Aproximación a la asociatividad y la estructuración de redes basadas en confianza en instituciones prestadoras de servicios de salud

En este documento se concentra en un análisis sobre la asociatividad y la conformación de redes empresariales en dos instituciones prestadoras de servicios de salud del municipio de Tenjo Cundinamarca. En la primera parte se desarrolla el estado de la asociatividad con un enfoque de red, se plantea los objetivos, la justificación y los alcances de la investigación. En el segunda parte se hace alusión al marco teórico, marco legal, sistema general de seguridad social en salud, y la importancia que tiene las asociaciones empresariales, cooperación, participación y la confianza en las instituciones de salud; haciendo mención sobre clusters, alianzas y ecosistemas empresariales. En la tercera parte se realizó el marco metodológico de la investigación, análisis de resultado de las entrevistas, se describen las organizaciones objeto de este estudio. En la cuarta parte se realizan la discusión de la investigación, y se presentan las conclusiones que los autores de este estudio han presentado sobre la confianza fortalecida y la obligación prolongada de las empresas en el tiempo. Finamente, esta investigación presenta un punto de partida para la conformación de modelos que integren varias empresas, que puedan mejorar la competitividad, en las instituciones prestadoras de servicios de salud, permitiendo el acercando de los procesos del área administrativa con el área asistencia, en procura de brindar un mejoramiento continuo en la atención de los pacientes y su grupo familiar.

Sustain Cycle

En la búsqueda de preservar el medio ambiente y estandarizar la disposición final de los residuos generados, Sustain Cycle nace como un gestor de residuos de aceite vegetal usado, reforzando la carente oferta del mercado. Fortaleciendo el compromiso de los generadores de este residuo además de una reducción de costos, la creación de Sustain Cycle se desarrolla bajo la figura jurídica de Fundación, deduciendo en los contribuyentes del impuesto el valor de las donaciones efectuadas. El aporte ambiental se basa en minimizar el riesgo de una mala disposición en la red de alcantarillado y su componente social se enfoca en evitar la reutilización ilegal y perjudicial para el consumidor. Sustain Cycle se centra en la recolección, acopio, filtrado y comercialización del AVU generado por todos los establecimientos comerciales que produzcan alimentos como papas a la francesa, empanadas, buñuelos, churros, plátanos y demás productos que requieran del aceite para su cocción.

La construcción de la política exterior de Rusia hacia Serbia: entre el pragmatismo y el Eurasianismo (2007-2015)

Esta monografía defenderá que la Rusia contemporánea cuenta con una ideología formada a partir de los elementos imperiales y religiosos previos a la Unión Soviética además de elementos políticos propios de la URSS como la colectividad y la oposición a occidente. La Rusia de Putin ha recobrado sus capacidades para defender sus intereses en el mundo frente a la injerencia de occidente, y en el caso de Serbia esto se hará evidente a través de la importancia de los lazos culturales e históricos reforzados por los vínculos económicos y estratégicos que representa la presencia de Rusia en Serbia. Los principales autores sobre los que se trabajará son Alexander Dugin y Alexander Panarin.

Anthelmintic effect of plant extracts containing condensed and hydrolyzable tannins on Caenorhabditis elegans, and their antioxidant capacity

Although tannin-rich forages are known to increase protein uptake and to reduce gastrointestinal nematode infections in grazing ruminants, most published research involves forages with condensed tannins (CT), while published literature lacks information on the anthelmintic capacity, nutritional benefits, and antioxidant capacity of alternative forages containing hydrolyzable tannins (HT). We evaluated the anthelmintic activity and the antioxidant capacity of plant extracts containing either mostly CT, mostly HT, or both CT and HT. Extracts were prepared with 70% acetone, lyophilized, redissolved to doses ranging from 1.0mg/mL to 25mg/mL, and tested against adult Caenorhabditis elegans as a test model. The extract concentrations that killed 50% (LC50) or 90% (LC90) of the nematodes in 24h were determined and compared to the veterinary anthelmintic levamisole (8mg/mL). Extracts were quantified for CT by the acid butanol assay, for HT (based on gallic acid and ellagic acid) by high-performance liquid chromatography (HPLC) and total phenolics, and for their antioxidant activity by the oxygen radical absorbance capacity (ORAC) assay. Extracts with mostly CT were Lespedeza cuneata, Salix X sepulcralis, and Robinia pseudoacacia. Extracts rich in HT were Acer rubrum, Rosa multiflora, and Quercus alba, while Rhus typhina had both HT and CT. The extracts with the lowest LC50 and LC90 concentrations, respectively, in the C. elegans assay were Q. alba (0.75 and 1.06mg/mL), R. typhina collected in 2007 (0.65 and 2.74mg/mL), A. rubrum (1.03 and 5.54mg/mL), and R. multiflora (2.14 and 8.70mg/mL). At the doses of 20 and 25mg/mL, HT-rich, or both CT- and HT-rich, extracts were significantly more lethal to adult C. elegans than extracts containing only CT. All extracts were high in antioxidant capacity, with ORAC values ranging from 1800μmoles to 4651μmoles of trolox equivalents/g, but ORAC did not correlate with anthelmintic activity. The total phenolics test had a positive and highly significant (r=0.826, p≤0.01) correlation with total hydrolyzable tannins. Plants used in this research are naturalized to the Appalachian edaphoclimatic conditions, but occur in temperate climate areas worldwide. They represent a rich, renewable, and unexplored source of tannins and antioxidants for grazing ruminants, whereas conventional CT-rich forages, such as L. cuneata, may be hard to establish and adapt to areas with temperate climate. Due to their high in vitro anthelmintic activity, antioxidant capacity, and their adaptability to non-arable lands, Q. alba, R. typhina, A. rubrum, and R. multiflora have a high potential to improve the health of grazing animals and must have their anthelmintic effects confirmed in vivo in both sheep and goats. © 2012.

Stress Abolishes the Effect of Previous Chronic Ethanol Consumption on Drug Place Preference and on the Mesocorticolimbic Brain Pathway

BackgroundConditioned place preference (CPP) to ethanol (EtOH) is an important addiction-related alteration thought to be mediated by changed neurotransmission in the mesocorticolimbic brain pathway. Stress is a factor of major importance for the initiation, maintenance, and reinstatement of drug abuse and modulates the neurochemical outcomes of drugs. Thus, the aim of this study was to investigate the effects of concomitant exposure to chronic EtOH and stress on CPP to this drug and alterations of dopaminergic and serotonergic neurotransmission in mice.MethodsMale Swiss mice were chronically treated with EtOH via a liquid diet and were exposed to forced swimming stress. After treatment, animals were evaluated for conditioning, extinction, and reinstatement of CPP to EtOH. Also, mice exposed to the same treatment protocol had their prefrontal cortex (PFC), nucleus accumbens (NAc), and amygdala dissected for the quantitation of dopamine, serotonin, and their metabolites content.ResultsData showed that previous chronic exposure to EtOH potentiated EtOH conditioning and increased dopaminergic turnover in PFC. Exposure to stress potentiated EtOH conditioning and decreased dopaminergic turnover in the NAc. However, animals exposed to both chronic EtOH and stress did not display alterations of CPP and showed an elevated content of dopamine in amygdala. No treatment yielded serotonergic changes.ConclusionsThe present study indicates that previous EtOH consumption as well as stress exposure induces increased EtOH conditioning, which can be related to dopaminergic alterations in the PFC or NAc. Interestingly, concomitant exposure to both stimuli abolished each other's effect on conditioning and PFC or NAc alterations. This protective outcome can be related to the dopaminergic increase in the amygdala.

Similar ethanol drinking in adolescent and adult C57BL/6J mice after chronic ethanol exposure and withdrawal

BACKGROUND: Increasing evidence shows that excessive alcohol consumption during adolescence increases vulnerability to alcohol use disorders in adulthood. The aim of this study was to examine differences between adolescent and adult C57BL/6J mice in drinking behavior and blood ethanol (EtOH) concentrations (BECs) after chronic EtOH exposure and withdrawal. METHODS: Male adolescent (PND = 28 to 30) and adult (PND = 70) C57BL/6J mice were allowed to consume EtOH in a 2-bottle choice paradigm (15% EtOH vs. water) for 3 weeks (Baseline drinking, Test 1, and Test 2), which were interspersed with 2 cycles (Cycles I and II) of chronic EtOH vapor or air inhalation (16 hours) and withdrawal (8 hours). BECs were determined during both cycles. RESULTS: Chronic EtOH exposure led to increased EtOH intake during Test 1 and Test 2 in both adolescent and adult mice compared with air-exposed controls, and no differences between age groups were observed. During Cycle I adult mice showed higher BECs compared with adolescents. During Cycle II, BECs were lower in adult mice as compared to Cycle I, and BECs in adolescent mice did not change between the 2 cycles. CONCLUSIONS: Chronic EtOH exposure followed by withdrawal periods increases EtOH consumption similarly in both adolescent and adult mice, despite differences in BECs

Palaeoenvironment in North-Western Romania during the last 15 000 years

The objectives of this thesis are to establish a chronological framework for environmental changes during the last 15,000 years in northwest Romania, to reconstruct the vegetation development, and to evaluate the underlying processes for forest dynamics. Furthermore, an overview of earlier and ongoing pollenstratigraphic work in Romania is provided. Sediments from two former crater lakes, Preluca Tiganului and Steregoiu, situated in the Gutaiului Mountains, on the western extremity of the Eastern Carpathians at 730 m and 790 m a.s.l., respectively were obtained and analysed for high-resolution pollen, macrofossils, charcoal, mineral magnetic parameters and organic matter. The chronostratigraphic framework was provided by dense AMS 14C measurements. Cold and dry climatic conditions are indicated by the occurrence of open vegetation with shrubs and herbs, and cold lake water prior to 14,700 cal. yr BP. The climatic improvement at the beginning of the Lateglacial interstadial (around 14,700 cal. yr BP) is seen by the development of open forests. These were dominated by Pinus and Betula, but contained also new arriving tree taxa, such as Populus, Alnus and Prunus. The gradual establishment of forests may have led to a stabilization of the soils in the catchment. Between ca. 14,100 and 13,800 cal. yr BP the forest density became reduced to stands of Pinus, Betula, Alnus, Larix and Populus trees and grassland expanded, suggesting colder climatic conditions. Picea arrived as a new taxon at around 13,800 cal. yr BP, and between 13,800 and 12,900 cal. yr BP, the surroundings of the sites were predominantly covered by Picea forest. This forest included Betula, Pinus, Alnus, Larix and Populus and, from 13,200 cal. yr BP onwards also Ulmus. At ca. 12,900 cal. yr BP, the forest became significantly reduced and at 12,600 cal. yr BP, a recurrence of open vegetation with stands of Larix, Pinus, Betula, Salix and Alnus is documented, lasting until 11,500 cal. yr BP. This distinct change in vegetation may by taken as a strong decline in temperature and moisture availability. At the transition to the Holocene, at ca. 11,500 cal. yr BP, Pinus, Betula and Larix quickly expanded (from small local stands) and formed open forests, probably as a response to warmer and more humid climatic conditions. At 11,250 cal. yr BP Ulmus and Picea expanded and the landscape became completely forested. The rapid increase of Ulmus and Picea after 11,500 cal. yr BP may suggest the existence of small residual populations close to the study sites during the preceding cold interval. Ulmus was the first and most prominent deciduous taxa in the early Holocene in the Gutaiului Mountains. From ca. 10,750 cal. yr BP onwards Quercus, Tilia, Fraxinus and Acer expanded and Corylus arrived. A highly diverse, predominantly deciduous forest with Ulmus, Quercus, Tilia, Fraxinus, Acer, Corylus and Picea developed between 10,700 and 8200 cal. yr BP, which possibly signifies more continental climatic conditions. The development of a Picea-Corylus dominated forest between 8200 and 5700 cal. yr BP is likely connected to a more humid and cooler climate. The establishment of Carpinus and Fagus was dated to 5750 cal. yr BP and 5200 cal. yr BP, respectively. The dominance of Fagus during the late Holocene, from 4000 cal. yr BP onwards, may have been related to cooler and more humid climatic conditions. First signs of human activities are recorded around 2300 cal. yr BP, but only during the last 300 years did local human impact become significant. The vegetation development recorded in the Gutaiului Mountains during the Lateglacial is very similar to reconstructions based on lowland sites, whereas higher elevation sites seem not to have always experienced visible vegetation changes. The time of tree arrival and expansion during the past 11,500 cal. yr BP seems to have occurred almost synchronously across Romania. The composition of the forests during the Holocene in the Gutaiului Mountains is consistent with that reconstructed at mid-elevation sites, but differs from the forest composition at higher elevations. Important differences between the Gutaiului Mountains and other studied sites in Romania are a low representation of Carpinus and a late and weak human impact. The available data sets for Romania give evidence for the presence of coniferous and cold-tolerant deciduous trees before 14,700 cal. yr BP. Glacial refugia for Ulmus may have occurred in different parts of Romania, whereas the existence of Quercus, Tilia, Corylus and Fraxinus has not been corroborated.

Marginalità centrale. Intervento di riqualificazione di un complesso residenziale sociale a Bologna

La tesi qui presentata è stata svolta all’interno del Laboratorio di Sintesi Finale “Architettura sostenibile" e propone la riqualificazione di un edificio ACER, sito a Bologna in via Gandusio, un’area strategicamente centrale a ridosso del centro storico e al contempo inserita all’interno delle dinamiche urbane della prima periferia. Si tratta di un complesso di edilizia residenziale sociale e, perciò, è stato necessario elaborare preliminarmente una sorta di quadro conoscitivo per individuare le problematiche e le tendenze comuni sia a casistiche italiane che europee. Dopo un inquadramento generale sulla situazione dei modelli famigliari e dell’abitare; è stata effettuata una panoramica su alcuni interventi europei, dai quali si è cercato di attingere e elaborare soluzioni e metodologie di intervento innovative, prendendo in considerazione sia elementi di rigenerazione del tessuto urbano, sia soluzioni tecnologiche e costruttive applicate a casi specifici. La situazione dell’edilizia residenziale sociale, attualmente, vede una forte scarsità di alloggi, tale da non riuscire a soddisfare tutte le richieste della popolazione. Negli ultimi trenta anni, la quota di produzione di alloggi di edilizia sociale è progressivamente calata, contrariamente agli altri paesi europei, caratterizzati da un andamento costante. Al contempo, si è registrato l’aumento di persone in condizioni di disagio abitativo e sociale. Il progetto risponde alle eterogenee esigenze dei rinnovati modelli famigliari contemporanei, prevedendo opere di completamento funzionale e una diversificazione dell’offerta tipologica degli alloggi, unita all’integrazione di nuovi servizi per gli abitanti e alla rivalorizzazione dell’identità dell’edificio in quanto manufatto polarizzante. Il progetto adotta il metodo della riqualificazione sostenibile e delle tematiche ad essa inerenti, approfondite durante il percorso di lavoro svolto all’interno del Laboratorio di Sintesi Finale “Architettura Sostenibile”. Tutti gli interventi eseguiti sul manufatto sono stati incentrati sul tema della sostenibilità, per ridurre l’uso dei materiali e l’uso del territorio. Sono stati ridotti i deficit tecnologici e soprattutto energetici dell’involucro edilizio, combinando all’applicazione di soluzioni tecnologiche la riqualificazione dello spazio urbano e della funzionalità degli spazi dell’abitare. Questo lavoro si propone di confrontarsi con la condizione attuale dell’housing sociale, cercando di rispondere alle esigenze abitative contemporanee, riqualificando e ripensando gli spazi e migliorandone il comportamento strutturale in caso di evento sismico. Per evitare di trattarlo come un episodio sporadico, un’anomalia, l’intervento ha cercato di collocarsi all’interno del contesto urbano e del tessuto insediativo, dialogando con essi per fornire risposte a problematiche concrete e reali. Per questo si è deciso di intervenire anche sulle aree adiacenti, provando a fornire soluzioni alle dinamiche incompiute e alle esigenze sociali del quartiere.

Il patrimonio dell'edilizia sociale a Forlì strategie di rigenerazione della città pubblica

La tesi di Laurea presenta una ricognizione dell'attuale patrimonio dell'edilizia pubblica a Forlì, effettuata a partire dai documenti conservati presso gli archivi dell'ACER. Il patrimonio dell'edilizia sociale è poi relazionato alle dinamiche di crescita della città e ai contenuti degli strumenti urbanistici al fine di individuare ambiti in cui sperimentare strategie di rigenerazione degli spazi pubblici e dei tessuti urbani. In particolare è stata approfondita la situazione del quartiere Ca' Ossi, sul quale la tesi formula alcune ipotesi progettuali.

Ri(abitare). Riqualificazione di un intervento di edilizia sociale a bologna, quartiere bolognina.

L’oggetto di questa tesi è un intervento di rigenerazione, riqualificazione ed efficientamento energetico di un edificio residenziale di 40 alloggi a Bologna, zona Bolognina. Quest’ultimo, vittima dei bombardamenti della seconda Guerra Mondiale fu ricostruito nel 1952 mantenendo le caratteristiche di quello precedente. Come in molti edifici analoghi per epoca di costruzione e aratteristiche, anche in questo caso si manifestano alcune criticità ricorrenti, in particolare: - Scarsa efficienza energetica; - Inadeguatezza sismica; - Comfort abitativo insoddisfacente; - Taglio degli alloggi pensato per nuclei famigliari diversi da quelli attuali; - Spazi pubblici, dotazioni e arredi urbani carenti. L'obiettivo che si pone la tesi è quello di migliorare la vivibilità dell'edificio e dell'area in cui si colloca, adattandolo alle esigenze di oggi e di domani. Il progetto propone un insieme di interventi coordinati, definiti con attenzione per la loro fattibilità tecnica e tenendo conto del fatto che si tratta di un complesso di edilizia residenziale pubblica del patrimonio ACER Bologna. In termini pratici, il progetto interviene sia sugli spazi circostanti l'edificio, sia sul manufatto architettonico. A scala micro-urbana è stata prevista la riorganizzazione e il riordino delle aree scoperte di pertinenza, ridefinendo la viabilità dotandole di elementi di arredo che ne consentano la fruizione. A scala edilizia è stato progettato un efficientamento energetico che portasse l'edificio in classe A dalla attuale classe energetica F. Ciò ha richiesto di ridefinire le stratigrafie delle chiusure verticali ed orizzontali in coerenza con gli aspetti di composizione delle facciate. Piccole riconfigurazioni interne hanno poi portato ad un riassetto del taglio degli alloggi per disporre in maggior numero di unità di piccole dimensioni, adatte alla domanda oggi prevalente.

The Importance of Glucocorticoids in AlcoholDependence and Neurotoxicity

http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.2010.01298.x/abstract

A VEGETATION RECONSTRUCTION OF UNION COUNTY, PENNSYLVANIA DURING THE EARLY HISTORICAL PERIOD (1755-1855)

This thesis assesses relationships between vegetation and topography and the impact of human tree-cutting on the vegetation of Union County during the early historical era (1755-1855). I use early warrant maps and forestry maps from the Pennsylvania historical archives and a warrantee map from the Union County courthouse depicting the distribution of witness trees and non-tree surveyed markers (posts and stones) in early European settlement land surveys to reconstruct the vegetation and compare vegetation by broad scale (mountains and valleys) and local scale (topographic classes with mountains and valleys) topography. I calculated marker density based on 2 km x 2 km grid cells to assess tree-cutting impacts. Valleys were mostly forests dominated by white oak (Quercus alba) with abundant hickory (Carya spp.), pine (Pinus spp.), and black oak (Quercus velutina), while pine dominated what were mostly pine-oak forests in the mountains. Within the valleys, pine was strongly associated with hilltops, eastern hemlock (Tsuga canadensis) was abundant on north slopes, hickory was associated with south slopes, and riparian zones had high frequencies of ash (Fraxinus spp.) and hickory. In the mountains, white oak was infrequent on south slopes, chestnut (Castanea dentata) was more abundant on south slopes and ridgetops than north slopes and mountain coves, and white oak and maple (Acer spp.) were common in riparian zones. Marker density analysis suggests that trees were still common over most of the landscape by 1855. The findings suggest there were large differences in vegetation between valleys and mountains due in part to differences in elevation, and vegetation differed more by topographic classes in the valleys than in the mountains. Possible areas of tree-cutting were evenly distributed by topographic classes, suggesting Europeans settlers were clearing land and harvesting timber in most areas of Union County.

Self-efficacy as a predictor of outcome after residential treatment programs for alcohol dependence: simply ask the patient one question!

Self-efficacy has been identified as one of the most consistent variables that predict the outcome of alcohol treatment. However, many previous studies in this field failed to control for other important predictors (e.g., dependences severity, psychiatric symptoms, and treatment goal). Our study's first goal was to evaluate the predictive value of self-efficacy when most other relevant variables were statistically controlled. The second goal was to compare the predictive values of self-efficacy assessed with the Situational Confidence Questionnaire (SCQ), and general self-efficacy assessed with a single question.

Impact of Lifetime Alcohol Use on Liver Fibrosis in a Population of HIV-Infected Patients With and Without Hepatitis C Coinfection

BACKGROUND: The effect of alcohol on liver disease in HIV infection has not been well characterized. METHODS: We performed a cross-sectional multivariable analysis of the association between lifetime alcohol use and liver fibrosis in a longitudinal cohort of HIV-infected patients with alcohol problems. Liver fibrosis was estimated with 2 noninvasive indices, "FIB-4," which includes platelets, liver enzymes, and age; and aspartate aminotransferase/platelet ratio index ("APRI"), which includes platelets and liver enzymes. FIB-4 <1.45 and APRI <0.5 defined the absence of liver fibrosis. FIB-4 >3.25 and APRI >1.5 defined advanced liver fibrosis. The main independent variable was lifetime alcohol consumption (<150 kg, 150 to 600 kg, >600 kg). RESULTS: Subjects (n = 308) were 73% men, mean age 43 years, 49% with hepatitis C virus (HCV) infection, 60% on antiretroviral therapy, 49% with an HIV RNA load <1,000 copies/ml, and 18.7% with a CD4 count <200 cells/mm(3) . Forty-five percent had lifetime alcohol consumption >600 kg, 32.7% 150 to 600 kg, and 22.3% <150 kg; 33% had current heavy alcohol use, and 69% had >9 years of heavy episodic drinking. Sixty-one percent had absence of liver fibrosis and 10% had advanced liver fibrosis based on FIB-4. In logistic regression analyses, controlling for age, gender, HCV infection, and CD4 count, no association was detected between lifetime alcohol consumption and the absence of liver fibrosis (FIB-4 <1.45) (adjusted odds ratio [AOR] = 1.12 [95% CI: 0.25 to 2.52] for 150 to 600 kg vs. <150 kg; AOR = 1.11 [95% CI: 0.52 to 2.36] for >600 kg vs. <150 kg; global p = 0.95). Additionally, no association was detected between lifetime alcohol use and advanced liver fibrosis (FIB-4 >3.25). Results were similar using APRI, and among those with and without HCV infection. CONCLUSIONS: In this cohort of HIV-infected patients with alcohol problems, we found no significant association between lifetime alcohol consumption and the absence of liver fibrosis or the presence of advanced liver fibrosis, suggesting that alcohol may be less important than other known factors that promote liver fibrosis in this population.