Evaluación del nivel del Riesgo de Desastres en la Institución Educativa Conchucos ante la ocurrencia de una Inundación – Conchucos 2016

La tesis tiene como objetivo general: Analizar el nivel del riesgo de desastres en la Institución Educativa Conchucos ante la ocurrencia de una inundación – Conchucos 2016. La población estuvo representada por los 393 estudiantes, 54 trabajadores y 8 miembros de la APAFA. La muestra obtenida de los alumnos fue de 195; a los trabajadores ni miembros de la APAFA se les aplicó la fórmula ya que se esperaba trabajar con todos pero solo estuvieron presenten 30 trabajadores y 5 miembros de la APAFA. Los instrumentos empleados para recolectar los datos, fueron un cuestionario estandarizado y dos listas de comprobación. Para procesar los datos se hizo uso del programa SPSS 20 y para poder determinar el nivel del riesgo, vulnerabilidad y peligrosidad de la institución se siguió la metodología tomada del Manual para la Evaluación de Riesgos originados por Fenómenos Naturales - CENEPRED, 2014. El resultado obtenido corrobora la hipótesis general, ya que el riesgo de la institución educativa es de nivel alto (valor de 0.0408). Se concluye que el nivel del riesgo de desastres de la Institución Educativa Conchucos ante la ocurrencia de una inundación es alto, ya que se obtuvo un valor de 0.0408, que al ser contrastado en la matriz de riesgo se ubica en el rango de nivel alto (0.018 ≤ R < 0.068). En consecuencia la Institución Educativa Conchucos, está propensa a sufrir fuertes daños ante la ocurrencia de una inundación

Measurement Properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain:A Systematic Review

Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), and Pain Severity subscale of the Brief Pain Inventory (BPI-PS)] are the most frequently used instruments to measure pain intensity in low back pain (LBP). However, their measurement properties in this population have not been systematically reviewed. The goal of this study was to provide such systematic evidence synthesis. Six electronic sources (MEDLINE, EMBASE, CINAHL, PsycINFO, SportDiscus, Google Scholar) were searched (July 2017). Studies assessing any measurement property in patients with non-specific LBP were included. Two reviewers independently screened articles and assessed risk of bias using the COSMIN checklist. For each measurement property: evidence quality was rated as high, moderate, low, or very low (GRADE approach); results were classified as sufficient, insufficient or inconsistent. Ten studies assessed the VAS, 13 the NRS, four the BPI-PS. The three instruments displayed low or very low quality evidence for content validity. High quality evidence was only available for NRS insufficient measurement error. Moderate evidence was available for: NRS inconsistent responsiveness, BPI-PS sufficient structural validity and internal consistency, and BPI-PS inconsistent construct validity. All VAS measurement properties were underpinned by no, low or very low quality evidence, likewise the other measurement properties of NRS and BPI-PS

Monitoring the South African National Antiretroviral Treatment Programme, 2003-2007: the IeDEA Southern Africa collaboration.

OBJECTIVES: To introduce the combined South African cohorts of the International epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration as reflecting the South African national antiretroviral treatment (ART) programme; to characterise patients accessing these services; and to describe changes in services and patients from 2003 to 2007. DESIGN AND SETTING: Multi-cohort study of 11 ART programmes in Gauteng, Western Cape, Free State and KwaZulu-Natal. SUBJECTS: Adults and children (<16 years old) who initiated ART with > or =3 antiretroviral drugs before 2008. RESULTS: Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17,835 patients per site. Among 45,383 adults and 6,198 children combined, median age (interquartile range) was 35.0 years (29.8-41.4) and 42.5 months (14.7-82.5), respectively. Of adults, 68% were female. The median CD4 cell count was 102 cells/microl (44-164) and was lower among males than females (86, 34-150 v. 110, 50-169, p<0.001). Median CD4% among children was 12% (7-17.7). Between 2003 and 2007, enrolment increased 11-fold in adults and 3-fold in children. Median CD4 count at enrolment increased for all adults (67-111 cells/microl, p<0.001) and for those in stage IV (39-89 cells/microl, p<0.001). Among children <5 years, baseline CD4% increased over time (11.5-16.0%, p<0.001). CONCLUSIONS: IeDEA-SA provides a unique opportunity to report on the national ART programme. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting

Everolimus Exposure as a Predictor of Toxicity in Renal Cell Cancer Patients in the Adjuvant Setting: Results of a Pharmacokinetic Analysis for SWOG S0931 (EVEREST), a Phase III Study (NCT01120249).

BackgroundS0931 is assessing recurrence-free survival in renal cell carcinoma (RCC) patients randomized to receive everolimus (EVE) versus placebo for one year following nephrectomy. Due to a higher than expected dropout rate, we assessed EVE trough levels in the adjuvant setting to evaluate the relationship between EVE exposure and probability of toxicity.MethodsPatients received 10 mg daily EVE for nine 6-week cycles. Pre-dose whole blood samples were collected pre-cycle 2 and pre-cycle 3 and analyzed for EVE. Patients with pre-cycle 2 and/or pre-cycle 3 EVE results were used in the analysis. Patients were segregated into quartiles (Q) based on EVE levels and logistic regression was used to model the most common adverse event outcomes using EVE trough as a predictor. Hazard and odds ratios were adjusted for age, BMI and performance status.ResultsA total of 467 patients were included in this analysis. Quartiles normalized to an EVE dose of 10 mg/day were &lt; 9.0, 9.0-12.9, 12.9-22.8, and &gt; 22.8 ng/mL, respectively. EVE trough levels increased with increasing age (p &lt; 0.001). Furthermore, EVE trough levels were higher in men than women (19.4 versus 15.4 ng/mL, p = 0.01). Risk of grade 2 + triglycerides was increased in Q2 and Q3 vs Q1 (OR = 2.08; p = 0.02 and OR = 2.63; p = 0.002). Risk of grade 2 + rash was increased in Q2 and Q4 vs Q1 (OR = 2.99; p = 0.01 and OR = 2.90; p = 0.02). There was also an increased risk of any grade 3 + tox in Q2 vs Q1 (OR = 1.71; p = 0.05).ConclusionsWe identified significant gender and age-related differences in EVE trough levels in patients receiving adjuvant treatment for RCC. Furthermore, our analysis identified significant associations between EVE exposure and probability of toxicity

Creating a Vision for SEAS Properties

The University of Michigan’s School for Environment and Sustainability (SEAS) currently owns 1,761 acres across six properties in Southeastern Michigan, including Saginaw Forest, Stinchfield Woods, Newcomb Tract, St. Pierre Wetland, Harper Preserve, and Ringwood Forest. These natural areas accompany various satellite properties owned or managed by other University departments, existing as part of a broad patchwork of preserved property across the state of Michigan. The diverse array of habitats across the sites and vast networks of local and regional stakeholders present a unique opportunity to reexamine the goals and management plans for these properties, and to further demonstrate the University’s commitment to land preservation, sustainable stewardship, and carbon neutrality. With these goals in mind, our team utilized several interdisciplinary research methods during the course of this project, largely consisting of carbon sequestration and storage analyses, remote sensing and GIS, and social research considerations. Over the past year, these approaches were used to arrive at holistic, concrete recommendations for both current and future property uses and considerations, which will lay the groundwork for forthcoming SEAS masters projects at each specific property. Our results point towards a wealth of new management and utilization objectives, including carbon neutrality and pricing, stewardship program initiatives, joint management models with land conservancies, and expanded opportunities for engagement with U-M faculty and students, local and regional institutions and organizations, and the general public.Master of ScienceSchool for Environment and SustainabilityUniversity of Michiganhttps://deepblue.lib.umich.edu/bitstream/2027.42/154880/1/372 Creating A Vision For SEAS Properties.pd

Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation

Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. METHODS: This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. DISCUSSION: We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health

Assessing the effect of interventions for axial spondyloarthritis according to the endorsed ASAS/OMERACT core outcome set: a meta-research study of trials included in Cochrane reviews.

The Assessment of SpondyloArthritis international Society (ASAS) has defined core sets for (i) symptom-modifying anti-rheumatic drugs (SM-ARD), (ii) clinical record keeping, and (iii) disease-controlling anti-rheumatic therapy (DC-ART). These include the following domains for all three core sets: physical function, pain, spinal mobility, spinal stiffness, and patient\u27s global assessment (PGA). The core set for clinical record keeping further includes the domains peripheral joints/entheses and acute phase reactants, and the core set for DC-ART further includes the domains fatigue and spine radiographs/hip radiographs. The Outcome Measures in Rheumatology (OMERACT) endorsed the core sets in 1998.Using empirical evidence from axSpA trials, we investigated the efficacy (i.e., net benefit) according to the ASAS/OMERACT core outcome set for axSpA across all interventions tested in trials included in subsequent Cochrane reviews. For all continuous scales, we combined data using the standardized mean difference (SMD) to meta-analyze outcomes involving the same domains. Also, through meta-regression analysis, we examined the effect of the separate SMD measures (independent variables) on the primary endpoint (log [OR], dependent variable) across all trials.Based on 11 eligible Cochrane reviews, from these, 85 articles were screened; we included 43 trials with 63 randomized comparisons. Mean (SD) number of ASAS/OMERACT core outcome domains measured for SM-ARD/physical therapy trials was 4.2 (1.7). Six trials assessed all proposed domains. Mean (SD) for number of core outcome domains for DC-ART trials was 5.8 (1.7). No trials assessed all nine domains. Eight trials (16%) were judged to have inadequate (i.e., high risk of) selective outcome reporting bias. The most responsible core domains for achieving success in meeting the primary objective per trial were pain, OR (95% CI) 5.19 (2.28, 11.77), and PGA, OR (95% CI) 1.87 (1.14, 3.07). In conclusion, selective outcome reporting (and missing data ) should be reduced by encouraging the use of the endorsed ASAS/OMERACT outcome domains in clinical trials. Overall outcome reporting was good for SM-ARD/physical therapy trials and poor for DC-ART trials. Our findings suggest that both PGA and pain provide a valuable holistic construct for the assessment of improvement beyond more objective measures of spinal inflammation

Consensus of the definitions of the OMERACT glucocorticoid impact core domain set for people with rheumatic and musculoskeletal diseases

Background: The Outcome Measures in Rheumatology (OMERACT) Glucocorticoid (GC) Impact Working Grouphas been working to develop a core domain set to measure the impact of GCs on patients living with rheumaticand musculoskeletal diseases. The mandatory domains previously identified for inclusion in all clinical trialsmeasuring the GC effects include infection, bone fragility, mood disturbance, hypertension, diabetes, weight,fatigue, and mortality. Before progressing to instrument selection, the Working Group sought to establish precisedefinitions of all mandatory domains within the core domain set.Methods: OMERACT methodology was applied with the use of evidence and consensus-based decision making ofall stakeholder groups (patient research partners, health care professionals, clinician researchers, industrymembers and methodologists) to develop detailed definitions for the broad domain, target domain and domaincomponents, taking into consideration sources of variability that could affect measurement of the domain. Theworking group synthesized prior qualitative studies, quantitative work, and results from Delphi rounds, todevelop a rich definition of ‘what’ is to be measured.Results: Between 2021 and 2023, the OMERACT Working Group on GC Impact conducted virtual meetings toestablish domain definitions. First, we mapped each domain onto an OMERACT Core Area. All domains wereprimarily represented within the Pathophysiological Manifestations Core Area, except from Fatigue which wasprimarily Life Impact and Weight which spanned both Core Areas. Sources of variability included cultural factors, age, gender, education level, socioeconomic status, personal experiences, emotional state, and languagebarriers. The domain definitions will form the foundation for instrument selection and the initial step of domain /concept match and content validity in the OMERACT pillar of ‘truth’ before moving on to feasibility anddiscrimination.Conclusion: The OMERACT GC Impact Working Group has developed and agreed upon detailed domain definitions for core domains. Future steps of the working group are to select instruments and develop the core outcom

Equity in evidence synthesis : you can’t play on broken strings

Peer reviewe

GERMINAÇÃO DE SEMENTES DE CAFEEIRO SUBMETIDAS A DIFERENTES TRATAMENTOS DE REMOÇÃO DO PERGAMINHO

Objetivou-se com esse trabalho avaliar métodos alternativos para a remoção do pergaminho de sementes de cafeeiro. O experimento foi conduzido em delineamento inteiramente casualizado, com seis tratamentos e quatro repetições de 100 sementes. Foram utilizadas sementes de Coffea arabica L., cultivar Arara, obtidas de frutos no estádio cereja, colhidos manualmente. Os tratamentos foram: imersão das sementes em hipoclorito de sódio 5% durante 6h, imersão em álcool 70% por 6h, imersão em calda de limão durante 6h, imersão em água por 24h, sementes intactas (com pergaminho) e remoção manual do pergaminho. O tratamento com hipoclorito de sódio na concentração de 5% apresentou resultados promissores, podendo substituir o método de remoção manual do pergaminho utilizado rotineiramente por produtores e pesquisadores para acelerar a germinação. Para os demais tratamentos, as substâncias não demonstraram capacidade de remoção do pergaminho.  Palavras-chave: Coffea arabica L., pergaminho, hipoclorito de sódio