Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011-2012 Pilot European Sentinel Registry.

BACKGROUND The use of transcatheter mitral valve repair (TMVR) has gained widespread acceptance in Europe, but data on immediate success, safety, and long-term echocardiographic follow-up in real-world patients are still limited. OBJECTIVES The aim of this multinational registry is to present a real-world overview of TMVR use in Europe. METHODS The Transcatheter Valve Treatment Sentinel Pilot Registry is a prospective, independent, consecutive collection of individual patient data. RESULTS A total of 628 patients (mean age 74.2 ± 9.7 years, 63.1% men) underwent TMVR between January 2011 and December 2012 in 25 centers in 8 European countries. The prevalent pathogenesis was functional mitral regurgitation (FMR) (n = 452 [72.0%]). The majority of patients (85.5%) were highly symptomatic (New York Heart Association functional class III or higher), with a high logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) (20.4 ± 16.7%). Acute procedural success was high (95.4%) and similar in FMR and degenerative mitral regurgitation (p = 0.662). One clip was implanted in 61.4% of patients. In-hospital mortality was low (2.9%), without significant differences between groups. The estimated 1-year mortality was 15.3%, which was similar for FMR and degenerative mitral regurgitation. The estimated 1-year rate of rehospitalization because of heart failure was 22.8%, significantly higher in the FMR group (25.8% vs. 12.0%, p[log-rank] = 0.009). Paired echocardiographic data from the 1-year follow-up, available for 368 consecutive patients in 15 centers, showed a persistent reduction in the degree of mitral regurgitation at 1 year (6.0% of patients with severe mitral regurgitation). CONCLUSIONS This independent, contemporary registry shows that TMVR is associated with high immediate success, low complication rates, and sustained 1-year reduction of the severity of mitral regurgitation and improvement of clinical symptoms.

The ADO index as a predictor of two-year mortality in general practice-based chronic obstructive pulmonary disease cohorts.

BACKGROUND Existing prediction models for mortality in chronic obstructive pulmonary disease (COPD) patients have not yet been validated in primary care, which is where the majority of patients receive care. OBJECTIVES Our aim was to validate the ADO (age, dyspnoea, airflow obstruction) index as a predictor of 2-year mortality in 2 general practice-based COPD cohorts. METHODS Six hundred and forty-six patients with COPD with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV were enrolled by their general practitioners and followed for 2 years. The ADO regression equation was used to predict a 2-year risk of all-cause mortality in each patient and this risk was compared with the observed 2-year mortality. Discrimination and calibration were assessed as well as the strength of association between the 15-point ADO score and the observed 2-year all-cause mortality. RESULTS Fifty-two (8.1%) patients died during the 2-year follow-up period. Discrimination with the ADO index was excellent with an area under the curve of 0.78 [95% confidence interval (CI) 0.71-0.84]. Overall, the predicted and observed risks matched well and visual inspection revealed no important differences between them across 10 risk classes (p = 0.68). The odds ratio for death per point increase according to the ADO index was 1.50 (95% CI 1.31-1.71). CONCLUSIONS The ADO index showed excellent prediction properties in an out-of-population validation carried out in COPD patients from primary care settings.

Stent placement vs. balloon angioplasty for popliteal artery treatment: two-year results of a prospective, multicenter, randomized trial.

PURPOSE To investigate the 2-year technical and clinical results of primary nitinol stent placement in comparison with percutaneous transluminal angioplasty (PTA) in the treatment of de novo lesions of the popliteal artery. METHODS The ETAP study (Endovascular Treatment of Atherosclerotic Popliteal Artery Lesions: balloon angioplasty vs. primary stenting; www.ClinicalTrials.gov identifier NCT00712309) is a prospective, randomized trial that enrolled 246 patients (158 men; mean age 72 years) who were randomly assigned to receive a nitinol stent (n=119) or PTA (n=127) for lesions averaging 42.3 mm in length. The results of the primary study endpoint were published. Secondary outcome measures and endpoints included primary patency (freedom from duplex-detected target lesion restenosis), target lesion revascularization (TLR), secondary patency, changes in ankle-brachial index and Rutherford class, and event-free survival (freedom from target limb amputation, TLR, myocardial infarction, and death). RESULTS In total, 183 patients (89 stent and 94 PTA) were available for the 2-year analysis. The primary patency rate was significantly higher in the stent group (64.2%) than in the PTA group (31.3%, p=0.0001). TLR rates were 22.4% and 59.5%, respectively (p=0.0001). When provisional stent placement in the PTA arm was not considered as TLR and loss in patency, the differences prevailed between the study groups but were not significant (64.2% vs. 56.1% for primary patency, respectively; p=0.44). A significant improvement in ABI and Rutherford category was observed at 2 years in both groups. CONCLUSION In treatment of obstructive popliteal artery lesions, provisional stenting reveals equivalent patency in comparison to primary stenting. However, the 2-year results of this trial suggest the possibility of a shift toward higher patency rates in favor of primary stenting.

Emergence of acquired HIV-1 drug resistance has almost been stopped in Switzerland - a 15 year prospective cohort analysis

BACKGROUND  Drug resistance is a major barrier to successful antiretroviral treatment (ART). Therefore, it is important to monitor time trends at a population level. METHODS  We included 11,084 ART-experienced patients from the Swiss HIV Cohort Study (SHCS) between 1999 and 2013. The SHCS is highly representative and includes 72% of patients receiving ART in Switzerland. Drug resistance was defined as the presence of at least one major mutation in a genotypic resistance test. To estimate the prevalence of drug resistance, data for patients with no resistance test was imputed based on patient's risk of harboring drug resistant viruses. RESULTS  The emergence of new drug resistance mutations declined dramatically from 401 to 23 patients between 1999 and 2013. The upper estimated prevalence limit of drug resistance among ART-experienced patients decreased from 57.0% in 1999 to 37.1% in 2013. The prevalence of three-class resistance decreased from 9.0% to 4.4% and was always <0.4% for patients who initiated ART after 2006. Most patients actively participating in the SHCS in 2013 with drug resistant viruses initiated ART before 1999 (59.8%). Nevertheless, in 2013, 94.5% of patients who initiated ART before 1999 had good remaining treatment options based on Stanford algorithm. CONCLUSION  HIV-1 drug resistance among ART-experienced patients in Switzerland is a well-controlled relic from the pre-combination ART era. Emergence of drug resistance can be virtually stopped with new potent therapies and close monitoring.

Importance of antibiotic class to the development of Clostridium difficile infection (CDI) in adults: A systematic review

C. difficile causes gastrointestinal infections in humans, including severe diarrhea. It is implicated in 20%-30% of cases of antibiotic-associated diarrhea, in 50%-70% of cases of antibiotic-associated colitis, and in >90% of cases of antibiotic-associated pseudomembranous colitis. Exposure to antimicrobial agent, hospitalization and age are some of the risk factors that predispose to CDI. Virtually all hospitalized patients with nosocomially-acquired CDI have a history of treatment with antimicrobials or neoplastic agent within the previous 2 months. The development of CDI usually occurs during treatment with antibiotics or some weeks after completing the course of the antibiotics. ^ After exposure to the organism (often in a hospital), the median incubation period is less than 1 week, with a median time of onset of 2days. The difference in the time between the use of antibiotic and the development of the disease relate to the timing of exogenous acquisition of C. difficile. ^ This paper reviewed the literature for studies on different classes of antibiotics in association with the rates of primary CDI and RCDI from the year 1984 to 2012. The databases searched in this systematic review were: PubMed (National Library of Medicine) and Medline (R) (Ovid). RefWorks was used to store bibliographic data. ^ The search strategy yielded 733 studies, 692 articles from Ovid Medline (R) and 41 articles from PubMed after removing all duplicates. Only 11 studies were included as high quality studies. Out of the 11 studies reviewed, 6 studies described the development of CDI in non-CDI patients taking antibiotics for other purposes and 5 studies identified the risk factors associated with the development of recurrent CDI after exposure to antibiotics. ^ The risk of developing CDI in non-CDI patients receiving beta lactam antibiotics was 2.35%, while fluoroquinolones, clindamycin/macrolides and other antibiotics were associated with 2.64%, 2.54% and 2.35% respectively. Of those who received beta lactam antibiotic, 26.7% developed RCDI, while 36.8% of those who received any fluoroquinolone developed RCDI, 26.5% of those who received either clindamycin or macrolides developed RCDI and 29.1% of those who received other antibiotics developed RCDI. Continued use of non-C. difficile antibiotics especially fluoroquinolones was identified as an important risk factor for primary CDI and recurrent CDI. ^

(Table 1) Population density and infestation of Paracalanus parvus during the year in the Blue Bay, Black Sea

The life cycle of infusorians belonging to genus Colpoda, dormant cysts of which were found on planktic crustaceans of the Black Sea coastal waters, is described. Population strength of Colpoda is maximum in autumn. The infusorians had no harmful effect on their host. It has been noted that Colpoda enhances decomposition of dead animals.

Investigations on Fucus vesiculosus and Fucus serratus at outer Kiel Fjord over one year (August 2012 - July 2013)

Macroalgae, especially perennial species, are exposed to a seasonally variable fouling pressure. It was hypothesized that macroalgae regulate their antifouling defense to fouling pressure. Over one year, the macrofouling pressure and the chemical anti-macrofouling defense strength of the brown algae Fucus vesiculosus and Fucus serratus were assessed with monthly evaluation. The anti-macrofouling defense was assessed by means of surface-extracted Fucus metabolites tested at near-natural concentrations in a novel in situ bioassay. Additionally, the mannitol content of both Fucus species was determined to assess resource availability for defense production. The surface chemistry of both Fucus species exhibited seasonal variability in attractiveness to Amphibalanus improvisus and Mytilus edulis. Of this variability, 50-60% is explained by a sinusoidal model. Only F. vesiculosus extracts originating from the spring and summer significantly deterred settlement of A. improvisus. The strength of macroalgal antifouling defense did not correlate either with in situ macrofouling pressure or with measured mannitol content, which, however, were never depleted.

Effects of N fertilisation, year and prolamin alleles on guten quality in durum wheat (Triticum turgidum L. ssp. turgidum) landraces from Spain

A subset of durum wheat Spanish landraces, previously evaluated for yield at low and high nitrogen (N) levels, was analysed for quality, protein content (P) and sodium dodecyl sulphate sedimentation (SDSS) test. The evaluation was carried out at the two N rates and in two years. The influence of prolamin alleles at the Glu-1, Glu-3, Glu-B2 and Gli-1 loci on quality parameters was also studied. The non significant Variety-by-Year or Variety-by-N interactions suggested that year and N affected all the varieties in a similar manner. Year and N effects were larger than variety effect for P, which increased with N. In contrast, variety genotype exhibited a stronger influence on SDSS test, which was not affected by year and fertilizer. Variety effects on P did not reflect the variety differences for SDSS test. A high positive influence of some prolamin alleles on quality parameters was detected, mainly for SDSS values. No correlation between yield and P was detected in the landraces adapted to low N. Based on the results of yield and quality evaluations, four landraces with high yield and high gluten strength were pre-selected for low N production.

Multiobjective optimization applied to structural sizing of low cost university-class microsatellite projects

In recent years, there has been continuing interest in the participation of university research groups in space technology studies by means of their own microsatellites. The involvement in such projects has some inherent challenges, such as limited budget and facilities. Also, due to the fact that the main objective of these projects is for educational purposes, usually there are uncertainties regarding their in orbit mission and scientific payloads at the early phases of the project. On the other hand, there are predetermined limitations for their mass and volume budgets owing to the fact that most of them are launched as an auxiliary payload in which the launch cost is reduced considerably. The satellite structure subsystem is the one which is most affected by the launcher constraints. This can affect different aspects, including dimensions, strength and frequency requirements. In this paper, the main focus is on developing a structural design sizing tool containing not only the primary structures properties as variables but also the system level variables such as payload mass budget and satellite total mass and dimensions. This approach enables the design team to obtain better insight into the design in an extended design envelope. The structural design sizing tool is based on analytical structural design formulas and appropriate assumptions including both static and dynamic models of the satellite. Finally, a Genetic Algorithm (GA) multiobjective optimization is applied to the design space. The result is a Pareto-optimal based on two objectives, minimum satellite total mass and maximum payload mass budget, which gives a useful insight to the design team at the early phases of the design.

Multidisciplinary Design Optimization Application to Conceptual Design of University-class Microsatellite Projects

Esta tesis se ha realizado en el contexto del proyecto UPMSat-2, que es un microsatélite diseñado, construido y operado por el Instituto Universitario de Microgravedad "Ignacio Da Riva" (IDR / UPM) de la Universidad Politécnica de Madrid. Aplicación de la metodología Ingeniería Concurrente (Concurrent Engineering: CE) en el marco de la aplicación de diseño multidisciplinar (Multidisciplinary Design Optimization: MDO) es uno de los principales objetivos del presente trabajo. En los últimos años, ha habido un interés continuo en la participación de los grupos de investigación de las universidades en los estudios de la tecnología espacial a través de sus propios microsatélites. La participación en este tipo de proyectos tiene algunos desafíos inherentes, tales como presupuestos y servicios limitados. Además, debido al hecho de que el objetivo principal de estos proyectos es fundamentalmente educativo, por lo general hay incertidumbres en cuanto a su misión en órbita y cargas útiles en las primeras fases del proyecto. Por otro lado, existen limitaciones predeterminadas para sus presupuestos de masa, volumen y energía, debido al hecho de que la mayoría de ellos están considerados como una carga útil auxiliar para el lanzamiento. De este modo, el costo de lanzamiento se reduce considerablemente. En este contexto, el subsistema estructural del satélite es uno de los más afectados por las restricciones que impone el lanzador. Esto puede afectar a diferentes aspectos, incluyendo las dimensiones, la resistencia y los requisitos de frecuencia. En la primera parte de esta tesis, la atención se centra en el desarrollo de una herramienta de diseño del subsistema estructural que evalúa, no sólo las propiedades de la estructura primaria como variables, sino también algunas variables de nivel de sistema del satélite, como la masa de la carga útil y la masa y las dimensiones extremas de satélite. Este enfoque permite que el equipo de diseño obtenga una mejor visión del diseño en un espacio de diseño extendido. La herramienta de diseño estructural se basa en las fórmulas y los supuestos apropiados, incluyendo los modelos estáticos y dinámicos del satélite. Un algoritmo genético (Genetic Algorithm: GA) se aplica al espacio de diseño para optimizaciones de objetivo único y también multiobjetivo. El resultado de la optimización multiobjetivo es un Pareto-optimal basado en dos objetivo, la masa total de satélites mínimo y el máximo presupuesto de masa de carga útil. Por otro lado, la aplicación de los microsatélites en misiones espaciales es de interés por su menor coste y tiempo de desarrollo. La gran necesidad de las aplicaciones de teledetección es un fuerte impulsor de su popularidad en este tipo de misiones espaciales. Las misiones de tele-observación por satélite son esenciales para la investigación de los recursos de la tierra y el medio ambiente. En estas misiones existen interrelaciones estrechas entre diferentes requisitos como la altitud orbital, tiempo de revisita, el ciclo de vida y la resolución. Además, todos estos requisitos puede afectar a toda las características de diseño. Durante los últimos años la aplicación de CE en las misiones espaciales ha demostrado una gran ventaja para llegar al diseño óptimo, teniendo en cuenta tanto el rendimiento y el costo del proyecto. Un ejemplo bien conocido de la aplicación de CE es la CDF (Facilidad Diseño Concurrente) de la ESA (Agencia Espacial Europea). Está claro que para los proyectos de microsatélites universitarios tener o desarrollar una instalación de este tipo parece estar más allá de las capacidades del proyecto. Sin embargo, la práctica de la CE a cualquier escala puede ser beneficiosa para los microsatélites universitarios también. En la segunda parte de esta tesis, la atención se centra en el desarrollo de una estructura de optimización de diseño multidisciplinar (Multidisciplinary Design Optimization: MDO) aplicable a la fase de diseño conceptual de microsatélites de teledetección. Este enfoque permite que el equipo de diseño conozca la interacción entre las diferentes variables de diseño. El esquema MDO presentado no sólo incluye variables de nivel de sistema, tales como la masa total del satélite y la potencia total, sino también los requisitos de la misión como la resolución y tiempo de revisita. El proceso de diseño de microsatélites se divide en tres disciplinas; a) diseño de órbita, b) diseño de carga útil y c) diseño de plataforma. En primer lugar, se calculan diferentes parámetros de misión para un rango práctico de órbitas helio-síncronas (sun-synchronous orbits: SS-Os). Luego, según los parámetros orbitales y los datos de un instrumento como referencia, se calcula la masa y la potencia de la carga útil. El diseño de la plataforma del satélite se estima a partir de los datos de la masa y potencia de los diferentes subsistemas utilizando relaciones empíricas de diseño. El diseño del subsistema de potencia se realiza teniendo en cuenta variables de diseño más detalladas, como el escenario de la misión y diferentes tipos de células solares y baterías. El escenario se selecciona, de modo de obtener una banda de cobertura sobre la superficie terrestre paralelo al Ecuador después de cada intervalo de revisita. Con el objetivo de evaluar las interrelaciones entre las diferentes variables en el espacio de diseño, todas las disciplinas de diseño mencionados se combinan en un código unificado. Por último, una forma básica de MDO se ajusta a la herramienta de diseño de sistema de satélite. La optimización del diseño se realiza por medio de un GA con el único objetivo de minimizar la masa total de microsatélite. Según los resultados obtenidos de la aplicación del MDO, existen diferentes puntos de diseños óptimos, pero con diferentes variables de misión. Este análisis demuestra la aplicabilidad de MDO para los estudios de ingeniería de sistema en la fase de diseño conceptual en este tipo de proyectos. La principal conclusión de esta tesis, es que el diseño clásico de los satélites que por lo general comienza con la definición de la misión y la carga útil no es necesariamente la mejor metodología para todos los proyectos de satélites. Un microsatélite universitario, es un ejemplo de este tipo de proyectos. Por eso, se han desarrollado un conjunto de herramientas de diseño para encarar los estudios de la fase inicial de diseño. Este conjunto de herramientas incluye diferentes disciplinas de diseño centrados en el subsistema estructural y teniendo en cuenta una carga útil desconocida a priori. Los resultados demuestran que la mínima masa total del satélite y la máxima masa disponible para una carga útil desconocida a priori, son objetivos conflictivos. En este contexto para encontrar un Pareto-optimal se ha aplicado una optimización multiobjetivo. Según los resultados se concluye que la selección de la masa total por satélite en el rango de 40-60 kg puede considerarse como óptima para un proyecto de microsatélites universitario con carga útil desconocida a priori. También la metodología CE se ha aplicado al proceso de diseño conceptual de microsatélites de teledetección. Los resultados de la aplicación del CE proporcionan una clara comprensión de la interacción entre los requisitos de diseño de sistemas de satélites, tales como la masa total del microsatélite y la potencia y los requisitos de la misión como la resolución y el tiempo de revisita. La aplicación de MDO se hace con la minimización de la masa total de microsatélite. Los resultados de la aplicación de MDO aclaran la relación clara entre los diferentes requisitos de diseño del sistema y de misión, así como que permiten seleccionar las líneas de base para el diseño óptimo con el objetivo seleccionado en las primeras fase de diseño. ABSTRACT This thesis is done in the context of UPMSat-2 project, which is a microsatellite under design and manufacturing at the Instituto Universitario de Microgravedad “Ignacio Da Riva” (IDR/UPM) of the Universidad Politécnica de Madrid. Application of Concurrent Engineering (CE) methodology in the framework of Multidisciplinary Design application (MDO) is one of the main objectives of the present work. In recent years, there has been continuing interest in the participation of university research groups in space technology studies by means of their own microsatellites. The involvement in such projects has some inherent challenges, such as limited budget and facilities. Also, due to the fact that the main objective of these projects is for educational purposes, usually there are uncertainties regarding their in orbit mission and scientific payloads at the early phases of the project. On the other hand, there are predetermined limitations for their mass and volume budgets owing to the fact that most of them are launched as an auxiliary payload in which the launch cost is reduced considerably. The satellite structure subsystem is the one which is most affected by the launcher constraints. This can affect different aspects, including dimensions, strength and frequency requirements. In the first part of this thesis, the main focus is on developing a structural design sizing tool containing not only the primary structures properties as variables but also the satellite system level variables such as payload mass budget and satellite total mass and dimensions. This approach enables the design team to obtain better insight into the design in an extended design envelope. The structural design sizing tool is based on the analytical structural design formulas and appropriate assumptions including both static and dynamic models of the satellite. A Genetic Algorithm (GA) is applied to the design space for both single and multiobejective optimizations. The result of the multiobjective optimization is a Pareto-optimal based on two objectives, minimum satellite total mass and maximum payload mass budget. On the other hand, the application of the microsatellites is of interest for their less cost and response time. The high need for the remote sensing applications is a strong driver of their popularity in space missions. The satellite remote sensing missions are essential for long term research around the condition of the earth resources and environment. In remote sensing missions there are tight interrelations between different requirements such as orbital altitude, revisit time, mission cycle life and spatial resolution. Also, all of these requirements can affect the whole design characteristics. During the last years application of the CE in the space missions has demonstrated a great advantage to reach the optimum design base lines considering both the performance and the cost of the project. A well-known example of CE application is ESA (European Space Agency) CDF (Concurrent Design Facility). It is clear that for the university-class microsatellite projects having or developing such a facility seems beyond the project capabilities. Nevertheless practicing CE at any scale can be beneficiary for the university-class microsatellite projects. In the second part of this thesis, the main focus is on developing a MDO framework applicable to the conceptual design phase of the remote sensing microsatellites. This approach enables the design team to evaluate the interaction between the different system design variables. The presented MDO framework contains not only the system level variables such as the satellite total mass and total power, but also the mission requirements like the spatial resolution and the revisit time. The microsatellite sizing process is divided into the three major design disciplines; a) orbit design, b) payload sizing and c) bus sizing. First, different mission parameters for a practical range of sun-synchronous orbits (SS-Os) are calculated. Then, according to the orbital parameters and a reference remote sensing instrument, mass and power of the payload are calculated. Satellite bus sizing is done based on mass and power calculation of the different subsystems using design estimation relationships. In the satellite bus sizing, the power subsystem design is realized by considering more detailed design variables including a mission scenario and different types of solar cells and batteries. The mission scenario is selected in order to obtain a coverage belt on the earth surface parallel to the earth equatorial after each revisit time. In order to evaluate the interrelations between the different variables inside the design space all the mentioned design disciplines are combined in a unified code. The integrated satellite system sizing tool developed in this section is considered as an application of the CE to the conceptual design of the remote sensing microsatellite projects. Finally, in order to apply the MDO methodology to the design problem, a basic MDO framework is adjusted to the developed satellite system design tool. Design optimization is done by means of a GA single objective algorithm with the objective function as minimizing the microsatellite total mass. According to the results of MDO application, there exist different optimum design points all with the minimum satellite total mass but with different mission variables. This output demonstrates the successful applicability of MDO approach for system engineering trade-off studies at the conceptual design phase of the design in such projects. The main conclusion of this thesis is that the classical design approach for the satellite design which usually starts with the mission and payload definition is not necessarily the best approach for all of the satellite projects. The university-class microsatellite is an example for such projects. Due to this fact an integrated satellite sizing tool including different design disciplines focusing on the structural subsystem and considering unknown payload is developed. According to the results the satellite total mass and available mass for the unknown payload are conflictive objectives. In order to find the Pareto-optimal a multiobjective GA optimization is conducted. Based on the optimization results it is concluded that selecting the satellite total mass in the range of 40-60 kg can be considered as an optimum approach for a university-class microsatellite project with unknown payload(s). Also, the CE methodology is applied to the remote sensing microsatellites conceptual design process. The results of CE application provide a clear understanding of the interaction between satellite system design requirements such as satellite total mass and power and the satellite mission variables such as revisit time and spatial resolution. The MDO application is done with the total mass minimization of a remote sensing satellite. The results from the MDO application clarify the unclear relationship between different system and mission design variables as well as the optimum design base lines according to the selected objective during the initial design phases.

Assessing Creativity In Engineering Students: A Comparative Between Degrees and Sudents In First And Last Year

An online open access test (CREAX self-assessment) has been used in this work so that students from degrees in engineering in the Universidad Polite¿cnica of Madrid (UPM) could self-assess their creative competence after several classroom activities. Different groups from the first year course have been statistically compared using data from their assessment. These first year students had different professors in the subject ?Technical Drawing? and belonged to several degrees in the UPM. They were as well compared regarding sex and a group of first year students was also compared to another last year group of the degree so as to observe possible differences in the achievement of this competence. Only one difference was detected concerning sex in one of the degrees. Among degrees, the higher marks obtained by students who had done specific exercises for the development of creativity in class is highlighted. Finally, a significantly high mark was observed in students during their last year of degree with respect to first year students. The tool CREAX has become very useful in the assessment of this competence in the UPM degrees in which it has been implemented.

Estudio de los parámetros necesarios para establecer las medidas de actuación por tipos de buques en situaciones de emergencia después de un accidente

La “Actuación en la Crisis”, objetivo principal de esta tesis, trata de establecer y concretar los procedimientos y apoyos desde tierra y a bordo de los buques, tanto técnicos como operacionales, a seguir por el Capitán y tripulación de un buque después de un accidente, en especial cuando el buque tiene un riesgo importante de hundimiento o necesidad de abandono. La aparición de este concepto es relativamente reciente, es decir desde el año 1995, después de los estudios y propuestas realizados, por el Panel de Expertos de IMO, como consecuencia del hundimiento del buque de pasaje y carga rodada, Estonia, en el que perdieron la vida más de 850 personas a finales de Septiembre de 1994. Entre las propuestas recomendadas y aceptadas por los gobiernos en la Conferencia Internacional SOLAS 1995, figuraba este concepto novedoso, que luego fue adoptado de una forma generalizada para todos los tipos de buques, que hasta entonces sólo disponían de documentos dispersos y a veces contradictorios para la actuación en estos momentos de peligro, que dio lugar a un profundo tratamiento de este problema, que iba a afectar a los buques, tanto en los conceptos y parámetros de proyecto, como a la propia operación del buque. La tesis desarrolla los fundamentos, estado del arte, implantación y consecuencias sobre la configuración y explotación del buque, que han dado lugar a una serie de documentos, que se han incluido en diversos Convenios Internacionales, Códigos y otros documentos de obligada aplicación en la industria naval generados en IMO (SOLAS, Retorno Seguro a Puerto, Plano y Libro de Control de Averías, ISM). La consecuencia más novedosa e interesante de este concepto ha sido la necesidad de disponer cada compañía explotadora del buque, de un servicio importante de “apoyo en la crisis”, que ha dado lugar a implantar un “servicio de emergencia especial”, disponible las 24 horas del día y 365 de año que ofrecen las Sociedades de Clasificación. El know-how de los accidentes que tratan estos servicios, hacen que se puedan establecer ciertas recomendaciones, que se centran, en que el buque tenga, por sus propios medios, una posibilidad de aumentar el KM después de una avería, la garantía de la resistencia estructural adecuada y el aumento del tiempo de hundimiento o el tiempo de mantenimiento a flote (otro tipo de averías vinculadas con la maquinaria, equipo o protección y lucha contra incendios, no son objeto de tesis). Las conclusiones obtenidas, son objeto de discusión especialmente en IACS e IMO, con el fin de establecer las aplicaciones pertinentes, que permitan dar al buque una mayor seguridad. Como objetivo principal de esta tesis es establecer estos puntos de mejora consecuencia de esta actuación en la crisis, con la aportación de varias soluciones que mejorarían los problemas mencionados para los tres tipos de buques que consideramos más importantes (pasaje, petroleros y bulkcarriers) La tesis recorre, desde el principio en 1995, la evolución de esta actuación en la crisis, hasta el momento actual., los puntos básicos que se establecen, que van muy de la mano de la llamada “cultura de seguridad”, objetivo nacido durante los años 90, con el fin de implantar una filosofía distinta para abordar el tratamiento de la seguridad del buque, a la que se venía aplicando hasta el momento, en donde se contemplaba tratar el tema de forma singular y específica para cada caso. La nueva filosofía, trataba de analizar el problema, desde un aspecto global y por tanto horizontal, realizando un estudio exhaustivo de las consecuencias que tendría la aplicación de una nueva medida correctora, en los restantes equipos y sistemas del buque., relativos al proyecto, configuración, operación y explotación del buque. Se describen de manera sucinta las profundas investigaciones a que dio lugar todo lo anterior, estando muchas de ellas, vinculadas a grandes proyectos europeos. La mayor parte de estos proyectos fueron subvencionados por la Comunidad Económica Europea durante la primera década del siglo actual. Dentro de estas investigaciones, donde hay que destacar la participación de todos los agentes del sector marítimo europeo, se hacen imprescindibles la utilización de dos herramientas novedosas para nuestro sector, como son el “Estudio de Riesgos” y la “Evaluación de la Seguridad”, más conocida técnicamente por su nombre ingles “Safety Assessment”, cuyos principios también son incluidos en la tesis. Además se especifican las bases sobre las que se establecen la estabilidad intacta y en averías, con nuevos conceptos, no tratados nunca hasta entonces, como la “altura crítica de agua en cubierta” para la cual el buque se hundiría sin remisión, “estado de la mar” en la que se puede encontrar el buque averiado, el cálculo del tiempo de hundimiento, u otros aspectos como el corrimiento de la carga, o bien el tratamiento de los problemas dinámicos en el nuevo “Código de Estabilidad Intacta”. Con respecto a la resistencia estructural, especialmente el estudio de la “resistencia estructural después de la avería”, que tiene en cuenta el estado de la mar en la que se encontraría el buque afectado. Se analizan los tipos de buques mencionados uno por uno y se sacan, como aportación fundamental de esta tesis, separadamente, las acciones y propuestas a aplicar a estos buques. En primer lugar, las relativas al proyecto y configuración del buque y en segundo lugar, las de operación, explotación y mantenimiento, con el fin de acometer, con garantías de éxito, la respuesta a la ayuda en emergencia y la solución a la difícil situación que pueden tener lugar en condiciones extremas. Para ver el efecto de algunas de las propuestas que se incluyen, se realizan y aplican concretamente, a un buque de pasaje de carga rodada, a un petrolero y a un bulkcarrier, para demostrar el mejor comportamiento de estos buques en situación de emergencia. Para ello se han elegido un buque ejemplo para cada tipo, efectuándose los cálculos de estabilidad y resistencia longitudinal y comparar la situación, en la que quedaría el buque averiado, antes y después de la avería. La tesis se completa con una estadística real de buques averiados de cada uno de estos tres tipos, distinguiendo el tipo de incidente y el número de los buques que lo han sufrido, considerándose como más importantes los incidentes relacionados con varadas, colisiones y fuego resumiéndose lo más relevante de esta aportación también importante de esta tesis. ABSTRACT The "Response in an emergency" is the main objective of this thesis, it seeks to establish and define procedures for technical and operational support onboard and shore, to be followed by the captain and crew on of a ship after an accident, especially when the ship has a significant risk of sinking or a need to abandon it. The emergence of this concept is relatively recent, in 1995, after studies and proposals made by the Panel of Experts IMO, following the sinking of the “Estonia” vessel, where more than 850 people died in late September 1994. In the International Convention SOLAS 1995, among the recommended proposals and accepted regulations, this new concept was included, which was later adopted for all types of ships which until then had only scattered some documents, sometimes including contradictory actions in emergency situations. This led to a profound treatment of this problem, which would affect the vessels in both the concepts and design parameters, as to the proper operation of the vessel. The thesis develops the foundations, state of the art, implementation and consequences on the design and operation of the vessel, this has led to a series of Circulars and Regulations included in several International Codes and Conventions issued by IMO which are required to be complied with (SOLAS Safe Return to Port, Damage Control Plan and Booklet, ISM). The most novel and interesting consequence of this concept has been the need for every company operating the ship to have a shore based support service in emergency situations which has led to implement special emergency services offered by Class Societies which are available 24 hours a day, 365 days per year. The know-how of these services dealing with all types of accidents can establish certain recommendations, which focus on the ship capability to increase the KM after damage. It can also be determined adequate structural strength and the increase of the capsizing time or time afloat (other types of damages associated with the machinery, equipment or firefighting, are not the subject of this thesis). The conclusions are discussed especially in IACS and IMO, in order to establish appropriate applications to improve the security of the vessels. The main objective of this thesis is to establish actions to improve emergency actions, resulting from different responses in the crisis, with the contribution of several solutions that improve the problems mentioned for three types of ships that we consider most important (passenger vessels, tankers and bulk carriers) The thesis runs from the beginning in 1995 to date, the evolution of the response on the crisis. The basics established during the 90s with the "safety culture" in order to implement a different philosophy to address the treatment of the safety of the ship, which was being previously implemented, as something singular and specific to each case. The new philosophy tried to analyse the problem from a global perspective, doing an exhaustive study of the consequences of the implementation of the new regulation in the ship systems and equipment related to the design, configuration and operation of the vessel. Extensive investigations which led to the above are described, many of them being linked to major European projects. Most of these projects were funded by the European Union during the first decade of this century. Within these investigations, which it must be highlighted the participation of all players in the European maritime sector, a necessity to use two new tools for our industry, such as the "Risk Assessment" and "Safety Assessment" whose principles are also included in the thesis. The intact and damage stability principles are established including new concepts, never treated before, as the "critical height of water on deck" for which the ship would sink without remission, "sea state" where the damaged vessel can be found, calculation of capsizing time, or other aspects such cargo shifting or treatment of dynamic problems in the new Intact Stability Code in development. Regarding the structural strength, it has to be especially considered the study of the "residual strength after damage", which takes into account the state of the sea where the vessel damaged can be found. Ship types mentioned are analysed one by one, as a fundamental contribution of this thesis, different actions and proposals are established to apply to these types of vessels. First, those ones relating to the design and configuration of the vessel and also the ones related to the operation and maintenance in order to support successfully responses to emergency situations which may occur in extreme situations. Some of the proposals are applied specifically to a RoRo passenger ship, an oil tanker and a bulkcarrier, to demonstrate the improved performance of these vessels damaged. An example for each type vessel has been chosen, carrying out stability and longitudinal strength calculations comparing the situation of the ship before and after damage. The thesis is completed with incidents statics for each of these three types, distinguishing the type of incident and the number of ships having it. The most important incidents considered are the ones related to groundings, collisions and fire being this other relevant contribution of this thesis.

1.6 Lloyd Gaines, Valedictorian, Vashon Class of 1931

Lloyd Gaines also helped to support his family by selling magazine subscriptions. He graduated in 1931 after only three years and served as the Valedictorian of his class. As a senior, Gaines finished first in a local essay contest, winning a prize of $250 (equivalent to $3000 in modern currency) that he used to enroll as a student at Stowe Teachers College in St. Louis for the 1931-32 school year

A two-year experience teaching computer literacy to first-year medical students using skill-based cohorts

Because it is widely accepted that providing information online will play a major role in both the teaching and practice of medicine in the near future, a short formal course of instruction in computer skills was proposed for the incoming class of students entering medical school at the State University of New York at Stony Brook. The syllabus was developed on the basis of a set of expected outcomes, which was accepted by the dean of medicine and the curriculum committee for classes beginning in the fall of 1997. Prior to their arrival, students were asked to complete a self-assessment survey designed to elucidate their initial skill base; the returned surveys showed students to have computer skills ranging from complete novice to that of a systems engineer. The classes were taught during the first three weeks of the semester to groups of students separated on the basis of their knowledge of and comfort with computers. Areas covered included computer basics, e-mail management, MEDLINE, and Internet search tools. Each student received seven hours of hands-on training followed by a test. The syllabus and emphasis of the classes were tailored to the initial skill base but the final test was given at the same level to all students. Student participation, test scores, and course evaluations indicated that this noncredit program was successful in achieving an acceptable level of comfort in using a computer for almost all of the student body.