Exam 2001

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Exam 1998 pdf

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Asociación de la concentración de material particulado en Bogotá con infarto agudo de miocardio

Introducción: la contaminación atmosférica no solo tiene efectos sobre el sistema respiratorio sino también sobre el cardiovascular. El objetivo de este estudio es generar evidencia que permita establecer una asociación entre el infarto agudo del miocardio y la concentración de PM10 en el ambiente como un estudio preliminar para un grupo de pacientes en Bogotá. Metodología: la asociación entre la concentración del material particulado (en este caso PM10 medido en la estación más cercana del lugar reportado por el paciente) y el infarto agudo del miocardio se estableció utilizando el diseño case crossover. Se utilizó información de las historias clínicas de los pacientes con infarto agudo del miocardio que ingresaron al Servicio de Urgencias de la FSFB, y las concentraciones de PM10 medido en la estación más cercana al lugar de inicio de los síntomas de síndrome coronario agudo, reportado por el paciente. Resultados: se encontró que la asociación entre la concentración de PM10 y el diagnóstico de infarto agudo del miocardio es estadísticamente significativa teniendo en cuenta tres momentos de control: 2 horas antes del evento, 24 horas antes del evento y 48 horas antes del evento. Discusión: este estudio sugiere que las altas concentraciones de material particulado en el ambiente son un factor de riesgo para el desarrollo de infarto agudo del miocardio especialmente en personas con enfermedad coronaria subyacente. Con esta investigación se demuestra la importancia de generar acciones que disminuyan la contaminación de la ciudad y de esta forma proteger la salud de las personas.

Ventilación mecánica en posición prona en pacientes con síndrome de dificultad respiratoria aguda

Introducción La ventilación en posición prona ha demostrado mejorar la oxigenación y la mecánica ventilatoria en pacientes con síndrome de dificultad respiratoria aguda (SDRA). Nosotros evaluamos si la posición prona disminuye el riesgo de mortalidad en pacientes adultos con SDRA vs. ventilación en posición supino. Metodología. Se realizó un metanálisis de ensayos clínicos controlados aleatorizados (ECAs) que compararon pacientes en posición prono vs supino. Se realizó una búsqueda en Pubmed, Embase, Cochrane Library y LILACS. Se evaluó mortalidad, estancia hospitalaria, días de ventilación mecánica y efectos adversos. Resultados. Siete ECAs (2119 pacientes) fueron incluidos en el análisis. La posición prona mostró una tendencia no significativa a disminuir la mortalidad (OR 0.76; IC 95% 0.54–1.06; p=0.11). Al estratificar por subgrupos se encontró una disminución significativa en el riesgo de mortalidad en los pacientes ventilados con volumen corriente bajo (OR 0.58; IC 95%: 0.38-0.87; p=0.009), pronación prolongada (OR 0.6; IC 95% 0.43–0,83, p=0,002), instauración antes de 48h de evolución de la enfermedad (OR 0.49; IC 95% 0.35–0.68; p=0.0001) e hipoxemia severa (OR 0,51; IC 95% 0.36–1.25; p=0.0001). Los efectos adversos relacionados con la pronación fueron el desarrollo de ulceras por presión y obstrucción del tubo orotraqueal.

Adaptaciones en la enseñanza de los maestros de educación general : repercusiones de las respuestas de inclusión.

Resumen tomado de la publicación. Monográfico con el título: 'La educación ante la inclusión del alumnado con necesidades específicas de apoyo'

L'adquisició de la lectura en una mostra d'alumnes de segon a cinquè d'Educació Primària

L'objectiu general d'aquesta tesi fou estudiar longitudinalment l'adquisició lectora (català i castellà), de 2n. a 5è. cursos d'Educació Primària, en una mostra de 214 alumnes (101 nenes i 113 nens) d'una escola pública catalana, a partir dels resultats obtinguts en les Proves Psicopedagògiques d'Aprenentatges Instrumentals (P.P.A.I.; Canals, Carbonell, Estaún i Añaños, 1988), aplicades a principi i final de cada curs. Les P.P.A.I. valoren la velocitat i exactitud de descodificació lectora a través de la lectura de textos diferents per a cada curs, i la comprensió lectora mitjançant exercicis diferents per a cada curs (ordenar frases, executar ordres escrites, respondre qüestions sobre el contingut d'un text...). Els resultats van ser: -La majoria de la mostra, escolaritzada en català, amb independència de la llengua més parlada a casa (català o castellà), van desenvolupar progressivament i de forma similar les habilitats lectores (català i castellà) iniciades en cursos anteriors, aconseguint a finals de 5è. l'automatització dels procés de descodificació lectora en ambdues llengües. -La velocitat lectora pràcticament es va triplicar, passant d'unes 40 paraules/minut inicials a unes 130 paraules /minut a finals de 5è. - L'exactitud lectora també va augmentar i, a finals de 5è., la majoria de la mostra llegien sense quasi errors d'exactitud. -La comprensió lectora cada cop fou més elaborada i la majoria es van afrontar progressivament, amb èxit, a activitats més complexes de comprensió lectora. -En general, el desenvolupament de les habilitats lectores va ser bastant similar en els dos sexes, però a finals de 5è. es van detectar més nens que nenes amb nivell baix (descodificació i/o comprensió) i més nenes que nens amb nivell alt (descodificació i/o comprensió). -Els subjectes que es van situar en un nivell mig (descodificació i/o comprensió) a 2n., van ser els que més es van mantenir en el mateix nivell fins a 5è. En canvi, els que a 2n. mostraven nivells extrems (alt o baix), van evolucionar de forma més variable. -Es va observar que les habilitats adequades de descodificació lectora no van implicar, necessàriament, haver desenvolupat un bon nivell de comprensió lectora. I al revés, un bon nivell de comprensió no sempre va correlacionar amb un nivell correcte de descodificació. -Després de classificar la mostra en tres subgrups (mig, alt i baix) a partir dels resultats en descodificació i comprensió en català de l'última valoració de 5è., es van observar evolucions bastant paral·leles entre els subgrups en velocitat i comprensió, mantenint-se cada subgrup en el nivell que els definia al llarg dels diferents cursos. Però un 6,54% de la mostra, amb dificultats de comprensió lectora en català a finals de 5è, va experimentar, respecte la mostra i el seu propi rendiment en la primera valoració de 5è., una important disminució de la comprensió lectora a finals de 5è.

O Supervisor como mediador no processo do desenvolvimento pessoal e profissional do professor : do ideal ao real na escola do séc. XXI em Portugal

O presente estudo de investigação visa percepcionar o papel e o trabalho de um supervisor pedagógico na escola portuguesa que possibilite compreender os equívocos e deturpação ligados ao papel do supervisor, quer por quem exerce a função quer por aqueles que são supervisionados. A revisão da literatura foi orientada no sentido de definir a acção e competências do supervisor e os efeitos no desenvolvimento pessoal e profissional do professor avaliado num contexto de uma escola aprendente ou reflexiva, segundo algumas abordagens mais modernas, que gera um trabalho colaborativo entre pares e leva a melhoria do processo ensino-aprendizagem. Analisaram-se desta forma quais os aspectos mais relevantes para nomeação do supervisor, competências e trabalho a desenvolver por este e efeitos no desenvolvimento pessoal e profissional do professor supervisionado e ainda as dificuldades sentidas na concretização da supervisão pedagógica. A investigação decorreu numa Escola do concelho de Matosinhos, recorreu-se a procedimentos metodológicos quantitativos através de inquéritos por questionário aplicados aos professores Relatores/Supervisores e aos professores Avaliados/Supervisionados. Desta investigação ressalta um desfasamento entre os subgrupos inquiridos, sobretudo em relação aos aspectos a ter em conta para sua nomeação, perfil e competências inerentes à função, e no trabalho a desenvolver e desenvolvido pelo Relator/Supervisor.

Heavy metals - geochemical bogey men?

Heavy metals is a loose term usually used to indicate environmentally "bad" metals. It is poorly defined with a multitude of often contradictory definitions based on density, atomic weight, atomic number or other properties of the elements or their compounds. Alternative. scientifically rigorous definitions exist for subgroups of metals and should be used instead. (C) 2003 Elsevier Ltd. All rights reserved.

Recategorization and subgroup identification: predicting and preventing threats from common ingroups

Much work has supported the idea that recategorization of ingroups and outgroups into a superordinate category can have beneficial effects for intergroup relations. Recently, however, increases in bias following recategorization have been observed in some contexts. It is argued that such unwanted consequences of recategorization will only be apparent for perceivers who are highly committed to their ingroup subgroups. In Experiments 1 to 3, the authors observed, on both explicit and implicit measures, that an increase in bias following recategorization occurred only for high subgroup identifiers. In Experiment 4, it was found that maintaining the salience of subgroups within a recategorized superordinate group averted this increase in bias for high identifiers and led overall to the lowest levels of bias. These findings are discussed in the context of recent work on the Common Ingroup Identity Model.

Germin and germin-like proteins: evolution, structure, and function

Germin and germin-like proteins (GLPs) are encoded by a family of genes found in all plants. They are part of the cupin superfamily of biochemically diverse proteins, a superfamily that has a conserved tertiary structure, though with limited similarity in primary sequence. The subgroups of GLPs have different enzyme functions that include the two hydrogen peroxide-generating enzymes, oxalate oxidase (OxO) and superoxide dismutase. This review summarizes the sequence and structural details of GLPs and also discusses their evolutionary progression, particularly their amplification in gene number during the evolution of the land plants. In terms of function, the GLPs are known to be differentially expressed during specific periods of plant growth and development, a pattern of evolutionary subfunctionalization. They are also implicated in the response of plants to biotic (viruses, bacteria, mycorrhizae, fungi, insects, nematodes, and parasitic plants) and abiotic (salt, heat/cold, drought, nutrient, and metal) stress. Most detailed data come from studies of fungal pathogenesis in cereals. This involvement with the protection of plants from environmental stress of various types has led to numerous plant breeding studies that have found links between GLPs and QTLs for disease and stress resistance. In addition the OxO enzyme has considerable commercial significance, based principally on its use in the medical diagnosis of oxalate concentration in plasma and urine. Finally, this review provides information on the nutritional importance of these proteins in the human diet, as several members are known to be allergenic, a feature related to their thermal stability and evolutionary connection to the seed storage proteins, also members of the cupin superfamily.

Participatory rural appraisal of dairy farms in the north west province of Cameroon

A Participatory Rural Appraisal (PRA) was conducted in dairy farms of the North West Province of Cameroon. The aim of the PRA was to have a better understanding of the prevailing dairy systems, identify problems, and set priorities for research and development that can contribute to improved systems of production. A multidisciplinary team of researchers and extension agents was constituted. It was made up of scientists of the following fields: cattle management, forage science, agro economy, veterinary, dairy technology, nutrition and extension. The research team visited farmers' groups and divided itself into subgroups for farm and village walks during which direct observations were also noted. The extension agent of the locality, key informants, gave additional information overlooked by farmers. Interviews were also carried out with other stakeholders of the dairy sector. The research team met the day following the visit to agree on a common report. Results show that five small scale dairy production systems are found in the region: transhumance, improved extensive, semi intensive, zero grazing and peri-urban. Agriculture is well integrated to dairying. Main constraints include in order of importance: poor marketing opportunities and long distances to market, limited grazing land and poor supplementation strategies, poor reproductive management and poor calving interval, inadequate knowledge in processing, hygiene and milk preservation, and limited health control. In market oriented farms, reproduction and feeding were the most important constraints. Main factors influencing dairy production are: milk collection, fresh milk price, consumer demand, genotype and management. These results suggest that much can be done to improve production by extending improved packages to dairy farmers.

Action following the discovery of a global association between the whole genome and adverse event risk in a clinical drug-development programme

Observation of adverse drug reactions during drug development can cause closure of the whole programme. However, if association between the genotype and the risk of an adverse event is discovered, then it might suffice to exclude patients of certain genotypes from future recruitment. Various sequential and non-sequential procedures are available to identify an association between the whole genome, or at least a portion of it, and the incidence of adverse events. In this paper we start with a suspected association between the genotype and the risk of an adverse event and suppose that the genetic subgroups with elevated risk can be identified. Our focus is determination of whether the patients identified as being at risk should be excluded from further studies of the drug. We propose using a utility function to? determine the appropriate action, taking into account the relative costs of suffering an adverse reaction and of failing to alleviate the patient's disease. Two illustrative examples are presented, one comparing patients who suffer from an adverse event with contemporary patients who do not, and the other making use of a reference control group. We also illustrate two classification methods, LASSO and CART, for identifying patients at risk, but we stress that any appropriate classification method could be used in conjunction with the proposed utility function. Our emphasis is on determining the action to take rather than on providing definitive evidence of an association. Copyright (C) 2008 John Wiley & Sons, Ltd.

Effect of sex and genotype on cardiovascular biomarker response to fish oils: the FINGEN Study

Background: The lipid-modulatory effects of high intakes of the fish-oil fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are well established and likely to contribute to cardioprotective benefits. Objectives: We aimed to determine the effect of moderate EPA and DHA intakes (< 2 g EPA + DHA/d) on the plasma fatty acid profile, lipid and apolipoprotein concentrations, lipoprotein subclass distribution, and markers of oxidative status. We also aimed to examine the effect of age, sex, and apolipoprotein E (APOE) genotype on the observed responses. Design: Three hundred twelve adults aged 20-70 y, who were prospectively recruited according to age, sex, and APOE genotype, completed a double-blind placebo-controlled crossover study. Participants consumed control oil, 0.7 g EPA + DHA/d (0.7FO), and 1.8 g EPA + DHA/d (1.8FO) capsules in random order, each for an 8-wk intervention period, separated by 12-wk washout periods. Results: In the group as a whole, 8% and 11% lower plasma triacylglycerol concentrations were evident after 0.7FO and 1.8FO, respectively (P < 0.001): significant sex x treatment (P = 0.038) and sex x genotype x treatment (P = 0.032) interactions were observed, and the greatest triacylglycerol-lowering responses (reductions of 15% and 23% after 0.7FO and 1.8FO, respectively) were evident in APOE4 men. Furthermore, lower VLDL-cholesterol (P = 0.026) and higher LDL-cholesterol (P = 0.010), HDL-cholesterol (P < 0.001), and HDL2 (P < 0.001) concentrations were evident after fish-oil intervention. Conclusions: Supplements providing EPA + DHA at doses as low as 0.7 g/d have a significant effect on the plasma lipid profile. The results of the current trial, which used a prospective recruitment approach to examine the responses in population subgroups, are indicative of a greater triacylglycerol-lowering action of long-chain n-3 polyunsaturated fatty acids in males than in females.

Does genotype and equol-production status affect response to isoflavones? Data from a pan-European study on the effects of isoflavones on cardiovascular risk markers in post-menopausal women

The increase in CVD incidence following the menopause is associated with oestrogen loss. Dietary isoflavones are thought to be cardioprotective via their oestrogenic and oestrogen receptor-independent effects, but evidence to support this role is scarce. Individual variation in response to diet may be considerable and can obscure potential beneficial effects in a sample population; in particular, the response to isoflavone treatment may vary according to genotype and equol-production status. The effects of isoflavone supplementation (50hairspmg/d) on a range of established and novel biomarkers of CVD, including markers of lipid and glucose metabolism and inflammatory biomarkers, have been investigated in a placebo-controlled 2x8-week randomised cross-over study in 117 healthy post-menopausal women. Responsiveness to isoflavone supplementation according to (1) single nucleotide polymorphisms in a range of key CVD genes, including oestrogen receptor (ER) alpha and beta and (2) equol-production status has been examined. Isoflavones supplementation was found to have no effect on markers of lipids and glucose metabolism. Isoflavones improve C-reactive protein concentrations but do not affect other plasma inflammatory markers. There are no differences in response to isoflavones according to equol-production status. However, differences in HDL-cholesterol and vascular cell adhesion molecule 1 response to isoflavones v. placebo are evident with specific ER beta genotypes. In conclusion, isoflavones have beneficial effects on C-reactive protein, but not other cardiovascular risk markers. However, specific ER beta gene polymorphic subgroups may benefit from isoflavone supplementation.

Analytical and compositional aspects of isoflavones in food and their biological effects

This paper provides an overview of analytical techniques used to determine isoflavones (IFs) in foods and biological fluids with main emphasis on sample preparation methods. Factors influencing the content of IFs in food including processing and natural variability are summarized and an insight into IF databases is given. Comparisons of dietary intake of IFs in Asian and Western populations, in special subgroups like vegetarians, vegans, and infants are made and our knowledge on their absorption, distribution, metabolism, and excretion by the human body is presented. The influences of the gut microflora, age, gender, background diet, food matrix, and the chemical nature of the IFs on the metabolism of IFs are described. Potential mechanisms by which IFs may exert their actions are reviewed, and genetic polymorphism as determinants of biological response to soy IFs is discussed. The effects of IFs on a range of health outcomes including atherosclerosis, breast, intestinal, and prostate cancers, menopausal symptoms, bone health, and cognition are reviewed on the basis of the available in vitro, in vivo animal and human data.