The impact and perspectives of a capacitating culinary awareness program, in the knowledge development of culinary identity, nutrition, hygiene, meal planning and culinary techniques applications in the community “El Progreso” situated in Pedro Vicente Maldonado Province of Pichincha Ecuador

Master's thesis in International hotel and tourism management: Culinary leadership and innovationThe purpose of this development project is to settle a Culinary Capacitating program along the community “El Progreso”, located in Pedro Vicente Maldonado, Province of Pichincha, Ecuador, in order to analyze the impact and perspectives that culinary knowledge can rapport. It has been taken in consideration the daily habits of the community, thus to improve their daily life of the people, to make them understand the importance of culinary knowledge and identity and portrait the richness and natural diversity of their area. To accomplish this awareness, program a deep research project has being made: the territory, the history of the culinary culture and development of the community, the creation of the outline of the capacitation program, which follows a logical order to achieve the capacitation: objectives, activities, results and indicators. For the investigation of the research, we have reached different sources such as interviews to important representatives of the community, the opinion of the community, research of the local area about natural resources and social development history and the analysis of various Literary and technical processes that allowed this project to be issued. After analyzing the feasibility and setting the invitation to the community in order to set the capacitation, it was concluded that certainly a culinary capacitation program in the community “El Progreso” could improve its habitant’s lifestyle and develop a complementary value for the community. Once this capacitation has been implemented, the lifestyle of each of the members of the community “El Progreso” will be improved, it can rapport a new understanding of culinary habits that will rapport them a better management of the natural resources, will strengthen their gastronomical identity, improve their health, and rapport economically to the household

Obesidad en relacion con el estilo de vida, nivel educacional, nivel socioeconomico, ira y personalidad tipo A en adultos de la ciudad de Talca

113 p.La obesidad es uno de los problemas de salud más relevante a nivel mundial de las últimas décadas y se ha relacionado directamente con el desarrollo de diversas enfermedades como la diabetes, hipertensión, enfermedades cardiovasculares y más recientemente se ha asociado a algunos trastornos psicológicos. Diversos estudios han propuesto factores de riesgo para el desarrollo de esta enfermedad. En la presente investigación se analizan las posibles relaciones de la obesidad con las variables sociodemográficas nivel socioeconómico, nivel educacional, estilo de vida y las variables psicológicas ira y patrón de conducta tipo A, en una muestra de 1007 participantes de la ciudad de Talca. Se realizaron análisis descriptivos, correlacionales y de regresión logística, obteniéndose relaciones discretas entre los factores de riesgo tradicionales y la obesidad. No se observaron relaciones significativas entre los factores psicológicos propuestos y la obesidad. Se discute acerca de estos resultados

Multicenter, randomized trial of a bionic pancreas in type 1 diabetes

BACKGROUND: Currently available semiautomated insulin-delivery systems require individualized insulin regimens for the initialization of therapy and meal doses based on carbohydrate counting for routine operation. In contrast, the bionic pancreas is initialized only on the basis of body weight, makes all dose decisions and delivers insulin autonomously, and uses meal announcements without carbohydrate counting. METHODS: In this 13-week, multicenter, randomized trial, we randomly assigned in a 2:1 ratio persons at least 6 years of age with type 1 diabetes either to receive bionic pancreas treatment with insulin aspart or insulin lispro or to receive standard care (defined as any insulin-delivery method with unblinded, real-time continuous glucose monitoring). The primary outcome was the glycated hemoglobin level at 13 weeks. The key secondary outcome was the percentage of time that the glucose level as assessed by continuous glucose monitoring was below 54 mg per deciliter; the prespecified noninferiority limit for this outcome was 1 percentage point. Safety was also assessed. RESULTS: A total of 219 participants 6 to 79 years of age were assigned to the bionic-pancreas group, and 107 to the standard-care group. The glycated hemoglobin level decreased from 7.9% to 7.3% in the bionic-pancreas group and did not change (was at 7.7% at both time points) in the standard-care group (mean adjusted difference at 13 weeks, -0.5 percentage points; 95% confidence interval [CI], -0.6 to -0.3; P\u3c0.001). The percentage of time that the glucose level as assessed by continuous glucose monitoring was below 54 mg per deciliter did not differ significantly between the two groups (13-week adjusted difference, 0.0 percentage points; 95% CI, -0.1 to 0.04; P\u3c0.001 for noninferiority). The rate of severe hypoglycemia was 17.7 events per 100 participant-years in the bionic-pancreas group and 10.8 events per 100 participant-years in the standard-care group (P = 0.39). No episodes of diabetic ketoacidosis occurred in either group. CONCLUSIONS: In this 13-week, randomized trial involving adults and children with type 1 diabetes, use of a bionic pancreas was associated with a greater reduction than standard care in the glycated hemoglobin level. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number, NCT04200313.)

The CLEF-2023 CheckThat! Lab: Checkworthiness, Subjectivity, Political Bias, Factuality, and Authority

The five editions of the CheckThat! lab so far have focused on the main tasks of the information verification pipeline: check-worthiness, evidence retrieval and pairing, and verification. The 2023 edition of the lab zooms into some of the problems and---for the first time---it offers five tasks in seven languages (Arabic, Dutch, English, German, Italian, Spanish, and Turkish): Task 1 asks to determine whether an item, text or a text plus an image, is check-worthy; Task 2 requires to assess whether a text snippet is subjective or not; Task 3 looks for estimating the political bias of a document or a news outlet; Task 4 requires to determine the level of factuality of a document or a news outlet; and Task 5 is about identifying authorities that should be trusted to verify a contended claim

Diferentes técnicas quirúrgicas en el tratamiento del cáncer papilar de tiroides y los factores asociados a la presencia de recidivas tumorales

Introducción: En la actualidad, existen diversas técnicasquirúrgicas para el cáncer de tiroides, sin embargo, la recurrenciade éste posterior a las mismas no ha sido analizadaen nuestra población, es por ello que el objetivo delpresente estudio fue describir diferentes técnicas quirúrgicasy los factores asociados a las recidivas en pacientescon cáncer papilar de tiroides.Materiales y métodos: Se realizó un estudio epidemiológico,observacional de cohorte retrospectivo analítico,que se llevó a cabo en el Hospital Carlos Andrade Marínde la ciudad de Quito en el periodo comprendido entreenero de 2005 y diciembre de 2015. El cual constó de larecolección de los datos de 368 sujetos con el diagnósticode cáncer papilar de tiroides, incluyendo informaciónreferente a las características demográficas, diagnóstico,tratamiento y evolución dentro del hospital.Resultados: Del total de 368 pacientes, el 85,1% (n=313)fueron mujeres y el 14,9% (n=55) fueron hombres, lamedia de edad fue de 48,86±13,07, el 38% (n=140) seencontraba en la categoría de los menores de 45 años yel 62% (n=228) en el grupo de mayores de 45 años, losfactores que se encontraron asociados a la presencia derecidiva fueron, la lobectomía, la tiroidectomía ampliada,disección modificada completa de cuello, disección radicalde cuello, variante histológica columnares altas, mala diferenciacióndel tumor, invasión capsular, invasión vascular,márgenes comprometidos, extensión extratiroidea, músculospretiroideos, lesión del nervio laríngeo recurrente,tráquea, laringe, faringe y piel.Conclusión: Se debe realizar un manejo integral del pacientecon cáncer de tiroides y definir de manera adecuadala cirugía de elección dependiendo de sus características,de igual manera se debe determinar fase de seguimientoen aquellos pacientes con los factores previamente mencionadosya que se encuentran en relación con la recidivadel tumor

Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

BACKGROUND: Regenerative medicine is a medical subspecialty that seeks to recruit and enhance the body\u27s own inherent healing armamentarium in the treatment of patient pathology. This therapy\u27s intention is to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous or allogenic biologics. This field is rising like a Phoenix from the ashes of underperforming conventional therapy midst the hopes and high expectations of patients and medical personnel alike. But, because this is a relatively new area of medicine that has yet to substantiate its outcomes, care must be taken in its public presentation and promises as well as in its use. OBJECTIVE: To provide guidance for the responsible, safe, and effective use of biologic therapy in the lumbar spine. To present a template on which to build standardized therapies using biologics. To ground potential administrators of biologics in the knowledge of the current outcome statistics and to stimulate those interested in providing biologic therapy to participate in high quality research that will ultimately promote and further advance this area of medicine. METHODS: The methodology used has included the development of objectives and key questions. A panel of experts from various medical specialties and subspecialties as well as differing regions collaborated in the formation of these guidelines and submitted (if any) their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these guidelines. The literature pertaining to regenerative medicine, its effectiveness, and adverse consequences was thoroughly reviewed using a best evidence synthesis of the available literature. The grading for recommendation was provided as described by the Agency for Healthcare Research and Quality (AHRQ). SUMMARY OF EVIDENCE: Lumbar Disc Injections: Based on the available evidence regarding the use of platelet-rich plasma (PRP), including one high-quality randomized controlled trial (RCT), multiple moderate-quality observational studies, a single-arm meta-analysis and evidence from a systematic review, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best-evidence synthesis. Based on the available evidence regarding the use of medicinal signaling/ mesenchymal stem cell (MSCs) with a high-quality RCT, multiple moderate-quality observational studies, a single-arm meta-analysis, and 2 systematic reviews, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Epidural Injections Based on one high-quality RCT, multiple relevant moderate-quality observational studies and a single-arm meta-analysis, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Facet Joint Injections Based on one high-quality RCT and 2 moderate-quality observational studies, the qualitative evidence for facet joint injections with PRP has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Sacroiliac Joint Injection Based on one high-quality RCT, one moderate-quality observational study, and one low-quality case report, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. CONCLUSION: Based on the evidence synthesis summarized above, there is Level III evidence for intradiscal injections of PRP and MSCs, whereas the evidence is considered Level IV for lumbar facet joint, lumbar epidural, and sacroiliac joint injections of PRP, (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis.Regenerative therapy should be provided to patients following diagnostic evidence of a need for biologic therapy, following a thorough discussion of the patient\u27s needs and expectations, after properly educating the patient on the use and administration of biologics and in full light of the patient\u27s medical history. Regenerative therapy may be provided independently or in conjunction with other modalities of treatment including a structured exercise program, physical therapy, behavioral therapy, and along with the appropriate conventional medical therapy as necessary. Appropriate precautions should be taken into consideration and followed prior to performing biologic therapy. Multiple guidelines from the Food and Drug Administration (FDA), potential limitations in the use of biologic therapy and the appropriate requirements for compliance with the FDA have been detailed in these guidelines. KEY WORDS: Regenerative medicine, platelet-rich plasma, medicinal signaling cells, mesenchymal stem cells, stromal vascular fraction, bone marrow concentrate, chronic low back pain, discogenic pain, facet joint pain, Food and Drug Administration, minimal manipulation, evidence synthesis

Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American society of interventional pain physicians (ASIPP) guidelines

Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ)

A collaboratively derived environmental research agenda for Galapagos

Galápagos is one of the most pristine archipelagos in the world and its conservation relies upon research and sensible management. In recent decades both the interest in, and the needs of, the islands have increased, yet the funds and capacity for necessary research have remained limited. It has become, therefore, increasingly important to identify areas of priority research to assist decision-making in Galápagos conservation. This study identified 50 questions considered priorities for future research and management. The exercise involved the collaboration of policy makers, practitioners and researchers from more than 30 different organisations. Initially, 360 people were consulted to generate 781 questions. An established process of preworkshop voting and three rounds to reduce and reword the questions, followed by a two-day workshop, was used to produce the final 50 questions. The most common issues raised by this list of questions were human population growth, climate change and the impact of invasive alien species. These results have already been used by a range of organisations and politicians and are expected to provide the basis for future research on the islands so that its sustainability may be enhanced. </jats:p

Aquatic Primary Productivity Field Protocols for Satellite Validation and Model Synthesis

In 2018, a working group sponsored by the NASA Plankton, Aerosol, Cloud, and ocean Ecosystem (PACE) project, in conjunction with the International Ocean Colour Coordinating Group (IOCCG), European Organization for the Exploitation of Meteorological Satellites (EUMETSAT), and Japan Aerospace Exploration Agency (JAXA), was assembled with the aim to develop community consensus on multiple methods for measuring aquatic primary productivity used for satellite validation and model synthesis. A workshop to commence the working group efforts was held December 5–7, 2018, at the University Space Research Association headquarters in Columbia, MD, USA, bringing together 26 active researchers from 16 institutions. In this document, we discuss and develop the workshop findings as they pertain to primary productivity measurements, including the essential issues, nuances, definitions, scales, uncertainties, and ultimately best practices for data collection across multiple methodologies.PUBLI

Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

BACKGROUND: Regenerative medicine is a medical subspecialty that seeks to recruit and enhance the body\u27s own inherent healing armamentarium in the treatment of patient pathology. This therapy\u27s intention is to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous or allogenic biologics. This field is rising like a Phoenix from the ashes of underperforming conventional therapy midst the hopes and high expectations of patients and medical personnel alike. But, because this is a relatively new area of medicine that has yet to substantiate its outcomes, care must be taken in its public presentation and promises as well as in its use. OBJECTIVE: To provide guidance for the responsible, safe, and effective use of biologic therapy in the lumbar spine. To present a template on which to build standardized therapies using biologics. To ground potential administrators of biologics in the knowledge of the current outcome statistics and to stimulate those interested in providing biologic therapy to participate in high quality research that will ultimately promote and further advance this area of medicine. METHODS: The methodology used has included the development of objectives and key questions. A panel of experts from various medical specialties and subspecialties as well as differing regions collaborated in the formation of these guidelines and submitted (if any) their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these guidelines. The literature pertaining to regenerative medicine, its effectiveness, and adverse consequences was thoroughly reviewed using a best evidence synthesis of the available literature. The grading for recommendation was provided as described by the Agency for Healthcare Research and Quality (AHRQ). SUMMARY OF EVIDENCE: Lumbar Disc Injections: Based on the available evidence regarding the use of platelet-rich plasma (PRP), including one high-quality randomized controlled trial (RCT), multiple moderate-quality observational studies, a single-arm meta-analysis and evidence from a systematic review, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best-evidence synthesis. Based on the available evidence regarding the use of medicinal signaling/ mesenchymal stem cell (MSCs) with a high-quality RCT, multiple moderate-quality observational studies, a single-arm meta-analysis, and 2 systematic reviews, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Epidural Injections Based on one high-quality RCT, multiple relevant moderate-quality observational studies and a single-arm meta-analysis, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Facet Joint Injections Based on one high-quality RCT and 2 moderate-quality observational studies, the qualitative evidence for facet joint injections with PRP has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Sacroiliac Joint Injection Based on one high-quality RCT, one moderate-quality observational study, and one low-quality case report, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. CONCLUSION: Based on the evidence synthesis summarized above, there is Level III evidence for intradiscal injections of PRP and MSCs, whereas the evidence is considered Level IV for lumbar facet joint, lumbar epidural, and sacroiliac joint injections of PRP, (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis.Regenerative therapy should be provided to patients following diagnostic evidence of a need for biologic therapy, following a thorough discussion of the patient\u27s needs and expectations, after properly educating the patient on the use and administration of biologics and in full light of the patient\u27s medical history. Regenerative therapy may be provided independently or in conjunction with other modalities of treatment including a structured exercise program, physical therapy, behavioral therapy, and along with the appropriate conventional medical therapy as necessary. Appropriate precautions should be taken into consideration and followed prior to performing biologic therapy. Multiple guidelines from the Food and Drug Administration (FDA), potential limitations in the use of biologic therapy and the appropriate requirements for compliance with the FDA have been detailed in these guidelines. KEY WORDS: Regenerative medicine, platelet-rich plasma, medicinal signaling cells, mesenchymal stem cells, stromal vascular fraction, bone marrow concentrate, chronic low back pain, discogenic pain, facet joint pain, Food and Drug Administration, minimal manipulation, evidence synthesis