Hypertrophy of the Trochlearis Calcanei: Etiology, clinical manifestations and treatment

El diagnóstico de una hipertrofia de la tróclea o tuberosidad peroneal del calcáneo se asocia a una tenosinovitis estenosante del tendón del músculo Peroneo Largo o Corto. Hay autores que plantearon que la hipertrofia de la tróclea del calcáneo no provocaba dolor por si misma sino que se produce una exacerbación del dolor cuando el paciente utiliza un zapato que comprime el pie afecto, lo cual produce una irritación en la piel por la compresión a la que ésta estaba sometida, acompañada muchas veces por una afectación sensitiva superficial por atrapamiento del nervio Dorso Cutáneo Lateral.The diagnosis of troclear hypertrophy or fibular tuberosity of calcaneus is associated to stenotic tenosinovitis of long or short the peroneal tendon. There are authors states that troclear hypertrophy of calcaneus did not cause pain by itself but the pain increase when the patient uses a tight shoe that compresses the area affected, this compression produces skin irritation under the area affected accompanied often a sensorial affectation at level of the superficial nerve due to entrapment of dorso cutaneous lateral nerve

Educación ambiental a partir del pensamiento crítico en el Colegio Villa Amalia

228 p.El presente trabajo “Educación ambiental a partir del pensamiento crítico en el Colegio Villa Amalia”, parte de la intención de mejorar las actitudes que manifiestan los estudiantes en su relación con el medio ambiente institucional. Las indagaciones sobre estudios e investigaciones previas acerca de esta relación se obtuvieron de los análisis documentales, de la aplicación de instrumentos de cartografía social, de implementación de cuestionarios, los cuales arrojan como resultado que, en los estudiantes existe conocimiento ecológico básico al igual que la intencionalidad de actuar positivamente frente al medio. Pero ¿Por qué entonces no se actúa en concordancia? Se evidencia como problema la desconexión que existe entre lo que se sabe, lo que se piensa y finalmente lo que se hace.The present work "Sustainable environment al education based on critical thinking at the Villa Amalia school", is part of the intention to improve the relationship presented by students with the institutional environment. The diagnostic inquiries about this relationship, which were obtained from documentary analysis, application of social mapping tools, implementation of questionnaires, result in the existence of basic ecological knowledge in students, as well as the intention to act positively in front of the medium. But why then do they not act in accordance? The disconnection between what is known, what is thought and finally what is done is evidenced as a problem. The challenge is then to generate that connection, and the proposal to do so is to develop a proposal for environmental education based on the development of critical thinking, based on the strategy proposed by Peter Facione (2007) , which is based on the development of thinking skills (Interpret, analyze, evaluate, infer, explain and self-regulate). The research is qualitative - descriptive, circumscribed in the action research, taking postulates of Kemmis and McTaggart in terms of critical action research and Orlando Fals Borda(1985), in terms of participatory action research. As a pedagogical strategy, the didactic sequence proposed by Anna Camps (2003), is taken, attending in the development of activities to the lines of action of environmental education proposed by the Belgrade Charter.Magíster en EducaciónMaestríaBásica secundariaCiencias naturales y educación ambientalEstudiantesEstudio cualitativoDidácticaMedio ambienteProcesos de aprendizajeNivelLa didáctica aplicada para optimizar la educación ambiental, basada en el desarrollo del pensamiento crítico, puede aplicarse en el desarrollo de cualquier disciplin

Perspectivas de innovación en gestión, educación ambiental para la adaptación y la mitigación

Esta publicación del libro-foro sobre ciudad y cambio climático responde al aporte de los diferentes profesionales de las entidades públicas y privadas que participaron en calidad de conferencistas, ponentes, panelistas y expositores y compartieron sus experiencias en la ciudad como una contribución al conocimiento de las comunidades acerca de la creciente importancia y consideración de la adaptación y mitigación. Se consideraron acciones de políticas públicas por parte de las administraciones públicas, los sectores económicos y la sociedad, grupos ecológicos y fundaciones ecológicas y de igual forma las acciones y grandes esfuerzos realizados por el Ministerio del Ambiente, el IDEAM, la CAR, la Secretaría de Ambiente, el Jardín Botánico, la Red RAUS y de los grupos de investigación de las universidades

Diagnóstico sobre el nivel de representaciones espaciales de los estudiantes el grado sexto del C.E.D. la Belleza /

Esta investigación identifica el nivel de representaciones espaciales de los estudiantes del grado sexto en el CED la Belleza, se hace énfasis en la percepción, las vivencias y representaciones del espacio de los alumnos, todo enmarcado desde el ámbito de la "psicología ambiental". Este trabajo propone la elaboración de un instrumento pedagógico acorde a las necesidades de los alumnos y que propicie el desarrollo de las habilidades de pensamiento espacial

Business plan of an electronic platform information and choice of factoring bidders for MSME interested in financing sales by offering their negotiable invoices

El presente trabajo de investigación tiene como finalidad desarrollar el Plan de Negocio de una plataforma electrónica de información y elección de ofertantes de factoring para las MIPYME interesadas en financiamiento de ventas mediante oferta de facturas negociables. Esta propuesta se dirige a empresarios de diferentes rubros y cuyos niveles de facturación caracterizan a sus empresas como micro, pequeñas y medianas, especialmente para aquellos que valoran mucho contar con la liquidez de fondos necesarios para financiar sus operaciones al menor costo posible. Para ello se realizó un sondeo el cuál permitió validar nuestra propuesta explicada en este documento, destacando que el 67,3% manifiesta estar muy dispuesto a usar la plataforma “Elige – Factoring”. Para implementar este modelo de negocio se requerirá de una inversión de S/ 105 000 distribuidos en desarrollo de plataforma web, adquisición de bienes de cómputo, campañas de difusión y otros gastos pre-operativos, así como capital de trabajo requerido para financiar las actividades del primer año de operación. Se usará redes sociales y se generará contenido de calidad para desarrollar una estrecha y contínua relación con los clientes. La estrategia del presente plan se basará en la diferenciación y la focalización. Esta solución será la finetch referente de provisión de información de Factoring y de negociación de tasas de descuento de Facturas Negociables en el Perú. A partir del análisis financiero realizado, concluimos que el proyecto tendrá un VAN de de S/133 321,46 y una TIR de 36,7%, luego de 5 años de operaciones, haciéndolo atractivo para invertir.The purpose of this research work is to develop the Business Plan of an electronic platform of information and choice of factoring bidders for MSME interested in financing sales by offering their negotiable invoices. This proposal is aimed at businessman of different sectors and whose billing levels characterize their companies as micro, small and medium-sized, especially for those who highly value having the liquidity of funds necessary to finance their operations at the lowest possible cost. For this, a poll was carried out which allowed us to validate our proposal explained in this document, highlighting that 67.3% state that they are very willing to use the platform "Elige - Factoring". To implement this business model, its will need an investment of S/ 105 000 distributed in web platform development, acquisition of computer assets, dissemination campaigns and other pre-operational expenses, as well as the working capital required to finance the activities of the first year of operation. Social networks will be used and quality content will be generated to develop a close and continuous relationship with customers. The strategy of this plan will be based on differentiation and targeting. This solution will be the benchmark finetch for the provision of Factoring information and the negotiation of discount rates of Negotiable Invoices in Peru. From the financial analysis carried out, we conclude that the project will have a NPV of S / 133 321,46 and an IRR of 36,7%, after 5 years of operations, making it attractive to invest.Trabajo de investigació

Characterization of the attention to the Occupational Health in the Policlínico Juan José Apolinaire Pennini. Cienfuegos 2018.

Background: considering that work accidents constitute a large source of cost generation and that in Cuba there is an aging age distribution, health care for workers is a fundamental process in primary health care.Objective: to characterize occupational health care at the Juan José Apolinaire Pennine Polyclinic in Cienfuegos.Methods: descriptive, cross-sectional study carried out in 2018. The sample made up of workers from the Carlos Manuel de Céspedes Thermoelectric Plant, chosen by simple random sampling, and doctors and nurses from the polyclinic family, intentionally selected. To obtain the information, two instruments were used, one applied to health personnel, to identify knowledge about occupational health and the other to the workers of the selected company to determine perceived satisfaction with the care received.Results: in the professionals of the Juan José Apolinaire Pennini polyclinic in Cienfuegos, there is evidence of a lack of knowledge about occupational health, by not showing clarity about occupational risks, causes of work accidents, examinations to be carried out in the working population and criteria for declaring an occupational disease . In addition, the surveyed patients are moderately satisfied with the care received, mainly due to deficiencies in stability, need and comprehensiveness of care.Conclusions: the research results suggest that there is a relationship between the lack of knowledge about occupational health in polyclinic workers and the insufficient attention perceived by the surveyed patients.</p

The effects of depth and diet on red abalone growth and survival in cage mariculture at San Jeronimo Island, Baja California, Mexico

In recent decades, global abalone aquaculture has significantly increased, while wild abalone fishery landings have decreased drastically, shifting production from fishing to farming. In California (USA) and Baja California (Mexico), overfishing and climate changelinked diseases are thought to be responsible for mass mortalities and significant declines in abalone fisheries landings. Conservation aquaculture is an option for enhancing abalone populations through captive propagation and cage mariculture with subsequent restockings into the wild. To test, inform, and promote innovative sustainable seafood production strategies in the Northeastern Pacific, we designed an experimental mariculture system at San Jeronimo Island, Baja California. We explored the feasibility of rearing juvenile red abalone, Haliotis rufescens, in a near-shore mariculture cage-based production system to supply individuals for local restoration programs. We tested the effects of 2 different depths, surface and bottom (5 m), and 3 macroalgal diets (Macrocystis pyrifera, Eisenia arborea, and a mixed diet of Pelagophycus porra with M. pyrifera) on the survival and growth of juvenile red abalone (32 ± 3.33 mm in shell length) inside cages attached to a long-line system. Over the 90-d experiment, survival was 99% for the surface treatment and 95% for the bottom treatment. Mean daily increment in shell length was 93 ± 12 µm·d–1 in surface cages and 82 ± 13 µm·d–1 in bottom cages. Depth did not affect growth or survival. Growth was highest using the E. arborea diet (99 ± 7 µm·d–1) but not significantly different from the M. pyrifera and mixed diets (88 ± 10 and 74 ± 13 µm·d–1, respectively). High survivorship and growth indicate that San Jeronimo Island can support cage-based mariculture of red abalone and that this strategy may be a useful tool in developing climate-resilient abalone restoration solutions aimed at bolstering seafood production

Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance. Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of greater than= 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of less than 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden). Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P less than 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P less than 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P less than 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections. Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome