ResumenLa estancia hospitalaria prolongada constituye una preocupación mundial, ya que genera efectos negativos en el sistema de salud como, por ejemplo: aumento en los costos, deficiente accesibilidad a los servicios de hospitalización, saturación de las urgencias y riesgos de eventos adversos. El presente trabajo presenta una investigación que enumera las causas más comunes encontradas en la prolongación de la estancia y las metodologías de logística hospitalaria más aplicadas para su estudio y mejoramiento. Resultados: los factores causales de estancias prolongadas más encontrados en la literatura son: demora en la realización de procedimientos quirúrgicos y diagnósticos, necesidad de atención en otro nivel de complejidad, situación sociofamiliar y edad del paciente. Se concluye que para analizar el problema de la estancia hospitalaria es conveniente realizar un "ajuste por riesgo", utilizando el método de grupo relacionado de diagnóstico (grd) y que una metodología adecuada es la simulación, para la identificación de cuellos de botella.Palabras clave: estancia hospitalaria; grupo relacionado de diagnóstico; flujo del paciente; logística hospitalaria; gestión de camas; procesos asistenciales AbstractProlonged hospitalization constitutes a grave concern worldwide because it generates negative effects on the health system such as, for example: increase in costs, deficient accessibility to hospitalization services, overload of emergency services, and the risk of adverse effects. This work presents a research that lists the most common causes found in the extension of the hospitalizations and the most applied hospital logistic methodologies for its study and improvement. Results: The causal agents of extended hospitalizations found with higher frequency in literature are: delay in the performance of surgical and diagnostic procedures; need for attention in another complexity level; social-family situation, and the age of the patient. We conclude that to analyze the problem of hospitalizations it is convenient to perform an "adjustment for risk", using the method of the related diagnosis group (grd), and simulations are an appropriate methodology to identify bottlenecks. ResumoA estancia hospitalar prolongada constitui uma preocupação mundial pois gera efeitos negativos no sistema de saúde como, por exemplo: aumento nos custos, deficiente acessibilidade aos serviços de hospitalização, saturação das urgências e risco de eventos adversos. O presente trabalho apresenta pesquisa que enumera as causas mais comuns encontradas na prolongação da estância e as metodologias de logística hospitalar mais aplicadas para o seu estudo e melhoramento. Resultados: os fatores causais de estâncias prolongadas mais encontrados na literatura são: demora na realização de procedimentos cirúrgicos e diagnósticos, necessidade de atendimento em outros níveis de complexidade, situação sociofamiliar e idade do paciente. Conclui-se que para analisar o problema da estância hospitalar é conveniente realizar um "ajuste por risco", utilizando o mé...

In this work, the effect of the incorporation of leather wastes from chrome tanning on the mechanical and rheometric properties of natural rubber-based composite was evaluated. Chrome content in leather wastes diminished as a result of a chemical treatment with a sodium bicarbonate solution. The treatment also improved the tensile properties of composites with 0, 20 and 40 parts per hundred rubber of leather wastes with particle size between 590 and 840 µm. In a second stage of the experimental work, 0, 20, 40, 60, 80 and 100 parts per hundred rubber of chemically treated leather wastes with particle size between 297 and 590 µm were incorporated to the same natural rubber compound studied in the first part of this study. All the composites were prepared in a torque rheometer, seeking to determine their rheological behaviour during mixing. Rheometric properties of all the composites during curing were monitored in a moving die rheometer. Tensile properties, tear strength, hardness, compressive modulus, compression-set, abrasive wear resistance and De Mattia flexing fatigue resistance for composites obtained in the second experimental set of this work were evaluated. It was found that leather wastes improved the hardness, stiffness, tear strength and abrasive wear resistance on the composites. However, elongation at break, flexural fatigue and tensile strength diminished when a large quantity of wastes was incorporated.

Biopolymers as polylactic acid (PLA) have some drawbacks in processing and the final product is characterized by a high permeability to steam/gases and low thermal and mechanical resistance. The addition of reinforcement materials in the biopolymer matrix provides opportunities to minimize these disadvantages. Thus, this research focuses on the inclusion of non-wooden lignocellulosic fillers from bamboo Guadua angustifolia in a polymer matrix obtained from PLA. Three types of fillers were applied: sawdust, fiber from a Kraft process, and fiber with low lignin content. The blends of PLA reinforced with 5% organic fillers were performed on a torque rheometer at temperatures between 170 to 200℃ with the addition of glycerol as plasticizer and viscosity reducer of the system and maleic anhydride as compatibilizer. The evaluation on rheological, thermal, mechanical and morphological properties were investigated by rotational rheometry, differential scanning calorimetry (DSC), universal testing machine, wide angle X-ray diffraction (WAXD) and scanning electron microscopy (SEM). The results showed that the inclusion of the lignocellulosic material generated a positive response in obtaining polymeric biocomposite. The use of fibers subjected to a process of delignification with bleaching sequences OQPoPWa resulted in a greater influence on the mechanical strength, an adequate distribution of the fibers in the PLA matrix and the viscosity of the mixture.

Las urgencias médicas pueden saturarse debido a factores externos e internos al ser vicio. Esto se refleja en congestión, tiempos de espera elevados e insatisfacción de los usuarios. Identificar y simular estrategias para gestionar las urgencias médicas, procurando atenuar la saturación. Investigación exploratoria y analítica, con trabajo de campo en cuatro unidades de urgencias de Medellín y simulación de estrategias contra la saturación mediante dinámica de sistemas. Las estrategias utilizadas son: reorganizar el registro,remitir los pacientes que no requieren atención urgente, implementar consultorio fast-track e incrementar el traslado a pisos. Esta última es la estrategia más efectiva en la simulación. Aunque las estrategias de flujo pueden ayudar a resolver la saturación a partir de sus causas internas, como lo sugiere la literatura, su alcance es limitado. Se requieren estrategias de entrada, que no están al alcance del ser vicio, y estrategias de salida del sistema hospitalario. Es posible disminuir la saturación, concibiendo las urgencias y el hospitalcomo dos elementos de un mismo sistema, de modo que se agilice el flujo de pacientes y se cuente con oferta adecuada de camas hospitalarias sin sobredimensionar la capacidad instalada.

In this work, the evaluation of a post-industrial residue of coffee industry (coffee husk) as organic filler in functionalised linear low-density polyethylene matrix was investigated. The properties of these composites were compared with more widely used inorganic fillers, such as calcium carbonate and SiO 2 . All the composites were prepared by grafting of linear low-density polyethylene maleic anhydride and then by melt mixing of fillers. The rheological behaviour of the compounds during processing was established to evaluate the effects of a nanosized (SiO 2 ), micron sized calcium carbonate and coffee husk fillers. Additionally, thermal, morphological and mechanical properties of the polymer composites were evaluated. The results indicated an increase in tensile modulus and tensile strength resulting from incorporation of fillers in the polymer matrix. Some relevant modifications of melting temperature and crystallinity degree for coffee husk composites were observed, but not observed for inorganic fillers composites. The properties of the composites prepared with coffee husk were comparable to those obtained with inorganic fillers, demonstrating that this coffee residue can be used as filler for obtaining composites for many possible applications.