Aging Compensation in a Class-A High-Frequency Amplifier with DC Temperature Measurements.

One of the threats to nanometric CMOS analog circuit reliability is circuit performance degradation due to transistor aging. To extend circuit operating life, the bias of the main devices within the circuit must be adjusted while the aging degradation process affects them by using a monitor circuit that tracks the evolution of the circuit performance. In this paper, we propose the use of DC temperature measurements in the proximity of the circuit to perform the monitoring of circuit performance degradation and as an observable variable to adjust the bias of the main devices to restore the degraded performance to the original values. To this end, we present experimental results obtained from nine samples of a standard CMOS integrated circuit containing a high-frequency class-A power amplifier and a differential temperature sensor. After accelerated aging, the gain of the amplifier is degraded up to 50%. We propose two different procedures to perform DC temperature measurements that allow tracking of the amplifier gain degradation due to aging and, by uniquely observing temperature readings, automatically set a new bias for the amplifier devices that restores the original amplifier gain. Whereas one of the procedures is able to restore the gain up to a certain limit, the second allows full gain restoration.

Guidelines on epidemics in Mexico. Historical perspective.

A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.

Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.

Directrices en torno a las epidemias en México. Perspectiva histórica / Guidelines on epidemics in Mexico. Historical perspective

Resumen Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.

Abstract A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.

[The estimated economic impact of cardiovascular and diabetes mellitus complications 2019-2028]. / Estimación del impacto económico por complicaciones cardiovasculares y de diabetes mellitus 2019-2028.

Background: In Mexico, diabetes mellitus (DM) and diseases cardiovascular, register an upward trend. Objective: To estimate the number of complications due to cardiovascular events (CVD) and complications derived from DM (CDM) accumulated in beneficiaries of the Mexican Institute of Social Security (IMSS) from 2019 to 2028, as well as the expense for medical and economic benefits in a scenario baseline and one of change in metabolic profile due to lack of medical follow-up during the COVID-19 pandemic. Material and methods: The number of CVD and CDM was estimated from 2019, with a 10-year risk projection using the ESC CVD Risk Calculator and United Kingdom Prospective Diabetes Study, considering risk factors registered in the institutional databases. Results: From 2019 to 2028, cumulative CVD cases were estimated at 2 million and those of CDM in 960 thousand, with an impact on medical spending of 439,523 million pesos and on the economic benefits of 174,085 millions. When considering the COVID-19 pandemic, CVD events and CDM increased by 589 thousand, with an increase in spending of 93,787 million pesos for medical care and 41,159 million for economic benefits. Conclusions: Without a comprehensive intervention in the management of CVD and CDM, the cost by both diseases will continue to increase, with financial pressures getting older.

Introducción: en México la diabetes mellitus (DM) y las enfermedades cardiovasculares, registran una tendencia ascendente. Objetivo: estimar el número de complicaciones por eventos cardiovasculares (ECV) y complicaciones derivadas de la DM (CDM) acumuladas en derechohabientes del Instituto Mexicano del Seguro Social (IMSS) de 2019 a 2028, así como el gasto por prestaciones médicas y económicas en un escenario de referencia y uno de cambio en el perfil metabólico debido a la falta de seguimiento médico durante la pandemia por COVID-19. Material y métodos: se estimó el número de ECV y CDM a partir de 2019, con una proyección de riesgo a 10 años con los modelos ESC CVD Risk Calculator y United Kingdom Prospective Diabetes Study, considerando los factores de riesgo registrados en las bases de datos institucionales. Resultados: de 2019 a 2028, los casos acumulados de ECV se estimaron en 2 millones y los de CDM en 960 mil, con un impacto sobre el gasto médico de 439,523 millones de pesos y sobre las prestaciones económicas de 174,085 millones. Al considerar la pandemia por COVID-19, los eventos de ECV y de las CDM aumentaron en 589 mil, con un incremento del gasto en 93,787 millones de pesos por atención médica y en 41,159 millones por prestaciones económicas. Conclusiones: sin una intervención integral al manejo de ECV y de CDM, el gasto por ambas enfermedades seguirá incrementándose, con presiones financieras cada vez mayores.

New routes to the future.

Not available.

BPF-Based Thermal Sensor Circuit for On-Chip Testing of RF Circuits.

A new sensor topology meant to extract figures of merit of radio-frequency analog integrated circuits (RF-ICs) was experimentally validated. Implemented in a standard 0.35 µm complementary metal-oxide-semiconductor (CMOS) technology, it comprised two blocks: a single metal-oxide-semiconductor (MOS) transistor acting as temperature transducer, which was placed near the circuit to monitor, and an active band-pass filter amplifier. For validation purposes, the temperature sensor was integrated with a tuned radio-frequency power amplifier (420 MHz) and MOS transistors acting as controllable dissipating devices. First, using the MOS dissipating devices, the performance and limitations of the different blocks that constitute the temperature sensor were characterized. Second, by using the heterodyne technique (applying two nearby tones) to the power amplifier (PA) and connecting the sensor output voltage to a low-cost AC voltmeter, the PA's output power and its central frequency were monitored. As a result, this topology resulted in a low-cost approach, with high linearity and sensitivity, for RF-IC testing and variability monitoring.

The COVID-19 pandemic: A call to action for health systems in Latin America to strengthen quality of care.

The Covid-19 and other recent pandemics has highlighted existing weakness in health systems across the Latin-America and the Caribbean (LAC) region to effectively prepare for and respond to Public Health Emergencies. It has been stated that quality of care will be among the most influential factors on Covid 19 mortality rates and low systems performance is the common case in these countries. More comprehensive and system level strategies are required to address the challenges. These must focus on redesigning and strengthening health systems to make them more resilient to the changing needs of populations and based on quality improvement methods that have shown rigorously evaluated positive effects in previous local and regional experiences. A call to action is being made by the Latin American Consortium for Quality, Patient Safety and Innovation (CLICSS) and they provide specific recommendations for decision makers.

Great personalities of medicine, great lessons.

The analysis of three characters corresponding to different spaces and times shows the close link between literature and the history of medicine. On one hand, Don Quixote of La Mancha, who reflects the thought of the last years of the Renaissance and that has been assimilated in contemporary Mexico. On the other hand, Doctors Miguel Francisco Jiménez and Rita Levi Montalcini, who lived in the 19th and 20th centuries, respectively. Despite the years that separate these three personalities, many elements in common are observed that do not lose their validity: the value that is given to health, ethics, tenacity and experience to attain successful results. All three characters refer to the medicine of their time, their achievements and the promotion of humanism, always inherent to medicine.

El análisis de tres personajes correspondientes a espacios y tiempos diferentes muestra el estrecho vínculo entre la literatura y la historia de la medicina. Por un lado, don Quijote de la Mancha, quien refleja el pensamiento de los últimos años del Renacimiento y ha sido asimilado en el México contemporáneo. Por otro lado, los doctores Miguel Francisco Jiménez y Rita Levi Montalcini, quienes vivieron en los siglos XIX y XX, respectivamente. A pesar de los años que separan a los tres personaje, se advierten numerosos elementos en común que no pierden vigencia: el valor que se otorga a la salud, la ética, la tenacidad y la experiencia para obtener resultados exitosos, entre otros. Los tres personajes aluden a la medicina de su tiempo, los logros alcanzados y la promoción del humanismo, siempre inherente a la medicina.

Grandes personajes de la medicina, grandes lecciones / Great personalities of medicine. Great lessons

Resumen El análisis de tres personajes correspondientes a espacios y tiempos diferentes muestra el estrecho vínculo entre la literatura y la historia de la medicina. Por un lado, don Quijote de la Mancha, quien refleja el pensamiento de los últimos años del Renacimiento y ha sido asimilado en el México contemporáneo. Por otro lado, los doctores Miguel Francisco Jiménez y Rita Levi Montalcini, quienes vivieron en los siglos XIX y XX, respectivamente. A pesar de los años que separan a los tres personaje, se advierten numerosos elementos en común que no pierden vigencia: el valor que se otorga a la salud, la ética, la tenacidad y la experiencia para obtener resultados exitosos, entre otros. Los tres personajes aluden a la medicina de su tiempo, los logros alcanzados y la promoción del humanismo, siempre inherente a la medicina.

Abstract The analysis of three characters corresponding to different spaces and times shows the close link between literature and the history of medicine. On one hand, Don Quixote of La Mancha, who reflects the thought of the last years of the Renaissance and that has been assimilated in contemporary Mexico. On the other hand, Doctors Miguel Francisco Jiménez and Rita Levi Montalcini who lived in the 19th and 20th centuries, respectively. Despite the years that separate these three personalities, many elements in common are observed that do not lose their validity: the value that is given to health, ethics, tenacity and experience to attain successful results. All three characters refer to the medicine of their time, their achievements and the promotion of humanism, always inherent to medicine.

Differential Temperature Sensors: Review of Applications in the Test and Characterization of Circuits, Usage and Design Methodology.

Differential temperature sensors can be placed in integrated circuits to extract a signature of the power dissipated by the adjacent circuit blocks built in the same silicon die. This review paper first discusses the singularity that differential temperature sensors provide with respect to other sensor topologies, with circuit monitoring being their main application. The paper focuses on the monitoring of radio-frequency analog circuits. The strategies to extract the power signature of the monitored circuit are reviewed, and a list of application examples in the domain of test and characterization is provided. As a practical example, we elaborate the design methodology to conceive, step by step, a differential temperature sensor to monitor the aging degradation in a class-A linear power amplifier working in the 2.4 GHz Industrial Scientific Medical-ISM-band. It is discussed how, for this particular application, a sensor with a temperature resolution of 0.02 K and a high dynamic range is required. A circuit solution for this objective is proposed, as well as recommendations for the dimensions and location of the devices that form the temperature sensor. The paper concludes with a description of a simple procedure to monitor time variability.

[Results of certification audit in Mexican hospitals, a review from 2009 to 2012]. / Revisión de los resultados de la auditoría de certificación en hospitales mexicanos de 2009 a 2012.

OBJECTIVE: To analyze the participation of Mexican hospitals in the certification process (equivalent to accreditation in other countries). MATERIAL AND METHODS: Crosssectional study that analyzes results of 136 establishments audited between 2009 and 2012. Standards with an excellent rating (9.0-10.0), approving (6-8.9) and non-approving (0-5.9) were identified. With a multinomial model, the probability of obtaining non-approving, approving and excellent qualification was calculated. RESULTS: The general average score was 7.72, higher in ambulatory surgery centers (9.10), than in general hospitals (7.30) and specialty hospitals (7.99). All public establishments obtained an approval score. Hospitals audited in 2011 had a higher risk of obtaining an approval (RRR= 4.6, p<0.05) and excellent (RRR= 6.6, p<0.05) rating. CONCLUSIONS: The scope of the certification process in Mexico has been limited, with greater participation of the private sector. The evaluation certificate applied in 2011 favored the achievement of approval and excellence results. We recommend homologating the entire process with that of the Joint Commission International JCI.

OBJETIVO: Analizar la participación de hospitales mexicano en el proceso de certificación (equivalente a la acreditación en otros países). MATERIAL Y MÉTODOS: Estudio transversal, analiza resultados de 136 establecimientos auditados entre 2009 y 2012. Se identificaron estándares con calificación excelente (9.0-10.0), aprobatoria (6-8.9) y no aprobatoria (0-5.9). Con un modelo logístico multinomial se calculó la probabilidad de obtener calificación no aprobatoria, aprobatoria y excelente. RESULTADOS: La calificación promedio general fue 7.72, más alta en hospitales de cirugía ambulatoria (9.10), que en hospitales generales (7.30) y de especialidad (7.99). Todos los establecimientos públicos obtuvieron calificación aprobatoria. Los hospitales auditados en 2011 tuvieron mayor riesgo de obtener calificación aprobatoria (RRR= 4.6, p<0.05) y excelente (RRR= 6.6, p<0.05). CONCLUSIONES: El alcance del proceso de certificación en México ha sido limitado, con mayor participación del sector privado. La cé- dula de evaluación aplicada en 2011 favoreció la obtención de resultados aprobatorios y de excelencia. Se recomienda homologar el proceso en su totalidad con el empleado por la Joint Commission International (JCI).

Revisión de los resultados de la auditoría de certificación en hospitales mexicanos de 2009 a 2012 / Results of certification audit in Mexican hospitals, a review from 2009 to 2012

Resumen: Objetivo: Analizar la participación de hospitales mexicanos en el proceso de certificación (equivalente a la acreditación en otros países). Material y métodos: Estudio transversal, analiza resultados de 136 establecimientos auditados entre 2009 y 2012. Se identificaron estándares con calificación excelente (9.0-10.0), aprobatoria (6-8.9) y no aprobatoria (0-5.9). Con un modelo logístico multinomial se calculó la probabilidad de obtener calificación no aprobatoria, aprobatoria y excelente. Resultados: La calificación promedio general fue 7.72, más alta en hospitales de cirugía ambulatoria (9.10), que en hospitales generales (7.30) y de especialidad (7.99). Todos los establecimientos públicos obtuvieron calificación aprobatoria. Los hospitales auditados en 2011 tuvieron mayor riesgo de obtener calificación aprobatoria (RRR= 4.6, p<0.05) y excelente (RRR= 6.6, p<0.05). Conclusiones: El alcance del proceso de certificación en México ha sido limitado, con mayor participación del sector privado. La cédula de evaluación aplicada en 2011 favoreció la obtención de resultados aprobatorios y de excelencia. Se recomienda homologar el proceso en su totalidad con el empleado por la Joint Commission International (JCI).

Abstract: Objective: To analyze the participation of Mexican hospitals in the certification process (equivalent to accreditation in other countries). Materials and methods: Cross-sectional study that analyzes results of 136 establishments audited between 2009 and 2012. Standards with an excellent rating (9.0-10.0), approving (6-8.9) and non-approving (0-5.9) were identified. With a multinomial model, the probability of obtaining non-approving, approving and excellent qualification was calculated. Results: The general average score was 7.72, higher in ambulatory surgery centers (9.10), than in general hospitals (7.30) and specialty hospitals (7.99). All public establishments obtained an approval score. Hospitals audited in 2011 had a higher risk of obtaining an approval (RRR= 4.6, p<0.05) and excellent (RRR= 6.6, p<0.05) rating. Conclusions: The scope of the certification process in Mexico has been limited, with greater participation of the private sector. The evaluation certificate applied in 2011 favored the achievement of approval and excellence results. We recommend homologating the entire process with that of the Joint Commission International JCI.

A different approach for the analysis of grapes: Using the skin as sensing element.

In this work, an alternative method to monitor the phenolic maturity of grapes was developed. In this approach, the skins of grapes were used to cover the surface of carbon paste electrodes and the voltammetric signals obtained with the skin-modified sensors were used to obtain information about the phenolic content of the skins. These sensors could easily detect differences in the phenolic composition of different Spanish varieties of grapes (Mencía, Prieto Picudo and Juan García). Moreover, sensors were able to monitor changes in the phenolic content throughout the ripening process from véraison until harvest. Using PLS-1 (Partial Least Squares), correlations were established between the voltammetric signals registered with the skin-modified sensors and the phenolic content measured by classical methods (Glories or Total Polyphenol Index). PLS-1 models provided additional information about Brix degree, density or sugar content, which usually used to establish the harvesting date. The quality of the correlations was influenced by the maturation process and the structural and mechanical skin properties. Thus the skin sensors fabricated with Juan García and Prieto Picudo grapes (that showed faster polyphenolic maturation and a higher amount of extractable polyphenols than Mencía), showed good correlations and therefore could be used to monitor the ripening.

[Benefits for the nation: population health care]. / Beneficios que ha traído a la nación: población atendida.

The best way to assess the Social Service is by measuring its impact on the population, on the health care institutions and on the very students in Social Service. Yet, we have to face the difficulty to obtain reliable data to measure those benefits beyond any doubt. How much the health system is really benefited from these students in relation to the benefits for the population and to the students themselves is also a matter of speculation. Thus, the Social Service could be evaluated as a public policy, a medical act, and a teaching process, if it is really so. The number of consultations provided is not enough, since also preventive actions and health promotion activities are also performed which are even harder to be measured.

[Quality and accessibility]. / Calidad y accesibilidad.

The accessibility and quality makes sense of the historical moment in which they discuss, so, before starting the actual analysis of these concepts, we present a historical overview of development and their application within the Mexican health system. Remarkable efforts have been made in Mexico to increase the accessibility and quality of health services. However, the challenges are growing: to break the paradigm of "curing the disease" where the disease process is countered by the medical staff has required increasing specialization in more areas, and which has resulted in fragmentation of care, and therefore services for the "prevention" which not only interfere the medical field, but everyone involved. The shift to this paradigm could lead to a better quality medical care.

[Quality and health systems]. / Calidad y los sistemas de salud.

The purpose of this paper is to demonstrate, through an example, the impact of health systems in populations in terms of access and quality. One of the most telling examples is the issue of maternal deaths in which both variables, accessibility and quality, are expressed starkly, for better or for worse. Before that, it is necessary to consider three principles as a framework of reference. Hence, from the premises will look at the example and from there reach some conclusions on the topic.