Determinantes de la gestión clínica en atención médica domiciliaria de personas con secuelas de enfermedad cerebro-vascular

La atención domiciliaria constituye hoy una modalidad de atención que permite solventar las dificultades derivadas de la sobreocupación hospitalaria y la cronicidad, los cuales constituyen un problema de interés en salud pública en los países desarrollados y que pueden ser manejados en el domicilio del paciente como una opción costo-efectiva y segura. Para lo cual es necesario buscar estrategias que permitan su desarrollo, gestión de riesgos y modelos de atención, logrando mejorar las condiciones de salud de la población. Uno de los principales retos de la gestión de programas de atención en salud, se encuentra en definir los aspectos donde intervenir para potenciar la eficacia y la calidad en la prestación del servicio, por lo que dichos aspectos se constituyen como determinantes de la atención del paciente y su familia. En este documento se abordan los principales determinantes en la atención de personas con secuelas de Enfermedad cerebrovascular, que reciben manejo medico domiciliario, con el objetivo de identificar las áreas prioritarias de intervención, garantizando una mejor gestión clínica en tres áreas específicas: sobrecarga del cuidador, Polimedicación y ulceras por decúbito.

Valor en riesgo del portafolio de TES de los bancos colombianos

En este trabajo se realiza la medición del riesgo de mercado para el portafolio de TES de un banco colombiano determinado, abordando el pronóstico de valor en riesgo (VaR) mediante diferentes modelos multivariados de volatilidad: EWMA, GARCH ortogonal, GARCH robusto, así como distintos modelos de VaR con distribución normal y distribución t-student, evaluando su eficiencia con las metodologías de backtesting propuestas por Candelon et al. (2011) con base en el método generalizado de momentos, junto con los test de independencia y de cobertura condicional planteados por Christoffersen y Pelletier (2004) y por Berkowitz, Christoffersen y Pelletier (2010). Los resultados obtenidos demuestran que la mejor especificación del VaR para la medición del riesgo de mercado del portafolio de TES de los bancos colombianos, es el construido a partir de volatilidades EWMA y basado en la distribución normal, ya que satisface las hipótesis de cobertura no condicional, independencia y cobertura condicional, al igual que los requerimientos estipulados en Basilea II y en la normativa vigente en Colombia.

Percentiles de grasa corporal por bioimpedancia eléctrica en niños y adolescentes de Bogotá, Colombia: Estudio FUPRECOL

Objetivo: Recientemente, se han propuesto varios dispositivos de impedancia bioeléctrica (BIA) para la estimación rápida de la grasa corporal. Sin embargo, no han sido publicadas referencias de grasa corporal para niños y adolescentes en población Colombiana. El objetivo de este estudio fue establecer percentiles de grasa corporal por BIA en niños y adolescentes de Bogotá, Colombia de entre 9 y 17.9 años, pertenecientes al estudio FUPRECOL. Métodos: Estudio descriptivo y transversal, realizado en 2.526 niños y 3.324 adolescentes de entre 9 y 17.9 años de edad, pertenecientes a instituciones educativas oficiales de Bogotá, Colombia. El porcentaje de grasa corporal fue medido con Tanita® Analizador de Composición Corporal (Modelo BF-689), según edad y sexo. Se tomaron medidas de peso, talla, circunferencia de cintura, circunferencia de cadera y estado de maduración sexual por auto-reporte. Se calcularon los percentiles (P3, P10, P25, P50, P75, P90 y P97) y curvas centiles por el método LMS según sexo y edad y se realizó una comparación entre los valores de la CC observados con estándares internacionales. Resultados: Se presentan valores de porcentaje de grasa corporal y las curvas de percentiles. En la mayoría de los grupos etáreos la grasa corporal de las chicas fue mayor a la de los chicos. Sujetos cuyo porcentaje de grasa corporal estaba por encima del percentil 90 de la distribución estándar normal se consideró que tenían un elevado riesgo cardiovascular (chicos desde 23,4-28,3 y chicas desde 31,0-34,1). En general, nuestros porcentajes de grasa corporal fueron inferiores a los valores de Turquía, Alemania, Grecia, España y Reino Unido. Conclusiones: Se presentan percentiles del porcentaje de grasa por BIA según edad y sexo que podrán ser usados de referencia en la evaluación del estado nutricional y en la predicción del riesgo cardiovascular desde edades tempranas.

Effect of Temperature on the Development and Survival of the Argentine Ant, Linepithema humile

The influence of temperature on the developmental times and survival of insects can largely determine their distribution. For invasive species, like the Argentine ant, Linepithema humile Mayr (Hymenoptera: Formicidae), these data are essential for predicting their potential range based on mechanistic models. In the case of this species, such data are too scarce and incomplete to make accurate predictions based on its physiological needs. This research provides comprehensive new data about brood survival and developmental times at a wide range of temperatures under laboratory conditions. Temperature affected both the complete brood development from egg to adult worker and each of the immature stages separately. The higher the temperature, the shorter the development times. Brood survival from egg to adult was low, with the maximum survival rate being only 16% at 26º C. Temperature also affected survival of each of the immature stages differently: eggs were negatively affected by high temperatures, while larvae were negatively affected by low temperatures, and the survival of pupae was apparently independent of environmental temperature. At 32º C no eggs survived, while at 18º C less than 2% of the eggs hatched into larva. The data from the present study are essential for developing prediction models about the distribution range of this tramp species based on its physiological needs in relation to temperature

Desenvolupament de mètodes de predicció de soroll i anàlisi de l'impacte acústic produït pel trànsit viari i el ferrocarril en la ciutat de Girona

La feina feta en aquest treball de tesis s'ha desenvolupat a partir de tres objectius vertebradors, que fonamentalment són: ·El primer dels objectius d'aquest treball de tesis és presentar un recull dels factors que intervenen en l'acústica urbanística: soroll produït pels diferents vehicles, fórmules de predicció de soroll, geometria dels edificis... , tot estudiant els seus efectes en la ciutat de Girona. ·Un altre objectiu ha estat desenvolupar uns mètodes numèrics propis, contrastats experimentalment i extrapolables a qualsevol entorn urbanístic, que permetin predir els valors de les pertorbacions acústiques produïdes pels diferents vehicles en diferents situacions, entre els que es destaquen: -Fórmula de predicció del soroll en un entorn urbà i la seva aplicació a Girona. -Càlcul de l'increment de soroll en un carrer provocat per les reflexions de les ones sonores en les façanes dels edificis. -Estudi del nivell de soroll en la boca de la cavitat d'un túnel produït pel pas del ferrocarril. -Determinació del soroll provocat pel pas d'un tren sobre un viaducte. -Mètode de distribució i planificació del trànsit urbà per disminuir l'impacte acústic sobre la zona. ·El darrer objectiu consisteix en fer una descripció analítica de les principals fonts de soroll que afecten a la ciutat: el trànsit viari i el ferrocarril. Per realitzar aquests objectius s'ha disposat d'un banc de dades amb més de 2.000 mesures sonores de Girona (nivells equivalents de 10 minuts de durada). La metodologia seguida i els principis en que es fonamenta es detallen a l'inici de cada apartat. La finalitat de tots aquests estudis, no és altre que millorar el confort acústic, i la qualitat de vida, de les ciutats. Gairebé tots els grans nuclis de població del planeta es veuen afectats per una gravíssima problemàtica mediambiental, doncs a l'anomenada contaminació acústica cal afegir uns alts índexs de pol·lució atmosfèrica (altes concentracions de biòxid de carboni, generació d'illes de calor...). Aquesta situació, generalitzada arreu del planeta, ha propiciat l'aparició de mesures dràstiques consistents fonamentalment en restringir l'accés dels vehicles motoritzats als nuclis i zones centrals de les àrees urbanes. Precisament aquesta opció s'ha proposat per les zones interiors de Girona on l'elevada densitat de les edificacions deixa un escàs marge per plantejar la construcció de noves rutes o vies alternatives. Cal esmentar que tots els càlculs i teories que es desenvolupen en aquest treball de tesis reflecteixen la realitat acústica actual provocada pels diferents mitjans de transport. Molt possiblement, en un futur no massa llunyà, els nivells de soroll (dB) enregistrats en situacions de tràfic similar seran força menors. Són molts els factors que poden contribuir a aquesta disminució de la intensitat de les emissions sonores: reducció del fregament mecànic, augment del coeficient aerodinàmic, nous materials pels pneumàtics i l'asfalt ... Sense cap mena de dubte, però, una millora transcendental, i no només pel que fa al confort acústic sinó per l'ecosistema en general, seria potenciar la construcció de motors elèctrics o d'hidrogen. Aquests últims per exemple, a diferència dels motors de combustió, funcionen mitjançant piles de combustible que converteixen, amb molta netedat, el gas hidrogen en electricitat i possibiliten l'existència de vehicles no contaminants propulsats per motors elèctrics menys sorollosos. Així, al haver-hi menys fregament entre les parts mòbils del motor (no hi ha pistons ni cilindres) el soroll generat es reduiria considerablement.

Serviceability behaviour of fibre reinforced polymer reinforced concrete beams

El uso de materiales compuestos de matriz polimérica (FRP) emerge como alternativa al hormigón convencionalmente armado con acero debido a la mayor resistencia a la corrosión de dichos materiales. El presente estudio investiga el comportamiento en servicio de vigas de hormigón armadas con barras de FRP mediante un análisis teórico y experimental. Se presentan los resultados experimentales de veintiséis vigas de hormigón armadas con barras de material compuesto de fibra de vidrio (GFRP) y una armada con acero, todas ellas ensayadas a flexión de cuatro puntos. Los resultados experimentales son analizados y comparados con algunos de los modelos de predicción más significativos de flechas y fisuración, observándose, en general, una predicción adecuada del comportamiento experimental hasta cargas de servicio. El análisis de sección fisurada (CSA) estima la carga última con precisión, aunque se registra un incremento de la flecha experimental para cargas superiores a las de servicio. Esta diferencia se atribuye a la influencia de las deformaciones por esfuerzo cortante y se calcula experimentalmente. Se presentan los aspectos principales que influyen en los estados límites de servicio: tensiones de los materiales, ancho máximo de fisura y flecha máxima permitida. Se presenta una metodología para el diseño de dichos elementos bajo las condiciones de servicio. El procedimiento presentado permite optimizar las dimensiones de la sección respecto a metodologías más generales.

The accuracy of Doppler radar wind retrievals using insects as targets

Insect returns from the UK's Doppler weather radars were collected in the summers of 2007 and 2008, to ascertain their usefulness in providing information about boundary layer winds. Such observations could be assimilated into numerical weather prediction models to improve forecasts of convective showers before precipitation begins. Significant numbers of insect returns were observed during daylight hours on a number of days through this period, when they were detected at up to 30 km range from the radars, and up to 2 km above sea level. The range of detectable insect returns was found to vary with time of year and temperature. There was also a very weak correlation with wind speed and direction. Use of a dual-polarized radar revealed that the insects did not orient themselves at random, but showed distinct evidence of common orientation on several days, sometimes at an angle to their direction of travel. Observation minus model background residuals of wind profiles showed greater bias and standard deviation than that of other wind measurement types, which may be due to the insects' headings/airspeeds and to imperfect data extraction. The method used here, similar to the Met Office's procedure for extracting precipitation returns, requires further development as clutter contamination remained one of the largest error contributors. Wind observations derived from the insect returns would then be useful for data assimilation applications.

Can desert dust explain the outgoing longwave radiation anomaly over the Sahara during July 2003?

Measurements of the top‐of‐the‐atmosphere outgoing longwave radiation (OLR) for July 2003 from Meteosat‐7 are used to assess the performance of the numerical weather prediction version of the Met Office Unified Model. A significant difference is found over desert regions of northern Africa where the model emits too much OLR by up to 35 Wm−2 in the monthly mean. By cloud‐screening the data we find an error of up to 50 Wm−2 associated with cloud‐free areas, which suggests an error in the model surface temperature, surface emissivity, or atmospheric transmission. By building up a physical model of the radiative properties of mineral dust based on in situ, and surface‐based and satellite remote sensing observations we show that the most plausible explanation for the discrepancy in OLR is due to the neglect of mineral dust in the model. The calculations suggest that mineral dust can exert a longwave radiative forcing by as much as 50 Wm−2 in the monthly mean for 1200 UTC in cloud‐free regions, which accounts for the discrepancy between the model and the Meteosat‐7 observations. This suggests that inclusion of the radiative effects of mineral dust will lead to a significant improvement in the radiation balance of numerical weather prediction models with subsequent improvements in performance.

A case study of the radiative forcing of persistent contrails evolving into contrail-induced cirrus

The radiative forcing due to a distinct pattern of persistent contrails that form into contrail-induced cirrus near and over the UK is investigated in detail for a single case study during March 2009. The development of the contrail-induced cirrus is tracked using a number of high-resolution polar orbiting and lower-resolution geostationary satellite instruments and is found to persist for a period of around 18 h, and at its peak, it covers over 50,000 km2. The shortwave (SW) and longwave (LW) radiative forcing of the contrail-induced cirrus is estimated using a combination of geostationary satellite instruments, numerical weather prediction models, and surface observation sites. As expected, the net radiative effect is a relatively small residual of the much stronger but opposing SW and LW effects, locally totaling around 10 W m−2 during daylight hours and 30 W m−2 during nighttime. A simple estimate indicates that this single localized event may have generated a global-mean radiative forcing of around 7% of recent estimates of the persistent contrail radiative forcing due to the entire global aircraft fleet on a diurnally averaged basis. A single aircraft operating in conditions favorable for persistent contrail formation appears to exert a contrail-induced radiative forcing some 5000 times greater (in W m−2 km−1) than recent estimates of the average persistent contrail radiative forcing from the entire civil aviation fleet. This study emphasizes the need to establish whether similar events are common or highly unusual for a confident assessment of the total climate effect of aviation to be made.

A case study of the radiative forcing of persistent contrails evolving into contrail-induced cirrus

The radiative forcing due to a distinct pattern of persistent contrails that form into contrail-induced cirrus near and over the UK is investigated in detail for a single case study during March 2009. The development of the contrail-induced cirrus is tracked using a number of high-resolution polar orbiting and lower-resolution geostationary satellite instruments and is found to persist for a period of around 18 h, and at its peak, it covers over 50,000 km2. The shortwave (SW) and longwave (LW) radiative forcing of the contrail-induced cirrus is estimated using a combination of geostationary satellite instruments, numerical weather prediction models, and surface observation sites. As expected, the net radiative effect is a relatively small residual of the much stronger but opposing SW and LW effects, locally totaling around 10 W m−2 during daylight hours and 30 W m−2 during nighttime. A simple estimate indicates that this single localized event may have generated a global-mean radiative forcing of around 7% of recent estimates of the persistent contrail radiative forcing due to the entire global aircraft fleet on a diurnally averaged basis. A single aircraft operating in conditions favorable for persistent contrail formation appears to exert a contrail-induced radiative forcing some 5000 times greater (in W m−2 km−1) than recent estimates of the average persistent contrail radiative forcing from the entire civil aviation fleet. This study emphasizes the need to establish whether similar events are common or highly unusual for a confident assessment of the total climate effect of aviation to be made.

A fast radiative transfer model for the assimilation of water vapor radiances from the Kalpana very high resolution radiometer

A fast radiative transfer model (RTM) to compute emitted infrared radiances for a very high resolution radiometer (VHRR), onboard the operational Indian geostationary satellite Kalpana has been developed and verified. This work is a step towards the assimilation of Kalpana water vapor (WV) radiances into numerical weather prediction models. The fast RTM uses a regression‐based approach to parameterize channel‐specific convolved level to space transmittances. A comparison between the fast RTM and the line‐by‐line RTM demonstrated that the fast RTM can simulate line‐by‐line radiances for the Kalpana WV channel to an accuracy better than the instrument noise, while offering more rapid radiance calculations. A comparison of clear sky radiances of the Kalpana WV channel with the ECMWF model first guess radiances is also presented, aiming to demonstrate the fast RTM performance with the real observations. In order to assimilate the radiances from Kalpana, a simple scheme for bias correction has been suggested.

A comparative method to evaluate and validate stochastic parametrizations

There is a growing interest in using stochastic parametrizations in numerical weather and climate prediction models. Previously, Palmer (2001) outlined the issues that give rise to the need for a stochastic parametrization and the forms such a parametrization could take. In this article a method is presented that uses a comparison between a standard-resolution version and a high-resolution version of the same model to gain information relevant for a stochastic parametrization in that model. A correction term that could be used in a stochastic parametrization is derived from the thermodynamic equations of both models. The origin of the components of this term is discussed. It is found that the component related to unresolved wave-wave interactions is important and can act to compensate for large parametrized tendencies. The correction term is not proportional to the parametrized tendency. Finally, it is explained how the correction term could be used to give information about the shape of the random distribution to be used in a stochastic parametrization. Copyright © 2009 Royal Meteorological Society

Qualitative modelling of sustainable energy scenarios: An application and extension of the Bon Qualitative Input-Output model

Climate change is one of the major challenges facing economic systems at the start of the 21st century. Reducing greenhouse gas emissions will require both restructuring the energy supply system (production) and addressing the efficiency and sufficiency of the social uses of energy (consumption). The energy production system is a complicated supply network of interlinked sectors with 'knock-on' effects throughout the economy. End use energy consumption is governed by complex sets of interdependent cultural, social, psychological and economic variables driven by shifts in consumer preference and technological development trajectories. To date, few models have been developed for exploring alternative joint energy production-consumption systems. The aim of this work is to propose one such model. This is achieved in a methodologically coherent manner through integration of qualitative input-output models of production, with Bayesian belief network models of consumption, at point of final demand. The resulting integrated framework can be applied either (relatively) quickly and qualitatively to explore alternative energy scenarios, or as a fully developed quantitative model to derive or assess specific energy policy options. The qualitative applications are explored here.

Verification of cloud-fraction forecasts

Cloud radar and lidar can be used to evaluate the skill of numerical weather prediction models in forecasting the timing and placement of clouds, but care must be taken in choosing the appropriate metric of skill to use due to the non- Gaussian nature of cloud-fraction distributions. We compare the properties of a number of different verification measures and conclude that of existing measures the Log of Odds Ratio is the most suitable for cloud fraction. We also propose a new measure, the Symmetric Extreme Dependency Score, which has very attractive properties, being equitable (for large samples), difficult to hedge and independent of the frequency of occurrence of the quantity being verified. We then use data from five European ground-based sites and seven forecast models, processed using the ‘Cloudnet’ analysis system, to investigate the dependence of forecast skill on cloud fraction threshold (for binary skill scores), height, horizontal scale and (for the Met Office and German Weather Service models) forecast lead time. The models are found to be least skillful at predicting the timing and placement of boundary-layer clouds and most skilful at predicting mid-level clouds, although in the latter case they tend to underestimate mean cloud fraction when cloud is present. It is found that skill decreases approximately inverse-exponentially with forecast lead time, enabling a forecast ‘half-life’ to be estimated. When considering the skill of instantaneous model snapshots, we find typical values ranging between 2.5 and 4.5 days. Copyright c 2009 Royal Meteorological Society

A new method for evaluating regional air quality forecasts

A Kriging interpolation method is combined with an object-based evaluation measure to assess the ability of the UK Met Office's dispersion and weather prediction models to predict the evolution of a plume of tracer as it was transported across Europe. The object-based evaluation method, SAL, considers aspects of the Structure, Amplitude and Location of the pollutant field. The SAL method is able to quantify errors in the predicted size and shape of the pollutant plume, through the structure component, the over- or under-prediction of the pollutant concentrations, through the amplitude component, and the position of the pollutant plume, through the location component. The quantitative results of the SAL evaluation are similar for both models and close to a subjective visual inspection of the predictions. A negative structure component for both models, throughout the entire 60 hour plume dispersion simulation, indicates that the modelled plumes are too small and/or too peaked compared to the observed plume at all times. The amplitude component for both models is strongly positive at the start of the simulation, indicating that surface concentrations are over-predicted by both models for the first 24 hours, but modelled concentrations are within a factor of 2 of the observations at later times. Finally, for both models, the location component is small for the first 48 hours after the start of the tracer release, indicating that the modelled plumes are situated close to the observed plume early on in the simulation, but this plume location error grows at later times. The SAL methodology has also been used to identify differences in the transport of pollution in the dispersion and weather prediction models. The convection scheme in the weather prediction model is found to transport more pollution vertically out of the boundary layer into the free troposphere than the dispersion model convection scheme resulting in lower pollutant concentrations near the surface and hence a better forecast for this case study.