Estimación de la Turbidez Atmosférica Usando el Modelo IQC en el Área Metropolitana de Huancayo – Perú

Por naturaleza el cielo no es totalmente limpio, sin embargo cuando la concentración de partículas es mayor a la normal puede atenuar con mayor intensidad la de radiación solar. Por lo que la cantidad de radiación solar que llega hasta la superficie terrestre depende en gran medida de la turbidez atmosférica. De esta manera, el objetivo de este trabajo fue estimar los valores óptimos diarios de la turbidez atmosférica y parámetros radiativos de superficie tales como: el coeficiente de turbidez de Angstrom (β), exponente de longitud de onda de Angstrom (α), el albedo de dispersión simple (ω0) y dispersión ascendente (Fc). Mediante mediciones de radiación solar incidente (global, directa y difusa), realizadas entre junio y julio del 2019 en la Provincia de Huancayo-Perú, se realizó los cálculos de los parámetros antes presentados. El modelo numérico usado para calcular los componentes de radiación solar directa, difusa y global, es el modelo numérico de parametrización de banda ancha para cielo despejado; IQC (Iqbal, 1993) el cual se basa en información sinóptica. Los resultados muestran valores de β y α de 0.16 y 1.3 respectivamente, sugiriendo una atmósfera parcialmente contaminada

Is lumbar facet joint tropism developmental or secondary to degeneration? An international, large-scale multicenter study by the AOSpine Asia Pacific Research Collaboration Consortium

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Critical values of facet joint angulation and tropism in the development of lumbar degenerative spondylolisthesis: an international, large-scale multicenter study by the AOSpine Asia Pacific Research Collaboration Consortium

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Sense of entitlement to support for the reconciliation of employment and family life

This article explores young European women and men’s expectations of support - from the state and employers - for reconciling paid employment and family life. It is based on a qualitative study employing focus groups with young women and men in Norway, Sweden, Portugal, Ireland and the UK. Drawing on the concept of sense of entitlement, derived from social justice theory, it was expected that the type of welfare state and ‘gender contract’ that young adults have experienced will influence their sense of entitlement to support for work and family life. Findings indicate that participants perceived their entitlement to state and employer support differently across national context. However this is moderated by gender, parental and occupational status, and particularly by awareness of provisions in other countries in the case of state support, while perceived entitlement to employer support varies according to the specific policy considered, gender and perception of benefits to employers. Some implications for public policy makers and employers are discussed

The dis/comfort of white British nationhood: encounters, otherness and postcolonial continuities

Recent work on the affective dimensions of nationhood, identity and belonging has often overlooked discomfort in favour of positive experiences of sameness and security. Contrary to this tendency, this paper, based on interview narratives produced with white British middle-class people in the suburbs of London, examines the role of discomfort in experiences of nationhood, as well as the nature and meaning of that discomfort. In the first part of thepaper, I demonstrate how nationhood becomes in and through uncomfortable encounters with other people, places and objects. Then, in the second part, I show how, for some, the experience of becoming national in encounters with the ‘other’ is itself experienced uncomfortably in the context of a postcolonial Britain where people are expected to ‘love themselves as different’. On the one hand, the paper challenges the idea of privileged national belonging as wholly comfortable. Yet, the analysis also exposes the relative comfort of white British people’s nationhood. The paper offers important insight into the uneven and hierarchical nature of contemporary nationhood and highlights the value of attending to the entanglement of comfort and discomfort in work on affective nationalism

Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic

Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020–June 19, 2020) and late 2020 (June 20, 2020–December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p <.001). Crude 28-day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46–0.98, p =.016). Between the early and late periods, the use of corticosteroids (≥6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p <.001 and 50/571 [8.8%] vs. 213/402 [52.2%], p <.001, respectively), and the use of hydroxychloroquine and IL-6/IL-6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p <.001 and 73/571 [12.8%] vs. 5/402 [1.2%], p <.001, respectively). Mortality among SOTR hospitalized for COVID-19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study

COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study

Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p =.02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p =.032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0–2.6, p =.04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0–11.3, p =.05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality

Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel.

BACKGROUND: The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS: We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS: Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS: Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice

Trainee and Program Director Perspectives on Meaningful Patient Attribution and Clinical Outcomes Data

BackgroundThe Accreditation Council for Graduate Medical Education specifies that trainees must receive clinical outcomes and quality benchmark data at specific levels related to institutional patient populations. Program directors (PDs) are challenged to identify meaningful data and provide them in formats acceptable to trainees.ObjectiveWe sought to understand what types of patients, data/metrics, and data delivery systems trainees and PDs prefer for supplying trainees with clinical outcomes data.MethodsTrainees (n = 21) and PDs (n = 12) from multiple specialties participated in focus groups during academic year 2017-2018. They described key themes for providing clinical outcomes data to trainees.ResultsTrainees and PDs differed in how they identified patients for clinical outcomes data for trainees. Trainees were interested in encounters where they felt a sense of responsibility or had autonomy/independent decision-making opportunities, continuity, or learned something new; PDs used broader criteria including all patients cared for by their trainees. Both groups thought trainees should be given trainee-level metrics and consistently highlighted the importance of comparison to peers and/or benchmarks. Both groups found value in "push" and "pull" data systems, although trainees wanted both, while PDs wanted one or the other. Both groups agreed that trainees should review data with specific faculty. Trainees expressed concern about being judged based on their patients' clinical outcomes.ConclusionsTrainee and PD perspectives on which patients they would like outcomes data for differed, but they overlapped for types of metrics, formats, and review processes for the data