Evolución del diseño de interiores en los grandes Centros Comerciales de Lima Central Sur en las últimas tres décadas

La investigación responde a una problemática que se evidencia a través de una serie de debilidades que repercuten en el diseño de dichos centros comerciales. El conocimiento de nuevas tecnologías para el diseño interior era escaso, no había conocimientos de enchapes, acabados finos, iluminación decorativa y diseño interior en general. Los materiales tampoco eran de gran ayuda, solo se conocían las estructuras comunes, como el cemento y el acero. Tampoco había conocimientos sobre técnicas constructivas

Intermittent Catheter Reimbursement in the United States: The Experience of Nine Stakeholders Through the Lens of Actor-Network Theory

A narrow interpretation of “medical necessity” can result in poorer health as well as a more restricted life for people with disabilities. We examined the impact of US policy on reimbursement of intermittent catheters (ICs) on the lives of people with neurogenic bladder (NB) who require catheters to urinate. We conducted in-depth, longitudinal interviews with nine stakeholders. Actor-Network Theory was used to describe interactions among human agents, IC products, and policies in the reimbursement arena. Restrictions on the type and quantities of ICs reimbursed emerged as the most potent inhibitor to health and wellbeing among consumers with NB. IC suppliers, due to the large number of other stakeholders with whom they interact in the reimbursement process, emerged as strong enablers of preferred IC use among people with NB. Lack of an impartial central clearinghouse on IC products and coverage impeded consumers’ ability to make informed decisions

A Review of Dabigatran, an Oral Anticoagulant

Serious clinical complications associated with venous thrombotic embolism (VTE) necessitate prophylaxis in patient groups who are at high risk of VTE, specifically those recovering from orthopedic surgery with atrial fibrillation, with mechanical heart valves, at increased risk for stroke, or recovering post-MI. Currently, prophylaxis with warfarin, enoxaparin, or fondaparinux has been the standard of therapy, but these therapies each have their limitations. Dabigatran etexilate is an orally available pro-drug of dabigatran, a competitive, reversible, direct inhibitor thrombin (Factor lla). The agent is converted by esterases, and, thus, not associated with the complications of the CYP enzyme system. Dabigatran follows a linear dose-response curve simplifying dosing compared to other agents. In the BISTRO II study, a dose as low as 50 mg dabigatran was found to be non-inferior to the current standard of therapy of 40 mg enoxaparin, and BISTRO I and II, RE-NOVATE and RE-LY all found dabigatran was better or equivalent to warfarin therapy for post-hip and knee replacements. Dabigatran could be especially beneficial in patients who have a contraindication to warfarin, need long-term anticoagulation and require less patient monitoring. With FDA approval and release of this drug, time will provide safety and efficacy data to solidify dabigatran\u27s place in therapy along current anti-coagulation guidelines

A computational group theoretic symmetry reduction package for the SPIN model checker

Symmetry reduced model checking is hindered by two problems: how to identify state space symmetry when systems are not fully symmetric, and how to determine equivalence of states during search. We present TopSpin, a fully automatic symmetry reduction package for the Spin model checker. TopSpin uses the Gap computational algebra system to effectively detect state space symmetry from the associated Promela specification, and to choose an efficient symmetry reduction strategy by classifying automorphism groups as a disjoint/wreath product of subgroups. We present encouraging experimental results for a variety of Promela examples

Study design and rationale for investigating phosphodiesterase type 5 inhibition for the treatment of pulmonary hypertension due to chronic obstructive lung disease: the TADA-PHiLD (TADAlafil for Pulmonary Hypertension associated with chronic obstructive Lung Disease) trial

Abstract In patients with chronic obstructive pulmonary disease (COPD), moderate or severe pulmonary hypertension (COPD-PH) is associated with increased rates of morbidity and mortality. Despite this, approaches to treatment and the efficacy of phosphodiesterase type 5 inhibition (PDE-5i) in COPD-PH are unresolved. We present the clinical rationale and study design to assess the effect of oral tadalafil on exercise capacity, cardiopulmonary hemodynamics, and clinical outcome measures in COPD-PH patients. Male and female patients 40–85 years old with GOLD stage 2 COPD or higher and pulmonary hypertension diagnosed on the basis of invasive cardiac hemodynamic assessment (mean pulmonary artery pressure [mPAP] >30 mmHg, pulmonary vascular resistance [PVR] >2.5 Wood units, and pulmonary capillary wedge pressure ≤18 mmHg at rest) will be randomized at a 1∶1 ratio to receive placebo or oral PDE-5i with tadalafil (40 mg daily for 12 months). The primary end point is change from baseline in 6-minute walk distance at 12 months. The secondary end points are change from baseline in PVR and mPAP at 6 months and change from baseline in peak volume of oxygen consumption () during exercise at 12 months. Changes in systemic blood pressure and/or oxyhemoglobin saturation (Sao2) at rest and during exercise will function as safety outcome measures. TADA-PHiLD (TADAlafil for Pulmonary Hypertension assocIated with chronic obstructive Lung Disease) is the first sufficiently powered randomized clinical trial testing the effect of PDE-5i on key clinical and drug safety outcome measures in patients with at least moderate PH due to COPD

Aeronautic Instruments. Section IV : Direction Instruments

Part one points out the adequacy of a consideration of the steady state gyroscopic motion as a basis for the discussion of displacements of the gyroscope mounted on an airplane, and develops a simple theory on this basis. Principal types of gyroscopic inclinometers are described and requirements stated. Part two describes a new type of stabilizing gyro mounted on top of a spindle by means of a universal joint, the spindle being kept in a vertical position by supporting it as a pendulum of which the bob is the driving motor. Methods of tests and the difficulties in designing a satisfactory and reliable compass for aircraft use in considered in part three. Part four contains a brief general treatment of the important features of construction of aircraft compasses and description of the principal types used

Intraoperative detection of insufficient surgical margins in head and neck cancer resection using dual aperture fluorescence ratio imaging

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Naive Evaluation of Queries over Incomplete Databases

International audienceThe term naive evaluation refers to evaluating queries over incomplete databases as if nulls were usual data values, i.e., to using the standard database query evaluation engine. Since the semantics of query answering over incomplete databases is that of certain answers, we would like to know when naive evaluation computes them: i.e., when certain answers can be found without inventing new specialized algorithms. For relational databases it is well known that unions of conjunctive queries possess this desirable property, and results on preservation of formulae under homomorphisms tell us that within relational calculus, this class cannot be extended under the open-world assumption. Our goal here is twofold. First, we develop a general framework that allows us to determine, for a given semantics of incompleteness, classes of queries for which naive evaluation computes certain answers. Second, we apply this approach to a variety of semantics, showing that for many classes of queries beyond unions of conjunctive queries, naive evaluation makes perfect sense under assumptions different from open-world. Our key observations are: (1) naive evaluation is equivalent to monotonicity of queries with respect to a semantics-induced ordering, and (2) for most reasonable semantics of incompleteness, such monotonicity is captured by preservation under various types of homomorphisms. Using these results we find classes of queries for which naive evaluation works, e.g., positive first-order formulae for the closed-world semantics. Even more, we introduce a general relation-based framework for defining semantics of incompleteness, show how it can be used to capture many known semantics and to introduce new ones, and describe classes of first-order queries for which naive evaluation works under such semantics