Propuesta metodol?gica para la implementaci?n de una planta provincial (L?bano ? murillo- Villahermosa) productora de abonos org?nicos en la granja la Alsacia del municipio del L?bano Tolima.

212 P?ginasRecurso Electr?nicoEl desarrollo poblacional y la gran migraci?n del campo a la ciudad ha provocado unos cambios significativos en diferentes aspectos, entre ellos la generaci?n de residuos s?lidos y el manejo t?cnico y ambiental para su disposici?n, situaci?n que hoy en d?a es una de las problem?ticas ambientales en la mayor?a de ciudades por las grandes cantidades de residuos producidos sin ning?n control versus la vida ?til corta de los rellenos; los municipios peque?os no cuentan con un sitio de disposici?n t?cnicamente; es decir en este momento no existe una soluci?n real a esta problem?tica. En el municipio del L?bano se han adelantado con buenos resultados proyectos de producci?n de abonos org?nicos a base de residuos org?nicos que corresponden al 65% de los residuos generados, por lo cual se hace necesario el montaje de una planta provincial vinculando los municipios de Murillo y Villahermosa para el aprovechamiento de estos residuos con fundamento en el Art?culo 14 de la Ley 1454 de 2011 (Asociaci?n de Municipios), este tipo de iniciativa se ha llevado a cabo en otros pa?ses donde se recupera el 90% de los residuos generados evitando la contaminaci?n ambiental, generando nuevas fuentes de empleo e ingresos, desarrollando un potencial representado en una oportunidad econ?mica y que en algunos pa?ses se da uso a este material en la generaci?n de energ?a. Al realizar la viabilidad t?cnica, financiera, administrativa, legal mercadol?gica se determina que esta iniciativa genera grandes beneficios, no s?lo econ?micos, sino un positivo impacto ambiental y social. Igualmente, se aplica el modelo gerencial que se ajusta a la figura organizacional de la Empresa, donde se tienen en cuenta la administraci?n del recurso humano, del riesgo, de la normatividad vigente y del sistema de informaci?n y comunicaci?n, al igual, que la aplicaci?n de herramientas t?cnicas y tecnol?gicas (Project, diagrama de Gantt, diagrama de red entre otras), que permiten implementar un control y seguimiento m?s preciso al proyecto en su etapa de ejecuci?n.ABSTRACT The population development and the great migration to the city has led to some significant changes in various aspects , including the generation of solid waste and environmental technical management and disposal , a situation which today is one of the environmental issues most cities by the large amounts of waste produced versus uncontrolled short shelf life of landfills , small municipalities do not have a technically disposal site that is at this time there is no real solution to this problem. In the town of Lebanon have successfully advance production projects based organic fertilizers organic residues representing 65 % of the waste generated , so it is necessary to mount a provincial plant Murillo linking municipalities and Villahermosa for the use of these wastes on the basis of Article 14 of Law 1454 of 2011 ( Association of Municipalities ) , this type of initiative has been carried out in other countries where it recovers 90 % of the waste generated preventing pollution environmental , generating new sources of employment and income , developing the potential represented an economic opportunity and in some countries there is use this material in power generation. When the technical , financial, administrative , legal mercadol?gica determined that this initiative brings great benefits , not just economic , but a positive environmental and social impact . Also applies the managerial model that fits the company 's organizational figure , which takes into account human resource management , risk , current regulations and information and communication system , as well , that the application technical and technological tools (Project , Gantt chart, network diagram etc.) , enabling an accurate control and monitoring the project in its execution phase.INTRODUCCI?N 12 1. DEFINICI?N Y PLANTEAMIENTO DEL PROBLEMA 14 1.1. DEFINICION DEL PROBLEMA 14 1.2. ALCANCE DEL PROYECTO 14 1.3. PRONOSTICO DE LA SITUACION ACTUAL 14 1.4. SISTEMATIZACI?N DEL PROBLEMA A NIVEL GERENCIAL 15 2. JUSTIFICACI?N 16 3 OBJETIVOS 17 3.1. OBJETIVO GENERAL 17 3.2. OBJETIVOS ESPECIFICOS 17 4. METODOLOGIA 18 5. DESCRIPCI?N GENERAL DEL PROYECTO 20 5.1. GENERALIDADES 20 5.2. ENTIDADES RESPONSABLES O FORMULADORES 20 5.3. VISI?N GENERAL DEL PROYECTO 20 5.4. RESUMEN DEL PROYECTO 21 5.4.1. Viabilidad del Mercado 21 5.4.2. Viabilidad T?cnica. 24 5.4.3. Viabilidad Administrativa y Legal. 25 5.4.4. Viabilidad Ambiental 26 5.4.5 Evaluaci?n Financiera 27 6. EL CONTEXTO DEL PROYECTO 29 4 6.1. AN?LISIS SECTORIAL DE LOS ABONOS ORGANICOS Y DE LOS RESIDUOS SOLIDOS 29 6.1.1. Aspecto Nacional 29 7. GERENCIA DEL PROYECTO 41 7.1. INICIACION 44 7.1.1 Project Charter 44 7.1.2. Acta de inicio de Obra 46 7.2. PLANEACION 47 7.2.1. Objetivo. 47 7.2.2. Estructura de desglose de trabajo EDT. 47 7.2.3. Matriz de responsabilidades. 48 7.2.4. Definici?n de Actividades 50 7.3. GESTION DEL ALCANCE 52 7.3.1. Objetivo y Alcance del Proyecto 52 7.3.2. Productos Entregables 53 7.3.3. Tipo de Estructura a implementar para la ejecuci?n del Proyecto 53 7.3.4. Poblaci?n Beneficiaria 58 7.3.5. Oportunidades de negocio 47 7.3.6. Restricciones 59 7.3.7. Supuestos 59 7.4. GESTI?N DEL TIEMPO 59 7.4.1. Matriz de Precedencia 59 7.4.2. Diagrama de la Red de la Ruta Cr?tica 60 7.5. GESTI?N DEL COSTO 66 7.5.1. Estudio Financiero 66 7.5.2 Evaluaci?n financiera 70 7.6. GESTI?N DE RIESGOS 72 7.6.1. Identificaci?n de riesgos 72 7.6.2. Activos de los proceso de la organizaci?n 73 5 7.6.3. An?lisis cualitativo 74 7.6.4. Planificaci?n de respuestas 74 7.6.6. Seguimiento y control. 76 7.7. GESTI?N DEL TALENTO HUMANO 76 7.7.1. Estructura de Organizaci?n para la Ejecuci?n del Proyecto. 76 7.7.2. Proceso de Selecci?n del Gerente de Proyectos y su Equipo Nuclear 78 7.8. MODELO GERENCIAL APLICADO A LA EJECUCI?N DEL PROYECTO 100 7.8.1. Estrategias Gerenciales del Proyecto. 100 7.8.2. El Sistema de Informaci?n y Comunicaci?n para la Ejecuci?n del Proyecto 102 7.8.3. Sistema de Recopilaci?n, Recuperaci?n y Distribuci?n de la Informaci?n 112 7.9. CONTRATACI?N PARA LA EJECUCI?N DEL PROYECTO 115 7.9.1. Aprovisionamiento del Talento Humano 116 7.10. APLIACI?N DEL PROJECT MANAGER 118 7.11. CIERRE 119 7.11.1. Acta de Liquidaci?n 121 7.12. CONTROL 122 8. CONCLUSIONES Y RECOMENDACIONES 128 REFERENCIAS 130 ANEXOS 13

Hawksbill turtle terra incognita: conservation genetics of eastern Pacific rookeries

Prior to 2008 and the discovery of several important hawksbill turtle (Eretmochelys imbricata) nesting colonies in the EP (Eastern Pacific), the species was considered virtually absent from the region. Research since that time has yielded new insights into EP hawksbills, salient among them being the use of mangrove estuaries for nesting. These recent revelations have raised interest in the genetic characterization of hawksbills in the EP, studies of which have remained lacking to date. Between 2008 and 2014, we collected tissue samples from 269 nesting hawksbills at nine rookeries across the EP and used mitochondrial DNA sequences (766 bp) to generate the first genetic characterization of rookeries in the region. Our results inform genetic diversity, population differentiation, and phylogeography of the species. Hawksbills in the EP demonstrate low genetic diversity: We identified a total of only seven haplotypes across the region, including five new and two previously identified nesting haplotypes (pooled frequencies of 58.4% and 41.6%, respectively), the former only evident in Central American rookeries. Despite low genetic diversity, we found strong stock structure between the four principal rookeries, suggesting the existence of multiple populations and warranting their recognition as distinct management units. Furthermore, haplotypes EiIP106 and EiIP108 are unique to hawksbills that nest in mangrove estuaries, a behavior found only in hawksbills along Pacific Central America. The detected genetic differentiation supports the existence of a novel mangrove estuary “reproductive ecotype” that may warrant additional conservation attention. From a phylogeographic perspective, our research indicates hawksbills colonized the EP via the Indo‐Pacific, and do not represent relict populations isolated from the Atlantic by the rising of the Panama Isthmus. Low overall genetic diversity in the EP is likely the combined result of few rookeries, extremely small reproductive populations and evolutionarily recent colonization events. Additional research with larger sample sizes and variable markers will help further genetic understanding of hawksbill turtles in the EP

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26 of infants (580/2,265; range, 0�100; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received �1 antimicrobial agent (92, antibacterial; 19, antifungal; 4, antiviral). The most common reasons for antibiotic therapy were �rule-out� sepsis (32) and �culture-negative� sepsis (16) with ampicillin (40), gentamicin (35), amikacin (19), vancomycin (15), and meropenem (9) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26), amikacin (20), and meropenem (16) were the most prescribed agents. Length of therapy for culture-positive and �culture-negative� infections was 12 days (median; IQR, 8�14) and 7 days (median; IQR, 5�10), respectively. Mortality was 6 (42, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding: Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship © 2021 The Author

Population typing of the causal agent of cassava bacterial blight in the Eastern Plains of Colombia using two types of molecular markers

Background: Molecular typing of pathogen populations is an important tool for the development of effective strategies for disease control. Diverse molecular markers have been used to characterize populations of Xanthomonas axonopodis pv. manihotis (Xam), the main bacterial pathogen of cassava. Recently, diversity and population dynamics of Xam in the Colombian Caribbean coast were estimated using AFLPs, where populations were found to be dynamic, diverse and with haplotypes unstable across time. Aiming to examine the current state of pathogen populations located in the Colombian Eastern Plains, we also used AFLP markers and we evaluated the usefulness of Variable Number Tandem Repeats (VNTRs) as new molecular markers for the study of Xam populations. Results: The population analyses showed that AFLP and VNTR provide a detailed and congruent description of Xam populations from the Colombian Eastern Plains. These two typing strategies clearly separated strains from the Colombian Eastern Plains into distinct populations probably because of geographical distance. Although the majority of analyses were congruent between typing markers, fewer VNTRs were needed to detect a higher number of genetic populations of the pathogen as well as a higher genetic flow among sampled locations than those detected by AFLPs. Conclusions: This study shows the advantages of VNTRs over AFLPs in the surveillance of pathogen populations and suggests the implementation of VNTRs in studies that involve large numbers of Xam isolates in order to obtain a more detailed overview of the pathogen to improve the strategies for disease control