Stationary Engineer checking air conditioning gauges

Inscriptions: Verso: [stamped] Photograph by Freda Leinwand. [463 West Street, Studio 229G, New York, NY 10014].

Study of Liquid Desiccant Air-Conditioning for High Performance Greenhouses

Greenhouses have become an invaluable source of year-round food production. Further development of viable and efficient high performance greenhouses is important for future food security. Closing the greenhouse envelope from the environment can provide benefits in space heating energy savings, pest control, and CO2 enrichment. This requires the application of a novel air conditioning system to handle the high cooling loads experienced by a greenhouse. Liquid desiccant air-conditioning (LDAC) have been found to provide high latent cooling capacities, which is perfect for the application of a humid greenhouse microclimate. TRNSYS simulations were undertaken to study the feasibility of two liquid desiccant dehumidification systems based on their capacity to control the greenhouse microclimate, and their cooling performance. The base model (B-LDAC) included a natural gas boiler, and two cooling systems for seasonal operation. The second model (HP-LDAC) was a hybrid liquid desiccant-heat pump dehumidification system. The average tCOPdehum and tCOPtotal of the B-LDAC system increased from 0.40 and 0.56 in January to 0.94 and 1.09 in June. Increased load and performance during a sample summer day improved these values to 3.5 and 3.0, respectively. The average eCOPdehum and eCOPtotal values were 1.0 and 1.8 in winter, and 1.7 and 2.1 in summer. The HP-LDAC system produced similar daily performance trends where the annual average eCOPdehum and eCOPtotal values were 1.3 and 1.2, but the sample day saw peaks of 2.4 and 3.2, respectively. The B-LDAC and HP-LDAC results predicted greenhouse temperatures exceeding 30°C for 34% and 17% of the month of July, respectively. Similarly, humidity levels increased in summer months, with a maximum of 14% of the time spent over 80% in May for both models. The percentage of annual savings in space heating energy associated with closing the greenhouse to ventilation was 34%. The additional annual regeneration energy input was reduced by 26% to 526 kWhm-2, with the implementation of a heat recovery ventilator on the regeneration exhaust air. The models also predicted an electrical energy input of 245 kWhm-2 and 305 kWhm-2 for the B-LDAC and HP-LDAC simulations, respectively.

The corporate regimen of labour companies in the New Act 44/2015, on 14th October, of labour and investee companies

Act 44/2015, on 14th October, of labour and investee companies, aims to accommodate the different instruments, limits and requirements with which the legal regime of the labour companies is set, to the current economic and legal context where they must develop their economic activity. The purpose of the law is to preserve their special status, while it seeks to modernize its legal structure to ensure the economic solvency of the business plan, without weakening the social profile that is required. The new law includes two organisational figures, ‘labour companies’ and the calling ‘investee companies’, of the last one, only leaving evidence of what is to be understood by them referring its regulation to a subsequent regulatory development. Until the publication of the regulation, our work has focused on the corporate aspect of the labour companies by analysing the modifications made on the typological elements and legal regime of these organisational figures to determine whether the law is the necessary and sufficient instrument to achieve the challenge proposed.

Cabazitaxel for hormone-relapsed metastatic prostate cancer previously treated with a docetaxel-containing regimen (review of TA255)

Prostate cancer is the most common cancer amongst men in the England and currently affects ~40,000 people around 6,000 of whom suffer from metastatic disease. Overall patients with metastatic disease have a life expectancy of less than 24 months and a poor prognosis.

Docetaxel was the first agent to show survival benefit in metastatic Hormone Refractory Prostate Cancer (mHRPC) and since approval by NICE in 2006 (TA101) has for many years been the mainstay of treatment.

To appraise the clinical and cost effectiveness of cabazitaxel within its marketing authorisation for treating hormone-relapsed metastatic prostate cancer previously treated with a docetaxel-containing regimen.

Cabazitaxel for Hormone-Relapsed Metastatic Prostate Cancer Previously Treated With a Docetaxel-Containing Regimen: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the company that manufactures cabazitaxel (Jevtana(®), Sanofi, UK) to submit evidence for the clinical and cost effectiveness of cabazitaxel for treatment of patients with metastatic hormone-relapsed prostate cancer (mHRPC) previously treated with a docetaxel-containing regimen. The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology based upon the company's submission to NICE. Clinical evidence for cabazitaxel was derived from a multinational randomised open-label phase III trial (TROPIC) of cabazitaxel plus prednisone or prednisolone compared with mitoxantrone plus prednisone or prednisolone, which was assumed to represent best supportive care. The NICE final scope identified a further three comparators: abiraterone in combination with prednisone or prednisolone; enzalutamide; and radium-223 dichloride for the subgroup of people with bone metastasis only (no visceral metastasis). The company did not consider radium-223 dichloride to be a relevant comparator. Neither abiraterone nor enzalutamide has been directly compared in a trial with cabazitaxel. Instead, clinical evidence was synthesised within a network meta-analysis (NMA). Results from TROPIC showed that cabazitaxel was associated with a statistically significant improvement in both overall survival and progression-free survival compared with mitoxantrone. Results from a random-effects NMA, as conducted by the company and updated by the ERG, indicated that there was no statistically significant difference between the three active treatments for both overall survival and progression-free survival. Utility data were not collected as part of the TROPIC trial, and were instead taken from the company's UK early access programme. Evidence on resource use came from the TROPIC trial, supplemented by both expert clinical opinion and a UK clinical audit. List prices were used for mitoxantrone, abiraterone and enzalutamide as directed by NICE, although commercial in-confidence patient-access schemes (PASs) are in place for abiraterone and enzalutamide. The confidential PAS was used for cabazitaxel. Sequential use of the advanced hormonal therapies (abiraterone and enzalutamide) does not usually occur in clinical practice in the UK. Hence, cabazitaxel could be used within two pathways of care: either when an advanced hormonal therapy was used pre-docetaxel, or when one was used post-docetaxel. The company believed that the former pathway was more likely to represent standard National Health Service (NHS) practice, and so their main comparison was between cabazitaxel and mitoxantrone, with effectiveness data from the TROPIC trial. Results of the company's updated cost-effectiveness analysis estimated a probabilistic incremental cost-effectiveness ratio (ICER) of £45,982 per quality-adjusted life-year (QALY) gained, which the committee considered to be the most plausible value for this comparison. Cabazitaxel was estimated to be both cheaper and more effective than abiraterone. Cabazitaxel was estimated to be cheaper but less effective than enzalutamide, resulting in an ICER of £212,038 per QALY gained for enzalutamide compared with cabazitaxel. The ERG noted that radium-223 is a valid comparator (for the indicated sub-group), and that it may be used in either of the two care pathways. Hence, its exclusion leads to uncertainty in the cost-effectiveness results. In addition, the company assumed that there would be no drug wastage when cabazitaxel was used, with cost-effectiveness results being sensitive to this assumption: modelling drug wastage increased the ICER comparing cabazitaxel with mitoxantrone to over £55,000 per QALY gained. The ERG updated the company's NMA and used a random effects model to perform a fully incremental analysis between cabazitaxel, abiraterone, enzalutamide and best supportive care using PASs for abiraterone and enzalutamide. Results showed that both cabazitaxel and abiraterone were extendedly dominated by the combination of best supportive care and enzalutamide. Preliminary guidance from the committee, which included wastage of cabazitaxel, did not recommend its use. In response, the company provided both a further discount to the confidential PAS for cabazitaxel and confirmation from NHS England that it is appropriate to supply and purchase cabazitaxel in pre-prepared intravenous-infusion bags, which would remove the cost of drug wastage. As a result, the committee recommended use of cabazitaxel as a treatment option in people with an Eastern Cooperative Oncology Group performance status of 0 or 1 whose disease had progressed during or after treatment with at least 225 mg/m(2) of docetaxel, as long as it was provided at the discount agreed in the PAS and purchased in either pre-prepared intravenous-infusion bags or in vials at a reduced price to reflect the average per-patient drug wastage.

Thyroid function in multidrug-resistant tuberculosis patients with or without human immunodeficiency virus (HIV) infection before commencement of MDR-TB drug regimen.

Background: Mycobacterium tuberculosis and human immunodeficiency virus (HIV) are known to cause abnormal thyroid function. There is little information on whether HIV infection aggravates alteration of thyroid function in patients with MDRTB. Objectives: This study was carried out to determine if HIV co-infection alters serum levels of thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH) in patients with MDR-TB patients and to find out the frequency of subclinical thyroid dysfunction before the commencement of MDR-TB therapy. Methods: This observational and cross-sectional study involved all the newly admitted patients in MDR-TB Referral Centre, University College Hospital, Ibadan, Nigeria between July 2010 and December 2014. Serum levels of thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were determined using ELISA. Results: Enrolled were 115 patients with MDR-TB, out of which 22 (19.13%) had MDR-TB/HIV co-infection. Sick euthyroid syndrome (SES), subclinical hypothyroidism and subclinical hyperthyroidism were observed in 5 (4.35%), 9 (7.83%) and 2 (1.74%) patients respectively. The median level of TSH was insignificantly higher while the median levels of T3 and T4 were insignificantly lower in patients with MDR-TB/HIV co-infection compared with patients with MDRT-TB only. Conclusion: It could be concluded from this study that patients with MDR-TB/HIV co-infection have a similar thyroid function as patients having MDR-TB without HIV infection before commencement of MDR-TB drug regimen. Also, there is a possibility of subclinical thyroid dysfunction in patients with MDR-TB/HIV co-infection even, before the commencement of MDR-TB therapy.

Remote Ischemic Conditioning Influences Mitochondrial Dynamics

International audience

A new method for conditioning stochastic groundwater flow models in fractured media

Many geological formations consist of crystalline rocks that have very low matrix permeability but allow flow through an interconnected network of fractures. Understanding the flow of groundwater through such rocks is important in considering disposal of radioactive waste in underground repositories. A specific area of interest is the conditioning of fracture transmissivities on measured values of pressure in these formations. This is the process where the values of fracture transmissivities in a model are adjusted to obtain a good fit of the calculated pressures to measured pressure values. While there are existing methods to condition transmissivity fields on transmissivity, pressure and flow measurements for a continuous porous medium there is little literature on conditioning fracture networks. Conditioning fracture transmissivities on pressure or flow values is a complex problem because the measurements are not linearly related to the fracture transmissivities and they are also dependent on all the fracture transmissivities in the network. We present a new method for conditioning fracture transmissivities on measured pressure values based on the calculation of certain basis vectors; each basis vector represents the change to the log transmissivity of the fractures in the network that results in a unit increase in the pressure at one measurement point whilst keeping the pressure at the remaining measurement points constant. The fracture transmissivities are updated by adding a linear combination of basis vectors and coefficients, where the coefficients are obtained by minimizing an error function. A mathematical summary of the method is given. This algorithm is implemented in the existing finite element code ConnectFlow developed and marketed by Serco Technical Services, which models groundwater flow in a fracture network. Results of the conditioning are shown for a number of simple test problems as well as for a realistic large scale test case.

Therapeutic education, the premise of adherence to the type 2 diabetes therapeutic regimen

Background: type 2 diabetes mellitus includes changes in lifestyle in its etiology of prevention, but the evidence is clear —even when people know what to do and what they want to do, they simply do not adopt adherence behaviors. Structured education will allow improving not only metabolic control, but also the adjustment process to a new situation of disease, as well as to develop the patient’s skills in order to make him the key manager of his illness. Objectives: To determine patients’ adherence to prescribed therapeutic regimens. Material and methods: Quantitative, cross-sectional, non-experimental, descriptive, correlational study, with a sample of 102 people with type 2 diabetes, aged between 40 and 85 years old, mostly male (51.96%). The evaluation protocol included social-demographic and clinical questionnaire, Diabetes Self-care Scale and a questionnaire on Diabetes’ knowledge. We also used HbA1c in order to directly assess adherence. Results: It appears that there is no statistically signiicant correlation between socio-demographic variables such as gender and age and adherence. Variables, such as blood glucose monitoring, speciic diet compliance and knowledge, reveal a statistically signiicant effect on adherence (P < .05). Conclusion: The evidence is clear on the urgent need to recognize the importance of measuring patient adherence to a diabetes treatment plan for the maintenance of glycaemic control. We suggest the reinforcement of educational programs in people with type 2 diabetes so as to improve adherence to self-care.

Adherence to therapeuthic regimen and metabolic control of type 1 diabetes

Abstract Objectives: To assess the adherence to therapeutic regimen; to determine the Hemoglobin Glycation Index (HbA1c); to analyse the relationship that exists between the adherence to therapeutic regimen and metabolic control. Design: correlational analytical study, carried out according to a cross-sectional perspective. Participants: A non-probabilistic sample of 266 people with type 1 diabetes aged between 18 and 78 years old (mean M = 51.02 ± SD = 18.710), attending follow-up diabetes consultations. Mostly male individuals (51.88%), with low schooling level (50.75% had only inished elementar school). Measuring Instruments: We used the following data collection tools: a questionnaire on clinical and socio-demographic data, blood analysis of venous blood to determine the glycated hemoglobin level (HbA1c).Three self-report scales were used: Accession to Diabetes Treatment (Matos, 1999), Self-perception Scale (Vaz Serra, 1986) and Social Support Scale (Matos & Rodrigues, 2000). Results: In a sample in which the mean disease duration is 12.75 years, 69.17% of the sample run glycemic control tests between once a day and four times a year and 42.86% of them undergo insulin treatment. In the last 3 weeks, 26.32% of these people have experienced an average of 4.22 to 44.36%, hypoglycemic crises and experienced an average of 6.18 hyperglycemic crises. 57% of the individuals have showed a poor metabolic control (mean HbA1c higher than 7.5% (HbA1c mean M ≥ 7.50%). The mean psychosocial proile revealed individuals who show a decent self-esteem (M = 70.81) and acceptable social support (M = 58.89). Conclusions: The results suggest we should develop a kind of investigation that could be used to monitor the strenght of the mediation effect effect of the psychosocial predictive dimension of the adherence, since it has become essential to support a multidisciplinary approach which center lays in the promotion of a co-responsible self-management from the person who suffers from diabetes. This will enable a better quality of life; fewer years of people’s lives lost prematurely and a better health with less economical costs for citizens and healthcare systems.

Geographical patterns of the species richness of helminth parasites of moles (Talpa spp.) in Spain: Separating the effects of sampling effort from those of other conditioning factors

We analysed the viscera of 534 moles (Ta l p a spp.) from 30 of the 47 provinces of peninsular Spain, including 255 individuals of T. europaea from eight provinces, 154 individuals of T. occidentalis from 20 provinces, and 125 unidentified Ta l p a individuals from two provinces. We identified their helminth parasites and determined parasite species richness. We related parasite species richness with sampling effort using both a linear and a logarithmic function. We then performed stepwise linear regressions to predict mole parasite species richness from a small set of selected predictor variables that included sampling effort. We applied the resulting models to forecast T. euro p a e a, T. occidentalis, and Ta l p a spp. parasite species richness in all provinces with recorded host presence, assuming different levels of sampling eff o r t . F i n a l l y, we used partial regression analysis to partition the variation explained by each of the selected variables in the models. We found that mole parasite species richness is strongly conditioned by sampling effort, but that other factors such as cropland area and environmental disturbance have significant independent effects.

Effects of dry-land strength and conditioning programs in age group swimmers

Context: Even though dry-land S&C training is a common practice in swimming, there are countless uncertainties over it effects in performance of age group swimmers. Objective: To investigate the effects of dry-land S&C programs in swimming performance of age group swimmers. Participants: A total of 21 male competitive swimmers (12.7±0.7 years) were randomly assigned to the Control Group (n=7) and experimental GR1 and GR2 (n=7 for each group). Intervention: Control group performed a 10-week training period of swim training alone, GR1 followed a 6-week dry-land S&C program based on sets/repetitions plus a 4-week swim training program alone and GR2 followed a 6-week dry-land S&C program focused on explosiveness, plus a 4-week program of swim training alone. Results: For the dry-land tests a time effect was observed between week 0 and week 6 for vertical jump (p<0.01) in both experimental groups, and for the GR2 ball throwing (p<0.01), with moderate-strong effect sizes. The time*group analyses showed that for performance in 50 m, differences were significant, with the GR2 presenting higher improvements than their counterparts (F=4.156; ƿ=0.007; η2=0.316) at week 10. Conclusions: The results suggest that 6 weeks of a complementary dry-land S&C training may lead to improvements in dry-land strength. Furthermore, a 4-week adaptation period was mandatory to achieve beneficial transfer for aquatic performance. Additional benefits may occur if coaches plan the dry-land S&C training focusing on explosiveness.