Breve Estudio de la Medicina Rural en El Salvador

La presente tesis es una breve reseña donde el autor realiza un reflexión sobre la lucha y el sacrificio que existe en la medicina salvadoreña para llegar a aquellos núcleos de población que la necesitan, y esta constituida en su mayor parte por la clase más pobre. Contribuyendo que se necesita mejorar la medicina rurales del país para lograr mejoras en benéfico de la población salvadoreña

A transfer matrix method for the analysis of fractal quantum potentials

The scattering properties of quantum particles on fractal potentials at different stages of fractal growth are obtained by means of the transfer matrix method. This approach can be easily adopted for project assignments in introductory quantum mechanics for undergraduates. The reflection coefficients for both the fractal potential and the finite periodic potential are calculated and compared. It is shown that the reflection coefficient for the fractal has a self-similar structure associated with the fractal distribution of the potential

The Quest For Equity and Quality Examining Provider Experiences and Participation in Texas Rising Star

Exposure to high-quality child care is the foundation for a child's academic and social-emotional success, especially for children from low-income families. Increasing access to subsidized child care is one of the many strategies used to provide affordable early education to children from low-income families. However, increasing access alone is not enough when it comes to early learning. Children need to be in high-quality care to reap the many benefits.One systematic way to measure and increase quality of child care programs is through a state's Quality Rating and Improvement Systems (QRIS). QRIS is a systematic framework used to measure, improve, and communicate the quality of early childhood education (ECE) providers across a range of indicators. In Texas, this system is called Texas Rising Star (TRS). TRS is only open to child care providers who accept families receiving subsidy child care assistance. While TRS offers incentives for participation including professional development and increased reimbursement rates, currently TRS reaches only a fraction of lowincome children and the providers.

Tritordeum breads are well tolerated with preference over gluten-free breads in non-celiac wheat-sensitive patients and its consumption induce changes in gut bacteria

[Backgound] The ingestion of wheat and other cereals are related to several gut disorders. The specific components responsible for non-celiac wheat-sensitivity (NCWS) may include gluten and other compounds. Tritordeum is a new cereal derived from crossing durum wheat with a wild barley species, which differs from bread wheat in its gluten composition. In the present work, we examined the response of NCWS patients to tritordeum bread Gastrointestinal symptoms as well as tritordeum acceptability, gluten immunogenic peptides excretion, and the composition and structure of the intestinal microbiota were evaluated.[Results] Gastrointestinal symptoms of the subjects showed no significant change between the gluten-free bread and the tritordeum bread. Participating subjects rated tritordeum bread higher than the gluten-free bread. Analysis of the bacterial gut microbiota indicated that tritordeum consumption does not alter the global structure and composition of the intestinal microbiota, and only a few changes in some butyrate-producing bacteria were observed. [Conclusions] All the results derived from acceptability, biochemical and microbiological tests suggest that tritordeum may be tolerated by a sub-set of NCWS sufferers who do not require strict exclusion of gluten from their diet. © 2020 Society of Chemical Industry.This research was funded by Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidad, project AT-5985 and the European Regional Development Fund (FEDER)

Proton–hydride tautomerism in hydrogen evolution catalysis

Efficient generation of hydrogen from renewable resources requires development of catalysts that avoid deep wells and high barriers. Information about the energy landscape for H_2 production can be obtained by chemical characterization of catalytic intermediates, but few have been observed to date. We have isolated and characterized a key intermediate in 2e^– + 2H^+ → H_2 catalysis. This intermediate, obtained by treatment of Cp*Rh(bpy) (Cp*, η^5-pentamethylcyclopentadienyl; bpy, κ^2-2,2′-bipyridyl) with acid, is not a hydride species but rather, bears [η^4-Cp*H] as a ligand. Delivery of a second proton to this species leads to evolution of H_2 and reformation of η^5-Cp* bound to rhodium(III). With suitable choices of acids and bases, the Cp*Rh(bpy) complex catalyzes facile and reversible interconversion of H^+ and H_2

An approach to assess flooding and erosion risk for open beaches in a changing climate

This paper examines the vulnerability to flooding and erosion of four open beach study sites in Europe. A framework for the quantitative estimation of present and future coastal flood and erosion risks is established using methods, data and tools from across a range of disciplines, including topographic and bathymetric data, climate data from observation, hindcast and model projections, statistical modelling of current and future climates and integrated risk analysis tools. Uncertainties in the estimation of future coastal system dynamics are considered, as are the consequences for the inland systems. Different implementations of the framework are applied to the study sites which have different wave, tidal and surge climate conditions. These sites are: Santander, Spain—the Atlantic Ocean; Bellocchio, Italy—the Adriatic Sea; Varna, Bulgaria—the Black Sea; and the Teign Estuary, UK—the northern Atlantic Ocean. The complexity of each system is first simplified by sub-division into coastal "impact units" defined by homogeneity in the local key forcing parameters: wave, wind, tide, river discharge, run-off, etc. This reduces the simulation to that of a number of simpler linear problems which are treated by applying the first two components of the Source–Pathway–Receptor–Consequence (S–P–R–C) approach. The case studies reveal the flexibility of this approach, which is found useful for the rapid assessment of the risks of flooding and erosion for a range of scenarios and the likely effectiveness of flood defences

Improved Alere Determine Lipoarabinomannan Antigen Detection Test for the Diagnosis of Human and Bovine Tuberculosis by Manipulating Urine and Milk

Tuberculosis (TB) disease still kills 1-person every 21-seconds. Few TB diagnostic tests are considered truly appropriate for point of care settings. The WHO-endorsed immunodiagnostic Alere Determine Lipoarabinomannan Ag-test (LAM-test) detects Mycobacterium tuberculosis complex LAM in urine, and its use is recommended for TB diagnosis among HIV co-infected individuals with low CD4 T-cell counts. Here we found that a simple 15-minute enzymatic treatment at room temperature of LAM-spiked urine with \xCE\xB1-mannosidase (for human TB), and LAM-spiked milk with combined lactase and caseinase (for bovine TB), enhanced 10-fold the detection levels of the LAM-test and thus, improved the detection of LAM by the LAM-test in urine and milk that otherwise could be missed in the field. Future separate clinical research studies specifically designed to address the potential of these findings are required

Optical nanofibers and spectroscopy

We review our recent progress in the production and characterization of tapered optical fibers with a sub-wavelength diameter waist. Such fibers exhibit a pronounced evanescent field and are therefore a useful tool for highly sensitive evanescent wave spectroscopy of adsorbates on the fiber waist or of the medium surrounding. We use a carefully designed flame pulling process that allows us to realize preset fiber diameter profiles. In order to determine the waist diameter and to verify the fiber profile, we employ scanning electron microscope measurements and a novel accurate in situ optical method based on harmonic generation. We use our fibers for linear and non-linear absorption and fluorescence spectroscopy of surface-adsorbed organic molecules and investigate their agglomeration dynamics. Furthermore, we apply our spectroscopic method to quantum dots on the surface of the fiber waist and to caesium vapor surrounding the fiber. Finally, towards dispersive measurements, we present our first results on building and testing a single-fiber bi-modal interferometer.Comment: 13 pages, 18 figures. Accepted for publication in Applied Physics B. Changes according to referee suggestions: changed title, clarification of some points in the text, added references, replacement of Figure 13

The Surgical Infection Society revised guidelines on the management of intra-abdominal infection

Background: Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations. Methods: Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and then developed key questions on these various topics. All questions were approached using general and specific literature searches, focusing on articles and other information published since 2008. These publications and additional materials published before 2008 were reviewed by the task force as a whole or by individual subgroups as to relevance to individual questions. Recommendations were developed by a process of iterative consensus, with all task force members voting to accept or reject each recommendation. Grading was based on the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) system; the quality of the evidence was graded as high, moderate, or weak, and the strength of the recommendation was graded as strong or weak. Review of the document was performed by members of the SIS who were not on the task force. After responses were made to all critiques, the document was approved as an official guideline of the SIS by the Executive Council. Results: This guideline summarizes the current recommendations developed by the task force on the treatment of patients who have IAI. Evidence-based recommendations have been made regarding risk assessment in individual patients; source control; the timing, selection, and duration of antimicrobial therapy; and suggested approaches to patients who fail initial therapy. Additional recommendations related to the treatment of pediatric patients with IAI have been included. Summary: The current recommendations of the SIS regarding the treatment of patients with IAI are provided in this guideline

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty