Mejoramiento en la prestación de los servicios de seguridad ciudadana por parte de la Municipalidad Provincial del Cusco

La oportunidad de mejora continua, debe ser la primera opción que todo gestor público debe optar. Así, en un sinfín de procesos administrativos por modernizar en nuestras localidades, la materialización de iniciativas públicas, surgidas desde la academia, que destraben el desarrollo de espacios ciudadanos comunes, deben ser prioritarios. Corresponde a los gobiernos locales, como función específica y exclusiva, organizar y gestionar el servicio de seguridad ciudadana, ello está dispuesto en la Ley Orgánica de Municipalidades, Ley No 27972 y la Ley del Sistema Nacional de Seguridad Ciudadana, Ley N° 27933. De este modo, este trabajo presenta una propuesta de agilizar, profesionalizar y modernizar la provisión del servicio de seguridad ciudadana, que está a cargo de la Municipalidad Provincial del Cusco. Para responder a la necesidad de solucionar una inadecuada prestación del servicio de seguridad pública en el gobierno provincial del Cusco, proponemos, principalmente dos objetivos, el primero que llevará per se, a mejorar el proceso de selección de los recursos humanos, que estará a cargo de la provisión del servicio de seguridad ciudadana y el segundo, fortalecerá la articulación del trabajo conjunto, que desarrollará el personal de seguridad ciudadana, junto a la Policía Nacional del Perú. La principal motivación que encontramos al proponer este modelo de prestación de servicio, en favor de los ciudadanos, radica en las personas que actualmente vienen laborando en la Subgerencia de Seguridad Ciudadana y Servicios Municipales, pues cuentan con experiencia en la materia y tienen conocimiento de la localidad. Por ello, uno de nuestros planteamientos es que sea el actual personal el que, luego de un proceso de asistencia técnica y capacitación, estén calificados para asumir la nueva configuración del servicio de seguridad ciudadana. Dentro de la estrategia del presupuesto por resultados, se ha diseñado el Programa Presupuestal 030: “Reducción de delitos y faltas que afectan a la seguridad ciudadana”, programa presupuestal que ha previsto acciones y lineamientos que de manera integral y articulada, buscan dar soluciones a los problemas de la inseguridad ciudadana, siendo una unidad de programación presupuestaria, permite a los municipios, disponer y orientar recursos, para que los servicios de seguridad ciudadana, tengan efectos favorables a favor de los ciudadanos, en la respectiva jurisdicción del gobierno local. Por lo tanto, es importante la modernización del enfoque de trabajo, respecto a la labor municipal en materia de seguridad ciudadana, pues de materializar esta propuesta, será la responsable de actualizar y profesionalizar al personal que labora día a día en la seguridad de las personas. Por último, es importante señalar que el presente trabajo cuenta con viabilidad política, técnica, social, presupuestal y operativa, pues el abordaje de seguridad ciudadana es una prioridad para el país, expresada en la Visión del País al 2050. Así mismo, la Ley del Sistema Nacional de Seguridad Ciudadana (No 27933) busca garantizar el irrestricto uso de las libertades y derechos de las personas para garantizar su tranquilidad, seguridad y paz de los ciudadanos en el territorio nacional

Relative leg length as a biological marker to trace the developmental history of individuals and populations: Growth delay and increased body fat

The purpose of this study was to determine whether differences in leg length index are related to differences in body fat. The study included a cross-sectional sample of 21,021 subjects ranging in age from 2 to 90 years who had anthropometric information and poverty income ratio that participated in the third National Health and Nutrition Survey (NHANES III) of the United Stated conducted during 1988–1994. Of the total 21,021 participants, 7,810 were non-Hispanic white (3,900 men and 3,910, women), 8,134 were African-American black (3,127 men and 2,889 women) and 6,237 were Mexican-American (3,221 and 3,016 women). In both males and females and in all three ethnic groups and across socio-economic status (measured by the poverty income ratio) a low leg length index is associated with increased body fat (measured by skinfold thickness) when compared with those with high leg length index. It is postulated that a low leg length index reflects the consequence of negative environmental conditions leading to growth delay. Previous studies indicate that individuals exposed both during development and adulthood to under-nutrition respond through inter-related physiological mechanisms oriented at improving energetic efficiency and low oxidation of fat. These interrelated compensatory physiological adjustments work together to promote fat storage among growth delayed individuals or populations. Am. J. Hum. Biol., 2007. © 2007 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56145/1/20676_ftp.pd

Lactate Regulates Metabolic and Proinflammatory Circuits in Control of T Cell Migration and Effector Functions

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Applying refinement to the use of mice and rats in rheumatoid arthritis research

Rheumatoid arthritis (RA) is a painful, chronic disorder and there is currently an unmet need for effective therapies that will benefit a wide range of patients. The research and development process for therapies and treatments currently involves in vivo studies, which have the potential to cause discomfort, pain or distress. This Working Group report focuses on identifying causes of suffering within commonly used mouse and rat ‘models’ of RA, describing practical refinements to help reduce suffering and improve welfare without compromising the scientific objectives. The report also discusses other, relevant topics including identifying and minimising sources of variation within in vivo RA studies, the potential to provide pain relief including analgesia, welfare assessment, humane endpoints, reporting standards and the potential to replace animals in RA research

Intravenous fluid bolus rates associated with outcomes in pediatric sepsis: A multi-center analysis

Purpose: Pediatric sepsis guidelines recommend rapid intravenous fluid (IVF) bolus administration rates (BAR). Recent sepsis studies suggest that rapid BAR may be associated with increased morbidity. We aimed to describe the association between emergency department (ED) IVF BAR and clinical outcomes in pediatric sepsis. Patients and methods: Secondary post-hoc analysis of retrospective cohort data from 19 hospitals in the Pediatric Septic Shock Collaborative (PSSC) database. Patients with presumed septic shock were defined by severe sepsis/septic shock diagnostic codes, receipt of septic shock therapies, or floor-to-ICU transfers within 12 hours from ED admission for septic shock. Patients (2 months-21 years) with complete data on weight, antibiotic receipt, bolus timing, and bolus volumes were included. The primary outcome was 30-day mortality. Associations between BAR and mortality and secondary (intubation or non-invasive positive pressure ventilation = NIPPV) outcomes were assessed using unadjusted and adjusted logistic regression. Results: The PSSC database included 6731 patients; 3969 met inclusion and received a median ED volume of 40.2 mL/kg. Seventy-six (1.9%) patients died, 151 (3.8%) were intubated, and 235 (5.9%) had NIPPV administered. The median BAR was 25.7 mL/kg/hr. For each 20 mL/kg/hr increase in BAR, the adjusted odds ratio (aOR) for 30-day mortality [aOR = 1.11 (95% CI 1.01, 1.23)], intubation [aOR = 1.25 (95% CI 1.09, 1.44)], and NIPPV [aOR = 1.20 (95% CI 1.05, 1.38)] significantly increased. Conclusion: Faster ED IVF bolus administration rates in this pediatric sepsis database were associated with higher adjusted odds of death, intubation and NIPPV. Controlled trials are needed to determine if these associations are replicable

Pediatric septic shock collaborative improves emergency department sepsis care in children

Objectives: The pediatric emergency department (ED)-based Pediatric Septic Shock Collaborative (PSSC) aimed to improve mortality and key care processes among children with presumed septic shock. Methods: This was a multicenter learning and improvement collaborative of 19 pediatric EDs from November 2013 to May 2016 with shared screening and patient identification recommendations, bundles of care, and educational materials. Process metrics included minutes to initial vital sign assessment and to first and third fluid bolus and antibiotic administration. Outcomes included 3- and 30-day all-cause in-hospital mortality, hospital and ICU lengths of stay, hours on increased ventilation (including new and increases from chronic baseline in invasive and noninvasive ventilation), and hours on vasoactive agent support. Analysis used statistical process control charts and included both the overall sample and an ICU subgroup. Results: Process improvements were noted in timely vital sign assessment and receipt of antibiotics in the overall group. Timely first bolus and antibiotics improved in the ICU subgroup. There was a decrease in 30-day all-cause in-hospital mortality in the overall sample. Conclusions: A multicenter pediatric ED improvement collaborative showed improvement in key processes for early sepsis management and demonstrated that a bundled quality impr