Prospective study about the impact of a community pharmaceutical care service in patients with asthma

BACKGROUND: At present, there are a lot of drugs for the therapeutic approach of all the severity levels of asthma in developed countries. However, there are big difficulties in the correct use of inhalation devices, and usually there are drug related problems causing poorly controlled asthma. The objective of the study is to prove if the community-based pharmaceutical care service improves health outcomes in patients with asthma. METHODS: Community intervention trial, with a controlled multicenter quasi-experimental design, measuring the response variables before and after an observation period of 9 months. 96 patients were recruited in the Intervention group and 69 in the Control group, in 37 pharmacies. The measurement instruments used were the specific quality of life questionnaires AQLQ (adults) and PAQLQ (pediatric) of Juniper, and initial and final interviews containing a scale of 10 signs of poorly controlled asthma and data about health services utilization. RESULTS: Quality of life measures in the Intervention group achieved a mean increase of 0.82 points in adults and 0.81 in children, both clinically significant because they exceed the established clinical thresholds (0.5 and 0.42 respectively). Also there was a statistically significant difference in the final comparason between groups. The signs of poorly controlled asthma decreased significantly in the Intervention group from an initial mean of 2.72 into 1.15. Also a significant difference was found in the final comparason between groups. CONCLUSIONS: The community-based pharmaceutical care service had a beneficial effect in health related quality of life in asthma patients, and in the signs of poorly controlled asthma. It was not found a significant improvement in health services utilization. Fundamento: En la actualidad, en los países desarrollados se encuentran disponibles una gran cantidad de medicamentos antiasmáticos para el abordaje terapéutico de la enfermedad en sus diferentes niveles de gravedad. Sin embargo, existen grandes dificultades en la utilización adecuada de los dispositivos de inhalación, y con frecuencia se presentan problemas relacionados con la medicación que ocasionan un mal control de la enfermedad. El objetivo del estudio es comprobar si el servicio de atención farmacéutica comunitaria mejora los resultados en salud obtenidos con la farmacoterapia en pacientes asmáticos. Métodos: Es un estudio de intervención comunitaria, con diseño cuasiexperimental multicéntrico controlado, con medición de las variables respuesta antes y después de un período de observación de 9 meses. Contó con 96 pacientes en el grupo de intervención y 69 en el grupo control, captados en 37 farmacias. Como instrumentos de medida se utilizaron los cuestionarios de calidad de vida específicos AQLQ (adultos) y PAQLQ (pediátrico) de Juniper, y entrevistas de inicio y cierre con una escala de 10 signos de mal control del asma y datos sobre utilización de recursos sanitarios. Resultados: En las medidas de calidad de vida en el grupo intervención, se produjo un aumento medio de 0,82 puntos en adultos, y 0,81 puntos en niños, ambos clínicamente significativos por superar los umbrales clínicos establecidos (0,5 y 0,42 respectivamente). También se obtuvo una diferencia estadísticamente significativa en la comparación final entre los 2 grupos de estudio. Los signos de mal control del asma disminuyeron significativamente en el grupo intervención desde una media inicial de 2,72 hasta 1,15. También se encontró una diferencia significativa en la comparación final entre los grupos de estudio. Conclusiones: El servicio de atención farmacéutica comunitaria tuvo un efecto beneficioso sobre la calidad de vida relacionada con la salud de los pacientes asmáticos y sobre los signos de mal control del asma. No se evidenció una mejora significativa en la utilización de recursos sanitarios

Propuesta de supply chain Management y logística para la empresa ferretería Don Alberto

NALas nuevas tendencias globales de competitividad y sostenibilidad comercial llevan a que las empresas se enfoquen en mejorar sus procesos productivos, tanto de productos como de servicios, con el fin de generar valor agregado que marque la diferencia y que sea un atractivo para fidelizar los clientes reales y potenciales, en el desarrollo de esta propuesta de investigación aplicaremos todos los conceptos para establecer los procesos claves en la gestión Supply Chain Quality Management (SCQM) para la FERRETERÍA DON ALBERTO. Se pretende realizar una Propuesta de mejora basada en la gestión (SCQM), que estructure de manera sistémica y estratégica la Gestión de la Cadena de Suministro y Profundización Logística, incluyendo la lectura interna, después de definir la red de transporte para la entrega eficiente de materia prima que garantice la entrega de productos terminados a distribuidores y clientes finales en los tiempos estipulados, se definieron los espacios y las ubicaciones adecuadas de la mercancía, insumos, herramientas y material terminado, definimos el método correcto de valuación de inventarios, cuantificación de stock mínimos proyectados con estudios de mercado, definición de los tiempos de reposición de materiales con los proveedores estratégicos, implementación del software de control de inventarios y la capacitación del personal necesario, logrando integrar cada eslabón en una red de colaboración sistémica y mejoramiento continuo, con el fin de disminuir los impactos en el suministro y de encontrar alternativas preventivas sobre posibles problemas de materiales que mejore el desempeño de las operaciones individuales. Palabras Claves: Supply Chain Quality Management (SCQM), Tendencias, Competitividad, Estratégicos, Procesos, Suministro, Clientes.The new global trends of competitiveness and commercial sustainability lead companies to focus on improving their production processes, both products and services, in order to generate added value that makes a difference and that is an attraction to build loyalty of real and potential customers, in the development of this research proposal we will apply all the concepts to establish the key processes in the Supply Chain Quality Management (SCQM) for FERRETERÍA DON ALBERTO. It is intended to make a Proposal for improvement based on management (SCQM), which structures in a systemic and strategic way the Supply Chain Management and Logistics Deepening, including internal reading, after defining the transportation network for the efficient delivery of raw material that guarantees the delivery of finished products to distributors and final customers in the stipulated times, we defined the spaces and appropriate locations of the merchandise, inputs, tools and finished material, we defined the correct method of inventory valuation, We defined the correct method of inventory valuation, quantified the minimum projected stock with market studies, defined the replenishment times of materials with strategic suppliers, implemented the inventory control software and trained the necessary personnel, managing to integrate each link in a network of systemic collaboration and continuous improvement, in order to reduce the impacts on supply and to find preventive alternatives on possible problems of materials that improve the performance of individual operations. Keywords: Supply Chain Quality Management (SCQM), Trends, Competitiveness, Strategic, Processes, Supply, Customers

Patient Blood Management in Cesarean Section

Worldwide, every minute a woman dies due to complications during pregnancy, obstetric hemorrhage being the leading cause. However, most of these deaths are preventable with prompt recognition and management. The main objective of its management in the initial phase of resuscitation is to aggressively optimize macro and microhemodynamic parameters by ensuring effective resuscitation. Patient blood management (PBM) consists in the timely application of evidence-based medical and surgical procedures aimed at maintaining hemoglobin concentration, optimizing hemostasis and minimizing blood loss to improve patient outcome, all of these based in three pillars: endogenous erythropoiesis, platelet and coagulation factors function and physiological reserve of anemia. PBM consider various strategies to reach the main goal, including transfusional, non-transfusional and surgical measures. At preoperative period the prevention and treatment of anemia is the corner stone of the PBM guideline. Once at the operating room the fluid management, uterotonic and pro-coagulant drugs, fibrinogen and blood products transfusion play a key role and surgical techniques have to be done if the patient life is threatened. Manage postpartum anemia by appropriate iron administration. Optimize the patient’s physiological response to anemia, treat infections and maximize oxygen delivery to minimize transfusions if they are not strictly necessary

Perspective for Aquaponic Systems: (Omic) Technologies for Microbial Community Analysis

Aquaponics is the combined production of aquaculture and hydroponics, connected by a water recirculation system. In this productive system, the microbial community is responsible for carrying out the nutrient dynamics between the components. The nutrimental transformations mainly consist in the transformation of chemical species from toxic compounds into available nutrients. In this particular field, the microbial research, the "Omic" technologies will allow a broader scope of studies about a current microbial profile inside aquaponics community, even in those species that currently are unculturable. This approach can also be useful to understand complex interactions of living components in the system. Until now, the analog studies were made to set up the microbial characterization on recirculation aquaculture systems (RAS). However, microbial community composition of aquaponics is still unknown. "Omic" technologies like metagenomic can help to reveal taxonomic diversity. The perspectives are also to begin the first attempts to sketch the functional diversity inside aquaponic systems and its ecological relationships. The knowledge of the emergent properties inside the microbial community, as well as the understanding of the biosynthesis pathways, can derive in future biotechnological applications. Thus, the aim of this review is to show potential applications of current "Omic" tools to characterize the microbial community in aquaponic systems

Ciencias de la Biología y Agronomía

Este volumen I contiene 17 capítulos arbitrados que se ocupan de estos asuntos en Tópicos Selectos de Ciencias de la Biología y Agronomía, elegidos de entre las contribuciones, reunimos algunos investigadores y estudiantes. Se presenta un Estudio Comparativo de los Recursos Hidrológico-Forestales de la Microcuenca de la Laguna de Epatlan, Pue. (1993 a 2014); la Situación Actual de la Mancha de Asfalto en Maíz (Zea mays L.) en los Municipios de Jiquipilas y Ocozocoautla, Chiapas, México; las poblaciones sobresalientes de maíz de la raza Zapalote Chico, en la Región Istmeña de Oaxaca; Se indica el índice de área foliar de cultivo de Chile Poblano mediante dos métodos en condiciones protegidas; Esquivel, Urzúa y Ramírez exploran el efecto de la biofertilización con Azospirillum en el crecimiento y producción de Jitomate; esbozan su artículo sobre la determinación del nivel de Heterosis en híbridos de Maíz para la Comarca Lagunera; una investigación sobre la estabilización de semilla de Solanum lycopersicum durante el almacenamiento y estimulación de la germinación; acotan sobre el CTAB como una nueva opción para la detección de Huanglongbing en cítricos, plantean su evaluación sobre el aluminio y cómo afecta la vida de florero de Heliconia psittacorum; indican sobre el impacto del H-564C, como un híbrido de maíz con alta calidad de proteina para el trópico húmedo de México; presetan su investigación sobre la producción de Piña Cayena Lisa y MD2 (Ananas comosus L.) en condiciones de Loma Bonita, en Oaxaca; acotan sobre el efecto de coberteras como control biológico por conservación contra áfidos en Nogal Pecanero; esbozan sobre la caracterización de cuatro genotipos de Frijol Negro en Martínez de la Torre, Veracruz, México; presentan una caracterización hidroecológica de la microcuenca de Arroyo Prieto, Yuriría, Gto., y alternativas para su restauración ambiental; presentan su investigación sobre el efecto del hongo Beauveria bassiana sobre solubilización de fosfatos y la disponibilidad de fósforo en el suelo; plantean su investigación sobre la Germinación y regeneración in vitro de Epidendrum falcatum LINDL; esbozan su artículo sobre genotipos de frijol negro y su tolerancia a sequía terminal en Veracruz, México

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Estimation précise et robuste de l’état de vieillissement de piles PEMFC par observateurs bayésiens dans le cadre d’une approche basée modèle

PHM (Prognostics and Health Management) represents a real opportunity to improve fuel cell performance and extend the life of fuel cells. This field of study has recently gained much interest. The main goal is to make optimum use of the data measured by all available sensors in order to evaluate the specific indicators of PEMFC ageing and possibly modify the operation of the fuel cell in order to optimize its lifetime. The proposed PhD is part of a model-based approach and willbe based on the expertise in fuel cell modelling developed at the Modelling Laboratory. An on-line estimator of the ageing state of the fuel cell will be developed. The proposed observer presents the characteristic of combining a state model derived from the MePHYSTO fuel cell model with the different data sensors available (voltage, current, pressure, temperature). The envisaged method makes it possible to jointly estimate the state variables, and in particular the ageing state, as well as to update the model parameters. Given the nature of the state variables to be estimated, we will move towards sophisticated observers adapted to non-linear and non-Gaussian problems in order to obtain a solution approaching the optimal Bayesian estimate.Le PHM (Prognostics and Health Management) représente une réelle opportunité en vue d’une amélioration des performances des piles à combustibles et d’une augmentation de leur durée de vie. Ce champs d’étude a récemment beaucoup gagné en intérêt. Le but principal est d’utiliser de manière optimale les données mesurées par l’ensemble des capteurs disponibles afin d’évaluer les indicateurs caractéristiques du vieillissement et éventuellement modifier l’opération de la pile afin d’optimiser sa durée de vie. La thèse proposée se place dans le cadre d’une approche basée modèle et s’appuiera sur l’expertise en modélisation des piles à combustible développées au laboratoire de modélisation LMP. Un estimateur en-ligne de l’état de vieillissement de la pile sera développé. L’observateur envisagé présente la caractéristique de combiner un modèle d’état dérivé à partir du modèle pile MePHYSTO, avec les différentes données capteurs disponibles (tension, courant, pression, température). Il permet d’opérer de manière conjointe une estimation des variables d’état, et en particulier l’état de vieillissement, ainsi que la mise à jour des paramètres du modèle. Etant donné la nature des variables d’état à estimer, on se dirigera vers des observateurs sophistiqués adaptés aux problèmes non-linéaires et non-gaussiens permettant d’obtenir une solution approchant l’estimé Bayésien optimal

Estimation précise et robuste de l’état de vieillissement de piles PEMFC par observateurs bayésiens dans le cadre d’une approche basée modèle

PHM (Prognostics and Health Management) represents a real opportunity to improve fuel cell performance and extend the life of fuel cells. This field of study has recently gained much interest. The main goal is to make optimum use of the data measured by all available sensors in order to evaluate the specific indicators of PEMFC ageing and possibly modify the operation of the fuel cell in order to optimize its lifetime. The proposed PhD is part of a model-based approach and willbe based on the expertise in fuel cell modelling developed at the Modelling Laboratory. An on-line estimator of the ageing state of the fuel cell will be developed. The proposed observer presents the characteristic of combining a state model derived from the MePHYSTO fuel cell model with the different data sensors available (voltage, current, pressure, temperature). The envisaged method makes it possible to jointly estimate the state variables, and in particular the ageing state, as well as to update the model parameters. Given the nature of the state variables to be estimated, we will move towards sophisticated observers adapted to non-linear and non-Gaussian problems in order to obtain a solution approaching the optimal Bayesian estimate.Le PHM (Prognostics and Health Management) représente une réelle opportunité en vue d’une amélioration des performances des piles à combustibles et d’une augmentation de leur durée de vie. Ce champs d’étude a récemment beaucoup gagné en intérêt. Le but principal est d’utiliser de manière optimale les données mesurées par l’ensemble des capteurs disponibles afin d’évaluer les indicateurs caractéristiques du vieillissement et éventuellement modifier l’opération de la pile afin d’optimiser sa durée de vie. La thèse proposée se place dans le cadre d’une approche basée modèle et s’appuiera sur l’expertise en modélisation des piles à combustible développées au laboratoire de modélisation LMP. Un estimateur en-ligne de l’état de vieillissement de la pile sera développé. L’observateur envisagé présente la caractéristique de combiner un modèle d’état dérivé à partir du modèle pile MePHYSTO, avec les différentes données capteurs disponibles (tension, courant, pression, température). Il permet d’opérer de manière conjointe une estimation des variables d’état, et en particulier l’état de vieillissement, ainsi que la mise à jour des paramètres du modèle. Etant donné la nature des variables d’état à estimer, on se dirigera vers des observateurs sophistiqués adaptés aux problèmes non-linéaires et non-gaussiens permettant d’obtenir une solution approchant l’estimé Bayésien optimal

Accurate and robust estimation of the PEM Fuel Cells degradation state with Bayesian observers using a model-based approach

Le PHM (Prognostics and Health Management) représente une réelle opportunité en vue d’une amélioration des performances des piles à combustibles et d’une augmentation de leur durée de vie. Ce champs d’étude a récemment beaucoup gagné en intérêt. Le but principal est d’utiliser de manière optimale les données mesurées par l’ensemble des capteurs disponibles afin d’évaluer les indicateurs caractéristiques du vieillissement et éventuellement modifier l’opération de la pile afin d’optimiser sa durée de vie. La thèse proposée se place dans le cadre d’une approche basée modèle et s’appuiera sur l’expertise en modélisation des piles à combustible développées au laboratoire de modélisation LMP. Un estimateur en-ligne de l’état de vieillissement de la pile sera développé. L’observateur envisagé présente la caractéristique de combiner un modèle d’état dérivé à partir du modèle pile MePHYSTO, avec les différentes données capteurs disponibles (tension, courant, pression, température). Il permet d’opérer de manière conjointe une estimation des variables d’état, et en particulier l’état de vieillissement, ainsi que la mise à jour des paramètres du modèle. Etant donné la nature des variables d’état à estimer, on se dirigera vers des observateurs sophistiqués adaptés aux problèmes non-linéaires et non-gaussiens permettant d’obtenir une solution approchant l’estimé Bayésien optimal.PHM (Prognostics and Health Management) represents a real opportunity to improve fuel cell performance and extend the life of fuel cells. This field of study has recently gained much interest. The main goal is to make optimum use of the data measured by all available sensors in order to evaluate the specific indicators of PEMFC ageing and possibly modify the operation of the fuel cell in order to optimize its lifetime. The proposed PhD is part of a model-based approach and willbe based on the expertise in fuel cell modelling developed at the Modelling Laboratory. An on-line estimator of the ageing state of the fuel cell will be developed. The proposed observer presents the characteristic of combining a state model derived from the MePHYSTO fuel cell model with the different data sensors available (voltage, current, pressure, temperature). The envisaged method makes it possible to jointly estimate the state variables, and in particular the ageing state, as well as to update the model parameters. Given the nature of the state variables to be estimated, we will move towards sophisticated observers adapted to non-linear and non-Gaussian problems in order to obtain a solution approaching the optimal Bayesian estimate