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.

TRIBUNAL ARBITRAL DE D&S S.A, CONSTRUCCIONES NAMUS S.A, SOHINCO CONSTRUCTORA S.A, YAMIL SABBAGH SOLANO y DAVID VEGA LUNA (MIEMBROS DE LA UNION TEMPORAL AGUAS TINTAL) VS. EMPRESA DE ACUEDUCTO Y ALCANTARILLADO DE BOGOTÁ E.S.P.

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Pulmonary tuberculosis in Continental Portugal 2000-2010: temporal trends clustering as a tool for control evaluation

Clustering analysis is a useful tool to detect and monitor disease patterns and, consequently, to contribute for an effective population disease management. Portugal has the highest incidence of tuberculosis in the European Union (in 2012, 21.6 cases per 100.000 inhabitants), although it has been decreasing consistently. Two critical PTB (Pulmonary Tuberculosis) areas, metropolitan Oporto and metropolitan Lisbon regions, were previously identified through spatial and space-time clustering for PTB incidence rate and risk factors. Identifying clusters of temporal trends can further elucidate policy makers about municipalities showing a faster or a slower TB control improvement.

Análisis de la actuación de la Autoridad Ejecutiva Temporal de las Naciones Unidas – (UNTEA) en la protección de los derechos políticos de los grupos vulnerables. Estudio de caso: Adhesión de Papúa Occidental a Indonesia (1962-1969)

Estudio de caso en el análisis de la situación afrontada por la población de Papúa Occidental durante el periodo de 1962-1969, época en la que la nueva República de Indonesia y Holanda se disputaban la soberanía sobre el territorio papuano. Dicha disputa tuvo lugar durante la época de Guerra Fría, lo que llevó a que Estados Unidos junto con sus aliados en la región y la Unión Soviética intervinieran en él. Finalmente, Estados Unidos teniendo en cuenta sus intereses favoreció a la República de Indonesia y obligó a Holanda firmar el Acuerdo de Nueva York, en el que se establecía que sería la Autoridad Ejecutiva Temporal de las Naciones Unidas quien administrara y preparara el territorio para un futuro Acto de Libre Elección. En cualquiera que fuese el panorama, las Naciones Unidas no cumplieron con lo establecido en el Acuerdo lo que llevó a que fueran condescendientes con todas las peticiones indonesias sin tener en cuenta los deseos y los derechos de la población papuana, violándose su derecho de auto-determinación de los pueblos.

Temporal evolution and electric potential structure of the auroral acceleration region from multispacecraft measurements

Bright aurorae can be excited by the acceleration of electrons into the atmosphere in violation of ideal magnetohydrodynamics. Modelling studies predict that the accelerating electric potential consists of electric double layers at the boundaries of an acceleration region but observations suggest that particle acceleration occurs throughout this region. Using multi-spacecraft observations from Cluster we have examined two upward current regions on 14 December 2009. Our observations show that the potential difference below C4 and C3 changed by up to 1.7 kV between their respective crossings, which were separated by 150 s. The field-aligned current density observed by C3 was also larger than that observed by C4. The potential drop above C3 and C4 was approximately the same in both crossings. Using a novel technique of quantitatively comparing the electron spectra measured by Cluster 1 and 3, which were separated in altitude, we determine when these spacecraft made effectively magnetically conjugate observations and use these conjugate observations to determine the instantaneous distribution of the potential drop in the AAR. Our observations show that an average of 15% of the potential drop in the AAR was located between C1 at 6235 km and C3 at 4685 km altitude, with a maximum potential drop between the spacecraft of 500~V and that the majority of the potential drop was below C3. By assuming a spatial invariance along the length of the upward current region, we discuss these observations in terms of temporal changes and the vertical structure of the electrostatic potential drop and in the context of existing models and previous observations single- and multi-spacecraft observations.

On the nature of ULF wave power during nightside auroral activations and substorms: 2. temporal evolution

We present a statistical analysis of the time evolution of ground magnetic fluctuations in three (12–48 s, 24–96 s and 48–192 s) period bands during nightside auroral activations. We use an independently derived auroral activation list composed of both substorms and pseudo-breakups to provide an estimate of the activation times of nightside aurora during periods with comprehensive ground magnetometer coverage. One hundred eighty-one events in total are studied to demonstrate the statistical nature of the time evolution of magnetic wave power during the ∼30 min surrounding auroral activations. We find that the magnetic wave power is approximately constant before an auroral activation, starts to grow up to 90 s prior to the optical onset time, maximizes a few minutes after the auroral activation, then decays slightly to a new, and higher, constant level. Importantly, magnetic ULF wave power always remains elevated after an auroral activation, whether it is a substorm or a pseudo-breakup. We subsequently divide the auroral activation list into events that formed part of ongoing auroral activity and events that had little preceding geomagnetic activity. We find that the evolution of wave power in the ∼10–200 s period band essentially behaves in the same manner through auroral onset, regardless of event type. The absolute power across ULF wave bands, however, displays a power law-like dependency throughout a 30 min period centered on auroral onset time. We also find evidence of a secondary maximum in wave power at high latitudes ∼10 min following isolated substorm activations. Most significantly, we demonstrate that magnetic wave power levels persist after auroral activations for ∼10 min, which is consistent with recent findings of wave-driven auroral precipitation during substorms. This suggests that magnetic wave power and auroral particle precipitation are intimately linked and key components of the substorm onset process.

In-situ spatio-temporal measurements of the detailed azimuthal substructure of the substorm current wedge

The substorm current wedge (SCW) is a fundamental component of geomagnetic substorms. Models tend to describe the SCW as a simple line current flowing into the ionosphere towards dawn and out of the ionosphere towards dusk, linked by a westward electrojet. We use multi-spacecraft observations from perigee passes of the Cluster 1 and 4 spacecraft during a substorm on 15 Jan 2010, in conjunction with ground-based observations, to examine the spatial structuring and temporal variability of the SCW. At this time, the spacecraft travelled east-west azimuthally above the auroral region. We show that the SCW has significant azimuthal sub-structure on scales of 100~km at altitudes of 4,000-7,000~km. We identify 26 individual current sheets in the Cluster 4 data and 34 individual current sheets in the Cluster 1 data, with Cluster 1 passing through the SCW 120-240~s after Cluster 4 at 1,300-2,000~km higher altitude. Both spacecraft observed large-scale regions of net upward and downward field-aligned current, consistent with the large-scale characteristics of the SCW, although sheets of oppositely directed currents were observed within both regions. We show that the majority of these current sheets were closely aligned to a north-south direction, in contrast to the expected east-west orientation of the pre-onset aurora. Comparing our results with observations of the field-aligned current associated with bursty bulk flows (BBFs) we conclude that significant questions remain for the explanation of SCW structuring by BBF driven ``wedgelets". Our results therefore represent constraints on future modelling and theoretical frameworks on the generation of the SCW.

Spatial and temporal variations of the seasonal sea level cycle in the northwest Pacific

The seasonal sea level variations observed from tide gauges over 1900-2013 and gridded satellite altimeter product AVISO over 1993-2013 in the northwest Pacific have been explored. The seasonal cycle is able to explain 60-90% of monthly sea level variance in the marginal seas, while it explains less than 20% of variance in the eddy-rich regions. The maximum annual and semi-annual sea level cycles (30cm and 6cm) are observed in the north of the East China Sea and the west of the South China Sea respectively. AVISO was found to underestimate the annual amplitude by 25% compared to tide gauge estimates along the coasts of China and Russia. The forcing for the seasonal sea level cycle was identified. The atmospheric pressure and the steric height produce 8-12cm of the annual cycle in the middle continental shelf and in the Kuroshio Current regions separately. The removal of the two attributors from total sea level permits to identify the sea level residuals that still show significant seasonality in the marginal seas. Both nearby wind stress and surface currents can explain well the long-term variability of the seasonal sea level cycle in the marginal seas and the tropics because of their influence on the sea level residuals. Interestingly, the surface currents are a better descriptor in the areas where the ocean currents are known to be strong. Here, they explain 50-90% of inter-annual variability due to the strong links between the steric height and the large-scale ocean currents.

Spatial-temporal variations in phytoplankton size and colored detrital matter absorption at global and regional scales, as derived from twelve years of SeaWiFS data (1998-2009)

A procedure has been proposed by Ciotti and Bricaud (2006) to retrieve spectral absorption coefficients of phytoplankton and colored detrital matter (CDM) from satellite radiance measurements. This was also the first procedure to estimate a size factor for phytoplankton, based on the shape of the retrieved algal absorption spectrum, and the spectral slope of CDM absorption. Applying this method to the global ocean color data set acquired by SeaWiFS over twelve years (1998-2009), allowed for a comparison of the spatial variations of chlorophyll concentration ([Chl]), algal size factor (S-f), CDM absorption coefficient (a(cdm)) at 443 nm, and spectral slope of CDM absorption (S-cdm). As expected, correlations between the derived parameters were characterized by a large scatter at the global scale. We compared temporal variability of the spatially averaged parameters over the twelve-year period for three oceanic areas of biogeochemical importance: the Eastern Equatorial Pacific, the North Atlantic and the Mediterranean Sea. In all areas, both S-f and a(cdm)(443) showed large seasonal and interannual variations, generally correlated to those of algal biomass. The CDM maxima appeared in some occasions to last longer than those of [Chl]. The spectral slope of CDM absorption showed very large seasonal cycles consistent with photobleaching, challenging the assumption of a constant slope commonly used in bio-optical models. In the Equatorial Pacific, the seasonal cycles of [Chl], S-f, a(cdm)(443) and S-cdm, as well as the relationships between these parameters, were strongly affected by the 1997-98 El Ni o/La Ni a event.