Plan de negocio para la viabilidad comercial, operativa y econ?mica en la implementaci?n de un gimnasio para bebes de 4 meses a ni?os de 5 a?os, en Lima Norte

La obesidad en los ni?os representa un problema a largo plazo, afectando su salud al incrementarse el riesgo de padecer enfermedades cardiovasculares o diabetes; se recomienda desde la etapa infantil, una correcta alimentaci?n y una actividad f?sica frecuente, desarrollando h?bitos saludables. En ese sentido, la siguiente propuesta es un plan de negocio para implementar un gimnasio para bebes de 4 meses a 5 a?os en Lima Norte, considerando la importante tasa de crecimiento en este sector de la poblaci?n, determinando como mercado objetivo madres de los NSE B y C, de los distritos de Comas, San Mart?n de Porres, Los Olivos e Independencia. Del estudio de mercado se ha identificado una demanda potencial de servicios que contribuyan al desarrollo infantil y no se conocen gimnasios para ni?os menores de 5 a?os. La propuesta de valor del gimnasio Baby Gym es ofrecer el servicio de gimnasio para a trav?s de un ambiente l?dico se fortalezcan habilidades al propio ritmo de cada ni?o. Con una inversi?n inicial estimada de S/. 164,100.00 y un periodo de an?lisis de 10 a?os, se obtiene un VAN = S/. 96,977 y TIR de 29.3% respectivamente, con lo cual, el an?lisis financiero concluye que el negocio es viable

Relationship Between Quorum Sensing and Secretion Systems

Quorum sensing (QS) is a communication mechanism between bacteria that allows specific processes to be controlled, such as biofilm formation, virulence factor expression, production of secondary metabolites and stress adaptation mechanisms such as bacterial competition systems including secretion systems (SS). These SS have an important role in bacterial communication. SS are ubiquitous; they are present in both Gram-negative and Gram-positive bacteria and in Mycobacterium sp. To date, 8 types of SS have been described (T1SS, T2SS, T3SS, T4SS, T5SS, T6SS, T7SS, and T9SS). They have global functions such as the transport of proteases, lipases, adhesins, heme-binding proteins, and amidases, and specific functions such as the synthesis of proteins in host cells, adaptation to the environment, the secretion of effectors to establish an infectious niche, transfer, absorption and release of DNA, translocation of effector proteins or DNA and autotransporter secretion. All of these functions can contribute to virulence and pathogenesis. In this review, we describe the known types of SS and discuss the ones that have been shown to be regulated by QS. Due to the large amount of information about this topic in some pathogens, we focus mainly on Pseudomonas aeruginosa and Vibrio spp

LipoDDx: a mobile application for identification of rare lipodystrophy syndromes

BACKGROUND: Lipodystrophy syndromes are a group of disorders characterized by a loss of adipose tissue once other situations of nutritional deprivation or exacerbated catabolism have been ruled out. With the exception of the HIV-associated lipodystrophy, they have a very low prevalence, which together with their large phenotypic heterogeneity makes their identification difficult, even for endocrinologists and pediatricians. This leads to significant delays in diagnosis or even to misdiagnosis. Our group has developed an algorithm that identifies the more than 40 rare lipodystrophy subtypes described to date. This algorithm has been implemented in a free mobile application, LipoDDx(R). Our aim was to establish the effectiveness of LipoDDx(R). Forty clinical records of patients with a diagnosis of certainty of most lipodystrophy subtypes were analyzed, including subjects without lipodystrophy. The medical records, blinded for diagnosis, were evaluated by 13 physicians, 1 biochemist and 1 dentist. Each evaluator first gave his/her results based on his/her own criteria. Then, a second diagnosis was given using LipoDDx(R). The results were analysed based on a score table according to the complexity of each case and the prevalence of the disease. RESULTS: LipoDDx(R) provides a user-friendly environment, based on usually dichotomous questions or choice of clinical signs from drop-down menus. The final result provided by this app for a particular case can be a low/high probability of suffering a particular lipodystrophy subtype. Without using LipoDDx(R) the success rate was 17 +/- 20%, while with LipoDDx(R) the success rate was 79 +/- 20% (p < 0.01). CONCLUSIONS: LipoDDx(R) is a free app that enables the identification of subtypes of rare lipodystrophies, which in this small cohort has around 80% effectiveness, which will be of help to doctors who are not experts in this field. However, it will be necessary to analyze more cases in order to obtain a more accurate efficiency value

Programa Gallego de Atenci?n al Infarto Agudo de Miocardio. Protocolo de actuaci?n para pacientes con s?ndrome coronario agudo con elevaci?n del segmento ST en Galicia

A enfermidade coronaria sup?n un importante problema de sa?de p?blica debido ? s?a incidencia crecente e a que constit?e a principal causa de morte no mundo. no ?mbito da Comunidade Aut?noma de Galicia, p?xose en marcha en maio de 2005 o Programa Galego de Atenci?n ao Infarto Agudo de Miocardio (PROGALIAM). Este programa foi un dos primeiros en implantarse en Espa?a (s? por detr?s dos de Murcia e Navarra). Debido ao tempo transcorrido, viuse necesario adaptar o Progaliam do ano 2005 ?s novas e actuais evidencias, e ?s actuais recomendaci?ns das Gu?as de Pr?ctica Cl?nica. ? por iso, que na Direcci?n Xeral de Asistencia Sanitaria, constitu?use un grupo de traballo formado por cardi?logos intervencionistas das 7 ?reas sanitarias, as? como profesionais m?dicos de Atenci?n Primaria e Urxencias.La enfermedad coronaria supone un importante problema de salud p?blica debido a su incidente creciente y la que constituye la principal causa de muerte en el mundo. en el ?mbito de la Comunidad Aut?noma de Galicia, se puso en marcha en mayo de 2005 el Programa Gallego de Atenci?n al Infarto Agudo de Miocardio (PROGALIAM). Este programa fue uno de los primeros en implantarse en Espa?a (solo por detr?s de los de Murcia y Navarra). Debido al tiempo transcurrido, se vio necesario adaptar el Progaliam del a?o 2005 a las noticias y actuales evidencias, y a las actuales recomendaciones de las Gu?as de Pr?ctica Cl?nica. Es por eso, que en la Direcci?n General de Asistencia Sanitaria, se constituy? un grupo de trabajo formado por cardi?logos intervencionistas de las 7 ?reas sanitarias, as? como profesionales m?dicos de Atenci?n Primaria y Urgencias

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Elliptic flow of charged particles in Pb-Pb collisions at 2.76 TeV

We report the first measurement of charged particle elliptic flow in Pb-Pb collisions at 2.76 TeV with the ALICE detector at the CERN Large Hadron Collider. The measurement is performed in the central pseudorapidity region (|$\eta$|<0.8) and transverse momentum range 0.2< $p_{\rm T}$< 5.0 GeV/$c$. The elliptic flow signal v$_2$, measured using the 4-particle correlation method, averaged over transverse momentum and pseudorapidity is 0.087 $\pm$ 0.002 (stat) $\pm$ 0.004 (syst) in the 40-50% centrality class. The differential elliptic flow v$_2(p_{\rm T})$ reaches a maximum of 0.2 near $p_{\rm T}$ = 3 GeV/$c$. Compared to RHIC Au-Au collisions at 200 GeV, the elliptic flow increases by about 30%. Some hydrodynamic model predictions which include viscous corrections are in agreement with the observed increase.Comment: 10 pages, 4 captioned figures, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/389

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery