Applicability of Winthrop Score for the Diagnosis of Influenza A in the Emergency Department of Hospital Pablo Arturo Suárez, January to March of 2018

Introduction: In 2010, the Department of Infectious Diseases at Winthrop University Hospital designed a score system for the diagnosis of Legionella pneumonia. In this study, we applied the score to patients with acute respiratory symptoms suspected of having type A influenza. The identification of patients at medium to high risk of Influenza A allows for early initiation of treatment.Objective: To study the applicability of the Winthrop score for the diagnosis of Influenza A.Methodology: A prospective cohort study was performed in 2018 at Hospital Pablo Arturo Suárez, in Quito, Ecuador. Patients 0 to 100 years old presenting to the emergency department with influenza-like illness in January-March of 2018 were included in the study. Winthrop score results were then compared with the result of the reverse transcription polymerase chain reaction (RT-PCR) for influenza A, the gold standard for diagnosis. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were used to establish the diagnostic performance of this point system for influenza A within the sample at large and in subgroup analyses by age (<5 years, 5-65 years, and >65 years) and comorbidities.Results: 149 patients were enrolled in the study period. The study population included 81 males (54.4%) and the majority of patients were less than 5 years of age (N=85, 57.0%). Furthermore, almost one-third of the patients were less than one year old (N=38, 25.5%). According to the Winthrop point system, 68.5% of the cases had a low probability of having influenza (n = 102), 8.7% of cases had a medium probability (n = 13) and 22.8 % of cases had a high probability (n = 34). The RT-PCR test for influenza was positive for 26.2% of patients (n = 39). The Winthrop point system had a sensitivity of 97.4%, specificity of 91.8%, positive predictive value of 80.8%, negative predictive value of 99.0%, positive likelihood ratio of 11.9, and negative likelihood ratio of 35.8 in the total study population. For children under 5 years, a sensitivity of 100%, specificity of 96.3%, positive predictive value of 77.7%, negative predictive value of 100%, positive likelihood ratio of 27, and negative likelihood ratio of 0. In patients older than 6 years, a sensitivity of 96.9%, specificity of 89%, positive predictive value of 84.21%, negative predictive value of 98%, positive likelihood ratio of 8.8, and negative likelihood ratio of 29.4. Testing in patients over 65 years had a sensitivity of 100%, specificity of 90%, positive predictive value of 87.5%, negative predictive value of 100%, positive likelihood ratio of 10 and negative likelihood ratio of 0. Finally, patients with comorbidities had a sensitivity of 90%, specificity of 88.24%, positive predictive value of 81.82%, negative predictive value of 93.75%, positive likelihood ratio of 7.65, and negative likelihood ratio of 8.82.Conclusions: The Winthrop score performed well in predicting Influenza A in patients with acute respiratory symptoms. This score may be useful in settings were Influenza A PCR testing is unavailable

Inadequate Access to Healthy Opportunities and Structural Violence: A Case Study of Health Disparities among Hispanics in McLean County

Significant disproportionate human suffering is experienced by socially disadvantaged populations as a result of preventable difference in the burden of disease, injury, violence, and/or opportunities to achieve optimal health. Disparities in health refer to differences between two or more population groups in health outcomes and in the prevalence, incidence, or burden of disease, disability, injury, or death (CNHEOa 2013). Health disparities are discriminatory and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources (CDC 2007). While such disparities are more visible when comparing health status of whole countries, they are also embedded in the structure within individual countries and even with local communities. In this thesis I argue that significant health disparities exist between ethnic-minorities and whites in the United States as a result of social and governmental structures, such as national and local policies and lack of accessibility to community social services. Structures that allow such indirect yet noteworthy forms of human suffering are forms of structural violence. On various structural levels, scholars, policy makers, and ordinary people alike, must recognize health disparities as an issue of injustice for the specific groups subjected to systematic racial discrimination. First, I explore the value of health care in the United States, and then examine differences in health statuses in various social determinants among ethnic-minorities and whites in the United States. Second, I discuss how barriers of inadequate access of healthier opportunities are an act of structural violence. Thirdly, I provide a small case study of health disparities among Hispanics in McLean County Illinois where the Hispanic population has significantly increased in recent years in a predominately white community. Lastly, I explore innovated strategies to eliminate health disparities and strive for health equity. I conclude that (1) health care is fundamentally a ethical issue and a matter of basic human rights, (2) health disparities can be viewed as an act of structural violence and exist on various structural levels, including the community level, and (3) health disparities can be reduced and eventually eliminated by advancing policies, programs or practices that address factors that impact health

Illinois State University’s Student Health Agenda

This essay is a short study of Illinois State University’s (ISU) student health agenda. The study examines ISU’s perspective and approach on student health efforts, infrastructure of health departments on campus, and ongoing Health Promotion and Wellness programs and their impact on campus and in the local community. Methods used include interviews with faculty in the Department of Health Wellness and Promotion, ethnographic observations of peer-to-peer health promotion programs, review of Department of Health Promotion and Wellness sponsored materials, and health behavior data. The principle finding is that the University’s agenda and value of health reflects national cultural trends in that health is taken for granted and not a priority issue

Sistema “mixto” de producción de semilla de papa entre el INIAP y el CONPAPA.

La papa representa el 7.4% del Producto Interno Bruto Agropecuario (PIBA) del Ecuador. Se estima que 30.000 t es el volumen anual de papa procesada. Utiliza mano de obra en forma intensiva. El 10,5% de los trabajadores agropecuarios están involucrados en este cultivo. En el período 2002 a 2006, se reporta una producción de 409.733 t de papa al año, con una superficie de cultivo de 43.300 ha y un rendimiento de 9,5 t/ha. Menos del 2% de la superficie de papa se siembra con semilla del sistema formal. El resto se lo hace con material proveniente del sistema informal, el cual presenta deficiencias de calidad, cantidad, oportunidad. El CONPAPA es una organización que busca el posicionamiento de productores de pequeña y mediana escala en segmentos de mercado de alto valor agregado, lo que constituye un reto para este nivel de agricultores. En este esquema, el principal limitante resultó ser la falta de semilla de calidad, cantidad, oportunidad y estado fisiológico en que necesitan los socios, lo que obligó a la construcción de un sistema “mixto” de semilla. Dicho sistema funciona así: INIAP genera una nueva variedad y determina los usos más adecuados para la misma, promueve su uso en nichos específicos de manera que se induzca a la utilización de la misma. Una vez que se ha generado demanda se limpia de virus y patógenos, se produce semilla limpia y se entrega al CONPAPA de la provincia de Tungurahua, el cual se encarga de multiplicar semilla por dos o tres generaciones con sus semilleristas. Posteriormente realiza el Control Interno de Calidad (CIC) y entrega a sus socios para que produzcan papa comercial. Los actores del sistema son: el INIAP como proveedor de nuevas variedades, tecnología, semilla inicial limpia; el CONPAPA de la provincia de Tungurahua quien compra la semilla y distribuye para sus semilleristas y luego adquiere el material que ha sido multiplicado; los semilleristas quienes la multiplican a partir del material limpio; y finalmente los agricultores productores de papa comercial. El CIC se realiza entre el técnico de la organización, el promotor y el semillerista. Para la comercialización se utiliza un esquema de contratación, mayoritariamente verbal. Los precios se basan en los costos de producción más una ganancia. Los resultados relevantes son: el CONPAPA produce y comercializa entre 150 a 200 t por año y la organización es reconocida y sostenible. Las fortalezas son: semilleristas capacitados y experimentados, posicionamiento en el mercado, capital propio, infraestructura para procesamiento y almacenamiento y protocolo de CIC. Las oportunidades son: demanda de semilla por parte de organizaciones de productores, ONGs, OGs. Las debilidades son: falta consolidación de la organización, éxodo de productores. Finalmente, las amenazas son: inestabilidad del precio de la papa y de la semilla, disminución del consum

Design of flapping wing kinematics for trimmed flight

The main objective of this project is to develop a numerical tool using MATLAB that calculates a set of initial conditions and wing kinematic parameters that result in a trimmed flight for a given flapping wing MAV model. The project adapts the unsteady panel method developed by [4] to obtain the aerodynamic forces of the wings, and the dynamic model developed by [25], to integrate these forces and obtain the movement of the model with time. The tool is meant to be used at the first stages of the design of a given MAV, in order to check the general effects of a selected geometry and the impact that some parameters may have on the performance. A second requirement is to obtain a tool that is able to perform such a high number of analyses without a high computation time/cost, but being as rigorous as possible.Ingeniería Aeroespacia

Un repaso a las oraciones subordinadas sustantivas en las Catilinarias

En la enseñanza del latín, sobre todo en el nivel de la educación secundaria, están proliferando métodos novedosos que buscan eficacia y motivación, acercándolo en ocasiones al estudio de lenguas modernas

LA PERCEPCIÓN DE LOS VISITANTES SOBRE LA GESTIÓN SOSTENIBLE DEL TURISMO EN DESTINOS DE NATURALEZA. ESTUDIO DE CASO EN EL PARQUE NACIONAL GALÁPAGOS (ECUADOR)

This work is based on the confluence of two lines of research that are well established in the scientific literature on protected natural areas: social participation in studies on tourism and the construction of systems of sustainability indicators in nature destinations. With the application of a survey of visitors to the Galapagos National Park (Ecuador) and the use of proven indicators, the strengths and weaknesses of its tourism management have been identified and valued to incorporate this knowledge into decision-making through participation processes. The gaze of visitors turns out to be relevant and complementary in the governance of this space, given that tourism causes transformations in its natural environment, given the circumstance that its quality attributes constitute one of the main comparative advantages of it. Galapagos National Park’s mostly urban demand seeks a satisfactory global experience identified with the authenticity, uniqueness, and quality of its environmental and sociocultural environment, while there is a dilemma between the harmonization of a leisure space for visitors and the need to promote local development in which traditional activities are increasingly less viable.Este trabajo parte de la confluencia de dos líneas de investigación muy consolidadas en la literatura científica sobre espacios naturales protegidos: la participación social en los estudios sobre turismo y la construcción de sistemas de indicadores de sostenibilidad en destinos de naturaleza. Con la aplicación de una encuesta a visitantes del P.N. Galápagos (Ecuador) y la utilización de indicadores contrastados se han identificado y valorado los puntos fuertes y débiles de su gestión turística para incorporar este conocimiento en la toma de decisiones a través de procesos de participación. La mirada de los visitantes resulta ser relevante y complementaria en la gobernanza de este espacio, dado que el turismo provoca transformaciones en su medio natural de dimensión y alcance diversos, dándose la circunstancia de que sus atributos de calidad constituyen una de las principales ventajas comparativas del mismo. Su demanda mayoritariamente urbana busca una experiencia satisfactoria global identificada con la autenticidad, singularidad y calidad de su entorno ambiental y sociocultural, al tiempo que se produce un dilema entre la armonización de un espacio de ocio para los visitantes y la necesidad de impulsar un desarrollo local en el que las actividades tradicionales son cada vez menos viables