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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.

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.

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.

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.

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.

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.

Perú ha sido uno de los países más afectados por la pandemia de COVID-19. Luego de haber sufrido dos olas epidémicas devastadoras, el departamento de emergencia del Hospital Nacional Edgardo Rebagliati Martins mantuvo como reto la preparación, de forma constante y dinámica, para afrontar una tercera ola que ya azotó a muchos países del mundo. Para esto, el departamento se preparó en todos los ámbitos para contribuir a la reducción del impacto de la enfermedad, garantizando no solo la calidad en la atención, sino también la seguridad del personal de salud, modulando la carga laboral y mental generada por la sobredemanda de la pandemia. De esta manera, el departamento estuvo mejor preparado cuando ocurrió la tercera ola. En conclusión, la preparación constante y dinámica es fundamental para afrontar el aumento de casos; así como también, garantizar la seguridad y bienestar del personal de salud.

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, non-structural 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. Treatments included pruning at (i) 3 months only, (ii) 3 and 6 months, and (iii) 3, 6 and 9 months, with each pruning removing shoot biomass above 50% of the initial height. Increased pruning frequency decreased above- and belowground dry matter (DM), and root NSC levels. The decrease in aboveground DM correlated with reduced levels of starch, sugar and total non-structural carbohydrates. Pruning more frequently significantly decreased nodulation, the percentage N derived from the atmosphere and N2 fixed. It could be concluded that more frequent prunings decreases biomass and NSC levels which could reduce the regeneration capacity of trees since they rely on NSCs to regrow. The suppressive effects of increased pruning frequency on N2 fixation could decrease the desirable benefits of legume trees on soil N fertility improvement.

Background There is a compelling need to prepare our societies and healthcare systems to deal with the oncoming wave of population ageing. The majority of older persons maintain a desire to be valued and useful members of society and of their social networks. Aims We sought to investigate the perception of usefulness among persons aged 65 years and over in four European countries. Methods We performed a cross-sectional survey with a representative sample of individuals aged 65 years or older from the population of retired persons (including recently retired persons and oldest-old individuals) from 4 European countries selected using quota sampling. In February 2016, an internet questionnaire was sent to all selected individuals. The characteristics used for the quota sampling method were sex, age, socio-professional category, region, city size, number of persons in household, autonomy, marital status, place of residence, income and educational status. The questionnaire contained 57 questions. Sociodemographic characteristics were recorded. Responses were analysed with principal components analysis (PCA). Results A total of 4025 persons participated; 51% were males, and 70% were aged 65–75 years. PCA identified six classes of individuals, of which two classes (Classes 2 and 3) were characterized by more socially isolated individuals with little or no sense of usefulness, low self-esteem and a poor sense of well-being. These two classes accounted for almost 20% of the population. Younger and more autonomous classes reported a more salient sense of usefulness. Conclusions The loss of the sense of usefulness is associated with dissatisfaction with life and a loss of pleasure, and persons with profiles corresponding to Classes 2 and 3 should, therefore, be targeted for interventions aimed at restoring social links.

Tipo de estudio: retrospectivo - descriptivo, periodo junio de 1997 a mayo de 2002 en el hospital Roberto Gilbert Elizalde con un universo de 418 pacientes.Objetivos: Determinar la incidencia del traumatismo craneo encefalico (TCE) agudo. Describir el comportamiento clinico e imagenologico del TCE agudo en ninos. Establecer las causas, complicaciones y procedimientos utilizados en la casuistica del TCE agudo.Resultados: De los 418 pacientes con diagnostico de TCE agudo el 50% llegaron directamente a emergencia y el otro 50% fueron motivo de trasferencia. El grupo de edad que prevalecio fue el de los escolares (38,4%), el sexo masculino fue el mas afectado (67,5%) y la causa mas frecuente en nuestro medio de TCE son las caidas.Conclusiones: El diagnostico oportuno y el reconocimiento de signos y sintomas que alerten sobre la gravedad del trauma. La tomografia axial computada (TAC) es un medio diagnostico muy importante en los pacientes con compromiso neurologico. La prevencion del TCE es el procedimiento mas idoneo.

Objetivo: Describir la capacidad de agencia de autocuidado de la salud en docentes de la carrera de Enfermería de la Universidad Estatal del Sur de Manabí. Metodología: De tipo cuantitativo descriptivo transversal y con un diseño no experimental, la población estuvo constituida por 14 docentes de la carrera de Enfermería de la Universidad Estatal del Sur de Manabí. Conclusión: La capacidad de agencia de autocuidado es deficiente en la mitad de los participantes, al lograr ubicarse entre el nivel medio y bajo de evaluación. Asimismo, el total de los docentes participan en reuniones o festividades sociales, comparten actividades de recreación con su familia y nunca sustituyen la comunicación directa con su familia por el uso del chat, teléfono o celular.

Introduction Disability in RA is associated with loss of workdays, greater use of health resources and a higher prevalence of depression. The purpose of this study was to determine the prevalence of functional disability and the factors associated with it. Methods A cross-sectional study was carried out during January-June 2019 at a rheumatology clinic in the city of Guayaquil. Patients with pre-established RA were included. Functional disability was measured using the HAQ-DI. Data were analyzed using the statistical program SPSS v22. We compared characteristics between patients with and without disability using Student's t-test and chi-square. A multiple logistic regression model for functional disability was made. Results We included 395 patients, 87.8% female and 12.2% male with a mean age of 51.4±12 years and mean duration of disease 13.8±7 years. Most patients had extra-articular manifestations (80.8%) and comorbidities (81.3%). The mean HAQ-DI was 0.8±0.9, with a prevalence of disability of 26.6%. We found a statistically significant relationship between disability and female sex (p=0.018), age (p=0.020), presence of extra-articular manifestations (p=0.008), myalgia (p

El principal objetivo de la educación de los niños es su utilidad para mejorar calidad de vida presente y futura en todos los ámbitos, “social, cultural, psicológico”; es decir, lograr que, a través de su educación, mejore su comportamiento personal en relación con los demás. Partiendo de esta premisa la educación musical puede aportar mucho para el cumplimiento de este objetivo. La música es un fenómeno fisiológico natural, íntimo y personal, que se encuentra dentro de cada persona -la voz-y del sentido de la audición; responden a eventos emocionales que se presentan en el pulso, la respiración, la adrenalina, así como el flujo, tal como lo señala Willen (1994). La utilización de la música como medio de enseñanza en la actualidad es muy importante porque a través de ella el estudiante desarrolla destrezas y actitudes que le motivan a realizar acciones de integración y solidaridad social que beneficia de manera significativa a los grupos donde el estudiante de desenvuelve y aplica la conducta aprendida a través del coro. En este sentido, la práctica coral durante la infancia se está erigiendo como una herramienta de primer orden para favorecer la convivencia escolar. El beneficio de desarrollar las habilidades cognitivas socio - afectivas a través de la práctica musical es considerar al estudiante protagonista de una experiencia musical compuesta por actividades que salen de la cotidianidad, pero que no dejan de proporcionar conocimientos teóricos y además potencian el desarrollo de la sensibilidad, la creatividad y habilidades intrapersonales e interpersonales. PALABRAS CLAVE: Educación musical; aprendizaje; habilidades cognitivas; didáctica; pedagógico. MUSIC AS A MEANS OF TEACHING-LEARNING OF THE CHILDREN OF THE GABRIELA MISTRAL INITIAL EDUCATION CENTER OF THE PORTOVIEJO CANTON ABSTRACT The main objective of children's education is its usefulness to improve present and future quality of life in all areas, "social, cultural, psychological"; that is, achieve that, through their education, improve their personal behavior in relation to others. Starting from this premise, music education can contribute a lot for the fulfillment of this objective. Music is a natural, intimate and personal physiological phenomenon that is found within each person -the voice- and the sense of hearing; respond to emotional events that occur in the pulse, breathing, adrenaline, as well as the flow, as pointed out by Willen (1994). The use of music as a means of education today is very important because through it the student develops skills and attitudes that motivate him to perform integration and social solidarity actions that significantly benefit the groups where the student develops and apply the learned behavior through the choir. In this sense, choral practice during childhood is being established as a tool of the first order to favor school coexistence. The benefit of developing socio - affective cognitive skills through musical practice is to consider the student protagonist of a musical experience composed of activities that come out of everyday life, but that do not stop providing theoretical knowledge and also enhance the development of sensitivity, creativity and intrapersonal and interpersonal skills. KEYWORDS: Music education; learning; cognitive skills; didactics; pedagogical.

This study investigated the engagement of men, women spouses (WS) and women heads-of-household (WHH) in the planning and construction of rural roads in two Ethiopian districts of Tigray and Amhara, and the differential impacts of rural roads on the mobility and transport of men, WS and WHH. The fieldwork established that there is a strong demand among women for both road use and employment opportunities in road construction. Compared with men, women demonstrated specific priorities with respect to rural road development, such as access to ambulance services, flat, wide and levelled roads, and improved access to means of transport. Although women's concerns have been slowly but steadily pushed up the planning agenda, there are gaps between gender provision in rural road development and implementation. The benefits of roads for women can be enhanced by targeting gender mainstreaming provisions to take into account the specific travel and transport needs of WS and WHH.

With the emergence of artificial intelligence (AI) in medical imaging, radiographers are likely to be at the forefront of this technological advancement. Studies have therefore been conducted recently to understand radiographers' opinions on AI adoption. This study extends that work by using a qualitative approach to further explore radiographers' knowledge, perceptions, and expectations of AI.Six online focus groups were conducted with 22 radiographers from the three public healthcare clusters in Singapore. They were purposively sampled, and participants were recruited from a broad demographic background with varying years of working experience and designations. The focus group sessions were transcribed verbatim and thematic analysis was performed on their responses.Participants demonstrated limited knowledge of AI. Their perceptions of AI were mixed, recognising its benefits in increasing efficiency and improving patient care, but also aware of its limitations in accuracy and bias. On how patients may perceive AI, participants felt that patients would accept AI if they felt it improves their care but may reject it once they lose trust in it. Expectations wise, participants envisioned several applications in pre-, peri‑, and post-procedural workflows including order vetting, patient positioning, language translation, and artefact removal. On radiographers' role and career opportunities, some participants see an opportunity for radiographers to specialise in AI, becoming involved in algorithm development and its clinical implementation.Our findings suggest that widespread implementation of AI would require limited knowledge amongst radiographers and current AI limitations to be addressed. While radiographers are positively anticipating the integration of AI into their practices, they should also become actively involved in the development of AI tools such that those they envisioned. This would help align optimal use of AI tools and radiographer role changes. Patients' acceptance and reactions to AI also warrant further research.