Análisis del manejo y disposición final de los computadores como productos electrónicos, para la formulación de lineamientos que disminuyan la generación de residuos en el país

El Estado como ente de control, ha generado una serie de políticas dentro de un marco regulatorio (leyes, decretos y acuerdos), las cuales buscan velar por el manejo adecuado de los residuos sólidos; residuos producto de computadores y demás aparatos eléctricos y electrónicos que por sus componentes están catalogados como residuos peligrosos, los cuales juegan un papel importante a nivel ambiental en todo el país considerando su incremento acelerado en los últimos años, que ponen en riesgo a su vez la salud humana. La compra y venta de tecnología es un factor importante en la economía del país, inclusive el gobierno ha reactivado e impulsado este sector con la eliminación de aranceles e impuestos, lo que favoreció y se vio reflejado en las ventas de los últimos años, a pesar de esto el gobierno no ha sido consecuente en fortalecer las medidas que se deben tomar para controlar los residuos producidos en cada una de las etapas de esta actividad contribuyendo así al deterioro de los recursos naturales y el medio ambiente en general. Actualmente, los intentos desarrollados para lograr un manejo adecuado y responsable de los RAEE han sido insuficientes si se comparan con la generación anual de este tipo de residuos en la última década, la situación empeora gracias al desconocimiento tanto de los consumidores como productores, apáticos a la situación que deberá afrontar el país si no se realizan acciones contundentes para abordar esta situación. El presente trabajo de grado realizó un análisis de la situación actual de los residuos de computadores generados en el país con el fin de proponer lineamientos para el manejo y su disposición adecuada; este análisis muestra como la situación actual debe ser tratada de forma rápida y concreta para evitar un mayor deterioro ambiental, ya que se evidencian grandes falencias a la hora de la toma de decisiones y la realización de actividades encaminadas al control de la situación

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes