traditions in and about teaching. A categorisation of educational philosophies was used to teachers’ habits of teaching to a collective level and to show how habits can be transformed and developed over time in specific sociocultural contexts. The teachers were categorised as using essentialist and/or progressivist educational philosophy. In the responses to the introduction of grading and national testing, the teachers took three approaches: Their habits being reinforced, revised or unchanged in relation to the reforms. Although the responses were different, a striking similarity was that all teachers justified their responses with wanting to do what is best for students. However, how to show care for students differed, from delivering scientific knowledge in alignment with an essentialist educational philosophy, to preparing students to do well on tests, to supporting their development as individuals, which is in alignment with a progressivist educational philosophy

'Immunising' physicians against availability bias in diagnostic reasoning: A randomised controlled experiment

Background: Diagnostic errors have often been attributed to biases in physicians' reasoning. Interventions to 'immunise' physicians against bias have focused on improving reasoning processes and have largely failed. Objective: To investigate the effect of increasing physicians' relevant knowledge on their susceptibility to availability bias. Design, settings and participants: Three-phase multicentre randomised experiment with second-year internal medicine residents from eight teaching hospitals in Brazil. Interventions: Immunisation: Physicians diagnosed one of two sets of vignettes (either diseases associated with chronic diarrhoea or with jaundice) and compared/contrasted alternative diagnoses with feedback. Biasing phase (1 week later): Physicians were biased towards either inflammatory bowel disease or viral hepatitis. Diagnostic performance test: All physicians diagnosed three vignettes resembling inflammatory bowel disease, three resembling hepatitis (however, all with different diagnoses). Physicians who increased their knowledge of either chronic diarrhoea or jaundice 1 week earlier were expected to resist the bias attempt. Main outcome measurements: Diagnostic accuracy, measured by test score (range 0-1), computed for subjected-to-bias and not-subjected-to-bias vignettes diagnosed by immunised and not-immunised physicians. Results: Ninety-one residents participated in the experiment. Diagnostic accuracy differed on subjected-to-bias vignettes, with immunised physicians performing better than non-immunised physicians (0.40 vs 0.24; difference in accuracy 0.16 (95% CI 0.05 to 0.27); p=0.004), but not on not-subjected-to-bias vignettes (0.36 vs 0.41; difference -0.05 (95% CI -0.17 to 0.08); p=0.45). Bias only hampered non-immunised physicians, who performed worse on subjected-to-bias than not-subjected-to-bias vignettes (difference -0.17 (95% CI -0.28 to -0.05); p=0.005); immunised physicians' accuracy did not differ (p=0.56). Conclusions: An intervention directed at increasing knowledge of clinical findings that discriminate between similar-looking diseases decreased physicians' susceptibility to availability bias, reducing diagnostic errors, in a simulated setting. Future research needs to examine the degree to which the intervention benefits other disease clusters and performance in clinical practice. Trial registration number: 68745917.1.1001.0068