Uso de las TICs como metodología de enseñanza aprendizaje de Ciencias Naturales en noveno grado del centro escolar José Dimas González, municipio El Tuma - La Dalia, Matagalpa durante el primer semestre 2017

La presente investigación aborda el uso de las TICs como metodología de enseñanza aprendizaje de Ciencias Naturales en noveno grado del centro escolar José Dimas González, Municipio el Tuma - La Dalia Matagalpa, durante el primer semestre 2017, tiene como propósito analizar la influencia pedagógica de las TICs en la enseñanza del aprendizaje de las ciencias naturales en los estudiantes del noveno grado del centro escolar José Dimas González, el Tuma - La Dalia, Matagalpa durante el primer semestre 2017. En el desarrollo del estudio se aplicaron instrumentos de investigación como encuestas a estudiantes y entrevistas a docentes, lo que facilitó la recolección de datos de información en el campo investigativo, utilizando la población total de 50 estudiantes de noveno grado de secundaria y 8 docentes. De acuerdo a los resultados generados en la presente investigación los docentes como estudiantes usan sus propios medios tecnológicos como alternativa en su labor educativa de manera ocasional 2 o 3 veces por semana. Entre las limitantes de las TICs, se encontraron el desconocimiento de las herramientas para el desarrollo de las actividades académicas, seguido con la dificultad en el manejo de TICs y la limitación de no contar con equipos tecnológicos de información y comunicación en el centro. Por ello se hace necesario fortalecer el aprendizaje significativo con el uso de las TICs, como herramienta metodológica de la práctica educativa, fortaleciendo capacidades en el uso de las TICs, implementando la producción de nuevos materiales educativos a la integración de las tecnologías de la información y comunicación, fomentando su uso adecuado para fortalecer el aprendizaje en las Ciencias Naturale

Higiene y Seguridad Laboral en la Dirección de Administración de la Alcaldía Municipal de Jinotega durante el primer semestre del año 2015

La presente investigación se enfoca en analizar la Higiene y Seguridad Laboral aplicada en empresas del departamento de Jinotega en el año 2015 delimitando el estudio al área de administración de la Alcaldía del Municipio de Jinotega durante el primer semestre 2015. El presente estudio busca fortalecer el desempeño laboral de los empleados de la institución antes mencionada, mediante el mejoramiento de las condiciones Higiénicas y de Seguridad, para proteger a los empleados de accidentes y enfermedades profesionales. Las variables de estudios fueron: la Higiene Ocupacional y la Seguridad Laboral, se procedió a realizar una investigación de campo, utilizando las técnicas e instrumentos como: encuesta, entrevista y la observación necesaria capaz de suministrar la información requerida de la forma más adecuada posible, contando también con datos referentes a la Alcaldía, proporcionados por el Gerente municipal para elaborar un diagnóstico de la situación actual de la institución, siendo del tipo descriptivo. Al concluir la investigación se determinó que no se cumple la ley de Higiene y Seguridad Ocupacional, careciendo así también del comité encargado de velar por medidas de Higiene y de Seguridad, que deben mantener los empleados en los puestos de trabajo, por lo que se recomienda la implementación de un programa que contribuya a disminuir los casos de accidente y enfermedades entre los empleado

Análisis de la estructura de la pequeña empresa “El Emporio” del departamento de Matagalpa para la adopción de las NIIF para PYMES en el I semestre del año 2012

Hemos estudiado la estructura de la pequeña empresa “El Emporio” del municipio de Matagalpa para la adopción de las NIIF para PYMES en el I Semestre del año 2012. El propósito de la investigación fue la evaluación de las características generales de la estructura de la empresa y de esta forma analizar si la empresa cuenta con la estructura adecuada para poder adoptar las NIIF para PYMES como marco de referencia contable. La importancia de que la entidad adopte las NIIF para PYMES es que permiten que la pequeña empresa “El Emporio” cuente con una mejor imagen empresarial, que brinde mayor confianza a otras empresas que tienen relaciones comerciales con ésta, como son los proveedores e inversionistas. Además la empresa adquiere una mejor estructura financiera, ya que esta norma está dirigida especialmente a PYMES y es aceptada a nivel mundial. La pequeña empresa El Emporio posee un sistema contable manual y una estructura organizacional poco eficiente, ya que no se aplican correctamente los procedimientos administrativos en cuanto a la delegación de funciones. Además no posee un Manual de Control Interno, causando que el Manual de Procedimientos existente no sea efectivo en su aplicación. Esta pequeña empresa trabaja con capital propio y tiene proveedores extranjeros y nacionales, sin embargo no posee conocimiento acerca de las NIIF para PYMES. Es importante señalar que la pequeña empresa El Emporio actualmente no posee la estructura adecuada para adoptar las NIIF para PYME

La santé mentale à l’école : « Apprivoiser la complexité! » Évaluation d’une formation-accompagnement

Cet article présente l’évaluation en méthode mixte d’une formation-accompagnement en santé mentale à l’école, proposée aux enseignants, aux équipes-écoles et à leurs partenaires des Centres de santé et des services sociaux (CSSS). Les résultats démontrent que la formation a augmenté le sentiment de compétence des participants quant à leurs interventions, leur confort par rapport aux décisions partagées avec leurs partenaires et leur motivation face aux collaborations interdisciplinaires. Ces résultats suggèrent que cette formation peut améliorer l’arrimage entre les milieux de l’éducation et de la santé face aux problèmes de santé mentale des jeunes à l’école

Genome-Wide Association Study Identifies First Locus Associated with Susceptibility to Cerebral Venous Thrombosis

Objective Cerebral venous thrombosis (CVT) is an uncommon form of stroke affecting mostly young individuals. Although genetic factors are thought to play a role in this cerebrovascular condition, its genetic etiology is not well understood. Methods A genome-wide association study was performed to identify genetic variants influencing susceptibility to CVT. A 2-stage genome-wide study was undertaken in 882 Europeans diagnosed with CVT and 1,205 ethnicity-matched control subjects divided into discovery and independent replication datasets. Results In the overall case-control cohort, we identified highly significant associations with 37 single nucleotide polymorphisms (SNPs) within the 9q34.2 region. The strongest association was with rs8176645 (combined p = 9.15 x 10(-24); odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.76-2.31). The discovery set findings were validated across an independent European cohort. Genetic risk score for this 9q34.2 region increases CVT risk by a pooled estimate OR = 2.65 (95% CI = 2.21-3.20, p = 2.00 x 10(-16)). SNPs within this region were in strong linkage disequilibrium (LD) with coding regions of the ABO gene. The ABO blood group was determined using allele combination of SNPs rs8176746 and rs8176645. Blood groups A, B, or AB, were at 2.85 times (95% CI = 2.32-3.52, p = 2.00 x 10(-16)) increased risk of CVT compared with individuals with blood group O. Interpretation We present the first chromosomal region to robustly associate with a genetic susceptibility to CVT. This region more than doubles the likelihood of CVT, a risk greater than any previously identified thrombophilia genetic risk marker. That the identified variant is in strong LD with the coding region of the ABO gene with differences in blood group prevalence provides important new insights into the pathophysiology of CVT. ANN NEUROL 2021Peer reviewe

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

The Global Burden of Diseases, Injuries and Risk Factors 2017 includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice