La responsabilidad patrimonial del Estado por la falla en la prestación del servicio médico asistencial. Acto médico defectuoso en las entidades de salud del Estado. -Una visión desde la doctrina y desarrollo jurisprudencial del Consejo de Estado-.

La complejidad que supone abarcar el estudio de la responsabilidad patrimonial del Estado en el ámbito médico sanitario, hace preciso prestar atención a ciertos temas que resultan especialmente relevantes y que han sido decantados jurisprudencialmente por el Honorable Consejo de Estado. De esta manera el presente trabajo desarrolla temas descollantes y novedosos en materia de imputabilidad como viene a ser la prueba de la falla médica mediante la teoría "res ipsa loquitur"; la prueba del nexo causal a través de la prueba indiciaria y la teoría de la probabilidad preponderante. Así mismo se estudian los diversos tipos de daños antijurídicos que pueden darse dentro de la prestación médica a cargo del Estado, destacando especialmente la lesión al derecho a recibir una atención oportuna y eficaz, la pérdida de una oportunidad debida a la no obtención del consentimiento informado del paciente, lo que supone, a su vez, el cercenamiento del derecho de este a elegir someterse o no a determinado tratamiento, previo valoración de pros y contras de la terapia sugerida por el galeno (principio de no agravación). Así mismo se analizanlas hipótesis de daños antijurídicos derivados del error en el diagnóstico, la falla por la omisión de las entidades de control y vigilancia, falla en gineco-obstetricia, así como las hipótesis de responsabilidad objetiva del Estado por óblito quirúrgico, para finalmente tratar el tema novedoso del alea terapéutica con sus particulares características y eventual aplicabilidad en el sistema jurídico colombiano.

Las adicciones a la luz del psicoanálisis, una revisión de literatura

El presente trabajo de grado es una revisión de la literatura que permite hacer un recorrido desde el psicoanálisis acerca de la compleja problemática de las adicciones. Para ello, se revisaron las bases de datos PepWeb, Ebsco, y Jstor, revisando las posiciones del psicoanálisis freudiano, lacaniano y otras corrientes psicoanalíticas respondiendo a las siguientes preguntas de investigación: (a) ¿Cómo se comprenden las adicciones desde un marco de referencia psicoanalítico? (b) ¿Cómo –desde la teoría freudiana y la teoría lacaniana - se aborda la comprensión de la adicción? (c) ¿Qué dice el psicoanálisis contemporáneo sobre ésta problemática? Se abordan temas como la concepción de una adicción desde la perspectiva de Freud y Lacan hasta psicoanalistas contemporáneos, el rol que juega el goce en la adicción y, finalmente, el complejo debate incipiente sobre la legalidad del tóxico. Se encontró que es un campo de constante publicación y es necesario que los clínicos y los psicoanalistas aborden este campo de estudio clínico permanentemente y sigan produciendo investigaciones sobre el fenómeno.

Coneixements dels professionals de la salut de l'atenció primària sobre prevenció del consum de drogues

The aim of this research is to know the training of health professionals in health promotion and disease prevention, and to examine its manifestation among the actions and interventions for prevention of tobacco, alcohol or cannabis consumption. The sample includes 225 professionals. The study used a self-made design of quantitative methodology (survey study). The most important results are: the formative limitations in health education and prevention of substance use and the fact that professionals who have received specific training in substance use tap more health education as a prevention tool in their daily activities. It is also noted that 80% of professionals believe they should improve quality training, and 67% quantity, always in relation to the tobacco, alcohol and cannabis use. Generally, the overload care and the lack of time are cited as factors preventing the health education activities. Finally, the study also shows that secondary prevention activities are the most used, while community interventions are underutilized by professionals.

El recurso de casación en materia penal

El tema central y alcance de la presente tesis de maestría está circunscrito al actual recurso de casación penal, contenido en los artículos 656 y 657 del Código Orgánico Integral Penal. La perspectiva teórico-metodológica utilizada ha sido de tipo documental y dogmática, recurriendo primariamente a textos legales, doctrina y jurisprudencia actualizada. El concepto principal que sigue esta tesis es que actualmente se ha disuelto la pretensión original del fin político de la casación, pues no se puede seguir pensando en términos de una teórica justicia absoluta abstracta, sino más bien en ir hacia una justicia razonable del caso concreto. Por tanto la idea que debe guiarnos es que la protección del sistema jurídico se ha ampliado a la efectiva protección de los derechos y garantías fundamentales, lo cual termina contorneando la casación penal de una manera muy diferente a la originalmente diseñada para su funcionamiento. En el capítulo primero se realiza un análisis histórico de la casación, con su "fin político o Ius constitutionis", esto es las funciones nomofiláctica y la uniformadora, y la creciente importancia del "fin procesal o Ius litigatoris" esto es la función dikelógica. Se analiza las características y principios de la casación penal. Y la llegada y desenvolvimiento de dicha institución procesal penal en nuestro país. En el capítulo segundo, se realiza un análisis de la correcta conceptualización de los conceptos de error in procedendo y error in iudicando, y dentro de éste último el error de derecho (in jure) y el error de hecho (in facto). Se resalta el tema del error de juicio in iudicando in factum, esto es la problemática del segundo inciso del Art. 656 del COIP, que bien puede ser la parte más importante de esta tesis. En el capítulo tercero se analiza la técnica de casación penal; y se hace un análisis de los titulares del recurso, de su admisión, de la audiencia pública de fundamentación; así como de la sentencia de casación.

The predictability of extratropical storm tracks and the sensitivity of their prediction to the observing system

A new method for assessing forecast skill and predictability that involves the identification and tracking of extratropical cyclones has been developed and implemented to obtain detailed information about the prediction of cyclones that cannot be obtained from more conventional analysis methodologies. The cyclones were identified and tracked along the forecast trajectories, and statistics were generated to determine the rate at which the position and intensity of the forecasted storms diverge from the analyzed tracks as a function of forecast lead time. The results show a higher level of skill in predicting the position of extratropical cyclones than the intensity. They also show that there is potential to improve the skill in predicting the position by 1 - 1.5 days and the intensity by 2 - 3 days, via improvements to the forecast model. Further analysis shows that forecasted storms move at a slower speed than analyzed storms on average and that there is a larger error in the predicted amplitudes of intense storms than the weaker storms. The results also show that some storms can be predicted up to 3 days before they are identified as an 850-hPa vorticity center in the analyses. In general, the results show a higher level of skill in the Northern Hemisphere (NH) than the Southern Hemisphere (SH); however, the rapid growth of NH winter storms is not very well predicted. The impact that observations of different types have on the prediction of the extratropical cyclones has also been explored, using forecasts integrated from analyses that were constructed from reduced observing systems. A terrestrial, satellite, and surface-based system were investigated and the results showed that the predictive skill of the terrestrial system was superior to the satellite system in the NH. Further analysis showed that the satellite system was not very good at predicting the growth of the storms. In the SH the terrestrial system has significantly less skill than the satellite system, highlighting the dominance of satellite observations in this hemisphere. The surface system has very poor predictive skill in both hemispheres.

Evaluation of suitable spectral intervals for near-IR laboratory detection of water vapour continuum absorption

The water vapour continuum absorption is an important component of molecular absorption of radiation in atmosphere. However, uncertainty in knowledge of the value of the continuum absorption at present can achieve 100% in different spectral regions leading to an error in flux calculation up to 3-5 W/m2 global mean. This work uses line-by-line calculations to reveal the best spectral intervals for experimental verification of the CKD water vapour continuum models in the currently least studied near-infrared spectral region. Possible sources of errors in continuum retrieval taken into account in the simulation include the sensitivity of laboratory spectrometers and uncertainties in the spectral line parameters in HITRAN-2004 and Schwenke-Partridge database. It is shown that a number of micro-windows in near-IR can be used at present for laboratory detection of the water vapour continuum with estimated accuracy from 30 to 5%.

Achieving accurate FTIR measurements on high performance bandpass filters

The sources of ordinate error in FTIR spectrometers are reviewed with reference to measuring small out-of-band features in the spectra of bandpass filters. Procedures for identifying instrumental artefacts are described. It is shown that features well below 0.01%T can be measured reliably.

Isolating the signal of ocean global warming

Identifying the signature of global warming in the world's oceans is challenging because low frequency circulation changes can dominate local temperature changes. The IPCC fourth assessment reported an average ocean heating rate of 0.21 ± 0.04 Wm−2 over the period 1961–2003, with considerable spatial, interannual and inter-decadal variability. We present a new analysis of millions of ocean temperature profiles designed to filter out local dynamical changes to give a more consistent view of the underlying warming. Time series of temperature anomaly for all waters warmer than 14°C show large reductions in interannual to inter-decadal variability and a more spatially uniform upper ocean warming trend (0.12 Wm−2 on average) than previous results. This new measure of ocean warming is also more robust to some sources of error in the ocean observing system. Our new analysis provides a useful addition for evaluation of coupled climate models, to the traditional fixed depth analyses.

Modelling the hydraulics of the Carlisle 2005 flood event

The performance of a 2D numerical model of flood hydraulics is tested for a major event in Carlisle, UK, in 2005. This event is associated with a unique data set, with GPS surveyed wrack lines and flood extent surveyed 3 weeks after the flood. The Simple Finite Volume (SFV) model is used to solve the 2D Saint-Venant equations over an unstructured mesh of 30000 elements representing channel and floodplain, and allowing detailed hydraulics of flow around bridge piers and other influential features to be represented. The SFV model is also used to corroborate flows recorded for the event at two gauging stations. Calibration of Manning's n is performed with a two stage strategy, with channel values determined by calibration of the gauging station models, and floodplain values determined by optimising the fit between model results and observed water levels and flood extent for the 2005 event. RMS error for the calibrated model compared with surveyed water levels is ~±0.4m, the same order of magnitude as the estimated error in the survey data. The study demonstrates the ability of unstructured mesh hydraulic models to represent important hydraulic processes across a range of scales, with potential applications to flood risk management.

Can desert dust explain the outgoing longwave radiation anomaly over the Sahara during July 2003?

Measurements of the top‐of‐the‐atmosphere outgoing longwave radiation (OLR) for July 2003 from Meteosat‐7 are used to assess the performance of the numerical weather prediction version of the Met Office Unified Model. A significant difference is found over desert regions of northern Africa where the model emits too much OLR by up to 35 Wm−2 in the monthly mean. By cloud‐screening the data we find an error of up to 50 Wm−2 associated with cloud‐free areas, which suggests an error in the model surface temperature, surface emissivity, or atmospheric transmission. By building up a physical model of the radiative properties of mineral dust based on in situ, and surface‐based and satellite remote sensing observations we show that the most plausible explanation for the discrepancy in OLR is due to the neglect of mineral dust in the model. The calculations suggest that mineral dust can exert a longwave radiative forcing by as much as 50 Wm−2 in the monthly mean for 1200 UTC in cloud‐free regions, which accounts for the discrepancy between the model and the Meteosat‐7 observations. This suggests that inclusion of the radiative effects of mineral dust will lead to a significant improvement in the radiation balance of numerical weather prediction models with subsequent improvements in performance.

An interpretation of baroclinic initial value problems: results for simple basic states with nonzero interior PV gradients

In the Eady model, where the meridional potential vorticity (PV) gradient is zero, perturbation energy growth can be partitioned cleanly into three mechanisms: (i) shear instability, (ii) resonance, and (iii) the Orr mechanism. Shear instability involves two-way interaction between Rossby edge waves on the ground and lid, resonance occurs as interior PV anomalies excite the edge waves, and the Orr mechanism involves only interior PV anomalies. These mechanisms have distinct implications for the structural and temporal linear evolution of perturbations. Here, a new framework is developed in which the same mechanisms can be distinguished for growth on basic states with nonzero interior PV gradients. It is further shown that the evolution from quite general initial conditions can be accurately described (peak error in perturbation total energy typically less than 10%) by a reduced system that involves only three Rossby wave components. Two of these are counterpropagating Rossby waves—that is, generalizations of the Rossby edge waves when the interior PV gradient is nonzero—whereas the other component depends on the structure of the initial condition and its PV is advected passively with the shear flow. In the cases considered, the three-component model outperforms approximate solutions based on truncating a modal or singular vector basis.

A wavenumber independent boundary element method for an acoustic scattering problem

In this paper we consider the impedance boundary value problem for the Helmholtz equation in a half-plane with piecewise constant boundary data, a problem which models, for example, outdoor sound propagation over inhomogeneous. at terrain. To achieve good approximation at high frequencies with a relatively low number of degrees of freedom, we propose a novel Galerkin boundary element method, using a graded mesh with smaller elements adjacent to discontinuities in impedance and a special set of basis functions so that, on each element, the approximation space contains polynomials ( of degree.) multiplied by traces of plane waves on the boundary. We prove stability and convergence and show that the error in computing the total acoustic field is O( N-(v+1) log(1/2) N), where the number of degrees of freedom is proportional to N logN. This error estimate is independent of the wavenumber, and thus the number of degrees of freedom required to achieve a prescribed level of accuracy does not increase as the wavenumber tends to infinity.

A high-wavenumber boundary-element method for an acoustic scattering problem

In this paper we show stability and convergence for a novel Galerkin boundary element method approach to the impedance boundary value problem for the Helmholtz equation in a half-plane with piecewise constant boundary data. This problem models, for example, outdoor sound propagation over inhomogeneous flat terrain. To achieve a good approximation with a relatively low number of degrees of freedom we employ a graded mesh with smaller elements adjacent to discontinuities in impedance, and a special set of basis functions for the Galerkin method so that, on each element, the approximation space consists of polynomials (of degree $\nu$) multiplied by traces of plane waves on the boundary. In the case where the impedance is constant outside an interval $[a,b]$, which only requires the discretization of $[a,b]$, we show theoretically and experimentally that the $L_2$ error in computing the acoustic field on $[a,b]$ is ${\cal O}(\log^{\nu+3/2}|k(b-a)| M^{-(\nu+1)})$, where $M$ is the number of degrees of freedom and $k$ is the wavenumber. This indicates that the proposed method is especially commendable for large intervals or a high wavenumber. In a final section we sketch how the same methodology extends to more general scattering problems.

An estimate of the global impact of multiple scattering by clouds on outgoing long-wave radiation

Although the potential importance of scattering of long-wave radiation by clouds has been recognised, most studies have concentrated on the impact of high clouds and few estimates of the global impact of scattering have been presented. This study shows that scattering in low clouds has a significant impact on outgoing long-wave radiation (OLR) in regions of marine stratocumulus (-3.5 W m(-2) for overcast conditions) where the column water vapour is relatively low. This corresponds to an enhancement of the greenhouse effect of such clouds by 10%. The near-global impact of scattering on OLR is estimated to be -3.0 W m(-2), with low clouds contributing -0.9 W m(-2), mid-level cloud -0.7 W m(-2) and high clouds -1.4 W m(-2). Although this effect appears small compared to the global mean OLR of 240 W m(-2), it indicates that neglect of scattering will lead to an error in cloud long-wave forcing of about 10% and an error in net cloud forcing of about 20%.

Moist singular vectors and the predictability of some high impact European cyclones

The ECMWF full-physics and dry singular vector (SV) packages, using a dry energy norm and a 1-day optimization time, are applied to four high impact European cyclones of recent years that were almost universally badly forecast in the short range. It is shown that these full-physics SVs are much more relevant to severe cyclonic development than those based on dry dynamics plus boundary layer alone. The crucial extra ingredient is the representation of large-scale latent heat release. The severe winter storms all have a long, nearly straight region of high baroclinicity stretching across the Atlantic towards Europe, with a tongue of very high moisture content on its equatorward flank. In each case some of the final-time top SV structures pick out the region of the actual storm. The initial structures were generally located in the mid- to low troposphere. Forecasts based on initial conditions perturbed by moist SVs with opposite signs and various amplitudes show the range of possible 1-day outcomes for reasonable magnitudes of forecast error. In each case one of the perturbation structures gave a forecast very much closer to the actual storm than the control forecast. Deductions are made about the predictability of high-impact extratropical cyclone events. Implications are drawn for the short-range forecast problem and suggestions made for one practicable way to approach short-range ensemble forecasting. Copyright © 2005 Royal Meteorological Society.