Abstract Introduction: Nursing staffing in adult intensive care has been at a ratio of two patients per nurse or one patient for one nurse. Currently, patients require complex and specialized care that provides safety and reduces Healthcare-Associated Infections. Objective: Evidencing the importance of equipping nursing personnel according to the severity of the patient compared to the nurse-patient ratio in order to reduce Healthcare-Associated Infections in patients in the adult intensive care unit. Methodology: This is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted from September 2021 to March 2022. The databases PubMed, ScienceDirect, Epistemonikos and CUIDEN were used, and the following terms were utilized, i.e., nursing personnel, patient severity, nurse-patient ratio, healthcare-associated infections, and the Boolean operators AND, OR, and WITH. The sample consisted of 8 studies that were assessed using the Critical Reading Cards (FLC 3.0) and graded according to the National Institute for Health and Care Excellence. Results: Staffing according to patient severity compared to the nurse-patient indicator reduced healthcare-associated infections, mortality, sepsis occurrence, and medication errors. The impact on patients and nursing personnel showed improved quality of care and reduced burnout and work stress, which benefited the patient. Conclusion: It is important to provide nursing personnel according to the severity of the patient and with personnel having an academic level of at least a bachelor's degree in order to improve the quality of care and reduce healthcare-associated infections.

Abstrato Introdução: A equipe de enfermagem na terapia intensiva de adultos tem estado em uma proporção de dois pacientes para um enfermeiro ou um paciente para um enfermeiro. Atualmente, os pacientes que chegam exigem cuidados complexos e especializados que ofereçam segurança e reduzam as infecções associadas à assistência à saúde. Objetivo: Demonstrar a importância do dimensionamento do pessoal de enfermagem de acordo com a gravidade do paciente em comparação com o indicador enfermeiro-paciente, para reduzir as infecções associadas à assistência à saúde em pacientes adultos internados em unidades de terapia intensiva. Metodologia: Revisão sistemática com base nas diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses, realizada entre setembro de 2021 e março de 2022, mediante os bancos de dados PubMed, ScienceDirect, Epistemonikos e CUIDEN, e usando os seguintes termos: pessoal de enfermagem, gravidade do paciente, relação enfermeiro-paciente, infecções associadas à assistência à saúde, operadores AND, OR, WITH. A amostra consistiu em 8 estudos, avaliados usando os programas Critical Reading Card e classificados de acordo com o Instituto Nacional de Excelência em Saúde e Cuidados. Resultados: O dimensionamento de profissionais de acordo com a gravidade do paciente, em comparação com o indicador enfermeiro-paciente, reduziu as infecções associadas à assistência à saúde, mortalidade, ocorrência de sepse e erros de medicação. O impacto sobre os pacientes e o pessoal de enfermagem mostrou uma melhor qualidade de atendimento, redução do esgotamento e do estresse no trabalho, o que beneficiou o paciente. Conclusão: É importante fornecer pessoal de enfermagem de acordo com a gravidade do paciente e com pessoal com nível acadêmico de, no mínimo, bacharelado, a fim de melhorar a qualidade do atendimento e reduzir as infecções associadas à assistência à saúde.

Resumen Introducción: Dotar al personal de enfermería en la terapia intensiva adultos ha sido en proporción dos pacientes por enfermera o 1:1. Actualmente, los pacientes que ingresan requieren cuidados complejos y especializados que proporcionen seguridad y disminución de infecciones asociadas a la atención en salud. Objetivo: Evidenciar la importancia de dotar al personal de enfermería según gravedad del paciente comparado con indicador enfermera-paciente para disminuir infecciones asociadas a la atención en salud en pacientes de la unidad de terapia intensiva adultos. Metodología: Revisión sistemática, basada en la declaración Preferred Reporting Items for Sistematyc Reviews and Meta-analyses, realizada en septiembre 2021 a marzo 2022, se utilizaron las bases de datos PubMed, ScienceDirect, Epistemonikos y CUIDEN, empleando términos: personal de enfermería, gravedad del paciente, relación enfermero-paciente, infecciones asociadas a la atención a la salud, operadores boléanos AND, OR, WITH. La muestra fue de 8 estudios, evaluados mediante los programas de Fichas de Lectura Crítica y gradados según el National Institute for Health and Care Excellence. Resultados: Dotar de personal según gravedad del paciente comparado con indicador enfermera-paciente disminuyó infecciones asociadas a la atención en salud, mortalidad, aparición de sepsis y errores en la medicación. Las repercusiones en pacientes y personal de enfermería mostraron mejor calidad de la atención, disminución de agotamiento y estrés laboral lo que benefició al paciente. Conclusión: Es importante dotar al personal de enfermería según gravedad del paciente, con personal de nivel académico licenciatura para mejorar la calidad de atención y disminuir las infecciones asociadas a la atención en salud.

Resumen A partir de un estudio sociodemográfico, se describe la disolución conyugal por divorcio y separación, en familias de la región fronteriza del norte de México. Se proporciona una visión general acerca del nivel de frecuencia de la inestabilidad conyugal a nivel regional y algunas de las diferencias entre las entidades federativas que la componen. Se utiliza la Encuesta Nacional de la Dinámica Demográfica (Enadid) de 2018 y otras fuentes de información secundaria. El análisis se basa en los indicadores obtenidos de las disoluciones de la primera unión conyugal de mujeres alguna vez unidas, mediante el uso de la técnica de tablas de vida y los modelos de regresión logística. Entre otros resultados, se encontró que la región norteña tiene uno de los niveles más altos de disolución conyugal en el país, pero con interesantes diferencias que destacan entre los estados del noroeste y el noreste, generando un patrón dual en la región.

Abstract This is a descriptive socio-demographic study of the marital dissolution by divorce and separation in the northern border region of Mexico. The objective is to provide a general view of the level of this type of dissolutions in the region and some of its differences among the federal entities that form it. For this purpose, we use information from the National Survey of the Demographic Dynamics 2018 (ENADID) and secondary sources of information. The analysis is based on the indicators about the dissolution of the first conjugal union of ever-married women that were calculated through the life table technique and logistic regression models. The results evidence that the northern region has one of the highest levels of marital dissolution in the country, but with interesting differences between the states located in the northwest and the northeast generating a dual pattern in the region.

Abstract The Plans for the Social Organization of Rural Property (POSPR) in Colombia would allow the implementation of the Integral Rural Reform (RRI), an essential component of the Peace Agreements. Specifically, POSPR’s institutional design in Ovejas (a municipality in the Department of Sucre) would enable the implementation of the RRI. Information from interviews with key actors, the review of national legislation, and the use of software to elaborate databases show that, in this locality, plans to incorporate hectares into the Land Fund and the delivery of land titles strengthen community participation with gender equity and guarantee territorial planning. However, the gradual suspension of these plans at the national level has halted the progress of rural reform. Ovejas would be the only municipality complying with this point of the Peace Agreements.

Resumen Los planes de ordenamiento social de la propiedad rural (POSPR) en Colombia permitirían la implementación de la reforma rural integral (RRI), componente esencial del Acuerdo de Paz. De manera puntual, se argumenta que el diseño institucional del POSPR de Ovejas, municipio del Departamento de Sucre, posibilitaría la ejecución de la RRI. La información de entrevistas a actores clave, la revisión de legislación nacional y la elaboración de matrices en un software muestran que, en esta localidad, los planes de incorporación de hectáreas al Fondo de Tierras y de entrega de títulos de propiedad fortalecen la participación comunitaria con equidad de género y garantiza el ordenamiento del territorio. No obstante, la suspensión paulatina a escala nacional de estos planes ha detenido el avance de la reforma rural. Ovejas sería el único municipio que estaría cumpliendo con este punto del Acuerdo de Paz.

Resumen Este estudio tiene como objetivo analizar la relación entre el desajuste y el rendimiento educativo diferenciado por género. Los datos para el análisis proceden de la Encuesta Nacional de Ocupación y Empleo 2022. Los resultados se estimaron con estadísticas de frecuencia, la ecuación de ingresos de Mincer y el modelo de regresión cuántilica. De los principales resultados se destaca que el desajuste educativo afecta al 50% de los trabajadores con educación superior, el rendimiento es mejor en empleos ajustados a la formación y la brecha salarial persiste tanto dentro del nivel de estudios como en los trabajos ajustados a su formación educativa.

Abstract This study aims to analyze the relationship between mismatch and educational performance differentiated by gender. The data for the analysis comes from the National Survey of Occupation and Employment 2022. The results were estimated using frequency statistics, the Mincer earnings equation, and the quantile regression model. The main findings highlight that educational mismatch affects 50% of workers with higher education, performance is better in jobs adjusted with education, and the wage gap persists both within the educational level and in jobs adjusted with their educational background.

ABSTRACT External financing is one of the limitations of development in MSME entrepreneurship, among which are agricultural ventures. Therefore, the objective of the research work was to identify the origin of external financing in horticultural producers in three locations in the district of Julián Augusto Saldívar, Central Department. A research with a quantitative approach of descriptive scope was applied. Its design is non-experimental quantitative. The in-depth interview method is applied for a better approach to the subjects. All of the farms are family-type. 48% of the ventures do not operate with external financing or credit, 52% have some level of debt. The Agricultural Habilitation Credit (CAH) has provided financing to 22%. The Ministry of Agriculture and Livestock at 9%. 33% claim to have received financing from banks. The Cooperatives have contributed 25% to the financing. Credit Houses at 9%. The foundations contributed 13%. Finally, there is 8% that consider Supplier Credit as sources of financing. Considering that 52% of those surveyed reports having debt, it can be stated that, although external financing at a general level can be considered scarce, due to the lack of access to credit, the ventures studied would be a little above the statistics national.

RESUMEN El financiamiento externo es una de las limitantes del desarrollo en emprendimiento MIPYMES entre los cuales se encuentran los emprendimientos agropecuarios. Por tanto, el trabajo de investigación, tuvo como objetivo identificar el origen del financiamiento externo en productores hortícolas de tres localidades del distrito de Julián Augusto Saldívar, Departamento Central. Se aplicó una investigación con enfoque cuantitativo de alcance descriptivo. El diseño del mismo es no experimental cuantitativa. Se aplica el método de la entrevista en profundidad para un mejor abordaje de los sujetos. La totalidad de las fincas son del tipo familiar. El 48% de los emprendimientos no operan con financiamiento o crédito externo, el 52% cuenta con algún nivel de endeudamiento. El Crédito Agrícola de Habilitación (CAH) ha aportado financiamiento a un 22%. El Ministerio de Agricultura y Ganadería a un 9%. El 33% afirma haber recibido financiamiento de Bancos. Las Cooperativas han aportado al financiamiento a un 25%. Las Casas de Crédito a un 9%. Las fundaciones aportaron a un 13%. Finalmente, existe un 8% que considera al Crédito de Proveedores como fuentes de financiamiento. Considerando que el 52% de los encuestados informa contar con endeudamiento, se puede afirmar que, si bien el financiamiento externo a nivel general puede considerarse escaso, por la falta de acceso al crédito, los emprendimientos estudiados se encontrarían un poco por encima de las estadísticas nacionales.

Abstract Introduction Despite the evidence against drain placement after thyroidectomy, there is a lack of consensus on drain use in patients with substernal goiter. Objective To assess the factors that increase the likelihood of drain placement and its impact on postoperative hematoma and other 30-day complications among adult patients undergoing thyroidectomy for substernal goiter. Methods A retrospective cohort study that used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Adult patients (aged ≥ 18 years) who underwent elective thyroidectomy for substernal goiter from 2016 to 2020 were included. Cases with closed suction neck drains placed upon completion of surgery were included in the drain group, and the remaining cases formed the nondrain group. Results A total of 1,229 patients were included (46.5% with drain placement). The factors that increased the likelihood of drain placement included body mass index (BMI) ≥ 30 kg/m2, score between 3 and 5 on the American Society of Anesthesiologists (ASA) physical status classification, sternal split/transthoracic surgical approach, operative time ≥ 90 minutes, and surgery conducted by otolaryngologists. Patients with clean-contaminated or contaminated wound classifications were less likely to be submitted to drain placement. In addition, drain use had no impact on postoperative hematoma formation but was found to independently increase the risk of prolonged length of hospital stay. Conclusion Thyroidectomy without drain placement might be safe for substernal goiter. However, this decision should be individualized for each patient. Level Of Evidence: 3 30day day ACSNSQIP. ACSNSQIP ACS NSQIP . (ACS-NSQIP) aged 1 years 201 202 group 1229 229 1,22 46.5% 465 46 (46.5 placement) BMI (BMI kgm2 kgm kg m2 m kg/m2 ASA (ASA classification splittransthoracic split transthoracic approach 9 minutes otolaryngologists cleancontaminated clean addition stay However patient Evidence (ACS-NSQIP 20 122 22 1,2 46.5 4 (46. kg/m 2 12 1, 46. (46 (4 (

ABSTRACT Introduction: A quality education for university students of medical sciences is part of the policy established by the Cuban State for Higher Education. Correspondingly, a research project is being developed aimed at raising the quality in the training process of the students of the University of Medical Sciences of Camagüey; For this reason, the objective of this text is to present the results of the process of characterization of the assumed problematic situation, taking into account the linguistic and technological dimensions, based on the application of research instruments during the initial diagnosis stage to professionals and students who make up the sample. Method: The research is classified as R&D, of a causal explanatory observational nature, which produces systems of actions to raise the quality of the training of future professionals at the University of Medical Sciences of Camagüey and is developed between January 2023 and December 2024. The non-probabilistic sampling by quota is made up of students from different faculties, teachers, professionals and non-teaching workers. Results: Insufficiencies were found in the development of computer skills to complement their studies through the search for information in virtual learning environments, to which are added the difficulties that the students in the sample present in expressing themselves and understanding texts, using the use of English for professional purposes. Discussion: The results were compared with those of con scholars who, at a national and global level, have investigated the topic of achieving quality in training processes at the university, and with this the usefulness of the study was corroborated.

RESUMEN Introducción: Una educación de calidad para los estudiantes universitarios de las ciencias médicas es parte de la política establecida por el Estado cubano para el nivel superior. En correspondencia se desarrolla un proyecto de investigación dirigido a la elevación de la calidad en el proceso formativo de los estudiantes de la Universidad de Ciencias Médicas de Camagüey; por ello el presente texto tiene como objetivo exponer los resultados del proceso de caracterización de la situación problémica asumida, atendiendo a las dimensiones lingüística y tecnológica, a partir de la aplicación de los instrumentos de investigación durante la etapa del diagnóstico inicial a profesionales y estudiantes que conforman la muestra. Método: La investigación clasifica como I+D, de carácter observacional explicativo causal, que produce sistemas de acciones para elevar la calidad de la formación del futuro profesional de la Universidad de Ciencias Médicas de Camagüey y se desarrolla entre enero de 2023 y diciembre de 2024. El muestreo no probabilístico por cuota está constituido por estudiantes de las diferentes facultades, docentes, profesionales y trabajadores no docentes. Resultados: Se constataron insuficiencias en el desarrollo de las habilidades informáticas para complementar sus estudios mediante la búsqueda de información en los entornos virtuales de aprendizaje, a lo que se suman las dificultades que presentan los alumnos dela muestra para expresarse y comprender textos, valiéndose del empleo del inglés con fines profesionales. Discusión: Se confrontaron los resultados con los de otros estudiosos que, a nivel nacional y mundial, han investigado sobre la temática acerca del logro de la calidad en los procesos de formación en la universidad y con ello se corroboró la utilidad del estudio.

ABSTRACT This research analyzes the level of satisfaction of public financing programs for the strengthening of Technological Innovation processes in Paraguayan companies: Case of the DETIEC Program (Technological Development, Innovation and Conformity) Assessment of Council National Science and Technology (CONACYT). This study is descriptive and not experimental, a mixed methodology has been used, which combines a qualitative and quantitative analysis. Likert scale surveys have been used, as well as questionnaire guides for the interview with technicians from the DETIEC program, where among the most important results it has been observed that the beneficiary companies have been able to train their Human Capital, as well as link up with foreign companies. and improve its production on the other hand, among the weaknesses, the lack of trained collaborators to submit proposals to government entities to compete for public funds stands out.

RESUMEN Este trabajo de investigación tiene por finalidad analizar el nivel de satisfacción de los programas públicos de financiamiento para el fortalecimiento de los procesos de Innovación Tecnológica en las empresas paraguayas: Caso del Programa DETIEC (Desarrollo Tecnológico, Innovación y Evaluación de la Conformidad), del Consejo Nacional de Ciencia y Tecnología (CONACYT). Este estudio es de carácter descriptivo y no experimental, se ha utilizado una metodología mixta, la cual combina un análisis cualitativo y cuantitativo. Se han utilizado encuestas en escala Likert, y también cuestionario guías para la entrevista a técnicos del programa DETIEC, donde se han observado entre los resultados más importantes se destacan que las empresas beneficiarias han podido capacitar a su Capital Humano, así como vincularse con empresas extranjeras y mejorar su producción, por otra parte, entre las debilidades se resalta la falta de colaboradores capacitados para postular propuestas a entes del Gobierno para concursar a fondos públicos.

Resumen El estudio se ha orientado desde el enfoque cuantitativo, el objetivo fue determinar si existe dependencia entre las variables sociodemográficas como grado de instrucción, religión, estado civil, carga familiar, género y rango de edad con la variable felicidad, la población considerada para el estudio fue la del último censo nacional peruano conformado por 179096 ciudadanos cuyas edades oscilan entre los 18 y 60 años; el muestreo probabilístico fue de tipo estratificado y cuenta con un nivel de confianza del 97 %. Se obtuvo una muestra de 1035 sujetos, se ha aplicado la escala de la felicidad de Lima (EFL); arrojando un indicador de 0.893 según el alfa de Cronbach con un coeficiente de alta confiabilidad. Se ha considerado las normas éticas y el consentimiento informado para esta investigación. A través de la prueba Chi cuadrada se pudo conocer la dependencia de las variables y se ha logrado obtener como resultado que el 40% de la población se encuentra en un nivel de baja felicidad; del mismo modo, se determinó la relación de dependencia entre las variables religión, estado civil, ausencia de dependencia con respecto a la carga familiar, género, rango de edad y grado de instrucción. La rigurosidad del estudio permite la extrapolación con poblaciones con las que se realizaron estudios similares.

Abstract The study has been oriented from the quantitative approach, the objective was to determine if there is dependence between sociodemographic variables such as educational level, religion, marital status, family burden, gender and age range with the happiness variable, the population considered for the study was that of the last Peruvian national census made up of 179096 citizens whose ages range between 18 and 60 years; the probability sampling was stratified and has a confidence level of 97%. A sample of 1035 subjects was obtained, the Lima Happiness Scale (EFL) was applied, yielding an indicator of 0.893 according to Cronbach's alpha with a high reliability coefficient. Ethical standards and informed consent were considered for this research. The Chi-square test was used to determine the dependence of the variables and the result was that 40% of the population is at a low level of happiness; likewise, the relationship of dependence between the variables religion, marital status, absence of dependence with respect to family burden, gender, age range and degree of education was determined. The rigor of the study allows extrapolation with populations with which similar studies were carried out.

RESUMO A pandemia da Covid-19 colocou importantes desafios sanitários e económicos aos Estados e às suas burocracias. Tanto nos países desenvolvidos como nos países em desenvolvimento, as políticas implementadas reativaram as discussões sobre o papel do Estado e os seus graus de intervenção. Da mesma forma, implicaram mudanças nas condições de trabalho dos servidores públicos em função das medidas de cuidado e isolamento adotadas. Estas mudanças tiveram impacto na dinâmica das disputas trabalhistas no sector? Os conflitos registrados apresentaram novas características? Houve diferenças dependendo do nível de governo? Este artigo analisa os conflitos trabalhistas promovidos pelos trabalhadores das Administrações Públicas municipais, provinciais e nacional durante o período 2020-2022. Para caracterizar as estratégias adotadas nesta situação excepcional, são abordados especificamente os tipos de reclamações e o repertório de ações desenvolvidas foram aquelas com ou sem greve. Os dados são comparados também com os registros pré-pandêmicos. A análise desenvolvida alimenta-se da integração de dados da Base de Conflitos Trabalhistas do Ministério do Trabalho, Emprego e Seguridade Social, regulamentos, documentos oficiais e artigos de jornais. Este trabalho procura fornecer evidências empíricas que sirvam ao debate mais amplo sobre as disputas trabalhistas no setor público.

RESUMEN La pandemia de la Covid-19 concitó importantes desafíos sanitarios y económicos para los Estados y sus burocracias. Tanto en países desarrollados como en vías de desarrollo, las políticas implementadas para mitigar su impacto reactivaron las discusiones respecto del rol del Estado y sus grados de intervención. Asimismo, implicaron cambios en las condiciones de trabajo de los empleados de las Administraciones Públicas pues debieron readaptar el modo de desempeñar sus tareas ante las medidas de cuidado y aislamiento dispuestas. ¿Estos cambios impactaron sobre la dinámica de la conflictividad laboral en el sector? ¿Los conflictos laborales registrados presentaron características novedosas? ¿Existieron diferencias según el nivel de gobierno? En este trabajo se analiza el caso argentino considerando los conflictos laborales impulsados por los trabajadores de las Administraciones Públicas municipales, provinciales y nacional durante el período 2020-2022. A fin de determinar las estrategias desplegadas en ese contexto de excepcionalidad, se abordan específicamente los tipos de reclamos planteados y el repertorio de acciones desarrolladas fueran éstas con o sin paro. Asimismo para ampliar la caracterización, los datos son comparados con lo ocurrido durante 2019, año previo a la declaración de la pandemia. El análisis realizado se nutre de la integración de datos provenientes de la Base de Conflictos Laborales del Ministerio de Trabajo, Empleo y Seguridad Social de la Nación (MTEySS), normativas, documentos oficiales y artículos periodísticos. Mediante este trabajo se procura aportar evidencia empírica que sirva al debate más amplio respecto de la conflictividad laboral en el sector público.

ABSTRACT The COVID-19 pandemic raised important health and economic challenges for the States and their bureaucracies. In both developed and developing countries, the policies implemented restarted the discussions regarding the role of the State and its degrees of intervention. Likewise, they implied changes in public servants’ working conditions in light of care and isolation measures taken. Did these changes have an impact on Public Administration labor conflict dynamic? Did labor conflicts present new characteristics under pandemic context? Were there any differences depending on the level of government? This paper analyzes labor conflicts promoted by Argentine public servants of municipal, provincial and national Public Administrations during the period 2020-2022. In order to characterize their strategies in this exceptional situation, the types of claims and their repertoire of actions (strike and non-strike disputes) are specifically addressed. The data are also compared with pre-pandemic figures. The analysis is based on the data of the Labor Conflict Base of the National Ministry of Labor, Employment and Social Security, regulations, official documents and newspaper articles. This work provides empirical evidence that contributes to the broadest debate about the labor conflicts in the public sector.

Climate change adaptation (CCA) and disaster risk reduction (DRR) agendas converge in their priorities to reduce social vulnerability and enhance resilience in the face of climate change. However, they are often treated separately in practice and in local government plans. In South Africa, while municipalities are legally mandated to develop Integrated Development Plans (IDPs) and Disaster Management Plans (DMPs), this is not the case for CCA. In this study, we assessed the engagement with, and linkages between, CCA and DRR in 20 local municipalities from contrasting socio-economic contexts in the Eastern Cape Province of South Africa by conducting an analysis of their IDPs, DMPs and any plans or strategies pertaining to CCA. Our results show that none of the municipalities had separate CCA strategies, with only two municipalities complying with the mandate to have DMPs. While municipalities mostly included CCA- and DRR-related activities in their IDPs, there were no explicit linkages made between the two approaches. Apparent was the prioritisation of bolstering infrastructure with little attention towards addressing social vulnerability and building resilience. Overall, little has been done to prioritise or link CCA and DRR at the local government level, especially in the context of addressing social vulnerability and building resilience. These findings suggest the need for South Africa to implement and promulgate legal instruments, policies and resources to capacitate local municipalities in mainstreaming and integrating CCA and DRR. SIGNIFICANCE: • This study highlights that, while CCA and DRR converge in theoretical frameworks and international and national policies, little has been done to link the two at the local government level in South Africa. • Overall, findings indicate that social vulnerability reduction and resilience building are still not recognised as important aspects of CCA and DRR. • Local municipalities prioritise technical solutions and infrastructure maintenance, with little attention to development and structural causes of vulnerability. • Support, in terms of resources, is needed to capacitate local municipalities in (1) linking CCA and DRR and (2) reducing social vulnerability and building resilience.

The provision of political goods and governance in marginalised local communities, located in Cape Town, South Africa, during the national lockdown periods (due to the COVID-19 pandemic) is described. The focus is on an African city, drawing attention to the growing importance of urban governance on the continent. Rapid urbanisation and emergency periods (such as the pandemic) are adding to the complexity of the urban space. This study found that communities in the city relied mostly on themselves for the provision of goods, and that the provision of security remains a critical political good, informing governance. However, the findings confront literature on a hierarchy of political goods, in which security is at the apex. In the given context, the sequence of the provision of goods changes to a non-hierarchical process. The fulfilment of other political goods will facilitate improved provision of security. Good governance needs to be informed by an integrated approach to, and the synchronous fulfilment of, political goods. SIGNIFICANCE: • During times of emergencies, already marginalised urban communities experience greater political neglect and are left to protect themselves and to provide for each other. • These communities experience desertion across the spectrum of political goods. • Resilience in such communities needs to be improved through good governing principles. • Although optimal local level governance relies heavily on the provision of security, the importance of the provision of education, employment, political freedom, housing, and health services (to mention a few) requires renewed attention.

Internationally, there has been a push for the prioritisation of research impact beyond its scholarly contribution. Traditionally, research impact assessments have focused on academic impact and quantitative measures, at the expense of researchers for whom research impact cannot be quantified. Bibliometric indicators and other quantitative measures are still the most widely used method for evaluating research impact because these measures are easy to use and provide a quick solution for evaluators. Conversely, metric indicators fail to capture important dimensions of high-quality research. Hence, in this study, we explored challenges with metric indicators. We adopted a case study of the University of Cape Town and used document analysis, a questionnaire survey to collect data from academics and researchers, as well as semi-structured interviews with a sample of academic and research staff. The findings highlight common challenges with quantitative measures, such as bias and discipline coverage, and the ability of measures to drive researchers' behaviour in another direction. We propose the adoption of responsible research metrics and assessment in South African higher education institutions for more inclusive and equitable research impact assessments. SIGNIFICANCE: • The study highlights the importance of understanding the challenges and influence of current measures used for assessing research impact in higher education institutions. • There is a need for higher education leaders, policymakers and funders to advocate and support responsible metrics. • Higher education leaders, funders and policymakers need to collaborate at the national level to initiate and support research assessment reform.

Emergency medical services (EMS) are a vital component of the health system and provide pre-hospital emergency care and specialised transport for patients requiring access to health facilities, thereby contributing to universal health coverage and improving health outcomes. Evidence regarding the current state of EMS within South Africa to fulfil this role is lacking and was the motivation for this review. Our objective was to describe the current state of EMS in South Africa. A literature search was conducted using keywords, BOOLEAN operating terms, and eligibility criteria on Sabinet, EBSCOhost, Google Scholar, ProQuest, Medline, PubMed, and ScienceDirect databases to find articles related to the components of the EMS system in South Africa. The articles were critically assessed, and six themes emerged: leadership and governance; resources; preparedness (knowledge, attitude, and practices) of the emergency care provider; health and safety; training; and communications. Challenges were found in all themes at a provincial EMS level despite improvements in legislation, leadership, and governance from the National Department of Health. These themes demonstrate that all components in the EMS system are not functioning optimally and may be affecting its contribution to improving universal health coverage and health outcomes. The current state of EMS appears to be constrained and requires greater leadership and governance from the Provincial Departments of Health to improve poorly functioning components of the EMS system. SIGNIFICANCE: The current state of EMS in South Africa lacks efficiency in its role to provide emergency care and transportation for patients wanting to access health facilities. Poorly functioning components of the EMS system have been identified and provide an opportunity for health authorities to make improvements so that the goal of universal health coverage and improved health outcomes can be realised.

ABSTRACT The research entitled Approach by competencies - Perspectives for the implementation of the credit system in Higher Education in Paraguay, aims to analyze the situation of the approach by competencies and its relationship with the perspective for the implementation of the credit system in Paraguay. Methodologically it had a mixed, analytical approach; The population was made up of teachers from the National University of Itapúa, from the Faculty of Humanities, Social Sciences and Guaraní Culture. Totaling 50 teachers and the sample 45 teachers. Among the most notable results, it was determined that 59% of teachers stated that a competency-based curriculum allows for more active learning; and the same percentage stated that it helps students solve life problems; Another important fact to highlight is that 78% of teachers take into account the three dimensions: cognitive, procedural and attitudinal. Regarding the linking of the credit system with the competency-based approach, it has been consulted, according to his perception as a university professional, when transferring the current curriculum to the Higher Education Credit System (SCES) whether it will improve educational quality at this level; The response was quite varied, with 37% stating that they somewhat agreed, while 30% strongly agreed and 22% neither agreed nor disagreed. In conclusion, from the teaching perspective, the competency-based approach is related to the implementation of the credit system in Paraguay.

Resumen La investigación titulada Enfoque por competencias - Perspectivas para la implementación del sistema de créditos en la Educación Superior en el Paraguay, tiene por objetivo analizar la situación del enfoque por competencias y su relación con la perspectiva para la implementación del sistema de créditos en Paraguay. Metodológicamente tuvo un enfoque mixto, de tipo analítica; la población estuvo compuesta por docentes de la Universidad Nacional de Itapúa, de la Facultad de Humanidades, Ciencias Sociales y Cultura Guaraní. Totalizando 50 docentes y la muestra 45 docentes. Entre los resultados más resaltantes se ha determinado que, el 59 % de los docentes manifestaron que un currículo basado en competencias permite un aprendizaje más activo; y un mismo porcentaje manifestó que sirve a los estudiantes para solucionar problemáticas de la vida; otro dato importante a resaltar es que el 78 % de los docentes tiene en cuenta las tres dimensiones: cognitiva, procedimental y actitudinal. Respecto a la vinculación del sistema de créditos con el enfoque por competencias se ha consultado, según su percepción como profesional universitario, al pasar el currículo actual al Sistema de Créditos en la Educación Superior (SCES) si va mejorar la calidad educativa en este nivel; la respuesta fue bastante variada, siendo que el 37% manifestó estar algo de acuerdo, mientras que el 30 % estar muy de acuerdo y el 22% ni de acuerdo ni en desacuerdo. En conclusión, desde la perspectiva docente el enfoque por competencias guarda relación con la implementación del sistema de créditos en Paraguay.