Ultrasound Strain Elastography Reliability in the Assessment of the Plantar Fascia and Its Relationship with the Plantar Thickness in Healthy Adults: An Intra and Interobserver Reliability Study in Novice Evaluators

Partial funding for open access charge: Universidad de Málag

Diseño y construcción de una herramienta neumática orientada al cambio de amortiguadores con espirales para el taller de Ingeniería Automotriz de la ESPOCH.

El desarrollo del presente trabajo de titulación tiene como objetivo, diseñar y construir una herramienta neumática orientada al cambio de amortiguadores con espirales para el taller de la escuela de ingeniería automotriz. Se planteó como problema, el gran riesgo y demora de comprimir espirales con herramientas convencionales. Para su diseño, se partió con un análisis de laboratorio, donde se sometieron a compresión en la máquina universal diferentes tipos de espirales de autos existentes en el mercado, con lo cual se pudo determinar la fuerza máxima necesaria para comprimirlos. Una vez obtenida esta fuerza, se inició con el diseño conceptual de la herramienta, en el cual se pudieron evaluar las diferentes alternativas para la realización de este proyecto, eligiéndose la numero 1, que contaba con las mejores cualidades. A continuación se procedió a la elección de los elementos neumáticos mediante el uso del software FESTO FLUIDSIM 3.6, ya seleccionados los elementos se inició con el dimensionamiento del cilindro neumático, basándose en los datos obtenidos del compresor de aire existente en el taller de Ingeniería Automotriz y de la fuerza máxima obtenida en las pruebas de laboratorio. Posteriormente se inició con el modelado de la herramienta con ayuda del software SOLIDWORKS 2015; una vez obtenidas las medidas necesarias, se procedió a realizar un análisis estático, tanto de la estructura base como de cada elemento para garantizar un factor de seguridad mayor a 1.3, mediante el uso del software ANSYS WORKBENCH R16.1 .Con todos los cálculos y medidas necesarias se construyó la herramienta neumática , la cual fue probada, realizando perfectamente la función requerida, logrando comprimir toda clase de espirales sin contratiempos y realizando la operación requerida 3 veces más rápido que una herramienta convencional, brindando seguridad y el mínimo esfuerzo para el operario. Se recomienda mantener lubricadas las barras guía para evitar ruidos y desgaste.The aim of this present research is to design and build a pneumatic tool oriented to the change of shock absorbers with coil springs for the School of Automotive Engineering repair shop. As a problem, there is a great risk and delay of compressing coil springs with conventional tools. For its design, it was started with a laboratory analysis. Different types of cars coil springs on the market were subjected to compression in the universal machine. As a result, it was possible to determine the maximum force necessary to compress them. Once this force has been obtained, it began with the conceptual design of the tool. Therefore, it was possible to evaluate the different alternatives for the execution of this project. In consequence, the number 1 had the best qualities. The pneumatic elements were then selected using the FESTO FLUIDSIM 3.6 software. Once the elements have been selected, it was started with the pneumatic cylinder measurement, based on the data obtained from the air compressor in the Automotive Engineering repair shop and the maximum force obtained in the laboratory tests. Subsequently, the modeling of the tool was started with the help of SOLIDWORKS 2015 software. Once the necessary measures were obtained, a static analysis was carried out on both the basic structure and each element to guarantee a safety factor greater than 1.3, using the ANSYS WORKBENCH R16.1 software. The pneumatic tool was built with all the necessary calculations and measurements which was tested, perfectly performing the required function, compressing all kinds of coil springs without problems and performing the required operation 3 times faster than a conventional tool, as well as providing safety and minimum effort for the operator. It is recommended that the guide bars are keep lubricated to avoid noise and wear

Herramientas para la implementación del Sistema Integrado de Gestión en la empresa INVERSIONES HC RAAD S.A.S, sector Terciario

Tabla 1. Lista de chequeo, Figura 1. Análisis Pestel, Tabla 2. Mapa de Riesgos, Figura 2. Matriz Vester, Figura 3. Resultado matriz vester, Figura 4. Modelo Mendelow, Figura 6. Proceso productivo de bienes o servicios, Tabla 3. Necesidades y expectativas pertinentes y los requisitos para el sistema integrado de gestión -SIG, Figura 7. Jerarquía de procesos, Figura 5. PHVA, Tabla 4. REQUISITOS COMUNES, Tabla 5. REQUISITOS COMUNES, Tabla 6. REQUISITOS COMUNES, Tabla 7. REQUISITOS NO COMUNES, Tabla 8. Recursos y Operación, Tabla 9. Norma UNE 66117, Tabla 10. Norma UNE 66117, Tabla 11. Norma UNE 66117, Figura 9. VideoEl SIG se implementará en todos los procesos de la organización con el objetivo de guiar a la empresa a ser un referente a nivel nacional por la prestación eficiente de servicios de saneamiento básico; garantizando bajo la conformidad de la estructura del HSEQ la promoción de la mejora continua, permitiendo el cumplimiento de la normatividad ambiental y de SST vigente y aportando al cumplimiento de los Objetivos de Desarrollo Sostenible acordados por Colombia en la Agenda 2030The SIG will be implemented in all the processes of the organization with the objective of guiding the company to be a benchmark at the national level for the efficient provision of basic sanitation services; guaranteeing under the conformity of the HSEQ structure the promotion of continuous improvement, allowing compliance with current environmental and OSH regulations and contributing to compliance with the Sustainable Development Goals agreed by Colombia in the 2030 Agend

Ready To Drink

El presente trabajo de investigación se ha elaborado con la finalidad de implementar una nueva idea de negocio innovadora en la ciudad de Lima Metropolitana. Básicamente nuestro trabajo de investigación contiene algunos pasos previos antes de dar a conocer nuestro producto en el mercado. Por ello, se realizó una investigación de mercado con el objetivo de tener un mayor conocimiento acerca de cómo se mueve el mercado Limeño y sobre los productos y servicios que el ciudadano limeño necesita en la actualidad. Los resultados obtenidos después haber hechos entrevistas, encuestas y amplias charlas con personas que formen parte de nuestro público objetivo, nos indicaron que: aquellas personas que acostumbran salir a reuniones con sus amigos o van a discotecas, buscan adquirir bebidas alcohólicas que sean de calidad y de buen sabor, también optan por adquirir bebidas que tengan precios aceptables de acuerdo a la ocasión. Es por ello, que después de todas esta investigaciones e hipótesis realizadas, nuestro equipo de trabajo optó por concretar este nuevo emprendimiento de una bebida con Pisco a base de frutas exóticas (Aguaymanto y Mora), pero con una presentación diferente al resto de productos que forman parte de nuestra competencia, nuestra bebida tendrá una presentación de 5 litros, con envases de vidrio, ya que buscamos tener un compromiso con el cuidado del medio ambiente y de nuestros consumidores, además nuestra bebida tendrá una preparación artesanal. Asimismo, nuestras ventas se realizarán a través de nuestras páginas de Facebook e Instagram.This research work has been prepared with the purpose of implementing a new innovative business idea in the city of Metropolitan Lima. Basically, our research work contains some preliminary steps before making our product known in the market. For this reason, a market research was carried out with the aim of having a better knowledge about how the Limean market moves and about the products and services that the Limean citizen needs today. The results obtained after having conducted interviews, surveys and extensive talks with people who are part of our target audience, indicated that: Those people who usually go out to mee- tings with their friends or go to discos, seek to purchase alcoholic beverages that are of quality and good taste, they also choose to purchase drinks that have acceptable prices according to the occasion. That´s why, after all these investigations and hypotheses carried out, our work team chose to specify this new undertaking of a Pisco drink based on exotic fruits (Aguaymanto and Mora), but with a different presentation than the rest of the products that They are part of our competition, our drink will have a presentation of 5 liters, with glass containers, since we seek to have a commitment to caring for the environment and our consumers, in addition our drink will have a handmade preparation. Likewise, our sales will be made through our Facebook and Instagram pages.Trabajo de investigació

Respiratory viruses detected in Mexican children younger than 5 years old with community-acquired pneumonia: a national multicenter study

Background: Acute respiratory infections are the leading cause of mortality in children worldwide, especially in developing countries. Pneumonia accounts for 16% of all deaths of children under 5 years of age and was the cause of death of 935 000 children in 2015. Despite its frequency and severity, information regarding its etiology is limited. The aim of this study was to identify respiratory viruses associated with community-acquired pneumonia (CAP) in children younger than 5 years old. Methods: One thousand four hundred and four children younger than 5 years of age with a clinical and/or radiological diagnosis of CAP in 11 hospitals in Mexico were included. Nasal washes were collected, placed in viral medium, and frozen at �70 C until processing. The first 832 samples were processed using the multiplex Bio-Plex/Luminex system and the remaining 572 samples using the Anyplex multiplex RT-PCR. Clinical data regarding diagnosis, clinical signs and symptoms, radiographic pattern, and risk factors were obtained and recorded. Results: Of the samples tested, 81.6% were positive for viruses. Respiratory syncytial virus (types A and B) was found in 23.7%, human enterovirus/rhinovirus in 16.6%, metapneumovirus in 5.7%, parainfluenza virus (types 1–4) in 5.5%, influenza virus (types A and B) in 3.6%, adenovirus in 2.2%, coronavirus (NL63, OC43, 229E, and HKU1) in 2.2%, and bocavirus in 0.4%. Co-infection with two or more viruses was present in 22.1%; 18.4% of the samples were negative. Using biomass for cooking, daycare attendance, absence of breastfeeding, and co-infections were found to be statistically significant risk factors for the presence of severe pneumonia. Conclusions: Respiratory syncytial virus (types A and B), human enterovirus/rhinovirus, and metapneumovirus were the respiratory viruses identified most frequently in children younger than 5 years old with CAP. Co-infection was present in an important proportion of the children

Enfermedades crónicas

Adherencia al tratamiento farmacológico y relación con el control metabólico en pacientes con DM2Aluminio en pacientes con terapia de reemplazo renal crónico con hemodiálisis en Bogotá, ColombiaAmputación de extremidades inferiores: ¿están aumentando las tasas?Consumo de edulcorantes artificiales en jóvenes universitariosCómo crecen niños normales de 2 años que son sobrepeso a los 7 añosDiagnóstico con enfoque territorial de salud cardiovascular en la Región MetropolitanaEfecto a corto plazo de una intervención con ejercicio físico, en niños con sobrepesoEfectos de la cirugía bariátrica en pacientes con síndrome metabólico e IMC < 35 KG/M2Encuesta mundial de tabaquismo en estudiantes de profesiones de saludEnfermedades crónicas no transmisibles: Consecuencias sociales-sanitarias de comunidades rurales en ChileEpidemiología de las muertes hospitalarias por patologías relacionadas a muerte encefálica, Chile 2003-2007Estado nutricional y conductas alimentarias en adolescentes de 4º medio de la Región de CoquimboEstudio de calidad de vida en una muestra del plan piloto para hepatitis CEvaluación del proceso asistencial y de resultados de salud del GES de diabetes mellitus 2Factores de riesgo cardiovascular en población universitaria de la Facsal, universidad de TarapacáImplicancias psicosociales en la génesis, evolución y tratamiento de pacientes con hipertensión arterial esencialInfarto agudo al miocardio (IAM): Realidad en el Hospital de Puerto Natales, 2009-2010Introducción de nuevas TIC y mejoría de la asistencia a un programa de saludNiños obesos atendidos en el Cesfam de Puerto Natales y su entorno familiarPerfil de la mortalidad por cáncer de cuello uterino en Río de JaneiroPerfil del paciente primo-consultante del Programa de Salud Cardiovascular, Consultorio Cordillera Andina, Los AndesPrevalencia de automedicación en mujeres beneficiarias del Hospital Comunitario de Til-TiPrevalencia de caries en población preescolar y su relación con malnutrición por excesoPrevalencia de retinopatía diabética en comunas dependientes del Servicio de Salud Metropolitano Occidente (SSMOC)Problemas de adherencia farmacológica antihipertensiva en población mapuche: Un estudio cualitativoRol biológico de los antioxidantes innatos en pacientes portadores de VIH/SidaSobrepeso en empleados de un restaurante de una universidad pública del estado de São Paul

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013