Clima organizacional y satisfacción laboral en el centro de atención primaria nivel I-3 Metropolitano Callao – Essalud 2014

Objetivos: Determinar la relación entre Clima organizacional y satisfacción laboral en el personal del Centro de Atención Primaria Nivel I-3 Metropolitano Callao - Essalud 2014. Material y métodos: El presente estudio fue prospectivo descriptivo, transversal, correlacional realizada a 56 trabajadores de salud del Centro de Atención Primaria Nivel I-3 Metropolitano Callao - Essalud en el año 2014. Resultados: Nuestro estudio estuvo conformado por 40(71.4 %), y 16 varones (28.65).La media de la edad del total de entrevistados fue de 34.2+/-5.4 años, siendo la mínima de 24 años y la máxima de 49 años. El 66.1 % eran personal profesional. El 33.9 % eran personal técnico, seguido de igual frecuencia de tecnólogos médicos y enfermeras (12.5 %).El 98.2 % de los entrevistados eran contratados. El 44.6 % tenían entre 4 a 6 años en la institución y el 39.3 % tenían entre 4 a 6 años trabajando en su puesto actual. Encontramos que el 35.7 % percibieron un bajo nivel del clima organizacional, el 32.1% percibió un nivel medio y el 32.1 % percibió un alto nivel del clima organizacional. El 33.9 % estaban insatisfechos, el 35.7 % refirieron sentirse satisfechos y el 30.4% refirieron sentirse muy satisfechos

RORα-expressing T regulatory cells restrain allergic skin inflammation

Atopic dermatitis is an allergic inflammatory skin disease characterized by the production of the type 2 cytokines in the skin by type 2 innate lymphoid cells (ILC2s) and T helper 2 (TH2) cells, and tissue eosinophilia. Using two distinct mouse models of atopic dermatitis, we show that expression of retinoid-related orphan receptor α (RORα) in skin-resident T regulatory cells (Tregs) is important for restraining allergic skin inflammation. In both models, targeted deletion of RORα in mouse Tregs led to exaggerated eosinophilia driven by interleukin-5 (IL-5) production by ILC2s and TH2 cells. Expression of RORα in skin-resident Tregs suppressed IL-4 expression and enhanced expression of death receptor 3 (DR3), which is the receptor for tumor necrosis factor (TNF) family cytokine, TNF ligand–related molecule 1 (TL1A), which promotes Treg functions. DR3 is expressed on both ILC2s and skin-resident Tregs. Upon deletion of RORα in skin-resident Tregs, we found that Tregs were no longer able to sequester TL1A, resulting in enhanced ILC2 activation. We also documented higher expression of RORα in skin-resident Tregs than in peripheral blood circulating Tregs in humans, suggesting that RORα and the TL1A-DR3 circuit could be therapeutically targeted in atopic dermatitis

A randomised controlled trial evaluating arrhythmia burden, risk of sudden cardiac death and stroke in patients with Fabry disease:The role of implantable loop recorders (RaILRoAD) compared with current standard practice

Background: Fabry disease (FD) is a genetic disorder caused by a deficiency in the enzyme alpha-galactosidase A, leading to an accumulation of glycosphingolipids in tissues across the body. Cardiac disease is the leading cause of morbidity and mortality. Advanced disease, characterised by extensive left ventricular hypertrophy, ventricular dysfunction and fibrosis, is known to be associated with an increase in arrhythmia. Data identifying risk factors for arrhythmia are limited, and no Fabry-specific risk stratification tool is available to select those who may benefit from initiation of medical or device therapy (implantable cardiac defibrillators). Current monitoring strategies have a limited diagnostic yield, and implantable loop recorders (ILRs) have the potential to change treatment and clinical outcomes. Aim: The aim of this study is to determine whether ILRs can (1) improve arrhythmia detection in FD and (2) identify risk predictors of arrhythmia. Methods: A prospective, 5-year, open-label, international, multi-centre randomised controlled trial of a minimum of 164 participants with genetically or enzymatically confirmed FD (or both) who have evidence of cardiac disease will be recruited from five centres: Queen Elizabeth Hospital, Birmingham, UK; Salford Royal Hospital, Salford, UK; Royal Free Hospital, London, UK; Addenbrookes Hospital, Cambridge, UK; and Westmead Hospital, Sydney, Australia. Participants will be block-randomised (1:1) to two study arms for cardiac monitoring (i) control arm: standard of care with annual 24 h or 5-day Holter monitor or (ii) treatment arm: continuous cardiac monitoring with ILR implantation plus standard of care. Participants will undergo multiple investigations - blood/urine biomarkers, 12-lead and advanced electrocardiogram (ECG) recording, echocardiography and cardiovascular magnetic resonance (CMR) imaging - at baseline and 6-12 monthly follow-up visits. The primary endpoint is identification of arrhythmia requiring initiation or alteration in therapy. Secondary outcome measures include characterising the risk factors associated with arrhythmia and outcome data in the form of imaging, ECG and blood biomarkers. Discussion: This is the first study evaluating arrhythmia burden and the use of ILR across the spectrum of risk profiles in Fabry cardiomyopathy. This will enable detailed characterisation of arrhythmic risk predictors in FD and ultimately support formulation of Fabry-specific guidance in this high-risk population. Trial registration: ClinicalTrials.gov (NCT03305250). Registered on 9 October 2017

Study of indications for cardiac device implantation and utilisation in Fabry cardiomyopathy

Background: Fabry disease is a treatable X-linked condition leading to progressive cardiomyopathy, arrhythmia and premature death. Atrial and ventricular arrhythmias contribute significantly to adverse prognosis; however, guidance to determine which patients require cardiovascular implantable electronic devices (CIEDs) is sparse. We aimed to evaluate indications for implantation practice in the UK and quantify device utilisation. Methods: In this retrospective study, we included demographic, clinical and imaging data from patients in four of the largest UK Fabry centres. Ninety patients with Fabry disease were identified with CIEDs implanted between June 2001 and February 2018 (FD-CIED group). To investigate differences in clinical and imaging markers between those with and without devices, these patients were compared with 276 patients without a CIED (FD-control). Results: In the FD-CIED group, 92% of patients with permanent pacemakers but only 28% with implantable cardioverter-defibrillators had a class 1 indication for implantation. A further 44% of patients had defibrillators inserted for primary prevention outside of current guidance. The burden of arrhythmia requiring treatment in the FD-CIED group was high (asymptomatic atrial fibrillation: 29%; non-sustained ventricular tachycardia requiring medical therapy alone: 26%; sustained ventricular tachycardia needing anti-tachycardia pacing/defibrillation: 28%). Those with devices were older, had greater LV mass, more scar tissue and larger atrial size. Conclusions: Arrhythmias are common in Fabry patients. Those with cardiac devices had high rates of atrial fibrillation requiring anticoagulation and ventricular arrhythmia needing device treatment. These are as high as those in hypertrophic cardiomyopathy, supporting the need for Fabry-specific indications for device implantation

Planeamiento estratégico para el sector textil

El propósito principal de esta tesis es investigar alternativas para orientar el fortalecimiento de la industria textil en el Perú, desarrollando un planeamiento estratégico para el período 2017-2027. Para ello, seha utilizado la metodología del proceso estratégico propuesta por D’Alessio (2015).Perú cuenta con materia prima textil de gran calidad y talento humano especializado y creativo; recursos que al ser combinados pueden materializar productos de alto valor agregado para atender la demanda de los mercados extranjeros más exigentes. Se analizan las fortalezas y debilidades delaindustria con el propósito de delinear un marco estratégico para potenciar las primeras y mitigar las segundas, en tanto se aprovechan oportunidades del contexto procurando reducir las amenazas. La visión que se ha creado de la industria textil para el año 2027 la propone como rentable y socialmente responsable, operando en la formalidad para el beneficio de sus empleados y clientes, creando productos de excelente calidad, tanto en algodón como en lana. Todo esto será posible a través de la implementación de siete estrategias:(a) penetrar en el mercado alemán con prendas de algodón para caballeros y damas, (b) penetrar en el mercado chileno con prendas de algodón para caballeros, (c) desarrollar prendas apropiadas para distintos climas o estaciones, (d) hacer encadenamientos de productores textiles con retailers que operan en Perú y en la región, (e) obtener acreditación de la sostenibilidad de los procesos productivos / certificaciones de RSE, SST, OHSAS; (f) integrarse verticalmente hacia adelante para tener oficina de representación en los principales mercados de destino, y (g) desarrollar la marca Perú para identificar a los productos textiles, asociándola con alta calidadThe main purpose of this thesis is to investigate alternatives to guide the strengthening of the Textile Industry in Peru, developing strategic planning for the period 2017-2027. This has been done using the methodology of the Strategic Process that was proposed by D'Alessio (2015). Peru has high quality textile raw materials and specialized and creative human talent; Resources that when combined can materialize products of high added value, to meet the demand of the most demanding foreign markets. The strengths and weaknesses of the industry are analyzed with the purpose of delineating a strategic framework to promote the former and mitigate the latter; While taking advantage of context opportunities to reduce threats. The vision that has been created of the Textile Industry for the year 2027 proposes it as profitable and socially responsible, operating in the formality, for the benefit of its employees and customers, creating products of excellent quality, both in cotton and in wool. All this will be possible through the implementation of seven strategies: (a) penetrate the German market with knit and ladies cotton garments; (b) penetrate the Chilean market with knitted cotton garments; (c) develop clothing appropriate to different climates or seasons; (d) linking textile producers with retailers operating in Peru and in the region; (e) obtain accreditation of the sustainability of the productive processes / certifications of CSR, SST, OHSAS; (f) integrate vertically forward to have representation office in the main target markets; and (g) develop the Peru brand to identify textile products, associating it with high qualityTesi

Physicochemical properties of nanostructured Pd/lanthanide-doped ceria spheres with high catalytic activity for CH4 combustion

This work has been supported by: the Brazilian Synchrotron Light Laboratory (LNLS, Brazil), under proposals D04B-XAFS1-13435 and D12A-XRD1-13437; Chinese Scholarship Council (CSC, China); and Agencia Nacional de Promoción Científica y Tecnológica (Argentina, PICT 2012-1506). Dr. J. J. Delgado thanks the “Ramón y Cajal” program of the Ministry of Economy, Industry and Competitiveness of Spain. Dr. R.O. Fuentes gratefully acknowledges the UCA-International fellowship (UCA/R82REC/2016), Universidad de Cadiz, Spain.In this work, nanostructured Ce0.9Gd0.1O2-δ (GDC) and Ce0.9Pr0.1O2-δ (PrDC) spheres previously obtained by microwave assisted hydrothermal homogeneous co-precipitation were impregnated with 1wt% Pd by the incipient wetness impregnation of an aqueous Pd2+ solution. Their properties were characterized by synchrotron radiation X-ray diffraction (SR-XRD), X-ray absorption near-edge spectroscopy (XANES) and scanning and high resolution electron microscopy with X-ray spectroscopy. Spherical particles with average diameters around 200 nm were found to consist of crystallites of average size, 10 nm, with small particles of PdO finely dispersed over the sphere surface. In situ XRD and XANES experiments were carried out under reducing and oxidizing conditions in order to investigate the redox behaviour of these materials and to evaluate the effect of Pd loading on the oxidation state of Ce. All of the lanthanide-doped ceria (LnDC) supports were found to have a cubic crystal structure (Fm3m space group). An increase in lattice parameters was observed under reducing conditions which was attributed to the reduction of Ce4+ ions to the larger Ce3+ ions, and to the associated increase in oxygen vacancy (VO) concentration. Addition of Pd to the LnDC spheres increased their Ce3+ content. Finally, catalytic tests for CH4 combustion were performed on the LnDC and Pd/LnDC nanocatalysts. The best performance was observed in samples with 1 wt% Pd loading, which exhibited T50 values (temperature at which 50% of CH4 conversion was reached) close to 310 °C. These values are 220 °C and 260 °C lower than those obtained for nanostructured PrDC and GDC spheres alone, respectively.PostprintPeer reviewe

Mechanical effects of left ventricular midwall fibrosis in non-ischemic cardiomyopathy

Background: Left ventricular (LV) mid-wall fibrosis (MWF), which occurs in about a quarter of patients with non-ischemic cardiomyopathy (NICM), is associated with high risk of pump failure. The mid LV wall is the site of circumferential myocardial fibers. We sought to determine the effect of MWF on LV myocardial mechanics. Methods: Patients with NICM (n = 116; age: 62.8 ± 13.2 years; 67 % male) underwent late gadolinium enhancement cardiovascular magnetic resonance (CMR) and were categorized according to the presence (+) or absence (-) of MWF. Feature tracking (FT) CMR was used to assess myocardial deformation. Results: Despite a similar LVEF (24.3 vs 27.5 %, p = 0.20), patients with MWF (32 [24 %]) had lower global circumferential strain (εcc: -6.6 % vs -9.4 %, P = 0.004), but similar longitudinal (εll: -7.6 % vs. -9.4 %, p = 0.053) and radial (εrr: 14.6 % vs. 17.8 % p = 0.18) strain. Compared with - MWF, + MWF was associated with reduced LV systolic, circumferential strain rate (-0.38 ± 0.1 vs -0.56 ± 0.3 s-1, p = 0.005) and peak LV twist (4.65 vs. 6.31°, p = 0.004), as well as rigid LV body rotation (64 % vs 28 %, P cc: 0.34 vs. 0.46 s-1; DSRll: 0.38 vs. 0.50s-1; DSRrr: -0.55 vs. -0.75 s-1; all

Greyzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction >35%

AIMS: To determine whether myocardial fibrosis and greyzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) is associated with ventricular arrhythmias in patients with coronary artery disease (CAD) and a left ventricular ejection fraction (LVEF) >35%. METHODS AND RESULTS: In this retrospective study of CAD patients, GZF mass using the 3SD method (GZF3SD) and total fibrosis mass using the 2SD method (TF2SD) on CMR were assessed in relation to the primary, combined endpoint of sudden cardiac death, ventricular tachycardia, ventricular fibrillation, or resuscitated cardiac arrest. Among 701 patients [age: 65.8 ± 12.3 years (mean ± SD)], 28 (3.99%) patients met the primary endpoint over 5.91 years (median; interquartile range 4.42-7.64). In competing risks analysis, a GZF3SD mass ≥5.0 g was strongly associated with the primary endpoint [subdistribution hazard ratio (sHR): 17.4 (95% confidence interval, CI 6.64-45.5); area under receiver operator characteristic curve (AUC): 0.85, P 35%, GZF3SD mass was strongly associated with the arrhythmic endpoint. These findings hold promise for its use in identifying patients with CAD and an LVEF >35% at risk of arrhythmic events