Aporte a la toma de decisiones Del Instituto de Ortopedia Infantil Roosevelt a partir del análisis estructural del sector estratégico de hospitales universitarios

El concepto de hospitales universitarios ha ido evolucionando en el mundo, siendo cada vez más estricta la legislación que los regula y los mecanismos de evaluación para asegurar la calidad de la educación a los estudiantes que realizan prácticas en ambientes hospitalarios. El direccionamiento estratégico de los hospitales universitarios requiere en primer lugar de un análisis específico del sector, mediante pruebas como el análisis de hacinamiento, levantamiento del panorama competitivo, el análisis estructural de las fuerzas de mercado y un estudio de competidores que permitan el diagnóstico del sector estratégico. Por otro lado la realización de un modelo matricial aportará a la planificación estratégica mediante la integración del análisis cuantitativo y cualitativo. La presente investigación busca analizar el sector estratégico de hospitales universitarios y de manera particular la situación del Instituto de Ortopedia Infantil Roosevelt como integrante del sector. En primer lugar se realizó una investigación del concepto de hospitales universitarios en el tiempo, tanto a nivel nacional como internacional y de la legislación existente. Posteriormente se identificaron las instituciones que constituyen el sector estratégico y se realizó el análisis del medioambiente empresarial para la identificación de la situación real del sector y un análisis particular del área de educación e investigación del Instituto de Ortopedia Infantil Roosevelt, para construir las estrategias y el horizonte institucional.

Cirugía bariatrica : gastrogastroplastia laparoscópica y bypass gástrico en pacientes con obesidad mórbida

La obesidad es un problema de salud global siendo la cirugía bariatrica el mejor tratamiento demostrado. El Bypass Gástrico (BGYR) es el método más utilizado que combina restricción y malabsorcion; sin embargo los procedimientos restrictivos se han popularizado recientemente. La Gastro-gastroplastia produce restricción gástrica reversible por medio de un pouch gástrico con anastomosis gastrogástrica y propusimos su evaluación Métodos: Estudio retrospectivo no randomizado que evaluó archivos de pacientes con GG y BGYR laparoscópicos entre Febrero de 2008 y Abril de 2011 Resultados: 289 pacientes identificados: 180 GG y 109 BGYR de los cuales 138 cumplieron criterios de inclusión, 77 (55.8%) GG y 61 (44,2%) BGYR, 18 (13%) hombres y 120 (87%) mujeres. Para GG la mediana del peso inicial fue 97,15 (± 17,3) kg, IMC inicial de 39,35 (± 3,38) kg/m2 y exceso de peso de 37,1 (±11,9). La mediana de IMC a los 1, 6 y 12 meses fue 34,8 (±3,58) kg/m2, 30,81 (±3,81) kg/m2, 29,58 (±4,25) kg/m2 respectivamente. La mediana de % PEP 1, 6 y 12 meses fue 30,9 (±14,2) %, 61,88 (±18,27) %, 68,4 (±19,64) % respectivamente. Para BGYR la mediana del peso inicial fue 108,1 (± 25,4) kg, IMC inicial 44,4 (± 8,1) y exceso de peso de 48,4 (±15,2) %. La mediana de IMC a los 1, 6 y 12 meses fue 39 (±7,5) kg/m2, 33,31 (±4,9) kg/m2, 30,9 (±4,8) kg/m2 respectivamente. La mediana de % PEP 1, 6 y 12 meses fue 25,9 (±12,9) %, 61,87 (±18,62) %, 71,41 (±21,09) % respectivamente. Seguimiento a un año. Conclusiones: La gastro-gastroplastia se plantea como técnica restrictiva, reversible, con resultados óptimos en reducción de peso y alternativa quirúrgica en pacientes con obesidad. Son necesarios estudios a mayor plazo para demostrar mantenimiento de cambios en el tiempo.

Reimplantes de punta de dedo. Fundación Santafé de Bogotá 2003 – 2011. Serie de Casos

Introducción: El objetivo de este trabajo es caracterizar los pacientes con amputaciones de punta de dedo en zonas I & II de Ishikawa & Tamai y describir los casos exitosos y de fallas en estos niveles tan distales de reimplantación. Materiales y Métodos: serie de casos retrospectiva de reimplantes de punta de dedo. Se registraron variables pre, intra y postoperatorias y de seguimiento. Resultados preliminares: 8 casos fueron reimplantes en las zonas I y II. Tiempo promedio de isquemia: 5,1 hs, promedio de edad 39,5. Se reimplantaron: 2 pulgares, 2 índices, 2 medios y 2 anulares, 6 dedos del lado derecho y 2 dedos del lado izquierdo. 5 reimplantes en zona II y 3 en zona I. El mecanismo de trauma más frecuente fue avulsión, seguido de aplastamiento. En todos los casos se logro hacer una anastomosis arterial. En cinco pacientes no se logro hacer una anastomosis venosa. No se observó estandarización el esquema antitrombótico ni en la estrategia para manejar la congestión venosa. Cinco reimplantes fueron exitosos. Todos los pacientes durante el primer año fueron tratados con fisioterapia. A pesar de que los pacientes reportan perdida de la movilidad comparativa con el dedo contralateral, ninguno reportó molestias a causa de este déficit o alteraciones en la sensibilidad que impactaran negativamente su calidad de vida. Discusión: se requieren estudios prospectivos para evaluar los resultados objetivamente y estandarizar el protocolo de reimplantes en la FSFB.

The pattern of fall of serum bilirubin after operative relief of obstructive jaundice. A preliminary report

This is the beginning of a prospective study on patients who have obstructive jaundice to see how the serum bilirubin falls after operative relief of the obstruction. Seven of such patients have been studied; four had carcinoma of the head of the pancreas while the other three had choledocholithiasis. The patients with carcinoma had relief of the jaundice through a biliary-enteric anastomosis and those with common bile duct stones had choledochotomy with stone extraction which was completed with insertion of a T-tube. Serial bilirubin estimations were then performed post-operatively to chart the pattern and rate of descent of this in each patient. Our observations suggest that the pattern of fall of serum bilirubin after successful decompression of the extra-hepatic biliary tree exhibit a distinct pattern regardless of the surgical procedure performed for the relief of the obstruction.

Análisis de los informes emitidos por Human Rights Watch y su incidencia en la firma y ratificación del tratado de libre comercio entre Estados Unidos y Colombia: estudio de caso periodo 2002-2008

Este artículo tiene como objetivo analizar, la incidencia que tienen actualmente las ONG s internacionales sobre la toma de decisiones de los gobiernos de diferentes Estados. Con el fin de hacer más específico dicho análisis, el trabajo se centra en el estudio del caso de la firma del Tratado de Libre Comercio entre Estados Unidos cuyo proceso, según se explica a lo largo del texto, se vio afectado de manera significativa por la acción de Human Rights Watch. El artículo presenta una exposición de la mecánica política requerida para la aprobación de este tipo de tratados en ambos países involucrados, así como la forma en que las asimetrías de poder entre ellos abrieron el campo a la acción de Human Rights Watch.

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

Desenvolupament i caracterització d'aliatges de base ferro produïts per aliatge mecànic i solidificació ràpida

L'objectiu general d'aquest treball és l'obtenció de nous materials nanoestructurats magnètics tous produïts mitjançant la tècnica de l'aliatge mecànic. Forma part d'un projecte més ampli de desenvolupament d'aquests tipus d'aliatges amb altres tècniques, com les de solidificació ràpida, i la seva posterior molturació i compactació per a l'aplicació a la indústria pulverimetal·lúrgica. Aquests materials tindran una estructura amorfa i/o nanocristal·lina que comportarà una millora de les seves propietats magnètiques. Els objectius particulars d'aquest treball són: - Síntesi d'aliatges de Fe-Ni-Zr-B-(Co), Fe-Nb-B-(Cu), i Fe-Ni-Nb-B mitjançant aliatge mecànic. Es parteix de precursors cristal·lins i es tracta d'obtenir un aliatge bàsicament nanocristal·lí. En concret, es pretén obtenir aliatges: ·Amb una alta estabilitat tèrmica que afavoreixi posteriors estudis de consolidació. ·Amb la presència de nanocristalls de reduïdes dimensions o d'una fase amorfa que permeti posteriors tractaments tèrmics per a produir aliatges de nanoestructura controlada. -Comparació entre les mostres produïdes per aliatge mecànic amb diferents micromolins de les mostres Fe-Nb-B. Els micromolins utilitzats són un P7 i un SPEX 8000 -Estudi de la influència dels diferents precursors i de la quantitat relativa dels mateixos que s'ha utilitzat per a cada mostra, concretament: ·La substitució en els aliatges de Fe-Nb-B de Fe per Ni, tot i que interessa que els aliatges tinguin una alta quantitat de ferro perquè tingui millors propietats magnètiques. ·La substitució en els aliatges de Fe-Ni-Zr-B de Fe per Co. ·La inclusió de Cu en les mostres Fe-Nb-B ·La comparació entre els aliatges amb Nb i amb Ni-Zr -Modelització del comportament termodinàmic d'equilibri dels compostos Fe-Nb-B, mitjançant software de minimització de l'energia lliure dels diferents elements. S'han utilitzat una sèrie de tècniques analítiques per a avaluar l'estabilitat tèrmica i realitzar la caracterització estructural dels aliatges obtinguts. Anàlisi de l'estabilitat tèrmica mitjançant anàlisi calorimètrica diferencial (DSC) i termogravimetria (TG). També s'analitzarà la cinètica de cristal·lització mitjançant tractaments isotèrmics i dinàmics. -Anàlisi morfològic de les diferents mostres per microscòpia electrònica de rastreig (SEM) i caracterització estructural de les diferents fases presents i de les diferents microestructures obtingudes mitjançant difracció de raigs X XRD)i microscòpia electrònica de transmissió(TEM). S'identificaran les diferents fases presents i es calcularan els diferents paràmetres de cel·la, així com la dimensió de les microestructures. L'anàlisi microestructural es complementarà amb algunes mesures 'espectroscòpia Mössbauer de transmissió (TMS)

Characterization and origin of infection of Rhizoctonia solani associated with Brassica oleracea crops in the UK

An extensive study was conducted to determine where in the production chain Rhizoctonia solani became associated with UK module-raised Brassica oleracea plants. In total, 2600 plants from 52 crops were sampled directly from propagators and repeat sampled from the field. Additional soil, compost and water samples were collected from propagation nurseries and screened using conventional agar isolation methods. No isolates of R. solani were recovered from any samples collected from propagation nurseries. Furthermore, nucleic acid preparations from samples of soil and compost from propagation nurseries gave negative results when tested for R. solani using real-time PCR. Conversely, R. solani was recovered from 116 of 1300 stem bases collected from field crops. All the data collected suggested R. solani became associated with B. oleracea in the field rather than during propagation. Parsimony and Bayesian phylogenetic studies of ribosomal DNA suggested the majority of further classified isolates belonged to anastomosis groups 2-1 (48/57) and AG-4HGII (8/57), groups known to be pathogenic on Brassica spp. in other countries. Many R. solani isolates were recovered from symptomless plant material and the possibilities for such an association are discussed.

Molecular tools to investigate Rhizoctonia solani distribution in soil

Real-time PCR protocols were developed to detect and discriminate 11 anastomosis groups (AGs) of Rhizoctonia solani using ribosomal internal transcribed spacer (ITS) regions (AG-1-IA, AG-1-IC, AG-2-1, AG-2-2, AG-4HGI+II, AG-4HGIII, AG-8) or beta-tubulin (AG-3, AG-4HGII, AG-5 and AG-9) sequences. All real-time assays were target group specific, except AG-2-2, which showed a weak cross-reaction with AG-2tabac. In addition, methods were developed for the high throughput extraction of DNA from soil and compost samples. The DNA extraction method was used with the AG-2-1 assay and shown to be quantitative with a detection threshold of 10-7 g of R. solani per g of soil. A similar DNA extraction efficiency was observed for samples from three contrasting soil types. The developed methods were then used to investigate the spatial distribution of R. solani AG-2-1 in field soils. Soil from shallow depths of a field planted with Brassica oleracea tested positive for R. solani AG-2-1 more frequently than soil collected from greater depths. Quantification of R. solani inoculum in field samples proved challenging due to low levels of inoculum in naturally occurring soils. The potential uses of real-time PCR and DNA extraction protocols to investigate the epidemiology of R. solani are discussed.

The N-terminal SH2 domain of Syk is required for (hem)ITAM, but not integrin, signaling in mouse platelets

We have used a novel knockin mouse to investigate the effect of disruption of phosphotyrosine binding of the N-terminal SH2 domain of Syk on platelet activation by GPVI, CLEC-2, and integrin αIIbβ3. The Syk(R41Afl/fl) mouse was crossed to a PF4-Cre(+) mouse to induce expression of the Syk mutant in the megakaryocyte/platelet lineage. Syk(R41Afl/fl;PF4-Cre) mice are born at approximately 50% of the expected frequency and have a similar phenotype to Syk(fl/fl;PF4-Cre) mice, including blood-lymphatic mixing and chyloascites. Anastomosis of the venous and lymphatic vasculatures can be seen in the mesenteric circulation accounting for rapid and continuous mixing of the 2 vasculatures. Platelet activation by CLEC-2 and GPVI is abolished in Syk(R41Afl/fl;PF4-Cre) platelets. Syk phosphorylation on Tyr519/20 is blocked in CLEC-2-stimulated platelets, suggesting a model in which binding of Syk via its N-terminal SH2 domain regulates autophosphorylation. In contrast, outside-in signaling by integrin αIIbβ3 is not altered, but it is inhibited in the presence of inhibitors of Src and Syk tyrosine kinases. These results demonstrate that αIIbβ3 regulates Syk through an ITAM-independent pathway in mice and provide novel insight into the course of events underlying Syk activation and hemITAM phosphorylation by CLEC-2.

Effect of hydrophobic plasticizers on functional properties of gelatin-based films

The aim of this study was the production and characterization of gelatin-based films using hydrophobic plasticizers derived from citric acid and soy lecithin as emulsifier. The films were characterized as to their mechanic properties, permeability to water vapor, opacity, morphology and possible interactions using Fourier transform infrared spectroscopy. Tensile strength values (TS) varied from 36 to 103 MPa, how-ever, the increase in the concentration of plasticizers (acetyltributyl citrate and tributyl citrate) reduced TS by 57% and no relation was observed between plasticizer quantities and the elongation in the quantities tested. Permeability to water vapor varied between 0.17 and 0.34 (g mm/m(2) h kPa), slightly increasing with the increase in concentration of plasticizers. The effectiveness in the use of soy lecithin emulsifier in the homogenization between the compounds could be proven by microscopic observation using confocal laser microscopy. (C) 2009 Elsevier Ltd. All rights reserved.

POLYGLYCOLIC ACID TUBE ASSOCIATED WITH GM1 IN REGENERATION OF PERIPHERAL NERVES

Introduction: Nerve allografting is regarded as a treatment of choice in large neural tissue losses preventing repair by primary anastomosis. In these cases, a synthetic polyglycolic acid tube is an alternative for nerve grafting. On the other hand, several studies have emphasized the importance of neurotrophic factors on neural regeneration, including substances with potential to optimize neural regeneration, especially the GM1, an neurotrophic enhancer factor. Objective: to compare, in rats, the neural regeneration degree using histological analysis, regenerated myelinized axons count, and functional analysis with the use of neurotube and GM1. Methods: This assessment was performed by interposing allograft (group A), polyglycolic acid tube (group B) and polyglycolic acid tube associated to GM1 (group C) on 5-mm sciatic nerve defects. Results: Neuroma formation was found only on group A. Groups A and C showed similar histological patterns, except for the regenerated axons on group C, which were shown to be better organized and myelinized than in group A. Conclusion: on functional recovery, no statistically significant difference was found for the three groups, despite of qualitative and quantitative histological differences found.

Preventive and curative glycoside kaempferol treatments attenuate the TH2-driven allergic airway disease

Asthma is a chronic respiratory disease characterized by airway inflammation and airway hyperresponsiveness (AHR). One strategy to treat allergic diseases is the development of new drugs. Flavonoids are compounds derived from plants and are known to have antiallergic, anti-inflammatory, and antioxidant properties. To investigate whether the flavonoid kaempferol glycoside 3-O-[beta-D-glycopiranosil-(1 -> 6)-alpha-L-ramnopiranosil]-7-O-alpha-L-ramnopiranosil-kaempferol (GRRK) would be capable of modulating allergic airway disease (AAD) either as a preventive (GRRK P) or curative (GRRK C) treatment in an experimental model of asthma. At weekly intervals, BALB/c mice were subcutaneously (sc) sensitized twice with ovalbumin (OVA)/alum and challenged twice with OVA administered intranasally. To evaluate any preventive effects GRRK was administered 1 h (hour) before each OVA-sensitization and challenge, while to analyze the curative effects mice were first sensitized with OVA, followed by GRRK given at day 18 through 21. The onset: of AAD was evaluated 24 h after the last OVA challenge. Both treatments resulted in a dose-dependent reduction in total leukocyte and eosinophil counts in the bronchoalveolar lavage fluid (BAL). GRRK also decreased CD4(+), B220(+), MHC class II and CD40 molecule expressions in BAL cells. Histology and lung mechanic showed that GRRK suppressed mucus production and ameliorated the AHR induced by OVA challenge. Furthermore, GRRK impaired Th2 cytokine production (IL-5 and IL-13) and did not induce a Th1 pattern of inflammation. These findings demonstrate that GRRK treatment before or after established allergic lung disease down-regulates key asthmatic features. Therefore. GRRK has a potential clinical use for the treatment of allergic asthma. (C) 2009 Elsevier B.V. All rights reserved.

Game-based Learning (Interactive Demo)

What does the lesson “Finding Citations,” the game “Trivial Pursuit,” and the mechanic “Bluffing” all have in common? In this bootcamp brainstorm facilitated by a CUNY professor, attendees are broken up into design teams whose job it is to enhance a traditional lesson with the mechanics of popular board games in only 20 minutes. Whether you have to teach the rules of citation or the rules of interviewing, there is usually a game plan that can help. This game teaches you how to integrate educational games into your classroom, while providing a fun introduction to the principles of game-based learning.

ANALYSIS & STUDY OF AI TECHNIQUES FORAUTOMATIC CONDITION MONITORING OFRAILWAY TRACK INFRASTRUCTURE : Artificial Intelligence Techniques

Since the last decade the problem of surface inspection has been receiving great attention from the scientific community, the quality control and the maintenance of products are key points in several industrial applications.The railway associations spent much money to check the railway infrastructure. The railway infrastructure is a particular field in which the periodical surface inspection can help the operator to prevent critical situations. The maintenance and monitoring of this infrastructure is an important aspect for railway association.That is why the surface inspection of railway also makes importance to the railroad authority to investigate track components, identify problems and finding out the way that how to solve these problems. In railway industry, usually the problems find in railway sleepers, overhead, fastener, rail head, switching and crossing and in ballast section as well. In this thesis work, I have reviewed some research papers based on AI techniques together with NDT techniques which are able to collect data from the test object without making any damage. The research works which I have reviewed and demonstrated that by adopting the AI based system, it is almost possible to solve all the problems and this system is very much reliable and efficient for diagnose problems of this transportation domain. I have reviewed solutions provided by different companies based on AI techniques, their products and reviewed some white papers provided by some of those companies. AI based techniques likemachine vision, stereo vision, laser based techniques and neural network are used in most cases to solve the problems which are performed by the railway engineers.The problems in railway handled by the AI based techniques performed by NDT approach which is a very broad, interdisciplinary field that plays a critical role in assuring that structural components and systems perform their function in a reliable and cost effective fashion. The NDT approach ensures the uniformity, quality and serviceability of materials without causing any damage of that materials is being tested. This testing methods use some way to test product like, Visual and Optical testing, Radiography, Magnetic particle testing, Ultrasonic testing, Penetrate testing, electro mechanic testing and acoustic emission testing etc. The inspection procedure has done periodically because of better maintenance. This inspection procedure done by the railway engineers manually with the aid of AI based techniques.The main idea of thesis work is to demonstrate how the problems can be reduced of thistransportation area based on the works done by different researchers and companies. And I have also provided some ideas and comments according to those works and trying to provide some proposal to use better inspection method where it is needed.The scope of this thesis work is automatic interpretation of data from NDT, with the goal of detecting flaws accurately and efficiently. AI techniques such as neural networks, machine vision, knowledge-based systems and fuzzy logic were applied to a wide spectrum of problems in this area. Another scope is to provide an insight into possible research methods concerning railway sleeper, fastener, ballast and overhead inspection by automatic interpretation of data.In this thesis work, I have discussed about problems which are arise in railway sleepers,fastener, and overhead and ballasted track. For this reason I have reviewed some research papers related with these areas and demonstrated how their systems works and the results of those systems. After all the demonstrations were taking place of the advantages of using AI techniques in contrast with those manual systems exist previously.This work aims to summarize the findings of a large number of research papers deploying artificial intelligence (AI) techniques for the automatic interpretation of data from nondestructive testing (NDT). Problems in rail transport domain are mainly discussed in this work. The overall work of this paper goes to the inspection of railway sleepers, fastener, ballast and overhead.