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Patients after Fontan palliation represent a growing pediatric population requiring heart transplant (HTx) and often have lymphopenia (L) and/or hypogammaglobinemia that may be exacerbated by protein-losing enteropathy (PLE, P). The post-HTx effects of this altered immune phenotype are not well studied.In this study of the Pediatric Heart Transplant Society Registry, 106 Fontan patients who underwent HTx between 2005 and 2018 were analyzed. The impact of lymphopenia and PLE on graft survival, infection, rejection, and malignancy was analyzed at 1 and 5 years post-HTx.The following combinations of lymphopenia and PLE were noted: +L+P, n = 37; +L-P, n = 23; -L+P, n = 10; and -L-P, n = 36. Graft survival between the groups was similar within the first year after transplant (+L+P: 86%, +L-P: 86%, -L+P: 87%, -L-P: 89%, p = .9). Freedom from first infection post-HTx was greatest among -L-P patients compared to patients with either PLE, lymphopenia, or both; with a 22.1% infection incidence in the -L-P group and 41.4% in all others. These patients had a significantly lower infection rate in the first year after HTx (+L+P: 1.03, +L-P: 1, -L+P: 1.3, -L-P: 0.3 infections/year, p .001) and were similar to a non-single ventricle CHD control group (0.4 infections/year). Neither freedom from rejection nor freedom from malignancy 1 and 5 years post-HTx, differed among the groups.Fontan patients with altered immunophenotype, with lymphopenia and/or PLE, are at increased risk of infection post-HTx, although have similar early survival and freedom from rejection and malignancy. These data may encourage alternative immunosuppression strategies and enhanced monitoring for this growing subset of patients.

We report on a 10-year-old female who rapidly developed a left atrial (LA) mass two months after orthotopic heart transplant. Nine days prior to detection of the mass, she received high-dose corticosteroids for acute cellular rejection (grade 2). Despite negative echocardiogram five days prior to detection, a large echogenic mass was noted in the LA (18 x 12 x 24 mm); it was surgically resected after unsuccessful anticoagulation treatment. Pathogenesis of this LA thrombus remains uncertain, but immunosuppression, acute rejection, and high-dose steroid therapy may have contributed. Surgical thrombectomy is a safe and effective treatment option for LA thrombus.

Resumen Objetivo La interconsulta medica es una labor asistencial generalmente poco valorada y estudiada. El principal objetivo ha sido describir y analizar las interconsultas solicitadas a Dermatologia y los aspectos que inciden en su resolucion. Pacientes y metodos Estudio observacional retrospectivo en el que se recogieron las interconsultas de los pacientes ingresados durante 36 meses. Se analizaron variables con relacion al manejo de los pacientes y a la calidad asistencial. Resultados Se incluyo a 750 pacientes, con una edad media de 64,85 ± 20,23 anos. Los servicios medicos fueron los mas solicitantes y, principalmente, Medicina Interna (37,9%). Destacaron las dermatosis inflamatorias (36,2%). El diagnostico individual mas frecuente correspondio al exantema medicamentoso (8,1%). Conclusiones La actividad consultora conlleva un importante impacto en el manejo de los pacientes ingresados, implica una mejora en la calidad asistencial y una reduccion del coste sanitario, y conforma un valor formativo para los medicos residentes.

Objective Medical interconsultations are a healthcare task that is generally undervalued and understudied. The main objective of this study was to describe and analyse the interconsultations requested of dermatology departments and the aspects that are involve in resolving the interconsultations. Patients and methods We conducted an observational retrospective study that collected the interconsultations for patients hospitalised over a period of 36 months. We analysed variables related to the management of patients and the quality of the care. Results The study included 750 patients with a mean age of 64.85 (±20.23) years. The medical departments requested the most consultations, mainly internal medicine departments (37.9 %). The most common topic for the consultations was inflammatory dermatoses (36.2 %). The most common individual diagnosis was drug rash (8.1 %). Conclusions Consultation activities have a significant impact on the management of hospitalised patients, resulting in improved quality of care and reduced healthcare costs. These activities are also of training value for resident physicians.

Resumen El ectropion o eversion del parpado, es la malposicion palpebral mas frecuente. Al alterar la funcion protectora palpebral puede causar epifora, lagoftalmos, queratinizacion, irritacion cronica, dolor o ulceracion. Se distinguen 5 tipos de ectropion en funcion de su mecanismo causal: congenito, paralitico, involutivo, cicatricial y mecanico. Lo mas habitual en dermatologia, es la presencia de ectropion de tipo mixto, con elementos involutivos y mecanico-traccionales. Existen varias tecnicas reparadoras de ectropion cuya indicacion dependera del componente patogenico principal. Revisamos la anatomia basica palpebral y exponemos la tecnica exploratoria que nos permitira analizar el riesgo de ectropion para prevenir su aparicion o determinar la patogenia del ectropion ya establecido para definir la tecnica reparadora mas apropiada.

Ectropion, or eyelid eversion, is the most common form of eyelid malposition. By impairing the eyelid's protective function, ectropion can cause epiphora, lagophthalmos, keratinization, chronic irritation, pain, and ulceration. There are 5 types of ectropion, each with a different cause: congenital, paralytic, involutional, cicatricial, and mechanical. The most common presentation in dermatology is involutional eversion with a mechanical or tractional element. Several options exist for the surgical repair of ectropion and choice of technique will depend on the main pathogenic component. We review the basic anatomy of the eyelid and describe examination techniques for assessing risk and preventing ectropion and for identifying the main pathogenic component in order to select the most suitable repair technique.

International audience; Real-time 3-D ultrasound imaging with matrix arrays remains a challenge in Non-Destructive Testing (NDT) due to the time-consuming reconstruction algorithms based on delay-and-sum operations. Other algorithms operating in the Fourier domain have lower algorithmic complexities and therefore higher frame rates at the cost requiring more storage space, which may limit the number of reconstruction points. In this paper, we present a 3-D real-time implementation of the Total Focusing Method (TFM) and the Plane Wave Imaging (PWI), as well as of their Fourier-domain counterparts, referred to as k-TFM and k-PWI. For both acquisition types, the Fourier-domain algorithms are used to increase frame rates, and they are compared to the time-domain TFM and PWI in terms of image quality, frame rates and memory requirements. In order to greatly reduce their memory requirements, a new implementations of k-TFM and k-PWI are proposed. The four imaging methods are then evaluated in real time on a block of stainless steel made by additive layer manufacturing using a laser powder bed fusion process and containing a 3-D network of spherical porosities.

The excess of both private and public vehicles has hindered the mobility of large cities and, likewise, has begun to affect small cities, increasing environmental pollution, accidents, mortality, among others. The following research work includes the diagnosis and projection to the year 2021 of the traffic generated in the road corridor for future constructions in the adjacent area of the tennis club of the city of “San José de Cúcuta, Colombia”, through the collection of data by capacity of vehicles, traffic counts, surveys and vehicle registration, determining the present and future annual average daily traffic, within the main findings it was found that this sector is mostly traveled by cars, trucks and taxis. It was determined that the flow of vehicles will increase in the year 2021 by 24.62%, the constructions of shopping centers will be executed within the sector.

Urban transport is an indispensable component for the development of cities, however, the massive use of motorized modes of transport with polluting technologies has generated the non-sustainability of the sector. Colombian cities are no strangers to this problem and as an improvement strategy, the testing and implementation of electric transport technologies is considered as an opportunity for modernization, efficient use of energy, reduction of emissions and energy diversification taking advantage of the energy resources available in Colombia. In Bogotá, the taxi fleet, due to its high energy demand and responsibility in polluting emissions, is a segment where electric vehicles can offer benefits to the operator, the citizen and the city. A description of Bogota‘s taxi fleet, the presentation of electric vehicle technology and a comparison between a gasoline vehicle and an equivalent electric vehicle in regular operation are presented, as well as some results from the pilot‘s early years. The technology has demonstrated reliability and efficiency, benefits to drivers and significant savings in greenhouse gases, but requires new incentives for massification.

The clay is used in the area of constructions, ceramics and industrial applications: insecticides, pharmaceutical industry, cosmetics and painting, for its physical and chemical properties that are suitable for different civil projects (roads, public services network, constructions); the dosage is a technique to modify and improve the conditions of the soil-cement in reference to the resistance, conditions of insolubility, impermeability, durability and appearance. In this study, high plasticity clay was evaluated through different laboratory tests (humidity test, soil liquid limit, plasticity index, granulometric analysis, California Bearing Ratio) for three samples and specifying the methodology used in each step, with the objective of knowing its structure and functioning in rural roads in combination with soil-cement, looking for a more profitable and lasting option in this sector, in order to benefit the people surrounding these sectors, improving the income of the sector and seeking to mitigate the environmental impact.

Aqueduct systems help to record water consumption, being a connection between nature and the population, allowing water to be transported continuously; a good design of aqueduct networks is necessary to meet the purpose of providing the community with a technical report that can serve as a starting point to carry out a construction of the aqueduct for the public battery. This research presents the simulation of an aqueduct system by means of the epanet software according to the daily maximum flow, pressure, velocities of the distribution network, pumping time, with respect to the different pressures and diameters, diagnosing the routes, nodes, forms of access, restrictions and limitations that may affect the proper functioning of the system; In this way, the advantages and the magnitude of beneficiaries who will have this new access and improved service to meet the needs of the inhabitants are evident, according to the technical requirements of drinking water and sanitation of the technical regulation of the drinking water and basic sanitation sector, where it can be implemented by any public company in the country.

Dosage is a technique to modify and improve the conditions of the soil-cement that comply with the conditions of the “Instituto Nacional de Vías” standard and in the same way, is economic to be implemented in different types of clay. The clay was classified depending on its plasticity (high plasticity and low plasticity) and the behavior at loads; making laboratory tests of modified proctor, compaction and CBR% for the clays with 4% of soil cement; at the same time, the results of CBR% of soil cement of 4% with natural soils, of 6% of cement and 1 were compared. In this way, was made a proposal of the elaboration of each type of soil-cement with its respective percentage, concluding that the clay of high plasticity can be used for subgrade and the one of low plasticity has a weak bearing capacity.

The increase in distractions when driving or walking on a road has proportionally increased the number of accidents that occur each year, with pedestrians being the most affected. For this reason, an attempt is made to study the characteristics of a vehicle road, identifying the critical points and road sections of maximum demand of the inhabitants, who are the ones most in need of pedestrian crossings. For this reason, a statistical and technical study of traffic is proposed by means of vehicular gauges with respect to the most representative days that help to determine quantitatively the vehicular flow that circulates through this road corridor, by means of graphs, tables that help to identify the statistical data without still leaving aside the importance of a study of pedestrian traffic by means of a count in typical days of mobilization with the purpose of determining the pedestrian volume, due to its increase in the indexes of accidents caused by different types of transport, in which the motorcycles stand out.

In 1993, Law 100 introduced major reforms to Colombia’s health system and regulated the health care industry. We analyzed the structure of the social space of Colombia’s health system and the trans...

In this research, a methodology based on the development of numerical simulations is proposed to analyze the physical behavior of centrifugal pumps such as a turbine. Numerical simulations were carried out using OpenFOAM software. For the validation of the numerical model, the construction of an experimental test bench was carried out. The analysis carried out involves the evaluation of performance parameters of the pump as a turbine, such as head, power, and efficiency. Additionally, the effect of the rotation speed on the previous parameters is evaluated. From the results obtained, it was shown that the maximum relative error was 4%, 3.4%, and 3.8% for the head, power, and efficiency parameters, respectively. In general, it was evidenced that the proposed numerical simulation has the ability to describe the real trends of the pump as a turbine for different flow conditions. In addition, an 11% increase in rotational speed was shown to cause a 12%, 1.9%, and 3% increase in head, power, and maximum efficiency. The proposed methodology is considered an adequate tool to analyze performance and identify the best efficiency point of pump systems such as a turbine. In this way, greater energy use is guaranteed.

This paper presents the implementation and design features of a gravimetric-based fuel consumption system. The proposed system comprises a gravimetric balance with serial output, a fuel pump, and a control valve that are integrated into a complete engine test bench via Arduino UNO®. The study implements an instrumentation methodology to minimize measurement disturbance and error propagation, which represents a major concern in engine experimental testing. Moreover, an interactive virtual environment is developed to reinforce user interaction via LabView™. Results demonstrated that the proposed measurement system features robust and reliable operation while maintaining negligible disturbance and overall uncertainty ranging from 0.010-0.23 g/s. Additionally, it was evidenced that the measurement system allows the analysis of key parameters to evaluate engine performance. The study of the fuels blends shows that the ethanol content causes a 6.8% increase in brake specific fuel consumption and a 4% decrease in the brake thermal efficiency. Due to the low cost of the developed measurement system can be easily adapted to test bench laboratories to promote a better learning process and in industrial sectors for better energy management.

The automobile is the main means of transportation in most cities of the world, however, its excessive use has generated several environmental and social problems, one of them is the lack of control over parking on public roads, affecting vehicle traffic, disturbing the image of the city, increasing the rate of accidents and causing negative effects on the mood of drivers and pedestrians. There are different alternatives to reduce these indicators, highlighting the effectiveness of the implementation of parking meter systems, which seek to regulate parking on public roads through a fee and a time limit. This article demonstrates the design, feasibility and impact (economic, social and environmental) of an implementation of the parking meter system in the center of the city of San José de Cúcuta, Colombia, with data from the Secretariat of Transit of the metropolitan area of the city of San José de Cúcuta, Colombia and the national institute of roads, achieving a solution to the problem of traffic congestion in the city and also contributing to create citizen culture among its inhabitants.

In this project, a descriptive research was carried out in order to analyze, evaluate and detail the behavior of buildings between 4 and 18 floors of residential use in the City of San José de Cúcuta, Colombia, at the moment they are subjected to forces produced by earthquakes. For this purpose, a sample of 40 buildings framed in the above-mentioned characteristics was used by means of the SAP 2000 software. The seismic analysis of each building was made and the displacements of these were obtained when they are submitted before an earthquake. With this information, it was possible to calculate the drifts and evaluate them based on the requirements that determine the stiffness conditions present in the buildings. Finally, a document was drawn up identifying those buildings that are susceptible to significant damage in the event of a seismic movement and recommendations, due to the fact that they represent a social risk.

Medical consultations are a healthcare task that is generally undervalued and understudied. The main objective of this study was to describe and analyse the consultations requested of dermatology departments and the aspects that are involve in resolving the consultations.We conducted an observational retrospective study that collected the consultations for patients hospitalised over a period of 36 months. We analysed variables related to the management of patients and the quality of the care.The study included 750 patients with a mean age of 64.85 (±20.23) years. The medical departments requested the most consultations, mainly internal medicine departments (37.9%). The most common topic for the consultations was inflammatory dermatoses (36.2%). The most common individual diagnosis was drug rash (8.1%).Consultation activities have a significant impact on the management of hospitalised patients, resulting in improved quality of care and reduced healthcare costs. These activities are also of training value for resident physicians.

Public transport is one of the major means of mobilization for the general population of a country, achieving great importance to its policies of mobilization and economic analysis because it creates controversy to have a poor quality of service, directly affecting the users and drivers of these means. Due to the above, an alternative is proposed for the decongestion of main public transport routes, presenting the degree of saturation and the performance index that can create different alternative routes by moving a percentage of the routes in the city of Cucuta, Colombia. In order to evaluate the effectiveness of this solution, information was collected by means of surveys for users and drivers, analyzing the data with the SPSS version 21 software, manifesting that there is low quality in public transport. In this way, the final characteristics of this method are evaluated in the new alternatives and in the problem sector, satisfying the quality requirements of public transport worldwide.

Ectropion, or eyelid eversion, is the most common form of eyelid malposition. By impairing the eyelid's protective function, ectropion can cause epiphora, lagophthalmos, keratinization, chronic irritation, pain, and ulceration. There are 5 types of ectropion, each with a different cause: congenital, paralytic, involutional, cicatricial, and mechanical. The most common presentation in dermatology is involutional eversion with a mechanical or tractional element. Several options exist for the surgical repair of ectropion and choice of technique will depend on the main pathogenic component. We review the basic anatomy of the eyelid and describe examination techniques for assessing risk and preventing ectropion and for identifying the main pathogenic component in order to select the most suitable repair technique.

The purpose of this article is to present manufacturing methodologies through reverse engineering of socket design for a transtibial amputee, bearing in mind that it is a customized product. In addition, the traditional manufacturing process will be arrived at in comparison with the model proposed. In this sense, this document proposes a new practical approach to modeling the contact interface, i.e. the prosthetic socket and the skin, and thus making a more functional prosthesis by helping people to visibly improve their quality of life.

Vehicle congestion is a phenomenon that affects the world due to the potential increase in its population. Consequently, the capacity and level of service of Norte de Santander, Colombia, main avenue was analyzed, being the epicenter of the problem. This article was carried out using the highway capacity manual 2000, in addition to collecting information by means of vehicle gauges, conceptualizing the causes and critical points of the sector to diagnose the vehicle situation, proceeding to classify and process according to the highway capacity manual 2000. It is concluded that currently the system is with a level of service D and E, being these unstable, with tolerable speeds in some specific hours, but an incident on the road would cause little mobility, long queues and high waiting times for its narrow road space.

There are different factors that can cause a vehicular accident, starting with the carelessness of the driver or pedestrian, putting in risk his life and the life of third parties; by roads in bad conditions and lack of signaling, without warning him of the adversities that continue in the road, for this reason, the research work was developed on the causes of road accidents in four sectors, compiling information on the roads corresponding to the proposed streets and avenues, followed by defining the possible causes of the problems in the critical sites and thus defining the potential factors of an accident. Finally, solutions are proposed to reduce the percentages of vehicle accidents at the critical points found, decreasing the indicators of accident and mortality in this vehicle sector, giving people peace of mind when leaving their homes.

Colombia is an exporting country of quality coffee in the world; divergent factors in the short and long term, such as inclement weather, geographic changes, and socio-political development, are some of the factors that influence the price of this product. Knowing the future behavior of this phenomenon is one of the most important studies for economists, academics, coffee growers, entrepreneurs, and exporters. Brownian motion, a physical phenomenon that describes the irregular movement of some particles suspended in a fluid, was described by the probability of finding a particle in a position at a specific time. Fractional Brownian motion describes the random fluctuation of a stochastic process continuous in time and is characterized by the Hurst coefficient to observe persistence and volatility in a time series. The percentage of volatility that changes in the price of coffee present allows generating strategies to maintain the quality of the product and, therefore, its positioning in the market. In this work it was found that the series of data on coffee prices is persistent and that its volatility is 43.77%.

The system of porticoes resistant to moments of reinforced concrete is a set of beams and columns connected by means of knots that allows the generation of adequate spaces with facility before changes by the same users, whereas the industrialized system of structural walls of reinforced concrete, they are used for numerous, repetitive and of low price real estate, but they are completely immobile and in some occasions with problems of segregation and anthills. In this research work, a comparative study of the costs and budgets of the two proposed structural systems of the building was carried out in order to determine the structural system with the lowest costs and execution times, showing the results in explanatory graphs.

The selection of suitable materials for a construction defines the costs and characteristics that can contribute to the building, being of vital importance to make a correct choice. Lightening is an element to reduce costs and optimize resources, adding a better index of resistance against earthquakes, being of vital importance the good choice of this: concrete, clay or EPS. In this investigation a comparison of costs and incidence of the three types of lighteners that are used in the construction of three levels houses with reinforced concrete portico based on the requirements of NSR-10 was made by means of statistical samples/data, graphs and tables of data analysis, on the quotations and information collected from different studies on lightening costs in structures.

The need to improve people’s living conditions starts from the reality of the durability of rural road constructions, which have a short useful life and have a negative impact on the inhabitants of these regions. This project aims to improve access to rural areas, rural economic development and thus improve the quality of life of people in the sector; taking into account that at the moment of building a rural road, has a better resistance and durability in time, this was done by analyzing the properties of the clay mixture of low plasticity in the dosage of soil-cement that were tested by tests to determine the liquid limit of soils, determination of the plastic limit, plasticity index, moisture test, classification of soil by sieving, granulometric analysis, unit weight-humidity relations in soils, soil support relationship in the laboratory; in order to find the best dosage that provides greater strength, long-term durability and risk reduction. The results indicate that this type of clay requires an improvement with cement, due to its bearing capacity of 2% and 4%, which gives it a very poor quality to be used in the construction of rural roads.

Traditionally a limb that has suffered a fracture, rupture or dislocation is immobilized with plaster, a procedure that generates discomfort in the patient to take a shower, besides producing excessive itching and sweating, stimulating the growth of the bacteria and leading to an odorous form, unhygienic and difficult to keep clean of treatment. On the other hand, if the plaster remains for a long period, it can cause injuries in joints and ligaments. This project describes a methodology of manufacturing a prototype of orthosis for upper limb printed in 3D, through additive manufacturing and reverse engineering, technology that is presented as an excellent alternative to solve the problems of traditional plaster molds. The model of the orthosis is obtained through the Meshmixer software and the structural viability of the design is studied using methods of finite element analysis and biomimetics, to guarantee the best possible mechanical properties. The realization of this work provides a custom-made prototype orthosis, a more comfortable, hygienic and aesthetically pleasing solution, which in turn allows the reduction of the time of use of the plaster molds.

Bendopnea is a recently described symptom of advanced heart failure. Its prevalence and prognostic utility in other cardiac conditions are unknown. METHODS: We prospectively enrolled 108 consecutive patients (75 ± 3 years, 68% men) with severe symptomatic aortic stenosis referred for surgical aortic valve replacement (SAVR). Preoperatively, patients were tested for bendopnea, which was considered to be present when dyspnoea occurred within 30 s of bending forward. Univariable and stepwise multivariable analyses tested the association of bendopnea with preoperative echocardiographic parameters and postoperative clinical outcomes. RESULTS: Bendopnea was present in 46 of 108 (42%) patients. The mean time of onset was 10.5 ± 3.4 s. Bendopnea was associated with higher estimated pulmonary artery systolic pressures [51 (11) mmHg vs 40 (11) mmHg), P

Light and temperature are major drivers in the ecology and biogeography of symbiotic dinoflagellates living in corals and other cnidarians. We examined variations in physiology among 11 strains comprising five species of clade A Symbiodinium. We grew cultures at 26°C (control) and 32°C (high temperature) over a duration of 18 days while measuring growth and photochemical efficiency (Fv/Fm). Responses to thermal stress ranged from susceptible to tolerant across species and strains. Most strains exhibited a decrease in cell densities and Fv/Fm when grown at 32°C. Tolerance to high temperature (T32) was calculated for all strains, ranging from 0 (unable to survive at high temperature) to 1 (able survive at high temperature). There was substantial variation in thermotolerance across species and among strains. One strain had a T32 close to 1, indicating that growth was not reduced at 32°C for only this one strain. To evaluate the combined effect of temperature and light on physiological stress, we selected three strains with different levels of thermotolerance (tolerant, intermediate and susceptible) and grew them under five different light intensities (65, 80, 100, 240 and 443 μmol quanta m−2 s−1) at 26 and 32°C. High irradiance exacerbated the effect of high temperature, particularly in strains from thermally sensitive species. This work further supports the recognition that broad physiological differences exist not only among species within Symbiodinium clades, but also among strains within species demonstrating that thermotolerance varies widely between species and among strains within species.

Polyethylene terephthalate (PET) currently occupies an important space in the manufacture of bottles for carbonated beverages and mineral water, however, its use has become another pollution problem in the world, due to the fact that most of them end up in landfills, increasing the volume of plastics waste. The present investigation focuses on the analysis of recycled polyethylene terephthalate (RPET) analyzing whether it is possible to modify the thermal behavior of this plastic, by adding flame retardant, with the aim of improving its thermal properties. The thermal properties of the mixture and the degradation were evaluated by thermogravimetric analysis (TGA) and Dynamic Thermal Analysis (DTA), characterizing its decomposition process in increase of temperature, showing the little variation of the behavior of the mixture of RPET and % of MCA as a flame retardant additive compared to virgin PET.