Fisioterapia en la rehabilitación del usuario con síndrome doloroso regional complejo

Por sus múltiples causas y su sintomatología inespecífica, el síndrome doloroso regional complejo es una de las situaciones clínicas que mayor dificultad genera en el tratamiento fisioterapéutico. Este síndrome se define como una disfunción vasomotora, mediada por el sistema simpático en donde su manifestación primaria es un dolor que aumenta y permanece en el tiempo y que no tolera las diferentes modalidades y técnicas utilizadas por los Fisioterapeutas como herramientas de intervención. A través del tiempo el Fisioterapeuta ha tenido una acción relevante en el manejo del usuario con dolor, sin importar la causa o consecuencia del mismo. Por esta razón con esta revisión se quiere, integrar acciones terapéuticas como la carga de peso, la desensibilización y la relajación, que han dado excelentes resultados, a las prácticas tradicionales (medios físicos, ultrasonido, masaje sedativo y diferentes tipos de corrientes) aplicables a quienes padecen dolor secundario, traumático o visceral que compromete el sistema simpático en forma refleja.

Challenges of the accession of Turkey into the European Union

Turkey's accession to the European Union (EU) has become, over the years, one of the most contentious issues of European integration. On October 3rd 2005, the European Commission began negotiations for its accession, and, although they will probably not be completed within a decade, its objective is the full accession to the Union. Turkey's accession to the EU presents challenges for both parties, but especially for the European Union. There are very different challenges from the previous accessions, indeed. This work aims to analyze the challenges the EU will face towards Turkey's possible accession to the European Community. Therefore, this work has been divided into three sections. In the first of them, entitled "Brief history of a complex negotiation", the negotiation is briefly described. The second, "Aspects to take into account for Turkey's accession to the European Union", in which different relevant (geopolitical, economic and financial, demographic, cultural and religious) aspects of the possible a cession are discussed: aspects that will have an important impact in the development and performance of the European Community, once accession is fulfilled. The third and last section, "Turkey's incorporating challenges", discusses the challenges the EU will have to face with the potential accession of Turkey, specifically concerning four dimensions: institutional capacity, regional and cohesion policy, EU common security and foreign policy.

La Estrategia Nacional de Defensa de Brasil como respuesta al dilema de seguridad regional con Chile, Venezuela y Colombia (1998-2008)

El interés de esta monografía es analizar la influencia que la configuración de un dilema de seguridad en Suramérica entre Chile, Venezuela y Colombia durante el periodo 1998-2008, tuvo en la formulación de la Estrategia Nacional de Defensa de Brasil de 2008. Se analiza cómo el cambio en la estructura de poder regional y en la distribución relativa de capacidades producto de las acciones de estos actores, afectó la definición de los lineamientos y acciones estratégicas de la Estrategia Nacional de Defensa, en tanto Brasil buscaba consolidar su papel como potencia en Suramérica. Teniendo en cuenta el realismo defensivo como marco explicativo y su enfoque en temas asociados a la seguridad, se realiza un análisis que permita comprender la situación suramericana descrita y el alcance de la teoría como herramienta analítica.

La estrategia de liderazgo regional de la India a través de la cooperación sur-sur (2003-2012)

La presente investigación tiene como objetivo analizar en qué medida la estrategia de liderazgo regional de la India ha sido impulsada a través de los programas y proyectos de cooperación sur-sur ofrecidos por este país en el periodo de 2003-2012. De igual forma se pretende indagar sobre el papel histórico que ha jugado la India en el establecimiento y posterior evolución de esta nueva forma de cooperación que ha sido vista por la mayoría de los académicos como un complemento de la cooperación norte-sur, y que responde a una serie de intereses particulares. En este caso en particular, la cooperación sur-sur ha sido utilizada por India como una herramienta para incrementar sus capacidades de poder que le permitan consolidarse como líder regional.

El arsenal de Israel como amenaza para la seguridad regional, pero no para la seguridad mundial

Con el fin de la Guerra Fría, la disolución de la Unión Soviética y el comienzo del proceso de Globalización, nuevos factores de amenaza no había recibido la trascendencia necesaria, pero muy silenciosamente iban cobrando vitalidad dentro del amplio concepto de seguridad. Este es el caso de la proliferación nuclear, que ha dejado de ser exclusivo de las grandes potencias, como herramienta fundamental de contención entre ambos bloques durante la Guerra Fría, para estar al alcance de países de menor importancia o grupo de personas, que quieran satisfacer su ambición de convertirse en una potencia nuclear, dejando incluso de lado o simplemente olvidando una serie de necesidades básicas de su población.

El rol del Centro de Estudios Estratégicos de Defensa de la Unión de Naciones Suramericanas en la formación de un pensamiento estratégico regional

El presente estudio de caso analiza los aportes del Centro de Estudios Estratégicos de Defensa (CEED) de la Unión de Naciones Suramericanas (Unasur) en la formación de un pensamiento estratégico regional. Cuatro años han transcurrido desde la creación de dicho Centro, por lo que resulta pertinente estudiar sus principales logros y los aportes realizados al Consejo de Defensa Suramericano (CDS) para la formación de un pensamiento estratégico regional en materia de seguridad y defensa.

The political influence of the kurdish community in Syria and its possible transboundary Effects in the subregion of the Middle East, during the period 2011-2014

El interés de esta monografía es analizar las interacciones no-lineales con resultados emergentes que mantuvo la comunidad kurda en Siria, durante el periodo 2011-2014, y por las cuales se produjeron formas de auto-organización como resultado de la estructura compleja a la que pertenece. De esta forma, se explica cómo a raíz de la crisis política siria y los enfrentamientos con el Estado Islámico, se transformó el rol de los kurdos en Siria y se influenciaron las estructuras políticas del país y las naciones de la región con población kurda. Por lo tanto, esta investigación se propone analizar este fenómeno a través del enfoque de complejidad en Relaciones Internacionales y el concepto de Auto-Organización. A partir de ello, se indaga sobre las interacciones surgidas en estructuras más pequeñas, que habrían afectado un sistema mayor; estableciendo nuevas formas de organización que no pueden ser explicadas, únicamente, a partir de elementos causales.

A actuação do enfermeiro como gestor na unidade de terapia intensiva do Hospital Regional do Baixo Amazonas-Santarém-Pará-Brasil : um estudo de caso

Estudo descritivo que teve como objetivo avaliar a atuação do enfermeiro como gestor da Unidade de Terapia Intensiva do Hospital Regional do Baixo Amazonas Dr. Waldemar Pena – HRBA, o qual obteve o selo de Acreditado em Nível 1 em 2012. Para a obtenção dos dados utilizou-se um questionário elaborado com 10 perguntas subjetivas e aplicado aos enfermeiros gerentes que atuam nas Unidades de Terapia Intensiva e CTI do HRBA. Verificou-se nesse estudo que são indivíduos na faixa etária de 25 a 45 anos, com predominância do gênero feminino, com especialização em áreas diversas da enfermagem. Na atuação no setor de gerência, os enfermeiros estabelecem prioridades, direcionando sua equipe para os atendimentos assistenciais complexos aos pacientes, ficando o trabalho burocrático para ser realizado por último. Os entraves relatados são a insatisfação e o desgaste no exercício da função de gerente da unidade devido ao excesso de funcionários sem experiência em UTI, falta de autonomia, dupla jornada de trabalho, excesso de burocracia entre outras situações que se tornam motivos de estresse. Concluiu-se que a atuação do enfermeiro como gerente se respalda na função assistencial ao paciente através de cuidados diretos e indiretos e na organização dos trabalhos burocráticos na Unidade de Terapia Intensiva.

Seguridad cooperativa regional (Artículos Varios)

El autor reflexiona sobre las condiciones en que los países pobres son vulnerables a diversas fuentes de inseguridad. En este contexto, el artículo analiza el caso de Colombia, amenazada por el narcotráfico y la guerrilla, y vincula la inestabilidad colombiana con la estabilidad y paz regionales. El autor insinúa, asimismo, tres escenarios posibles del conflicto y sus consecuencias en la región y propone la seguridad cooperativa regional como respuesta a este problema.

Seguridad democrática e integración en los países andinos ¿consolidación o fragmentación? (Tema Central)

Desde finales de los ochenta, los países miembros del Grupo Andino nician un proceso de reestructuración de las instituciones subregionales y reimpulsan su proceso de integración. Desde una perspectiva venezolana, en este artículo se esbozan algunas ideas respecto a la presencia convergente de fuerzas centrífugas y centrípetas dentro del área andina, con la finalidad de identificar un conjunto de variables que permitan comprender la compleja relación entre los conflictos internos a los países andinos, su seguridad individual y colectiva y la integración. Finalmente, la autora presenta algunas propuestas para superar las encrucijadas que afronta el proceso de integración subregional.

The European Union-an expanding security community? EU Diplomacy Paper 06/2012, August 2012

This paper investigates why and how the geographical scope of the security community centered around the European Union (EU) is expanding. It starts from the assumption that the EU itself is a ‘tightly-coupled mature pluralistic security community’. The analysis of the expansion of this peaceful area is based on the theoretical framework first designed by Karl Deutsch and later developed by Emmanuel Adler and Michael Barnett. Contrary to the logic of the adage ‘si vis pacem para bellum’, I argue that the security community is expanding because the EU’s own origins and self-perception are driven by an ambition to create lasting peace. The key mechanisms I explore are the EU’s enlargement and neighborhood policies, which are best understood when analyzed against the concept of concentric circles: the regional EU-centered security community is a multi-speed security community, stronger at its core and weaker as it spreads towards its margins.

Using learning networks to understand complex systems: a case study of biological, geophysical and social research in the Amazon

Developing high-quality scientific research will be most effective if research communities with diverse skills and interests are able to share information and knowledge, are aware of the major challenges across disciplines, and can exploit economies of scale to provide robust answers and better inform policy. We evaluate opportunities and challenges facing the development of a more interactive research environment by developing an interdisciplinary synthesis of research on a single geographic region. We focus on the Amazon as it is of enormous regional and global environmental importance and faces a highly uncertain future. To take stock of existing knowledge and provide a framework for analysis we present a set of mini-reviews from fourteen different areas of research, encompassing taxonomy, biodiversity, biogeography, vegetation dynamics, landscape ecology, earth-atmosphere interactions, ecosystem processes, fire, deforestation dynamics, hydrology, hunting, conservation planning, livelihoods, and payments for ecosystem services. Each review highlights the current state of knowledge and identifies research priorities, including major challenges and opportunities. We show that while substantial progress is being made across many areas of scientific research, our understanding of specific issues is often dependent on knowledge from other disciplines. Accelerating the acquisition of reliable and contextualized knowledge about the fate of complex pristine and modified ecosystems is partly dependent on our ability to exploit economies of scale in shared resources and technical expertise, recognise and make explicit interconnections and feedbacks among sub-disciplines, increase the temporal and spatial scale of existing studies, and improve the dissemination of scientific findings to policy makers and society at large. Enhancing interaction among research efforts is vital if we are to make the most of limited funds and overcome the challenges posed by addressing large-scale interdisciplinary questions. Bringing together a diverse scientific community with a single geographic focus can help increase awareness of research questions both within and among disciplines, and reveal the opportunities that may exist for advancing acquisition of reliable knowledge. This approach could be useful for a variety of globally important scientific questions.

Conceptualizing change in the Portuguese footwear industry: regional voices and cognitive spaces of agency

Expanding national services sectors and global competition aggravate current and perceived future market pressures on traditional manufacturing industries. These perceptions of change have provoked a growing intensification of geo-political discourses on technological innovation and ‘learning’, and calls for competency in design among other professional skills. However, these political discourses on innovation and learning have paralleled public concerns with the apparent ‘growth pains’ from factory closures and subsequent increases in unemployment, and its debilitating social and economic implications for local and regional development. In this respect the following investigation sets out to conceptualize change through the complementary and differing perceptions of industry and regional actors’ experiences or narratives, linking these perceptions to their structure-determined spheres of agent-environment interactivity. It aims to determine whether agents’ differing perceptions of industry transformation can have a role in the legitimization of their interests in, and in sustaining their organizational influence over the process of industry-regional transformation. It argues that industry and regional agent perceptions are among the cognitive aspects of agent-environment interactivity that permeate agency. It stresses agents’ ability to reason and manipulate their work environments to preserve their self-regulating interests in, and task representative influence over the multi-jurisdictional space of industry-regional transformation. The contributions of this investigation suggest that agents’ varied perceptions of industry and regional change inform or compete for influence over the redirection of regional, industry and business strategies. This claim offers a greater appreciation for the reflexive and complex institutional dimensions of industry planning and development, and the political responsibility to socially just forms of regional development. It positions the outcomes of this investigation at the nexus of intensifying geo-political discourses on the efficiency and equity of territorial development in Europe.

Daily precipitation statistics in regional climate models: evaluation and intercomparison for the European Alps

An evaluation is undertaken of the statistics of daily precipitation as simulated by five regional climate models using comprehensive observations in the region of the European Alps. Four limited area models and one variable-resolution global model are considered, all with a grid spacing of 50 km. The 15-year integrations were forced from reanalyses and observed sea surface temperature and sea ice (global model from sea surface only). The observational reference is based on 6400 rain gauge records (10–50 stations per grid box). Evaluation statistics encompass mean precipitation, wet-day frequency, precipitation intensity, and quantiles of the frequency distribution. For mean precipitation, the models reproduce the characteristics of the annual cycle and the spatial distribution. The domain mean bias varies between −23% and +3% in winter and between −27% and −5% in summer. Larger errors are found for other statistics. In summer, all models underestimate precipitation intensity (by 16–42%) and there is a too low frequency of heavy events. This bias reflects too dry summer mean conditions in three of the models, while it is partly compensated by too many low-intensity events in the other two models. Similar intermodel differences are found for other European subregions. Interestingly, the model errors are very similar between the two models with the same dynamical core (but different parameterizations) and they differ considerably between the two models with similar parameterizations (but different dynamics). Despite considerable biases, the models reproduce prominent mesoscale features of heavy precipitation, which is a promising result for their use in climate change downscaling over complex topography.

The application of Regional Climate Model output for the simulation of high-mountain permafrost scenarios

This study investigates the possibilities and limitations of using Regional Climate Model (RCM) output for the simulation of alpine permafrost scenarios. It focuses on the general problem of scale mismatch between RCMs and impact models and, in particular, the special challenges that arise when driving an impact model in topographically complex high-mountain environments with the output of an RCM. Two approaches are introduced that take into account the special difficulties in such areas, and thus enable the use of RCM for alpine permafrost scenario modelling. Intended as an initial example, they are applied at the area of Corvatsch (Upper Engadine, Switzerland) in order to demonstrate and discuss the application of the two approaches, rather than to provide an assessment of future changes in permafrost occurrence. There are still many uncertainties and inaccuracies inherent in climate and impact models, which increase when driving one model with the output of the other. Nevertheless, our study shows that the use of RCMs offers new and promising perspectives for the simulation of high-mountain permafrost scenarios