Climatización de una casa unifamiliar mediante una máquina de absorción de triple estado alimentada con paneles solares térmicos : estudio de viabilidad económica y medioambiental en comparación con sistemas convencionales

El objetivo del presente proyecto es conseguir un grado de confort tanto en invierno como en verano, similar al que ofrecen los sistemas de refrigeracion y calefaccion convencionales, para los 6 ocupantes de una vivienda unifamiliar de 200 m2 situada en la Comunidad de Madrid, la cual, posee una piscina propia. Para llevar a cabo el proyecto, se utilizara una maquina de absorcion de triple estado (ClimateWell_10), la cual dara cobertura tanto a la refrigeracion, como a la calefaccion, como al ACS. La energia necesaria para el funcionamiento de la maquina de absorcion, sera obtenida mediante la utilizacion de paneles solares termicos. Ademas, se especificaran las condiciones tecnicas de funcionamiento del circuito, junto con el esquema del mismo para que funcione correctamente; todo esto, siguiendo las recomendaciones y especificaciones del fabricante. Para el buen funcionamiento de la maquina de absorcion, esta, necesita tres circuitos basicos. El circuito de captacion de calor (paneles solares), el circuito de disipacion de calor (piscina), y el circuito de distribucion (suelo radiante, que dara cobertura tanto a calefaccion como a refrigeracion). Ademas, se instalara una caldera auxiliar y un tanque de almacenamiento de agua para garantizar la demanda de ACS y calefaccion. Hay que tener en cuenta, que se contará con dos intercambiadores de calor, tanto en el circuito de captacion como en el circuito de disipacion de calor para separar los flujos correspondientes, con sus respectivas bombas hidraulicas, sensores, valvulas de corte, etc. Se analizaran las energias renovables en el marco actual, y mas concretamente en los paneles solares, a la vez que se realizara un estudio del sistema de refrigeracion por compresion y por absorción para, a continuación, hacer una comparativa con la maquina de absorcion elegida. Ademas, una descripcion de la vivienda donde se lleva a cabo el proyecto, con su posterior explicacion del cálculo de cargas termicas para la determinación de las demandas necesarias. En toda la realizacion del proyecto, se tendra en cuenta la cumplimentacion de la normativa vigente tanto a nivel estatal como de la misma Comunidad y del Ayuntamiento de Madrid. Finalmente se realiza un calculo detallado mediante el software dinamico denominado “TRNSYS”, (proporcionado por la misma empresa ClimateWell) en el que se obtendra un informe comparativo tanto economico como medioambiental del sistema utilizado en el proyecto, en relación a un sistema convencional. A partir del informe obtenido, se calculara la rentabilidad económica del mismo, dependiendo del precio de combustible y de las subvenciones existentes en el momento, llegando a una serie de conclusiones que se comentarán al final del proyecto

Clustering of energy balance-related behaviours, sleep, and overweight among Finnish adolescents

To examine how clusters of energy balance-related behaviours (EBRBs), including sleep related factors, were associated with overweight among adolescents. In Finland, 4262 adolescents, aged 13-15, participated in the cross-national Health Behaviour in School-aged Children study. The adolescents completed questionnaires assessing EBRBs [sleep duration, discrepancy and quality, physical activity (PA), screen time, junk food, fruit, and vegetable intake] and height and weight. Clusters were identified with kappa-means cluster analysis and their associations with overweight with logistic regression analyses. Common clusters for boys and girls were labelled "Healthy lifestyle" and "High screen time, unhealthy lifestyle". In addition, the cluster "Low/moderate screen time, unhealthy lifestyle" was identified among boys, and the cluster "Poor sleep, unhealthy lifestyle" among girls. Only girls in the cluster "High screen time, unhealthy lifestyle" were at increased risk for overweight. Girls, whose EBRB was characterized by high screen time and low PA, but not with poor sleep, were at increased risk for overweight. Future studies should examine ways to promote PA among adolescent girls with high interest in screen-based activities.Peer reviewe

How Are Adolescents Sleeping? Adolescent Sleep Patterns and Sociodemographic Differences in 24 European and North American Countries

© 2020 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Purpose: Insufficient and poor sleep patterns are common among adolescents worldwide. Up to now, the evidence on adolescent sleep has been mostly informed by country-specific studies that used different measures and age groups, making direct comparisons difficult. Cross-national data on adolescent sleep that could inform nations and international discussions are lacking. We examined the sleep patterns of adolescents across 24 countries and by gender, age, and affluence groups. Methods: We obtained sleep data on 165,793 adolescents (mean age 13.5 years; 50.5% girls) in 24 European and North American countries from the recent cross-sectional Health Behaviour in School-aged Children surveys (2013–2014 and 2017–2018). For each country, we calculated the age-standardized mean in sleep duration, timing, and consistency and the proportions meeting sleep recommendations on school and nonschool days from self-reported bedtimes and wake times. We conducted stratified analyses by gender, age, and family affluence group. Results: Adolescent sleep patterns varied cross-nationally. The average sleep duration ranged between 7:47 and 9:07 hours on school days and between 9:31 and 10:22 hours on nonschool days, and the proportion of adolescents meeting sleep recommendations ranged between 32% and 86% on school days and between 79% and 92% on nonschool days. Sleep patterns by gender and affluence groups were largely similar, but older adolescents slept less and went to bed later on school days than younger adolescents in all countries. Conclusions: The sleep patterns of adolescents vary across countries and sociodemographic groups. Insufficient sleep on school days is common in many countries. Public health and policy efforts to promote healthy adolescent sleep are encouraged.The work was supported by the European Regional Development Fund-Project "Effective Use of Social Research Studies for Practice" (No. CZ.02.1.01/0.0/0.0/16_025/0007294) and by funding from the Technology Agency of the Czech Republic (ÉTA TL01000335) and the Ministry of Education, Youth and Sports, Inter-Excellence, LTT18020 (HBSC Czech Republic); the Public Health Agency of Canada (HBSC Canada); the Juho Vainio Foundation and the University of Jyvaskyla (HBSC Finland); and the Portugal- National Foundation for Science and Technology (HBSC Portugal).info:eu-repo/semantics/publishedVersio

Protocol for the Foot in Juvenile Idiopathic Arthritis trial (FiJIA): a randomised controlled trial of an integrated foot care programme for foot problems in JIA

<b>Background</b>: Foot and ankle problems are a common but relatively neglected manifestation of juvenile idiopathic arthritis. Studies of medical and non-medical interventions have shown that clinical outcome measures can be improved. However existing data has been drawn from small non-randomised clinical studies of single interventions that appear to under-represent the adult population suffering from juvenile idiopathic arthritis. To date, no evidence of combined therapies or integrated care for juvenile idiopathic arthritis patients with foot and ankle problems exists. <b>Methods/design</b>: An exploratory phase II non-pharmacological randomised controlled trial where patients including young children, adolescents and adults with juvenile idiopathic arthritis and associated foot/ankle problems will be randomised to receive integrated podiatric care via a new foot care programme, or to receive standard podiatry care. Sixty patients (30 in each arm) including children, adolescents and adults diagnosed with juvenile idiopathic arthritis who satisfy the inclusion and exclusion criteria will be recruited from 2 outpatient centres of paediatric and adult rheumatology respectively. Participants will be randomised by process of minimisation using the Minim software package. The primary outcome measure is the foot related impairment measured by the Juvenile Arthritis Disability Index questionnaire's impairment domain at 6 and 12 months, with secondary outcomes including disease activity score, foot deformity score, active/limited foot joint counts, spatio-temporal and plantar-pressure gait parameters, health related quality of life and semi-quantitative ultrasonography score for inflammatory foot lesions. The new foot care programme will comprise rapid assessment and investigation, targeted treatment, with detailed outcome assessment and follow-up at minimum intervals of 3 months. Data will be collected at baseline, 6 months and 12 months from baseline. Intention to treat data analysis will be conducted. A full health economic evaluation will be conducted alongside the trial and will evaluate the cost effectiveness of the intervention. This will consider the cost per improvement in Juvenile Arthritis Disability Index, and cost per quality adjusted life year gained. In addition, a discrete choice experiment will elicit willingness to pay values and a cost benefit analysis will also be undertaken

Social recognition provision patterns in professional Q&A forums in Healthcare and Construction

© 2015 Elsevier Ltd. All rights reserved. For some decades, professional Q&A forums have been used as a mainstream way of sharing practices between novices and experts. Several forums have had time to develop their own communities and habits, which made them a suitable place to explore patterned epistemic practices. In this paper we look at the social recognition, help seeking and informal learning patterns in communities of practice; our aim is to use the corresponding outputs to scaffold technology supported informal learning. We analyzed professional discussion forums in two countries (UK and Germany) in two different sectors (Healthcare and Construction). We identified a set of interrelated patterns that are used for socially verifying and maturing rules and guidelines, solving problems, introducing new practices and triggering learning. Some particular social recognition and learning trends common in Healthcare and Construction sector Q&A forums are highlighted. We discuss epistemic practice pattern networks for developing scaffolds to enhance the quality of informal learning in workplace environments in an integrated way. We suggest and validate empirically a model of social recognition provision in Q&A forums

Sleep patterns and habits in high school students in Iran

<p>Abstract</p> <p>Background</p> <p>Sleep patterns and habits in high school students in Iran have not been well studied to date. This paper aims to re-address this balance and analyse sleep patterns and habits in Iranian children of high school age.</p> <p>Methods</p> <p>The subjects were 1,420 high school students randomly selected by stratified cluster sampling. This was a self-report study using a questionnaire which included items about usual sleep/wake behaviours over the previous month, such as sleep schedule, falling asleep in class, difficulty falling asleep, tiredness or sleepiness during the day, difficulty getting up in the morning, nightmares, and taking sleeping pills.</p> <p>Results</p> <p>The mean duration of night sleep was 7.7 h, with no difference between girls, boys, and school year (grade). The mean time of waking in the morning was not different between genders. About 9.9% of the girls and 4.6% of the boys perceived their quality of sleep as being bad, and 58% of them reported sleepiness during the day. About 4.2% of the subjects had used medication to enhance sleep. The time of going to bed was associated with grade level and gender. Sleep latency was not associated with gender and grade leve, l and 1.4% experienced bruxism more than four times a week.</p> <p>Conclusion</p> <p>Our results are in contrast with that of previous studies that concluded sleep duration is shorter in Asia than in Europe, that boys woke-up significantly later than girls, and that the frequency of sleep latency category was associated with gender and grade level. The magnitude of the daytime sleepiness, daytime sleepiness during classes, sleep latency, and incidences of waking up at night represent major public health concerns for Iran.</p

The development and assessment of biological treatments for children

The development of biological agents with specific immunological targets has revolutionized the treatment of a wide variety of paediatric diseases where traditional immunosuppressive agents have been partly ineffective or intolerable. The increasing requirement for pharmaceutical companies to undertake paediatric studies has provided impetus for studies of biologics in children. The assessment of biological agents in children to date has largely relied upon randomized controlled trials using a withdrawal design, rather than a parallel study design. This approach has been largely used due to ethical concerns, including use of placebo treatments in children with active chronic disease, and justified on the basis that treatments have usually already undergone robust assessment in related adult conditions. However, this study design limits the reliability of the data and can confuse the interpretation of safety results. Careful ongoing monitoring of safety and efficacy in real-world practice through national and international biologics registries and robust reporting systems is crucial. The most commonly used biological agents in children target tumour necrosis factor-α, interleukin-1, interleukin-6 and cytotoxic lymphocyte-associated antigen-4. These agents are most frequently used in paediatric rheumatic diseases. This review discusses the development and assessment of biologics within paediatric rheumatology with reference to the lessons learned from use in other subspecialties

Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study

BACKGROUND: The ankle region is frequently involved in juvenile idiopathic arthritis (JIA) but difficult to examine clinically due to its anatomical complexity. The aim of the study was to evaluate the role of ultrasonography (US) of the ankle and midfoot (ankle region) in JIA. Doppler-US detected synovial hypertrophy, effusion and hyperemia and US was used for guidance of steroid injection and to assess treatment efficacy. METHODS: Forty swollen ankles regions were studied in 30 patients (median age 6.5 years, range 1-16 years) with JIA. All patients were assessed clinically, by US (synovial hypertrophy, effusion) and by color Doppler (synovial hyperemia) before and 4 weeks after US-guided steroid injection. RESULTS: US detected 121 compartments with active disease (joints, tendon sheaths and 1 ganglion cyst). Multiple compartments were involved in 80% of the ankle regions. The talo-crural joint, posterior subtalar joint, midfoot joints and tendon sheaths were affected in 78%, 65%, 30% and 55% respectively. Fifty active tendon sheaths were detected, and multiple tendons were involved in 12 of the ankles. US-guidance allowed accurate placement of the corticosteroid in all 85 injected compartments, with a low rate of subcutaneous atrophy (4,7%). Normalization or regression of synovial hypertrophy was obtained in 89%, and normalization of synovial hyperemia in 89%. Clinical resolution of active arthritis was noted in 72% of the ankles. CONCLUSIONS: US enabled exact anatomical location of synovial inflammation in the ankle region of JIA patients. The talo-crural joint was not always involved. Disease was frequently found in compartments difficult to evaluate clinically. US enabled exact guidance of steroid injections, gave a low rate of subcutaneous atrophy and was proved valuable for follow-up examinations. Normalization or regression of synovial hypertrophy and hyperemia was achieved in most cases, which supports the notion that US is an important tool in the management of ankle involvement in JIA

The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation

Background: Juvenile idiopathic arthritis (JIA) is characterised by joint pain, swelling and limitation of movement caused by inflammation. Subsequent joint damage can lead to disability and growth restriction. Treatment commonly includes disease modifying anti-rheumatic drugs (DMARD) such as methotrexate. Clinical practice now favours newer drugs termed biologic DMARDs where indicated.Objective: To assess the clinical and cost-effectiveness of four biologic DMARDs (etanercept, abatacept, adalimumab and tocilizumab - with or without methotrexate where indicated) for the treatment of JIA (systemic or oligoarticular JIA excluded).Data sources: Electronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and DARE were searched for published studies from inception to May 2015 for English language articles. Bibliographies of related papers, systematic reviews and company submissions were screened and experts were contacted to identify additional evidence.Review methods: Systematic reviews of clinical-effectiveness, health-related quality of life and cost-effectiveness were undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A cost-utility decision analytic model was developed to compare estimated cost-effectiveness of biologic DMARDs versus methotrexate. The base case time horizon was 30 years and the model took a National Health Service (NHS) perspective, with costs and benefits discounted at 3.5%.Results: Four placebo-controlled RCTs met the inclusion criteria for the clinical-effectiveness review (one RCT evaluating each biologic DMARD). Only one RCT included UK participants. Participants had to achieve an American College of Rheumatology Pediatric (ACR Pedi) 30 response to open-label lead-in treatment in order to be randomised. An exploratory adjusted indirect comparison suggests that the four biologic DMARDs are similar with fewer disease flares and greater proportions with ACR Pedi 50 and 70 responses among participants randomised to continued biologic DMARD. However, confidence intervals were wide, the number of trials was low and there was clinical heterogeneity between trials. Open-label extensions of the trials showed that generally ACR responses remained constant or even increased after the double-blind phase. The proportions of adverse events and serious adverse events were generally similar between treatment and placebo groups. Four economic evaluations of biologic DMARDs for patients with JIA were identified but all had limitations. Two quality of life studies were included, one of which informed the cost-utility model. The incremental cost-effectiveness ratio (ICER) for adalimumab, etanercept and tocilizumab versus methotrexate was £38,127, £32,526 and £38,656 per QALY, respectively. The ICER for abatacept versus methotrexate as a second line biologic was £39,536 per QALY.Limitations: The model does not incorporate the natural history of JIA in terms of long-term disease progression, as the current evidence is limited. There are no head-to-head trials of biologic DMARDs and clinical evidence for specific JIA subtypes is limited.Conclusions: Biologic DMARDs are superior to placebo (with methotrexate where permitted) in children with (predominantly) polyarticular course JIA, and an insufficient response to previous treatment. Randomised comparisons of biologic DMARDs with long-term efficacy and safety follow- are needed to establish comparative effectiveness. RCTs for JIA subtypes where evidence is lacking are also required.Funding: The National Institute for Health Research Health Technology Assessment programme. <br/