Certificación de la eficiencia energética de edificios existentes

Este proyecto se elabora con la finalidad de reducir las emisiones de CO2 de edificios y ahorrar energía, caminando de esta forma hacia la sostenibilidad del planeta. Los certificados de eficiencia energética de edificios constituyen el documento acreditativo y objetivo de las características energéticas del edificio de forma que se pueda valorar y comparar su eficiencia energética con el fin de favorecer la promoción de edificios de alta eficiencia energética y las inversiones de ahorro de energía.Departamento de Ingeniería Química y Tecnología del Medio AmbienteMáster en Gestión de la Prevención de Riesgos Laborales, Calidad y Medio Ambient

The effects of adulterants on the detection of delta-9-tetrahydrocannabinol and methamphetamine in oral fluid immunoassay testing

Drug screening is widespread in contexts such as the criminal justice system, employment, and substance abuse treatment centers. Traditionally, drug testing methods have targeted urine matrices and extensive research is available regarding urine drug screening. Due to the nature of sample collection, urine specimen may be tampered or adulterated in efforts to invalidate or pass a drug test. Examples of this include substituting a sample with synthetic urine, diluting a sample with water, or adding a substance to the sample. The addition of a substance is referred to as adulteration and is done in an effort to mask drugs in the sample or to invalidate the test results. For various reasons, including the effects of adulteration, time, and costs associated with urine drug tests, oral fluid (OF) has become an increasingly important alternative matrix for screening drugs of abuse. It offers distinct advantages since tests can be administered noninvasively, quickly, and under observation, thus reducing the risk of tampering. Studies have also shown that drugs of abuse detected in OF may correlate better to user impairment at the time of collection, as compared to other matrices. In 2019, the Substance Abuse and Mental Health Service Administration (SAMHSA) published mandatory guidelines for oral fluid testing. Although these guidelines only directly impact federal spaces, they also serve as a blueprint for developing drug testing laws and policies in other organizations. Despite requirements and procedures controlling for specimen adulteration, it is recognized that manufacturers will continue to develop and market new products to avoid drug detection, just as with urine drug tests. The design of this experiment was to investigate the effects of the commercially available drug testing subversion products High Voltage Saliva Cleanse Mouthwash (High Voltage Detox, Las Vegas, Nevada, USA) and Stinger Detox Mouthwash (Stinger Detox, Phoenix, Arizona, USA) on immunoassay testing for tetrahydrocannabinol (THC) and methamphetamine (MET) in OF. The High Voltage Saliva Cleanse was designated adulterant “A”, and the Stinger Detox was designated adulterant “B”. Two separate immunoassay kits, Discover™ (American Screening Corporation, Inc., Shreveport, Louisiana, USA) and Orawell® (Jiangsu Well Biotech Co., Ltd, Changzhou, Jiangsu, China), were assessed to investigate the differences in performance of the current available test devices in addition to the effects of the subversion products. Using Discover™, samples were spiked according to 0.5 times (x), 1x, and 2x the cutoff concentrations of 50 ng/mL THC and 50 ng/mL MET without adulterant, with Adulterant A, and with Adulterant B. Testing with Orawell® devices was initially conducted at 1x and 2x the cutoff concentrations of 40 ng/mL THC and 50 ng/mL of MET. Based on the lack of response, testing at 0.5x was not conducted. Additional testing was conducted at 1.5x and 3x the cutoff concentrations without adulterant, with Adulterant A, and with Adulterant B. It was concluded that the adulterants affected the test results in the Orawell® device, by producing false positives for drugs of abuse not present in the sample for 17 (56.7%) of the 30 tests containing adulterants. Additionally, it was concluded that both immunoassay tests assessed were lacking in analytical sensitivity and reproducibility

Clima institucional y desempeño docente en la Institución Educativa Pública \"José Carlos Mariátegui\", Distrito de Huarmey 2018

El presente estudio se trazó como objetivo relacionar el clima institucional y el desempeño docente en la I.E.P ?José Carlos Mariátegui? ubicada en la provincia Huarmey, 2018. Se optó por una indagación de tipo descriptiva, a partir del diseño no experimental transaccional correlacional. La población muestral estuvo conformada por 24 profesores del nivel secundario a los mismos que se les subministro dos cuestionarios como instrumentos: el primero para determinar el nivel de clima institucional y el segundo para desempeño docente, los mismos que son válidos y confiables. Los resultados evidenciaron un nivel de clima institucional es bueno (62.50%) entre todos los docentes y en cuanto al desempeño docente demuestra que en un 54.17% de los profesores muestran un nivel de desempeño alto. Asimismo, se estableció que hay una correlación positiva de r = 0,581 y significativa p = 0,003Tesi

Nivel de conocimiento sobre primeros auxilios en los docentes de la I. E PNP Precursores de la Independencia Nacional - Los Olivos, 2020

El presente trabajo de investigación tuvo como propósito Determinar el nivel de conocimiento sobre primeros auxilios en los docentes de la I.E PNP Precursores de Independencia Nacional. El estudio es de tipo básica, de enfoque cuantitativo, de alcance descriptivo, de diseño no experimental y de corte transversal. Se consideró la totalidad de la población compuesta por 62 docentes que laboran del nivel secundario y primario de dicha institución nacional. Para realizar el proyecto, se utilizó la técnica de la encuesta y como instrumento un cuestionario anónimo de 25 preguntas con respuesta dicotómicas. Fue validado a tras de 6 jueces de expertos y para hallar la confiabilidad se aplicó una prueba estadística de Kuder de Richardson -20 el cual tuvo como valor de 0.860. Los resultados fueron a través de dimensiones el 53% en nivel medio de conocimiento en PA, el 27% poseen un nivel bajo de conocimiento en PA, y el 19% de nivel alto de conocimiento en PA. En cuanto a la dimensión de conocimiento en desmayo, el 48% en nivel medio de conocimiento, el 37% en nivel bajo de conocimiento, y el 15% de nivel alto de conocimiento. En cuanto a la dimensión atragantamiento, el 60% de nivel bajo de conocimiento, el 37% en nivel medio de conocimiento y el 3% en nivel alto de conocimiento. Para la dimensión de hemorragias y heridas, el 39% en nivel medio de conocimiento, el 31% de nivel bajo de conocimiento y el 31% en nivel alto de conocimiento. En la dimensión de quemaduras, el 45% en nivel medio de conocimiento el 35% de nivel alto de conocimiento y el 19% de nivel bajo de conocimiento. Finalmente, en la dimensión de nivel de conocimiento en contusión, el 35% de nivel bajo de conocimiento, el 34% de nivel medio de conocimiento y el 31% nivel alto de conocimiento. Se concluye que los maestros tienen un nivel de conocimiento medio sobre primeros auxilios. Esto quiero decir que su conocimiento es ligeramente óptimo, pero a nivel teórico, porque a nivel práctico no conocen como realizar las técnicas que se debe utilizar en cada situación

Momento Económico (10-11)

En este Temas de hoy, 2/ La economía cubana en 1984, 3/ Alicia Girón: La renegociación de la deuda externa, 13/ Mario J. Zepeda: 1984: Primer semestre, 17/ Raúl Huerta García: Repunte de la industria nacional en 1984, 23/ Manuel Lois Méndez: Crisis y número : cambios recientes en la industria automotriz, 2

Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic copd spanish patients

Purpose: Umeclidinium/vilanterol (UMEC/VI) is a novel fixed dose combination of a long-acting muscarinic receptor antagonist (LAMA) and a long-acting beta 2 receptor antagonist (LABA) agent. This analysis evaluated the incremental cost-effectiveness ratio (ICER) of UMEC/VI compared with tiotropium (TIO), from the Spanish National Health System (NHS) perspective. Methods: A previously published linked equations cohort model based on the epidemiological longitudinal study ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) was used. Patients included were COPD patients with a post-bronchodilator forced expiratory volume in 1 second (FEV1) ≤70% and the presence of respiratory symptoms mea­sured with the modified Medical Research Council dyspnea scale (modified Medical Research Council ≥2). Treatment effect, expressed as change in FEV1 from baseline, was estimated from a 24-week head-to-head phase III clinical trial comparing once-daily UMEC/VI with once-daily TIO and was assumed to last 52 weeks following treatment initiation (maximum duration of UMEC/VI clinical trials). Spanish utility values were derived from a published local observa­tional study. Unitary health care costs (€2015) were obtained from local sources. A 3-year time horizon was selected, and 3% discount was applied to effects and costs. Results were expressed as cost/quality-adjusted life years (QALYs). Univariate and probabilistic sensitivity analysis (PSA) was performed. Results: UMEC/VI produced additional 0.03 QALY and €590 vs TIO, leading to an ICER of €21,475/QALY. According to PSA, the probability of UMEC/VI being cost-effective was 80.3% at a willingness-to-pay of €30,000/QALY. Conclusion: UMEC/VI could be considered as a cost-effective treatment alternative compared with TIO in symptomatic COPD patients from the Spanish NHS perspective

01-09-2021 PRINCIPALES ENFERMEDADES ZOONÓTICAS CAUSADAS POR MICROORGANISMOS EN MÉXICO

Es de suma importancia conocer y analizar las múltiples enfermedades zoonóticas causadas por microorganismos emergentes que existen en México, estas representan una potencial amenaza para la salud pública. Muchas de estas enfermedades causadas por microorganismos tienen su origen en animales domésticos y de vida silvestre, de ahí la importancia de tratar este tema ya que estas enfermedades pueden ser transmitidas a la población humana por diferentes factores, ya sea por contacto directo entre animales y personas o por vectores [1]. Estas zoonosis desencadenan una gran problemática social epidemiológica. La relación que tienen las enfermedades emergentes y reemergentes está ligada principalmente a la pérdida de la biodiversidad por las actividades humanas, esto debido a la destrucción de hábitats naturales, tráfico de fauna silvestre y a la pérdida de diversidad genética [2]. Mucha de la fauna al verse afectada por la destrucción de sus hábitats emigra a lugares más cercanos a la población, por lo que existe un mayor contacto y posibilidad de transmisiones zoonóticas [3]. Aunado a esto, el ser humano se ha encargado de extraer especímenes endémicos de sus hábitats para su tráfico y explotación, siendo esto otro factor importante para la transmisión de estas enfermedades [4]. Todos estos aspectos ya mencionados desempeñan una función muy importante en la aparición de las patologías de origen infeccioso [5]. Esta investigación intenta acercarse al conocimiento de las zoonosis transmitidas por animales a causa de microorganismos y su impacto en la población

Generic utilities in chronic obstructive pulmonary disease patients stratified according to different staging systems.

Background To determine generic utilities for Spanish chronic obstructive pulmonary disease (COPD) patients stratified by different classifications: GOLD 2007, GOLD 2013, GesEPOC 2012 and BODEx index. Methods Multicentre, observational, cross-sectional study. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from EQ-5D-3 L. Means, standard deviations (SD), medians and interquartile ranges (IQR) were computed based on the different classifications. Differences in median utilities between groups were assessed by non-parametric tests. Results 346 patients were included, of which 85.5% were male with a mean age of 67.9 (SD = 9.7) years and a mean duration of COPD of 7.6 (SD = 5.8) years; 80.3% were ex-smokers and the mean smoking history was 54.2 (SD = 33.2) pack-years. Median utilities (IQR) by GOLD 2007 were 0.87 (0.22) for moderate; 0.80 (0.26) for severe and 0.67 (0.42) for very-severe patients (p 2: 0.89 (0.20); group 34: 0.80 (0.27); group 56: 0.67 (0.29); group 79: 0.41 (0.31). All comparisons were significant (p 4 and 56. Conclusion Irrespective of the classification used utilities were associated to disease severity. Some clinical phenotypes were associated with worse utilities, probably related to a higher frequency of exacerbations. GOLD 2007 guidelines and BODEx index better discriminated patients with a worse health status than GOLD 2013 guidelines, while GOLD 2013 guidelines were better able to identify a smaller group of patients with the best health

Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients receiving allogeneic haematopoieticcell transplantation. The deep immunosuppression and a variety of potential additional complications developed in these patients result in IA reaching mortality rates of around 50-60%. This mortality is even higher when the patients are infected with azole-resistant isolates, demonstrating that, despite the complexity of management, adequate azole treatment can have a beneficial effect. It is therefore paramount to understand the reasons why antifungal treatment of IA infections caused by azole-susceptible isolates is often unsuccessful. In this respect, there are already various factors known to be important for treatment efficacy, for instance the drug concentrations achieved in the blood, which are thus often monitored. We hypothesize that antifungal persistence may be another important factor to consider. In this study we present two case reports of haematological patients who developed proven IA and suffered treatment failure, despite having been infected with susceptible isolates, receiving correct antifungal treatment and reaching therapeutic levels of the azole. Microbiological analysis of the recovered infective isolates showed that the patients were infected with multiple strains, several of which were persisters to voriconazole and/or isavuconazole. Therefore, we propose that azole persistence may have contributed to therapeutic failure in these patients and that this phenomenon should be considered in future studies.This research was funded by “Proyecto de I+D+I en salud-ISCIII 2022 de la Acción Estratégica en Salud Intramural (AESI)”, grant number “PI22CIII/00053”.S