Optimización de distribución indirecta de la división de helados de Nestlé Perú

La presente propuesta de tesis ha sido elaborada con la finalidad de optimizar la red de distribución indirecta de la división de helados de Nestlé Perú. Se entiende por distribución indirecta o venta indirecta al flujo de producto terminado desde el almacén central de Nestlé hacia sus clientes distribuidores, ubicados en distintas ciudades del Perú. El alcance del estudio comprende los procesos de almacenaje, transporte y distribución de los helados D’Onofrio para el canal de venta indirecta. El objetivo principal de su desarrollo es la optimización de los costos logísticos relacionados con el almacenaje, el transporte y la distribución de los productos terminados, brindando el nivel de servicio deseado a los distribuidores a nivel nacional, lo cual, en conjunto, permite asegurar la continuidad de la cadena de suministro de la compañía. El desarrollo de la propuesta está basado en: el diagnóstico de la situación actual de la cadena de abastecimiento de la división de helados; la presentación de alternativas de mejora de los procesos de almacenamiento, transporte y distribución de helados; la justificación cualitativa y cuantitativa de cada proyecto planteado, y conclusiones relacionadas con la implementación del proyecto integral elegido

The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review

<p>Abstract</p> <p>Background</p> <p>Lumbar spinal stenosis (LSS) is prevalent in those over the age of 65 years and the leading cause of spinal surgery in this population. Recent systematic reviews have examined the effectiveness of conservative management for LSS, but not relative to surgical interventions. The aim of this review was to systematically examine the effectiveness of land based exercise compared with decompressive surgery in the management of patients with LSS.</p> <p>Methods</p> <p>A systematic review of randomised controlled trials and clinical trials was undertaken. The databases MEDLINE, Embase, CINAHL, PEDro and Cochrane Library Register of Controlled Trials were searched from January 2000 to June 2011. Only studies that included subjects with lumbar spinal canal stenosis were considered in this review. Studies also had to use a patient reported functional outcome measure for a land based exercise intervention or lumbar decompressive surgery.</p> <p>Results</p> <p>Only one study compared the effectiveness of exercise and decompressive surgery for LSS. Surgery demonstrated statistically significant improvements in patient reported functional outcome scores at 6, 12 and 24-months post-intervention (<it>p </it>< 0.01). To facilitate further analysis, the results from 12 exercise and 10 surgical intervention arms were compared using percentage change in patient reported functional outcome measure scores. Exercise interventions showed initial improvements, ranging from 16 to 29% above baseline. All decompressive surgical interventions demonstrated greater and sustained improvements over 2-years (range 38-67% improvement) with moderate to large effect sizes. The most commonly reported complications associated with surgery were dural tears, while details of adverse effects were lacking in exercise interventions.</p> <p>Conclusions</p> <p>This systematic review of the recent literature demonstrates that decompressive surgery is more effective than land based exercise in the management of LSS. However, given the condition's slowly progressive nature and the potential for known surgical complications, it is recommended that a trial of conservative management with land based exercise be considered prior to consideration of surgical intervention.</p

Revisiting Photovoice: Perceptions of Dementia among Researchers with Intellectual Disability

There is limited evidence internationally exploring perceptions of dementia among people with intellectual disabilities. This article presents findings from the first known study where an inclusive research team, including members with intellectual disability, used photovoice methodology to visually represent views of people with intellectual disabilities and dementia. Drawing on Freire’s empowerment pedagogy, study aims were consistent with global photovoice aims: enabling people to visually record critical dialogue about dementia through photography and social change. We investigated the benefits and challenges of photovoice methodology with this population and sought to identify perspectives of dementia from people with intellectual disabilities. Findings challenge the notion that a key photovoice aim of reaching policymakers is always achievable, suggesting that revisiting Freire’s original methodological aims may lead to improved outcomes in co-produced research with marginalized groups. Qualitative themes emerged identifying issues such as peers ‘disappearing’ and the importance of maintaining friendship as dementia progressed

Determinación de la huella de carbono de la facultad de recursos naturales de la ESPOCH al año 2019.

La presente investigación tuvo como objetivo determinar la Huella de Carbono al año 2019 generada por la Facultad de Recursos Naturales de la ESPOCH a través de la metodología de la Norma ISO 14604:1 para proponer estrategias de mitigación y neutralización de carbono para minimizar los impactos ambientales de la organización. Para ello, se realizó un inventario de emisiones de gases de efecto invernadero (GEI), donde se estipularon los límites de la organización, los límites de informe y posteriormente se identificó las fuentes de emisiones de GEI y se categorizaron las emisiones en: emisiones directas de combustión móvil, emisiones indirectas por electricidad importada, emisiones indirectas causadas por el transporte y emisiones indirectas provenientes de la disposición de residuos sólidos. Posteriormente, para la cuantificación de emisiones se utilizó las ecuaciones propuestas por la Norma ISO 14064:2018 y se consideró los factores de emisión propuestos por el Grupo Intergubernamental de Expertos sobre el Cambio Climático (IPCC), a excepción del factor de emisión para la electricidad importada, pues se utilizó el dato proporcionado el Sistema Nacional Interconectado (SNI). Los resultados apuntaron qué, la Facultad de Recursos Naturales en sus operaciones generó un total de 456,79 toneladas de carbono equivalente, de esto, un 54% corresponde a emisiones provenientes del parque automotor, el 21% corresponde a la combustión móvil generadas por la quema de combustibles en el uso de maquinaria agrícola, seguidamente, el 18% corresponde a emisiones por la electricidad importada y el 7% restante corresponde a emisiones generadas por la gestión de residuos. Se recomienda continuar con la determinación de la Huella de Carbono para el resto de Facultades de la ESPOCH para así obtener un indicador global para toda la institución.The objective of this investigation was to determine the Carbon Footprint for the year 2019 generated by the Faculty of Natural Resources of ESPOCH through the methodology ISO 14604:1 Standard to propose mitigation and carbon neutralization strategies to minimize environmental impacts of the organization. For this, an inventory of greenhouse gas (GHG) emissions was carried out, where the limits of the organization, the reporting limits were stipulated and later the sources of GHG emissions were identified and the emissions were categorized into: direct emissions mobile combustion, indirect emissions from imported electricity, indirect emissions caused by transportation, and indirect emissions from solid waste disposal. Subsequently, for the quantification of emissions, the equations proposed by the ISO 14064:2018 Standard were used and the emission factors proposed by the Intergovernmental Group of Experts on Climate Change (IPCC) were considered, with the exception of the emission factor for electricity imported, since the data provided by the National Interconnected System (SNI) was used. The results pointed out that, the Faculty of Natural Resources in its operations generated a total of 456.79 tons of equivalent carbon, of this, 54% corresponds to emissions from the automotive fleet, 21% corresponds to mobile combustion generated by the fuel burning in the use of agricultural machinery, then 18% corresponds to emissions from imported electricity and the remaining 7% corresponds to emissions generated by waste management. It is recommended to continue with the determination of the Carbon Footprint for the rest of the ESPOCH Faculties in order to obtain a global indicator for the entire institution

La matematización como modelo de aprendizaje de las matemáticas para mejorar el nivel de desempeño de los estudiantes de séptimo grado

El bajo índice de desempeño de los estudiantes en el área de matemáticas, preocupa preponderantemente al principal ente que regula la calidad de la educación, como lo es el Ministerio de Educación Nacional de Colombia. Es por ello que este trabajo investigativo, fundamenta sus razones en la importancia de formar estudiantes competentes en matemáticas, con sentido crítico y con habilidades lógicas, siendo estos uno de los principales retos que se debe proponer la educación en la actualidad en aras de garantizar los nuevos ciudadanos del país. Así mismo, se podrá evidenciar una transformación en el perfil del estudiante y el rol que desempeña dentro y fuera del aula de clases

FSI simulations for explosions very near reinforced concrete structures

The analysis of explosives in contact or very near to reinforced concrete (RC) structures is an important aspect in the design of protective structures and vulnerability assessments. Although this remains a topic of high importance for defence, a more widespread interest has developed as civilian structures become the targets of terrorism. This type of assessment requires a robust simulation method for coupled fluid-structural interactions (FSI) which can handle the explosive detonation, air blast propagation, structural deformation, and damage evolution. This paper describes the application of a loose-coupling method which combines the FEFLO CFD code and SAIC’s CSD code for 3D numerical simulations of unconfined and semi-confined explosions near RC structures. This approach takes advantage of the unstructured tetrahedral mesh for the CFD and an embedded method for CSD structures inside the fluid domain. Comparisons of simulations with experiment provide validation, but also reveal some weaknesses of the method. A good agreement between simulation and experiment is found with moderate explosive loading. However, a severe explosive loading with confinement results in extensive damage to the structure which is difficult to reproduce in simulations

Pnaum: Integrated Approach To Pharmaceutical Services, Science, Technology And Innovation

This paper describes the development process of the Pesquisa Nacional sobre Acesso, Utilizacao e Promocao do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines) based on an integrated approach to pharmaceutical services, science, technology and innovation. It starts by contextualizing health and development in Brazil and features elements of the National Policy for Science, Technology and Innovation in Health in Brazil and the National Policy for Pharmaceutical Services. On presenting pharmaceutical policy guidelines, it stresses the lack of nationwide data. This survey, commissioned by the Brazilian Ministry of Health, has two components: household survey and evaluation of pharmaceutical services in primary care. The findings point to perspectives that represent, besides the enhancement of public policy for pharmaceutical services and public health, results of government action aimed at developing the economic and industrial health care complex to improve the health conditions of the Brazilian population.502Department for Pharmaceutical Services and Strategic Health Supplies (DAF) of the Secretariat of Science, Technology and Strategic Inputs - SCTIE of the Brazilian Ministry of Health [25000.111834/2]Department of Science and Technology (DECIT) of the Secretariat of Science, Technology and Strategic Inputs - SCTIE of the Brazilian Ministry of Health [25000.111834/2

Sistema internacional de gestión de seguridad y salud en el trabajo y el impacto en la reducción de riesgos laborales en una empresa industrial – Trujillo, año 2022

La presente tesis, tiene como objetivo mostrar el impacto que provocó el Sistema Internacional de Gestión de Seguridad y Salud en la Reducción de Riesgos Laborales de una empresa industrial, teniendo en cuenta la coyuntura actual del COVID 19. Por ello, este estudio se desarrolló dentro de un enfoque mixto y se tiene como unidad de estudio a los trabajadores de la empresa. Además, se usó Fuentes Secundarias (Bibliografía Jurídica) y las encuestas como instrumentos de recolección y análisis de datos. Los resultados obtenidos mediante los diferentes instrumentos, reflejaron que, los trabajadores de la empresa están expuestos a diversos riesgos, los cuales no se están tratando correctamente, no capacitan al personal, no tienen manual de funciones, ni un programa de seguridad y salud y esta ausencia de medidas de seguridad ha generado daños en la salud de los trabajadores. Ante ello, se utilizó los Check List, el Mapa de Riesgos, el Plan Anual de Seguridad y Salud, un Programa y el Manual de Gestión de Seguridad y Salud, como instrumentos que ayudaron a medir los niveles de cumplimiento de la Seguridad y Salud, obteniendo como resultado un impacto favorable en la Reducción de Riesgos en una empresa industrial