On well-posedness for some thermo-piezoelectric coupling models

There is an increasing reliance on mathematical modelling to assist in the design of piezoelectric ultrasonic transducers since this provides a cost-effective and quick way to arrive at a first prototype. Given a desired operating envelope for the sensor the inverse problem of obtaining the associated design parameters within the model can be considered. It is therefore of practical interest to examine the well-posedness of such models. There is a need to extend the use of such sensors into high temperature environments and so this paper shows, for a broad class of models, the well-posedness of the magneto-electro-thermo-elastic problem. Due to its widespread use in the literature, we also show the well-posedness of the quasi-electrostatic case

Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study

Background: Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. Methods: Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants' satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. Discussion: Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project "PI21/00738" and co-funded by the European Union. The funders did not and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Implementation of the last planner system in the construction of the extension of the Cayetano Heredia Medical Clinic

El sector de la industria de la construcción en el Perú, a diferencia de otras industrias se caracteriza por tener una alta variabilidad debido a la poca industrialización con la que cuenta, asimismo el crecimiento de este sector se asocia directamente al crecimiento económico del país, ya que es una fuente generadora de empleo. Uno de los aspectos favorables que tiene este sector se muestra cuando la inversión pública o privada se incrementa, pues reacciona casi de inmediato.  Sin embargo, el sector de la construcción siempre ha sido asociado a un mal desempeño. Debido a la baja productividad del trabajador de construcción civil, el sector construcción tiene baja productividad y calidad; actualmente esta perspectiva del trabajador de construcción está cambiando yaqué aquellos trabajadores que quieren formar parte del sector es necesario que estén en el RETCC (Registro De Trabajadores de Construcción Civil); con el cual se busca la formalización del trabajador, capacitación, especialización y ejercer cargos sindicales dentro del sector. Es sabido que la actividad de construcción es un trabajo de alto riesgo, el mismo que se ha visto incrementado por que en muchas obras se realizan trabajos en condiciones inseguras aumentando el numero de accidentes dentro de las obras, si bien esta situación ha ido cambiando poco a poco por la toma de conciencia del factor seguridad y la supervisión permanente del ministerio de trabajo lo cual es beneficioso, pero genera presión sobre los trabajadores y el personal calificado lo cual a veces provoca que no se den soluciones apropiadas para los problemas del día a día en obra. En adición a los problemas antes mencionados la mala o poca planificación de las obras generan la baja productividad de estas, así, por ejemplo, es muy común en las obras que los materiales o equipos necesarios para la ejecución de una actividad no lleguen en forma oportuna, situación completamente predecible si es que se tuviera una adecuada planificación. Gran parte de los problemas antes mencionados son debidos a la falta de una adecuada planificación de las obras El objeto de la presente investigación es demostrar que la planificación de obras mediante una herramienta como el Lean Construction (herramienta que proviene de la metodología Lean Production de la industria automotriz de la Toyota de los anos 50 , que ha sido adaptada a la industria de la construcción), puede ayudar a un aumento de la productividad y por tanto reducir plazos de ejecución de obra , costos de producción, así como mejorar la calidad y seguridad en el proceso de ejecución de las obras. Es pues el objetivo final de este trabajo demostrar como aplicando herramientas del “Lean Construction” como es el “Last Planner” a un proyecto determinado en este caso a la parte estructural del proyecto de construcción de la ampliación de la clínica medica Cayetano Heredia puede lograrse una mejor planificación de la obra que a su vez lograra cumplimiento o reducción del plazo de obra, así como mejora en los costos de producción ( ahorro en materiales al disminuir desperdicios, ahorro en mano de obra al tener previstas las necesidades logísticas y los procesos), estas últimas (resultados económicos) demostrados mediante la medición de la mejora de los indicadores financieros ( Van y Tir ) aplicados tanto a la programación tradicional como a la programación resultante de la utilización del “Last Planner”.The construction industry sector in Peru, unlike other industries, is characterized by high variability due to the little industrialization it has, and the growth of this sector is directly associated with the economic growth of the country, since which is a source of employment generation. One of the favorable aspects of this sector is shown when public or private investment increases, as it reacts almost immediately. However, the construction sector has always been associated with poor performance. Construction has always been seen as a poorly productive and dubious quality sector given the low specialization of workers in the sector; Currently this perspective of the construction worker is changing because those workers who want to be part of the sector need to be in the RETCC (Civil Construction Workers Registry); which seeks the formalization of the worker, training, specialization and exercise union positions within the sector. In addition, the sector has been classified as a high-risk activity due to the numerous accidents that from time to time come to public light and are caused by the unsafe conditions in which the workers work, creating uncertainty about the working conditions in which workers perform. The principal characteristic of the sector is the pressure of work that all workers must endure, including the construction team, which means that appropriate solutions to the problems that arise on the ground are not always given, mainly because they live day to day. In addition to the aforementioned problems, poor or little planning of works generates low productivity, for example, it is very common in works that the materials or equipment necessary for the execution of an activity do not arrive in a timely manner. , a completely predictable situation if there is adequate planning. The purpose of this research is to demonstrate that construction planning using a tool such as Lean Construction (a tool that comes from the Lean Production methodology of the Toyota automotive industry of the 1950s, which has been adapted to the automotive industry). construction), can help increase productivity and therefore reduce work execution times, production costs, as well as improve quality and safety in the work execution process. It is therefore the final objective of this work to demonstrate how applying “Lean Construction” tools such as the “Last Planner” to a specific project in this case to the structural part of the construction project of the Cayetano Heredia medical clinic extension can be achieved better planning of the work that in turn will achieve compliance or reduction of the work deadline, as well as improvement in production costs (savings in materials by reducing waste, saving in labor by having planned logistics needs and processes) , the latter (economic results) demonstrated by measuring the improvement of the financial indicators (Van and Tir) applied both to the traditional programming and to the programming resulting from the use of the “Last Planner”.Trabajo de investigació

Adaptación de Mycobacterium smegmatis ante el agotamiento de nutrientes y su efecto en la expresión de esat-6

When resources are scarce, mycobacteria stop growing to make way for genes adaptation allow. Conversely, whengrowth continues under stress conditions, specific genes metabolic networks for protection are activating. In thissense, the protein encoded by esat-6 (early secretory antigenic target, 6 kDa) gene in Mycobacterium tuberculosis,acting in the lysis of alveolar epithelial and macrophage membranes to escape and invade other cells. But it can have other functions, such as interfering with cell-cell contact and transfer their DNA. In M. smegmatis, the ESX-1 (Secretion Ejectosoma BOX) system that facilitates secretion of ESAT-6 protein, probably it is sensitive to one or more nutrients of the culture medium. So it in the present study culture conditions limiting nutrient for growth of M. smegmatis are evaluated and relate the expression of esat-6. Culture media tested were minimal medium Hartmans Bond (HdB), carbon-limited (HdB<C), nitrogen (HdB<N) and inorganic phosphate (HdB<Pi). M. smegmatis HdB adapted to minimal medium, HdB<C and HdB<N and resume its metabolic activity in fresh medium, but not expressed esat-6. In HdB <Pi M. smegmatis loses its metabolic capacity for resistance acid-alcohol and expressed esat-6. Therefore, the culture media tested as a model for gene expression under nutrient limitation is proposed.Cuando los recursos son escasos, las micobacterias detienen su crecimiento para dar paso a los genes de la adaptación. Contrariamente, cuando el crecimiento continúa bajo condiciones de estrés, se activan genes específicos de redes metabólicas para su protección. En este sentido, la proteína codificada por esat-6 (por sus siglas en inglés: early secretory antigenic target, 6 kDa) en Mycobacterium tuberculosis, actúa en la lisis del epitelio alveolar y membranas de los macrófagos para escapar e invadir otras células. Pero puede tener otras funciones, tales como interferir en el contacto célula-célula y transferir su ADN. En M. smegmatis, el sistema ESX-1 (por sus siglas en inglés: Secretion Ejectosoma BOX) facilita la secreción de la proteína ESAT-6, probablemente es sensible a uno o más nutrientes del medio de cultivo. Por lo que en el presente estudio se evalúan las condiciones de cultivo limitantes en nutrientes para el crecimiento de M. smegmatis y su relación con la expresión del gen esat-6. Los medios de cultivos probados fueron Hartmans de Bond medio mínimo (HdB), limitado en carbono (HdB<C), nitrógeno (HdB<N) y fosfato inorgánico (HdB<Pi). M. smegmatis se adapta a HdB medio mínimo, HdB<C y HdB<N y reanuda su actividad metabólica en medio fresco, pero no se expresa esat-6. En HdB<Pi M. smegmatis pierde su capacidad metabólica respecto a la resistencia alcohol-ácido y expresa esat-6. Por lo tanto, se proponen los medios de cultivo probados como modelo para la expresión génica bajo limitación por nutrientes