Evaluación de la disfunción sexual en mujeres con incontinencia urinaria antes y después de la cinta suburetral

Objetivo: Evaluar prospectivamente el grado de disfunción sexual en pacientes con incontinencia urinaria de esfuerzo antes y después de la cinta suburetral libre de tensión mediante el cuestionario PISQ-12 validado en español. Materiales y Métodos: Estudio observacional longitudinal de antes y después. Se seleccionaron 60 mujeres sexualmente activas con algún grado de disfunción sexual, entre abril del 2014 hasta marzo del 2015, diagnosticadas con incontinencia urinaria, programadas para colocación de cinta suburetral transobturadora en el Hospital Universitario Mayor Méderi. La mayoría de las pacientes presentaron algún grado de prolapso genital y requirieron corrección quirúrgica asociada a la cinta. Todas las pacientes respondieron el cuestionario PISQ-12 antes y 6 meses después del procedimiento. Resultados: La edad promedio fue 48 ± 4.58 años. El grado de prolapso con mayor frecuencia fue el estadío II del POP-Q 55% (n=33). El 96.7% (n=50) de las pacientes requirieron además de la colocación de la cinta suburetral corrección quirúrgica del prolapso genital. En la evaluación preoperatoria la disfunción sexual se distribuyó así: Severa: 70%, Moderada 18.3% y Leve 11.7%, después de 6 meses postoperatorios se encontró una diferencia estadísticamente significativa del cambio en el grado de disfunción sexual así: Moderada 41.5% y Leve 58.2% donde ninguna paciente quedó clasificada con disfunción severa. Discusión y Conclusión: Las pacientes que presentaron disfunción sexual severa obtuvieron mayor cambio en el grado de disfunción, luego de la colocación de la cinta suburetral.

Sustain Cycle

En la búsqueda de preservar el medio ambiente y estandarizar la disposición final de los residuos generados, Sustain Cycle nace como un gestor de residuos de aceite vegetal usado, reforzando la carente oferta del mercado. Fortaleciendo el compromiso de los generadores de este residuo además de una reducción de costos, la creación de Sustain Cycle se desarrolla bajo la figura jurídica de Fundación, deduciendo en los contribuyentes del impuesto el valor de las donaciones efectuadas. El aporte ambiental se basa en minimizar el riesgo de una mala disposición en la red de alcantarillado y su componente social se enfoca en evitar la reutilización ilegal y perjudicial para el consumidor. Sustain Cycle se centra en la recolección, acopio, filtrado y comercialización del AVU generado por todos los establecimientos comerciales que produzcan alimentos como papas a la francesa, empanadas, buñuelos, churros, plátanos y demás productos que requieran del aceite para su cocción.

Desempeño de las RISS en relación al acceso, coordinación y calidad de la atención en cáncer de mama y diabetes mellitus tipo 2 en Colombia

El objetivo de este capítulo es mostrar los resultados de investigación del desempeño de las redes de servicios de salud frente a diferentes dimensiones relacionadas al acceso, coordinación y calidad de la atención en dos enfermedades crónicas como es el cáncer de mama y la diabetes en Colombia, importantes patologías por su incidencia e impacto así como por la necesidad de la mecanismos efectivos de coordinación para la adecuada atención de los usuarios del sistema de salud. Por tanto, se realiza el análisis del desempeño de dos redes de servicios de salud en la atención de usuarias con diagnostico confirmado de cáncer de mama, vinculadas unas a redes pertenecientes al régimen contributivo y otras al régimen subsidiado. Redes que también fueron consideradas para el análisis del desempeño en la atención de usuarios con diagnostico confirmado de diabetes, en el que de manera adicional participó otra red perteneciente al régimen subsidiado con área de operación en el municipio de Soacha, puesto que las dos anteriores tiene influencia en la ciudad de Bogotá. La fuente primaria de los datos fue la historia clínica y éstos fueron extraídos de acuerdo a ciertos indicadores seleccionados por el equipo investigador a través de un previo proceso de validación y a partir de su importancia para evidenciar el desempeño de las redes de servicios de salud en las dimensiones enunciadas anteriormente. Se muestran los resultados del estudio, a partir de los cuales se propone una breve discusión y conclusiones.

“La construcción de la opinión pública digital en Colombia: Twitter y Juan Manuel Santos: un estudio de caso”

El presente trabajo de investigación tiene como objetivo explicar el papel de las redes sociales en el proceso de conformación de la opinión pública en Colombia en el gobierno de Juan Manuel Santos. Lo que se quiere comprobar es que las redes sociales han ejercido un papel de herramienta configuradora de agendas en el gobierno de Juan Manuel Santos. Las antiguas formas de comunicación como las tertulias en los cafés y las discusiones cara a cara se han reemplazado por las conversaciones “online”, modificando así los procesos comunicativos entre los individuos y la forma de producir opinión pública. Para llevar a cabo esta investigación es pertinente desarrollar los conceptos de opinión pública, esfera pública y redes sociales; además de hacer uso de un método de recolección y análisis de información cualitativo con herramientas cuantitativas como las encuestas, estadísticas y gráficas.

Simplification, approximation and deformation of large models

The high level of realism and interaction in many computer graphic applications requires techniques for processing complex geometric models. First, we present a method that provides an accurate low-resolution approximation from a multi-chart textured model that guarantees geometric fidelity and correct preservation of the appearance attributes. Then, we introduce a mesh structure called Compact Model that approximates dense triangular meshes while preserving sharp features, allowing adaptive reconstructions and supporting textured models. Next, we design a new space deformation technique called *Cages based on a multi-level system of cages that preserves the smoothness of the mesh between neighbouring cages and is extremely versatile, allowing the use of heterogeneous sets of coordinates and different levels of deformation. Finally, we propose a hybrid method that allows to apply any deformation technique on large models obtaining high quality results with a reduced memory footprint and a high performance.

Anàlisi dels descartaments efectuats per la flota d'arrossegament en el Golf de Lleó

La pesca d'arrossegament practicada al mar Mediterrani incideix sobre un rang batimètric molt ampli i afecta a nombrosos tipus de fons que presenten comunitats molt diversificades, on les espècies de peixos, crustacis, cefalòpodes, altres mol·luscs, equinoderms i d'altres macroorganismes epibentònics interaccionen entre si. D'aquí la importància de caracteritzar amb una aproximació multiespecífica els fons explotats, com la que aquí hem dut a terme, prenent en consideració no tan sols les espècies d'interès comercial sinó totes les espècies que conformen la comunitat. Els objectius concrets d'aquesta tesi estan centrats en l'estudi qualitatiu i quantitatiu dels descartaments produïts per la pesca d'arrossegament que efectua la flota espanyola en la zona del Golf de Lleó, i en aspectes relacionats a millorar la selectivitat de les xarxes emprades canviant el disseny de la malla tradicional per malla quadrada. El mostreig s'ha dut a terme a bord d'una embarcació d'arrossegament comercial, amb una freqüència setmanal, dins el període comprès entre març del 1998 i març del 2000. En total s'han analitzat 68 pesques. Totes les mostres estudiades provenen del primer vol del dia i s'han capturat a fondàries entre 50 i 500 metres. De tot el volum capturat durant l'estudi s'han identificat un total de 307 espècies pertanyent a diversos grups taxonòmics. El grup taxonòmic majoritari és el dels peixos amb 133 espècies, seguit dels crustacis, els cefalòpodes, els equinoderms i finalment el grup d'altres invertebrats. L'espècie més capturada en nombre a la pesquera del Golf de Lleó ha estat la cervellina (Leptometra phalangium) i les més capturades en biomassa han estat la sardina (Sardina pilchardus) i el lluç mediterrani (Merluccius merluccius smiridus). Pel total de la captura la fracció descartada en nombre d'individus representa el 71% mentre que la biomassa descartada és de l'ordre del 36%. La causa més important en quant a quantitat de rebuig produït és la que respon al compliment de la normativa vigent, ja sigui per les talles mínimes legals o per les captures acompanyants permeses. Els majors descartaments estacionals en termes d'abundància es donen a la primavera i l'estiu, coincidint amb l'època de reclutament de la majoria de les espècies explotades. En canvi, els descartaments estacionals en termes de biomassa són excepcionalment elevats a l'estiu i estan provocats per la captura massiva de sardina (S. pilchardus) durant aquesta època de l'any. El rebuig expressat tant en nombre com en pes disminueix en funció de l'estrat de fondària, essent la quantitat descartada major en l'estrat A (50-200 m) i menor en l'estrat C (>400 m). S'ha comprovat que el disseny de malla quadrada aplicat al cóp de les xarxes d'arrossegament fa augmentar dràsticament, tant en nombre com en pes, el percentatge d'individus escapats, disminuint a la vegada la quantitat de descartament. També s'aconsegueix un augment de la mida de primera captura (L50) de totes les espècies excepte en la bruixa de quatre taques (Lepidorhombus boscii). A més es redueix l'impacte de la pesca sobre els estocs d'individus juvenils, sobretot d'espècies que presenten una secció de cos rodona com el lluç mediterrani (M. merluccius smiridus) i el verat (Scomber scombrus), disminuint així la sobrepesca de creixement i de reclutament al mateix temps que s'assegura i es millora la venda d'exemplars de mida legal.

Use of fused airborne scanning laser altimetry and digital map data for urban flood modelling

Flood modelling of urban areas is still at an early stage, partly because until recently topographic data of sufficiently high resolution and accuracy have been lacking in urban areas. However, Digital Surface Models (DSMs) generated from airborne scanning laser altimetry (LiDAR) having sub-metre spatial resolution have now become available, and these are able to represent the complexities of urban topography. The paper describes the development of a LiDAR post-processor for urban flood modelling based on the fusion of LiDAR and digital map data. The map data are used in conjunction with LiDAR data to identify different object types in urban areas, though pattern recognition techniques are also employed. Post-processing produces a Digital Terrain Model (DTM) for use as model bathymetry, and also a friction parameter map for use in estimating spatially-distributed friction coefficients. In vegetated areas, friction is estimated from LiDAR-derived vegetation height, and (unlike most vegetation removal software) the method copes with short vegetation less than ~1m high, which may occupy a substantial fraction of even an urban floodplain. The DTM and friction parameter map may also be used to help to generate an unstructured mesh of a vegetated urban floodplain for use by a 2D finite element model. The mesh is decomposed to reflect floodplain features having different frictional properties to their surroundings, including urban features such as buildings and roads as well as taller vegetation features such as trees and hedges. This allows a more accurate estimation of local friction. The method produces a substantial node density due to the small dimensions of many urban features.

A collocation method for high frequency scattering by convex polygons

We consider the problem of scattering of a time-harmonic acoustic incident plane wave by a sound soft convex polygon. For standard boundary or finite element methods, with a piecewise polynomial approximation space, the computational cost required to achieve a prescribed level of accuracy grows linearly with respect to the frequency of the incident wave. Recently Chandler–Wilde and Langdon proposed a novel Galerkin boundary element method for this problem for which, by incorporating the products of plane wave basis functions with piecewise polynomials supported on a graded mesh into the approximation space, they were able to demonstrate that the number of degrees of freedom required to achieve a prescribed level of accuracy grows only logarithmically with respect to the frequency. Here we propose a related collocation method, using the same approximation space, for which we demonstrate via numerical experiments a convergence rate identical to that achieved with the Galerkin scheme, but with a substantially reduced computational cost.

A Galerkin boundary element method for high frequency scattering by convex polygons

In this paper we consider the problem of time-harmonic acoustic scattering in two dimensions by convex polygons. Standard boundary or finite element methods for acoustic scattering problems have a computational cost that grows at least linearly as a function of the frequency of the incident wave. Here we present a novel Galerkin boundary element method, which uses an approximation space consisting of the products of plane waves with piecewise polynomials supported on a graded mesh, with smaller elements closer to the corners of the polygon. We prove that the best approximation from the approximation space requires a number of degrees of freedom to achieve a prescribed level of accuracy that grows only logarithmically as a function of the frequency. Numerical results demonstrate the same logarithmic dependence on the frequency for the Galerkin method solution. Our boundary element method is a discretization of a well-known second kind combined-layer-potential integral equation. We provide a proof that this equation and its adjoint are well-posed and equivalent to the boundary value problem in a Sobolev space setting for general Lipschitz domains.

A tale of two elements: P1ncP1 and RTO

The and RT0 finite element schemes are among the most promising low order elements for use in unstructured mesh marine and lake models. They are both free of spurious elevation modes, have good dispersive properties and have a relatively low computational cost. In this paper, we derive both finite element schemes in the same unified framework and discuss their respective qualities in terms of conservation, consistency, propagation factor and convergence rate. We also highlight the impact that the local variables placement can have on the model solution. The main conclusion that we can draw is that the choice between elements is highly application dependent. We suggest that the element is better suited to purely hydrodynamical applications while the RT0 element might perform better for hydrological applications that require scalar transport calculations.

A high-order arbitrarily unstructured finite-volume model of the global atmosphere: tests solving the shallow-water equations

Simulations of the global atmosphere for weather and climate forecasting require fast and accurate solutions and so operational models use high-order finite differences on regular structured grids. This precludes the use of local refinement; techniques allowing local refinement are either expensive (eg. high-order finite element techniques) or have reduced accuracy at changes in resolution (eg. unstructured finite-volume with linear differencing). We present solutions of the shallow-water equations for westerly flow over a mid-latitude mountain from a finite-volume model written using OpenFOAM. A second/third-order accurate differencing scheme is applied on arbitrarily unstructured meshes made up of various shapes and refinement patterns. The results are as accurate as equivalent resolution spectral methods. Using lower order differencing reduces accuracy at a refinement pattern which allows errors from refinement of the mountain to accumulate and reduces the global accuracy over a 15 day simulation. We have therefore introduced a scheme which fits a 2D cubic polynomial approximately on a stencil around each cell. Using this scheme means that refinement of the mountain improves the accuracy after a 15 day simulation. This is a more severe test of local mesh refinement for global simulations than has been presented but a realistic test if these techniques are to be used operationally. These efficient, high-order schemes may make it possible for local mesh refinement to be used by weather and climate forecast models.

Consistent Dirichlet Boundary Conditions for Numerical Solution of Moving Boundary Problems

We consider the imposition of Dirichlet boundary conditions in the finite element modelling of moving boundary problems in one and two dimensions for which the total mass is prescribed. A modification of the standard linear finite element test space allows the boundary conditions to be imposed strongly whilst simultaneously conserving a discrete mass. The validity of the technique is assessed for a specific moving mesh finite element method, although the approach is more general. Numerical comparisons are carried out for mass-conserving solutions of the porous medium equation with Dirichlet boundary conditions and for a moving boundary problem with a source term and time-varying mass.

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.

Developing the next-generation climate system models: challenges and achievements

Although climate models have been improving in accuracy and efficiency over the past few decades, it now seems that these incremental improvements may be slowing. As tera/petascale computing becomes massively parallel, our legacy codes are less suitable, and even with the increased resolution that we are now beginning to use, these models cannot represent the multiscale nature of the climate system. This paper argues that it may be time to reconsider the use of adaptive mesh refinement for weather and climate forecasting in order to achieve good scaling and representation of the wide range of spatial scales in the atmosphere and ocean. Furthermore, the challenge of introducing living organisms and human responses into climate system models is only just beginning to be tackled. We do not yet have a clear framework in which to approach the problem, but it is likely to cover such a huge number of different scales and processes that radically different methods may have to be considered. The challenges of multiscale modelling and petascale computing provide an opportunity to consider a fresh approach to numerical modelling of the climate (or Earth) system, which takes advantage of the computational fluid dynamics developments in other fields and brings new perspectives on how to incorporate Earth system processes. This paper reviews some of the current issues in climate (and, by implication, Earth) system modelling, and asks the question whether a new generation of models is needed to tackle these problems.

Mesozoic climates: General circulation models and the rock record

General circulation models (GCMs) use the laws of physics and an understanding of past geography to simulate climatic responses. They are objective in character. However, they tend to require powerful computers to handle vast numbers of calculations. Nevertheless, it is now possible to compare results from different GCMs for a range of times and over a wide range of parameterisations for the past, present and future (e.g. in terms of predictions of surface air temperature, surface moisture, precipitation, etc.). GCMs are currently producing simulated climate predictions for the Mesozoic, which compare favourably with the distributions of climatically sensitive facies (e.g. coals, evaporites and palaeosols). They can be used effectively in the prediction of oceanic upwelling sites and the distribution of petroleum source rocks and phosphorites. Models also produce evaluations of other parameters that do not leave a geological record (e.g. cloud cover, snow cover) and equivocal phenomena such as storminess. Parameterisation of sub-grid scale processes is the main weakness in GCMs (e.g. land surfaces, convection, cloud behaviour) and model output for continental interiors is still too cold in winter by comparison with palaeontological data. The sedimentary and palaeontological record provides an important way that GCMs may themselves be evaluated and this is important because the same GCMs are being used currently to predict possible changes in future climate. The Mesozoic Earth was, by comparison with the present, an alien world, as we illustrate here by reference to late Triassic, late Jurassic and late Cretaceous simulations. Dense forests grew close to both poles but experienced months-long daylight in warm summers and months-long darkness in cold snowy winters. Ocean depths were warm (8 degrees C or more to the ocean floor) and reefs, with corals, grew 10 degrees of latitude further north and south than at the present time. The whole Earth was warmer than now by 6 degrees C or more, giving more atmospheric humidity and a greatly enhanced hydrological cycle. Much of the rainfall was predominantly convective in character, often focused over the oceans and leaving major desert expanses on the continental areas. Polar ice sheets are unlikely to have been present because of the high summer temperatures achieved. The model indicates extensive sea ice in the nearly enclosed Arctic seaway through a large portion of the year during the late Cretaceous, and the possibility of sea ice in adjacent parts of the Midwest Seaway over North America. The Triassic world was a predominantly warm world, the model output for evaporation and precipitation conforming well with the known distributions of evaporites, calcretes and other climatically sensitive facies for that time. The message from the geological record is clear. Through the Phanerozoic, Earth's climate has changed significantly, both on a variety of time scales and over a range of climatic states, usually baldly referred to as "greenhouse" and "icehouse", although these terms disguise more subtle states between these extremes. Any notion that the climate can remain constant for the convenience of one species of anthropoid is a delusion (although the recent rate of climatic change is exceptional). (c) 2006 Elsevier B.V. All rights reserved.