Propuesta de guía para un sistema de clasificación de información de construcción mediante la aplicación de la norma ISO 12006 y el software Revit

En el ámbito de la construcción a nivel internacional, se requiere estandarizar y catalogar los objetos y/o elementos que forman parte del ciclo de vida de proyectos, con la finalidad de facilitar el uso correcto de la información en todos los procesos relacionados a la construcción, como la cuantificación de acuerdo con las especificaciones técnicas, el cálculo de presupuestos, cuantificación de materiales, entre otros. Este tema ha tenido mayor importancia desde que la metodología BIM (Building Information Modeling) ha tenido mayor acogida al desarrollar proyectos de construcción, ya que permite realizar una pre-construcción del proyecto a través de modelación de objetos 3D orientados geométricamente. (Convers Rivera, 2020) La norma ISO 12006 se realizó para la organización de información de obras de construcción y consta de parte 2 - Marco de clasificación y parte 3 - Marco para información orientada a objetos, esta norma es aplicable a lo largo del ciclo de vida de un proyecto. El Instituto Nacional de Calidad del Perú (INACAL) publicó estas normas a principios de abril del 2021; sin embargo, hasta la fecha, en nuestro país no se ha publicado un Sistema de Clasificación que emana de esta norma y facilite el intercambio y la comprensión de información por todos los involucrados. Por ello, el presente trabajo de investigación pretende ser una propuesta de guía, tanto para el sector público como el sector privado, con el propósito de incentivar a los involucrados en este rubro, con el fin de que empleen permanente la clasificación de todos los elementos que conforman un proyecto, aplicando la norma mediante el uso de la metodología BIM y, en un futuro cercano, crear un Sistema de Clasificación Nacional, apoyándose en los sistemas de clasificaciones globales como, en este caso, UniFormat. Esta investigación se aplicará en la ejecución del laboratorio de Ing. Sanitaria, Hidráulica e Hidrología de la carrera de Ingeniería Civil y en el edificio A2, ambos pertenecientes a la Universidad de Lima.In the field of construction internationally, it’s necessary to standardize and catalog the objects and/or elements that are part of the project life cycle, to facilitate the correct use of information in all processes related to construction, such as quantification according to technical specifications, calculation of budgets, quantification of materials, among others. This topic has been more important since the BIM (Building Information Modeling) methodology has been more popular when developing construction projects since it allows a pre-construction of the project to be carried out through the modeling of geometrically oriented 3D objects. (Convers Rivera, 2020) The ISO 12006 standard was made for the organization of construction site information and consists of part 2 - Classification framework and part 3 - Framework for object-oriented information, this standard is applicable to the entire life cycle of a project. The National Quality Institute of Peru (INACAL for its acronym in Spanish) published these standards in early April 2021; however, to date, in our country a Classification System that emanates from this standard and facilitates the exchange and understanding of information by all stakeholders has not been published. For this reason, the present research work intends to be a guide proposal, both for the public sector and the private sector, with the purpose of encouraging those involved in this area, to permanently use the classification of all the elements. that make up a project, applying the standard using the BIM methodology and soon, creating a National Classification System, relying on global classification systems such as, in this case, UniFormat. This research will be applied in the execution of the laboratory of Sanitary, Hydraulic and Hydrology Engineering of the Civil Engineering career and in the A2 building, both belonging to the University of Lima

Business consulting - AGP S.A.C.

AGP Sociedad Anónima Cerrada es una empresa peruana con 19 años de experiencia, líder en el mercado de semillas forrajeras del país, con almacenes en las ciudades de Lima, Arequipa, Cuzco y Cajamarca; las mismas que han sido ubicadas estratégicamente para un correcto almacenamiento, venta y distribución de sus productos. De acuerdo a la revisión de la información brindada por el personal clave de la compañía, se detectó el deterioro en la cadena de suministro y se determinó que problema principal es la deficiente gestión de planeamiento y la inexactitud del registro de inventarios, esto se ve reflejado en las notas de crédito que se deben emitir por falta de stock o errores en los códigos. Asimismo, AGP S.A.C. no ha desarrollado un Plan estratégico y no tiene objetivos a largo plazo, lo que ocasiona la ausencia de indicadores para controlar su eficiencia y adoptar oportunidades de mejora. A partir de la identificación del problema se realizó el análisis de causa raíz donde se observaron como causas principales: La falta de planificación de las ventas, falta de políticas de reposición de inventarios y ausencia de controles de inventarios; por lo que se han propuesto acciones que permitan resolver las causas identificadas, siendo algunas de ellas: La conformación de un equipo de mejora continua, la implementación de un tablero de control Integral, la implementación de un método para el cálculo del pronóstico de venta, entre otras. Finalmente, se ha determinado que es necesaria la disposición de los recursos tangibles e intangibles indicados para la implementación de las acciones propuestas señalados en el diagrama de Gantt que incluye presupuesto y responsables para cada etapa del Plan de Implementación; todo ello permitirá que AGP S.A.C. pueda crecer de forma planificada y alcance los objetivos trazados, reforzando su propuesta de valor en el mercado.AGP Sociedad Anónima Cerrada is a Peruvian company with 19 years of experience, leader in the country's forage seed market, with stores in the cities of Lima, Arequipa, Cuzco and Cajamarca; the same ones that have been strategically located for a correct storage, sale and distribution of their products. According to the review of the information provided by the company's key personnel, the deterioration in the supply chain was detected and it was determined that the main problem is poor planning management and the inaccuracy of the inventory record, this is reflected in the credit notes that must be issued due to lack of stock or errors in the codes. Also, AGP S.A.C. It has not developed a Strategic Plan and does not have long-term objectives, which causes the absence of indicators to control its efficiency and adopt opportunities for improvement. From the identification of the problem, the root cause analysis was carried out where the main causes were observed: Lack of sales planning, lack of inventory replenishment policies and absence of inventory controls; Therefore, actions have been proposed to resolve the identified causes, some of them being: The formation of a continuous improvement team, the implementation of an Integral control panel, the implementation of a method for calculating the sales forecast, among other. Finally, it has been determined that the availability of the indicated tangible and intangible resources are necessary for the implementation of the proposed actions indicated in the Gantt chart that includes the budget and those responsible for each stage of the Implementation Plan; All this will allow AGP S.A.C. can grow in a planned way and achieve the objectives set, reinforcing its value proposition in the market

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

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Assessment of plasma chitotriosidase activity, CCL18/PARC concentration and NP-C suspicion index in the diagnosis of Niemann-Pick disease type C : A prospective observational study

Niemann-Pick disease type C (NP-C) is a rare, autosomal recessive neurodegenerative disease caused by mutations in either the NPC1 or NPC2 genes. The diagnosis of NP-C remains challenging due to the non-specific, heterogeneous nature of signs/symptoms. This study assessed the utility of plasma chitotriosidase (ChT) and Chemokine (C-C motif) ligand 18 (CCL18)/pulmonary and activation-regulated chemokine (PARC) in conjunction with the NP-C suspicion index (NP-C SI) for guiding confirmatory laboratory testing in patients with suspected NP-C. In a prospective observational cohort study, incorporating a retrospective determination of NP-C SI scores, two different diagnostic approaches were applied in two separate groups of unrelated patients from 51 Spanish medical centers (n = 118 in both groups). From Jan 2010 to Apr 2012 (Period 1), patients with ≥2 clinical signs/symptoms of NP-C were considered 'suspected NP-C' cases, and NPC1/NPC2 sequencing, plasma chitotriosidase (ChT), CCL18/PARC and sphingomyelinase levels were assessed. Based on findings in Period 1, plasma ChT and CCL18/PARC, and NP-C SI prediction scores were determined in a second group of patients between May 2012 and Apr 2014 (Period 2), and NPC1 and NPC2 were sequenced only in those with elevated ChT and/or elevated CCL18/PARC and/or NP-C SI ≥70. Filipin staining and 7-ketocholesterol (7-KC) measurements were performed in all patients with NP-C gene mutations, where possible. In total across Periods 1 and 2, 10/236 (4%) patients had a confirmed diagnosis o NP-C based on gene sequencing (5/118 [4.2%] in each Period): all of these patients had two causal NPC1 mutations. Single mutant NPC1 alleles were detected in 8/236 (3%) patients, overall. Positive filipin staining results comprised three classical and five variant biochemical phenotypes. No NPC2 mutations were detected. All patients with NPC1 mutations had high ChT activity, high CCL18/PARC concentrations and/or NP-C SI scores ≥70. Plasma 7-KC was higher than control cut-off values in all patients with two NPC1 mutations, and in the majority of patients with single mutations. Family studies identified three further NP-C patients. This approach may be very useful for laboratories that do not have mass spectrometry facilities and therefore, they cannot use other NP-C biomarkers for diagnosis

Diálogo en bioeconomía: la UNA al servicio del desarrollo nacional

Contiene los resúmenes de las presentaciones realizadas en el Taller Diálogo en bioeconomía: la UNA al servicio del desarrollo nacional, celebrada en noviembre 2020, con el siguiente contenido: Ponencias Magistrales: Bioeconomía: una visión glonal y regional, Estrategia nacional de bioeconomía Costa Rica 2020-2030, Bioeconomía y retos del desarrollo, Procesos de innovación en centros de investigación: casos de éxito en LANOTEC CENAT CONARE. Ejes: Bioeconomía para el desarrollo social, Biodiversidad y desarrollo, Biorrefinería de biomasa residual y bioeconomía avanzada Bioeconomía urbana y ciudades verdes. Para Finalizar con el resumen del conversatorio.Universidad Nacional, Costa RicaEscuela de EconomíaCentro Internacional de Política Económica para el Desarrollo SostenibleEscuela de QuímicaVicerrectoría de InvestigaciónInstituto Regional de Estudios en Sustancias Tóxica

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd

A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study

© 2023Background: The benefit of pharmacogenetic testing before starting drug therapy has been well documented for several single gene–drug combinations. However, the clinical utility of a pre-emptive genotyping strategy using a pharmacogenetic panel has not been rigorously assessed. Methods: We conducted an open-label, multicentre, controlled, cluster-randomised, crossover implementation study of a 12-gene pharmacogenetic panel in 18 hospitals, nine community health centres, and 28 community pharmacies in seven European countries (Austria, Greece, Italy, the Netherlands, Slovenia, Spain, and the UK). Patients aged 18 years or older receiving a first prescription for a drug clinically recommended in the guidelines of the Dutch Pharmacogenetics Working Group (ie, the index drug) as part of routine care were eligible for inclusion. Exclusion criteria included previous genetic testing for a gene relevant to the index drug, a planned duration of treatment of less than 7 consecutive days, and severe renal or liver insufficiency. All patients gave written informed consent before taking part in the study. Participants were genotyped for 50 germline variants in 12 genes, and those with an actionable variant (ie, a drug–gene interaction test result for which the Dutch Pharmacogenetics Working Group [DPWG] recommended a change to standard-of-care drug treatment) were treated according to DPWG recommendations. Patients in the control group received standard treatment. To prepare clinicians for pre-emptive pharmacogenetic testing, local teams were educated during a site-initiation visit and online educational material was made available. The primary outcome was the occurrence of clinically relevant adverse drug reactions within the 12-week follow-up period. Analyses were irrespective of patient adherence to the DPWG guidelines. The primary analysis was done using a gatekeeping analysis, in which outcomes in people with an actionable drug–gene interaction in the study group versus the control group were compared, and only if the difference was statistically significant was an analysis done that included all of the patients in the study. Outcomes were compared between the study and control groups, both for patients with an actionable drug–gene interaction test result (ie, a result for which the DPWG recommended a change to standard-of-care drug treatment) and for all patients who received at least one dose of index drug. The safety analysis included all participants who received at least one dose of a study drug. This study is registered with ClinicalTrials.gov, NCT03093818 and is closed to new participants. Findings: Between March 7, 2017, and June 30, 2020, 41 696 patients were assessed for eligibility and 6944 (51·4 % female, 48·6% male; 97·7% self-reported European, Mediterranean, or Middle Eastern ethnicity) were enrolled and assigned to receive genotype-guided drug treatment (n=3342) or standard care (n=3602). 99 patients (52 [1·6%] of the study group and 47 [1·3%] of the control group) withdrew consent after group assignment. 652 participants (367 [11·0%] in the study group and 285 [7·9%] in the control group) were lost to follow-up. In patients with an actionable test result for the index drug (n=1558), a clinically relevant adverse drug reaction occurred in 152 (21·0%) of 725 patients in the study group and 231 (27·7%) of 833 patients in the control group (odds ratio [OR] 0·70 [95% CI 0·54–0·91]; p=0·0075), whereas for all patients, the incidence was 628 (21·5%) of 2923 patients in the study group and 934 (28·6%) of 3270 patients in the control group (OR 0·70 [95% CI 0·61–0·79]; p <0·0001). Interpretation: Genotype-guided treatment using a 12-gene pharmacogenetic panel significantly reduced the incidence of clinically relevant adverse drug reactions and was feasible across diverse European health-care system organisations and settings. Large-scale implementation could help to make drug therapy increasingly safe. Funding: European Union Horizon 2020