Factores que inciden en la comprensión lectora

A partir de la reflexión y de la observación, se analiza la necesidad en educación sobre la comprensión lectora; prioridad en esta década. Hoy nadie duda de que haya que enseñar a pensar en la escuela, desde la educación inicial hasta la Universidad

Patients presenting with metastases: stage IV uveal melanoma, an international study

Objective To analyse ocular and systemic findings of patients presenting with systemic metastasis. Methods and analysis It is an international, multicentre, internet-enabled, registry-based retrospective data analysis. Patients were diagnosed between 2001 and 2011. Data included: primary tumour dimensions, extrascleral extension, ciliary body involvement, American Joint Committee on Cancer (AJCC)-tumour, node, metastasis staging, characteristics of metastases. Results Of 3610 patients with uveal melanoma, 69 (1.9%; 95% CI 1.5 to 2.4) presented with clinical metastasis (stage IV). These melanomas originated in the iris, ciliary body and choroid in 4%, 16% and 80% of eyes, respectively. Using eighth edition AJCC, 8 (11%), 20 (29%), 24 (35%), and 17 (25%) belonged to AJCC T-categories T1-T4. Risk of synchronous metastases increased from 0.7% (T1) to 1.5% (T2), 2.6% (T3) and 7.9% (T4). Regional lymph node metastases (N1a) were detected in 9 (13%) patients of whom 6 (67%) had extrascleral extension. Stage of systemic metastases (known for 40 (59%) stage IV patients) revealed 14 (35%), 25 (63%) and 1 (2%) had small (M1a), medium-sized (M1b) and large-sized (M1c) metastases, respectively. Location of metastases in stage IV patients were liver (91%), lung (16%), bone (9%), brain (6%), subcutaneous tissue (4%) and others (5%). Multiple sites of metastases were noted in 24%. Compared with the 98.1% of patients who did not present with metastases, those with synchronous metastases had larger intraocular tumours, more frequent extrascleral extension, ciliary body involvement and thus a higher AJCC T-category. Conclusions Though higher AJCC T-stage was associated with risk for metastases at diagnosis, even small T1 tumours were stage IV at initial presentation. The liver was the most common site of metastases; however, frequent multiorgan involvement supports initial whole-body staging.Ophthalmic researc

La redefinición del espacio público: el caso de las escuelas autogestionadas en Argentina Redefining the public sphere: self-managed schools in Argentina

El Proyecto de las Escuelas Experimentales o Autogestionadas de la Provincia de San Luis adquiere sentido en el marco de la denominada Transformación Educativa y de las políticas desarrolladas en las últimas décadas en Argentina, que, al igual que en gran parte de los países latinoamericanos, han estado orientadas por discursos y prácticas tendientes a legitimar un nuevo modelo económico, social, político, cultural y educativo. La reforma educativa argentina de la década del '90 puede analizarse como una respuesta frente a la crisis de la matriz estado-céntrica que caracterizó la institucionalización y expansión del sistema educativo. El Proyecto de las Escuelas Experimentales en la Provincia de San Luis, inspirado en el modelo de las charter schools de Estados Unidos, es presentado por el Gobierno de la Provincia como un caso precursor en nivel regional en el marco de lo que caracterizan como la "necesaria e imperante reforma de los sistemas educativos". En este sentido, el objetivo de este trabajo es analizar la lógica que orienta el modelo de estas escuelas así como presentar algunas problemáticas centrales vinculadas con el proceso de implementación de la propuesta.<br>The educational reform that took place in Argentina during the '90s was an answer to the crisis of the state-centered model that fostered the expansion of the school system in the XXth. Century. This reform assumed that the solution to improve the quality of education should focus on such issues as: reducing the role of the state in the system assessment; profoundly reforming the school organization; considering new forms of demand-side financing; introducing incentives; giving autonomy to individual schools; involving non-state institutions in policy management; producing information in order to guarantee the freedom of choice; offering new career for teachers based on merit and derogation of the labor statute. Nevertheless, the educational reform should be analyzed in the context of a broader reform process implemented in the whole Latin America in the '90s, aimed at legitimating a new economic, social, political and cultural model. Inspired in the "charter schools" model, the Experimental Schools Project in the Province of San Luis is a leading case in the region of what is characterized as the "necessary and imperative reform of the educational systems". In this context, the aim of this article is both to analyze the logic behind this model and to discuss the main issues of its implementation process

Multicenter, International Assessment of the Eighth Edition of the American Joint Committee on Cancer Cancer Staging Manual for Conjunctival Melanoma

MTG4Molecular tumour pathology - and tumour genetic

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events