MARGINAL PRODUCTIVITY INDEX POLICIES FOR SCHEDULING A MULTICLASS DELAY-/LOSS-SENSITIVE QUEUE

We address the problem of scheduling a multiclass M/M/1 queue with a finite dedicated buffer for each class. Some classes are delay-sensitive, modeling real-time traffic (e.g. voice, video), whereas others are loss-sensitive, modeling nonreal-time traffic (e.g. data). Different levels of tolerance to delay and loss are modeled by appropriate linear holding cost and rejection cost rates. The goal is to design well-grounded and tractable scheduling policies which nearly minimize the discounted or long-run average expected cost objective. We develop new dynamic index policies, prescribing to give higher service priority to classes with larger index values, where the priority index of a class measures the marginal productivity of work at its current state. To construct the indices, we deploy the theory of marginal productivity indices (MPIs) and PCLindexability we have introduced in recent work, and further introduce significant extensions to such theory motivated by phenomena observed in the model of concern. The MPI policies are shown to furnish new, insightful structural results, and to exhibit a nearly optimal performance in a computational study.

Transdisciplinary management of patients with disorders of sexual development in Colombia. Limiting factors for appropriate management

Introducción Los desórdenes del desarrollo sexual (DDS) se presentan en 0,76 por cada 4.500 nacimientos. El manejo es complejo y requiere de la habilidad de múltiples especialidades, lo cual tendrá un impacto positivo en el pronóstico y reducción de la discapacidad de estos pacientes. El objetivo del presente trabajo es describir una población manejada por un grupo transdisciplinario de DDS en nuestro medio y establecer las limitantes que enfrentan nuestros pacientes en la atención de sus condiciones. Metodología Se describe el seguimiento de los pacientes con DDS valorados por el grupo transdisciplinario de DDS desde 2007. Se tuvo en cuenta el proceso clínico y genético para establecer el diagnóstico. Se hizo una descripción de los casos llevados a cirugía y su evolución postoperatoria desde el punto de vista médico y administrativo. Resultado Se valoró a 55 pacientes con DDS, encontrando que la patología más frecuente es la hiperplasia suprarrenal congénita. Se realizó un seguimiento promedio de 17,2 meses desde su ingreso al grupo. El 36% de los casos fueron llevados a cirugía por su condición con una edad promedio de 5 años de edad. La valoración extrainstitucional inicial nunca fue por un grupo multidisciplinario y solo el 72% fue estudiado con cariotipo con análisis de 25 metafases. Ninguno de los casos con mosaicismo fue diagnosticado con los cariotipos con 25 metafases, sino luego de extender el análisis a 100 metafases. El 18% tuvo cambio de género con el que fueron registrados extrainstitucionalmente. Conclusiones Los DDS son patologías muy complejas que requieren del tratamiento integral por múltiples especialidades. Esto se manifiesta con clara reducción en complicaciones, costos y, lo más importante, una mejoría del pronóstico y la discapacidad. En nuestro medio, las limitantes que presentar el sistema de salud para lograr un tratamiento integral transdisciplinario a nuestros pacientes están lejos de ser óptimas. Es importante que los prestadores de la salud tengan conocimiento de los grupos transdisciplinarios para así promover un adecuado tratamiento.Q4Artículo original164-168Introduction Disorders of sex development (DSD) are present in 0.76 per 4,500 births. The management is complex and requires the ability of a multi-disciplinary team, which can have a positive impact on the prognosis. The aim of this article is to describe a population managed by a cross-disciplinary DSD group in our environment, and presenting the limitations faced by our patients in the care of their conditions. Methodology Description of the follow-up of patients with DSD by a cross-disciplinary group since 2007. The DSD clinical approach and genetic and diagnostic processes are described. Also a description of cases taken to surgery and their postoperative course was also evaluated from a medical and administrative point of view. Result The study included 55 patients wIth DSD, with the most common disease being congenital adrenal hyperplasia. The mean follow-up was 17.2 months. Surgery was performed in 36% of cases due to their condition, with a mean age of 5 years at the time of surgery. An initial extra-institutional initial assessment was never made by a multidisciplinary group, and only 72% were studied by karyotype analysis by analysing 25 metaphases. None of the cases were diagnosed as having mosaicism when 25 metaphases were analysed, but were detected after extending the analysis to 100 metaphases. Eighteen percent had gender reasigned. Conclusions DSD are very complex diseases that require comprehensive treatment by multiple specialties. This is demonstrated by clear reduction in complications, costs and most importantly, an improvement in prognosis and reduction in disability. In our environment, limitations by the health system provides is alarming. A comprehensive treatment by a cross-disciplinary team to these patients is far from optimal. It is important that health care providers are aware of cross-disciplinary groups in order to promote proper treatment

Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries

Background: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. Methods: From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). Results: About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. Conclusions: Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.Revisión por pare

XV International Congress of Control Electronics and Telecommunications: "The role of technology in times of pandemic and post-pandemic: innovation and development for strategic social and productive sectors"

La anterior selección, motivados por la aseveración de Manuel Castells -hace casi 20 años ya- que la innovación y la difusión de la tecnología parecía ser la herramienta apropiada para el desarrollo en la era de la información. Este 2020, sin embargo, ante la situación disruptiva que aquejó y aqueja a la sociedad red como una estructura social emergente de la Era de la Información basada en redes de producción, energizadas por el poder y la experiencia; falló y debe reencontrar su rumbo. Es así que los problemas acuciantes, ahora, fueron: la atención sanitaria y la superación de la epidemia de Sars Cov 2; tomó forma la, hasta entonces, visión irrealista de Castells que … no podemos avanzar con nuestros modelos de desarrollo actual, destruyendo nuestro entorno y excluyendo a la mayor parte de la humanidad de los beneficios de la revolución tecnológica más extraordinaria de la historia, sin sufrir una devastadora reacción por parte de la sociedad y la naturaleza. Fue así que el Cuarto Mundo, específicamente, donde la suficiencia de recurso humano, de capital, trabajo, información y mercado -vinculados todos a través de la tecnología- supuso que atendería eficazmente a través de la población que podía por su capacidad hacer uso racional y profesional del conocimiento, las necesidades de la mayoritaria población vulnerable y vulnerada. Por lo anterior, poner en el centro a las personas, en entornos de tarea y trabajo globales hiperconectados combinando espacios físicos, corrientes de información con canales de conexión expeditos, y formando profesionales del conocimiento que asuman y afronten los retos derivados de la transformación digital de empresas, universidades, y organizaciones, pero en condiciones de equidad y sujetos de prosperidad, será el desafío en los escenarios presentes y futuros inmediatos.The previous selection, motivated by the assertion of Manuel Castells -almost 20 years ago- that innovation and diffusion of technology seemed to be the appropriate tool for development in the information age. This 2020, however, in the face of the disruptive situation that afflicted and continues to afflict the network society as an emerging social structure of the Information Age based on production networks, energized by power and experience; He failed and must find his way again. Thus, the pressing problems now were: health care and overcoming the Sars Cov 2 epidemic; Castells' until then unrealistic vision took shape that... we cannot advance with our current development models, destroying our environment and excluding the majority of humanity from the benefits of the most extraordinary technological revolution in history, without suffering a devastating reaction from society and nature. It was thus that the Fourth World, specifically, where the sufficiency of human resources, capital, work, information and market - all linked through technology - meant that it would serve effectively through the population that could, due to its capacity, make rational use. and knowledge professional, the needs of the majority vulnerable and vulnerable population. Therefore, putting people at the center, in hyperconnected global task and work environments, combining physical spaces, information flows with expedited connection channels, and training knowledge professionals who assume and face the challenges derived from the digital transformation of companies, universities, and organizations, but in conditions of equality and subject to prosperity, will be the challenge in the present and immediate future scenarios.Bogot