Caracterización y prevalencia del compromiso ocular en pacientes con enfermedad autoinmune y autoinflamatoria en un centro de referencia reumatológica en Colombia entre los años 2000 a 2015

RESUMEN Objetivo: Estimar la prevalencia de las diferentes enfermedades oftalmológicas que aparecen en el contexto de una enfermedad autoinmune (EAI) en pacientes de un centro de referencia reumatológica en Colombia, según características clínicas y sociodemográficas durante un período de 15 años, comprendido entre los años 2000 a 2015. Métodos: Se realizó un estudio descriptivo, observacional de prevalencia. El tipo de muestreo fue aleatorio estratificado con asignación proporcional en el programa Epidat 3.4. Los datos se analizaron en el programa SPSS v22.0 y se realizó análisis univariado de las variables categóricas, para las variables cuantitativas se realizaron medidas de tendencia central. Resultados: De 1640 historias clínicas revisadas, se encontraron 634 pacientes (38,65%) con compromiso ocular. Si excluimos los pacientes con SS, que por definición presentan ojo seco, 222 pacientes (13,53%) presentaron compromiso oftalmológico. Del total de pacientes, el 83,3% fueron mujeres. La AR fue la enfermedad autoinmune con mayor compromiso oftalmológico con 138 pacientes (62,2%), y en último lugar la sarcoidosis con 1 solo paciente afectado. La QCS fue la manifestación más común en todos los grupos diagnósticos de EAI, con 146 pacientes (63,5%). De 414 pacientes con Síndrome de Sjögren (SS) y QCS 8 presentaron compromiso ocular adicional, siendo la uveítis la segunda patología ocular asociada en pacientes con SS y la primera causa en las espondiloartropatias (71,4 %). Los pacientes con catarata (4,1%) presentaron la mayor prevalencia de uso de corticoide (88.8%). De 222 pacientes, 28 (12,6%) presentaron uveítis. Del total de pacientes, 16 (7,2%) presentaron maculopatía por antimalaráricos y 6 (18,75%) de los pacientes con LES. Los ANAS se presentaron en el 100% los pacientes con trastorno vascular de la retina. Los pacientes con epiescleritis presentaron la mayor proporción de positivización de anticuerpos anti-DNA. La EAI que más presentó epiescleritis fue LES con 4 pacientes (12,5%) El 22% de paciente con anticuerpos anti-RNP presentaron escleritis y 32,1% de los pacientes con uveítis presentaron HLA-B27 positivo. Las manifestaciones oftalmológicas precedieron a las sistémicas entre un 11,1% y un 33,3% de los pacientes. Conclusión: Las enfermedades oculares se presentan con frecuencia en los pacientes colombianos con EAI (38.65%), siendo la AR la enfermedad con mayor compromiso ocular (62,2%) y la QCS la enfermedad ocular con mayor prevalencia en todas las EAI (63,5%). La uveítis se presentó en 28 pacientes (12,6%). Las manifestaciones oftalmológicas pueden preceder a las sistémicas. El examen oftalmológico debe ser incluido en los pacientes con EAI, por ser la enfermedad ocular una comorbilidad frecuente. Adicionalmente, los efectos oftalmológicos de las medicaciones sistémicas utilizadas en EAI deben ser estrechamente monitorizados, durante el curso del tratamiento.

ASSESSMENT OF ENERGY CONSUMPTION IN GREENHOUSE PRODUCTION IN THE WEST REGION OF PORTUGAL

Greenhouse production is a very important activity in the West region of Portugal, with an area of approximately 800 ha where the regular production consists in two crops per year, one in winter-spring and the other in summer-autumn. Many growers are now prepared to better exploit market opportunities, since they know that the big export window opportunity is from June to September, when the production is difficult in other regions of south due to high temperatures. Grower’s use new and more productive varieties, either in soil or hydroponic systems, mostly in unheated greenhouses, naturally ventilated, and equipped with modern fertigation systems. Greenhouse production causes some environmental impacts due to the high use of inputs. Several improvements in technologies and crop practices may contribute to increase the use efficiency of resources, decreasing the negative environmental impacts. Greenhouse vegetable production in Northern EU countries is based on the supply of heating and differs significantly from the production system in the Southern EU countries. In the Northern countries, direct energy inputs, mostly for heating, are predominant while in the South the indirect energy input is also important, mainly associated with fertilizers, plastic cover materials and other auxiliary materials. The main objective of this work was to characterise the greenhouse production systems in the West region of Portugal, in order to evaluate the energetic consumptions (direct and indirect), the GHH emissions, the production costs and the farmer’s income. With this work the mostly important inputs were identified, allowing proposing alternative measures to improve efficiency and sustainability. All the data was obtained by surveys performed directly with growers, previously selected to be representative of the crop practices and greenhouse type of the region. However, more research should be performed in order to develop and to test technologies capable to improve resources use efficiency in greenhouse production.

Irrigation management with remote sensing: Evaluating irrigation requirement for maize under Mediterranean climate condition

tWater use control methods and water resources planning are of high priority. In irrigated agriculture, theright way to save water is to increase water use efficiency through better management. The present workvalidates procedures and methodologies using remote sensing to determine the water availability in thesoil at each moment, giving the opportunity for the application of the water depth strictly necessaryto optimise crop growth (optimum irrigation timing and irrigation amount). The analysis is applied tothe Irrigation District of Divor, Évora, using 7 experimental plots, which are areas irrigated by centre-pivot systems, cultivated to maize. Data were determined from images of the cultivated surface obtainedby satellite and integrated with atmosphere and crop parameters to calculate biophysical indicatorsand indices of water stress in the vegetation—Normalized Difference Vegetation Index (NDVI), Kc, andKcb. Therefore, evapotranspiration (ETc) was estimated and used to calculate crop water requirement,together with the opportunity and the amount of irrigation water to allocate. Although remote sensingdata available from satellite imagery presented some practical constraints, the study could contribute tothe validation of a new methodology that can be used for irrigation management of a large irrigated area,easier and at lower costs than the traditional FAO recommended crop coefficients method. The remotesensing based methodology can also contribute to significant saves of irrigation water.

Noninvasive Ventilation and Droplet dispersion. Health professional protocols. Nurse perspective. in: Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events,

The past few decades have seen major impacts of different pandemics and mass casualty events on health resource use in terms of rising health cost and increased mortality.

Sugarcane Water Productivity Assessments in the São Paulo state, Brazil.

São Paulo state, Brazil, has been highlighted by the sugarcane crop expansion. The actual scenario of climate and land use changes, bring attention for the large-scale water productivity (WP) analyses. MODIS images were used together with gridded weather data for these analyses. A generalized sugarcane growing cycle inside a crop land mask, from September 2011 to October 2012, was considered in the main growing regions of the state. Actual evapotranspiration (ET) is quantified by the SAFER (Simple Algorithm for Evapotranspiration Retrieving) algorithm, the biomass production (BIO) by the RUE (Radiation Use Efficiency) Monteith?s model and WP is considered as the ratio of BIO to ET. During the four generalized sugarcane crop phases, the mean ET values ranged from 0.6 to 4.0 mm day-1; BIO rates were between 20 and 200 kg ha-1 day-1, resulting in WP ranging from 2.8 to 6.0 kg m-3. Soil moisture indicators are applied, indicating benefits from supplementary irrigation during the grand growth phase, wherever there is water availability for this practice. The quantification of the large-scale water variables may subsidize the rational water resources management under the sugarcane expansion and water scarcity scenarios.

Fertilizers with coated urea in upland rice production and nitrogen apparent recovery.

Urea is the most used N fertilizer for upland rice, however, a great percentage of N loss can occur with the use of this fertilizer. The use of products that provide reduction of N loss for urea fertilizers can contribute to increase N use efficiency. The objective of this study was to determine the effect of N rates applied in the form of coated urea in the content and accumulation of N in dry biomass, apparent recovery of nitrogen and grain yield of upland rice. The experimental design was a randomized complete blocks arranged in a 4 x 3 + 1 factorial scheme. The treatments consisted of four sources of N fertilizer [1. Common urea; 2. Polymer-coated urea for slow release of N (PCU); 3. urea with the urease inhibitor N-(n-Butyl) thiophosphoric triamide (NBPT); and 4. urea coated with copper sulfate and boric acid as urease inhibitors (UCCB)], with three fertilization rates (30, 60 and 90 kg ha-1 of N). In addition, we included a control treatment without N application. Coated urea did not provide increases in rice grain yield in relation to common urea. The increasing amount of N resulted in significant increases in rice grain yield (from 3217 to 5548 kg ha-1, 2010/11, and from 3392 to 4560 kg ha-1, 2011/12). The apparent nitrogen recovery rate decreased with the increase in N applied doses.

Evapotranspiration: Present and Future Challenges

The thesis first explored and evaluated some of the most used models that were developed to account for the effect of CO2 on evapotranspiration. This review depicts the complexity of the modeling procedure and underlines the advantages and shortcomings of each model. Then, the projected climate change in the near future (2021-2050) in different locations in Emilia-Romagna (Italy) was studied, with an emphasis on the opposite effect of an increase in both air temperature and CO2 levels on ETo. The case study used reanalysis data as a surrogate to historical weather stations measurements and an ensemble of regional climate models (RCMs) for the future projections. Results show that higher CO2 levels moderated the increase in ETo that accompanies an increase in air temperature, taking in consideration the change in other weather variables i.e. solar radiation, wind speed and dew point temperature. The outcomes of this study show that considering the CO2 fertilization effect when calculating reference evapotranspiration might give a more realistic estimation of water use efficiency and irrigation requirements in Emilia-Romagna and a better analysis of the future availability and distribution of water resources in the region. Finally, data from a model forecasting reference evapotranspiration (FRET) and the different variables involved in its calculation for the state of California (USA) were compared with similar data from the regional weather station network (CIMIS) to evaluate their accuracy and reliability. The evaluation was done in locations with different microclimates and included also sample irrigation schedules developed using FRET ETo. The obtained results demonstrate that FRET ETo forecasts are a viable alternative to traditional ETo measurements with some differences depending on the climatic condition of the location considered in this study. This implies that FRET could be replicated in other areas with similar climate settings.

A technology diffusion perspective of Enterprise Resource Planning across European Small and Medium Enterprises: from determinants to Use to Value

Tese apresentada como requisito parcial para obtenção do grau de Doutor em Gestão de Informação

Population based resource allocation: The use of hybrid risk adjustment

The emphasis on integrated care implies new incentives that promote coordinationbetween levels of care. Considering a population as a whole, the resource allocation systemhas to adapt to this environment. This research is aimed to design a model that allows formorbidity related prospective and concurrent capitation payment. The model can be applied inpublicly funded health systems and managed competition settings.Methods: We analyze the application of hybrid risk adjustment versus either prospective orconcurrent risk adjustment formulae in the context of funding total health expenditures for thepopulation of an integrated healthcare delivery organization in Catalonia during years 2004 and2005.Results: The hybrid model reimburses integrated care organizations avoiding excessive risktransfer and maximizing incentives for efficiency in the provision. At the same time, it eliminatesincentives for risk selection for a specific set of high risk individuals through the use ofconcurrent reimbursement in order to assure a proper classification of patients.Conclusion: Prospective Risk Adjustment is used to transfer the financial risk to the healthprovider and therefore provide incentives for efficiency. Within the context of a National HealthSystem, such transfer of financial risk is illusory, and the government has to cover the deficits.Hybrid risk adjustment is useful to provide the right combination of incentive for efficiency andappropriate level of risk transfer for integrated care organizations.

Capacity Building in the Use of Geospatial Tools for Natural Resource Management in Tajikistan: Inception report

The sustainable management of natural resources is a key issue for sustainable development of a poor, mountainous country such as Tajikistan. In order to strengthen its agricultural and infrastructural development efforts and alleviate poverty in rural areas, spatial information and analysis are of crucial importance to improve priority setting and decision making efficiency. However, poor access to geospatial data and tools, and limited capacity in their use has greatly constrained the ability of governmental institutions to effectively assess, plan, and monitor natural resources management. The Centre for Development and Environment (CDE) has thus been mandated by the World Bank Group to provide adequate technical support to the Community Agriculture and Watershed Management Project (CAWMP). This support consists of a spatial database on soil degradation trends in 4 watersheds, capacity development in and awareness creation about geographic information technology and a spatial data exchange hub for natural resources management in Tajikistan. CDE’s support has started in July 2007 and will last until December 2007 with a possible extension in 2008.

Resource Efficiency Indicators for Policy-Making. CEPS Working Document No. 415/November 2015

In the EU, resource efficiency has been high on the political agenda since 2011, when the European Commission first included it as one of the seven flagship initiatives in its Europe 2020 Strategy for “smart, sustainable and inclusive growth”. Resource efficiency is not only considered an environmental necessity, but also a political, economic and security opportunity. This paper first stresses the benefits and opportunities for the EU of improving its resource efficiency. It then explains the added value of the www.measuring-progress.eu web tool, which aims to improve the way policy-makers and others involved in the policy process can access, understand and use indicators for resource efficiency. It provides practical examples of relevant indicators in the form of the EU Resource Efficiency Scoreboard and a case study showing how the web tool established by NETGREEN can be used in practice. The paper concludes with a number of policy messages.

Designing Policy Mixes for Resource Efficiency: The Role of Public Acceptability

Where the public acceptability of a policy can influence its chance of success, it is important to anticipate and mitigate potential concerns. This paper applies search frequency analysis and a form of claims-making analysis to identify public acceptability concerns among fourteen policies proposed by the EU-funded DYNAMIX project to achieve EU resource efficiency. Key points of contention in the corresponding public discourses focus primarily on trust, fairness, effectiveness and cost. We use our findings to provide specific recommendations for the design and implementation of the proposed policy mix which are intended to improve the public acceptability of contentious aspects, and highlight some broader insights for policymakers.

Energy efficiency analysis considering the use of an intelligent systems management in a smart home

In this abstract is presented an energy management system included in a SCADA system existent in a intelligent home. The system control the home energy resources according to the players definitions (electricity consumption and comfort levels), the electricity prices variation in real time mode and the DR events proposed by the aggregators.

Energy resource management in smart grids considering an Intensive use of electric vehicles

The introduction of electricity markets and integration of Distributed Generation (DG) have been influencing the power system’s structure change. Recently, the smart grid concept has been introduced, to guarantee a more efficient operation of the power system using the advantages of this new paradigm. Basically, a smart grid is a structure that integrates different players, considering constant communication between them to improve power system operation and management. One of the players revealing a big importance in this context is the Virtual Power Player (VPP). In the transportation sector the Electric Vehicle (EV) is arising as an alternative to conventional vehicles propel by fossil fuels. The power system can benefit from this massive introduction of EVs, taking advantage on EVs’ ability to connect to the electric network to charge, and on the future expectation of EVs ability to discharge to the network using the Vehicle-to-Grid (V2G) capacity. This thesis proposes alternative strategies to control these two EV modes with the objective of enhancing the management of the power system. Moreover, power system must ensure the trips of EVs that will be connected to the electric network. The EV user specifies a certain amount of energy that will be necessary to charge, in order to ensure the distance to travel. The introduction of EVs in the power system turns the Energy Resource Management (ERM) under a smart grid environment, into a complex problem that can take several minutes or hours to reach the optimal solution. Adequate optimization techniques are required to accommodate this kind of complexity while solving the ERM problem in a reasonable execution time. This thesis presents a tool that solves the ERM considering the intensive use of EVs in the smart grid context. The objective is to obtain the minimum cost of ERM considering: the operation cost of DG, the cost of the energy acquired to external suppliers, the EV users payments and remuneration and penalty costs. This tool is directed to VPPs that manage specific network areas, where a high penetration level of EVs is expected to be connected in these areas. The ERM is solved using two methodologies: the adaptation of a deterministic technique proposed in a previous work, and the adaptation of the Simulated Annealing (SA) technique. With the purpose of improving the SA performance for this case, three heuristics are additionally proposed, taking advantage on the particularities and specificities of an ERM with these characteristics. A set of case studies are presented in this thesis, considering a 32 bus distribution network and up to 3000 EVs. The first case study solves the scheduling without considering EVs, to be used as a reference case for comparisons with the proposed approaches. The second case study evaluates the complexity of the ERM with the integration of EVs. The third case study evaluates the performance of scheduling with different control modes for EVs. These control modes, combined with the proposed SA approach and with the developed heuristics, aim at improving the quality of the ERM, while reducing drastically its execution time. The proposed control modes are: uncoordinated charging, smart charging and V2G capability. The fourth and final case study presents the ERM approach applied to consecutive days.

A Hybrid Simulated Annealing approach to handle Energy Resource Management considering an intensive use of Electric Vehicles

The massification of electric vehicles (EVs) can have a significant impact on the power system, requiring a new approach for the energy resource management. The energy resource management has the objective to obtain the optimal scheduling of the available resources considering distributed generators, storage units, demand response and EVs. The large number of resources causes more complexity in the energy resource management, taking several hours to reach the optimal solution which requires a quick solution for the next day. Therefore, it is necessary to use adequate optimization techniques to determine the best solution in a reasonable amount of time. This paper presents a hybrid artificial intelligence technique to solve a complex energy resource management problem with a large number of resources, including EVs, connected to the electric network. The hybrid approach combines simulated annealing (SA) and ant colony optimization (ACO) techniques. The case study concerns different EVs penetration levels. Comparisons with a previous SA approach and a deterministic technique are also presented. For 2000 EVs scenario, the proposed hybrid approach found a solution better than the previous SA version, resulting in a cost reduction of 1.94%. For this scenario, the proposed approach is approximately 94 times faster than the deterministic approach.