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يضم كتاب \"المتسول وقصص أخرى\" اثنى عشرة نص لم ينشر من قبل للكاتب والشاعر فرناندو بيسوا، تشكل جزءا يسيرا من النثر التخيلي الذي تركه الكاتب. إنها قصص فلسفية أو فكرية -كمْ يسميها بيسوا نفسه- ومفارقة لأن الحالات التي تقدمها تتعارض مع الحس المشترك، بعضها على شكل حكايات ذات مغزى، وأخرى ذات شكل مختلف. ‎تقدم هذه القصص حوارات فلسفية على لسان حكماء يتخذون وجوها مختلفة وأقنعة متعددة، كالمتسول والزاهد والسكير، ويعرضون حكمتهم على من يصادفهم في الطريق، طريق التعلم وتكوين الذات. مثلا، قد يكون طريق السالك الذي يصادف رجلا ذا ملابس سوداء، أو طريق ذلك البحار الذي يحاور شخصا غريبا على رصيف الميناء. ‎تعرض هذه النصوص السردية وجها مختلفا عن بيسوا، وقد تدهش القارئ بعمقها الفلسفي وجرأتها في طرح المواضيع المختلفة التي كانت تشغل الكاتب.

High-dose alcohol misuse induces multiple noxious cardiac effects, including myocyte hypertrophy and necrosis, interstitial fibrosis, decreased ventricular contraction and ventricle enlargement. These effects produce diastolic and systolic ventricular dysfunction leading to congestive heart failure, arrhythmias and an increased death rate. There are multiple, dose-dependent, synchronic and synergistic mechanisms of alcohol-induced cardiac damage. Ethanol alters membrane permeability and composition, interferes with receptors and intracellular transients, induces oxidative, metabolic and energy damage, decreases protein synthesis, excitation-contraction coupling and increases cell apoptosis. In addition, ethanol decreases myocyte protective and repair mechanisms and their regeneration. Although there are diverse different strategies to directly target alcohol-induced heart damage, they are partially effective, and can only be used as support medication in a multidisciplinary approach. Alcohol abstinence is the preferred goal, but control drinking is useful in alcohol-addicted subjects not able to abstain. Correction of nutrition, ionic and vitamin deficiencies and control of alcohol-related systemic organ damage are compulsory. Recently, several growth factors (myostatin, IGF-1, leptin, ghrelin, miRNA, and ROCK inhibitors) and new cardiomyokines such as FGF21 have been described to regulate cardiac plasticity and decrease cardiac damage, improving cardiac repair mechanisms, and they are promising agents in this field. New potential therapeutic targets aim to control oxidative damage, myocyte hypertrophy, interstitial fibrosis and persistent apoptosis In addition, stem-cell therapy may improve myocyte regeneration. However, these strategies are not yet approved for clinical use.

Waste-to-energy (WtE) processes, or the combustion of refuse-derived fuel (RDF) for energy generation, has the potential to reduce landfill volume while providing a renewable energy source. We aimed to systematically review and summarise current evidence on the potential health effects (benefits and risks) of exposure to WtE/RDF-related combustion emissions. We searched PubMed and Google Scholar using terms related to health and WtE/RDF combustion emissions, following PRISMA guidelines. Two authors independently screened titles, abstracts and then full-texts of original, peer-reviewed research articles published until 20th March 2020, plus their relevant references. Overall quality of included epidemiological studies were rated using an amended Navigation framework. We found 19 articles from 269 search results that met our inclusion criteria, including two epidemiological studies, five environmental monitoring studies, seven health impact or risk assessments (HIA/HRA), and five life-cycle assessments. We found a dearth of health studies related to the impacts of exposure to WtE emissions. The limited evidence suggests that well-designed and operated WtE facilities using sorted feedstock (RDF) are critical to reduce potential adverse health (cancer and non-cancer) impacts, due to lower hazardous combustion-related emissions, compared to landfill or unsorted incineration. Poorly fed WtE facilities may emit concentrated toxins with serious potential health risks, such as dioxins/furans and heavy metals; these toxins may remain problematic in bottom ash as a combustion by-product. Most modelling studies estimate that electricity (per unit) generated from WtE generally emits less health-relevant air pollutants (also less greenhouse gases) than from combustion of fossil fuels (e.g. coal). Some modelled estimates vary due to model sensitivity for type of waste processed, model inputs used, and facility operational conditions. We conclude that rigorous assessment (e.g. HRA including sensitivity analyses) of WtE facility/technological characteristics and refuse type used is necessary when planning/proposing facilities to protect human health as the technology is adopted worldwide.

Introduction: The aging of the population and the increase in chronic patients represent a huge challenge for the sustainability of all healthcare systems. The Basque governance has dedicates time and resources to tackle this problem. One of the initiatives is represented by the Basque Health Service´s integrated intervention for multimorbid population program within ACT@Scale project. Theory/Methods: The program follows the multi-organizational structured collaborative quality improvement methods based on Plan-Do-Study-Act (PDSA) cycle.  Applying the PDSA methodology, the latest achievements have been: Create a scorecard to evaluate the care pathway effectiveness Generate training sessions on several aspects related to the care pathway Results: Scorecard definition Dimensions 1- Resources 2- Services 3- Care Integration 4- Effectiveness 5- Safety 6- Equality 7- Efficiency ImplementationDesign of on-line staff training programs in: 1- Patients Empowerment program, Kronik-On 2- Risk Stratification approach and tools Discussions: The program is already up and running in Osakidetza. These new achievements will facilitate the coverage of almost 15000 patients by the end of 2019. We believe these new results will promote the scaling-up of the program and, at the same time, it will help measure and evaluate the process effectiveness. A central engine will help in data storage and extraction. Conclusions: The team has defined and described the indicators necessary to periodically evaluate the care pathway effectiveness. This scorecard is a result of a broad consensus among Osakidetza’s healthcare professionals. The training program has been realized taking into account the healthcare professionals needs and structured according to Osakidetza Department of education’s guidelines. Lessons learned: In order to obtain sustainable results it is important to take into account: Specific organizational peculiarity The stakeholder’s needs The implementation has to be simple Limitations: Indicators need to be tested and eventually reshaped in six months/one year. The Integrated program management system is not fully operative yet. Suggestions for future research: The multimorbid program has been deployed in all local organizations. With these new tools we will be able to evaluate the effectiveness of it and we will provide health professionals will the suitable information/training to perform their daily activity within the program. We will need to study the results of this program in six months/one year, and possibly tune the indicators accordingly.

Objective To compare the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DWI) and frozen-section analysis in assessing myometrial invasion in endometrial cancer to guide surgery. Methods In this prospective study, 51 women with diagnosed endometrial cancer were examined using magnetic resonance imaging (MRI) and subsequently underwent hysterectomy with intraoperative frozen-section assessment. The MRI protocol included T2-weighted images (T2WI), a dynamic T1-weighted post-gadolinium series, and DWI sequences acquired with b values of 0, 150, and 800 s/mm 2 . Apparent diffusion coefficient (ADC) maps were obtained in all the studies. Deep myometrial invasion was defined as involvement of ≥50% of the thickness of the myometrium. The final postoperative pathological evaluation was considered as the reference standard. Results The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of DWI for detecting deep invasion of the myometrium were 90.2%, 77.8%, 97%, 93.3%, and 88.9%, respectively. For the intraoperative frozen section, these figures were 90.2%, 73.7%, 100%, 100%, and 86.5%. The precision for both tests was the same using McNemar’s test ( p  = 1). Conclusion In assessing the depth of myometrial invasion, ADC maps show the same accuracy as intraoperative histological studies in endometrial cancers. They also allow for a more precise assessment than conventional MRI sequences. Frozen-section analysis can be avoided if the preoperative MRI study includes DWI sequences and ADC maps.

Introduction: Basque Health Service´s integrated intervention for multimorbid population program participates to ACT@Scale. The aging of the population and the increase in chronic patients represent a huge challenge for the sustainability of healthcare systems.Short description of practice change implemented: The public healthcare provider is Osakidetza which includes all hospitals and primary care centers organized in 13 Integrated Care Organizations ICOs.Osakidetza has a target population of more than 2 million inhabitants.Aging and chronic conditions account for 80% of the medical consultations, 75% of the total health budget.Aim and theory of change: the program follows the multi-organizational structured collaborative quality improvement methods based on Plan-Do-Study-ActPDSA cycle.Applying the PDSA methodology, the program has been working on:Define a common integrated care pathwayClarify the necessary actors and rolesStandardize and systematize the process of empowering patients and caregivers and assess the empowerment impactEvaluate the care pathway effectivenessTraining sessions on several aspects related to the care pathwayTargeted population and stakeholders: Population based stratification identifyes Multimorbid patients. Moreover, at least two of these conditions must be diagnosed: Chronic Obstructive Pulmonary Disease COPD, diabetes mellitus both insulin-dependent and noninsulin-dependent or Congestive Heart Failure CHF.Stakeholders 34: team dynamics experts-3; internists -6; implementation experts-2; managerial team-12; Healthcare Directorate representative-1; project manager-1; local organizations representatives-9.Timeline: Three years: Baseline phase-March’16-Sept’16; Learning cycle-Sept’16-Sept’17; Coaching cycle-Sept’17-Sept’18; Dissemination phase-Sept’18-March’19Comments on sustainability: Osakidetza runs on public founding. Multimorbid patient’s care pathway is one of the priority areas of the strategic plan that the Health Department and Osakidetza have for 2017-2020.Comments on transferability: Scale it up to a total of 12 ICOs, which in terms of number of patients means from 4944 to 14516 patients.Conclusions: The team has defined and described the roles and actions needed within the integrated care, and it has created a homogeneous pathway for multimorbid patient’s integrated care. The team has tackle down the problematic of patient empowerment. The team has been able to generate an empowerment protocol for patients/caregivers and an empowerment evaluation method has been established.Discussions: The expected result of Basque Country is to scale the program and reaching a total of almost 15000 patients by 2019. This would mean:1- Impacting: reach critical-mass in numbers of users within the region; reduce in resources utilization2- Engaging: get the endorsement of end-users and professionals; increase empowerment of patients and caregivers; equality of the service offered3 Ensuring sustainability: increase the number of professionals using the service as their usual practice; the generated pathway takes into account the local resources available and the local differences in terms of organizational structure.Lessons learned: In order to achieve our aim we consider that one of the most important factors has been to build a multidisciplinary team, composed by stakeholders of distinct levels macro, meso and micro with varied roles and representatives of all organizations where the intervention was expected to be implemented. In addition, the Collaborative Methodology gave the opportunity to define the intervention needed in a structured way.

Globally, and nationally in Australia, bushfires are expected to increase in frequency and intensity due to climate change. To date, protection of human health from fire smoke has largely relied on individual-level actions. Recent bushfires experienced during the Australian summer of 2019–2020 occurred over a prolonged period and encompassed far larger geographical areas than previously experienced, resulting in extreme levels of smoke for extended periods of time. This particular bushfire season resulted in highly challenging conditions, where many people were unable to protect themselves from smoke exposures. The Centre for Air pollution, energy and health Research (CAR), an Australian research centre, hosted a two-day symposium, Landscape Fire Smoke: Protecting health in an era of escalating fire risk, on 8 and 9 October 2020. One component of the symposium was a dedicated panel discussion where invited experts were asked to examine alternative policy settings for protecting health from fire smoke hazards with specific reference to interventions to minimise exposure, protection of outdoor workers, and current systems for communicating health risk. This paper documents the proceedings of the expert panel and participant discussion held during the workshop.