Diseño y aplicación de un manual de técnicas e instrumentos de evaluación, para mejorar el trabajo docente, dentro del proceso de enseñanza aprendizaje de los niños de la escuela de practica “Luìs Napoleòn Dillon” del barrio San Juan, del cantón Pujilì durante el año lectivo 2009- 2010.

El principal objetivo de la presente investigación es mejorar el trabajo docente, dentro del proceso de enseñanza aprendizaje de los niños de la Escuela de Práctica “Luis Napoleón Dillon” del Barrio San Juan, de Cantón Pujilí, lo que permitirá que los docentes tengan un documento en donde se puedan guiar para aplicarlos a los estudiantes, y sea de mucha facilidad al momento de realizar una evaluación. Los objetivos fijados están de acuerdo con el planteamiento del problema para poder tener una orientación y alcanzar resultados. La aplicación de técnicas de observación, encuestas y entrevista, nos ayudo a obtener datos reales como un resultado de los análisis e interpretación de los resultados, sobre los cuales se aplico el diseño de la propuesta para mejorar el proceso enseñanza aprendizaje del estudiante. La presente investigación servirá como un aporte para la institución educativa, pues se determino las falencias así como también la fijación de metas y objetivos por medio de la aplicación de métodos y técnicas basadas en el marco teórico, ayudando en la educación

Patiromer to Enable Spironolactone Use in the Treatment of Patients with Resistant Hypertension and Chronic Kidney Disease: Rationale and Design of the AMBER Study

BACKGROUND: While chronic kidney disease (CKD) is common in resistant hypertension (RHTN), prior studies -evaluating mineralocorticoid receptor antagonists excluded patients with reduced kidney function due to risk of hyperkalemia. AMBER (ClinicalTrials.gov identifier NCT03071263) will evaluate if the potassium-binding polymer patiromer used concomitantly with spironolactone in patients with RHTN and CKD prevents hyperkalemia and allows more persistent spironolactone use for hypertension management. METHODS: Randomized, double-blind, placebo-controlled parallel group 12-week study of patiromer and spironolactone versus placebo and spironolactone in patients with uncontrolled RHTN and CKD. RHTN is defined as unattended systolic automated office blood pressure (AOBP) of -135-160 mm Hg during screening despite taking ≥3 antihypertensives, including a diuretic, and an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker -(unless not tolerated or contraindicated). The CKD inclusion criterion is an estimated glomerular filtration rate (eGFR) of 25 to ≤45 mL/min/1.73 m2. Screening serum potassium must be 4.3-5.1 mEq/L. The primary efficacy endpoint is the between-group difference (spironolactone plus patiromer versus spironolactone plus placebo) in the proportion of patients remaining on spironolactone at Week 12. RESULTS: Baseline characteristics have been analyzed as of March 2018 for 146 (of a targeted 290) patients. Mean (SD) baseline age is 69.3 (10.9) years; 52.1% are male, 99.3% White, and 47.3% have diabetes. Mean (SD) baseline serum potassium is 4.68 (0.25) mEq/L, systolic AOBP is 144.3 (6.8) mm Hg, eGFR is 35.7 (7.7) mL/min/1.73 m2. CONCLUSION: AMBER will define the ability of patiromer to facilitate the use of spironolactone, an effective antihypertensive therapy for patients with RHTN and CKD

UNA EXPERIENCIA DIDÁCTICA CON INCIDENCIA EN LA INTERPRETACIÓN DE GRÁFICAS CINEMÁTICAS

Este artículo da cuenta de una investigación realizada con el objetivo de estudiar la habilidad de interpretación de gráficas cinemáticas. Para alcanzarlo se utilizó el método de investigación-acción, sobre la base del cual, se diseñó, aplicó y evaluó, una secuencia de aprendizaje orientada por el enfoque del desarrollo del pensamiento y lenguaje variacional. Las acciones de interpretación de gráficas estudiadas fueron de dos tipos: locales y globales. Las primeras se centraron en la extracción de datos específicos de velocidad y aceleración, las segundas se refieren al comportamiento global de las gráficas de tales funciones y sus relaciones entre sí. Los resultados obtenidos fueron valorados mediante el método pre-post test, comparando sus interpretaciones al inicio y al final de la aplicación de la secuencia de aprendizaje. Los resultados indican que los estudiantes son capaces de interpretar las propiedades locales de las gráficas, no así de sus propiedades globales, además se notó la preferencia de los estudiantes por utilizar las fórmulas de las funciones o de sus derivadas enlugar de la información variacional subyacente en las gráficas

Treatment with patiromer decreases aldosterone in patients with chronic kidney disease and hyperkalemia on renin-angiotensin system inhibitors

Elevated serum aldosterone can be vasculotoxic and facilitate cardiorenal damage. Renin-angiotensin system inhibitors reduce serum aldosterone levels and/or block its effects but can cause hyperkalemia. Patiromer, a nonabsorbed potassium binder, decreases serum potassium in patients with chronic kidney disease on renin-angiotensin system inhibitors. Here we examined the effect of patiromer treatment on serum aldosterone, blood pressure, and albuminuria in patients with chronic kidney disease on renin-angiotensin system inhibitors with hyperkalemia (serum potassium 5.1–6.5 mEq/l). We analyzed data from the phase 3 OPAL-HK study (4-week initial treatment phase of 243 patients; 8-week randomized withdrawal phase of 107 patients). In the treatment phase, the (mean ± standard error) serum potassium was decreased concordantly with the serum aldosterone (−1.99 ± 0.51 ng/dl), systolic/diastolic blood pressure (−5.64 ± 1.04 mm Hg/−3.84 ± 0.69 mm Hg), and albumin-to-creatinine ratio (−203.7 ± 54.7 mg/g), all in a statistically significant manner. The change in the plasma renin activity (−0.44 ± 0.63 μg/l/hr) was not significant. In the withdrawal phase, mean aldosterone levels were sustained with patiromer (+0.23 ± 1.07 ng/dl) and significantly increased with placebo (+2.78 ± 1.25 ng/dl). Patients on patiromer had significant reductions in mean systolic/diastolic blood pressure (−6.70 ± 1.59/−2.15 ± 1.06 mm Hg), whereas those on placebo did not (−1.21 ± 1.89 mm Hg/+1.72 ± 1.26 mm Hg). Significant changes in plasma renin activity were found only in the placebo group (–3.90 ± 1.41 μg/l/hr). Thus, patiromer reduced serum potassium and aldosterone levels independent of plasma renin activity in patients with chronic kidney disease and hyperkalemia on renin-angiotensin system inhibitors

Enfoque Metodológico para la Gestión de Proyectos Geográficos Alineado con Estándares del PMI para la Empresa H&G Consultores S.A.S.

El presente trabajo se enfoca en el desarrollo de una metodología de estándares para la identificación, planificación, diseño e implementación de una solución orientada a los sistemas de información geográficos (SIG) para la empresa H&G Consultores S.A.S. tomando como base el estándar PMI, que es el encargado de recopilar procesos en el ámbito gerencial, los cuales son revisados y actualizados periódicamente por expertos de todas las disciplinas en el mundo y cuyos lineamientos se consolidan en el PMBOOK, libro que es el pilar de desarrollo investigativo.Corporación Universitaria Minuto de Dio

Effect of patiromer on reducing serum potassium and preventing recurrent hyperkalaemia in patients with heart failure and chronic kidney disease on RAAS inhibitors

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/115921/1/ejhf402_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/115921/2/ejhf402.pd

Long‐term effects of patiromer for hyperkalaemia treatment in patients with mild heart failure and diabetic nephropathy on angiotensin‐converting enzymes/angiotensin receptor blockers: results from AMETHYST‐DN

AimsChronic kidney disease (CKD) in heart failure (HF) increases the risk of hyperkalaemia (HK), limiting angiotensin‐converting enzyme inhibitor (ACE‐I) or angiotensin receptor blocker (ARB) use. Patiromer is a sodium‐free, non‐absorbed potassium binder approved for HK treatment. We retrospectively evaluated patiromer’s long‐term safety and efficacy in HF patients from AMETHYST‐DN.Methods and resultsPatients with Type 2 diabetes, CKD, and HK [baseline serum potassium >5.0–5.5 mmol/L (mild) or >5.5–88%) and moderate (≥73%) HK had normokalaemia at each visit from Weeks 12 to 52. Three HF patients were withdrawn because of high (n = 1) or low (n = 2) serum potassium. The most common patiromer‐related adverse event was hypomagnesaemia (8.6%).ConclusionsIn patients with a clinical diagnosis of HF, diabetes, CKD, and HK on ACE‐I/ARB, patiromer was well tolerated and effective for HK treatment over 52 weeks.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145406/1/ehf212292.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145406/2/ehf212292_am.pd

Peginesatide in patients with anemia undergoing hemodialysis

BACKGROUND: Peginesatide, a synthetic peptide-based erythropoiesis- stimulating agent (ESA), is a potential therapy for anemia in patients with advanced chronic kidney disease. METHODS: We conducted two randomized, controlled, open-label studies (EMERALD 1 and EMERALD 2) involving patients undergoing hemodialysis. Cardiovascular safety was evaluated by analysis of an adjudicated composite safety end point - death from any cause, stroke, myocardial infarction, or serious adverse events of congestive heart failure, unstable angina, or arrhythmia - with the use of pooled data from the two EMERALD studies and two studies involving patients not undergoing dialysis. In the EMERALD studies, 1608 patients received peginesatide once monthly or continued to receive epoetin one to three times a week, with the doses adjusted as necessary to maintain a hemoglobin level between 10.0 and 12.0 g per deciliter for 52 weeks or more. The primary efficacy end point was the mean change from the baseline hemoglobin level to the mean level during the evaluation period; noninferiority was established if the lower limit of the two-sided 95% confidence interval was -1.0 g per deciliter or higher in the comparison of peginesatide with epoetin. The aim of evaluating the composite safety end point in the pooled cohort was to exclude a hazard ratio with peginesatide relative to the comparator ESA of more than 1.3. RESULTS: In an analysis involving 693 patients from EMERALD 1 and 725 from EMERALD 2, peginesatide was noninferior to epoetin in maintaining hemoglobin levels (mean between-group difference, -0.15 g per deciliter; 95% confidence interval [CI], -0.30 to -0.01 in EMERALD 1; and 0.10 g per deciliter; 95% CI, -0.05 to 0.26 in EMERALD 2). The hazard ratio for the composite safety end point was 1.06 (95% CI, 0.89 to 1.26) with peginesatide relative to the comparator ESA in the four pooled studies (2591 patients) and 0.95 (95% CI, 0.77 to 1.17) in the EMERALD studies. The proportions of patients with adverse and serious adverse events were similar in the treatment groups in the EMERALD studies. The cardiovascular safety of peginesatide was similar to that of the comparator ESA in the pooled cohort. CONCLUSIONS: Peginesatide, administered monthly, was as effective as epoetin, administered one to three times per week, in maintaining hemoglobin levels in patients undergoing hemodialysisSupported by Affymax and Takeda Pharmaceutica

Performance/outcomes data and physician process challenges for practical big data efforts in radiation oncology

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146290/1/mp13136.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146290/2/mp13136_am.pd

Elevated cerebrospinal fluid pressure in patients with Alzheimer's disease

BACKGROUND: Abnormalities in cerebrospinal fluid (CSF) production and turnover, seen in normal pressure hydrocephalus (NPH) and in Alzheimer's disease (AD), may be an important cause of amyloid retention in the brain and may relate the two diseases. There is a high incidence of AD pathology in patients being shunted for NPH, the AD-NPH syndrome. We now report elevated CSF pressure (CSFP), consistent with very early hydrocephalus, in a subset of AD patients enrolled in a clinical trial of chronic low-flow CSF drainage. Our objective was to determine the frequency of elevated CSFP in subjects meeting National Institutes of Neurological and Communicative Diseases and Stroke – Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for AD, excluding those with signs of concomitant NPH. METHODS: AD subjects by NINCDS-ADRDA criteria (n = 222), were screened by history, neurological examination, and radiographic imaging to exclude those with clinical or radiographic signs of NPH. As part of this exclusion process, opening CSFP was measured supine under general anesthesia during device implantation surgery at a controlled pCO(2 )of 40 Torr (40 mmHg). RESULTS: Of the 222 AD subjects 181 had pressure measurements recorded. Seven subjects (3.9%) enrolled in the study had CSFP of 220 mmH(2)0 or greater, mean 249 ± 20 mmH(2)0 which was significantly higher than 103 ± 47 mmH(2)O for the AD-only group. AD-NPH patients were significantly younger and significantly less demented on the Mattis Dementia Rating Scale (MDRS). CONCLUSION: Of the AD subjects who were carefully screened to exclude those with clinical NPH, 4% had elevated CSFP. These subjects were presumed to have the AD-NPH syndrome and were withdrawn from the remainder of the study