3D printed scaled setup for smoke transport analysis in a subterranean passenger platform

In this work, the study of smoke fire transportation inside of a subway passenger platform is presented. The study includes a set of numerical simulations to observe the behavior of the smoke inside the platform. Two smoke transport simulations using the FDS program are also included. Subsequently, the development of a 3D - 1:100 scale model is described and it was used to perform an experimental observation of the phenomenon. The model was built by using a 3D printer which allowed to include more architectural details of the real scenario. The inclusion of these details allowed to observe qualitative similarity between the results of the simulation and the experimental work. Although there are clear differences between what could happen in a real scenario and what was observed in the scale model, it was identified that the model is an important complement to the simulations. In addition to the simulations, the use of this type of 3D models allows the observation of the phenomenon by different specialists such as firefighters, policeman, medical personnel, etc., in the same place and its intention is to provide a more interactive tool to the observation group, increasing the time devoted to the development of contingency actions and reducing the costs associated with the logistics of a real simulacrum. The model allows to better identify the strengths, opportunities, weaknesses and threats of the contingency procedures developed by the safety and hygiene groups and to make their corresponding adjustments if necessary.Peer Reviewe

Soluble RAGE as a severity marker in community acquired pneumonia associated sepsis

<p>Abstract</p> <p>Background</p> <p>Community-acquired pneumonia (CAP) is considered the most important cause of death from infectious disease in developed countries. Severity assessment scores partially address the difficulties in identifying high-risk patients. A lack of specific and valid pathophysiologic severity markers affect early and effective sepsis therapy. HMGB-1, sRAGE and RAGE have been involved in sepsis and their potential as severity markers has been proposed. The aim of this study was to evaluate HMGB-1, RAGE and sRAGE levels in patients with CAP-associated sepsis and determine their possible association with clinical outcome.</p> <p>Method</p> <p>We evaluated 33 patients with CAP-associated sepsis admitted to the emergency room and followed in the medical wards. Severity assessment scores (CURB-65, PSI, APACHE II, SOFA) and serologic markers (HMGB-1, RAGE, sRAGE) were evaluated on admission.</p> <p>Results</p> <p>Thirty patients with a diagnosis of CAP-associated sepsis were enrolled in the study within 24 hours after admission. Fourteen (46.6%) had pandemic (H1N1) influenza A virus, 2 (6.6%) had seasonal influenza A and 14 other diagnoses. Of the patients in the study group, 16 (53.3%) had a fatal outcome. ARDS was observed in 17 (56.6%) and a total of 22 patients had severe sepsis on admission (73%). The SOFA score showed the greatest difference between surviving and non-surviving groups (<it>P </it>= .003) with similar results in ARDS patients (<it>P </it>= .005). sRAGE levels tended to be higher in non-surviving (<it>P </it>= .058) and ARDS patients (<it>P </it>= .058). Logistic regression modeling demonstrated that SOFA (<it>P </it>= .013) and sRAGE (<it>P </it>= .05) were the only variables that modified the probability of a fatal outcome.</p> <p>Conclusion</p> <p>The association of elevated sRAGE with a fatal outcome suggests that it may have an independent causal effect in CAP. SOFA scores were the only clinical factor with the ability to identify surviving and ARDS patients.</p

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Nitrogen incorporation in Al2O3 thin films prepared by pulsed ultrasonic sprayed pyrolysis

The electrical characteristics and the chemical composition profiles determined by XPS and SIMS for aluminum oxide thin films deposited by pulsed ultrasonic spray pyrolysis are reported. The films were deposited on c-Si at 550 ºC using a chemical solution of aluminum acetylacetonate as source of aluminum and N,NDimethylformamide as solvent, in addition a H2O-NH4OH mist was supplied simultaneously during deposition to improve the overall properties of these films. The results show that there is nitrogen incorporation in the films at the interface with the Si substrate. There is also a clear migration of silicon into the deposited film. The thickness of the films was in the range of 30 nm. Infrared spectroscopy also shows the presence of Si-O bonds. The dielectric constant for these films was higher than 8 and their interface trap density at midgap was in the 1010 eV-1cm-2 range.InvestigaciónINSTITUTO POLITECNICO NACIONA

Intestinal obstruction by deep enteric endometriosis: case report and literature review

Deep endometriosis (DE) is an uncommon cause of bowel obstruction; preoperative diagnosis is a challenging task due to its rarity and pathological confirmation. Surgery is the appropriate treatment and complications are common. A 26-year-old Latin female was admitted to emergency department with 72 hours history of abdominal pain associated with inability to pass stool or gas, vomiting and nausea. Abdominal distention and pain without acute abdomen signs. Laboratory tests reported normal. Abdominal contrast-enhanced computed tomography showed distal small bowel obstruction. Patient underwent exploratory laparotomy with segmental resection bearing ileal strictures and Brook´s ileostomy was performed. Postoperative course of patient was uneventful and after pathology report treatment with dienogest was established. DE remains challenging entity to treat, medical treatment can reduce symptoms, but surgical resection is required. Bowel resection is reserved for mayor stenosis lesions. Anastomotic leakage is frequent. Surgery represents the definitive treatment for bowel obstruction by DE. Resection improves pain and intestinal symptoms. Recurrence, stenosis, and anastomotic leakage rates vary across the studies. Surgical and medical treatment should be considered

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Seroprevalencia de marcadores de infecciones transmisibles por vía transfusional en banco de sangre de Colombia

OBJETIVO: Determinar la seroprevalencia de marcadores de infecciones transmisibles por vía transfusional. MÉTODOS: Estudio transversal con fuente de información secundaria, basada en los resultados de pruebas biológicas en los donantes de un banco de sangre de Medellín, Colombia, de 2007 a 2010. Se determinó la seroprevalencia de los marcadores de infección y se compararon según sexo y tipo de donante a través de análisis de frecuencias, chi cuadrado, Fisher y razones de prevalencia. RESULTADOS: La población de base estuvo conformada por 65.535 donantes de los cuales, 3,3% presentaran al menos una prueba biológica positiva. El marcador más prevalente en las pruebas del banco de sangre fue sífilis (1,2%), seguido de tripanosomiasis (1,0%), virus de la hepatitis C (VHC) (0,6%), virus de la inmunodeficiencia humana (VIH) (0,5%) y virus de la hepatitis B (VHB) (0,2%). Con base en el laboratorio de referencia se halló una prevalencia de 0,6% para sífilis, 0,1% para VHB y 0% para VHC, VIH y Chagas. Se hallaron diferencias estadísticas en la prevalencia de VHB y sífilis según sexo y tipo de donante. CONCLUSIONES: Los resultados son coherentes con las prevalencias dadas por la Organización Panamericana de la Salud (OPS) y se pueden correlacionar con la prevalencia mundial de las infecciones transmisibles por via transfusional. Los resultados hallados en las pruebas del banco de sangre posibilitan la disminución del riesgo transfusional pero limitan la optimización de recursos al excluir donantes clasificados como falsos positivos

Development of a Tool to Measure the Clinical Response to Biologic Therapy in Uncontrolled Severe Asthma: The FEV1, Exacerbations, Oral Corticosteroids, Symptoms Score

Background: There is a lack of tools to quantify the response to monoclonal antibodies (mAbs) holistically in severe uncontrolled asthma patients. Objective: To develop a valid score to assist specialists in this clinical context. Methods: The score was developed in four subsequent phases: (1) elaboration of the theoretical model of the construct intended to be measured (response to mAbs); (2) definition and selection of items and measurement instruments by Delphi survey; (3) weight assignment of the selected items by multicriteria decision analysis using the Potentially All Pairwise RanKings of All Possible Alternatives methodology using the 1000minds software; and (4) face validity assessment of the obtained score. Results: Four core items, with different levels of response for each, were selected: severe exacerbations, oral corticosteroid use, symptoms (evaluated by Asthma Control Test), and bronchial obstruction (assessed by FEV1 percent predicted). Severe exacerbations and oral corticosteroid maintenance dose were weighted most heavily (38% each), followed by symptoms (13%) and FEV1 (11%). Higher scores in the weighted system indicate a better response and the range of responses runs from 0 (worsening) to 100 (best possible response). Face validity was high (intraclass correlation coefficient of 0.86). Conclusions: The FEV1, exacerbations, oral corticosteroids, symptoms score allows clinicians to quantify response in severe uncontrolled asthma patients who are being treated with mAbs

New Insight on the Increasing Seismicity during Tenerife's 2004 Volcanic Reactivation

Starting in April 2004, unusual seismic activity was observed in the interior of the island of Tenerife (Canary Islands, Spain) with much evidence pointing to a reawakening of volcanic activity. This seismicity is now analyzed with techniques unprecedented in previous studies of this crisis. The 200 earthquakes located onshore during 2004 and 2005 have been classified by cross-correlation, resulting in a small number of significant families. The application of a relative location algorithm (hypoDD) revealed important features about the spatial distribution of the earthquakes. The seismic catalogue has been enhanced with more than 800 additional events, detected only by the closest seismic station. These events were assigned to families by correlation and as a consequence their hypocentral location and magnitude were estimated by comparing them to the earthquakes of each family. The new catalogue obtained by these methods identifies two major seismogenic zones, one to the northwest and the other to the southwest of the Teide-Pico Viejo complex and having a separation of at least 10 km between them. These regions alternate their activity starting in January 2004, i.e., three months earlier than previously thought. We propose a simple model based on the results of this work which will also concur with all previous geophysical and geochemical studies of the 2004 crisis. The model proposes a single magma intrusion affecting the central part of the island with lateral dikes driven by the rifts to the northwest and southwest.Comment: 20 pages, 15 figure