El espacio imaginario y la memoria en tres novelas de Julio Llamazares: Luna de Lobos, La lluvia amarilla y El cielo de Madrid

The research aims to investigate the presence and the treatment of the memory and the space in The yellow rain, Wolves moon and the Madrid’s sky. The first part deals with the narrative structure of the three novels. The second part investigates the circulation between the imaginary space and real space. In the third part, we will present the interaction between memory and narrative space as well as their symbolic significance. Basically, the space is a relevant element of the three novels, which not only helps to create possible worlds, making them credible to readers, but also is an indissoluble link with the problematic and complex condition of the human being. In fact, the imaginary space of three novels has an important symbolic significance of solitude, decay and death. By means of the construction of imaginary space, Llamazares is able to recreate the narrative originality.El presente estudio tiene como objetivo investigar la presencia y el tratamiento del espacio narrativo y su relación con la memoria en tres novelas de Julio Llamazares: Luna de Lobos, La lluvia amarilla y El cielo de Madrid. La primera parte trata de la estructura de las tres novelas. En la segunda parte se estudia la interacción y la circulación entre los espacios imaginarios y reales de las tres obras. En la tercera parte, estudiamos la estrecha unión entre los espacios imaginarios y la memoria. En realidad, en las tres novelas de Julio Llamazares, el espacio se erige como un elemento relevante de la ficción, que contribuye no sólo a crear mundos posibles haciéndolos verosímiles ante los lectores, sino que también tiene un enlace indisoluble con la condición problemática y compleja de los personajes, resaltando así los problemas y conflictos del ser humano. La asociación entre la memoria y la vivencia del espacio configura en la narración la reiterada simbología de la soledad, el deterioro y la muerte. El escritor se vale del espacio como eje que guía las tramas, y sobre el que recrea toda la originalidad narrativa

Ethnicity and age as factors in sildenafil treatment of erectile dysfunction

IntroductionSildenafil has been evaluated in >16 000 men with erectile dysfunction (ED) in doubleâ blind, placeboâ controlled trials.AimTo assess efficacy and safety of sildenafil in ED by ethnicity (white, black Asian) and age (â ¤45, 46â 60, â ¥61 years).MethodsData were pooled from 38 doubleâ blind, placeboâ controlled, flexibleâ dose trials. Most had starting sildenafil doses of 50 mg once daily, ~1 hour before sexual activity, with adjustment to 100 or 25 mg as needed.Main Outcome MeasuresChange from baseline in International Index of Erectile Function erectile function (IIEFâ EF) domain score assessed with analysis of covariance and a Global Assessment Question (GAQ; â Did the treatment improve your erections?â ) at endpoint assessed with logistic regression analysis.Results4120 and 3714 men received sildenafil and placebo, respectively (2740 and 2671 White; 407 and 385 Black; 973 and 658 Asian). For sildenafil vs. placebo groups, overall treatment differences for IIEFâ EF domain and GAQ were significant for each ethnic and age group (P<.0001); significant treatmentâ byâ ethnicity and treatmentâ byâ age interactions were also observed for change in IIEFâ EF domain scores (P<.05), with differences significantly greater for White vs. Black (P<.0001), White vs. Asian (P=.0163), and Asian vs. Black (P=.0036) men. A significant treatmentâ byâ ethnicity interaction was observed for GAQ (P=.0004). The OR comparison for GAQ was significantly greater (P=.0001) with sildenafil vs. placebo in White (OR=11.2) or Asian (OR=12.4) men vs. Black men (OR=5.1). Adverseâ event rates were generally similar, with some age variations.ConclusionsSildenafil is effective and wellâ tolerated regardless of ethnicity or age; however, treatment effects can vary.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137386/1/ijcp12945_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137386/2/ijcp12945.pd

Negotiating The Maze: Confronting Dysphagia Together With My Stroke-Afflicted Family Member

Aim: To generate a descriptive theory grounded in the responses of family caregivers caring for their family stroke survivors with dysphagia during hospitalization. Design and Method: A qualitative study employing the grounded theory method was used. Fifteen family caregivers participated in comprehensive interviews. The interview data were analyzed using the constant comparative method. Findings: ‘Negotiating the maze: Confronting dysphagia with my stroke-afflicted family member’ was the core category guiding the care process for dysphagia family members among caregivers. After surviving stroke, the caregivers felt ‘more confusion less rejoicing’ as the antecedent condition. The following three interaction categories were identified: (1) ‘being overwhelmed by nasogastric (NG) tube issues’; (2) ‘searching for the right helper and information’; and (3) ‘food culture conflicts with the formula diet administered through the NG tube’. Additionally, ‘Maintaining positivity’ described the consequence of this process. Conclusions: This study highlights the critical perspective of family members who care for dysphagia stroke survivors in the hospital. Participants were under tremendous pressure during the disease treatment process. However, all attempted to maintain a positive attitude and treasured the chance to accompany their family members. Clinical Relevance: These findings can assist health professionals in charting the effects of dysphagia and in understanding the problems and needs according to the subjective perspectives of family caregivers. They can also provide a necessary foundation for comprehensive care interventions for family caregivers of stroke survivors with dysphagia

New Plasma Separation Glucose Oxidase-based Glucometer in Monitoring of Blood With Different PO2 Levels

BackgroundThe PalmLab glucometer is a newly designed plasma separation glucose oxidase (GO)-based glucometer. Past studies have shown that the accuracy of GO-based glucometers is compromised when measurements are taken in patients with high PO2 levels. We performed a two-arm study comparing the fitness of the PalmLab blood glucometer with that of a standard glucose analyzer in monitoring blood glucose levels in pediatric patients, especially when arterial partial pressure of oxygen (PO2) was high.MethodsIn the first arm of the study, arterial blood samples from pediatric patients were measured by the PalmLab blood glucometer and the YSI 2302 Plus Glucose/Lactate analyzer. In the second arm of the study, venous blood samples from adult volunteers were spiked with glucose water to prepare three different levels of glucose (65, 150, and 300mg/dL) and then oxygenated to six levels of PO2 (range, 40–400mmHg). The biases of the PalmLab glucometer were calculated.ResultsA total of 162 samples were collected in the first arm of the study. Results of linear regression showed that the coefficient of determination (R2) between PalmLab glucometer and standard glucose analyzer was 0.9864. Error grid analysis revealed that all the results were within Zone A (clinically accurate estimate zone). The biases between the two systems were low at different PO2 levels. In the second arm of the study, the results were also unaffected by changes in PO2.ConclusionThe PalmLab glucometer provides accurate results in samples with high PO2 and is suitable for measuring arterial glucose levels in pediatric patients

Seroepidemiology of Klebsiella pneumoniae colonizing the intestinal tract of healthy chinese and overseas chinese adults in Asian countries

[[abstract]]BACKGROUND:Capsular serotypes K1 and K2 of Klebsiella pneumoniae are thought to the major virulence determinants responsible for liver abscess. The intestine is one of the major reservoirs of K. pneumoniae, and epidemiological studies have suggested that the majority of K. pneumoniae infections are preceded by colonization of the gastrointestinal tract. The possibility of fecal-oral transmission in liver abscess has been raised on the basis of molecular typing of isolates. Data on the serotype distribution of K. pneumoniae in stool samples from healthy individuals has not been previously reported. This study investigated the seroepidemiology of K. pneumoniae isolates from the intestinal tract of healthy Chinese in Asian countries. Stool specimens from healthy adult Chinese residents of Taiwan, Japan, Hong Kong, China, Thailand, Malaysia, Singapore, and Vietnam were collected from August 2004 to August 2010 for analysis.RESULTS:Serotypes K1/K2 accounted for 9.8% of all K. pneumoniae isolates from stools in all countries. There was no significant difference in the prevalence of K1/K2 isolates among the countries excluding Thailand and Vietnam. The antimicrobial susceptibility pattern was nearly the same in K. pneumoniae isolates. The result of pulsed-field gel electrophoresis revealed no major clonal cluster of serotype K1 isolates.CONCLUSIONS:The result showed that Chinese ethnicity itself might be a major factor predisposing to intestinal colonization by serotype K1/K2 K. pneumoniae isolates. The prevalent serotype K1/K2 isolates may partially correspond to the prevalence of K. pneumoniae liver abscess in Asian countries

Extremity Exercise Program in Breast Cancer Survivors Suffering from Chemotherapy-Induced Peripheral Neuropathy: A Feasibility Pilot Study

Objectives: To evaluate the feasibility of implementation of an extremity exercise program and to examine its preliminary effects in breast cancer survivors suffering from chemotherapy-induced peripheral neuropathy (CIPN). Sample & Setting: Thirteen breast cancer survivors from one hospital in northern Taiwan. Methods and Variables: A single group with repeated measures, and a quasi-experimental design. The intervention program was a four week, home-based extremity exercise program that was comprised of 10 skilled hand exercises and Buerger-Allen exercises. The Total Neuropathy Scale (clinical version), Functional Assessment of Cancer Therapy/Gynecologic Oncology Group, Neurotoxicity (13-Item Version), Identification Pain Questionnaire, and pain Visual Analogue Scale were used to measure CIPN before exercise (T1), during (T2~T4), and after exercise (T5). Qualitative data were also collected at each time point. Data were analyzed by using descriptive statistics, generalized estimating equations, and directed content analysis. Results: None of the participants reported adverse events during the study period. The extremity exercise program significantly improved patient-reported CIPN after intervention at T4 or T5 but was insignificant on clinician-assessed CIPN. The qualitative data of participant experience indicated that this program is feasible and easy to follow. Conclusion: The extremity exercise program is feasible but needs to increase the sample size and prolong the intervention period for confirmation

Calcium oscillations coordinate feather mesenchymal cell movement by SHH dependent modulation of gap junction networks

Collective cell migration mediates multiple tissue morphogenesis processes. Yet how multi-dimensional mesenchymal cell movements are coordinated remains mostly unknown. Here we report that coordinated mesenchymal cell migration during chicken feather elongation is accompanied by dynamic changes of bioelectric currents. Transcriptome profiling and functional assays implicate contributions from functional voltage-gated Ca^(2+) channels (VGCCs), Connexin-43 based gap junctions, and Ca^(2+) release activated Ca^(2+) (CRAC) channels. 4-Dimensional Ca^(2+) imaging reveals that the Sonic hedgehog-responsive mesenchymal cells display synchronized Ca^(2+) oscillations, which expand progressively in area during feather elongation. Inhibiting VGCCs, gap junctions, or Sonic hedgehog signaling alters the mesenchymal Ca^(2+) landscape, cell movement patterns and feather bud elongation. Ca^(2+) oscillations induced by cyclic activation of opto-cCRAC channels enhance feather bud elongation. Functional disruption experiments and promoter analysis implicate synergistic Hedgehog and WNT/β-Catenin signaling in activating Connexin-43 expression, establishing gap junction networks synchronizing the Ca^(2+) profile among cells, thereby coordinating cell movement patterns

Effects of and satisfaction with short message service reminders for patient medication adherence: a randomized controlled study

BACKGROUND: Medication adherence is critical for patient treatment. This study involved evaluating how implementing Short Message Service (SMS) reminders affected patient medication adherence and related factors. METHODS: We used a structured questionnaire to survey outpatients at three medical centers. Patients aged 20 years and older who were prescribed more than 7 days of a prescription medication were randomized into SMS intervention or control groups. The intervention group received daily messages reminding them of aspects regarding taking their medication; the control group received no messages. A phone follow-up was performed to assess outcomes after 8 days. Data were collected from 763 participants in the intervention group and 435 participants in the control group. RESULTS: After participants in the intervention group received SMS reminders to take medication or those in the control group received no messages, incidences of delayed doses were decreased by 46.4 and 78.8% for those in the control and intervention groups, respectively. The rate of missed doses was decreased by 90.1% for participants in the intervention group and 61.1% for those in the control group. We applied logistic regression analysis and determined that participants in the intervention group had a 3.2-fold higher probability of having a decrease in delayed doses compared with participants in the control group. Participants in the intervention group also showed a 2.2-fold higher probability of having a decrease in missed doses compared with participants in the control group. CONCLUSIONS: Use of SMS significantly affected the rates of taking medicine on schedule. Therefore, daily SMS could be useful for reminding patients to take their medicine on schedule