Optimización de un proceso de recocido : una aproximación desde la estadística y la ciencia de materiales a un caso de aplicación en la manufactura de envases de vidrio

RESUMEN: El recocido es uno de los procesos más importantes en la manufactura del vidrio ya que proporciona la relajación de la red vítrea de SiO2 y por ende define importantes propiedades mecánicas requeridas para hacer a este material útil. Sin embargo, dicho proceso también es costoso debido a las grandes cantidades de energía y tiempo involucradas para llevarlo a cabo, razón por la cual hay al interior de la industria del vidrio un paradigma concerniente a los posibles problemas involucrados con el cambio de variables para mejorar el proceso a nivel técnico sin afectar la calidad del vidrio. En este orden de ideas, disminuciones progresivas de temperatura y tiempo fueron llevadas a cabo al interior de un archa de recocido real pretendiendo así medir, analizar y comparar los valores de esfuerzo obtenidos con el proceso actual contra los valores obtenidos con los procesos propuestos. Todo lo anterior siguiendo las normas ASTM C336-71 y ASTM C148-14, así como haciendo uso de herramientas estadísticas tales como: Diseño de Experimentos (DOE) y Análisis de Varianza (ANOVA). Como resultados fueron obtenidos cambios estadísticamente no significativos entre los valores de esfuerzo obtenidos para la mayoría de las disminuciones efectuadas, lo cual permite pensar en dichas disminuciones como una opción para los altos costos de la industria del vidrio.ABSTRACT: Annealing is one of the most important processes to manufacture glass since it provides relaxation to the SiO2 vitreous network and therefore it determines important mechanical properties required for doing this material useful. However, this process is also expensive due to there are involved high quantities of energy and time to carry it out, and for these reasons there is into the glass industry a paradigm regarding possible issues involved with the changing of variables to improve the process at the technical level without affecting the glass quality. In this order of ideas, progressive decreases of both, temperature and time were performed into an actual lehr, aiming to measure, to analyze and to compare the values of stress obtained from the actual and the proposed processes, all of this using the ASTM C336- 71 and the ASTM C148-14 standards, as well as using statistical tools such as: Design of Experiments (DOE) and Analysis of Variance (ANOVA). As results were obtained nonsignificant statistical changes between the values of stress obtained for the majority of decreases performed, which allows to think about these decreases as an option for the high glass industry costs

Evaluation of the influence of the chemical composition and the time of fusion on the physical properties of the glass obtained from recycled bottle material

RESUMEN: Este estudio presenta la influencia de la composición química y el tiempo de fusión del vidrio reciclado de botella empleado como materia prima en el proceso de soplado a boca. Se planteó el diseño de experimentos empleando el método Taguchi considerando tres factores: Na2CO3, Na2SO4 y tiempo de permanencia del vidrio dentro del horno, para analizar el efecto sobre el diámetro y cantidad de burbujas, densidad, dureza, viscosidad y color. La formulación que presentó mejor desempeño son 10% Na2CO3, 0.5% Na2SO4 y un tiempo de fusión de 6 horas.ABSTRACT: This study presents the influence of the chemical composition and fusing time of recycled bottle glass used as raw material in the mouth-blowing process. The design of experiments was proposed using the Taguchi method considering three factors: Na2CO3, Na2SO4 and fusing time of the glass inside the furnace, to analyze the effect on the diameter and amount of bubbles, density, hardness, viscosity and color. The formulation that presented the best results are 10% Na2CO3, 0.5% Na2SO4, and a fusing time of 6 hours

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Étude tribologique à hautes températures de matériaux céramiques structurés à différentes échelles

In order to evaluate and to understand the wear performance and mechanisms at high temperatures that take place when different chemical compositions (Al2O3, ZrO2, mullite), scales (finely structured, microstructured and submillimetric) and configurations (single layer, bilayer and volume) interact, atmospheric plasma sprayed coatings manufactured on a silicoaluminous ceramic substrate were used. The Al2O3, ZrO2-Al2O3 and ZrO2-Y2O3 coatings correspond to the monolayer configuration, as well as the finely and microstructured scales, while the Mullite/Al2O3, Mullite/ ZrO2-Al2O3 and of Mullite/ ZrO2-Y2O3 correspond to the bilayer configuration, where the outer mullite layer is microstructured and the sub-layers can correspond to finely and microstructured scales. In the same way, the Al2O3 and AZS commercial refractories correspond to the volume configuration and the submillimeter scale, taking into account that these have also been used as references because of the high resistance to wear that they show in glass and cement industries. Subsequently, these ceramic materials were subjected to sliding contact wear conditions (5 N, 20000 rpm and 0,10 ms-1) with a ball on disk tribometer at temperatures of: 25, 500, 750 and 1000 °C. The results indicate that the wear of the Al2O3, ZrO2-Al2O3 and ZrO2-Y2O3 coatings at 25 and 1000 ° C was by ductile deformation, showing wear rates of the order of 10-4-10- 6 and 10-4-10-5 mm3.N-1.m-1 respectively, while at 500 and 750 °C was by brittle deformation with wear rates of the order of 10-3-10-4 mm3.N-1.m-1 for both temperatures, finding a slightly higher wear resistance in finely structured coatings due primarily to toughness. Regarding the two electro-melted volume refractories at submillimetric scale, they showed wear by ductile deformation only at 1000 °C, showing wear rates of the order of 10-4 mm3.N-1.m-1. On the other hand, the mullite bilayer systems showed wear by brittle deformation at all evaluated temperatures, with wear rates of the order of 10-3-10-4 mm3.N-1.m-1, without showing any improvement at all because of the presence of the sub-layers. Finally, aiming to seek more economical options, as well as to give other applications to the materials studied, it has also been determined the influence on wear at high temperature of Al2O3 coatings, finely and microstructured, manufactured by the chep technique of oxy-flame spraying, as well as the same Al2O3 coatings manufactured by plasma spraying on a metallic substrate of Inconel 718, which is used by the space and aerospace industries, obtaining for both cases comparable and similar results to all those obtained previously.Con el fin de evaluar el desempeño y comprender los mecanismos de desgaste de materiales cerámicos que se producen a alta temperatura cuando diferentes composiciones químicas (Al2O3, base ZrO2, mullita), diferentes escalas de estructura (finamente estructurado, microestructurado y submilimétrico) y diferentes configuraciones (mono-capa, bi-capa y en volumen) interactúan, fueron realizados recubrimientos cerámicos por proyección térmica de plasma sobre un sustrato cerámico silico-aluminoso. Los recubrimientos de Al2O3, ZrO2-Al2O3 y ZrO2-Y2O3 corresponden con la configuración mono-capa y con las escalas finamente estructurada y microestructurada. Mientras que los recubrimientos de mullita/Al2O3, mullita/ ZrO2-Al2O3 y mullita/ ZrO2-Y2O3 corresponden con la configuración bi-capa, donde la capa superior de los recubrimientos es de mullita microstructurada y las subcapas pueden ser finamente estructuradas y microestructuradas. Dichos recubrimientos fueron comparados con refractarios electrofundidos de Al2O3 y AZS correspondientes con la configuración en volumen y con la escala submilimétrica, los cuales también fueron utilizados como referencias debido a sus altas resistencias al desgaste a altas temperaturas en industrias tales como: la del vidrio y el cemento. Todos los materiales cerámicos fueron sometidos a condiciones de desgaste por contacto deslizante (5 N, 20000 vueltas y 0,10 m.s-1) con un tribómetro de tipo bola-disco a temperaturas de 25, 500, 750 y 1000 °C. Los resultados indican que el desgaste en los recubrimientos de Al2O3 y base ZrO2 a 25 y 1000 °C fue por deformación dúctil, con tasas de desgaste de 10-4-10-6 et 10-4-10-5 mm3.N-1.m-1 respectivamente, mientras que a 500 y 750 °C el desgaste fue por deformación frágil con tasas de desgaste del orden de 10-3-10-4 mm3.N- 1.m-1 para ambas temperaturas y ambos materiales. La resistencia al desgaste en los recubrimientos finamente estructurados fue ligeramente superior debido principalmente a la mayor tenacidad tenacidad a la fractura. Para los dos refractarios electrofundidos en volumen a escala submilimétrica, el desgaste por deformación dúctil fue detectado solo a 1000 °C, con tasas de desgaste del orden de 10-4 mm3.N-1.m-1. Para los sistemas bi-capa de mullita, el desgaste por deformación frágil se observó a todas las temperaturas evaluadas, con tasas de desgaste del orden de 10-3-10-4 mm3.N-1.m-1, sin mostrar ninguna mejora debido a la presencia de una subcapa cerámica. Finalmente, en aras de buscar tanto soluciones más económicas como otras aplicaciones, el comportamiento tribológico a alta temperatura se estudió también en recubrimientos de Al2O3 finamente estructurados y microestructurados, realizados mediante proyección térmica de llama oxiacetilénica, más económica que la proyección de plasma, así como sobre los mismos recubrimientos de Al2O3 realizados mediante proyección de plasma sobre un sustrato metálico de Inconel 718, utilizado comúnmente en las industrias espacial y aeronáutica. En ambos casos, los resultados fueron similares a los obtenidos por plasma o por sustrato refractario.Dans le but d’évaluer la performance et de comprendre les mécanismes d'usure, à haute température, de matériaux céramiques, de compositions chimiques différentes (Al2O3, base ZrO2, mullite), à différentes échelles de structure (finement structuré, microstructuré et submillimétrique) et de configurations différentes (monocouche, bicouche et en volume), des revêtements céramiques ont été réalisés par projection plasma à pression atmosphérique sur un substrat céramique silico-alumineux. Les revêtements d’Al2O3, de ZrO2-Al2O3 et de ZrO2- Y2O3 correspondant à la configuration monocouche ont été élaborés avec deux échelles de structure : finement structurée et microstructurée. Tandis que les revêtements de mullite/Al2O3, mullite/ ZrO2-Al2O3 et mullite/ ZrO2-Y2O3 correspondant à la configuration bicouche, ont été réalisés avec la couche supérieure (top coat) de mullite microstructurée sur les sous-couches (bond coat) finement structurés et microstructurés. Les revêtements ont été comparés à des réfractaires électrofondus d’Al2O3 et d’AZS correspondant à la configuration en volume à l’échelle submillimétrique, utilisés comme références en raison de leur grande résistance à l’usure à haute température dans les industries de fabrication du verre et des ciments. Tous les matériaux céramiques ont été exposés à des conditions d’usure par contact glissant (5 N, 20000 tours et 0,10 m.s-1) avec un tribomètre de type bille sur disque à des températures de 25, 500, 750 et 1000 °C. Les résultats indiquent que l’usure des revêtements d’Al2O3, de ZrO2- Al2O3 et de ZrO2-Y2O3 à 25 et 1000 °C est due à une déformation ductile, avec des taux d’usure respectifs de l’ordre de 10-4-10-6 et 10-4-10-5 mm3.N-1.m-1, tandis qu’à 500 et 750 °C l’usure se fait par déformation fragile avec des taux d’usure de l’ordre de 10-3-10-4 mm3.N-1.m-1 pour les deux températures. La résistance à l’usure a été trouvée légèrement supérieure dans les revêtements finement structurés principalement en raison de la ténacité plus élevée. Pour les deux réfractaires électrofondus en volume à échelle submillimétrique, l’usure par déformation ductile est prépondérante à 1000 °C, avec des taux d’usure de l’ordre de 10-4 mm3.N-1.m-1. Pour les systèmes bicouches de mullite, l’usure par déformation fragile a été observée à toutes les températures évaluées, avec des taux d’usure de l’ordre de 10-3-10-4 mm3.N-1.m-1, sans montrer aucune amélioration du fait de la présence d’une sous-couche céramique. En cherchant des solutions plus économiques et pour d’autres applications, le comportement tribologique à haute température a également été étudié sur des revêtements d’Al2O3 finement structurés et microstructurés, réalisés par projection à la flamme oxyacétylénique, plus économique que la projection plasma, ainsi que sur les mêmes revêtements d’Al2O3 réalisés par projection plasma sur un substrat métallique d’Inconel 718, couramment utilisé dans les industries spatiale et aéronautique. Dans les deux cas, les résultats étaient similaires à ceux obtenus par projection plasma sur un substrat réfractaire

Estudio tribológico a altas temperaturas de materiales cerámicos estructurados a diferentes escalas

Dans le but d’évaluer la performance et de comprendre les mécanismes d'usure, à haute température, de matériaux céramiques, de compositions chimiques différentes (Al2O3, base ZrO2, mullite), à différentes échelles de structure (finement structuré, microstructuré et submillimétrique) et de configurations différentes (monocouche, bicouche et en volume), des revêtements céramiques ont été réalisés par projection plasma à pression atmosphérique sur un substrat céramique silico-alumineux. Les revêtements d’Al2O3, de ZrO2-Al2O3 et de ZrO2- Y2O3 correspondant à la configuration monocouche ont été élaborés avec deux échelles de structure : finement structurée et microstructurée. Tandis que les revêtements de mullite/Al2O3, mullite/ ZrO2-Al2O3 et mullite/ ZrO2-Y2O3 correspondant à la configuration bicouche, ont été réalisés avec la couche supérieure (top coat) de mullite microstructurée sur les sous-couches (bond coat) finement structurés et microstructurés. Les revêtements ont été comparés à des réfractaires électrofondus d’Al2O3 et d’AZS correspondant à la configuration en volume à l’échelle submillimétrique, utilisés comme références en raison de leur grande résistance à l’usure à haute température dans les industries de fabrication du verre et des ciments. Tous les matériaux céramiques ont été exposés à des conditions d’usure par contact glissant (5 N, 20000 tours et 0,10 m.s-1) avec un tribomètre de type bille sur disque à des températures de 25, 500, 750 et 1000 °C. Les résultats indiquent que l’usure des revêtements d’Al2O3, de ZrO2- Al2O3 et de ZrO2-Y2O3 à 25 et 1000 °C est due à une déformation ductile, avec des taux d’usure respectifs de l’ordre de 10-4-10-6 et 10-4-10-5 mm3.N-1.m-1, tandis qu’à 500 et 750 °C l’usure se fait par déformation fragile avec des taux d’usure de l’ordre de 10-3-10-4 mm3.N-1.m-1 pour les deux températures. La résistance à l’usure a été trouvée légèrement supérieure dans les revêtements finement structurés principalement en raison de la ténacité plus élevée. Pour les deux réfractaires électrofondus en volume à échelle submillimétrique, l’usure par déformation ductile est prépondérante à 1000 °C, avec des taux d’usure de l’ordre de 10-4 mm3.N-1.m-1. Pour les systèmes bicouches de mullite, l’usure par déformation fragile a été observée à toutes les températures évaluées, avec des taux d’usure de l’ordre de 10-3-10-4 mm3.N-1.m-1, sans montrer aucune amélioration du fait de la présence d’une sous-couche céramique. En cherchant des solutions plus économiques et pour d’autres applications, le comportement tribologique à haute température a également été étudié sur des revêtements d’Al2O3 finement structurés et microstructurés, réalisés par projection à la flamme oxyacétylénique, plus économique que la projection plasma, ainsi que sur les mêmes revêtements d’Al2O3 réalisés par projection plasma sur un substrat métallique d’Inconel 718, couramment utilisé dans les industries spatiale et aéronautique. Dans les deux cas, les résultats étaient similaires à ceux obtenus par projection plasma sur un substrat réfractaire.In order to evaluate and to understand the wear performance and mechanisms at high temperatures that take place when different chemical compositions (Al2O3, ZrO2, mullite), scales (finely structured, microstructured and submillimetric) and configurations (single layer, bilayer and volume) interact, atmospheric plasma sprayed coatings manufactured on a silicoaluminous ceramic substrate were used. The Al2O3, ZrO2-Al2O3 and ZrO2-Y2O3 coatings correspond to the monolayer configuration, as well as the finely and microstructured scales, while the Mullite/Al2O3, Mullite/ ZrO2-Al2O3 and of Mullite/ ZrO2-Y2O3 correspond to the bilayer configuration, where the outer mullite layer is microstructured and the sub-layers can correspond to finely and microstructured scales. In the same way, the Al2O3 and AZS commercial refractories correspond to the volume configuration and the submillimeter scale, taking into account that these have also been used as references because of the high resistance to wear that they show in glass and cement industries. Subsequently, these ceramic materials were subjected to sliding contact wear conditions (5 N, 20000 rpm and 0,10 ms-1) with a ball on disk tribometer at temperatures of: 25, 500, 750 and 1000 °C. The results indicate that the wear of the Al2O3, ZrO2-Al2O3 and ZrO2-Y2O3 coatings at 25 and 1000 ° C was by ductile deformation, showing wear rates of the order of 10-4-10- 6 and 10-4-10-5 mm3.N-1.m-1 respectively, while at 500 and 750 °C was by brittle deformation with wear rates of the order of 10-3-10-4 mm3.N-1.m-1 for both temperatures, finding a slightly higher wear resistance in finely structured coatings due primarily to toughness. Regarding the two electro-melted volume refractories at submillimetric scale, they showed wear by ductile deformation only at 1000 °C, showing wear rates of the order of 10-4 mm3.N-1.m-1. On the other hand, the mullite bilayer systems showed wear by brittle deformation at all evaluated temperatures, with wear rates of the order of 10-3-10-4 mm3.N-1.m-1, without showing any improvement at all because of the presence of the sub-layers. Finally, aiming to seek more economical options, as well as to give other applications to the materials studied, it has also been determined the influence on wear at high temperature of Al2O3 coatings, finely and microstructured, manufactured by the chep technique of oxy-flame spraying, as well as the same Al2O3 coatings manufactured by plasma spraying on a metallic substrate of Inconel 718, which is used by the space and aerospace industries, obtaining for both cases comparable and similar results to all those obtained previously.Con el fin de evaluar el desempeño y comprender los mecanismos de desgaste de materiales cerámicos que se producen a alta temperatura cuando diferentes composiciones químicas (Al2O3, base ZrO2, mullita), diferentes escalas de estructura (finamente estructurado, microestructurado y submilimétrico) y diferentes configuraciones (mono-capa, bi-capa y en volumen) interactúan, fueron realizados recubrimientos cerámicos por proyección térmica de plasma sobre un sustrato cerámico silico-aluminoso. Los recubrimientos de Al2O3, ZrO2-Al2O3 y ZrO2-Y2O3 corresponden con la configuración mono-capa y con las escalas finamente estructurada y microestructurada. Mientras que los recubrimientos de mullita/Al2O3, mullita/ ZrO2-Al2O3 y mullita/ ZrO2-Y2O3 corresponden con la configuración bi-capa, donde la capa superior de los recubrimientos es de mullita microstructurada y las subcapas pueden ser finamente estructuradas y microestructuradas. Dichos recubrimientos fueron comparados con refractarios electrofundidos de Al2O3 y AZS correspondientes con la configuración en volumen y con la escala submilimétrica, los cuales también fueron utilizados como referencias debido a sus altas resistencias al desgaste a altas temperaturas en industrias tales como: la del vidrio y el cemento. Todos los materiales cerámicos fueron sometidos a condiciones de desgaste por contacto deslizante (5 N, 20000 vueltas y 0,10 m.s-1) con un tribómetro de tipo bola-disco a temperaturas de 25, 500, 750 y 1000 °C. Los resultados indican que el desgaste en los recubrimientos de Al2O3 y base ZrO2 a 25 y 1000 °C fue por deformación dúctil, con tasas de desgaste de 10-4-10-6 et 10-4-10-5 mm3.N-1.m-1 respectivamente, mientras que a 500 y 750 °C el desgaste fue por deformación frágil con tasas de desgaste del orden de 10-3-10-4 mm3.N- 1.m-1 para ambas temperaturas y ambos materiales. La resistencia al desgaste en los recubrimientos finamente estructurados fue ligeramente superior debido principalmente a la mayor tenacidad tenacidad a la fractura. Para los dos refractarios electrofundidos en volumen a escala submilimétrica, el desgaste por deformación dúctil fue detectado solo a 1000 °C, con tasas de desgaste del orden de 10-4 mm3.N-1.m-1. Para los sistemas bi-capa de mullita, el desgaste por deformación frágil se observó a todas las temperaturas evaluadas, con tasas de desgaste del orden de 10-3-10-4 mm3.N-1.m-1, sin mostrar ninguna mejora debido a la presencia de una subcapa cerámica. Finalmente, en aras de buscar tanto soluciones más económicas como otras aplicaciones, el comportamiento tribológico a alta temperatura se estudió también en recubrimientos de Al2O3 finamente estructurados y microestructurados, realizados mediante proyección térmica de llama oxiacetilénica, más económica que la proyección de plasma, así como sobre los mismos recubrimientos de Al2O3 realizados mediante proyección de plasma sobre un sustrato metálico de Inconel 718, utilizado comúnmente en las industrias espacial y aeronáutica. En ambos casos, los resultados fueron similares a los obtenidos por plasma o por sustrato refractario

Latin America: situation and preparedness facing the multi-country human monkeypox outbreak

Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Risaralda, Colombia / Universidad Científica del Sur. Master of Clinical Epidemiology and Biostatistics. Lima, Peru / Latin American network of Monkeypox Virus Research. Pereira, Risaralda, ColombiaUniversity of Buenos Aires. Cátedra de Enfermedades Infecciosas. Buenos Aires, Argentina.Hospital Britanico de Buenos Aires. Servicio de Infectología. Buenos Aires, Argentina.University of Buenos Aires. Cátedra de Enfermedades Infecciosas. Buenos Aires, Argentina / Hospital de Enfermedades Infecciosas F. J. Muniz. Buenos Aires, Argentina.University of Buenos Aires. Cátedra de Enfermedades Infecciosas. Buenos Aires, Argentina / Hospital de Enfermedades Infecciosas F. J. Muniz. Buenos Aires, Argentina.Hospital Clínico Viedma. Cochabamba, Bolivia.Gobierno Autonomo Municipal de Cochabamba. Secretaría de Salud. Centros de Salud de Primer Nivel. Direction. Cochabamba, Bolivia.Franz Tamayo University. National Research Coordination. La Paz, Bolivia.Paulista State University Júlio de Mesquita Filho. Botucatu Medical School. Infectious Diseases Department. São Paulo, SP, Brazil / Brazilian Society for Infectious Diseases. Sãao Paulo, SP, Brazil.Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brazil.Institute of Infectious Diseases Emilio Ribas. São Paulo, Brazil.Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Centro de Referencia de Salud Dr. Salvador Allende Gossens. Policlínico Neurología. Unidad Procedimientos. Santiago de Chile, Chile.Pontificia Universidad Católica de Chile. School of Medicine. Department of Pediatric Infectious Diseases and Immunology. Santiago de Chile, Chile.Universidad Austral de Chile. Facultad de Medicina. Instituto de Salud Publica. Valdivia, Chile.Ministerio de Salud. Hospital de San Fernando. San Fernando, VI Region, Chile.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Risaralda, Colombia.Universidad Nacional de Colombia. Department of Pediatrics. Bogota, DC, Colombia / Hospital Pediatrico La Misericordia. Division of Infectious Diseases. Bogota, DC, Colombia.Hemera Unidad de Infectología IPS SAS. Bogota, Colombia.Hospital San Vicente Fundacion. Rionegro, Antioquia, Colombia.Clinica Imbanaco Grupo Quironsalud. Cali, Colombia / Universidad Santiago de Cali. Cali, Colombia / Clinica de Occidente. Cali, Colombia / Clinica Sebastian de Belalcazar. Valle del Cauca, Colombia.National Institute of Gastroenterology. Epidemiology Unit. La Habana, CubaHospital Salvador Bienvenido Gautier. Santo Domingo, Dominican Republic.Pontificia Universidad Catolica Madre y Maestra. Santiago, Dominican Republic.International University of Ecuador. School of Medicine. Quito, Ecuador.Universidad Tecnica de Ambato. Ambato, Ecuador.Hospital Roosevelt. Guatemala City, Guatemala.Universidad Nacional Autonoma de Honduras. Faculty of Medical Sciences. School of Medical. Unit of Scientific Research. Tegucigalpa, Honduras.Hospital Infantil de Mexico. Federico Gomez, Mexico City, Mexico.Hospital General de Tijuana. Departamento de Infectología. Tijuana, Mexico.Hospital General de Tijuana. Departamento de Infectología. Tijuana, Mexico.Asociacion de Microbiólogos y Químicos Clínicos de Nicaragua. Managua, Nicaragua.Hospital Santo Tomas. Medicine Department-Infectious Diseases Service. Panama City, Panama / Instituto Oncologico Nacional. Panama city, Panama.University of Arizona College of Medicine-Phoenix. Division of Endocrinology. Department of Medicine. Phoenix, AZ, USA / Indian School Rd. Phoenix, AZ, USA.Dirección Nacional de Vigilancia Sanitaria. Dirección de Investigación. Asunción, Paraguay.Universidad Nacional de Asuncion. Faculty of Medical Sciences. Division of Dermatology. Asuncion, Paraguay.Instituto Nacional de Salud del Nino San Borja. Infectious Diseases Division. Lima, Peru / Universidad Privada de Tacna. Facultad de Ciencias de la Salud. Tacna, Peru.Universidad San Juan Bautista. Lima, Peru.Universidad San Ignacio de Loyola. Vicerrectorado de Investigación. Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru.Hospital Evangelico de Montevideo. Montevideo, Uruguay.Icahn School of Medicine at Mount Sinai. Molecular and Cell-based Medicine. Department of Pathology. Molecular Microbiology Laboratory. New York, USA / Universidad del Rosario. Facultad de Ciencias Naturales. Centro de Investigaciones en Microbiología y Biotecnología-UR. Bogota, Colombia.Hospital Evangélico de Montevideo. Montevideo, Uruguay / Venezuelan Science Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network. Infectious Diseases Research Branch. Cabudare, Lara, Venezuela.Universidad Central de Venezuela. Faculty of Medicine. Caracas, Venezuela.Universidad Central de Venezuela. Faculty of Medicine. Caracas, Venezuela / Biomedical Research and Therapeutic Vaccines Institute. Ciudad Bolivar, Venezuela.Universidad Central de Venezuela. Tropical Medicine Institute, Infectious Diseases Section. Caracas, Venezuela.Instituto Conmemorativo Gorgas de Estudios de la Salud. Clinical Research Department. Investigador SNI Senacyt Panama. Panama City, Panama

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research