Drawing the double circle on a grid of minimum size

In 1926, Jarník introduced the problem of drawing a convex n-gon with vertices having integer coordinates. He constructed such a drawing in the grid [1, c ·n 3/2]2 for some constant c > 0, and showed that this grid size is optimal up to a constant factor. We consider the analogous problem of drawing the double circle, and prove that it can be done within the same grid size. Moreover, we give an O(n log n)-time algorithm to construct such a point set.Consejo Nacional de Ciencia y Tecnologia (México)Programa de Apoyo a Proyectos de Investigación e Innovación Tecnológica (Universidad Nacional Autónoma de México)Comisión Nacional de Investigación Científica y Tecnológica (Chile)Fondo Nacional de Desarrollo Científico y Tecnológico (Chile

Design of a management control program for the surgical area of the Bucaramanga Metropolitan Clinic

Los cambios generados desde la Constitución Política de 1991, las leyes, resoluciones y decretos que se han dictado, no han sido ajenos a los servicios de salud; al contrario, la compleja organización hospitalaria no solo desde la perspectiva de sus propios objetivos, sino por los elementos que lo conforman: trabajo interdisciplinario, oportunidad, alta tecnología, diversidad de insumos y procesos y alto nivel de exigencia por parte de los usuarios, han hecho que las instituciones inicien un cambio donde el cliente externo, el talento humano, los procesos internos, el manejo de recursos y el aprendizaje sean el punto alrededor del cual se centre la gestión. El análisis sistemático considerado como una de las formas más completas de evaluación de una institución o servicio, fue el que se aplicó en el área quirúrgica de la Clínica Metropolitana de Bucaramanga. A partir de ahí, se identificaron los problemas en cada una de las fases: entradas, procesos y salidas. Posterior a este análisis se estudió la situación actual del área, producto de la cual se plantea a la institución el uso de indicadores como las herramientas que van a permitir visualizar el comportamiento de los atributos que se espera que cumplan los diferentes elementos del sistema, para evaluar y hacer seguimiento de cada uno de los procesos.INTRODUCCION 9 JUSTIFICACION 10 1. OBJETIVOS 11 1.1 GENERALES 11 1.2 ESPECIFICOS 11 2. MARCO DE REFERENCIA 12 2.1 SOPORTE LEGAL 12 2.2 MARCO CONCEPTUAL 14 2.2.1 El control de gestión y las organizaciones de salud 14 2.2.1.1 Generalidades 14 2.2.1.2 Fundamentos de control de gestión 16 2.2.1.3 La evaluación como componente del control de gestión 16 2.2.1.4 Los indicadores como instrumentos para el control de la gestión .17 2.3 MARCO INSTITUCIONAL 18 2.3.1 Reseña histórica 18 2.3.2 Filosofía institucional 19 2.3.2.1 Misión 19 2.3.2.2 Visión 19 2.3.2.3 Valores 19 2.3.3 Descripción del área quirúrgica de la Clínica Metropolitana de Bucaramanga 20 2.3.3.1 Planta física 20 2.3.3.2 Dependencia administrativa 21 2.3.3.3 Coordinación del personal 21 2.3.4 Situación actual del área de cirugía de la Clínica Metropolitana de 22 Bucaramanga 3. METODOLOGIA 24 4. ANALISIS DEL AREA QUIRURGICA DE LA CLINICA METROPOLITANA DE BUCARAMANGA 25 4.1 ANALISIS SISTEMATICO 25 4.2 ANALISIS DE LA SITUACION ACTUAL 26 4.3 IDENTIFICACION DE PROBLEMAS 28 4.3.1 Problemas administrativos relacionados con el paciente 28 4.3.2 Problemas médicos 28 4.3.3 Problemas de talento humano 29 4.3.4 Problemas de suministros 30 4.3.5 Problemas de información 30 5. MODELO DE CONTROL DE GESTION PARA EL AREA QUIRURGICA 31 DE LA CLINICA METROPOLITANA DE BUCARAMANGA 5.1 TABLERO INTEGRADO DE GESTION PARA EL AREA QUIRURGICA 31 DE LA CLINICA METROPOLITANA DE BUCARAMANGA 6. CONCLUSIONES 42 7. RECOMENDACIONES 43 7.1 STANDARIZACION DE PROCESOS 43 7.1.2 Administrativos 43 7.1.3 Asistenciales 44 7.2 INFORMES DE CONTROL INTERNO 44 7.3 ORGANIZACION DEL AREA 45 7.4 CULTURA DE AUTOCONTROL 45 7.5 GESTION DE TALENTO HUMANO 45 7.6 AUDITORIA DEL SERVICIO Y DE LA CALIDAD 46EspecializaciónThe changes generated since the Political Constitution of 1991, the laws, resolutions and decrees that have been issued, have not been alien to health services; On the contrary, the complex hospital organization, not only from the perspective of its own objectives, but also because of the elements that make it up: interdisciplinary work, opportunity, high technology, diversity of supplies and processes, and a high level of demand on the part of users, have made that the institutions initiate a change where the external client, human talent, internal processes, resource management and learning are the point around which management is centered. The systematic analysis considered as one of the most complete forms of evaluation of an institution or service, was the one that was applied in the surgical area of ​​the Bucaramanga Metropolitan Clinic. From there, we identified problems in each of the phases: inputs, processes and outputs. After this analysis, the current situation of the area was studied, as a result of which the use of indicators is proposed to the institution as tools that will allow visualizing the behavior of the attributes that the different elements of the system are expected to fulfill, in order to Evaluate and monitor each of the processes

Marcadores ecográficos de cromosomopatías en el I trimestre de la gestación: ductus venoso

La evaluación Doppler del flujo en el ductus venoso en el primer trimestre ha venido a contribuir con información clínica relevante en las orientaciones a los padres. No sólo se mostró eficaz en el rastreo de anomalías cromosómicas, como la trisomía 21, disminuyendo la tasa de procedimientos invasivos, sino también en el rastreo de cardiopatías congénitas, redefiniendo el grupo de alto riesgo a ser sometido aecocardiografía precoz. Por su parte, un flujo anormal en el ductus venoso asociado a la translucencia nucal aumentada en uno o en ambos fetos de un embarazo monocoriónico parece una combinación sensible para rastrear precozmente el síndrome de transfusión feto fetal. En todas estas situaciones, el ductus venoso se muestra un marcador eficaz deinsuficiencia/disfunción cardíaca

Marcadores ecográficos de cromosomopatías en el I trimestre de la gestación: translucencia nucal

El examen ecográfico detallado de la anatomía fetal permite detectar por un lado las malformaciones y por otro los marcadores ecográficos de cromosomopatías. Analizando especialmente a la translucencia nucal, que representa el grosor del espacio econegativo localizado entre la piel y el tejido blando subcutáneo del embrión a nivel cervical, visualizado entre las semanas 11 a 13+6 de gestación. Se debe utilizar un equipo de ultrasonografía capaz de aumentar lo suficiente la imagen como para que la cabeza y la parte superior del tórax del feto ocupen el monitor y permita diferenciar medidas de hasta 0,1 mm, por vía abdominal o vaginal, situando los calipers en una posición dentro-dentro y evitando confundir la presencia del amnios como un valor alterado de la medida.La translucencia nucal se comporta como el marcador primario por excelencia en el I trimestre del embarazo, en gestaciones únicas o múltiples, de bajo o alto riesgo genético, no solo para discriminar las cromosomopatías, sino también por su importante asociación en fetoseuploides con mayor probabilidad de padecer malformaciones severas, sobre todo cardíacas. Sin embargo, la valoración óptima del riesgo incluye la consideración de otros factores, entre ellos la edad materna, antecedentes familiares y marcadores bioquímicos

Tau Protein is Associated with Longitudinal Memory Decline in Cognitively Healthy Subjects with Normal Alzheimer's Disease Cerebrospinal Fluid Biomarker Levels

Background: We investigated a sample of cognitively healthy subjects with normal Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarker levels to identify the earliest variables related to longitudinal memory changes. Objective: Employing a new highly demanding learning and memory test (the Ancient Farming Equipment Test; AFE-T), we aimed to investigate whether a biomarker related to neurodegeneration (i.e., CSF tau) was associated with longitudinal memory decline. Methods: Thirty-two cognitively and biologically normal (CBN) subjects underwent MRI, neuropsychological assessment, and the AFE-T at baseline and 18 months later. To explore the relationship between cognitive performance and relevant factors, a linear model was set up. For a secondary analysis that further explore the effect of tau, the subjects were divided into CBN-Tau↓ (tau  228.64 pg/ml; n = 16). We also performed voxel-based morphometry (VBM) to identify regions of grey matter volume that would predict both baseline and longitudinal cognitive performance. Results: Our main finding was an association between CSF tau and longitudinal memory decline measured with AFE-T (B = -0.17, p < 0.05; r = -0.414; p < 0.01), and further analyses showed different evolvement between subgroups, with an accelerated decline in individuals with higher tau (F(1,31) = 8.37; p < 0.01). VBM results suggested that AFE-T performance is related to grey matter volume in a medial temporal, middle frontal, and posterior cerebellar network at baseline, and that there are strategic brain areas driving the longitudinal cognitive changes. Conclusions: The present findings provide evidence for structural and biological markers linked to cognitive aging by highlighting the role of tau, a marker of neurodegeneration, which can be related with the earliest memory changes in healthy subjects

Soil contamination in nearby natural areas mirrors that in urban greenspaces worldwide

Soil contamination is one of the main threats to ecosystem health and sustainability. Yet little is known about the extent to which soil contaminants differ between urban greenspaces and natural ecosystems. Here we show that urban greenspaces and adjacent natural areas (i.e., natural/semi-natural ecosystems) shared similar levels of multiple soil contaminants (metal(loid)s, pesticides, microplastics, and antibiotic resistance genes) across the globe. We reveal that human influence explained many forms of soil contamination worldwide. Socio-economic factors were integral to explaining the occurrence of soil contaminants worldwide. We further show that increased levels of multiple soil contaminants were linked with changes in microbial traits including genes associated with environmental stress resistance, nutrient cycling, and pathogenesis. Taken together, our work demonstrates that human-driven soil contamination in nearby natural areas mirrors that in urban greenspaces globally, and highlights that soil contaminants have the potential to cause dire consequences for ecosystem sustainability and human wellbeing

Unearthing the soil-borne microbiome of land plants

Plant–soil biodiversity interactions are fundamental for the functioning of terrestrial ecosystems. Yet, the existence of a set of globally distributed topsoil microbial and small invertebrate organisms consistently associated with land plants (i.e., their consistent soil-borne microbiome), together with the environmental preferences and functional capabilities of these organisms, remains unknown. We conducted a standardized field survey under 150 species of land plants, including 58 species of bryophytes and 92 of vascular plants, across 124 locations from all continents. We found that, despite the immense biodiversity of soil organisms, the land plants evaluated only shared a small fraction (less than 1%) of all microbial and invertebrate taxa that were present across contrasting climatic and soil conditions and vegetation types. These consistent taxa were dominated by generalist decomposers and phagotrophs and their presence was positively correlated with the abundance of functional genes linked to mineralization. Finally, we showed that crossing environmental thresholds in aridity (aridity index of 0.65, i.e., the transition from mesic to dry ecosystems), soil pH (5.5; i.e., the transition from acidic to strongly acidic soils), and carbon (less than 2%, the lower limit of fertile soils) can result in drastic disruptions in the associations between land plants and soil organisms, with potential implications for the delivery of soil ecosystem processes under ongoing global environmental change

The global contribution of soil mosses to ecosystem services

Soil mosses are among the most widely distributed organisms on land. Experiments and observations suggest that they contribute to terrestrial soil biodiversity and function, yet their ecological contribution to soil has never been assessed globally under natural conditions. Here we conducted the most comprehensive global standardized field study to quantify how soil mosses influence 8 ecosystem services associated with 24 soil biodiversity and functional attributes across wide environmental gradients from all continents. We found that soil mosses are associated with greater carbon sequestration, pool sizes for key nutrients and organic matter decomposition rates but a lower proportion of soil-borne plant pathogens than unvegetated soils. Mosses are especially important for supporting multiple ecosystem services where vascular-plant cover is low. Globally, soil mosses potentially support 6.43 Gt more carbon in the soil layer than do bare soils. The amount of soil carbon associated with mosses is up to six times the annual global carbon emissions from any altered land use globally. The largest positive contribution of mosses to soils occurs under a high cover of mat and turf mosses, in less-productive ecosystems and on sandy and salty soils. Our results highlight the contribution of mosses to soil life and functions and the need to conserve these important organisms to support healthy soils.The study work associated with this paper was funded by a Large Research Grant from the British Ecological Society (no. LRB17\1019; MUSGONET). D.J.E. is supported by the Hermon Slade Foundation. M.D.-B. was supported by a Ramón y Cajal grant from the Spanish Ministry of Science and Innovation (RYC2018-025483-I), a project from the Spanish Ministry of Science and Innovation for the I + D + i (PID2020-115813RA-I00 funded by MCIN/AEI/10.13039/501100011033a) and a project PAIDI 2020 from the Junta de Andalucía (P20_00879). E.G. is supported by the European Research Council grant agreement 647038 (BIODESERT). M.B. is supported by a Ramón y Cajal grant from Spanish Ministry of Science (RYC2021-031797-I). A.d.l.R is supported by the AEI project PID2019-105469RB-C22. L.W. and Jianyong Wang are supported by the Program for Introducing Talents to Universities (B16011) and the Ministry of Education Innovation Team Development Plan (2013-373). The contributions of T.G. and T.U.N. were supported by the Research Program in Forest Biology, Ecology and Technology (P4-0107) and the research projects J4-3098 and J4-4547 of the Slovenian Research Agency. The contribution of P.B.R. was supported by the NSF Biological Integration Institutes grant DBI-2021898. J. Durán and A. Rodríguez acknowledge support from the FCT (2020.03670.CEECIND and SFRH/BDP/108913/2015, respectively), as well as from the MCTES, FSE, UE and the CFE (UIDB/04004/2021) research unit financed by FCT/MCTES through national funds (PIDDAC)

Global hotspots for soil nature conservation

19 páginas.- 5 figuras.- 98 referencias.- Supplementary information The online version contains supplementary material available at https://doi.org/10.1038/s41586-022-05292-xSoils are the foundation of all terrestrial ecosystems1. However, unlike for plants and animals, a global assessment of hotspots for soil nature conservation is still lacking2. This hampers our ability to establish nature conservation priorities for the multiple dimensions that support the soil system: from soil biodiversity to ecosystem services. Here, to identify global hotspots for soil nature conservation, we performed a global field survey that includes observations of biodiversity (archaea, bacteria, fungi, protists and invertebrates) and functions (critical for six ecosystem services) in 615 composite samples of topsoil from a standardized survey in all continents. We found that each of the different ecological dimensions of soils—that is, species richness (alpha diversity, measured as amplicon sequence variants), community dissimilarity and ecosystem services—peaked in contrasting regions of the planet, and were associated with different environmental factors. Temperate ecosystems showed the highest species richness, whereas community dissimilarity peaked in the tropics, and colder high-latitudinal ecosystems were identified as hotspots of ecosystem services. These findings highlight the complexities that are involved in simultaneously protecting multiple ecological dimensions of soil. We further show that most of these hotspots are not adequately covered by protected areas (more than 70%), and are vulnerable in the context of several scenarios of global change. Our global estimation of priorities for soil nature conservation highlights the importance of accounting for the multidimensionality of soil biodiversity and ecosystem services to conserve soils for future generations.This project received funding from the British Ecological Society (agreement LRA17\1193; MUSGONET). C.A.G. and N.E. were funded by DFG–FZT 118, 202548816; C.A.G. was supported by FCT-PTDC/BIA-CBI/2340/2020; M.D.-B. was supported by RYC2018-025483-I, PID2020-115813RA-I00\MCIN/AEI/10.13039/501100011033 and P20_00879. M.A.M.-M. and S.A. were funded by FONDECYT 1181034 and ANID-PIA-Anillo INACH ACT192057. J.D. and A.R. acknowledge support from IF/00950/2014, 2020.03670.CEECIND, SFRH/BDP/108913/2015 and UIDB/04004/2020. Y.-R.L. was supported by 2662019PY010 from the FRFCU. L.T. was supported by the ESF grant PRG632. F.B. and J.L.M. were supported by i-LINK+2018 (LINKA20069) funded by CSIC. C.T.-D. was supported by the Grupo de Biodibersidad & Cambio Global UBB–GI 170509/EF. C.P. was supported by the EU H2020 grant agreement 101000224. H.C. was supported by NSFC32101335, FRFCU2412021QD014 and CPSF2021M690589. J.P.V. was supported by DST (DST/INT/SL/P-31/2021) SERB (EEQ/2021/001083) and BHU-IoE (6031).Peer reviewe

Biogenic factors explain soil carbon in paired urban and natural ecosystems worldwide

12 páginas.- 4 figuras.- 49 referencia.- Supplementary information The online version contains supplementary material available at https://doi.org/10.1038/s41558-023-01646-z .- Full-text access to a view-only version (Acceso a texto completo de sólo lectura en este enlace) https://rdcu.be/c8vZiUrban greenspaces support multiple nature-based services, many of which depend on the amount of soil carbon (C). Yet, the environmental drivers of soil C and its sensitivity to warming are still poorly understood globally. Here we use soil samples from 56 paired urban greenspaces and natural ecosystems worldwide and combine soil C concentration and size fractionation measures with metagenomics and warming incubations. We show that surface soils in urban and natural ecosystems sustain similar C concentrations that follow comparable negative relationships with temperature. Plant productivity’s contribution to explaining soil C was higher in natural ecosystems, while in urban ecosystems, the soil microbial biomass had the greatest explanatory power. Moreover, the soil microbiome supported a faster C mineralization rate with experimental warming in urban greenspaces compared with natural ecosystems. Consequently, urban management strategies should consider the soil microbiome to maintain soil C and related ecosystem services.This study was supported by a 2019 Leonardo Grant for Researchers and Cultural Creators, BBVA Foundation (URBANFUN), and by BES Grant Agreement No. LRB17\1019 (MUSGONET). M.D-B., P.G-P., J.D. and A.R. acknowledge support from TED2021-130908B-C41/AEI/10.13039/501100011033/ Unión Europea NextGenerationEU/PRTR. M.D.-B. also acknowledges support from the Spanish Ministry of Science and Innovation for the I + D + i project PID2020-115813RA-I00 funded by MCIN/AEI/10.13039/501100011033. M.D.-B. was also supported by a project of the Fondo Europeo de Desarrollo Regional (FEDER) and the Consejería de Transformación Económica, Industria, Conocimiento y Universidades of the Junta de Andalucía (FEDER Andalucía 2014-2020 Objetivo temático ‘01 - Refuerzo de la investigación, el desarrollo tecnológico y la innovación’) associated with the research project P20_00879 (ANDABIOMA). D.J.E. was supported by the Hermon Slade Foundation. J.P.V. thanks the Science and Engineering Research Board (SERB) (EEQ/2021/001083, SIR/2022/000626) and the Department of Science and Technology (DST), India (DST/INT/SL/P-31/2021) and Banaras Hindu Univeristy-IoE (6031)-incentive grant for financial assistance for research in plant-microbe interaction and soil microbiome. J.D. and A. Rodríguez acknowledge support from the FCT (2020.03670.CEECIND and SFRH/BDP/108913/2015, respectively), as well as from the MCTES, FSE, UE and the CFE (UIDB/04004/2021) research unit financed by FCT/MCTES through national funds (PIDDAC).Peer reviewe