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The EU Regulation 517/2014 has recently been approved in a further attempt to curb the effects of Global Warming. As a consequence, the refrigeration sector is moving towards refrigerants with a low Global Warming Potential (GWP100) in accordance with the limit fixed by these regulations (150). In this regard, the old refrigerant R152a attracts renewed interest due to its low GWP (138) and its similarity to R134a. The present work shows the results of using R152a in a vapour compression plant equipped with a hermetic compressor and an IHX designed for R134a. The refrigerant was replaced by a conventional “drop-in” process in order to carry out an energy comparison. The results have revealed an improvement in the COP with R152a up to 13% despite a reduction in the cooling capacity of about 10%. During the test campaign, R134a hermetic compressors have been shown to be capable of operating with R152a. The authors acknowledge Jaume I University of Spain, who financed partially the present study through the research project P1⋅B2013-10.

Background and purpose: Information received by IBD patients about their disease is of particular importance. The objective of the study was to determine the information resources these patients used, together with their perceived information gaps and expected preferences. Patients and methods: A prospective, observational, cross-sectional study conducted on IBD patients attending 13 Spanish hospitals during 2008. Patients completed a semi-structured 52-question survey. Results: Survey was adequately completed by 379 of 385 patients (98%), of whom 57% had Crohn's disease and 43% ulcerative colitis. Mean patient age was 37.9 years (range, 16-76 years). Gastroenterologists were the most commonly used resource (98%), followed by the Internet (60%), and general practitioners (50%). More than 90% reported good to excellent satisfaction with gastroenterologists, nurses, and patients' associations. Only 56% considered their information needs to be covered. The Internet was mostly used by young patients and those with a high education level. In the future, 85% of the patients would like to receive information from the gastroenterologists, and 92% by face-to-face interviews. Patients mainly want additional information on treatment (medical and surgical), clinical manifestations, cancer, and mortality risks. They also think that they are poorly informed about their social and work rights, risks of cancer and death, and research trials. Conclusions: Patients with IBD use and prefer gastroenterologists as the main source of information, but only half of them consider their information needs to be covered. (C) 2014 Elsevier Espana, S.L.U. and AEEH y AEG. All rights reserved.

Aim: colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate. Material and method: this is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30) was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results. Results: indicators results are: quality of bowel preparation (87%), kappa 0.74 (95% CI: 0.48-0.99); cecal intubation rate (90%) 0.74 (95% CI: 0.49-0.99); adenoma detection and removal rate (96%), kappa: 0.78 (95% CI: 0.53-0.99); withdrawal time: 13.36 min (95% CI: 10.48-16.11). Kappa: 0.78 (95% CI: 0.49-0.99). Conclusions: quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice. Objetivo: la colonoscopia constituye la técnica exploratoria del colon más importante en la actualidad. Su uso, cada vez más frecuente conlleva la aparición de problemas en su aplicación. Es necesario medir la calidad en la realización de esta técnica, para ello es preciso definir indicadores válidos que permitan la realización de ciclos de evaluación de la calidad. En este estudio se presenta la aplicación de algunos de estos indicadores. Los indicadores propuestos en este estudio son: nivel de limpieza, intubación cecal, indicador de pólipos y tiempo de retirada. Pacientes y método: estudio prospectivo de 12 meses de las colonoscopias realizadas en un programa de cribado de cáncer colorrectal en el área de salud VI de la Región de Murcia. En este estudio se incluyen todos los pacientes con resultado positivo al test de sangre oculta en heces (SOH) desde febrero de 2006 a febrero de 2007 (n: 609). Se extrae una muestra de 30 pacientes para evaluar la fiabilidad de los indicadores y realizar un análisis preliminar de los resultados. Resultados: los resultados preliminares obtenidos de cumplimiento para cada indicador fueron los siguientes: indicador de nivel de limpieza (87%). Índice de kappa 0,74 (IC del 95%: 0,48-0,99); intubación cecal (90%) 0,74 (IC del 95%: 0,49-0,99); indicador de pólipos (96%), índice de kappa de 0,78 (IC del 95%: 0,53-0,99); tiempo de retirada: 13,36 min (IC del 95%: 10,48-16,11). Índice kappa de 0,78 (IC del 95%: 0,49-0,99). Conclusiones: la definición y aplicación de indicadores de calidad en la práctica de la colonoscopia es posible. Se precisan más estudios para definir el papel de estos indicadores en la práctica asistencial.

Aim: to evaluate the utility of double-balloon enteroscopy for small-bowel disease. Design: a prospective study of 50 consecutive enteroscopies performed from December 2004 to July 2005 to analyze diagnoses and treatments. Patients: 44 patients (33 had undergone a previous capsule endoscopy) with indications for obscure digestive hemorrhage, angiodysplasia, Peutz-Jeghers syndrome, ulcer, suspected Crohn's disease, tumors, and refractory celiac disease. Results: we carried out enteroscopy studies in 44 patients by the oral route and, in 6 additional patients, by both the oral and anal routes. We reached the ileon with the oral route in all cases but one (jejunal stenosis), and in 4 cases out of 7 with the anal route, with an average duration of 73 minutes. We found angiodysplasia in 19 cases, as well as NSAID-related enteropathy, Crohn's disease, diverticulosis, and Waldenström's disease. We performed biopsies in 31% of cases with diagnoses of adenocarcinoma, lymphangiectasia secondary to tumor in celiac disease, and Whipple's disease. We treated 19 patients with angiodysplasia (1 to 20 synchronous lesions) with argon, and 4 patients with polyps using polipectomy (sporadic polyps or Peutz-Jeghers syndrome). A retained capsule in one patient with stenosis was removed. Conclusions: double-balloon enteroscopy is a useful and effective technique in the diagnosis and treatment of small intestine diseases, thus complementing capsule endoscopy. More studies are needed to analyze its impact on the management of this condition. Objetivo: valorar la utilidad de la enteroscopia de doble balón en enfermedades de intestino delgado. Diseño: estudio prospectivo descriptivo de 50 enteroscopias consecutivas (diciembre 2004 a julio 2005), analizando diagnóstico y terapéutica. Pacientes: cuarenta y cuatro pacientes (33 con cápsula endoscópica previa) con hemorragia digestiva oculta o lesiones detectadas mediante cápsula (angiodisplasias, pólipos, úlceras, enfermedad de Crohn, celiaca refractaria y tumores). Resultados: se realizó enteroscopia vía oral a 44 pacientes y vía oral más anal a 6. Por vía oral se progresó hasta íleon en todos los casos excepto uno (estenosis yeyunal), por vía anal en 4 de 7 (3 casos con dificultad de paso por Bahuin). La duración media fue 73 minutos. Se detectaron angiodisplasias (19 casos), úlceras en enteropatía por AINE, enfermedad de Crohn, enfermedad de Waldenström, y divertículos. Se realizaron biopsias en yeyuno-íleon en un tercio de los casos (adenocarcinoma, linfangiectasias secundarias a tumor sobre celíaca, enfermedad de Whipple). Se realizó terapéutica con argón a 19 pacientes con angiodisplasias (1 a 20 lesiones), polipectomía a 4 pacientes con pólipos esporádicos o Peutz Jeghers (1 a 15 pólipos) y se extrajo una cápsula endoscópica retenida en una estenosis. Conclusiones: la enteroscopia de doble balón es una técnica útil y eficaz en el diagnóstico y tratamiento de las lesiones del intestino delgado, complementando a la cápsula endoscópica. Hacen falta más estudios para analizar el impacto esperado en el cambio del manejo de estos pacientes.

[EN] A new interactive tool for supporting practical learning in the educational field of refrigeration is presented in this paper. The application, called REFLAB, is used for on-line representation of the main operating variations in real refrigeration plants, such as cooling capacity, power consumption and coefficient of performance. The implementation of this interactive tool covers two groups of practical lessons, in which students operate with two refrigeration plants (a single-stage and a two-stage) and obtain, by means of its graphical interface, the effects produced by changes in the operating conditions. The use of REFLAB allows a quick comprehension of the theoretical concepts explained in class and an intuitive assimilation of the behaviour of the refrigeration plants. The aim of this paper is to explain how the interactive tool works and which are the main objectives pursued in the practical lessons. The paper includes a series of graphical animations that simulate the practice lessons received by the students., This project was sponsored by the U.S.E. of the Universitat Jaume I under the 'Projectes de Millora Educativa 05G073-310' programme.