Written survey on recently deceased patients in germany and switzerland: how do general practitioners see their role?

BACKGROUND General practitioners (GPs) play an important role in end-of-life care due to their proximity to the patient's dwelling-place and their contact to relatives and other care providers. METHODS In order to get a better understanding of the role which the GP sees him- or herself as playing in end-of-life care and which care their dying patients get, we conducted this written survey. It asked questions about the most recently deceased patient of each physician. The questionnaire was sent to 1,201 GPs in southern North Rhine-Westphalia (Germany) and the Canton of Bern (Switzerland). RESULTS Response rate was 27.5 % (n = 330). The average age of responding physicians was 54.5 years (range: 34-76; standard derivation: 7.4), 68 % of them were male and 45 % worked alone in their practice. Primary outcome measures of this observational study are the characteristics of recently deceased patients as well as their care and the involvement of other professional caregivers. Almost half of the most recently deceased patients had cancer. Only 3 to 16 % of all deceased suffered from severe levels of pain, nausea, dyspnea or emesis. More than 80 % of the doctors considered themselves to be an indispensable part of their patient's end-of-life care. Almost 90 % of the doctors were in contact with the patient's family and 50 % with the responsible nursing service. The majority of the GPs had taken over the coordination of care and cooperation with other attending physicians. CONCLUSION The study confirms the relevance of caring for dying patients in GPs work and provides an important insight into their perception of their own role.

A growth factor-induced, spatially organizing cytoskeletal module enables rapid and persistent fibroblast migration

Directional migration requires robust front/back polarity. We find that fibroblasts treated with platelet-derived growth factor (PDGF) and prepolarized by plating on a fibronectin line substrate exhibit persistent migration for hours. This does not occur in the absence of PDGF or on uniformly coated fibronectin substrates. Persistent migration arises from establishment of two functional modules at cell front and back. At the front, formation of a zone containing podosome-like structures (PLS) dynamically correlates with low RhoA and myosin activity and absence of a contractile lamella. At the back, myosin contractility specifically controls tail retraction with minimal crosstalk to the front module. The PLS zone is maintained in a dynamic steady state that preserves size and position relative to the cell front, allowing for long-term coordination of front and back modules. We propose that front/back uncoupling achieved by the PLS zone is crucial for persistent migration in the absence of directional cues.

Developing an Agriculture-Related Digital Project

With the increasing expectation of information searchers for all information to be available online, digital projects are growing in number and importance. These projects allow libraries to become producers, if not of content, then of new accessibility options for their patrons. One librarian’s experience in the development and coordination of a digital project in an academic setting is presented, in order to demonstrate potential best practices for similar projects. Selection, coordination, standards, outsourcing, and funding of projects are all discussed. It is possible relatively quickly and inexpensively to produce a useful, quality digital project.

Border intervention by Promotores for type 2 diabetes

Purpose of the study. This study had two components. The first component of the study was the development and implementation of an infrastructure that integrated Promotores who teach diabetes self-management into a community clinic. The second component was a six-month randomized clinical trial (RCT) designed to test the effectiveness of the Promotores in changing knowledge, beliefs, and HbA1c levels among Mexican American patients with type 2 diabetes. ^ Methods. Starfield's adaptation of the Donbedian structure, process, and outcome methodology was used to develop a clinic infrastructure that allowed the integration of Promotores as diabetes educators. The RCT of the culturally sensitive Promotores-led 10-week diabetes self-management program compared the outcomes of 63 patients in the intervention group with 68 patients in a wait-list, usual care control group. Participants were Mexican Americans, at least 18 years of age, with type 2 diabetes, who were patients at a Federally Qualified Health Center on the Texas-Mexico border. At baseline, three months, and six months, data were collected using the Diabetes Knowledge Questionnaire (DKQ, the Health Beliefs Questionnaire (HBQ, and HbA1c levels were drawn by the clinic laboratory. A mixed model methodology was used to analyze the data. ^ Results. The infrastructure to support a Promotores-led diabetes self-management course designed in concert with administration, the physicians, and the CDE, resulted in (1) employment of Promotores to teach diabetes self-management courses; (2) integration of provider and nurse oversight of course design and implementation; (3) management of Promotora training, and the development of teaching competencies and skills; (4) coordination of care through communication and documentation policies and procedures; (5) utilization of quality control mechanisms to maintain patient safety; and (6) promotion of a culturally competent approach to the educational process. The RCT resulted in a significant improvement in the intervention group's DKQ scores over time (F [1, 129] = 4.77, p = 0.0308), and in treatment by time (F [2, 168] = 5.85, p = 0.0035). Neither the HBQ scores nor the HbA1c changed over time. However, the baseline HbA1c was 7.49, almost at the therapeutic level. The DKQ, HBQ, and HbA1c results were significantly affected by age; the DKQ and HbA1c by years with diabetes. ^ Conclusions. The clinic model provides a systematic approach to safely address the educational needs of large numbers of patients with type 2 diabetes who live in communities that suffer from a lack of health care professionals. The Promotores-led diabetes self-management course improved the knowledge of patients with diabetes and may be a culturally sensitive strategy for meeting patient educational needs. The low baseline HbA1c levels in this border community suggested that patients in this Federally Qualified Health Center on the Texas-Mexico border were experiencing good medical management of their diabetes. ^

Environmental sustainability and the human element: Decision making in National Cancer Institute-designated cancer centers and Practice Greenhealth subscribing institutions

Background. Various aspects of sustainability have taken root in the hospital environment; however, decisions to pursue sustainable practices within the framework of a master plan are not fully developed in National Cancer Institute (NCI) -designated cancer centers and subscribing institutions to the Practice Greenhealth (PGH) listserv.^ Methods. This cross sectional study was designed to identify the organizational characteristics each study group pursed to implement sustainability practices, describe the barriers they encountered and reasons behind their choices for undertaking certain sustainability practices. A web-based questionnaire was pilot tested, and then sent out to 64 NCI-designated cancer centers and 1638 subscribing institutions to the PGH listserv.^ Results. Complete responses were received from 39 NCI-designated cancer centers and 58 subscribing institutions to the PGH listserv. NCI-designated cancer centers reported greater progress in integrating sustainability criteria into design and construction projects than hospitals of institutions subscribing to the PHG listserv (p-value = <0.05). Statistically significant differences were also identified between these two study groups in undertaking work life options, conducting energy usage assessments, developing energy conservation and optimization plans, implementing solid waste and hazardous waste minimization programs, using energy efficient vehicles and reporting sustainability progress to external stakeholders. NCI-designated cancer centers were further along in implementing these programs (p-value = <0.05). In comparing the self-identified NCI-designated cancer centers to centers that indicated they were both and NCI and PGH, the later had made greater progress in using their collective buying power to pursue sustainable purchasing practices within the medical community (p-value = <0.05). In both study groups, recycling programs were well developed.^ Conclusions. Employee involvement was viewed as the most important reason for both study groups to pursue recycling initiatives and incorporated environmental criteria into purchasing decisions. A written sustainability commitment did not readily translate into a high percentage that had developed a sustainability master plan. Coordination of sustainability programs through a designated sustainability professional was not being undertaken by a large number of institutions within each study group. This may be due to the current economic downturn or management's attention to the emerging health care legislation being debated in congress. ^ Lifecycle assessments, an element of a carbon footprint, are seen as emerging areas of opportunity for health care institutions that can be used to evaluate the total lifecycle costs of products and services.^

Avances metodológicos del proceso de adopción de los Planes de Ordenamiento de segunda generación frente a los vacios jurídicos de la Legislación Colombiana en materia de Ordenamiento Territorial a la luz del P.O.T. Armenia 2007/2019 “Una Ciudad para la Vida"

Las nuevas realidades territoriales, bajo el innovador panorama constitucional colombiano, requieren de procesos de planificación coherentes, ajustados a las necesidades reales de desarrollo de nuestras sociedades en constante crecimiento. Se requieren acciones inmediatas y contundentes de fortalecimiento, asistencia técnica, desarrollo institucional e implementación de instrumentos de Gestión y financiación del suelo, para responder a la insuficiente capacidad de los entes territoriales para asumir con responsabilidad la formulación e implementación de los instrumentos de planificación y ordenamiento territorial planteados por la ley y la normatividad urbanística vigente. Dicha normatividad, dada su falta de reglamentación y regulación, hace compleja su aplicación en pequeñas y medianas ciudades, debido a la deficiente capacidad operativa y ejecutoria que tienen sus administraciones. El 24 de enero de 1999 el Concejo Municipal de Armenia aprobaba el primer plan de ordenamiento territorial para un municipio Colombiano bajo el marco de la Ley de Desarrollo Territorial 388 de 1997. Veinticuatro horas después se produce un sismo de 6.4 grados (Richter) con epicentro a 24 kilómetros de distancia, generando devastadoras consecuencias en toda la región del eje cafetero, tanto en lo físico como en lo social: “Cuando teníamos las respuestas… cambiaron las preguntas". Las nuevas determinantes territoriales generadas como efecto de la tragedia pondrían el proceso de implementación del plan en un escenario complejo y contradictorio. A pesar de que el concepto de gestión del riesgo había sido abordado por el P.O.T., las realidades del desastre superaban la expectativa planificadora, desbordando cualquier escala de ejecutabilidad de la norma recientemente aprobada. El equipo de formulación del nuevo plan, bajo la coordinación del D.A.P.M. y con apoyo de la academia identificó de manera inmediata la complejidad del proceso. Además, realizó aportes que permitieran a los demás municipios Colombianos evitar cometer los mismos errores, superar los obstáculos, agilizar procesos particulares de planificación territorial y dotar así a sus municipios de unos Planes de Ordenamiento mas aterrizados, realizables y sobretodo mas consecuentes con las necesidades particulares de sus municipios.

Luis María Ravagnan : Psicología y filosofía : Del Bergsonismo a la fenomenología existencial

Este trabajo resume la historia intelectual de Luis María Ravagnan, uno de los autores más productivos de la psicología argentina de mediados del siglo XX. Su concepción de la psicología, íntimamente vinculada con la filosofía, lo diferenciaba claramente de otros autores de su época, más interesados en el psicoanálisis o en los aspectos aplicados de la disciplina. Sin embargo, el rol que desempeñó en la recepción del pensamiento francés en general y de la fenomenología existencial en particular lo situó en una zona de intersecciones que fue fundamental para la construcción de los discursos de la psicología en los años 60

Luis María Ravagnan : Psicología y filosofía : Del Bergsonismo a la fenomenología existencial

Este trabajo resume la historia intelectual de Luis María Ravagnan, uno de los autores más productivos de la psicología argentina de mediados del siglo XX. Su concepción de la psicología, íntimamente vinculada con la filosofía, lo diferenciaba claramente de otros autores de su época, más interesados en el psicoanálisis o en los aspectos aplicados de la disciplina. Sin embargo, el rol que desempeñó en la recepción del pensamiento francés en general y de la fenomenología existencial en particular lo situó en una zona de intersecciones que fue fundamental para la construcción de los discursos de la psicología en los años 60

Luis María Ravagnan : Psicología y filosofía : Del Bergsonismo a la fenomenología existencial

Este trabajo resume la historia intelectual de Luis María Ravagnan, uno de los autores más productivos de la psicología argentina de mediados del siglo XX. Su concepción de la psicología, íntimamente vinculada con la filosofía, lo diferenciaba claramente de otros autores de su época, más interesados en el psicoanálisis o en los aspectos aplicados de la disciplina. Sin embargo, el rol que desempeñó en la recepción del pensamiento francés en general y de la fenomenología existencial en particular lo situó en una zona de intersecciones que fue fundamental para la construcción de los discursos de la psicología en los años 60

Yangtze River Delta's system integration: institutional barriers and countermeasures

This paper addresses the issue of institutional barriers to the Yangtze River Delta integration and the resulting slow development. It analyzes the problems including the coordination of local interests and regional interests, market segmentation during the regional integration, competition for the local government‘s investment on the public goods, labor movement within the delta. The paper argues that to reduce the negative impacts of these barriers and to promote the further integration of the Yangtze Delta region, the central government should strengthen the coordination between local governments, regulate their disorderly competition and reform the official evaluation system.

Response timing in the lunge and target change in elite versus medium-level fencers.

The aim of the present work is to examine the differences between two groups of fencers with different levels of competition, elite and medium level. The timing parameters of the response reaction have been compared together with the kinetic variables which determine the sequence of segmented participation used during the lunge with a change in target during movement. A total of 30 male sword fencers participated, 13 elite and 17 medium level. Two force platforms recorded the horizontal component of the force and the start of the movement. One system filmed the movement in 3D, recording the spatial positions of 11 markers, while another system projected a mobile target over a screen. For synchronisation, an electronic signal enabled all the systems to be started simultaneously. Among the timing parameters of the reaction response, the choice reaction time (CRT) to the target change during the lunge was measured. The results revealed differences between the groups regarding the flight time, horizontal velocity at the end of the acceleration phase, and the length of the lunge, these being higher for the elite group, as well as other variables related to the temporal sequence of movement. No significant differences have been found in the simple reaction time or in CRT. According to the literature, the CRT appears to improve with sports practice, although this factor did not differentiate the elite from medium-level fencers. The coordination of fencing movements, that is, the right technique, constitutes a factor that differentiates elite fencers from medium-level ones.

Self-assembled MgxZn1−xO quantum dots (0 ≤ x ≤ 1) on different substrates using spray pyrolysis methodology

By using the spray pyrolysis methodology in its classical configuration we have grown self-assembled MgxZn1−xO quantum dots (size [similar]4–6 nm) in the overall range of compositions 0 ≤ x ≤ 1 on c-sapphire, Si (100) and quartz substrates. Composition of the quantum dots was determined by means of transmission electron microscopy-energy dispersive X-ray analysis (TEM-EDAX) and X-ray photoelectron spectroscopy. Selected area electron diffraction reveals the growth of single phase hexagonal MgxZn1−xO quantum dots with composition 0 ≤ x ≤ 0.32 by using a nominal concentration of Mg in the range 0 to 45%. Onset of Mg concentration about 50% (nominal) forces the hexagonal lattice to undergo a phase transition from hexagonal to a cubic structure which resulted in the growth of hexagonal and cubic phases of MgxZn1−xO in the intermediate range of Mg concentrations 50 to 85% (0.39 ≤ x ≤ 0.77), whereas higher nominal concentration of Mg ≥ 90% (0.81 ≤ x ≤ 1) leads to the growth of single phase cubic MgxZn1−xO quantum dots. High resolution transmission electron microscopy and fast Fourier transform confirm the results and show clearly distinguishable hexagonal and cubic crystal structures of the respective quantum dots. A difference of 0.24 eV was detected between the core levels (Zn 2p and Mg 1s) measured in quantum dots with hexagonal and cubic structures by X-ray photoemission. The shift of these core levels can be explained in the frame of the different coordination of cations in the hexagonal and cubic configurations. Finally, the optical absorption measurements performed on single phase hexagonal MgxZn1−xO QDs exhibited a clear shift in optical energy gap on increasing the Mg concentration from 0 to 40%, which is explained as an effect of substitution of Zn2+ by Mg2+ in the ZnO lattice.

The morphofunctional approach to emotion modelling in robotics

In this conceptual paper, we discuss two areas of research in robotics, robotic models of emotion and morphofunctional machines, and we explore the scope for potential cross-fertilization between them. We shift the focus in robot models of emotion from information-theoretic aspects of appraisal to the interactive significance of bodily dispositions. Typical emotional phenomena such as arousal and action readiness can be interpreted as morphofunctional processes, and their functionality may be replicated in robotic systems with morphologies that can be modulated for real-time adaptation. We investigate the control requirements for such systems, and present a possible bio-inspired architecture, based on the division of control between neural and endocrine systems in humans and animals. We suggest that emotional epi- sodes can be understood as emergent from the coordination of action control and action-readiness, respectively. This stress on morphology complements existing research on the information-theoretic aspects of emotion.

Modelo para la certificación del coordinador en materia de seguridad y salud basado en sus competencias

La figura del coordinador en materia de seguridad y salud en el sector de la construcción, aparecida en nuestra legislación a través de las trasposiciones de las Directivas Europeas, (en nuestro caso en el RD 1627/97 sobre disposiciones mínimas de seguridad y salud en las obras de construcción), se encuentra identificada, en cuanto a su posible contratación y actuación dentro de este sector, de forma diferente en distintos países de la Unión Europea. La coordinación en materia de seguridad y salud también es un proceso de gestión que requiere de unas competencias, no solamente basadas en la formación técnica o profesional, si no que, considerando el entorno de trabajo, precisan de la aplicación de estrategias y herramientas relacionadas con la experiencia y con las habilidades personales. A través de una primera fase de investigación realizada y considerando la opinión de expertos en la materia, se han detectado cuáles son estas competencias que debe poseer el coordinador en materia de seguridad y salud para fortalecer el cumplimiento de sus obligaciones y así, mejorar su actividad de coordinación. El resultado de los análisis realizados permitirá construir un modelo que sirva de referencia para la certificación de los coordinadores en materia de seguridad y salud basado en sus competencias. Las conclusiones recogidas en esta Tesis doctoral proporcionarán criterios para establecer el diseño de programas formativos y construir metodologías para la selección de los coordinadores en materia de seguridad y salud en base a sus competencias. ABSTRACT The figure of the health and safety coordinator in the construction sector appeared in our legislation through the incorporation of the European Directives. In our case, Royal Decree 1627/97 on the minimum health and safety regulations in construction works. This figure is viewed differently, in terms of recruitment and performance, in different countries of the European Union. The coordination of health and safety issues is a management process that requires certain competencies not only based on technical or professional training. It is also necessary, depending on the work environment, the implementation of strategies and tools that are related to experience and personal skills. The skill requirements for the health and safety coordinator have been defined considering the opinion of experts in this field, gained through the realization of a first phase of research. These competences should be used to strengthen the performance of their duties and thereby improve their coordination activity.