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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Temporal Characterization of Ossification of the Crania in Australian Subadults: New standards for Age Estimation using Computed Tomography

After attending this presentation, attendees will gain awareness of the ontogeny of cranial maturation, specifically: (1) the fusion timings of primary ossification centers in the basicranium; and (2) the temporal pattern of closure of the anterior fontanelle, to develop new population-specific age standards for medicolegal death investigation of Australian subadults. This presentation will impact the forensic science community by demonstrating the potential of a contemporary forensic subadult Computed Tomography (CT) database of cranial scans and population data, to recalibrate existing standards for age estimation and quantify growth and development of Australian children. This research welcomes a study design applicable to all countries faced with paucity in skeletal repositories. Accurate assessment of age-at-death of skeletal remains represents a key element in forensic anthropology methodology. In Australian casework, age standards derived from American reference samples are applied in light of scarcity in documented Australian skeletal collections. Currently practitioners rely on antiquated standards, such as the Scheuer and Black1 compilation for age estimation, despite implications of secular trends and population variation. Skeletal maturation standards are population specific and should not be extrapolated from one population to another, while secular changes in skeletal dimensions and accelerated maturation underscore the importance of establishing modern standards to estimate age in modern subadults. Despite CT imaging becoming the gold standard for skeletal analysis in Australia, practitioners caution the application of forensic age standards derived from macroscopic inspection to a CT medium, suggesting a need for revised methodologies. Multi-slice CT scans of subadult crania and cervical vertebrae 1 and 2 were acquired from 350 Australian individuals (males: n=193, females: n=157) aged birth to 12 years. The CT database, projected at 920 individuals upon completion (January 2014), comprises thin-slice DICOM data (resolution: 0.5/0.3mm) of patients scanned since 2010 at major Brisbane Childrens Hospitals. DICOM datasets were subject to manual segmentation, followed by the construction of multi-planar and volume rendering cranial models, for subsequent scoring. The union of primary ossification centers of the occipital bone were scored as open, partially closed or completely closed; while the fontanelles, and vertebrae were scored in accordance with two stages. Transition analysis was applied to elucidate age at transition between union states for each center, and robust age parameters established using Bayesian statistics. In comparison to reported literature, closure of the fontanelles and contiguous sutures in Australian infants occur earlier than reported, with the anterior fontanelle transitioning from open to closed at 16.7±1.1 months. The metopic suture is closed prior to 10 weeks post-partum and completely obliterated by 6 months of age, independent of sex. Utilizing reverse engineering capabilities, an alternate method for infant age estimation based on quantification of fontanelle area and non-linear regression with variance component modeling will be presented. Closure models indicate that the greatest rate of change in anterior fontanelle area occurs prior to 5 months of age. This study complements the work of Scheuer and Black1, providing more specific age intervals for union and temporal maturity of each primary ossification center of the occipital bone. For example, dominant fusion of the sutura intra-occipitalis posterior occurs before 9 months of age, followed by persistence of a hyaline cartilage tongue posterior to the foramen magnum until 2.5 years; with obliteration at 2.9±0.1 years. Recalibrated age parameters for the atlas and axis are presented, with the anterior arch of the atlas appearing at 2.9 months in females and 6.3 months in males; while dentoneural, dentocentral and neurocentral junctions of the axis transitioned from non-union to union at 2.1±0.1 years in females and 3.7±0.1 years in males. These results are an exemplar of significant sexual dimorphism in maturation (p<0.05), with girls exhibiting union earlier than boys, justifying the need for segregated sex standards for age estimation. Studies such as this are imperative for providing updated standards for Australian forensic and pediatric practice and provide an insight into skeletal development of this population. During this presentation, the utility of novel regression models for age estimation of infants will be discussed, with emphasis on three-dimensional modeling capabilities of complex structures such as fontanelles, for the development of new age estimation methods.

Large latitudinal gradients and temporal heterogeneity in aerosol black carbon and its mass mixing ratio over southern and northern oceans observed during a trans-continental cruise experiment

Extensive, and collocated measurements of the mass concentrations (M-B) of aerosol black carbon (BC) and (M-T) of composite aerosols were made over the Arabian Sea, tropical Indian Ocean and the Southern Ocean during a trans-continental cruise experiment. Our investigations show that MB remains extremely low(<50 ng m(-3)) and remarkably steady (in space and time) in the Southern Ocean (20 degrees S to 56 degrees S). In contrast, large latitudinal gradients exist north of similar to 20 degrees S; M-B increasing exponentially to reach as high as 2000 ng m(-3) in the Arabian Sea (similar to 8 degrees N). Interestingly, the share of BC showed a distinctly different latitudinal variation, with a peak close to the equator and decreasing on either side. Large fluctuations were seen in M-T over Southern Ocean associated with enhanced production of sea-salt aerosols in response to sea-surface wind speed. These spatio-temporal changes in M-B and its mixing ratio have important implications to regional and global climate.

Wage differentials between Permanent and Temporal Contracts: Further Evidence

The main objective of this paper is to estimate wage differentials between permanent and temporal workers for different qualification levels and decompose such differentials to see which factors contribute more to explain them. The data we use is the "Encuesta de Estructura Salarial", a survey carried out in 1995 in all countries of the European Union, which contains very detailed information on wages and other characteristics for about 180.000 workers. The empirical results indicate that (a) the wage gap between permanent and temporal workers increases with qualification and it is smaller for females than for males, (b) when decomposing average wage differentials for each qualification level, we observe that the vast majority of such differential is explainedby differences in characteristics, and in particular by differences in tenure and occupation. With respect to differences in returns, our results indicate that the returns to tenure are higher for temporal workres relative to permanent workers for both males and females and for every qualification level. Returns to occupation are higher for permanent than for temporal workers, and the differenceis particularly high for females.

Prospective information for pass decisional behaviour in Rugby Union

Decision-making requires the perception of relevant information variables that emerge from the player–environment interaction. The purpose of the present article is to empirically assess whether players’ decisional behavior about which type of pass to make is influenced by the spatio-temporal variable tau. Time series positional data of rugby players were analyzed from video footage taken in real match scenarios. The tau of the distance motion gap between attacker and defender was calculated, along with the duration of the next pass. Results revealed that the initial tau value predicted 64% of the variance found in pass duration. A qualitative distinction of tau dynamics between two periods of the approach between the attacker and the defender was also observed. We argue that the time-to-contact between the attacker and the defender may yield information about future pass possibilities. Additionally, the informational fields constraining attacker–defender interaction may be viewed as a convergent channeling of possibilities towards a single pass solution.

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 and temporal variation in the breeding of Masked Lapwings (Vanellus miles) in Australia

Spatial and temporal variation in the breeding of Masked Lapwings (Vanellus miles) in Australia were examined using data from Birds Australia’s Nest Record Scheme (NRS; 1957–2002), the Atlas of Australian Birds (1998–2006), and climatic data (1952–2006). Breeding in north-western Australia was concentrated in summer, while in other regions the peak of breeding occurred during spring. Breeding success varied between regions and years but was generally highest in Tasmania. Clutch-size (mean 3.57 eggs ± 0.033 s.e., n = 549 clutches) did not vary regionally or temporally. In the north-east, breeding became earlier over time (~1.9 days per year, NRS), while in the south-east, breeding became later (~0.9 days per year); in other regions temporal trends were not evident. Only Tasmania showed a significant temporal change in breeding success (decrease of ~1.5% per year). All regions experienced warming climates, and annual rainfall increased in north-western regions and decreased in eastern regions. There were weak or no relationships between the amount or success of breeding, clutch-size and the climatic variables considered (with the possible exception of Tasmania), suggesting either that data limitations precluded us from detecting subtle effects or that Masked Lapwings have been little influenced or are resilient to changes in climate over most of their range.

Predicting spatio-temporal distribution for eastern Australian birds using birds Australia's atlas data : survey method, habitat and seasonal effects

Faunal atlases are landscape-level survey collections that can be used for describing spatial and temporal patterns of distribution and densities. They can also serve as a basis for quantitative analysis of factors that may influence the distributions of species. We used a subset of Birds Australia’s Atlas of Australian Birds data (January 1998 to December 2002) to examine the spatio-temporal distribution patterns of 280 selected species in eastern Australia (17–37°S and 136–152°E). Using geographical information systems, this dataset was converted into point coverage and overlaid with a vegetation polygon layer and a half-degree grid. The exploratory data analysis involved calculating species-specific reporting rates spatially, per grid and per vegetation unit, and also temporally, by month and year. We found high spatio-temporal variability in the sampling effort. Using generalised linear models on unaggregated point data, the influences of four factors – survey method and month, geographical location and habitat type – were analysed for each species. When counts of point data were attributed to grid-cells, the total number of species correlated with the total number of surveys, while the number of records per species was highly variable. Surveys had high interannual location fidelity. The predictive values of each of the four factors were species-dependent. Location and habitat were correlated and highly predictive for species with restricted distribution and strong habitat preference. Month was only of importance for migratory species. The proportion of incidental sightings was important for extremely common or extremely rare species. In conclusion, behaviour of species differed sufficiently to require building a customized model for each species to predict distribution. Simple models were effective for habitat specialists with restricted ranges, but for generalists with wide distributions even complex models gave poor predictions.