Utilización de métodos reológicos no lineales (LAOS, OSP, 1D SAOS, 1D PARALLEL SUPERPOSITION) en la caracterización de muestras representativas de familias con características mecánicas definidas

Programa Oficial de Doutoramento en Enxeñaría Naval e Industrial . 5015V01[Resumen] La mayoría de los procesos industriales que tienen lugar sobre materiales semisólidos o líquidos se producen fuera del régimen lineal. Por lo tanto, el estudio de las propiedades viscoelásticas de dichos materiales debería ser realizado fuera del rango lineal. Sin embargo, hasta el momento, los estudios viscoelásticos acostumbran a ser realizados dentro del régimen lineal extrapolando después el resultado fuera del mismo. Los ensayos oscilatorios son básicos para una completa caracterización del comportamiento viscoelástico. Los ensayos oscilatorios se pueden realizar fuera del rango de viscoelasticidad lineal en modo cizalla oscilatoria de gran amplitud (Large Amplitude Oscillatory Shear/LAOS). Existen una serie de problemas experimentales asociados a dichos ensayos que impiden una correcta caracterización. Además, una correcta interpretación de los resultados es, en muchos de los casos, difícil de conseguir. Por este motivo se ha propuesto un nuevo método para trabajar fuera del régimen lineal. Este método se denomina superposición ortogonal (Orthogonal Superposition/OSP). En este tipo de ensayos, se cizalla la muestra con una velocidad de corte determinada y se miden las propiedades viscoelásticas en un movimiento oscilatorio perpendicular a la cizalla. Este movimiento oscilatorio está dentro del régimen lineal pero los valores de los módulos viscoelásticos son función de la velocidad de cizalla aplicada por lo que se puede estudiar cómo influye dicha cizalla en las propiedades reológicas en su conjunto. Es posible además utilizar el método OSP para producir cizalla en la muestra en dos direcciones simultáneamente de forma oscilatoria. De esta forma se puede estudiar la anisotropía de un material de forma sencilla El objetivo de este proyecto de tesis es utilizar todas estas técnicas en diferentes clases de materiales desde newtonianos hasta pseudoplásticos y viscoplásticos intentando comprender sus fundamentos, integrando los métodos y proporcionando una metodología coherente que permita una correcta interpretación de los resultados. En algunos casos, se han diseñado y fabricado nuevos útiles OSP con la geometría modificada para poder utilizarlos con materiales que responden a campos eléctricos o magnéticos.[Resumo] A mayoría dos procesos industriáis nos que hay involucrados materiales líquidos ou semisólidos, producense fora do réxime lineal. Polo tanto, o estudio das propiedades viscoelásticas deses materiais debería ser feita fora do rango lineal. Sin embargo, ditos estudios viscoelasticos normalmente están feitos dentro do réxime lineal, extrapolando o resultado despois fora do mesmo. Os ensaios oscilatorios son básicos para entender completamente o comportamento viscoelástico. Ditos ensaios podense realizar fora do rango lineal en modo LAOS (Large Amplitude Oscillation Shear / Cizalla Oscilatoria de Gran Amplitude) Existen unha serie de problemas experimentais asociados a ditos ensaios que impoiden unha correcta caracterización. Ademáis, unha correcta interpretación dos resultados é, en moitos casos, difícil de conquerir. Ë por esto motivo polo que se propon un novo método para traballar fora do réxime lineal. Dito método denomínase OSP (Orthogonal Superposition/Superposición Ortógonal). Nos ensaios OSP, a mostra é cizallada con unha velocidade de corte determinada e mídense as propiedades viscoelásticas nun movemento oscilatorio perpendicular á cizalla. O movemento oscilatorio está dentro do réxime lineal pero os valores dos módulos viscoelásticos son función da velocidade de cizalla aplicada polo que pódese estudiar cal é a unfluencia da cizalla nas propiedades reolóxicas no seú conxunto. É posible además utilizar a tecnología OSP para producir cizalla en dos direciones espaciais simultáneamente de forma oscilatoria. De esta forma pódese estudiala anisotropía dun mateiral de forma sinxela. O obxetivo de este proxecto de tesis é utilizar todas estas técnicas en diiferentes clases de mateirais dende newtonianos ata pseudoplasticos ou viscoelasticos intentando comprender os seús fundamentos, integgrando métodos e proporcionando unha metodoloxía coherente que permita unha correcta interpretación física dos resultados. Nalgúns casos, rediseñamos adaptación da Geometría OSP para poder ser utilizada en materiais que responden a campos eléctricos ou magnéticos.[Abstract] Most industrial processes occurring on semi-solid or liquid materials occur outside the linear regime. Therefore, the study of the viscoelastic properties of such materials should be performed outside the linear range. However, up to now, the viscoelastic studies are usually performed within the linear regime and then, the results are extrapolated out of it. Oscillatory tests are basic for a complete characterization of viscoelastic behavior. Oscillatory tests can be performed outside the range of linear viscoelasticity in LAOS (Large Amplitude Oscillatory Shear) mode. There are a number of experimental problems associated with such tests that prevent proper characterization. In addition, a correct interpretation of the results is, in many cases, difficult to achieve. For this reason a new method for working outside the linear regime has been proposed. This method is called OSP (Orthogonal superposition). In this type of tests, the sample is sheared with a determined shearing rate and the viscoelastic properties are measured in an oscillatory movement perpendicular to the shear. This oscillatory movement is within the linear viscoelastic range but the values of the viscoelastic modules are a function of the shear rate applied so that it is possible to study how the shear affects the rheological properties as a whole. It is also possible to use the OSP Technology to produce shear in the sample in two simultaneous directions of oscillation. In this way the anisotropy of a material of simple form can be studied The objective of this thesis project is to use all these techniques in different kinds of materials from Newtonian to pseudoplastic or viscoplastic, trying to understand its fundamentals, integrating the methods and providing a coherent methodology that allows a full physical interpretation of the results. For this, in some cases, adaptations of the OSP Geometry have been designed to be able to be used in materials that respond to electric or magnetic fields

Human-Robot Cooperation for Surface Repair Combining Automatic and Manual Modes

This article develops a human-robot cooperation to carry out treatments such as sanding, polishing, etc. on the surface of a known rigid object. For this purpose, a vision system is considered to get the object location to ensure not only the perpendicularity of the robot tool to the object surface but also a smooth approach of the tool to the surface. In order to add flexibility, the proposal includes the simultaneous combination of automatic and manual modes of operation. Thus, the human user can guide the robot tool to treat arbitrary areas (manual mode) and, when the operator releases the tool, the robot goes into the automatic mode to treat prior established areas. The method uses a task prioritization framework and three types of controllers: an admittance controller for the tool guidance; a hybrid controller to modify the tool orientation and, in the automatic mode, the tool position; and a sliding mode controller to limit the velocity at which the tool approaches the object surface. The applicability and efficacy of the proposed method is demonstrated experimentally using a conventional 6R robot arm

Los socios de la RSEHN y el desarrollo de las colecciones científicas del MNCN

Valencia, del 8 al 11 de septiembre de 2021. El tema principal tuvo como lema: “La huella Humana en la Naturaleza”.Las colecciones científicas son una infraestructura de investigación única e irremplazable para numerosas áreas de la ciencia. En la actualidad, se estima que en el Museo Nacional de Ciencias Naturales se conservan 10 millones de especímenes, lo que suponen casi la mitad de todos los conservados en España. Esta infraestructura científica o este tesoro, como puede ser llamado, se ha reunido principalmente a lo largo del último siglo, y se debe al trabajo conjunto de muchos especialistas, estudiosos e interesados en diferentes disciplinas de las ciencias naturales. En esta ponencia se quiere poner en valor la aportación de los socios de la RSEHN en el incremento y desarrollo de las colecciones científicas del MNCN. Se ha realizado un análisis preliminar de los fondos de las diferentes colecciones del MNCN y de los ingresos efectuados por los socios de RSEHN desde su fundación (1871) hasta el momento en que abandona el MNCN (1971). Se realizó en cada una de ellas una consulta de los diferentes colectores y personas que aportaron especímenes y que aparecen en las bases de datos, cruzándola con la base de datos de socios durante dicho periodo. Se ha contabilizado el número de especímenes, número de tipos y taxones correspondientes a éstos. La cifra de socios total supera el centenar. El número de ejemplares ingresados por estos socios, entre esas fechas, se estima que superan el millón y medio, lo que supone al menos un 15% del total actual estimado. Hay que tener en cuenta que las colecciones no se encuentran informatizadas al 100%

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

The CARBA-MAP study: national mapping of carbapenemases in Spain (2014–2018)

Introduction:Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018.Methods: A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.Results: A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017–2018 compared to 2014–2016.Discussion: Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation