Monocytes in coronary artery disease and atherosclerosis:where are we now?

Despite improvements in interventional and pharmacological therapy of atherosclerotic disease, it is still the leading cause of death in the developed world. Hence, there is a need for further development of effective therapeutic approaches. This requires better understanding of the molecular mechanisms and pathophysiology of the disease. Atherosclerosis has long been identified as having an inflammatory component contributing to its pathogenesis, whereas the available therapy primarily targets hyperlipidemia and prevention of thrombosis. Notwithstanding a pleotropic anti-inflammatory effect to some therapies, such as acetyl salicylic acid and the statins, none of the currently approved medicines for management of either stable or complicated atherosclerosis has inflammation as a primary target. Monocytes, as representatives of the innate immune system, play a major role in the initiation, propagation, and progression of atherosclerosis from a stable to an unstable state. Experimental data support a role of monocytes in acute coronary syndromes and in outcome post-infarction; however, limited research has been done in humans. Analysis of expression of various cell surface receptors allows characterization of the different monocyte subsets phenotypically, whereas downstream assessment of inflammatory pathways provides an insight into their activity. In this review we discuss the functional role of monocytes and their different subpopulations in atherosclerosis, acute coronary syndromes, cardiac healing, and recovery with an aim of critical evaluation of potential future therapeutic targets in atherosclerosis and its complications. We will also discuss technical difficulties of delineating different monocyte subpopulations, understanding their differentiation potential and function.

36 monocyte subpopulations counts and associations with global longitudinal strain in st-elevation myocardial infarction patients with normal ejection fraction

Introduction - Monocytes, with 3 different subsets, are implicated in the initiation and progression of the atherosclerotic plaque contributing to plaque instability and rupture. Mon1 are the “classical” monocytes with inflammatory action, whilst Mon3 are considered reparative with fibroblast deposition ability. The function of the newly described Mon2 subset is yet to be fully described. In PCI era, fewer patients have globally reduced left ventricular ejection fraction post infarction, hence the importance of studying regional wall motion abnormalities and deformation at segmental levels using longitudinal strain. Little is known of the role for the 3 monocyte subpopulations in determining global strain in ST elevation myocardial infarction patients (STEMI). Conclusion In patients with normal or mildly impaired EF post infarction, higher counts of Mon1 and Mon2 are correlated with GLS within 7 days and at 6 months of remodelling post infarction. Adverse clinical outcomes in patients with reduced convalescent GLS were predicted with Mon1 and Mon2 suggestive of an inflammatory role for the newly identified Mon2 subpopulation. These results imply an important role for monocytes in myocardial healing when assessed by subclinical ventricular function indices. Methodology - STEMI patients (n = 101, mean age 64 ± 13 years; 69% male) treated with percutaneous revascularisation were recruited within 24 h post-infarction. Peripheral blood monocyte subpopulations were enumerated and characterised using flow cytometry after staining for CD14, CD16 and CCR2. Phenotypically, monocyte subpopulations are defined as: CD14++CD16-CCR2+ (Mon1), CD14++CD16+CCR2+ (Mon2) and CD14+CD16++CCR2- (Mon3). Phagocytic activity of monocytes was measured using flow cytometry and Ecoli commercial kit. Transthoracic 2D echocardiography was performed within 7 days and at 6 months post infarct to assess global longitudinal strain (GLS) via speckle tracking. MACE was defined as recurrent acute coronary syndrome and death. Results - STEMI patients with EF ≥50% by Simpson’s biplane (n = 52) had GLS assessed. Using multivariate regression analysis higher counts of Mon1 and Mon 2 and phagocytic activity of Mon2 were significantly associated with GLS (after adjusting for age, time to hospital presentation, and peak troponin levels) (Table 1). At 6 months, the convalescent GLS remained associated with higher counts of Mon1, Mon 2. At one year follow up, using multivariate Cox regression analysis, Mon1 and Mon2 counts were an independent predictor of MACE in patients with a reduced GLS (n = 21)

Executive characteristics and going concern opinions

Auditors have come under increased scrutiny over the past several years about the growing number of client failures without a warning in the form of a going-concern modified (GCM) audit opinion. Statement on Auditing Standards No. 59 requires auditors to evaluate whether substantial doubt exists on an audit client’s ability to continue as a going concern (AICPA 1988). My dissertation consists of three essays. ^ For the three essays, I empirically investigate issues related to GCM audit opinions and executive characteristics. Specifically, I examine the impact of executive tenure and gender on the issuance of GCM audit opinions. In addition, my dissertation addresses two other unique issues. Given that the Sarbanes-Oxley Act represents an important watershed event in the history and regulation of the accounting profession, I provide evidence about auditors’ propensities to issue GCM audit opinions in the post-SOX period. Further, I also expand extant research in this area by using multiple outcomes and thus go beyond the traditional use of bankruptcy alone as a tool to evaluate auditors’ GCM opinion. ^ The results indicate that, after controlling for other financial characteristics, GCM audit opinions are significantly more likely for firms that have CFOs with short tenure and/or for firms with a female CFO or CEO. However, when examining the association between executive characteristics and two types of reporting errors, the results vary with the type of reporting error. Overall, the results provide evidence that executive characteristics are associated with auditors' reporting decisions. ^

Executive Characteristics and Going Concern Opinions

Auditors have come under increased scrutiny over the past several years about the growing number of client failures without a warning in the form of a going-concern modified (GCM) audit opinion. Statement on Auditing Standards No. 59 requires auditors to evaluate whether substantial doubt exists on an audit client’s ability to continue as a going concern (AICPA 1988). My dissertation consists of three essays. For the three essays, I empirically investigate issues related to GCM audit opinions and executive characteristics. Specifically, I examine the impact of executive tenure and gender on the issuance of GCM audit opinions. In addition, my dissertation addresses two other unique issues. Given that the Sarbanes-Oxley Act represents an important watershed event in the history and regulation of the accounting profession, I provide evidence about auditors’ propensities to issue GCM audit opinions in the post-SOX period. Further, I also expand extant research in this area by using multiple outcomes and thus go beyond the traditional use of bankruptcy alone as a tool to evaluate auditors’ GCM opinion. The results indicate that, after controlling for other financial characteristics, GCM audit opinions are significantly more likely for firms that have CFOs with short tenure and/or for firms with a female CFO or CEO. However, when examining the association between executive characteristics and two types of reporting errors, the results vary with the type of reporting error. Overall, the results provide evidence that executive characteristics are associated with auditors' reporting decisions.

Demora en la entrega de predios necesarios para la ejecución de proyectos viales concesionados

El problema de la demora en la obtención de los predios necesarios para la ejecución de los proyectos de inversión concesionados, se ha convertido en una de las principales trabas para la ejecución de las obras viales en el Perú, situación que podría generar dudas respecto a la pertinencia del modelo de Asociación Público Privada promovido por el Estado peruano. Esta situación trae consigo perjuicios para el Estado (incumplimiento de compromisos y renegociaciones contractuales), para la empresa privada (retraso en el cumplimiento de la entrega de obras y reducción de sus ingresos) y para la sociedad en general (demora de los beneficios de la nueva infraestructura y servicios públicos de buena calidad). Estas consecuencias negativas hacen relevante el estudio de este problema, desarrollándose, para ello, el concepto de Gestión Predial, el mismo que comprende tres actividades: la identificación, la valuación y la adquisición de los predios, habiéndose identificado las limitantes que enfrenta el Estado peruano en cada una de ellas, así como las propuestas de solución. Para el análisis de la problemática en la entrega de los terrenos, se tomó en cuenta el marco teórico desarrollado (instituciones, costos de transacción, información asimétrica, riesgo moral), la experiencia internacional (Chile y Colombia), el análisis de los procedimientos vigentes en el Perú (expropiaciones, tasaciones y saneamiento físico legal), así como el análisis de los dieciséis contratos de concesión de carreteras firmados a la fecha. Como resultado del estudio, se ha observado que los principales motivos de la demora están en la identificación y valuación de los predios, así como en el saneamiento físico-legal de los mismos, mientras que, en la etapa de adquisición de inmuebles, se concluye que el trato directo es el mecanismo más eficiente para obtener la propiedad de los predios afectados por obras de infraestructura pública. A pesar de ello, las soluciones provenientes del Estado han sido modificar las normas que regulan el procedimiento de expropiación, a través de la aprobación del Decreto Legislativo 1192 y trasladar la competencia para aprobar las tasaciones al Ministerio de Transportes y Comunicaciones (Ley 30264), las cuales consideramos medidas poco eficientes económicamente. La primera de ellas, porque los cambios incluidos no garantizan la reducción del tiempo necesario para la obtención de los predios y tendrían efectos negativos contra el derecho de la propiedad. Mientras que la segunda solución desaprovecha la experiencia y el conocimiento de la Dirección de Construcciones del Ministerio de Vivienda, Construcción y Saneamiento, generando una duplicidad de funciones que irroga gastos adicionales al Estado peruano, debido a que se tiene que dotar de insumos necesarios para cumplir esa tarea, a dos entidades públicas distintas. Finalmente, el presente trabajo concluye que al ser el retraso en la entrega de los terrenos un problema de carácter multidimensional, se necesitan soluciones de la misma naturaleza, a fin de garantizar la ejecución de la inversión en los plazos estipulados en los contratos y, con ello, el disfrute de los beneficios de contar con infraestructura y servicios públicos de calidad a tiempo.

Comunicación terapéutica de enfermería en el cuidado de pacientes sometidos a cateterismo cardíaco del Hospital Almanzor Aguinaga 2015

La presente investigación es de tipo cualitativo, con abordaje de estudio de caso, sustentado por Polit. Tuvo como objetivo conocer, describir y analizar la comunicación terapéutica de enfermería en el cuidado de pacientes sometidos a cateterismo cardiaco. El escenario fue el Servicio de Cardiología del Hospital Almanzor Aguinaga – Chiclayo. Para la recolección de datos se utilizó la entrevista semiestructurada a profundidad que se aplicó a las enfermeras de la Unidad de Hemodinamia y enfermeras del servicio de Cardiología para realizar la triangulación de los datos obtenidos con el fin de lograr resultados fiables. El marco teórico se sustentó en los aportes conceptuales de Imogene King, Valverde, Pepine, y Lambert. El análisis de datos fue de contenido temático de los discursos según Hernández, se tuvo en cuenta los criterios de rigor científico sustentado por Morse y los Principios de la Bioética Personalista sustentados por Sgreccia. Como resultado se han obtenido 3 categorías siendo las siguientes: La comunicación terapéutica como elemento sustancial en el cuidado de pacientes sometidos a cateterismo cardiaco, la comunicación terapéutica como estrategia efectiva en el cuidado humanizado a pacientes sometidos a cateterismo cardiaco y la comunicación terapéutica limitada por diversos factores que influyen en el cuidado a paciente sometidos a cateterismo cardiaco. Los resultados demostraron que los elementos primordiales para una comunicación terapéutica son: toque humano, empatía y respeto a la escucha activa, los cuales se debe dar entre enfermera – paciente. Las enfermeras de hemodinamia reconocen saber sobre comunicación terapéutica, sin embargo no es ejecutado por diversas limitaciones.

The impact of implementing tpr stress-free activities for encouraging participation from students of a public school in their english class

Tesis (Licenciado en Lenguas Castellana, Inglés y Francés).--Universidad de La Salle. Facultad de Ciencias de La Educación. Licenciatura en Lengua Castellana, Inglés y Francés, 2014

Project-Based learning approach to foster strategic competences of adult students at Cafam Santa Lucia School

Tesis (Licenciado en Lenguas Castellana, Inglés y Francés).--Universidad de La Salle. Facultad de Ciencias de La Educación. Licenciatura en Lengua Castellana, Inglés y Francés, 2014

La construction d'un project interculturel pour la promotion d'espaces communicatifs á travers l'etude de la réalité du Sénégal

Tesis (Licenciado en Lenguas Castellana, Inglés y Francés).--Universidad de La Salle. Facultad de Ciencias de La Educación. Licenciatura en Lengua Castellana, Inglés y Francés, 2013

Gestão de marcas e arranjos produtivos: A marca «vinho do Porto»

A gestão da marca, enquanto elemento distintivo organizacional, progressivamente, merece atenção especial no mundo dos negócios. Ativo intangível de especial significância cuja gestão profissional é essencial para a construção de sinergias com os objetivos organizacionais e implementação de estratégias de negócio. Este artigo tem como objetivo analisar características inerentes à gestão da marca “Vinho do Porto”, destacando a perspectiva da “marca-país” e relevância da gestão desta como vantagem competitiva, para o produto e país de modo geral, particularmente, num ambiente em que as externalidades positivas são estimuladas, no âmbito do arranjo produtivo. A coleta de dados baseou-se na observação – durante período de vivência em Portugal por um dos autores –, informações levantadas em Institutos relacionados ao Vinho do Porto, empresas comerciantes, e obras publicadas sobre o Vinho. A análise baseou-se em referencial relacionado à gestão de marcas, publicidade, posicionamento e clusters. Destacam-se os esforços das empresas na divulgação da marca no mercado global, Institutos envolvidos e até mesmo do governo, por se tratar de um produto não só gerador de muitos empregos diretos e indiretos, mas um efetivo instrumento de difusão da marca-país/Portugal, além fronteiras.

Aprovechamiento de algunos componentes bioactivos de pétalos como agentes antioxidantes en pulpa de pera (Variedad Triunfo de Viena)

Bogotá (Colombia): Universidad de La Salle. Facultad de Ingeniería. Programa de Ingeniería de Alimentos

Construction and demolition waste as a source of PVC for recycling

Construction and demolition waste can contain considerable amounts of polyvinyl chloride (PVC). This paper describes a study of the recycling of PVC pipes collected from such waste materials. In a sorting facility for the specific disposal of construction and demolition waste, PVC was found to represent one-third of the plastics separated by workers. Pipes were sorted carefully to preclude any possible contamination by poly(ethylene terephthalate) (PET) found in the waste. The material was ground into two distinct particle sizes (final mesh of 12.7 and 8 mm), washed, dried and recycled. The average formulation of the pipes was determined based on ash content tests and used in the fabrication of a similar compound made mainly of virgin PVC. Samples of recycled pipes and of compound based on virgin material were subjected to tensile and impact tests and provided very similar results. These results are a good indication of the application potential of the recycled material and of the fact that longer grinding to obtain finer particles is not necessarily beneficial.

Características del liderazgo femenino en la asociación nacional de mujeres campesinas, negras e indígenas de Colombia - ANMUCIC, 2013

Tesis (Trabajadora Social).-- Universidad de La Salle. Facultad de Ciencias Económicas y sociales. Programa de Trabajo Social, 2014