Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study

Objective: To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. Methods: Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH <6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units. Results: We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4–11): 2934 (34.3%) had a LOH 15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0–64.9) when LOH was 11–15 days, and by 72.0% (95%CI = 42.6–107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4–36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk. Conclusions: Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments

Plan estratégico del sector portuario colombiano

El presente plan estratégico aplicado orienta el Sector Portuario Marítimo Colombiano hacia una visión al año 2013. El sistema portuario colombiano posee las condiciones para ubicarse dentro de los 10 mejores del mundo según el índice de competitividad mundial. Se parte de una era de alta corrupción y atraso que concluye con la Ley 1 de 1991 que inicia la gran conversión. Desde 1991 a 2013, el sector se ha desarrollado bajo la protección a la inversión extranjera, la gran apalancadora del sector, una extrema sujeción a la libre competencia, y el reciente florecimiento de los tratados de libre comercio. Colombia posee una ventaja comparativa fundamental, que es la salida al Pacífico y al Atlántico. En este PEA, se propone como estrategia fundamental retenida la construcción de un puerto de alto calado natural en el Pacífico, en Tribugá, la construcción de dos hubs interlands para abastecer las ciudades de Medellín y Bogotá y en sentido general, propone una serie de acciones que conduzcan hacia la alta competitividad basada en la gente, la certificación de los mejores estándares de calidad, el crecimiento sostenible y en últimas, la implementación de la responsabilidad social como directriz del crecimiento empresarial colombiano. Este PEA plantea la necesidad de articular el sector portuario con la construcción de carreteras, tramos férreos, y establecer ajustes legales relacionados a los mejores estándares de industria mundial. La planeación de este sector se origina del grupo de estrategas que lo crea y redacta y se apoya en criterios tomados de expertos del sector, el amplio conocimiento del mercado, y de la metodología de planeación estratégica del profesor Fernando D´Alessio, Director General de CENTRUM CatólicaThis Applied Strategic Plan points in the direction and orients the Colombian Maritime Ports Sector towards a 2030 vision. The Colombian Maritime Ports Sector has the strengths and is exposed to the opportunities to be in worlds top 10 ports in accordance to the worlds Competitive Index. We part from an era of high corruption levels and lack of development and competitiveness and begin a new era with the passing and signing of the 1 law of 1991 that gave birth to the great transformation period. Since 1991 to present moments, the seaports sector has developed jointly with the inflows of foreign direct investment capitals, the greatest leverage tool for the sector, and the extreme union and promotion of free competition as well as the flourishing free trade agreements the country has successfully signed and is actively seeking. Colombia has a fundamental comparative advantage and that is the access to both the Atlantic and Pacific Ocean. In this Applied Strategic Plan, it is proposes as a fundamental retained strategy the construction of a new port in the Pacific Ocean with the right natural draught depth in Tribuga, Choco and the construction of two inland hubs that can connect and meet supply and demand needs for Bogota and Medellin, a race towards high competitiveness based on people development, the certification of the worlds best quality standards, sustainable growth and development and last but not least, the implementation of social responsibility as a core requirement for the continued growth of the Colombian business sector. This Applied Strategic Plan proposes and traces the necessity to articulate the maritime ports sector with the construction of new roads, new railroad sections and establish legal adjustments in accordance to the best world's standards practiced in the industryTesi

Plan de negocio para implementar un colegio en Villa El Salvador, 2019

El presente proyecto de plan de negocio tiene como objetivo implementar un colegio en Villa el Salvador, el cual nos muestra que, según el análisis de mercado, nuestra decisión estratégica permitirá explotar las actuales y recientes necesidades educativas de las nuevas familias emergentes con mayor capacidad adquisitiva y mayores factores aspiracionales de crecimiento socioeconómico. Por lo que existe una conveniente oportunidad de negocio, la misma que se ve fortalecida por la cercanía de nuestra sede a los nuevos centros de desarrollo urbano y a los polos productivos de la zona. El nombre elegido para el colegio es Terra Nova, el cual ofrecerá una moderna infraestructura, equipamiento vanguardista, con convenios para segundo idioma e informática, áreas multifuncionales, talleres, formación técnica extracurricular para secundaria y capacidad para 680 alumnos, ofreciendo una educación de alta calidad con una metodología basada en el aprendizaje por proyectos (ABP), todo ello concreta una sinergia diferenciadora y altamente apreciada en el nivel socioeconómico C – D. Para la ejecución del presente proyecto se requerirá una inversión de S/ 8,168,595, financiado por los accionistas y de una entidad financiera. Los valores positivos obtenidos mediante el análisis financiero nos permiten asegurar que el proyecto es viable y atractivo, pues supera las expectativas de los accionistas y se muestra sostenible más allá del período analizado de 10 años.This business plan project aims at implementing a school in Villa El Salvador. According to the market analysis, our strategic decision will exploit the current and recent educational needs of new emerging families with greater monetary capacity, and greater aspirational factors of socioeconomic growth. Therefore, it is a business opportunity, which is strengthened by the proximity of our headquarters to the new urban development centers and the productive poles of the area. The name chosen for the school is Terra Nova, which will offer a modern infrastructure, avant-garde equipment, with conventions for second language and computer labs, multifunctional areas, workshops, extracurricular technical training for secondary students, and a capacity for 680 students. Offering a high quality education with a methodology based on Project based learning (PBL), all these form a differentiating synergy, which is highly appreciated in the socioeconomic levels C and D. For the execution of this project, an investment of S / 8,168,595 will be required, financed by the shareholders and a financial entity. The positive values obtained through financial analysis allow us to ensure that the project is viable and attractive, since it exceeds the expectations of shareholders and is sustainable beyond the analyzed period of 10 years.Trabajo de investigació

Effect of Poultry Manure-Derived Compost on the Growth of eucalypts spp. Hybrid Clones

Interspecific hybrids of E. grandis &times; E. camaldulensis were generated to widen the plantation area. The aim of this study was to assess root capability and development for six different clones of eucalyptus grown in substrates made with three different composts derived from poultry manure. A factorial design was used to assess the effect of different composts on six growth variables. The analysis detected a greater effect from the genotype than the substrate. E. grandis &times; E. camaldulensis hybrid vegetative propagation was successful in alternative substrates formulated from composted poultry manure. GC8 was the genotype that showed the greatest differences for four the different variables among the substrates, being both the most sensitive and the one with the highest values for all parameters measured. The hybrids&rsquo; vegetative propagation was determined in alternative substrates formulated from poultry manure compost. The physicochemical characteristics of substrates composed of pine bark and sawdust provided adequate conditions for the growth of eucalyptus. GC8 was the genotype most sensitive to the use of different substrates, showing significant differences in the ratio of roots/callus, radicular dry weight, and cutting dry weight. These clones might be a good option for evaluating compost-based substrates for forestry applications

Distribución, registros de nidificación y notas sobre la ecología de Phalcoboenus albogularis

Endemic to Patagonia, the White-throated Caracara (Phalcoboenus albogularis) is one of the least studied caracara species, with several aspects of its ecology, such as breeding biology and diet, largely unexplored. Using citizen science records and opportunistic observations, we obtained data on the breeding biology, nest sites, and diet of the species in Chile and Argentina. Nests were in rocky outcrops and cliffs, and aspects of diet corroborated others’ observations that this species feeds on live prey as well as carrion. The species’ nesting season apparently begins in September and ends in March, with some regional variation. The modal brood size is two, and many nests apparently are used across multiple years. Using citizen science data, we created the first distribution models for the White-throated Caracara, one for the breeding season and one for the winter season. The species predominantly occupies the highland plateaus of western Santa Cruz Province, Argentina, and the Andes Range from around 40° south to southern Tierra del Fuego. The models indicate a mostly consistent distribution without significant latitudinal changes between seasons and, apparently, only a limited transition to lower-elevation areas east of the Andes in winter. In both seasons, this caracara is associated primarily with barren rocky areas and Andean and sub-Andean herbaceous steppe—all open environments—rather than forested areas as has been thought previously. This study provides new knowledge of this regional endemic yet the species remains a poorly known raptor in southern South America. Additional and on-the-ground field research would likely produce benefits when addressing species-related conservation issues.Endémico de la Patagonia, Phalcoboenus albogularis es una de las especies menos estudiadas de caracara, con varios aspectos fundamentales de su ecología, como la biología reproductiva o la dieta, en gran medida desconocidos. Aprovechando información de plataformas de ciencia ciudadana y observaciones oportunistas, en este trabajo recopilamos información sobre biología reproductiva, sitios de nidificación y dieta de la especie en Chile y Argentina. Los nidos estuvieron en roquedos y acantilados y los datos de dieta corroboran observaciones previas que indican que la especie se alimenta de presas vivas y carroña. La temporada reproductiva de P. albogularis comienza aparentemente en septiembre y termina en marzo, aunque con cierta variación regional. El tamaño de nidada modal fue de dos polluelos. Muchos nidos son usados todos los años por la especie que se reproduce frecuentemente con éxito. Utilizando datos de ciencia ciudadana, creamos los primeros modelos de distribución de la especie, tanto de la época reproductiva como de la época invernal. La especie ocupa principalmente las mesetas de altura del oeste de la provincia de Santa Cruz, Argentina, así como la cordillera de los Andes desde aproximadamente los 40 S hasta el sur de Tierra del Fuego. Los modelos indicaron una distribución consistente y sin cambios latitudinales entre temporadas y, aparentemente, solo una transición limitada hacia zonas más bajas de los Andes durante el invierno. En ambas temporadas, los ambientes donde P. albogularis fue observado con mayor probabilidad fueron las zonas rocosas sin vegetación y las estepas herbáceas andinas y subandinas, todos ambientes abiertos, totalmente distintos a las áreas boscosas que históricamente se consideraban su principal hábitat. Este estudio presenta algunos avances en el conocimiento sobre este endemismo regional, aunque todavía sigue siendo una de las rapaces menos conocidas de Sudamérica. A futuro, se necesitarán estudios de campo específicos para evaluar las posibles amenazas que afectan a esta especie.Fil: Grande, Juan Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Ciencias de la Tierra y Ambientales de La Pampa. Universidad Nacional de La Pampa. Facultad de Ciencias Exactas y Naturales. Instituto de Ciencias de la Tierra y Ambientales de La Pampa; ArgentinaFil: Rivas Fuenzalida, Tomás. Reserva Natural El Natri. Fundación Ñankulafkén; ChileFil: Díaz Tavie, José. Reserva Natural El Natri. Fundación Ñankulafkén; ChileFil: Asún, Cristian. Reserva Natural El Natri. Fundación Ñankulafkén; ChileFil: Castrilli, Santiago. Reserva Natural El Natri. Fundación Ñankulafkén; ChileFil: Ziehlmann Mena, Enrique. Reserva Natural El Natri. Fundación Ñankulafkén; ChileFil: Romo Cancino, Daniel. Reserva Natural El Natri. Fundación Ñankulafkén; ChileFil: Pendaries, Morgan Dorian Boris. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; ArgentinaFil: Fasola, Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; ArgentinaFil: Gabarain, Gabriela Tamara. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; ArgentinaFil: Imberti, Santiago. Asociación Ambiente Sur; ArgentinaFil: Ricci, Mauro. Asociación Ambiente Sur; ArgentinaFil: Padron, María Florencia. Asociación Ambiente Sur; ArgentinaFil: Bejarano, Nicolás. Nico Bejarano Birding; ArgentinaFil: Sympson, Lorenzo. Sociedad Naturalista Andino Patagónica; ArgentinaFil: Beaudoin, Federico. Sociedad Naturalista Andino Patagónica; ArgentinaFil: Diez Peña, Mariano. Sociedad Naturalista Andino Patagónica; ArgentinaFil: Sahores, Mercedes. Sociedad Naturalista Andino Patagónica; ArgentinaFil: Paritsis, Juan. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; ArgentinaFil: Gorleri, Fabricio Carlos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Fundación Bariloche; ArgentinaFil: Roesler, Carlos Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Fundación Bariloche; Argentin

Genetic and epigenetic modifications of Sox2 contribute to the invasive phenotype of malignant gliomas.

We undertook this study to understand how the transcription factor Sox2 contributes to the malignant phenotype of glioblastoma multiforme (GBM), the most aggressive primary brain tumor. We initially looked for unbalanced genomic rearrangements in the Sox2 locus in 42 GBM samples and found that Sox2 was amplified in 11.5% and overexpressed in all the samples. These results prompted us to further investigate the mechanisms involved in Sox2 overexpression in GBM. We analyzed the methylation status of the Sox2 promoter because high CpG density promoters are associated with key developmental genes. The Sox2 promoter presented a CpG island that was hypomethylated in all the patient samples when compared to normal cell lines. Treatment of Sox2-negative glioma cell lines with 5-azacitidine resulted in the re-expression of Sox2 and in a change in the methylation status of the Sox2 promoter. We further confirmed these results by analyzing data from GBM cases generated by The Cancer Genome Atlas project. We observed Sox2 overexpression (86%; N = 414), Sox2 gene amplification (8.5%; N = 492), and Sox 2 promoter hypomethylation (100%; N = 258), suggesting the relevance of this factor in the malignant phenotype of GBMs. To further explore the role of Sox2, we performed in vitro analysis with brain tumor stem cells (BTSCs) and established glioma cell lines. Downmodulation of Sox2 in BTSCs resulted in the loss of their self-renewal properties. Surprisingly, ectopic expression of Sox2 in established glioma cells was not sufficient to support self-renewal, suggesting that additional factors are required. Furthermore, we observed that ectopic Sox2 expression was sufficient to induce invasion and migration of glioma cells, and knockdown experiments demonstrated that Sox2 was essential for maintaining these properties. Altogether, our data underscore the importance of a pleiotropic role of Sox2 and suggest that it could be used as a therapeutic target in GBM

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women