Escuela y sociedad : una mirada hacia el futuro.

Esta publicación recopila las ponencias, planes de mejora, talleres y experiencias educativas presentadas durante las Jornadas de Formación del Profesorado, celebradas en Santander en 1997. El libro se estructura en cuatro bloques de contenido; El primero en el que se desarrollan tres ponencias: 1. Manuel Maceiras Fafián, analiza el asunto de los valores en educación. 2. José Luis García Garrido, ofrece una panorámica de la educación en Europa y de las perspectivas de la misma de cara al siglo XXI. 3. Juan Carlos Tedesco, abarca el tema de la educación y multiculturalidad. A continuación se contemplan los casos de cuatro centros escolares en los que se han llevado a cabo planes de mejora. El tercer bloque es el de los talleres de Teatro, Astronomía, Bibliotecas, Medio Natural, etc. En último lugar encontramos las experiencias en Educación Infantil, Primaria y Secundaria, así como unas consideraciones generales, sumando entre todas ellas, cincuenta y dos.

Competition between HMO and PPO: A Two-Sided Market Approach

We set-up a two-sided market framework to model competition between a Prefered Provider Organization (PPO) and a Health Maintenance Organization (HMO). Both health plans compete to attract policyholderson one side and providers on the other side. The PPO, which is characterized by a higher diversity of providers, attracts riskier policyholders. Our two-sided framework allows to examine the consequences of this risk segmentation on the providers’ side, especially in terms of remuneration. The outcome of competition mainly depends on two effects: a demand effect, influenced by the value put by policyholders on providers access and an adverse selection effect, captured by the characteristics of the health risk distribution. If the adverse selection effect is too strong, the HMO gets a higher profit in equilibrium. On the contrary, if the demand effect dominates, the PPO profit is higher in spite of the unfavorable risk segmentation. We believe that our model, by highlighting the two-sided market structure of the health plans’ competition, provides new insights to understand the increase in the PPOs’ market share observed during the last decade in the US.

Incidencia y factores asociados a infecciones bacterianas en el primer mes postrasplante hepático en la Fundación Cardioinfantil

Introducción: El trasplante hepático ortotópico es la colocación de un nuevo hígado en la misma ubicación del explantado. El objetivo es prolongar la duración y la calidad de vida en pacientes con enfermedades hepáticas terminales. Sin embargo, las infecciones bacterianas son una complicación en los pacientes receptores del trasplante, comprometiendo el éxito del procedimiento. El objetivo fue determinar los factores asociados a infecciones bacterianas en el primer mes tras realizada la intervención y describir las características demográficas de esa población. De 332 trasplantes realizados, que 262 cumplieron criterios para el análisis. Métodos: Se realizó un estudio observacional analítico de casos y controles anidado en una cohorte, en mayores de 18 años, receptores de trasplante hepático primario, de la FCI-IC de 2005 a 2014; excluyendo trasplante combinado hígado riñón, retrasplantes o fallecidos por causa diferente a la infecciosa durante el primer mes. Resultados: Se encontró que la ventilación mecánica por más de 1 día, el catéter venoso central mayor de 3 días son los principales factores de riesgo para infecciones bacterianas. La albúmina mayor de 2,6gr/dl se asoció a menor infección. Los agentes etiológicos predominantes fueron gérmenes gram negativos como E. coli, K. pneumonia y E. cloacae. Mientras que bacteremia, infección urinaria y peritonitis fueron las infecciones más frecuentes. La incidencia de infección bacteriana en esta población fue 24%. Discusión: Se recomienda por tanto extubación antes de 24 horas, uso de catéter central menor de 3 días y limitar el uso del catéter vesical.

A1 Noradrenergic Neurons Lesions Reduce Natriuresis and Hypertensive Responses to Hypernatremia in Rats

Noradrenergic neurons in the caudal ventrolateral medulla (CVLM; A1 group) contribute to cardiovascular regulation. The present study assessed whether specific lesions in the A1 group altered the cardiovascular responses that were evoked by hypertonic saline (HS) infusion in non-anesthetized rats. Male Wistar rats (280-340 g) received nanoinjections of antidopamine-β-hydroxylase-saporin (A1 lesion, 0.105 ng.nL-1) or free saporin (sham, 0.021 ng.nL-1) into their CVLMs. Two weeks later, the rats were anesthetized (2% halothane in O2) and their femoral artery and vein were catheterized and led to exit subcutaneously between the scapulae. On the following day, the animals were submitted to HS infusion (3 M NaCl, 1.8 ml • kg-1, b.wt., for longer than 1 min). In the sham-group (n = 8), HS induced a sustained pressor response (ΔMAP: 35±3.6 and 11±1.8 mmHg, for 10 and 90 min after HS infusion, respectively; P<0.05 vs. baseline). Ten min after HS infusion, the pressor responses of the anti-DβH-saporin-treated rats (n = 11)were significantly smaller(ΔMAP: 18±1.4 mmHg; P<0.05 vs. baseline and vs. sham group), and at 90 min, their blood pressures reached baseline values (2±1.6 mmHg). Compared to the sham group, the natriuresis that was induced by HS was reduced in the lesioned group 60 min after the challenge (196±5.5 mM vs. 262±7.6 mM, respectively; P<0.05). In addition, A1-lesioned rats excreted only 47% of their sodium 90 min after HS infusion, while sham animals excreted 80% of their sodium. Immunohistochemical analysis confirmed a substantial destruction of the A1 cell group in the CVLM of rats that had been nanoinjected withanti-DβH-saporin. These results suggest that medullary noradrenergic A1 neurons are involved in the excitatory neural pathway that regulates hypertensive and natriuretic responses to acute changes in the composition of body fluid. © 2013 da Silva et al.

Repeated laser-assisted high-flow bypass for recurrent giant intracranial aneurysm

The treatment of intracranial aneurysms is changing as endovascular obliteration possibilities and long-term results are being published in regard to outcome. However, not all aneurysms are amenable to direct endovascular or surgical treatment. In such situations, a high flow bypass for flow preservation can be considered as indirect treatment alternative, enabling a trapping of the aneurysm or occlusion of the feeding artery. We present the case history of a 57 year-old patient suffering of a recurrent giant intracranial carotid aneurysm. The aneurysm could be excluded using a new cerebral high-flow bypass technique for which no temporary occlusion of any intracranial vessels is required. This technique reduces the risks of perioperative neurological complications.

Effect of atorvastatin and pravastatin on platelet inhibition by aspirin and clopidogrel treatment in patients with coronary stent thrombosis

We sought to determine a potential interaction between statins and antiplatelet therapy with aspirin and clopidogrel. Previous laboratory studies have shown a possible drug-drug interaction of statins metabolized by cytochrome P450 3A4 and clopidogrel (prodrug metabolized by cytochrome P450 3A4), resulting in an impaired inhibitory effect of clopidogrel on platelet aggregation. However, conclusive prospective data assessing this potentially relevant interaction are lacking. In 73 patients, 23 with previous coronary stent thrombosis (ST) (ST group) and 50 without coronary ST (control group), platelet aggregation was measured 3 times in monthly intervals using light transmission aggregometry (adenosine diphosphate [ADP] and arachidonic acid induction). Measurements were carried out with aspirin monotherapy (100 mg/day), dual antiplatelet therapy with aspirin plus clopidogrel (75 mg/day), and additional treatment of 20 mg/day of atorvastatin or 40 mg/day of pravastatin. ADP (5 and 20 micromol)-induced platelet aggregation was significantly decreased with clopidogrel (p <0.001) but remained stable under additional treatment with atorvastatin or pravastatin in the 2 groups. Patients with previous ST showed a higher ADP-induced aggregation level than control subjects. This difference was not influenced by clopidogrel or statin treatment. In conclusion, patients with previous ST show a higher aggregation level than control subjects independent of statin treatment. Atorvastatin and pravastatin do not interfere with the antiaggregatory effect of aspirin and clopidogrel. In conclusion, drug-drug interaction between dual antiplatelet therapy and atorvastatin or pravastatin seems not to be associated with ST.

Marked improvement in nail psoriasis during treatment with adalimumab

BACKGROUND: Nail involvement is known as a common finding in psoriatic patients and represents a significant impact on patients' quality of life. The treatment of nail psoriasis is often challenging, and there is a need for new therapeutic options. Biologicals effective in the treatment of moderate to severe chronic plaque psoriasis may represent a new therapeutic modality for this disease. Adalimumab is a fully human IgG1 monoclonal antibody that binds to tumor necrosis factor alpha with high affinity and specificity. OBSERVATIONS: We report two cases of rapid improvement in nail psoriasis under adalimumab monotherapy with maintained effectiveness despite intermittent treatment as well as long remission after therapy discontinuation. CONCLUSION: The marked improvement of our two cases indicates that adalimumab may also help ameliorate nail psoriasis and warrants further controlled studies to establish the effectiveness and therapeutic regimes.

[Collection de cartes postales classées méthodiquement pour l'enseignement de la géographie, Paris, F. Nathan, s.d. (1928), offert par l'éditeur. 353 cartes postales en 15 paquets. 1. Généralités, définitions principales (1-25) 2. Ports de commerce, de pêche, militaires, fluviaux (26-50) 3. Pêches et industries diverses (51-75) 4. Relief du sol (76-95) 5. Communications en montagne (96-119) 6. Histoire d'un fleuve (120-139) 7. Phénomènes dus à l'érosion (140-159) 8. Voies de communication (160-179) 9. Paris (180-204) 10. Algérie (205-228) 11. Tunisie (229-253) 12. Maroc (254-278) 13. A.O.F. et A.E.F. (279-303) 14. Madagascar (304-328) 15. Indochine (329-353)]

Donateur : Nathan, Fernand (1858-1947)

Muistosanat Tanskan pääministerin hautajaisissa 6.2.1955

Puhe

Förteckning på Läse-sällskapets i Helsingfors swenska böcker. 6:te häftet

Sisältää ruotsinkielistä kirjallisuutta numerot 330-353.

Response of interleukin-6 during euglycaemic and hyperglycaemic exercise in patients with type 1 diabetes mellitus

The aim of this randomized, single-blinded cross-over study was to investigate the response of interleukin-6 (IL-6) during moderate aerobic exercise in stable euglycaemia and hyperglycaemia in seven male patients with type 1 diabetes mellitus. IL-6 increased significantly over the entire study period in euglycaemia, but not in hyperglycaemia.

Concentrations of total organic carbon on vertical profiles in waters of the Weddell Sea measured on water bottle sample during POLARSTERN cruise ANT-X/6

Concentrations of dissolved organic carbon (DOC) and nitrogen (DON) were measured during early austral Spring 1992 at a number of stations along the 6°W meridian between 47° and 60°S. This included the Polar Front in the north, the zone of melting sea-ice in the south, and waters of the Antarctic Circumpolar Current in between. Concentrations of DOC were low in deep water (34-38 ?M) with generally similar or slightly higher values in the surface mixed layer (38-55 ?M). DOC:DON ratios are wider in surface water than in deep water, i.e. surface accumulations contain relatively C-rich dissolved organic matter. The highly variable distribution of the surface DOC was not related to hydrographic or biotic features (fronts, plankton development) indicating the lability and transient occurrence of this material. Growth rates of bacteria were determined in subsamples from 51 0.8-?m-filtered batches of seawater incubated in the dark at in-situ temperature. Thymidine and leucine uptake and bacterial biomass change as well as changes in dissolved organic carbon in the batches, and oxygen consumption in parallel incubations correlated linearly over 2 weeks of incubation which allowed extrapolation to in-situ conditions. Bacterial growth in these experiments depended strongly on the amount of initial DOC. Growth in water from greater depth (1000 m) containing 38 ?M DOC was minimal, as were DOC-decrease and oxygen consumption. Higher rates were observed in surface water slightly enriched with DOC, and highest rates in surface water amended with DOC-rich melted sea ice. Bacterial growth efficiencies (biomass C-increase vs DOC consumed) were about 30%. The experiments showed that at least 40-60% of the DOC in excess of deep water concentrations was available to bacteria.