Análisis de la satisfacción del turista con discapacidad física en los hoteles de 4 estrellas en Miraflores, Lima, 2016

En el presente trabajo de investigación que tiene como objetivo principal determinar el nivel de la satisfacción del turista con discapacidad física en hoteles de 4 estrellas en el distrito de Miraflores, Lima, 2016. Esta investigación tiene como idea fundamental mostrar teorías de autores que responden de manera correcta y responden el problema en cuestión como es ¿Cuál es el nivel de satisfacción del turista con discapacidad física en hoteles de 4 estrellas en Miraflores, Lima, 2016? Se realizó un cuestionario con una muestra de 24 turistas encuestados que se hospedaron en 4 hoteles de Miraflores para poder determinar el nivel de satisfacción con eficacia en los turistas por lo que se incluyeron 24 turistas en donde se pudo obtener como resultado que un 70% de los turistas están conformes con la calidad de los servicios brindados en los hoteles de Miraflores; además se logró tener como resultado que un 60% de los turistas encuestados nos brindaron como información de que según ellos el análisis de satisfacción frente a la calidad de los servicios brindados es “de acuerdo” por lo que se logró determinar el objetivo principal. Esta investigación tiene como conclusión que las expectativa de los turistas con discapacidad sobre la satisfacción de estos turistas es favorable debido a todos los factores que intervinieron para esta investigación que nos han dado como resultado a que el distrito de Miraflores es uno de los distritos de nuestra capital, que es elegido con mayor amplitud para aquellas personas que tienen alguna discapacidad

Evaluación del control interno basado en el coso III a “Riohospital” del cantón Riobamba, provincia de Chimborazo, periodo 2018

El presente trabajo de titulación tuvo como objetivo realizar una Evaluación del Control Interno basado en el COSO III a “RIOHOSPITAL” del Cantón Riobamba, Provincia de Chimborazo, período 2018, con la finalidad de verificar el nivel de cumplimiento de los procesos administrativos y contables. Para la ejecución del siguiente trabajo se empleó técnicas como la entrevista al gerente para de esta manera obtener información más relevante y precisa, observación se realizó acudiendo a la empresa para poder recabar información y las encuestas dirigida a todo el personal que labora en dicha institución. Los hallazgos encontrados fueron los siguientes: no existe una adecuada capacitación al personal en el área de salud como son médicos, enfermeras, instrumentistas, el departamento de contabilidad y la administración no realiza un adecuado control de los procesos internos, no cuenta con indicadores que evalúen el cumplimiento de eficiencia, eficacia. Por este motivo se ejecutó la evaluación de control interno donde se desarrolló los cuestionarios de control interno para determinar el nivel de riesgo y confianza, se realizó hojas de procedimientos con sus respectivos flujogramas en donde se encuentran explícitos los pasos de cada una de las actividades que se van generando en los departamentos de acuerdo a las necesidades, así también se elaboró un informe final. Se concluyó que los procesos contables, administrativos entre otros muestran un nivel de confianza del 76% y un nivel de riesgo del 24%. Se recomienda realizar evaluaciones de control interno de manera periódica a los procesos que va desarrollando en cada actividad.The objective of this study was to carry out an Internal Control Evaluation based on COSO III at "RIOHOSPITAL" located in Riobamba city, province of Chimborazo, term 2018, in order to verify the level of compliance with the administrative and accounting processes. For the development of this study, an interview was applied to the manager in order to obtain more relevant and precise information, an observation technique by visiting the company to be able to collect information and also surveys applied to the personnel who work in the institution. The findings go as follows: there is no an adequate training system for the staff in the health area such as physicians, nurses, scrubbers; the accounting department and the administration do not carry out an adequate control of internal processes, it lacks of indicators to evaluate the compliance of efficiency, effectiveness. For this reason, the internal control evaluation was carried out where the internal control questionnaires were developed to determine the level of risk and confidence, procedure sheets with their respective flowcharts were elaborated where the steps of each one of the activities generated by each department are explicit according to their needs, along with the presentation of a final report. It was concluded that the accounting and administrative processes, among others, show a confidence level of 76% and a risk level of 24%. It is recommended to carry out constant internal control evaluations for the processes that are being developed in each activity

O-28: Molecular basis for the insurmountable AT-1 receptor antagonism of telmisartan

In vitro studies have shown that telmisartan is an insurmountable angiotensin II AT-1 receptor antagonist. In this study we have investigated the molecular basis of this insurmountable antagonism. The association and dissociation kinetics of telmisartan to angiotensin AT-1 receptors were measured using an in vitro radio-receptor binding assay. These radioligand binding studies were conducted either directly on rat vascular (aorta) smooth muscle cells (RVSMC) expressing solely the AT-1 receptor or on membrane preparation obtained from the same cells. The specific binding of3H-telmisartan to the surface of living RVSMC or membranes was saturable. From these data, a Kd value of 1.7 nM was estimated. Scatchard analysis of the3H-telmisartan binding on RVSMC indicated the existence of a single class of binding sites. The affinity of telmisartan for AT-1 receptor is only poorly affected by the presence of proteins (0.4% of rat plasma proteins) in the binding buffer, indicating that no great competition between telmisartan binding to its specific AT-1 receptor and to non-specific proteins binding sites occurs. In association experiments, the specific binding of3H-telmisartan increases quickly and reaches equilibrium within less than 1 hour, with an association rate constant calculated to be 0.006 min-1nM-1. Telmisartan dissociates very slowly from the AT-1 receptor, either in RVSMC membrane preparation or in living cells with a dissociation rate constant of ca. 0.01 min-1 resulting in a dissociation half-life (t1/2) of about 60 min, which is comparable to the previously published data for candesartan in bovine adrenal cortical membranes and almost 5 times slower than that of 125I-angiotensin II binding (t1/2=12 min). In contrast to candesartan that has been shown to re-associate with the AT-1 receptor, telmisartan does not appear to re-associate. Indeed, when the dissociation of labeled-telmisartan from AT-1 receptors was induced by washing the cells with cold-binding buffer, followed by addition of fresh binding buffer containing either cold telmisartan, Ang II or losartan, or nothing, no difference were observed in the dissociation rate constants measured with telmisartan whatever the composition of the binding buffer after removal of labeled-telmisartan. In conclusion, these results suggest that the insurmountable antagonism of telmisartan is due mainly to its very slow dissociation from angiotensin AT-1 receptor

Assessment of angiotensin II receptor blockade in humans using a standardized angiotensin II receptor-binding assay

An in vitro angiotensin II (AngII) receptor-binding assay was developed to monitor the degree of receptor blockade in standardized conditions. This in vitro method was validated by comparing its results with those obtained in vivo with the injection of exogenous AngII and the measurement of the AngII-induced changes in systolic blood pressure. For this purpose, 12 normotensive subjects were enrolled in a double-blind, four-way cross-over study comparing the AngII receptor blockade induced by a single oral dose of losartan (50 mg), valsartan (80 mg), irbesartan (150 mg), and placebo. A significant linear relationship between the two methods was found (r = 0.723, n = 191, P < .001). However, there exists a wide scatter of the in vivo data in the absence of active AngII receptor blockade. Thus, the relationship between the two methods is markedly improved (r = 0.87, n = 47, P < .001) when only measurements done 4 h after administration of the drugs are considered (maximal antagonist activity observed in vivo) suggesting that the two methods are equally effective in assessing the degree of AT-1 receptor blockade, but with a greatly reduced variability in the in vitro assay. In addition, the pharmacokinetic/pharmacodynamic analysis performed with the three antagonists suggest that the AT-1 receptor-binding assay works as a bioassay that integrates the antagonistic property of all active drug components of the plasma. This standardized in vitro-binding assay represents a simple, reproducible, and precise tool to characterize the pharmacodynamic profile of AngII receptor antagonists in human

Diet-Related Metabolites Associated with Cognitive Decline Revealed by Untargeted Metabolomics in a Prospective Cohort

Scope: Untargeted metabolomics may reveal preventive targets in cognitive aging, including within the food metabolome. Methods and results: A case-control study nested in the prospective Three-City study includes participants aged &65 years and initially free of dementia. A total of 209 cases of cognitive decline and 209 controls (matched for age, gen- der, education) with slower cognitive decline over up to 12 years are contrasted. Using untargeted metabolomics and bootstrap-enhanced penalized regression, a baseline serum signature of 22 metabolites associated with subsequent cognitive decline is identified. The signature includes three coffee metabolites, a biomarker of citrus intake, a cocoa metabolite, two metabolites putatively derived from fish and wine, three medium-chain acylcarnitines, glycodeoxycholic acid, lysoPC(18:3), trimethyllysine, glucose, cortisol, creatinine, and arginine. Adding the 22 metabolites to a reference predictive model for cognitive decline (conditioned on age, gender, education and including ApoE-ε4, diabetes, BMI, and number of medications) substantially increases the predictive performance: cross-validated Area Under the Receiver Operating Curve = 75% [95% CI 70-80%] compared to 62% [95% CI 56-67%]. Conclusions: The untargeted metabolomics study supports a protective role of specific foods (e.g., coffee, cocoa, fish) and various alterations in the endogenous metabolism responsive to diet in cognitive aging

Reprint of: Minimizing noise in pediatric task-based functional MRI; Adolescents with developmental disabilities and typical development

Functional Magnetic Resonance Imaging (fMRI) represents a powerful tool with which to examine brain functioning and development in typically developing pediatric groups as well as children and adolescents with clinical disorders. However, fMRI data can be highly susceptible to misinterpretation due to the effects of excessive levels of noise, often related to head motion. Imaging children, especially with developmental disorders, requires extra considerations related to hyperactivity, anxiety and the ability to perform and maintain attention to the fMRI paradigm. We discuss a number of methods that can be employed to minimize noise, in particular movement-related noise. To this end we focus on strategies prior to, during and following the data acquisition phase employed primarily within our own laboratory. We discuss the impact of factors such as experimental design, screening of potential participants and pre-scan training on head motion in our adolescents with developmental disorders and typical development. We make some suggestions that may minimize noise during data acquisition itself and finally we briefly discuss some current processing techniques that may help to identify and remove noise in the data. Many advances have been made in the field of pediatric imaging, particularly with regard to research involving children with developmental disorders. Mindfulness of issues such as those discussed here will ensure continued progress and greater consistency across studies