RESUMO
The discriminative and predictive power of a continuous-valued marker for survival outcomes can be summarized using the receiver operating characteristic and predictiveness curves, respectively. In this paper, fully parametric and semi-parametric copula-based constructions of the joint model of the marker and the survival time are developed for characterizing, plotting, and analyzing both curves along with other underlying performance measures. The formulations require a copula function, a parametric specification for the margin of the marker, and either a parametric distribution or a non-parametric estimator for the margin of the time to event, to respectively characterize the fully parametric and semi-parametric joint models. Estimation is carried out using maximum likelihood and a two-stage procedure for the parametric and semi-parametric models, respectively. Resampling-based methods are used for computing standard errors and confidence bounds for the various parameters, curves, and associated measures. Graphical inspection of residuals from each conditional distribution is employed as a guide for choosing a copula from a set of candidates. The performance of the estimators of various classification and predictiveness measures is assessed in simulation studies, assuming different copula and censoring scenarios. The methods are illustrated with the analysis of two markers using the familiar primary biliary cirrhosis data set.
Assuntos
Modelos Estatísticos , Simulação por Computador , Curva ROCRESUMO
The development of real-time monitoring sensors for pyro-metallurgical processes is an analytical challenge, mainly due to adverse environmental conditions, high spectral interferences and multiphase (molten and gas) reactions. This work demonstrates the suitability of stand-off LIBS (ST-LIBS) for real time monitoring of the desulfurization of blister copper which is carried out in molten phase. Here sulfur is removed by the formation of SO2 by supplying oxygen in molten phase. Using ST-LIBS the relative emission intensities of Cu(I) at 351.06 nm, O at 777.34 nm and S at 921.29 nm in both molten and gaseous phase were considered simultaneously during the process. This was possible only by the use high energy laser pulse over up to 270 mJ per pulse. In the case of copper, the selection of emission lines was assessed considering non-linear behavior, which is caused by self-absorption. For the first time, real time determination of sulfur in ppm range is reported by ST-LIBS using low sensitive lines from the NIR region. These results were validated with differential optical absorption spectroscopy (DOAS) as gold standard method. The analytical information obtained by LIBS can precisely determine the critical end-point of the desulfurization where the removal of sulfur is finished, and copper started to oxidize.
Assuntos
Vesícula , Cobre , Humanos , Lasers , Análise Espectral , EnxofreRESUMO
In this paper, a novel optical technique for following the progress of the blister copper desulfurization process is presented. The technique is based on the changes observed in the continuous spectrum of the visible-near-infrared (VIS-NIR) radiation that the blister melt emits while the chemical reactions of the sulfur elimination process are taking place. Specifically, the proposed technique uses an optical probe composed of an optical fiber, a collimating lens, and a quartz tube, which is immersed in the melt. This optical probe provides a field of view of the blowing zone where the desulfurization reaction occurs. The experimental results show that the melt VIS-NIR total irradiance evolves inversely to the SO2 concentration reported by a gas analyzer based on differential optical absorption spectroscopy. Furthermore, the blister copper spectral emissivity as well as the total emissivity observed throughout the process show strong correlation with the sulfur content during desulfurization reaction.
RESUMO
Background: Paravalvular leak (PVL) is a frequent and important complication after surgical valvular replacement that can cause heart failure and hemolytic anemia and is associated with poor clinical outcomes. Surgical reoperation has been the standard treatment, but it is associated with high morbidity and mortality. Transcatheter closure is a therapeutic alternative. The aim of the present study is to analyze the feasibility and the short- and medium-term outcomes of the transcatheter closure of PVLs. Methods: Single-center registry of consecutive patients with post-surgical PVLs that underwent transcatheter closure, between January 2006 and December 2016. Efficacy and safety results were analyzed during the procedure and at 6-month follow-up. Results: Twenty-one PVLs (15 mitral, 5 aortic, and 1 tricuspid) were closure during 20 procedures. In the initial echocardiography, 91% of the leaks were severe. The most used device was the Amplatzer Vascular Plug III® in 10 procedures (50%). The three-dimensional transesophageal echocardiography was used in 70% of cases. The device was successfully implanted in 95% of cases, a regurgitation reduction ≥ 1 grade was achieved in 95% of the cases, and the clinical success was 79%. Six-month survival was 100%; however, three cases required valvular surgery (15%). Conclusions: Transcatheter closure of PVLs is a feasible and safe procedure with high rates of technical, echocardiographic, and clinical success in the short and medium term. It is an adequate therapeutic alternative, mainly in high surgical risk patients and multiples comorbidities.
Introducción: La fuga paravalvular es una complicación frecuente e importante posterior al reemplazo valvular quirúrgico que puede ocasionar insuficiencia cardiaca, anemia hemolítica y se relaciona con malos resultados clínicos. La reintervención quirúrgica ha sido el tratamiento habitual, pero se acompaña de alta morbimortalidad. El cierre transcatéter es una alternativa terapéutica. El objetivo del presente estudio es analizar la factibilidad y los resultados a corto y mediano plazo del cierre transcatéter de fugas paravalvulares con dispositivos oclusores. Métodos: Registro unicéntrico de una serie consecutiva de pacientes con fugas paravalvulares posquirúrgicas que fueron cerradas vía transcatéter con dispositivos oclusores, entre enero del 2006 y diciembre del 2016. Se analizaron los resultados de eficacia y seguridad durante el procedimiento y a seis meses. Resultados: Se trataron 21 fugas paravalvulares (15 mitrales, 5 aórticas y 1 tricuspídea) durante 20 procedimientos. El 91% de las fugas fue grave en la ecocardiografía inicial. El dispositivo utilizado con más frecuencia fue el Amplatzer Vascular Plug III® en 10 procedimientos (50%). Se utilizó ecocardiografía transesofágica tridimensional en 70% de los casos. Se logró implantar el dispositivo con éxito en el 95% de los casos; se consiguió una reducción ≥ 1 del grado de regurgitación en el 95% de las veces y se alcanzó el éxito clínico en el 79%. A seis meses la supervivencia fue del 100%; sin embargo, tres casos requirieron cirugía valvular (15%). Conclusiones: El cierre transcatéter de fugas paravalvulares es un procedimiento factible, seguro y con tasas elevadas de éxito técnico, ecocardiográfico y clínico a corto y mediano plazo. Es una alternativa terapéutica adecuada, en particular en pacientes considerados de alto riesgo quirúrgico y múltiples comorbilidades.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Cateterismo Cardíaco/métodos , Insuficiência da Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Adulto , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Sistema de Registros , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do TratamentoRESUMO
Abstract Background: Paravalvular leak (PVL) is a frequent and important complication after surgical valvular replacement that can cause heart failure and hemolytic anemia and is associated with poor clinical outcomes. Surgical reoperation has been the standard treatment, but it is associated with high morbidity and mortality. Transcatheter closure is a therapeutic alternative. The aim of the present study is to analyze the feasibility and the short- and medium-term outcomes of the transcatheter closure of PVLs. Methods: Single-center registry of consecutive patients with post-surgical PVLs that underwent transcatheter closure, between January 2006 and December 2016. Efficacy and safety results were analyzed during the procedure and at 6-month follow-up. Results: Twenty-one PVLs (15 mitral, 5 aortic, and 1 tricuspid) were closure during 20 procedures. In the initial echocardiography, 91% of the leaks were severe. The most used device was the Amplatzer Vascular Plug III® in 10 procedures (50%). The three-dimensional transesophageal echocardiography was used in 70% of cases. The device was successfully implanted in 95% of cases, a regurgitation reduction ≥ 1 grade was achieved in 95% of the cases, and the clinical success was 79%. Six-month survival was 100%; however, three cases required valvular surgery (15%). Conclusions: Transcatheter closure of PVLs is a feasible and safe procedure with high rates of technical, echocardiographic, and clinical success in the short and medium term. It is an adequate therapeutic alternative, mainly in high surgical risk patients and multiples comorbidities.
Resumen Introducción: La fuga paravalvular es una complicación frecuente e importante posterior al reemplazo valvular quirúrgico que puede ocasionar insuficiencia cardiaca, anemia hemolítica y se relaciona con malos resultados clínicos. La reintervención quirúrgica ha sido el tratamiento habitual, pero se acompaña de alta morbimortalidad. El cierre transcatéter es una alternativa terapéutica. El objetivo del presente estudio es analizar la factibilidad y los resultados a corto y mediano plazo del cierre transcatéter de fugas paravalvulares con dispositivos oclusores. Métodos: Registro unicéntrico de una serie consecutiva de pacientes con fugas paravalvulares posquirúrgicas que fueron cerradas vía transcatéter con dispositivos oclusores, entre enero del 2006 y diciembre del 2016. Se analizaron los resultados de eficacia y seguridad durante el procedimiento y a seis meses. Resultados: Se trataron 21 fugas paravalvulares (15 mitrales, 5 aórticas y 1 tricuspídea) durante 20 procedimientos. El 91% de las fugas fue grave en la ecocardiografía inicial. El dispositivo utilizado con más frecuencia fue el Amplatzer Vascular Plug III® en 10 procedimientos (50%). Se utilizó ecocardiografía transesofágica tridimensional en 70% de los casos. Se logró implantar el dispositivo con éxito en el 95% de los casos; se consiguió una reducción ≥ 1 del grado de regurgitación en el 95% de las veces y se alcanzó el éxito clínico en el 79%. A seis meses la supervivencia fue del 100%; sin embargo, tres casos requirieron cirugía valvular (15%). Conclusiones: El cierre transcatéter de fugas paravalvulares es un procedimiento factible, seguro y con tasas elevadas de éxito técnico, ecocardiográfico y clínico a corto y mediano plazo. Es una alternativa terapéutica adecuada, en particular en pacientes considerados de alto riesgo quirúrgico y múltiples comorbilidades.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Insuficiência da Valva Aórtica/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Cateterismo Cardíaco/métodos , Insuficiência da Valva Mitral/cirurgia , Fatores de Tempo , Falha de Prótese , Próteses Valvulares Cardíacas , Sistema de Registros , Seguimentos , Resultado do Tratamento , Ecocardiografia Transesofagiana , Ecocardiografia Tridimensional , Dispositivo para Oclusão SeptalRESUMO
Background: Paravalvular leak is a frequent and important complication after surgical valvular replacement that can cause heart failure, hemolytic anemia and is associated with poor clinical outcomes. Surgical reoperation has been the standard treatment, but it is associated with high morbidity and mortality. Transcatheter closure is a therapeutic alternative. The aim of the present study is to analyze the feasibility and the short and medium-term outcomes of the transcatheter closure of paravalvular leaks. Methods: Single-centre registry of consecutive patients with post-surgical paravalvular leaks, that underwent transcatheter closure, between January 2006 and December 2016. Efficacy and safety results were analyzed during the procedure and at 6-month follow-up. Results: 21 paravalvular leaks (15 mitral, 5 aortic and 1 tricuspid) were closure during 20 procedures. In the initial echocardiography 91% of the leaks were severe. The most used device was the Amplatzer Vascular Plug III® in 10 procedures (50%). The 3D transesophageal echocardiography was used in 70% of cases. The device was successfully implanted in 95% of cases, a regurgitation reduction ≥ 1 grade was achieved in 95% of the cases, and the clinical success was 79%. Six month survival was 100%; however, 3 cases required valvular surgery (15%). Conclusions: Transcatheter closure of paravalvular leaks is a feasible and safe procedure with high rates of technical, echocardiographic and clinical success in the short and medium term. It is an adequate therapeutic alternative, mainly in high surgical risk patients and multiples comorbidities.
Introducción: La fuga paravalvular es una complicación frecuente e importante posterior al reemplazo valvular quirúrgico que puede ocasionar insuficiencia cardiaca, anemia hemolítica y se relaciona con malos resultados clínicos. La reintervención quirúrgica ha sido el tratamiento habitual, pero se acompaña de alta morbimortalidad. El cierre transcatéter es una alternativa terapéutica. El objetivo del presente estudio es analizar la factibilidad y los resultados a corto y mediano plazo del cierre transcatéter de fugas paravalvulares con dispositivos oclusores. Métodos: Registro unicéntrico de una serie consecutiva de pacientes con fugas paravalvulares posquirúrgicas que fueron cerradas vía transcatéter con dispositivos oclusores, entre enero del 2006 y diciembre del 2016. Se analizaron los resultados de eficacia y seguridad durante el procedimiento y a seis meses. Resultados: Se trataron 21 fugas paravalvulares (15 mitrales, 5 aórticas y 1 tricuspídea) durante 20 procedimientos. El 91% de las fugas fue grave en la ecocardiografía inicial. El dispositivo utilizado con más frecuencia fue el Amplatzer Vascular Plug III® en 10 procedimientos (50%). Se utilizó ecocardiografía transesofágica tridimensional en 70% de los casos. Se logró implantar el dispositivo con éxito en el 95% de los casos; se consiguió una reducción ≥ 1 del grado de regurgitación en el 95% de las veces y se alcanzó el éxito clínico en el 79%. A seis meses la supervivencia fue del 100%; sin embargo, tres casos requirieron cirugía valvular (15%). Conclusiones: El cierre transcatéter de fugas paravalvulares es un procedimiento factible, seguro y con tasas elevadas de éxito técnico, ecocardiográfico y clínico a corto y mediano plazo. Es una alternativa terapéutica adecuada, en particular en pacientes considerados de alto riesgo quirúrgico y múltiples comorbilidades.
Assuntos
Cateterismo Cardíaco/métodos , Ecocardiografia Transesofagiana , Doenças das Valvas Cardíacas/cirurgia , Adulto , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Valva Mitral/cirurgia , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/patologia , Valva Tricúspide/cirurgiaRESUMO
El articulo busca estimar la carga de enfermedad de diabetes mellitus en Bogotá, D. C., para el periodo 2009-2015. Fechas y lugares de ejecución: el estudio se realizó con la información actualizada de la Secretaría Distrital de Salud (SDS) en 2016 y 2017. Métodos: es un estudio de carga de enfermedad retrospectivo; para estimar los años de vida perdidos por discapacidad (AVD) se utilizaron las bases de datos del Registro Individual de Prestación de Servicios (RIPS), y para los años de vida perdidos por muerte prematura (AVP) se emplearon los registros de estadísticas vitales de defunción del Departamento Administrativo Nacional de Estadística (DANE), en contraste con la esperanza de vida calculada para Colombia para 2010; posteriormente, se sumaron estos dos indicadores para estimar los años de vida perdidos por muerte prematura ajustados por discapacidad (AVAD) en diabetes mellitus. Resultados: las tasas de mortalidad y AVP presentan una tendencia a la disminución; en la proporción de prevalencia y en los AVPD, tienen una tendencia significativa al aumento; la carga de enfermedad está a expensas de la discapacidad en un 56,49 %; por sexo, las mujeres presentan mayor carga de enfermedad, y por grupo de edad se observa un aumento cronológico con la edad; por régimen de seguridad, la mayor cantidad de carga la presenta el subsidiado. En cuanto a los tipos de diabetes, la mayor proporción se presenta en la diabetes tipo 2, seguida de la diabetes tipo 1, la diabetes gestacional y la diabetes específica. Conclusión: la diabetes mellitus en Bogotá durante el periodo 2009-2015 muestra que la carga de enfermedad tiene una tendencia al aumento, a expensas del incremento en la carga de discapacidad.
Assuntos
Humanos , Prevalência , Mortalidade , Diabetes Mellitus , Mulheres , Estatísticas Vitais , Expectativa de Vida , Diabetes Gestacional , Efeitos Psicossociais da Doença , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Mortalidade PrematuraRESUMO
Objetivo: estimar la carga de enfermedad de diabetes mellitus en Bogotá, D. C., para el periodo 2009-2015. Fechas y lugares de ejecución: el estudio se realizó con la información actualizada de la Secretaría Distrital de Salud (SDS) en 2016 y 2017. Métodos: es un estudio de carga de enfermedad retrospectivo; para estimar los años de vida perdidos por discapacidad (AVD) se utilizaron las bases de datos del Registro Individual de Prestación de Servicios (RIPS), y para los años de vida perdidos por muerte prematura (AVP) se emplearon los registros de estadísticas vitales de defunción del Departamento Administrativo Nacional de Estadística (DANE), en contraste con la esperanza de vida calculada para Colombia para 2010; posteriormente, se sumaron estos dos indicadores para estimar los años de vida perdidos por muerte prematura ajustados por discapacidad (AVAD) en diabetes mellitus. Resultados: las tasas de mortalidad y AVP presentan una tendencia a la disminución; en la proporción de prevalencia y en los AVPD, tienen una tendencia significativa al aumento; la carga de enfermedad está a expensas de la discapacidad en un 56,49 %; por sexo, las mujeres presentan mayor carga de enfermedad, y por grupo de edad se observa un aumento cronológico con la edad; por régimen de seguridad, la mayor cantidad de carga la presenta el subsidiado. En cuanto a los tipos de diabetes, la mayor proporción se presenta en la diabetes tipo 2, seguida de la diabetes tipo 1, la diabetes gestacional y la diabetes específica. Conclusión: la diabetes mellitus en Bogotá durante el periodo 2009- 2015 muestra que la carga de enfermedad tiene una tendencia al aumento, a expensas del incremento en la carga de discapacidad
Objective: To estimate the burden of diabetes mellitus disease in Bogotá D.C., 2009 - 2015. Material and Methods: This is a study of retrospective disease burden. In order to estimate the years of life lost due to disability (YLD), we used the databases Individual Service Provider Records (RIPS) and for the years of life lost due to premature death (YLL), the vital death statistics registers were used of the DANE, in contrast to the life expectancy calculated for Colombia in 2010; later these two indicators are added to estimate Years of life lost due to premature death adjusted for disability (DALYs) in diabetes mellitus. Results: Mortality rates and YLL, the tendency is to decrease; instead, in the proportion of prevalence and in the YLD, a significant tendency to increase; the disease burden is at the expense of disability, this is due to a 56.49 % disability; by sex, women present a greater burden of disease, by age group a chronological increase is observed with age, by safety regime the largest amount of burden is presented by the subsidized. In the types of diabetes the highest proportion occurs in type 2 diabetes, followed by type 1 diabetes, gestational diabetes and specific diabetes. Conclusion: Diabetes mellitus in Bogotá during 2009-2015 shows that the burden of disease has a tendency to increase, at the expense of the increase in the burden of disability
Objetivo: Estimar a carga de diabetes mellitus em Bogotá D.C., 2009 - 2015. Material e Métodos: Trata-se de um estudo de carga de doença retrospectiva. Para estimar os anos de vida perdidos por invalidez (YLD), utilizamos os bancos de dados Registros Individuais de Prestação de Serviços (RIPS) e, para os anos de vida perdidos por morte prematura (YLL), foram utilizados os registros estatísticos de óbitos vitais o DANE, em contraste com a expectativa de vida calculada para a Colômbia em 2010; mais tarde, esses dois indicadores são adicionados para estimar os anos de vida perdidos devido a morte prematura ajustada por incapacidade (DALYs) no diabetes mellitus. Resultados: As taxas de mortalidade e o YLL tendem a diminuir; na proporção de prevalência e na YLD, eles têm uma tendência significativa a aumentar; o ônus da doença é à custa da deficiência, que é de 56,49 % devido à deficiência; por sexo, as mulheres apresentam maior carga de doença, por faixa etária observa- se um aumento cronológico com a idade, pelo regime de segurança o maior montante de sobrecarga é apresentado pelos subsidiados. Nos tipos de diabetes, a maior proporção ocorre no diabetes tipo 2, seguido pelo diabetes tipo 1, diabetes gestacional e diabetes específico Conclusão: O diabetes mellitus em Bogotá durante 2009-2015 mostra que o ônus da doença tende a aumentar, em detrimento do aumento da carga de incapacidade
Assuntos
Humanos , Masculino , Feminino , Prevalência , Diabetes Mellitus , Registros , Doença , Expectativa de Vida , Mortalidade , Diabetes Gestacional , Efeitos Psicossociais da Doença , MorteRESUMO
OBJECTIVE: To determine the effects of lipid-based nutrient supplements (LNS) on children's Hb, linear growth and development, compared with supplementation with micronutrient powder (MNP). DESIGN: The study was a two-arm parallel-group randomized controlled trial, where participants received either LNS or MNP for daily consumption during 6 months. Supplements were delivered by staff at government-run health centres. Hb, anthropometric, motor development, language development and problem-solving indicators were measured by trained research assistants when children were 12 months of age. SETTING: The study was conducted in five rural districts in the Province of Ambo in the Department of Huánuco, Peru. SUBJECTS: We enrolled 6-month-old children (n 422) at nineteen health centres. RESULTS: Children who received LNS had a higher mean Hb concentration and lower odds of anaemia than those who received MNP. No significant differences in height-for-age, weight-for-height or weight-for-age Z-score, or stunting and underweight prevalence, were observed. Provision of LNS was associated with a higher pre-verbal language (gestures) score, but such effect lost significance after adjustment for covariates. Children in the LNS group had higher problem-solving task scores and increased odds of achieving this cognitive task than children in the MNP group. No significant differences were observed on receptive language or gross motor development. CONCLUSIONS: LNS between 6 and 12 months of age increased Hb concentration, reduced anaemia and improved cognitive development in children, but showed no effects on anthropometric indicators, motor or language development.
Assuntos
Deficiências do Desenvolvimento/prevenção & controle , Gorduras na Dieta/uso terapêutico , Suplementos Nutricionais , Transtornos da Nutrição do Lactente/prevenção & controle , Fenômenos Fisiológicos da Nutrição do Lactente , Micronutrientes/uso terapêutico , Saúde da População Rural , Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Método Duplo-Cego , Feminino , Seguimentos , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Transtornos da Nutrição do Lactente/epidemiologia , Análise de Intenção de Tratamento , Desenvolvimento da Linguagem , Perda de Seguimento , Masculino , Peru/epidemiologia , Prevalência , Resolução de Problemas , Risco , Serviços de Saúde Rural , Magreza/epidemiologia , Magreza/prevenção & controleRESUMO
UNLABELLED: Objectives . To determine the effect of consumption of a lipid-based nutrient supplement (LNS) on hemoglobin levels, anemia and anthropometric indicators in children aged six to eleven months old in five districts in the province of Ambo in the region of Huanuco, Peru. MATERIALS AND METHODS: A pre-experimental, pre-post study was performed. The study population included children aged six to eleven months old in 19 health facilities in five districts with very high vulnerability to chronic malnutrition in the province of Ambo, Huanuco. Data from 147 children who received the lipid-based nutrient supplement (LNS) from six to eleven months old were obtained. RESULTS: The mean hemoglobin significantly increased by 0.67 g/dL (p<0.05), the proportion of anemia dropped by 27 percentage points (p<0.001) and the mean z score for height/age decreased by 0.12 (p<0.05). No significant differences for z scores of weight/age and weight/height at the end of the study were found. The LNS had an adherence greater than 90%, and less than 10% of children in the study reported discomfort during consumption. CONCLUSIONS: LNS supplementation achieved improved hemoglobin levels and reduced the prevalence of anemia in children under twelve months, which might constitute an effective alternative to prevent and control childhood anemia.
Assuntos
Anemia/sangue , Anemia/dietoterapia , Estatura , Peso Corporal , Gorduras na Dieta/uso terapêutico , Suplementos Nutricionais , Hemoglobinas/análise , Anemia/epidemiologia , Feminino , Humanos , Lactente , Masculino , PeruAssuntos
Humanos , Antropometria , Gorduras na Dieta , Hemoglobinas , Indicadores e Reagentes , Criança , Suplementos NutricionaisRESUMO
We explore in detail the potential energy surfaces of the Al(x)Mg(y) (x, y = 1-4) systems as case studies to test the utility and limitations of simple rules based on electron counts and the phenomenological shell model (PSM) for bimetallic clusters. We find that it is feasible to design stable structures that are members of this set of small Al-Mg binary clusters, using simple electron count rules, including the classical 4n + 2 Hückel model, and the most recently proposed PSM. The thermodynamic stability of the title compounds has been evaluated using several different descriptors, including the fragmentation energies and the electronic structure of the systems. Three stable systems emerge from the analysis: the Al(4)Mg, Al(2)Mg(2) and Al(4)Mg(4) clusters. The relative stability of Al(4)Mg is explained by the stability of the Al(4)(2-) subunit to which the Mg atom donates its electrons. Here the Mg(2+) sits above the aromatic 10 π-electron Al(4)(2-) planar ring. The Al(2)Mg(2) and Al(4)Mg(4) clusters present more complicated 3D structures, and their stabilities are rationalized as a consequence of their closed shell nature in the PSM, with 10 and 20 itinerant electrons, respectively.
RESUMO
La presente publicación describe qué es la sectorización y cuáles son sus objetivos, las fases y las tareas para la sectorización. Contribuye con una propuesta de los roles y responsabilidades de los actores sociales en el gobierno local, sector salud y comunidad para la implementación exitosa de la sectorización. En los anexos se encuentran doce instrumentos que facilitan el trabajo del personal de salud y de los miembros de la comunidad en las etapas de diagnóstico, planificación, implementación y monitoreo de la promoción de la salud en la comunidad(AU)
Assuntos
Promoção da Saúde , Medicina de Família e Comunidade , Gestão em Saúde , Estratégias de Saúde Locais , PeruRESUMO
La publicación describe qué es la sectorización y cuáles son sus objetivos, las fases y las tareas para la sectorización. Contribuye con una propuesta de los roles y responsabilidades de los actores sociales en el gobierno local, sector salud y comunidad para la implementación exitosa de la sectorización. En los anexos se encuentran doce instrumentos que facilitan el trabajo del personal de salud y de los miembros de la comunidad en las etapas de diagnóstico, planificación, implementación y monitoreo de la promoción de la salud en la comunidad
Assuntos
Estratégias de Saúde Locais , Gestão em Saúde , Medicina de Família e Comunidade , Promoção da Saúde , PeruRESUMO
En este trabajo se diseñó un material educativo para la enseñanza de la conservación del Cóndor de los Andes (Vultur gryphus) en el Parque Nacional Natural Los Nevados, localizado en la Cordillera Central de Colombia con alturas comprendidas entre 2600 y 5300 metros sobre el nivel del mar. Para la realización de este material se tomó como referentes teóricos el modelo educativo Escuela Nueva, los estándares para la educación en Colombia y los conceptos de lúdica y creatividad. Se realizó una selección de los estándares por grados y por área, y se procedió a estructurar actividades lúdico-creativas de acuerdo con los parámetros establecidos en el modelo educativo Escuela Nueva. El material educativo está compuesto por un texto guía que contiene actividades desde cuatro áreas del conocimiento como lo son las ciencias sociales, las matemáticas, las ciencias naturales y la lengua castellana; y una cartilla que es necesaria para el desarrollo de las actividades que se proponen en el texto guía y contiene la información sobre los aspectos biológicos, ecológicos, literarios y de conservación referentes al cóndor. Se obtuvo un texto guía que contiene seis unidades y 11 guías; y se obtuvo una cartilla con 13 puntos generales sobre el Cóndor de los Andes (Vultur gryphus). El texto guía diseñado ofrece un gran número y variedad de actividades de tipo flexible, lúdicas y creativas que se dinamiza con la cartilla de la especie objeto de conservación. El material educativo diseñado está dirigido a docentes de los centros educativos, facilitadores y promotores ambientales, guías del parque, turistas y a la comunidad en general.
In this work, an educative material was designed for the conservation teaching of the Andean Condor (Vultur gryphus) in the Parque Nacional Natural Los Nevados, located in the Central Cordillera of Colombia, with heights ranging between 2600 and 5300 m. There were taken as theoretical referring the Escuela Nueva educational model, the standards for education in Colombia, and the concepts of playful and creativity. We performed a selection of standards by grade and by area and proceeded to organize the activities in accordance with the parameters established in the Escuela Nueva educational model. The educative material consists of a guide text which contains activities from four areas of knowledge such as social sciences, mathematics, natural sciences and the castilian language, and a handbook that is necessary for the development of the activities proposed in the guide text and contains information about biological, ecological, literature and conservation concerning to the condor. The result was a guide text that contains six units and 11 guides, and a handbook with 13 general points of the Andean Condor (Vultur gryphus). The guide text designed offers a great number and variety of flexible, playful and creative activities that is invigorated with the handbook of the specie object of conservation. The educational material designed is aimed at teachers of schools, facilitators and environmental promoters, park guides, tourists and the community in general.
Assuntos
Humanos , Espécies em Perigo de Extinção , Instituições Acadêmicas , Ensino , EducaçãoRESUMO
La determinación de la producción de follaje verde en el primer año de siembra de la Acacia decurrens se realizó en la finca La Ramada, Quindío, a 4° 31' 41" de latitud norte y 75° 32' 41'' de longitud oeste, con una temperatura promedio de 16 °C. Las plantas fueron establecidas con un mes de edad, en surcos paralelos a la pendiente, podadas al alcanzar 1,8 m de altura y defoliadas manualmente simulando el ramoneo que realiza el ganado. Las densidades de siembra fueron: alta, media y baja: 1664, 832 y 416 acacias/hectárea, respectivamente; se realizaron defoliaciones por periodos a los 6, 9 y 12 meses de siembra. Las variables a medir fueron: peso en gramos de follaje verde por árbol e incremento en gramos de follaje verde/árbol/día. Todos los datos fueron analizados por ANOVA. No fue encontrada diferencia significativa (P>0,05) entre las variables analizadas al estudiar las diferentes densidades de siembra. Se evidenció diferencia significativa (P<0,05) entre periodos de defoliación, al analizar la variable de incremento en gramos de follaje verde por día, esto indica, que la producción de gramos de follaje verde fue mejor en el tercer periodo. La producción de follaje verde de la acacia en el primer año no se ve afectada por las diferentes densidades de siembra y hay un incremento de la producción de follaje verde a medida que las acacias incrementan su edad.
The determination of green foliage production of Acacia decurrens in the first planting year, was in La Ramada farm, Quindío, located 4° 31' 41'' of latitude north and 75° 32' 41'' longitude west, an average temperature 16 °C. The age for planting was one month, in parallel rows to the slope, pruning to 1,5 m of high and the acacia's browsing was simulated by manual defoliation; The planting densities were high, medium, and low: 1664, 832 and 416 acacias/hectare, respectively; and the periods o frequency of defoliation was to 6, 9 and 12 months of planting. The variables were grams/tree of foliage production and grams/tree/day of foliage increment. All data were analyzed by ANOVA. In this trial, the planting densities were not significantly (P>0.05), however, between periods the grams/tree/day of foliage increment were significantly (P<0.05), because the better production was in the third defoliation period. Acacia foliage production is similar in the first planting year with three different densities, and the foliage production increment improves with the time.
Assuntos
Humanos , Acacia , Produção Agrícola , Diagnóstico , HemípterosRESUMO
A 28 years old male on chronic hemodialysis for 40 months due to a IgA crescentic glomerulonephritis developed pancytopenia (hematocrit 16%, white blood cell count 3,800 mm3 and platelets 11,000 mm3. The bone marrow aspirate showed erythropoietic hyperplasia. Hemolytic anemia, folate or vitamin B12 deficiency and paroxysmal nocturnal hemoglobinuria were ruled out. Steroids were given with a transient elevation of red cells and platelets, which lasted only for some weeks. Afterwards, intravenous immunoglobulin was given without benefit. Two months after, a bone marrow biopsy and a bone marrow magnetic resonance imaging showed severe aplasia. Cyclosporine was started with a rapid increase in blood cells count. Eight months later, he received a renal transplant from a cadaveric donor. Immunosupression was achieved with cyclosporine, prednisone and mycofenolate mofetil. The patient required hemodialysis for the first three weeks and a mild acute cellular rejection was treated with methylprednisolone. At discharge, 6 weeks later, serum creatinine was 2.4 mg/dl and creatinine clearance 37.6 ml/min. During the first months after transplant, platelet count and hemoglobin decreased and a bone marrow biopsy showed only mild hypoplasia. Four months after renal transplant the hematocrit was 43%, white blood cell count 6,600 mm3 and platelets, 150,000 mm3 and did not change during the first year of follow up.