Caracterización de las variables nutricionales en pacientes incidentes de diálisis peritoneal rts 2011-2012

Los pacientes con enfermedad renal crónica (ERC) terminal se caracterizan por presentar alteraciones nutricionales que se perpetúan independiente de la modalidad de la Terapia de Reemplazo Renal (TRR). En la diálisis peritoneal, tanto APD (automated peritoneal dialysis) como la CAPD (continuous ambulatory peritoneal dialysis) existe un alto riesgo de pérdida de albúmina por el filtrado peritoneal, sin diferencias claras en el estatus nutricional. El presente estudio caracteriza el estado nutricional de los pacientes incidentes en diálisis peritoneal de RTS Bogotá Regional 1, con un seguimiento de un año, para conocer los cambios en las variables nutricionales. Se realizó un estudio de cohortes retrospectivo, analizando 2 grupos según el tipo de diálisis peritoneal escogida (APD o CAPD), con un análisis análisis descriptivo trimestral de las características nutricionales y posteriormente una comparación entre las 2 modalidades de TRR. Encontrando un promedio de edad de 60,8 años, la mayoría hombres y etiología principal nefropatía diabética. La mayoría de las variables nutricionales permanecieron sin cambios durante seguimiento. El Test de equilibrio peritoneal para glucosa y creatinina mostró valores promedio bajo y promedio alto y la mayoría de pacientes un rango nutricional normal. Al comparar APD y CAPD, solo se encontraron de forma aislada, diferencias significativas en algunas variables aisladas. Este es el primer estudio en Colombia que evalúa diferentes aspectos nutricionales en diálisis peritoneal. Aunque con limitaciones metodológicas, es un punto de partida para la realización de estudios más robustos que del estado nutricional de los pacientes en diálisis peritoneal

Genética, riesgo y derecho penal: una aproximación interdisciplinaria

Este texto presenta un estudio científico y jurídico sobre la genética y el derecho penal, con el objeto de realizar un pequeño aporte para la superación de la polarización política y moral de los debates sobre la genética y el derecho, que sólo ha conducido a una desafortunada paralización de la regulación sobre el tema que aumenta los riesgos para la salud humana y el equilibrio de los ecosistemas. Ante una problemática tan compleja, el derecho moderno no plantea una solución unitaria, sino una metodología a través de la cual cada sociedad democráticamente pueda adoptar sus propias decisiones frente a la salvaguarda de su patrimonio genético.

Factores perinatales para riesgo de sobrepeso y obesidad en niños de 4 a 5 años en Colombia 2010.

Introducción: La OMS revela que en 2010 alrededor de 43 millones de niños menores de 5 años presentan sobrepeso. En Colombia según la Encuesta Nacional de Situación Nutricional en Colombia en su versión 2005, mostraba una prevalencia general de sobrepeso de 3.1% niños de 0 a 4 años. Es una condición de salud de origen multifactorial en la que interviene factores genéticos, ambientales, maternos y perinatales. Objetivo: Establecer la asociación de riesgo entre el bajo peso al nacer y el desarrollo de sobrepeso y obesidad en niños de 4 a 5 años. Metodología: Se realizó un estudio observacional descriptivo retrospectivo de corte transversal con los datos nutricionales, maternos y perinatales de la Encuesta Nacional de Demografía en Salud del año 2010 en Colombia. Se analizó la asociación entre la variable independiente bajo peso al nacer con el desenlace sobrepeso y obesidad en menores de 4 a 5 años, usando como medida el IMC según la edad. Se realizaron análisis univariados, bivariados y de regresión logística con un modelo de riesgo según las variables que inciden en el desenlace y la variable independiente. Resultados: La muestra obtenida para el estudio fue de 2166 niños de 4 a 5 años de edad quienes cumplían los criterios de inclusión. La prevalencia de sobrepeso u obesidad en la primera infancia fue de 21.8% (472) y el bajo peso al nacer. Los resultados sugieren la asociación de bajo peso y sobrepeso u obesidad es de ORajustado= 0.560 (0.356 – 0.881). Conclusiones: Los resultados sugieren que existe una asociación como factor protector entre el bajo peso y el sobrepeso u obesidad en la primera infancia. Sin embargo, debido al comportamiento de las variables consideradas en la muestra no hay suficiente información para rechazar completamente la hipótesis nula.

El feedback y el feedforward en la evaluaci??n de las competencias de estudiantes universitarios

Resumen basado en el de la publicaci??n

Museu inspirador: exercício de aplicação da ferramenta de auto-avaliação - Inspiring learning for all em quatro serviços educativos de museus portugueses

Esta dissertação tem como objectivo principal procurar contribuir para a discussão em torno das valências das ferramentas da Qualidade aplicadas ao campo museal. O seu enfoque particular desenvolve-se ao nível dos serviços educativos, procurando avaliar os seus processos e resultados. Partindo da premissa de que os museus que aplicam os princípios da Qualidade nas suas práticas museais estão mais aptos a inspirarem e apoiarem as necessidades de aprendizagem dos seus utilizadores, esta dissertação defenderá as instituições museológicas enquanto organizações de conhecimento, sendo a aprendizagem o âmago da sua acção. A sua questão orientadora centra-se em torno da pertinência da aplicação da ferramenta de auto-avaliação Inspiring Learning for All em museus portugueses.

Assessing range-wide habitat suitability for the Lesser Prairie-Chicken

Population declines of many wildlife species have been linked to habitat loss incurred through land-use change. Incorporation of conservation planning into development planning may mitigate these impacts. The threatened Lesser Prairie-Chicken (Tympanuchus pallidicinctus) is experiencing loss of native habitat and high levels of energy development across its multijurisdictional range. Our goal was to explore relationships of the species occurrence with landscape characteristics and anthropogenic effects influencing its distribution through evaluation of habitat suitability associated with one particular habitat usage, lekking. Lekking has been relatively well-surveyed, though not consistently, in all jurisdictions. All five states in which Lesser Prairie-Chickens occur cooperated in development of a Maxent habitat suitability model. We created two models, one with state as a factor and one without state. When state was included it was the most important predictor, followed by percent of land cover consisting of known or suspected used vegetation classes within a 5000 m area around a lek. Without state, land cover was the most important predictor of relative habitat suitability for leks. Among the anthropogenic predictors, landscape condition, a measure of human impact integrated across several factors, was most important, ranking third in importance without state. These results quantify the relative suitability of the landscape within the current occupied range of Lesser Prairie-Chickens. These models, combined with other landscape information, form the basis of a habitat assessment tool that can be used to guide siting of development projects and targeting of areas for conservation.

The potential for high performance design adoption in retail property portfolios

Growing legislative pressures and increasing stakeholder awareness of environmental issues are pushing the property market to consider high-performance, low-impact retail buildings. The office sector is relatively advanced in its apparent appreciation of such buildings; however, the retail sector is slow to recognize these benefits. In exploring the business case for high-performance design adoption in the retail sector, this paper examines the overlaps between office and retail sector benefits and considers the potential benefits peculiar to retailers. Barriers to high-performance design adoption are then addressed through case research, interviews with key representatives from the retail property market and a questionnaire survey of FTSE listed retail company property departments. The paper concludes that information gaps are a significant hindrance to high-performance property development and that they can be reduced, to some extent, by the forthcoming introduction of the BREEAM Retail environmental assessment tool. Copyright © 2003 John Wiley & Sons, Ltd and ERP Environment.

Vegetation dynamics in abandoned crop fields on a Mediterranean island: Development of succession model and estimation of disturbance thresholds

This case study on the Sifnos island, Greece, assesses the main factors controlling vegetation succession following crop abandonment and describes the vegetation dynamics of maquis and phrygana formations in relation to alternative theories of secondary succession. Field survey data were collected and analysed at community as well as species level. The results show that vegetation succession on abandoned crop fields is determined by the combined effects of grazing intensity, soil and geological characteristics and time. The analysis determines the quantitative grazing thresholds that modify the successional pathway. Light grazing leads to dominance by maquis vegetation while overgrazing leads to phryganic vegetation. The proposed model shows that vegetation succession following crop abandonment is a complex multi-factor process where the final or the stable stage of the process is not predefined but depends on the factors affecting succession. An example of the use of succession models and disturbance thresholds as a policy assessment tool is presented by evaluating the likely vegetation impacts of the recent reform of the Common Agricultural Policy on Sifnos island over a 20-30-year time horizon. (c) 2006 Elsevier B.V. All rights reserved.

Coordinated management of intelligent pervasive spaces

The content of this paper is a snapshot of a current project looking at producing a real-time sensor-based building assessment tool, and a system that personalises workspaces using multi-agent technology. Both systems derive physical environment information from a wireless sensor network that allows clients to subscribe to real-time sensed data. The principal ideologies behind this project are energy efficiency and well-being of occupants; in the context of leveraging the current state-of-the-art in agent technology, wireless sensor networks and building assessment systems to enable the optimisation and assessment of buildings. Participants of this project are from both industry (construction and research) and academia.

Midpoint perturbation response in haptically-guided movements

This study investigates the human response to impulse perturbations at the midpoint of a haptically-guided straight-line point-to-point movement. Such perturbation response may be used as an assessment tool during robot-mediated neuro-rehabilitation therapy. Subjects show variety in their perturbation responses. Movements with a lower perturbation displacement exhibit high frequency oscillations, indicative of increased joint stiffness. Equally, movements with a high perturbation displacement exhibit lower frequency oscillations with higher amplitude and a longer settling time. Some subjects show unexpected transients during the perturbation impulse, which may be caused by complex joint interactions in the hand and arm.

Co-ordinated management of intelligent pervasive spaces

The content of this paper is a snapshot of a current project looking at producing a real-time sensor-based building assessment tool, and a system that personalises work-spaces using multi-agent technology. Both systems derive physical environment information from a wireless sensor network that allows clients to subscribe to real-time sensed data. The principal ideologies behind this project are energy efficiency and well-being of occupants; in the context of leveraging the current state-of-the-art in agent technology, wireless sensor networks and building assessment systems to enable the optimisation and assessment of buildings. Participants of this project are from both industry (construction and research) and academia.

Considering the normative, systemic and procedural dimensions in indicator-based sustainability assessments in agriculture

This paper develops a framework for evaluating sustainability assessment methods by separately analyzing their normative, systemic and procedural dimensions as suggested by Wiek and Binder [Wiek, A, Binder, C. Solution spaces for decision-making – a sustainability assessment tool for city-regions. Environ Impact Asses Rev 2005, 25: 589-608.]. The framework is then used to characterize indicator-based sustainability assessment methods in agriculture. For a long time, sustainability assessment in agriculture has focused mostly on environmental and technical issues, thus neglecting the economic and, above all, the social aspects of sustainability, the multifunctionality of agriculture and the applicability of the results. In response to these shortcomings, several integrative sustainability assessment methods have been developed for the agricultural sector. This paper reviews seven of these that represent the diversity of tools developed in this area. The reviewed assessment methods can be categorized into three types: (i) top-down farm assessment methods; (ii) top-down regional assessment methods with some stakeholder participation; (iii) bottom-up, integrated participatory or transdisciplinary methods with stakeholder participation throughout the process. The results readily show the trade-offs encountered when selecting an assessment method. A clear, standardized, top-down procedure allows for potentially benchmarking and comparing results across regions and sites. However, this comes at the cost of system specificity. As the top-down methods often have low stakeholder involvement, the application and implementation of the results might be difficult. Our analysis suggests that to include the aspects mentioned above in agricultural sustainability assessment, the bottomup, integrated participatory or transdisciplinary methods are the most suitable ones.

Development of a food-exchange model to replace saturated fat with MUFAS and n-6 PUFAS in adults at moderate cardiovascular risk

The recommendation to reduce saturated fatty acid (SFA) consumption to ≤10% of total energy (%TE) is a key public health target aimed at lowering cardiovascular disease (CVD) risk. Replacement of SFA with unsaturated fats may provide greater benefit than replacement with carbohydrates, yet the optimal type of fat is unclear. The aim was to develop a flexible food-exchange model to investigate the effects of substituting SFAs with monounsaturated fatty acids (MUFAs) or n-6 (ω-6) polyunsaturated fatty acids (PUFAs) on CVD risk factors. In this parallel study, UK adults aged 21-60 y with moderate CVD risk (50% greater than the population mean) were identified using a risk assessment tool (n = 195; 56% females). Three 16-wk isoenergetic diets of specific fatty acid (FA) composition (%TE SFA:%TE MUFA:%TE n-6 PUFA) were designed using spreads, oils, dairy products, and snacks as follows: 1) SFA-rich diet (17:11:4; n = 65); 2) MUFA-rich diet (9:19:4; n = 64); and 3) n-6 PUFA-rich diet (9:13:10; n = 66). Each diet provided 36%TE total fat. Dietary targets were broadly met for all intervention groups, reaching 17.6 ± 0.4%TE SFA, 18.5 ± 0.3%TE MUFA, and 10.4 ± 0.3%TE n-6 PUFA in the respective diets, with significant overall diet effects for the changes in SFA, MUFA, and n-6 PUFA between groups (P < 0.001). There were no differences in the changes of total fat, protein, carbohydrate, and alcohol intake or anthropometric measures between groups. Plasma phospholipid FA composition showed changes from baseline in the proportions of total SFA, MUFA, and n-6 PUFA for each diet group, with significant overall diet effects for total SFA and MUFA between groups (P < 0.001). In conclusion, successful implementation of the food-exchange model broadly achieved the dietary target intakes for the exchange of SFA with MUFA or n-6 PUFA with minimal disruption to the overall diet in a free-living population. This trial was registered at clinicaltrials.gov as NCT01478958.

Clinical risk factors for osteoporotic fractures in Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)

The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older. The prevalence of fragility fractures is about 15.1% in the women and 12.8% in the men. Moreover, advanced age, sedentarism, family history of hip fracture, current smoking, recurrent falls, diabetes mellitus and poor quality of life are the main clinical risk factors associated with fragility fractures. The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older with the purpose of identifying the prevalence and the main clinical risk factors (CRF) associated with osteoporotic fracture in our population. A total of 2,420 individuals (women, 70%) from 150 different cities in the five geographic regions in Brazil, and all different socio-economical classes were selected to participate in the present survey. Anthropometrical data as well as life habits, fracture history, food intake, physical activity, falls and quality of life were determined by individual quantitative interviews. The representative sampling was based on Brazilian National data provided by the 2000 and 2003 census. Low trauma fracture was defined as that resulting of a fall from standing height or less in individuals 50 years or older at specific skeletal sites: forearm, femur, ribs, vertebra and humerus. Sampling error was 2.2% with 95% confidence intervals. Logistic regression analysis models were designed having the fragility fracture as the dependent variable and all other parameters as the independent variable. Significance level was set as p < 0.05. The average of age, height and weight for men and women were 58.4 +/- 12.8 and 60.1 +/- 13.7 years, 1.67 +/- 0.08 and 1.56 +/- 0.07 m and 73.3 +/- 14.7 and 64.7 +/- 13.7 kg, respectively. About 15.1% of the women and 12.8% of the men reported fragility fractures. In the women, the main CRF associated with fractures were advanced age (OR = 1.6; 95% CI 1.06-2.4), family history of hip fracture (OR = 1.7; 95% CI 1.1-2.8), early menopause (OR = 1.7; 95% CI 1.02-2.9), sedentary lifestyle (OR = 1.6; 95% CI 1.02-2.7), poor quality of life (OR = 1.9; 95% CI 1.2-2.9), higher intake of phosphorus (OR = 1.9; 95% CI 1.2-2.9), diabetes mellitus (OR = 2.8; 95% CI 1.01-8.2), use of benzodiazepine drugs (OR = 2.0; 95% CI 1.1-3.6) and recurrent falls (OR = 2.4; 95% CI 1.2-5.0). In the men, the main CRF were poor quality of life (OR = 3.2; 95% CI 1.7-6.1), current smoking (OR = 3.5; 95% CI 1.28-9.77), diabetes mellitus (OR = 4.2; 95% CI 1.27-13.7) and sedentary lifestyle (OR = 6.3; 95% CI 1.1-36.1). Our findings suggest that CRF may contribute as an important tool to identify men and women with higher risk of osteoporotic fractures and that interventions aiming at specific risk factors (quit smoking, regular physical activity, prevention of falls) may help to manage patients to reduce their risk of fracture.

Pedagogisk dokumentation i förskolan : En intervjustudie om några förskollärares uppfattningar om begreppet pedagogisk dokumentation och dess innebörd

I dagens förskoleverksamhet är det i regel ett måste att dokumentera lärandeprocesser för att kunna uppfylla samtliga mål i utbildningsplaner och bistå med god utbildningskvalitet. Pedagogisk dokumentation – som grundades av Reggio Emilia – är ett utvärderingsverktyg som skall observera barnets lärandeprocesser samt förskollärarnas förhållningssätt. I vardagliga situationer i förskoleverksamheten har pedagogisk dokumentation många fördelar som kan kartlägga och ge bra förutsättningar genom att skapa förståelse för hur barn lär sig och utvecklas bäst. Syftet med denna studie var att genomföra en litteraturstudie i kombination med kvalitativa intervjuer som utgick ifrån följande frågeställningar: Hur definierar förskollärare begreppet dokumentation respektive pedagogisk dokumentation? Hur beskriver förskollärare arbetet med pedagogisk dokumentation? Och hur menar förskollärare att arbetet med pedagogisk dokumentation utvecklar verksamheten? Intervjuerna transkriberades och kategoriserades sedan kring hur förskollärarna använder pedagogisk dokumentation, hur synen på pedagogisk dokumentation ser ut samt vilka olika arbetssätt som används. Vid färdigställande av resultatet framgick det att tre av fyra respondenter upplevde pedagogisk dokumentation som något positivt och modernt. En respondent av fyra fann inte pedagogisk dokumentation som ett bra hjälpmedel för utvärdering, då verktyget kan vara oetiskt på så sätt att det kan användas som ett bedömningsverktyg på det enskilda barnet. Diskussionsavsnittet kopplar samman tidigare forskning med förskollärarnas svar kring hur de ser på pedagogisk dokumentation, hur de beskriver arbetet med pedagogisk dokumentation och hur arbetssättet kan utveckla verksamheten.