Diseño y rehabilitación del camino vecinal Pelejo – Papaplaya

In recent years the country has gone through a difficult economic situation and order public which particularly affects rural areas, both in productive activity as in the situation of roads and roads that allow their articulation with the most dynamic areas in the jungle and thus further deteriorating their life conditions. In our country, the road system is still many shortcomings, so no is .llega to meet the needs of peoples, especially in places more away; this leads to the annual production of those areas affected, why products can not reach the main markets in the area. The construction of the road Pelejo - Papaplaya becomes the continuation of the Pongo previously executed road Caynarachi - Barranquita - Pelejo and is part of this major project it consists of the construction of the road level road said that seeks integration between terrestrial environment existing villages in areas · Lower, Huallaga Valley Caynarachi and Chipurana, This section seeks to reach the Papaplaya District. In our region we can see that there are still districts, towns that They do not have their roads and the best if there are these, most part are dirt roads that do not meet the Technical Specifications minimum for efficient service. Thus understood, the transcendental importance of road networks and the imperious need for an efficient road system that generates progress and social welfare, I have elaborated this thesis work, terming "Geometric Design Vecinal Pelejo- Papaplaya road. "The project basically involves the study of the main critical areas that have the area such as slope stabilization, shaping embankments, removal of organic material and a layer claimed to improve! to c.apa rolling.En los últimos años el país ha atravesado por una difícil situación económica y de orden público que afecta particularmente al ámbito rural, tanto en la actividad productiva como en ,la situación de las carreteras y caminos vecinales que posibilitan su articulación con las zonas de mayor dinamismo en la selva y en consecuencia deteriorando aún más sus condiciones de vida. En nuestro país el sistema vial se encuentra todavía con muchas carencias, por lo que no se .llega a cubrir las necesidades de los pueblos, especialmente en los lugares más alejados; esto conlleva a que la producción anual de dichas zonas se vea afectado, motivo por el cual los productos no pueden llegar a los principales mercados de la zona. La construcción de la carretera Pelejo - Papaplaya viene a ser la continuación de la carretera anteriormente ejecutada Pongo de Caynarachi - Barranquita - Pelejo y que forma parte de este proyecto de gran envergadura, consiste en la construcción de la carretera a nivel de afirmado que busca la integración vial por medio terrestre entre los pueblos existentes en las zonas· del Bajo, Huallaga, Valle de Caynarachi y del Chipurana, este tramo busca llegar hasta el distrito de Papaplaya. En nuestra Región se puede apreciar que aún existen Distritos, centros poblados que no cuentan con sus carreteras y en el mejor de los casos si existen éstas, en su mayor parte son trochas carrozables que no cumplen con las Especificaciones Técnicas mínimas para un eficiente servicio. Entendido así, la trascendental importancia de las redes viales y frente a la imperiosa necesidad de contar con un sistema vial eficiente que genere progreso y bienestar social, he ,elaborado el presente trabajo de Tesis, denominando "Diseño Geométrico de la Carretera Vecinal Pelejo- Papaplaya". El Proyecto comprende básicamente el estudio de las principales zonas críticas que tiene la zona tales como la estabilización de taludes, conformación de terraplenes, eliminación de material orgánico, así como una capa de afirmado para mejorar !a c.apa de rodadura.Tesi

Actitud emprendedora y desarrollo sustentable en los programas de emprendimientos del FONCODES UT Tarapoto, 2022

El presente trabajo investigativo tuvo como objetivo determinar la relación entre la actitud emprendedora y el desarrollo sustentable en los programas de emprendimientos del FONCODES UT Tarapoto, 2022. Se desarrolló una investigación de tipo básica, diseño no experimental de corte transversal. La muestra lo conformaron 123 emprendedores, la técnica aplicada fue la encuesta y como instrumentos los cuestionarios. Los resultados evidencian que los niveles de la actitud emprendedora y el desarrollo sustentable son buenos con 95,1% y 91,9% respectivamente. Asimismo, las dimensiones de innovación y autoestima de la actitud emprendedora se relacionan con el desarrollo sustentable con un p-valor de 0,020 y 0,010 respectivamente; por el contrario, la dimensión necesidad de logro no se relaciona con el desarrollo sustentable. Finalmente, existe relación entre la actitud emprendedora y el desarrollo sustentable con un coeficiente de correlación de 0,386. Se concluyó, que existe relación entre la actitud emprendedora y el desarrollo sustentable, encontrando un p-valor de 0,000 (p-valor≤0,05), los niveles de la actitud emprendedora y desarrollo sustentable son buenos. También, existe relación entre las dimensiones innovación y autoestima con la variable desarrollo sustentable; sin embargo, no existe relación entre la dimensión necesidad de logro y la variable desarrollo sustentable

Accuracy assessment and screening of a dairy herd with paratuberculosis by three different ELISAs

Although the culture of Mycobacterium avium subsp. paratuberculosisis is the gold standard for the diagnosis of paratuberculosis, this bacterium is difficult to grow. In contrast, serological tests like ELISAs are inexpensive, rapid, and easy to perform. The aims of this study were to evaluate the accuracy of three different ELISAs: one with the commercial antigen PPA-3, another one with L5P (a recently described lipopentapeptide), and a third one with an in-house antigen whole cell lysates (WCL) of M. avium (MAA) strain D4ER (Study 1), and to compare them with other tests for paratuberculosis (PTB) diagnosis (Study 2). In Study 1, the sensitivities of the three ELISAs tested were 74.1%, 37% and 74.1%, respectively, whereas their specificities were 98.9%, 100% and 100%, respectively. In Study 2, we compared the three above-mentioned ELISAs with the intradermal reaction test using Avian PPD (PPDa) and fecal culture associated with Ziehl-Neelsen stain and PCR tests, in a dairy herd with 4.6% of cows with clinical signs of PTB. The results showed that fecal samples from 14 cows (16%) were culture-positive and that fecal samples from nine cows (10%) were PPDa-positive. Most of these animals (culture-positive and PPDa-positive) were detected as positive with any of the three ELISAs tested. Serological results showed that 31% of the animals were positive to ELISA-PPA-3, 17% to ELISA-L5P and 42.5% to ELISA-WCL. The combination of these three ELISAs identified 50.6% of the animals as positive in the infected herd. In particular, the results show that the locally developed ELISA seems to be useful for identifying many infected animals in a herd.Fil: Costanzo, Gabriel. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Biotecnología; ArgentinaFil: Alvarado Pinedo, María Fiorella. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Departamento de Clínica. Centro de Diagnóstico e Investigaciones Veterinarias; ArgentinaFil: Mon, Maria Laura. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Biotecnología; ArgentinaFil: Viale, Mariana Noelia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Biotecnología; ArgentinaFil: Gil, Andres. Universidad de la Republica. Facultad de Veterinaria.; UruguayFil: Carrica Illia, Mariano. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Gioffré, Andrea Karina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Biotecnología; ArgentinaFil: Arese, Alicia. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Biotecnología; ArgentinaFil: Travería, Gabriel Eduardo. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Departamento de Clínica. Centro de Diagnóstico e Investigaciones Veterinarias; ArgentinaFil: Romano, Maria Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Biotecnología; Argentin

Modelo unidimensional de crecimiento epitaxial : distribución de tamaño de islas.

Se estudia el efecto de la agregación obstaculizada en el proceso de formación de islas en una y dos dimensiones para un modelo de islas puntuales de crecimiento epitaxial con tamaño de núcleo crítico. En nuestro modelo, la adhesión de monómeros a islas pre-existentes está obstaculizado por una barrera adicional, caracterizada por una longitud la. Para la=0 las islas se comportan como sumideros perfectos mientras que para la → ∞ se comportan como fronteras reflectivas. Para valores intermedios de la, el sistema exhibe un cambio entro dos tipos diferentes de procesos: agregación limitada por difusión (DLA) y agregación limitada por reacción (ALA). Las distribuciones de zonas de captura (CZ) y de tamaño de islas (IS) son calculadas para diferentes valores de i y la. Con el fin de obtener una buena descripción del proceso de nucleación, se propone un modelo de fragmentación basado en una descripción aproximada de la nucleación dentro de los espaciamientos en 1D y de las zonas de captura en 2D. En ambos casos, la nucleación es descrita usando dos probabilidades con fundamento físico cada una de las cuales está relacionada con los parámetros microscópicos del modelo (i y la). Probamos nuestro modelo analítico con extensas simulaciones numéricas y con resultados establecidos previamente. El modelo propuesto describe excelentemente el comportamiento estadístico del sistema para valores arbitrarios de la e i = 1, 2 y 3; esto nos permite usar el modelo para determinar el valor de la barrera a partir de resultados experimentales.Para el estudio del sistema propuesto se usaron simulaciones de Monte Carlo cinético, acompañadas de modelos de reacción difusión que permiten escribir un conjunto de ecuaciones auto consistentes. Este modelo analítico se probo para diferentes valores de $i$ y de la barrera de agregación

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Registro ACESUR: atención de pacientes adultos con crisis epilépticas en servicios de urgencias: diferencias entre primer episodio y recurrencia

Objetivo. Describir las características y la atención recibida de pacientes adultos que consultan por crisis epiléptica (CE) en los servicios de urgencias hospitalarios (SUH), diferenciando entre primera crisis y recurrencia en epiléptico conocido. Método. ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático, los días pares de febrero y julio alternando con los impares de abril y octubre de 2017. Se incluyeron pacientes 18 años con diagnóstico de CE en los SUH. Se recogieron variables clínico-asistenciales de la visita índice de pacientes, distinguiendo entre primera CE y recurrencia en epiléptico. Resultados. El registro ACESUR recogió a 664 pacientes procedentes de 18 SUH españoles, 229 (34, 5%) con primera CE y 435 (65, 5%) con CE recurrentes. Los pacientes con primera CE fueron de mayor edad (p < 0, 001), presentaron motivos de consulta distintos (p < 0, 001) y requirieron más traslados en ambulancia (p < 0, 001). La atención recibida en el SUH fue diferente, en pacientes con primera CE se solicitó con mayor probabilidad una prueba complementaria específica (OR ajustada = 13, 94; IC95%:7, 29-26, 7; p < 0, 001) y se necesitó mayor hospitalización o estancia prolongada en el SUH (OR ajustada = 1, 69; IC95%:1, 11-2, 58; p = 0, 015). No hubo diferencias en cuanto al tratamiento farmacológico en fase aguda ni preventivo (OR ajustada = 1, 40; IC95%:0, 94-2, 09; p = 0, 096). Se inició tratamiento con fármacos antiepiépticos (FAE) en 100 pacientes (43, 7%) tras primera CE y se reinició o modificó añadiendo nuevo FAE en 142 pacientes (32, 6%) con CE recurrentes. Conclusiones. Las características clínicas y la atención recibida de pacientes adultos con primera CE en SUH en España difieren de las recurrencias en epiléptico conocido. Objective. To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epilepsy. Methods. ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient''s visit, including whether the event was a first or recurrent seizure. Results. A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. Two hundred twenty-nine (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (P<.001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio [aOR], 13.94; 95% CI, 29-26.7; P<.001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11-2.58; P=.015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94-2.09; P=.096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%). Conclusions. The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs