Diseño de una herramienta web basada en el marco de trabajo CSF NIST para la evaluación de riesgos informáticos e implementación de controles de seguridad en la infraestructura tecnológica de la empresa G0 S.A.S.

G0 S.A.S al ser parte del grupo de las pymes de Colombia, toma decisiones de acuerdo su operatividad, dejando en segundo plano el desarrollo de un análisis de riesgos para su infraestructura tecnológica. Entendiendo su situación, se desarrolla el siguiente trabajo como una opción que le permita tanto a G0 S.A.S como a las pequeñas empresas a acceder a estas mejoras de una forma fácil y sencilla. Se escogió el marco de trabajo CSF NIST porque se adapta muy bien a este tipo de empresas ya que llega más al detalle en la identificación del riesgo, para luego ser evaluado de una forma óptima, contribuyendo al ciclo de vida del desarrollo de la organización. Con los resultados obtenidos, se encontró que G0 S.A.S presenta falencias salvaguardado la confidencialidad, integridad y disponibilidad en los procedimientos que se efectúan en la empresa. Las oportunidades de mejora en los procesos de la organización, se dan para la segregación de roles y funciones, opciones de tratamiento de riesgos y algunos controles que, de alguna forma, se pueden mitigar para este tipo de riesgo. Para lograr que G0 SAS tenga acceso a este tipo de conocimiento, se plantea el prototipo presentado en este documento, el cual le permitirá tener acceso de una forma rápida y oportuna habiendo evaluado previamente los riesgos. Adicional, se presenta un listado de controles sugeridos los cuales le permitirán entender a G0 S.A.S si son aplicados de manera oportuna librándolos de eventos de amenaza que pueda causar daños reputacionales o pérdidas monetarias que afecten a la organización

Microconformado de Materiales Metálicos mediante Pulsos Láser en el Dominio de ns

La demanda de miniaturización introducida, entre otros, por la industria de fabricación de MEMS (Micro Electro Mechanical Systems), hace necesario caracterizar y validar los procesos que emplean el láser en el microconformado de materiales metálicos a escala submilimétrica. Como alternativa al microconformado térmico, que hace uso de las deformaciones de origen térmico inducidas por la radiación láser, el microconformado mediante pulsos láser en el dominio de ns hace posible el conformado de materiales metálicos manteniendo, o incluso mejorando, las propiedades mecánicas de los mismos debido a la inducción de tensiones residuales de compresión en la superficie de la pieza tratada. Se presenta en este trabajo el estudio teórico y experimental del microconformado láser mediante la caracterización de diversas pruebas elementales. Miniaturization of components demanded by MEMS (Micro Electro Mechanical Systems) industry, makes necessary the validation of the manufacturing processes applied to submillimetric metallic materials in which laser is used. As an alternative to thermal microforming in which laser induced thermal fields are responsible for the forming phenomena, the use of ns laser pulses makes possible microforming of metallic materials preserving, or even improving, their mechanical properties, due to the induction of residual stresses in the surface. In the present paper experimental tests and FEM simulation results on nanosecond time scale laser microforming are presented

Laser Shock Microforming of Thin Metal Sheets: Physical Principles, Modelling and Experimental Implementation

The increasing demands in MEMS fabrication are leading to new requirements in production technology. Especially the packaging and assembly require high accuracy in positioning and high reproducibility in combination with low production costs. Conventional assembly technology and mechanical adjustment methods are time consuming and expensive. Each component of the system has to be positioned and fixed. Also adjustment of the parts after joining requires additional mechanical devices that need to be accessible after joining. Accurate positioning of smallest components represents an up-to-date key assignment in micro-manufacturing. It has proven to be more time and cost efficient to initially assemble the components with widened tolerances before precisely micro-adjusting them in a second step

Application of high intensity short pulse lasers to precision micromanufacturing

Los procesos de micromecanizado con láser representan una de las opciones más prometedoras en el ámbito de desarrollo de procesos de microfabricación en diferentes sectores estratégicos. Si bien este tipo de procesos se han utilizado exitosamente en ámbitos como el de la fabricación electrónica desde hace más de veinte años, el desarrollo de nuevas fuentes láser comerciales de excímero y de estado sólido bombeado por diodo (DPSS) ha abierto la posibilidad de abordar aplicaciones completamente novedosas en el campo de la microfluídica, fabricación de sensores y MEMs, biomedicina, etc. Sin embargo, el rápido crecimiento de determinadas áreas tecnológicas ha traído como consecuencia el desarrollo de sistema específicamente dedicados (la mayoría de ellos estrictamente 2D), generándose un importante vacío en los sistemas potencialmente utilizables en le procesado de geometrías complejas estrictamente 3D. En este trabajo se presenta la concepción, diseño y algunas aplicaciones significativas de un sistema de micromecanizado láser 3D que integra dos fuentes láser trabajando en UV (excímero y DPSS) y un sofisticado sistema de posicionamiento (con seis grados de libertad) para el procesado de piezas de geometría compleja en el rango dimensional del micrómetro

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Lo glocal y el turismo. Nuevos paradigmas de interpretación.

El estudio del turismo se realiza desde múltiples escalas y enfoques, este libro aborda muchos temas que es necesario discutir desde diversas perspectivas; es el caso de la reflexión sobre la propia disciplina y sus conceptos, así como los asuntos específicos referidos al impacto territorial, los tipos de turismo, las cuestiones ambientales, el tema de la pobreza, la competitividad, las políticas públicas, el papel de las universidades, las áreas naturales protegidas, la sustentabilidad, la cultura, el desarrollo, la seguridad, todos temas centrales documentados y expuestos con originalidad y dominio del asunto. Lo multiescalar es básico para la comprensión del sistema turístico, sistema formado de procesos globales, regionales y locales. El eje de discusión del libro es lo glocal, esa interacción entre lo nacional y local con lo global

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide