Desempeño de las RISS en relación al acceso, coordinación y calidad de la atención en cáncer de mama y diabetes mellitus tipo 2 en Colombia

El objetivo de este capítulo es mostrar los resultados de investigación del desempeño de las redes de servicios de salud frente a diferentes dimensiones relacionadas al acceso, coordinación y calidad de la atención en dos enfermedades crónicas como es el cáncer de mama y la diabetes en Colombia, importantes patologías por su incidencia e impacto así como por la necesidad de la mecanismos efectivos de coordinación para la adecuada atención de los usuarios del sistema de salud. Por tanto, se realiza el análisis del desempeño de dos redes de servicios de salud en la atención de usuarias con diagnostico confirmado de cáncer de mama, vinculadas unas a redes pertenecientes al régimen contributivo y otras al régimen subsidiado. Redes que también fueron consideradas para el análisis del desempeño en la atención de usuarios con diagnostico confirmado de diabetes, en el que de manera adicional participó otra red perteneciente al régimen subsidiado con área de operación en el municipio de Soacha, puesto que las dos anteriores tiene influencia en la ciudad de Bogotá. La fuente primaria de los datos fue la historia clínica y éstos fueron extraídos de acuerdo a ciertos indicadores seleccionados por el equipo investigador a través de un previo proceso de validación y a partir de su importancia para evidenciar el desempeño de las redes de servicios de salud en las dimensiones enunciadas anteriormente. Se muestran los resultados del estudio, a partir de los cuales se propone una breve discusión y conclusiones.

Peter Riss: Stahlbad Anno 17 [Rezension]

M-x.

The role of knowledge intermediaries in developing firm learning capabilities

Regional innovation systems (RISs) literature has emphasized the critical role of interactive learning and knowledge exchange amongst firms and a variety of spatially connected innovation institutions as the foundation of regional innovation. Knowledge intermediaries have been analysed in terms of the technology-transaction services they provide firms and/or knowledge producers such as universities and therefore the role they play in facilitating interaction within the RIS. However, innovation also depends on the capability of the firm to learn. Some studies have suggested that intermediaries also play a role in that regard as participation in intermediary knowledge transfer programmes can contribute to the development of firm capabilities for problem-solving and learning. Our research is based on two case study intermediary programmes involving interviews with facilitators and participants. Our data show that knowledge intermediaries affect organizational learning capabilities by impacting on firms' network relationships, internal and external communication channels and internal learning processes which in turn affect the ability to interpret and use knowledge within the firm. This suggests that the role of knowledge intermediaries might be greater than facilitating interactions in the innovation system, as knowledge intermediation may affect the ability of firms to learn and absorb knowledge from their environment.

Análisis tipológico de la serie industrial achelense de Puyo (Lannemezan, Hautes-Pyrénées, France). Ensayo de clasificación de piezas “hacheroides”

[ES] El conjunto industrial achelense de Puyo (Lannemezan, Hautes-Pyrénées), descubierto por G. Laplace en 1954 en posición estratigráfica rissiense, está compuesto por 360 ejemplares líticos tallados en cuarcita local. Este efectivo industrial se reparte entre: 218 piezas retocadas (en las que se han definido 226 tipos primarios), 136 lascas y 6 núcleos. Tecnológicamente, la mayor parte de las industrias parecen estar en relación con un debitado sobre yunque; técnica de talla que ha procurado unas lascas con unos atributos muy específicos, en las que, en varios casos, son más que evidentes sus analogías morfológicas con los "hachereaux". En este sentido, la elevada presencia de "hachereaux" bien formateados y de otras piezas hacheroides más elementales, menos elaboradas, así como de varias formas particulares de utillaje macrolítico (ojivas, puntas), nos ha llevado a plantear una propuesta de definición y clasificación analítica particular para estos temas. La contribución global de estas piezas macrolíticas es superior a la de los útiles convencionales o más habituales. Por último, en lo que concierne a la valoración tipológica, este original complejo achelense está definido esencialmente, además de por los más numerosos tipos hacheroides, por una casi similar presencia de denticulados y una importante contribución de puntas carenoides. Más complementariamente, deben estimarse las aportaciones de ojivas y raederas, y son francamente minoritarios los restantes grupos tipológicos considerados (de cantos tallados, truncaduras, puntas planas, abruptos, raspadores, "becs", fragmentos de piezas bifaciales indeterminadas y "écaillés").

Probing small molecule binding to amyloid fibrils.

Much effort has focussed in recent years on probing the interactions of small molecules with amyloid fibrils and other protein aggregates. Understanding and control of such interactions are important for the development of diagnostic and therapeutic strategies in situations where protein aggregation is associated with disease. In this perspective article we give an overview over the toolbox of biophysical methods for the study of such amyloid-small molecule interactions. We discuss in detail two recently developed techniques within this framework: linear dichroism, a promising extension of the more traditional spectroscopic techniques, and biosensing methods, where surface-bound amyloid fibrils are exposed to solutions of small molecules. Both techniques rely on the measurement of physical properties that are very directly linked to the binding of small molecules to amyloid aggregates and therefore provide an attractive route to probe these important interactions.

Rissbildung und Zugtragverhalten von mit Stabstahl und Fasern bewehrtem Ultrahochfesten Beton (UHPC)

Ultrahochfester Beton (UHPC) ist ein sehr gefügedichter zementgebundener Werkstoff, der sich nicht nur durch eine hohe Druckfestigkeit, sondern auch durch einen hohen Widerstand gegen jede Form physikalischen oder chemischen Angriffs auszeichnet. Duktiles Nachbruchverhalten bei Druckversagen wird meist durch die Zugabe dünner kurzer Fasern erreicht. In Kombination mit konventioneller Betonstahl- oder Spannbewehrung ermöglicht UHPC die Ausführung sehr schlanker, weitgespannter Konstruktionen und eröffnet zugleich neue Anwendungsgebiete, wie zum Beispiel die flächenhafte Beschichtung von Brückendecks. Durch das Zusammenwirken kontinuierlicher Bewehrungselemente und diskontinuierlich verteilter kurzer Fasern ergeben sich unter Zugbeanspruchung Unterschiede gegenüber dem bekannten Stahl- und Spannbeton. In der vorliegenden Arbeit wird hierzu ein Modell entwickelt und durch eine umfangreiche Versuchsreihe abgesichert. Ausgangspunkt sind experimentelle und theoretische Untersuchungen zum Verbundverhalten von Stabstählen in einer UHPC-Matrix und zum Einfluss einer Faserzugabe auf das Reiß- und Zugtragverhalten von UHPC. Die Modellbildung für UHPC-Zugelemente mit gemischter Bewehrung aus Stabstahl und Fasern erfolgt auf der Grundlage der Vorgänge am diskreten Riss, die daher sehr ausführlich behandelt werden. Für den elastischen Verformungsbereich der Stabbewehrung (Gebrauchslastbereich) kann damit das Last-Verformungs-Verhalten für kombiniert bewehrte Bauteile mechanisch konsistent unter Berücksichtigung des bei UHPC bedeutsamen hohen Schwindmaßes abgebildet werden. Für die praktische Anwendung wird durch Vereinfachungen ein Näherungsverfahren abgeleitet. Sowohl die theoretischen als auch die experimentellen Untersuchungen bestätigen, dass der faserbewehrte UHPC bei Kombination mit kontinuierlichen Bewehrungselementen selbst kein verfestigendes Verhalten aufweisen muss, um insgesamt verfestigendes Verhalten und damit eine verteilte Rissbildung mit sehr keinen Rissbreiten und Rissabständen zu erzielen. Diese Beobachtungen können mit Hilfe der bisher zur Verfügung stehenden Modelle, die im Wesentlichen eine Superposition isoliert ermittelter Spannungs-Dehnungs-Beziehungen des Faserbetons und des reinen Stahls vorsehen, nicht nachvollzogen werden. Wie die eigenen Untersuchungen zeigen, kann durch ausreichend dimensionierte Stabstahlbewehrung zielgerichtet und ohne unwirtschaftlich hohe Fasergehalte ein gutmütiges Verhalten von UHPC auf Zug erreicht werden. Die sichere Begrenzung der Rissbreiten auf deutlich unter 0,1 mm gewährleistet zugleich die Dauerhaftigkeit auch bei ungünstigen Umgebungsbedingungen. Durch die Minimierung des Material- und Energieeinsatzes und die zu erwartende lange Nutzungsdauer lassen sich so im Sinne der Nachhaltigkeit optimierte Bauteile realisieren.

Punching Shear Behavior of UHPC Flat Slabs

At the Institute of Structural Engineering of the Faculty of Civil Engineering, Kassel University, series tests of slab-column connection were carried out, subjected to concentrated punching load. The effects of steel fiber content, concrete compressive strength, tension reinforcement ratio, size effect, and yield stress of tension reinforcement were studied by testing a total of six UHPC slabs and one normal strength concrete slab. Based on experimental results; all the tested slabs failed in punching shear as a type of failure, except the UHPC slab without steel fiber which failed due to splitting of concrete cover. The post ultimate load-deformation behavior of UHPC slabs subjected to punching load shows harmonic behavior of three stages; first, drop of load-deflection curve after reaching maximum load, second, resistance of both steel fibers and tension reinforcement, and third, pure tension reinforcement resistance. The first shear crack of UHPC slabs starts to open at a load higher than that of normal strength concrete slabs. Typically, the diameter of the punching cone for UHPC slabs on the tension surface is larger than that of NSC slabs and the location of critical shear crack is far away from the face of the column. The angle of punching cone for NSC slabs is larger than that of UHPC slabs. For UHPC slabs, the critical perimeter is proposed and located at 2.5d from the face of the column. The final shape of the punching cone is completed after the tension reinforcement starts to yield and the column stub starts to penetrate through the slab. A numerical model using Finite Element Analysis (FEA) for UHPC slabs is presented. Also some variables effect on punching shear is demonstrated by a parametric study. A design equation for UHPC slabs under punching load is presented and shown to be applicable for a wide range of parametric variations; in the ranges between 40 mm to 300 mm in slab thickness, 0.1 % to 2.9 % in tension reinforcement ratio, 150 MPa to 250 MPa in compressive strength of concrete and 0.1 % to 2 % steel fiber content. The proposed design equation of UHPC slabs is modified to include HSC and NSC slabs without steel fiber, and it is checked with the test results from earlier researches.

Análisis de la instrumentalización de las organizaciones internacionales por parte de los estados para construir su identidad de rol. Un estudio a partir de la experiencia de Francia entre 1940 y 1946 en el marco de los primeros años de la ONU

Analisis de la transformación de la identidad de rol francesa durante la segunda guerra mundial y la importancia de la fundación de la onu para la reconstrucción de dicha identidad.

On the development of novel cocaine-analogues for in vivo imaging of the dopamine transporter status

The present thesis is concerned with the development of novel cocaine-derived dopamine transporter ligands for the non-invasive exploration of the striatal and extra-striatal dopamine transporter (DAT) in living systems. The presynaptic dopamine transporter acquires an important function within the mediation of dopaminergic signal transduction. Its availability can serve as a measure for the overall integrity of the dopaminergic system. The DAT is upregulated in early Parkinson’s disease (PD), resulting in an increased availability of DAT-binding sites in the striatal DAT domains. Thereby, DAT imaging has become an important routine diagnostic tool for the early diagnosis of PD in patients, as well as for the differentiation of PD from symptomatically similar medical conditions. Furthermore, the dopaminergic system is involved in a variety of psychiatric diseases. In this regard, DAT-selective imaging agents may provide detailed insights into the scientific understanding of the biochemical background of both, the progress as well as the origins of the symptoms. DAT-imaging may also contribute to the determination of the dopaminergic therapeutic response for a given medication and thereby contribute to more convenient conditions for the patient. From an imaging point of view, the former demands a high availability of the radioactive probe to facilitate broad application of the modality, whereas the latter profits from short-lived probes, suitable for multi-injection studies. Therefore, labelling with longer-lived 18F-fluoride and in particular the generator nuclide 68Ga is worthwhile for clinical routine imaging. In contrast, the introduction of a 11C-label is a prerequisite for detailed scientific studies of neuronal interactions. The development of suitable DAT-ligands for medical imaging has often been complicated by the mixed binding profile of many compounds that that interact with the DAT. Other drawbacks have included high non-specific binding, extensive metabolism and slow accumulation in the DAT-rich brain areas. However, some recent examples have partially overcome the mentioned complications. Based on the structural speciality of these leads, novel ligand structures were designed and successfully synthesised in the present work. A structure activity relationship (SAR) study was conducted wherein the new structural modifications were examined for their influence on DAT-affinity and selectivity. Two of the compounds showed improvements in in vitro affinity for the DAT as well as selectivity versus the serotonin transporter (SERT) and norepinephrine transporter (NET). The main effort was focussed on the high-affinity candidate PR04.MZ, which was subsequently labelled with 18F and 11C in high yield. An initial pharmacological characterisation of PR04.MZ in rodents revealed highly specific binding to the target brain structures. As a result of low non-specific binding, the DAT-rich striatal area was clearly visualised by autoradiography and µPET. Furthermore, the radioactivity uptake into the DAT-rich brain regions was rapid and indicated fast binding equilibrium. No radioactive metabolite was found in the rat brain. [18F]PR04.MZ and [11C]PR04.MZ were compared in the primate brain and the plasma metabolism was studied. It was found that the ligands specifically visualise the DAT in high and low density in the primate brain. The activity uptake was rapid and quantitative evaluation by Logan graphical analysis and simplified reference tissue model was possible after a scanning time of 30 min. These results further reflect the good characteristics of PR04.MZ as a selective ligand of the neuronal DAT. To pursue 68Ga-labelling of the DAT, initial synthetic studies were performed as part of the present thesis. Thereby, a concept for the convenient preparation of novel bifunctional chelators (BFCs) was developed. Furthermore, the suitability of novel 1,4,7-triazacyclononane based N3S3-type BFCs for biomolecule-chelator conjugates of sufficient lipophilicity for the penetration of the blood-brain-barrier was elucidated.

Gain of chromosome 8q is associated with metastases and poor survival of patients with clear cell renal cell carcinoma

The aim of this study was to evaluate the prevalence of chromosome 8q gain in clear cell renal cell carcinoma (CCRCC) and to correlate the findings with tumor phenotype and disease-specific survival (DSS).