Effect of the Rainfall Infiltration Processes on the Landslide Hazard Assessment of Unsaturated Soils in Tropical Mountainous Regions

Natural disasters caused by meteorological phenomena are affecting countries of the world with increasing frequency, and they are producing severe damage to population and its infrastructure, hampering the economic development of the countries. The rainfall-induced landslides occur almost every year in all mountainous regions, and globally, 14% of economic losses and 0.53% of deaths from disasters caused by natural phenomena are attributed to landslides. For this reason, landslide risk assessment has become more applied in recent years. We present an assessment of the effect of rainfall infiltration on unsaturated soils on slope stability. Initially, a theoretical approach of the problem is presented, and a model of probabilistic analysis is described. Subsequently, an application of the model is carried out in an eastern zone of Medellin, Colombia. The probability of saturation and the landslide hazard are determined and validated considering the effect of a rainfall event registered in November 2010 that caused severe damages in the studied zone. The influence of infiltration under static scenario is evaluated using two different approaches, and the soil parameters for these evaluations are determined by field and laboratory tests. Finally, the effect of the rainfall infiltration processes on the landslide hazard assessment of evaluated unsaturated soils is determined

Prevalencia de adiposidad corporal y dislipidemia en funcionarios de la Policía Nacional Bolivariana de la Universidad Nacional Experimental de la Seguridad

Introduction: Body composition is one of the key in the development of the operational work of the police officer, who, with a high percentage of body fat, would be very difficult performance, also individuals with an excess of body fat they commonly exhibit an altered lipid profile called atherogenic Dyslipidemia, being both parameters associated with the origin of cardiovascular disease (CVD). In this study, investigates the prevalence of body adiposity and lipid irregularities and the relationship between these as risk factors associated with CVD in a group of the Bolivarian national police officers.Material and Methods: 45 men and 20 women formed the sample. We calculated the index of body mass (IMC) and the % of fat (% GC) as indicators of adipose and lipid profile as biochemical indicators.Results: Both groups were placed in higher categories than those recommended, obtaining men and women a BMI and a % GC of 29.7 and 27.6% and 25.6 and 33.4%, both with significant differences. In the same way, women exceeded the upper limit of triglycerides with 151,8 mg/dL, and being close to the upper limit of cholesterol and at the same time, obtained lower values of HDL-c (40.5 mg/dL). A large percentage of both groups presented alteration on biochemical indicators with the exception of the LDL-c. Cholesterol and triglycerides had moderate correlation with BMI in women, and moderate, low and reverse correlations between the parameters of lipid profile with BMI and GC % in men.Conclusions: We conclude that a significant percentage of officials, show high fat, and is related to alterations in lipids, may increase the risk for the development of CVD.Introducción: La composición corporal es uno de los elementos clave en el desarrollo de la labor operacional del funcionario policial, que, con un elevado porcentaje de adiposidad corporal, resultarían muy difícil su desempeño, asimismo, los individuos con un exceso de masa grasa exhiben comúnmente un perfil lipídico alterado denominado dislipidemia aterogénica, estando ambos parámetros asociados al origen de enfermedades cardiovasculares (ECV). En éste estudio, se investiga la prevalencia de adiposidad corporal e irregularidades lipídicas y la relación entre estos como factores de riesgo asociados con las ECV en un grupo de funcionarios de la Policía Nacional Bolivariana.Material y Métodos: La muestra la conformaron 45 hombres y 20 mujeres. Se calculó el Índice de Masa Corporal (IMC) y el porcentaje de grasa (%GC) como indicadores adiposos y el perfil lipídico como indicadores bioquímicos. Resultados: Ambos grupos se ubicaron en categorías superiores a las recomendadas, obteniendo los hombres y mujeres un IMC y un %GC de 29,7 y 27,6% y 25,6 y 33,4%, ambos con diferencias significativas. De la misma forma, las mujeres superaron el límite superior de triglicéridos con 151,8 mg/dL, y estando cerca del límite superior del colesterol y a su vez, obtuvieron valores inferiores del HDL-c (40,5 mg/dL). Un porcentaje importante de ambos grupos presentó alteración en los indicadores bioquímicos a excepción del c-LDL. El colesterol y los triglicéridos tuvieron moderada correlación con el IMC en las mujeres, y moderadas, bajas y correlaciones inversas entre los parámetros de perfil lipídico con el IMC y el %GC en los hombres. Conclusiones: Se concluye que un importante porcentaje de funcionarios, muestran alta adiposidad, y ésta, relacionada con alteraciones en los lípidos, puede incrementar el riesgo para el desarrollo de ECV

Gerencia Estratégica Orientado A Optimizar La Eficiencia De La Gestión Comercial De La Empresa SAN ANTONIO LAB. S.A.C, LIMA 2015

La Gerencia Estratégica es un instrumento que sirve para administrar y ordenar cambios, esto permite que la organización pueda establecer estrategias para lograr los objetivos propuestos, por otro lado, la Gestión Comercial, tiene la de la investigación, reside en gestión estratégica que recae en todos los miembros responsabilidad de hacer conocer y abrir nuevos mercados para la empresa en su contexto regional o global; y se ocupa de dos problemas fundamentales; la satisfacción del cliente y la participación o el aumento de su propuesta comercial, dado esto, es necesario desarrollar un sistema adecuado de calidad, es decir, un departamento de servicio óptimo. El presente trabajo de investigación tiene como objetivo determinar el resultado de eficacia de SAN ANTONIO LAB S.A.C. en función de sus indicadores económicos y financieros. Con este fin la pregunta de investigación es la siguiente ¿De qué manera los directivos de la organización cumplen su relación con la gestión comercial en la empresa San Antonio LAB, Lima 2015? El objetivo de la investigación se analizará de manera funcional los diversos aportes en relación a la temática de nuestra investigación que comprende los estados financieros de la empresa y la decisión de la gerencia en relación a gestión comercial, donde se manifiesta de manera transparente la problemática de la organización. Se recomienda el posicionamiento de la empresa deberá permitir conocer y preparar a vendedores capacitados y formados con las últimas tecnologías para lograr ventas potenciales con clientes potenciales. De igual manera, ingresar a las ventas públicas por medio de los concursos y las licitaciones públicas para ventas grandes; conocer los mecanismos para lograr atender a empresas grandes, para ello debe certificarse con programas de calidad como las ISO 9000, ISO 14000 Y LAS OHSAS 18000, como garantía de crecimiento.The Strategic Management is an instrument that serves to manage and order changes, this allows the organization to establish strategies to achieve the proposed objectives, on the other hand, Business Management, has the research, resides in strategic management that falls on all members responsible for making known and opening new markets for the company in its regional or global context; and deals with two fundamental problems; customer satisfaction and the participation or increase of their commercial proposal, given this, it is necessary to develop an adequate quality system, that is, an optimal service department. The objective of this research work is to determine the efficacy result of SAN ANTONIO LAB S.A.C. based on its economic and financial indicators. To this end, the research question is as follows: How do the executives of the organization fulfill their relationship with commercial management in the company San Antonio LAB, Lima 2015? The objective of the investigation will be analyzed in a functional way the various contributions in relation to the subject of our research that includes the financial statements of the company and the decision of the management in relation to commercial management, where the problem of the organization. It is recommended the positioning of the company should allow to know and prepare trained and trained sales people with the latest technologies to achieve potential sales with potential customers. Likewise, enter public sales through contests and public tenders for large sales; know the mechanisms to manage large companies, for it must be certified with quality programs such as ISO 9000, ISO 14000 AND OHSAS 18000, as a guarantee of growth.Trabajo de investigació

Neumonía intersticial aguda por micosis pulmonar. Presentación de caso clínico.

Introduction: Interstitial pneumonia is an acute and rapidly progressive lung disease that often leads to respiratory failure and respiratory distress syndrome. Pulmonary mycosis is an infection that can behave like a chronic lung disease or an invasive fungal infection, mainly in immunocompromised patients. Objective: the general objective is to report a clinical case of a patient with acute interstitial pneumonia due to pulmonary mycosis, treated in the intensive care unit, as well as to describe its diagnosis, treatment and evolution. Materials and methods: A descriptive study was carried out; With presentation of a clinical case, relevant aspects of acute interstitial pneumonia due to pulmonary mycosis, authorization was requested from the teaching and research department of the Teodoro Maldonado Carbo hospital, for the review of the clinical history, images, and data publication. Clinical case: the case of a 41-year-old male patient with acquired immunodeficiency syndrome is presented, who was admitted to the intensive care unit due to neurological deterioration and who developed pulmonary sepsis due to Candida tropicalis, hemodynamically unstable with outcome not favorable. Discussion: Pulmonary fungal infections are associated with high morbidity and mortality. The risk factors that favor the presence of invasive pulmonary mycosis are: structural lung damage, immunological compromise such as immunodeficiency, patients in critical condition and with haematological tumors, the latter group being the most at risk.  Conclusion: Candida tropicalis is a fungus rarely reported as a cause of pneumonia. The importance of the case presented lies in the fact that this was the causative agent of infection, evidencing invasive candidiasis, characteristic of biofilm-forming candida species, having a more serious course than other species, since its diagnosis and treatment in due time they are vital.La neumonía intersticial es una enfermedad pulmonar aguda y rápidamente progresiva que a menudo conduce a insuficiencia respiratoria y síndrome de dificultad respiratoria. La micosis pulmonar es una infección que se puede comportar como una enfermedad pulmonar crónica o una infección fúngica invasiva, principalmente en pacientes inmunodeprimidos. Objetivo: el objetivo general es realizar el reporte de un caso clínico, de un paciente con neumonía intersticial aguda por micosis pulmonar, atendido en la unidad de cuidados intensivos, así como describir su diagnóstico, tratamiento y evolución. Materiales y métodos: Se realizó un estudio descriptivo; con presentación de caso clínico, aspectos relevantes sobre neumonía intersticial aguda por micosis pulmonar, se solicitó autorización al departamento de docencia e investigación del hospital Teodoro Maldonado Carbo, para la revisión de historia clínica, imágenes y publicación de datos. Caso clínico: se presenta el caso de un paciente masculino de 41 años de edad con síndrome de inmunodeficiencia adquirida,  que ingresó a la unidad de cuidados intensivos, por  deterioro neurológico y   que desarrollo sepsis de foco pulmonar,  por Cándida tropicalis,  Hemodinámicamente inestable con desenlace no favorable. Discusión: Las infecciones pulmonares por hongos, se asocian con una morbilidad y mortalidad elevada. Los factores de riesgo que favorecen la presencia de micosis pulmonar invasiva son: daño pulmonar estructural, compromiso inmunológico como inmunodeficiencia, pacientes en estado crítico y con tumores hematológicos, siendo este último grupo los de mayor riesgo. Conclusión: La Cándida tropicalis es un hongo poco reportado como causa de  neumonía. La importancia del caso presentado radica en que, ésta, fue el agente causal de infección, evidenciándose candidiasis invasiva, característico de especies de cándidas formadoras de biopelículas, teniendo un curso más grave que otras especies, por cuanto su diagnóstico y tratamiento en el debido tiempo son vitales

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Evaluación del desempeño de mezclas de suelo y residuos de la construcción como una alternativa para el mejoramiento de subrasantes de vías de bajo volumen de tránsito

Although they are of great economic importance for the communities, rural roads can generally be considered low traffic volume (LTV) roads, which makes their paving difficult to make financially feasible. As a result, most of these roads are unpaved, causing traffic difficulties, particularly during the rainy season. On the other hand, construction and demolition waste ( ) is an environmental problem in cities; its use in road construction has been identified as an alternative for its final disposal. The purpose of this research was to evaluate an alternative for use in low traffic volume roads as a material for the improvement of pavement subgrades. Specifically, the use of waste from brick masonry construction (WBMC) or demolition was evaluated. A technical and economic evaluation was carried out, for which pavement designs were made by adding between 10 and 40 % of WBMCL and residual soil in determined proportions and compared with conventional pavement designs using granular materials from quarry exploitation. The same traffic conditions, subgrade soils and design methodologies were used for all designs. The results obtained show that the use of WBMC mixed with soil as a subgrade improvement results in reductions in pavement granular layer thicknesses that can make it possible to dispense with the granular subbase layer with the respective economic and environmental benefits.Aunque las vías rurales por lo general tienen gran importancia económica para las comunidades, se pueden considerar de bajo volumen de tránsito (BVT), lo cual lleva a que su pavimentación sea difícil de viabilizar financieramente. Por lo anterior, la mayoría de estas vías son no pavimentadas, generando dificultades para el tránsito, particularmente durante temporadas lluviosas. De otro lado, los residuos de construcción y demolición (RCD) constituyen un problema ambiental en las ciudades; se ha identificado su uso en la construcción de carreteras como una alternativa para su disposición final. Esta investigación tuvo como finalidad evaluar una alternativa para el uso en vías de bajo volumen de tránsito como material para el mejoramiento de subrasantes del pavimento. En específico, se evaluó el empleo de residuos procedentes de las construcciones o demoliciones de mampostería de ladrillo. Se realizó una evaluación tanto técnica como económica, para lo cual se realizaron diseños de pavimentos adicionando en proporciones determinadas entre 10 % y 40 % de RDCL y suelo residual, y se compararon con diseños de pavimentos convencionales usando materiales granulares de explotación de canteras. Para todos los diseños se usaron las mismas condiciones de tránsito, suelos de subrasante y metodologías de diseño. Los resultados obtenidos muestran que el uso de RCDL mezclado con suelo como mejoramiento de la subrasante, se obtienen reducciones en espesores de capas granulares del pavimento que pueden permitir prescindir de la capa de subbase granular con los respectivos beneficios económicos y ambientales