La experiencia de los receptores en el trasplante de órganos y tejidos

El trasplante de órganos y/o tejidos es considerado como una opción terapéutica viable para el tratamiento tanto de enfermedades crónicas o en estadios terminales, como de afectaciones no vitales, pero que generen una disminución en la calidad de vida percibida por el paciente. Este procedimiento, de carácter multidimensional, está compuesto por 3 actores principales: el donante, el órgano/tejido, y el receptor. Si bien un porcentaje significativo de investigaciones y planes de intervención han girado en torno a la dimensión biológica del trasplante, y a la promoción de la donación; el interés por la experiencia psicosocial y la calidad de vida de los receptores en este proceso ha aumentado durante la última década. En relación con esto, la presente monografía se plantea como objetivo general la exploración de la experiencia y los significados construidos por los pacientes trasplantados, a través de una revisión sistemática de la literatura sobre esta temática. Para ello, se plantearon unos objetivos específicos derivados del general, se seleccionaron términos o palabras claves por cada uno de estos, y se realizó una búsqueda en 5 bases de datos para revistas indexadas: Ebsco Host (Academic Search; y Psychology and Behavioral Sciences Collection); Proquest; Pubmed; y Science Direct. A partir de los resultados, se establece que si bien la vivencia de los receptores ha comenzado a ser investigada, aún es necesaria una mayor exploración sobre la experiencia de estos pacientes; exploración que carecería de objetivo si no se hiciera a través de las narrativas o testimonios de los mismos receptores

Desarrollo de un estado de la cuestión acerca de las interacciones entre el control de gestión y el aprendizaje organizacional.

Las organizaciones en la actualidad deben encontrar diferentes maneras de sobrevivir en un tiempo de rápida transformación. Uno de los mecanismos usados por las empresas para adaptarse a los cambios organizacionales son los sistemas de control de gestión, que a su vez permiten a las organizaciones hacer un seguimiento a sus procesos, para que la adaptabilidad sea efectiva. Otra variable importante para la adaptación es el aprendizaje organizacional siendo el proceso mediante el cual las organizaciones se adaptan a los cambios del entorno, tanto interno como externo de la compañía. Dado lo anterior, este proyecto se basa en la extracción de documentación soporte valido, que permita explorar las interacciones entre estos dos campos, los sistemas de control de gestión y el aprendizaje organizacional, además, analizar el impacto de estas interacciones en la perdurabilidad organizacional. ​

Analytical methodologies based on X-Ray Fluorescence Spectrometry (XRF) and Inductively Couple Plasma Spectroscopy (ICP) for the assessment of metal dispersal around mining environments

La investigació que es presenta en aquesta tesi es centra en l'aplicació i millora de metodologies analítiques existents i el desenvolupament de nous procediments que poden ser utilitzats per a l'estudi dels efectes ambientals de la dispersió dels metalls entorn a les zones mineres abandonades. En primer lloc, es van aplicar diferents procediments d'extracció simple i seqüencial per a estudiar la mobilitat, perillositat i bio-disponibilitat dels metalls continguts en residus miners de característiques diferents. Per altra banda, per a estudiar les fonts potencials de Pb en la vegetació de les zones mineres d'estudi, una metodologia basada en la utilització de les relacions isotòpiques de Pb determinades mitjançant ICP-MS va ser avaluada. Finalment, tenint en compte l'elevat nombre de mostres analitzades per a avaluar l'impacte de les activitats mineres, es va considerar apropiat el desenvolupament de mètodes analítics d'elevada productivitat. En aquest sentit la implementació d'estratègies quantitatives així com l'aplicació de les millores instrumentals en els equips de XRF han estat avaluades per a aconseguir resultats analítics fiables en l'anàlisi de plantes. A més, alguns paràmetres de qualitat com la precisió, l'exactitud i els límits de detecció han estat curosament determinats en les diverses configuracions de espectròmetres de XRF utilitzats en el decurs d'aquest treball (EDXRF, WDXRF i EDPXRF) per a establir la capacitat de la tècnica de XRF com a tècnica alternativa a les clàssiques comunament aplicades en la determinació d'elements en mostres vegetals.

A study on the phylogeny and the ecology of ammonia-oxidizing bacteria using a new molecular marker based on the gene amoB

L'agricultura i la industrialització han causat un augment significatiu del nombre d'ambients rics en amoni. La presència de compostos nitrogenats redueix la qualitat de l'aigua, causant problemes de toxicitat, deteriorant el medi ambient i fins i tot afectant la salut humana. En conseqüència, la nitrificació s'ha convertit en un procés global que afecta al cicle del nitrogen a la biosfera. Els bacteris oxidadors d'amoni (AOB) són els responsables de l'oxidació de l'amoni a nitrit, i juguen un paper essencial en el cicle del nitrogen. Els primers oxidadors d'amoni foren aïllats a finals del segle XIX, però la lentitud del seu creixement i les dificultats per cultivar-los feren que fins als anys 80, amb els primers estudis emprant el gen 16SrDNA, no s'assolís un coneixement complert d'aquest grup bacterià. Actualment les bases de dades contenen multitud d'entrades amb seqüències corresponents a AOB. L'objectiu d'aquest treball era trobar, desenvolupar i avaluar eines útils i fiables per a l'estudi dels AOB en mostres ambientals. En aquest treball primer descrivim la utilització de la hibridació in situ amb fluorescència (FISH), mitjançant l'aplicació de sondes amb diana en el 16SrRNA dels AOB. La FISH ens va permetre detectar i recomptar aquest grup bacterià; no obstant, aquest mètode no permetia la detecció de noves seqüències, pel que es necessitava una nova eina. Amb aquesta intenció vam aplicar la seqüència de la sonda Nso1225 en una PCR. El fet d'amplificar específicament un fragment del 16SrDNA dels AOB va suposar el desenvolupament d'una nova eina molecular que permetia detectar la presència i diversitat d'aquests bacteris en ambients naturals. Malgrat tot, algunes seqüències pertanyents a bacteris no oxidadors d'amoni del subgrup β dels proteobacteris, eren també obtingudes amb aquesta tècnica. Així mateix, un dels inconvenients de l'ús del 16SrDNA com a marcador és la impossibilitat de detectar simultàniament els AOB que pertanyen als subgrups β i γ dels proteobacteris. El gen amoA, que codifica per la subunitat A de l'enzim amoni monooxigenasa (AMO), era aleshores àmpliament utilitzat com a marcador per a la detecció dels AOB. En aquest treball també descrivim la utilització d'aquest marcador en mostres procedents d'un reactor SBR. Aquest marcador ens va permetre identificar seqüències de AOB en la mostra, però la necessitat de detectar amoA mitjançant clonatge fa que l'ús d'aquest marcador requereixi massa temps per a la seva utilització com a eina en estudis d'ecologia microbiana amb moltes mostres. Per altra banda, alguns autors han assenyalat l'obtenció de seqüències de no AOB en utilitzar amoA en un protocol de PCR-DGGE. Amb la finalitat d'obtenir una eina ràpida i rigorosa per detectar i identificar els AOB, vam desenvolupar un joc nou d'oligonucleòtids amb diana en el gen amoB, que codifica per a la subunitat transmembrana de l'enzim AMO. Aquest gen ha demostrat ser un bon marcador molecular pels AOB, oferint, sense tenir en compte afiliacions filogenètiques, una elevada especificitat, sensibilitat i fiabilitat. En aquest treball també presentem una anàlisi de RT-PCR basada en la detecció del gen amoB per a la quantificació del gènere Nitrosococcus. El nou joc d'oligonucleòtids dissenyat permet una enumeració altament específica i sensible de tots els γ-Nitrosococcus coneguts. Finalment, vam realitzar un estudi poligènic, comparant i avaluant els marcadors amoA, amoB i 16SrDNA, i vàrem construir un arbre filogenètic combinat. Com a resultat concloem que amoB és un marcador adequat per a la detecció i identificació dels AOB en mostres ambientals, proporcionant alhora agrupacions consistents en fer inferències filogenètiques. Per altra banda, la seqüència sencera del gen 16S rDNA és indicada com a marcador en estudis amb finalitats taxonòmiques i filogenètiques en treballar amb cultius purs de AOB.

Visualizing knowledge in project-based work

This article considers how visual practices are used to manage knowledge in project-based work. It compares project-based work in a capital goods manufacturer and an architectural firm. Visual representations are used extensively in both cases, but the nature of visual practice differs significantly between the two. The research explores the kinds of knowledge that are (and aren't) developed and made visible in strategizing and planning activities. For example, whereas the emphasis of project-based work in the former firm is on exploitation of knowledge and it visualizes its project context largely in commercial and processual terms, the emphasis in the latter is on exploration and it uses a wide range of visual materials to understand physical interdependencies across the project boundary. We contend particular kinds of visual tools can help project teams step between exploration and exploitation within a project, and articulate the types of representations, foci of attention and patterns of interaction involved. The findings suggest that business managers can make more deliberate choices about how knowledge is made visible, and can change visual practice to align the project with exploring and exploiting opportunities. It raises the question: What don't you see within your organization? The work contributes to academic debates about managing through projects, strategising and organizing, while the focus on visual representation disrupts the tacit-codified dichotomy in the broad debate on knowledge and learning, and highlights the craft skills central to strategizing and organizing.

The elasticity of demand is about occupancy, not prices: building European demand curves based on occupancy elasticity

The peak congestion of the European grid may create significant impacts on system costs because of the need for higher marginal cost generation, higher cost system balancing and increasing grid reinforcement investment. The use of time of use rates, incentives, real time pricing and other programmes, usually defined as Demand Side Management (DSM), could bring about significant reductions in prices, limit carbon emissions from dirty power plants, and improve the integration of renewable sources of energy. Unlike previous studies on elasticity of residential electricity demand under flat tariffs, the aim of this study is not to investigate the known relatively inelastic relationship between demand and prices. Rather, the aim is to assess how occupancy levels vary in different European countries. This reflects the reality of demand loads, which are predominantly determined by the timing of human activities (e.g. travelling to work, taking children to school) rather than prices. To this end, two types of occupancy elasticity are estimated: baseline occupancy elasticity and peak occupancy elasticity. These represent the intrinsic elasticity associated with human activities of single residential end-users in 15 European countries. This study makes use of occupancy time-series data from the Harmonised European Time Use Survey database to build European occupancy curves; identify peak occupancy periods; draw time use demand curves for video and TV watching activity; and estimate national occupancy elasticity levels of single-occupant households. Findings on occupancy elasticities provide an indication of possible DSM strategies based on occupancy levels and not prices.

Context-based interaction design for smart homes

This paper presents the notion of Context-based Activity Design (CoBAD) that represents context with its dynamic changes and normative activities in an interactive system design. The development of CoBAD requires an appropriate context ontology model and inference mechanisms. The incorporation of norms and information field theory into Context State Transition Model, and the implementation of new conflict resolution strategies based on the specific situation are discussed. A demonstration of CoBAD using a human agent scenario in a smart home is also presented. Finally, a method of treating conflicting norms in multiple information fields is proposed.

Mutual dependency grid for stakeholder mapping: a component-based approach to supply chain participant analysis

Stakeholder analysis plays a critical role in business analysis. However, the majority of the stakeholder identification and analysis methods focus on the activities and processes and ignore the artefacts being processed by human beings. By focusing on the outputs of the organisation, an artefact-centric view helps create a network of artefacts, and a component-based structure of the organisation and its supply chain participants. Since the relationship is based on the components, i.e. after the stakeholders are identified, the interdependency between stakeholders and the focal organisation can be measured. Each stakeholder is associated with two types of dependency, namely the stakeholder’s dependency on the focal organisation and the focal organisation’s dependency on the stakeholder. We identify three factors for each type of dependency and propose the equations that calculate the dependency indexes. Once both types of the dependency indexes are calculated, each stakeholder can be placed and categorised into one of the four groups, namely critical stakeholder, mutual benefits stakeholder, replaceable stakeholder, and easy care stakeholder. The mutual dependency grid and the dependency gap analysis, which further investigates the priority of each stakeholder by calculating the weighted dependency gap between the focal organisation and the stakeholder, subsequently help the focal organisation to better understand its stakeholders and manage its stakeholder relationships.

Multi-agent based modeling and simulation of complex system in hospital

This study puts forward a method to model and simulate the complex system of hospital on the basis of multi-agent technology. The formation of the agents of hospitals with intelligent and coordinative characteristics was designed, the message object was defined, and the model operating mechanism of autonomous activities and coordination mechanism was also designed. In addition, the Ontology library and Norm library etc. were introduced using semiotic method and theory, to enlarge the method of system modelling. Swarm was used to develop the multi-agent based simulation system, which is favorable for making guidelines for hospital's improving it's organization and management, optimizing the working procedure, improving the quality of medical care as well as reducing medical charge costs.

Knowledge-based clinical pathway for medical quality improvement

Clinical pathways have been adopted for various diseases in clinical departments for quality improvement as a result of standardization of medical activities in treatment process. Using knowledge-based decision support on the basis of clinical pathways is a promising strategy to improve medical quality effectively. However, the clinical pathway knowledge has not been fully integrated into treatment process and thus cannot provide comprehensive support to the actual work practice. Therefore this paper proposes a knowledgebased clinical pathway management method which contributes to make use of clinical knowledge to support and optimize medical practice. We have developed a knowledgebased clinical pathway management system to demonstrate how the clinical pathway knowledge comprehensively supports the treatment process. The experiences from the use of this system show that the treatment quality can be effectively improved by the extracted and classified clinical pathway knowledge, seamless integration of patient-specific clinical pathway recommendations with medical tasks and the evaluating pathway deviations for optimization.

Integrated clinical pathway management for medical quality improvement-based on a semiotically inspired systems architecture

Clinical pathway is an approach to standardise care processes to support the implementations of clinical guidelines and protocols. It is designed to support the management of treatment processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care across different disciplines and sectors. However, in the practical treatment process, the lack of knowledge sharing and information accuracy of paper-based clinical pathways burden health-care staff with a large amount of paper work. This will often result in medical errors, inefficient treatment process and thus poor quality medical services. This paper first presents a theoretical underpinning and a co-design research methodology for integrated pathway management by drawing input from organisational semiotics. An approach to integrated clinical pathway management is then proposed, which aims to embed pathway knowledge into treatment processes and existing hospital information systems. The capability of this approach has been demonstrated through the case study in one of the largest hospitals in China. The outcome reveals that medical quality can be improved significantly by the classified clinical pathway knowledge and seamless integration with hospital information systems.

Problem-based learning approaches in meteorology

Problem-Based Learning, despite recent controversies about its effectiveness, is used extensively as a teaching method throughout higher education. In meteorology, there has been little attempt to incorporate Problem-Based Learning techniques into the curriculum. Motivated by a desire to enhance the reflective engagement of students within a current field course module, this project describes the implementation of two test Problem-Based Learning activities and testing and improvement using several different and complementary means of evaluation. By the end of a 2-year program of design, implementation, testing, and reflection and re-evaluation, two robust, engaging activities have been developed that provide an enhanced and diverse learning environment in the field course. The results suggest that Problem-Based Learning techniques would be a useful addition to the meteorology curriculum and suggestions for courses and activities that may benefit from this approach are included in the conclusions.

The drivers of multinational enterprise subsidiary entrepreneurship in China: a new resource-based view perspective

This paper extends the resource-based view (RBV) of the firm, as applied to multinational enterprises (MNEs), by distinguishing between two critical resource dimensions, namely relative resource superiority (capabilities) and slack. Both dimensions, in concert with specific environmental conditions, are required to increase entrepreneurial activities. We propose distinct configurations (three-way moderation effects) of capabilities, slack, and environmental factors (i.e. dynamism and hostility) to explain entrepreneurship. Using survey data from 66 Canadian subsidiaries operating in China, we find that higher subsidiary entrepreneurship requires both HR slack and strong downstream capabilities in subsidiaries, subject to the industry environment being dynamic and benign. However, high HR slack alone, in a dynamic and benign environment, but without the presence of strong capabilities, actually triggers the fewest initiatives, with HR slack redirected from entrepreneurial experimentation towards complacency and inefficiency. This paper has major implications for MNEs seeking to increase subsidiary entrepreneurship in fast growing emerging markets.

A review of measurement-based assessments of the aerosol direct radiative effect and forcing

Aerosols affect the Earth's energy budget directly by scattering and absorbing radiation and indirectly by acting as cloud condensation nuclei and, thereby, affecting cloud properties. However, large uncertainties exist in current estimates of aerosol forcing because of incomplete knowledge concerning the distribution and the physical and chemical properties of aerosols as well as aerosol-cloud interactions. In recent years, a great deal of effort has gone into improving measurements and datasets. It is thus feasible to shift the estimates of aerosol forcing from largely model-based to increasingly measurement-based. Our goal is to assess current observational capabilities and identify uncertainties in the aerosol direct forcing through comparisons of different methods with independent sources of uncertainties. Here we assess the aerosol optical depth (τ), direct radiative effect (DRE) by natural and anthropogenic aerosols, and direct climate forcing (DCF) by anthropogenic aerosols, focusing on satellite and ground-based measurements supplemented by global chemical transport model (CTM) simulations. The multi-spectral MODIS measures global distributions of aerosol optical depth (τ) on a daily scale, with a high accuracy of ±0.03±0.05τ over ocean. The annual average τ is about 0.14 over global ocean, of which about 21%±7% is contributed by human activities, as estimated by MODIS fine-mode fraction. The multi-angle MISR derives an annual average AOD of 0.23 over global land with an uncertainty of ~20% or ±0.05. These high-accuracy aerosol products and broadband flux measurements from CERES make it feasible to obtain observational constraints for the aerosol direct effect, especially over global the ocean. A number of measurement-based approaches estimate the clear-sky DRE (on solar radiation) at the top-of-atmosphere (TOA) to be about -5.5±0.2 Wm-2 (median ± standard error from various methods) over the global ocean. Accounting for thin cirrus contamination of the satellite derived aerosol field will reduce the TOA DRE to -5.0 Wm-2. Because of a lack of measurements of aerosol absorption and difficulty in characterizing land surface reflection, estimates of DRE over land and at the ocean surface are currently realized through a combination of satellite retrievals, surface measurements, and model simulations, and are less constrained. Over the oceans the surface DRE is estimated to be -8.8±0.7 Wm-2. Over land, an integration of satellite retrievals and model simulations derives a DRE of -4.9±0.7 Wm-2 and -11.8±1.9 Wm-2 at the TOA and surface, respectively. CTM simulations derive a wide range of DRE estimates that on average are smaller than the measurement-based DRE by about 30-40%, even after accounting for thin cirrus and cloud contamination. A number of issues remain. Current estimates of the aerosol direct effect over land are poorly constrained. Uncertainties of DRE estimates are also larger on regional scales than on a global scale and large discrepancies exist between different approaches. The characterization of aerosol absorption and vertical distribution remains challenging. The aerosol direct effect in the thermal infrared range and in cloudy conditions remains relatively unexplored and quite uncertain, because of a lack of global systematic aerosol vertical profile measurements. A coordinated research strategy needs to be developed for integration and assimilation of satellite measurements into models to constrain model simulations. Enhanced measurement capabilities in the next few years and high-level scientific cooperation will further advance our knowledge.

Dynamic hydrological modeling in drylands with TRMM based rainfall

This paper introduces and evaluates DryMOD, a dynamic water balance model of the key hydrological process in drylands that is based on free, public-domain datasets. The rainfall model of DryMOD makes optimal use of spatially disaggregated Tropical Rainfall Measuring Mission (TRMM) datasets to simulate hourly rainfall intensities at a spatial resolution of 1-km. Regional-scale applications of the model in seasonal catchments in Tunisia and Senegal characterize runoff and soil moisture distribution and dynamics in response to varying rainfall data inputs and soil properties. The results highlight the need for hourly-based rainfall simulation and for correcting TRMM 3B42 rainfall intensities for the fractional cover of rainfall (FCR). Without FCR correction and disaggregation to 1 km, TRMM 3B42 based rainfall intensities are too low to generate surface runoff and to induce substantial changes to soil moisture storage. The outcomes from the sensitivity analysis show that topsoil porosity is the most important soil property for simulation of runoff and soil moisture. Thus, we demonstrate the benefit of hydrological investigations at a scale, for which reliable information on soil profile characteristics exists and which is sufficiently fine to account for the heterogeneities of these. Where such information is available, application of DryMOD can assist in the spatial and temporal planning of water harvesting according to runoff-generating areas and the runoff ratio, as well as in the optimization of agricultural activities based on realistic representation of soil moisture conditions.