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El propósito de las ciencias sociales y jurídicas es fomentar la convivencia y ayudar a resolver problemas para alcanzar los objetivos de las personas. Cuando surgen conflictos relacionados con el avance tecnológico o las teorías constructivistas, es necesario que los juristas intervengan para encontrar un equilibrio entre el progreso y los intereses afectados por los cambios disruptivos utilizando principios jurídicos.

Las críticas de la oposición a la gestión de los fondos de recuperación en España señalan su manipulación clientelar. El Gobierno ha respondido que está cumpliendo todas las normas europeas. Sin embargo, que sería conveniente un mayor énfasis en principios recogidos en los reglamentos europeos, incluyendo más participación de las comunidades autónomas, las entidades locales y los agentes políticos y sociales en las decisiones de distribución y asignación de los recursos. Un futuro de consenso parece deseable en los proyectos de nueva generación.

Background Diagnosis and treatment of prostate cancer is associated with anxiety, fear, and depression in up to one-third of men. Yoga improves health-related quality of life (QoL) in patients with several types of cancer, but evidence of its efficacy in enhancing QoL is lacking in prostate cancer. Methods In this randomized controlled study, 29 men newly diagnosed with localized prostate cancer were randomized to yoga for 6 weeks (n = 14) or standard-of-care (n = 15) before radical prostatectomy. The primary outcome was self-reported QoL, assessed by the Expanded Prostate Index Composite (EPIC), Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT–F), Functional Assessment of Cancer Therapy-General (FACT-G) at baseline, preoperatively, and 6 weeks postoperatively. Secondary outcomes were changes in immune cell status and cytokine levels with yoga. Results The greatest benefit of yoga on QoL was seen in EPIC-sexual (mean difference, 8.5 points), FACIT-F (6.3 points), FACT-Functional wellbeing (8.6 points), FACT-physical wellbeing (5.5 points), and FACT-Social wellbeing (14.6 points). The yoga group showed increased numbers of circulating CD4+ and CD8+ T-cells, more production of interferon-gamma by natural killer cells, and increased Fc receptor III expression in natural killer cells. The yoga group also showed decreased numbers of regulatory T-cells, myeloid-derived suppressor cells, indicating antitumor activity, and reduction in inflammatory cytokine levels (granulocyte colony-stimulating factor [0.55 (0.05–1.05), p = 0.03], monocyte chemoattractant protein [0.22 (0.01–0.43), p = 0.04], and FMS-like tyrosine kinase-3 ligand [0.91 (−0.01, 1.82), p = 0.053]. Conclusions Perioperative yoga exercise improved QoL, promoted an immune response, and attenuated inflammation in men with prostate cancer. Yoga is feasible in this setting and has benefits that require further investigation. Trial registration clinicaltrials.org (NCT02620033).

La crisis COVID ha producido un impacto sobre la economía y el empleo sin precedentes. La reactivación requerirá movilizar recursos públicos derivados del instrumento europeo de recuperación, para lo cual se ha aprobado el Real Decreto-Ley 36/2020, así como medidas paralelas en el ámbito autonómico. El Plan para nuestro país, presentado por el Gobierno de España a la comisión europea a finales de abril, debería tener más en cuenta los proyectos e iniciativas de las entidades locales, por su proximidad a los problemas, su conocimiento de las necesidades y su capacidad de intervención más ágil e inmediata.

Presentación del número 8 de la revista Documentación Administrativa

The emergence of highly transmissible SARS-CoV-2 variants has led to surges in cases and the need for global genomic surveillance. While some variants rapidly spread worldwide, other variants only persist nationally. There is a need for more fine-scale analysis to understand transmission dynamics at a country scale. For instance, the Mu variant of interest, also known as lineage B.1.621, was first detected in Colombia and was responsible for a large local wave but only a few sporadic cases elsewhere. To provide a better understanding of the epidemiology of SARS-Cov-2 variants in Colombia, we used 14,049 complete SARS-CoV-2 genomes from the 32 states of Colombia, and performed Bayesian phylodynamic analyses to estimate the time of variants introduction, their respective effective reproductive number, and effective population size, and the impact of disease control measures. We detected a total of 188 SARS-CoV-2 Pango lineages circulating in Colombia since the start of the pandemic. We showed that the effective reproduction number oscillated drastically throughout the first two years of the pandemic, with Mu showing the highest transmissibility (Re and growth rate estimation). Our results reinforce that genomic surveillance programs are essential for countries to make evidence-driven interventions towards the emergence and circulation of novel SARS-CoV-2 variants.

Objective: To compare cancer-specific mortality (CSM) and all-cause mortality (ACM) between patients with and without sarcopenia who underwent radical cystectomy for bladder cancer. Materials and methods: We performed a systematic review and meta-analysis of original articles published from October 2010 to March 2019 evaluating the effect of sarcopenia on CSM and ACM. We extracted hazard ratios (HRs) and 95% confidence intervals (CIs) for CSM and ACM from the included studies. Heterogeneity amongst studies was measured using the Q-statistic and the I2 index. Meta-analysis was performed using a random-effects model if heterogeneity was high and fixed-effects models if heterogeneity was low. Results: We identified 145 publications, of which five were included in the meta-analysis. These five studies represented 1447 patients of which 453 were classified as sarcopenic and 534 were non-sarcopenic. CSM and ACM were increased in sarcopenic vs non-sarcopenic patients (HR 1.64, 95% CI 1.30–2.08, P

La crisis COVID-19 ha puesto en evidencia la falta de capacidad de anticipación de nuestra gobernanza multinivel, por una tardía respuesta desde el nivel central. Una metodología más descentralizada y sin soluciones de ¿talla única¿ hubiera sido más apropiada en la toma de decisiones, en la línea sugerida por la ciencia de definición estratégica de escenarios. COVID-19 krisiak agerian utzi du maila anitzeko gure Gobernantzak ez duela aurrea hartzeko gaitasunik, maila zentraletik berandu erantzun delako. Denontzat neurri berak ezarri ordez metodologia deszentralizatuago batean oinarrituz gero, agertokien definizio estrategikoko zientziak iradokitzen duen ildoari jarraikiz, erabaki egokiagoak hartuko ziren. The COVID-19 crisis has revealed the lack of capacity to anticipate of our multilevel governance, due to a slow reaction of central power. A more decentralized and not ¿one size fits all¿ decision-making methodology could have been smarter, as suggested by the state of science of strategic scenario definition.

Este trabajo explica las razones para mejorar las normas sobre responsabilidad de los servidores públicos, garantizando al tiempo la seguridad jurídica y el interés general. La correcta comprensión de las diferencias entre las responsabilidades penales, administrativas y contables es muy importante para alcanzar estos objetivos y prevenir la arbitrariedad.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of the current COVID-19 pandemic, has evolved to have a wide range of hosts, including non-human primates, wild and domestic animals. The ACE2 protein has a high level of conservation and is the common receptor invertebrate species for a viral infection to occur; this receptor could give rise to anthroponotic events. This article describes the first event of symptomatic transmission in Latin America from a human to a dog by the B.1.625 lineage of SARS-CoV-2. We found 21 shared mutations in the complete genomes of viral sequences from owners and dogs. Further phylogenetic and molecular analysis showed that 100% co-localization of the clade helps to understand human-animal transmission. Prediction of the Spike protein structure of the sequenced virus and docking analyzes showed that the E484K mutation in the receptor-binding domain (RBD) could contribute to the viral affinity of dACE2. Therefore, close contact between SARS-CoV-2-infected humans and pets should be avoided to prevent the emergence of novel mutations of public health importance from anthroponotic events.

Although more than half of the world's population is already vaccinated, the appearance of new variants of concern puts public health at risk due to the generation of new immunogens against the virus as a crucial and relevant strategy in the control of these new variants.A preclinical study used a potential vaccine candidate (RBD, SARS-CoV-2). Four groups of BALB/c mice were used, a control group, an adjuvant group, a group inoculated with one dose of RBD subunit protein, and the fourth group inoculated with two doses of RBD subunit protein.No inflammatory or cellular changes were shown in the mice's anatomopathological evaluation. Higher kinetics and 75% seroconversion were obtained in the mice inoculated with two doses of RBD (P 0.0001).The application of two doses of the RBD vaccine candidate in BALB/c mice proved safe and immunogenic against SARS-CoV-2.

Introduction. COVID-19 is a pathology caused by the SARS-CoV2 virus. The World Health Organization has reported more than 94 million cases and two million deaths worldwide. Objective: To describe the seroprevalence, spatial distribution, and clinical and sociodemographic variables of SARS-CoV2 in a community of the Colombian Amazon region. Methods. In December 2020, a cross-sectional observational study was carried out in a population located in the Colombian Amazon in the municipality of Mitú. Sociodemographic and clinical data were taken. Besides, 590 blood samples were taken, and an antibody detection was carried out with an ELISA and a recombinant protein N antigen of SARS-CoV2. Results. A seroprevalence of 57.6% was observed. The highest proportion of the infection is located in inter-municipal transport zones. The bivariate analysis did not show differences in the SARS-CoV2 infection rate concerning the variables sex, age-range, and the presence of comorbidities (P> 0.05). The bivariate and multivariate analysis showed that being symptomatic and presenting neurological manifestations of the upper respiratory tract are clinical variables associated with SARS-CoV2 infection (P

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the etiological agent of the current COVID-19 pandemic, has been proven to have a broad range of host species, including non-human primates, as well as domestic animals and pets. A high conservation degree in the structure of the ACE2 receptor, which is the critical protein for viral infection among vertebrate species, could lead to anthroponotic events. The present paper reports the first symptomatic human-to-dog transmission event of the SARS-CoV-2 Iota variant in Latin America. We found a total of 21 mutations shared across the complete genomes of owner and dog viral sequences. Further phylogenetic and molecular analysis showed a 100% support of clade co-localization supporting the transmission event. Spike protein structure prediction of sequenced virus and docking analyses showed that E484K mutation in the receptor-binding domain (RBD) could enhance viral affinity towards dACE2. Therefore, close contact should be avoided between humans infected with SARS-CoV-2 and pets to avoid the appearance of novel mutations of importance in public health from anthroponotic events.

INTRODUCTION AND OBJECTIVE:Yoga improves health-related quality of life (QoL) in patients with several types of cancer, but its benefits have not been studied in prostate cancer. We performed a pha...

Diagnosis and treatment of prostate cancer is associated with anxiety, fear, and depression in up to one-third of men. Yoga improves health-related quality of life (QoL) in patients with several types of cancer, but evidence of its efficacy in enhancing QoL is lacking in prostate cancer.In this randomized controlled study, 29 men newly diagnosed with localized prostate cancer were randomized to yoga for 6 weeks (n = 14) or standard-of-care (n = 15) before radical prostatectomy. The primary outcome was self-reported QoL, assessed by the Expanded Prostate Index Composite (EPIC), Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Functional Assessment of Cancer Therapy-General (FACT-G) at baseline, preoperatively, and 6 weeks postoperatively. Secondary outcomes were changes in immune cell status and cytokine levels with yoga.The greatest benefit of yoga on QoL was seen in EPIC-sexual (mean difference, 8.5 points), FACIT-F (6.3 points), FACT-Functional wellbeing (8.6 points), FACT-physical wellbeing (5.5 points), and FACT-Social wellbeing (14.6 points). The yoga group showed increased numbers of circulating CD4+ and CD8+ T-cells, more production of interferon-gamma by natural killer cells, and increased Fc receptor III expression in natural killer cells. The yoga group also showed decreased numbers of regulatory T-cells, myeloid-derived suppressor cells, indicating antitumor activity, and reduction in inflammatory cytokine levels (granulocyte colony-stimulating factor [0.55 (0.05-1.05), p = 0.03], monocyte chemoattractant protein [0.22 (0.01-0.43), p = 0.04], and FMS-like tyrosine kinase-3 ligand [0.91 (-0.01, 1.82), p = 0.053].Perioperative yoga exercise improved QoL, promoted an immune response, and attenuated inflammation in men with prostate cancer. Yoga is feasible in this setting and has benefits that require further investigation.clinicaltrials.org (NCT02620033).

Introduction. Currently, more than 1.8 billion doses of SARS-CoV-2 vaccines have been applied worldwide. However, some developing countries are still a long way from achieving herd immunity through vaccination. In some territories, such as the Colombian Amazon, mass immunization strategies have been implemented with the CoronaVac® vaccine. Due to its proximity to Brazil, where one of the variants of interest of SARS-CoV-2 circulates. Objective. To determine the efficacy of the CoronaVac® vaccine in a population of the Colombian Amazon. Methods. Between February 24, 2021, and May 19, 2021, a descriptive observational study was carried out in which a population of individuals over 18 years of age immunized with two doses of the CoronaVac® vaccine was evaluated. The study site was in the municipality of Mitú, Vaupés, in southeastern Colombia, a region located in the Amazon bordering Brazil. Results. 87% of the urban population of the Mitú municipality were vaccinated with CoronaVac®. To date, 2.1% of vaccinated individuals have become ill, and only 0.1% of these require hospitalization. No deaths attributable to COVID-19 have been reported among vaccinated individuals, and the vaccine has shown 97% efficacy against mild disease and 100% against severe infection. Conclusions. The herd immunity achieved through mass vaccination in this population has made it possible to reduce the rate of complicated cases and mortality from COVID-19 in this region of the Colombian Amazon.

Las universidades han superado en el pasado circunstancias muy difíciles: guerras, desastres, crisis económicas e incluso otras pandemias. El recuerdo de la historia es suficiente para acreditar su renacimiento ab ipso ferro (Fray Luis de León), con nuevo brío y motivación. Quien se pregunte si es posible cambiar la Universidad, debería saber que la principal característica definitoria de esta institución es su inteligencia, capacidad que permite superar las propias debilidades. El futuro de la Universidad, en fin, no es un arcano, ni un misterio o una incógnita. Mañana y dentro de un año, la próxima década y después, las aulas volverán a reunir gentes; docentes y discentes se reencontrarán. Los creadores de conocimiento lo mostrarán para beneficio de sus destinatarios, jóvenes de mente y espíritu inquieto, quienes seguirán estando aquí cuando los anteriores nos marchemos. Así se mantienen las instituciones, gracias a personas convencidas de su sentido, utilidad y acierto. Tantas organizaciones humanas hoy ya no existen, han desaparecido, pero la Universidad permanece.

The COVID-19 outbreak has a considerable impact on all business domains worldwide, almost with negative consequences. The digital transformation was already a requirement for all governments and institutions that this pandemic has accelerated to solve the confinement and the limitations to work and share the same spaces. Face-to-face higher education institutions moved towards an urgent and unplanned online teaching. After having closed one of the processes that has had the most significant impact on universities, the time has come to reflect and draw conclusions that will serve to face these institutions' future. A crisis always represents risks but also opportunities to change from a disruptive situation. This chapter reflects universities' futures from a strengths-weaknesses-opportunities-threats approach with the perspective of the experiences lived during the end of the 2019-2020 academic year by some face-to-face universities in Spain.

COVID-19 disease caused an out-breaking with implications in citizens’ private and public life. Face-to-face higher education had to adapt their lectures abruptly to a remote emergency mode. In this situation, both methodological and technological decisions had a principal role in closing the 2019-2020 academic course successfully. In this paper, the strategic decisions of the University of Salamanca (Spain) at the institutional level are summarized, taking into account not only the principal goal of ending a contingency situation but focusing on how to face the 2020-2021 academic course, in which one all the universities know that they will have to operate with the disease, but the uncertainty will be still present.

Background Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is an emerging viral pandemic disease. In the last 6 months, SARS-CoV-2 has caused millions of reported cases and hundreds of thousands of deaths. As other world regions, South America has not contained the pandemic’s advance since it lacks the hospital and economic capacities. Public health implications of transmission, while the asymptomatic/presymptomatic infection is a critical concern at the current pandemic. Objective Describe the socio-demographic, clinical, and viral features of a cohort of SARS-CoV-2 infected individuals from the Colombian Caribbean. Methods Six hundred eighty-six clinical samples of suspected SARS-CoV-2 infection cases and contacts individuals from several hospital centers in the department of Córdoba, Colombia, were received at our laboratory between April 9th and May 16th, 2020. RNA was extracted using lysis buffers and spin columns. The samples were tested for SARS-CoV-2 by reverse transcription real-time polymerase chain reaction (RT-qPCR) using commercially available multiplex real-time PCR assay for simultaneous detection of 3 target genes of SARS-CoV-2 (Allplex™, 2019-nCoV assay, Korea). Viral copies quantification was done using a standard curve constructed from seriated dilutions of a SARS-CoV-2 positive control. Statics descriptive methods were used. Results Thirty-five nasopharyngeal samples were positive for SARS-CoV-2 infection; the average age was 43 (range, 1–95 years). Seventeen of 35 (49%) of the patients showed symptoms. Most of them had a cough, fever, and odynophagia; three of the patients reported having arthralgia. Only two patients required hospitalization. None of the patients had known co-morbidities. RT-qPCR results show that two of the symptomatic patients had significantly higher RNA copies than the rest. Eighteen of 35 (51%) individuals were asymptomatic, and the average age was 30 (range, 6–61 years). Four asymptomatic individuals showed a higher copy than some symptomatic patients; nonetheless, the average of RNA copies 8.26 × 1010 was lower than the symptomatic. Conclusions This study shows that asymptomatic patients may develop infections with a high number of RNA copies. Since a considerable percentage of infections may be asymptomatic/presymptomatic, enhanced testing approaches may be needed to detect these persons. Due the occurrence of a large proportion of infections being a result from transmission originated in asymptomatic/presymptomatic individuals, public health interventions in Colombia should be based on two steps: a massive molecular screening, and viral load quantification. Finally, a remarkable issue in our study is the average age of symptomatic and asymptomatic groups (43 and 30 respectively) which may be important because of the economic impact that has been caused by the coronavirus pandemic and may be probably the cause of the reduced lethality observed in the country and the department at the time of this study.

A serological survey was carried out in Monteria (500 000 population), a mid-size city in Colombia. An overall prevalence of 55.3% (95% confidence interval, 52.5%–57.8%) was found among a sample of 1.368 people randomly selected from the population. Test positivity was related to economic characteristics with the highest prevalence found in the most impoverished areas, representing 83.8% of the city’s population. We found a prevalence that might be associated with some important level of population immunity.

Highlights • Colombia as an endemic country for Dengue, Chikungunya, and Zika virus. • Co-epidemics of SARS-CoV-2 with other etiologies is a matter for concern. • Serological cross-reactivity in acute Zika infection using a SARS-CoV-2 ELISA test., Objectives We investigated seroreactivity, using a commercial SARS-CoV-2 ELISA test, in samples collected from different individuals’ groups, including patients diagnosed as Dengue, Zika, and Chikungunya infection during 2015 and 2019, from an endemic area at the Caribbean Colombian region. Methods A total of 127 sera, obtained from six different groups of individuals, were included in this study: Group A: patients with confirmed SARS-CoV-2 infection; Group B: patients with symptoms suggestive of COVID-19 or asymptomatic contacts of confirmed patients; Group C: patients with acute or recent dengue virus infection; Group D: patients with acute Zika virus infection; Group E: patients with previous Chikungunya virus infection; and Group F: individuals with exposure to spotted fever group rickettsiae. Results Overall, group A, group B, and group D showed seroreactivity to SARS-CoV-2 in 92%, 75%, and 26% of samples, respectively; meanwhile, group C, group E, and group F showed 100% of seronegative. Conclusions We found 26% of serological cross-reactivity in patients with acute Zika virus infection using a commercial SARS-CoV-2 ELISA test. Further studies could evaluate if serological cross-reaction is maintaining along the time in a non-acute patient with previous exposure to the Zika virus and its effect in SARS-CoV-2 serosurveys in endemic areas for this arbovirus.

Background. Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is an emerging viral pandemic disease. In the last six months, SARS-CoV-2 has caused millions of reported cases and hundreds of thousands of deaths. As other world regions, nowadays, South America has not contained the pandemic's advance since it lacks the hospital and economic capacities. Public health implications of transmission, while the asymptomatic infection is a critical concern at the current pandemic.Objective: Describe the socio-demographic, clinical, and viral kinetics features of a cohort of SARS-CoV-2 infected individuals from the Colombian Caribbean. Methods: Six hundred eighty-six clinical samples of suspected SARS-CoV-2 infection cases and contacts individuals from several hospital centers in the department of Córdoba, Colombia, were received at our laboratory between April 9th and May 16th, 2020. RNA was extracted using lysis buffers and spin columns. The samples were tested for SARS-CoV-2 by RT-qPCR (Reverse transcription real-time polymerase chain reaction) using commercially available multiplex real-time PCR assay for simultaneous detection of 3 target genes of SARS-CoV-2 (AllplexTM, 2019-nCoV assay, Korea). Viral copies quantification was done using a standard curve constructed from seriated dilutions of a SARS-CoV-2 positive control. Statics descriptive methods were used. Results: Thirty-five nasopharyngeal samples were positive for SARS-CoV-2 infection; the average age was 43 (range, 1-95 years). Seventeen of 35 (49%) of the patients showed symptoms. Most of them had a cough, fever, and odynophagia; three of the patients reported having arthralgia. Only two patients required hospitalization. None of the patients had known co-morbidities. RT-qPCR results show that two of the symptomatic patients had significantly higher RNA copies than the rest. Eighteen of 35 (51%) individuals were asymptomatic, and the average age was 30 (range, 6-61 years). Four asymptomatic individuals showed a higher copy than some symptomatic patients; nonetheless, the average of RNA copies 8.26 x10+10 was lower than the symptomatic.Conclusions: the population studied was young, with an average of 43 years in symptomatic and 30 years of asymptomatic; this is important because of the high impact in the economy. Because a large proportion of infections may result from transmission from asymptomatic or pre-symptomatic persons, the usefulness of public health interventions in Colombian provinces should be based on molecular screening in a vast conglomerate population and quantify the viral load.

A systematic review and meta-analysis of clinical trials was undertaken to compare percutaneous thermal ablation versus partial nephrectomy (PN) for stage T1 renal tumors.A comprehensive search of major databases was conducted from October 2000 to July 2016. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Incidences of all-cause mortality (ACM), cancer-specific mortality (CSM), local recurrence (LR), and metastases, as well as complication rates and changes in estimated glomerular filtration rate (eGFR), were evaluated.Inclusion criteria were met by 15 of 961 papers. These studies represented 3,974 patients who had undergone an ablative procedure (cryoablation or radiofrequency ablation; n = 1,455; 37%) or PN (n = 2,519; 63%). ACM and CSM rates were higher for ablation than for PN (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.54-2.87 [P.05]; HR, 3.84; 95% CI, 1.66-8.88 [P .05], respectively). No statistically significant difference in LR rate or risk of metastasis was seen between ablation and PN (HR, 1.32; 95% CI, 0.79-2.22 [P = .22]; HR, 1.83; 95% CI, 0.67-5.01 [P = 0.23], respectively). Complication rates were lower for ablation than for PN (13% vs 17.6%; odds ratio, 0.49; 95% CI, 0.25-0.94; P.05). A significantly greater decrease in eGFR was observed after PN (13.09 mL/min/1.73 mThermal ablation showed no significant difference in LR or metastases compared with PN. Thermal ablation was associated with a lower morbidity rate and a lesser reduction in eGFR compared with PN, but with higher ACM and CSM rates.

Presentación del número 7 de la revista Documentación Administrativa

La nueva legislación sobre procedimiento administrativo y sector público abre infinidad de posibilidades, pero también retos para una administración basada en el soporte papel, siendo su actualización obligatoria durante los próximos años, analizando en el presente artículo las principales novedades y retos que se plantean. Administrazio-prozedurari eta sektore publikoari buruzko legeria berriak konta ezin ahala aukera irekitzen ditu, baina baita erronkak ere paperezko euskarrian oinarritutako administrazio batentzat, zeinaren eguneratzea nahitaezkoa den datozen urteotan. Artikulu honetan, planteatzen diren berritasun eta erronka nagusiak aztertzen dira. The new law on administrative procedure and public sector opens endless possibilities but also challenges for the role -based administration supports, and its update mandatory for years, analyzing the major developments and challenges in this article.

Engaging new clinical providers in the HIV workforce is a critical need due to rapidly evolving treatment paradigms, aging out of existing providers, and special population needs. The 1-year competency-based Clinician Scholar Program for minority-serving providers with limited HIV care experience was individually tailored for each provider ( n = 74), mostly nurse practitioners, physicians, and clinical pharmacists. Baseline and endpoint self-assessments of clinical knowledge and skills showed significant improvements in all 11 targeted competencies, particularly in managing antiretroviral medications, screening and testing methods, incorporating prevention into HIV care, understanding risk reduction methods, and describing current care standards. Faculty mentor assessments also showed significant improvement in most competencies. Additional benefits included ongoing access to mentorship and training, plus sustained engagement in local and statewide HIV care networks. Our intensive mentoring program model is replicable in other AIDS Education and Training Centers and in other structured training programs.

Introduction and Objectives: New diagnosis of prostate cancer (PCa) may lead to anxiety, mental distress, fear and depression in up to 30% of men, which can contribute to poor quality of life (QOL). Recent research on Yoga in cancer patients has shown significant improvement in health related QOL, emotional health and fatigue. Given the lack of randomized clinical data regarding the effects of Yoga in PCa, we performed this study to evaluate the potential impact of Yoga on disease-specific QOL in men undergoing radical prostatectomy (RP) for PCa. Material and Method: We randomly assigned newly diagnosed men with localized prostate cancer to Yoga (n = 15) or standard of care (n= 15) prior to their RP. Yoga was given to the intervention group twice a week for 6 weeks for 60 minutes before the surgery and then re-initiated 3 to 6 weeks after the surgery for another six weeks. Self-report measures of QOL [ Expanded Prostate Index Composite (EPIC), Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Functional Assessment of Cancer Therapy-General (FACT-G) and Five Facets of Mindfulness Questionnaire (FFMQ) primary outcomes], blood specimen (cytokine and immune markers; secondary outcome) were collected at baseline, prior to the surgery and 6 weeks after surgery. Results: Improvements in EPIC sexual domain (mean difference: 8.5 points), FACT-P (mean difference: 5.3 points), FACIT-F (mean difference: 5.4 points), and FACT-G (mean difference: 7.2 points) were seen at 6 weeks in the Yoga arm compared with controls. Greatest benefit of Yoga was seen in the subdomains of EPIC sexual function (mean difference: 8.9 points), EPIC sexual bother (mean difference: 7.6 points), FACT emotional wellbeing (mean difference: 5.4 points), FACT functional wellbeing (mean difference 8.3 points) and FACT social wellbeing (mean difference 14.1 points). We identified statistically significant reduction in the inflammatory cytokines- granulocyte colony-stimulating factor (G-CSF; 0.55 [0.05 - 1.05]; p-value = 0.03), Monocyte chemoattractant protein (MCP-1; 0.22 [0.01 - 0.43]; p-value = 0.04), FMS-like tyrosine kinase-3 ligand (FLT-3 L; 0.91 [-0.01 - 1.82]; p-value = 0.053) in the Yoga group during the same time period. Conclusions: A structured Yoga intervention in the preoperative setting improved QOL, especially in the domains of sexual function, social, emotional and functional well-being as well as fatigue. Yoga positively modulates chronic low-grade inflammation which may impact tumor microenvironment. Yoga is feasible and safe and has promising benefits to physical, mental and emotional well-being. Health care providers can utilize the preoperative period as a window of opportunity for an intervention and a teaching moment for the patient to enhance their overall health. Further integrated large-scale research into molecular impact of yoga on markers of inflammation and immune function are essential. Source of Funding: This project was supported by the ThriveWell Cancer Foundation grant to Dharam Kaushik. The content is solely the responsibility of the authors and does not necessarily represent the official views of the ThriveWell Cancer Foundation. Citation Format: Dharam Kaushik, Pankil Shah, Kumar A. Pratap, Ian M. Thompson, Robert S. Svatek, Javier Hernandez, Ian Thompson, Ahmed Mansour, Richapriya Jha, Yang Xiaoyu, Deepak K. Pruthi, Hanzhang Wang, J. Ricardo Rivero, Nydia Darby, Ronald Rodriguez, Michael A. Liss. A randomized controlled trial of yoga in men with prostate cancer undergoing radical prostatectomy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-292.

El saber antiguo conocía los riesgos del ejercicio del poder arbitrario y la necesidad de prevenirlos. Las diversas instituciones diseñadas para exigir responsabilidades a las autoridades y funcionarios (desde el juicio de residencia a las vigentes leyes de probidad), han de encontrar un punto de equilibrio entre la indeseable impunidad y la paralización de la toma de decisiones, por temor a sus consecuencias. La responsabilidad política no es suficiente para alcanzarlo, así que necesitamos mecanismos preventivos de la arbitrariedad y un nuevo énfasis en los aspectos subjetivos (personales, humanos) de la responsabilidad.

In this article my PhD research plan will be presented. This work revolves around communication and perception strategies that serve as guidelines for public administrations. Currently the science of behavior has taken a turn with the arrival of mass communication. In this sense, the agents that need to reach the population to make sense, such as public administrations, have changed their communication, marketing and message design strategies. This Project aims to analyze the behavior and reactions of different types of public to certain messages by public administrations to know whether these messages work or not. To do this, we will use traditional methodologies such as observation and analysis of official data and experimental methodologies in the application of strategies in order to know their effectiveness. When this investigation is completed, it is expected to offer a guide of good practices on the incidence of these strategies by public administrations on the behavior of citizens. This research work is divided into five sections: Context and motivation that drives the dissertation research; State-of-the-art; Research objectives and research questions; Research approach and methods; and Conclusions and future work.

INTRODUCTION The Clinician Scholars Program is designed to improve the capacity and quality of HIV care by training clinicians in underserved areas. A mentoring approach is used to deliver individualized educational opportunities over the course of a year focused on preparing clinicians to provide high-quality patient-centered HIV care. Evaluation of the program has illustrated increases in knowledge, skills, and practice behavior, yet critical domains remain unexplored, particularly the potential for the program to affect professional identity formation and networking between individual clinicians. METHODS Qualitative exit interviews (N = 50) were conducted over 4 years of the Clinician Scholars Program. Interviews were transcribed and analyzed using an open-coding process with multiple coders. Interrater reliability was assessed. Themes related to professional development and networking emerged. RESULTS Thematic analysis revealed changes in several professional development domains, including self-efficacy, HIV care clinician identity, and career development. In addition, clinicians began to develop key connections with mentors, other clinicians, and health systems-gaining a foundation in the HIV care community, enabled and strengthened by growth in professional confidence and competence within the clinician's care context. DISCUSSION Evaluations of clinical training programs often focus on knowledge and skill gains without addressing professional identity development and place within the care community. This study illustrates that a longitudinal clinician training program has the potential to influence professional identify development, particularly affect how clinicians view themselves as a resource in the HIV care community and begins to facilitate necessary connections to other clinicians and the wider care system.

The Clinician Scholars Program at the Midwest AIDS Training and Education Center strengthens the workforce by increasing knowledge and skills related to HIV prevention and care. The 1-year individualized training program for minority-serving clinicians includes intensive mentoring and networking. Qualitative exit interviews (N = 50) conducted over 4 years demonstrate the effectiveness of the training, including changes at the individual and systems levels. Findings show that almost all graduates reported improvements in knowledge, two-thirds reported changes in empathic capacity and cultural competence, and nearly three-quarters reported changes in clinical practice. Scholars indicated improvements in knowledge and practice of HIV prevention, including pre-exposure prophylaxis and managing medications and comorbidities. A third of the Scholars reported improvements in their clinical practices related to linking and retaining patients in HIV care, which demonstrated positive movement along the HIV care continuum, a key focus area of the National HIV AIDS Strategy.

Este trabajo analiza el grado de cumplimiento de las exigencias de la transposición de la Directiva 2006/123/CE, del Parlamento Europeo y del Consejo, de 12 de diciembre de 2006, relativa a los Servicios en el Mercado Interior, en la Comunidad Autónoma de Andalucía, después del ingente esfuerzo realizado para adaptar numerosas normas y reglamentos del Ordenamiento autonómico a sus principios. Tras exponer el iter de las reformas efectuadas en el nivel estatal y andaluz, se exponen también las medidas de simplificación administrativa y régimen local, para concluir señalando tanto lo conseguido como lo que todavía está por hacer.

The Midwest AIDS Training and Education Center (MATEC) implemented a Web-based survey method to measure impact on practitioners of HIV/AIDS skill-building workshops offered in seven midwestern states. Surveys were sent to 2,949 participants from 230 workshops 4-6 weeks after each workshop. Of those surveyed, 631 respondents provided usable data (22.4%). Self-reported narrative responses described practice changes attributed to training. Changes were categorized as (a) practitioner attitude/knowledge, (b) practitioner practice behavior, (c) planning system change, and (d) implemented adaptations to the clinical care system. Other outcome measures were attending more programs and consulting with colleagues. Change was reported by 341 (54.0%) individuals, with a total of 411 change events/activities documented. Of the change events, 302 (73%) related to changes in health provider practices and 109 (27%) related to the care systems. Findings from this evaluation project provide evidence that MATEC workshops do impact practitioners' behaviors and care systems consistent with the literature about translating research into practice.

Ecotaxes allow the internalization of costs that are considered externalities associated with polluting industrial process emissions to the atmosphere. In this paper, ecotaxes internalize polluting emissions negative impacts that are added to electricity and steam generated costs of a steam turbine and heat recovery systems from a utilities refinery plant. Steam costs were calculated by means of an exergy analysis tool and Aspen Plus simulation models. Ecotaxes were calculated for specific substances emitted in the refinery flue gases, based on a toxicity and pollution scale. Ecotaxes were generated from a model that includes damages produced to biotic and abiotic resources and considers the relative position of those substances in a toxicity and pollution scale. These ecotaxes were internalized by an exergoeconomic analysis resulting in an increase in the cost per kWh produced. This kind of ecotax is not applied in Mexico. The values of ecotaxes used in the cost determination are referred to the values currently applied by some European countries to nitrogen oxides emissions.

The exergy analysis method was applied in order to evaluate the new combined cycle proposed by Goswami [Solar thermal technology: present status and ideas for the future. Energy Sources 1998;20:137–45], using Hasan–Goswami–Vijayaraghavan parameters. This new combined cycle was proposed to produce both power and cooling simultaneously with only one heat source and using ammonia–water mixture as the working fluid. The simulation of the cycle was carried out in the process simulator ASPEN Plus. The Redlich–Kwong–Soave equation of state was used to calculate the thermodynamic properties. The cycle was simulated as a reversible as well as an irreversible process to clearly show the effect of the irreversibilities in each component of the cycle. At the irreversible process two cases were considered, changing the environmental temperature. However, in order to know the performance of the new cycle at different conditions of operation, the second irreversible case was analyzed varying the rectification temperatures, the isentropic efficiency of the turbine and the return temperature of the chilled water. Exergy effectiveness values of ∼53% and ∼51% were obtained for the irreversible cycles; with heat input requirements at temperatures of 125 and 150 °C. Solar collectors or waste heat are suggested as heat sources to operate the cycle.

The combined distillation unit is the first plant in a crude oil refinery, in which several intermediate products, i.e. liquid petroleum gas (LPG), naphtha, jet fuel, kerosene, diesel fuel, gas oils and reduced crude, are obtained through atmospheric and vacuum distillation of the crude oil mixture. It is important to determine the critical points in the unit from the exergy view point and to properly allocate the total production cost to the different simultaneously produced streams, to determine the monetary flows all through the plant, and to state the relevance in economic terms of the exergy losses of each individual equipment item. The results of the exergy and exergoeconomic analyses are presented in this paper. The most important factor affecting the transformation, operation and production costs of the products is the cost of the crude oil raw material; utilities, salaries, maintenance and even capital investment costs are less important. Also the critical points of the plant are presented which provide the basis for the optimization of the unit showing additional opportunities for process integration.

Diabatic distillation is a separation process in which heat is transferred on the trays inside the column as opposed to classical adiabatic columns where heat is only supplied to the reboiler and extracted from the condenser. Such diabatic columns dramatically reduce the exergy needed to perform the separation. One implementation, particularly suitable for retrofitting applications, uses a single heating fluid circulating in series from one tray to the next below the feed tray and a single cooling fluid circulating in series above the feed tray. The optimal design of these sequential heat exchangers, minimizing the overall rate of entropy production in the separation process, is a difficult optimization problem because traditional algorithms for optimization invariably get stuck. However, an algorithm based on physical intuition for adjusting the temperature profile can find the optimum. The resulting column operation is compared to the optimal operation with independent heat transfer to each tray (the co...

This paper presents the results of a detailed exergy analysis of a tertiary amyl methyl ether (TAME) unit of a crude oil refinery and the application of diabatic distillation to the depentanizer tower of the unit. Diabatic distillation is a separation process in which heat is not only supplied to the reboiler and extracted from the condenser [as in a conventional (adiabatic) distillation column], but is also transferred inside the column. The process enables operation to approach equilibrium conditions, thus reducing exergy losses and increasing exergy effectiveness. In a TAME unit of a refinery, isoamylenes are converted to TAME. Before transforming the isoamylenes in the reactors, it is necessary to recover them from a catalytic gasoline stream by a depentanization process. The exergy losses of this depentanization process represent about 70% of the total exergy losses of the unit. The results of the exergy analysis of the TAME unit are presented and a detailed exergy analysis of the conventional adiabatic depentanizer column is conducted for comparison purposes. Then, the application of diabatic distillation to the system is evaluated by using cooling water circulating in series from tray to tray in the rectification section and by making the steam emanating from the reboiler circulate in series from tray to tray in the stripping section. The results in terms of the reduction of exergy losses, heating and cooling media flow rates, and cost effectiveness of the diabatic option for the depentanizer section of the plant are compared to the original adiabatic system, and the effect of the diabatization on the overall exergy performance parameters of the depentanizer section and on the whole TAME unit, are presented in this paper.

In this paper, the past, present and future applications of the exergy concept in applied process research, development and engineering projects in the petroleum refining and petrochemical industry, conducted at the Mexican Petroleum Institute (IMP), are described. These applications are the result of a clear recognition of the challenge represented by the reduction of energy degradation, i.e. the application of the second law of thermodynamics, through the exergy concept, which allows to simultaneously consider the three E's model: energy-economy-ecology. Applications can be grouped in two complementary directions: the first, methodological, direction consists in integrating within general simulation, analysis and optimization programs, the subroutines required to conduct exergy analyses, in order to get in a quick and precise manner, all information required to integrally optimize chemical processes through detailed exergoeconomic and exergoecologic studies. The second direction refers to research and technological development of specific systems and processes, integrally optimum, of which the justification lies on the exergy analysis, i.e. on its capacity to simultaneously consider energy, economy and ecology aspects, such as diabatic distillation, absorption heat pumps, coking-gasification-combined cycle co- and tri-generation, fuel cells, etc. Utilisation de l'analyse exergetique pour optimiser la conception d'unite de reformage du naphta des raffineries Tula et Salina Cruz (Mexique), de colonne de ditillation, de pompe a chaleur a absorption, d'unite a cycle integre de cokefaction du petrole et de gazeification du coke produit et pour l'utilisation de pile a combustible dans des raffineries. Ce type d'analyse permet d'optimiser la conception, le fonctionnement ou l'utilisation de dispositifs energetiques du point de vue des performances techniques, du cout et de l'impact sur l'environnement.