El papel del fenotipado como herramienta de alerta precoz en el manejo prehospitalario del paciente COVID-19 con alto riesgo de deterioro

The pandemic caused by COVID-19 has posed great challenges to face a health, labor, economic and social crisis. The assistance to patients with acute pathology in the prehospital context has evolved exponentially in recent years, making diagnosis and treatment possible at the point of care on many occasions, since one of the challenges professionals face is the ability to to detect risk of mortality in fundamentally time-dependent pathologies, where a diagnostic or therapeutic delay can negatively influence the outcome. The use of early warning scales represents a tool that allows the systematized evaluation of patients and can predict possible serious adverse events, providing considerable help, especially when the outcomes are not initially suspected or detected. However, on certain occasions a scale that covers the entire population spectrum is unfeasible. Knowledge about the full spectrum of phenotypic abnormalities associated with a given disease can help prevent complications or at least recognize them early enough that effective treatments are available and personalize care for each patient. The main objective of this thesis was to develop a system of tools for risk stratification in the prehospital care process of patients with COVID-19 disease. To this end, three multicenter, retrospective, observational cohort studies have been carried out. We have obtained a bedside scale derived through variables obtained by telephone, through which professionals can very quickly and effectively discern the real short-term risk of patients. Second, after the results we conclude that the SpO2/FiO2 ratio is a simple, non-invasive, fast and promising tool to predict that it can help to make an early estimate of the degree of hypoxemia in infected patients even in patients with a high risk of deterioration. clinical but with low initial suspicion. Lastly, patients assessed at the bedside can be classified into four different phenotypes with differentiating characteristics and prognostic implications common to the group to which they belong. Through this tool, health professionals can discriminate risk and future implications, helping in the decision-making process with the proper use of resources.La pandemia provocada por la COVID-19 ha supuesto grandes retos para hacer frente a una crisis sanitaria, laboral, económica y social. La asistencia a pacientes con patología aguda en el contexto prehospitalario ha evolucionado exponencialmente en los últimos años, haciendo posible un diagnóstico y tratamiento en el punto de atención en muchas ocasiones, ya que uno de los desafíos a los que se enfrentan los profesionales es la capacidad de detectar riesgo de mortalidad en patologías fundamentalmente tiempo dependientes, donde un retraso diagnóstico o terapéutico puede influir negativamente en el desenlace. El uso de escalas de alerta precoz representa una herramienta que permite la evaluación sistematizada de los pacientes y puede predecir posibles eventos adversos graves, proporcionando una ayuda considerable sobre todo cuando los desenlaces no son sospechados o detectados inicialmente. Sin embargo, en determinadas ocasiones una escala que cubra todo el espectro poblacional es irrealizable. El conocimiento sobre el espectro completo de anomalías fenotípicas asociadas con una determinada enfermedad puede ayudar a prevenir complicaciones o al menos reconocerlas en una etapa lo suficientemente temprana como para que haya tratamientos efectivos disponibles y personalizar la atención de cada paciente. El objetivo principal de la presente tesis fue desarrollar un sistema de herramientas para la estratificación del riesgo en el proceso de atención prehospitalaria de los pacientes con enfermedad por COVID-19. Para ello se han realizado tres estudios observacionales de cohorte retrospectiva, multicéntricos. Hemos obtenido una escala a pie de cama derivada a través de variables obtenidas por teléfono, a través de la cual los profesionales pueden discernir de forma muy rápida y efectiva el riesgo real a corto plazo de los pacientes. En segundo lugar, tras los resultados concluimos que el cociente SpO2/FiO2 es una herramienta simple, no invasiva, rápida y prometedora para predecir que puede ayudar a realizar una estimación temprana del grado de hipoxemia en pacientes infectados, incluso en pacientes con alto riesgo de deterioro clínico pero con baja sospecha inicial. Por último, los pacientes valorados a pie de cama se pueden clasificar en cuatro fenotipos diferentes con características diferenciadoras e implicaciones pronósticas comunes al grupo al que pertenecen. Mediante esta herramienta los profesionales sanitarios pueden discriminar el riesgo y las implicaciones futuras, ayudando en el proceso de toma de decisiones con el adecuado uso de recursos.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la Salu

La transparencia en la información de Financiera Efectiva S. A., oficina principal Chiclayo y su incidencia en el costo de la calidad de atención de sus usuarios 2019

En la actualidad, las personas juegan un rol importante dentro de la economía mundial, la capacidad de consumo promueve el dinamismo entre la oferta y demanda en un entorno muy competitivo; esta eficacia y agilidad, suele ser artífice de una serie de problemas, derivados de los protocolos de contratación y de las limitaciones de transparencia, con la que la información es transmitida a los usuarios, dando pie a una asimétrica interpretación de la misma, favoreciendo de manera indebida y premeditada, a una de las partes. Bajo este antecedente, los gobiernos, salen en defensa del consumidor dictando una serie de leyes y normas con el fin de protegerlos de métodos, procedimientos y cláusulas de contratación abusiva que merman los principios de buena fe y de soberanía del consumidor. Financiera Efectiva S. A., pertenece al sistema financiero peruano y no es ajena a estas medidas de protección; el ente supervisor, la Superintendencia de Banca, Seguros y AFP´s, ha emitido una vasta normativa que se complementa con la dictada por otros entes de protección al consumidor, tal es el caso de INDECOPI, entre otros. Así pues, la atención de los usuarios, toma relevancia, ante la exigencia de implementar y adecuar una serie de medidas que buscan la transparencia de la información, generando en las empresas, gastos operativos adicionales que deben ser absorbidos por la empresa, ya que la misma norma, prohíbe que este costo sea traslado al consumidor. Como cualquier norma, las vinculadas a proteger a los usuarios, penalizan a las empresas que incumplen con las mismas, creando procedimientos de control y alertas tempranas que permiten a los entes supervisores, tomar conocimiento de los casos que afectan indebidamente a los consumidores. Por tanto, es importante, que las organizaciones, preparen un presupuesto especial que les permita operar dentro de las normas vigentes de protección al consumidor, tomando relevancia, que su costo operativo, no se incremente por falencias en su sistema de atención y comunicación con sus usuarios.Trabajo de investigaciónCampus Chiclay

Integridade Estrutural da Inteligência Estratégica: uma Avaliação em uma Corporação Cooperativa

The process of transforming information into useful and dynamic knowledge has different structural levels that can determine the development of strategic intelligence (SI) in an organization. That is, the way an organization develops and organizes its intelligence actions characterize the structural integrity of the process and can determine its strategic role. This article aims to analyze the relationship between the structural integrity of the processes of SI and its strategic dimension in a group of 44 companies that are part of a large cooperative of companies in the Autonomous Community of the Basque Country in Spain. Data were collected from the general managers, R&D directors and innovation directors. To measure the SI constructs, a multi-item scale was adopted from prior studies. To identify a typology of companies, cluster analysis was performed. This study confirms that the more solid and organized the structure of the process of strategic intelligence is, the greater the strategic potential of the activity will be. O processo de transformar a informação em conhecimento útil e dinâmico tem diferentes níveis estruturais que podem determinar o desenvolvimento da Inteligência Estratégica (IE) em uma organização. Isto é, a forma pela qual uma organização desenvolve e organiza suas ações de inteligência caracterizam a integridade estrutural do processo e pode determinar seu papel estratégico. Esse artigo tem como objetivo analisar a relação entre a integridade estrutural dos processos de IE e sua dimensão estratégica em um grupo de 44 empresas que fazem parte de uma grande cooperativa de empresas na Comunidade Autônoma do País Basco na Espanha. Os dados foram coletados com os gerentes gerais, diretores de P&D e diretores de inovação. Para medir os construtos de IE, uma escala multi-item de estudos anteriores foi adotada. Para identificar uma tipologia das empresas, foi feita uma análise de clusters. Essa pesquisa confirma que quanto mais sólida e organizada é a estrutura do processo de Inteligência Estratégica, maior será o potencial estratégico da atividade.&nbsp

Síntesis, caracterización fisicoquímica y ensayos de biodistribución de nanopartículas con aplicaciones en el transporte de fármacos

Se realizó la síntesis de nanopartículas de oro (AuNPs) de 3 tamaños diferentes (aproximadamente 15, 40 y 70 nm), las cuales se postfuncionalizaron con el polisorbato Tween 20 (AuNPs-T) con el fin de que tengan aplicación como potenciales vehículos de drogas con acción a nivel de sistema nervioso central. Las AuNPs-T se caracterizaron en forma preliminar por espectroscopía UV-visible y mediante microscopía de fuerzas atómicas (AFM) se analizó su morfología y la distribución de tamaños. Para estudiar su biodistribución in vivo se inyectó una dispersión de AuNPs-T a ratones y se analizaron cortes de cerebro y otros órganos por microscopías óptica y de transmisión electrónica (TEM).Gold nanoparticles (AuNPs) of different sizes (approximately 15, 40 and 70 nm) have been synthesized and surface modified with the polysorbate Tween 20 (AuNP-T) with the final purpose of using them as carriers for drugs acting on the central nervous system. The different AuNP-T´s have been preliminarily characterized by UV-visible spectroscopy and their shape and size distribution have been studied by Atomic Force Microscopy (AFM). To study their in vivo biodistribution, AuNP-T dispersions were injected into mice. Brain and other organ sections were analyzed both by optical and transmission electron microscopies (OM and TEM).Fil: Alberdi, Emilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Huergo, María Ana Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Enrique, Andrea Verónica. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Departamento de Ciencias Biológicas. Cátedra de Química Medicinal; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bruno Blanch, Luis. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Departamento de Ciencias Biológicas. Cátedra de Química Medicinal; ArgentinaFil: Vericat, Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; Argentin

Optimal Maintenance Thresholds to Perform Preventive Actions by Using Multi-Objective Evolutionary Algorithms

Maintenance has always been a key activity in the manufacturing industry because of its economic consequences. Nowadays, its importance is increasing thanks to the Industry 4.0 or fourth industrial revolution. There are more and more complex systems to maintain, and maintenance management must gain efficiency and effectiveness in order to keep all these devices in proper conditions. Within maintenance, Condition-Based Maintenance (CBM) programs can provide significant advantages, even though often these programs are complex to manage and understand. For this reason, several research papers propose approaches that are as simple as possible and can be understood by users and modified by experts. In this context, this paper focuses on CBM optimization in an industrial environment, with the objective of determining the optimal values of preventive intervention limits for equipment under corrective and preventive maintenance cost criteria. In this work, a cost-benefit mathematical model is developed. It considers the evolution in quality and production speed, along with condition based, corrective and preventive maintenance. The cost-benefit optimization is performed using a Multi-Objective Evolutionary Algorithm. Both the model and the optimization approach are applied to an industrial case.This research was funded by the HAZITEK call of the Basque Government, project acronym HORDAGO

Optimal Maintenance Thresholds to Perform Preventive Actions by Using Multi-Objective Evolutionary Algorithms

[EN] Maintenance has always been a key activity in the manufacturing industry because of its economic consequences. Nowadays, its importance is increasing thanks to the Industry 4.0 or fourth industrial revolution. There are more and more complex systems to maintain, and maintenance management must gain efficiency and effectiveness in order to keep all these devices in proper conditions. Within maintenance, Condition-Based Maintenance (CBM) programs can provide significant advantages, even though often these programs are complex to manage and understand. For this reason, several research papers propose approaches that are as simple as possible and can be understood by users and modified by experts. In this context, this paper focuses on CBM optimization in an industrial environment, with the objective of determining the optimal values of preventive intervention limits for equipment under corrective and preventive maintenance cost criteria. In this work, a cost-benefit mathematical model is developed. It considers the evolution in quality and production speed, along with condition based, corrective and preventive maintenance. The cost-benefit optimization is performed using a Multi-Objective Evolutionary Algorithm. Both the model and the optimization approach are applied to an industrial case.This research was funded by the HAZITEK call of the Basque Government, project acronym HORDAGO.Goti, A.; Oyarbide-Zubillaga, A.; Alberdi, E.; Sánchez Galdón, AI.; Garcia-Bringas, P. (2019). Optimal Maintenance Thresholds to Perform Preventive Actions by Using Multi-Objective Evolutionary Algorithms. Applied Sciences. 9(15). https://doi.org/10.3390/app915306891

Estudio de viabilidad de mercados para la comercialización internacional del cultivo de aguaymanto proveniente del distrito de Lalaquiz provincia de Morropón para el año 2011

La presente tesis de investigación tiene por objetivo determinar la viabilidad técnica, económica y financiera del cultivo de aguaymanto en el distrito de Lalaquiz, provincia de Morropón, para la comercialización a mercados internacionales y el impacto dentro de la cobertura mencionada, por ello es necesario conocer los antecedentes, situación actual y proyecciones del mercado mundial y nacional de aguaymanto para poder obtener una visión objetiva del problema estudiado y lograr a una solución que beneficie a todos los involucrados. Con la finalidad de cumplir con los objetivos planteados, la investigación se divide en la siguiente forma: ▪ En el primer capítulo se hace referencia a la problemática de la investigación, justificación y antecedentes, limitación de la investigación y objetivos respectivos. ▪ En el segundo capítulo se profundiza el marco teórico y conceptual relacionado con las teorías que se han desarrollado sobre competitividad y evolución del cultivo en el mercado internacional en los últimos años y se busca explicar en qué consiste la producción de aguaymanto; así mismo damos a conocer como se encuentra la oferta y la demanda de este producto y cuáles son sus proyecciones para los próximos 10 años, estudiamos sus precios y la manera correspondiente para exportar. ▪ En el tercer capítulo se desarrolla el marco metodológico donde desarrollaremos una serie de instrumentos de investigación para determinar si es viable realizar el proyecto y cuál sería la rentabilidad de este. ▪ En el cuarto capítulo muestra los resultados obtenidos de la investigación, donde después de analizar las variables podemos llegar a nuestros resultados. ▪ Finalmente, en el quinto capítulo podemos tener la evaluación financiera que se enfoca en la sensibilidad del proyecto; y de esta forma lograremos dar las conclusiones y sugerencias para el óptimo desarrollo del proyect

Computerized restriction endonuclease analysis compared with O-serotype and phage type in the epidemiologic fingerprinting of Pseudomonas aeruginosa strains

ObjectiveTo assess restriction endonuclease analysis (REA) of chromosomal DNA using SalI enzyme, low-concentration (0.4%) agarose gels and digitalized data management of the REA patterns obtained for the typing of clinical Pseudomonas aeruginosa isolates.MethodsA group of 67 clinical unrelated isolates from 10 Spanish hospitals was used to study the discriminatory power, reproducibility and typeability of REA typing.ResultsA SalI REA pattern consisted of a variety (1–10) of restriction bands in the range between 12.2 and 48.5 kb and an unresolvable smear of low-molecular-weight bands. Forty different SalI REA patterns with an index of discrimination of 0.979 were obtained. Low typeability (91.04%) was the major limitation of REA typing. Analysis of blinded subcultures of eight Pseudomonas aeruginosa strains showed the reproducibility of REA typing to be 87.5%. Combined phenotypic typing (O-serotyping and phage typing) performed on the same group of strains showed comparable discrimination but much lower reproducibility. Isolates selected from five clusters of nosocomial infections in hospitals in the UK were typed by REA typing, and the results show high agreement when compared with conventional phenotypic typing methods in distinguishing between strains.ConclusionsThese data underline the usefulness of REA typing enhanced with digitalized data management for the epidemiologic subtyping of clinical Pseudomonas aeruginosa isolates

MUC1 positive cutaneous metastasis with transepidermal elimination from a breast carcinoma

Breast cancer is the most common cause of cutaneous metastases from internal malignancies. Generally, the neoplastic cells are located in the dermis or hypodermis, while a finding of transepidermal elimination on cutaneous metastases is exceptional. In this report we present a patient with perforating cutaneous metastases from breast cancer with mucin 1 expression. Cutaneous, bone, lung, and hepatic lesions were detected two years after the diagnosis of the primary tumor.Centro de Investigaciones Inmunológicas Básicas y Aplicada

Influence of chemistry and fiber diameter of electrospun PLA, PCL and their blend membranes, intended as cell supports, on their biological behavior

.The prevalence of osteoarthritis, a degenerative cartilage disease that causes joint surface erosion and loss of mobility, emphasizes the need of producing a functional articular cartilage replacement. Tissue engineering has been the focus of recent research as a possible strategy for cartilage regeneration and repair. The most widely used technique for the manufacture of nanofibers is polymer electrospinning. Polylactic acid (PLA) and polycaprolactone (PCL) have been proved particularly suitable for nanofiber preparation, with many biomedical applications. The main aim of this work was to evaluate the behavior of adipose tissue-derived mesenchymal stem cells (ASCs) cultured on biomaterials of PLA, PCL and a combination of both (PLA/PCL), manufactured by electrospinning. We analyzed the bioactive properties of these cells in cultures on them, in terms of proliferation, adhesion, morphology, viability and differentiation. In addition, the influence of the thickness of the fibers in each biomaterial on these cellular characteristics was evaluated for their use in Cartilage Regenerative Medicine applications to promote chondrogenic differentiation. Depending on the parameter assessed, different results were obtained on each biomaterial. Using both polymers successful results on cellular viability were obtained, although in the case of PCL the cellular response in all the experiments was significantly better. As for the blends, positive outcomes were obtained, but they did not overtake the characteristics of PCL. Interestingly, ASCs were able to differentiate into chondrocytes without adding specific chondrogenic media in the three biomaterials tested. Moreover, a marked cell differentiation on PCL with 1.8 μm-fiber diameter and PLA/PCL blends was observed. These findings may play a key role in cartilage Regenerative Medicine and Tissue Engineering.S