Capacidad de respuesta hospitalaria distrital en Bogotá ante un evento con múltiples victimas

Los hospitales son el pilar fundamental para la atención de las víctimas de situaciones de emergencia o desastre. Las instituciones de salud son consideradas indispensables para la población, por lo que deben estar preparadas para funcionar no solo en condiciones normales sino en situaciones de alerta, como suele suceder en desastres de origen natural como los sismos. La relevancia de la problemática, radica en que de acuerdo con la amenaza sísmica de Colombia, Bogotá se encuentra en una zona de amenaza sísmica intermedia, los actuales eventos naturales como el terremoto de Haití con un saldo de 300.000 muertos y más de 700.000 mil heridos, y el de Chile, nos hace pensar en la importancia de la preparación hospitalaria ante un evento con múltiples víctimas como lo es un sismo. El Objetivo general del estudio es identificar la capacidad de respuesta hospitalaria distrital en Bogotá ante un evento con múltiples víctimas (terremoto). Además se identificaran las oportunidades de mejora para optimizar la respuesta hospitalaria de acuerdo a su nivel de atención. La Investigación se realizó por medio de un estudio de corte transversal, en donde se tomó una muestra de la red hospitalaria Distrital por conveniencia, bajo la aplicación de una encuesta dirigida. Los resultados fueron recopilados en una base de datos de Excel 2013, y fueron analizados bajo un software estadístico, STATA 12.0, donde se evaluaron variables, categóricas, nominales y cuantitativas. Como resultados se encontraron un porcentaje de ocupación de más del 100% en el 25% de los hospitales. Los 16 hospitales encuestados cuentan con comité hospitalario de emergencias, así como también con la elaboración de planes de emergencia y la revisión e implementación de estos. El 50% de los hospitales contemplan dentro su estructura de plan de emergencias, el sistema comando de incidentes; Sólo el 18.8% de los hospitales cuentan con reforzamiento estructural, y el 81,2% de los hospitales refieren tener una cooperación con organizaciones locales o externas. Solo 4 de los 16 hospitales cuentan con protocolos de diagnóstico y tratamiento médico en desastres. El plan de contingencia para un Sismo, es el plan bandera de todos los hospitales dado el esfuerzo por parte de la secretaria de salud y de FOPAE en información y capacitación en todo el Distrito, es por eso que el 93,85 de todos los hospitales cuentan con este plan. Al realizar el análisis general, la red hospitalaria no está en capacidad de una adecuada respuesta en caso de un evento con múltiples víctimas, en el escenario de un sismo de gran magnitud, teniendo en cuenta el porcentaje de ocupación actual donde el 25% de la red hospitalaria distrital cuenta con sobrecupo y el 50% se encuentra a tope de su capacidad instalada. En cuanto a la capacidad de respuesta, no se cuenta con protocolos de atención; Haciendo una evaluación según los niveles de atención, solo los hospitales de III nivel estarían medianamente preparados y con capacidad de respuesta ante un evento con víctimas en masa.

Incidencia de las agresiones a la seguridad cibernética en el desarrollo informático de las Fuerzas Armadas de Estados Unidos (2003-2013)

La presente investigación tiene como objetivo analizar la incidencia de las agresiones cibernéticas en el desarrollo informático de las Fuerzas Armadas de Estados Unidos. Los diferentes estudios que se han realizado sobre el ciberespacio se han enfocado en el papel del individuo como actor principal y se ha dejado de lado las repercusiones que éste ha tenido para el Estado, como un nuevo eje de amenazas. Teniendo en cuenta lo anterior, esta investigación demostrará a partir del concepto de securitización, que se busca priorizar la “ciberseguridad” dentro de la agenda del gobierno estadounidense. Al ser este un estudio que aborda experiencias concretas durante un periodo de tiempo de más de 10 años, el diseño metodológico de la investigación será longitudinal, ya que abarcará estudios, artículos, textos y resoluciones que se han realizado desde 2003 hasta la actualidad.

Factores asociados con la duración del circuito extracorpóreo en terapias continúas de reemplazo renal en la Fundación Cardioinfantil

Introducción: las terapias continuas de reemplazo renal son una importante medida a utilizar en los pacientes con lesión renal aguda que ingresan a la unidad de cuidado intensivo, la pérdida temprana del circuito por coagulación del mismo es una situación que afecta a este grupo de pacientes. Materiales y métodos: se realizo un estudio de casos y controles de una duración de tres meses tomando los pacientes que eran sometidos a terapia continua de reemplazo renal en la fundación Cardioinfantil, se eligieron como casos aquellos pacientes que no lograban completar 72 horas de terapia por perdida del circuito relacionada con coagulación, y aquellos que si se tomaron como controles, se analizaron ambos grupos en función de diferentes variables demográficas, clínicas y del circuito, tomando como análisis primario el primer filtro utilizado y haciendo un análisis secundario incluyendo todos los filtros. Resultados: se recolectaron 24 pacientes para el análisis primario y 101 filtros para el análisis secundario, el 37,5% de los filtros duró > 72 horas y 62,5%, menos de este tiempo. El puntaje APACHE II (OR: 0,76, p 0.003) y sitio de inserción femoral derecho (OR: 0.14, p 0.007) se encontraron protectoras para la disfunción temprana. Discusión: aunque no se alcanzó la muestra total, se encontró asociación protectora del acceso femoral derecho, que fue novedosa, pero requiere confirmación. El APACHE II, también protector, puede corresponder a un sesgo, se necesitan más estudios para aclarar estos hallazgos y determinar la presencia de otras variables que intervengan.

Fem un retaule : proposta didàctica per treballar a l'aula abans de la visita al museu. 'Hagamos un retablo : propuesta didáctica para trabajar en el aula antes de la visita al museo'.

El cuaderno recoge un dosier para el profesorado donde se presenta la visita-taller que se trabajará con este dosier, y a la vez recoge un dosier para el alumno que consta de una serie de textos históricos que pretenden aportar información y acercar a los alumnos al contexto histórico del gótico.

¿Qué entienden los jóvenes universitarios por monogamia y sexo sin penetración, como estrategias preventivas de la transmisión sexual del virus del SIDA? = What university students understand by monogamy and sex without penetration as preventive strategies of sexual transmission of AIDS virus?

Monogamy and sex without penetration are behaviors recommended by the WHO to avoid AIDS virus sexual transmission. Seven hundred and fifty university students from 18 to 25 years (67.7% women) were surveyed and they were asked to give a maximum of three free definitions of the words monogamy and sex without penetration to prevent AIDS virus sexual transmission. Their participation was voluntary and anonymous. Although the majority of the answers was correct, there was a considerable percentage of wrong answers, either for monogamy (3.7% masturbation; 2.1% to have many partners; 0.9% homosexual relations), or for sex without penetration (20.5% oral sex; 1.1% anal coitus; 0.8% coitus without orgasm; 0.4% coitus interruptus). Some definitions or examples differ by gender. The amount of wrongs or incomplete answers put researchers on the alert about insufficient preventive knowledge in a population with a high educational level

California's Endangered Belding’s Savannah Sparrow (Passerculus sandwichensis beldingi): Tolerance of Pedestrian Disturbance

Salt marshes constitute habitat islands for many endemic animal species, particularly along the California coast, where urban sprawl has fragmented this habitat. Recreational activities in salt marshes have increased recently, posing an interesting problem: how do endemic species lacking alternative habitat modify their tolerance to humans? We assessed seasonal and site variations in three tolerance parameters (distances at which animals became alert, fled, and moved after fleeing) of California's endangered Belding’s Savannah Sparrow ((Passerculus sandwichensis beldingi). We approached individuals on trails in three salt marshes with different levels of vehicle and pedestrian traffic. Belding’s Savannah Sparrows became aware and fled at shorter distances in the salt marsh coincident with greater levels of recreational activity as a result of habituation or visual obstruction effects. Seasonal effects in tolerance varied between sites. Alert and flight initiation distances were higher in the pre-nesting than in the non-breeding season in the site with the highest levels of recreational use likely due to greater exposure of breeding individuals; however, the opposite seasonal trend was found in each of the two sites with relatively lower human use, probably because individuals were less spatially attached in the non-breeding season when they foraged in aggregations. Distance fled was greater in the non-breeding than in the breeding season. Our findings call for dynamic management of recreational activities in different salt marshes depending on the degree of exposure to humans and seasonal variations in tolerance. We recommend a minimum approaching distance of 63 m and buffer areas of 1.3 ha around Belding's Savannah Sparrows.

An FLIR video surveillance system to avoid bridge-ship collision

In this paper, a forward-looking infrared (FLIR) video surveillance system is presented for collision avoidance of moving ships to bridge piers. An image pre-processing algorithm is proposed to reduce clutter noises by multi-scale fractal analysis, in which the blanket method is used for fractal feature computation. Then, the moving ship detection algorithm is developed from image differentials of the fractal feature in the region of surveillance between regularly interval frames. Experimental results have shown that the approach is feasible and effective. It has achieved real-time and reliable alert to avoid collisions of moving ships to bridge piers

A bridge-ship collision avoidance system based on FLIR image sequences

In this paper, a forward-looking infrared (FLIR) video surveillance system is presented for collision avoidance of moving ships to bridge piers. An image preprocessing algorithm is proposed to reduce clutter background by multi-scale fractal analysis, in which the blanket method is used for fractal feature computation. Then, the moving ship detection algorithm is developed from image differentials of the fractal feature in the region of surveillance between regularly interval frames. When the moving ships are detected in region of surveillance, the device for safety alert is triggered. Experimental results have shown that the approach is feasible and effective. It has achieved real-time and reliable alert to avoid collisions of moving ships to bridge piers.

New dimensions in early flood warning across the globe using grand-ensemble weather predictions

Early and effective flood warning is essential to initiate timely measures to reduce loss of life and economic damage. The availability of several global ensemble weather prediction systems through the “THORPEX Interactive Grand Global Ensemble” (TIGGE) archive provides an opportunity to explore new dimensions in early flood forecasting and warning. TIGGE data has been used as meteorological input to the European Flood Alert System (EFAS) for a case study of a flood event in Romania in October 2007. Results illustrate that awareness for this case of flooding could have been raised as early as 8 days before the event and how the subsequent forecasts provide increasing insight into the range of possible flood conditions. This first assessment of one flood event illustrates the potential value of the TIGGE archive and the grand-ensembles approach to raise preparedness and thus to reduce the socio-economic impact of floods.

Heaps and Chains: Is the Chaining Argument for parity a sorites?

I argue that the Ruth Chang’s Chaining Argument for her parity view of value incomparability trades illicitly on the vagueness of the predicate ‘is comparable with’. Chang is alert to this danger and argues that the predicate is not vague, but this defense does not succeed. The Chaining Argument also faces a dilemma. The predicate is either vague or precise. If it is vague, then the argument is most plausibly a sorites. If it is precise, then the argument is either question begging or dialectically ineffective. I argue that no chaining-type argument can succeed.

Sex differences in the programming effects of prenatal stress on psychopathology and stress responses: an evolutionary perspective

There is strong evidence from animal studies that prenatal stress has different effects on male and female offspring. In general, although not always, prenatal stress increases anxiety, depression and stress responses, both hypothalamic–pituitary–adrenal and cardiovascular, in female offspring rather than in male. Males are more likely to show learning and memory deficits. There have been few studies so far in humans which differentiate effects of prenatal stress on male and female psychopathology. Some studies support the animal models, but the evidence is inconsistent. The mediating mechanisms for any sex specific effects are little understood, but there is evidence that placental function can differ depending on the sex of the fetus. We suggest that there may be an evolutionary reason for any sex differences in the long term effects of prenatal stress. In a stressful environment it may be adaptive for females, who are more likely to stay in one place and look after children, to be more vigilant, alert to danger and thus show more stress responsiveness. This can give rise to a more anxious or depressed phenotype. With males it may be more adaptive to go out and explore new environments, compete with other males, and be more aggressive. For this it may help to be less responsive to external stressors. More research is needed into sex differences in the effects of prenatal stress in humans, to test these ideas.

Current model capabilities for simulating black carbon and sulfate concentrations in the Arctic atmosphere: a multi-model evaluation using a comprehensive measurement data set

The concentrations of sulfate, black carbon (BC) and other aerosols in the Arctic are characterized by high values in late winter and spring (so-called Arctic Haze) and low values in summer. Models have long been struggling to capture this seasonality and especially the high concentrations associated with Arctic Haze. In this study, we evaluate sulfate and BC concentrations from eleven different models driven with the same emission inventory against a comprehensive pan-Arctic measurement data set over a time period of 2 years (2008–2009). The set of models consisted of one Lagrangian particle dispersion model, four chemistry transport models (CTMs), one atmospheric chemistry-weather forecast model and five chemistry climate models (CCMs), of which two were nudged to meteorological analyses and three were running freely. The measurement data set consisted of surface measurements of equivalent BC (eBC) from five stations (Alert, Barrow, Pallas, Tiksi and Zeppelin), elemental carbon (EC) from Station Nord and Alert and aircraft measurements of refractory BC (rBC) from six different campaigns. We find that the models generally captured the measured eBC or rBC and sulfate concentrations quite well, compared to previous comparisons. However, the aerosol seasonality at the surface is still too weak in most models. Concentrations of eBC and sulfate averaged over three surface sites are underestimated in winter/spring in all but one model (model means for January–March underestimated by 59 and 37 % for BC and sulfate, respectively), whereas concentrations in summer are overestimated in the model mean (by 88 and 44 % for July–September), but with overestimates as well as underestimates present in individual models. The most pronounced eBC underestimates, not included in the above multi-site average, are found for the station Tiksi in Siberia where the measured annual mean eBC concentration is 3 times higher than the average annual mean for all other stations. This suggests an underestimate of BC sources in Russia in the emission inventory used. Based on the campaign data, biomass burning was identified as another cause of the modeling problems. For sulfate, very large differences were found in the model ensemble, with an apparent anti-correlation between modeled surface concentrations and total atmospheric columns. There is a strong correlation between observed sulfate and eBC concentrations with consistent sulfate/eBC slopes found for all Arctic stations, indicating that the sources contributing to sulfate and BC are similar throughout the Arctic and that the aerosols are internally mixed and undergo similar removal. However, only three models reproduced this finding, whereas sulfate and BC are weakly correlated in the other models. Overall, no class of models (e.g., CTMs, CCMs) performed better than the others and differences are independent of model resolution.

How do people perceive, understand, and anticipate responding to flash flood risks and warnings? Results from a public survey in Boulder, Colorado, USA

This study investigates flash flood forecast and warning communication, interpretation, and decision making, using data from a survey of 418 members of the public in Boulder, Colorado, USA. Respondents to the public survey varied in their perceptions and understandings of flash flood risks in Boulder, and some had misconceptions about flash flood risks, such as the safety of crossing fast-flowing water. About 6% of respondents indicated consistent reversals of US watch-warning alert terminology. However, more in-depth analysis illustrates the multi-dimensional, situationally dependent meanings of flash flood alerts, as well as the importance of evaluating interpretation and use of warning information along with alert terminology. Some public respondents estimated low likelihoods of flash flooding given a flash flood warning; these were associated with lower anticipated likelihood of taking protective action given a warning. Protective action intentions were also lower among respondents who had less trust in flash flood warnings, those who had not made prior preparations for flash flooding, and those who believed themselves to be safer from flash flooding. Additional analysis, using open-ended survey questions about responses to warnings, elucidates the complex, contextual nature of protective decision making during flash flood threats. These findings suggest that warnings can play an important role not only by notifying people that there is a threat and helping motivate people to take protective action, but also by helping people evaluate what actions to take given their situation.

Institutional legacies and capabilities: work practices and employment relations in Portugal and Mozambique

This is a study of institutional change and continuity, comparing the trajectories followed by Mozambique and its formal colonial power Portugal in HRM, based on two surveys of firm level practices. The colonial power sought to extend the institutions of the metropole in the closing years of its rule, and despite all the adjustments and shocks that have accompanied Mozambique’s post-independence years, the country continues to retain institutional features and associated practices from the past. This suggests that there is a post-colonial impact on human resource management. The implications for HRM theory are that ambitious attempts at institutional substitution may have less dramatic effects than is commonly assumed. Indeed, we encountered remarkable similarities between the two countries in HRM practices, implying that features of supposedly fluid or less mature institutional frameworks (whether in Africa or the Mediterranean world) may be sustained for protracted periods of time, pressures to reform notwithstanding. This highlights the complexities of continuities which transcend formal rules; as post-colonial theories alert us, informal conventions and embedded discourse may result in the persistence of informal power and subordination, despite political and legal changes.