Cost effective technology applied to domotics and smart home energy management systems

Premio extraordinario de Trabajo Fin de Máster curso 2019/2020. Máster en Energías Renovables DistribuidasIn this document is presented the state of art for domotics cost effective technologies available on market nowadays, and how to apply them in Smart Home Energy Management Systems (SHEMS) allowing peaks shaving, renewable management and home appliance controls, always in cost effective context in order to be massively applied. Additionally, beyond of SHEMS context, it will be also analysed how to apply this technology in order to increase homes energy efficiency and monitoring of home appliances. Energy management is one of the milestones for distributed renewable energy spread; since renewable energy sources are not time-schedulable, are required control systems capable of the management for exchanging energy between conventional sources (power grid), renewable sources and energy storage sources. With the proposed approach, there is a first block dedicated to show an overview of Smart Home Energy Management Systems (SMHEMS) classical architecture and functional modules of SHEMS; next step is to analyse principles which has allowed some devices to become a cost-effective technology. Once the technology has been analysed, it will be reviewed some specific resources (hardware and software) available on marked for allowing low cost SHEMS. Knowing the “tools” available; it will be shown how to adapt classical SHEMS to cost effective technology. Such way, this document will show some specific applications of SHEMS. Firstly, in a general point of view, comparing the proposed low-cost technology with one of the main existing commercial proposals; and secondly, developing the solution for a specific real case.En este documento se aborda el estado actual de la domótica de bajo coste disponible en el mercado actualmente y cómo aplicarlo en los sistemas inteligentes de gestión energética en la vivienda (SHEMS) permitiendo el recorte de las puntas de demanda, gestión de energías renovables y control de electrodomésticos, siempre en el contexto del bajo coste, con el objetivo de lograr la máxima difusión de los SHEMS. Adicionalmente, más allá del contexto de la tecnología SHEMS, se analizará cómo aplicar esta tecnología para aumentar la eficiencia energética de los hogares y para la supervisión de los electrodomésticos. La gestión energética es uno de los factores principales para lograr la difusión de las energías renovables distribuidas; debido a que las fuentes de energía renovable no pueden ser planificadas, se requieren sistemas de control capaces de gestionar el intercambio de energía entre las fuentes convencionales (red eléctrica de distribución), energías renovables y dispositivos de almacenamiento energético. Bajo esta perspectiva, este documento presenta un primer bloque en el que se exponen las bases de la arquitectura y módulos funcionales de los sistemas inteligentes de gestión energética en la vivienda (SHEMS); el siguiente paso será analizar los principios que han permitido a ciertos dispositivos convertirse en dispositivos de bajo coste. Una vez analizada la tecnología, nos centraremos en los recursos (hardware y software) existentes que permitirán la realización de un SHEMS a bajo coste. Conocidas las “herramientas” a nuestra disposición, se mostrará como adaptar un esquema SHEMS clásico a la tecnología de bajo coste. Primeramente, comparando de modo genérico la tecnología de bajo coste con una de las principales propuestas comerciales de SHEMS, para seguidamente desarrollar la solución de bajo coste a un caso específico real

Ancient landscape changes of mining origin in León (Spain): location and morphometric features of the Roman gold pit lakes

[ES] Las minas a cielo abierto producen cambios drásticos en el relieve y en los paisajes donde se asientan. Esos cambios dependen de la magnitud de las explotaciones, de los sistemas de explotación y del tipo de mineral extraído. Las explotaciones auríferas realizadas por los romanos en la provincia de León requirieron la movilización de grandes volúmenes de roca para extraer las bajas concentraciones de oro que contenían. Esto generó numerosos cambios en los paisajes primigenios siendo uno de ellos la aparición de lagunas mineras. Estas surgieron en minas que excavaron profundamente la superficie del terreno interceptando las aguas subterráneas que, a partir de ese momento, se acumulan en el fondo de la explotación dando lugar a la laguna. También se deben a la acumulación de escombros mineros que obturaron la escorrentía superficial de los cursos de agua. Aquellos cambios en los paisajes antiguos fueron de tal magnitud que aún hoy persisten algunas lagunas creadas por la minería aurífera romana después de dos mil años. El presente trabajo localiza y analiza los caracteres morfométricos de 12 lagunas con agua permanente que aún perduran.[EN] The open pit mines produce drastic changes in the relief and in the landscapes where they are located. These changes depend on the size of the exploitations, the exploitation systems and the type of mineral extracted. The gold mining carried out by the Romans in the province of León required the mobilization of large volumes of rock to extract the low concentrations of gold they contained, which generated great changes in the primitive landscapes, one of which is the appearance of pit lakes. The gold pit lakes appeared in mines that deeply excavated the surface of the land, intercepting the aquifer that, from that moment, accumulate at the bottom of the exploitation originating to the open pit; or they are due to the accumulation of mining dumps that blocked the surface runoff. In any case, those changes in ancient landscapes were of such magnitude that some open pits created by Roman gold mining more than two thousand years ago still persist today. The work locates and analyzes the morphometric characters of 12 pit lakes with permanent water that still exist

The origin and collapse of rock glaciers during the Bølling-Allerød interstadial: A new study case from the Cantabrian Mountains (Spain)

.During the Late Pleistocene, the main mountain ranges of the Iberian Peninsula were covered by small icefields and cirque and alpine glaciers. The deglaciation triggered paraglacial processes that generated landforms, mostly within the ice-free glacial cirques. In this research we analyse the deglaciation process in the Muxivén Cirque (42°15′N – 6°16′W), in the upper Sil River Basin, which includes some of the largest relict rock glaciers of the Cantabrian Mountains. We addressed this objective by means of accurate geomorphological reconstructions, sedimentological analysis, Schmidt-hammer surface weathering measurements and a dataset of 10 10Be Cosmic-Ray Exposure ages. Results reveal that after ~16 ka, glaciers retreated to the bottom of the cirques at the headwaters of the valley, leaving the walls free of ice and triggering rock avalanches onto the remnants of these glaciers. This paraglacial process supplied debris to a small glacier within Muxivén Cirque, which transformed in two rock glaciers. These debris isolated the ice inside the rock glaciers only for a very short period of time and ended up melting completely before the Younger Dryas. The lower sector of the largest one stabilized at 14.5 ± 1.5 ka, while the upper sector remained active until 13.5 ± 0.8 ka. Previous to the stabilization of the lower sector of the northern rock glacier, at its margin a high-energy debris avalanche occurred at ~14.0 ± 0.9 ka. These data agree with previous research, corroborating the paraglacial origin of most Iberian rock glaciers during the Bølling-Allerød interstadial.S

Beta cell functionality and hepatic insulin resistance are major contributors to type 2 diabetes remission and starting pharmacological therapy: from CORDIOPREV randomized controlled trial

In order to assess whether previous hepatic IR (Hepatic-IR fasting) and beta-cell functionality could modulate type 2 diabetes remission and the need for starting glucose- lowering treatment, newly-diagnosed type 2 diabetes participants who had never received glucose-lowering treatment (190 out of 1002) from the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (a prospective, randomized and controlled clinical trial), were randomized to consume a Mediterranean or a low-fat diet. Type 2 diabetes remission was defined according to the American Diabetes Association recommendation for levels of HbA1c, fasting plasma glucose and 2h plasma glucose after oral glucose tolerance test, and having maintained them for at least 2 consecutive years. Patients were classified according to the median of Hepatic-IR fasting and beta-cell functionality, measured as the disposition index (DI) at baseline. Cox proportional hazards regression determined the potential for Hepatic-IR fasting and DI indexes as predictors of diabetes remission and the probability of starting pharmacological treatment after a 5-year follow-up. Low-Hepatic-IR fasting or high-DI patients had a higher probability of diabetes remission than high-Hepatic-IR fasting or low-DI subjects (HR:1.79; 95% CI 1.06_3.05; and HR:2.66; 95% CI 1.60_4.43, respectively) after a dietary intervention with no pharmacological treatment and no weight loss. The combination of low- Hepatic-IR fasting and high-DI presented the highest probability of remission (HR:4.63; 95% CI 2.00_10.70). Among patients maintaining diabetes, those with high- Hepatic-IR fasting and low-DI showed the highest risk of starting glucose-lowerin

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

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