Análisis económico de las vacunas 10-valente y 13-valente contra neumococo: revisión sistemática

Introducción: Las vacunas clásicamente han representado un método económico y eficaz para el control y prevención de múltiples enfermedades infecciosas. En los últimos años se han introducido nuevas vacunas contra neumococo a precios elevados, y los diferentes análisis económicos a nivel mundial de estas vacunas no muestran tendencias. El objetivo de este trabajo era resumir la evidencia existente a través de los diferentes estudios económicos evaluando las dos vacunas de segunda generación contra neumococo en la población a riesgo. Metodología: En este trabajo se realizo una revisión sistemática de la literatura en 8 bases de datos localizadas en diferentes partes del mundo y también que tuvieran literatura gris. Los artículos fueron inicialmente evaluados acorde a su titulo y resumen, posteriormente los elegidos se analizaron en su totalidad. Resultados: Se encontraron 404 artículos, de los cuales 20 fueron incluidos en el análisis final. Se encontró que la mayoría de los estudios se realizaron en áreas donde la enfermedad tiene una carga baja, como es Norte América y Europa, mientras que en los lugares del mundo donde la carga es mas alta, se realizaron pocos estudios. De igual manera se observo que la mayoría de los estudios mostraron por los menos ser costo efectivos respecto a la no vacunación, y en su totalidad las dos vacunas de segunda generación mostraron costo efectividad respecto a la vacunación con PCV-7. Los resultados de los estudios son muy heterogéneos, hasta dentro del mismo país, señalando la necesidad de guías para la conducción de este tipo de estudios. De igual manera, la mayoría de los estudios fueron financiados por farmacéuticas, mientras en un numero muy reducido por entes gubernamentales. Conclusiones: La mayoría de los estudios económicos sobre las vacunas de segunda generación contra neumococo han sido realizados en países con un alto índice de desarrollo económico y patrocinados por farmacéuticas. Dado que la mayoría de la carga de la enfermedad se encuentran en regiones con un menor nivel de desarrollo económico se deberían realizar mas en estas zonas. De igual manera, al ser la vacunación un asunto de salud publica y con un importante impacto económico los gobiernos deberían estar mas involucrados en los mismos.

Perfil CIO Colombiano

La identificación del perfil del Chief Information Officer (CIO) en el entorno empresarial nacional responde a la necesidad de comparar o constatar el rol aplicado en Colombia en relación a la expectativa de la academia y la pertinencia que lleva en un entorno empresarial global. La migración del concepto de CIO y sus definiciones es resultado de la implementación local de prácticas, teorías y estrategias de alto impacto en mercados internacionales. En el presente documento, se profundiza en las competencias estratégicas y roles prácticos que abarca el perfil del CIO como es visto desde aportes académicos y casuísticos en fuentes internacionales líderes en la construcción de conocimiento.

Identificación y descripción de las características de un líder global

El liderazgo ha sido definido de diferentes maneras por cientos de autores debido al contexto en el que estudian este concepto. Ninguna de estas definiciones es errónea pero algunas han tomado mayor importancia debido a los diferentes factores que enfrenta la sociedad. Desde hace unos años los países se han abierto a diferentes mercados lo cual les ha permitido eliminar las barreras políticas, económicas y culturales existentes. Esto ha llevado a que los líderes deban evaluar la nueva forma de dirigir y direccionar las organizaciones. Este es tan solo uno de los ejemplos que han llevado a modificar el concepto de liderazgo, añadiendo los nuevos retos a los que se ven enfrentados los líderes. En este trabajo de grado se estudia el que se considera uno de los mayores retos de los siglos XX y XXI: la globalización. Este fenómeno ha acercado al mundo a través del intercambio de información, de bienes, de servicios, de conocimientos y sobre todo de cultura. Esto se ha logrado a través de nuevas tecnologías, nuevos servicios de comunicación y transporte, de la ciencia y los avances de la industria. El nuevo líder debe romper la barrera nacional y abrirse a mercados extranjeros, para esto debe contar con ciertas características que le permitirán entender los diferentes mercados y a las personas que se encuentran en este. En este trabajo se identifican las que se consideran las principales características de un líder global; estas son el resultado de la investigación de diferentes autores y estudios.

Análisis de supervivencia en pacientes con prótesis valvular biológica, Fundación Cardioinfantil-Instituto de Cardiología, Colombia, 2005-2013

Introducción: A partir de la década de los cincuenta el manejo de la enfermedad valvular presenta cambios significativos cuando se incorporan los reemplazos valvulares tanto mecánicos como biológicos dentro de las opciones de tratamiento quirúrgico (1). Las válvulas biológicas se desarrollaron como una alternativa que buscaba evitar los problemas relacionados con la anticoagulación y con la idea de utilizar un tejido que se comportara hemodinámicamente como el nativo. Este estudio está enfocado en establecer la sobrevida global y la libertad de reoperación de la válvula de los pacientes sometidos a reemplazo valvular aórtico y mitral biológicos en la Fundación Cardioinfantil - IC a 1, 3, 5 y 10 años. Materiales y métodos: Estudio de cohorte retrospectiva de supervivencia de pacientes sometidos a reemplazo valvular aórtico y/o mitral biológico intervenidos en la Fundación Cardioinfantil entre 2005 y 2013. Resultados: Se obtuvieron 919 pacientes incluidos en el análisis general y 876 (95,3%) pacientes con seguimiento efectivo para el análisis de sobrevida. La edad promedio fue 64años. La sobrevida a 1, 3, 5 y 10 años fue 95%,90%,85% y 69% respectivamente. El seguimiento efectivo para el desenlace reoperación fue del 55% y se encontró una libertad de reoperación del 99%, 96%, 93% y 81% a los 1, 3, 5 y 10 años. No hubo diferencias significativas entre la localización de la válvula ni en el tipo de válvula aortica empleada. Conclusiones: La sobrevida de los pacientes que son llevados a reemplazo valvular biológico en este estudio es comparable a grandes cohortes internacionales. La sobrevida de los pacientes llevados a reemplazo valvular con prótesis biológicas en posición mitral y aortica fue similar a 1, 3, 5 y 10 años.

Multi-layer survivability: routing schemes for GMPLS-based networks

En les xarxes IP/MPLS sobre WDM on es transporta gran quantitat d'informacio, la capacitat de garantir que el trafic arriba al node de desti ha esdevingut un problema important, ja que la fallada d'un element de la xarxa pot resultar en una gran quantitat d'informacio perduda. Per garantir que el trafic afectat per una fallada arribi al node desti, s'han definit nous algoritmes d'encaminament que incorporen el coneixement de la proteccio en els dues capes: l'optica (WDM) i la basada en paquets (IP/MPLS). D'aquesta manera s'evita reservar recursos per protegir el trafic a les dues capes. Els nous algoritmes resulten en millor us dels recursos de la xarxa, ofereixen rapid temps de recuperacio, eviten la duplicacio de recursos i disminueixen el numero de conversions del trafic de senyal optica a electrica.

ICT for growth: a targeted approach. Bruegel Policy Contribution 2012/10, June 2012

This Policy Contribution assesses the broad obstacles hampering ICT-led growth in Europe and identifies the main areas in which policy could unlock the greatest value. We review estimates of the value that could be generated through take-up of various technologies and carry out a broad matching with policy areas. According to the literature survey and the collected estimates, the areas in which the right policies could unlock the greatest ICT-led growth are product and labour market regulations and the European Single Market. These areas should be reformed to make European markets more flexible and competitive. This would promote wider adoption of modern data-driven organisational and management practices thereby helping to close the productivity gap between the United States and the European Union. Gains could also be made in the areas of privacy, data security, intellectual property and liability pertaining to the digital economy, especially cloud computing, and next generation network infrastructure investment. Standardisation and spectrum allocation issues are found to be important, though to a lesser degree. Strong complementarities between the analysed technologies suggest, however, that policymakers need to deal with all of the identified obstacles in order to fully realise the potential of ICT to spur long-term growth beyond the partial gains that we report.

Networks of contextualised ontologies for the Semantic Web

Currently many ontologies are available for addressing different domains. However, it is not always possible to deploy such ontologies to support collaborative working, so that their full potential can be exploited to implement intelligent cooperative applications capable of reasoning over a network of context-specific ontologies. The main problem arises from the fact that presently ontologies are created in an isolated way to address specific needs. However we foresee the need for a network of ontologies which will support the next generation of intelligent applications/devices, and, the vision of Ambient Intelligence. The main objective of this paper is to motivate the design of a networked ontology (Meta) model which formalises ways of connecting available ontologies so that they are easy to search, to characterise and to maintain. The aim is to make explicit the virtual and implicit network of ontologies serving the Semantic Web.

Krakatoa lives: The effect of volcanic eruptions on ocean heat content and thermal expansion

A suite of climate model experiments indicates that 20th Century increases in ocean heat content and sea-level ( via thermal expansion) were substantially reduced by the 1883 eruption of Krakatoa. The volcanically-induced cooling of the ocean surface is subducted into deeper ocean layers, where it persists for decades. Temporary reductions in ocean heat content associated with the comparable eruptions of El Chichon ( 1982) and Pinatubo ( 1991) were much shorter lived because they occurred relative to a non-stationary background of large, anthropogenically-forced ocean warming. Our results suggest that inclusion of the effects of Krakatoa ( and perhaps even earlier eruptions) is important for reliable simulation of 20th century ocean heat uptake and thermal expansion. Inter-model differences in the oceanic thermal response to Krakatoa are large and arise from differences in external forcing, model physics, and experimental design. Systematic experimentation is required to quantify the relative importance of these factors. The next generation of historical forcing experiments may require more careful treatment of pre-industrial volcanic aerosol loadings.

Marine ecosystem models for earth systems applications: the MarQUEST experience

The MarQUEST (Marine Biogeochemistry and Ecosystem Modelling Initiative in QUEST) project was established to develop improved descriptions of marine biogeochemistry, suited for the next generation of Earth system models. We review progress in these areas providing insight on the advances that have been made as well as identifying remaining key outstanding gaps for the development of the marine component of next generation Earth system models. The following issues are discussed and where appropriate results are presented; the choice of model structure, scaling processes from physiology to functional types, the ecosystem model sensitivity to changes in the physical environment, the role of the coastal ocean and new methods for the evaluation and comparison of ecosystem and biogeochemistry models. We make recommendations as to where future investment in marine ecosystem modelling should be focused, highlighting a generic software framework for model development, improved hydrodynamic models, and better parameterisation of new and existing models, reanalysis tools and ensemble simulations. The final challenge is to ensure that experimental/observational scientists are stakeholders in the models and vice versa.

Data assimilation for marine monitoring and prediction: The MERCATOR operational assimilation systems and the MERSEA developments

During the past 15 years, a number of initiatives have been undertaken at national level to develop ocean forecasting systems operating at regional and/or global scales. The co-ordination between these efforts has been organized internationally through the Global Ocean Data Assimilation Experiment (GODAE). The French MERCATOR project is one of the leading participants in GODAE. The MERCATOR systems routinely assimilate a variety of observations such as multi-satellite altimeter data, sea-surface temperature and in situ temperature and salinity profiles, focusing on high-resolution scales of the ocean dynamics. The assimilation strategy in MERCATOR is based on a hierarchy of methods of increasing sophistication including optimal interpolation, Kalman filtering and variational methods, which are progressively deployed through the Syst`eme d’Assimilation MERCATOR (SAM) series. SAM-1 is based on a reduced-order optimal interpolation which can be operated using ‘altimetry-only’ or ‘multi-data’ set-ups; it relies on the concept of separability, assuming that the correlations can be separated into a product of horizontal and vertical contributions. The second release, SAM-2, is being developed to include new features from the singular evolutive extended Kalman (SEEK) filter, such as three-dimensional, multivariate error modes and adaptivity schemes. The third one, SAM-3, considers variational methods such as the incremental four-dimensional variational algorithm. Most operational forecasting systems evaluated during GODAE are based on least-squares statistical estimation assuming Gaussian errors. In the framework of the EU MERSEA (Marine EnviRonment and Security for the European Area) project, research is being conducted to prepare the next-generation operational ocean monitoring and forecasting systems. The research effort will explore nonlinear assimilation formulations to overcome limitations of the current systems. This paper provides an overview of the developments conducted in MERSEA with the SEEK filter, the Ensemble Kalman filter and the sequential importance re-sampling filter.

Intergenerational effects of birth weight on glucose tolerance and reproductive performance

Women who were themselves small-for-gestational age (SGA) are at a greater risk of adulthood diseases such as non-insulin-dependent diabetes mellitus (NIDDM), and twice at risk of having an SGA baby themselves. The aim of this study was to examine the intergenerational pig. Low (L) and normal (N) birth weight female piglets were followed throughout their first pregnancy (generation 1 (0)). After they had given birth, the growth and development of the lightest (I) and heaviest (n) female piglet from each litter were monitored until approximately 5 months of age (generation 2 (G2)). A glucose tolerance test (GTT) was conducted on G1 pig at similar to 6 months of age and again during late pregnancy; a GTT was also conducted on G2 pigs at similar to 4 months of age. G1 L offspring exhibited impaired glucose metabolism in later life compared to their G1 N sibling but in the next generation a similar scenario was only observed between I and n offspring born to G1 L mothers. Despite G1 L mothers showing greater glucose intolerance in late pregnancy and a decreased litter size, average piglet birth weight was reduced and there was also a large variation in litter weight; this suggests that they were, to some extent, prioritising their nutrient intake towards themselves rather than promoting their reproductive performance. There were numerous relationships between body shape at birth and glucose curve characteristics in later life, which can, to some extent, be used to predict neonatal outcome. In conclusion, intergenerational effects are partly seen in the pig. It is likely that some of the intergenerational influences may be masked due to the pig being a litter-bearing species.

Exploring context-awareness in the construction logistics services delivery

Managing a construction project supply chain effectively and efficiently is extremely difficult due to involvement of numerous sectors that are supported by ineffective communication system. An efficient construction supply chain system ensures the delivery of materials and other services to construction site while minimising costs and rewarding all sectors based on value added to the supply chain. The advancement of information, communication and wireless technologies is driving construction companies to deploy supply chain management strategies to seek better outputs. As part of the emerging wireless technologies, contextaware computing capability represents the next generation of ICT to the construction services. Conceptually, context-awareness could be integrated with Web Services in order to ensure the delivery of pertinent information to construction site and enhance construction supply chain collaboration. An initial study has indicated that this integrated system has the potential of serving and improving the construction services delivery through access to context-specific data, information and services on as-needed basis.