Análisis de la Gestión Pública y la corrupción en el Gobierno Subnacional Perú.

The challenge of public management in the national and subnational government is referred to the modernization of the State and the fight against corruption, the objective of the present is to analyze the management of good government practices to contribute to the modernization and generation of public value, for Therefore, this research seeks to identify the critical points of public management and corruption in the subnational government. The problem of the present is that, How does inadequate public management induce corruption in Peru?, and ends with reflections that influence through the implementation of strategies, to prevent functional misconduct. The approach is qualitative, the technique used has been the bibliographic review of articles, and an analysis matrix has been used as an instrument, where cases of corruption arising during the health crisis have been recorded and the documentary analysis of 50 articles 26 in English and 24 in Spanish. We conclude that there is a probability of preventing corruption through a change of behavior in the users of the public administration and providing adequate technological tools for public management.El reto de la gestión pública en el gobierno nacional y subnacional está referido a la modernización del Estado y la lucha contra la corrupción, el objetivo del presente es analizar el manejo de buenas prácticas gubernamentales para contribuir a la modernización y generación de valor público, por lo tanto la presente investigación busca identificar los puntos críticos de la gestión pública y la corrupción en el gobierno subnacional. El problema del presente radica en que, ¿Cómo la gestión pública inadecuada induce a la corrupción en el Perú?, y finaliza con reflexiones que influyan a través de la implementación de estrategias, para prevenir las inconductas funcionales. El enfoque es cualitativo, la técnica empleada ha sido la revisión bibliográfica de artículos, y como instrumento se ha utilizado una matriz de análisis, donde se ha registrado casos de corrupción suscitados durante la crisis sanitaria y el análisis documental de 50 artículos 26 en inglés y 24 en español. Llegamos a la conclusión, de que existe la probabilidad de prevenir la corrupción a través de un cambio de conducta en los usuarios de la administración pública y proveer de herramientas tecnológicas adecuadas a la gestión pública

Las habilidades comunicativas en las carreras de las Ciencias de la Salud

Fundamento: las habilidades como componentes cognitivo-instrumentales de la actuación del sujeto, han sido ampliamente estudiadas en el ámbito pedagógico para fortalecer la didáctica específica de las Ciencias de la Salud y de esta forma enseñar a los estudiantes a establecer una adecuada comunicación. Objetivo: definir las habilidades comunicativas que pueden ser tratadas mediante el sistema de conocimientos de las asignaturas y las actividades preprofesionalizantes en los estudiantes de las carreras de las Ciencias de la Salud. Métodos: del nivel teórico: histórico-lógico, inductivo-deductivo, analítico- sintético, sistémico-estructural, y la modelación; del nivel empírico: análisis de documentos, reunión con los grupos de discusión, observación, encuesta a profesores, triangulación de resultados y criterio de expertos; del nivel estadístico: análisis porcentual y método Delphi. Resultados: se definieron las habilidades comunicativas: para la expresión, habilidades para la observación y habilidades para la relación empática, para ser desarrolladas mediante el carácter sistémico e integrador de los contenidos de las asignaturas y la práctica pre-profesionalizante en las carreras de las Ciencias de la Salud. Conclusiones: las habilidades comunicativas son imprescindibles para el desempeño del futuro profesional de la Salud, es necesario que se puedan desarrollar en los estudiantes mediante la integración entre el sistema de asignaturas, los contenidos y las actividades preprofesionalizantes derivado de cada situación presentada en la práctica pedagógica y docente-asistencial

Contribution of Rare and Low-Frequency Variants to Multiple Sclerosis Susceptibility in the Italian Continental Population

Genome-wide association studies identified over 200 risk loci for multiple sclerosis (MS) focusing on common variants, which account for about 50% of disease heritability. The goal of this study was to investigate whether low-frequency and rare functional variants, located in MS-established associated loci, may contribute to disease risk in a relatively homogeneous population, testing their cumulative effect (burden) with gene-wise tests. We sequenced 98 genes in 588 Italian patients with MS and 408 matched healthy controls (HCs). Variants were selected using different filtering criteria based on allelic frequency and in silico functional impacts. Genes showing a significant burden (n = 17) were sequenced in an independent cohort of 504 MS and 504 HC. The highest signal in both cohorts was observed for the disruptive variants (stop-gain, stop-loss, or splicing variants) located in EFCAB13, a gene coding for a protein of an unknown function (p < 10(-4)). Among these variants, the minor allele of a stop-gain variant showed a significantly higher frequency in MS versus HC in both sequenced cohorts (p = 0.0093 and p = 0.025), confirmed by a meta-analysis on a third independent cohort of 1298 MS and 1430 HC (p = 0.001) assayed with an SNP array. Real-time PCR on 14 heterozygous individuals for this variant did not evidence the presence of the stop-gain allele, suggesting a transcript degradation by non-sense mediated decay, supported by the evidence that the carriers of the stop-gain variant had a lower expression of this gene (p = 0.0184). In conclusion, we identified a novel low-frequency functional variant associated with MS susceptibility, suggesting the possible role of rare/low-frequency variants in MS as reported for other complex diseases

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Anales del III Congreso Internacional de Vivienda y Ciudad "Debate en torno a la nueva agenda urbana"

Acta de congresoEl III Congreso Internacional de Vivienda y Ciudad “Debates en torno a la NUEVa Agenda Urbana”, ha sido una apuesta de alto compromiso por acercar los debates centrales y urgentes que tensionan el pleno ejercicio del derecho a la ciudad. Para ello las instituciones organizadoras (INVIHAB –Instituto de Investigación de Vivienda y Hábitat y MGyDH-Maestría en Gestión y Desarrollo Habitacional-1), hemos convidado un espacio que se concretó con potencia en un debate transdisciplinario. Convocó a intelectuales de prestigio internacional, investigadores, académicos y gestores estatales, y en una metodología de innovación articuló las voces académicas con las de las organizaciones sociales y/o barriales en el Foro de las Organizaciones Sociales que tuvo su espacio propio para dar voz a quienes están trabajando en los desafíos para garantizar los derechos a la vivienda y los bienes urbanos en nuestras ciudades del Siglo XXI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The hydration state of human red blood cells and their susceptibility to invasion by Plasmodium falciparum

In most inherited red blood cell (RBC) disorders with high gene frequencies in malaria-endemic regions, the distribution of RBC hydration states is much wider than normal. The relationship between the hydration state of circulating RBCs and protection against severe falciparum malaria remains unexplored. The present investigation was prompted by a casual observation suggesting that falciparum merozoites were unable to invade isotonically dehydrated normal RBCs. We designed an experimental model to induce uniform and stable isotonic volume changes in RBC populations from healthy donors by increasing or decreasing their KCl contents through a reversible K+ permeabilization pulse. Swollen and mildly dehydrated RBCs were able to sustain Plasmodium falciparum cultures with similar efficiency to untreated RBCs. However, parasite invasion and growth were progressively reduced in dehydrated RBCs. In a parallel study, P falciparum invasion was investigated in density-fractionated RBCs from healthy subjects and from individuals with inherited RBC abnormalities affecting primarily hemoglobin (Hb) or the RBC membrane (thalassemias, hereditary ovalocytosis, xerocytosis, Hb CC, and Hb CS). Invasion was invariably reduced in the dense cell fractions in all conditions. These results suggest that the presence of dense RBCs is a protective factor, additional to any other protection mechanism prevailing in each of the different pathologies. (Blood. 2005; 105:4853-4860

Validation of the Canadian occupational performance measure in Italian Parkinson’s disease clients

Aims: To assess internal consistency, validity and test-retest reliability of Italian version of Canadian Occupational Performance Measure (COPM) in Parkinson's disease (PD) clients.Methods: Sixty-one subjects completed COPM at baseline, 45 attended re-test within 10 days. Internal consistency and test-retest reliability were determined on average satisfaction and performance scores. Hoehn and Yahr (H&amp; Y) scale and MDS-Unified-Parkinson's-Disease-Rating-Scale-part III (MDS-UPDRS-III) were used to evaluate disease severity and construct validity.Results: COPM showed moderate-high internal consistency (Cronbach's alpha 0.684 for performance and 0.805 for satisfaction). Test-retest reliability was moderate for both performance and satisfaction scores ( ICC values 0.545 - CI95% 0.307-0.720, and 0.693 - CI 95% 0.506-0.819, respectively). COPM did not demonstrate significant correlation with H&amp;Y nor MDS-UPDRS-III.Conclusions: COPM is a valid and reliable tool promoting client-centered approach in PD. The role of the client in assessing needs and defining priority outcomes may increase compliance to intervention and awareness of occupational performance