5 resultados para patient best interest

em Universidad Politécnica de Madrid


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La presión sobre el acceso a la tierra en la península de Dakar, Senegal, ha generado un proceso de transformación físico-social del mayor asentamiento auto-producido de la periferia urbana de Dakar (Pikine Irregular Sur) en el periodo 2005-2011. Esta investigación se propone analizar en qué medida las acciones llevadas a cabo: i) satisfacen o no el sistema integral de necesidades de los afectados (Demanda); ii) favorecen la implicación de los afectados o, por el contrario, fortalecen las estructuras de poder dominantes (Oferta), y iii) promueven o no la autonomía económica, la sostenibilidad ambiental, la equidad social y la legitimidad de los actores que participan (Entorno). La investigación se ha llevado a cabo por el método de estudio de casos, mediante un proceso de recogida de información participativo, articulado de abajo hacia arriba, en el que han participado 196 personas; la información recogida se ha procesado mediante la utilización de dos herramientas de análisis de realidades complejas: flujo de programa y sistema funcional. Los resultados del estudio de los casos 1 y 2 muestran que las acciones se han llevado a cabo en beneficio de los intereses de los mercados y de los actores que toman las decisiones y gestionan los recursos, incrementando la dependencia económica, empobreciendo a los directamente afectados y fragmentando su tejido social, promoviendo un desarrollo urbano desequilibrado, disperso y segregado, y deslegitimando a las instituciones involucradas. En el estudio del caso 3, en cambio, se verifica que la acción se ha llevado a cabo en beneficio de los intereses de los directamente afectados, utilizando recursos endógenos, fortaleciendo su tejido social, promoviendo un desarrollo urbano concentrado e inclusivo, e incrementando la legitimidad de las instituciones involucradas. El análisis cruzado de los resultados muestra que la pobreza, la exclusión social y la precariedad habitacional, en el contexto específico de la periferia de Dakar, no son un problema de falta de recursos, sino de falta de ética por parte de quienes gestionan y financian los procesos de transformación físico-social, y de falta de voluntad por parte de las autoridades de implicar a los ciudadanos, y en particular a los directamente afectados, en los procesos de toma de decisiones de las acciones y los programas que les afectan. Finalmente se concluye que no se trata de luchar contra la pobreza, sino de luchar contra los sistemas injustos que generan la pobreza y la exclusión. ABSTRACT The pressure on the access to land in the area of Dakar, Senegal, has generated a physical/social transformation process in the largest self-produced settlement in the urban periphery of Dakar (South Irregular Pikine), in the period 2005-2011. This research aims to analyze to what extent the actions carried out: i) satisfy the integral needs of the affected population (Demand), ii) encourage the involvement of those affected or otherwise strengthen dominant power structures (Supply), and iii) promote or inhibit economic autonomy, environmental sustainability, social equity and legitimacy of the actors involved (Environment). The research was conducted by the case study method. 196 people participated in a bottom-up participatory process of information gathering. The information collected was processed using two custom tools aimed to analyse complex systems: the program flow and the functional system. The results of case studies 1 and 2 show that the actions were carried out in the best interest of the markets and the actors who made decisions and managed resources, increasing economic dependence, impoverishing those directly affected and fragmenting their social network by promoting an unbalanced, dispersed and segregated urban development, and de-legitimizing the institutions involved in the process. On the contrary, in the case study 3 it is verified that the action has been carried out on behalf of the interests of those directly affected, using endogenous resources, strengthening the social network, promoting a focused and inclusive urban development, and increasing legitimacy of the institutions involved. The comparative analysis of the results shows that poverty, social exclusion and precarious housing in South Irregular Pikine are not a problem of lack of resources but of unethical behaviour of those who manage and finance physical and social transformation processes, as well as unwillingness on the part of the authorities to involve citizens in the decision making processes for the actions and programs that affect them. Finally we conclude that the enemy to fight against is not poverty but unfair systems that generate poverty and exclusion. RÉSUMÉ La pression sur le foncier dans la presqu'île de Dakar, au Sénégal, a généré un processus de transformation physico-sociale du plus grand établissement auto-produit de la périphérie urbaine de Dakar (Pikine Irrégulier Sud), durant la période 2005-2011. Cette recherche vise à analyser dans quelle mesure les actions menées: i) répondent ou non à l’ensemble des besoins intégrales des personnes concernés (Demande), ii) encouragent l'implication des concernées ou au contraire renforcent les structures de pouvoir dominant (Offre), et iii) favorisent ou non l'autonomie économique, la durabilité environnementale, l'équité sociale et la légitimité des acteurs concernés (Contexte). La recherche a été menée par la méthode des études de cas, par un processus de collecte d'information participative articulée du bas vers le haut dans lequel ont participé 196 personnes. Les informations recueillies ont été traitées à l'aide de deux outils d'analyse de réalités complexes: le système fonctionnel et le flux de programme. Les résultats de l'étude de cas 1 et 2 montrent que les actions ont été menées au profit des intérêts des marchés et des acteurs qui prennent les décisions et gèrent les ressources, augmentant la dépendance économique, appauvrissant ceux qui sont directement concernés et fragmentant leur tissu social, encourageant un développement urbain déséquilibré, dispersé et ségrégé, et délégitimant les institutions concernées. Dans l'étude de cas 3, cependant, il est vérifié que l'action a été menée au profit des intérêts de ceux qui sont directement concernés, en utilisant des ressources endogènes, en renforçant son tissu social, en encourageant un développement urbain concentré et inclusif, et en augmentant la légitimité des institutions concernées. L'analyse comparée des résultats montre que la pauvreté, l'exclusion sociale et le logement précaire, dans le contexte spécifique de la banlieue de Dakar, ne sont pas un problème de manque de ressources, mais de manque d'éthique de la part de ceux qui gèrent et financent les processus de transformation physico-sociale, et de manque de volonté de la part des autorités d'impliquer les citoyens, en particulier ceux qui sont directement concernés, dans le processus de prise de décision des actions et des programmes qui les impliquent. Finalement, on conclut qu'il ne s'agit pas de lutter contre la pauvreté, mais de lutter contre les systèmes injustes qui produisent la pauvreté et l'exclusion.

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This work studies the most beneficial way of allocating water in an irrigation community in water shortage situations. Therefore, it proposes that the irrigation surface area be divided into homogeneous zones, each with a beneficial relationship with respect to the water applied. The mathematical formula that enables one to obtain the optimal quota for the users or irrigation community as a whole has been found for individual relations of a quadratic or power type, and these have yielded different and complementary characteristics. Dimensionless variables have been used to display the results, and to compare with other alternative allocation rules such as the proportional rule, referencing the situation without water restrictions. As a result, for each water shortage situation, the water that is allocated to each user is obtained, together with the losses in individual income and the losses for the community as a whole. Furthermore, a proposal is put forth for establishing the marginal benefit from the water available, which could be of interest in enabling each community to analyze whether it is in its best interest to invest in increasing the resource, or to sell the resource to other users. Finally, an example is given to demonstrate how the method works and to show that, when the differences between the production schemes are considered, the differences in benefit reduction between the proportional allocation and the optimal allocation are also sizeable. Read More: http://ascelibrary.org/doi/abs/10.1061/(ASCE)IR.1943-4774.0000667

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Through progress in medical imaging, image analysis and finite element (FE) meshing tools it is now possible to extract patient-specific geometries from medical images of abdominal aortic aneurysms(AAAs), and thus to study clinically-relevant problems via FE simulations. Such simulations allow additional insight into human physiology in both healthy and diseased states. Medical imaging is most often performed in vivo, and hence the reconstructed model geometry in the problem of interest will represent the in vivo state, e.g., the AAA at physiological blood pressure. However, classical continuum mechanics and FE methods assume that constitutive models and the corresponding simulations begin from an unloaded, stress-free reference condition.

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A novel method for generating patient-specific high quality conforming hexahedral meshes is presented. The meshes are directly obtained from the segmentation of patient magnetic resonance (MR) images of abdominal aortic aneu-rysms (AAA). The MRI permits distinguishing between struc-tures of interest in soft tissue. Being so, the contours of the lumen, the aortic wall and the intraluminal thrombus (ILT) are available and thus the meshes represent the actual anato-my of the patient?s aneurysm, including the layered morpholo-gies of these structures. Most AAAs are located in the lower part of the aorta and the upper section of the iliac arteries, where the inherent tortuosity of the anatomy and the presence of the ILT makes the generation of high-quality elements at the bifurcation is a challenging task. In this work we propose a novel approach for building quadrilateral meshes for each surface of the sectioned geometry, and generating conforming hexahedral meshes by combining the quadrilateral meshes. Conforming hexahedral meshes are created for the wall and the ILT. The resulting elements are evaluated on four patients? datasets using the Scaled Jacobian metric. Hexahedral meshes of 25,000 elements with 94.8% of elements well-suited for FE analysis are generated.

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In order to perform finite element (FE) analyses of patient-specific abdominal aortic aneurysms, geometries derived from medical images must be meshed with suitable elements. We propose a semi-automatic method for generating conforming hexahedral meshes directly from contours segmented from medical images. Magnetic resonance images are generated using a protocol developed to give the abdominal aorta high contrast against the surrounding soft tissue. These data allow us to distinguish between the different structures of interest. We build novel quadrilateral meshes for each surface of the sectioned geometry and generate conforming hexahedral meshes by combining the quadrilateral meshes. The three-layered morphology of both the arterial wall and thrombus is incorporated using parameters determined from experiments. We demonstrate the quality of our patient-specific meshes using the element Scaled Jacobian. The method efficiently generates high-quality elements suitable for FE analysis, even in the bifurcation region of the aorta into the iliac arteries. For example, hexahedral meshes of up to 125,000 elements are generated in less than 130 s, with 94.8 % of elements well suited for FE analysis. We provide novel input for simulations by independently meshing both the arterial wall and intraluminal thrombus of the aneurysm, and their respective layered morphologies.