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5. La educación Socio-Integradora: Un enfoque participativo para la Convivencia Escolar

Author

Velasco Suárez Gonzalo Arnulfo, Sissy Elizabeth Rivas Muñoz, Edwin Francisco Meza Villares, Edgar Manuel Maldonado Naranjo, and Tatiana Gardenia Correa Aizaga

Subjects
General Medicine
Abstract

La finalidad epistémica de este artículo es comprender la educación y su enfoque participativo, como ese medio sistémico que integra y armoniza la convivencia escolar desde la integración familiar, dada su implicación en los sistemas de cambio y desarrollo integral. La primera, atiende la dinámica situacional y todo su componente cultural, familiar e institucional, develando las relaciones interpersonales desde una conciencia común de igualdad y respeto, donde la comunicación constituya ese mecanismo de concilio y superación. La segunda, posibilita el decantamiento de situaciones perturbadoras, limitantes del progreso personal, organizacional y académico en los estudiantes, al favorecerlos o encasillarlos en modélicas restrictivas por una asociación de controversias. Por ello, es impostergable construir una formación basada en el idealismo familiar, social y cultural, solo así, el conocimiento tendrá una implicación significativa.

Published
2023
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8. Kinematic Metrics from a Wireless Stylus Quantify Tremor and Bradykinesia in Parkinson’s Disease

Author

Andres Maldonado-Naranjo, Mandy Miller Koop, Olivia Hogue, Jay Alberts, and Andre Machado

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

A fundamental challenge in the clinical care of Parkinson disease (PD) is the current dependence on subjective evaluations of tremor and bradykinesia. New technologies offer the ability to evaluate motor deficits using purely objective measures. The aim of this study was to develop and evaluate the efficacy of a wireless stylus (Cleveland Clinic Stylus) with an embedded motion sensor to quantitatively assess tremor and bradykinesia in patients with PD with subthalamic nucleus (STN) deep brain stimulation (DBS). Twenty-one subjects were tested in various on and off DBS conditions while holding the Cleveland Clinic Stylus while at rest, maintaining a postural hold, and during a movement task. Kinematic metrics were calculated from the motion sensor data, including 3D angular velocity and 3D acceleration data, and were compared between the on and off conditions. Generalized estimating equations (GEEs) were used to determine the relationship between kinematic metrics and MDS-Unified Parkinson’s Disease Rating Scale Motor III (UPDRS-III) subscores. Kinematic metrics from the rest and postural tasks were significantly related to the UPDRS-III subscores of tremor (p

Published
2019
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10. Feasibility and performance of a frameless stereotactic system for targeting subcortical nuclei in nonhuman primates

Author

Leonardo A. Frizon, Adriana Regina Martin, Brett A Campbell, Kenneth B Baker, Andre G. Machado, Andres L. Maldonado-Naranjo, and Felipe Branco de Paiva

Subjects
Deep brain stimulation, medicine.medical_treatment, Deep Brain Stimulation, Functional neurosurgery, Basal Ganglia, Article, 03 medical and health sciences, 0302 clinical medicine, Imaging, Three-Dimensional, Subthalamic Nucleus, Medicine, Animals, Intraoperative imaging, Electrode placement, Neuronavigation, Observer Variation, business.industry, Cerebellar dentate nucleus, Brain, General Medicine, Macaca mulatta, Magnetic Resonance Imaging, Nonhuman primate, Electrodes, Implanted, Subthalamic nucleus, Macaca fascicularis, 030220 oncology & carcinogenesis, Feasibility Studies, Female, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Algorithms, Frameless stereotaxy, Biomedical engineering
Abstract

OBJECTIVE Deep brain stimulation (DBS) is an effective therapy for different neurological diseases, despite the lack of comprehension of its mechanism of action. The use of nonhuman primates (NHPs) has been historically important in advancing this field and presents a unique opportunity to uncover the therapeutic mechanisms of DBS, opening the way for optimization of current applications and the development of new ones. To be informative, research using NHPs should make use of appropriate electrode implantation tools. In the present work, the authors report on the feasibility and accuracy of targeting different deep brain regions in NHPs using a commercially available frameless stereotactic system (microTargeting platform). METHODS Seven NHPs were implanted with DBS electrodes, either in the subthalamic nucleus or in the cerebellar dentate nucleus. A microTargeting platform was designed for each animal and used to guide implantation of the electrode. Imaging studies were acquired preoperatively for each animal, and were subsequently analyzed by two independent evaluators to estimate the electrode placement error (EPE). The interobserver variability was assessed as well. RESULTS The radial and vector components of the EPE were estimated separately. The magnitude of the vector of EPE was 1.29 ± 0.41 mm and the mean radial EPE was 0.96 ± 0.63 mm. The interobserver variability was considered negligible. CONCLUSIONS These results reveal the suitability of this commercial system to enhance the surgical insertion of DBS leads in the primate brain, in comparison to rigid traditional frames. Furthermore, our results open up the possibility of performing frameless stereotaxy in primates without the necessity of relying on expensive methods based on intraoperative imaging.

Published
2019

13. The Safety and Efficacy of Using the O-Arm Intraoperative Imaging System for Deep Brain Stimulation Lead Implantation

Author

Andres L. Maldonado-Naranjo, Jianning Shao, Sean J. Nagel, Leonardo A. Frizon, Hubert H. Fernandez, Andre G. Machado, and Darlene A. Lobel

Subjects
Male, Parkinson's disease, Deep brain stimulation, medicine.medical_treatment, Deep Brain Stimulation, Statistics, Nonparametric, Cohort Studies, 03 medical and health sciences, Microelectrode recording, 0302 clinical medicine, Imaging, Three-Dimensional, medicine, Humans, 030212 general & internal medicine, Lead (electronics), Intraoperative imaging, business.industry, Parkinson Disease, General Medicine, medicine.disease, Magnetic Resonance Imaging, Microelectrode, Anesthesiology and Pain Medicine, Neurology, Anesthesia, Procedure Duration, Female, Neurology (clinical), business, Lead Placement, Tomography, X-Ray Computed, Microelectrodes, 030217 neurology & neurosurgery
Abstract

INTRODUCTION Accurate electrode implantation is a major goal of deep brain stimulation (DBS) surgery. Intraoperative physiology with microelectrode recording (MER) is routinely used to refine stereotactic accuracy during awake electrode implantation. Recently, portable imaging systems such as the O-arm have become widely available and can be used in isolation or in association with MER to guide DBS lead placement. The aim of this study was to evaluate how the routine use of the O-arm affected DBS surgery safety, efficiency, and outcomes. METHODS Two cohorts of patients with Parkinson's disease who underwent MER-guided awake subthalamic DBS lead implantation with and without O-arm were compared. We examined the total number of microelectrode and macroeletrode passes during each surgery, procedure duration, surgical complications, lead revisions, and motor outcomes. RESULTS A total of 50 procedures in 41 unique patients were analyzed, of which 26 were performed without O-arm and 24 performed without the O-arm. The mean number of microelectrode passes was 2.46 (SD = 0.99) in the group without O-arm utilization, compared to 1.29 (SD = 0.75) in the group with O-arm usage (p

Published
2017

14. Outcomes following deep brain stimulation lead revision or reimplantation for Parkinson's disease

Author

Jianning Shao, Leonardo A. Frizon, Andres L. Maldonado-Naranjo, Francis J. May, Sean J. Nagel, Hubert H. Fernandez, and Andre G. Machado

Subjects
medicine.medical_specialty, Deep brain stimulation, Parkinson's disease, Lead revision, business.industry, medicine.medical_treatment, General Medicine, Disease, medicine.disease, Surgery, medicine, Complication, Lead (electronics), Lead Placement, business, Device failure
Abstract

OBJECTIVEThe number of patients who benefit from deep brain stimulation (DBS) for Parkinson’s disease (PD) has increased significantly since the therapy was first approved by the FDA. Suboptimal outcomes, infection, or device failure are risks of the procedure and may require lead removal or repositioning. The authors present here the results of their series of revision and reimplantation surgeries.METHODSThe data were reviewed from all DBS intracranial lead removals, revisions, or reimplantations among patients with PD over a 6-year period at the authors’ institution. The indications for these procedures were categorized as infection, suboptimal outcome, and device failure. Motor outcomes as well as lead location were analyzed before removal and after reimplant or revision.RESULTSThe final sample included 25 patients who underwent 34 lead removals. Thirteen patients had 18 leads reimplanted after removal. There was significant improvement in the motor scores after revision surgery among the patients who had the lead revised for a suboptimal outcome (p = 0.025). The mean vector distance of the new lead location compared to the previous location was 2.16 mm (SD 1.17), measured on an axial plane 3.5 mm below the anterior commissure–posterior commissure line. When these leads were analyzed by subgroup, the mean distance was 1.67 mm (SD 0.83 mm) among patients treated for infection and 2.73 mm (SD 1.31 mm) for those with suboptimal outcomes.CONCLUSIONSPatients with PD who undergo reimplantation surgery due to suboptimal outcome may experience significant benefits. Reimplantation after surgical infection seems feasible and overall safe.

Published
2017

15. Disseminated cerebral toxoplasmosis in a patient with chronic lymphocytic leukemia

Author

Sean J. Nagel, Jordan Xu, Katherine Holman, Leonardo A. Frizon, Andres L. Maldonado-Naranjo, Kuruvilla John, and Rod J. Nault

Subjects
Pathology, medicine.medical_specialty, Biopsy, medicine.medical_treatment, Chronic lymphocytic leukemia, Central nervous system, Opportunistic Infections, Immunocompromised Host, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), medicine, Humans, Chemotherapy, medicine.diagnostic_test, business.industry, Brain biopsy, Immunosuppression, General Medicine, Middle Aged, medicine.disease, Leukemia, Lymphocytic, Chronic, B-Cell, Toxoplasmosis, Leukemia, medicine.anatomical_structure, Neurology, Toxoplasmosis, Cerebral, 030220 oncology & carcinogenesis, Female, Surgery, Neurology (clinical), business, 030215 immunology
Abstract

Infections are one of the most common causes of mortality in immunocompromised patients. In patients diagnosed with hematologic malignancies, treatment with stem cell transplants (SCT) or T-cell suppressing chemotherapy increases the risk of central nervous system (CNS) infections, of which toxoplasmosis is the most common. We report the case of a 63 year-old woman with chronic lymphocytic leukemia (CLL) that presented with gait instability and visual changes. Intracranial lesions were noted on initial neuro-imaging. A rapid decline in the patient's mental status warranted an urgent biopsy of the lesions that revealed tachyzoites consistent with toxoplasmosis. In the presence of diffuse brain lesions that lack a metastatic pattern or contrast enhancement, a common approach is to perform biopsy only after a battery of non-invasive testing. This diagnostic delay may take several days, exposing the patient to a rapidly fatal infection. This report illustrates the utility of early brain biopsy in high-risk patients with hematologic malignancies and CNS lesions.

Published
2018
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17. Subsequent Pulse Generator Replacement Surgery Does Not Increase the Infection Rate in Patients With Deep Brain Stimulator Systems: A Review of 1537 Unique Implants at a Single Center

Author

Erin Yamamoto, Andres L. Maldonado-Naranjo, Navin C. Sabharwal, Sean J. Nagel, Josephine Volovetz, Olivia Hogue, Darlene A. Lobel, Leonardo A. Frizon, Andre G. Machado, Jaes Jones, and Connor A. Wathen

Subjects
Male, Reoperation, medicine.medical_specialty, Movement disorders, Deep brain stimulation, medicine.medical_treatment, Deep Brain Stimulation, Single Center, Logistic regression, Deep brain stimulator, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Surgical Wound Infection, In patient, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, business.industry, General Medicine, Middle Aged, Infection rate, Surgery, Electrodes, Implanted, Anesthesiology and Pain Medicine, Neurology, Female, Neurology (clinical), Implant, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Introduction Deep brain stimulation (DBS) is a well-recognized treatment for patients with movement disorders and other neurological diseases. The implantable pulse generator (IPG) is a fundamental component of the DBS system. Although IPG implantation and replacement surgeries are comparatively minor procedures relative to the brain lead insertion, patients often require multiple IPG replacements during their lifetime with each operation carrying a small but possibly cumulative risk of complications. To better educate our patients and improve surgical outcomes, we reviewed our series of patients at our institution. Methods Using electronic health record data, we retrospectively reviewed all initial and subsequent IPG surgeries from patients who underwent at least one IPG surgery between the years of 2010 and 2015 at the Cleveland Clinic main campus. We calculated infection rates for initial IPG implantation surgeries and the infection rate for subsequent replacements. Fisher's exact tests were used to evaluate the chance of an infection between the initial implantation and replacement. Fisher's exact tests and simple logistic regression analyses were used to determine the predictive ability of selected demographic and clinical variables Results Our final sample included 697 patients and 1537 surgeries. For all patients, the infection rate at the first surgery was 2.01%; at the second surgery, it was 0.44%; and at the third surgery, it was 1.83%. When considering only patients that underwent at least three replacement surgeries (n = 114) the infection rate did not change in a significant manner with subsequent interventions compared to the first replacement. No other variable of interest was a significant predictor of infection. Conclusion We did not find increasing rates of infection with subsequent IPG replacement procedures.

Published
2016

18. 321 Subsequent Pulse Generator Replacement Surgery does not Increase the Infection Rate in Patients with Deep Brain Stimulator Systems: A Review of 1537 Unique Implants at a Single Center

Author

Frizon, Leonardo A, primary, Hogue, Olivia, additional, Wathen, Connor, additional, Yamamoto, Erin A, additional, Sabharwal, Navin C, additional, Jones, Jaes, additional, Volovetz, Josephine, additional, Maldonado-Naranjo, Andres, additional, Lobel, Darlene Angela, additional, Machado, Andre, additional, and Nagel, Sean J, additional

Published
2017
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19. 321 Subsequent Pulse Generator Replacement Surgery does not Increase the Infection Rate in Patients with Deep Brain Stimulator Systems

Author

Leonardo A. Frizon, Josephine Volovetz, Connor Wathen, Andres L. Maldonado-Naranjo, Olivia Hogue, Andre G. Machado, Darlene A. Lobel, Erin A Yamamoto, Jaes Jones, Navin C. Sabharwal, and Sean J. Nagel

Subjects
medicine.medical_specialty, business.industry, Pulse generator, medicine, Surgery, In patient, Neurology (clinical), Single Center, business, Deep brain stimulator, Infection rate
Published
2017
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20. Polyetheretherketone (PEEK) intervertebral cage as a cause of chronic systemic allergy: a case report

Author

Andres L. Maldonado-Naranjo, Andrew T. Healy, and Iain H. Kalfas

Subjects
Male, medicine.medical_specialty, Allergy, Polymers, Context (language use), Polyethylene Glycols, Benzophenones, Peek, Hypersensitivity, Medicine, Humans, Orthopedics and Sports Medicine, business.industry, Prostheses and Implants, Ketones, Middle Aged, medicine.disease, Spinal surgery, Surgery, Skin patch test, Spinal Fusion, Treatment Outcome, Orthopedic surgery, Cervical Vertebrae, Neurology (clinical), Implant, business, Cage
Abstract

Background context Polyetheretherketone (PEEK) is an organic polymer thermoplastic with strong mechanical and chemical resistance properties. It has been used in industry to fabricate items for demanding applications such as bearings, piston parts, compressor plate valves, and cable insulation. Since the early 1980s, polyetheretherketone polymers have been increasingly used in orthopedic and spinal surgery applications. Numerous studies and years of clinical experience have confirmed the biocompatibility of this material. Purpose The purpose of the study was to report a case of chronic systemic allergy after anterior cervical decompression and fusion (ACDF) and implantation of an intervertebral PEEK cage, with resolution of symptoms after removal of PEEK cage. Study design/setting This study is a case report with clinical evidence for allergy to PEEK. Methods The methods involve clinical findings and review of current literature. Results After ACDF and implantation of an intervertebral PEEK cage, the patient had developed an angioedema-like picture marked by severe redness, itching, swelling of his tongue, and skin thickening. A skin patch test was positive for PEEK. Removal of the implant resulted in the resolution of his allergy symptoms shortly after surgery. Conclusions Tissue reactions to PEEK are extremely rare. Herein, we present the first report of a chronic allergic response to interbody PEEK material.

Published
2014

22. Non-traumatic superior hypophyseal aneurysm with associated pseudoaneurysm presenting with massive epistaxis

Author

Andres L. Maldonado-Naranjo, Gábor Tóth, Mark Bain, and Varun R. Kshettry

Subjects
Nasal cavity, medicine.medical_specialty, Sphenoid Sinus, medicine.medical_treatment, Pituitary Diseases, Pseudoaneurysm, Aneurysm, Dural arteriovenous fistulas, medicine, Humans, cardiovascular diseases, Embolization, medicine.diagnostic_test, business.industry, Angiography, Digital Subtraction, Intracranial Aneurysm, General Medicine, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Embolization, Therapeutic, Surgery, Cerebral Angiography, Paranasal sinuses, medicine.anatomical_structure, Epistaxis, Treatment Outcome, cardiovascular system, Cauterization, Female, Neurology (clinical), business, Tomography, X-Ray Computed, Aneurysm, False, Cerebral angiography
Abstract

Although a common medical problem, epistaxis rarely requires eurosurgical intervention. Bleeding most commonly occurs from iesselbach’s plexus in the anterior septal area and usually resolves ith manual compression, vasoconstrictors, or simple nasal packng. Epistaxis from the posterior nasal cavity is more difficult to anage and if not resolved with conservative measures, sometimes equires endoscopic cauterization or endovascular embolization of he internal maxillary artery (IMA). Rare neurosurgical causes of pistaxis include traumatic and infectious pseudoaneurysms, cavrnous aneurysms, sellar tumors, and dural arteriovenous fistulas. The first case of massive epistaxis caused by an intracranial neurysm was published at a lecture at the Royal College of Sureons of England by Dr. Beadles in 1907 [1]. Since then, there ave been several reports of severe epistaxis from aneurysms r pseudoaneurysms eroding into the paranasal sinuses [2]. The ajority of these reports are extradural pseudoaneurysms of the C4 egment secondary to severe head trauma, particularly with fracures of the skull base [2]. Although extremely rare, non-traumatic neurysms or pseudoaneurysms causing massive epistaxis have lso been reported in the literature. Again, these are generally xtradural aneurysms most commonly of the C4 segment. Known auses include radiation, infection, and aneurysms associated with umors.

Published
2013

24. Proyecto de mejora de la gestión en la empresa Caja Municipal de Ahorro y Crédito Piura

Author

Chalco Flores, Víctor, Maldonado Naranjo, David Arturo, Pomasoncco Canchari, Alfredo Adolfo, Rosales Pereda, Vicente Linder, Chalco Flores, Víctor, Maldonado Naranjo, David Arturo, Pomasoncco Canchari, Alfredo Adolfo, and Rosales Pereda, Vicente Linder

Abstract

La Caja Piura es una institución financiera dedicada al otorgamiento de créditos a personas naturales y a micro y pequeñas empresas, así como a la captación de ahorros. Tiene como objetivo mejorar la calidad de vida de sus clientes, incrementando la bancarización en el país; en un contexto en el que el sistema financiero nacional vio crecer sus captaciones en 8.5% durante el año 2017 y las colocaciones en 5.3%. A través de un diagnóstico empresarial, se identificó que el problema principal de la Caja Piura es que su rendimiento sobre ventas es inferior al de sus competidores, debido, entre otras cosas, a sus altos costos de operación y a las elevadas tasas de morosidad. Mediante un análisis profundo, se descubrieron las siguientes causas principales: (a) el personal del Área de Créditos es medido solamente por la colocación de cartera o ventas y no por los índices de cobranza de los préstamos que ha colocado, (b) hay una excesiva división de tareas en el Área de Créditos, con repeticiones de trabajos, lo que trae altos costos administrativos; (c) no existe un proceso de cobranza preventiva, ni antes de que se venza el crédito ni durante los primeros 30 días de su vencimiento, lo cual genera cartera morosa; y (d) el personal de Recuperaciones está sobresaturado de casos, por lo que no se alcanzan a realizar la cantidad de visitas ni de contactos que establecen las hojas de rutas, ejerciendo poca presión de cobro sobre los clientes. Para reducir la morosidad y lograr un ahorro en cuentas incobrables que lleve al incremento de la rentabilidad, se proponen cambios tanto en el Área de Créditos como en la de Cobranzas. En créditos se tiene que hacer un rediseño de procesos, acompañado de la implementación de indicadores que permitan evaluar a cada ejecutivo a través de la recuperación de su cartera y no solo de la colocación. En cambio, dentro del Área de Cobranzas se debe implementar un proceso de cobro preventivo antes del vencimiento, así como durante los primeros 30 d, Caja Piura is a financial institution dedicated to the granting of loans to individuals and micro and small businesses. Its objective is to improve the quality of life of its clients, increasing the banking industry penetration in the country; in a context in which the national financial system saw its deposits grow by 8.5% during 2017 and loans by 5.3%. Through a business diagnosis, it was found that Caja Piura’s return over sales is lower than its competitors, becoming the main problem, which is due, among other things, to its high operating costs and high default rates. Through an in-depth analysis, it was discovered that the main causes of the problem are: (a) credit area’s personnel is only measured by the portfolio or sales placement and not by the collection rates of the loans they have placed; (b) there is an excessive division of tasks in the area of credits, with repetitions of work, which brings high administrative costs; (c) there is no preventive collection process, neither before the credit expires nor during the first 30 days of its expiration, which generates a delinquent portfolio; and (d) the recovery staff is overcrowded in cases, so that the number of visits and contacts established by the route sheets are not achieved, exerting little collection pressure on the clients. To reduce default rates and achieve cost savings that lead to increased profitability, changes are proposed in both the credit area and the collection area. In credits, a process redesign must be done, accompanied by the implementation of indicators that allow each executive to measure through the recovery of their portfolio and not just the placement. On the other hand, within the collections area, a preventive collection process must be implemented before expiration, as well as during the first 30 days of expiration, and the area must be reorganized to avoid inefficiencies and outsourcing calls to customers.

25. Proyecto de mejora de la gestión en la empresa Caja Municipal de Ahorro y Crédito Piura

Author

Chalco Flores, Víctor, Maldonado Naranjo, David Arturo, Pomasoncco Canchari, Alfredo Adolfo, Rosales Pereda, Vicente Linder, Chalco Flores, Víctor, Maldonado Naranjo, David Arturo, Pomasoncco Canchari, Alfredo Adolfo, and Rosales Pereda, Vicente Linder

Abstract

La Caja Piura es una institución financiera dedicada al otorgamiento de créditos a personas naturales y a micro y pequeñas empresas, así como a la captación de ahorros. Tiene como objetivo mejorar la calidad de vida de sus clientes, incrementando la bancarización en el país; en un contexto en el que el sistema financiero nacional vio crecer sus captaciones en 8.5% durante el año 2017 y las colocaciones en 5.3%. A través de un diagnóstico empresarial, se identificó que el problema principal de la Caja Piura es que su rendimiento sobre ventas es inferior al de sus competidores, debido, entre otras cosas, a sus altos costos de operación y a las elevadas tasas de morosidad. Mediante un análisis profundo, se descubrieron las siguientes causas principales: (a) el personal del Área de Créditos es medido solamente por la colocación de cartera o ventas y no por los índices de cobranza de los préstamos que ha colocado, (b) hay una excesiva división de tareas en el Área de Créditos, con repeticiones de trabajos, lo que trae altos costos administrativos; (c) no existe un proceso de cobranza preventiva, ni antes de que se venza el crédito ni durante los primeros 30 días de su vencimiento, lo cual genera cartera morosa; y (d) el personal de Recuperaciones está sobresaturado de casos, por lo que no se alcanzan a realizar la cantidad de visitas ni de contactos que establecen las hojas de rutas, ejerciendo poca presión de cobro sobre los clientes. Para reducir la morosidad y lograr un ahorro en cuentas incobrables que lleve al incremento de la rentabilidad, se proponen cambios tanto en el Área de Créditos como en la de Cobranzas. En créditos se tiene que hacer un rediseño de procesos, acompañado de la implementación de indicadores que permitan evaluar a cada ejecutivo a través de la recuperación de su cartera y no solo de la colocación. En cambio, dentro del Área de Cobranzas se debe implementar un proceso de cobro preventivo antes del vencimiento, así como durante los primeros 30 d, Caja Piura is a financial institution dedicated to the granting of loans to individuals and micro and small businesses. Its objective is to improve the quality of life of its clients, increasing the banking industry penetration in the country; in a context in which the national financial system saw its deposits grow by 8.5% during 2017 and loans by 5.3%. Through a business diagnosis, it was found that Caja Piura’s return over sales is lower than its competitors, becoming the main problem, which is due, among other things, to its high operating costs and high default rates. Through an in-depth analysis, it was discovered that the main causes of the problem are: (a) credit area’s personnel is only measured by the portfolio or sales placement and not by the collection rates of the loans they have placed; (b) there is an excessive division of tasks in the area of credits, with repetitions of work, which brings high administrative costs; (c) there is no preventive collection process, neither before the credit expires nor during the first 30 days of its expiration, which generates a delinquent portfolio; and (d) the recovery staff is overcrowded in cases, so that the number of visits and contacts established by the route sheets are not achieved, exerting little collection pressure on the clients. To reduce default rates and achieve cost savings that lead to increased profitability, changes are proposed in both the credit area and the collection area. In credits, a process redesign must be done, accompanied by the implementation of indicators that allow each executive to measure through the recovery of their portfolio and not just the placement. On the other hand, within the collections area, a preventive collection process must be implemented before expiration, as well as during the first 30 days of expiration, and the area must be reorganized to avoid inefficiencies and outsourcing calls to customers., Tesis

26. Proyecto de mejora de la gestión en la empresa Caja Municipal de Ahorro y Crédito Piura

Author

Chalco Flores, Víctor, Maldonado Naranjo, David Arturo, Pomasoncco Canchari, Alfredo Adolfo, Rosales Pereda, Vicente Linder, Chalco Flores, Víctor, Maldonado Naranjo, David Arturo, Pomasoncco Canchari, Alfredo Adolfo, and Rosales Pereda, Vicente Linder

Abstract

La Caja Piura es una institución financiera dedicada al otorgamiento de créditos a personas naturales y a micro y pequeñas empresas, así como a la captación de ahorros. Tiene como objetivo mejorar la calidad de vida de sus clientes, incrementando la bancarización en el país; en un contexto en el que el sistema financiero nacional vio crecer sus captaciones en 8.5% durante el año 2017 y las colocaciones en 5.3%. A través de un diagnóstico empresarial, se identificó que el problema principal de la Caja Piura es que su rendimiento sobre ventas es inferior al de sus competidores, debido, entre otras cosas, a sus altos costos de operación y a las elevadas tasas de morosidad. Mediante un análisis profundo, se descubrieron las siguientes causas principales: (a) el personal del Área de Créditos es medido solamente por la colocación de cartera o ventas y no por los índices de cobranza de los préstamos que ha colocado, (b) hay una excesiva división de tareas en el Área de Créditos, con repeticiones de trabajos, lo que trae altos costos administrativos; (c) no existe un proceso de cobranza preventiva, ni antes de que se venza el crédito ni durante los primeros 30 días de su vencimiento, lo cual genera cartera morosa; y (d) el personal de Recuperaciones está sobresaturado de casos, por lo que no se alcanzan a realizar la cantidad de visitas ni de contactos que establecen las hojas de rutas, ejerciendo poca presión de cobro sobre los clientes. Para reducir la morosidad y lograr un ahorro en cuentas incobrables que lleve al incremento de la rentabilidad, se proponen cambios tanto en el Área de Créditos como en la de Cobranzas. En créditos se tiene que hacer un rediseño de procesos, acompañado de la implementación de indicadores que permitan evaluar a cada ejecutivo a través de la recuperación de su cartera y no solo de la colocación. En cambio, dentro del Área de Cobranzas se debe implementar un proceso de cobro preventivo antes del vencimiento, así como durante los primeros 30 d, Caja Piura is a financial institution dedicated to the granting of loans to individuals and micro and small businesses. Its objective is to improve the quality of life of its clients, increasing the banking industry penetration in the country; in a context in which the national financial system saw its deposits grow by 8.5% during 2017 and loans by 5.3%. Through a business diagnosis, it was found that Caja Piura’s return over sales is lower than its competitors, becoming the main problem, which is due, among other things, to its high operating costs and high default rates. Through an in-depth analysis, it was discovered that the main causes of the problem are: (a) credit area’s personnel is only measured by the portfolio or sales placement and not by the collection rates of the loans they have placed; (b) there is an excessive division of tasks in the area of credits, with repetitions of work, which brings high administrative costs; (c) there is no preventive collection process, neither before the credit expires nor during the first 30 days of its expiration, which generates a delinquent portfolio; and (d) the recovery staff is overcrowded in cases, so that the number of visits and contacts established by the route sheets are not achieved, exerting little collection pressure on the clients. To reduce default rates and achieve cost savings that lead to increased profitability, changes are proposed in both the credit area and the collection area. In credits, a process redesign must be done, accompanied by the implementation of indicators that allow each executive to measure through the recovery of their portfolio and not just the placement. On the other hand, within the collections area, a preventive collection process must be implemented before expiration, as well as during the first 30 days of expiration, and the area must be reorganized to avoid inefficiencies and outsourcing calls to customers.

27. Feasibility and performance of a frameless stereotactic system for targeting subcortical nuclei in nonhuman primates.

Author

Branco de Paiva F, Campbell BA, Frizon LA, Martin A, Maldonado-Naranjo A, Machado AG, and Baker KB

Subjects
Algorithms, Animals, Basal Ganglia anatomy & histology, Basal Ganglia surgery, Brain anatomy & histology, Deep Brain Stimulation methods, Electrodes, Implanted, Feasibility Studies, Female, Imaging, Three-Dimensional, Macaca fascicularis, Macaca mulatta, Magnetic Resonance Imaging methods, Observer Variation, Subthalamic Nucleus, Tomography, X-Ray Computed, Brain surgery, Neuronavigation
Abstract

Objective: Deep brain stimulation (DBS) is an effective therapy for different neurological diseases, despite the lack of comprehension of its mechanism of action. The use of nonhuman primates (NHPs) has been historically important in advancing this field and presents a unique opportunity to uncover the therapeutic mechanisms of DBS, opening the way for optimization of current applications and the development of new ones. To be informative, research using NHPs should make use of appropriate electrode implantation tools. In the present work, the authors report on the feasibility and accuracy of targeting different deep brain regions in NHPs using a commercially available frameless stereotactic system (microTargeting platform)., Methods: Seven NHPs were implanted with DBS electrodes, either in the subthalamic nucleus or in the cerebellar dentate nucleus. A microTargeting platform was designed for each animal and used to guide implantation of the electrode. Imaging studies were acquired preoperatively for each animal, and were subsequently analyzed by two independent evaluators to estimate the electrode placement error (EPE). The interobserver variability was assessed as well., Results: The radial and vector components of the EPE were estimated separately. The magnitude of the vector of EPE was 1.29 ± 0.41 mm and the mean radial EPE was 0.96 ± 0.63 mm. The interobserver variability was considered negligible., Conclusions: These results reveal the suitability of this commercial system to enhance the surgical insertion of DBS leads in the primate brain, in comparison to rigid traditional frames. Furthermore, our results open up the possibility of performing frameless stereotaxy in primates without the necessity of relying on expensive methods based on intraoperative imaging.

Published
2020
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