Acercamiento a la relación del marketing digital con el consumidor y descripción de la tendencia en Colombia

El presente trabajo contiene una recopilación de las diferentes percepciones que se han establecido a lo largo del tiempo en lo relacionado a Marketing Digital. Constituyéndose como un consolidado que tiene como propósito examinar el vínculo que se presenta con el usuario final y los elementos que se deben tener en cuenta para potencializar su crecimiento y desarrollo en la organización. A través de diversas fuentes, se busca también que el lector pueda extraer una idea concisa y clara del enfoque de este, visualice el impacto que tiene en el individuo y evidencie a grandes rasgos como se está dando el desempeño y funcionamiento de este en el país. Como resultado se obtuvo una apreciación positiva puesto que genera beneficios tanto para el consumidor como para la empresa sin dejar de lado lo crucial que es el cuidado con especial rigurosidad de este lazo de unión.The present work contains a compilation of the different perceptions that have been established throughout the time in relation to Digital Marketing. Constituted as a consolidated whose purpose is to examine the link between the end user and the marketing elements that must be taken into account to enhance their growth and development in the organization. Across diverse sources, it is also intented that the reader can extract a concise and clear idea of the approach of this, visualize the impact that has on the individual and understand in broad outlines the performance in the country. The result obtained show a positive appreciation, since it generates benefits for the consumer and the company, without leaving of side the crucial care that needs to be taken into account with special rigor of this union

A farmers' market in a food desert : evaluating walkability and streetscape as factors of farmers' market effectiveness in food accessibility : the case of Farmers' Market East in Austin, Texas

textFood deserts are defined by absence of large grocery stores to access affordable food that constitute a healthy diet resulting in high levels of obesity, diabetes and cardiovascular diseases in the community. Farmers' markets have resulted as an approach to improving food accessibility in food deserts, however the lack of public transportation, incomplete sidewalks, and dilapidated streetscape in many American neighborhoods, can really affect farmers markets' usage. To answer this question, this research uses the Sustainable Food Center (SFC) Farmers Market East Austin as a case study area to investigate how built environment around the market affect its usage.Community and Regional Plannin

The frequency of rehospitalization and associated factors in Colombian psychiatric patients: a cohort study

BACKGROUND: The rehospitalization of patients with mental disorders is common, with rehospitalization rates of up to 80% observed in these patients. This phenomenon negatively impacts families, patients, and the health care system. Several factors have been associated with an increased likelihood of rehospitalization. This study was aimed at determining the frequency and the factors associated with rehospitalization in a psychiatric clinic. METHODS: We performed a prospective cohort study with 361 patients who were hospitalized at the Clinic of Our Lady of Peace in Bogota, Colombia from August-December 2009. We calculated the incidence rates of rehospitalization and the risk factors using Cox regression. RESULTS: Overall, 60% of the patients in this cohort were rehospitalized during the year that followed the index event. The variables associated with rehospitalization were separated, divorced, or single status; higher socio-economic strata; a longer duration of index hospitalization; and a diagnosis of substance abuse, schizophrenia, bipolar disorder, or depression. CONCLUSIONS: The rehospitalization rate in our study was as high as reported in other studies. The associated factors with it in this group, may contribute to the design of programs that will reduce the frequency of rehospitalization among patients with mental disorders, in countries like Colombia. Additionally, these results may be useful in interventions, such as coping skills training, psycho-education, and community care strategies, which have been demonstrated to reduce the frequency of rehospitalization

It takes a big heart to shape atrophic hepatocytes: Hypoxic hepatitis secondary to congestive heart failure

Introduction: Hypoxic hepatitis (HH) also known as ischemic hepatitis is the result of a hypoperfusion state during diffuse hepatic injury1. The incidence of HH is 2:1000 of patients within any hospital care level. 94% of HH are related to chronic heart failure (HF). In this setting, hepatic dysfunction occurs as a result of passive venous congestion2. The most common predisposing factors are acute heart failure and shock states, however, more than half of the cases are not related to any hemodynamic change, thus, underrecognized. Case description: A 77-year-old woman is admitted to the hospital for acute decompensated HF. She has a medical history of HF with reduced EF of 30%, paroxysmal atrial fibrillation, coronary artery disease with bypass grafting. Medication lists include sacubitril-valsartan, furosemide, metoprolol, and amiodarone. Upon admission, vital signs are within normal limits, she is in mild respiratory distress, with JVD at 3 cm, upper lobe crackles and wheezing on lung fields, and lower extremity non-pitting edema. Laboratory studies showed BUN/Cr 29/1.4 mg/dl, AST 377 IU/L, ALT 295 IU/L, BNP \u3e4500, troponin 0.3, with unremarkable ECG. The patient was started on furosemide, and amiodarone and sacubitril-valsartan are suspended due to suspected hepatic toxicity and acute kidney injury, respectively. Echocardiogram reported EF 20-25% with severe diffuse hypokinesis, RVSP of 54 mmHg, tricuspid valve with moderate-severe regurgitation. The abdominal US with a prominence of the hepatic veins and inferior vena cava. Patient LFTs continued to trend up during hospitalization, with a peak in AST 2080 IU/L, ALT 1371IU/L, ALP 75IU/L, total bilirubin 1.1 mg/dL. Viral serologic markers were negative as well as a workup for autoimmune hepatitis, and primary biliary cholangitis. Gastroenterology is consulted, the patient is initiated on N-Acetylcysteine, and transaminases trended down. Admission Day 3 Day 8 AST 377 2080 69 ALT 295 1371 319 Discussion: The prevalence of hepatic dysfunction in acute HF is 20% to 30%. The mechanism of injury was previously thought to be solely related to HF, however, new studies suggest that patients with underlying liver conditions and even mild hemodynamic changes are predisposed to develop HH. The mechanism involves the liver’s high metabolic demands and oxygen requirements. The hepatocytes compensate for impaired blood flow by increasing oxygen extraction, which may lead to hepatocellular hypoxia and necrosis. HH is diagnosed clinically by three main criteria, 1. Presence of cardiac, circulatory, or pulmonary failure; 2. Severe and transient increase in aminotransferase levels \u3e20 times the upper limit of normal and 3. Exclusion of other possible causes of liver damage. HH is usually self-limited, and aminotransferases trend down within 3-5 days, however fulminant hepatic failure can develop. Management involves treating underlying HF, as there is no specific treatment for HH. In our case, the progression of the HF was the cause that explained the acute increase in transaminases. It is important to keep in mind the gastrointestinal manifestation of HF, furthermore, that even with mild circulatory changes patients can develop HH

Lianas Significantly Reduce Aboveground and Belowground Carbon Storage: A Virtual Removal Experiment

Lianas are a quintessential tropical plant growth-form; they are speciose and abundant in tropical forests worldwide. Lianas compete intensely with trees, reducing nearly all aspects of tree performance. However, the negative effects of lianas on trees have never been combined and quantified for multiple tropical forests. Here, we present the first comprehensive standardized quantification of the effect of lianas on trees across tropical forests worldwide. We used data from 50 liana removal experiments and quantified the effect size of lianas on tree growth, biomass accretion, reproduction, mortality, leaf water potential, sap flow velocity, and leaf area index (LAI) across different forest types. Using a three-level mixed-effect meta-analysis, we found unequivocal evidence that lianas significantly reduce tree growth and biomass accretion in ecological, logging, and silvicultural studies. Lianas also significantly reduce tree reproduction, recruitment, and physiological performance. The relative detrimental effect of lianas on trees does not increase in drier forests, where lianas tend to be more abundant. Our results highlight the substantial liana-induced reduction in tree performance and biomass accumulation, and they provide quantitative data on the effects of lianas on trees that are essential for large-scale plant demographic and ecosystem models that predict forest change and carbon dynamics

Interrupting the Axis: A Case of IgG-4 Related Hypophysitis in a Young Hispanic Male

Background: Hypophysitis refers to inflammation of the pituitary gland that can lead to the disruption of the hypothalamic-pituitary-adrenal axis. Primary hypophysitis has five variants differentiated by histologic findings: lymphocytic, granulomatous, xanthomatous, IgG4-related, and necrotizing. IgG4-related hypophysitis is very rare and is commonly a manifestation of a multi-organ systemic disorder. We present a case of a 43-year-old man presenting with severe headache and symptomatic hyponatremia in the setting of isolated IgG-4 related hypophysitis. Case Presentation: A 43-year-old male presented with a two-day history of severe posterior headache associated with several episodes of vomiting, photophobia, generalized weakness and fatigue. Patient had no history of headaches and denied any recent trauma, focal weakness, altered mentation, changes in vision or seizure activity. Vitals on admission were remarkable for BP 179/99 mmHg. Neurological examination was non-focal, cranial nerves were grossly intact. Labs showed unremarkable CBC, sodium 117 mmol/L, potassium 3.3 mmol/L, chloride 84 mmol/L, glucose 244 mg/d, TSH 0.6 uIU/mL, cortisol 4.6 ug/dL, urine osmolality 540, serum osmolality 259 and prolactin level 7.8. CT head without contrast showed a mass-like enlargement of the Sella measuring 1.6 cm x 1.4 cm suspicious for macroadenoma. Patient was started on hypertonic saline, fludrocortisone, hydrocortisone, and salt tablets in the setting of suspected macroadenoma. Once the patient was stabilized, he underwent transsphenoidal resection of pituitary lesion. Pathology of the lesion showed a small area rich in plasma cells with positive IgG4 immunostaining in most of the plasma cells, consistent with IgG4-related pituitary hypophysitis. Conclusion: IgG4 hypophysitis usually presents in a context of multiple organ IgG4 involvement, however isolated hypophysitis has been reported. The patients present with mass effect symptoms and/or anterior hypopituitarism. When histologic diagnosis is obtained via biopsy, IgG4 hypophysitis can be managed exclusively with corticosteroids

Propuesta de intervención en salud publica

A través de la historia la salud pública ha venido cobrando gran importancia en todo el mundo, es vital para los gobiernos el establecer políticas para reducir la mortalidad y morbilidad de sus poblaciones; prevenir y evitar factores ambientales, sociales y conductuales que provoque enfermedades y que se desencadene en la muerte. Es por lo tanto uno de los grandes retos del país en materia de salud pública generar un equilibrio entre las amplias diferencias que existen en los distintos grupos poblacionales, entender la salud como el resultado coherente y armónico de la interacción entre el individuo, la sociedad y las condiciones de vida en las que se desarrolla. El siguiente proyecto tiene como fin proponer estrategias de intervención en salud, para disminuir las tasas de mortalidad por desnutrición de la población menor a cinco años del Departamento de la Guajira especialmente de la comunidad Wayuu; propuesta basada en los lineamientos del plan decenal de salud pública y los objetivos para el desarrollo sostenible.Public health management project for the prevention of malnutrition in the population under 5 years of age in the department of La Guajir

Condições de possibilidade psicossociais de uma estudante de psicologia com doença motora de origem cerebral

The research was carried out as part of the Bachelor of Psychology at Corporación Universitaria Minuto de Dios—Uniminuto, main campus. The purpose was to understand the conditions of psychosocial possibilities present in the development of the educational process of a psychology student with motor disease of athetosic cerebral origin. In this investigation, the student fulfilled a double role as both the subject of the case study and the research assistant. The methodology of the research included the autobiographical reconstruction of the educational experience in higher education and interviewing important actors in the experience (direct family, classmates, teachers, and administrative staff). In the analysis, based on Foucault (2007) and Courtine (2006), it was established that the discursive practices that uphold the social relationships with people with disabilities include looking at them as though they were monsters, giving them a look of compassion or an empty gaze of subjectivity. From Foucault’s perspective of discourse analysis, three conditions of possibility were identified, such as exercises of resistance to said discursive practices and, at the same time, keys to develop better education processes for diversity: (a) dissolving the correlation between cerebral palsy and cognitive disability, (b) questioning specialized know-how about disability, and (c) overcome the fear of establishing a relationship with diverse bodies.La investigación se llevó a cabo en el Programa de Psicología de la Corporación Universitaria Minuto de Dios – UNIMINUTO – Sede Principal. Tuvo como objetivo  comprender las condiciones de posibilidad psicosociales que estuvieron presentes en el desarrollo del proceso educativo de una estudiante de psicología con enfermedad motora de origen cerebral, tipo atetósica. En esta investigación la estudiante cumplió doble rol al ser el sujeto del estudio de caso y asistente de investigación. La metodología de la investigación contempló la revisión de investigaciones y sistematizaciones de casos similares, la reconstrucción autobiográfica de la experiencia educativa en educación superior, y la realización de entrevistas a los actores significativos de la experiencia. A partir del análisis de las prácticas discursivas desde Foucault se encontraron tres condiciones de posibilidad para desarrollar procesos para la educación para la diversidad: (a) disolver la correlación entre parálisis cerebral y discapacidad cognitiva, (b) cuestionar el saber-hacer especializado sobre la discapacidad, y (c) superar el miedo a relacionarse con los cuerpos diversos.A pesquisa foi realizada no programa de Psicologia da Corporação Universitária Minuto de Dios —Uniminuto—, campus principal. Esta visou compreender as condições de possibilidade psicossociais presentes no desenvolvimento do processo educativo de uma estudante de psicologia com doença motora de origem cerebral atetósica. Nesta pesquisa, a estudante desempenhou um duplo papel como sujeito do estudo de caso e assistente de pesquisa. A metodologia da pesquisa incluiu a reconstrução autobiográfica da experiência educativa no Ensino Superior e a realização de entrevistas aos atores significativos da experiência (núcleo familiar, colegas, professores e administrativos). Na análise, baseada em Foucault (2007) e Courtine (2006), estabelecemos que as práticas discursivas presentes nas relações sociais com as pessoas com deficiência são: o olhar monstruoso, o olhar compassivo e o olhar vazio de subjetividade. Desde a perspectiva foucaultiana da análise do discurso, identificamos três condições de possibilidade, como exercícios de resistência a essas práticas discursivas e, ao mesmo tempo, dicas para desenvolver melhores processos de educação para a diversidade: (a) dissolver a correlação entre paralisia cerebral e deficiência cognitiva; (b) questionar o saber-fazer especializado sobre a deficiência; e (c) vencer o medo a se relacionar com os corpos diversos

Gnathostomosis, an emerging foodborne zoonotic disease in Acapulco, Mexico.

Between 1993 and 1997, 98 gnathostomosis cases were clinically identified in Acapulco, Mexico. Intermittent cutaneous migratory swellings were the commonest manifestation. Larvae were identified in 26 cases, while in 72, final diagnosis was made on the basis of epidemiologic data, food habits, and positive enzyme-linked immunosorbent assay and Western blot results

Unusual case of disseminated Langerhans cell histiocytosis in a young male, a case report

Background: Langerhans cell histiocytosis (LCH), is an uncommon hematological disorder characterized by uncontrolled stimulation and proliferation of normal antigen presenting cells, Langerhans cells. It’s estimated incidence in adults is approximately one to two cases per million. The purpose of this report is to describe the case of LCH in a 21-year-old male with multiple organ involvement including the brain, liver, bone; also, to discuss clinical, radiological, and histopathological features of LCH, and the role of internist in diagnosing and managing such disease. Case presentation: We describe the case of a 21-year-old Hispanic man with Langerhans cell histiocytosis involving his liver, skull, brain, and lungs. Initially patient presented to the hospital with upper GI bleeding. Upon review of his chart, it was found that the patient had previously a skull mass resection with immunohistochemistry confirming Langerhans cells which stain strongly positive for S100, CD 1a and langerin 3 year previous, and also a diagnosis of panhypopituitarism with a brain MRI with a 1 1.4 x 1.5 x 1.4 cm mass within the hypothalamus. Liver biopsy during current admission demonstrated a CD68 positive for histiocytes. Conclusions: This case report might contribute to a better understanding of the pathogenesis of LCH and will help to expand the knowledge of health professionals about this condition