Propuesta de mejora en las áreas de producción y logística para reducir los costos operativos de una empresa de calzado de la ciudad de Trujillo

El presente trabajo de investigación tiene como objetivo general determinar en qué medida la propuesta de mejora en el área de producción y logística reduce los costos operativos de una empresa de calzado de la ciudad de Trujillo. En primer lugar, se encuentran la realidad problemática del sector calzado, seguido de antecedentes, bases teóricas, formulación del problema de investigación y los objetivos. Posteriormente, se realizó un diagnóstico actual de la empresa el cual permitió identificar cuáles son los problemas más críticos que presentan ambas áreas, así como un costeo de pérdidas de estas. Las metodologías y herramientas que se emplearon para el desarrollo de la propuesta de mejora fueron las siguientes: Sistema de Planificación de Requerimientos de Materiales (MRP), Sistema de Rotación ABC y Kárdex las cuales disminuyeron los costos operativos en un 25%. Finalmente, se hizo la elaboración de la evaluación económica financiera donde se obtuvo un VAN de S/. 40, 846.46, un TIR de 70.8%, un PRI de 3.2 años y un B/C de S/. 1.1, lo que concluye que la propuesta de mejora es factible para la empresa Grupo Calzamil E.I.R.L.The general objective of this research work is to determine to what extent the improvement proposal in the production and logistics area reduces the operating costs of a footwear company in the city of Trujillo. In the first place, the problematic reality of the footwear sector is found, followed by antecedents, theoretical bases, formulation of the research problem and objectives. Subsequently, a current diagnosis of the company was carried out, which allowed identifying which are the most critical problems that both areas present, as well as a cost estimate of their losses. The methodologies and tools used for the development of the improvement proposal were the following: Material Requirements Planning System (MRP), ABC Rotation System and Transcript, which reduced operating costs by 25%. Finally, the economic and financial evaluation was prepared, where a NPV of S /. 40, 846.46, an IRR of 70.8%, a PRI of 3.2 years and a B / C of S /. 1.1, which concludes that the improvement proposal is feasible for the company Grupo Calzamil E.I.R.L

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030