Análisis ecocardiográfico de la función sistólica del ventrículo izquierdo por médicos no cardiólogos con un dispositivo de bolsillo

Se realizó un estudio transversal, se incluyeron 3 residentes no cardiólogos y se les dio formación básica en ecocardiografía (horas teóricas 22, horas prácticas 65), con recomendaciones de la Sociedad Americana de Ecocardiografia y aportes del aprendizaje basado en problemas, con el desarrollo de competencia técnicas y diagnósticas necesarias, se realizó el análisis de concordancia entre residentes y ecocardiografistas expertos, se recolectaron 122 pacientes hospitalizados que cumplieran con los criterios de inclusión y exclusión, se les realizo un ecocardiograma convencional por el experto y una valoración ecocardiográfica por el residente, se evaluó la ventana acústica, contractilidad, función del ventrículo izquierdo y derrame pericárdico. La hipótesis planteada fue obtener una concordancia moderada. Resultados: Se analizó la concordancia entre observadores para la contractilidad miocárdica (Kappa: 0,57 p=0,000), función sistólica del ventrículo izquierdo (Kappa 0,54 p=0.000) siendo esta moderada por estar entre 0,40 – 0,60 y con una alta significancia estadística, para la calidad de la ventana acústica (Kappa: 0,22 p= 0.000) y presencia de derrame pericárdico (Kappa: 0,26 p= 0.000) se encontró una escasa concordancia ubicándose entre 0,20 – 0,40. Se estableció una sensibilidad de 90%, especificidad de 67%, un valor predictivo positivo de 80% y un valor predictivo negativo de 85% para el diagnóstico de disfunción sistólica del ventrículo izquierdo realizado por los residentes.

Innovación en tecnologías digitales

Los videojuegos ya no deberían ser vistos como el dominio exclusivo de adolescentes, sino más bien como parte de una corriente comercial, de hecho su impacto en la sociedad es de gran alcance. Por ejemplo, las innovaciones líderes en el área de diseño de procesadores, gráficos y la inteligencia artificial están siendo impulsados por la industria de los videojuegos, de esta manera es posible que en la actualidad el software del juego se utilice para entrenar a los soldados para la batalla, y entrenar a los pilotos en los controles de vuelo y de navegación. (Wesley & Balzac, 2010)

Definition of an it project portfolio management methodology for a pharmaceutical company

Con la creciente popularidad de las soluciones de IT como factor clave para aumentar la competitividad y la creación de valor para las empresas, la necesidad de invertir en proyectos de IT se incrementa considerablemente. La limitación de los recursos como un obstáculo para invertir ha obligado a las empresas a buscar metodologías para seleccionar y priorizar proyectos, asegurándose de que las decisiones que se toman son aquellas que van alineadas con las estrategias corporativas para asegurar la creación de valor y la maximización de los beneficios. Esta tesis proporciona los fundamentos para la implementación del Portafolio de dirección de Proyectos de IT (IT PPM) como una metodología eficaz para la gestión de proyectos basados en IT, y una herramienta para proporcionar criterios claros para los directores ejecutivos para la toma de decisiones. El documento proporciona la información acerca de cómo implementar el IT PPM en siete pasos, el análisis de los procesos y las funciones necesarias para su ejecución exitosa. Además, proporciona diferentes métodos y criterios para la selección y priorización de proyectos. Después de la parte teórica donde se describe el IT PPM, la tesis aporta un análisis del estudio de caso de una empresa farmacéutica. La empresa ya cuenta con un departamento de gestión de proyectos, pero se encontró la necesidad de implementar el IT PPM debido a su amplia cobertura de procesos End-to-End en Proyectos de IT, y la manera de asegurar la maximización de los beneficios. Con la investigación teórica y el análisis del estudio de caso, la tesis concluye con una definición práctica de un modelo aproximado IT PPM como una recomendación para su implementación en el Departamento de Gestión de Proyectos.

Loan sales under asymmetric information

Loans are illiquid assets that can be sold in a secondary market even that buyers have no certainty about their quality. I study a model in which a lender has access to new investment opportunities when all her assets are illiquid. To raise funds, the lender may either borrow using her assets as collateral, or she can sell them in a secondary market. Given asymmetric information about assets quality, the lender cannot recover the total value of her assets. There is then a role for the government to correct the information problem using fiscal tools.

Experiencia en el manejo de cancer colorrectal en el hospital universitario mayor - Mederi

Introducción: El cáncer colorrectal es el tercer cáncer más diagnosticado en los hombres y el segundo en las mujeres a nivel mundial. Hasta 1.000 casos nuevos se diagnostican en Colombia cada año, por lo que es importante conocer la experiencia con esta patología en un centro de experiencia recientemente creado en el “Méderi, Hospital Universitario Mayor”. Materiales y métodos: Se realizó un estudio de corte transversal de la población con diagnóstico de cáncer colorrectal atendida entre agosto 2012 y diciembre 2014 que corresponde al tiempo de funcionamiento del servicio de Coloproctología. Resultados: Se atendieron un total de 152 pacientes con cáncer colorrectal en la institución. Se operó el 91% de los pacientes. El estadío más frecuente fue el IV. Solo el 4.9% presentó dehiscencia de anastomosis, datos concordantes con la literatura cuando el manejo es a cargo de expertos. El subtipo histológico más frecuente fue adenocarcinoma moderadamente diferenciado y la mortalidad perioperatoria de 2.63%. Discusión: El cáncer colorrectal es una entidad con alta morbimortalidad lo cual puede cambiar si se realizan pruebas de tamizaje, para realizar un manejo temprano y oportuno. Además juega un papel importante la experiencia del cirujano y la discusión de los pacientes en juntas multidisciplinarias. Palabras clave: cáncer de colon, cáncer de recto, epidemiología, estadificación

Tres momentos del discurso conservador ecuatoriano, 1860-1875 (Estudios)

Artículo basado en fuentes hemerográficas, específicamente en la sección No oficial del periódico El Nacional, entre 1860 y 1875. Analiza los cambios del discurso conservador en el poder durante el período estudiado y muestra que esta corriente fue dúctil e impulsora de innovaciones en diversos ámbitos políticos. El estudio concatena tres grandes momentos discursivos con sus correspondientes coyunturas políticas.

Reflections: 50 Years of Medieval Archaeology, 1957-2007

This volume celebrates the 50th anniversary of the Society for Medieval Archaeology (established in 1957), presenting reflections on the history, development and future prospects of the discipline. The papers are drawn from a series of conferences and workshops that took place in 2007-2008, in addition to a number of contributions that were commissioned especially for the volume. They range from personal commentaries on the history of the Society and the growth of the subject, to historiographical, regional and thematic overviews of major trends in the evolution and current practice of medieval archaeology in Britain. Critical overviews are presented of the archaeology of medieval landscapes, buildings and material culture; new developments in the scientific study of medieval health, diet and materials; and innovations in social approaches to medieval archaeology. A series of papers on southern Europe provide a comparative perspective, featuring overviews on medieval archaeology in Italy, Spain and southeastern Europe.

Mid-infrared filters for astronomical and remote sensing instrumentation

As improvements to the optical design of spectrometer and radiometer instruments evolve with advances in detector sensitivity, use of focal plane detector arrays and innovations in adaptive optics for large high altitude telescopes, interest in mid-infrared astronomy and remote sensing applications have been areas of progressive research in recent years. This research has promoted a number of developments in infrared coating performance, particularly by placing increased demands on the spectral imaging requirements of filters to precisely isolate radiation between discrete wavebands and improve photometric accuracy. The spectral design and construction of multilayer filters to accommodate these developments has subsequently been an area of challenging thin-film research, to achieve high spectral positioning accuracy, environmental durability and aging stability at cryogenic temperatures, whilst maximizing the far-infrared performance. In this paper we examine the design and fabrication of interference filters in instruments that utilize the mid-infrared N-band (6-15 µm) and Q-band (16-28 µm) atmospheric windows, together with a rationale for the selection of materials, deposition process, spectral measurements and assessment of environmental durability performance.

Ethnographic methodologies for construction research: knowing, practice and interventions

Ethnographic methodologies developed in social anthropology and sociology hold considerable promise for addressing practical, problem-based research concerned with the construction site. The extended researcher-engagement characteristic of ethnography reveals rich insights, yet is infrequently used to understand how workplace realities are lived out on construction sites. Moreover, studies that do employ these methods are rarely reported within construction research journals. This paper argues that recent innovations in ethnographic methodologies offer new routes to: posing questions; understanding workplace socialities (i.e. the qualities of the social relationships that develop on construction sites); learning about forms, uses and communication of knowledge on construction sites; and turning these into meaningful recommendations. This argument is supported by examples from an interdisciplinary ethnography concerning migrant workers and communications on UK construction sites. The presented research seeks to understand how construction workers communicate with managers and each other and how they stay safe on site, with the objective of informing site health-and-safety strategies and the production and evaluation of training and other materials.

Understanding the early stages of the innovation diffusion process: awareness, influence and communication networks

The themes of awareness and influence within the innovation diffusion process are addressed. The innovation diffusion process is typically represented as stages, yet awareness and influence are somewhat under-represented in the literature. Awareness and influence are situated within the contextual setting of individual actors but also within the broader institutional forces. Understanding how actors become aware of an innovation and then how their opinion is influenced is important for creating a more innovation-active UK construction sector. Social network analysis is proposed as one technique for mapping how awareness and influence occur and what they look like as a network. Empirical data are gathered using two modes of enquiry. This is done through a pilot study consisting of chartered professionals and then through a case study organization as it attempted to diffuse an innovation. The analysis demonstrates significant variations across actors’ awareness and influence networks. It is argued that social network analysis can complement other research methods in order to present a richer picture of how actors become aware of innovations and where they draw their influences regarding adopting innovations. In summarizing the findings, a framework for understanding awareness and influence associated with innovation within the UK construction sector is presented. Finally, with the UK construction sector continually being encouraged to be innovative, understanding and managing an actor’s awareness and influence network will be beneficial. The overarching conclusion thus describes the need not only to build research capacity in this area but also to push the boundaries related to the research methods employed.

Implications of climate change for expanding cities worldwide

This paper analyses the trends of the changing environmental effects within growing megacities as their diameters exceed 50–100 km and their populations rise beyond 30 million people. The authors consider how these effects are influenced by climate change, to which urban areas themselves contribute, caused by their increasing greenhouse gas emissions associated with rapidly expanding energy use. Other environmental and social factors are assessed, quantitatively and qualitatively, using detailed modelling of urban mesoscale meteorology, which shows how these factors can lead to large conurbations becoming more vulnerable to climatic and environmental hazards. The paper discusses the likely changes in meteorological and hydrological hazards in urban areas, both as the climate changes and the sizes of urban areas grow. Examples are given of how these risks are being reduced through innovations in warning and response systems, planning and infrastructure design, which should include refuges against extreme natural disasters. Policies are shown to be more effective when they are integrated and based on substantial community involvement. Some conclusions are drawn regarding how policies for the natural and artificial environment and for reducing many kinds of climate and hazard risk are related to future designs and planning of infrastructure and open spaces.

A bank lending channel or a credit supply shock?

Shifts in credit supply could have a bearing on house prices e.g. through financial innovations and changes in regulation independently of the existence of a bank lending channel of monetary policy. This paper assesses the responses of US house prices to an exogenous credit supply shock and compares them with the effects from variations in credit supply associated with a bank lending channel. The contribution of the study is twofold. First, innovations in credit supply are identified using a mortgage mix variable, thereby accounting for the market-based financial intermediaries. As a robustness check a survey variable of bank lending standards for mortgage loans is also used. Second, the policy-induced credit supply effect on house prices is disentangled and compared with the effect from an exogenous credit supply shock. It is shown that in the first 3 years credit supply shocks affect house prices exogenously rather than through the bank lending channel. Monetary policy has still a large impact on house prices, even when the bank lending channel is ‘turned off’.

Optimal frame length for keeping normalized goodput with lowest requirement on BER

This paper presents an adaptive frame length mechanism based on a cross-layer analysis of intrinsic relations between the MAC frame length, bit error rate (BER) of the wireless link and normalized goodput. The proposed mechanism selects the optimal frame length that keeps the service normalized goodput at required levels while satisfying the lowest requirement on the BER, thus increasing the transmission reliability. Numerical results are provided and show that an optimal frame length satisfying the lowest BER requirement does indeed exist. The performance of BER requirement as a function of the MAC frame length is evaluated and compared for transmission scenarios with and without automatic repeat request (ARQ). Furthermore, issues related to the MAC overhead length are also discussed to illuminate the functionality and performance of the proposed mechanism.