La lepra en Colombia: estigma, identidad y resistencia en los siglos XX y XXI

Este artículo analiza la historia de la lepra o enfermedad de Hansen como un concepto reelaborado a lo largo de la historia por los discursos científicos, políticos, religiosos y por los saberes populares, puesto en relación al problema de la estigmatización. Buscamos realizar un análisis desde la teoría del estigma como un proceso social, que produce el aislamiento, la exclusión, discriminación y rechazo al enfermo y su familia, deteriorando la identidad de los mismos. Encontramos y analizamos cómo se produce en la interacción social la estigmatización, y a su vez, cómo los enfermos reelaboran su identidad, generando una serie de estrategias de afrontamiento y ocultamiento del estigma, estrategias de resistencia con las que reconstruyen su tejido social. Las categorías de análisis de la información fueron percepciones y creencias sobre la enfermedad, relaciones sociales y familiares, construcción de la imagen del enfermo y las metáforas de la enfermedad, actos de discriminación y rechazo, y actos de ocultamiento y afrontamiento del estigma. En este trabajo de carácter cualitativo, analítico y diacrónico, se utilizaron metodologías de investigación cualitativa, consistentes en entrevistas, observación etnográfica, trabajos de memoria y cartografía social, y revisión y análisis de fuentes primarias y secundarias, recolectando información de Colombia, específicamente los municipios de Agua de Dios, Cundinamarca y Contratación, Santander, considerando como marco temporal los siglos XX y XXI

A dispatching-fuzzy ahp-topsis model for scheduling flexible job-shop systems in industry 4.0 context

Scheduling flexible job-shop systems (FJSS) has become a major challenge for different smart factories due to the high complexity involved in NP-hard problems and the constant need to satisfy customers in real time. A key aspect to be addressed in this particular aim is the adoption of a multi-criteria approach incorporating the current dynamics of smart FJSS. Thus, this paper proposes an integrated and enhanced method of a dispatching algorithm based on fuzzy AHP (FAHP) and TOPSIS. Initially, the two first steps of the dispatching algorithm (identification of eligible operations and machine selection) were implemented. The FAHP and TOPSIS methods were then integrated to underpin the multi-criteria operation selection process. In particular, FAHP was used to calculate the criteria weights under uncertainty, and TOPSIS was later applied to rank the eligible operations. As the fourth step of dispatching the algorithm, the operation with the highest priority was scheduled together with its initial and final time. A case study from the smart apparel industry was employed to validate the effectiveness of the proposed approach. The results evidenced that our approach outperformed the current company’s scheduling method by a median lateness of 3.86 days while prioritizing high-throughput products for earlier delivery. View Full-Tex

A hybrid fuzzy multi-criteria decision making model for selecting a sustainable supplier of forklift filters: a case study from the mining industry

Supplier selection has long been a strategic cornerstone for the advancement of companies from the mining sector due to its impact on many sectors as inventory management, production planning, maintenance scheduling, financial resources and environment. In this regard, expert decision-makers should deem a number of performance conflicting criteria and supplier alternatives. Moreover, choosing a suitable Multi-Criteria Decision Making (MCDM) approach has become a key strategic consideration for supplier selection. Hence, this paper presents a combination of powerful MCDM methods to select the most suitable supplier of forklift filters. The Fuzzy Analytic Hierarchy Process (FAHP) is first used to calculate the initial weights of criteria and sub-criteria under uncertainty, followed by the implementation of Fuzzy Decision Making Trial and Evaluation Laboratory (FDEMATEL) to assess the interrelations and feedback between them. The fuzzy theory is used in both AHP and DEMATEL methods to represent the human vagueness when making judgments. Then, FAHP and FDEMATEL are combined to obtain the final contributions of both criteria and sub-criteria on the basis of interrelations and uncertainty. Finally, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) is used to rank the supplier alternatives. To validate the effectiveness of the proposed framework, a case study is presented. The results evidence that quality criterion is the most crucial aspect when selecting suppliers of forklift filters

WTO Law & Environmental policies : consistency of eco-labels, carbon taxes and green subsidies under WTO provisions

La presente monografía propone soluciones legales a la tensión entre el comercio internacional y el medio ambiente en el marco de la OMC. Medidas como impuestos al carbono, etiquetas ambientales y subsidios ambientales son comúnmente implementados con el objetivo de reducir las emisiones de carbono. No obstante, los Miembros deben diseñar cuidadosamente las medidas para evitar inconsistencias con las obligaciones del GATT, el OTC y el Acuerdo sobre Subvenciones y Medidas Compensatorias. Adicionalmente, el Artículo XX del GATT incluye excepciones que buscan un balance entre el acuerdo multilateral y el derecho de cada Miembro a establecer sus propias políticas públicas.This monograph aims to provide legal solutions to the tension between trade and environment within the WTO forum. Policy instruments such as Carbon Taxes, Eco- labels and Green Subsidies are commonly used by WTO Members to tackle climate change’s effects as they incentivize the de-carbonization of national economies. Nonetheless, Members must carefully design these environmental measures to avoid inconsistencies with its commitments under the GATT, the TBT and the SCM Agreements. Moreover, Article XX of the GATT enshrines exceptions that provide a balance between the multilateral agreement and the individual policy space that every Member is entitled to.Abogado (a)Pregrad

Percutaneous biopsies in breast lesions and the importance of ultrasound as an adjunct to mammography

El cáncer de mama es el tumor invasivo más frecuente en mujeres, con más de un millón de casos y cerca de 600.000 muertes al año en todo el mundo (1), con tasas de incidencia más altas en países industrializados, como Estados Unidos, Australia y países de Europa Occidental, que pueden estar relacionadas con mudanzas en los patrones reproductivos así como un mayor uso de la mamografía (2, 3, 4 y 5). La tasa de incidencia no es igual para todos los grupos raciales y étnicos reflejando los diversos grados de desarrollo socioeconómico y características culturales (6). Las tasas promedio anuales de incidencia ajustadas para la edad desde 1996 hasta el 2000 fueron 140,8 casos/100000 entre mujeres blancas, 121,7 entre afroamericanas, 97,2 entre Asiático-americanas/isleñas del pacífico, 89,8 en hispánicas y 58 en indios americanos/nativos de Alaska (6). En América latina según la unión internacional para el control de cáncer, Uruguay, Argentina y Chile tienen la tasa más alta de incidencia y mortalidad por cáncer de mama, mientras que en Perú y México el cáncer cervicouterino sigue ocupando el primer lugar. A nivel mundial se observa una tendencia al aumento del cáncer de mama mientras que el cervicouterino disminuye, sin embargo en Colombia la incidencia de cáncer con una tasa ajustada para la edad fue del 36.8 por cien mil para el cuello uterino y del 30 por cien mil para la mama.1. PLANTEAMIENTO DEL PROBLEMA 12 2. JUSTIFICACION 14 3. MARCO TEORICO 15 3.1 TAMIZAJE PARA DETECCIÓN TEMPRANA DE CÁNCER DE MAMA 15 3.2 MÉTODOS DIAGNÓSTICOS EN CÁNCER DE MAMA 17 3.2.1 Mamografía. 17 3.2.2 Ecografía mamaria 22 3.2.3 Birads Combinado Final 37 3.3 METODOS DE OBTENCIÓN DE MUESTRAS PARA ESTUDIO HISTOPATOLÓGICO 38 3.3.1 Biopsia por aspiración con aguja fina 39 3.3.2 Biopsia con aguja gruesa guiada por ecografía 39 3.3.3 Biopsia con aguja gruesa guiada por estereotaxia 40 3.3.4 Radiografía de los cilindros de microbiopsia 41 3.3.5 Biopsia escisional previa marcación con arpón 41 3.3.6 Radiografía de pieza quirúrgica posterior a marcaje con aguja y correlación histopatológica 42 3.3.7 Revisión de la mamografía e histologia de las muestras con aguja gruesa 42 3.4 AUDITORIA BIRADS 43 3.4.1 Sensibilidad y especificidad. 47 3.4.2 Mamografías falsas negativas 47 3.4.3 Valor predictivo positivo 48 3.4.4 Valor predictivo negativo 49 3.4.5 Revisión de los resultados 49 3.4.6 Valor predictivo positivo de la biopsia de mama 50 3.4.7 Causas de mamografía falsas negativas 50 3.5 CLASIFICACIÓN HISTOLÓGICA DE PATOLOGÍA MAMARIA: 51 3.5.1 Lesiones benignas de la mama. 51 3.5.2 Lesiones malignas 54 3.6 FACTORES DE RIESGO 60 3.6.1 Factores de riesgo establecidos 60 3.6.2 Factores de riesgo no establecidos o en investigación 63 4. OBJETIVOS 67 4.1 OBJETIVO GENERAL 67 4.2 OBJETIVOS ESPECÍFICOS 67 5. METODOLOGIA 68 5.1 TIPO DE ESTUDIO 68 5.2 POBLACION 68 5.3 VARIABLES 68 5.4 RECOLECCION DE DATOS 69 5.5 CRITERIOS DE INCLUSION 69 5.6 CRITERIOS DE EXCLUSION 70 5.7 TECNICA DE RECOLECCION 70 5.8 PLAN DE ANALISIS 72 6. RESULTADOS 73 6.1 ANALISIS UNIVARIADO 73 6.2 ANALISIS BIVARIADO 80 7. DISCUSION 106 8. CONCLUSIONES 110 REFERENCIAS BIBLIOGRAFICAS 111EspecializaciónBreast cancer is the most common invasive tumor in women, with more than a million cases and nearly 600,000 deaths a year worldwide (1), with higher incidence rates in industrialized countries, such as the United States, Australia and Western European countries, which may be related to changes in reproductive patterns as well as increased use of mammography (2, 3, 4 and 5). The incidence rate is not the same for all racial and ethnic groups, reflecting varying degrees of socioeconomic development and cultural characteristics (6). Average annual incidence rates adjusted for age from 1996 to 2000 were 140.8 cases / 100,000 among white women, 121.7 among African-Americans, 97.2 among Asian-American / Pacific Islander, 89.8 among Hispanic and 58 in American Indians / Alaska Natives (6). In Latin America, according to the International Union for Cancer Control, Uruguay, Argentina and Chile have the highest incidence and mortality rates from breast cancer, while in Peru and Mexico cervical cancer continues to rank first. Worldwide, there is a trend towards an increase in breast cancer while cervical cancer decreases, however in Colombia the incidence of cancer with an age-adjusted rate was 36.8 per hundred thousand for the cervix and 30 per hundred thousand for mom

La lepra en Colombia: estigma, identidad y resistencia en los siglos XX y XXI

Este artículo analiza la historia de la lepra o enfermedad de Hansen como un concepto reelaborado a lo largo de la historia por los discursos científicos, políticos, religiosos y por los saberes populares, puesto en relación al problema de la estigmatización. Buscamos realizar un análisis desde la teoría del estigma como un proceso social, que produce el aislamiento, la exclusión, discriminación y rechazo al enfermo y su familia, deteriorando la identidad de los mismos. Encontramos y analizamos cómo se produce en la interacción social la estigmatización, y a su vez, cómo los enfermos reelaboran su identidad, generando una serie de estrategias de afrontamiento y ocultamiento del estigma, estrategias de resistencia con las que reconstruyen su tejido social. Las categorías de análisis de la información fueron percepciones y creencias sobre la enfermedad, relaciones sociales y familiares, construcción de la imagen del enfermo y las metáforas de la enfermedad, actos de discriminación y rechazo, y actos de ocultamiento y afrontamiento del estigma. En este trabajo de carácter cualitativo, analítico y diacrónico, se utilizaron metodologías de investigación cualitativa, consistentes en entrevistas, observación etnográfica, trabajos de memoria y cartografía social, y revisión y análisis de fuentes primarias y secundarias, recolectando información de Colombia, específicamente los municipios de Agua de Dios, Cundinamarca y Contratación, Santander, considerando como marco temporal los siglos XX y XXI

A FAHP-VIKOR approach for supporting the selection of tomography equipment in LMIC hospitals: a case study

Computerized Tomography Scanners (CT-SCAN) provide detailed cross-sectional images of the human body which are employed for the easier detection and further analysis of abnormalities concerning the functionality and structure of the skeleton, tissues, and organs. However, the appropriate CT-SCAN selection is an arduous task considering the complexity and high cost of these medical devices. This decision is even more sharpener in hospitals from Low-and-Middle-Income-Countries (LMIC) where the available budget is usually restricted and correct resource allocation should be therefore ensured while granting the greatest impact on the timeliness and efficacy of healthcare services. In this framework, multiple criteria from diverse fields need to be taken into account to satisfy the intricate requirements of users. In this regard, it is necessary to fully elicit the expectations of stakeholders as well as identify their importance in an overall decision-making context. To address these gaps, this study proposes a novel integration between the Fuzzy Analytic Hierarchy Process (FAHP) and VIKOR methods for the CT-SCAN selection problem. Initially, a Multi-Criteria Decision-Making (MCDM) model will be designed for selecting the most suitable CT-SCAN option for a particular LMIC hospital. Then IF-AHP will be applied to calculate the relative priorities of criteria and sub-criteria under uncertainty. Ultimately, VIKOR will be implemented for obtaining an overall decision-making context. To address these gaps, this study proposes a novel integration between the Fuzzy Analytic Hierarchy Process (FAHP) and VIKOR methods for the CT-SCAN selection problem. Initially, a Multi-Criteria Decision-Making (MCDM) model will be designed for selecting the most suitable CT-SCAN option for a particular LMIC hospital. Then IF-AHP will be applied to calculate the relative priorities of criteria and sub-criteria under uncertainty. Ultimately, VIKOR will be implemented for obtaining an overall appropriateness index per CT-SCAN candidate and thereby identifying the most pertinent one (s) for a specific LMIC medical institution. © 2021, Springer Nature Switzerland AG

A fuzzy hybrid mcdm approach for assessing the emergency department performance during the COVID-19 outbreak

The use of emergency departments (EDs) has increased during the COVID-19 outbreak, thereby evidencing the key role of these units in the overall response of healthcare systems to the current pandemic scenario. Nevertheless, several disruptions have emerged in the practical scenario including low throughput, overcrowding, and extended waiting times. Therefore, there is a need to develop strategies for upgrading the response of these units against the current pandemic. Given the above, this paper presents a hybrid fuzzy multicriteria decision-making model (MCDM) to evaluate the performance of EDs and create focused improvement interventions. First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) technique is used to estimate the relative priorities of criteria and sub-criteria considering uncertainty. Then, the intuitionistic fuzzy decision making trial and evaluation laboratory (IF-DEMATEL) is employed to calculate the interdependence and feedback between criteria and sub-criteria under uncertainty, Finally, the combined compromise solution (CoCoSo) is implemented to rank the EDs and detect their weaknesses to device suitable improvement plans. The aforementioned methodology was validated in three emergency centers in Turkey. The results revealed that the most important criterion in ED performance was ER facilities (14.4%), while Procedures and protocols evidenced the highest positive D + R value (18.239) among the dispatchers and is therefore deemed as the main generator within the performance network

Supply Chain Management y logística Gas Natural Fenosa

Analizar el nivel de cumplimiento del modelo referencial en logística de la empresa Gas Natural Fenosa.Analyze the level of compliance with the Reference Model in logistics of the company Gas Natural Fenosa

Predicting Activity Duration in Smart Sensing Environments Using Synthetic Data and Partial Least Squares Regression: The Case of Dementia Patients

The accurate recognition of activities is fundamental for following up on the health progress of people with dementia (PwD), thereby supporting subsequent diagnosis and treatments. When monitoring the activities of daily living (ADLs), it is feasible to detect behaviour patterns, parse out the disease evolution, and consequently provide effective and timely assistance. However, this task is affected by uncertainties derived from the differences in smart home configurations and the way in which each person undertakes the ADLs. One adjacent pathway is to train a supervised classification algorithm using large-sized datasets; nonetheless, obtaining real-world data is costly and characterized by a challenging recruiting research process. The resulting activity data is then small and may not capture each person’s intrinsic properties. Simulation approaches have risen as an alternative efficient choice, but synthetic data can be significantly dissimilar compared to real data. Hence, this paper proposes the application of Partial Least Squares Regression (PLSR) to approximate the real activity duration of various ADLs based on synthetic observations. First, the real activity duration of each ADL is initially contrasted with the one derived from an intelligent environment simulator. Following this, different PLSR models were evaluated for estimating real activity duration based on synthetic variables. A case study including eight ADLs was considered to validate the proposed approach. The results revealed that simulated and real observations are significantly different in some ADLs (p-value < 0.05), nevertheless synthetic variables can be further modified to predict the real activity duration with high accuracy ([Formula: see text])