La experiencia de los padres, madres y profesionales enfermeros en relación a la participación familiar en la hospitalización infantil.

Trabajo fin de grado en EnfermeríaIntroducción: la hospitalización infantil, independientemente del motivo y de las características del ingreso, es una amenaza para los niños y sus padres. Actualmente, se considera que la atención centrada en la familia es el modelo más acertado en pediatría, ya que reconoce el papel vital que tienen las familias en el cuidado del niño hospitalizado. Para que se dé este tipo de atención, tiene que producirse una colaboración entre los padres y los profesionales sanitarios, que se traduce en la participación activa de los padres en dicha atención. Objetivo: explorar las experiencias de los padres y de los profesionales de Enfermería con respecto a la participación de la familia en los cuidados durante la hospitalización infantil. Asimismo, se pretende identificar las necesidades familiares, los escenarios de participación familiar, las estrategias desarrolladas por los profesionales de Enfermería y las dificultades surgidas en relación a la participación de la familia en la hospitalización pediátrica. Metodología: se ha llevado a cabo una revisión narrativa de la literatura, mediante la consulta en bases de datos como Pubmed, CINAHL, CUIDEN y PsycInfo y en bibliotecas virtuales como Scielo. Resultados: la mayoría de las necesidades familiares detectadas se encuentran en consonancia con los nueve principios establecidos para la atención centrada en la familia. Los escenarios de participación familiar son muy variados en cada estudio y en cada país, siendo uno de los escenarios menos mencionados la participación de los padres en la toma de decisiones. Algunos profesionales inician estrategias propias para favorecer esta participación, sin embargo, en muchas investigaciones se detecta la necesidad de crear políticas a favor de la implicación familiar. Por último, las dificultades encontradas se relacionan principalmente con la situación clínica de los niños y la carga de trabajo de Enfermería. Conclusiones: la evidencia actual muestra la existencia de una colaboración de transición, siendo necesario aspirar a una colaboración transaccional. Se considera que la figura del profesional enfermero es la idónea para incentivar la participación familiar en la atención pediátrica.Introduction: children’s hospitalization, even though the reason for and characteristics of the admission, is a threat to children and their parents. Currently, family-centered care is consider to be the most successful model in pediatrics, because of its recognition of the vital rol that family play in the hospitalized child’s care. To make this happen, there has to set up a partnertship between parents and health care professionals, which means an active involvement of parents. Objective: to explore the experiences of parents and nursing professionals attending to family participation in care during child hospitalization. In addition, the aim consist on the identification of family needs, family participation scenarios, strategies developed by nurses and difficulties that arise in relation to the family involvement in pediatric hospitalization. Methodology: a narrative review of the literature has been carried out, consulting different health care databases such as Pubmed, CINAHL, CUIDEN and PsyqInfo and in online libraries such as Scielo. Results: the majority of the detected family needs are in accordance with the nine principles established for family-centered care. Family involvement scenarios are very varied in each study and in each country, being one of the least mentioned scenarios parental participation in decision making. Some professionals iniciate their own stragedies to encourage this participation, however, many investigations identify the need of creating policies in favor of family involvement. Finally, the difficulties encountered are mainly related to the situation of children and the working conditions of nurses. Conclusions: the current evidence shows the existence of a transitional collaboration, and it is necessary to aspire to a transactional collaboration. The figure of the nursing profesional is considered to be the ideal one to encourage family participation in paediatric car

Exportación de puertas de aluminio de España a Venezuela: Gexpoalum, S.L.

Desarrollo de un proyecto de fin de Master de Comercio exterior sobre Exportación de puertas de aluminio de España a Venezuela. Se buscó un producto duradero y tecnológicamente desarrollado,a fin que sus características físicas permitiese cubrir de una forma adecuada las demandas existentes en el mercado internacional, bajo una rentabilidad aceptable y la factibilidad de una posible expansión a mediano plazo en la cuota de mercado. «Puertas de aluminio tipo sándwich». Este producto, que mantiene un alto nivel de competitividad en la UE y bajo coste por la tecnología empleada en su fabricación en España, se plantea explorar el nicho de negocio y la posible demanda existente en Sudamérica, en especial Venezuela, donde los últimos años ha aumentado considerablemente la expansión en el sector de la construcción en las zonas costeras.Los autores constituyeron la Empresa GEXPOALUM SL., la cual realizó los Estudios, linimientos estratégicos, trámites legales administrativos y de coordinación, así como de negocio para lograr conseguir el proveedor más adecuado, que nos ofrecerá el mejor precio con objeto de obtener una adecuada rentabilidad

Relation among Aromatase P450 and Tumoral Growth in Human Prolactinomas

[EN]The pituitary gland is part of hypothalamic-pituitary–gonadal axis, which controls development, reproduction, and aging in humans and animals. In addition, the pituitary gland is regulated mainly by hormones and neurotransmitters released from the hypothalamus and by systemic hormones secreted by target glands. Aromatase P450, the enzyme responsible for the catabolization of aromatizable androgens to estrogens, is expressed in different parts of body, including the pituitary gland. Moreover, aromatase P450 is involved in sexual dimorphism where alteration in the level of aromatase can initiate a number of diseases in both genders. On the other hand, the direct actions of estrogens, mainly estradiol, are well known for stimulating prolactin release. Numerous studies have shown that changes in the levels of estrogens, among other factors, have been implicated in the genesis and development of prolactinoma. The pituitary gland can produce estradiol locally in several types of endocrine cells, and it is possible that aromatase could be responsible for the maintenance of the population of lactotroph cells and the modulation of the action of central or peripheral regulators. Aromatase overexpression due to inappropriate gene regulation has clinical effects such as the pathogenesis of prolactinomas. The present study reports on the synthesis of pituitary aromatase, its regulation by gonadal steroids, and the physiological roles of aromatase on pituitary endocrine cells. The involvement of aromatase in the pathogenesis of pituitary tumors, mainly prolactinomas, through the auto-paracrine production of estradiol is reviewed

Integrated Genomic Analysis of Chromosomal Alterations and Mutations in B-Cell Acute Lymphoblastic Leukemia Reveals Distinct Genetic Profiles at Relapse

The clonal basis of relapse in B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is complex and not fully understood. Next-generation sequencing (NGS), array comparative genomic hybridization (aCGH), and multiplex ligation-dependent probe amplification (MLPA) were carried out in matched diagnosis-relapse samples from 13 BCP-ALL patients to identify patterns of genetic evolution that could account for the phenotypic changes associated with disease relapse. The integrative genomic analysis of aCGH, MLPA and NGS revealed that 100% of the BCP-ALL patients showed at least one genetic alteration at diagnosis and relapse. In addition, there was a significant increase in the frequency of chromosomal lesions at the time of relapse (p = 0.019). MLPA and aCGH techniques showed that IKZF1 was the most frequently deleted gene. TP53 was the most frequently mutated gene at relapse. Two TP53 mutations were detected only at relapse, whereas the three others showed an increase in their mutational burden at relapse. Clonal evolution patterns were heterogeneous, involving the acquisition, loss and maintenance of lesions at relapse. Therefore, this study provides additional evidence that BCP-ALL is a genetically dynamic disease with distinct genetic profiles at diagnosis and relapse. Integrative NGS, aCGH and MLPA analysis enables better molecular characterization of the genetic profile in BCP-ALL patients during the evolution from diagnosis to relapse

Clinical, biological, and prognostic implications of SF3B1 co-occurrence mutations in very low/low- and intermediate-risk MDS patients

SF3B1 is a highly mutated gene in myelodysplastic syndrome (MDS) patients, related to a specific subtype and parameters of good prognosis in MDS without excess blasts. More than 40% of MDS patients carry at least two myeloid-related gene mutations but little is known about the impact of concurrent mutations on the outcome of MDS patients. In applying next-generation sequencing (NGS) with a 117 myeloid gene custom panel, we analyzed the co-occurrence of SF3B1 with other mutations to reveal their clinical, biological, and prognostic implications in very low/low- and intermediate-risk MDS patients. Mutations in addition to those of SF3B1 were present in 80.4% of patients (median of 2 additional mutations/patient, range 0–5). The most frequently mutated genes were as follows: TET2 (39.2%), DNMT3A (25.5%), SRSF2 (10.8%), CDH23 (5.9%), and ASXL1, CUX1, and KMT2D (4.9% each). The presence of at least two mutations concomitant with that of SF3B1 had an adverse impact on survival compared with those with the SF3B1 mutation and fewer than two additional mutations (median of 54 vs. 87 months, respectively: p = 0.007). The co-occurrence of SF3B1 mutations with specific genes is also linked to a dismal prognosis: SRSF2 mutations were associated with shorter overall survival (OS) than SRSF2wt (median, 27 vs. 75 months, respectively; p = 0.001), concomitant IDH2 mutations (median OS, 11 [mut] vs. 75 [wt] months; p = 0.001), BCOR mutations (median OS, 11 [mut] vs. 71 [wt] months; p = 0.036), and NUP98 and STAG2 mutations (median OS, 27 and 11 vs. 71 months, respectively; p = 0.008 and p = 0.002). Mutations in CHIP genes (TET2, DNMT3A) did not significantly affect the clinical features or outcome. Our results suggest that a more comprehensive NGS study in low-risk MDS SF3B1mut patients is essential for a better prognostic evaluation.This work was supported by grants from the following: Contrato Rio Hortega, CM17/00171; Gerencia Regional de Salud (Castilla y León) para proyectos de investigación año 2018, 1850/A/18; Spanish Fondo de Investigaciones Sanitarias, PI15/01471, PI18/01500; Instituto de Salud Carlos III (ISCIII); European Regional Development Fund (ERDF) “Una manera de hacer Europa”; Consejería de Educación, Junta de Castilla y León (SA271P18); Proyectos de Investigación del SACYL, Spain, GRS1847/A/18, GRS1653/A17; SYNtherapy, Synthetic Lethality for Personalized Therapy-based Stratification In Acute Leukemia (ERAPERMED2018–275); ISCIII (AC18/00093), co-funded by ERDF/ESF, “Investing in your future”, by grants from Red Temática de Investigación Cooperativa en Cáncer (RTICC) (RD12/0036/0069) and Centro de Investigación Biomédica en Red de Cáncer (CIBERONC CB16/12/00233). JMHS is supported by a research grant from Fundación Española de Hematología y Hemoterapia. MM is currently supported by an Ayuda predoctoral de la Junta de Castilla y León from the Fondo Social Europeo (JCYL- EDU/556/2019 PhD scholarship)

Formas de Hispanidad

Este texto presenta estudios sobre las múltiples formas de hispanidad, desarrollados en los últimos años por destacados investigadores del mundo hispánico que, poco a poco, han estado construyendo un nuevo espacio de investigación para una creciente y activa comunidad científica. En este libro el lector encontrará estudios con enfoques desde la ciencia política, la teoría política, la historia, la filosofía, la sociología, la economía, los estudios literarios y culturales, entre otras perspectivas académicas. Los aportes de cada aproximación teórica y disciplinar están orientados al logro de una meta común: la de reconstruir y reinterpretar la tradición histórica hispánica, desmantelando prejuicios ideológicamente provocados, con el fin de comprender los fenómenos políticos que la caracterizan. Por las mismas razones este libro se sitúa en el debate sobre las formas de escritura de la historia, que no es sólo un debate de teoría de la historia sino también de filosofía de lo histórico

A chromosome-level genome assembly enables the identification of the follicule stimulating hormone receptor as the master sex-determining gene in the flatfish Solea senegalensis

Sex determination (SD) shows huge variation among fish and a high evolutionary rate, as illustrated by the Pleuronectiformes (flatfishes). This order is characterized by its adaptation to demersal life, compact genomes and diversity of SD mechanisms. Here, we assembled the Solea senegalensis genome, a flatfish of great commercial value, into 82 contigs (614 Mb) combining long- and short-read sequencing, which were next scaffolded using a highly dense genetic map (28,838 markers, 21 linkage groups), representing 98.9% of the assembly. Further, we established the correspondence between the assembly and the 21 chromosomes by using BAC-FISH. Whole genome resequencing of six males and six females enabled the identification of 41 single nucleotide polymorphism variants in the follicle stimulating hormone receptor (fshr) consistent with an XX/XY SD system. The observed sex association was validated in a broader independent sample, providing a novel molecular sexing tool. The fshr gene displayed differential expression between male and female gonads from 86 days post-fertilization, when the gonad is still an undifferentiated primordium, concomitant with the activation of amh and cyp19a1a, testis and ovary marker genes, respectively, in males and females. The Y-linked fshr allele, which included 24 nonsynonymous variants and showed a highly divergent 3D protein structure, was overexpressed in males compared to the X-linked allele at all stages of gonadal differentiation. We hypothesize a mechanism hampering the action of the follicle stimulating hormone driving the undifferentiated gonad toward testisEuropean Union's Horizon 2020 research and innovation programme under grant agreement (AQUA-FAANG). Grant Number: 81792. Junta de Andalucía-FEDER Grant. Grant Number: P20-00938. Spanish Ministry of Economy and Competitiveness, FEDER Grants. Grant Numbers: RTI2018-096847-B-C21, RTI2018-096847-B-C22S

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment : A qualitative pilot study

Background: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. Methods: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. Results: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. Conclusions: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. Trial registration: ClinicalTrials.gov, NCT02757781. Registered on 25 April 2016

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment: A qualitative pilot study

Background: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. Methods: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. Results: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. Conclusions: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. Trial registration: ClinicalTrials.gov, NCT02757781. Registered on 25 April 2016.This study was financed by Instituto de Salud Carlos III and Cofinanced by Fondo Europeo de Desarrollo Regional (FEDER). Ministerio de Economía y Competitividad. Gobierno de España. (PI15/00164, PI15/00586, PI15/00566

Genome-wide DNA copy number analysis of acute lymphoblastic leukemia identifies new genetic markers associated with clinical outcome

Altres ajuts: FUCALHH 2013; HUS272U13; GRS 994/A/14, BIO/SA10/14, BIO/SA31/13; Fundación Española de Hematología y Hemoterapia (FEHH), Universidad Pedagógica y Tecnológica de Colombia 223-2011Identifying additional genetic alterations associated with poor prognosis in acute lymphoblastic leukemia (ALL) is still a challenge. Aims: To characterize the presence of additional DNA copy number alterations (CNAs) in children and adults with ALL by whole-genome oligonucleotide array (aCGH) analysis, and to identify their associations with clinical features and outcome. Array-CGH was carried out in 265 newly diagnosed ALLs (142 children and 123 adults). The NimbleGen CGH 12x135K array (Roche) was used to analyze genetic gains and losses. CNAs were analyzed with GISTIC and aCGHweb software. Clinical and biological variables were analyzed. Three of the patients showed chromothripsis (cth6, cth14q and cth15q). CNAs were associated with age, phenotype, genetic subtype and overall survival (OS). In the whole cohort of children, the losses on 14q32.33 (p = 0.019) and 15q13.2 (p = 0.04) were related to shorter OS. In the group of children without good- or poor-risk cytogenetics, the gain on 1p36.11 was a prognostic marker independently associated with shorter OS. In adults, the gains on 19q13.2 (p = 0.001) and Xp21.1 (p = 0.029), and the loss of 17p (p = 0.014) were independent markers of poor prognosis with respect to OS. In summary, CNAs are frequent in ALL and are associated with clinical parameters and survival. Genome-wide DNA copy number analysis allows the identification of genetic markers that predict clinical outcome, suggesting that detection of these genetic lesions will be useful in the management of patients newly diagnosed with ALL