Application of AHP and corrective factors for the determination of best available techniques and emission limit values at installation level: A case study in four cement installations

After the adoption of the Industrial Emissions Directive in the European Union, requirements regarding emission limit values were made legally binding, and the competent authorities shall ensure that they do not exceed the emission levels associated with the best available techniques. This paper describes a two-stage method for the determination of best available techniques (BAT) and emission limit values (ELV) at installation level, applicable to all industrial sectors covered by the IED and to all pollutants to air and to water. This new method may support competent authorities to implement BAT conclusions into the IED permits. The determination of BAT is based on the use of analytical hierarchy process, while the ELV is determined by using corrective factors based on consumption and emission indicators from the installation. The method is applied in a case study on four existing cement installations in the region of Andalucia (Spain)

Transferring the Integrated Pollution Prevention and Control (IPPC) Approach and Best Available Techniques (BAT) Concepts to Egypt, Tunisia and Morocco

The principles introduced by the Directive Concerning Integrated Pollution Prevention and Control (IPPC) (currently known as the Industrial Emissions Directive (2010/75/EU)) are innovative and have raised interests in the framework of the literature debate on environmental regulation. Many articles describe and analyze the application of the Directive in European countries, but only a few articles focus on how the interest for the Directive's principles, including the integrated approach, have reached countries outside the European Union. This paper aims to contribute to this topic, describing the experience of the authors in carrying out an EU-funded project on transferring the IPPC approach and Best Available Techniques (BAT) concepts to three Arab countries, i.e. , Egypt, Morocco and Tunisia. The paper presents the experience referring to two sectors falling within the scope of the IPPC Directive: the textile and dairy sector. The objectives, methodologies, activities and experiences are described and can be used and valorized to integrate the IPPC approach and BAT concepts in the current environmental legislation of the three countries

Eco-innovative practices for sustainable consumption and production: what are the possible benefits for companies ?

The paper aims to present some eco-innovative practices regarding Sustainable Consumption and Production (SCP). The study also focuses on potential benefits for the actors who implement these practices, mainly with reference to companies. After a literature review on the actual importance of SCP and on the effects of eco-innovation tools and policies on companies, authors present the developed eco-innovation practices in three focus areas related to sustainable consumption and production. The aim of the study is to contribute to literature studies on SCP with the development of eco-innovative practices resulting by the integration of existing tools, by pointing out and valorizing their potentials and synergies. These practices have been pointing out in the framework of the international European project. Three focus areas are involved by the practices: sustainability of products and services, sustainability of production processes and sustainable management of industrial areas. Authors developed four eco innovative practices resulting from the integration of 15 existing tools. These practices offer many opportunities to many actors, mainly companies and public authorities, in order to achieve environmental and competitive benefits and implement eco-innovation principles with a cooperative and shared approach

Renal profile of patients treated with elvitegravir/ cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine: 120-week results from a real-world cohort

[Abstract] Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate (EVG/c/FTC/TAF) and dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) are currently available for HIV patients. Objectives: This study evaluated modifications in the renal safety profile in a large real-world cohort of patients who had received EVG/c/FTC/TAF or DTG/ABC/3TC. Methods: A retrospective observational study of HIV-infected patients who received EVG/c/FTC/TAF or DTG/ABC/3TC between March 2015 and June 2019 at a reference hospital in north-western Spain was conducted. Epidemiological, clinical, immunovirological data and information regarding antiretroviral therapy were recorded. The statistical differences between treatments were calculated. Results: A total of 457 patients were evaluated, 266 using EVG/c/FTC/TAF and 191 using DTG/ABC/3TC. Up to week 120, serum creatinine improved in both study groups among experienced patients (EVG/c/FTC/TAF 1.01±0.24 vs 0.91±0.19, p<0.001; DTG/ABC/3TC 1.08±0.24 vs 1.02±0.31, p<0.001), while in naïve patients serum creatinine remained stable compared with baseline. Statistically significant differences were found in serum creatinine when comparing both treatments at week 48 in experienced (0.94±0.21 vs 1.09±0.28, p<0.001) and naïve patients (0.89±0.16 vs 1.06±0.20, p=0.001), and among experienced patients at week 120 (0.91±0.19 vs 1.02±0.31, p=0.015) for the EVG/c/FTC/TAF and DTG/ABC/3TC groups, respectively. During the follow-up, 39 patients in EVG/c/FTC/TAF and 33 in DTG/ABC/3TC (p=0.449) discontinued treatment. The main reason for stopping treatment was adverse events, which were similar in both groups. Conclusions: During the follow-up, patients experienced changes that were not clinically relevant in both treatment groups. Differences in renal events were not found

Metodologías grupales en el aula: desarrollo de procesos innovadores y aprendizaje continuado

El proyecto aborda la aplicación de metodologías grupales en el desarrollo y en el final de los procesos formativos. Recoge experiencias de 40 profesores de 6 universidades madrileñas

From the sierra to the lowlands: new data on the settlement of the Barbanza Peninsula from Prehistoric to Medieval times

Procédese á revisión dos traballos de prospección previa na serra do Barbanza e ampliados aos montes de Macenda e Bealo na procura de asentamentos gandeiros/pastorís, no curso deses traballos localizáronse ademáis un interesante xacemento de cronoloxía calcolítca e un castro inédito. Asemade, dáse conta dos resultados das intervencións en dous xacementos, un de carácter gandeiro que presenta un palimpsesto estrutural e cronolóxico (Río Barbanza), e outro relacionado con sistemas de control territorial (Outeiro da Torre).We review the survey works carried through in the district of Barbanza, now extended to the parishes of Macenda and Bealo in search of livestock / pastoral settlements. In the course of these explorations a Copper Age site was discovered and, nearby, a previously unknown hillfort. An account is given of the results of the digging in two sites; one related to husbandry tasks, that presents a structural and chronological palimpsest (Rio Barbanza); and another more, related to territorial control systems (Outeiro da Torre)

Comprehensive description of clinical characteristics of a large systemic Lupus Erythematosus Cohort from the Spanish Rheumatology Society Lupus Registry (RELESSER) with emphasis on complete versus incomplete lupus differences

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple organ involvement and pronounced racial and ethnic heterogeneity. The aims of the present work were (1) to describe the cumulative clinical characteristics of those patients included in the Spanish Rheumatology Society SLE Registry (RELESSER), focusing on the differences between patients who fulfilled the 1997 ACR-SLE criteria versus those with less than 4 criteria (hereafter designated as incomplete SLE (iSLE)) and (2) to compare SLE patient characteristics with those documented in other multicentric SLE registries. RELESSER is a multicenter hospital-based registry, with a collection of data from a large, representative sample of adult patients with SLE (1997 ACR criteria) seen at Spanish rheumatology departments. The registry includes demographic data, comprehensive descriptions of clinical manifestations, as well as information about disease activity and severity, cumulative damage, comorbidities, treatments and mortality, using variables with highly standardized definitions. A total of 4.024 SLE patients (91% with ≥4 ACR criteria) were included. Ninety percent were women with a mean age at diagnosis of 35.4 years and a median duration of disease of 11.0 years. As expected, most SLE manifestations were more frequent in SLE patients than in iSLE ones and every one of the ACR criteria was also associated with SLE condition; this was particularly true of malar rash, oral ulcers and renal disorder. The analysis-adjusted by gender, age at diagnosis, and disease duration-revealed that higher disease activity, damage and SLE severity index are associated with SLE [OR: 1.14; 95% CI: 1.08-1.20 (P < 0.001); 1.29; 95% CI: 1.15-1.44 (P < 0.001); and 2.10; 95% CI: 1.83-2.42 (P < 0.001), respectively]. These results support the hypothesis that iSLE behaves as a relative stable and mild disease. SLE patients from the RELESSER register do not appear to differ substantially from other Caucasian populations and although activity [median SELENA-SLEDA: 2 (IQ: 0-4)], damage [median SLICC/ACR/DI: 1 (IQ: 0-2)], and severity [median KATZ index: 2 (IQ: 1-3)] scores were low, 1 of every 4 deaths was due to SLE activity. RELESSER represents the largest European SLE registry established to date, providing comprehensive, reliable and updated information on SLE in the southern European population

Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study

Background: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. Methods: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero (2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. Findings: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16-0·55; p<0·0001, compared with the VIR-N1-Storm group). 106 (26%) of 403 patients in the VIR-N1-Low group died within 90 days (OR for death 0·39, 95% CI 0·26-0·57; p<0·0001, compared with the VIR-N1-Storm group). Interpretation: The presence of a so-called viral storm is associated with increased all-cause death in patients admitted to the intensive care unit with severe COVID-19. Preventing this viral storm could help to reduce poor outcomes. Viral storm could be an enrichment marker for treatment with antivirals or purification devices to remove viral components from the blood.This work was supported by grants from the Instituto de Salud Carlos III (FONDO-COVID19, COV20/00110, CIBERES, 06/06/0028; AT), Proyectos de Investigación en Salud (PI19/00590; JFB-M), Miguel Servet (CP20/00041; DdG-C), Sara Borrell (CD018/0123; APT), and Predoctorales de Formación en Investigación en Salud (FI20/00278; AdF). We also received funds from Programa de Donaciones Estar Preparados, UNESPA (Madrid, Spain), and from the Canadian Institutes of Health Research (CIHR OV2–170357; DJK and JFB-M), Research Nova Scotia, Li-Ka Shing Foundation (DJK), and finally by a Research Grant 2020 from ESCMID (APT). COV20/00110, PI19/00590, CP20/00041, CD018/0123, FI20/00278 were co-funded by European Regional Development Fund and European Social Fund (A way to make Europe, and Investing in your future). We thank the IRB-Lleida Biobank 119 (B.0000682) and Plataforma Biobancos PT17/0015/0027 in Lleida, the Hospital Clinic Barcelona (HCB)-IDIBAPS biobank in Barcelona, and the National DNA Bank and the Hospital Universitario de Salamanca biobank (both in Salamanca) for their logistical support with sample processing and storage. We are indebted to the Fundació Glòria Soler for its contribution and support to the COVIDBANK of HCBIDIBAPS Biobank. This work was not supported by any pharmaceutical company or other agency.S