Diferencia entre tratamientos en pacientes con angioma cavernoso del tallo cerebral en el instituto nacional de neurología y neurocirugía Manuel Velasco Suárez

Introducción: la historia natural de la hemorragia en el tallo cerebral secundaria a un angioma cavernoso es benigna. Sin embargo, el riesgo de recurrencia y de mayor discapacidad parece incrementarse con el tiempo a pesar del tratamiento recibido; hecho que plantea dudas acerca de si el manejo quirúrgico de estas lesiones ofrece mayor beneficio sobre el manejo médico después del primer evento hemorrágico. El objetivo del estudio fue evaluar el riesgo de resangrado y el grado de discapacidad final en los angiomas cavernosos del tallo cerebral según el tratamiento recibido. Métodos: estudio observacional, analítico tipo cohorte. Se incluyeron pacientes con un primer sangrado en el tallo cerebral secundario a angioma cavernoso que fueron tratados en el Instituto Nacional de Neurología y Neurocirugía (INNN) de Ciudad de México. Resultados: noventa y nueve (99) pacientes fueron incluidos en un periodo de 25 años (1990-2015). Treinta y siete (37) recibieron tratamiento quirúrgico y sesenta y dos (62) recibieron tratamiento médico tras su primer sangrado. El promedio de edad fue de 38 años (DS: 14,17) para el grupo que recibió tratamiento médico y 36 años (DS: 12,82) para los que recibieron tratamiento quirúrgico. La incidencia acumulada de resangrado para el tratamiento médico fue de 5,1 por 100 años/persona y para el tratamiento quirúrgico de 3,9 por 100 años/persona (p = 0,016). Se realizó un análisis estratificado donde no se encontró ninguna asociación entre resangrado y edad o sexo del paciente. Se evaluó la discapacidad final con la escala de Rankin (mRs) sin encontrar diferencias significativas entre tratamientos (p=0.77). Por último, se realizó un modelo explicativo de regresión logística binaria donde se encontró que la edad superior a 55 años (OR: 2.19 IC 95%: 1.67-47,6), el tamaño mayor a 15 mm (OR: 2,5 IC 95%: 3,8-45,9) y la recurrencia del sangrado (OR: 1,7 IC 95%: 1,63-18,7) son factores asociados a un desenlace desfavorable en cuanto a discapacidad final. Discusión y Conclusiones: en los pacientes con angioma cavernoso del tallo cerebral que han presentado un primer evento de sangrado no se encontró una diferencia estadísticamente significativa entre el tratamiento médico o quirúrgico al evaluar la discapacidad funcional con la escala de Rankin modificada, a pesar de evidenciar una diferencia significativa en la incidencia acumulada de resangrado por grupos de tratamiento. El tamaño de la lesión, la recurrencia del sangrado y la edad superior a 55 años son factores asociados a un desenlace desfavorable en este grupo de pacientes.

La cooperación internacional para el desarrollo como herramienta de política exterior japonesa en África Subsahariana

El presente caso de estudio tiene como objetivo explicar el rol de la cooperación internacional para el desarrollo en Tanzania, Mozambique, Nigeria para la consolidación del liderazgo político internacional de Japón. El interés de realizar esta investigación es la ampliación del conocimiento sobre el uso del poder blando, para alcanzar los objetivos de política exterior japonesa. Por eso, se llevara a cabo una revisión bibliográfica para el análisis de documentos oficiales y artículos académicos para la consolidación de información. A partir de ello, se pretende demostrar que la cooperación al desarrollo es una herramienta de política exterior japonesa para consolidarse como líder, en la medida en que el uso de herramientas propias de la cooperación y el presupuesto destinada a la ejecución de éstas tienen incidencia en los votos de estos Estados africanos para las iniciativas japonesas en las Naciones Unidas.

Integración de sensores de teléfonos en servicios de sensores OGC

Presentación de gvSIG Mobile Sensor, que integra la tecnología SOS (Sensor Observation Service) en los dispositivos móviles a partir de una nueva extensión de gvSIG Mobile. Esta funcionalidad almacena las peticiones SOS en plantillas, representado a los distintos sensores registrados. Las plantillas sirven para transformar los datos obtenidos por el sensor en un instante dado, en peticiones de inserción de observación válidas para el servicio SOS-T

Amenzas a través de la telefonía móvil e internet: perfil psicológico y consecuencias emocionales

En los últimos años se ha producido un incremento del uso de la telefonía móvil e Internet con fines intimidatorios o simplemente para amenazar a los iguales en los centros escolares de nuestro país. Con la voluntad de aportar datos que puedan ayudar a su prevención, se ha realizado un estudio de encuesta en el que se ha obtenido información relativa a las amenazas recibidas a través de los nuevos medios de comunicación, es decir, Internet y la telefonía móvil. Los resultados indican que un 23.3% de los estudiantes de los centros públicos de Enseñanza Secundaria Obligatoria de la ciudad de Girona (Cataluña), durante el curso escolar, han recibido vía Internet o telefonía móvil algún mensaje que, por su contenido, ha supuesto una amenaza para su bienestar. Se analizan las consecuencias emocionales y las estrategias de afrontamiento utilizadas por parte de estos adolescentes

Measurement Quality in Indicators of Compositions: a Compositional Multitrait-Multimethod Approach

Compositional data, also called multiplicative ipsative data, are common in survey research instruments in areas such as time use, budget expenditure and social networks. Compositional data are usually expressed as proportions of a total, whose sum can only be 1. Owing to their constrained nature, statistical analysis in general, and estimation of measurement quality with a confirmatory factor analysis model for multitrait-multimethod (MTMM) designs in particular are challenging tasks. Compositional data are highly non-normal, as they range within the 0-1 interval. One component can only increase if some other(s) decrease, which results in spurious negative correlations among components which cannot be accounted for by the MTMM model parameters. In this article we show how researchers can use the correlated uniqueness model for MTMM designs in order to evaluate measurement quality of compositional indicators. We suggest using the additive log ratio transformation of the data, discuss several approaches to deal with zero components and explain how the interpretation of MTMM designs di ers from the application to standard unconstrained data. We show an illustration of the method on data of social network composition expressed in percentages of partner, family, friends and other members in which we conclude that the faceto-face collection mode is generally superior to the telephone mode, although primacy e ects are higher in the face-to-face mode. Compositions of strong ties (such as partner) are measured with higher quality than those of weaker ties (such as other network members)

Indicadores da individualização de cuidados para o curso de licenciatura em enfermagem

RESUMO: A individualização dos cuidados de enfermagem tem sido associada a uma evolução clínica mais favorável, representando um importante parâmetro de avaliação e de desenvolvimento dos serviços de saúde. A tónica atribuída a esta problemática não só é evidenciada por diversos autores, como se enquadra nas metas de modernização do Sistema Nacional de Saúde e é destaque em vários códigos normativos da profissão nacionais e internacionais, como uma obrigação moral e deontológica. Assim, pretende-se mediante os ganhos em saúde sensíveis às intervenções de enfermagem, identificar quais indicadores do cuidado individualizado, para se efectivar a sua incorporação na formação inicial em enfermagem. Para tal efeito, construiu-se uma bateria de indicadores mediante análise de duas revisões sistemáticas da literatura, que teve por base o Modelo da Eficácia do Papel de Enfermagem, desenvolvido por Irvine et al. (1998). Para à adaptação à realidade portuguesa recorreu-se à técnica de Delphi, com duas rondas, que incluiu respectivamente, 12 e 10 peritos de enfermagem. Na análise de dados utilizou-se o nível de concordância superior ou igual a 90%, na última ronda. Na segunda fase do estudo, aplicou-se um inquérito por questionário (α de Cronbach = 0,919) para testar a sua aplicabilidade dos indicadores, a 156 enfermeiros, do mesmo hospital da área da grande Lisboa, no Serviço de Medicina e Cirurgia. Recorreu-se ao SPSS, versão 19 e realizou-se análise univariada e estatística analítica. Na bateria final de indicadores foram incorporados aqueles com ponderação positiva (≥51%). Os dados qualitativos obtidos foram submetidos a análise de conteúdo. Dos 58 indicadores iniciais, consolidaram-se 8 categorias: cuidado à pessoa em fim de vida e família, toque terapêutico, educação para a auto-gestão da saúde, cuidados de proximidade, gestão de casos, empoderamento/ literacia para a saúde, linha telefónica de apoio permanente/ tele-assistência e apoio psico-emocional, com valorização de 28 indicadores. O tempo de experiência profissional, tipo de serviço e tempo de permanência no mesmo serviço influenciou a percepção dos enfermeiros, confirmando os pressupostos de Irvine et al. (1998) e Benner (2001). A correlação total dos indicadores, no questionário, variou entre 0,248 e 0,650, para p<0,01. O facto de todas as correlações serem positivas significa que provavelmente estão associados à problemática da individualização, pelo que se sugere a sua transposição para o ensino de enfermagem. ABSTRACT: The individualization of nursing care has been associated with a more favorable clinical evolution, an important parameter for the evaluation and development of health services. The emphasis given to this problem is not only evidenced by several authors, as fits the goals of modernizing the National Health System and is featured in several normative codes of the profession nationally and internationally, as a moral and ethical obligation. Thus, it is intended by the gains in health sensitive to nursing interventions, identify indicators of individualized care and give effect to its incorporation into the initial training in nursing. For this purpose, we constructed a series of indicators by analyzing two systematic reviews of literature, which was based on the The Nursing Role Effectiveness Model developed by Irvine et al. (1998). For the adaptation to the Portuguese appealed to the Delphi technique with two rounds, which included, respectively, 10 and 12 nursing experts. In data analysis we used the level of agreement greater than or equal to 90% in the last round. In the second phase of the study, we applied a questionnaire (Cronbach's α = 0.919) to test the applicability of the indicators, the 156 nurses in the same hospital in the Greater Lisbon area, the Department of Medicine and Surgery. Done using the SPSS, version 19 and conducted a univariate analysis and analytical statistics. In the final heat of indicators were incorporated into those with positive weight (≥ 51%). Qualitative data were subjected to content analysis. Of the initial 58 indicators, eight were consolidated categories: care to the person and family life, therapeutic touch education for self-management of health care outreach, case management, empowerment / literacy to health, a telephone line permanent support / tele-assistance and psycho-emotional, with an appreciation of 28 indicators. The length of professional experience, type of service and length of stay in the same service influenced the perception of nurses, confirming the assumptions of Irvine et al. (1998) and Benner (2001). The total correlation of the indicators in the questionnaire ranged between 0.248 and 0.650, p <0.01. The fact that all correlations are positive means that are probably associated with the problem of individuation, which is suggested by its implementation in nursing education.

O papel do operador telemarketing : processo de negociação e conflito via telefone

A negociação é um processo complexo que ocorre diariamente no quotidiano de todos os actores organizacionais. Enquanto processo de resolução de conflitos, a negociação, implica uma actividade de intersecção social entre diversos actores, quando duas ou mais partes se desentendem e têm comportamentos e atitudes divergentes, a negociação envolve a gestão destes aspectos de modo que ambas as partes resolvam os interesses aceitáveis para ambas. Nesse sentido, em pleno acto de negociação via telefone, a qualidade do atendimento telefónico, num primeiro contacto com o cliente transmite a imagem da empresa é fundamental para o desenrolar da chamada. Actualmente existem milhares de equipas de telemarketing nas empresas, que tem como função divulgar e comercializar produtos e serviços através do contacto telefónico. Na elaboração deste trabalho, é possível verificar que num processo de negociação via telefone os colaboradores devem adoptar os seus comportamentos em função das situações que estão a experienciar, quer as mesmas se revelem positivas ou negativas. Ainda outro conceito que abordamos é o conflito, o mesmo encontra-se presente em diferentes sistemas sociais, desde o individual, o familiar, o grupal, o organizacional ao internacional, entre outros. Os conflitos surgem por diversas razões no dia-a-dia das organizações e até mesmo no quotidiano da nossa vida pessoal, vivemos o conflito de diferentes maneiras. O conflito ocorre, normalmente, mais como um processo contínuo e sequencial do que como um facto isolado. Geralmente, o conflito surge quando uma ou ambas as partes vê ou pressentem ameaçados os seus planos ou escolhas. É ainda mencionado o conceito telemarketing que surgiu nos anos 80 nos EUA, significando vendas por telefone.

Difference between default telecoil and programmed microphone frequency response in behind-the-ear hearing aids

The notion that the default telecoil (t-coil) frequency response should match the programmed microphone frequency response to provide optimal telephone understanding for hearing aid patients has received little attention. This study addresses differences in the average frequency response of the two transducers in behind-the-ear (BTE) hearing aids.

Public values for badgers, bovine TB reduction and management strategies

This paper applies an attribute-based stated choice experiment approach to estimate the value that society places on changes to the size of the badger population in England and Wales. The study was undertaken in the context of a rising incidence of bovine tuberculosis (bTB) in cattle and the government's review of current bTB control policy. This review includes consideration of culling badgers to reduce bTB in cattle, since badgers are thought to be an important wildlife reservoir for the disease. The design of the CE involved four attributes (size of badger population, cattle slaughtered due to bTB, badger management strategy and household tax) at four levels with eight choice sets of two alternatives presented to respondents. Telephone interviews were undertaken with over 400 respondents, which elicited their attitudes and preferences concerning badgers, bTB in cattle and badger management strategies. The study estimated a willingness to pay of 0.10 pound per household per year per 100,000 badgers and 1.52 pound per household per year per 10,000 cattle slaughtered due to bTB which aggregated to 22 per badger and 3298 pound per bTB slaughtered animal for all households in England and Wales. Management strategy toward badgers had a very high valuation, highlighting the emotive issue of badger culling for respondents and the importance of government policy towards badgers.

Measuring and comparing constraints to improved biosecurity amongst GB farmers, veterinarians and the auxiliary industries

Constraints to the introduction of enhanced biosecurity systems are rarely considered in sufficient detail when population medicine specialists initiate new control schemes. The main objective of our research was to investigate and compare the different attitudes constraining improvement in biosecurity for cattle and sheep farmers, practising veterinary surgeons and the auxiliary industries in Great Britain (GB). This study was carried out utilizing farmer focus groups, a questionnaire survey of veterinary practitioners and a telephone survey of auxiliary industry representatives. It appears that farmers and veterinarians have their own relatively clear definitions for biosecurity in relation to some major diseases threatening GB agriculture. Overall, farmers believe that other stakeholders, such as the government, should make a greater contribution towards biosecurity within GB. Conversely, veterinary practitioners saw their clients' ability or willingness to invest in biosecurity measures as a major constraint. Veterinary practitioners also felt that there was need for additional proof of efficacy and/or the potential economic benefits of proposed farm biosecurity practices better demonstrated. Auxiliary industries, in general, were not certain of their role in biosecurity although study participants highlighted zoonoses as part of the issue and offered that most of the constraints operated at farm level. (C) 2008 Elsevier B.V. All rights reserved.

Measuring and comparing constraints to improved biosecurity amongst GB farmers, veterinarians and the auxiliary industries

Constraints to the introduction of enhanced biosecurity systems are rarely considered in sufficient detail when population medicine specialists initiate new control schemes. The main objective of our research was to investigate and compare the different attitudes constraining improvement in biosecurity for cattle and sheep farmers, practising veterinary surgeons and the auxiliary industries in Great Britain (GB). This study was carried out utilizing farmer focus groups, a questionnaire survey of veterinary practitioners and a telephone survey of auxiliary industry representatives. It appears that farmers and veterinarians have their own relatively clear definitions for biosecurity in relation to some major diseases threatening GB agriculture. Overall, farmers believe that other stakeholders, such as the government, should make a greater contribution towards biosecurity within GB. Conversely, veterinary practitioners saw their clients' ability or willingness to invest in biosecurity measures as a major constraint. Veterinary practitioners also felt that there was need for additional proof of efficacy and/or the potential economic benefits of proposed farm biosecurity practices better demonstrated. Auxiliary industries, in general, were not certain of their role in biosecurity although study participants highlighted zoonoses as part of the issue and offered that most of the constraints operated at farm level. (C) 2008 Elsevier B.V. All rights reserved.

Is NHS Direct meeting the needs of mental health callers?

Background: NHS Direct is a new service that offers 24-hour advice from trained nurses. The National Service Framework for Mental Health and the National Strategy for Carers both mention NHS Direct as an important source of support for people with mental health problems. Aims: This paper reports findings from an evaluation of the Department of Health's NHS Direct mental health initiative. This initiative was established to ensure that NHS Direct can meet the needs of callers with mental health problems by offering additional training to all staff and improving the database of mental health services. Method: The findings reported here are based on routine computer data provided by 12 out of 17 NHS Direct sites, 552 data forms completed by nurse advisers from the 17 sites, and 111 questionnaires administered over the telephone with callers to the 17 sites. Results: Mental health calls accounted for 3% of NHS Direct's workload, although these calls were often longer and more complex than other calls. The majority of callers to the service were in touch with other services for their mental health problems (59%), typically their GP. Most callers had 'moderate' mental health problems, as indicated by the Global Assessment of Functioning Scale. Generally callers were satisfied with the service they received, although satisfaction was lower in some areas than previous studies of NHS Direct. Conclusions: Improvements could be made in the mechanisms for referring callers on to other services, and training to increase nurse advisers' knowledge of mental health problems.

Farmers’ willingness to pay for a tuberculosis cattle vaccine

We use contingent valuation (CV) and choice experiment (CE) methods to assess cattle farmers’ attitudes to and willingness to pay (WTP) for a bovine tuberculosis (bTB) cattle vaccine, to help inform vaccine development and policy. A survey questionnaire was administered by means of telephone interviews to a stratified sample of 300 cattle farmers in annually bTB-tested areas in England and Wales. Farmers felt that bTB was a major risk for the cattle industry and that there was a high risk of their cattle getting the disease. The CE estimate produced a mean WTP of £35 per animal per single dose for a vaccine that is 90% effective at reducing the risk of a bTB breakdown and an estimated £55 for such a vaccine backed by 100% insurance of loss if a breakdown should occur. The CV estimate produced a mean WTP of nearly £17 per dose/per animal/per year for a vaccine (including 100% insurance) which, given the average lifespan of cattle, is comparable to the CE estimate. These WTP estimates are substantially higher than the expected cost of a vaccine which suggests that farmers in high risk bTB ‘hotspot’ areas perceive a substantial net benefit from buying the vaccine.

Cloud based global positioning system as a safety monitor for dementia patients

The aim of using GPS for Alzheimer's Patients is to give carers and families of those affected by Alzheimer's Disease, as well as all the other dementia related conditions, a service that can, via SMS text message, notify them should their loved one leave their home. Through a custom website, it enables the carer to remotely manage a contour boundary that is specifically assigned to the patient as well as the telephone numbers of the carers. The technique makes liberal use of such as Google Maps.

Is there a demand for sustainable offices? An analysis of UK business occupier moves (2006–2008)

‘Sustainable’ or ‘green’ commercial buildings are frequently seen as a growth sector in the property investment market. This research examines the emergence of sustainable commercial buildings in both the UK and overseas. The empirical part of the paper is based on a telephone survey of 50 UK corporate (private sector) occupiers taking leased and owner–occupied office space, which was carried out during the period of April to November 2008. The survey focused on actual moves made within the previous two years, or moves that were imminent during 2006–2008. The research suggests that although there is an emerging and increasing demand for sustainable offices in the UK, other factors such as location and availability of stock continue to remain more important than sustainability in determining occupiers’ final choice of office. Occupiers who moved to a Building Research Establishment Environmental Assessment Method (BREEAM)‐rated building, and were in business sectors with strong environmental and corporate responsibility policies, placed more emphasis on sustainability than other groups in the final choice of office, but location and availability remained paramount.