Consultoría para la empresa Agropall Export SAC

Agropall Export SAC es una empresa dedicada a la exportación de mango fresco y congelado, perteneciente a un grupo empresarial Agropall, que pretende cerrar el círculo productivo en la cosecha, producción y exportación. Su principal mercado es Estados Unidos y para cumplir con sus clientes, adicionalmente a la cosecha en sembríos propios se ve obligada a adquirir el producto a terceros. Los terceros son agricultores que en terrenos propios se dedican al sembrío, cosecha y venta de mango para las agroexportadoras. En cada campaña de mango se aseguran la venta de su producción a través de intermediarios, quienes en las condiciones en las que se encuentre el producto, lo adquiere para venderla a terceros. Ante esta situación, Agropall Export SAC se ve obligada a adquirir a través de los intermediarios, la producción de mango para exportación, por ello, se ha analizado a través de la presente consultoría, la compra de producción a terceros a través de intermediarios a fin de satisfacer las necesidades en cantidad y calidad del mango, generando una alianza que permita al agricultor vender anticipadamente su producto y acceder a los recursos tecnológicos para producir mango de calidad y que reditúe ganancias a favor de Agropall Export SAC y los agricultores. Finalmente, se recomienda la suscripción de un contrato de bien futuro, con las condiciones que permita respetar los compromisos asumidos por ambas partes hasta el final de las campañas de mango, en el cual se establecerán las condiciones para que Agropall Export SAC cumpla con el agricultor y viceversa.Agropall Export SAC is a company dedicated to the export of fresh and frozen mango, belonging to a business group that intends to close the productive circle in harvest, production and export. Its main market is the United States and to meet its customers, in addition to harvesting its own crops, it is forced to acquire the product from third parties. The third parties are farmers who grow, harvest and sell mangoes on their own land for agro exporters. In each mango campaign, the sale of their production is ensured through intermediaries, who, under the conditions in which the product is found, acquire it to sell it to third parties. Faced with this situation, Agropall Export SAC is forced to acquire through intermediaries, the production of mango for export, therefore, it has been analyzed through this consultancy the purchase of production from third parties through intermediaries to In order to satisfy the quantity and quality needs of the mango, creating an alliance that allows the farmer to sell his product in advance and access the technological resources to produce quality mangoes and that returns profits in favor of Agropall Export SAC and the farmers. Finally, the signing of a future good contract is recommended, with the conditions that allow respecting the commitments assumed by both parties until the end of the mango campaigns, in which the conditions will be established for Agropall Export SAC to comply with the farmer and vice versa

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study

© 2023Background: The benefit of pharmacogenetic testing before starting drug therapy has been well documented for several single gene–drug combinations. However, the clinical utility of a pre-emptive genotyping strategy using a pharmacogenetic panel has not been rigorously assessed. Methods: We conducted an open-label, multicentre, controlled, cluster-randomised, crossover implementation study of a 12-gene pharmacogenetic panel in 18 hospitals, nine community health centres, and 28 community pharmacies in seven European countries (Austria, Greece, Italy, the Netherlands, Slovenia, Spain, and the UK). Patients aged 18 years or older receiving a first prescription for a drug clinically recommended in the guidelines of the Dutch Pharmacogenetics Working Group (ie, the index drug) as part of routine care were eligible for inclusion. Exclusion criteria included previous genetic testing for a gene relevant to the index drug, a planned duration of treatment of less than 7 consecutive days, and severe renal or liver insufficiency. All patients gave written informed consent before taking part in the study. Participants were genotyped for 50 germline variants in 12 genes, and those with an actionable variant (ie, a drug–gene interaction test result for which the Dutch Pharmacogenetics Working Group [DPWG] recommended a change to standard-of-care drug treatment) were treated according to DPWG recommendations. Patients in the control group received standard treatment. To prepare clinicians for pre-emptive pharmacogenetic testing, local teams were educated during a site-initiation visit and online educational material was made available. The primary outcome was the occurrence of clinically relevant adverse drug reactions within the 12-week follow-up period. Analyses were irrespective of patient adherence to the DPWG guidelines. The primary analysis was done using a gatekeeping analysis, in which outcomes in people with an actionable drug–gene interaction in the study group versus the control group were compared, and only if the difference was statistically significant was an analysis done that included all of the patients in the study. Outcomes were compared between the study and control groups, both for patients with an actionable drug–gene interaction test result (ie, a result for which the DPWG recommended a change to standard-of-care drug treatment) and for all patients who received at least one dose of index drug. The safety analysis included all participants who received at least one dose of a study drug. This study is registered with ClinicalTrials.gov, NCT03093818 and is closed to new participants. Findings: Between March 7, 2017, and June 30, 2020, 41 696 patients were assessed for eligibility and 6944 (51·4 % female, 48·6% male; 97·7% self-reported European, Mediterranean, or Middle Eastern ethnicity) were enrolled and assigned to receive genotype-guided drug treatment (n=3342) or standard care (n=3602). 99 patients (52 [1·6%] of the study group and 47 [1·3%] of the control group) withdrew consent after group assignment. 652 participants (367 [11·0%] in the study group and 285 [7·9%] in the control group) were lost to follow-up. In patients with an actionable test result for the index drug (n=1558), a clinically relevant adverse drug reaction occurred in 152 (21·0%) of 725 patients in the study group and 231 (27·7%) of 833 patients in the control group (odds ratio [OR] 0·70 [95% CI 0·54–0·91]; p=0·0075), whereas for all patients, the incidence was 628 (21·5%) of 2923 patients in the study group and 934 (28·6%) of 3270 patients in the control group (OR 0·70 [95% CI 0·61–0·79]; p <0·0001). Interpretation: Genotype-guided treatment using a 12-gene pharmacogenetic panel significantly reduced the incidence of clinically relevant adverse drug reactions and was feasible across diverse European health-care system organisations and settings. Large-scale implementation could help to make drug therapy increasingly safe. Funding: European Union Horizon 2020