Confort higrotérmico para actividades en espacios exteriores: periodo cálido, en clima cálido seco extremo

El tiempo de duración de las actividades en espacios exteriores en clima cálido seco extremo, depende de las condiciones de confort higrotérmico de los usuarios. Además por condiciones de ambiente térmico existen riesgos como deshidratación o golpe de calor. El objetivo del presente estudio fue estimar condiciones confort por temperatura y humedad relativa de usuarios de espacios exteriores de un centro recreativo de Mexicali, Baja California, México. Se presenta la estimación de temperatura y humedad relativa neutral con rangos de confort térmico para espacios exteriores, en el período cálido en un clima desértico. Se diseñó un cuestionario basado en ISO 10551, se midieron temperatura de bulbo seco y humedad relativa. Se aplicaron 822 encuestas en julio y agosto del 2008. Se estimaron temperatura y humedad relativa neutra y rangos de confort con el método de medias por intervalo de sensación térmica. El análisis se hizo para tres niveles de actividad: pasiva, moderada e intensa y uno combinado con los tres niveles. El período analizado presentó un comportamiento de clima asimétrico. Los valores de temperatura son aproximadamente simétricos con respecto a sus rangos de confort térmico, mientras que el confort por humedad relativa en actividad moderada e intensa fue asimétrico. Las temperaturas y humedad relativa neutras obtenidas muestran que los sujetos en actividad intensa, con práctica periódica de ejercicio y hábitos apropiados a las condiciones de clima, tienen una temperatura y humedad relativa de confort similar a aquellos con actividad pasiva.The duration of outdoor activities in extreme dry in warm weather, depends on the hygrothermal comfort conditions for users. In addition to the thermal environment conditions there are risks such as dehydration or Heat Stroke. The objective of this study was to estimate the comfort conditions for temperature and relative humidity of outdoor users of a recreational center in Mexicali, Baja California, Mexico. This work shows the estimated neutral temperatura, neutral relative humidity and thermal comfort ranges during the warm period for a public recreational green area located on a desert climate. A questionnaire was designed based on the scale of thermal sensation of ISO 10551 were measured dry bulb temperatura and relative humidity. A total of 822 questionnaires were applied during the months of July and August 2008. By estimated neutral temperatura, neutral relative humidity and comfort range with a statistical method of correlation. The analysis was done for three activity levels: passive, moderate e intense, besides the three levels together. The period of climate analyzed was asymmetric. The neutral temperature values obtained are approximately symmetrical with respect to the thermal comfort range, while the relative humidity comfort for moderate and intensity activity was asymmetric. The neutral temperatures and relative humidity obtained show that the intense activity in subjects with regular exercise and practice habits appropriate to the weather conditions, had a temperature of comfort similar to subjects with passive activity.Peer Reviewe

Nasal intermittent positive pressure ventilation and bronchopulmonary dysplasia among very preterm infants never intubated during the first neonatal admission: a multicenter cohort study

[Abstract] Introduction: While non-invasive positive-pressure ventilation (NIPPV) is increasingly used as a mode of respiratory support for preterm infants, it remains unclear whether this technique translates into improved respiratory outcomes. We assessed the association between NIPPV use and bronchopulmonary dysplasia (BPD)-free survival in never intubated very preterm infants. Methods: This multicenter cohort study analyzed data from the Spanish Neonatal Network SEN1500 corresponding to preterm infants born at <32 weeks gestational age and <1,500 g and not intubated during first admission. The exposure of interest was use of NIPPV at any time and the main study outcome was survival without moderate-to-severe BPD. Analyses were performed both by patients and by units. Primary and secondary outcomes were compared using multilevel logistic-regression models. The standardized observed-to-expected (O/E) ratio was calculated to classify units by NIPPV utilization and outcome rates were compared among groups. Results: Of the 6,735 infants included, 1,776 (26.4%) received NIPPV during admission and 6,441 (95.6%) survived without moderate-to-severe BPD. After adjusting for confounding variables, NIPPV was not associated with survival without moderate-to-severe BPD (OR 0.84; 95%CI 0.62–1.14). A higher incidence of moderate-to-severe BPD-free survival was observed in high- vs. very low-utilization units, but no consistent association was observed between O/E ratio and either primary or secondary outcomes. Conclusion: NIPPV use did not appear to decisively influence the incidence of survival without moderate-to-severe BPD in patients managed exclusively with non-invasive ventilation

Estructura y geometría de fallas activas a lo largo de los Andes Centrales peruanos a partir de sondeos magnetotelúricos

Los Andes centrales es una prominente región constituida por estructuras paralelas a la fosa oceánica entre el norte del Perú y el norte de Chile. Es una zona de deformación que presenta actividad volcánica y sismicidad activa, por lo que, la caracterización de estos procesos geológicos es de suma importancia. La implicancia de fluidos, fallas y magmatismo son procesos geodinámicos descritos en la región que pueden afectar el comportamiento geoeléctrico del subsuelo. El método magnetotelúrico (MT) susceptible a estos parámetros puede resolver la distribución de la conductividad eléctrica. Para estudiar estos procesos, presentamos en este trabajo un modelo de resistividad a escala cortical de las fallas geológicas activas a partir de sondeos magnetotelúricos. Las estaciones MT fueron adquiridas a lo largo de un transecto, realizado desde de la costa peruana hasta la zona de frontera con Bolivia. El procesamiento, análisis y rutinas de inversión fueron llevados a cabo mediante técnicas robustas, lo cual garantiza la fiabilidad de nuestro modelo. Los resultados nos permitieron definir la cinemática y el ángulo de buzamiento de las fallas geológicas a lo largo del perfil y su correlación con la geología a una escala de 30 km de profundidad. Estos datos servirán para la generación de mapas de aceleraciones máximas en el suelo, más conocidos por sus siglas en inglés como mapas de PGA (Peak Ground Aceleration), los cuales brindan información valiosa para estudios de peligro sísmico que el INGEMMET viene realizando en las fallas activas del sur peruano

Influence of surface integrity induced by multiple machining processes upon the fatigue performance of a nickel based superalloy

Machining operations are of key importance to the fatigue performance of nickel based superalloys due to the high thermal/mechanical loadings yielded on the machined workpiece which can significantly alter the surface integrity of the components. Therefore, understanding the influence mechanisms of machining induced surface integrity upon fatigue response is vital to determine their manufacturing processes and applications. In this respect, this paper investigates the surface integrity of nickel based superalloy subject to different mechanical and thermal loadings induced by various machining processes including conventional machining (e.g. finish and rough milling) and nonconventional machining (e.g. laser assisted milling and abrasive waterjet cutting) methods, as well as their influences upon fatigue performance and failure mechanisms. In-depth surface metallurgical and crystallographic analysis has been conducted to reveal the surface damage mechanisms, which allows the description of the machining induced mechanical and thermal alterations on the machined workpiece. Furthermore, the examination of the fractography from the fatigue specimen has been conducted, which enables the understanding of the influence mechanism of the corresponding surface defects on the fatigue crack initiation and propagation, subject to a four points bending fatigue test. While the resulted S-N curves indicate that the high cycle fatigue of machined nickel based superalloy is mainly dominated by the machining induced residual stress conditions, the surface defects from different machining processes can particularly influence fatigue crack initiation and propagation mechanisms in both the low and high cycle regimes

Perfusion Decellularization of Extrahepatic Bile Duct Allows Tissue-Engineered Scaffold Generation by Preserving Matrix Architecture and Cytocompatibility

Reconstruction of bile ducts damaged remains a vexing medical problem. Surgeons have few options when it comes to a long segment reconstruction of the bile duct. Biological scaffolds of decellularized biliary origin may offer an approach to support the replace of bile ducts. Our objective was to obtain an extracellular matrix scaffold derived from porcine extrahepatic bile ducts (dECM-BD) and to analyze its biological and biochemical properties. The efficiency of the tailored perfusion decellularization process was assessed through histology stainings. Results from 4’-6-diamidino-2-phenylindole (DAPI), Hematoxylin and Eosin (H&E) stainings, and deoxyribonucleic acid (DNA) quantification showed proper extracellular matrix (ECM) decellularization with an effectiveness of 98%. Immunohistochemistry results indicate an effective decrease in immunogenic marker as human leukocyte antigens (HLA-A) and Cytokeratin 7 (CK7) proteins. The ECM of the bile duct was preserved according to Masson and Herovici stainings. Data derived from scanning electron microscopy (SEM) and thermogravimetric analysis (TGA) showed the preservation of the dECM-BD hierarchical structures. Cytotoxicity of dECM-BD was null, with cells able to infiltrate the scaffold. In this work, we standardized a decellularization method that allows one to obtain a natural bile duct scaffold with hierarchical ultrastructure preservation and adequate cytocompatibility

Tissue-specific Activated Regulatory Lymphocytes Immunophenotype in Chronic Rhinosinusitis with Nasal Polyps

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a chronic inflammatory disease that affects about 5% of the general global population [...]This work was supported by Grant PI-0212-2017, PIGE-0367-2019 and RH-0048-2021 of the “Consejería de Salud y Familias, Junta de Andalucía” Spain.Peer reviewe

Allogeneic Stem Cell Transplantation in Mature T Cell and Natural Killer/T Neoplasias: A Registry Study from Spanish GETH/GELTAMO Centers

Despite advances in understanding the biology of mature T and natural killer (NK)/T cell neoplasia, current therapies, even the most innovative ones, are still far from ensuring its cure. The only treatment to date that has been shown to control aggressive T cell neoplasms in the long term is allogeneic stem cell transplantation (alloSCT). We aim to report the results of alloSCT for advanced mature T and NK/T neoplasias performed in centers from our national GELTAMO/GETH (Grupo Español de Linfoma y Trasplante de Médula Ósea/Grupo Español de Trasplante Hematopoyético y Terapia Celular) over the past 25 years. As a secondary objective, we analyzed the results of alloSCT from haploidentical donors. We performed a retrospective analysis of all patients who received an alloSCT in Spanish centers (n = 201) from September 1995 to August 2018. The 2-year overall survival (OS) and disease-free survival (DFS) were 65.5% and 58.2%, respectively. The univariate for OS and DFS showed statistically different hazard ratios for conditioning intensity, response pre-alloSCT, comorbidity index, donor/receptor cytomegalovirus status and Eastern Cooperative Oncology Group (ECOG) pre-alloSCT, but only a better ECOG pre-alloSCT remained significant in the multivariate analysis. There was an increased incidence of relapse in those patients who did not develop chronic graft-versus-host disease (GVHD) and an increased risk of death in those developing moderate to severe acute GVHD. The 1-year nonrelapse mortality was 21.9% and was mainly due to GVHD (30%) and bacterial infections (17%). When comparing unrelated donors with haploidentical donors, we found similar results in terms of OS and DFS. There was, however, a reduction of acute GVHD in the haploidentical group (P = .04) and trend to a reduction of chronic GVHD. In conclusion, alloSCT is the only curative option for most aggressive T cell neoplasias. Haploidentical donors offer similar results to related donors in terms of survival with a reduction of acute GVHD

Risk factors and outcome of COVID-19 in patients with hematological malignancies

Background: Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defned. Patients and methods: This was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confrmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020. Results: We included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n=58) or allogeneic stem cell transplantation (allo-SCT) (n=65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1-93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p=0.02). Prognostic factors identifed for day 45 overall mortality (OM) by logistic regression multivariate analysis included age>70 years [odds ratio (OR) 2.1, 95% con‑ fdence interval (CI) 1.2-3.8, p=0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6-5.2, p20 mg/dL (OR 3.3, 95% CI 1.7-6.4, p<0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2-0.89 and OR 0.31, 95% CI 0.11-0.87, respectively, p=0.02) whereas the use of hidroxycloroquine did not show signifcant improvement in OM (OR 0.64, 95% CI 0.37-1.1, P=0.1). Conclusions: In most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of infammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19

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

Preventing the onset of major depression based on the level and profile of risk of primary care attendees: protocol of a cluster randomised trial (the predictD-CCRT study)

BACKGROUND: The 'predictD algorithm' provides an estimate of the level and profile of risk of the onset of major depression in primary care attendees. This gives us the opportunity to develop interventions to prevent depression in a personalized way. We aim to evaluate the effectiveness, cost-effectiveness and cost-utility of a new intervention, personalized and implemented by family physicians (FPs), to prevent the onset of episodes of major depression. METHODS: This is a multicenter randomized controlled trial (RCT), with cluster assignment by health center and two parallel arms. Two interventions will be applied by FPs, usual care versus the new intervention predictD-CCRT. The latter has four components: a training workshop for FPs; communicating the level and profile of risk of depression; building up a tailored bio-psycho-family-social intervention by FPs to prevent depression; offering a booklet to prevent depression; and activating and empowering patients. We will recruit a systematic random sample of 3286 non-depressed adult patients (1643 in each trial arm), nested in 140 FPs and 70 health centers from 7 Spanish cities. All patients will be evaluated at baseline, 6, 12 and 18 months. The level and profile of risk of depression will be communicated to patients by the FPs in the intervention practices at baseline, 6 and 12 months. Our primary outcome will be the cumulative incidence of major depression (measured by CIDI each 6 months) over 18 months of follow-up. Secondary outcomes will be health-related quality of life (SF-12 and EuroQol), and measurements of cost-effectiveness and cost-utility. The inferences will be made at patient level. We shall undertake an intention-to-treat effectiveness analysis and will handle missing data using multiple imputations. We will perform multi-level logistic regressions and will adjust for the probability of the onset of major depression at 12 months measured at baseline as well as for unbalanced variables if appropriate. The economic evaluation will be approached from two perspectives, societal and health system. DISCUSSION: To our knowledge, this will be the first RCT of universal primary prevention for depression in adults and the first to test a personalized intervention implemented by FPs. We discuss possible biases as well as other limitations.Trial registration: ClinicalTrials.gov identifier: NCT01151982