Accesos vasculares para hemodiálisis, cuál es el más costo efectivo?

Marco conceptual: La enfermedad renal crónica es un serio problema de salud pública en nuestro país por la gran cantidad de recursos económicos que requiere su atención. La hemodiálisis es el tratamiento más usado en nuestro medio; el acceso vascular y sus complicaciones derivadas son el principal aspecto que incrementa los costos de atención en éstos pacientes. Materiales y métodos: Se realizó un estudio económico de los accesos vasculares en pacientes incidentes de hemodiálisis en el año 2012 en la agencia RTS-Fundación Cardio Infantil. Se estableció el costo de creación y mantenimiento del acceso con catéter central, fístula arteriovenosa nativa, fístula arteriovenosa con injerto; y el costo de atención de las complicaciones para cada acceso. Se determinó la probabilidad de ocurrencia de complicaciones. Mediante un árbol de decisiones se trazó el comportamiento de cada acceso en un período de 5 años. Se establecieron los años de vida ajustados por calidad (QALY) en cada acceso y el costo para cada uno de éstos QALY. Resultados: de 36 pacientes incidentes de hemodiálisis en 2012 el 100% inició con catéter central, 16 pacientes cambiaron a fístula arteriovenosa nativa, 1 a fístula arteriovenosa con injerto que posteriormente pasó a CAPD, 15 continuaron su acceso con catéter y 4 pacientes fallecieron. En 5 años se obtuvieron 2,36 QALY para los pacientes con catéter central que costarían $ 24.813.036,39/QALY y 2,535 QALY para los pacientes con fístula nativa que costarían $ 6.634.870,64/QALY. Conclusiones: el presente estudio muestra que el acceso vascular mediante fístula arteriovenosa nativa es el más costo-efectivo que mediante catéter

Cambios en calidad de vida en Colombia durante 1997-2003: otra aproximación

Este trabajo analiza, estática y dinámicamente, los cambios en las condiciones de vida de los hogares en Colombia entre los años 1997 y 2003. Se propone un indicador alternativo y se contrasta a nivel nacional, regional y de centro poblacional con el Índice de Calidad de Vida (ICV) convencional. El indicador alterno reconoce la importancia que tienen aspectos de salud y el tiempo gastado en desplazamiento. Estas variables adicionales reducen el impacto de los aspectos concernientes al capital físico y distancian aún más las condiciones de las zonas rurales frente a las urbanas. La importancia de profundizar en las políticas de salud en las zonas rurales y en políticas que permitan disminuir el tiempo gastado en desplazamiento para ambas zonas se torna evidente.

Mirades turístiques a la ciutat. Anàlisi del comportament dels visitants del Barri Vell de Girona

Mirades Turístiques a la ciutat és un estudi sobre el comportament del turisme en les ciutats monumentals, a partir de l'experiència viscuda pels visitants del Barri Vell de Girona. Una recerca que ha pretès determinar, precisament, la forma com els visitants entren en contacte amb el patrimoni monumental de la ciutat medieval. A partir, d'identificar quins factors influeixen (i quins no) en el comportament dels turistes durant la seva visita, tant pel que fa referència als factors ambientals generals (la meteorologia, la congestió, la informació...) com els factors singulars de cada visitant. Per tal d'assolir aquests objectius, en hem plantejat una sèrie d'hipòtesis de treball: 1. Existeix una manera turística d'apropar-se al patrimoni que té les seves pròpies regles, les seves estructures específiques i en conseqüència la necessitat d'uns instruments de gestió particulars. 2. L'aproximació del turista al patrimoni monumental és el resultat de dues forces aparentment contradictòries. D'una banda, el turista tendeix a reproduir pautes de comportament socialment construïdes que prenen la forma d'un ritual. D'altra banda, més enllà d'aquest patró comú, cada visitant viu una experiència singular. Per tant, la relació amb el patrimoni és el resultat d'un subtil equilibri entre experiència i ritual. 3. El consum turístic del patrimoni depèn de la relació entre quatre factors. El primer, la imatge del lloc, és la projecció (sovint idealitzada) de l'espai de visita, una metàfora de la ciutat. El segon, el codi d'interpretació turístic , actua com una mena de ritual, un guió no escrit de la pràctica turística. En tercer lloc, el substrat material que són els components artístics, històrics o culturals de la destinació: la geometria del casc, les visuals, el pes de la història o el valor estètic de les peces condicionen, com és obvi, la mirada turística. Finalment, l'experiència està condicionada per la gestió (pública i privada) del turisme: informació, fluxos, interpretació... L'estudi s'ha sustentat en una metodologia inèdita basada en l'observació directa a partir del seguiment dels visitants durant els seus recorreguts. Hem observat el visitants i hem recollit la informació bàsica de la seva visita: l'itinerari, els monuments visitats, les actituds manifestades, els temps d'estada... Aquesta metodologia ha estat ja implementada en alguns estudis de públic de diversos museus. S'han recollit tres tipus de dades: dades relacionades amb els arcs (segment de carrer entre dues interseccions), dades relacionades amb els nodes (els elements d'interès) i dades relacionades amb el visitant. Les tres fonts estan unides per un identificador comú, que és el codi del turista. Això ens ha permès vincular les dades dels visitants amb el seu recorregut i la seva visita als monuments de la ciutat. Els resultats de l'estudi ens han permès identificar els factors que singularitzen l'apropament dels visitants al patrimoni i que el diferencien d'altres formes de relació o ús. És a dir, els factors que incideixen en el comportament dels visitants de Girona. Així mateix, hem pogut definir models d'itineraris amb una estructura interna molt compacta però molt diferents entre ells; que ens evidencien que, malgrat les regularitats detectades en les visites dels turistes de la ciutat, també existeixen elements diferencials en el seu comportament. Hem detectat quatre models de recorreguts urbans que hem anomenat: itinerari bàsic, comercial, complex i de les muralles, que a l'hora es poden subdividir en varies categories. Finalment, els estadístics multivariants ens han permès demostrar que la relació entre el turista i el patrimoni respon almenys a quatre formes de consum diferenciades, que hem anomenat "no turistes", "rituals", "interessats" i "erudits".

Attention and selection behavior on ‘universal search’ result pages

The ISO norm line 9241 states some criteria for ergonomics of human system interaction. In markets with a huge variety of offers and little possibility of differentiation, providers can gain a decisive competitive advantage by user oriented interfaces. A precondition for this is that relevant information can be obtained for entrepreneurial decisions in this regard. To test how users of universal search result pages use those pages and pay attention to different elements, an eye tracking experiment with a mixed design has been developed. Twenty subjects were confronted with search engine result pages (SERPs) and were instructed to make a decision while conditions “national vs. international city” and “with vs. without miniaturized Google map” were used. Different parameters like fixation count, duration and time to first fixation were computed from the eye tracking raw data and supplemented by click rate data as well as data from questionnaires. Results of this pilot study revealed some remarkable facts like a vampire effect on miniaturized Google maps. Furthermore, Google maps did not shorten the process of decision making, Google ads were not fixated, visual attention on SERPs was influenced by position of the elements on the SERP and by the users’ familiarity with the search target. These results support the theory of Amount of Invested Mental Effort (AIME) and give providers empirical evidence to take users’ expectations into account. Furthermore, the results indicated that the task oriented goal mode of participants was a moderator for the attention spent on ads. Most important, SERPs with images attracted the viewers’ attention much longer than those without images. This unique selling proposition may lead to a distortion of competition on markets.

Desenvolvimento da força nas aulas de Educação Física : aplicação de exercícios específicos

Com os avanços da tecnologia as crianças e jovens passam demasiado tempo sem realizar atividade física (Rodrigues, 2000), exceto a que é proporcionada na escola. É nas aulas de Educação Física que se notam as dificuldades sentidas pelos alunos na realização de exercícios devido à sua fraca aptidão física, sendo a força uma das capacidades motoras com maior défice. O presente trabalho pretende analisar as possibilidades de melhorias da força através da realização de exercícios específicos nas aulas de Educação Física. Para tal, realizámos um estudo experimental com dois grupos: GE (grupo experimental), onde foi aplicado um programa de treino de desenvolvimento da força superior e média, durante seis semanas, em três sessões semanais e GC (grupo de controlo) onde não foi aplicado o programa de treino. A amostra foi constituída por trinta e quatro alunos, de ambos os géneros, pertencentes a três turmas do 9º ano de escolaridade, com idades compreendidas entre os catorze e os dezasseis anos, da Escola EB 2,3 António Gedeão em Odivelas. Após a análise estatística (Teste T-Pares) constatámos que existiram melhorias nos dois testes, nos dois géneros, em ambos os grupos, com as seguintes exceções: extensões de braços nas raparigas do GC (decréscimo não significativo); abdominais das raparigas do GC (valor manteve-se); extensões de braços das raparigas no GE (melhoria significativa). Concluímos que a aplicação de alguns exercícios específicos, devidamente integrados no normal funcionamento das aulas, provocou melhorias na força. O estudo sugere a possibilidade de alcançar melhores resultados ao nível da aptidão física mediante a inclusão de exercícios específicos no plano de aulas.

A time study

This paper presents a time study of a classroom with the goal of evaluating how time was spent. The time study allows evaluation of teaching methods and classroom interactions.

El funcionamiento del tributo en Nueva Granada a finales del siglo XVII: Guatavita en 1690 (Estudios)

Este ensayo examina los mecanismos de articulación política que se crearon entre el corregidor y los pueblos de indios que integraron el partido de Guatavita. Analiza la naturaleza y el monto del tributo que pagaron los indios y el manejo que el corregidor hizo de estos recursos. Estudia las cargas fiscales que se impusieron sobre la encomienda y los vínculos políticos que se desarrollaron entre encomenderos, corregidores y Estado colonial. La evidencia histórica que sirve de sustento a este trabajo proviene de la contabilidad que presentó el corregidor de Guatavita ante las autoridades coloniales a finales del siglo XVII.

The Influence of Body Condition on the Stopover Ecology of Least Sandpipers in the Lower Mississippi Alluvial Valley during Fall Migration

Many shorebirds are long-distance migrants and depend on the energy gained at stopover sites to complete migration. Competing hypotheses have described strategies used by migrating birds; the energy-selection hypothesis predicts that shorebirds attempt to maximize energy gained at stopover sites, whereas the time-selection hypothesis predicts that shorebirds attempt to minimize time spent at stopover sites. The energy- and time-selection hypotheses both predict that birds in better condition will depart sites sooner. However, numerous studies of stopover duration have found little support for this prediction, leading to the suggestion that migrating birds operate under energy and time constraints for only a small portion of the migratory season. During fall migration 2002, we tested the prediction that birds in better condition depart stopover sites sooner by examining the relationship between stopover duration and body condition for migrating Least Sandpipers (Calidris minutilla) at three stopover sites in the Lower Mississippi Alluvial Valley. We also tested the assumption made by the Lower Mississippi Alluvial Valley Migratory Bird Science Team that shorebirds stay in the Mississippi Valley for 10 d. The assumption of 10 d was used to estimate the amount of habitat required by shorebirds in the Mississippi Valley during fall migration; a period longer than 10 d would increase the estimate of the amount habitat required. We used multiple-day constancy models of apparent survival and program MARK to estimate stopover duration for 293 individually color-marked and resighted Least Sandpipers. We found that a four-day constancy interval and a site x quadratic time trend interaction term best modeled apparent survival. We found only weak support for body condition as a factor explaining length of stopover duration, which is consistent with findings from similar work. Stopover duration estimates were 4.1 d (95% CI = 2.8–6.1) for adult Least Sandpipers at Bald Knob National Wildlife Refuge, Arkansas, 6.5 d (95% CI = 4.9–8.7) for adult and 6.1 d (95% CI =4.2–9.1) for juvenile Least Sandpipers at Yazoo National Wildlife Refuge, Mississippi, and 6.9 d (95% CI = 5.5–8.7) for juvenile Least Sandpipers at Morgan Brake National Wildlife Refuge, Mississippi. Based on our estimates of stopover duration and the assumption made by the Lower Mississippi Alluvial Valley Migratory Bird Science Team, there is sufficient habitat in the lower Mississippi Valley to support shorebirds during fall migration.

The effectiveness of assessment learning objects produced using pair programming

Pair Programming is a technique from the software development method eXtreme Programming (XP) whereby two programmers work closely together to develop a piece of software. A similar approach has been used to develop a set of Assessment Learning Objects (ALO). Three members of academic staff have developed a set of ALOs for a total of three different modules (two with overlapping content). In each case a pair programming approach was taken to the development of the ALO. In addition to demonstrating the efficiency of this approach in terms of staff time spent developing the ALOs, a statistical analysis of the outcomes for students who made use of the ALOs is used to demonstrate the effectiveness of the ALOs produced via this method.

Facebook & Blackboard: comparison of learner perspectives

Different systems, different purposes – but how do they compare as learning environments? We undertook a survey of students at the University, asking whether they learned from their use of the systems, whether they made contact with other students through them, and how often they used them. Although it was a small scale survey, the results are quite enlightening and quite surprising. Blackboard is populated with learning material, has all the students on a module signed up to it, a safe environment (in terms of Acceptable Use and some degree of staff monitoring) and provides privacy within the learning group (plus lecturer and relevant support staff). Facebook, on the other hand, has no learning material, only some of the students using the system, and on the face of it, it has the opportunity for slips in privacy and potential bullying because the Acceptable Use policy is more lax than an institutional one, and breaches must be dealt with on an exception basis, when reported. So why do more students find people on their courses through Facebook than Blackboard? And why are up to 50% of students reporting that they have learned from using Facebook? Interviews indicate that students in subjects which use seminars are using Facebook to facilitate working groups – they can set up private groups which give them privacy to discuss ideas in an environment which perceived as safer than Blackboard can provide. No staff interference, unless they choose to invite them in, and the opportunity to select who in the class can engage. The other striking finding is the difference in use between the genders. Males are using blackboard more frequently than females, whilst the reverse is true for Facebook. Interviews suggest that this may have something to do with needing to access lecture notes… Overall, though, it appears that there is little relationship between the time spent engaging with Blackboard and reports that students have learned from it. Because Blackboard is our central repository for notes, any contact is likely to result in some learning. Facebook, however, shows a clear relationship between frequency of use and perception of learning – and our students post frequently to Facebook. Whilst much of this is probably trivia and social chit chat, the educational elements of it are, de facto, contructivist in nature. Further questions need to be answered - Is the reason the students learn from Facebook because they are creating content which others will see and comment on? Is it because they can engage in a dialogue, without the risk of interruption by others?

The effect of organic materials on the mobility and toxicity of metals in contaminated soils

Organic materials such as compost are often proposed as suitable materials for the remediation of contaminated brownfield sites intended for soft end-use. In addition to vitalising the soil, they are also believed to immobilise metals thereby breaking contaminant-receptor pathways and reducing the ecotoxicity of the contaminants. However, some research has demonstrated contradictory effects between composts on metal immobilisation. In the present study, four different composts and a liming product containing organic matter (LimeX70) were tested to examine both their metal retention and toxicity reduction capabilities on three different metal contaminated soils. Leaching tests, a plant growth test with Greek cress (Lepidium sativum), an earthworm (Eisenia fetida) survival and condition test and a bacterial toxicity test using Vibrio fischeri were carried out. The leaching test results showed that spent mushroom compost caused an increase in metal concentration in the leachates, while LimeX70 caused a decrease. The variation in behaviour between different amendments for each soil was high, so a generic conclusion could not be drawn. Toxicity tests showed significant reduction of metal bioavailability and toxicity for Greek cress, earthworms and bacteria. The results also suggest that more research should be undertaken to understand the mechanisms involved in metal complexation using different types of organic matter, in order to optimise the use of organic materials like compost for soil remediation. Crown Copyright (C) 2007 Published by Elsevier Ltd. All rights reserved.

The effect of organic materials on the mobility and toxicity of metals in contaminated soils

Organic materials such as compost are often proposed as suitable materials for the remediation of contaminated brownfield sites intended for soft end-use. In addition to vitalising the soil, they are also believed to immobilise metals thereby breaking contaminant-receptor pathways and reducing the ecotoxicity of the contaminants. However, some research has demonstrated contradictory effects between composts on metal immobilisation. In the present study, four different composts and a liming product containing organic matter (LimeX70) were tested to examine both their metal retention and toxicity reduction capabilities on three different metal contaminated soils. Leaching tests, a plant growth test with Greek cress (Lepidium sativum), an earthworm (Eisenia fetida) survival and condition test and a bacterial toxicity test using Vibrio fischeri were carried out. The leaching test results showed that spent mushroom compost caused an increase in metal concentration in the leachates, while LimeX70 caused a decrease. The variation in behaviour between different amendments for each soil was high, so a generic conclusion could not be drawn. Toxicity tests showed significant reduction of metal bioavailability and toxicity for Greek cress, earthworms and bacteria. The results also suggest that more research should be undertaken to understand the mechanisms involved in metal complexation using different types of organic matter, in order to optimise the use of organic materials like compost for soil remediation. Crown Copyright (C) 2007 Published by Elsevier Ltd. All rights reserved.

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

The impact of a closed-loop electronic prescribing and automated dispensing system on the ward pharmacist’s time and activities

Objective To assess the impact of a closed-loop electronic prescribing and automated dispensing system on the time spent providing a ward pharmacy service and the activities carried out. Setting Surgical ward, London teaching hospital. Method All data were collected two months pre- and one year post-intervention. First, the ward pharmacist recorded the time taken each day for four weeks. Second, an observational study was conducted over 10 weekdays, using two-dimensional work sampling, to identify the ward pharmacist's activities. Finally, medication orders were examined to identify pharmacists' endorsements that should have been, and were actually, made. Key findings Mean time to provide a weekday ward pharmacy service increased from 1 h 8 min to 1 h 38 min per day (P = 0.001; unpaired t-test). There were significant increases in time spent prescription monitoring, recommending changes in therapy/monitoring, giving advice or information, and non-productive time. There were decreases for supply, looking for charts and checking patients' own drugs. There was an increase in the amount of time spent with medical and pharmacy staff, and with 'self'. Seventy-eight per cent of patients' medication records could be assessed for endorsements pre- and 100% post-intervention. Endorsements were required for 390 (50%) of 787 medication orders pre-intervention and 190 (21%) of 897 afterwards (P < 0.0001; chi-square test). Endorsements were made for 214 (55%) of endorsement opportunities pre-intervention and 57 (30%) afterwards (P < 0.0001; chi-square test). Conclusion The intervention increased the overall time required to provide a ward pharmacy service and changed the types of activity undertaken. Contact time with medical and pharmacy staff increased. There was no significant change in time spent with patients. Fewer pharmacy endorsements were required post-intervention, but a lower percentage were actually made. The findings have important implications for the design, introduction and use of similar systems.

Financing road transport infrastructure

In the UK, public expenditure on transport infrastructure is nearly £6 billion for the past few years. Over £500 million per year were spent on bridge assessment and strengthening and reducing the backlog of road requiring maintenance. A further £200 million a year will be spent on keeping the safe operation of the network and efficiently through day to day maintenance, lighting and signing . The Department of Transport is planning to extend private sector experience in road management and operation by introducing Design, Build, Finance and Operate (DBFO) This paper investigates the different ways of financing road transport infrastructure including road pricing, private finance in transport infrastructure, the role of the private sector, Design, Build, Finance and Operate (DBFO) schemes, the benefits and problems of such schemes. The paper considers planning gain as a means of financing transport infrastructure with examples of developers to fund link road building and improvements to the local planning system