24 research outputs found
Propuesta de un plan de mejora para el clima organizacional de la empresa AGESO S.A.S. ubicada en la ciudad de CĂșcuta â Norte de Santander
AGESOS SAS es una empresa prestadora de servicios IPS la cual brinda asesorĂas de gerencia, educaciĂłn y salud para los colaboradores la cual cuenta con una trayectoria de 24 años en el mercado. Esta empresa en la actualidad ha presentado problemas dentro de su clima organizacional. debido a la mala organizaciĂłn y el poco reconocimiento que la empresa le brinda a sus colaboradores y es que se logra observar que la empresa no ha establecido con claridad los puestos de trabajo y las funciones correspondiente a cada uno de estos, generando demoras en el cumplimiento de las actividades y aumentando la carga laboral, lo que a su vez supone un sobrecargo en los horarios de los colaboradores los cuales se ven obligados seguir trabajando fuera de sus horarios correspondientes, provocando que estos se sientan inconformes y poco valorados.
Esta situaciĂłn ha sido sumamente preocupante debido a que en caso de que no se haga nada al respecto lo organizaciĂłn podrĂa entrar en un estado de alerta, por lo tanto, durante el desarrollo de este proyecto se busca realizar un anĂĄlisis de la empresa mediante la utilizaciĂłn de mĂ©todos de recolecciĂłn de informaciĂłn como fuentes de informaciĂłn primaria y la aplicaciĂłn de encuestas, esto permitirĂĄ diseñar una serie de recomendaciones que la empresa podrĂa implementar con el fin de mitigar de forma significativa los problemas que esta presenta.AGESOS SAS is a company that provides IPS services which provides management, education, and health consultancies for employees, which has a 24-year history in the market.
This company has currently presented problems within its organizational climate. Due to the poor organization and little recognition that the company gives its collaborators, it is possible to observe that the company has not clearly established the jobs and the functions corresponding to each of these, generating delays in compliance. of the activities and increasing the workload, which in turn supposes an overload in the schedules of the collaborators who are forced to continue working outside their corresponding hours, causing them to feel dissatisfied and undervalued.
This situation has been extremely worrying because if nothing is done about it, the organization could go into a state of alert, therefore, during the development of this project, an analysis of the company is sought by using of information collection methods such as primary information sources and the application of surveys, this will allow the design of a series of recommendations that the company could implement in order to significantly mitigate the problems that it presents
Canagliflozin and renal outcomes in type 2 diabetes and nephropathy
BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodiumâglucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with reninâangiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years
Global Retinoblastoma Presentation and Analysis by National Income Level.
Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (nâ=â3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (nâ=â2638 [62.8%]), followed by strabismus (nâ=â429 [10.2%]) and proptosis (nâ=â309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs
Sensitivity of South American tropical forests to an extreme climate anomaly
The tropical forest carbon sink is known to be drought sensitive, but it is unclear which forests are the most vulnerable to extreme events. Forests with hotter and drier baseline conditions may be protected by prior adaptation, or more vulnerable because they operate closer to physiological limits. Here we report that forests in drier South American climates experienced the greatest impacts of the 2015â2016 El Niño, indicating greater vulnerability to extreme temperatures and drought. The long-term, ground-measured tree-by-tree responses of 123 forest plots across tropical South America show that the biomass carbon sink ceased during the event with carbon balance becoming indistinguishable from zero (â0.02 ± 0.37 Mg C ha â1 per year). However, intact tropical South American forests overall were no more sensitive to the extreme 2015â2016 El Niño than to previous less intense events, remaining a key defence against climate change as long as they are protected
The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries
DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0â36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8â100·0) for children from high-income countries, 91·2% (89·5â93·0) for children from upper-middle-income countries, 80·3% (78·3â82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76â50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44â18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23â1·56). For children aged 3â7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt
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 Hirschsprungâs 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 Hirschsprungâs 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 36â39) and median bodyweight at presentation was 2·8 kg (2·3â3·3).
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;
pâ€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 1·88â4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59â2·79], p<0·0001), sepsis at presentation (1·20
[1·04â1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4â5 vs ASA 1â2, 1·82 [1·40â2·35], p<0·0001; ASA 3 vs ASA 1â2, 1·58, [1·30â1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02â1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41â2·71], p=0·0001; parenteral nutrition 1·35, [1·05â1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47â0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50â0·86], p=0·0024) or percutaneous central line (0·69 [0·48â1·00], 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
Sensitivity of South American tropical forests to an extreme climate anomaly
NERC Knowledge Exchange Fellowship (NE/V018760/1) to E.N.H.C.The tropical forest carbon sink is known to be drought sensitive, but it is unclear which forests are the most vulnerable to extreme events. Forests with hotter and drier baseline conditions may be protected by prior adaptation, or more vulnerable because they operate closer to physiological limits. Here we report that forests in drier South American climates experienced the greatest impacts of the 2015â2016 El Niño, indicating greater vulnerability to extreme temperatures and drought. The long-term, ground-measured tree-by-tree responses of 123 forest plots across tropical South America show that the biomass carbon sink ceased during the event with carbon balance becoming indistinguishable from zero (â0.02 ± 0.37 Mg C haâ1 per year). However, intact tropical South American forests overall were no more sensitive to the extreme 2015â2016 El Niño than to previous less intense events, remaining a key defence against climate change as long as they are protected.Publisher PDFPeer reviewe
Recommended from our members
Sensitivity of South American tropical forests to an extreme climate anomaly
Funder: A Moore Foundation grant, Royal Society Global Challenges grant (Sensitivity of Tropical Forest Ecosystem Services to Climate Changes), CNPq grants (441282/2016-4, 403764/2012-2 and 558244/2009-2), FAPEAM grants 1600/2006, 465/2010 and PPFOR 147/2015, CNPq grants 473308/2009-6 and 558320/2009-0. European Research Council (ERC Advanced Grant 291585 â âT-FORCESâ), the Gordon and Betty Moore Foundation (#1656 âRAINFORâ, and âMonANPeruâ), the European Unionâs Fifth, Sixth and Seventh Framework Programme (EVK2-CT-1999-00023 â âCARBONSINK-LBAâ, 283080 â âGEOCARBONâ, 282664 â âAMAZALERT), the Natural Environment Research Council (NE/ D005590/1 â âTROBITâ, NE/F005806/1 â âAMAZONICAâ, E/M0022021/1 - âPPFORâ), several NERC Urgency and New Investigators Grants, the NERC/State of SĂŁo Paulo Research Foundation (FAPESP) consortium grants âBIO-REDâ (NE/N012542/1), âECOFORâ (NE/K016431/1, 2012/51872-5, 2012/51509-8), âARBOLESâ (NE/S011811/1, FAPESP 2018/15001-6), âSEOSAWâ (NE/P008755/1), âSECOâ (NE/T01279X/1), Brazilian National Research Council (PELD/CNPq 403710/2012-0), the Royal Society (University Research Fellowships and Global challenges Awards) (ICA/R1/180100 - âFORAMAâ), the National Geographic Society, US National Science Foundation (DEB 1754647) and Colombiaâs Colciencias. We thank the National Council for Science and Technology Development of Brazil (CNPq) for support to the Cerrado/Amazonia Transition Long-Term Ecology Project (PELD/441244/2016-5), the PPBio Phytogeography of Amazonia/Cerrado Transition Project (CNPq/PPBio/457602/2012-0), PELD-RAS (CNPq, Process 441659/2016-0), RESFLORA (Process 420254/2018-8), Synergize (Process 442354/2019-3), the Empresa Brasileira de Pesquisa AgropecuĂĄria â Embrapa (SEG: 02.08.06.005.00), the Fundação de Amparo Ă Pesquisa do Estado de SĂŁo Paulo â FAPESP (2012/51509-8 and 2012/51872-5), the GoiĂĄs Research Foundation (FAPEG/PELD: 2017/10267000329) the EcoSpace Project (CNPq 459941/2014-3) and several PVE and Productivity Grants. We also thank the âInvestissement dâAvenirâ program (CEBA, ref. ANR-10LABX-25-01), the SĂŁo Paulo Research Foundation (FAPESP 03/12595-7) and the Sustainable Landscapes Brazil Project (through Brazilian Agricultural Research Corporation (EMBRAPA), the US Forest Service, USAID, and the US Department of State) for supporting plot inventories in the Atlantic Forest sites in Sao Paulo, Brazil. L.E.O.C.A. was supported by CNPq (processes 305054/2016-3 and 442371/2019-5). We thank to the National Council for Technological and Scientific Development (CNPq) for the financial support of the PELD project (441244/2016-5, 441572/2020-0) and FAPEMAT (0346321/2021). NE/B503384/1, NE/N012542/1 - âBIO-REDâ, ERC Advanced Grant 291585 - âT-FORCESâ, NE/F005806/1 - âAMAZONICAâ, NE/N004655/1 - âTREMORâ, NERC New Investigators Awards, the Gordon and Betty Moore Foundation (âRAINFORâ, âMonANPeruâ), ERC Starter Grant 758873 -âTreeMortâ, EU Framework 6, a Royal Society University Research Fellowship, and a Leverhulme Trust Research Fellowship.The tropical forest carbon sink is known to be drought sensitive, but it is unclear which forests are the most vulnerable to extreme events. Forests with hotter and drier baseline conditions may be protected by prior adaptation, or more vulnerable because they operate closer to physiological limits. Here we report that forests in drier South American climates experienced the greatest impacts of the 2015â2016 El Niño, indicating greater vulnerability to extreme temperatures and drought. The long-term, ground-measured tree-by-tree responses of 123 forest plots across tropical South America show that the biomass carbon sink ceased during the event with carbon balance becoming indistinguishable from zero (â0.02 ± 0.37 Mg C haâ1 per year). However, intact tropical South American forests overall were no more sensitive to the extreme 2015â2016 El Niño than to previous less intense events, remaining a key defence against climate change as long as they are protected
Recommended from our members
Sensitivity of South American tropical forests to an extreme climate anomaly
Funder: A Moore Foundation grant, Royal Society Global Challenges grant (Sensitivity of Tropical Forest Ecosystem Services to Climate Changes), CNPq grants (441282/2016-4, 403764/2012-2 and 558244/2009-2), FAPEAM grants 1600/2006, 465/2010 and PPFOR 147/2015, CNPq grants 473308/2009-6 and 558320/2009-0. European Research Council (ERC Advanced Grant 291585 - 'T-FORCES'), the Gordon and Betty Moore Foundation (#1656 'RAINFOR', and 'MonANPeru'), the European Union's Fifth, Sixth and Seventh Framework Programme (EVK2-CT-1999-00023 - 'CARBONSINK-LBA', 283080 - 'GEOCARBON', 282664 - 'AMAZALERT), the Natural Environment Research Council (NE/ D005590/1 - 'TROBIT', NE/F005806/1 - 'AMAZONICA', E/M0022021/1 - 'PPFOR'), several NERC Urgency and New Investigators Grants, the NERC/State of Sao Paulo Research Foundation (FAPESP) consortium grants 'BIO-RED' (NE/N012542/1), 'ECOFOR' (NE/K016431/1, 2012/51872-5, 2012/51509-8), 'ARBOLES' (NE/S011811/1, FAPESP 2018/15001-6), 'SEOSAW' (NE/P008755/1), 'SECO' (NE/T01279X/1), Brazilian National Research Council (PELD/CNPq 403710/2012-0), the Royal Society (University Research Fellowships and Global challenges Awards) (ICA/R1/180100 - 'FORAMA'), the National Geographic Society, US National Science Foundation (DEB 1754647) and Colombia's Colciencias. We thank the National Council for Science and Technology Development of Brazil (CNPq) for support to the Cerrado/Amazonia Transition Long-Term Ecology Project (PELD/441244/2016-5), the PPBio Phytogeography of Amazonia/Cerrado Transition Project (CNPq/PPBio/457602/2012-0), PELD-RAS (CNPq, Process 441659/2016-0), RESFLORA (Process 420254/2018-8), Synergize (Process 442354/2019-3), the Empresa Brasileira de Pesquisa Agropecuaria - Embrapa (SEG: 02.08.06.005.00), the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - FAPESP (2012/51509-8 and 2012/51872-5), the Goias Research Foundation (FAPEG/PELD: 2017/10267000329) the EcoSpace Project (CNPq 459941/2014-3) and several PVE and Productivity Grants. We also thank the "Investissement d'Avenir" program (CEBA, ref. ANR-10LABX-25-01), the Sao Paulo Research Foundation (FAPESP 03/12595-7) and the Sustainable Landscapes Brazil Project (through Brazilian Agricultural Research Corporation (EMBRAPA), the US Forest Service, USAID, and the US Department of State) for supporting plot inventories in the Atlantic Forest sites in Sao Paulo, Brazil. L.E.O.C.A. was supported by CNPq (processes 305054/2016-3 and 442371/2019-5). We thank to the National Council for Technological and Scientific Development (CNPq) for the financial support of the PELD project (441244/2016-5, 441572/2020-0) and FAPEMAT (0346321/2021). NE/B503384/1, NE/N012542/1 - 'BIO-RED', ERC Advanced Grant 291585 - 'T-FORCES', NE/F005806/1 - 'AMAZONICA', NE/N004655/1 - 'TREMOR', NERC New Investigators Awards, the Gordon and Betty Moore Foundation ('RAINFOR', 'MonANPeru'), ERC Starter Grant 758873 -'TreeMort', EU Framework 6, a Royal Society University Research Fellowship, and a Leverhulme Trust Research Fellowship.AbstractThe tropical forest carbon sink is known to be drought sensitive, but it is unclear which forests are the most vulnerable to extreme events. Forests with hotter and drier baseline conditions may be protected by prior adaptation, or more vulnerable because they operate closer to physiological limits. Here we report that forests in drier South American climates experienced the greatest impacts of the 2015â2016 El Niño, indicating greater vulnerability to extreme temperatures and drought. The long-term, ground-measured tree-by-tree responses of 123 forest plots across tropical South America show that the biomass carbon sink ceased during the event with carbon balance becoming indistinguishable from zero (â0.02â±â0.37âMgâCâhaâ1 per year). However, intact tropical South American forests overall were no more sensitive to the extreme 2015â2016 El Niño than to previous less intense events, remaining a key defence against climate change as long as they are protected.</jats:p
Infective Endocarditis in Patients on Chronic Hemodialysis
International audienceInfective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD)