Impacto de las cirugías múltiples, en un solo tiempo quirúrgico, sobre el patrón de marcha en niños con parálisis cerebral

Introducción: La Parálisis Cerebral (PC) es la enfermedad neurológica más incapacitante en niños, su historia natural tiende al deterioro motor y funcional. Con este estudio se busca establecer sí las cirugías múltiples de miembros inferiores, en un tiempo quirúrgico, mantienen el nivel motor y funcional. Material y Método: Estudio analítico de cohortes. Se compara un grupo de pacientes sometidos a cirugías múltiples contra un grupo de pacientes no operados, en el Instituto de Ortopedia Infantil Roosevelt. Se evaluaron los pacientes con dos Laboratorios para el Análisis del Movimiento (LAM) y se midieron los desenlaces mediante el cambio en la puntuación del perfil de marcha (GPS) y el nivel funcional motor grueso (GMFCS). Resultados: 109 pacientes cumplieron con los criterios de selección, 67 pacientes fueron sometidos a cirugía y 42 pacientes no. Los pacientes operados mejoraron el GPS promedio (diferencia -1,94; p=0,002) comparado con los pacientes no operados (diferencia 1,74; p=0,001), indicando una mejoría significativa de la cinemática de la marcha. En un modelo de regresión logística predictivo, el paciente que es operado tiene una probabilidad del 78% de mantener su patrón de marcha, mientras que sí no se opera su probabilidad disminuye al 37%. El nivel funcional motor GMFCS no mostró cambios significativos entre los grupos. Discusión: Las cirugías múltiples de miembros inferiores mantienen de manera significativa el patrón de marcha en pacientes con PC. Se destaca el seguimiento de los pacientes mediante el LAM y se sugiere el uso del GPS para valorar resultados en este tipo de pacientes.

Percepción de calidad de vida relacionada con la salud en pacientes con síndrome de apnea e hipoapnea obstructiva del sueño

El objetivo de esta investigación es describir la calidad de vida y la calidad del sueño en los pacientes con diagnóstico de Síndrome de Apnea Hipoapnea del sueño, mediante el uso de un grupo de cuestionarios para obtener datos demográficos, la evaluación del grado de somnolencia diurna percibida, la percepción de la calidad del sueño y la percepción de la calidad de vida relacionada con la salud con encuestas en sus respectivas versiones validadas para Colombia.

Evaluación de la validez de la escala llanto para el dolor en neonatos y menores de cinco años

Introducción: La escala LLANTO para dolor es una escala que hasta la fecha ha sido solo validada en población infantil española, actualmente no se conocen datos en población colombiana. Se pretende validar la escala de dolor LLANTO en pacientes neonatos y menores de 5 años, a través de su aplicación en pacientes atendidos en una de tres instituciones, además comparándola con las escalas FLACC y PIPP dependiendo de edad del paciente. Metodología: Se incluyeron niños con cualquier tipo de dolor, clasificándolos en dos grupos por edad: 1) neonatos y 2) niños entre 1 mes y 5 años de edad, que asistieron a la Fundación Cardioinfantil, Clínica Infantil Colsubsidio o al Hospital Universitario Mayor. Las escalas fueron aplicadas por dos residentes de pediatría y una enfermera especializada en el cuidado de población infantil. Para la prueba piloto se diseñó un cuestionario determinar dificultades en la aplicación de la escala LLANTO. Una vez corregidos los problemas identificados se procederá a la validación de la escala. Resultados: Se presentan los datos de la prueba piloto. Se incluyeron 8 neonatos y 8 niños entre 1 mes y 5 años, esta muestra fue obtenida en un periodo de un mes, con la encuesta se evaluó la aceptación y entendimiento de la escala LLANTO por parte de los evaluadores. La prueba piloto mostró resultados favorables en el 100% de los encuestados. Discusión: Se considera que la escala LLANTO no requiere cambios para continuar con su validación.

Abordajes teóricos en la comprensión de la influencia de los recursos económicos en la actividad física

Estudio cualitativo que analiza los abordajes teóricos utilizados por diferentes autores en la comprensión de la influencia de los recursos económicos en la actividad física desde los modelos de determinantes y determinación social.

Engagement y productividad en las empresas

El presente trabajo pretende mostrar algunos avances en el término “engagement”, y como puede ser implementado en las organizaciones, teniendo en cuenta los diferentes factores que intervienen, para que los trabajadores se sientan “engaged” dentro de la organización. Además busca relacionar las diferentes habilidades y tipos de liderazgo que los altos mandos utilizan con sus empleados y como éste afecta la productividad de los trabajadores en las organizaciones. Para esto, se realizó una investigación de las clases de liderazgo y los comportamientos de los altos mandos, que pueden afectar positiva y negativamente el vínculo y sentido de pertenencia que tienen los trabajadores con la empresa en la que trabajan. Considerando importante las habilidades del liderazgo transformacional, para lograr desarrollar algún grado de engagement en los trabajadores, lo cual genera a su vez, un alza en la productividad de sus resultados dentro de la organización.

Comparación de las dinámicas de uso y apropiación del espacio público en parques de origen informal y formal: parque Villa de la Torre y parque Cayetano Cañizares

El interés de este estudio de caso es comparar las dinámicas de uso y apropiación del espacio público en parques de origen formal e informal, y discutir sus implicaciones en la vida social y urbana, teniendo como zonas el parque Villa de la Torre (informal) y el parque Cayetano Cañizares (formal). Este trabajo se enmarca en conceptos de uso y apropiación del espacio público, a partir de los cuales se examinan las dinámicas de formalidad e informalidad de los parques zonas de estudio, explorando qué efectos puede tener su origen, y revisando si el parque informal implica falta de apropiación y usos conflictivos, o si por el contrario, las dinámicas que en espacios públicos se dan pueden incluir dinámicas positivas y negativas indistintamente de su origen.

Network externalities across financial institutions

We propose and estimate a financial distress model that explicitly accounts for the interactions or spill-over effects between financial institutions, through the use of a spatial continuity matrix that is build from financial network data of inter bank transactions. Such setup of the financial distress model allows for the empirical validation of the importance of network externalities in determining financial distress, in addition to institution specific and macroeconomic covariates. The relevance of such specification is that it incorporates simultaneously micro-prudential factors (Basel 2) as well as macro-prudential and systemic factors (Basel 3) as determinants of financial distress. Results indicate network externalities are an important determinant of financial health of a financial institutions. The parameter that measures the effect of network externalities is both economically and statistical significant and its inclusion as a risk factor reduces the importance of the firm specific variables such as the size or degree of leverage of the financial institution. In addition we analyze the policy implications of the network factor model for capital requirements and deposit insurance pricing.

A dynamic knowledge-based decision support system to handle solids separation problems in activated sludge systems: development and validation

El sistema de fangs activats és el tractament biològic més àmpliament utilitzat arreu del món per la depuració d'aigües residuals. El seu funcionament depèn de la correcta operació tant del reactor biològic com del decantador secundari. Quan la fase de sedimentació no es realitza correctament, la biomassa no decantada s'escapa amb l'efluent causant un impacte sobre el medi receptor. Els problemes de separació de sòlids, són actualment una de les principals causes d'ineficiència en l'operació dels sistemes de fangs activats arreu del món. Inclouen: bulking filamentós, bulking viscós, escumes biològiques, creixement dispers, flòcul pin-point i desnitrificació incontrolada. L'origen dels problemes de separació generalment es troba en un desequilibri entre les principals comunitats de microorganismes implicades en la sedimentació de la biomassa: els bacteris formadors de flòcul i els bacteris filamentosos. Degut a aquest origen microbiològic, la seva identificació i control no és una tasca fàcil pels caps de planta. Els Sistemes de Suport a la Presa de Decisions basats en el coneixement (KBDSS) són un grup d'eines informàtiques caracteritzades per la seva capacitat de representar coneixement heurístic i tractar grans quantitats de dades. L'objectiu de la present tesi és el desenvolupament i validació d'un KBDSS específicament dissenyat per donar suport als caps de planta en el control dels problemes de separació de sòlids d'orígen microbiològic en els sistemes de fangs activats. Per aconseguir aquest objectiu principal, el KBDSS ha de presentar les següents característiques: (1) la implementació del sistema ha de ser viable i realista per garantir el seu correcte funcionament; (2) el raonament del sistema ha de ser dinàmic i evolutiu per adaptar-se a les necessitats del domini al qual es vol aplicar i (3) el raonament del sistema ha de ser intel·ligent. En primer lloc, a fi de garantir la viabilitat del sistema, s'ha realitzat un estudi a petita escala (Catalunya) que ha permès determinar tant les variables més utilitzades per a la diagnosi i monitorització dels problemes i els mètodes de control més viables, com la detecció de les principals limitacions que el sistema hauria de resoldre. Els resultats d'anteriors aplicacions han demostrat que la principal limitació en el desenvolupament de KBDSSs és l'estructura de la base de coneixement (KB), on es representa tot el coneixement adquirit sobre el domini, juntament amb els processos de raonament a seguir. En el nostre cas, tenint en compte la dinàmica del domini, aquestes limitacions es podrien veure incrementades si aquest disseny no fos òptim. En aquest sentit, s'ha proposat el Domino Model com a eina per dissenyar conceptualment el sistema. Finalment, segons el darrer objectiu referent al seguiment d'un raonament intel·ligent, l'ús d'un Sistema Expert (basat en coneixement expert) i l'ús d'un Sistema de Raonament Basat en Casos (basat en l'experiència) han estat integrats com els principals sistemes intel·ligents encarregats de dur a terme el raonament del KBDSS. Als capítols 5 i 6 respectivament, es presenten el desenvolupament del Sistema Expert dinàmic (ES) i del Sistema de Raonament Basat en Casos temporal, anomenat Sistema de Raonament Basat en Episodis (EBRS). A continuació, al capítol 7, es presenten detalls de la implementació del sistema global (KBDSS) en l'entorn G2. Seguidament, al capítol 8, es mostren els resultats obtinguts durant els 11 mesos de validació del sistema, on aspectes com la precisió, capacitat i utilitat del sistema han estat validats tant experimentalment (prèviament a la implementació) com a partir de la seva implementació real a l'EDAR de Girona. Finalment, al capítol 9 s'enumeren les principals conclusions derivades de la present tesi.

Nest Boxes Facilitate Local-Scale Conservation of Common Goldeneye (Bucephala clangula) and Bufflehead (Bucephala albeola) in Alberta, Canada

We tested the general predictions of increased use of nest boxes and positive trends in local populations of Common Goldeneye (Bucephala clangula) and Bufflehead (Bucephala albeola) following the large-scale provision of nest boxes in a study area of central Alberta over a 16-year period. Nest boxes were rapidly occupied, primarily by Common Goldeneye and Bufflehead, but also by European Starling (Sturnus vulgaris). After 5 years of deployment, occupancy of large boxes by Common Goldeneye was 82% to 90% and occupancy of small boxes by Bufflehead was 37% to 58%. Based on a single-stage cluster design, experimental closure of nest boxes resulted in significant reductions in numbers of broods and brood sizes produced by Common Goldeneye and Bufflehead. Occurrence and densities of Common Goldeneye and Bufflehead increased significantly across years following nest box deployment at the local scale, but not at the larger regional scale. Provision of nest boxes may represent a viable strategy for increasing breeding populations of these two waterfowl species on landscapes where large trees and natural cavities are uncommon but wetland density is high.

Climate response to basin-scale warming and cooling of the North Atlantic Ocean

Using experiments with an atmospheric general circulation model, the climate impacts of a basin-scale warming or cooling of the North Atlantic Ocean are investigated. Multidecadal fluctuations with this pattern were observed during the twentieth century, and similar variations--but with larger amplitude--are believed to have occurred in the more distant past. It is found that in all seasons the response to warming the North Atlantic is strongest, in the sense of highest signal-to-noise ratio, in the Tropics. However there is a large seasonal cycle in the climate impacts. The strongest response is found in boreal summer and is associated with suppressed precipitation and elevated temperatures over the lower-latitude parts of North and South America. In August­-September-­October there is a significant reduction in the vertical shear in the main development region for Atlantic hurricanes. In winter and spring, temperature anomalies over land in the extratropics are governed by dynamical changes in circulation rather than simply reflecting a thermodynamic response to the warming or cooling of the ocean. The tropical climate response is primarily forced by the tropical SST anomalies, and the major features are in line with simple models of the tropical circulation response to diabatic heating anomalies. The extratropical climate response is influenced both by tropical and higher-latitude SST anomalies and exhibits nonlinear sensitivity to the sign of the SST forcing. Comparisons with multidecadal changes in sea level pressure observed in the twentieth century support the conclusion that the impact of North Atlantic SST change is most important in summer, but also suggest a significant influence in lower latitudes in autumn and winter. Significant climate impacts are not restricted to the Atlantic basin, implying that the Atlantic Ocean could be an important driver of global decadal variability. The strongest remote impacts are found to occur in the tropical Pacific region in June­-August and September­-November. Surface anomalies in this region have the potential to excite coupled ocean­atmosphere feedbacks, which are likely to play an important role in shaping the ultimate climate response.

The role of nonhydrostatic dynamics in controlling development of a surface ocean front

Numerical studies of surface ocean fronts forced by inhomogeneous buoyancy loss show nonhydrostatic convective plumes coexisting with baroclinic eddies. The character of the vertical overturning depends sensitively on the treatment of the vertical momentum equation in the model. It is less well known how the frontal evolution over scales of O(10 km) is affected by these dynamics. Here, we compare highly resolved numerical experiments using nonhydrostatic and hydrostatic models and the convective-adjustment parametrization. The impact of nonhydrostatic processes on average cross-frontal transfer is weak compared to the effect of the O(1 km) scale baroclinic motions. For water-mass distribution and formation rate nonhydrostatic dynamics have similar influence to the baroclinic eddies although adequate resolution of the gradients in forcing fluxes is more important. The overall implication is that including nonhydrostatic surface frontal dynamics in ocean general circulation models will have only a minor effect on scales of O(1 km) and greater.

Controls on development and diversity of Early Archean stromatolites

The ≈3,450-million-year-old Strelley Pool Formation in Western Australia contains a reef-like assembly of laminated sedimentary accretion structures (stromatolites) that have macroscale characteristics suggestive of biological influence. However, direct microscale evidence of biology—namely, organic microbial remains or biosedimentary fabrics—has to date eluded discovery in the extensively-recrystallized rocks. Recently-identified outcrops with relatively good textural preservation record microscale evidence of primary sedimentary processes, including some that indicate probable microbial mat formation. Furthermore, we find relict fabrics and organic layers that covary with stromatolite morphology, linking morphologic diversity to changes in sedimentation, seafloor mineral precipitation, and inferred microbial mat development. Thus, the most direct and compelling signatures of life in the Strelley Pool Formation are those observed at the microscopic scale. By examining spatiotemporal changes in microscale characteristics it is possible not only to recognize the presence of probable microbial mats during stromatolite development, but also to infer aspects of the biological inputs to stromatolite morphogenesis. The persistence of an inferred biological signal through changing environmental circumstances and stromatolite types indicates that benthic microbial populations adapted to shifting environmental conditions in early oceans.

Problem structuring methods: theorizing the benefits of deconstructing sustainable development projects

Problem structuring methods or PSMs are widely applied across a range of variable but generally small-scale organizational contexts. However, it has been argued that they are seen and experienced less often in areas of wide ranging and highly complex human activity-specifically those relating to sustainability, environment, democracy and conflict (or SEDC). In an attempt to plan, track and influence human activity in SEDC contexts, the authors in this paper make the theoretical case for a PSM, derived from various existing approaches. They show how it could make a contribution in a specific practical context-within sustainable coastal development projects around the Mediterranean which have utilized systemic and prospective sustainability analysis or, as it is now known, Imagine. The latter is itself a PSM but one which is 'bounded' within the limits of the project to help deliver the required 'deliverables' set out in the project blueprint. The authors argue that sustainable development projects would benefit from a deconstruction of process by those engaged in the project and suggest one approach that could be taken-a breakout from a project-bounded PSM to an analysis that embraces the project itself. The paper begins with an introduction to the sustainable development context and literature and then goes on to illustrate the issues by grounding the debate within a set of projects facilitated by Blue Plan for Mediterranean coastal zones. The paper goes on to show how the analytical framework could be applied and what insights might be generated.

The use of earth observation techniques to improve catchment-scale pollution predictions

Remote sensing can potentially provide information useful in improving pollution transport modelling in agricultural catchments. Realisation of this potential will depend on the availability of the raw data, development of information extraction techniques, and the impact of the assimilation of the derived information into models. High spatial resolution hyperspectral imagery of a farm near Hereford, UK is analysed. A technique is described to automatically identify the soil and vegetation endmembers within a field, enabling vegetation fractional cover estimation. The aerially-acquired laser altimetry is used to produce digital elevation models of the site. At the subfield scale the hypothesis that higher resolution topography will make a substantial difference to contaminant transport is tested using the AGricultural Non-Point Source (AGNPS) model. Slope aspect and direction information are extracted from the topography at different resolutions to study the effects on soil erosion, deposition, runoff and nutrient losses. Field-scale models are often used to model drainage water, nitrate and runoff/sediment loss, but the demanding input data requirements make scaling up to catchment level difficult. By determining the input range of spatial variables gathered from EO data, and comparing the response of models to the range of variation measured, the critical model inputs can be identified. Response surfaces to variation in these inputs constrain uncertainty in model predictions and are presented. Although optical earth observation analysis can provide fractional vegetation cover, cloud cover and semi-random weather patterns can hinder data acquisition in Northern Europe. A Spring and Autumn cloud cover analysis is carried out over seven UK sites close to agricultural districts, using historic satellite image metadata, climate modelling and historic ground weather observations. Results are assessed in terms of probability of acquisition probability and implications for future earth observation missions. (C) 2003 Elsevier Ltd. All rights reserved.

Can genetically-modified cotton contribute to sustainable development in Africa?

Genetically modified (GM) crops and sustainable development remain the foci of much media attention, especially given current concerns about a global food crisis. However, whilst the latter is embraced with enthusiasm by almost all groups, GM crops generate very mixed views. Some countries have welcomed GM, but others, notably those in Europe, adopt a cautious stance. This article aims to review the contribution that GM crops can make to agricultural sustainability in the developing world. Following brief reviews of both issues and their linkages, notably the pros and cons of GM cotton as a contributory factor in sustainability, a number of case studies from resourcepoor cotton farmers in Makhathini Flats, South Africa, is presented for a six-year period. Data on expenditure, productivity and income indicate that Bacillus thuringiensis (Bt) cotton is advantageous because it reduces costs, for example, of pesticides, and increases income, and the indications are that those benefits continued over at least the six years covered by the studies. There are repercussions of the additional income in the households; debts are reduced and money is invested in children's education and in the farms. However, in the general GM debate, the results show that GM crops are not miracle products which alleviate poverty at a stroke, but nor is there evidence that they will cause the scale of environmental damage associated with indiscriminate pesticide use. Indeed, for some GM antagonists, perhaps even the majority, such debates are irrelevant – the transfer of genes between species is unnatural and unethical. For them, GM crops will never be acceptable despite the evidence and pressure to increase world food production.