El documento de Voluntades Vitales Anticipadas en Andalucia:analisis critico y propuesta de mejora

Nuestra tesis doctoral surge de la observación personal -como registradora de datos- de la poca aceptación y desconocimiento del documento de Voluntades Anticipadas (VVAA) en la población andaluza. A pesar de ver en el documento de VVAA una expresión palmaria de un derecho que consagra la autonomía personal, nos ha interesado profundizar en la razón de su escasa adherencia en la población andaluza. Para ello hemos analizado una muestra representativa de los registros que a tal efecto existen en nuestra comunidad autónoma, evaluando sus respuestas e identificando sus carencias y limitaciones. Además en otro apartado hemos investigado, la actitud y conocimiento de los registradores del documento VVAA con objeto de poder deducir de ello su posible influencia en los propios resultados. Finalmente quisimos estudiar si una intervención de enfermería -facilitando información sobre las Voluntades Vitales Anticipadas, en la urgencia del HVV de Málaga a pacientes mayores de 65 años- podría ser efectiva para impulsar una Planificación anticipada en la que se incluyera la declaración de Voluntades vitales. Con todos los datos recogidos, una vez analizados, hemos concluido con unas sugerencias para mejorar en el Documento de VVAA y la Guía que se acompaña para realizarlos. Además proponemos algunas estrategia de información/comunicación para pacientes y formación para los profesionales sanitarios implicados.

Outcome of childhood malignancies at the University of Port Harcourt Teaching Hospital: a call for implementation of palliative care.

Background: Cancers in children are yet to be recognised as an important cause of childhood morbidity and mortality in developing countries where more than 70% of the world annual cases occur. Despite the limited resources and whatever the projected outcome, children with cancer need treatment, be it curative or palliative. Objectives: To determine outcome of cancers in children at the UPTH; identify factors that influence outcome, highlight the need for palliative care. Method: A retrospective study of cases of childhood malignancies admitted into Paediatric Oncology unit of UPTH over a two year period. Clinical profile of patients and outcome were analyzed using SPSS version 20.0. Results: Sixty cases were analysed: 35(58.3%) males, 25(41.7%) females giving a M:F ratio of 1.4:1. Under-fives constituted 55%. Twenty-seven (45%) patients presented within 4 weeks of onset of symptoms. Median duration of symptoms before presentation was 8 weeks while 36 (60%) had metastatic disease at diagnosis. Twenty patients (33.3%) defaulted with or without specific treatment. Mortality was recorded in 26(43.4%) of cases. Conclusion: There were more cases of cancer amongst under-fives with male preponderance. Late presentation, financial constraints and high default rate were contributory factors to poor outcome in most cases. Lack of palliative care left many families to face their sufferings.

De-venir Hombre…Mujer Paso de la villa de la candelaria a la ciudad de Medellín 1900-1940

En este ensayo Ángela Garcés presenta cómo la modernidad es disolución, esto significa que el nuevo espacio antropológico que con él se crea, es un espacio donde es más importante la circulación y la mutación que la sustancia. Y no porque lo real desaparezca de forma apocalíptica, sino que lo real emerge como una nueva manera de ser, es, como la quieren los futuristas italianos: un nuevo dominio, donde lo real se ha vuelto evanescente y fluido, porque la velocidad ha comenzado a intervenir en todas las entidades del nuevo universo maquínico. Y es en este nuevo mundo rupturista en donde nos coloca la autora., pues es el lugar donde todo se disuelve en el aire. De alguna manera fue la experiencia de Baudelaire, tan bien trabajado por Ángela en sus viajes extraordinarios, del París de Asuman y de los impresionistas que se afanaron por lograr técnicas para captar la vida móvil y efervescente que se desplegaba en la gran ciudad y en sus lugares privilegiados de exhibición: Los Bulkevares, el café, el teatro, la ópera, los pasajes, las grandes exposiciones universales, los parques visitados por la burguesía al borde del Sena, etc. Ángela desplegará la existencia de estos cuerpos masculinos y femeninos en los espacios y tiempos de la metrópolis emergente. Por ello la problemática de la identidad se desprenderá de cualquier nostalgia naturalista, señalando, en cambio, las relaciones que tiene con la modernización de los imaginarios, que afectan tanto al dispositivo tecno-económico de la ciudad desrterritorializada, como a los cuerpos que se desprenden y se atrincheran en remodificaciones nuevas, para esbozar lo que ella denomina vidas separadas. Inquietante situación, pues con ello la idea emancipatoria de la ilustración había sido amansada por la sociedad burguesa y su doble moral. Late también en el fondo, parte de nuestra historia machista, que sólo comenzó a adquirir nuevos tintes de liberación femenina en Medellín, a partir del Festival de Ancón, y nuestra versión local del gap between generation impulsado por el movimiento Hippie, mundialmente expandido. Base como ejemplo el caso Débora Arango para ilustrar las formas ambiguas de esa encarnación de los imaginarios modernos, que reterritorializó las posibilidades de los que significaba la modernidad femenina: si lo virtual ya se había conseguido como proceso de desnaturalización, lo posible como figura latente de lo realizable tuvo su moratoria gracia a las voces y al poder del Ansíen Régimen, presidido por una burguesía recalcitrante y los poderes políticos aliados con la iglesia, en el país del Sagrado Corazón de Jesús.

Development and validation of the team learning questionnaire

Nowadays the organizational scenario is changing in several aspects that affect organization commitment. Team learning construct has emerged as a tool to deal with these changes and the dynamic nature of this situation. Although team learning has acquired importance in recent years, instruments to measure team learning should be developed. The aim of this paper is to develop and validate a team learning scale, the Team Learning Questionnaire, attending to four dimensions of team learning: Continued Improvement Seeking, Dialogue Promotion and Open Communication, Collaborative Learning, and Strategic and Proactive Leadership that Promote Learning. Results provide evidence of the reliability and validity of the scale.

Drinking water disinfection by-products, genetic polymorphisms, and birth outcomes in a european mother-child cohort study

International audience

Improving robustness of rolling stock circulations in rapid transit networks

The rolling stock circulation depends on two different problems: the rolling stock assignment and the train routing problems, which up to now have been solved sequentially. We propose a new approach to obtain better and more robust circulations of the rolling stock train units, solving the rolling stock assignment while accounting for the train routing problem. Here robustness means that difficult shunting operations are selectively penalized and propagated delays together with the need for human resources are minimized. This new integrated approach provides a huge model. Then, we solve the integrated model using Benders decomposition, where the main decision is the rolling stock assignment and the train routing is in the second level. For computational reasons we propose a heuristic based on Benders decomposition. Computational experiments show how the current solution operated by RENFE (the main Spanish train operator) can be improved: more robust and efficient solutions are obtained

Robust infraestructure design in rapid transit rail systems

Incidents and rolling stock breakdowns are commonplace in rapid transit rail systems and may disrupt the system performance imposing deviations from planned operations. A network design model is proposed for reducing the effect of disruptions less likely to occur. Failure probabilities are considered functions of the amount of services and the rolling stock’s routing on the designed network so that they cannot be calculated a priori but result from the design process itself. A two recourse stochastic programming model is formulated where the failure probabilities are an implicit function of the number of services and routing of the transit lines.

Train scheduling in high speed railways: considering competitive effects

The railway planning problem is usually studied from two different points of view: macroscopic and microscopic. We propose a macroscopic approach for the high-speed rail scheduling problem where competitive effects are introduced. We study train frequency planning, timetable planning and rolling stock assignment problems and model the problem as a multi-commodity network flow problem considering competitive transport markets. The aim of the presented model is to maximize the total operator profit. We solve the optimization model using realistic probleminstances obtained from the network of the Spanish railwa operator RENFE, including other transport modes in Spain

Train scheduling and rolling stock assignment in high speed trains

The Train Timetabling Problem (TTP) has been widely studied for freight and passenger rail systems. A lesser effort has been devoted to the study of high-speed rail systems. A modeling issue that has to be addressed is to model departure time choice of passengers on railway services. Passengers who use these systems attempt to travel at predetermined hours due to their daily life necessities (e.g., commuter trips). We incorporate all these features into TTP focusing on high-speed railway systems. We propose a Rail Scheduling and Rolling Stock (RSch-RS) model for timetable planning of high-speed railway systems. This model is composed of two essential elements: i) an infrastructure model for representing the railway network: it includes capacity constraints of the rail network and the Rolling-Stock constraints; and ii) a demand model that defines how the passengers choose the departure time. The resulting model is a mixed-integer programming model which objective function attempts to maximize the profit for the rail operator

Analysis of mortality during the winter seasons in Mexico from 2000 to 2012

To analyze mortality from all causes in Mexico during the winter months. Methods: Data was extracted and tabulated on monthly all-cause mortality in the general population from 2000 to 2012 from the INEGI database. Coeficients of seasonal variation in mortality were calculated. Results: In Mexico there was an increase of 14 % in mortality in the general population during winter. The more susceptible age groups were older people and children, with increases of 18% and 13% respectively. The months with low levels of mortality were April, October and September for children, adolescents and older people respectively. Conclusions: Important increases in winter mortality occur in Mexico.

Industrial synthesis and characterization of nanophotocatalysts materials: titania

Despite the recent synthesis and identification of a diverse set of new nanophotocatalysts that has exploded recently, titanium dioxide (TiO2) remains among the most promising photocatalysts because it is inexpensive, non-corrosive, environmentally friendly, and stable under a wide range of conditions. TiO2 has shown excellent promise for solar cell applications and for remediation of chemical pollutants and toxins. Over the past few decades, there has been a tremendous development of nanophotocatalysts for a variety of industrial applications (i.e. for water purification and reuse, disinfection of water matrices, air purification, deodorization, sterilization of soils). This paper details traditional and new industrial routes for the preparation of nanophotocatalysts and the characterization techniques used to understand the physical chemical properties of them, like surface area, ζ potential, crystal size, and phase crystallographic, morphology, and optical transparency. Finally we present some applications of the industrial nanophotocatalysts.

Long-term influence of chitin concentration on the resistance of cement pastes determined by atomic force microscopy

The presence of sulfates potentialize damage on cementbased materials, leading to structural failures. Therefore, structures must be designed to compensate for this effect. The mechanical properties of cement–chitin mixtures are investigated with different percentages of chitin (0.5, 1.3, and 2.1 wt.%) and aging of composite in a joint nanoscopic- and macroscopic-scale by experimental study. The objective is to increase the durability of concrete elements at coastal aquifers where concrete structures are in constant exposure to sulfate ions, chloride ions among others. Tapping mode AFM was used to characterize the surface structure and roughness of the cement pastes. To verify the chitin addition and the formation of sulfate-based aggregates Raman and IR spectra were recorded and are presented in this work. Then, force spectroscopy was used to obtain the nanomechanical properties at three different exposure times (1 day, 6 months, and 1 year) into water or a SO4 2 environment. Macroscopic parameters (e.g., compression strength of cylindrical probes) were assessed for comparison following standard guidelines. The results show a decrease of its mechanical properties as a function of the polymer concentration but more importantly, they correlate the elasticity and adhesion at the nanoscale with the behavior of the bulk material.

Sonochemical synthesis of CuO nanostructures and their morphology dependent optical and visible light driven photocatalytic properties

A controlled synthesis of CuO nanostructures with various morphologies were successfully achieved by presence/absence of low frequency (42 kHz) ultrasound with two different methods. The size, shape and morphology of the CuO nanostructures were tailored by altering the ultrasound, mode of addition and solvent medium. The crystalline structure and molecular vibrational modes of the prepared nanostructures were analysed through X-ray diffraction and FTIR measurement, respectively which confirmed that the nanostructures were phase pure high-quality CuO with monoclinic crystal structure. The morphological evaluation and elemental composition analysis were done using TEM and EDS attached with SEM, respectively. Furthermore, we demonstrated that the prepared CuO nanostructures could be served as an effective photocatalyst towards the degradation of methyl orange (MO) under visible light irradiation. Among the various nanostructures, the spherical shape CuO nanostructures were found to have the better catalytic activities towards MO dye degradation. The catalytic degradation performance of MO in the presence of CuO nanostructures showed the following order: spherical\nanorod \layered oval \nanoleaf \triangular \shuttles structures. The influence of loading and reusability of catalyst revealed that the efficiency of visible light assisted degradation of MO was effectively enhanced and more than 95 % of degradation was achieved after 3 cycles

Structural and mechanical properties of La0.6Sr0.4M0.1Fe0.9O3-δ (M: Co, Ni and Cu) perovskites

La0.6Sr0.4M0.1Fe0.9O3-δ (M: Co, Ni and Cu) perovskite nanostructures were synthesized using low frequency ultrasound assisted synthesis technique and effect of substitution of Fe by Co, Ni and Cu on crystal structure and mechanical properties in La0.6Sr0.4FeO3-δ perovskite were studied. The HRTEM and Rietveld refinement analyses revealed the uniform equi-axial shape of the obtained nanostructures with the existence of La0.6Sr0.4M0.1Fe0.9O3−δ with mixed rhombohedral and orthorhombic structures. Substitution of Cu decreases the melting point of La0.6Sr0.4FeO3-δ. The results of mechanical characterizations show that La0.6Sr0.4Co0.1Fe0.9O3−δ and La0.6Sr0.4Ni0.1Fe0.9O3−δ have ferroelastic behavior and comparable elastic moduli, however, subtitution of Ni shows higher hardness and lower fracture toughness than Co in Bsite doping

Sonophotocatalytic mineralization of Norflurazon in aqueous environment

Norflurazon (4-chloro-5-(methylamino)-2-[3- trifluoromethyl)phenyl]pyridazin-3(2H)-one; C12H9ClF3N3O) is an excellent weed controlling agent being practiced in the agricultural lands. The excessive addition or the undissolved Norflurazon (maximum solubility 28 mg/L at 25 C) enters into the aquatic environment and causes the adverse effects associated with its high concentration. To avoid the perilous effects, visible light assisted photocatalysis set-up coupled with the 42 kHz ultrasound producing bath type sonicator is used to completely mineralize the Norflurazon. TiO2, ZnO and gold loaded zinc oxide nanocatalysts were utilized to study the mineralization of Norflurazon. AueZnO shows the greater efficiency for the sonophotocatalytic removal of Norflurazon among the various nanocatalysts employed to study the mineralization. The order of Norflurazon mineralization was sonophotocatalysis > sonocatalysis > photocatalysis. The additive effect was achieved for the sonophotocatalytic degradation. The high performance liquid chromatography (HPLC) and liquid chromatography-mass spectrometric (LCMS) analyses were employed to identify the various intermediates produced during the mineralization. The identification of four pseudo molecular ions and various intermediates using the LCMS analysis evidently suggests the sonophotocatalytic degradation was preceded in various decay pathways. A suitable mechanism has been proposed for the sonophotocatalytic mineralization of Norflurazon