Diseño de la instalación eléctrica y de climatización mediante trigeneración de un hotel

El objetivo del presente proyecto es realizar el diseño de climatización y electricidad para un hotel mediante un sistema de trigeneración. Para poder realizar este sistema será necesaria la instalación de una máquina de absorción y de una planta de cogeneración. La finalidad del sistema de trigeneración es no realizar un consumo de energía eléctrica en la instalación de climatización, reduciendo de esta manera el consumo total de energía eléctrica. Esta instalación se realizará en la planta Baja (aparcamiento) del inmueble HOTELERA DEL ALBIR SL, un hotel de 118 habitaciones mas servicios comunes, ubicado en la localidad de Peñiscola (CASTELLÓN) La instalación del sistema de trigeneración se realizará en el inmueble HOTELERA DEL ALBIR, S.L, un hotel ubicado en Peñiscola (CASTELLÓN), con un total de 118 habitaciones más servicios comunes. La instalación eléctrica partirá de un centro de transformación existente en el exterior del edificio, mediante 4 líneas generales de alimentación. Estas cuatro líneas reparten la energía eléctrica de forma equitativa a todos los consumos, para conseguir un reparto de potencias intentando que todas las líneas tengan aproximadamente el mismo consumo eléctrico. Se realizará un suministro de socorro mediante grupo electrógeno, el cual estará conectado mediante conmutación a una de las líneas que provienen del CT. La instalación de climatización será mediante un sistema de fan-coil (frio-calor) en el interior de las estancias, habitaciones, bufet, recepción, cafetería y hall. Se realizará mediante un sistema a cuatro tubos, dos de agua fría, ida y retorno, y dos de agua caliente, dos de agua caliente, ida y retorno. Las máquinas que generarán el agua fría y caliente, son una máquina de cogeneración (microturbina), una máquina de absorción, una recuperadora de humos/agua y una caldera auxiliar para agua caliente

Diseño de la instalación eléctrica y de climatización mediante trigeneración de un hotel

El objetivo del presente proyecto es realizar el diseño de climatización y electricidad para un hotel mediante un sistema de trigeneración. Para poder realizar este sistema será necesaria la instalación de una máquina de absorción y de una planta de cogeneración. La finalidad del sistema de trigeneración es no realizar un consumo de energía eléctrica en la instalación de climatización, reduciendo de esta manera el consumo total de energía eléctrica. Esta instalación se realizará en la planta Baja (aparcamiento) del inmueble HOTELERA DEL ALBIR SL, un hotel de 118 habitaciones mas servicios comunes, ubicado en la localidad de Peñiscola (CASTELLÓN) La instalación del sistema de trigeneración se realizará en el inmueble HOTELERA DEL ALBIR, S.L, un hotel ubicado en Peñiscola (CASTELLÓN), con un total de 118 habitaciones más servicios comunes. La instalación eléctrica partirá de un centro de transformación existente en el exterior del edificio, mediante 4 líneas generales de alimentación. Estas cuatro líneas reparten la energía eléctrica de forma equitativa a todos los consumos, para conseguir un reparto de potencias intentando que todas las líneas tengan aproximadamente el mismo consumo eléctrico. Se realizará un suministro de socorro mediante grupo electrógeno, el cual estará conectado mediante conmutación a una de las líneas que provienen del CT. La instalación de climatización será mediante un sistema de fan-coil (frio-calor) en el interior de las estancias, habitaciones, bufet, recepción, cafetería y hall. Se realizará mediante un sistema a cuatro tubos, dos de agua fría, ida y retorno, y dos de agua caliente, dos de agua caliente, ida y retorno. Las máquinas que generarán el agua fría y caliente, son una máquina de cogeneración (microturbina), una máquina de absorción, una recuperadora de humos/agua y una caldera auxiliar para agua caliente

Diseño de la instalación eléctrica y de climatización mediante trigeneración de un hotel

El objetivo del presente proyecto es realizar el diseño de climatización y electricidad para un hotel mediante un sistema de trigeneración. Para poder realizar este sistema será necesaria la instalación de una máquina de absorción y de una planta de cogeneración. La finalidad del sistema de trigeneración es no realizar un consumo de energía eléctrica en la instalación de climatización, reduciendo de esta manera el consumo total de energía eléctrica. Esta instalación se realizará en la planta Baja (aparcamiento) del inmueble HOTELERA DEL ALBIR SL, un hotel de 118 habitaciones mas servicios comunes, ubicado en la localidad de Peñiscola (CASTELLÓN) La instalación del sistema de trigeneración se realizará en el inmueble HOTELERA DEL ALBIR, S.L, un hotel ubicado en Peñiscola (CASTELLÓN), con un total de 118 habitaciones más servicios comunes. La instalación eléctrica partirá de un centro de transformación existente en el exterior del edificio, mediante 4 líneas generales de alimentación. Estas cuatro líneas reparten la energía eléctrica de forma equitativa a todos los consumos, para conseguir un reparto de potencias intentando que todas las líneas tengan aproximadamente el mismo consumo eléctrico. Se realizará un suministro de socorro mediante grupo electrógeno, el cual estará conectado mediante conmutación a una de las líneas que provienen del CT. La instalación de climatización será mediante un sistema de fan-coil (frio-calor) en el interior de las estancias, habitaciones, bufet, recepción, cafetería y hall. Se realizará mediante un sistema a cuatro tubos, dos de agua fría, ida y retorno, y dos de agua caliente, dos de agua caliente, ida y retorno. Las máquinas que generarán el agua fría y caliente, son una máquina de cogeneración (microturbina), una máquina de absorción, una recuperadora de humos/agua y una caldera auxiliar para agua caliente

Development and Application of an Assay to Evaluate the Anti-Parasitic Effect of Humoral Responses against <i>Trypanosoma cruzi</i>

Mounting a balanced and robust humoral immune response is of utmost importance for reducing the infectivity of Trypanosoma cruzi. While the role of such a response in controlling the infection is well known, there is a lack of tools that can be used to quickly evaluate it. We developed a serum parasite inhibition assay (to evaluate changes in the parasite infection after exposing infective T. cruzi trypomastigotes to serum samples from infected patients). It is based on Vero cells as the hosts and the Tulahuen β-galactosidase parasite strain, genetically engineered to be quantifiable by spectrophotometry. In parallel, we developed an in-house ELISA to correlate the anti-T. cruzi antibody titres of the clinical samples with their observed anti-parasitic effect in the serum parasite inhibition assay. Serum samples from chronically T. cruzi-infected patients significantly inhibited parasite invasion in a titre-dependant manner, regardless of the patient’s clinical status, compared to samples from the non-infected controls. In addition, there was a clear correlation between the reactivity of the samples to the whole-parasite lysates by ELISA and the inhibitory effect. The results of this work confirm the previously described anti-parasitic effect of the serum of individuals exposed to T. cruzi and present a framework for its large-scale evaluation in further studies. The serum parasite inhibition assay represents a reproducible way to evaluate the intensity and anti-parasitic effect of humoral responses against T. cruzi, which could be applied to the evaluation of candidate antigens/epitopes in the design of Chagas disease vaccine candidates

Antibiotic use and associated factors in a large sample of hospitalised older people.

OBJECTIVES: The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy. METHODS: Data were obtained from the 2010-2017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged ≥65 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use. RESULTS: A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed antibiotics during their hospitalisation. The most frequently prescribed antibiotic class was β- lactams, accounting for 50% of the total prescriptions. Poor physical independence, corticosteroid use and being hospitalised in Northern Italy were factors associated with a higher likelihood of being prescribed antibiotics. Antibiotic use was associated with an increased risk of in-hospital mortality (odds ratio=2.52, 95% confidence interval 1.82-3.48) also when accounting for factors associated with their use. CONCLUSION: Hospitalised older people are often prescribed antibiotics. Factors related to poor physical independence and corticosteroid use are associated with increased antibiotic use. Being prescribed antibiotics is also associated with an increased risk of in-hospital death. These results demand the implementation of specific stewardship programmes to improve the correct use of antibiotics in hospital settings and to reduce the risk of antimicrobial resistance

Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients.

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Implementation of the Frailty Index in hospitalized older patients: Results from the REPOSI register

Background: Frailty is a state of increased vulnerability to stressors, associated to poor health outcomes. The aim of this study was to design and introduce a Frailty Index (FI; according to the age-related accumulation of deficit model) in a large cohort of hospitalized older persons, in order to benefit from its capacity to comprehensively weight the risk profile of the individual. Methods: Patients aged 65 and older enrolled in the REPOSI register from 2010 to 2016 were considered in the present analyses. Variables recorded at the hospital admission (including socio-demographic, physical, cognitive, functional and clinical factors) were used to compute the FI. The prognostic impact of the FI on in-hospital and 12-month mortality was assessed. Results: Among the 4488 patients of the REPOSI register, 3847 were considered eligible for a 34-item FI computation. The median FI in the sample was 0.27 (interquartile range 0.21\u20130.37). The FI was significantly predictive of both in-hospital (OR 1.61, 95%CI 1.38\u20131.87) and overall (HR 1.46, 95%CI 1.32\u20131.62) mortality, also after adjustment for age and sex. Conclusions: The FI confirms its strong predictive value for negative outcomes. Its implementation in cohort studies (including those conducted in the hospital setting) may provide useful information for better weighting the complexity of the older person and accordingly design personalized interventions

Prognostic relevance of glomerular filtration rate estimation obtained through different equations in hospitalized elderly patients

The estimated glomerular filtration rate (eGFR) is a predictor of important outcomes and its reduction has been associated with the risk of all-cause mortality in both general population and elderly patients. However while reduced renal function is common in older people, the best method for estimating GFR remains unclear, especially in an acute care setting. Most studies analyzing the accuracy of eGFR in the elderly were carried out in different heterogeneous settings. In this study, we compare the prognostic value of different formulas estimating GFR in predicting the risk of in-hospital morbidity and mortality within 3 months from discharge in elderly hospitalized patients. Data were extracted from \u201cRegistro Politerapia Societ\ue0 Italiana di Medicina Interna (REPOSI)\u201d. Patients with available creatinine values at hospital admission were selected and eGFR was calculated according to the different formulas: Cockcroft-Gault, Modification of Diet in Renal Disease equation, Chronic Kidney Disease Epidemiology Collaboration, Berlin Initiative Study and Full Age Spectrum. 4621 patients were included in the analysis. Among these, 4.2% and 14.2% died during hospitalization and within 3 months from discharge, respectively. eGFR &gt; 60 ml/min/1.73 m2 at admission was associated with a very low risk of mortality during the hospital stay and within 90 days from discharge, while an eGFR &lt; 60 ml/min/1.73 m2 was associated with unfavorable outcomes, although with a poor level of accuracy (AUC 0.60\u20130.66). No difference in predictive power between different equations was found. Physicians should be aware of the prognostic role of eGFR in a comprehensive assessment of elderly in-patients

Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards

Background: Chronic pain is a frequent characteristic of elderly people and represents an actual and still poorly debated topic. Objective: We investigated pain prevalence and intensity, and its pharmacological therapy in elderly patients hospitalized in 101 internal medicine wards. Methods: Taking advantage of the “REgistro POliterapie Società Italiana Medicina Interna” (REPOSI), we collected 2535 patients of whom almost a quarter was older than 85 years old. Among them, 582 patients were affected by pain (either chronic or acute) and 296 were diagnosed with chronic pain. Results: Patients with pain showed worse cognitive status, higher depression and comorbidities, and a longer duration of hospital stay compared to those without pain (all p &lt;.0366). Patients with chronic pain revealed lower level of independency in their daily life, worse cognitive status and higher level of depression compared to acute pain patients (all p &lt;.0156). Moreover, most of them were not treated for pain at admission (73.4%) and half of them was not treated with any analgesic drug at discharge (50.5%). This difference affected also the reported levels of pain intensity. Patients who received analgesics at both admission and discharge remained stable (p =.172). Conversely, those not treated at admission who received an analgesic treatment during the hospital stay decreased their perceived pain (p &lt;.0001). Conclusions: Our results show the need to focus more attention on the pharmacological treatment of chronic pain, especially in hospitalized elderly patients, in order to support them and facilitate their daily life after hospital discharge

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study

Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the \u2018Registro Politerapie SIMI\u2019 study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p\ua0=\ua00.002), had a higher Short Blessed Test (SBT; p\ua0=\ua00.022) and a lower Barthel Index (p\ua0=\ua00.047). Polypharmacy (p\ua0=\ua00.001), heart failure (p\ua0=\ua00.005) and diabetes (p\ua0=\ua00.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p\ua0=\ua00.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94\u20131.00, p\ua0=\ua00.037], diabetes (OR 0.48, 95% CI 0.26\u20130.87, p\ua0=\ua00.016) and polypharmacy (OR 0.58, 95% CI 0.34\u20130.99, p\ua0=\ua00.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p\ua0=\ua00.89; and 15.9 vs. 14.1%, p\ua0=\ua00.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up