Diagnóstico Y Análisis De La Comercialización De Arroz Para Elaborar Una Alternativa En Mejorar La Rentabilidad De Los Productores De La Zona De Babahoyo

The development of the production of arrocera in Ecuador was possible because it consolidated a complementary industrial sector. The rice industry, however, appears as a consequence and condition for the consolidation of this branch of production. The general advancement of the production process takes into account the growth of an industrial sector devoted to the decorticamiento of the gramínea. This is based on the fact that the industrialisation of the grain is a condition for the increase of consumption. In turn, one can understand the growth of the latter (especially in the sierra), if they take into account the new forms of utilisation of the rice that the processing gives place. This is a fundamental requirement for the development of the industry and, therefore, the general production. It should be emphasised that after the harvesting process, the primary production concludes with the storage of the grain in sacks or silos. The industrialisation of rice begins with the drying of the grains. Once these are completely dehydrated, it proceeded to the husked and the removal of the husk thereof. As a result of this process, you can get the brown rice which in some cases is treated with specialized polishing machines to obtain the white rice that is consumed regularly. Usually, the process of industrialization ends with the packaging of the rice for human consumption. In actuality, the rice sector faces great challenges. This is the same ones that make it essential to form rice associations for small and medium producers to handle their own industrialization process. It, however, begins with the drying of rice Peel, storage in silos, hulling and elimination of husk, polishing (white rice) and packaging, and taking care of the marketing in the domestic market, i.e. direct selling, especially in supermarkets and Points of Sale being the best option. For Producers, the commercial opening is an opportunity for rice activity

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

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease