How small and medium-sized enterprises can uptake the sustainable development goals through a cluster management organization: a case study

Even though many small and medium-sized enterprises (SMEs) realize the importance of the Sustainable Development Goals (SDGs) for their sustainable business development, they face difficulties when individually pursuing this target. This paper aims to provide cluster-based SMEs with a framework to facilitate the uptake of the SDGs through a cluster network model. By focusing on the case study of a furniture production Cluster Management Organization (CMO Habic a network-based approach to sustainability management is analyzed in order to integrate the SDGs framework into SMEs’ everyday language and day-to-day operations. Through a cluster model approach, industry-specific sustainability material issues are tackled jointly and with the aim of applying a common solution to a similar challenge, Lehi-ODS, an online sustainability management tool for SME self-evaluation, has been developed wherein the participating SMEs can gain an overarching knowledge about the UN 2030 Agenda, assess their own alignment with the SDGs and with respect to that of their peers, and prioritize initiatives to correctly deliver them. The main conclusion derived from the paper is that a CMO is deemed to be a valuable driver in identifying common sector-specific challenges of corporate sustainability and in addressing collectively the question of contributing to the SDGs

Analysis of a cusped helicon plasma thruster discharge

A compact helicon plasma thruster that features a cusp in its internal magnetic field is analyzed with experiments and simulations. A compensated Langmuir probe and a Faraday cup are used in the former, while a hybrid PIC/fluid transport model combined with a frequency-domain electromagnetic field model are used in the latter. Measurements serve to tune the anomalous transport parameters of the model and overall show the same trends as the numerical results, including a secondary peak of electron temperature downstream in the magnetic nozzle, where electron cyclotron resonance conditions for the 13.56 MHz excitation frequency are met. The cusp plays a central role in determining the plasma losses to the walls and the profile of electron temperature, which in turn defines the excitation and ionization losses. While losses to the rear wall are reduced, losses to the lateral wall are increased, which, together with the low production efficiency, limit the performance of the device. Shorter chamber lengths and optimization of antenna and cusp location are suggested as potential ways to improve performance

Factores de Riesgo Asociados a la Rehospitalización en Pacientes Egresados Post- Covid Agudo en el Antiguo Hospital Civil de Guadalajara

A few years after the first cases of COVID-19 were reported in Wuhan (China), the disease caused by coronavirus 2019 (COVID-19) persists as one of the main causes of morbidity and mortality worldwide. Many health facilities were exceeded their capacity, causing an unprecedented health crisis. The SARS-CoV-2 virus has affected more than 281 million people worldwide. Despite this, little is known about the long-term outcome of patients who required hospitalization for COVID-19, and little is known about the causes of rehospitalization in patients infected with SARS-CoV-2. The present work analyzes the factors related to the rehospitalization of post-acute COVID patients. Given that the evolution of COVID-19 remains uncertain (presence of multiple mutations) characterization of the clinical course of patients who return to inpatient wards after discharge is potentially important for discharge planning and post-discharge care. this; as well as being able to identify traits and promptly identify the population at risk to avoid readmissions or complications. Conclusion: The independent risk factors associated with rehospitalization and identified in our study group are reported below in number of times compared to the control group: chronic kidney disease (73.12, P < 0.01), obesity (13.34, P < 0.01 )), lung disease (14.33, P < 0.01), smoking (6.62, P < 0.01), invasive mechanical ventilation (5.88, P < 0.01).A unos años de haber sido reportados los primeros casos de COVID-19 en Wuhan (China), la enfermedad causada por el coronavirus 2019 (COVID-19) persiste como una de las principales causas de morbilidad y mortalidad en todo el mundo. Muchas instalaciones sanitarias fueron sobrepasadas de su capacidad, provocando una crisis sanitaria sin precedentes. El virus SARS-CoV-2  ha afectado a más de 281 millones de personas en todo el mundo. A pesar de esto, se sabe poco sobre el resultado a largo plazo de los pacientes que requirieron hospitalización por COVID-19, igualmente se conoce poco sobre las causas de rehospitalización en pacientes infectados por SARS-CoV-2.  El presente trabajo analiza los factores relacionados a la rehospitalización de pacientes post COVID agudo. Dado a que la evolución de COVID-19 sigue siendo incierta, (presencia de multiples mutaciones) la caracterización del curso clínico de los pacientes que vuelven a presentarse en salas de hospitalización después del alta es potencialmente importante para la planificación del alta y atención posterior a ésta; así como poder identificar rasgos e identificar de manera oportuna a la población en riesgo para evitar reingresos o complicaciones. Conclusión: Los factores de riesgo independientes asociados a rehospitalización e identificados en nuestro grupo de estudio, se reportan a continuación en número de veces en comparación al grupo control: enfermedad renal crónica (73.12, P < 0.01), obesidad (13.34, P < 0.01), neumopatía (14.33, P < 0.01), tabaquismo (6.62, P < 0.01), ventilación mecánica invasiva (5.88, P < 0.01

Implementation of clinical practice guideline (CPG) for early detection, diagnosis and comprehensive care of the depressive episode and recurrent depressive disorder in adults at hospital universitario cari ESE neurociencias de barranquilla (Colombia)

Objetivo: Implementar una Guía de Práctica Clínica (GPC) para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos en los servicios de consulta prioritaria, consulta externa y hospitalización del Hospital Universitario Cari ESE Neurociencias de la ciudad de Barranquilla. Materiales y métodos: Se desarrolló el Plan de implementación de una GPC de manejo de episodio depresivo y trastorno depresivo recurrente, de acuerdo con la metodología del manual de implementación de guías de práctica clínica basadas en evidencia del Ministerio de Salud. El instrumento de recolección de datos utilizado fue el cuestionario. Se indagó acerca de la preparación académica, el tiempo laborado en el ESE Cari mental y la experiencia profesional específica; así como del manejo que tienen en su vida profesional y preferencias las GPC - depresión. Resultados: La GPC elegida por consenso fue la Guía de Práctica Clínica (GPC) para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos, atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente. Conclusiones: La demanda de servicios de salud siempre parece ser superior a la cantidad de recursos disponibles para satisfacerla. La anterior afirmación es válida en todas las sociedades, aun en los países clasificados como de altos ingresos. Es por ello que la adopción de GPC en el contexto clínico-administrativo de la ESE Cari mental –incluyendo los demás entes territoriales– es una decisión que redunda en la racionalización del recurso humano y administrativo, el cual siempre será escasoObjective: Implement a Clinical Practice Guideline (CPG) for early detection and diagnosis of depressive episode and recurrent depressive disorder in adults, services for priority consultation, outpatient and inpatient University Hospital Cari ESE Neurosciences city Barranquilla. Materials and methods: Implementation Plan GPC management depressive episode and recurrent depressive disorder, according to the methodology manual implementation of clinical practice guidelines based on evidence from the Ministry of Health was developed. The data collection instrument used was the questionnaire. He asked about academic preparation, the time worked in the mental Cari and specific professional experience; as well as management they have in their professional life and preferences CPG - depression. Results: The GPC was chosen by consensus Clinical Practice Guideline (CPG) for early detection and diagnosis of depressive episode and recurrent depressive disorder in adults, comprehensive care of adults diagnosed with depressive episode or recurrent depressive disorder. Conclusions: The demand for health services always seems to be greater than the amount of resources available to meet. The above statement is valid in all societies, even in countries classified as high income. It is therefore that the adoption of GPC in the clinical contextAdministrative of Cari Mental Hospital –including other local authorities– is a decision that results in the rationalization of human and administrative resource, which will always be scarce

The Camp Nou Stadium as a testbed for city physiology: a modular framework for urban digital twins

In this paper, the Camp Nou stadium is used as a testbed for City Physiology, a theoretical framework for urban digital twins. With this case study, the modularity and adaptability of the framework, originally intended for city-scale simulations, are tested on a large facility venue. As a proof of concept, several statistical techniques and an agent-based simulation platform are coupled to simulate a crowd in the stadium, and a process of four steps is followed to build the case study. Both the conceptual (interdomain) and technical (domain specific) layers of the digital twin are defined and connected in a nonlinear process so that they represent the complexity of the object to be simulated. &e result obtained is a strategy to build a digital twin from the domain point of view, paving the way for more complex, more ambitious simulatorsThis project has received funding from the European Union’s Horizon 2020 Research and Innovation Programme under the IoTwins Project (Grant agreement no. 857191). I. Meta was partially funded by the Agencia Estatal de Investigación-Ministerio de Ciencia Innovación (AEI MICINN) and the European Social Fund (ESF) under the FPI program (scholarship no. PRE2019-090239).Peer ReviewedPostprint (published version

Assessment of platelet REACtivity after transcatheter aortic valve replacement

OBJECTIVES: The REAC-TAVI (Assessment of platelet REACtivity after Transcatheter Aortic Valve Implantation) trial enrolled patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) pre-treated with aspirin + clopidogrel, aimed to compare the efficacy of clopidogrel and ticagrelor in suppressing high platelet reactivity (HPR) after TAVI. BACKGROUND: Current recommendations support short-term use of aspirin + clopidogrel for patients with severe AS undergoing TAVR despite the lack of compelling evidence. METHODS: This was a prospective, randomized, multicenter investigation. Platelet reactivity was measured at 6 different time points with the VerifyNow assay (Accriva Diagnostics, San Diego, California). HPR was defined as (P2Y12 reaction units (PRU) ≥208. Patients with HPR before TAVR were randomized to either aspirin + ticagrelor or aspirin + clopidogrel for 3 months. Patients without HPR continued with aspirin + clopidogrel (registry cohort). The primary endpoint was non-HPR status (PRU <208) in ≥70% of patients treated with ticagrelor at 90 days post-TAVR. RESULTS: A total of 68 patients were included. Of these, 48 (71%) had HPR (PRU 273 ± 09) and were randomized to aspirin + ticagrelor (n = 24, PRU 277 ± 08) or continued with aspirin + clopidogrel (n = 24, PRU 269 ± 49). The remaining 20 patients (29%) without HPR (PRU 133 ± 12) were included in the registry. Overall, platelet reactivity across all the study time points after TAVR was lower in patients randomized to ticagrelor compared with those treated with clopidogrel, including those enrolled in the registry (p < 0.001). The primary endpoint was achieved in 100% of patients with ticagrelor compared with 21% with clopidogrel (p < 0.001). Interestingly, 33% of clopidogrel responder patients at baseline developed HPR status during the first month after TAVR. CONCLUSIONS: HPR to clopidogrel is present in a considerable number of patients with AS undergoing TAVR. Ticagrelor achieves a better and faster effect, providing sustained suppression of HPR to these patients. (Platelet Reactivity After TAVI: A Multicenter Pilot Study [REAC-TAVI]; NCT02224066)

Assessment of Platelet REACtivity After Transcatheter Aortic Valve Replacement: The REAC-TAVI Trial

OBJECTIVES: The REAC-TAVI (Assessment of platelet REACtivity after Transcatheter Aortic Valve Implantation) trial enrolled patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) pre-treated with aspirin + clopidogrel, aimed to compare the efficacy of clopidogrel and ticagrelor in suppressing high platelet reactivity (HPR) after TAVI. BACKGROUND: Current recommendations support short-term use of aspirin + clopidogrel for patients with severe AS undergoing TAVR despite the lack of compelling evidence. METHODS: This was a prospective, randomized, multicenter investigation. Platelet reactivity was measured at 6 different time points with the VerifyNow assay (Accriva Diagnostics, San Diego, California). HPR was defined as (P2Y12 reaction units (PRU) ≥208. Patients with HPR before TAVR were randomized to either aspirin + ticagrelor or aspirin + clopidogrel for 3 months. Patients without HPR continued with aspirin + clopidogrel (registry cohort). The primary endpoint was non-HPR status (PRU <208) in ≥70% of patients treated with ticagrelor at 90 days post-TAVR. RESULTS: A total of 68 patients were included. Of these, 48 (71%) had HPR (PRU 273 ± 09) and were randomized to aspirin + ticagrelor (n = 24, PRU 277 ± 08) or continued with aspirin + clopidogrel (n = 24, PRU 269 ± 49). The remaining 20 patients (29%) without HPR (PRU 133 ± 12) were included in the registry. Overall, platelet reactivity across all the study time points after TAVR was lower in patients randomized to ticagrelor compared with those treated with clopidogrel, including those enrolled in the registry (p < 0.001). The primary endpoint was achieved in 100% of patients with ticagrelor compared with 21% with clopidogrel (p < 0.001). Interestingly, 33% of clopidogrel responder patients at baseline developed HPR status during the first month after TAVR. CONCLUSIONS: HPR to clopidogrel is present in a considerable number of patients with AS undergoing TAVR. Ticagrelor achieves a better and faster effect, providing sustained suppression of HPR to these patients. (Platelet Reactivity After TAVI: A Multicenter Pilot Study [REAC-TAVI]; NCT02224066)

Genetic polymorphisms located in genes related to immune and inflammatory processes are associated with end-stage renal disease: a preliminary study

Background Chronic kidney disease progression has been linked to pro-inflammatory cytokines and markers of inflammation. These markers are also elevated in end-stage renal disease (ESRD), which constitutes a serious public health problem. Objective To investigate whether single nucleotide polymorphisms (SNPs) located in genes related to immune and inflammatory processes, could be associated with ESRD development. Design and methods A retrospective case-control study was carried out on 276 patients with ESRD and 288 control subjects. Forty-eight SNPs were genotyped via SNPlex platform. Logistic regression was used to assess the relationship between each sigle polymorphism and the development of ESRD. Results Four polymorphisms showed association with ESRD: rs1801275 in the interleukin 4 receptor (IL4R) gene (OR: 0.66 (95%CI=0.46-0.95); p=0.025; overdominant model), rs4586 in chemokine (C-C motif) ligand 2 (CCL2) gene (OR: 0.70 (95%CI=0.54-0.90); p=0.005; additive model), rs301640 located in an intergenic binding site for signal transducer and activator of transcription 4 (STAT4) (OR: 1.82 (95%CI=1.17-2.83); p=0.006; additive model) and rs7830 in the nitric oxide synthase 3 (NOS3) gene (OR: 1.31 (95%CI=1.01-1.71); p=0.043; additive model). After adjusting for multiple testing, results lost significance. Conclusion Our preliminary data suggest that four genetic polymorphisms located in genes related to inflammation and immune processes could help to predict the risk of developing ESRD.This work was supported by grants from Instituto de Salud Carlos III (Ref: PI08/0738 and PI11/00245) to SR and Junta de Castilla y Leon (Ref: GRS 234/A/08) to ET. 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Evaluating the extent and impact of the extreme Storm Gloria on Posidonia oceanica seagrass meadows

Extreme storms can trigger abrupt and often lasting changes in ecosystems by affecting foundational (habitat-forming) species. While the frequency and intensity of extreme events are projected to increase under climate change, its impacts on seagrass ecosystems remain poorly documented. In January 2020, the Spanish Mediterranean coast was hit by Storm Gloria, one of the most devastating recent climate events in terms of intensity and duration. We conducted rapid surveys of 42 Posidonia oceanica meadows across the region to evaluate the extent and type of impact (burial, unburial and uprooting). We investigated the significance of oceanographic (wave impact model), geomorphological (latitude, depth, exposure), and structural (patchiness) factors in predicting impact extent and intensity. The predominant impact of Storm Gloria was shoot unburial. More than half of the surveyed sites revealed recent unburial, with up to 40 cm of sediment removed, affecting over 50 % of the meadow. Burial, although less extensive, was still significant, with 10–80 % of meadow cover being buried under 7 cm of sediment, which is considered a survival threshold for P. oceanica. In addition, we observed evident signs of recently dead matte in some meadows and large amounts of detached drifting shoots on the sea bottom or accumulated as debris on the beaches. Crucially, exposed and patchy meadows were much more vulnerable to the overall impact than sheltered or continuous meadows. Given how slow P. oceanica is able to recover after disturbances, we state that it could take from decades to centuries for it to recoup its losses. Seagrass ecosystems play a vital role as coastal ecological infrastructure. Protecting vulnerable meadows from anthropogenic fragmentation is crucial for ensuring the resilience of these ecosystems in the face of the climate crisis.This study was funded by the CSIC project “Effects of storm Gloria on the western Mediterranean meadows (202030E052) and “Storms of change: as phenomena extreme weather alters Mediterranean coastal ecosystems, their services and their perception by society" (PID2020-113745RB-I00), state program of I+D+I Oriented to the Challenges of the Society and within the framework of the activities of the Spanish Government through the "Maria de Maeztu Centre of Excellence” accreditation to IMEDEA (CSIC-UIB) (CEX2021-001198). We want to thank the SPAS (Society of Fishing and Underwater Activities of Mataró) and the Mataró City Council, which has financed 25 years of the Alguer de Mataró project

A Universal Power-law Prescription for Variability from Synthetic Images of Black Hole Accretion Flows

We present a framework for characterizing the spatiotemporal power spectrum of the variability expected from the horizon-scale emission structure around supermassive black holes, and we apply this framework to a library of general relativistic magnetohydrodynamic (GRMHD) simulations and associated general relativistic ray-traced images relevant for Event Horizon Telescope (EHT) observations of Sgr A*. We find that the variability power spectrum is generically a red-noise process in both the temporal and spatial dimensions, with the peak in power occurring on the longest timescales and largest spatial scales. When both the time-averaged source structure and the spatially integrated light-curve variability are removed, the residual power spectrum exhibits a universal broken power-law behavior. On small spatial frequencies, the residual power spectrum rises as the square of the spatial frequency and is proportional to the variance in the centroid of emission. Beyond some peak in variability power, the residual power spectrum falls as that of the time-averaged source structure, which is similar across simulations; this behavior can be naturally explained if the variability arises from a multiplicative random field that has a steeper high-frequency power-law index than that of the time-averaged source structure. We briefly explore the ability of power spectral variability studies to constrain physical parameters relevant for the GRMHD simulations, which can be scaled to provide predictions for black holes in a range of systems in the optically thin regime. We present specific expectations for the behavior of the M87* and Sgr A* accretion flows as observed by the EHT