Burnout en la profesión enfermera: una aproximación bibliométrica inicial

Objetivo: obtener datos del estado de la investigación sobre burnout en profesionales de la Enfennerfa desde 1952 hasta el año 2011. Método: búsqueda bibliográfica electrónica de la literatura relevante publicada sobre el burnout de las enfermeras hasta diciembre del 2011. Las bases de datos consultadas fueron: PubMed (Medline), BVSalud Biblioteca Virtual en Salud, Biblioteca Complutense de Madrid, Trip Database, DOAJ (Directory ofOpen Acces Journals), ENFlSPO, BioMed, Cochrane, Dialnet, Gopubmed, Psyke: catálogo de artículos sobre psicología en español, Highwire Standford University, Science Direct, SciELO, Cinahl, Cuiden, Cuidatge y Wylley-Blackwell. Resultados y conclusiones: se obtuvieron 4.506 artículos. La media de producción anual durante los 60 años analizados fue de 75,l, presentó unos niveles bajos durante los primeros años y no fue hasta 1981 cuando la producción aumentó de manera importante. El análisis de la productividad por autores revela que la mayor parte de los mismos solamente han publicado un artículo durante este periodo, y solo un 22% del total han producido más de diez artículos durante este periodo. El grupo de las diez revistas más productivas representa el 21,4% de la producción total de artículos incluidos en el estudio. El 68,l% proceden de revistas de Enfermería.

Burnout en la profesión enfermera: una aproximación bibliométrica inicial

Objetivo: obtener datos del estado de la investigación sobre burnout en profesionales de la Enfennerfa desde 1952 hasta el año 2011. Método: búsqueda bibliográfica electrónica de la literatura relevante publicada sobre el burnout de las enfermeras hasta diciembre del 2011. Las bases de datos consultadas fueron: PubMed (Medline), BVSalud Biblioteca Virtual en Salud, Biblioteca Complutense de Madrid, Trip Database, DOAJ (Directory ofOpen Acces Journals), ENFlSPO, BioMed, Cochrane, Dialnet, Gopubmed, Psyke: catálogo de artículos sobre psicología en español, Highwire Standford University, Science Direct, SciELO, Cinahl, Cuiden, Cuidatge y Wylley-Blackwell. Resultados y conclusiones: se obtuvieron 4.506 artículos. La media de producción anual durante los 60 años analizados fue de 75,l, presentó unos niveles bajos durante los primeros años y no fue hasta 1981 cuando la producción aumentó de manera importante. El análisis de la productividad por autores revela que la mayor parte de los mismos solamente han publicado un artículo durante este periodo, y solo un 22% del total han producido más de diez artículos durante este periodo. El grupo de las diez revistas más productivas representa el 21,4% de la producción total de artículos incluidos en el estudio. El 68,l% proceden de revistas de Enfermería.

Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images.

STUDY DESIGN.: Retrospective radiologic study on a prospective patient cohort. OBJECTIVE.: To devise a qualitative grading of lumbar spinal stenosis (LSS), study its reliability and clinical relevance. SUMMARY OF BACKGROUND DATA.: Radiologic stenosis is assessed commonly by measuring dural sac cross-sectional area (DSCA). Great variation is observed though in surfaces recorded between symptomatic and asymptomatic individuals. METHODS.: We describe a 7-grade classification based on the morphology of the dural sac as observed on T2 axial magnetic resonance images based on the rootlet/cerebrospinal fluid ratio. Grades A and B show cerebrospinal fluid presence while grades C and D show none at all. The grading was applied to magnetic resonance images of 95 subjects divided in 3 groups as follows: 37 symptomatic LSS surgically treated patients; 31 symptomatic LSS conservatively treated patients (average follow-up, 2.5 and 3.1 years); and 27 low back pain (LBP) sufferers. DSCA was also digitally measured. We studied intra- and interobserver reliability, distribution of grades, relation between morphologic grading and DSCA, as well relation between grades, DSCA, and Oswestry Disability Index. RESULTS.: Average intra- and interobserver agreement was substantial and moderate, respectively (k = 0.65 and 0.44), whereas they were substantial for physicians working in the study originating unit. Surgical patients had the smallest DSCA. A larger proportion of C and D grades was observed in the surgical group. Surface measurementsresulted in overdiagnosis of stenosis in 35 patients and under diagnosis in 12. No relation could be found between stenosis grade or DSCA and baseline Oswestry Disability Index or surgical result. C and D grade patients were more likely to fail conservative treatment, whereas grades A and B were less likely to warrant surgery. CONCLUSION.: The grading defines stenosis in different subjects than surface measurements alone. Since it mainly considers impingement of neural tissue it might be a more appropriate clinical and research tool as well as carrying a prognostic value.

6.2

Airborne particles can come from a variety of sources and contain variable chemical constituents. Some particles are formed by natural processes, such as volcanoes, erosion, sea spray, and forest fires, while other are formed by anthropogenic processes, such as industrial- and motor vehicle-related combustion, road-related wear, and mining. In general, larger particles (those greater than 2.5 μm) are formed by mechanical processes, while those less than 2.5 μm are formed by combustion processes. The chemical composition of particles is highly influenced by the source: for combustion-related particles, factors such as temperature of combustion, fuel type, and presence of oxygen or other gases can also have a large impact on PM composition. These differences can often be observed at a regional level, such as the greater sulphate-composition of PM in regions that burn coal for electricity production (which contains sulphur) versus regions that do not. Most countries maintain air monitoring networks, and studies based on the resulting data are the most common basis for epidemiology studies on the health effects of PM. Data from these monitoring stations can be used to evaluate the relationship between community-level exposure to ambient particles and health outcomes (i.e., morbidity or mortality from various causes). Respiratory and cardiovascular outcomes are the most commonly assessed, although studies have also considered other related specific outcomes such as diabetes and congenital heart disease. The data on particle characteristics is usually not very detailed and most often includes some combination of PM2.5, PM10, sulphate, and NO2. Other descriptors that are less commonly found include particle number (ultrafine particles), metal components of PM, local traffic intensity, and EC/OC. Measures of association are usually reported per 10 μg/m3 or interquartile range increase in pollutant concentration. As the exposure data are taken from regional monitoring stations, the measurements are not representative of an individual's exposure. Particle size is an important descriptor for understanding where in the human respiratory system the particles will deposit: as a general rule, smaller particles penetrate to deeper regions of the lungs. Initial studies on the health effects of particulate matter focused on mass of the particles, including either all particles (often termed total suspended particulate or TSP) or PM10 (all particles with an aerodynamic diameter less than 10 μm). More recently, studies have considered both PM10 and PM2.5, with the latter corresponding more directly to combustion-related processes. UFPs are a dominant source of particles in terms of PNC, yet are negligible in terms of mass. Very few epidemiology studies have measured the effect of UFPs on health; however, the numbers of studies on this topic are increasing. In addition to size, chemical composition is of importance when understanding the toxicity of particles. Some studies consider the composition of particles in addition to mass; however this is not common, in part due the cost and labour involved in such analyses.

Insurance coverage of pediatric burns: Switzerland versus USA.

Burn care and research have significantly improved over the past years. However, insurance coverage of such treatments does not reflect the improvements in this multi-disciplinary field. Government insurance policies in first world countries renown for burn care treatment, such as Switzerland and the United States, have not adapted to the complexity and longitudinal nature of burn care. Using case studies from both countries, we have analyzed both the institutional and policy approach to pediatric burn treatment coverage. Subsequently, by presenting the Shriners burn care model, we offer a policy recommendation to both the Swiss and the American governments to better their present legislation and infrastructure on pediatric burn coverage.

Medial migration of lag screw after gamma nailing.

Fractures of the proximal femur are common in the elderly population. Intramedullary nailing has become the standard treatment for intertrochanteric fractures although several extramedullary implants (e.g. dynamic hip screw (DHS), blade plate, locking compression plate (LCP), etc.) exist. However, despite this being a very common operation in traumatology, there are numerous associated complications. We report the rare complication of the migration of the medial lag screw into the pelvis at five and a half weeks postoperatively. The implant was removed and replaced by a total hip arthroplasty with simultaneous grafting of the acetabular defect and strapping of the greater trochanter. The evolution was favourable. We also present a review of the literature and analyze our case.

Modelling of a Hydrogen Catalytic Recombiner for Nuclear Power Plant Containment Studies; Case: Siemens FR90/1-150 Recombiner in TONUS OD Code

Ydinvoimalaitokset on suunniteltu ja rakennettu niin, että niillä on kyky selviytyä erilaisista käyttöhäiriöistä ja onnettomuuksista ilman laitoksen vahingoittumista sekä väestön ja ympäristön vaarantumista. On erittäin epätodennäköistä, että ydinvoimalaitosonnettomuus etenee reaktorisydämen vaurioitumiseen asti, minkä seurauksena sydänmateriaalien hapettuminen voi tuottaa vetyä. Jäädytyspiirin rikkoutumisen myötä vety saattaa kulkeutua ydinvoimalaitoksen suojarakennukseen, jossa se voi muodostaa palavan seoksen ilman hapen kanssa ja palaa tai jopa räjähtää. Vetypalosta aiheutuvat lämpötila- ja painekuormitukset vaarantavat suojarakennuksen eheyden ja suojarakennuksen sisällä olevien turvajärjestelmien toimivuuden, joten tehokas ja luotettava vedynhallintajärjestelmä on tarpeellinen. Passiivisia autokatalyyttisiä vetyrekombinaattoreita käytetäänyhä useammissa Euroopan ydinvoimaitoksissa vedynhallintaan. Nämä rekombinaattorit poistavat vetyä katalyyttisellä reaktiolla vedyn reagoidessa katalyytin pinnalla hapen kanssa muodostaen vesihöyryä. Rekombinaattorit ovat täysin passiivisiaeivätkä tarvitse ulkoista energiaa tai operaattoritoimintaa käynnistyäkseen taitoimiakseen. Rekombinaattoreiden käyttäytymisen tutkimisellatähdätään niiden toimivuuden selvittämiseen kaikissa mahdollisissa onnettomuustilanteissa, niiden suunnittelun optimoimiseen sekä niiden optimaalisen lukumäärän ja sijainnin määrittämiseen suojarakennuksessa. Suojarakennuksen mallintamiseen käytetään joko keskiarvoistavia ohjelmia (Lumped parameter (LP) code), moniulotteisia virtausmalliohjelmia (Computational Fluid Dynamics, CFD) tai näiden yhdistelmiä. Rekombinaattoreiden mallintaminen on toteutettu näissä ohjelmissa joko kokeellisella, teoreettisella tai yleisellä (eng. Global Approach) mallilla. Tämä diplomityö sisältää tulokset TONUS OD-ohjelman sisältämän Siemens FR90/1-150 rekombinaattorin mallin vedynkulutuksen tarkistuslaskuista ja TONUS OD-ohjelmalla suoritettujen laskujen tulokset Siemens rekombinaattoreiden vuorovaikutuksista. TONUS on CEA:n (Commissariat à 1'En¬ergie Atomique) kehittämä LP (OD) ja CFD -vetyanalyysiohjelma, jota käytetään vedyn jakautumisen, palamisenja detonaation mallintamiseen. TONUS:sta käytetään myös vedynpoiston mallintamiseen passiivisilla autokatalyyttisillä rekombinaattoreilla. Vedynkulutukseen vaikuttavat tekijät eroteltiin ja tutkittiin yksi kerrallaan. Rekombinaattoreiden vuorovaikutuksia tutkittaessa samaan tilavuuteen sijoitettiin eri kokoisia ja eri lukumäärä rekombinaattoreita. Siemens rekombinaattorimalli TONUS OD-ohjelmassa laskee vedynkulutuksen kuten oletettiin ja tulokset vahvistavat TONUS OD-ohjelman fysikaalisen laskennan luotettavuuden. Mahdollisia paikallisia jakautumia tutkitussa tilavuudessa ei voitu havaita LP-ohjelmalla, koska se käyttäälaskennassa suureiden tilavuuskeskiarvoja. Paikallisten jakautumien tutkintaan tarvitaan CFD -laskentaohjelma.

Puristinhuopien pesutehokkuuden vaikutus puristinosan ajettavuuteen

Työn tarkoituksena oli kehittää jatkuvatoimiseen pesuun soveltuva emäksinen ja hapan huovanpesuaine sekä tutkia huovanpesun parametreja laboratoriossa ja paperikoneella. Kirjallisuusosassa tarkasteltiin paperikoneen puristinosaa, puristinhuopien ominaisuuksia, puristinhuovissa esiintyviä saostumia ja puristinhuopien kunnostusta sekä esiteltiin FeltPerm-vedenläpäisykykymittari. Kokeellisessa osassa analysoitiin käytetty huopa kvalitatiivisesti ja kvantitatiivisesti ja kun huopaa tukkivien yhdisteiden kemiallinen luonne oli selvitetty, kehitettiin käynninaikaiseen pesuun soveltuva emäksinen ja hapan huovanpesuaine. Huovanpesuaineiden kehitystyössä pesuaineiden tehokkuutta tutkittiin kolmella eri menetelmällä, joista kaksi perustui huovan massan muutoksen määrittämiseen pesussa ja yksi huovan vedenläpäisykyvyn mittaamiseen. Kehitetyillä pesuaineilla optimoitiin laboratoriossa happo- ja emäspesun pH sekä vaikutusaika. Lisäksi tutkittiin huovan turpoamista emäspesussa ja lämpötilan vaikutusta pesutulokseen. Puristinhuopien vedenläpäisykykyä tutkittiin FeltPerm-laitteella kahdella eri SC-paperikoneella, joista toisella oli käytössä käynninaikainen jaksottainen pesu ja toisella pelkät seisokkipesut. Koneella, jossa huovat pestiin käynninaikaisesti, määritettiin pesuparametreja ja optimoitiin emäsvaiheen aikainen pH. Kehitetyillä pesuaineilla suoritettiin koeajo tehtaalla.

Formation and Control of Trace Metal Emissions in Co-Firing of Biomass, Peat, and Wastes in Fluidised Bed Combustors

Environmentally harmful consequences of fossil fuel utilisation andthe landfilling of wastes have increased the interest among the energy producers to consider the use of alternative fuels like wood fuels and Refuse-Derived Fuels, RDFs. The fluidised bed technology that allows the flexible use of a variety of different fuels is commonly used at small- and medium-sized power plants ofmunicipalities and industry in Finland. Since there is only one mass-burn plantcurrently in operation in the country and no intention to build new ones, the co-firing of pre-processed wastes in fluidised bed boilers has become the most generally applied waste-to-energy concept in Finland. The recently validated EU Directive on Incineration of Wastes aims to mitigate environmentally harmful pollutants of waste incineration and co-incineration of wastes with conventional fuels. Apart from gaseous flue gas pollutants and dust, the emissions of toxic tracemetals are limited. The implementation of the Directive's restrictions in the Finnish legislation is assumed to limit the co-firing of waste fuels, due to the insufficient reduction of the regulated air pollutants in the existing flue gas cleaning devices. Trace metals emission formation and reduction in the ESP, the condensing wet scrubber, the fabric filter, and the humidification reactor were studied, experimentally, in full- and pilot-scale combustors utilising the bubbling fluidised bed technology, and, theoretically, by means of reactor model calculations. The core of the model is a thermodynamic equilibrium analysis. The experiments were carried out with wood chips, sawdust, and peat, and their refuse-derived fuel, RDF, blends. In all, ten different fuels or fuel blends were tested. Relatively high concentrations of trace metals in RDFs compared to the concentrations of these metals in wood fuels increased the trace metal concentrations in the flue gas after the boiler ten- to hundred-folds, when RDF was co-fired with sawdust in a full-scale BFB boiler. In the case of peat, lesser increase in trace metal concentrations was observed, due to the higher initial trace metal concentrations of peat compared to sawdust. Despite the high removal rate of most of the trace metals in the ESP, the Directive emission limits for trace metals were exceeded in each of the RDF co-firing tests. The dominat trace metals in fluegas after the ESP were Cu, Pb and Mn. In the condensing wet scrubber, the flue gas trace metal emissions were reduced below the Directive emission limits, whenRDF pellet was used as a co-firing fuel together with sawdust and peat. High chlorine content of the RDFs enhanced the mercuric chloride formation and hence the mercury removal in the ESP and scrubber. Mercury emissions were lower than theDirective emission limit for total Hg, 0.05 mg/Nm3, in all full-scale co-firingtests already in the flue gas after the ESP. The pilot-scale experiments with aBFB combustor equipped with a fabric filter revealed that the fabric filter alone is able to reduce the trace metal concentrations, including mercury, in the flue gas during the RDF co-firing approximately to the same level as they are during the wood chip firing. Lower trace metal emissions than the Directive limits were easily reached even with a 40% thermal share of RDF co-firing with sawdust.Enrichment of trace metals in the submicron fly ash particle fraction because of RDF co-firing was not observed in the test runs where sawdust was used as the main fuel. The combustion of RDF pellets with peat caused an enrichment of As, Cd, Co, Pb, Sb, and V in the submicron particle mode. Accumulation and release oftrace metals in the bed material was examined by means of a bed material analysis, mass balance calculations and a reactor model. Lead, zinc and copper were found to have a tendency to be accumulated in the bed material but also to have a tendency to be released from the bed material into the combustion gases, if the combustion conditions were changed. The concentration of the trace metal in the combustion gases of the bubbling fluidised bed boiler was found to be a summary of trace metal fluxes from three main sources. They were (1) the trace metal flux from the burning fuel particle (2) the trace metal flux from the ash in the bed, and (3) the trace metal flux from the active alkali metal layer on the sand (and ash) particles in the bed. The amount of chlorine in the system, the combustion temperature, the fuel ash composition and the saturation state of the bed material in regard to trace metals were discovered to be key factors affecting therelease process. During the co-firing of waste fuels with variable amounts of e.g. ash and chlorine, it is extremely important to consider the possible ongoingaccumulation and/or release of the trace metals in the bed, when determining the flue gas trace metal emissions. If the state of the combustion process in regard to trace metals accumulation and/or release in the bed material is not known,it may happen that emissions from the bed material rather than the combustion of the fuel in question are measured and reported.

Verbrennungen--Von der Bagatelle zur Katastrophe [Burns--from trifle case to mass casualty]

Burn injuries are very frequent, most being trifle cases. Nevertheless every year about 200 patients need to be treated in one of the two specialised Swiss burns centres. Admission criteria are burns > 15% body surface or burns to critical areas (face neck, hands, genitalia, joints) and electrical injuries. The paper reviews the physiophathology of the burn wound which differs depending on the thermal or electrical aetiology. The airway may be threatened due to true inhalation, but also to burns to the face or neck. In major burns >20% body surface in adults, or > 10% in children, fluid resuscitation will be required; oral hydration is generally sufficient by smaller burns. Surgical treatment of 2nd and 3rd degree burns starts within the first 24 days after injury. While complex treatment is generally available in peace time, a major accident such as a disco-fire that can generate hundreds casualties in a few minutes, can threaten our system and force the adoption of triage rules, and simplified treatments. Attitudes to adopt in such conditions are discussed.

Necrosis del tomate: "torrao "o "cribado"

Desde la primavera de 2001, viene presentándose en España una nueva enfermedad conocida con el nombre de "torrao" o "cribado". Los síntomas que habitualmente presentan las plantas afectadas son una necrosis en la parte basal del foliolo que evoluciona a cribado, en los peciolos aparecen manchas longitudinales en ocasiones endurecidas que llegan a curvar los foliolos, y los frutos manifiestan manchas necróticas, deformaciones que finalmente lo rajan, quedando comercialmente inviables. Muestreos realizados desde su aparición han determinado la mayor incidencia de la enfermedad en la zona de Murcia, seguido de Canarias y en menor proporción Almería, y Alicante. Los resultados de los análisis realizados a las 369 muestras recogidas determinan que el 67% de las muestras analizadas eran positivas a Pepino mosaic virus (PepMV). En los ensayos de transmisión, únicamente mediante el injerto, se consiguió reproducir los síntomas de la enfermedad en dos casos, en el resto las plantas inoculadas e injertadas únicamente mostraban síntomas típicos de PepMV y los análisis realizados confirmaron este aspecto. A la vista de los resultados obtenidos, se diseñó un nuevo método de diagnóstico que ha permitido la caracterización del 89% de las muestras analizadas como aislado Chileno 2 de PepMV, recientemente publicado en el Gen Bank (Accesión number: DQ000985). De acuerdo con lo expuesto podría tratarse de uno de los agentes implicados en el desarrollo del síndrome junto con otros factores aún por determinar

Uso del fuego prescrito para la creación de rodales cortafuegos: estudio del caso de Las Mesas de Ana López, Vega de San Mateo, Gran Canaria (España)

Los regímenes de fuegos forestales están cambiando en Gran Canaria y los grandes incendios forestales son más probables que antiguamente. Esto es un cambio importante en el régimen de perturbaciones y una grave amenaza a la biodiversidad. El Plan de Prevención de Incendios Forestales de Gran Canaria, año 2002 dejó clara la obligación de cambiar las estructuras de vegetación de la Isla en dos ámbitos: paisaje y protección de zonas sensibles. El uso de fuego prescrito (años 2002-2005) ha resultado ser una herramienta especialmente eficiente en este ámbito y muy adecuada para compatibilizar las acciones de prevención de incendios con el mantenimiento de los procesos ecológicos. Estas primeras experiencias en Gran Canaria muestran la idoneidad de los tratamientos para establecer rodales resistentes al paso del fuego en zonas estratégicas (deducidas tras simulación con Farsite y FlamMap). Y revelan lo conveniente que es que estos rodales resistentes estén distribuidos por nuestros montes de modo que los incendios potencialmente grandes encuentren zonas en las que sea factible controlar los perímetros. Este control se pudo hacer eficientemente en el incendio de las Mesas de 17 de agosto de 2004.

Seospellettien pienpoltto

This work is a part of Vapos research over mixed pellets. In this work combustion of ten different mixed pellets are examined. This is done by two kinds of tests, burning tests and ash melting tests. First there is a short review how different bio fuels burn and what kind of problems they cause. After this burning characteristics and flue gas calculation methods are acquainted. In test part burning tests and ash melting tests and their results are reported. Lastly conclusions and considerations over further study are done.

Advances in research and development of mango industry

World mango production is spread over 100 countries that produce over 34.3 million tons of fruit annually. Eighty percent of this production is based in the top nine producing nations that also consume upward of 90% of their production domestically. One to 2 percent of fruit is traded internationally in to markets in the European Community, USA, Arabian Peninsula and Asia. This paper outlines some of the recent research and development advances in mango breeding and genomics, rootstock development, disease management and harvest technologies that are influencing the production and quality of mango fruit traded domestically and internationally.