Calidad de servicio de los pacientes en los consultorios externos del Hospital Sergio Enrique Bernales, 2017

La investigación titulada: “Calidad de servicio de los pacientes en consultorios externos del Hospital Sergio Enrique Bernales, 2017” tiene como objetivo general determinar el nivel de calidad de atención de los usuarios en el Hospital Sergio Enrique Bernales, durante el año 2017. Este trabajo de investigación busca brindar respuestas al siguiente problema metodológico de investigación: ¿Cuál es el nivel de calidad de servicio de los pacientes en los consultorios externos del Hospital Sergio Enrique Bernales, 2017? Metodológicamente, podemos establecer que el tipo de investigación es descriptivo, el nivel de investigación descriptiva y el enfoque es cuantitativo. Para la formulación de los resultados se contó con la técnica de la encuesta elaborado en base a la escala de Likert de la cual presentan 5 alternativas que están representadas como 1 nunca, 2 Casi nunca, 3 A veces, 4 Casi siempre y Siempre. Los instrumentos usados para la recolección de datos e información fueron dos cuestionarios, los mismos que fueron aplicados a los usuarios de los consultorios externos. La muestra estuvo conformada por 120 pacientes en consultorios externos del Hospital Sergio Enrique Bernales, durante el año 2017. La validez de los instrumentos se sirvió mediante RM Nº 527 – 2011/Minsa, Guía Técnica para la Evaluación de la Satisfacción del Usuario Externo en los Establecimientos de Salud y Servicios médicos de apoyo. Para la confiabilidad de cada instrumento se utilizó el Alfa de Cronbach, que es un coeficiente que mide la fiabilidad de una escala de medida. Con referencia al objetivo general: Determinar el nivel de calidad de Servicio de los pacientes de consultorios externos del Hospital Sergio Enrique Bernales, 2017. Se concluye que, pese a que el nivel y calidad de atención recibida por el usuario es de buena calidad, es importante ponerle más énfasis en la Capacidad de respuesta

Promoting Social Competence in Preschool with an Executive Functions Program Conducted by Teachers

The objective of this research is to examine the effectiveness of the “Executive Function Training Program in Preschool” (EFE-P) that includes real-world activities and applies different required methodologies for a sustainable education. In addition, it is evaluated whether the improvement of executive functions is transferred to the social competence domain. The study involved 100 students aged 5–6 years, of which 50 were randomly assigned to the active control group and 50 to the experimental group. Executive functions (BRIEF-P) and social competence (BASC and PKBS-2) were measured at two time points (pre-intervention and post-intervention). Data were analyzed using the Generalized Estimating Equation (GEE) for repeated data and results showed that children in the experimental group obtained better scores on executive functions and social competence compared to their peers in the control group. It is discussed if the executive functions training can be effective in improving social competence as long as the programs include real-world activities that encourage such transfer, as the EFE-P does

Reducing Aggression by Developing Emotional and Inhibitory Control

The objective of this study is to measure the effectiveness of a program on improving inhibitory and emotional control among children. In addition, it is assessed whether the improvement of these skills has an effect on the reduction of aggressive behavior in pre-school children. The participants were 100 children, 50 belonging to the control group and 50 to the experimental group, aged between 5 and 6 years. Pre-intervention and post-intervention measures of inhibitory and emotional control (BRIEF-P) and aggression (BASC) were taken. A Generalized Linear Mixed Model analysis (GLMM) was performed and found that children in the experimental group scored higher on inhibitory and emotional control compared to their peers in the control group. In addition, these improvements have an effect on the decrease in aggressiveness. In conclusion, preventive research should have among its priorities the design of such program given their implications for psychosocial development

Effects of Extending Milk Replacer Feeding during the Fattening Period on the Behaviour and Welfare of Lambs: A Preliminary Study

There is a lack of information on the behavioural and welfare effects of sustaining artificial milk feeding in fattening lambs. Therefore, the present work aimed to study the effects of prolonged artificial milk feeding during fattening with a high concentrate diet on the behaviour of lambs. The behaviour of 16 non castrated male lambs of the Manchega sheep breed (eight lambs were in the group that were fed daily a bottle of milk, and the other eight were in the weaned group) was recorded with four fixed cameras just before bottle feeding (~8:30 a.m.) of the unweaned group till four hours later, every day for 7 weeks. The solid diet (pelleted concentrate plus cereal straw) and housing conditions were the same in both groups. Solid feeds were offered ad libitum. There were no differences between groups in time spent eating nor in drinking, playing, scratching and oral activity behaviours (p > 0.05), but resting episodes were longer in weaned lambs (p < 0.05). Weaned lambs presented a higher frequency of self-grooming behaviour (p < 0.05), while the unweaned group performed a higher frequency of interaction behaviour (p < 0.05). In conclusion, the behaviours of lambs that were fed daily a bottle of milk during the fattening period did not substantially differ from the weaned individuals

Neutropthil-to-lymphocyte ratio as a predictor of postsurgical intraabdominal abscess in children operated for acute appendicitis

Aimof the study: Postoperative intra-abdominal abscess (PIAA) is a frequent and severe complication of acute appendicitis (AA) with peritonitis. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker that has been related to the development of peritonitis; however, its diagnostic role in predicting PIAA has not been evaluated. This is the first study that analyzes the usefulness of NLR as a predictor of PIAA in children operated for AA. Material and Methods: Retrospective observational study in children operated for AA in our institution during 2017–2018. Patients aged under 5 years or with incomplete laboratory determinations at hospital admission (blood count, C-reactive protein, and fibrinogen) were excluded. Demographic and laboratory parameters and the development of PIAA were analyzed. NLR was calculated by dividing the absolute number of neutrophils by the absolute number of lymphocytes. Bymeans of ROC curves, we determined the sensitivity and specificity of the different laboratory parameters to predict the development of PIAA. Results: A total of 388 patients aged 10.5 ± 2.9 year were included. Twenty (5.2%) developed PIAA. NLR presented an area under the curve (AUC) of 0.85, significantly higher than the determination of leukocytes (AUC 0.69, p < 0.001), neutrophils (AUC 0.74, p < 0.001), fibrinogen (AUC 0.68, p < 0.001) and C-reactive protein (AUC 0.73, p 10.5, with a sensitivity of 85% and a specificity of 75.2%. Conclusions: NLR is the laboratory parameter with the highest sensitivity and specificity for predicting the development of PIAA in children operated for AA. It can be useful as a predictor of worse postoperative course

What is an urban river? A methodological approach for its delimitation in Spain

A pesar de que las publicaciones en torno a ríos urbanos son abundantes, no hay investigaciones que se centren en su definición y, por esa misma razón, tampoco procedimientos oficiales para delimitarlos. El presente trabajo tiene como objetivos (1) definir qué es un río urbano y (2) delimitar los tramos fluviales urbanos para el territorio español. Las principales motivaciones para realizar este estudio son de diversa índole. En primer lugar, el interés científico-geográfico que entraña analizar una cuestión compleja como esta; en segundo lugar, la evidencia de que existen conflictos entre ayuntamientos y administraciones hidráulicas por la asunción de competencias y; por último, la idea, cada vez más extendida entre la comunidad científica, de promover una gestión diferenciada del espacio fluvial urbano y rural. A través del análisis del escenario de planificación y gestión de los cursos de agua en las zonas urbanas y la reflexión en torno al concepto “río urbano”, se concluye que un tramo de un río debe considerarse como urbano cuando se encuentren usos urbanos en su Dominio Público Hidráulico o sus Zonas de Protección y/o cuando dicho tramo se encuentre inmerso en una matriz urbana. En base a esta definición, se elabora una metodología de delimitación a escala nacional que indica que un 6 % de la red fluvial del territorio español tiene carácter urbano

Minimized natural versions of fungal ribotoxins show improved active site plasticity

Fungal ribotoxins are highly specific extracellular RNases which cleave a single phosphodiester bond at the ribosomal sarcin-ricin loop, inhibiting protein biosynthesis by interfering with elongation factors. Most ribotoxins show high degree of conservation, with similar sizes and amino acid sequence identities above 85%. Only two exceptions are known: Hirsutellin A and anisoplin, produced by the entomopathogenic fungi Hirsutella thompsonii and Metarhizium anisopliae, respectively. Both proteins are similar but smaller than the other known ribotoxins (130 vs 150 amino acids), displaying only about 25% sequence identity with them. They can be considered minimized natural versions of their larger counterparts, best represented by α-sarcin. The conserved α-sarcin active site residue Tyr48 has been replaced by the geometrically equivalent Asp, present in the minimized ribotoxins, to produce and characterize the corresponding mutant. As a control, the inverse anisoplin mutant (D43Y) has been also studied. The results show how the smaller versions of ribotoxins represent an optimum compromise among conformational freedom, stability, specificity, and active-site plasticity which allow these toxic proteins to accommodate the characteristic abilities of ribotoxins into a shorter amino acid sequence and more stable structure of intermediate size between that of other nontoxic fungal RNases and previously known larger ribotoxins

Galaxy classification: deep learning on the OTELO and COSMOS databases

Context. The accurate classification of hundreds of thousands of galaxies observed in modern deep surveys is imperative if we want to understand the universe and its evolution. Aims. Here, we report the use of machine learning techniques to classify early- and late-type galaxies in the OTELO and COSMOS databases using optical and infrared photometry and available shape parameters: either the Sersic index or the concentration index. Methods. We used three classification methods for the OTELO database: 1) u-r color separation , 2) linear discriminant analysis using u-r and a shape parameter classification, and 3) a deep neural network using the r magnitude, several colors, and a shape parameter. We analyzed the performance of each method by sample bootstrapping and tested the performance of our neural network architecture using COSMOS data. Results. The accuracy achieved by the deep neural network is greater than that of the other classification methods, and it can also operate with missing data. Our neural network architecture is able to classify both OTELO and COSMOS datasets regardless of small differences in the photometric bands used in each catalog. Conclusions. In this study we show that the use of deep neural networks is a robust method to mine the cataloged dataComment: 20 pages, 10 tables, 14 figures, Astronomy and Astrophysics (in press

Biomarkers and polymorphisms in pancreatic neuroendocrine tumors treated with sunitinib

Several circulating biomarkers and single nucleotide polymorphisms (SNPs) have been correlated with efficacy and tolerability to antiangiogenic agents. These associations remain unexplored in well-differentiated, metastatic pancreatic neuroendocrine tumors treated with the multitargeted tyrosine kinase inhibitor sunitinib. We have assessed the effect on tumor response at 6 months, overall survival, progression-free survival and safety of 14 SNPs, and 6 soluble proteins. Forty-three patients were recruited. Two SNPs in the vascular endothelial growth factor receptor 3 (VEGFR-3) gene predicted lower overall survival: rs307826 with hazard ratio (HR) 3.67 (confidence interval [CI] 95%, 1.35-10.00) and rs307821 with HR 3.84 (CI 95%, 1.47-10.0). Interleukin-6 was associated with increased mortality: HR 1.06 (CI 95%, 1.01-1.12), and osteopontin was associated with shorter PFS: HR 1.087 (1.01-1.16), independently of Ki-67. Furthermore, levels of osteopontin remained higher at the end of the study in patients considered non-responders: 38.5 ng/mL vs. responders: 18.7 ng/mL, p-value=0.039. Dynamic upward variations were also observed with respect to IL-8 levels in sunitinib-refractory individuals: 28.5 pg/mL at baseline vs. 38.3 pg/mL at 3 months, p-value=0.024. In conclusion, two VEGFR-3 SNPs as well as various serum biomarkers were associated with diverse clinical outcomes in patients with well-differentiated pancreatic neuroendocrine tumors treated with sunitinib