Evaluación de tecnologías sanitarias aplicada a la selección de un módulo de proteína para uso hospitalario

Introducción: La evaluación de tecnologías en salud aplicadas a la selección de un módulo de proteína para uso hospitalario, tiene como finalidad servir de apoyo en la elección de productos costo efectivos y seguros, con el fin de favorecer la toma de decisiones a los diferentes agentes que participan en la elección de alternativas terapéuticas, recomendadas en pacientes con necesidades elevadas de proteínas, como es el caso de la presente investigación. Objetivo: Aplicar un método matemático - multicriterio que permita evaluar los módulos de proteína disponibles en el mercado para la terapia nutricional institucional. Métodos: Se establecieron dos fases, una revisión de la literatura para establecer y priorizar los criterios de evaluación técnica de las diferentes ofertas de módulos de proteína, y dos se realizó una aplicación de un modelo matemático con el fin de considerar el modulo proteico para uso dentro de las instituciones hospitalarias, el cual consistió en la asignación de un valor a cada una de las variables mediante una escala diferencial semántica establecida, que permitieron calcular el peso porcentual de cada una de las variables, cuya sumatoria arrojo la calificación porcentual de cada alternativa. Resultados: Respecto a la búsqueda de criterios de evaluación técnica para las diferentes ofertas de módulos de proteína, en la literatura se identificaron las siguientes variables para evaluación, la naturaleza o equivalencia, condiciones de administración y uso, seguridad, y eficacia. La naturaleza se evaluó mediante la calificación del cómputo químico de aminoácidos corregido por digestibilidad proteica (PDCAAS) con un peso en la evaluación del 39.05%, en referencia a las condiciones de administración y uso se tuvo en cuenta factores incluidos en los sistemas de distribución por dosis unitaria con un peso del 27.61%, la eficacia fue definida por la tasa de eficiencia proteica (PER) la cual impacta el 19.53% de la calificación y finalmente, el criterio de seguridad con un 13.81% referente al empaque y etiquetado. Conclusiones: Al realizar la evaluación de cuatro alternativas de módulos de proteína, ofertadas por las diferentes casas farmacéuticas, la mayor puntuación correspondiente a las alternativas con una calificación superior al 90%, la obtuvieron dos alternativas de módulos de proteína para uso hospitalario, las cuales contienen proteínas del suero (“Whey”) y aminoácidos en combinaciones.

Autoreporte de la calidad de vida en niños y adolescentes colombianos: Estudio FUPRECOL

RESUMEN Introducción: El EQ-5D-Y proxy es un cuestionario genérico, de fácil comprensión y aplicación, que evalúa distintas dimensiones de la salud percibida. El objetivo del siguiente estudio fue describir por autoreporte la calidad de vida relacionada con la salud (CVRS) en una población escolar de Bogotá, Colombia, pertenecientes al estudio FUPRECOL. Métodos: Estudio descriptivo y transversal, realizado en 3.245 niños y 3.354 adolescentes, entre 9 y 17.9 años de edad, de 24 instituciones educativas oficiales de Bogotá, Colombia. Se aplicó de manera auto-administrada la versión validada al castellano por Olivares et al. (2009) del instrumento de CVRS infantil EQ-5D-Y proxy. Se analizaron los datos por medidas de tendencia central y se realizó una comparación de los observados en Colombia con estudios internacionales. Resultados: De la población evaluada, el 58,3% (n=3.848), fueron mujeres. En general, se observa puntuaciones elevadas en la CVRS en niños y adolescentes de ambos sexos. Al comparar por género, las dimensiones del EQ-5D-Y proxy “sentirse triste/preocupado o infeliz” y “tener dolor/malestar”, presentaron la mayor frecuencia de repuesta en el grupo de las mujeres. Al comparar los resultados de este estudio, por grupos de edad, con trabajos internacionales de niños y adolescentes, se observa que las puntuaciones del EQ-5D-Y proxy fueron superiores a los reportados en Suráfrica, Alemania e Italia. Conclusión: Se presentan valores de la CVRS según edad y sexo que podrán ser usados en la evaluación de la salud percibida en el ámbito escolar. Se hace necesario evaluar las propiedades psicométricas del EQ-5D-Y proxy en población Colombiana.

Poverty impacts of increased openness and fiscal policies in a dollarized economy: a CGE-micro approach for Ecuador

We quantify the effects on poverty and income distribution in Ecuador of bilateral trade liberalization with the US and a budget-neutral value added tax increase which seeks to compensate tariff revenue losses. We stress the study of fiscal policies that the government could tap in order to compensate for tariff revenue loss. This is a very important issue for Ecuador because this country adopted the US dollar as its currency in 2000, forgiving the use of important policy instruments. To study these issues we combine a reduced-form micro household income and occupational choice model (using 2005/6 data from the Ecuadorian LSMS) with a standard single-country computable general equilibrium model (employing a 2004 SAM). We follow a sequential approach that simulates the full distributional impact of trade and tax policies. We find that the impact of these policy changes on extreme poverty and income distribution is small but positive.

Toxina botulínica en manejo de síntomas del tracto urinario bajo en pacientes con hiperplasia prostática benigna - revisión sistemática de la literatura

Revisión sistemática de la literatura tomando ensayos clínicos aleatorizados sobre el uso de la inyección intraprostática de la toxina botulínica en los pacientes con hiperplasia prostática benigna evaluando una escala validada de síntomas del tracto urinario bajo como desenlace primario

Oaxaca-Blinder type counterfactual decomposition methods for duration outcomes

Los métodos disponibles para realizar análisis de descomposición que se pueden aplicar cuando los datos son completamente observados, no son válidos cuando la variable de interés es censurada. Esto puede explicar la escasez de este tipo de ejercicios considerando variables de duración, las cuales se observan usualmente bajo censura. Este documento propone un método del tipo Oaxaca-Blinder para descomponer diferencias en la media en el contexto de datos censurados. La validez de dicho método radica en la identificación y estimación de la distribución conjunta de la variable de duración y un conjunto de covariables. Adicionalmente, se propone un método más general que permite descomponer otros funcionales de interés como la mediana o el coeficiente de Gini, el cual se basa en la especificación de la función de distribución condicional de la variable de duración dado un conjunto de covariables. Con el fin de evaluar el desempeño de dichos métodos, se realizan experimentos tipo Monte Carlo. Finalmente, los métodos propuestos son aplicados para analizar las brechas de género en diferentes características de la duración del desempleo en España, tales como la duración media, la probabilidad de ser desempleado de largo plazo y el coeficiente de Gini. Los resultados obtenidos permiten concluir que los factores diferentes a las características observables, tales como capital humano o estructura del hogar, juegan un papel primordial para explicar dichas brechas.

Economic shocks and crime: evidence from the crash of ponzi schemes

In November 2008, Colombian authorities dismantled a network of Ponzi schemes, making hundreds of thousands of investors lose tens of millions of dollars throughout the country. Using original data on the geographical incidence of the Ponzi schemes, this paper estimates the impact of their break down on crime. We find that the crash of Ponzi schemes differentially exacerbated crime in affected districts. Confirming the intuition of the standard economic model of crime, this effect is only present in places with relatively weak judicial and law enforcement institutions, and with little access to consumption smoothing mechanisms such as microcredit. In addition, we show that, with the exception of economically-motivated felonies such as robbery, violent crime is not affected by the negative shock.

Distribution of diatom communities in agricultural and mining watersheds of Southwest Spain

Els sistemes aquàtics continental representen un dels ecosistemes més amenaçats a nivell mundial, com a conseqüència de l'ús intensiu quel'home en fa. La conca del Guadiana no està lliure d'aquestes pressions antròpiques. Les grans infraestructures hidràuliques i l'escorrentia provinent de l'agricultura són només exemples dels greus problemes que pateix la conca. Aquests problemes es fan especialment palesos en la zona alta de la conca, on l'escassetat d'aigua no fa més que agreujar el problema.Tot això ha generat la necessitat urgent d'avaluar l'estat de conservació d'aquests ecosistemes aquàtics continentals, poder determinar la mesura i la magnitud de les pertorbacions que els estan afectant i així proposar mesures de gestió destinades a restaurar-ne la integritat ecològica. El principal objectiu que presenta aquest és determinar els patrons de distribució de les comunitats de algals (amb una menció especial en el grup de les diatomees) i de les seves causes en la conca del Guadiana i associades, amb la finalitat d'establir i proposar eines que permetin avaluar l'estat de conservació de les masses d'aigua d'aquestes conques.

Criação de um Microtesauro na área da Dança

Este trabalho de Investigação teve como objetivo a construção de um microtesauro na área da Dança. Face à inexistência de um Tesauro especializado na área da Dança, quer a nível nacional, quer internacional, e para dar resposta às necessidades de uma recuperação mais eficaz de informação nas Unidades Documentaisi Especializadas em Dança. Neste caso, em particular, no Centro de Informação e Documentação (CDI) da Escola Superior de Dança (ESD). Percebeu-se que a construção deste microtesauro, tendo em conta as normas nacionais e internacionais para o efeito. No âmbito das funções desempenhadas no CDI foi identificada a necessidade de existir um instrumento de Linguagem Documental adequado, que permitisse nas Pesquisas bibliográficas, recuperar por Assunto os documentos existentes na Base de Dados. A Pesquisa Bibliográfica, apenas disponível por Título e por Autor, veio a revelar-se insuficiente, e a impossibilidade de pesquiasr os documentos por Assunto traduzia-se numa carência crescente dos utilizadores e do próprio Serviço. A Metodologia seguida para a construção deste Microtesauro, teve como base uma lista de Termos de Indexação construída a partir da análise de uma amostra de 125 monografias e a consulta de várias fontes de informção (monografias e obras de referência, linguagens documentais, e entrevistas informais a docentes da ESD). A análise, quantificação e qualificação dos termos que constituem este microtesauro teve o acompanhamento, avaliação e adequação contínua por parte de alguns docentes da ESD, investigadores e especialistas em Dança. A Dança, enquanto objeto de exploração teórica, revela-se uma disciplina transversal a várias áreas do conhecimento que, agrupadas em classes, correspondem a 8 áreas do saber, relacionadas com a Dança, tendo em consideração as temáticas do espólio documental do CDI e as matérias lecionadas nas Unidades Curriculares dos cursos de Licenciatura e Mestrados da ESD. O microtesauro na área da Dança, que resulta do nosso trabalho de investigação, é constituído por Descritores, Não-Descritores, e suas relações de equivalência hierárquicas e associativas, apresentando-se no final deste trabalho, em apêndice, devido à sua dimensão. O mesmo resulta de um processos de construção individual, inicialmente elaborado de forma manual e posteriormente transposto para um Software Documental CDS/ISIS para Windows, que veio agilizar a estruturação do microtesauro. Este microtesauro na área da Dança, em Língua Portuguesa, constitui um importante contributo para as Bibliotecas e Centros de Documentação que detêm documentação nesta área específica, dado colmatar uma lacuna existente neste domínio do conhecimento.

What kind of European Banking Union? Bruegel Policy Contribution [2012/12?]June 25, 2012

This paper discusses the creation of a European Banking Union. First, we discuss questions of design. We highlight seven fundamental choices that decision makers will need to make: Which EU countries should participate in the banking union? To which categories of banks should it apply? Which institution should be tasked with supervision? Which one should deal with resolution? How centralised should the deposit insurance system be? What kind of fiscal backing would be required? What governance framework and political institutions would be needed? In terms of geographical scope, we see the coverage of the banking union of the euro area as necessary and of additional countries as desirable, even though this would entail important additional economic difficulties. The system should ideally cover all banks within the countries included, in order to prevent major competitive and distributional distortions. Supervisory authority should be granted either to both the ECB and a new agency, or to a new agency alone. National supervisors, acting under the authority of the European supervisor, would be tasked with the supervision of smaller banks in accordance with the subsidiarity principle. A European resolution authority should be established, with the possibility of drawing on ESM resources. A fully centralized deposit insurance system would eventually be desirable, but a system of partial reinsurance may also be envisaged at least in a first phase. A banking union would require at least implicit European fiscal backing, with significant political authority and legitimacy. Thus, banking union cannot be considered entirely separately from fiscal union and political union. The most difficult challenge of creating a European banking union lies with the short-term steps towards its eventual implementation. Many banks in the euro area, and especially in the crisis countries, are currently under stress and the move towards banking union almost certainly has significant distributional implications. Yet it is precisely because banks are under such stress that early and concrete action is needed. An overarching principle for such action is to minimize the cost to the tax payers. The first step should be to create a European supervisor that will anchor the development of the future banking union. In parallel, a capability to quickly assess the true capital position of the system’s most important banks should be created, for which we suggest establishing a temporary European Banking Sector Task Force working together with the European supervisor and other authorities. Ideally, problems identified by this process should be resolved by national authorities; in case fiscal capacities would prove insufficient, the European level would take over in the country concerned with some national financial participation, or in an even less likely adverse scenario, in all participating countries at once. This approach would require the passing of emergency legislation in the concerned countries that would give the Task Force the required access to information and, if necessary, further intervention rights. Thus, the principle of fiscal responsibility of respective member states for legacy costs would be preserved to the maximum extent possible, and at the same time, market participants and the public would be reassured that adequate tools are in place to address any eventuality.

Modeling and Mapping Golden-winged Warbler Abundance to Improve Regional Conservation Strategies

Conservation planning requires identifying pertinent habitat factors and locating geographic locations where land management may improve habitat conditions for high priority species. I derived habitat models and mapped predicted abundance for the Golden-winged Warbler (Vermivora chrysoptera), a species of high conservation concern, using bird counts, environmental variables, and hierarchical models applied at multiple spatial scales. My aim was to understand habitat associations at multiple spatial scales and create a predictive abundance map for purposes of conservation planning for the Golden-winged Warbler. My models indicated a substantial influence of landscape conditions, including strong positive associations with total forest composition within the landscape. However, many of the associations I observed were counter to reported associations at finer spatial extents; for instance, I found Golden-winged Warblers negatively associated with several measures of edge habitat. No single spatial scale dominated, indicating that this species is responding to factors at multiple spatial scales. I found Golden-winged Warbler abundance was negatively related with Blue-winged Warbler (Vermivora cyanoptera) abundance. I also observed a north-south spatial trend suggestive of a regional climate effect that was not previously noted for this species. The map of predicted abundance indicated a large area of concentrated abundance in west-central Wisconsin, with smaller areas of high abundance along the northern periphery of the Prairie Hardwood Transition. This map of predicted abundance compared favorably with independent evaluation data sets and can thus be used to inform regional planning efforts devoted to conserving this species.

An integral equation method for a boundary value problem arising in unsteady water wave problems

In this paper we consider the 2D Dirichlet boundary value problem for Laplace’s equation in a non-locally perturbed half-plane, with data in the space of bounded and continuous functions. We show uniqueness of solution, using standard Phragmen-Lindelof arguments. The main result is to propose a boundary integral equation formulation, to prove equivalence with the boundary value problem, and to show that the integral equation is well posed by applying a recent partial generalisation of the Fredholm alternative in Arens et al [J. Int. Equ. Appl. 15 (2003) pp. 1-35]. This then leads to an existence proof for the boundary value problem. Keywords. Boundary integral equation method, Water waves, Laplace’s

A review of the theoretical basis for bulk mass flux convective parameterization

Most parameterizations for precipitating convection in use today are bulk schemes, in which an ensemble of cumulus elements with different properties is modelled as a single, representative entraining-detraining plume. We review the underpinning mathematical model for such parameterizations, in particular by comparing it with spectral models in which elements are not combined into the representative plume. The chief merit of a bulk model is that the representative plume can be described by an equation set with the same structure as that which describes each element in a spectral model. The equivalence relies on an ansatz for detrained condensate introduced by Yanai et al. (1973) and on a simplified microphysics. There are also conceptual differences in the closure of bulk and spectral parameterizations. In particular, we show that the convective quasi-equilibrium closure of Arakawa and Schubert (1974) for spectral parameterizations cannot be carried over to a bulk parameterization in a straightforward way. Quasi-equilibrium of the cloud work function assumes a timescale separation between a slow forcing process and a rapid convective response. But, for the natural bulk analogue to the cloud-work function (the dilute CAPE), the relevant forcing is characterised by a different timescale, and so its quasi-equilibrium entails a different physical constraint. Closures of bulk parameterization that use the non-entraining parcel value of CAPE do not suffer from this timescale issue. However, the Yanai et al. (1973) ansatz must be invoked as a necessary ingredient of those closures.

Potential economic impacts of terminator technologies: policy implications for developing countries

The terminator gene can render seeds sterile, so forcing farmers to purchase fresh seed every year. It is a technological solution to the problem of market failure that could increase the appropriability of R&D investment more effectively than intellectual property rights legislation or patents. This paper shows that appropriability should be more than tripled and that this leads to greater private R&D investment, which may be expected to double or triple. This would bring open-pollinating varieties into line with F1 hybrids, for which seed cannot be saved. In turn, the increased investment should raise yield increases to levels similar to those for hybrid crops. Thus, there are benefits to set against the possible ecological and environmental costs and the clear distributional and social consequences. The paper discusses the way the seed market is developing, the possible impacts, especially from a developing country viewpoint, and considers the policy changes that are needed.

The double triangular test in practice

The double triangular test was introduced twenty years ago, and the purpose of this paper is to review applications that have been made since then. In fact, take-up of the method was rather slow until the late 1990s, but in recent years several clinical trial reports have been published describing its use in a wide range of therapeutic areas. The core of this paper is a detailed account of five trials that have been published since 2000 in which the method was applied to studies of pancreatic cancer, breast cancer, myocardial infarction, epilepsy and bedsores. Before those accounts are given, the method is described and the history behind its evolution is presented. The future potential of the method for sequential case-control and equivalence trials is also discussed. Copyright © 2004 John Wiley & Sons, Ltd.

Cyclamen: time, sea and speciation biogeography using a temporally calibrated phylogeny

Aim The Mediterranean region is a species-rich area with a complex geographical history. Geographical barriers have been removed and restored due to sea level changes and local climatic change. Such barriers have been proposed as a plausible mechanism driving the high levels of speciation and endemism in the Mediterranean basin. This raises the fundamental question: is allopatric isolation the mechanism by which speciation occurs? This study explores the potential driving influence of palaeo-geographical events on the speciation of Cyclamen (Myrsinaceae), a group with most species endemic to the Mediterranean region. Cyclamen species have been shown experimentally to have few genetic barriers to hybridization. Location The Mediterranean region, including northern Africa, extending eastwards to the Black Sea coast. Methods A generic level molecular phylogeny of Myrsinaceae and Primulaceae is constructed, using Bayesian approximation, to produce a secondary age estimate for the stem lineage of Cyclamen. This estimate is used to calibrate temporally an infrageneric phylogeny of Cyclamen, built with nrDNA ITS, cpDNA trnL-F and cpDNA rps16 sequences. A biogeographical analysis of Cyclamen is performed using dispersal-vicariance analysis. Results The emergence of the Cyclamen stem lineage is estimated at 30.1-29.2 Ma, and the crown divergence at 12.9-12.2 Ma. The average age of Cyclamen species is 3.7 Myr. Every pair of sister species have mutually exclusive, allopatric distributions relative to each other. This pattern appears typical of divergence events throughout the evolutionary history of the genus. Main conclusions Geographical barriers, such as the varying levels of the Mediterranean Sea, are the most plausible explanation for speciation events throughout the phylogenetic history of Cyclamen. The genus demonstrates distributional patterns congruent with the temporally reticulate palaeogeography of the Mediterranean region.