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Introduction and objectives Transcatheter aortic valve implant has become a widely accepted treatment for inoperable patients with aortic stenosis and patients at high surgical risk. Its indications have recently been expanded to include patients at intermediate and low surgical risk. Our aim was to evaluate the efficiency of SAPIEN 3 vs conservative medical treatment (CMT) or surgical aortic valve replacement (SAVR) in symptomatic inoperable patients at high or intermediate risk. Methods We conducted a cost-effectiveness analysis of SAPIEN 3 vs SAVR/CMT, using a Markov model (monthly cycles) with 8 states defined by the New York Heart Association and a time horizon of 15 years, including major complications and management after hospital discharge, from the perspective of the National Health System. Effectiveness parameters were based on the PARTNER trials. Costs related to the procedure, hospitalization, complications, and follow-up were included (euros in 2019). An annual discount rate of 3% was applied to both costs and benefits. Deterministic and probabilistic sensitivity analyses (Monte Carlo) were performed. Results Compared with SAVR (high and intermediate risk) and CMT (inoperable), SAPIEN 3 showed better clinical results in the 3 populations and lower hospital stay. Incremental cost-utility ratios (€/quality-adjusted life years gained) were 5471 (high risk), 8119 (intermediate risk) and 9948 (inoperable), respectively. In the probabilistic analysis, SAPIEN 3 was cost-effective in more than 75% of the simulations in the 3 profiles. Conclusions In our health system, SAPIEN 3 facilitates efficient management of severe aortic stenosis in inoperable and high- and intermediate-risk patients.

The physiological and agronomic responses of two irrigation systems were compared in ‘Fino 49′ lemon trees (Citrus limon [L.] Burm. fil.). The irrigation systems consisted of different designs of the irrigation installation (same amount of water and irrigation frequency): a conventional design (2L, two drip lines with six drippers per tree), and a design with a larger wetted surface (3L, implementing the conventional design with a third drip line with nine drippers per tree). Results indicated that the 3L design promoted a better distribution of water and fertilisers in the soil profile, improving some gas-exchange parameters in periods of low evaporative demand or after rain. The agronomic response showed two main effects on fruit quality: (1) the total numer of fruits affected by endoxerosis was reduced, and (2) the first harvest (the earliest fruits harvested) moved forward in time. From an economic point of view, economic water productivity was increased, mainly due to an increment in the proportion of first-harvested lemon, but also due to the decrease in lemon produced for the industry (affected by endoxerosis). The 3L irrigation system could be an interesting alternative to favour fruit precocity, improving the use of the available water resources for early lemon tree growers.

Background: Nursing students need to experience caring in their educational environment in order to learn how to care for the patients. Objective: The present study describes the caring model demonstrated by the faculty to the nursing students through their behaviours, from the perspective of both students and faculty members. Design: A cross-sectional, descriptive, observational study was conducted. Participants: The sample included 286 students and faculty members. Methods: The Nursing Students' Perceptions of Instructor Caring assessing tool was used to gather the data. Results: After analysing 676 questionnaires, it was revealed a moderately high level of caring perceived by the students. The most appreciated dimension was control versus flexibility, reporting a mean value of 82.29 and a confidence interval from 81.14 to 83.44, and the least valued was appreciation of life's meanings, reporting a mean value of 63.90 and a confidence interval from 62.20 to 65.60. The students' perception of the care demonstrated by the faculty was significantly lower than the care that the latter believed to transmit in all dimensions (p < 0.001). Conclusions: The caring perceived by the student was expressed through behaviours that inspired confidence in them, promoted a climate of learning and support, helped them to recognise the meaning of life, showed them flexibility and fostered their professional autonomy. The findings of this study can help to improve nursing education by providing a view of the interpersonal relations that the students established during their training with the faculty., This work was supported by Universidad de Huelva and Consorcio de Bibliotecas Universitarias de Andalucía

Achilles tendon tendinopathy (AT) is a musculoskeletal condition characterized by pain in the Achilles tendon and impaired physical performance or sport activities. AT is difficult to treat, and the results are variable. Preliminary evidence suggests a positive effect for pain of percutaneous electrolysis in patients with tendinopathy. Our aim was to determine the validity and safety of a percutaneous electrolysis approach targeting the interphase between the Achilles tendon and the Kager’s fat with ultrasound imaging in both healthy individuals and on a fresh cadaver model (not ultrasound guiding). A needle was inserted from the medial to the lateral side under the body of the Achilles tendon, just between the tendon and the Kager’s triangle, about 5 cm from the insertion of tendon in the calcaneus in 10 healthy volunteers (ultrasound study) and 10 fresh cadaver legs. An accurate needle penetration of the interphase was observed in 100% of the approaches, in both human and cadaveric models. No neurovascular bundle of the sural nerve was pierced in any insertion. The distance from the tip of the needle to the sural nerve was 5.28 ± 0.7 mms in the cadavers and 4.95 ± 0.68 mms in the volunteer subjects, measured in both cases at a distance of 5 cm from the insertion of the Achilles tendon. The results of the current study support that percutaneous electrolysis can be safely performed at the Kager’s fat–Achilles tendon interphase if it is US guided. In fact, penetration of the sural nerve was not observed in any needle approach when percutaneous needling electrolysis was performed by an experienced clinician. Future studies investigating the clinical effectiveness of the proposed intervention are needed.

In arid and semiarid regions, the current lack of natural water resources is driving the use of alternative sources for crop irrigation, such as desalinated seawater (DSW). However, the use of DSW could affect the crop productivity due to its chemical composition (predominance of phytotoxic ions: Na+, Cl−, and B). Citrus species are classified as salt and boron-sensitive; however, the rootstock plays a fundamental role in the tree’s tolerance of abiotic stresses. One-year-old ‘Verna’ lemon trees grafted on two rootstocks (CM, Citrus macrophylla, and SO, sour orange) were used. These rootstocks differ in their salinity and boron tolerance, SO being more tolerant than CM. The experiment was carried out at high temperature (35/27°C), and the plants were irrigated with three types of water supplemented with Hoagland nutrients: DSW, DLB (DSW with low boron), and Control (distilled water). The plants were irrigated three times per week and harvested 7 months after the treatments started. The response to high levels of Cl−, Na+, and B was rootstock-dependent. Under the high temperature conditions, the growth of plants grafted on SO was not affected by DSW, and these plants did not reach the Cl− threshold of phytotoxicity, so the decrease in the shoot growth of plants grafted on CM due to DSW irrigation was related more to Cl− rather than the foliar Na+ accumulation. Plants grafted on SO and irrigated with DSW accumulated more B than those grafted on CM, surpassing the threshold of phytotoxicity and producing greater oxidative stress. As the growth of these plants was not reduced, the effects of DSW on plant growth were not directly related to the concentration of B and there must be some mechanisms that allow these plants to withstand the negative effects of high foliar B, such as the increased levels of quaternary ammonium compounds. Since the response of citrus plants to DSW depended on the rootstock, the results obtained in this experiment, using DSW at high temperature, could be useful for the future management of citrus crops, because climate change will increase temperatures and exacerbate the scarcity of water resources in citrus-growing areas.

Entrapment of the radial nerve at the arcade of Frohse could contribute to symptoms in patients with lateral epicondylalgia or radial tunnel syndrome. Our aim was to determine the validity of applying percutaneous electrolysis, targeting the supinator muscle at the Frohse’s arcade with ultrasound imaging and in a Thiel-embalmed cadaver model (not ultrasound-guiding). Percutaneous electrolysis targeting the supinator muscle was conducted in five healthy volunteers (ultrasound study) and three Thiel-embalmed cadaver forearms. Two approaches, one with the forearm supinated and other with the forearm pronated were conducted. The needle was inserted until the tip reached the interphase of both bellies of the supinator muscle. Accurate needle penetration of the supinator muscle was observed in 100% in both US-imaging and cadaveric studies. No neurovascular bundle of the radial-nerve deep branch was pierced in any insertion. The distance from the tip of the needle to the neurovascular bundle was 15.3 ± 0.6 mm with the forearm supinated, and 11.2 ± 0.6 mm with the forearm pronated. The results of the current study support that percutaneous electrolysis can properly target the supinator muscle with either the forearm in supination or in pronation. In fact, penetration of the neurovascular bundle was not observed in any approach when percutaneous needling electrolysis was performed by an experienced clinician.

This paper aims to evaluate different design configurations of a combined heat and power (CHP) plant with post-combustion CO2 capture. Three cases are involved in this study: case 1 consists of three trains and each train has a configuration of one gas turbine with a heat recovery steam generator (HRSG); case 2 consists of three trains and one steam turbine; and case 3 consists of only two trains. The third case presented the highest CHP efficiency of 72.86% with 511.8 MW net power generation. After selecting the optimum configuration, a parabolic-trough collector (PTC) was incorporated to generate additional saturated steam at 3.5 bar for the capture plant, adding greater flexibility to the CHP because more steam was available. In addition, the efficiency of the cycle increased from 72.86% to 80.18%. Although case 2 presented lower efficiency than case 3, it has a steam turbine which brings the possibility of increasing the amount of electricity instead of steam production. When the PTC was incorporated in case 2, the power generated in the steam turbine increased from 23.22 MW to 52.6 MW, and the net efficiency of the cycle from 65.4% to 68.21%.

A new mathematical model for analyzing the rheology of a drilling fluid was developed based on a nonlinear function fit of measured data of shear stress and shear rate of the drilling mud used during the drilling process of petroleum and geothermal wells. This mathematical model was obtained from a rational polynomial model proposed for determining of the viscosity behavior. We proposed an analytical approximation to allow a simple fit that approximately describes the rheology of a drilling mud obtaining squared correlation coefficients greater than 0.9995 for the fitted series. The logarithmic function and rational functions obtained describe the shear stress and viscosity behavior, respectively. The fitting process was automated using a simple Wolfram language script. The result is a simple, accurate and practical method to describe the rheology of a drilling mud. This model was compared against most used models, applied to a set of 87 experimental data series, had a good agreement in 81% of the analyzed series and being the best choice in 48.3% of all cases. The method has the advantages of using the Wolfram script with common measurements made during a drilling process and can be applied in either the petroleum or geothermal industries to analyze the drilling mud rheology.

La situación mundial del comercio de alimentos obliga a los países exportadores a reforzar sus sistemas de control y adoptar y vigilar estrategias de control de la inocuidad basadas en el riesgo de contaminación. El objetivo de esta investigación fue aislar enterobacterias en diversos insumos usados en la producción agrícola en La Comarca Lagunera y determinar el riesgo que implica su uso en las actividades agrícolas. Se analizaron microbiológicamente muestras a partir de diferentes fuentes de agua, estiércoles y suelo, usados en la producción agrícola de La Comarca Lagunera, México, durante los años 2014-2016. Se identificó a Klebsiella spp. como el principal factor de riesgo de contaminación bacteriana en el agua que se utiliza para el riego de los diferentes cultivos con una prevalencia de 46.95%. En las muestras de suelo se aisló únicamente a Klebsiella spp. con una prevalencia de 60%, mientras que en muestras estiércol bovino se aisló E. coli (30%) y Klebsiella spp. (40%), Salmonella spp. (14%) en estiércol caprino y Salmonella spp. (100%) en estiércol pollinaza. Lo anterior representa un factor de riesgo para la salud del consumidor final, en el caso de productores que pretendan exportar sus productos agrícolas, les restaría competitividad y les pudieran cerrar los mercados internacionales. Una investigación más profunda es necesaria a lo largo de la cadena de producción de frutas y hortalizas con el fin de reducir esta contaminación.

A hard-core double Yukawa potential is taken as an approximation of the Lennard–Jones (LJ) potential. Using first-order thermodynamic perturbation theory with a hard-sphere fluid as the reference s...

Electrode materials for energy storage devices based on carbon materials have shown to be a reliable choice in supercapacitors or Li-ion batteries. The development of novel carbon materials may improve the performance of such devices and the use of eco-friendly materials from biomass waste may provide a breakthrough in the area. In this study, we give theoretical insights into the in silico design of carbon materials based on lignocellulosic molecules present in the waste residues. We performed pyrolysis-simulated calculations at the ReaxFF level with the Adler's softwood lignin model as the precursor material. Different models were implemented by randomly combining massive lignocellulosic molecules. The simulated pyrolysis of the lignocellulosic components was performed starting with a heating step from room temperature to a temperature limit of 1280 K, followed by a stabilization period. The reaction was subjected to quenching, and finally to a period of thermal equilibrium. The formed char was characterized as nanoporous carbon according to its density, radial distribution function and pore size distributions. Comparison of these results with our available experimental data revealed reasonable agreement. This may aid in the design of carbon electrodes for energy storage devices and applications in which stable and predictable properties are desirable.

Rationale and Aim: Advanced Practice Nurse (APN) is a specialist who has acquired clinical skills to make complex decisions for a better professional practice. In the United States, this figure has been developed in different ways, but in some European countries, it is not yet fully developed, although it may imply a significant advance in terms of continuity and quality of care in patients with chronic or multiple pathologies, including cardiac ones and, more specifically, heart failure (HF). The follow- up of HF patients in many countries has focused on the medical management of the process, neglecting all the other comprehensive health aspects that contribute to decompensation of HF, worsening quality indicators or patient satisfaction, and there are not updated reviews to clarify the relevance of APN in HF, comparing the results of APN interventions with doctors clinical practice, since the complexity of care that HF patients need makes it difficult to control the disease through regular treatment. For this reason, this systematic review was proposed in order to update the available knowledge on the effectiveness of APN interventions in HF patients, analysing four PICO questions (Patients, Interventions, Comparison and Outcomes): whether APN implies a reduction in the number of hospital readmissions, if it reduces mortality, if it has a positive cost- benefit relationship and if it implies any improvement in the quality of life of HF patients. Design and Methods: A systematic review was performed based on the PRISMA statement, searching at four databases: PubMed, CINAHL, Scopus and Cuiden. Articles were selected based on the following criteria: English/Spanish language, up to 6 years since publication, and original quantitative studies of experimental, quasi- experimental or observational character. Papers were excluded if they do not comply with CONSORT or STROBE checklists, and if they had not been published in journals indexed in JCR and/or SJR. For the analysis, two separate researchers used the Cochrane Handbook form for systematic reviews of intervention, collecting authorship variables, study methods, risks of bias, intervention and comparison groups, results obtained, PICO question or questions answered, and the main conclusions. Results: A total of 43,754 patients participated in the 11 included studies for the development of this review, mostly from United States and non- European countries, with a clearly visible lack of European publications. Regarding the results related to first PICO question, researches reviewed proved that APN implied a reduction in the number of hospital readmissions in patients with heart failure (up to 33%). Regarding the second question, mortality was always lower in groups assisted by APN versus in control groups (up to 7.8% vs. 17.7%). Regarding the third question, APN was costeffective in this type of patient as the cost reduction was eventually calculated in 1.9 million euros. Regarding the last question, quality of life of patients who have been cared for by an APN had notoriously improved, although one of the papers concluded that no significant differences were found. All the questions addressed obtained a positive answer; therefore, APN is a practice that reduced hospital readmissions and mortality in HF patients. The cost- effectiveness is much better with APN than with usual care, and although the quality of life of HF patients seems to improve with APN, more studies are needed to support this focused on this.

In this paper, the modeling and real time simulation of an off-grid wind energy conversion systems based on isolated multilevel cascaded H-bridge topology is presented. The system is tested under a synthetic wind speed signal generated by Gaussian Process, even with wind variations. The off-grid WECS structure is made through an AC/DC power converter formed by a VSC in rectifier mode, which is designed through the permanent magnet synchronous generator characteristics; the DC voltage is isolated by a DC/DC modified boost converter and subsequently is applied to the DC/AC multilevel cascaded H-bridge of 5-levels converter. The system validation is achieved in MATLAB-Simulink® and with the laboratory tests using the concept of model in the loop and the real-time simulator Opal-RT Technologies®. The obtained results show a robust and effective methodology generating a total output power of 30 kW off-grid.

Background. Overweight and obesity arise from a complex range of genetic, environmental, behavioral, educational, and socioeconomic factors. The present study explored the sedentary practices and some life habits related to health among children from the school population of Uruguaiana (Rio Grande do Sul, Brazil). Methods: A cross-sectional descriptive study was conducted to characterize the life habits of the school boys and girls from fourth grade (9&ndash, 10 years old). Results: A total of 470 fourth-grade boys and girls (9&ndash, 10 years old) participated in the study. As regards the variables linked to habits, 24% of the boys and girls answered they had not had breakfast the day they completed the questionnaire and 51.8% stated they did not have breakfast any given day of the week. Regarding sedentary habits, 25.3% of children watched TV or played video games five or more hours a day and 9% rarely played sports with their parents or caregivers. Statistical significance was recorded between &ldquo, number of hours watching TV and playing video games&rdquo, and &ldquo, playing sports with parents or caregivers&rdquo, (p &lt, 0.05). Conclusions: Association between the times spent watching TV or playing video games and the practice of physical exercise in the family proves once again the importance of the family in education for the health of children. The school provides direct access to schoolchildren and their parents to launch numerous health education programs.

The use of masks is one of the measures to protect against the Covid-19 pandemic. The type of mask and how to use it during physical exercise has generated controversy. This work aims to analyse the effect of the use of masks in the practice of high intensity physical exercise.An exploratory review was conducted by querying the PubMed, Scopus, Google Scholar and CUIDEN databases.Respiratory physiology at rest and performing intense physical exercise was described, explaining how the use of masks during high-intensity physical exercise affects it in relation to gas exchange.In case of intense physical exercise, the use of masks is not recommended because of the enhancing effect on PCOEl uso de mascarillas es una de las medidas de protección ante la pandemia de Covid-19. El tipo de mascarilla y cómo usarla durante la realización de ejercicio físico ha generado controversia. Este trabajo tuvo como objetivo analizar el efecto del uso de mascarillas en la práctica de ejercicio físico de alta intensidad.Se realizó una revisión exploratoria consultando las bases de datos PubMed, Scopus, Google Scholar y CUIDEN.Se describieron la fisiología respiratoria en reposo, al realizar ejercicio físico intenso y cómo afecta el uso de mascarillas durante el ejercicio físico de alta intensidad, en relación con el intercambio gaseoso.En caso de ejercicio físico intenso no se aconseja el uso de mascarillas por el efecto potenciador de la PCO

Background Overweight and obesity arise from a complex range of genetic, environmental, behavioural, educational, and socioeconomic factors. Poor eating habits and poor physical activity increase the probability that children will become obese adolescents. The sedentary lifestyle, encouraged by the rapid evolution of technology, has been accentuated in recent years. Strategies to accelerate obesity prevention include modifying the child's environment for healthy eating and physical activity. For this, it is essential to analyze the characteristics and life habits of children population. This study tries to know the sedentary practices and some life habits related to health among children from the school population of Uruguaiana (RS, Brazil), identifying the sociodemographic factors that can influence it.Methods The sample was composed of 470 school boys and girls, aged between 9 and 10 years. In order to obtain the sample, a random plampling was performed by clusters of the 24 urban public schools of the city. Sociodemographic variables and sedentary habits were measured.Results As regards the variables linked to habits, 24% of the boys and girls answered they had not had breakfast the day they completed the questionnaire. 51.8% stated they did not have breakfast any given day of the week. Regarding to sedentary habits, 25.3% of children watched TV or played video games 5 or more hours a day and 9% rarely played sports with their parents or caregivers. Statistical significance was recorded between “number of hours watching TV and playing video games” and “playing sports with parents or caregivers” (p Conclusions Association between the times spent watching TV or playing video games and the practice of physical exercise in the family, proves once again the importance of the family in education for the health of children. The school provides direct Access to schoolchildren and their parents to launch numerous health education programs.

Mortality rates among pluripathological patients are significantly higher in the hospital setting, with advanced age and dependence on certain vital functions the main clinical aspects. Other features involved in the care, such as the loss of autonomy and social problems, have important ethical implications. The aim of this article is to analyze the health problems and the functional and social situation of chronic patients after hospital admission in order to determine their care needs and the ethical implications these might have. For this, a cross-sectional descriptive study is being carried out with a sample of 111 chronic pluripathological patients admitted to the internal medicine service and discharged later. Overall, 96.6% of the patients in the sample were dependent, 91.7% had social problems or were at social risk and 36.9% had cognitive impairment. Among dependent patients, 59.4% had social problems (p = 0.029), 19.2% lived alone (p = 0.13), and in 73.3% of cases the housing was inadequate (p = 0.47). Among those with cognitive impairment, 79.5% of patients had social problems (p = 0.001), and 10.3% lived alone (p = 0.038). The results of the study confirm the presence of dependence and social problems at hospital discharge in a high proportion of chronic patients. Planning their care can lead to ethical conflicts related to the use of information technologies, which are destined to promote the patients&rsquo, autonomy, and to the social problems associated with the illness.