Ultrasonic radiation influence on the bioadsorbent characteristics of citrus (citrus x lemon) & (citrus x sinensis)

Of all the materials used as adsorbents, activated charcoal is the most popular as it is excellent for reducing/eliminating a wide variety of contaminants. This capacity is mainly due to its structural characteristics that give it a large surface area. However, it has several disadvantages. The most important are that the adsorbent material is quite expensive as is its regeneration. For this reason, more economical absorbents have been sought, highlighting the study of adsorption phenomena in some types of biomass as adsorbents. Bioadsorption is considered a viable alternative to the physical-chemical methods currently used for the recovery or removal of heavy metals dissolved in liquid effluents. Its main attraction, from an industrial point of view, is its low cost due to the great abundance, easy to obtain and low price of the bioadsorbent material. Bioadsorption is very effective in treating metal concentrations below 100 mg/L, where the application of physical-chemical methods is neither technically nor economically feasible. One of these materials of interest is citrus peels, because, due to their abundance as a waste product of the food industries, they are hardly reused and currently have little economic value. However, these residues have a low adsorption capacity, so both physical and chemical modifications are required to increase their adsorption properties. This study compares the characteristics of orange and lemon peels undergoing a physical-chemical treatment with ultrasonic radiation assistance and the optimization of experimental conditions to obtain useful bioadsorbents in discontinuous processes (batch)Postprint (published version

Planeamiento estratégico para el sector construcción del departamento de La Libertad

El objetivo principal de esta tesis en Planeamiento Estratégico del Sector Construcción del Departamento de La Libertad es contribuir y promover la competitividad de las empresas del sector. Planteamos como visión que para el año 2020, el sector construcción del Departamento de la Libertad contará con empresas competitivas que ejecutarán proyectos sostenibles e incrementarán su rentabilidad en un 5% minimizando sus costos con una gestión ordenada de sus procesos. Para el logro de nuestra visión nos planteamos objetivos de corto plazo y de largo buscando impulsar la competitividad comprendida en lograr construcciones de calidad, eficiencia en la ejecución de los proyectos, incrementar el nivel de rentabilidad, alineando al Departamento de la Libertad en un PLANDET (*), iniciativa que ya está planteada en la provincia de Trujillo y que proponemos implementar en todas las provincias del Departamento de La Libertad. Para el desarrollo de la competitividad del sector Construcción, planteamos como necesaria la participación de diversos actores supervisores como el Gobierno regional, Municipalidades y los diversos Colegios Profesionales vinculados al sector. En la elaboración del análisis externo del sector se identificó las oportunidades de desarrollo que genera el sector construcción, destacando las expectativas de construcciones de conjuntos habitacionales, centros comerciales, inversión en infraestructura promovidas por el gobierno regional; en el análisis externo también se han identificado como posibles amenazas la recesión económica mundial. En el análisis interno y con la ayuda de especialistas profesionales en el sector se identificó que las empresas son lideradas por gerentes con buena capacidad de decisión gerencial, así también estas empresas cuentan con buena posición financiera. Se identificó además algunas debilidades como poca de los procesos constructivos, inadecuada certificación del personal de construcción y cuidado de la seguridad e higiene laboral en el lugar de trabajo, además de la poca supervisión por parte de los entes reguladores de los proyectos de construcción. Finalmente luego del análisis de planeamiento estratégico, planteamos como estrategias las siguientes: Que para el 2020, el 100% de las empresas constructoras con facturación superior a 151 UIT tendrán certificaciones de calidad ISO 9000, erradicar las construcciones que no cuenten con las licencias y permisos de la municipalidad o que no se encuentren contemplados en el PLANDET; todos los procesos de licitaciones públicas de construcción serán supervisados por una comisión independiente de los colegios profesionales relacionados al sector a través de normas para promover transparencia entre las empresas.The aim of this thesis about Strategic Planning of the Construction Sector in La Libertad Department is to contribute and promote competitiveness in all the construction companies. It is our vision that in 2020 the Construction Sector in La Libertad will have competitive companies which will perform sustainable projects and will increase their profitability in 5% by minimizing costs with better procedures. Short term and long term objectives were set to achieve our vision. All of them are seeking to encourage competitiveness which includes: to have quality construction, to execute projects efficiently and to increase profitability, therefore La Libertad will be aligned into a Territorial Development Plan (PLANDET). This Territorial Development Plan is already set in Trujillo city and our proposal is to implement it in all the districts of La Libertad Department. For reaching our vision we set long term and short term objectives to encourage competitiveness which means: To have quality constructions, efficiency in projects execution, increasing profitability; aligning La Libertad Department in a Territorial Development Plan, initiative that is already set in Trujillo city and we propose to implement in all districts of La Libertad Department. For the construction sector competitiveness development, we consider as necessary the participation of many actors like the Regional Government and many professional associations related to construction sector. In the elaboration of external analysis were identified development opportunities that the construction sector generates, emphasizing construction expectations of malls and infrastructure investments promoted by the regional government; on the other hand, possible threats were also identified like international crisis and a real state bubble. The internal analysis was performed with the collaboration of professionals in the construction sector. We identified that construction companies have good financial positions and are leading by managers with good management skills and capabilities. We also identified some weaknesses like inappropriate construction procedures, lack of certification of the workforce, deficient occupational health and safety, inadequate work environment, and poor surveillance from authorities. Finally and after the strategic planning analysis, we set as strategies the following: In 2020, the 100% of construction companies that sell above 151 UIT, will have ISO certification; constructions without license or outside PLANDET will be eradicated; all tender public procedures will be supervised by an independent commission of the professional associations related to the sector, through rules which promote transparency among construction companies.Tesi

Combined Immunoglobulin Free Light Chains Are Novel Predictors of Cardiovascular Events in Patients With Abdominal Aortic Aneurysm.

Abdominal aortic aneurysm (AAA) is characterised by the presence of B cells and immunoglobulins in the aortic wall, mainly in the adventitia. Kappa (κ) and lambda (λ) free light chains (FLCs) are produced from B cells during immunoglobulin synthesis. This study investigated the presence and prognostic value of combined FLCs (cFLCs or summed κ and λ) in patients with AAA. cFLCs were analysed by a turbidimetric specific assay in tissue conditioned media from AAA samples (n = 34) compared with healthy aortas (n = 34) from France and in plasma samples from patients with AAA (n = 434) and age matched controls (n = 104) selected from the Viborg Vascular (VIVA) AAA screening trial in Denmark. t test, logistic regression, and Cox regression were used to test whether plasma cFLCs serve as a marker for AAA presence and whether cFLCs were predictive of death, major adverse cardiovascular events (MACE), or major adverse lower limb events (MALE). Increased cFLC levels were detected in the AAA adventitial layer compared with the AAA medial layer and healthy media layer (13.65 ± 3.17 vs. 6.57 ± 1.01 vs. 0.49 ± 0.09 mg/L, respectively, p < .050). The upper tertile of plasma cFLCs was independently associated with AAA presence after correcting for confounders (odds ratio [OR] 7.596, 95% confidence intervals [CI] 3.117 - 18.513; p < .001). Of 434 patients with AAA, 89 (20.5%) died, 104 (24.0%) suffered MACE, and 63 (14.5%) suffered MALE, during a five year follow up. In univariable analysis, the cFLC upper tertile was associated with a higher risk of death, MACE, and MALE (p < .001 for all). After adjustment for confounders, cFLCs remained an independent predictor of all cause mortality (hazard ratio [HR] 4.310, 95% CI 2.157 - 8.609; p < .001), MACE (HR 2.153, 95% CI 1.218 - 3.804; p = .008), or MALE (HR 3.442, 95% CI 1.548 - 7.652; p = .002) for those in the upper tertile. Increased cFLCs are observed in adventitial tissue of patients with AAA, indicating local activation of B cells. Plasma cFLC levels are an independent predictor of death, MACE, and MALE in patients with AAA.This study was funded by the Spanish MINECO (PID2019- 106814RB-I00 and PGC2018-097019-B-I00), la Caixa Foundation (HR17-00247), CAM (S2017/BMD-3673), and Fondo de Investigaciones Sanitarias ISCiii-FEDER (PI19/ 00128).S

Knowledge, attitudes and preventive practices of primary health care professionals towards alcohol use: A national, cross-sectional study

Introduction Primary care (PC) professionals' knowledge about alcohol use has been identified as one of the barriers PC providers face in their clinic. Both PC professionals' level of training and attitude are crucial in the clinical practice regarding alcohol use. Objective To evaluate the knowledge, attitude, and preventive practices of Spanish PC physicians and nurses towards alcohol use. Design An observational, descriptive, cross-sectional, multi-center study. Methodology Location: PC centers of the Spanish National Health System (NHS). Participants: PC physicians and nurses selected randomly from health care centers, and by sending an e-mail to semFYC and SEMERGEN members. Healthcare providers completed an online survey on knowledge, attitude, and follow-up recommendations for reducing alcohol intake. A descriptive, bivariate, and multivariate statistical analysis was conducted (p<0.05). Results Participants: 1, 760 healthcare providers completed the survey (75.6% [95% CI 73.5-77.6] family physicians; 11.4% [95% CI 9.9-12.9] medical residents; and 12.5% [95% CI 10.9-14.1] nurses), with a mean age of 44.7 (SD 11.24, range: 26-64, 95% CI: 47.2-48.2). Knowledge was higher in family physicians (p<0.001), older professionals (Spearman's r = 0.11, p<0.001), and resident trainers (p<0.001). The PC professional most likely to provide advice for reducing alcohol use was: a nurse (p<0.001), female (p = 0.010), between 46 and 55 years old (p <0.001). Conclusions PC providers' knowledge and preventive practices regarding alcohol use are scarce, hence specific training strategies to increase their knowledge and improve their attitude and skills with regard to this health problem should be considered a healthcare policy priority

Knowledge, attitudes and preventive practices of primary health care professionals towards alcohol use: A national, cross-sectional study.

Introduction Primary care (PC) professionals' knowledge about alcohol use has been identified as one of the barriers PC providers face in their clinic. Both PC professionals’ level of training and attitude are crucial in the clinical practice regarding alcohol use. Objective To evaluate the knowledge, attitude, and preventive practices of Spanish PC physicians and nurses towards alcohol use. Design An observational, descriptive, cross-sectional, multi-center study. Methodology Location: PC centers of the Spanish National Health System (NHS). Participants: PC physicians and nurses selected randomly from health care centers, and by sending an e-mail to semFYC and SEMERGEN members. Healthcare providers completed an online survey on knowledge, attitude, and follow-up recommendations for reducing alcohol intake. A descriptive, bivariate, and multivariate statistical analysis was conducted (p<0.05). Results Participants: 1,760 healthcare providers completed the survey (75.6% [95% CI 73.5–77.6] family physicians; 11.4% [95% CI 9.9–12.9] medical residents; and 12.5% [95% CI 10.9–14.1] nurses), with a mean age of 44.7 (SD 11.24, range: 26–64, 95% CI: 47.2–48.2). Knowledge was higher in family physicians (p<0.001), older professionals (Spearman's r = 0.11, p<0.001), and resident trainers (p<0.001). The PC professional most likely to provide advice for reducing alcohol use was: a nurse (p <0.001), female (p = 0.010), between 46 and 55 years old (p <0.001). Conclusions PC providers’ knowledge and preventive practices regarding alcohol use are scarce, hence specific training strategies to increase their knowledge and improve their attitude and skills with regard to this health problem should be considered a healthcare policy priority.post-print507 K

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic