Impacto de la prestación de servicios de salud bajo el modelo de red en el municipio de Sogamoso

El presente estudio es de tipo analítico, cohorte retrospectiva, tiene como objeto estudiar un modelo de prestación de servicios de salud bajo el concepto de red integrada, conformada por las clínicas privadas de segundo y tercer nivel de complejidad del municipio de Sogamoso (Boyacá). Se analizó el período comprendido entre los años 2012 a 2014, donde se puede evidenciar la implementación y puesta en marcha del modelo. En el mes de agosto del año 2012, la estrategia de asociatividad la adelantaron las tres instituciones de manera libre y autónoma, utilizando como guía la metodología propuesta por la Cepal en el año 2010; las diferencias entre esta metodología y el modelo utilizado se deben a las particularidades de las clínicas y del contexto en el que se desarrolló. Este modelo de atención surgió de la necesidad de prestar los servicios de salud ofertados por las clínicas, acorde con su capacidad instalada, al total de la población de la Nueva EPS en Sogamoso, que en ese momento coyuntural no se estaba cumpliendo en el municipio, y ninguna de las instituciones tenía la infraestructura individual para atender a toda su población. El resultado de la asociación de las tres clínicas se logró gracias a un grado de confianza previo entre los directivos de las instituciones y posterior a varias reuniones, en las que se tomó la determinación de trabajar con el modelo de Unión Temporal, ya que no son una persona jurídica diferente a las que la conforman Se demuestra el impacto de este modelo asociativo de cada una de las organizaciones que la componen evaluando cuatro ámbitos como la capacidad de aprendizaje, capacidad de gestión estratégica, economía de escala y poder de negociación y externalidades. Para la recolección de la información se utilizaron las bases de datos de las instituciones hospitalarias con la información de los indicadores de oportunidad, así como el incremento de la facturación y del recaudo antes y después de la formación de la Unión Temporal; adicionalmente se realizaron encuestas a los directores de las clínicas como fuente de información para desarrollo de nuevos productos, reducción de costos, ampliación de la oferta hospitalaria, establecimientos de alianza, puesta en marcha de servicios comunes y apertura de nuevos mercados. Sumado a lo anterior, se realizó una encuesta adicional a los usuarios del nuevo producto desarrollado. Como resultado de este estudio se encuentra beneficio en todos los ámbitos evaluados para las instituciones que interactúan bajo este modelo y se espera que obtengan los mismos beneficios que los demás actores participantes en él, como las EAPB, los cuales no hacen parte del presente estudio. En Colombia no se observa la existencia de un modelo similar en sistema de salud, a pesar del leve intento de la Ley 1438 del 2011 por iniciar la conformación de redes; por esta razón se puede decir que este estudio marca un derrotero para que las organizaciones de salud tengan un modelo de articulación ante la falta de desarrollos de esquemas de red y por tratarse de un modelo con ausencia de reglamentación.

Detection of Horizontal Two-Phase Flow Patterns Through a Neural Network Model

One of the main problems related to the transport and manipulation of multiphase fluids concerns the existence of characteristic flow patterns and its strong influence on important operation parameters. A good example of this occurs in gas-liquid chemical reactors in which maximum efficiencies can be achieved by maintaining a finely dispersed bubbly flow to maximize the total interfacial area. Thus, the ability to automatically detect flow patterns is of crucial importance, especially for the adequate operation of multiphase systems. This work describes the application of a neural model to process the signals delivered by a direct imaging probe to produce a diagnostic of the corresponding flow pattern. The neural model is constituted of six independent neural modules, each of which trained to detect one of the main horizontal flow patterns, and a last winner-take-all layer responsible for resolving when two or more patterns are simultaneously detected. Experimental signals representing different bubbly, intermittent, annular and stratified flow patterns were used to validate the neural model.

An interaction and network perspective of horizontal relationships in the portuguese pharmaceutical industry

Doutoramento em Gestão

Regulation of horizontal gene transfer of the catabolic island ICEclc

ICEclc is a mobile genetic element found in two copies on the chromosome of the bacterium Pseudomonas knackmussii B13. ICEclc harbors genes encoding metabolic pathways for the degradation of chlorocatechols (CLC) and 2-aminophenol (2AP). At low frequencies, ICEclc excises from the chromosome, closes into a circular DNA molecule which can transfer to another bacterium via conjugation. Once in the recipient cell, ICEclc can reintegrate into the chromosome by site-specific recombination. This thesis aimed at identifying the regulatory network underlying the decisions for ICEclc horizontal transfer (HGT). The first chapter is an introduction on integrative and conjugative elements (ICEs) more in general, of which ICEclc is one example. In particular I emphasized the current knowledge of regulation and conjugation machineries of the different classes of ICE. In the second chapter, I describe a transcriptional analysis using microarrays and other experiments to understand expression of ICEclc in exponential and stationary phase. By overlaying transcriptomic profiles with Northern hybridizations and RT- PCR data, we established a transcription map for the entire core region of ICEclc, a region assumed to encode the ICE conjugation process. We also demonstrated how transcription of the ICEclc core is maximal in stationary phase, which correlates to expression of reporter genes fused to key ICEclc promoters. In the third chapter, I present a transcriptome analysis of ICEclc in a variety of different host species, in order to explore whether there are species-specific differences. In the fourth chapter, I focus on the role of a curious ICEclc-encoded TetR-type transcriptional repressor. We find that this gene, which we name mfsR, not only controls its own expression but that of a set of genes for a putative multi-drug efflux pump (mfsABC) as well. By using a combination of biochemical and molecular biology techniques, I could show that MfsR specifically binds to operator boxes in two ICEclc promoters (PmfsR and PmfsA), inhibiting the transcription of both the mfsR and mfsABC-orf38184 operons. Although we could not detect a clear phenotype of an mfsABC deletion, we discuss the implications of pump gene reorganizations in ICEclc and close relatives. In the fifth chapter, we find that mfsR not only controls its own expression and that of the mfsABC operon, but is also indirectly controlling ICEclc transfer. Using gene deletions, microarrays, transfer assays and microscopy-based reporter fusions, we demonstrate that mfsR actually controls a small operon of three regulatory genes. The last gene of this mfsR operon, orf17162, encodes a LysR-type activator that when deleted strongly impairs ICEclc transfer. Interestingly, deletion of mfsR leads to transfer competence in almost all cells, thereby overruling the bistability process in the wild-type. In the final sixth chapter, I discuss the relevance of the present thesis and the resulting perspectives for future studies.

Quantifying network properties in multi-electrode recordings: spatiotemporal characterization and inter-trial variation of evoked gamma oscillations in mouse somatosensory cortex in vitro.

Linking the structural connectivity of brain circuits to their cooperative dynamics and emergent functions is a central aim of neuroscience research. Graph theory has recently been applied to study the structure-function relationship of networks, where dynamical similarity of different nodes has been turned into a "static" functional connection. However, the capability of the brain to adapt, learn and process external stimuli requires a constant dynamical functional rewiring between circuitries and cell assemblies. Hence, we must capture the changes of network functional connectivity over time. Multi-electrode array data present a unique challenge within this framework. We study the dynamics of gamma oscillations in acute slices of the somatosensory cortex from juvenile mice recorded by planar multi-electrode arrays. Bursts of gamma oscillatory activity lasting a few hundred milliseconds could be initiated only by brief trains of electrical stimulations applied at the deepest cortical layers and simultaneously delivered at multiple locations. Local field potentials were used to study the spatio-temporal properties and the instantaneous synchronization profile of the gamma oscillatory activity, combined with current source density (CSD) analysis. Pair-wise differences in the oscillation phase were used to determine the presence of instantaneous synchronization between the different sites of the circuitry during the oscillatory period. Despite variation in the duration of the oscillatory response over successive trials, they showed a constant average power, suggesting that the rate of expenditure of energy during the gamma bursts is consistent across repeated stimulations. Within each gamma burst, the functional connectivity map reflected the columnar organization of the neocortex. Over successive trials, an apparently random rearrangement of the functional connectivity was observed, with a more stable columnar than horizontal organization. This work reveals new features of evoked gamma oscillations in developing cortex.

The Politics of Network Governance in Europe: The Case of Energy Regulation

Networks are considered increasingly important for policy-making. The literature on new modes of governance in Europe suggests that their horizontal coordination capacity and flexible and informal structures are particularly suitable for governing the multilevel architecture of the European polity. However, empirical evidence about the effects of networks on policy-making and public policies is still quite limited. This article uses the case of the European network of energy regulators to explore the determinants of the position of network members and, in turn, the domestic adoption of soft rules developed within this network. The empirical analysis, based on multivariate statistics and semi-directive interviews, supports the expectation that institutional complementarities increase actors' centrality in networks, while arguments based on organisational resources and age are disproved. Furthermore, results show that the overall level of adoption is considerable and that centrality might have a small positive effect on domestic adoption.

Eficacia e ineficacia de la comunicación horizontal en los movimientos sociales. Caso análisis: Oposiciones justas en Cataluña 2011

Las redes sociales están generando un amplio entramado de comunicaciones, a distintos niveles y con distintos objetivos. En este artículo analizamos un caso concreto, fruto de la observación y el seguimiento de un grupo creado para la defensa de unas oposiciones justas para el acceso a la función pública de docentes para educación secundaria. Se trata de un grupo creado como reacción a una serie de posibles irregularidades. Interesa observar tanto la creación del grupo, como las distintas fases que sigue la evolución, muy ligada a la efectividad de los procesos de comunicación, y la vinculación de estos últimos a las posibilidades de acción y resolución del conflicto que existe en la base del grupo

Local Services in a Fourth Generation Mobile Network

Neljännen sukupolven mobiiliverkot kokoaa kaikki tietoliikenneverkot ja palvelut Internetin ympärille. Tämä mullistus muuttaa vanhat vertikaaliset tietoliikenneverkot joissa yhden tietoliikenneverkon palvelut ovat saatavissa vain kyseisen verkon päätelaitteille horisontaaliseksi malliksi jossa päätelaitteet käyttävät omaa verkkoansa pääsynä Internetin palveluihin. Tämä diplomityö esittelee idean paikallisista palveluista neljännen sukupolven mobiiliverkossa. Neljännen sukupolven mobiiliverkko yhdistää perinteiset televerkkojen palvelut ja Internet palvelut sekä mahdollistaa uuden tyyppisten palveluiden luonnin. TCP/IP protokollien ja Internetin evoluutio on esitelty. Laajakaistaiset, lyhyen kantaman radiotekniikat joita käytetään langattomana yhteytenä Internetiin on käsitelty. Evoluutio kohti neljännen sukupolven mobiiliverkkoja on kuvattu esittelemällä vanhat, nykyiset ja tulevat mobiiliverkot sekä niiden palvelut. Ennustukset palveluiden ja markkinoiden tulevaisuuden kehityksestä on käsitelty. Neljännen sukupolven mobiiliverkon arkkitehtuuri mahdollistaa paikalliset palvelut jotka ovat saatavilla vain yhdessä paikallisessa 4G verkossa. Paikalliset palvelut voidaan muunnella jokaiselle käyttäjälle erikseen käyttäen profiili-informaatiota ja paikkatietoa. Työssä on pohdittu paikallisten palveluiden käyttökelpoisuutta ja mahdollisuuksia käyttäen Lappeenrannan teknillisen korkeakoulun 4G projektin palvelupilotin tuloksia.

Health care network formation and policyholders' welfare

We develop a model in which two insurers and two health care providers compete for a fixed mass of policyholders. Insurers compete in premium and offer coverage against financial consequences of health risk. They have the possibility to sign agreements with providers to establish a health care network. Providers, partially altruistic, are horizontally differentiated with respect to their physical address. They choose the health care quality and compete in price. First, we show that policyholders are better off under a competition between conventional insurance rather than under a competition between integrated insurers (Managed Care Organizations). Second, we reveal that the competition between a conventional insurer and a Managed Care Organization (MCO) leads to a similar equilibrium than the competition between two MCOs characterized by a different objective i.e. private versus mutual. Third, we point out that the ex ante providers’ horizontal differentiation leads to an exclusionary equilibrium in which both insurers select one distinct provider. This result is in sharp contrast with frameworks that introduce the concept of option value to model the (ex post) horizontal differentiation between providers.

Cloud droplet size and liquid water path retrievals from zenith radiance measurements: examples from the Atmospheric Radiation Measurement Program and the Aerosol Robotic Network

The ground-based Atmospheric Radiation Measurement Program (ARM) and NASA Aerosol Robotic Net- work (AERONET) routinely monitor clouds using zenith ra- diances at visible and near-infrared wavelengths. Using the transmittance calculated from such measurements, we have developed a new retrieval method for cloud effective droplet size and conducted extensive tests for non-precipitating liquid water clouds. The underlying principle is to combine a liquid-water-absorbing wavelength (i.e., 1640 nm) with a non-water-absorbing wavelength for acquiring information on cloud droplet size and optical depth. For simulated stratocumulus clouds with liquid water path less than 300 g m−2 and horizontal resolution of 201 m, the retrieval method underestimates the mean effective radius by 0.8μm, with a root-mean-squared error of 1.7 μm and a relative deviation of 13%. For actual observations with a liquid water path less than 450 g m−2 at the ARM Oklahoma site during 2007– 2008, our 1.5-min-averaged retrievals are generally larger by around 1 μm than those from combined ground-based cloud radar and microwave radiometer at a 5-min temporal resolution. We also compared our retrievals to those from combined shortwave flux and microwave observations for relatively homogeneous clouds, showing that the bias between these two retrieval sets is negligible, but the error of 2.6 μm and the relative deviation of 22 % are larger than those found in our simulation case. Finally, the transmittance-based cloud effective droplet radii agree to better than 11 % with satellite observations and have a negative bias of 1 μm. Overall, the retrieval method provides reasonable cloud effective radius estimates, which can enhance the cloud products of both ARM and AERONET.

Modernizing the Brazilian active control network

The Brazilian Network for Continuous Monitoring of GPS - RBMC, since its foundation in December of 1996, has been playing an essential role for the maintenance and user access of the fundamental geodetic frame in the country,. It provides users with a direct link to the Brazilian Geodetic System - SGB. Its role has become more relevant with the increasing use of space navigation technology in the country. Recently, Brazil adopted a new geodetic system, SIRGAS2000, in February 2005, fully compatible with GNSS technology. The paper provides an overview of the recent modernization phases the RBMC network has undergone highlighting its future steps. From its current post-mission mode, the RBMC will evolve into a real-time network, providing real-time data and real-time correction to users. The network enhanced with modern GPS receivers and the addition of atomic clocks will be used to compute WADGPS-type corrections to be transmitted, in real time, to users in Brazil and surrounding areas. It is estimated that users will be able to achieve a horizontal accuracy around 0.5 m (1σ) in static and kinematic positioning and better for dual frequency users. The availability of the WADGPS service will allow users to tie to the new SIRGAS2000 system in a more rapid and transparent way for positioning and navigation applications. It should be emphasized that support to post-mission static positioning will continue to be provided to users interested in higher accuracy levels. In addition to this, a post-mission Precise Point Positioning (PPP) service will be provided based on the one currently provided by the Geodetic Survey Division of NRCan (CSRS-PPP). The modernization of the RBMC is under development based on a cooperation signed at the end of 2004 with the University of New Brunswick, supported by the Canadian International Development Agency and the Brazilian Cooperation Agency. The Geodetic Survey Division of NRCan is also participating in this modernization effort under the same project.

Latest Enhancements in the Brazilian Active Control Network

The Brazilian Network for Continuous Monitoring of GPS - RBMC, since its foundation in December of 1996, has been playing an essential role for the maintenance and user access of the fundamental geodetic frame in the country. It provides to users a direct link to the Brazilian Geodetic System. Its role has become more relevant with the increasing use of space navigation technology in the country. Recently, Brazil adopted a new geodetic frame, SIRGAS2000, in February 2005, fully compatible with GNSS technology. The paper provides an overview of the recent modernization phases the RBMC network has undergone highlighting its future steps. From its current post-mission mode, the RBMC will evolve into a real-time network, providing real-time data and real-time correction to users. The network enhanced with modern GPS receivers and the addition of atomic clocks will be used to compute WADGPS-type corrections to be transmitted, in real time, to users in Brazil and surrounding areas. It is estimated that users will be able to achieve a horizontal accuracy around 0.5 m (1 σ) in static and kinematic positioning and better for dual frequency users. The availability of the WADGPS service will allow users to tie to the new SIRGAS2000 frame in a more rapid and transparent way for positioning and navigation applications. It should be emphasized that support to post-mission static positioning, will continue to be provided to users interested in higher accuracy levels. In addition to this, a post-mission Precise Point Positioning (PPP) service will be provided based on the one currently provided by the Geodetic Survey Division of NRCan (CSRS-PPP). The modernization of the RBMC is under development based on a cooperation signed at the end of 2004 with the University of New Brunswick, supported by the Canadian International Development Agency and the Brazilian Cooperation Agency. The Geodetic Survey Division of NRCan is also participating in this modernization effort under the same project. © Springer-Verlag Berlin Heidelberg 2009.

Stakeholder analysis combined with social network analysis provides fine-grained insights into water infrastructure planning processes

Environmental policy and decision-making are characterized by complex interactions between different actors and sectors. As a rule, a stakeholder analysis is performed to understand those involved, but it has been criticized for lacking quality and consistency. This lack is remedied here by a formal social network analysis that investigates collaborative and multi-level governance settings in a rigorous way. We examine the added value of combining both elements. Our case study examines infrastructure planning in the Swiss water sector. Water supply and wastewater infrastructures are planned far into the future, usually on the basis of projections of past boundary conditions. They affect many actors, including the population, and are expensive. In view of increasing future dynamics and climate change, a more participatory and long-term planning approach is required. Our specific aims are to investigate fragmentation in water infrastructure planning, to understand how actors from different decision levels and sectors are represented, and which interests they follow. We conducted 27 semi-structured interviews with local stakeholders, but also cantonal and national actors. The network analysis confirmed our hypothesis of strong fragmentation: we found little collaboration between the water supply and wastewater sector (confirming horizontal fragmentation), and few ties between local, cantonal, and national actors (confirming vertical fragmentation). Infrastructure planning is clearly dominated by engineers and local authorities. Little importance is placed on longer-term strategic objectives and integrated catchment planning, but this was perceived as more important in a second analysis going beyond typical questions of stakeholder analysis. We conclude that linking a stakeholder analysis, comprising rarely asked questions, with a rigorous social network analysis is very fruitful and generates complementary results. This combination gave us deeper insight into the socio-political-engineering world of water infrastructure planning that is of vital importance to our well-being.

Sustainability principles put into practice: case studies of network analysis in Swiss climate change adaptation

Climate adaptation policies increasingly incorporate sustainability principles into their design and implementation. Since successful adaptation by means of adaptive capacity is recognized as being dependent upon progress toward sustainable development, policy design is increasingly characterized by the inclusion of state and non-state actors (horizontal actor integration), cross-sectoral collaboration, and inter-generational planning perspectives. Comparing four case studies in Swiss mountain regions, three located in the Upper Rhone region and one case from western Switzerland, we investigate how sustainability is put into practice. We argue that collaboration networks and sustainability perceptions matter when assessing the implementation of sustainability in local climate change adaptation. In other words, we suggest that adaptation is successful where sustainability perceptions translate into cross-sectoral integration and collaboration on the ground. Data about perceptions and network relations are assessed through surveys and treated via cluster and social network analysis.