Forecasting the ecological footprint of G20 countries in the next 30 years.

The Ecological Footprint evaluates the difference between the availability of renewable resources and the extent of human consumption of these resources. Over the past few decades, historical records have shown an accelerated decline in the availability of resources. Based on national footprint and biocapacity accounts, this analysis aims to advance the forecasting of the G20 countries' ecological footprints over a 30-year time frame. We employed a time series forecasting approach implemented in Python, which included-modular regression (Prophet) and Autoregressive Integrated Moving Average (ARIMA & Auto-ARIMA) methods. We evaluated and combined the performance of these three methods. The results indicated that among the largest economies of the G20, only four countries are projected to have a positive ecological footprint balance by 2050. These countries share the common denominator of large land areas and a moderate population growth projection. However, the overall trend of the indicator suggests that it will continue to decline.

Microbial Composition Dynamics in Peloids Used for Spa Procedures in Lithuania: Pilot Study.

Despite peloids' acknowledged therapeutic and cosmetic potential, there remains a limited understanding of their microbial diversity and dynamics, especially concerning beneficial and non-beneficial microorganisms under different heating conditions. Our study employs both cultivation and metagenomic methods to assess the microbiota of peloids, focusing on lake sapropel and peat under heating conditions recommended for external application and safety assurance. By applying microbial indicators specified in national regulatory documents, we found that all peloids reached thresholds for sulphite-reducing clostridia and colony-forming units. Each peloid exhibited a distinctive bacterial composition based on metagenomic analysis, and temperature-induced changes were observed in microbial diversity. We identified beneficial bacteria potentially contributing to the therapeutic properties of peloids. However, the same peloids indicated the presence of bacteria of human faecal origin, with a notably higher abundance of Escherichia coli, pointing to a potential source of contamination. Unfortunately, it remains unclear at which stage this contamination entered the peloids. The findings underscore the importance of monitoring and controlling microbial aspects in peloid applications, emphasising the need for measures to prevent and address contamination during their preparation and application processes.

Responsible Leadership and Affective Organizational Commitment: The Mediating Effect of Corporate Social Responsibility.

Organizations and their leaders are challenged to assume a responsible behavior given the increase of corporate scandals and the deterioration of employee commitment. However, relatively few studies have investigated the impact of responsible leadership (RL) on employee commitment and the effect of corporate social responsibility (CSR) in this relationship. Using the social identity theory this article examined the mediating effect of CSR practices in the relationship between RL and affective organizational commitment (AOC). Data collection was done through a paper survey completed by 309 full-time Colombian employees. Structural equation modeling was used to analyze the data. The results showed that CSR fully mediated the influence of RL on AOC. Thus, RL is an effective mechanism to develop CSR practices that in turn increase the levels of AOC of employees.

Calidad asistencial y percibida en colecistectomía laparoscópica ambulatoria. Consideraciones metodológicas y cuestionarios / Quality of perception and quality of care in ambulatory laparoscopic cholecystectomy. Methodological considerations and questionnaires

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Análisis de la mortalidad expósita de la inclusa de Toledo y sus condicionantes (1900-1930) / Analysis of the mortality experience among the abandoned children in the foundling hospital of Toledo and its determinants (1900-1930)

El objetivo de este trabajo es analizar la mortalidad expósita y sus causas en una cohorte de niños abandonados en la inclusa toledana, aquellos que nacieron en la Maternidad aneja, como grupo homogéneo que partía de unas condiciones de alumbramiento similares y fueron institucionalizados al nacer. Ello permite comparar esta mortalidad expósita con la de otras inclusas españolas y con la mortalidad poblacional, a la vez que explica los distintos factores que pudieron condicionarla (AU)

The aim of this work is to analyze the mortality and its causes in the abandoned children of the Children’s home of Toledo, who were born in the Maternity House, because it was a homogeneous group which had the same conditions in their delivery and they were abandoned at the moment of their birth. It allows us to compare the mortality of this group of foundlings with the mortality of the general population and with the mortality of those abandoned in other Charity Institutions. This paper explains the different factors which could determine the mortality (AU)

Las primeras experiencias en cirugía laparoscópica de colon en España. Valencia, noviembre de 1991 / The first experiences with colorectal laparoscopic surgery in Spain. Valencia, November 1991

El desarrollo de la cirugía laparoscópica de colon en nuestro país ha sido muy rápida desde su comienzo a finales de 1991. La resección de colon y recto por cirugía mínimamente invasiva ha cambiado desde sus inicios la manera de tratar a nuestros enfermos, debido esencialmente a las ventajas a corto plazo sobre la cirugía abierta, por su menor morbimortalidad y mejor calidad de vida con igualdad a largo plazo en los resultados oncológicos. En la enseñanza y difusión de estos conceptos en forma de cursos, estudios aleatorizados, artículos científicos y libros han participado y participan un ingente número de cirujanos españoles que gozan del reconocimiento internacional

The development of laparoscopic colon surgery in Spain has spread quickly since its beginnings at the end of 1991. Colorectal Minimally Invasive Surgery is widely implemented and has changed the way we treat our patients, specially due to the short-term advantages such as lower morbidity with a better quality of life with the same oncological outcomes in the long term. A huge number of Spanish surgeons have contributed to the implementation of techniques and spreading the knowledge of these concepts by means of courses, controlled randomized studies, scientific papers, and books, and have obtained international recognition

Colecistectomía laparoscópica ambulatoria por minilaparoscopia versus colecistectomía laparoscópica ambulatoria multipuerto tradicional. Estudio prospectivo aleatorizado / Ambulatory laparoscopic cholecystectomy by minilaparoscopy versus traditional multiport ambulatory laparoscopic cholecystectomy. Prospective randomized trial

OBJETIVO: Determinar la existencia de diferencias en tasa de ambulatorización, dolor percibido, consumo de analgésicos y recuperación de las actividades de la vida diaria (AVD) en pacientes tratados mediante colecistectomía laparoscópica multipuerto (CLMP) y colecistectomía por minilaparoscopia con material de 3 mm (MLC). MÉTODO: Estudio prospectivo aleatorizado de 40 pacientes consecutivos tratados mediante colecistectomía laparoscópica. Los criterios de pareamiento incluyeron factores ecográficos predictivos de colecistectomía técnicamente dificultosa, historia previa de enfermedad biliar complicada y factores demográficos. Se analizan los resultados en términos de tasa de ambulatorización, dolor percibido, consumo de analgésicos, recuperación de las AVD, grado de dificultad técnica, grado de hemorragia asociada, tasa de ambulatorización, porcentaje de estancia over-night, reingresos y conversión parcial o total. RESULTADOS: Ambos procedimientos mostraron similar duración de intervención, puntuación de dificultad técnica y de hemorragia. La MLC mostró porcentaje similar de ambulatorización (85%) y de estancia over-night(15%), con solo un 15% de conversiones parciales y 0% de conversión a CLMP. La MLC mostró menor dolor postoperatorio (p = 0,026), menor consumo de analgésicos (p = 0,006) con similar recuperación de las AVD (p = 0,879). CONCLUSIONES: La MLC no es inferior a la CLMP en términos de ambulatorización, resultando en menor dolor postoperatorio y menor consumo de analgésicos, con similar resultado en cuanto a reincorporación a las AVD

OBJECTIVE: Difference analysis of ambulatorization rate, pain, analgesic requirements and daily activities recovery in patients undergoing laparoscopic cholecystectomy with standard multiport access (CLMP) versus a minilaparoscopic, 3 mm size, technique. METHODS: Prospective randomized trial of 40 consecutive patients undergoing laparoscopic cholecystectomy. Comparison criteria included predictive ultrasound factors of difficult cholecystectomy, previous history of complicated biliary disease and demographics. Results are analyzed in terms of ambulatorization rate, pain, analgesic requirements, postoperative recovery, technical difficulty, hemorrhage intensity, overnight stay, readmission rate and total or partial conversion. RESULTS: Both procedures were similar in surgery time, technical score and hemorrhage score. MLC was associated with similar ambulatorization rate, 85%, and over-night stay 15%, with only 15% partial conversion rate. MLC showed less postoperative pain (P=.026), less analgesic consumption (P=.006) and similar DAR (P=.879). CONCLUSIONS: MLC is similar to CLMP in terms of ambulatorization with less postoperative pain and analgesic requirements without differences in postoperative recovery

[The first experiences with colorectal laparoscopic surgery in Spain. Valencia, November 1991]. / Las primeras experiencias en cirugía laparoscópica de colon en España. Valencia, noviembre de 1991.

The development of laparoscopic colon surgery in Spain has spread quickly since its beginnings at the end of 1991. Colorectal Minimally Invasive Surgery is widely implemented and has changed the way we treat our patients, specially due to the short-term advantages such as lower morbidity with a better quality of life with the same oncological outcomes in the long term. A huge number of Spanish surgeons have contributed to the implementation of techniques and spreading the knowledge of these concepts by means of courses, controlled randomized studies, scientific papers, and books, and have obtained international recognition.

[Ambulatory laparoscopic cholecystectomy by minilaparoscopy versus traditional multiport ambulatory laparoscopic cholecystectomy. Prospective randomized trial]. / Colecistectomía laparoscópica ambulatoria por minilaparoscopia versus colecistectomía laparoscópica ambulatoria multipuerto tradicional. Estudio prospectivo aleatorizado.

OBJECTIVE: Difference analysis of ambulatorization rate, pain, analgesic requirements and daily activities recovery in patients undergoing laparoscopic cholecystectomy with standard multiport access (CLMP) versus a minilaparoscopic, 3mm size, technique. METHODS: Prospective randomized trial of 40 consecutive patients undergoing laparoscopic cholecystectomy. Comparison criteria included predictive ultrasound factors of difficult cholecystectomy, previous history of complicated biliary disease and demographics. Results are analyzed in terms of ambulatorization rate, pain, analgesic requirements, postoperative recovery, technical difficulty, hemorrhage intensity, overnight stay, readmission rate and total or partial conversion. RESULTS: Both procedures were similar in surgery time, technical score and hemorrhage score. MLC was associated with similar ambulatorization rate, 85%, and over-night stay 15%, with only 15% partial conversion rate. MLC showed less postoperative pain (P=.026), less analgesic consumption (P=.006) and similar DAR (P=.879). CONCLUSIONS: MLC is similar to CLMP in terms of ambulatorization with less postoperative pain and analgesic requirements without differences in postoperative recovery.

Evaluación del gastrointestinal quality of life index como sistema de selección para la priorización de pacientes en lista de espera de colecistectomía laparoscópica / Evaluation of the gastrointestinal quality of life index as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy

Introducción Evaluación prospectiva de la calidad de vida relacionada con la salud (CVRS) mediante el gastrointestinal quality of life index (GIQLI) como sistema de priorización de pacientes en lista de espera para el proceso colecistectomía laparoscópica (CL) y su correlación con un sistema lineal de priorización (SP) desarrollado en el Instituto de Cirugía General y Aparato Digestivo (ICAD) de la Clínica Quirón de Valencia. Material y métodos Un total de 100 pacientes consecutivos a los que se les realizó CL electiva ambulatoria. Principales medidas de resultados 1) repercusión de la enfermedad mediante el GIQLI; 2) evaluación de un sistema objetivo basado en criterios científico-técnicos; 3) evaluación del valor de la CL en términos de CVRS mediante el GIQLI analizando la utilidad esperable y la obtenida en términos de change ratio (CR) y 4) análisis de la correlación entre el sistema objetivo lineal, la CVRS y la utilidad. Resultados El GIQLI es útil en la evaluación de la repercusión. La CL obtiene un beneficio en CVRS significativo en pacientes tanto oligosintomáticos como sintomáticos. Los factores objetivos o clínicos no permiten evaluar la percepción sobre el proceso ni medir o inferir la repercusión en CVRS. Un SP basado en tramos de puntuación del GIQLI permite una selección en función de la utilidad de la CL esperable (deterioro en CVRS) y obtenida (ganancia en CVRS).Conclusiones Un SP debe incluir la utilidad para garantizar la equidad. El GIQLI objetiva la repercusión sobre el paciente mientras que los factores clínicos-objetivos no tienen relación con las expectativas de priorización. Un SP debe incluir ambos a fin de mantener el equilibrio repercusión/adecuada indicación (AU)

Introduction We prospectively evaluated health-related quality of life (HRQoL) through the gastrointestinal quality of life index (GIQLI) as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy (LC) and its correlation with a linear prioritization system developed in the General and Gastrointestinal Surgery Institute of Clínica Quirón in Valencia. Material and methods There were 100 consecutive patients who underwent elective outpatient LC. The main outcome measures consisted of: 1) assessment of the impact of the disease, measured through the GIQLI; 2) evaluation of an objective system based on technical scientific criteria; 3) evaluation of the utility of LC in improving HRQoL through the GIQLI by analyzing expected and obtained utility through the change ratio, and 4) analysis of the correlation between the objective linear system, HRQoL and utility. Results The GIQLI was useful in evaluating the impact of the disease. LC significantly improved HRQoL in both oligosymptomatic and symptomatic patients. The objective or clinical factors did not allow perceptions of the process to be evaluated or the impact on HRQoL to be measured or inferred. A prioritization system based on GIQLI scores allows patients to be selected according to the expected utility (worsening of HRQoL) and obtained utility (improvement in HRQoL) of CL.Conclusions Prioritization systems should include utility to guarantee equity. The GIQLI shows the impact of the disease on the patient while the clinical/objective factors are unrelated to the expectation of prioritization. Prioritization systems should include both elements to maintain the balance between impact and appropriate indication (AU)

Colecistectomía laparoscópica ambulatoria. Estudio de cohortes de 1.600 casos consecutivos / Ambulatory laparoscopic cholecystectomy. A cohort study of 1, 600 consecutive cases

Objetivo Describir la experiencia de nuestro grupo en colecistectomía laparoscópica ambulatoria en una cohorte de 1.600 casos consecutivos realizados en el Instituto de Cirugía y Aparato (CLA) Digestivo (ICAD) en la Clínica Quirón de Valencia durante el período 1997-2010.Pacientes y método Estudio prospectivo, observacional de 1.601 pacientes consecutivos remitidos para colecistectomía laparoscópica, procedentes de la Agencia Valenciana de Salud (AVS) y compañías aseguradoras privadas (CAP).Principales medidas de resultados: se evalúan los resultados con el análisis de índice de sustitución, tasa de ingresos no planeados, reingresos, estancia postoperatoria, duración de intervención y factores demográficos. Resultados El índice de sustitución de la serie fue de 80,8% con un porcentaje de pacientes intervenidos en régimen de estancia over-night (EON) de 13,4% y un porcentaje de ingresos en hospitalización convencional de 4,6%. La mortalidad de la serie fue de 0,13%, 0,08 en el grupo de CLA y 0,5% en el grupo de CL con EON. El índice de reingresos fue de 2,1% en la serie global, 1,6% en los pacientes ambulatorios, 5,4% en los pacientes con EON y 4,2% en los pacientes ingresados. Conclusiones La CLA es un procedimiento seguro y fiable. La reducción en la necesidad de ingreso de los pacientes es fundamental en la optimización coste efectividad del procedimiento de colecistectomía. La CLA debería ser considerada como el patrón oro del tratamiento de la colelitiasis sintomática (AU)

Objective A descriptive analysis of day-case laparoscopic cholecystectomy (ALC) in a cohort of 1,600 consecutive patients performed in Instituto de Cirugía y Aparato Digestivo (ICAD), Clínica Quirón de Valencia in the period 1997-2010.Patients and methods Prospective observational study of 1,601 consecutive patients undergoing elective laparoscopic cholecystectomy (LC) provided by the regional health service and private health companies. Main measures Conversion rate, non-planned admissions, readmissions, surgery duration and demographics. Results ALC was successfully performed in 80.8% of cases. LC with over-night (ON) stay accounted for 13.4% of patients. Admission was necessary in 4.6%. Mortality was 0.13%, 0.08 in ALC and 0.5% in ON LC. Readmissions occurred in 2.1%, 1.6% in ALC group, 5.4% in ON stay and 4.2% in admission group. Conclusions ALC is a reliable and safe procedure. Minimization of admission rates is the key for cost-effective optimization in the management of cholelithiasis. ALC should be considered as the reference standard in gallbladder stone disease treatment (AU)

[Evaluation of the gastrointestinal quality of life index as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy]. / Evaluación del gastrointestinal quality of life index como sistema de selección para la priorización de pacientes en lista de espera de colecistectomía laparoscópica.

INTRODUCTION: We prospectively evaluated health-related quality of life (HRQoL) through the gastrointestinal quality of life index (GIQLI) as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy (LC) and its correlation with a linear prioritization system developed in the General and Gastrointestinal Surgery Institute of Clínica Quirón in Valencia. MATERIAL AND METHODS: There were 100 consecutive patients who underwent elective outpatient LC. The main outcome measures consisted of: 1) assessment of the impact of the disease, measured through the GIQLI; 2) evaluation of an objective system based on technical scientific criteria; 3) evaluation of the utility of LC in improving HRQoL through the GIQLI by analyzing expected and obtained utility through the change ratio, and 4) analysis of the correlation between the objective linear system, HRQoL and utility. RESULTS: The GIQLI was useful in evaluating the impact of the disease. LC significantly improved HRQoL in both oligosymptomatic and symptomatic patients. The objective or clinical factors did not allow perceptions of the process to be evaluated or the impact on HRQoL to be measured or inferred. A prioritization system based on GIQLI scores allows patients to be selected according to the expected utility (worsening of HRQoL) and obtained utility (improvement in HRQoL) of CL. CONCLUSIONS: Prioritization systems should include utility to guarantee equity. The GIQLI shows the impact of the disease on the patient while the clinical/objective factors are unrelated to the expectation of prioritization. Prioritization systems should include both elements to maintain the balance between impact and appropriate indication.

[Ambulatory laparoscopic cholecystectomy. A cohort study of 1,600 consecutive cases]. / Colecistectomía laparoscópica ambulatoria. Estudio de cohortes de 1.600 casos consecutivos.

OBJECTIVE: A descriptive analysis of day-case laparoscopic cholecystectomy (ALC) in a cohort of 1,600 consecutive patients performed in Instituto de Cirugía y Aparato Digestivo (ICAD), Clínica Quirón de Valencia in the period 1997-2010. PATIENTS AND METHODS: Prospective observational study of 1,601 consecutive patients undergoing elective laparoscopic cholecystectomy (LC) provided by the regional health service and private health companies. MAIN MEASURES: Conversion rate, non-planned admissions, readmissions, surgery duration and demographics. RESULTS: ALC was successfully performed in 80.8% of cases. LC with over-night (ON) stay accounted for 13.4% of patients. Admission was necessary in 4.6%. Mortality was 0.13%, 0.08 in ALC and 0.5% in ON LC. Readmissions occurred in 2.1%, 1.6% in ALC group, 5.4% in ON stay and 4.2% in admission group. CONCLUSIONS: ALC is a reliable and safe procedure. Minimization of admission rates is the key for cost-effective optimization in the management of cholelithiasis. ALC should be considered as the reference standard in gallbladder stone disease treatment.

Tumor de la estroma gastrointestinal familiar por mutación en el exón 13 (K642E) del gen KIT / Familial gastrointestinal stroma tumor due to mutation in exon 13 (K642E) of the KIT gene

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Hirsutismo. Un problema estético en adolescentes / Hirsutism. An esthetic problem in adolescents

El hirsutismo tiene una prevalencia del 8% en mujeres en edad reproductiva, con importante repercusión estética en algunos casos. La historia y el examen físico son de vital importancia para la aproximación diagnóstica de estas pacientes. Nuestro reto, además de identificar aquellos casos con enfermedades subyacentes graves, es proporcionar un tratamiento lo más eficaz posible para evitar problemas psicológicos (AU)

Hirsutism has a prevalence of 8% in women of reproductive age, with significant esthetic repercussions in some cases. History and physical examination are of vital importance in the diagnostic work-up of these patients. Our challenge, in addition to identifying those cases with serious underlying disease, is to provide the most effective treatment possible to prevent psychological problems (AU)