Guía para implementación de un sistema de gestión de la calidad bajo la norma NTC GP 1000:2004 en empresas prestadoras de servicios públicos, caso particular: empresas de acueductos

La Ley 872 de 2003 reglamentada a través del decreto 4110 de 2004 precisa en su artículo 1, que el propósito de implementar un sistema de gestión de la calidad es servir como “…una herramienta de gestión sistemática y transparente que permita dirigir y evaluar el desempeño institucional, en términos de calidad y satisfacción social en la prestación de los servicios…”. Este documento pretende convertirse en una ayuda didáctica para aquellas empresas prestadoras de servicios públicos domiciliarios cuya intención este orientada en lograr la satisfacción de sus clientes a través de la estandarización de sus procesos que en última instancia garantiza un buen servicio ya sea: de agua potable, saneamiento básico y /o aseo. Aunque la norma NTCGP 1000:2004 se deriva de la norma ISO 9001 versión 2000: muy popular a nivel internacional, este tipo de certificación solo tiene validez en Colombia, donde se le transformo, a partir de la mencionada, hasta convertirla en una herramienta de evaluación de la gestión pública. El que existan pocos antecedentes de normativas de igual interés en otros países, se convierte en obstáculo para su interpretación y aplicación. La norma NTCGP 1000:2004, no se reduce a un ISO. La literatura existente acerca del tema se limita a referirse a modelos que distan mucho del alcance de las empresas prestadoras de servicio públicos domiciliarios. Este documento abordará el tema específico de las empresas que prestan el servicio de acueducto y como este tipo de entidades pueden relacionarse con la norma en cuestión

Assessing the Sensitivity of Different Life Stages for Sexual Disruption in Roach (Rutilus rutilus) Exposed to Effluents from Wastewater Treatment Works

Surveys of U.K. rivers have shown a high incidence of sexual disruption in populations of wild roach (Rutilus rutilus) living downstream from wastewater treatment works (WwTW), and the degree of intersex (gonads containing both male and female structural characteristics) has been correlated with the concentration of effluent in those rivers. In this study, we investigated feminized responses to two estrogenic WwTWs in roach exposed for periods during life stages of germ cell division (early life and the postspawning period). Roach were exposed as embryos from fertilization up to 300 days posthatch (dph; to include the period of gonadal sex differentiation) or as postspawning adult males, and including fish that had received previous estrogen exposure, for either 60 or 120 days when the annual event of germ cell proliferation occurs. Both effluents induced vitellogenin synthesis in both life stages studied, and the magnitude of the vitellogenic responses paralleled the effluent content of steroid estrogens. Feminization of the reproductive ducts occurred in male fish in a concentration-dependent manner when the exposure occurred during early life, but we found no effects on the reproductive ducts in adult males. Depuration studies (maintenance of fish in clean water after exposure to WwTW effluent) confirmed that the feminization of the reproductive duct was permanent. We found no evidence of ovotestis development in fish that had no previous estrogen exposure for any of the treatments. In wild adult roach that had previously received exposure to estrogen and were intersex, the degree of intersex increased during the study period, but this was not related to the immediate effluent exposure, suggesting a previously determined programming of ovotestis formation

Características de la demanda de I+D de las universidades de la Comunidad Valenciana

9 pages, 7 tables, 1 figurePeer reviewe

Análisis a la información de costos y gastos generada en la sede Almacentro del Hospital Mental para determinar la rentabilidad obtenida

Mental Hospital of Antioquia, seeking to be more competitive in the marketplace, extended its coverage in the alternative site located in the Mall Almacentro, which provides outpatient services for Medical Specialist Psychiatrist, Medical subspecialists, Child Psychiatry, Outpatient by Medical Specialist Neurologist and outpatient drug market through the sale of pharmacy. Each business unit which makes up seat is making a number of costs that independently analyzed show a disproportionate distribution in relation to the generation of income. Currently the costs for outpatient services are not covered by income, only to consolidate the information casts reasonable results, to analyze the return produced. For the development of this paper we analyze the different components of the costs associated with the provision of outpatient services and sale of pharmaceutical products to determine the variables that affect the return in each business unit individually and consolidated headquarters Almacentro. The analysis was performed using spreadsheets, which were detailed in hospital costs for labor, supplies, overhead, distribution costs, among others, the collection of these data and the application of the linear estimation formula, we set the total variable and fixed costs, elements that allowed us to make the break-even analysis and contribution margin for the consultation service and product sales pharmaceutical required in the recovery of costs incurred and analysis generated in the consolidated return of information from headquarters.El Hospital Mental de Antioquia, buscando ser más competitivo en el mercado, amplió su cobertura, con la sede alterna ubicada en el Centro Comercial Almacentro, donde se presta los servicios de Consulta Externa por Médico Especialista Psiquiatra, Médico Subespecialista, Psiquiatría Infantil, Consulta Externa por Médico Especialista Neurólogo y comercialización de medicamentos ambulatorios a través de la venta de farmacia. Cada unidad de negocio, que conforma esta sede, está incurriendo en una serie de costos que analizados independientemente muestran una distribución desproporcionada, en relación con la generación de los ingresos. Actualmente los costos por servicio de consulta externa, no son cubiertos con los ingresos, solo al consolidar la información arroja resultados razonables, para analizar la rentabilidad producida. Para el desarrollo de este trabajo analizamos los diferentes componentes de los costos asociados con la prestación del servicio de consulta externa y la venta de productos farmacéuticos para determinar las variables que afectan la rentabilidad en cada unidad de negocio de manera individual y el consolidado de la sede Almacentro. El análisis lo realizamos a través de hojas de cálculo, en las cuales se detallaron los costos hospitalarios de mano de obra, suministros, gastos generales, costos distribuidos, entre otros y con la recopilación de estos datos y con la aplicación de la fórmula de estimación lineal, establecimos los costos variables y fijos totales, elementos que nos permitió realizar el análisis de punto de equilibrio y margen de contribución para el servicio de consulta y venta de productos farmacéuticos requeridos en la recuperación de los costos incurridos, así como el análisis de la rentabilidad generada en el consolidado de la información de la sede

First-Order Decoupling Transition in the Vortex Lattice of Bi2Sr2CaCu2O8 from Local Mutual Inductance Measurements

We have used a miniature mutual inductance technique to measure the ac transmittivity of Bi2Sr2CaCu2O8 crystals in small applied dc fields. A sharp change in the inductive voltage in the vicinity of the irreversibility line at fields below 60 mT and temperatures above about 40 K is observed. The effects of ac frequency, dc field, and the orientation of the applied dc field with respect to the c axis are investigated. This sharp feature appears to be similar to the melting transition recently observed in local magnetic measurements. We find it is associated with changes in the c-axis resistivity and is consistent with a first-order decoupling transition

A review of segmentation and deformable registration methods applied to adaptive cervical cancer radiation therapy treatment planning

Objective: Manual contouring and registration for radiotherapy treatment planning and online adaptation for cervical cancer radiation therapy in computed tomography (CT) and magnetic resonance images (MRI) are often necessary. However manual intervention is time consuming and may suffer from inter or intra-rater variability. In recent years a number of computer-guided automatic or semi-automatic segmentation and registration methods have been proposed. Segmentation and registration in CT and MRI for this purpose is a challenging task due to soft tissue deformation, inter-patient shape and appearance variation and anatomical changes over the course of treatment. The objective of this work is to provide a state-of-the-art review of computer-aided methods developed for adaptive treatment planning and radiation therapy planning for cervical cancer radiation therapy. Methods: Segmentation and registration methods published with the goal of cervical cancer treatment planning and adaptation have been identified from the literature (PubMed and Google Scholar). A comprehensive description of each method is provided. Similarities and differences of these methods are highlighted and the strengths and weaknesses of these methods are discussed. A discussion about choice of an appropriate method for a given modality is provided. Results: In the reviewed papers a Dice similarity coefficient of around 0.85 along with mean absolute surface distance of 2-4. mm for the clinically treated volume were reported for transfer of contours from planning day to the treatment day. Conclusions: Most segmentation and non-rigid registration methods have been primarily designed for adaptive re-planning for the transfer of contours from planning day to the treatment day. The use of shape priors significantly improved segmentation and registration accuracy compared to other models

Health effects in fish of long-term exposure to effluents from wastewater treatment works

The effects of simple mixtures of chemicals, with similar mechanisms of action, can be predicted using the concentration addition model (CA). The ability of this model to predict the estrogenic effects of more complex mixtures such as effluent discharges, however, has yet to be established. Effluents from 43 U.K. wastewater treatment works were analyzed for the presence of the principal estrogenic chemical contaminants, estradiol, estrone, ethinylestradiol, and nonylphenol. The measured concentrations were used to predict the estrogenic activity of each effluent, employing the model of CA, based on the relative potencies of the individual chemicals in an in vitro recombinant yeast estrogen screen (rYES) and a short-term (14-day) in vivo rainbow trout vitellogenin induction assay. Based on the measured concentrations of the four chemicals in the effluents and their relative potencies in each assay, the calculated in vitro and in vivo responses compared well and ranged between 3.5 and 87 ng/L of estradiol equivalents (E2 EQ) for the different effluents. In the rYES, however, the measured E2 EQ concentrations in the effluents ranged between 0.65 and 43 ng E2 EQ/L, and they varied against those predicted by the CA model. Deviations in the estimation of the estrogenic potency of the effluents by the CA model, compared with the measured responses in the rYES, are likely to have resulted from inaccuracies associated with the measurement of the chemicals in the extracts derived from the complex effluents. Such deviations could also result as a consequence of interactions between chemicals present in the extracts that disrupted the activation of the estrogen response elements in the rYES. E2 EQ concentrations derived from the vitellogenic response in fathead minnows exposed to a series of effluent dilutions were highly comparable with the E2 EQ concentrations derived from assessments of the estrogenic potency of these dilutions in the rYES. Together these data support the use of bioassays for determining the estrogenic potency of WwTW effluents, and they highlight the associated problems for modeling approaches that are reliant on measured concentrations of estrogenic chemicals

Spatial two tissue compartment model for DCE-MRI

In the quantitative analysis of Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) compartment models allow to describe the uptake of contrast medium with biological meaningful kinetic parameters. As simple models often fail to adequately describe the observed uptake behavior, more complex compartment models have been proposed. However, the nonlinear regression problem arising from more complex compartment models often suffers from parameter redundancy. In this paper, we incorporate spatial smoothness on the kinetic parameters of a two tissue compartment model by imposing Gaussian Markov random field priors on them. We analyse to what extent this spatial regularisation helps to avoid parameter redundancy and to obtain stable parameter estimates. Choosing a full Bayesian approach, we obtain posteriors and point estimates running Markov Chain Monte Carlo simulations. The proposed approach is evaluated for simulated concentration time curves as well as for in vivo data from a breast cancer study

Comparison of magnetic resonance imaging and computed tomography for breast target volume delineation in prone and supine positions

Purpose To\ua0determine whether T2-weighted MRI improves seroma cavity (SC) and whole breast (WB) interobserver conformity for radiation therapy purposes, compared with the gold standard of CT, both in the prone and supine positions. Methods and Materials Eleven observers (2 radiologists and 9 radiation oncologists) delineated SC and WB clinical target volumes (CTVs) on T2-weighted MRI and CT supine and prone scans (4 scans per patient) for 33 patient datasets. Individual observer's volumes were compared using the Dice similarity coefficient, volume overlap index, center of mass shift, and Hausdorff distances. An average cavity visualization score was also determined. Results Imaging modality did not affect interobserver variation for WB CTVs. Prone WB CTVs were larger in volume and more conformal than supine CTVs (on both MRI and CT). Seroma cavity volumes were larger on CT than on MRI. Seroma cavity volumes proved to be comparable in interobserver conformity in both modalities (volume overlap index of 0.57\ua0(95% Confidence Interval (CI) 0.54-0.60) for CT supine and 0.52\ua0(95% CI 0.48-0.56) for MRI supine, 0.56\ua0(95% CI 0.53-0.59) for CT prone and 0.55\ua0(95% CI 0.51-0.59) for MRI prone); however, after registering modalities together the intermodality variation (Dice similarity coefficient of 0.41\ua0(95% CI 0.36-0.46) for supine and 0.38\ua0(0.34-0.42) for prone) was larger than the interobserver variability for SC, despite the location typically remaining constant. Conclusions Magnetic resonance imaging interobserver variation was comparable to CT for the WB CTV and SC delineation, in both prone and supine positions. Although the cavity visualization score and interobserver concordance was not significantly higher for MRI than for CT, the SCs were smaller on MRI, potentially owing to clearer SC definition, especially on T2-weighted MR images