Estimación de la reducción del consumo de combustible en vehículos como consecuencia de la reducción del peso

Ponencia presentada en el XIV Congreso Internacional de Ingeniería de Proyectos celebrado en Madrid, 30 de junio, 1 y 2 de julio de 2010The automotive sector, given the need to reduce energy demand and environmental impact of vehicles, needs to reduce the weight of vehicles. Lightweighting strategy to implement is based on the massive use of plastics and composites, which are lighter than steel and alloys. Use of plastics and composites will significantly reduce emissions during the use stage In that phase energy demand is about 85% of the total energy required during the life cycle of the vehicle. However, it should be assessed whether the improvements are not offset in other stages of the life of the product, in which steels and alloys may have less environmental impact than plastics and composites. In order to work out the fuel savings achieved during the use stage of the vehicle due to the weight reduction, several mathematical models can be used during the design phase. The study of those models will let us know the design parameters that must be considered in order to successfully apply the lightweighting strategy.El sector del automóvil, ante la necesidad de reducir la demanda energética y el impacto medioambiental de los vehículos, necesita aligerar el peso del vehículo. La estrategia de aligeramiento a aplicar se basa en la utilización masiva de plásticos y composites –más ligeros que los aceros y las aleaciones. La utilización de plásticos y composites permitirá reducir significativamente las emisiones durante la etapa de utilización –etapa en la que se demanda aproximadamente el 85% del total de energía del ciclo de vida del vehículo. Sin embargo, se deberá evaluar si las mejoras logradas no son contrarrestadas en otras etapas de la vida del producto en las que losaceros y las aleaciones puedan tener un impacto medioambiental inferior al de los plásticos y composites. Para determinar en la etapa de diseño el ahorro de combustible logrado en la etapa de utilización, debido a la reducción de peso, se pueden utilizar distintos modelos matemáticos. El estudio de estos modelos permitirá conocer las variables de diseño fundamentales que deben considerarse para aplicar con éxito la estrategia de aligeramiento

Mastoplastia reductora con analgesia acupuntural. A mamaplastic reduction using acupunctural analgesia

Se realizó un ensayo clínico prospectivo y descriptivo con 40 pacientes portadoras de hipertrofia mamaria que acudieron a consulta de Cirugía Plástica en el Hospital Universitario "Abel Santamaría Cuadrado" de Pinar del Río entre septiembre de 2002 y agosto de 2003 a las que se les realizó mastoplastia reductora con analgesia acupuntural (puntos C1, IG4, VC17, VG20 y un punto especial) evaluando la calidad de la analgesia acupuntural transoperatoria, el comportamiento hemodinámico transoperatorio y la ocurrencia de complicaciones postoperatorias. Para la validación estadística se utilizó el paquete Systat Con nivel de ajuste µ= 0.05. Se logró con la acupuntura un nivel analgésico transoperatorio satisfactorio en el 50 % de los casos, incluyendo pacientes de todos los grupos de edad, sobre todo en intervenciones que duraran hasta dos horas, independientemente del grado de hipertrofia mamaria. El comportamiento hemodinámico transoperatorio fue satisfactorio en las pacientes operadas con acupuntura; con esta técnica el registro de complicaciones fue inferior al reportado con anestesia general endotraqueal por otros autores, sin que se reportaran reacciones adversas por el uso de la acupuntura. DeCS: ACUPUNTURA/ tratamiento, CIRUGÍA PLÁSTICA, MAMA/ cirugía. ABSTRACT A prospective descriptive clinical trial was carried out in a sample of 40 patients suffering from breast hypertrophy who attended Cosmetic Surgery Office at Abel Santamaría General Hospital between September 2002 and August 2003. A reductive mastoplasia using acupunctural analgesia was carried out (C1, IG4, VC17, VG20 points and special one) assessing the quality of transoperative acupunctural analgesia, transoperative hemodynamic behaviour and the occurrence of postoperative complications. Systat pack was used for statistical validation with a fitted level of a = 0.05. a transoperative analgesic level was achieved successfully in 50 % of cases  including patients from every age group particularly in up to two hours surgeries irrespective of the breast hypertrophy. The transoperative homodynamic behaviour was successful in patients operated under acupuncture, using this technique it was found that endotraqueal general anaesthesia by other authors, reporting no eventful experiences when performing acupuncture. DeCS: ACUPUNCTURE/ treatment, SURGERY, PLASTIC BREAST/ surger

Mastoplastia reductora con analgesia acupuntural. A mamaplastic reduction using acupunctural analgesia

Se realizó un ensayo clínico prospectivo y descriptivo con 40 pacientes portadoras de hipertrofia mamaria que acudieron a consulta de Cirugía Plástica en el Hospital Universitario "Abel Santamaría Cuadrado" de Pinar del Río entre septiembre de 2002 y agosto de 2003 a las que se les realizó mastoplastia reductora con analgesia acupuntural (puntos C1, IG4, VC17, VG20 y un punto especial) evaluando la calidad de la analgesia acupuntural transoperatoria, el comportamiento hemodinámico transoperatorio y la ocurrencia de complicaciones postoperatorias. Para la validación estadística se utilizó el paquete Systat Con nivel de ajuste µ= 0.05. Se logró con la acupuntura un nivel analgésico transoperatorio satisfactorio en el 50 % de los casos, incluyendo pacientes de todos los grupos de edad, sobre todo en intervenciones que duraran hasta dos horas, independientemente del grado de hipertrofia mamaria. El comportamiento hemodinámico transoperatorio fue satisfactorio en las pacientes operadas con acupuntura; con esta técnica el registro de complicaciones fue inferior al reportado con anestesia general endotraqueal por otros autores, sin que se reportaran reacciones adversas por el uso de la acupuntura. DeCS: ACUPUNTURA/ tratamiento, CIRUGÍA PLÁSTICA, MAMA/ cirugía. ABSTRACT A prospective descriptive clinical trial was carried out in a sample of 40 patients suffering from breast hypertrophy who attended Cosmetic Surgery Office at Abel Santamaría General Hospital between September 2002 and August 2003. A reductive mastoplasia using acupunctural analgesia was carried out (C1, IG4, VC17, VG20 points and special one) assessing the quality of transoperative acupunctural analgesia, transoperative hemodynamic behaviour and the occurrence of postoperative complications. Systat pack was used for statistical validation with a fitted level of a = 0.05. a transoperative analgesic level was achieved successfully in 50 % of cases  including patients from every age group particularly in up to two hours surgeries irrespective of the breast hypertrophy. The transoperative homodynamic behaviour was successful in patients operated under acupuncture, using this technique it was found that endotraqueal general anaesthesia by other authors, reporting no eventful experiences when performing acupuncture. DeCS: ACUPUNCTURE/ treatment, SURGERY, PLASTIC BREAST/ surger

Efficacy, Safety and Cost-Effectiveness of Methotrexate, Adalimumab or Their Combination in Non-infectious Non-anterior Uveitis: A Protocol for a Multicentre, Randomised, Parallel Three Arms, Active-Controlled, Phase III Open Label With Blinded Outcome Assessment Study

[Abstract] Introduction: Non-infectious uveitis include a heterogeneous group of sight-threatening and incapacitating conditions. Their correct management sometimes requires the use of immunosuppressive drugs (ISDs), prescribed in monotherapy or in combination. Several observational studies showed that the use of ISDs in combination could be more effective than and as safe as their use in monotherapy. However, a direct comparison between these two treatment strategies has not been carried out yet. Methods and analysis: The Combination THerapy with mEthotrexate and adalImumAb for uveitis (CoTHEIA) study is a phase III, multicentre, prospective, randomised, single-blinded with masked outcome assessment, parallel three arms with 1:1:1 allocation, active-controlled, superiority study design, comparing the efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis. We aim to recruit 192 subjects. The duration of the treatment and follow-up will last up to 52 weeks, plus 70 days follow-up with no treatment. The complete and maintained resolution of the ocular inflammation will be assessed by masked evaluators (primary outcome). In addition to other secondary measurements of efficacy (quality of life, visual acuity and costs) and safety, we will identify subjects’ subgroups with different treatment responses by developing prediction models based on machine learning techniques using genetic and proteomic biomarkers. Ethics and dissemination: The protocol, annexes and informed consent forms were approved by the Reference Clinical Research Ethic Committee at the Hospital Clínico San Carlos (Madrid, Spain) and the Spanish Agency for Medicines and Health Products. We will elaborate a dissemination plan including production of materials adapted to several formats to communicate the clinical trial progress and findings to a broad group of stakeholders. The promoter will be the only access to the participant-level data, although it can be shared within the legal situation. Trial registration number: 2020-000130-18; NCT04798755.This work was supported by the Instituto de Salud Carlos III, grant number [ICI19/00020]. Sponsor: Fundación para la Investigacion Biomédica del Hospital Clínico San Carlos. Executive Committee: Administrative and executive arm of the clinical trial, providing overall oversight for the study and making decisions on day-to-day operational issues (Study Coordinator (Luis Rodriguez-Rodriguez), a representative from the Spanish Clinical Trial Network (Amanda López Picado), and 5 Site Directors (these seats will be rotatory, with changes every 6 months months)); Data Coordinating and Analysis Committee: Supervising data collection,management and quality control, designing the statistical analysis plan, performing unmasked data analysis and preparing interim and final reports for the Data Security Monitoring Board and the Executy Committee (Study Coordinator (Luis Rodriguez-Rodriguez), a representative from the Spanish Clinical Trial Network (Amanda López Picado) and Ester Carreño); Biobank and Biomarker Identification Committee (Maintaining an up-to-date manual of operations for blood extraction, processing and storage, and monitoring procedures adherence, supervising biological sample collection, sample shipment coordination, coordinating the phamacogenetic and proteomic analysis (Study Coordinator (Luis Rodriguez-Rodriguez), a representative from the Instituto de Salud Carlos III Biobank Platform (Elena Molino), a representative the Instituto de Investigación Biomédica de A Coruña, a representative from, the Data Coordinating and Analysis Committee); Data Security Monitoring Committee (PierGiogio Neri, Andrew Dick, Loreto Carmona

Utility of a thematic network in primary health care: a controlled interventional study in a rural area

BACKGROUND: UniNet is an Internet-based thematic network for a virtual community of users (VCU). It supports a virtual multidisciplinary community for physicians, focused on the improvement of clinical practice. This is a study of the effects of a thematic network such as UniNet on primary care medicine in a rural area, specifically as a platform of communication between specialists at the hospital and doctors in the rural area. METHODS: In order to study the effects of a thematic network such as UniNet on primary care medicine in a rural area, we designed an interventional study that included a control group. The measurements included the number of patient displacements due to disease, number of patient hospital stays and the number of prescriptions of drugs of low therapeutic utility and generic drug prescriptions by doctors. These data were analysed and compared with those of the control center. RESULTS: Our study showed positive changes in medical practice, reflected in the improvement of the evaluated parameters in the rural health area where the interventional study was carried out, compared with the control area. We discuss the strengths and weaknesses of UniNet as a potential medium to improve the quality of medical care in rural areas. CONCLUSION: The rural doctors had an effective, useful, user-friendly and cheap source of medical information that may have contributed to the improvement observed in the medical quality indices

Impacts of Use and Abuse of Nature in Catalonia with Proposals for Sustainable Management

This paper provides an overview of the last 40 years of use, and in many cases abuse, of the natural resources in Catalonia, a country that is representative of European countries in general, and especially those in the Mediterranean region. It analyses the use of natural resources made by mining, agriculture, livestock, logging, fishing, nature tourism, and energy production and consumption. This use results in an ecological footprint, i.e., the productive land and sea surface required to generate the consumed resources and absorb the resulting waste, which is about seven times the amount available, a very high number but very similar to other European countries. This overexploitation of natural resources has a huge impact on land and its different forms of cover, air, and water. For the last 25 years, forests and urban areas have each gained almost 3% more of the territory at the expense of agricultural land; those municipalities bordering the sea have increased their number of inhabitants and activity, and although they only occupy 6.7% of the total surface area, they account for 43.3% of the population; air quality has stabilized since the turn of the century, and there has been some improvement in the state of aquatic ecosystems, but still only 36% are in good condition, while the remainder have suffered morphological changes and different forms of nonpoint source pollution; meanwhile the biodiversity of flora and fauna remains still under threat. Environmental policies do not go far enough so there is a need for revision of the legislation related to environmental impact and the protection of natural areas, flora, and fauna. The promotion of environmental research must be accompanied by environmental education to foster a society which is more knowledgeable, has more control and influence over the decisions that deeply affect it. Indeed, nature conservation goes hand in hand with other social and economic challenges that require a more sustainable vision. Today's problems with nature derive from the current economic model, which is environmentally unsustainable in that it does not take into account environmental impacts. Lastly, we propose a series of reasonable and feasible priority measures and actions related to each use made of the country's natural resources, to the impacts they have had, and to their management, in the hope that these can contribute to improving the conservation and management of the environment and biodiversity and move towards sustainability

International Consensus Document on Obstructive Sleep Apnea

El objetivo principal de este documento internacional de consenso sobre apnea obstructiva del sueno es proporcionar unas directrices que permitan a los profesionales sanitarios tomar las mejores decisiones en la asistencia de los pacientes adultos con esta enfermedad según un resumen crítico de la literatura más actualizada. El grupo de trabajo de expertos se ha constituido principalmente por 17 sociedades científicas y 56 especialistas con amplia representación geográfica (con la participación de 4 sociedades internacionales), además de un metodólogo experto y un documentalista del Centro Cochrane Iberoamer icano. El documento consta de un manuscrito principal, con las novedades más relevantes del DIC, y una serie de manuscritos online que recogen las búsquedas bibliográficas sistemáticas de cada uno de los apartados del DIC. Este documento no cubre la edad pediátrica ni el manejo del paciente en ventilación mecánica crónica no invasiva (que se publicarán en sendos documentos de consenso aparte)

Impacts of Use and Abuse of Nature in Catalonia with Proposals for Sustainable Management

This paper provides an overview of the last 40 years of use, and in many cases abuse, of the natural resources in Catalonia, a country that is representative of European countries in general, and especially those in the Mediterranean region. It analyses the use of natural resources made by mining, agriculture, livestock, logging, fishing, nature tourism, and energy production and consumption. This use results in an ecological footprint, i.e., the productive land and sea surface required to generate the consumed resources and absorb the resulting waste, which is about seven times the amount available, a very high number but very similar to other European countries. This overexploitation of natural resources has a huge impact on land and its different forms of cover, air, and water. For the last 25 years, forests and urban areas have each gained almost 3% more of the territory at the expense of agricultural land; those municipalities bordering the sea have increased their number of inhabitants and activity, and although they only occupy 6.7% of the total surface area, they account for 43.3% of the population; air quality has stabilized since the turn of the century, and there has been some improvement in the state of aquatic ecosystems, but still only 36% are in good condition, while the remainder have suffered morphological changes and different forms of nonpoint source pollution; meanwhile the biodiversity of flora and fauna remains still under threat. Environmental policies do not go far enough so there is a need for revision of the legislation related to environmental impact and the protection of natural areas, flora, and fauna. The promotion of environmental research must be accompanied by environmental education to foster a society which is Land 2021, 10, 144 3 of 53 more knowledgeable, has more control and influence over the decisions that deeply affect it. Indeed, nature conservation goes hand in hand with other social and economic challenges that require a more sustainable vision. Today’s problems with nature derive from the current economic model, which is environmentally unsustainable in that it does not take into account environmental impacts. Lastly, we propose a series of reasonable and feasible priority measures and actions related to each use made of the country’s natural resources, to the impacts they have had, and to their management, in the hope that these can contribute to improving the conservation and management of the environment and biodiversity and move towards sustainability.info:eu-repo/semantics/publishedVersio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality