Salud reproductiva, organización familiar e identidad de genero

El presente trabajo resume los resultados de una experiencia de .investigación realizada por docentes de la Facultad de Enfermería y de la Facultad de Estudios Interdisciplinarios (FEI), conjuntamente con alumnas de V Semestre de Enfermería en su práctica de Atención a la mujer en el área de Gineco-Obstetricia. Esta experiencia, además de la generación de los datos que aquí se analizan, tiene otras especificidades que consideramente relevante señalar: En primer lugar, constituye uno de los componentes del Espacio Académico Interdisciplinarios sobre Salud-Mujer y Familia, que se inició entre las dos facultades a finales de 1988. Este espaciobusca consolidar un equipo de reflexión y de acción alrededor de la problemática de salud femenina y su interacción con la organización y dinámica familiar.

Correlación entre el flujo vehicular, el PM2,5 y variables meteorológicas, un estudio de caso al oriente de Bucaramanga (Colombia)

El problema de dispersión atmosférica de un contaminante es un tema complejo, donde variables como la velocidad del viento, la temperatura, la época del año, entre otros, contribuyen en mayor o menor grado al incremento o decremento de la concentración de las especies químicas. El objetivo de la investigación fue identificar la correlación entre variables climatológicas y la contaminación por los automotores (PM2,5 Y COV) en un punto de acceso a una institución ubicada al oriente de Bucaramanga (Colombia). Con relación a los datos del estudio, se utilizó un medidor manual y se registraron datos de PM2,5, Compuestos Orgánicos Volátiles (COV) y variables climatológicas de temperatura y humedad relativa para 26 días en la zona de interés durante 3 franjas horarias específicas del día, cada 5 minutos; además, se utilizaron los datos relacionados con la dirección y velocidad del viento de la estación Neomundo, según el documento del Instituto de Hidrología, Meteorología y Estudios Ambientales (IDEAM) para los años (2005-2009), por ser una zona similar en cuanto a la topografía. El análisis se realizó usando el software libre R (versión 3.5.3) y su librería OpenAir. Los resultados obtenidos muestran las correlaciones correspondientes del PM2,5, los COV, y las variables ambientales corroborando por una parte la influencia del tráfico vehicular en la concentración de PM2,5 principalmente debido a las motocicletas, y por otra parte la relación del PM2.5 con respecto a la Humedad relativa y la temperatura

Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine

Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

An Interval-Arithmetic-Based Approach to the Parametric Identification of the Single-Diode Model of Photovoltaic Generators

Parametric identification of the single diode model of a photovoltaic generator is a key element in simulation and diagnosis. Parameters&rsquo; values are often determined by using experimental data the modules manufacturers provide in the data sheets. In outdoor applications, the parametric identification is instead performed by starting from the current vs. voltage curve acquired in non-standard operating conditions. This paper refers to this latter case and introduces an approach based on the use of interval arithmetic. Photovoltaic generators based on crystalline silicon cells are considered: they are modeled by using the single diode model, and a divide-and-conquer algorithm is used to contract the initial search space up to a small hyper-rectangle including the identified set of parameters. The proposed approach is validated by using experimental data measured in outdoor conditions. The information provided by the approach, in terms of parametric sensitivity and of correlation between current variations and drifts of the parameters values, is discussed. The results are analyzed in view of the on-site application of the proposed approach for diagnostic purposes

Análisis de las condiciones, capacidades y recursos del sector de alojamiento y hospedaje en el Municipio de: San José del Guaviare y su proyección en la cadena del turismo, ejemplificación en estudio de caso

La intencionalidad del trabajo está dirigida a procurar insumos que sirvan al propósito de mejorar las condiciones y por ende el que se avance de manera efectiva hacia el apalancamiento del sector turístico que ha sido considerado como un renglón prioritario para la economía del Departamento. Si bien existe una categorización para los hoteles, cuyo estándar supone el cumplimiento de una serie de requisitos que apunten a lograr la satisfacción del cliente, éstos aún son incipientes y de ahí que sea prioritario el que se implementen los planes de mejora continua, de manera que en realidad el Departamento sea considerado como un destino turístico de excelencia En principio se acude a la verificación de condiciones generales de los establecimientos, de la mano de las normas técnicas vigentes y que son las que trazan la línea a nivel país, en tanto el turismo se ha catalogado como uno de los renglones fuertes que posibilitan la generación de ingresos, el empleo y la dinamización de otros sectores. Es así que se logra precisar que algunos establecimientos cumplen con parte de los requisitos de la norma y que por tanto son susceptibles de proyectarse dentro de la cadena turística en un menor tiempo, sin embargo existen otro número importante de éstos, cuya realidad se aleja de lo ideal. En este aspecto, se evidencia que para la categorización de una estrella, aún faltan condiciones por cumplir y en ello pudieran avanza aquellos que son los más avanzados y es urgente trabajar fuerte en los que no cumplen aún con criterios importantes. Seguidamente se selecciona uno de los establecimientos en los que se analizan los factores claves de éxito a partir de la consulta tanto a sus clientes internos como externos, se aplican instrumentos que permiten identificar sus capacidades y recursos y como producto de ello se formula un plan de mejora, acorde a su tamaño y posibilidad de gestión.The intentionality of the work is aimed at procuring inputs that serve the purpose of improving the conditions and therefore the one that moves effectively towards the leverage of the tourism sector that has been considered as a priority line for the Department's economy. Although there is a categorization for hotels, whose standard implies compliance with a series of requirements that aim to achieve customer satisfaction, these are still incipient and hence it is a priority to implement continuous improvement plans, so that the Department is actually considered as a tourist destination of excellence In principle, the general conditions of the establishments are checked, in accordance with the technical standards in force and which are those that draw the line at the country level, while tourism has been classified as one of the strong lines that enable the income generation, employment and revitalization of other sectors. Thus, it is possible to specify that some establishments comply with part of the requirements of the standard and that therefore they are likely to be projected within the tourist chain in a shorter time, however there are another important number of these, whose reality departs from The ideal. In this regard, it is evident that for the categorization of a star, there are still conditions to be fulfilled and those that are the most advanced may advance and it is urgent to work hard on those who do not yet meet important criteria. Next, one of the establishments in which the key success factors are analyzed from the consultation of both its internal and external clients is selected, instruments are applied that allow to identify their capacities and resources and as a product of this a plan of development is formulated improvement, according to its size and management possibility

Parameter Estimation of the Bishop Photovoltaic Model Using a Genetic Algorithm

Photovoltaic panels can be affected by partial shading, which causes some shaded cells to consume the energy generated by other cells of the panel. That is, shaded cells stop operating in the first quadrant and start operating in the second quadrant, with negative voltage at their terminals, causing power losses and other negative effects in the cells. The Bishop model is an accurate representation of the cells behavior at the second quadrant, but estimating its parameters is not a trivial task. Therefore, this paper presents a procedure to estimate the parameters of the Bishop model by using the Chu–Beasley optimization technique. The effectiveness of this procedure was evaluated using different accuracy measures such as RMSE and MAPE, obtaining values lower than 0.5%. In addition, the results of this study demonstrate that it is essential to estimate all the parameters of the Bishop model, illustrate the variation in the parameters according to the cell technology and show the strong influence of the shunt resistance into the behavior at the second quadrant