Background Little is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety programme for paediatric care in Guatemala. Methods We used a mixed methods design to examine the implementation of a patient safety programme across 11 paediatric units at the Roosevelt Hospital in Guatemala. The safety programme included: (1) tools to measure and foster safety culture, (2) education of patient safety, (3) local leadership engagement, (4) safety event reporting systems, and (5) quality improvement interventions. Key informant staff (n=82) participated in qualitative interviews and quantitative surveys to identify implementation challenges early during programme deployment from May to July 2018, with follow-up focus group discussions in two units 1 year later to identify opportunities for programme modification. Data were analysed using thematic analysis, and integrated using triangulation, complementarity and expansion to identify emerging themes using the Consolidated Framework for Implementation Research. Salience levels were reported according to coding frequency, with valence levels measured to characterise the degree to which each construct impacted implementation. Results We found several facilitators to safety programme implementation, including high staff receptivity, orientation towards patient-centredness and a desire for protocols. Key barriers included competing clinical demands, lack of knowledge about patient safety, limited governance, human factors and poor organisational incentives. Modifications included use of tools for staff recognition, integration of education into error reporting mechanisms and designation of trained champions to lead unit-based safety interventions. Conclusion Implementation of safety programmes in low-resource settings requires recognition of facilitators such as staff receptivity and patient-centredness as well as barriers such as lack of training in patient safety and poor organisational incentives. Embedding an implementation analysis during programme deployment allows for programme modification to enhance successful implementation.

National forest inventories (NFIs) are a reliable source for national forest measurements. However, they are usually not developed for linking with remotely sensed (RS) biomass information. There are increasing needs and opportunities to facilitate this link towards better global and national biomass estimation. Thus, it is important to study and understand NFI characteristics relating to their integration with space-based products; in particular for the tropics where NFIs are quite recent, less frequent, and partially incomplete in several countries. Here, we (1) assessed NFIs in terms of their availability, temporal distribution, and extent in 236 countries from FAO's Global Forest Resources Assessment (FRA) 2020; (2) compared national forest biomass estimates in 2018 from FRA and global space-based Climate Change Initiative (CCI) product in 182 countries considering NFI availability and temporality; and (3) analyzed the latest NFI design characteristics in 46 tropical countries relating to their integration with space-based biomass datasets. We observed significant NFI availability globally and multiple NFIs were mostly found in temperate and boreal countries while most of the single NFI countries (94 %) were in the tropics. The latest NFIs were more recent in the tropics and many countries (35) implemented NFIs from 2016 onwards. The increasing availability and update of NFIs create new opportunities for integration with space-based data at the national level. This is supported by the agreement we found between country biomass estimates for 2018 from FRA and CCI product, with a significantly higher correlation in countries with recent NFIs. We observed that NFI designs varied greatly in tropical countries. For example, the size of the plots ranged from 0.01 to 1 ha and more than three-quarters of the countries had smaller plots of ≤0.25 ha. The existing NFI designs could pose specific challenges for statistical integration with RS data in the tropics. Future NFI and space-based efforts should aim towards a more integrated approach taking advantage of both data streams to improve national estimates and help future data harmonization efforts. Regular NFI efforts can be expanded with the inclusion of some super-site plots to enhance data integration with currently available space-based applications. Issues related to cost implications versus improvements in the accuracy, timeliness, and sustainability of national forest biomass estimation should be further explored.

Background The implementation of programs to improve patient safety remains challenging in low- and middle-income countries. The goal of our study was to define the barriers and facilitators to implementation of a perioperative patient safety program in Guatemala. Material and methods We conducted semi-structured interviews with 16 staff pre-intervention and a follow-up focus group discussion 1 year later in the perioperative department at the Roosevelt Hospital in Guatemala. We performed qualitative thematic analysis to identify barriers and facilitators to the implementation process, with analysis guided by the Consolidated Framework for Implementation Research. Results We found several dominant themes affecting implementation of a patient safety program. Implementation facilitators included strong prioritization of patient needs, program compatibility with existing workflow, and staff attributes. Barriers included a lack of knowledge about patient safety, limited resources, limited leadership engagement, and lack of formal implementation leaders. Several program modifications were made to enhance successful implementation iteratively during the implementation process. Discussion Our analysis highlights several dominant themes which affect the implementation of a perioperative safety program in Guatemala. Understanding the barriers and facilitators to implementation during program deployment allows for program modification and improvement of the implementation process itself.

Programmes to modify the safety culture have led to lasting improvements in patient safety and quality of care in high-income settings around the world, although their use in low-income and middle-income countries (LMICs) has been limited. This analysis explores (1) how to measure the safety culture using a health culture survey in an LMIC and (2) how to use survey data to develop targeted safety initiatives using a paediatric nephrology unit in Guatemala as a field test case. We used the Safety, Communication, Operational Reliability, and Engagement survey to assess staff views towards 13 health climate and engagement domains. Domains with low scores included personal burnout, local leadership, teamwork and work-life balance. We held a series of debriefings to implement interventions targeted towards areas of need as defined by the survey. Programmes included the use of morning briefings, expansion of staff break resources and use of teamwork tools. Implementation challenges included the need for education of leadership, limited resources and hierarchical work relationships. This report can serve as an operational guide for providers in LMICs for use of a health culture survey to promote a strong safety culture and to guide their quality improvement and safety programmes.

The present paper analyzes the socioeconomic and educational factors associated to the academic performance of students who took the Saber Pro exam in 2009, according to gender and level of education. With this purpose in mind, certain data bases from ICFES were used and a data set with 4.031 observations was created. First, a descriptive analysis using frequency distributions was carried out. Next, the independence of variables was tested using the Pearson‘s chi-squared test. Then, a multiple linear regression analysis was conducted to determine the factors associated to the student’s academic performance according to gender and level of education. It was concluded that previous academic performance, measured by Saber 11 scores, is strongly and positively associated with the performance of higher education students, regardless their gender and level of education. On the other hand, socioeconomic and educational variables are weakly associated with the students’ performance in higher education as compared to their previous performance in high school education. Recibido: 20/12/2013 Evaluado: 23/02/2014 Factores asociados al desempeno academico segun nivel de formacion pregrado y genero de los estudiantes de educacion superior Colombia //Fatores associados ao desempenho academico segundo o nivel de formacao de graduacao e o sexo dos estudantes de educacao superior Colombia //Factors associated to academic performance according to level of education and gender among colombian higher education students

El presente artículo tiene como objetivo analizar los factores socio–económicos y educativos asociados con el desempeño académico según nivel de formación y género de los estudiantes que presentaron la prueba Saber Pro 2009. Para lo anterior, se utilizaron bases de datos suministradas por el ICFES, de las cuales se conformó una base de datos de trabajo con 4.031 observaciones. Inicialmente, se realiza un análisis de tipo descriptivo utilizando distribuciones de frecuencia y se continúa con un análisis inferencial, usando pruebas de hipótesis, para verificar la independencia entre variables. Posteriormente, se utiliza un análisis de regresión lineal múltiple para determinar los factores asociados al desempeño académico, según género y nivel de formación, de los estudiantes evaluados con la prueba Saber Pro 2009. Se concluye que el desempeño académico previo medido en los puntajes obtenidos en las pruebas Saber 11 está asociado fuerte y positivamente con el de desempeño de los estudiantes sin importar su género o nivel de formación. Por su parte, las variables socio-económicas y educativas estudiadas resultaron, en comparación con el desempeño previo, estar débilmente asociadas con el desempeño en la educación superior.

Effectiveness of silver sulfadiazine in reepithelization of hot liquid burns affecting neutral zones in children Background: The treatment of burn injuries with Silver Sulfadiazine is used in many burn centers. Objective: Determine the duration of clinical reepithelization in children treated with enriched Silver Sulfadiazine, according to sex, age, neutral zone burned (thorax - abdomen - limbs without joint damage), extention, presence of infections, bandage adherence and derivation to rehabilitation. Method: Retrospective review of 263 clinical records during 2004 that fulfilled the items for inclusion (children age under 15 yearsold, with burn injuries of partial thickness caused by scalding liquids, treated at COANIQUEM Acute Unit with Silver Sulfadiazine plus Lidocaine plus Vitamin A and not needing grafts). Normal and median position between period of clinical reepithelization and variables considered with p < 0.05 were proven. Results: The median for clinical reepithelization was 10 days (range 5 - 23); if rehabilitation was required: 15 days and not required: 9 days (p < 0.0001). Lower limbs, children under 5 years-old and girls need longer reepithelization time. 0.4% cases presented infections and 1.1% gauze adherence. Conclusions: Duration of clinical reepithelization with enriched Silver Sulfadiazine, associated to low infection rate and few adverse effects make it highly efficient for ambulatory treatments. (Key words: Children, partial thickness burns, scalding liquids, reepithelization time, Silver Sulfadiazine, effectiveness, neutral zone). Rev Chil Pediatr 2007; 78 (6): 607-614

Factors involved in wound healing and their interdependence are not yet fully understood; nevertheless, new prospects for therapy to favor speedy and optimal healing are emerging. Reports about wound healing modulation by local application of simple and natural agents abound even in the recent literature, however, most are anecdotal and lack solid scientific evidence. We describe the effect of silver sulfadiazine and moist exposed burn ointment (MEBO), a recently described burn ointment of herbal origin, on mast cells and several wound healing cytokines (bFGF, IL-1, TGF-β, and NGF) in the rabbit experimental burn model. The results demonstrate that various inflammatory cells, growth factors and cytokines present in the wound bed may be modulated by application of local agents with drastic effects on their expression dynamics with characteristic temporal and spatial regulation and changes in the expression pattern. Such data are likely to be important for the development of novel strategies for wound healing since they shed some light on the potential formulations of temporally and combinatory optimized therapeutic regimens.

A goal of a National Forest Inventory (NFI) is the provision of information which is relevant and required for national level decision making and monitoring in forestry, but also for related sectors.This paper presents and discusses a pilot study from Costa Rica where in 2000/2001 a low intensity sampling approach was used to generate national level forestry information. On a 15 km x 15 km grid air photo plots were interpreted for forest and land cover type. Readily available 1997 aerial photographs were used that were, however, only available for about 70% of the country: of the 228 grid points for the whole country only 159 could be aerial photo interpreted. Out of the 15 km x 15 km base grid of sample points, a 2 x 3 subset was selected for field assessment, resulting in a sample of 40 cluster plots, each comprising of four elongated rectangular sub-plots of 150 m x 20 m located on the perimeter of a square of 500 m side length.Two novel components were integrated into the inventory: (1) the field plots were established on all lands, so that the tree resource was not only tallied inside forests but also on all other tree-bearing lands outside forests. (2) In addition to the biophysical information gathered on the traditional field plots, interviews were carried out with forest owners on the site of the field plots. in order to obtain data on the use of the forest resource.Field work was carried out by 6 field crews and took altogether about 3 months. Results were generated from the field samples for the entire country. Aerial photo based area estimates were compared to the corresponding estimations from field sampling for the same area. According to the field sampling the forest cover for Costa Rica in 2001 is estimated to be 48.4% (simple standard error percent 9.3%). An estimated 8.2% of the total volume (dbh > 30 cm, all species) is outside forest.This inventory took place with support from Food and Agriculture Organization (FAO) in the framework of FAO-Forest Resources Assessment's (FRA) Program Support to National Forest Assessments: it was carried out jointly by Sistema Nacional de Areas de Conservacion (SINAC). the Costa Rican authority responsible for forestry issues, and Centro Agronomico de Investigacion y Ensenanza (CATIE), an international agricultural research center, Experiences of the study were subsequently used to implement similar inventories in three more countries (Guatemala, Cameroon, The Philippine). (c) 2005 Elsevier B.V. All rights reserved.

Desde finales de la década pasada, Guatemala se ha visto envuelta en acciones conservacionistas, que se ven reflejadas en la emisión del Decreto 68-89 de Ley de Protección y Mejoramiento del Medio Ambiente, Decreto 4-89 Ley de Areas Protegidas, Lista Roja de Fauna Silvestre para Guatemala ubicada en 1994 y 1996, ratificación de la Estrategia Global sobre Diversidad Biológica (21 febrero 1 995), etc. A pesar de ello, es sabido que en Guatemala son muchas las instituciones que colectan, manejan y generan información sobre fauna de nuestro país, amentablemente esta valiosa información se encuentra dispersa, aislada o poco accesible a otros investigadores, por lo que es difícil tener un panorama exacto del conocimiento faunístico en Guatemala. Viendo esta problemática, el CDC realizó desde febrero '995 hasta junio 1998 el proyecto “Evaluación y Conservación del Patrimonio Natural Faunístico en Peligro de Extinción de Guatemala (Fase i y 11)“, cofinanciado por varias instituciones de investigación del país. El objetivo de este proyecto fue recopilar los zatos de diversidad, ecología y distribución de la fauna ’".acional con énfasis en aquellas en peligro de extinción o ara ordenar y sistematizar toda la información, con el fin de que su manejo sea práctico y útil a usuarios y tomadores de decisiones.

Forest inventories are more and more developing towards more comprehensive natural resources inventories, broadening their scope in two major manners: (1) by inclusion of additional non-traditional variables (such as biodiversity, forest functions, socio-economic attributes), and (2) by expanding the target population towards non-traditional objects like non-wood forest products, and trees outside the forest. This paper focuses on tree resources outside the forest (TROF). Though it is largely accepted that TROF play a relevant role, ecologically and economically, in quantitative and in qualitative terms, already now and likely even more in the future, the availability of hard data is surprisingly limited, particularly when it comes to quantify this resource for larger areas. Those data, however, would be helpful and necessary to formulate and monitor policies and management strategies for this resource. Data generating activities, such as TROF inventories - stand-alone, or integrated into other natural resources inventories - ma y provide the required information. Though, in principle, tree resources outside the forest do have much in common with the forest resource, there are a series of differences that do also affect inventory planning and implementation. In this paper, we discuss the principal characteristics of TROF that are relevant for inventory planning and implementation, and compare it with experiences from forest inventories. We present preliminary results from a EU funded research project in which inventory techniques for large area assessment of TROF are devised.