Estrategia de servicio en el Ciclo de Preventa-Venta-Posventa en Cruz Blanca EPS En el régimen contributivo en la Ciudad de Santafé de Bogotá

De acuerdo con las tendencias actuales del mercado, enmarcados en un entorno económico lleno de incertidumbre y como consecuencia de la competencia generada por la Ley 100 de 1993 se hace necesario diseñar estrategias que confluyan la identificación

Evaluación expost del plan piloto para un sistema de atención médica prehospitalaria en Santa Fe de Bogotá

Específicamente en el sector salud tantas veces motivo de discusión, la mayoría de sus proyectos afectan directa o indirectamente la calidad de vida de las personas de forma no claramente cuantificable, siendo las externalidades positivas o negativas

Generación de nuevos recursos para la beneficencia de Cundinamarca

Para entender mejor la situación actual de la Beneficencia de Cundinamarca, es necesario explicar su origen y su funcionamiento desde su fundación, especificando los antecedentes que han deteriorado las finanzas de esta Entidad Estatal.

Cost-effectiveness of an intervention to reduce emergency re-admissions to hospital among older patients

Background. The objective is to estimate the cost-effectiveness of an intervention that reduces hospital readmission among older people at high risk. A cost-effectiveness model to estimate the costs and health benefits of the intervention was implemented. Methodology/Principal Findings. The model used data from a randomised controlled trial conducted in an Australian tertiary metropolitan hospital. Participants were acute medical admissions aged >65 years with at least one risk factor for readmission: multiple comorbidities, impaired functionality, aged >75 years, 30 recent multiple admissions, poor social support, history of depression. The intervention was a comprehensive nursing and physiotherapy assessment and an individually tailored program of exercise strategies and nurse home visits with telephone follow-up; commencing in hospital and continuing following discharge for 24 weeks. The change to cost outcomes, including the costs of implementing the intervention and all subsequent use of health care services, and, the change to health benefits, represented by quality adjusted life years, were estimated for the intervention as compared to existing practice. The mean change to total costs and quality 38 adjusted life years for an average individual over 24 weeks participating in the intervention were: cost savings of $333 (95% Bayesian credible interval $-1,932:1,282) and 0.118 extra quality adjusted life years (95% Bayesian credible interval 0.1:0.136). The mean net41 monetary-benefit per individual for the intervention group compared to the usual care condition was $7,907 (95% Bayesian credible interval $5,959:$9,995) for the 24 week period. Conclusions/Significance. The estimation model that describes this intervention predicts cost savings and improved health outcomes. A decision to remain with existing practices causes unnecessary costs and reduced health. Decision makers should consider adopting this 46 program for elderly hospitalised patients.

A comparison of the hazard perception ability of matched groups of healthy drivers aged 35 to 55, 65 to 74, and 75 to 84 years

We examined differences in response latencies obtained during a validated video-based hazard perception driving test between three healthy, community-dwelling groups: 22 mid-aged (35-55 years), 34 young-old (65-74 years), and 23 old-old (75-84 years) current drivers, matched for gender, education level, and vocabulary. We found no significant difference in performance between mid-aged and young-old groups, but the old-old group was significantly slower than the other two groups. The differences between the old-old group and the other groups combined were independently mediated by useful field of view (UFOV), contrast sensitivity, and simple reaction time measures. Given that hazard perception latency has been linked with increased crash risk, these results are consistent with the idea that increased crash risk in older adults could be a function of poorer hazard perception, though this decline does not appear to manifest until age 75+ in healthy drivers.

Railways, Urban Development and Town Planning in Britain: 1948–2008, Haywood R. Ashgate (2009). £65.00, ISBN: 9780754673927

This book is a thorough investigation of the relationship between land use planning and the railways in Britain, through review of the factors affecting the two sectors and their integration during the period of public ownership. The rationale behind the book is explained as a timely analysis of the dynamic correlation involving town planning and management of the railway in a period when growing congestion on the road network is forcing people to look for alternative modes and capacity is badly needed to accommodate this increased demand for travel. The book calls for a modal shift from road to rail for passenger and freight traffic.

Nutrition screening and risk factors prior to chemotherapy in cancer patients 65 years and older

Background The largest proportion of cancer patients are aged 65 years and over. Increasing age is also associated with nutritional risk and multi-morbidities—factors which complicate the cancer treatment decision-making process in older patients. Objectives To determine whether malnutrition risk and Body Mass Index (BMI) are associated with key oncogeriatric variables as potential predictors of chemotherapy outcomes in geriatric oncology patients with solid tumours. Methods In this longitudinal study, geriatric oncology patients (aged ≥65 years) received a Comprehensive Geriatric Assessment (CGA) for baseline data collection prior to the commencement of chemotherapy treatment. Malnutrition risk was assessed using the Malnutrition Screening Tool (MST) and BMI was calculated using anthropometric data. Nutritional risk was compared with other variables collected as part of standard CGA. Associations were determined by chi-square tests and correlations. Results Over half of the 175 geriatric oncology patients were at risk of malnutrition (53.1%) according to MST. BMI ranged from 15.5–50.9kg/m2, with 35.4% of the cohort overweight when compared to geriatric cutoffs. Malnutrition risk was more prevalent in those who were underweight (70%) although many overweight participants presented as at risk (34%). Malnutrition risk was associated with a diagnosis of colorectal or lung cancer (p=0.001), dependence in activities of daily living (p=0.015) and impaired cognition (p=0.049). Malnutrition risk was positively associated with vulnerability to intensive cancer therapy (rho=0.16, p=0.038). Larger BMI was associated with a greater number of multi-morbidities (rho =.27, p=0.001. Conclusions Malnutrition risk is prevalent among geriatric patients undergoing chemotherapy, is more common in colorectal and lung cancer diagnoses, is associated with impaired functionality and cognition and negatively influences ability to complete planned intensive chemotherapy.

Health Information Literacy and the Experience of 65 to 79 Year Old Australians

Information literacy is presented here from a relational perspective, as people’s experience of using information to learn in a particular context. A detailed practical example of such a context is provided, in the health information literacy experience of 65–79 year old Australians. A phenomenographic investigation found five qualitatively distinct ways of experiencing health information literacy: Absorbing (intuitive reception), Targeting (a planned process), Journeying (a personal quest), Liberating (equipping for independence) and Collaborating (interacting in community). These five ways of experiencing indicated expanding awareness of context (degree of orientation towards their environment), source (breadth of esteemed information), beneficiary (the scope of people who gain) and agency (amount of activity), across HIL core aspects of information, learning and health. These results illustrate the potential contribution of relational information literacy to information science.

Comparative studies of how living circumstances influence medication adherence in ≥ 65 year olds

Background Resources to help the older aged (≥65 year olds) manage their medicines should probably target those in greatest need. The older-aged have many different types of living circumstances. There are different locations (urban, rural), different types of housing (in the community or in retirement villages), different living arrangements (living alone or with others), and different socioeconomic status (SES) circumstances. However, there has been limited attention to whether these living circumstances affect adherence to medicines in the ≥65 year olds. Aim of the review The aim was to determine whether comparative studies, including logistic regression studies, show that living circumstances affect adherence to medicines by the ≥65 year olds. Methods A literature search of Medline, CINAHL and the Internet (Google) was undertaken. Results Four comparative studies have not shown differences in adherence to medicines between the ≥65 year olds living in rural and urban locations, but one study shows lower adherence to medicines for osteoporosis in rural areas compared to metropolitan, and another study shows greater adherence to antihypertensive medicines in rural than urban areas. There are no comparative studies of adherence to medicines in the older-aged living in indigenous communities compared to other communities. There is conflicting evidence as to whether living alone, being unmarried, or having a low income/worth is associated with nonadherence. Preliminary studies have suggested that the older-aged living in rental, low SES retirement villages or leasehold, middle SES retirement villages have a lower adherence to medicines than those living in freehold, high SES retirement villages. Conclusions The ≥65 year olds living in rural communities may need extra help with adherence to medicines for osteoporosis. The ≥65 year olds living in rental or leasehold retirement villages may require extra assistance/resources to adhere to their medicines. Further research is needed to clarify whether living under certain living circumstances (e.g. living alone, being unmarried, low income) has an effect on adherence, and to determine whether the ≥65 year olds living in indigenous communities need assistance to be adherent to prescribed medicines.

Development of near infrared analysis of faeces to estimate non-grass proportions in diets selected by cattle grazing tropical pastures

Grass (monocots) and non-grass (dicots) proportions in ruminant diets are important nutritionally because the non-grasses are usually higher in nutritive value, particularly protein, than the grasses, especially in tropical pastures. For ruminants grazing tropical pastures where the grasses are C-4 species and most non-grasses are C-3 species, the ratio of C-13/C-12 in diet and faeces, measured as delta C-13 parts per thousand, is proportional to dietary non-grass%. This paper describes the development of a faecal near infrared (NIR) spectroscopy calibration equation for predicting faecal delta C-13 from which dietary grass and non-grass proportions can be calculated. Calibration development used cattle faeces derived from diets containing only C-3 non-grass and C-4 grass components, and a series of expansion and validation steps was employed to develop robustness and predictive reliability. The final calibration equation contained 1637 samples and faecal delta C-13 range (parts per thousand) of [12.27]-[27.65]. Calibration statistics were: standard error of calibration (SEC) of 0.78, standard error of cross-validation (SECV) of 0.80, standard deviation (SD) of reference values of 3.11 and R-2 of 0.94. Validation statistics for the final calibration equation applied to 60 samples were: standard error of prediction (SEP) of 0.87, bias of -0.15, R-2 of 0.92 and RPD of 3.16. The calibration equation was also tested on faeces from diets containing C-4 non-grass species or temperate C-3 grass species. Faecal delta C-13 predictions indicated that the spectral basis of the calibration was not related to C-13/C-12 ratios per se but to consistent differences between grasses and non-grasses in chemical composition and that the differences were modified by photosynthetic pathway. Thus, although the calibration equation could not be used to make valid faecal delta C-13 predictions when the diet contained either C-3 grass or C-4 non-grass, it could be used to make useful estimates of dietary non-grass proportions. It could also be ut :sed to make useful estimates of non-grass in mixed C-3 grass/non-grass diets by applying a modified formula to calculate non-grass from predicted faecal delta C-13. The development of a robust faecal-NIR calibration equation for estimating non-grass proportions in the diets of grazing cattle demonstrated a novel and useful application of NIR spectroscopy in agriculture.

Plan Krivorogskogo okruga Bozhedarovskogo raĭona na uchastok zemli kolfonda N 65 poselok N 3

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Process variability-aware statistical hybrid modeling of dynamic power dissipation in 65 nm CMOS designs

A generalized technique is proposed for modeling the effects of process variations on dynamic power by directly relating the variations in process parameters to variations in dynamic power of a digital circuit. The dynamic power of a 2-input NAND gate is characterized by mixed-mode simulations, to be used as a library element for 65mn gate length technology. The proposed methodology is demonstrated with a multiplier circuit built using the NAND gate library, by characterizing its dynamic power through Monte Carlo analysis. The statistical technique of Response. Surface Methodology (RSM) using Design of Experiments (DOE) and Least Squares Method (LSM), are employed to generate a "hybrid model" for gate power to account for simultaneous variations in multiple process parameters. We demonstrate that our hybrid model based statistical design approach results in considerable savings in the power budget of low power CMOS designs with an error of less than 1%, with significant reductions in uncertainty by atleast 6X on a normalized basis, against worst case design.

Työhön liittyvä kilpailu 18 - 65-vuotiaiden pyhtääläisten kuvaamana

Tutkimuksen kohteena olivat Pyhtään työikäisten asukkaiden näkemykset ja kokemukset työssä esiintyvästä kilpailusta Tutkimusongelma oli työhön liittyvän kilpailun ilmiön hahmottaminen. Tutkimuksen tarkoitus oli valottaa työhön liittyvän kilpailun moninaisuutta antaen esimerkkejä sen eri muodoista, esittäen ajatuksia uusien tulkintojen tekemiselle ja herättäen ideoita kilpailun eri muotojen soveltamiselle työn ja työilmapiirin tutkimuksissa. Tavoitteena oli tutkia haastatteluissa esiintyviä tapoja käsittää työhön liittyvä kilpailu ja sitä, missä määrin eri ammateissa kuvattiin sosiaalista kilpailua verrattuna välineelliseen kilpailuun. Työyhteisöön samastumista tarkasteltiin kilpailun ja koetun oikeudenmukaisuuden näkökulmista. Työn arvostusta käsiteltiin tarkastellen haastateltujen käsitystä ammattinsa yleisestä arvostuksesta sekä haastateltujen omia arvioita ammatistaan, sekä millä tavalla ammattirooli nousi esiin haastateltujen itsen kuvauksissa. Työpaikan ihmissuhteita ja valtaa tarkasteltiin kohdistamalla huomio työtovereiden kanssa toimeen tulemiseen ja työpaikan ihmissuhteiden aiheuttamaan stressiin sekä haastateltujen työssään kokeman oman vaikutusvallan, tasavertaisuuden, epäreiluuden, arvostuksen ja kilpailun määrään. Selvitettiin myös miten vallankäyttöä ja kiusaamista kuvattiin ja millä tavalla vallankäytön ja kiusaamisen katsottiin edesauttavan tavoitteiden saavuttamisessa. Lopuksi tarkastelun kohteina olivat ongelmien käsittely, työssä viihtyminen ja viihtymiseen vaikuttavat seikat. Aineisto kerättiin Pyhtäällä kesällä 2007. Vastaajia oli yhteensä 245 ja vastausprosentti oli 50. Tutkimuksessa mukana olivat kalkki työilmapiiriä ja työpaikan ihmissuhteita koskeviin kysymyksiin vastanneet haastatellut (N = 167). Suurimmaksi osaksi tutkimus oli kuvailevaa, mutta siinä oli myös kvantitatiivista kysymyksenasettelua. Tutkimuksessa käytettiin sekä kvalitatiivisia että kvantitatiivisia analyysimenetelmiä. Puolistrukturoiduissa yksilöhaastatteluissa hyödynnettiin tulkitsevaa fenomenologista analyysia. Kirjattuja avovastauksia tutkittiin luokittavalla ja tulkitsevalla sisällönanalyysilla. Lisäksi laskettiin tilastollisia merkitsevyyksiä Työpaikalla esiintyvä kilpailu nähtiin haastateltujen selonteoissa hyvin moninaisena, sekä myönteisenä että haitallisena. Siihen ymmärrettiin kuuluvan niin resursseihin, työtehtäviin, tuloksiin ja palkkioihin liittyvää välineellistä kilpailua, kuin ihmisten välistä sosiaalista valtataisteluakin. Suhteessa välineelliseen kilpailuun sosiaalista kilpailua kuvattiin eniten hoiva- ja sosiaalialan ammateissa. Suhteessa sosiaaliseen kilpailuun välineellistä kilpailua kuvasivat eniten yrittäjät Vastausten perusteella suun kilpailun määrä korreloi työpaikan ihmissuhteiden aiheuttamaan stressiin, mutta vain silloin, kun kokemus työpaikan oikeudenmukaisuudesta oli matala. Kilpailun eri muotojen (kilpailu omien tavoitteiden saavuttamisesta vs. kilpailu organisaation tavoitteiden saavuttamisesta) väliset yhteydet työyhteisöön samastumiseen eivät aineistossa olleet tilastollisesti merkitseviä. Haastatellun arvio oman ammattinsa arvostuksesta ei myöskään ennustanut haastatellun todennäköisyyttä esittää itsensä ammattikuntansa edustajana avoimen itsen kuvauksen tilanteessa. Koettu oikeudenmukaisuus kuitenkin korreloi työyhteisöön samastumiseen. Mitä oikeudenmukaisempana haastatellut työpaikkaansa pitivät, sitä tärkeämmäksi samastumiskohteeksi he sen tyypillisesti arvioivat. Myös työssä viihtymisen ja työpaikan koetun oikeudenmukaisuuden välinen korrelaatio oli aineistossa voimakas. Lisäksi silloin, kun kokemus oikeudenmukaisuudesta oli matalalla tasolla, oli myös työpaikan ihmissuhteiden aiheuttama stressi yhteydessä vähäiseen työssä viihtymiseen. Tärkeimmät läheet tutkimuksessa olivat: Turner. John C 1975. Social comparison and social identity. Some prospects for intergroup behaviour. European Journal of Social Psychology, 5(1), 5-34. Haslam, S. Alexander 2004. Psychology in organizalions. The social identity approach Second Edition. London: SAGE Publications. Tyler, Tom - Blader. Steven 2000. Cooperation in Groups: Procedural Justice, Social Identity, and Behavioural Engagement. Essays in Social Psychology. Philadelphia: Psychology Press / Taylor & Francis Group. Kantolahti, T. - Tikander, T. 2010. Puheenvuoroja työn kuormittavuudesta. Sosiaali- ja terveysministeriön selvityksiä 2010:17

Studies of interfaces in Al-65 Cu20Fe15

The study of interfaces in quasicrystalline alloys is relatively new. Apart From the change in orientation, symmetry and chemistry which can occur across homophase and heterophase boundaries in crystalline materials, we have the additional, exciting possibility of an interface between quasicrystalline and its rational approximant. High resolution electron microscopy is a powerful technique to study the structural details of such interfaces. We report the results of a HREM study of the interface between the icosahedral phase and the related Al13Fe4 type monoclinic phase in melt spun and annealed Al65Cu20Fe15 alloy.

LiSr1.65 square 0.35B1.3B ' O-1.7(9) (B = Ti, Zr; B ' = Nb, Ta): New lithium ion conductors based on the perovskite structure

We describe the design and synthesis of new lithium ion conductors with the formula, LiSr(1.65)rectangle(0.35)B(1.3)B'O-1.7(9) (rectangle = vacancy; B = Ti, Zr; B' = Nb, Ta), on the basis of a systematic consideration of the composition-structure-property correlations in the well-known lithium-ion conductor, La-(2/3-x)Li(3x)rectangle((1/3)-2x)TiO3 (I), as well as the perovskite oxides in Li-A-B,B'-O (A = Ca, Sr, Ba; B = Ti, Zr; B' = Nb, Ta) systems. A high lithium-ion conductivity of ca. 0.12 S/cm at 360 degrees C is exhibited by LiSr(1.65)rectangle(0.35)Ti(1.3)Ta(1.7)O(9) (III) and LiSr(1.65)rectangle(0.35)Zr(1.3)Ta(1.7)O(9) (IV), of which the latter containing stable Zr(IV) and Ta(V) oxidation states is likely to be a candidate electrolyte material for all-solid-state lithium battery application. More importantly, we believe the approach described here could be extended to synthesize newer, possibly better, lithium ion conductors.