Browsing by Type "Article"
  • Institution Publication
    A case of polydactyly in a pig from Cajamarca city, Peru Technical note
    ( 2024-01-01)
    Malca–Coba S.M.
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    Albarrán–Ríos J.W.
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    Portal–Torres J.
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    Cueva–Rodríguez M.
    Polydactyly is a condition characterized by the presence of extra fingers on the limbs. This paper describes a case of polydactyly in a pig. Through observation, physical examination, and palpation of the additional digits on the forelimb, it was determined that this was polydactyly. The additional digits were fully formed and had a solid, flexible consistency upon palpation. From a dorsal view, five digits with five nails were observed, and from a plantar view, four digits with their respective nails were visualized. The importance of studying malformations in pigs is emphasized in order to improve understanding and develop management and prevention strategies that benefit both the animals and the swine industry as a whole.
  • Institution Publication
    Canine Lead Exposure in Automotive Repair Workshops: A Pilot Study Conducted in Cajamarca City, Peru
    ( 2025-01-31)
    Alcántara-Villar G.
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    Villanueva C.J.
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    Vargas-Rocha L.
    Introduction. Lead is a heavy metal widely used in the automotive industry and is considered one of the most harmful toxic agents for living organisms. Dogs inhabiting automotive repair workshops may experience chronic exposure to this metal, making them potential sentinels of environmental contamination. Objective. This study aimed to determine blood lead levels in dogs residing in automotive repair workshops in the city of Cajamarca (Peru). Materials and Methods. Blood lead levels were quantified in 16 dogs using graphite furnace atomic absorption spectrometry. Results and Discussion. Blood lead levels ranged from 0.427 µg/dL (0.0043 ppm) to 4.348 µg/dL (0.0435 ppm), with a mean ± standard deviation of 2.264 ± 1.243 µg/dL and a coefficient of variation of 54.907%. A proportion of the evaluated dogs (18.75%; 3/16) presented blood lead levels exceeding 3.5 µg/dL, the reference value established by the Centers for Disease Control and Prevention (CDC) for children in the United States, indicating environmental exposure within these settings. Conclusions. Although most dogs exhibited blood lead levels below the critical threshold for human health, the presence of elevated levels in certain individuals suggests potential long-term risks for both the animals and workshop personnel. These findings highlight the need for further research to identify sources of exposure and assess their implications within a One Health framework.
  • Institution Publication
    Cardiovascular diseases and in-hospital mortality on COVID-19 in health centers from Region Cajamarca, 2020
    ( 2024-01-01)
    Ninatanta-Ortiz J.A.
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    García-Flores S.A.
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    Rivadeneira I.R.D.
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    Torres E.V.
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    Cieza K.M.P.
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    Sánchez S.E.P.
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    Angulo-Bazán Y.
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    Angulo-Bazán Y.
    Introduction. Cardiovascular diseases are one of the most frequently reported comorbidities in COVID-19 cases. Objective. To evaluate the relationship between the presence of cardiovascular risk diseases and death from COVID-19 in a cohort of hospitalized patients in the Cajamarca Region, during the year 2020. Methods. Retrospective cohort of 576 patients hospitalized for COVID-19 between July and December 2020, from four hospitals in the Cajamarca Region. A survival analysis was carried out using Cox regression to establish the relationship between death from COVID-19 and the presence of arterial hypertension (HTA), type 2 diabetes, obesity, and multimorbidity, using models adjusted for sociodemographic and clinical factors seeking to identify possible effect modifying variables. Results. The mortality from COVID-19 was 45.1%. In the bivariate analysis, the history of HTA was the only cardiovascular disease that was related to a higher probability of death from COVID-19 (HR: 1.43; 95% CI: 1.12-1.85). Two subgroup evaluations were developed: a) by age group and b) by oxygen saturation on admission (SatO2). An association was found between death from COVID-19 and DM2 in those under 60 years of age (HR: 4.56; 95% CI: 2.32-8.95); as well as with HTA in patients with SatO2 less than 80% on admission (HR: 1.67; 95% CI: 1.04-2.69). Conclusion. A relationship was found between death from COVID-19 and cardiovascular diseases such as HTA or type 2 diabetes, in specific subgroups (patients with SatO2 less than 80% on admission or age less than 60 years respectively) of patients who were hospitalized in health establishments of the Cajamarca Region.
  • Institution Publication
    Chlorella sp. inoculum doses affect ethinylestradiol removal in a wastewater treatment plant in the Peruvian Andes
    ( 2025)
    Collantes A.C.
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    Acosta R.A.S.
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    Apaza L.D.V.
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    Ruiz J.C.
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    Plasencia E.E.A.
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    Rojas E.W.C.
    The microalgae Chlorella sp. have demonstrated efficiency in the removal of pharmaceutical contaminants. However, there is no agreement on the inoculum dose since it depends on the contaminant concentration and other very specific parameters in each case. This study aims to evaluate the effect of Chlorella sp. inoculum doses on ethinylestradiol (EE) removal from wastewater treatment plant effluent in Celendín district of the province of Celendín, Cajamarca region, Peru. Four doses of inoculum (0, 100, 200, and 300 mL) were tested at a 2,1x106 cell∙mL-1 microalgae cell concentration and 4 mg∙L-1 of ethinylestradiol in photobioreactors. The final concentration of ethinylestradiol was determined after 20 days through High Performance Liquid Chromatography (HPLC). It was evidenced that a dose of 300 mL∙L-1 of Chlorella sp. could remove 96,49% of ethinylestradiol from wastewater, unlike the other tested concentrations, which were below 80,92% removal. It was concluded that at a higher dose of Chlorella sp. inoculum, a higher ethinylestradiol removal percentage was observed in a wastewater sample from a treatment plant in the Peruvian Andes.
  • Institution Publication
    Comparing efficiency across markets: An extension and critique of the Zhang and Bartels (1998) methodology
    (Elsevier, 2010-09-16)
    Chumpitaz R.
    The use of non-parametric frontier methods for the evaluation of product market efficiency in heterogeneous markets seems to have gained some popularity recently. However, the statistical properties of these frontier estimators have been largely ignored. The main point is that non-parametric frontier estimators are biased and that the degree of bias depends on specific sample properties, most importantly sample size and number of dimensions of the model. To investigate the effect of this bias on comparing market efficiency, this contribution estimates the efficiency for several datasets for two main product categories. Following (Zhang, Y., Bartels, R., 1998. The effect of sample size on the mean efficiency in DEA with an application to electricity distribution in Australia, Sweden and New Zealand. Journal of Productivity Analysis, 9(3), 187-204.), these results comprise re-estimates for the larger samples limiting their size to that of the smaller samples when the model dimensions for different samples are identical. Furthermore, sample sizes are adjusted to mitigate the eventual differences in dimensions in specification. This allows comparing market efficiency for different markets on a more equal footing, since it reduces the bias effect to a minimum making the comparison of market efficiency possible. However, the article also points out the critical limitations of this [Zhang, Y., Bartels, R., (1998). The effect of sample size on the mean efficiency in DEA with an application to electricity distribution in Australia, Sweden and New Zealand. Journal of Productivity Analysis 9 (3), 187-204] approach in certain respects. Apart from reporting these negative results, we also offer some suggestions for future work. © 2010 Elsevier B.V. All rights reserved.
  • Institution Publication
    Concentration of nitrates and sulphates in surface runoff wáter
    ( 2023)
    Fernández P.H.
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    Orihuela J.A.
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    Figueroa O.L.
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    Fernández A.H.
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    Arce V.V.
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    Elguera V.C.
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    Arteaga B.A.
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    Cruz M.U.
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    Fernández P.V.
    The objective of this research was to evaluate the concentration levels of nitrates and sulfates in the surface runoff waters of the Huangamarca and Pollo micro-watersheds in Otuzco Pro^vince, La Libertad Region. Experimental studies of the water collected from surface runoff in the agroecosystems determined average nitrate concentrations of 0.214 meq/l and 0.662 meq/l in the Huangamarca and Pollo micro-watersheds, respectively. Sulfates ranged from 0.435 meq/l in Huangamarca to 1.321 meq/l in the Pollo microbasin. These values, according to the permissible levels, are below the contamination levels according to the water quality standards for irrigation. It is concluded that the waters of the Huangamarca and Pollo micro-watersheds studied are safe for use.
  • Institution Publication
    Cranioracopagus in Sheep Clinical case
    ( 2024-01-01)
    Cercado D.L.I.
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    Rayco J.E.C.
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    Portal–Torres J.
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    Cueva–Rodríguez M.
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    Guevara–Cruzado E.
    Monozygotic embryonic twins are classified early in development according to the direction of the embryonic plates as thoracopagus, ischiopagus, omphalopagus and others. The objective of the study was to determine a pathology in a sheep. A case of congenital anomaly of a sheep of 4 months of unborn gestation is presented, with predominance of the male sex, it is about twins with unusual characteristics such as male sex in both sheep. As a result, the conformation of the fetus was apparently normal: apparently normal skull, two ocular orbits, two auricular pavilions, a nasal and oral cavity, at the same time it was observed that at the level of the thorax the union of both bodies (thoracoabdominal) with a single navel, 4 posterior members, 2 anterior members, both of the same sex. In conclusion, it was determined that the pathology is craniothoracopagus in sheep.
  • Institution Publication
    Detection and prevalence of parasites in creole cattle from a rural area in an Andean district of Peru
    ( 2025-06)
    Rojas-Moncada J.
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    Torrel T.
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    Vargas-Rocha L.
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    Vargas-Rocha L.
    Animals raised in rural areas often lack sufficient healthcare and nutrition due to limited access to professional services or state programs. This situation is worsened by extensive grazing practices, which expose cattle to parasites. This study aimed to identify helminths and coccidia by examining fecal eggs and oocysts in creole cattle from small-scale producers raised under grazing conditions at altitudes above 3,000 m in the rural area of Chota district, Cajamarca, Peru. Fecal samples from 385 cattle were analyzed, with 357 (92.73 ± 2.59%) testing positive for parasite eggs and oocysts. At the farm level, all (37/37) were infected with parasites. Natural sedimentation identified eggs of Fasciola hepatica (19.48 ± 3.96%). Flotation concentration using a saturated sugar solution revealed eggs of strongylid-like nematodes (SLN) (81.56 ± 3.87%), Capillaria spp (1.82 ± 1.33%), Trichuris spp (2.86 ± 1.66%), Toxocara vitulorum (2.08 ± 1.42%), Moniezia spp (8.05 ± 2.72%), and oocysts of Eimeria spp (55.58 ± 4.96%). The parasitic load of SLN and Eimeria spp was associated with sex and showed a moderate negative correlation with age (p < 0.05). Females exhibited an odds ratio (OR) of 0.393 [95%CI 0.187 – 0.825] for SLN infection, OR = 0.298 [95%CI 0.177 – 0.503] for Eimeria spp, and OR = 2.206 95%CI 1.111 – 4.382] for F. hepatica compared to males (p < 0.05). Younger cattle had a higher probability of infection with SLN, Moniezia spp, and Eimeria spp while showing a lower likelihood of F. hepatica infection than those older than four years (p < 0.05). The initial study conducted in the rural area of the Chota district revealed a high frequency of infections by various internal parasites in creole cattle, but with low parasite loads. These findings suggest further research on whether parasite loads impact animal health or production.
  • Institution Publication
    Exploring the moderating effect of gender in the relationship between individuals' aspirations and career success among engineers in Peru
    (Taylor & Francis Online, 2011-09-01)
    Bejarano A.
    Purpose: The aim of this paper is to analyse the relationship between career success and individual career aspirations for engineers, and to test whether this differs according to gender. The primary hypothesis in this research is that gender does make a significant difference. Design/methodological/approach: The sample consists of 1011 engineers who graduated from a prestigious Peruvian college between 1998 and 2005. Female graduates constituted only 4% of the sample, which is similar to the national statistics for engineers in Peru during this period. The relationships were primarily tested using multiple regression and structural equation modelling analyses. Findings: Findings show a positive relationship between individual career aspirations and career success for men, but not necessarily for women; this supports the hypothesis that gender moderates this relationship. Females seek more secure career orientation than their male counterparts. In addition, females have shown that their career success is more related to feminine themes such as achieving 'work-family balance'. The findings are in line with previously published results in other countries in which female engineers have career orientations with a preference for a balance between work and family as well as work stability. Research limitations/implications: The sample is limited to graduates from a single Peruvian college of engineering. Although the sample has similar demographic characteristic to a national population, a more heterogeneous sample is called for in a future research. Moreover, additional moderators should be incorporated, such as family background, residency (large urban cities vs. small villages) and perhaps other variables. Practical implications: Results can help Human Resource Managers to design better career plans, which consider gender in defining policies for the attraction and retention of competent female engineers. © 2011 Taylor & Francis.
  • Institution Publication
    Fiscal windfalls and entrepreneurship: fostering entry or promoting incumbents?
    ( 2024-01-01)
    Garmaise M.J.
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    Natividad G.
    We study the impact of government fiscal windfalls on entrepreneurship through an analysis of shocks to transfer payments in Peru. These pure transfers generate higher government spending, and we contrast the impacts on incumbent firms and entrants. Incumbent exits from the financial system are reduced, but previously troubled firms experience deteriorating performance. Increased transfers result in higher rates of firm entry into formal borrowing and superior entrant outcomes. Overall, startups outperform non-startups after heightened transfers.
  • Institution Publication
    Frequency of the mecA gene in methicillin-resistant Staphylococcus aureus in a tertiary care hospital in Peru
    ( 2023-06-19)
    Bustamante-Cabrera A.M.
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    Bustamante-Cabrera A.M.
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    Quiroz-Ruiz H.R.
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    Quiroz-Ruiz H.R.
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    Vega-Fernandez J.A.
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    Vega-Fernandez J.A.
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    Rivera-Jacinto M.A.
    Objective: to determine the frequency of the mecA gene in methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients treated at a third-level hospital in the Cajamarca region, Peru; as well as, to determine which of the two antibiotics used as phenotypic screening is more useful in explaining the presence of said gene. Methods: 71 bacterial isolates were analyzed from samples obtained from the Hospital Regional Docente of Cajamarca. The identification of S. aureus was carried out using the MicroScan system. Phenotypic screening for resistance to methicillin was performed using the diffusion technique with cefoxitin and oxacillin discs. DNA extraction was performed by heat shock, mecA gene detection was performed through polymerase chain reaction. For data analysis, the statistical software SPSS v.25 was used. Results: from 71 isolates, 40 (56,3%) were MRSA carriers of the mecA gene, the majority of these isolates corresponded to hospitalized patients 22 (31,0%), being more frequent in bronchial secretion samples 27 (38,0%). Phenotypic screening with cefoxitin disc was a better predictor for the presence of the mecA gene [P=0,010; Exp(B)= 12,3] compared to the oxacillin disc. Conclusions: It is shown a high frequency of positive MRSA mecA in samples of clinical origin, mainly from hospitalized patients. It is important to establish surveillance guidelines to identify MRSA in all hospitals in the region.
  • Institution Publication
    Mesosphere and Lower Thermosphere Wind Perturbations Due To the 2022 Hunga Tonga-Hunga Ha'apai Eruption as Observed by Multistatic Specular Meteor Radars
    ( 2024-08-01)
    Chau J.L.
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    Poblet F.L.
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    Liu H.
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    Liu A.
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    Gulbrandsen N.
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    Jacobi C.
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    Rodriguez R.R.
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    Scipion D.
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    Tsutsumi M.
    Utilizing multistatic specular meteor radar (MSMR) observations, this study delves into global aspects of wind perturbations in the mesosphere and lower thermosphere (MLT) from the unprecedented 2022 eruption of the Hunga Tonga-Hunga Ha'apai (HTHH) submarine volcano. The combination of MSMR observations from different viewing angles over South America and Europe, and the decomposition of the horizontal wind in components along and transversal to the HTHH eruption's epicenter direction allow an unambiguous detection and identification of MLT perturbations related to the eruption. The performance of this decomposition is evaluated using Whole Atmosphere Community Climate Model with thermosphere/ionosphere extension (WACCM-X) simulations of the event. The approach shows that indeed the HTHH eruption signals are clearly identified, and other signals can be easily discarded. The winds in this decomposition display dominant Eastward soliton-like perturbations observed as far as 25,000 km from HTHH, and propagating at 242 m/s. A weaker perturbation observed only over Europe propagates faster (but slower than 300 m/s) in the Westward direction. These results suggest that we might be observing the so-called Pekeris mode, also consistent with the L1 pseudomode, reproduced by WACCM-X simulations at MLT altitudes. They also rule out the previous hypothesis connecting the observations in South America to the Tsunami associated with the eruption because these perturbations are observed over Europe as well. Despite the progress, the L0 pseudomode in the MLT reproduced by WACCM-X remains elusive to observations.
  • Institution Publication
    ON the EFFECT of IMPERFECT COLLUSION on PROFITABILITY and R&D
    (World Scientific, 2017-11-21)
    Guillén J.
    We consider a theoretical model where firms can reduce their initial unit costs by spending on R&D. We show that the degree of product market collusion (captured by the coefficient of cooperation) might reduce firms’ profits if innovation is made non-cooperatively. The intuition is that non-cooperative R&D introduces a negative externality where firms invest over and above the amount required to minimize costs so as to extract profits from their rival firm. Therefore, when product market competition drops below a certain level, a relatively large amount is spent on R&D with just a small output, making further collusion unprofitable. On the contrary, a Research Joint Venture (RJV) helps to internalize the externality and further product market collusion always increases firms’ profits. As a consequence, total welfare may be lower if R&D is made cooperatively.
  • Institution Publication
    Short-term repeat HPV testing for triaging HPV-positive women in cervical cancer screening
    ( 2025-12-28)
    Baena A.
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    Baena A.
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    Picconi M.A.
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    Mendoza L.
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    Ferrera A.
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    Mesher D.
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    Lineros J.
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    Brizuela M.
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    Mongelos P.
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    Cabrera Y.
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    Fellner M.D.
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    Zambrana O.
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    García L.
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    Hernández P.
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    Bobadilla M.L.
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    Ramon M.
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    Venegas G.
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    Venegas G.
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    Villagra V.
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    Cruz A.
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    Rodríguez G.
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    Terán C.
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    Calderón A.
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    Wiesner C.
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    Herrero R.
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    Herrero R.
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    Almonte M.
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    Almonte M.
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    Sosa Quesada C.
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    Soilán A.
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    Salgado Y.
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    Rodríguez de la Peña M.
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    Rodriguez M.I.
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    Ramirez A.T.
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    Pinastel Monet R.
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    Pérez N.
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    Ortega M.
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    Murillo V.
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    Kasamatsu E.
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    Hernández M.d.l.L.
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    Gimenez D.
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    Flores B.
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    Figueroa J.
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    Correa R.M.
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    Colucci M.C.
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    Beracochea A.
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    Bellido-Fuentes Y.
    Background: Persistent HPV infection causes cervical cancer, but most infections are transient. Triage methods identify high-risk women needing further evaluation or treatment. We assessed short-term repeat HPV testing as an alternative triage option. Methods: In ESTAMPA, women aged 30–64 years were screened with HPV testing (HC2 or Cobas) and cytology. Screen positives were referred to colposcopy approximately two months after screening, where cervical samples were collected again for repeat HPV testing. We evaluated the performance of repeat HPV for CIN3+ among HPV-positive women and explored its combination with limited HPV genotyping (HPV16/18). Results: Among 5390 HPV-positive women (including 629 CIN3 cases and 53 cancers), 61% retested positive at ~2 months (median: 1.8, interquartile range: 1.2–2.8). Repeat HPV sensitivity for CIN3+ was 81.5% (95% CI 77.2–85.2) for HC2 and 87.7% (83.7–90.8) for Cobas. Specificity was <50% with referral rates of 57.4% (55.7–59.0) and 68.2% (66.1–70.2) for HC2 and Cobas. HPV16/18 genotyping followed by repeat HPV among non-HPV16/18-positive women did not greatly improve performance. However, HPV16/18 positivity doubled the risk of CIN3+, supporting its combination with repeat HPV when available. Conclusions: Short-term repeat HPV testing could be a practical option for triaging HPV-positive women, either alone or in combination with limited HPV genotyping. Trial registration: ClinicalTrials.gov, NCT01881659
  • Institution Publication
    Sociodemographic and educational factors associated with mental health disorders in medical students of clinical years: A multicenter study in Peru
    ( 2023-06-01)
    Zila-Velasque J.P.
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    Zila-Velasque J.P.
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    Grados-Espinoza P.
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    Grados-Espinoza P.
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    Regalado-Rodríguez K.M.
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    Sosa-Nuñez F.
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    Alcarraz-Jaime A.
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    Cortez-Soto A.G.
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    Chambergo-Michilot D.
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    Soriano-Moreno A.N.
    Objective To identify sociodemographic and educational factors associated with mental health disorders in Peruvian medical students in clinical years. Methods Cross-sectional study. We surveyed students from 24 Peruvian medical schools. We defined negative perception of educational environment as having a Dundee Ready Educational Environment Measure score below 100 points; we defined anxiety and depression as having more than 4 points on the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scales, respectively. Poisson regression with robust variance was used to assess the association between negative perception of educational environment and mental health alterations. Results Among the 808 participants, the prevalence of anxiety and depression symptoms was 77.6% and 67.3%, respectively. Negative perception of the educational environment was 31.6%. The factors associated with anxiety were being male (PR = 0.95, 95% CI:0.91–0.98), previous medical condition (Prevalence ratios PR = 1.10, 95% CI:1.05–1.16), previous diagnosis of coronavirus disease 2019 (PR = 0.93, 95% CI: 0.93–0.94), being from highlands (PR = 1.11, 95% CI: 1.05–1.16), studying at a national university (PR = 0.90, 95% CI: 0.88–0.92), and negative perception of the educational environment (PR = 1.04, 95% CI: 1.03–1.05), while factors associated with depression were being male (PR = 0.94, 95% CI: 0.93–0.95), previous medical condition (PR = 1.12, 95% CI: 1.08–1.17), type of university (national) (PR = 0.95, 95% CI: 0.95–0.96), and negative perception of the educational environment (PR = 1.11, 95% CI: 1.07–1.16). Conclusion We found evidence that during the COVID-19 pandemic anxiety and depression are prevalent among Peruvian medical students. Sociodemographic factors and negative perception of educational environment were associated with the presence of these conditions.
  • Institution Publication
    Trainable Gaussian-based activation functions for sensor-based human activity recognition
    ( 2024-12-01)
    Machacuay J.
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    Quinde M.
    Neural networks’ capability to model non-linear relationships strongly depends on their activation functions (AFs). This dependency makes the search for AFs with better performance a relevant open research subject. This research work proposes two Trainable Gaussian-based AFs for Multilayer Perceptron neural networks on sensor-based human activity recognition (HAR), namely, the Four-Parameter Activation Gaussian Radial Basis Function (T4GRBF) and the Weighted Gaussian Radial Basis Function (WGRBF). The T4GRBF considers the training of four parameters. Two of these parameters regulate the center and spread of the Gaussian shape separately. Another parameter regulates the center and shape simultaneously, and the last parameter regulates the output range of the AF. The WGRBF adjusts the Gaussian shape with only two trainable parameters, and it is then scaled by the AF input. The proposals are validated through experiments on the Opportunity and UniMiB SHAR benchmark datasets. The results found for the Opportunity dataset in this research work evidence that the sliding window segmentation method has a high impact on the AFs’ performance, and the results in the UniMiB dataset show that the trainable GRBF-based AFs improve the HAR models performance. Furthermore, in both datasets, the Trainable Gaussian-based AFs fit the training data better than the standard AFs, regardless of the specific time window setup used in the experiments.
  • Institution Publication
    Vacunagate: Vaccines for all or privilege of the few?
    (Emerald Publishing, 2025-01-01)
    Perez J.E.
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    Horna Saldaña, César Jhonnathan Paseli
    Case overview/synopsis: The COVID-19 pandemic highlighted the profound limitations of the Peruvian health-care system. Despite its rapid economic growth in previous years, Peru faced the collapse of its health-care infrastructure in the face of the spread of the virus. In this context, the country was selected in 2020 to participate in a Phase III clinical trial of the Sinopharm vaccine, led by the Universidad Peruana Cayetano Heredia (UPCH). The research team, under the direction of Dr Germán Málaga, administered 12,000 doses in a randomized, controlled study, seeking to validate the safety and efficacy of the vaccine. However, the arrival of an additional batch of 3,200 doses, not included in the official trial, opened an ethical crossroads. As hospitals collapsed and the country suffered one of the highest mortality rates in the region, senior officials pushed to receive these additional doses in secret, prioritizing their personal use over the most vulnerable groups. Should Dr Malaga: Apply the extra vaccines to personnel outside the health system in the clinical trial? Or follow strict protocols and reserve the doses only for those directly involved in the research? This case exposes not only the ethical challenges, but also the need to make decisions in high-pressure environments. Complexity academic level: The Vacunagate case is designed for students of undergraduate programs, in subjects related to health sciences and medicine, such as bioethics, health administration and hospital management. Also, in subjects related to administration and business, such as business ethics, crisis management, leadership and decision-making. In summary, the case allows students to explore issues such as the impact of individual decisions, the management of public trust and the evaluation of ethical responsibility in the management of resources in a health-care context. Supplementary material: Teaching notes are available for educators only. Subject code: CSS10: Public Sector Management.