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Introduction: Allergic rhinoconjunctivitis and asthma are the most common IgE-mediated diseases worldwide. Allergen-specific immunotherapy (AIT) is currently the only modifying treatment for these IgE-mediated diseases in both children and adults. Subcutaneous immunotherapy is widely used, but in patients over 65 years old, there may be an increased risk of adverse reactions and a worse response to treatment. Oral immunotherapy (OIT) has been proven to be effective and safe, but currently, in most countries, it has been licensed only for patients up to 65 years old based on its technical datasheet. So far, no studies on the efficacy and safety of this type of immunotherapy in patients older than 65 years old have been published. Case Presentation: We present four patients older than 65 years old with a diagnosis of moderate seasonal rhinoconjunctivitis and moderate-persistent seasonal pollen-induced asthma. Off-label use of oral immunotherapy (OIT) for grass pollen was prescribed due to the severity of their rhinoconjunctivitis symptoms and the worsening of asthma symptoms during the spring. Improvement in the rhinoconjunctivitis and asthma symptoms was reported by all patients since the first spring season and was maintained during the following two years of follow-up. There were no systemic reactions, and only two patients initially had self-limiting oral pruritus. Conclusion: Oral immunotherapy for pollens appears to be a convenient, effective, and safe option in older patients (>65 years) with comorbidities after a three-year treatment. This is, to the best of our knowledge, the first report on the off-label use of OIT in patients over 65 years old with symptoms of allergic rhinoconjunctivitis and asthma.

Introduction: Emphysematous osteomyelitis (EO) is an extremely rare bone infection by gas-forming bacteria with few documented cases in the literature. Our study aims to highlight characteristic imaging features, including the novel use of positron emission tomography-magnetic resonance imaging (PET-MRI) in the diagnosis of this potentially fatal entity. Case: Radiography and computed tomography (CT) of the pelvis were performed due to complaints of persistent back pain in a 36 year old male with history of recent abdominal aorta surgery. Sacroiliac joint aspiration was performed and a follow-up PET-MRI was subsequently performed. Results: Radiography and CT demonstrated bilateral sacroiliitis, osteonecrosis and EO in the bony pelvis. Left sacroiliac joint aspiration identified Staphylococcus aureus as the causative organism. PET-MRI revealed EO with left iliopsoas abscess and abdominal aortic graft infection. The patient's symptoms resolved following antibiotic therapy and image-guided abscess drainage. Conclusion: EO is a lethal variant of osteomyelitis with a dearth of published cases. Pertinent imaging characteristics of EO on radiography, CT and PET-MRI are discussed here, along with a review of the literature surrounding this rare condition.

Introduction: The feasibility of preparing the “in-house” generators and the Th- DTPA(DOTA)-Nimotuzumab radioimmunoconjugate was evaluated. 226Th is perspective for TAT, however, due to short half-life it is preferable to apply this radionuclide for readily available epithelial malignancies. Nimotuzumab being specific for EGFR expressing cells as a targeting moiety is considered to be suitable for thorium delivery. Methods: TEVA extraction chromatographic resin and anion exchange resin AG 1x8 were used as sorbents for 226Th generator. In order to determine features of labeling by Th4+ we applied 234Th as a longer-lived analog of short-lived 226Th and the immunoconjugates DTPA(DOTA)-Nimotuzumab were used for radiolabeling. Results: The generator on the base of TEVA resin has shown higher volume activity of the product compared to the AG 1x8. The 226Th volume concentration was up to 80%/mL. The radiolabeling of BFCA by thorium radioisotopes reached 95% at the MR(Th:p-SCN-Bn-DTPA) = 1:100 and 86% for MR(Th:p-SCN-Bn-DOTA) = 1:5000 at 90°C. The procedure of Nimotuzumab labeling with Th4+ for radiotherapy of EGFR-overexpressing carcinomas was established. The overall labeling yield in both radioimmunoconjugates - DTPA and DOTA functionalized - was in the range of 45-50%. The immunoconjugate Nimotuzumab-p-SCN-Bn-DTPA was obtained with a molar ratio 1:25 (Nimotuzumab: BFCA), within 1 hour of conjugation at 25¹C and labelled via postconjugation approach. Whereas Nimotuzumab-p-SCN-Bn-DOTA was obtained at the same conditions, but radiolabeled by the method of pre-conjugation. Conclusion: Thorium-234 incorporation into both radioimmunoconjugates reached 45-50%. It has been shown that Th-DTPA-Nimotuzumab radioimmunoconjugate specifically bound with EGFR overexpressing epidermoid carcinoma A431 cells.

Finding the cause of fever of unknown origin can sometimes be a real challenge. We present an adolescent whose diagnosis was achieved after 4 months of fever onset by performing a positron emission tomography (PET)–CT. A young woman presented with prolonged, intermittent fever along with inflammatory and iron deficiency anaemia, loss of weight and abdominal and chest pain. First investigational studies showed high-titre positive antinuclear antibodies, extractable nuclear antibodies and anti-Sjögren's-syndrome-related antigen a autoantibodies (anti-SSA), and mild pericardial effusion and aortic regurgitation, but without meeting criteria for systemic lupus erythematosus. She had maxillary sinusitis that did not resolve with antibiotics. Further study displayed elevated calprotectin in faeces. After normal abdominal ultrasound and CT, an intestinal MRI showed thickening of the terminal ileum, orienting towards an inflammatory bowel disease. A colonoscopy showed only minor macroscopic changes. A PET–CT scan was finally requested, which exhibited a diffuse increase in metabolism in the wall of the thoracic and abdominal aortas, suggesting Takayasu’s arteritis.

Objective:The purpose of this work was to establish a statistical relationship of the results obtained with two different techniques. The comparison was made between the ideal facial height proposed in the Silva cephalometric method (SCM) and the facial height obtained using Euclid's rectangle or golden rectangle. Materials and Methods:38 cephalometric radiographs of dentistry students of Universidad de Cuenca, of both sexes, were used. All of these radiographs had suitable characteristics for cephalometric tracing in the NemoStudio 2022 software. Once the cephalometric tracing was made using these software tools, SCM was performed on each one of them to collect the data, and then we proceeded to overlap Euclid’s rectangle on all the images. The correlation of these two methods was established with Pearson’s correlation coefficient. Results:It was concluded that the Pearson correlation coefficient was [r]: 0.9271 Conclusions:5% of the patients presented compatibility with the logarithmic spiral of the golden ratio.

10 Pág., Usutu virus (USUV) is an emerging zoonotic arbovirus that has caused an increasing number of animal and human cases in Europe in recent years. Understanding the vector species and avian hosts involved in the USUV enzootic cycle in an area of active circulation is vital to anticipate potential outbreaks. Mosquitoes were captured in 2020, while wild birds were sampled in both 2020 and 2021 in Extremadura, southwestern Spain. The presence of USUV in the mosquito vectors was assessed by a real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay and confirmed by sequencing amplicons from two generic RT-PCR sets for flaviviruses. Sequences were analysed phylogenetically. Bird sera were screened for flavivirus antibodies with a blocking ELISA kit and subsequently tested for virus-specific antibodies with a micro-virus-neutralization test. Overall, 6,004 mosquitoes belonging to 13 species were captured, including some well-known flavivirus vectors (Culex pipiens, Cx. perexiguus, and Cx. univittatus). Of the 438 pools tested, USUV was detected in two pools of Cx. pipiens. Phylogenetic analysis using a fragment of the NS5 gene assigned the USUV detected the Africa 3 lineage. Out of 1,413 wild birds tested, USUV-specific antibodies were detected in 17 birds (1.2%, 10 males and 7 females) from eight species. The first detection of USUV Africa 3 lineage in mosquitoes from Spain, together with serologically positive resident wild birds in urban and rural areas, indicates active circulation and a possible risk of exposure for the human population, with necessity to establish specific surveillance plans., This study was funded from Ayudas Fundación BBVA a Equipos de Investigación Científica 2019 (PR (19_ECO_0070)), Research State Agency Project (PID2020-116768RR-C21/C22), Instituto de Salud Carlos III (PI19CIII_00014), Consejería de Economía e Infraestructura of the Junta de Extremadura, and the European Regional Development Fund, a Way to Make Europe, through the research project under grant numbers IB20089, GR21122, and GR21084. MF was supported by a Juan de la Cierva 2017 Formación contract (FJCI-2017-34394) from the Spanish Ministry of Science, Innovation and Universities, and she is currently funded by the European Union’s Horizon 2020 Research and Innovation Programme under the Marie Sklodowska-Curie grant agreement no. 844285, “EpiEcoMod.” CMR was funded by a FPU grant from the Ministry of Universities of Spain (reference: FPU20/01039). FGC was supported by “Ayudas a la Formación Investigador Predoctoral 2018” Formative contract (PD18056) from the Extremadura Regional Government.

La cultura organizacional y el desempeño empresarial poseen factores que condicionan y determinan el resultado de su interacción, lo que hace relevante conocer y entender cómo se relacionan dichas variables. Considerando que el objetivo de implementar una cultura en una organización es incentivar su mejor desempeño, ya que promueve la comunicación y mejora las relaciones laborales, repercutiendo en el rendimiento de la empresa, por ello, se busca establecer desde una metodología de revisión literaria, la incidencia de la cultura organizacional en el desempeño empresarial definiendo con base en análisis de diferentes estudios sus factores determinantes. Como resultado se estableció que la cultura organizacional está en constante cambio y evolución, acoplándose a los entornos y factores externos de los mercados y sociedad, definiéndola como el conjunto de formas de actuar, sentir y pensar de forma compartida en todos los niveles de la organización como resultado de la satisfacción laboral y un entorno y mandos altos que la promuevan. Concluyendo que la creación de una cultura organizacional con base en factores específicos y determinados permite mejorar la competitividad del talento humano por medio de la satisfacción laboral y de un entorno apropiado resultado de un desempeño óptimo y eficiente de la organización.

Bitter pit (BP) is one of the most relevant post-harvest disorders for apple industry worldwide, which is often related to calcium (Ca) deficiency at the calyx end of the fruit. Its occurrence takes place along with an imbalance with other minerals, such as potassium (K). Although the K/Ca ratio is considered a valuable indicator of BP, a high variability in the levels of these elements occurs within the fruit, between fruits of the same plant, and between plants and orchards. Prediction systems based on the content of elements in fruit have a high variability because they are determined in samples composed of various fruits. With X-ray fluorescence (XRF) spectrometry, it is possible to characterize non-destructively the signal intensity for several mineral elements at a given position in individual fruit and thus, the complete signal of the mineral composition can be used to perform a predictive model to determine the incidence of bitter pit. Therefore, it was hypothesized that using a multivariate modeling approach, other elements beyond the K and Ca could be found that could improve the current clutter prediction capability. Two studies were carried out: on the first one an experiment was conducted to determine the K/Ca and the whole spectrum using XRF of a balanced sample of affected and non-affected ‘Granny Smith’ apples. On the second study apples of three cultivars (‘Granny Smith’, ‘Brookfield’ and ‘Fuji’), were harvested from two commercial orchards to evaluate the use of XRF to predict BP. With data from the first study a multivariate classification system was trained (balanced database of healthy and BP fruit, consisting in 176 from each group) and then the model was applied on the second study to fruit from two orchards with a history of BP. Results show that when dimensionality reduction was performed on the XRF spectra (1.5 - 8 KeV) of ‘Granny Smith’ apples, comparing fruit with and without BP, along with K and Ca, four other elements (i.e., Cl, Si, P, and S) were found to be deterministic. However, the PCA revealed that the classification between samples (BP vs. non-BP fruit) was not possible by univariate analysis (individual elements or the K/Ca ratio).Therefore, a multivariate classification approach was applied, and the classification measures (sensitivity, specificity, and balanced precision) of the PLS-DA models for all cultivars evaluated (‘Granny Smith’, ‘Fuji’ and ‘Brookfield’) on the full training samples and with both validation procedures (Venetian and Monte Carlo), ranged from 0.76 to 0.92. The results of this work indicate that using this technology at the individual fruit level is essential to understand the factors that determine this disorder and can improve BP prediction of intact fruit.

A menudo se hace interesante constatar como han llegado las obras de un artista a las colecciones estatales y como han sido utilizadas éstas desde el Estado para una política determinada. Lo que, por otra parte, suele emparentarse a razones y circunstancias que rebasan el mero hecho de una donación o de una oportunidad concreta de uso del arte con fines políticos.

25 Pág., How drought affects tree and stand growth is an old question, but is getting unprecedented relevance in view of climate change. Stress effects related to drought have been mostly studied at the individual tree level, mostly investigating dominant trees and using their responses as indicator for the impact at the stand level. However, findings at tree and stand level may differ, as the stand responses include interactions and feedbacks that may buffer or aggravate what is observed at the individual tree level. Here, we trace drought effects on growth and development from tree to the stand scale. Therefore, we analyse annually measured data from long-term experiments in temperate and Mediterranean forests. With this analysis, we aim to disclose how well results of dominant tree growth reflect stand-level behaviour, hypothesizing that drought resistance of dominant trees’ can strongly deviate from the overall sensitivity of the stand. First, we theoretically derive how drought responses at the stand level emerge from the tree-level behaviour, thereby considering that potential drought resistance of individual trees is modulated by acclimation and tree–tree interactions at the stand level and that the overall stress response at the stand level results from species-specific and size-dependent individual tree growth and mortality. Second, reviewing respective peer-reviewed literature (24 papers) and complementing findings by own measurements (22 experiments) from temperate and Mediterranean monospecific and mixed-species forests, we are able to reveal main causes for deviations of tree-level and stand-level findings regarding drought stress responses. Using a long-term experiment in Norway spruce (Picea abies (L.) KARST.) and European beech (Fagus sylvatica L.), we provide evidence that the species-dependent and size-dependent reactions matter and how the size–frequency distribution affects the scaling. We show by examples that tree-level derived results may overestimate growth losses by 25%. Third, we investigate the development of the growth dominance coefficient based on measurements gathered at the Bavarian forest climate stations. We show that drought changes stand biomass partitioning in favour of small trees, reduce social differentiation, and homogenize the vertical structure of forests. Finally, we discuss the drought-related consequences of the social class-specific growth reaction patterns for inventory and monitoring and highlight the importance of these findings for understanding site-specific stand dynamics, for forest modelling, and for silvicultural management., The publication is part of the CARE4C project that has received funding from the European Union’s HORIZON 2020 research and innovation program under the Marie Skłodowska-Curie grant Agreement No 778322. Thanks go also to the Bayerische Staatsforsten (BaySF) for supporting the establishment and maintenance of the underlying long-term experiments and to the Bavarian State Ministry for Nutrition, Agriculture and Forestry for funding the project "Adaptability of trees and forest stands to drought stress" (klifW006 # Z3-7831-1/1015) and for the permanent support of the project W007, entitled “Long-term experimental plots for forest growth and yield research” (# 7831-22209-2013). Thanks go furthermore to the Junta de Castilla y León, Spain, and the European Union for funding the Projects VA183P20 (SMART—Bosques mixtos: Selvicultura, Mitigación, Adaptación, Resiliencia y Trade-offs) and CLU-2019-01—iuFOR Institute Unit of Excellence of the University of Valladolid through the ERDF "Europe drives our growth". We also thank anonymous reviewers for their constructive criticism

Introduction: Vicosupplementation with hyaluronic acid in knee osteoarthritis has proven to be a safe and effective treatment. Its effectiveness is maintained for at least 6 months. Few studies have compared the efficacy of two single injection products at 12 months. Objective: To evaluate the efficacy results in patients infiltrated with two single injection hyaluronic acid : Hyalone® (H) and Adant One® (A), at 12 months. Material and methods: A retrospective observational study has been designed on a cohort of patients with knee osteoarthritis. They were treated by intra-articular knee viscosupplementation with two types of single injection hyaluronic acid. Its efficacy was evaluated according to the WOMAC scale and the VAS at 6 and 12 months. Results: 86 patients were treated with single doses of A and 67 with H. A significant improvement was found in the WOMAC assessment at 6 months with A (p = 0.035), while at 12 months the result no longer showed statistical significance (p = 0.184). With H at 12 months the improvement in the WOMAC values continued to be favorable (p = 0.039). Regarding pain control, an improvement in the VAS was observed, which was significant only in the case of H at 12 months (p = 0.020). Conclusions: A single H injection at 12 months was more effective for pain control and improved functionality in patients with knee osteoarthritis compared to A. It is possible to make viscosupplementation protocols for knee osteoarthritis with hyaluronic acid at annual intervals using H.

Several studies have evidenced that children in out-of-home care (OOHC), including foster family care and residential care, reveal high levels of mental health disorders (ranging from 40% to 88%). This study examines the outcomes in mental health reported by key residential workers in a group of children and youth (N = 492) between 8-17 years old who were in residential child care (RCC) in Spain. The research also aims to explore the relationship between mental health outcomes and the provision of mental health services (i.e., receiving any mental health treatment) as well as the influence of child, family, and placement factors. The design of this study includes two measures: a baseline (T1) and a follow-up two years later (T2). The results indicated that 29.9% of young people enjoyed sustained mental health; 26% meaningful improvement in their mental health; 23.5% meaningful deterioration; and the remaining 20.5% showed no meaningful change. One of the main findings was that receiving mental health treatment had a significant impact on mental health outcomes. It is crucial to establish protocols and systematic detection tools to assess mental health and ensure detection and referral to proper treatment

El presente trabajo plantea un análisis sobre la cobertura periodística entre abril y agosto del año 2009, de la exhibición de pintura Si nuevas cadenas preparan… el paisito marcha, del artista plástico ecuatoriano Miguel Varea. Además de la discusión a partir de textos académicos de arte y periodismo, este estudio busca analizar la información cultural en los medios impresos, respecto al artista, en medio de la coyuntura de su muestra de pintura, la misma que fue mostrada en tres ocasiones, en las ciudades de Quito y Cuenca. Para ello se recurre a la metodología cualitativa y se efectúa una observación de veinte y dos documentos periodísticos, los mismos que han sido desagregados e insertados en una matriz para aplicar el valor noticioso como una alternativa de análisis de contenido, con el fin de identificar las principales características de la prensa respecto a la exposición de Varea. Este estudio permitirá reconocer las prácticas periodísticas de distintos medios impresos respecto al artista y su obra que ha promovido un potente discurso social y político. En este sentido, se busca determinar el género periodístico más utilizado, las palabras recurrentes en los textos, los titulares de las notas, los medios que le dieron mayor cobertura, identificando fuentes que contribuyeron a la construcción de las noticias en análisis. Los principales resultados indican que el género más utilizado para la cobertura de Varea han sido las notas informativas, seguido de los reportajes y artículos de opinión.

We use the surface detector of the Pierre Auger Observatory to search for air showers initiated by photons with an energy above 1019 eV. Photons in the zenith angle range from 30∘ to 60∘ can be identified in the overwhelming background of showers initiated by charged cosmic rays through the broader time structure of the signals induced in the water-Cherenkov detectors of the array and the steeper lateral distribution of shower particles reaching ground. Applying the search method to data collected between January 2004 and June 2020, upper limits at 95% CL are set to an E-2 diffuse flux of ultra-high energy photons above 1019 eV, 2 × 1019 eV and 4 × 1019 eV amounting to 2.11 × 10-3, 3.12 × 10-4 and 1.72 × 10-4 km-2 sr-1 yr-1, respectively. While the sensitivity of the present search around 2 × 1019 eV approaches expectations of cosmogenic photon fluxes in the case of a pure-proton composition, it is one order of magnitude above those from more realistic mixed-composition models. The inferred limits have also implications for the search of super-heavy dark matter that are discussed and illustrated.

The isocitrate dehydrogenase enzyme 2 (IDH2) gene is mutated in ∼5% of patients with myelodysplastic syndrome (MDS). Enasidenib is an oral, selective, mutant IDH2 inhibitor approved for IDH2-mutated (mIDH2) relapsed/refractory acute myeloid leukemia. We designed a 2-arm multicenter study to evaluate safety and efficacy of (A) the combination of enasidenib with azacitidine for newly diagnosed mIDH2 MDS, and (B) enasidenib monotherapy for mIDH2 MDS after prior hypomethylating agent (HMA) therapy. Fifty patients with mIDH2 MDS enrolled: 27 in arm A and 23 in arm B. Median age of patients was 73 years. The most common adverse events were neutropenia (40%), nausea (36%), constipation (32%), and fatigue (26%). Hyperbilirubinemia from off-target UGT1A1 inhibition occurred in 14% of patients (8%; grades 3 and 4), and IDH-inhibitor–associated differentiation syndrome (IDH-DS) in 8 patients (16%). In the combination arm, the overall response rate (ORR: complete remission [CR] + marrow CR [mCR] + partial remission) was 74%, including 70% composite CR (CRc: CR + mCR). Median time to best response was 1 month (range, 1-4), and a median of 4 cycles was received (1-32). The median overall survival (OS) was 26 months (range, 14 to not reached). In the enasidenib monotherapy cohort after HMA failure, ORR and CRc were both 35% (n = 8), with 22% CR (n = 5). Median time to first response was 27 days, and time to best response was 4.6 months (2.7-7.6 months). A median of 7 cycles was received (range, 1-29), and the median OS was 20 months (range, 11 to not reached). Enasidenib is an effective treatment option for mIDH2 MDS, both in combination with azacitidine for treatment-naïve high-risk MDS, and as a single agent after prior HMA therapy. This trial is registered at www.clinicaltrials.gov as #NCT03383575.

Residents in nursing facilities (NFs) are at greater risk of developing urinary tract infections (UTIs) with higher hospitalizations and costs than people living in communities. These residents also have increased likelihood of uroseptic shock and death. The objective of the study was to prevent UTIs and to reduce UTI-associated costs among NF residents.Quality assurance performance improvement initiative conducted between April 1, 2018 and March 31, 2022 at a large skilled NF. Participants were 262 residents newly diagnosed with UTIs without indwelling catheters. The initiative consisted of (1) a 12-month baseline; (2) a 12-month intervention; and (3) a 24-month follow-up. A novel care bundle which included staff's hand hygiene monitoring, residents' hydration status, effective incontinence and perineal care, and in-house UTI treatment was implemented during the intervention. The plan-do-study-act cycle was used to gauge its effectiveness.Quarterly UTI rates decreased from 4.2% at baseline to 0.9% at follow-up, a 79% reduction (P.001). All 262 residents were treated in-house with no UTI-related hospitalizations. Antibiotic prescriptions fell from 373 at baseline down to 143 at follow-up, a 62% reduction. Facility costs decreased from $42,188 at baseline to $8,281 at follow-up (P0.001).This bundle was very effective in preventing UTIs and reducing UTI-associated costs. Its use in other NFs is encouraged to determine suitability elsewhere.

Background: The purpose of this study is to identify the mechanical properties of orthodontic aligners and the effect produced by thermoforming and aging in vitro. Material and Methods: A review of the literature was carried out at the end of 2022 in different search engines (PubMed, Scielo, UNAM), using the search strategy: (aligners), (transparent) and (orthodontics) to identify articles that present information on the mechanical properties and the effect of humidity and temperature on orthodontic aligners. Results: Of a total of 17,130 articles found in search engines, only 21 articles met the inclusion and exclusion criteria. For this systematic review, the most frequent criteria were: aligners, mechanical, and thermoplastic. Conclusions: With the review of the literature carried out, it was concluded that aging due to the effect of water absorption and temperature does not affect the thermomechanical properties and the molecular composition as much as the thermoforming process does.

El mercado accionario colombiano constantemente se ve en la obligación de diversificar las opciones de inversión en aras de proteger los excedentes de capital de los clientes inversionistas y de evitar grandes niveles de pérdida. Por tal razón, un portafolio eficiente seleccionado bajo estándares matemáticos estrictos, compuesto por las acciones más líquidas que cotizan dentro de la bolsa de valores y aquellas que manejan una adecuada relación entre rentabilidad-riesgo, son hito fundamental como herramienta para una toma de decisiones sensata en el marco de la inversión. Así las cosas, el presente artículo tiene como objetivo ejecutar un análisis cualitativo-descriptivo del propósito de un portafolio eficiente para clientes inversionistas, haciendo énfasis en los modelos matemáticos apoyados en la Teoría de Harry Markowitz siendo el coeficiente beta y modelo de valoración de activos CAPM, para con ello, lograr impacto a nivel económico, social y académico. Lo resultados evidencian que los betas mayores obtenidos se dan en el sector financiero, liderado por la acción de Bancolombia, mientras que en el sector de hidrocarburos, liderado por la acción de TERPEL, los betas son menores.

Digital media has allowed restaurants to maintain their sales, positioning, and better relationships with consumers in adverse situations such as the COVID-19 pandemic. This study seeks to determine the relationship between social networks as an inbound marketing tool and the generation of digital experiences in consumers of fast-food restaurants. This is a quantitative, correlational, and non-experimental analysis. The sample includes the most popular fast-food restaurants in Peru (Norky’s, Roky’s, and Kentucky Fried Chicken) that demonstrate significant presence in social networks and possess potential characteristics to provide customers with a positive experience. One hundred one respondents between 18 and 35 years of age, residents of Lima (Peru), and frequent consumers of fast food establishments were surveyed via Google Forms. The results were tabulated in MS Excel and the quantitative data analysis was performed with the IBM SPSS tool; descriptive and inferential statistics were applied and the correlation was obtained through Spearman’s coefficient. The findings highlighted that 61.39% of the respondents agree that the social network experiences of the restaurants influence their expectations; 47.5% react with likes and comments to the publications, and 63.4% recommend the restaurants thanks to the constant dissemination of their content. Finally, a significance level of less than 0.05 was obtained between the variables, demonstrating that one variable has a relationship with the other. The study concludes a moderate direct relationship between social networks as an inbound marketing strategy and the generation of digital experiences in the study group.

Introduction: Throughout time, calcaneal burst fractures have been referred to as lovers fractures because the injury occurred when a suitor jumped off a lovers balcony to avoid detection. The calcaneus is part of the 7 tarsal bones, calcaneus, talus, cuboid, navicular, first, second and third cuneiform. Calcaneal fractures are infrequent, however, they have a high potential to weaken the limb. Objective: to detail current information related to calcaneal fractures, epidemiology, anatomy, mechanism of injury, clinical evaluation, imaging evaluation, classification, treatment and complications. Methodology: a total of 30 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 21 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: calcaneal fracture, calcaneus, calcaneal osteosynthesis, foot fractures. Results: The calcaneus is the most commonly fractured tarsal bone, representing 2% of all fractures. Calcaneal fractures are bilateral in 5 to 10%, and are usually related to fractures of the lumbar spine and other fractures of the lower limb caused by high-impact trauma. About 10 % of calcaneal fractures are open. Conclusions: The calcaneus is the most commonly fractured tarsal bone, accounting for 2 % of all fractures. Calcaneal fractures are bilateral in 5 to 10% and are usually related to fractures of the lumbar spine and other fractures of the lower limb caused by high impact trauma. About 10% of calcaneal fractures are open, and neurovascular injuries are infrequent in calcaneal fractures. Calcaneal fractures are more related to high energy impacts that generate axial loading of the bone, however they can occur with any injury to the foot and ankle. The main characteristics of individuals affected with a calcaneal fracture are pain, swelling, widening, deformity, ecchymosis and functional impotence. To make the radiological diagnosis of calcaneal fracture in the first instance it is recommended to request an anteroposterior projection of the foot, lateral projection of the rearfoot, Harris axial projection and an ankle series; if necessary, a computed tomography can be performed. In practice, calcaneal fractures can be classified as intra-articular or thalamic and extra-articular; in addition, classification systems such as Sanders and Essex-Lopresti are used. Treatment is controversial. Even with adequate reduction and management, calcaneal fractures can become extremely disabling injuries, presenting a mutable prognosis with various types of functional limitation and pain. Currently, some factors have been found to be related to better outcomes, however, the literature comparing various methods of surgical versus conservative treatment show that surgical management has increased complication rates, however, it may lead to optimal functional outcomes in some individuals. Generally, the incidence of complications of calcaneal fractures is high and increases the worse the wound. Among the most common are calcaneal osteomyelitis, post-traumatic osteoarthritis, wound dehiscence, increased heel width, loss of subtalar mobility, chronic peroneal tendonitis, and complex regional pain syndrome. KEY WORDS: fracture, calcaneus, osteosynthesis, foot.

Chronic musculoskeletal pain (CMP) is one of the most common symptoms of musculoskeletal disorders. Carpal tunnel syndrome (CTS) and subacromial syndrome (SAS) are the most prevalent musculoskeletal disorders of the upper limbs. By collecting the opinions of patients with CTS and SAS, we aim to identify variables that could be introduced in the follow-up of CMP, and to detect barriers and facilitators of its treatments to improve their acceptance. This qualitative study is being conducted in Lleida, Spain, and explores the experiences and feelings of patients, and their acceptance of the standard of care. It follows the consolidated criteria for reporting qualitative research (COREQ) through focus groups, addressing issues with rigor and representativeness. By collecting patients’ opinions, we expect to obtain valuable information to complement the set of variables previously used by health professionals in the follow-up of CMP, and to understand treatment barriers and facilitators.

Objectives: The objective of this study was to conduct a systematic review of the possible association between transforming growth factor B3 (TGFB3) and fibroblast growth factors (FGFs) gene polymorphisms and nonsyndromic cleft lip with or without cleft palate (NSCL/P). Material and Methods: Two reviewers independently screened studies by examining all titles and abstracts. Studies were included if they met the following criteria: The outcome of interest was NSCL/P; the polymorphisms studied were TGFB3 and FGF; they presented sufficient data, that is, allele/genotype frequency between cases and controls; or their odds ratio with 95% confidence interval. Study quality was independently assessed by a risk of bias assessment for genetic association studies. Results: Based on the inclusion criteria, we have selected a total of six articles (four for TGFB and two for FGF). Particularly for the TGFB gene, we have found significant results in exon 4 in the variant g.15812T>G, and in the single-nucleotide polymorphisms rs2300607 A/T, in the distribution between cases and controls. On the other hand, for the FGF gene, we observed a statistically significant in the genotype rs34010 CA. Conclusion: None of the genetic variations that show the association is verified in different populations; therefore, there is not enough scientific validation regarding the association between TGFB and FGF polymorphism and NSCL/P. The findings of the different studies suggest the need for further investigations with samples composed of a larger number of individuals in different populations, which should be performed with all the standards for genetic studies, thus allowing an understanding of the molecular basis of the disease.

El objetivo de esta investigación fue evaluar la participación promovida por profesionales de la Educación Ambiental, usando para ello taxonomías desprendidas de estudios con adultos, niños, niñas y adolescentes. Mediante una encuesta online se involucró a 98 personas que trabajan en este campo en Chile y se realizaron análisis de contenido temático y análisis estadísticos descriptivos. Se asociaron sus respuestas a cuatro posiciones discursivas adultocéntricas y tres infantocéntricas, y se crearon perfiles de cada grupo con base en las otras variables de estudio. Se identificó que las personas con posiciones infantocéntricas tienden a ser más críticas de su práctica, llevan más años de experiencia en el campo y se desempeñan generalmente como activistas o comunicadores ambientales. A partir de lo evidenciado, el presente estudio da luces para la construcción de instrumentos de medición de la participación que sean más sofisticados, y concluye con aspectos que deben ser profundizados o subsanados en próximas evaluaciones.

The organic carbon (Corg) stored in seagrass meadows is globally significant and could be relevant in strategies to mitigate increasing CO2 concentration in the atmosphere. Most of that stored Corg is in the soils that underlie the seagrasses. We explored how seagrass and soil characteristics vary among seagrass meadows across the geographic range of turtlegrass (Thalassia testudinum) with a goal of illuminating the processes controlling soil organic carbon (Corg) storage spanning 23° of latitude. Seagrass abundance (percent cover, biomass, and canopy height) varied by over an order of magnitude across sites, and we found high variability in soil characteristics, with Corg ranging from 0.08 to 12.59% dry weight. Seagrass abundance was a good predictor of the Corg stocks in surficial soils, and the relative importance of seagrass-derived soil Corg increased as abundance increased. These relationships suggest that first-order estimates of surficial soil Corg stocks can be made by measuring seagrass abundance and applying a linear transfer function. The relative availability of the nutrients N and P to support plant growth was also correlated with soil Corg stocks. Stocks were lower at N-limited sites than at P-limited ones, but the importance of seagrass-derived organic matter to soil Corg stocks was not a function of nutrient limitation status. This finding seemed at odds with our observation that labile standard substrates decomposed more slowly at N-limited than at P-limited sites, since even though decomposition rates were 55% lower at N-limited sites, less Corg was accumulating in the soils. The dependence of Corg stocks and decomposition rates on nutrient availability suggests that eutrophication is likely to exert a strong influence on carbon storage in seagrass meadows.

El presente artículo pretende comunicar la existencia de nuevas estelas discoideas pro-cedentes de las localidades aragonesas de Sos del Rey Católico y de Navardún, próximas a Navarra. Para ello, se van a estudiar los posibles lugares de procedencia de las mismas, posteriormente se va a llevar a cabo una descripción de los ornamentos y su simbología, a continuación, se va a realizar una clasificación de las estelas y una búsqueda de paralelos y se va terminar con las conclusiones. Estas han ayudado a ampliar el catálogo de estelas discoideas conocidas en las Cinco Villas de Aragón.

La Diabetes Mellitus 2 es una enfermedad crónico-degenerativa que representa un grave problema de salud pública y de alto costo que afecta a aproximadamente 250 millones de personas en el mundo, por lo que resulta necesario la intervención del profesional de enfermería, ya que, estas retrasan y disminuyen la probabilidad de desarrollo de complicaciones en pacientes diabéticos. Esta investigación, tiene como propósito establecer las intervenciones de enfermería en pacientes con diabetes mellitus II, a partir del análisis fundamentado en la literatura científica existente. Se trata de una investigación en base a una revisión bibliográfica de revisiones sistemáticas, estudios observacionales y ensayos clínicos aleatorizados, sobre los cuidados enfermeros en la evolución del paciente con diabetes mellitus 2. Los criterios de elección y variables de la revisión incluyen artículos científicos publicados en las bases de datos: PubMed, IBECS, SCIELO, CUIDEN, COCHRANE, DIALNET y BVS. La calidad de los artículos se evalúa mediante las escalas CASPe, PRISMA y STROBE. En conclusión, la atención de los cuidados enfermeros debe individualizarse, tratando de manera holística al paciente, estableciendo intervenciones específicas para la prevención y promoción del autocuidado.

Tailoring personalized treatments demands the analysis of a patient’s characteristics, which may be scattered over a wide variety of sources. These features include family history, life habits, comorbidities, and potential treatment side effects. Moreover, the analysis of the services visited the most by a patient before a new diagnosis, as well as the type of requested tests, may uncover patterns that contribute to earlier disease detection and treatment effectiveness. Built on knowledge-driven ecosystems, we devise DE4LungCancer, a health data ecosystem of data sources for lung cancer. In this data ecosystem, knowledge extracted from heterogeneous sources, e.g., clinical records, scientific publications, and pharmacological data, is integrated into knowledge graphs. Ontologies describe the meaning of the combined data, and mapping rules enable the declarative definition of the transformation and integration processes. DE4LungCancer is assessed regarding the methods followed for data quality assessment and curation. Lastly, the role of controlled vocabularies and ontologies in health data management is discussed, as well as their impact on transparent knowledge extraction and analytics. This paper presents the lessons learned in the DE4LungCancer development. It demonstrates the transparency level supported by the proposed knowledge-driven ecosystem, in the context of the lung cancer pilots of the EU H2020-funded project BigMedilytic, the ERA PerMed funded project P4-LUCAT, and the EU H2020 projects CLARIFY and iASiS.

La información narrativa de los distintos documentos publicados por las empresas ha adquirido un papel importante en las estrategias de comunicación de estas. El objetivo de nuestro trabajo es analizar la información textual publicada en el informe de gestión y el informe de resultados de las empresas cotizadas en el Ibex 35 para el periodo 2018-2021. En particular, estudiamos el tono de la información publicada y la extensión de dichos documentos. Nuestros resultados ponen de manifiesto que las empresas del Ibex 35 no incorporan sesgos significativos en la información narrativa de informes de gestión e informes de resultados, que está marcada por un reducido nivel de optimismo y un alto nivel de realismo. Asimismo, tampoco se observan diferencias importantes en el tono de la información narrativa determinadas por el rendimiento económico de las empresas o por el año en el que se publican los documentos. Sin embargo, la extensión del informe de resultados y, especialmente de los informes de gestión, ha crecido significativamente en el periodo analizado, particularmente en las empresas con menor rendimiento.

In the field of education, the benefits of playfulness are widely known in the teaching-learning process, from where they contribute to the integral development of the student. As a problem in the Juan Montalvo Educational Unit No. 41, these activities have not been used as a strategic tool to facilitate the teaching-learning process, the objective of the research is to analyze the playful activities in the teaching-learning process, in its development the playful characterizes , its benefits in the teaching-learning process are identified, and activities are proposed to strengthen the teaching-learning process. This study is based on a qualitative type of research where the documentary analysis and interview techniques were used. The study population corresponds to two managers, to whom the interview was applied. It was obtained as a result that the playful are necessary in the teaching-learning process, having benefits that contribute to creative thinking.

ObjectivesSurgeons become uncomfortable while performing surgery because heat transfer and evaporative cooling are restricted by insulating surgical gowns. Consequently, perceptions of thermal discomfort during surgery may impair cognitive performance. We, therefore, aimed to evaluate surgeons’ thermal comfort, cognitive performance, core and mean skin temperatures, perceptions of sweat-soaked clothing, fatigue and exertion with and without a CoolSource cooling vest (Cardinal Health, Dublin, Ohio, USA).MethodsThirty orthopaedic surgeons participated in a randomised cross-over trial, each performing four total-joint arthroplasties with randomisation to one of four treatment sequences. The effects of cooling versus no cooling were measured using a repeated-measures linear model accounting for within-subject correlations.ResultsThe cooling vest improved thermal comfort by a mean (95% CI) of −2.1 (–2.7 to –1.6) points on a 0–10 scale, pConclusionsA cooling vest worn during surgery lowered core and skin temperatures, improved thermal comfort, and decreased perceptions of sweating and fatigue, but did not improve cognition. Thermal discomfort during major orthopaedic surgery is thus largely preventable, but cooling does not affect cognition.Trial registration numberNCT04511208.

La leishmaniasis es una enfermedad causada por un protozoo flagelado perteneciente al género Leishmania. Tiene distribución mundial, aunque la mayoría de los casos se agrupan en América del Sur, la cuenca mediterránea y algunas zonas de Asia y África. En América Latina la leishmaniasis cutánea se ha ido presentando en mayor cantidad, es una enfermedad desentendida. El objetivo principal de este artículo es indagar y actualizar los conocimientos sobre Leishmaniasis Cutánea, prevalencia, factores de riesgo y diagnóstico en Latinoamérica. Se trata de un tipo de investigación de revisión documental y descriptiva junto a la presentación de un caso de paciente diagnosticado con leishmaniasis cutánea. Para la búsqueda bibliográfica se recabó información de aquellos artículos, estudios de casos, o revisiones que hayan sido publicados en idioma español e inglés y ser encontrados en base de datos como Scielo, Redalyc, PubMed y Google Académico. Los resultados demostraron que la leishmaniasis cutánea es endémica en los países de Latinoamérica y que pese a esto no es muy tomada en cuenta al momento de tomar decisiones que puedan contrarrestar la enfermedad. Sus factores de riesgo se deben a las condiciones socioeconómicas en los que viven muchos habitantes, puesto a que no tienen los recursos económicos necesarios para adecuar sus hogares y puedan ser más protegidos por los flebótomos. El obtener un diagnóstico definitivo de la leishmaniasis cutánea usan técnicas de laboratorio como el frotis, la prueba de Montenegro y el cultivo. Se concluye que la leishmaniasis cutánea afecta especialmente a las poblaciones más pobres ya que se asocia por la malnutrición o malas condiciones de vivienda. Es indispensable que el personal de salud debe ser capacitado para reconocer la zoonosis en su primera etapa, tratarlos oportunamente y evitar errores diagnósticos. Así como iniciar el tratamiento acorde con los parámetros dispuestos, esperando que la evolución de los pacientes sea favorable

The $J^k$ space of $k$-jets of a real function of one real variable $x$ admits the structure of a sub-Riemannian manifold, which then has an associated Hamiltonian geodesic flow, and it is integrable. As in any Hamiltonian flow, a natural question is the existence of periodic solutions. Does $J^k$ have periodic geodesics? This study will find the action-angle coordinates in $T^*J^k$ for the geodesic flow and demonstrate that geodesics in $J^k$ are never periodic.

Este estudio tuvo como objetivo es evaluar la eficiencia y eficacia de la Unidad de Atención Ciudadana del Distrito de Educación 13D06 Junín-Bolivar para identificar las falencias existentes. Se aplicaron dos instrumentos: por un lado, se aplicó una entrevista al analista responsable de esta unidad distrital para conocer lo servicios que ofrecen a la ciudadanía, y, por otro lado, para conocer el nivel de satisfacción de los usuarios se aplicó una encuesta basada en la guía metodológica para la medición y evaluación de la percepción de la calidad de los servicios públicos. Los resultados muestran que en esta unidad distrital existen varios inconvenientes tales como: un considerable índice de insatisfacción en algunos usuarios por falta de claridad de información brindada; malestar por porque los requerimientos o dudas por lo cual el usuario asiste a esta unidad distrital no son atendidos en su totalidad o en algunos de los casos demoran bastante tiempo. Todas las falencias encontradas pueden servir para que esta unidad distrital analice los procesos que no están haciendo de forma eficiente, y puedan mejorar así la eficiencia y eficacia que como servidores públicos tienen la obligación de ofrecerle a la ciudadanía.

El desarrollo de la investigación educativa en el Ecuador y otros países de América del Sur es un avance dentro de los procesos de fortalecimiento de la función de investigación en las universidades, las cuales están encargadas de producir y divulgar conocimiento en diferentes disciplinas, dentro de ellas la educación. Sobre lo mencionado, el presente trabajo se orienta con la finalidad de describir la comparación de los resultados de métricas de SJR (SCImago Journal Rank) y Scielo Analitycs sobre producción científica en el área de la educación del Ecuador con respecto a otros países de América del Sur desde el 2015 hasta el 2020. La metodología del estudio se basó en la educación comparada por medio del proceso de definición del problema, la formulación de hipótesis, la selección de las unidades de análisis, la descripción de los resultados, análisis comparativo, conclusiones comparativas y síntesis y recomendaciones. Los resultados de la investigación demuestran que la producción de conocimiento del Ecuador en el área de la educación ha venido incrementando desde el 2015 hasta el 2020, específicamente con más publicaciones desde el 2017. De forma concluyente, se demuestra la tendencia del país a seguir incrementando la investigación pedagógica, lo cual posibilita que se vaya escalando en posiciones con respecto a los demás países de América del Sur.

La cuarta revolución industrial interactúa con otras vertientes como Cloud Computing, Internet de las Cosas, Ciencia de Datos, Ingeniero de datos, Inteligencia Artificial con Machine Learning. Porque cada vez es más inevitable, no transformar los datos del mundo real en datos digitales como: Textos, audio, imágenes, videos, etc, para su tratamiento y una óptima toma de decisión, en el contexto que se requiera. En consecuencia, de las tecnologías mencionadas deviene el término de Big Data, que subyace con términos estructurados, semi estructurados y no estructurados y todo ello tiene que ser procesado, administrado y gestionado mediante técnicas de ETL, Power BI Desktop y Power BI de servicio cloud, Looker Studio, Arquitectura de Hadoop para Big Data, ASF-Apache Software Foundation, brinda un respaldo al ecosistema de Hadoop, para crear, diseñar y aplicar como investigación, aplicación y distribución en Universidades, PYMES y Empresas e industrias respectivamente, además las multinacionales empresas como Oracle cloud, IBM, Amazon, Azure y Google, se basan con esta tecnología de código abierto – open source de Hadoop.

La economía naranja, creativa está liderando lo que tradicionalmente implicaba la economía, siendo uno de los factores relevantes, las áreas artísticas y culturales que comprende, los recursos y materiales que requiere, así como los talentos de artistas, profesionales, expertos o sencillamente, emprendedores culturales que se han forjado en estas áreas con conocimiento empírico. En tal contexto, el objetivo del presente involucró la relación entre la economía naranja con el desarrollo tecnológico de los emprendimientos de arte y cultura en Portoviejo, ciudad capital de la provincia de Manabí, Ecuador; para lo cual se hizo uso del enfoque mixto de investigación, mediante la aplicación de 4 entrevistas a artistas, gestores culturales, expertos y profesionales en estas áreas; así como de un cuestionario de encuesta a 30 emprendedores en arte y cultura de la ciudad. Los resultados implicaron un mediano uso de la tecnología para el desarrollo tecnológico de sus emprendimientos, siendo que emplean mayoritariamente herramientas tecnológicas como servicios en línea, aplicaciones móviles y redes sociales; y como equipos tecnológicos usan la laptop y el teléfono móvil, aunque otros emplean maquinarias y equipos convencionales para apoyar sus creaciones, sin tener planes de incorporar nuevas tecnologías a sus emprendimientos, siendo una tercera parte, apenas la que está en proceso de adquirirlas. A modo de conclusión, el enfoque de la economía naranja en los emprendimientos creativos de Portoviejo va más allá de la incorporación de tecnologías para promover su desarrollo tecnológico, pues esto depende únicamente del tipo de creaciones que producen.

This article shows the development of a new methodology whose purpose is to support and guide senior managers of manufacturing industries for the improvement and migration of their organizations to industry 4.0 (I4.0). This methodology is the result of a pure research developed in the last 3 years (2019-2022). Which is based on the study of science and engineering tools that have served in solving problems for manufacturing organizations in the last 100 years and are still valid and are key to the complete technological adoption and migration towards industry 4.0. As a result of the development of the current research, the following 3 new concepts to the scientific and industrial community are presented: 1.- The house of improvement and migration towards I4.0. 2.- Methodology of the 4 phases for the improvement and migration towards I4.0 and 3.- The cycle for the improvement and migration to I4.0. It is hoped that through the uses and applications of these concepts, manufacturing organizations will be able to migrate in a gradual, measurable and controllable way to Industry 4.0. Key Words: Industry 4.0, business management, methodology, migration, strategic objectives.

Objective: To introduce VFO and SK VFO Test: new, more representative terminology for symptoms of vitreous floaters/opacities (VFO) and new standardized kinetic (SK) anatomical-functional assessment. Materials and Methods: Eight eyes underwent before-after limited vitrectomy (LV): best-corrected visual acuity, low-luminance visual acuity, Minnesota Low Vision Reading Chart near visual acuity in logMAR, contrast sensitivity function (CV1000E), and straylight measurements (SM) (HDA/LDA/C-Quant). SK infrared confocal scanning laser ophthalmoscopy (SK IRcSLO) and swept-source widefield optical coherence tomography (SS-WF-OCT) identified VFO and posterior vitreous detachment (PVD). SK IRcSLO was performed with gaze directed towards the extreme superior, inferior, and lateral directions. Results: Anatomical-functional results after LV improved in 7 eyes (87.5%): objective scatter index (27.34%), disturbance index (47.97%) and C-Quant Log units (2.26%). Pre-LV SK IRcSLO and SS-WFOCT imaging identified dynamic well-defined VFO and PVD status (100%). A residual asymptomatic anterior cortical vitreous-induced shadowing ripple effect was detected post-LV. Conclusions: This is the first objective-standardized test accounting for VFO kinesis and intermittent effect. There is potential for personalizing treatment and establishing best candidates for laser or surgery. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:306–315.]