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Resumen Introducción: En Argentina, los medicamentos de alto costo (MAC) generan una carga económica elevada que deben afrontar las instituciones sanitarias. Sin embargo, no existe a la fecha un estu dio en Argentina que indique la magnitud del real problema de los MAC para la Seguridad Social. El presente trabajo, explora cuál es su impacto económico para una de las principales Obras Sociales del país. Métodos: Se realizó un estudio descriptivo con etapa analítica a partir de datos obtenidos en gerencia de prestaciones, área farmacia y área contable de la institución. Cada medicamento fue clasificado según recomendación de OMS (clasificación Anatómica-Terapéutica- Química-ATC). Los precios fueron consignados en tres valores: nominal al momento de adquisición, actualizado a pesos fin de 2021 utilizando el CER (coeficiente de estabilización de referencia), y en dólares (USD). Se evaluaron 105 324 dispensas de MAC, correspondientes a 258 011 unidades para 10 450 afiliados. Resultados: El gasto total anualizado fue 57 millones de dólares (USD), y por usuario 6220 USD. Solo 1.9% de los afiliados requirieron MAC, aunque el gasto fue del 21.9% de los ingresos (aportes + contribuciones). Los primeros 5 medicamentos que generaron el mayor gasto fueron enzalutamida, bevacizu mab, nivolumab, palbociclib, pembrolizumab. Las enfermedades oncológicas y reumatológicas representaron el 62.8% del gasto. Conclusión: A la luz de los resultados, se deduce que los MAC constituyen un riesgo potencial de desfinanciación del sistema de salud si son abordados de manera atomizada por cada subsector. Los MAC requieren de políticas globales de carácter nacional y/o regional.

Abstract Introduction: In Argentina, high-cost drugs (HCD) induce a high economic burden for all the health system sec tors. However, it does not exist in Argentina any data that indicates the real problem of HCD for Social Security. That is why, the present study explores the economic impact of the HCD for one of the main Institutions of the country. Methods: A descriptive study with an analytical stage was carried out based on data obtained from management, pharmacy and accounting area. Each drug was classified according to WHO recommendation (Anatomical-Therapeutic-Chemical-ATC classification). The prices were expressed in three ways: nominal value at the time of acquisition in local currency, updated using the CER (reference stabilization coefficient), and in US dollars. A total of 105 324 HCD dispensed were evaluated, which corresponded to 258 011 units destined to 10 450 patients. Results: Total annualized spend was US$57 million (US$6220 per patient). Only 1.9% of affiliates required HCD, although those expenses represented 21.9% of the institutions´ total income. The first 5 drugs associated to the highest expenditure were enzalutamide, bevacizumab, nivolumab, palbociclib, pembrolizumab. Oncological and rheumatological diseases represented 62.8% of the HCD costs. Conclusion: Considering the results obtained, it can be deduced that if the HCD problem is approached in a scattered way by each subsec tor, it will become a potential risk for health system defund. The HCD topic requires of global policies at national or even regional level.

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INTRODUCTION: In Argentina, high-cost drugs (HCD) induce a high economic burden for all the health system sectors. However, it does not exist in Argentina any data that indicates the real problem of HCD for Social Security. That is why, the present study explores the economic impact of the HCD for one of the main Institutions of the country. METHODS: A descriptive study with an analytical stage was carried out based on data obtained from management, pharmacy and accounting area. Each drug was classified according to WHO recommendation (Anatomical-Therapeutic-Chemical-ATC classification). The prices were expressed in three ways: nominal value at the time of acquisition in local currency, updated using the CER (reference stabilization coefficient), and in US dollars. A total of 105 324 HCD dispensed were evaluated, which corresponded to 258 011 units destined to 10 450 patients. RESULTS: Total annualized spend was US$57 million (US$6220 per patient). Only 1.9% of affiliates required HCD, although those expenses represented 21.9% of the institutions' total income. The first 5 drugs associated to the highest expenditure were enzalutamide, bevacizumab, nivolumab, palbociclib, pembrolizumab. Oncological and rheumatological diseases represented 62.8% of the HCD costs. CONCLUSION: Considering the results obtained, it can be deduced that if the HCD problem is approached in a scattered way by each subsector, it will become a potential risk for health system defund. The HCD topic requires of global policies at national or even regional level.

Introducción: En Argentina, los medicamentos de alto costo (MAC) generan una carga económica elevada que deben afrontar las instituciones sanitarias. Sin embargo, no existe a la fecha un estudio en Argentina que indique la magnitud del real problema de los MAC para la Seguridad Social. El presente trabajo, explora cuál es su impacto económico para una de las principales Obras Sociales del país. Métodos: Se realizó un estudio descriptivo con etapa analítica a partir de datos obtenidos en gerencia de prestaciones, área farmacia y área contable de la institución. Cada medicamento fue clasificado según recomendación de OMS (clasificación Anatómica-Terapéutica- Química-ATC). Los precios fueron consignados en tres valores: nominal al momento de adquisición, actualizado a pesos fin de 2021 utilizando el CER (coeficiente de estabilización de referencia), y en dólares (USD). Se evaluaron 105 324 dispensas de MAC, correspondientes a 258 011 unidades para 10 450 afiliados. Resultados: El gasto total anualizado fue 57 millones de dólares (USD), y por usuario 6220 USD. Solo 1.9% de los afiliados requirieron MAC, aunque el gasto fue del 21.9% de los ingresos (aportes + contribuciones). Los primeros 5 medicamentos que generaron el mayor gasto fueron enzalutamida, bevacizumab, nivolumab, palbociclib, pembrolizumab. Las enfermedades oncológicas y reumatológicas representaron el 62.8% del gasto. Conclusión: A la luz de los resultados, se deduce que los MAC constituyen un riesgo potencial de desfinanciación del sistema de salud si son abordados de manera atomizada por cada subsector. Los MAC requieren de políticas globales de carácter nacional y/o regional.

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Benzodiazepines and "Z-drugs" (BZD/Z) are overprescribed in many countries. This study evaluates their consumption in a social security sector health insurance provider with national coverage in Argentina. With a descriptive and observational approach, outpatient dispensations of BZD/Zs were analyzed for people over 18 years old from April 2020 to March 2021, disaggregated by sex, age, active ingredient, and half-life. An annual prevalence of use of 11.6% was found among the 431,445 adult affiliates, with higher rates in women and in those over age 60. Overall consumption of BZD/Zs was 77.6 defined daily doses (DDD) per 1000 enrollee-days. The average user received 5.1 annual dispensations and the equivalent of 1.4 DDD for each day of the year. BZD/Zs with long half-life were the most used. We found high levels of BZD/Z consumption and for longer periods than recommended. It is necessary to improve the quality of consumption and reduce the negative impact of inappropriate use of these drugs among treated individuals.

Las benzodiazepinas y los "fármacos Z" (BZD-Z) se prescriben en exceso en muchos países. Este estudio evaluó su consumo en una organización de la seguridad social (obra social) de Argentina de alcance nacional. A partir de un diseño observacional descriptivo se analizó la dispensa ambulatoria de BZD-Z, entre abril 2020 y marzo 2021, a mayores de 18 años; desagregada por sexo, edad, principio activo y vida media. Se encontró una prevalencia anual de uso del 11,6% entre los 431.445 afiliados adultos, con valores más elevados en las mujeres y mayores de 60 años. El consumo global de BZD-Z fue de 77,6 dosis diarias definidas (DDD) cada 1.000 afiliados-día. El usuario promedio recibió 5,1 dispensas anuales y el equivalente a 1,4 DDD por cada día del año. Las BZD-Z más usadas fueron las de vida media larga. El consumo de BZD-Z resultó elevado y más prolongado que lo recomendado. Es necesario mejorar la calidad en el consumo y reducir el impacto negativo del uso inapropiado de estos fármacos entre los individuos tratados.

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RESUMEN Las benzodiazepinas y los "fármacos Z" (BZD-Z) se prescriben en exceso en muchos países. Este estudio evaluó su consumo en una organización de la seguridad social (obra social) de Argentina de alcance nacional. A partir de un diseño observacional descriptivo se analizó la dispensa ambulatoria de BZD-Z, entre abril 2020 y marzo 2021, a mayores de 18 años; desagregada por sexo, edad, principio activo y vida media. Se encontró una prevalencia anual de uso del 11,6% entre los 431.445 afiliados adultos, con valores más elevados en las mujeres y mayores de 60 años. El consumo global de BZD-Z fue de 77,6 dosis diarias definidas (DDD) cada 1.000 afiliados-día. El usuario promedio recibió 5,1 dispensas anuales y el equivalente a 1,4 DDD por cada día del año. Las BZD-Z más usadas fueron las de vida media larga. El consumo de BZD-Z resultó elevado y más prolongado que lo recomendado. Es necesario mejorar la calidad en el consumo y reducir el impacto negativo del uso inapropiado de estos fármacos entre los individuos tratados.

ABSTRACT: Benzodiazepines and "Z-drugs" (BZD/Z) are overprescribed in many countries. This study evaluates their consumption in a social security sector health insurance provider with national coverage in Argentina. With a descriptive and observational approach, outpatient dispensations of BZD/Zs were analyzed for people over 18 years old from April 2020 to March 2021, disaggregated by sex, age, active ingredient, and half-life. An annual prevalence of use of 11.6% was found among the 431,445 adult affiliates, with higher rates in women and in those over age 60. Overall consumption of BZD/Zs was 77.6 defined daily doses (DDD) per 1000 enrollee-days. The average user received 5.1 annual dispensations and the equivalent of 1.4 DDD for each day of the year. BZD/Zs with long half-life were the most used. We found high levels of BZD/Z consumption and for longer periods than recommended. It is necessary to improve the quality of consumption and reduce the negative impact of inappropriate use of these drugs among treated individuals.

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In this paper, we introduce a model to describe the decay of the number of unobserved ordinal patterns as a function of the time series length in noisy chaotic dynamics. More precisely, we show that a stretched exponential model fits the decay of the number of unobserved ordinal patterns for both discrete and continuous chaotic systems contaminated with observational noise, independently of the noise level and the sampling time. Numerical simulations, obtained from the logistic map and the x coordinate of the Lorenz system, both operating in a totally chaotic dynamics were used as test beds. In addition, we contrast our results with those obtained from pure stochastic dynamics. The fitting parameters, namely, the stretching exponent and the characteristic decay rate, are used to distinguish whether the dynamical nature of the data sequence is stochastic or chaotic. Finally, the analysis of experimental records associated with the hyperchaotic pulsations of an optoelectronic oscillator allows us to illustrate the applicability of the proposed approach in a practical context.

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RESUMEN La yuca es determinante para la seguridad alimentaria de cientos de millones de personas alrededor del mundo. A pesar de que el principal medio de propagación del cultivo es a través de semilla asexual por estacas (tallos maduros) se ha revelado una relativamente alta diversidad intraespecífica, principalmente en los sistemas de cultivo de manejo tradicional. En esta revisión se documentan algunos estudios realizados sobre la diversidad de la yuca, tanto por marcadores moleculares como morfológicos, centrándose en aquellos realizados en el Amazonas. También se exponen los principales factores que han determinado el aprovechamiento y conservación de esta diversidad, tales como la aparición espontánea de semillas de origen sexual, el sistema de chagras indígenas, la memoria biocultural y la facilidad de intercambio de semilla entre comunidades. Finalmente, se pone de manifiesto que en los sistemas de manejo tradicional la conservación y uso de la diversidad intraespecífica se constituye en un elemento prioritario que se ha perdido en los sistemas de cultivo a gran escala. En los sistemas de manejo tradicional existe un vínculo etnobotánico que pervive e invita a buscar prácticas alternativas que aseguran un mantenimiento de la diversidad, permitiendo una productividad eficiente e incluso se hace un mejor manejo para disminuir los riesgos de incidencia de algunas plagas y enfermedades.

ABSTRACT Cassava is crucial for the food security of hundreds ofmillions of people around the world. Even though the main source of propagation of the crop is through asexual seed by stakes (stems-cuttings) a relative high intraspecific diversity has been identified, mainly in the traditionally managed cultivation systems. Some studies on the diversity of cassava, based on molecular and morphological markers, are documented focusing on those made in the Amazon in this review. Also, the main factors that have determined the use and conservation of this diversity are exposed, such as the spontaneous appearance of seeds of sexual origin, the system of indigenous chagras, the biocultural memory and the ease of seed exchange between communities. From this perspective, it is evident that in traditional management systems the conservation and use of intraspecific diversity is a priority element that has been lost in large-scale farming systems. In traditional management systems, there is an ethnobotanical link that survives and invites us to seek alternative practices that ensure the maintenance of diversity, allowing efficient productivity and even better management to reduce the risk of incidence of some pests and diseases.

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RESUMEN Este artículo de reflexión teórica aborda la investigación narrativa como su objeto. Esto obedece a las consideraciones metodológicas de la investigación que originaron esta reflexión. De esta manera, se acude, por una parte, a la bibliografía encontrada sobre tema narrativo, y a la experiencia con los estudiantes con quienes se trabajó. Se encontró que las narraciones permiten penetrar de manera profunda en un contexto familiar que vive un país conflictivo, con grandes escisiones sociales, políticas y económicas. La reflexión se basa en una investigación realizada con los estudiantes del programa de Desarrollo Familiar en la Universidad de Caldas, Manizales (Colombia), y acude a un diálogo con ellos sobre el proceso investigativo, de modo que este artículo se articula en torno a tres fuentes: la investigación de base, la bibliografía sobre narrativas y memoria y el diálogo con los estudiantes.

ABSTRACT This teoric reflection paper deals with narrative research as its main objet, concerning methodological considerations in research which generated this reflection. On one hand the bibliography regarding the subject of narrative is used, on the other hand the experience of the students involve in this study. The findings of this study show that the accounts allow a deep exploration in a family context within a trouble country, with large social, political and economical divisions. The reflection is based on a research carried out with the students of the Desarrollo Familiar program at the Universidad de Caldas, Manizales (Colombia), and they go to a dialogue with them about the investigative process, so this article has three sources: basic research, the bibliography on narratives and memory and the dialogue with students.

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We have experimentally quantified the temporal structural diversity from the coordinate fluctuations of a laser beam propagating through isotropic optical turbulence. The main focus here is on the characterization of the long-range correlations in the wandering of a thin Gaussian laser beam over a screen after propagating through a turbulent medium. To fulfill this goal, a laboratory-controlled experiment was conducted in which coordinate fluctuations of the laser beam were recorded at a sufficiently high sampling rate for a wide range of turbulent conditions. Horizontal and vertical displacements of the laser beam centroid were subsequently analyzed by implementing the symbolic technique based on ordinal patterns to estimate the well-known permutation entropy. We show that the permutation entropy estimations at multiple time scales evidence an interplay between different dynamical behaviors. More specifically, a crossover between two different scaling regimes is observed. We confirm a transition from an integrated stochastic process contaminated with electronic noise to a fractional Brownian motion with a Hurst exponent H=5/6 as the sampling time increases. Besides, we are able to quantify, from the estimated entropy, the amount of electronic noise as a function of the turbulence strength. We have also demonstrated that these experimental observations are in very good agreement with numerical simulations of noisy fractional Brownian motions with a well-defined crossover between two different scaling regimes.

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La red informatizada de salud SALGEN se utiliza desde el 2009 en la atención genética a la gestante y el recién nacido en la provincia de Sancti Spíritus, insertada en las facilidades de conexión en tiempo real entre todas las instituciones de salud que brinda INFOMED. Se han atendido 34 452 gestantes hasta septiembre 2015, realizando evaluación de riesgo genético, pesquisa de anemia de hematíes falciformes, dosificación de alfafetoproteína, diagnóstico prenatal citogenético, ultrasonido de cada trimestre, características del parto y del recién nacido, pesquisas metabólicas neonatales y evaluación genético clínica del lactante. El software brinda160 reportes que han permitido evaluar la calidad de todos los procederes del programa de la atención genética a gestantes y recién nacidos y otras acciones organizativas del programa de atención materno infantil además de indicadores evaluativos para ecografía prenatal de acuerdo a estándares internacionales que son visualizados online por los especialistas como forma de autoevaluación. Los resultados validan al sistema informático para su utilización a nivel de cualquier policlínico, municipio o provincia del país. Este trabajo tiene por objetivo evidenciar la utilidad de SALGEN en el perfeccionamiento de la atención genética a gestantes y recién nacidos y en el control de calidad de acciones del Programa de Atención Materno Infantil (PAMI)(AU)

The Sancti Spíritus Provincial Medical Genetics Network has been using the Salgen informatics platform since 2009 for health care, administrative and research activities oconcerning pregnant mothers and newborns. The network uses the national Infomed backbone to provide real-time connection between community-based polyclinics in primary health care and the Provincial Medical Genetics Reference Center. Until September 2015 the platform has recorded 34 452 pregnant women and sequential clinical data on genetic risk assessment in early pregnancy, prenatal ultrasound, sickle cell anemia screening, alpha-fetoprotein levels, cytogenetic antenatal diagnosis, delivery and newborn characteristics, neonatal metabolic screening, and infant clinical assessment. The system makes health care results immediately available and provides 160 health alerts to enable timely preventive care for pregnant women. It also provides guidelines for processes and practices, and streamlines administrative and monitoring activities through statistical reports. The database generates indicators for assessing fetal growth and applies international standards for antenatal ultrasound quality control. Salgen can be use in any institution of primary health services, municipality or provinces of Cuba(AU)

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Sampling rate and frequency content determination for optical quantities related to light propagation through turbulence are paramount experimental topics. Some papers about estimating properties of the optical turbulence seem to use ad hoc assumptions to set the sampling frequency used; this chosen sampling rate is assumed good enough to perform a proper measurement. On the other hand, other authors estimate the optimal sampling rate via fast Fourier transform of data series associated to the experiment. When possible, with the help of analytical models, cut-off frequencies, or frequency content, can be determined; yet, these approaches require prior knowledge of the optical turbulence. The aim of this paper is to propose an alternative, practical, experimental method to estimate a proper sampling rate. By means of the discrete wavelet transform, this approach can prevent any loss of information and, at the same time, avoid oversampling. Moreover, it is independent of the statistical model imposed on the turbulence.

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Under the Geometrics Optics approximation is possible to estimate the covariance between the displacements of two thin beams after they have propagated through a turbulent medium. Previous works have concentrated in long propagation distances to provide models for the wandering statistics. These models are useful when the separation between beams is smaller than the propagation path-regardless of the characteristics scales of the turbulence. In this work we give a complete model for these covariances, behavior introducing absolute limits to the validity of former approximations. Moreover, these generalizations are established for non-Kolmogorov atmospheric models.

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We introduce the Lévy fractional Brownian field family to model the turbulent wavefront phase. This generalized model allows us to overcome the limitations found in a previous approach [Perez et al., J. Opt. Soc. Am. A 21, 1962 (2004)]. More precisely, our new model provides stationary phase increments over the full inertial range. Thus it successfully extends classical results to non-Kolmogorov turbulence without any approximation.

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We introduce a new, general formalism to model the turbulent wave-front phase by using fractional Brownian motion processes. Moreover, it extends results to non-Kolmogorov turbulence. In particular, generalized expressions for the Strehl ratio and the angle-of-arrival variance are obtained. These are dependent on the dynamic state of the turbulence.

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