Socio-Economic Dimensions of Health Care Development Among Tribals in Kerala: A Study of Tribal Communities in Wynad

The contemporary explanations and discussions of the relationship between medicine and health, and society centre around assumptions that can be broadly classified into three setsl. The first set considers health and illness as predominantly ‘biological’ and therefore, having nothing to do with the social and economic environment in which it occurs. The struggle to combat illness therefore, lies entirely within the purview of modern medicine which is neutral to economic or social change. The second considers practice of medicine as a natural science. It allows the doctor to separate himself from his subject matter, the patient, in the samelway as the natural scientist is assumed to separate himself from his subject matter, the natural world. As a 'science' and with the scientific method, it can produce unchallengable and autonomous body of knowledge which is free from the wider social and economic context. The third, different from the above, recognises the relationship between health, medicine and society. Social and environmental aspects as determinants of illness or of health comes to sharp focus here and it assigns to medicine the status of a mediator, the only viable mediator, between people and diseases. In this scheme of things the usefulness of medicine is unquestionable but the problem lies in not having enough of it to go arounds.

Catalogue Interfaces of Integrated Library Management Systems (ILMS): Experiences in a Proprietary and Open Source Software

The Central Library of Cochin University of Science and Technology (CUSAT) has been automated by proprietary software (Adlib Library) since 2000. After 11 years, in 2011, the university authorities decided to shift to an open source software (OSS), for integrated library management system (ILMS), Koha for automating the library housekeeping operations. In this context, this study attempts to share the experiences in cataloging with both type of software. The features of the cataloging modules of both the software are analysed on the badis of certain check points. It is found that the cataloging module of Koha is almost in par with that of proven proprietary software that has been in market for the past 25 years. Some suggestions made by this study may be incorporated for the further development and perfection of Koha.

Plant genetic diversity, irrigation and nutrient cycling in traditional mountain oases of northern Oman

Little is known about plant biodiversity, irrigation management and nutrient fluxes as criteria to assess the sustainability of traditional irrigation agriculture in eastern Arabia. Therefore interdisciplinary studies were conducted over 4 yrs on flood-irrigated fields dominated by wheat (Triticum spp.), alfalfa (Medicago sativa L.) and date palm (Phoenix dactylifera L.) in two mountain oases of northern Oman. In both oases wheat landraces consisted of varietal mixtures comprising T. aestivum and T. durum of which at least two botanical varieties were new to science. During irrigation cycles of 6-9 days on an alfalfa-planted soil, volumetric water contents ranged from 30-13%. For cropland, partial oasis balances (comprising inputs of manure, mineral fertilizers, N2-fixation and irrigation water, and outputs of harvested products) were similar for both oases, with per hectare annual surpluses of 131 kg N, 37 kg P and 84 kg K at Balad Seet and of 136 kg N, 16 kg P and 66 kg K at Maqta. Respective palm grove surpluses, in contrast were with 303 kg N, 38 kg P, and 173 kg K ha^-1 yr^-1 much higher at Balad Seet than with 84 kg N, 14 kg P and 91 kg K ha^-1 yr^-1 at Maqta. The results show that the sustainability of these irrigated landuse systems depends on a high quality of the irrigation water with low Na but high CaCO3, intensive recycling of manure and an elaborate terrace structure with a well tailored water management system that allows adequate drainage.

User Profile Management and Selection in Context-Aware Service Platforms for Networks Beyond 3G

In recent years, progress in the area of mobile telecommunications has changed our way of life, in the private as well as the business domain. Mobile and wireless networks have ever increasing bit rates, mobile network operators provide more and more services, and at the same time costs for the usage of mobile services and bit rates are decreasing. However, mobile services today still lack functions that seamlessly integrate into users’ everyday life. That is, service attributes such as context-awareness and personalisation are often either proprietary, limited or not available at all. In order to overcome this deficiency, telecommunications companies are heavily engaged in the research and development of service platforms for networks beyond 3G for the provisioning of innovative mobile services. These service platforms are to support such service attributes. Service platforms are to provide basic service-independent functions such as billing, identity management, context management, user profile management, etc. Instead of developing own solutions, developers of end-user services such as innovative messaging services or location-based services can utilise the platform-side functions for their own purposes. In doing so, the platform-side support for such functions takes away complexity, development time and development costs from service developers. Context-awareness and personalisation are two of the most important aspects of service platforms in telecommunications environments. The combination of context-awareness and personalisation features can also be described as situation-dependent personalisation of services. The support for this feature requires several processing steps. The focus of this doctoral thesis is on the processing step, in which the user’s current context is matched against situation-dependent user preferences to find the matching user preferences for the current user’s situation. However, to achieve this, a user profile management system and corresponding functionality is required. These parts are also covered by this thesis. Altogether, this thesis provides the following contributions: The first part of the contribution is mainly architecture-oriented. First and foremost, we provide a user profile management system that addresses the specific requirements of service platforms in telecommunications environments. In particular, the user profile management system has to deal with situation-specific user preferences and with user information for various services. In order to structure the user information, we also propose a user profile structure and the corresponding user profile ontology as part of an ontology infrastructure in a service platform. The second part of the contribution is the selection mechanism for finding matching situation-dependent user preferences for the personalisation of services. This functionality is provided as a sub-module of the user profile management system. Contrary to existing solutions, our selection mechanism is based on ontology reasoning. This mechanism is evaluated in terms of runtime performance and in terms of supported functionality compared to other approaches. The results of the evaluation show the benefits and the drawbacks of ontology modelling and ontology reasoning in practical applications.

Genetic variation of and environmental effects on inducibility of resistance in tomatoes (Solanum lycopersicum L.) to Phytophthora infestans (Mont) de Bary

Many plant strengtheners are promoted for their supposed effects on nutrient uptake and/or resistance induction (IR). In addition, many organic fertilizers are supposed to enhance plant health and several studies have shown that tomatoes grown organically are more resistant to late blight, caused by Phytophthora infestans to tomatoes grown conventionally. Much is known about the mechanisms underlying IR. In contrast, there is no systematic knowledge about genetic variation for IR. Therefore, the following questions were addressed in the presented dissertation: (i) Is there genetic variation among tomato genotypes for inducibility of resistance to P. infestans? (ii) How do different PS compare with the chemical inducer BABA in their ability to IR? (iii) Does IR interact with the inducer used and different organic fertilizers? A varietal screening showed that contrary to the commonly held belief IR in tomatoes is genotype and isolate specific. These results indicate that it should be possible to select for inducibility of resistance in tomato breeding. However, isolate specificity also suggests that there could be pathogen adaptation. The three tested PS as well as two of the three tested organic fertilisers all induced resistance in the tomatoes. Depending on PS or BABA variety and isolate effects varied. In contrast, there were no variety and isolate specific effects of the fertilisers and no interactions with the PS and fertilisers. This suggests that the different PS should work independent of the soil substrate used. In contrast the results were markedly different when isolate mixtures were used for challenge inoculations. Plants were generally less susceptible to isolate mixtures than to single isolates. In addition, the effectiveness of the PS was greater and more similar to BABA when isolate mixtures were used. The fact that the different PS and BABA differed in their ability to induce resistance in different host genotype -pathogen isolate combinations puts the usefulness of IR as a breeding goal in question. This would result in varieties depending on specific inducers. The results with the isolate mixtures are highly relevant. On the one hand they increase the effectiveness of the resistance inducers. On the other hand, measures that increase the pathogen diversity such as the use of diversified host populations will also increase the overall resistance of the hosts. For organic tomato production the results indicate that it is possible to enhance the tomato growing system with respect to plant health management by using optimal fertilisers, plant strengtheners and any measures that increase system diversity.

Sensorische Erfassung von Grünlandbiomassen als Grundlage für ein teilflächenspezifisches Management im Ökologischen Landbau

Vor dem Hintergund der Integration des wissensbasierten Managementsystems Precision Farming in den Ökologischen Landbau wurde die Umsetzung bestehender sowie neu zu entwickelnder Strategien evaluiert und diskutiert. Mit Blick auf eine im Precision Farming maßgebende kosteneffiziente Ertragserfassung der im Ökologischen Landbau flächenrelevanten Leguminosen-Grasgemenge wurden in zwei weiteren Beiträgen die Schätzgüten von Ultraschall- und Spektralsensorik in singulärer und kombinierter Anwendung analysiert. Das Ziel des Precision Farming, ein angepasstes Management bezogen auf die flächeninterne Variabilität der Standorte umzusetzen, und damit einer Reduzierung von Betriebsmitteln, Energie, Arbeit und Umwelteffekten bei gleichzeitiger Effektivitätssteigerung und einer ökonomischen Optimierung zu erreichen, deckt sich mit wesentlichen Bestrebungen im Ökogischen Landbau. Es sind vorrangig Maßnahmen zur Erfassung der Variabilität von Standortfaktoren wie Geländerelief, Bodenbeprobung und scheinbare elektrische Leitfähigkeit sowie der Ertragserfassung über Mähdrescher, die direkt im Ökologischen Landbau Anwendung finden können. Dagegen sind dynamisch angepasste Applikationen zur Düngung, im Pflanzenschutz und zur Beseitigung von Unkräutern aufgrund komplexer Interaktionen und eines eher passiven Charakters dieser Maßnahmen im Ökologischen Landbau nur bei Veränderung der Applikationsmodelle und unter Einbindung weiterer dynamischer Daten umsetzbar. Beispiele hiefür sind einzubeziehende Mineralisierungsprozesse im Boden und organischem Dünger bei der Düngemengenberechnung, schwer ortsspezifisch zuzuordnende präventive Maßnamen im Pflanzenschutz sowie Einflüsse auf bodenmikrobiologische Prozesse bei Hack- oder Striegelgängen. Die indirekten Regulationsmechanismen des Ökologischen Landbaus begrenzen daher die bisher eher auf eine direkte Wirkung ausgelegten dynamisch angepassten Applikationen des konventionellen Precision Farming. Ergänzend sind innovative neue Strategien denkbar, von denen die qualitätsbezogene Ernte, der Einsatz hochsensibler Sensoren zur Früherkennung von Pflanzenkrankheiten oder die gezielte teilflächen- und naturschutzorientierte Bewirtschaftung exemplarisch in der Arbeit vorgestellt werden. Für die häufig große Flächenanteile umfassenden Leguminosen-Grasgemenge wurden für eine kostengünstige und flexibel einsetzbare Ertragserfassung die Ultraschalldistanzmessung zur Charakterisierung der Bestandeshöhe sowie verschiedene spektrale Vegetationsindices als Schätzindikatoren analysiert. Die Vegetationsindices wurden aus hyperspektralen Daten nach publizierten Gleichungen errechnet sowie als „Normalized Difference Spectral Index“ (NDSI) stufenweise aus allen möglichen Wellenlängenkombinationen ermittelt. Die Analyse erfolgte für Ultraschall und Vegetationsindices in alleiniger und in kombinierter Anwendung, um mögliche kompensatorische Effekte zu nutzen. In alleiniger Anwendung erreichte die Ultraschallbestandeshöhe durchweg bessere Schätzgüten, als alle einzelnen Vegetationsindices. Bei den letztgenannten erreichten insbesondere auf Wasserabsorptionsbanden basierende Vegetationsindices eine höhere Schätzgenauigkeit als traditionelle Rot/Infrarot-Indices. Die Kombination beider Sensorda-ten ließ eine weitere Steigerung der Schätzgüte erkennen, insbesondere bei bestandesspezifischer Kalibration. Hierbei kompensieren die Vegetationsindices Fehlschätzungen der Höhenmessung bei diskontinuierlichen Bestandesdichtenänderungen entlang des Höhengradienten, wie sie beim Ährenschieben oder durch einzelne hochwachsende Arten verursacht werden. Die Kombination der Ultraschallbestandeshöhe mit Vegetationsindices weist das Potential zur Entwicklung kostengünstiger Ertragssensoren für Leguminosen-Grasgemenge auf. Weitere Untersuchungen mit hyperspektralen Vegetationsindices anderer Berechnungstrukturen sowie die Einbindung von mehr als zwei Wellenlängen sind hinsichtlich der Entwicklung höherer Schätzgüten notwendig. Ebenso gilt es, Kalibrierungen und Validationen der Sensorkombination im artenreichen Grasland durchzuführen. Die Ertragserfassung in den Leguminosen-Grasgemengen stellt einen wichtigen Beitrag zur Erstellung einer Ertragshistorie in den vielfältigen Fruchtfolgen des Ökologischen Landbaus dar und ermöglicht eine verbesserte Einschätzung von Produktionspotenzialen und Defizitarealen für ein standortangepasstes Management.

Pathogens occuring in the winter pea-maize-winter wheat rotation, their host specificity and the potential of compost in suppressing foot and root disease of peas

The overall aim of the work presented was to evaluate soil health management with a specific focus on soil borne diseases of peas. For that purpose field experiments were carried out from 2009 until 2013 to assess crop performance and pathogen occurrence in the rotation winter pea-maize-winter wheat and if the application of composts can improve system performance. The winter peas were left untreated or inoculated with Phoma medicaginis, in the presence or absence of yard waste compost at rate of 5 t dry matter ha-1. A second application of compost was made to the winter wheat. Fusarium ssp. were isolated and identified from the roots of all three crops and the Ascochyta complex pathogens on peas. Bioassays were conducted under controlled conditions to assess susceptibility of two peas to Fusarium avenaceum, F. solani, P. medicaginis and Didymella pinodes and of nine plant species to F. avenaceum. Also, effects of compost applications and temperature on pea diseases were assessed. Application of composts overall stabilized crop performance but it did not lead to significant yield increases nor did it affect pathogen composition and occurrence. Phoma medicaginis was dominating the pathogen complex on peas. F. graminearum, F. culmorum, F. proliferatum, Microdochium nivale, F. crookwellense, F. sambucinum, F. oxysporum, F. avenaceum and F. equiseti were frequently isolated species from maize and winter wheat with no obvious influence of the pre-crop on the Fusarium species composition. The spring pea Santana was considerably more susceptible to the pathogens tested than the winter pea EFB33 in both sterile sand and non-sterilized field soil. F. avenaceum was the most aggressive pathogen, followed by P. medicaginis, D. pinodes, and F. solani. Aggressiveness of all pathogens was greatly reduced in non-sterile field soil. F. avenaceum caused severe symptoms on roots of all nine plant species tested. Especially susceptible were Trifolium repens, T. subterraneum, Brassica juncea and Sinapis alba in addition to peas. Reduction of growing temperatures from 19/16°C day/night to 16/12°C and 13/10°C did not affect the efficacy of compost. It reduced plant growth and slightly increased disease on EFB33 whereas the highest disease severity on Santana was observed at the highest temperature, 19/16°C. Application of 20% v/v of compost reduced disease on peas due to all four pathogens depending on pea variety, pathogen and growing media used. Suppression was also achieved with lower application rate of 3.5% v/v. Tests with γ sterilized compost suggest that the suppression of disease caused by Fusarium spp. is biological in origin, whereas chemical and physical properties of compost are playing an additional role in the suppression of disease caused by D. pinodes and P. medicaginis.

Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

Interviews with more than 40 leaders in the Boston area health care industry have identified a range of broadly-felt critical problems. This document synthesizes these problems and places them in the context of work and family issues implicit in the organization of health care workplaces. It concludes with questions about possible ways to address such issues. The defining circumstance for the health care industry nationally as well as regionally at present is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care – specifically the widespread replacement of indemnity insurance by market-based managed care and business models of operation--have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce, from technicians and aides to nurses and physicians. Under such strains, relations between managers and workers providing care are uneasy, ranging from determined efforts to maintain respectful cooperation to adversarial negotiation. Taken together, the interviews identify five key issues affecting a broad cross-section of occupational groups, albeit in different ways: Staffing shortages of various kinds throughout the health care workforce create problems for managers and workers and also for the quality of patient care. Long work hours and inflexible schedules place pressure on virtually every part of the healthcare workforce, including physicians. Degraded and unsupportive working conditions, often the result of workplace "deskilling" and "speed up," undercut previous modes of clinical practice. Lack of opportunities for training and advancement exacerbate workforce problems in an industry where occupational categories and terms of work are in a constant state of flux. Professional and employee voices are insufficiently heard in conditions of rapid institutional reorganization and consolidation. Interviewees describe multiple impacts of these issues--on the operation of health care workplaces, on the well being of the health care workforce, and on the quality of patient care. Also apparent in the interviews, but not clearly named and defined, is the impact of these issues on the ability of workers to attend well to the needs of their families--and the reciprocal impact of workers' family tensions on workplace performance. In other words, the same things that affect patient care also affect families, and vice versa. Some workers describe feeling both guilty about raising their own family issues when their patients' needs are at stake, and resentful about the exploitation of these feelings by administrators making workplace policy. The different institutions making up the health care system have responded to their most pressing issues with a variety of specific stratagems but few that address the complexities connecting relations between work and family. The MIT Workplace Center proposes a collaborative exploration of next steps to probe these complications and to identify possible locations within the health care system for workplace experimentation with outcomes benefiting all parties.

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.

Aplicación de la Teoría de Restricciones en la gestión de la seguridad del paciente

La seguridad del paciente constituye una prioridad y un reto para los organismos Gubernamentales y para las instituciones de salud tanto a nivel nacional como internacional (Sescam, 2007), quienes han emprendido una búsqueda de soluciones por medio de diferentes metodologías y estrategias que permitan reducir al máximo los riesgos de la atención de salud para el paciente (Ministerio de Sanidad y Consumo, 2002). Aunque se cuenta con mejores sistemas o metodología de análisis y sistemas de notificación la persistencia del fenómeno es constante. ( Requena, Aranaz, Gea, Limón, Miralles, & Vitaller , 2010). En esta tesis se plantea una nueva alternativa de gestión en la seguridad del paciente a través de la Teoría de Restricciones (TOC) para emprender acciones que permitan analizar el sistema bajo esta nueva metodología, intervenir de manera oportuna, impactar y estimular al personal de salud a trabajar en la búsqueda del mejoramiento continuo para el establecimiento de un sistema efectivo de gestión de la seguridad del paciente y una cultura de seguridad de los trabajadores de la institución de salud.

Condiciones asistenciales y administrativas que potencialmente influirían en la satisfacción del cliente interno y externo de un servicio de salud: Implicaciones para la gestión operacional

Calidad en salud y Satisfacción en salud son dos fenómenos de naturaleza distinta, sin embargo la literatura reporta que en las mediciones de ambas parecen evaluarse factores similares en la prestación de los servicios de salud. La calidad en salud hace referencia a las ¨creencias que como forma de la percepción forman parte de la cognición mientras que la satisfacción concebida como un juicio de valor positivo o negativo que construye el sujeto que ha recibido el servicio de acuerdo al cumplimiento de sus expectativas, es considerada uno de los principales objetivos de la calidad de atención en salud y un indicador del óptimo funcionamiento de las instituciones hospitalarias, así entonces, el objetivo de este estudio fue determinar cuáles son las características asistenciales y administrativas que potencialmente influirían en la valoración de la satisfacción del usuario y funcionario frente a la atención en los servicios de salud del Hospital Municipal del Guamo-Tolima, mediante la identificación, medición y descripción de las mismas .Los resultados del estudio obtenidos a partir de la comparación de medias de cada uno de los ítems evaluados, y de la diferencia significativa de medias, mostraron que existen diferencias significativas entre la importancia asignada por los usuarios frente a la asignada por los funcionarios.

Teoría de restricciones aplicada a la cadena de suministros en un operador logístico de productos farmacéuticos

En las instituciones hospitalarias es fundamental el tema relacionado con los medicamentos y dispositivos médicos para la atención del paciente, por lo tanto el mecanismo de adquisición y disponibilidad de éstos productos, ha llevado a la participación masiva de operadores logísticos (Outsoursing) interviniendo áreas de la cadena de suministros, desde el punto de fabricación con el producto terminado hasta la dispensación del medicamento o dispositivo médico, para que ser usado o administrado al paciente. Los operadores logísticos han emprendido una búsqueda de soluciones por medio de diferentes metodologías y estrategias que permitan entregar a tiempo en las farmacias hospitalarias, conservando las propiedades físicas y químicas de los medicamentos y dispositivos médicos, garantizando así la calidad de los productos. En ésta tesis se plantea una nueva alternativa de gestión de medicamentos y dispositivos médicos en un operador logístico de productos farmacéuticos a través de la teoría de restricciones (TOC), para emprender acciones que permitan analizar el sistema bajo esta metodología, intervenir de manera oportuna, impactar y estimular al personal a trabajar en la búsqueda del mejoramiento , aumentando a su vez la velocidad del flujo de operación en toda la cadena de suministros, basada no en el mejoramiento de los óptimos locales o de los subprocesos sino en la identificación de la verdadera restricción del sistema, permitiendo realizar un análisis más a fondo encontrando el conflicto raíz para mejorar el sistema a nivel global.

Análisis del sistema de salud colombiano desde la perspectiva de la nueva gerencia publica

Esta monografía hace un análisis de las implicaciones de la adopción de la Nueva gerencia pública como estrategia para gestionar el sistema de salud colombiano. Para evaluar el impacto de la Nueva Gerencia Pública, el análisis se hace a partir de los criterios de calidad, cobertura y acceso en el sistema general de seguridad social en salud. Este estudio también analiza las situaciones conflictivas entre los actores del sistema de salud y sus dos crisis representativas (2001 y 2009).

The Ergonomic Analysis and Back Injuries in Flexible Production System

Back injuries identification and diagnoses in the transition of the Taylor model to the flexiblemodel of production organization, demands a parallel intervention of prevention actors at work. This study uses simultaneously three intervention models (structured action analysis, muscle skeletal symptoms questionnaires and muscle skeletal assessment) for work activities in a packaging plant. In this study seventy and two (72) operative workers participated (28 workers with muscle skeletal evaluation). In an intervention period of 10 months, the physical, cognitive, organizational components and productive process dynamics were evaluated from the muscle skeletal demands issues. The differences established between objective exposure at risk, back injury risk perception, appreciation and a vertebral spine evaluation, in prior and post intervention, determines the structure for a muscle skeletal risk management system. This study explains that back injury symptoms can be more efficiently reduced among operative workers combining measures registered and the adjustment between dynamics, the changes at work and efficient gestures development. Relevance: the results of this study can be used to pre ent back injuries in workers of flexible production processes.

Desenlaces de las infecciones respiratorias en la unidad de cuidado intensivo de la fundación neumologica colombiana

Las infecciones asociadas a ventilación mecánica (VM) son frecuentes en la unidad de cuidado intensivo (UCI). Existen dos infecciones: neumonía (NAV) y traqueobronquitis (TAV). NAV genera impacto negativo en los desenlaces de los pacientes al aumentar la morbilidad, mortalidad y los tiempos en UCI y VM, pero no se conoce el impacto de TAV. El objetivo de este estudio fue identificar si hay diferencias entre NAV y TAV. Materiales y métodos: Se realizó un estudio de cohortes entre 2009 y 2013 en la UCI de la Fundación Neumológica Colombiana. De los pacientes con NAV y TAV se obtuvieron datos demográficos, epidemiológicos, microbiológicos y desenlaces como tiempos de estancia en UCI, VM y de hospitalización y mortalidad. Se compararon estadísticamente mediante t de Student y Chi2 para datos normales y prueba de Mann-Whitney para datos no normales. Resultados: Los pacientes con NAV y TAV fueron similares en la condición de ingreso a UCI. Al diagnóstico de la infección hubo diferencias significativas entre grupos en la oxigenación y tiempo de estancia hospitalaria, en UCI y VM. La microbiología fue con predominio de gérmenes Gram negativos y presencia de multirresistencia en el 52.5% de casos, sin diferencias significativas entre grupos. En los desenlaces, se observó diferencias en los tiempos totales de estancia en UCI, hospitalización y VM, pero sin diferencia en ellos después del diagnóstico. No hubo diferencias significativas en mortalidad. Conclusiones: NAV y TAV son similares en el impacto sobre la evolución de los pacientes en cuanto a morbilidad, estancias y mortalidad.