Measuring physicians\u27 productivity: A three-year study to evaluate a new remuneration system

PURPOSE: To evaluate a new assessment tool measuring physicians\u27 academic productivity and its use in a performance-based remuneration system. METHOD: The authors developed an assessment tool based on existing tools to measure productivity. Yearly, from 2008 to 2011, physicians at the University of Western Ontario received a score of up to three points for each of four components (impact, application, scholarly activity, mentorship) in each of four domains (clinical practice, education, research, administration). Scores were weighted by the percentage of time physicians spent on tasks in each domain. Year 1 scores were a baseline. In Years 2 and 3, scores were tied to remuneration. The authors compared scores and associations, accounting for age and academic rank, across the three years. RESULTS: The 37 participating physicians included 11 assistant, 23 associate, and 4 full professors. The mean weighted total baseline score across all four domains was 7.44. Years 2 and 3 scores were highly correlated with Year 1 scores (r = 0.85, Years 1 and 2; r = 0.89, Years 1 and 3). Year 2 mean weighted scores did not differ significantly from Year 1 scores. Assistant professors\u27 scores improved significantly between Years 1 and 2 (+1.08, P \u3c .001). Lower Year 1 scores were correlated with a greater improvement in scores between Years 1 and 2, and age was negatively correlated with score changes between Years 2 and 3. CONCLUSIONS: Although the tool may be a robust measurement of physicians\u27 productivity, performance-based remuneration had no effect on physicians\u27 overall performance

Finanzas a Corto y Mediano Plazo : Análisis de la planeación financiera a la empresa H y J,S.A. para la toma de decisiones estratégicas en el periodo 2014-2015

El presente Seminario de Graduación “ANALISIS DE LA PLANEACION FINANCIERA” estaba enfocado a identificar y aplicar las principales herramientas que se toman en cuenta en la planeación financiera para la toma de decisiones estratégicas. El objetivo general es llevar a cabo el proceso de planeación financiera a través de un caso práctico para la empresa H & J, S.A. Para llegar a lo lograr lo anteriormente descrito se recopiló la mayor información posible de libros, revistas científicas y boletas informativas. Con el fin de obtener resultados satisfactorios, de esta manera se pudo lograr la aplicación de las herramientas de planeación financiera observando así que los resultados obtenidos son de vital importancia en la toma de decisiones. Para evitar que la empresa H & J, S.A tenga problemas financieros es necesario implementar las herramientas de planeación financiera, como los presupuestos ya que aportará a la empresa información precisa, oportuna y valiosa que permitirá mitigar riesgos y aprovechar sus recursos financieros para poder tomar las mejores decisiones, pudiendo de esta manera obtener resultados que beneficien la estabilidad financiera para esta empresa

Mejora de la calidad educativa en la Escuela de Técnicos Laboratoristas

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/6652

Porous stainless steel for biomedical applications

Porous 316L austenitic stainless steel was synthesized by powder metallurgy with relative density of 0.50 and 0.30 using 15 and 30 wt. (%) respectively of ammonium carbonate and ammonium bicarbonate as foaming agents. The powders were mixed in a planetary ball mill at 60 rpm for 10 minutes. The samples were uniaxially pressed at 287 MPa and subsequently vacuum heat treated in two stages, the first one at 200 ºC for 5 hours to decompose the carbonate and the second one at 1150 ºC for 2 hours to sinter the steel. The sintered samples had a close porous structure and a multimodal pore size distribution that varied with the foaming agent and its concentration. The samples obtained by addition of 30 wt. (%) of foaming agents had a more homogeneous porous structure than that obtained with 15 wt. (%). The MTT cytotoxicity test (3-[4,5-dimethylthiazol]-2,5-diphenyltetrazolium bromide) was used to evaluate the mitochondrial activity of L929 cells with samples for periods of 24, 48, and 72 hours. The cytotoxicity test showed that the steel foams were not toxic to fibroblast culture. The sample with the best cellular growth, therefore the most suitable for biomedical applications among those studied in this work, was produced with 30 wt. (%) ammonium carbonate. In this sample, cell development was observed after 48 hours of incubation, and there was adhesion and spreading on the material after 72 hours. Electrochemical experiments using a chloride-containing medium were performed on steel foams and compared to massive steel. The massive steel had a better corrosion performance than the foams as the porosity contributes to increase the surface area exposed to the corrosive medium.Universidade do Vale do Paraíba Instituto de Pesquisa e DesenvolvimentoUniversidade Federal de São Paulo (UNIFESP) Instituto de Ciência e TecnologiaUNIFESP, Instituto de Ciência e TecnologiaSciEL

Parenchymal-sparing hepatectomy for colorectal liver metastases reduces postoperative morbidity while maintaining equivalent oncologic outcomes compared to non-parenchymal-sparing resection.

BACKGROUND Modern chemotherapy and repeat hepatectomy allow to tailor the surgical strategies for the treatment of colorectal liver metastases (CRLM). This study addresses the hypothesis that parenchymal-sparing hepatectomy reduces postoperative complications while ensuring similar oncologic outcomes compared to the standardized non-parenchymal-sparing procedures. METHODS Clinicopathological data of patients who underwent liver resection for CRLM between 2012 and 2019 at a hepatobiliary center in Switzerland were assessed. Patients were stratified according to the tumor burden score [TBS2 = (maximum tumor diameter in cm)2 + (number of lesions)2)] and were dichotomized in a lower and a higher tumor burden cohort according to the median TBS. Postoperative outcomes, overall survival (OS) and recurrence-free survival (RFS) of patients following parenchymal-sparing resection (PSR) for CRLM were compared with those of patients undergoing non-PSR. RESULTS During the study period, 153 patients underwent liver resection for CRLM with curative intent. PSR was performed in 79 patients with TBS <4.5, and in 42 patients with TBS ≥4.5. Perioperative chemotherapy was administered in equal rates in both groups (PSR vs. non-PSR) both in TBS ≥4.5 and TBS <4.5. In patients with lower tumor burden (TBS <4.5), PSR was associated with lower overall complication rate (15.2% vs. 46.2%, p = 0.009), a trend for lower major complication rate (8.9% vs. 23.1%, p = 0.123), and shorter length of hospital stay (5 vs. 9 days, p = 0.006) in comparison to non-PSR. For TBS <4.5, PSR resulted in equivalent 5-year OS (48% vs. 39%, p = 0.479) and equivalent 5-year RFS rates (44% vs. 29%, p = 0.184) compared to non-PSR. For TBS ≥4.5, PSR resulted in lower postoperative complication rate (33.3% vs. 63.2%, p = 0.031), a trend for lower major complication rate (23.8% vs. 42.2%, p = 0.150), lower length of hospital stay (6 vs. 9 days, p = 0.005), equivalent 5-year OS (29% vs. 22%, p = 0.314), and equivalent 5-year RFS rates (29% vs. 18%, p = 0.156) compared to non-PSR. Among all patients treated with PSR, patients undergoing minimal-invasive hepatectomy had equivalent 5-year OS (42% vs. 37%, p = 0.261) and equivalent 5-year RFS (34% vs. 34%, p = 0.613) rates compared to patients undergoing open hepatectomy. CONCLUSIONS PSR for CRLM is associated with lower postoperative morbidity, shorter length of hospital stay, and equivalent oncologic outcomes compared to non-PSR, independently of tumor burden. Our findings suggest that minimal-invasive PSR should be considered as the preferred method for the treatment of curatively resectable CRLM, if allowed by tumor size and location

La desnutrición infantil y su efecto en el neurodesarrollo: una revisión crítica desde la perspectiva ecuatoriana

El desarrollo infantil ocurre en hitos y cuando este proceso se ve afectado se presentan signos de alarma que muchas veces son parte de alteraciones en la evolución de los niños especialmente en edades tempranas, donde el proceso de neurodesarrollo es crucial para lograr el máximo potencial de las capacidades y habilidades del ser humano. Las causas que pueden marcar de manera negativa el proceso del neurodesarrollo son diversas, pero la presente investigación se basa en la desnutrición infantil, factor clave en el neurodesarrollo del niño menor de cinco años. El objetivo del estudio fue realizar una revisión bibliográfica de investigaciones sobre la desnutrición infantil y su efecto en el neurodesarrollo desde la perspectiva ecuatoriana. La metodología empleada se basó en el análisis documental y la revisión sistemática de literatura extraída de las bases de datos de SciELO, PudMed, Science Direct, RECIMUNDO, Dialnet, Revista Ecuatoriana de Neurología y Redalyc; con criterios de inclusión y exclusión. Se concluyó que la desnutrición infantil influye negativamente en el neurodesarrollo. En consecuencia, una alimentación adecuada es un medio para que el niño desarrolle sus capacidades tanto intelectuales como físicas.PALABRAS CLAVE: desnutrición; neurodesarrollo; nutrición; primera infancia.Child malnutrition and its effects on neurodevelopment: a critical review from the Ecuadorian perspectiveABSTRACTChild development occurs at milestones and when this process is affected there are alarm signs that are often part of alterations in the evolution of children, especially in early ages, where the neurodevelopmental process is crucial to achieve the maximum potential of the capacities and abilities of the human being. The causes that can negatively affect the evolution of neurodevelopment are diverse, but this research is based on child malnutrition, a key factor in the neurodevelopment of children under five years of age. The objective of the study was to carry out a bibliographic review of research on child malnutrition and its effect on neurodevelopment from the Ecuadorian perspective. The methodology used was based on the documentary analysis and the systematic review of literature extracted from the databases of in SciELO, PudMed, Science Direct, RECIMUNDO, Dialnet, Revista Ecuatoriana de Neurología y Redalyc; with inclusion and exclusion criteria. It was concluded that child malnutrition negatively influences neurodevelopment. Consequently, adequate nutrition is a means for the child to develop both their intellectual and physical abilities.KEYWORDS: Malnutrition; neurodevelopment; nutrition; early childhood.

Estudio de Prefactibilidad para la producción y comercialización de extracto de Noni, Managua, Nicaragua

En el estudio se determina la pre factibilidad de la producción y comercialización del extracto de Noni en la ciudad de Managua, Nicaragua en el periodo del 2016 al 2020, surge de la necesidad de aprovechar la fruta de noni buscando líneas que conlleven a la buena alimentación de la sociedad así como los factores que influyen en las preferencias que tienen los consumidores, tales como: producto, precio, plaza y promoción