Impacto de dos técnicas quirúrgicas sobre la recaída local de carcinoma de mama en pacientes de una clínica de Bogotá D.C.

Introducción: El carcinoma de mama es el tumor maligno más frecuente entre las mujeres y representa una significativa mortalidad en los países en vías de desarrollo. Según datos del Instituto Nacional de Cancerología en el 2010 se reportaron 672 nuevos casos de cáncer de mama, lo que representó el 18% de todos los tumores malignos en mujeres. Durante las últimas 3 décadas las técnicas quirúrgicas para el tratamiento del cáncer de mama han presentado un cambio significativo y proponen disminución de procedimientos agresivos y radicales, intervenciones como: mastectomía radical modificada, cirugía conservadora y la disección de ganglio centinela son ejemplos claros de esta evolución asociado al incremento de la reconstrucción mamaria inmediata. Metodología: Estudio observacional tipo cohorte retrospectivo en el cual se revisó una base de datos de pacientes con cáncer de mama de las cuales 632 fueron sometidas a mastectomía radical con preservación de piel y complejo areola- pezón y mastectomía radical con preservación de piel sin preservación del complejo areola-pezón, los dos procedimientos asociados a reconstrucción mamaria inmediata y se comparó la frecuencia de recaída local entre los dos grupos. Resultados: De las 632 pacientes estudiadas al 30.5% se les realizo preservación del complejo areola pezón. Las mujeres a quienes se les realizó preservación del complejo areola pezón presentaron menor sobrevida a la recaída local a 10 años (80.51%) comparado con las mujeres a quienes no se les preservó el complejo areola pezón (87.40%), sin embargo no se encontró diferencia estadísticamente significativa para determinar que las probabilidades de sobrevida sean diferentes. Discusión: No se evidenció diferencia estadísticamente significativa entre los 2 procedimientos quirúrgicos (con y sin preservación del complejo areola pezón) en relación a la recaída local, estudios retrospectivos no han evidenciado una mayor tasa de recaídas locales en pacientes a quienes se les preserva el complejo areola-pezón, sin embargo hacen falta estudios prospectivos y aleatorizados que puedan otorgar un mayor sustento científico que garantice la seguridad de la preservación del complejo areola-pezón.

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

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

La cooperación internacional para el desarrollo como herramienta de política exterior japonesa en África Subsahariana

El presente caso de estudio tiene como objetivo explicar el rol de la cooperación internacional para el desarrollo en Tanzania, Mozambique, Nigeria para la consolidación del liderazgo político internacional de Japón. El interés de realizar esta investigación es la ampliación del conocimiento sobre el uso del poder blando, para alcanzar los objetivos de política exterior japonesa. Por eso, se llevara a cabo una revisión bibliográfica para el análisis de documentos oficiales y artículos académicos para la consolidación de información. A partir de ello, se pretende demostrar que la cooperación al desarrollo es una herramienta de política exterior japonesa para consolidarse como líder, en la medida en que el uso de herramientas propias de la cooperación y el presupuesto destinada a la ejecución de éstas tienen incidencia en los votos de estos Estados africanos para las iniciativas japonesas en las Naciones Unidas.

Autocyclic erosion in tidal marshes

A common mode whereby destruction of coastal lowlands occurs is frontal erosion. The edge cliffing, nonetheless, is also an inherent aspect of salt marsh development in many northwest European tidal marshes. Quite a few geomorphologists in the earlier half of the past century recognized such edge erosion as a definite repetitive stage within an autocyclic mode of marsh growth. A shift in research priorities during the past decades (primarily because of coastal management concerns, however) has resulted in an enhanced focus on sediment-flux measurement campaigns on salt marshes. This, somewhat "object-oriented" strategy hindered any further development of the once-established autocyclic growth concept, which virtually has gone into oblivion in recent times. This work makes an attempt to resurrect the notion of autocyclicity by employing its premises to address edge erosion in tidal marshes. Through a review of intertidal morphosedimentology the underlying framework for autocyclicity is envisaged. The phenomenon is demonstrated in the Holocene salt marsh plain of Moricambe basin in NW England that displays several distinct phases of marsh retreat in the form of abandoned clifflets. The suite of abandoned shorelines and terraces has been identified in detailed field mapping that followed analysis of topographic maps and aerial photographs. Vertical trends in marsh plain sediments are recorded in trenches for signs of past marsh front movements. The characteristic sea level history of the area offers an opportunity to differentiate the morphodynamic variability induced in the autocyclic growth of the marsh plain in scenarios of rising and falling sea level and the accompanied change in sediment budget. The ideas gathered are incorporated to construct a conceptual model that links temporal extent of marsh erosion to inner tidal flat sediment budget and sea level tendency. The review leads to recognition of the necessity of adopting an holistic approach in the morphodynamic investigations where marshes should be treated as a component within the "marsh-mudflat system" as each element apparently modulates evolution of the other, with an eventual linkage to subtidal channels. (C) 2009 Elsevier B.V. All rights reserved.

The cumulus-capped boundary layer. II: Interface fluxes

This paper considers the relationship between the mean temperature and humidity profiles and the fluxes of heat and moisture at cloud base and the base of the inversion in the cumulus-capped boundary layer. The relationships derived are based on an approximate form of the scalar-flux budget and the scaling properties of the turbulent kinetic energy (TKE) budget. The scalar-flux budget gives a relationship between the change in the virtual potential temperature across either the cloud base transition zone or the inversion and the flux at the base of the layer. The scaling properties of the TKE budget lead to a relationship between the heat and moisture fluxes and the mean subsaturation through the liquid-water flux. The 'jump relation' for the virtual potential temperature at cloud base shows the close connection between the cumulus mass flux in the cumulus-capped boundary layer and the entrainment velocity in the dry-convective boundary layer. Gravity waves are shown to be an important feature of the inversion.

Frequency of word-use predicts rates of lexical evolution throughout Indo-European history

Greek speakers say "ovpa", Germans "schwanz'' and the French "queue'' to describe what English speakers call a 'tail', but all of these languages use a related form of 'two' to describe the number after one. Among more than 100 Indo-European languages and dialects, the words for some meanings (such as 'tail') evolve rapidly, being expressed across languages by dozens of unrelated words, while others evolve much more slowly-such as the number 'two', for which all Indo-European language speakers use the same related word-form(1). No general linguistic mechanism has been advanced to explain this striking variation in rates of lexical replacement among meanings. Here we use four large and divergent language corpora (English(2), Spanish(3), Russian(4) and Greek(5)) and a comparative database of 200 fundamental vocabulary meanings in 87 Indo-European languages(6) to show that the frequency with which these words are used in modern language predicts their rate of replacement over thousands of years of Indo-European language evolution. Across all 200 meanings, frequently used words evolve at slower rates and infrequently used words evolve more rapidly. This relationship holds separately and identically across parts of speech for each of the four language corpora, and accounts for approximately 50% of the variation in historical rates of lexical replacement. We propose that the frequency with which specific words are used in everyday language exerts a general and law-like influence on their rates of evolution. Our findings are consistent with social models of word change that emphasize the role of selection, and suggest that owing to the ways that humans use language, some words will evolve slowly and others rapidly across all languages.

Recovery of norbixin from a raw extraction solution of annatto pigments using colloidal gas aphrons (CGAs)

Annatto dyes are widely used in food and are finding increasing interest also for their application in the pharmaceutical and cosmetics industry. Bixin is the main pigment extracted from annatto seeds and accounts for 80% of the carotenoids in the outer coat of the seeds; norbixin being the water-soluble form of the bixin. Typically annatto dyes are extracted from the seeds by mechanical means or solutions of alkali, edible oil or organic solvents, or a combination of the two depending on the desired final product. In this work CGAs are investigated as an alternative separation method for the recovery of norbixin from a raw extraction solution of annatto pigments in KOH. A volume of CGAs generated from a cationic surfactant (CTAB) solution is mixed with a volume of annatto solution and when the mixture is allowed to settle it separates into the top aphron phase and the bottom liquid phase. Potassium norbixinate presented in the annatto solution will interact with the surfactant in the aphron phase, which results in the effective separation of norbixin. Recovery= 94% was achieved at a CTAB to norbixin molar ratio of 3.3. In addition a mechanism of separation is proposed here based on the separation results with the cationic surfactant and an anionic surfactant (bis-2-ethyl hexyl sulfosuccinate, AOT) and measurements of surfactant to norbixin ratio in the aphron phase; electrostatic interactions between the surfactant and norbixin molecules result in the fort-nation of a coloured complex and effective separation of norbixin. (c) 2005 Elsevier B.V. All rights reserved.

Influence of dynamics on the changes in tropical cloud radiative forcing during the 1998 El Niño

Satellite measurements of the radiation budget and data from the U.S. National Centers for Environmental Prediction–National Center for Atmospheric Research reanalysis are used to investigate the links between anomalous cloud radiative forcing over the tropical west Pacific warm pool and the tropical dynamics and sea surface temperature (SST) distribution during 1998. The ratio, N, of the shortwave cloud forcing (SWCF) to longwave cloud forcing (LWCF) (N = −SWCF/LWCF) is used to infer information on cloud altitude. A higher than average N during 1998 appears to be related to two separate phenomena. First, dynamic regime-dependent changes explain high values of N (associated with low cloud altitude) for small magnitudes of SWCF and LWCF (low cloud fraction), which reflect the unusual occurrence of mean subsiding motion over the tropical west Pacific during 1998, associated with the anomalous SST distribution. Second, Tropics-wide long-term changes in the spatial-mean cloud forcing, independent of dynamic regime, explain the higher values of N during both 1998 and in 1994/95. The changes in dynamic regime and their anomalous structure in 1998 are well simulated by version HadAM3 of the Hadley Centre climate model, forced by the observed SSTs. However, the LWCF and SWCF are poorly simulated, as are the interannual changes in N. It is argued that improved representation of LWCF and SWCF and their dependence on dynamical forcing are required before the cloud feedbacks simulated by climate models can be trusted.

Impact of a new anisotropic rheology on simulations of Arctic sea ice

new rheology that explicitly accounts for the subcontinuum anisotropy of the sea ice cover is implemented into the Los Alamos sea ice model. This is in contrast to all models of sea ice included in global circulation models that use an isotropic rheology. The model contains one new prognostic variable, the local structure tensor, which quantifies the degree of anisotropy of the sea ice, and two parameters that set the time scale of the evolution of this tensor. The anisotropic rheology provides a subcontinuum description of the mechanical behavior of sea ice and accounts for a continuum scale stress with large shear to compression ratio and tensile stress component. Results over the Arctic of a stand-alone version of the model are presented and anisotropic model sensitivity runs are compared with a reference elasto-visco-plastic simulation. Under realistic forcing sea ice quickly becomes highly anisotropic over large length scales, as is observed from satellite imagery. The influence of the new rheology on the state and dynamics of the sea ice cover is discussed. Our reference anisotropic run reveals that the new rheology leads to a substantial change of the spatial distribution of ice thickness and ice drift relative to the reference standard visco-plastic isotropic run, with ice thickness regionally increased by more than 1 m, and ice speed reduced by up to 50%.

The role of horizontal resolution in simulating drivers of the global hydrological cycle

The role of atmospheric general circulation model (AGCM) horizontal resolution in representing the global energy budget and hydrological cycle is assessed, with the aim of improving the understanding of model uncertainties in simulating the hydrological cycle. We use two AGCMs from the UK Met Office Hadley Centre: HadGEM1-A at resolutions ranging from 270 to 60 km, and HadGEM3-A ranging from 135 to 25 km. The models exhibit a stable hydrological cycle, although too intense compared to reanalyses and observations. This over-intensity is explained by excess surface shortwave radiation, a common error in general circulation models (GCMs). This result is insensitive to resolution. However, as resolution is increased, precipitation decreases over the ocean and increases over the land. This is associated with an increase in atmospheric moisture transport from ocean to land, which changes the partitioning of moisture fluxes that contribute to precipitation over land from less local to more non-local moisture sources. The results start to converge at 60-km resolution, which underlines the excessive reliance of the mean hydrological cycle on physical parametrization (local unresolved processes) versus model dynamics (large-scale resolved processes) in coarser HadGEM1 and HadGEM3 GCMs. This finding may be valid for other GCMs, showing the necessity to analyze other chains of GCMs that may become available in the future with such a range of horizontal resolutions. Our finding supports the hypothesis that heterogeneity in model parametrization is one of the underlying causes of model disagreement in the Coupled Model Intercomparison Project (CMIP) exercises.

Inverse modeling of the 14C bomb pulse in stalagmites to constrain the dynamics of soil carbon cycling at selected European cave sites

The decomposition of soil organic matter (SOM) is temperature dependent, but its response to a future warmer climate remains equivocal. Enhanced rates of decomposition of SOM under increased global temperatures might cause higher CO2 emissions to the atmosphere, and could therefore constitute a strong positive feedback. The magnitude of this feedback however remains poorly understood, primarily because of the difficulty in quantifying the temperature sensitivity of stored, recalcitrant carbon that comprises the bulk (>90%) of SOM in most soils. In this study we investigated the effects of climatic conditions on soil carbon dynamics using the attenuation of the 14C ‘bomb’ pulse as recorded in selected modern European speleothems. These new data were combined with published results to further examine soil carbon dynamics, and to explore the sensitivity of labile and recalcitrant organic matter decomposition to different climatic conditions. Temporal changes in 14C activity inferred from each speleothem was modelled using a three pool soil carbon inverse model (applying a Monte Carlo method) to constrain soil carbon turnover rates at each site. Speleothems from sites that are characterised by semi-arid conditions, sparse vegetation, thin soil cover and high mean annual air temperatures (MAATs), exhibit weak attenuation of atmospheric 14C ‘bomb’ peak (a low damping effect, D in the range: 55–77%) and low modelled mean respired carbon ages (MRCA), indicating that decomposition is dominated by young, recently fixed soil carbon. By contrast, humid and high MAAT sites that are characterised by a thick soil cover and dense, well developed vegetation, display the highest damping effect (D = c. 90%), and the highest MRCA values (in the range from 350 ± 126 years to 571 ± 128 years). This suggests that carbon incorporated into these stalagmites originates predominantly from decomposition of old, recalcitrant organic matter. SOM turnover rates cannot be ascribed to a single climate variable, e.g. (MAAT) but instead reflect a complex interplay of climate (e.g. MAAT and moisture budget) and vegetation development.

PedVis: A Structured, Space-Efficient Technique for Pedigree Visualization

Public genealogical databases are becoming increasingly populated with historical data and records of the current population`s ancestors. As this increasing amount of available information is used to link individuals to their ancestors, the resulting trees become deeper and more dense, which justifies the need for using organized, space-efficient layouts to display the data. Existing layouts are often only able to show a small subset of the data at a time. As a result, it is easy to become lost when navigating through the data or to lose sight of the overall tree structure. On the contrary, leaving space for unknown ancestors allows one to better understand the tree`s structure, but leaving this space becomes expensive and allows fewer generations to be displayed at a time. In this work, we propose that the H-tree based layout be used in genealogical software to display ancestral trees. We will show that this layout presents an increase in the number of displayable generations, provides a nicely arranged, symmetrical, intuitive and organized fractal structure, increases the user`s ability to understand and navigate through the data, and accounts for the visualization requirements necessary for displaying such trees. Finally, user-study results indicate potential for user acceptance of the new layout.

En analys av testprocesser med TMap som testmetod

Today there are many system development projects that break both budget and time plan. Often this depends on defects in the information systems that could have been prevented. The cost of test can in some cases be as high as 50 % of the projects total cost and it's at the same time an important part of development. Test as such has moved its focus from the software it self and its faults to a wider perspective on whole infrastructures of information systems where assure a good quality is important. Sogeti in the Netherlands have developed a test method called TMap (Test Management approach) that can be used for structured testing of information systems. TMap haven't been used as much as desired in the office in Borlänge. Because Microsoft is releasing a new version of their platform Visual Studio Team System (VSTS 2010) some colleges at Sogeti in the Netherlands are about to develop a template that can support the use of TMap in VSTS 2010. When we write this the template is still in development. The goal for Sogeti was to find out the differences between the test functionality in VSTS 2008 and 2010. By using the purpose with this essay, which was to analyze the test process in VSTS 2008 with TMap against the test process in VSTS 2010 together with the template we got much help to achieve the goal. The analysis was done with four different aspects: The TPI and TMMi models, problem and strength analyses and a few question formulations. The TPI and TMMi models where used to analyses and evaluate the test process. The analysis showed that there were differences between the both test processes. VSTS 2010 together with the template gave a better support to use TMap and perform test. In VSTS 2010 the test tool Camano is connected to TFS and the tool is also to make the execution and logging of tests easier. This leads to a test process that is easier to handle and has a better support for TMap.

Lanseringen och etableringen av ett socialt problem : En analys av debatten om ledarkulturen inom svensk landslagsgymnastik i Dagens Nyheter 2012–2013

The launching and establishment of a social problem: An analysis of the debate on Swedish national level gymnastics in Dagens Nyheter 2012-2013 In 2012 Sweden’s largest daily newspaper, Dagens Nyheter, published a number of articles on the state of affairs in Swedish national level gymnastics. In these articles, ex-gymnasts, coaches, parents and physicians stepped forward and testified about recurrent wrongdoings and abuse against young (particularly) female gymnasts. In response to the criticism, the accused coaches and representatives of the Swedish Gymnastics Federation downsized or dismissed the criticism as inaccurate. This being said, and using discursive psychology and a qualitative design, this article sheds light upon this debate – by viewing it as a struggle between a hegemonic discourse of ”the goodness” of sports, on the one hand, a number of unfavorable and negative testimonies of the state of affairs in Swedish national level gymnastics on the other. More concretely, this struggle has been analyzed with regard to the discursive and rhetoric resources the involved parties’ used to pursue their claims about the state of affairs in Swedish national level gymnastics and the impact these resources had for their credibility and legitimacy. Questions were: Who is entitled ”to spell out” their view on the state of affairs within Swedish national level gymnastics? What is mediated and how? How are descriptions and accounts about reality constructed as credible and factual? It is concluded that social problems are launched via co-production; in this process, the gymnastics community, the research community, single individuals, and the media – were co-actors. 

Contribuição da Endotelina-1 para o tônus coronariano de seres humanos: experimentos com o antagonista dos receptores ET-A

Introdução. A endotelina-1, o mais potente vasoconstritor endógeno, atua através de dois receptores de afinidades distintas, conhecidos como ETA e ETB. Os receptores ETA estão localizados predominantemente na musculatura lisa vascular e são os principais mediadores do efeito vasoconstritor da endotelina-1. Diversos estudos demonstraram que a endotelina-1 exerce um papel importante na manutenção do tônus arterial basal. Entretanto, a contribuição da endotelina-1 para o tônus coronariano basal em seres humanos, especialmente em coronárias com lesões ateroscleróticas, permanece alvo de interesse. Objetivos. Os objetivos deste estudo foram avaliar a contribuição da endotelina-1 no tônus coronariano epicárdico e na microcirculação em coronárias livres de lesões obstrutivas e em coronárias com lesões ateroscleróticas e comparar o método da contagem TIMI com o Doppler intracoronário na detecção de alterações do fluxo sangüíneo em resposta à adenosina. Métodos. Um total de 16 pacientes, sendo oito destes no grupo com coronárias livres de lesões obstrutivas e oito pacientes com lesões coronarianas obstrutivas, foram incluídos neste estudo. Todos pacientes receberam a infusão seletiva intracoronária de BQ-123, um inibidor específico dos receptores ETA da endotelina-1, durante 60 minutos. Adenosina e nitroglicerina foram administradas em bolus no tronco da coronária esquerda. O efeito do BQ-123 no diâmetro coronário epicárdico foi avaliado por angiografia quantitativa realizada a cada 15 minutos ao longo da infusão da droga. O efeito na microcirculação coronária foi avaliado por variações no fluxo sangüíneo medido por guia-Doppler e pelo método da contagem TIMI. Resultados. A infusão de BQ-123 resultou em aumento de 7% do diâmetro coronário e de 19% no fluxo sangüíneo volumétrico em pacientes com artérias livres de lesões obstrutivas (P < 0,001 para comparação com basal). O aumento do calibre do vaso ocorreu de forma progressiva e uniforme ao longo do vaso. Os pacientes com lesão aterosclerótica apresentaram um aumento de 16% (P < 0,001 para comparação com artérias livres de lesões obstrutivas) no diâmetro coronário e 28% no local da estenose. A velocidade do fluxo sangüíneo em coronárias livres de lesões obstrutivas não se alterou significativamente tanto na medida por Doppler como pelo método de contagem TIMI. Houve uma correlação de 0,67 (P < 0,05) entre o método da contagem TIMI e o Doppler para detecção de alterações na velocidade do fluxo sangüíneo em resposta à adenosina. Conclusões. A infusão seletiva intracoronária do inibidor específico dos receptores ETA da endotelina-1 em seres humanos pode ser feita de maneira segura. A endotelina-1 exerce um papel importante na manutenção do tônus coronariano basal em artérias livres de lesões obstrutivas, sendo responsável pela quase totalidade do tônus constritor aumentado presente em coronárias com lesões ateroscleróticas. O método da contagem TIMI apresenta uma boa correlação com o Doppler para medida do fluxo sangüíneo em condições de hiperêmia.