Curing children, caring for families:The path to personalized care in childhood cancer treatment in El Salvador

This dissertation follows the trajectory of the childhood cancer program of El Salvador in its quest to eliminate abandonment of treatment. Abandonment of treatment is said to occur when parents of children with cancer stop or even fail to start hospital treatment for their child. This happens relatively often in developing countries and results in the child’s death and is an important reason why cure rates don’t attain the levels of developed countries. This research approaches the question from the perspectives of both the parents and the hospital team, linking personal experience to institutional processes. The program’s trajectory can be summarized as follows: after measures intended to solve the most pressing material needs impeding parents’ continuation of treatment, the hospital’s health care team implemented a general methodology for patient follow up that systematized information and standardized actions aimed at the early detection and prevention of abandonment. The resultant protocol increased insight into adherence to treatment schedule, allowed for more accurate assessment of families’ needs, and thus resulted in an intensified and more personalized care provision, for all patients in the program. In contrast to conventional conceptions of protocolization as the end of personalized or ‘patient-centred’ care, this thesis thus shows that standardization can in fact increase personalization and the quality of care. It ends by outlining the necessary conditions for this to happen and using these to build a policy framework for those wishing to improve cancer programs in developing countries

Curing children, caring for families:The path to personalized care in childhood cancer treatment in El Salvador

This dissertation follows the trajectory of the childhood cancer program of El Salvador in its quest to eliminate abandonment of treatment. Abandonment of treatment is said to occur when parents of children with cancer stop or even fail to start hospital treatment for their child. This happens relatively often in developing countries and results in the child’s death and is an important reason why cure rates don’t attain the levels of developed countries. This research approaches the question from the perspectives of both the parents and the hospital team, linking personal experience to institutional processes. The program’s trajectory can be summarized as follows: after measures intended to solve the most pressing material needs impeding parents’ continuation of treatment, the hospital’s health care team implemented a general methodology for patient follow up that systematized information and standardized actions aimed at the early detection and prevention of abandonment. The resultant protocol increased insight into adherence to treatment schedule, allowed for more accurate assessment of families’ needs, and thus resulted in an intensified and more personalized care provision, for all patients in the program. In contrast to conventional conceptions of protocolization as the end of personalized or ‘patient-centred’ care, this thesis thus shows that standardization can in fact increase personalization and the quality of care. It ends by outlining the necessary conditions for this to happen and using these to build a policy framework for those wishing to improve cancer programs in developing countries

1-Butanol absorption in poly(styrene-divinylbenzene) ion exchange resins for catalysis

The swelling behaviour of poly(styrene-co-divinylbenzene), P(S-DVB), ion exchange resins in 1-butanol (BuOH) has been studied by means of atomistic classical molecular dynamics simulations (MD). The topological characteristics reported for the resin in the dry state, which exhibited complex internal loops (macropores), were considered for the starting models used to examine the swelling induced by BuOH contents ranging from 10% to 50% w/w. Experimental measurements using a laser diffraction particle size analyzer indicate that swelling causes a volume variation with respect to the dry resin of 21%. According to MD simulations, such a volume increment corresponds to a BuOH absorption of 31-32% w/w, which is in excellent agreement with the indirect experimental estimation (i.e. 31% w/w). Simulations reveal that, independently of the content of BuOH, the density of the swelled resin is higher than that of the dry resin, evidencing that the alcohol provokes important structural changes in the polymeric matrix. Thus, BuOH molecules cause a collapse of the resin macropores when the content of alcohol is <= 20% w/w. In contrast, when the concentration of BuOH is close to the experimental value (similar to 30% w/w), P(S-DVB) chains remain separated by pores faciliting the access of the reactants to the reaction centers. On the other hand, evaluation of both bonding and non-bonding interactions indicates that the mixing energy is the most important contribution to the absorption of BuOH into the P(S-DVB) resin. Overall, the results displayed in this work represent a starting point for the theoretical study of the catalytic conversion of BuOH into di-n-butyl ether in P(S-DVB) ion exchange resins using sophisticated electronic methods.Peer Reviewe