Defensa de la vida física del paciente en estado terminal : entre la dignidad y la autonomía

Resumen: Proponemos un análisis crítico de los fundamentos que sustentan la llamada “Ley de Muerte Digna” incorporada en la Ley que consagra la regulación de los derechos del paciente, historia clínica, consentimiento informado, (Art. 2º, inc. “e” párr. 2º de la Ley 26.529 modificada por la Ley 26.742), que introduce en nuestro país la existencia real de un sistema eutanásico formal sin fundamentos de orden científico, éticos e incluso jurídicos. ¿Es moralmente lícito suprimir la vida del enfermo terminal?, ¿la legalización de esta práctica eutanásica es la primera piedra de una nueva “cultura” de la vida? Entendemos que la llamada “tesis de la autonomía”, fundante de la reforma legislativa en cuestión, desde una óptica Bioética personalista, merece serias objeciones bioéticas ya que puede distorsionar gravemente el ejercicio de la medicina y la relación médico paciente.

La deshumanización en la atención profesional : ¿vulnera el derecho a la intimidad?

Resumen: El problema de la deshumanización de la atención médica sido enfocado desde ópticas diferentes (y en diversos momentos históricos), ya sea desde la perspectiva del paciente, de los familiares o del propio equipo de salud que presta los servicios, pero no hay un estudio de las causas y de las posibles soluciones. Al realizar un recorrido de la atención profesional en el mundo de la salud observamos que solo podemos re humanizar esa atención con el compromiso directo de todos los participantes del equipo de salud para promover actos y condiciones que tengan como finalidad el respeto de los derechos humanos que se afirman en la dignidad de cada persona enferma. Creemos que esta presentación puede llevar a tomar conciencia sobre la vulnerabilidad de la intimidad en el proceso, hoy deshumanizante, de la atención profesional en el ámbito de la salud y desde este punto de partida asumiendo las responsabilidades subjetivas, sin anular la moralidad objetiva del hecho, comprometiéndonos a denunciar estas situaciones injustas y a trabajar día a día para humanizar la atención y de esta forma respetar el derecho a la intimidad.

On The Interaction Of Channeling/Segmentation Cracks Of Coating: Study On The Critical Spacing

Channeling/segmentation cracks may arise in the coating subjected to in-plane tensile stress. The interaction between these multiple cracks, say the effect of the spacing between two adjacent cracks oil the behaviors of channels themselves and the interface around the interface corners, attracts wide interest. However, if the spacing is greater than a specific magniture,, namely the Critical Spacing (CS), there should be no interaction between such channeling/segmentation cracks. In this study, file mechanism of the effect of the crack spacing oil the interfacial stress around the interface corner will be Interpreted firstly. Then the existence of the CS will be verified and the relationship between the CS and the so-called stress transfer length Ill coating will be established for plane strain condition. Finally, the dependence of the stress transfer length, simultaneously of the CS, on the sensitive parameters will be investigated with finite element method and expressed with a simple empirical formula. (C) 2007 Elsevier Ltd. All rights reserved.

Paulo Orosio : una interpretación de la historiografía providencialista cristiana ante la caída de Roma en el 410

Resumen: En el entramado histórico del mundo Romano, la vida política y religiosa se han visto imbricadas de modo particular. El mito político ha sido fundamental para hilvanar el devenir de los hechos históricos centrales en el modo de vida de los romanos. La caída de Roma o el fin de la Pars Occidentalis del Imperio Romano han servido de arquetipo histórico o de referente político para el resto de los Imperios del Mundo Occidental. En ese contexto se insertará este trabajo, que pretenderá echar luz a una temática rodeada por líneas historiográficas y analíticas no solo diferentes sino antagónicas. El centro de la discordia historiográfica de hoy se pondrá en sincronía con la discordia histórica de ayer, puesto que tanto los paganos como los cristianos forjaron durante la Tardo-antigüedad un mito de fin de ciclo, que le agrega una fascinación particular a esta temática. En este trabajo me abocaré a interpretar la postura del historiador romano - cristiano Paulo Orosio, quien describió su propia visión sobre los hechos que antecedieron y provocaron, la caída de Roma.

Modeling, numerical methods, and simulation for particle-fluid two-phase flow problems

In this paper, we study the issues of modeling, numerical methods, and simulation with comparison to experimental data for the particle-fluid two-phase flow problem involving a solid-liquid mixed medium. The physical situation being considered is a pulsed liquid fluidized bed. The mathematical model is based on the assumption of one-dimensional flows, incompressible in both particle and fluid phases, equal particle diameters, and the wall friction force on both phases being ignored. The model consists of a set of coupled differential equations describing the conservation of mass and momentum in both phases with coupling and interaction between the two phases. We demonstrate conditions under which the system is either mathematically well posed or ill posed. We consider the general model with additional physical viscosities and/or additional virtual mass forces, both of which stabilize the system. Two numerical methods, one of them is first-order accurate and the other fifth-order accurate, are used to solve the models. A change of variable technique effectively handles the changing domain and boundary conditions. The numerical methods are demonstrated to be stable and convergent through careful numerical experiments. Simulation results for realistic pulsed liquid fluidized bed are provided and compared with experimental data. (C) 2004 Elsevier Ltd. All rights reserved.

A BIEM optimization method for fracture dynamics inverse problem

In the present paper, based on the theory of dynamic boundary integral equation, an optimization method for crack identification is set up in the Laplace frequency space, where the direct problem is solved by the author's new type boundary integral equations and a method for choosing the high sensitive frequency region is proposed. The results show that the method proposed is successful in using the information of boundary elastic wave and overcoming the ill-posed difficulties on solution, and helpful to improve the identification precision.

Fine mapping and functional analysis of the multiple sclerosis risk gene CD6

CD6 has recently been identified and validated as risk gene for multiple sclerosis (MS), based on the association of a single nucleotide polymorphism (SNP), rs17824933, located in intron 1. CD6 is a cell surface scavenger receptor involved in T-cell activation and proliferation, as well as in thymocyte differentiation. In this study, we performed a haptag SNP screen of the CD6 gene locus using a total of thirteen tagging SNPs, of which three were non-synonymous SNPs, and replicated the recently reported GWAS SNP rs650258 in a Spanish-Basque collection of 814 controls and 823 cases. Validation of the six most strongly associated SNPs was performed in an independent collection of 2265 MS patients and 2600 healthy controls. We identified association of haplotypes composed of two non-synonymous SNPs [rs11230563 (R225W) and rs2074225 (A257V)] in the 2nd SRCR domain with susceptibility to MS (Pmax(T) permutation=161024). The effect of these haplotypes on CD6 surface expression and cytokine secretion was also tested. The analysis showed significantly different CD6 expression patterns in the distinct cell subsets, i.e. – CD4+ naı¨ve cells, P = 0.0001; CD8+ naı¨ve cells, P,0.0001; CD4+ and CD8+ central memory cells, P = 0.01 and 0.05, respectively; and natural killer T (NKT) cells, P = 0.02; with the protective haplotype (RA) showing higher expression of CD6. However, no significant changes were observed in natural killer (NK) cells, effector memory and terminally differentiated effector memory T cells. Our findings reveal that this new MS-associated CD6 risk haplotype significantly modifies expression of CD6 on CD4+ and CD8+ T cells.

Clinical factors associated with a Candida albicans Germ Tube Antibody positive test in Intensive Care Unit patients

Background: Poor outcomes of invasive candidiasis (IC) are associated with the difficulty in establishing the microbiological diagnosis at an early stage. New scores and laboratory tests have been developed in order to make an early therapeutic intervention in an attempt to reduce the high mortality associated with invasive fungal infections. Candida albicans IFA IgG has been recently commercialized for germ tube antibody detection (CAGTA). This test provides a rapid and simple diagnosis of IC (84.4% sensitivity and 94.7% specificity). The aim of this study is to identify the patients who could be benefited by the use of CAGTA test in critical care setting. Methods: A prospective, cohort, observational multicentre study was carried out in six medical/surgical Intensive care units (ICU) of tertiary-care Spanish hospitals. Candida albicans Germ Tube Antibody test was performed twice a week if predetermined risk factors were present, and serologically demonstrated candidiasis was considered if the testing serum dilution was >= 1: 160 in at least one sample and no other microbiological evidence of invasive candidiasis was found. Results: Fifty-three critically ill non-neutropenic patients (37.7% post surgery) were included. Twenty-two patients (41.5%) had CAGTA-positive results, none of them with positive blood culture for Candida. Neither corrected colonization index nor antifungal treatment had influence on CAGTA results. This finding could corroborate that the CAGTA may be an important biomarker to distinguish between colonization and infection in these patients. The presence of acute renal failure at the beginning of the study was more frequent in CAGTA-negative patients. Previous surgery was statistically more frequent in CAGTA-positive patients. Conclusions: This study identified previous surgery as the principal clinical factor associated with CAGTA-positive results and emphasises the utility of this promising technique, which was not influenced by high Candida colonization or antifungal treatment. Our results suggest that detection of CAGTA may be important for the diagnosis of invasive candidiasis in surgical patients admitted in ICU.

Nonlinear Fluid Damping In Structure-Wake Oscillators In Modeling Vortex-Induced Vibrations

A Nonlinear Fluid Damping (NFD) in the form of the square-velocity is applied in the response analysis of Vortex-induced Vibrations (VIV). Its nonlinear hydrodynamic effects oil the coupled wake and structure oscillators are investigated. A comparison between the coupled systems with the linear and nonlinear fluid dampings and experiments shows that the NFD model can well describe response characteristics, such as the amplification of body displacement at lock-in and frequency lock-ill, both at high and low mass ratios. Particularly, the predicted peak amplitude of the body in the Griffin plot is ill good agreement with experimental data and empirical equation, indicating the significant effect of the NFD on the structure motion.

The diagnostics of density distribution for inhomogeneous dense DT plasmas using fast protons

The density distribution of inhomogeneous dense deuterium-tritium plasmas in laser fusion is revealed by the energy loss of fast protons going through the plasma. In our simulation of a plasma density diagnostics, the fast protons used for the diagnostics may be generated in the laser-plasma interaction. Dividing a two-dimensional area into grids and knowing the initial and final energies of the protons, we can obtain a large linear and ill-posed equation set. for the densities of all grids, which is solved with the Tikhonov regularization method. We find that the accuracy of the set plan with four proton sources is better than those of the set plans with less than four proton sources. Also we have done the density reconstruction especially. for four proton sources with and without assuming circularly symmetrical density distribution, and find that the accuracy is better for the reconstruction assuming circular symmetry. The error is about 9% when no noise is added to the final energy for the reconstruction of four proton sources assuming circular symmetry. The accuracies for different random noises to final proton energies with four proton sources are also calculated.

Mathematical study of complex networks : brain, internet, and power grid

The dissertation is concerned with the mathematical study of various network problems. First, three real-world networks are considered: (i) the human brain network (ii) communication networks, (iii) electric power networks. Although these networks perform very different tasks, they share similar mathematical foundations. The high-level goal is to analyze and/or synthesis each of these systems from a “control and optimization” point of view. After studying these three real-world networks, two abstract network problems are also explored, which are motivated by power systems. The first one is “flow optimization over a flow network” and the second one is “nonlinear optimization over a generalized weighted graph”. The results derived in this dissertation are summarized below.

Brain Networks: Neuroimaging data reveals the coordinated activity of spatially distinct brain regions, which may be represented mathematically as a network of nodes (brain regions) and links (interdependencies). To obtain the brain connectivity network, the graphs associated with the correlation matrix and the inverse covariance matrix—describing marginal and conditional dependencies between brain regions—have been proposed in the literature. A question arises as to whether any of these graphs provides useful information about the brain connectivity. Due to the electrical properties of the brain, this problem will be investigated in the context of electrical circuits. First, we consider an electric circuit model and show that the inverse covariance matrix of the node voltages reveals the topology of the circuit. Second, we study the problem of finding the topology of the circuit based on only measurement. In this case, by assuming that the circuit is hidden inside a black box and only the nodal signals are available for measurement, the aim is to find the topology of the circuit when a limited number of samples are available. For this purpose, we deploy the graphical lasso technique to estimate a sparse inverse covariance matrix. It is shown that the graphical lasso may find most of the circuit topology if the exact covariance matrix is well-conditioned. However, it may fail to work well when this matrix is ill-conditioned. To deal with ill-conditioned matrices, we propose a small modification to the graphical lasso algorithm and demonstrate its performance. Finally, the technique developed in this work will be applied to the resting-state fMRI data of a number of healthy subjects.

Communication Networks: Congestion control techniques aim to adjust the transmission rates of competing users in the Internet in such a way that the network resources are shared efficiently. Despite the progress in the analysis and synthesis of the Internet congestion control, almost all existing fluid models of congestion control assume that every link in the path of a flow observes the original source rate. To address this issue, a more accurate model is derived in this work for the behavior of the network under an arbitrary congestion controller, which takes into account of the effect of buffering (queueing) on data flows. Using this model, it is proved that the well-known Internet congestion control algorithms may no longer be stable for the common pricing schemes, unless a sufficient condition is satisfied. It is also shown that these algorithms are guaranteed to be stable if a new pricing mechanism is used.

Electrical Power Networks: Optimal power flow (OPF) has been one of the most studied problems for power systems since its introduction by Carpentier in 1962. This problem is concerned with finding an optimal operating point of a power network minimizing the total power generation cost subject to network and physical constraints. It is well known that OPF is computationally hard to solve due to the nonlinear interrelation among the optimization variables. The objective is to identify a large class of networks over which every OPF problem can be solved in polynomial time. To this end, a convex relaxation is proposed, which solves the OPF problem exactly for every radial network and every meshed network with a sufficient number of phase shifters, provided power over-delivery is allowed. The concept of “power over-delivery” is equivalent to relaxing the power balance equations to inequality constraints.

Flow Networks: In this part of the dissertation, the minimum-cost flow problem over an arbitrary flow network is considered. In this problem, each node is associated with some possibly unknown injection, each line has two unknown flows at its ends related to each other via a nonlinear function, and all injections and flows need to satisfy certain box constraints. This problem, named generalized network flow (GNF), is highly non-convex due to its nonlinear equality constraints. Under the assumption of monotonicity and convexity of the flow and cost functions, a convex relaxation is proposed, which always finds the optimal injections. A primary application of this work is in the OPF problem. The results of this work on GNF prove that the relaxation on power balance equations (i.e., load over-delivery) is not needed in practice under a very mild angle assumption.

Generalized Weighted Graphs: Motivated by power optimizations, this part aims to find a global optimization technique for a nonlinear optimization defined over a generalized weighted graph. Every edge of this type of graph is associated with a weight set corresponding to the known parameters of the optimization (e.g., the coefficients). The motivation behind this problem is to investigate how the (hidden) structure of a given real/complex valued optimization makes the problem easy to solve, and indeed the generalized weighted graph is introduced to capture the structure of an optimization. Various sufficient conditions are derived, which relate the polynomial-time solvability of different classes of optimization problems to weak properties of the generalized weighted graph such as its topology and the sign definiteness of its weight sets. As an application, it is proved that a broad class of real and complex optimizations over power networks are polynomial-time solvable due to the passivity of transmission lines and transformers.

The deep ocean density structure at the Last Glacial Maximum : What was it and why?

The search for reliable proxies of past deep ocean temperature and salinity has proved difficult, thereby limiting our ability to understand the coupling of ocean circulation and climate over glacial-interglacial timescales. Previous inferences of deep ocean temperature and salinity from sediment pore fluid oxygen isotopes and chlorinity indicate that the deep ocean density structure at the Last Glacial Maximum (LGM, approximately 20,000 years BP) was set by salinity, and that the density contrast between northern and southern sourced deep waters was markedly greater than in the modern ocean. High density stratification could help explain the marked contrast in carbon isotope distribution recorded in the LGM ocean relative to that we observe today, but what made the ocean's density structure so different at the LGM? How did it evolve from one state to another? Further, given the sparsity of the LGM temperature and salinity data set, what else can we learn by increasing the spatial density of proxy records?

We investigate the cause and feasibility of a highly and salinity stratified deep ocean at the LGM and we work to increase the amount of information we can glean about the past ocean from pore fluid profiles of oxygen isotopes and chloride. Using a coupled ocean--sea ice--ice shelf cavity model we test whether the deep ocean density structure at the LGM can be explained by ice--ocean interactions over the Antarctic continental shelves, and show that a large contribution of the LGM salinity stratification can be explained through lower ocean temperature. In order to extract the maximum information from pore fluid profiles of oxygen isotopes and chloride we evaluate several inverse methods for ill-posed problems and their ability to recover bottom water histories from sediment pore fluid profiles. We demonstrate that Bayesian Markov Chain Monte Carlo parameter estimation techniques enable us to robustly recover the full solution space of bottom water histories, not only at the LGM, but through the most recent deglaciation and the Holocene up to the present. Finally, we evaluate a non-destructive pore fluid sampling technique, Rhizon samplers, in comparison to traditional squeezing methods and show that despite their promise, Rhizons are unlikely to be a good sampling tool for pore fluid measurements of oxygen isotopes and chloride.

Developmentally regulated transcription factors in Drosophila melanogaster

During early stages of Drosophila development the heat shock response cannot be induced. It is reasoned that the adverse effects on cell cycle and cell growth brought about by Hsp70 induction must outweigh the beneficial aspects of Hsp70 induction in the early embryo. Although the Drosophila heat shock transcription factor (dHSF) is abundant in the early embryo, it does not enter the nucleus in response to heat shock. In older embryos and in cultured cells the factor is localized within the nucleus in an apparent trimeric structure that binds DNA with high affinity. The domain responsible for nuclear localization upon stress resides between residues 390 and 420 of the dHSF. Using that domain as bait in a yeast two-hybrid system we now report the identification and cloning of a nuclear transport protein Drosophila karyopherin-α3(dKap- α3). Biochemical methods demonstrate that the dKap-α3 protein binds specifically to the dHSF's nuclear localization sequence (NLS). Furthermore, the dKap-α3 protein does not associate with NLSs that contain point mutations which are not transported in vivo. Nuclear docking studies also demonstrate specific nuclear targeting of the NLS substrate by dKap-α3.Consistant with previous studies demonstrating that early Drosophila embryos are refractory to heat shock as a result of dHSF nuclear exclusion, we demonstrate that the early embryo is deficient in dKap-α3 protein through cycle 12. From cycle 13 onward the transport factor is present and the dHSF is localized within the nucleus thus allowing the embryo to respond to heat shock.

The pair-rule gene fushi tarazu (ftz) is a well-studied zygotic segmentation gene that is necessary for the development of the even-numbered parasegments in Drosophila melanogastor. During early embryogenesis, ftz is expressed in a characteristic pattern of seven stripes, one in each of the even-numbered parasegments. With a view to understand how ftz is transcriptionally regulated, cDNAs that encode transcription factors that bind to the zebra element of the ftz promoter have been cloned. Chapter Ill reports the cloning and characterization of the eDNA encoding zeb-1 (zebra element binding protein), a novel steroid receptor-like molecule that specifically binds to a key regulatory element of the ftz promoter. In transient transfection assays employing Drosophila tissue culture cells, it has been shown that zeb-1 as well as a truncated zeb-1 polypeptide (zeb480) that lacks the putative ligand binding domain function as sequencespecific trans-activators of the ftz gene.

The Oct factors are members of the POU family of transcription factors that are shown to play important roles during development in mammals. Chapter IV reports the eDNA cloning and expression of a Drosophila Oct transcription factor. Whole mount in-situ hybridization experiments revealed that the spatial expression patterns of this gene during embryonic development have not yet been observed for any other gene. In early embryogenesis, its transcripts are transiently expressed as a wide uniform band from 20-40% of the egg length, very similar to that of gap genes. This pattern progressively resolves into a series of narrower stripes followed by expression in fourteen stripes. Subsequently, transcripts from this gene are expressed in the central nervous system and the brain. When expressed in the yeast Saccharomyces cerevisiae, this Drosophila factor functions as a strong, octamer-dependent activator of transcription. The data strongly suggest possible functions for the Oct factor in pattern formation in Drosophila that might transcend the boundaries of genetically defined segmentation genes.

Model studies of Ziegler-Natta olefin polymerization using group 3 and group 4 metallocenes

Evidence for the stereochemical isomerization of a variety of ansa metallocene compounds is presented. For the scandocene allyl derivatives described here, we have established that the process is promoted by a variety of salts in both ether and hydrocarbon solvents and is not accelerated by light. A plausible mechanism based on an earlier proposal by Marks, et al., is offered as an explanation of this process. It involves coordination of anions and/or donor solvents to the metal center with cation assistance to encourage metalcyclopentadienyl bond heterolysis, rotation about the Si-Cp bond of the detached cyclopentadienide and recoordination of the opposite face. Our observations in some cases of thermodynamic racemic:meso ratios under the reaction conditions commonly used for the synthesis of the metallocene chlorides suggests that the interchange is faster than metallation, such that the composition of the reaction mixture is determined by thermodynamic, not kinetic, control in these cases.

Two new ansa-scandocene alkenyl compounds react with olefins resulting in the formation of η³-allyl complexes. Kinetics and labeling experiments indicate a tuck-in intermediate on the reaction pathway; in this intermediate the metal is bound to the carbon adjacent to the silyllinker in the rear of the metallocene wedge. In contrast, reaction of permethylscandocene alkenyl compounds with olefins results, almost exclusively, in vinylic C-H bond activation. It is proposed that relieving transition state steric interactions between the cyclopentadienyl rings and the olefin by either linking the rings together or using a larger lanthanide metal may allow for olefin coordination, stabilizing the transition state for allylic σ-bond metathesis.

A selectively isotopically labeled propylene, CH₂CD(¹³CH₃), was synthesized and its polymerization was carried out at low concentration in toluene solution using isospecific metallocene catalysts. Analysis of the NMR spectra (¹³C, ¹H, and ²H) of the resultant polymers revealed that the production of stereoerrors through chain epimerization proceeds exclusively by the tertiaryalkyl mechanism. Additionally, enantiofacial inversion of the terminally unsaturated polymer chain occurs by a non-dissociative process. The implications of these results on the mechanism of olefin polymerization with these catalysts is discussed.