Plan de negocios para el desarrollo de una aplicaci?n m?vil de servicios profesionales de enfermeras y t?cnicos en enfermer?a a domicilio en Lima Metropolitana

El presente plan de negocios ofrece servicios profesionales de enfermer?a a domicilio, usando como canal una aplicaci?n m?vil, que sirve de conexi?n entre las personas que demandan servicios de enfermer?a a domicilio y los profesionales que ofertan dichos servicios. El modelo de negocio estar? basado en ofrecer un servicio de calidad superior, a precios competitivos, a trav?s de un canal r?pido y flexible, un aplicativo m?vil, que permitir? a los profesionales de enfermer?a incrementar sus ingresos y a los usuarios obtener un profesional capacitado r?pidamente. El nombre comercial definido ser? Ayni Salud, por su significado en quechua ?Cooperaci?n y solidaridad rec?proca?

Força em crianças ativas e inativas em um intervalo de seis meses

As capacidades biofísicas são inerentes nos seres humanos; entre elas destaca-se a força, capacidade que é base para as demais, pois com um bom desenvolvimento dela, as outras possuem um aporte para se desenvolverem de forma integral. Um fator importante para a expressão da força muscular em escolares é o desenvolvimento do sistema nervoso, se a formação das bainhas de mielina das fibras nervosas estiver ausente ou incompleta, reações rápidas e movimentos que requerem habilidade não podem ser desempenhados com sucesso, e altos níveis de força e potência serão impossíveis. O presente estudo teve como objetivo comparar dados da valência física força dos escolares com idades entre 11 e 14 anos praticantes e não praticantes de programas de exercício extracurriculares. O estudo desenvolvido teve característica descritiva e analítica, realizado na cidade de Treze Tílias, SC. Para avaliar a força dos escolares foram utilizados os seguintes testes: teste de força/resistência abdominal; teste de força explosiva de membros inferiores e teste de força explosiva de membros superiores. Para observar se existe diferença entre o teste e o reteste foi utilizado o teste estatístico Pearson com intervalo de confiança de p menor que 0,05. Os resultados das avaliações realizadas no gênero feminino apontaram melhor desempenho de força nos três testes para as meninas ativas, diferentemente do gênero masculino. Os meninos ativos obtiveram melhores resultados somente no salto horizontal. Os resultados obtidos indicaram que há diferença entre os grupos investigados; as meninas ativas apresentaram melhores resultados de desenvolvimento do que as meninas inativas, já os meninos, o grupo ativo apresentou superioridade em apenas um indicativo para força. Palavras-chave: Crescimento. Força muscular. Escolares

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

CounterAttack: Automated Casino Loss-Prevention System

Background:   Goal:  The main purpose of this system is to automatically monitor multiple simultaneous games of blackjack in multiple geographic locations to detect potential card counters, who might erase or negate any potential profits for the casino hosting the game.  Our cloud-based solution carries out this process by using existing camera infrastructure and distributed object recognition algorithms to detect chips and cards on the playing table.  Once this data is captured, our algorithms calculate the correlation between the player’s bets and the remaining cards in the deck to calculate the likelihood that the player is counting cards with the intent of removing the house’s advantage I the game. Faculty Adviser:   Professor Pooria YaghiniTry out our free client-side Python API access library!CounterAttackLPS.co

CounterAttack: Automated Casino Loss-Prevention System

Background:   Goal:  The main purpose of this system is to automatically monitor multiple simultaneous games of blackjack in multiple geographic locations to detect potential card counters, who might erase or negate any potential profits for the casino hosting the game.  Our cloud-based solution carries out this process by using existing camera infrastructure and distributed object recognition algorithms to detect chips and cards on the playing table.  Once this data is captured, our algorithms calculate the correlation between the player’s bets and the remaining cards in the deck to calculate the likelihood that the player is counting cards with the intent of removing the house’s advantage I the game. Faculty Adviser:   Professor Pooria YaghiniTry out our free client-side Python API access library!CounterAttackLPS.co

The Future of Adhesion Prophylaxis Trials in Abdominal Surgery: An Expert Global Consensus

Postoperative adhesions represent a frequent complication of abdominal surgery. Adhesions can result from infection, ischemia, and foreign body reaction, but commonly develop after any surgical procedure. The morbidity caused by adhesions affects quality of life and, therefore, it is paramount to continue to raise awareness and scientific recognition of the burden of adhesions in healthcare and clinical research. This 2021 Global Expert Consensus Group worked together to produce consented statements to guide future clinical research trials and advise regulatory authorities. It is critical to harmonize the expectations of research, to both develop and bring to market improved anti-adhesion therapies, with the ultimate, shared goal of improved patient outcomes

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine