Caso de estudio. Megatex, compitiendo creativamente en un mundo cambiante

El caso hace la presentación sencilla de un problema común entre las pequeñas empresas en Colombia, en la época de principios de los años 2000, la falta de financiación para su capital de trabajo, establecida sobre una empresa importadora. Se conduce, entonces, a una solución integral, que se soporta tanto en la creatividad como en la estrategia, en las exigencias del mercado como en el análisis de rentabilidad. El análisis cuantitativo se hace sobre las consecuencias de las decisiones sobre los plazos y descuentos comerciales.

The Warwick-Edinburgh Mental Well-Being Scale

Background There is increasing international interest in the concept of mental well-being and its contribution to all aspects of human life. Demand for instruments to monitor mental well-being at a population level and evaluate mental health promotion initiatives is growing. This article describes the development and validation of a new scale, comprised only of positively worded items relating to different aspects of positive mental health: the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Methods WEMWBS was developed by an expert panel drawing on current academic literature, qualitative research with focus groups, and psychometric testing of an existing scale. It was validated on a student and representative population sample. Content validity was assessed by reviewing the frequency of complete responses and the distribution of responses to each item. Confirmatory factor analysis was used to test the hypothesis that the scale measured a single construct. Internal consistency was assessed using Cronbach’s alpha. Criterion validity was explored in terms of correlations between WEMWBS and other scales and by testing whether the scale discriminated between population groups in line with pre-specified hypotheses. Test-retest reliability was assessed at one week using intra-class correlation coefficients. Susceptibility to bias was measured using the Balanced Inventory of Desired Responding. Results WEMWBS showed good content validity. Confirmatory factor analysis supported the single factor hypothesis. A Cronbach’s alpha score of 0.89 (student sample) and 0.91 (population sample) suggests some item redundancy in the scale. WEMWBS showed high correlations with other mental health and well-being scales and lower correlations with scales measuring overall health. Its distribution was near normal and the scale did not show ceiling effects in a population sample. It discriminated between population groups in a way that is largely consistent with the results of other population surveys. Test–retest reliability at one week was high (0.83). Social desirability bias was lower or similar to that of other comparable scales. Conclusions WEMWBS is a measure of mental well-being focusing entirely on positive aspects of mental health. As a short and psychometrically robust scale, with no ceiling effects in a population sample, it offers promise as a tool for monitoring mental well-being at a population level. Whilst WEMWBS should appeal to those evaluating mental health promotion initiatives, it is important that the scale’s sensitivity to change is established before it is recommended in this context.

Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria.

Background: Malnutrition is a complication in chronic kidney disease (CKD) known to affect quality of life and prognosis although not often diagnosed. It is associated with rapid progression to end stage renal disease (ESRD) and mortality. Early identification and treatment will slow down progression to ESRD and mortality. Objective: To determine the prevalence and pattern of malnutrition in pre-dialysis CKD patients in Southern Nigeria. Methods: One hundred and twenty consecutive pre-dialysis CKD and 40 control subjects without CKD were studied. Data obtained from participants were demographics, body mass index (BMI), and aetiology of CKD. Indices used to assess presence of malnutrition were low BMI, hypocholesterolaemia and hypoalbuminaemia. Statistical significance was taken at 0.05 level. Results: The mean age of the CKD subjects was 48.8±16.6years with a male: female ratio of 1.7:1. Prevalence of malnutrition in the CKD subjects was 46.7%, higher than 27.5% observed in the controls (p=0.033). Prevalence of malnutrition increased significantly across CKD stages 2 to 5 (p=0.020). It was significantly commoner in elderly patients (p=0.047) but not significantly different between males and females(p=0.188). Conclusion: Malnutrition is common in pre-dialysis CKD patients even in early CKD stages. Prevalence of malnutrition increases with worsening kidney function and increasing age.

El bibliotecario profesional y para-profesional

Los programas que se brindan en el programa OEA/ UNA/ MEP/ no podrían realizarse sin la colaboración de distinguidos colegas y amigos que debemos mencionar a continuación, junto con el nombre de los cursos que están impartiendo.

Efeito de dois programas de reabilitação psicomotora (atividade contínua versus atividade intervalada) na capacidade neuromotora de idosos institucionalizados

Objetivo: Investigar o efeito de dois programas de reabilitação psicomotora (atividade contínua versus atividade intervalada) na capacidade neuromotora de idosos institucionalizados. Metodologia: A amostra integrou 17 participantes (85,81±6,26 anos) que, numa fase inicial, mantiveram as atividades durante 6 semanas (período de controlo) e, posteriormente, 9 integraram um programa com intervenção intervalada (GI) e 8 um programa com intervenção contínua (GC). Ambos os programas tiveram a duração de 12 semanas, com uma periodicidade de 2 sessões por semana e duração de 60 minutos. Foram avaliadas as variáveis atenção (Trail Making Test), capacidade de planeamento (Torre de Londres), o desempenho em situação de dupla tarefa (Timed Up and Go modificado) e equilíbrio (Timed Up and Go e Índice de Tinetti). Resultados: O GI evidenciou melhorias significativas nas variáveis da atenção, da capacidade de planeamento, dupla tarefa e equilíbrio (p<0,05), enquanto que o GC apenas o evidenciou na variável capacidade de planeamento (p<0,05). Conclusão: Os resultados sugerem que o programa de reabilitação psicomotora com atividade intervalada será mais benéfico para os idosos institucionalizados que programa com atividade contínua, particularmente na atenção, no desempenho em situação de dupla tarefa e no equilíbrio; ABSTRACT: Objective: To research the effect of two psychomotor rehabilitation programs (continuous activity against intervealed activity) in the neuromotor ability of institutionalized elderly people. Metodology: The sample had 17 participants (85.81 ± 6.26 years), that in an initial phase retained activity for 6 weeks (control period) and then, 9 integrated a program with intervealed intervention (GI) and 8 a program with continuous intervention (GC). ). Both of the programs had 12 weeks, 2 sessions per week and 60 minutes per session. Was evaluated the variables attention (Trail Making Test); planning capacity (London Tower); dual task capacity (modified Timed Up and Go) and balance (Timed Up and Go and Tinetti Index). Results: The GI showed significant improvements in the variables attention, performance in dual task ability and balance (p<0,05), while GC revealed significant improvements in planning capacity (p<0,05). Conclusion: The results suggest that the psychomotor rehabilitation program with intervealed activity will be more beneficial for the institutionalized elderly than the program with continuous activity, particularly in the attention, planning capacity, performance in dual task ability and balance.

Proyecto de estructuración de la disciplina matemática para el nivel medio superior de la Universidad Autónoma de Nuevo León, México

En las preparatorias de la U.A.N.L., a diferencia de las preparatorias del resto de las universidades mexicanas, desde el año 1993 se modificaron los cursos de matemática utilizándose un sistema modular en el cual la disciplina Matemática se imparte en cuatro módulos de 9 semanas cada uno separados por 9 semanas en las cuales no se enseña Matemática. La enseñanza fragmentada de esta disciplina provoca discontinuidad y falta de sistematicidad y vinculación entre los temas y poca asimilación de los contenidos que se traduce en olvido de muchos aspectos importantes por parte de los estudiantes. Es nuestro propósito diseñar un programa para la disciplina Matemática, con el que se logre una enseñanza didáctica y metodológica adecuada, basado en los fundamentos del enfoque histórico cultural y la teoría de la actividad.

A THEORETICAL STUDY OF INTERACTION OF NANOPARTICLES WITH BIOMOLECULE

Many types of materials at nanoscale are currently being used in everyday life. The production and use of such products based on engineered nanomaterials have raised concerns of the possible risks and hazards associated with these nanomaterials. In order to evaluate and gain a better understanding of their effects on living organisms, we have performed first-principles quantum mechanical calculations and molecular dynamics simulations. Specifically, we will investigate the interaction of nanomaterials including semiconducting quantum dots and metallic nanoparticles with various biological molecules, such as dopamine, DNA nucleobases and lipid membranes. Firstly, interactions of semiconducting CdSe/CdS quantum dots (QDs) with the dopamine and the DNA nucleobase molecules are investigated using similar quantum mechanical approach to the one used for the metallic nanoparticles. A variety of interaction sites are explored. Our results show that small-sized Cd4Se4 and Cd4S4 QDs interact strongly with the DNA nucleobase if a DNA nucleobase has the amide or hydroxyl chemical group. These results indicate that these QDs are suitable for detecting subcellular structures, as also reported by experiments. The next two chapters describe a preparation required for the simulation of nanoparticles interacting with membranes leading to accurate structure models for the membranes. We develop a method for the molecular crystalline structure prediction of 1,2-Dimyristoyl-sn-glycero-3-phosphorylcholine (DMPC), 1,2-Dimyristoyl-sn-glycero-3-phosphorylethanolamine (DMPE) and cyclic di-amino acid peptide using first-principles methods. Since an accurate determination of the structure of an organic crystal is usually an extremely difficult task due to availability of the large number of its conformers, we propose a new computational scheme by applying knowledge of symmetry, structural chemistry and chemical bonding to reduce the sampling size of the conformation space. The interaction of metal nanoparticles with cell membranes is finally carried out by molecular dynamics simulations, and the results are reported in the last chapter. A new force field is developed which accurately describes the interaction forces between the clusters representing small-sized metal nanoparticles and the lipid bilayer molecules. The permeation of nanoparticles into the cell membrane is analyzed together with the RMSD values of the membrane modeled by a lipid bilayer. The simulation results suggest that the AgNPs could cause the same amount of deformation as the AuNPs for the dysfunction of the membrane.

Covalent Protein Adduction by Drugs of Abuse

Recreational abuse of the drugs cocaine, methamphetamine, and morphine continues to be prevalent in the United States of America and around the world. While numerous methods of detection exist for each drug, they are generally limited by the lifetime of the parent drug and its metabolites in the body. However, the covalent modification of endogenous proteins by these drugs of abuse may act as biomarkers of exposure and allow for extension of detection windows for these drugs beyond the lifetime of parent molecules or metabolites in the free fraction. Additionally, existence of covalently bound molecules arising from drug ingestion can offer insight into downstream toxicities associated with each of these drugs. This research investigated the metabolism of cocaine, methamphetamine, and morphine in common in vitro assay systems, specifically focusing on the generation of reactive intermediates and metabolites that have the potential to form covalent protein adducts. Results demonstrated the formation of covalent adduction products between biological cysteine thiols and reactive moieties on cocaine and morphine metabolites. Rigorous mass spectrometric analysis in conjunction with in vitro metabolic activation, pharmacogenetic reaction phenotyping, and computational modeling were utilized to characterize structures and mechanisms of formation for each resultant thiol adduction product. For cocaine, data collected demonstrated the formation of adduction products from a reactive arene epoxide intermediate, designating a novel metabolic pathway for cocaine. In the case of morphine, data expanded on known adduct-forming pathways using sensitive and selective analysis techniques, following the known reactive metabolite, morphinone, and a proposed novel metabolite, morphine quinone methide. Data collected in this study describe novel metabolic events for multiple important drugs of abuse, culminating in detection methods and mechanistic descriptors useful to both medical and forensic investigators when examining the toxicology associated with cocaine, methamphetamine, and morphine.

Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy : a case study

Objective: Vulvovaginal atrophy (VVA), caused by decreased levels of estrogen, is a common problem in aging women. Main symptoms of VVA are vaginal dryness and dyspareunia. First-line treatment consists of the application of local estrogen therapy (ET) or vaginal moisturizer. In some cases however, symptoms and signs persist despite those interventions. This case study describes a 77-year-old woman with severe VVA symptoms despite use of local ET and the addition of pelvic floor muscle (PFM) training to her treatment. Methods: A patient with stress urinary incontinence and VVA was referred to a randomized clinical trial on PFM training. On pretreatment evaluation while on local ET, she showed VVA symptoms on the ICIQ Vaginal Symptoms questionnaire and the ICIQ-Female Sexual Matters associated with lower urinary tract Symptoms questionnaire, and also showed VVA signs during the physical and dynamometric evaluation of the PFM. She was treated with a 12-week PFM training program. Results: The patient reported a reduction in vaginal dryness and dyspareunia symptoms, as well as a better quality of sexual life after 12 weeks of PFM training. On posttreatment physical evaluation, the PFMs' tone and elasticity were improved, although some other VVA signs remained unchanged. Conclusions: Pelvic floor muscle training may improve some VVA symptoms and signs in women taking local ET. Further study is needed to investigate and confirm the present case findings and to explore mechanisms of action of this intervention for VVA.

Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy : a case study

Objective: Vulvovaginal atrophy (VVA), caused by decreased levels of estrogen, is a common problem in aging women. Main symptoms of VVA are vaginal dryness and dyspareunia. First-line treatment consists of the application of local estrogen therapy (ET) or vaginal moisturizer. In some cases however, symptoms and signs persist despite those interventions. This case study describes a 77-year-old woman with severe VVA symptoms despite use of local ET and the addition of pelvic floor muscle (PFM) training to her treatment. Methods: A patient with stress urinary incontinence and VVA was referred to a randomized clinical trial on PFM training. On pretreatment evaluation while on local ET, she showed VVA symptoms on the ICIQ Vaginal Symptoms questionnaire and the ICIQ-Female Sexual Matters associated with lower urinary tract Symptoms questionnaire, and also showed VVA signs during the physical and dynamometric evaluation of the PFM. She was treated with a 12-week PFM training program. Results: The patient reported a reduction in vaginal dryness and dyspareunia symptoms, as well as a better quality of sexual life after 12 weeks of PFM training. On posttreatment physical evaluation, the PFMs' tone and elasticity were improved, although some other VVA signs remained unchanged. Conclusions: Pelvic floor muscle training may improve some VVA symptoms and signs in women taking local ET. Further study is needed to investigate and confirm the present case findings and to explore mechanisms of action of this intervention for VVA.

Asfixia perinatal y proteína S100B

La asfixia perinatal es la principal causa de muerte en la primera semana de vida la nivel mundial, los niños que sufren esta complicación y sobreviven pueden presentar trastornos neurológicos de diferente nivel de compromiso que inciden en su desarrollo personal y social. Las cifras de muerte por este problema de salud han disminuido de manera importante, sin embargo en el reporte de la Organización Mundial de Salud (OPS) del 2010, la asfixia perinatal es causa del 29% de muertes infantiles en los países de América Latina y el Caribe 2. Es necesario conocer además la extensión del daño neurológico que sufren estos niños, con este fin se desarrolló un estudio piloto en el Hospital Universitario Mayor Mederi de Bogotá, en el cual se determinó la concentración de un marcador metabólico de daño cerebral, la proteína S100B en suero de 60 recién nacidos sanos, con el objetivo de analizar la asociación del mismo con el peso al nacer, la edad gestacional y el diagnóstico. Los resultados no mostraron diferencias significativas entre este marcador y las variables analizadas que puede asociarse al pequeño número de pacientes, sin embargo han sentado las bases para el desarrollo de un estudio que incluya varios hospitales de Bogotá y sobre todo la determinación del mismo en recién nacidos con diagnóstico de hipoxia en el período perinatal, lo cual aportará información del grado de la alteración que puedan tener a nivel cerebral y contribuya al mejor manejo evolutivo con la aplicación de medidas de intervención en estadios tempranos de la vida.

Efectos jurídicos de prohibir minería en ecosistemas de páramos con títulos mineros preexistentes

A raíz del impacto ambiental que produce la actividad minera sobre la biodiversidad y los recursos naturales, el sistema jurídico colombiano sustrajo de esta actividad, zonas de especial importancia ecológica y ambiental, que podrían llegar a deteriorarse en su totalidad. Sin embargo, si bien es clara la importancia de proteger estas zonas de la actividad extractiva, lo cierto es que en la actualidad se presenta un alto porcentaje de estas zonas que se superponen con títulos mineros. Circunstancia que conlleva a que entren en tensión intereses constitucionales protegidos. Por un lado, el interés general de proteger el medio ambiente y los recursos naturales y por el otro, el interés público de desarrollar la actividad minera. De acuerdo a lo anterior, a través de este trabajo de investigación, se busca describir y analizar las consecuencias en el ámbito jurídico, que se generan, al prohibir la actividad minera en zonas sobre las cuales el Estado había autorizado la realización de actividades de exploración y /o explotación minera con anterioridad al cambio regulatorio. En consecuencia, se expondrán los escenarios en que se puede encontrar un contrato de concesión, con la prohibición legal de desarrollar actividades mineras en ecosistemas de páramos. Específicamente, se analizará la situación de los títulos mineros que cuenten con licencia ambiental, títulos mineros que se encuentren en etapa de exploración y los títulos que habiendo terminado la etapa de exploración su licencia ambiental se encuentre en trámite.

Comportamiento metabólico, fisiológico y electrocardiográfico en trabajadores expuestos a altas temperaturas en una empresa líder en la explotación y coquización del carbón en Boyacá, Colombia, 2016

Objetivo: Establecer la relación entre la exposición ocupacional a altas temperaturas o sobrecarga térmica con el comportamiento fisiológico, metabólico y electrocardiográfico. Métodos: estudio de corte transversal, donde se incluyeron dos grupos (expuesto y no expuesto a altas temperaturas) en una empresa minera, en el departamento de Boyacá, Colombia, en el año 2016. El número de participantes fue de 160 trabajadores del género masculino, grupo expuesto (n=86) y grupo no expuesto (n=74). La exposición ocupacional a sobrecarga térmica se evaluó con el índice de temperatura de globo y bulbo húmedo (TGBH), el comportamiento fisiológico con el índice de costo cardiaco relativo (ICCR) con mediciones de frecuencia cardiaca (FC), el comportamiento metabólico con la determinación del colesterol total (CT), colesterol de alta densidad (C-HDL), colesterol de baja densidad (C-LDL), triglicéridos (TG) y glicemia basal (GL). Las alteraciones electrocardiográficas con la toma de Electrocardiograma de 12 derivaciones. También fueron evaluadas variables antropométricas, tensión arterial, hábitos y antecedentes de enfermedad cardiovascular en ambos grupos. Resultados: incrementos significativos del ICCR (p<0.001) y la carga física (p<0.001) fueron encontrados en los trabajadores expuestos a altas temperaturas. Los índices lipídicos y glicemia, así como los antecedentes personales cardiovasculares, IMC, consumo de cigarrillo y consumo de alcohol, no mostraron significancia. El antecedente familiar de ACV (p=0.043) y el EKG alterado (p=0.011) mostraron una asociación significativa con la exposición a altas temperaturas. El modelo de regresión lineal múltiple explicó la relación entre el incremento del ICCR y la exposición a altas temperaturas (β=4,213, IC 95%: 1.57,6.85) ajustado por variables fisiológicas y electrocardiográficas. Conclusiones: La exposición ocupacional a altas temperaturas, presenta asociación con las alteraciones cardiovasculares a nivel fisiológico y electrocardiográfico, aumentando el ICCR y la carga física de trabajo (GE trabajo).

Evaluación de costo efectividad de la profilaxis versus tratamiento a demanda en pacientes con Hemofilia A moderada y severa para prevenir sangrado articular de una aseguradora en Colombia

Introducción: En Colombia existe un protocolo de manejo para pacientes con hemofilia A severa sin inhibidores que recomienda el manejo de profilaxis primaria y secundaria con FVIII. Objetivos: Estimar la relación incremental de costo-efectividad (RICE) de la profilaxis con Factor VIII vs tratamiento a demanda para prevenir sangrados articulares en pacientes con hemofilia A moderada y severa de una aseguradora en Colombia. Materiales y Métodos: Se adaptó un modelo de Markov desde la perspectiva del tercer pagador. Las probabilidades de transición se ajustaron mediante un modelo de regresión logística multinomial explicadas por la edad y el peso. Las tasas de eventos son anuales. Las efectividades se extrajeron de la cohorte de la aseguradora y de la literatura. Los costos incluyeron el FVIII, medicamentos, hospitalización, procedimientos quirúrgicos, apoyo diagnóstico y consultas médicas. La tasa de descuento fue del 3%. Resultados: En pacientes con hemofilia A moderada y severa la profilaxis con FVIII evitará en promedio 7 sangrados articulares, el RICE para el sangrado articular es de $303.457. Conclusiones: La profilaxis con Factor VIII es una estrategia costo-efectiva en el manejo de pacientes con hemofilia A moderada y severa para la aseguradora, disminuyendo el número de sangrados articulares al año.