Síndrome de Burnout en médicos generales de consulta externa

Objetivos : Establecer la prevalencia de Síndrome de Burnout en 17 médicos de consulta externa de una IPS de Bogotá, antes de la jornada laboral y después de la misma. Determinar las dimensiones del Síndrome de Burnout y relacionarlas con las variables sociodemográficas escogidas para este caso. Metodología: Se realizó un estudio longitudinal con una población de 17 médicos generales de consulta externa de una IPS de la cuidad de Bogotá Colombia, en el año 2009. Se les aplicó el Test de Maslach, para determinar las tres dimensiones del Síndrome de Burnout las cuales son: agotamiento emocional, despersonalización y realización personal para establecer la relación con las variables escogidas previamente. Para el análisis estadístico se usó el Software Epi Info Versión 3.51. Las variables cuantitativas fueron resumidas teniendo en cuenta medidas de tendencia central y las variables cuantitativas se expresaron en forma de proporciones. Para realizar las comparaciones se utilizó la prueba Ji cuadrado con ajuste por Test de Fischer. Se consideró significancia estadística con p ‹ 0.05. Resultado : La población estudiada fue en su mayoría de género femenino, con una mediana de edad de 30 años. El 41.2% de los médicos trabajan 8 horas diarias y el 35.3% trabajan más de 8 horas al día. Se calificaron las tres dimensiones que propone el test de Maslach, las cuales son agotamiento emocional, despersonalización y realización personal dando un puntaje de alto medio y bajo según las respuestas de los médicos evaluados. . Dentro de las dimensiones analizadas del test de Maslach antes de la jornada laboral el 35.3 % presentan agotamiento emocional dentro de la puntuación alta y después de la jornada se aumenta a 47.1%. En cuanto al puntaje para medio en esta misma dimensión fue de 23.5 % y bajo 41.2% previo a la jornada , con un porcentaje al finalizar de la jornada de 17.6% y 35.3% respectivamente. La dimensión de despersonalización antes de la jornada fue de 29,4% para alto, 23.5% para medio y 47.1% para bajo. Al finalizar la jornada no se observan cambios significativos en los porcentajes de esta dimensión. No se obtuvo prevalencia significativa entre las variables estudiadas y cada una de las dimensiones del Test de Maslach. Discusión : Los resultados muestran que existe un cambio en la dimensión de agotamiento emocional al inicio de la jornada laboral comparado con el final de la misma. Las calificaciones obtenidas tuvieron valores altos, mientras que en los de valores medio y bajo disminuyó este agotamiento al finalizar la jornada. Para la despersonalización los valores no se vieron modificados tras la jornada de trabajo. En cuanto a la realización personal hubo una variación ya que los sujetos que fueron calificados al iniciar la jornada con valores altos disminuyeron al finalizar y los de valores medio y bajo aumentaron su realización personal al finalizar la jornada. De otra parte no se establecieron relaciones significativas con los factores extralaborales e individuales evaluados, teniendo en cuenta probablemente el tamaño de la población de estudio y el tiempo de evaluación.

First Attempt with Maya

3d modeling and rendering is one of the thinks I really like. Talking about 3D Studio Max or Cinema 4D it was very easy to understand and I just get used to it, wile Maya is absolutely different. So I starting to learn it by myself and it seems to be very interesting. Here is the first render. It is an old silver Russian ruble.

Caracterización de cardiopatías congénitas en pacientes con Síndrome de Down en una institución especializada de Bogotá

Las cardiopatías son el principal defecto congénito asociado al Síndrome de Down (SD), y su detección e intervención oportuna contribuye a reducir la morbimortalidad. El objetivo del presente estudio fue caracterizar las malformaciones cardiacas congénitas de la población pediátrica con SD que asiste a un centro de atención especializado en la ciudad de Bogotá (Colombia). Materiales y métodos: Se realizó un estudio descriptivo transversal con registros clínicos de pacientes con diagnostico cariotípico de SD, evaluando las cardiopatías congénitas documentadas en las valoraciones pediátricas institucionales; se estudió su posible relación con determinados factores como la edad de los padres y el género del hijo. Resultados: Se revisaron 157 historias clínicas que cumplieron con los criterios de calidad para estudio. El 57,2% eran hombres y el 42,8% mujeres. El cariotipo del 91,7% fue trisomía libre, 3.8% mosaicismos y un caso de translocación. El diagnóstico prenatal se realizó en el 12,1% de los evaluados. Se observó algún defecto cardiaco congénito en el 65,8% de los pacientes (n=103). Se identificaron defectos aislados en 53 pacientes (33,7%), siendo el ductus arterioso persistente el más frecuente con un 26,2%. El defecto múltiple más recurrente fue la comunicación interauricular asociada a comunicación interventricular con un 18,4%. No se identificó relación entre los factores de riesgo estudiados y algún tipo de cardiopatía. Conclusiones: Se identificó una prevalencia de cardiopatías congénitas similar a la reportada por la literatura, sin embargo se documentaron diferencias en cuanto a la frecuencia y tipos de defectos únicos y múltiples descritos en otros estudios. Palabras Clave: Síndrome Down, Cardiopatías congénitas, Colombia.

Procesos de difusión del derecho Internacional Humanitario desarrollado por el Comité Internacional de la Cruz Rojas en Colombia en el periodo comprendido entre 1997 y 2003.

Establecer la base jurídica y metodológica sobre la cual realiza la Cruz Roja su actividad operacional de difusión y la importancia de dicha acción. Descripción de las operaciones realizadas por el CICR en el estado Colombiano

Comparación de la anestesia espinal con anestesia general endovenosa para legrado uterino obstétrico

Introducción: La elección de la técnica anestésica para cualquier procedimiento quirúrgico debe estar basada en su seguridad, la rapidez para su aplicación, la recuperación óptima para el paciente y minimización de los efectos secundarios, la anestesia raquídea es una técnica anestésica que puede ser utilizada con buenos resultados clínicos y minimas complicaciones . Materiales y métodos: Se realizó un estudio observacional con recolección prospectiva en mujeres clasificadas como ASA I - II y que posteriormente fueron llevadas a la realización de legrado uterino obstétrico por embarazo no viable durante las primeras 12 semanas de gestación, las técnicas anestésicas fueron anestesia espinal o anestesia general endovenosa dependiendo de la elección hecha por el anestesiólogo previo al procedimiento. Se midieron variables hemodinámicas, control del dolor postoperatorio, tiempo de recuperación y complicaciones perioperatorias con el fin de determinar si se presentaban diferencias significativas entre estas dos técnicas anestésicas. Resultados: Se incluyeron un total de 110 pacientes, 63.6% (n=70) con anestesia general y 36.4% (n40) con anestesia espinal. Ambas poblaciones fueron comparables. Se presentaron menos efectos secundarios con la técnica espinal, hay una diferencia estadísticamente significativa en cuanto al dolor a favor de la anestesia espinal (p0,000) Discusión: La anestesia raquídea es una opción viable, sencilla , fácil y eficaz para la realización de legrados obstétricos, se puede realizar con monitorización básica y las complicaciones son mínimas. Se requieren estudios más amplios para determinar el papel de cual es la mejor técnica. Palabras claves: legrado uterino instrumentado, anestesia espinal, anestesia general endovenosa

Schools and Web 2.0 : a critical perspective.

Resumen de la revista. - El artículo pertenece a una sección monográfica dedicada a la escuela en la sociedad digital

On the generation mechanisms of short-scale unbalanced modes in rotating two-layer flows with vertical shear

We report on the results of a laboratory investigation using a rotating two-layer annulus experiment, which exhibits both large-scale vortical modes and short-scale divergent modes. A sophisticated visualization method allows us to observe the flow at very high spatial and temporal resolution. The balanced long-wavelength modes appear only when the Froude number is supercritical (i.e. $F\,{>}\,F_\mathrm{critical}\,{\equiv}\, \upi^2/2$), and are therefore consistent with generation by a baroclinic instability. The unbalanced short-wavelength modes appear locally in every single baroclinically unstable flow, providing perhaps the first direct experimental evidence that all evolving vortical flows will tend to emit freely propagating inertia–gravity waves. The short-wavelength modes also appear in certain baroclinically stable flows. We infer the generation mechanisms of the short-scale waves, both for the baro-clinically unstable case in which they co-exist with a large-scale wave, and for the baroclinically stable case in which they exist alone. The two possible mechanisms considered are spontaneous adjustment of the large-scale flow, and Kelvin–Helmholtz shear instability. Short modes in the baroclinically stable regime are generated only when the Richardson number is subcritical (i.e. $\hbox{\it Ri}\,{<}\,\hbox{\it Ri}_\mathrm{critical}\,{\equiv}\, 1$), and are therefore consistent with generation by a Kelvin–Helmholtz instability. We calculate five indicators of short-wave generation in the baroclinically unstable regime, using data from a quasi-geostrophic numerical model of the annulus. There is excellent agreement between the spatial locations of short-wave emission observed in the laboratory, and regions in which the model Lighthill/Ford inertia–gravity wave source term is large. We infer that the short waves in the baroclinically unstable fluid are freely propagating inertia–gravity waves generated by spontaneous adjustment of the large-scale flow.

The acoustic signature of fluid flow in complex porous media

Effective medium approximations for the frequency-dependent and complex-valued effective stiffness tensors of cracked/ porous rocks with multiple solid constituents are developed on the basis of the T-matrix approach (based on integral equation methods for quasi-static composites), the elastic - viscoelastic correspondence principle, and a unified treatment of the local and global flow mechanisms, which is consistent with the principle of fluid mass conservation. The main advantage of using the T-matrix approach, rather than the first-order approach of Eshelby or the second-order approach of Hudson, is that it produces physically plausible results even when the volume concentrations of inclusions or cavities are no longer small. The new formulae, which operates with an arbitrary homogeneous (anisotropic) reference medium and contains terms of all order in the volume concentrations of solid particles and communicating cavities, take explicitly account of inclusion shape and spatial distribution independently. We show analytically that an expansion of the T-matrix formulae to first order in the volume concentration of cavities (in agreement with the dilute estimate of Eshelby) has the correct dependence on the properties of the saturating fluid, in the sense that it is consistent with the Brown-Korringa relation, when the frequency is sufficiently low. We present numerical results for the (anisotropic) effective viscoelastic properties of a cracked permeable medium with finite storage porosity, indicating that the complete T-matrix formulae (including the higher-order terms) are generally consistent with the Brown-Korringa relation, at least if we assume the spatial distribution of cavities to be the same for all cavity pairs. We have found an efficient way to treat statistical correlations in the shapes and orientations of the communicating cavities, and also obtained a reasonable match between theoretical predictions (based on a dual porosity model for quartz-clay mixtures, involving relatively flat clay-related pores and more rounded quartz-related pores) and laboratory results for the ultrasonic velocity and attenuation spectra of a suite of typical reservoir rocks. (C) 2003 Elsevier B.V. All rights reserved.

Chlorine tolerant, multilayer reverse-somosis membranes with high permeate flux and high salt rejection

A new class of high molecular weight polyethersulfone ionomers is described in which the ionic content can be varied, at will, over a very wide and fully-controllable range. A novel type of coating process enables these materials to be deposited from alcohol-type solvents as cohesive but very thin (50 – 250 nm) films on porous support-membranes, giving high-flux membranes (3.3 – 5.0 L m-2 h-1 bar-1) with very good, though not outstanding salt rejection (typically 92 - 96%). A secondary layer, of formaldehyde-cross-linked polyvinyl alcohol, can be deposited from aqueous solution on the surface of the ionomer membrane, and this layer increases salt rejection to greater than 99% without serious loss of water permeability. The final multi-layer membrane shows excellent chlorine tolerance in reverse-osmosis operation.

Short communication: Suppressor of cytokine signaling-2 mRNA increases after parturition in the liver of dairy cows

After parturition, the somatotropic axis of the dairy cow is uncoupled, partly because of reduced concentration of liver-specific GH receptor (GHR) 1A. Estradiol-17 beta (E-2) concentrations increase at parturition and E-2 upregulates suppressors of cytokine signaling-2 (SOCS-2) mRNA expression, potentially inhibiting GH signaling. Therefore, we hypothesized that SOCS-2 mRNA is upregulated after parturition. Multiparous Holstein cows (n = 18) were dried off 45 d before expected parturition and fed diets to meet nutrient requirements at ad libitum or limited dry matter intake during the dry period. All cows were fed the same diet ad libitum from calving until 4 wk after parturition. Blood samples were collected weekly and more frequently near parturition. Liver biopsies obtained at -21, -7, 2, and 28 d relative to parturition were assessed for SOCS-2 and GHR 1A mRNA by quantitative real-time reverse-transcription PCR. The relative amount of SOCS-2 mRNA increased after parturition with both treatments and was greater on d 2 for cows limit-fed during the dry period compared with cows fed at ad libitum dry matter intake. Plasma E2 concentrations increased on d -13, -5 and 1 relative to parturition and the increases were greater in limit-fed cows. Plasma GH concentration was greater for limit-fed cows and increased after parturition in all cows. The amount of GHR 1A mRNA did not differ between diets but decreased on d 2. In addition to reduced GHR 1A, increased SOCS-2 mRNA after parturition, perhaps because of increased E-2, may further uncouple GH signaling in the liver of the transition dairy cow.

Bovine follicle development is associated with divergent changes in activin-A, inhibin-A and follistatin and the relative abundance of different follistatin isoforms in follicular fluid

The aim was to determine whether follicle growth in cattle is accompanied by changes in levels of inhibin-A (inh-A), activin-A (act-A) and different Mr isofomus of follistatin (FS) in bovine follicular fluid (bFF), reflecting differential roles of these proteins during folliculogenesis. Follcles (n= 146) from 2-20 min diameter were dissected from ovaries of similar to 40 cattle. Immunoassays were used to measure total FS, act-A, inh-A, oestradiol (E) and progesterone (P) levels; immunoblotting was used to quanti, the relative abundance of different FS isoforms. Follicle growth from 2-6 mm was associated with a 6-fold increase in inh-A and 30-fold increase in act-A; FS remained uniformly high from 2-10 turn. From 6-2 min, inh-A remained high while act-A and FS fell 3-fold and 2-fold, respectively. Act-A/FS ratio increased 20-fold from 2-6 mm before falling slightly through to 20 mm. Act-A/inh-A ratio increased 6-fold from 2-6 nun before falling 2-fold from 6 to 17-20 mm. These findings imply a marked increase in relative activin 'tone' around the stage at which dominant follicle,;election occurs. When larger follicles (13-20 mm) were subdivided according to E/P ratio, those with high (> 5) E/P ratio had lower (2-fold; P < 0(.)001) levels of inh-A and act-A in comparison to follicles with low (< 5) E/P ratio, but there were no significant diffierences in FS, act-A/inh-A ratio or act-A/FS ratio. Thus follicle size, but not oestrogenic status, has a major influence on the intrafollicular balance between act-A and its opposing factors, inh-A and FS. Six FS isoforms were detected in bFF (apparent Mr: 65, 41, 37, 35, 33 and 31 kDa) averaging 6, 13, 24, 26 13 and 17% respectively of total FS. During growth from 2-20 mm the proportion of total FS represented by 605, 41 and 37 kDa isoforms increased similar to 2-fold while the proportion represented by the 33 and 31 kDa isoforms decreased by 3-fold and 1(.)6-fold, respectively. Treatment of bovine granulosa cells in vitro with FSH and IGF alone or in combination increased total FS secretion up to 12-fold but did not affect the relative abundance of the five different FS isoforms detected. While the functional significance of the intriguing shift in FS isoform abundance in bFF during follicle development remains to be established, we have shown that a marked increase in intrafollicular activin 'tone' accompanies bovine follicle growth from 3-6 min, corresponding to the stage at which the FSH-dependent follicle selection mechanism operates in this species.

Stille reactions of 2,3-bis(stannyl)butenoates: an unexpected regioselectivity

The palladium-catalyzed cross-coupling reaction of methyl (Z)-2,3-bis(tributylstannyl)butenoate with aryl iodides is regioselective, leading to 2-aryl-3-stannylated products; this selectivity is the opposite to that observed in the reaction between halides and 3,4-bis(stannyl)furan-2(5H)-one. Since the resulting butenoates can be converted into the corresponding furanones, the method provides useful flexibility in the preparation of functionalized butenoates and furanones.

Azide 1,3-dipolar cycloadditions to N-propynoyl and N-propenoyl (5R)-5-phenylmorpholin-2-one: diastereocontrolled aziridine formation

N-Propynoyl (5R)-5-phenylmorpholin-2-one undergoes nonregioselective cycloaddition with aromatic azides to furnish mixtures of the corresponding triazoles, whereas N-propenoyl (5R)-5-phenylmorpholin-2-one reacts to furnish the corresponding diastereoisomerically pure aziridines in moderate to good yields, presumably via the intermediate triazolines.

An unprecedented mononuclear double helicate with a square planar metal ion

Reactions of the 1:2 condensate (L) of benzil dihydrazone and 1-methyl-2-imidazole carboxaldehyde with Cd(ClO4)(2)center dot xH(2)O and CdI2 yield [CdL2]( ClO4)(2) (1) and LCdI2 (2), respectively. The yellow ligand L, and its yellow complexes 1 and 2 are characterized by NMR and single crystal X-ray diffraction. Though L contains four N-donor centers, 1 is found to be a four-coordinate double helicate with a square planar Cd(II)N-4 core and 2 a spiral coordination polymer with tetrahedral Cd(II)N2I2 moieties. The bidentate nature of L and the occurrence of the square planar coordination of Cd( II) is explained by DFT calculations. (c) 2007 Elsevier B. V. All rights reserved.

Palladium and platinum complexes of 2-(2 '-carboxyphenylazo)-4-methylphenol: synthesis, structure and spectral properties

Reaction of 2-(2'-carboxyphenylazo)-4-methylphenol (H2L) with [M(PPh3)(2)Cl-2] (M = Pd, Pt) affords mixed-ligand complexes of type [M(PPh3)(L)]. Structures of both the complexes have been determined by X-ray crystallography. Both the complexes are square planar, where the 2-(2'-carboxyphenylazo)-4-methylphenol is coordinated to the metal center, via dissociation of the two acidic protons, as a dianionic tridentate O,N,O-donor, and the fourth position is occupied by the triphenylphosphine. These complexes show intense MLCT transitions in the visible region.