Search results for: Jose R. Garcia
342 Impact of Reverse Technology Transfer on Innovation Capabilities: An Econometric Analysis for Mexican Transnational Corporations
Authors: Lissette Alejandra Lara, Mario Gomez, Jose Carlos Rodriguez
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ransnational corporations (TNCs) as units in which it is possible technology and knowledge transfer across borders and the potential for generating innovation and contributing in economic development both in home and host countries have been widely acknowledged in the foreign direct investment (FDI) literature. Particularly, the accelerated expansion of emerging countries TNCs in the last decades has guided an uprising research stream that measure the presence of reverse technology transfer, defined as the extent to which emerging countries’ TNCs use outward FDI in a host country through certain mechanisms to absorb and transfer knowledge thus improving its technological capabilities in the home country. The objective of this paper is to test empirically the presence of reverse technology transfer and its impact on the innovation capabilities in Mexican transnational corporations (MXTNCs) as a part of the emerging countries TNCs that have successfully entered to industrialized markets. Using a panel dataset of 22 MXTNCs over the period 1994-2015, the results of the econometric model demonstrate that the amount of Mexican outward FDI and the research and development (R&D) expenditure in host developed countries had a positive impact on the innovation capabilities at the firm and industry level. There is also evidence that management of acquired brands and the organizational structure of Mexican subsidiaries improved these capabilities. Implications for internationalization strategies of emerging countries corporations and future research guidelines are discussed.Keywords: emerging countries, foreign direct investment, innovation capabilities, Mexican transnational corporations, reverse technology transfer
Procedia PDF Downloads 227341 Comparison of the Curvizigzag Incision with Transverse Stewart Incision in Women Undergoing Modified Radical Mastectomy for Carcinoma Breast
Authors: John Joseph S. Martis, Rohanchandra R. Gatty, Aaron Jose Fernandes, Rahul P. Nambiar
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Introduction: Surgery for breast cancer is either mastectomy or breast conservation surgery. The most commonly used incision for modified radical mastectomy is the transverse Stewart incision. But this incision may have the disadvantage of causing disparity between the closure lines of superior and inferior skin flaps in mastectomy and can cause overhanging of soft tissue below and behind the axilla. The curvizigzag incision, on principle, may help in this regard and can prevent scar migration beyond the anterior axillary line. This study aims to compare the two incisions in this regard. Methods: 100 patients with cancer of breast were included in the study after satisfying inclusion and exclusion criteria. They underwent surgery at Father Muller Medical College, Mangalore, India, between November 2019 to September 2021. The patients were divided into two groups. Group A patients were subjected to modified radical mastectomy with curvizigzag incision and group B patients with transverse Stewart incision. Results: Seroma on postoperative day1, day 2 was 0% in both the groups. Seroma on postoperative day 30 was present in 14% of patients in group B. 60% of patients in group B had sag of soft tissue below and behind the axilla, and none of the patients in group A had this problem. In 64% of the patients in group B, the incision crossed the anterior axillary fold, 64% of the patients in group B had tension in the incision site while approximation of the skin flaps. Conclusion: Curvizigzag incision is statistically better with lesser complications when compared to the transverse Stewart incision for modified radical mastectomy for carcinoma breast.Keywords: breast cancer, curvizigzag incision, transverse Stewart incision, seroma, modified radical mastectomy
Procedia PDF Downloads 95340 Case Study of the Roma Tomato Distribution Chain: A Dynamic Interface for an Agricultural Enterprise in Mexico
Authors: Ernesto A. Lagarda-Leyva, Manuel A. Valenzuela L., José G. Oshima C., Arnulfo A. Naranjo-Flores
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From August to December of 2016, a diagnostic and strategic planning study was carried out on the supply chain of the company Agropecuaria GABO S.A. de C.V. The final product of the study was the development of the strategic plan and a project portfolio to meet the demands of the three links in the supply chain of the Roma tomato exported annually to the United States of America. In this project, the strategic objective of ensuring the proper handling of the product was selected and one of the goals associated with this was the employment of quantitative methods to support decision making. Considering the antecedents, the objective of this case study was to develop a model to analyze the behavioral dynamics in the distribution chain, from the logistics of storage and shipment of Roma tomato in 81-case pallets (11.5 kg per case), to the two pre-cooling rooms and eventual loading onto transports, seeking to reduce the bottleneck and the associated costs by means of a dynamic interface. The methodology used was that of system dynamics, considering four phases that were adapted to the purpose of the study: 1) the conceptualization phase; 2) the formulation phase; 3) the evaluation phase; and 4) the communication phase. The main practical conclusions lead to the possibility of reducing both the bottlenecks in the cooling rooms and the costs by simulating scenarios and modifying certain policies. Furthermore, the creation of the dynamic interface between the model and the stakeholders was achieved by generating interaction with buttons and simple instructions that allow making modifications and observing diverse behaviors.Keywords: agrilogistics, distribution, scenarios, system dynamics
Procedia PDF Downloads 230339 Universal Design for Learning: Its Impact for Enhanced Performance in General Psychology
Authors: Jose Gay D. Gallego
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This study examined the learning performance in General Psychology of 297 freshmen of the CPSU-Main through the Pre and Post Tests. The instructional intervention via Universal Design for Learning (UDL) was applied to 33% (97 out of 297) of these freshmen as the Treatment Group while the 67% (200) belonged to the Control Group for traditional instructions. Statistical inferences utilized one-way Analysis of Variance for mean differences; Pearson R Correlations for bivariate relationships, and; Factor Analysis for significant components that contributed most to the Universal Design for Learning instructions. Findings showed very high levels of students’ acquired UDL skills. Results in the pre test in General Psychology, respectively, were low and average when grouped into low and high achievers. There was no significant mean difference in the acquired nine UDL components when categorized into seven colleges to generalize that between colleges they were on the same very high levels. Significant differences were found in three test areas in General Psychology in eight colleges whose students in College of teacher education taking the lead in the learning performance. Significant differences were also traced in the post test in favor of the students in the treatment group. This proved that UDL really impacted the learning performance of the low achieving students. Significant correlations were revealed between the components of UDL and General Psychology. There were twenty four significant itemized components that contributed most to UDL instructional interventions. Implications were emphasized to maximizing the principles of UDL with the contention of thoughtful planning related to the four curricular pillars of UDL: (a) instructional goals, (b) instructional delivery methods, (c) instructional materials, and (d) student assessments.Keywords: universal design for learning, enhanced performance, teaching innovation, technology in education, social science area
Procedia PDF Downloads 277338 Assessment of Airtightness Through a Standardized Procedure in a Nearly-Zero Energy Demand House
Authors: Mar Cañada Soriano, Rafael Royo-Pastor, Carolina Aparicio-Fernández, Jose-Luis Vivancos
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The lack of insulation, along with the existence of air leakages, constitute a meaningful impact on the energy performance of buildings. Both of them lead to increases in the energy demand through additional heating and/or cooling loads. Additionally, they cause thermal discomfort. In order to quantify these uncontrolled air currents, pressurization and depressurization tests can be performed. Among them, the Blower Door test is a standardized procedure to determine the airtightness of a space which characterizes the rate of air leakages through the envelope surface, calculating to this purpose an air flow rate indicator. In this sense, the low-energy buildings complying with the Passive House design criteria are required to achieve high levels of airtightness. Due to the invisible nature of air leakages, additional tools are often considered to identify where the infiltrations take place. Among them, the infrared thermography entails a valuable technique to this purpose since it enables their detection. The aim of this study is to assess the airtightness of a typical Mediterranean dwelling house located in the Valencian orchad (Spain) restored under the Passive House standard using to this purpose the blower-door test. Moreover, the building energy performance modelling tools TRNSYS (TRaNsient System Simulation program) and TRNFlow (TRaNsient Flow) have been used to determine its energy performance, and the infiltrations’ identification was carried out by means of infrared thermography. The low levels of infiltrations obtained suggest that this house may comply with the Passive House standard.Keywords: airtightness, blower door, trnflow, infrared thermography
Procedia PDF Downloads 123337 Sustainable Tourism a Challenge to Competitivity: OBSERVE Project
Authors: Rui Lança, Elisa Silva, Fátima Farinha, Miguel José Oliveira, Manuel Duarte Pinheiro, Cátia Miguel
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Tourism has a great potential to bring up progress across the Sustainable Development Goals (SDGs). If well managed and monitored, the tourism sector can create quality jobs, reduce poorness and offer incentives for environmental preservation, helping on the transition towards more inclusive and resilient economies. However, without proper safeguards and investments, expansion of the tourism market will increase pressure on biodiversity and the ecosystems on which the livelihoods of local communities depend. Competitivity is a key dimension in tourism, sustainable tourism challenge new dimensions to competitivity, namely environmental, social, institutional and economic achieve a medium and long-term competitivity. It is undoubtedly clear on the tourism sector, the importance of the region sustainability in the current touristic destinations offer. The basis of a tourism region prosperity will depend on /of it. The OBSERVE project intends to be an instrument for monitoring and evaluating the sustainability levels of the Algarve region. Its main objective is to provide environmental, economic, social-cultural and institutional indicators to support the decision-making process for a sustainable growth of the region. The project´s main goal is a digital portal with the most relevant indicators to allow evaluating and communicating the performance of the region in a sustainable growth perspective. This paper presents the OBSERVE project and highlights the potential contribution to a broad perspective of competitivity and its contribution for different stakeholders and the touristic value chain. Limitations and opportunities are also discussed.Keywords: sustainable tourism, competitivity, OBSERVE project, Algarve region
Procedia PDF Downloads 148336 Use of Alternative and Complementary Therapies in Patients with Chronic Pain in a Medical Institution in Medellin, Colombia, 2014
Authors: Lina María Martínez Sánchez, Juliana Molina Valencia, Esteban Vallejo Agudelo, Daniel Gallego González, María Isabel Pérez Palacio, Juan Ricardo Gaviria García, María De Los Ángeles Rodríguez Gázquez, Gloria Inés Martínez Domínguez
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Alternative and complementary therapies constitute a vast and complex combination of interventions, philosophies, approaches, and therapies that acquire a holistic healthcare point of view, becoming an alternative for the treatment of patients with chronic pain. Objective: determine the characteristics of the use of alternative and complementary therapies in patients with chronic pain who consulted in a medical institution. Methodology: cross-sectional and descriptive study, with a population of patients that assisted to the outpatient consultation and met the eligibility criteria. Sampling was not conducted. A form was used for the collection of demographic and clinical variables and the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) was validated. The analysis and processing of information was carried out using the SPSS program vr.19. Results: 220 people with chronic pain were included. The average age was 54.7±16.2 years, 78.2% were women, and 75.5% belonged to the socioeconomic strata 1 to 3. Musculoskeletal pain (77.7%), migraine (15%) and neuralgia (9.1%) were the most frequently types of chronic pain. 33.6% of participants have used some kind of alternative and complementary therapy; the most frequent were: homeopathy (14.5%), phytotherapy (12.7%), and acupuncture (11.4%). The total average HCAMQ score for the study group was 30.2±7.0 points, which shows a moderate attitude toward the use of complementary and alternative medicine. The highest scores according to the type of pain were: neuralgia (32.4±5.8), musculoskeletal pain (30.5±6.7), fibromyalgia (29.6±7.3) and migraine (28.5±8.8). The reliability of the HCAMQ was acceptable (Cronbach's α: 0.6). Conclusion: it was noted that the types of chronic pain and the clinical or therapeutic management of patients correspond to the data available in current literature. Despite the moderate attitude toward the use of these alternative and complementary therapies, one of every three patients uses them.Keywords: chronic pain, complementary therapies, homeopathy, acupuncture analgesia
Procedia PDF Downloads 515335 A Stochastic Diffusion Process Based on the Two-Parameters Weibull Density Function
Authors: Meriem Bahij, Ahmed Nafidi, Boujemâa Achchab, Sílvio M. A. Gama, José A. O. Matos
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Stochastic modeling concerns the use of probability to model real-world situations in which uncertainty is present. Therefore, the purpose of stochastic modeling is to estimate the probability of outcomes within a forecast, i.e. to be able to predict what conditions or decisions might happen under different situations. In the present study, we present a model of a stochastic diffusion process based on the bi-Weibull distribution function (its trend is proportional to the bi-Weibull probability density function). In general, the Weibull distribution has the ability to assume the characteristics of many different types of distributions. This has made it very popular among engineers and quality practitioners, who have considered it the most commonly used distribution for studying problems such as modeling reliability data, accelerated life testing, and maintainability modeling and analysis. In this work, we start by obtaining the probabilistic characteristics of this model, as the explicit expression of the process, its trends, and its distribution by transforming the diffusion process in a Wiener process as shown in the Ricciaardi theorem. Then, we develop the statistical inference of this model using the maximum likelihood methodology. Finally, we analyse with simulated data the computational problems associated with the parameters, an issue of great importance in its application to real data with the use of the convergence analysis methods. Overall, the use of a stochastic model reflects only a pragmatic decision on the part of the modeler. According to the data that is available and the universe of models known to the modeler, this model represents the best currently available description of the phenomenon under consideration.Keywords: diffusion process, discrete sampling, likelihood estimation method, simulation, stochastic diffusion process, trends functions, bi-parameters weibull density function
Procedia PDF Downloads 307334 Comparative Study of Stability of Crude and Purified Red Pigments of Pokeberry (Phytolacca Americana L.) Fruits
Authors: Nani Mchedlishvili, Nino Omiadze, Marine Abutidze, Jose Neptuno Rodriguez-Lopez, Tinatin Sadunishvili, Nikoloz Pruidze, Giorgi Kvesitadze
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Recently, there is an increased interest in the development of food natural colorants as alternatives to synthetic dyes because of both legislative action and consumer concern. Betalains are widely used in the food industry as an alternative of synthetic colorants. The interest of betalains are caused not only by their coloring effect but also by their beneficial properties. The aim of the work was to study of stability of crude and purified red pigments of pokeberry (Phytolacca america L.). The pokeberry fruit juice was filtrated and concentrated by rotary vacuum evaporator up to 25% and the concentrated juice was passed through the Sepadex-25(fine) column (20×1.1 cm). From the column the pigment elution rate was 18 ml/hr. 1.5ml fractions of pigment were collected. In the fractions the coloring substances were determined using CuS04 x 7 H2O as a standard. From the Sephadex G-25 column only one fraction of the betalain red pigment was eluted with the absorption maximum at 538 nm. The degree of pigment purification was 1.6 and pigment yield from the column was 15 %. It was shown that thermostability of pokeberry fruit red pigment was significantly decreased after the purification. For example, during incubation at 100C for 10 min crude pigment retained 98 % of its color while under the same conditions only 72% of the color of purified pigment was retained. The purified pigment was found to be characterized by less storage stability too. The storage of the initial crude juice and the pigment fraction obtained after the gelfiltration for 10 days at 4°C showed the lost of color by 29 and 74 % respectively. From the results obtained, it can be concluded that during the gelfiltration the pokeberry fruit red pigment gets separated from such substances that cause its stabilization in the crude juice.Keywords: betalains, gelfiltration, pokeberry fruit, stability
Procedia PDF Downloads 288333 Optimization of the Co-Precipitation of Industrial Waste Metals in a Continuous Reactor System
Authors: Thomas S. Abia II, Citlali Garcia-Saucedo
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A continuous copper precipitation treatment (CCPT) system was conceived at Intel Chandler Site to serve as a first-of-kind (FOK) facility-scale waste copper (Cu), nickel (Ni), and manganese (Mn) co-precipitation facility. The process was designed to treat highly variable wastewater discharged from a substrate packaging research factory. The paper discusses metals co-precipitation induced by internal changes for manufacturing facilities that lack the capacity for hardware expansion due to real estate restrictions, aggressive schedules, or budgetary constraints. Herein, operating parameters such as pH and oxidation reduction potential (ORP) were examined to analyze the ability of the CCPT System to immobilize various waste metals. Additionally, influential factors such as influent concentrations and retention times were investigated to quantify the environmental variability against system performance. A total of 2,027 samples were analyzed and statistically evaluated to measure the performance of CCPT that was internally retrofitted for Mn abatement to meet environmental regulations. In order to enhance the consistency of the influent, a separate holding tank was cannibalized from another system to collect and slow-feed the segregated Mn wastewater from the factory into CCPT. As a result, the baseline influent Mn decreased from 17.2+18.7 mg1L-1 at pre-pilot to 5.15+8.11 mg1L-1 post-pilot (70.1% reduction). Likewise, the pre-trial and post-trial average influent Cu values to CCPT were 52.0+54.6 mg1L-1 and 33.9+12.7 mg1L-1, respectively (34.8% reduction). However, the raw Ni content of 0.97+0.39 mg1L-1 at pre-pilot increased to 1.06+0.17 mg1L-1 at post-pilot. The average Mn output declined from 10.9+11.7 mg1L-1 at pre-pilot to 0.44+1.33 mg1L-1 at post-pilot (96.0% reduction) as a result of the pH and ORP operating setpoint changes. In similar fashion, the output Cu quality improved from 1.60+5.38 mg1L-1 to 0.55+1.02 mg1L-1 (65.6% reduction) while the Ni output sustained a 50% enhancement during the pilot study (0.22+0.19 mg1L-1 reduced to 0.11+0.06 mg1L-1). pH and ORP were shown to be significantly instrumental to the precipitative versatility of the CCPT System.Keywords: copper, co-precipitation, industrial wastewater treatment, manganese, optimization, pilot study
Procedia PDF Downloads 269332 A Tale of Seven Districts: Reviewing The Past, Present and Future of Patent Litigation Filings to Form a Two-Step Burden-Shifting Framework for 28 U.S.C. § 1404(a)
Authors: Timothy T. Hsieh
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Current patent venue transfer laws under 28 U.S.C. § 1404(a) e.g., the Gilbert factors from Gulf Oil Corp. v. Gilbert, 330 U.S. 501 (1947) are too malleable in that they often lead to frequent mandamus orders from the U.S. Court of Appeals for the Federal Circuit (“Federal Circuit”) overturning district court rulings on venue transfer motions. Thus, this paper proposes a more robust two-step burden-shifting framework that replaces the eight Gilbert factors. Moreover, a brief history of venue transfer patterns in the seven most active federal patent district courts is covered, with special focus devoted to the venue transfer orders from Judge Alan D Albright of the U.S. District Court for the Western District of Texas. A comprehensive data summary of 45 case sets where the Federal Circuit ruled on writs of mandamus involving Judge Albright’s transfer orders is subsequently provided, with coverage summaries of certain cases including four precedential ones from the Federal Circuit. This proposed two-step burden shifting framework is then applied to these venue transfer cases, as well as Federal Circuit mandamus orders ruling on those decisions. Finally, alternative approaches to remedying the frequent reversals for venue transfer will be discussed, including potential legislative solutions, adjustments to common law framework approaches to venue transfer, deference to the inherent powers of Article III U.S. District Judge, and a unified federal patent district court. Overall, this paper seeks to offer a more robust and consistent three-step burden-shifting framework for venue transfer and for the Federal Circuit to follow in administering mandamus orders, which might change somewhat in light of Western District of Texas Chief Judge Orlando Garcia’s order on redistributing Judge Albright’s patent cases.Keywords: Patent law, venue, judge Alan Albright, minimum contacts, western district of Texas
Procedia PDF Downloads 109331 Synthesis of Highly Efficient Bio-Octane Number Booster Using Nano Au-NiAlZr-Layered Double Hydroxides Catalyst
Authors: Bachir Redouane, Dib Nihel, Bedrane Sumeya, Blanco Ginesa, Calvino José Juan
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Furfural, a key biomass-derived platform compound, holds significant potential for biofuel production and the synthesis of high-value intermediates. This study investigates the hydrogenation-condensation reaction of furfural issued from lignocellulosique biomass with isopropyl alcohol to produce isopropylfurfuryl ether (iPFE), a next-generation synfuel with a high-octane number. iPFE’s water stability and resistance to methanol absorption make it a sustainable alternative to conventional gasoline additives, offering comparable performance. The catalyst used in this reaction is based on NiAl layered double hydroxides (LDH), with zirconium incorporated to enhance the distribution and structure of active sites. Gold (Au) was deposited on the NiAlZr-LDH support to improve selectivity and yield. The addition of Zr improved the thermal and mechanical stability of the catalyst, while the Au modification further increased selectivity toward iPFE. Extensive catalytic experiments were conducted to optimize reaction conditions, including temperature, hydrogen pressure, and Au loading, to maximize iPFE yield. The results demonstrate a high conversion rate of furfural, exceeding 90% under optimal conditions, with enhanced selectivity toward iPFE. Moreover, iPFE was shown to have a higher-octane number compared to traditional furfuryl ethers, making it a highly promising candidate for advanced fuel applications.Keywords: Au-NiAlZr-LDH, biofuels, furfural, green chemistry, hydrogenation, isopropylfurfuryl ether, octane number.
Procedia PDF Downloads 10330 Networks in the Tourism Sector in Brazil: Proposal of a Management Model Applied to Tourism Clusters
Authors: Gysele Lima Ricci, Jose Miguel Rodriguez Anton
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Companies in the tourism sector need to achieve competitive advantages for their survival in the market. In this way, the models based on association, cooperation, complementarity, distribution, exchange and mutual assistance arise as a possibility of organizational development, taking as reference the concept of networks. Many companies seek to partner in local networks as clusters to act together and associate. The main objective of the present research is to identify the specificities of management and the practices of cooperation in the tourist destination of São Paulo - Brazil, and to propose a new management model with possible cluster of tourism. The empirical analysis was carried out in three phases. As a first phase, a research was made by the companies, associations and tourism organizations existing in São Paulo, analyzing the characteristics of their business. In the second phase, the management specificities and cooperation practice used in the tourist destination. And in the third phase, identifying the possible strengths and weaknesses that potential or potential tourist cluster could have, proposing the development of the management model of the same adapted to the needs of the companies, associations and organizations. As a main result, it has been identified that companies, associations and organizations could be looking for synergies with each other and collaborate through a Hiperred organizational structure, in which they share their knowledge, try to make the most of the collaboration and to benefit from three concepts: flexibility, learning and collaboration. Finally, it is concluded that, the proposed tourism cluster management model is viable for the development of tourism destinations because it makes it possible to strategically address agents which are responsible for public policies, as well as public and private companies and organizations in their strategies competitiveness and cooperation.Keywords: cluster, management model, networks, tourism sector
Procedia PDF Downloads 284329 Patients' Out-Of-Pocket Expenses-Effectiveness Analysis of Presurgical Teledermatology
Authors: Felipa De Mello-Sampayo
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Background: The aim of this study is to undertake, from a patient perspective, an economic analysis of presurgical teledermatology, comparing it with a conventional referral system. Store-and-forward teledermatology allows surgical planning, saving both time and number of visits involving travel, thereby reducing patients’ out-of-pocket expenses, i.e., costs that patients incur when traveling to and from health providers for treatment, visits’ fees, and the opportunity cost of time spent in visits. Method: Patients’ out-of-pocket expenses-effectiveness of presurgical teledermatology were analyzed in the setting of a public hospital during two years. The mean delay in surgery was used to measure effectiveness. The teledermatology network covering the area served by the Hospital Garcia da Horta (HGO), Portugal, linked the primary care centers of 24 health districts with the hospital’s dermatology department. The patients’ opportunity cost of visits, travel costs, and visits’ fee of each presurgical modality (teledermatology and conventional referral), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated from initial primary care visit until surgical intervention. Two groups of patients: those with squamous cell carcinoma and those with basal cell carcinoma were distinguished in order to compare the effectiveness according to the dermatoses. Results: From a patient perspective, the conventional system was 2.15 times more expensive than presurgical teledermatology. Teledermatology had an incremental out-of-pocket expenses-effectiveness ratio of €1.22 per patient and per day of delay avoided. This saving was greater in patients with squamous cell carcinoma than in patients with basal cell carcinoma. Conclusion: From a patient economic perspective, teledermatology used for presurgical planning and preparation is the dominant strategy in terms of out-of-pocket expenses-effectiveness than the conventional referral system, especially for patients with severe dermatoses.Keywords: economic analysis, out-of-pocket expenses, opportunity cost, teledermatology, waiting time
Procedia PDF Downloads 140328 Prevalence of Human Papillomavirus in Squamous Intraepithelial Lesions and Cervical Cancer in Women of the North of Chihuahua, Mexico
Authors: Estefania Ponce-Amaya, Ana Lidia Arellano-Ortiz, Cecilia Diaz-Hernandez, Jose Alberto Lopez-Diaz, Antonio De La Mora-Covarrubias, Claudia Lucia Vargas-Requena, Mauricio Salcedo-Vargas, Florinda Jimenez-Vega
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Cervical Cancer (CC) is the second leading cause of death among women worldwide and it had been associated with a persistent infection of human papillomavirus (HPV). The goal of the current study was to identify the prevalence of HPV infection in women with abnormal Pap smear who were attended at Dysplasia Clinic of Ciudad Juarez, Mexico. Methods: Cervical samples from 146 patients, who attended the Colposcopy Clinic at Sanitary Jurisdiction II of Cd Juarez, were collected for histopathology and molecular study. DNA was isolated for the HPV detection by Polymerase Chain Reaction (PCR) using MY09/011 and GP5/6 primers. The associated risk factors were assessed by a questionnaire. The statistical analysis was performed by ANOVA, using EpiINFO V7 software. Results: HPV infection was present in 142 patients (97.3 %). The prevalence of HPV infection was distributed in a 96% of all evaluated groups, low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HISIL) and CC. We found a statistical significance (α = <0.05) between gestation and number of births as risk factors. The median values showed an ascending tend according with the lesion progression. However, CC showed a statistically significant difference with respect to the pre-carcinogenic stages. Conclusions: In these Mexican patients exists a high prevalence of HPV infection, and for that reason, we are studying the most prevalent HPV genotypes in this population.Keywords: cervical cancer, HPV, prevalence hpv, squamous intraepithelial lesion
Procedia PDF Downloads 320327 Effect of Food Supplies Holstein Calves Supplemented with Bacillus Subtilis PB6 in Morbidity and Mortality
Authors: Banca Patricia Pena Revuelta, Ramiro Gonzalez Avalos, Juan Leonardo Rocha Valdez, Jose Gonzalez Avalos, Karla Rodriguez Hernandez
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Probiotics are a promising alternative to improve productivity and animals' health. In addition, they can be part of the composition of different types of products, including foods (functional foods), medicines, and dietary supplements. The objective of the present work was to evaluate the effect of the feeding of Holstein calves supplemented with bacillus subtilis PB6 in morbidity and mortality. 60 newborn animals were used, randomly included in 1 of 3 treatments. The treatments were as follows: T1 = control, T2 = 10 g / calf / day. The first takes within 20 min after birth, T3 = 10 g / calf/day. The first takes between 12 and 24 h after birth. In all the treatments, 432 L of pasteurized whole milk divided into two doses/day 07:00 and 15:00, respectively, were given for 60 days. The addition of bacillus subtilis PB6 was carried out in the milk tub at the time of feeding them. The first colostrum intake (2 L • intake) was given within 2 h after birth, after which they were given a second 6 h after the first one. The diseases registered to monitor the morbidity and mortality of the calves were: diarrhea and pneumonia. The registry was carried out from birth to 60 days of life. The parameter evaluated was food consumption. The variable statistical analysis was performed using analysis of variance, and comparison of means was performed using the Tukey test. The value of P < 0.05 was used to consider the statistical difference. The results of the present study in relation to the consumption of food show no statistical difference P < 0.05 between treatments (14,762, 11,698, and 12,403 kg of food average, respectively). Calves group to which they were not provided Bacillus subtilis PB6 obtained higher feed intake. The addition of Bacillus subtilis PB6 in feeding calves does not increase feed intake.Keywords: feeding, development, milk, probiotic
Procedia PDF Downloads 147326 Aeronautical Noise Management inside an Aerodrome: Analysis of Sound Exposure on Aviation Professional’s Health
Authors: Rafael Felipe Guatura da Silva, José Luis Gomes da Silva, Luiz Antonio, Ferreira Perrone de Brito
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Noise can cause serious damage to human health, such as hearing loss, stress, irritability, fatigue, and others. Aviation is a place where your entire process should be work out with the utmost attention and commitment of human resources, thus the need to study the effects of noise in this sector, as aeronautical noise levels are high. This study aimed to evaluate the impact of noise pollution on the performance of professionals regarding the fatigue generated by aeronautical noise and time to noise exposure. The methodology used consists of measurements of sound pressure levels at 42 points of the aerodrome. The selected points are located inside the hangars and outside the airfield hangars. All points chosen are close to the professionals' work areas, seeking to identify the sound pressure levels to which they submitted. The other part of the research used the principle on the application of a self-report questionnaire to a sample of 207 people working inside the aerodrome. The 207 professionals surveyed consist of aircraft mechanics, pilots, maintenance managers, and administrative professionals. The questionnaire was intended to evaluate the knowledge that professionals have about health risks caused by sound exposure as well as to identify diseases that professionals have, and that may be associated with exposure to high levels of sound pressure. Preliminary results identify points with sound pressure levels of up to 91.7 dB, thus highlighting the need for the use of personal protective equipment that reduces noise exposure. It was also identified a large number of professionals who are bothered by the sound exposure and approximately 25% of professionals interviewed reported having a hearing disorder.Keywords: aeronautical noise, fatigue, noise and health, noise management
Procedia PDF Downloads 146325 Design and Integration of a Renewable Energy Based Polygeneration System with Desalination for an Industrial Plant
Authors: Lucero Luciano, Cesar Celis, Jose Ramos
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Polygeneration improves energy efficiency and reduce both energy consumption and pollutant emissions compared to conventional generation technologies. A polygeneration system is a variation of a cogeneration one, in which more than two outputs, i.e., heat, power, cooling, water, energy or fuels, are accounted for. In particular, polygeneration systems integrating solar energy and water desalination represent promising technologies for energy production and water supply. They are therefore interesting options for coastal regions with a high solar potential, such as those located in southern Peru and northern Chile. Notice that most of the Peruvian and Chilean mining industry operations intensive in electricity and water consumption are located in these particular regions. Accordingly, this work focus on the design and integration of a polygeneration system producing industrial heating, cooling, electrical power and water for an industrial plant. The design procedure followed in this work involves integer linear programming modeling (MILP), operational planning and dynamic operating conditions. The technical and economic feasibility of integrating renewable energy technologies (photovoltaic and solar thermal, PV+CPS), thermal energy store, power and thermal exchange, absorption chillers, cogeneration heat engines and desalination technologies is particularly assessed. The polygeneration system integration carried out seek to minimize the system total annual cost subject to CO2 emissions restrictions. Particular economic aspects accounted for include investment, maintenance and operating costs.Keywords: desalination, design and integration, polygeneration systems, renewable energy
Procedia PDF Downloads 125324 Factors Associated with Overweight and Obesity among Recipients of Antiretroviral Therapy at HIV Clinics in Botswana
Authors: Jose G. Tshikuka, Goabaone Rankgoane-Pono, Mgaywa G. M. D. Magafu, Julius C. Mwita, Tiny Masupe, Fortunat M. Kandanda, Shimeles G. Hamda, Roy Tapera, Mooketsi Molefi, John T. Tlhakanelo
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Background: Factors associated with overweight and obesity among antiretroviral therapy (ART) recipients have not been sufficiently studied in Botswana. We aimed to study (i) the prevalence and trends in overweight/obesity by duration of exposure to ART among recipients, (ii) changes in body mass index (BMI) categories among recipients before ART initiation (BMI-1) and after ART initiation (BMI-2), (iii) associations between ART and overweight/obesity and (iv) factors associated with BMI changes among ART recipients. Methods: A 12 years retrospective record-based review was conducted. Factors potentially associated with BMI change among patients after at least three years of ART exposure were examined using multiple regression model. Adjusted odds ratios (AOR) and their 95% confidence intervals (CIs) were computed. ART regimens, duration of exposure to ART, and recipients’ demographic and biomedical characteristics including the presence or absence of diabetes mellitus related comorbidities (DRC) were investigated as potential factors associated with overweight/obesity. Results: Twenty-nine percent of recipients were overweight, 16.6% had obesity of whom 2.4% were morbidly-obese at the last clinic visit. Overweight/obesity recipients were more likely to be female, to have DRC and less likely to have nadir CD4 count or CD4 count between 201 – 249 cells/mm³. Neither the first-line nor the second-, third-line ART regimens predicted overweight/obesity more than the other and neither did the duration of exposure to ART. No significant linear trends were observed in the prevalence of overweight/obesity by the duration of exposure to ART. Conclusions: These results indicate that overweight/obesity seen among ART recipients is not directly induced by ART. ART used CD4 and/or DRC pathway to induce overweight/obesity seen among recipients; suggesting that, weight gain documented herein is likely a reflection of improved health status that mirrors trends in the general population or a DRC related effect. Weight management programs may be important components of HIV care.Keywords: overweight/obesity, recipients of antiretroviral therapy, HIV/AIDS, Botswana
Procedia PDF Downloads 159323 A Model of Applied Psychology Research Defining Community Participation and Collective Identity as a Major Asset for Strategic Planning and Political Decision: The Project SIA (Social Inclusion through Accessibility)
Authors: Rui Serôdio, Alexandra Serra, José Albino Lima, Luísa Catita, Paula Lopes
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We will present the outline of the Project SIA (Social Inclusion through Accessibility) focusing in one of its core components: how our applied research model contributes to define community participation as a pillar for strategic and political agenda amongst local authorities. Project ISA, supported by EU regional funding, was design as part of a broader model developed by SIMLab–Social Inclusion Monitoring Laboratory, in which the relation University-Community is a core element. The project illustrates how University of Porto developed a large scale project of applied psychology research in a close partnership with 18 municipalities that cover almost all regions of Portugal, and with a private architecture enterprise, specialized in inclusive accessibility and “design for all”. Three fundamental goals were defined: (1) creation of a model that would promote the effective civic participation of local citizens; (2) the “voice” of such participation should be both individual and collective; (3) the scientific and technical framework should serve as one of the bases for political decision on inclusive accessibility local planning. The two main studies were run in a standardized model across all municipalities and the samples of the three modalities of community participation were the following: individual participation based on 543 semi-structured interviews and 6373 inquiries; collective participation based on group session with 302 local citizens. We present some of the broader findings of Project SIA and discuss how they relate to our applied research model.Keywords: applied psychology, collective identity, community participation, inclusive accessibility
Procedia PDF Downloads 445322 Fuzzy Climate Control System for Hydroponic Green Forage Production
Authors: Germán Díaz Flórez, Carlos Alberto Olvera Olvera, Domingo José Gómez Meléndez, Francisco Eneldo López Monteagudo
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In recent decades, population growth has exerted great pressure on natural resources. Two of the most scarce and difficult to obtain resources, arable land, and water, are closely interrelated, to the satisfaction of the demand for food production. In Mexico, the agricultural sector uses more than 70% of water consumption. Therefore, maximize the efficiency of current production systems is inescapable. It is essential to utilize techniques and tools that will enable us to the significant savings of water, labor and fertilizer. In this study, we present a production module of hydroponic green forage (HGF), which is a viable alternative in the production of livestock feed in the semi-arid and arid zones. The equipment in addition to having a forage production module, has a climate and irrigation control system that operated with photovoltaics. The climate control, irrigation and power management is based on fuzzy control techniques. The fuzzy control provides an accurate method in the design of controllers for nonlinear dynamic physical phenomena such as temperature and humidity, besides other as lighting level, aeration and irrigation control using heuristic information. In this working, firstly refers to the production of the hydroponic green forage, suitable weather conditions and fertigation subsequently presents the design of the production module and the design of the controller. A simulation of the behavior of the production module and the end results of actual operation of the equipment are presented, demonstrating its easy design, flexibility, robustness and low cost that represents this equipment in the primary sector.Keywords: fuzzy, climate control system, hydroponic green forage, forage production module
Procedia PDF Downloads 397321 Heat-Induced Uncertainty of Industrial Computed Tomography Measuring a Stainless Steel Cylinder
Authors: Verena M. Moock, Darien E. Arce Chávez, Mariana M. Espejel González, Leopoldo Ruíz-Huerta, Crescencio García-Segundo
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Uncertainty analysis in industrial computed tomography is commonly related to metrological trace tools, which offer precision measurements of external part features. Unfortunately, there is no such reference tool for internal measurements to profit from the unique imaging potential of X-rays. Uncertainty approximations for computed tomography are still based on general aspects of the industrial machine and do not adapt to acquisition parameters or part characteristics. The present study investigates the impact of the acquisition time on the dimensional uncertainty measuring a stainless steel cylinder with a circular tomography scan. The authors develop the figure difference method for X-ray radiography to evaluate the volumetric differences introduced within the projected absorption maps of the metal workpiece. The dimensional uncertainty is dominantly influenced by photon energy dissipated as heat causing the thermal expansion of the metal, as monitored by an infrared camera within the industrial tomograph. With the proposed methodology, we are able to show evolving temperature differences throughout the tomography acquisition. This is an early study showing that the number of projections in computer tomography induces dimensional error due to energy absorption. The error magnitude would depend on the thermal properties of the sample and the acquisition parameters by placing apparent non-uniform unwanted volumetric expansion. We introduce infrared imaging for the experimental display of metrological uncertainty in a particular metal part of symmetric geometry. We assess that the current results are of fundamental value to reach the balance between the number of projections and uncertainty tolerance when performing analysis with X-ray dimensional exploration in precision measurements with industrial tomography.Keywords: computed tomography, digital metrology, infrared imaging, thermal expansion
Procedia PDF Downloads 121320 Quality of Life for Families with Children/Youth with Autism Spectrum Disorder
Authors: José Nogueira
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This research aims to analyze the impact of autism spectrum disorders (ASD) in families with children and youth (0-25 years) with ASD in Portugal. The impact will be evaluated on a multidimensional perspective, following the work on the concept of quality life from WHOQOL Group (UN). The study includes quantitative and qualitative methodology. It correlates statistical sources and other information with the data obtained through a survey of a sample of about 100 families with children/youth with ASD (October and November 2013). The results indicate a strong impact of autism on the quality of life for families in all study dimensions. The research shows a negative impact on quality of life for families in material and financial conditions, physical and emotional well-being, career progression, feelings of injustice, social participation and self-perception of happiness. The quality of life remained in the relationship with the family and the spouse, interpersonal relationships and beliefs about himself. The ASD improved the quality of life aspects such as interest, knowledge and exercise of rights on disability, autonomy to make decisions and be able to deal with stress. Other dimensions are contemplated: a detailed characterization of the child/young with ASD and all family members (household composition, relationship status, academic qualifications, occupation, income, and leisure) the impact of diagnosis in the family wellbeing, medical and therapeutic processes, school inclusion, public support, social participation, and the adequacy and implementation of legislation. The study evaluates also the strengths and weaknesses of the Portuguese public rehabilitation system and demonstrates how a good law-in-theory may not solve the problems of families in practice due to the allocation of insufficient public resources, both financial and human resources.Keywords: autism, families, quality of life, autism spectrum disorder
Procedia PDF Downloads 357319 Estimation of Energy Losses of Photovoltaic Systems in France Using Real Monitoring Data
Authors: Mohamed Amhal, Jose Sayritupac
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Photovoltaic (PV) systems have risen as one of the modern renewable energy sources that are used in wide ranges to produce electricity and deliver it to the electrical grid. In parallel, monitoring systems have been deployed as a key element to track the energy production and to forecast the total production for the next days. The reliability of the PV energy production has become a crucial point in the analysis of PV systems. A deeper understanding of each phenomenon that causes a gain or a loss of energy is needed to better design, operate and maintain the PV systems. This work analyzes the current losses distribution in PV systems starting from the available solar energy, going through the DC side and AC side, to the delivery point. Most of the phenomena linked to energy losses and gains are considered and modeled, based on real time monitoring data and datasheets of the PV system components. An analysis of the order of magnitude of each loss is compared to the current literature and commercial software. To date, the analysis of PV systems performance based on a breakdown structure of energy losses and gains is not covered enough in the literature, except in some software where the concept is very common. The cutting-edge of the current analysis is the implementation of software tools for energy losses estimation in PV systems based on several energy losses definitions and estimation technics. The developed tools have been validated and tested on some PV plants in France, which are operating for years. Among the major findings of the current study: First, PV plants in France show very low rates of soiling and aging. Second, the distribution of other losses is comparable to the literature. Third, all losses reported are correlated to operational and environmental conditions. For future work, an extended analysis on further PV plants in France and abroad will be performed.Keywords: energy gains, energy losses, losses distribution, monitoring, photovoltaic, photovoltaic systems
Procedia PDF Downloads 176318 Diaper Dermatitis and Pancytopenia as the Primary Manifestation in an Infant with Vitamin B12 Deficiency
Authors: Ekaterina Sánchez Romero, Emily Gabriela Aguirre Herrera, Sandra Luz Espinoza Esquerra, Jorge García Campos
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Female, 7 months old, daughter of a mother with anemia during pregnancy, with no history of atopy in the family, since birth she presents with recurrent dermatological and gastrointestinal infections, chronically treated for recurrent diaper dermatitis. At 6 months of age, she begins with generalized pallor, hyperpigmentation in hands and feet, smooth tongue, psychomotor retardation with lack of head support, sedation, and hypoactivity. She was referred to our hospital for a fever of 38°C, severe diaper rash, and pancytopenia with HB 9.3, platelets 38000, neutrophils 0.39 MCV: 86.80 high for her age. The approach was initiated to rule out myeloproliferative syndrome, with negative immunohistochemical results of bone marrow aspirate; during her stay, she presented neurological regression, lack of sucking, and focal seizures. CT scan showed cortical atrophy. The patient was diagnosed with primary immunodeficiency due to history; gamma globulin was administered without improvement with normal results of immunoglobulins and metabolic screening. When dermatological and neurological diagnoses were ruled out as the primary cause, a nutritional factor was evaluated, and a therapeutic trial was started with the administration of vitamin B12 and zinc, presenting clinical neurological improvement and resolution of pancytopenia in 2 months. It was decided to continue outpatient management. Discussion: We present a patient with neurological, dermatological involvement, and pancytopenia, so the most common differential diagnoses in this population were ruled out. Vitamin B12 deficiency is an uncommon entity. Due to maternal and clinical history, a therapeutic trial was started resulting in an improvement. Conclusion: VitaminB12 deficiency should be considered one of the differential diagnoses in the approach to pancytopenia with megaloblastic anemia associated with dermatologic and neurologic manifestations. Early treatment can reduce irreversible damage in these patients.Keywords: vitamin B12 deficiency, pediatrics, pancytopenia, diaper dermatitis
Procedia PDF Downloads 96317 Design of 3D Bioprinted Scaffolds for Cartilage Regeneration
Authors: Gloria Pinilla, Jose Manuel Baena, Patricia Gálvez-Martín, Juan Antonio Marchad
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Cartilage is a dense connective tissue with limited self-repair properties. Currently, the therapeutic use of autologous or allogenic chondrocytes makes up an alternative therapy to the pharmacological treatment. The design of a bioprinted 3D cartilage with chondrocytes and biodegradable biomaterials offers a new therapeutic alternative able of bridging the limitations of current therapies in the field. We have developed an enhanced printing processes-Injection Volume Filling (IVF) to increase the viability and survival of the cells when working with high-temperature thermoplastics without the limitation of the scaffold geometry in contact with cells. We have demonstrated the viability of the printing process using chondrocytes for cartilage regeneration. This development will accelerate the clinical uptake of the technology and overcomes the current limitation when using thermoplastics as scaffolds. An alginate-based hydrogel combined with human chondrocytes (isolated from osteoarthritis patients) was formulated as bioink-A and the polylactic acid as bioink-B. The bioprinting process was carried out with the REGEMAT V1 bioprinter (Regemat 3D, Granada-Spain) through a IVF. The printing capacity of the bioprinting plus the viability and cell proliferation of bioprinted chondrociytes was evaluated after five weeks by confocal microscopy and Alamar Blue Assay (Biorad). Results showed that the IVF process does not decrease the cell viability of the chondrocytes during the printing process as the cells do not have contact with the thermoplastic at elevated temperatures. The viability and cellular proliferation of the bioprinted artificial 3D cartilage increased after 5 weeks. In conclusion, this study demonstrates the potential use of Regemat V1 for 3D bioprinting of cartilage and the viability of bioprinted chondrocytes in the scaffolds for application in regenerative medicine.Keywords: cartilage regeneration, bioprinting, bioink, scaffold, chondrocyte
Procedia PDF Downloads 313316 Digital Demands: Addressing the Digital Divide in Basic Education and Its Relation to Academic Performance and Aspirations
Authors: Jose Rodrigo Zubiri, Sofia Carmen Tomacruz
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Amidst an increasingly digitalized society, information and communication technologies have been seamlessly integrated into the economic, social, and political life of individuals. Information has been regarded as a primary good, essential to the wellbeing and self-respect of individuals in society. The digital engagements of an individual play a key role in a variety of life outcomes ranging from academic performance to entrepreneurial success to health service uptake. As a result of varying degrees of access to the Internet and ICTs across populations and individuals, a digital divide emerges. Education, a sector pivotal to directing individual life trajectories, has been radically transformed with regards to the learning process and access to information and thus faces the implications of the digital divide, as new waves of inequalities are introduced in the classroom. As the period of basic education is critical to transitioning into civic life or higher education, digital inequalities are capable of aggravating pre-existing social inequalities. Through survey-questionnaires, conducted on 152 high school students from a Philippine public school, the study reveals the correlation of academic performance and aspirations (for their highest academic qualification) to access to digital technologies and the Internet, according to Van Dijk’s four measurements of digital poverty, namely: motivational access, material access, skills access, and usage access. The findings reveal a positive correlation for academic performance whereas no correlation was found between aspirations and digital access. In the study, significant correlational differences were also found between genders, specifically, in terms of skills access and academic performance.Keywords: digital divide, ICTs, inequality, education, life trajectories
Procedia PDF Downloads 269315 Comparative Ante-Mortem Studies through Electrochemical Impedance Spectroscopy, Differential Voltage Analysis and Incremental Capacity Analysis on Lithium Ion Batteries
Authors: Ana Maria Igual-Munoz, Juan Gilabert, Marta Garcia, Alfredo Quijano-Lopez
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Nowadays, several lithium-ion battery technologies are being commercialized. These chemistries present different properties that make them more suitable for different purposes. However, comparative studies showing the advantages and disadvantages of different chemistries are incomplete or scarce. Different non-destructive techniques are currently being employed to detect how ageing affects the active materials of lithium-ion batteries (LIBs). For instance, electrochemical impedance spectroscopy (EIS) is one of the most employed ones. This technique allows the user to identify the variations on the different resistances present in LIBs. On the other hand, differential voltage analysis (DVA) has shown to be a powerful technique to detect the processes affecting the different capacities present in LIBs. This technique shows variations in the state of health (SOH) and the capacities for one or both electrodes depending on their chemistry. Finally, incremental capacity analysis (ICA) is a widely known technique for being capable of detecting phase equilibria. It reminds of the commonly used cyclic voltamperometry, as it allows detecting some reactions taking place in the electrodes. In these studies, a set of ageing procedures have been applied to commercial batteries of different chemistries (NCA, NMC, and LFP). Afterwards, results of EIS, DVA, and ICA have been used to correlate them with the processes affecting each cell. Ciclability, overpotential, and temperature cycling studies envisage how the charge-discharge rates, cut-off voltage, and operation temperatures affect each chemistry. These studies will serve battery pack manufacturers, as for common battery users, as they will determine the different conditions affecting cells for each of the chemistry. Taking this into account, each cell could be adjusted to the final purpose of the battery application. Last but not least, all the degradation parameters observed are focused to be integrated into degradation models in the future. This fact will allow the implementation of the widely known digital twins to the degradation in LIBs.Keywords: lithium ion batteries, non-destructive analysis, different chemistries, ante-mortem studies, ICA, DVA, EIS
Procedia PDF Downloads 128314 Simulation of a Sustainable Irrigation System Development: The Case of Sitio Kantaling Village Farm Lands, Danao City, Cebu, Philippines
Authors: Amando A. Radomes Jr., LLoyd Jun Benjamin T. Embernatre, Cherssy Kaye F. Eviota, Krizia Allyn L. Nunez, Jose Thaddeus B. Roble III
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Sitio Kantaling is one of the 34 villages in Danao City, Cebu, in the central Philippines. As of 2015, the eight households in the mountainous village extending over 40 hectares of land area, including 12 hectares of arable land, are the source of over a fifth of the agricultural products that go into the city. Over the years, however, the local government had been concerned with the decline in agricultural productivity because increasing number of residents are migrating into the urban areas of the region to look for better employment opportunities. One of the major reasons for the agricultural productivity decline is underdeveloped irrigation infrastructure. The local government had partnered with the University of San Carlos to conduct research on developing an irrigation system that could sustainably meet both agricultural and household consumption needs. From a macro-perspective, a dynamic simulation model was developed to understand the long-term behavior of the status quo and proposed the system. Data on population, water supply and demand, household income, and urban migration were incorporated in the 20-year horizon model. The study also developed a smart irrigation system design. Instead of using electricity to pump water, a network of aqueducts with three main nodes had been designed and strategically located to take advantage of gravity to transport water from a spring. Simulation results showed that implementing a sustainable irrigation system would be able to significantly contribute to the socio-economic progress of the local community.Keywords: agriculture, aqueduct, simulation, sustainable irrigation system
Procedia PDF Downloads 172313 Total Plaque Area in Chronic Renal Failure
Authors: Hernán A. Perez, Luis J. Armando, Néstor H. García
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Background and aims Cardiovascular disease rates are very high in patients with renal failure (CRF), but the underlying mechanisms are incompletely understood. Traditional cardiovascular risk factors do not explain the increased risk, and observational studies have observed paradoxical or absent associations between classical risk factors and mortality in dialysis patients. A large randomized controlled trial, the 4D Study, the AURORA and the ALERT study found that statin therapy in CRF do not reduce cardiovascular events. These results may be the results of ‘accelerated atherosclerosis’ observed on these patients. The objective of this study was to investigate if carotid total plaque area (TPA), a measure of carotid plaque burden growth is increased at progressively lower creatinine clearance in patients with CRF. We studied a cohort of patients with CRF not on dialysis, reasoning that risk factor associations might be more easily discerned before end stage renal disease. Methods: The Blossom DMO Argentina ethics committee approved the study and informed consent from each participant was obtained. We performed a cohort study in 412 patients with Stage 1, 2 and 3 CRF. Clinical and laboratory data were obtained. TPA was determined using bilateral carotid ultrasonography. Modification of Diet in Renal Disease estimation formula was used to determine renal function. ANOVA was used when appropriate. Results: Stage 1 CRF group (n= 16, 43±2yo) had a blood pressure of 123±2/78±2 mmHg, BMI 30±1, LDL col 145±10 mg/dl, HbA1c 5.8±0.4% and had the lowest TPA 25.8±6.9 mm2. Stage 2 CRF (n=231, 50±1 yo) had a blood pressure of 132±1/81±1 mmHg, LDL col 125±2 mg/dl, HbA1c 6±0.1% and TPA 48±10mm2 ( p< 0.05 vs CRF stage 1) while Stage 3 CRF (n=165, 59±1 yo) had a blood pressure of 134±1/81±1, LDL col 125±3 mg/dl, HbA1c 6±0.1% and TPA 71±6mm2 (p < 0.05 vs CRF stage 1 and 2). Conclusion: Our data indicate that TPA increases along the renal function deterioration, and it is not related with the LDL cholesterol and triglycerides levels. We suggest that mechanisms other than the classics are responsible for the observed excess of cardiovascular disease in CKD patients and finally, determination of total plaque area should be used to measure effects of antiatherosclerotic therapy.Keywords: hypertension, chronic renal failure, atherosclerosis, cholesterol
Procedia PDF Downloads 271