Impacts of the Inclusion of Distributed Generation on Congestion of Distribution Networks and in the Islanding Operation Capability

The growing demand for electricity in the world has led to power systems having to constantly increase their generation capacity and expand their transmission and distribution systems. Consequently, distributed generation has positioned as a technology able to integrate generation close to consumption centers, freeing up capacity in the transport systems, which can be translated into a deferral of investments in network expansion. Therefore, this paper analyzes the impact of the inclusion of distributed generation in the congestion of a typical distribution network and evaluates the potential of providing the island operation capability ancillary service in a section of the system to identify the possible challenges and benefits that the development of this technical support service could have in typical Colombian distribution networks.Universidad Tecnológica de Bolíva

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

Reversible metal-insulator transition in SrIrO_3 ultrathin layers by field effect control of inversion symmetry breaking

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License The authors acknowledge receiving funding from the project To2Dox of FlagERA ERANET Cofund implemented within the European Union's Horizon Europe Program. Work (J.S., C.L., F.M., M.G.-H.) supported by Spanish AEI through grants, PID2020-118078RB-I00 and by Regional Government of Madrid CAM through SINERGICO project Y2020/NMT-6661 CAIRO-CM. G.S.-S. acknowledges financial support from Spanish MCI Grant Nos. RTI2018-099054-J-I00 (MCI/AEI/FEDER, UE) and IJC2018-038164-I. M.C.M. acknowledges the financial support provided by PID2021-122980OB-C55. J.I.B. acknowledges the financial support provided by PID2021-122980OB-C51 and computational support provided by the Red Espanola de Supercomputacion under the projects FI-2018-1-0038 and FI-2019-3-0034.Strong spin-orbit coupling in SrIrO_3 mixes the orbital character of iridium d-bands, resulting in correlated narrow bands and a metal-insulator transition. Here, the electric field generated by ionic liquid gating is used to manipulate the band structure, triggering a reversible control of the metal-insulator transition. SrIrO_3 is a correlated semimetal with narrow t_2g d-bands of strong mixed orbital character resulting from the interplay of the spin-orbit interaction due to heavy iridium atoms and the band folding induced by the lattice structure. In ultrathin layers, inversion symmetry breaking, occurring naturally due to the presence of the substrate, opens new orbital hopping channels, which in presence of spin-orbit interaction causes deep modifications in the electronic structure. Here, we show that in SrIrO_3 ultrathin films the effect of inversion symmetry breaking on the band structure can be externally manipulated in a field effect experiment. We further prove that the electric field toggles the system reversibly between a metallic and an insulating state with canted antiferromagnetism and an emergent anomalous Hall effect. This is achieved through the spin-orbit driven coupling of the electric field generated in an ionic liquid gate to the electronic structure, where the electric field controls the band structure rather than the usual band filling, thereby enabling electrical control of the effective role of electron correlations. The externally tunable antiferromagnetic insulator, rooted in the strong spin-orbit interaction of iridium, may inspire interesting applications in spintronics.Unión Europea. H2020Ministerio de Ciencia e Innovación (MICINN)Comunidad de MadridRed Española de Supercomputación (RES)Depto. de Física de MaterialesFac. de Ciencias FísicasTRUEpu

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women