Experience in the Surgical Management of Abdominal Compartment Syndrome in the Hospital Occidente de Kennedy

The abdominal compartment syndrome (ACS) is the result of various physiological alterations produced by an abnormal increase of the intra-abdominal pressure. Some of these patients will undergo a surgical procedure for its management. Methods: This is a retrospective case series of 28 patients with ACS who required surgical treatment at the Hospital Occidente de Kennedy between 1999 and 2003. We assessed retrospectively the behavior of McNelis’s equation for prediction of the development of the ACS. Results: The leading cause of ACS in our study was intraabadominal infection (n=6 21,4%). Time elapsed between diagnosis and surgical decompression was less than 4 hours in 75% (n=21) of the cases. The variables that improved significantly after the surgical decompression were CVP (T: 4,0 p: 0,0001), PIM (T: 2,7; p: 0,004), PIA (T1,8; p:0,034) and Urine Output (T:-2,4; p:0,02). The values of BUN, Creatinine and the cardiovascular instability did not show improvement. The ICU and hospital length of stay were 11 days (SD: 9) and 18 days (SD13) respectively. Global mortality was 67,9% (n=19) and mortality directly attributable to the syndrome was 30% (n=8). The behavior of the McNelis’s equation was erratic. Conclusions: The demographic characteristics as well as disease processes associated with ACS are consistent with the literature. The association between physiological variables and ACS is heterogeneous between patients. Mortality rates attributable to ACS in our institution are within the range described world-wide. The behavior of the McNelis’s equation seems to depend greatly upon fluid balance.

Prospects for the Development of Administration and Challenges for the Management of Organizations

Administration, as incipient science, presents a series of challenges to the organization’sdirector and for academy itself. The adaptation, the strategy, the communication skills andeven the ability to radiate in the organization in the organization a sense of accomplishment,are approaches that will shape the development of the organization and management as aset of knowledge that should facilitate the sustainability of the organization as a complexsystem.

Resources for an Intersectorial Management of Public Policies: Mobility and Access

The objective of this paper is to integrate mobility as across component of the management of specific public actions. The case of study concerns the public health services in Argentina, and mother’s mobility conditions in the suburban of the Buenos Aires Metropolitan Area. In terms of methodology, the paper working on the concept of access trying to identify, measure and evaluate the relationship between mobility conditions and maternal health care. Access is weighted according to the realization of health services, and not according to the arrival at the places where they are offers. The result is innovative empirical evidence, useful as an indicator to make more relevant the role of mobility within the public agenda of transport and others specific sectors, asa basic social right behind the access that requires coordinated actions and cross-sectoral approaches.

Optimal management of natural resources. Accounting for heterogeneity

Dynamic optimization methods have become increasingly important over the last years in economics. Within the dynamic optimization techniques employed, optimal control has emerged as the most powerful tool for the theoretical economic analysis. However, there is the need to advance further and take account that many dynamic economic processes are, in addition, dependent on some other parameter different than time. One can think of relaxing the assumption of a representative (homogeneous) agent in macro- and micro-economic applications allowing for heterogeneity among the agents. For instance, the optimal adaptation and diffusion of a new technology over time, may depend on the age of the person that adopted the new technology. Therefore, the economic models must take account of heterogeneity conditions within the dynamic framework. This thesis intends to accomplish two goals. The first goal is to analyze and revise existing environmental policies that focus on defining the optimal management of natural resources over time, by taking account of the heterogeneity of environmental conditions. Thus, the thesis makes a policy orientated contribution in the field of environmental policy by defining the necessary changes to transform an environmental policy based on the assumption of homogeneity into an environmental policy which takes account of heterogeneity. As a result the newly defined environmental policy will be more efficient and likely also politically more acceptable since it is tailored more specifically to the heterogeneous environmental conditions. Additionally to its policy orientated contribution, this thesis aims making a methodological contribution by applying a new optimization technique for solving problems where the control variables depend on two or more arguments --- the so-called two-stage solution approach ---, and by applying a numerical method --- the Escalator Boxcar Train Method --- for solving distributed optimal control problems, i.e., problems where the state variables, in addition to the control variables, depend on two or more arguments. Chapter 2 presents a theoretical framework to determine optimal resource allocation over time for the production of a good by heterogeneous producers, who generate a stock externalit and derives government policies to modify the behavior of competitive producers in order to achieve optimality. Chapter 3 illustrates the method in a more specific context, and integrates the aspects of quality and time, presenting a theoretical model that allows to determine the socially optimal outcome over time and space for the problem of waterlogging in irrigated agricultural production. Chapter 4 of this thesis concentrates on forestry resources and analyses the optimal selective-logging regime of a size-distributed forest.

Integrated management of urban wastewater systems: a model-based approach

The main objective pursued in this thesis targets the development and systematization of a methodology that allows addressing management problems in the dynamic operation of Urban Wastewater Systems. The proposed methodology will suggest operational strategies that can improve the overall performance of the system under certain problematic situations through a model-based approach. The proposed methodology has three main steps: The first step includes the characterization and modeling of the case-study, the definition of scenarios, the evaluation criteria and the operational settings that can be manipulated to improve the system’s performance. In the second step, Monte Carlo simulations are launched to evaluate how the system performs for a wide range of operational settings combinations, and a global sensitivity analysis is conducted to rank the most influential operational settings. Finally, the third step consists on a screening methodology applying a multi-criteria analysis to select the best combinations of operational settings.

A deterministic model for lake clarity; application to management of Lake Tahoe (California-Nevada), USA

This dissertation has as its goal the quantitative evaluation of the application of coupled hydrodynamic, ecological and clarity models, to address the deterministic prediction of water clarity in lakes and reservoirs. Prediction of water clarity is somewhat unique, insofar as it represents the integrated and coupled effects of a broad range of individual water quality components. These include the biological components such as phytoplankton, together with the associated cycles of nutrients that are needed to sustain their popuiations, and abiotic components such as suspended particles that may be introduced by streams, atmospheric deposition or sediment resuspension. Changes in clarity induced by either component will feed back on the phytoplankton dynamics, as incident light also affects biological growth. Thus ability to successfully model changes in clarity will by necessity have to achieve the correct modeling of these other water quality parameters. Water clarity is also unique in that it may be one of the earliest and most easily detected wamings of the acceleration of the process of eutrophication in a water body.

Management of industrial wastewater discharges in river basins through agents'argumentation

La gestió de l'aigua residual és una tasca complexa. Hi ha moltes substàncies contaminants conegudes però encara moltes per conèixer, i el seu efecte individual o col·lgectiu és difícil de predir. La identificació i avaluació dels impactes ambientals resultants de la interacció entre els sistemes naturals i socials és un assumpte multicriteri. Els gestors ambientals necessiten eines de suport pels seus diagnòstics per tal de solucionar problemes ambientals. Les contribucions d'aquest treball de recerca són dobles: primer, proposar l'ús d'un enfoc basat en la modelització amb agents per tal de conceptualitzar i integrar tots els elements que estan directament o indirectament involucrats en la gestió de l'aigua residual. Segon, proposar un marc basat en l'argumentació amb l'objectiu de permetre als agents raonar efectivament. La tesi conté alguns exemples reals per tal de mostrar com un marc basat amb agents que argumenten pot suportar diferents interessos i diferents perspectives. Conseqüentment, pot ajudar a construir un diàleg més informat i efectiu i per tant descriure millor les interaccions entre els agents. En aquest document es descriu primer el context estudiat, escalant el problema global de la gestió de la conca fluvial a la gestiódel sistema urbà d'aigües residuals, concretament l'escenari dels abocaments industrials. A continuació, s'analitza el sistema mitjançant la descripció d'agents que interaccionen. Finalment, es descriuen alguns prototips capaços de raonar i deliberar, basats en la lògica no monòtona i en un llenguatge declaratiu (answer set programming). És important remarcar que aquesta tesi enllaça dues disciplines: l'enginyeria ambiental (concretament l'àrea de la gestió de les aigües residuals) i les ciències de la computació (concretament l'àrea de la intel·ligència artificial), contribuint així a la multidisciplinarietat requerida per fer front al problema estudiat. L'enginyeria ambiental ens proporciona el coneixement del domini mentre que les ciències de la computació ens permeten estructurar i especificar aquest coneixement.

Improvement of strategies for the management of fire blight (Erwinia amylovora). Evaluation and optimization of physical and chemical control methods, and use of decision support systems

El foc bacterià és una malaltia que afecta a plantes de la família de la rosàcies, causada pel bacteri Erwinia amylovora. El seu rang d'hostes inclou arbres fruiters, com la perera, la pomera o el codonyer, i plantes ornamentals de gran interès comercial i econòmic. Actualment, la malaltia s'ha dispersat i es troba àmpliament distribuïda en totes les zones de clima temperat del món. A Espanya, on la malaltia no és endèmica, el foc bacterià es va detectar per primer cop al 1995 al nord del país (Euskadi) i posteriorment, han aparegut varis focus en altres localitzacions, que han estat convenientment eradicats. El control del foc bacterià, és molt poc efectiu en plantes afectades per la malaltia, de manera que es basa en mesures encaminades a evitar la dispersió del patogen, i la introducció de la malaltia en regions no endèmiques. En aquest treball, la termoteràpia ha estat avaluada com a mètode d'eradicació d'E. amylovora de material vegetal de propagació asimptomàtic. S'ha demostrat que la termoteràpia és un mètode viable d'eradicar E. amylovora de material de propagació. Gairebé totes les espècies i varietats de rosàcies mantingudes en condicions d'humitat sobrevivien 7 hores a 45 ºC i més de 3 hores a 50 ºC, mentre que més d'1 hora d'exposició a 50 ºC amb calor seca produïa danys en el material vegetal i reduïa la brotació. Tractaments de 60 min a 45 ºC o 30 min a 50 ºC van ser suficients per reduir la població epífita d'E. amylovora a nivells no detectables (5 x 102 ufc g-1 p.f.) en branques de perera. Els derivats dels fosfonats i el benzotiadiazol són efectius en el control del foc bacterià en perera i pomera, tant en condicions de laboratori, com d'hivernacle i camp. Els inductors de defensa de les plantes redueixen els nivells de malaltia fins al 40-60%. Els intervals de temps mínims per aconseguir el millor control de la malaltia van ser 5 dies pel fosetil-Al, i 7 dies per l'etefon i el benzotiadiazol, i les dosis òptimes pel fosetil-Al i el benzotiadiazol van ser 3.72 g HPO32- L-1 i 150 mg i.a. L-1, respectivament. Es millora l'eficàcia del fosetil-Al i del benzotiadiazol en el control del foc bacterià, quan es combinen amb els antibiòtics a la meitat de la dosi d'aquests últims. Tot i que l'estratègia de barrejar productes és més pràctica i fàcil de dur a terme a camp, que l'estratègia de combinar productes, el millor nivell de control de la malaltia s'aconsegueix amb l'estratègia de combinar productes. Es va analitzar a nivell histològic i ultrastructural l'efecte del benzotiadiazol i dels fosfonats en la interacció Erwinia amylovora-perera. Ni el benzotiadiazol, ni el fosetil-Al, ni l'etefon van induir canvis estructurals en els teixits de perera 7 dies després de la seva aplicació. No obstant, després de la inoculació d'E. amylovora es va observar en plantes tractades amb fosetil-Al i etefon una desorganització estructural cel·lular, mentre que en les plantes tractades amb benzotiadiazol aquestes alteracions tissulars van ser retardades. S'han avaluat dos models (Maryblyt, Cougarblight) en un camp a Espanya afectat per la malaltia, per determinar la precisió de les prediccions. Es van utilitzar dos models per elaborar el mapa de risc, el BRS-Powell combinat i el BIS95 modificat. Els resultats van mostrar dos zones amb elevat i baix risc de la malaltia. Maryblyt i Cougarblight són dos models de fàcil ús, tot i que la seva implementació en programes de maneig de la malaltia requereix que siguin avaluats i validats per un període de temps més llarg i en àrees on la malaltia hi estigui present.

Diagnosis and management of auditory neuropathy/dys-sychrony

This paper discusses auditory neuropathy (AN) and auditory dys-sychrony (AD), and means of testing and diagnosis.