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El presente artículo presenta los resultados respecto a factores socioculturales que favorecen la permanencia en la Educación Superior de la población indígena bribri. Estos se derivan de la investigación titulada Permanencia del estudiantado indígena Bribri de la Sede Rodrigo Facio Brenes, Universidad de Costa Rica: una mirada desde el enfoque intercultural, la cual fue llevada a cabo entre los años 2018-2019. La investigación parte del paradigma naturalista bajo el enfoque cualitativo y emplea el método fenomenológico en el diseño investigativo, acceso al campo, elaboración de instrumentos y análisis de los datos recolectados. Se emplearon entrevistas a profundidad y grupos focales para conocer la experiencia universitaria de seis estudiantes indígenas provenientes del pueblo Bribri. El estudio utiliza un enfoque intercultural en el análisis de los factores, que promueve la permanencia de la población en la educación superior, y es esa mirada la que permite abordar el factor sociocultural en el fenómeno de la permanencia. Dentro de los principales hallazgos se reconoce la tendencia de la población participante a brindarle especial reconocimiento y valoración a su propia cultura mediante el rescate de saberes ancestrales y espirituales que les enorgullecen e identifican en el contexto universitario. Se concluye, además, la importancia de favorecer, desde la universidad, los ajustes necesarios para que la población indígena permanezca en el sistema educativo superior. Asimismo, se destacan los esfuerzos que el estudiantado realiza al tener que trasladarse del territorio indígena a lo urbano, lo que representa un cambio de contexto, y la complejidad de establecer nuevas relaciones con otros agentes educativos, factores que influyen de manera significativa en su desarrollo integral y éxito académico.

Abstract Background Sepsis is a severe systemic inflammatory response to infections that is accompanied by organ dysfunction and has a high mortality rate in adult intensive care units. Most genetic studies have identified gene variants associated with development and outcomes of sepsis focusing on biological candidates. We conducted the first genome-wide association study (GWAS) of 28-day survival in adult patients with sepsis. Methods This study was conducted in two stages. The first stage was performed on 687 European sepsis patients from the GEN-SEP network and 7.5 million imputed variants. Association testing was conducted with Cox regression models, adjusting by sex, age, and the main principal components of genetic variation. A second stage focusing on the prioritized genetic variants was performed on 2,063 ICU sepsis patients (1362 European Americans and 701 African-Americans) from the MESSI study. A meta-analysis of results from the two stages was conducted and significance was established at p

In this work, an entropy-stable and well-balanced numerical scheme for a one-dimensional blood flow model is presented. Such a scheme was obtained from an explicit entropy-conservative flux along with a second-order discretisation of the source term by using centred finite differences. We prove that the scheme is entropy-stable and preserves steady-state solutions. In addition, some numerical examples are included to test the performance of the proposed scheme.

Abstract Diabetes is a rare, but potentially life‐threatening, adverse event of immune checkpoint inhibitors that requires prompt recognition and treatment. It usually occurs in the first 3 months of treatment and is typically related to programmed cell death‐1 antibodies, alone or in combined therapy. It has rarely been described developing after immunotherapy cessation. We present a 51‐year‐old man with metastatic melanoma, who developed acute‐onset diabetes 52 days after combined immunotherapy cessation with nivolumab and ipilimumab, and 25.6 months after receiving the first dose. He presented with acute hyperglycemic symptoms, ketosis, complete insulin depletion and negative autoimmunity, fulfilling the criteria of fulminant type 1 diabetes. The patient had previously developed hypophysitis with isolated adrenocorticotropic hormone deficiency during immunotherapy. We describe a case of late‐onset fulminant type 1 diabetes developing after immunotherapy cessation. Patient education and active follow up after immunotherapy discontinuation are crucial to warrant a timely intervention.

Abstract Silicosis is a diffuse interstitial lung disease caused by sustained inhalation of silica and silicates. Several cytokines are activated by their inhalation and can mediate the process of pulmonary fibrosis. The identification of biomarkers could allow an early diagnosis before the development of radiological alterations and help monitor the evolution of patients. The objetive of this study was to determine the clinical significance of specific biomarkers, to estimate their association with the development, severity and/or progression of silicosis, and identify determinants of this evolution. We conducted a prospective observational study in patients attending the pulmonology clinic from 2009 to 2018. Serum levels of the following inflammatory mediators were assessed: interleukin-6 (IL-6), interleukin 2 receptor subunit alpha (IL2R) interleukin 1 beta (IL1B), interleukin-8 (IL-8), tumour necrosis factor-alpha (TNF-α), transforming growth factor-beta1 (TGF-β1), alpha-1 antitrypsin (AAT), C-reactive protein (CRP), lactate dehydrogenase (LDH) and ferritin in subjects exposed to silica, with and without silicosis. Association between those inflammatory mediators with lung function measurements and radiological severity of disease and their impact on prognosis were analysed. 337 exposed to silica (278 with silicosis) and 30 subjects in the control group were included. IL-8, α1AT, ferritin, CRP and LDH levels were higher in silicosis than in those exposed to silica without silicosis. IL-8, LDH and AAT levels were associated with progression of silicosis and IL-6, IL-8, LDH, AAT, ferritin, and CRP with vital status. The results of the ROC analysis indicated the potential of IL-8 as a biomarker in the presence of silicosis and for the prediction of mortality.

OBJECTIVES:. To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome (ARDS), in the era of lung-protective mechanical ventilation (MV). DESIGN:. A 6-month prospective, epidemiological, observational study. SETTING:. A network of 22 multidisciplinary ICUs in Spain. PATIENTS:. Consecutive mechanically ventilated patients with AHRF (defined as Pao2/Fio2 ≤ 300 mm Hg on positive end-expiratory pressure [PEEP] ≥ 5 cm H2O and Fio2 ≥ 0.3) and followed-up until hospital discharge. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Primary outcomes were prevalence of AHRF and ICU mortality. Secondary outcomes included prevalence of ARDS, ventilatory management, and use of adjunctive therapies. During the study period, 9,803 patients were admitted: 4,456 (45.5%) received MV, 1,271 (13%) met AHRF criteria (1,241 were included into the study: 333 [26.8%] met Berlin ARDS criteria and 908 [73.2%] did not). At baseline, tidal volume was 6.9 ± 1.1 mL/kg predicted body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H2O. ARDS patients received higher Fio2 and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H2O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H2O, respectively [p < 0.0001]). Adjunctive therapies were rarely used in non-ARDS patients. Patients without ARDS had higher ventilator-free days than ARDS (12.2 ± 11.6 vs 9.3 ± 9.7 d; p < 0.001). All-cause ICU mortality was similar in AHRF with or without ARDS (34.8% [95% CI, 29.7–40.2] vs 35.5% [95% CI, 32.3–38.7]; p = 0.837). CONCLUSIONS:. AHRF without ARDS is a very common syndrome in the ICU with a high mortality that requires specific studies into its epidemiology and ventilatory management. We found that the prevalence of ARDS was much lower than reported in recent observational studies.

Este artículo presenta resultados de una revisión documental de tipo investigativo, pedagógico y didáctico en el campo de la danza inclusiva.1 El propósito del texto fue estudiar aquellas categorías puestas en relación cuando se considera la enseñanza de la danza a estudiantes sordos, con miras a obtener un aporte en la comprensión de este campo pedagógico y didáctico. Como datos se recopilan 61 registros publicados en este campo, en los ámbitos local, regional y global; este análisis rastreó significados sobre: inclusión, danza, danza inclusiva y sobre una persona sorda. A partir de lo anterior, se identifican problemáticas, interrogantes y vacíos en este emergente campo de investigación, concluyendo que es importante existe una necesidad por establecer elementos para una didáctica de la danza inclusiva que involucre un factor epistemológico que este contextualmente ubicado en el encuentro de sí mismo y del otro. Finalmente, se consideran las posibilidades de las experiencias sensibles, éticas, estéticas, dialógicas y políticas que nos acogen a todos, siendo cuerpos plurales, sin excepción. Es decir, la necesidad de una danza para todos.

Abstract Background COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. Methods A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. Results The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p

Abstract Background Lipoprotein disturbances have been associated with increased cardiovascular disease (CVD) risk in type 1 diabetes mellitus (T1DM). We assessed the advanced lipoprotein profile in T1DM individuals, and analysed differences with non-diabetic counterparts. Methods This cross-sectional study involved 508 adults with T1DM and 347 controls, recruited from institutions in a Mediterranean region of Spain. Conventional and advanced (assessed by nuclear magnetic resonance [NMR] spectroscopy) lipoprotein profiles were analysed. Crude and adjusted (by age, sex, statin use, body mass index and leukocyte count) comparisons were performed. Results The median (interquartile range) age of the study participants was 45 (38–53) years, 48.2% were men. In the T1DM group, the median diabetes duration was 23 (16–31) years, and 8.1% and 40.2% of individuals had nephropathy and retinopathy, respectively. The proportion of participants with hypertension (29.5 vs. 9.2%), and statin use (45.7% vs. 8.1%) was higher in the T1DM vs. controls (p 1000 nmol/L: 38 vs. 21.2%; p

Acute respiratory distress syndrome (ARDS) is an inflammatory process of the lungs that develops primarily in response to pulmonary or systemic sepsis, resulting in a disproportionate death toll in intensive care units (ICUs). Given its role as a critical activator of the inflammatory and innate immune responses, previous studies have reported that an increase of circulating cell-free mitochondrial DNA (mtDNA) is a biomarker for fatal outcome in the ICU. Here we analyzed the association of whole-blood mtDNA (wb-mtDNA) copies with 28-day survival from sepsis and sepsis-associated ARDS. We analyzed mtDNA data from 687 peripheral whole-blood samples within 24 h of sepsis diagnosis from unrelated Spanish patients with sepsis (264 with ARDS) included in the GEN-SEP study. The wb-mtDNA copies were obtained from the array intensities of selected probes, with 100% identity with mtDNA and with the largest number of mismatches with the nuclear sequences, and normalized across the individual-probe intensities. We used Cox regression models for testing the association with 28-day survival. We observed that wb-mtDNA copies were significantly associated with 28-day survival in ARDS patients (hazard ratio = 3.65, 95% confidence interval = 1.39–9.59, p = 0.009) but not in non-ARDS patients. Our findings support that wb-mtDNA copies at sepsis diagnosis could be considered an early prognostic biomarker in sepsis-associated ARDS patients. Future studies will be needed to evaluate the mechanistic links of this observation with the pathogenesis of ARDS.

Recombinant MHC class II molecules are instrumental in antigen-specific T-cell identification assays and showed efficacy as experimental medicines. Here, the authors engineer MHC class II molecules with species-specific knob-into-hole heteromerization domains, enabling a translatable purification process with improved stability, yields, and biological potency.

La presente investigación expone el desarrollo de una aplicación móvil desde una perspectiva ingenieril, fundamentada en la línea de procedimiento de diseño y prototipado, basado en pantallas de interacción con el usuario para dar solución a un problema específico en el ámbito de la bioingeniería, la prevención por infección de VIH/SIDA por medio de la obtención de informes interpretativos, que son el resultado de las pruebas diagnósticas. Ergo, se recurre al diseño iterativo como método para la construcción de un prototipo funcional de una aplicación, titulada PreVIH, utilizando HTML/CCS/JS/WebSQL para ser instalada en teléfonos inteligentes que cuenten con el sistema operativo Android 9 o versiones posteriores. La app resultante demostró la practicidad de utilizar aplicaciones móviles en entornos donde la alta tecnología es de difícil acceso y la necesidad de tener al alcance información es fundamental para la atención primaria, donde los médicos tratantes no cuentan con especializaciones. De allí que, el enfoque de PreVIH sea viable para su mejora y posterior implantación.

Introduction: Toothbrush swallowing, whether voluntary or accidental, is a rare event and must be handled as an emergency, because these foreign bodies, due to their length and hardness, are not expected to pass completely through the digestive tract and may cause serious complications. Case presentation: A 22-year-old woman with an eating disorder (bulimia nervosa) involuntarily swallowed a toothbrush while inducing vomiting. Unfortunately, after the initial assessment in the emergency department, and due to the lack of symptoms, her psychiatric history, and the fact the toothbrush was not observed in imaging studies, she was discharged. Due to the patient's insistence that she was telling the truth, she was referred to a secondary healthcare institution by her treating physician, where the successful endoscopic extraction of the toothbrush was performed 36 hours after it was swallowed. The procedure was carried out with the patient under sedation and by experts in digestive extraction who used an overtube, foreign body forceps, and polypectomy loops. Conclusion: Cases of toothbrush swallowing are rarely reported and occur mainly in people with mental illnesses, such as eating disorders involving self-induced vomiting. Therefore, in these cases, physicians should always believe what these patients say, even in the absence of symptoms and imaging findings, as this enables their timely referral to a digestive service to confirm whether the toothbrush was swallowed or not and to perform the endoscopic extraction as soon as possible, since it can cause serious complications due to its characteristics.

Este artículo tiene como objetivo describir un tipo de evaluación de saberes de madres comunitarias en profesionalización para el desarrollo infantil, como medio de valoración de la atención a la primera infancia en Colombia. El alcance es descriptivo con enfoque mixto. La población está conformada por un grupo de madres comunitarias de Hogares infantiles comunitarios. Como técnica investigativa se utilizó la entrevista a grupo focal, mediante instrumento validado por expertos y orientado a la indagación de los ejes nucleares de la cualificación del talento humano desde lineamientos técnicos para atención educativa infantil. Los resultados están relacionados con los saberes de las madres comunitarias de Programa de Pedagogía Infantil en temáticas específicas de la educación infantil: concepción de infancia, conocimiento sobre política pública de infancia, gestión de proyectos pedagógicos, inter-sectorialidad en servicios integrales, didáctica y estrategias pedagógicas desarrolladas para la atención a la primera infancia en el desarrollo de la profesionalización.

Abstract Background Early appropriate antibiotic treatment is essential in sepsis. We aimed to evaluate the impact of a multifaceted educational intervention to improve antibiotic treatment. We hypothesized that the intervention would hasten and improve the appropriateness of empirical antibiotic administration, favor de-escalation, and decrease mortality. Methods We prospectively studied all consecutive patients with sepsis/septic shock admitted to 72 intensive care units (ICUs) throughout Spain in two 4-month periods (before and immediately after the 3-month intervention). We compared process-of-care variables (resuscitation bundle and time-to-initiation, appropriateness, and de-escalation of empirical antibiotic treatment) and outcome variables between the two cohorts. The primary outcome was hospital mortality. We analyzed the intervention’s long-term impact in a subset of 50 ICUs. Results We included 2628 patients (age 64.1 ± 15.2 years; men 64.0%; Acute Physiology and Chronic Health Evaluation (APACHE) II, 22.0 ± 8.1): 1352 in the preintervention cohort and 1276 in the postintervention cohort. In the postintervention cohort, the mean (SD) time from sepsis onset to empirical antibiotic therapy was lower (2.0 (2.7) vs. 2.5 (3.6) h; p = 0.002), the proportion of inappropriate empirical treatments was lower (6.5% vs. 8.9%; p = 0.024), and the proportion of patients in whom antibiotic treatment was de-escalated was higher (20.1% vs. 16.3%; p = 0.004); the expected reduction in mortality did not reach statistical significance (29.4% in the postintervention cohort vs. 30.5% in the preintervention cohort; p = 0.544). Gains observed after the intervention were maintained in the long-term follow-up period. Conclusions Despite advances in sepsis treatment, educational interventions can still improve the delivery of care; further improvements might also improve outcomes.

Abstract Background Pre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity. Methods This was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score at ICU admission (SOFA

Este texto deviene de la investigación realizada en el segundo semestre del año 2018 y el primero de 2019, titulada “Orientaciones pedagógicas para el fortalecimiento de la expresión emocional en población infantil con Trastorno del Espectro Autista - TEA - del Gimnasio Campestre de Guilford”, institución de educación inclusiva que tiene como misión ofrecer una formación integral propiciando un ambiente académico emocional y social, desde el desarrollo cognitivo, físico y socio afectivo, respetando ritmos de aprendizaje, la formación en valores, el reconocimiento a las diferencias individuales y el desarrollo de la autonomía; escenario educativo que propone un diseño curricular flexible y que permite formación a partir de las condiciones particulares de los estudiantes. El objetivo del estudio fue diseñar orientaciones pedagógicas que fortalezcan las habilidades de expresión emocional de la población infantil de la institución educativa participante y a su vez favorecer los procesos de inclusión. Las orientaciones pedagógicas son entendidas para esta investigación como pautas que apoyan la praxis del docente en el aula, desde el perfil del Pedagogo Infantil y buscan ser una guía para fortalecer la expresión emocional en los niños, aspecto concebido como eje fundamental de la dimensión social y afectiva del ser humano, que asegura el desarrollo integral de la infancia. En términos metodológicos este estudio es básico de corte cualitativo y trabaja el método estudio de caso, con técnicas e instrumentos como la observación participante a través de un registro, entrevista semiestructurada a docentes con guion de entrevista y matrices de sistematización y análisis. Los resultados están enmarcados en la caracterización de habilidades de expresión emocional de la población infantil con TEA, en procesos de inclusión, de la institución educativa participante, así como las apreciaciones de los docentes para identificar los rasgos distintivos en cuanto a la expresión de emociones en la muestra poblacional, permitiendo la construcción de pautas pedagógicas como propuesta de reflexión y observación soporte, para la aplicación – a partir de las orientaciones - desde la mirada del docente en el aula, que aporte a potenciar la expresión emocional de los niños desde el perfil del profesor.

La presente propuesta está enmarcada dentro del Proyecto ACACIA, co-financiado por el Programa Erasmus+ de la Unión Europea. En este contexto se propone, desde uno de los módulos del Proyecto (APOYA), la formación, información y difusión en toda la comunidad académica de orientaciones que permitan fomentar en la comunidad universitaria el respeto, reconocimiento y aprecio de la interculturalidad y la diversidad. Este trabajo se desarrolla buscando mejorar las condiciones de salud emocional y de bienestar de los miembros de la comunidad educativa de las universidades, y de esta manera reducir los riesgos de exclusión, tanto sociales como del sistema de educación superior, lo anterior a través del trabajo colaborativo de los equipos de 13 universidades de Iberoamérica y una de Rumania para la construcción de guías y campañas que permitan definir las estrategias de actuación para el trato con alumnos en situaciones que pueden llevarles a la exclusión, tales como capacidades diferenciales, diversidad sexual, violencia de género, diversidad cultural, drogadicción, diversidad religiosa, violencia intrafamiliar. Se presentan resultados, no obstante que el proyecto se encuentra en curso, los cuales hacen referencia a la estructura y propósito de contenidos educativos en forma de guías para la comunidad universitaria que incluyen afectividad, estados emocionales, tolerancia y diversidad para ser aplicados en los ambientes de la educación superior. Los autores agradecen a la Comisión Europea por su apoyo y cofinanciación, así como a los socios del proyecto: ERASMUS+: Higher Education International Capacity Building–ACACIA– (561754-EPP-1-2015-1-CO-EPKA2-CBHE-JP). Esta publicación es responsabilidad exclusiva de sus autores

This article describes and analyzes the metadata defined by the information management team of Spanish regional TV broadcaster Canal Extremadura Televisión, as used in their documentation management system. The presented metadata covers both news as well as entertainment broadcasts. The article also offers a brief introduction to the metadata problem space, including the most important Spanish-language authors in this area - as well as an analysis of the documentation management system of Canal Extremadura Televisión, including its history.

Las personas con Enfermedad Renal Crónica en diálisis permanentemente toman decisiones sobre lo que pueden y deben hacer en relación a su situación de salud, limitación y requerimiento personal para mantener la homeostasis y controlar los factores de riesgo; por lo tanto conocer y potenciar su capacidad de autocuidado es fundamental para diseñar estrategias que impacten sus necesidades. Objetivo: Determinar la capacidad de autocuidado de las personas con Insuficiencia Renal Crónica en diálisis, así como su relación con las características sociodemográficas y clínicas. Material y Método: Estudio cuantitativo descriptivo de corte transversal. La población estuvo conformada por 111 personas dializadas en una unidad renal de Florencia (Colombia). Se aplicaron los instrumentos: caracterización sociodemográfica y clínica, y capacidad de agencia de autocuidado en el paciente hipertenso. Los datos se analizaron mediante la estadística descriptiva. Resultados: Edad promedio de la población 56 años (DE:+14); género masculino 55.9%; su capacidad de agencia de autocuidado fue alta y media (80,2% y 19,8%) respectivamente; se encontró significación entre la variable capacidad de autocuidado y edad, que indica que a mayor edad, disminuye la capacidad de autocuidado (p=0,024

This article describes the way as the University of Zulia assumes institutional communication and disclosure of its scientific production, through the Web portal: LUZ-Web, Agency de Notices (light/DNA), as a means of communication that facilitates the processing and dissemination of scientific journalism. The general objective was to examine media coverage of climate change on the web site of the University of Zulia, through the analysis of their news content of these topics, stored in your repository of cyberspace. The results showed a University communication related with the scientific journalism as part of the dissemination of the work of the institution, which recorded one hundred and seventy-five information about science and technology published between June 2009 and September 2012, including twenty-four linked directly or indirectly with the climate change, however, in general there is precedence of other content on the University and the Academy in relation to messages about the intellectual production carried outreason why it is concluded that the various activities of the University events, such as teaching, research and extension, form part of unevenly from the institutional communication universe that spreads and disseminates through the light/DNA.