The phenomenology of a modern architect and his sense of place: Henry Klumb's residential architecture in Puerto Rico, 1944-1975

At the center of this dissertation is an architect's sense of place – how did it develop or grow within him, what did it consist of, and how did he apply it in his work? The architect, Heinrich "Henry" Klumb (1905-1984), was a German immigrant, a one-time associate of Frank Lloyd Wright, and from 1944 to 1984 a prolific and celebrated modern architect in the Caribbean island of Puerto Rico. Within this study a sense of place is defined as the beliefs people adopt, the actions they undertake, and the feelings they develop towards those locations that through time, experience, group norms and practices, personal investment, or immediate appreciation have become important or meaningful to them. Klumb's sense of place was a defining and demonstrable quality of his life in architecture. It was characterized by a heartfelt affection for various places where he lived and worked, and for the local populations at those places. These places and peoples included Frank Lloyd Wright's Taliesin, the American desert Southwest and its Native American populations, Puerto Rico's mountainous countryside and its rural working poor populations, and parts of the San Juan metropolitan area. This sense of place was evident in Klumb's reactions to and recollections of these locations and peoples. It was likewise evident in his views on what he thought to be the rightful interrelation between people and their surroundings. All of these aspects were chronicled in his collection of letters, public speeches, essays, and other private papers spanning a period of over fifty-five years. The focus of this dissertation is twofold. First is an examination of the key events, people, experiences, and locations that impressed a sense of place on Klumb. Second is an analysis of the houses that he designed and built in Puerto Rico from 1944 to 1975. These two subjects coalesce in this dissertation based on the underlying assertions that Klumb's houses in Puerto Rico were a direct result of those experiences that instilled in him an ability to bring together the daily lives of people in a harmonious relationship with their built and natural environments. Further, with such an idea in mind Klumb in turn attempted to create houses that were meant to foster the same harmonious relationship for others. Nowhere was Klumb's fondness for a location and its peoples more evident and directly relatable than in the houses that he designed and built in Puerto Rico. That is because when we look at the many circumstances in Klumb's life that led him to value specific locations through his demonstrated beliefs, actions, and feelings, we see that these same circumstances found direct expression in his residential practice on the island. The principal research question of this study is: how did Henry Klumb's life experiences shape his sense of place, and consequently his houses? An important contribution of this dissertation to the scholarly research on Klumb is in applying insights derived from architectural phenomenology and other related fields to reexamine some of the key turning points over the long arc of Klumb's life and career. In doing so the aim is to uncover the very genetic makeup of Klumb's affinity for specific locations and their peoples. A crucial assumption is that a person’s most deeply felt connections with various places have their genesis not in a personal philosophy or a conceptual framework. Such connections arise initially and principally out of an accumulation of experiences that are inexorably tied to where those experiences occurred. Those experiences and places then have an impact upon a person's thinking, actions, and feelings. Through this dissertation I trace the pivotal elements that shaped Klumb's sense of place from when he emigrated from Cologne, Germany in 1927, through his seventeen year sojourn in the United States, on to his career in Puerto Rico. I also track the evolution of Klumb's houses over five decades, determine various trajectories in his residential practice in Puerto Rico, and identify four common physical and conceptual threads in his houses. These four common threads are, first, that a principal way that Klumb fused select houses with their topographies was through the innovative use of planning grid systems. Second, Klumb's houses in Puerto Rico owed a great deal to the vernacular Jibaro hut of Puerto Rico’s rural and working poor. Third, the principal spaces in a Klumb house were his open air rooms. These were spaces that were conceived in response to the prevailing breezes at their building sites. Fourth, Klumb's affinity with nature was so strong that even in densely-packed, urban, residential communities Klumb tried to strike a balance between natural and built elements. This dissertation focuses on Klumb and his residential architecture for a number of reasons. First, Klumb's legacy is an important part of Puerto Rico's cultural heritage. Second, while a small number of Klumb's houses have been venerated in Puerto Rico by local architects and scholars, a full understanding of the history of his residential architecture practice is lacking. Third, given today’s global imperative to safeguard the environment, Klumb's houses offer valuable lessons in sustainable design. Finally, Klumb's life and works have great potential to augment our understanding of notions of place. Specifically, this dissertation offers an opportunity to readdress issues related to organic architecture, modernism, regionalism, vernacular architecture, and environmentally and socially conscious design. It also shines a light on an important chapter in mid-twentieth century Latin American modernism. In the end, this dissertation presents a history of a regional architect who only in recent years has begun to be recognized outside of Puerto Rico for his prodigious and nuanced merging of modern architecture and a special place. As a consequence of the history presented herein, an understanding of Klumb's sense of place serves as an example of how to study other architects with strong ties to specific places. It also serves as a guide for present and future architects so that they can reflect on and strengthen their positions on the notions of place

Oferta y Demanda de Especialistas Relacionada con la Atención Oncológica en Pacientes Con Neoplasia Maligna Instituto Regional de Enfermedades Neoplásicas IREN Norte

La presente investigación tuvo por objetivo, determinar la relación entre la oferta y demanda de especialistas con la atención oncológica de pacientes con neoplasias malignas del Instituto Regional de Enfermedades Neoplásicas del Norte en período 2014 al 2017. El diseño fue correlacional. La población y la muestra fueron la totalidad de la oferta y la demanda de especialistas con la atención oncológica en el Instituto Regional de Enfermedades Neoplásicas del Norte en el periodo 2014 al 2017. Como técnica se utilizó revisión documentaria y el instrumento fue la ficha de información de atención oncológica. Se encontró que en el año 2014 la oferta fue de 36 especialistas, mientras que la demanda fue de 44 especialistas, obteniendo una demanda insatisfecha de 8 especialistas (18.2%). En el año 2015 la oferta fue de 40 especialistas mientras que la demanda fue de 51 especialistas, obteniendo una demanda insatisfecha de 11 especialistas (21.6%); en el año 2016 la oferta fue de 45 especialistas, mientras la demanda fue de 54 especialistas, obteniendo una demanda insatisfecha de 9 especialistas (16.7%); en el año 2017 la oferta fue de 51 especialistas, mientras que la demanda fue 76 especialistas, obteniendo una demanda insatisfecha de 25 especialistas (32.9%). En conclusión la brecha existente entre los especialistas y la atención oncológica de los pacientes del Instituto Regional de Enfermedades Neoplásicas del Norte fue para el año 2014, 1440 pacientes, mientras que la brecha fue de 8 profesionales (18.2%), para el año 2015, la atención oncológica fue de 1877 pacientes, mientras que la brecha fue de 11 profesionales (21.6%), para el año 2016, la atención oncológica fue de 1879 pacientes, mientras que la brecha fue de 9 profesionales (16.7 %) y para el año 2017, la atención oncológica fue de 1895 pacientes, mientras que la brecha fue de 25 profesionales (32.9%)

Increased regional gray matter atrophy and enhanced functional connectivy in male multiple sclerosis patients

Evidence suggests that sex/gender is an important factor for understanding multiple sclerosis (MS) and that some of its neuropathological consequences might manifest earlier in males. In the present study, we assessed gray matter (GM) volume and functional connectivity (FC) in a sample of female and male MS patients (MSp) and female and male healthy controls (HCs). As compared to female MSp, male MSp showed decreased GM volume in the bilateral frontal areas and increased FC between different brain regions. Because both sets of changes correlated significantly and no differences in cognitive performance were observed, we suggest that the FC increase observed in male MSp acts as a compensatory mechanism for their more extensive GM loss and that it promotes a functional convergence between male- and female-MSp.This research has been supported by grant P1-1B2014-15 provided to Cristina Forn by the Universitat Jaume I

Hippocampal dysfunction is associated with memory impairment in multiple sclerosis: A volumetric and functional connectivity study

BACKGROUND: Previous studies have suggested a relationship between neuroanatomical and neurofunctional hippocampal alterations and episodic memory impairments in multiple sclerosis (MS) patients OBJECTIVE: We examined hippocampus volume and functional connectivity (FC) changes in MS patients with different episodic memory capabilities. METHODS: hippocampal subfield volume and FC changes were compared in two subgroups of MS patients with and without episodic memory impairment (MSi and MSp, respectively) and healthy controls. A discriminant function (DF) analysis was used to identify which of these neuroanatomical and neurofunctional parameters were the most relevant components of the mnemonic profiles of HC, MSp and MSi. RESULTS: MSi showed reduced volume in several hippocampal subfields compared to MSp and HC. Ordinal gradation (MSi>MSp>HC) was also observed for FC between the posterior hippocampus and several cortical areas. DF-based analyses revealed that reduced right fimbria volume and enhanced FC at the right posterior hippocampus were the main neural signatures of the episodic memory impairments observed in the MSi group. CONCLUSIONS: Before any sign of episodic memory alterations (MSp), FC increased on several pathways that connect the hippocampus with cortical areas. These changes further increased when the several hippocampal volumes reduced and memory deficits appeared (MSi).This study was sponsored by grants P1-1B2014-15 awarded by Universitat Jaume I and PSI2015-67285-R awarded by MINECO to Dr. Cristina For

Impacto da COVID-19 no diagnóstico e tratamento do câncer urológico

INTRODUÇÃO: No final de 2019, foi relatado o surgimento de uma nova doença causada pelo SARS- CoV-2, originário de Wuhan, China, responsável por causar uma síndrome respiratória aguda grave. Causando-se, assim, uma crise de saúde sem precedentes, lotando os hospitais e causando cancelamento dos atendimentos médicos não urgentes. O impacto da implementação de protocolos de priorização cirúrgica estão sendo um dos maiores desafios para os urologistas nessa npandemia, devido ao aumento de cirurgias oncológicas adiadas. MATERIAIS E MÉTODOS: O presente estudo consiste em uma revisão de literatura, na qual os dados apresentados provêm de artigos científicos publicados no ano de 2020. A busca desses artigos foi realizada nos bancos de dados SCIELO e PUBMED. DISCUSSÃO: O trabalho buscou relatar os efeitos globais da pandemia do COVID-19 na prática clínica cirúrgica e oncológica em urologia, mostrando que o adiamento de certas cirurgias pode causar progressão clínica de curto prazo do câncer, aumento da mortali- dade específica por câncer e alguns danos psicológicos, tais como ansiedade e depressão . CONCLUSÃO: Como explanado na maioria dos artigos sobre o tema, o médico tem papel fundamental na classificação dos pacientes quanto aos riscos de sua doença e risco de internação, além da grande importância do desenvolvimento de protocolos por equipes multidisciplinares para melhor categorizar as prioridades e minimizar os prejuízos desses adiamentos cirúrgicos para os pacientes

Supercritical extraction of lyophilized strawberry anthocyanins with pulsed electric fields pretreatment

Anthocyanins from LSB and with a PEF pretreatment were extracted with ethanol + SCCO2. The extraction at 200 bar, 333.15, 3.3% wt. of ethanol as cosolvent and using LSB with a PEF pretreatment of 1 kV/cm, produced an extraction yield of 0.284 % and a TAC of 0.231 (g/100 g of ethanol + SCCO2). The individual effect of 1.0 kV/cm of PEF pretreatment increases the %EY by 25 % and the TAC by 29 %. The individual effect of the cosolvent increases the %EY by 32% and that of TAC by 36.4%. However, the combined effect of 1.0 kV cm-1 and 3.3 % ethanol, produced an increase of 78.2 % and 85.3% in the %EY and TAC, respectively. Therefore, these results suggest that there is a synergistic effect, which means that both the electroporation caused by PEF in the LSB and the increase in polarity due to the addition of ethanol produce a substantial improvement over %ET and TAC. Furthermore, the process of extracting anthocyanins from LSB using a mixture of ethanol + supercritical carbon dioxide can be satisfactorily described by a solubility-based model such as the Kumar and Johnston model.The lyophilized strawberry anthocyanins were extracted using a supercritical extraction (SE) process. The effect of pulsed electric fields (PEF) as pretreatment and the influence of the addition of ethanol as a cosolvent on the percentage of extraction yield (EY) and the total anthocyanin concentration (TAC) were analyzed. The effect of PEF was evaluated at 0.5 and 1.0 kV/cm, while the effect of the cosolvent was studied in mixtures of supercritical carbon dioxide - ethanol (SCCO2 + ethanol) at 1.6 and 3.3% by weight. The best results (% EY = 0.506, TAC = 0.428 g /100 g of lyophilized strawberry) were obtained with a PEF pretreatment of 1.0 kV cm-1, 3.3%wt. ethanol at 200 bar and 333.15 K. The experimental results of solubility were suitably adjusted with the Kumar and Johnston model. The maximum solubility (0.114 g/100 g of solvent mixture) was obtained at 300 bar and 313.15 K.The authors would like to thank the National Council of Science and Technology of Mexico (CONACyT) for the scholarship granted to the master’s student in chemical sciences Marco A. Ávila-Hernández

Influence of metal alloy and the profile of coronary stents in patients with multivessel coronary disease

BACKGROUND: In Brazil, despite the recommendations of the Brazilian Society of Hemodynamics and Interventional Cardiology, the National Health System has not yet approved the use of drug-eluting stents. In percutaneous coronary interventions performed in the public and part of the private health care system, bare metal stents are used as the only option. Therefore, new information on bare metal stents is of great importance. The primary endpoint was to evaluate the influence of the alloy and the profile of coronary stents on late loss and restenosis rates 6 months after implantation in patients with multivessel coronary disease. METHODS: Single center, randomized and prospective study comparison of cobalt-chromium versus stainless steel stent implantation in 187 patients with multivessel coronary disease. At least one cobalt-chromium and one stainless steel stent were implanted per patient. RESULTS: Mean age of patients was 59.5 + 10.1 years with a prevalence of males (66.3%) and patients with acute coronary syndrome (56%). Baseline clinical characteristics were similar with hypertension in 146 (78%), dyslipidemia in 85 (45.5%) and diabetes in 68 (36.4%). Two hundred and twenty-nine cobalt-chromium and 284 stainless steel stents were implanted. Angiographic variables showed no statistically significant difference. Angiographic follow-up to 6 months after implantation showed similar late loss and restenosis rates. CONCLUSION: The use of two different alloys, stainless steel and cobalt-chrome stents, in the same patient and in the same vessel produced similar 6-month restenosis and late loss rates

Influence of metal alloy and the profile of coronary stents in patients with multivessel coronary disease

BACKGROUND: In Brazil, despite the recommendations of the Brazilian Society of Hemodynamics and Interventional Cardiology, the National Health System has not yet approved the use of drug-eluting stents. In percutaneous coronary interventions performed in the public and part of the private health care system, bare metal stents are used as the only option. Therefore, new information on bare metal stents is of great importance. The primary endpoint was to evaluate the influence of the alloy and the profile of coronary stents on late loss and restenosis rates 6 months after implantation in patients with multivessel coronary disease. METHODS: Single center, randomized and prospective study comparison of cobalt-chromium versus stainless steel stent implantation in 187 patients with multivessel coronary disease. At least one cobalt-chromium and one stainless steel stent were implanted per patient. RESULTS: Mean age of patients was 59.5 + 10.1 years with a prevalence of males (66.3%) and patients with acute coronary syndrome (56%). Baseline clinical characteristics were similar with hypertension in 146 (78%), dyslipidemia in 85 (45.5%) and diabetes in 68 (36.4%). Two hundred and twenty-nine cobalt-chromium and 284 stainless steel stents were implanted. Angiographic variables showed no statistically significant difference. Angiographic follow-up to 6 months after implantation showed similar late loss and restenosis rates. CONCLUSION: The use of two different alloys, stainless steel and cobalt-chrome stents, in the same patient and in the same vessel produced similar 6-month restenosis and late loss rates