Cardiopatía isquémica crónica en el anciano

Este artículo pretende tener en cuenta las peculiaridades y características específicas de los pacientes ancianos con cardiopatía isquémica crónica desde una perspectiva multidisciplinar, con la participación de la Sociedad Española de Cardiología (secciones de Cardiología Geriátrica y Cardiopatía Isquémica/Cuidados Agudos Cardiovasculares), la Sociedad Española de Medicina Interna, la Sociedad Española de Médicos de Atención Primaria y la Sociedad Española de Geriatría y Gerontología. En este documento de consenso se detalla cómo el abordaje de estos enfermos de edad avanzada exige una valoración integral de la comorbilidad, la fragilidad, el estado funcional, la polifarmacia y las interacciones medicamentosas. Concluimos que en la mayoría de los pacientes el tratamiento médico es la mejor opción y que, a la hora de programarlo, se deben tener en cuenta los factores anteriores y las alteraciones biológicas asociadas al envejecimiento.

The subjunctive mood in Late Middle English adverbial clauses: the interaction of form and function

This thesis focuses on the history of the inflexional subjunctive and its functional substitutes in Late Middle English. To explore why and how the inflexional subjunctive declined in the history of English language, I analysed 2653 examples of three adverbial clauses introduced by if (1882 examples), though (305 examples) and lest (466 examples). Using a corpus-based approach, this thesis argues that linguistic change in subjunctive constructions did not happen suddenly but rather gradually, and the way it changed was varied , and that different constructions changed at different speeds in different environments. It is well known that the inflexional subjunctive declined in the history of English, mainly because of inflexional loss. Strangely however this topic has been comparatively neglected in the scholarly literature, especially with regard to the Middle English period, probably due to the limitations of data and also because study of this development requires very cumbersome textual research. This thesis has derived and analysed the data from three large corpora in the public domain: the Middle English Grammar Corpus (MEG-C for short), the Innsbruck Computer Archive of Machine-Readable English Texts (ICAMET for short), and some selected texts from The Corpus of Middle English Prose and Verse, part of the Middle English Compendium that also includes the Middle English Dictionary. The data were analysed from three perspectives: 1) clausal type, 2) dialect, and 3) textual genre. The basic methodology for the research was to analyse the examples one by one, with special attention being paid to the peculiarities of each text. In addition, this thesis draw on some complementary – indeed overlapping -- linguistic theories for further discussion: 1) Biber’s multi-dimensional theory, 2) Ogura and Wang’s (1994) S-curve or ‘diffusion’ theory, 3) Kretzchmar’s (2009) linguistics of speech, and 4) Halliday’s (1987) notion of language as a dynamic open system. To summarise the outcomes of this thesis: 1) On variation between clausal types, it was shown that the distributional tendencies of verb types (sub, ind, mod) are different between the three adverbial clauses under consideration. 2) On variation between dialects, it has been shown that the northern area, i.e. the so-called Great Scandinavian Belt, displays an especially high comparative ratio of the inflexional subjunctive construction compared to the other areas. This thesis suggests that this result was caused by the influence of Norse, relating the finding to the argument of Samuels (1989) that the present tense -es ending in the northern dialect was introduced by the influence of the Scandinavians. 3) On variation between genres, those labelled Science, Documents and Religion display relatively high ratio of the inflexional subjunctive, while Letter, Romance and History show relatively low ratio of the inflexional subjunctive. This results are explained by Biber’s multi-dimensional theory, which shows that the inflexional subjunctive can be related to the factors ‘informational’, ‘non-narrative’, ‘persuasive’ and ‘abstract’. 4) Lastly, on the inflexional subjunctive in Late Middle English, this thesis concludes that 1) the change did not happen suddenly but gradually, and 2) the way language changes varies. Thus the inflexional subjunctive did not disappear suddenly from England, and there was a time lag among the clausal types, dialects and genres, which can be related to Ogura and Wang’s S-curve (“diffusion”) theory and Kretzchmars’s view of “linguistic continuum”. This thesis has shown that the issues with regard to the inflexional subjunctive are quite complex, so that research in this area requires not only textual analysis but also theoretical analysis, considering both intra- and extra- linguistic factors.

Alteraciones cutáneas de miembros superiores por exposición a agroquímicos en cultivos de arroz, departamento de La Guajira 2016

Introducción: la vida, salud y trabajo del agricultor tienen sus propias particularidades, estilos y actividades, su calidad de vida puede afectarse por exponerse a sustancias químicas, convirtiéndola en una labor muy riesgosa. Objetivo: establecer la prevalencia de las alteraciones cutáneas de miembros superiores por exposición a agroquímicos en cultivos de arroz. Material y método: estudio de corte transversal, población de 100 trabajadores, ubicadas en zona rural de Fonseca La Guajira, durante el año 2016. Se analizaron variables sociodemográficas, laborales y clínicas relacionadas. Para el análisis estadístico se aplicaron las pruebas de Shapiro-Wilk, Ji-Cuadrado de Pearson, medidas de asociación con OR y sus respectivos intervalos de confianza del 95%, análisis multivariado con una Regresión Logística Incondicional, nivel de significancia del 5% (p<0.05) para pruebas estadísticas. Resultados: el 98,9% fueron hombres, las edades oscilaron entre los 18 y 83 años (media de 43,7 años). El 40,91% reporto fumigar y el, 15,15% abona. Reportaron tener rinitis alérgica el 21,2%, alergia ocular 25,3%, asma 16,41%, eczemas en las manos 19,15% y ronchas o habones 17,95%; el 40,31% uso herbicidas, 8,77% fungicidas, 35,09% insecticidas, 14,04% fertilizante y 1,75% coadyuvante. La dependencia es prácticamente nula entre la aparición de eczemas y categoría toxica (p=0,021); R de Pearson (R=0,121; p=0,247) con correlación positiva; no existe una relación entre el número de personas con alergias dérmicas y la toxicidad (X2= 2,271; p=0,518), el R de Pearson (R=-0,152; p=0,150). Conclusión: la exposición a agroquímicos sin las condiciones mínimas de seguridad y salud en el trabajo, se relaciona con la aparición de alteraciones cutáneas.

The application of symphytosociology in landscape architecture in the Western Mediterranean

This essay addresses the application of indigenous plants in Landscape Architecture projects, based on studies carried out in the field of phytosociology and sinphytosociology. Through this knowledge, it is possible to increase and improve the use of indigenous plants in Projects, aiming at the preservation of biodiversity. Thus, to better understand the western Mediterranean territory, we present a brief biophysical characterization, in which we point out the main factors which contribute to the ground coverage’s distribution in the landscape, namely, concerning climate (oceanity, ombroclimate and thermoclimate) and substrate (geology and lithology). In view of the high level of uniqueness of the identified conditions, a synthesis of the potential main existing climatophilous woods is carried out, regarding sinphytosocialogical class/order, furthermore, pointing out, the main serial stages, their vegetation bioindicators and the ecological peculiarities of each stage (regressive or progressive). Therefore, based on the study area, we point out the vegetation bioindicator’s value as a work tool during analysis, thus allowing us to understand the existing edaphoclimatic conditions, as well as to elaborate a quick diagnosis of each potential climatophilous vegetation series. Moreover, based on the main stages of substitution, it is also possible to identify the presence of endemic plants, or under protection status, and finally, the conservation state of the study area. Further ahead, in project proposal phase, based on information gathered previously, we point out the possibility of elaborating a list of plants correctly adapted to the existing mesologicall conditions. Thus, within each serial stage, the necessary ecological conditions for a correct adaption of the vegetation material are referred, therefore, avoiding possible limiting factors to their development, such as precipitation, soil erosion, light availability, salinity, among many others. Lastly, some considerations are made about the main ideas that should be remembered throughout this essay, namely, regarding the importance of the use of sinphytosociology’s knowledge as an analysis tool, as well as of high interest for the elaboration of proposals which aim at the floristic heritage’s conservation and the landscape’s scenic quality. Ce travail traite de l`application de plantes autochtones dans des projets d`Architecture Paysagiste ayant pour base des études réalisées dans le cadre de la phytosociologie et Symphytosociologie. À travers ces connaissances, il est possible d`incrémenter et améliorer l`utilisation de plantes autochtones dans les Projets basés sur la conservation de la biodiversité. Ainsi, afin de mieux comprendre le territorie de la méditérrannée occidentale, on présente une brève caractérisation biophysique, dans laquelle nous soulignons les principaux facteurs qui contribuent à la répartition de la végétation dans le paysage, notamment au niveau climatique (l`océanité, ombrothermique et thermoclimatique) et du substrat (géologie et lithologie). Face aux conditions, identifiées ci-dessus, élévées en originalité, il est utile d`élaborer une synthèse des principaux bois potentiels climatophiles existants au niveau de la classe/ordre symphitosociologique, en soulignant également les principales étapes de série, leurs bioindicateurs végétaux et aux particularités écologiques de chaque étape (régressive ou progressive). Ainsi, sur la base de l`interprétation de la zone d`étude, le bioindicateur végétal se distingue comme un outil de travail durant l`analyse, permettant de cette façon comprendre les conditions édapho-climatiques existantes, ainsi comme élaborer un rapide diagnostic de chaque série de végétation potentielle climatophile. En outre, sur la base des principales étapes de remplacement, il est également possible d`identifier la présence de plantes endémiques, ou avec un statut de protection et enfin l`état de conservation de la zone d`étude. Déjà au stade de proposition du projet, basée sur l`information recueillie précédemment, il y a la possibilité d`établir une liste de plantes bien adaptées aux conditions mésologiques. Ainsi, dans chaque étape de série, les conditions écologiques nécessaires à une bonne adaptation de la matière végétale sont référées, évitant ainsi des facteurs limitant à son développement, tels que les précipitations, l`érosion des soís, disponibilité de la lumière, de la salinité, parmi beaucoup d`autres. Et enfin, quelques considérations se tissent sur les principales idées à retenir tout au long du travail, notamment l`importance d`utiliser la connaissance de la symphytosociologie comme un outil d`analyse d`un grand intérêt pour la développement de propositions pour la conservation du patrimoine floristique et la qualité pittoresque du paysage.

The locations of recent supernovae near the Sun from modelling 60Fe transport

The signature of 60Fe in deep-sea crusts indicates that one or more supernovae exploded in the solar neighbourhood about 2.2 million years ago1–4. Recent isotopic analysis is consistent with a core-collapse or electron-capture supernova that occurred 60 to 130 parsecs from the Sun5. Moreover, peculiarities in the cosmic ray spectrum point to a nearby supernova about two million years ago6. The Local Bubble of hot, diffuse plasma, in which the Solar System is embedded, originated from 14 to 20 supernovae within a moving group, whose surviving members are now in the Scorpius– Centaurus stellar association7,8. Here we report calculations of the most probable trajectories and masses of the supernova progenitors, and hence their explosion times and sites. The 60Fe signal arises from two supernovae at distances between 90 and 100 parsecs. The closest occurred 2.3 million years ago at present-day galactic coordinates l = 327°, b = 11°, and the second-closest exploded about 1.5 million years ago at l = 343°, b = 25°, with masses of 9.2 and 8.8 times the solar mass, respectively. The remaining supernovae, which formed the Local Bubble, contribute to a smaller extent because they happened at larger distances and longer ago (60Fe has a half- life of 2.6 million years9,10). There are uncertainties relating to the nucleosynthesis yields and the loss of 60Fe during transport, but they do not influence the relative distribution of 60Fe in the crust layers, and therefore our model reproduces the measured relative abundances very well.

Gestão democrática caminhos e possibilidades : um estudo de caso em uma escola pública de ensino fundamental em Belém

A linha de pesquisa desenvolvida nesta dissertação não é inédita, todavia, apresenta algumas peculiaridades a respeito da gestão democrática para a educação brasileira, mais especificamente em Belém do Pará, que são no mínimo, um contributo à sociedade. Principalmente porque demonstra sucintamente, no primeiro e segundo capítulos a trajetória sócio histórica e a política-pedagógica da gestão democrática no Brasil a partir dos meados do século XVI, até a implementação da LDB nº 9394/96. No terceiro capítulo trato a respeito das Leis de Diretrizes e Bases da Educação Nacional, nº 5692/71 e da LDB nº 9394/96, esta última objetivou romper com os resquícios deixados pela 5692/71, vale frisar que o primeiro estado a implementar as Leis de Diretrizes e Bases, assentadas na Lei nº 9394/96, foi o estado do Pará. Nos capítulos: quarto e quinto destaco a Metodologia aplicada à pesquisa de campo; às análises dos dados coletados e mensurados, e construo uma triangulação e/ou cruzamento (Teoria-Práxis-Teoria que resultará à práxis), entre a teoria pesquisada e analisada, com as referências bibliográficas e com os dados coletados no campo acerca dos caminhos e possibilidades necessários para articular a gestão democrática no município de Belém. Para construir esse trajeto recorri às leituras bibliográficas de autores que já aprofundaram o assunto como: José Júlio Chiavenato, Luiz Fernando Dourado, Paulo Freire, Moacir Gadotti, Carlos Libâneo, João Monlevad, Vítor Paro, Michel Thiollent, Sofia Lérché Vieira entre outros autores que contribuíram para a construção teórica e prática, e que estão citados na referência. No que concerne a pesquisa de campo foi efetivada uma sondagem prévia e uma apresentação do tema à direção da escola e para a presidente do Conselho Escolar, em seguida foram feitos contatos com os profissionais da educação através de conversas informais a cerca do assunto. Após esse processo foram aplicados questionários com vinte e seis perguntas objetivas e duas perguntas subjetivas, que estão expostas no anexo desta dissertação; outros mecanismos utilizados na pesquisa de campo foram as entrevistas in lócus com alguns profissionais da escola pesquisada, utilizou-se também a observação participante com o viés na abordagem sócio histórica. O trabalho de campo e as referências bibliográficas coadunadas à observação participante, no cotidiano da comunidade escolar, foram essenciais para a consolidação deste trabalho dissertativo que envolveu um tema, que certamente, está em voga na educação brasileira e que serviu como base para o título desta dissertação: Gestão democrática caminhos e possibilidades:. Um estudo de caso em uma escola pública de ensino fundamental em Belém. A dissertação em questão também apresenta no capítulo quinto o tripé básico para a análise científica relacionada a gestão democrática que são: Eleição direta para o Conselho Escolar, eleição direta para o diretor/articulador/social, eleição para o grêmio estudantil, esta sob a direção dos alunos. A base desse tripé deve estar assentada na participação qualitativa de todas as categorias da comunidade escolar, preservando e respeitando a autonomia de cada categoria, bem como demonstra a aproximação e a contribuição da comunidade externa para o processo de ensino-aprendizagem. E, por fim, não menos importante, proponho algumas sugestões que estão expostas nas conclusões e demonstram claramente a necessidade de implementação de alguns caminhos a serem seguidos e implementados para que de fato e de direito se processe a gestão democrática participativa, à luz dos conceitos apresentados nesta dissertação que estão diretamente relacionados à formação, à participação, e à autonomia, para isso é necessário alguns ajustes na lei nº 7.722/94, na resolução nº036/2008 e o conhecimento e domínio da Lei nº 9394/96.__ ABSTRACT: The line of research developed in this thesis is not new, however, presents some peculiarities about the democratic management in Brazilian education, specifically in Belem, which are at least a contribution to society. Mainly because it shows succinctly in the first and second chapters the history and socio-historical political-pedagogical democratic management in Brazil since the mid-sixteenth century through implementation of the LDB 9394/96. ln the third chapter dealing with respect to the Laws of Directives and Bases of National Education, 5692/71 and 9394/96 LDB, the latter aimed to break with the remnants left over from 5692/71, it is worth stressing that the first state to implement the laws Guidelines and Bases, sitting in the Law 9394/96, was the Para The fourth and fifth chapters highlight the Methodology applied to field research, the analysis of data collected and measured and construct a triangulation and I or intersection (Theory-Praxis-Theory resulting praxis), between theory researched and analyzed with the references and the data collected in the field about the ways and possibilities necessary to articulate the democratic management at the education system in the municipality of Belém. To construct this path resorted to reading literature by authors who have explored the subject as: Jose Julio Chiavenato, Luiz Fernando Dourado, Paulo Freire, Moacir Gadotti, Carlos Libâneo John Monlevade, Paro Vítor, Michel Thiollent, Sofia Lerche Vieira and others who contributed to the theoretical and practical construction andare cited in the reference. Regarding the field research, it was carried a survey and a preliminary presentation of the theme to the school principal and to the School Board president, then were made contacts with professionals in education, through informal conversations about the subject. After this procedure were applied questionnaires with twenty-six objective questions and two subjective questions that are exposed in the appendix of this thesis. Other mechanisms used in field research were interviews in locus with some professionals of the surveyed. It was also used participant observation with the bias in the socio-historical approach. The field research and the references link ed to the participant observation in daily school community. were essential for the consolidation of this dissertational work involving a theme, which certainly, is in vogue in the Brazilian education and That served as the basis for this title dissertation: Management democratic ways and possibilities: A in a public elementary school case study in Belém. This dissertation Thesis presents in Its fifth chapter the basic tripod for scientific analysis related to the democratic management which are: Direct election for the School Board, direct election for chief articulator/social, for students union, this last one under the direction of the students. The basis of this tripod must be seated in the qualitative participation of all categories of the school community, preserving and respecting the autonomy of each on and demonstrates the approach and the contribution of the externa! community to the process of teaching and learning. At finally, but not less important propose some suggestions that are exposed on the conclusion and clearly demonstrate the need to implement some ways to be followed and implemented so that actually and by law the participatory democratic management, may be conducted according to Ulrich the concepts of this dissertation, are directly related to education, participation, and autonomy. However, this requires some adjustments in the Law 7.722/94, in its resolution 036/2008, and indeed the knowledge mastery of the Law 9394/96.

Effect of heat stress on milk production of goats from Alpine and Saanen breeds in Brazil.

The purpose of this bibliography review was to approach the thermal comfort rates on milk production of goats from Alpine and Saanen breeds in Brazil. The caloric stress caused by weather changes to which the animals are submitted, influence on the mechanisms of normal physiological processes of the body. Thus, the effect on the lactation process in goats can be mentioned, where it decreases the amount of water in the body with the consequent decrease in synthesis and milk ejection interfering in the production of hormone prolactin and growth hormone. The animal?s interaction with the environment must be considered when the aim in livestock farming is welfare, because the different responses of the animal to the peculiarities of each region are crucial for the success of the animal adaptation. So, the correct identification of the factors that influence the productive life of the animal, such as the stress caused by the seasonal fluctuations of the environment, allow production systems management, making it possible to make them sustainable and viable. The maintenance of these parameters in normal levels is very important, to the point of being used in the evaluation of climate adaptability of breeds to a certain environmental condition. In this way, the concerns about animal welfare and environmental comfort are due to the climatic variables and the behavioral, physiological and productive responses are prevailing when implementing the suitability of certain production systems.