Correlación y concordancia entre ecocardiografía y cateterismo cardiaco derecho para determinación de la presión sistólica de arteria pulmonar

Introducción. El cateterismo cardiaco derecho representa el estándar de referencia para el diagnóstico de hipertensión pulmonar, sin embargo el rendimiento de la ecocardiografía como estudio inicial ha mostrado buena correlación con las variables medidas por cateterismo. El presente estudio pretende describir el grado de correlación y concordancia entre la ecocardiografía y el cateterismo cardiaco derecho para la medición de la presión sistólica de la arteria pulmonar. Materiales y métodos. Se realizó un estudio observacional retrospectivo de los pacientes sometidos a cateterismo cardiaco derecho entre los años 2009 a 2014 y se compararon con los datos de ecocardiograma más cercano a este cateterismo, teniendo en cuenta la presión sistólica de la arteria pulmonar (PSAP) en las dos modalidades diagnósticas mediante correlación y concordancia estadística según los coeficientes de Pearson y el índice de Lin respectivamente. Resultados. Se recolectaron un total de 169 pacientes con un índice de correlación (r) obtenido para la medición de PSAP del total de la muestra de 0.73 p < 0.0001 mostrando un grado de correlación alto para toda la muestra evaluada. El análisis de concordancia obtenido para toda la población a partir del índice de Lin fue de 0.71 lo que determinó una pobre concordancia. Discusión. Se encontró buena correlación entre ecocardiografía y cateterismo cardiaco derecho para la medición de la PSAP, sin embargo la concordancia entre los métodos diagnósticos es pobre, por tanto el ecocardiograma no reemplaza al cateterismo cardiaco derecho como estudio de elección para diagnóstico y seguimiento de pacientes con hipertensión pulmonar.

Relación entre el desarrollo de sistemas de control de gestión y los recursos y capacidades caso : Teleperformance Colombia

Siguiendo un marco teórico integrado por varios autores entorno a los sistemas de control de gestión a lo largo de varias décadas, este trabajo pretende estudiar y contrastar la relación entre el desarrollo de dichos sistemas y los recursos y capacidades. Para tal fin, se desarrolló un estudio de caso en Teleperformance Colombia (TC), una empresa dedicada a prestación de servicio de tercerización de procesos o business process outsourcing. En el estudio se establecieron dos variables para evaluar el desarrollo de sistema de control de gestión: el diseño y el uso. A su vez, para cada uno de ellos, se definieron los indicadores y preguntas que permitieran realizar la observación y posterior análisis. De igual manera, se seleccionaron los recursos y capacidades más importantes para el desarrollo del negocio: innovación, aprendizaje organizacional y capital humano. Sobre estos se validó la existencia de relación con el SCG implementado en TC. La información obtenida fue analizada y contrastada a través de pruebas estadísticas ampliamente utilizadas en este tipo de estudios en las ciencias sociales. Finalmente, se analizaron seis posibles relaciones de las cuales, solamente se ratificó el relacionamiento positivo entre uso de sistema de control gestión y el recurso y capacidad capital humano. El resto de relacionamientos, refutaron los planteamientos teóricos que establecían cierta influencia de los sistemas de control de gestión sobre recursos y capacidades de innovación y aprendizaje organizacional.

Impacto financiero de la unificación del plan obligatorio de salud subsidiado (pos-s) en las empresas sociales del estado (ese) de mediana complejidad de Cundinamarca

A partir de la Ley 100 de 1993, el sistema de salud en Colombia ha presentado una serie de trasformaciones que buscan mejorar la prestación de los servicios y lograr cubrimiento de la población no favorecida y excluida del Plan Obligatorio de Salud (POS). Sin embargo, las Empresas sociales del Estado (ESE), en aras de dar cumplimiento a las disposiciones y normatividades que exige la ley, funcionan y prestan sus servicios acorde con los objetivos corporativos planteados por ellas mismas, a pesar de tener una gran cartera por parte de las Entidades Promotoras de Salud (EPS). El propósito de esta investigación es evaluar el impacto financiero en una muestra de cuatro hospitales públicos de Cundinamarca (las ESE San Rafael de Facatativá, Fusagasugá, Cáqueza, y el Salvador de Ubaté), luego de la aplicación del Acuerdo 032 del 2012 de la Comisión de Regulación en Salud (CRES). Se seleccionaron cuatro hospitales públicos de mediana complejidad de Cundinamarca, por ser uno de los departamentos más representativos en hospitales de este tipo. Se encontró una mayor convergencia en términos de estructura administrativa y financiera, lo que hace posible que la información obtenida sea comparable y útil para la medición en términos de presupuesto y liquidez. El incremento de la cartera y la disminución de la rotación de la misma, con la afectación respectiva de la liquidez y la rentabilidad, dificultan el logro de las instituciones como lo son la sostenibilidad y perdurabilidad. El cambio del pagador después de la aplicación de la norma incidió directamente en lo anterior; igualmente, traspasar la población no cubierta al régimen subsidiado eliminó el desembolso por parte de la Secretaría de Salud y lo trasladó a las EPS subsidiados, afectando directamente los tiempos de rotación de cartera como se documenta en el análisis.

SPARTIAN: Propuesta de mejoramiento de la gestión comercial de la empresa Wholesale and Retail Place LLC

El propósito básico de este proyecto es optimizar el proceso de ventas de la empresa internacional Wholesale and Retail Place LLC a través de una solución tecnológica. Para esto, se busca diagnosticar los procesos de gestión comercial de la empresa a través de indicadores que permitan medir su situación actual, con el propósito de implementar una aplicación móvil que se articule con la fuerza comercial que apoya el proceso de ventas, y se genere un impacto positivo en los indicadores formulados después de la aplicación de la herramienta móvil.

Validity evidence based on internal structure

Resumen tomado de la publicación

La Hipertensió arterial a la pràctica: optimització de la mesura de la pressió arterial i de l'avaluació de l'afectació dels òrgans diana

Objectius: a) avaluar la utilitat de la mesura de la pressió arterial a la consulta pel diplomat d'infermeria; b) establir quin és el punt de tall pel valor normal de l'automesura de la pressió arterial al domicili del propi malalt; c) determinar si l'exploració del fons d'ull als malalts hipertensos permet una millor estratificació del risc cardiovascular. Resultats: a) primer objectiu: els valors de la PAC de la infermera són molt similars a l'AMPA i les decisions s'han de prendre en funció d'aquesta mesura. b) segon objectiu: el risc de presentar alguna AOD en els hipertensos recent diagnosticats amb hipertensió clínica aïllada passa de forma progressiva d'una OR de 2.5 per un punt de tall de <125/80 mmHg a una OR de 4.0 pel punt de tall <135/85 mmHg. c) tercer objectiu: un nombre significatiu de pacients canvien de grup de risc quan es consideren els resultats de l'exploració del fons d'ull.

Referencing of street-level flows measured during the DAPPLE 2004 campaign

Street-level mean flow and turbulence govern the dispersion of gases away from their sources in urban areas. A suitable reference measurement in the driving flow above the urban canopy is needed to both understand and model complex street-level flow for pollutant dispersion or emergency response purposes. In vegetation canopies, a reference at mean canopy height is often used, but it is unclear whether this is suitable for urban canopies. This paper presents an evaluation of the quality of reference measurements at both roof-top (height = H) and at height z = 9H = 190 m, and their ability to explain mean and turbulent variations of street-level flow. Fast response wind data were measured at street canyon and reference sites during the six-week long DAPPLE project field campaign in spring 2004, in central London, UK, and an averaging time of 10 min was used to distinguish recirculation-type mean flow patterns from turbulence. Flow distortion at each reference site was assessed by considering turbulence intensity and streamline deflection. Then each reference was used as the dependent variable in the model of Dobre et al. (2005) which decomposes street-level flow into channelling and recirculating components. The high reference explained more of the variability of the mean flow. Coupling of turbulent kinetic energy was also stronger between street-level and the high reference flow rather than the roof-top. This coupling was weaker when overnight flow was stratified, and turbulence was suppressed at the high reference site. However, such events were rare (<1% of data) over the six-week long period. The potential usefulness of a centralised, high reference site in London was thus demonstrated with application to emergency response and air quality modelling.

The influence of project complexity on estimating accuracy

With the rapid development in technology over recent years, construction, in common with many areas of industry, has become increasingly complex. It would, therefore, seem to be important to develop and extend the understanding of complexity so that industry in general and in this case the construction industry can work with greater accuracy and efficiency to provide clients with a better service. This paper aims to generate a definition of complexity and a method for its measurement in order to assess its influence upon the accuracy of the quantity surveying profession in UK new build office construction. Quantitative data came from an analysis of twenty projects of varying size and value and qualitative data came from interviews with professional quantity surveyors. The findings highlight the difficulty in defining and measuring project complexity. The correlation between accuracy and complexity was not straightforward, being subjected to many extraneous variables, particularly the impact of project size. Further research is required to develop a better measure of complexity. This is in order to improve the response of quantity surveyors, so that an appropriate level of effort can be applied to individual projects, permitting greater accuracy and enabling better resource planning within the profession.

High resolution simulation of recent Arctic and Antarctic stratospheric chemical ozone loss compared to observations

Simulations of polar ozone losses were performed using the three-dimensional high-resolution (1∘ × 1∘) chemical transport model MIMOSA-CHIM. Three Arctic winters 1999–2000, 2001–2002, 2002–2003 and three Antarctic winters 2001, 2002, and 2003 were considered for the study. The cumulative ozone loss in the Arctic winter 2002–2003 reached around 35% at 475 K inside the vortex, as compared to more than 60% in 1999–2000. During 1999–2000, denitrification induces a maximum of about 23% extra ozone loss at 475 K as compared to 17% in 2002–2003. Unlike these two colder Arctic winters, the 2001–2002 Arctic was warmer and did not experience much ozone loss. Sensitivity tests showed that the chosen resolution of 1∘ × 1∘ provides a better evaluation of ozone loss at the edge of the polar vortex in high solar zenith angle conditions. The simulation results for ozone, ClO, HNO3, N2O, and NO y for winters 1999–2000 and 2002–2003 were compared with measurements on board ER-2 and Geophysica aircraft respectively. Sensitivity tests showed that increasing heating rates calculated by the model by 50% and doubling the PSC (Polar Stratospheric Clouds) particle density (from 5 × 10−3 to 10−2 cm−3) refines the agreement with in situ ozone, N2O and NO y levels. In this configuration, simulated ClO levels are increased and are in better agreement with observations in January but are overestimated by about 20% in March. The use of the Burkholder et al. (1990) Cl2O2 absorption cross-sections slightly increases further ClO levels especially in high solar zenith angle conditions. Comparisons of the modelled ozone values with ozonesonde measurement in the Antarctic winter 2003 and with Polar Ozone and Aerosol Measurement III (POAM III) measurements in the Antarctic winters 2001 and 2002, shows that the simulations underestimate the ozone loss rate at the end of the ozone destruction period. A slightly better agreement is obtained with the use of Burkholder et al. (1990) Cl2O2 absorption cross-sections.

Triple isotope (δD, δ17O, δ18O) study on precipitation, drip water and speleothem fluid inclusions for a central European cave (NW Switzerland)

Deuterium (dD) and oxygen (d18O) isotopes are powerful tracers of the hydrological cycle and have been extensively used for paleoclimate reconstructions as they can provide information on past precipitation, temperature and atmospheric circulation. More recently, the use of 17Oexcess derived from precise measurement of d17O and d18O gives new and additional insights in tracing the hydrological cycle whereas uncertainties surround this proxy. However, 17Oexcess could provide additional information on the atmospheric conditions at the moisture source as well as about fractionations associated with transport and site processes. In this paper we trace water stable isotopes (dD, d17O and d18O) along their path from precipitation to cave drip water and finally to speleothem fluid inclusions for Milandre cave in northwestern Switzerland. A two year-long daily resolved precipitation isotope record close to the cave site is compared to collected cave drip water (3 months average resolution) and fluid inclusions of modern and Holocene stalagmites. Amount weighted mean dD, d18O and d17O are �71.0‰, �9.9‰, �5.2‰ for precipitation, �60.3‰, �8.7‰, �4.6‰ for cave drip water and �61.3‰, �8.3‰, �4.7‰ for recent fluid inclusions respectively. Second order parameters have also been derived in precipitation and drip water and present similar values with 18 per meg for 17Oexcess whereas d-excess is 1.5‰ more negative in drip water. Furthermore, the atmospheric signal is shifted towards enriched values in the drip water and fluid inclusions (D of ~ þ 10‰ for dD). The isotopic composition of cave drip water exhibits a weak seasonal signal which is shifted by around 8e10 months (groundwater residence time) when compared to the precipitation. Moreover, we carried out the first d17O measurement in speleothem fluid inclusions, as well as the first comparison of the d17O behaviour from the meteoric water to the fluid inclusions entrapment in speleothems. This study on precipitation, drip water and fluid inclusions will be used as a speleothem proxy calibration for Milandre cave in order to reconstruct paleotemperatures and moisture source variations for Western Central Europe.

Multiscale Curvature Analysis of Asphaltic Aggregate Particles

A new method for characterization and analysis of asphaltic mixtures aggregate particles is reported. By relying on multiscale representation of the particles, curvature estimation, and discriminant analysis for optimal separation of the categories of mixtures, a particularly effective and comprehensive methodology is obtained. The potential of the methodology is illustrated with respect to three important types of particles used in asphaltic mixtures, namely basalt, gabbro, and gravel. The obtained results show that gravel particles are markedly distinct from the other two types of particles, with the gabbro category resulting with intermediate geometrical properties. The importance of each considered measurement in the discrimination between the three categories of particles was also quantified in terms of the adopted discriminant analysis.

Fabrication of disposable voltammetric electronic tongues by using Prussian Blue films electrodeposited onto CD-R gold surfaces and recognition of milk adulteration

A new approach to fabricate a disposable electronic tongue is reported. The fabrication of the disposable sensor aimed the integration of all electrodes necessary for measurement in the same device. The disposable device was constructed with gold CD-R and copper sheets substrates and the sensing elements were gold, copper and a gold surface modified with a layer of Prussian Blue. The relative standard deviation for signals obtained from 20 different disposable gold and 10 different disposable copper electrodes was below 3.5%. The performance, electrode materials and the capability of the device to differentiate samples were evaluated for taste substances model, milk with different pasteurization processes (homogenized/pasteurized, ultra high temperature (UHT) pasteurized and UHT pasteurized with low fat content) and adulterated with hydrogen peroxide. In all analysed cases, a good separation between different samples was noticed in the score plots obtained from the principal component analysis (PCA). Crown Copyright (C) 2008 Published by Elsevier B.V. All rights reserved.

Mensuração de Capacidade Tecnológica no Contexto de Industrialização Recente: Uma Breve Reflexão Crítica Sobre Taxonomias e Evidências de Pesquisas Recentes

This dissertation aims at examining empirical evidences obtained in the light of taxonomies and strategies for measuring firms technological capabilities and innovation in the context of developing countries, motivated by the fact that debates and studies directed to innovation has been intensified, for the last thirty years, by the recognition of its vital and growing importance to the technological, economic, competitive and industrial development of firms and countries. Two main tendencies can be identified on this debate. At one side, it¿s the literature related to the developed countries logic, whose companies are, in majority, positioned at the technological frontier, characterized by the domain of innovative advanced capabilities, directed to its sustaining, deepening and renewal. At the other side, there are the perspectives directed to the developing countries reality, where there is a prevalence of companies with deficiency of resources, still in process of accumulating basic and intermediate technological capabilities, with characteristics and technological development trajectories distinct or even reverse from those of developing countries. From this last tradition of studies, the measuring approaches based in C&T indicators and in types and levels of technological capabilities stand out. The first offers a macro level, aggregated perspective, through the analysis of a representative sample of firms, seeking to the generation of internationally comparable data, without addressing the intraorganizational specificities and nuances of the paths of technological accumulation developed by the firms, using, mostly, R&D statistics, patents, individual qualifications, indicators that carry their own limitations. On the other hand, studies that examine types and levels of technological capabilities are scarce, usually directed to a small sample of firms and/or industrial sectors. Therefore, in the light of the focus and potentialities of each of the perspectives, this scenario exposes a lack of studies that examine, in a parallel and complementary way, both types of strategies, seeking to offer more realistic, consistent and concrete information about the technological reality of developing countries. In order to close this gap, this dissertation examines (i) strategies of innovation measurement in the contexts of developing countries based on traditional approaches and C&T indicators, represented by four innovation surveys - ECIB, PINTEC, PAEP and EAI, and, (ii) from the perspective of technological capabilities as an intrinsic resource of the firm, the development of which occurs in a cumulative way and based on learning, presents and extracts generalizations of empirical applications of a metric that identifies types and levels of technological capabilities, through a dynamic and intra-firm perspective. The exam of the empirical evidences of the two approaches showed what each one of the metrics are capable to offer and the way they can contribute to the generation of information that reflect the technological development of specific industrial sectors in developing countries. In spite of the fact that the focus, objective, perspective, inclusion, scope and lens used are substantially distinct, generating, on a side, an aggregated view, and of other, an intra-sector, intra-organizational and specific view, the results suggest that the use of one doesn't implicate discarding or abdicating the other. On the contrary, using both in a complementary way means the generation of more complete, rich and relevant evidences and analysis that offer a realistic notion of the industrial development and contribute in a more direct way to the design of corporate strategies and government policies, including those directed to the macro level aspects just as those more specific and focused, designed to increment and foment firms in-house innovative efforts.

Participação nos lucros ou resultados nas empresas estatais federais: questões emergentes, problemas e desafios

Esta dissertação é um estudo de caso exploratório sobre a atuação do Departamento de Coordenação e Governança das Empresas Estatais (DEST), vinculado à Secretaria-Executiva do Ministério do Planejamento, Orçamento e Gestão, na análise e na aprovação das propostas de participação nos lucros ou resultados (PLR) dos empregados das empresas estatais em que a União é acionista majoritária. Quatro empresas estatais que apresentaram propostas de PLR para o exercício de 2008 foram selecionadas qualitativamente. As informações coletadas a partir das propostas das empresas, de documentos oficiais do DEST se manifestando sobre o assunto, do marco legal existente e das entrevistas com representantes do órgão foram analisadas criticamente com base na teoria da agência, da literatura sobre mensuração de desempenho no setor público, das reformas administrativas no Brasil e dos pressupostos do novo institucionalismo. Com isso, foi possível: (i) analisar o DEST e o marco legal da PLR enquanto as instituições intermediando o processo entre as propostas e as aprovações; (ii) caracterizar as preferências do DEST em relação aos programas de PLR; (iii) caracterizar as propostas de PLR das empresas estatais; (iv) caracterizar os resultados que as instituições em consideração estão produzindo; (v) analisar os fatores limitantes e/ou facilitadores para o funcionamento das instituições; e (vi) levantar as percepções de ex- e atuais envolvidos no processo de análise e aprovação das propostas no DEST acerca da PLR nas empresas estatais enquanto instrumento de incentivo à produtividade. Como resultado, verificou-se (i) que as aprovações do DEST refletem apenas parcialmente as preferências do órgão com relação ao formato dos programas e (ii) que a atuação do DEST varia de intensidade entre os eixos que compõem os programas (seleção de indicadores, estabelecimento de metas, definição do montante e forma de sua distribuição).

A gestão do poder judiciário uma análise do sistema de mensuração de desempenho do judiciário brasileiro

Esta dissertação traz uma análise do atual sistema de mensuração de desempenho do Poder Judiciário brasileiro, mais especificamente no tocante ao processo que visa à disseminação e a incorporação da prática da mensuração na cultura organizacional das unidades judiciárias de todo o país. Após análise bibliográfica e documental, é tomada a experiência de mensuração do desempenho judiciário dos países europeus como referência comparativa ao sistema brasileiro, bem como são consideradas percepções de gestores deste sistema com relação a seus entendimentos acerca da gestão e mensuração de desempenho no Judiciário, aos esforços políticos e administrativos adotados, ao possível futuro do sistema, dentre outras. Uma vez que esta representa uma primeira experiência no sentido da adoção da mensuração de desempenho judiciário enquanto política nacional, o estudo também discute a natureza de problemas estruturais e organizacionais a serem trabalhados no Judiciário brasileiro visando à prática da mensuração, além da necessidade de uma padronização em processos administrativos ligados a esta prática nas heterogêneas organizações judiciárias brasileiras.