2-(methylamido)pyridine–borane : a tripod κ3N,H,H-ligand in trigonal bipyramidal rhodium(I) and iridium(I) complexes with an asymmetric coordination of its BH3 group

The complexes [M(κ3N,H,H-mapyBH3)(cod)] (M = Rh, Ir; HmapyBH3 = 2-(methylamino)pyridine–borane; cod = 1,5-cyclooctadiene), which contain a novel anionic tripod ligand coordinated to the metal atom through the amido N atom and through two H atoms of the BH3 group, have been prepared by treating the corresponding [M2(μ-Cl)2(cod)2] (M = Rh, Ir) precursor with K[mapyBH3]. X-ray diffraction studies and a theoretical QTAIM analysis of their electron density have confirmed that the metal atoms of both complexes are in a very distorted trigonal bipyramidal coordination environment, in which two equatorial sites are asymmetrically spanned by the H–B–H fragment. While both 3c–2e BH–M interactions are more κ1H (terminal sigma coordination of the B–H bond) than κ2H,B (agostic-type coordination of the B–H bond), one BH–M interaction is more agostic than the other and this difference is more marked in the iridium complex than in the rhodium one. This asymmetry is not evident in solution, where the cod ligand and the BH3 group of these molecules participate in two concurrent dynamic processes of low activation energies (VT-NMR and DFT studies), namely, a rotation of the cod ligand that interchanges its two alkene fragments (through a square pyramidal transition state) and a rotation of the BH3 group about the B–N bond that equilibrates the three B–H bonds (through a square planar transition state). While the cod rotation has similar activation energy in 2 and 3, the barrier to the BH3 group rotation is higher in the iridium complex than in the rhodium one

Supercritical water oxidation for energy production by hydrothermal flame as internal heat source. Experimental results and energetic study

Producción CientíficaThe cooled wall reactor has been modified by adding an additional upper outlet of products at 500–700 °C to improve energy recovery and make possible energy generation with the supercritical water oxidation of different waste. Experimental and modeling results of the performance of this new reactor configuration are presented as well as a theoretical analysis of the energy recovery of the reactor compared to other supercritical water oxidation reactors. Different flow distributions were tested to find the best elimination conditions. Total organic carbon removal over 99.99% was obtained at room injection temperatures, when the fraction of products leaving the reactor in the upper effluent is lower than 70% of feed flow. The performance of the reactor was tested with the oxidation of a recalcitrant compound such as ammonia. Removals higher than 99% of were achieved at temperatures near 700 °C. The behavior of the reactor working with feeds with up to 2.5% wt Na2SO4 could be injected in the reactor without plugging problems. Upper effluent always presented a concentration of salt lower than 30 ppm. Theoretical energetic analysis shows that the performance of this reactor is superior to other designs obtaining a maximum power efficiency of 27% (0.339 kW/kg-feed).Ministerio de Economía, Industria y Competitividad - FEDER (Proyect CTQ2013-44143-R

ESAMEN: Descripción y medida de la estructura de los servicios de atención comunitaria en salud mental

La estructura básica de los servicios de salud mental orientados a la comunidad se compone de cuatro tipos de dispositivos: las unidades de salud mental en los hospitales generales, los hospitales de día, los centros de salud mental y los centros de rehabilitación psicosocial, complementados con el apoyo social aportado por los servicios sociales especializados. Debido a que los dispositivos pueden acoger actividades muy diversas que pueden implicar a varios sectores de la Administración y del Tercer Sector simultánea o sucesivamente, y también debido a su implantación geográfica irregular, la gestión de los servicios de salud mental es un asunto complejo sobre el que todavía no se ha alcanzado un acuerdo. En el momento actual disponemos de varios instrumentos de medida y clasificación de los servicios para facilitar su evaluación, pero ninguno de ellos ha logrado popularizarse.El objetivo de este trabajo consiste en dar cuenta de un nuevo instrumento, ESAMEN, para describir y medir la estructura de los servicios de salud mental comunitaria, y someterlo a un estudio de viabilidad. Este método no se basa en la clasificación de los dispositivos como se ha hecho hasta ahora, sino en la clasificación de las 32 actividades o módulos de atención que se practican en ellos.Para este estudio de viabilidad, se remitió una encuesta a los coordinadores de 380 dispositivos de salud mental de Andalucía, Euskadi y Madrid, solicitándoles información sobre el área de cobertura y el número de profesionales de cada uno de los módulos dispensados en su dispositivo. Con estos datos se elaboraron indicadores de capacidad (expresada como el tiempo máximo de dedicación por habitante y unidad de tiempo) y alcance (proporción del total de habitantes que es potencialmente beneficiaria del módulo). Las tablas de resultados muestran con claridad y sencillez la estructura de los servicios, valorando cada módulo según su capacidad y alcance poblacional, evidenciando desequilibrios en su distribución, permitiendo comparaciones entre áreas y comunidades, y dejando la puerta abierta al refinamiento de los indicadores y a la inclusión de nuevos módulos de actividad que se puedan desarrollar en el futuro

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Desarrollo de reactores de tanque para oxidación en agua supercrítica con llama hidrotermal como fuente de energía interna

La oxidación en agua supercrítica (OASC) es una tecnología prometedora para la destrucción de residuos, pero su comercialización se ha retrasado por los problemas de corrosión y el depósito de sal asociados a esta tecnología así como por su alto consumo energético. el uso de reactores con una llama hidrotermal como fuente de calor contribuyen a superar muchos de los desafíos que presenta esta tecnología. La inyección de los reactivos sobre una llama hidrotermal puede permitir la posibilidad de inyectar la alimentación en el reactor a temperaturas bajas, evitando los problemas de corrosión y taponamiento en un sistema de precalentamiento. También la cinética es mucho más rápida lo que permite destrucciones completas de los contaminantes en tiempos de residencia inferiores a 1 segundo. Junto a esto, las altas temperaturas asociadas a las llamas hidrotermales contribuyen a una mejor recuperación de la energía del calor liberado en la reacción para una posible producción de electricidad A través de esta tesis, diferentes estudios sobre el proceso de oxidación en agua supercrítica con llamas hidrotermales se llevan a cabo con el fin de desarrollar un nuevo diseño de reactor para oxidación en agua supercrítica capaz de inyectar alimentaciones a temperatura ambiente, eliminar desechos que contienen sales inorgánicas y a optimizar el uso energético del proceso.Departamento de Ingeniería Química y Tecnología del Medio Ambient