Reestructuración del Layout del centro de distribución de Casa Luker

El mundo de la logística nos exige buscar eficiencias de manera permanente, es por ello que toda la cadena de suministros debe de funcionar de manera sincronizada, buscando que las empresas cada vez sean más competitivas, una logística eficiente permitirá un apalancamiento para el cumplimiento de las metas y objetivos de las compañías. En el centro de distribución más grande del país de la empresa Casa Luker se evidencia improductividad por parte de los operarios que se encargan de realizar el alistamiento de los pedidos en los primeros niveles, esto se da en gran medida por los amplios desplazamientos que deben de realizar dentro del almacén, dado que las posiciones de picking se encuentran en lugares distantes a los muelles de carga, generando que los operarios deban de realizar mayores recorridos y consumiendo un tiempo valioso dentro de la operación. Es por esta razón que se plantea una reestructuración del layout que permita eliminar de forma radical los desplazamientos innecesarios y tiempos muertos dentro de la operación de almacén, esto incrementará sustancialmente la productividad operativa en el proceso asignado para el alistamiento de los pedidos.The world of logistics requires us to permanently seek efficiencies, which is why the entire supply chain must work in a synchronized manner, seeking to make companies increasingly competitive, efficient logistics will allow leverage for compliance with the company goals and objectives. In the country's largest distribution center of the Casa Luker company, there is evidence of unproductiveness on the part of the operators who are in charge of preparing the orders at the first levels, this is largely due to the extensive displacements that must be carried out. within the warehouse, given that the picking positions are located in places far from the loading docks, causing the operators to have to make longer journeys and consuming valuable time within the operation. It is for this reason that a restructuring of the layout is proposed that allows to radically eliminate unnecessary displacements and downtime within the warehouse operation, this will substantially increase the operational productivity in the process assigned for the enlistment of orders

American Tegumentary Leishmaniasis: Is Antimonial Treatment Outcome Related to Parasite Drug Susceptibility?

BackgroundAntimonials are the first drug of choice for the treatment of American tegumentary leishmaniasis (ATL); however, their efficacy is not predictable, and this may be linked to parasite drug resistance. We aimed to characterize the in vitro antimony susceptibility of clinical isolates of Peruvian patients with ATL who were treated with sodium stibogluconate and to correlate this in vitro phenotype with different treatment outcomes MethodsThirty-seven clinical isolates were obtained from patients with known disease and treatment histories. These isolates were typed, and the susceptibility of intracellular amastigotes to pentavalent (SbV) and trivalent (SbIII) antimonials was determined ResultsWe observed 29 SbV-resistant isolates among 4 species of subgenus Viannia most of which exhibited primary resistance; isolates resistant only to SbIII; and 3 combinations of in vitro phenotypes: (1) parasites sensitive to both drugs, (2) parasites resistant to both drugs, and (3) parasites resistant to SbV only (the majority of isolates fell into this category). There was no correlation between in vitro susceptibility to both antimonials and the clinical outcome of therapy ConclusionAntimony insensitivity might occur in a stepwise fashion (first to SbV and then to SbIII). Our data question the definition of true parasite resistance to antimonials. Further studies of treatment efficacy should apply standardized protocols and definitions and should also consider host factor

Estudio de la contaminación auditiva en la plazoleta de la gobernación del Cesar

Este artículo es el trabajo final de una investigación realizada en la ciudad de Valledupar,Cesar, en la remodelación del estadiode fútbol Armando Maestre Pavajeau, donde las empresas constructoras han enfrentado el mayor desafío con la naturaleza: convivir con el nivel freático a la hora de construir. Este contratiempo que sufre la obra se debe porque la ciudad presenta un alto nivel freático y cualquier obra de gran magnitud que requiera excavaciones profundas puede tener un atraso en las labores ingenieriles al encontrarse con esas inmensas masas de agua, como está sucediendo en esta obra. El aspecto que ha hecho más visible la problemática es el vertimiento del agua a las calles porque el plan de contingencia que se creó inicialmente para controlar el agua subterránea no tuvo la suficiente capacidad de almacenarla. La finalidad de este artículo es indagar sobre los problemas que puede acarrear a la construcción en Valledupar. Entre los resultados se encontraron atrasos sin un límite estipulado, también incrementos en los presupuestos iniciales, debido a la implementación urgente que se ha debido hacer para tratar las aguas subterráneas.Es aquí donde surgen dudas acerca del buen desarrollo de los estudios que se deben realizar en toda obra ingenieril

GACETA SANITARIA in 2017. Improving the quality of our journal

Empezamos este año 2018 con nuestra Nota editorial anual, en la cual pretendemos compartir con los/las lectores/as, personas autoras y la sociedad la actividad realizada por el equipo editorial de la revista a lo largo del año anterior. El documento también permite analizar los avances y las áreas de mejora en marcha de la revista. A continuación, presentaremos brevemente las actividades realizadas durante el año 2017, así como la información sobre el desempeño de la revista. Muchas de estas actividades se ven reflejadas también en el blog del comité editorial de Gaceta Sanitaria

A collaboratively derived environmental research agenda for Galapagos

Galápagos is one of the most pristine archipelagos in the world and its conservation relies upon research and sensible management. In recent decades both the interest in, and the needs of, the islands have increased, yet the funds and capacity for necessary research have remained limited. It has become, therefore, increasingly important to identify areas of priority research to assist decision-making in Galápagos conservation. This study identified 50 questions considered priorities for future research and management. The exercise involved the collaboration of policy makers, practitioners and researchers from more than 30 different organisations. Initially, 360 people were consulted to generate 781 questions. An established process of preworkshop voting and three rounds to reduce and reword the questions, followed by a two-day workshop, was used to produce the final 50 questions. The most common issues raised by this list of questions were human population growth, climate change and the impact of invasive alien species. These results have already been used by a range of organisations and politicians and are expected to provide the basis for future research on the islands so that its sustainability may be enhanced. </jats:p

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Evaluation of Antiretroviral Resistance in population of Men who have sex with Men in a Multicenter study in Brazil by Respondent Driven Sampling

O HIV-1 apresenta uma alta diversidade genetica, resultado principalmente de sua alta taxa de replicacao e das caracteristicas da atividade de sua Transcriptase Reversa. Existem poucos estudos sobre os subtipos de HIV e de resistencia transmitida e secundaria aos medicamentos antirretrovirais em amostras de homens que tem sexo com homens (HSH) no Brasil. Com a finalidade de estudar as caracteristicas virologicas, foram empregadas amostras de voluntarios das cinco regioes brasileiras selecionados atraves da metodologia de respondent driven sampling (RDS). Analisamos a diversidade genetica do HIV e a prevalencia de mutacoes associadas com resistencia antirretroviral em HSH nas cinco regioes geograficas do Brasil. Usando RDS foram recrutados e entrevistados 3.515 HSH em 10 cidades. Destes, 299 (9,5%) eram infectados com HIV e 178 concordaram em testes de genotipagem. Nos descrevemos neste trabalho os resultados de 162 amostras; os subtipos mais comuns foram: B (81,4%), C (7,4%), F (4,3%), D (0,6%) e formas recombinantes (6,2%). Especificamente de 143 pessoas cujas amostras foram adequadas para analise e tinham disponiveis dados epidemiologicos: 44 (30,8%) tinham recebido terapia antirretroviral (ART) (AE) e 99 (69,2%) eram ART-naive (AN). Apos o sequenciamento nas regioes da transcriptase reversa e protease do virus, a analise para mutacoes de resistencia foi feita usando os parametros da OMS. A prevalencia da resistencia primaria foi de 21,4%, isto e, entre os NA; e a de resistencia secundaria foi de 35,8% (isto e, entre os AE). A prevalencia de resistencia a inibidores de protease (IP) foi de 3,9% (AN) e 4,4% (AE); para inibidor da transcriptase reversa analogo de nucleosideos (NRTI) 15,0% (AN) e 31,0% (AE) e para inibidor da transcriptase reversa nao analogo de nucleosideos (NNRTI) 5,5% (AN) e 13,2% (AE). A mutacao de resistencia mais comum para NRTIs foi 184V (17 casos) e para NNRTIs: 103N (16 casos). Nossos dados sugerem um alto nivel de resistencia transmitida em HSH no Brasil. Estudos epidemiologicos desenhados para medir a prevalencia de resistencia primaria nesta populacao sao necessarios para identificar os correlatos e as causas da resistencia antirretroviral para poder limitar o desenvolvimento de resistencia nesta e outras populacoesBV UNIFESP: Teses e dissertaçõe

La empresa unipersonal en el derecho

El artículo 71 introduce el ordenamiento comercial colombiano la figura de la empresa unipersonal, de especial interés entre comerciantes, ya que por medio de ella se puede afectar un porcentaje del patrimonio de una person

La empresa unipersonal en el derecho

El artículo 71 introduce el ordenamiento comercial colombiano la figura de la empresa unipersonal, de especial interés entre comerciantes, ya que por medio de ella se puede afectar un porcentaje del patrimonio de una person