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We consider a pressure correction temporal discretization for the incompressible Navier-Stokes equations in EMAC form. We prove stability and error estimates for the case of mixed finite element spatial discretization, and in particular that the Gronwall constant's exponential dependence on the Reynolds number is removed (for sufficiently smooth true solutions) or at least significantly reduced compared to the commonly used skew-symmetric formulation. We also show the method preserves momentum and angular momentum, and while it does not preserve energy it does admit an energy inequality. Several numerical tests show the advantages EMAC can have over other commonly used formulations of the nonlinearity. Additionally, we discuss extensions of the results to the usual Crank-Nicolson temporal discretization.

BACKGROUND The liver has traditionally been regarded as resistant to antibody-mediated rejection (AMR). AMR in liver transplants is a field in its infancy compared to kidney and lung transplants. In our case we present a patient with alpha-1-antitrypsin disease who underwent ABO compatible liver transplant complicated by acute liver failure (ALF) with evidence of antibody mediated rejection on allograft biopsy and elevated serum donor-specific antibodies (DSA). This case highlights the need for further investigations and heightened awareness for timely diagnosis. CASE SUMMARY A 56 year-old woman with alpha-1-antitrypsin disease underwent ABO compatible liver transplant from a deceased donor. The recipient MELD at the time of transplant was 28. The flow cytometric crossmatches were noted to be positive for T and B lymphocytes. The patient had an uneventful recovery postoperatively. Starting on postoperative day 5 the patient developed fevers, elevated liver function tests, distributive shock, renal failure, and hepatic encephalopathy. She went into ALF with evidence of antibody mediated rejection with portal inflammation, bile duct injury, endothelitis, and extensive centrizonal necrosis, and C4d staining on allograft biopsy and elevated DSA. Despite various interventions including plasmapheresis and immunomodulating therapy, she continued to deteriorate. She was relisted and successfully underwent liver retransplantation. CONCLUSION This very rare case highlights AMR as the cause of ALF following liver transplant requiring retransplantation.

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[ES]Introducción, traducción y comentario de los epigramas de Amiano

The psychosocial impact on people who were deported to Mexico from the United States or were forcibly returned tends to be greater than on those who return voluntarily. This text examines the way the emotional discomfort experienced by a group of Mexicans who were returned in these ways is constructed, through the analysis of anthropological interviews conducted with five women and thirteen men in which the following phases were explored: pre-migration, stay in the United States, return and reinsertion. This discomfort began in the pre-migration stage, during which they experienced various forms of disempowerment caused by the socioeconomic conditions of Mexico that determine the migratory trajectory, including reintegration. If, despite the disadvantages accumulated during the pre-migration phase, migrants manage to partly reverse their material and psychosocial disempowerment during their stay in the United States, on their return to a context such as Mexico, both their disempowerment and emotional discomfort are exacerbated. We therefore consider that the harm associated with the migratory saga will continue for an indefinite number of years following a person's return to Mexico and must be treated as a social rather than a clinical problem.

En un contexto de comunicación 2.0, las redes sociales se han convertido en una poderosa herramienta de comunicación para organizaciones e instituciones, que ven en ellas una oportunidad de interactuar con el ciudadano, presentar sus servicios, promocionarse y mejorar su imagen como marca. La plataforma social Twitter, por sus características, es hoy en día una de las más utilizadas por las empresas de transporte público, quienes ven a la figura del community manager, ya no como un nuevo perfil profesional, sino como una pieza clave dentro de la empresa. De su trabajo y de la atención que se le brinde al ciudadano respondiendo sus quejas o sugerencias dependerá en gran medida la reputación de entidades como Titsa o Guaguas Municipales, las dos principales compañías de guaguas de Canarias. Por ello, en este trabajo se intentará conocer el funcionamiento de los perfiles en Twitter de estas dos empresas, incluyendo entrevistas en profundidad a los encargados de gestionar las cuentas y analizando sus tuits para concluir si con su uso se innova en la gestión de la comunicación y se consiguen los fines mencionados. In a context of communication 2.0, social media has become a powerful communication tool for organizations and institutions, which see in them an opportunity to interact with the citizen, present their services, promote themselves and improve their image as a brand. The social platform Twitter, by its characteristics, is today one of the most used by public transport companies, which see community managers, no longer as a new professional profile, but as a key piece within the company. His work ant the attention given to the users answering to their questions or suggestions will depend to a large extent on the reputation of companies like Titsa or Guaguas Municipales, the two main Canarian bus companies. Because of that, in this paper we will try to know how the Twitter profiles of these two companies work, including depth interviews with account managers and analyzing their tweets to conclude whether its use innovates in the management communication and achieves the aforementioned purposes.

Introduction: chronic kidney disease contributes to decreased muscle strength and physical function through a decrease in muscle mass. Current evidence suggests that hemodialysis can accentuate this complication, as well as lead to deterioration of the patient's overall health. The aim of this study is to compare muscle strength in a group of Mexican patients undergoing hemodialysis, evaluated by dynamometry, with available reference values. Materials and methods: a cross-sectional study was conducted in male and female patients between 20 and 81 years of age, with stage-5 chronic kidney disease, from the outpatient Hospital General Regional No 46 of the Mexican Social Security Institute. Muscle strength was assessed by means of a mechanical dynamometer. The average value classified by age and gender was compared with the 50th percentile of a reference study. Inter-group differences were calculated with the nonparametric Mann-Whitney U-test, and correlation using Pearson's test, logistic regression, and chi-squared test. All patients signed an informed consent form. Results: a total of 150 patients, 97 (64.7 %) men and 53 (35.3 %) women, were included in the study. The mean dynamometric value for muscle strength was 21.5 ± 10.1 kg, and a significant correlation was found with age, weight, and hemoglobin concentration. Conclusion: patients undergoing hemodialysis treatment for chronic kidney disease were found to be at the 10th percentile for muscle strength, as measured by dynamometry, thus demonstrating a marked decrease in muscle strength. This result could, however, also have been affected by different variables such as patient age, height, weight, glomerular filtration rate (GFR), hemoglobin concentration, serum creatinine, serum glucose, and the subjective global assessment, given that a significant association was also found between these and muscle strength.

Instantánea Clínica sobre el nacimiento anómalo de la arteria coronaria derecha

Carbapenemase–producing Klebsiella pneumoniae strains (Cp-Kpn) represent a challenge for clinical practitioners due to their increasing prevalence in hospital settings and antibiotic resistance. Clinical practitioners are often overwhelmed by the extensive list of publications regarding Cp-Kpn infections, treatment, characteristics, identification, and diagnosis. In this perspective article, we provide key points for clinical practitioners to consider for improved patient management including identification of risk factors and strategies for treatment. Additionally, we also discuss genetic underpinnings of antibiotic resistance, implementation of an antimicrobial stewardship program (ASP), and use of automated systems for detection of Cp-Kpn. Collectively, implementation of such key points would enhance clinical practices through providing practical knowledge to health professionals worldwide.

Instantánea clínica que demuestra la presencia de espacios de Virchow-Robin en el cerebro, publicada en Revista de Medicina Clínica volumen 3, número 1 de 2019.

Supplementary material. Usefulness of Sputum Gram Stain for Etiologic Diagnosis in Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis. This file contains Figure S1 (LR analysis); Figure S2A, Subgroup analysis of good quality sputum Gram stain in S. pneumoniae; Figure S2B, Subgroup analysis of good quality sputum Gram stain in H. influenzae; Figure S3A. Subgroup analysis of positive sputum Gram stain in S. pneumoniae; Figure S3B, Subgroup analysis of positive sputum Gram stain in H. influenzae; Figure S4A, Subgroup analysis of sputum Gram stain in previous antibiotics for S. pneumoniae; Figure S4B. Subgroup analysis of sputum Gram stain in previous antibiotics for H. influenzae; Table S1. QUADAS-2 Analysis; Table S2. Description of datasets included in the analysis of S. pneumoniae; Table S3. Description of datasets included in the analysis of H. influenzae; Table S4. Description of datasets included in the analysis of S. aureus; Table S5. Description of datasets included in the analysis of Gram-negative bacilli; Table S6. Description of datasets included in the subgroup analysis of good quality sputum Gram stain in S. pneumoniae; Table S7. Description of datasets included in the subgroup analysis of good quality sputum Gram stain in H. influenzae; Table S8. Description of datasets included in the subgroup analysis of positive sputum Gram stain in S. pneumoniae; Table S9. Description of datasets included in the subgroup analysis of positive sputum Gram stain in H. influenzae; Table S10. Description of datasets included in the subgroup analysis of sputum Gram stain in previous antibiotics for S. pneumoniae, and Table S11. Description of datasets included in the subgroup analysis of sputum Gram stain in previous antibiotics for H. influenzae. (DOCX 131 kb)

For almost 20 years, the Systems and Automation Engineering Area of the Universidad de La Laguna has had PUMA-type manipulator robots of the Intelitek Scorbot ER IX and V models in the Robotics labs. With the pass of the time, the equipment has been updated, but the control programs for the robotic arms, provided by the manufacturer, have become obsolete. Due to this, the objective of this work is to develop a new control terminal and a module that allows the connection between the terminal and the new interface with the controller of the robotic arms, enabling the manipulation of the robots. With this, we can update the control software and run the designded application on modern equipment. In addition, the aim is to introduce improvements that have not been implemented before, enabling the use for the students and making interaction with the robots more enjoyable. Desde hace casi 20 años, el Área de Ingeniería de Sistemas y Automática de la Universidad de La Laguna dispone de robots manipuladores tipo PUMA, de los modelos Scorbot Er IX y V+ de Intelitek que se encuentran en el laboratorio de Robótica. Debido al paso del tiempo los equipos se van actualizando, pero los programas de control de los brazos robóticos, proporcionados por el fabricante, se quedan obsoletos. A causa de esto, el objetivo de este trabajo ha sido desarrollar un nueva terminal de control y un módulo que permita la conexión entre la terminal y la nueva interfaz con el controlador de los brazos robóticos, y que permita la manipulación de estos. Con ello, podemos actualizar su software de control y poder ejecutar la aplicación en equipos modernos. Además, se pretende introducir mejoras que no se han implementado antes y hacer más amena la interacción con el robot, facilitando el uso a los alumnos.

El objetivo principal de este proyecto se basa en determinar la idoneidad técnica y la viabilidad económica de una instalación de picoturbinado hidrocinético en los canales del sistema de riego de la Huerta de Murcia. Este primer propósito conlleva una serie de objetivos secundarios que también deben desarrollarse con el mismo rigor, de forma que se obtenga finalmente una conclusión sólida y bien fundamentada, dando lugar a posibles estudios futuros en este campo u otros similares. El estudio de viabilidad deberá llevar consigo un diseño de la instalación. Se trata de un diseño completo del rotor hidrocinético, incluyendo posteriormente un modelo CAD 3D de la instalación completa y su adecuación al emplazamiento. Se buscarán medidas para generalizar, en la medida de lo posible, la instalación a otros emplazamientos del sistema de riego, al igual que se intentará respetar al máximo el entorno ambiental de la zona. Por su parte, el diseño detallado del rotor necesitará de información hidráulica y geométrica del emplazamiento en cuestión. Se realizará una relación de emplazamientos potenciales dentro del sistema de riego de la Huerta de Murcia para este tipo de generación. Eligiendo el óptimo, se procederá a su caracterización técnica integral. Debido a la importancia de la energía cinética disponible, se medirá la velocidad del flujo en la ubicación, obteniendo los valores de las magnitudes hidráulicas pertinentes para el diseño. Todo el proceso de diseño y caracterización se verá influenciado por el conocimiento en el campo de las turbinas hidrocinéticas. Por ello, se realizará previamente una revisión bibliográfica profunda de la tecnología. Además, para la búsqueda de emplazamientos será esencial la compresión de todo el sistema de riego. Con el propósito de contextualizar el proyecto, también se realizará una reseña histórica de la red de acequias. Finalmente, a modo de profundizar en las antiguas máquinas hidráulicas presentes y ligando ingeniería antigua y moderna, se estimará la potencia de la Rueda de La Ñora. Acabo el proceso de diseño y regresando al punto final, la viabilidad económica de la instalación se calculará mediante los parámetros financieros pertinentes. En general, el proyecto fin de grado pretende determinar la rentabilidad económica de un pequeño sistema de generación eléctrica en los cauces de la Huerta de Murcia, utilizando métodos de cálculo hidráulicos y mecánicos. También se añadirá una aportación cultural que intentará realizar una simbiosis entre ingeniería hidráulica antigua y moderna en la zona. Escuela Técnica Superior de Ingeniería Industrial Universidad Politécnica de Cartagena

In this thesis, numerical results using the Boundary Element Method (BEM) for groundwater flow in a domain with a boundary that contains numerous singularities with a phreatic surface are developed. The flow in the domain is modeled using Darcy's law for a homogeneous isotropic porous medium. The boundary conditions are a combination of Dirichlet and Neumann with the phreatic surface having both boundary conditions. Exact solutions by Conformal Mapping for simplified domains with the same singularity as the original domain allow for modifications to the BEM resulting in an improvement to the numerical solution. An iterative process is used to determine the location of the phreatic surface and the location of the exit point. The iteration starts with an initial guess for the phreatic surface using the exact solution by conformal mapping for an infinite unconfined domain that preserves the important features of the domain around phreatic surface near the exit point. Initially, the problem is solved using the conventional BEM as described by Liggett and Liu (1983). It is expected that the singularities and unknown location of the phreatic surface will lead to a failure of the BEM solution especially near the singular points and on the phreatic surface. Then, the modified BEM with the conformal mapping improvements is used to find the solution. The modified and conventional BEM are then compared with an emphasis on accuracy of the numerical solutions. Several tables and figures are produced to illustrate the results.

Los deportes de equipo son actividades de cooperación – oposición, donde se realizan esfuerzos intermitentes por parte de los jugadores de los equipos que participan. Para cuantificar estos esfuerzos se debe disponer de instrumentos que permitan una valoración fiable de las diferentes acciones. La literatura científica, remite principalmente a cuatro herramientas para cuantificar la carga interna de entrenamiento para este tipo de actividades; La frecuencia cardiaca (FC), el consumo de oxígeno (VO2), la concentración de lactato en sangre (CLS) y la percepción subjetiva del esfuerzo (PSE). Estas cuatro formas de cuantificar la carga servirá tanto para valoraciones en tests de laboratorio y campo, como para valoraciones in situ del entrenamiento. Así pues el objetivo del presente trabajo fue revisar los diferentes estudios que usan alguno de estos medios para la cuantificación de la carga interna de entrenamiento en deportes de equipo.

Thermophoresis is a tool often applied in complex plasma experiments. One of the usual stated benefits over other experimental tools is that changes induced by thermophoresis neither directly depend on, nor directly influence, the plasma parameters. From electronic data, plasma emission profiles in the sheath, and Langmuir probe data in the plasma bulk, we conclude that this assumption does not hold. An important effect on the levitation of dust particles in argon plasma is observed as well. The reason behind the changes in plasma parameters seems to be the change in neutral atom density accompanying the increased gas temperature while running at constant pressure., Comment: 14 pages, 12 figures

La ocurrencia de diferentes fenómenos durante las últimas décadas da cuenta del surgimiento de una sociedad de carácter planetario diferenciada de cualquier otra sociedad conocida, la cual genera infinitas posibilidades de progreso pero arrastra riesgos e incertidumbres que incrementan la vulnerabilidad de los más desfavorecidos sobre la tierra. Los recursos naturales, el trabajo manual de la tierra y la energía han perdido principalía como generadores de riqueza, pasando a ocupar tal espacio el conocimiento. De esta forma el ser humano maximiza su potencial como sujeto y destinatario del conocimiento que genera, y en este contexto se pone de relieve el papel de la educación como el instrumento por excelencia con el que cuenta el hombre para su formación en orden a la producción de conocimientos, a la innovación de procedimientos y a la aplicación del saber para satisfacción de las nuevas necesidades y a su personal promoción. A pesar de sus asimetrías sociales y económicas, la República Dominicana cuenta con las posibilidades semejantes a las de otros países, pequeños o grandes, para competir. Sin embargo su sistema educativo se caracteriza por el bajo rendimiento interno y estándares de calidad escasamente exigentes y hasta obsoletos, por lo que requiere con urgencia de una reforma profunda. El sub-sistema de educación secundaria registra las mayores precariedades por los pobres resultados que obtiene, lo que justifica la formulación de una propuesta alternativa, como la que se ofrece en esta tesis, que le devuelva pertinencia, relevancia, eficiencia, eficacia y equidad, que son dimensiones sobrentendidas en una educación de calidad. La propuesta integra teorías y tendencias, incluye un modelo de planificación institucional y un programa de formación permanente del profesorado, incorpora un sistema de monitoreo y evaluación y un programa de intervenciones pedagógicas que vehiculan el desarrollo de estrategias de evaluación formativa en el contexto del aula, de inducción, de formación vocacional y de tutorías estudiantiles, de rendición de cuentas y de voluntariado familiar, así como estrategias de educación compensatoria y reinserción social.[ABSTRACT] The occurrence of a number of economic, political, natural and social phenomena within the last decades indicates the birth of an emerging society with planetary characteristics, differentiated of any other society ever known, which generates infinite possibilities of progress, but at the same time, it brings as a consequence risks and uncertainties which increase the vulnerability of the earth. The natural resources, the work of the land done by hand and the energy, have lost importance as generators of richness, which have been substituted by Knowledge, in this way human beings maximize their potential as receptors of the knowledge generated by themselves, and in this context, the role of education is highlighted as the best instrument which human beings use to satisfy the new necessities of education. Despite the social and economical inequalities, the Dominican Republic has similar possibilities as other countries, big and small, to compete. However, our educational system is characterized by low achievement and not very demanding quality standards, or even obsolete ones, for this reason, it urgently requires a deep reform. Secondary education is the most affected by low achievement, which justifies the proposal of a new alternative, like the one offered in this research, which allows it to gain back its sense of pertinence, relevance, efficiency and equality, we assume that these dimensions are implied in an education with quality. The proposal includes: theory, tendencies and institutional plan, and a permanent training program of the teacher’s staff, incorporates a monitoring and evaluation system, and a program of pedagogical interventions that connect the development of formative strategies of evaluation within the context of the classroom, a strategy of induction and vocational formation and student’s tutoring, strategies of accountability and family volunteering, as well as strategies of compensatory education and social reintegration.

Gegenstand des vorliegenden Beitrags ist die Beschreibung qualitativer Methodologien im öffentlichen Gesundheitswesen, genauer: im Bereich seelischer Gesundheit, wie sie in der medizinischen Fakultät der Universidad Nacional Autónoma de México zum Einsatz kommen. Wir skizzieren hierzu zunächst unsere Lehrerfahrungen (Master- und Doktorarbeiten), um hiervon ausgehend zum einen die Schwierigkeiten zu diskutieren, die Lehrende und Studierende erfahren, wenn sie qualitative Ansätze praktisch im Bereich des Gesundheitswesens einsetzen wollen, und zum anderen die Präferenzen für spezifische Themen auf Seiten der Studierenden näher darzustellen. Vor dem Hintergrund dieser Erfahrungen kommen wir zu dem Schluss, dass die wesentlichste Herausforderung darin besteht, qualitative Forschung niveauvoll und methodisch elaboriert zu betreiben, um sie als akzeptierten Forschungsansatz in diesem Themenfeld etablieren zu können. The primary objective of the present paper is to describe the use of qualitative methodologies in public mental health as practiced by the Faculty of Medicine at the National University Autonomous of Mexico. Starting from describing our teaching experiences with qualitative methodologies at the masters and doctoral levels, this paper also includes a series of reflections and concerns in relation to the difficulties instructors and students have when proposing qualitative approaches to the practice of public mental health and the topics students choose to study. From these reflections we conclude that one of the most important challenges is to develop high quality and rigorous qualitative research in order to establish it as a respected methodological approach in the study of public mental health. Este trabajo tiene por objetivo describir el programa de la materia que sobre metodología cualitativa en el área de salud mental pública se imparte en la Facultad de Medicina de la Universidad Nacional Autónoma de México. Partiendo de la experiencia como docentes, a nivel maestría y doctorado de esta materia, en este documento se incluye también una serie de reflexiones y preocupaciones en torno a las dificultades enfrentadas por maestros y estudiantes al proponer una aproximación diferente, así como los temas que los estudiantes adscritos a este programa abordaron. Finalmente, producto de estas reflexiones, se concluye que uno de los principales desafíos es generar investigación de calidad para que sea una tradición respetada por investigadores e instituciones.