Urban development modifies lake food webs in the Pacific Northwest

Thesis (Master's)--University of Washington, 2015

Constrained Consumption Shifting Management in the Distributed Energy Resources Scheduling Considering Demand Response

Demand response concept has been gaining increasing importance while the success of several recent implementations makes this resource benefits unquestionable. This happens in a power systems operation environment that also considers an intensive use of distributed generation. However, more adequate approaches and models are needed in order to address the small size consumers and producers aggregation, while taking into account these resources goals. The present paper focuses on the demand response programs and distributed generation resources management by a Virtual Power Player that optimally aims to minimize its operation costs taking the consumption shifting constraints into account. The impact of the consumption shifting in the distributed generation resources schedule is also considered. The methodology is applied to three scenarios based on 218 consumers and 4 types of distributed generation, in a time frame of 96 periods.

Economic Evaluation of Ticagrelor for Secondary Prevention Following Acute Coronary Syndromes

INTRODUCTION AND OBJECTIVES: To estimate the cost-effectiveness and cost-utility of ticagrelor in the treatment of patients with acute coronary syndromes (unstable angina or myocardial infarction with or without ST-segment elevation), including patients treated medically and those undergoing percutaneous coronary intervention or coronary artery bypass grafting. METHODS: A short-term decision tree and a long-term Markov model were used to simulate the evolution of patients' life-cycles. Clinical effectiveness data were collected from the PLATO trial and resource use data were obtained from the Hospital de Santa Marta database, disease-related group legislation and the literature. RESULTS: Ticagrelor provides increases of 0.1276 life years and 0.1106 quality-adjusted life years (QALYs) per patient. From a societal perspective these clinical gains entail an increase in expenditure of €610. Thus the incremental cost per life year saved is €4780 and the incremental cost per QALY is €5517. CONCLUSIONS: The simulation results show that ticagrelor reduces events compared to clopidogrel. The costs of ticagrelor are partially offset by lower costs arising from events prevented. The use of ticagrelor in clinical practice is therefore cost-effective compared to generic clopidogrel.

Cost-Effectiveness of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation in Portugal

INTRODUCTION AND OBJECTIVES:Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. METHODS: A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). RESULTS:Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. CONCLUSIONS:Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.

Enmalle de los recursos costeros con uso del zumbador en Pacasmayo

pesca a bordo de embarcaciones artesanales utilizando redes de enmalle con diferentes tamaños de malla y zumbadores, para la pesca de los principales recursos comerciales costeros (coco, lorna, pintadilla, cachema). Las redes de enmalle operadas en forma lineal se calaron entre 4 y 8 minutos, reposo de 2:39 a 4:45 horas y cobrado de 10 a 28 minutos; las operadas en forma semicircular se calaron entre 5 a 6 minutos, reposo de 6 a 16 minutos y cobrado de 31 a 46 minutos. Se capturó un total de 179 kg, entre coco (126 kg), cachema (20 kg), pintadilla (9 kg), lorna (5 kg) y otros (19 kg). Los mayores índices de CPUE para el coco registrado en las diferentes zonas de pesca correspondió a 975 kg/h en Milagros y 275 kg/h en Puémape; esta captura, estuvo conformada principalmente por juveniles.

Framework for middleware executed on mobile devices

Die ubiquitäre Datenverarbeitung ist ein attraktives Forschungsgebiet des vergangenen und aktuellen Jahrzehnts. Es handelt von unaufdringlicher Unterstützung von Menschen in ihren alltäglichen Aufgaben durch Rechner. Diese Unterstützung wird durch die Allgegenwärtigkeit von Rechnern ermöglicht die sich spontan zu verteilten Kommunikationsnetzwerken zusammen finden, um Informationen auszutauschen und zu verarbeiten. Umgebende Intelligenz ist eine Anwendung der ubiquitären Datenverarbeitung und eine strategische Forschungsrichtung der Information Society Technology der Europäischen Union. Das Ziel der umbebenden Intelligenz ist komfortableres und sichereres Leben. Verteilte Kommunikationsnetzwerke für die ubiquitäre Datenverarbeitung charakterisieren sich durch Heterogenität der verwendeten Rechner. Diese reichen von Kleinstrechnern, eingebettet in Gegenstände des täglichen Gebrauchs, bis hin zu leistungsfähigen Großrechnern. Die Rechner verbinden sich spontan über kabellose Netzwerktechnologien wie wireless local area networks (WLAN), Bluetooth, oder UMTS. Die Heterogenität verkompliziert die Entwicklung und den Aufbau von verteilten Kommunikationsnetzwerken. Middleware ist eine Software Technologie um Komplexität durch Abstraktion zu einer homogenen Schicht zu reduzieren. Middleware bietet eine einheitliche Sicht auf die durch sie abstrahierten Ressourcen, Funktionalitäten, und Rechner. Verteilte Kommunikationsnetzwerke für die ubiquitäre Datenverarbeitung sind durch die spontane Verbindung von Rechnern gekennzeichnet. Klassische Middleware geht davon aus, dass Rechner dauerhaft miteinander in Kommunikationsbeziehungen stehen. Das Konzept der dienstorienterten Architektur ermöglicht die Entwicklung von Middleware die auch spontane Verbindungen zwischen Rechnern erlaubt. Die Funktionalität von Middleware ist dabei durch Dienste realisiert, die unabhängige Software-Einheiten darstellen. Das Wireless World Research Forum beschreibt Dienste die zukünftige Middleware beinhalten sollte. Diese Dienste werden von einer Ausführungsumgebung beherbergt. Jedoch gibt es noch keine Definitionen wie sich eine solche Ausführungsumgebung ausprägen und welchen Funktionsumfang sie haben muss. Diese Arbeit trägt zu Aspekten der Middleware-Entwicklung für verteilte Kommunikationsnetzwerke in der ubiquitären Datenverarbeitung bei. Der Schwerpunkt liegt auf Middleware und Grundlagentechnologien. Die Beiträge liegen als Konzepte und Ideen für die Entwicklung von Middleware vor. Sie decken die Bereiche Dienstfindung, Dienstaktualisierung, sowie Verträge zwischen Diensten ab. Sie sind in einem Rahmenwerk bereit gestellt, welches auf die Entwicklung von Middleware optimiert ist. Dieses Rahmenwerk, Framework for Applications in Mobile Environments (FAME²) genannt, beinhaltet Richtlinien, eine Definition einer Ausführungsumgebung, sowie Unterstützung für verschiedene Zugriffskontrollmechanismen um Middleware vor unerlaubter Benutzung zu schützen. Das Leistungsspektrum der Ausführungsumgebung von FAME² umfasst: • minimale Ressourcenbenutzung, um auch auf Rechnern mit wenigen Ressourcen, wie z.B. Mobiltelefone und Kleinstrechnern, nutzbar zu sein • Unterstützung für die Anpassung von Middleware durch Änderung der enthaltenen Dienste während die Middleware ausgeführt wird • eine offene Schnittstelle um praktisch jede existierende Lösung für das Finden von Diensten zu verwenden • und eine Möglichkeit der Aktualisierung von Diensten zu deren Laufzeit um damit Fehlerbereinigende, optimierende, und anpassende Wartungsarbeiten an Diensten durchführen zu können Eine begleitende Arbeit ist das Extensible Constraint Framework (ECF), welches Design by Contract (DbC) im Rahmen von FAME² nutzbar macht. DbC ist eine Technologie um Verträge zwischen Diensten zu formulieren und damit die Qualität von Software zu erhöhen. ECF erlaubt das aushandeln sowie die Optimierung von solchen Verträgen.

Uncover the Concealed Link: Gender & Ethnicity-Divided Local Knowledge on the Agro-Ecosystem of a Forest Margin

This research is a study about knowledge interface that aims to analyse knowledge discontinuities, the dynamic and emergent characters of struggles and interactions within gender system and ethnicity differences. The cacao boom phenomenon in Central Sulawesi is the main context for a changing of social relations of production, especially when the mode of production has shifted or is still underway from subsistence to petty commodity production. This agrarian change is not only about a change of relationship and practice, but, as my previous research has shown, also about the shift of knowledge domination, because knowledge construes social practice in a dialectical process. Agroecological knowledge is accumulated through interaction, practice and experience. At the same time the knowledge gained from new practices and experiences changes mode of interaction, so such processes provide the arena where an interface of knowledge is manifested. In the process of agro-ecological knowledge interface, gender and ethnic group interactions materialise in the decision-making of production and resource allocation at the household and community level. At this point, power/knowledge is interplayed to gain authority in decision-making. When authority dominates, power encounters resistance, whereas the dominant power and its resistance are aimed to ensure socio-economic security. Eventually, the process of struggle can be identified through the pattern of resource utilisation as a realisation of production decision-making. Such processes are varied from one community to another, and therefore, it shows uniqueness and commonalities, especially when it is placed in a context of shifting mode of production. The focus is placed on actors: men and women in their institutional and cultural setting, including the role of development agents. The inquiry is informed by 4 major questions: 1) How do women and men acquire, disseminate, and utilise their agro ecological knowledge, specifically in rice farming as a subsistence commodity, as well as in cacao farming as a petty commodity? How and why do such mechanisms construct different knowledge domains between two genders? How does the knowledge mechanism apply in different ethnics? What are the implications for gender and ethnicity based relation of production? ; 2) Using the concept of valued knowledge in a shifting mode of production context: is there any knowledge that dominates others? How does the process of domination occur and why? Is there any form of struggle, strategies, negotiation, and compromise over this domination? How do these processes take place at a household as well as community level? How does it relate to production decision-making? ; 3) Putting the previous questions in two communities with a different point of arrival on a path of agricultural commercialisation, how do the processes of struggle vary? What are the bases of the commonalities and peculiarities in both communities?; 4) How the decisions of production affect rice field - cacao plantation - forest utilisation in the two villages? How does that triangle of resource use reflect the constellation of local knowledge in those two communities? What is the implication of this knowledge constellation for the cacao-rice-forest agroecosystem in the forest margin area? Employing a qualitative approach as the main method of inquiry, indepth and dialogic interviews, participant observer role, and document review are used to gather information. A small survey and children’s writing competition are supplementary to this data collection method. The later two methods are aimed to give wider information on household decision making and perception toward the forest. It was found that local knowledge, particularly knowledge pertaining to rice-forest-cacao agroecology is divided according to gender and ethnicity. This constellation places a process of decision-making as ‘the arena of interface’ between feminine and masculine knowledge, as well as between dominant and less dominant ethnic groups. Transition from subsistence to a commercial mode of production is a context that frames a process where knowledge about cacao commodity is valued higher than rice. Market mechanism, as an external power, defines valued knowledge. Valued knowledge defines the dominant knowledge holder, and decision. Therefore, cacao cultivation becomes a dominant practice. Its existence sacrifices the presence of rice field and the forest. Knowledge about rice production and forest ecosystem exist, but is less valued. So it is unable to challenge the domination of cacao. Various forms of struggles - within gender an ethnicity context - to resist cacao domination are an expression of unequal knowledge possession. Knowledge inequality implies to unequal access to withdraw benefit from market valued crop. When unequal knowledge fails to construct a negotiated field or struggles fail to reveal ‘marginal’ decision, e.g. intensification instead of cacao expansion to the forest, interface only produces divergence. Gender and ethnicity divided knowledge is unabridged, since negotiation is unable to produce new knowledge that accommodates both interests. Rice is loaded by ecological interest to conserve the forest, while cacao is driven by economic interest to increase welfare status. The implication of this unmediated dominant knowledge of cacao production is the construction of access; access to the forest, mainly to withdraw its economic benefit by eliminating its ecological benefit. Then, access to cacao as the social relationship of production to acquire cacao knowledge; lastly, access to defend sustainable benefit from cacao by expansion. ‘Socio-economic Security’ is defined by Access. The convergence of rice and cacao knowledge, however, should be made possible across gender and ethnicity, not only for the sake of forest conservation as the insurance of ecological security, but also for community’s socio-economic security. The convergence might be found in a range of alternative ways to conduct cacao sustainable production, from agroforestry system to intensification.

Horizontal nutrient fluxes and production efficiencies in urban and peri-urban crop and livestock husbandry of Niamey, Niger

Urban and peri-urban agriculture (UPA) increasingly supplies food and non-food values to the rapidly growing West African cities. However, little is known about the resource use efficiencies in West African small-scale UPA crop and livestock production systems, and about the benefits that urban producers and retailers obtain from the cultivation and sale of UPA products. To contribute to filling this gap of knowledge, the studies comprising this doctoral thesis determined nutrient use efficiencies in representative urban crop and livestock production system in Niamey, Niger, and investigated potential health risks for consumers. Also assessed was the economic efficiency of urban farming activities. The field study, which was conducted during November 2005 to January 2008, quantified management-related horizontal nutrient flows in 10 vegetable gardens, 9 millet fields and 13 cattle and small ruminant production units. These farms, selected on the basis of a preceding study, represented the diversity of UPA crop and livestock production systems in Niamey. Based on the management intensity, the market orientation and especially the nutrient input to individual gardens and fields, these were categorized as high or low input systems. In the livestock study, high and low input cattle and small ruminant units were differentiated based on the amounts of total feed dry matter offered daily to the animals at the homestead. Additionally, economic returns to gardeners and market retailers cultivating and selling amaranth, lettuce, cabbage and tomato - four highly appreciated vegetables in Niamey were determined during a 6-months survey in forty gardens and five markets. For vegetable gardens and millet fields, significant differences in partial horizontal nutrient balances were determined for both management intensities. Per hectare, average annual partial balances for carbon (C), nitrogen (N), phosphorus (P) and potassium (K) amounted to 9936 kg C, 1133 kg N, 223 kg P and 312 kg K in high input vegetable gardens as opposed to 9580 kg C, 290 kg N, 125 kg P and 351 kg K in low input gardens. These surpluses were mainly explained by heavy use of mineral fertilizers and animal manure to which irrigation with nutrient rich wastewater added. In high input millet fields, annual surpluses of 259 kg C ha-1, 126 kg N ha-1, 20 kg P ha-1 and 0.4 kg K ha-1 were determined. Surpluses of 12 kg C ha-1, 17 kg N ha-1, and deficits of -3 kg P ha-1 and -3 kg K ha-1 were determined for low input millet fields. Here, carbon and nutrient inputs predominantly originated from livestock manure application through corralling of sheep, goats and cattle. In the livestock enterprises, N, P and K supplied by forages offered at the farm exceeded the animals’ requirements for maintenance and growth in high and low input sheep/goat as well as cattle units. The highest average growth rate determined in high input sheep/goat units was 104 g d-1 during the cool dry season, while a maximum average gain of 70 g d-1 was determined for low input sheep/goat units during the hot dry season. In low as well as in high input cattle units, animals lost weight during the hot dry season, and gained weight during the cool dry season. In all livestock units, conversion efficiencies for feeds offered at the homestead were rather poor, ranging from 13 to 42 kg dry matter (DM) per kg live weight gain (LWG) in cattle and from 16 to 43 kg DM kg-1 LWG in sheep/goats, pointing to a substantial waste of feeds and nutrients. The economic assessment of the production of four high value vegetables pointed to a low efficiency of N and P use in amaranth and lettuce production, causing low economic returns for these crops compared to tomato and cabbage to which inexpensive animal manure was applied. The net profit of market retailers depended on the type of vegetable marketed. In addition it depended on marketplace for amaranth and lettuce, and on season and marketplace for cabbage and tomato. Analysis of faecal pathogens in lettuce irrigated with river water and fertilized with animal manure indicated a substantial contamination by Salmonella spp. with 7.2 x 104 colony forming units (CFU) per 25 g of produce fresh matter, while counts of Escherichia coli averaged 3.9 x 104 CFU g-1. In lettuce irrigated with wastewater, Salmonella counts averaged 9.8 x 104 CFU 25 g-1 and E. coli counts were 0.6 x 104 CFU g-1; these values exceeded the tolerable contamination levels in vegetables of 10 CFU g-1 for E. coli and of 0 CFU 25 g-1 for Salmonella. Taken together, the results of this study indicate that Niamey’s UPA enterprises put environmental safety at risk since excess inputs of N, P and K to crop and livestock production units favour N volatilisation and groundwater pollution by nutrient leaching. However, more detailed studies are needed to corroborate these indications. Farmers’ revenues could be significantly increased if nutrient use efficiency in the different production (sub)systems was improved by better matching nutrient supply through fertilizers and feeds with the actual nutrient demands of plants and animals.

Socio-economic characterization of integrated cropping systems in urban and peri-urban agriculture of Faisalabad, Pakistan

Faisalabad city is surrounded by agricultural lands, where farmers are growing vegetables, grain crops, and fodder for auto-consumption and local marketing. To study the socioeconomic impact and resource use in these urban and peri-urban agricultural production (UPA) systems, a baseline survey was conducted during 2009–2010. A total of 140 households were selected using a stratified sampling method and interviewed with a structured questionnaire. The results revealed that 96 % of the households rely on agriculture as their main occupation. Thirty percent of the households were owners of the land and the rest cultivated either rented or sharecropped land. Most of the families (70 %) were headed by a member with primary education, and only 10 % of the household head had a secondary school certificate. Irrigationwater was obtained from waste water (37 %), canals (27 %), and mixed alternative sources (36 %). A total of 35 species were cultivated in the UPA systems of which were 65% vegetables, 15% grain and fodder crops, and 5% medicinal plants. Fifty-nine percent of the households cultivated wheat, mostly for auto-consumption. The 51 % of the respondents grew cauliflower (Brassica oleracea L.) and gourds (Cucurbitaceae) in the winter and summer seasons, respectively. Group marketing was uncommon and most of the farmers sold their produce at the farm gate (45 %) and on local markets (43 %). Seeds and fertilizers were available from commission agents and dealers on a credit basis with the obligation to pay by harvested produce. A major problem reported by the UPA farmers of Faisalabad was the scarcity of high quality irrigation water, especially during the hot dry summer months, in addition to lacking adequate quantities of mineral fertilizers and other inputs during sowing time. Half of the respondents estimated their daily income to be less than 1.25 US$ and spent almost half of it on food. Monthly average household income and expenses were 334 and 237 US$, respectively.

Interrelatedness of grazing livestock with vegetation parameters and farmers’ livelihoods in the Mahafaly region, southwestern Madagascar

The study aims to get deeper insight into the highly extensive system of animal husbandry in the Mahafaly region of southwestern Madagascar. It tries to understand the major drivers for pastoral dynamics, land and resource use along a gradient in altitude and vegetation to consider the area’s high spatial and temporal heterogeneity. The study also analyzes the reproductive performance of local livestock as well as the owners’ culling strategies to determine herd dynamics, opportunities for economic growth, and future potential for rural development. Across seasons, plateau herds from both livestock species covered longer distances (cattle 13.6±3.02 km, goats 12.3±3.48 km) and were found further away from the settlements (cattle 3.1±0.96 km, goats 2.8±0.98 km) than those from the coastal plain (walking_dist: cattle 9.5±3.25 km, goats 9.2±2.57 km; max_dist: cattle 2.6±1.28 km, goats 1.8±0.61 km). Transhumant cattle were detected more vulnerable through limited access to pasture land and water resources compared to local herds. Seasonal water shortage has been confirmed as a key constraint on the plateau while livestock keeping along the coast is more limited by dry season forage availability. However, recent security issues and land use conflicts with local crop farmers are gaining importance and force livestock owners to adapt their traditional grazing management, resulting in spatio-temporal variation of livestock numbers and in the impending risk of local overgrazing and degradation of rangelands. Among the 133 plant species consumed by livestock, 13 were determined of major importance for the animals’ nutrition. The nutritive value and digestibility of the natural forage, as well as its abundance in the coastal zone, substantially decreased over the course of the dry season and emphasized the importance of supplementary forage plants, in particular Euphorbia stenoclada. At the same time, an unsustainable utilization and overexploitation of its wild stocks may raise the pressure on the vegetation and pasture resources within the nearby Tsimanampetsotsa National Park. Age at first parturition was 40.5±0.59 months for cattle and 21.3±0.63 months for goats. Both species showed long parturition intervals (cattle 24.2±0.48 months, goats 12.4±0.30 months), mostly due to the maintenance of poorly performing breeding females within the herds. Reported offspring mortality, however, was low with 2.5% of cattle and 18.8% of goats dying before reaching maturity. The analysis of economic information revealed higher than expected market dynamics, especially for zebus, resulting in annual contribution margins of 33 € per cattle unit and 11 € per goat unit. The application of the PRY Herd Life model to simulate herd development for present management and two alternate scenarios confirmed the economic profitability of the current livestock system and showed potential for further productive and economic development. However, this might be clearly limited by the region’s restricted carrying capacity. Summarizing, this study illustrates the highly extensive and resources-driven character of the livestock system in the Mahafaly region, with herd mobility being a central element to cope with seasonal shortages in forage and water. But additional key drivers and external factors are gaining importance and increasingly affect migration decisions and grazing management. This leads to an increased risk of local overgrazing and overexploitation of natural pasture resources and intensifies the tension between pastoral and conservation interests. At the same time, it hampers the region’s agronomic development, which has not yet been fully exploited. The situation therefore demonstrates the need for practical improvement suggestions and implication measures, such as the systematic forestation of supplemental forage plant species in the coastal zone or a stronger integration of animal husbandry and crop production, to sustain the traditional livestock system without compromising peoples’ livelihoods while at the same time minimizing the pastoral impact on the area’s unique nature and environment.

Ayer mineros, hoy eco-guías y concesionarios: tensiones en torno a la conservación ambiental, el uso de la tierra y el trabajo en Guasca, Cundinamarca

En Guasca, Cundinamarca, se han configurado cambios profundos en el uso de los recursos naturales y el trabajo. En la misma área donde operó una mina de cal a cielo abierto por más de sesenta años, hoy en día existe una reserva biológica. Este proceso ha conllevado transformaciones y negociaciones entre las formas locales de uso de los recursos naturales y los usos propuestos por la conservación ambiental. Por su parte, el trabajo en la vereda se ha visto afectado por el cambio reciente en el usufructo de los recursos ambientales y las precariedades económicas del agro en Colombia. El argumento central de este texto es que la declaratoria de áreas protegidas privadas, como práctica suscrita al discurso ambientalista global, más que un proceso neutro, es una fuente de tensión constante entre pobladores locales y administradores de las zonas de conservación ecológica por cuenta del manejo territorial y ambiental, el entendimiento del uso de los recursos naturales y la naturaleza, la propiedad, el empleo y la descentralización del poder estatal. Así las cosas, este trabajo se preocupa por analizar las tensiones e implicaciones que supone la declaratoria de áreas protegidas para las poblaciones locales, en particular en su economía, trabajo y formas de apropiarse de la naturaleza y sus recursos.

Diferencias en costo efectividad del cuidado paliativo domiciliario frente a la atención convencional hospitalaria para el manejo de enfermedades crónicas en fase terminal

En Colombia la dinámica poblacional ha experimentado cambios a través de los años; lo cual modifica las características epidemiológicas y los perfiles de morbimortalidad de la población, aumentando la incidencia y prevalencia de enfermedades crónicas de difícil pronóstico dentro de la población; siendo estos grupos etarios hacía quienes deben destinarse nuevas modalidades de atención y soporte paliativo. Se realizó una revisión sistemática de diversos artículos, clasificados con niveles de evidencia I y II; cuyas variables de análisis fueron: El lugar de fallecimiento del paciente, alivio de la sintomatología, nivel de satisfacción del paciente y sus cuidadores con los servicios recibidos, número de ingresos hospitalarios independientemente de la causa y días promedio de estancia hospitalaria. El 88% de los pacientes que fueron vinculados a la atención domiciliaria falleció en su hogar; el 68% refirió haber experimentado disminución en la intensidad de al menos 2 síntomas como resultado de la atención en casa. El nivel de satisfacción para el cuidado en casa puntuó 19 puntos porcentuales por encima de la calificación que obtuvo el manejo hospitalario. El 23% de los pacientes tratados en su hogar, requirió al menos una hospitalización durante el manejo; mostrando una disminución en el tiempo de estancia hospitalaria de 3.4 días promedio. El manejo paliativo domiciliario de pacientes crónicos en fase terminal, no sólo es una alternativa en la reducción de costos para el sistema de salud, sino que es un factor protector de tipo emocional que refleja también una importante disminución de los riesgos de la hospitalización.

Desenlaces clínicos del cuidado perioperatorio de reemplazos articulares según grupos relacionados de diagnóstico en un hospital de cuarto nivel

Introducción Los Grupos Relacionados de Diagnóstico (GRD) se han usado para determinar la calidad de la atención en varios sistemas de salud. Esto ha llevado a que se obtengan resultados en el mejoramiento continuo de la atención y del cuidado. El objetivo de este estudio es determinar desenlaces clínicos de los pacientes a quienes se les había realizado reemplazo de articulares según la complejidad clínica definida mediante GRD. Métodos Se realizó un estudio longitudinal descriptivo en el cual se incluyeron todos los pacientes que tuvieron cirugía de reemplazo total de hombro, cadera y rodilla entre 2012 y 2014. Se realizó la estratificación de los pacientes de acuerdo a tres niveles de complejidad dados por el sistema de GRD y se determinaron las proporciones de pacientes para las variables de estancia hospitalaria, enfermedad trombo-embólica, cardiovascular e infección del sitio operatorio. Resultados Se realizaron en total 886 reemplazos articulares de los cuales 40 (4.5%) presentaron complicaciones. Los eventos más frecuentes fueron las complicaciones coronarias, con una presencia de 2.4%. El GRD1, sin complicaciones ni comorbilidades, fue el que presentó mayor número de eventos. La estancia hospitalaria fue de 3.8 a 9.3 días para todos los reemplazos. Conclusiones Contrario a lo planteado en la hipótesis de estudio, se encontró que el primer GRD presentó el mayor número de complicaciones, lo que puede estar relacionado con el tamaño del grupo. Es necesario realizar nuevas investigaciones que soporten el uso de los GRD como herramienta para evaluar desenlaces clínicos.

Gobernanza Ambiental en América Latina: hacia una agenda de investigación integradora (Tema Central)

América Latina juega un papel importante en relación con la Gobernanza Ambiental. El conocimiento generado por estudios empíricos y teóricos sobre los desafíos ambientales del presente pueden apoyar los renovados esfuerzos de la región por alcanzar un uso de los recursos naturales que sea equitativo y sustentable. A pesar de que los vínculos entre las dimensiones social y ambiental han sido explorados por la academia desde los años noventa, las nuevas tendencias de la Gobernanza Ambiental en América Latina requieren una aproximación analítica comprehensiva. Los autores argumentan que, a fin de potenciar las “perspectivas latinoamericanas” para la solución de los dilemas socioambientales, algunas corrientes de investigación deben juntarse en marcos analíticos integradores que puedan generar complejas preguntas relacionadas con las interacciones a múltiples niveles entre Estado, sociedad civil y actores de mercado.

The population dynamical consequences of density-dependence in fungal plant pathogens

Almost all stages of a plant pathogen life cycle are potentially density dependent. At small scales and short time spans appropriate to a single-pathogen individual, density dependence can be extremely strong, mediated both by simple resource use, changes in the host due to defence reactions and signals between fungal individuals. In most cases, the consequences are a rise in reproductive rate as the pathogen becomes rarer, and consequently stabilisation of the population dynamics; however, at very low density reproduction may become inefficient, either because it is co-operative or because heterothallic fungi do not form sexual spores. The consequence will be historically determined distributions. On a medium scale, appropriate for example to several generations of a host plant, the factors already mentioned remain important but specialist natural enemies may also start to affect the dynamics detectably. This could in theory lead to complex (e.g. chaotic) dynamics, but in practice heterogeneity of habitat and host is likely to smooth the extreme relationships and make for more stable, though still very variable, dynamics. On longer temporal and longer spatial scales evolutionary responses by both host and pathogen are likely to become important, producing patterns which ultimately depend on the strength of interactions at smaller scales.