880 resultados para Small-sized hospitals
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This thesis explores how multinational corporations of different sizes create barriers to imitation and therefore sustain competitive advantage in rural and informal Base of the Pyramid economies. These markets require close cooperation with local partners in a dynamic environment that lacks imposable property rights and follows a different rationale than developed markets. In order to explore how competitive advantage is sustained by different sized multinational corporations at the Base of the Pyramid, the natural-resource-based view and the dynamic capabilities perspective are integrated. Based on this integration the natural-resource-based view is extended by identifying critical dynamic capabilities that are assumed to be sources of competitive advantage at the Base of the Pyramid. Further, a contrasting case study explores how the identified dynamic capabilities are protected and their competitive advantage is sustained by isolating mechanisms that create barriers to imitation for a small to medium sized and a large multinational corporation. The case study results give grounds to assume that most resource-based isolating mechanisms create barriers to imitation that are fairly high for large and established multinational corporations that operate at the rural Base of the Pyramid and have a high product and business model complexity. On the contrary, barriers to imitation were found to be lower for young and small to medium sized multinational corporations with low product and business model complexity that according to some authors represent the majority of rural Base of the Pyramid companies. Particularly for small to medium sized multinational corporations the case study finds a relationship- and transaction-based unwillingness of local partners to act opportunistically rather than a resource-based inability to imitate. By offering an explanation of sustained competitive advantage for small to medium sized multinational corporations at the rural Base of the Pyramid this thesis closes an important research gap and recommends to include institutional and transaction-based research perspectives.
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Comparing the experiences of selected Latin America and the Caribbean countries and their trajectories over the past 15 years offers rich insights into the dynamics and causes for not meeting the 2015 MDGs. They also offer clues for post-MDG strategies. Central to achieving sustainable growth are government policies able to support small and medium-sized farms and peasants, as they are crucial for the achievement of several goals, centrally: to achieve food security; to provide a sound and stable rural environment able to resist external (financial) shocks; to secure healthy food; to secure local food; and to protect vibrant and culturally rich local communities. This paper analyses and compares the most successful government policies to the least successful policies carried out over the last 15 years in selected Latin American and Caribbean countries and based on this analysis, offers strategies for more promising post-MDG politics, able to reduce poverty, reduce inequality, fight back informality, and achieve more decent work in poor countries.
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In the midst of health care reform, Colombia has succeeded in increasing health insurance coverage and the quality of health care. In spite of this, efficiency continues to be a matter of concern, and small-area variations in health care are one of the plausible causes of such inefficiencies. In order to understand this issue, we use individual data of all births from a Contributory-Regimen insurer in Colombia. We perform two different specifications of a multilevel logistic regression model. Our results reveal that hospitals account for 20% of variation on the probability of performing cesarean sections. Geographic area only explains 1/3 of the variance attributable to the hospital. Furthermore, some variables from both demand and supply sides are found to be also relevant on the probability of undergoing cesarean sections. This paper contributes to previous research by using a hierarchical model and by defining hospitals as cluster. Moreover, we also include clinical and supply induced demand variables.
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Epidemiological studies and healthy eating guidelines suggest a positive correlation between ingestion of whole grain cereal and food rich in fibre with protection from chronic diseases. The prebiotic potential of whole grains may be related, however, little is known about the microbiota modulatory capability of oat grain or the impact processing has on this ability. In this study the fermentation profile of whole grain oat flakes, processed to produce two different sized flakes (small and large), by human faecal microbiota was investigated in vitro. Simulated digestion and subsequent fermentation by gut bacteria was investigated using pH controlled faecal batch cultures inoculated with human faecal slurry. The different sized oat flakes, Oat 23’s (0.53–0.63 mm) and Oat 25’s/26’s (0.85–1.0 mm) were compared to oligofructose, a confirmed prebiotic, and cellulose, a poorly fermented carbohydrate. Bacterial enumeration was carried out using the culture independent technique, fluorescent in situ hybridisation, and short chain fatty acid (SCFA) production monitored by gas chromatography. Significant changes in total bacterial populations were observed after 24 h incubation for all substrates except Oat 23’s and cellulose. Oats 23’s fermentation resulted in a significant increase in the Bacteroides–Prevotella group. Oligofructose and Oats 25’s/26’s produced significant increases in Bifidobacterium in the latter stages of fermentation while numbers declined for Oats 23’s between 5 h and 24 h. This is possibly due to the smaller surface area of the larger flakes inhibiting the simulated digestion, which may have resulted in increased levels of resistant starch (Bifidobacterium are known to ferment this dietary fibre). Fermentation of Oat 25’s/26’s resulted in a propionate rich SCFA profile and a significant increase in butyrate, which have both been linked to benefiting host health. The smaller sized oats did not produce a significant increase in butyrate concentration. This study shows for the first time the impact of oat grain on the microbial ecology of the human gut and its potential to beneficially modulate the gut microbiota through increasing Bifidobacterium population.
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Electrospinning is a technique employed to produce nanoscale to microscale sized fibres by the application of a high voltage to a spinneret containing a polymer solution. Here we examine how small angle neutron scattering data can be modelled to analyse the polymer chain conformation. We prepared 1:1 blends of deuterated and hydrogenated atactic-polystyrene fibres from solutions in N, N-Dimethylformamide and Methyl Ethyl Ketone. The fibres themselves often contain pores or voiding within the internal structure on the length scales that can interfere with scattering experiments. A model to fit the scattering data in order to obtain values for the radius of gyration of the polymer molecules within the fibres has been developed, that includes in the scattering from the voids. Using this model we find that the radius of gyration is 20% larger than in the bulk state and the chains are slightly extended parallel to the fibre axis.
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Lipid cubic phases are complex nanostructures that form naturally in a variety of biological systems, with applications including drug delivery and nanotemplating. Most X-ray scattering studies on lipid cubic phases have used unoriented polydomain samples as either bulk gels or suspensions of micrometer-sized cubosomes. We present a method of investigating cubic phases in a new form, as supported thin films that can be analyzed using grazing incidence small-angle X-ray scattering (GISAXS). We present GISAXS data on three lipid systems: phytantriol and two grades of monoolein (research and industrial). The use of thin films brings a number of advantages. First, the samples exhibit a high degree of uniaxial orientation about the substrate normal. Second, the new morphology allows precise control of the substrate mesophase geometry and lattice parameter using a controlled temperature and humidity environment, and we demonstrate the controllable formation of oriented diamond and gyroid inverse bicontinuous cubic along with lamellar phases. Finally, the thin film morphology allows the induction of reversible phase transitions between these mesophase structures by changes in humidity on subminute time scales, and we present timeresolved GISAXS data monitoring these transformations.
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Background: The identification of patterns of inappropriate antimicrobial prescriptions in hospitals contributes to the improvement of antimicrobial stewardship programs (ASP). Methods: We conducted a cross-sectional study to identify predictors of inappropriateness in requests for parenteral antimicrobials (RPAs) in a teaching hospital with 285 beds. We reviewed 25% of RPAs for therapeutic purposes from y 2005. Appropriateness was evaluated according to current guidelines for antimicrobial therapy. We assessed predictors of inappropriateness through univariate and multivariate models. RPAs classified as 'appropriate' or 'probably appropriate' were selected as controls. Case groups comprised inappropriate RPAs, either in general or for specific errors. Results: Nine hundred and sixty-three RPAs were evaluated, 34.6% of which were considered inappropriate. In the multivariate analysis, general predictors of inappropriateness were: prescription on week-ends/holidays (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.20-2.28, p = 0.002), patient in the intensive care unit (OR 1.57, 95% CI 1.11-2.23, p = 0.01), peritoneal infection (OR 2.15, 95% CI 1.27-3.65, p = 0.004), urinary tract infection (OR 1.89, 95% CI 1.25 -2.87, p = 0.01), combination therapy with 2 or more antimicrobials (OR 1.72, 95% CI 1.15-2.57, p = 0.008) and prescriptions including penicillins (OR 2.12, 95% CI 1.39-3.25, p = 0.001) or 1(st) generation cephalosporins (OR 1.74, 95% CI 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR 0.34, 95% CI 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR 0.04, 95% CI 0.01-0.26, p = 0.001) and requests for agents with an insufficient antimicrobial spectrum (OR 0.14, 95% CI 0.03-0.30, p = 0.01). Conclusions: Our results demonstrate the importance of previous consultation with an ID specialist in assuring the quality of prescriptions. Also, they highlight prescription patterns that should be approached by ASP policies.
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Baiting studies performed in large, medium and small hospitals in Brazil revealed the presence of 14 ant species, with up to nine recorded in one hospital. Dominant species were exotic ants, and in the large hospital, Tapinoma melanocephalum was the most prevalent. Ants were not uniformly spread through the hospitals, but tended to be found in the more critical areas, particularly in nursery, intensive care, obstetrics, neurology and dermatology units. Bacteriological studies using specific media for bacteria associated with intra-hospital infections indicated the potential for the mechanical vectoring of species of Staphylococcus, Serratia, Klebsiella, Acinetobacter, Enterobacter, Candida and Enterococcus by ants. Although T. melanocephalum did not have the highest rate of association with these bacteria, its ubiquitous occurrences resulted in the highest overall potential as a vector of these bacteria. Because of a large number of ant species occurring in Brazilian hospitals, ants pose a potential problem to the spread of diseases in hospitals. Because of the number of associated ant species in hospitals, the control of this potential problem is much more difficult than in registered temperate areas.
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Anodic aluminium oxide (AAO) films exhibiting a homogeneous morphology of parallel pores perpendicular to the surface were prepared in a two-step anodization process and filled with copper by electrochemical deposition. The optimum growth conditions for the formation of freestanding AAO films with hexagonal compact array of cylindrical pores were studied by field emission scanning electron microscopy and small angle X-ray scattering. The results show well-defined periodic structures with uniform pores size distribution for films with pore diameters between 40 and 70 nm prepared using different voltages and temperatures during the second anodization step. X-ray photoelectron spectroscopy and X-ray diffraction analysis of AAO films filled with copper show the formation of nanowires with high structural order, exhibiting a preferential crystalline orientation along the (2 2 0) axis and only small fraction of copper oxides. The best results for textured Cu nanowires were obtained at a reduction potential of -300 mV. (C) 2009 Elsevier Ltd. All rights reserved.
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In this paper we present technical and economic studies of cogeneration systems utilizing combustion engines and gas turbines, applied in two establishments of the tertiary sector, regarding Brazilian conditions (according to Silveria, 1994). In the first step cogeneration systems utilizing combustion engines associated to absorption refrigeration systems are studied, in which electricity and cold air for a university building rate produced. In the second step some possibilities of the use of the gas turbine in cogeneration systems for a hospital are shown. In this case, the exhaust gases are utilized for the production of steam in a heat recovery steam generator (HRSG) or cold water in an absorption refrigeration system (for air conditioning) for the hospital building. The dynamic increment of the energy demand of Brazilian tertiary sector in last years can increase the installation of these cogeneration system (in compact version) as well as strengthen the development of the decentralized energy generation in Brazil.
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In the Brazilian Atlantic forest (BAF) there are at least 57 rodent species and most of them are considered omnivorous. These species feed, more or less frequently, on fruits and seeds. Nevertheless the potential role of each species as frugivorous, seed predator or seed disperser is still unclear. In the present study we analyzed patterns of fruit and seed exploitation by eight small rodent species from an Atlantic Forest site. We offered to captive animals fruits of 30 plant species (23 genera, 15 families). After 48 h we recorded consumption patterns of pulp/aril and seed. Rodent species differed in their patterns of fruit and seed exploitation. The smallest species, Akodon serrensis, Oligoryzomys nigripes, and Wilfredomys pictipes (body size range : 26-45 g), and also the medium-sized Oecomys aff. concolor (84 g) fed mainly on pulp and also on small to medium-sized seeds (< 10 mm diameter). The medium-sized rodent, Oryzomys russatus (91 g) fed on pulp and also on seeds with diameter ≤ 15 mm. Thus larger seeds remain intact after being manipulated by such species. The medium-sized Delomys dorsalis (72 g) and the larger Trinomys iheringi (274 g) and Nectomys squamipes (253 g) form a third group, which consumed both fruit and seed of most species independent of their size. These later two species and also O. russatus are probably the main seed predators in the rodent community of the BAF.
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Includes bibliography
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Impacts of micrometeoroids on the surfaces of the plutonian small satellites Nix and Hydra can generate dust particles. Even in this region so far from the Sun these tiny ejected particles are under the effects of the solar radiation pressure. In this work, we investigate the orbital evolution of the escaping ejecta from both the small satellites under the effects of the radiation pressure combined with the gravitational effects of Pluto, Charon, Nix and Hydra. The mass production rate of micron-sized dust particles generated by micrometeoroids hitting the satellites is obtained, and numerical simulations are performed to derive the lifetime of the ejecta. These pieces of information allow us to estimate the optical depth of a putative ring, which extends from the orbits of Nix to Hydra. The ejected particles, between the orbits of Nix and Hydra, form a wide ring of about 16 000 km. Collisions with the massive bodies and escape from the system are mainly determined by the effects of the solar radiation pressure. This is an important loss mechanism, removing 30 per cent of the initial set of 1 μm-sized particles in 1 yr. The surviving particles form a ring too faint to be detectable with the derived maximum optical depth of 4 × 10-11. © 2013 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society.
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ECLACs International Trade and Integration Division (DCII) will launch the book titled Information Technology for Development of Small and Medium-sized Exporters in Latin America and East Asia in the end of September 2005. The report provides an overview of the present condition of Information Technology (IT) and its use to promote international trade. It focuses on the experiences of IT usage by small- and medium-sized enterprises (SMEs) in the Latin American and Asian-Pacific regions, with a special focus on SME exporters in the 13 researched countries, that were selected from the Forum for East Asia - Latin America Cooperation (FEALAC) member countries. This issue of the FAL bulletin is produced based on the executive summary of the book.
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Dynamic Asia has overtaken the European Union as Latin America and the Caribbean’s second largest export market, after the United States. However, the region’s exports to Asia remain concentrated in few commodities involving a small number of large firms. This book explores the present and future scope for the participation of small and medium-sized enterprises (SMEs) in biregional trade and value chains and the measures that can be taken to make those chains more inclusive and sustainable. SMEs have a low direct presence in the region’s export flows and their participation in the supplier networks of multinational companies is weak. This volume reviews several supplier development programmes (SDPs) adopted in various countries in Asia and Latin America to increase SME linkages with multinational firms. These programmes, many of which are public-private initiatives, aim to boost SME productivity and enhance their participation in value chains.