Prefactibilidad agron?mica, econ?mica y financiera de la producci?n y exportaci?n al mercado chino de un cultivo nuevo con potencial de adaptaci?n a la sierra andina: el caso de la cereza para el distrito de Caraz (Regi?n Ancash)

Se busca determinar la viabilidad agron?mica, econ?mica y financiera de la producci?n de cereza en Caraz, regi?n Ancash, y su comercializaci?n en el mercado chino. La cereza fresca es altamente demanda por China, que tiene a Chile como su principal proveedor y que aprovecha la contra estaci?n de su cosecha respecto al hemisferio norte y esta ser? la gran oportunidad para la cereza de Caraz, que cosechar? dos meses antes que Chile. Se proyectan las actividades agr?colas en un predio de 50 hect?reas y la cosechada se trasladar? al puerto del callao, para embarcarse al puerto de Shanghai. Para la evaluaci?n econ?mico financiera se consider? a una densidad de 1,904 plantas/ha, con producci?n de 8 kg por planta, con precio FOB de 6.9 d?lares por kilo. La inversi?n total requerida ser? de 3,377,819 d?lares con 45.9% financiado por bancos a Tasa Efectiva Anual de 18% y el 54.1% restante con aporte de accionistas a un Costo de Oportunidad de 25%, con un VAN econ?mico de 1,116,994 d?lares, una TIR de 32% y VAN financiero de 2,852,717 d?lares con una TIR de 36.1%, un periodo de recuperaci?n de la inversi?n de 7 a?os

Plan de negocios para una empresa dedicada a la prestaci?n de servicios sobre estimulaci?n temprana en Lima Norte

El Centro de Estimulaci?n Temprana ?Grandes Peque?os Pasos?, se ubicar? en el distrito de Los Olivos, atendiendo a familias con ni?os de 0 a 36 meses de los estratos socioecon?micos B y C, provenientes de los distritos de Los Olivos, Independencia y San Mart?n de Porres, principalmente. Parte del conjunto de beneficios que ofrecer? el centro de estimulaci?n incluye la presencia de personal altamente calificado, un local acondicionado adecuadamente para las actividades de estimulaci?n, lo mismo que una buena ubicaci?n. As? tambi?n, contar? con una metodolog?a enmarcada dentro de la teor?a del Apego y junto con ?sta, una propuesta innovadora de las actividades pertinentes. ?Grandes Peque?os Pasos? tendr? como visi?n, el ser altamente apreciado y valorado por sus clientes debido a su preocupaci?n por los detalles, la seguridad, y sobre todo por la calidad en la que entrega sus servicios, no s?lo de talleres de estimulaci?n temprana para los infantes sino tambi?n de orientaci?n psicol?gica y pedag?gica para padres de familia. Finalmente, ?Grandes Peque?os Pasos?, se insertar? dentro de una red de aliados estrat?gicos tales como centros de rehabilitaci?n infantiles, cl?nicas pedi?tricas, entre otros servicios complementarios, que le permitir?n afianzar su posicionamiento como l?der en su sector

Characterization of pulmonary function in 10â18 year old patients with Duchenne muscular dystrophy

Pulmonary function loss in patients with Duchenne muscular dystrophy (DMD) is progressive and leads to pulmonary insufficiency. The purpose of this study in 10â18 year old patients with DMD is the assessment of the inter-correlation between pulmonary function tests (PFTs), their reliability and the association with the general disease stage measured by the Brooke score. Dynamic PFTs (peak expiratory flow [PEF], forced vital capacity [FVC], forced expiratory volume in one second [FEV1]) and maximum static airway pressures (MIP, MEP) were prospectively collected from 64 DMD patients enrolled in the DELOS trial (ClinicalTrials.gov, number NCT01027884). Baseline PEF percent predicted (PEF%p) was <80% and patients had stopped taking glucocorticoids at least 12 months prior to study start. At baseline PEF%p, FVC%p and FEV1%p correlated well with each other (Spearman's rho: PEF%pâFVC%p: 0.54; PEF%pâFEV1%p: 0.72; FVC%pâFEV1%p: 0.91). MIP%p and MEP%p correlated well with one another (MIP%pâMEP%p: 0.71) but less well with PEF%p (MIP%pâPEF%p: 0.40; MEP%pâPEF%p: 0.41) and slightly better with FVC%p (MIP%pâFVC%p: 0.59; MEP%pâFVC%p: 0.74). The within-subject coefficients of variation (CV) for successive measures were 6.97% for PEF%p, 6.69% for FVC%p and 11.11% for FEV1%p, indicating that these parameters could be more reliably assessed compared to maximum static airway pressures (CV for MIP%p: 18.00%; MEP%p: 15.73%). Yearly rates of PFT decline (placebo group) were larger in dynamic parameters (PEF%p: â8.9% [SD 2.0]; FVC%p: â8.7% [SD 1.1]; FEV1%p: â10.2% [SD 2.0]) than static airway pressures (MIP%p: â4.5 [SD 1.3]; MEP%p: â2.8 [SD 1.1]). A considerable drop in dynamic pulmonary function parameters was associated with loss of upper limb function (transition from Brooke score category 4 to category 5). In conclusion, these findings expand the understanding of the reliability, correlation and evolution of different pulmonary function measures in DMD patients who are in the pulmonary function decline phase

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Employment generation by small firms in Spain

Despite the relevance in terms of policy, we still know little in Spain about where and by whom jobs are created, and how that is affecting the size distribution of firms. The main innovation of this paper is to use a rich database that overcomes the problems encountered by other firm-level studies to shed some light on the employment generation of small firms in Spain. We find that small firms contribute to employment disproportionately across all sectors of the economy although the difference between their employment and job creation share is largest in the manufacturing sector. The job creators in that sector are both new and established firms whereas only new small firms outperform their larger counterparts in the service sector. The large annual job creation of the small firm size class is shifting the firm size distribution towards the very small production units, although not uniformly across industries of different technology intensit

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Manual suppression of adults of Phyllophaga spp. and Anomala spp. on maize in Mexico

3 gr?f. 2 tab. 21 ref.Se eliminaron manualmente adultos de Phyllophaga spp. y Anomala spp. en parcelas de ma?z en El Madrogal, Amatenango del Valle, Chiapas, M?xico entre abril y mayo de 1997. Para evaluar el efecto de la supresi?n sobre las larvas se realizaron 29 muestreos en plantas de ma?z, durante setiembre en El Madrogal y San Francisco (parcela de comparaci?n). Se recolectaron 40995 adultos, de las especies: Phyllophaga ravida, P. obsoleta, P. tenuipilis, P. testaceipannis, P. menetriesi, P. tumulosa, y dos especies de Anomala. Las especies mejor representadas durante las semanas de recolecci?n fueron P. menetriesi y P. tenuipilis. El mayor promedio de huevos por hembra se determin? para P. tenuipilis y P. testaceipennis, Las especies dominantes en San Francisco fueron P. menetriesi y P. tenupilis (con densidades de 17,24 y 13 larva/m{ostrok}, respectivamente). En el Madrogal s?lo se encontraron larvas de P. tumulosa, P. ravida y Anomala spp. con densidades relativamente bajas (1,5 larvas/m{ostrok}), lo cual indica que la supresi?n de adultos disminuye la densidad larval. La supresi?n de adultos podr?a ser una alternativa de manejo de la plaga econ?mica, sencilla y segura para la zona temporal que requiere del trabajo colectivo de la poblaci?n