AGA Clinical Practice Update on interventional EUS for vascular investigation and therapy: Commentary

DESCRIPTION: The purpose of this AGA Institute Clinical Practice Update is to review the available evidence supporting and examine opportunities for future research in endoscopic ultrasound-guided vascular investigation and therapies. METHODS: This Clinical Practice Update was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This expert commentary incorporates important as well as recently published studies in this field, and it reflects the experiences of the authors who are advanced endoscopists with expertise in endoscopic ultrasound-guided vascular investigation and therapy

Contaminación del agua por plomo, en el Cantón Sitio del Niño, La Libertad.

En el cantón Sitio del Niño, ubicado en el municipio de San Juan Opico, la Unidad de Salud Sitio del Niño reportó, durante la década de los dos mil, varios cuadros clínicos de pacientes que presentaban síntomas de intoxicación por plomo, metal pesado que puede generar diversos problemas de salud al ser altamente tóxico. Habitantes de esta región manifestaron en repetidas ocasiones, a diversas autoridades, que la fábrica de Baterías de El Salvador S.A. de C.V. conocida popularmente como “Baterías Record” era responsable de la contaminación ambiental que se estaba dando. Luego de muchos esfuerzos, se llevó a cabo una investigación de campo en la zona y se comprobó que la contaminación por plomo provenía de dicha fábrica; la cual fue cerrada en el año 2007. Sin embargo, el problema no se solucionó apropiadamente, los culpables huyeron de responsabilidades y dejaron todo al estado; el Ministerio de Salud (MINSAL) como encargado del saneamiento de la zona no realizó el procedimiento más urgente y costoso: el aseguramiento de los restos de la zona. El desastre se convirtió en una fuente de contaminación de los mantos acuíferos. A raíz de este desastre ambiental instituciones públicas y académicas llevaron a cabo distintos análisis para detectar plomo en aire, suelo y agua, razón por la cual en este trabajo se realizó una investigación bibliográfica de los estudios de plomo realizados en el periodo comprendido entre 2007 al 2020, en la cual se comparan los niveles de plomo encontrados en cada año e identificar de esta forma si existe un patrón de evolución, lo cual permite valorar a través del tiempo el desastre ambiental causado por la empresa, así mismo explicar las consecuencias generadas por la contaminación con plomo y evaluar el riesgo de intoxicación por agua en esta región

Phage inhibit pathogen dissemination by targeting bacterial migrants in a chronic infection model

The microbial communities inhabiting chronic infections are often composed of spatially organized micrometer-sized, highly dense aggregates. It has recently been hypothesized that aggregates are responsible for the high tolerance of chronic infections to host immune functions and antimicrobial therapies. Little is currently known regarding the mechanisms controlling aggregate formation and antimicrobial tolerance primarily because of the lack of robust, biologically relevant experimental systems that promote natural aggregate formation. Here, we developed an in vitro model based on chronic Pseudomonas aeruginosa infection of the cystic fibrosis (CF) lung. This model utilizes a synthetic sputum medium that readily promotes the formation of P. aeruginosa aggregates with sizes similar to those observed in human CF lung tissue. Using high-resolution imaging, we exploited this model to elucidate the life history of P. aeruginosa and the mechanisms that this bacterium utilizes to tolerate antimicrobials, specifically, bacteriophage. In the early stages of growth in synthetic sputum, planktonic cells form aggregates that increase in size over time by expansion. In later growth, migrant cells disperse from aggregates and colonize new areas, seeding new aggregates. When added simultaneously with phage, P. aeruginosa was readily killed and aggregates were unable to form. When added after initial aggregate formation, phage were unable to eliminate all of the aggregates because of exopolysaccharide production; however, seeding of new aggregates by dispersed migrants was inhibited. We propose a model in which aggregates provide a mechanism that allows P. aeruginosa to tolerate phage therapy during chronic infection without the need for genetic mutation

Modelo de gestión de recursos humanos para mejorar la idoneidad del personal operativo de la planta de producción de la empresa Unimuebles S.A. de C.V. del municipio de San Salvador.

La empresa UNIMUEBLES, S.A. DE C.V. que se dedica la producción y comercialización de productos muebles como juegos de sala y sus accesorios se ve en la necesidad de estandarizar todos los procesos debido a su crecimiento rentable y firme presenta deficiencias al no contar con un proceso previamente establecido que garantice la integración de personal idóneo y que suministre eficiencia en la utilización de los recursos. A consecuencia de ello el tema de estudio nace a partir de la necesidad de estandarizar todos los procesos vinculados con la gestión del talento humano, al no contar con un modelo de gestión de recursos humanos, ha representado deficiencias significativas hasta su actualidad, lo que ha generado uso deficiente de los recursos limitando así su competitividad. Uno de los objetivos de esta investigación es proponer un modelo de gestión de recursos humanos para mejorar la idoneidad del personal operativo de la planta de producción de la empresa UNIMUEBLES, S.A. DE C.V. por medio de la creación del departamento de recursos humanos que permita el diseño y mejoramiento de los procedimientos de la empresa en cuanto al talento humano y su desempeño. A través de herramientas técnico-administrativas que contribuyan al alcance de los objetivos planteados por la empresa. La metodología empleada para el desarrollo de esta investigación fue de tipo científica donde además se hizo de una base teórica que permitió contextualizar la gestión de recursos humanos en referencia la idoneidad del personal, así como su desempeño y formación donde el tipo de investigación fue descriptiva. Y se utilizó técnicas y herramientas para poder recolectar la información como el cuestionario y la entrevista otorgando un panorama amplio y certero. Desde un inicio el personal que se consideraba como candidato para ocupar un puesto ha sido integrado por la entidad de manera informal siendo este proceso deficiente o carente de este, sin el uso ni aplicación de instrumentos o herramientas adecuadas que respalden la idoneidad de su perfil para el puesto. Los empleados al momento de su vinculación con la organización recibieron variantes de la información, por lo tanto, es necesario que exista un documento oficial, en donde este escrito información útil sobre la empresa, como los beneficios, filosofía organizacional así objetivos que se persiguen, documento que tiene que ser compartido de manera estándar a todo el personal nuevo que ingrese a la empresa. Los empleados no son capacitados en ninguna de las áreas ii relacionadas a mejorar su rendimiento o en implementar nuevas técnicas que puedan facilitar y mejorar su trabajo en el área operativa de la empresa. Se propone la creación de un departamento de recursos humanos responsable de los todos los procesos relacionados a la gestión administrativa del personal como su integración y la creación de un manual de inducción y bienvenida. Además de la creación de instrumento relacionado con la evaluación del desempeño a fin de determinar programas de capacitación que mejores la eficiencia de todos los recursos de la organización

Representations of Utopian Urbanism and the Feminist Geopolitics of ‘New City’ Development

Increasingly over the past few years the building of new cities “from scratch” has become a key strategy to promote development across much of the Global South. While several projects are currently under construction, many others exist primarily as proposals awaiting adequate investment or government action. This paper builds on previous literature that considers representations of such projects – promotional materials, digitally-produced video simulations, and master plans – as key components in the production of imagined urban futures. Through an exploration of the proposed Zone for Economic Development and Employment (ZEDE) in Honduras, this article demonstrates a feminist geopolitical approach focused on how such representations of utopian urbanism circulate through the local communities slated for new city development. I examine how representations of future urban spaces and future urban governance regimes become appropriated by local residents in organizing opposition or otherwise making sense of the proposed project’s potential impact on their lives.12 month embargo; published online: 30 Dec 2018This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Estrategias metodológicas para el desarrollo de la competencia “lenguaje matemático” en tercer grado de educación básica

El presente informe tiene por objetivo principal describir las estrategias metodológicas para el desarrollo de la competencia Comunicación con Lenguaje Matemático que implementan los docentes de tercer grado de Educación Básica al impartir la asignatura de Matemática. También, identificar las estrategias más utilizadas por los docentes que propician dicho desarrollo. Así mismo, identificar el nivel de desarrollo de cada habilidad que comprende esta competenci

Asymptomatic bacteriuria in sickle cell disease: a cross-sectional study

BACKGROUND: It is known that there is significant morbidity associated with urinary tract infection and with renal dysfunction in sickle cell disease (SCD). However, it is not known if there are potential adverse outcomes associated with asymptomatic bacteriuria (ASB) infections in sickle cell disease if left untreated. This study was undertaken to determine the prevalence of ASB, in a cohort of patients with SCD. METHODS: This is a cross-sectional study of patients in the Jamaican Sickle Cell Cohort. Aseptically collected mid-stream urine (MSU) samples were obtained from 266 patients for urinalysis, culture and sensitivity analysis. Proteinuria was measured by urine dipsticks. Individuals with abnormal urine culture results had repeat urine culture. Serum creatinine was measured and steady state haematology and uric acid concentrations were obtained from clinical records. This was completed at a primary care health clinic dedicated to sickle cell diseases in Kingston, Jamaica. There were 133 males and 133 females in the sample studied. The mean age (mean ± sd) of participants was 26.6 ± 2.5 years. The main outcome measures were the culture of ≥ 10(5 )colony forming units of a urinary tract pathogen per milliliter of urine from a MSU specimen on a single occasion (probable ASB) or on consecutive occasions (confirmed ASB). RESULTS: Of the 266 urines collected, 234 were sterile and 29 had significant bacteriuria yielding a prevalence of probable ASB of 10.9% (29/266). Fourteen patients had confirmed ASB (prevalence 5.3%) of which 13 had pyuria. Controlling for genotype, females were 14.7 times more likely to have confirmed ASB compared to males (95%CI 1.8 to 121.0). The number of recorded visits for symptomatic UTI was increased by a factor of 2.5 (95% CI 1.4 to 4.5, p < 0.005) but serum creatinine, uric acid and haematology values were not different in patients with confirmed ASB compared with those with sterile urine. There was no association with history of gram negative sepsis. CONCLUSION: ASB is a significant problem in individuals with SCD and may be the source of pathogens in UTI. However, further research is needed to determine the clinical significance of ASB in SCD

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London