bluuebunny/crossref_metadata_2025 huggingface dataset:
Community Health Workers, Access to Care, and Service Utilization Among Florida Latinos: A Randomized Controlled Trial
Authors: Chang Aileen , Patberg Elizabeth , Cueto Victor , Li Hua , Singh Bhavana , Kenya Sonjia , Alonzo Yisel , Carrasquillo Olveen
Published: July 2018

Objectives. To determine whether a 1-year community health worker intervention improves access to care and service utilization among Latinos with diabetes.

Methods. We conducted a single-blind randomized trial of 300 adults with poorly controlled diabetes treated in 2 public hospital clinics in Miami, Florida. We began enrollment in 2010 and completed follow-up in 2015. We examined access and utilization using self-reported measures and data from electronic medical records.

Results. Participants randomized to the community health worker intervention self-reported fewer problems accessing needed care and prescriptions than did those in the usual care group (30% vs 43% and 28% vs 41%, respectively; P < .05 for both). Adjusting for age, gender, education, depression, and comorbidities showed similar results (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.29, 0.93 and OR = 0.45; CI = 0.24, 0.82, respectively). We found no significant utilization differences in primary care visits, emergency department utilization, or hospitalization between the 2 groups.

Conclusions. Among Latinos with poorly controlled diabetes, a 1-year community health worker intervention was associated with improvements in self-reported access to care but not service utilization.
A Community Health Worker Intervention to Increase Childhood Disease Treatment Coverage in Rural Liberia: A Controlled Before-and-After Evaluation
Authors: White Emily E. , Downey Jordan , Sathananthan Vidiya , Kanjee Zahir , Kenny Avi , Waters Ami , Rabinowich Jenny , Raghavan Mallika , Dorr Lorenzo , Halder Amal , Nyumah Joseph , Duokie Derry , Boima Tamba , Panjabi Raj , Siedner Mark J. , Kraemer John D.
Published: July 2018

Objectives. To assess a community health worker (CHW) program’s impact on childhood illness treatment in rural Liberia.

Methods. We deployed CHWs in half of Rivercess County in August 2015 with the other half constituting a comparison group until July 2016. All CHWs were provided cash incentives, supply chain support, and monthly clinical supervision. We conducted stratified cluster-sample population-based surveys at baseline (March–April 2015) and follow-up (April–June 2016) and performed a difference-in-differences analysis, adjusted by inverse probability of treatment weighting, to assess changes in treatment of fever, diarrhea, and acute respiratory infection by a qualified provider.

Results. We estimated a childhood treatment difference-in-differences of 56.4 percentage points (95% confidence interval [CI] = 36.4, 76.3). At follow-up, CHWs provided 57.6% (95% CI = 42.8, 71.2) of treatment in the intervention group. The difference-in-differences diarrhea oral rehydration therapy was 22.4 percentage points (95% CI = −0.7, 45.5).

Conclusions. Implementation of a CHW program in Rivercess County, Liberia, was associated with large, statistically significant improvements treatment by a qualified provider; however, improvements in correct diarrhea treatment were lower than improvements in coverage. Findings from this study offer support for expansion of Liberia’s new National Community Health Assistant Program.
Glenoid Bone Reaction to All-Soft Suture Anchors Used for Shoulder Labral Repairs
Authors: Tompane T. , Carney J. , Wu W.W. , Nguyen-Ta K. , Dewing C. , Provencher M. , McDonald L. , Gibson M. , LeClere L.
Published: July 2018

Background:

All-soft suture anchors (ASSAs) are commonly used for shoulder labral repair and capsulorrhaphy in patients with shoulder instability. While these anchors may have some specific advantages over other types of suture anchors, little is known about the prevalence and time-dependence of bone cyst formation and tunnel expansion after implantation of ASSAs. The aim of this study was to quantify the proportions of cyst formation and tunnel expansion around ASSAs and to characterize and test for differences in abnormalities observed at different postoperative time points.

Methods:

Thirty patients who were treated with arthroscopic shoulder stabilization surgery with ASSAs (1.4 mm; JuggerKnot, Biomet) underwent a computed tomography (CT) scan of the operatively treated shoulder at 1 month (10 patients), 6 months (10 patients), or 12 months (10 patients) postoperatively. Demographic and operative data were collected, and CT scans were evaluated for cyst formation, tunnel expansion, and tunnel volume measured in cubic millimeters. Statistical analyses were performed to detect differences in these outcomes among the follow-up groups. All shoulders were stable at all time points of the study, and there were no incidents of recurrent instability during the study period.

Results:

Ninety-one suture anchors were evaluated in 30 patients. Tunnel expansion was identified in the large majority of patients in the 6-month and 12-month follow-up groups, with a significant increase in these proportions compared with the 1-month follow-up group (p = 0.002). Mean tunnel volumes also significantly increased over the study period (p < 0.001). The presence of cyst formation was negligible in all 3 follow-up cohorts.

Conclusions:

This study demonstrated low rates of cyst formation but a significantly increased tunnel volume 6 and 12 months after shoulder labral surgery with ASSAs. There was no association with the initial tunnel location. Additional well-controlled studies with longer follow-up are needed to identify potential associations among tunnel expansion, intraoperative technique, and clinical outcomes.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Preoperative Opioid Use Is Associated with Higher Readmission and Revision Rates in Total Knee and Total Hip Arthroplasty
Authors: Weick Jack , Bawa Harpreet , Dirschl Douglas R. , Luu Hue H.
Published: July 2018

Background:

Prescription opioid use is epidemic in the U.S. Recently, an association was demonstrated between preoperative opioid use and increased health-care utilization following abdominal surgeries. Given that primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) are 2 of the most common surgical procedures in the U.S., we examined the association of preoperative opioid use with 30-day readmission and early revision rates.

Methods:

We reviewed 2003 to 2014 data from 2 Truven Health MarketScan databases (commercial insurance and Medicare plus commercial supplemental insurance). Subjects were included if they had a Current Procedural Terminology (CPT) code for primary TKA or THA and were continuously enrolled in the database for at least 6 months prior to the index procedure. Preoperative opioid prescriptions were identified using National Drug Codes (NDCs). Rates of 30-day readmissions and revision arthroplasty were identified and compared among patients with stratified durations of preoperative opioid use in the 6 months preceding TKA or THA.

Results:

The study included 324,154 patients in the 1-year follow-up group and 159,822 patients in the 3-year follow-up group. Opioid-naive TKA patients had a lower revision rate than did those with >60 days of preoperative opioid use (1-year cohort: 1.07% compared with 2.14%, p < 0.001; 3-year cohort: 2.58% compared with 5.00%, p < 0.001). A similar trend was noted among THA patients (1-year: 0.38% compared with 1.10%, p < 0.001; 3-year: 1.24% compared with 2.99%, p < 0.001). These trends persisted after adjusting for age, sex, and Charlson Comorbidity Index (CCI). The 30-day readmission rate after TKA or THA was significantly lower for patients with no preoperative opioid use compared with those with >60 days of preoperative opioid use (TKA: 4.82% compared with 6.17%, p < 0.001; THA: 3.71% compared with 5.85%, p < 0.001). Again, this association persisted after adjusting for age, sex, and CCI.

Conclusions:

Preoperative opioid use was associated with significantly increased risk of early revision and significantly increased risk of 30-day readmission after TKA and THA. This study illustrates the increased risk of poor outcomes and increased postoperative health-care utilization for patients with long-term opioid use prior to THA and TKA.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Policy of Regional Tourism Development
Authors: Sjafii Achmad , Pratiwi Ni Made Ida
Published: July 2018

In local autonomy era to achieve target of tourism development is required a strategy through policies and steps that must be implemented continuously. This policy is defined as a guide in conduct tourism both national and regional level. This paper is intended to explain the policy of East Java government in developing sustainable tourism. This qualitative research used literature approach. The data analysis used descriptive analysis. The results of this literature study showed that sustainable tourism development in the region has three dimensions, namely economic, socio-cultural, and environment. These dimensions are based on the principle of justice that not only benefits the present generation, but also future generations. In addition, important factor in the development of tourism is the supervision of standards and quality of tourism services.
Impact of Socio-Economics Tourism to Local Communities (Study on Fishing Tour of Delta Fishing Sidoarjo)
Authors: Choiriyah Ilmi Usrotin
Published: July 2018

Sidoarjo delta fishing becomes one of family destination that has consequences and impact on socio-economics of local tourism area. The purpose of this research is to identify the impacts or effects of fishing activities on the socio-economic life of local communities. This research method uses descriptive research type through qualitative approach. The results showed that the social impact of tourism activities on the local community, among others, the type of community work has more variation, development and improvement in the education level of local communities, as well as increasing the role and awareness of the community in maintaining the fishing tourist area of delta fishing Sidoarjo. Meanwhile, the economic impact of tourism activities include changes in the level of community income is quite significant on job opportunities and entrepreneurial communities.
Os Rolezinhos em Shopping Centers: Reflexões sobre o que Agregam e em que Desafiam os Estudos dos Shoppings como Espaços de Segregação Social e Urbana
Authors: Teixeira Juliana Cristina , Barros Amon Narciso de
Published: July 2018

O objetivo deste ensaio teórico é apresentar um breve panorama sobre o que os estudos que envolvem o espaço do shopping center (como os do campo da geografia urbana e os que estudam em geral as dinâmicas de segregação social nas cidades) já vinham discutindo a respeito de sua relação com o espaço urbano, com a segregação social, e com práticas culturais de consumo. Em seguida, como principal contribuição para a compreensão do fenômeno, refletir sobre o que os rolês agregam e em que desafiam os estudos sobre os shopping centers como espaços de segregação. Argumentamos que os rolês trazem novos elementos empíricos que reforçam a caracterização do shopping como espaço de segregação; e a caracterização dos espaços como estando envoltos por dinâmicas de significação, ressignificação e resistência.
Antimicrobial Resistance of Uropathogenic Escherichia coli from Elderly Patients at a General Hospital, Argentina
Authors: Delpech Gastón , Allende Natalia García , Lissarrague Sabina , Sparo Mónica
Published: July 2018

Background:

Urinary Tract Infection (UTI) is a common cause of morbidity and mortality in older adults.

Objective:

To investigate antimicrobial resistance of uropathogenic Escherichia coli from elderly patients in a General Hospital, Argentina.

Method:

During the period July 2011-July 2015, patients over 70 years old with urinary tract infections, without urinary catheters and with no antimicrobial therapy the previous week before sampling, were included. Phenotypic characterization was carried out. In vitro qualitative and quantitative antimicrobial resistances were investigated. Antimicrobials assayed: ampicillin, amoxicillin-clavulanate, cefazolin, cefuroxime, cefoxitin, cefotaxime, ceftazidime, cefepime, imipenem, ertapenem, gentamicin, nalidixic acid, ciprofloxacin, trimethoprim-sulfamethoxazole (TMS) and nitrofurantoin. Patients’ medical records were produced, and risk factors were analyzed by multivariate analysis.

Results:

768 bacterial isolates were identified as E. coli. Resistances to ampicillin (80.5%), nalidixic acid (61.7%), ciprofloxacin (42.8%), TMS (37.6%), amoxicillin-clavulanate (28.6%), cefazolin (21.6%), cefuroxime (20.7%), gentamicin (13.8%), cefotaxime (9.7%), ceftazidime (9.7%), cefepime (8.4%), cefoxitin (3.1%) and nitrofurantoin (2.3%) were observed. Resistance to carbapenems was not expressed. Production of extended spectrum β-lactamases was detected (7.6%) in community acquired (96%) and healthcare associated (4%) isolates. The independent risk factors for urinary infections produced by multi-resistant E. coli were: diabetes mellitus, recurrent infections, hospitalization during the last year and exposure to β-lactams in the last 3 months.

Conclusion:

A high prevalence of resistance to β-lactams and to other antimicrobials was observed. Detection of antimicrobial multi-resistant isolates highlights the need of antimicrobial resistance surveillance in elderly patients with urinary tract infections.
Factors in Pulmonary Embolus Diagnosis via CT Pulmonary Angiogram in Patients Undergoing Repair of Proximal Femur Fractures
Authors: Moriarty Peter , Moriarty Heather , Maher Michael , Harty James
Published: July 2018

Background:

As imaging technology improves small Pulmonary Emboli (PE) of debatable clinical relevance are increasingly detected leading to higher numbers of patients receiving anticoagulation. Although PE are an important cause of morbidity and mortality in patients undergoing repair of proximal femur fractures, this cohort of patients are at increased falls risk and are therefore largely unsuitable for long term anticoagulant therapy.

Objective:

1. To review sequential Computed Tomography Pulmonary Angiograms (CTPA) performed in patients who underwent repair of proximal femur fractures at our institution. 2. To establish the perioperative CT imaging performed.

Design:

A retrospective cross sectional study of all patients undergoing proximal femur fracture repair at a single tertiary referral.

Methods:

The theatre database was interrogated to reveal all patients undergoing proximal femur fracture repair over a 28 month period from 01/01/12 to 07/04/14 inclusive. This was cross-referenced with the Picture Archiving Communication System (PACS) to establish all imaging undertaken in the perioperative period. CTPA studies performed within the time period of 1 week prior to and 6 months post proximal femur fixation were included. CTPA studies and reports were assessed for quality and findings. D-Dimer results, if performed within 72 hours of the CTPA study, were recorded.

Results:

1388 patients underwent neck of femur fracture repair in the 28-month study period. Of this cohort 71 CTPA studies were performed in 71 patients (5.2%) with a mean age of 77.8 years (range 38 - 100). 53 (74.6%) of studies were negative for embolus and 17 (23.9%) studies revealed clot in a pulmonary artery (1 saddle embolus, 2 main pulmonary artery emboli, 7 lobar vessel emboli, 2 segmental artery emboli, 5 subsegmental emboli). Overall PE detection rate was 1.2% of our total study population. In all 71 studies, Houndsfield Unit (HU) in the main pulmonary artery (PA) was >200; which is considered to be of satisfactory quality to assess for segmental pulmonary emboli. 32% of patients had D Dimer levels performed, however no relationship with presence of PE on CTPA was demonstrated.

Conclusion:

The rate of positive CTPA studies in patients undergoing proximal femur fracture repair is 23.9% in our patient population, comparing favorably to published data. This is likely to reflect good compliance with prevention measures at ward level. D-Dimer results are unreliable for PE prediction.
Is it Possible to Recover Cardiac Functions After Total Knee Arthroplasty?
Authors: Arslan Aydın , Çuglan Bilal , Özkurt Bülent , Utkan Ali , Korkmaz Mehmet Fatih , Koca Tuba Tülay , Sevimli Resit
Published: July 2018

Background:

Patients suffering from knee osteoarthritis lead a less active life than their healthy peers. It is well known that insufficient physical activity is the most common cause of chronic diseases. However, there is not enough research to enlighten the effect of increased functional capacity on cardiac functions after Total Knee Arthroplasty (TKA). This study aimed to investigate whether the orthopedic surgeons can predict that the patients will be healthier after TKA in terms of cardiac functions or not?

Methods:

109 patients who underwent TKA were prospectively followed for one year. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short form 36 (SF-36) surveys, BMI measures, average step count per day, the six-minute walking test (6MWT), the Five-Times-Sit-to-Stand Test (FTSST) and Doppler echocardiography were performed both in the preoperative and postoperative period.

Results:

After TKA, there was a substantial improvement in terms of WOMAC and SF36 survey scores. The average step count increased from 2199.6±690.8 steps/day to 4124.3±1638.8 steps/day. 6MWT and FTSST improved significantly as well. The average brisk walking time was 174.23±95.11 minutes/week. The means of early and late mitral inflow velocity ratios (E/A and Em/Am ratios) increased from 0.71±0.12 to 0.77±0.13 and from 0.66±0.13 to 0.76± 0.15 at the first year follow-up visit, respectively (p<0.001).

Conclusion:

In the first year, objective physical capacity measures increased together with the expected improvements in disease-specific and generic measures. After TKA, left ventricular diastolic functions may be considered to have recovered in the light of the healing signsviaechocardiography.
Potential Dermal Exposure Assessment of Farmers to Herbicide Imazapic in an Agriculture Area
Authors: Mazlan Anis Zakiah , Hussain Hazilia , Mohamed Zawawi Mohamed Azwan
Published: July 2018

For decades, the percentage of pesticide usage has steadily increased in order to meet the demands of food production. The aim of this study is to estimate the risk posed towards farmers through exposure to surface water containing imazapic herbicide using dermal exposure assessment (DEA). For this purpose, hazard index (HI) value was calculated to estimate the risk posed towards the farmers. Although calculated HI showed a minimum level of risk, there are concerns toward the danger of long-term exposure to the farmers of an agricultural system that could affect their quality of life.
The Times They Are a-Changin� � Healthcare 4.0 is Coming! (Preprint)
Authors: Chen Chiehfeng , Loh El-Wui , Kuo Ken N. , Tam Ka-Wai
Published: July 2018

UNSTRUCTURED

The Industrial Revolution brought new economics and new epidemic patterns to the people, which formed the healthcare 1.0 that focused on public health solutions. The emergence of large production concept and technology brought healthcare to 2.0. Bigger hospitals and better medical education were established, and doctors were trained for specialty for better treatment quality. The size of computer shrunk. This allowed fast development of computer-based devices and information technology, leading the healthcare to 3.0. The initiation of smart medicine nowadays announces the arrival of healthcare 4.0 with new brain and new hands. It is an era of big revision of previous technologies, one of which is artificial intelligence which will lead humans to a new world that emphasizes more on advanced and continuous learnings.
Association of Inpatient Palliative Care with Health Care Utilization and Postdischarge Outcomes among Medicare Beneficiaries with End Stage Kidney Disease
Authors: Chettiar Alexis , Montez-Rath Maria , Liu Sai , Hall Yoshio N. , O’Hare Ann M. , Kurella Tamura Manjula
Published: July 2018

Background and objectives

Palliative care may improve quality of life and reduce the cost of care for patients with chronic illness, but utilization and cost implications of palliative care in ESKD have not been evaluated. We sought to determine the association of inpatient palliative care with health care utilization and postdischarge outcomes in ESKD.

Design, setting, participants, & measurements

In analyses stratified by whether patients died during the index hospitalization, we identified Medicare beneficiaries with ESKD who received inpatient palliative care, ascertained by provider specialty codes, between 2012 and 2013. These patients were matched to hospitalized patients who received usual care using propensity scores. Primary outcomes were length of stay and hospitalization costs. Secondary outcomes were 30-day readmission and hospice enrollment.

Results

Inpatient palliative care occurred in <1% of hospitalizations lasting >2 days. Among the decedent cohort (n=1308), inpatient palliative care was associated with a 21% shorter length of stay (−4.2 days; 95% confidence interval, −5.6 to −2.9 days) and 14% lower hospitalization costs (−$10,698; 95% confidence interval, −$17,553 to −$3843) compared with usual care. Among the nondecedent cohort (n=5024), inpatient palliative care was associated with no difference in length of stay (0.4 days; 95% confidence interval, −0.3 to 1.0 days) and 11% higher hospitalization costs ($4275; 95% confidence interval, $1984 to $6567) compared with usual care. In the 30-day postdischarge period, patients who received inpatient palliative care had higher likelihood of hospice enrollment (hazard ratio, 8.3; 95% confidence interval, 6.6 to 10.5) and lower likelihood of rehospitalization (hazard ratio, 0.8; 95% confidence interval, 0.7 to 0.9).

Conclusions

Among patients with ESKD who died in the hospital, inpatient palliative care was associated with shorter hospitalizations and lower costs. Among those who survived to discharge, inpatient palliative care was associated with no difference in length of stay and higher hospitalization costs but markedly higher hospice use and fewer readmissions after discharge.
Long-Term Administration of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease
Authors: Edwards Marie E. , Chebib Fouad T. , Irazabal Maria V. , Ofstie Troy G. , Bungum Lisa A. , Metzger Andrew J. , Senum Sarah R. , Hogan Marie C. , El-Zoghby Ziad M. , Kline Timothy L. , Harris Peter C. , Czerwiec Frank S. , Torres Vicente E.
Published: July 2018

Background and objectives

In the 3-year Tolvaptan Efficacy and Safety in Management of ADPKD and Its Outcomes (TEMPO) 3:4 and 1-year Replicating Evidence of Preserved Renal Function: an Investigation of Tolvaptan Safety and Efficacy in ADPKD (REPRISE) trials, tolvaptan slowed the decline of eGFR in patients with autosomal dominant polycystic kidney disease at early and later stages of CKD, respectively. Our objective was to ascertain whether the reduction associated with the administration of tolvaptan is sustained, cumulative, and likely to delay the need for kidney replacement therapy.

Design, setting, participants, & measurements

One hundred and twenty-eight patients with autosomal dominant polycystic kidney disease participated in clinical trials of tolvaptan at the Mayo Clinic. All had the opportunity to enroll into open-label extension studies. Twenty participated in short-term studies or received placebo only. The remaining 108 were analyzed for safety. Ninety seven patients treated with tolvaptan for ≥1 year (mean±SD, 4.6±2.8; range, 1.1–11.2) were analyzed for efficacy using three approaches: (1) comparison of eGFR slopes and outcome (33% reduction from baseline eGFR) to controls matched by sex, age, and baseline eGFR; (2) Stability of eGFR slopes with duration of follow-up; and (3) comparison of observed and predicted eGFRs at last follow-up.

Results

Patients treated with tolvaptan had lower eGFR slopes from baseline (mean±SD, −2.20±2.18 ml/min per 1.73 m2 per year) and from month 1 (mean±SD, −1.97±2.44 ml/min per 1.73 m2 per year) compared with controls (mean±SD, −3.50±2.09 ml/min per 1.73 m2 per year; P<0.001), and lower risk of a 33% reduction in eGFR (risk ratio, 0.63; 95% confidence interval, 0.38 to 0.98 from baseline; risk ratio, 0.53; 95% confidence interval, 0.31 to 0.85 from month 1). Annualized eGFR slopes of patients treated with tolvaptan did not change during follow-up and differences between observed and predicted eGFRs at last follow-up increased with duration of treatment.

Conclusions

Follow-up for up to 11.2 years (average 4.6 years) showed a sustained reduction in the annual rate of eGFR decline in patients treated with tolvaptan compared with controls and an increasing separation of eGFR values over time between the two groups.
Community Capacity Building for Energy Sovereignty: A First Nation Case Study
Authors: Rakshit Roopa , Shahi Chander , Smith M. A. (Peggy) , Cornwell Adam
Published: July 2018

Ontario’s 2017 Long-Term Energy Plan has identified the Wataynikaneyap Power transmission line as a priority project. The line will connect seventeen remote, off-grid, diesel-dependent First Nation communitiesin northwestern Ontario, Canada to the provincial grid. The province’s current energy mandates and policies commit program dollars to build the human capacities of the seventeen Wataynikaneyap Power communities through the Remote Electrification Readiness Program (RERP). This effort is part of growing interests, changing perspectives, and focus in the continuum of provincial strategies to encourage First Nations to meet their emerging energy transitional needs and to partake in the energy sector.

Capacity-building challenges are unique in the Wataynikaneyap Power communities because they experience higher levels of poverty and socio economic inequities, are subjected to antiquated and unjust institutional structures, are following a legal and self-governance status, and are maintaining distinct cultures and ways of life.

Capacity building as a concept is wide-ranging and offers a multitude of expressions and interpretations. For the Wataynikaneyap Power communities, capacity building has offered the opportunity to exert their inherent rights and to increase their participation in local and regional energy planning and development.
This community-based research is derived from grassroots ethnographic community observation. Through a case study of one of the Wataynikaneyap Power communities, Poplar Hill First Nation, the paper will: a) elucidate a working example of an Indigenous capacity-building process through the RERP; b) demonstrate that capacity development is a key building block for self-determination and to achieve energy sovereignty; and c) illustrate the broader scope of learnings and pathways to effective capacity building for Indigenous communities that will drive energy development initiatives and actions in Canada’s expansive energy sector.
Pemilihan Supplier dan Alokasi Order Asam Jawa Dengan Menggunakan Metode Fuzzy Ahp Dan Goal Programing
Authors: Mulasi Sebro
Published: July 2018

Supplier selection process was become important consideration to improve the efficiency of procurement department because the raw material cost could reach 70% of product cost.  The supplier selection process was multi-criteria problem involving qualitative and quantitative factors. The company often experienced shortage of  good quality tamarind  with a cheap price which companies often reject order from customers. Therefore the company should make a selective supplier selection and allocation of orders for optimum results by considering both qualitative and quantitative factors that can minimize the cost of purchase, maximizing the weight of suppliers and minimize the total defect order. This research will integrate supplier weight from Fuzzy Analytic Hierarchy Process and Goal Programming model for the final decision of supplier selection and allocation of orders. By running goal programming model give solution better than order allocation current model where it could reduce total cost of purchasing at Rp 130.000.000 to Rp 127.700.000 and reduce total of defect order at 4%  to 0,87%.
Estructura del ingreso y consumo de hogares rurales en diferentes regiones agro-económicas de Puebla, México.
Authors: Gurusamy Venkatesh , Jaramillo Villanueva José Luis , Jiménez Sánchez Leobardo , Martínez Carrera Daniel Claudio , Sánchez Hernández Miguel , Méndez Cadena Esther
Published: July 2018

La importancia del estudio del bienestar social de los hogares rurales a nivel municipal radica en que los resultados pueden ser usados para proponer estrategias de intervención específicas, atendiendo características productivas, socio-económicas y ambientales. Este estudio tuvo como objetivo calcular y analizar indicadores de bienestar socio-económico; pobreza y desigualdad del ingreso, y su relación con características sociodemográficas y productivas de los hogares rurales. Los datos se obtuvieron usando un cuestionario estructurado aplicado a una muestra de 141 hogares y a través de entrevistas en profundidad a informantes clave. Se utilizó un muestreo estadístico aleatorio simple. El tamaño de muestra se determinó con una confiabilidad de 95 % y una precisión de 5 %. El estudio se realizó en tres municipios del estado de Puebla: San Salvador el Verde, Tlapanalá, y Coatzingo. Los resultados indican que existen diferencias significativas en el ingreso y consumo de los hogares, explicado por la diversificación del ingreso, el acceso a activos productivos y por la calidad del temporal. La desigualdad, estimada por el índice de Gini, es alta; 0.502, 0.439, y 0.416 para San Salvador el Verde, Tlapanalá y Coatzingo, respectivamente. Los factores explicativos de la desigualdad son el valor de los activos de herencia, el índice de capital humano, y el valor de las transferencias a nivel municipal. El índice de pobreza para los tres municipios es mayor que el reportado por CONEVAL en 2014.
De campesinos indígenas a promotores de turismo. La experiencia del ejido San Cristóbal Hidalgo, México.
Authors: Félix Quezada María
Published: July 2018

En San Cristóbal, municipio de Cardonal, Hidalgo México se localiza la barranca de Tolantongo, considerada como única en su género en la entidad por sus especies botánicas, sus grutas y su río de aguas termales. Con estos recursos los ejidatarios crearon la â€œCooperativa Grutas Tolantongoâ€ para administrar y formalizar su proyecto turístico. Actualmente, San Cristóbal es uno de los principales destinos turísticos en Hidalgo; el proyecto ha detonado beneficios económicos para los ejidatarios y el resto de la población, y ha generado efectos multiplicadores a nivel regional. El objetivo de este artículo es analizar los factores que explican la conformación y la estructura organizativa de las grutas Tolantongo. Para ello se realizó investigación etnográfica entre mayo de 2011 a mayo de 2012, y julio y agosto de 2013; las técnicas utilizadas fueron la observación, la revisión documental y la entrevista. La evidencia empírica indica un proceso de apropiación de los recursos naturales, conciencia de su riqueza, defensa del territorio, un modelo de desarrollo alternativo y turismo comunitario donde la estructura comunitaria ancestral tiene un papel preeminente, todo ello en un contexto de tensiones latentes entre los principios comunitarios, la economía capitalista y con agentes externos como el gobierno e intereses particulares.
Burnout en médicos de un hospital del sector público en el Estado de Hidalgo.
Authors: Hernández García Tirso Javier
Published: July 2018

El Burnout se caracteriza por cansancio emocional, despersonalización y una baja realización personal. Este problema, derivado del estrés, se presenta frecuentemente en trabajadores del sector salud y es propiciado por diversos factores organizacionales, lo cual impide el desarrollo de un ambiente laboral armónico y una adecuada comunicación en los distintos niveles jerárquicos. El objetivo de este estudio consistió en determinar el grado de prevalencia de esta patología laboral en personal médico de un hospital del sector público en el Estado de Hidalgo, así como la relación que tiene con algunas variables demográficas y laborales. Se utilizó el instrumento desarrollado originalmente por Cristina Maslach en 1981, adaptado al contexto mexicano por Arana (2004). La muestra estuvo compuesta por 150 médicos y los principales resultados indican presencia de Burnout en la dimensión Agotamiento Emocional. Asimismo, se identificaron asociaciones significativas con variables como el género, la antigüedad en la institución y el turno de labores. Finalmente, existe la necesidad de realizar intervenciones dirigidas a prevenir la presencia del síndrome de Burnout en este tipo de personal.
El potencial territorial como factor del desarrollo. Modelo para la gestión rural.
Authors: Lee Cortés Jimena V. , Delgadillo Macías Javier
Published: July 2018

Ante los problemas que enfrenta el medio rural en la última década se han promovido instrumentos encaminados a su solución; sin embargo, los aportes institucionales han sido limitados y poco favorables para el mejor desenvolvimiento de los territorios. No obstante, se reconocen estos esfuerzos como referentes para la reorientación de la política pública dirigida al sector rural. El objetivo del trabajo es mostrar que los potenciales de desarrollo y los programas públicos con posible impacto requieren de propuestas metodológicas que sean sensibles a los componentes de la estructura productiva y social, y a los problemas que impiden mejorar las condiciones de vida de la población rural y promover el desarrollo territorial. Para ello se emplea un modelo de interacción socio-espacial que muestra las características de las actividades y recursos locales, así como del papel de la acción pública, social y privada como factores integradores de desarrollo de los territorios seleccionados.
La «DESINDUSTRIALIZACIÓN» en Colombia. Una verdad a medias que oculta la inequitativa distribución del valor agregado
Authors: Silva Colmenares Julio
Published: July 2018

Este artículo tiene como hipótesis que la «desindustrialización» en Colombia es una verdad a medias, sin que ello niegue la precaria situación de la industria. Para comprobar de manera empírica esta hipótesis se analiza la producción de los principales renglones y se compara su comportamiento en unidades físicas y en valores monetarios constantes, como una representación de los valores de uso y valores de cambio en la industria. Se comprueba que en 19 de los 28 renglones analizados, la producción en unidades físicas (valores de uso) aumentó a una tasa anual geométrica superior al incremento de la producción bruta en términos monetarios (valores de cambio, en precios constantes). Así pues, aunque la participación de la industria en el total del PIB se ha reducido, esto no se debe tanto a un proceso de desindustrialización, en sí, como a un mayor ritmo en el incremento de otras actividades económicas y a una reducción de costos unitarios por aumentos en la productividad bruta, en especial por cambios tecnológicos en los procesos, ya sea en la utilización del trabajo humano o en los insumos incorporados a la producción.
Pertinencia de los instrumentos de desarrollo empresarial ofertados por entidades que conforman la Comisión Regional de Competitividad e Innovación del departamento del Quindío
Authors: Cruz Díaz Joel , Blandón Lopez Alexander , Cruz Rincón Diego
Published: July 2018

El abordaje de la pertinencia de los instrumentos de desarrollo empresarial ofertados por las entidades que conforman la Comisión Regional de Competitividad e Innovación del Quindío, se hace con base en tres corrientes teóricas de la literatura académica: teorías y políticas de desarrollo local y regional, estrategias de competitividad y análisis de cadena de valor y clústeres. En el análisis de la información obtenida se pudo determinar que se están realizando ejercicios participativos de planificación estratégica con miras a fortalecer las capacidades competitivas de la estructura empresarial, pero la oferta de apoyos no tiene en cuenta la etapa del ciclo de vida de las empresas ni las especificidades del modelo de negocio donde compiten. También se evidencia la desarticulación interinstitucional y se refleja tímidamente en algunos sectores el enfoque orientado a incentivar interrelaciones entre empresas para estimular, fortalecer y desarrollar las capacidades competitivas. Finalmente es necesario crear un sistema territorial de información para estudiar las cadenas productivas y obtener datos estadísticos para diseñar las políticas de desarrollo productivo regional.
Teoría del Caos y Estrategia Empresarial
Authors: Martínez Moncaleano Carlos Javier
Published: July 2018

Este artículo propone un acercamiento de la teoría del caos a los modelos estratégicos empresariales. En primer lugar, se exponen algunos de los elementos fundamentales del caos, así, como de las ciencias de la complejidad en general, seguidamente, se plantean las nociones teóricas de la estrategia empresarial, considerando la enorme cantidad de variables que inciden en la organización y que condicionan sus diferentes atractores.
Emphasizing Mental Health in Nursing Education
Authors: Cavanaugh Sue
Published: July 2018

Becoming a psychiatric mental health (PMH) nurse wasn’t even on Natasha Churchill’s radar when she started nursing school. Her plan was to become a surgical nurse. Then she started her mental health rotation and something clicked. “On the first day, I thought, ‘Oh my gosh, this is what I want!’” After graduation, Churchill worked in mental health acute care for five years and is now a sessional faculty member at the Centre for Nursing Studies in St. John’s, where she facilitates mental health clinical placements.
Suicide Prevention and Postvention Innitiatives
Authors: Langille Jane
Published: July 2018

“Suicide is so final,” says Judy Dunn, whose son died by suicide. “You can’t take it back. It leaves a wake of devastation and countless people in great pain, becoming part of your life forever.” Dunn is an outreach man-ager with the Mood Disorders Association of Manitoba and co-founder of AndrewDunn.org, which works to raise awareness and reduce stigma about mental illness and suicide through education and fundraising activities.
March�s contest�s : contestations morales et populations vuln�rables
Authors: Steiner Philippe , Trespeuch Marie
Published: July 2018

La contestation morale favorise, retient ou bloque l��mergence des mar-ch�s contest�s sur lesquels sont commercialis�es les marchandises mo-ralement contest�es. Le pr�sent article �tudie les conditions qui permet-tent de rendre possible le fonctionnement de ces march�s et ceux qui en bloquent l�apparition. Nous proposons pour cela de concentrer l�attention sur les dispositifs qui rendent possible les transactions et sur les � popula-tions vuln�rables � que ces dispositifs se proposent de prot�ger du march� ou par le march�.
�Desta �gua n�o beberei e deste p�o n�o comerei�: negocia��es do comer e representa��es sociais dos riscos alimentares
Authors: Galindo Flavia , Portilho F�tima
Published: July 2018

As sociedades lidam de formas diversas com os riscos alimentares, construindo coletivamente diferentes percep��es sobre os mesmos. A partir do conceito de Food Safety, este di�rias artigo discute representa��es sociais do risco alimentar constru�das e negociadas nas rotinas. As an�lises adv�m de dados coletados em uma pesquisa densa de Grupo Focal que contou com a participa��o de 86 informantes. Como resultado da pesquisa, foram encontradas quatro representa��es sociais que revelam as l�gicas presentes na mem�ria coletiva das fam�lias, alicer�ando emo��es e impulsionando as a��es relativas ao comer: cidadania, desconfian�a, medo e impureza. Estas quatro representa��es sociais espelham valores �ticos, sociais e ambientais que modelam as preocupa��es e pr�ticas alimentares.
A partilha da dor: como pessoas e lugares se relacionam na Encosta da Serra, RS
Authors: Oliveira Everton De
Published: July 2018

Neste artigo analiso como a partilha da dor e do sofrimento atua enquanto o princ�pio motor da produ��o de pessoas e grupos em uma col�nia alem�, associados � principal preocupa��o �tica para seus moradores, o trabalho. Para tanto, parto de meu trabalho de campo realizado em um munic�pio que aqui chamo de S�o Martinho, de pouco mais de 6.000 habitantes, situado na regi�o da Encosta da Serra, RS. A aposta deste texto � que a dor e o sofrimento, relacionado ao ato de trabalhar, mais do que um estado a ser superado, formava e informava sobre grupos aparentados, em dois sentidos: em primeiro lugar, permitia a circula��o de aprecia��es morais, fundamentais nas distin��es e avalia��es de si; em segundo lugar, permitia a produ��o correlata de pessoas, est�rias e lugares na dor corporificada pela qual se constru�am as narrativas constitutivas de um passado singular, que moldava e se moldava ao cotidiano.�
A arte de falar mal dos outros e outras maledic�ncias: risos, pasquines e fofocas na comunidade Astrogilda Cafund� - Quilombo de Vargem Grande (RJ)
Authors: C�ceres Luz Stella Rodr�guez
Published: July 2018

Este artigo apresenta uma an�lise sobre a natureza da oralidade na comunidade Astrogilda Cafund� do Quilombo de Vargem Grande, localizado na zona oeste da cidade do Rio de Janeiro. Atos narrativos est�o presentes no cotidiano de trabalhos, festejos e lazer. A troca verbal das experi�ncias vividas promove a cria��o de uma comunidade narrativa que se expressa em v�rias situa��es que destacam a arte de relatar e conversar, onde al�m dos canais de sociabilidade se exp�e uma filosofia sobre a vida e o mundo existente e as rela��es sociais que os criam. Mediado pela narra��o o mundo � interpretado, ordenado e transmitido aos outros. A reflex�o explora n�o apenas o conte�do das narra��es, mas os formatos assumidos pelos atos narrativos tais como performances corporais, pasquins e fofocas. Em todos eles o riso e a irrever�ncia s�o ingredientes irresist�veis e onipresentes.
Uma trajet�ria antropol�gica: produ��o de conhecimento, responsabilidade social e �tica na pesquisa
Authors: O�Dwyer Eliane Cantarino
Published: July 2018

Este texto � uma vers�o resumida do Memorial defendido por Eliane Cantarino O�Dwyer em concurso�de acesso � classe de Professora Titular do Departamento de Antropologia da UFF em 2016.
�Televis�o para salvar": religi�o, m�dia e democracia no Brasil Contempor�neo
Authors: Cunha Christina Vital da
Published: July 2018

Nas �ltimas d�cadas, diferentes m�dias t�m sido alvo importante de propaganda institucional religiosa e de evangeliza��o. A m�dia televisiva, por ser identificada como �de massa�, � palco de disputas p�blicas recentes entre denomina��es evang�licas mais consolidadas no Brasil como Assembleia de Deus, Igreja Universal do Reino de Deus, Igreja Batista, entre algumas outras. Neste artigo pretendo refletir sobre sentidos atribu�dos por pol�ticos evang�licos � ocupa��o de espa�os na m�dia televisiva nacional e os jogos de revela��o e oculta��o do religioso nessas disputas com base em entrevistas e dados quantitativos coletados entre os anos 2007 e 2013 com apoio do ISER � Instituto de Estudos da Religi�o � e Funda��o Ford.
Sobre perman�ncias e transforma��es em contextos acad�mico-institutionais: um relato pessoal
Authors: Guedes Simoni Lahud
Published: July 2018

Esse texto � dedicado �queles colegas (professores e funcion�rios) com quem venho partilhando minha vida acad�mica. � dedicado tamb�m aos alunos que deram e d�o sentido a esta jornada, muitos deles hoje meus colegas.
The Role of Financial Sector Development in the Tourism- Growth Nexus: A Case of Southern African Countries
Authors: Tsaurai Kunofiwa
Published: July 2018

The study explored the impact of financial development on the tourism -growth nexus in Southern African (SADC) countries using the three panel data analysis approaches (pooled OLS, fixed and random effects). Specifically, the study investigated whether financial development is a channel through tourism influences economic growth in SADC countries or if the complementarity between financial development and tourism has a significant positive impact on economic growth in the SADC region? Theoretical and empirical literature review shows that the positive separate impact of tourism and financial development on economic growth is no longer a disputed matter. What has so far not been conclusively studied is whether financial management is a channel through which tourism influences economic growth. It is against this backdrop that the author undertook the current study in order to make a contribution to literature. The study found out that tourism had a significant negative influence on economic growth whereas financial development positively and significantly affected economic growth in the SADC region. The complementarity between tourism and financial development had a positive (fixed effects) and significant positive influence (pooled OLS and random effects) on economic growth in SADC countries, in line with theoretical predictions. SADC countries are therefore urged to improve their financial sector development levels in order to enhance the impact of tourism on economic growth.
Flexible Work Arrangements, Job Satisfaction and Performance
Authors: L. Govender , O. Migiro S. , K. Kyule A.
Published: July 2018

Flexible work arrangements (FWA) prefer to flexibility regarding an employeeâ€™s work location, working times and how much an employee works . FWA practices are designed to keep employees motivated and satisfied with work and non -work related roles. Existing empirical studies on the impact of flexible work arrangements on performance, and job satisfaction have mostly been conducted in developed countries. This paper sought to address this gap by undertaking a study in an organization specific context in a developing country, in particular Durban Westville Eskom, South Africa. The main aim of this paper was to establish the relationship between flexible work arrangements, performance and job satisfaction at Durban Westville Eskom shared services department. This paper is anchored on the two - factor theory, Vrooms expectancy theory, Role theory, and Spillover theory. The target population consisted of 120 employees reporting to revenue management shared services. Simple random sampling technique was used to determine the sample size whereby a sample of 92 employees was obtained . An online questionnaire was used to collect data from the sample. Data was analysed through descriptive statistics and correlation analysis. The findings show that a majority are satisfied with their current work arrangements, and that flexible work arrangement could make them stay with their current employer. In addition, it was found that performance and flexible work arrangement have a strong positive correlation. The study concluded that flexible work arrangements enhanced employee retention, and job satisfaction which led to higher productivity.