Proyecto sobre el mejoramiento del proceso hospitalario de asignación de camas y desinfección

El siguiente trabajo de grado tiene como propósito principal analizar los procesos realizados en Clínicas y Hospitales con respecto a la asignación de habitaciones para pacientes ingresando a estas instituciones médicas y con respecto a los procesos de desinfección y aseo que se llevan a cabo ahí mismo. El proyecto de mejoramiento del proceso hospitalario de asignación de camas y desinfección se basó en una auditoría realizada por los autores del mismo a la Clínica Nueva en la ciudad de Bogotá durante el primer semestre del año en curso. El trabajo se divide en cuatro partes: situación actual, diagnóstico, situación propuesta y conclusiones con sus respectivas recomendaciones. En la situación actual se observa la manera en la que se realizan los procesos dentro de la clínica en evaluación y cuyo diagnóstico se expone en la segunda parte. Luego se propone una situación en la cual el proceso de asignación de camas y de desinfección dentro de la clínica sería el óptimo, para así finalizar con las conclusiones del trabajo y las respectivas recomendaciones para poder implementar los planes de mejora establecidos a los largo del escrito.

Significado sedimentológico de los niveles con Assilinas de la Formación Armancies (Eoceno medio) y sus equivalentes laterales

In this paper we show some sedimentological characteristics of Assilina beds from Armancies Fm. (middle Eocene) and their lateral equivalents that let us to remark some aspects of their genesis. We arrive to the conclusion that, in occidental sector (Bagá-Campdevanol), ‘las barras de Assilinas’ from the Armancies Fm. are grain flow channels, first sedimented at W of Terrades and after slided, from E to W in a turbidite basin, without any coarse clastic

Percepção da gestão nos hospitais filantrópicos privados vinculados ao Sistema Único de Saúde (SUS) na cidade de Belém e região metropolitana, Pará

Os hospitais filantrópicos representam cerca de 1/3 do total de hospitais existentes no Brasil, são 1.917 instituições entre privados e não privados, lucrativos e sem fins lucrativos, constituídas aproximadamente por 132 mil leitos Se beneficiam de inúmeros privilégios fiscais que geram vantagens competitivas sobre o setor privado, dentre os quais, listam-se as isenções de impostos garantidas pela aquisição do certificado de filantropia, concedido pelo Ministério da Saúde. O objetivo geral da pesquisa é perceber a gestão desses hospitais e consiste em um estudo de caso com abordagem qualitativa e quantitativa desenvolvido em cima de uma amostra composta por 2 (dois) hospitais filantrópicos privados vinculados ao SUS da cidade de Belém, Pará, Brasil e região metropolitana, escolhidos aleatoriamente numa população de 4 (quatro) hospitais. Constatou-se que os gestores ainda apresentam uma visão mecanicista, os colaboradores demonstram pouco conhecimento sobre a gestão, os usuários por sua vez têm o SUS como única opção e acham apenas que a qualidade nos serviços precisa melhorar, o planejamento estratégico é desconhecido e não é elaborado de modo participativo, inexistindo na sua forma completa. Por outro lado, ainda que contraditório, os hospitais apresentam um bom nível de qualificação profissional na gestão.

Ancient lakes of the Sahara

As a result of climate change over the past 5000 years the Sahara changed from savannah to a desert landscape. The beds of ancient lakes are home to snail shells and the petrified roots of trees and shrubs. Examples of human occupation can also be seen in the form of fireplaces and discarded tools. Examination of the geological history of these sites can give a clearer picture of how the climate changed and how humans coped with these changes.

Granulometric characterization and evaluation of annually banded mid-Holocene estuarine silts, Welsh Severn Estuary (UK): coastal change, sea level and climate

Holocene silts (salt marshes) and highest intertidal-supratidal peats are superbly exposed on a 15 kin coastal transect which reveals two laterally extensive units of annually banded silts (Beds 3, 7) associated with three transgressive-regressive silt-peat cycles (early sixth-early fourth millennium BC). Bed 3 in places is concordantly and gradationally related to peats above and below, but in others transgresses older strata. Bed 7 also grades up into peat, but everywhere overlies a discordance. The banding in Bed 3 at three main and two minor sites was resolved and characterized texturally at high-resolution (2.5/5 mm contiguous slices) using laser granulometry (LS230 with PIDS) and a comprehensive scheme of data-assessment. Most of Bed 3 formed very rapidly, at peak values of several tens of millimetres annually, in accordance with modelled effects of sea-level fluctuations on mature marshes (bed concordant and gradational) and on marshes growing up after coastal erosion and retreat (bed with discordant base). Using data from the modern Severn Estuary, the textural contrast within bands, and its variation between bands, points to a variable but overall milder mid-Holocene climate than today. The inter-annual variability affected marsh dynamics, as shown by the behaviour of the finely divided plant tissues present. Given local calibration, the methodology is applicable to other tidal systems with banded silts in Britain and mainland northwest Europe. (c) 2006 Elsevier Ltd. All rights reserved.

Conical sedimentary structures, trace fossils or not? Observations, experiments, and review

Conical sedimentary structures are widespread in the geological column. Those that are mediated by organisms (or organic matter) can be attributed to seven principal processes, which are investigated by experiment and/or field observations: (1) sand collapse into a cavity (decomposed body, open shaft, or gallery), (2) upward (escape) or downward locomotion by an organism through the sediment, (3) upward adjustment (equilibration), (4) casting of coelenterates' excavations, (5) organism-mediated soft-sediment deformation in heterolithic sediment, (6) biodeformational small and large excavations by organisms, and (7) fluid (gas or liquid) escape structures. Footprint loading may also be included. Criteria are given to distinguish between these processes. Dewatering pipes are best recognized by a zone of deformed and fluidized sediment at the base, and association with non-life (lethal) facies. Care must be used in assigning specimens to ichnotaxa, and it is generally necessary to slab, and also to carry out stratinomic investigation in the field.

A groove-ploughing theory for the production of mega-scale glacial lineations, and implications for ice-stream mechanics

Mega-scale glacial lineations (MSGLs) are longitudinally aligned corrugations (ridge-groove structures 6-100 km long) in sediment produced subglacially. They are indicators of fast flow and a common signature of ice-stream beds. We develop a qualitative theory that accounts for their formation, and use numerical modelling, and observations of ice-stream beds to provide supporting evidence. Ice in contact with a rough (scale of 10-10(3) m) bedrock surface will mimic the form of the bed. Because of flow acceleration and convergence in ice-stream onset zones, the ice-base roughness elements experience transverse strain, transforming them from irregular bumps into longitudinally aligned keels of ice protruding downwards. Where such keels slide across a soft sedimentary bed, they plough through the sediments, carving elongate grooves, and deforming material up into intervening ridges. This explains MSGLs and has important implications for ice-stream mechanics. Groove ploughing provides the means to acquire new lubricating sediment and to transport large volumes of it downstream. Keels may provide basal drag in the force budget of ice streams, thereby playing a role in flow regulation and stability We speculate that groove ploughing permits significant ice-stream widening, thus facilitating high-magnitude ice discharge.

Spatangoid-produced ichnofabrics (Bateig Limestone, Miocene, Spain) and the preservation of spatangoid trace fossils

A spatangoid-produced ichnofabric is described from the Miocene Bateig Limestone, SE Spain. This ichnofabric is characterized by the dominant presence of large meniscate burrows (Bichordites) produced by irregular echinoids. This constitutes an unusual mode of occurrence for spatangoid bioturbation, as their traces are most typically preserved in bases and tops of sandstone event beds. In fact, despite their important role as burrowers in modern settings (that can be extended back to the Early Cretaceous based on their body fossil record), spatangoid trace fossils (Scolicia and Bichordites) are comparatively rare. Several factors play an important role in their preservation: mechanism of burrowing, sediment characteristics, early diagenesis and presence/absence of deep-tier burrowers. Spatangoid-produced ichnofabrics, such as those from the Bateig Limestone, characterize depositional settings with intermittent deposition of event beds where there is an absence of deeper-tier bioturbation. (C) 2008 Elsevier B.V. All rights reserved

An ichnofabric approach to the depositional interpretation of the intensely burrowed Bateig Limestone, Miocene, SE Spain

The foraminiferal-rich pelagic Bateig Limestone forms several varieties of the important building stones quarried at Bateig Hill in southeastern Spain. Three principal ichnofabrics (Bichordites, mottled-Palaeophycus and mottled-Ophiomorpha) are recognized, which are present in at least two (possibly up to four) repeated successions (cycles). Each succession begins with an erosional event. The Bichordites ichnofabric represents a new type of facies, formed as thin turbidity/grain flow, stratiform units derived from sediment slips off a fault into deep water. Each slipped unit became almost completely bioturbated by infaunal echinoids, colonizing by lateral migration. Because of the thinness of the units, successive colonizations tended to truncate the underlying burrows giving rise to a pseudo-stratification. As the Bichordites ichnofabric accumulated on the fault apron, thus reducing the effective height of the fault scarp, the substrate gradually came under the influence of currents traversing the shelf. This led to a change in hydraulic regime, and to the mottled-Palaeophycus and mottled-Ophiomorpha ichnofabrics in sediment deposited under bed load transport, and associated with laminar and cross-stratified beds and local muddy intervals. Reactivation of the fault triggered erosion and channeling and a return to grain flow sedimentation, and to the Bichordites ichnofabric of the succeeding cycle. The highest unit of the Bateig Limestone is formed entirely of cross-stratified calcarenites with occasional Ophiomorpha (Ophiomorpha-primary lamination ichnofabric) and is similar to many shallow marine facies but they still bear a significant content of pelagic foraminifera. The sedimentary setting bears resemblance with that described for the Pleistocene Monte Torre Paleostrait and the modem Strait of Messina (Italy), where the narrow morphology of the depositional area enhanced tidal currents and allowed for high-energy sandy deposition in relatively deep areas. More data on the Miocene paleogeography of the Bateig area should provide further testing for this hypothesis. The ichnofacies and stacking of the Bateig Limestone differ from the classic Seilacherian model in that they reflect changes in hydraulic process and are associated with faulting and subsidence and changes in sediment supply. Recognition of the unusual ichnofabrics and their relationships provides a clear indication of the overall dynamic setting. (c) 2006 Elsevier B.V. All rights reserved.

The application of ichnofabrics towards bridging the dichotomy between siliciclastic and carbonate shelf facies: examples from the Upper Jurassic Fulmar Formation (UK) and the Jubaila Formation (Saudi Arabia)

An initial study of the ichnofabrics of the Upper Jurassic (Kimmeridgian) Jubaila Formation of Saudi Arabia shows that the ichnofabrics are closely matched to the relatively well-described ichnofabrics of the contemporary Fulmar Formation of the UK Continental Shelf (North Sea), in respect of the lower shoreface/offshore transition facies to offshore facies. The ichnology and ichnofabrics of the Lower Jubaila Formation show that deposition took place on an open-marine platform on the Arabian craton subject to periodic storm activity, but under a persisting equilibrium between sediment accumulation and subsidence. This is consistent with the moderately deep-marine foraminiferal assemblages and the presence of calcareous nannofossils. Cyclicity is absent, though storm beds may be grouped, in contrast with the genetic sequences present in the rift and halokinetic scenario of the North Sea. In contrast with the siliciclastic setting hardgrotinds (with Gastrochaenolites), more common firmground omission surfaces, and micritic mudstones with Chondrites and Zoophycos are notable features of the carbonate facies. In siliciclastic successions (parasequences) the latter ichnotaxa are generally regarded as having been deposited in rather deeper water, but in the carbonate Jubaila Formation are interpreted as being associated with local areas of lower turbulence. Likewise, the hardgrounds and firmgrounds, which have not been traced laterally, are tentatively regarded to be of local significance.

Field meeting: Romney Marsh - its churches and geology, 22 May 2004

The building fabrics of seven churches situated either on Romney Marsh or the marshland fringe were examined briefly. These revealed important differences in the relative abundance of the two principal building stones. Ragstones from the Hythe Formation occurred more frequently in the northeast, while sandstones from the Ashdown 'Beds' were more common in the west. In the Romney Marsh area, both stones were quarried mainly from their adjoining coastlines, with, up to the thirteenth century, opportunist collection of beach boulders generally preceding the exploitation or hewn stone. Other building stones, possible distribution routes and impacts of the quarrying upon coastline development were also discussed.

Geomorphological Map of Ribbed Moraines on the Dubawnt Lake Palaeo-Ice Stream Bed: A Signature of Ice Stream Shut-down?

The beds of active ice streams in Greenland and Antarctica are largely inaccessible, hindering a full understanding of the processes that initiate, sustain and inhibit fast ice flow in ice sheets. Detailed mapping of the glacial geomorphology of palaeo-ice stream tracks is, therefore, a valuable tool for exploring the basal processes that control their behaviour. In this paper we present a map that shows detailed glacial geomorphology from a part of the Dubawnt Lake Palaeo-Ice Stream bed on the north-western Canadian Shield (Northwest Territories), which operated at the end of the last glacial cycle. The map (centred on 63 degrees 55 '' 42'N, 102 degrees 29 '' 11'W, approximate scale 1:90,000) was compiled from digital Landsat Enhanced Thematic Mapper Plus satellite imagery and digital and hard-copy stereo-aerial photographs. The ice stream bed is dominated by parallel mega-scale glacial lineations (MGSL), whose lengths exceed several kilometres but the map also reveals that they have, in places, been superimposed with transverse ridges known as ribbed moraines. The ribbed moraines lie on top of the MSGL and appear to have segmented the individual lineaments. This indicates that formation of the ribbed moraines post-date the formation of the MSGL. The presence of ribbed moraine in the onset zone of another palaeo-ice stream has been linked to oscillations between cold and warm-based ice and/or a patchwork of cold-based areas which led to acceleration and deceleration of ice velocity. Our hypothesis is that the ribbed moraines on the Dubawnt Lake Ice Stream bed are a manifestation of the process that led to ice stream shut-down and may be associated with the process of basal freeze-on. The precise formation of ribbed moraines, however, remains open to debate and field observation of their structure will provide valuable data for formal testing of models of their formation.

Analysis and application of ichnofabrics

Bioturbation at all scales, which tends to replace the primary fabric of a sediment by the ichnofabric (the overall fabric of a sediment that has been bioturbated), is now recognised as playing a major role in facies interpretation. The manner in which the substrate may be colonized, and the physical, chemical and ecological controls (grainsize, sedimentation rate, oxygenation, nutrition, salinity, ethology, community structure and succession), together with the several ways in which the substrate is tiered by bioturbators, are the factors and processes that determine the nature of the ichnofabric. Eleven main styles of substrate tiering are described, ranging from single, pioneer colonization to complex tiering under equilibria, their modification under environmental deterioration and amelioration, and diagenetic enhancement or obscuration. Ichnofabrics may be assessed by four attributes: primary sedimentary factors, Bioturbation Index (BI), burrow size and frequency, and ichnological diversity. Construction of tier and ichnofabric constituent diagrams aid visualization and comparison. The breaks or changes in colonization and style of tiering at key stratal surfaces accentuate the surfaces, and many reflect a major environmental shift of the trace-forming biota. due to change in hydrodynamic regime (leading to non-deposition and/or erosion and/or lithification), change in salinity regime, or subaerial exposure. The succession of gradational or abrupt changes in ichnofabric through genetically related successions, together with changes in colonization and tiering across event beds, may also be interpreted in terms of changes in environmental parameters. It is not the ichnotaxa per se that are important in discriminating between ichnofabrics, but rather the environmental conditions that determine the overall style of colonization. Fabrics composed of different ichnotaxa (and different taphonomies) but similar tier structure and ichnoguild may form in similar environments of different age or different latitude. Appreciation of colonization and tiering styles places ancient ichnofabrics on a sound processrelated basis for environmental interpretation. (C) 2002 Elsevier Science B.V. All rights reserved.

Ancient lakes of the Sahara

As a result of climate change over the past 5000 years the Sahara changed from savannah to a desert landscape. The beds of ancient lakes are home to snail shells and the petrified roots of trees and shrubs. Examples of human occupation can also be seen in the form of fireplaces and discarded tools. Examination of the geological history of these sites can give a clearer picture of how the climate changed and how humans coped with these changes.

The Wheal Jane wetlands model for bioremediation of acid mine drainage

Acid mine drainage (AMD) is a widespread environmental problem associated with both working and abandoned mining operations. As part of an overall strategy to determine a long-term treatment option for AMD, a pilot passive treatment plant was constructed in 1994 at Wheal Jane Mine in Cornwall, UK. The plant consists of three separate systems, each containing aerobic reed beds, anaerobic cell and rock filters, and represents the largest European experimental facility of its kind. The systems only differ by the type of pretreatment utilised to increase the pH of the influent minewater (pH <4): lime dosed (LD), anoxic limestone drain (ALD) and lime free (LF), which receives no form of pretreatment. Historical data (1994-1997) indicate median Fe reduction between 55% and 92%, sulphate removal in the range of 3-38% and removal of target metals (cadmium, copper and zinc) below detection limits, depending on pretreatment and flow rates through the system. A new model to simulate the processes and dynamics of the wetlands systems is described, as well as the application of the model to experimental data collected at the pilot plant. The model is process based, and utilises reaction kinetic approaches based on experimental microbial techniques rather than an equilibrium approach to metal precipitation. The model is dynamic and utilises numerical integration routines to solve a set of differential equations that describe the behaviour of 20 variables over the 17 pilot plant cells on a daily basis. The model outputs at each cell boundary are evaluated and compared with the measured data, and the model is demonstrated to provide a good representation of the complex behaviour of the wetland system for a wide range of variables. (C) 2004 Elsevier B.V/ All rights reserved.