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Business organizations are in an environment of constant changes to which it is essential to adapt to remain in the market. At the same time they must keep up with competitiveness, which leads them to realize the importance of pleasing the client for the achievement of business objectives; for this reason, the purpose of this study is to identify the quality of services and the level of satisfaction of ANDE customers in the city of Salto del Guaira. The level of research was descriptive. The clients of the ANDE of the city of Salto del Guaira constituted the population, from which a sample number of 58 people was randomly selected, through a simple random sampling. The data collection instrument was a form with open and closed questions that serves to detect the level of customer satisfaction, called Servqual Scale, which was analyzed and it could be deduced that the majority of customers surveyed marked option 3 of each item. This option corresponding to the “moderately satisfied” statement implies a medium level of customer dissatisfaction, that is, a customer who is not entirely sure of his satisfaction with the service received is a customer dissatisfied with the company, whether for small details in the care or service they have used. Concerning modern equipment, the clarity of the material elements, the physical facilities, the majority of respondents answered feeling moderately satisfied, at 50%, 75%, and 72% respectively. Likewise, in terms of the sufficiency of materials, 80% of the clients expressed feeling dissatisfied, as in obtaining the expected service and in the equality in the care received. About convenient schedules, 20% dissatisfied, 20% dissatisfied, and 40% moderately satisfied; thus noticing the minority of customers who feel satisfied or very satisfied with the services used. The present investigation is completed by accepting the hypothesis raised since most of the Company’s clients responded that they feel moderately satisfied concerning the survey questions, and this demonstrates the lack of satisfaction with the quality of the services received.

Plexopathy may be caused by diverse pathologies, including trauma, nerve entrapment, neoplasm, inflammation, infection, autoimmune disease, hereditary disease, and idiopathic etiologies. For patients presenting with brachial or lumbosacral plexopathy, dedicated plexus MRI is the most appropriate initial imaging modality for all clinical scenarios and can identify processes both intrinsic and extrinsic to the nerves. Other imaging tests may be appropriate for initial imaging depending on the clinical scenario. This document addresses initial imaging strategies for brachial and lumbosacral plexopathy in the following clinical situations: nontraumatic plexopathy with no known malignancy, traumatic plexopathy (not perinatal), and plexopathy occurring in the context of a known malignancy or posttreatment syndrome. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Spine infection is both a clinical and diagnostic imaging challenge due to its relatively indolent and nonspecific clinical presentation. The diagnosis of spine infection is based upon a combination of clinical suspicion, imaging evaluation and, when possible, microbiologic confirmation performed from blood cultures or image-guided percutaneous or open spine biopsy. With respect to the imaging evaluation of suspected spine infection, MRI without and with contrast of the affected spine segment is the initial diagnostic test of choice. As noncontrast MRI of the spine is often used in the evaluation of back or neck pain not responding to conservative medical management, it may show findings that are suggestive of infection, hence this procedure may also be considered in the evaluation of suspected spine infection. Nuclear medicine studies, including skeletal scintigraphy, gallium scan, and FDG-PET/CT, may be helpful in equivocal or select cases. Similarly, radiography and CT may be appropriate for assessing overall spinal stability, spine alignment, osseous integrity and, when present, the status of spine instrumentation or spine implants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

In the United States, acute low back pain, with or without radiculopathy, is the leading cause of years lived with disability and the third ranking cause of disability-adjusted life-years. Uncomplicated acute low back pain and/or radiculopathy is a benign, self-limited condition that does not warrant any imaging studies. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags, raising suspicion for a serious underlying condition, such as cauda equina syndrome, malignancy, fracture, or infection. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Myelopathy is a clinical diagnosis with localization of the neurological findings to the spinal cord, rather than the brain or the peripheral nervous system, and then to a particular segment of the spinal cord. Myelopathy can be the result of primary intrinsic disorders of the spinal cord or from secondary conditions, which result in extrinsic compression of the spinal cord. While the causes of myelopathy may be multiple, the acuity of presentation and symptom onset frame a practical approach to the differential diagnosis. Imaging plays a crucial role in the evaluation of myelopathy with MRI the preferred modality. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

espanolActualmente la medicion de la calidad del diseno arquitectural de software es un topico importante para los ingenieros de software. Sin embargo, algunas metricas de calidad aun no estan definidas, como lo son las metricas para medir el factor de flexibilidad y de herencia de implementacion de una arquitectura de clases, enfocadas en metodos abstractos. En este trabajo de investigacion se propone un conjunto de cinco metricas de calidad, tres de ellas son para medir el factor de herencia de implementacion, las cuales son: Factor de Herencia de Implementacion (FHI), Factor de Herencia de Implementacion por Jerarquia de Clases (FHIJ) y Factor Herencia de Implementacion de una Arquitectura de Clases (FHIAC); las dos restantes son para medir el factor de flexibilidad, estas son: Factor de Flexibilidad de Clase (FFC) y Factor Medio de Flexibilidad de Clases(FMFC). EnglishCurrently measuring the quality of architectural software design is an important topic for software engineers. However, some quality metrics are not yet defined such as the metrics for measuring the flexibility and implementation inheritance factor for a class architecture focused on abstract methods. In this research, a set of five quality metrics is proposed; three of them are to measure the inheritance implementation factor, which are: Implementation Inheritance Factor (FHI), Implementation Inheritance Factor by Class Hierarchy (FHIJ) and Implementation Inheritance Factor of a Class Architecture (FHIAC); the remaining two are to measure the flexibility factor, these are: Class Flexibility Factor (FFC) and Average Class Flexibility Factor (FMFC).

We report the synthesis and characterization of a fullerene‐steroid hybrid that contains H2@C60 and a dehydroepiandrosterone moiety synthesized by a cyclopropanation reaction with 76 % yield. Theoretical calculations at the DFT‐D3(BJ)/PBE 6‐311G(d,p) level predict the most stable conformation and that the saturation of a double bond is the main factor causing the upfield shielding of the signal appearing at −3.13 ppm, which corresponds to the H2 located inside the fullerene cage. Relevant stereoelectronic parameters were also investigated and reinforce the idea that electronic interactions must be considered to develop studies on chemical‐biological interactions. A molecular docking simulation predicted that the binding energy values for the protease‐hybrid complexes were −9.9 kcal/mol and −13.5 kcal/mol for PLpro and 3CLpro respectively, indicating the potential use of the synthesized steroid‐H2@C60 as anti‐SARS‐Cov‐2 agent., A H2@C60‐androsterone hybrid has been obtained through a cyclopropanation reaction. The structure was unequivocally determined by a combination of spectroscopic and analytical methods, including extensive NMR experiments. Theoretical calculations at the DFT‐D3(BJ)/PBE 6‐311G(d,p) level allowed the most stable conformation to be determined, and docking simulations suggest activity against SARS‐Cov‐2 proteases.Suarez @nazariolab et al. @unicomplutense @UdeLaHabana report on the synthesis and properties of an androsterone‐H2/C60 hybrid and molecular docking simulations with SARS‐Cov‐2

La forma tradicional de enseñar programación ha resultado ser ineficiente a la hora de motivar a las nuevas generaciones de ingenieros para encontrar su camino profesional. En la Universidad Autónoma de Bucaramanga se tomó la decisión de crear una estrategia para resolver este problema, con el objetivo de mejorar las métricas de desempeño sobre los alumnos y profesores, así como orientar el currículo hacia las tendencias específicas de la disciplina (apps, IoT, web, IA y videojuegos) y, por último, hacer una revisión de las herramientas, plataformas y lenguajes de programación que estaban en tendencia a nivel mundial para incluirlos en el plan docente en conjunto con una metodología de gamificación experimental diseñada por los mismos docentes. Como resultado, las calificaciones generales mejoraron, las tasas de deserción disminuyeron y la población estudiantil en general aumentó. The traditional way of teaching programming has proven to be ineffective in motivating new generations of engineers to find their career path. At the Universidad Autónoma de Bucaramanga, the decision was made to create a strategy to solve this problem, with the purpose of improving performance metrics on students and teachers, as well as guiding the curriculum towards specific trends in the discipline (apps, IoT, web, AI and videogames) and, finally, review the tools, platforms and programming languages that were trending worldwide to include them in the teaching plan jointly with an experimental gamification methodology designed by the teachers themselves. As a result, overall grades improved, dropout rates decreased, and the overall student population increased.

The experimental process was proposed in order to establish the viability of substituting part of the mineral fraction used at present (clayey material) by residues of combustion processes (ashes) of coal in thermoelectric, as an element to reduce the carbon footprint of the process of production of ceramic products, without altering the quality, properties and functionality of the final product. The study focuses on the specific case of a brick-making company in the metropolitan area of Cúcuta, and on the substitution of 10% of the raw material (clay) for ashes from the thermoelectric plant, for the production of ceramic blocks. The analyses carried out establish an energy saving derived from the use of 10% fly ash equivalent to 997.12Kg of Norte de Santander coal per burn. The results determine that, in the case of brick production, the annual reduction of emissions associated with the production process, with the use of ashes from the thermoelectric, would be 849.48 tons of CO2. Thus, the carbon footprint is reduced by 16.39kgCO2equiv/t finished product, which represents a decrease of 5.99% of the carbon footprint compared to the conventional process.

La evasión fiscal o evasión de impuestos, conocida también como fraude fiscal, es la actividad ilícita en la que incurren personas o empresas cuando ocultan bienes o ingresos a las autoridades tributarias, o sobrevaloran los conceptos deducibles, con el fin de pagar menos impuestos de los que legalmente les corresponden. Cuando supera una cierta cuantía, se considera delito fiscal, pudiéndose sancionar con penas privativas de libertad, mientras que los fraudes de menor cuantía se tramitan como infracción administrativa, sancionándose con multas. La finalidad de la investigación fue conocer la situación de la ciudad de Curuguaty a nivel económico, por lo que cada vez más va en aumento las pequeñas empresas, la problemática o situación a conocer es si todas las pequeñas empresas pagan su impuesto al fisco y que causas producen la evasión.

Las cooperativas que logran su objetivo de ser eficientes, brindando servicios competitivos para sus socios, son aquellos que cuentan con un importante volumen de masa societaria. Las cooperativas han alcanzado niveles de captación y colocación de cifras muy importantes. La ciudad de Salto del Guairá cuenta con Cooperativas de Crédito y Ahorro, donde la investigación se centró en estudiar el riesgo financiero de las mismas, dicha ciudad es fronteriza y la economía no es estable. Debido a estos constantes cambios ha aumentado el nivel de morosidad y disminuido la captación de nuevos créditos lo cual es una de las bases importantes para la cooperativa. Se determinó los riesgos financieros indicando los factores que inciden en la morosidad de las mismas, ya que hay factores que son mismos de la naturaleza y no se podrán evitar, se analizó y se identificó los tipos de créditos más demandados en la ciudad de Salto del Guairá.

There is currently great concern about the processes that directly or indirectly contribute to the potential for global warming, such as stratospheric ozone depletion or acidification. In this context, and provided that treated water is a basic public utility in urban centers around the world as well as in some rural areas, its impact on the environment is of great interest. Therefore, this study applied the environmental methodology of Life Cycle Assessment (LCA) to evaluate the environmental loads of four potable water treatment plants (PWTPs) located in northeastern Colombia following the international guidelines delineated in ISO 14040. The different stages of the drinking water process were thoroughly assessed, from the catchment point through pumping to the distribution network. The functional unit was defined as 1 m3 of drinking water produced at the plant. The data were analyzed through the database Ecoinvent v.3.01, and modeled and processed in the software LCA-Data Manager. The results showed that in plants PLA-CA and PLA-PO, the flocculation process has the highest environmental load, which is mostly attributable to the coagulant agent, with a range between 47-73% of the total impact. In plants PLA-TON and PLA-BOS, electricity consumption was identified as the greatest impact source, with percentages ranging from 67 to 85%. Treatment processes and techniques, bioclimatic conditions and culturally driven consumption behavior varied from region to region. Furthermore, changes in treatment processes and techniques are likely to affect the environment during all stages of a plant’s operational cycle.

This work shows the experimental results obtained by using dip-coater to develop a sol-gel membrane or film on plastic fiber mixed with pH indicators. This will be used as recogni tion components. pH concentration was detected and quantified by use absorbance. Parameters considered to have a preparation control and membrane thickness are explained.

La importancia de la actualización contable de los profesionales contadores radica en mantenerse competitivo dentro del mercado laboral y brindar mejores servicios a sus clientes. Las actualizaciones contables son una herramienta que cuenta el profesional contador para hacer frente a los cambios y exigencias de la administración financiera, además de elevar su cualificación, por ende, esta investigación se realiza con el fin de conocer el influjo de la actualización contable en la competitividad laboral de los contadores.

La maquila es un régimen de inversión a través del cual se producen localmente en Paraguay bienes y servicios de exportación con beneficios para los inversionistas nacionales y extranjeros como el de las tasas diferenciadas de tributos. Esta investigación se presenta bajo el título “Impacto laboral que produjo una industria maquiladora en sus funcionarios, en la ciudad de Salto del Guairá” y consistió en la recolección y análisis de datos de la empresa para determinar el impacto que ha producido en la ciudad como fuente de empleo a nivel social y económico. Se prevé asimismo dar respuesta a la interrogante acerca de la capacidad productiva de la empresa y las condiciones laborales en cuanto la seguridad social y las remuneraciones percibidas.En Salto del Guairá una firma brasilera dio apertura a una empresa bajo el régimen de maquila y produce implementos y artículos de limpieza para el hogar, utilizando mano de obra local para que una vez acabado el producto sea exportado al Brasil. Actualmente la maquiladora emplea a 44 personas, los cuales participaron de la investigación cuyo objetivo fue estudiar el impacto laboral que produjo una industria maquiladora.

There is currently great concern about the processes that directly or indirectly contribute to the potential for global warming, such as stratospheric ozone depletion or acidification. In this context, and provided that treated water is a basic public utility in urban centers around the world as well as in some rural areas, its impact on the environment is of great interest. Therefore, this study applied the environmental methodology of Life Cycle Assessment (LCA) to evaluate the environmental loads of four potable water treatment plants (PWTPs) located in northeastern Colombia following the international guidelines delineated in ISO 14040. The different stages of the drinking water process were thoroughly assessed, from the catchment point through pumping to the distribution network. The functional unit was defined as 1 m3 of drinking water produced at the plant. The data were analyzed through the database Ecoinvent v.3.01, and modeled and processed in the software LCA-Data Manager. The results showed that in plants PLA-CA and PLA-PO, the flocculation process has the highest environmental load, which is mostly attributable to the coagulant agent, with a range between 47-73% of the total impact. In plants PLA-TON and PLA-BOS, electricity consumption was identified as the greatest impact source, with percentages ranging from 67 to 85%. Treatment processes and techniques, bioclimatic conditions and culturally driven consumption behavior varied from region to region. Furthermore, changes in treatment processes and techniques are likely to affect the environment during all stages of a plant's operational cycle. Resumo Atualmente, existe uma grande preocupação com os processos que direta ou indiretamente contribuem para as alterações climáticas, destruição da camada de ozônio ou acidificação, entre outros impactos ambientais. Neste contexto, e desde que a água tratada constitui um serviço público básico em centros urbanos de todo o mundo e em algumas áreas rurais, o impacto de suas emissões no meio ambiente tem sido considerado de grande interesse. Assim, na pesquisa atual foi aplicada a metodologia ambiental de avaliação do ciclo da vida (LCA) para avaliar os impactos ambientais de quatro estações de tratamento de água potável (PWTPs), localizadas no nordeste da Colômbia seguindo diretrizes internacionais da ISO 14040. As diferentes etapas do processo de purificação a partir do ponto de captação por meio de bombeamento para a rede de distribuição foram completamente avaliadas. A unidade funcional foi definida como 1 m3 de água potável produzida na fábrica. Os dados foram analisados com base no banco de dados Ecoinvent v.3.01 e processados no software LCA-Data Manager. Os resultados possibilitaram determinar que em plantas PLA-CA e PLA -POR, o processo de floculação tem a maior carga ambiental, o que é principalmente atribuível ao agente coagulante, com uma percentagem entre 47 e 73% do impacto total. Em plantas PLA-TON e PLA-BOS, o consumo de energia eléctrica foi identificado como sendo a maior fonte de impacto, com percentagens que variam de 67 a 85%. Os processos e técnicas de tratamento, condições bioclimáticas e comportamento de consumo culturalmente impulsionado variam de região para região. Além disso, mudanças nos processos e técnicas de tratamento podem afetar o meio ambiente durante todos os estágios do ciclo de operação de uma planta.

There is currently great concern about the processes that directly or indirectly contribute to the potential for global warming, such as stratospheric ozone depletion or acidification. In this context, and provided that treated water is a basic public utility in urban centers around the world as well as in some rural areas, its impact on the environment is of great interest. Therefore, this study applied the environmental methodology of Life Cycle Assessment (LCA) to evaluate the environmental loads of four potable water treatment plants (PWTPs) located in northeastern Colombia following the international guidelines delineated in ISO 14040. The different stages of the drinking water process were thoroughly assessed, from the catchment point through pumping to the distribution network. The functional unit was defined as 1 m3 of drinking water produced at the plant. The data were analyzed through the database Ecoinvent v.3.01, and modeled and processed in the software LCA-Data Manager. The results showed that in plants PLA-CA and PLA-PO, the flocculation process has the highest environmental load, which is mostly attributable to the coagulant agent, with a range between 47-73% of the total impact. In plants PLA-TON and PLA-BOS, electricity consumption was identified as the greatest impact source, with percentages ranging from 67 to 85%. Treatment processes and techniques, bioclimatic conditions and culturally driven consumption behavior varied from region to region. Furthermore, changes in treatment processes and techniques are likely to affect the environment during all stages of a plant's operational cycle.

Se realizó una investigación descriptiva-prospectiva con el objetivo de validar nuestros criterios de riesgos en la identificación de la infección bacteriana severa (IBS) en niños febriles, para lo cual se establecieron las categorías de riesgos y se aplicaron en 215 niños febriles que habían ingresado por esta causa en un período de 12 meses. Se obtuvo que el 54,9 % de los niños se clasificaron como bajo riesgo y el 71,6 % sin IBS. No obstante, la frecuencia de dicha afección resultó elevada, 28,4 %, con predominio de las infecciones urinarias. Se triplicó el riesgo de padecer IBS en los niños con aspecto tóxico, temperatura mayor o igual a 39°C, test clínico de Bonadio mayor que 8, cituria mayor o igual a 10 000 células/mm³, con diferencias significativas entre las categorías de riesgo y la IBS, y fue mayor la frecuencia en los niños tóxicos y de riesgos, 92,8 y 54,3 %, respectivamente. Uno de cada 4 niños febriles presentó IBS. Se introdujo la categoría "Riesgo" y se recomienda un flujograma de evaluación.A descriptive-prospective research study was carried out to validate our risk criteria in the identification of severe bacterial infection in febrile young children. For this purpose, risk categories were set and applied in 215 febrile children who had been admitted in a period of 12 months. 54.9 % of febrile children were at low risk for serious bacterial infections whereas 71.6 % presented no risk at all. Nevertheless, the frequency of this affection was high, accounting for 28.4 % with predominance of urinary infections. The risk of getting SBI trippled in children who shared toxic look, temperature greater than or equal to 39 °C, Bonadium clinical test higher than 8, cyturia values over or equal to 10 000 cell/mm³, significant differences between risk and SBI categories and the highest frequency of such affection found in toxic children and in children at low risk (92.8 vs 54.3 %). One in every four febrile children had SBI. The Risk category was introduced and an evaluating flow chart is recommended.

Se realizó un trabajo descriptivo-retrospectivo sobre la influencia del bajo peso al nacer en el estado de salud al año de edad en el municipio Jaruco, desde el 1ro de enero de 1994 hasta 31 de diciembre de 1995. Se estudiaron 2 grupos de niños: grupo 1: formado por 55 niños con peso menor de 2 500 g en el período estudiado y grupo 2: escogidos del resto de nacidos con peso superior a los 2 500 g, numéricamente similar. Se concluye que los niños con bajo peso al nacer no muestran diferencias en el desarrollo físico al año de edad, pero sí aumento en los índices de morbilidad ambulatoria y hospitalaria por infecciones respiratorias agudas, enfermedades diarreicas agudas, sepsis urinaria y anemia, así como un peso importante en la mortalidad infantil. Se recomiendan actividades de promoción y prevención para disminuir el bajo peso al nacer.A descriptive and retrospective study was conducted on the influence of low birth weight on the health status at 1 year of age in Jaruco municipality from January 1, 1994 to December 31, 1995. Two groups of infants were studied: group 1 consisted of 55 infants with a body weight lower than 2 500 g during the period studied, and group 2 which consisted of infants selected from the rest of newborn infants with a body weight greater than 2 500 g. The groups were similar regarding the number of subjects. It is concluded that infants with low birth weight show no differences with respect to physical development, but they show an increase in the indexes of ambulatory and hospital morbidity due to acute respiratory infections, acute diarrhea, urinary sepsis and anemia, as well as a great infant mortality. Promotion and prevention interventions are recommended to reduce low birth weight.

Diferentes investigadores han realizado estudios sobre el manejo del niño febril y plantean que es un dilema al que se enfrenta a diario el médico que atiende niños. Motivados por este tema se efectuó un estudio descriptivo retrospectivo de los niños febriles, sin causa aparente en su valoración inicial, que asistieron al servicio de urgencias en un período de 9 meses, con el objetivo de identificar el diagnóstico definitivo al egreso y se precisó el tipo de infección bacteriana severa y relacionó la presencia de éstos con parámetros clínicos y de laboratorios. El mayor número de niños febriles valorados e ingresados mostraron edades desde 91 días hasta 36 meses. El menor porcenaje de ellos ingresaron y desarrollaron alguna infección bacteriana severa principalmente neumonía, y fue mayor el porcentaje de niños con esta patología a menos edad con predominio del aspecto tóxico y de la temperatura 39 EC. Resultó el manejo ambulatorio del niño febril mayor de 90 días y bajo riesgo de infección bacteriana severa un ahorro en vidas y dinero, por lo que se recomienda generalizar el flujograma propuesto para la evaluación y manejo del niño febril de 3 a 36 meses de edad.Different researches have performed studies on the management of the febrile infant and they point out that this is a dilemma faced by every physician who takes care of children. Motivated by this subject, a descriptive and retrospective study of febrile infants was conducted. The study was carried out to evaluate febrile infants without evident cause at the baseline evaluation who attended the emergency service during a period of 9 months with the objective of identifying the definite diagnosis at admission. The type of bacterial infection was accurately assessed and the presence of this was related to clinical and laboratory parameters. The greatest number of febrile infants evaluated and admitted to hospital were 91 days-36 months old. The lowest percentage of them were admitted to hospital and they developed some serious bacterial infection, mainly pneumonia. The percentage of infants presenting with pneumonia was greater in infants under the age above mentioned with predominance of the toxic aspect and of a temperature 39 EC. The outpatient management of the febrile infant over 90 days of life and low risk of serious bacterial infection resulted in lifes and money saved; that's why we recommend to systematized the flujogram proposed for the evaluation and management of the 3-36 months old febrile infant.

To assess the outcomes and safety after CT-guided percutaneous sacroplasty in patients with painful sacral insufficiency fractures or pathologic sacral lesions.A retrospective multicenter analysis of consecutive patients undergoing CT-guided sacroplasty for painful sacral insufficiency fractures or sacral lesions was undertaken. The inclusion criteria consisted of severe sacral pain not responding to conservative medical management with imaging evidence of unilateral or bilateral sacral insufficiency fractures or lesions. Outcome measures included hospitalization status (inpatient or outpatient), pre-treatment and post-treatment visual analog scale (VAS) scores, analgesic use and complications. Patients were followed at approximately 1 month and for at least 1 year after their sacroplasty procedure.Two hundred and forty-three patients were included in the study, 204 with painful sacral insufficiency fractures and 39 with symptomatic sacral lesions. The average pre-treatment VAS score of 9.2±1.1 was significantly improved after sacroplasty to 1.9±1.7 in patients with sacral insufficiency fractures (p0.001). The average pre-treatment VAS score of 9.0±0.9 in patients with sacral lesions was significantly improved after sacroplasty to 2.6±2.4 (p0.001). There were no major complications or procedure-related deaths. One patient who was treated for a sacral insufficiency fracture experienced radicular pain due to local extravasation of cement that subsequently required surgical decompression for symptomatic relief.CT-guided percutaneous sacroplasty is a safe and effective procedure in the treatment of painful sacral insufficiency fractures or lesions. It is associated with prompt and durable pain relief and should be considered as an effective treatment option in this patient population.

Life Cycle Assessment (LCA) tool has been applied to evaluate environmental impacts through the whole building life cycle. LCA has been carried out in accordance to the international standard of ISO 14040 and ISO 14044. As a reference, an application of LCA has been made to a Catalan house located in Barcelona, Spain with a projected 50 years life span. In this work, construction, use (operationand maintenance) and end-of-life phases have been considered. The operational energy consumed during thedwelling period was modeled using a mix of electrical power for electrical appliances, illumination, heating and cooling; and using thermal energy from natural gas for domestic hot water and cooking. Result shows that the highest environmental impacts during the dwelling’s life cycle took place during the use hase. The total impact of global warming potential was 4.52+01 kgCO2-Equiv. m-2 a-1 of which use phase accountedfor 92% (operation 90% and maintenance 2%), construction represented 7% and end-of-life contributed less than 1%. Regarding the operation phase, cooling had the highest environmental burden with 33%, heating represented 9%, followed by illumination 26% and electrical appliances 19%. The other two household activities accountedfor less than 12% (domestic hot water 9% and cooking 4%) of total phase. During the construction phase, the production of building materials represented about 97%, transport to the job site 2% and waste management 1% of total phase. The total primary energy demand was 5.26E+01 MJ m-2 a-1 (gross calorific value) of which non renewableprimary energy demand represents 78% and renewable energy demand 22%. In summary, data for a Catalan home has been provided to evaluate environmental impacts using LCA tool. Data have been modelled into the Gabi software system. Finally, LCA is a suitable tool to evaluate environmental impacts throughout all phases of the building life cycle.

The phrase “vertebroplasty versus kyphoplasty” evokes images of competitive procedures and groups of entrenched physicians locked in battle. Our involvement in the development and introduction of percutaneous vertebroplasty (PV) and kyphoplasty (KP) in the United States has given us a unique

Resumen tomado del autor El uso de los computadores y sus aplicaciones -particularmente la Internet- ya no es tarea exclusiva de profesionales altamente especializados. Es parte de la vida cotidiana. Los computadores y las redes de información están presentes en el ámbito de la producción, de la cultura, de las relaciones sociales, del entretenimiento, de la educación, la política, etc. Una persona medianamente alfabetizada para el mundo digital, puede consultar el saldo de su cuenta corriente desde un computador ubicado en cualquier parte del mundo, traspasar dinero desde o hacia su línea de crédito, pagar ciertos servicios, comprar un libro o un electrodoméstico, etc. En Chile existe, desde el 11 de mayo del 2001, un portal en Internet que permite a los ciudadanos efectuar trámites relacionados con dieciocho Servicios Públicos. A través de ese portal es posible obtener -entre otros- formularios de contribuciones, de nacimiento, de defunción, de matrimonio, etc., sin tener que concurrir físicamente a las distintas reparticiones fiscales. Estos hechos bastan para demostrar que los nuevos medios no sólo han cambiado la manera de ser y de actuar como científico o profesional, sino que están cambiando también la manera de ser y de actuar como ciudadano. Es una hecho, la era digital está aquí y nos toca directa o indirectamente a todos. Baleares Universitat de les Illes Balears. Redined Illes Balears; Edifici Guillem Cifre de Colonya. Ctra. de Valldemossa, Km 7,5; 07122 Palma; +34971172792; +34971173190; redined.balears@uib.es ESP

La deficiencia de información concerniente a niveles y caudales de ríos y quebradas, hace necesario recurrir a técnicas de análisis hidrológico que trabajan con información escasa como el Método Gradex. Esta metodología ha sido muy poco empleada en las diferentes zonas del País, a excepción del Departamento de Antioquia, por esto existe la necesidad de implementarlo en otras regiones y así poder determinar su efectiva aplicación. Este trabajo muestra el procedimiento y los resultados obtenidos al utilizar el Método Gradex en unas cuencas del Departamento de Cundinamarca.

We describe a computed tomography-(CT) guided percutaneous technique for obtaining a core tissue sample from the bony margin of the orbital apex via a lateral suprazygomatic approach. We found this route to be safe and effective while obviating the need for an open biopsy in a patient presenting with a mass encroaching on the left orbital apex.

Se realizó un estudio descriptivo y retrospectivo del estado de salud de un grupo de niños con corte transversal al año de edad, el cual forma parte de una investigación provincial. El universo y la muestra coincidieron (320 niños nacidos entre el 1 de enero de 1992 y el 30 de junio de 1992); predominó el crecimiento físico dentro de parámetros normales y dentro de los malnutridos los que estaban por defecto, la duración de la lactancia entre 3 y 6 meses, así como el comienzo de la ablactación después de los 4 meses, las enfermedades respiratorias y diarreicas agudas como causas de morbilidad y la invalidez neurológica, así como las cardiopatías congénitas como causas de mortalidad infantil. Se recomienda incrementar las labores de prevención y promoción de salud para lograr una mayor duración de la lactancia materna, disminuir las causas de invalidez, sobre todo neurológicas, y la mortalidad infantil.

A 43-year-old corrections officer developed right neck and posterior head pain following a karate punch to the right side of the neck during self-defense training. One week later, he developed an acute left hemiparesis. Magnetic resonance imaging demonstrated a right hemisphere cerebral infarction and absence of signal flow void in the right internal carotid artery. Carotid ultrasound demonstrated complete occlusion of the right internal carotid artery without evidence of atherosclerotic disease. Carotid occlusion with cerebrovascular infarction is a possible complication of martial arts training involving forceful blows to the neck.