Condiciones asistenciales y administrativas que potencialmente influirían en la satisfacción del cliente interno y externo de un servicio de salud: Implicaciones para la gestión operacional

Calidad en salud y Satisfacción en salud son dos fenómenos de naturaleza distinta, sin embargo la literatura reporta que en las mediciones de ambas parecen evaluarse factores similares en la prestación de los servicios de salud. La calidad en salud hace referencia a las ¨creencias que como forma de la percepción forman parte de la cognición mientras que la satisfacción concebida como un juicio de valor positivo o negativo que construye el sujeto que ha recibido el servicio de acuerdo al cumplimiento de sus expectativas, es considerada uno de los principales objetivos de la calidad de atención en salud y un indicador del óptimo funcionamiento de las instituciones hospitalarias, así entonces, el objetivo de este estudio fue determinar cuáles son las características asistenciales y administrativas que potencialmente influirían en la valoración de la satisfacción del usuario y funcionario frente a la atención en los servicios de salud del Hospital Municipal del Guamo-Tolima, mediante la identificación, medición y descripción de las mismas .Los resultados del estudio obtenidos a partir de la comparación de medias de cada uno de los ítems evaluados, y de la diferencia significativa de medias, mostraron que existen diferencias significativas entre la importancia asignada por los usuarios frente a la asignada por los funcionarios.

El trabajo en equipo en el Proceso Administrativo y de Compras en OPL Carga de Bucaramanga

El proceso administrativo y de compras de OPL Carga tiene algunas falencias entre ellas: fallas en la Comunicación entre el personal operativo, no se realizan llamadas internas usando con frecuencia el email, produciendo la saturación de solicitudes las cuales terminan sin ser resueltas en cuanto a roles se refiere, no hay enfoque de procesos en vista que no se tiene claras las tareas de cada cargo, adicionalmente no hay claridad en los subprocesos, perjudicando el proceso con el aumento de costos, pérdida de tiempo, las responsabilidades de los funcionario no todas las veces se ejecutan en el tiempo asignado, el liderazgo compartido presenta ambigüedades. Objetivos: Definir el trabajo en equipo en el proceso administrativo y de compras en OPL carga de Bucaramanga. La investigación que a realizar es de tipo descriptivo, busca descubrir las falencias o características que permiten diseñar y desarrollar un modelo de solución para los problemas del equipo de OPL Carga S.A.S. Materiales y métodos: La investigación efectuada es de tipo descriptivo, el objetivo es definir el modelo del trabajo en equipo y describir las falencias en el proceso administrativo y de compras en OPL carga de Bucaramanga, que permitan obtener un diagnóstico integral que conlleve a la implementación de estrategias de solución. Resultados: Se identificaron las falencias en los siguientes aspectos: Variable comunicación, rendimiento, destrezas complementarias, propósito significativo y meta específicas de los funcionarios en OPL carga sección administrativa. Conclusiones: El modelo de trabajo en equipo que OPL aplica es jerárquico, en el que se ofrece estabilidad, seguridad, se toman decisiones en forma piramidal, mediante la planeación de tareas, la colaboración, igualdad y respeto por los miembros, trabajando en pro de la solución de problemas. Se construyó un plano conceptual que permitió exponer la interpretación que la estudiante tiene de las teorías, investigaciones y antecedentes válidos para la comprensión del problema investigado. Área comunicacional: Coordinar acciones tendientes para que los funcionarios respondan a tiempo los emails atenientes a su trabajo. Área condiciones de trabajo: Clarificar y diseñar las reglas de comportamiento al interior de los equipos de trabajo que redunden en el mejoramiento del mismo y la búsqueda de soluciones oportunas. Área metas específicas: Procurar mediante auditorías el cumplimiento de las metas y objetivos propuestos por cada equipo de trabajo.

Measuring and testing for the systemically important financial institutions

This paper analyzes the measure of systemic importance ∆CoV aR proposed by Adrian and Brunnermeier (2009, 2010) within the context of a similar class of risk measures used in the risk management literature. In addition, we develop a series of testing procedures, based on ∆CoV aR, to identify and rank the systemically important institutions. We stress the importance of statistical testing in interpreting the measure of systemic importance. An empirical application illustrates the testing procedures, using equity data for three European banks.

Comparación de cambios clínicos y hemodinámicos en pacientes con insuficiencia venosa mixta según tipo de manejo.

Existen varias causas de la insuficiencia venosa profunda, la insuficiencia venosa superficial es una de ellas; por tal motivo, una intervención activa de la insuficiencia superficial ya sea cirugía convencional, esclerosis o radiofrecuencia mejora el reflujo del sistema venoso profundo. En nuestro medio no se acostumbra a intervenir los pacientes con insuficiencia venosa mixta bajo la creencia de exacerbar la enfermedad o generar complicaciones. Se pretende documentar los cambios clínicos y hemodinámicos en pacientes con insuficiencia venosa mixta según tipo de manejo, médico vs quirúrgico

Accumulation of six metals in the mangrove crab Ucides cordatus (Crustacea: Ucididae) and its food source, the red mangrove Rhizophora mangle (Angiosperma: Rhizophoraceae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

TRAIL-R3-related apoptosis: Epigenetic and expression analyses in women with ovarian neoplasia

Objective. To assess the expression of TRAIL-R3 and the methylation of a CpG island within the TRAIL-R3 promoter both in cystadenoma tumors and primary and metastatic epithelial ovarian carcinoma (EOC).Methods. RNA was obtained from women with normal ovarian (NO) tissues (n = 18), ovarian serous cystadenoma tumors (n = 11) and EOC (n = 16) using Trizol (R). Quantitative PCR (gRT-PCR) was performed to quantify the relative levels of TRAIL-R3. The methylation frequency of the CpG island in the TRAIL-R3 promoter was assessed using the methylation-specific PCR (MSP) assay after DNA bisulfite conversion. The differences between the groups were evaluated using the chi-square, Student's t, ANOVA, Mann-Whitney U, Wilcoxon or Kruskal-Wallis tests as indicated. The survival rates were calculated using the Kaplan-Meier method.Results. Cystadenoma and metastatic EOC tumors expressed significantly more TRAIL-R3 mRNA than primary EOC tumors. Methylation of the TRAIL-R3 promoter was absent in NO tissues, while hemimethylation of the TRAIL-R3 promoter was frequently found in the neoplasia samples with 45.4% of the cystadenoma tumors, 8.3% of the primary EOC samples and 11.1% of the metastatic EOC samples showing at least partial methylation (p = 0.018). Neither the expression of TRAIL-R3 nor alterations in the methylation profile were associated to cumulative progression-free survival or the overall survival in EOC patients.Conclusions. Primary EOC is associated to a lower TRAIL-R3 expression, which leads to a better understanding of the complex disease and highlighting potential therapeutic targets. Promoter DNA methylation was not related to this finding, suggesting the presence of other mechanisms to transcriptional control. (C) 2012 Elsevier B.V. All rights reserved.

Plasmodium falciparum: sequence diversity and antibody recognition of the Merozoite surface protein-2 (MSP-2) in Brazilian Amazonia

The merozoite surface protein-2 (MSP-2) of Plasmodium falciparum comprises repeats flanked by dimorphic domains defining the allelic families FC27 and IC1. Here, we examined sequence diversity at the msp-2 locus in Brazil and its impact on MSP-2 antibody recognition by local patients. Only 25 unique partial sequences of msp-2 were found in 61 isolates examined. The finding of identical msp-2 sequences in unrelated parasites, collected 6-13 years apart, suggests that no major directional selection is exerted by variant-specific immunity in this malaria-endemic area. To examine antibody cross-reactivity, recombinant polypeptides derived from locally prevalent and foreign MSP-2 variants were used in ELISA. Foreign IC1-type variants, such as 3D7 (currently tested for human vaccination), were less frequently recognized than FC27-type and local IC1-type variants. Antibodies discriminated between local and foreign IC1-type variants, but cross-recognized structurally different local IC1-type variants. The use of evolutionary models of MSP-2 is suggested to design vaccines that minimize differences between local parasites and vaccine antigens. (C) 2004 Elsevier B.V. All rights reserved.

Nonabelian Toda theories from parafermionic reductions of the WZW model

We investigate a class of conformal nonabelian-Toda models representing noncompact SL(2, R)/U(1) parafermions (PF) interacting with specific abelian Toda theories and having a global U(1) symmetry. A systematic derivation of the conserved currents, their algebras, and the exact solution of these models are presented. An important property of this class of models is the affine SL(2, R)(q) algebra spanned by charges of the chiral and antichiral nonlocal currents and the U(1) charge. The classical (Poisson brackets) algebras of symmetries VG(n), of these models appear to be of mixed PF-WG(n) type. They contain together with the local quadratic terms specific for the W-n-algebras the nonlocal terms similar to the ones of the classical PF-algebra. The renormalization of the spins of the nonlocal currents is the main new feature of the quantum VA(n)-algebras. The quantum VA(2)-algebra and its degenerate representations are studied in detail. (C) 1999 Academic Press.

T-duality of axial and vector dyonic integrable models

A general construction of affine nonabelian (NA)-Toda models in terms of the axial and vector gauged two loop WZNW model is discussed. They represent integrable perturbations of the conformal sigma -models (with tachyons included) describing (charged) black hole type string backgrounds. We study the off-critical T-duality between certain families of axial and vector type integrable models for the case of affine NA-Toda theories with one global U(1) symmetry. In particular we find the Lie algebraic condition defining a subclass of T-selfdual torsionless NA-Toda models and their zero curvature representation. (C) 2001 Academic Press.

Renormalization of singular potentials and power counting

We use a toy model to illustrate how to build effective theories for singular potentials. We consider a central attractive 1/r(2) potential perturbed by a 1/r(4) correction. The power-counting rule, an important ingredient of effective theory, is established by seeking the minimum set of short-range counterterms that renormalize the scattering amplitude. We show that leading-order counterterms are needed in all partial waves where the potential overcomes the centrifugal barrier, and that the additional counterterms at next-to-leading order are the ones expected on the basis of dimensional analysis. (C) 2008 Elsevier B.V. All rights reserved.

Periodic orbits for a class of reversible quadratic vector field on R-3

For a class of reversible quadratic vector fields on R-3 we study the periodic orbits that bifurcate from a heteroclinic loop having two singular points at infinity connected by an invariant straight line in the finite part and another straight line at infinity in the local chart U-2. More specifically, we prove that for all n is an element of N, there exists epsilon(n) > 0 such that the reversible quadratic polynomial differential systemx = a(0) + a(1y) + a(3y)(2) + a(4Y)(2) + epsilon(a(2x)(2) + a(3xz)),y = b(1z) + b(3yz) + epsilon b(2xy),z = c(1y) +c(4az)(2) + epsilon c(2xz)in R-3, with a(0) < 0, b(1)c(1) < 0, a(2) < 0, b(2) < a(2), a(4) > 0, c(2) < a(2) and b(3) is not an element of (c(4), 4c(4)), for epsilon is an element of (0, epsilon(n)) has at least n periodic orbits near the heteroclinic loop. (c) 2007 Elsevier B.V. All rights reserved.

Biodiversity, Species Interactions and Ecological Networks in a Fragmented World

Biodiversity is organised into complex ecological networks of interacting species in local ecosystems, but our knowledge about the effects of habitat fragmentation on such systems remains limited. We consider the effects of this key driver of both local and global change on both mutualistic and antagonistic systems at different levels of biological organisation and spatiotemporal scales.There is a complex interplay of patterns and processes related to the variation and influence of spatial, temporal and biotic drivers in ecological networks. Species traits (e.g. body size, dispersal ability) play an important role in determining how networks respond to fragment size and isolation, edge shape and permeability, and the quality of the surrounding landscape matrix. Furthermore, the perception of spatial scale (e.g. environmental grain) and temporal effects (time lags, extinction debts) can differ markedly among species, network modules and trophic levels, highlighting the need to develop a more integrated perspective that considers not just nodes, but the structural role and strength of species interactions (e.g. as hubs, spatial couplers and determinants of connectance, nestedness and modularity) in response to habitat fragmentation.Many challenges remain for improving our understanding: the likely importance of specialisation, functional redundancy and trait matching has been largely overlooked. The potentially critical effects of apex consumers, abundant species and supergeneralists on network changes and evolutionary dynamics also need to be addressed in future research. Ultimately, spatial and ecological networks need to be combined to explore the effects of dispersal, colonisation, extinction and habitat fragmentation on network structure and coevolutionary dynamics. Finally, we need to embed network approaches more explicitly within applied ecology in general, because they offer great potential for improving on the current species-based or habitat-centric approaches to our management and conservation of biodiversity in the face of environmental change.

Cloning, expression, purification and characterization of recombinant glutathione-S-transferase from Xylella fastidiosa

Xylella fastidiosa is an important pathogen bacterium transmitted by xylem-feedings leafhoppers that colonizes the xylem of plants and causes diseases on several important crops including citrus variegated chlorosis (CVC) in orange and lime trees. Glutathione-S-transferases (GST) form a group of multifunctional isoenzymes that catalyzes both glutathione (GSH)-dependent conjugation and reduction reactions involved in the cellular detoxification of xenobiotic and endobiotic compounds. GSTs are the major detoxification enzymes found in the intracellular space and mainly in the cytosol from prokaryotes to mammals, and may be involved in the regulation of stress-activated signals by suppressing apoptosis signal-regulating kinase 1. In this study, we describe the cloning of the glutathione-S-transferase from X. fastidiosa into pET-28a(+) vector, its expression in Escherichia coli, purification and initial structural characterization. The purification of recombinant xfGST (rxfGST) to near homogeneity was achieved using affinity chromatography and size-exclusion chromatography (SEC). SEC demonstrated that rxfGST is a homodimer in solution. The secondary and tertiary structures of recombinant protein were analyzed by circular dichroism and fluorescence spectroscopy, respectively. The enzyme was assayed for activity and the results taken together indicated that rxfGST is a stable molecule, correctly folded, and highly active. Several members of the GST family have been extensively studied. However, xfGST is part of a less-studied subfamily which yet has not been structurally and biochemically characterized. In addition, these studies should provide a useful basis for future studies and biotechnological approaches of rxfGST. (C) 2008 Elsevier B.V. All rights reserved.

Accumulation of six metals in the mangrove crab Ucides cordatus (Crustacea: Ucididae) and its food source, the red mangrove Rhizophora mangle (Angiosperma: Rhizophoraceae)

The crab Ucides cordatus and the red mangrove Rhizophora mangle are endemic mangrove species and potential bio-accumulators of metals. This study quantified the accumulation of six metals (Cd, Cr, Cu, Hg, Mn and Pb) in different organs (claw muscle, hepatopancreas and gills) of U. cordatus, as well as in different maturation stages of the leaves (buds, green mature, and pre-abscission senescent) of R. mangle. Samples were collected from mangrove areas in Cubatao, state of Sao Paulo, a heavily polluted region in Brazil. Data for metal contents in leaves were evaluated by one-way ANOVA; while for crabs a factorial ANOVA was used to investigate the effect of different tissues, animal size and the interactions between them. Means were compared by Tukey test at five percent, and the association between the metal concentrations in each crab organ, depending on the size, was evaluated by Pearson's linear correlation coefficient (r). Concentrations of Pb and Hg were undetectable for the different leaf stages and crab tissues, while Cd concentrations were undetectable in the leaf stages. In general, the highest accumulation of metals in R. mangle leaves occurred in pre-abscission senescent and green mature leaves, except for Cu, which was found in the highest concentrations in buds and green mature leaves. For the crab, Cd, Cu, Cr and Mn were present in concentrations above the detection limit, with the highest accumulation in the hepatopancreas, followed by the gills. Cu was accumulated mostly in the gills. Patterns of bioaccumulation between the crab and the mangrove tree differed for each metal, probably due to the specific requirements of each organism for essential metals. However, there was a close and direct relationship between metal accumulation in the mangrove trees and in the crabs feeding on them. Tissues of R. mangle leaves and U. cordatus proved effective for monitoring metals, acting as important bioindicators of mangrove areas contaminated by various metals. (C) 2012 Elsevier Inc. All rights reserved.