Asignatura electiva: “Acondicionamiento Natural”

La asignatura Acondicionamiento Natural forma parte de un grupo de materias electivas que se ofrecen en la carrera de arquitecto en la Facultad de Arquitectura y Urbanismo de la Universidad Nacional de Tucumán. Se ubica en un quinto y/o sexto año de la carrera, cumpliendo las veces de una línea de especialización. Tiene asignada una carga horaria de 48 hs.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Evaluación de las proporciones y dimensiones de aventanamientos en viviendas en relación con la iluminación

El objetivo del presente trabajo es evaluar y cuantificar la iluminación natural en un local a través de sus aventanamientos y su correlación con: las ganancias térmicas, la ventilación natural y los aspectos funcionales y estructurales. Para ello, con apoyo informático, se estudian las alternativas de diseño de los aventanamientos de una vivienda unifamiliar de carácter social, sus proporciones y dimensiones en relación con las propias del local al que pertenece y las ganancias termolumínicas que genera su disposición en la envolvente.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Experiencias de extensión en viviendas de escasos recursos en el sector rural de Tucumán

El objetivo del presente trabajo es presentar una experiencia realizada con alumnos y docentes de la Facultad de Arquitectura y Urbanismo de la Universidad Nacional de Tucumán, en relación con instalaciones sanitarias en viviendas rurales de la zona del Valle Calchaquí de la provincia de Tucumán, con incorporación de sistemas de calentamiento de agua solar.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Diagnóstico y escenario del sector de la vivienda rural en zonas de la provincia de Tucumán

El informe que se presenta corresponde a un avance del Proyecto de Investigación que desarrolla el Grupo de Trabajo, cuyo título es "Definición de Pautas de Diseño Bioambiental y Tecnológicas Apropiadas Para el Sector Vivienda en Zona Rural De La Provincia De Tucumán". Sus objetivos entre otros tienden a: Delimitar o las variables tipológicas - constructivas, a las cuales deben responder las viviendas que se realicen basándose en consideraciones bio-climáticas, de tecnología apropiadas y factores socioeconómicos. Trabajando en las zonas rurales de la provincia de Tucumán donde actúa el proyecto U.N.I.R. (Una Nueva Iniciativa Rural) que encara la Universidad Nacional de Tucumán, el Gobierno de la Provincia de Tucumán y las Comunidades del Valle Calchaquí, Trancas y Estribaciones del Aconquija. Caracterizar la arquitectura y materiales zonales, determinado la importancia de los distintos usos y aplicación. Identificar los factores climáticos de diseño de los distintos asentamientos rurales. Conocer las condiciones socioeconómicas, culturales de los asentamientos seleccionados. Elaboración de pautas de diseño y aplicaciones tecnológicas apropiadas Generar recursos humanos adecuados en los organismos de aplicación (IPVDU), para la continuidad de este proceso y puesta en práctica de sus resultados y avances, motivando e incentivando el interés en el uso racional de la energía en el diseño y uso de la viviendaFacultad de Arquitectura y Urbanism

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

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population