Structural Capital Management: A Guide For Indicators

Intellectual Capital is of vital importance, both for the scientific community and business reality. For this reason, over the past decades its relevance has rapidly increased. Within Intellectual Capital (from here on IC), Structural Capital (from here on, SC) plays an outstanding paper, given that is represents the part of knowledge that the organization is able to explicit, systematize and internalize and that, initially, is latent in employees or teams. This type of capital allows for organizational effectiveness improvement through the transmission of knowledge.The objectives of this paper is, first, to identify the elements of IC that help to guarantee the success of companies belonging to a given sector, paying special attention to the contributions of SC to IC. Second, and after observing that most existing papers are centered only on the measurement of SC and, therefore, leave aside elements regarding its management, our proposal fills this gap and includes various general indicators for SC that may help to manage it adequately. The basic aim is to allow managers themselves to choose the most adequate indicators within those presented, taking into account, of course, characteristics, objectives and strategies of the companies they manage

Factores que complican la nutrición en pacientes embarazadas que asisten al centro de salud Lucrecia Lindo sector # 1 del municipio de san Ramón, del departamento de Matagalpa en el II semestre del año 2016

Según MINSA (Ministerio de Salud). La nutrición es un proceso biológico mediante el cual, el cuerpo recibe y utiliza de forma equilibrada energía y nutrientes de los alimentos que se consumen cada día, permite que nuestro organismo funcione adecuadamente para crecer, trabajar y desarrollarse plenamente. Durante la gestación se produce un gasto metabólico; por ello la dieta debe aportar proteínas, vitaminas y minerales, elementos esenciales para que él bebe crezca adecuadamente. La deficiencia de estos nutrientes puede llevar a la obesidad o desnutrición; siendo como tales un problema grave, que se puede complicar, y a consecuencia su hijo tiene riesgo de morir o de presentar alteraciones. El presente trabajo está basado en los factores que complican la nutrición en pacientes embarazadas que asisten al centro de salud Lucrecia Lindo del municipio de San Ramón. Evaluar la calidad de la medida de datos antropométricos según las normas del programa, para comprobar si se cumplen en los servicios de salud. Estandarizar planes de cuidados según las necesidades nutricionales de la paciente en estudio. El universo lo constituyeron 21 gestantes de las cuales tomamos un grupo conformado por 11 pacientes embarazadas, para esta selección se aplicó un muestreo no probabilístico a conveniencia. Se elaboró un instrumento (encuestas) que consto de 16 ítems dividido de acuerdo a los objetivos de investigación. Se Identificaron que los factores que complican la nutrición en las embarazadas son: factor económico, factor biológico, factor social, factor cultural, también se evaluó la calidad en la toma de datos antropométricos según normas y protocolos, con un resultado no satisfactorio. Se estandarizaron planes de cuidados según las necesidades nutricionales de las pacientes en estudio basándose en el modelo de Virginia Henderso

Televisión digital en 2010: El reto de la interoperabilidad

En este artículo se plantea la situación actual de despliegue de la televisión digital en España desde el punto de vista de la necesaria interoperabilidad que debe haber entre los eslabones de la cadena de valor en un mercado horizontal, con especial atención, por una parte, a la navegación y la presentación de la información de programación y, por otra, a la accesibilidad de las personas con discapacidad. Los patentes problemas de interoperabilidad existentes se han producido a pesar de la existencia de un completo conjunto de disposiciones legales y normas técnicas, lo que sugiere la necesidad además de laboratorios de interoperabilidad que supongan un punto de encuentro entre los actores del sector, con el apoyo de las administraciones públicas (Utray 2009: 211‐225

Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study

Cardiac imaging; Myocardial injury; Noncardiac surgeryImatge cardíaca; Lesió del miocardi; Cirurgia no cardíacaImagen cardiaca; Lesión miocárdica; Cirugía no cardiacaBackground Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention. Methods Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48–72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality. Results We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%). Conclusion This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, obtained in a pilot study, suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes.The study has been supported by research grant from the Instituto de Salud Carlos III, Spain (PI16/01162), partly funded by Fondo Europeo de Desarrollo Regional (FEDER), Unión Europea, “Una manera de hacer Europa” to Ekaterine Popova, by Generalitat de Catalunya (PERIS SLT017/20/000089) to Ekaterine Popova and by a "Marato de TV3" grant (20150110) to Pablo Alonso-Coello

Incremental prognostic value of lung ultrasound on contemporary heart failure risk scores

Introduction: Over the last decades, several scores have been developed to aid clinicians in assessing prognosis in patients with heart failure (HF) based on clinical data, medications and, ultimately, biomarkers. Lung ultrasound (LUS) has emerged as a promising prognostic tool for patients when assessed at discharge after a HF hospitalization. We hypothesized that contemporary HF risk scores can be improved upon by the inclusion of the number of B-lines detected by LUS at discharge to predict death, urgent visit, or HF readmission at 6- month follow-up. Methods: We evaluated the discrimination improvement of adding the number of B-lines to 4 contemporary HF risk scores (Get with the Guidelines -GWTG-, MAGGIC, Redin-SCORE, and BCN Bio-HF) by comparing the change in the area under the receiver operating curve (AUC), the net reclassification index (NRI), and the integrated discrimination improvement (IDI). The population of the study was constituted by the 123 patients enrolled in the LUS-HF trial, adjusting the analyses by the intervention. Results: The AUC of the GWTG score increased from 0.682 to 0.789 (p = 0.02), resulting in a NRI of 0.608 and an IDI of 0.136 (p < 0.05). Similar results were observed when adding the number of B-lines to the MAGGIC score, with an AUC that increased from 0.705 to 0.787 (p < 0.05). This increase translated into a NRI of 0.608 and an IDI of 0.038 (p < 0.05). Regarding Redin-SCORE at 1-month and 1-year, the AUC increased from 0.714 to 0.773 and from 0.681 to 0.757, although it did not reach statistical significance (p = 0.08 and p = 0.06 respectively). Both IDI and NRI were significantly improved (0.093 and 0.509 in the 1-month score, p < 0.05; 0.056 and 0.111 in the 1-year score, p < 0.05). Lastly, the AUC for the BCN Bio-HF score increased from 0.733 to 0.772, which was statistically non-significant, with a NRI value of 0.363 (p = 0.06) and an IDI of 0.092 (p < 0.05). Conclusion: Adding the results of LUS evaluated at discharge improved the predictive value of most of the contemporary HF risk scores. As it is a simple, fast, and non-invasive test it may be recommended to assess prognosis at discharge in HF patients

Time course, factors related to, and prognostic impact of venoarterial extracorporeal membrane flow in cardiogenic shock

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is currently one of the most used devices in refractory cardiogenic shock. However, there is a lack of evidence on how to set the 'optimal' flow. We aimed to describe the evolution of VA-ECMO flows in a cardiogenic shock population and determine the risk factors of 'high-ECMO flow'. A 7 year database of patients supported with VA-ECMO was used. Based on the median flow during the first 48 h of the VA-ECMO run, patients were classified as 'high-flow' or 'low-flow', respectively, when median ECMO flow was ≥3.6 or <3.6 L/min. Outcomes included rates of ventilator-associated pneumonia, ECMO-related complications, days on ECMO, days on mechanical ventilation, intensive care unit and hospitalization lengths of stay, and in-hospital and 60 day mortality. Risk factors of high-ECMO flow were assessed using univariate and multivariate cox regression. The study population included 209 patients on VA-ECMO, median age was 51 (40-59) years, and 78% were males. The most frequent aetiology leading to cardiogenic shock was end-stage dilated cardiomyopathy (57%), followed by acute myocardial infarction (23%) and fulminant myocarditis (17%). Among the 209 patients, 105 (50%) were classified as 'high-flow'. This group had a higher rate of ischaemic aetiology (16% vs. 30%, P = 0.023) and was sicker at admission, in terms of worse Simplified Acute Physiology Score II score [40 (26-58) vs. 56 (42-74), P < 0.001], higher lactate [3.6 (2.2-5.8) mmol/L vs. 5.2 (3-9.7) mmol/L, P < 0.001], and higher aspartate aminotransferase [97 (41-375) U/L vs. 309 (85-939) U/L, P < 0.001], among others. The 'low-flow' group had less ventilator-associated pneumonia (40% vs. 59%, P = 0.007) and less days on mechanical ventilation [4 (1.5-7.5) vs. 6 (3-12) days, P = 0.009]. No differences were found in lengths of stay or survival according to the ECMO flow. The multivariate analysis showed that risk factors independently associated with 'high-flow' were mechanical ventilation at cannulation [odds ratio (OR) 3.9, 95% confidence interval (CI) 2.1-7.1] and pre-ECMO lactate (OR 1.1, 95% CI 1.0-1.2). In patients with refractory cardiogenic shock supported with VA-ECMO, sicker patients had higher support since early phases, presenting thereafter higher rates of ventilator-associated pneumonia but similar survival compared with patients with lower flows

HERMES-TDT: Herramientas de monitorización y control de servicios de accesibilidad para la TDT

Los servicios de accesibilidad a la televisión digital constituyen un medio para acceder al audio o vídeo de los programas de TV y son necesarios para un número creciente de personas

Los microorganismos que habitan los bañados de desborde fluvial como indicadores de los efectos de la urbanización y la actividad agropecuaria

Riverine wetlands play an integral role in the ecology of river basins and their self-purification capacity. The anthropic demand for space and water jeopardizes its biota and the ecosystem benefits they provide. The objectives of this work were to analyze the assemblages of microorganisms that inhabit riverine wetlands, relate their variations to anthropogenic impact and evaluate how the microbiota can be an indicator of these environmental changes. The assemblages of benthic diatoms, phytoplankton, zooplankton, ostracods and fungi of four riverine wetlands were studied: two of peri-urban location with agricultural and horticultural land use (Del Gato and Carnaval), and two of rural location and livestock land use (Cajaravillas and Chubichaminí). In most of the groups the differences in relation to geographical location were clearly expressed, resulting in two kind of assemblages: rural (with more species sensitive to pollution and eutrophication) and peri-urban (with more species highly tolerant to pollution and eutrophication). In the latter, both the participation of the main taxonomic groups and the trophic levels were more restricted and related to the detritivorous path over the photosynthetic one, and the strategies to face water stress were emphasized. The results show the effects of human pressure, the importance that microorganisms acquire and the need of adequate use of the territory plans to avoid the loss of functions and benefits of these environments.Los bañados de desborde fluvial (BDF) desempeñan un papel integral en la ecología de las cuencas fluviales y en su capacidad de autodepuración. La demanda antrópica de espacio y agua pone en riesgo su biota y los beneficios ecosistémicos que brindan. Los objetivos del trabajo fueron analizar los ensambles de microorganismos que habitan en BDF, relacionar sus variaciones al impacto antrópico y evaluar cómo la microbiota puede ser indicadora de estos cambios ambientales. Se estudiaron los ensambles de diatomeas bentónicas, fitoplancton, zooplancton, ostrácodos y hongos de cuatro BDF: dos de ubicación periurbana con uso del suelo agrícola y hortícola (Del Gato y Carnaval), y dos de ubicación rural y uso ganadero (Cajaravillas y Chubichaminí). En la mayoría de los grupos las diferencias vinculadas a la ubicación geográfica se expresaron claramente, resultando en una agrupación de ensambles en: BDF rurales (con un número de especies sensibles a la contaminación y a la eutrofización comparativamente mayor) y BDF periurbanos (donde fueron más importantes las especies muy tolerantes a la contaminación y a la eutrofización). En estos últimos, tanto la participación de los grandes grupos taxonómicos como los niveles tróficos estuvieron más restringidos y relacionados a la vía detritívora por sobre la fotosintética, y allí también se acentuaron las estrategias para afrontar el estrés hídrico. Los resultados evidencian los efectos de la presión humana, la importancia que adquieren los microorganismos y la necesidad de una planificación adecuada del uso del territorio para evitar la pérdida de funciones y beneficios en estos ambientes

Radiation therapy with curative intention in men with de novo metastatic prostate carcinoma: shoot ‘em all!

BACKGROUND: About 5% of prostate cancer cases are metastatic at diagnoses. Radiotherapy of both primary tumor and secondary lesions can be, in addition to systemic treatments, a radical alternative for selected patients. MATERIALS AND METHODS: Patients with de novo prostate carcinoma with bone or lymph node metastases were retrospectively reviewed. All patients received moderate hypofractionated IMRT/VMAT up to 63 Gy in 21 daily fractions of 3 Gy to prostate and metastases with neoadjuvant and concurrent androgen deprivation therapy (ADT). According to known advances some patients also received abiraterone, enzalutamide, or docetaxel. RESULTS: Between 2015–2020, we attended 26 prostate cancer patients (median age 69.5 years, range 52–84) with simultaneous oligometastases [mean 2.1 metastases, median 1.5 metastases (range 1–6)]. Eighteen patients (69%) presented lymph node metastases, 4 (15.5%) bone metastases and 4 (15.5%) both lymph node and bone metastases. With a median follow-up of 15.5 months (range 3–65 months), 16 patients (62%) are alive and tumor free while 10 (38%) are alive with tumor. Four patients (17%) developed tumor progression, out of irradiated area in all cases, with a median time to progression of 43.5 months (range 27–56 months). Actuarial progression-free survival (PFS) rates at 12 and 24 months were 94.1% and 84.7%, respectively. No grade &gt; 2 acute or late complications were recorded. CONCLUSIONS: Simultaneous directed radical hypofractionated radiation therapy for prostate and metastases is feasible, well tolerated and achieves an acceptable PFS rate. However, further studies with longer follow-up are necessary to definitively address these observations