Consulting report – Equipos Portuarios SA

Equiports es una empresa familiar creada en 2007 que se especializa en el alquiler, venta y post-venta de equipos de manipulación de contenedores para la industria portuaria peruana. Esta industria es altamente competitiva, siendo muy importante para la distribución exclusiva de marcas extranjeras tanto la relación con los clientes como la alta especialización técnica. El principal problema identificado dentro de la empresa es que Alejandro Sarria, el Gerente General y cofundador de Equiports, pronto tendrá que dejar su puesto como CEO con el fin de centrarse en otra empresa familiar. Sin embargo, como resultado del análisis realizado, hay retos internos que podrían poner en peligro el éxito de la empresa en el futuro. El problema se debe debido al alto grado de importancia que Alejandro ha tenido en Equiports. Como pequeña empresa, Equiports no ha desarrollado una adecuada gestión del conocimiento, y al ser una empresa familiar, no desarrolló un plan de sucesión que prepare talento interno para que pueda reemplazarlo cuando sea necesario. Se realizó un proceso de solución de problemas para asegurar que la empresa no perderá competitividad sin la presencia de su líder central, Alejandro. Se propone un plan de seis meses a ser implementado en Equiports para hacer frente al problema principal. El plan posee cuatro iniciativas: (a) desarrollar capacitación, (b) revisar los KPIs, (c) desarrollar una herramienta de gestión de recursos, y (d) mejorar la gestión del conocimiento. Este plan de sucesión para la posición de CEO puede ser adaptado con menores cambios para cualquier sucesión que la empresa tenga en el futuroEquiports was created in 2007 as a family-owned company that specializes in the rental, sales and after-sales of container handling equipment for the Peruvian port industry. The company plays in a high competitive industry in which both the relationship with customers and a highly technical experience are important to represent exclusively foreigner brands. The key problem identified within the company is that Alejandro Sarria, the General Manager and co-owner at Equiports, will soon need to leave his position as CEO at Equiports in order to be focused on another family-owned company. However, as a result of the conducted analysis, there are internal issues that could jeopardize the success of the company in the future. The firm is facing this challenge due to the degree of importance that Alejandro has had in Equiports. As a small company, Equiports did not understand the need to develop proper knowledge management, and being a family-owned company, it failed to develop a succession plan and groom internal talent that could replace the CEO position when needed. A problem-solving process was conducted to ensure that the firm will not struggle without the presence of its central and ever present leader, Alejandro. A six months plan is recommended to apply at Equiports to cope with the key problem. The plan has four initiatives: (a) to develop training and shadowing, (b) to review the KPIs, (c) to develop a resource management tool, and (d) to improve knowledge management. This implementation plan for the succession of CEO position can be adapted with minor alterations for any succession the company has in the futureTesi

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Experiencias de Aprendizaje-Servicio en la UPM: 2021 y 2022

La Oficina de Aprendizaje-Servicio (ApS) de la UPM, constituida en sesión del Consejo de Gobierno de diciembre de 2019 tiene, como misión fundamental, promover en el ámbito de las enseñanzas de esta universidad la metodología ApS. Con esta finalidad se vienen realizando convocatorias de proyectos de impacto social alineados con los ODS como un mecanismo más para la contribución a la Agenda 2030, y se colabora intensamente con las diversas oficinas constituidas con el mismo objetivo en otras universidades. Nuestra oficina pretende impulsar progresivamente la colaboración con entidades ajenas a la UPM, y atender demandas y necesidades sociales en las que nuestros estudiantes y profesores brinden sus conocimientos para la construcción de una mejor y más justa sociedad. Con este propósito, se han puesto en marcha numerosas iniciativas y colaboraciones con Ayuntamientos, Asociaciones, ONG, Fundaciones y centros de enseñanza, con el fin común de plantear mejoras y trabajar con entornos desfavorecidos, y colectivos vulnerables de nuestro entorno. Cabe destacar la muy positiva acogida que, progresivamente se está logrando, en lo relativo a la diseminación de estas iniciativas en el ámbito de la UPM, viéndose incrementada la participación e interés de nuestros docentes y estudiantes en los llamamientos que se realizan desde la oficina. Desde la constitución de la oficina, son ya más de 100 actividades desarrolladas con la participación de más de 500 profesores. Uno de los compromisos de la Oficina ApS de la UPM es dar visibilidad por su carácter meritorio a las experiencias realizadas por el profesorado y los estudiantes de nuestra universidad y, es por ello, que nos complace la presentación de esta primera edición del ebook, en el que se recogen algunas de las experiencias realizadas en nuestra universidad y que confiamos ampliar periódicamente con futuras ediciones. Nuestro más sincero agradecimiento a todos los profesores que habéis hecho posible esta primera publicación con vuestras contribuciones

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56\u20131.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion