Impact of alternative payment plans on professional equity and daily distress of physicians

The way physicians are paid for the provision of care is a relevant aspect of health care systems. Fee-for-service (FFS) payment system has been criticized for affecting quality of care, contributing to the fragmentation of health care, and for rising costs of health care systems. Alternative payment plans (APP) have been introduced as options to the traditional FFS payment scheme. Despite the link between payment methods and behavior of physicians that has been established; there is a lack of evidence about the impact of payment systems on wellness of physicians, specifically on their perception of professional equity and daily distress of physicians. The purpose of this study was to explore the effects of APP on physicians’ perceptions of professional equity and daily distress. The following questions guided this dissertation: 1) Does professional equity perceived by physicians vary among practitioners paid by FFS, APP, or blended alternatives? 2) Is the payment method associated with daily distress of medical practitioners? and 3) Are levels of professional equity, daily distress, and career satisfaction of physicians different by gender and payment methods? In 2011, a cross-sectional study was conducted with physicians practicing in the Saskatoon Health Region (SHR), the largest health authority of Saskatchewan, Canada. Physicians completed a questionnaire evaluating their perceptions of professional equity and daily distress. Analyses of variances (ANOVA) were performed to assess differences in professional equity (overall and by its fulfillment, financial, and recognition dimensions) and daily distress among physicians paid by FFS, APP, and blended schemes. As multivariable analyses, a linear regression was used to test the interaction between specialty and payment methods on the perception of professional equity, controlling for the number of patients, gender, and age group. A mixed linear regression model was built to predict daily distress, testing demographics, workload, complexity of patients, payment method, career satisfaction, and practice profile; the random component of the model considered the influence of geographic area of practice. Also, a multivariate analysis of variance (MANOVA) was conducted to evaluate differences among professional equity, daily distress, and career satisfaction by payment method and gender. In total, 382 (48.1%) physicians participated in the study. Response bias was tested and found to be negligible (Appendix F). The ANOVA identified that physicians paid by APP perceived higher professional equity than those paid by FFS (p=0.005), as well as higher levels of income (p=0.03) and recognition (p=0.001) equity than those with FFS. In the multivariable analyses, a higher level of professional equity was predicted among family practitioners (FPs) paid by APP and blended schemes in comparison to those paid by FFS. Additionally, the payment method was a predictor of daily distress when adjusted by other factors. Lower levels of distress were found among physicians who had more than 75% of patients with complex conditions and were paid by APP compared to those paid by FFS and blended methods. The MANOVA identified that female physicians had poorer wellness indicators than male practitioners. Multiple comparisons identified higher levels of equity among male physicians paid by APP than those with FFS, although this benefit was not observed among female ones. In conclusion, physicians paid by APP perceived higher professional equity (fair economic rewards and appropriate recognition) in comparison to those paid by FFS. Particularly, FPs paid by APP perceived higher professional equity than those FPs paid by FFS. Additionally, the payment method was identified as an associated factor with distress; lower levels of daily distress were predicted among physicians paid by APP who see high proportions of patients with complex conditions. Notwithstanding, female physicians had poorer wellness indicators and the impact of APP on professional equity was only distinguished among males. A potential unequal impact of APP must be recognized between female and male physicians

Plasma rico en plaquetas en la artrosis severa de cadera: acción biológica y perspectivas terapéuticas.

101 p.La artrosis de cadera es una enfermedad inflamatoria de bajo grado, altamente prevalente en la población mundial. Los tratamientos conservadores de esta enfermedad se limitaban al tratamiento de los síntomas asociados. La artrosis en una enfermedad compleja, que involucra a todos los tejidos articulares. Entre ellos, el hueso subcondral juega un papel fundamental en la regulación de la homeostasis articular y del cartílago. Así mismo en un reservorio fundamental de células mesenquimales estromales (MSC), con una función inmunomoduladora clave en los procesos de homeostasis de la articulación. La afectación de este hueso subcondral, con la consecuente alteración de las células mesenquimales presentes en él, ha puesto el foco en el desarrollo de nuevas terapias que permitan un tratamiento más completo de la enfermedad, entre las que se encuentran las infiltraciones con PRP intraóseo. En este trabajo se describe por primera vez la técnica de infiltración de PRP intraóseo en la articulación de la cadera, demostrando que es una técnica segura y reproducible. Así mismo, se muestran los resultados clínicos de un estudio piloto sobre pacientes con artrosis severa de cadera tratados con PRP intraóseo, que demuestra la superioridad de este tratamiento comparado con las infiltraciones intraarticulares. Por último, se ha estudiado por primera vez en humanos, el efecto que el PRP intraóseo tiene en las MSCs del hueso subcondral en su propio nicho celular, hallando un efecto positivo de este tratamiento en lo que se refiere a proliferación celular, resistencia a la senescencia y expresión de genes asociados con la formación ósea y la remodelación del cartílago

Vivienda rural: comportamiento térmico de la envolvente, con sistemas convencionales y panel prefabricado en PET

Trabajo de InvestigaciónEl PET es una de las principales fuentes de contaminación ambiental debido al alto consumo de energía que requiere su procesamiento. Se considera que, por su disponibilidad como residuo sólido, pueda ser reutilizado como material de envolvente en viviendas para mejorar su confort térmico. El objetivo de esta investigación, es validar este planteamiento a partir de un modelo base de vivienda rural en el Municipio de San Antonio del Tequendama, mediante el análisis comparativo con sistemas constructivos propios de la zona (madera, ladrillo, bahareque, entre otros.). El modelo de referencia para la vivienda rural tiene 52m2 y una distribución usual de la zona; cada espacio ha sido definido según la necesidad y requerimiento de la población. De la simulación del comportamiento térmico de la vivienda, se obtienen resultados donde la envolvente en PET resulta ser eficiente térmicamente. El desempeño de la envolvente en PET ha sido comparado con un sistema constructivos como el PVC . Las simulaciones realizadas a los materiales que componen el panel PET y los utilizados actualmente en las viviendas rurales, dieron como resultado una disminución comparativa de temperaturas operativas y radiantes que varían respecto al modelo base propuesto. se puede concluir que, mediante el uso de elementos reciclados como el PET, se logra plantear un sistema de envolvente que garantice los niveles de confort térmico en la vivienda rural.1. INTRODUCCIÓN 2. JUSTIFICACIÓN 4. OBJETIVOS 5. HIPÓTESIS 6. MARCO CONCEPTUAL 7. MARCO REFERENCIAL 8. MARCO TEÓRICO 9. METODOLOGÍA 10. CONCLUSIONES 11. BIBLIOGRAFÍAMaestríaMagíster en Diseño Sostenibl

A Framework to Evaluate Software Developer’s Productivity The VALORTIA Project

Currently, there is a lack in companies developing software in relation to assessing their staff’s productivity before executing software projects, with the aim of improving effectiveness and efficiency. QuEF (Quality Evaluation Framework) is a framework that allows defining quality management tasks based on a model. The main purpose of this framework is twofold: improve an entity’s continuous quality, and given a context, decide between a set of entity’s instances on the most appropriate one. Thus, the aim of this paper is to make this framework available to evaluate productivity of professionals along software development and select the most appropriate experts to implement the suggested project. For this goal, Valortia platform, capable of carrying out this task by following the QuEF framework guidelines, is designed. Valortia is a platform to certify users' knowledge on a specific area and centralize all certification management in its model by means of providing protocols and methods for a suitable management, improving efficiency and effectiveness, reducing cost and ensuring continuous quality.Ministerio de Ciencia e Innovación TIN2013-46928-C3-3-

La mejora en la enseñanza de grado por medio de la aplicación de las TIC: Caso de estudio cátedra de Introducción a la Administración - primer año - Facultad de Ciencias Económicas - Universidad Nacional de Córdoba

El presente trabajo tiene como finalidad compartir con todos la experiencia vivenciada en el marco de los cambios que hemos producido en la Cátedra de Introducción a la Administración - correspondiente al primer año del ciclo básico - Facultad de Ciencias Económicas. Nuestra experiencia radica en la incorporación de las TIC´s en el dictado de la materia bajo la modalidad presencial, hecho que significó que realizáramos importantes cambios en cuanto al diseño de la materia y rediseño de las actividades a los fines de poder acomodarnos a la nueva realidad que deseábamos.En este trabajo relatamos los procesos que fuimos atravesando de cómo funcionaba antes y cuáles fueron los cambios que se produjeron. También compartimos los resultados obtenidos en dos encuestas que fueron realizadas por el equipo de unidad pedagógica de la facultad donde se encuentran valoraciones diferentes en torno a los alumnos y la materia.https://rdu.unc.edu.ar/handle/11086/6472Fil: Cassutti, Marcela Beatriz. Universidad Nacional de Córdoba. Facultad de Ciencias Económicas; Argentina.Fil: Sánchez, Juan Nicolás. Universidad Nacional de Córdoba. Facultad de Ciencias Económicas; Argentina.Educación General (incluye capacitación, pedagogía y didáctica

Observer Influence with Other Variables on the Accuracy of Ultrasound Estimation of Fetal Weight at Term

Background and Objectives: The accuracy with which the estimation of fetal weight (EFW) at term is determined is useful in order to address obstetric complications, since it is a parameter that represents an important prognostic factor for perinatal and maternal morbidity and mortality. The aim of this study was to determine the role of the experienced observers with other variables that could influence the accuracy of the ultrasound used to calculate EFW at term, carried out within a period of seven days prior to delivery, in order to assess interobserver variability. Materials and Methods: A cross-sectional study was performed including 1144 pregnancies at term. The validity of the ultrasound used to calculate EFW at term was analyzed using simple error, absolute error, percentage error and absolute percentage error, as well as the percentage of predictions with an error less than 10 and 15% in relation to maternal, obstetric and ultrasound variables. Results: Valid predictions with an error less than 10 and 15% were 74.7 and 89.7% respectively, with such precision decreasing according to the observer as well as in extreme fetal weights. The remaining variables were not significant in ultrasound EFW at term. The simple error, absolute error, percentage error and absolute percentage error were greater in cases of extreme fetal weights, with a tendency to overestimate the low weights and underestimate the high weights. Conclusions: The accuracy of EFW with ultrasound carried out within seven days prior to birth is not affected by maternal or obstetric variables, or by the time interval between the ultrasound and delivery. However, accuracy was reduced by the observers and in extreme fetal weights

Hidrólisis ácida del residuo de poda de olivo en un reactor continuo de extrusión

La hidrólisis de materiales lignocelulósicos en condiciones suaves conduce a una disolución de azúcares procedentes de la fracción hemicelulósica, así como una serie de compuestos que pueden inhibir su posible fermentación.Para intentar reducir la degradación de los azúcares, se ha ensayado la hidrólisis del residuo de poda del olivar en un reactor de extrusión de doble hélice, ya que la acción mecánica de esta técnica permite aumentar la hidrólisis de las fibras y operar en continuo y a temperaturas inferiores. Se ha trabajado en el rango de temperatura de 70 a 100 ºC y a concentraciones de ácido sulfúrico de 1 a 3 N. El rendimiento en D-glucosa alcanza el 7,4% pero los rendimientos en pentosas son bajos,ya que las hemicelulosas son hidrolizadas en pequeñaextensión. Aunque este hecho puede restar interés a laextrusión como etapa única de hidrólisis, al menos en las condiciones ensayadas, le confiere un gran interés como pretratamiento si el objetivo del mismo es la obtenciónde D-xilosa fermentable

Using Near-Infrared Spectroscopy in Agricultural Systems

This chapter provides a review on the state of art of the use of the visible near-infrared (vis-NIR) spectroscopy technique to determine mineral nutrients, organic compounds, and other physical and chemical characteristics in samples from agricultural systems—such as plant tissues, soils, fruits, cocomposted sewage sludge and wastes, cereals, and forage and silage. Currently, all this information is needed to be able to carry out the appropriate fertilization of crops, to handle agricultural soils, determine the organoleptic characteristics of fruit and vegetable products, discover the characteristics of the various substrates obtained in composting processes, and characterize byproducts from the industrial sector. All this needs a large number of samples that must be analyzed; this is a time-consuming work, leading to high economic costs and, obviously, having a negative environmental impact owing to the production of noxious chemicals during the analyses. Therefore, the development of a fast, environmentally friendly, and cheaper method of analysis like vis-NIR is highly desirable. Our intention here is to introduce the main fundamentals of infrared reflectance spectroscopy, and to show that procedures like calibration and validation of data from vis-NIR spectra must be performed, and describe the parameters most commonly measured in the agricultural sector