La Dirección General de Aeronáutica Civil (DGAC) estuvo adscrita a la Secretaría de Infraestructura y Servicios Públicos (INSEP) durante 63 años, presentando problemas por la dilación de los procesos ...y procedimientos para ejercer una estricta vigilancia a la seguridad operacional en los aeropuertos internacionales y aeródromos del país, lo cual está evidenciado en el Reporte de “International Aviation Safety Assessment (IASA) de la Federal Aviation Administration (FAA - Results); debido principalmente a la: falta de personal especializado y certificado y a las carencias presupuestarias; esta situación tuvo como resultando la no observancia a las normativas internacionales por parte del Estado de Honduras. Mediante decretos ejecutivos (PCM-001-2014 del 22 de febrero de 2014,PCM-047- 2014 del 10 de octubre de 2014 y PCM-022-2015 del 18 de mayo de 2015) la DGAC pasó a formar parte del Gabinete Sectorial de Seguridad y Defensa, y se dispuso la creación de la Agencia Hondureña de Aeronáutica Civil (AHAC), como un ente desconcentrado de la Secretaría de Defensa Nacional (SEDENA); se supone que, la transición de la DGAC a AHAC permitirá a la entidad tener autonomía técnica, administrativa y financiera, favorecer la formulación planes, programas, proyectos de fortalecimiento institucional para garantizar el cumplimiento de los estándares y potenciar el capital humano con competencias aeronáuticas, para lograr la certificación de los aeropuertos hondureños. Esta investigación es de tipo cualitativa, ya que el proceso de transición corresponde a una separación de la Secretaría de Infraestructura y Servicios Públicos (INSEP) a la Secretaría de Defensa Nacional (SEDENA), a fin de operar como una institución desconcentrada. Siendo que el proceso de transición es el camino indicado para que la AHAC genere la independencia técnica, administrativa y financiera necesaria para cumplir con los estándares en materia de aviación civil internacional.Los principales resultados de la investigación destacan: 1) Una marcada resistencia al cambio, producto de los procedimientos agresivos utilizados en la transición; derivado de un cambio abrupto, se observó un claro desacuerdo por parte de algunos colaboradores con los temas relacionados a la transición (50% de la institución). 2) Desinformación en relación al nuevo sistema administrativo, por el cual, se rige la Agencia Hondureña de Aeronáutica Civil, lo cual se respalda, por la falta de comunicación formal escrita. 3) Los colaboradores de la Agencia ven el proceso de transición como algo negativo para la aviación civil de Honduras y a la vez, no sienten que la nueva institución les pueda brindar estabilidad laboral y se ha generado mucha incertidumbre en el personal. 4) El personal no siente que el proceso de transición haya sido necesario. Y una gran parte del personal no tiene ninguna expectativa con el proceso de transición, mostrando un alto nivel de desánimo. 5) Una minoría considera que el proceso de transición traerá oportunidades para adquirir nueva tecnología, capacitaciones, personal calificado y mejoras para la institución.
This paper presents the design and implementation of a prototype based on a SEPIC (Single-Ended Primary Inductance Converter) used to measure the characteristic curves of photovoltaic (PV) panels. ...The SEPIC is controlled to emulate a variable resistance at the output of the PV panel in order to obtain a set of values (voltages and currents) for different operating points at the output of the panel. The set of voltages and currents are stored and sent to a computer in order to display the characteristic curves in real-time. The performance of the prototype is firstly evaluated though simulations in PSIM and subsequently by experimental results. The results show the outstanding performance of the SEPIC converter and its suitable use for this kind of applications due to its low input current ripple and its operation as a buck-boost converter. The resulting prototype allows the characterization of PV panels up to 500 W.
Se trata de un paciente de 36años de edad que ingresa en nuestro hospital por presentar una neumonía en el contexto de una varicela.
El paciente a las 24h tiene que ser conectado a un respirador ...artificial por incapacidad de mantener saturaciones de oxígeno adecuadas.
A pesar del respirador, existe una hipoxemia refractaria a las medidas habituales utilizadas en la sala de cuidados intensivos.
Se comenta el caso al grupo de asistencias y se decide el implante de una ECMO venovenosa con el fin de oxigenar al paciente; ésta se instaura de manera urgente y en la propia unidad de cuidados intensivos.
Es una ECMO tipo Jostra Rotaflow y con oxigenador Quadrox. Las cánulas se introducen por vena femoral y vena yugular, consiguiendo flujos de 3 1/min, suficientes para conseguir saturaciones del 100%.
La asistencia respiratoria se mantiene 84h, y como complicaciones cabe destacar que durante el segundo día se reinterviene a nivel inguinal por sangrado.
El paciente es dado de alta a los 14días.
Pensamos que la asistencia respiratoria tipo ECMO venovenoso es muy útil en infecciones respiratorias virales, ya que conseguimos oxigenar y mantener hemodinámicamente al paciente mientras el resto del tratamiento intenta conseguir su objetivo.
Different
RET oncogene mutations have been found to be associated with inherited medullary thyroid carcinoma (MTC) in the context of three different syndromes including multiple endocrine neoplasia ...types 2A (MEN 2A) and 2B (MEN 2B) and familial medullary thyroid carcinoma (FMTC). These mutations have been recorded in different populations, but to date there is no corresponding study in Mexican families. Our purpose was identification of
RET mutations in Mexican families with inherited or sporadic MTC (SMTC) and search for RET protein expression as prognostic marker in MTC tumors.
Nine unrelated families with MTC corresponding either to two MEN 2A, three MEN 2B, or four SMTC were studied. Screening of exons 10, 11, and 13–16 of
RET oncogene in DNA from circulating lymphocytes and tumor samples were analyzed. Immuno- staining for RET was performed in the corresponding tumor.
Germline 918 ATG→ACG
RET mutation was present in three unrelated MEN 2B individuals and corresponding somatic mutation in one individual with SMTC; 634 TGC→TTC
RET mutation was detected in two related patients in an MEN 2A family and the 634 TGC→TAC
RET mutation was detected in 12 related individuals from a second MEN 2A family. RET protein expression was detected in all MTC tumors showing different staining intensity.
RET mutations found in Mexican patients with MTC are similar to those previously reported in several MTC families worldwide. This indicates that
RET mutations are highly conserved and that MTC etiology does not depend to a great extent on environmental factors or ethnic differences. Detection of RET protein in MTC tissue sections is not useful as prognostic marker.
Frontolateral laryngectomy is a surgical procedure that allows removal of a vocal cord, anterior commissure, one third of the healthy vocal cord and the thyroid cartilage keel. It is indicated in ...patients with T1a and T1b glottic-located carcinomas with adverse prognosis factors and selected T2 cases. The success relies on appropriate tumor excision. In order to make an assessment, we need to know the critical topics of clinic interest in the histopathologic study of the specimen. The objective is to analyze which are the significant factors to histologically assess in frontolateral laryngectomy and to report the histological study technique conducted at the Oncology Hospital of the National Medical Center of the Mexican Social Security Institute. According to the critical sites in the surgical technique and significant for local tumor recurrence, we report the histological study technique followed for the frontolateral laryngectomy specimens. The factors to assess in the frontolateral laryngectomy specimen are the anterior third part of the healthy cord, the paraglottic space and the crico-vocal ligament. The pathologic study technique reported herein allows us to satisfactorily assess these risk factors. Macroscopic tumor excision is not sufficient, and a satisfactory histological analysis is required that will allow us to assess the critical sites where there may be residual tumor. These may translate into a higher possibility of tumor recurrence for the patient. Communication between pathologists and surgeons is essential to achieve success in this procedure.
To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma GEMA) and the effect of ...this compliance on controlling the disease.
We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated.
Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06).
Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with a better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines.
Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad.
Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2864 pacientes.
Utilizando datos retrospectivos, 81 de los 314 médicos (25,8% IC del 95%, 21,3 a 30,9) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28,0% IC del 95%, 23,4 a 33,2) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0,19, IC del 95%, 0,13 a 0,28) y presentar un asma persistente grave al inicio del estudio (OR 0,20, IC del 95%, 0,12 a 0,34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1,70, IC del 95%, 1,40 a 2,06).
El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma.
The energy requirements of cities' inhabitants have grown during the last decade. Recent studies justify the necessity of reducing the energy consumption/emissions in cities. The present paper gives ...an overview of the factors affecting the energy consumption of the citizens based on studies conducted in cities across the globe. The studies cover all the factors that affect citizens' mobility choice that at the end, affects in the same way their final energy consumption. The results of the review are being used to support authorities in mobility decisions in order to achieve a sustainable transport sector in smart cities.
The transport sector is constantly growing as well as its complexity and energy consumption. One way to reduce the involvement and the volume of data to evaluate and monitor the energy efficiency of ...the sector for cities authorities is by using Key Performance Indicators (KPIs). This paper describes a set of KPIs to measure and track energy efficiency in the transport sector. The KPIs that are summarized in this paper were identified based on a literature review of mobility projects/strategies/policies that had been implemented in cities around the world. Future applications, which are presented at the end of this article, will give a better understanding of the systems and its components.
To measure the impact of transport projects in smart cities can be expensive and time-consuming. One challenge in measuring the effect of these projects is that impacts are poorly quantified or are ...not always immediately tangible. Due to transport projects nature, it is often difficult to show results in short term because much of the effort is invested in changing attitudes and behaviour on the mobility choices of city inhabitants. This paper presents a methodology that was developed to evaluate and define city transport projects for increasing energy efficiency. The main objective of this methodology is to help city authorities to improve the energy efficiency of the city by defining strategies and taking actions in the transportation domain. In order to define it, a review of current methodologies for measuring the impact of energy efficiency projects was performed. The defined energy efficiency methodology provides standard structure to the evaluation process, making sure that each project is being evaluated against its own goals and as detailed as it is required to the level of investment. An implementation in a smart city of the first step of this methodology is included in order to evaluate the implementation phase of the defined process.
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