Ciudad y Pandemia: Presión económica y brote epidemiológico en los sectores más vulnerables de Quito

Pandemic research are focuses on its escalation and impact on the most vulnerable segments of population. However, there is a little empirical evidence on the relationship between economic vulnerability and territorial expansion that has led by Covid19. This study aims to analyze the socioeconomic conditions of a population group -using a quantitative method (with the use of surveys and administrative records)- that carries out their work activities around fairs, markets and popular shopping malls of the city. Results show that there is an economic and labor inequality that forces them to leave to public space becoming a population exposed to virus contagion. There is a high and positive correlation (0.433) between these workers and the contagion level of city sectors where they exercise their economic activity. Finally, starting from public space as a transformative element of socio-spatial dynamics after the pandemic, a series of reflections that help to rethink the city and architecture in the 21st century is made.Las investigaciones sobre la pandemia se centran en su escalada y efectos en los sectores más vulnerables de la población. No obstante, existe poca evidencia empírica sobre la relación entre vulnerabilidad económica y expansión territorial que ha provocado la enfermedad conocida como Corona Virus Disease 2019. Este estudio tiene como objetivo analizar las condiciones socioeconómicas de un grupo de la población -a partir del método cuantitativo (con el uso de encuestas y registros administrativos)- que realiza sus actividades laborales alrededor de las ferias, mercados y centros comerciales populares de la urbe. Los resultados demuestran que existe una desigualdad económica y laboral que les obliga a salir al espacio público convirtiéndose en una población expuesta al contagio del virus. Existe una correlación alta y positiva (0.433) entre estos trabajadores y el nivel de contagio en los sectores de la ciudad donde ejercen su actividad económica. Finalmente, se realiza una serie de reflexiones que ayudan a re-pensar la ciudad y la arquitectura en el siglo XXI, a partir del espacio público como elemento transformador de las dinámicas socioespaciales después de la pandemia

Mejora de procesos en admisión a posgrado en Universidad Estatal de Milagro, basada en enfoque BPM

Higher education institutions are always interested in improving the efficiency of their processes and seeking a pleasant experience for their future and current students, so one of the relevant processes is admission to graduate programs; because it is considered to be the first step that professionals must complete before being admitted, and therefore the first contact they have with the institution. For this reason, the question is asked: In terms of efficiency in administrative management, is it convenient to apply the BPM methodology and semantic analysis to improve the admission process to postgraduate programs? Starting from this question, the objective was raised. to improve the administrative management of this process through an adaptation of the BPM (business process management) methodology and a semantic analysis through qualitative interviews with the key actors of the process, with the purpose of delimiting the weaknesses and improving the process. This methodology allowed testing in the simulation, optimal results, by obtaining a reduction in unnecessary activities and waiting time, and the efficient use of resources, in addition to being in accordance with the quality standards of national and international higher education, that is, ideal for immediate application in the institution studied. Keywords: BPM, Optimization, Improvement Plan, Processes.Las instituciones de educación superior siempre están interesadas en mejorar la eficiencia de sus procesos y buscar una experiencia agradable para sus futuros y actuales estudiantes, es así que uno los procesos relevantes es el de admisión a programas de posgrado; por considerase que es el primer paso que deben cumplir los profesionales antes de ser admitidos, y por consiguiente el primer contacto que tienen con la institución. Por tal motivo se formula la pregunta, ¿En términos de eficiencia en la gestión administrativa es conveniente la aplicación de la metodología BPM y el análisis semántico para la mejora del proceso de admisión a programas de posgrado?, partiendo de esta interrogante se planteó el objetivo de mejorar la gestión administrativa de este proceso mediante una adaptación de la metodología BPM (business process management) y un análisis semántico mediante entrevistas cualitativas a los actores claves del proceso, con el propósito de delimitar las debilidades y mejorar el proceso. Esta metodología permitió probar en la simulación, resultados óptimos, al obtener reducción de actividades innecesarias y del tiempo de espera, y el uso eficiente de los recursos, además de estar acorde a los estándares de calidad de la educación superior nacional e internacional, es decir ideal para su inmediata aplicación en la Institución estudiada. Palabras claves: BPM, Optimización, Plan de mejoras, Procesos. ABSTRACT Higher education institutions are always interested in improving the efficiency of their processes and seeking a pleasant experience for their future and current students, so one of the relevant processes is admission to graduate programs; because it is considered to be the first step that professionals must complete before being admitted, and therefore the first contact they have with the institution. For this reason, the question is asked: In terms of efficiency in administrative management, is it convenient to apply the BPM methodology and semantic analysis to improve the admission process to postgraduate programs? Starting from this question, the objective was raised. to improve the administrative management of this process through an adaptation of the BPM (business process management) methodology and a semantic analysis through qualitative interviews with the key actors of the process, with the purpose of delimiting the weaknesses and improving the process. This methodology allowed testing in the simulation, optimal results, by obtaining a reduction in unnecessary activities and waiting time, and the efficient use of resources, in addition to being in accordance with the quality standards of national and international higher education, that is, ideal for immediate application in the institution studied. Keywords: BPM, Optimization, Improvement Plan, Processes. Información del manuscrito:Fecha de recepción: 06 de abril de 2023.Fecha de aceptación: 29 de junio de 2023.Fecha de publicación: 10 de julio de 2023

ESTUDIO ETNOBOTÁNICO DE PLANTAS MEDICINALES E IMPORTANCIA DE CONSERVAR LAS ESPECIES VEGETALES SILVESTRES DEL CANTÓN CHILLA, ECUADOR

El objetivo de este estudio fue identificar las especies vegetales silvestres y cultivadas que utilizan las comunidades rurales del cantón Chilla, provincia del Oro-Ecuador, con la finalidad de conocer los conocimientos ancestrales, en cuanto al uso de plantas medicinales e indagar la resiliencia que presentan estas especies vegetales a condiciones atmosféricas adversas, que en general en esta área son las heladas y sequías producidas por el cambio climático. Para ello, se realizó un estudio de tipo cuantitativo etnográfico, observacional y trasversal. Desarrollado en 16 comunidades rurales del Cantón Chilla-Ecuador, con encuestas semiestructuradas e indagatorias evaluando a 83 pobladores con un rango de edad 20-70 años, 44% mujeres y 56% hombres. Se identificaron 92 especies vegetales, 59 exóticas y 33 nativas, presentes 45 familias y 83 géneros. Las categorías con más importancia fueron: uso medicinal respiratorio 26.81% y gastrointestinal 25.49%. El método de preparación fue: infusión 84%. Parte de la planta utilizada 55% hojas. Mecanismo de administración 78% bebida. El habitad 46% huertos. Las especies silvestres presentan mejor resiliencia a condiciones atmosféricas adversas infiriendo se deba a la huella genética, pero tienen menor uso en la población evaluada, debido a que plantas se encuentran en sitios inhóspitos, dificultando su adquisición. Se debe considerar medidas para proteger y conservar estas especies y sus características, ante la problemática de la expansión agrícola que propiciara la erosión genética de estas especies vegetales con características únicas para el posible desarrollo de fitofármacos. Además, se determinó que el 98% de los encuestados se identificaron como mestizo considerándose un aporte cultural pues se adjudica que parte de la protección vegetal es en su mayoría la etnia indígena.

Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry.

BACKGROUND It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic. METHODS Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic. RESULTS Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60-63] years vs 64 [62-66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic. CONCLUSION Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic

Ordered and deterministic cancer genome evolution after p53 loss

Although p53 inactivation promotes genomic instability1 and presents a route to malignancy for more than half of all human cancers2,3, the patterns through which heterogenous TP53 (encoding human p53) mutant genomes emerge and influence tumorigenesis remain poorly understood. Here, in a mouse model of pancreatic ductal adenocarcinoma that reports sporadic p53 loss of heterozygosity before cancer onset, we find that malignant properties enabled by p53 inactivation are acquired through a predictable pattern of genome evolution. Single-cell sequencing and in situ genotyping of cells from the point of p53 inactivation through progression to frank cancer reveal that this deterministic behaviour involves four sequential phases-Trp53 (encoding mouse p53) loss of heterozygosity, accumulation of deletions, genome doubling, and the emergence of gains and amplifications-each associated with specific histological stages across the premalignant and malignant spectrum. Despite rampant heterogeneity, the deletion events that follow p53 inactivation target functionally relevant pathways that can shape genomic evolution and remain fixed as homogenous events in diverse malignant populations. Thus, loss of p53-the 'guardian of the genome'-is not merely a gateway to genetic chaos but, rather, can enable deterministic patterns of genome evolution that may point to new strategies for the treatment of TP53-mutant tumours

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat