Academic literature on the topic 'Beneficiary Choice Program (U.S.)'

Objective: This study investigates the impact of the Community-Based Drinking Water and Sanitation Provision Program (Pamsimas Program), implemented in Bali from 2017 to 2021, on improving access to clean drinking water and sanitation in rural communities. Theoretical framework: It draws on the S-shape and Inverted L-shape curves to emphasize planned interventions and incentives, while the Theory of Change guides program evaluation by explaining how interventions lead to outcomes. Employing a five-stage results chain, the program focuses on inputs, activities, outputs, outcomes, and long-term impacts. Method: Through a comprehensive analysis of the program's effectiveness, we employ a natural experiment approach using Propensity Score Matching (PSM) and Multinomial Ordered Logit/Probit regression. The study compares villages receiving Pamsimas interventions in 2019, 2020, and 2021 with non-intervention villages, employing data from the 2014, 2018, and 2021 Village Potential Census (Podes). Results and conclusion: The findings reveal that Pamsimas significantly influences the choice of water sources and sanitation practices in beneficiary villages. The estimated marginal effects demonstrate a substantial improvement in water quality and sanitation in program-receiving villages compared to control villages. The paper concludes that the Pamsimas Program, by targeting easily achievable improvements, aligns with the pragmatic trend in development economics and provides valuable insights for future water and sanitation interventions. Originality/value: The analysis, guided by the paradigm shift in development economics towards pragmatic and low-hanging fruit solutions, positions Pamsimas as an effective strategy despite not being as cost-effective as certain health programs.

B a c k g r o u n d . The political awareness of military personnel is the basis for the formation of ideological beliefs and motivation for the armed defense of Ukraine. Since 2014, Ukraine has been repelling the armed aggression of the Russian Federation (RF), and starting February 24, 2022, the country is in the phase of a large-scale military invasion. General mobilization increased the Ukrainian army with non-professional military personnel. Political awareness formed on pro-Ukrainian positions is able to neutralize the informational and psychological influences of the enemy. Until 2021, pro-Russian media were present in the information space of Ukraine, which actively formed a distorted political picture of the world. Military media are part of Ukraine's information space; they can be one of the elements forming the political awareness of military personnel. The purpose of the study is to determine a list of materials that can be used to increase the political awareness of military personnel. The task is to monitor the media resources of the Ministry of Defence of Ukraine (MoD) to identify materials that will expand the political awareness of military personnel. The object of the research is the websites of the Ministry of Defence and the Information Agency MoD "ArmiaInform". M e t h o d s . The methods of monitoring, thematic analysis, and content analysis of materials posted on the websites of the Ministry of Defence and the Information Agency ArmiaInform from February 24, 2022, to October 31, 2022, were used. 1237 materials were analysed. The materials were grouped by topic into categories to policy areas and, were applied a ranking method, where the quantity of publications was used as an indicator of rank. R e s u l t s . In the news of the Ministry of Defence, the topic of war is presented in the 1st place, foreign policy is in the 2nd place, domestic policy is in the 3rd place. In the Information Agency "ArmiaInform", the topic of foreign policy is in the 1st place, the war is in the 2nd place, the domestic policy is in the 3rd place, and analytical materials on historical topics are in the 4th place. Out of 1,237 monitoring materials, 32 can become additions to the thematic matrix of the formation of political awareness in military personnel. C o n c l u s i o n s . The key components of political awareness that influence the subject's political behaviour are political literacy, political competence, rationality, and objectivity of political choice. The media of the Ministry of Defence of Ukraine can become part of a political awareness program by publishing materials that increase political literacy and political competence. News posted on the media resources of the Ministry of Defence can be used for political information.

Eating habits develop during the first years of a child's life, children learn what, when, and how much to eat through direct experience with food and by observing the eating habits of others. The aim of this study is to get a clear picture of the Eating program Healthy, starting from the planning, implementation, supervision, and evaluation as a case study of nutrition education; to get information about the advantages, disadvantages and effects of implementing a healthy eating program for children. This research was conducted through a case study with qualitative data analysed using Miles and Huberman techniques. Sample of children in Ananda Islāmic School Kindergarten. The results showed the Healthy Eating program could be implemented well, the diet was quite varied and could be considered a healthy and nutritious food. The visible impact is the emotion of pleasure experienced by children, children become fond of eating vegetables, and make children disciplined and responsible. Inadequate results were found due to the limitations of an adequate kitchen for cooking healthy food, such as cooking activities still carried out by the cook himself at the Foundation's house which is located not far from the school place; use of melamine and plastic cutlery for food; the spoon and fork used already uses aluminium material but still does not match its size; does not involve nutritionists. Keywords: Early Childhood, Eating Healthy Program References: Bandura, A. (1977). Social learning theory. Englewood Cliffs: Prentice-Hall. Bandura, Albert. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31(2), 143–164. https://doi.org/10.1177/1090198104263660 Battjes-Fries, M. C. E., Haveman-Nies, A., Renes, R. J., Meester, H. J., & Van’T Veer, P. (2015). Effect of the Dutch school-based education programme “Taste Lessons” on behavioural determinants of taste acceptance and healthy eating: A quasi-experimental study. Public Health Nutrition, 18(12), 2231–2241. https://doi.org/10.1017/S1368980014003012 Birch, L., Savage, J. S., & Ventura, A. (2007). Influences on the Development of Children’s Eating Behaviours: From Infancy to Adolescence. Canadian Journal of Dietetic Practice and Research : A Publication of Dietitians of Canada = Revue Canadienne de La Pratique et de La Recherche En Dietetique : Une Publication Des Dietetistes Du Canada, 68(1), s1– s56. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19430591%0Ahttp://www.pubmedcentral.nih.gov/a rticlerender.fcgi?artid=PMC2678872 Coulthard, H., Williamson, I., Palfreyman, Z., & Lyttle, S. (2018). Evaluation of a pilot sensory play intervention to increase fruit acceptance in preschool children. Appetite, 120, 609–615. https://doi.org/10.1016/j.appet.2017.10.011 Coulthard, Helen, & Sealy, A. (2017). Play with your food! Sensory play is associated with tasting of fruits and vegetables in preschool children. Appetite, 113, 84–90. https://doi.org/10.1016/j.appet.2017.02.003 Crain, W. C. (2005). Theories of development: Concepts and applications. Upper Saddle River: Pearson Prentice Hall. Dazeley, P., Houston-Price, C., & Hill, C. (2012). Should healthy eating programmes incorporate interaction with foods in different sensory modalities? A review of the evidence. British Journal of Nutrition, 108(5), 769–777. https://doi.org/10.1017/S0007114511007343 Derscheid, L. E., Umoren, J., Kim, S. Y., Henry, B. W., & Zittel, L. L. (2010). Early childhood teachers’ and staff members’ perceptions of nutrition and physical activity practices for preschoolers. Journal of Research in Childhood Education, 24(3), 248–265. https://doi.org/10.1080/02568543.2010.487405 Eliassen, E. K. (2011). The impact of teachers and families on young children’s eating behaviors. YC Young Children, 66(2), 84–89. Elliott, E., Isaacs, M., & Chugani, C. (2010). Promoting Self-Efficacy in Early Career Teachers: A Principal’s Guide for Differentiated Mentoring and Supervision. Florida Journal of Educational Administration & Policy, 4(1), 131–146. Emm, S., Harris, J., Halterman, J., Chvilicek, S., & Bishop, C. (2019). Increasing Fruit and Vegetable Intake with Reservation and Off-reservation Kindergarten Students in Nevada. Journal of Agriculture, Food Systems, and Community Development, 9, 1–10. https://doi.org/10.5304/jafscd.2019.09b.014 Flynn, M. A. T. (2015). Empowering people to be healthier: Public health nutrition through the Ottawa Charter. Proceedings of the Nutrition Society, 74(3), 303–312. https://doi.org/10.1017/S002966511400161X Franciscato, S. J., Janson, G., Machado, R., Lauris, J. R. P., de Andrade, S. M. J., & Fisberg, M. (2019). Impact of the nutrition education Program Nutriamigos® on levels of awareness on healthy eating habits in school-aged children. Journal of Human Growth and Development, 29(3), 390–402. https://doi.org/10.7322/jhgd.v29.9538 Froehlich Chow, A., & Humbert, M. L. (2014). Perceptions of early childhood educators: Factors influencing the promotion of physical activity opportunities in Canadian rural care centers. Child Indicators Research, 7(1), 57–73. https://doi.org/10.1007/s12187-013-9202-x Graham, H., Feenstra, G., Evans, A. M., & Zidenberg-Cherr, S. (2002). Healthy Eating Habits in Children. California Agriculture, 58(4), 200–205. Gucciardi, E., Nagel, R., Szwiega, S., Chow, B. Y. Y., Barker, C., Nezon, J., ... Butler, A. (2019). Evaluation of a Sensory-Based Food Education Program on Fruit and V egetable Consumption among Kindergarten Children. Journal of Child Nutrition & Management, 43(1). Holley, C. E., Farrow, C., & Haycraft, E. (2017). A Systematic Review of Methods for Increasing Vegetable Consumption in Early Childhood. Current Nutrition Reports, 6(2), 157–170. https://doi.org/10.1007/s13668-017-0202-1 Hoppu, U., Prinz, M., Ojansivu, P., Laaksonen, O., & Sandell, M. A. (2015). Impact of sensory- based food education in kindergarten on willingness to eat vegetables and berries. Food and Nutrition Research, 59, 1–8. https://doi.org/10.3402/fnr.v59.28795 Jarpe-Ratner, E., Folkens, S., Sharma, S., Daro, D., & Edens, N. K. (2016). An Experiential Cooking and Nutrition Education Program Increases Cooking Self-Efficacy and Vegetable Consumption in Children in Grades 3–8. Journal of Nutrition Education and Behavior, 48(10), 697-705.e1. https://doi.org/10.1016/j.jneb.2016.07.021 Jones, A. M., & Zidenberg-Cherr, S. (2015). Exploring Nutrition Education Resources and Barriers, and Nutrition Knowledge in Teachers in California. Journal of Nutrition Education and Behavior, 47(2), 162–169. https://doi.org/10.1016/j.jneb.2014.06.011 Jung, T., Huang, J., Eagan, L., & Oldenburg, D. (2019). Influence of school-based nutrition education program on healthy eating literacy and healthy food choice among primary school children. International Journal of Health Promotion and Education, 57(2), 67–81. https://doi.org/10.1080/14635240.2018.1552177 Lwin, M. O., Malik, S., Ridwan, H., & Sum Au, C. S. (2017). Media exposure and parental mediation on fast-food consumption among children in metropolitan and suburban Indonesian. Asia Pacific Journal of Clinical Nutrition, 26(5), 899–905. https://doi.org/10.6133/apjcn.122016.04 Mc Kenna, & L, M. (2010). Policy Options to Support Healthy Eating in Schools. Canadian Journal of Public Health, 101(2), S14–S18. https://doi.org/10.1007/BF03405619 Menkes, R. PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 41 TAHUN 2014. , Menteri Kesehatan Republik Indonesia § (2014). Mitsopoulou, A. V., Magriplis, E., Dimakopoulos, I., Karageorgou, D., Bakogianni, I., Micha, R., ... Zampelas, A. (2019). Association of meal and snack patterns with micronutrient intakes among Greek children and adolescents: data from the Hellenic National Nutrition and Health Survey. Journal of Human Nutrition and Dietetics, 32(4), 455–467. https://doi.org/10.1111/jhn.12639 Moffitt, A. (2019). Early Childhood Educators and the Development of Family Literacy Programs: A Qualitative Case Study. ProQuest Dissertations and Theses, 96. Retrieved from http://proxy.mul.missouri.edu/login?url=https://search.proquest.com/docview/2242479347 ?accountid=14576%0Ahttps://library.missouri.edu/findit?genre=dissertations+%26+theses &title=Early+Childhood+Educators+and+the+Development+of+Family+Literacy+Progra ms%3A+ Mustonen, S., & Tuorila, H. (2010). Sensory education decreases food neophobia score and encourages trying unfamiliar foods in 8-12-year-old children. Food Quality and Preference, 21(4), 353–360. https://doi.org/10.1016/j.foodqual.2009.09.001 Myszkowska-Ryciak, J., & Harton, A. (2019). Eating healthy, growing healthy: Outcome evaluation of the nutrition education program optimizing the nutritional value of preschool menus, Poland. Nutrients, 11(10), 1–17. https://doi.org/10.3390/nu11102438 Nekitsing, C., Hetherington, M. M., & Blundell-Birtill, P. (2018). Developing Healthy Food Preferences in Preschool Children Through Taste Exposure, Sensory Learning, and Nutrition Education. Current Obesity Reports, 7(1), 60–67. https://doi.org/10.1007/s13679- 018-0297-8 Noura, M. S. pd. (2018). Child nutrition programs in kindergarten schools implemented by the governmental sector and global nutrition consulting companies: A systematic review. Current Research in Nutrition and Food Science, 6(3), 656–663. https://doi.org/10.12944/CRNFSJ.6.3.07 Oh, S. M., Yu, Y. L., Choi, H. I., & Kim, K. W. (2012). Implementation and Evaluation of Nutrition Education Programs Focusing on Increasing Vegetables, Fruits and Dairy Foods Consumption for Preschool Children. Korean Journal of Community Nutrition, 17(5), 517. https://doi.org/10.5720/kjcn.2012.17.5.517 Osera, T., Tsutie, S., & Kobayashi, M. (2016). Using Soybean Products in School Lunch for Health Education may improve Children’s Attitude and Guardians’ Knowledge in Kindergarten. Journal of Child and Adolescent Behaviour, 04(05). https://doi.org/10.4172/2375-4494.1000310 Park, B. K., & Cho, M. S. (2016). Taste education reduces food neophobia and increases willingness to try novel foods in school children. Nutrition Research and Practice, 10(2), 221–228. https://doi.org/10.4162/nrp.2016.10.2.221 Pendidikan, K., & Kebudayaan, D. A. N. Menteri Pendidikan Dan Kebudayaan Republik Indonesia Nomor 137 Tahun 2013 Tentang Standar Nasional Pendidikan Anak Usia Dini. , (2015). Prima, E., Yuliantina, I., Nurfadillah, Handayani, I., Riana, & Ganesa, R. eni. (2017). Layanan Kesehatan,Gizi dan Perawatan. Jakarta: Direktorat Pembinaan Pendidikan Anak Usia Dini Direktorat Jenderal Pendidikan Anak Usia Dini dan Pendidikan Masyarakat Kementerian Pendidikan dan Kebudayaan. Resor, J., Hegde, A. V., & Stage, V. C. (2020). Pre-service early childhood educators’ perceived barriers and supports to nutrition education. Journal of Early Childhood Teacher Education, 00(00), 1–17. https://doi.org/10.1080/10901027.2020.1740841 Rizqie Aulianaca5804p200-169314. (2011). Gizi Seimbang Dan Makanan Sehat Untuk Anak Usia Dini. Journal of Nutrition and Food Research, 2(1), 1–12. Retrieved from http://staff.uny.ac.id/sites/default/files/pengabdian/rizqie-auliana-dra-mkes/gizi-seimbang- dan-makanan-sehat-untuk-anak-usia-dini.pdf Sandell, M., Mikkelsen, B. E., Lyytikäinen, A., Ojansivu, P., Hoppu, U., Hillgrén, A., & Lagström, H. (2016). Future for food education of children. Futures, 83, 15–23. https://doi.org/10.1016/j.futures.2016.04.006 Schanzenbach, D. W., & Thorn, B. (2019). Food Support Programs and Their Impacts on Young Children. Health Affairs, (march). Retrieved from https://www.healthaffairs.org/briefs Schmitt, S. A., Bryant, L. M., Korucu, I., Kirkham, L., Katare, B., & Benjamin, T. (2019). The effects of a nutrition education curriculum on improving young children’s fruit and vegetable preferences and nutrition and health knowledge. Public Health Nutrition, 22(1), 28–34. https://doi.org/10.1017/S1368980018002586 Sekiyama, M., Roosita, K., & Ohtsuka, R. (2012). Snack foods consumption contributes to poor nutrition of rural children in West Java, Indonesia. Asia Pacific Journal of Clinical Nutrition, 21(4), 558–567. https://doi.org/10.6133/apjcn.2012.21.4.11 Sepp, H., & Ho, K. (2016). Food as a tool for learning in everyday activities at preschool exploratory study from Sweden. Food & Nurtition Research, 1, 1–7. Shor, R., & Friedman, A. (2009). Integration of nutrition-related components by early childhood education professionals into their individual work with children at risk. Early Child Development and Care, 179(4), 477–486. https://doi.org/10.1080/03004430701269218 Taylor, C. M., & Emmett, P. M. (2019). Picky eating in children: Causes and consequences. Proceedings of the Nutrition Society, 78(2), 161–169. https://doi.org/10.1017/S0029665118002586 Taylor, C. M., Steer, C. D., Hays, N. P., & Emmett, P. M. (2019). Growth and body composition in children who are picky eaters: a longitudinal view. European Journal of Clinical Nutrition, 73(6), 869–878. https://doi.org/10.1038/s41430-018-0250-7 Unusan, N. (2007). Effects of a food and nutrition course on the self-reported knowledge and behavior of preschool teacher candidates. Early Childhood Education Journal, 34(5), 323– 327. https://doi.org/10.1007/s10643-006-0116-9 Usfar, A. A., Iswarawanti, D. N., Davelyna, D., & Dillon, D. (2010). Food and Personal Hygiene Perceptions and Practices among Caregivers Whose Children Have Diarrhea: A Qualitative Study of Urban Mothers in Tangerang, Indonesia. Journal of Nutrition Education and Behavior, 42(1), 33–40. https://doi.org/10.1016/j.jneb.2009.03.003 Witt, K. E., & Dunn, C. (2012). Increasing Fruit and V egetable Consumption among Preschoolers: Evaluation of Color Me Healthy. Journal of Nutrition Education and Behavior, 44(2), 107–113. https://doi.org/10.1016/j.jneb.2011.01.002

In this work, we are obviously interested in a general solution for the calculation of the image of a single bar in partially coherent illumination. The solution is based on the theory of Hopkins for the formation of images in optical instruments in which it was shown that for all practical cases, the illumination of the object may be considered as due to a self – luminous source placed at the exit pupil of the condenser , and the diffraction integral describing the intensity distribution in the image of a single bar – as an object with half – width (U0 = 8 ) and circular aperture geometry is viewed , which by suitable choice of the coherence parameters (S=0.25,1.0.4.0) can be fitted to the observed distribution in various types of microscope , the aberration were restricted to defocusing and coma upto third – order , the method of integration was Gauss quadrature: The necessary set of integration depends , of course , on the amount of present aberrations and had to be chosen (20) points of Gauss which decrease the computation time to few seconds: The aberration free systems corresponding to the paraxial receiving plane (W20= 0.0) is especially interesting as it predicts diffraction pattern shape. The influence of defocusing is very pronounced and relatively distorts the object , the influence of the off – axis aberration (third – order coma ), in which it was shown that for the high peaks in the images are most noticeable in the region of almost perfect coherence (S=0.25). As (S) is increased from (0.25) to (1.0) there is a pronounced redistribution of intensity, with peaks moving from one side of the image to the other. Calculations were also performed for systems having spherical aberration, but the results are qualitatively similar to an aberration – free defocused system and are omitted, so we will not present any numerical results. A computer program was written in FORTRAN 77 which solved the modified intensity distribution of Hopkins for(U´) dimensionless distance. The advantage of that additional work on this class of problems to investigate the development of more efficient numerical methods, also the reduction in computation time to few seconds for data runs for individual curves of intensity.

It was a great honor and personal privilege for us to organize the 9th Eurasia Conference on Chemical Sciences (EuAs C2S-9) in Antalya, Turkey, 9-13 September 2006. The choice of Turkey as a venue was especially appropriate in view of its special location and character as a bridge between Europe and Asia. Turkey's rich history and diversified cultural heritage provided an extra dimension to the atmosphere of the conference. The aim of the Eurasia Conferences is to support the scientific research of chemists in the Eurasia continent by inviting the participation of leading scientists from around the world. The Eurasia region has increased its profile in chemistry, particularly in chemical biology, over the last 20 years.The growing role of chemistry and the contributions of the chemical and pharmaceutical industries to science are significant. The next century will witness more momentous achievements in chemistry as well as its application in different fields for the benefit of mankind in terms of healthy, productive, long, and comfortable life.We particularly thank the participants who contributed scientific studies as oral and poster presentations at this conference. With the participation of the world's leading scientists from 39 countries, the conference was a good opportunity for all researchers to access recent information on achievements in the chemical sciences as well as to share and exchange their experiences during the conference.The scientific program consisted of 10 plenary lectures, 35 invited lectures, 12 session lectures, 24 oral presentations, and 128 poster presentations. The topics covered included biodiversity and natural product chemistry, biomolecular chemistry, catalysis and nanotechnology, computational chemistry, coordination chemistry (organized as a mini-symposium through the efforts of Prof. Dr. Susumu Kitagawa), environmental and analytical chemistry, and materials science and solution chemistry.The IUPAC-sponsored conference was attended by 268 participants from 39 countries. The participation of a large group of active young Turkish chemists was made possible by the financial support of the TUBITAK. In addition, a half-day excursion was organized for participants to Aspendos, Perge, and Side.The lecturers included: Prof. Dr. Robert Huber, Nobel laureate, from Germany and keynote speaker; HRH Princess Prof. Dr. Chulabhorn Mahidol from Thailand; Prof. Dr. U. K. Pandit; Prof. Dr. B. M. Rode; Prof. Dr. T. Norin; Prof. Dr. M. Isobe; Prof. Dr. S. Kitagawa; and Prof. Dr. H. Ohtaki.Six plenary lectures are published in this issue of Pure and Applied Chemistry along with the manuscripts from the project "Chemistry for Biology". The conference proceedings are being published by Springer-Verlag as Innovations in Chemical Biology.The news of the sudden and untimely death of Prof. Dr. Hitoshi Ohtaki on 5 November 2006 was received after the conference. He enthusiastically promoted international cooperation and took it upon himself to publicize Japanese science to the wider world. His plenary lecture will serve as a memorable contribution to that goal. He also prepared a separate chapter, including tributes, in the proceedings. Prof. Dr. Ohtaki will be missed by all of us.The next Eurasia conference, the 10th Eurasia Conference on Chemical Sciences (EuAs C2S-10), will be held in Manila, Philippines in 2008.Prof. Dr. Bilge SenerChair, National Organizing Committee

Abstract STUDY QUESTION Does GnRH-agonist trigger offer similar maturity rate (MR) in low and normal responders compared to high responders in women undergoing planned oocyte cryopreservation, for whom even a small risk of ovarian hyperstimulation syndrome (OHSS) may not be acceptable? SUMMARY ANSWER GnRH-agonist is an appropriate choice for final maturation of oocytes in planned oocyte cryopreservation, regardless of response to stimulation or risk of ovarian hyperstimulation syndrome. WHAT IS KNOWN ALREADY Numerous studies have demonstrated the utility of GnRH-agonist trigger for the prevention of ovarian hyperstimulation in high-responder in vitro fertilization cycles. Limited data exist supporting its use in normal or low responders, or in non-infertile women undergoing planned oocyte cryopreservation. STUDY DESIGN, SIZE, DURATION Retrospective cohort study of 1189 subjects including all planned oocyte cryopreservation cycles performed at a large, single center, oocyte cryopreservation program from April 2016 to December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 1680 cycles were included in the study. A total of 57.1% (959/1680) utilized GnRH-agonist for trigger. Demographic and clinical data were collected from the medical record. Maturation rate was calculated for the entire cohort, and by trigger type, using the quotient of Metaphase II (MII) oocytes and retrieved oocytes. A sub-cohort of GnRH-agonist trigger cycles were categorized by peak estradiol (E2) levels and maturation rates compared between groups. Associations were made using Student’s t test, ANOVA, Mann–Whitney U and Kruskal–Wallis, where appropriate. A sample size calculation for 90% power with a significance of 5% to detect non-inferiority of <0.05 from a 0.75 maturity rate between subjects with E2 > 3000 pg/mL and E2 < 3000 pg/mL demonstrated the need for at least 116 cycles per group. MAIN RESULTS AND THE ROLE OF CHANCE Mean MR was 0.71 ± 0.19 overall, and 0.73 ± 0.18 in the sub-cohort of GnRH-agonist trigger cycles. A total of 611 cycles (63.7%) had peak E2 < 3000, and 331 (34.5%) had E2 > 3000. No significant difference in maturity rate was noted between cycles with E2 levels >3000 pg/mL and <3000 pg/mL (0.72 ± 0.19 vs. 0.74 ± 0.14, P = 0.18), confirming the non-inferiority of maturity rates with GnRH-agonist triggers in cycles with peak E2 < 3000 pg/mL. While lower mean oocytes retrieved and mean MII oocytes were associated with lower peak E2 levels, maturity rate did not significantly differ amongst E2 level groups. Cycles with E2 < 1000 pg/mL had lower MR irrespective of trigger type. LIMITATIONS, REASONS FOR CAUTION The retrospective nature cannot entirely exclude selection biases, confounding factors or additional variables that could not be accounted for or were not collected by the electronic medical record. Given the nature of planned oocyte cryopreservation, studies of ongoing pregnancy rates and birth outcomes will naturally be delayed. Lastly, the study population was limited to women undergoing planned oocyte cryopreservation; therefore, the results may not be generalizable to women undergoing in vitro fertilization. WIDER IMPLICATIONS OF THE FINDINGS This is the first study specifically comparing the efficacy of GnRH-agonist in patients at lower risk for OHSS to those at high risk, as well the first study evaluating GnRH-agonist’s efficacy specifically in planned oocyte cryopreservation cycles. STUDY FUNDING/COMPETING INTEREST(S) Study support provided by departmental funds from the Center for Fertility Research and Education—Extend Fertility Medical Practice. BLM discloses personal fees from Ferring Pharmaceuticals and Merck KgAA, unrelated to the submitted work. C.S., M.G., L.R. and J.K. have nothing to disclose. TRIAL REGISTRATION NUMBER N/A.

Parents play an important role in the development of their children. This research reflects the role of parents in developing children. Through four stages of identification, screening, eligibility, and acceptable results, this method uses a systematic literature review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method. The findings from the fourteen articles examined show that parenting skills play an important role in a child's growth and development from birth to death. The determining factor in the development of physical, motoric, moral, language, social-emotional, and life skills aspects is the role of both parents as important teachers for children from birth to adulthood. Parents can also use a variety of parenting strategies and skills, many of which they have learned throughout their lives and passed on to their children, to help their children grow. Keywords: Role of Parents, Child Development, first education for children References: Albanese, A. M., Russo, G. R., & Geller, P. A. (2019). The role of parental self‐efficacy in parent and child well‐being. Child Care Health Dev, 45(3), 333–363. https://doi.org/10.1111/cch.12661. Almås, I., Cappelen, A. W., Sørensen, E. Ø., Tungodden, B., Alm, I., & Tungodden, B. (2010). Fairness and the Development of Inequality Acceptance Supporting materials for “ Fairness and the development of inequality acceptance .” Science, 328(5982), 1176–1178. https://doi.org/10.1126/science.1187300. Ahmadi, Abu. 2004. Psikologi Belajar. Jakarta : Rineka Cipta. Ahmetoglu, E., Acar, I. H., & Ozturk, M. A. (2022). Parental involvement and children’s peer interactions. Current Psychology, 41(7), 4447–4456. https://doi.org/10.1007/s12144-020-00965-0. Andhika, M. R. (2021). Peran Orang Tua Sebagai Sumber Pendidikan Karakter Bagi Anak Usia Dini. 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La investigación científica que hemos realizado es básica, es cuasi experimental, los factores de estudio son dos: programa de estrategias motivacionales y desempeño académico de los estudiantes de la carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo Ecuador 2015. La población está conformada por 324 estudiantes de carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo y la muestra está conformada por 60 estudiantes para el grupo control y 60 para el grupo experimental, que en total sumados representan el total de 120 estudiantes El diseño de la investigación es transaccional, cuasi experimental, bivariada, transversal. Para la recolección de datos se realizó 15 talleres sobre un programa de estrategias motivacionales y un cuestionario para ver las estrategias motivacionales que se aplicó a los estudiantes de la muestra. Los instrumentos cumplen con las cualidades de validez y confiabilidad. El estudio plantea la siguiente hipótesis de investigación: Existe diferencia significativa entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en el desempeño académico de los estudiantes de la carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo - Ecuador 2015. Los resultados obtenidos nos permiten aceptar la hipótesis investigada, pues, en el grupo de control el p- valor no es menor a 0,05, por lo tanto no hay mejora significativa y en el grupo experimental el p- valor con un nivel de significancia de 95% es de 0,00 de confiabilidad de acuerdo a la prueba no paramétrica U de Mann – Whitney, por lo tanto se rechaza la hipótesis nula y por lo tanto se acepta la hipótesis investigada y tenemos que: Existe diferencia entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en el desempeño académico de los estudiantes de la carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo - Ecuador 2015. Palabras Claves: Estrategias motivacionales – Desempeño académico - Universidad Nacional de Chimborazo - Ecuador Abstract.- Scientific research we have done is basic, is quasi-experimental factors are twofold: program of motivational strategies and academic performance of students studying accounting and auditing at the University of Chimborazo Ecuador 2015. The population is made up 324 undergraduates accounting and auditing at the University of Chimborazo and the sample consists of 60 students for the control group and 60 for the experimental group, which in total represent combined total of 120 students The research design is transactional, quasi-experimental, bivariate, cross. For data collection 15 workshops on a program of motivational strategies and a questionnaire for motivational strategies that applied to students of the sample was performed. The instruments meet the qualities of validity and reliability. The study raises the following hypothesis: There is significant difference between the control group and the experimental group in post test after implementing the program of motivational strategies "EMODECA" in the academic performance of students studying accounting and audit at the University of Chimborazo Ecuador 2015. The results allow us to refuse to accept the investigation, as in the control group the hypothesis p- value is less than 0.05, therefore no significant improvement in the experimental group and the p- value with a level of significance of 95% reliability is 0.00 according to the nonparametric Mann - Whitney, therefore the null hypothesis is rejected and therefore the investigated hypothesis is accepted and we have: There is a difference between the group control and experimental group in post test after implementing the program of motivational strategies "EMODECA" in the academic performance of students studying accounting and auditing at the University of Chimborazo Ecuador 2015 Key Words: Motivational Strategies - Academic performance - National University of Chimborazo - Ecuador Introducción.- En la actualidad el mundo universitario está cambiando. Las instituciones educativas son llamadas a formar parte de un nuevo modelo, en el que los estudiantes universitarios se convierten en futuros profesionales capaces de ser aprendices, con una óptima capacidad de aprender a aprender durante toda la vida, en un entorno globalizado (García, 2012). Actualmente en el mundo, según los estudios existe una importante relación entre el rendimiento académico con la utilización de estrategias de aprendizaje y con estrategias motivacionales esenciales en el aprendizaje autorregulado. Un estudio sobre las estrategias motivacionales y estrategias de aprendizaje en estudiantes universitarios de Ciencias de la Salud. (Rodríguez, 2008; Ocak y Yamaç, 2013) y de algunas variables específicas como la autoeficacia y la utilidad percibida como condición necesaria para este aprendizaje (Rosário y col., 2012). Además, el aprendizaje autorregulado aumenta la motivación intrínseca, es decir el interés por la tarea y por el aprendizaje en sí mismo sin ninguna recompensa externa, lo que es muy interesante en las titulaciones universitarias llamadas vocacionales en las diferentes carreras profesionales. También se han incorporado de manera novedosa al constructo de aprendizaje autorregulado, las denominadas estrategias motivacionales. Estas estrategias pueden guiar las cogniciones y las emociones de los estudiantes y tener efectos sobre el esfuerzo, la persistencia, además de sobre el rendimiento y la ejecución de las tareas (Suárez y Fernández, 2013). Actualmente, en el ambiente educativo internacional, está inmerso en un constante proceso de cambios superficiales, medianos y a veces profundos en todos los niveles, por lo que la educación ecuatoriana entra en este mundo de competitividad dentro del ámbito mundial, cumpliendo de esta manera el mandato de la Ley Orgánica de la Educación Superior, que nos indica las nuevas leyes y reglamentos a seguir en el ámbito educativo, por lo tanto es necesario hacer un diagnóstico y estudio de los factores actuales que influyen en el desempeño académico de los estudiantes para identificar sus problemas y buscar solución a ellos, mediante diversos procesos, tales como diseños de proyectos educativos a corto y largo plazo que permitan la consecución de los objetivos, como también el desarrollo de estrategias motivacionales. El bajo rendimiento en el inter aprendizaje de algunos estudiantes de la carrera de contabilidad y de auditoría de la Universidad Nacional de Chimborazo, ha motivado para buscar algunas causas y consecuencias que determinan que la falta de actualización e innovación pedagógica por parte del educando, así como la falta de capacitación de algunos docentes que además de no tener los materiales tecnológicos adecuados dan como consecuencia que los estudiantes no desarrollan sus capacidades investigativas, su inteligencia y creatividad y que se vuelven pasivos frente a la administración tanto en pequeños negocios como en grandes empresas. El paso del tiempo, nos ha hecho ver que en la contabilidad y la auditoría han desarrollado diversos temas y aplicado diversos métodos que se emplean hasta la presente fecha, se debe mencionar que la contabilidad y la auditoría han realizado una evolución acelerada debido a que el mercado mundial, llamado globalización se ha desarrollado enormemente sus fronteras, gracias al avance de la ciencia y tecnología que no podía estar ajena a esta transformación. Estos cambios que algunos países experimentan aceleradamente, fueron tan profundos y marcados en todos los aspectos, por lo que mueve al hombre de una vida tranquila, cómoda hacia un desarrollo económico que se mueve en forma acelerada mismos que se han esforzado en construir una teoría contable y auditoría con cierta dosis científica y tecnológica y que es urgente llevar esta teoría económica hacia las estudiantes de contabilidad y auditoría Según los objetivos que fue establecido por la Declaración de Bolonia, dentro del nuevo Espacio Europeo de Enseñanza Superior, destaca la idea de la implantación de un proceso de enseñanza continuada durante toda la vida laboral de los titulados universitarios, que va a llevar a un cambio de paradigma en el modelo de enseñanza. En ese sentido juega un papel importante las estrategias motivacionales para elevar el desempeño académico de los estudiantes de contabilidad y auditoría de la Universidad Nacional de Chimborazo Para conseguir este logro, las metodologías docentes tradicionales, aunque no han quedado obsoletas, van a ser sustituidas por otras que promueven una participación más activa por parte del estudiante y que genera motivaciones significativas en él sobre todo en los que estudian contabilidad y auditoría. En el caso de España para conseguir este objetivo, se creó la Comisión para la Renovación de las Metodologías Educativas en la Universidad quienes al terminar sus estudios elaboraron un informe sobre “Propuestas para la renovación de las metodologías educativas en la Universidad” (2006). De acuerdo al informe respecto al proceso educativo, se inclinan por un nuevo estilo de trabajo del docente más activo que potencie el uso de nuevas estrategias, metodologías en el aula. A su vez, considera la necesidad de otorgarle mayor protagonismo a los estudiante en su proceso del desarrollo de aprendizaje, fomentando el trabajo colaborativo y organizando la enseñanza en función de la adquisición, por éstos, de una serie de competencias y potenciando herramientas de aprendizaje autónomo y permanente. Asimismo generando estrategias motivacionales para superar problema de desempeño académico y que redunde en una mejora sustancial en su rendimiento estudiantil. Como objetivo general tenemos: Determinar diferencia que existe entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en el desempeño académico de los estudiantes de la carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo - Ecuador 2015. Los objetivos específicos son: Evaluar la diferencia que existe entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en la mejora académica de los estudiantes de la carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo - Ecuador 2015; Explicar la diferencia existe entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en el papel del docente para la mejora académica de los estudiantes de la carrera de contabilidad y auditoría en dicha Universidad; Determinar la diferencia que existe entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en la hora pedagógica de los estudiantes de la carrera de contabilidad y auditoría en la Universidad; Explicar la diferencia existe entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en las diferentes asignaturas de los estudiantes de la carrera de contabilidad y auditoría esta la Universidad. Justificación.- La presente investigación se justifica en la medida que los datos obtenidos van a contribuir al conocimiento de la realidad por la que atraviesan los estudiantes de contabilidad y auditoría de la Universidad Nacional de Chimborazo en cuanto se refiere a su desempeño académico y si esta lo suficiente motivado por el docente para elevar su autoestima y aprovechamiento. Conscientes de que las carreras de Contabilidad Auditoria constituye una de las herramientas de notable interés por su aplicabilidad legal, económica y financiero indispensable para controlar en gran parte la economía del mercado, de los negocios e inclusive en nuestro hogar, es necesario realizar el estudio del desempeño académico de los estudiantes de las dos carreras, con la finalidad de ver, en qué medida el estudiante está motivado para superar sus aprendizaje Para mejorar el desempeño académico en estas dos carreras que tiene la particular importancia de registrar, controlar y analizar operaciones financieras y auditarlos, merece una especial atención, por lo tanto, se cree conveniente que estas futuras generaciones tengan bases sólidas, mayor interés en aprender no solo en lo teórico sino en lo práctico y que mejor aún lo apliquen en su vida cotidiana, es necesario que parta de los contenidos programáticos que se imparten en los primeros años de estudio, debido a que hoy en día nuestra sociedad requiere jóvenes que sepan desenvolverse en diferentes campos y sean partícipes del avance tanto tecnológico y científico. En lo social: Se debe tener muy en cuenta que el avance del proceso de enseñanza aprendizaje, tiene buenos resultados cuando el docente conoce de la materia, sabe lo que va hacer, como lo va hacer y qué es lo que quiere lograr. Por lo tanto aquí juega un papel importante las estrategias motivacionales. Por lo que, la implementación en las aulas de nuestras técnicas y estrategias metodológicas de última tecnología proporcionan mayor facilidad para orientar y dirigir la clase. La realización de esta investigación es posible porque constituye un beneficio del educando para formar individuos reflexivos, creativos y críticos con principios éticos y morales para contribuir a la sociedad como entes competitivos. La Misión y Visión de la Universidad Nacional de Chimborazo reflejan el propósito y la manera en que se conducen para cumplir con los estudiantes que forman. En ellas existe la coincidencia de formar, en el proceso educativo, personas con altos niveles de excelencia, con responsabilidad social, con principios y valores éticos. La Ley de Educación Superior es muy clara sobre los fines, principios y la gestión misma de estas instituciones con respecto de los estudiantes, docentes, administrativos y su entorno. Material y método.- El cuestionario del programa de estrategia motivacional, permitirá obtener información que nos dé un diagnóstico del estado actual de desempeño académico del estudiante antes del tratamiento experimental al grupo a evaluar. Permitirá medir los datos recolectados teniendo una idea más clara de la información que queremos obtener. Se procederá a clasificar los datos que servirán para los fines de la investigación; se pasará luego a la Codificación de la información seleccionada para facilitar el manejo de la misma; se procederá luego a la Tabulación de los Datos para elaborar los Segunda.- Según la U de Mann-Whitney, se aprecia en los estadísticos de los grupos de estudio, siendo el nivel de significancia p= 0,000 menor que p=0,05 (p< α), comprobándose de este modo que: Existe diferencia significativa entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en la mejora académica de los estudiantes de la carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo - Ecuador 2015. Tercera.- Según la U de Mann-Whitney, se aprecia en los estadísticos de los grupos de estudio, siendo el nivel de significancia p= 0,000 menor que p=0,05 (p< α), comprobándose de este modo que: Existe diferencia significativa entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en el papel del docente para la mejora académica de los estudiantes de la carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo - Ecuador 2015. Cuarta.- Según la U de Mann-Whitney, se aprecia en los estadísticos de los grupos de estudio, siendo el nivel de significancia p= 0,000 menor que p=0,05 (p< α), comprobándose de este modo que: Existe diferencia significativa entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en la hora pedagógica de los estudiantes de la carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo - Ecuador 2015. Quinta.- Según la U de Mann-Whitney, se aprecia en los estadísticos de los grupos de estudio, siendo el nivel de significancia p= 0,000 menor que p=0,05 (p< α), comprobándose de este modo que: Existe diferencia significativa entre el grupo de control y el grupo experimental en el post test, luego de aplicar el programa de estrategias motivacionales “EMODECA” en las diferentes asignaturas de los estudiantes de la carrera de contabilidad y auditoría en la Universidad Nacional de Chimborazo - Ecuador 2015. Referencias Bibliográficas García, M. (2012). La autorregulación académica como variable explicativa de los procesos de aprendizaje universitario. Revista de currículum y formación del profesorado, 16(1), 203-221. Ocak, G., y Yamaç, A. (2013). Examination of the relationships between fifth grader´s self-regulated learning strategies, motivational beliefs, attitudes, and achievement. Educational Sciencies: Theory and Practice, 13(19, 380-387. Rodriguez, C. M. (2009). The impact of academic self-concept, expectations and the choice of learning strategy on academic achievement: The case of business students. Higher Education Research & Development, 28(5), 523-539. Rosário, P. (2012). Autoeficacia y utilidad percibida como condiciones necesarias para un aprendizaje académico autorregulado. Anales de Psicología, 28(1), 37-44. Suárez, J. M., y Fernández, A. P. (2013). Un modelo sobre cómo las estrategias de motivación relacionadas con el componente de afectividad inciden sobre las estrategias cognitivas y metacognitivas. Educación XXI, 16(2), 231-246

Post-transplant diabetes mellitus (PTDM) is a common problem among solid organ transplant recipients contributing to morbidity and affecting patient as well as graft survival adversely. It can occur at any period following transplantation, but maximum incidence is observed in the first few months, with a second peak after a few years after transplantation. The pathogenesis is complex and poorly understood, however, it is associated with both dysfunctional beta-cells and insulin resistance. Both nonpharmacologic and antidiabetic therapies are important for adequate glycemic control. This point of view article provides a short review on PTDM in solid organ transplantation (SOT) recipients from a general physician’s perspective. Solid organ transplantation is currently the best choice of treatment for most patients suffering from end-stage organ failure. Successful organ transplantation offers enhanced quality and duration of life with lower morbidity and mortality. Innovations in SOT, advances in surgical techniques, progress in immunosuppressive regimens, and critical care have greatly improved both the patient and graft survival in last several decades. The discovery of calcineurin inhibitors (CNIs) represents a milestone event in the history of immunosuppression and it has revolutionized transplant medicine; further breakthrough in immunosuppressive regimens is the cornerstone for existing successful transplant program. The current 5-year graft survival is about 80% for kidney and heart transplants, and 70% for liver and lung transplants (UNOS-OPTN and SRTR registry data). Cardiovascular disease (CVD), infections, and drug toxicity play an important role in the long-term morbidity and mortality of this patient population. This risk is not only due to presence of underlying pre-existing comorbidities, but also results from adverse effects of the immunosuppressive drugs such as hypertension, dyslipidemia, and PTDM. The risk of PTDM after SOT varies from 10 to 40% during the first 1 year. This risk depends on several factors including the type of transplanted organ [10–20% of kidney transplant recipients (KTRs) and 20–40% of patients with heart, liver, and lung transplants]. Post-transplant diabetes mellitus is widely studied in KTRs, but the risk factors and pathophysiology seem to be similar in all kinds of SOT. Post-transplant diabetes mellitus [previously termed, new-onset diabetes mellitus after transplantation (NODAT)] results in a remarkable proportion of SOT recipients and contributes to increased risk of CVD and infections, leading to significant mortality and morbidity. The pathogenesis is complex and poorly understood, however, it is associated with both dysfunctional beta-cells as well as reduced sensitivity to insulin. Consensus guidelines and proceedings from international consensus meeting on PTDM updated its recommendations in 2014, preferred to call it as PTDM rather than NODAT, as few patients could have undiagnosed diabetes prior to transplantation. New-onset diabetes mellitus after transplantation simply indicates exclusion of pretransplant diabetes and it is found that around 10% of KTRs have undetected diabetes prior to transplantation.1 Hence, PTDM represents timing of diagnosis in post-transplant period rather than time of occurrence of disease. The gold standard method to diagnose PTDM is the oral glucose tolerance test (OGTT). Post-transplant diabetes mellitus typically presents with postprandial hyperglycemia [impaired glucose tolerance (IGT)] rather than impaired fasting glucose (IFG). International consensus guidelines for PTDM recommend standard diagnostic criteria by American Diabetes Association (ADA) and World Health Organization (WHO) for the diagnosis of PTDM and these are almost same as to those used for type II diabetes mellitus (T2DM) in the general population with few exceptions (Table 1).2 Following transplantation, there is increased turnover of red blood cells due to perioperative blood loss and regain of renal function in case of kidney transplantation with normal erythropoietin production. The immunosuppressant drugs can have a negative effect on red cell proliferation in the bone marrow. Hence the glycated hemoglobin (HbA1c) can be erratic and accurate interpretation is not possible in the first 2–3 months, and is not a recommended test to identify PTDM in early post-transplant period. After 3 months post-transplant, HbA1c is reliable and ADA cut-off can be followed to diagnose PTDM. As per ADA guidelines, “prediabetes” is diagnosed with OGTT if fasting plasma glucose is 100–125 mg/dL (IFG) or 2-hour plasma glucose is 140–199 mg/dL (IGT). American Diabetes Association and WHO criteria differ with respect to normal ranges of fasting plasma glucose. American Diabetes Association criteria are more sensitive in detecting transplant candidates at risk for PTDM as its threshold value is lower.3 Impaired fasting glucose is diagnosed if fasting plasma glucose is ≥100 mg/dL by the ADA and ≥110 mg/dL by the WHO. Oral glucose tolerance test is more sensitive for detecting prediabetes as IGT is more commonly seen than IFG. The incidence of PTDM is higher in the first year, with a second peak after a few years following transplantation. Early peak is usually the result of metabolic adverse effects of immunosuppressive drugs, whereas late peak is due to post-transplant weight gain, obesity, metabolic syndrome, and insulin resistance. There is a great variability in the prevalence and incidence rates in the published literature. This is due to differences in the proposed diagnostic criteria, definitions used, organs transplanted, timing from transplantation, follow-up duration, population genetics, geographical differences, immunosuppressive drug regimens, and other risk factors. The prevalence of PTDM varied from 15 to 55% in the literature.4–8 It is identified that up to one-third of nondiabetic KTRs develop impaired glucose metabolism by 6 months following transplantation. Currently, the prevalence of PTDM appears to be reducing, mainly due to use of lower doses of immunosuppressive drugs targeting lower trough levels to prevent drug toxicity.9 Transient hyperglycemia is highly prevalent in the early post-transplant period; it can be identified in ~90% of KTRs in the first few weeks. It can result from use of higher doses of immunosuppressive drugs, antirejection therapy, stress, infections, sepsis, and other critical conditions. While detecting transient post-transplantation hyperglycemia is crucial as it is a predisposing factor for consequent PTDM, universally labeling all of them as PTDM in the early post-transplant setting is not acceptable. The diagnosis of PTDM should be delayed until the recipient is clinically stable, with stable allograft function, and is on lower doses of immunosuppression without acute infections. To avoid overdiagnosis, few authors proposed to define PTDM as a long-term (usually more than 3 months) need for antihyperglycemic therapy. The common predisposing factors for the occurrence of PTDM are side effects of immunosuppression and their effect on glucose metabolism, infections especially due to certain viruses, and hypomagnesemia, along with traditionally identified predisposing factors seen with T2DM (Table 2). Risk factors for PTDM should be analyzed during the pretransplant period to prevent or delay the development of PTDM. Some of these include older age, high-risk race or ethnic groups, obesity or metabolic syndrome, prediabetes prior to transplant, gestational diabetes, first degree relative with diabetes, nonalcoholic steatohepatitis, polycystic kidney disease, higher human leukocyte antigen (HLA)—mismatches, acute rejection episodes, cadaver donor, cytomegalovirus (CMV) and hepatitis C virus (HCV) infections, and use of immunosuppression.8 Induction with basiliximab may predispose patients to PTDM as concluded in a study from North India.10 Glucocorticoids induced PTDM seems to be dose-dependent. It is characterized mainly by insulin resistance and higher postprandial blood glucose levels. Although, it could be dose-dependent, there is no evidence that steroid withdrawal prevents or reduces PTDM incidence.11,12 Calcineurin inhibitors have toxic effect on islet cells of pancreas and alter insulin secretion pattern.13 Calcineurin inhibitors by causing hypomagnesemia, precipitate PTDM. Diabetes Incidence after Renal Transplantation: Neoral C Monitoring Versus Tacrolimus (DIRECT) study observed a greater risk of PTDM with tacrolimus than cyclosporine (CsA).14 In the Efficacy Limiting Toxicity Elimination (ELITE) study, low-dose tacrolimus (8.4%) was more diabetogenic at 1 year than standard-dose CsA (6%), low-dose CsA (4.2%), and low-dose sirolimus (6.6%).15 Various meta-analyses also concluded that tacrolimus is more diabetogenic than CsA.16,17 Mammalian target of rapamycin (mTOR) inhibitors such as sirolimus can also induce PTDM. Conversion from one of the CNIs (either tacrolimus or CsA) to sirolimus resulted in worsening of glycemic control and insulin resistance as shown in a study.18 Antimetabolites such as mycophenolate mofetil (MMF) and azathioprine seem to be nondiabetogenic and may not contribute to the pathogenesis of PTDM. The combination immunosuppressive drug regimens were assessed in some s t u d i e s . O n e s t u d y f o u n d t h a t t h e combination of CNI and sirolimus has a greater risk of PTDM than the combination of CNI and MMF.19 Some other drugs such as renin-angiotensin-aldosterone system (RAAS) blockers [angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)], co-trimoxazole and statins may reduce the risk of PTDM.20,21 Hepatitis C virus infection was associated with almost fourfold higher risk of acquiring PTDM than those who were not infected in a meta-analysis among KTRs. 22 The pathogenesis of HCV-induced PTDM seems to be multifactorial including abnormal glucose metabolism, insulin resistance, and beta-cell dysfunction. Anti-HCV treatment and sustained virological remission in pretransplant period may prevent the development of PTDM. A large North Indian retrospective study compared long-term outcomes of HCV-infected and noninfected KTRs and concluded greater risk of PTDM in the HCV-infected group (~40 vs 19%). In the same study, anti-HCV therapy was given to all infected recipients before transplantation.23 Hepatitis C virus-associated PTDM is usually noticed in liver transplant recipients, especially in cases with hepatic steatosis. Association of PTDM with CMV infection is unclear. There was a fourfold greater risk of PTDM in patients with asymptomatic CMV infection in a study.24 Prediabetes before transplantation can predispose to PTDM. A percentage of 35% of KTRs with PTDM had pretransplant IGT in one study.25 Risk adaptive approach and tailoring of immunosuppression seems to be the fundamental concept to delay and prevent the occurrence of PTDM, especially in those with greater risk for PTDM. Transient hyperglycemia is widely prevalent in early post-transplant period; though it can predispose the recipient to PTDM, it should not be considered as an expression of PTDM. The contribution of transient hyperglycemia to the risk of PTDM was assessed in the past. Around 29% of recipients with postoperative transient hyperglycemia progressed to develop PTDM within 1 year, in a study.26 In another similar study, 46.7% of recipients with early transient hyperglycemia developed PTDM. There was a fourfold higher risk of PTDM in patients with transient hyperglycemia.27 Post-transplant diabetes mellitus, due to its predisposition to infections and CVD, adversely affects graft and overall patient survival. Cardiovascular disease is the most common cause of death and poor patient survival in SOT recipients, and PTDM has a correlation with CVD mortality.28 There is also an adverse effect of PTDM on graft survival independent from excessive mortality. Various factors implicate in death-censored graft loss due to PTDM. Some of these include development of de novo diabetic nephropathy in the renal allograft, excessive risk for infections such as pneumonia, urinary tract infection, and viral infections including CMV.29 Also it could be due to reduced immunosuppression for glycemic control resulting in excessive risk for graft rejection and ultimately graft loss. The treatment of PTDM should be multidisciplinary as it predisposes to various complications including CVD and it is usually associated with other post-transplant complications. The risk for PTDM needs to be assessed during pretransplant assessment by taking thorough history, physical examination, evaluating for metabolic syndrome and prediabetes, and assessing for any other associated cardiovascular risk factors. All SOT recipients should be closely monitored for glycemic control postoperatively while on immunosuppression. Generally, blood sugars are monitored at regular intervals such as every week for initial 4 weeks, then at 3 and 6 months, and annually thereafter. Glycated hemoglobin is not reliable in early post-transplant period, but can be advised 3 months after transplant. Stringent glycemic control is not advisable in majority of SOT recipients as they are at high risk for CVD. Hence, management should target at achieving fair control of blood sugars to near normal glycemic targets without increasing risk for hypoglycemia. Glycated hemoglobin target of <7.5% is acceptable in majority, especially in elderly and those who have CVD. Treatment includes both nonpharmacological and antidiabetic therapies. Diet, exercise, lifestyle modification, control of obesity, and weight reduction constitute main components of nonpharmacologic therapy. Along with PTDM, control of hypertension, dyslipidemia, and other cardiovascular risk factors is also crucial to reduce CVD risk. Kidney Disease: Improving Global Outcomes (KDIGO) and other guidelines suggest statin therapy to all cardiac and renal SOT recipients. For liver and lung transplant recipients, statin therapy should be individualized. The risk of rejection should be analyzed and must be weighted for the potential usefulness of modifying immunosuppression for glycemic control. The doses of glucocorticoids can be cut down, however complete withdrawal can precipitate rejection. Tacrolimus to CsA switching can be considered in patients with PTDM refractory to therapy despite reduction in doses of tacrolimus targeting lower trough levels. In one North-Indian randomized open-label prospective study involving KTRs, there was significant control of PTDM in CsA switching arm vs tacrolimus continuation arm.30 Another randomized controlled trial (RCT) in KTRs also showed easy reversal of PTDM at 12 months after switching from tacrolimus to CsA in comparison with continued treatment with tacrolimus.31 Switching to sirolimus in PTDM is not advisable as it may further aggravate glycemic control. Most patients in initial few months require insulin therapy with or without OHA (single drug or combination OHAs). The preferred therapy for initial few weeks following transplantation is insulin. Intensified therapy with basal insulin-containing regimen for initial few months showed to reduce the risk of development of PTDM at 12 months after transplantation probably due to beta-cell protection mediated by early insulin therapy.32 The concept of “beta-cell rest” was proposed which states that early insulin therapy preserves beta-cell function over the long term. The principle is that early insulin therapy prevents glucotoxicity and stimulation of vulnerable beta-cells whereas OHAs induce overstimulation of beta-cells causing their exhaustion. Oral hypoglycemic agents might be preferred after first 1–2 months of transplantation, and this sequence of therapy (insulin followed by oral agents) is the converse of what is recommended in the management of T2DM. Most of the SOT recipients requiring insulin might not need it after the early post-transplant period. Conversion to oral agents is usually successful when the daily need for insulin dose is less than 20 units. Among OHAs, biguanides (metformin), sulfonylureas, m e glitinides, gliptins [dipeptidyl peptidase-4 (DPP-4) inhibitors], and thiazolidinediones (pioglitazone) have been evaluated for treatment of PTDM in SOT recipients. These are found to be safe and effective with no significant interaction with the immunosuppressive drugs. These classes of OHAs are the preferred agents currently for the treatment of PTDM. Some of the oral drugs need renal dose modification as per glomerular filtration rate (GFR) level. A significant proportion of long-term SOT recipients who are on CNIs develop nephrotoxicity with a drop in GFR level from baseline. Metformin is an age-old drug for management of T2DM. It is considered as first-line drug, especially in patients with obesity and insulin resistance. It can precipitate lactic acidosis in high-risk subgroup of patients, especially in the presence of renal dysfunction. Majority of the reported cases of lactic acidosis have been identified in patients who were already on RAAS blockers (ACEI or ARB) in the presence of renal dysfunction. It can be initiated safely in patients with an estimated glomerular filtration rate (eGFR) up to 45 mL/min/1.73 m2 . It is not recommended to start metformin once eGFR is less than 45 mL/min/1.73 m2 and is currently contraindicated if eGFR of <30 mL/min/1.73 m2 , although data are emerging on its metabolic benefits even in patients with advanced CKD. Due to its safet y concerns, it is necessary to monitor renal function closely while on metformin therapy. It can also aggravate gastrointestinal (GI) side effects of immunosuppressive drugs. Gliclazide, glipizide, and glimepiride are preferred among sulfonylureas in patients with renal dysfunction. Meglitinides, such as repaglinide, due to their short duration of action, may be preferred over sulfonylureas in the presence of low GFR as the latter drugs are associated with significant risk of hypoglycemia. However, there are no strong data supporting the use of repaglinide or nateglinide among SOT recipients, as the studies performed were short-term. But they were considered safe and efficacious. Dipeptidyl peptidase-4 inhibitors or gliptins inhibit DPP-4 enzyme which is responsible for degradation of endogenous incretins leading to restoration of insulin secretion and inhibition of glucagon release. They are weight neutral (do not induce weight gain), have glucose-dependent action with lesser risk for hypoglycemia, and are considered to be safe along with immunosuppressive drugs due to least interactions. They may be considered as the potential first-line OHAs to manage PTDM. The studies performed on the available gliptins such as sitagliptin and vildagliptin are of small sample size with short-term follow-up, however, they documented their safety and efficacy in SOT recipients. In T2DM, long-term safety data are available for sitagliptin but not for vildagliptin.33 Vildagliptin was considered as safe and effective in KTRs as concluded in a double-blind RCT.34 There is some drug interaction between sitagliptin and CNIs especially CsA with regard to prolongation of QT interval in the combination group. Linagliptin was found to be safe and effective for PTDM management as concluded in one Indian study. As it is nonrenally eliminated, it does not require dose adjustment in renal failure.35 Thiazolidinediones are considered as the last resort of therapy in SOT recipients with PTDM due to their side effect profile as these patients generally suffer from multiple comorbidities. These drugs can worsen post-transplant mineral bone disease and bone loss, precipitate congestive heart failure, and lead to anemia, fluid overload, and weight gain. Drug interaction with CNIs is observed as they predispose to CNI toxicity. Alpha-glucosidase inhibitors such as acarbose and miglitol are not recommended if eGFR is <30 mL/min/1.73 m2 and they can aggravate GI side effects of MMF. Incretin mimetics [glucagon-like peptide 1 (GLP1) receptor agonists] such as exenatide, liraglutide, lixisenatide, and semaglutide, have not been evaluated for their safety in SOT recipients except for a few small studies. Physicians should be cautious against using GLP1 receptor agonists due to risk of GI tract side effects and precipitation of prerenal acute kidney injury in SOT recipients having GFR <30 mL/min/1.73 m2 . Recent clinical trials with GLP1 receptor agonists in nontransplant population showed their potential benefit on adverse cardiovascular as well as renal outcomes in high-risk CVD patients; the data in SOT recipients are still awaited. The data are emerging for the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in SOT recipients with PTDM. Important drugs include canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. They have been evaluated in large clinical trials in nontransplant population and found to significantly reduce the risk of major adverse cardiovascular and renal outcomes. They are now considered as first choice therapies for both cardiovascular and renal protection in patients with heart failure with reduced ejection fraction, diabetic kidney disease, and proteinuric nondiabetic kidney diseases, and this benefit was observed irrespective of presence of diabetes. Their efficacy and safety in patients with kidney and other SOT recipients are not known as these patients were excluded from large clinical trials. The only concern with these drugs is increased predisposition to genital, fungal and lower urinary tract infections, and this could be life-threatening in immunosuppressed SOT recipients. The antihyperglycemic effect of these drugs diminishes once GFR is <60 mL/min/1.73 m2 and is practically nil at GFR <30 mL/min/1.73 m2 . In an RCT that included KTRs with PTDM who were randomized to either SGLT2 inhibitor or placebo found that empagliflozin is safe and efficacious for treatment of PTDM, and moderate weight loss was also observed in the treatment arm.36 A pilot study from India also concluded that canagliflozin use resulted in better glycemic control with lower HbA1c level, body weight, and blood pressure reduction. The requirement of other OHAs was also reduced, with no adverse effects including hypoglycemia in the treatment arm.37 There is an immense need for a large-scale intervention trials in SOT recipients with PTDM with these newer hypoglycemic agents, that is, GLP1 receptor agonists and SGLT2 inhibitors that have been proved to have pleiotropic benefits and lower major adverse cardiovascular and renal events in high-risk patients with T2DM.

More than a year ago, Ecuador suffered a 7.8 Mw Earthquake that was devastating, the automatic response was to rush to the affected areas and rebuild. Meche´s House is an alternative: the crisis as an opportunity to experiment and consolidate popular construction systems based on an endogenous and holistic approach. This study evaluates two different methodologies (Mutualista Pichincha´s Casa Lista and Meche´s House) of the selection process for the beneficiaries on a reconstruction post-disaster building program contrasting each case and its needs by analyzing its approaches to the reconstruction procedures: one automatic, non-reflexive and product-based, and one analytic and process-based. Founded on experience and how different processes need different beneficiaries this study will raise some questions about the effectiveness, pros, cons, and perspectives of different approaches to make the correct choice of beneficiary for the reconstruction process after a natural disaster.