Estrategia de comunicaciones para la inauguración del "Proyecto Lugar de la Memoria"

La memoria profesional Estrategia de comunicaciones para la inauguración del “Proyecto Lugar de la Memoria” presenta el desarrollo de las acciones realizadas como especialista de comunicaciones, en apoyo a la Comisión de Alto Nivel para inauguración del Lugar de la Memoria, la Tolerancia y la Inclusión Social. Esta memoria profesional expone el marco teórico a partir del cual se elaboró la estrategia comunicacional aplicada, y que tomó en cuenta lo aprendido durante el desarrollo de la carrera profesional. Además, presenta la contextualización de la experiencia, así como los problemas, tanto comunicacionales como no comunicacionales. El público objetivo, las acciones realizadas y las etapas de trabajo; analizadas desde las estadísticas de redes sociales, el impacto en los medios de comunicación, la asistencia del público y la asistencia de los afectados por la violencia, son algunas de las herramientas desarrolladas en este documento. Uno de los aspectos más importantes desarrollados en esta memoria es tratar de erradicar la visión de las comunicaciones como un trabajo meramente informativo o sólo a nivel de vínculo con los medios de comunicación, para pensar en las comunicaciones como una herramienta de cambio social a partir del vínculo con los directamente involucrados en los proyectos e iniciativas. Finalmente, se exponen las conclusiones y recomendaciones que se desprenden de la experiencia laboral, para abordar el aspecto comunicacional del espacio en cuestión y en general de los proyectos de desarrollo.Trabajo de suficiencia profesiona

Prognostic value of plasma pentraxin 3 levels in patients with septic shock admitted to intensive care

Objective: To evaluate the usefulness of a new marker, pentraxin, as a prognostic marker in septic shock patients. Materials and methods: Single-centre prospective observational study that included all consecutive patients 18 years or older who were admitted to the intensive care unit (ICU) with septic shock. Serum levels of procalcitonin (PCT), C reactive protein (CRP) and pentraxin (PTX3) were measured on ICU admission. Results: Seventy-five septic shock patients were included in the study. The best predictors of inhospital mortality were the severity scores: SAPS II (AUC = 0.81), SOFA (AUC = 0.79) and APACHE II (AUC = 0.73). The ROC curve for PTX3 (ng/mL) yielded an AUC of 0.70, higher than the AUC for PCT (0.43) and CRP (0.48), but lower than lactate (0.79). Adding PTX3 to the logistic model increased the predictive capacity in relation to SAPS II, SOFA and APACHE II for in-hospital mortality (AUC 0.814, 0.795, and 0.741, respectively). In crude regression models, significant associations were found between in-hospital mortality and PTX3. This positive association increased after adjusting for age, sex and immunosuppression: adjusted OR T3 for PTX3 = 7.83, 95% CI 1.35?45.49, linear P trend = 0.024. Conclusion: Our results support the prognostic value of a single determination of plasma PTX3 as a predictor of hospital mortality in septic shock patients

Wear and damage transitions of wheel and rail materials under various contact conditions

This study discusses a Tγ/A method of plotting wear data from a twin-disc machine for identifying the wear and damage transitions of wheel and rail materials. As found in previous work, three wear regimes (mild wear, severe wear and catastrophic wear) of U71Mn rail material were identified in dry rolling-sliding contact tests. It was determined that the damage mechanism transforms in the different wear regimes. Here earlier studies were extended to establish wear behavior for the presence of a number of third body materials (oil, water, friction enhancers) and a rail cladding process designed to make wheels and rails more durable. This has provided much needed data for Multi-Body Dynamics (MBD) simulations, and will allow better predictions of profile evolution of wheel and rail over a wider range of conditions

Tribological behaviour of microalloyed and conventional C–Mn rail steels in a pure sliding condition

This paper compares the tribological behaviour of microalloyed rail steel with conventional C–Mn rail steel under different test conditions (load, temperature and humidity). Pin-on-disc tribological tests were performed inside a climate chamber under different loads (20, 30 and 40 N), relative humidity (15, 55 and 70%) and temperatures (20 and 40 ℃). After the friction and wear tests, the worn surfaces were analysed using both confocal and scanning electron microscopies. The results obtained show that the use of microalloyed steel in railway applications under severe conditions (high loads and humidity) could lead to increased service life of the rails and could extend the time between maintenance operations

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

Wear resistance of pearlitic rail steels.

Modern railway transportation has imposed severe work conditions on the track. Wear of rails has become an important and costly phenomenon. Recent developments in the manufacture of rail steels have refined the interlamellar spacing to produce harder and more wear resistant pearlitic steels. Despite better nominal properties shown by bainitic and martensitic steels, pearlitic steels have shown lower wear rates. The aim of this study is to explain the mechanisms for the wear performance by observing how the lamellar pearlitic microstructure adapts to the wear loading. Four pearlitic rail steels, with similar chemical composition but with different hardnesses and interlamellar spacings, have been examined. Wear tests have been performed under both pure sliding and rolling-sliding conditions, the latter designed to simulate track conditions. The worn surfaces and the plastically deformed subsurface regions have been examined by optical metallography and scanning electron microscopy. It was observed that the plastic deformation produced considerable fracturing and realignment of the hard cementite lamellae. The effect of these realignments on the surface was to present an increased area fraction of hard cementite lamellae to the surface. Thinner cementite lamellae, associated with low interlamellar spacings, were easier to blend before fracturing. A relationship between the bulk hardness (HV) and the reciprocal root of the mean true interlamellar spacing has been proposed for fully pearlitic steels. Wear rates were found to be a function of the original bulk hardness, rather than the increased hardness of the plastically deformed layers. Also, wear rates were reduced as hardness increased by reducing the interlamellar spacing. Pure sliding and rolling-sliding wear tests ranked the four steels correctly. Furthermore, qualitative comparisons between experimental wear rates and those obtained in-track trials show the same scale in reduction of wear with increased hardness