Programa de seguridad basada en el comportamiento para reducir la accidentabilidad en la Empresa AGRICOLA COPACABANA, Chincha, 2022

La investigación tuvo el objetivo de determinar en qué medida la aplicación de la Seguridad basada en el Comportamiento reduce la accidentabilidad en la empresa AGRICOLA COPACABANA, Chincha, Ica, 2022. A partir de ello, se tomaron las dimensiones de frecuencia y gravedad de accidentes para el cálculo de la accidentabilidad. La investigación corresponde a una metodología de tipo aplicado, de enfoque cuantitativo, de nivel explicativo, de diseño preexperimental y de alcance temporal longitudinal. La población y muestra se conformó por 410 trabajadores activos de la empresa y las técnicas para la recolección de datos fueron la observación directa y el análisis documental. El desarrollo de cambios se basa en 3 fases de la metodología, tales como saber hacer, poder hacer y querer hacer, en donde se implementaron formatos, fichas de control, capacitaciones y cronogramas de supervisión. El análisis de los resultados indica una reducción del índice de accidentabilidad de 215.9 a 68.46; adicionalmente, a frecuencia de accidentes disminuyó de 528.9 a 241.9 y la gravedad de accidentes pasó de 401.46 a 210.08; por lo tanto, se concluye que la aplicación de la Seguridad basada en el Comportamiento reduce el índice de frecuencia en la empresa AGRICOLA COPACABANA, Ica, 2022

Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study

Background Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported. Objective To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors. Methods A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected. Results Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid. Conclusions A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites

Process design for the production of bioethanol from potato peels

El diseño del proceso para la producción de bioetanol fue realizado con el propósito de producir este biocombustible, el cual en el Perú es utilizado como un aditivo de la gasolina, con el fin de mejorar la calidad del combustible debido a que aumenta los niveles de oxígeno y reduce las emisiones de gases de efecto invernadero. El proceso diseñado tiene la capacidad de producir 5086.36 m3 /año (32 MBLS) de bioetanol con alta pureza (99.7% v/v) lo que podría abastecer el 2.9% del volumen importado en el Perú. Además, se consideró emplear la cáscara de papa como materia prima debido a su alto contenido de azúcares fermentables. A partir de las referencias bibliográficas se decidió trabajar con hidrólisis enzimática debido a su alto rendimiento de azúcares, y fermentación utilizando la levadura Saccharomyces cerevisiae ya que es un microorganismo capaz de fermentar hexosas de manera eficiente logrando producir etanol. Para la destilación extractiva se utilizó el solvente tetraetilenglicol porque permite una buena separación en la destilación, no es tóxico y no contamina el medio ambiente, además, se contó con una etapa de recuperación de solvente. En este trabajo se realizó el diseño del secador, reactores, columnas de destilación, bombas, intercambiadores de calor, entre otros. Para el diseño de los reactores se analizó la cinética que ocurre en cada uno de ellos y se determinaron sus dimensiones, obteniéndose una capacidad de 34 m3 para la etapa de hidrólisis y un reactor de una capacidad de 187 m3 para la etapa de fermentación. También, se realizó el diseño de tres columnas de destilación determinando el número de etapas reales, la altura y el diámetro. Así mismo, se realizó el diseño del equipo de secado, nueve intercambiadores de calor y una caldera cuya fuente de energía es el gas natural con un consumo de 2600.42 Sm3 por día. Con el objetivo de determinar las condiciones de operación de las tres columnas de destilación se utilizó el simulador ProMax 4.0. A través de la simulación, se determinó la potencia térmica en el rehervidor y condensador, el número de etapas teóricas necesarios para obtener la concentración deseada en la corriente de destilado y fondo determinando que se necesitan 17, 26 y 11 etapas teóricas para la primera, segunda y tercera columna de destilación, respectivamente. Asimismo, se analizó la concentración del etanol, agua y tetraetilenglicol en el flujo del destilado y fondo a medida que la posición de la etapa de alimentación variaba, determinándose la posición óptima para cada una de las columnas de destilación. Finalmente, se realizó la evaluación económica a un horizonte de 20 años considerando el precio de venta en Estados Unidos ($0.7/L), determinando a través del flujo de caja que el proyecto es rentable a partir del quinto año, con una tasa interna de retorno de 25$ 4,880,405.94. Con el análisis de sensibilidad, se halló que el OPEX es más sensible en comparación al precio de venta del bioetanol y el CAPEX ya que se demostró que cuando el OPEX aumenta en un 30% se obtiene una TIR de 12%.The design of the process for the production of bioethanol was carried out with the purpose of producing this biofuel, which in Peru is used as a gasoline additive, in order to improve the quality of the fuel because it increases oxygen levels and reduces greenhouse gas emissions. The designed process has the capacity to produce 5086.36 m3 /year (32 MBLS) of bioethanol with high purity (99.7% v/v), which could supply 2.9% of the imported volume in Peru. In addition, it was considered to use potato peel as raw material due to its high content of fermentable sugars. Based on the bibliographic references, it was decided to work with enzymatic hydrolysis due to its high yield of sugars, and fermentation using the yeast Saccharomyces cerevisiae since it is a microorganism capable of efficiently fermenting hexoses, producing ethanol. For the extractive distillation, the solvent tetraethylene glycol was used because it allows a good separation in the distillation, it isn’t toxic and doesn’t pollute the environment, in addition, it had a solvent recovery stage. In this work, the design of the dryer, reactors, distillation columns, pumps, heat exchangers, among others, was carried out. For the design of the reactors, the kinetics that occur in each of them were analyzed and their dimensions were determined, obtaining a capacity of 34 m3 for the hydrolysis step and a reactor with a capacity of 187 m3 for the fermentation step. Also, the design of three distillation columns was carried out, determining the number of real stages, the height and the diameter. Likewise, the design of the equipment was carried out, such as the dryer, nine heat exchangers and a boiler whose energy source is natural gas with a consumption of 2600.42 Sm3 per day. In order to determine the operating conditions of the three distillation columns, the ProMax 4.0 simulator was used. Through simulation, the thermal power in the reboiler and condenser was determined, the number of theoretical stages necessary to obtain the desired concentration in the distillate and bottom stream, determining that 17, 26 and 11 stages are needed for the first, second and third distillation column, respectively. Likewise, the concentration of ethanol, water and tetraethylene glycol in the distillate flow and bottom was analyzed as the position of the feed stage varied, determining the optimal position for each of the distillation columns. Finally, the economic evaluation was carried out at a horizon of 20 years considering the price with which it is sold in the United States ($0.7/L), determining through the cash flow that the project is profitable from the fifth year, with an internal rate of return (IRR) of 25$ 4,880,405.94. With the sensitivity analysis, it was found that OPEX is more sensitive compared to the sale price of bioethanol and CAPEX since it was shown that when OPEX increases by 30%, an IRR of 12% is obtained

Current utilization of interosseous access in pediatrics: a population-based analysis using an EHR database, TriNetX

Abstract Background When central or peripheral intravenous access cannot be achieved in a timely manner, intraosseous (IO) access is recommended as a safe and equally effective alternative for pediatric resuscitation. IO usage and its complications in the pediatric population have been primarily studied in the setting of cardiac arrest. However, population-based studies identifying noncardiac indications and complications associated with different age groups are sparse. Results This was a retrospective observational cohort study utilizing the TriNetX® electronic health record data. Thirty-seven hospitals were included in the data set with 1012 patients where an IO procedure code was reported in the emergency department or inpatient setting. The cohort was split into two groups, pediatric subjects < 1 year of age and those ≥ 1 year of age. A total incidence of IO line placement of 18 per 100,000 pediatric encounters was reported. Total mortality was 31.8%, with a higher rate of mortality seen in subjects < 1 year of age (39.2% vs 29.0%; p = 0.0028). A diagnosis of cardiac arrest was more frequent in subjects < 1 year of age (51.5% vs 38.0%; p = 0.002), and a diagnosis of convulsions was more frequent in those ≥ 1 of age (28.0% vs 13.8%; p <0.01). Overall, 29 (2.9%) subjects had at least one complication. Conclusions More IOs were placed in subjects ≥ 1 year of age, and a higher rate of mortality was seen in subjects < 1 year of age. Lower frequencies of noncardiac diagnoses at the time of IO placement were found in both groups, highlighting IO may be underutilized in noncardiac settings such as convulsions, shock, and respiratory failure. Given the low rate of complications seen in both groups of our study, IO use should be considered early on for urgent vascular access, especially for children less than 1 year of age