El costo de la enfermedad : La migraña y su tratamiento desde la medicina tradicional china en comparación con el manejo descrito basado en la evidencia occidental

La migraña es la cefalea mas frecuente, afecta entre el 6-7% de los hombres y 15-18% de las mujeres en edad laboral. En el 2002 las perdidas por incapacidad se estimaron en 19,600 millones de dólares para EEUU en 1990 se estimó entre 250 millones y 611 millones de libras el costo anual de la enfermedad en UK. Tanto el tratamiento alopático recomendado por el NICE y la acupuntura han mostrado eficacia. El costo del tratamiento con acupuntura en Alemania es de € 365,64 para el 2008 sin embargo a pesar de la relevancia económica y sobre la calidad de vida de este padecimiento no se ha estimado su costo en Colombia. Metodología Se realizó un estudio basado en la prevalencia con metodología botton up para la estimación de los costos asociados a la prestación de servicios de salud, tanto para el tratamiento con acupuntura como para el tratamiento propuesto por el NICE. La probabilidad de las complicaciones se tomo de la literatura indexada. y una aproximación basada en la prevalencia tipo top down para la estimación de los costos directos diferentes a servicios de salud. Las frecuencias de uso para la acupuntura se estimaron mediante consenso formal de expertos y las frecuencias de uso para el protocolo propuesto por NICE se extrajeron de las recomendaciones del mismo, los costos unitarios para acupuntura se levantaron mediante un estudio de corte transversal de una muestra representativa a juicio de experto, los costos unitarios para los medicamentos alopáticos fueron tomados del PLM y el costo de los servicios de los manuales tarifarios vigentes El horizonte temporal fue un año, la perspectiva usada fue la del tercer pagador. Resultados El costo del tratamiento con acupuntura equivale a: (1801323/505627,20 (valor upc) 3.56 UPC frente al costo del tratamiento definido con medicina alopatica que fue de (2760110+2778258 /505627,20) 10.95 UPC. El costo directo de aspectos distintos a servicios de salud fue de (# de días de incapacidad por la enfermedad en Colombia * pacientes afectados por la enfermedad * PIB per capita promedio 2010/ 365)/ Valor UPC (3 *438590*5400*2159/ 365) = 42.027.496.225 /505627,2 = 83120 UPC. / Abstract. Migraine headache is more common, affecting between 6-7% of men and 15-18% of women of working age. In 2002 disability losses were estimated at 19.600 million U.S. dollars in 1990 was estimated at between 250 million and 611 million pound annual cost of the disease in the UK. Both allopathic treatment recommended by occidental medicine and acupuncture have shown efficacy. The cost of acupuncture treatment in Germany is € 365.64 for 2008 but despite the economic importance and the quality of life of this condition has not estimated its cost in Colombia. Methodology We conducted a prevalence study based on the botton up with a methodology for estimating costs associated with providing health services for both the acupuncture treatment to the treatment proposed by occidental medicine. The probability of complications was taken from the indexed literature. and an approach based on top down the prevalence rate to estimate the direct costs other than health services. The frequency of use for acupuncture were estimated by formal consensus of experts and the frequency of use for the protocol proposed by occidental medicine recommendations were drawn from the same unit costs rose acupuncture by a crosssectional study of a representative sample expert's view, the unit costs for allopathic medicines were taken from the PLM and the cost of the services of existing tariff manuals The time horizon was one year, the perspective used was that of the third party payer. Results The cost of acupuncture treatment is equal to: (1801323 / 505,627.20 (value upc)) 3.56 UPC meet the cost of the treatment described with allopathic medicine which was (2760110 +2778258 / 505627.20) 10.95 UPC. The direct cost of various aspects of health services was (# of days of disability from the disease in Colombia * patients with the disease * GDP per capita average 2010/365) / Value UPC (3 * 438590 * 5400 * 2159 / 365) = 42,027,496,225 / 505627.2 = 83120 UPC The cost of migraine is a significant cost to the health system, decision makers and planners can use these results for policy development.Maestrí

Medium-frequency electrical resistance sintering of oxidized C.P. iron powder

Commercially pure (C.P.) iron powders with a deliberate high degree of oxidation were consolidated by medium-frequency electrical resistance sintering (MF-ERS). This is a consolidation technique where pressure, and heat coming from a low-voltage and high-intensity electrical current, are simultaneously applied to a powder mass. In this work, the achieved densification rate is interpreted according to a qualitative microscopic model, based on the compacts global porosity and electrical resistance evolution. The effect of current intensity and sintering time on compacts was studied on the basis of micrographs revealing the porosity distribution inside the sintered compact. The microstructural characteristics of compacts consolidated by the traditional cold-press and furnace-sinter powder metallurgy route are compared with results of MF-ERS consolidation. The goodness of MF-ERS versus the problems of conventional sintering when working with oxidized powders is analyzed. The electrical consolidation can obtain higher densifications than the traditional route under non-reducing atmospheres.Ministerio de Economía y Competitividad DPI2015-69550-C2-1-PMinisterio de Economía y Competitividad DPI2015-69550-C2-2-

Requerimientos de aplicación de una estrategia digital dual de comercialización por una empresa PyME dedicada a la venta de café

La evolución en el mundo, el crecimiento de ciudad, la forma de consumo en el mundo ha cambiado y, tanto usuarios como empresas, necesitan establecer nuevos mecanismos de comunicación y comercialización. En la actualidad 6 de cada 10 empresa vende por internet, las empresas saben que tener una presencia digital es obligatorio en la actualidad, de forma introductoria lo hacen por redes sociales, en ellas comparten imágenes, información de sus productos o servicios, o incluso precios. Aunque los canales físicos y las bases digitales propias son importantes, las PYMES saben de la fuerza de venta que significan multiplataformas como Amazon, mercado libre, e-bay por citar algunos. La importancia crece diariamente y el público se anima a comprar por medios digitales. Al final, lo que buscan es el aumento de venta en general. El presente trabajo, describe las recomendaciones que una empresa dedicada a la comercialización de una marca de café en la ciudad de Mexicali Baja California, comience una alternativa en ventas en un entorno digital

Nickel Porous Compacts Obtained by Medium-Frequency Electrical Resistance Sintering

A commercially pure (c.p.) nickel powder was consolidated by Medium-Frequency Electrical Resistance Sintering (MF-ERS). In this consolidation technique, a pressure and the heat released by a high-intensity and low-voltage electrical current are concurrently applied to a metal powder mass. A nickel powder with a high tap porosity (86%) and a low applied pressure (only 100 MPa) is chosen in order to be able to obtain compacts with different levels of porosity, to facilitate the study of the porosity influence on the compact properties. The influence of current intensity and heating time on the global porosity values, the porosity and microhardness distribution, and the electrical conductivity of the sintered compacts is studied. The properties of the compacts consolidated by MF-ERS are compared with the results obtained by the conventional powder metallurgy route, consisting of cold pressing and furnace sintering. A universal equation to describe the porosity influence on all the analyzed properties of powder aggregates and sintered compacts is proposed and validated

Nanostructured Au(111)/Oxide epitaxial heterostructures with tailoring plasmonic response by a one-step strategy

In this work, we present a strategy for developing epitaxial incommensurate nanostructured Au/oxide heterostructures with tunable plasmonic response. Previously, high-quality single-phase and single-oriented alfa-Fe2O3(0001) thin films were achieved, which have been used as a template for noble-metal epitaxial deposition. The complex systems have been grown by pulsed laser deposition on two different types of oxide substrates: alfa-Al2O3(0001) and SrTiO3(111). A one-step procedure has been achieved tailoring the isolated character and the morphological features of Au nanostructures through the substrate temperature during Au growth, without altering the structural characteristics of the hematite layer that is identified as a single iron oxide phase. The epitaxial character and the lattice coupling of Au/oxide bilayers are mediated through the sort of oxide substrate. Single-oriented Au(111) islands are disposed with a rotation of 30° between their crystallographic axes and those of alfa-Fe2O3(0001). The Au(111) and SrTiO3(111) lattices are collinear, while a rotation of 30° happens with respect to the alfa-Al2O3(0001) lattice. The crystallographic domain size and crystalline order of the hematite structure and the Au nanostructured layer are dependent on the substrate type and the Au growth temperature, respectively. Besides, the functional character of the complex systems has been tested. The localized surface plasmons related to Au nanostructures are excited and controlled through the fabrication parameters, tuning the optical resonance with the degree of Au nanostructuring.This work was supported by the Ministerio Español de Ciencia, Innovación y Universidades (MCIU), and the Consejo Superior de Investigaciones Cientificas (CSIC) through the project PIE-2010 6 OE 013. J.L.-S. and E.E. acknowledge the FPI fellowship and the Torres Quevedo contract (ref: PTQ-14-07289). The ESRF, MCIU, and CSIC are acknowledged for the provision of synchrotron radiation facilities. The authors thank Dr M.A. García for the useful discussion about the plasmonic results and Carlos Beltrán for technical support during the experiments at the BM25 beamline at The ESRF

Design of DOI PET detector Modules using phoswich and SIPMs: First Results

Proceedings of: 2011 IEEE Nuclear Science Symposium and Medical Imaging Conference (NSS/MIC). Valencia, Spain, 23-29 October 2011PET detector modules that implement depth of interaction information reduce uncertainties about the actual line-of-response after positron annihilation. This, in turn, has an effect in the spatial resolution and uniformity across the field of view of the reconstructed image. It also has an effect on the system sensitivity since it enables the use of thicker crystal with respect to a non-DOI system without deteriorating significantly the spatial resolution. In this work we evaluate a DOI detector design based on a scintillator phoswich of two types of pixelated crystals with different time decay constants. A matrix of silicon phomultipliers (SiPM) was coupled to this crystal array without any light-guide, and its outputs were connected to an anger logic type of charge divider which outputs were buffered using a transimpedance amplifier. These position signals were digitized using charge-to-digital converters, and the time decay constant of the crystal of interaction was measured using a delayed charge method. Previous works reported in the literature have demonstrated that this scheme for DOI PET detectors produce very good results in terms of spatial and energy resolution; however, the replacement of PMT with a SiPM matrix introduces some uncertainties that required further study. SiPM have demonstrated their good imaging capabilities when used with pixelated crystal scintillators, and their good timing performance allow us to predict that the DOI resolution was not going to be a problem with this technology. In this work we present quantitative results that assess the goodness of these detectors for its use on small-animal PET scanners.This work was supported in part by the CENIT-AMIT Ingenio 2010, TEC2008-06715 (Ministerio de Ciencia e Innovacion) RETIC-RECAVA (Ministerio de Sanidad y Consumo) ARTEMIS S2009/DPI-1802 (Comunidad de Madrid), and EU-FP7, FMT-XCT-201792.Publicad

Influence of processing parameters on the conduct of electrical resistance sintering of iron powders

The influence of the applied pressure and electrical parameters on the macrostructure of specimens consolidated by the medium-frequency electrical resistance sintering technique (MF-ERS) is analysed in this work. This technique is based on the application of pressure to a mass of conductive powder that, simultaneously, is being crossed by a high intensity and low voltage electric current. The simultaneous action of the pressure and the heat released by the Joule effect causes the densification and consolidation of the powder mass in a very short time. The effect of the current intensity and heating time on the global porosity, the porosity distribution, and the microhardness of sintered compacts is studied for two applied pressures (100 and 150 MPa). For the different experiments of electrical consolidation, a commercially available pure iron powder was chosen. For comparison purposes, the properties of the compacts consolidated by MF-ERS are compared with the results obtained by the conventional powder metallurgy route (cold pressing and furnace sintering). Results show that, as expected, higher current intensities and dwelling times, as well as higher pressures and the consolidation of compacts with lower aspects ratios, produce denser materials

Robot-Assisted Radical Cystectomy with Intra-Corporeal Neo-Bladder

The purpose of this chapter is to provide a step-by-step description of the robot-assisted radical cystectomy with an intra-corporeal neo-bladder technique and a recent review of its outcomes. The procedure is also known as anterior pelvic exenteration or cysto-prostatectomy in the case of female or male respectively. Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer, but there are also several surgical indications for non-muscle-invasive bladder cancer. In the past years, minimally invasive surgery and the da Vinci system technology have played a major role in this procedure, with description of brand-new techniques and specific approaches for the creation of a continent urinary reservoir. The following chapter provides a detailed description of the robot-assisted radical cystectomy (RARC) with Y-shaped intra-corporeal bladder as well as a literary review of distinct perioperative, functional and oncological outcomes from the available RARC randomized controlled trials. Despite its high cost and complexity, the intra-corporeal technique has become widely popular around the world and is used more frequently each time. The described data in this chapter, demonstrates that morbidity can be reduced whilst simultaneously offer non-inferior oncological results and less intraoperative blood loss in contrast to the open RC approach

Improving the co and ch4 gas sensor response at room temperature of alpha-fe2o3(0001) epitaxial thin films grown on srtio3(111) incorporating au(111) islands

In this work, the functional character of complex -Fe2O3(0001)/SrTiO3(111) and Au(111) islands/ -Fe2O3(0001)/SrTiO3(111) heterostructures has been proven as gas sensors at room temperature. Epitaxial Au islands and -Fe2O3 thin film are grown by pulsed laser deposition on SrTiO3(111) substrates. Intrinsic parameters such as the composition, particle size and epitaxial character are investigated for their influence on the gas sensing response. Both Au and -Fe2O3 layer show an island-type growth with an average particle size of 40 and 62 nm, respectively. The epitaxial and incommensurate growth is evidenced, confirming a rotation of 30 between the in-plane crystallographic axes of -Fe2O3(0001) structure and those of SrTiO3(111) substrate and between the in-plane crystallographic axes of Au(111) and those of -Fe2O3(0001) structure. -Fe2O3 is the only phase of iron oxide identified before and after its functionalization with Au nanoparticles. In addition, its structural characteristics are also preserved after Au deposition, with minor changes at short-range order. Conductance measurements of Au(111)/ -Fe2O3(0001)/SrTiO3(111) system show that the incorporation of epitaxial Au islands on top of the -Fe2O3(0001) layer induces an enhancement of the gas-sensing activity of around 25% under CO and 35% under CH4 gas exposure, in comparison to a bare -Fe2O3(0001) layer grown on SrTiO3(111) substrates. In addition, the response of the heterostructures to CO gas exposure is around 5–10% higher than to CH4 gas in each case.This work has been supported by the Ministerio Español de Ciencia e Innovación (MICINN) and the Consejo Superior de Investigaciones Cientificas (CSIC) through the projects PIE-2010-OE-013- 200014, PIE 2021-60-E-030 and RTI2018-095303-A-C52. The ESRF, MICINN and CSIC are acknowledged for the provision of synchrotron radiation facilities. A.S. acknowledges financial support from Comunidad de Madrid for an “Atracción de Talento Investigador” Contract (2017-t2/IND5395)