Requisitos de las causales de admisión del recurso extraordinario de casación, por violación indirecta de la ley sustancial por error de hecho, en Colombia : Análisis a partir de los recursos interpuestos ante la Corte Suprema de Justicia Sala de Casación Civil-Familia, durante el período 2010-2015-1

Como se ha dicho a lo largo de este estudio, una de las funciones de la casación es la realización del derecho objetivo, esto es, que las normas se acerquen a la realidad de los casos, para que efectivamente el derecho sea un elemento que construya y cohesione a la sociedad. Existe un principio que se relaciona estrechamente con tal reflexión: la primacía del derecho sustancial sobre el procesal, sin embargo la casación parece ser una excepción a este principio. En otras palabras, acudir al recurso de casación es un asunto especial del ejercicio del derecho. En primer lugar, porque se trata de un recurso que se presenta ante la máxima instancia de la jurisdicción ordinaria; en segundo lugar, porque se trata de un tema que se aborda, escasamente, en la formación del abogado en el nivel de pregrado, lo cual implica que son pocos los profesionales del derecho capacitados para tal emprendimiento, pues se carece del conocimiento pleno sobre causales y cargos que pueden formularse, para que el recurso extraordinario prospere con éxito. Lo anterior se constituye en una razón suficiente, para adentrarse en la presente investigación y más aún abordar el tema del error de hecho, especialmente, en lo referente a la prueba, toda vez que se trata de una causal de mucha complejidad, tanto para comprenderse, como para formularse

Señor. Don Fernando Estevan Delgado y Alarcon, Cavallero de la Orden de Calatrava, y Corregidor de la Ciudad, y Partido de Carmona, despojado del exercicio de este empleo ... busca el remedio en la notoria justificacion del Consejo ... se atreve à suplicar à V.S. se tome la de leer este impreso, en que con legalidad recopila quanto substancialmente resulta de la Causa de Pesquisa ... no dudando que esta previa instruccion ... se venga facilmente en conocimiento de la innocencia de este Corregidor, y quede à todas luces descubierta la calumnia de los ocultos Capitulantes

Precede a tít.: [Cristus]No v. da f. [1] figura a data: 1741Sign.: A-N\p2\

Development and Pilot-Testing of a Patient Decision Aid for Left Ventricular Assist Device Placement

Objectives: This paper describes the development methodology and pilot-testing of a decision aid for Left Ventricular Assist Device (LVAD) placement, combining traditional needs-assessment with a novel user-centered approach. Background: Studies indicate suboptimal patient understanding of the capabilities, lifestyle implications, and risks of LVAD therapy. Methods and Results: We developed the decision aid in line with the Ottawa Decision Support Framework (ODSF) and the International Patient Decision Aids Standards (IPDAS) for ensuring quality, patient-centered content. Structured interviews were conducted with patients, caregivers, candidates for LVAD treatment, and expert clinicians (n=71) to generate content based on patient values and decisional needs, and providers’ perspectives on knowledge needs for informed consent. The aid was alpha tested through cognitive interviews (n=5) and acceptability tested with LVAD patients (n=10), candidates (n=10), and clinicians (n=13). Patients, caregivers and clinicians reported they would recommend the aid to patients considering treatment options for heart failure. Patients and caregivers agreed that the decision aid is a balanced tool presenting risks and benefits of LVAD treatment and generating discussion about aspects of heart failure treatment that matter most to patients. Conclusion: We identified gaps in knowledge about heart failure treatment options, including diagnosis, decision-making, surgery, post-operative maintenance and lifestyle changes. Challenges included presenting risks and benefits for informed decision making without frightening patients and circumventing reflection, and balancing an emphasis on LVAD with other alternative treatment options like comfort-directed palliative and supportive care

Development and validation of a patient-centered knowledge scale for left ventricular assist device placement

A central tenet of patient-centered health care advocated by the Institute of Medicine and the American Medical Association is to enhance informed decision-making in a way that incorporates patient values, knowledge and beliefs. Achievement of this goal is constrained by a lack of validated measures of patients' knowledge needs. In this study we present a comprehensive and valid methodology for developing a clinically informed and patient-centered measure of knowledge about left ventricular assist device (LVAD) therapy to facilitate discussion and measure candidate understanding of treatment options. Using structured interviews with patients, caregivers, candidates for LVAD treatment (New York Heart Association Class III and IV) and expert clinicians (n = 71), we identified top patient decisional needs and perspectives on essential knowledge needs for informed decision-making. From this list, we generated 20 knowledge scale question items to refine in cognitive interviews (n = 5) with patients and patient consultants. Good internal consistency and reliability of the knowledge scale (Cronbach's α = 0.81) was seen in 30 LVAD patients and candidates. Knowledge was higher among patients currently with LVADs than candidates, regardless of receiving standard education (with education: 69.9 vs 50.1, adjusted p = 0.02; without education: 69.9 vs 37.6, adjusted p < 0.001). The LVAD knowledge scale may be useful in clinical settings to identify gaps in knowledge among patient candidates considering LVAD treatment, and to better tailor education and discussion with patients and their caregivers, and to enhance informed decision-making before treatment decisions are made

Assessment of patients’ and caregivers’ informational and decisional needs for left ventricular assist device placement: Implications for informed consent and shared decision-making

Several organizations have underscored the crucial need for patient-centered decision tools to enhance shared decision-making in advanced heart failure. The purpose of this study was to investigate the decision-making process and informational and decisional needs of patients and their caregivers regarding left ventricular assist device (LVAD) placement. In-depth, structured interviews with LVAD patients, candidates and caregivers (spouse, family members) (n = 45) were conducted. We also administered a Decisional Regret Scale. Participants reported LVAD decision-making to be quick and reflexive (n = 30), and deferred heavily to clinicians (n = 22). They did not perceive themselves as having a real choice (n = 28). The 2 most prevalent informational domains that participants identified were lifestyle issues (23 items), followed by technical (drive-line, battery) issues (14 items). Participants easily and clearly identified their values: life extension; family; and mobility. Participants reported the need to meet other patients and caregivers before device placement (n = 31), and to have an involved caregiver (n = 28) to synthesize information. Some participants demonstrated a lack of clarity regarding transplant probability: 9 of 15 patients described themselves as on a transplant trajectory, yet 7 of these were destination therapy patients. Finally, we found that decisional regret scores were low (1.307). Informed consent and shared-decision making should: (a) help patients offered highly invasive technologies for life-threatening disease get past the initial “anything to avoid thinking about death” reaction and make a more informed decision; (b) clarify transplant status; and (c) focus on lifestyle and technical issues, as patients have the most informational needs in these domains

Reasons Why Eligible Candidates Decline Left Ventricular Assist Device Placement

A greater understanding of how beliefs and perceptions inform LVAD placement refusals can help ensure that standards for informed decision making are met. We report on the factors that influence refusal and what accounts for changes in decliners' decision-making process when, and if, that occurs. We identified candidates (8 bridge to transplant; 6 destination therapy, 7 without designation) who declined LVAD placement (n = 21), 11 of whom were identified prospectively from February 2014 to March 2015, and 10 of whom were identified retrospectively with the use of our program database. Of these 21 decliners, 11 candidates persistently declined LVAD placement, with a median time of 175 days elapsing between time of LVAD offer and March 4, 2015. Ten candidates declined for an average of 224 days before agreeing to LVAD placement. From March 2014 to March 2015, we conducted structured interviews with LVAD decliners. Interviews were audio recorded, transcribed verbatim, and analyzed quantitatively with the use of Atlas.ti. The findings reflect that refusal can evolve over time. Decliners report that their initial refusals were made reflexively, but the 10 decliners who ultimately opted for LVAD placement changed their decisions as symptoms worsened. Decliners have concerns about the impacts of LVAD treatment on mobility, and they distrust LVAD technology. Some decliners believe LVAD placement would affect their ability to receive a transplant. Finally, decliners believe that they are not sick enough for LVAD placement when they are stabilized with medical management. Decliners' perspectives are integral for improving informed consent and refusal processes. Our analysis revealed decliners' decision-making processes and factors influencing their decisions. We provide several clinically based practical recommendations based on our findings. •Eligible candidates who decline LVAD placement make their decisions reflexively, quickly, and often with little information.•Declination evolves over time, consisting of a longitudinal dimension that has not previously been identified.•Decliners often believe that they are not sick enough for LVAD placement when they are stabilized with the use of optimal medical management, leading to a false sense of security.•Our findings should not be interpreted as suggesting that decliners are deficient in their decision-making process; rather, we raise an ethical concern that decisions may not be consistent with one's values when too much or too little weight is placed on one particular decision-making attribute

Energy Governance in Spain

Spain is lagging behind in the transition to a sustainable energy system compared to other EU member states. Its unique position as an energy island, coupled with errors in energy planning inherited from previous government regimes, constitute a legacy that makes changes in the system difficult to achieve. Current political instability adds to the difficulties, under a governance framework characterised by lack of coordination and supremacy of the central government in the decision making process, in an environment where traditional energy companies still exert lobby power. The continuous changes in the regulatory framework of the energy sector have hindered investments in low carbon sources of energy due to perceived uncertainty. Small changes in the right direction are being observed though, with a more prominent role expected from the local levels of government. But many measures still originate on requirements linked to EU commitments and more initiatives at the national level need to be seen

Genomic history of the origin and domestication of common bean unveils its closest sister species

Background: Modern civilization depends on only a few plant species for its nourishment. These crops were derived via several thousands of years of human selection that transformed wild ancestors into high-yielding domesticated descendants. Among cultivated plants, common bean (Phaseolus vulgaris L.) is the most important grain legume. Yet, our understanding of the origins and concurrent shaping of the genome of this crop plant is limited. Results: We sequenced the genomes of 29 accessions representing 12 Phaseolus species. Single nucleotide polymorphism-based phylogenomic analyses, using both the nuclear and chloroplast genomes, allowed us to detect a speciation event, a finding further supported by metabolite profiling. In addition, we identified ~1200 protein coding genes (PCGs) and ~100 long non-coding RNAs with domestication-associated haplotypes. Finally, we describe asymmetric introgression events occurring among common bean subpopulations in Mesoamerica and across hemispheres. Conclusions: We uncover an unpredicted speciation event in the tropical Andes that gave rise to a sibling species, formerly considered the “wild ancestor” of P. vulgaris, which diverged before the split of the Mesoamerican and Andean P. vulgaris gene pools. Further, we identify haplotypes strongly associated with genes underlying the emergence of domestication traits. Our findings also reveal the capacity of a predominantly autogamous plant to outcross and fix loci from different populations, even from distant species, which led to the acquisition by domesticated beans of adaptive traits from wild relatives. The occurrence of such adaptive introgressions should be exploited to accelerate breeding programs in the near future.This work was supported by the Ibero-American Programme for Science, Technology and Development - CYTED (PhasIbeAm project); Spanish Government - Ministry of Economy and Competitiveness (EUI2009-04052, BIO2011-26205), “Centro de Excelencia Severo Ochoa 2013-2017,” SEV-2012-0208 and Project PT13/0001/0021 (ISCIII - Subdirección General de Evaluación y Fomento de la Investigación/FEDER “Una Manera de hacer Europa”); Brazilian Government—National Council for Scientific and Technological Development - CNPq/Prosul (490725/2010-4); Ministerio de Ciencia, Tecnología e Innovación Productiva de la República Argentina; Consejo Nacional de Ciencia y Tecnología - Conacyt, Mexico (J010-214-2009, Fronteras 2015-2/814); and U.S. government: USDA National Institute of Food and Agriculture (2013-67013-21224. M. R-A. and J.M.M.-V. are indebted to Conacyt for a doctoral fellowship