MA311exam 1999 pdf

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Efecto de ajuste del flujo dializante (Qd) sobre la eficacia en hemodialisis a pacientes de bajo peso

Introducción: Las guías KDOQI del 2006 utilizan patrón de adecuación de diálisis el Kt/V, donde V es volumen de distribución de la úrea, pacientes de bajo peso tienen menor agua corporal total, menor V, que podrían reducir el requerimiento de Qd sin afectar la eficiencia de la diálisis. Objetivo: Evaluar el efecto sobre la adecuación de hemodiálisis que produce la reducción del Qd en pacientes con peso menor o igual a 60 kg . Metodología: Se incluyeron pacientes con Enfermedad Renal crónica en hemodiálisis de forma regular con peso menor o igual a 60 Kg de la unidad renal, para evaluar dos períodos I y II, se continuaron los parámetros de la terapia, con descenso del Qd para el segundo período . Las variables fueron recolectadas de forma directa por los investigadores de la historia clínica . Los valores así obtenidos serían comparados mediante prueba t para variables relacionadas o pareadas, y significancia estadística de la prueba inferior a 0,05. Resultados: Se incluyeron 61 pacientes, el 60.7% sexo femenino, promedio de edad 57,3 años (DE 14,8). Edad promedio de los hombres 60,1 (DE 13,9) y de las mujeres fue de 55,9 (DE 15,4). No se encontraron diferencias estadísticamente significativas para las variables Kt/V y Hb, con descenso significativo del P. (p 0.015) Conclusiones: Este estudio demuestra que se logra una adecuada terapia con Qd inferiores a los estándares tradicionales, con 400ml /min en pacientes de bajo peso, siempre y cuando se mantengan los demás parámetros de suplencia renal.

Teoría de restricciones aplicada a la cadena de suministros en un operador logístico de productos farmacéuticos

En las instituciones hospitalarias es fundamental el tema relacionado con los medicamentos y dispositivos médicos para la atención del paciente, por lo tanto el mecanismo de adquisición y disponibilidad de éstos productos, ha llevado a la participación masiva de operadores logísticos (Outsoursing) interviniendo áreas de la cadena de suministros, desde el punto de fabricación con el producto terminado hasta la dispensación del medicamento o dispositivo médico, para que ser usado o administrado al paciente. Los operadores logísticos han emprendido una búsqueda de soluciones por medio de diferentes metodologías y estrategias que permitan entregar a tiempo en las farmacias hospitalarias, conservando las propiedades físicas y químicas de los medicamentos y dispositivos médicos, garantizando así la calidad de los productos. En ésta tesis se plantea una nueva alternativa de gestión de medicamentos y dispositivos médicos en un operador logístico de productos farmacéuticos a través de la teoría de restricciones (TOC), para emprender acciones que permitan analizar el sistema bajo esta metodología, intervenir de manera oportuna, impactar y estimular al personal a trabajar en la búsqueda del mejoramiento , aumentando a su vez la velocidad del flujo de operación en toda la cadena de suministros, basada no en el mejoramiento de los óptimos locales o de los subprocesos sino en la identificación de la verdadera restricción del sistema, permitiendo realizar un análisis más a fondo encontrando el conflicto raíz para mejorar el sistema a nivel global.

Diseño de una propuesta de mejoramiento de la gestión administrativa del hospital el tunal, mediante la aplicación de la filosofía de teoría de restricciones (TOC)

El objetivo de este trabajo es presentar el diseño de un proyecto de mejora a través de la filosofía TOC para la gestión Administrativa del Hospital El Tunal del Nivel III de Bogotá DC, durante el período 2013. Para lograr el objetivo de la propuesta de mejoramiento basada en la filosofía TOC (Inglés siglas Theory of Constraints), se centra en crear un proceso de mejora continua en la gestión administrativa del Hospital El Tunal. Esta entidad es una Empresa Social del Estado y tiene por objeto la prestación de servicios de salud a usuarios que presentan algún tipo de enfermedad o trastorno orgánico que afecta su salud; se centra en mejorar, corregir y proporcionar una mejor calidad de vida al usuario que viene a cubrir sus necesidades de salud. Este producto de investigación terminará con una propuesta centrada en la mejora de la gestión administrativa, basada en la filosofía TOC aplicado a la cartera morosa, tratando de ofrecer una serie de soluciones a los problemas actuales que impactan estas organizaciones centrándose en la mejora continua, la velocidad de flujo de los recursos administrativos, verificando si es eficaz en beneficio de los usuarios y los profesionales de la salud.

Aprofitament de residus vegetals per a la concentració i separació d'ions metàl·lics de solucions aquoses

La adsorció sobre carbó actiu és un tractament habitual para a l'eliminació de metalls contaminants d'afluents aquosos. Amb la finalitat de reduir el cost dels tractament actuals s'està estudiant la utilització d'adsorbents de baix cost com a substituts dels sorbents convencionals que s'utilitzen usualment en els tractaments d'aigües. En aquesta tesi s'ha avaluat la possibilitat d'aprofitar diversos residus vegetals procedents de processos agrícoles o residus industrials, com a sorbents per a l'eliminació de metalls de solucions aquoses. En concret, el treball s'ha centrat en assolir dos grans objectius, primer de tot, conèixer la possibilitat d'utilitzar el pinyol d'oliva com a adsorbent de metalls divalents de solucions aquoses, com són el Cd(II), Cu(II), Ni(II) i Pb(II), i en segon lloc, avaluar la utilització de quatre residus vegetals (escorça de yohimbe, rapa de raïm, suro i pinyol d'oliva) per a l'extracció de Cr(VI) de solucions aquoses i utilitzar el residu vegetal més apropiat com a base per tal d'obtenir un nou sorbent, amb més bona morfologia per ser utilitzat en sistemes d'eliminació de Cr(VI) en continu. Les dades cinètiques d'adsorció es van tractar amb el model cinètic de pseudo-segon ordre, amb el que es van determinar la velocitat inicial d'adsorció dels metalls. Els models d'isotermes d'equilibri de Langmuir i Freundlich es van utilitzar per descriure els equilibris d'adsorció i calcular els paràmetres de les isotermes. En els assajos amb mescles binàries de metalls, els resultats es van tractar amb el model ampliat de Langmuir. En aquest treball s'ha determinat, primerament, que el pinyol d'oliva és un bon sorbent dels metalls divalents estudiats. S'ha determinat que l'adsorció dels metalls varia amb el pH de la solució i que la presència de sals en la solució provoca una davallada en l'adsorció. També es va determinar la competència en l'adsorció entre els metalls al realitzar assajos en mescles binàries. Amb els estudis d'extracció de Cr(VI) amb els quatre materials s'ha determinat que aquests vegetals poden adsorbir el Cr(VI) en solució, tot i que la rapa i la yohimbe són els materials que presenten unes capacitats d'adsorció més elevades. Les anàlisis amb espectroscòpia electrònica de Raig-X realitzats en la rapa de raïm i la yohimbe en contacte amb Cr(VI) varen demostrar la presència del metall en els dos estats d'oxidació, Cr(VI) i Cr(III), evidenciant la participació del mecanisme de reducció de Cr(VI) en l'adsorció del metall sobre els materials. Amb l'encapsulació de la rapa de raïm es va incrementar significativament la capacitat d'adsorció del metall respecta a la seva utilització en la forma original. Les dades experimentals es van tractar amb un model de difusió i es va determinar el coeficient de difusió en l'adsorció en el sorbent amb diferent percentatge de rapa en l'interior. Finalment s'han realitzat estudis preliminars d'adsorció de crom hexavalent en continu utilitzant columnes de petites dimensions farcides amb el sorbent format per boles de rapa encapsulada en alginat càlcic. En aquests assajos s'ha determinat l'efecte en l'adsorció de metall de diversos paràmetres d'operació, com la concentració inicial de metall, el cabal i l'alçada de llit. El model de transferència de matèria i difusió en columna emprat pel tractament de les dades experimentals va mostrar l'efecte de la concentració inicial i del cabal en els coeficients de difusió i transferència de matèria. El model BDST no va predir correctament el temps de servei en els diferents paràmetres d'operació experimentats a causa de la complexitat del procés d'adsorció. Amb aquests assajos preliminars s'han establert les bases de l'adsorció de Cr(VI) amb el nou sorbent en sistemes en continu amb la finalitat de realitzar estudis posteriors d'eliminació del metall en columnes de majors dimensions.

An integrative model of amino acid metabolism in the liver of the lactating dairy cow

The objective of this work was to construct a dynamic model of hepatic amino acid metabolism in the lactating dairy cow that could be parameterized using net flow data from in vivo experiments. The model considers 22 amino acids, ammonia, urea, and 13 energetic metabolites, and was parameterized using a steady-state balance model and two in vivo, net flow experiments conducted with mid-lactation dairy cows. Extracellular flows were derived directly from the observed data. An optimization routine was used to derive nine intracellular flows. The resulting dynamic model was found to be stable across a range of inputs suggesting that it can be perturbed and applied to other physiological states. Although nitrogen was generally in balance, leucine was in slight deficit compared to predicted needs for export protein synthesis, suggesting that an alternative source of leucine (e.g. peptides) was utilized. Simulations of varying glucagon concentrations indicated that an additional 5 mol/d of glucose could be synthesized at the reference substrate concentrations and blood flows. The increased glucose production was supported by increased removal from blood of lactate, glutamate, aspartate, alanine, asparagine, and glutamine. As glucose Output increased, ketone body and acetate release increased while CO2 release declined. The pattern of amino acids appearing in hepatic vein blood was affected by changes in amino acid concentration in portal vein blood, portal blood flow rate and glucagon concentration, with methionine and phenylalanine being the most affected of essential amino acids. Experimental evidence is insufficient to determine whether essential amino acids are affected by varying gluconeogenic demands. (C) 2004 Published by Elsevier Ltd.

Modelling heterotachy in phylogenetic inference by reversible-jump Markov chain Monte Carlo

The rate at which a given site in a gene sequence alignment evolves over time may vary. This phenomenon-known as heterotachy-can bias or distort phylogenetic trees inferred from models of sequence evolution that assume rates of evolution are constant. Here, we describe a phylogenetic mixture model designed to accommodate heterotachy. The method sums the likelihood of the data at each site over more than one set of branch lengths on the same tree topology. A branch-length set that is best for one site may differ from the branch-length set that is best for some other site, thereby allowing different sites to have different rates of change throughout the tree. Because rate variation may not be present in all branches, we use a reversible-jump Markov chain Monte Carlo algorithm to identify those branches in which reliable amounts of heterotachy occur. We implement the method in combination with our 'pattern-heterogeneity' mixture model, applying it to simulated data and five published datasets. We find that complex evolutionary signals of heterotachy are routinely present over and above variation in the rate or pattern of evolution across sites, that the reversible-jump method requires far fewer parameters than conventional mixture models to describe it, and serves to identify the regions of the tree in which heterotachy is most pronounced. The reversible-jump procedure also removes the need for a posteriori tests of 'significance' such as the Akaike or Bayesian information criterion tests, or Bayes factors. Heterotachy has important consequences for the correct reconstruction of phylogenies as well as for tests of hypotheses that rely on accurate branch-length information. These include molecular clocks, analyses of tempo and mode of evolution, comparative studies and ancestral state reconstruction. The model is available from the authors' website, and can be used for the analysis of both nucleotide and morphological data.

Seasonal 'fall out' of sessile macro-fauna from submarine cliffs: quantification, causes and implications

Submarine cliffs are typically crowded with sessile organisms, most of which are ultimately exported downwards. Here we report a 24 month study of benthic fauna dropping from such cliffs at sites of differing cliff angle and flow rates at Lough Hyne Marine Nature Reserve, Co. Cork, Ireland. The magnitude of 'fall out' material collected in capture nets was highly seasonal and composed of sessile and mobile elements. Sponges, ascidians, cnidarians, polychaetes, bryozoans and barnacles dominated the sessile forms. The remainder (mobile fauna) were scavengers and predators such as asteroid echinoderms, gastropod molluscs and malacostracan crustaceans. These were probably migrants targeting fallen sessile organisms. 'Fall out' material (including mobile forms) increased between May and August in both years. This increase in 'fall out' material was correlated with wrasse abundance at the cliffs (with a one month lag period). The activities of the wrasse on the cliffs (feeding, nest building and territory defence) were considered responsible for the majority of 'fall out' material, with natural mortality and the activity of other large mobile organisms (e.g. crustaceans) also being triplicated. Current flow rate and cliff profile were important in amount of 'fall out' material collected. In low current situations export of fallen material was vertical, while both horizontal and vertical export was associated with moderate to high current environments. Higher 'fall out' was associated with overhanging than vertical cliff surfaces. The 'fall out' of marine organisms in low current situations is likely to provide ail important source of nutrition in close proximity to the cliff, in an otherwise impoverished soft sediment habitat. However, in high current areas material will be exported some distance from the source, with final settlement again occurring in soft sediment habitats (as current speed decreases).

The trapping and decomposition of toxic gases such as hydrogen cyanide using modified mesoporous silicates

Selected silicas were modified with the covalently bound ligand 2,6-bis(benzoxazoyl)pyridine (BBOP), equilibrated with copper(II) nitrate, then challenged with toxic vapour containing HCN (8000 mg m(-3) at 80% relative humidity). The modified SBA-15 material (Cu-BBOP-SBA-15) had an improved breakthrough time for HCN (36 min at a flow rate of 30 cm(3) min(-1)) when compared to the other siliceous materials prepared in this study, equating to a hydrogen cyanide capacity of 58 mg g(-1), which is close to a reference activated carbon adsorbent (24 min at 50 cm(3) min(-1)) that can trap 64 mg g(-1). The enhanced performance observed with Cu-BBOP-SBA-15 has been related to the greater accessibility of the functional groups, arising from the ordered nature of the interconnected porous network and large mesopores of 5.5 nm within the material modified with the Cu(II)-BBOP complex. Modified MCM-41 and MCM-48 materials (Cu-BBOP-MCM-41 and Cu-BBOP-MCM-48) were found to have lower hydrogen cyanide capacities (38 and 32 mg g(-1) respectively) than the Cu-BBOP-SBA-15 material owing to the restricted size of the pores (2.2 and <2 nm respectively). The materials with poor nano-structured ordering were found to have low hydrogen cyanide capacities, between 11 and 19 mg g(-1), most likely owing to limited accessibility of the functional groups. (C) 2004 Elsevier Inc. All rights reserved.

Effect of damper and heat source on wind catcher natural ventilation performance

Experimental wind tunnel and smoke visualisation testing and CFD modelling were conducted to investigate the effect of air flow control mechanism and heat source inside rooms on wind catchers/towers performance. For this purpose, a full-scale wind catcher was connected to a test room and positioned centrally in an open boundary wind tunnel. Pressure coefficients (C-p's) around the wind catcher and air flow into the test room were established. The performance of the wind catcher depends greatly on the wind speed and direction. The incorporation of dampers and egg crate grille at ceiling level reduces and regulates the air flow rate with an average pressure loss coefficient of 0.01. The operation of the wind catcher in the presence of heat sources will potentially lower the internal temperatures in line with the external temperatures.

Investigation of air quality, comfort parameters and effectiveness for two floor-level air supply systems in classrooms

The method of distributing the outdoor air in classrooms has a major impact on indoor air quality and thermal comfort of pupils. In a previous study, ([11] Karimipanah T, Sandberg M, Awbi HB. A comparative study of different air distribution systems in a classroom. In: Proceedings of Roomvent 2000, vol. II, Reading, UK, 2000. p. 1013-18; [13] Karimipanah T, Sandberg M, Awbi HB, Blomqvist C. Effectiveness of confluent jets ventilation system for classrooms. In: Idoor Air 2005, Beijing, China, 2005 (to be presented).) presented results for four and two types of air distribution systems tested in a purpose built classroom with simulated occupancy as well as computational fluid dynamics (CFD) modelling. In this paper, the same experimental setup has been used to investigate the indoor environment in the classroom using confluent jet ventilation, see also ([12]Cho YJ, Awbi HB, Karimipanah T. The characteristics of wall confluent jets for ventilated enclosures. In: Proceedings of Roomvent 2004, Coimbra, Portugal, 2004.) Measurements of air speed, air temperature and tracer gas concentrations have been carried out for different thermal conditions. In addition, 56 cases of CFD simulations have been carried to provide additional information on the indoor air quality and comfort conditions throughout the classroom, such as ventilation effectiveness, air exchange effectiveness, effect of flow rate, effect of radiation, effect of supply temperature, etc., and these are compared with measured data.

Reducing fouling during UHT treatment of goat's milk

Whole fresh goat's milk was heat treated at 135 degrees C for 4 s using a miniature UHT plant. The temperature of the milk in the preheating and sterilizer sections, and the milk flow rate were monitored to evaluate the overall heat transfer coefficient (OHTC). The decrease in OHTC was used to estimate the extent of fouling. Goat's milk fouled very quickly and run times of the UHT plant were short. The use of sodium hexametaphosphate, trisodium citrate and cation exchange resins to reduce ionic calcium prior to UHT processing, increased the pH and alcohol stability of the milk and markedly increased the run time of the UHT plant.

Separation of astaxanthin from cells of Phaffia rhodozyma using colloidal gas aphrons (CGA) in a flotation column

The aim of this study is to investigate the separation of astaxanthin from the cells of Phaffia rhodozyma using colloidal gas aphrons (CGA), which are surfactant stabilized microbubbles, in a flotation column. It was reported in previous studies that optimum recoveries are achieved at conditions that favor electrostatic interactions. Therefore, in this study, CGA generated from the cationic surfactant hexadecyl trimethyl ammonium bromide (CTAB) were applied to suspensions of cells pretreated with NaOH. The different operation modes (batch or continuous) and the effect of volumetric ratio of CGA to feed, initial concentration of feed, operating height, and flow rate of CGA on the separation of astaxanthin were investigated. The volumetric ratio was found to have a significant effect on the separation of astaxanthin for both batch and continuous experiments. Additionally, the effect of homogenization of the cells on the purity of the recovered fractions was investigated, showing that the homogenization resulted in increased purity. Moreover, different concentrations of surfactant were used for the generation of CGA for the recovery of astaxanthin on batch mode; it was found that recoveries up to 98% could be achieved using CGA generated from a CTAB solution 0.8 mM, which is below the CTAB critical micellar concentration (CMC). These results offer important information for the scale-up of the separation of astaxanthin from the cells of P. rhodozyma using CGA.

Natural ventilation assessment in typical open an semi-open urban environments under various wind directions

Semi-open street roofs protect pedestrians from intense sunshine and rains. Their effects on natural ventilation of urban canopy layers (UCL) are less understood. This paper investigates two idealized urban models consisting of 4(2×2) or 16(4×4) buildings under a neutral atmospheric condition with parallel (0°) or non-parallel (15°,30°,45°) approaching wind. The aspect ratio (building height (H) / street width (W)) is 1 and building width is B=3H. Computational fluid dynamic (CFD) simulations were first validated by experimental data, confirming that standard k-ε model predicted airflow velocity better than RNG k-ε model, realizable k–ε model and Reynolds stress model. Three ventilation indices were numerically analyzed for ventilation assessment, including flow rates across street roofs and openings to show the mechanisms of air exchange, age of air to display how long external air reaches a place after entering UCL, and purging flow rate to quantify the net UCL ventilation capacity induced by mean flows and turbulence. Five semi-open roof types are studied: Walls being hung above street roofs (coverage ratio λa=100%) at z=1.5H, 1.2H, 1.1H ('Hung1.5H', 'Hung1.2H', 'Hung1.1H' types); Walls partly covering street roofs (λa=80%) at z=H ('Partly-covered' type); Walls fully covering street roofs (λa=100%) at z=H ('Fully-covered' type).They basically obtain worse UCL ventilation than open street roof type due to the decreased roof ventilation. 'Hung1.1H', 'Hung1.2H', 'Hung1.5H' types are better designs than 'Fully-covered' and 'Partly-covered' types. Greater urban size contains larger UCL volume and requires longer time to ventilate. The methodologies and ventilation indices are confirmed effective to quantify UCL ventilation.

Quantitative ventilation assessments of idealized urban canopy layers with various urban layouts and the same building packing density

This paper investigates urban canopy layers (UCL) ventilation under neutral atmospheric condition with the same building area density (λp=0.25) and frontal area density (λf=0.25) but various urban sizes, building height variations, overall urban forms and wind directions. Turbulent airflows are first predicted by CFD simulations with standard k-ε model evaluated by wind tunnel data. Then air change rates per hour (ACH) and canopy purging flow rate (PFR) are numerically analyzed to quantify the rate of air exchange and the net ventilation capacity induced by mean flows and turbulence. With a parallel approaching wind (θ=0o), the velocity ratio first decreases in the adjustment region, followed by the fully-developed region where the flow reaches a balance. Although the flow quantities macroscopically keep constant, however ACH decreases and overall UCL ventilation becomes worse if urban size rises from 390m to 5km. Theoretically if urban size is infinite, ACH may reach a minimum value depending on local roof ventilation, and it rises from 1.7 to 7.5 if the standard deviation of building height variations increases (0% to 83.3%). Overall UCL ventilation capacity (PFR) with a square overall urban form (Lx=Ly=390m) is better as θ=0o than oblique winds (θ=15o, 30o, 45o), and it exceeds that of a staggered urban form under all wind directions (θ=0o to 45o), but is less than that of a rectangular urban form (Lx=570m, Ly=270m) under most wind directions (θ=30o to 90o). Further investigations are still required to quantify the net ventilation efficiency induced by mean flows and turbulence.