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La educación a nivel global, supone un reto en la actualidad; dado los cambios que han surgido, es necesario readaptar las estrategias educativas de modo que estás se hagan más innovadoras y puedan llegar de manera más cercana a todas las poblaciones, que abarcan los niveles formativos y modalidades, dado que hacer partícipe a todos del proceso, independientemente de su condición, es necesario para que el sistema subsista y vaya hacia la consolidación de la inclusión con calidad. Está se hace de manifiesto cuando se observa de manera tangible, que cada vez más aumenta la población de estudiantes con capacidades especiales dentro de las aulas de clase; propiciando la reconsideración de las estrategias tradicionales educativas, permitiendo la innovación de ellas para lograr que estos estudiantes se encuentren incluidos en el sistema educativo y que además de ello, se pueda obtener resultados al nivel que se espera, integrándose de manera total en el proceso académico actual. Según la Secretaría de Educación de Bogotá para el año 2019 se matricularon 62.888 estudiantes en la localidad de Engativá, de los cuales 1.430 tienen algún tipo de discapacidad y de ellos aproximadamente el 63% de la población presenta discapacidad intelectual (948). Esta investigación se enmarca en el diseño metodológico de campo no experimental y pretende a partir del arquero de fuentes primarias y secundarias, proponer el diseño de una estrategia didáctica basada en la matemática que contribuya al desarrollo del pensamiento crítico, en los estudiantes con discapacidad intelectual en la localidad diez de la ciudad de Bogotá.

Este documento corresponde a un artículo de reflexión que está pensado en presentar la evaluación de los programas educativos de instituciones educativas de América Latina y la región como una herramienta básica para alcanzar la calidad de la educación tan anhelada debdo a los bajos resultados obtenidos por nuestros sistemas educativos en las pruebas censales como PISA y Saber, en el caso de Colombia. La era del conocimiento, como se le ha llamado al movimiento apresurado de los avances tecnológicos, técnicos y científicos que demanda nuestra sociedad, trae consigo una serie de recursos nunca vistos para la circulación y almacenamiento de la información, al punto que se necesita una sociedad que sea capaz de administrarlas. Saber qué, cómo y quién lo hace es lo que atañe a las instituciones educativas; la formación brindada a la sociedad requiere involucramiento de todos los entes de la sociedad, se necesitan recursos de todo tipo para saber decidir cómo y qué programas ofrecer a la gente, conocimientos teóricos adaptados a la civilización, y es la evaluación continua, crítica y detallada la que puede garantizar las bases de las competencias del futuro ya presente. Este artículo contiene información relacionada con las distintas perspectivas, que, a través de la historia, dan fundamentación efectiva y acertada de los tipos y modelos de evaluación de programas de educación.

4-H is the largest positive youth development organization in the United States and is implemented by the land grant university system. To achieve program expansion, the century-old organization will need to recruit and retain millions more youth that reflect their increasingly diversified communities. Higher education has also worked to recruit and retain youth previously not engaged in college. This paper explores the hypothesis that there are lessons to be learned by the 4-H program from the literature on first-generation college students. Literature on risk factors and retention are presented for both first-generation college students and 4-H youth members. The two literatures are compared for similarities. Parallels existing between the experience of a first-generation college student entering an undergraduate program and the experience of a first-generation 4-H youth member entering the 4-H program were explored. Considerable overlap is found between recruitment and retention challenges in both audiences prior to enrollment/participation and during matriculation/participation providing considerable opportunities for 4-H and positive youth development organizations to identify adaptations to support first-generation youth members.

Background: Evidence-practice gaps exist in urology. We previously surveyed European Association of Urology (EAU) guidelines for strong recommendations underpinned by high-certainty evidence that impact patient experience for which practice variations were suspected. The recommendation “Do not offer neoadjuvant androgen deprivation therapy (ADT) before surgery for patients with prostate cancer” was prioritised for further investigation. ADT before surgery is neither clinically effective nor cost effective and has serious side effects. The first step in improving implementation problems is to understand their extent. A clear picture of practice regarding ADT before surgery across Europe is not available. Objective: To assess current ADT use before prostate cancer surgery in Europe. Design, setting, and participants: This was an observational cross-sectional study. We retrospectively audited recent ADT practices in a multicentre international setting. We used nonprobability purposive sampling, aiming for breadth in terms of low- versus high-volume, academic, versus community and public versus private centres. Outcome measurements and statistical analysis: Our primary outcome was adherence to the ADT recommendation. Descriptive statistics and a multilevel model were used to investigate differences between countries across different factors (volume, centre type, and funding type). Subgroup analyses were performed for patients with low, intermediate, and high risk, and for those with locally advanced prostate cancer. We also collected reasons for nonadherence. Results and limitations: We included 6598 patients with prostate cancer from 187 hospitals in 31 countries from January 1, 2017 to May 1, 2020. Overall, nonadherence was 2%, (range 0–32%). Most of the variability was found in the high-risk subgroup, for which nonadherence was 4% (range 0–43%). Reasons for nonadherence included attempts to improve oncological outcomes or preoperative tumour parameters; attempts to control the cancer because of long waiting lists; and patient preference (changing one's mind from radiotherapy to surgery after neoadjuvant ADT had commenced or feeling that the side effects were intolerable). Although we purposively sampled for variety within countries (public/private, academic/community, high/low-volume), a selection bias toward centres with awareness of guidelines is possible, so adherence rates may be overestimated. Conclusions: EAU guidelines recommend against ADT use before prostate cancer surgery, yet some guideline-discordant ADT use remains at the cost of patient experience and an additional payer and provider burden. Strategies towards discontinuation of inappropriate preoperative ADT use should be pursued. Patient summary: Androgen deprivation therapy (ADT) is sometimes used in men with prostate cancer who will not benefit from it. ADT causes side effects such as weight gain and emotional changes and increases the risk of cardiovascular disease, diabetes, and osteoporosis. Guidelines strongly recommend that men opting for surgery should not receive ADT, but it is unclear how well the guidance is followed. We asked urologists across Europe how patients in their institutions were treated over the past few years. Most do not use ADT before surgery, but this still happens in some places. More research is needed to help doctors to stop using ADT in patients who will not benefit from it.

El sistema educacional en Chile está pasando por distintos procesos de cambios, los cuales de una u otra manera están afectando a los diversos actores insertos en la comunidad educativa. El objetivo de este estudio es analizar la disposición al cambio de los profesores y directivos de establecimientos municipales y particulares subvencionados de la comuna de San Pedro de la Paz, Chile, para afrontar los diferentes procesos de cambio. Corresponde a una investigación descriptiva en que se encuestaron a 128 profesores de 7 establecimientos educacionales diferentes, a los cuales se les administró un cuestionario con escala tipo Likert de los autores Lozada y Fernández (1999) y adaptaciones de los autores Dym (1999) y, García y Dolán (1997). Dentro de los principales resultados se evidencia que los sujetos a estudio se muestran ambivalentes o indecisos frente al cambio y presentan actitudes de poca resistencia a estos, independiente del tipo de establecimiento al cual pertenezcan. Entre las principales conclusiones se destaca la importancia de la credibilidad y preparación que debe poseer el equipo directivo para liderar este tipo de procesos.

Monitoring for cytomegalovirus (CMV)-specific cell-mediated immunity (CMV-CMI) may be useful for individualizing valganciclovir (VGCV) prophylaxis after kidney transplantation (KT). We performed a commercial ELISA-based interferon (IFN)-γ release assay (QTF-CMV) from posttransplant months 2-5 (362 points) in 120 CMV-seropositive KT recipients that received antithymocyte globulin as induction therapy and VGCV prophylaxis (median of 92 days). Forty-seven patients (39.3%) had CMV infection after discontinuation of prophylaxis. The QTF-CMV assay was reactive, nonreactive, and indeterminate in 264 (72.9%), 90 (24.9%), and 8 points (2.2%). The QTF-CMV assay at prophylaxis discontinuation exhibited suboptimal accuracy for predicting protective CMV-CMI (sensitivity: 77.4%; specificity: 34.3%; positive predictive value [PPV]: 64.1%; negative predictive value [NPV]: 50.0%), with no differences in 1-year CMV infection rates between patients with negative (nonreactive or indeterminate) or reactive results (45.8% vs 36.1%; P = .244). Specificity and PPV to predict protective CMV-CMI improved by elevating the IFN-γ cutoff value to 1.13 IU/mL (65.7% and 71.4%) and 7.0 IU/mL (85.7% and 76.2%), although NPVs decreased. The QTF-CMV assay as per manufacturer's interpretative criteria performed poorly to predict protection from CMV infection following discontinuation of VGCV prophylaxis among ATG-treated CMV-seropositive KT recipients. This performance is slightly improved by modifying the IFN-γ positivity threshold.

espanolResumen Introduccion: esta reflexion investigativa surge en el marco de la situacion que vivia Colombia con miras a consolidar el acuerdo de paz, por lo cual, se hacia necesario centrar la mirada en la formacion de maestros, ya que estos son actores sociales, eticos y politicos que con su trabajo pedagogico le aportan a la construccion de una cultura de paz. En este sentido, el objetivo estuvo orientado a develar las practicas discursivas en torno a la educacion para la paz y construccion de ciudadania que circulan y se apropian en la formacion de maestros en ocho facultades de educacion y dos normales superiores en el departamento de Antioquia. Los materiales y metodos: la investigacion es cualitativa con enfoque fenomenologico y documental, las tecnicas utilizadas: entrevista, grupo focal y analisis documental; los instrumentos: guia de entrevista, guia de grupo focal y ficha para el analisis de documentos institucionales. El analisis se hizo con la informacion que arrojaba cada instrumento y posteriormente se triangulo en una matriz de cuatro cuadrantes del sentido propuesta por los investigadores. Los resultados: los sentidos de las practicas discursivas se plantearon desde cuatro perspectivas, que son subjetiva, objetiva, intersubjetiva e inter objetiva. Se Concluye que los sentidos de las practicas discursivas se situan desde lo subjetivo en el propio saber, sentir y vivencia. Lo objetivo en las experiencias, protocolos y estrategias. Lo intersubjetivo en la interrelacion y cultura discursiva y la inter objetiva se refiere a la institucionalizacion y aplicacion explicita de las politicas educativas. EnglishAbstract Introduction: This research reflection arises within the framework of the situation that Colombia was living in order to consolidate the peace agreement, so it was necessary to focus on the training of teachers, since these are social, ethical and political actors who, with their pedagogical work, contribute to the construction of a culture of peace. Objective: Unveil the discursive practices around education for peace and citizenship construction that circulate and are appropriated in the training of teachers in eight Faculties of Education and two Normal Schools in the department of Antioquia. Materials and methods: The research is qualitative with a phenomenological and documentary approach. The techniques used are: interview, focus group and documentary analysis; the instruments: interview guide, focus group guide and card for the analysis of institutional documents. The analysis was made with the information provided by each instrument and subsequently triangulated into a matrix of four meaning quadrants proposed by the researchers. Results: The meanings of the discursive practices were raised from four perspectives, namely subjective, objective, inter-subjective and inter-objective. Conclusions: The meanings of the discursive practices are placed from the subjective in one's own knowledge, feeling and experience; from the objective in experiences, protocols and strategies; from the inter-subjective in the interrelation and discursive culture; and from the inter-objective in the institutionalization and explicit application of educational policies. portuguesResumo Introducao: esta reflexao de pesquisa emerge no marco da situacao que vivia Colombia a fim de consolidar o acordo da paz, e por isso que, se fiz necessario centrar o olhar na formacao de educadores, pois estes sao atores sociais, eticos e politicos que com seu trabalho pedagogico aportam a construcao uma cultura de paz. Neste sentido, o objetivo esteve orientado para revelar as praticas discursivas em torno a educacao para a paz e construcao de cidadania que circulam e se apropriam na formacao de educadores em oito faculdades de educacao e dois normais superiores no departamento de Antioquia. Os materiais e metodos: a pesquisa e qualitativa com a abordagem fenomenologico e documental, as tecnicas utilizadas: entrevista, grupo focal e analise documental; os instrumentos: guia de entrevista, guia de grupo focal e o ficho para a analise de documentos institucionais. A analise se realizou com a informacao que emitia cada instrumento e posteriormente se triangulou em uma matriz de quatro quadrantes do sentido proposto pelos pesquisadores. Os resultados: os sentidos das praticas discursivas se plantearam desde quatro perspectivas, que sao subjetiva, objetiva, intersubjetiva e interobjetiva. Se Conclui que os sentidos das praticas discursivas estao situados desde o subjetivo no proprio saber, sentir e vivencia. O objetivo nas experiencias, protocolos e estrategias. O intersubjetivo na inter-relacao e cultura discursiva e a interobjetiva se refere a institucionalizacao e aplicacao explicita das politicas educativas.

Previous reports hypothesized that cytomegalovirus (CMV) may predispose to non-CMV infection after kidney transplantation (KT). We analysed the incidence of non-CMV infection (overall, bacterial and opportunistic) in 291 KT recipients according to the previous development of any level or high-level (≥1,000 IU/ml) CMV viremia. Exposure to CMV replication was assessed throughout fixed intervals covering first the 30, 90, 180 and 360 post-transplant days (cumulative exposure) and non-overlapping preceding periods (recent exposure). Adjusted Cox models were constructed for each landmark analysis. Overall, 67.7 and 50.5% patients experienced non-CMV and CMV infection, respectively. Patients with cumulative CMV exposure had higher incidence of non-CMV infection beyond days 30 (p-value = 0.002) and 90 (p-value = 0.068), although these associations did not remain after multivariable adjustment. No significant associations were observed for the remaining landmark models (including those based on high-level viremia or recent CMV exposure), or when bacterial and opportunistic infection were separately analysed. There were no differences in viral kinetics (peak CMV viremia and area under curve of CMV viral load) either. Our findings do not support the existence of an independent association between previous CMV exposure and the overall risk of post-transplant infection, although results might be affected by power limitations.

Este escrito da a conocer algunas reflexiones en torno a la responsabilidad de los docentes en la formación ciudadana de los niños y las niñas, también da a conocer estrategias pedagógicas diseñadas para promover la formación ética de los niños y las niñas a partir de la autonomía. A través de ellas se busca desarrollar la capacidad de ponerse en el lugar del otro, ser consecuentes con los actos, generar actitudes que respeten la diversidad, la diferencia y el pluralismo. Finaliza con una aproximación a la relación de la formación ética y el desarrollo del pensamiento.

Background The effect of immunomodulatory therapy with tocilizumab for coronavirus disease 2019 (COVID-19) in real-life clinical practice remains controversial. Methods Single-center retrospective matched cohort analysis including 47 consecutive patients treated with intravenous tocilizumab for severe COVID-19 pneumonia (“TCZ group”), matched by age, comorbidities, time from symptoms onset and baseline SpO2/FiO2 ratio with 47 patients receiving standard of care alone (“SoC group”). Results There were no significant differences between the TCZ and SoC groups in the rate of clinical improvement (hospital discharge and/or a decrease of ≥2 points on a six-point ordinal scale) by day 7 (51.1% [24/47] versus 48.9% [23/47]; P-value = 1.000). No differences were observed at day 14 in terms of clinical improvement (72.3% versus 76.6%; P-value = 0.791), all-cause mortality (10.6% versus 12.8%; P-value = 1.000), and the composite of invasive mechanical ventilation and/or death (25.5% versus 23.4%; P-value = 1.000) either. Patients in the TCZ group had a more rapid normalization of C-reactive protein levels. Conclusions No apparent benefit was observed in patients with severe COVID-19 treated with tocilizumab as compared to a matched retrospective cohort.

Whether immunosuppression impairs severe acute respiratory syndrome coronavirus 2‐specific T‐cell‐mediated immunity (SARS‐CoV‐2‐CMI) after liver transplantation (LT) remains unknown. We included 31 LT recipients in whom SARS‐CoV‐2‐CMI was assessed by intracellular cytokine staining (ICS) and interferon (IFN)‐γ FluoroSpot assay after a median of 103 days from COVID‐19 diagnosis. Serum SARS‐CoV‐2 IgG antibodies were measured by ELISA. A control group of non‐transplant immunocompetent patients were matched (1:1 ratio) by age and time from diagnosis. Post‐transplant SARS‐CoV‐2‐CMI was detected by ICS in 90.3% (28/31) of recipients, with higher proportions for IFN‐γ‐producing CD4+ than CD8+ responses (93.5% versus 83.9%). Positive spike‐specific and nucleoprotein‐specific responses were found by FluoroSpot in 86.7% (26/30) of recipients each, whereas membrane protein‐specific response was present in 83.3% (25/30). An inverse correlation was observed between the number of spike‐specific IFN‐γ‐producing SFUs and time from diagnosis (Spearman's rho: ‐0.418; P‐value = 0.024). Two recipients (6.5%) failed to mount either T‐cell‐mediated or IgG responses. There were no significant differences between LT recipients and non‐transplant patients in the magnitude of responses by FluoroSpot to any of the antigens. Most LT recipients mount detectable —but declining over time— SARS‐CoV‐2‐CMI after a median of 3 months from COVID‐19, with no meaningful differences with immunocompetent patients.

The replication kinetics of nonpathogenic anelloviruses belonging to the Alphatorquevirus genus (such as torque teno virus) might reflect the overall state of posttransplant immunosuppression. We analyzed 221 kidney transplant (KT) recipients in whom plasma alphatorquevirus DNA load was quantified by real-time polymerase chain reaction at baseline and regularly through the first 12 posttransplant months. Study outcomes included posttransplant infection and a composite of opportunistic infection and/or de novo malignancy (immunosuppression-related adverse event [iRAE]). Alphatorquevirus DNA loads at month 1 were higher among patients who subsequently developed posttransplant infection (P = .023) or iRAE (P = .009). Likewise, those with iRAE beyond months 3 and 6 also exhibited higher peak viral loads over the preceding periods. Areas under the curve for log10 alphatorquevirus DNAemia estimated by months 1 or 6 were significantly higher in patients experiencing study outcomes. Alphatorquevirus DNA loads above 3.15 and 4.56 log10 copies/mL at month 1 predicted the occurrence of posttransplant infection (adjusted hazard ratio [aHR]: 2.88; 95% confidence interval [CI]: 1.13-7.36; P = .027) and iRAE (aHR: 5.17; 95% CI: 2.01-13.33; P = .001). In conclusion, posttransplant monitoring of plasma alphatorquevirus DNA kinetics may be useful to identify KT recipients at increased risk of immunosuppression-related complications.

BACKGROUND: The magnitude and kinetics of severe acute respiratory syndrome coronavirus 2-specific cell-mediated immunity (SARS-CoV-2-CMI) in kidney transplant (KT) recipients remain largely unknown. METHODS: We enumerated SARS-CoV-2-specific interferon-I³-producing CD69+ CD4+ and CD8+ T cells at months 4 and 6 from the diagnosis of coronavirus disease 2019 (COVID-19) in 21 KT recipients by intracellular cytokine staining. Overlapping peptides encompassing the SARS-CoV-2 spike (S) glycoprotein N-terminal 1- to 643-amino acid sequence and the membrane protein were used as stimulus. SARS-CoV-2 IgG antibodies targeting the S1 protein were assessed by ELISA at month 6. RESULTS: Detectable (≥0.1%) SARS-CoV-2-specific CD4+ T-cell response was found in 57.1% and 47.4% of patients at months 4 and 6. Corresponding rates for CD8+ T cells were 19.0% and 42.1%, respectively. Absolute SARS-CoV-2-specific T-cell counts increased from month 4 to month 6 in CD8+ (P = 0.086) but not CD4+ subsets (P = 0.349). Four of 10 patients with any detectable response at month 4 had lost SARS-CoV-2-CMI by month 6, whereas 5 of 9 patients mounted SARS-CoV-2-CMI within this period. All but 2 patients (89.5%) tested positive for SARS-CoV-2 IgG. Patients lacking detectable SARS-CoV-2-specific CD4+ response by month 6 were more likely to be under tacrolimus (100.0% versus 66.7%; P = 0.087) and to have received tocilizumab for the previous COVID-19 episode (40.0% versus 0.0%; P = 0.087). CONCLUSIONS: Although still exploratory and limited by small sample size, the present study suggests that a substantial proportion of KT recipients exhibited detectable SARS-CoV-2-CMI after 6 months from COVID-19 diagnosis.

Analytical method by liquid chromatography coupled to mass spectrometry (LC/MS) was developed and validated for the quantification of the polypeptide mixture of glatiramer acetate (GA) as an injectable solution, the method was linear, precise, accurate and capable of separating the polypeptide mixture consisting of four amino acids that make up the glatiramer (L-glutamic acid, L-alanine, L-tyrosine and L-lysine), using a Waters Acquity® UPLC BEH300 C18 1.7 µm column, 2.1 × 100 mm, a mobile phase composed of 0.2% formic acid and acetonitrile at a flow rate of 0.2 mL/min, a mass spectrometry detector (WATERS Acquity QDa®). As a result, the fragmented ions related to each molecule were obtained with the following values: 564 m/z for GA, 148 m/z for glutamic acid, 90 m/z for alanine, 182 m/z for tyrosine and 147 m/z for lysine; with retention times of 4.1 min, 11.2 min, 11.3 min, 12.1 min and 10.9 min respectively. The method shows linear and reproducible responses in a range of 128-192 µg/mL GA, with a correlation coefficient (r) of 0.997, recoveries of 99 ± 1.2% and an accuracy of 0.5%.

El Campus virtual tiene varios objetivos: fortalecer la formación universitaria mediante el diseño de modelos y prácticas educativas mediadas por tecnologías digitales; crear comunidades de aprendizaje y redes de conocimiento; promover el acceso libre a la información y al conocimiento con responsabilidad social; y brindar servicios de asesoría, capacitación, soporte y desarrollo de recursos digitales a profesores e investigadores en las áreas de formación de la facultad. Se articulan cuatro planes maestros vinculados a cuatro procesos de gestión específicos: “Aprendizaje”, “Producción del Conocimiento”, “Uso y Distribución Social del Conocimiento” y “Mejora Continua”. Los diversos programas han consolidado el uso crítico de las TIC en la formación de los estudiantes y de la formación de cuadros docentes capaces de generar, promover y conducir innovaciones en los procesos educativos, los contenidos, los métodos, las prácticas y los medios dirigidos a mejorar la calidad del aprendizaje en todo tipo de ambiente educativo. The virtual campus aims to strengthen university education through the design of educational models and practices mediated by digital technologies; create learning communities and knowledge networks; free access to information and knowledge with social responsibility; provide consulting services, training, support and development of digital resources services to teachers and researchers in the areas of teacher training. Four Master Plans linked to four specific Management Processes: Learning, Knowledge Production, Use and Social Distribution of Knowledge and Continuous Improvement. Some programs have consolidated the critical use of TIC in the training of students and the training of teaching staff capable of generating, promoting and carrying out innovations in the processes, contents, methods, practices and educational means aimed at improving the quality of the learning in all types of educational environment.

El rinofima, a pesar de no ser una entidad común, sí es una patología que altera en forma importante la estética facial del individuo; por tal razón, su entendimiento, adecuado diagnóstico y terapia precisa son de gran relevancia para lograr la mejor recuperación posible. Entre las opciones de manejo existen múltiples herramientas, que van desde la prevención hasta procedimientos quirúrgicos agresivos. A pesar de lo anterior, los pacientes con rosácea, condición patológica inicial, avanzan por los diferentes estadios de la evolución de la enfermedad sin tratamiento médico adecuado, y terminan en el rinofima, condición final del proceso patológico. El objetivo de este artículo fue realizar una revisión de la literatura actual del tema..

Objectives To evaluate the potential role of PCR-based assays in the over-diagnosis of Clostridium difficile infection (CDI) by using a validated diagnostic algorithm in daily clinical practice. Methods We performed a retrospective cohort study evaluating all C. difficile -positive stool samples identified at our institution during a 12-month period, to compare outcomes and recurrence rates between patients with a positive enzyme immunoassay (EIA) for both glutamate dehydrogenase (GDH) and toxin A/B (‘toxin-positive group'), with those with GDH-positive, toxin-negative samples in whom the diagnosis was made by a positive PCR-based assay (‘toxin – /PCR + group'). Medical records were reviewed by two independent investigators blinded to the mode of diagnosis. Results We analysed 231 first CDI episodes (106 (45.8 %) in the ‘toxin-positive group' and 125 (54.1%) in the ‘toxin – /PCR + group'). Both groups had similar baseline characteristics. Patients in the ‘toxin-positive group' presented more frequently with a severe/severe complicated form than those in the ‘toxin – /PCR + group' (36 (33.9%) versus 24 (19.2%); p 0.011) and had more recurrences (27 (25.5%) versus 9 (7.2%); p 0.001). Diagnosis of CDI based on a GDH/toxin-positive EIA independently predicted severe/severe-complicated course (adjusted OR 2.11; 95% CI 1.06–4.22; p 0.033) and recurrence (adjusted OR 3.79; 95% CI 1.65–8.69; p 0.002). There were no differences in all-cause mortality (12.3% versus 12.0%; p 0.95) or CDI-attributable mortality (4.7% versus 4.8%; p 0.93). Conclusions Toxin-positive patients were more likely to have severe-complicated forms of CDI and recurrences. Nevertheless, CDI-related complications may still occasionally occur among toxin-negative patients diagnosed by PCR, which stresses the need for individualized clinical evaluation.

[ES]INTRODUCCIÓN La infección del tracto urinario (ITU) es la infección bacteriana más frecuente en los pacientes trasplantados renales. Se cree que la ITU inferior y la bacteriuria asintomática no afectan a la función renal a largo plazo, sin embargo, se desconoce si la pielonefritis aguda (PNA) causa pérdida del injerto o bien es un marcador de enfermedad subyacente grave. MATERIAL Y MÉTODOS La hipótesis del estudio fue que existen factores que influyen en la incidencia y pronóstico de las infecciones del tracto urinario en trasplantados renales. Se realizó un estudio multicéntrico, retrospectivo y observacional de 1845 pacientes trasplantados renales. Los pacientes fueron divididos en Grupo A (n=1395), los trasplantados renales con ITU post-trasplante en el primer año de seguimiento; y Grupo B (n=450), aquellos trasplantados renales sin ITU post-trasplante. El grupo A fue subdividido en: A1 (n=324) quienes recibieron antibiótico (ATB) a demanda, A2 (n=45): ATB a demanda y 2g de D-manosa, 140 mg de proantocianidinas y 7,98 mg de ácido ursólico; A3 (n=18): ATB a demanda y 160 mg de trimetoprim/800 mg de sulfametoxazol nocturno; A4 (n=63): 160 mg de trimetoprim/800 mg de sulfametoxazol nocturno; A5 (n=81): vacuna polibacteriana sublingual “elaborada” y A6 (n=864): tratamiento o profilaxis diferentes a los otros subgrupos. El grupo B fue subdividido en B1 (n=224): ATB a demanda ante sospecha de ITU no confirmada; B2 (n=18): 160 mg de trimetoprim/800 mg de sulfametoxazol nocturno y B3 (n=207): ni tratamiento ni profilaxis. Los resultados se analizaron mediante test t de Student, Chi2, test exacto de Fisher, ANOVA (Scheffe's para muestras normales y Kruskal Wallys para otras distribuciones), estudios de correlación de Pearson y Spearman. RESULTADOS El 75,6% de los trasplantados renales presentó algún urocultivo (UC) positivo después del trasplante durante el primer año de seguimiento. Un 28,78% de los trasplantados renales presentaron más de 2 UC positivos al año en el primer año postrasplante. No se encontraron diferencias (p=0.33) entre la edad media del GA (56.58 años, SD 14,62) y la del GB (55.84 años, SD 13.01). No hubo diferencia en la distribución del sexo entre los trasplantados con ITU (34,8% mujeres y 65,2% varones) y sin ITU (34,2% mujeres y 65,8% varones). Más mujeres recibieron profilaxis ATB sola (71,4%) y vacuna (66%). Más varones (55,6%) recibieron ATB a demanda, ATB más profilaxis ATB y ATB a demanda más manosa (60%). La ITU pretrasplante fue más frecuente en GA (14,3%) frente a los pacientes sin ITU (2,2%). En el subgrupo vacuna (A5) fue más frecuente la ITU pretrasplante (33,3%) que en el resto, salvo A4 (no significativo). El número de UC positivos en el año en la muestra fue de media 3.09 (SD 3.05, rango 0-13), fue inferior en A6 y superior en A5 (7.3). No se aisló E.coli BLEE ni P. aeruginosa en el grupo de ATB a demanda más manosa, ATB más profilaxis ATB ni el de vacuna. En exfumadores es más probable que no haya ITU postrasplante (30%) a que las haya (19,1%). No hubo diferencias en cuanto a hipertensión arterial y diabetes mellitus entre los pacientes con y sin ITU. No se detectaron diferencias en la evolución del injerto entre pacientes con o sin ITU, tampoco entre los diferentes subgrupos. La tasa de pérdida del injerto con ITU fue del 2,65% y sin ITU 2,66%. CONCLUSIONES Es clave diferenciar los conceptos de ITU, entendida como bacteriuria significativa más clínica, frente al concepto de bacteriuria significativa asintomática (UC positivo). No hay diferencias en el pronóstico de la función del injerto entre los pacientes con ITU o sin ella después del trasplante.

The objective of the present study was to evaluate the value of the PCR cycle threshold (CT) for predicting the recurrence/severity of infection compared to that of toxin detection plus clinical variables. First episodes of Clostridium difficile infection (CDI) diagnosed during 2015 at our institution were included. Samples were tested for glutamate dehydrogenase (GDH) and toxin A/B by use of a single enzyme immunoassay (EIA). The Xpert C. difficile PCR assay was performed on GDH-positive samples. Medical data were reviewed by investigators blinded to diagnostic results for comparison of patients with and without recurrence or a poor outcome (severe/severe-complicated CDI episodes and all-cause death). We generated two sets of predictive models by incorporating the presence of a positive toxin EIA (“EIA-including model”) or the optimal PCR CT cutoff value (“PCR-including model”) into the clinical variables. Among 227 episodes of CDI included in the study, the rates of recurrence and poor outcome were 15.8% and 30.8%, respectively. The mean PCR CT was lower for episodes with recurrence (24.00 ± 3.28 versus 26.02 ± 4.54; P = 0.002) or a poor outcome (24.9 ± 4.24 versus 26.05 ± 4.47; P = 0.07). The optimal cutoff value for recurrence was 25.65 (sensitivity, 77.8% [95% confidence interval {CI}, 60.9 to 89.9]; and specificity, 46.6% [95% CI, 39.4 to 53.9]). The area under the receiver operator characteristics curve (auROC) for the “PCR-including model” was similar to that for the “EIA-including model” (0.785 versus 0.775, respectively). The optimal PCR CT value for poor outcome was 27.55 (sensitivity, 78.6% [95% CI, 67.1 to 87.5]; and specificity, 35.7% [95% CI, 28.2 to 43.7]). The auROC of the “PCR-including model” was again similar to that of the “EIA-including model” (0.804 versus 0.801). Despite the inverse correlation between PCR CT and the risk of CDI recurrence/severity, this determination does not meaningfully increase the predictive value of clinical variables plus toxin EIA.

Despite its impact on quality of life and potential for complications, specific risk and protective factors for herpes zoster (HZ) after kidney transplantation (KT) remain to be clarified. We included 444 patients undergoing KT between November 2008 and March 2013. Peripheral blood lymphocyte subpopulations were measured at baseline and months 1 and 6. The risk factors for early (first post-transplant year) and late HZ (years 1-5) were separately assessed. We observed 35 episodes of post-transplant HZ after a median follow-up of 48.3 months (incidence rate: 0.057 per 1000 transplant-days). Median interval from transplantation was 18.3 months. Six patients (17.1%) developed disseminated infection. Postherpetic neuralgia occurred in 10 cases (28.6%). The receipt of anti-cytomegalovirus (CMV) prophylaxis with (val)ganciclovir decreased the risk of early HZ [adjusted hazard ratio (aHR): 0.08; 95% CI: 0.01-1.13; P-value = 0.062], whereas the natural killer (NK) cell at month 6 was protective for the occurrence of late HZ [aHR (per 10-cells/μl increase): 0.94; 95% CI: 0.88-1.00; P-value = 0.054]. In conclusion, two easily ascertainable factors (whether the patient is receiving anti-CMV prophylaxis and the NK cell count at month 6) might be potentially useful to tailor preventive strategies according to individual susceptibility to post-transplant HZ.

Objective Previous studies on monitoring of post-transplant cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) are limited by single-centre designs and disparate risk categories. We aimed to assess the clinical value of a regular monitoring strategy in a large multicentre cohort of intermediate-risk kidney transplant (KT) recipients. Methods We recruited 124 CMV-seropositive KT recipients with no T-cell-depleting induction pre-emptively managed at four Spanish institutions. CMV-specific interferon-γ-producing CD4+ and CD8+ T cells were counted through the first post-transplant year by intracellular cytokine staining after stimulation with pp65 and immediate early-1 peptides (mean of six measurements per patient). The primary outcome was the occurrence of any CMV event (asymptomatic infection and/or disease). Optimal cut-off values for CMV-specific T cells were calculated at baseline and day 15. Results Twelve-month cumulative incidence of CMV infection and/or disease was 47.6%. Patients with pre-transplant CMV-specific CD8+ T-cell count Conclusions Monitoring for CMV-specific CMI in intermediate-risk KT recipients must be regular to reflect dynamic changes in overall immunosuppression and individual susceptibility. The early assessment at post-transplant day 15 remains particularly informative.

International audience; User-centered and participatory innovation practices like Living-Labs are nowadays increasingly been used to integrate, design and improve users' experience (UX) in different fields. These methods that had emerged from web and mobile design fields can contribute to the UX in several other fields. Museum visitors experience is a field that can benefit from them. The purpose of this paper is to contribute to the understanding of the museum visitors' experience through the use of tools from UX and usability studies. Among those techniques, field trials studies can help to better understand users' preferences as experience is tested in a real life setting. Exposition curators and managers can then use these understandings to improve visitors' experience. We present a study held at the Museum Aquarium of Nancy-MAN (France). In this study, were evaluated visitors' preferences among four different information supports in an exhibition module using a protocol that combines eyes tracking and an after use survey. Results show that interactive supports, as tablets and screens, even if not preferred by the majority of participants, once engaged with these supports, they interact longer time. Found evidence let us conclude that supports that are different and uncommon are preferred by most of the participants but, they don't keep them engaged for a long time.

This work is the result of a technical research patent on dendritogenesis and neuronal maturation, in which the existence was determined of patent documents involving the use of melatonin for the treatment of anxiety, obesity and related diseases of the peripheral and CNS. In this study, an analysis of the state of the art in order to collect technical and scientific elements for the drafting of a new patent on the use of the melatonin molecule in stimulating neuronal maturation in dendritogenesis and mammals was conducted in adults. This study is based on an invention related with this novel use of melatonin.

Background In vitro studies support that integrase inhibitors, such as raltegravir, may inhibit human T cell lymphotropic virus type 1 (HTLV-1) replication. However, this hypothesis has not been tested in vivo. Methods HTLV-1-infected individuals were invited to participate in a pilot, open study that examined whether 400 mg of raltegravir twice daily could exhibit any recognizable virological effect over 12 months. Proviral DNA was measured by a real-time PCR targeting the pol region. HTLV-1 integrase sequences were obtained from peripheral blood mononuclear cells (PBMCs) at baseline and during follow-up. Results A total of five HTLV-1-infected individuals entered the study. All were infected with HTLV-1 subtype a. Two patients had HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), the rest being asymptomatic. The HTLV-1 proviral load was high in all cases (median 758 HTLV-1 DNA copies/10(4) PBMCs). Following the initiation of raltegravir therapy and for up to 6 months, both of the HAM/TSP patients experienced a transient decline in the HTLV-1 proviral load (2248 to 519 and 1033 to 861 copies/10(4) PBMCs, respectively), returning to baseline levels on subsequent determinations. No significant changes in the HTLV-1 proviral load were noticed in the three asymptomatic individuals (median proviral load of 755 copies/10(4) PBMCs over time). A total of 20 integrase sequences could be obtained from the five patients, and no genotypic substitutions were recognized comparing baseline and follow-up specimens under raltegravir. Conclusions Treatment with raltegravir in HTLV-1-infected individuals does not result in a significant reduction of proviral load beyond 6 months of therapy. The lack of continuous viral replication cycles in chronic HTLV-1 carriers most likely explains our findings.

Objetivos: Determinar si pacientes con perforación timpánica causada por trauma por onda explosiva tienen un resultado quirúrgico peor que el encontrado en pacientes con perforación timpánica causada por otitis media crónica. Métodos: Estudio observacional analítico tipo cohorte prospectiva. Se comparó los resultados en timpanoplastia tipo I entre pacientes expuestos a trauma por onda explosiva (cohorte expuesta) y pacientes con perforación causada por otitis media crónica (cohorte no expuesta). Se incluyeron pacientes mayores de 18 años en quienes se utilizó técnica "over-under" de colocación de injerto de cartílago. Se excluyeron pacientes en quienes se utilizó otras técnicas quirúrgicas, a quienes se les practicó mastoidectomia u osciculoplastia, aquellos con perforaciones secundarias a otra etiología y quienes tenían colesteatoma. El tamaño de la muestra se calculó para la variable resultado anatómico y fue de 43 pacientes por cohorte. El estudio se terminó una vez se consiguió el tamaño de muestra propuesto. El análisis principal fue la comparación del resultado anatómico (estado del neo tímpano) y funcional (brecha aíre-hueso

Percutaneous surgical techniques are suitable for the correction of the hallux valgus deformity. Satisfactory aesthetic and functional results obtained with the Reverdin- Isham osteotomy have been reported. The aim of this study was to describe dynamic plantar pressure redistribution after the correction of the deformity using this technique. A sample of 20 feet with mild or moderate hallux valgus was conformed and surgically treated using the Reverdin-Isham osteotomy. Clinical, radiological, surface and pressure assessments were performed pre and postoperatively. Postoperative mean (± SD) values of the American Orthopaedic Foot and Ankle Society (AOFAS) score, metatarsophalangeal, first intermetatarsal and proximal articular sect angles were 95.7 (3.3), 15.5° (5.4), 9.5° (1.5) y 5.3° (3.0), respectively. A significant decrease was observed in surface values of both lateral (P = 0.003) and medial (P = 0.001) masks of the forefoot. Mean pressure values of the lateral forefoot region denoted a significant increase (P0.001) while the medial forefoot region showed no change (P = 0.137). There is evidence that this particular surgical technique promotes a new plantar pressure pattern in the foot that might significantly favour the increase of the pressure observed under the lesser metatarsal heads and might not induce meaningful changes in the mean pressure registered under the first metatarsal head and hallux.

Instituto de Investigaciones Agropecuarias y Forestales. Facultad de Biología. Facultad de Medicina Veterinaria y Zootecnia. Facultad de Agrobiología. Facultad de Químico Farmacobiología. Programa Institucional de Maestría en Ciencias Biológicas The Biosphere Reserve of Los Tuxtlas four species of Tinamidae (Tinamus greater, Crypturellus soui, C. cinnamomeus, C. boucardi) and three of Tinamidae Cracidae (Crax rubra, Penelope purpurascens, Ortalis vetula) are found; of which six are in a risk category according to NOM-059-2001. The main problems that affect them are habitat fragmentation and hunting: besides, little is known of their populations. In this situation the objectives of this study were to verify the presence of the species and assess their distribution and abundance. En la Reserva de la Biósfera de Los Tuxtlas se encuentran cuatro especies de Tinamidae (Tinamus mayor, Crypturellus soui, C. cinnamomeus, C. boucardi) de Tinamidae y tres de Cracidae (Crax rubra, Penelope purpurascens, Ortalis vetula); de ellas seis se encuentran en alguna categoría de riesgo según la NOM-059-2001. Los principales problemas que las afectan son la fragmentación del hábitat y la cacería: además, se sabe poco de sus poblaciones. Ante esta situación los objetivos de este trabajo fueron verificar la presencia de las especies y evaluar su distribución y abundancia.