Diseño de un Plan de Negocio Turístico en el Balneario "El Platanal", ubicado en el Km. 57 1/2 carretera La Boquita-Casares, comprendido en el periodo de Agosto a Diciembre del 2007

En relación al estudio realizado en el Balneario “El Platanal” ubicado en el Km. 57 ½ carretera a la Boquita-Casares, se efectúo un Plan de Negocio a través del cual se logró conocer muchos aspectos que se pueden mejorar, así como darle a esta pequeña iniciativa de su propietaria Sra. Margina Martínez, un giro de un gran negocio, ya que este dispone de los recursos físicos para llevarlo acabo, cuenta con suficiente área, flora y fauna atractiva a los clientes turistas. Se identificó como principal competencia a Inversiones Ecoturísticas S.A La Máquina, la cual presta servicios atractivos, no obstante el Balneario “El Platanal”, al hacer mejoras, y prestar nuevos servicios turísticos tiene toda la capacidad para alcanzar un porcentaje adicional al que atiende, así como incentivar a los turistas a visitar el lugar en aquellos momentos en que a la fecha se le ha considerado temporada baja. El estudio arrojó una demanda insatisfecha negativa, debido a que la competencia satura el mercado existente, sin embargo a través de estrategias de mercado se hace posible captar la demanda efectiva del negocio. Se determinó que al aplicar precios favorables con respecto a la competencia y una publicidad efectiva los resultados futuros serán satisfactorios. Basándose en el estudio de Mercado y la aplicación de los instrumentos como entrevista, matriz FODA y encuesta, se define el producto/servicio turístico, así como el diseño y estructuración del mismo, el cual permite enriquecer de esta manera la oferta turística del balneario. Dicho producto tuvo gran aceptación por parte de los turistas nacionales y extranjeros permitiendo de esta manera enriquecer la oferta turista del municipio de Diriamba. El estudio financiero realizado en el Balneario El Platanal, se realizó conforme a las normas internacionales de contabilidad, donde se reflejan las diferentes técnicas contables para mostrar cédulas físicas y monetarias para las proyecciones de venta, mostrando la cantidad de insumos a utilizarse por mes en el 2008, además se calcularon flujos de efectivos anuales sin carretera y con carretera; inversiones proyectadas por medio de proformas seleccionando las mejores propuestas para su ejecución, demostrado por razones financieras para los años 2008, 2009, 2010

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030