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The risks associated with the maritime transport of Noxious and Potentially Hazardous Substances (HNS), almost all of them chemicals, are greatly increasing due to the continuous expansion of maritime traffic, the quantities of new products, the difficulties in managing incidents involving these substances due to the different modes of transport and the possibility of illegal use of these goods or terrorist acts due to the human and environmental damage that may result. HNS can be released into the sea as a result of illegal discharges or maritime accidents, such as stranding or collisions; and while major incidents involving an HNS spills are relatively rare, they can be very complex and potentially serious impacts on human health, the environment, and socio-economic resources., Los riesgos en el trasporte marítimo de Sustancias Nocivas y Potencialmente Peligrosas (SNPP), casi todas ellas productos químicos, se están incrementando en gran medida por la continua expansión del tráfico marítimo, por las cantidades de nuevos productos, por las dificultades de gestionar incidentes en los que estén envueltas estas sustancias, por los distintos modos de trasporte y por la posibilidad de usar estas mercancías ilegalmente o para cometer actos terroristas, debido a los daños tanto humanos como medioambientales que pueden producirse como consecuencia de los mismos. Las SNPP pueden liberarse en el mar por descargas ilegales o accidentes marítimos, como embarrancamientos o abordajes; y si bien los incidentes importantes que involucran un derrame de SNPP son relativamente escasos, pueden ser muy complejos y potencialmente tener impactos severos en la salud humana, el medioambiente y los recursos socioeconómicos.

Objective: Effectiveness evaluation of the combination of functional electrical stimulation and mirror therapy in the recovery of the upper limb function in people with stroke. Methods: Pre- post case study in a person with stroke. Various scales were used for data collection, such as: Functional Independence Measure, Motor Activity Log, Box & Blocks Test or Abilhand, among others. The intervention lasted 8 weeks in which 3 weekly sessions were held, making a total of 24 sessions. The assessments were done pre- and post-treatment. Discussion: The combination of these techniques or approaches has proven to be effective, improving the functionality of the upper extremity and, consequently, the quality of life and Independence of a person with stroke., Objetivos: evaluar la efectividad de la combinación de la estimulación eléctrica funcional y terapia en espejo en la recuperación de la función de la extremidad superior en personas con un accidente cerebro vascular. Métodos: estudio de caso pre- post en una persona con accidente cerebro vascular. Para la recogida de datos se han empleado diversas escalas como: Functional Independence Measure, Motor Activity Log, Box & Blocks Test o Abilhand entre otras. La intervención duró 8 semanas en las que se realizaron 3 sesiones semanales, sumando un total de 24 sesiones. Las evaluaciones se hicieron pre- y post-tratamiento. Discusión: la combinación de estas técnicas o abordajes ha demostrado ser eficaz, mejorando la funcionalidad de la extremidad superior y, consecuentemente, su calidad de vida e independencia de una persona que sufrió un accidente cerebro vascular.

[Resumen:] El presente proyecto tiene como objetivo satisfacer la demanda de productos petrolíferos para el traslado del tráfico de graneles líquidos al puerto exterior de Punta Langosteira. Actualmente, el puerto exterior cuenta con instalaciones que permiten abastecer la demanda para el tráfico de crudo, pero sin contar con el tráfico de productos refinados, para lo que sería necesaria la ejecución de dos nuevos atraques. Por ello, se propone la ampliación del pantalán actual por el lado opuesto al atraque que hay operativo actualmente, disponiéndose dos nuevos atraques en línea para satisfacer la demanda de tráfico de refinos, dimensionados para un buque máximo previsto de 30.000 TMP, a partir de una solución formada por un pantalán discontinuo con duques de alba en amarre y atraque. Ambas plataformas de atraque estarán compuestas por cajones de hormigón armado, con duques de alba en sus extremos, conectados entre sí a partir de pasarelas metálicas para el tránsito peatonal. Además, dichas plataformas se conectarán al eje principal del pantalán a partir de puentes con una tipología estructura formada de vigas prefabricadas de hormigón pretensado, apoyadas sobre soportes de neopreno en la estructura superior de los cajones de hormigón armado, y sirviendo de base para la ejecución de las losas superiores. Estos puentes servirán para dar acceso rodado a las plataformas de atraque, además de como soporte para las conducciones que transportarán el material refinado.

Background Previous studies have shown that men with HIV and germ cell cancer (HIV-GCC) have inferior overall survival (OS) in comparison with their HIV-negative counterparts. However, little information is available on treatments and outcomes of HIV-GCC in the era of combination antiretroviral therapy (cART). Methods This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression-free survival (PFS). Results Data for 89 men with a total of 92 HIV-GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T-cell count at GCC diagnosis was 420 cells/mu L, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good-, intermediate-, and poor-prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS-defining illness (n = 3), and other causes (n = 4). After a median follow-up of 6.5 years, the 5- and 10-year PFS rates were 81% and 73%, respectively, and the 5- and 10-year OS rates were 91% and 85%, respectively. Conclusions The 5- and 10-year PFS and OS rates of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients. Lay Summary Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV-associated germ cell cancer (HIV-GCC) is poorer than the survival of their HIV-negative counterparts. This study examined the characteristics, treatments, and outcome

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients).Outcome measurements and statistical analysis: The primary endpoints were 18mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests.Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42-1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including compl

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients).Outcome measurements and statistical analysis: The primary endpoints were 18mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests.Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42-1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including compl

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients).Outcome measurements and statistical analysis: The primary endpoints were 18mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests.Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42-1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including compl

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients). Outcome measurements and statistical analysis: The primary endpoints were 18-mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests. Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42–1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including co

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients). Outcome measurements and statistical analysis: The primary endpoints were 18-mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests. Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42–1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including co

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients). Outcome measurements and statistical analysis: The primary endpoints were 18-mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests. Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42–1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including co

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients).Outcome measurements and statistical analysis: The primary endpoints were 18mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests.Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42-1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including compl

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients). Outcome measurements and statistical analysis: The primary endpoints were 18-mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests. Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42–1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including co

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients). Outcome measurements and statistical analysis: The primary endpoints were 18-mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests. Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42–1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including co

Background: Previous studies have shown that men with HIV and germ cell cancer (HIV-GCC) have inferior overall survival (OS) in comparison with their HIV-negative counterparts. However, little information is available on treatments and outcomes of HIV-GCC in the era of combination antiretroviral therapy (cART). Methods: This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression-free survival (PFS). Results: Data for 89 men with a total of 92 HIV-GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T-cell count at GCC diagnosis was 420 cells/µL, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good-, intermediate-, and poor-prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS-defining illness (n = 3), and other causes (n = 4). After a median follow-up of 6.5 years, the 5- and 10-year PFS rates were 81% and 73%, respectively, and the 5- and 10-year OS rates were 91% and 85%, respectively. Conclusions: The 5- and 10-year PFS and OS rates of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients. Lay Summary: Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV-associated germ cell cancer (HIV-GCC) is poorer than the survival of their HIV-negative counterparts. This study examined the characteristics, treatments, an

Background: Previous studies have shown that men with HIV and germ cell cancer (HIV-GCC) have inferior overall survival (OS) in comparison with their HIV-negative counterparts. However, little information is available on treatments and outcomes of HIV-GCC in the era of combination antiretroviral therapy (cART). Methods: This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression-free survival (PFS). Results: Data for 89 men with a total of 92 HIV-GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T-cell count at GCC diagnosis was 420 cells/µL, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good-, intermediate-, and poor-prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS-defining illness (n = 3), and other causes (n = 4). After a median follow-up of 6.5 years, the 5- and 10-year PFS rates were 81% and 73%, respectively, and the 5- and 10-year OS rates were 91% and 85%, respectively. Conclusions: The 5- and 10-year PFS and OS rates of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients. Lay Summary: Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV-associated germ cell cancer (HIV-GCC) is poorer than the survival of their HIV-negative counterparts. This study examined the characteristics, treatments, an

Background Previous studies have shown that men with HIV and germ cell cancer (HIV-GCC) have inferior overall survival (OS) in comparison with their HIV-negative counterparts. However, little information is available on treatments and outcomes of HIV-GCC in the era of combination antiretroviral therapy (cART). Methods This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression-free survival (PFS). Results Data for 89 men with a total of 92 HIV-GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T-cell count at GCC diagnosis was 420 cells/mu L, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good-, intermediate-, and poor-prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS-defining illness (n = 3), and other causes (n = 4). After a median follow-up of 6.5 years, the 5- and 10-year PFS rates were 81% and 73%, respectively, and the 5- and 10-year OS rates were 91% and 85%, respectively. Conclusions The 5- and 10-year PFS and OS rates of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients. Lay Summary Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV-associated germ cell cancer (HIV-GCC) is poorer than the survival of their HIV-negative counterparts. This study examined the characteristics, treatments, and outcome

[Resumen] Objetivos: Determinar la eficacia del uso de gafas de realidad virtual (RV) en el proceso de intervención de Terapia Ocupacional (TO) para personas con heminegligencia visoespacial (HVE) tras un evento de daño cerebral adquirido (DCA). Asimismo, conocer el grado de satisfacción y experiencia de las personas participantes en cuanto a la intervención desarrollada y detallar el papel que desempeña el terapeuta ocupacional en este tipo de intervención. Metodología: Estudio de investigación mixto. Mayoritariamente cuantitativo, a través de la “Functional Independence Measure and Functional Assessment Measure” (FIM+FAM), el “Motor Activity Log” (MAL) y “Cuestionario de Experiencia del Juego”, complementada con una parte cualitativa, a través de entrevistas semiestructuradas. Muestra de 2 personas con DCA y HVE. Resultados: No se han obtenido cambios significativos en el desempeño ocupacional tras la aplicación de las sesiones con la tecnología de RV. Sin embargo, esta es un medio de intervención que motiva a las personas participantes y les hace sentir “útiles”, considerando que puede tener beneficios a largo plazo y que la combinarían con su terapia habitual. Conclusiones: Es necesario seguir investigando, ya que existe muy poca evidencia al respecto, y la que existe no aborda el desempeño ocupacional y la independencia de las personas. El papel del terapeuta ocupacional es crucial para el diseño de escenarios accesibles y para adaptarlos particularmente para cada individuo, teniendo en cuenta sus prioridades, capacidades y necesidades., [Resumo] Obxectivos: Determinar a eficacia do uso das gafas de realidade virtual (RV) no proceso de intervención de Terapia Ocupacional (TO) para persoas con hemineglixencia visoespacial (HVE) tras un evento de dano cerebral adquirido (DCA). Asimesmo, coñecer o grao de satisfacción e experiencia das persoas participantes en canto a intervención desenvolvida e detallar o papel que desempeña o terapeuta ocupacional neste tipo de intervención. Metodoloxía: Estudio de investigación mixto. Maioritariamente cuantitativo, a través da “Functional Independence Measure and Functional Assessment Measure” (FIM+FAM), o “Motor Activity Log” (MAL) e o “Cuestionario de Experiencia del Juego”, complementada cunha parte cualitativa, a través de entrevistas semiestruturadas. Mostra de 2 persoas con DCA e HVE. Resultados: Non experimentaron cambios significativos no rendemento ocupacional despois das sesións de RV. Non obstante, esta é un medio de intervención que motiva aos participantes e fai que se sintan "útiles", considerando que este tipo de intervencións poden ter beneficios a longo prazo e que o combinarían coa súa terapia habitual. Conclusións: Precísase máis investigación sobre este tema, xa que hai moi poucas evidencias sobre o mesmo e as que existen non abordan o rendemento ocupacional nin a independencia. O papel do terapeuta ocupacional é fundamental para o deseño de escenarios accesibles para adaptalos especialmente a cada individuo, tendo en conta as súas prioridades, capacidades e necesidades., [Abstract] Goals: To determine the efficiency on the use of virtual reality (VR) in the Occupational Therapist (OT) intervention process for people with visual spatial hemineglect (VSH) after an acquired brain injury (ABI). Also, to find out the degree of satisfaction and experience of the participants regarding the intervention and to detail the role played by the occupational therapist in this type of intervention. Methodology: Mixed research study. Mainly quantitative, through the “Functional Independence Measure and Functional Assessment Measure” (FIM+FAM), the “Motor Activity Log” (MAL) and the “Cuestionario de Expereincia de Juego”, complemented with a qualitative part, through semi-structured interviews. A sample of 2 persons with ABI and VSN. Results: Participants have not experienced significant changes in occupational performance following the VR sessions. However, it is a means of intervention that motivates participants while making them feel "useful", as they believe that this type of intervention can have long-term benefits and that they would combine it with their usual therapy. Conclusions: More research is needed on this topic, as there is very little evidence on the subject, and the evidence that does exist does not address occupational performance and independence. On the other hand, the figure of the occupational therapist is crucial for the design of accessible settings and to adapt them particularly for each individual, taking into account their priorities, abilities and needs.

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients).Outcome measurements and statistical analysis: The primary endpoints were 18mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests.Results and limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42-1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including compl

[ES] Una de las principales características de las empresas del sector de fabricación de locomotoras y material ferroviario son sus altos costes productivos, lo que supone una desventaja a la hora de competir en el actual marco global. La gestión de procesos de negocio es una herramienta que puede ayudar a optimizar las tareas y procesos productivos, reducir costes, mejorar el servicio al cliente y, por consiguiente, obtener mejores resultados y aumentar la competitividad de la empresa. El presente Trabajo Fin de Máster se centra en mejorar el proceso de aprovisionamiento a línea de montaje con sus consiguientes subprocesos como son el de seguimiento de material a los proveedores, el de gestión de almacenes y el subproceso de replanificar un proyecto. Se realizará una revisión de las diferentes metodologías para la mejora de procesos y se escogerá, preferiblemente, la metodología As-Is/To-Be, por tratarse de una metodología fácilmente adaptable a todo tipo de procesos. En un primer lugar, se debe establecer el estado actual, definir el As-Is y proceder a su análisis. A partir de los problemas identificados se realizará la propuesta de mejoras. A su vez, a través del To-Be se representará el estado futuro con el objetivo a alcanzar. Las mejoras planeadas para los procesos permitirán a la empresa entregar los pedidos a tiempo, mejorar la comunicación entre departamentos, aumentar la flexibilidad en la replanificación de los proyectos, aumentar el seguimiento de los materiales pedidos al proveedor, disminuir los retrasos en la línea de montaje y evitar roturas de stocks., [EN] One of the main characteristics of companies in the locomotive and railway equipment manufacturing sector is their high production costs, which is a disadvantage when competing in today's global market. The management of business processes is a tool that can help to optimize tasks and production processes, reduce costs, improve customer service and, consequently, obtain better results and increase the company's competitiveness. The present Master Thesis is focused on improving the processes of supplying to the assembly line with its consequent sub-processes such as the follow-up of material to the suppliers, the management of stores and the sub-process of re-planning a project. A review of the different methodologies for process improvement will be carried out and the As-Is/To-Be methodology will be preferably chosen, as it is a methodology easily adaptable to all kinds of processes. First of all, the current status has to be established, the As-Is has to be defined and its analysis has to be carried out. Based on the problems identified, a proposal for improvements will be made. Afterwards, through the To-Be, the future status will be represented with the objective to be achieved. The improvements planned for the processes allow the company to deliver orders on time, improve communication between departments, increase flexibility in the replanning of projects, increase the follow-up of the materials ordered from the supplier, reduce delays in the assembly line and avoid stock delays.

[ES] Una de las principales características de las empresas del sector de fabricación de locomotoras y material ferroviario son sus altos costes productivos, lo que supone una desventaja a la hora de competir en el actual marco global. La gestión de procesos de negocio es una herramienta que puede ayudar a optimizar las tareas y procesos productivos, reducir costes, mejorar el servicio al cliente y, por consiguiente, obtener mejores resultados y aumentar la competitividad de la empresa. El presente Trabajo Fin de Máster se centra en mejorar el proceso de aprovisionamiento a línea de montaje con sus consiguientes subprocesos como son el de seguimiento de material a los proveedores, el de gestión de almacenes y el subproceso de replanificar un proyecto. Se realizará una revisión de las diferentes metodologías para la mejora de procesos y se escogerá, preferiblemente, la metodología As-Is/To-Be, por tratarse de una metodología fácilmente adaptable a todo tipo de procesos. En un primer lugar, se debe establecer el estado actual, definir el As-Is y proceder a su análisis. A partir de los problemas identificados se realizará la propuesta de mejoras. A su vez, a través del To-Be se representará el estado futuro con el objetivo a alcanzar. Las mejoras planeadas para los procesos permitirán a la empresa entregar los pedidos a tiempo, mejorar la comunicación entre departamentos, aumentar la flexibilidad en la replanificación de los proyectos, aumentar el seguimiento de los materiales pedidos al proveedor, disminuir los retrasos en la línea de montaje y evitar roturas de stocks., [EN] One of the main characteristics of companies in the locomotive and railway equipment manufacturing sector is their high production costs, which is a disadvantage when competing in today's global market. The management of business processes is a tool that can help to optimize tasks and production processes, reduce costs, improve customer service and, consequently, obtain better results and increase the company's competitiveness. The present Master Thesis is focused on improving the processes of supplying to the assembly line with its consequent sub-processes such as the follow-up of material to the suppliers, the management of stores and the sub-process of re-planning a project. A review of the different methodologies for process improvement will be carried out and the As-Is/To-Be methodology will be preferably chosen, as it is a methodology easily adaptable to all kinds of processes. First of all, the current status has to be established, the As-Is has to be defined and its analysis has to be carried out. Based on the problems identified, a proposal for improvements will be made. Afterwards, through the To-Be, the future status will be represented with the objective to be achieved. The improvements planned for the processes allow the company to deliver orders on time, improve communication between departments, increase flexibility in the replanning of projects, increase the follow-up of the materials ordered from the supplier, reduce delays in the assembly line and avoid stock delays.

The treatment of advanced prostate cancer has evolved due to recent advances in molecular research and new drug development. Dynamic aberrations in the androgen receptor, DNA repair genes, PTEN-PI3K, and other pathways drive the behavior of advanced prostate cancer allowing a better selection of therapies in each patient. Tumor testing for BRCA1 and BRCA2 is recommended for patients with metastatic prostate cancer, also considering a broad panel to guide decisions and genetic counseling. In symptomatic metastatic patients, castration should be stared to palliate symptoms and prolong survival. In high-risk or high-volume metastatic hormone-naïve patients, castration should be combined with docetaxel, abiraterone, enzalutamide or apalutamide. Radiotherapy to the primary tumor combined with systemic therapy is recommended in low-volume mHNPC patients. In patients with non-metastatic castration-resistant tumors, risk stratification can define the frequency of imaging. Adding enzalutamide, darolutamide or apalutamide to these patients prolongs metastasis-free and overall survival, but potential adverse events need to be taken into consideration. The choice of docetaxel, abiraterone or enzalutamide for treating metastatic castration-resistant patients depends on previous therapies, with cabazitaxel being also recommended after docetaxel. Olaparib is recommended in BRCA1/BRCA2 mutated castration-resistant patients after progression on at least one new hormonal therapy. Aggressive variants of prostate cancer respond to platinum-based chemotherapy. To optimize treatment efficiency, oncologists should incorporate all of these advances into an overall therapeutic strategy.

The aim of this study is to affirm that recurrence is a tool in the judge’s assessment at the time of imposing the measure of Pretrial detention in prison. To this end, a mixed methodology was applied to two axes: first, the Spearman correlation was used in the quantitative examination of the statistical relationship between arrests for theft in all its forms, personal injury and homicide, and behaviors contrary to coexistence (CCC) that put at risk the life and integrity of people, contemplated in numerals 1, 2, 3, 6, 7 of the National Code of Security and Citizen Coexistence (CNSCC) (Law 1801, 2016, art. 27), making use of official data registered in Colombia, in the Statistical, Criminal, Contraventional and Operational Information System of the National Police (SIEDCO), between 2017 and 2019. Secondly, a qualitative analysis was carried out that compares the two most relevant cases of recurrent catches that occurred in Colombia during the years 2017 and 2019. The results reveal that there is a significant non-causal statistical relationship between such behaviour and arrests for the aforementioned offences; this relationship tends to strengthen over time. In addition, it is found that individuals with more recurrent captures act according to a criminological learning that allows them to develop strategies to minimize the risk of obtaining a measure of detention restrictive of liberty. In conclusion, it is found that the recurrence can provide relevant information in the assessment of the establishment of the preventive detention measure in prison, which allows this evaluation to be strengthened., Resumo O presente estudo tem como objetivo afirmar que a reincidência é uma ferramenta na avaliação do Juiz no momento da imposição da medida de prisão preventiva em estabelecimento prisional. Para isso, foi aplicada uma metodologia mista a dois eixos: primeiro, a correlação de Spearman foi utilizada no exame quantitativo da relação estatística entre prisões por roubo em todas as suas formas, lesões pessoais e homicídio, e comportamentos contrários à convivência (CCC) que colocavam em risco a vida e a integridade das pessoas, contemplados nos numerais 1, 2, 3, 6, 7 do Código Nacional de Segurança e Convivência Cidadã (CNSCC) (Lei 1801, de 2016, art. 27), fazendo uso de dados oficiais registrados na Colômbia, no Sistema de Informações Estatísticas, Criminais, Contrariacionais e Operacionais da Polícia Nacional (SIEDCO), entre 2017 e 2019. Em segundo lugar, foi realizada uma análise qualitativa que compara os dois casos mais relevantes de capturas recorrentes ocorridos na Colômbia durante os anos de 2017 e 2019. Os resultados revelam que há uma relação estatística não causal significativa entre tal comportamento e prisões pelos crimes supracitados; essa relação tende a se fortalecer com o tempo. Além disso, constatase que indivíduos com capturas mais recorrentes atuam de acordo com uma aprendizagem criminológica que lhes permite desenvolver estratégias para minimizar o risco de obtenção de medida de detenção restritiva à liberdade. Em conclusão, constatase que a recorrência pode fornecer informações relevantes na avaliação do estabelecimento da medida de prisão preventiva, o que permite que essa avaliação seja reforçada., Resumen El presente estudio tiene como objetivo argumentar que la recurrencia es una herramienta en la valoración del juez al momento de imponer la medida de detención preventiva en establecimiento carcelario. Para ello, se aplicó una metodología mixta frente a dos ejes: primero, se empleó la correlación de Spearman en el examen cuantitativo de la relación estadística entre las capturas por hurto en todas sus modalidades, lesiones personales y homicidio, y los comportamientos contrarios a la convivencia que ponen en riesgo la vida e integridad de las personas, contemplados en los numerales 1, 2, 3, 6 y 7 del Código Nacional de Seguridad y Convivencia Ciudadana (Ley 1801 de 2016, art. 27), haciendo uso de datos oficiales registrados en Colombia, en el Sistema de Información Estadístico, Delincuencial, Contravencional y Operativo de la Policía Nacional, entre los años 2017 y 2019. Segundo, se realizó un análisis cualitativo que compara los dos casos más relevantes de capturas recurrentes ocurridos en Colombia durante los años 2017 y 2019. Los resultados revelan que existe una relación estadística significativa no causal entre dichos comportamientos y las capturas por los delitos mencionados; esta relación tiende a fortalecerse en el tiempo. Además, se encuentra que los individuos con más capturas recurrentes actúan de acuerdo con un aprendizaje criminológico que les permite desarrollar estrategias para disminuir al máximo el riesgo de obtener una medida de detención restrictiva de la libertad. Como conclusión, se tiene que la recurrencia puede aportar información importante en la valoración de la instauración de la medida de detención preventiva en establecimiento carcelario, lo que fortalece dicha evaluación.

[Resumen] Antecedentes y estado actual: Existe evidencia que muestra que las personas con trastorno mental grave presentan un importante impacto en distintas esferas de su vida y que esto puede repercutir en la cotidianidad de su entorno más cercano. La familia constituye un papel esencial, siendo en la mayoría de las ocasiones, la única red social de la persona con dicho trastorno, por lo que puede llegar a encontrarse en una situación de vulnerabilidad. Por ello, es importante realizar estudios donde se lleve a cabo una aproximación de la cotidianidad de las familias. Objetivo: Conocer las vivencias que presentan las familias de personas con TMG con el fin de detectar las posibles necesidades ocupacionales que puedan tener en relación a su desempeño ocupacional, rutinas, hábitos y roles. Metodología: Se realizará un estudio piloto, con una metodología mixta. En relación a la vertiente cualitativa, se establecerá un enfoque fenomenológico, mediante entrevistas semiestructuradas, mientras que, desde la vertiente cuantitativa, se empleará el Cuestionario de Necesidades de Familiares de personas con Trastornos Mentales Graves y el Cuestionario SF-36., [Resumo] Antecedentes e estado actual: Existe evidencia que mostra que as persoas con trastorno mental grave presentan un importante impacto en distintas esferas da súa vida e que isto pode repercutir na cotiandade da súa contorna máis próxima. A familia constitúe un papel esencial, sendo na maioría das ocasións, a única rede social da persoa co devandito trastorno, o que pode posicionarlle nunha posición de vulnerabilidade. Por iso, é importante realizar estudos nos que se leve a cabo unha aproximación da cotiandade das familias. Obxectivo: Coñecer as vivencias que presentan as familias de persoas con Trastorno Mental Grave co fin de detectar as posibles necesidades ocupacionais que poidan ter en relación ao seu desempeño ocupacional, rutinas, hábitos e roles. Metodoloxía: Realizarase un estudo piloto, cunha metodoloxía mixta. En relación á vertente cualitativa, establecerase un enfoque fenomenológico, mediante entrevistas semiestructuradas, mentres que, desde a vertente cuantitativa, empregarase o Cuestionario de Necesidades de Familiares de persoas con Trastornos Mentais Graves e o Cuestionario SF-36., [Abstract] Background and current state of affairs: There is evidence showing that people with Severe Mental Disorders experiece a significant impact on different spheres of their lives and that this can affect the daily life of their closest relatives. Families play an essential role and frequently constitute the only social network of the person with these disorders. However, they may find themselves in a position of vulnerability. For this reason, studies that address the daily life of relatives of people with Severe Mental Disorders must be carried out. Objective: To study the experiences of the families of people with Severe Mental Disorder in order to detect the potential occupational needs that they may have in relation to their occupational performance, routines, habits and roles. Methodology: Pilot study with a mixed methodology. Qualitatively, a phenomenological approach is adopted by conducting semi-structured interviews, while, from the quantitative aspect, the CNF-TMG Questionnaire and the SF-36 are used.

[ES] Este proyecto se basa en la aplicación de herramientas Lean en el proceso productivo de la fabricación de los barrales de fibra de carbono (brazos auxiliares de 40 metros de longitud que permiten fumigar a los tractores) de una multinacional. El principal objetivo del estudio es eliminar todo tipo de desperdicio, mejorar la productividad y calidad de los productos e implicar al trabajador. En primer lugar, para poner en contexto el presente trabajo se describe la empresa, su flujo de procesos y la organización por la que está formada. A continuación, se procede a analizar los procesos productivos a través de un VSM. Una vez analizada la situación inicial, y a partir de la toma de tiempos se aplican las herramientas Lean: SMED tanto interno como externo y la implementación de estándares de trabajo. Finalmente, se comparará el resultado obtenido con la implementación de las mejoras en el proceso productivo con respecto a la situación inicial, realizando además una valoración del impacto generado., [EN] This project is based on the application of Lean tools in the production process of the carbon fiber barrels (auxiliary arms of 40 meters long that allow to fumigate the tractors) of a multinational company. The main objective of the study is to eliminate all types of waste, improve productivity and product quality, and involve the worker. Firstly, to put this work into context, the company, its process flow, and the organization it is made up of are described. The production processes are then analyzed using a VSM. Once the initial situation has been analyzed, and from the time recording, the Lean tools are applied: SMED both internal and external, and the implementation of work standards. Finally, the result obtained will be compared with the implementation of the improvements in the production process with respect to the initial situation, also making an assessment of the impact generated., [CA] Aquest projecte es basa en l'aplicació d'eines Lean en el procés productiu de la fabricación dels barrals de fibra de carboni (braços auxiliars de 40 metres de longitud que permeten fumigar als tractors) d'una multinacional. El principal objectiu de l'estudi és eliminar tot tipus de desaprofitament, millorar la productivitat i qualitat dels productes i implicar el treballador. En primer lloc, per a posar en context el present treball es descriu l'empresa, el seu flux de processos i l'organització per la qual està formada. A continuació, es procedeix a analizar els processos productius a través d'un VSM. Una vegada analitzada la situació inicial, i a partir de la presa de temps s'apliquen les eines Lean: SMED tant intern com extern i la implementación d'estàndards de treball. Finalment, es compararà el resultat obtingut amb la implementació de les millores en el procés productiu respecte a la situació inicial, realitzant a més una valoració de l'impacte generat.

[Resumen]: El objetivo del presente Proyecto de Fin de Carrera consiste en el diseño de una planta de tratamiento de residuos de construcción y demolición en la localidad de Bembibre, situada al noroeste de la provincia de León. Estos residuos son reciclables en su mayoría, por lo que, con unas infraestructuras óptimas para su tratamiento, se les puede ofrecer una nueva puesta en obra en forma de árido reciclado, evitando así la proliferación de vertederos ilegales que generan graves problemas medioambientales. En este proyecto se pretende garantizar la gestión de los RCD en su zona de influencia. Las instalaciones de la planta se proyectarán dentro del Polígono Industrial Bierzo Alto, situado a las afueras de Bembibre, lugar idóneo para su emplazamiento tanto por su localización como por la morfología del terreno. Se ha decidido dividir las instalaciones en una serie de zonas en las cuales se realizarán las diferentes fases del proceso de valorización de los residuos. Por un lado, dispondremos de una zona de control y pesaje, con báscula empotrada para camiones y casetas prefabricadas de control, una playa de descarga para el material admitido y una zona de acopio para el material valorizado, además de disponer de contenedores para fracciones de RCD no pétreo y residuos peligrosos. Sin embargo, la mayor parte del proyecto se enfocará en la proyección de una estructura metálica de 49,5x22 m, la cual servirá de resguardo para la zona de trituración, clasificación y limpieza del RCD, es decir, toda la maquinaria de tratamiento. Además, se dispondrá de cerramientos en un lateral de la estructura, con el fin de proporcionar a la planta de una zona dedicada a tareas administrativas y diferentes usos del personal de las instalaciones.

[ES] Este proyecto se basa en la aplicación de herramientas Lean en el proceso productivo de la fabricación de los barrales de fibra de carbono (brazos auxiliares de 40 metros de longitud que permiten fumigar a los tractores) de una multinacional. El principal objetivo del estudio es eliminar todo tipo de desperdicio, mejorar la productividad y calidad de los productos e implicar al trabajador. En primer lugar, para poner en contexto el presente trabajo se describe la empresa, su flujo de procesos y la organización por la que está formada. A continuación, se procede a analizar los procesos productivos a través de un VSM. Una vez analizada la situación inicial, y a partir de la toma de tiempos se aplican las herramientas Lean: SMED tanto interno como externo y la implementación de estándares de trabajo. Finalmente, se comparará el resultado obtenido con la implementación de las mejoras en el proceso productivo con respecto a la situación inicial, realizando además una valoración del impacto generado., [EN] This project is based on the application of Lean tools in the production process of the carbon fiber barrels (auxiliary arms of 40 meters long that allow to fumigate the tractors) of a multinational company. The main objective of the study is to eliminate all types of waste, improve productivity and product quality, and involve the worker. Firstly, to put this work into context, the company, its process flow, and the organization it is made up of are described. The production processes are then analyzed using a VSM. Once the initial situation has been analyzed, and from the time recording, the Lean tools are applied: SMED both internal and external, and the implementation of work standards. Finally, the result obtained will be compared with the implementation of the improvements in the production process with respect to the initial situation, also making an assessment of the impact generated., [CA] Aquest projecte es basa en l'aplicació d'eines Lean en el procés productiu de la fabricación dels barrals de fibra de carboni (braços auxiliars de 40 metres de longitud que permeten fumigar als tractors) d'una multinacional. El principal objectiu de l'estudi és eliminar tot tipus de desaprofitament, millorar la productivitat i qualitat dels productes i implicar el treballador. En primer lloc, per a posar en context el present treball es descriu l'empresa, el seu flux de processos i l'organització per la qual està formada. A continuació, es procedeix a analizar els processos productius a través d'un VSM. Una vegada analitzada la situació inicial, i a partir de la presa de temps s'apliquen les eines Lean: SMED tant intern com extern i la implementación d'estàndards de treball. Finalment, es compararà el resultat obtingut amb la implementació de les millores en el procés productiu respecte a la situació inicial, realitzant a més una valoració de l'impacte generat.

La competencia dentro de las ONGs ha crecido de forma considerable en los últimos años, por lo que se ha hecho necesario la elaboración de estrategias de comunicación creativas que les permitan obtener recursos para realizar sus proyectos. En el presente TFG se va a intentar reforzar uno de los recursos fundamentales para el funcionamiento de cualquier ONG: los voluntarios. Considero que UNICEF Comité Español puede conseguir este objetivo a través de la comunicación comercial. En el TFG se propone un plan de comunicación cuyo objetivo es fomentar esta forma de colaboración entre los individuos jóvenes., Competition within NGOs has grown considerably in recent years, so it has become necessary to develop creative communication strategies that allow them to obtain resources to carry out their projects. In this TFG, I will try to reinforce one of the fundamental resources for the functioning of any NGO: volunteers. I believe that UNICEF Spanish Committee can achieve this goal through commercial communications. The TFG proposes a communication plan whose objective is to promote this form of collaboration among young people., Departamento de Organización de Empresas y Comercialización e Investigación de Mercados, Grado en Marketing e Investigación de Mercados

La competencia dentro de las ONGs ha crecido de forma considerable en los últimos años, por lo que se ha hecho necesario la elaboración de estrategias de comunicación creativas que les permitan obtener recursos para realizar sus proyectos. En el presente TFG se va a intentar reforzar uno de los recursos fundamentales para el funcionamiento de cualquier ONG: los voluntarios. Considero que UNICEF Comité Español puede conseguir este objetivo a través de la comunicación comercial. En el TFG se propone un plan de comunicación cuyo objetivo es fomentar esta forma de colaboración entre los individuos jóvenes., Competition within NGOs has grown considerably in recent years, so it has become necessary to develop creative communication strategies that allow them to obtain resources to carry out their projects. In this TFG, I will try to reinforce one of the fundamental resources for the functioning of any NGO: volunteers. I believe that UNICEF Spanish Committee can achieve this goal through commercial communications. The TFG proposes a communication plan whose objective is to promote this form of collaboration among young people., Departamento de Organización de Empresas y Comercialización e Investigación de Mercados, Grado en Marketing e Investigación de Mercados

La competencia dentro de las ONGs ha crecido de forma considerable en los últimos años, por lo que se ha hecho necesario la elaboración de estrategias de comunicación creativas que les permitan obtener recursos para realizar sus proyectos. En el presente TFG se va a intentar reforzar uno de los recursos fundamentales para el funcionamiento de cualquier ONG: los voluntarios. Considero que UNICEF Comité Español puede conseguir este objetivo a través de la comunicación comercial. En el TFG se propone un plan de comunicación cuyo objetivo es fomentar esta forma de colaboración entre los individuos jóvenes., Competition within NGOs has grown considerably in recent years, so it has become necessary to develop creative communication strategies that allow them to obtain resources to carry out their projects. In this TFG, I will try to reinforce one of the fundamental resources for the functioning of any NGO: volunteers. I believe that UNICEF Spanish Committee can achieve this goal through commercial communications. The TFG proposes a communication plan whose objective is to promote this form of collaboration among young people., Departamento de Organización de Empresas y Comercialización e Investigación de Mercados, Grado en Marketing e Investigación de Mercados

[Resumen] Objetivo: Conocer y compartir cómo la población que presenta esclerosis múltiple percibe su estado de salud y calidad de vida con relación a su cotidianidad. Indagar en la percepción de los profesionales de terapia ocupacional acerca de la esclerosis múltiple y su abordaje. Metodología: Trabajo de investigación de metodología mixta. La vertiente cualitativa ha permitido indagar en el fenómeno de estudio, a través de entrevistas y un grupo focal. Cuantitativamente, se han empleado la London Handicap Scale, Medida Canadiense del Desempeño Ocupacional y la SF-36. La muestra fue de 70 participantes: 15 personas con esclerosis múltiple y 55 terapeutas ocupacionales. Resultados: La población afectada por la esclerosis múltiple presenta diversas restricciones en la participación en sus ocupaciones, donde destacan las actividades de la vida diaria y la pérdida del rol como trabajador/a. Además, manifiestan que sus necesidades no se encuentran cubiertas desde el sistema público de salud, afectando esto a su calidad de vida. Los terapeutas ocupacionales exponen la necesidad de promover la investigación en este ámbito y destacar la intervención terapéutica en el medio natural del usuario. Conclusiones: Las actividades de la vida diaria e instrumentales son identificadas como un desafío en la cotidianidad de la población con esclerosis múltiple, donde el rol de trabajador aporta gran significado a la identidad de la persona. Además, el estigma hacia la enfermedad y el autoestigma definen un patrón negativo en la calidad de vida de las personas afectadas., [Resumo] Obxectivo: Coñecer e compartir como a poboación que presenta esclerose múltiple percibe o seu estado de saúde e calidade de vida en relación coa súa cotidianidade. Indagar na percepción dos profesionais de terapia ocupacional acerca da esclerose múltiple e a súa abordaxe. Metodoloxía: Traballo de investigación cunha metodoloxía mixta. A vertente cualitativa permitiu profundizar no fenómeno de estudo, a través de entrevistas e un grupo focal. Cuantitativamente, empregáronse a London Handicap Scale, Medida Canadiense del Desempeño Ocupacional e a SF-36. A mostra foi de 70 participantes: 15 persoas con esclerose múltiple e 55 terapeutas ocupacionais. Resultados: A poboación afectada pola esclerose múltiple presenta diversas restriccións na participación nas súas ocupacións, onde destacan as actividades da vida diaria e a pérdida do rol como traballador/a. Ademáis, manifestan que as súas necesidades non se atopan cubertas dende o sistema público de saúde, afectando isto á sua calidade de vida. Os terapeutas ocupacionais expoñen a necesidade de promover a investigación neste ámbito e destacar a intervención terapéutica no medio natural do usuario. Conclusións: As actividades da vida diaria e instrumentáis son identificadas coma un desafío na cotidianidade da poboación con esclerose múltiple, onde o rol de traballador aporta gran significado á identidade da persoa. Ademáis, o estigma dirixido á enfermidade e o auto-estigma definen un patrón negativo na calidade de vida das persoas afectadas. Palabras clave: esclerose múltiple; cotidianidade; autopercepción; terapia ocupacional., [Abstract] Goal: Knowing and sharing how the multiple sclerosis community perceives their health condition and quality of life in relation to their daily life. Exploring the perception of occupational therapy professionals about multiple sclerosis and its whole approach. Methodology: A mixed methodology was used in this research study. The qualitative side has allowed to investigate the phenomenon of study through interviews and a focus group. Quantitatively, the London Handicap Scale, Canadian Occupational Performance Measure and the SF-36 have been used. The study participants were seventy: fifteen people diagnosed with multiple sclerosis and fifty-five occupational therapists. Results: The community of people living with multiple sclerosis presents several restrictions on the participation of their occupations, which include the activities of daily life and the loss of the role as a worker. Furthermore, it shows that their needs aren’t covered by the public health system, suffering in their quality of life. The occupational therapists emphasize the need to promote the research in this area and emphasize the therapeutic intervention in the natural environment of the user. Conclusions: The instrumental activities of daily life are identified as a challenge in the daily living of the multiple sclerosis community, where the role of the worker brings a hug significance to the identity of the person. In addition, the stigma towards illness and self-stigma determinate a negative pattern in the quality of life of affected people.

En este trabajo se pretende evaluar la eficacia de una intervención de enfermería enfocada a la prevención del síndrome de inmovilidad del anciano proponiendo el establecimiento de unas pautas para la asistencia del paciente anciano con posibilidad de sufrir una inmovilización. Esta intervención se centrará en la valoración integral del anciano, la modificación de los hábitos de vida y la enseñanza de conocimientos al anciano o cuidador principal, así como la revisión del mismo anciano mediante un seguimiento y un plan de cuidados basados en la evidencia científica., Departamento de Enfermería, Grado en Enfermería

En este trabajo se pretende evaluar la eficacia de una intervención de enfermería enfocada a la prevención del síndrome de inmovilidad del anciano proponiendo el establecimiento de unas pautas para la asistencia del paciente anciano con posibilidad de sufrir una inmovilización. Esta intervención se centrará en la valoración integral del anciano, la modificación de los hábitos de vida y la enseñanza de conocimientos al anciano o cuidador principal, así como la revisión del mismo anciano mediante un seguimiento y un plan de cuidados basados en la evidencia científica., Departamento de Enfermería, Grado en Enfermería

En este trabajo se pretende evaluar la eficacia de una intervención de enfermería enfocada a la prevención del síndrome de inmovilidad del anciano proponiendo el establecimiento de unas pautas para la asistencia del paciente anciano con posibilidad de sufrir una inmovilización. Esta intervención se centrará en la valoración integral del anciano, la modificación de los hábitos de vida y la enseñanza de conocimientos al anciano o cuidador principal, así como la revisión del mismo anciano mediante un seguimiento y un plan de cuidados basados en la evidencia científica., Departamento de Enfermería, Grado en Enfermería

The aim of this study is to describe the results obtained after growth hormone (GH) treatment and neurorehabilitation in a young man that suffered a very grave traumatic brain injury (TBI) after a plane crash. Methods: Fifteen months after the accident, the patient was treated with GH, 1 mg/day, at three-month intervals, followed by one-month resting, together with daily neurorehabilitation. Blood analysis at admission showed that no pituitary deficits existed. At admission, the patient presented: spastic tetraplegia, dysarthria, dysphagia, very severe cognitive deficits and joint deformities. Computerized tomography scanners (CT-Scans) revealed the practical loss of the right brain hemisphere and important injuries in the left one. Clinical and blood analysis assessments were performed every three months for three years. Feet surgery was needed because of irreducible equinovarus. Results: Clinical and kinesitherapy assessments revealed a prompt improvement in cognitive functions, dysarthria and dysphagia disappeared and three years later the patient was able to live a practically normal life, walking alone and coming back to his studies. No adverse effects were observed during and after GH administration. Conclusions: These results, together with previous results from our group, indicate that GH treatment is safe and effective for helping neurorehabilitation in TBI patients, once the acute phase is resolved, regardless of whether or not they have GH-deficiency (GHD)

In the present paper it is analyzed the presence of violence in the graphic news contents anput the islamic revolutions of the Arab Spring, and how it could modify the perception of the facts related in that news. In addition, it is compared how high is the violence grade in the most important Spanish newspapers., En el presente artículo se analiza cuál es la presencia de la violencia en las fotografías relacionadas con informaciones sobre las revoluciones de la Primavera Árabe, y se interpreta cuál puede ser la influencia en la percepción de los hechos contados en las noticias. Además, se hace una comparación entre el grado de violencia mostrado por las cabeceras más importantes de España, al relatar las revoluciones de la Primavera Árabe.

En el artículo 1905 del Código civil se contempla una responsabilidad civil extracontractual derivada de la tenencia de animales, mientras que en el 1906 y en el artículo 33 de la Ley de caza se prevé la responsabilidad por daños causados por piezas de caza. En este trabajo se analizan los presupuestos que deben de darse para que puedan exigirse ambos tipos de responsabilidad, así como la jurisprudencia que se ha dictado al respecto y los diferentes cambios normativos que han ido aconteciendo., Grado en Derecho

En el artículo 1905 del Código civil se contempla una responsabilidad civil extracontractual derivada de la tenencia de animales, mientras que en el 1906 y en el artículo 33 de la Ley de caza se prevé la responsabilidad por daños causados por piezas de caza. En este trabajo se analizan los presupuestos que deben de darse para que puedan exigirse ambos tipos de responsabilidad, así como la jurisprudencia que se ha dictado al respecto y los diferentes cambios normativos que han ido aconteciendo., Grado en Derecho

En el artículo 1905 del Código civil se contempla una responsabilidad civil extracontractual derivada de la tenencia de animales, mientras que en el 1906 y en el artículo 33 de la Ley de caza se prevé la responsabilidad por daños causados por piezas de caza. En este trabajo se analizan los presupuestos que deben de darse para que puedan exigirse ambos tipos de responsabilidad, así como la jurisprudencia que se ha dictado al respecto y los diferentes cambios normativos que han ido aconteciendo., Grado en Derecho