Multiplicidad de soluciones estacionarias para un modelo climático con una condición de contorno difusiva no lineal

En este trabajo se estudian las soluciones estacionarias de un modelo climático bidimensional (latitud - profundidad), del tipo del propuesto por R.G. Watts y R. Morantine en 1990 que corresponde al acoplamiento entre la temperatura superficial promediada y la temperatura interior de un océano profundo.Comunidad Autónoma de MadridUniversidad Complutense de Madri

Numerical and analytical study of an atherosclerosis inflammatory disease model

We study a reaction–diffusion mathematical model for the evolution of atherosclerosis as an inflammation process by combining analytical tools with computer-intensive numerical calculations. The computational work involved the calculation of more than sixty thousand solutions of the full reaction–diffusion system and lead to the complete characterisation of the ωω-limit for every initial condition. Qualitative properties of the solution are rigorously proved, some of them hinted at by the numerical stud

The Strait of Gibraltar: submarine morphology, oceanogra- phic connections and evolution

32 pages, 10 figures[EN] The Strait of Gibraltar is a first-order physiographic feature between southern Iberia and northern Africa. It has been excavated over the Arc of Gibraltar in favor of a conjugated ENE-WSW and WNW-ESE fault system that have acted as weakness structures. The Strait was generated by erosive processes of the water masses coming from the Atlantic Ocean in the lower Pliocene, due to the rude and rapid flooding of the Alboran Sea basin. Once the flood stabilized the exchange and interaction of the Atlantic and Mediterranean water masses began as we know it today; the Atlantic water that circulates on the surface of the Strait towards the Alborán Sea, and the Mediterranean water masses that circulate in depth towards the Atlantic Ocean. The acceleration of the Atlantic and Mediterranean water masses in the Strait corridor has favored the development of erosive processes.These processeshave allowed the outcrops of the rocky substratum, the development of sedimentary instabilities and the generation of paleochannels, carbonate crusts and cold-water coral formations during the Pliocene and Quaternary. Likewise, the acceleration of the Mediterranean water masses on their way in and out of the Strait and their interaction with the sea floor have controlled sedimentation both in the Alborán Sea basin and in the Gulf of Cádiz, forming contouritic depositional systems[ES] El estrecho de Gibraltar es un rasgo fisiográfico de primer orden entre el sur de Iberia y el norte de África. Ha sido excavado sobre el Arco de Gibraltar a favor de un sistema de fallas conjugadas de direcciones ENE-OSO y ONO-ESE que han actuado como estructuras de debilidad. El Estrecho fue generado por procesos erosivos de las masas de agua procedentes del océano Atlántico en el Plioceno inferior, al producirse de forma brusca y rápida la inundación de la cuenca del mar de Alborán. Una vez estabilizada la inundación comenzó el intercambio y la interacción de las masas de agua atlántica y mediterránea tal y como hoy la conocemos: el agua atlántica que circula en la superficie del Estrecho hacia el mar de Alborán, y las masas de agua mediterráneas que transitan en profundidad hacia el océano Atlántico. La aceleración de las masas de agua atlántica y mediterránea en el corredor del Estrecho ha favorecido el desarrollo de procesos erosivos. Estos procesos han permitido los afloramientos del substrato rocoso, el desarrollo de inestabilidades sedimentarias, generación de paleocanales, costras carbonatas y formaciones coralígenas de aguas frías durante el Plioceno y el Cuaternario.Asimismo, la aceleración de las masas de agua mediterráneas en su camino de entrada y salida del Estrecho y su interacción con el suelo marino han controlado la sedimentación tanto en la cuenca del mar de Alborán como en el golfo de Cádiz, formando sistemas deposicionales contorníticosWith the institutional support of the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S)Peer reviewe

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

4to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

Este volumen acoge la memoria académica de la Cuarta edición del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad Politécnica Salesiana (UPS) en su sede de Guayaquil. El Congreso ofreció un espacio para la presentación, difusión e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnológicas para la gestión de los trabajos de investigación como la plataforma Open Conference Systems y la web de presentación del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el país. La preocupación de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensión humana y social de nuestro entorno, hace que se persiga en cada edición del evento la presentación de trabajos con calidad creciente en cuanto a su producción científica. Quienes estuvimos al frente de la organización, dejamos plasmado en estas memorias académicas el intenso y prolífico trabajo de los días de realización del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad al alcance de todos y todas

Numerical simulation of a porous-medium type two-dimensional atherosclerosis model

This work is focused on the study of the first stages of atherosclerosis development as an inflammatory disease. The mathematical model on which this research is based is given by a system of two-dimensional nonlinear reaction-diffusion equations with a nonlinear source term in one of the equations, that was proposed originally in [1]. In addition, this model incorporates a nonlinear nonhomogeneous Neumann boundary condition which represents the recruitment of immune cells through the upper boundary as a response to the production of cytokines. In this work a new model is proposed considering nonlinear porous-medium type diffusion. The model is solved using a finite volume scheme with dimension-by-dimension WENO reconstruction in space, using entire polynomials, unlike the pointwise WENO reconstruction commonly used, and a third order Runge-Kutta TVD scheme for time integration. The evolution of the inflammation is studied according to the results of the numerical simulation, depending on the values of the bio-physical parameters and the size of the initial inflammation

On the number of steady states of a climate energy balance model

We are concerned with a global climate model with deep ocean effect. The model includes a dynamic and diffusive boundary condition arising from an energy balance on the Earth surface. The scales of time and space are relatively large. One of the characteristics of climate energy balance models is the sensitivity to the variations of a Solar parameter Q. Analytically, it was proved that there exists a range of Q with at least three stationary solutions. In this work we analyze numerically the existence of more than three stationary solutions according to that positive parameter Q

Numerical simulation of a porous-medium type two-dimensional atherosclerosis model

This work is focused on the study of the first stages of atherosclerosis development as an inflammatory disease. The mathematical model on which this research is based is given by a system of two-dimensional nonlinear reaction-diffusion equations with a nonlinear source term in one of the equations, that was proposed originally in [1]. In addition, this model incorporates a nonlinear nonhomogeneous Neumann boundary condition which represents the recruitment of immune cells through the upper boundary as a response to the production of cytokines. In this work a new model is proposed considering nonlinear porous-medium type diffusion. The model is solved using a finite volume scheme with dimension-by-dimension WENO reconstruction in space, using entire polynomials, unlike the pointwise WENO reconstruction commonly used, and a third order Runge-Kutta TVD scheme for time integration. The evolution of the inflammation is studied according to the results of the numerical simulation, depending on the values of the bio-physical parameters and the size of the initial inflammation