Comparison of the interobserver variability of 2 different methods of dietary assessment in a geriatric ward: a pilot study.

BACKGROUND: Protein-energy malnutrition is highly prevalent in aged populations. Associated clinical, economic, and social burden is important. A valid screening method that would be robust and precise, but also easy, simple, and rapid to apply, is essential for adequate therapeutic management. OBJECTIVES: To compare the interobserver variability of 2 methods measuring food intake: semiquantitative visual estimations made by nurses versus calorie measurements performed by dieticians on the basis of standardized color digital photographs of servings before and after consumption. DESIGN: Observational monocentric pilot study. SETTING/PARTICIPANTS: A geriatric ward. The meals were randomly chosen from the meal tray. The choice was anonymous with respect to the patients who consumed them. MEASUREMENTS: The test method consisted of the estimation of calorie consumption by dieticians on the basis of standardized color digital photographs of servings before and after consumption. The reference method was based on direct visual estimations of the meals by nurses. Food intake was expressed in the form of a percentage of the serving consumed and calorie intake was then calculated by a dietician based on these percentages. The methods were applied with no previous training of the observers. Analysis of variance was performed to compare their interobserver variability. RESULTS: Of 15 meals consumed and initially examined, 6 were assessed with each method. Servings not consumed at all (0% consumption) or entirely consumed by the patient (100% consumption) were not included in the analysis so as to avoid systematic error. The digital photography method showed higher interobserver variability in calorie intake estimations. The difference between the compared methods was statistically significant (P < .03). CONCLUSIONS: Calorie intake measures for geriatric patients are more concordant when estimated in a semiquantitative way. Digital photography for food intake estimation without previous specific training of dieticians should not be considered as a reference method in geriatric settings, as it shows no advantages in terms of interobserver variability.

Measurement of total estrone content in foods. Application to dairy products.

Estrone is a powerful growth-inducing hormone that is present in milk, mainly in the form of fatty acid esters, at concentrations that promote growth in experimental animals. We present here a method useful for the measurement of this natural hormone in foods and applied it to several common dairy products. Samples were frozen, finely powdered, and lyophilized then extracted with trichloromethane/methanol; the dry extract was saponified with potassium hydroxide. The free estrone evolved was extracted with ethyl acetate and was used for the estimation of total estrone content through radioimmunoassay. Application of the method to dairy products showed high relative levels of total estrone (essentially acyl-estrone) in milk, in the range of 1 ¿M, which were halved in skimmed milk. Free estrone levels were much lower, in the nanomolar range. A large proportion of estrone esters was present in all other dairy products, fairly correlated with their fat content. The amount of estrone carried by milk is well within the range, where its intake may exert a physiological response in the sucklings for which it is provided. These growth-inducing and energy expenditure-lowering effects may affect humans ingesting significant amounts of dairy products.

Association between mannose-binding lectin deficiency and cytornegalovirus infection course after organ transplantation.

Background: Mannose binding lectin (MBL) is an innate humoral immune effector and MBL defi ciency has been suggested as a risk factor for the development of certain viral infections. However, there is no data about the possible association between MBL defi ciency and CMV, especially after organ transplantation. Methods: We measured MBL levels in 16 kidney transplant recipients with highrisk CMV serostatus (D+/R-) who received valganciclovir prophylaxis for 3 months (Study 1). In addition, MBL levels were retrospectively assayed in 55 recipients from a previous study of organ transplant recipients managed preemptively (Study 2). In Study 2, protracted CMV infection was associated with recipient CMV seronegativity, increasing age, and high viral load during the initial episode. In both studies, MBL defi ciency was diagnosed if MBL levels were <500 ng/ml. Results: In Study 1, after a follow-up of 12 months, 7 out of 16 patients developed CMV disease, 4 patients developed asymptomatic CMV infection, and 5 patients never developed any sign of CMV replication. Overall, 9/16 patients (56%) had MBL defi ciency: 5/7 (71%) of patients with CMV disease, 4/4 (100%) of patients with asymptomatic CMV infection, and 0/5 (0%) of patients without CMV infection (p=0.005, between CMV infection/disease versus no infection). Median MBL concentrations were higher in patients without CMV infection than in those with CMV infection (p<0.005). In Study 2, among 30 patients with CMV infection, 9/25 (36%) patients without MBL defi ciency had a protracted course, while 4/5 (80%) with MBL defi ciency did so (p=0.07). Conclusion: Data from two separate patient populations suggest that MBL defi ciency may be a signifi cant risk factor for late CMV disease/infection after prophylaxis, and protracted infection after preemptive treatment. This suggests a role for MBL in the control of CMV infection after organ transplantation.

Iowa's Renewable Energy and Infrastructure Impacts, TR-593, 2010

The federal government is aggressively promoting biofuels as an answer to global climate change and dependence on imported sources of energy. Iowa has quickly become a leader in the bioeconomy and wind energy production, but meeting the United States Department of Energy’s goal having 20% of U.S. transportation fuels come from biologically based sources by 2030 will require a dramatic increase in ethanol and biodiesel production and distribution. At the same time, much of Iowa’s rural transportation infrastructure is near or beyond its original design life. As Iowa’s rural roadway structures, pavements, and unpaved roadways become structurally deficient or functionally obsolete, public sector maintenance and rehabilitation costs rapidly increase. More importantly, costs to move all farm products will rapidly increase if infrastructure components are allowed to fail; longer hauls, slower turnaround times, and smaller loads result. When these results occur on a large scale, Iowa will start to lose its economic competitive edge in the rapidly developing bioeconomy. The primary objective of this study was to document the current physical and fiscal impacts of Iowa’s existing biofuels and wind power industries. A four-county cluster in north-central Iowa and a two-county cluster in southeast Iowa were identified through a local agency survey as having a large number of diverse facilities and were selected for the traffic and physical impact analysis. The research team investigated the large truck traffic patterns on Iowa’s secondary and local roads from 2002 to 2008 and associated those with the pavement condition and county maintenance expenditures. The impacts were quantified to the extent possible and visualized using geographic information system (GIS) tools. In addition, a traffic and fiscal assessment tool was developed to understand the impact of the development of the biofuels on Iowa’s secondary road system. Recommended changes in public policies relating to the local government and to the administration of those policies included standardizing the reporting and format of all county expenditures, conducting regular pavement evaluations on a county’s system, cooperating and communicating with cities (adjacent to a plant site), considering utilization of tax increment financing (TIF) districts as a short-term tool to produce revenues, and considering alternative ways to tax the industry.

Optimization of wind blade design including its energetic characteristics

The goal of the Master’s thesis is to develop and to analyze the optimization method for finding a geometry shape of classical horizontal wind turbine blades based on set of criteria. The thesis develops a technique that allows the designer to determine the weight of such factors as power coefficient, sound pressure level and the cost function in the overall process of blade shape optimization. The optimization technique applies the Desirability function. It was never used before in that kind of technical problems, and in this sense it can claim to originality of research. To do the analysis and the optimization processes more convenient the software application was developed.

Utilization of a Time Domain Simulator in the Technical and Economic Analysis of a Wind Turbine Electric Drive Train

The amount of installed wind power has been growing exponentially during the past ten years. As wind turbines have become a significant source of electrical energy, the interactions between the turbines and the electric power network need to be studied more thoroughly than before. Especially, the behavior of the turbines in fault situations is of prime importance; simply disconnecting all wind turbines from the network during a voltage drop is no longer acceptable, since this would contribute to a total network collapse. These requirements have been a contributor to the increased role of simulations in the study and design of the electric drive train of a wind turbine. When planning a wind power investment, the selection of the site and the turbine are crucial for the economic feasibility of the installation. Economic feasibility, on the other hand, is the factor that determines whether or not investment in wind power will continue, contributing to green electricity production and reduction of emissions. In the selection of the installation site and the turbine (siting and site matching), the properties of the electric drive train of the planned turbine have so far been generally not been taken into account. Additionally, although the loss minimization of some of the individual components of the drive train has been studied, the drive train as a whole has received less attention. Furthermore, as a wind turbine will typically operate at a power level lower than the nominal most of the time, efficiency analysis in the nominal operating point is not sufficient. This doctoral dissertation attempts to combine the two aforementioned areas of interest by studying the applicability of time domain simulations in the analysis of the economicfeasibility of a wind turbine. The utilization of a general-purpose time domain simulator, otherwise applied to the study of network interactions and control systems, in the economic analysis of the wind energy conversion system is studied. The main benefits of the simulation-based method over traditional methods based on analytic calculation of losses include the ability to reuse and recombine existing models, the ability to analyze interactions between the components and subsystems in the electric drive train (something which is impossible when considering different subsystems as independent blocks, as is commonly done in theanalytical calculation of efficiencies), the ability to analyze in a rather straightforward manner the effect of selections other than physical components, for example control algorithms, and the ability to verify assumptions of the effects of a particular design change on the efficiency of the whole system. Based on the work, it can be concluded that differences between two configurations can be seen in the economic performance with only minor modifications to the simulation models used in the network interaction and control method study. This eliminates the need ofdeveloping analytic expressions for losses and enables the study of the system as a whole instead of modeling it as series connection of independent blocks with no lossinterdependencies. Three example cases (site matching, component selection, control principle selection) are provided to illustrate the usage of the approach and analyze its performance.

Wind turbine operation in cold climate

The goal of the master‘s thesis is to determine and estimate ice accretion influence on the wind turbine blade performance. The thesis describes the technique of ice accretion calculation on the wind turbine blade and determination characteristics of the turbine with ice accreted. The methodology of the classic Blade Element Moment Theory was used. Iced blade experimental data was investigated in order to calculate blade with ice characteristics. The obtained results shows that iced blade power coefficient is lower than clean blade one. The heating system implementation shows that in the particular site in the Lapland region it is efficient.

Spatial multicriteria decision analysis for the siting of on-shore wind power in Kemiönsaari

Wind power is a low-carbon energy production form that reduces the dependence of society on fossil fuels. Finland has adopted wind energy production into its climate change mitigation policy, and that has lead to changes in legislation, guidelines, regional wind power areas allocation and establishing a feed-in tariff. Wind power production has indeed boosted in Finland after two decades of relatively slow growth, for instance from 2010 to 2011 wind energy production increased with 64 %, but there is still a long way to the national goal of 6 TWh by 2020. This thesis introduces a GIS-based decision-support methodology for the preliminary identification of suitable areas for wind energy production including estimation of their level of risk. The goal of this study was to define the least risky places for wind energy development within Kemiönsaari municipality in Southwest Finland. Spatial multicriteria decision analysis (SMCDA) has been used for searching suitable wind power areas along with many other location-allocation problems. SMCDA scrutinizes complex ill-structured decision problems in GIS environment using constraints and evaluation criteria, which are aggregated using weighted linear combination (WLC). Weights for the evaluation criteria were acquired using analytic hierarchy process (AHP) with nine expert interviews. Subsequently, feasible alternatives were ranked in order to provide a recommendation and finally, a sensitivity analysis was conducted for the determination of recommendation robustness. The first study aim was to scrutinize the suitability and necessity of existing data for this SMCDA study. Most of the available data sets were of sufficient resolution and quality. Input data necessity was evaluated qualitatively for each data set based on e.g. constraint coverage and attribute weights. Attribute quality was estimated mainly qualitatively by attribute comprehensiveness, operationality, measurability, completeness, decomposability, minimality and redundancy. The most significant quality issue was redundancy as interdependencies are not tolerated by WLC and AHP does not include measures to detect them. The third aim was to define the least risky areas for wind power development within the study area. The two highest ranking areas were Nordanå-Lövböle and Påvalsby followed by Helgeboda, Degerdal, Pungböle, Björkboda, and Östanå-Labböle. The fourth aim was to assess the recommendation reliability, and the top-ranking two areas proved robust whereas the other ones were more sensitive.

Wind Turbine Direct-Drive Permanent-Magnet Generator with Direct Liquid Cooling for Mass Reduction

Today’s electrical machine technology allows increasing the wind turbine output power by an order of magnitude from the technology that existed only ten years ago. However, it is sometimes argued that high-power direct-drive wind turbine generators will prove to be of limited practical importance because of their relatively large size and weight. The limited space for the generator in a wind turbine application together with the growing use of wind energy pose a challenge for the design engineers who are trying to increase torque without making the generator larger. When it comes to high torque density, the limiting factor in every electrical machine is heat, and if the electrical machine parts exceed their maximum allowable continuous operating temperature, even for a short time, they can suffer permanent damage. Therefore, highly efficient thermal design or cooling methods is needed. One of the promising solutions to enhance heat transfer performances of high-power, low-speed electrical machines is the direct cooling of the windings. This doctoral dissertation proposes a rotor-surface-magnet synchronous generator with a fractional slot nonoverlapping stator winding made of hollow conductors, through which liquid coolant can be passed directly during the application of current in order to increase the convective heat transfer capabilities and reduce the generator mass. This doctoral dissertation focuses on the electromagnetic design of a liquid-cooled direct-drive permanent-magnet synchronous generator (LC DD-PMSG) for a directdrive wind turbine application. The analytical calculation of the magnetic field distribution is carried out with the ambition of fast and accurate predicting of the main dimensions of the machine and especially the thickness of the permanent magnets; the generator electromagnetic parameters as well as the design optimization. The focus is on the generator design with a fractional slot non-overlapping winding placed into open stator slots. This is an a priori selection to guarantee easy manufacturing of the LC winding. A thermal analysis of the LC DD-PMSG based on a lumped parameter thermal model takes place with the ambition of evaluating the generator thermal performance. The thermal model was adapted to take into account the uneven copper loss distribution resulting from the skin effect as well as the effect of temperature on the copper winding resistance and the thermophysical properties of the coolant. The developed lumpedparameter thermal model and the analytical calculation of the magnetic field distribution can both be integrated with the presented algorithm to optimize an LC DD-PMSG design. Based on an instrumented small prototype with liquid-cooled tooth-coils, the following targets have been achieved: experimental determination of the performance of the direct liquid cooling of the stator winding and validating the temperatures predicted by an analytical thermal model; proving the feasibility of manufacturing the liquid-cooled tooth-coil winding; moreover, demonstration of the objectives of the project to potential customers.

Lightweight, liquid-cooled, direct-drive generator for highpower wind turbines: motivation, concept, and performance

Thesis: A liquid-cooled, direct-drive, permanent-magnet, synchronous generator with helical, double-layer, non-overlapping windings formed from a copper conductor with a coaxial internal coolant conduit offers an excellent combination of attributes to reliably provide economic wind power for the coming generation of wind turbines with power ratings between 5 and 20MW. A generator based on the liquid-cooled architecture proposed here will be reliable and cost effective. Its smaller size and mass will reduce build, transport, and installation costs. Summary: Converting wind energy into electricity and transmitting it to an electrical power grid to supply consumers is a relatively new and rapidly developing method of electricity generation. In the most recent decade, the increase in wind energy’s share of overall energy production has been remarkable. Thousands of land-based and offshore wind turbines have been commissioned around the globe, and thousands more are being planned. The technologies have evolved rapidly and are continuing to evolve, and wind turbine sizes and power ratings are continually increasing. Many of the newer wind turbine designs feature drivetrains based on Direct-Drive, Permanent-Magnet, Synchronous Generators (DD-PMSGs). Being low-speed high-torque machines, the diameters of air-cooled DD-PMSGs become very large to generate higher levels of power. The largest direct-drive wind turbine generator in operation today, rated just below 8MW, is 12m in diameter and approximately 220 tonne. To generate higher powers, traditional DD-PMSGs would need to become extraordinarily large. A 15MW air-cooled direct-drive generator would be of colossal size and tremendous mass and no longer economically viable. One alternative to increasing diameter is instead to increase torque density. In a permanent magnet machine, this is best done by increasing the linear current density of the stator windings. However, greater linear current density results in more Joule heating, and the additional heat cannot be removed practically using a traditional air-cooling approach. Direct liquid cooling is more effective, and when applied directly to the stator windings, higher linear current densities can be sustained leading to substantial increases in torque density. The higher torque density, in turn, makes possible significant reductions in DD-PMSG size. Over the past five years, a multidisciplinary team of researchers has applied a holistic approach to explore the application of liquid cooling to permanent-magnet wind turbine generator design. The approach has considered wind energy markets and the economics of wind power, system reliability, electromagnetic behaviors and design, thermal design and performance, mechanical architecture and behaviors, and the performance modeling of installed wind turbines. This dissertation is based on seven publications that chronicle the work. The primary outcomes are the proposal of a novel generator architecture, a multidisciplinary set of analyses to predict the behaviors, and experimentation to demonstrate some of the key principles and validate the analyses. The proposed generator concept is a direct-drive, surface-magnet, synchronous generator with fractional-slot, duplex-helical, double-layer, non-overlapping windings formed from a copper conductor with a coaxial internal coolant conduit to accommodate liquid coolant flow. The novel liquid-cooling architecture is referred to as LC DD-PMSG. The first of the seven publications summarized in this dissertation discusses the technological and economic benefits and limitations of DD-PMSGs as applied to wind energy. The second publication addresses the long-term reliability of the proposed LC DD-PMSG design. Publication 3 examines the machine’s electromagnetic design, and Publication 4 introduces an optimization tool developed to quickly define basic machine parameters. The static and harmonic behaviors of the stator and rotor wheel structures are the subject of Publication 5. And finally, Publications 6 and 7 examine steady-state and transient thermal behaviors. There have been a number of ancillary concrete outcomes associated with the work including the following. X Intellectual Property (IP) for direct liquid cooling of stator windings via an embedded coaxial coolant conduit, IP for a lightweight wheel structure for lowspeed, high-torque electrical machinery, and IP for numerous other details of the LC DD-PMSG design X Analytical demonstrations of the equivalent reliability of the LC DD-PMSG; validated electromagnetic, thermal, structural, and dynamic prediction models; and an analytical demonstration of the superior partial load efficiency and annual energy output of an LC DD-PMSG design X A set of LC DD-PMSG design guidelines and an analytical tool to establish optimal geometries quickly and early on X Proposed 8 MW LC DD-PMSG concepts for both inner and outer rotor configurations Furthermore, three technologies introduced could be relevant across a broader spectrum of applications. 1) The cost optimization methodology developed as part of this work could be further improved to produce a simple tool to establish base geometries for various electromagnetic machine types. 2) The layered sheet-steel element construction technology used for the LC DD-PMSG stator and rotor wheel structures has potential for a wide range of applications. And finally, 3) the direct liquid-cooling technology could be beneficial in higher speed electromotive applications such as vehicular electric drives.

Permanent magnet synchronous generator design solution for large directdrive wind turbines: Thermal behavior of the LC DD-PMSG

Wind is one of the most compelling forms of indirect solar energy. Available now, the conversion of wind power into electricity is and will continue to be an important element of energy self-sufficiency planning. This paper is one in a series intended to report on the development of a new type of generator for wind energy; a compact, high-power, direct-drive permanent magnet synchronous generator (DD-PMSG) that uses direct liquid cooling (LC) of the stator windings to manage Joule heating losses. The main param-eters of the subject LC DD-PMSG are 8 MW, 3.3 kV, and 11 Hz. The stator winding is cooled directly by deionized water, which flows through the continuous hollow conductor of each stator tooth-coil winding. The design of the machine is to a large degree subordinate to the use of these solid-copper tooth-coils. Both steady-state and timedependent temperature distributions for LC DD-PMSG were examined with calculations based on a lumpedparameter thermal model, which makes it possible to account for uneven heat loss distribution in the stator conductors and the conductor cooling system. Transient calculations reveal the copper winding temperature distribution for an example duty cycle during variable-speed wind turbine operation. The cooling performance of the liquid cooled tooth-coil design was predicted via finite element analysis. An instrumented cooling loop featuring a pair of LC tooth-coils embedded in a lamination stack was built and laboratory tested to verify the analytical model. Predicted and measured results were in agreement, confirming the predicted satisfactory operation of the LC DD-PMSG cooling technology approach as a whole.

Experimentation on Wind Powered Hydraulic Heating System

It is common knowledge of the world’s dependency on fossil fuel for energy, its unsustainability on the long run and the changing trend towards renewable energy as an alternative energy source. This aims to cut down greenhouse gas emission and its impact on the rate of ecological and climatic change. Quite remarkably, wind energy has been one of many focus areas of renewable energy sources and has attracted lots of investment and technological advancement. The objective of this research is to explore wind energy and its application in household heating. This research aims at applying experimental approach in real time to study and verify a virtually simulated wind powered hydraulic house heating system. The hardware components comprise of an integrated hydraulic pump, flow control valve, hydraulic fluid and other hydraulic components. The system design and control applies hardware in-the-loop (HIL) simulation setup. Output signal from the semi-empirical turbine modelling controls the integrated motor to generate flow. Throttling the volume flow creates pressure drop across the valve and subsequently thermal power in the system to be outputted using a heat exchanger. Maximum thermal power is achieved by regulating valve orifice to achieve optimum system parameter. Savonius rotor is preferred for its low inertia, high starting torque and ease of design and maintenance characteristics, but lags in power efficiency. A prototype turbine design is used; with power output in range of practical Savonius turbine. The physical mechanism of the prototype turbine’s augmentation design is not known and will not be a focus in this study.

Economic and environmental evaluation of renewable energy systems

The main objective of this thesis is to evaluate the economic and environmental effectiveness of three different renewable energy systems: solar PV, wind energy and biomass energy systems. Financial methods such as Internal Rate of Return (IRR) and Modified Internal Rate of Return (MIRR) were used to evaluate economic competitiveness. Seasonal variability in power generation capability of different renewable systems were also taken into consideration. In order to evaluate the environmental effectiveness of different energy systems, default values in GaBi software were taken by defining the functional unit as 1kWh. The results show that solar PV systems are difficult to justify both in economic as well as environmental grounds. Wind energy performs better in both economic and environmental grounds and has the capability to compete with conventional energy systems. Biomass energy systems exhibit environmental and economic performance at the middle level. In each of these systems, results vary.

Caracterización de la exposición ocupacional a los gases, dióxido de azufre (so2), sulfuro de hidrógeno (h2s), y monóxido de carbono (co), y la percepción de salud de los trabajadores, en una empresa del sector hidrocarburo en Colombia

En el proceso de extracción de petróleo (crudo) deben realizarse tratamientos físicos y químicos en estaciones de recolección del hidrocarburo con el fin de garantizar su calidad antes de su entrega para el transporte y comercialización. Para la realización de esta actividad el personal operativo requerido (operadores) debe realizar diferentes actividades, tales como ronda operacional, verificación de sistemas de almacenamiento del crudo, agua residual del proceso e insumos químicos utilizados en su tratamiento y manipulación de facilidades en las estaciones de recolección, entre otras. Como resultados de las actividades rutinarias los operadores están expuestos a factores de riesgo químico asociados a gases y vapores orgánicos generados en los procesos de tratamiento del crudo. En el presente trabajo se realizaron mediciones de calidad de aire e higiene industrial en diferentes estaciones tratamiento de crudo, con el propósito de evaluar los niveles de exposición de los operadores a gases y vapores de hidrocarburos durante el proceso de tratamiento de crudo y dar respuesta a la siguiente pregunta: ¿existe relación entre la exposición ocupacional, las emisiones atmosféricas de gases (SO2, CO, H2S) y la percepción de afectación de la salud de los trabajadores que se encuentran expuestos durante la actividad laboral, en una empresa del sector de hidrocarburos? Se realizó un estudio de corte transversal, mediante la aplicación de cuestionarios sobre las condiciones de trabajo y de salud a 30 trabajadores que laboran en una estación de tratamiento de crudo de una compañía del sector de hidrocarburos. Los operadores objeto de estudio laboran en turnos rotativos, han estado vinculados con la compañía por más de dos años y tienen contrato directo, adicionalmente, se identificaron los factores de riesgos ambientales y ocupacionales para el grupo de trabajadores y se realizó una revisión de los informes de medición de higiene industrial y de calidad de aire de las estaciones donde labora el personal seleccionado con el fin de establecer si los resultados se relacionan. Los resultados obtenidos indican que el 100% de los trabajadores son de género masculino y se desempeñan en cargos de operadores, recorredores de pozos de crudo y supervisores. El 97% de los operadores tiene más de cuarenta años de edad y el 80% de los mismos ha laborado por más de 6 años en la compañía. Acerca de la percepción de los trabajadores sobre su estado de salud el 90% afirma que su salud es buena, el 97% respondió que no presenta problemas respiratorios, el 23% manifiesta que presenta trastornos dermatológicos y el 27% indican que presenta dolor de cabeza constante. De la revisión de los informes de calidad de aire disponibles se encontró que las mediciones de Dióxido de Azufre SO2, Monóxido de Carbono CO se encuentran dentro del rango definido como el de menor impacto para la salud humana. De los datos del informe se puede concluir que la calidad del aire es buena en el 100% de las áreas de influencia de las estaciones de tratamiento de crudo. Según los informes de higiene industrial el 34% de las instalaciones presenta concentraciones de Sulfuro de Hidrógeno (H2S) en el límite permisible para exposiciones crónicas en un promedio ponderado de tiempo (TLV-TWA) y el límite permisible para exposiciones agudas en un límite de exposición a corto plazo (TLV-STEL). Solo el 37% de los trabajadores objeto de este estudio percibe el riesgo por la exposición a factores de riesgo químicos y son claramente consientes que se encuentran expuestos a estos riesgos por la manipulación de productos químicos y exposición a sustancias químicas producto de sus actividades rutinarias, el 73% no percibe el riesgo de exposición por su actividad laboral. Se recomienda que la compañía fortalezca su esquema de vigilancia para generar alternativas que eleven los niveles de consciencia del riesgo del trabajador. Los factores de riesgo ambiental y ocupacional, de los gases y vapores generados se deben al proceso de tratamiento de crudo, están mutuamente relacionados dado que al generarse una emisión y/o escape no controlado como consecuencia se tiene una afectación directa al medio ambiente y a los trabajadores.

Factores asociados a infección de fracturas abiertas de extremidades por accidentes de tránsito. Bogotá, 2012-2013

Los traumatismos por accidentes de tránsito, constituyen un problema de salud pública, a nivel mundial. Las lesiones más frecuentes son las fracturas de extremidades (84.3%). Las fracturas tienen un elevado riesgo de presentar infecciones, secuelas e incapacidades permanentes. Objetivo : Determinar si los factores asociados con la patología (lugar de fractura, clasificación de fractura, comorbilidades del paciente) y/o los factores relacionados con la atención médica (uso de profilaxis antibiótica diferente al protocolo institucional, tiempo prolongado para remisión, demoras en manejo quirúrgico) se asocian a mayor probabilidad de presentar infección de fracturas abiertas, en población mayor a 15 años, atendidos por accidente de tránsito, en una clínica de Bogotá de tercer nivel especializada en atención de SOAT, durante el período Octubre de 2012 a Octubre de 2013. Metodología: Estudio de casos y controles no apareado, relación 1:3, conformado por 43 casos (fracturas abiertas infectadas) y 129 controles (fracturas abiertas no infectadas). Resultados: La edad media de los casos fue de 39.42 +/- 16.82 años (med=36 años) y la edad media de los controles fue de 33.15 +/- 11.78 años (med=30 años). El 83.7% de los casos y el 78.3% de los controles corresponden al sexo masculino. Predominaron los accidentes en motocicleta en el 81.4% de los casos y el 86% de los controles. En el análisis bivariado se encuentra que la edad mayor a 50 años (p=0.042), una clasificación de la fractura grado IIIB o IIIC (p=0.02), cumplimiento del protocolo antibiótico institucional según el grado de fractura (p=0.014) y un tiempo mayor a 24 horas desde el momento del accidente al centro especializado en trauma (p=0.035) se asociaron significativamente con infección de la fractura abierta. En el análisis multivariado se encuentra únicamente que la clasificación de la fractura grado IIIB o IIIC se asocia con infección de la fractura OR 2.6 IC95% (1.187 – 5.781) (p=0.017). La duración de hospitalización fue mayor en los casos (32.37+/- 22.92 días, med=26 días) que en los controles (8.81 +/- 7.52 días, med=6 días) (p<0.001). El promedio de lavados quirúrgicos fue mayor en los casos (4.85±4.1, med=4.0) que en el grupo control (1.94±1.26, med=2) (p<0.001). Conclusiones: La infección posterior a una fractura abierta, implica costos elevados de atención con hospitalizaciones prolongadas y mayor frecuencia de intervenciones quirúrgicas como se evidencia en el presente estudio. Se debe fortalecer el sistema de remisión y contra remisión para acortar los tiempos de inicio de manejo especializado de los pacientes con fracturas abiertas. Se debe incentivar dentro de las instituciones, el cumplimiento de protocolos de profilaxis antibiótica según el grado de la fractura para disminuir el riesgo de complicación infecciosa.