Diseño y construcción de un marco muestral automatizado de la ciudad de Guayaquil parte a

SE REALIZA UNA INTRODUCCION DE LA UTILIZACION DE MUESTREO EN EL ECUADOR, INFORMACION SOBRE LA EVOLUCION Y VENTAJA DEL MUESTREO Y LOS CENSOS DE POBLACION. SE DESCRIBE LA INFORMACION DE LOS ORGANISMOS DEL SECTOR PUBLICO Y PRIVADO QUE REALIZAN TRABAJOS DE CARACTER ESTADISTICO. PRESENTA LA CONFIGURACION GEOGRAFICO DE LA CIUDAD DE GUAYAQUIL, EN ESTE SE DESCRIBE LOS LIMITES, UBICACION Y COMO SE ENCUENTRA ESTRUCTURADO INTERNAMENTE ENTRE SUS CALLES. SE ESTABLECE UNA INTRODUCION DE LO QUE ES EL MUESTREO PROBABILISTICO Y SISTEMATICO, ALGUNOS CONCEPTOS Y DEFINICIONES IMPORTANTE EN ESTE CONTEXTO, ASI COMO TAMBIEN SE DESCRIBE CADA UNA DE LAS TECNICAS DE MUESTREO QUE SE UTILIZAN EN EL MARCO MUESTRAL AUTOMATIZADO DE LA CIUDAD DE GUAYAQUIL COMO PARTE A. SE PRESENTA EL DISEÑO DE LA BASE DE DATOS "GUAYAQUIL A" QUE COMPRENDEN EL ALMACENAMIENTO DE VIVIENDAS, CALLES, MANZANAS, ETC

The Automotive Sector in Ecuador: Background, current situation and perspectives

El presente artículo es de carácter investigativo con razonamiento inductivo y paradigmas analítico y sintético, busca determinar el comportamiento del sector automotriz con un periodo de análisis del 2000 a 2019, para ello se realizó un estudio de estadística descriptiva que permita establecer el comportamiento del mercado automotriz. Los resultados demuestran que la producción vehicular nacional ha presentado un declive a partir del 2013, dando oportunidad al crecimiento de la importación vehicular. Pichincha y Guayas concentran la mayor cantidad de la venta vehicular nacional, el segmento automóviles es el de mayor venta aunque el segmento de SUV está en proyección de incremento a nivel nacional. A pesar de la existencia de 7 marcas ensambladoras de vehículos el Ecuador presenta un saldo negativo dando a notar su dependencia a la importación de vehículos. Palabras Clave: Crecimiento económico, Comportamiento del Mercado, Sector industrial. Referencias [1]J. Vieyra Medrano, «Innovación y nuevas estrategias espaciales en el sector automotriz. El caso de la nissan mexicana,» Revista Electrónica de Geografía y Ciencias Sociales, vol. 69, nº 87, 2000. [2]A. Vieyra, 4 Octubre 1999. [En línea]. Available: https://www.aehe.es/wp-content/uploads/2001/10/vieyra.pdf. [Último acceso: 4 Abril 2021]. [3]Y. Carbajal Suárez, «Sector automotriz: reestructuración tecnológica y reconfiguración del mercado mundial,» Paradigma económico, vol. 2, nº 1, pp. 24-52, 2010. [4]V. Francisco y K. Rajiv, «the automotive supply chain: global trends and asian perspectives,» Economics and research department, nº 3, pp. 1-41, 2002. [5]P. B. Joseph, Mass Customization: The New Frontier in Business Competition, Harvard Business School Press, 1993. [6]A. David M. y P. B. J., Agile Product Development for Mass Customization: How to Develop and Deliver Products for Mass Customization, Niche Markets, JIT, Build-to-order, and Flexible Manufacturing, Irwin Professional Pub, 1997. [7]FENALCO, «Comportamiento del Mercado Automotor Acumulado a diciembre de 2.008,» Bogotá, 2009. [8]D. Carrillo, «Diagnóstico del sector Automotriz,» Quito, 2009. [9]AEADE, «Anuario 2018,» Editorial Ecuador F.B.T. Cía. Ltda, Quito, 2019.This article is of an investigative nature with inductive reasoning and analytical and synthetic paradigms, that pursues to determine the behavior of the automotive sector with an analysis period from 2000 to 2019, it has been made a descriptive statistics study, which allows establishing the behavior of the automotive market. The results have shown that the national vehicle production presented a decline from 2013, giving an opportunity to the growth of vehicle imports. Pichincha and Guayas has the largest amount of national vehicle sales, the automobile segment is the one with the highest sales although the SUV segment is in projection to rise at the national level. In spite of the existence of 7 vehicle assembly brands, Ecuador has a negative balance that shows its dependence on vehicle imports. Keywords: Economic growth, Market behavior, Industrial Sector. References [1]J. Vieyra Medrano, «Innovación y nuevas estrategias espaciales en el sector automotriz. El caso de la nissan mexicana,» Revista Electrónica de Geografía y Ciencias Sociales, vol. 69, nº 87, 2000. [2]A. Vieyra, 4 Octubre 1999. [En línea]. Available: https://www.aehe.es/wp-content/uploads/2001/10/vieyra.pdf. [Último acceso: 4 Abril 2021]. [3]Y. Carbajal Suárez, «Sector automotriz: reestructuración tecnológica y reconfiguración del mercado mundial,» Paradigma económico, vol. 2, nº 1, pp. 24-52, 2010. [4]V. Francisco y K. Rajiv, «the automotive supply chain: global trends and asian perspectives,» Economics and research department, nº 3, pp. 1-41, 2002. [5]P. B. Joseph, Mass Customization: The New Frontier in Business Competition, Harvard Business School Press, 1993. [6]A. David M. y P. B. J., Agile Product Development for Mass Customization: How to Develop and Deliver Products for Mass Customization, Niche Markets, JIT, Build-to-order, and Flexible Manufacturing, Irwin Professional Pub, 1997. [7]FENALCO, «Comportamiento del Mercado Automotor Acumulado a diciembre de 2.008,» Bogotá, 2009. [8]D. Carrillo, «Diagnóstico del sector Automotriz,» Quito, 2009. [9]AEADE, «Anuario 2018,» Editorial Ecuador F.B.T. Cía. Ltda, Quito, 2019

Clinical assessment using an algorithm based on fuzzy C-means clustering

The Fuzzy c-means (FCM) algorithms define a grouping criterion from a function, which seeks to minimize iteratively the function up to until an optimal fuzzy partition is obtained. In the execution of this algorithm each element to the clusters is related to others that belong in the same n-dimensional space, which means that an element can belong to more than one clusters. This proposal aims to define a fuzzy clustering algorithm which allows the patient classifications based on the clinical assessment of the medical staff. In this work 30 cases were studied using the Glasgow Coma Scale to measure the level of awareness for each one which were prioritized by triage Manchester method. After applying the FCM algorithm the data is separated data into two clusters, thus, verified the fuzzy grouping in patients with a degree of membership that specifies the level of prioritization

Migrating SOA applications to cloud: a systematic mapping study

Cloud Computing has emerged as an economical option to use IT resources when needed without considerations about where they are allocated or how they are delivered. Cloud Computing expands the SOA capabilities by adding scalability, elasticity and other relevant quality attributes. In this context, many companies have started to migrate their SOA applications to Cloud environments without proper support. We conducted a systematic mapping study to gather the current knowledge about existing strategies for migrating SOA applications to cloud computing. 105 papers were identified and the results show that most of the approaches follow a semi-automated (conventional) strategy for migrating to the Cloud (93%) and that most of the reported works follow a hybrid deployment model (60%). We additionally identify several research gaps such as the need for more technology-independent solutions, a common definition for concepts and resources, tool support, and validation

Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS : a propensity score analysis

Background: The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. Methods: We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Results: Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). Conclusions: In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.</p

A Survey of Empirical Results on Program Slicing

International audienceBACKGROUND:Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.METHODS:This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.FINDINGS:Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).INTERPRETATION:Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research