Trasplante hepato-renal. Caso clínico

La hiperoxaliuria primaria tipo I es una enfermedad genética autosómica recesiva, cuyo defecto primario es el déficit, parcial o completo, de la enzima glioxilato aminotransferasa en el hígado que produce la formación de oxalato. El depósito progresivo de oxalato en el riñón es el causante, primero de urolitiasis y nefrocalcinosis, y después de un daño renal progresivo, que lleva a una insuficiencia renal crónica y posteriormente al acúmulo sistémico de oxalato en el sistema músculo-esquelético, en las arterias y en el sistema nervioso. La existencia de oxalosis sistémica es el principal factor de morbi-mortalidad antes y después del trasplante, dada su asociación a malnutrición y daño óseo. En estos casos el trasplante hepatorenal es la mejor opción para resolver el defecto metabólico. La realización de este trasplante es técnicamente más fácil al no existir hipertensión portal y en general la hemodiálisis se mantiene durante el postrasplante para facilitar la eliminación de la sobrecarga de oxalato existente mientras la función renal no se normaliza completamente. A continuación presentamos un caso en el que se expone la evolución clínica de un paciente afecto de esta patología y que se sometió a un trasplante hepatorenal.

The Arts (Music, Arts&Crafts and Drama) as a procedure for learning pre-school content: Grupo Edebé Project

There is nothing as amazing and fascinating as children learning process. Between 0 and 6 years old, a child brain develops in a waythat will never be repeated. At this age, children are eager to discover and they have great potential of active and affective life.Because of this, their learning capacity in this period is incalculable. (Jordan-Decarbo y Nelson, 2002; Wild, 1999).Pre-school Education is a unique and special stage, with self identity, which aims are:attending children as a whole,motivate them to learn,give them an affective and stable environment in which they can grow up and get to be balanced and confident people and inwhich they can relate to others, learn, enjoy and be happy.Arts, Music, Visual Arts and Drama (Gardner, 1994) can provide a framework of special, even unique, personal expression.With the aim of introducing qualitative improvements in the education of children and to ensure their emotional wellbeing, and havingnoticed that teachers had important needs and concerns as regards to diversity in their student groups, we developed a programbased on the detection of needs and concerns explained by professionals in education.This program of Grupo edebé, object of our research, is a multicultural, interdisciplinary and globalizing project the aims of which are:developing children's talent and personality,keeping their imagination and creativity and using these as a learning resource,promoting reasoning, favouring expression and communication,providing children with the tools to manage their emotions,and especially, introducing Arts as a procedure to increase learning.We wanted to start the research by studying the impact (Brice, 2003) that this last point had on the learning of five-year-old childrenschooled in multicultural environments.Therefore, the main goal of the research was the assessment of the implementation of a child education programme attending todiversity in a population of five-year-old children, specifically in the practice of procedures based on the use of Arts (music, arts andcrafts and theatre) as a vehicle or procedure for learning contents in Pre-school stage.Because children emotional welfare was a subject of our concern, and bearing in mind that the affective aspects are of vitalimportance for learning and child development (Parke and Gauvain, 2009), Grupo Edebé has also evaluated the starting, evolving andfinal impact in five-year-old children given that they finish Pre-school education at that age.

Las artes (Música, Plástica y Teatro) como procedimiento para el aprendizaje de contenidos propios de la Etapa Infantil

En la educación infantil las artes (Gardner, 1994; Wild, 1999 Jordan-Decarbo y Nelson, 2002) pueden proporcionar un marco especial, incluso único, de expresión personal, tanto para el maestro/a como para el niño/a y pueden ser usadas de igual forma como procedimiento o como fin en sí mismo, atendiendo a la diversidad con sus distintas fortalezas (Brice, 2003). El principal objetivo de la presente investigación es: Evaluar la implementación de un programa de educación con población infantil (5 años), poniendo en práctica procedimientos basados en la utilización de las artes, como vehículo de aprendizaje para contenidos propios de la etapa -lógica, cantidad, forma, grafomotricidad y conocimiento del entorno-.Ya que los aspectos afectivos son de vital importancia para el aprendizaje y desarrollo del niño (Parke y Gauvain, 2009), hemos evaluado el impacto inicial, procesual y final a la implementación del programa en el estado emocional del niño de cinco años, ya que a esa edad finaliza la etapa infantil.Metodológicamente nos acogemos al modelo de investigación evaluativa participativa, ya que nuestras pretensiones son valorar la eficacia de la implementación de un elemento, proceso o programa educativo (Sandín, 2003). La muestra está constituida por 100 niños y niñas de Madrid y Barcelona de edades comprendidas entre cinco y seis años. Los instrumentos utilizados para la recogida de los datos han sido: el test del Dibujo la Figura Humana (Koppitz, 2010), una pauta de observación sistematizada y una entrevista estructurada abierta.Los resultados obtenidos certifican los efectos positivos del programa implementado, concluyendo que la incidencia emocional ha resultado significativamente beneficiosa para una gran parte del conjunto de la muestra (81,2%), mejorando con respecto al primer periodo concretamente en estabilidad emocional y autoestima.

Las lesbianas (no) somos mujeres. En torno a Monique Wittig (introducción)

Este texto es un homenaje, ahora que se cumplen diez años de su muerte, a la persona y la obra de Monique Wittig (1935-2003). También es el producto de ciertas y felices confluencias, de esas extraordinarias confluencias que el azar y la voluntad a la vez hacen posibles; la primera, mi amistad de años tan fecunda y tan enriquecedora con María Jesús Fariña Busto y Elvira Burgos Díaz. De ella nacieron con el tiempo espacios de intercambio de ideas y deemociones, de afectos y complicidades. Cuando pensé que ya era hora de que nos embarcásemos en un proyecto de investigación tan necesario y tan sin hacer en el Estado español como este, lasconvoqué. De esta convocatoria surgieron también los nombres de Isabel Balza Múgica, Aránzazu Hernández Piñero y Gracia Trujillo Barbadillo, amigas de menos tiempo pero compañeras de las mismas batallas. El círculo se había cerrado. En 2009 el entonces MICINN nos concedió financiación para el proyecto «Feminismos lesbianos y queer: representación, visibilidad y políticas» (FEM2009-12946), una de cuyas materializaciones es este libro.

Cartulaire de l'abbaye de Silly (dioc. de Sées).

Acquis le 14 mars 1837 de M. Collet pour le prix de 400 francs; cf. B.n.F., département des Manuscrits, registre des acquisitions 1833-1848, n° 2026; cf. Delisle, Cab. des mss., II, 294.

Identifying the unmet health needs of patients with congenital hypogonadotropic hypogonadism using a web-based needs assessment: implications for online interventions and peer-to-peer support.

BACKGROUND: Patients with rare diseases such as congenital hypogonadotropic hypogonadism (CHH) are dispersed, often challenged to find specialized care and face other health disparities. The internet has the potential to reach a wide audience of rare disease patients and can help connect patients and specialists. Therefore, this study aimed to: (i) determine if web-based platforms could be effectively used to conduct an online needs assessment of dispersed CHH patients; (ii) identify the unmet health and informational needs of CHH patients and (iii) assess patient acceptability regarding patient-centered, web-based interventions to bridge shortfalls in care. METHODS: A sequential mixed-methods design was used: first, an online survey was conducted to evaluate health promoting behavior and identify unmet health and informational needs of CHH men. Subsequently, patient focus groups were held to explore specific patient-identified targets for care and to examine the acceptability of possible online interventions. Descriptive statistics and thematic qualitative analyses were used. RESULTS: 105 male participants completed the online survey (mean age 37 ± 11, range 19-66 years) representing a spectrum of patients across a broad socioeconomic range and all but one subject had adequate healthcare literacy. The survey revealed periods of non-adherence to treatment (34/93, 37%) and gaps in healthcare (36/87, 41%) exceeding one year. Patient focus groups identified lasting psychological effects related to feelings of isolation, shame and body-image concerns. Survey respondents were active internet users, nearly all had sought CHH information online (101/105, 96%), and they rated the internet, healthcare providers, and online community as equally important CHH information sources. Focus group participants were overwhelmingly positive regarding online interventions/support with links to reach expert healthcare providers and for peer-to-peer support. CONCLUSION: The web-based needs assessment was an effective way to reach dispersed CHH patients. These individuals often have long gaps in care and struggle with the psychosocial sequelae of CHH. They are highly motivated internet users seeking information and tapping into online communities and are receptive to novel web-based interventions addressing their unmet needs.

Definition of linear color models in the RGB vector color space to detect red peaches in orchard images taken under natural illumination

This work proposes the detection of red peaches in orchard images based on the definition of different linear color models in the RGB vector color space. The classification and segmentation of the pixels of the image is then performed by comparing the color distance from each pixel to the different previously defined linear color models. The methodology proposed has been tested with images obtained in a real orchard under natural light. The peach variety in the orchard was the paraguayo (Prunus persica var. platycarpa) peach with red skin. The segmentation results showed that the area of the red peaches in the images was detected with an average error of 11.6%; 19.7% in the case of bright illumination; 8.2% in the case of low illumination; 8.6% for occlusion up to 33%; 12.2% in the case of occlusion between 34 and 66%; and 23% for occlusion above 66%. Finally, a methodology was proposed to estimate the diameter of the fruits based on an ellipsoidal fitting. A first diameter was obtained by using all the contour pixels and a second diameter was obtained by rejecting some pixels of the contour. This approach enables a rough estimate of the fruit occlusion percentage range by comparing the two diameter estimates.

Espigueo por la toponimia mayor del Valle Medio e Inferior del Ésera (Huesca)

El present treball pretén donar llum a una sèrie de topònims majors de la Ribagorça occidental, tot al llarg de la vall mitjana i inferior del riu Éssera. Aquests topònims es remunten a temps molt antics: preromans, romans i germànics bàsicament. Aquesta anàlisi permet apreciar l'estratigrafi a lingüística de la zona. La no-aparició de topònims d'origen àrab en el nostre treball no vol dir que no hi hagués penetració àrab a la zona, sinó que la seva arribada va ser posterior a la creació dels principals nuclis de població. Sí que hi ha topònims àrabs a la toponímia menor, que resta fora del present treball.

O ensino da radiologia nos cursos de graduação em fisioterapia

O trabalho identifica a presença e traz uma visão panorâmica do ensino da disciplina Radiologia e Diagnóstico por Imagem em 11 de 19 cursos de graduação em fisioterapia, que funcionam no Estado do Rio de Janeiro. Avalia a importância do ensino da especialidade médica na formação do fisioterapeuta e faz uma análise qualitativa deste ensino, a partir de entrevistas, por intermédio de questionários direcionados a fisioterapeutas, alunos e coordenadores de cursos de graduação em fisioterapia. Apresenta aspectos para uma linha a ser considerada no preparo de um conteúdo básico, direcionado às necessidades do profissional no exercício das suas funções. Por fim, avalia o papel do docente na disciplina, valorizando a presença do médico radiologista no processo ensino-aprendizagem.

Taloushallinnon toimintatapojen ja laskentajärjestelmien integroiminen perustajarakennuttamisprosessiin

Työn tavoitteena on tuottaa kehitysehdotuksia kohdeyrityksen perustajarakennuttamisprosessiin. Toiminnan tarkastelun painopiste on taloushallinnossa ja tietojärjestelmissä. Prosessin analysoimisessa hyödynnetään liiketoimintaprosessikuvausta, jossa eritellään yksilöiden sekä järjestelmien toimintaa. Työn teoriaosuudessa tarkastellaan prosesseja ja niiden kuvaamista, talousohjausta sekä rakennuttamisliiketoimintaa yleisesti. Synteesiosuudessa prosessin kulku analysoidaan. Prosessin tarkastelussa keskitytään prosessin sopimusvaiheeseen sekä taloushallinnon ja tietojärjestelmien toteutukseen. Analyysin perusteella esitetään toiminnan keskeiset ongelmakohdat. Toiminnan ongelmat jakautuvat kolmelle tasolle: operatiiviseen toimintaan, taloushallinnon toteutukseen sekä tietojärjestelmäratkaisuihin. Operatiivisella tasolla ongelmat liittyvät yksilöiden toimintaan ja taloushallinnossa etenkin kustannusten kohdistamiseen. Tietojärjestelmien avulla yhdistetään operatiivinen ja taloushallinnollinen taso toisiinsa. Työssä esitettyjen ratkaisuehdotusten avulla kohdeyritys voi kehittää prosessia kokonaisuutena.

SYNTHESIS AND BIOLOGICAL EVALUATION OF SPIRO[INDOLINE-3,4’-PYRANO[2,3-C:6,5-C’]DIPYRAZOL]- 2-ONES IN THE PRESENCE OF SBA-Pr-SO3H AS A NANOCATALYST

Sulfonic acid functionalized SBA-15 nanoporous material (SBA-Pr-SO3H) with a large pore size of 6 nm, a high surface area, high selectivity, and excellent chemical and thermal stability was applied as an efficient heterogeneous nanoporous acid catalyst in the reaction of isatin with pyrazolones under mild reaction conditions. A novel class of symmetrical spiro[indoline-3,4'-pyrano[2,3-c:6,5-c']dipyrazol]-2-one derivatives was successfully obtained in high yields. Comparison of these results with those reported in the literature shows that the current method is efficient, and results in better reaction times and yields of the desired products. Other advantages of this new method are its operational simplicity, easy work-up procedure, and the use of SBA-Pr-SO3H as a reusable and environmentally benign nanoreactor, such that the reaction proceeds easily in its nanopores. We also tested the antimicrobial activity of the prepared compounds using the disc diffusion method, and some of the synthesized compounds exhibited the best results against B. subtilis and S. aureus.

Hyvää elämää ei voi mitata rahassa? Tutkielma vaikeasti vammaisen lapsen perheen kunnallisten hyvinvointipalveluiden taloudellisista vaikutuksista

Hyvää elämää ei voi mitata rahassa? Tutkielma vaikeasti vammaisen lapsen perheen kunnallisten hyvinvointipalveluiden taloudellisista vaikutuksista Tarkastelen pro gradussani vaikeasti vammaisen lapsen perheen kunnallisten palveluiden järjestämisen kontekstissa, onko hyvä elämä rahassa mitattavissa. Aloitan tutkimukseni tarkastelemalla hyvä elämä- paradigmojen moninaisuutta ja siirryn sitten tutkimaan, millainen on hyvinvointivaltio Suomi. Keskeisen kiinnostuksen kohteena on, miten sen kunnallisia palveluja järjestetään. Tarkastelen erilaisia yhteiskuntamalleja, vallitsevaa aihetta koskevaa lainsäädäntöä ja sen tulkinnan kautta syntyneitä toimintatapoja. Jatkan tuomalla esiin kunnallisten palveluiden järjestämistä koskevia kansallisia ja globaaleja talouskysymyksiä sekä tarkastelemalla aiempaa tutkimusta taloudellisesta vaikuttavuudesta niin terveydenhuollon, sosiaalihuollon kuin koulutuksen parissa. Kuvaan sen jälkeen kahden hypoteettisen vaikeasti vammaisen lapsen perheen Mäkisten ja Virtasten saamia kunnallisia palveluita. Sitten tarkoituksenani on ”eurottaa” tarinat. Tällä tarkoitan sitä, että tarkastelemalla tarinoissa ilmenevien palveluiden kustannuksia sekä vaikutuksia, voisi olla mahdollista mitata hyvää elämää rahassa. Teen tarinoiden pohjalta myös kustannus-hyötyanalyysin ja vertaan sitten näitä laskentatapoja toisiinsa. Tarina-aineiston keruumenetelmänä käytän eläytymismenetelmää soveltaen sitä siten, että käytän omia kokemuksiani vaikeasti vammaisten lasten perheiden tilanteista luodessani itse kaksi ääripäitä kuvaavaa tarinaa. Perheen aikuisten täysityöllistyminen tai sen estyminen ovat tarinoita erottava tekijä. Työelämään osallistuminen on yleisin suomalaisen hyvän elämän rakennusaine. Laskelmat osoittavat, että hyvän elämän mittaaminen rahassa on mahdollista. Asenteet vaikuttavat päätöksentekoon ja vaikeasti vammaisen hyvä elämä rakentuu useimmin muista lähtökohdista kuin hänen omistaan. Tärkeää on tunnistaa, kenen hyvä elämä-käsityksiin perustuen kunnallisia palveluja järjestetään. Taloudellisen vaikuttavuuden arviointia on tehty sosiaalialalla hyvin vähän ja sen tarve on ilmeinen. Helppokäyttöisten arviointimenetelmien kehittäminen lisäisi niiden käyttöä arjen palvelupäätöksiä tehtäessä.

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