Asociación entre nutrientes y hemoglobina glicosilada en diabéticos tipo 2

Introducción: la hiperglicemia es la característica principal de la diabetes (DM). La restricción de CHO en la dieta presenta el mayor efecto en la disminución de los niveles de glucosa en sangre tanto en DM 1 y 2. Objetivo: asociar la ingesta de macro y micronutrientes con el control metabólico de pacientes con diabetes tipo 2. Material y métodos: se entrevistó a 714 pacientes diabéticos tipo 2 de ambos sexos, entre 27 y 90 años, en centros de salud familiar de Santiago de Chile. Se les aplicó una encuesta alimentaria y una evaluación antropométrica. Se realizó prueba de regresión logística, se estimó además el valor del Odds Ratio (OR) y su correspondiente intervalo de confianza (IC). Resultados: el IMC promedio fue de 30,8 ± 5,7 kg/m², el 29,8% de los sujetos tenía una HbA1c compensada. Se puede observar que solo la ingesta elevada de carbohidratos (percentil 75) se asoció con un incremento en el riesgo de tener HbA1c elevada OR = 2,7 (IC 95% 1,5-4,8; p < 0,001). Conclusiones: la ingesta elevada de carbohidratos de rápida absorción, altos en sacarosa y bajos en fibra se asocia como factor de riesgo en el incremento de HbA1c. La ingesta total de energía y el patrón de alimentación saludable se debe priorizar sobre la distribución de macronutrientes. Es importante la asesoría de un experto en nutrición especializado en diabetes quien, en colaboración con el equipo médico, debe determinar el tratamiento para cumplir con los objetivos individuales del paciente.

Plan de mercadeo para la comercialización de la jalea artesanal bella fruta en el mercado de ventas al detalle del municipio de San Salvador.

“Bella Fruta” es una empresa, que se dedica a la elaboración de jalea artesanal de piña y fresa; de la mejor calidad y que es comercializada como insumo a empresas dedicadas a la elaboración de pan. En la actualidad la empresa solo vende su producto en el mercado mayorista y en la presentación que ya se mencionó, por lo que con la intención de adquirir mayor participación en el mercado y mejorar sus resultados, muestra la necesidad de incursionar en el mercado de ventas al detalle y poder comercializar su producto al consumidor directamente. En este sentido surge este trabajo de graduación que se titula “PLAN DE MERCADEO PARA LA COMERCIALIZACIÓN DE LA JALEA ARTESANAL “BELLA FRUTA” EN EL MERCADO DE VENTAS AL DETALLE DEL MUNICIPIO DE SAN SALVADOR”, como una propuesta ante sus necesidades de corto y largo plazo. Dicho plan de mercadeo contribuirá a que la administración de la empresa posea una herramienta que los oriente a mejorar sus resultados a través de comercializar su producto en el mercado detallista. Para recopilar la información que permitiera el desarrollo de la investigación se hizo necesario un estudio de campo, haciendo uso de instrumentos tales como: La observación directa, entrevista con las autoridades de la empresa, cuestionarios a los posibles distribuidores del producto, cuestionarios al público en general para poder identificar de esta manera las necesidades de la empresa, y diferentes actividades que tuvieron como objetivo ofrecer al cliente potencial muestras del producto a fin de conocer su opinión acerca de las características principales del producto. Una vez recopilada la información se procedió a tabularla e interpretarla, obteniendo datos que ponen de manifiesto las cualidades y deficiencias de la empresa “Bella Fruta”, estos resultados sirvieron como base para la elaboración del diagnóstico el cual facilitó la formulación de conclusiones y recomendaciones, las cuales dieron origen a las estrategias de largo plazo y las recomendaciones a corto plazo que deben ser ejecutadas. Tomando en cuenta los resultados obtenidos en el presente estudio e implementando las estrategias propuestas se lograría incursionar exitosamente en el mercado detallista y posicionar adecuadamente el producto en la mente del consumidor.

Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy

Importance A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex. Objective To evaluate the rate of within-couple HIV transmission (heterosexual and men who have sex with men [MSM]) during periods of sex without condoms and when the HIV-positive partner had HIV-1 RNA load less than 200 copies/mL. Design, Setting, and Participants The prospective, observational PARTNER (Partners of People on ART-A New Evaluation of the Risks) study was conducted at 75 clinical sites in 14 European countries and enrolled 1166 HIV serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex (September 2010 to May 2014). Eligibility criteria for inclusion of couple-years of follow-up were condomless sex and HIV-1 RNA load less than 200 copies/mL. Anonymized phylogenetic analysis compared couples' HIV-1 polymerase and envelope sequences if an HIV-negative partner became infected to determine phylogenetically linked transmissions. Exposures Condomless sexual activity with an HIV-positive partner taking virally suppressive ART. Main Outcomes and Measures Risk of within-couple HIV transmission to the HIV-negative partner. Results Among 1166 enrolled couples, 888 (mean age, 42 years [IQR, 35-48]; 548 heterosexual [61.7%] and 340 MSM [38.3%]) provided 1238 eligible couple-years of follow-up (median follow-up, 1.3 years [IQR, 0.8-2.0]). At baseline, couples reported condomless sex for a median of 2 years (IQR, 0.5-6.3). Condomless sex with other partners was reported by 108 HIV-negative MSM (33%) and 21 heterosexuals (4%). During follow-up, couples reported condomless sex a median of 37 times per year (IQR, 15-71), with MSM couples reporting approximately 22 000 condomless sex acts and heterosexuals approximately 36 000. Although 11 HIV-negative partners became HIV-positive (10 MSM; 1 heterosexual; 8 reported condomless sex with other partners), no phylogenetically linked transmissions occurred over eligible couple-years of follow-up, giving a rate of within-couple HIV transmission of zero, with an upper 95% confidence limit of 0.30/100 couple-years of follow-up. The upper 95% confidence limit for condomless anal sex was 0.71 per 100 couple-years of follow-up. Conclusions and Relevance Among serodifferent heterosexual and MSM couples in which the HIV-positive partner was using suppressive ART and who reported condomless sex, during median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission (upper 95% confidence limit, 0.30/100 couple-years of follow-up). Additional longer-term follow-up is necessary to provide more precise estimates of risk.

Towards understanding resprouting at the global scale

Understanding and predicting plant response to disturbance is of paramount importance in our changing world. Resprouting ability is often considered a simple qualitative trait and used in many ecological studies. Our aim is to show some of the complexities of resprouting while highlighting cautions that need be taken in using resprouting ability to predict vegetation responses across disturbance types and biomes. There are marked differences in resprouting depending on the disturbance type, and fire is often the most severe disturbance because it includes both defoliation and lethal temperatures. In the Mediterranean biome, there are differences in functional strategies to cope with water deficit between resprouters (dehydration avoiders) and nonresprouters (dehydration tolerators); however, there is little research to unambiguously extrapolate these results to other biomes. Furthermore, predictions of vegetation responses to changes in disturbance regimes require consideration not only of resprouting, but also other relevant traits (e.g. seeding, bark thickness) and the different correlations among traits observed in different biomes; models lacking these details would behave poorly at the global scale. Overall, the lessons learned from a given disturbance regime and biome (e.g. crown-fire Mediterranean ecosystems) can guide research in other ecosystems but should not be extrapolated at the global scale.

Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic

AIMS AND OBJECTIVES: To evaluate the test-retest stability in assessments of perceived symptom intensity on the Edmonton Symptom Assessment System-revised and the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. The possible interchangeability between the instruments and the patients' experiences of completing the instruments were also studied. BACKGROUND: The two instruments assess the same symptoms, but the symptom intensity is assessed on 11-point numerical scales on the Edmonton Symptom Assessment System-revised and on four-point verbal descriptive scales on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. Both instruments are commonly used; however, uncertainty exists about which instrument should be recommended and about the interchangeability of the instruments. DESIGN: This study used a test-retest design with inter-scale comparisons. METHODS: Data from 54 patients with cancer who were receiving palliative care in an oncology outpatient clinic were self-reported by the patients in the clinic, at home and when patients returned to the clinic. RESULTS: The assessments on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative verbal rating scales showed a higher level of test-retest stability than the assessments on the Edmonton Symptom Assessment System-revised numerical scoring scales, indicating higher reliability. The correspondence between the verbal categories and the numerical scores of symptom intensity were low because different verbal categories were used by patients who assessed the same numerical score. CONCLUSIONS: The test-retest stability in the assessments was higher on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative and the results show that assessments on the two instruments could not be used interchangeably. Therefore, the symptom instrument chosen must be specified and unchanged within a patient to improve efficacy in clinical practice. RELEVANCE TO CLINICAL PRACTICE: The Edmonton Symptom Assessment System-revised or the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative can be used for initial assessments of patients, but should not be compared or used interchangeably. It is vitally important to have individual follow-up for all patients who score an instrument.

The trajectory of dispersal research in conservation biology. Systematic review

Dispersal knowledge is essential for conservation management, and demand is growing. But are we accumulating dispersal knowledge at a pace that can meet the demand? To answer this question we tested for changes in dispersal data collection and use over time. Our systematic review of 655 conservation-related publications compared five topics: climate change, habitat restoration, population viability analysis, land planning (systematic conservation planning) and invasive species. We analysed temporal changes in the: (i) questions asked by dispersal-related research; (ii) methods used to study dispersal; (iii) the quality of dispersal data; (iv) extent that dispersal knowledge is lacking, and; (v) likely consequences of limited dispersal knowledge. Research questions have changed little over time; the same problems examined in the 1990s are still being addressed. The most common methods used to study dispersal were occupancy data, expert opinion and modelling, which often provided indirect, low quality information about dispersal. Although use of genetics for estimating dispersal has increased, new ecological and genetic methods for measuring dispersal are not yet widely adopted. Almost half of the papers identified knowledge gaps related to dispersal. Limited dispersal knowledge often made it impossible to discover ecological processes or compromised conservation outcomes. The quality of dispersal data used in climate change research has increased since the 1990s. In comparison, restoration ecology inadequately addresses large-scale process, whilst the gap between knowledge accumulation and growth in applications may be increasing in land planning. To overcome apparent stagnation in collection and use of dispersal knowledge, researchers need to: (i) improve the quality of available data using new approaches; (ii) understand the complementarities of different methods and; (iii) define the value of different kinds of dispersal information for supporting management decisions. Ambitious, multi-disciplinary research programs studying many species are critical for advancing dispersal research.

Planning for country: empowering built environment students with Indigenous protocols and knowledge

Increasingly, Built Environment (BE) professionals, including planner, architect and landscape architect practitioners, are becoming involved in the planning and design of projects for, and in direct consultation with Indigenous communities and their proponents. These projects range from inserting Indigenous cultural landscape analysis into planning schemes, including Indigenous protocols and aspirations in policy statements; designing cultural centres, information centres and housing; drafting cultural tourism strategies and devising cross-cultural land management plans. This entails working with Indigenous communities or their nominated representatives as stakeholders in community engagement, consultation, and planning processes. Critically, BE professionals must be able to plan and design with regard to Indigenous community’s cultural protocols, issues and values. Yet many (domestic and or international) students graduate with little or no comprehension of Indigenous knowledge systems or the protocols for engagement with the communities in which they are required to work, whether they be Australian or international Indigenous communities. Contextually, both PIA and the planning academe have struggled with coming to terms with this realm over the last 10 years. This paper will report on a recently completed Australian Government Office of Learning & Teaching (OLT) funded research project that has sought to improve opportunities to improve the knowledge and skills of tertiary students in the BE professions through the enhancement of their competency, appreciation and respect for Indigenous protocols and processes that also implicates the professional accreditation systems that these courses are accountable. It has proposed strategies and processes to expose students in the BE professions to Australian Indigenous knowledge and cultural systems and the protocols for engaging with Indigenous Australians about their rights, interests, needs and aspirations. Included in these findings is the provision of a tool that enables and offers guidance to BE tertiary students and academics how to enhance comprehension, exposure to, and knowledge and cultural systems of, Indigenous Australians. While the scope of this report is cross-BE, this paper will focus upon the planning practice, policy and academe realms.

Calcolo del flusso di raggi-γ del Blazar PKS B1424-418

Lo scopo di questo lavoro è quello di analizzare i dati raccolti dal Large Area Telescope a bordo del satellite Fermi con l'obiettivo di ricavare il flusso di raggi-γ, di energia compresa tra 100 MeV e 300 GeV, prodotti dal Blazar PKS B1424-418 in un periodo compreso tra l'1 Gennaio 2012 e il 4 Settembre 2016. Secondo alcuni modelli questo blazar potrebbe essere infatti la prima sorgente di Ultra High Energy Cosmic Ray associata sperimentalmente all'emissione di neutrini. L'analisi dei dati è effettuata tramite il pacchetto di software Fermi Science Tools.

Clustering of tau-immunoreactive pathology in chronic traumatic encephalopathy

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder which may result from repetitive brain injury. A variety of tau-immunoreactive pathologies are present, including neurofibrillary tangles (NFT), neuropil threads (NT), dot-like grains (DLG), astrocytic tangles (AT), and occasional neuritic plaques (NP). In tauopathies, cellular inclusions in the cortex are clustered within specific laminae, the clusters being regularly distributed parallel to the pia mater. To determine whether a similar spatial pattern is present in CTE, clustering of the tau-immunoreactive pathology was studied in the cortex, hippocampus, and dentate gyrus in 11 cases of CTE and 7 cases of Alzheimer’s disease neuropathologic change (ADNC) without CTE. In CTE: (1) all aspects of tau-immunoreactive pathology were clustered and the clusters were frequently regularly distributed parallel to the tissue boundary, (2) clustering was similar in two CTE cases with minimal co-pathology compared with cases with associated ADNC or TDP-43 proteinopathy, (3) in a proportion of cortical gyri, estimated cluster size was similar to that of cell columns of the cortico-cortical pathways, and (4) clusters of the tau-immunoreactive pathology were infrequently spatially correlated with blood vessels. The NFT and NP in ADNC without CTE were less frequently randomly or uniformly distributed and more frequently in defined clusters than in CTE. Hence, the spatial pattern of the tau-immunoreactive pathology observed in CTE is typical of the tauopathies but with some distinct differences compared to ADNC alone. The spread of pathogenic tau along anatomical pathways could be a factor in the pathogenesis of the disease.

Culturas celulares

As culturas celulares apareceram no século XX e têm vindo a evoluir como método de estudo e análise de patologias e de novos medicamentos para as combater. Com o passar dos anos surgiram diferentes métodos de cultivo de células diversificando assim as culturas celulares em mono-camada, suspensas e imobilizadas. Um dos propósitos das culturas celulares é a manipulação das células de modo a permitir a visualização das alterações celulares como o envelhecimento da célula (senescência), a apoptose, a necrose e a autofagia da célula. Este método tem provado ser útil tanto no diagnostico e tratamento de várias patologias como em doenças oncológicas, neuro-degenerativas ou do sistema imunitário.

The role of cultural heritage in attracting skilled individuals

The purpose of this paper is to examine the role played by built heritages and cultural environments, alongside other locational factors, in explaining the growth of human capital in Sweden. We distinguish between urban, natural and cultural qualities as different sources of regional attractiveness and estimate their influence on the observed growth of individuals with at least three years of higher education during 2001–2010. Neighborhood-level data are used, and unobserved heterogeneity and spatial dependencies are modeled by employing random effects estimations and an instrumental variable approach. Our findings indicate that the local supply of built heritages and cultural environments explain a significant part of human capital growth in Sweden. Results suggest that these types of cultural heritages are important place-based resources with a potential to contribute to improved regional attractiveness and growth.

Implantation d’une innovation au sein d’une région rurale éloignée au Québec : le rôle d’infirmière praticienne spécialisée en soins de première ligne- une étude de cas multiples

Introduction : La situation de l’accès, de la continuité et de la coordination des services de santé au Canada et au Québec est des plus préoccupantes. Pour contribuer à résoudre ces problématiques, l’élargissement des champs de pratique professionnels a été proposé. Lorsqu’il est question d’élargir le rôle des infirmières, la pratique infirmière avancée (PIA) est fréquemment abordée. Au Québec, ce n’est qu’en 2006 qu’un rôle associé à la PIA en première ligne a pu officiellement être mis en place, celui d’infirmière praticienne spécialisée en soins de première ligne (IPSPL) (Durand, Allard, & Ménard, 2006). L’implantation du rôle d’IPSPL est récente et peut être conçue comme une innovation. Les difficultés liées à l’implantation des rôles de PIA font l’objet d’un consensus. Pour pallier à ces difficultés, il est proposé d’approfondir la compréhension de la façon dont les rôles de PIA sont implantés, et ce, en considérant les contextes. Encore peu de recherches s’intéressent au processus d’implantation du rôle d’IPSPL au Québec, et aucune n’est centrée sur le contexte rural éloigné. But : Cette recherche vise à comprendre le processus d’implantation du rôle d’IPSPL au sein d’une région rurale éloignée du Québec, à travers l’éclairage d’un cadre de référence intégrant les théories de la diffusion de l’innovation et des transitions. Méthode : Cette étude de trois cas se situe dans un paradigme pragmatique, avec des visées descriptive et explicative. Des stratégies de collecte de données mixtes ont été utilisées auprès de personnes provenant du contexte québécois, de la région ciblée et des cas (IPSP, médecins partenaires, DSI, DSP, gestionnaires, personnes soignées et leur famille). Résultats : L’implantation est un processus multidimensionnel, multifactoriel et évolutif. Le contexte, le déroulement, la compréhension, les acteurs et le temps sont des parties intégrantes de l’implantation et sont étroitement inter-reliés. Le déroulement de l’implantation et des transitions se produit simultanément. Discussion : Cette recherche a permis de mettre en lumière la raison pour laquelle le processus d’implantation du rôle d’IPSPL doit être considéré comme un processus complexe. Cette thèse contribue à éclairer la recherche axée sur l’efficacité en permettant de mieux comprendre les différentes composantes de l’implantation. Mots-clés : implantation, rôle, infirmière praticienne, première ligne, rural, éloigné, innovation, transition.

El discurso del codesarrollo y la ideología poscolonial: La perpetuación de la migración desde África del Sahel hacia Francia

La cercanía geográfica y los vínculos históricos existentes entre Francia y África mantienen hasta la actualidad unas relaciones enmarcadas en un escenario de cooperación entre ambos. Sin embargo, el creciente número de migrantes de 1999 a 2013 desde las antiguas excolonias francesas, Malí y Senegal, llevó a Francia a impulsar una serie de herramientas para el codesarrollo, es decir, un conjunto de estrategias para que el migrante fuera un vector de desarrollo no solo para Francia sino para sus países de orígen. En ese sentido, este artículo pretende evaluar el codesarrollo como una herramienta discursiva de la política exterior francesa –a través del método de análisis del discurso de Teun van Dijk– en la cual ha prevalecido el poscolonialismo como una ideología que refleja una relación poder-conocimiento.

Incidencia de la adopción de los estándares de pacto global, en las instituciones de educación superior en Colombia en los años 2010 - 2015

La presente investigación busca analizar el impacto en los procesos organizacionales de las Instituciones de Educación Superior IES, por la adhesión voluntaria a Pacto Global mediante la verificación del cumplimiento de los principios a nivel documental y práctico. Esta iniciativa encuentra de gran valor la participación de la academia por su aporte a los aspectos críticos en las actividades, su contribución a la investigación, aprendizaje, recursos educativos, a la formación de líderes responsables, entre otros. En ese orden de ideas, el objetivo es conocer cuáles son los beneficios de la adopción de los diez principios relacionados con derechos humanos, estándares laborales, medio ambiente y anticorrupción en las IES, a partir de la revisión de los Comunicados de Progreso (COPs) y/o Comunicados de Involucramientos (COEs), trabajo de campo pertinente a la investigación. En una primera etapa se realizó el diagnóstico, basado en la revisión documental de los informes de cada IES activas en Pacto Global y de la verificación del cumplimiento de los compromisos descritos en los informes a través de las entrevistas realizadas en las IES seleccionadas. La segunda etapa consistió en evaluar en una matriz: el nivel de conocimiento, cumplimiento, motivación y efectividad de los resultados de cada IES. Los resultados obtenidos hacen referencia a la unificación de esfuerzos dentro de la organización, la transferencia del conocimiento, mayor visibilidad en la sociedad, entre otros. En definitiva, la adhesión a Pacto ha permitido que las IES sean organizaciones responsables al servicio de la comunidad educativa y empresarial.

Análisis de la influencia del programa de mejoramiento integral de barrios de Bogotá en el territorio del API El tesoro de la localidad de Ciudad Bolívar

La expansión urbana mediante asentamientos de origen informal ha ido aumentado en los últimos años debido al déficit en la oferta de vivienda formal, el costo del suelo urbano y factores económicos, sociales y culturales. Estos asentamientos no cuentan con infraestructura básica y los terrenos que generalmente son invadidos se encuentran en zonas de riesgo y no ofrecen las condiciones físicas y habitacionales adecuadas para el habitar de las personas. El distrito a través del Programa de Mejoramiento Integral de Barrios (PMIB) busca intervenir sobre los aspectos críticos en cada barrio, habilitar la infraestructura básica que permita su integración a la ciudad y mejorar la calidad de vida de los habitantes. Este proceso parte de delimitar las zonas críticas y definir las intervenciones físicas, sociales y ambientales que deben ser llevadas a cabo por diferentes entidades distritales. En este estudio se hace un análisis de las intervenciones que se han llevado a cabo en la Área Prioritaria de Intervención (API) El Tesoro, para analizar cuales intervenciones llevadas a cabo han sido exitosas y cuales requieren de ajustes para lograr un mejor impacto. Se encontró que estas intervenciones no han sido suficientes para mejorar las condiciones habitacionales de las personas, razón por lo cual es necesario revisar la política y formas de intervención.