Theoretical and experimental structural studies of historical Latin-American laminated planked timber arches

This article describes a first group of theoretical and experimental works undertaken at the Polytechnic University of Madrid. One major purpose is to obtain a structural model for the assessment of historical Latin-American vertically laminated planked timber arches built by the Spanish, mainly in the XVII and XVIII centuries. Many of those constructions still stand and represent a notable historical heritage. Pedro Hurtado recently presented his Ph. D. thesis on historical and construction topics. A structural study was then undertaken. This step of the structural research focussed on static analysis, most especially the deformation in the connection system. This article describes part of this first structural research. Even though it is still at a basic level, it shows reasonable agreement with the experimental results. Further static analytical models are been now developed and implemented. The next stage will address the dynamic problem, even though improvements will be made also in the constitutive equations

SOBERANIA E DIREITO INTERNACIONAL COMO DISCURSO: A ORGANIZAÇÃO MUNDIAL DA SAÚDE, O COMPORTAMENTO DOS ESTADOS E A PANDEMIA DE SARS-COV-2 DE 2020

A pesquisa consolidada neste artigo teve como ponto de partida a relação entre a soberania e o direito internacional. O problema proposto teve como premissa o fortalecimento, nos últimos anos, do poder soberano dos Estados nas suas relações entre pares e com a institucionalidade internacional buscando compreender em que medida haveria contradição entre o comportamento e o discurso desses sujeitos de direito internacional. A pandemia do vírus Sars-CoV-2 em 2020 e a relação dos Estados com a Organização Mundial de Saúde – OMS - foram escolhidas como variáveis especiais para a análise proposta. Foram consultadas fontes oficiais das organizações internacionais, doutrina e notícias de jornais e sites para a verificação desse movimento em 2020, especificamente, no que se refere ao comportamento dos Estados e as declarações, recomendações e ações da OMS. Conclui-se, finalmente, que pelo fato de o direito internacional proporcionar legitimidade, os Estados, exercendo soberania muitas vezes em aparente confronto com a ordem global instituída, recorrem à institucionalidade internacional – suas regras e princípios jurídicos - para justificar ações e comportamentos

Plan de formación y desarrollo para el personal operativo de la industria de alimentos que asegure la sostenibilidad y crecimiento del negocio

La producción de alimentos de consumo masivo trae consigo tanto amenazas como oportunidades, ya que la falla de un proceso operativo impacta a millones de consumidores, por ello, es importante asegurar la elaboración de productos inocuos y de calidad. En este proceso el recurso humano interviene directamente en toda la cadena de producción desde la materia prima hasta la distribución al consumidor. En el rubro industrial de la empresa en estudio, el personal operativo representa más del 50% de los colaboradores, los mismos que deben estar constantemente capacitados en temas especializados en su rama industrial, por ejemplo: Buenas Prácticas de Manufactura (BPM), Inocuidad y calidad, HACCAP (Análisis de puntos críticos), etc., con el objetivo de generar en ellos hábitos, habilidades y destrezas que contribuyan a la eficiencia en la producción. La normativa peruana e internacional exige altos estándares de calidad a todos los que intervienen en esta cadena de producción que son: los proveedores (los que proporcionan la materia prima), los fabricantes (las industrias de procesamiento) y los clientes (las grandes cadenas de supermercados, distribuidoras, y las mismas industrias de procesamiento) generando auditorías e inspecciones para garantizar el cumplimiento. Siendo la plana operativa importante en este rubro, el plan de formación debe ser diseñado teniendo en cuenta las características de este perfil, el programa debe ser lúdico, innovador, motivador, dinámico, experimental, vivencial, simple y claro que garanticen el aprendizaje aplicado a su actividad, contribuyendo a la sostenibilidad y el crecimiento del negocio.The production of food for mass consumption brings with it both threats and opportunities, since the failure of an operational process impacts millions of consumers, therefore, it is important to ensure the production of safe and quality products. In this process, human resources intervene directly in the entire production chain from raw material to distribution to the consumer. In this industrial area of ​​the company under study, the operational staff represents more than 50% of the collaborators, the same ones who must be constantly trained in specialized topics in their industrial branch, for example: Good Manufacturing Practices (BPM), Safety and quality, HACCAP (Critical Point Analysis), etc., with the aim of generating habits, abilities and skills that contribute to production efficiency. International and Peruvian regulations require high quality standards from all those involved in this production chain, which are suppliers (those who provide the raw material), manufacturers (processing industries) and customers (large chains of supermarkets, distributors, and the same processing industries) generating audits and inspections to ensure compliance. Being the important operational plan in this area, the training plan must be designed taking into account the characteristics of this profile, the program must be playful, innovative, motivating, dynamic, experimental, experiential, simple and clear that guarantee the learning applied to its activity, contributing to the sustainability and growth of the business.Trabajo de investigació

MRI pattern characterization of cerebral cardioembolic lesions following atrial fibrillation ablation

BackgroundRecognizing etiology is essential for treatment and secondary prevention of cerebral ischemic events. A magnetic resonance imaging (MRI) pattern suggestive of an embolic etiology has been described but, to date, there are no uniformly accepted criteria.AimThe purpose of the study is to describe MRI features of ischemic cerebral lesions occurring after transcatheter ablation of atrial fibrillation (AF).MethodsA systematic review and meta-analysis of studies performing brain imaging investigations before and after AF transcatheter ablation was performed. The incidence of cerebral ischemic lesions after AF transcatheter ablation was the primary endpoint. The co-primary endpoints were the prevalence of the different neuroimaging features regarding the embolic cerebral ischemic lesions.ResultsA total of 25 studies, encompassing 3,304 patients, were included in the final analysis. The incidence of ischemic cerebral lesions following AF transcatheter ablation was 17.2% [95% confidence interval (CI) 12.2%–23.8%], of which a minimal fraction was symptomatic [0.60% (95% CI 0.09%–3.9%)]. Only 1.6% of the lesions (95% CI 0.9%–3.0%) had a diameter >10 mm, and in 20.5% of the cases the lesions were multiple (95% CI 17.1%–24.4%). Brain lesions were equally distributed across the two hemispheres and the different lobes; cortical location was more frequent [64.0% (95% CI 42.9%–80.8%)] while the middle cerebral artery territory was the most involved 37.0% (95% CI 27.3–48.0).ConclusionsThe prevailing MRI pattern comprises a predominance of small (<10 mm) cortical lesions, more prevalent in the territory of the middle cerebral artery

Medida restritiva para comercialização de antimicrobianos no Brasil: resultados alcançados

OBJECTIVE: To assess whether the incidence of hospital infection by a resistant microorganism decreased after the implementation of the restrictive measure of the National Health Surveillance Agency for the commercialization of antimicrobials. METHODS: A historical cohort study of medical records of adult patients admitted to a general and public hospital from May 2010 to July 2011. A cohort was formed with patients admitted in the period before the restrictive measure for the commercialization of antimicrobials (Phase I) and a second cohort was formed with patients admitted after the implementation of the restrictive measure (Phase II). RESULTS: The instantaneous risk of hospital infection by a resistant microorganism was estimated at seven by 1,000 people-time (95%CI 0.006–0.008) in Phase I, and four by 1,000 people-time (95%CI 0.003–0.005) in Phase II of the study. The differences between the survival curves in the different phases of the study and stratified by age group were also significant (p < 0.05). CONCLUSIONS: The results suggest that the implementation of the restrictive measure of the commercialization of antimicrobials by the National Health Surveillance Agency reduced the incidence of hospital infection by a resistant microorganism.OBJETIVO: Avaliar se a incidência de infecção hospitalar por microrganismo resistente diminuiu após a implementação da medida restritiva da Agência Nacional de Vigilância Sanitária para comercialização de antimicrobianos. MÉTODOS: Estudo de coorte histórica de registros de prontuários de pacientes adultos admitidos para internação em um hospital geral e público no período de maio de 2010 a julho de 2011. Foi formada uma coorte com pacientes internados em período anterior à medida restritiva para comercialização de antimicrobianos (Fase I) e uma segunda coorte com pacientes admitidos após a implantação da medida restritiva (Fase II). RESULTADOS: O risco instantâneo de infecção hospitalar por microrganismo resistente foi estimado em sete por 1.000 pessoas-tempo (IC95% 0,006–0,008) na Fase I, e quatro por 1.000 pessoas-tempo (IC95% 0,003–0,005) na Fase II do estudo. As diferenças entre as curvas de sobrevida nas diferentes fases do estudo e estratificadas pela faixa etária também foram significativas (p < 0,05). CONCLUSÕES: Os resultados sugerem que a implantação da medida restritiva de comercialização de antimicrobianos pela Agência Nacional de Vigilância Sanitária reduziu a incidência de infecção hospitalar por microrganismo resistente

Comunica-Media: Uso de la grabación de clases, el screencast y la videoconferencia en el aula

A medida que la tecnología mejora y se extiende entre los usuarios es conveniente y necesario que los sistemas educativos se adapten y aprovechen lo que estas nuevas tecnologías pueden ofrecer. Así se puede motivar más a los alumnos y profesores ofreciéndoles contenidos más completos e interactivos. En esta comunicación se presenta el proyecto Comunica-Media del Servicio de Innovación Educativa de la Universidad Politécnica de Madrid (UPM). El objetivo principal de este proyecto es promover y evaluar el uso de la grabación de clases, la videoconferencia y el screencast en seis diferentes escuelas y asignaturas de la UPM

Theoretical and practical approach of spirituality in institutionalized patients.

A rela??o entre medicina e espiritualidade ? alvo de estudos da atualidade, cujos resultados evidenciam associa??o positiva com comportamentos saud?veis. No entanto, h? uma lacuna de tal abordagem na forma??o em sa?de. O presente projeto de extens?o objetiva construir com estudantes de medicina substrato te?rico e viv?ncias pr?ticas na abordagem da espiritualidade de pacientes institucionalizados atrav?s de question?rios validados como o FICA. As interven??es com as atividades registradas e discutidas com os professores visam ofertar cuidado humanizado e valorizar a integralidade dos sujeitos. A an?lise qualitativa dos dados revelou aus?ncia de abordagem pr?via da espiritualidade dos pacientes, cuja maioria manifestou interesse nessa interven??o. ? relevante para o m?dico saber o momento e a forma adequada dessa abordagem visando ? singularidade de cada caso.The relationship between medicine and spirituality is subject of current studies, whose results show a positive association with healthy behaviors. However, there is a lack of such approach in healthcare education. The objectives of this extension project were to build together with medical students theoretical and practical experiences in approaching the spirituality of institutionalized patients through validated questionnaires, such as FICA. The interventions with the activities record and discussion with professors aim to offer humanized care and to value the integrality of these individuals. Qualitative data analysis revealed a lack of previous approach to the spirituality of the patients, whom (most of them) expressed interest in this intervention. It is relevant for the physician to know the timing and appropriate way of this approach aiming at the uniqueness of each case

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: a quality improvement study

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6+/-9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; pPeer reviewe

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH