Plan de negocios para la apertura de un centro médico de rehabilitación y terapia física en el distrito de Jesús María

The objective of this project is determining of viability to open a medical rehabilitation and physical therapy center in Jesús María district. To corroborate whether the center is viable, the project focuses on analyzing the possible profitability to obtain taking into account various factors.The project is divided into ten chapters, the first chapter being the general aspects. Among the aspects are the objectives to be achieved with the research, characteristics of the sector in the meeting of the project and the analysis of the Peruvian economic environment.In the subsequent two chapters, it identifies the legal and tax aspects to which the project is based and defines the organizational design that will take the form according to the identification of the type of service and its characteristics. In addition, it analyzes the methodological aspects through various techniques.In chapter four the market study is carried out, a commercial study, where the target market from which the project starts quantitatively is identified. Subsequently, the demand and supply in the market is evaluated, referring to the study topic.In the next four chapters, define the marketing plan to work to achieve established sales for unmet demand, the servuction and quality processes according toeconomic scope, the location analysis of the center and the human resources processes necessary to maintain personnel. satisfied and with a high level of attention.In chapter nine the strategic planning of the project is carried out, establishing the competitive profile, the policies, the schedules and the schedule starting from the implementation of the business.In the final chapter, we carry out the financial projections with a duration of 5 years, having 2021 as the effective start year. Analyze various indicators to know the profitability level of the project.El presente proyecto tiene como objetivo determinar la viabilidad en la apertura de un Centro Médico de Rehabilitación y Terapia Física en el distrito de Jesús María. Para tal efecto, el proyecto se enfoca en analizar la rentabilidad posible a obtener tomando en cuenta diversos factores. El proyecto se divide en diez capítulos, siendo el primer capítulo los aspectos generales. Entre los aspectos se encuentran los objetivos a lograr con la investigación, características del sector en el cual se centra el proyecto y el análisis del entorno económico peruano. En los posteriores dos capítulos, se identifica los aspectos legales y tributarios a los que se acoge el proyecto y se define el diseño organizacional que tomará forma según la identificación del tipo de servicio y sus características. Adicionalmente, se analiza los aspectos metodológicos a través de diversas técnicas. En el capítulo cuatro se realiza el estudio de mercado y comercial, donde se identifica el mercado objetivo de donde parte cuantitativamente el proyecto. Posteriormente, se evalúa la demanda y oferta en el mercado, referida al tema de estudio. En los siguientes cuatro capítulos se define el plan de marketing a trabajar para lograr las ventas establecidas respecto a la demanda insatisfecha, los procesos de servucción y calidad acorde al alcance económico, el análisis de localización del centro y los procesos de recursos humanos necesarios para mantener al personal satisfecho y con alto nivel de Atención. En el capítulo nueve se realiza la planificación estratégica del proyecto, estableciendo el perfil competitivo, las políticas, plazos y cronograma, iniciando desde la implementación del negocio. En el capítulo final se realizan las proyecciones financieras con una duración a 5 años, teniendo como año de inicio efectivo el 2021. Se analiza diversos indicadores que dan a conocer el nivel de rentabilidad del proyecto

Velocity Loss Thresholds Reliably Control Kinetic and Kinematic Outputs during Free Weight Resistance Training.

Exercise velocity and relative velocity loss thresholds (VLTs) are commonly used in velocity-based resistance training. This study aims to quantify the between-day reliability of 10%, 20%, and 30% VLTs on kinetic and kinematic outputs, changes in external load, and repetition characteristics in well-trained athletes. Using a repeated, counter-balanced crossover design, twelve semi-professional athletes completed five sets of the back squat with an external load corresponding to a mean concentric velocity of ~0.70 m·s-1 and a VLT applied. The testing sessions were repeated after four weeks of unstructured training to assess the long-term reliability of each VLT. A coefficient of variation (CV) 10% (CV: 11.14-14.92%). Alternatively, the repetitions completed within each set showed large variation (CV: 18.92-67.49%). These findings demonstrate that by utilizing VLTs, kinetic and kinematic outputs can be prescribed and replicated across training mesocycles. Thus, for practitioners wishing to reliably control the kinetic and kinematic stimulus that is being applied to their athletes, it is advised that a velocity-based approach is used

Decisional Profile on Competing Volleyball Athletes From Autonomous University of Chihuahua (Uach): Gender Comparison

Sports psychology considers the athlete as an individual capable of processing information and making their own decisions which reflects in the results obtained as a team in a competition within the sports environment. This paper focuses on comparing the competing decisional profile on the sports performance of volleyball players at the Autonomous University of Chihuahua and also determines gender differences. For this, a descriptive, comparative investigation was carried out, where 24 representative athletes of the university participated in this discipline. Here, the questionnaire of Decision Style in the Sport of Ruiz and Graupera (2005) was applied to measure aspects of decision making in sports. Among the most relevant aspects is the commitment to their training. It combines not only the concern for the adversary, for knowing their customs and their concerns in the competition, but clearly emphasizes the importance of relying on the coach's tactical plan and following his instructions. The results analyzed with the Mann-Whitney U test show that there are no differences in the decision profile between genders; however, it was determined that the men presented themselves to present perceived decision-making competence and commitment to decisionmaking than women, plus, they face less anxiety and stress when deciding. Therefore, it is concluded that the decision profile may be related to the competitive experience, since the men of the present study have shown better sports performance in previous meetings than women

3D stochastic bicontinuous microstructures: Generation, topology and elasticity

Motivated by recent experimental investigations of the mechanical behavior of nanoporous metal we explore an efficient and robust method for generating 3D representative volume elements (RVEs) with strikingly similar behavior. Our approach adopts Cahn's method of generating a Gaussian random field by taking a superposition of standing sinusoidal waves of fixed wavelength but random in direction and phase. In its theory part, our study describes closed-form expressions for how the solid volume fraction affects the binarization level, mean structure size, specific surface area, averages of mean and Gaussian curvature, and the scaled topological genus. Based on numerical studies we report on criteria for achieving representative realizations of the structure by proper choice of the number of waves and element size. We also show that periodic structures are readily created. We analyze the mechanical properties considering linear and infinitesimal elasticity and evaluate the residual anisotropy (which can be made small) and the effective values of the Young's modulus and Poisson's ratio. The numerical results are in excellent agreement with experimental findings for the variation of stiffness with solid fraction of nanoporous gold made by dealloying. We propose scaling relations that achieve naturally a perfect agreement with the numerical and experimental data. The scaling relation for the stiffness accounts for a percolation-to-cluster transition in the random field microstructure at a finite solid fraction. We propose that this transition is the origin of the previously reported anomalous compliance of nanoporous gold

The Effects of 10%, 20%, and 30% Velocity Loss Thresholds on Kinetic, Kinematic, and Repetition Characteristics During the Barbell Back Squat.

PURPOSE: Prescribing resistance training using velocity loss thresholds can enhance exercise quality by mitigating neuromuscular fatigue. Since little is known regarding performance during these protocols, we aimed to assess the effects of 10%, 20%, and 30% velocity loss thresholds on kinetic, kinematic, and repetition characteristics in the free-weight back squat. METHODS: Using a randomised crossover design, sixteen resistance-trained men were recruited to complete five sets of the barbell back squat. Lifting load corresponded to a mean concentric velocity (MV) of ~0.70 m·s-1 (115 ±22kg). Repetitions were performed until a 10%, 20% or 30% MV loss was attained. RESULTS: Set MV and power output were substantially higher in the 10% protocol (0.66 m.s-1 & 1341 W, respectively), followed by the 20% (0.62 & 1246) and 30% protocols (0.59 & 1179). There were no substantial changes in MV (-0.01- -0.02) or power output (-14- -55 W) across the five sets for all protocols and individual differences in these changes were typically trivial to small. Mean set repetitions were substantially higher in the 30% protocol (7.8), followed by the 20% (6.4) and 10% protocols (4.2). There were small to moderate reductions in repetitions across the five sets during all protocols (-39%, -31%, -19%, respectively) and individual differences in these changes were small to very large. CONCLUSIONS: Velocity training prescription maintains kinetic and kinematic output across multiple sets of the back squat, with repetition ranges being highly variable. Our findings therefore challenge traditional resistance training paradigms (repetition-based) and add support to a velocity-based approach

Application of velocity loss thresholds during free-weight resistance training : Responses and reproducibility of perceptual, metabolic, and neuromuscular outcomes.

The aim of this study was to investigate the differences and long-term reliability in perceptual, metabolic, and neuromuscular responses to velocity loss resistance training protocols. Using a repeated, counterbalanced, crossover design, twelve team-sport athletes completed 5-sets of barbell back-squats at a load corresponding to a mean concentric velocity of ~0.70 m·s-1. On different days, repetitions were performed until a 10%, 20% or 30% velocity loss was attained, with outcome measures collected after each set. Sessions were repeated after four-weeks. There were substantial between-protocol differences in post-set differential ratings of perceived exertion (dRPE, i.e., breathlessness and leg muscles, AU) and blood lactate concentration (B[La], mmol·L-1), such that 30%>20%>10% by small to large magnitudes. Differences in post-set countermovement jump (CMJ) variables were small for most variables, such that 30%<20%<10%. Standard deviations representing four-week variability of post-set responses to each protocol were: dRPE, 8-11; B[La], 0.8-1.0; CMJ height, 1.6-2.0; CMJ PPO, 1.0-1.8; CMJ PCV, 0.04-0.06; CMJ 100ms-Impulse, 5.7-11.9. Velocity loss thresholds control the magnitude of perceptual, metabolic, and neuromuscular responses to resistance training. For practitioners wanting to reliably prescribe training that can induce a given perceptual, metabolic, or neuromuscular response, it is strongly advised that velocity-based thresholds are implemented

Prognostic value of the 6-gene OncoMasTR test in hormone receptor–positive HER2-negative early-stage breast cancer: Comparative analysis with standard clinicopathological factors

Aim: The aim of the study was to assess the prognostic performance of a 6-gene molecular score (OncoMasTR Molecular Score [OMm]) and a composite risk score (OncoMasTR Risk Score [OM]) and to conduct a within-patient comparison against four routinely used molecular and clinicopathological risk assessment tools: Oncotype DX Recurrence Score, Ki67, Nottingham Prognostic Index and Clinical Risk Category, based on the modified Adjuvant! Online definition and three risk factors: patient age, tumour size and grade. Methods: Biospecimens and clinicopathological information for 404 Irish women also previously enrolled in the Trial Assigning Individualized Options for Treatment [Rx] were provided by 11 participating hospitals, as the primary objective of an independent translational study. Gene expression measured via RT-qPCR was used to calculate OMm and OM. The prognostic value for distant recurrence-free survival (DRFS) and invasive disease-free survival (IDFS) was assessed using Cox proportional hazards models and Kaplan-Meier analysis. All statistical tests were two-sided ones. Results: OMm and OM (both with likelihood ratio statistic [LRS] P Discussion: Both OncoMasTR scores were significantly prognostic for DRFS and IDFS and provided additional prognostic information to the molecular and clinicopathological risk factors/tools assessed. OM was also the most accurate risk classification tool for identifying DR. A concise 6-gene signature with superior risk stratification was shown to increase prognosis reliability, which may help clinicians optimise treatment decisions. Trial registration: ClinicalTrials.gov NCT02050750 NCT00310180.</p

Use of recommended medications after myocardial infarction in Austria

Guidelines recommend long-term use of beta-blockers (BB), statins, and angiotensin-converting-enzyme-inhibitors or angiotensin-receptor-blockers (ACEI/ARB) after myocardial infarction (MI), but data on their use after discharge are scarce. From Austrian sickness funds claims, we identified all acute MI patients who were discharged within 30 days and who survived ≥120 days after MI in 2004. We ascertained outpatient use of ACEI/ARBs, BBs, statins, and aspirin from all filled prescriptions between discharge and 120 days post MI. Comorbidities were ascertained from use of indicator drugs during the preceding year. Multivariate logistic regression was used to evaluate the independent determinants of study drug use. We evaluated 4,105 MI patients, whose mean age was 68.8 (±13.2) years; 59.5% were men. Within 120 days after MI, 67% filled prescriptions for ACE/ARBs, 74% for BBs, and 67% for statin. While 41% received all these classes and 34% two, 25% of patients received only one or none of these drugs. Older age and presence of severe mental illness were associated with lower use of all drug classes. Diabetics had greater ACEI/ARB use. Fewer BBs were used in patients with obstructive lung disease. Statin use was lower in patients using treatment for congestive heart failure (all P < 0.001). We conclude that recommended medications were underused in Austrian MI survivors. Quality indicators should be established and interventions be implemented to ensure maximum secondary prevention after MI

Anatomically heterogeneous populations of CB cannabinoid receptor-expressing interneurons in the CA3 region of the hippocampus show homogeneous input-output characteristics

A subpopulation of GABAergic cells in cortical structures expresses CB1 cannabinoid receptors (CB1 ) on their axon terminals. To understand the function of these interneurons in information processing, it is necessary to uncover how they are embedded into neuronal circuits. Therefore, the proportion of GABAergic terminals expressing CB1 and the morphological and electrophysiological properties of CB1 -immunoreactive interneurons should be revealed. We investigated the ratio and the origin of CB1 -expressing inhibitory boutons in the CA3 region of the hippocampus. Using immunocytochemical techniques, we estimated that approximately 40% of GABAergic axon terminals in different layers of CA3 also expressed CB1 . To identify the inhibitory cell types expressing CB1 in this region, we recorded and intracellularly labeled interneurons in hippocampal slices. CB1 -expressing interneurons showed distinct axonal arborization, and were classified as basket cells, mossy-fiber-associated cells, dendritic-layer-innervating cells or perforant-path-associated cells. In each morphological category, a substantial variability in axonal projection was observed. In contrast to the diverse morphology, the active and passive membrane properties were found to be rather similar. Using paired recordings, we found that pyramidal cells displayed large and fast unitary postsynaptic currents in response to activating basket and mossy-fiber-associated cells, while they showed slower and smaller synaptic events in pairs originating from interneurons that innervate the dendritic layer, which may be due to dendritic filtering. In addition, CB1 activation significantly reduced the amplitude of the postsynaptic currents in each cell pair tested. Our data suggest that CB1 -expressing interneurons with different axonal projections have comparable physiological characteristics, contributing to a similar proportion of GABAergic inputs along the somato-dendritic axis of CA3 pyramidal cells. (c) 2014 Wiley Periodicals, Inc