International Benchmarking in Electricity Distribution: A Comparison of French and German Utilities

In this paper we present an international cross-country benchmarking analysis for utility regulation of France and Germany, the two largest electricity distribution countries in Europe. We examine the relative performance of 99 French and 77 German distribution companies operating within two different market structures. This paper applies several parametric benchmarking approaches to assess the relative technical efficiency of the utilities, such as deterministic Corrected Ordinary Least Squares (COLS) and Stochastic Frontier Analysis (SFA). Our base model uses the number of employees as a proxy for labor and network length as a proxy for capital as inputs. Units sold and the numbers of customers are considered as outputs. Our model variations and extensions analyze the effect of different characteristics of distribution areas (e.g. population density and the choice of investment in underground cable network). We find that utilities operating in urban areas feature higher efficiency scores and that investment in underground cables increase the technical efficiency of the distribution utilities.International benchmarking, electricity distribution, parametric efficiency analysis

Identificación de variantes del gen KRAS asociadas a cáncer colorrectal en la población panameña

El Cáncer colorrectal (CCR) es la 3ra neoplasia más común en el mundo. En Panamá, el CCR ocupa el 4to lugar de incidencia atendido en el Instituto Oncológico Nacional (ION). La tasa de cáncer por cada 100 mil habitantes en Panamá se incrementó de 8.3 a 8.8 en los últimos tres años. La vía de señalización del Receptor del factor de crecimiento epidérmico (EGFR) ha sido el centro del desarrollo de nuevas dianas moleculares, ya que se sobreexpresa en el 80% de los casos de CCR. Cetuximab. es un anticuerpo monoclonal que se une específicamente al EGFR bloqueando su fosforilación con una actividad efectiva como terapia de primera y segunda línea para el Cáncer colorrectal metastásico (CCRm), solo o en combinación con terapia tradicional. El gen KRAS (Kirsten rat sarcoma viral oncogene) codifica una proteína implicada en la transducción de señales activada por EGFR. KRAS pierde la actividad GTPasa (Guanosin trifosfatasa) al estar mutado el gen (principalmente en codones 12 y 13 del exón 2), que conlleva a una pérdida de la regulación de la proliferación celular y a la trasformación tumoral del tejido. Se realizó un estudio para detectar las mutaciones más frecuentes en el gen KRAS, en una población total de 118 pacientes, provenientes del ION, con diagnóstico de CCRm. y un promedio de edad de 63 años. Se evaluaron 7 mutaciones, en los codones 12 y 13 del exón 2 del gen KRAS, en ADN extraído de muestras de tejido de resección tumoral embebidos en parafina. La detección de mutaciones se realizó mediante PCR en tiempo real usando el KRAS RGQ PCR Kit. Se detectaron mutaciones en el gen KRAS en 43 pacientes (36.75%), siendo la mutación más frecuentes Glyl2Asp (7.69%). El 16.95% de los pacientes estudiados eran menores de 50 años. La frecuencia de mutaciones encontradas en este trabajo es similar a algunas de las reportadas a nivel mundial y su detección utilizando la técnica de PCR en Tiempo Real es una herramienta valiosa como parámetro pronóstico en el CCRm y para el direccionamiento del tratamiento

Propuesta de un programa psicoterapéutico de estimulación afectiva en las relaciones familiares de los pacientes diabéticos.

Factores psicológicos que influyen en las personas que adolescen diábetes -- Características y componentes de las emociones -- Aspectos físicos del paciente con diábetes -- Autoestima -- Estados de ánimo bajo -- Influencia del estrés en la salud

Centro comunitario de capacitación “RUWASUNCHIS”, para el A.H. San Pablo Mirador – Manchay, Pachacamac

La ONG venía realizando sus actividades en un espacio destinado para el PRONOEI, Programa No Escolarizado de Educación Inicial, cedido temporalmente por la comunidad. A finales del 2014 la comunidad informó que les cedían permanentemente el terreno. Esto generó que se planteara la construcción de una nueva sede que cuente con todos los espacios y servicios necesarios para el desarrollo de las actividades de Ruwasunchis. Este nuevo espacio debe de ser un centro comunitario de desarrollo para la población de San pablo Mirador donde se puedan realizar las diferentes actividades y talleres que se requieran para su desarrollo. Adicionalmente encontramos que la infraestructura donde vienen desempeñando sus actividades es un espacio que no fue planificado ya que no cuenta con los requerimientos mínimos para facilitar el aprendizaje. Las aulas cuentan con una iluminación deficiente casi nula, no existe ventilación, el mobiliario existente es inadecuado y en las áreas exteriores no se cuenta con la implementación deportiva ni áreas verdes

Identificación del fenotipo inflamatorio del asma mediante métodos no invasivos

Premi Extraordinari de Doctorat concedit pels programes de doctorat de la UAB per curs acadèmic 2017-2018La tesis doctoral que presento es el resultado del trabajo realizado en el Servicio de Neumología del Hospital de la Santa Creu i Sant Pau de Barcelona y del Institut de Recerca Biomèdica de Sant Pau (IIB Sant Pau), siguiendo las normativas de la Universitat Autònoma de Barcelona para su presentación como compendio de publicaciones. El estudio de la inflamación bronquial en el asma, se ha convertido en una herramienta valiosa para el diagnóstico, control y predicción de respuestas terapéuticas. En los últimos años ha aumentado el interés en los métodos que permitan evaluar de una forma no invasiva la inflamación de la vía aérea. Entre los métodos no invasivos descritos usados en la práctica clínica para evaluar la inflamación de la vía aérea figuran: el recuento de células inflamatorias en el esputo inducido y la fracción exhalada de óxido nítrico (FeNO). La temperatura del aire exhalado y la nariz electrónica se plantean como nuevas herramientas de medición de la inflamación bronquial y del control del asma. La línea de investigación desarrollada tuvo como objetivo fundamental mejorar los conocimientos sobre los fenotipos inflamatorios del asma a través de métodos no invasivos. Está basada en tres proyectos. El primero, es un proyecto clínico cuyos resultados muestran que existen un alto porcentaje de pacientes con disociación entre los resultados de la FeNO y de los eosinófilos en el esputo inducido y que cursan con características clínicas e inflamatorias diferenciales. Los otros dos proyectos permiten conocer la utilidad en el asma de dos nuevos métodos no invasivos como lo son, la temperatura del aire exhalado (TAE) y el reconocimiento de patrones de compuestos orgánicos volátiles mediante la "nariz electrónica". Estos trabajos aportaron como resultados principales que en el caso de la TAE, no parece que éste sea un método que proporcione una información clínica útil puesto que no se encontró ninguna correlación entre este método y el grado de control del asma, la gravedad de la enfermedad, la obstrucción bronquial, o la inflamación bronquial. Por otro lado, los resultados del tercer estudio sí que fueron alentadores, puesto que de manera significativa, el uso de la nariz electrónica en un entorno clínico habitual permitió discriminar con fiabilidad los diferentes fenotipos inflamatorios bronquiales en pacientes con asma. Así pues, los resultados de esta tesis sirven como fundamento del estudio y aplicabilidad de diversos métodos no invasivos en el asma.This doctoral thesis is the result of the work done in the Service of Respiratory Medicine of the Hospital de la Santa Creu i Sant Pau in Barcelona and the Institute of Biomedical Research of Sant Pau (IIB Sant Pau), following the regulations of the Universitat Autònoma de Barcelona. The study of bronchial inflammation in asthma has become a valuable tool for its diagnosis, monitoring and prediction of therapeutic responses. In recent years, there has been an increased interest in methods of noninvasive evaluation of the airway inflammation. The described non-invasive methods used in the clinical practice to assess airway inflammation include the inflammatory cell counts in induced sputum and the fractional exhaled nitric oxide (FeNO). The exhaled breath temperature and the electronic nose device are considered to be new tools for measuring airway inflammation and control of asthma. The line of the developed research had as a main goal to improve the knowledge of inflammatory phenotypes of asthma through non-invasive methods. It is based on three projects. The first (1) is a clinical project that shows a high percentage of patients with dissociation between the results of the FeNO and eosinophils in induced sputum, presenting clinical and inflammatory differential characteristics. The other two projects provide an insight into the utility of two non-invasive diagnostic methods: 2) the exhaled breath temperature (EBT) and 3) the recognition of the patterns formed by organic volatile compounds using the electronic nose device. The second study does not support the usefulness of the EBT plateau, because no correlation was found between EBT and control of asthma, severity of disease, bronchial obstruction or bronchial inflammation. Furthermore, the results of the third study were encouraging since the using of an e-nose device in a regular clinical setting can reliably discriminate different inflammatory asthma phenotypes among patients with persistent asthma. Thus, the results of this thesis disclosed the applicability of various non-invasive methods performed in routine clinical practice

Identification of Two Eosinophil Subsets in Induced Sputum from Patients with Allergic Asthma According to CD15 and CD66b Expression

Allergic asthma; Eosinophil subsets; Induced sputumAsma alérgica; Subconjuntos de eosinófilos; Esputo inducidoAsma al·lèrgica; Subconjunts d'eosinòfils; Esput induïtTwo subsets of eosinophils have been described: resident eosinophils with homeostatic functions (rEOS) in healthy subjects and in patients with nonallergic eosinophilic asthma, and inflammatory eosinophils (iEOS) in blood and lung samples from patients with allergic asthma. We explored if it would be possible to identify different subsets of eosinophils using flow cytometry and the gating strategy applied to induced sputum. We conducted an observational cross-sectional single-center study of 62 patients with persistent allergic asthma. Inflammatory cells from induced sputum samples were counted by light microscopy and flow cytometry, and cytokine levels in the supernatant were determined. Two subsets of eosinophils were defined that we call E1 (CD66b-high and CD15-high) and E2 (CD66b-low and CD15-low). Of the 62 patients, 24 were eosinophilic, 18 mixed, 10 paucigranulocytic, and 10 neutrophilic. E1 predominated over E2 in the eosinophilic and mixed patients (20.86% vs. 6.27% and 14.42% vs. 4.31%, respectively), while E1 and E2 were similar for neutrophilic and paucigranulocytic patients. E1 correlated with IL-5, fractional exhaled nitric oxide, and blood eosinophils. While eosinophil subsets have been identified for asthma in blood, we have shown that they can also be identified in induced sputum.This research was supported by the Spanish Allergy and Clinical Immunology Society (SEAIC) by means of a grant awarded in the call of 2017 (reference 17/06) and a BRN—Fundació Pla i Armengol grant in the call of 2018. The funds provided contributed to the acquisition of the material necessary to carry out the study, but the collaborating entities had no role in the analysis or interpretation of the results

Characteristics of Induced-Sputum Inflammatory Phenotypes in Adults with Asthma : Predictors of Bronchial Eosinophilia

The objectives of this study were, for patients attending a specialist asthma clinic at a tertiary care hospital, to determine, from sputum induction (SI), proportions of bronchial inflammatory phenotypes, demographic, clinical and functional characteristics of each phenotype, and the most accessible non-invasive inflammatory marker that best discriminates between phenotypes. Included were 96 patients with asthma, attending a specialist asthma clinic at a tertiary care hospital, who underwent testing as follows: SI, spirometry, fractional exhaled nitric oxide (FeNO), blood eosinophilia, total immunoglobulin E (IgE), and a skin prick test. SI phenotypes were 46.9% eosinophilic, 33.3% paucigranulocytic, 15.6% neutrophilic, and 4.2% mixed. No significantly different clinical or functional characteristics were observed between the phenotypes. A positive correlation was observed between SI eosinophilia and both emergency visits in the last 12 months (p = 0.041; r = 0.214) and FeNO values (p = 0.000; r = 0.368). Blood eosinophilia correlated with SI eosinophilia (p = 0.001; r = 0.362) and was the best predictor of bronchial eosinophilia, followed by FeNO, and total blood IgE (area under the receiver operating characteristic curve (AUC-ROC) 72%, 65%, and 53%, respectively), although precision was only fair. In consultations for severe asthma, the most frequent phenotype was eosinophilic. Peripheral blood eosinophilia is a reliable marker for discriminating between different bronchial inflammatory phenotypes, is useful in enabling doctors to select a suitable biologic treatment and so prevent asthma exacerbation, and is a better predictor of bronchial eosinophilia than FeNO and IgE values

Clinical Impact of Electronic Monitoring Devices of Inhalers in Adults with Asthma or COPD: A Systematic Review and Meta-Analysis

We conducted a systematic review and meta-analysis to gain insight into the characteristics and clinical impact of electronic monitoring devices of inhalers (EMDs) and their clinical interventions in adult patients with asthma or COPD. The search included PubMed, Web of Science, Cochrane, Scopus and Embase databases, as well as official EMDs websites. We found eight observational studies and ten clinical trials, assessing a wide range of clinical outcomes. Results from the meta-analysis on adherence to inhalers in a period over three months were favourable in the EMD group (fixed effects model: SMD: 0.36 [0.25-0.48]; random effects model SMD: 0.41 [0.22-0.60]). An exploratory meta-analysis found an improvement in ACT score (fixed effect model SMD: 0.25 [0.11-0.39]; random effects model: SMD: 0.47 [−0.14-1.08]). Other clinical outcomes showed mixed results in the descriptive analyses. The findings of this review highlight the benefits of EMDs in the optimization of adherence to inhaled therapy as well as the potential interest in other clinical outcomes

Concordance of opinions between patients and physicians and their relationship with symptomatic control and future risk in patients with moderate-severe asthma

Differences between the opinions of patients and physicians on the impact of asthma are common. We hypothesised that patient-physician discordance may negatively affect asthma outcome. A total of 2902 patients (61% women, mean age 47 years) with moderate-severe asthma and 231 physicians participated in a prospective study. At the baseline visit, data on demographics, clinical variables, degree of asthma control according to the Asthma Control Test (ACT), basic spirometry and the Hospital Anxiety and Depression Scale (HADS) were collected and an ad hoc questionnaire was completed that allowed the degree of concordance between doctors and patients to be assessed. A scheduled telephone call after 3 months was used to elicit the ACT score and the future risk of asthma. At the final visit at 6 months, the following data were recorded: ACT score, spirometry, HADS score and an ad hoc questionnaire to assess the agreement between the doctor and the patient. Changes in study variables according to patient-physician concordance or discordance were analysed. The rate of patient-physician discordance was 27.2%, with overestimation of disease impact by the physician in 12.3% and underestimation in 14.9%. Patient-physician opinion discordance, particularly in the case of physicians underestimating the impact of asthma, showed worse results with statistically significant differences in ACT score, a higher percentage of patients with poor asthma control and lower HADS scores. The need for hospital and emergency department admissions was also higher. Patient-physician opinion discordance may be contributing to lower symptomatic control and increased future risk, with a higher impact when physicians underestimate the impact of asthma on their patients