Browsing by Issue Date, starting with "2018-09-13"
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- Plan de movilidad urbana y espacios públicos sostenibles. Caso de estudio Bahía de CaráquezPublication . Gutierrez, Daniel Alfredo Delgado; Silva, Joao Pedro Cruz da; Fernández, Luis Santiago QuirozEl presente trabajo propone un Plan de Movilidad Urbana y Espacios Públicos Sostenibles para la ciudad de Bahía de Caráquez, ubicada en la provincia de Manabí, República del Ecuador. Para la definición del mismo, se realiza un análisis de los principales aspectos teóricos sobre la temática y se efectúa un diagnóstico integral de todos los componentes de la movilidad actual identificando las principales deficiencias generadas por los diversos tipos de transportes existentes. El Plan de Movilidad Urbana y Espacios Públicos Sostenibles propuesto aborda de manera integral las interrogantes sobre el transporte y movilidad, promoviendo el uso de un transporte urbano más sostenible y fomentando a la vez la actuación conjunta y coordinada de las distintas entidades administrativas pertinentes, incentiva la movilización no motorizada, el transporte público, el uso racional y adecuado del vehículo privado, promoviendo la preservación del medio ambiente y fomentando la identidad ecológica de la ciudad. El plan describe objetivos y directrices generales para el cambio en el modelo de transporte y movilidad actual de Bahía de Caráquez, de forma que los nuevos sistemas se rijan bajo criterios de sostenibilidad no solo en el ámbito económico, sino también en el aspecto social y ambiental, contribuyendo al desarrollo local y al aumento en la calidad de vida de sus ciudadanos en general.
- Consecuencias de cargas excesivas para los pavimentos de la red rodoviaria de EcuadorPublication . Moreira, John Jairo Molina; Silva, João Pedro Cruz da; Almeida, Arminda; Viteri, Carlos VillacresesThe present investigation makes the study of the structural consequences in the pavements of the road network of Ecuador due to heavy vehicles that circulate with excess loads, using mathematical calculations and a load simulation and efforts calculation software, with the purpose of determining the life span variation of pavements in several scenarios of traffic circulation, climatic conditions and thickness of asphalt layers. These scenarios of traffic circulation, climatic conditions and asphalt layers allow the understanding of the real conditions in asphalt layers of the weight loads and therefore their damage. This research thesis describes the historical background of the national road network, as well as the general objective and the specific objectives set and the methodology adopted to obtain the expected final results. It refers the theoretical concepts and the importance of a correct calculation of the damage to the pavement and the obtaining of the periods of useful life on the flexible pavements; also the characteristics of the national road network and the types of vehicles that circulate through it are exposed. TruckSim software was used for the heavy vehicles simulation and their loads by axis and type of vehicle for the several tragic and road circulation scenarios. All the comparison scenarios for obtaining asphalt load factors as well as the deformability modules and the calculation of the extensions in the critical points of the pavement were obtained using the KenPave software, with which it was possible to determine the number of equivalent axes for three different currents of vehicular traffic and a period of 20 years, obtaining a loss of useful life that varies between 19% and 37% when driving with excess load.
- Defining clinical conditions in long-term healthcare as a first step to implement Time-Driven Activity Based Costing (TDABC)Publication . Querido, Ana; Sargento, Ana; Santos, Isa; Carvalho, Henrique; Reis, Catarina; Frederico, Manuela; Maximiano, Marisa; Oliveira, Sandra; Leal, SusanaBackground Increasing healthcare costs is a concern of all developed countries. In Long-Term Healthcare (LTH) this is reinforced by population ageing and corresponding prevalence of chronic diseases. Thus, it is fundamental to accurately measure costs and outcomes in healthcare, improving value created for patients, i.e., patientcentred health outcomes per monetary unit of cost [1, 2]. TDABC methodology applied to healthcare allows identifying the cost for each clinical condition in the full cycle of care, mapping processes, activities, resources and allocated time [3–5]. It has been mostly applied in acute-care settings, partly due to complexity of defining chronic condition [6]. Objective This paper focuses on the cost component of a larger on-going research project (CARE4VALUE), aiming to enhance value creation in LTH providers and applied to a partner LTH unit. Specifically, the main objective is to define clinical conditions in the context of LTH, as a first step in the implementation of TDBAC. Methods Mixed qualitative and quantitative methods were applied, including: 1) three focus groups conducted with the health team of the LTH unit (physician, nurses, physiotherapist, psychologist, social assistant) to select, discuss and validate the criteria to define clinical conditions; 2) construction of a composite indicator and testing it over a sample of anonymized clinical data from 21 patients; 3) structured observation of processes taken throughout the full cycle of care of patients in different conditions. Qualitative data was submitted to content analysis and validated among participants. Quantitative data used in the composite indicator, based on validated scales, was subject to normalization, aggregation and sensitivity analysis. Results One consensual outcome of the focus groups was that, in LTH, the disease or cause of entrance is less relevant to costs than the overall complexity of the patient, entailing psychical, social, spiritual and psychic-mental dimensions. Accordingly, a multidimensional classification model of patients in four complexity levels was delivered, after being validated and receiving consensus from the LTH team. Additionally, it will include a logging tool and dashboard to integrate separate patient-centred information and aid patient classification in complexity conditions. BMC Health Services Research 2018, 18(Suppl 2):684 Page 75 of 183 Conclusions The completion of this step allowed progressing in the design and implementation of the cost model, which, in turn, will support value measurement, and enhancing of the focus LTH unit. Besides, all involved professionals stated that their engagement in this phase of the project generated exceptional opportunities for interdisciplinary meetings and debate, contributing to closer ties between different areas of LTH.