Abstract In this paper, diversity and composition of dung beetles assemblage was study in three urbanized areas with different ecological characteristics from Sucre department , Colombia. Individuals were captured with baited pitfall traps. Sampling effort, range-abundance curves, alpha and beta diversity indices were estimated and compared among the sites. Seven hundred ten individuals grouped into nine genera and 13 species were recorded. The completeness analysis yielded values above 97%. The most diverse assemblage in any of the three orders of "q" was found in the site with a mixture of buildings, gardens, and a patch of secondary vegetation forest, followed by the site with few facilities and open green spaces, and the least diverse site corresponded to the area surrounded by buildings with little vegetation cover. Sorensen-Dice index similarity among the three sites was 38%. The range-abundance curves showed higher species equitability in the most diverse site. The results show that the beetle assemblage composition depends on environmental conditions and the degree of urbanization. It was also evident that some species have high adaptability to urban spaces and others are potentially at risk of local extinction events.

Resumen En el presente trabajo se estudia la diversidad de escarabajos coprófagos en tres zonas urbanizadas del departamento de Sucre, Colombia, cada una con características ecológicas distintas. Los individuos fueron capturados con trampas de caída cebadas. Se analizaron el esfuerzo de muestreo, las curvas de rango-abundancia y los índices de diversidad alfa y beta. Se capturaron 710 individuos, agrupados en nueve géneros y 13 especies. El análisis de completitud arrojó valores por encima del 97%. El ensamble más diverso en cualquiera de los tres órdenes de “q” se encontró en la zona que alberga edificaciones, jardines y un parche de bosque de vegetación secundaria, seguido por una zona de pastizales, con pocas edificaciones; el ensamble de menor diversidad correspondió a la zona rodeada de edificaciones y con escasa cobertura vegetal. El índice de Sorensen-Dice arrojó una similitud total entre las tres zonas del 38%. Las curvas de rango-abundancia mostraron mayor equidad de especies en la zona más diversa. Los resultados indicaron que la composición del ensamble de escarabajos depende de las condiciones ambientales y el grado de urbanización. Así mismo, se evidenció que algunas especies pueden tener alta adaptabilidad y que algunas de ellas corren el riesgo potencial de presentar eventos de extinción local.

RESUMO Objetivo Analisar as etapas de um programa de saúde auditiva, da triagem ao encaminhamento para reabilitação, segundo os indicadores de qualidade de programas de triagem neonatal. Método Trata-se de um estudo de coorte, observacional e retrospectivo, constituído por todos os neonatos inscritos no Sistema de Informação Municipal de Mogi Mirim/SP, de 2010 a 2016. Além dos dados que constam no Sistema de Informações sobre Nascidos Vivos, foram analisados idade do neonato no primeiro teste, resultado dos testes, do diagnóstico e encaminhamento para reabilitação. A análise dos dados foi feita segundo os critérios de indicadores de qualidade das diretrizes de atenção à triagem auditiva neonatal, por meio de programa estatístico. Resultados Participaram 7.800 neonatos e com relação à análise dos indicadores de qualidade do programa foram obtidos os seguintes resultados: 1) Etapa da TAN: 97% de cobertura do primeiro teste; 91% dos neonatos com até 30 dias de vida; 2) Etapa do Diagnóstico: 0,24% encaminhados após falharem no segundo teste; 94,73% de adesão; 13,66% concluíram até os três meses de idade e 3) Etapa da Reabilitação: 100% iniciaram terapia fonoaudiológica imediatamente após o diagnóstico; 20% receberam o aparelho de amplificação sonora individual com até um mês do diagnóstico. Conclusão O programa, realizado em nível ambulatorial, atingiu as recomendações das Diretrizes do Ministério da Saúde com relação à cobertura e idade do primeiro exame, idade da triagem até um mês de vida, encaminhamento para diagnóstico e início da intervenção. Tais resultados só puderam ser obtidos com o apoio institucional do município.

ABSTRACT Purpose To analyze the stages of a hearing health program, from screening to referral for rehabilitation, based on the quality indicators for neonatal screening programs. Methods This is a cohort, observational, retrospective study encompassing all newborns included in the Municipal Information System of Mogi Mirim, São Paulo, from 2010 to 2016. Besides the data present in the Information System on Live Newborns, the newborn’s age at the first test, test and diagnosis results, and referrals for rehabilitation were analyzed, based on the quality indicator criteria recommended by the Neonatal Hearing Screening Care Guidelines, with a statistical program. Results A total of 7,800 newborns participated. The following results were obtained in the analysis of the program quality indicators: 1) Neonatal hearing screening stage: 97% coverage in the first test; 91% of newborns by 30 days old; 2) Diagnosis stage: 0.24% referred after failing the second test; 94.73% adherence; 13.66% confirmed diagnosis by 3 months old; 3) Rehabilitation stage: 100% began speech-language-hearing therapy immediately after the diagnosis; 20% received the hearing aid within 1 month from diagnosis. Conclusion The program, conducted in an outpatient setting, met the recommendations of the guidelines presented by the Ministry of Health concerning the coverage and age at first examination, age at screening up to 1 month old, referral for diagnosis, and beginning the intervention. These results were obtained thanks to institutional support from the municipality.

Abstract: Introduction: The reference standard for the diagnosis of COVID-19 remains reverse transcriptase polymerase chain reaction (RT-PCR)-positive, while plain chest computed tomography (CT) has been more sensitive and specific in severity classification. In defining the severity of SARS-CoV-2, clinical, imaging and laboratory criteria have been specified, mentioning several markers, including lactate dehydrogenase (LDH). Historically, LHD has been of interest as a biomarker associated with lung damage, with a greater peak during the influenza A H1N1 pandemic, and taken as a marker in the definition of severity. Objective: To determine the diagnostic performance of serum LHD levels on admission to the ICU as a marker of severity in patients with SARS-CoV-2 infection. Material and methods: Observational, analytical, longitudinal and prospective study, carried out in two stages, the first (April 1, 2020 to September 30, 2020) consisted of a correlation study between serum LHD levels at Intensive Care Unit (ICU) admission and simple chest CT, a moderate correlation was obtained between serum LHD levels and severity score by pulmonary tomography, with an r = 0.5 and p < 0.0001; a severity-associated serum LHD cut-off point of 396 U/dL was obtained (p < 0.001, sensitivity 86.02%, specificity 75%). The second stage was extended until December 31, 2020, in which analysis is performed for diagnostic test performance, in inferential statistics correlation tests are performed, a multiple linear regression model is built, analysis was performed for diagnostic tests by building two-by-two contingency Tables, determining sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and Bayesian analysis. Results: 155 patients were included in the study to determine the diagnostic performance of serum LHD levels in patients with severe SARS-CoV-2 infection; by multiple linear regression analysis, it was determined that LHD levels on admission to the ICU is a predictor of severity in patients with SARS-CoV-2. A sensitivity of 0.92, specificity 0.41, with PPV 0.854, NPV 0.57 and an accuracy of 0.83, an LR + 1.57 and LR- 0.63 were obtained. In the post-test probability results, patients with DHL > 396 U/dL have a 86.3% probability of developing severe COVID-19. DHL levels have a direct correlation with ICU days of stay and days of invasive mechanical ventilation with statistical significance (p = 0.001, p = 0.033 respectively). Conclusion: Serum LHD levels have a high sensitivity to diagnose COVID-19 severity; and in the absence of simple chest CT, it can predict severe lung damage. It constitutes a test with high screening power in severe cases of COVID-19; with a probability of almost double (LR + 1.6) that of predicting a severe case.

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Resumo: Introdução: O padrão de referência para o diagnóstico de COVID-19 continua sendo a reação em cadeia da polimerase com transcriptase reversa positiva (RT-PCR), enquanto a tomografia computadorizada (TC) de tórax simples tem se mostrado mais sensível e específica na classificação de gravidade. Na definição da gravidade do SARS-CoV-2, foram especificados critérios clínicos, de imagem e laboratoriais, mencionando vários marcadores, incluindo a desidrogenase láctica (DHL). A DHL ao longo da história tem sido de interesse como biomarcador associado a danos pulmonares, com maior boom durante a pandemia de influenza A H1N1, e tomado como marcador na definição de gravidade. Objetivo: Determinar o desempenho diagnóstico de dois níveis séricos de DHL na admissão à UTI como marcador de gravidade em pacientes com infecção por SARS-CoV-2. Métodos: Estudo observacional, analítico, longitudinal e prospectivo, realizado em duas etapas, a primeira (01 de abril de 2020 a 30 de setembro de 2020) consistiu em um estudo de correlação entre os níveis séricos de DHL na admissão na UTI e TC simples de tórax, um foi obtida correlação entre os níveis séricos de DHL e o escore de gravidade pela tomografia pulmonar, com r 0.5 ep < 0.0001; um ponto de corte para DHL sérico associado à gravidade de 396 U/dL foi obtido (p < 0.001, sensibilidade 86.02%, especificidade 75%). A segunda etapa foi estendida até 31 de dezembro de 2020, na qual são realizadas análises para realização de testes diagnósticos, testes de correlação em estatística inferencial, construção de um modelo de regressão linear múltipla, análise para testes diagnósticos, construção tabelas de contingência dois a dois, determinando sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo, razões de verossimilhança e análise Bayesiana. Resultados: 155 pacientes foram incluídos no estudo para determinar o desempenho diagnóstico dos níveis séricos de DHL em pacientes com infecção grave por SARS-CoV-2; pela análise de regressão linear múltipla, determina-se que os níveis de DHL na admissão à UTI é um preditor de gravidade em pacientes com SARS-CoV-2. Obteve-se sensibilidade de 0.92, especificidade de 0.41, com VPP 0.854, VPN 0.57 e exatidão de 0.83, LR+ 1.57 e LR- 0.63. Nos resultados de probabilidade pós-teste, pacientes com DHL > 396 U/Dl têm probabilidade de 86.3% de desenvolver doença grave por COVID-19. Os níveis de DHL têm correlação direta com os dias de permanência na UTI e os dias de tratamento invasivo ventilação mecânica com significância estatística (p = 0.001, p = 0.33 respectivamente). Conclusão: Os níveis séricos de DHL têm alta sensibilidade para diagnosticar gravidade por COVID-19; e na ausência de TC simples de tórax, pode predizer danos pulmonares graves. Constitui um teste com alto poder de escrutínio em casos graves de COVID-19; com quase o dobro da probabilidade (LR + 1.6) de predizer uma condição grave.

RESUMO Considerando sete municípios que fazem parte da aglomeração Rionegro, é estudado o ordenamento territorial, os aspectos tributários específicos dos municípios e faz-se uma revisão de literatura sobre esses temas e aglomeração econômica, com o objetivo de identificar o cumprimento da norma e o comportamento institucional e social das unidades de análise. Através da análise exploratória dos dados, a informação oficial construída a partir das camadas de informação cartográfica e projeções de população em cada cidade, em forma gráfica, são feitas as deduções sobre a relação das variáveis incluídas para ter elementos que permitem verificar comportamentos hipotéticos das instituições e das pessoas, associado as características do ordenamento territorial e a importância que se dá a mesma, em termos de consciência coletiva, como uma forma de organização social e das atividades econômicas. Encontra-se um possível problema entre o estabelecido no marco normativo em matéria de ordenamento territorial e comportamento das instituições e das pessoas. CLASSIFICAÇÃO JEL: O18, Q15, R12 CONTEÚDO: Introdução; 1. Referentes teóricos institucionais e acadêmicos; 2. Métodos recentes para estudar a relação entre aglomeração, uso do solo e os instrumentos tributários territoriais; 3. Estrutura e metodologia da AED relacionado com o trabalho; 4. Conclusão; Referências.

RESUMEN Considerando siete municipios que hacen parte de la aglomeración Rionegro, se estudia el ordenamiento territorial, los aspectos tributarios específicos de los municipios y se hace una revisión de literatura sobre estos temas y aglomeración económica, con el propósito de identificar el cumplimiento de la norma y el comportamiento institucional y social de las unidades de análisis. Mediante el análisis exploratorio de los datos, la información oficial construida a partir de las capas de información cartográfica y proyecciones de población en cada municipio, en forma gráfica, se hacen las deducciones sobre la relación de las variables incluidas para tener elementos que permitan verificar comportamientos hipotéticos de las instituciones y de las personas, asociado a las características del ordenamiento territorial y a la importancia que se le da a la misma, en términos de consciencia colectiva, como una forma de organización social y de las actividades económicas. Se encuentra un posible conflicto entre lo establecido en el marco normativo en materia de ordenamiento territorial y el comportamiento de las instituciones y de las personas. CLASIFICACIÓN JEL: O18, Q15, R12 CONTENIDO: Introducción; 1. Referentes teóricos institucionales y académicos; 2. Métodos recientes para estudiar la relación entre aglomeración, uso del suelo y los instrumentos tributarios territoriales; 3. Estructura y metodología del AED relacionado con el trabajo; 4. Conclusiones; Referencias.

ABSTRACT Considering the seven municipalities that make up the Rionegro agglomeration, this work studies the territorial planning and the specific tax aspects, while perform a literature review of these topics and economic agglomeration with the purpose of identifying the compliance with the norm and institutional and social behavior of the analysis’ units. Through the exploratory analysis of data, the official information constructed with layers of cartographic information and population projections of each municipality, the study makes deductions about the relation of the variables included for having elements that allow the verification of hypothetical behaviors of people and institutions, associated with the characteristics of the territorial planning and the importance assigned to it in terms of collective consciousness as a way of organizing social and economic activities. The study finds a possible conflict between the established in the judicial framework in regards to territorial planning and the behavior of institutions and people. JEL CLASSIFICATION: O18, Q15, R12 CONTENT: Introduction; 1. Academic and institutional theoretical references; 2. Recent methods for studying the relation between agglomeration, use of soil and territorial tax instruments; 3. Structure and methodology of the AED in regards to work; 4. Conclusions; References.

RESUMO Objetivo: descrever os resultados de um programa de saúde auditiva neonatal e verificar se há associação entre presença de indicador de risco para perda auditiva e falhas nos testes e no diagnóstico. Métodos: trata-se do estudo de uma coorte, observacional e retrospectiva, com dados secundários contidos em planilha eletrônica sobre condições sociodemográficas da família, história clínica e resultados dos exames de 7.800 participantes que realizaram a Triagem Auditiva, de 2010 a 2016. Na descrição da primeira e segunda etapa, utilizou-se frequência absoluta e valores percentuais. Na associação entre indicador de risco com falhas nas EOA, utilizaram-se Odds Ratio, Intervalo de Confiança e nível de significância 0,5%. Resultados: dos 12 lactentes com perda auditiva, oito apresentaram como indicador de risco, a medicação ototóxica e permanência em UTI, sendo que a chance de falhar nas EOA ocorreu com onze indicadores. A chance do diagnóstico de perda auditiva foi 13 vezes maior quando há indicador de risco, 18 vezes maior quando usou medicação ototóxica e 16,62 vezes maior com permanência em UTI. Conclusão: os resultados mostram que conhecer os indicadores levará à reflexão de ações a serem adotadas pela equipe responsável.

ABSTRACT Purpose: to describe the results of a neonatal hearing health program and verify whether there is an association between the presence of risk indicators for hearing loss and failure in the tests and diagnosis. Methods: a one-cohort, observational, retrospective study with secondary data contained in a spreadsheet concerning the family’s sociodemographic condition, clinical history, and examination results of 7,800 participants who were submitted to hearing screening between 2010 and 2016. Absolute frequency and percentages were used in the description of the first and second stages. In the association between risk indicators and failures in the otoacoustic emissions, the odds ratio, confidence interval, and significance level at 0.5% were used. Results: the risk indicators in 8 out of the 12 infants presented with hearing loss were ototoxic medication and intensive care unit (ICU) stay, whereas the likelihood of failure in the otoacoustic emissions occurred along with 11 indicators. The likelihood of a diagnosis of hearing loss was 13 times greater when there was a risk indicator, 18 times greater when an ototoxic medication had been used, and 16.62 times greater when they stayed in ICUs. Conclusion: the results show that knowing the indicators leads to considering the actions the team in charge should take.

Resumen: Este trabajo de investigación estima el efecto de la política de mezcla de biocombustibles sobre la generación de empleo rural en Colombia, a través de la aplicación de la metodología empírica basada en vectores autorregresivos (VAR), para estimar la elasticidad del nivel de empleo y simular su comportamiento cuando la producción y los precios de biocombustibles o combustibles fósiles sufren variaciones. Se construye una base de datos que contiene nivel de producción, precios y empleo con periodicidad mensual entre 2009 y 2015 en Colombia. Se estudia la estructura empírica subyacente y la manera como se puede estimar la elasticidad en modelos vectoriales, finalmente se analiza la política de promoción de los biocombustibles y sus efectos sobre la generación de empleo. Las correlaciones dinámicas estimadas muestran que no existe un efecto apreciable sobre el nivel de empleo cuando hay variaciones en los niveles de producción y precios de los biocombustibles.

Abstract This paper estimates the effect of the biofuel mixing policy on the Colombian rural employment. To this end, we apply an empirical methodology based on autoregressive vectors -VAR-. This one allows us to estimate the short-run employment elasticity and to simulate its evolution when biofuel or its prices suffer a positive shock. We construct a monthly database that contains production, prices, and employment levels during 2009-2015 in Colombia. Underlying empirical structure and how elasticity can be estimated in vector models will be studied, and finally we analyze biofuel promotion policy and its effects on jobs. The estimated dynamic correlations show that there is no appreciable effect on the employment levels when there are variations in biofuels production and prices levels.

ABSTRACT A 48-year-old woman with a history of type 2 diabetes mellitus treated with empaglifozine came to consultation after 8 hours of abdominal pain, nausea, vomiting, and shortness of breath. After the physical examination, the patient was alert, allergic, pale, with dry mucosa, tachypnea, tachycardia, and with diffuse abdominal pain without signs of peritoneal irritation. The results of his laboratory showed a serum glucose of 115 mg/dL (70-100 mg/dL), arterial blood gasometry with metabolic acidosis with an elevated gap anion of 20 mmol/L. Urine analysis reported ketonuria (150 ketone bodies) and HbA1C was 12.4% (4.8% -6%). A surgical cause of abdominal pain was ruled out and she was finally diagnosed with euglycemic diabetic ketoacidosis secondary to the use of sodium-glucose cotransporter inhibitors 2.

RESUMEN Mujer de 48 años con antecedentes de diabetes mellitus tipo 2 tratada con empaglifozina acudió a consulta después de 8 horas de dolor abdominal, náuseas, vómitos y falta de aliento. Tras el examen físico, la paciente estaba alerta, álgica, pálida, con mucosas secas, taquipneica, taquicárdica y con dolor abdominal difuso sin signos de irritación peritoneal. Los resultados de su laboratorio mostraron una glucemia sérica de 115 mg/dL (70-100 mg/dL), gasometría arterial con acidosis metabólica con anión gap elevado 20 mmol/L. El análisis de orina reportó cetonuria (cuerpos cetónicos 150) y la HbA1C fue 12,4% (4,8%-6%). Se descartó una causa quirúrgica de dolor abdominal y finalmente fue diagnosticada con cetoacidosis diabética euglucémica secundaria al uso de Inhibidores del cotransportador de sodio-glucosa 2.

ABSTRACT The transmission system is the infrastructure that allows the transfer of energy from the production points to the consumption centers. It has the characteristics of a regulated natural monopoly. For the efficiency and economic equity of the electricity market, electricity losses and costs for the use of the network must be adequately distributed among all the agents that make use of this system. Due to the non-linear equations of the power flows and the coupling and cross effect between active and reactive power, it makes the loss and cost allocation process a very complicated task. In this article we propose a new method to solve these problems. The proposed method models the agents as sources of complex power, which allows simultaneously considering the coupling and the cross effect that exists between the active and reactive power in the process of allocation of electrical losses and transmission costs. The Proposed Method combines circuit theory with the Aumann-Shapley Method of Game Theory, ensuring a fair and transparent allocation process. The proposed method was implemented in a 5-bar test system and an IEEE 30-bar system. The results obtained were compared with other methods reported in the literatura.

RESUMEN El sistema de transmisión es la infraestructura que permite la transferencia de energía desde los puntos de producción hasta los centros de consumo. Tiene características de monopolio natural regulado. Para eficiencia y equidad económica del mercado eléctrico, las pérdidas eléctricas y los costos por el uso de la red deben ser adecuadamente distribuidos entre todos los agentes que hacen uso de este sistema. Debido a las ecuaciones no lineales de los flujos de potencia, el acoplamiento y efecto cruzado entre potencia activa y reactiva hace del proceso de asignación de pérdidas y costos una tarea muy complicada. En este artículo proponemos un nuevo método para resolver estos problemas. El método propuesto modela a los agentes como fuentes de potencia compleja, lo cual permite considerar simultáneamente el acoplamiento y el efecto cruzado que existe entre la potencia activa y reactiva en el proceso de asignación de pérdidas eléctricas y costos de transmisión. El Método Propuesto combina la teoría de circuitos con el Método Aumann-Shapley de la Teoría de Juegos, garantizando un proceso de asignación justo y transparente. El método propuesto fue implementado en un sistema de prueba de 5 barras y un sistema IEEE 30 barras. Los resultados obtenidos fueron comparados con otros métodos reportados en la literatura.

ABSTRACT A 53-year-old female patient was admitted by a clinical case of 10 days of evolution characterized by myalgia and edema in the lower extremities. On physical examination: facial swelling, dry skin, fine hair, decreased axillary and pubic hair. In the laboratory there is evidence of elevation of muscle enzymes (myoglobin 3000 U/L, CPK 2876 U/L), alteration of serum Na 112 mEq/L, altered thyroid profile (normal to low TSH 1.14 IU/mL and FT4 low 0.08 IU/ml), AM cortisol 7.2 mcg/dL. Magnetic resonance imaging is requested with sella Turcica protocol. It is observed a decreased pituitary gland in all its diameters confirming the finding of a partially empty sella syndrome. Hyponatremia associated with hypopituitarism is uncommon.

RESUMEN Paciente femenino de 53 años de edad, que ingreso por cuadro clínico de 10 días de evolución caracterizado por mialgias y edema en extremidades inferiores. Al examen físico: facie abotagada, piel seca, cabello fino, disminución del vello axilar y púbico. En laboratorio se evidencia elevación de enzimas musculares (mioglobina 3000 U/L, CPK 2876 U/L), alteración del Na sérico 112 mEq/L, perfil tiroideo alterado (TSH normal a baja 1,14 UI/mL y FT4 baja 0,08 UI/ml), cortisol AM de 7,2 mcg/dL. Se solicito resonancia magnética con protocolo de silla turca se observa; hipófisis disminuida de tamaño en todos sus diámetros que confirma el hallazgo de un síndrome de silla turca parcialmente vacía. La hiponatremia asociada a hipopituitarismo es poco común.

This study was carried out in order to compare the relative bioavailability of two different formulations containing 400 mg of acetaminophen + 4 mg of phenylephrine hydrochloride + 4 mg of chlorpheniramine maleate, Test formulation (Cimegripe®) and Reference formulation (Resfenol®) in 84 healthy volunteers of both sexes under fasting conditions. The study was conducted in a single dose, randomized, open-label, crossover 3-way and partially replicated. The tolerability was evaluated by the monitoring of adverse events and vital signs, results of clinical and laboratory tests. Plasma concentrations were quantified by validated bioanalytical methods using the ultra-performance liquid chromatography coupled to tandem mass spectrometry. The Cmax, Tmax, AUC0-t, AUC0-inf, T1/2 and Kel pharmacokinetic parameters were calculated from these obtained concentrations. The 90% confidence intervals were constructed for the ratio reference/test from the geometric average of the Cmax and AUC parameters which were comprised between 80% and 125%. Only the Cmax parameter of the phenylephrine was applied the scaled average bioequivalence due to the intraindividual coefficient of variation > 30% obtained, thus extending the acceptance limits of the interval. It can be concluded that the two formulations were bioequivalent in terms of rate and absorption extent and thus interchangeable.

Abstract: A debilitated turkey vulture (Cathartes aura), showing prominent nodular masses in its head, was found in Antofagasta, Chile. Histopathological examination revealed the presence of epidermal hyperplasia and hypertrophy with typical eosinophilic intracytoplasmatic inclusion bodies in epithelial cells. Accordingly, a diagnosis of avian pox was established, corresponding to the first known occurrence of the disease in the southern hemisphere.

Resumen Se analizan las consecuencias de impuestos ambientales que diferencian espacial-mente a contaminadores ubicados sobre una cuenca hidrográfica. Se construye un modelo de equilibrio general con capital natural como insumo y restricción a la acti-vidad económica. Se encuentran mejoras en el bienestar social al aplicar impuestos diferenciados espacialmente, y se elaboran recomendaciones para la construcción y aplicación de impuestos separando las cuencas por tramos. Finalmente, se deba-te la normatividad ambiental colombiana sobre control de vertimientos en cuerpos de agua, señalando que más que modificar la regulación actual basta con llevar esta legislación a un nivel de “hacer cumplir” más estricto. JEL: D58, D62, Q53, Q25.

Resumo Analisam-se as consequências dos impostos ambientais que diferenciam espacialmente os poluidores localizados em uma bacia hidrográfica. Um modelo de equilíbrio geral é construído com o capital natural como insumo e restrição à atividade econômica. Melhorias no bem-estar social são encontradas através da aplicação de impostos espacialmente diferenciados, e recomendações são feitas para a construção e aplicação de impostos, separando as bacias por seções. Finalmente, são discutidas as regulamentações ambientais colombianas sobre o controle de verteduras em corpos de água, apontando que, em vez de modificar o regulamento atual, é suficiente levar essa legislação a um nível de "aplicação" mais rigorosa. JEL: D58, D62, Q53, Q25.

Abstract We analyse the consequences of implementing environmental taxes that differ spatially depending on the polluting agent’s location within a river basin. We build a general equilibrium model that includes natural capital as input on the production function and economic activity restrictions. From a social welfare point of view and compared with homogeneous taxes, there are improvements if taxes are differentiated. This paper recommends taxes being applied that consider the separation of the river basins by sections. There is debate as to the water pollution regulations, and it is pointed out that rather than modifying the current regulation, more enforcement is needed. JEL: D58, D62, Q53, Q25.

Résumé On analyse les conséquences des impôts environnementaux qui différencient spatialement les pollueurs situés dans un bassin hydrographique. On construit un modèle d’équilibre général avec capital naturel comme intrant et restriction de l’activité économique. On trouve des améliorations dans le bien-être social lorsqu’on établit des impôts spatialement différenciés, et on formule des recommandations pour la construction et l’établissement d’impôts en séparant les bassins hydrographiques en tronçons. Enfin, on examine la normativité environnementale colombienne sur le contrôle des versements dans les cours d’eau et on souligne que, plutôt que modifier la réglementation actuelle, un niveau plus strict de mise en œuvre de celle-ci suffirait. JEL: D58, D62, Q53, Q25.

ABSTRACT Background: The evaluation of right-sided heart chambers is extremely important for the diagnosis and prognosis of differ-ent conditions. However, there is little information in the bibliography about the reference values of the right-sided heart chambers dimensions and right ventricular function. Objective: The aim of this study was to establish the reference values of the right-sided heart chambers, to identify the dif-ferences associated with sex and anthropometric variables and to evaluate the interobserver and intraobserver variability in determining these values. Methods: The study included healthy men and women ≥16 years. Strict exclusion criteria were applied. A subgroup of 40 people underwent multiple measurementis of the right-sided heart chambers and interobserver and intraobserver variability was estimated. Resultis: A total of 438 persons were included; 55.2% (n=242) were men. Mean age was 34±9 years. There were significant differences in the variables analyzed between men and women that persisted after they were indexed to body surface area. Interobserver concordance (ICC>0.75) was excellent in 50% of the variables evaluated, fair to good (ICC 0.4 to 0.75) in 47.4% and poor (ICC<0.4) in 2.6%. Intraobserver concordance was excellent in 54.8% of the variables, fair to good in 42.8% and poor in 2.4%. Conclusion: The reference values for the evaluation of right-sided heart chambers are presented. The differences observed between sexes and related to body surface area emphasize the need for discriminating according to these parameters in daily practice. Interobserver and intraobserver concordance was excellent to good in most of the variables analyzed.

RESUMEN Introducción: La evaluación de las cavidades cardíacas derechas es de gran importancia diagnóstica y pronóstica en diversas patologías. Sin embargo, existen pocos datos bibliográficos acerca de los valores de referencia de sus dimensiones así como de la función del ventrículo derecho. Objetivo: Nuestro objetivo fue establecer dichos valores, identificar diferencias asociadas al sexo y a variables antropométricas y evaluar la variabilidad inter- e intraobservador en su determinación. Material y métodos: Se incluyeron prospectivamente personas sanas ≥ 16 años, de ambos sexos. Se aplicaron estrictos criterios de exclusión. Se realizó la evaluación ecocardiográfica con múltiples mediciones de cavidades derechas y la estimación de la variabilidad inter- e intraobservador en un subgrupo de 40 personas. Resultados: Se incluyeron 438 personas, el 55,2% (n = 242) fueron hombres. La media de edad fue 34 ± 9 años. Las variables analizadas mostraron diferencias significativas entre hombres y mujeres, que persistieron al indexarlas a superficie corporal. La fuerza de concordancia para la variabilidad interobservador fue excelente (CCI > 0,75) en el 50% de las variables estudiadas, regular a buena (CCI 0,4 a 0,75) en el 47,4% y pobre (CCI < 0,4) en el 2,6%. La concordancia intraobservador fue excelente en el 54,8% de las variables, regular a buena en el 42,8% de ellas y pobre en el 2,4%. Conclusión: Presentamos valores de referencia para la evaluación de las cavidades derechas. Las diferencias observadas entre sexos y según la superficie corporal hacen necesaria su discriminación acorde con dichos parámetros en la práctica diaria. La concordancia interobservador e intraobservador fue excelente a buena en la mayoría de las variables estudiadas.

Resumen Objetivo: Estimar los costos directos de la atención de infección respiratoria aguda (IRAG) en niños y adultos en tres países de América Central. Métodos: Los costos de pacientes hospitalizados fueron estimados a través de análisis retrospectivo en una muestra aleatoria de registros de historias clínicas de casos de IRAG tratado en hospitales universitarios durante el periodo 2009-2011. Las actividades incurridas por paciente fueron registradas y un costo especifico para cada sitio fue estimado. El costo por cada niño y adulto mayor fue estimado para cada país. En Nicaragua sólo se incluyó población pediátrica. Los costos fueron expresados en moneda local (2011), dolar americano y dolar internacional (2005). Resultados: El costo por caso en niños en Guatemala fue el más barato (I$971.95) comparado al de Nicaragua (I$1,431.96) y Honduras (I$1,761.29). En adultos, el costo de tratamiento para Guatemala fue el más costoso: I$4,065.00 vs. I$2,707.91 en Honduras. Conclusión: Los costos de tratar casos IRAG estimados a partir de costos promedios pro caso pueden tener validez externa para hospitales con perfiles epidemiologicos similares y nivel de complejidad de atención para los países del estudio. Esta información es muy relevante para la toma de decisiones.

Abstract Objective: To estimate the direct medical costs of severe acute respiratory infection (SARI) in children and adults from three Central American countries with a bottom-up costing approach. Methods: The costs of inpatients treatment were estimated through the retrospective bottom-up costing in a randomized sample of clinical records from SARI patients treated in teaching tertiary hospitals during 2009 - 2011 period. Activities incurred per patient were registered and a setting-specific cost per activity was acquired. Average cost per patient in the group of children and elderly adults was estimated for each country. In Nicaragua, only the pediatric population was included. Costs were expressed in local currency (2011), American dollars, and international dollars (2005) for country comparison. Results: The care cost per case in children in Guatemala was the cheaper (I$971.95) compared to Nicaragua (I$1,431.96) and Honduras (I$1,761.29). In adults, the treatment cost for Guatemala was the more expensive: I$4,065.00 vs. I$2,707.91 in Honduras. Conclusion: Bottom-up costing of SARI cases allowed the mean estimates per treated case that could have external validity for the target population diagnosed in hospitals with similar epidemiological profiles and level of complexity for the study countries. This information is very relevant for the decision-making.