Normas Internacionales de Información Financiera (NIIF) para Pequeñas y Medianas Entidades : Propuesta de valuación y control de inventarios según la sección 13 de las normas internacionales de información financiera para pequeñas y medianas entidades (NIIF Pymes); para el hotel Lupita durante el segundo semestre 2016

La contabilidad ha evolucionado y las Normas Internacionales de Información Financiera surgen para tener un marco mundial que rija la presentación de los estados financieros. En Nicaragua son de aplicación sugerida desde el año 2011. Las PYMES son, por lo general, empresas familiares que llevan una contabilidad simplificada y a veces; esto causa que no registren bien sus costos y que no tengan la rentabilidad suficiente. El objetivo principal de este trabajo es diseñar una propuesta de valuación y control del inventario para el Hotel Lupita La contabilización del inventario en las empresas turísticas, es más complejo puesto que se usan algunos postulados de la contabilidad comercial y otros de la industrial y en Nicaragua existe poca bibliografía al respecto. Por lo tanto, las PYMES llevan su contabilidad conforme a una empresa comercial y esto puede causar determinación inadecuada de los costos, lo que influye directamente en la asignación de precios y podría generar pérdidas. A través de la investigación se determinó que el Hotel Lupita aplica los PCGA. En este trabajo se hizo una ejemplificación de la sección trece de las Normas Internacionales para Pequeñas y Medianas Entidades. (NIIF para PYMES). Se presenta una propuesta de valuación del inventario de acuerdo al costo de adquisición donde se incluyeron todos los costos necesarios para llevar la materia prima y suministros al hotel y se propuso el método promedio para asignar los precios a registrar en los kardex y luego determinar los costos de los platos y otros servicios ofrecidos. Determinados los costos, se asignaron porcentajes por los costos de operación y posterior se calcularon los precios de venta. Al finalizar se ilustran las ventas de los servicios ofrecidos. Al elaborar esta propuesta se concluyó que el Hotel Lupita no asigna todos los costos incurridos en la compra de materia prima en el registro de esta; lo que ocasiona que los precios de ventas establecidos no sean lo suficientemente rentables para el Hotel. Se desea que el trabajo facilite al Hotel Lupita herramientas que le permitan valuar y controlar el inventario según las NIIF para PYMES, que sea de utilidad para otras empresas del sector turismo y al mismo tiempo para consultas de estudiantes de contabilidad

Diseño de un Plan de Negocio Turístico para el Bar EMMA ubicado en Buena Vista del Sur Municipio de Diriamba, Departamento de Carazo durante el período de Agosto-Diciembre del 2007

El seminario de graduación tiene por objetivo: Favorecer y mejorar la sostenibilidad y la competitividad de las microempresas turísticas del departamento de Carazo hacia sus mercados, y así facilitar su permanencia en aquellos en que ya están insertas y su inserción en mercados futuros que se pretende alcanzar mediante el diseño del plan de negocios turístico elaborado por las carreras de Mercadotecnia, Turismo Sostenible y Contabilidad pública y finanzas. El siguiente documento del plan de negocio turístico está dividido en tres capítulos: Estudio de mercado: El presente estudio de mercado tiene como principal objetivo proporcionar información necesaria acerca de la demanda que puede tener un nuevo servicio en el Bar Emma, mediante un instrumento (Cuestionario) el cual se aplicó a la PEA ocupada en trabajos profesionales de los principales municipios del departamento de Carazo (Jinotepe, Diriamba, San Marcos) aplicando el instrumento a 46 personas. Una vez aplicado el instrumento se procedió a analizar la demanda y oferta que posee actualmente Bar Emma para determinar la demanda insatisfecha que no está siendo atendida. Además se establecieron sistemas de comercialización adecuados para comercializar el servicio turístico que ofertara Bar Emma tomando en cuenta las características propias del servicio, el mercado y la demanda. Posteriormente se determinó precios del servicio turístico a ofrecer considerando el margen de ganancia que espera el propietario y el nivel de ingreso del cliente ya que la mayoría su salario asciende a los C$ 4,000, contribuyendo el precio para la realización de las proyecciones de venta futuras del negocio (2008 al 2010). 5 Diseño del producto / servicio turístico: Luego de haber realizado el estudio de mercado se diseño el producto servicio turístico el cual inicia con la delimitación del área de estudio “Bar Emma”. El primer estudio consistió en identificar sus fortalezas, debilidades, oportunidades y amenazas la siguiente etapa la elaboración del modelo de oferta de servicios del bar, se realizaron observaciones, análisis y estudios de campo que permitieron la formulación de un nuevo concepto de empresa de servicios turísticos. Definido el modelo de desarrollo de infraestructura turística se procedió a realizar los estudios correspondientes para el diseño de productos / servicios turísticos del bar Emma que está compuesto por la planificación y organización del Bar y Restaurante, incluye los aspectos legales, organizacionales, administrativos, y las estrategias de marketing turísticos. Para el diseño se tomaron en cuenta los resultados obtenidos del estudio de mercado que incluyo la aplicación de encuestas a la Población Económicamente Activa Ocupada del departamento de Carazo y a los turistas nacionales y extranjeros que visitaban la ciudad de Granada. El diseño del producto / servicio turístico tiene por finalidad mejorar la oferta de la empresa, convirtiendo al bar Emma en una empresa prestadora de servicios turísticos “La Casona de Emma” bar y restaurante de un tenedor. 6 Estudio financiero: El estudio financiero consiste en elaborar un plan financiero que tiene como propósito determinar la Rentabilidad del negocio en tres año (2008, 2009 y 2010) para lo cual se utilizó herramientas financieras como: a) Elaborar un plan de Ventas que permitió proyectarlas en tres años. b) Elaborar un plan de compras que permitió proyectarlas en tres años. c) Elaborar un plan de gastos de operación para determinar el flujo de gastos de venta, administración y financieros de la Casona de Emma d) Elaborar un flujo de Efectivo que permitió el grado de liquides con que cuenta la empresa e) Determinamos un estudio a través de razones financiera para visualizar el desempeño financiero del negocio

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

EDUCACIÓN AMBIENTAL Y SOCIEDAD. SABERES LOCALES PARA EL DESARROLLO Y LA SUSTENTABILIDAD

Este texto contribuye al análisis científico de varias áreas del conocimiento como la filosofía social, la patología, la educación para el cuidado del medio ambiente y la sustentabilidad que inciden en diversas unidades de aprendizaje de la Licenciatura en Educación para la Salud y de la Maestría en Sociología de la SaludLas comunidades indígenas de la sierra norte de Oaxaca México, habitan un territorio extenso de biodiversidad. Sin que sea una área protegida y sustentable, la propia naturaleza de la región ofrece a sus visitantes la riqueza de la vegetación caracterizada por sus especies endémicas que componen un paisaje de suma belleza

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Measurement of t(t)over-bar normalised multi-differential cross sections in pp collisions at root s=13 TeV, and simultaneous determination of the strong coupling strength, top quark pole mass, and parton distribution functions

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