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.

EcoClean S.A.S

Empresa dedicada a la producción y distribución de elementos de limpieza tales como escobas, traperos y cepillos, caracterizados principalmente por ser 100% ecológicos, fabricados con los estándares de calidad más altos y diseño innovador.

Ecologia demogràfica de la perca americana (Micropterus salmoides) a l'Estany de Banyoles

L'Estany de Banyoles, sistema peculiar tant des del punt de vista de la seva formació geològica com de les seves característiques limnològiques, conté actualment una comunitat de peixos profundament modificada respecte de la comunitat original. La perca americana (Micropterus salmoides), introduïda a finals dels anys seixanta del segle XX, és avui una de les espècies dominants en aquesta comunitat, i ocupa sobretot l'hàbitat litoral de l'Estany. Es tracta d'una espècie molt ben estudiada a Nord Amèrica des de diverses disciplines de la biologia i des de fa diverses dècades, cosa que ha comportat que actualment es disposi d'un gran volum d'informació sobre ella. Amb tot, fora del seu continent d'origen ha rebut poca atenció, malgrat l'amplia expansió que ha experimentat arreu del món. En aquesta tesi doctoral s'han abordat, amb un enfocament descriptiu, aspectes fins ara desconeguts per a l'espècie a l'Estany de Banyoles, a la península ibèrica i fins i tot a Europa. Concretament, se n'ha analitzat la condició, el creixement i la demografia, així com les seves variacions temporals. Amb aquesta finalitat, s'ha dissenyat un mostreig composat de deu campanyes de pesca intensives més alguns petits mostrejos addicionals intercalats, mostreig que s'ha allargat des del juliol del 1997 i fins el novembre del 1999. La captura dels exemplars s'ha realitzat mitjançant una tècnica de pesca elèctrica amb una embarcació posada a punt expressament per a aquest estudi, la qual s'ha mostrat considerablement eficient malgrat les dificultats que ofereix el medi. S'ha realitzat un mostreig de marcatge-recaptura basat en la mutilació d'aletes i, en alguns casos, en el marcatge amb pintura acrílica. Només en la darrera campanya (novembre del 1999) s'ha sacrificat una part important de les captures a fi de retirar-ne els otòlits per a la determinació de l'edat. Pel que fa a l'anàlisi de les dades, s'ha aplicat un ampli ventall de mètodes i models per a cada un dels aspectes estudiats, a fi de contrastar-ne els resultats i validar-ne la seva fiabilitat. En el cas de la condició, s'han aplicat mètodes d'anàlisi de la covariància (ANCOVA) i altres mètodes anàlegs, així com, paral·lelament, regressions i anàlisis derivades a partir de la relació longitud-pes. En l'estudi del creixement, s'han realitzat ajustaments de diversos models mitjançant regressions sobre dades de mida a l'edat i sobre dades d'increments de mida observats per interval de temps. També s'han aplicat anàlisis de freqüències de longitud, i, finalment, s'han aplicat mètodes de retrocàlcul a partir dels increments anuals del radi observats en els otòlits. Finalment, en el cas de l'estudi de la demografia, s'han aplicat models de marcatge-recaptura per a l'estimació de la grandària poblacional i de la supervivència, i, a més, s'han ajustat diversos models continus de supervivència sobre aquestes estimacions prèvies. També s'han estimat les capturabilitats associades a la nova tècnica de captura. Per una altra banda, s'ha implementat i realitzat un mostreig sobre la població de pescadors esportius de l'Estany encarat a determinar, bàsicament, la pressió de pesca a què es veu sotmesa l'espècie. Els resultats mostren sobretot una alta estabilitat interanual en tots els aspectes estudiats, que s'explica per l'estabilitat ambiental que, al seu torn, és característica d'aquest ecosistema lacustre. Això reverteix en una longevitat màxima observada que iguala la màxima descrita a la literatura per a l'espècie. Alhora, també s'han descrit fortes oscil·lacions estacionals tant en la condició, com en el creixement, com també en la supervivència, les quals, però, presenten certes diferències en la seva temporalitat, cosa que indica una certa diferenciació en els factors que les regulen.

A Reabilitação face à Sustentabilidade : Casa Burguesa do Porto

Os centros históricos são o resultado de um parque habitacional corrente, com uma grande uniformidade, coerência construtiva e espaços urbanos de modo a proporcionar uma identidade própria. Um dos grandes problemas urbanos são as vastas áreas degradadas do ponto de vista arquitetónico como também social, cultural e económico. Conhecidos os principais problemas dos edifícios de habitação e suas causas, para sua resolução existe necessidade de adaptar o processo de reabilitação tradicional ao conceito de sustentabilidade. Estes dois assuntos conjugados são atualmente emergentes, devido à necessidade de reabilitação do parque habitacional, nomeadamente centros históricos. A casa burguesa do Porto apresenta um elevado grau de degradação, porém apesar de existentes as ações de intervenção que sobre ela reincidem, não são proporcionais à necessidade atual. A cidade do Porto é marcada, maioritariamente, pelas Casas Burguesas, das quais foram executadas segundo padrões de conforto e de utilização da época. É, então, fundamental um estudo pormenorizado da casa burguesa do Porto, avaliando o contexto em que esta se encere (na cidade e na respetiva habitação), os subsistemas construtivos e as praticas de reabilitação.

Baldomera: el instinto y la irrupción del cuerpo (Del Fabulador)

La autora parte de la concepción de Alfredo Pareja sobre el acto de escribir (sostiene que a través de sus personajes logró dar vida a sus ideas y proyectos políticos), y afirma que un ejemplo cabal de ella es la construcción de la mulata Baldomera. Reflexiona entonces sobre el autor, a partir de su biografía y de la creación de sus personajes. Baldomera sería una metáfora de la mujer de la época, ubicada entre la sujeción y la búsqueda de una autonomía, en este proceso ella se rebela, no contra los hombres, sino fundamentalmente contra su cuerpo, contra sí misma, evidenciando la doble moral de la mentalidad patriarcal, que persigue la sumisión de la mujer por medio de la violencia. Entonces, "¿qué representa Baldomera? Es un cuerpo roto, escindido, marcado y sufriente. Una muestra de la obscenidad de la miseria".

Decadal-scale rainfall variability in Ethiopia recorded in an annually laminated, Holocene-age, stalagmite

An annually laminated, uranium-series dated, Holocene stalagmite from southeast Ethiopia has been analysed for growth rate and δ13C and δ18O variations at annual to biennial resolution, in order to provide the first long duration proxy record of decadal-scale rainfall variability in this climatically sensitive region. Our study site (10°N) is climatically influenced by both summer (June—August) and spring (March—May) rainfall caused by the annual movement of the Inter-Tropical Convergence Zone (ITCZ) and modulated by large-scale anomalies in the atmospheric circulation and in ocean temperatures. Here we show that stalagmite growth, episodic throughout the last 7800 years, demonstrates decadal-scale (8—25 yr) variability in both growth rate and δ 18O. A hydrological model was employed and indicates that this decadal variability is due to variations in the relative amounts of rainfall in the two rain seasons. Our record, unique in its combination of length (a total of ~1000 years), annual chronology and high resolution δ18O, shows for the first time that such decadal-scale variability in rainfall in this region has occurred through the Holocene, which implies persistent decadal-scale variability for the large-scale atmospheric and oceanic driving factors.

The locally twisted cubes

This paper introduces a new variant of the popular n-dimensional hypercube network Q(n), known as the n-dimensional locally twisted cube LTQ(n), which has the same number of nodes and the same number of connections per node as Q(n). Furthermore. LTQ(n) is similar to Q(n) in the sense that the nodes can be one-to-one labeled with 0-1 binary sequences of length n. so that the labels of any two adjacent nodes differ in at most two successive bits. One advantage of LTQ(n) is that the diameter is only about half of the diameter of Q(n) We develop a simple routing algorithm for LTQ(n), which creates a shortest path from the source to the destination in O(n) time. We find that LTQ(n) consists of two disjoint copies of Q(n) by adding a matching between their nodes. On this basis. we show that LTQ(n) has a connectivity of n.

Locally twisted cubes are 4-pancyclic

The locally twisted cube is a newly introduced interconnection network for parallel computing. Ring embedding is an important issue for evaluating the performance of an interconnection network. In this paper, we investigate the problem of embedding rings into a locally twisted cube. Our main contribution is to find that, for each integer l is an element of (4,5,...,2(n)}, a ring of length I can be embedded into an n-dimensional locally twisted cube so that both the dilation and the load factor are one. As a result, a locally twisted cube is Hamiltonian. We conclude that a locally twisted cube is superior to a hypercube in terms of ring embedding capability. (C) 2004 Elsevier Ltd. All rights reserved.

Non-word repetition in adolescents with Specific Language Impairment and Autism plus Language Impairments: a qualitative analysis

Non-word repetition (NWR) was investigated in adolescents with typical development, Specific Language Impairment (SLI) and Autism Plus language Impairment (ALI) (n = 17, 13, 16, and mean age 14;4, 15;4, 14;8 respectively). The study evaluated the hypothesis that poor NWR performance in both groups indicates an overlapping language phenotype (Kjelgaard & Tager-Flusberg, 2001). Performance was investigated both quantitatively, e.g. overall error rates, and qualitatively, e.g. effect of length on repetition, proportion of errors affecting phonological structure, and proportion of consonant substitutions involving manner changes. Findings were consistent with previous research (Whitehouse, Barry, & Bishop, 2008) demonstrating a greater effect of length in the SLI group than the ALI group, which may be due to greater short-term memory limitations. In addition, an automated count of phoneme errors identified poorer performance in the SLI group than the ALI group. These findings indicate differences in the language profiles of individuals with SLI and ALI, but do not rule out a partial overlap. Errors affecting phonological structure were relatively frequent, accounting for around 40% of phonemic errors, but less frequent than straight Consonant-for-Consonant or vowel-for-vowel substitutions. It is proposed that these two different types of errors may reflect separate contributory mechanisms. Around 50% of consonant substitutions in the clinical groups involved manner changes, suggesting poor auditory-perceptual encoding. From a clinical perspective algorithms which automatically count phoneme errors may enhance sensitivity of NWR as a diagnostic marker of language impairment. Learning outcomes: Readers will be able to (1) describe and evaluate the hypothesis that there is a phenotypic overlap between SLI and Autism Spectrum Disorders (2) describe differences in the NWR performance of adolescents with SLI and ALI, and discuss whether these differences support or refute the phenotypic overlap hypothesis, and (3) understand how computational algorithms such as the Levenshtein Distance may be used to analyse NWR data.

Ventilation for air quality and energy efficiency

This article addresses the need for providing good standards of indoor air quality (IAQ) in buildings from the view point of health, well-being and productivity of building occupants. It briefly outlines the role of ventilation in achieving the required IAQ targets and discusses the performance of different types of ventilation systems in use. As a result of new energy efficiency directives and legislations in Europe and elsewhere, the ventilation energy component of HVAC systems has increased in relative terms and this article introduces a method for evaluating the performance air distribution systems that is based on ventilation and energy effectiveness. A range of ventilation systems are discussed, including mechanical and natural ventilation, and results for more recently developed mechanical air distribution systems are compared with conventional systems. The article provides an assessment and comparison of some of these systems with reference to ventilation performance and energy efficiency

Strengthening artisanal mining research and policy through baseline census activities

Over the past 10-15 years, several governments have implemented an array of technology, support-related, sustainable livelihoods (SL) and poverty-reduction projects for artisanal and small-scale mining (ASM). In the majority of cases, however, these interventions have failed to facilitate improvements in the industry's productivity and raise the living standards of the sector's subsistence operators. This article argues that a poor understanding of the demographics of target populations has precipitated these outcomes. In order to strengthen policy and assistance in the sector, governments must determine, with greater precision, the number of people operating in ASM regions, their origins and ethnic backgrounds, ages, and educational levels. This can be achieved by carrying out basic and localized census work before promoting ambitious sector-specific projects aimed at improving working conditions in the industry.

Cinnamate ester containing liquid crystalline side chain polymers

The synthesis of methacrylate esters of 4-cyanophenyl-(4-(ω-hydroxyalkyloxy)) cinnamates, with spacer lengths of 2 and 6 methylene units and the synthesis of the corresponding acrylate ester with a spacer of 2 methylene units are described. The methacrylate monomers were polymerized by free radical polymerization, both as homopolymers and as copolymers with the analogous benzoate monomer of spacer length 6. The acrylate ester could not be polymerized successfully under the same reaction conditions. Polymers were characterized by NMR spectroscopy, gel permeation chromatography, differential scanning calorimetry, and thermo-optic observations. Of the monomers prepared, only the cinnamate with a hexamethylene spacer shows a mesophase, seen on supercooling of the melt. All of the polymers prepared were liquid crystalline, with smectic behavior predominating in the polymethacrylates with the longer spacer group. A narrow nematic region is seen just below the clearing temperature with a range of 3–9°C, nematic character is increased in the copolymer series with the degree of incorporation of the cinnamate monomer with the spacer group of length 2.

'Doctor, Doctor...' entrepreneurial diagnosis and market making

Doctor-patient jokes are universally popular because of the information asymmetries within the diagnostic relationship. We contend that entrepreneurial diagnosis is present in markets where consumers are unable to diagnose their own problems and, instead, may rely on the entrepreneur to diagnose them. Entrepreneurial diagnosis is a cognitive skill possessed by the entrepreneur. It is an identifiable subset of entrepreneurial judgment and can be modeled – which we attempt to do. In order to overcome the information asymmetries and exploit opportunities, we suggest that entrepreneurs must invest in market making innovations (as distinct from product innovations) such as trustworthy reputations. The diagnostic entrepreneur described in this paper represents a creative response to difficult diagnostic problems and helps to explain the success of many firms whose products are not particularly innovative but which are perceived as offering high standards of service. These firms are trusted not only for their truthfulness about the quality of their product, but for their honesty, confidentiality and understanding in helping customers identify the most appropriate product to their needs.

Globalisation and MA TESOL programs in the UK

This article reports the results of a mixed-methods approach to investigating the association between globalisation and MATESOL in UK universities. Qualitative and quantitative data collected from academic staff through eight emails, four interviews and 41 questionnaires indicate that the globalised context of higher education have affected these programmes in a number of ways including an increasing interest in recruiting more international students and a growing awareness about the need for curriculum and content modifications. The analysis of the data suggests that although change has been an inherent characteristic of these MAs over the past decade, it has been implemented gradually and conservatively, often relying on a dialectic relationship between academic staff and universities’ policies. The results imply that factors other than globalisation have also been at work. Many of the participants contend that globalisation has not lowered the quality of these MAs or standards of good practice.