Plan estratégico comercial Circulo de Viajes Universal sede Villavicencio

49 Páginas.Las proyecciones que tiene esta empresa son muy grandes y ambiciosas, tienen establecidos métodos de servicio y algunas estrategias que aunque son antiguas, han venido teniendo un desarrollo lento pero si son difundidas en los empleado de la organización. El tipo de gerencia utilizado es totalmente visible y mantiene mucho contacto directo con los subalternos y los clientes, situación que le permite estar 5 enterados de muchas realidades de los asesores y clientes. Aunque aún no hay una cultura de servicio implementada, ni se tienen niveles altos de servicio al cliente la empresa se preocupa periódicamente por buscar mejorar en este aspecto en la medida que se detecten errores, tal vez un plan estratégico de servicios les permitiría anticiparse a muchas situaciones

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

La magia de tus pensamientos : poesías & cuentos

Recopilación de poesías y cuentos realizados por aprendices del SENA de los programas de Mantenimiento de Motores Diesel, Técnico en Sistemas, Automatización Industrial, Electricidad Industrial, Diseño e Integración de Automatismos Mecatrónicos, Mantenimiento de Equipo Biomédico, Animación 3D, Manejo Ambiental, Diseño e integración de Automatismos Mecatrónicos y Mantenimiento mecatrónico automotriz, entre 2015 y 2017.Poesías 2018 -- Dándome tu vida / Brayan Orlando Jaimes Chaparro -- Tierra infinita / Christian Ricardo Caballero Villamizar -- Lamento a la tierra / Jeferson Alexis Montoya Moreno -- Conciencia por favor / Daniel Rincón -- Salvar un hogar llamado tierra / William Gamboa Arguello -- Planeta tierra / Iván Arley jurado -- Salvemos nuestro planeta / Jonathan David Silva -- Tierra bella / Martin Santiago -- Mi planeta / Fabián Moreno -- Generando conciencia / José Alberto Lizarazo -- Añoranza / Javier Casanova -- Sin tierra… / Gustavo Andrés Rodríguez Mendoza -- Planeta vivo y limpio / Yesid Serrano -- Palabras del destino / Osneider David Hernández Otalvaro -- Planeta tierra / Luis Fernando Isidro -- Medio ambiente / Yorgin David Hernández -- Prevenir / Brayan Mauricio Sanmiguel Luengas -- Nada será cómo antes / Jaime Andres Rodriguez Parrado -- Yo…Sol / Jonathan Bautista -- Lamento / Héctor Mauricio Parra Cuesta -- Nuestro hogar / Juan José Amaya -- Te agradecemos / Edwin Andrés Navarro Rozo, Anderson Cardozo Villamizar -- HErmoso milagro / Jhonatan Jaimes Solano -- El creador / Ana Rosa Hernández Santana -- Cuentos 2015 -- Juventud en la zona azul / Jeniffer Solano Ardila -- Los Ucayali y los Cubeo / Oscar Ivan Rueda Quintero -- Vientos de armonía / Ever Edinson Monsalve Salcedo -- El nacimiento de una nueva era / Carlos Leonardo Ardila Alvarado -- Luz de sueños / Hugo Andrés Álvarez -- Sol de medio día / Claudia Ramírez Guarín -- Cuentos 2016 -- Mucha verraquera mano / Héctor Josué Amado Sandoval -- El viaje de irse y nunca volver / Dayana Marcela Fuentes Duran -- “Santander es hermosa” / Kelly Tatiana Pabón Blanco -- Los valores del SENA / Ana Rosa Hernandez Santana -- La fuerza del espiritu y el deseo de cambiar / Pablo Andrés Capera Rodríguez -- SENA, paz y reconciliación / Adrián Benítez R., Rubén Darío Martínez -- Cuentos 2017 -- Cartas a un pasado / Angelita Delgado Pérez -- ¿Por qué así? ¿por qué tan blanco? ¿por qué no de otra manera? / Cristian Felipe Vargas Buenahora -- El gato pacho pacho, el gato más pacho de todos los pachos / Edwin Matajira García -- Freeland “el paraíso perdido” / Dámaso Antonio Morales Palacin -- Un mundo al revés / Fabio Eduardo Contreras Piñeresna91 página

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

microbeMASST: A Taxonomically-informed Mass Spectrometry Search Tool for Microbial Metabolomics Data

microbeMASST, a taxonomically informed mass spectrometry (MS) search tool, tackles limited microbial metabolite annotation in untargeted metabolomics experiments. Leveraging a curated database of >60,000 microbial monocultures, users can search known and unknown MS/MS spectra and link them to their respective microbial producers via MS/MS fragmentation patterns. Identification of microbe-derived metabolites and relative producers without a priori knowledge will vastly enhance the understanding of microorganisms’ role in ecology and human health

A Taxonomically-informed Mass Spectrometry Search Tool for Microbial Metabolomics Data

MicrobeMASST, a taxonomically-informed mass spectrometry (MS) search tool, tackles limited microbial metabolite annotation in untargeted metabolomics experiments. Leveraging a curated database of >60,000 microbial monocultures, users can search known and unknown MS/MS spectra and link them to their respective microbial producers via MS/MS fragmentation patterns. Identification of microbial-derived metabolites and relative producers, without a priori knowledge, will vastly enhance the understanding of microorganisms’ role in ecology and human health

Megaprojects managements in Ecuador: challenges and opportunities

Megaprojects are described as large, complex and expensive construction projects. Recent studies have shown that megaprojects often result in cost overruns, time extensions and undesired outcomes. Regardless, megaprojects are common, particularly in developing countries, as they are a trigger for social and economic development (Li et al., 2010). Since 2007, the Government of Ecuador has begun an unprecedent investment in infrastructure. Through the National Water Secretary, the government has 16 projects in agenda accounting for over $3 billion, with 6 projects currently under construction. These projects are considered flagship infrastructure in the endeavour to enhance the country´s productivity.The Bulubulu-Naranjal-Cañar project, a$406 million multi-purpose hydraulic project for irrigation and flood control, consists of over 1,000 activities and was proposed to be completed by 2015. This novel project for Ecuador, presented as a case study, represents a challenge for project management and financing. The purpose of this preliminary study is to provide an insight to megaproject management in Ecuador, and propose improvements to megaproject management through optimization of stochastic project schedules