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One's attitude toward and fear of death in the nursing field can determine the quality of care that a dying patient receives, which makes this topic an important one to consider and discuss. It is necessary for one to learn to perceive death as a natural process. Healthcare workers treat dying patients, interpreting the phenomenon of death as well as death itself through their own personal lens and breadth of understanding. Training in thanatology and palliative care is scarcely and irregularly included in regular academic curricula. The objective of this study is to analyze the contributions of 3rd-year nursing students on the subject of palliative care upon writing a reflective journal entry about an article that surrounds a nurse's view on the process of dying. Phenomenology was used as a methodological instrument which intended to inductively draw up a standardized explanation of the phenomenon of death through the students' expressed thoughts on the matter. Relating to the attitudes that nurses that work with the terminally ill have towards death, the following facts stand out as impactful: lack of preparation, ineffective coping, and personal fears, values, and beliefs. Additionally, uneasiness associated with the use of life support and the care team's obstinate insistence on saving what cannot be saved is predominant. The results emphasize a very elevated level of the nurse's emotional involvement in caring for a dying patient. Specific preparation geared toward a better adaptation in working with terminal patients has been identified as a fundamental pillar for nurses in this line of work. Personal interest and emphasis on occupational excellence also stand out as influential factors. It is very important to analyze the problems regarding this "environment of death" and its impact on nursing students. Qualitative research in this field could be a useful tool in detecting worries and uncertainties surrounding this matter. [ABSTRACT FROM AUTHOR]

The water retention curve (θ(ψ)), which defines the relationship between soil volumetric water content (θ) and matric potential (ψ), is of paramount importance in characterizing the hydraulic behaviour of soils. However, few methods are so far available for estimating θ(ψ) in undisturbed soil samples. We present a new design of TDR-pressure cell (TDR-Cell) for estimating θ(ψ) in undisturbed soil samples. The TDR-Cell consists of a 50-mm-long and 50-mm internal diameter stainless steel cylinder (which constitutes the outer frame of a coaxial line) attached to a porous ceramic disc and closed at the ends with two aluminium lids. A 49-mm-long and 3-mm-diameter stainless steel rod, which runs longitudinally through the centre of the cylinder, constitutes the inner rod of a coaxial TDR probe. The TDR-Cell was used to determine the θ(ψ) curves of a packed sand and seven undisturbed soil samples from three profiles of agricultural soils. These θ(ψ) curves were subsequently compared to those obtained from the corresponding 2-mm sieved soils using the pressure plate method. Measurements of bulk electrical conductivity, σa, as a function of the water content, σa(θ), of the undisturbed soil samples were also performed. An excellent correlation ( R2 = 0·988) was found between the θ values measured by TDR on the different undisturbed soils and the corresponding θ obtained from the soil gravimetric water content. A typical bimodal θ(ψ) function was found for most of the undisturbed soil samples. Comparison between the θ(ψ) curves measured with the TDR-Cell and those obtained from the 2-mm sieved soils showed that the pressure plate method overestimates θ at low ψ values. The σa(θ) relationship was well described by a simple power expression ( R2 > 0·95), in which the power factor, defined as tortuosity, ranged between 1·18 and 3·75. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: Ganser syndrome is a rare medical disorder situated between hysterical etiopathogenesis and psychosis, factitious disorders and organic lesions which results in a difficult diagnosis. It is listed in DSM VI as a dissociative disorder whose main symptom is approximate answers, other accompanying symptoms appearing in Ganser: clouding of consciousness, somatic conversion symptoms and hallucinations. Psychopathologically explains a mental state of escape from a situation difficult to being tolerated. Organically appears in pathologies involving the frontal lobes Objectives: We present a case of a XX year old man who suddenly develops a depressive disorder with no apparent cause. Initially he was a professionally developed man. Famous archaeologist. University professor. Guitarist in a musical group. He deteriorated through the years, appearing dementia data with auditive hallucinations and resistant headache. He begins to have difficulty speaking correctly, with paraphasias and short answers, continually repeating "I don't know", Short-term amnesia and bed-chair life Methods: It was impossible to perform both the Mini-Mental State Examination test and the fototest because the patient refused claiming to be very nervous. The CT and MRI showed a slight temporary atrophy and vascular age changes. Subsequently, PET was performed without notable findings. Antidepressant and anxiolytic treatment was introduced without success as well as treatment for dementia and antipsychotic treatment. Results: The headache was improved. The rest of the symptoms did not disappear Conclusions: Ganser syndrome is a psychiatric condition that is difficult to diagnose and treat. [ABSTRACT FROM AUTHOR]

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Long fallowing (16 to 17 months), in the cereal/fallow rotation, may favor soil losses by wind erosion in agricultural soils of semiarid Aragon (NE Spain). With the objective of evaluating the risk of wind erosion in this area, soil losses for the most critical period of fallow (February-April) were estimated from a total of 67 fallow fields by using the Wind Erosion Equation (WEQ). All soils were medium textured, with this loam the most frequent textural class (45%). The CaCO3 content in the soil was higher than 200 g kg-1 in 90% of the fields. Mouldboard plough, chisel plough, and disk harrow were the main primary tillage tools used by farmers during fallow. Soil cover by crop residues was negligible (< 1%) in 76% of the fields, and only 20% tilling was done perpendicularly to dominant wind direction. The highest erodibility values corresponded to soils with a sandy loam texture and traditionally tilled with mouldboard plough. Predicted wind erosion was high to very high in 30% of the fields (> 20 Mg ha-1). The WEQ estimated erosion reductions to tolerable levels if reduced tillage, with chiseling as the primary tillage, is adequately adopted in the dryland cereal production areas of semiarid Aragon. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the impact of Staphylococcus aureus phenotype (vancomycin MIC) and genotype (agr group, clonal complex CC) on the prognosis and clinical characteristics of infective endocarditis (IE)., Methods: We performed a multicentre, longitudinal, prospective, observational study (June 2013 to March 2016) in 15 Spanish hospitals. Two hundred and thirteen consecutive adults (≥18 years) with a definite diagnosis of S. aureus IE were included. Primary outcome was death during hospital stay. Main secondary end points were persistent bacteraemia, sepsis/septic shock, peripheral embolism and osteoarticular involvement., Results: Overall in-hospital mortality was 37% (n = 72). Independent risk factors for death were age-adjusted Charlson co-morbidity index (OR 1.20; 95% CI 1.08-1.34), congestive heart failure (OR 3.60; 95% CI 1.72-7.50), symptomatic central nervous system complication (OR 3.17; 95% CI 1.41-7.11) and severe sepsis/septic shock (OR 4.41; 95% CI 2.18-8.96). In the subgroup of methicillin-susceptible S. aureus IE (n = 173), independent risk factors for death were the age-adjusted Charlson co-morbidity index (OR 1.17; 95% CI 1.03-1.31), congestive heart failure (OR 3.39; 95% CI 1.51-7.64), new conduction abnormality (OR 4.42; 95% CI 1.27-15.34), severe sepsis/septic shock (OR 5.76; 95% CI 2.57-12.89) and agr group III (OR 0.27; 0.10-0.75). Vancomycin MIC ≥1.5 mg/L was not independently associated with death during hospital nor was it related to secondary end points. No other genotype variables were independently associated with in-hospital death., Conclusions: This is the first prospective study to assess the impact of S. aureus phenotype and genotype. Phenotype and genotype provided no additional predictive value beyond conventional clinical characteristics. No evidence was found to justify therapeutic decisions based on vancomycin MIC for either methicillin-resistant or methicillin-susceptible S. aureus., (Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Infective endocarditis (IE) caused by anaerobic bacteria is a rare and poorly characterized disease. Most data reported in the literature are from case reports [1-3]. Therefore, we assessed the situation of anaerobic IE (AIE) in Spain using the database of the Spanish Collaboration on Endocarditis (GAMES)., Methods: We performed a prospective study from 2008 to 2016 in 26 Spanish centers. We included 2491 consecutive cases of definite IE (Duke criteria)., Results: Anaerobic bacteria caused 22 cases (0.9%) of definite IE. Median age was 66 years (IQR, 56-73), and 19 (86.4%) patients were men. Most patients (14 [63.6%]) had prosthetic valve IE and all episodes were left-sided: aortic valves, 12 (54.5%); and mitral valves, 8 (36.4%). The most common pathogens were Propionibacterium acnes (14 [63.6%]), Lactobacillus spp (3 [13.63%]), and Clostridium spp. (2 [9.0%]), and the infection was mainly odontogenic. Fifteen of the 22 patients (68.2%) underwent cardiac surgery. Mortality was 18.2% during admission and 5.5% after 1 year of follow-up. When patients with AIE were compared with the rest of the cohort, we found that although those with AIE had a similar age and Charlson comorbidity index, they were more likely to have community-acquired IE (86.4% vs. 60.9%, p = 0.01), have undergone cardiac surgery (68.2% vs 48.7% p = 0.06), and have had lower mortality rates during admission (18.2% vs. 27.3%)., Conclusion: IE due to anaerobic bacteria is an uncommon disease that affects mainly prosthetic valves and frequently requires surgery. Otherwise, there are no major differences between AIE and IE caused by other microorganisms., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This research refers to the case study of a patient, a male college student, who was given psychotherapeutic care. Initially, the patient self-referral to the Mental Health area, which is a service permanently offered by the Autonomous University of the State of Mexico, through the Research Center in Medical Sciences (CICMED). The process of the case allowed analyzing the administrative procedure that operates in the CICMED and the process between this and the educational establishment in which the patient studied.

Summary Objective: To evaluate the current trends in the clinical characteristics and the prognosis of Streptococcus agalactiae infective endocarditis (IE), uncommon disease associated with high mortality., Methods: Descriptive analysis of 27 cases of a large cohort (961 episodes) of infective endocarditis collected in seven hospitals of Andalusia (Spain) between 1984 and 2008., Results: Native valves were affected in most cases (85. 2%), multiple valves were frequently involved (22.2%). The median age of the patients was 65 (51-76) years (59.3% men), with a comorbidity, according to the Charlson index, of 2.6+/-2.3. The most frequent underlying diseases were diabetes mellitus (25.9%), chronic obstructive pulmonary disease (14.8%), neoplasms (14.8%), urological disorders (11%) and chronic liver disease (11%). Clinical presentation was characterized by rapid worsening (median of 9 (5.7-15) days from onset of symptoms until diagnosis), a high rate of embolisms (37%) and cardiac complications (abscesses, fistulas or valve rupture) - 37% of cases. Surgery was performed in 12 patients (44.4%) and a high mortality (40.7%) was observed., Conclusion: S. agalactiae IE is a serious disease with aggressive course and high mortality rate and affects patients with debilitating diseases. We must be alert of the development of complications and consider early valve surgery when it is necessary., (Copyright (c) 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.)

Little is known about survival and clinical prognostic factors in females with chronic obstructive pulmonary disease (COPD). The aim of the present study was to determine the survival difference between males and females with COPD and to compare the value of the different prognostic factors for the disease. In total, 265 females and 272 males with COPD matched at baseline by BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) and American Thoracic Society/European Respiratory Society/Global Initiative of Chronic Obstructive Lung Disease criteria were prospectively followed. Demographics, lung function, St George's Respiratory Questionnaire, BODE index, the components of the BODE index and comorbidity were determined. Survival was documented and sex differences were determined using Kaplan-Meier analysis. The strength of the association of the studied variables with mortality was determined using multivariate and receiver operating curves analysis. All-cause (40 versus 18%) and respiratory mortality (24 versus 10%) were higher in males than females. Multivariate analysis identified the BODE index in females and the BODE index and Charlson comorbidity score in males as the best predictors of mortality. The area under the curve of the BODE index was a better predictor of mortality than the forced expiratory volume in one second for both sexes. At similar chronic obstructive pulmonary disease severity by BODE index and forced expiratory volume in one second, females have significantly better survival than males. For both sexes the BODE index is a better predictor of survival than the forced expiratory volume in one second.

In order to study the importance of two pontine regions modulating laryngeal resistance, electrical current or microinjections of glutamate (10-30 nl, 1-3 nmol) were made into the pontine parabrachial complex and the A5 region in spontaneously breathing anaesthetized rats. Two distinct patterns of laryngeal and respiratory responses were elicited. An increase of subglottal pressure was accompanied with an expiratory facilitatory response consisted of a decrease in both respiratory rate and phrenic nerve activity. A decrease of subglottal pressure was accompanied with an inspiratory facilitatory response consisted of an increase in both respiratory rate and phrenic nerve activity. The modification of laryngeal calibre occurred during both respiratory phases in most cases. The concomitant cardiovascular changes of these responses were also analyzed. Controls using guanethidine to block autonomic responses which might interact with respiratory control were also made. Histological analysis of stimulation sites showed a topographical organization of these responses: laryngeal constriction was evoked from Kölliker-Fuse, medial parabrachial nuclei and A5 region, whilst the laryngeal dilation was evoked from the lateral parabrachial nucleus.

The common bean (Phaseolus vulgaris L.) is cultivated widely in Central and South America and particularly in the Northwest of Argentina. In order to describe the diversity of the common bean nodulating rhizobial population from the bean producing area in Northwest Argentina (NWA), a collection of about 400 isolates of common beans recovered from nodules and soil samples from NWA were characterized by using nifH-PCR, analysis of genes coding for 16S rRNA and nodC, and REP-fingerprinting, respectively. It was found that species Rhizobium etli is predominant in common bean nodules although a high degree of diversity was found within the species. Other bean nodulating genotypes recovered from soils by using Leucaena sp. as the trapping host was found to have the 16S rDNA alleles of species such as Sinorhizobium fredii, Sinorhizobium saheli, Sinorhizobium teranga, Mesorhizobium loti, and Rhizobium tropici. Some of the bean genotypes that were found to be more efficient in green house experiments were selected and assayed in two successive bean-cropping seasons in the field environment in NWA, and an increase in yields with inoculation was found. The performance of strains isolated from the region indicates potential for exploiting the diversity.

Objective: To evaluate the effect of interventions at a highway, in the occurrence and severity of injuries by traffic accidents., Method: It was made a comparative analysis of two cross-sectional studies in 1994 and 1996., Results: In 1994 the rate was 7.96 accidents/ 100,000 vehicles and in 1996 8.49 / 100,000 vehicles. The increase was not significant (p>0.05). The rate of injured drivers in 1994 was of 2.10 / 100,000 vehicles and of 1.35 / 100,000 vehicles in 1996, which was a significant decrease (p<0.000). The self-report of use of seat belt (63.46% versus 76.6%), the small vehicles involved in accidents (7.9% versus 37.7%), nocturnal schedule (23.7% versus 31.8%) and in Mexico-Cuernavaca direction (45% versus 66.7%), were more frequent in 1996 (p<0.05). The risk of injury, using a logistic regression model, between drivers exposed to the interventions (1996) and those that were not exposed (1994) adjusted by: age, speed, use of seat belt, alcohol intake and external cause, showed a protective effect of the interventions at the highway (OR 0.42 CI95% 0.27-0.66)., Conclusion: There is an evident need of multisectorial approaches in the study and evaluation of the interventions in the field of the traffic accidents. The present research is a clear example of the repercussions over health of interventions developed by the transportation sector at the highway.

Objectives: Our aim was to evaluate the validity and reliability of a questionnaire to measure the functional capacity in older people., Design: Observational cross-sectional study., Setting: Community level. Three basic health areas., Participants: 519 individuals over 64 selected by systematic random sampling taking as sampling units a list of household living at least an individual over 64 years., Measurements and Main Results: A new questionnaire was developed starting from the OARS-MFAQ, the CVA. This new questionnaire is shorter but it maintains the same structure. Ten interviews were recorded in a videotape and subsequently analyzed and marked by four different observers to evaluate the inter-observer agreement. To assess the criterion validity the rates of 40 individuals in the CVA were compared with the rates assigned to the same individuals by experts in each area of the questionnaire (physical health, mental health, daily activities, economic resources, and social support). The criterion validity of the version to proxies of CVA (CVA-I) was studied comparing the answers in the CVA of 31 individuals and the answers given in the CVA-I by proxies of the same 31 individuals. The internal consistency in both versions of the questionnaire was studied in 519 individuals, agreement showed values of kappa coefficient between 0.43 and 0.69. Correlation coefficients Interobserver between expert's rates showed values between 0.54 and 0.74. Correlation coefficients between CVA and CVA-I showed values between 0.60 and 0.74 except in the social support dimension (0.16). The Cronbach alpha coefficient were 0.73 for CVA and 0.62 for CVA-I., Conclusions: The CVA questionnaire showed an acceptable validity and reliability except in the social support dimension of the CVA-I.

Background: Assessment of different diagnostic sequences, in patients VIH(+) with a suspected pulmonary infection., Methods: A cross-sectional descriptive study of 76 HIV(+) patients with suspected respiratory infection. It has been determined the validity and the pretest and post-test probability of the radiology (Rx) of thorax, 67Ga pulmonary scintigraphy and seric LDH levels, in order to design four different diagnostic algorithms., Results: The diagnostic sequence Rx-LDH-scintigraphy with normal results involved an infection probability of 58.0%. Pathological Rx with successively normal LDH and scintigraphy, implied a likelihood of 97.0%. The LDH elevation in sequence with scintigraphy and Rx rose to 96.1% if both were abnormal and diminished to 8.3% if normal., Conclusions: The LDH elevation associated with the sequence of normal Rx and scintigraphy suggests a low infection likelihood. On the contrary, associated with pathological Rx and scintigraphy in sequence, practically assures the pulmonary infection.