La simplificación administrativa y la satisfacción de los clientes como factor de eficiencia y eficacia empresarial en la Municipalidad de Lima Metropolitana 2019

Esta investigación tiene como objetivo estudiar el cumplimiento de la simplificación administrativa que afecta a los usuarios de la Municipalidad de Lima, razón por la que los gobiernos locales no aplican procesos de simplificación administrativa para beneficiar a la ciudadanía. Diseño de investigación no experimental, transversal e investigación correlacional –cualitativo. El estudio de la población está conformado por clientes de la municipalidad, en este caso los ciudadanos que realizan diligencias en la municipalidad de Lima. Población 40 y Muestra 36 personas, instrumento de encuesta Likert. La tabulación y el procesamiento de datos se hicieron en SPSS Statistics. Los resultados indican que el 60% [de la muestra de clientes] del distrito de Lima está[n] insatisfecho[s] por el servicio brindado por la demora, poca claridad y desconfianza que trasmiten al momento de cualquier gestión demandada, también el bajo desempeño del personal perjudicando el cumplimiento de sus actividades.Campus Lima Centr

PREFACE: DROPS, BUBBLES, AND THIN FILMS, SPECIAL ISSUE HONORING PROFESSOR OLEG KABOV

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Plan estratégico 2020-2024 para el Hotel Presidente

A través del presente documento se busca crear estrategias y definir procedimientos. Se trata de un plan de acción a largo plazo diseñado para lograr los objetivos estratégicos, que se diferencia de otras tácticas inmediatas realizadas previamente con los recursos disponibles. Este plan estratégico de largo alcance busca ayudar al Hotel Presidente a establecer sus prioridades y atender mejor las necesidades de las partes interesadas. El plan pretende ser flexible y práctico, además de servir como guía para implementar programas, evaluar cómo funcionan estos programas y hacer ajustes cuando sea necesario

MYC activation impairs cell-intrinsic IFNγ signaling and confers resistance to anti-PD1/PD-L1 therapy in lung cancer

Elucidating the adaptive mechanisms that prevent host immune response in cancer will help predict efficacy of anti-programmed death-1 (PD1)/L1 therapies. Here, we study the cell-intrinsic response of lung cancer (LC) to interferon-y (IFNy), a cytokine that promotes immunoresponse and modulates programmed death-ligand 1 (PD-L1) levels. We report complete refractoriness to IFNy in a subset of LCs as a result of JAK2 or IFNGR1 inactivation. A submaximal response affects another subset that shows constitutive low levels of IFNy-stimulated genes (IySGs) coupled with decreased H3K27ac (histone 3 acetylation at lysine 27) depo-sition and promoter hypermethylation and reduced IFN regulatory factor 1 (IRF1) recruitment to the DNA on IFNy stimulation. Most of these are neuroendocrine small cell LCs (SCLCs) with oncogenic MYC/MYCL1/ MYCN. The oncogenic activation of MYC in SCLC cells downregulates JAK2 and impairs IySGs stimulation by IFNy. MYC amplification tends to associate with a worse response to anti-PD1/L1 therapies. Hence alterations affecting the JAK/STAT pathway and MYC activation prevent stimulation by IFNy and may predict anti-PD1/L1 efficacy in LC

Rivaroxaban for secondary stroke prevention in patients with embolic strokes of undetermined source : Design of the NAVIGATE ESUS randomized trial

Peer reviewe

Multi-ancestry GWAS reveals excitotoxicity associated with outcome after ischaemic stroke

During the first hours after stroke onset, neurological deficits can be highly unstable: some patients rapidly improve, while others deteriorate. This early neurological instability has a major impact on long-term outcome. Here, we aimed to determine the genetic architecture of early neurological instability measured by the difference between the National Institutes of Health Stroke Scale (NIHSS) within 6 h of stroke onset and NIHSS at 24 h. A total of 5876 individuals from seven countries (Spain, Finland, Poland, USA, Costa Rica, Mexico and Korea) were studied using a multi-ancestry meta-analyses. We found that 8.7% of NIHSS at 24 h of variance was explained by common genetic variations, and also that early neurological instability has a different genetic architecture from that of stroke risk. Eight loci (1p21.1, 1q42.2, 2p25.1, 2q31.2, 2q33.3, 5q33.2, 7p21.2 and 13q31.1) were genome-wide significant and explained 1.8% of the variability suggesting that additional variants influence early change in neurological deficits. We used functional genomics and bioinformatic annotation to identify the genes driving the association from each locus. Expression quantitative trait loci mapping and summary data-based Mendelian randomization indicate that ADAM23 (log Bayes factor = 5.41) was driving the association for 2q33.3. Gene-based analyses suggested that GRIA1 (log Bayes factor = 5.19), which is predominantly expressed in the brain, is the gene driving the association for the 5q33.2 locus. These analyses also nominated GNPAT (log Bayes factor = 7.64) ABCB5 (log Bayes factor = 5.97) for the 1p21.1 and 7p21.1 loci. Human brain single-nuclei RNA-sequencing indicates that the gene expression of ADAM23 and GRIA1 is enriched in neurons. ADAM23, a presynaptic protein and GRIA1, a protein subunit of the AMPA receptor, are part of a synaptic protein complex that modulates neuronal excitability. These data provide the first genetic evidence in humans that excitotoxicity may contribute to early neurological instability after acute ischaemic stroke. Ibanez et al. perform a multi-ancestry meta-analysis to investigate the genetic architecture of early stroke outcomes. Two of the eight genome-wide significant loci identified-ADAM23 and GRIA1-are involved in synaptic excitability, suggesting that excitotoxicity contributes to neurological instability after ischaemic stroke.Peer reviewe