"Adecuación del dimensionamiento de una tolva semiroquera de 15mc y el montaje sobre un chasis volvo FMx440 6x4 o scania P420 6x4. empresa Rmb Sateci S.A.C"

En este informe, tuvo como objetivo la adecuación dimensional de una tolva semiroquera de 15 m3 para camiones tipo volquete, buscando estandarizar una tolva en la cual pueda ser ensamblada sobre un camión de chasis Volvo o Scania, y sin afectar las condiciones del fabricante del camión (peso bruto limitado), simulando las cargas aplicables limitadas a escenarios estáticos. Los fundamentos teóricos para la realización de este informe se basó en la teoría de la mecánica de materiales, y para simular el efecto de la carga sobre la tolva semiroquera se basó en la teoría de empuje de tierras, para luego insertar los parámetros de entrada en un software de elementos finitos (Solid work). De igual manera para la realización de este informe se ha consultado a diseñadores y constructores de tolvas y bastidores para volquetes y revistas especializadas de ingeniería de equipos semipesados en la que los expertos opinan respecto a este tema. El método de cálculo se ha establecido a partir de todas estas fuentes y de otras bibliografías, y además de la propia experiencia del autor de este informe.Trabajo de suficiencia profesiona

Análisis y propuesta de implementación de herramientas Lean Logistics en los almacenes de producto terminado de una empresa láctea

Se desarrolló la consultoría de negocios en una empresa peruana dedicada a la fabricación y comercialización de alimentos, principalmente de productos lácteos importantes para la nutrición de las familias peruanas, cuenta con varios años en el mercado peruano e internacional. La consultoría se realizó con el objetivo de identificar el problema central en el área de almacenes de producto terminado, de la unidad de negocios de alimentos, que ha tenido una serie de reclamos e indicadores no favorables. Se utilizó la metodología del ciclo de Deming y las herramientas de priorización de causas por factores, matrices de enfrentamiento, diagrama de Ishikawa y diagrama de Pareto. Se identificaron 17 problemas, y al realizar el análisis de las causas raíz más importantes se encontraron 21 posibles causas raíz. Luego, se aplicaron las herramientas de la metodología Lean Logistics: Evaluación de Mudas, VSM actual, VSM futuro, 5S, SMED y ANDON en la solución de las causas raíz encontradas. Como base de la implementación, se propuso que la filosofía sea adoptada en primera instancia por los puestos gerenciales y ejecutivos, para producir el efecto de cascada, así como la concientización del personal. Además, se mostraron las posibles mejoras, y se procedió a realizar una revisión de la madurez de los procesos de la unidad de negocios de alimentos de la empresa láctea, con el uso de la matriz de Hammer. Posteriormente, se elaboró el plan de implementación con 36 actividades, y se detalló en el diagrama de Gantt el tiempo estimado de implementación, que fue de 104 días. De igual manera, se calcularon los costos asociados de implementación que ascendieron a S/262, 928, los ahorros moderados que ascendieron a S/16,538 al mes, finalmente se calculó un VAN de S/225, 774 y un payback de 2.4 años.The following executive summary is developed in a company dedicated to manufacturing and marketing food, primarily dairy products, aiming to bring nutrition to Peruvian families. It has been in the Peruvian and international markets for several years. The consultancy objective is to identify the central problem in the finished product warehouse area of the food business unit, which has had a series of complaints and unfavorable indicators. For this purpose, it applied the Deming cycle, tools for prioritizing caused by factors, confrontation matrices, the Ishikawa diagram, and the Pareto diagram. Using the methodologies and tools shows the main problem. Seventeen problems are the priority, and the analysis of the main root causes that generate said problems gives a total of 21 root causes. Applying then, the tools of Lean Logistics methodology: Mudas Evaluation, current VSM, future VSM, 5S, SMED, and ANDON in solving the root causes found. For this, as a basis for the implementation, the cascade effect can be achieved if the management and executive positions embrace the philosophy in the first instance. As well as raise staff awareness. A review of the maturity of the processes of the food business unit of the Diary Company is done after showing the possible improvements, using the Hammer matrix for this purpose. Preparing 36 activities for the implementation plan and the estimated implementation time, which was 104 days, was detailed in the Gantt chart. In the same way, the associated implementation costs are calculated to the amount of S/262,928, and the moderate savings amounted to S/16,538 per month, calculating an NVP of S/225,774 and a payback of 2.4 years

Intraoperative transfusion practices in Europe

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially