Preliminary design of a demonstration heat pump/AC unit

Análisis y diseño del sistema y todos los componentes necesarios para implementar un equipo que aúne la capacidad de funcionar como aire acondicionado y bomba de calor teniendo en cuenta las características y los principios basados en termodinámica, fluidomecánica y transferencia de calor

Otitis externa maligna causada por Pseudomonas aeruginosa resistente a ciprofloxacino

  Malignant otitis externa is an inflammatory condition caused by Pseudomonas infection of the ear canal with involvement of the temporal bone. It is usually seen in elderly patients with diabetes or patients with immunosuppression. Characteristically the patient presents severe pain and an external canal often edematous, inflammed, and coated with exudate. If the condition is not promptly treated lower cranial nerve palsies can develop due to subtemporal extension of the infection. Treatment consists of prolonged administration (i.e. 6-8 weeks) of an anti-pseudomonal antibiotic (usually oral ciprofloxacin), but recently the emergence of resistant strains have been described.La otitis externa maligna es una enfermedad inflamatoria causada por la infección por Pseudomonas del canal auditivo con afectación del hueso temporal. Generalmente, aparece en sujetos ancianos con diabetes o pacientes con inmunosupresión. Característicamente, el paciente presenta dolor intenso y un canal auditivo externo edematoso, inflamado y cubierto con exudado. Si la infección no se trata a tiempo puede aparecer parálisis de nervios craneales debido a la extensión de la infección al hueso temporal. El tratamiento consiste en la adminis- tración prolongada (p. ej., 6-8 semanas) de un antibiótico anti-Pseudomonas (generalmente ciprofloxacino oral), pero recientemente se ha descrito la aparición de resistencias

Lack of didactic materials affect students the learning Grammar process in fourth year’s students at Maria Auxiliadora nightly shift

We know there is a low academic performance in the country, we consider very important to research about one of the most important sub skill in the process of learning English because we consider that exist real problem in the students when they use grammar. This research work was done in Maria Auxiliadora high school nightly shift Granada, in 4th year. A long this work we define the grammar word and the different step of the grammar. We try to explain how important is the grammar sub skill in the English language and also we wrote some comments of some knowledge in this research work. This work is also composed by a short definition of the “language”, and how to present and explain grammar in the classroom. The grammatical mistakes are also presented in this research and so on. This research work has the goal to help teachers to improve the learning of grammar into the classroom so we give extra information about some techniques that the teacher could use in the classroom. This work explain two concepts that were taught by two American teachers they are teaching grammar as process and teaching grammar as form. The successful of these methods ending in a new one which is called “Grammaring”. The presentation of the student’s experiences and opinion is presented in this work, as a form to give you general information about the group that was selected to do this research work

Análisis de la brecha de ocupación por género en España

Este Trabajo de Fin de Grado aborda un análisis del mercado laboral español desde unaperspectiva de género. Más en concreto, ahonda en la organización sociocultural quedetermina las diferencias de género en el mercado de trabajo y desgrana susconsecuencias.En su vertiente más cuantitativa, estima el impacto económico que para las mujeres tieneel modo en el que acceden (o no) al mercado de trabajo a través de las variablespertinentes. A este respecto, es crucial su mayor dedicación a los cuidados familiares ylas labores del hogar, derivada de un arraigado contexto cultural. Las dificultades (ya nolegales, sino culturales y sociales) que las mujeres encuentran todavía a la hora deenfrentarse al mercado laboral se traducen en una menor tasa de actividad y una mayortasa de paro.A partir de la Encuesta de Población Activa que resulta de los microdatos del InstitutoNacional de Estadística, muestra que esta diferencia en la ocupación se debe por una partea las diferencias en las características de los individuos y por otra a la discriminaciónocupacional por razones de género. Este resultado ha sido obtenido a través del análisisen Gretl con el método de estimación MCO.<br /

Understanding Carbohydrate Metabolism and Insulin Resistance in Acute Intermittent Porphyria

Porphobilinogen deaminase (PBGD) haploinsufficiency (acute intermittent porphyria, AIP) is characterized by neurovisceral attacks associated with high production, accumulation and urinary excretion of heme precursors, δ-aminolevulinic acid (ALA) and porphobilinogen (PBG). The estimated clinical penetrance for AIP is extremely low (<1%), therefore it is likely that other factors may play an important role in the predisposition to developing attacks. Fasting is a known triggering factor. Given the increased prevalence of insulin resistance in patients and the large urinary loss of succinyl-CoA to produce ALA and PBG, we explore the impact of reduced availability of energy metabolites in the severity of AIP pathophysiology. Classic studies found clinical improvement in patients affected by AIP associated with the administration of glucose and concomitant insulin secretion, or after hyperinsulinemia associated with diabetes. Molecular studies have confirmed that glucose and insulin administration induces a repressive effect on hepatic ALA Synthase, the first and regulatory step of the heme pathway. More recently, the insulin-mimicking α-lipoic acid has been shown to improve glucose metabolism and mitochondrial dysfunction in a hepatocyte cell line transfected with interfering RNA targeting PBGD. In AIP mice, preventive treatment with an experimental fusion protein of insulin and apolipoprotein A-I improved the disease by promoting fat mobilization in adipose tissue, increasing the metabolite bioavailability for the TCA cycle and inducing mitochondrial biogenesis in the liver. In this review, we analyze the possible mechanisms underlying abnormal hepatocellular carbohydrate homeostasis in AIP.Fac. de MedicinaTRUEUnión EuropeaInstituto de Salud Carlos IIIFundación Mutua Madrileña de Investigación Médicapu

Early biomarkers of diabetic kidney disease. A focus on albuminuria and a new combination of antidiabetic agents

Aims: We aimed to determine the efficacy and safety of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists to prevent worsening urinary albumin-to-creatinine ratio as an early biomarker of diabetes kidney disease. Methods: A total of 178 patients with type 2 diabetes and obesity received combination treatment with SGLT2i added to GLP1ra (n = 76), GLP1ra added to SGLT2i (n = 50) or GLP1ra plus SGLT2i from start (n = 52), according to investigators´ best clinical judgement. Major outcomes assessed at 26 weeks were changes in urine albumintocreatinine-ratio (UACR), estimated glomerular filtration rate (eGFR), glycated haemoglobin, body weight and systolic blood pressure. Results: All patients (58.6% men, mean age 61.9 ± 10.0 years) completed the study. Baseline HbA1c, weight and eGFR levels were 8.2 ± 0.9%, 109.9 ± 19 kg and 83.3 ± 19.6 mL/min/m2 , respectively. At 26 weeks, we found significant reductions in HbA1c (1.16%), weight (5.17 kg) and systolic blood pressure (8.13 mmHg). The reduction in UACR was 15.14 mg/g (95% CI 8.50-22.4) (-24.6 ± 64.7%), which was greatest in the group of patients with SGLT2i added on to GLP1ra therapy (116.7 mg/g; 95% CI: 54-296.5 mg/g; P < .001. Patients with urinary albumin-to-creatinine ratio ≥30 mg/g, showed a higher declines (63.18 mg/g [95% CI 44.5-104.99]) (-56 ± 65.9%). The greatest reduction in urinary albumin-to-creatinine ratio was obtained when SGLT2i was added to GLP1ra (116.7 mg/g). The eGFR did not significantly change along the study period. Conclusion: Our results show the beneficial effect of GLP1ra and SGLT2i combination therapy on early biomarkers of diabetes kidney disease such as albuminuria and in other significant outcomes for diabetes control

Combination Therapy With Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors in Older Patients With Type 2 Diabetes: A Real-World Evidence Study

Objectives: Scientific literature about the combination of glucagon-like peptide-1 receptor agonists (GLP1ra) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in older patients is scarce. We sought to assess the real-world efficacy and safety of SGLT2 inhibitors and GLP-1ra combination therapy in older patients (>65 years of age). Methods: This was an observational, prospective, multicenter study based on clinical practice. Patients were stratified according to tertiles of baseline glycated hemoglobin (A1C) levels and to treatment schedule. Results: We included 113 patients (65.5% men, mean age 70.4±8.8 years). The body mass index was 36.5 (±6.6) kg/m2. The baseline A1C level was 8.0% (±1.2%). At the 6-month follow up, we found a significant reduction in A1C levels (–1.1%; p<0.0001), body mass index (–2.1 kg/m2; p<0.00003) and systolic blood pressure (–13 mmHg; p<0.000005). Patients who had the highest baseline A1C levels (≥8.4%) showed greater improvement in A1C levels (p<0.0001), weight (p<0.0001) and quality-of-life scores (p<0.0001). The greatest reduction in A1C levels and weight was seen in patients who started both drugs simultaneously (p<0.0001). The second greatest reduction was seen when GLP-1ra was added to previous treatment with an SGLT2i (p<0.0001). Also of note was a decrease in systolic blood pressure in patients for whom an SGLT2i was added to previous GLP-1ra treatment (p<0.0001). Of the patients, 34.3% achieved the combined endpoint of A1C levels <7% and weight loss ≥5% without hypoglycemia. Conclusions: This study’s findings provide evidence of clinically meaningful reductions in A1C level, body weight and systolic blood pressure in older patients with type 2 diabetes who are taking combined regimens. The dropout and hypoglycemia rates were minimal, and treatment was tolerated well

Clinical Characteristics and Prognosis of COPD Patients Hospitalized with SARS-CoV-2

Objective To describe the characteristics and prognosis of patients with COPD admitted to the hospital due to SARS-CoV-2 infection. Methods The SEMI-COVID registry is an ongoing retrospective cohort comprising consecutive COVID-19 patients hospitalized in Spain since the beginning of the pandemic in March 2020. Data on demographics, clinical characteristics, comorbidities, laboratory tests, radiology, treatment, and progress are collected. Patients with COPD were selected and compared to patients without COPD. Factors associated with a poor prognosis were analyzed. Results Of the 10,420 patients included in the SEMI-COVID registry as of May 21, 2020, 746 (7.16%) had a diagnosis of COPD. Patients with COPD are older than those without COPD (77 years vs 68 years) and more frequently male. They have more comorbidities (hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, heart failure, ischemic heart disease, peripheral vascular disease, kidney failure) and a higher Charlson Comorbidity Index (2 vs 1, p<0.001). The mortality rate in COPD patients was 38.3% compared to 19.2% in patients without COPD (p<0.001). Male sex, a history of hypertension, heart failure, moderate–severe chronic kidney disease, presence of cerebrovascular disease with sequelae, degenerative neurological disease, dementia, functional dependence, and a higher Charlson Comorbidity Index have been associated with increased mortality due to COVID-19 in COPD patients. Survival was higher among patients with COPD who were treated with hydroxychloroquine (87.1% vs 74.9%, p<0.001) and with macrolides (57.9% vs 50%, p<0.037). Neither prone positioning nor non-invasive mechanical ventilation, high-flow nasal cannula, or invasive mechanical ventilation were associated with a better prognosis. Conclusion COPD patients admitted to the hospital with SARS-CoV-2 infection have more severe disease and a worse prognosis than non-COPD patients

The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions : A Scoping Review of Reviews

Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions