Estudi d'utilització de la digoxina : utilitat de la digoxinèmia com a marcador del seu ús /

Consultable des del TDXTítol obtingut de la portada digitalitzadaPenden

Numerical simulation of cavitation in a Francis runner under different operating conditions

The behavior of suction side leading edge cavitation on the runner blades of the GAMM Francis turbine has been investigated under different operating conditions at the best efficiency point (BEP) and at off-design operations. Steady state numerical simulations have been carried out with the Zwart-Gerber-Belamri (ZGB) two-phase model and with the Shear Stress Transport (SST) turbulence model available in ANSYS¿ CFX. The numerical model had been previously validated at BEP by comparing the cavity size and location, the pressure drop and the torque with experimental values obtained in a reduced scale model testutility. These results obtained at BEP have now been compared with analogous results calculated at different flow rates and heads. In particular, the runner flow has been computed at part load and at high load while keeping the nominal head. For that, the flow rate and the incidence angle of the inlet absolute velocity has been changed according to the corresponding guide vane opening angle. Furthermore, other operation conditions comprising higher and lower heads than the nominal one have also been considered, while keeping the angle of the inlet absolute velocity constant as if the guide vane position were the same for all the cases. The results show that the size of leading edge cavitation decreases significantly for operating conditions with lower flow rates and heads than the BEP. Meanwhile, similar cavitation developments are found for operating conditions with higher flow rates and heads than the BEP.Peer ReviewedPostprint (published version

Efficiency as a determinant of loyalty among users of a community of clinical practice: a comparative study between the implementation and consolidation phases

A community of clinical practice called the Online Communication Tool between Primary and Hospital Care (ECOPIH) was created to enable primary care and specialist care professionals to communicate with each other in order to resolve real clinical cases, thereby improving communication and coordination between care levels. The present work seeks to analyse whether ECOPIH makes it possible to reduce the number of referrals. To that end, the objectives are: (1) To find out the degree of loyalty among ECOPIH users, by comparing the medical professionals' profiles in the tool's implementation phase to those in its consolidation phase. (2) To evaluate the degree of fulfilment of users' expectations, by establishing the determining factors that had an influence on the physicians' intention to use ECOPIH in the implementation phase and observing whether its use had an effective, direct impact on the number of patient referrals that primary care physicians made to specialist care professionals. Two studies were conducted. Based on a survey of all the physicians in a Primary Care area, Study 1 was a descriptive study in ECOPIH's implementation phase. Study 2 was a randomised intervention study of ECOPIH users in the tool's consolidation phase. The results from both studies were compared. Various bivariate and multivariate statistical techniques (exploratory factor analysis, cluster analysis, logistic regression analysis and ANOVA) were used in both studies, which were conducted on a sample of 111 and 178 physicians, respectively. We confirmed the existence of an ECOPIH user profile stable across both phases: under-50-year-old women. Regarding the second objective, there were two particular findings. First, the discriminant factors that had an influence on greater ECOPIH use were habitual Social media website and app use and Perceived usefulness for reducing costs. Second, PC professionals who were ECOPIH members made fewer referrals to SC professionals in Cardiology, Endocrinology and Gastroenterology than older PC professionals who were not ECOPIH members. The use of a community of clinical practice by primary care and specialist care professionals helps to reduce the number of referrals among medical professionals

The impact of a programme to improve quality of care for people with type 2 diabetes on hard to reach groups: The GEDAPS study

AIMS: We investigated whether a continuous quality improvement programme in primary care for people with type 2 diabetes led to better care and outcomes in hard to reach groups. METHODS: GEDAPS was implemented in Catalonia, Spain between 1993 (n=2239) and 2002 (n=5819). Process (e.g., education), intermediate (e.g., HbA1c) and final (e.g. retinopathy) outcomes were compared between urban and rural areas, and between younger (≤74 years) and older (≥75 years) individuals as examples of harder to reach groups. RESULTS: In 1993, people in urban areas had significantly better or similar outcomes to rural areas; by 2002, most outcomes improved in urban and rural areas. For all outcomes, the improvement in rural areas was similar to or better than urban areas. Similarly, for most outcomes, the younger and older group improved, with the older group experiencing similar or better improvements than the younger group for all indicators, except coronary artery disease. CONCLUSIONS: A quality improvement programme was associated with equivalent or better outcomes in hard to reach groups, regardless of whether they were specifically targeted. The ability to apply one programme to all populations could save time and money

Epitaxial YBa2Cu3O7-x nanocomposite thin films from colloidal solutions

A methodology of general validity to prepare epitaxial nanocomposite films based on the use of colloidal solutions containing different crystalline preformed oxide nanoparticles (ex situ nanocomposites) is reported. The trifluoroacetate (TFA) metal-organic chemical solution deposition route is used with alcoholic solvents to grow epitaxial YBaCuO (YBCO) films. For this reason stabilizing oxide nanoparticles in polar solvents is a challenging goal. We have used scalable nanoparticle synthetic methodologies such as thermal and microwave-assisted solvothermal techniques to prepare CeO and ZrO nanoparticles. We show that stable and homogeneous colloidal solutions with these nanoparticles can be reached using benzyl alcohol, triethyleneglycol, nonanoic acid, trifluoroacetic acid or decanoic acid as protecting ligands, thereby allowing subsequent mixing with alcoholic TFA solutions. An elaborate YBCO film growth analysis of these nanocomposites allows the identification of the different relevant growth phenomena, e.g. nanoparticles pushing towards the film surface, nanoparticle reactivity, coarsening and nanoparticle accumulation at the substrate interface. Upon mitigation of these effects, YBCO nanocomposite films with high self-field critical currents (J ∼ 3-4 MA cm at 77 K) were reached, indicating no current limitation effects associated with epitaxy perturbation, while smoothed magnetic field dependences of the critical currents at high magnetic fields and decreased effective anisotropic pinning behavior confirm the effectiveness of the novel developed approach to enhance vortex pinning. In conclusion, a novel low cost solution-derived route to high current nanocomposite superconducting films and coated conductors has been developed with very promising features.All authors acknowledge the EU (EU-FP7 NMP-LA-2012-280432 EUROTAPES project). ICMAB acknowledges MINECO (MAT2014-51778-C2-1-R) and Generalitat de Catalunya (2014SGR 753 and Xarmae). UGhent acknowledges the Special Research Fund (BOF), the Research Foundation Flanders (FWO) and the Institute for the Promotion of Innovation through Science and Technology in Flanders (IWT). TEM microscopy work was conducted in the Catalan Institute of Nanoscience and Nanotechnology (ICN2). The authors acknowledge the ICN2 Electron Microscopy Division for offering access to their instruments and expertise. Part of the STEM microscopy work was conducted in 'Laboratorio de Microscopias Avanzadas' at the Instituto de Nanociencia de Aragon—Universidad de Zaragoza. The authors acknowledge the LMA-INA for offering access to their instruments and expertise. JG and MC also acknowledge the Ramon y Cajal program (RYC-2012-11709 and RYC-2013-12448 respectively).Peer Reviewe

Attitudes and perceptions of medical students about family medicine in Spain: protocol for a cross-sectional survey

Background: Despite the fact that family medicine (FM) has become established as a specialty in the past 25 years, this has not been reflected in the inclusion of the specialty in the majority of medical schools in Spain. Almost 40% of the students will work in primary care but, in spite of this, most universities do not have an assessed placement as such. There are only specific practice periods in health centres or some student-selected components with little weight in the overall curricula. Objectives: To evaluate the attitudes and perceptions of medical students about FM in the health system and their perception about the need for specific training in FM at the undergraduate level. To explore change over time of these attitudes and perceptions and to examine potential predictive factors for change. Finally, we will review what teaching activity in FM is offered across the Spanish schools of medicine. Methods: Descriptive cross-sectional survey. Each one of the different analyses will consist of two surveys: one for all the students in the first, third and fifth year of medical school in all the Spanish schools of medicine asking about their knowledge, perceptions and attitudes in relation to primary care and FM. There will be an additional survey for the coordinating faculty of the study in each university about the educational activities related to FM that are carried out in their centres. The repetition of the study every 2 years will allow for an analysis of the evolution of the cohort of students until they receive their degree and the potential predictive factors. Discussion: This study will provide useful information for strategic planning decisions, content and educational methodology in medical schools in Spain and elsewhere. It will also help to evaluate the influence of the ongoing changes in FM, locally and at the European level, on the attitudes and perceptions of the students towards FM in SpainThis project is funded with a grant from the Instituto de Salud Carlos III, Ministerio de Sanidad, Spain (PI070975). PA-C is funded by a Miguel Servet contract by the Instituto de Salud Carlos III (CP09/00137)

Causas específicas de mortalidad en una cohorte de pacientes con diabetes mellitus tipo 2

La diabetis mellitus és un trastorn metabòlic a causa del dèficit de secreció d'insulina i a un augment de la seva resistència perifèrica. En el present estudi es van determinar les causes específiques de mortalitat en pacients amb diabetis mellitus. Es va observar que la mortalitat cardiovascular segueix sent la principal causa de mort en pacients amb diabetis metllitus tipus 2, seguida de la mortalitat per neoplàsies. La mortalitat total i específica per patologia cardiovascular o per neoplàsies va ser significativament superior en els pacients homes.La diabetes mellitus es un trastorno metabólico debido al déficit de secreción de insulina y a un aumento de su resistencia periférica. En el presente estudio se determinó las causas específicas de mortalidad en pacientes con diabetes mellitus. Se observó que la mortalidad cardiovascular sigue siendo la principal causa de muerte en pacientes con diabetes metllitus tipo 2, seguida de mortalidad por neoplasias. La mortalidad total y específica por patología cardiovascular o por neoplasias fue significativamente superior en los pacientes varones