Estudio para la instalación de un centro de hemodiálisis en la ciudad de Lima

La enfermedad renal crónica terminal (ERCT) afecta a gran cantidad de personas en todo el mundo, y si no se recibe un tratamiento adecuado, puede llevar a la muerte. El presente artículo es un estudio para la instalación de un centro privado de hemodiálisis en la ciudad de Lima dirigido a pacientes de EsSalud, institución que atiende al 95 % de personas que sufren de esta enfermedad, pero cuya infraestructura y servicios hospitalarios no son suficientes para tratar directamente a todos sus pacientes, por lo que terceriza el 56 % del servicio. Dicho centro se llevaría a cabo a través de una licitación pública

An?lisis de la propuesta de concesi?n para el transporte p?blico de Lima : viabilidad financiera de un potencial operador

Actualmente, el transporte p?blico en la ciudad de Lima cuenta con aproximadamente 31,500 unidades, por lo que hay una sobreoferta con el consiguiente deterioro de la calidad del servicio, lo que genera caos en toda la ciudad. Adem?s hay 403 rutas activas que circulan en la provincia de Lima y 156 rutas en la Provincia Constitucional del Callao. El 80% de los viajes que se realizan en Lima utilizan el transporte p?blico, con un tiempo promedio de traslado de entre tres y cuatro horas al d?a. Estas pocas cifras reflejan una grave crisis de transporte urbano en la ciudad. Para hacer frente a esta situaci?n, la Municipalidad Metropolitana de Lima (MML) lanz? la iniciativa del Sistema Integrado de Transporte P?blico de Lima Metropolitana (SIT de Lima), de vital importancia para ordenar el tr?nsito vehicular en la ciudad. Este nuevo sistema propone operar corredores viales complementarios, corredores de integraci?n y corredores de aproximaci?n, eliminar la superposici?n de rutas y disminuir el n?mero de unidades mediante su reemplazo por buses patr?n. Tambi?n busca la formalizaci?n del sector, la reducci?n del tiempo promedio de viaje, la disminuci?n de la congesti?n vehicular, la mejora de la productividad y la disminuci?n de la contaminaci?n ambiental. En este contexto, la presente investigaci?n analiza el problema y propone una alternativa de soluci?n desde el punto de vista de los actores que intervienen en este servicio. As?, se enfoca en el an?lisis de la viabilidad t?cnico-econ?mica de una empresa que quiera participar como concesionaria en uno de los corredores complementarios bajo el esquema de concesiones de rutas dentro del SIT de Lima. Con este prop?sito, se utiliza el caso de una empresa de transporte urbano que actualmente opera con una ruta autorizada; y con fines de evaluaci?n, se consideran las condiciones propuestas por la MML. Este estudio puede servir como marco de referencia para cualquier empresa de transportes que desee formar parte del nuevo SIT de Lima. Asimismo, es de relevancia para la toma de decisiones de las actuales empresas de transporte urbano, las empresas proveedoras de buses, los agentes financieros, la MML, el MTC y la Municipalidad Provincial del Callao

Gesti?n del riesgo cambiario de las empresas emisoras de bonos en mercados internacionales, 2005-2015

En la ?ltima d?cada, el mayor crecimiento econ?mico de Am?rica Latina, en un contexto de condiciones favorables de financiamiento externo, reflejado en la disminuci?n de las tasas globales de inter?s, ha fomentado un r?pido crecimiento en las emisiones de bonos del sector privado en los mercados internacionales. El Per? no ha sido ajeno a esta coyuntura, y, a partir del 2012, registr? saldos positivos con una participaci?n del 8% en la emisi?n de bonos dentro de la regi?n, que en el 2015 lleg? al 15%. Como contrapartida, estas empresas se vieron afectadas por su exposici?n al riesgo cambiario, pues operan negocios que reciben ingresos en soles y contraen obligaciones en d?lares. Por esta raz?n surge el concepto de gesti?n del riesgo cambiario. Una de las herramientas que permite mitigar la exposici?n a este tipo de riesgo es el empleo de instrumentos financieros derivados de cobertura. Si bien su uso a?n es muy limitado y se negocian en mercados over the counter (OTC), estos instrumentos aseguran un flujo futuro porque permiten pactar un tipo de cambio a la firma del contrato. El presente estudio busca realizar un an?lisis profundo del impacto de los resultados financieros en casos significativos de empresas peruanas seleccionadas, como resultado de la volatilidad en el tipo cambio durante el periodo 2005-2015. Tambi?n pretende evaluar la gesti?n del riesgo cambiario de estas operaciones, cuyas consecuencias no han sido favorables para varias empresas emisoras. Finalmente, mediante una simulaci?n financiera, se presentan propuestas de mejora en el uso de instrumentos derivados de cobertura

Índice de progreso social del distrito de Lince

Los indicadores económicos, como el producto bruto interno (PBI), por sí solos, no miden el progreso social de la población. Es por ello que surgió el Índice de Progreso Social (IPS) como herramienta holística e integral que nos proporciona una medida de forma independiente a los indicadores económicos y el cual fue creado con la finalidad de apoyar las acciones de mejora del progreso social enfocada a satisfacer las necesidades básicas humanas, de establecer elementos fundamentales para la mejora del bienestar de las personas, y de crear las oportunidades para que los ciudadanos puedan lograr su desarrollo tanto personal como profesional. El IPS tiene tres dimensiones: Necesidades Humanas Básicas, Fundamentos del Bienestar y Oportunidades, donde cada una de ellas está conformada por cuatro componentes. Asimismo, la metodología del IPS abarca los principios de: a) indicadores exclusivamente sociales y ambientales, b) se enfoca en resultados y no en esfuerzos, c) es holístico y relevante para todos los países y d) es una herramienta aplicable que ayuda a los líderes de sociedad a implementar políticas para el progreso social. El propósito de la investigación es calcular el nivel de progreso social del distrito de Lince, departamento de Lima de acuerdo a la metodología implementada por la organización no gubernamental Social Progress Imperative y adaptada, a nivel distrital por CENTRUM Católica. El resultado de la presente investigación de enfoque cuantitativo y diseño no experimental ubica al distrito de Lince en un nivel medio bajo con un puntaje de 61.74 en una escala del 0 al 100, y a nivel de dimensiones obtuvo los siguientes resultados: en Necesidades Humanas Básicas obtuvo 70.24 puntos, en Fundamentos del Bienestar obtuvo 58.94 puntos y en Oportunidades obtuvo un puntaje de 56.03 puntos. La muestra estuvo conformada por 414 hogares y la recolección de datos se realizó a través de encuestas como fuente primaria, así como de fuentes secundarias provenientes de instituciones públicas. Esta medición permitirá a las autoridades del distrito conocer y comparar el progreso social del distrito de Lince y tomar las medidas necesarias a fin de supervisar y mejorar el progreso social, e implementar políticas públicas que ayuden al desarrollo social y medioambiental de sus habitantes. Asimismo, se pretende incentivar a la gestión municipal del distrito de Lince en continuar periódicamente con el cálculo de este indicador y así observar su evolución y el impacto logrado producto de las decisiones por parte de sus autoridades.Economic indicators, such as GDP, by themselves, do not measure the social progress of the citizens. The Social Progress Index (SPI) provides us an independent measure of economic indicators. That is why the Social Progress Index (SPI) emerged as a holistic and comprehensive tool that provides us with a measure independent of the economic indicators and which was created with the purpose of supporting actions to improve social progress of a society focused on satisfying the basic human needs, to establish fundamental elements for the improvement of people´s welfare, and to create opportunities for citizens to achieve their personal and professional development. The IPS has three dimensions: basic human needs, welfare fundamentals and opportunities, where each of them is made up of four components. Likewise, the IPS methodology covers the principles of a) exclusively social and environmental indicators, b) it focuses on results and not on efforts, c) it is holistic and relevant for all countries and d) it is an applicable tool that helps society leaders to implement policies for social progress. The purpose of the research is to calculate the level of social progress of the district of Lince, Lima, according to the methodology implemented by the nongovernmental organization Social Progress Imperative and adapted, at district level by CENTRUM Católica. The result of the present investigation of quantitative approach and non-experimental design locates the district of Lince in a middle-low level with a score of 61.74 on a scale from 0 to 100, and at the level of dimensions obtained the following results: in Basic Human Needs obtained 70.24 points, in Foundations of Wellbeing obtained 58.94 points and in Opportunities obtained a score of 56.03 points. The sample consisted of 414 homes and data collection was carried out through surveys as a primary source, as well as secondary sources from public institutions. This measurement will allow the district authorities to know and compare the social progress of the district of Lince and take the necessary measures to monitor and improve social progress and implement public policies that help the social and environmental development of its citizens. Likewise, it is intended to encourage the municipal management of the Lince district to periodically continue with the calculation of this indicator and thus observe its evolution and the impact achieved as a result of decisions by its authorities.Tesi

Common non-synonymous SNPs associated with breast cancer susceptibility: findings from the Breast Cancer Association Consortium.

Candidate variant association studies have been largely unsuccessful in identifying common breast cancer susceptibility variants, although most studies have been underpowered to detect associations of a realistic magnitude. We assessed 41 common non-synonymous single-nucleotide polymorphisms (nsSNPs) for which evidence of association with breast cancer risk had been previously reported. Case-control data were combined from 38 studies of white European women (46 450 cases and 42 600 controls) and analyzed using unconditional logistic regression. Strong evidence of association was observed for three nsSNPs: ATXN7-K264R at 3p21 [rs1053338, per allele OR = 1.07, 95% confidence interval (CI) = 1.04-1.10, P = 2.9 × 10(-6)], AKAP9-M463I at 7q21 (rs6964587, OR = 1.05, 95% CI = 1.03-1.07, P = 1.7 × 10(-6)) and NEK10-L513S at 3p24 (rs10510592, OR = 1.10, 95% CI = 1.07-1.12, P = 5.1 × 10(-17)). The first two associations reached genome-wide statistical significance in a combined analysis of available data, including independent data from nine genome-wide association studies (GWASs): for ATXN7-K264R, OR = 1.07 (95% CI = 1.05-1.10, P = 1.0 × 10(-8)); for AKAP9-M463I, OR = 1.05 (95% CI = 1.04-1.07, P = 2.0 × 10(-10)). Further analysis of other common variants in these two regions suggested that intronic SNPs nearby are more strongly associated with disease risk. We have thus identified a novel susceptibility locus at 3p21, and confirmed previous suggestive evidence that rs6964587 at 7q21 is associated with risk. The third locus, rs10510592, is located in an established breast cancer susceptibility region; the association was substantially attenuated after adjustment for the known GWAS hit. Thus, each of the associated nsSNPs is likely to be a marker for another, non-coding, variant causally related to breast cancer risk. Further fine-mapping and functional studies are required to identify the underlying risk-modifying variants and the genes through which they act.BCAC is funded by Cancer Research UK (C1287/A10118, C1287/A12014) and by the European Community’s Seventh Framework Programme under grant agreement n8 223175 (HEALTH-F2–2009-223175) (COGS). Meetings of the BCAC have been funded by the European Union COST programme (BM0606). Genotyping of the iCOGS array was funded by the European Union (HEALTH-F2-2009-223175), Cancer Research UK (C1287/A10710), the Canadian Institutes of Health Research for the ‘CIHR Team in Familial Risks of Breast Cancer’ program and the Ministry of Economic Development, Innovation and Export Trade of Quebec (PSR-SIIRI-701). Additional support for the iCOGS infrastructure was provided by the National Institutes of Health (CA128978) and Post-Cancer GWAS initiative (1U19 CA148537, 1U19 CA148065 and 1U19 CA148112—the GAME-ON initiative), the Department of Defence (W81XWH-10-1-0341), Komen Foundation for the Cure, the Breast Cancer Research Foundation, and the Ovarian Cancer Research Fund. The ABCFS and OFBCR work was supported by grant UM1 CA164920 from the National Cancer Institute (USA). The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast Cancer Family Registry (BCFR), nor does mention of trade names, commercial products or organizations imply endorsement t by the US Government or the BCFR. The ABCFS was also supported by the National Health and Medical Research Council of Australia, the New South Wales Cancer Council, the Victorian Health Promotion Foundation (Australia) and the Victorian Breast Cancer Research Consortium. J.L.H. is a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellow and M.C.S. is a NHMRC Senior Research Fellow. The OFBCR work was also supported by the Canadian Institutes of Health Research ‘CIHR Team in Familial Risks of Breast Cancer’ program. The ABCS was funded by the Dutch Cancer Society Grant no. NKI2007-3839 and NKI2009-4363. The ACP study is funded by the Breast Cancer Research Trust, UK. The work of the BBCC was partly funded by ELAN-Programme of the University Hospital of Erlangen. The BBCS is funded by Cancer Research UK and Breakthrough Breast Cancer and acknowledges NHS funding to the NIHR Biomedical Research Centre, and the National Cancer Research Network (NCRN). E.S. is supported by NIHR Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust in partnership with King’s College London, UK. Core funding to the Wellcome Trust Centre for Human Genetics was provided by the Wellcome Trust (090532/Z/09/Z). I.T. is supported by the Oxford Biomedical Research Centre. The BSUCH study was supported by the Dietmar-Hopp Foundation, the Helmholtz Society and the German Cancer Research Center (DKFZ). The CECILE study was funded by the Fondation de France, the French National Institute of Cancer (INCa), The National League against Cancer, the National Agency for Environmental l and Occupational Health and Food Safety (ANSES), the National Agency for Research (ANR), and the Association for Research against Cancer (ARC). The CGPS was supported by the Chief Physician Johan Boserup and Lise Boserup Fund, the Danish Medical Research Council and Herlev Hospital.The CNIO-BCS was supported by the Genome Spain Foundation the Red Temática de Investigación Cooperativa en Cáncer and grants from the Asociación Española Contra el Cáncer and the Fondo de Investigación Sanitario PI11/00923 and PI081120). The Human Genotyping-CEGEN Unit, CNIO is supported by the Instituto de Salud Carlos III. D.A. was supported by a Fellowship from the Michael Manzella Foundation (MMF) and was a participant in the CNIO Summer Training Program. The CTS was initially supported by the California Breast Cancer Act of 1993 and the California Breast Cancer Research Fund (contract 97-10500) and is currently funded through the National Institutes of Health (R01 CA77398). Collection of cancer incidence e data was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885. HAC receives support from the Lon V Smith Foundation (LVS39420). The ESTHER study was supported by a grant from the Baden Württemberg Ministry of Science, Research and Arts. Additional cases were recruited in the context of the VERDI study, which was supported by a grant from the German Cancer Aid (Deutsche Krebshilfe). The GENICA was funded by the Federal Ministry of Education and Research (BMBF) Germany grants 01KW9975/5, 01KW9976/8, 01KW9977/0 and 01KW0114, the Robert Bosch Foundation, Stuttgart, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), as well as the Department of Internal Medicine , Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus Bonn, Germany. The HEBCS was supported by the Helsinki University Central Hospital Research Fund, Academy of Finland (132473), the Finnish Cancer Society, The Nordic Cancer Union and the Sigrid Juselius Foundation. The HERPACC was supported by a Grant-in-Aid for Scientific Research on Priority Areas from the Ministry of Education, Science, Sports, Culture and Technology of Japan, by a Grant-in-Aid for the Third Term Comprehensive 10-Year strategy for Cancer Control from Ministry Health, Labour and Welfare of Japan, by a research grant from Takeda Science Foundation , by Health and Labour Sciences Research Grants for Research on Applying Health Technology from Ministry Health, Labour and Welfare of Japan and by National Cancer Center Research and Development Fund. The HMBCS was supported by short-term fellowships from the German Academic Exchange Program (to N.B), and the Friends of Hannover Medical School (to N.B.). Financial support for KARBAC was provided through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, the Stockholm Cancer Foundation and the Swedish Cancer Society. The KBCP was financially supported by the special Government Funding (EVO) of Kuopio University Hospital grants, Cancer Fund of North Savo, the Finnish Cancer Organizations, the Academy of Finland and by the strategic funding of the University of Eastern Finland. kConFab is supported by grants from the National Breast Cancer Foundation , the NHMRC, the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia and the Cancer Foundation of Western Australia. The kConFab Clinical Follow Up Study was funded by the NHMRC (145684, 288704, 454508). Financial support for the AOCS was provided by the United States Army Medical Research and Materiel Command (DAMD17-01-1-0729), the Cancer Council of Tasmania and Cancer Foundation of Western Australia and the NHMRC (199600). G.C.T. and P.W. are supported by the NHMRC. LAABC is supported by grants (1RB-0287, 3PB-0102, 5PB-0018 and 10PB-0098) from the California Breast Cancer Research Program. Incident breast cancer cases were collected by the USC Cancer Surveillance Program (CSP) which is supported under subcontract by the California Department of Health. The CSP is also part of the National Cancer Institute’s Division of Cancer Prevention and Control Surveillance, Epidemiology, and End Results Program, under contract number N01CN25403. LMBC is supported by the ‘Stichting tegen Kanker’ (232-2008 and 196-2010). The MARIE study was supported by the Deutsche Krebshilfe e.V. (70-2892-BR I), the Federal Ministry of Education Research (BMBF) Germany (01KH0402), the Hamburg Cancer Society and the German Cancer Research Center (DKFZ). MBCSG is supported by grants from the Italian Association ciation for Cancer Research (AIRC) and by funds from the Italian citizens who allocated a 5/1000 share of their tax payment in support of the Fondazione IRCCS Istituto Nazionale Tumori, according to Italian laws (INT-Institutional strategic projects ‘5 × 1000’). The MCBCS was supported by the NIH grants (CA122340, CA128978) and a Specialized Program of Research Excellence (SPORE) in Breast Cancer (CA116201), the Breast Cancer Research Foundation and a generous gift from the David F. and Margaret T. Grohne Family Foundation and the Ting Tsung and Wei Fong Chao Foundation. MCCS cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further supported by Australian NHMRC grants 209057, 251553 and 504711 and by infrastructure provided by Cancer Council Victoria. The MEC was supported by NIH grants CA63464, CA54281, CA098758 and CA132839. The work of MTLGEBCS was supported by the Quebec Breast Cancer Foundation, the Canadian Institutes of Health Research (grant CRN-87521) and the Ministry of Economic Development, Innovation and Export Trade (grant PSR-SIIRI-701). MYBRCA is funded by research grants from the Malaysian Ministry of Science, Technology and Innovation (MOSTI), Malaysian Ministry of Higher Education (UM.C/HlR/MOHE/06) and Cancer Research Initiatives Foundation (CARIF). Additional controls were recruited by the Singapore Eye Research Institute, which was supported by a grant from the Biomedical Research Council (BMRC08/1/35/19,tel:08/1/35/19./550), Singapore and the National medical Research Council, Singapore (NMRC/CG/SERI/2010). The NBCS was supported by grants from the Norwegian Research council (155218/V40, 175240/S10 to A.L.B.D., FUGE-NFR 181600/ V11 to V.N.K. and a Swizz Bridge Award to A.L.B.D.). The NBHS was supported by NIH grant R01CA100374. Biological sample preparation was conducted the Survey and Biospecimen Shared Resource, which is supported by P30 CA68485. The OBCS was supported by research grants from the Finnish Cancer Foundation, the Sigrid Juselius Foundation, the Academy of Finland, the University of Oulu, and the Oulu University Hospital. The ORIGO study was supported by the Dutch Cancer Society (RUL 1997-1505) and the Biobanking and Biomolecular Resources Research Infrastructure (BBMRI-NLCP16). The PBCS was funded by Intramural Research Funds of the National Cancer Institute, Department of Health and Human Services, USA. pKARMA is a combination of the KARMA and LIBRO-1 studies. KARMA was supported by Ma¨rit and Hans Rausings Initiative Against Breast Cancer. KARMA and LIBRO-1 were supported the Cancer Risk Prediction Center (CRisP; www.crispcenter.org), a Linnaeus Centre (Contract ID 70867902) financed by the Swedish Research Council. The RBCS was funded by the Dutch Cancer Society (DDHK 2004-3124, DDHK 2009-4318). SASBAC was supported by funding from the Agency for Science, Technology and Research of Singapore (A∗STAR), the US National Institute of Health (NIH) and the Susan G. Komen Breast Cancer Foundation KC was financed by the Swedish Cancer Society (5128-B07-01PAF). The SBCGS was supported primarily by NIH grants R01CA64277, R01CA148667, and R37CA70867. Biological sample preparation was conducted the Survey and Biospecimen Shared Resource, which is supported by P30 CA68485. The SBCS was supported by Yorkshire Cancer Research S305PA, S299 and S295. Funding for the SCCS was provided by NIH grant R01 CA092447. The Arkansas Central Cancer Registry is fully funded by a grant from National Program of Cancer Registries, Centers for Disease Control and Prevention (CDC). Data on SCCS cancer cases from Mississippi were collected by the Mississippi Cancer Registry which participates in the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the Mississippi Cancer Registry. SEARCH is funded by a programme grant from Cancer Research UK (C490/A10124) and supported by the UK National Institute for Health Research Biomedical Research Centre at the University of Cambridge. The SEBCS was supported by the BRL (Basic Research Laboratory) program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2012-0000347). SGBCC is funded by the National Medical Research Council Start-up Grant and Centre Grant (NMRC/CG/NCIS /2010). The recruitment of controls by the Singapore Consortium of Cohort Studies-Multi-ethnic cohort (SCCS-MEC) was funded by the Biomedical Research Council (grant number: 05/1/21/19/425). SKKDKFZS is supported by the DKFZ. The SZBCS was supported by Grant PBZ_KBN_122/P05/2004. K. J. is a fellow of International PhD program, Postgraduate School of Molecular Medicine, Warsaw Medical University, supported by the Polish Foundation of Science. The TNBCC was supported by the NIH grant (CA128978), the Breast Cancer Research Foundation , Komen Foundation for the Cure, the Ohio State University Comprehensive Cancer Center, the Stefanie Spielman Fund for Breast Cancer Research and a generous gift from the David F. and Margaret T. Grohne Family Foundation and the Ting Tsung and Wei Fong Chao Foundation. Part of the TNBCC (DEMOKRITOS) has been co-financed by the European Union (European Social Fund – ESF) and Greek National Funds through the Operational Program ‘Education and Life-long Learning’ of the National Strategic Reference Framework (NSRF)—Research Funding Program of the General Secretariat for Research & Technology: ARISTEIA. The TWBCS is supported by the Institute of Biomedical Sciences, Academia Sinica and the National Science Council, Taiwan. The UKBGS is funded by Breakthrough Breast Cancer and the Institute of Cancer Research (ICR). ICR acknowledges NHS funding to the NIHR Biomedical Research Centre. Funding to pay the Open Access publication charges for this article was provided by the Wellcome Trust.This is the advanced access published version distributed under a Creative Commons Attribution License 2.0, which can also be viewed on the publisher's webstie at: http://hmg.oxfordjournals.org/content/early/2014/07/04/hmg.ddu311.full.pdf+htm

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Estudio para la instalación de un centro de hemodiálisis en la ciudad de Lima

La enfermedad renal crónica terminal (ERCT) afecta a gran cantidad de personas en todo el mundo, y si no se recibe un tratamiento adecuado, puede llevar a la muerte. El presente artículo es un estudio para la instalación de un centro privado de hemodiálisis en la ciudad de Lima dirigido a pacientes de EsSalud, institución que atiende al 95 % de personas que sufren de esta enfermedad, pero cuya infraestructura y servicios hospitalarios no son suficientes para tratar directamente a todos sus pacientes, por lo que terceriza el 56 % del servicio. Dicho centro se llevaría a cabo a través de una licitación pública.Terminal Chronic Kidney Disease (TCKD) is a disease that affects a large number of people around the world and, if not received proper treatment, can lead to death. This article has as main objective the installation of a private Hemodialysis center in Lima targeting patients from EsSalud, serving 95% of people suffering from this disease, but whose infrastructure and hospital services are not sufficient to meet directly to all their patients, so that 56% of the service is outsourced. This will be done through a public tender

Análisis de la propuesta de concesión para el transporte público de Lima : viabilidad financiera de un potencial operador

Actualmente, el transporte público en la ciudad de Lima cuenta con aproximadamente 31,500 unidades, por lo que hay una sobreoferta con el consiguiente deterioro de la calidad del servicio, lo que genera caos en toda la ciudad. Además hay 403 rutas activas que circulan en la provincia de Lima y 156 rutas en la Provincia Constitucional del Callao. El 80% de los viajes que se realizan en Lima utilizan el transporte público, con un tiempo promedio de traslado de entre tres y cuatro horas al día. Estas pocas cifras reflejan una grave crisis de transporte urbano en la ciudad. Para hacer frente a esta situación, la Municipalidad Metropolitana de Lima (MML) lanzó la iniciativa del Sistema Integrado de Transporte Público de Lima Metropolitana (SIT de Lima), de vital importancia para ordenar el tránsito vehicular en la ciudad. Este nuevo sistema propone operar corredores viales complementarios, corredores de integración y corredores de aproximación, eliminar la superposición de rutas y disminuir el número de unidades mediante su reemplazo por buses patrón. También busca la formalización del sector, la reducción del tiempo promedio de viaje, la disminución de la congestión vehicular, la mejora de la productividad y la disminución de la contaminación ambiental. En este contexto, la presente investigación analiza el problema y propone una alternativa de solución desde el punto de vista de los actores que intervienen en este servicio. Así, se enfoca en el análisis de la viabilidad técnico-económica de una empresa que quiera participar como concesionaria en uno de los corredores complementarios bajo el esquema de concesiones de rutas dentro del SIT de Lima. Con este propósito, se utiliza el caso de una empresa de transporte urbano que actualmente opera con una ruta autorizada; y con fines de evaluación, se consideran las condiciones propuestas por la MML. Este estudio puede servir como marco de referencia para cualquier empresa de transportes que desee formar parte del nuevo SIT de Lima. Asimismo, es de relevancia para la toma de decisiones de las actuales empresas de transporte urbano, las empresas proveedoras de buses, los agentes financieros, la MML, el MTC y la Municipalidad Provincial del Callao

Utilización de limas manuales luego de la preparación de conductos simulados con los sistemas ProFile y ProTaper The use of hand files after rotary preparation with ProFile and ProTaper in artificial root canals

Resumen Objetivo: Este estudio realizado in vitro evaluó el patrón de desgaste producido por las limas manuales tipo K Nitiflex #35 y #40 utilizadas como complemento en la porción apical de los conductos curvos simulados en bloques de resina acrílica preparados con los sistemas ProTaper y ProFile. Materiales y métodos: Se evaluó el área en mm2 de material removido durante la preparación quirúrgica de 30 conductos artificiales fabricados en resina poliéster y estandarizados en base a longitud, radio y ángulo de la curvatura. Se designaron 3 etapas de evaluación que correspondían a los diámetros apicales de preparación propuestos por los fabricantes y al de las limas manuales Nitiflex #35 y #40. Imágenes pre y postoperatorias de cada etapa fueron digitalizadas utilizando un Scanner y el software Adobe Photoshop 7.0. Las imágenes fueron analizadas en el programa Image Tool (UTHSCSA) para determinar el área en mm2 de material removido durante la preparación en 3 niveles específicos: ensanchamiento total del conducto, zona apical interna y zona apical externa. Resultados: Se encontró que los instrumentos de NiTi rotatorios fueron el factor más significativo para determinar la cantidad de área desgastada en todos los niveles evaluados. Aumentar el diámetro apical hasta la etapa correspondiente a la lima manual de #35 en los sistemas ProTaper y ProFile no aumentó significativamente el área de desgaste en la totalidad del conducto. Los sistemas de preparación rotatoria evaluados produjeron un menor desgaste a nivel de la zona apical externa en comparación con la técnica totalmente manual. Conclusiones: La utilización complementaria de la lima de níquel titanio tipo K manual #35 mostró aumentar el diámetro apical sin alterar significativamente el patrón de desgaste original del conducto simulado instrumentado con los sistemas rotatorios ProFile y ProTaper. Mientras que el uso de una lima tipo K manual #40 produjo un aumento significativo en él. Palabras clave: preparación biomecánica, diámetro apical, instrumentación rotatoria. Abstract Objective: This in vitro study evaluated the wear pattern produced by K-type hand files Nitiflex #35 and #40 used as complement in the apical portion of the simulated curved canals in acrylic resin blocks prepared with ProTaper and ProFile systems. Materials and methods: The area in mm 2 of material removed during the surgical preparation of 30 artificial canals made in polyester resin and standardized according to the length and angle of curvature was assessed. Three designated evaluation stages that corresponded to the apical preparation diameters suggested by manufacturers and to #35 and #40 Nitiflex files were established. Pre and post-operative images of each stage were digitalized using a scanner and the Adobe Photoshop software. The images were analyzed using the Image Tool software (UTHSCSA) to determine the area in mm2 of material removed during preparation in 3 specific levels: total widening of the canal, external apical area and internal apical area. Results: Rotary NiTi instruments were the most significant factor in determining the amount of removed material at all the tested levels. Increasing the apical diameter to the stage corresponding to the manual file #35 mm in both ProTaper and ProFile systems did not increase significantly the area of the artificial canal. The rotary preparation systems preserved more material at the external apical area in comparison to the manual technique. Conclusions: The complementary use of a manual K-type file #35 showed an increase in the apical diameter without significantly altering the wear pattern of the original simulated canal whereas the use of K-type manual file #40 increased significantly the wear pattern of the original simulated canal. Key words: biomechanical preparation, apical diameter, rotary instrumentation