Impacto de la jornada ?nica escolar en la instituci?n educativa la reforma de Rovira Tolima

60 p. Recurso Electr?nicoLa jornada ?nica nace como una estrategia del plan nacional de desarrollo 2014-2018 que tiene como objetivo garantizar un mejor futuro para el pa?s. En Colombia son muy pocas las investigaciones que han estudiado los resultados de esta pol?tica educativa. A trav?s de la presente investigaci?n se realiz? un estudio en el que se determinaron dos variables (social y acad?mica) para evaluar el impacto de la jornada ?nica en los niveles de b?sica y media de la sede central de la Instituci?n Educativa La Reforma de Rovira Tolima, luego de un a?o de su implementaci?n. Para esto se analizaron y contrastaron los beneficios y dificultades que ha generado la implementaci?n de la Jornada ?nica en este plantel educativo, as? como la inversi?n que el estado ha suministrado en la ejecuci?n de la misma y la visi?n que tiene la comunidad educativa sobre la extensi?n del horario escolar en esta instituci?n. Palabras claves: Jornada ?nica, Impacto, Estrategia, Horario escolarSingle-shift school system is born like a 2014-2018 National Development Plan strategy that aims to guarantee a better future for the nation. In Colombia, very few researches have studied the results of this educational policy. Through the present investigation a study was carried out in which two variables (academic and social) were determined to evaluate the Single School Day impact in grades 6th to 11th from La Reforma School headquarters in Rovira Tolima after a year of its implementation. For this, benefits and difficulties generated by the single-shift school implementation in this educational establishment were analyzed and contrasted, as well as the investment that state has provided in its execution and vision that community has about the school schedule extension. Keywords: Single School Day, Impact, Strategy, School schedul

Reconocimiento de la tradici?n constructiva y la cultura habitacional de la comunidad ind?gena Mesa de Cucuana Aceituno en Ortega Tolima

348 p. Recurso Electr?nicoEste proyecto de grado busca reconocer la tradici?n constructiva y la cultura habitacional de la comunidad ind?gena Mesa de Cucuana Aceituno, en el Municipio de Ortega, Departamento del Tolima; para preservar las din?micas socio-espaciales de la poblaci?n del cabildo, que a trav?s de los a?os han venido desapareciendo a ra?z de diferentes factores. Con la finalidad de ofrecerles a los habitantes de la comunidad ind?gena una alternativa de vivienda acorde a sus modos de vida y din?micas espaciales tradicionales; y as? ayudar a subsanar el d?ficit tanto cualitativo como cuantitativo presente actualmente en la comunidad, se plantea el reconocimiento de la habitabilidad mediante la investigaci?n meticulosa para desarrollar una propuesta coherente con lo descrito anteriormente. De esta manera, el trabajo se desarrolla en tres etapas: Reconocimiento de las t?cnicas tradicionales, procesos y materialidad en la construcci?n de viviendas propias del territorio ind?gena de Mesa de Cucuana Aceituno. Seguidamente, el estudio y an?lisis de los modos de vida, costumbres y tradiciones de la habitabilidad de la poblaci?n con respecto a sus viviendas y el entorno donde se encuentran emplazadas. Finalmente, a partir de todo el reconocimiento desarrollado, plantear el dise?o arquitect?nico y urban?stico de una propuesta de agrupaci?n de viviendas junto con tres modelos de vivienda ind?gena acordes con sus costumbres y tradiciones, respetando su cultura habitacional y las condiciones de su entorno; por ?ltimo, proyectar un esquema b?sico del dise?o de un equipamiento social y sede del Cabildo Mesa de Cucuana Aceituno, como espacio complementario a la vivienda.This degree seeks to recognize the traditional construction and residential culture of the indigenous community Mesa of Cucuana Aceituno, in the municipality of Ortega, Department of Tolima; to preserve the socio-spatial dynamics of the population of the Town Hall, that through the years have been disappearing as a result of various factors. With the purpose of offer you to the inhabitants of the community indigenous an alternative of housing according to their modes of life and dynamic space traditional; and thus help to remedy the deficit both qualitative as quantitative present currently in the community. In this way, the work develops in three stages: recognition of traditional techniques, processes and material in the construction of houses of the indigenous territory of Mesa of Cucuana Aceituno. Then, the study and analysis of the ways of life, customs and traditions of the habitability of the population with regard to their homes and the environment where they are placed. Finally, through the design architectural and urban project three models of housing indigenous chords with their customs and traditions, a proposed of grouping of housing, respecting its culture housing and the conditions of its environment, and, finally, a scheme basic of the design of an equipment social and headquarters of the Cabildo Mesa of Cucuana Aceituno, as space complementary to it housing. Key words: Indigenous housing, liveability, constructive traditio

Regulatory T cells participate in the recovery of ischemic stroke patients

BACKGROUND: Recent preclinical studies have shown that regulatory T cells (Treg) play a key role in the immune response after ischemic stroke (IS). However, the role of Treg in human acute IS has been poorly investigated. Our aim was to study the relationship between circulating Treg and outcome in human IS patients. METHODS: A total of 204 IS patients and 22 control subjects were recruited. The main study variable was good functional outcome at 3 months (modified Rankin scale </=2) considering infarct volume, Early Neurological Deterioration (END) and risk of infections as secondary variables. The percentage of circulating Treg was measured at admission, 48, 72 h and at day 7 after stroke onset. RESULTS: Circulating Treg levels were higher in IS patients compared to control subjects. Treg at 48 h were independently associated with good functional outcome (OR, 3.5; CI: 1.9-7.8) after adjusting by confounding factors. Patients with lower Treg at 48 h showed higher frequency of END and risk of infections. In addition, a negative correlation was found between circulating Treg at 48 h (r = - 0.414) and 72 h (r = - 0.418) and infarct volume. CONCLUSIONS: These findings suggest that Treg may participate in the recovery of IS patients. Therefore, Treg may be considered a potential therapeutic target in acute ischemic stroke

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis

Identifying the complexities of the effect of sex on stroke risk, etiology, and lesion progression may lead to advances in the treatment and care of ischemic stroke (IS) and non-traumatic intracerebral hemorrhage patients (ICH). We studied the sex-related discrepancies on the clinical course of patients with IS and ICH, and we also evaluated possible molecular mechanisms involved. The study's main variable was the patient's functional outcome at 3-months. Logistic regression models were used in order to study the influence of sex on different inflammatory, endothelial and atrial dysfunction markers. We recruited 5,021 patients; 4,060 IS (54.8% male, 45.2% female) and 961 ICH (57.1% male, 42.9% female). Women were on average 5.7 years older than men (6.4 years in IS, 5.1 years in ICH), and more likely to have previous poor functional status, to suffer atrial fibrillation and to be on anticoagulants. IS patients showed sex-related differences at 3-months regarding poorer outcome (55.6% women, 43.6% men, p < 0.0001), but this relationship was not found in ICH (56.8% vs. 61.9%, p = 0.127). In IS, women had higher levels of NT-proBNP and 3-months worse outcome in both cardioembolic and non-cardioembolic stroke patients. Stroke patients showed sex-related differences in pre-hospital data, clinical variables and molecular markers, but only IS patients presented independent sex-related differences in 3-months poor outcome and mortality. There was a relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, resulting in a possible indicator of increased dysfunction

Elaboraci?n e implementaci?n de un Cuadro de Mandos para el control y monitoreo de las nuevas sedes de Pardo?s Chicken

El presente trabajo presenta un plan de acci?n para la apertura de dos unidades de la red Pardos Chicken en provincias usando el Modelo OKR. Pardos Chicken es una importante cadena peruana de restaurantes con m?s de 36 a?os de experiencia en el sector. Pardos pertenece al Holding Wu Restaurantes y son embajadores de la gastronom?a peruana a trav?s del plato bandera de Pollo a la Brasa. En concordancia con los objetivos empresariales de Pardos, las ciudades a elecci?n para la apertura de sus nuevas unidades son Arequipa y Cusco, ciudades no solo importantes econ?micamente, sino con alto atractivo tur?stico, tanto nacional como internacional. El campo de acci?n del presente trabajo son las actividades de marketing necesarias y esenciales a la hora de realizar el desarrollo de nuevos mercados con un servicio, en este caso, una sucursal de una cadena de restaurantes

Intra- and extra-hospital improvement in ischemic stroke patients: influence of reperfusion therapy and molecular mechanisms

Neuroprotective treatments in ischemic stroke are focused to reduce the pernicious effect of excitotoxicity, oxidative stress and inflammation. However, those cellular and molecular mechanisms may also have beneficial effects, especially during the late stages of the ischemic stroke. The objective of this study was to investigate the relationship between the clinical improvement of ischemic stroke patients and the time-dependent excitotoxicity and inflammation. We included 4295 ischemic stroke patients in a retrospective study. The main outcomes were intra and extra-hospital improvement. High glutamate and IL-6 levels at 24 hours were associated with a worse intra-hospital improvement (OR:0.993, 95%CI: 0.990-0.996 and OR:0.990, 95%CI: 0.985-0.995). High glutamate and IL-6 levels at 24 hours were associated with better extra-hospital improvement (OR:1.13 95%CI, 1.07-1.12 and OR:1.14, 95%CI, 1.09-1.18). Effective reperfusion after recanalization showed the best clinical outcome. However, the long term recovery is less marked in patients with an effective reperfusion. The variations of glutamate and IL6 levels in the first 24 hours clearly showed a relationship between the molecular components of the ischemic cascade and the clinical outcome of patients. Our findings suggest that the rapid reperfusion after recanalization treatment blocks the molecular response to ischemia that is associated with restorative processes

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens