Impacto de una adecuada codificación de la desnutrición relacionada con la enfermedad en los índices hospitalarios

Introducción: la desnutrición relacionada con la enfermedad (DRE) afecta al menos a una cuarta parte de los pacientes hospitalizados, aumentando la morbimortalidad del paciente durante su hospitalización y al alta. Sin embargo, su repercusión en la actividad hospitalaria no está bien cuantificada. Objetivo: determinar el impacto de una adecuada codificación de la DRE y los procedimientos empleados para revertirla en el peso medio del hospital y otros índices hospitalarios. Material y métodos: estudio comparativo realizado en todos los pacientes subsidiarios de soporte nutricional artificial seguidos por la Unidad de Nutrición Clínica y Dietética de la Sección de Endocrinología y Nutrición (UNCyD-SEyN) del Complejo Asistencial Universitario de León durante los años 2008 y 2013. Se realizó un informe de codificación nutricional del diagnóstico, el tratamiento nutricional y la vía de acceso según la CIE-9-MC. Se comparó el peso medio depurado del hospital, el índice de estancia media ajustada (IEMA), la casuística e índice de funcionamiento previo a la codificación nutricional y tras la misma. Resultados: el peso medio depurado del hospital se incrementó tras la codificación, tanto en 2008 (+ 4,1%) como en 2013 (+1,7%) y especialmente en aquellos servicios en los que se realiza cribado nutricional (Hematología, +10,5%). El IEMA se redujo por debajo de 1 (-5,7% y -0,2% en 2008 y 2013), indicando un mejor funcionamiento, y también disminuyó el índice funcional (-5,6% y -0,4% en 2008 y 2013), lo que supondría una mayor eficiencia. Conclusión: la correcta codificación del diagnóstico y el tratamiento nutricional del paciente con desnutrición aumenta el peso medio depurado de un hospital de tercer nivel, y mejora el IEMA y el índice de funcionamiento.

External ophthalmomyiasis by Oestrus ovis treated with tobacco: clinical case report and medical literature review

External ophthalmomyiasis is an infestation of conjunctiva with larvae or maggots of certain lies. Oestrus ovis is the most common cause of human ophthalmomyiasis. The case of a 16-yearold female is described, who presented with foreign body sensation, pain, and redness in the left eye. Slit-lamp biomicroscopy revealed 32 tiny larvae crawling around the conjunctival sac. The larvae were mechanically removed under topical anesthesia, and identiied under a light microscope as irst-stage larvae of O. ovis causing external ophthalmomyiasis. She was successfully treated with topical tobacco juice. Follow-up examination of these cases is recommended to avoid possible complications.

A demand-driven analysis of tourist accommodation price: A quantile regression of room bookings

Tourist accommodation expenditure is a widely investigated topic as it represents a major contribution to the total tourist expenditure. The identification of the determinant factors is commonly based on supply-driven applications while little research has been made on important travel characteristics. This paper proposes a demand-driven analysis of tourist accommodation price by focusing on data generated from room bookings. The investigation focuses on modeling the relationship between key travel characteristics and the price paid to book the accommodation. To accommodate the distributional characteristics of the expenditure variable, the analysis is based on the estimation of a quantile regression model. The findings support the econometric approach used and enable the elaboration of relevant managerial implications.

Travel frequency of seniors tourists

Current demand for tourism is characterized by more frequent, shorter trips throughout the year. Such trends may have adverse effects on the hospitality industry but benefit the travel industry. Most current literature assumes that the variables that determine travel participation are identical to those that influence travel frequency, though there is no evidence to support this assumption. Therefore, the current study seeks to identify variables that influence travel frequency among Spanish senior tourists, who represent a key target market for the tourism industry. The results specify that gender, self-perceived economic status, and self-perceived time available variables strongly determine Spanish seniors' travel frequency.

Detecting Free Riders in Collective Brands through a Hierarchical Choice Process

Free-riding behaviors exist in tourism and they should be analyzed from a comprehensive perspective; while the literature has mainly focused on free riders operating in a destination, the destinations themselves might also free ride when they are under the umbrella of a collective brand. The objective of this article is to detect potential free-riding destinations by estimating the contribution of the different individual destinations to their collective brands, from the point of view of consumer perception. We argue that these individual contributions can be better understood by reflecting the various stages that tourists follow to reach their final decision. A hierarchical choice process is proposed in which the following choices are nested (not independent): “whether to buy,” “what collective brand to buy,” and “what individual brand to buy.” A Mixed Logit model confirms this sequence, which permits estimation of individual contributions and detection of free riders.

Parâmetros urbanísticos na regulação do uso e ocupação do solo: estudo da densidade e do coeficiente de aproveitamento nos planos diretores de Natal de 1994 e 2007

A Constituição Federal de 1988 e o Estatuto da Cidade estabelecem o Plano Diretor como instrumento básico da política de ordenamento territorial, tendo como princípio fundamental o cumprimento da função social da propriedade e do direito à cidade. Na perspectiva de adequação às diretrizes e objetivos da política urbana estabelecidos em 1988, o município de Natal elaborou os Planos Diretores de 1994 e 2007, definindo instrumentos e parâmetros de regulação do uso e ocupação do solo possíveis de assegurar o cumprimento da função social da propriedade urbana e de gerar subsídios ao planejamento e à gestão da cidade. Apesar de Natal ter sido um dos municípios brasileiros pioneiros na adoção desses princ pios, antecipando e incorporando os instrumentos que em 2001 viriam a ser definidos no Estatuto da Cidade, identifica-se que alguns desses instrumentos e parâmetros direcionados à regulação do uso e ocupação do solo não tiveram sua aplicação plena, a exemplo do mecanismo de acompanhamento e controle dado pelo Estoque de Área Edificável e da Densidade, que foi substituída pelo Coeficiente de Aproveitamento no Plano Diretor de 2007. Questionando esse procedimento, busca-se na presente pesquisa investigar de que maneira essa substituição do parâmetro densidade pelo coeficiente de aproveitamento influenciou na capacidade da gestão pública de regular os processos de uso e ocupação do solo, de forma a adequar a sua intensificação ao suporte da infraestrutura instalada. Foram tomadas como referência teórico-conceitual as contribuições sobre a prática de planejamento urbano no Brasil, nos marcos do ideário da reforma urbana, com destaque para as reflexõe s de Flávio Villaça, Orlando Alves Santos Junior e Daniel Todtmann Montandon, Luiz César de Q. Ribeiro, Raquel Rolnik, Ermínia Maricato, Laura Machado de Bueno e Renato Cymbalista, José Roberto Bassul e Carlos F. Lago Burnett, e, com relação aos parâmetros de controle urbanístico, o estudo identifica as diferentes abordagens sobre a densidade urbana e o coeficiente de aproveitamento com base nas reflexões de Claudio Acioly Jr., Forbes Davidson, Juan Luis Mascaró, Ricardo Ojima, Marcelo de Souza, José Rámon Navarro Vera e Armando Ortuño Padilla, Nestor Goulart Reis, Marta Dora Grostein e Susana Ricardo Alves. Como conclusão, discute-se a hipótese formulada, inicialmente, de que a mudança de parâmetros verificada colocou limites para o município realizar uma gestão adequada do solo urbano e, portanto, de fazer cumprir a função social da propriedade, considerando a necessidade de adequação entre a intensificação do uso e ocupação do solo e a infraestrutura instalada

Multivalent reuse of web data about temporary art exhibitions: The Exhibitium Project

Our proposal aims to display the analysis techniques, methodologies as well as the most relevant results expected within the Exhibitium project framework (http://www.exhibitium.com). Awarded by the BBVA Foundation, the Exhibitium project is being developed by an international consortium of several research groups . Its main purpose is to build a comprehensive and structured data repository about temporary art exhibitions, captured from the web, to make them useful and reusable in various domains through open and interoperable data systems.

Exploring barriers to breastfeeding among chinese mothers living in Madrid, Spain

In Spain, immigrant women have high rates for initiating breastfeeding. In contrast, the case of immigrant Chinese mothers stands out, due to the low rate. In China, breastfeeding has historically been the cultural norm. An ethnographic study was conducted to explore aspects related to the low rate of breastfeeding. Field observations and informal interviews were conducted in two hospitals and a primary care center. Semi-structured interviews were performed with Chinese mothers and health workers. Among Spanish health workers, there is a belief that Chinese women do not breastfeed due to cultural reasons. The rapid return to work and the popular phenomenon of sending babies back to China for grandparents to raise constitute barriers for breastfeeding. Although in China breastfeeding is common practice, in Madrid the prioritization of productivity over reproduction and the existence of the so-called “satellite babies” and transnational maternity make the establishment and maintenance of breastfeeding difficult.

Transboundary dimensions of marine spatial planning: Fostering inter-jurisdictional relations and governance

There is broad agreement that marine spatial planning (MSP) should incorporate transboundary considerations, reflecting the cross-border nature of marine and coastal ecosystem dynamics and maritime resources and activities. This is recognised in the European Union's recent legislation on MSP, and experience in transboundary approaches is developing through official processes and pilot studies.

Asfixia perinatal y proteína S100B

La asfixia perinatal es la principal causa de muerte en la primera semana de vida la nivel mundial, los niños que sufren esta complicación y sobreviven pueden presentar trastornos neurológicos de diferente nivel de compromiso que inciden en su desarrollo personal y social. Las cifras de muerte por este problema de salud han disminuido de manera importante, sin embargo en el reporte de la Organización Mundial de Salud (OPS) del 2010, la asfixia perinatal es causa del 29% de muertes infantiles en los países de América Latina y el Caribe 2. Es necesario conocer además la extensión del daño neurológico que sufren estos niños, con este fin se desarrolló un estudio piloto en el Hospital Universitario Mayor Mederi de Bogotá, en el cual se determinó la concentración de un marcador metabólico de daño cerebral, la proteína S100B en suero de 60 recién nacidos sanos, con el objetivo de analizar la asociación del mismo con el peso al nacer, la edad gestacional y el diagnóstico. Los resultados no mostraron diferencias significativas entre este marcador y las variables analizadas que puede asociarse al pequeño número de pacientes, sin embargo han sentado las bases para el desarrollo de un estudio que incluya varios hospitales de Bogotá y sobre todo la determinación del mismo en recién nacidos con diagnóstico de hipoxia en el período perinatal, lo cual aportará información del grado de la alteración que puedan tener a nivel cerebral y contribuya al mejor manejo evolutivo con la aplicación de medidas de intervención en estadios tempranos de la vida.

José Rodrigues Santos de Sousa Ramos (1948-2007): The diversity of dynamical systems

José Rodrigues Santos de Sousa Ramos, mathematician of great merit, passed away on January 1st, 2007, in Lisbon. He was buried in Sobral da Adiça. His death was a huge loss for the development of mathematics in Portugal. The course of time will increase the dimension of this loss. Therefore, we dedicated this theme issue on Dynamical Systems to recall his memory and underline his work. We never forget you.

Solar and thermal radiative effects during the 2011 extreme desert dust episode over Portugal

This paper analyses the influence of the extreme Saharan desert dust (DD) event on shortwave (SW) and longwave (LW) radiation at the EARLINET/AERONET Évora station (Southern Portugal) from 4 up to 7 April 2011. There was also some cloud occurrence in the period. In this context, it is essential to quantify the effect of cloud presence on aerosol radiative forcing. A radiative transfer model was initialized with aerosol optical properties, cloud vertical properties and meteorological atmospheric vertical profiles. The intercomparison between the instantaneous TOA shortwave and longwave fluxes derived using CERES and those calculated using SBDART, which was fed with aerosol extinction coefficients derived from the CALIPSO and lidar-PAOLI observations, varying OPAC dataset parameters, was reasonably acceptable within the standard deviations. The dust aerosol type that yields the best fit was found to be the mineral accumulation mode. Therefore, SBDART model constrained with the CERES observations can be used to reliably determine aerosol radiative forcing and heating rates. Aerosol radiative forcings and heating rates were derived in the SW (ARFSw, AHRSw) and LW (ARFLw, AHRLw) spectral ranges, considering a cloud-aerosol free reference atmosphere. We found that AOD at 440 nm increased by a factor of 5 on 6 April with respect to the lower dust load on 4 April. It was responsible by a strong cooling radiative effect pointed out by the ARFSw value (−99 W/m2 for a solar zenith angle of 60°) offset by a warming radiative effect according to ARFLw value (+21.9 W/m2) at the surface. Overall, about 24% and 12% of the dust solar radiative cooling effect is compensated by its longwave warming effect at the surface and at the top of the atmosphere, respectively. Hence, larger aerosol loads could enhance the response between the absorption and re-emission processes increasing the ARFLw with respect to those associated with moderate and low aerosol loads. The unprecedented results derived from this work complement the findings in other regions on the modifications of radiative energy budget by the dust aerosols, which could have relevant influences on the regional climate and will be topics for future investigations.

Empresas Multinacionales y Espacios Geograficos. El caso de la Noranda Mines

A partir del análisis de la importancia de una empresa canadiense, la Noranda Mines Ltd., especializada en la producción de cobre, madera y derivados y metalurgia, se describe la dimensión espacial internacional de esa compañía, así como el impacto en regiones específicas tales como Abitibi, Canadá, y El Limón en Nicaragua.

Nutriología básica por Luis Juan Tijerina Sánchez

UANL