Optimización del almacenamiento para centrales solares de concentración

Uno de los grandes problemas de la generación eléctrica que utiliza técnicas que dependen en gran medida de las condiciones climatológicas es la dificultad para disponer de energía cuando se necesita. La generación eléctrica se produce cuando existen condiciones favorables, no cuando existe un consumo. Este hecho tiene dos consecuencias: por un lado, es necesario poder prever con exactitud la energía eléctrica que generará una determinada instalación y, por otro, hay que generar energía cuando exista demanda. Ambos problemas podrían solventarse si la energía se generase cuando las condiciones fuesen favorables, y consumirse cuando se requiriese. Esto supone introducir un “almacén” que permita acompasar los ritmos de producción y demanda. Este Trabajo se basará en este principio. Se programará un modelo que permita simular una planta con sistema de almacenamiento térmico, ofreciendo la posibilidad de variar ciertos parámetros y así poder abarcar cualquier planta en el emplazamiento que se desee. Se analizará el funcionamiento de la planta para su posterior optimización tanto energética como rentable. El punto óptimo más adecuado será aquel que resulte más rentable y con el que se puedan obtener los mayores beneficios. Por último, se realizará un análisis del coste de inversión de una central termosolar detallado, seguido de unas conclusiones en las que se abordarán las líneas futuras que puede seguir este Trabajo.Ingeniería Mecánic

Risk factors and outcome associated with the acquisition of linezolid-resistant Enterococcus faecalis

Objectives: Linezolid is a synthetic oxazolidinone antibiotic frequently used to treat vancomycin-resistant enterococcal infections. Vancomycin-susceptible Enterococcus faecalis can develop resistance to linezolid in environments with excessive linezolid use. The aim of this study was to define risk factors and outcome associated with the acquisition of linezolid-resistant E. faecalis (LREfs). Methods: A retrospective case–control study was designed including patients hospitalised from January 2014 to October 2017 at Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’ in Guadalajara, Mexico. A total of 50 patients culture-positive for LREfs and 100 control patients hospitalised in the same room and time as the cases were included. Clinical and demographic data were collected and analysed. Results: Risk factors for the presence of LREfs included prior linezolid use [odds ratio (OR) = 6.74], prior clindamycin use (OR = 6.72) and previous surgery (OR = 5.79). The mortality rate was 18% for LREfs cases versus 9% for controls. Conclusion: LREfs has emerged and spread in our hospital, an environment in which linezolid use is considerable. Risk factors for LREfs are prior antibiotic use, including linezolid, and previous surgery

CREMATTO

El presente proyecto de investigación es Crematto Helado y nació a partir de querer desmentir la relación común entre alimentos saludables y un gasto elevado. La idea de Crematto Helado vende prácticamente la idea de un helado artesanal de frutos exóticos que cuenten con un sabor inusual en un helado y, además, cuente con altas propiedades nutricionales. El producto será ofrecido al mercado en un precio competitivo con una entrega de manera rápida y eficiente. Los ingresos del proyecto Crematto Helado se obtendrán por medio de la venta online de Helados Artesanales y los costos principales son los recursos tales como los envases de vidrio, fruta y mano de obra. Para desarrollar, de manera exitosa, el presente proyecto, establecimos como socios clave principales a los proveedores de fruta y envases de vidrio. El modelo de negocio de Crematto Helado está dirigido a hombres y mujeres de entre 18 a 35 años con un Nivel Socio Económico A y B, con un estilo de vida moderno, sofisticado y adaptado, quienes claramente cuentan con buenos hábitos alimenticios y algunas preferencias por lo eco-amigable. La falta de postres de frutos exóticos bajos de azúcar y la creciente demanda y responsabilidad ambiental de los consumidores nos permitió encontrar un segmento muy llamativo e interesante. En el Concierge, tras publicar en las redes sociales los sabores que se ofrecerían, distintos seguidores de Crematto Helado, denominados hoy “Cremattolovers”, comenzaron a comentar y compartir la publicación. Fue entonces que establecimos nuestra misión el brindar la mejor opción de un helado saludable de frutas exóticas y visión el ser referencia de marca a nivel nacional reconocidos por nuestros helados de sabores no convencionales. El precio final determinado por frasco de helado saludable es de 15 soles, el cual es relativamente menor al de la competencia de cualquier naturaleza; sin embargo, en cuanto a sabores, no llevamos ventaja, ya que Crematto Helado cuenta con solo cinco. Tras establecer objetivos por área decidimos nuestra estrategia genérica, el cual es de Diferenciación porque su característica principal es el ser una alternativa de helado de sabores exóticos.The present research project is Crematto and it came from wanting to disprove the common relationship between healthy foods and high spending. The idea of Crematto is practically sell the idea of an artisan ice cream with exotic fruits that have an unusual flavor in an ice cream and, in addition, have high nutritional properties. The product will be offered to the market at a competitive price with a fast and efficient delivery. The income from the Crematto project will be obtained through the online sale of Artisan Ice Creams and the main costs are resources such as glass containers, fruit, and labor. To successfully develop this project, we established as main key partners the suppliers of fruit and glass containers. Crematto business model is aimed at people between 18 and 35 years old with a Socio-Economic Level A and B, with a modern, sophisticated, and adapted lifestyle, who clearly have good eating habits and some preferences for eco-friendly products. The lack of low-sugar exotic fruit desserts and the increasing demand and environmental responsibility of consumers allowed us to find an extremely attractive and interesting segment. At the Concierge, after posting the flavors that would be offered on social media, different followers of Crematto, today called “Cremattolovers,” began to comment and share the publication. Then we established our mission to provide the best option for a healthy exotic fruit ice cream and vision to be a national brand reference recognized for our ice cream with unconventional flavors. The last price determined per jar of healthy ice cream is 15 soles, which is less than that of the competition of any nature; However, in terms of flavors, we are not ahead, since Crematto has only five. After establishing objectives by area, we decided on our generic strategy, which is Differentiation because its main characteristic is that it is an alternative to ice cream with exotic flavors.Trabajo de investigació

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Predictive factors of clinical activity in a patient with early rheumatoid arthritis in a Colombian cohort

ilustraciones, tablasMateriales y Métodos: El proyecto se realizó a partir de una cohorte histórica de la Clínica de Artritis Reumatoide de la fundación santa fe de Bogotá, seleccionando pacientes con inicio de los síntomas menores de 12 meses. Buscamos encontrar factores asociados a remisión sostenida a corto plazo definida como DAS28 VSG <2.6, DAS 28 PCR <2.6, SDAI <3.3 CDAI <2.8 en al menos dos ocasiones consecutivas donde el tiempo entre la primera y la última visita en la que la enfermedad estaba en remisión fue ≥ 6 meses o ≥ 24 meses remisión sostenida a largo plazo. Se realizó un análisis univariado y análisis multivariado de Regresión Logística para la selección de variables Resultados: 165 paciente fueron incluidos. Se logro remisión sostenida a corto plazo por DAS 28 VSG en 74% de los pacientes, remisión por DAS 28 PCR en el 50% de los pacientes, remisión sostenida a largo plazo DAS 28 VSG en 46% de los pacientes, DAS 28 PCR en 52% de los pacientes. Los predictores de remisión sostenida a corto plazo fueron Artritis reumatoide muy temprana (OR 2,6 CI 1.26-5.91; P=0.012), Consumo de alcohol (OR 3,86 CI 0.98-18.1 P=0.065), DAS 28 VSG_0 (OR 0.41 CI 0.26-0.62 P=<0.001), Antecedente familiar de AR (OR 0.42 CI 0.17-0.99 P=0.052) y los factores de remisión sostenida a largo plazo fueron el sexo masculino (OR 5.21; CI 1.98-14.9; P=0.001), y la duración de síntomas e inicio de FARME (OR 0.81 CI 0.66-0.99; P=0-046) Conclusiones: Las características demográficas de la cohorte fueron similares a las encontradas en cohortes previamente descritas, los factores que podrían predecir remisión sostenida a corto plazo con significancia estadística fueron el diagnóstico temprano de la enfermedad (VERA), el consumo de alcohol y la menor clinimetria por DAS28 VSG, al ingreso a la cohorte y los factores predictores de remisión sostenida a largo plazo fueron ser hombre y el inicio temprano de terapia.Rheumatoid arthritis is a chronic systemic disease, in which early diagnosis is essential in the prevention of unfavorable outcomes. Materials and methods: This project was elaborated from a historic cohort from the Clínica de Artritis Reumatoide, Fundación Santa Fe de Bogotá, selecting patients with an onset of symptoms lesser than 12 moths. We aim to find associated factors with a short term sustained remission defined by DAS28 VSG <2.6, DAS 28 PCR <2.6, SDAI <3.3 CDAI <2.8 in least in two consecutive locations in between the first and last medical visit, time in which the disease was on remission, ≥ 6 months defined as short term sustained remission or ≥ 24 moths defined as long term sustained remission. A univariate analysis was made, along with a multivariate logistic regression analysis to carry out the selection of the variables. Results: 165 patients were included in the study. Short term sustained remission by DAS 28 VSG was achieved in 74%of the patients, DAS 28 PCR in 50% of the patients, long term sustained remission by DAS 28 VSG in 46% of the patients and DAS 28 PCR in 52% of the patients. The predictors of short term sustained remission were Very Early Rheumatoid Arthritis OR 2,69; (OR 2,6 CI 1.26-5.91; P=0.012), alcohol consumption (OR 3,86 CI 0.98- 18.1 P=0.065), DAS 28 VSG_0 (OR 0.41 CI 0.26-0.62 P=<0.001), and family history of AR (OR 0.42 CI 0.17-0.99 P=0.052). The predictors for long term sustained remission were male gender (OR 5.21; CI 1.98-14.9; P=0.001), duration of the symptoms and the onset of FARME (OR 0.81 CI 0.66-0.99; P=0-046).Especialidades MédicasEspecialista en ReumatologiaEstudio de cohorte históric

Efecto del cambio de profilaxis antimicrobiana en cirugía cardiovascular con implante de prótesis en la Fundación Cardioinfantil

INTRODUCCIÓN: La mediastinitis es una infección profunda del sitio operatorio con compromiso del espacio retroesternal, su incidencia varía de 0,2% a 5,0% según lo reportado por American College of Cardiology/American Heart Association (ACC/AHA). OBJETIVO: Establecer el efecto del cambio de esquema de profilaxis antibiótica sobre la incidencia de mediastinitis posquirúrgica en pacientes sometidos a cirugía cardiovascular con implante de prótesis en los años 2012-2013 en la FCI–IC. METODOLOGÍA: Estudio observacional analítico de cohorte histórica en pacientes sometidos a cirugía cardíaca con implante de prótesis. Se compararon las cohortes de pacientes que recibieron Cefalosporinas Vs Vancomicina-Gentamicina. RESULTADOS: Se realizó el análisis sobre una población de 464 pacientes, 163 recibieron profilaxis con Cefalosporinas (Cef) y 301 con Vancomicina – Gentamicina (Van-Gen). Los 3 procedimientos más frecuentemente realizados fueron reemplazo de válvula aortica (40.1%) Válvula mitral (22.2%) y Cirugía de Bentall (11.6%). La incidencia acumulada anual de mediastinitis fue de 4.76 y de 1.57 en el 2012 y 2013 respectivamente, siendo mayor en el grupo de Cef. El riesgo de ocurrencia de mediastinitis con Van-Gen es menor comparado con el uso de cefalosporinas (RR 0.25 IC 0.08-0.79) ajustado por edad y género. El principal germen aislado fué Staphylococcus Aureus MS (29.4%). CONCLUSIONES: Si existen diferencias en esta población con respeto a la incidencia de mediastinitis en pacientes sometidos a cirugía cardíaca con implante de prótesis, siendo menor en el grupo que recibe profilaxis antibiótica con Van-Gen comparado con Cef.INTRODUCTION: Mediastinitis is a deep infection of the surgical site with involvement of the retrosternal space, its incidence varies from 0. 2% to 5. 0% as reported by the American College of Cardiology / American Heart Association (ACC / AHA). OBJECTIVE: Establish the effect of the change of antibiotic prophylaxis scheme on the incidence of postoperative mediastinitis in patients undergoing cardiovascular surgery with prothesis implantation in the years 2012-2013 in the FCI-IC. METHODS: An observational, historical cohort study of patients undergoing cardiac surgery with prothesis implant. Cohorts of patients receiving Cephalosporins Vs Vancomycin-Gentamicin were compared. RESULTS: A population of 464 patients was analyzed, 163 received cephalosporin prophylaxis (Cef) and 301 Vancomycin - Gentamicin (Van - Gen) prophylaxis. The three most frequently performed procedures were aortic valve replacement (40. 1%), mitral valve (22. 2%) and Bentall`s surgery (11. 6%). The cumulative annual incidence of mediastinitis was 4. 76 and 1. 57 in 2012 and 2013 respectively, being higher in the group of Cef. The risk of occurrence of mediastinitis with Van-Gen was lower compared to the use of cephalosporins (RR 0. 25 IC 0. 08-0. 79) adjusted for age and gender. The main isolated germ was Staphylococcus Aureus MS (29. 4%). CONCLUSIONS: The incidence of mediastinitis in patients undergoing cardiac surgery with prothesis implantation, was lower in the group receiving antibiotic prophylaxis with Van-Gen compared to Cef

Efecto del cambio de profilaxis antimicrobiana en cirugía cardiovascular con implante de prótesis en la Fundación Cardioinfantil

INTRODUCCIÓN: La mediastinitis es una infección profunda del sitio operatorio con compromiso del espacio retroesternal, su incidencia varía de 0,2% a 5,0% según lo reportado por American College of Cardiology/American Heart Association (ACC/AHA). OBJETIVO: Establecer el efecto del cambio de esquema de profilaxis antibiótica sobre la incidencia de mediastinitis posquirúrgica en pacientes sometidos a cirugía cardiovascular con implante de prótesis en los años 2012-2013 en la FCI–IC. METODOLOGÍA: Estudio observacional analítico de cohorte histórica en pacientes sometidos a cirugía cardíaca con implante de prótesis. Se compararon las cohortes de pacientes que recibieron Cefalosporinas Vs Vancomicina-Gentamicina. RESULTADOS: Se realizó el análisis sobre una población de 464 pacientes, 163 recibieron profilaxis con Cefalosporinas (Cef) y 301 con Vancomicina – Gentamicina (Van-Gen). Los 3 procedimientos más frecuentemente realizados fueron reemplazo de válvula aortica (40.1%) Válvula mitral (22.2%) y Cirugía de Bentall (11.6%). La incidencia acumulada anual de mediastinitis fue de 4.76 y de 1.57 en el 2012 y 2013 respectivamente, siendo mayor en el grupo de Cef. El riesgo de ocurrencia de mediastinitis con Van-Gen es menor comparado con el uso de cefalosporinas (RR 0.25 IC 0.08-0.79) ajustado por edad y género. El principal germen aislado fué Staphylococcus Aureus MS (29.4%). CONCLUSIONES: Si existen diferencias en esta población con respeto a la incidencia de mediastinitis en pacientes sometidos a cirugía cardíaca con implante de prótesis, siendo menor en el grupo que recibe profilaxis antibiótica con Van-Gen comparado con Cef.INTRODUCTION: Mediastinitis is a deep infection of the surgical site with involvement of the retrosternal space, its incidence varies from 0. 2% to 5. 0% as reported by the American College of Cardiology / American Heart Association (ACC / AHA). OBJECTIVE: Establish the effect of the change of antibiotic prophylaxis scheme on the incidence of postoperative mediastinitis in patients undergoing cardiovascular surgery with prothesis implantation in the years 2012-2013 in the FCI-IC. METHODS: An observational, historical cohort study of patients undergoing cardiac surgery with prothesis implant. Cohorts of patients receiving Cephalosporins Vs Vancomycin-Gentamicin were compared. RESULTS: A population of 464 patients was analyzed, 163 received cephalosporin prophylaxis (Cef) and 301 Vancomycin - Gentamicin (Van - Gen) prophylaxis. The three most frequently performed procedures were aortic valve replacement (40. 1%), mitral valve (22. 2%) and Bentall`s surgery (11. 6%). The cumulative annual incidence of mediastinitis was 4. 76 and 1. 57 in 2012 and 2013 respectively, being higher in the group of Cef. The risk of occurrence of mediastinitis with Van-Gen was lower compared to the use of cephalosporins (RR 0. 25 IC 0. 08-0. 79) adjusted for age and gender. The main isolated germ was Staphylococcus Aureus MS (29. 4%). CONCLUSIONS: The incidence of mediastinitis in patients undergoing cardiac surgery with prothesis implantation, was lower in the group receiving antibiotic prophylaxis with Van-Gen compared to Cef

The "Brain Stress Timing" phenomenon and other misinterpretations of randomized clinical trial on aneurysmal subarachnoid hemorrhage

Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Long-term follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.Fil: Martinez-Perez, Rafael. Universidad Austral de Chile; ChileFil: Rayo, Natalia. Western University; CanadáFil: Montivero, Agustin. Instituo de Neurocirugía Dr Alfonso Asenjo; Chile. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Farmacología Experimental de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Farmacología Experimental de Córdoba; ArgentinaFil: Mura, Jorge Marcelo. Instituo de Neurocirugía Dr Alfonso Asenjo; Chil

Role of the patient comorbidity in the recurrence of chronic subdural hematomas

Chronic subdural hematoma (CSDH) is an old blood collection between the cortical surface and the dura. Recurrence of CSDH after surgical evacuation occurs in up to a quarter of patients. The association between patient premorbid status and the rate of recurrence is not well known, and some previous results are contradictory. We aim to determine the impact of patient comorbidities in the risk of recurrence after surgical evacuation of CSDH. Retrospective data of a single institution’s surgically evacuated CSDH cases followed up for at least 6 months were analyzed, and univariate and multivariate analyses were performed to identify the relationships between recurrence of CSDH and factors such as age, gender, CSDH thickness, neurological impairment at admission (NIHSS score), location of the CSDH (unilateral vs bilateral), Charlson Comorbidity Index (CCI), prothrombin time (PT), hemoglobin levels, and platelet count. A total of 90 patients (71 men and 19 women), aged 41–100 years (mean age, 76.4 ± 11.2 years), were included. CSDH recurred in 17 patients (18.9%). A higher CCI correlated with higher scores in the NIHSS. In the univariate analysis, recurrence was associated with a higher CCI (2.39 vs 1.22, p = 0.002), higher NIHSS scores (6.5 vs 4, p = 0.034), and lower PT levels (9.9 vs 13.4, p = 0.007). In multivariate analysis, only PT and CCI demonstrated to be independent risk factors for CSDH recurrence after surgical evacuation (p = 0.033 and p = 0.024, respectively). Patients with more comorbidities have a higher risk of developing recurrent CSDH. CCI provides a simple way of predicting recurrence in patients with CSDH and should be incorporated into decision-making processes, when counseling patients