Expected impact of applying new 2013 AHA/ACC cholesterol guidelines criteria on the recommended lipid target achievement after acute coronary syndromes.

BACKGROUND 2013 AHA/ACC guidelines on the treatment of cholesterol advised to tailor high-intensity statin after ACS, while previous ATP-III recommended titration of statin to reach low-density lipoprotein cholesterol (LDL-C) targets. We simulated the impact of this change of paradigm on the achievement of recommended targets. METHODS Among a prospective cohort study of consecutive patients hospitalized for ACS from 2009 to 2012 at four Swiss university hospitals, we analyzed 1602 patients who survived one year after recruitment. Targets based on the previous guidelines approach was defined as (1) achievement of LDL-C target < 1.8 mmol/l, (2) reduction of LDL-C ≥ 50% or (3) intensification of statin in patients who did not reach LDL-C targets. Targets based on the 2013 AHA/ACC guidelines approach was defined as the maximization of statin therapy at high-intensity in patients aged ≤75 years and moderate- or high-intensity statin in patients >75 years. RESULTS 1578 (99%) patients were prescribed statin at discharge, with 1120 (70%) at high-intensity. 1507 patients (94%) reported taking statin at one year, with 909 (57%) at high-intensity. Among 482 patients discharged with sub-maximal statin, intensification of statin was only observed in 109 patients (23%). 773 (47%) patients reached the previous LDL-C targets, while 1014 (63%) reached the 2013 AHA/ACC guidelines targetsone year after ACS (p value < 0.001). CONCLUSION The application of the new 2013 AHA/ACC guidelines criteria would substantially increase the proportion of patients achieving recommended lipid targets one year after ACS. Clinical trial number, NCT01075868.

Sustainable transport and the impact on the built environment : Future trends and directions

We love the automobile and the independence that it gives us. We are more mobile than we have ever been before in recorded history. In Australia 80% of journeys are by private motor vehicle. But it is becoming increasingly obvious that this era has a very limited lifespan. Fuel prices have skyrocketed recently with no end in sight. In spite of massive amounts of road construction, our cities are becoming increasingly congested. We desperately need to address climate change and the automobile is a major contributor. Carbon trading schemes will put even more upward pressure on fuel prices. At some point in the near future, most of us will need to reconsider our automobile usage whether we like it or not. The time to plan for the future is now. But what will happen to our mobility when access to cheap and available petroleum becomes a thing of the past? Will we start driving electric/hydrogen/ethanol vehicles? Or will we flock to public transport? Will our public transport systems cope with a massive increase in demand? Will thousands of people take to alternatives such as bicycles? If so, where do we put them? How do we change our roads to cope? How do we change our buildings to suit? Will we need recharging stations in our car park for example? Some countries are less reliant on the car than others e.g. Holland and Germany. How can the rest of the world learn from them? This paper discusses many of the likely outcomes of the inevitable shift away from society’s reliance on petroleum and examines the expected impact on the built environment. It also looks at ways in which the built environment can be planned to help ease the transition to a fossil free world. 1.

Impact of IS/IT Investments on Firm Performance: Does Stakeholder Orientation Matter?

This research project addresses a central question in the IS business value field: Does IS/IT investments impact positively on firm financial performance? IS/IT investments are seen as having an enormous potential impact on the competitive position of the firm, on its performance, and demand an active and motivated participation of several stakeholder groups. Actual research conducted in the Information Systems field, relating IS/IT investments with firm performance use transactions costs economics and resource-based view of the firm to try to explain and understand that relationship. However, it lacks to stress the importance of stakeholder management, as a moderator variable in that relationship. Stakeholder theory sees the firm as the hub centric to the spokes representing various stakeholders who were in essence equidistant to the firm, and survival and continuing profitability of the corporation depend upon its ability to fulfil its economic and social purpose, which is to create and distribute wealth or value sufficient to ensure that each primary stakeholder group continues as part of the corporation’s stakeholder system. Stakeholder theory in its instrumental version, argues that if a firm pays attention to the stakes of all stakeholder groups (and not just shareholders), it will obtain higher levels of financial performance. With this premise in mind, the aim of this paper is to discuss and test the use of stakeholder theory in the IS business value stream of research, in order to achieve a better understanding of the impact of IS/IT investments on firm performance (moderated by stakeholder management). To achieve the expected impact from an IS/IT investment, it is argued that firms need a strong commitment from those stakeholder groups, which lead us to the need of a corporate “stakeholder orientation”. When firm financial performance is measured by returns on assets (ROA), returns on investments (ROI) and returns on sales (ROS), the results show that “stakeholder orientation” impact positively in the relation between IS/IT and firm performance, using a sample of Portuguese large companies.

Lighting the way: Towards reducing misorientation of olive ridley hatchlings due to artificial lighting at Rushikulya, India

Sea-finding behavior in sea turtle hatchlings is modified by the visual cues provided by artificial beach front lighting. The consequent landward movement of hatchlings in response to coastal electric lighting reduces their survival rates. We assessed the potential impact of coastal lighting at Rushikulya, an important mass nesting site of the olive ridley sea turtle (Lepidochelys olivacea) in the Indian Ocean region. We examined the response of hatchlings to light characteristics in an experimental setup, as well as to the existing lighting regimes along the beach, using arena trials. Previous studies on other species indicate preferential orientation towards low wavelength and high intensity light. Our study confirms these preferences among hatchlings from the Indian Ocean population of olive ridleys. In addition we also found that wavelength and intensity could have an interactive effect upon hatchling orientation. Hatchlings at the study site respond both to visible point sources of light and to sheer glows of light. Though beach plantations of introduced Casuarina equisetifolia are generally considered to have negative impacts on sea turtle nesting beaches, we found that they acted as an effective light barrier when planted about 50 m away from the high tide line. We developed a model of the expected impact of artificial lighting on hatchling orientation during mass hatching events of previous years, and predict as much as 50% misorientation in some years. We also developed a map representing the misorientation of hatchlings due to artificial lighting based on arena trials in different regions of the beach. The results of the study helped identify focal areas for light management on the beach, which could be critical for the survival of this population.

Uso de los recursos generados desde 2008 por las concesiones de sal de Zipaquirá y Nemocón y proyección de los ingresos hasta 2038

En primera instancia, con este trabajo se busca contextualizar a las personas del común acerca de las concesiones explicándoles qué es una concesión y cómo se relacionan con la economía. Adicional se explicará qué es la sal, cuáles son sus derivados y sus usos. En una segunda instancia, y en forma más concreta, se explicará en qué consisten las concesiones de sal de Nemocón y Zipaquirá, mostrando la manera como se han usado los recursos monetarios generados por dichas concesiones y determinando el grado de influencia que estos recursos han tenido sobre los proyectos que se esperan generen mayor beneficio a la comunidad. Finalmente, se proyectó el flujo de ingresos que el gobierno espera recibir por compensaciones generadas de las concesiones de sal hasta el año 2038 y de esta forma poder brindar, en valor presente, la cantidad de dinero en la que el gobierno podría llegar a endeudarse teniendo como garantía los ingresos que generarán las concesiones de las áreas mineras de sal de Nemocón y Zipaquirá.

Sponge layer feedbacks in middle-atmosphere models

Middle-atmosphere models commonly employ a sponge layer in the upper portion of their domain. It is shown that the relaxational nature of the sponge allows it to couple to the dynamics at lower levels in an artificial manner. In particular, the long-term zonally symmetric response to an imposed extratropical local force or diabatic heating is shown to induce a drag force in the sponge that modifies the response expected from the “downward control” arguments of Haynes et al. [1991]. In the case of an imposed local force the sponge acts to divert a fraction of the mean meridional mass flux upward, which for realistic parameter values is approximately equal to exp(−Δz/H), where Δz is the distance between the forcing region and the sponge layer and H is the density scale height. This sponge-induced upper cell causes temperature changes that, just below the sponge layer, are of comparable magnitude to those just below the forcing region. In the case of an imposed local diabatic heating, the sponge induces a meridional circulation extending through the entire depth of the atmosphere. This circulation causes temperature changes that, just below the sponge layer, are of opposite sign and comparable in magnitude to those at the heating region. In both cases, the sponge-induced temperature changes are essentially independent of the height of the imposed force or diabatic heating, provided the latter is located outside the sponge, but decrease exponentially as one moves down from the sponge. Thus the effect of the sponge can be made arbitrarily small at a given altitude by placing the sponge sufficiently high; e.g., its effect on temperatures two scale heights below is roughly at the 10% level, provided the imposed force or diabatic heating is located outside the sponge. When, however, an imposed force is applied within the sponge layer (a highly plausible situation for parameterized mesospheric gravity-wave drag), its effect is almost entirely nullified by the sponge-layer feedback and its expected impact on temperatures below largely fails to materialize. Simulations using a middle-atmosphere general circulation model are described, which demonstrate that this sponge-layer feedback can be a significant effect in parameter regimes of physical interest. Zonally symmetric (two dimensional) middle-atmosphere models commonly employ a Rayleigh drag throughout the model domain. It is shown that the long-term zonally symmetric response to an imposed extratropical local force or diabatic heating, in this case, is noticeably modified from that expected from downward control, even for a very weak drag coefficient

Den nya kassaregisterlagen

The government appointed in 2004 a special investigator with the objective to investigate the possibility of introducing a new law concerning implementation of obligatory cash registers with certain certification. This resulted in SOU 2005:35 ”Krav på kassaregister - Effektivare utredning av skattebrott” (Proposition 2006/07: 105). Following advice received from the respondents, the government has drafted a bill submitted to parliament in March 2007. Government bill 2006/07: 105 proposals for new law on cash registers, and submitted to parliament 2007th Act (2007:592) on the cash register was adopted by parliament in March that year and came into force on 1 January 2010. Earlier great opportunities for tax cheating has been available by various methods so as to simply not punch in a sale at the checkout, use the training function type, use receipt copies, manipulate register functions on its program level, using alternative programming etc. These opportunities are eliminated in the certified cash registers. Respondent traders believed the most part has not changed the competition or that the change will be relatively small. They also thought it was too early to see any change at this time. A tendency among traders we have asked is that they feel negatively for the costs it imposes, with the new registry and that they are skeptical about the expected impact of the law, among others due to the scarce resources spent on follow-up. The Swedish tax agency is responsible for control and the new systems make it easier for Tax control, but actual physical on-scene control must be performed to detect irregularities.

Generality is predictive of prediction accuracy

During knowledge acquisition multiple alternative potential rules all appear equally credible. This paper addresses the dearth of formal analysis about how to select between such alternatives. It presents two hypotheses about the expected impact of selecting between classification rules of differing levels of generality in the absence of other evidence about their likely relative performance on unseen data. It is argued that the accuracy on unseen data of the more general rule will tend to be closer to that of a default rule for the class than will that of the more specific rule. It is also argued that in comparison to the more general rule, the accuracy of the more specific rule on unseen cases will tend to be closer to the accuracy obtained on training data. Experimental evidence is provided in support of these hypotheses. We argue that these hypotheses can be of use in selecting between rules in order to achieve specific knowledge acquisition objectives.

Política de formação docente na América Latina :Argentina, Brasil e Chile

This work aims at studying the policies of teaching training and their impact in the actors and in the education systems of the countries in which these policies were implemented into the context of neoliberal reforms. We particularly studied these policies in three Latin America countries: Argentina, Brazil and Chile. The policies studied here are the ones implemented from the 90 s. However, the horizon of this study is at the beginning of the 80 s, period that starts one of the four intervention initiatives of education here studied: The Main Project of Education For Latin America and Caribbean (PROMEDLAC), which in 2002 goes into a new stage and it is called Regional Project of Education for Latin America and Caribbean (PRELAC), worked out by UNESCO as a request of government representatives of countries of the region, based on the suggestions of Declaration of Mexico , signed by them in 1979. These suggestions will be in the base of the other three initiatives: The Education For All (EPT); Ibero-American Conferences of Education (CIE) and The Hemisphere Action Plan of Education (PAHE), whose documents are the base to the production of an abundant legislation and normatization on education that created the parameters on which the policies of education reforms were worked out and implemented and the dynamism of our education systems from the last two decades of the twentieth century on. All these initiatives intend to work with objectives, projects and programs that, in some cases, in isolation or in groups, are under influence of their actions in a way that frequently it is difficult to identify which of them is the main responsible for some advances. It is important to stand out that not all of the suggestions produced by these initiatives were implemented as policies, and many of them to be implemented were changed in such a way that they were distorted, even they were a result of a multilateral deal, each country gave to them its own interpretation. Moreover, in all these processes the teaching entities had and keep having a fundamental role. The evidences, result of the evaluations of each initiative, show that education policies implemented produced advances in several aspects. They are still not the ideal ones, in truth, but they do exist. In relation to the teaching questions, there were and are still being implemented multiples and varied actions that did not have the expected impact in the education systems of the countries, objects of this study, but, many of them that go on, are promising and start to have a positive impact into the education systems. Even so, the teaching subject matter, even playing a central role in the agenda of all countries of the region, still represents one of the big challenges to the advance and improvement of our education systems

Groundwater resources in Brazil: a review of possible impacts caused by climate change

Groundwater has a strategic role in times of climate change mainly because aquifers can provide water for long periods, even during very long and severe drought. The reduction and/or changes on the precipitation pattern can diminish the recharge mainly in unconfined aquifer, causing available groundwater restriction. The expected impact of long-term climate changes on the Brazilian aquifers for 2050 will lead to a severe reduction in 70% of recharge in the Northeast region aquifers (comparing to 2010 values), varying from 30% to 70% in the North region. Data referring to the South and Southeast regions are more favorable, with an increase in the relative recharge values from 30% to 100%. Another expected impact is the increase in demand and the decrease in the surface water availability that will make the population turn to aquifers as its main source of water for public or private uses in many regions of the country. Thus, an integrated use of surface and groundwater must therefore be considered in the water use planning. The solution of water scarcity is based on three factors: society growth awareness, better knowledge on the characteristics of hydraulic and chemical aquifers and effective management actions.

Development of the optimal estimation method for inversion of stratospheric emission spectra and validation of HNO3 profiles

This doctoral thesis focuses on ground-based measurements of stratospheric nitric acid (HNO3)concentrations obtained by means of the Ground-Based Millimeter-wave Spectrometer (GBMS). Pressure broadened HNO3 emission spectra are analyzed using a new inversion algorithm developed as part of this thesis work and the retrieved vertical profiles are extensively compared to satellite-based data. This comparison effort I carried out has a key role in establishing a long-term (1991-2010), global data record of stratospheric HNO3, with an expected impact on studies concerning ozone decline and recovery. The first part of this work is focused on the development of an ad hoc version of the Optimal Estimation Method (Rodgers, 2000) in order to retrieve HNO3 spectra observed by means of GBMS. I also performed a comparison between HNO3 vertical profiles retrieved with the OEM and those obtained with the old iterative Matrix Inversion method. Results show no significant differences in retrieved profiles and error estimates, with the OEM providing however additional information needed to better characterize the retrievals. A final section of this first part of the work is dedicated to a brief review on the application of the OEM to other trace gases observed by GBMS, namely O3 and N2O. The second part of this study deals with the validation of HNO3 profiles obtained with the new inversion method. The first step has been the validation of GBMS measurements of tropospheric opacity, which is a necessary tool in the calibration of any GBMS spectra. This was achieved by means of comparisons among correlative measurements of water vapor column content (or Precipitable Water Vapor, PWV) since, in the spectral region observed by GBMS, the tropospheric opacity is almost entirely due to water vapor absorption. In particular, I compared GBMS PWV measurements collected during the primary field campaign of the ECOWAR project (Bhawar et al., 2008) with simultaneous PWV observations obtained with Vaisala RS92k radiosondes, a Raman lidar, and an IR Fourier transform spectrometer. I found that GBMS PWV measurements are in good agreement with the other three data sets exhibiting a mean difference between observations of ~9%. After this initial validation, GBMS HNO3 retrievals have been compared to two sets of satellite data produced by the two NASA/JPL Microwave Limb Sounder (MLS) experiments (aboard the Upper Atmosphere Research Satellite (UARS) from 1991 to 1999, and on the Earth Observing System (EOS) Aura mission from 2004 to date). This part of my thesis is inserted in GOZCARDS (Global Ozone Chemistry and Related Trace gas Data Records for the Stratosphere), a multi-year project, aimed at developing a long-term data record of stratospheric constituents relevant to the issues of ozone decline and expected recovery. This data record will be based mainly on satellite-derived measurements but ground-based observations will be pivotal for assessing offsets between satellite data sets. Since the GBMS has been operated for more than 15 years, its nitric acid data record offers a unique opportunity for cross-calibrating HNO3 measurements from the two MLS experiments. I compare GBMS HNO3 measurements obtained from the Italian Alpine station of Testa Grigia (45.9° N, 7.7° E, elev. 3500 m), during the period February 2004 - March 2007, and from Thule Air Base, Greenland (76.5°N 68.8°W), during polar winter 2008/09, and Aura MLS observations. A similar intercomparison is made between UARS MLS HNO3 measurements with those carried out from the GBMS at South Pole, Antarctica (90°S), during the most part of 1993 and 1995. I assess systematic differences between GBMS and both UARS and Aura HNO3 data sets at seven potential temperature levels. Results show that, except for measurements carried out at Thule, ground based and satellite data sets are consistent within the errors, at all potential temperature levels.

The role of reinfection and partner notification in the efficacy of Chlamydia screening programs

Repeated Chlamydia trachomatis infections after treatment are common. One reason is reinfection from untreated partners in ongoing sexual partnerships. Mathematical models that are used to predict the impact of screening on reducing chlamydia prevalence often do not incorporate reinfection and might overestimate the expected impact. We describe a pair compartmental model that explicitly incorporates sexual partnership duration and reinfection. The pair model predicts a weaker impact of screening when compared directly with a model that does not accommodate partnerships. Effective management of sex partners to prevent reinfection might need to be strengthened in chlamydia control programs.

Barriers to a wider Implementation of LMS in Higher Education: a Swedish case study, 2006-2011

This article investigates barriers to a wider utilization of a Learning Management System (LMS). The study aims to identify the reasons why some tools in the LMS are rarely used, in spite of assertions that the learning experience and students’ performance can be improved by interaction and collaboration, facilitated by the LMS. Lecturers’ perceptions about the use of LMSs over the last four years at the School of Engineering, University of Borås were investigated. Seventeen lecturers who were interviewed in 2006 were interviewed again in 2011. The lecturers’ still use the LMS primarily for distribution of documents and course administration. The results indicate that their attitudes have not changed significantly. The apparent reluctance to utilize interactive features in the LMS is analyzed, by looking at the expected impact on the lecturers’ work situation. The author argues that the main barrier to a wider utilization of LMS is the lecturers’ fear of additional demands on their time. Hence, if educational institutions want a wider utilization of LMS, some kind of incentives for lecturers are needed, in addition to support and training.

Impacto del cambio climático sobre los usos del agua en Europa

Esta Tesis realiza una contribución metodológica al estudio del impacto del cambio climático sobre los usos del agua, centrándose particularmente en la agricultura. Tomando en consideración su naturaleza distinta, la metodología aborda de forma integral los impactos sobre la agricultura de secano y la agricultura de regadío. Para ello incorpora diferentes modelos agrícolas y de agua que conjuntamente con las simulaciones de los escenarios climáticos permiten determinar indicadores de impacto basados en la productividad de los cultivos, para el caso de la agricultura de secano, e indicadores de impacto basados en la disponibilidad de agua para irrigación, para el caso de la agricultura de regadío. La metodología toma en consideración el efecto de la variabilidad climática en la agricultura, evaluando las necesidades de adaptación y gestión asociadas a los impactos medios y a la variabilidad en la productividad de los cultivos y el efecto de la variabilidad hidrológica en la disponibilidad de agua para regadío. Considerando la gran cantidad de información proporcionada por las salidas de las simulaciones de los escenarios climáticos y su complejidad para procesarla, se ha desarrollado una herramienta de cálculo automatizada que integra diferentes escenarios climáticos, métodos y modelos que permiten abordar el impacto del cambio climático sobre la agricultura, a escala de grandes extensiones. El procedimiento metodológico parte del análisis de los escenarios climáticos en situación actual (1961-1990) y futura (2071-2100) para determinar su fiabilidad y conocer qué dicen exactamente las proyecciones climáticas a cerca de los impactos esperados en las principales variables que intervienen en el ciclo hidrológico. El análisis hidrológico se desarrolla en los ámbitos territoriales de la planificación hidrológica en España, considerando la disponibilidad de información para validar los resultados en escenario de control. Se utilizan como datos observados las series de escorrentía en régimen natural estimadas el modelo hidrológico SIMPA que está calibrado en la totalidad del territorio español. Al trabajar a escala de grandes extensiones, la limitada disponibilidad de datos o la falta de modelos hidrológicos correctamente calibrados para obtener los valores de escorrentía, muchas veces dificulta el proceso de evaluación, por tanto, en este estudio se plantea una metodología que compara diferentes métodos de interpolación y alternativas para generar series anuales de escorrentía que minimicen el sesgo con respecto a los valores observados. Así, en base a la alternativa que genera los mejores resultados, se obtienen series mensuales corregidas a partir de las simulaciones de los modelos climáticos regionales (MCR). Se comparan cuatro métodos de interpolación para obtener los valores de las variables a escala de cuenca hidrográfica, haciendo énfasis en la capacidad de cada método para reproducir los valores observados. Las alternativas utilizadas consideran la utilización de la escorrentía directa simulada por los MCR y la escorrentía media anual calculada utilizando cinco fórmulas climatológicas basadas en el índice de aridez. Los resultados se comparan además con la escorrentía global de referencia proporcionada por la UNH/GRDC que en la actualidad es el “mejor estimador” de la escorrentía actual a gran escala. El impacto del cambio climático en la agricultura de secano se evalúa considerando el efecto combinado de los riesgos asociados a las anomalías dadas por los cambios en la media y la variabilidad de la productividad de los cultivos en las regiones agroclimáticas de Europa. Este procedimiento facilita la determinación de las necesidades de adaptación y la identificación de los impactos regionales que deben ser abordados con mayor urgencia en función de los riesgos y oportunidades identificadas. Para ello se utilizan funciones regionales de productividad que han sido desarrolladas y calibradas en estudios previos en el ámbito europeo. Para el caso de la agricultura de regadío, se utiliza la disponibilidad de agua para irrigación como un indicador del impacto bajo escenarios de cambio climático. Considerando que la mayoría de estudios se han centrado en evaluar la disponibilidad de agua en régimen natural, en este trabajo se incorpora el efecto de las infraestructuras hidráulicas al momento de calcular el recurso disponible bajo escenarios de cambio climático Este análisis se desarrolla en el ámbito español considerando la disponibilidad de información, tanto de las aportaciones como de los modelos de explotación de los sistemas hidráulicos. Para ello se utiliza el modelo de gestión de recursos hídricos WAAPA (Water Availability and Adaptation Policy Assessment) que permite calcular la máxima demanda que puede atenderse bajo determinados criterios de garantía. Se utiliza las series mensuales de escorrentía observadas y las series mensuales de escorrentía corregidas por la metodología previamente planteada con el objeto de evaluar la disponibilidad de agua en escenario de control. Se construyen proyecciones climáticas utilizando los cambios en los valores medios y la variabilidad de las aportaciones simuladas por los MCR y también utilizando una fórmula climatológica basada en el índice de aridez. Se evalúan las necesidades de gestión en términos de la satisfacción de las demandas de agua para irrigación a través de la comparación entre la disponibilidad de agua en situación actual y la disponibilidad de agua bajo escenarios de cambio climático. Finalmente, mediante el desarrollo de una herramienta de cálculo que facilita el manejo y automatización de una gran cantidad de información compleja obtenida de las simulaciones de los MCR se obtiene un proceso metodológico que evalúa de forma integral el impacto del cambio climático sobre la agricultura a escala de grandes extensiones, y a la vez permite determinar las necesidades de adaptación y gestión en función de las prioridades identificadas. ABSTRACT This thesis presents a methodological contribution for studying the impact of climate change on water use, focusing particularly on agriculture. Taking into account the different nature of the agriculture, this methodology addresses the impacts on rainfed and irrigated agriculture, integrating agricultural and water planning models with climate change simulations scenarios in order to determine impact indicators based on crop productivity and water availability for irrigation, respectively. The methodology incorporates the effect of climate variability on agriculture, assessing adaptation and management needs associated with mean impacts, variability in crop productivity and the effect of hydrologic variability on water availability for irrigation. Considering the vast amount of information provided by the outputs of the regional climate model (RCM) simulations and also its complexity for processing it, a tool has been developed to integrate different climate scenarios, methods and models to address the impact of climate change on agriculture at large scale. Firstly, a hydrological analysis of the climate change scenarios is performed under current (1961-1990) and future (2071-2100) situation in order to know exactly what the models projections say about the expected impact on the main variables involved in the hydrological cycle. Due to the availability of information for validating the results in current situation, the hydrological analysis is developed in the territorial areas of water planning in Spain, where the values of naturalized runoff have been estimated by the hydrological model SIMPA, which are used as observed data. By working in large-scale studies, the limited availability of data or lack of properly calibrated hydrological model makes difficult to obtain runoff time series. So as, a methodology is proposed to compare different interpolation methods and alternatives to generate annual times series that minimize the bias with respect to observed values. Thus, the best alternative is selected in order to obtain bias-corrected monthly time series from the RCM simulations. Four interpolation methods for downscaling runoff to the basin scale from different RCM are compared with emphasis on the ability of each method to reproduce the observed behavior of this variable. The alternatives consider the use of the direct runoff of the RCMs and the mean annual runoff calculated using five functional forms of the aridity index. The results are also compared with the global runoff reference provided by the UNH/GRDC dataset, as a contrast of the “best estimator” of current runoff on a large scale. Secondly, the impact of climate change on rainfed agriculture is assessed considering the combined effect of the risks associated with anomalies given by changes in the mean and variability of crop productivity in the agro-climatic regions of Europe. This procedure allows determining adaptation needs based on the regional impacts that must be addressed with greater urgency in light of the risks and opportunities identified. Statistical models of productivity response are used for this purpose which have been developed and calibrated in previous European study. Thirdly, the impact of climate change on irrigated agriculture is evaluated considering the water availability for irrigation as an indicator of the impact. Given that most studies have focused on assessing water availability in natural regime, the effect of regulation is incorporated in this approach. The analysis is developed in the Spanish territory considering the available information of the observed stream flows and the regulation system. The Water Availability and Adaptation Policy Assessment (WAAPA) model is used in this study, which allows obtaining the maximum demand that could be supplied under certain conditions (demand seasonal distribution, water supply system management, and reliability criteria) for different policy alternatives. The monthly bias corrected time series obtained by previous methodology are used in order to assess water availability in current situation. Climate change projections are constructed taking into account the variation in mean and coefficient of variation simulated by the RCM. The management needs are determined by the agricultural demands satisfaction through the comparison between water availability under current conditions and under climate change projections. Therefore, the methodology allows evaluating the impact of climate change on agriculture to large scale, using a tool that facilitates the process of a large amount of complex information provided by the RCM simulations, in order to determine the adaptation and management needs in accordance with the priorities of the indentified impacts.

Modelado experimental de un sistema de e-Salud aplicado en cooperación al desarrollo

Los Objetivos de Desarrollo del Milenio comprometieron a los países con una nueva alianza mundial de alcanzar gradualmente una cobertura universal de los niveles mínimos de bienestar en los países en desarrollo (reducir la pobreza y el hambre y dar respuesta a problemas como la mala salud, las desigualdades de género, la falta de educación, el acceso a agua salubre y la degradación ambiental). Para dar continuidad a esta iniciativa, recientemente en septiembre de 2015, la ONU promulgó la declaración de los Objetivos de Desarrollo Sostenible. Los ODM sitúan la salud en el corazón del desarrollo y establecen un novedoso pacto mundial que vincula a los países desarrollados y los países en desarrollo por medio de obligaciones claras y recíprocas. En este sentido, diversos organismos de cooperación a través de sus programas de cooperación internacional, tratan de mejorar el acceso a la asistencia sanitaria, especialmente a la población vulnerable que vive en zonas rurales de países en desarrollo. Con el fin de ayudar a cumplir los ODM que apoyan los temas de salud en dicha población, estos organismos desarrollan proyectos que despliegan sistemas de e-salud. Las intervenciones se enfrentan a múltiples retos: condicionantes de los países en desarrollo, las necesidades y demandas de los sistemas sanitarios y la complejidad de implantar las TIC en entornos complejos y altamente dinámicos como son los países en desarrollo. Estos condicionantes ocasionan la mayoría de proyectos fallidos que terminan convirtiéndose en soluciones aisladas, que anteponen la tecnología a las necesidades de la población y no generan el impacto esperado en su desarrollo. En este contexto tuvo origen esta tesis doctoral, que persigue como objetivo analizar, planificar, diseñar, verificar y validar un marco arquitectónico de implantación de sistemas de e-salud en áreas rurales de países en desarrollo, que promueva el mejoramiento de la calidad de vida de la población vulnerable de estas regiones y la efectividad de las intervenciones de e-salud en el marco de proyectos de cooperación al desarrollo. Para lograrlo, tomé como punto de partida, diversas estrategias, modelos, metodologías de implantación de e-salud, modelos de gestión de proyectos propuestos por distintos organismos internacionales y propuse una instanciación de estos modelos a proyectos de implantación de sistemas de e-salud en países en desarrollo. Apliqué la metodología action research y los enfoques twin track, middle out y design thinking que me permitieron el refinamiento iterativo del modelo propuesto en la tesis doctoral mediante el trabajo de campo realizado en dos zonas rurales de países de Centroamérica: Jocotán (Guatemala) y San José de Cusmapa (Nicaragua). Como resultado obtuve un modelo experimental basado en cuatro componentes: un modelo de referencia tipo, un modelo conceptual de e-salud, los procesos de gestión y de implantación de sistemas de e-salud en países en desarrollo y una arquitectura de referencia. El modelo experimental resultante aporta herramientas importantes para el despliegue de sistemas de e-salud en países en desarrollo. Se ha propuesto un modelo de referencia que proporciona una visión holística del contexto del país en desarrollo donde se desarrollarán las intervenciones. Un modelo conceptual de e-salud que representa los principales conceptos involucrados en un sistema de e-salud. Los procesos ii- de gestión del proyecto y de implantación del sistema que proporcionan a los grupos de cooperación, herramientas para el análisis, diseño, desarrollo y despliegue de los sistemas de e-salud en áreas rurales de países en desarrollo. Y finalmente la arquitectura de referencia que sienta las bases para la aplicación de estos procesos a un contexto en particular. Las líneas futuras de trabajo sugieren extender el modelo a más casos de estudio que permitan su refinamiento y evaluar los futuros usos que pueden surgir de los sistemas de e-salud resultantes. ABSTRACT Millennium Development Goals (MDGs) committing the countries with a new global partnership to achieve universal coverage of minimum levels of well-being in Developing Countries (for addressing extreme poverty in its many dimensions-income poverty, hunger, disease, lack of adequate housing, and exclusion-while promoting gender equality, education, and environmental sustainability). From September 2015, these goals are replaces with Sustainable Development Goals (SDGs). The MDG place health at the heart of development and establish a novel global compact, linking developed and developing countries through clear, reciprocal obligations. Many public and private institutions promote international cooperation programs to support in achieving the MDGs. Some of these cooperation programs deal improving access to healthcare to poor people living in isolated areas from developing countries. In order to accomplish this goal organizations perform projects (interventions or cooperation projects) that deploy e-health systems in these zones. Nevertheless, this kind of projects face multiple challenges that dismiss the effectiveness of the projects results. In particular, cooperation teams face issues such as constraints in developing countries, lack of electrical and ICT infrastructure, scarce transport, extreme climate conditions, lack ICT capacity, lack of access to healthcare and inefficient delivery methods, etc. Hence, these issues increase the complexity of implementing e-health in developing countries and then causes the most projects fail. In other words, the solutions do not meet population needs and do not generate the expected impact on development. This context is the starting point of this doctoral thesis, which deals with analysing, planning, designing, testing and validating an architectural framework in order to implement e-health systems in rural areas from developing countries, promote development of the population in these regions, and thus improve the impact of interventions of development cooperation projects. To achieve this goal, I took as a starting point the strategies, models, e-health implementation methodologies and projects management models proposed by various international agencies. Then I proposed an instantiation of these models to manage the intervention and implement e-health systems in developing countries. I applied the action research methodology and the approaches twin track, middle out and design thinking which allowed me the iterative refinement of the model proposed in this doctoral thesis. The proposed framework was validated by running two cases studies in rural areas of Central America: Jocotán (Guatemala) and San José de Cusmapa (Nicaragua). As a result, I obtained an experimental model based on four components: a Type reference model, an e-health conceptual model, both process management and implementation e-health systems in developing countries and a reference architecture. The resulting experimental model provides important tools for the deployment of e-health systems in developing countries. The model become as reference model that provides a holistic view of the developing countries context where the interventions will be running. The conceptual model of e-health represents the main concepts involved into an e-health system. The project management and implementation processes of the iv- system provide to the cooperation teams with tools for analysing, designing, developing and deploying e-health systems in rural areas from developing countries. Finally, the reference architecture provides the basis for the implementation of these processes into a particular context. The future research suggest the extension the model to other cases studies in order to refine and evaluate the viability the model.