Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism.

Protein energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with adverse clinical outcomes, especially in individuals receiving maintenance dialysis therapy. A multitude of factors can affect the nutritional and metabolic status of CKD patients requiring a combination of therapeutic maneuvers to prevent or reverse protein and energy depletion. These include optimizing dietary nutrient intake, appropriate treatment of metabolic disturbances such as metabolic acidosis, systemic inflammation, and hormonal deficiencies, and prescribing optimized dialytic regimens. In patients where oral dietary intake from regular meals cannot maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is shown to be effective in replenishing protein and energy stores. In clinical practice, the advantages of oral nutritional supplements include proven efficacy, safety, and compliance. Anabolic strategies such as anabolic steroids, growth hormone, and exercise, in combination with nutritional supplementation or alone, have been shown to improve protein stores and represent potential additional approaches for the treatment of PEW. Appetite stimulants, anti-inflammatory interventions, and newer anabolic agents are emerging as novel therapies. While numerous epidemiological data suggest that an improvement in biomarkers of nutritional status is associated with improved survival, there are no large randomized clinical trials that have tested the effectiveness of nutritional interventions on mortality and morbidity.

Refrigeració de les gillettes d’ una talladora industrial

L’empresa Proslit Equipment forma part del Grup Comexi i la seva activitat consisteix en la fabricació de màquines talladores de material flexible. Degut als avenços tecnològics, s’han incrementat les prestacions de les seves màquines, entre altres coses, s’ha augmentat la velocitat de tall del film fins a 800 m/min. Aquest factor afegit a condicionants com per exemple treballar amb materials gruixuts i abrasius, a temperatures ambientals elevades, etc. fa que sorgeixi una problemàtica en el tall gillette. Degut a la fricció entre el film que circula i les gillettes que el tallen, es crea una energia calorífica que fa augmentar la temperatura de les gillettes fins a tal extrem que aquestes provoquen petites fusions del plàstic, aquest s’incrusta a les gillettes que s’acaben trencant. L’objecte principal d’aquest projecte és fer una anàlisi tècnica mitjançant elements finits de la problemàtica que s’ha detectat a les màquines talladores de l’empresa Proslit Equipment, concretament de l’escalfament de les gillettes utilitzades en el sistema de tall. Es pretén crear un model teòric que s’aproximi al màxim a la realitat de manera que es pugui observar el comportament tèrmic del sistema de tall en funció de les condicions que es determinin com a més desfavorables. Una vegada s’obtinguin aquests resultats teòrics, es valoraran i es proposaran solucions

Finca-Museo agroindustrial San Julián : proyecto para la difusión y la conservación del patrimonio industrial de Guatemala

Disseny d'un espai multidisciplinar que permeti l'interpretació del Patrimoni Industrial i Cultural de la Finca agroindustrial de San Julián (Guatemala), amb l'objectiu de fomentar la difusió i la conservació del Patrimonio Industrial del país

Projecte de nau industrial sostenible

La majoria de naus industrials són edificis contenidors, senzills, modulars i, sobretot, concebuts com a edificis rendibles, sense tenir en compte criteris de protecció del medi ambient. En el projecte s’ha optat per fer el disseny i càlcul d’una nau industrial prefabricada de formigó armat per a la fabricació de maquinària per la indústria agroalimentària, amb dos nivells d’oficines, zona de producció amb pont grua, laboratoris i magatzems amb una superfície total aproximada de 1800 m². Per tal que sigui un edifici sostenible, s’ha optat per la instal·lació de plaques solars fotovoltaiques, aïllament tèrmic, aprofitament d’aigües plujanes, gestió de residus, aprofitament òptim, il·luminació natural, estalvi d’energia a causa d'una bona gestió dels recursos energètics

Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel.

CONTEXT: Recent data regarding the consequences of untreated human immunodeficiency virus (HIV) infection and the expansion of treatment choices for antiretroviral-naive and antiretroviral-experienced patients warrant an update of the International AIDS Society-USA guidelines for the use of antiretroviral therapy in adults with HIV infection. OBJECTIVES: To provide updated recommendations for management of HIV-infected adults, using antiretroviral drugs and laboratory monitoring tools available in the international, developed-world setting. This report provides guidelines for when to initiate antiretroviral therapy, selection of appropriate initial regimens, patient monitoring, when to change therapy, and what regimens to use when changing. DATA SOURCES AND STUDY SELECTION: A panel with expertise in HIV research and clinical care reviewed relevant data published or presented at selected scientific conferences since the last panel report through April 2010. Data were identified through a PubMed search, review of scientific conference abstracts, and requests to antiretroviral drug manufacturers for updated clinical trials and adverse event data. DATA EXTRACTION AND SYNTHESIS: New evidence was reviewed by the panel. Recommendations were drafted by section writing committees and reviewed and edited by the entire panel. The quality and strength of the evidence were rated and recommendations were made by full panel consensus. CONCLUSIONS: Patient readiness for treatment should be confirmed before initiation of antiretroviral treatment. Therapy is recommended for asymptomatic patients with a CD4 cell count < or = 500/microL, for all symptomatic patients, and those with specific conditions and comorbidities. Therapy should be considered for asymptomatic patients with CD4 cell count > 500/microL. Components of the initial and subsequent regimens must be individualized, particularly in the context of concurrent conditions. Patients receiving antiretroviral treatment should be monitored regularly; treatment failure should be detected and managed early, with the goal of therapy, even in heavily pretreated patients, being HIV-1 RNA suppression below commercially available assay quantification limits.

Projecte constructiu d’una nau industrial

Definició d’una nau industrial per a magatzem frigorífic mitjançant lamemòria tècnica, els plànols i els càlculs ubicada al terme municipal de Begur (Baix Empordà)

Trends in qualifying biomarkers in drug safety. Consensus of the 2011 meeting of the spanish society of clinical pharmacology.

In this paper we discuss the consensus view on the use of qualifying biomarkers in drug safety, raised within the frame of the XXIV meeting of the Spanish Society of Clinical Pharmacology held in Málaga (Spain) in October, 2011. The widespread use of biomarkers as surrogate endpoints is a goal that scientists have long been pursuing. Thirty years ago, when molecular pharmacogenomics evolved, we anticipated that these genetic biomarkers would soon obviate the routine use of drug therapies in a way that patients should adapt to the therapy rather than the opposite. This expected revolution in routine clinical practice never took place as quickly nor with the intensity as initially expected. The concerted action of operating multicenter networks holds great promise for future studies to identify biomarkers related to drug toxicity and to provide better insight into the underlying pathogenesis. Today some pharmacogenomic advances are already widely accepted, but pharmacogenomics still needs further development to elaborate more precise algorithms and many barriers to implementing individualized medicine exist. We briefly discuss our view about these barriers and we provide suggestions and areas of focus to advance in the field.

Gestió d'un magatzem recanvis industrial

El treball final de carrera tracta l'estudi i disseny de la gestió d'un magatzem, en particular enfocat a un magatzem de recanvis d'una empresa de caire industrial, que a banda d'utilitzar els materials per a realitzar el manteniment dels equips productius també els necessita per a la construcció d'automatismes per a la automatització del procés productiu. L'estudi esta enfocat a una posterior parametrització e implementació mitjançant SAP R/3, ja que aquest ERP és una de les eines més potents que existeixen al mercat mundial per la gestió de magatzems, amb el valor afegit d'integrar el sistema de emmagatzematge amb la resta de àrees funcionals de l'empresa.

Evaluation of work-related volatile organic compounds (VOCs) exposition in automotive painting cabins industrial cleanings

Automotive painting cabins are cleaned with several solvents, being great part of them mixtures of volatile organic compounds (VOCs), where the three xylene isomers are the most important constituents. To evaluate the work-related exposition of the cleaners that use these mixtures of solvents, xylenes have been determined in the working ambient air as well as its metabolite, o-m-p-methyl hippuric acid, has been analysed in urine to establish the dermal and respiratory exposition. This evaluation has been done in order to assess the occupational exposure to VOCs and to know the working conditions of the cleaners, but also to evaluate the effectiveness of personal protective equipment (PPE), the engineering control and the work practices.The xylenes have been chosen as indicators of exposition because they are the main components in the cleaning solvents used, with a level of concentration between 50% and 85%.The Xylenes have an occupational exposure limit (8 h TWA) of 50 ppm (221 mg/m3) and a short-term exposure limit (STEL) of 100 ppm (442 mg/m3). On the other hand, the biological exposure index (BEI) for xylenes is the sum of the total methyl hippuric acids in urine at the end of the work-shift, being the value 1500 mg/g creatinine.

Dashboard industrial: panell d'indicadors per gestionar una fàbrica d'una multinacional del sector d'automoció

En el context de globalització i competitivitat actuals, sobretot en el sectord’automoció, les diferències competitives entre empreses o companyies estàcada vegada més relacionada amb els factors immaterials, tals com elconeixement, la investigació, el desenvolupament tecnològic i la qualificaciódels recursos humans i l’eficiència en la gestió.L’eficiència en la gestió és bàsica per aconseguir un plus de competitivitatque és clau per satisfer els clients, i per tant, també per agilitzar lesorganitzacions i posar-les a punt per a nous reptes i per a nous models denegoci per donar resposta a la demanda de la canviant i exigent societat.Aquest treball exposa un exemple d’un sistema de gestió basat en el panelld’indicadors (“Dashboard Industrial”) per una planta d’una multinacional delsector d’automoció.Aquesta eina, que està alineada amb l’estratègia de la companyia, es potextrapolar altres empreses i a altres sectors. Està basada en lametodologia PDCA (Plan Do Check Act) és a dir planificant objectius,posant-los en pràctica mesurant-los periòdicament i prenent decisions per lamillora contínua dels resultats de cada una dels indicadors.Sens dubte, l’eficiència en la gestió és un dels factors clau per lesorganitzacions amb ànim innovador i competitiu.En el treball també es destaca la importància que té la tasca dels enginyersen la gestió al llarg de la seva vida laboral.

Official Positions for FRAX(®) clinical regarding glucocorticoids: the impact of the use of glucocorticoids on the estimate by FRAX(®) of the 10 year risk of fracture from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®).

Given the significant impact the use of glucocorticoids can have on fracture risk independent of bone density, their use has been incorporated as one of the clinical risk factors for calculating the 10-year fracture risk in the World Health Organization's Fracture Risk Assessment Tool (FRAX(®)). Like the other clinical risk factors, the use of glucocorticoids is included as a dichotomous variable with use of steroids defined as past or present exposure of 3 months or more of use of a daily dose of 5 mg or more of prednisolone or equivalent. The purpose of this report is to give clinicians guidance on adjustments which should be made to the 10-year risk based on the dose, duration of use and mode of delivery of glucocorticoids preparations. A subcommittee of the International Society for Clinical Densitometry and International Osteoporosis Foundation joint Position Development Conference presented its findings to an expert panel and the following recommendations were selected. 1) There is a dose relationship between glucocorticoid use of greater than 3 months and fracture risk. The average dose exposure captured within FRAX(®) is likely to be a prednisone dose of 2.5-7.5 mg/day or its equivalent. Fracture probability is under-estimated when prednisone dose is greater than 7.5 mg/day and is over-estimated when the prednisone dose is less than 2.5 mg/day. 2) Frequent intermittent use of higher doses of glucocorticoids increases fracture risk. Because of the variability in dose and dosing schedule, quantification of this risk is not possible. 3) High dose inhaled glucocorticoids may be a risk factor for fracture. FRAX(®) may underestimate fracture probability in users of high dose inhaled glucocorticoids. 4) Appropriate glucocorticoid replacement in individuals with adrenal insufficiency has not been found to increase fracture risk. In such patients, use of glucocorticoids should not be included in FRAX(®) calculations.

Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.

Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.