Selección de forjados unidireccionales con criterios técnicos, económicos y sostenibles

This paper presents a method for finding the optimal floor slabs according to the requirements of the Spanish Building Code (CTE), the Spanish Structural Concrete Code (EHE-08) and good building practices. This method is applied to the case of one-way floor slabs with on-site cast ribs according with the characteristics and performance parameters usually offered by firms in the industry. The initial data and the variables involved in the process cover the technical viability, sustainability and monetary cost of slabs by incorporating specific ratios to assess the suitability of each solution. The method set out here may prove helpful to construction specialists who need to select optimal-cost floor slabs with the lowest environmental impacts.<br><br>En este artículo se presenta un método para la búsqueda de forjados óptimos tomando en cuenta las exigencias del Código Técnico de la Edificación, CTE, de la Instrucción de Hormigón Estructural, EHE-08, y de la buena práctica constructiva. Esta metodología se aplica al caso de forjados unidireccionales con nervio hormigonado <i>in situ</i> de acuerdo a las características y prestaciones habituales que ofertan las empresas del sector. Los datos de partida y las variables implicadas en el proceso hacen referencia a la viabilidad técnica, sostenibilidad y coste económico de los forjados a través de la incorporación de ratios específicos que evalúan la idoneidad de cada solución. El método aquí expuesto pretende servir de ayuda para el profesional de la construcción que necesite seleccionar aquellos forjados de coste óptimo que proporcionen el menor impacto medioambiental

Coping style and health-related quality of life in caregivers of epilepsy patients

Epilepsy has a significant impact on health-related quality of life (HRQOL) of patients and personal coping style is an important determinant. Less is known about home caregivers. This study investigates HRQOL and coping style of both patients and caregivers and their interaction. Epilepsy patients attending the outpatient clinic of the University Medical Centre in Utrecht and their caregivers were sent EQ5D and RAND-36 questionnaires. The Utrecht Coping List was used to chart personal coping styles. HRQOL scores of patients and caregivers were compared to the general Dutch population. The association between patient and caregiver HRQOL scores was calculated. A stepwise backward multivariate linear regression analysis was used to explain variances in caregiver HRQOL. Eighty-six couples (49%) returned all questionnaires. Caregiver HRQOL scores were comparable to the general Dutch population (EQ5D: 0.88–0.88; p = 0.90, RAND-36 MCS: −2 points; p = 0.16), while patients HRQOL scores were lower (EQ5D: 0.79; p < 0.01, RAND-36 MCS −10 points; p < 0.01). However, on several specific domains, associations between patient and caregiver HRQOL scores within couples were found. Passive coping style explained 50% of variation in HRQOL scores of caregivers. As a group, caregivers of epilepsy patients have normal HRQOL, but there are significant associations between patient and caregiver HRQOL scores. Improving caregiver HRQOL through interventions on coping style might benefit patients as well. Recognizing personal coping styles of both patient and caregiver should be part of a patient-oriented approach in treatment

The ITS1-5.8S-ITS2 Sequence Region in the Musaceae: Structure, Diversity and Use in Molecular Phylogeny

Genes coding for 45S ribosomal RNA are organized in tandem arrays of up to several thousand copies and contain 18S, 5.8S and 26S rRNA units separated by internal transcribed spacers ITS1 and ITS2. While the rRNA units are evolutionary conserved, ITS show high level of interspecific divergence and have been used frequently in genetic diversity and phylogenetic studies. In this work we report on the structure and diversity of the ITS region in 87 representatives of the family Musaceae. We provide the first detailed information on ITS sequence diversity in the genus Musa and describe the presence of more than one type of ITS sequence within individual species. Both Sanger sequencing of amplified ITS regions and whole genome 454 sequencing lead to similar phylogenetic inferences. We show that it is necessary to identify putative pseudogenic ITS sequences, which may have negative effect on phylogenetic reconstruction at lower taxonomic levels. Phylogenetic reconstruction based on ITS sequence showed that the genus Musa is divided into two distinct clades – Callimusa and Australimusa and Eumusa and Rhodochlamys. Most of the intraspecific banana hybrids analyzed contain conserved parental ITS sequences, indicating incomplete concerted evolution of rDNA loci. Independent evolution of parental rDNA in hybrids enables determination of genomic constitution of hybrids using ITS. The observation of only one type of ITS sequence in some of the presumed interspecific hybrid clones warrants further study to confirm their hybrid origin and to unravel processes leading to evolution of their genomes

Use of the aluminum phosphate-binders in hemodialysis in the ultrapure water era

INTRODUCTIONAluminium binder has been ill-advised, but his use remain applicable in the clinique practice in very seleccionated and particular patients. The repercussion of prolonged treatment with low doses of aluminium phosphate-binders in haemodialysis was studied. The haemodialysis unit had a double osmosis inverse and the aluminium levels in haemodialysis liquid was less than 2 micrograms/liter.METHODS41 patients of the 295 on haemodialysis received aluminium phosphate-binders since the 2005 January to the 2007 November. The mean time of treatment was 17.8 months, and the doses was 3.9 tablets day (mean of 463 grams in the studied period). The association of low doses of aluminium phosphate-binders permitted a better control of phosphorus (6.8 to 4.8 mg/dl; p<0.0001), with a reduction of the others phosphate-binders: sevelamer (10.4 a 8 tablets/day; p<0.0001) and calcium phosphate-binders (4.6 to 3.1 tablets/day; p<0.0001). The serum aluminium increased after the aluminium treatment (6.8 to 13.8 mcg/l; p<0.0001), and no toxicity indirect signs were observed on CMV, haemoglobin, none PTH. Five patients (12.1%) reached aluminium serum levels higher 20 mcg/l, and none reached the 40 mcg/l.CONCLUSIONSThe aluminium phosphate-binders were effective, economical and, now, with an apparent better security profile than in a previous time, but it is very important to be careful with this use and to follow a vigilance strict on patients and haemodialysis liquid

Can we improve our results in hemodialysis? Setting quality objectives, feedback, and benchmarking

To diminish inter centres variability in applied medical treatments, as well as in the results obtained with them, is one of the main challenges that Nephrology faces now a days. The systematic and planned use of Clinical Performance Measures (CPMs), Feedback and Benchmarking are tools that can help clinicians to reach such an objective. In this study we evaluate the consequences of applying those techniques in the results obtained in three haemodialysis units. we analyzed the results obtained in 311 patients dialyzed in the three units during the period 2006-2007. Established and evaluated objectives were as follows: 1.- To increase the percentage of patients with a serum calcium below 9,5 mg/dl over 70%; 2.- To increase the percentage of patients with a serum phosphorus under 5,5 mg/dl over 80%; 3.- To increase the percentage of patients with a serum PTH in between 150-300 pg/ml over 40%; 4.- To diminish the percentage of patients with a serum ferritine below 100 ng/ml under 10%, in one of the units that at the beginning of the study was not accomplishing that objective. Every three months each unit received their own results as well as the results of the two other units. the percentage of patients with serum calcium below 9,5 mg/dl increased significantly in the three units (54,6%, 56,1% and 55,6% at the beginning; 87,7%, 82.9% and 75,1% at the end of the study, respectively; p<0,001). The same was observed for the percentage of patients with a serum phosphorus below 5,5 mg/dl (77,9%, 73,6% and 66,0% at the beginning; 81,7%, 78,0% and 85.9% at the end, respectively; p: not significant), and for the percentage of patients with PTH between 150-300 pg/ml (32,9%, 43,1% and 26,4% versus 47,5%, 41,4% and 39.5%, respectively; p: not significant). The percentage of patients with a serum ferritin below 100 ng/ml in unit B diminished from 30% to 5,3% (p<0,001), reaching results similar the the two other units. Mean erythropoietin (EPO) consumption during the year 2005 was 145,5+/-13,2 U/kg/week in unit A; 226,2+/-39,8 U/kg/week in unit B, and 175,5+/-13,9 U/kg/week in unit C. At the end of year 2007, mean EPO consumption was significantly lower in unit B (144,2+/-15 U/kg/week), and similar to the other two units (140+/-14,2 in unit A and 135,1+/-13,8 in unit C). The results of this study permit to conclude that the use of QPM's and quality targets, combined with feedback and benchmarking, allows for the improvement of clinical results. Each centre should establish their own objectives, independently of the defined quality standards, so as to reach such standards or even to improve them. In this study, the three units showed a general improvement in their results, tending towards similar outcomes for the same clinical processes