La humanización del ejercicio de la vocación médica : un desafío fáctico

Resumen: Frente a los avances tecnológicos y el progreso de la ciencia; y en medio de la despersonalización que sufre la sociedad y consecuentemente la medicina, sería conveniente que los médicos propendan una actitud aún más reflexiva en la concepción del ejercicio de su profesión. Es tiempo de replantearse la vocación y posicionarse sobre las raíces de las ciencias médicas. La relación que se establece entre médico y paciente reviste ciertas particularidades en donde el vínculo se manifiesta de diferentes maneras. El propósito es analizar y reflexionar el aspecto peculiar que reviste ese encuentro interpersonal, a fin de que el trato con la persona enferma adquiera dimensiones profundamente más humanizadas. Como resultado de esta acción se podrá reconocer a la persona en todos los aspectos constitutivos. El médico debiera poseer la suficiente formación profesional a fin de percibir la vivencia de enfermar que experimentan todos los pacientes, y en un segundo tiempo, reconocer la manera en la cual se manifiesta esa experiencia. La mayoría de las veces este aspecto de la relación parece quedar librado al azar. Aquellos que observan más allá de los hechos manifiestos, perciben los gestos de humanidad del enfermo, arribando al diagnóstico de la patología con visión holística de la persona. Esta actitud genera en los pacientes seguridad y confianza, la cual puede teñir el resultado de cualquier tipo de terapéutica aplicada. Es precisamente en y con las personas, desde donde se construyen las profesiones.

Some advances in study of crack identification problems

In the present paper, the crack identification problems are investigated. This kind of problems belong to the scope of inverse problems and are usually ill-posed on their solutions. The paper includes two parts: (1) Based on the dynamic BIEM and the optimization method and using the measured dynamic information on outer boundary, the identification of crack in a finite domain is investigated and a method for choosing the high sensitive frequency region is proposed successfully to improve the precision. (2) Based on 3-D static BIEM and hypersingular integral equation theory, the penny crack identification in a finite body is reduced to an optimization problem. The investigation gives us some initial understanding on the 3-D inverse problems.

Estatuto antropológico de la enfermedad y el dolor en el enfermo terminal

Resumen: Los conceptos de dolor, enfermedad y enfermedad terminal exceden plenamente el ámbito meramente biológico y solo pueden abordarse acabadamente desde una perspectiva hilemorfista de persona humana. El enfoque integral de estos conceptos permite descubrir un significado antropológico de los mismos. Su comprensión adecuada constituye un imperativo moral en el cuidado del paciente terminal. En este sentido, es posible rescatar el valor de los cuidados paliativos como una modalidad de atención integral del paciente. En este contexto surge el proyecto de la Casa de la Bondad Salta, que pertenece a la Fundación Manos Abiertas. La Casa de la Bondad tiene como objetivo implementar cuidados paliativos a enfermos terminales. Se parte de la necesidad de realizar un abordaje integral del enfermo desde un enfoque transdisciplinar.

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.

A imagem pública do Congresso: uma análise político-midiática

Traz um estudo sobre como e por que a imagem pública do Congresso Nacional pode ser vista como cronicamente negativa no senso comum, nas sondagens de opinião pública e nas representações da mídia informativa, bem como nas percepções dos atores políticos. Com esse objetivo, além da síntese de reflexões teóricas que podem ser relacionadas ao campo interdisciplinar da comunicação política, foi realizada uma série de entrevistas qualitativas com 20% dos parlamentares que formavam a Câmara dos Deputados na Legislatura 2003/2007. Embora as conclusões apontem para uma forte conexão entre tal imagem negativa, recorrentes escândalos políticos e questões institucionais de caráter estrutural e conjuntural, há também nesse contexto uma insuficiência de pluralismo político e social que revela um problema maior e mais complexo: a crise da democracia representativa - pois as organizações da sociedade civil não dispõem de canais adequados de participação que permitam a representação equilibrada de suas demandas tanto na mídia quanto no campo político parlamentar.

New Oncogenic Drivers in Hepatocellular Carcinoma: Role of the RNA Binding Protein Hu antigen R

156 p. : graf.

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.