Application of systems dynamics and group model building to identify barriers and facilitators to acute care delivery in a resource limited setting

BACKGROUND: Group model building (GMB) is a method to facilitate shared understanding of structures and relationships that determine system behaviors. This project aimed to determine the feasibility of GMB in a resource-limited setting and to use GMB to describe key barriers and facilitators to effective acute care delivery at a tertiary care hospital in Malawi. METHODS: Over 1 week, trained facilitators led three GMB sessions with two groups of healthcare providers to facilitate shared understanding of structures and relationships that determine system behaviors. One group aimed to identify factors that impact patient flow in the paediatric special care ward. The other aimed to identify factors impacting delivery of high-quality care in the paediatric accident and emergency room. Synthesized causal maps of factors influencing patient care were generated, revised, and qualitatively analyzed. RESULTS: Causal maps identified patient condition as the central modifier of acute care delivery. Severe illness and high volume of patients were identified as creating system strain in several domains: (1) physical space, (2) resource needs and utilization, (3) staff capabilities and (4) quality improvement. Stress in these domains results in worsening patient condition and perpetuating negative reinforcing feedback loops. Balancing factors inherent to the current system included (1) parental engagement, (2) provider resilience, (3) ease of communication and (4) patient death. Perceived strengths of the GMB process were representation of diverse stakeholder viewpoints and complex system synthesis in a visual causal pathway, the process inclusivity, development of shared understanding, new idea generation and momentum building. Challenges identified included time required for completion and potential for participant selection bias. CONCLUSIONS: GMB facilitated creation of a shared mental model, as a first step in optimizing acute care delivery in a paediatric facility in this resource-limited setting

Efecto antagónico in vitro de actinomicetos aislados de purines de chipaca (bidens pilosa l.) frente a phytophthora infestans (mont) de bary

Se estudió el efecto inhibidor de los actinomicetos presentes en purines o extractos fermentados de plantas de chipaca (Bidens pilosa L.), sobre el crecimiento de Phytophthora infestans (Mont) de Bary, causante del tizón tardío de la papa. Se elaboraron cuatro purines de flores, raíces, hojas-tallos y su mezcla. De estos purines se obtuvieron 25 aislamientos de actinomicetos, cada uno de los cuales se enfrentó con P. infestans en placas de medio de cultivo, utilizando la técnica de anillos de Gauze y estableciendo las concentraciones iniciales de esporas mediante conteos microscópicos en cámara de Neubauer. Los actinomicetos no crecieron en el purin de flores debido, posiblemente, a que en él no se utiliza suelo rizosférico o porque su pH (9) es mayor que el rango normal de crecimiento de estos microorganismos ( pH 6 – 8). Se evidenció inhibición del crecimiento del oomycete por parte de 8 aislamientos de actinomicetos con porcentajes de inhibición entre 33,3 - 77,8%, provenientes de los purines de raíces, tallos-hojas y mezcla de partes de la planta. La mayor inhibición se obtuvo en los aislamientos AC001, AC010, AC011 y AC025 con conteos de 0,4, 6,0, 3,0, y 3,6 x105 esporas mL-1)

Mechanisms of Transcranial Doppler Ultrasound phenotypes in paediatric cerebral malaria remain elusive.

BACKGROUND: Cerebral malaria (CM) results in significant paediatric death and neurodisability in sub-Saharan Africa. Several different alterations to typical Transcranial Doppler Ultrasound (TCD) flow velocities and waveforms in CM have been described, but mechanistic contributors to these abnormalities are unknown. If identified, targeted, TCD-guided adjunctive therapy in CM may improve outcomes. METHODS: This was a prospective, observational study of children 6 months to 12 years with CM in Blantyre, Malawi recruited between January 2018 and June 2021. Medical history, physical examination, laboratory analysis, electroencephalogram, and magnetic resonance imaging were undertaken on presentation. Admission TCD results determined phenotypic grouping following a priori definitions. Evaluation of the relationship between haemodynamic, metabolic, or intracranial perturbations that lead to these observed phenotypes in other diseases was undertaken. Neurological outcomes at hospital discharge were evaluated using the Paediatric Cerebral Performance Categorization (PCPC) score. RESULTS: One hundred seventy-four patients were enrolled. Seven (4%) had a normal TCD examination, 57 (33%) met criteria for hyperaemia, 50 (29%) for low flow, 14 (8%) for microvascular obstruction, 11 (6%) for vasospasm, and 35 (20%) for isolated posterior circulation high flow. A lower cardiac index (CI) and higher systemic vascular resistive index (SVRI) were present in those with low flow than other groups (p \u3c 0.003), though these values are normal for age (CI 4.4 [3.7,5] l/min/m2, SVRI 1552 [1197,1961] dscm-5m2). Other parameters were largely not significantly different between phenotypes. Overall, 118 children (68%) had a good neurological outcome. Twenty-three (13%) died, and 33 (19%) had neurological deficits. Outcomes were best for participants with hyperaemia and isolated posterior high flow (PCPC 1-2 in 77 and 89% respectively). Participants with low flow had the least likelihood of a good outcome (PCPC 1-2 in 42%) (p \u3c 0.001). Cerebral autoregulation was significantly better in children with good outcome (transient hyperemic response ratio (THRR) 1.12 [1.04,1.2]) compared to a poor outcome (THRR 1.05 [0.98,1.02], p = 0.05). CONCLUSIONS: Common pathophysiological mechanisms leading to TCD phenotypes in non-malarial illness are not causative in children with CM. Alternative mechanistic contributors, including mechanical factors of the cerebrovasculature and biologically active regulators of vascular tone should be explored

Evaluation and data analysis of user experience for the Doctrina system: a skilled tutor

Gamification is a growing concept and very popular mainly with young audiences. In the education context its application allows not only ex-tra motivation by the student, but also a capacity for greater abstraction to more complex concepts. The purpose of this work is to present, through a software, de-veloped specifically for mobile devices, a gamified environment for the teaching-learning process. The software will work in a personalized way for each student through the intelligent tutor system, based on bio-inspired algorithms, aligned with reinforcement learning practices and hierarchy graph structures. A syste-matic analysis of system usability system was performed through globally known heuristics. Finally, the user responses were analyzed with the objective of dis-covering patterns for system improvement

Transcranial Doppler Ultrasonographic Evaluation of Cerebrovascular Abnormalities in Children With Acute Bacterial Meningitis

Introduction: Bacterial meningitis (BM) is a global public health concern that results in significant morbidity and mortality. Cerebral arterial narrowing contributes to stroke in BM and may be amenable to intervention. However, it is difficult to diagnose in resource-limited settings where the disease is common.Methods: This was a prospective observational study from September 2015 to December 2019 in sub-Saharan Africa. Children 1 month−18 years of age with neutrophilic pleocytosis or a bacterial pathogen identified in the cerebrospinal fluid were enrolled. Transcranial Doppler ultrasound (TCD) of the middle cerebral arteries was performed daily with the aim to identify flow abnormalities consistent with vascular narrowing.Results: Forty-seven patients were analyzed. The majority had Streptococcus pneumoniae (36%) or Neisseria meningitides (36%) meningitis. Admission TCD was normal in 10 (21%). High flow with a normal pulsatility index (PI) was seen in 20 (43%) and high flow with a low PI was identified in 7 (15%). Ten (21%) had low flow. All children with a normal TCD had a good outcome. Patients with a high-risk TCD flow pattern (high flow/low PI or low flow) were more likely to have a poor outcome (82 vs. 38%, p = 0.001).Conclusions: Abnormal TCD flow patterns were common in children with BM and identified those at high risk of poor neurological outcome.</jats:p

Etiology of hospital mortality in children living in low- and middle-income countries:a systematic review and meta-analysis

In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%–4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9–14)]; respiratory [9 (95% CI 5–13)]; and gastrointestinal [9 (95% CI 6–11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231–280)]; infectious [214 (95% CI 193–234)]; and gastrointestinal [166 (95% CI 143–190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation

Development Management System Safety and Health Working Grupo Kopelle Ltda., Under the Requirements Decree 1072 of 2015 Chapter VI

Las necesidades del mercado, los constantes cambios del entorno en el actual mundo empresarial, orienta a las empresas cada vez más a buscar estrategias gerenciales que permitan que sus organizaciones sean capaces de anticiparse y adaptarse permanentemente a sus competidores, logrando el máximo aprovechamiento de sus recursos. Para ello es necesaria la implementación de sistemas de gestión en estas organizaciones; que logren direccionar sus actividades en un mundo competitivo y que les permita posicionarse como compañías de calidad. Grupo Kopelle Ltda., por el momento no cuenta con mecanismos ni procedimientos de gestión formalmente establecidos; por ello se considera indispensable el desarrollo del sistema de gestión de seguridad y salud en el trabajo en el Grupo Kopelle Ltda, con el fin de dar cumplimiento a la normatividad legal vigente y adicionalmente contribuir con la política de calidad en la que uno de los puntos hace referencia al bienestar de sus trabajadores. El desarrollo de este sistema y su posterior implementación por parte de la empresa, permitirá controlar los riesgos a los que están expuestos los trabajadores, así como el mantenimiento y la mejora continua.Market needs, the constantly changing environment in today's business world, guides companies increasingly seek management strategies for their organizations are able to anticipate and constantly adapt to its competitors, making maximum use of its resources . For this, the implementation of management systems in these organizations is necessary; achieve direct their activities in a competitive world and allow them to position themselves as quality companies Grupo Kopelle Ltda., for the moment no mechanisms or formally established management procedures; therefore the development of the management system of health and safety at work in the Grupo Kopelle Ltda., in order to comply with current legal regulations and further contribute to the quality policy is considered essential in that one of the points It refers to the welfare of their workers. The development of this system and its implementation by the company, will control the risks to which workers are exposed as well as the maintenance and continuous improvement

Creación de Empresa "Soluciones en Logistica y Embalajes S.A.S"

162 p. // 15 -29 : 0016Este proyecto constituye la elaboración de un plan de negocios para la producción y comercialización de zuncho plástico, para empresas dedicadas a la distribución en Bogotá. Se centra en brindar a los clientes la posibilidad de crear una ficha técnica para asegurar la confiabilidad y seguridad del producto; aspectos definidos, en una investigación previa de mercados con la cual se determina la viabilidad del proyecto. El mercado potencial se analizó bajo el marco de referencia de la base datos de la cámara de comercio, donde se tiene en cuenta las localidades de: Mártires, Engativá y Suba; los cuales fueron predeterminados como principales consumidores del producto, la población encuestada es de 94 establecimientos que distribuyen el producto. Se tiene en cuenta PYMES, para buscar la mayor representatividad posible y segmentar el mercado de la manera más acertada. En el estudio de mercado se analiza y se determina a través de la investigación de fuentes primarias (encuestas), que la producción principal es zuncho plástico calibre 3 por 500 metros, seguido del calibre 4 por 1000 metros. Con la investigación de mercado realizada se determina que hay gran potencial de clientes, facilidad de adquisición de materia prima, las necesidades de los distribuidores para brindar un producto excelente y condiciones de calidad óptimas para la satisfacción del cliente teniendo en cuenta el bajo costo

La investigación formativa contable en universidades de Tunja

In the years 2010 to 2015, a study on formative research in public accounting programs of higher education institutions in the city of Tunja, Colombia, was made. The research assumes the qualitative and descriptive approach. The results show that the training of public accountants in Tunja, is framed in areas such as auditing, finances, taxation, international financial reporting standards and costs. The predominant tendencies are auditing and finance, reflecting the articulation with the global economic policies that over time have led the way within the construction of curriculum, guaranteeing updated and quality training processes. In the same way, the research process represents a low percentage in relation to the other options to choose a professional degree, such as internships and specialization or master's courses related to the field of study. In conclusion, there is still a long way to go in the field of formative accounting research, so that proposals are generated to strengthen its praxis in the area of influence of the universities.Se presenta un estudio sobre la investigación formativa en los programas de Contaduría Pública, de las Instituciones de Educación superior de la ciudad de Tunja, Colombia, en el periodo 2010 a 2015. La investigación asume el enfoque cualitativo, de tipo descriptivo. Los resultados develan que la formación de los Contadores Públicos en Tunja, se encuentra enmarcada en áreas como: Auditoría, Finanzas, Tributaria, Normas Internacionales de Información Financiera, y Costos. Las tendencias predominantes son auditoría y finanzas, reflejando la articulación con las políticas económicas globales que con el tiempo han marcado la pauta dentro de la construcción de mallas curriculares, garantizando procesos formativos actualizados y de calidad. Asimismo, el proceso investigativo representa un porcentaje bajo en relación con las demás opciones para optar al título profesional, como son: pasantías y cursos en un programa de especialización o maestría, afines al campo de formación. Se concluye que queda un largo trayecto por recorrer en el ámbito de la investigación formativa contable, de modo que se generen propuestas para fortalecer su praxis en el área de influencia de las Universidades

Creación de Empresa "Soluciones en Logistica y Embalajes S.A.S"

162 p. // 15 -29 : 0016Este proyecto constituye la elaboración de un plan de negocios para la producción y comercialización de zuncho plástico, para empresas dedicadas a la distribución en Bogotá. Se centra en brindar a los clientes la posibilidad de crear una ficha técnica para asegurar la confiabilidad y seguridad del producto; aspectos definidos, en una investigación previa de mercados con la cual se determina la viabilidad del proyecto. El mercado potencial se analizó bajo el marco de referencia de la base datos de la cámara de comercio, donde se tiene en cuenta las localidades de: Mártires, Engativá y Suba; los cuales fueron predeterminados como principales consumidores del producto, la población encuestada es de 94 establecimientos que distribuyen el producto. Se tiene en cuenta PYMES, para buscar la mayor representatividad posible y segmentar el mercado de la manera más acertada. En el estudio de mercado se analiza y se determina a través de la investigación de fuentes primarias (encuestas), que la producción principal es zuncho plástico calibre 3 por 500 metros, seguido del calibre 4 por 1000 metros. Con la investigación de mercado realizada se determina que hay gran potencial de clientes, facilidad de adquisición de materia prima, las necesidades de los distribuidores para brindar un producto excelente y condiciones de calidad óptimas para la satisfacción del cliente teniendo en cuenta el bajo costo