Flexibilidad y adaptabilidad para las diferentes formas de vivir. Vivienda post pandémica en entorno patrimonial

Artículo de gradoEl articulo expone un proyecto basado en el análisis de la vivienda actual y personal desde la pandemia 2020, donde se identifican algunas necesidades a partir de las nuevas modalidades de estudio, trabajo, y otras actividades identificadas en mi hogar. A partir de ello, se generan conjuntos de vivienda unifamiliares permitiendo una progresividad autónoma, así como dos tipologías de apartamentos flexibles que se repiten, obteniendo como resultado la implantación estratégica de un conjunto residencial colectivo, con el objetivo de frenar la tendencia de producir hogares cada vez más limitados ofreciendo la posibilidad de crear espacios multifuncionales adaptables a las circunstancias y necesidades cambiantes, proponiendo un lugar urbano adecuado. Lo anterior se proyecta del municipio de Villa de Leyva – Monumento nacional, en el casco urbano en la periferia del centro histórico, conectando con la quebrada de San Agustín.Resumen 1. Introducción 2. Hipótesis y objetivos 3. Metodología 4. Resultados 5. Discusión 6. Conclusiones 7. Agradecimientos Referencias AnexosPregradoArquitect

Empirical investigation to explore potential gains from the amalgamation of Phase Changing Materials (PCMs) and wood shavings

The reduction of gained heat, heat peak shifting and the mitigation of air temperature fluctuations are some desirable properties that are sought after in any thermal insulation system. It cannot be overstated that these factors, in addition to others, govern the performance of such systems thus their effect on indoor ambient conditions. The effect of such systems extends also to Heating, Ventilation and Air-conditioning (HVAC) systems that are set up to operate optimally in certain conditions. Where literature shows that PCMs and natural materials such as wood-shavings can provide efficient passive insulation for buildings, it is evident that such approaches utilise methods that are of a degree of intricacy which requires specialist knowledge and complex techniques, such as micro-encapsulation for instance. With technical and economic aspects in mind, an amalgam of PCM and wood-shavings has been created for the purpose of being utilised as a feasible thermal insulation. The amalgamation was performed in the simplest of methods, through submerging the wood shavings in PCM. An experimental procedure was devised to test the thermal performance of the amalgam and compare this to the performance of the same un-amalgamated materials. Comparative analysis revealed that no significant thermal gains would be expected from such amalgamation. However, significant reduction in the total weight of the insulation system would be achieved that, in this case, shown to be up to 20.94%. Thus, further reducing possible strains on structural elements due to the application of insulation on buildings. This can be especially beneficial in vernacular architectural approaches where considerably large amounts and thicknesses of insulations are used. In addition, cost reduction could be attained as wood shavings are significantly cheaper compared to the cost of PCMs

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Pulsioximetría: papel en el paciente COVID-19 domiciliario.

COVID-19 behaves like a heterogeneous disease. Some patients may develop dyspnea-free hypoxemia during its evolution (silent hypoxemia). Pulse oximetry plays a crucial role in detecting hypoxemia in these patients, especially when they remain at home. Patients with SpO2 levels ≤ 92% or desaturations ≥ 3% after exercise test require hospital admission. Progressive saturation declines reaching SpO2 level

SEMERGEN positioning on approaching chronic heart failure in primary care

La insuficiencia cardíaca (IC) es un problema de salud pública que genera una gran carga asistencial tanto hospitalaria como en atención primaria (AP). La publicación de numerosos estudios sobre IC durante los últimos años ha supuesto un cambio de paradigma en el abordaje de este síndrome, en el que la labor de los equipos de AP va adquiriendo un protagonismo mayor. Las recientes guías publicadas por la Sociedad Europea de Cardiología han introducido cambios fundamentalmente en el manejo del paciente con IC. La nueva estrategia propuesta, con fármacos que reducen las hospitalizaciones y frenen la progresión de la enfermedad, debe ser ya una prioridad para todos los profesionales implicados. En este documento de posicionamiento se analiza una propuesta de abordaje basada en equipos multidisciplinares con el liderazgo de los médicos de familia, clave para proporcionar una atención de calidad a lo largo de todo el proceso de la enfermedad, desde su prevención hasta el final de la vida.Heart failure (HF) is a public health problem that generates a large healthcare burden both in hospitals and in Primary Care (PC). The publication of numerous studies about HF in recent years has led to a paradigm shift in the approach to this syndrome, in which the work of PC teams is gaining greater prominence. The recent guidelines published by the European Society of Cardiology have fundamentally introduced changes in the management of patients with HF. The new proposed strategy, with drugs that reduce hospitalizations and slow the progression of the disease, should now be a priority for all professionals involved. This position document analyzes a proposal for an approach based on multidisciplinary teams with the leadership of family doctors, key to providing quality care throughout the entire process of the disease, from its prevention to the end of the life

Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review

The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together.La eficacia y la seguridad de la profilaxis con ácido acetilsalicílico (AAS) para la prevención primaria de la enfermedad cardiovascular arteriosclerótica (ECVA) siguen siendo controvertidas en personas con diabetes (DM) sin ECVA, ya que el posible aumento del riesgo de hemorragias graves podría superar la posible disminución del riesgo de mortalidad y de los principales episodios adversos cardiovasculares (MACE) considerados individualmente o en conjunto