El costo de la atención ambulatoria del lupus eritematoso sistémico en Colombia. Contrastes y comparaciones con otras poblaciones.

Introducción: el lupus eritematoso sistémico (LES) es considerado una enfermedad de alto costo. La expresión clínica de la enfermedad depende de la ubicación geografía y la etnicidad. El objetivo de este estudio fue el calcular los costos ambulatorios relacionado al LES en una cohorte colombiana, identificar los predictores de costos y comparar nuestro resultados con otras poblaciones. Métodos: Se realizó una aproximación de tipo prevalencia en 100 pacientes LES en quienes se evaluaron los costos directos médicos, directos no médicos, indirectos e intangibles. Todos los costos médicos fueron evaluados usando una metodología abajo hacia arriba. Los costos directos fueron valorados desde una perspectiva social usando una metodología de micro-costeo. Los costos indirectos se evaluaron mediante una aproximación de capital humano, y los costos intangibles calculados a partir de los años de vida ajustados por calidad (AVAC). Se analizaron los datos por medio de un análisis multivariado. Para comparaciones con otras poblaciones todos los costos fueron expresados como la razón entre los costos y producto interno bruto nacional per cápita. Resultados: La media de costos totales fue 13.031±9.215 USD (ajustados por el factor de conversión de paridad del poder adquisitivo), lo cual representa el 1,66 del PIB per capita de Colombia. Los costos directos son el 64% de los costos totales. Los costos médicos representan el 80% de los costos directos,. Los costos indirectos fueron el 10% y los costos intangibles el 25% de los costos totales. Los medicamentos representaron el 45% de los costos directos. Mayores costos se relacionaron con el estrato socioeconómico, seguro médico privado, AVAC, alopecia, micofenolato mofetilo, y terapia anticoagulante. Los costos directos ajustados de los pacientes con LES en Colombia fueron mayores que en Norte América y en Europa. Conclusiones: el LES impone una carga económica importante para la sociedad. Los costos relacionados con la atención médica y AVAC fueron los principales contribuyentes al alto costo de la enfermedad. Estos resultados pueden ser referencia para determinar políticas en salud pública así como comparar el gasto en salud de forma internacional.

Labor's shares - aggregate and industry: accounting for both in a model of unbalanced growth with induced innovation

The relative stability of aggregate labor's share constitutes one of the great macroeconomic ratios. However, relative stability at the aggregate level masks the unbalanced nature of industry labor's shares – the Kuznets stylized facts underlie those of Kaldor. We present a two-sector – one labor-only and the other using both capital and labor – model of unbalanced economic development with induced innovation that can rationalize these phenomena as well as several other empirical regularities of actual economies. Specifically, the model features (i) one sector ("goods" production) becoming increasingly capital-intensive over time; (ii) an increasing relative price and share in total output of the labor-only sector ("services"); and (iii) diverging sectoral labor's shares despite (iii) an aggregate labor's share that converges from above to a value between 0 and unity. Furthermore, the model (iv) supports either a neoclassical steadystate or long-run endogenous growth, giving it the potential to account for a wide range of real world development experiences.

Vibration-rotation spectra of nitrous acid, HONO

High-resolution Fourier-transform infrared spectra have been recorded and analyzed for the nu4, nu5, and nu6 fundamental bands of trans-HONO, and for the nu4 fundamental of cis-HONO. The spectral resolution was better than 0.01/cm, and the rotational structure has been analyzed to give improved ground-state and excited-state rotational constants, with a standard deviation of the fit to the observed line positions of around 0.0006/cm. Two Coriolis interactions have been analyzed between the nu5 and nu6 bands of trans-HONO.

Vibration-rotation spectra of deuterated nitrous acid, DONO

High-resolution Fourier transform infrared spectra have been recorded and analyzed for the ν3, ν4, ν5, and ν6 fundamental bands of trans-DONO, and for the ν4 fundamental of cis-DONO. The spectral resolution was better than 0.01 cm−1, and the bands have been fitted using an asymmetric top Hamiltonian with a standard deviation of around 0.0006 cm−1.

Influence of gut morphology on passive transport of freshwater bryozoans by waterfowl in Donana (southwestern Spain)

Waterbirds have been proposed as important vectors for the passive dispersal of those aquatic invertebrates and plants that lack a capacity for active dispersal between isolated water bodies. We analysed the frequency of internal transport of bryozoan propagules (statoblasts) by waterbirds in Donana, Spain, by examining their presence in the intestines and ceca of dead birds and analysing the role of different aspects of gut characteristics in explaining variation in the presence/absence and abundance of statoblasts. Of the 228 samples examined, 7.9% presented intact statoblasts of Plumatella fungosa (Pallas, 1768), Plumatella emarginata Allman, 1844, and two unidentified Plumatella species. For a given bird species, individuals with heavier gizzards and shorter ceca had a lower incidence and abundance of statoblasts in the lower gut. Grit mass and intestine length were unrelated to the presence or abundance of statoblasts. Our results suggest that waterbirds frequently transport bryozoans on a local scale, with lighter gizzards and longer ceca favouring such transport. Lighter gizzards are likely to destroy fewer propagules before they reach the lower gut. Species and individuals with longer ceca are particularly good candidates for long-distance dispersal of bryozoans, given the longer passage time of propagules that enter the ceca.

Preparation of enantiopure long chain threo-2-amino-3-hydroxyesters via chiral morpholinone-derived azomethine ylids

The synthetic approach to threo-2-amino-3-hydroxyesters possessing long alkyl chains outlined herein centres on the generation of chiral azomethine ylids by reaction of (5R)-5-phenyl-morpholin-2-one, (R)-(1), with long chain aldehydes. In the presence of a second equivalent of aldehyde, the azomethine ylid can be trapped to afford a cycloadduct with three new stereodefined centres. Degradation of the cycloadduct allows entry to beta-substituted-alpha-amino acid derivatives, which have potential as building blocks for sphingosine synthesis.

The synthesis, structure, and electrochemical properties of Fe(C CC N)(dppe)Cp and related compounds

The cyanoacetylide complex Fe(CCCN)(dppe)Cp (3) is readily obtained from sequential reaction of Fe(CCSiMe3)(dppe)Cp with methyllithium and phenyl cyanate. Complex 3 is a good metalloligand, and coordination to the metal fragments [RhCl(CO)(2)], [Ru(PPh3)(2)Cp](+), and [Ru(dppe)Cp*](+) affords the corresponding cyanoaceylide-bridged heterobimetallic complexes. In the case of the 36-electron complexes [Cp(dppe)Fe-CCCN-MLn](n+), spectroscopic and structural data are consistent with a degree of charge transfer from the iron centre to the rhodium or ruthenium centre via the C3N bridge, giving rise to a polarized ground state. Electrochemical and spectroelectrochemical methods reveal significant interactions between the metal centres in the oxidized (35 electron) derivatives, [Cp(dppe)Fe-CCCN-MLn]((n+1)+).

Poverty traps in small-scale mining communities: the case of sub-Saharan Africa

This paper critically reflects on why, in many rural stretches of sub-Saharan Africa, scores of people engage in artisanal and small-scale mining (ASM) activity – low-tech, labour intensive mineral extraction – for lengthy periods of time. It argues that a large share of the region’s ASM operators have mounting debts which prevent them from pursuing alternative, less arduous, employment. The paper concludes with an analysis of findings from research carried out by the author in Talensi-Nabdam District, Northern Ghana, which captures the essence of the poverty trap now plaguing so many ASM communities in sub-Saharan Africa.

Tobit estiamtion with unknown point of censoring with an application to milk market participation in the Ethiopian highlands

Data augmentation is a powerful technique for estimating models with latent or missing data, but applications in agricultural economics have thus far been few. This paper showcases the technique in an application to data on milk market participation in the Ethiopian highlands. There, a key impediment to economic development is an apparently low rate of market participation. Consequently, economic interest centers on the “locations” of nonparticipants in relation to the market and their “reservation values” across covariates. These quantities are of policy interest because they provide measures of the additional inputs necessary in order for nonparticipants to enter the market. One quantity of primary interest is the minimum amount of surplus milk (the “minimum efficient scale of operations”) that the household must acquire before market participation becomes feasible. We estimate this quantity through routine application of data augmentation and Gibbs sampling applied to a random-censored Tobit regression. Incorporating random censoring affects markedly the marketable-surplus requirements of the household, but only slightly the covariates requirements estimates and, generally, leads to more plausible policy estimates than the estimates obtained from the zero-censored formulation

A digital ecosystems model of assessment feedback on student learning

The term ecosystem has been used to describe complex interactions between living organisms and the physical world. The principles underlying ecosystems can also be applied to complex human interactions in the digital world. As internet technologies make an increasing contribution to teaching and learning practice in higher education, the principles of digital ecosystems may help us understand how to maximise technology to benefit active, self-regulated learning especially among groups of learners. Here, feedback on student learning is presented within a conceptual digital ecosystems model of learning. Additionally, we have developed a Web 2.0-based system, called ASSET, which incorporates multimedia and social networking features to deliver assessment feedback within the functionality of the digital ecosystems model. Both the digital ecosystems model and the ASSET system are described and their implications for enhancing feedback on student learning are discussed.

Postnatal development of the mucosal immune system and consequences on health in adulthood

The intestinal microbiota is a dynamic multifaceted ecosystem which has evolved a complex and mutually beneficial relationship with the mammalian host. The contribution to host fitness is evident, but in recent years it has become apparent that these commensal microorganisms may exert far more influence over health and disease than previously thought. The gut microbiota are implicated in many aspects of biological function, such as metabolism, angiogenesis and immune development: disruption, especially during the neonatal period, which may impose life-long penalty. Elimination of the microbiota appears difficult, but manipulation of the ratios and dominance of composite populations can be achieved by alterations in diet, rearing environment, antibiotics and/or probiotics. Components of the intestinal microbiota are frequently documented to affect normal function of the mucosal immune system in experimental animals and in domesticated, agricultural species. However, it is not always clear that the effects described are sufficiently well understood to provide a sound basis for commercial intervention. Some microbial interventions may be beneficial to the host under particular circumstances, while detrimental during others. It is essential that we further our understanding of the complex and intricate host-commensal relationship to avoid causing more long-term damage than advantage

Surface water temperature observations of large lakes by optimal estimation

Optimal estimation (OE) and probabilistic cloud screening were developed to provide lake surface water temperature (LSWT) estimates from the series of (advanced) along-track scanning radiometers (ATSRs). Variations in physical properties such as elevation, salinity, and atmospheric conditions are accounted for through the forward modelling of observed radiances. Therefore, the OE retrieval scheme developed is generic (i.e., applicable to all lakes). LSWTs were obtained for 258 of Earth's largest lakes from ATSR-2 and AATSR imagery from 1995 to 2009. Comparison to in situ observations from several lakes yields satellite in situ differences of −0.2 ± 0.7 K for daytime and −0.1 ± 0.5 K for nighttime observations (mean ± standard deviation). This compares with −0.05 ± 0.8 K for daytime and −0.1 ± 0.9 K for nighttime observations for previous methods based on operational sea surface temperature algorithms. The new approach also increases coverage (reducing misclassification of clear sky as cloud) and exhibits greater consistency between retrievals using different channel–view combinations. Empirical orthogonal function (EOF) techniques were applied to the LSWT retrievals (which contain gaps due to cloud cover) to reconstruct spatially and temporally complete time series of LSWT. The new LSWT observations and the EOF-based reconstructions offer benefits to numerical weather prediction, lake model validation, and improve our knowledge of the climatology of lakes globally. Both observations and reconstructions are publically available from http://hdl.handle.net/10283/88.