Análisis y estrategia organizativa de la atención neurológica del ictus agudo en la Comunidad de Madrid

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Medicina. Fecha de lectura: 3 de Diciembre del 200

Factores de personalidad asociados al éxito en las exportaciones de empresarios mexicanos

El objetivo de esta comunicación es presentar los factores de personalidad asociados al éxito exportador de los empresarios mexicanos de la Zona Metropolitana de Guadalajara, México. La justificación del estudio está en la necesidad que México tiene de generar un mayor número de empresas exportadoras, impulsando el emprendimiento internacional. De acuerdo a los resultados de esta investigación, hay relación entre el éxito exportador y los factores de personalidad de empresarios mexicanos que son exportadores exitosos. México necesita reducir su dependencia de la exportación de manufacturas realizada por la inversión extranjera directa e incrementar las exportaciones de las empresas mexicanas. Se espera que las universidades y los organismos empresariales consideren estos resultados en el momento de seleccionar alumnos para desarrollar sus programas orientados al emprendimiento internacional.The objective of this article is to present, the results of this research whose main goal was to identify the elements of personality associated to the export of Mexican entrepreneurs in the MAG. The main justification for carrying out this study is the need of Mexico to reduce its current dependence on manufacturing export from foreign investment and increase exports of its Mexican companies. According to this study, there is association between export success and personality elements in the Mexican successful exporters. With the spread of these findings, it is expected that both, universities and business organizations, consider these results when developing curricula and programs related to international venture

The singular properties of photosynthetic cytochrome c 550 from the diatom Phaeodactylum tricornutum suggest new alternative functions

Cytochrome c 550 is an extrinsic component in the luminal side of photosystem II (PSII) in cyanobacteria, as well as in eukaryotic algae from the red photosynthetic lineage including, among others, diatoms. We have established that cytochrome c 550 from the diatom Phaeodactylum tricornutum can be obtained as a complete protein from the membrane fraction of the alga, although a C-terminal truncated form is purified from the soluble fractions of this diatom as well as from other eukaryotic algae. Eukaryotic cytochromes c 550 show distinctive electrostatic features as compared with cyanobacterial cytochrome c 550 . In addition, co-immunoseparation and mass spectrometry experiments, as well as immunoelectron microscopy analyses, indicate that although cytochrome c 550 from P. tricornutum is mainly located in the thylakoid domain of the chloroplast – where it interacts with PSII –, it can also be found in the chloroplast pyrenoid, related with proteins linked to the CO 2 concentrating mechanism and assimilation. These results thus suggest new alternative functions of this heme protein in eukaryotes.Ministerio de Economía, Industria y Competitividad BIO2015-64169-PJunta de Andalucía PAIDI BIO-02

Meta-Analysis Design and Results in Real Life: Problem Solvers or Detour to Maze. A Critical Review of Meta-Analysis of DAPT Randomized Controlled Trials.

Therapeutic strategies - such as duration of dual antiplatelet therapy after coronary artery stenting - usually generate a large quantity of meta-analyses. The meta-analyses that include the same randomized clinical trials should produce similar results. Our aim in the study is to analyze the quality and to compare the results of meta-analyses focused on a controversial topic such as dual antiplatelet therapy after percutaneous coronary intervention. We searched all published meta-analyses published up to November 2015 (near DAPT trial publication) selecting those that included the same randomized clinical trials comparing patterns of briefer versus longer-term double antiplatelet therapy. Seventeen meta-analyses achieved our selection criteria. Of the seventeen analyzed, we identified seven (41.1%) based on the same ten randomized clinical trials (RCTs), yet their results varied widely. Many of the meta-analyses differed in only some minor aspect of the design (i.e. eligible studies, length of comparators and statistical methods used). Some authors differed in the number of patients participating in RCTs and even, despite reviewing the same underlying trials, only 2 of the 7 meta-analyses included the same number of patients. Meta-analyses around cardiovascular, all-cause or non-cardiovascular death differ frequently. In the DAPT duration setting, several meta-analyses have been recently published based on the same data, presenting several issues making it difficult to determine clear recommendations on certain points.IN receives research funding from Astrazeneca; has received minor consulting fees from Boston, Medtronic, Astrazeneca; and speaking fees or support for attending scientificmeetings fromBoehringer, Daiichi-Sankyo, Lilly, AstraZeneca and Pfizer. AE is Astrazeneca employee. HB receives research funding from the Instituto de Salud Carlos III (PIE16/00021), AstraZeneca, BMS, Janssen and Novartis; has received consulting fees from Abbott, AstraZeneca, Bayer, BMS-Pfizer, Novartis; and speaking fees or support for attending scientificmeetings from AstraZeneca, Bayer, BMS-Pfizer, Ferrer, Novartis, Servier and MEDSCAPE-the heart.og. The other authors pose no relevant disclosures regarding this manuscript.S

Rescue treatment with terlipressin in children with refractory septic shock: a clinical study

INTRODUCTION: Refractory septic shock has dismal prognosis despite aggressive therapy. The purpose of the present study is to report the effects of terlipressin (TP) as a rescue treatment in children with catecholamine refractory hypotensive septic shock. METHODS: We prospectively registered the children with severe septic shock and hypotension resistant to standard intensive care, including a high dose of catecholamines, who received compassionate therapy with TP in nine pediatric intensive care units in Spain, over a 12-month period. The TP dose was 0.02 mg/kg every four hours. RESULTS: Sixteen children (age range, 1 month–13 years) were included. The cause of sepsis was meningococcal in eight cases, Staphylococcus aureus in two cases, and unknown in six cases. At inclusion the median (range) Pediatric Logistic Organ Dysfunction score was 23.5 (12–52) and the median (range) Pediatric Risk of Mortality score was 24.5 (16–43). All children had been treated with a combination of at least two catecholamines at high dose rates. TP treatment induced a rapid and sustained improvement in the mean arterial blood pressure that allowed reduction of the catecholamine infusion rate after one hour in 14 out of 16 patients. The mean (range) arterial blood pressure 30 minutes after TP administration increased from 50.5 (37–93) to 77 (42–100) mmHg (P < 0.05). The noradrenaline infusion rate 24 hours after TP treatment decreased from 2 (1–4) to 1 (0–2.5) µg/kg/min (P < 0.05). Seven patients survived to the sepsis episode. The causes of death were refractory shock in three cases, withdrawal of therapy in two cases, refractory arrhythmia in three cases, and multiorgan failure in one case. Four of the survivors had sequelae: major amputations (lower limbs and hands) in one case, minor amputations (finger) in two cases, and minor neurological deficit in one case. CONCLUSION: TP is an effective vasopressor agent that could be an alternative or complementary therapy in children with refractory vasodilatory septic shock. The addition of TP to high doses of catecholamines, however, can induce excessive vasoconstriction. Additional studies are needed to define the safety profile and the clinical effectiveness of TP in children with septic shock

Inhibidores de la proproteína convertasa subtilisina/kexina tipo 9 (iPCSK9) en la prevención secundaria de episodios vasculares en pacientes con ictus isquémico: documento de consenso y aplicaciones prácticas

Practice guideline[Abstract] Introduction: Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. Methods: A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. Conclusions: PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels <20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.[Resumen] Introducción. Los pacientes, tras un ictus o un ataque isquémico transitorio, presentan un riesgo muy elevado de sufrir nuevos episodios vasculares. La reducción del nivel de colesterol unido a lipoproteínas de baja densidad (cLDL) reduce la incidencia de nuevos episodios, si bien una proporción importante de pacientes no alcanza los objetivos terapéuticos recomendados con los tratamientos hipolipemiantes actuales. El objetivo de este documento de consenso es actualizar el papel de los inhibidores de la proproteína convertasa subtilisina/kexina tipo 9 (iPCSK9; alirocumab y evolocumab) en la prevención secundaria de episodios vasculares en pacientes con ictus isquémico previo. Métodos. Se realizó una revisión bibliográfica para identificar las principales evidencias sobre el uso de iPCSK9 en estos pacientes y los objetivos terapéuticos recomendados de cLDL. Los resultados se discutieron en 2 reuniones de consenso, que constituyeron la base para la elaboración del documento. Conclusiones. Los iPSCSK9 son eficaces en la reducción del riesgo vascular en prevención secundaria y, específicamente, evolocumab ha demostrado esta reducción en pacientes con ictus isquémico previo. Ambos fármacos han demostrado un buen perfil de seguridad, incluso en pacientes que alcanzaron un nivel de cLDL <20 mg/dL. En este sentido, en el subestudio de episodios neurocognitivos con evolocumab no se observó ninguna señal de empeoramiento de la función cognitiva en pacientes con nivel muy bajo de cLDL. Con base en estas evidencias, en el documento se presentan recomendaciones prácticas sobre el uso de iPCSK9 para la prevención secundaria y seguimiento de episodios vasculares en pacientes con ictus isquémico previo

Implementation of a new social skills training program for adults with intellectual disabilities

El presente estudio tiene como fin elaborar y aplicar un nuevo programa de entrenamiento para fomentar el uso de habilidades sociales (HHSS) en un grupo de personas adultas con discapacidad intelectual (DI). Contó con un diseño metodológico cuasi-experimental para probar la efectividad del programa. La muestra estuvo formada por 21 adultos con discapacidad intelectual, usuarios de una unidad de día con terapia ocupacional (10 participantes siguieron el programa y 11 no). Las habilidades sociales fueron evaluadas por medio de una adaptación de la Escala de Habilidades Sociales de Gismero (2010). Los resultados ponen de manifiesto una mejoría significativa en las puntuaciones globales del grupo de tratamiento respecto al grupo contraste. De igual forma, se evidenció un incremento en las puntuaciones del grupo de tratamiento en cinco de las seis subescalas. Las mejoras detectadas resultan claves para el desarrollo individual de este grupo y se discuten las implicaciones de los resultados.The present study has the purpose to develop and apply a new training program in order to promote the use of social skills in a group of adults with intellectual disabilities. It contains a quasi-experimental methodological design to prove the program effectiveness. The sample used consists of 21 adults with intellectual disabilities, users of an occupational therapy day entity (10 persons participated in the program and 11 did not). The social skills were evaluated using an adjusted version of the Social Skills Scale Model of Gismero (2010). The outcomes of this study show a significant improvement in the overall score of the group included in the program in comparison with the rest of the group. Likewise, the group under the program obtained an increase in the scores within 5 out of 6 subscales evaluated. The identified improvements are key elements for the individual development of this group. The implications of the results are discussed

Health in neighbourhoods: impact of extreme temperatures

[ES] Las proyecciones de cambio climático prevén un aumento en el número e intensidad de las olas de calor. En España, se prevé un ritmo de incremento de las temperaturas máximas diarias de 0,4 ºC por década en el periodo 2021–2050 y de 0,6ºC por década en el 2051–2100 en un escenario de máximas emisiones (RCP8.5). Este incremento de temperaturas puede implicar importantes sobrecostes sanitarios que se sumarán a los actuales aumentos de mortalidad y morbilidad provocados por la exposición de la población a extremos térmicos. El entorno urbano construido, así como la edificación, juegan un papel fundamental en el grado de exposición de la población a estas temperaturas extremas. La alta densidad de las ciudades y la ausencia de espacios verdes son modificadores del clima urbano y en grandes urbes se expresan mediante una alta intensidad del fenómeno de isla de calor. La ausencia de eficiencia energética de gran parte del parque de viviendas y los elevados precios de la energía se suman a esta problemática, en especial, en aquellas situaciones de pobreza energética en la que los hogares no pueden mantener su vivienda a unas temperaturas adecuadas para unas óptimas condiciones de salud. Las intervenciones en barrios deben acometerse desde una perspectiva de salud con un objetivo claro de reducción de la exposición de la población a temperaturas extremas y los riesgos sanitarios asociados. Resulta necesario combinar las actuaciones sobre el espacio público orientadas a la mejora del microclima urbano con aquellas destinadas la mejora de las condiciones de bienestar térmico de las viviendas. [POR] As projecções de alterações climáticas prevêem um aumento no número e na intensidade das ondas de calor. Em Espanha, prevê-se um aumento nas temperaturas máximas diárias de 0,4 ºC por década no período de 2021–2050 e de 0,6 ºC por década em 2051–2100, num cenário de emissões máximas (RCP8.5). Este aumento de temperaturas pode implicar custos adicionais significativos para a saúde que se somarão aos atuais aumentos de mortalidade e morbilidade causados pela exposição da população a extremos térmicos. O ambiente urbano construído, assim como a edificação, desempenham um papel fundamental no grau de exposição da população a essas temperaturas extremas. A alta densidade das cidades e a ausência de espaços verdes são modificadores do clima urbano e nas grandes cidades expressam-se por meio de uma alta intensidade do fenómeno das ilhas de calor. A ausência de eficiência energética em grande parte do parque habitacional e os elevados preços da energia aumentam esse problema, especialmente em situações de pobreza energética em que as famílias não conseguem manter suas casas em temperaturas adequadas para condições de saúde óptimas.As intervenções nas áreas residenciais devem ser realizadas a partir de uma perspectiva de saúde com um objectivo claro de reduzir a exposição da população a temperaturas extremas e os riscos para a saúde associados. É necessário conjugar as acções no espaço público que visam a melhoria do microclima urbano com aquelas que visam a melhoria das condições de bem-estar térmico das habitações. [EN] Projections about climate change forecast an increase in the number and intensity of heat waves. In Spain daily maximum temperatures are projected to increase by 0.4 °C per decade in the 2021-2050 period and by 0.6°C per decade in the 2051-2100 period in a maximum emissions scenario (RCP8.5). This increase in temperatures may lead to significant healthcare costs, on top of current mortality and morbidity increases, as a result of the population’s exposure to temperature extremes.The built urban environment and buildings proper play a key role in the population’s degree of exposure to these temperature extremes. The high density of cities and the absence of green spaces are modifiers of urban climate. In large cities this is manifested in a high intensity of the heat island phenomenon. The poor energy efficiency of much of the housing pool and high energy prices compound this problem, especially in energy poverty situations where households are unable to keep their homes at temperatures suitable for optimal health conditions.Interventions should be made in neighborhoods with health in mind, the clear objective of which should be reducing the population’s exposure to extreme temperatures and the associated health risks. It is necessary to combine actions on the public space aimed at improving the urban microclimate with measures intended to improve the thermal comfort conditions in dwellings.Esta investigación se ha realizado con el apoyo de la Fundación Biodiversidad proyecto ENPY 470/19, el Ministerio de Economía y Competitividad. Proyecto MODIFICA (BIA2013-41732-R) y con el apoyo de un contrato FPU del Ministerio de Educación, Cultura y Deporte (FPU15/05052).S

Controversias constitucionales

La lucha por el control de las fuentes del derecho es una de las preocupaciones centrales de la teoría jurídica contemporánea. Esta lucha ha dividido a los juristas en dos grandes escuelas. Por una parte, están aquellos doctrinantes que consideran al imperio de la ley como el valor fundamental de un ordenamiento jurídico. La seguridad jurídica, la paz social y legalidad de las decisiones judiciales serían ideales mucho más importantes para que la supremacía constitucional o la homogeneidad de la jurisprudencia. Por otra parte, están aquellos juristas que consideran a la jurisprudencia, la costumbre y la doctrina constitucional como valores fundamentales de un ordenamiento jurídico legítimo.En Colombia, los fallos de la Corte Constitucional han suscitado una de las controversias más interesantes en la ya clásica discusión sobre las fuentes de derecho. En especial, el fenómeno conocido como constitucionalización del derecho ha traído consigo numerosas modificaciones, principalmente, en en el campo del derecho civil y comercial (muchas de ellas sumamente polémicas). Sin duda, este libro constituye uno de los más serios intentos por analizar críticamente los efectos de la intervención de la Corte Constitucional en el derecho colombiano

Assessment of pavement deflection under vehicle loads using a 3D-DIC system in the field

This study aims to introduce the use of 3D-digital image correlation (DIC) to the in situ testing of pavements and to support the development of techniques for a rapid evaluation of the conservation status of existing roads. Little research was found on this topic. The passage of a car wheel on an asphalt pavement was adopted as a case study. The DIC measurements were compared to those gathered by contact sensors. From a qualitative point of view, the DIC measurements captured the realistic shape of a deflection basin. From a quantitative point of view, the deflection values provided by the DIC system had a mean error of 0.015 mm and a standard deviation of 0.011 mm. At the moment of highest load, these errors had a mean value and standard deviation of − 0.016 mm and 0.021 mm, respectively. Thus, to improve the accuracy of the system, we propose modifying the camera support, speckle pattern, and control of natural lightWe thank Extraco S.A. for allowing us to perform the test on their company facilities. This work was supported by the Strategic Researcher Cluster BioReDes funded by the Xunta de Galicia (Regional Government of Galicia) under project ref. ED431E 2018/09 and by the Xunta de Galicia under the grant “Financial aid for the consolidation and structure of competitive units of investigation in the universities of the University Galician System (2020-22)” under project ref. ED341B 2016/30. This work was also made possible due to the Spanish Agencia Estatal de Investigación (AEI), since Dr. Bastos was contracted in the frame of the postdoctoral grant Juan de la Cierva – Formación (FJC2019-039743-I/AEI/10.13039/501100011033)S