Modelo de gestión tecnológica para las empresas metalmecánicas localizadas en la ciudad de Cartagena /

La Gestión Tecnológica (GT) de las empresas metalmecánicas de la ciudad de Cartagena está determinada por siete variables a saber: Base Tecnológica, consiste en la capacidad de desarrollar un flujo constante de nuevos productos que satisfagan las necesidades del mercado (incluyendo alta calidad y bajos costos) Arquitectura Estratégica, es una variable que se deriva del proceso de planeación estratégica. Análisis del Ciclo de la Tecnología, que parte del establecimiento de un procedimiento formal para llegar a ser conscientes de Tecnologías relevantes y que finaliza en la toma de decisión en relación con la obsolescencia de una tecnología en particular. Arquitectura de la GT (o Arquitectura para la GT), permite entender la 22 relación entre las disciplinas funcionales y la gestión de la tecnología como el parámetro causal para conseguir, mantener y mejorar resultados adecuados para la organización. Procesos de Aprendizaje, tal como lo menciona Peter Senge en su obra “La Quinta Disciplina”, las organizaciones que aprenden son posibles, porque en lo más profundo todos somos aprendices. Análisis de la Tecnología, busca principios comunes para abordar todas las tecnologías y los conceptos para entender la totalidad de los panoramas tecnológicos o brindar una perspectiva estratégica sobre tecnología. Proceso de Gestión, es el manejo de recursos, infraestructura y funciones aplicando las diferentes herramientas de gestión (tales como Alianzas Estratégicas, Benchmarking, Análisis de mercados, etc.).Incluye bibliografí

Elementos estructurales para el diseño de modelos de negocio para contratos de concesión vial de obras públicas a partir de la experiencia de la concesión vial "corredor de acceso rápido a la variante de Cartagena" /

Con el presente trabajo se propuso realizar una investigación de tipo descriptiva y exploratoria apoyándose en la metodología de estudio de casos como estrategia metodológica, con el fin de redactar un caso de negocio, específicamente relacionado con el modelo de negocios desarrollado por la empresa Concesión Vial de Cartagena S.A., empresa pionera en el diseño, construcción y operación de concesiones urbanas en Colombia. En esta investigación se presentan los datos más relevantes a la compañía objeto de estudio, Concesión Vial de Cartagena S.A. y además se expone un resumen sobre la evolución del modelo de gestión adoptado por esta compañía, la cual es pionera en Colombia en este tipo de modelos de negocio. Adicionalmente, se presenta el marco teórico mediante el cual se revisó el concepto de modelo de negocios, los elementos estructurales del modelo de negocios, al igual que sus interrelaciones. Posteriormente, se describieron los principales aspectos metodológicos que se tuvieron en cuenta para la realización de esta investigación, al igual que las fuentes de información utilizadas para obtener los resultados esperados; destacando desde la perspectiva conceptual, los planteamientos de Paul Timmers (1998), al ser más concreto en cuanto a los diferentes actores que deben interactuar para que el modelo sea exitoso.Incluye anexosIncluye bibliografí

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

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

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially