Diseño de una propuesta de mejoramiento de la gestión administrativa del hospital el tunal, mediante la aplicación de la filosofía de teoría de restricciones (TOC)

El objetivo de este trabajo es presentar el diseño de un proyecto de mejora a través de la filosofía TOC para la gestión Administrativa del Hospital El Tunal del Nivel III de Bogotá DC, durante el período 2013. Para lograr el objetivo de la propuesta de mejoramiento basada en la filosofía TOC (Inglés siglas Theory of Constraints), se centra en crear un proceso de mejora continua en la gestión administrativa del Hospital El Tunal. Esta entidad es una Empresa Social del Estado y tiene por objeto la prestación de servicios de salud a usuarios que presentan algún tipo de enfermedad o trastorno orgánico que afecta su salud; se centra en mejorar, corregir y proporcionar una mejor calidad de vida al usuario que viene a cubrir sus necesidades de salud. Este producto de investigación terminará con una propuesta centrada en la mejora de la gestión administrativa, basada en la filosofía TOC aplicado a la cartera morosa, tratando de ofrecer una serie de soluciones a los problemas actuales que impactan estas organizaciones centrándose en la mejora continua, la velocidad de flujo de los recursos administrativos, verificando si es eficaz en beneficio de los usuarios y los profesionales de la salud.

Extreme gender biased post-fledging brood division in the toc-toc

The possibility that parents of one sex may preferentially invest in offspring of a certain sex raises profound evolutionary questions about the relative worth of sons and daughters to their mothers and fathers. Post-fledging brood division-in which cacti parent feeds a different subset of offspring-has been well documented in birds. However, a lack of empirical evidence that this may be based oil offspring sex, combined with the theoretical difficulty of explaining such an interaction, has led researchers to consider a gender bias in post-fledging brood division highly unlikely. Here we show that in the toc-toc, Foudia sechellarum, postfledging brood division is extreme and determined by sex; where brood composition allows, male parents exclusively provision male fledglings, whereas female parents provision female fledglings. This is the first study to provide unambiguous evidence, based on molecular sexing, that sex-biased post-fledging brood division can occur in birds. Male and female parents provisioned at the same rate and neither offspring nor parent survival appeared to be affected by the sex of the parent or offspring, respectively. The current hypotheses predicting advantages for brood division and preferential care for one specific type of offspring are discussed in the light of our results.

Heart rate variability is associated with amygdala functional connectivity with MPFC across younger and older adults

The ability to regulate emotion is crucial to promote well-being. Evidence suggests that the medial prefrontal cortex (mPFC) and adjacent anterior cingulate (ACC) modulate amygdala activity during emotion regulation. Yet less is known about whether the amygdala-mPFC circuit is linked with regulation of the autonomic nervous system and whether the relationship differs across the adult lifespan. The current study tested the hypothesis that heart rate variability (HRV) reflects the strength of mPFC-amygdala interaction across younger and older adults. We recorded participants’ heart rates at baseline and examined whether baseline HRV was associated with amygdala-mPFC functional connectivity during rest. We found that higher HRV was associated with stronger functional connectivity between the amygdala and the mPFC during rest across younger and older adults. In addition to this age-invariant pattern, there was an age-related change, such that greater HRV was linked with stronger functional connectivity between amygdala and ventrolateral PFC (vlPFC) in younger than in older adults. These results are in line with past evidence that vlPFC is involved in emotion regulation especially in younger adults. Taken together, our results support the neurovisceral integration model and suggest that higher heart rate variability is associated with neural mechanisms that support successful emotional regulation across the adult lifespan.

Somatostatin-based radiopeptide therapy with [177Lu-DOTA]-TOC versus [90Y-DOTA]-TOC in neuroendocrine tumours

PURPOSE Somatostatin-based radiopeptide treatment is generally performed using the β-emitting radionuclides (90)Y or (177)Lu. The present study aimed at comparing benefits and harms of both therapeutic approaches. METHODS In a comparative cohort study, patients with advanced neuroendocrine tumours underwent repeated cycles of [(90)Y-DOTA]-TOC or [(177)Lu-DOTA]-TOC until progression of disease or permanent adverse events. Multivariable Cox regression and competing risks regression were employed to examine predictors of survival and adverse events for both treatment groups. RESULTS Overall, 910 patients underwent 1,804 cycles of [(90)Y-DOTA]-TOC and 141 patients underwent 259 cycles of [(177)Lu-DOTA]-TOC. The median survival after [(177)Lu-DOTA]-TOC and after [(90)Y-DOTA]-TOC was comparable (45.5 months versus 35.9 months, hazard ratio 0.91, 95% confidence interval 0.63-1.30, p = 0.49). Subgroup analyses revealed a significantly longer survival for [(177)Lu-DOTA]-TOC over [(90)Y-DOTA]-TOC in patients with low tumour uptake, solitary lesions and extra-hepatic lesions. The rate of severe transient haematotoxicities was lower after [(177)Lu-DOTA]-TOC treatment (1.4 vs 10.1%, p = 0.001), while the rate of severe permanent renal toxicities was similar in both treatment groups (9.2 vs 7.8%, p = 0.32). CONCLUSION The present results revealed no difference in median overall survival after [(177)Lu-DOTA]-TOC and [(90)Y-DOTA]-TOC. Furthermore, [(177)Lu-DOTA]-TOC was less haematotoxic than [(90)Y-DOTA]-TOC.

Sedimentation rate calculations and isotopic analysis on sediment cores along the IODP Expedition 311 transect

The oceanographic and tectonic conditions of accretionary margins are well-suited for several potential processes governing methane generation, storage and release. To identify the relevant methane evolution pathways in the northern Cascadia accretionary margin, a four-site transect was drilled during Integrated Ocean Drilling Program Expedition 311. The d13C values of methane range from a minimum value of -82.2 per mil on an uplifted ridge of accreted sediment near the deformation front (Site U1326, 1829 mbsl, meters below sea level) to a maximum value of -39.5 per mil at the most landward location within an area of steep canyons near the shelf edge (Site U1329, 946 mbsl). An interpretation based solely on methane isotope values might conclude the 13C-enrichment of methane indicates a transition from microbially- to thermogenically-sourced methane. However, the co-existing CO2 exhibits a similar trend of 13C-enrichment along the transect with values ranging from -22.5 per mil to +25.7 per mil. The magnitude of the carbon isotope separation between methane and CO2 (Ec = 63.8 ± 5.8) is consistent with isotope fractionation during microbially mediated carbonate reduction. These results, in conjunction with a transect-wide gaseous hydrocarbon content composed of > 99.8% (by volume) methane and uniform dDCH4 values (-172 per mil ± 8) that are distinct from thermogenic methane at a seep located 60 km from the Expedition 311 transect, suggest microbial CO2 reduction is the predominant methane source at all investigated sites. The magnitude of the intra-site downhole 13C-enrichment of CO2 within the accreted ridge (Site U1326) and a slope basin nearest the deformation front (Site U1325, 2195 mbsl) is ~ 5 per mil. At the mid-slope site (Site U1327, 1304 mbsl) the downhole 13C-enrichment of the CO2 is ~ 25 per mil and increases to ~ 40 per mil at the near-shelf edge Site U1329. This isotope fractionation pattern is indicative of more extensive diagenetic alteration at sites with greater 13C-enrichment. The magnitude of the 13C-enrichment of CO2 correlates with decreasing sedimentation rates and a diminishing occurrence of stratigraphic gas hydrate. We suggest the decreasing sedimentation rates increase the exposure time of sedimentary organic matter to aerobic and anaerobic degradation, during burial, thereby reducing the availability of metabolizable organic matter available for methane production. This process is reflected in the occurrence and distribution of gas hydrate within the northern Cascadia margin accretionary prism. Our observations are relevant for evaluating methane production and the occurrence of stratigraphic gas hydrate within other convergent margins.

Seawater carbonate chemistry, chlorophyll a and photosynthetic carbon fixation rate under different light and pCO2 conditions during experiments, 2010

We carried out short term pCO2/pH perturbation experiments in the coastal waters of the South China Sea to evaluate the combined effects of seawater acidification (low pH/high pCO2) and solar UV radiation (UVR, 280-400 nm) on photosynthetic carbon fixation of phytoplankton assemblages. Under photosynthetically active radiation (PAR) alone treatments, reduced pCO2 (190 ppmv) with increased pH resulted in a significant decrease in the photosynthetic carbon fixation rate (about 23%), while enriched pCO2 (700 ppmv) with lowered pH had no significant effect on the photosynthetic performance compared to the ambient level. The apparent photosynthetic efficiency decreased under the reduced pCO2 level, probably due to C-limitation as well as energy being diverged for up-regulation of carbon concentrating mechanisms (CCMs). In the presence of UVR, both UV-A and UV-B caused photosynthetic inhibition, though UV-A appeared to enhance the photosynthetic efficiency under lower PAR levels. UV-B caused less inhibition of photosynthesis under the reduced pCO2 level, probably because of its contribution to the inorganic carbon (Ci)-acquisition processes. Under the seawater acidification conditions (enriched pCO2), both UV-A and UV-B reduced the photosynthetic carbon fixation to higher extents compared to the ambient pCO2 conditions. We conclude that solar UV and seawater acidification could synergistically inhibit photosynthesis.

Radiocarbon dating, sedimentation rate, granulometry and organic carbon content of ODP Leg 182 sites

This data report presents sedimentological (grain size) and geochemical (X-ray diffraction, total organic carbon, accelerator mass spectrometry radiocarbon, and percent carbonate) information obtained from the western transect (Sites 1132, 1130, and 1134) and the eastern transect (Sites 1129, 1131, and 1127) in the Great Australian Bight during Leg 182. The purpose is to quantify changing rates of sediment accumulation and changes in sediment type from the late Pleistocene and Holocene, in order to relate these changes to the well-known sea level curve that exists for this time frame. Ultimately, these data can be used to more effectively interpret lithologic variations deeper in the Pleistocene succession, which most likely represent orbitally forced sea level events.

Characteristics, pyrolysis, age, lithology, sedimentation rate, organic matter, and thermal alteration index at DSDP Leg 67 Holes

Marine-derived amorphous organic matter dominates hemipelagic and trench sediments in and around the Middle America Trench. These sediments contain, on the average, 1% to 2% total organic carbon (TOC), with a maximum of 4.8%. Their organic facies and richness reflect (1) the small land area of Guatemala, which contributes small amounts of higher land plant remains, and (2) high levels of marine productivity and regionally low levels of dissolved oxygen, which encourage deposition and preservation of marine organic remains. These sediments have good potential for oil but are now immature. For this reason, gaseous hydrocarbons like the ethane identified in the deep parts of the section, as at Sites 496 and 497, are probably migrating from a mature section at depth. The pelagic sediments of the downgoing Cocos Plate are lean in organic carbon and have no petroleum potential

Accumulation rate, carbon geochemistry and clay mineralogy of ODP Site 181-1123 sediments, southwest Pacific

Site 1123 is located on the northeastern flank of the Chatham Rise. Sedimentological and clay mineralogical analyses indicate a very fine grained carbonate-rich sediment. Smectite and illite are the main constituents of the clay mineral assemblage. High smectite values in the Eocene decrease in younger sediment sequences. Illite and chlorite concentrations increase in younger sediments with significant steps at 13.5, 9, and 6.4 Ma. The kaolinite content is near the detection limit and not significant. We observed only small fluctuations of the clay mineral composition, which indicates a uniform sedimentation process, probably driven by long-term processes. Good correspondence is shown between increasing illite and chlorite values and the tectonic uplift history of the Southern Alps.