Urinary lithiasis and extracorporeal shock wave lithotripsy: new approachments

While ESWL is generally considered safe and effective, new methods are being created as result of continuous lithotripsy research to enhance the procedure's results. The aim is to conduct a complete and structured analysis of the most current extracorporeal lithotripsy systems in the management of kidney stones, and collect and evaluate the complications associated with using conventional ones.Medicin

How is CSR incorporated into a firm's strategy: the pedagogical case study of Henkel

Corporate Social Responsibility is a trending subject among company's communication towards their consumers, but the truth is that only a few companies can really own the concept of CSR, by having it as a key factor of its business strategy. The process of successfully implement a strategy that takes into account the impact of their operations in society and the environment constitutes a challenge for the management and it has to include a long-term perspective. This pedagogical case study aims to assess how does Henkel, the world's number one adhesives producer and one of the biggest Home Care and Beauty FMCG companies globally, integrates Corporate Social Responsibility into its business strategy. Moreover, this case will identify Henkel’s driver for being in business, the way it delivers additional value to its various stakeholders and what influence CSR has in the decision-making process and the day-to-day operations. This essay can be a practical tool to comprehend the scale of strategic management on a renowned company, provide guidelines for what is essential when implementing a CSR strategy, and the benefits and challenges that can be meet.A Responsabilidade Social das empresas (RSE) é uma nova tendência presente nos canais de comunicação dirigidos aos seus clientes, contudo são poucas as empresas que aplicam efetivamente este conceito de Responsabilidade Social como fator chave na sua estratégia de negócio. O sucesso da implementação desta estratégia, que tem em conta o impacto das suas operações na sociedade e no meio ambiente, constitui um desafio para a gestão e deve incluir uma perspetiva a longo-prazo. O presente caso de estudo pedagógico propõe analisar se a Henkel, a maior produtora de "Adhesive Technologies" do mundo e globalmente uma das maiores empresas de "Home Care" e "Beauty Care", integra o conceito de Responsabilidade Social das empresas na sua estratégia de negócio. Adicionalmente, este caso de estudo irá identificar as motivações da empresa para permanecer no negócio, como é que gera valor para os seus "stakeholders" e qual a influência que a RS tem ao longo do processo de tomada de decisão e nas operações do dia-a-dia. Este caso de estudo pedagógico pode ser uma ferramenta prática para compreender a dimensão da gestão estratégica de uma empresa de renome, para apresentar diretrizes sobre os elementos essenciais na implementação de uma estratégia de RSE. assim como os potenciais benefícios e desafios que possam ser apresentados

The property on Taquile Island, Titicaca lake

Un ensayo etnológico y etnohistórico que describe la lucha por la propiedad de las tierras de cultivo de una comunidad indígena de habla quechua ubicada en una isla del Lago Titicaca. En la segunda mitad del siglo XVI fue adjudicada en remate a un español y desde entonces en sucesivos remates a otros hasta el siglo XVIII en que propietarios puneños la explotaron como su hacienda considerando colonos a sus habitantes.En 1942 los indígenas lograron iniciar la compra de sus tierras con título de propiedad, una singular reforma agraria que los hizo dueños respaldados por documentos públicos. Estudio apasionante de las vicisitudes y luchas por lograrlo y de la situación de la isla Taquile en la década 1950.ownership of farmland in a Quechua speaking native community located in an island on Lake Titicaca. Taquile was sold at auction to a Spaniard during the second half of the XVI century and then successively to others at several auctions until the XVIII century, when owners from Puno developed it as their own estate, referring to its inhabitants as settlers. A remarkable agrarian reform began in 1942, when the natives started buying their land and obtaining official title deeds to their property. A passionate study about their struggle to achieve this and the state of affairs in Taquile island during the fifties

A 802.11p prototype implementation

This paper presents an IEEE 802.11p full-stack prototype implementation to data exchange among vehicles and between vehicles and the roadway infrastructures. The prototype architecture is based on FPGAs for Intermediate Frequency (IF) and base band purposes, using 802.11a based transceivers for RF interfaces. Power amplifiers were also addressed, by using commercial and in-house solutions. This implementation aims to provide technical solutions for Intelligent Transportation Systems (ITS) field, namely for tolling and traffic management related services, in order to promote safety, mobility and driving comfort through the dynamic and real-time cooperation among vehicles and/or between vehicles and infrastructures. The performance of the proposed scheme is tested under realistic urban and suburban driving conditions. Preliminary results are promising, since they comply with most of the 802.11p standard requirements

Uso tutelado del tratamiento intraluminal de los aneurismas de aorta abdominal mediante prótesis intavasculares

Conocer los resultados del tratamiento con prótesis intravasculares en pacientes con aneurismas de aorta abdominal (AAA) a través de un registro multicéntrico de casos. El objetivo final es establecer recomendaciones que permitan garantizar la aplicación del procedimiento en las condiciones de mayor eficacia y seguridad en el Sistema Nacional de Salud.Introducción. Antecedentes. Definición. Epidemiología e importancia sanitaria de los AAA. Clínica e historia natural de la enfermedad. Diagnóstico y tratamiento. Estado actual de la evidencia científica. Método. Resultados. Análisis de los resultados de la intervención intraluminal. Análisis de los resultados de la intervención intraluminal según el carácter retrospectivo o prospectivo de la recogida de los casos. Análisis de los resultados de la intervención intraluminal según factor de riesgo:sistema ASA. Análisis de los resultados de la intervención intraluminal según tamaño del aneurisma. Análisis de los resultados de la intervención intraluminal según el sexo del paciente. Análisis de los resultados en los seguimientos de los pacientes intervenidos mediante PIVs. Análisis de los casos de muerte. Tablas. Características de los pacientes con AAA intervenidos con PIVs. Datos de la intervención intraluminal. Datos del postoperatorio. Análisis de los resultados de la intervención intraluminal: Según el carácter retrospectivo o prospectivo de la recogida de los casos. Según factor de riesgo: sistema ASA. Según tamaño del AAA. Según sexo. Análisis de los seguimientos de los pacientes: Intervenidos con PIVs. Intervenidos con PIVs estratificados según el carácter retrospectivo o prospectivo de la recogida de los casos. Intervenidos con PIVs estratificados según factor de riesgo: sistema ASA. Intervenidos con PIVs estratificados según el tamaño del aneurisma. Intervenidos con PIVs estratificados según sexo. Discusión. Conclusiones. Referencias Bibliográficas. ANEXO. Protocolo de Uso Tutelado

Differences in the factors related to the use of mammograms among Spanish women in 1994 and 2000

BACKGROUND: The screening mammography is the most highly effective procedure for early breast cancer detection. This study is aimed at ascertaining the differences in the factors related to Spanish women 40-70 years of age having had mammograms in 1994 and 2000 and among those having had at least one mammogram within the two years prior. METHOD: Comparison of the results of two surveys conducted in 1994 and 2000, each on samples of women representative of Spanish women 40-70 years of age (3,218 in 1994 and 2,409 in 2000). An analysis was made of sociodemographic, sociosanitary and the women's attitude and awareness-related variables. RESULTS: Statistically significant differences were found between 1994 and 2000, the intention of having a mammogram in the future (96% in 2000 vs. 79% in 1994) (p<0.0001). A total of 59% of the 51-65 age group had a mammogram in 2000, as compared to the 50% who had one in 1994. CONCLUSIONS: The profile of Spanish women has undergone a change from 1994 to 2000, although those women who had had a mammogram were of similar sociodemographic and sociosanitary characteristics. However, the screening is being done to a greater extent on the age 51-65 age group in 2000, and the women are showing more positive attitudes toward having a mammogram. Fundamento: La mamografía de cribado es el procedimiento más efectivo para la detección precoz del cáncer de mama. El objetivo del presente estudio es conocer las diferencias en los factores relacionados con el uso de mamografía en 1994 y en 2000 en las mujeres españolas de 40-70 años, y en aquéllas con al menos una mamografía en los dos años previos. Método: Comparación de los resultados de dos encuestas realizadas en 1994 y en 2000 en sendas muestras de mujeres representativas de las mujeres españolas de 40-70 años (3.218 en 1994 y 2.409 en 2000). Se analizaron variables sociodemográficas, socio-sanitarias y de actitudes e información de la mujer. Resultados: De 1994 a 2000 se encuentran diferencias estadísticamente significativas en las actitudes, destacando la intención de hacerse una mamografía en el futuro (96% en 2000 vs 79% en 1994) (p<0,0001). El porcentaje de realización de la prueba en el grupo de 51-65 años es de 59% en 2000 vs 50% en 1994. Conclusiones: El perfil de las mujeres españolas ha cambiado de 1994 a 2000, aunque las mujeres que se habían realizado una mamografía presentan características sociodemográficas y socio-sanitarias similares. No obstante, en el año 2000 la mamografía se realiza en mayor medida en el grupo de 51-65 años de edad y las mujeres muestran actitudes más positivas ante la mamografía.Este estudio está basado en un proyecto de investigación financiado por el Fondo de Investigación Sanitaria, Instituto de Salud Carlos III. Ministerio de Sanidad y Consumo ()

Revisión sistemática sobre la eficacia y seguridad de los neuroestimuladores periféricos del ganglio esfenopalatino para el tratamiento de la cefalea crónica en racimos refractaria

[EN] Introduction: This study aimed to assess the safety and effectiveness of peripheral neurostimulation of the sphenopalatine ganglion (SPG) in the treatment of refractory chronic cluster headache. Development: Various medical databases were used to perform a systematic review of the scientific literature. The search for articles continued until 31 October 2016, and included clinical trials, systematic reviews and/or meta-analyses, health technology assessment reports, and clinical practice guidelines that included measurements of efficiency/effectiveness or adverse effects associated with the treatment. The review excluded cohort studies, case–control studies, case series, literature reviews, letters to the editor, opinion pieces, editorials, and studies that had been duplicated or outdated by later publications from the same institution. Regarding effectiveness, we found that SPG stimulation had positive results for pain relief, attack frequency, medication use, and patients’ quality of life. In the results regarding safety, we found a significant number of adverse events in the first 30 days following the intervention. Removal of the device was necessary in some patients. Little follow-up data, and no long-term data, is available. Conclusions: These results are promising, despite the limited evidence available. We consider it essential for research to continue into the safety and efficacy of SPG stimulation for patients with refractory chronic cluster headache. In cases where this intervention may be indicated, treatment should be closely monitored. [ES] Introducción: El objetivo es evaluar la eficacia y seguridad de los neuroestimuladores periféricos del ganglio esfenopalatino (GEP) para el tratamiento de la cefalea en racimos crónica refractaria al tratamiento. Desarrollo: Revisión sistemática de la literatura científica. Se identificaron estudios mediante una búsqueda en diferentes bases de datos. Las estrategias de búsqueda se realizaron hasta el 31 de octubre de 2016, incluyendo ensayos clínicos, revisiones sistemáticas o metaanálisis, informes de evaluación de tecnologías sanitarias y guías de práctica clínica que recogieran medidas de eficacia/efectividad o efectos adversos asociados al tratamiento. Se excluyeron estudios de cohortes, casos y controles, series de casos, revisiones narrativas, cartas al director, artículos de opinión, editoriales y estudios duplicados o desfasados por estudios posteriores de la misma institución. Respecto a la eficacia, los resultados son positivos tras la estimulación del GEP en relación con el alivio de dolor, el número de episodios, el uso de la medicación o la calidad de vida del paciente. En relación con la seguridad, hay un número importante de efectos adversos en los primeros 30 días de la intervención y en algunos pacientes fue necesaria la retirada del dispositivo. Los datos de seguimiento son a corto plazo y escasos. Conclusiones: Los resultados resultan prometedores a pesar de que la evidencia disponible es limitada. Consideramos fundamental continuar con la investigación sobre la seguridad y eficacia de los neuroestimuladores del GEP en la cefalea en racimos crónica. En aquellos casos en que pueda estar indicada la intervención, el tratamiento debería realizarse supervisado en un estudio de monitorización.S

Dendritic self-assembled structures from therapeutic charged pentapeptides

CRENKA [Cys-Arg-(NMe)Glu-Lys-Ala, where (NMe)Glu refers to N-methyl-Glu], an anti-cancer pentapeptide that induces prostate tumor necrosis and significant reduction in tumor growth, was engineered to increase the resistance to endogenous proteases of its parent peptide, CREKA (Cys-Arg-Glu-Lys-Ala). Considering their high tendency to aggregate, the self-assembly of CRENKA and CREKA into well-defined and ordered structures has been examined as a function of peptide concentration and pH. Spectroscopic studies and atomistic molecular dynamics simulations reveal significant differences between the secondary structures of CREKA and CRENKA. Thus, the restrictions imposed by the (NMe)Glu residue reduce the conformational variability of CRENKA with respect to CREKA, which significantly affects the formation of well-defined and ordered self-assembly morphologies. Aggregates with poorly defined morphology are obtained from solutions with low and moderate CREKA concentrations at pH 4, whereas well-defined dendritic microstructures with fractal geometry are obtained from CRENKA solutions with similar peptide concentrations at pH 4 and 7. The formation of dendritic structures is proposed to follow a two-step mechanism: (1) pseudo-spherical particles are pre-nucleated through a diffusion-limited aggregation process, pre-defining the dendritic geometry, and (2) such pre-nucleated structures coalesce by incorporating conformationally restrained CRENKA molecules from the solution to their surfaces, forming a continuous dendritic structure. Instead, no regular assembly is obtained from solutions with high peptide concentrations, as their dynamics is dominated by strong repulsive peptide–peptide electrostatic interactions, and from solutions at pH 10, in which the total peptide charge is zero. Overall, results demonstrate that dendritic structures are only obtained when the molecular charge of CRENKA, which is controlled through the pH, favors kinetics over thermodynamics during the self-assembly process.Peer ReviewedPostprint (published version

Efficacy and safety of robotic spine surgery: systematic review and meta-analysis

Background: Robotic surgery (RS) may offer benefits compared with freehand/conventional surgery (FS) in the treatment of patients with spinal disease. The aim of this study was to evaluate the efficacy and safety of RS versus FS in spinal fusion. Methods: A systematic review and meta-analysis was performed. Data analysis and risk of bias assessment were analysed using REVMAN V5.3. Results: We found 11 randomised clinical trials involving 817 patients (FS: 408, RS: 409). The main diagnosis was degenerative spine disease. SpineAssist, Renaissance (Mazor Robotics), Tianji Robot and TiRobot robots (TINAVI Medical Technologies) were used. Pedicle screw placement within the safety zone (grades A + B according to the Gertzbein and Robbins scale) ranged from 93% to 100% in FS versus 85-100% in RS (relative risk 1.01, 95% CI 1.00-1.03, p = 0.14). Regarding intervention time, the meta-analysis showed a mean difference (MD) of 6.45 min (95% CI -13.59 to 26.49, p = 0.53). Mean hospital stay was MD of -0.36 days (95% CI -1.03 to 0.31, p = 0.30) with no differences between groups. Contradictory results were found regarding fluoroscopy time, although there seems to be a lower radiation dose in RS versus FS (p < 0.05). Regarding safety, the studies included surgical revision frequency. Conclusions: No conclusive results were found suggesting that there are benefits in using RS over FS for spinal fusion. Further research with adequate patient selection, robot type and quality-of-life variables is needed.S