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Objective: Although observational cohort studies report that interventions to achieve functionality are clinically successful in 85% of patients, the proportion of newly created autologous arteriovenous fistulas that result in functional vascular access typically is only 70 -80%. To address this discrepancy, the selection and outcomes of interventions to achieve functionality in a multicentre prospective cohort study were analysed. Methods: The Shunt Simulation Study enrolled 222 patients who needed a first arteriovenous fistula in nine dialysis units in The Netherlands from 2015 to 2018 and followed these patients until one year after access creation. In this observational study, the technical and clinical success rates of interventions to achieve functionality based on lesion and intervention characteristics were analysed and the clinical outcomes of arteriovenous fistulas with assisted and unassisted functionality were compared. Results: For patients who were on dialysis treatment at the end of the study, unassisted fistula functionality was 54% and overall fistula functionality was 78%. Thirty-four per cent of arteriovenous fistulas required an intervention to achieve functionality, 68% of which eventually became functional. Seventy-five per cent of these interventions were percutaneous balloon angioplasties of vascular access stenoses. Patients with clinically successful interventions to achieve functionality had larger pre-operative vein diameters (2.8 + 1.0 mm vs. 2.3 + 0.6 mm, p = .036) and less often presented with thrombosed fistulas than patients with unsuccessful interventions (7% vs. 43%, p = .006). Arteriovenous fistulas with assisted functionality had similar secondary patency as fistulas with unassisted functionality (100% and 98% at six months, p = .44), although they required more interventions to maintain function (2.6 vs. 1.7 per year; rate ratio 1.52, 95% CI 1.04 -2.18, p = .032). Conclusion: Interventions to achieve functionality were needed in about a third of newly created arteriovenous fistulas. Most thrombosed fistulas were abandoned, and when selected for thrombectomy rarely reached clinical success. On the other hand, interventions to achieve functionality of patent fistulas had high clinical success rates and therefore can be done repeatedly until the fistula has become functional.

The visible problems among persons living with human immunodeficiency virus are insufficiency of HIV information about the impact it will bring into their lives and non-compliance to treatment due to fear of disclosure. The need to enhance information about the human immunodeficiency virus (HIV) through extensive health teaching and exemplary education modeling may help persons living with HIV live with dignity and hope as children of God. The purpose of the study is to discover what substantive theory can be used to unearth variables such as active involvement in the society, life change advocacy, life promotion and dignity, one finds oneself, sensitivity to one’s knowledge needs, and accountability and commitment to be safe which led to the development of “all loving support-information, education, and counselling theory. A mixed method embedded experimental design was used in testing the theory through a double-blind approach that quantified the grounded explored experiences of the participants. The qualitative participants were 20 in focus group discussion and the quantitative participants were 30 college students living with HIV, 18-24 years old, male, Christian, and currently enrolled in a college or university in the Davao region excluding those who are sick and admitted to the hospital. Pretest findings revealed that the participants were moderately informed about facts on HIV and moderately followed the course of treatment but after a series of tests (post-test after two weeks, after one month, and after two months), reported that they were totally informed about the facts on HIV and will strictly adhere to the therapy. The pretest and post-test scores on the level of awareness and medical compliance showed significant differences after a series of tests. Thus, the application of ALS-IEC theory is effective among persons living with HIV in assessing HIV awareness and drug adherence encompassing bio-psycho-sexual-social-cultural-spiritual domains. Continued use of the personalized health assessment will also offer a learning opportunity (information) through reading (education) and nurse-delivered counselling as extended care after HIV screening counseling will address the immediate needs of clients.

This non-experimental quantitative study established the best-fit structural model for employee satisfaction (ES) with public leadership roles (PLR), professional identity (PI), and quality of work life (QWL) as the exogenous latent variables. The stratified random sampling method selected the four hundred local government employees in Region XI to participate in the survey. Data analysis yielded the following results: The mean statistic showed very high levels of professional identity and employee satisfaction compared to the high levels of public leadership roles and work-life quality. Pearson r revealed a significant and positive relationship between public leadership roles, professional identity, quality of work-life and employee satisfaction. The multiple regression analysis revealed that public leadership roles, professional identity, and quality of work-life significantly influence employee satisfaction by 58.6 percent. The Structural Equation Modeling (SEM) bared that two exogenous latent variables predict employee satisfaction: public leadership roles (indicated by network governance and political leadership) and professional identity (characterized by knowledge and philosophy of the profession, attitude, engagement behavior, and interaction are predictors of employee satisfaction). In addition, employee satisfaction has these indicators: leadership and planning, corporate culture and communication, role in the organization, work environment, training, development and resources, pay and benefits, and overall employment experience. These findings are relevant to Human Resource Management Offices in the public and private sectors, with implications for employment policies, especially for employees career growth. KEYWORDS: public administration, local government employees, public leadership roles, professional identity, quality of work-life, employee satisfaction, SEM, Philippines

El presente artículo se centra en las plumastapiragede los textiles miniatura con arte plumario hallados en el templo Huaca de la Luna del sitio Huacas de Moche (Valle de Moche, Perú), asociados a la ocupación Chimú (1000-1440 dC). Eltapiragees una técnica de manipulación biológica, practicada por ciertos grupos amazónicos, que altera el color de las plumas de algunos psitácidos de los génerosArayAmazona. Para confirmar la existencia de plumastapirageen estos textiles, se realizó una identificación taxonómica macroscópica y microscópica de las plumas arqueológicas. Por último, se aplicaron análisis arqueométricos de microscopía de barrido electrónico (SEM) y microscopía digital para identificar los cambios en las microestructuras de las plumas, como también las especies de las plumas mismas. Los resultados muestran que las plumas de los textiles chimúes de Huaca de la Luna presentan plumastapirage, lo que permite discutir sobre las relaciones de intercambio entre la costa norte peruana y la Amazonia, y avanzar en la interpretación de los significados de estas plumas en los rituales de la cultura Chimú, por su valor simbólico y capacidad de acceso a estas bienes por parte de estas comunidades costeras.

La investigación tuvo como objetivo analizar la cadena de comercialización de cacao fino de aroma en el cantón Pichincha, Ecuador. El método de investigación teórico fue inductivo deductivo y el estudio de investigación descriptivo con un diseño de investigación no experimental. Se realizó una encuesta a los representantes de los centros de acopio (tres en el sector urbano y tres del sector rural) quienes adquieren el producto de los pequeños agricultores de la localidad. Los principales resultados evidenciaron que las empresas no utilizan intermediarios al momento de adquirir el producto, sin embargo, si lo requieren al momento de comercializarlo en el mercado nacional. Otro de los resultados demuestra que el nivel de comercialización actual no ha variado en relación a las ventas antes y después de la pandemia. Por otra parte, el impacto es positivo debido a que se genera rentabilidad y sostenibilidad económica en el cantón Pichincha.

The archaeology and heritage of South Sinai is rich and varied. Most research to date has focused on the High Mountains, specifically the area around the famous St Catherine’s Monastery, placed on the UNESCO World Heritage List in 2002 (Saint Catherine Area, World Heritage Site 954). Recently, the Sinai Peninsula Research and the Endangered Archaeology in the Middle East and North Africa projects have focused on the landscape surrounding the St Catherine’s Monastery. These projects highlighted the wealth of archaeological and heritage sites spanning the prehistoric to modern periods, including sites that are still in use by local communities today, as well as the environmental and anthropogenic factors that threaten their survival, such as climate change, tourism, and the impact of infrastructure developments. By contrast, the archaeology and heritage of the coastal areas was never surveyed systematically until the research presented in this paper. Remote sensing work by the Maritime Endangered Archaeology project revealed a coastal landscape that is likewise rich in archaeological and heritage sites. As in the High Mountains, many of the coastal sites are under significant threat, but they do not enjoy the same level of recognition and protection. This paper compares the coastal sites to those in the High Mountains, including their disturbances and threats, and demonstrates the need for a locally specific heritage management and protection strategy for different parts of South Sinai.

El objetivo general de la presente investigación fue describir las técnicas de estudios para el desarrollo de competencias en estudiantes universitarios caso: Enfermería. Se empleó el paradigma positivista, desde la perspectiva cuantitativa, enmarcada en un diseño documental-bibliográfico, ya que se analiza y estudia una serie de datos obtenidos relacionados al tema de investigación, desde fuentes bibliográficas que apoyan esta indagación documental. La población se constituyó por revistas y trabajos arbitrados; fundamentando el contenido teórico. En relación a la técnica de análisis de contenido, permitió estudiar y considerar las características y dimensiones, generando la relación de las mismas, lo que permitió comparar y contrastar con la realidad y cumplir con el objetivo. Se concluye, que las técnicas de estudio favorecen la adquisición de varios métodos que contribuyen al desarrollo de hábitos de estudios, necesarios en la formación profesional durante los estudios universitarios, permite desarrollar competencias en el campo de la salud.

The purpose of this study is to discuss the role and response of the people of East Kalimantan regarding the transfer of the national capital. Collect data in this article using online questionnaires using google form, which is then analyzed using spss program version 21, previous research, and summarize the results of respondents' responses and take some information on the internet. Based on the results of the study, it is known that the number of people who are pro or agree with the government of the national capital is more than the people who counter or disagree with the number of people who agree, which is as many as 67 or 65.7% of the people. Meanwhile, based on the results obtained that the number of people who also consider that government planning related to the transfer of the national capital to East Kalimantan is a solution, with the number of people who responded that the transfer into a solution is as many as 58 communities as many as 58 people or 56.9%.

Background The twenty first- century marked the exponential growth in the use of intelligent robots and artificial intelligent in nursing compared to the previous decades. To the best of our knowledge, this article is first in responding to question, “Can nurses in clinical practice ascribe responsibility to intelligent robots and artificial intelligence when they commit errors?”. Purpose The objective of this article is to present two worldviews (anthropocentrism and biocentrism) in responding to the question at hand chosen based on the roles of the entities involved in the use of intelligent robots and artificial intelligence in nursing. Methods The development of this article was motivated by the immense discoveries, the current landscape, and nurses’ role in relation to advanced technologies in healthcare. The paper begins the discussion by situating the use of intelligent robots and artificial intelligence in nursing and healthcare and presenting its ethical and moral implications. Then, we presented the two worldviews: anthropocentrism and biocentrism which are used to respond to the task at hand. Results Anthropocentrism puts humans in the center in terms of moral standing and thus responsibility rests on them alone. Biocentrism declares that all creations deserve moral consideration and thus responsibility is equally allocated to all entities. Within these two worldviews, consensus development was offered to resolve these issues. Consensus provides clarity and democracy between and among the societies. Conclusions The findings of this article can be basis in (1) instituting mechanisms of robust peer review and a rigorous series of simulation before adopting or implementing intelligent robots and artificial intelligence in clinical practice; (2) education and training of highly specialized nurse practitioners who can be focal persons in responding to ethical and moral issues with regard to these advanced technologies; and (3) harmonization of robotics research, manufacturing, and clinical practice.

Students report experiencing elevated levels of academic stress while in Advanced Placement (AP) and International Baccalaureate Diploma (IBD) classes. In response, we developed a classwide, preventative coping and connectedness curriculum, which consists of 12 50-minute modules for 9th-grade students enrolled in accelerated coursework. In this pilot study, we implemented the curriculum in 2 schools and sought user feedback. After describing the curriculum, we examine the acceptability of this social-emotional curriculum at three stages: prior to, during, and following implementation. Overall, all stakeholders—including students, parents, and educators—deemed the curriculum highly acceptable. Teachers, administrators, and parents rated the content and lessons as highly acceptable for addressing students’ academic stressors and development of necessary coping and strategies. Included is a discussion of these findings relative to prior acceptability research, including research with gifted learners, limitations, and the role of acceptability in the line of inquiry for this curriculum intervention development.

La investigación que sintetiza este artículo tuvo como objetivo diseñar una estrategia didáctica basada en el diálogo y la narración para mejorar la expresión oral en niñas y niños del nivel preescolar de la Escuela de Educación Fiscal Básica “Dr. Rómulo Romeo Santana Delgado”. Metodológicamente, la investigación se enmarcó en un enfoque cualitativo, con un diseño de investigación acción participativa con base en los principios de Elliot, a través de la acción metódica de comprensión, planeación e implementación. El grupo de estudio fue de veinticinco (25) niños, niñas y una (01) docente de la etapa inicial. Las técnicas de recolección de datos fueron la observación participante y la entrevista no estructurada aplicada a docentes de la institución. Los resultados de la fase de comprensión develan debilidades en la expresión oral de los niños en relación con el léxico, la verbalización, tono de voz y congruencia de ideas; además, se evidenció un marcado miedo escénico al interactuar en el aula. Durante la planeación se reflexionó colectivamente sobre el valor didáctico del dialogo y la narración para la promoción del lenguaje oral, lo que se comprobó con la aplicación de la estrategia. Se concluye que los niños presentaron cierto nivel de retraso en la adquisición de destrezas para la oratoria y que existen fallas en el proceso de socialización de los párvulos tanto en el hogar como en la escuela. Finalmente, se corroboró en la fase de implementación la efectividad de la estrategia y actividades planificadas.

Objective: While instructional videos are commonly used in surgical education, there is a paucity of data on home laparoscopic box trainers. This pilot study evaluated impacts of augmenting instructional videos with these devices. Design: This was a randomized controlled pilot study evaluating laparoscopic surgical performance on the LapSim virtual surgical simulator before and after a 2 week curriculum of instructional videos alone (n = 8, 47.1%) vs videos plus a home laparoscopic box trainer (n = 9, 52.9%). The LapSim recorded mistake number, time, and instrument path length to complete each task. Participants completed surveys about their perceptions of surgery before and after the course. Participants: Preclinical medical students were recruited. Those with extensive surgical experience or did not complete the course were excluded. Results: For the box trainer group vs the videos alone group: mean change in mistakes was −10.0 (standard deviation [SD]:17.1) vs +.5 (SD:21.59) ( P = .28); mean change in time was −433.24 (SD:304.67) seconds vs −366.16 (SD:240.10) seconds ( P = .62); mean change in instrument path length was −4.27 (SD:4.38) meters vs −3.19 (SD:4.86) meters ( P = .64). The box trainer group ranked “I feel as though surgery comes naturally” 1.58 points higher (95% confidence interval [CI]: .85, 2.32; P < .01) and “I am worried about being skilled at surgery” 1.26 points lower (95% CI: 2.29, −.24; P = .02) upon completing the study. The videos alone group reported no significant changes in survey responses. Conclusion: Home laparoscopic box trainers can generate confidence and reduce anxiety regarding surgical fields. This study provides a framework for future larger scale works.

Food waste from a school feeding nutrition program, if not correctly disposed, has a high level of pollution. Food waste can be utilised as a substrate for biogas production. The aim of the research was to construct a low-cost biogas digester for Bongumusa FET School in Mpumalanga province in South Africa and to assess its performance when fed with available food waste. A prototype biogas digester was designed, constructed and fed with food waste namely: vegetable peels, mealie meal, samp, rice, pilchards and fruit peels. The food waste was crushed and mixed with water before it was fed into the biogas digester. Cow dung was used as inoculum for the food waste. The temperature of slurry, the pH and biogas production were measured during a retention time of thirty days. It was observed that the initial pH dropped at the start of the experiment and this was attributed to the volatile fatty acid formation in acidogenesis and acetogenesis. The pH began to rise gradually as the volatile fatty acids were consumed by the methanogens to methane and carbon dioxide. From the results, it was observed that food waste is a good source of biogas for the school. In addition, the food waste was found to be an attractive method for environmental protection and energy saving for Bongumusa FET School. The biogas from the food waste can be used to replace imported Liquid Petroleum Gas (LPG) that is used in the school for heating purposes.

This paper will present initial results from excavations at Maritime Academy, Frindsbury which produced several handaxes, two of which can be classed as ‘giant handaxes’. Artefacts were recovered from fluvial deposits in the Medway Valley and are thought to date from the Marine Isotope Stage 9 interglacial. This paper will focus on the largest of these handaxes and will present metrical data for the artefact and initial comparison with similar artefacts from the British Palaeolithic.

El objetivo de la investigación es el diseñar una estrategia que promueva el aprendizaje significativo de la lectura en los estudiantes de séptimo año de educación básica, para la elaboración de esta se desarrolló una metodología cualitativa, cuantitativa y descriptiva. Para generar datos sobre el desarrollo de la investigación se aplicaron instrumentos como fue la encuesta, entrevista estructurada y el fichero bibliográfico como parte de los contrastes teóricos. Los resultados indican que los estudiantes en su gran mayoría dedican tiempo a la lectura en un aproximado de 20 a 25 minutos y que actualmente el gusto de lecturas recae en información como son los animes y que esta literatura les causa un mayor interés en su hábito lector, además el uso de internet se ha convertido en una de sus principales herramientas educativas. El diseño de la estrategia para mejorar el aprendizaje de los estudiantes constará del uso de tecnologías de la información y comunicación (Tics) y se verá relacionada con lecturas lúdicas mediante la conformación de actividades que permitan el desarrollo de un aprendizaje significativo en ellos. PALABRAS CLAVE: Estrategia educativa: Proceso de aprendizaje; Estudiante de primaria; Escolaridad; didáctica educativa. Didactic strategy for the learning of reading in students of the General Basic Education System ABSTRACT The objective of the research is to design a strategy that promotes the meaningful learning of reading in the students of the seventh year of basic education, for the elaboration of the same a qualitative, quantitative, and descriptive methodology was developed. To generate data on the development of the research, instruments such as the survey, structured interview and the bibliographic file were applied as part of the theoretical contrasts. The results indicate that most students dedicate time to reading in approximately 20 to 25 minutes and that currently the taste of reading is based on information such as anime and that this literature causes them a greater interest in their reading habit Furthermore, the use of the internet has become one of its main educational tools. The design of the strategy to improve student learning will consist of the use of information and communication technologies (ICTs) and will be related to playful readings through the creation of activities that allow the development of meaningful learning in them. KEYWORDS: Educational strategy; Learning process; Elementary school student; Schooling; educational didactics.

El síndrome de Pfeiffer es un trastorno autosómico dominante infrecuente, que afecta aproximadamente a 1 de cada 100.000 nacidos vivos, se acompaña de craneosinostosis, primeros dedos anchos y desviados, sindactilia parcial en manos y pies. Caso clínico: Se describe un neonato masculino, con antecedentes perinatales, craneosinostosis diagnosticado por ecografía a las 29,2 semanas de gestación. El paciente nació a las 39 semanas mediante cesárea y presentó dificultad respiratoria aguda (Apgar 8 -9). En la exploración física el neonato mostró cráneo en trébol, hipertelorismo, proptosis severa bilateral, puente nasal ancho, atresia de coanas, hipoplasia malar, maxilar y paladar ojival. El Tórax estrecho tenía leves retracciones subcostales, que a la auscultación indicó una leve disminución de aire en campo pulmonar izquierdo, ruidos cardíacos normales. El abdomen no presentó visceromegalias, el genital externo hidrocele derecho. Sus extremidades superiores tenían hipertrofia de primeros metacarpianos, pulgares anchos; las inferiores tenían hipertrofia de primeros metatarsianos y con desviación en varo. El tratamiento se realizó de manera interdisciplinaria, el manejo de craneosinostosis requirió varias fases de intervenciones quirúrgicas.Conclusiones: Este caso tiene características clínicas compatibles con síndrome de Pfeiffer tipo 2 y el cuidado ha sido multidisciplinario, involucrando los conocimientos especializados de muchos equipos clínicos.

Purpose Mokken scale analysis (MSA) is an attractive scaling procedure for ordinal data. MSA is frequently used in health-related quality of life research. Two of MSA's prime features are the scalability coefficients and the automated item selection procedure (AISP). The AISP partitions a (large) set of items into scales based on the observed item scores; the resulting scales can be used as measurement instruments. There exist two issues in MSA: First, point estimates, standard errors, and test statistics for scalability coefficients are inappropriate for clustered item scores, which are omnipresent in quality of life research data. Second, the AISP insufficiently takes sampling fluctuation of Mokken’s scalability coefficients into account. Methods We solved both issues by providing point estimates and standard errors for the scalability coefficients for clustered data and by implementing a Wald-based significance test in the AISP algorithm, resulting in a test-guided AISP (T-AISP), that is available for both nonclustered and clustered test scores. Results We integrated the T-AISP into a two-step, test-guided MSA for scale construction, to guide the analysis for nonclustered and clustered data. The first step is performing a T-AISP and select the final scale( s ). For clustered data, within-group dependency is investigated on the final scale(s). In the second step, the strength of the scale(s) is determined and further analyses are performed. The procedure was demonstrated on clustered item scores obtained from administering a questionnaire on quality of life in schools to 639 students nested in 30 classrooms. Conclusions We developed a two-step, test-guided MSA for scale construction that takes into account sample fluctuation of all scalability coefficients and that can be applied to item scores obtained by a nonclustered or clustered sampling design.

Improved forest management (IFM) has the potential to remove and store large quantities of carbon from the atmosphere. Around the world, 293 IFM offset projects have produced 11% of offset credits by voluntary offset registries to date, channeling substantial climate mitigation funds into forest management projects. This paper summarizes the state of the scientific literature for key carbon offset quality criteria—additionality, baselines, leakage, durability, and forest carbon accounting—and discusses how well currently used IFM protocols align with this literature. Our analysis identifies important areas where the protocols deviate from scientific understanding related to baselines, leakage, risk of reversal, and the accounting of carbon in forests and harvested wood products, risking significant over-estimation of carbon offset credits. We recommend specific improvements to the protocols that would likely result in more accurate estimates of program impact, and identify areas in need of more research. Most importantly, more conservative baselines can substantially reduce, but not resolve, over-crediting risk from multiple factors.

Background – The incidence of pediatric asthma exacerbations during the COVID-19 pandemic has been evaluated; however, the incidence of severe acute asthma (SAA) requiring a Pediatric Intensive Care Unit (PICU) admission is unknown. Furthermore, we examined several factors which might influence this incidence, such as environmental triggers or changes in COVID-19 lockdown regulations. Methods – In this single-center, retrospective cohort study running from 2018 to 2021, all PICU admissions for SAA of children above two years of age at a tertiary hospital in the Netherlands were included. Information on potential asthma triggers during the pandemic, including viral infections, concentrations of ambient fine particulate matter (PM2.5) and pollen index were evaluated. Results – In total, 168 children were included in this study. While we observed a decrease in PICU admissions for SAA during lockdown periods, there was an increase in the admission rates in the periods without a lockdown, with the highest peak from August to November of 2021. This peak in the fall of 2021 did not align with pollen or ambient PM2.5 concentrations (r =-0.04 for pollen and r =0.23 for PM2.5). Discussion – COVID-19 lockdowns influenced the admission rates for SAA at the PICU both during and after the lockdowns in the Netherlands. We hypothesize that an increase in viral infections after lockdown periods was the reason for the altered incidence of SAA at the PICU in late 2021, rather than air pollution and pollen concentrations.

The objective of this article was to design a pedagogical proposal as an innovative learning resource in the area of Language and Literature with the application of digital tools. A mixed, descriptive, field and documentary approach methodology was applied. The techniques used were the observation of students, interviews with teachers and survey of parents, as instruments the observation sheet and questionnaire of questions. The population 421 students and 19 teachers, the intentional non-probabilistic type sample made up of 37 students, 37 parents and 2 teachers of the third basic year. The results showed that the application of digital tools is limited by teachers, therefore, children show low performance in Language and Literature. It is concluded that there is a need in the application of a pedagogical proposal as an innovative learning resource in the area of Language and Literature using digital tools. Keywords: Digital Tools, Learning Resource, Innovation., El objetivo del presente artículo fue diseñar una propuesta pedagógica como recurso de aprendizaje innovador en el área de Lengua y Literatura con la aplicación de herramientas digitales. Se aplicó una metodología de enfoque mixto, descriptivo, de campo y documental. Las técnicas utilizadas fueron la observación a los estudiantes, entrevista a docentes y encuesta a padres de familia, como instrumentos la ficha de observación y cuestionario de preguntas. La población 421 estudiantes y 19 docentes, la muestra de tipo no probabilístico intencionada conformada por 37 estudiantes, 37 padres de familia y 2 docentes de tercer año básico. Los resultados evidenciaron que la aplicación de herramientas digitales es limitada por parte de los docentes, por lo cual, los niños demuestran bajo rendimiento en Lengua y Literatura. Se concluye que existe la necesidad en la aplicación de una propuesta pedagógica como recurso de aprendizaje innovador en el área de Lengua y Literatura utilizando herramientas digitales. Palabras claves: Herramientas Digitales, Estrategia Pedagógica, Recursos de Aprendizajes Innovadores. Abstract The objective of this article was to design a pedagogical proposal as an innovative learning resource in the area of Language and Literature with the application of digital tools. A mixed, descriptive, field and documentary approach methodology was applied. The techniques used were the observation of students, interviews with teachers and survey of parents, as instruments the observation sheet and questionnaire of questions. The population 421 students and 19 teachers, the intentional non-probabilistic type sample made up of 37 students, 37 parents and 2 teachers of the third basic year. The results showed that the application of digital tools is limited by teachers, therefore, children show low performance in Language and Literature. It is concluded that there is a need in the application of a pedagogical proposal as an innovative learning resource in the area of Language and Literature using digital tools. Keywords: Digital Tools, Learning Resource, Innovation. Información del manuscrito:Fecha de recepción: 05 de octubre de 2022.Fecha de aceptación: 04 de enero de 2023.Fecha de publicación: 10 de enero de 2023.

The research provides a tool for decision making concerning maintenance activities in water pipelines. The thesis aims to bring attention to the fact that use of modern and faster non-destructive technologies can improve conventional maintenance strategies as long as the results can be interpreted. More precisely, this thesis aims to propose a framework to help decision makers understand the results from a potential new technology and make the most appropriate decision in order to achieve preventive maintenance. This can improve water losses reduction. Considering the complexity of the deterioration process of urban pipelines, the lack of framework to interpret results of condition assessment, and the fact that decision makers should deal with uncertainty, Belief Function Theory arise as an applicable method to determine which maintenance activity should be carried out: repair or replace. As a result, a decision framework was proposed to choose the most appropriate maintenance activity based on current pipeline condition and expert knowledge. Since this thesis is a basis for future research, Fitness for Service approach was also included in the proposed framework. Its possible application was illustrated with the evaluation of three cases. The presented tool illustrated the first steps of developing a framework for a practical decision-making. This framework, which is aimed to be employed in maintenance strategies of water pipelines, ensures a proper implementation of the results of condition assessment. This was exemplified by analyzing three case studies which illustrate the framework’s application in water pipelines maintenance activities. Despite its simplicity, the result showed that the proposed framework could facilitate decision-making process in maintenance activities by having a graphical representation.

Summary Background & aims Donor human milk (DHM) is recommended as the first alternative for preterm infants if their mother's own milk is not available or if the quantity is not sufficient. The most commonly used technique to eliminate microbial contaminants in DHM is holder pasteurization (HoP). However, the heating process during HoP partially destroys milk bioactive factors such as insulin. Therefore, innovative techniques have been developed as alternatives to HoP. The objective of this study was to determine the effect of HoP, high-temperature–short-time (HTST), thermoultrasonication (TUS), ultraviolet-C irradiation (UV-C), and high-pressure processing (HPP) on the insulin concentration in DHM. Methods Milk samples from 28 non-diabetic mothers were collected. The milk samples were aliquoted and either left untreated or treated with HoP (62.5 °C; 30 min), HTST (72 °C; 15 s), TUS (60 W; 6 min), UV-C (4863 J/L), or HPP (500 MPa; 5 min). Results The mean insulin concentration in untreated milk was 79 ± 41 pmol/L. The mean insulin retention rate was 67% for HoP, 78% for HTST, 97% for TUS, 94% for UV-C, and 106% for HPP. The mean insulin concentration in milk treated with HoP was significantly lower compared to untreated milk (p = 0.01). Conclusion TUS, UV-C, and HPP preserve insulin in DHM. The insulin concentration in DHM is affected to a larger extent by HoP than by HTST. These results indicate that TUS, UV-C, and HPP may serve as alternatives to HoP.

BACKGROUND OBJECTIVES: Human milk (HM) is better tolerated than formula in preterm infants. Insulin, which is naturally present in HM but not in formula, has been suggested as a key factor for feeding tolerance, as it appears to stimulate intestinal maturation. Its precise concentrations during the early postnatal period, however, remains unknown. The objective of this study was to assess the natural timecourse of the HM insulin concentration during the first ten days postpartum. The effect of preterm delivery, maternal obesity, and diurnal rhythm were also assessed. METHOD: HM was collected from 31 non-diabetic mothers (21 preterm [gestational age (GA)

BACKGROUND Rheumatology is considered a low-risk specialty, but studies have shown a prevalence of burnout between 42% and 51%. OBJECTIVES The aim was to determine the prevalence of burnout in rheumatologists in Latin America and the factors associated with it. METHODS Cross-sectional study based on a survey completed through Google Forms platform that was sent by the national rheumatology associations of Latin America. Burnout was assessed with the Maslach Burnout Inventory. Data were analyzed using the statistical program SPSS v.22. RESULTS Two hundred ninety-seven rheumatologists from 15 countries were included, mainly Argentina (28.3%), Brazil (26.3%), and Mexico (12.8%). The majority were women 62%, 42.4% worked in public hospitals with an average of 40.1 ± 14.2 hours per week; 31.3% did research, 13.1% clinical trials, 56.6% teaching, and 42.8% administrative work; 36% received an annual income less than $25,000; 56.6% had burnout in at least 1 dimension. Only 20.2% thought they had burnout, 9.1% were currently receiving professional help, and 15.8% had sought help in the past; 72.1% said they were willing to participate in a program to reduce burnout. The rheumatologists with burnout were younger than those without burnout (46.5 vs 49.9 years, p = 0.015). CONCLUSIONS Burnout affects near half of rheumatologists in Latin America and was associated with younger age, long working hours, low satisfaction, less happiness, higher Patient Health Questionnaire-9, suicidal thoughts, anxiety, income, presence of comorbidities, and low self-esteem.

Livestock production by smallholder farmers in southern Africa is often constrained by insufficient fodder during the dry season. The aim of this study was to determine if inclusion of pigeon pea (Cajanus cajan (L.) Millsp.) hedgerows in Megathyrsus maximus ‘Gatton’ pastures could improve fodder production and nutritional yields, and to investigate effects of hedgerow cutting height on fodder production (including both browse and herbage). Treatments included three simulated silvopastoral systems with M. maximus planted between hedgerows, and one treatment that was M. maximus pasture alone. Hedgerows were cut at 60 or 90 cm above ground, or were uncut. Over the first two growing seasons, browse and grass fodder was harvested, dried and weighed four times. A portion of the fodder (comprising browse and herbage) was conserved in the second year and samples analysed for crude protein (CP), neutral detergent fibre (NDF) and acid detergent fibre (ADF) contents (%) and CP, phosphorus (P) and zinc (Zn) yields (kg ha−1). Hedgerows decreased cumulative grass biomass by 18.5%, but increased 1.22-fold the cumulative total fodder biomass when hedgerows were cut to 90 cm, compared to no hedgerows. Hedgerows had no effect on conserved grass herbage biomass (2.7 Mg ha−1 on average), but doubled biomass of conserved total fodder (5.0 Mg ha−1 on average) if hedgerows were cut. Cutting hedgerows increased CP, P and Zn yields, and increased CP and ADF contents, compared to not cutting them or not including them, while NDF was unaffected. Cutting hedgerows to 90 cm increased total browse production, compared to cutting to 60 cm. Pigeon pea seed biomass was unaffected by hedgerow cutting height (870 kg ha−1 on average). In conclusion, pigeon pea hedgerows included into grass pastures increase the quantity and quality of total fodder for livestock feed supplementation during the dry season.

This study is a meta-analytical study that examines the effectiveness of gamification in learning performance in educational settings (n = 29; year-span = 2011–2019). Specifically, it aimed to investigate (a) whether gamification could improve learning performance, and (b) whether peer interaction (i.e., peer competition and peer collaboration) moderated the effectiveness of gamification in learning performance. Results from random-effects models showed significant effects of gamification in learning performance (g = .595, 95% CI [.432, .758], N = 3515). This effect remained robust after excluding outliers and was stable in a sub-split analysis that excludes studies with low methodological rigor (i.e., studies with pre-post test design). Subgroup analyses revealed a moderating effect of peer competition in gamification in learning, suggesting that competitive games were better than non-competitive games for promoting learning performance in educational settings. However, this effect was not robust and no evidence of subgroup differences were found in the sub-split analysis. Peer collaboration did not moderate the effectiveness of gamification in learning as no subgroup differences were found between collaborative games and non-collaborative games. The effectiveness of games that were both competitive and collaborative did not differ from those that were only competitive. Other moderators such as education level and research design were also investigated. No subgroup differences were found for these two moderators. Educational implications and limitations were further discussed.

La detección y atención de factores psicosociales que afectan al sector laboral docente, resulta prioritario ya que no es un aspecto que preocupe al nivel directivo de las instituciones de educación superior y aunque las exigencias en seguridad y salud ocupacional obliga a la detección, identificación, prevención y adopción de medidas para garantizar la salud y neutralizar los riesgos ocupacionales, en la práctica no surgen acciones concretas para abordar y tratar los factores de riesgo psicosocial que afectan a los docentes del sistema de educación superior. El objetivo de esta investigacion es identificar los riesgos de la salud ocupacional en el teletrabajo docente, métodos se realizó un estudio de tipo descriptivo de cohorte transversal, el universo se constituyó por docentes de la Facultad de Ciencias de la Salud de la Universidad Técnica de Manabí en un total de 65 docentes. La muestra se conformó por 54 docentes, 33 de la carrera de Psicología y 21 de la carrera de Nutrición. Los resultados de la investigación se obtuvieron mediante la aplicación de encuestas online, mismos que se tabularon en Excel y se presentaron tablas estadísticas con su respectivo análisis, se concluye que se hay factores como carga y fatiga mental en docentes que superan los 39 años de edad por actividades de teletrabajo.

Financial support is a critical enabling factor for healthy agri-food innovation systems, particularly within resource-limited settings, though additional forms of support are also necessary. This motivated a critical comparative review of evidence in peer-reviewed and gray literature on the range of instruments that support innovation in agri-food systems in the Global South, toward achieving sustainable agriculture intensification. The main aim is to provide recommendations to innovation managers on the choice of different instruments for supporting innovation. The key guiding questions for the comparative analysis were whether the instrument fosters uptake of innovation and whether it promotes inclusive development. A review of the literature was supplemented with a scan of websites for sources of peer-reviewed and gray literature documenting the application of the 12 selected instruments. The study revealed three categories of instruments: (Type A) those that support entrepreneurship; (Type B) those that primarily finance innovation; and (Type C) those that support innovation in real-life contexts. Our analysis indicates that innovation managers and funders need to select instruments that are likely to fit the specific context as well as to address the mandates of their organizations, and in so doing, they must consider how to ensure the sustainability of their investments and meet the needs of their beneficiaries. This review represents one of a handful that have compared the use of multiple instruments across multiple continents in the Global South, and can serve as an important decision-making tool for investors and funders looking to invest in agri-food innovation systems.

La investigación tuvo lugar en la provincia del Azuay - Ecuador, con el objetivo de determinar el porcentaje de animales con alto Recuento de Células Somáticas (RCS), relacionarlo con la etapa productiva y compararlos con la normativa de calidad higiénica, usando citometría de imagen para su análisis. El 53% resultaron positivos a mastitis con altos RCS. The research took place in the province of Azuay - Ecuador, with the objective of determining the percentage of animals with high SCC, relating it to the productive stage and comparing them with the hygienic quality regulations, using image cytometry to analyze. 53% were positive for mastitis with high SCR.

El presente libro reporta un proceso de investigación orientado al diseño de una propuesta de ejecución de una tienda de bicicletas, la cual también se aspira preste el servicio de alquiler de bicicletas en el cantón Pedernales, Ecuador. Esta iniciativa se fundamenta a que en la actualidad es notorio el uso de bicicletas en la población, por ello se desea fomentar la cultura deportiva de ciclismo, en toda la ciudadanía, cubriendo la necesidad de los pobladores y comprendiendo la situación actual del país, visto desde la viabilidad en crear una pequeña empresa dedicada a las ventas y alquiler de bicicletas, generando empleo en el cantón. Por todo ello, se analiza el éxito de la pequeña empresa y sus ventajas competitivas, elaborando un análisis vital de las características de la empresa y las actividades que se desarrolla para adoptar las estrategias de crecimiento con la finalidad de ejecutar este emprendimiento en práctica, a través de los contenidos percibidos durante la carrera en la universidad, y para crecer como población activa en le economía local. Para el desarrollo de la propuesta se consideraron los siguientes apartados: en primer lugar, se expone la argumentación problemática que contextualiza el estudio; en segundo término, se presentan algunos relatos teóricos sobre la temática. Luego se expone el planteamiento estratégico de la propuesta, para dar paso a los capítulos donde se describen los estudios que sustentan el análisis de mercadotecnia, el estudio técnico, el estudio económico, y la evaluación financiera. Por última se finaliza con algunas reflexiones y cierre y recomendaciones sobre la ejecución factible de la propuesta.

Although it has never been a real top priority, road safety is an important issue in the Netherlands and much progress has been made. In the last 50 years, the country experienced an enormous growth in population (+30%) and in kilometers travelled (+300%), but the mortality rate dropped by 80%. Many effective interventions were taken. Over time, new insights in traffic risks and causes of crashes led to the adoption of a new road safety vision in the early 1990s: Sustainable Safety, the first attempt worldwide of a Safe System approach (1992). This vision was inspired by the UN-Brundtland report Our Common Future (1987) and applied to road safety. Its basis originated in the knowledge and experiences in the decades before.In a sustainably safe road transport system, risks of crashes and serious injuries are drastically reduced or even eliminated by an infrastructure that is adapted to the limitations of human capacity by proper road design, by vehicles fitted with ways to simplify the tasks of man and constructed to protect the vulnerable human being as effectively as possible, and by road users who are adequately educated, informed, and, where necessary, controlled. If crashes still do occur, serious injuries must be excluded. The vision Sustainable Safety has been translated into a set of characteristics and into Sustainable Safety principles.Sustainable Safety was welcomed by Dutch road safety professionals and received great political support. A massive implementation program was initiated and carried out as from 1995. Many stakeholders were engaged. An evaluation study covering the period 1998–2007 revealed a 30% reduction in the number of fatalities. Benefits of the investments were four times higher than costs. Sustainable Safety empowered and strengthened the Dutch road safety research community and heavily influenced the discourse on road safety in the country.As from 2000, several developments (a different planning structure of road transport, less political priority for road safety – perhaps as a result of successes in the past – and decentralization of policies) caused that Sustainable Safety became less prominent and safety effects less visible. However, the vison and the principles remain a solid basis for making progress towards a casualty-free road transport system and to respond to new developments, such as a changing demography, changing transport modes and traffic patterns, and new technologies. Two more editions have been published (2005 and 2018). Results and impacts are being discussed.

Tree pruning is a management tool in agroforestry systems for reducing shade, enhancing nutrient cycling or providing fodder. However, little information is available on the effect of pruning management on plant growth, nonstructural carbohydrate (NSC) levels in the roots and N2 fixation of Sesbania sesban. A glasshouse experiment was conducted to assess the effect of pruning frequency on biomass production, NSC levels and N2 fixation of Sesbania sesban. Pruning treatments consisted of a control (PF0), one pruning at 3 months after transplanting (MAT) (PF1), two successive prunings at 3 and 6 MAT (PF2), and three successive prunings at 3, 6 and 9 MAT (PF3), with each pruning removing shoot biomass above 50% of the initial height. The experiment was laid out in a completely randomized design (CRD) with four replications. Results showed that increasing pruning frequency resulted in decreased nodulation and nonstructural carbohydrate levels in the roots. Above and below ground biomass, root length, percentage N derived from the atmosphere and amount of N2 fixed were decreased in a similar manner whether plants were successively pruned twice or thrice. It can be concluded that two or three successive prunings in nine months significantly reduce nonstructural carbohydrates, DM productivity and N2 fixation of S. sesban, and might result in supply of insufficient biomass required for improving soil N fertility and livestock production.

Climate change in the Mediterranean-like regions of South Africa has resulted in increased rainfall variability, a delayed start to the wet winter season, and increased occurrences of out-of-season summer rainfall events. These changes in bioclimatic conditions are predicted to become more pronounced and, therefore, could result in poor seedling establishment and false breaks from the soil seed bank, followed by seedling desiccation in annual medic and clover pastures. This study therefore aimed to quantify and compare the responses of three annual Medicago species and five annual Trifolium species to drought stress imposed at the seed germination, seedling establishment, and early seedling growth stages. Three separate controlled trials were conducted. Firstly, the seeds were germinated in seed germination chambers at constant temperatures ranging from 5 to 30 °C, in 5 °C increments, with five osmotic treatments within each temperature, and germination was recorded daily. For the second experiment, seeds were planted at 100, 70, 50, and 30% of the soil’s moisture-holding capacity without subsequent watering, and emergence was recorded daily. For the third experiment, one-month-old seedlings were subjected to two water-limitation periods (15 or 30 days), and their subsequent morphological responses were measured. The results from these experiments indicated that the species differed significantly in their responses to drought, and the best-performing species often differed when drought was imposed at different development stages. Five species—M. polymorpha L., M. truncatula Gaertn., T. alexandrinum L., T. vesiculosum Savi., and T. subterraneum L. ssp. subterraneum—were able to tolerate incidences of drought better than other species and, thus, should be prioritized for further research into the variation in drought tolerance between cultivars within these species.

Background: Studies comparing how the European nursing homes (NHs) handled the first wave of the COVID-19 pandemic remain scarce. Methods: A cross-sectional study was conducted during the first wave in a private NHs network in Belgium, France, Germany and Italy. Mortality rates were estimated, and prevention and control measures were described by country. Data from the Oxford governmental response tracker project were used to elaborate a “modified stringency index” measuring the magnitude of the COVID-19 global response. Results: Of the 580 NHs surveyed, 383 responded to the online questionnaire. The COVID-19 mortality rate was similar in France (3.9 deaths per 100 residents) and Belgium (4.5). It was almost four times higher in Italy (11.9) and particularly low in Germany (0.3). Prevention and control measures were diversely implemented: residents’ sectorization was mainly carried out in France and Italy (~90% versus ~30% in Germany and Belgium). The “modified stringency index” followed roughly the same pattern in each country. Conclusion: This study, conducted in a European network of NHs, showed differences in mortality rate which could be explained by the characteristics of the residents, the magnitude of the first wave and the prevention and control measures implemented. These results may inform future European preparedness plans.

The objective of this article was to analyze the credit activity of the Popular and Solidarity Financial Sector of Ecuador in the first five-month period of 2021, according to the data generated by the Superintendency of Popular and Solidarity Economy with cuts to the months of January, February, March, April, and May of the same year. The figures of the loan portfolio by the segment of the popular and solidarity financial sector, by economic activity, as well as the distribution of the loan portfolio by segment, type of credit, sex, age range, and level of education were identified and analyzed, which made it possible to know the performance of the credit portfolio in this sector during the time analyzed. Keywords: popular and solidarity financial sector, credit portfolio, economic activity. Resumen Este artículo tuvo como objetivo analizar la actividad crediticia del Sector Financiero Popular y Solidario del Ecuador del primer quinquemestre del año 2021, según los datos generados por la Superintendencia de Economía Popular y Solidaria con corte a los meses de enero, febrero, marzo, abril y mayo del mismo año. Se identificaron y analizaron las cifras de la cartera de crédito por segmento del sector financiero popular y solidario, por actividad económica, así como la distribución de la cartera de crédito por segmento, por tipo de crédito, por sexo, rango etario y nivel de instrucción, lo que permitió conocer el desempeño de la cartera de crédito de este sector del tiempo analizado. Palabras Clave: sector financiero popular y solidario, cartera de crédito, actividad económica.

This paper introduces the EAMENA database, from a user perspective, as a living document of archaeological datasets, assessing its utility for research and heritage management with respect to unfinished data collection and ongoing database development. An incomplete dataset of Crusader sites provides a useful case study of heritage places. First, through a simple analysis using the site function field, the paper demonstrates how users can query the database to identify areas or themes for future research. Second, it analyses condition assessments of Crusader sites in Lebanon to investigate whether these places are disproportionally affected by certain types of modern disturbance. Throughout, the paper discusses aspects of the EAMENA data recording process, highlighting several technical developments that the project has implemented since the public launch of its database in 2017. In doing so, it demonstrates the value of responsive database development to remain at the cutting edge of research technologies.

Despite data supporting the rapid adoption of telehealth in the delivery of clinical care in North America, the implementation of telehealth visits in clinical research studies has faced critical barriers. These challenges include: (1) variations in state licensure requirements for telehealth; (2) disparities in access to telehealth among disadvantaged populations; (3) lack of consistency among individual Investigational Review Boards (IRBs). Each barrier prevents the systematic conversion of research protocols to include telehealth visits. The Parkinson’s Foundation and members of the Parkinson Study Group submit this Comment to highlight current challenges to implementing telehealth visits for clinical research studies. Our objective is to provide a consensus statement emphasizing the urgent need for regulators to standardize adoption of telehealth practices and to propose recommendations to reduce the burden for implementation in existing research study protocols.

Inadequate nutrition limits small-scale livestock production by smallholder farmers in South Africa but can be addressed by the introduction of woody fodder species. Cutting woody plants to harvest fodder affects their productivity and thus it is necessary to determine the optimum cutting height. Cutting affects the productivity and survival of woody plants because it alters concentrations of non-structural carbohydrates, which are used to support their recovery. Since pigeon pea (Cajanus cajan (L.) Millsp.) is not widely grown in South Africa and is not managed as a pruned hedgerow, there was a need to investigate the effect of cutting height under local conditions, especially in areas that experience frost. The trial was established in November 2016, ran over two growing seasons (2016/2017 and 2017/2018) and concluded in August 2018. The treatments comprised three silvopastoral systems with Panicum maximum planted between pigeon pea hedgerows that were cut at 60 cm and 90 cm above the ground, or left uncut and sole P. maximum. Over the two year period, the pigeon pea plants cut at 90 cm above ground produced significantly more leaf, twig and total biomass than the plants cut at 60 cm. Cutting height also had a significant effect on the percentage twig, with pigeon pea plants cut at 90 cm having significantly higher percentage twig than those cut at 60 cm (P 0.05). In July 2018 there were a number of days with temperatures below 0 °C. Prior to this no mortalities had been observed, but the frost events resulted in die-off. The mortality rates were determined in August 2018 when it was clear which of the shrubs had clearly died. The shrub mortality rates were higher for pruned relative to unpruned shrubs, but the effect was not significant (P > 0.05). It was concluded that the choice of cutting height is important for maximising browse production. Future research should consider the effect of pruning on non-structural carbohydrate concentration and total pool in the roots to better understand the reasons for reduced production and shrub mortalities.