Hipotensión arterial y variabilidad de la frecuencia cardiaca en pacientes embarazadas llevadas a cesarea bajo anestesia raquídea

INTRODUCCION La hipotensión arterial por anestesia raquídea en embarazadas llevadas a cesárea es frecuente y deletérea para la madre y el feto, sin que a la fecha exista una herramienta clínicamente útil para predecirla. La variabilidad de la frecuencia cardiaca es una medida que estima la actividad del sistema nervioso autónomo y algunos estudio iniciales indican una posible utilidad como herramienta predictiva de hipotensión arterial en esta población. METODOLOGIA Se realizó un estudio observacional descriptivo para examinar el comportamiento de la variabilidad de la frecuencia cardiaca, medida como razón de Baja frecuencia/Alta frecuencia, con un punto de corte de 2.5 tomada con un reloj POLAR RS800CX, en una población de pacientes con embarazo a término llevadas a cesárea, en un hospital de tercer nivel en Bogotá- Colombia entre Febrero y Abril del 2015. RESULTADOS El estudio incluyó 82 pacientes. Se determinó que la razón Baja frecuencia/Alta frecuencia mayor a 2,5 era poco frecuente en nuestra población (15.85%), y su asociación no fue significativa. DISCUSION El presente estudio demostró que la asociación entre la presencia de hipotensión y un índice Baja frecuencia/Alta frecuencia con punto de corte de 2.5 no es significativo para nuestra población de mujeres con embarazo a término llevadas a cesárea con anestesia espinal. Según los resultados se sugieres un punto de corte de 1.6 como punto de partida para la realización de nuevos estudios que permitan validar este valor.

The EU societal awareness of landscape indicator: a review of its meaning, utility and performance across different scales

There is increasing recognition that agricultural landscapes meet multiple societal needs and demands beyond provision of economic and environmental goods and services. Accordingly, there have been significant calls for the inclusion of societal, amenity and cultural values in agri-environmental landscape indicators to assist policy makers in monitoring the wider impacts of land-based policies. However, capturing the amenity and cultural values that rural agrarian areas provide, by use of such indicators, presents significant challenges. The EU social awareness of landscape indicator represents a new class of generalized social indicator using a top-down methodology to capture the social dimensions of landscape without reference to the specific structural and cultural characteristics of individual landscapes. This paper reviews this indicator in the context of existing agri-environmental indicators and their differing design concepts. Using a stakeholder consultation approach in five case study regions, the potential and limitations of the indicator are evaluated, with a particular focus on its perceived meaning, utility and performance in the context of different user groups and at different geographical scales. This analysis supplements previous EU-wide assessments, through regional scale assessment of the limitations and potentialities of the indicator and the need for further data collection. The evaluation finds that the perceived meaning of the indicator does not vary with scale, but in common with all mapped indicators, the usefulness of the indicator, to different user groups, does change with scale of presentation. This indicator is viewed as most useful when presented at the scale of governance at which end users operate. The relevance of the different sub-components of the indicator are also found to vary across regions.

TOWARD SEMANTIC WEB SERVICES AS MVC APPLICATIONS: FROM OWL-S VIA UML

OWL-S is an application of OWL, the Web Ontology Language, that describes the semantics of Web Services so that their discovery, selection, invocation and composition can be automated. The research literature reports the use of UML diagrams for the automatic generation of Semantic Web Service descriptions in OWL-S. This paper demonstrates a higher level of automation by generating complete complete Web applications from OWL-S descriptions that have themselves been generated from UML. Previously, we proposed an approach for processing OWL-S descriptions in order to produce MVC-based skeletons for Web applications. The OWL-S ontology undergoes a series of transformations in order to generate a Model-View-Controller application implemented by a combination of Java Beans, JSP, and Servlets code, respectively. In this paper, we show in detail the documents produced at each processing step. We highlight the connections between OWL-S specifications and executable code in the various Java dialects and show the Web interfaces that result from this process.

Improving data perturbation testing techniques for Web services

The widespread use of service-oriented architectures (SOAs) and Web services in commercial software requires the adoption of development techniques to ensure the quality of Web services. Testing techniques and tools concern quality and play a critical role in accomplishing quality of SOA based systems. Existing techniques and tools for traditional systems are not appropriate to these new systems, making the development of Web services testing techniques and tools required. This article presents new testing techniques to automatically generate a set of test cases and data for Web services. The techniques presented here explore data perturbation of Web services messages upon data types, integrity and consistency. To support these techniques, a tool (GenAutoWS) was developed and applied to real problems. (C) 2010 Elsevier Inc. All rights reserved.

Insurance services in multi-agent systems

In a multi-agent environment, there is often the need for an agent to cooperate with others so as to ensure that a given task is achieved timely and cost-effectively. Present agent systems currently maximizes this through mechanisms such as trust and risk assessments. In this paper, we extend this mechanism by introducing the concept of insurance, in which the insurance agents act as a bridge between agents who require resources from others. Unlike traditional systems, agents purchase insurance so as to guarantee to have the requested resources during the task execution time and thus minimize the risk in task failure. The novelty of this proposal is that it ensures agents continuously to exchange resources and to seek maximum expected utility in a dynamic environment at the same time. Our experimental results confirm the feasibility of our approach.

The utility of the trans-theoretical model of behavior change in the treatment of sex offenders

This paper discusses the use of the Trans-theoretical Model of Behavior Change in the treatment of sex offenders. Constructs within this theory are the Stages of Change, Processes of Change and Decisional Balance. The first section of this paper provides a brief description of these constructs. The second section provides a brief review of research related to these constructs and discusses the implications of this research in relation to the treatment of sex offenders. The third section of this paper provides a practical description of the use of the constructs of the Trans-theoretical Model of Behaviour Change in the treatment of sex offenders. Although the validity of this model among sex offenders requires further investigation, the Trans-theoretical Model of Behavior Change appears to have considerable utility as an overarching theoretical model to conceptualize and facilitate behavior change among sex offenders.

Integrating insurance services, trust and risk mechanisms into multi-agent systems

In multi-agent systems, there is often the need for an agent to cooperate with others so as to ensure that a given task is achieved timely and cost effectively. Currently multi-agent systems maximize this through mechanisms such as coalition formation, trust and risk assessments, etc. In this paper, we incorporate the concept of insurance with trust and risk mechanisms in multi-agent systems. The novelty of this proposal is that it ensures continuous sharing of resources while encouraging expected utility to be maximized in a dynamic environment. Our experimental results confirm the feasibility of our approach.

Not the same : a comparison of female and male clients seeking treatment from problem gambling counselling services

Previous studies of problem gamblers portray this group as being almost exclusively male. However, this study demonstrates that females comprised 46% of the population (n = 1,520) of persons who sought assistance due to concerns about their gambling from the publicly-funded BreakEven counselling services in the state of Victoria, Australia, in one 12-month period. This suggests that the model of service delivery which is community based counselling on a non-residential basis may be better able to attract female clients than treatment centres where males predominate such as veterans centres. A comparative analysis of the social and demographic characteristics of female and male gamblers within the study population was undertaken. As with previous studies, we have found significant differences between males and females who have sought help for problems associated with their gambling. Gender differences revealed in this study include females being far more likely to use electronic gaming machines (91.1% vs. 61.4%), older (39.6 years vs. 36.1 years), more likely to be born in Australia (79.4% vs. 74.7%), to be married (42.8% vs. 30.2%), living with family (78.9% vs. 61.5%) and to have dependent children (48.4% vs. 35.7%), than males who present at these services. Female gamblers (A$7,342) reported average gambling debts of less than half of that owed by males (A$19,091). These gender differences have implications for the development and conduct of problem gambling counselling services as it cannot be assumed that models of service which have demonstrated effectiveness with males will be similarly effective with females.

Economic evaluation of Australian stroke services: a prospective, multicenter study comparing dedicated stroke units with other care modalities

Background and Purpose: Level I evidence from randomized controlled trials demonstrates that the model of hospital care influences stroke outcomes; however, the economic evaluation of such is limited. An economic appraisal of 3 acute stroke care models was facilitated through the Stroke Care Outcomes: Providing Effective Services (SCOPES) study in Melbourne, Australia. The aim was to describe resource use up to 28 weeks poststroke for each model and examine the cost-effectiveness of stroke care units (SCUs). Methods: A prospective, multicenter, cohort study design was used. Costs and outcomes of stroke patients receiving 100% treatment in 1 of 3 inpatient care models (SCUs, mobile service, conventional care) were compared. Health-sector resource use up to 28 weeks was measured in 1999. Outcomes were thorough adherence to a suite of important clinical processes and the number of severe inpatient complications. Results: The sample comprised 395 participants (mean age 73 [SD 14], 77% first-ever strokes, males 53%). When compared with conventional care (n=84), costs for mobile service (n=209) were significantly higher (P=0.024), but borderline for SCU (n=102, P=0.08; $AUD12 251; $AUD15 903; $AUD15 383 respectively). This was primarily explained by the greater use of specialist medical services. The incremental cost-effectiveness of SCUs over conventional care was $AUD9867 per patient achieving thorough adherence to clinical processes and $AUD16 372 per patient with severe complications avoided, based on costs to 28 weeks. Conclusions: Although acute SCU costs are generally higher, they are more cost-effective than either mobile service or conventional care.

Extending social marketing to emergency services organisations

Social marketing theory is examined in relation to an organisational context which has received little attention. This paper examines the development of an integrated social marketing campaign for a State Emergency Service, and focusses on a particularly serious scenario where the penalty for miscommunication may be death, widespead injury or substantial property damage. The researchers take an action research approach, identifying community perceptions of risk to determine appropriate communication message development. The study identifies the factors contributing to risk perception beyond traditional concepts of involvement which are common in studies of consumer behaviour. Additionally, this paper provides an investigation of some of the issues that affect communication effectiveness, such as the influence of stakeholders, the poor performance of traditional communications methods, the utility of social marketing principles, and segmentation requirements, as well as influential ideas from the general risk communication literature.

The robustness of the behavioural-intentions battery in services scenarios

The consensus among researchers is that loyalty is a very complex construct (Javalgi & Moberg 1997). Various typologies have been developed to measure the loyalty construct (e.g., Curassi and Kennedy 2002; Hoare 2000; Knox 1998; Zeithaml, Parasuraman & Berry 1996). Zeithaml, Berry & Parasuraman (1996) developed a service loyalty framework comprising 13 items across five dimensions: “loyalty”, “switch”, “pay more”, “external responses”, and “internal responses”. This framework was criticised by Bloemer, de Ruyter & Wetzels (1999) for having conceptual and empirical limitations. Upon re-examination of the same 13 items, they concluded that the loyalty construct comprised only four factors: “word-of-mouth”, “purchase intentions”, “price sensitivity”, and “complaining behaviour”. Questions remain as to the precise dimensionality of the service loyalty construct as proposed by Zeithaml, Parasuraman & Berry (1996), and its stability or robustness generically, i.e., to what extent is there an invariant factor structure across the range of marketing contexts to which the battery may be applied? This paper reports on the testing of the goodness-of-fit of the five and fourfactor models to data collected in a study of consumer reaction to the service supplied by an Australian Internet Service Provider (ISP), through a series of hypothetical scenarios. In addition, comparisons were conducted with the results of exploratory factor analyses of the eight scenarios. The results suggested that factor structures are unstable across the data subsets, thereby limiting the generalisability and utility of the proposed models.

A set of patterns for the web-based interfaces of an employee services system

The provision of Human Resource (HR), especially payroll, is a core function in every organization. Previously, providers of HR/payroll have offered their services to their clients via conventional modes of communication, such as telephones, facsimile, and courier services. In recent years, with the advent of the Internet and the emergence of web-based electronic commerce, there has been a rise in the adoption of web-based technology and information
systems by service providers, thereby enabling them to interact with their clients through this medium. This development necessitates the use of web-based user interfaces as workspaces between the HR/payroll providers and their clients, and thus, raises certain concerns that determine the effectiveness of web-based workflow systems. These concerns, related to the use of web interfaces, form the basis of the patterns discussed in this paper

Managing academic support for international students: the appropriateness of a learning support unit in an Australian tertiary institution

The higher education environment in Australia has undergone a radical change since the 1980s with the phenomenal increase in the intake of international students, particularly from what are referred to as Confucian Heritage Cultures (CHC): China, Korea, Japan, Malaysia and Singapore. Students from these countries view the Australian higher education system very favourably. The present increase in the proportion of full-fee paying students at Australian universities is also a result of decreasing government funding to the Australian higher education sector, which has now risen to be one of the most important elements of the Australian economy. These push-pull factors have drawn more Australian tertiary institution providers into the market place, as they seek more international student enrolments for their domestic campuses and also establish campuses overseas. Potential higher education students are becoming more discerning in their choices and are choosing learning environments that offers them both relevant and stimulating educational experiences and good qualifications, along with a range of both IT and academic support services that cater to their individual learning needs. Increasing competition, both within Australia and internationally, calls for a focus on student satisfaction in order to sustain the existence of the providers. This paper addresses the issue of what international students seek in terms of academic support and demonstrates that present levels of cost efficient services by Australian higher education providers, generally characterized by IT and language support services, are inadequate and do not meet the specific needs of the students.

Promoting community capacity through university-community engagement: the Deakin University / Department of Human Services (Barwon South West) Partnership

The formal Partnership between Deakin University and the Victorian Department of Human Services (Barwon-South Western Region), based in Geelong, aims to bring together the knowledge, experience and resources of the Department and Deakin University for the benefit of the people living in that region, as well as for the mutual benefit of both organisations. A recent review process featured stakeholder interviews and focus groups. A special workshop on university-community engagement was also held for interested stakeholders in late 2006. This was facilitated by Prof. Judith Ramaley, President of Winona State University, during her visit to Deakin University as a Fulbright Visiting Senior Specialist. Visioning and strategic planing have continued throughout 2007.

This paper will describe the efforts and achievements of the Partnership through the complementary lenses of Healthy Cities, health-promoting universities and community capacity. This framework will be used to describe how the Partnership coordinators have used Prof Ramaley’s insights to establish a draft Business Plan that espouses a more mature form of collaboration and embraces shared, transformative goals. The paper will describe how the notion of community capacity is being used to evaluate the Partnership’s overall contribution to community engagement.