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Despite advances in the treatment of chronic urticaria, in a significant percentage of the patients symptoms are not fully controlled with conventional approaches. New strategies under development include blocking intracellular mediators of mast cell and basophil activation. We aim to investigate the effects of the Bruton's tyrosine kinase (BTK) inhibitor remibrutinib on human blood basophils and CD34+-derived mast cells activation induced by serum obtained from chronic urticaria patients. Twenty-two patients with chronic spontaneous urticaria (mean age 52 years, 27% women) and 22 patients with chronic inducible urticaria (46 years, 27% women) were included in the study together with a sex-matched control group. Patients were classified as responders or non-responders to anti-IgE therapy on the basis of their clinical data, FcεR1a expression on blood basophils and total IgE levels. Changes on CD63 expression—as an activation marker-, were used to evaluate in vitro the response of basophils and mast cells to serum exposure and the inhibitory effects of remibrutinib. Remibrutinib inhibits degranulation induced by IgE cross-linking in mast cells and basophils and also the activation triggered by factors present in the sera of spontaneous and inducible chronic urticaria patients. Patient's serum induces a greater degranulation of effector cells than controls. Activation of mast cells and basophils by patient sera and remibrutinib effects were not related to omalizumab responsiveness. Remibrutinib inhibits activation of human basophils and mast cells induced in vitro by exposure to the serum of chronic urticaria patients independently of their response to omalizumab.

Background: We aim to investigate the effects of the Bruton’s tyrosine kinase (BTK) inhibitor remibrutinib on human in vitro cell activation induced by serum obtained from chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU) patients. Methods: 22 patients with CSU (mean age 52 years, 27% women) and 22 with CIndU (46 years, 27% women) were included. A sex-equivalent control group was enrolled. Total IgE serum levels and the FcεR1a expression on blood basophils were determined before the initiation of omalizumab therapy. Patients were then classified as responders or non-responders to anti-IgE therapy, according to their clinical data and IgE and FcεR1a receptor expression. Mast cell generation and stimulation and basophil stimulation were performed. Flow cytometry was used to analyze samples. Percentage of activation, degranulation and inhibition in basophils and mast cells are studied. Results: Main results show that remibrutinib inhibits mast cells and basophil degranulation induced by IgE cross-linking. Also, serum from patients induced a greater degranulation of mast cells and basophils compared to controls. We found that activation of mast cells and basophils by patient sera was not related to omalizumab responsiveness. Conclusion: Our results show that remibrutinib is able to inhibit the degranulation of human basophils and mast cells in vitro, independently of the patient’s expression of FcεR1 expression and response to omalizumab.

Consensus about the definition and classification of "plaque" in mycosis fungoides is lacking.To delineate a comprehensive view on how the "plaque" entity is defined and managed in clinical practice; to evaluate whether the current positioning of plaques in the TNMB classification is adequate.A 12-item survey was circulated within a selected panel of 22 experts (pathologists, dermatologists, hematologists, oncologists), members of the EORTC and International Society for Cutaneous Lymphoma. The questionnaire discussed clinical and histopathological definitions of plaques and its relationship with staging and treatment.Total consensus and very high agreement rates were reached in 33.3% of questions, as all panelists regularly check for the presence of plaques, agree to evaluate the presence of plaques as a potential separate T class, and concur on the important distinction between plaque and patch for the management of early-stage MF. High agreement was reached in 41.7% of questions, since more than 50% of the responders use Olsen's definition of plaque, recommend the distinction between thin/thick plaques, and agree on performing a biopsy on the most infiltrated/indurated lesion. High divergence rates (25%) were reported regarding the possibility of a clinically based distinction between thin and thick plaques and the role of histopathology to plaque definition.The definition of "plaque" is commonly perceived as a clinical entity and its integration with histopathological features is generally reserved to specific cases. To date, no consensus is achieved as for the exact definition of thin and thick plaques and current positioning of plaques within the TNMB system is considered clinically inadequate. Prospective studies evaluating the role of histopathological parameters and other biomarkers, as well as promising diagnostic tools, such as US/RM imaging and high throughput blood sequencing, are much needed to fully integrate current clinical definitions with more objective parameters.

Objetivo: El objetivo de nuestro estudio es analizar si el hecho de combinar los estudios universitarios y la Actividad Laboral Remunerada se asocia con el síndrome de burnout académico en los estudiantes de 1º curso de la Universidad de Vic-Universidad Central de Catalunya (UVic-UCC) y si existe una relación sobre el rendimiento académico. Metodología: Es un estudio observacional, transversal. La muestra comprende 301 estudiantes de 1º curso. Los instrumentos utilizados son una encuesta telemática y el Maslach Burnout Inventory-Student Survey. Resultados: El 16,9% de los estudiantes presentan Burnout Académico. No se observan diferencias significativas según el sexo. El 33% de los estudiantes combinan actividad laboral remunerada y estudios. De estos, el 14,1% presentan Burnout Académico. No se observan diferencias significativas en el rendimiento académico entre los estudiantes que trabajan y estudian y los que solo estudian. Conclusión: Los estudiantes presentan burnout tanto sí trabajan como no. Al inicio del primer curso del grado, un tercio de los estudiantes combinaban sus estudios con el trabajo y no se aprecia un incremento de burnout académico. El rendimiento académico no se ve afectado por el hecho de combinar el trabajo y los estudios universitarios. Abstract. Goal. The aim of our study is to analyze whether combining university studies and professional work activity is associated with academic burnout syndrome in 1st year students at the University of Vic-Central University of Catalonia (UVic-UCC) and the relationship on performance academic. Methodology. It is a non-experimental observational study of cross-sectional design. The sample consisted of 301 1st year undergraduate students in the UVic-UCC. The instruments used consist of a telematic structured survey and the Maslach Burnout Inventory-Student Survey questionnaire. Results. 16.9% of the students present academic burnout. No statistically significant differences were observed by sex. 33% of students have a remunerated job that they combine with their studies. Of these students, 14.1% have academic burnout. There are no significant differences in academic performance between students who work and study and those who only study. Conclusion: At the beginning of the first year of the university degree, a third of the students combined their studies with work. The fact of working and starting university studies does not produce an increase in academic burnout. Students show burnout whether they work or not. Academic performance is not affected by combining work and university studies.

Background Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author’s purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs. Methods The authors applied the Arksey and O’Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin. Results The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren’t worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation. Conclusion PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.

Background: The first years of university can be very challenging for students. Previous research has focused on the study of the prevalence of burnout and of psychological distress in medical students. The aim of this study was to investigate the prevalence of psychological symptoms and burnout reported by first-year students, the relationship between these variables and their academic performance, and the differences between health and non-health sciences students. Methods: An observational study with a cross-sectional design was performed. Students of health sciences (medicine, nursing, physiotherapy, psychology), and non-health sciences (biology, social sciences, business management, and engineering) undergraduate programs completed the Brief Symptom Inventory (BSI-18) and the Maslach Burnout Inventory-Student Survey (MBI-SS). Students' grades for the first semester were collected. Results: A sample of 506 students participated. Prevalence of psychological distress was 27.1% and burnout was 7.3%. Academic performance was unaffected in relation to either psychological distress or burnout. Non-health sciences students showed a greater risk of depression. Conclusions: This study provides evidence of the high prevalence of psychological distress in the first year of college. Even when burnout prevalence was low, the results suggest the need to introduce prevention programs to improve the psychological wellbeing of these students. Keywords: burnout; psychological distress; academic performance; mental health; university students; medical students

Solar thermal applications for industries must be designed to operate at high temperature levels; however, the thermal dependency of the accuracy of the incidence angle modifier factorization has not been sufficiently analyzed. In this study, the annually delivered energy based on both factorized and non-factorized incidence angle modifier values were compared with each other. The integration was conducted for a typical meteorological year in Seville and Stockholm. Four collector types were considered: evacuated tube collector, MaReCo collector, Fresnel collector, and CCStaR collector. Thermal process parameters were shown to have an influence on the error made by the factorization approach; however, within the economically viable temperature range of an industrial heat application, this influence is not significant.

The building was built in the late 90s, had a solar installation of 200 m 2 with 4 tanks of DHW and the support of diesel boilers and district heating. After 16 years 25% of the solar collectors are damaged, and some of the storage tanks have rust and lime with leaking. A new design and retrofit is needed to improve the existing installation. New advanced systems are being designed in different phases. The first phase consists of installing new collectors and combisystems tanks. If we add the pool to the system, it is further possible to improve the water management of the building. During this first phase 25% of the solar field will be added with higher efficiency collectors. The estimated energy savings are 14% and the cost savings will be near to 30%.

International audience; AIM: To determine the detection rates, clinical features, and risk factors for lack of registration of alcohol use in medical patients admitted in European hospitals.METHODS: A point-prevalence, cross-sectional, multicenter survey involving 2100 medical inpatients from 43 hospitals from 8 European countries. Patients were screened for current alcohol use, using standardized questionnaires. Alcohol use recording in medical records was assessed.RESULTS: Of the 2100, more than a half reported alcohol use. Significant differences were shown in the prevalence of drinking and the recording rates of alcohol use among the hospitals and countries involved. Overall, 346 patients (16%) fulfilled criteria for alcohol use disorder. Alcohol use was registered in 909 (43%) of medical records, with quantification in 143 (7%). Multivariate analysis showed that women (OR 1.49), older age patients (OR 1.23), patients from the Northern European countries (OR 4.79) and from hospitals with high local alcohol prevalence (OR 1.59) were more likely to have lack of alcohol use registration in their medical files.CONCLUSIONS: A considerable proportion of medical patients admitted in European hospitals fulfill criteria for alcohol use disorders. These patients are frequently overlooked during hospitalization and not appropriately registered in medical records. Women, older patients, and inpatients from European areas with high local alcohol use prevalence are at higher risk associated with a non-recording of alcohol use.

To minimize the experimental effort of assessing biaxial incidence angle characteristics of solar collectors with complex geometries, current testing standards (EN 12975-2, ASHRAE 93, ISO 9806:2013) recommend the factorization method proposed by McIntire (1982). Due to a lack of consensus, researchers in the low and high temperature fields of solar thermal have applied this model in very different ways, either referring to different radiation references (beam radiation on tilted surface vs. direct normal irradiance) or angle projections (θT-θL-domain vs. θT-θi-domain). In this study, the influence of each approach on the factorization error is estimated. Four different collector geometries were considered: compound parabolic collector, maximum reflector collector, linear Fresnel reflector, and fixed-mirror collector (Concentrating Collector with Stationary Reflector, CCStaR V2). The 3D incidence angle modifier surface of each collector was calculated with a sophisticated in-house ray tracing tool and compared with the incidence angle modifier surface constructed by various factorization models. The error was defined as difference between direct normal irradiance weighted annual integration of ray tracing and factorized incidence angle modifier, given the collector’s location and orientation. This allows the deviations to be represented more intuitively by plotting the relative error over latitude. Factorization in the (θT,θi)-domain was shown to constantly yield accurate results even in the case of static collectors.

Solar thermal energy is able to provide a considerable fraction of the medium-temperature energy demand and should be more widely used in specific industrial sectors in 100–250 °C range. For energy collection within this temperature range, solar collector designs usually have optical concentration systems, and therefore, the optical behavior of these devices, especially Incidence Angle Modifier (IAM) term in the standard equations, is of paramount importance to the energy equation balance. In the last few decades various new designs have been developed specifically for industrial applications. At the end of 2013, the new revised version of International Standard ISO 9806 for solar thermal collector test methods was published for worldwide certification. This new Standard unifies all the former American, European and International Standards. However, some solar collector types still do not fit to the Standard testing methodology, in particular solar collectors with variable-geometry. This paper describes the points in International Standard ISO 9806 defined specifically for testing solar collectors with solar tracking and concentration, and present a theoretical model to specify the range of the incidence angles which should be tested on variable-geometry collectors to validate the IAM terms in the energy equation balance. Finally some issues are proposed to extend the scope of the current standards for testing collector designs with variable-geometry, in particular for medium-temperature applications.

The solar trackers are devices used to orientate solar concentrating systems in order to increase the focusing of the solar radiation on a receiver. A solar concentrator with a medium or high concentration ratio needs to be orientated correctly by an accurate solar tracking mechanism to avoid losing the sunrays out from the receiver. Hence, to obtain an appropriate operation, it is important to know the accuracy of a solar tracker in regard to the required precision of the concentrator in order to maximize the collector optical efficiency. A procedure for the characterization of the accuracy of a solar tracker is presented for a single-axis solar tracker. More precisely, this study focuses on the estimation of the positioning angle error of a parabolic trough collector using a direct procedure. A testing procedure, adapted from the International standard IEC 62817 for photovoltaic trackers, was defined. The results show that the angular tracking error was within ±0.4° for this tracker. The optical losses due to the tracking were calculated using the longitudinal incidence angle modifier obtained by ray-tracing simulation. The acceptance angles for various transversal angles were analyzed, and the average optical loss, due to the tracking, was 0.317% during the whole testing campaign. The procedure presented in this work showed that the tracker precision was adequate for the requirements of the analyzed optical system.

Ray-tracing tools are commonly used to optically characterize solar concentrators, but the International Standards used to certify collectors for heating do not allow the use of these tools to analyse the optical behaviour of solar thermal systems. Solar concentrators for the medium temperature range often are of large dimensions and cannot be easily reoriented to the sun without an expensive rotating test platform suggested by the International Standards; therefore, some deficiencies can be detected if the standards procedures are applied to these types of concentrating collectors. In this paper, the use of ray-tracing tools combined with thermal experimental data is proposed to determine the energy balance coefficients by a Weighted Least Square adjustment (WLS). The main advantages of this methodology are that the measurement of the thermal efficiency at normal incidence and solar concentrator reorientation are not required, the optical behaviour of the system can be determined for any position of the sun, and it can be used for in situ measurements for large-scale solar thermal collectors.

The set of optical models that is implemented in ray-tracing software determines the accuracy of its output. A sensitivity analysis was carried out using a powerful in-house program, which provides a large number of surface reflectance and scattering models and in addition, can also run spectral simulations. A linear Fresnel collector was selected as a test case together with the most accurate data that can be found in the literature for the optical properties of its components. The test results indicate that simulations based on constant values, such as mostly provided by the manufacturer, are generally inaccurate and a spectral simulation is not essential for thermal applications.

The determination of the accuracy of a solar tracker used in domestic hot water solar collectors is not yet standardized. However, while using optical concentration devices, it is important to use a solar tracker with adequate precision with regard to the specific optical concentration factor. Otherwise, the concentrator would sustain high optical losses due to the inadequate focusing of the solar radiation onto its receiver, despite having a good quality. This study is focused on the estimation of long-term optical losses due to the tracking error of a low-temperature collector using low-concentration optics. For this purpose, a testing procedure for the incidence angle modifier on the tracking plane is proposed to determinate the acceptance angle of its concentrator even with different longitudinal incidence angles along the focal line plane. Then, the impact of maximum tracking error angle upon the optical efficiency has been determined. Finally, the calculation of the long-term optical error due to the tracking errors, using the design angular tracking error declared by the manufacturer, is carried out. The maximum tracking error calculated for this collector imply an optical loss of about 8.5%, which is high, but the average long-term optical loss calculated for one year was about 1%, which is reasonable for such collectors used for domestic hot water.

In order to increase the trust and willingness to invest in concentrating solar collectors, an accurate labeling and certification process is of utmost importance. Today’s collector testing standards specify methods for assessing the thermal performance of most types of fluid heating solar collectors. However, they do not provide an applicable testing procedure for obtaining the incidence angle modifier of large-scale line-focusing collectors. Such collectors need to be tested directly in the field, where optical characterization by conventional methods, such as factorization, fails. This study presents a new approach to obtain the incidence angle modifier by fitting ray-tracing curves to the measured optical efficiency data set. The new method has been tested on a fixed mirror solar concentrator with a mobile focus. Prior to this study, 49 experimental data points have been obtained for the optical efficiency after measuring for four testing days according to the ISO 9806 rules. These experimental data points served as a basis for the fitting procedure to validate the ray-tracing model. Stable optimized solutions of the collector’s optical parameters have been determined within a reasonable computation time scale. From a comparison of the optimized solution to a simplified ray-tracing simulation, it was seen that the weighted root-mean-square error was improved by 27.7%. In conclusion, the proposed procedure overcomes practical hurdles and has many advantages over conventional methods.

Concentrating solar collectors are mentioned in the International Standards, but the general testing methods for solar collectors mentioned cannot easily be applied to such unusual collector designs. In this study, the best optical and thermal model for a variable geometry solar concentrator has been investigated. In the particular case of a collector with a fixed mirror concentrator, the relative position of the receiver with respect to the reflector is not constant during the day, and this variable geometry is not taken into account in the current testing Standards. An optical characterization of the prototype using a ray-tracing program has been performed, and the results have been used as an initial hypothesis to define two thermal models adapted from the European Standard. Those two different models have been compared. The optical results obtained from experiments have been compared to ray-tracing simulation results, and they have been found to be quite similar, considering the measurement uncertainties. This validation procedure of the optical simulation could be an important point to be taken into account in a future Standard revision for variable geometry collector types for which the normal incidence is not easy to obtain.

Raquel Pascual , Gemma Prieto , M. Rosario Taco c y Ramon Pujol Farriols * a Servicio de Neumologia, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Espana b Servicio de Radiodiagnostico, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Espana c Servicio de Anatomia Patologica, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Espana d Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Espana

We investigate the absorptance and the power conversion efficiency of a perovskite thin-film solar cell at a specular and Lambertian reflection on the cell's back-surface reflector. The analysis is done by means of the Monte-Carlo ray tracing simulations, complemented by the transfer-matrix method to account for the interference phenomenon in the local generation rate G ( z ) of carriers inside the semiconductor. This function is employed further in the transport equations to calculate the current-voltage characteristics of the cell. Taking the perovskite absorber CH3NH3PbI3 as an example, we analyse its efficiency, altering the absorber thickness in the interval 50 ÷ 1000 nm. We find that in the cell ( ∼ 200 nm) the enhanced photon absorption due to the Lambertian reflection yields the efficiency increase on 2.2% as opposed to the specular reflection case. Moreover, the maximum efficiency, obtained for the perovskite layer of the thickness ∼ 150 nm, exceeds the one obtained for the perovskite layer of the thickness ∼ 500 nm with the specular reflection.

The Curved Slats Fixed Mirror Solar Concentrator (CSFMSC) is a solar concentrator with a static reflector and a moving receiver. An optical analysis using ray-tracing tools was presented in a previous study in function of three design parameters: the number of mirrors N, the ratio of focal length and reflector width F/W, and the aperture concentration Ca. However, less is known about the thermal behavior of this geometry. In this communication, the integrated thermal output of the CSFMSC has been determined in order to find the optimal values for the design parameters at a working temperature of 200 °C. The results were obtained for three different climates and two axial orientations (North–South, and East–West). The results show that CSFMSC can produce heat at 200 °C with an annual thermal efficiency of 41, 47, and 51%, dependent of the location considered (Munich, Palma de Mallorca, and Cairo). The best FMSC geometries in function of the design parameters are exhibited for medium temperature applications.

Palma Beach is the most developed tourist area in the Balearic Islands, there is a Master Plan who wants to build a District Heating and Cooling system. The aim of this study is to identify the viability of integrating Large Solar Plants, in buildings of tourist and residential areas. The energy costs, by a sample of collectors with different temperatures will be used in this study. The results show that collective system can reduce about a 60% the CO2 emissions using only Solar Thermal energy and find out future net zero energy building scenarios with other renewable energy sources.

Background: Poor vitamin D status, i.e. low serum levels of 25-hydroxyvitamin D [25(OH)D], is common in the general population. Prospective epidemiologic data on the association between vitamin D and mortality in oldest old subjects are limited. Objective: This study aimed to determine whether 25(OH)D concentrations were prospectively and independently associated with cardiovascular disease (CVD) mortality and all-cause mortality in oldest old subjects. Methods: A total of 312 subjects aged 85 years old at baseline (Octabaix study) were followed for 3 years. Sociodemographic and overall geriatric assessment data were collected. Serum 25(OH)D concentrations were used to assess vitamin D status. Data on overall and cardiovascular mortality were collected. Results: The mean serum 25(OH)D levels were 28 ± 30 ng/ml. During the follow-up period, 58 subjects (18.5%) died. Twenty-five of the deaths (8%) were related to CVD. There were no differences in mortality rates according to the different quartiles of vitamin D (p = 0.41 for total mortality and p = 0.86 for CVD mortality). Conclusion: In community-dwelling oldest old subjects, serum 25(OH)D levels were not associated with overall or CVD mortality after a 3-year follow-up.

Medium temperature collectors will play an important role in the development of process heat applications. Nevertheless, the assessment and comparison of collectors based on different technologies is not yet straight forward from the information currently provided by most manufacturers. It is shown that it is not possible to draw conclusions about the thermal performance of a given collector based on its efficiency curve alone. Therefore a simulation program for three different collector technologies was carried out for 995 locations and weather conditions at 8 working temperature levels ranging from 100 °C to 310 °C. After an analysis of the different parameters affecting collector performance a novel contour chart format is presented.

Purpose Following the detection of an anomaly on Octavius4D pre-treatment QA results for some patients, an investigation to determine its origin was conducted. A problem was found on the angular measurements performed by the inclinometer. The aim of this work is to study the influence of the angular accuracy on Octavius4D results and the ability of the Octavius4D system to detect angular deviations. Methods Measurements were performed using Octavius4D modular system and analysed using Verisoft 7.0 (PTW-Freiburg, Freiburg, Germany). Measurements performed using the malfunctioning inclinometer for 61 patients undergoing VMAT treatments were compared with the same measurements carried out using a new inclinometer. Two different locations were analysed: 40 prostates and 21 pelvises (15 of them were prostates with SIB and 6 of them were gynaecologic pathologies). 3D gamma analysis was computed over the entire volume with acceptance criteria of 3% dose difference and 3 mm distance to agreement. 2%-2 mm gamma test was also calculated. Dose differences were calculated referenced to the maximum dose in calculated volume and the threshold considered was 10% of the maximum dose. The angular lectures of the inclinometer were obtained from .xcc raw files. Results Mean angle differences at 180 degrees (where the greatest difference was observed) are 2.25° for prostates and 2.21° for pelvises. In several cases, the 3%-3 mm gamma criterion does not show any difference between measurements carried out using both inclinometers. The 2%-2 mm gamma criterion leads to a mean difference of 1.71% for prostates and 4.04% for pelvises. In all cases 3%-3 mm gamma passing rates were greater than 95%, making difficult to identify this problem by only applying this criterion. It is observable a dependence of the results on the symmetry of the dose distribution. PTVs comprising only the prostate which are highly symmetrical had lesser variations than more complex treatments. Conclusions 2% dose difference and 2 mm distance to agreement criterion showed better ability to find angular differences when performing gamma analysis for VMAT treatments. This can be potentially used to discover problems in gantry position but a further analysis must be performed.

Introduccion Existen pocos datos sobre los efectos de un programa global de control de los factores de riesgo cardiovascular (FRCV) que incluya cambios tanto en el estilo de vida como en el tratamiento farmacologico. El objetivo de este estudio es valorar si el control multiple e intensive de los FRCV mediante un programa de prevencion cardiovascular mejoraria significativamente el control en los pacientes con enfermedad arterial coronaria (EAC) comparado con el cuidado medico habitual. Pacientes y metodo Se asigno al azar a 227 pacientes (198 varones y 29 mujeres; edad media, 60,31 ± 8,9 anos) con un episodio arterial coronario de origen isquemico a un grupo de cuidado habitual (n = 108) o a un grupo de reduccion de riesgo multifactorial dentro de un programa de prevencion cardiovascular (n = 119). A los pacientes asignados al grupo de reduccion global del riesgo se les proporciono programas individualizados que incluian una dieta baja en grasas saturadas, practica de ejercicio fisico, perdida de peso y consejos para dejar de fumar y se les indico, cuando era necesario, el tratamiento con farmacos hipolipemiantes. El parametro principal de valoracion fue el numero de individuos que alcanzaban un colesterol unido a lipoproteinas de baja densidad (cLDL) Resultados Los pacientes asignados al programa de prevencion experimentaron una mejoria significativa en varios FRCV, entre ellos el colesterol total (CT), el colesterol no unido a lipoproteinas de alta densidad, los trigliceridos, la apolipoproteina (apo) B, y el tabaquismo con respecto a los pacientes que recibieron los cuidados habituales. No se observaron diferencias significativas en el colesterol unido a lipoproteinas de alta densidad (cHDL), el cociente cHDL/cLDL, la apo-AI, la perdida de peso, las presiones arteriales sistolica y diastolica y el fibrinogeno entre ambos grupos. Conclusiones El tratamiento multifactorial y protocolizado de los FRCV durante un periodo de 9 meses logro un mejor control de los factores de riesgo lipidicos y no lipidicos que la asistencia convencional en los pacientes con EAC.

The most important decisions that affect the thermal behaviour of buildings are taken in the initial stages of design. Design evaluation may be supported by the results of building simulation. The aim of this paper is to predict the thermal behaviour of an office building with TRNSYS and to propose architectonical and management improvement actions. These improvements are formulated to solve one design problem of this building. The results shows that models in TRNSYS are a good system to simulate the reality and they can represent the different scenarios to evaluate energy and economic savings in short period of time and without spend the money. The best solutions are the ones who are tough for the all year with all the conditions, analyzing the life cycle and the savings in a medium-long period of time; it can reach an energy saving of 33%. The calculations show that it’s possible to reduce 33% of cooling energy with free-cooling ventilation and an energy saving of 20% increasing 1oC the comfort temperature during summer.

Resumen Las laceraciones traqueobronquiales traumaticas postintubacion son una complicacion clinica poco frecuente en la practica diaria. Se han relacionado con intentos repetitivos de intubacion e hiperinsuflacion del balon, asi como con alteraciones anatomicas y factores individuales que puedan predisponerla. El diagnostico se obtiene, actualmente, mediante la endoscopia respiratoria, ya que informa sobre su localizacion y la extension lesional. Presentamos el caso de una paciente con laceracion de la cara posterior traqueal secundaria a intubacion endotraqueal que comenzo con enfisema mediastinico subcutaneo y neumotorax bilateral en el postoperatorio inmediato. El diagnostico se realizo mediante fibrobroncoscopia y tomografia computarizada y requirio cirugia traqueal de urgencia.

The fixed mirror solar concentrator (FMSC) possesses a geometry that can produce thermal energy in medium temperature range. Due to its static reflector, the FMSC has several advantages when compared to other designs, such as being one of the best adapted for integration onto building roofs. An optical ray-tracing analysis of its geometry was presented in a previous paper (Pujol Nadal and Martínez Moll, 2012, “Optical Analysis of the Fixed Mirror Solar Concentrator by Forward Ray-Tracing Procedure,” Trans ASME J. Solar Energy Eng., 134(3), pp. 031009-1-14). The optical results were obtained in function of three design parameters: the number of mirrors N, the ratio of focal length and reflector width F/W, and the intercept factor γ (in order to represent different receiver widths). In this communication, the integrated thermal output of the same parameter combinations has been determined in order to find optimal values of the design parameters at a working temperature of 200 °C. The results were obtained for three different climates and two orientations (North-South and East-West). The results show that FMSC can produce heat at 200 °C with an annual thermal efficiency of 39, 44, and 48%, dependent of the location considered (Munich, Palma de Mallorca, and Cairo). The best FMSC geometries in function of the design parameters are exhibited for medium range applications.

ObjectiveSubclinical thyroid disorders are common in older individuals. Health risks associated with subclinical hypothyroidism in older adults are unclear. The aim of the study is to evaluate whether thyroid status in elderly subjects correlates with physical and cognitive function at baseline and with 3-year mortality.DesignA population-based, prospective cohort of the OCTABAIX study (307 inhabitants aged 85 years at baseline).MethodsChronic drug prescription, functional status (Barthel and Lawton indices) and cognitive status according to the Spanish version of the Mini-Mental State Examination were recorded. Quality of life was assessed using the visual analogue scale of the quality of life test. Concentrations of TSH and thyroxine were measured. Participants were classified in accordance with clinical categories of thyroid function.ResultsTwenty (6.5%) individuals had subclinical hypothyroidism and five (1.6%) had subclinical hyperthyroidism. Compared with euthyroid subjects (n=280; 91.8%), subclinical hypo- and hyperthyroidism subjects were not significantly associated with poor physical or cognitive function at baseline. Fifty-one (15.1%) subjects died during the 36 months of follow-up. TSH values and subclinical hypo- and hyperthyroidism were not associated with an increased overall mortality risk (hazard ratio (HR) 1.086, 95% CI 0.987–1.196 and HR 0.905, 95% CI 0.902–1.053 respectively).ConclusionsThis study does not support the association of TSH or thyroid disorders with physical or cognitive function at baseline or with 3-year mortality in the oldest old subjects.

To describe the prevalence of the risk of being undernourished in a community-dwelling population of 85-year-olds, and to study associated factors.A cross-sectional community-based survey of 328 inhabitants assigned to seven primary healthcare teams was carried out. Geriatric assessment was based on sociodemographic variables, the Barthel Index (BI), the Lawton Index (LI), the Spanish version of the Mini-Mental State Examination, the Charlson Comorbidity Index, chronic diseases, social risk measured by Gijon's Social-Familial Evaluation Scale, prescriptions and blood tests. Nutritional status was assessed using the Mini Nutritional Assessment (MNA). Participants were defined as being at risk of undernourishment when they had a MNA score above or equal to 23.5. A comparative analysis was carried out between patients with and without risk of being undernourished, and a multiple logistic regression analysis was carried out.The prevalence risk of being undernourished was 34.5%. A statistically significant association was found with being female (OR 2.44, 95% CI 1.28-4.54), LI (OR 1.47, 95% CI 1.29-1.66), social risk (OR 1.15, 95% CI 1.02-1.29) and prescription drugs taken (OR 5.58, 95% CI 2.09-14.92). Cardiovascular prescription showed a protective association (OR 4.34, 95% CI 1.78-10.0). No statistical differences between the risks of being undernourished were found in the laboratory analysis.There is a high risk of being undernourished in 85-year-old subjects. This nutritional status was positively associated with being female, disability, increased social risk and a high number of prescription drugs, whereas there was a protective relationship with cardiovascular prescription. In evaluations of nutritional status in the community, a multidisciplinary assessment is more valid than analytical findings.

The fixed mirror solar concentrator (FMSC) is a mobile focus concentrator whose design emerged in the 1970s in an effort to reduce electricity production costs in solar thermal power plants. This geometry has not yet been analyzed with 3D ray-tracing procedures. The geometry of FMSC is defined using three parameters: the number of mirrors N, the ratio of focal length and reflector width F/W, and the intercept factor γ (in order to represent different receiver widths). For the analysis, a 3D ray-tracing code that allows the characterization of solar concentrators was developed. A standard evacuated tube was used as a receiver. The geometric concentration ratio, the optical efficiency, and the transversal and longitudinal incidence angle modifier (IAM) curves for different values of design parameters were calculated. High concentrations imply low F/W values and for high efficiencies, large intercept factor values are required. Increasing the F/W ratio has a positive effect on the transversal IAM, yet a negative one for the longitudinal IAM. Increasing the number of mirrors has a negative effect on both IAM curves due to the self-shadowing between the adjacent steps. Increasing the intercept factor only has a significant positive effect on the longitudinal IAM. The goodness of the IAM factorization approach was analyzed, and it was found that it can be used as long as a new correction factor to account for the focus displacement is introduced. The results presented in this paper provide information, in form of curves, regarding the optical behavior of the FMSC in terms of different design parameters in order to know the possibility to use the FMSC in medium range temperature applications.

KLICK syndrome is a rare autosomal-recessive skin disorder characterized by palmoplantar keratoderrna, linear hyperkeratotic papules, and ichthyosiform scaling. In order to establish the genetic cause of this disorder, we collected DNA samples from eight European prohands. Using high-density genome-wide SNP analysis, we identified a 1.5 Mb homozygous candidate region on chromosome 13q. Sequence analysis of the ten annotated genes in the candidate region revealed homozygosity for a single-nucleotide deletion at position c.-95 in the proteasome maturation protein (POMP) gene, in all probands. The deletion is included in POMP transcript variants with long 5' untranslated regions (UTRs) and was associated with a marked increase of these transcript variants in keratinocytes from KLICK patients. POMP is a ubiquitously expressed protein and functions as a chaperone for proteasome maturation. Immunohistochemical analysis of skin biopsies from KLICK patients revealed an altered epidermal distribution of POMP, the proteasome subunit proteins alpha 7 and beta 5, and the ER stress marker CHOP. Our results suggest that KLICK syndrome is caused by a single-nucleotide deletion in the 5' UTR of POMP resulting in altered distribution of POMP in epidermis and a perturbed formation of the outermost layers of the skin. These findings imply that the proteasome has a prominent role in the terminal differentiation of human epidermis.