Gestión local de planes y proyectos: introducción a la preparación de proyectos = Local management of plans and projects: introduction to project preparation

Incluye Bibliografía

Rehabilitative management of swallowing and oral-motor movements in patients with tetanus of a public service in Brazil

When looking at developing countries, the prolonged intensive medical and nursing care required by many patients places extra demands on an already stretched healthcare budget. The purpose of this study was to verify the effectiveness of a systematic rehabilitative program for swallowing and oral-motor movements in intensive care unit patients with the diagnosis of tetanus. Forty-five patients who were clinically diagnosed with tetanus were included in the study. Participants were divided in two groups: Cl - consisted of 18 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2002 to December 2005, prior to the existence of a systematic swallowing and oral-motor intervention: GII - consisted of 27 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2006 to December 2009 and were submitted to a specific rehabilitative management of swallowing and of the oral-motor movements. Results indicate that the proposed rehabilitative program reduced by approximately 50% the time patients remained in the ICU. The significant improvement observed in patients with tetanus who were submitted to the rehabilitative program for swallowing and oral-motor movements occurred in conjunction with a reduction in the amount of time necessary to reintroduce oral feeding, to decannulate and to remove the feeding tubes. In conclusion, swallowing/muscle exercise, in patients with severe/very severe tetanus, seem to promote the remission of muscle tension and seem to maximize functional swallowing. (C) 2012 Elsevier B.V. All rights reserved.

Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease

OBJECTIVE This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship of functional foods with added plant sterols and/or plant stanols, as components of a healthy lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk. METHODS AND RESULTS Plant sterols/stanols (when taken at 2 g/day) cause significant inhibition of cholesterol absorption and lower LDL-C levels by between 8 and 10%. The relative proportions of cholesterol versus sterol/stanol levels are similar in both plasma and tissue, with levels of sterols/stanols being 500-/10,000-fold lower than those of cholesterol, suggesting they are handled similarly to cholesterol in most cells. Despite possible atherogenicity of marked elevations in circulating levels of plant sterols/stanols, protective effects have been observed in some animal models of atherosclerosis. Higher plasma levels of plant sterols/stanols associated with intakes of 2 g/day in man have not been linked to adverse effects on health in long-term human studies. Importantly, at this dose, plant sterol/stanol-mediated LDL-C lowering is additive to that of statins in dyslipidaemic subjects, equivalent to doubling the dose of statin. The reported 6-9% lowering of plasma triglyceride by 2 g/day in hypertriglyceridaemic patients warrants further evaluation. CONCLUSION Based on LDL-C lowering and the absence of adverse signals, this EAS Consensus Panel concludes that functional foods with plant sterols/stanols may be considered 1) in individuals with high cholesterol levels at intermediate or low global cardiovascular risk who do not qualify for pharmacotherapy, 2) as an adjunct to pharmacologic therapy in high and very high risk patients who fail to achieve LDL-C targets on statins or are statin- intolerant, 3) and in adults and children (>6 years) with familial hypercholesterolaemia, in line with current guidance. However, it must be acknowledged that there are no randomised, controlled clinical trial data with hard end-points to establish clinical benefit from the use of plant sterols or plant stanols.

Management of fever and neutropenia in paediatric cancer patients: room for improvement?

PURPOSE OF REVIEW Fever and neutropenia is the most common complication in the treatment of childhood cancer. This review will summarize recent publications that focus on improving the management of this condition as well as those that seek to optimize translational research efforts. RECENT FINDINGS A number of clinical decision rules are available to assist in the identification of low-risk fever and neutropenia however few have undergone external validation and formal impact analysis. Emerging evidence suggests acute fever and neutropenia management strategies should include time to antibiotic recommendations, and quality improvement initiatives have focused on eliminating barriers to early antibiotic administration. Despite reported increases in antimicrobial resistance, few studies have focused on the prediction, prevention, and optimal treatment of these infections and the effect on risk stratification remains unknown. A consensus guideline for paediatric fever and neutropenia research is now available and may help reduce some of the heterogeneity between studies that have previously limited the translation of evidence into clinical practice. SUMMARY Risk stratification is recommended for children with cancer and fever and neutropenia. Further research is required to quantify the overall impact of this approach and to refine exactly which children will benefit from early antibiotic administration as well as modifications to empiric regimens to cover antibiotic-resistant organisms.

Variation in Current Management of Term and Late-Preterm Neonates at Risk for Early-Onset Sepsis "An International Survey and Review of Guidelines"

BACKGROUND Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management. METHODS A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n=5) were reviewed and compared to the results of the survey. RESULTS 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for five to seven days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations. CONCLUSIONS There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

European legislation and implementation measures in the management of construction and demolition waste.

The intense activity in the construction sector during the last decade has generated huge volumes of construction and demolition (C&D) waste. In average, Europe has generated around 890 million tonnes of construction and demolition waste per year. Although now the activity has entered in a phase of decline, due to the change of the economic cycle, we don’t have to forget all the problems caused by such waste, or rather, by their management which is still far from achieving the overall target of 70% for C&D waste --excludes soil and stones not containing dangerous substances-- should be recycled in the EU Countries by 2020 (Waste Framework Directive). But in fact, the reality is that only 50% of the C&D waste generated in EU is recycled and 40% of it corresponds to the recycling of soil and stones not containing dangerous substances. Aware of this situation, the European Countries are implementing national policies as well as different measures to prevent the waste that can be avoidable and to promote measures to increase recycling and recovering. In this aspect, this article gives an overview of the amount of C&D waste generated in European countries, as well as the amount of this waste that is being recycled and the different measures that European countries have applied to solve this situation.

Legal Aspects which Implement Good Practice Measures in the Management of Construction and Demolition Waste

The construction industry, one of the most important ones in the development of a country, generates unavoidable impacts on the environment. The social demand towards greater respect for the environment is a high and general outcry. Therefore, the construction industry needs to reduce the impact it produces. Proper waste management is not enough; we must take a further step in environmental management, where new measures need to be introduced for the prevention at source, such as good practices to promote recycling. Following the amendment of the legal frame applicable to Construction and Demolition Waste (C&D waste), important developments have been incorporated in European and International laws, aiming to promote the culture of reusing and recycling. This change of mindset, that is progressively taking place in society, is allowing for the consideration of C&D waste no longer as an unusable waste, but as a reusable material. The main objective of the work presented in this paper is to enhance C&D waste management systems through the development of preventive measures during the construction process. These measures concern all the agents intervening in the construction process as only the personal implication of all of them can ensure an efficient management of the C&D waste generated. Finally, a model based on preventive measures achieves organizational cohesion between the different stages of the construction process, as well as promoting the conservation of raw materials through the use and waste minimization. All of these in order to achieve a C&D waste management system, whose primary goal is zero waste generation

Proposal for the Management of temporal and semantic components of Geographic Information

This poster raises the issue of a research work oriented to the storage, retrieval, representation and analysis of dynamic GI, taking into account The ultimate objective is the modelling and representation of the dynamic nature of geographic features, establishing mechanisms to store geometries enriched with a temporal structure (regardless of space) and a set of semantic descriptors detailing and clarifying the nature of the represented features and their temporality. the semantic, the temporal and the spatiotemporal components. We intend to define a set of methods, rules and restrictions for the adequate integration of these components into the primary elements of the GI: theme, location, time [1]. We intend to establish and incorporate three new structures (layers) into the core of data storage by using mark-up languages: a semantictemporal structure, a geosemantic structure, and an incremental spatiotemporal structure. Thus, data would be provided with the capability of pinpointing and expressing their own basic and temporal characteristics, enabling them to interact each other according to their context, and their time and meaning relationships that could be eventually established

Proposal for the Management of temporal and semantic components of Geographic Information

This poster raises the issue of a research work oriented to the storage, retrieval, representation and analysis of dynamic GI, taking into account the semantic, the temporal and the spatiotemporal components. We intend to define a set of methods, rules and restrictions for the adequate integration of these components into the primary elements of the GI: theme, location, time [1]. We intend to establish and incorporate three new structures (layers) into the core of data storage by using mark-up languages: a semantictemporal structure, a geosemantic structure, and an incremental spatiotemporal structure. The ultimate objective is the modelling and representation of the dynamic nature of geographic features, establishing mechanisms to store geometries enriched with a temporal structure (regardless of space) and a set of semantic descriptors detailing and clarifying the nature of the represented features and their temporality. Thus, data would be provided with the capability of pinpointing and expressing their own basic and temporal characteristics, enabling them to interact each other according to their context, and their time and meaning relationships that could be eventually established

Improving the management of water and nitrogen resources in cropping systems by using simulation models

Los modelos de simulación de cultivos permiten analizar varias combinaciones de laboreo-rotación y explorar escenarios de manejo. El modelo DSSAT fue evaluado bajo condiciones de secano en un experimento de campo de 16 años en la semiárida España central. Se evaluó el efecto del sistema de laboreo y las rotaciones basadas en cereales de invierno, en el rendimiento del cultivo y la calidad del suelo. Los modelos CERES y CROPGRO se utilizaron para simular el crecimiento y rendimiento del cultivo, mientras que el modelo DSSAT CENTURY se utilizó en las simulaciones de SOC y SN. Tanto las observaciones de campo como las simulaciones con CERES-Barley, mostraron que el rendimiento en grano de la cebada era mas bajo para el cereal continuo (BB) que para las rotaciones de veza (VB) y barbecho (FB) en ambos sistemas de laboreo. El modelo predijo más nitrógeno disponible en el laboreo convencional (CT) que en el no laboreo (NT) conduciendo a un mayor rendimiento en el CT. El SOC y el SN en la capa superficial del suelo, fueron mayores en NT que en CT, y disminuyeron con la profundidad en los valores tanto observados como simulados. Las mejores combinaciones para las condiciones de secano estudiadas fueron CT-VB y CT-FB, pero CT presentó menor contenido en SN y SOC que NT. El efecto beneficioso del NT en SOC y SN bajo condiciones Mediterráneas semiáridas puede ser identificado por observaciones de campo y por simulaciones de modelos de cultivos. La simulación del balance de agua en sistemas de cultivo es una herramienta útil para estudiar como el agua puede ser utilizado eficientemente. La comparación del balance de agua de DSSAT , con una simple aproximación “tipping bucket”, con el modelo WAVE más mecanicista, el cual integra la ecuación de Richard , es un potente método para valorar el funcionamiento del modelo. Los parámetros de suelo fueron calibrados usando el método de optimización global Simulated Annealing (SA). Un lisímetro continuo de pesada en suelo desnudo suministró los valores observados de drenaje y evapotranspiración (ET) mientras que el contenido de agua en el suelo (SW) fue suministrado por sensores de capacitancia. Ambos modelos funcionaron bien después de la optimización de los parámetros de suelo con SA, simulando el balance de agua en el suelo para el período de calibración. Para el período de validación, los modelos optimizados predijeron bien el contenido de agua en el suelo y la evaporación del suelo a lo largo del tiempo. Sin embargo, el drenaje fue predicho mejor con WAVE que con DSSAT, el cual presentó mayores errores en los valores acumulados. Esto podría ser debido a la naturaleza mecanicista de WAVE frente a la naturaleza más funcional de DSSAT. Los buenos resultados de WAVE indican que, después de la calibración, este puede ser utilizado como "benchmark" para otros modelos para periodos en los que no haya medidas de campo del drenaje. El funcionamiento de DSSAT-CENTURY en la simulación de SOC y N depende fuertemente del proceso de inicialización. Se propuso como método alternativo (Met.2) la inicialización de las fracciones de SOC a partir de medidas de mineralización aparente del suelo (Napmin). El Met.2 se comparó con el método de inicialización de Basso et al. (2011) (Met.1), aplicando ambos métodos a un experimento de campo de 4 años en un área en regadío de España central. Nmin y Napmin fueron sobreestimados con el Met.1, ya que la fracción estable obtenida (SOC3) en las capas superficiales del suelo fue más baja que con Met.2. El N lixiviado simulado fue similar en los dos métodos, con buenos resultados en los tratamientos de barbecho y cebada. El Met.1 subestimó el SOC en la capa superficial del suelo cuando se comparó con una serie observada de 12 años. El crecimiento y rendimiento del cultivo fueron adecuadamente simulados con ambos métodos, pero el N en la parte aérea de la planta y en el grano fueron sobreestimados con el Met.1. Los resultados variaron significativamente con las fracciones iniciales de SOC, resaltando la importancia del método de inicialización. El Met.2 ofrece una alternativa para la inicialización del modelo CENTURY, mejorando la simulación de procesos de N en el suelo. La continua emergencia de nuevas variedades de híbridos modernos de maíz limita la aplicación de modelos de simulación de cultivos, ya que estos nuevos híbridos necesitan ser calibrados en el campo para ser adecuados para su uso en los modelos. El desarrollo de relaciones basadas en la duración del ciclo, simplificaría los requerimientos de calibración facilitando la rápida incorporación de nuevos cultivares en DSSAT. Seis híbridos de maiz (FAO 300 hasta FAO 700) fueron cultivados en un experimento de campo de dos años en un área semiárida de regadío en España central. Los coeficientes genéticos fueron obtenidos secuencialmente, comenzando con los parámetros de desarrollo fenológico (P1, P2, P5 and PHINT), seguido de los parámetros de crecimiento del cultivo (G2 and G3). Se continuó el procedimiento hasta que la salida de las simulaciones estuvo en concordancia con las observaciones fenológicas de campo. Después de la calibración, los parámetros simulados se ajustaron bien a los parámetros observados, con bajos RMSE en todos los casos. Los P1 y P5 calibrados, incrementaron con la duración del ciclo. P1 fue una función lineal del tiempo térmico (TT) desde emergencia hasta floración y P5 estuvo linealmente relacionada con el TT desde floración a madurez. No hubo diferencias significativas en PHINT entre híbridos de FAO-500 a 700 , ya que tuvieron un número de hojas similar. Como los coeficientes fenológicos estuvieron directamente relacionados con la duración del ciclo, sería posible desarrollar rangos y correlaciones que permitan estimar dichos coeficientes a partir de la clasificación del ciclo. ABSTRACT Crop simulation models allow analyzing various tillage-rotation combinations and exploring management scenarios. DSSAT model was tested under rainfed conditions in a 16-year field experiment in semiarid central Spain. The effect of tillage system and winter cereal-based rotations on the crop yield and soil quality was evaluated. The CERES and CROPGRO models were used to simulate crop growth and yield, while the DSSAT CENTURY was used in the SOC and SN simulations. Both field observations and CERES-Barley simulations, showed that barley grain yield was lower for continuous cereal (BB) than for vetch (VB) and fallow (FB) rotations for both tillage systems. The model predicted higher nitrogen availability in the conventional tillage (CT) than in the no tillage (NT) leading to a higher yield in the CT. The SOC and SN in the top layer, were higher in NT than in CT, and decreased with depth in both simulated and observed values. The best combinations for the dry land conditions studied were CT-VB and CT-FB, but CT presented lower SN and SOC content than NT. The beneficial effect of NT on SOC and SN under semiarid Mediterranean conditions can be identified by field observations and by crop model simulations. The simulation of the water balance in cropping systems is a useful tool to study how water can be used efficiently. The comparison of DSSAT soil water balance, with a simpler “tipping bucket” approach, with the more mechanistic WAVE model, which integrates Richard’s equation, is a powerful method to assess model performance. The soil parameters were calibrated by using the Simulated Annealing (SA) global optimizing method. A continuous weighing lysimeter in a bare fallow provided the observed values of drainage and evapotranspiration (ET) while soil water content (SW) was supplied by capacitance sensors. Both models performed well after optimizing soil parameters with SA, simulating the soil water balance components for the calibrated period. For the validation period, the optimized models predicted well soil water content and soil evaporation over time. However, drainage was predicted better by WAVE than by DSSAT, which presented larger errors in the cumulative values. That could be due to the mechanistic nature of WAVE against the more functional nature of DSSAT. The good results from WAVE indicate that, after calibration, it could be used as benchmark for other models for periods when no drainage field measurements are available. The performance of DSSAT-CENTURY when simulating SOC and N strongly depends on the initialization process. Initialization of the SOC pools from apparent soil N mineralization (Napmin) measurements was proposed as alternative method (Met.2). Method 2 was compared to the Basso et al. (2011) initialization method (Met.1), by applying both methods to a 4-year field experiment in a irrigated area of central Spain. Nmin and Napmin were overestimated by Met.1, since the obtained stable pool (SOC3) in the upper layers was lower than from Met.2. Simulated N leaching was similar for both methods, with good results in fallow and barley treatments. Method 1 underestimated topsoil SOC when compared with a 12-year observed serial. Crop growth and yield were properly simulated by both methods, but N in shoots and grain were overestimated by Met.1. Results varied significantly with the initial SOC pools, highlighting the importance of the initialization procedure. Method 2 offers an alternative to initialize the CENTURY model, enhancing the simulation of soil N processes. The continuous emergence of new varieties of modern maize hybrids limits the application of crop simulation models, since these new hybrids should be calibrated in the field to be suitable for model use. The development of relationships based on the cycle duration, would simplify the calibration requirements facilitating the rapid incorporation of new cultivars into DSSAT. Six maize hybrids (FAO 300 through FAO 700) were grown in a 2-year field experiment in a semiarid irrigated area of central Spain. Genetic coefficients were obtained sequentially, starting with the phenological development parameters (P1, P2, P5 and PHINT), followed by the crop growth parameters (G2 and G3). The procedure was continued until the simulated outputs were in good agreement with the field phenological observations. After calibration, simulated parameters matched observed parameters well, with low RMSE in most cases. The calibrated P1 and P5 increased with the duration of the cycle. P1 was a linear function of the thermal time (TT) from emergence to silking and P5 was linearly related with the TT from silking to maturity . There were no significant differences in PHINT between hybrids from FAO-500 to 700 , as they had similar leaf number. Since phenological coefficients were directly related with the cycle duration, it would be possible to develop ranges and correlations which allow to estimate such coefficients from the cycle classification.