The Devil in the details: The factors determining the selection of intrazonal congestion management methods across Europe.

The European electricity market is becoming increasingly interconnected, raising questions about how intrazonal congestion management, typically governed by national regulations, interacts with the coupled cross-zonal markets. A major concern is the lack of information regarding intrazonal congestion management methods. This paper addresses this issue by examining different ways in which European transmission system operators (TSOs) use third-party resources to manage congestion in short-term electricity markets. We create a decision-tree-based classification to represent all identified congestion management methods and select three cases for comprehensive evaluation using predefined assessment criteria. While doing so, we identify a trade-off between efficiency and ease of implementation. The balance between these two factors is determined by the severity of the congestion. In a severely congested grid, locational signals are critical, requiring a better alignment between the network representation in the market clearing and the physical network constraints. When the congestion is less severe, TSOs can choose other congestion management methods based on factors such as the predictability of congestion and resource availability. These findings shed light on the complexities of congestion management in an integrated European market and can inform future policy decisions.

Design of Ti64/Ta Hybrid Materials by Powder Metallurgy Mimicking Bone Structure.

This work reports on the fabrication of a novel two-layer material composed of a porous tantalum core and a dense Ti6Al4V (Ti64) shell by powder metallurgy. The porous core was obtained by mixing Ta particles and salt space-holders to create large pores, the green compact was obtained by pressing. The sintering behavior of the two-layer sample was studied by dilatometry. The interface bonding between the Ti64 and Ta layers was analyzed by SEM, and the pore characteristics were analyzed by computed microtomography. Images showed that two distinct layers were obtained with a bonding achieved by the solid-state diffusion of Ta particles into Ti64 during sintering. The formation of ß-Ti and α' martensitic phases confirmed the diffusion of Ta. The pore size distribution was in the size range of 80 to 500 µm, and a permeability value of 6 × 10-10 m2 was close to the trabecular bones one. The mechanical properties of the component were dominated mainly by the porous layer, and Young's modulus of 16 GPa was in the range of bones. Additionally, the density of this material (6 g/cm3) was much lower than the one of pure Ta, which helps to reduce the weight for the desired applications. These results indicate that structurally hybridized materials, also known as composites, with specific property profiles can improve the response to osseointegration for bone implant applications.

Urban dynamics through the lens of human mobility.

The urban spatial structure represents the distribution of public and private spaces in cities and how people move within them. Although it usually evolves slowly, it can change quickly during large-scale emergency events, as well as due to urban renewal in rapidly developing countries. Here we present an approach to delineate such urban dynamics in quasi-real time through a human mobility metric, the mobility centrality index ΔKS. As a case study, we tracked the urban dynamics of eleven Spanish cities during the COVID-19 pandemic. The results revealed that their structures became more monocentric during the lockdown in the first wave, but kept their regular spatial structures during the second wave. To provide a more comprehensive understanding of mobility from home, we also introduce a dimensionless metric, KSHBT, which measures the extent of home-based travel and provides statistical insights into the transmission of COVID-19. By utilizing individual mobility data, our metrics enable the detection of changes in the urban spatial structure.

Sintering Analysis of Porous Ti/xTa Alloys Fabricated from Elemental Powders.

The present work is focused on developing Ti-xTa porous alloys processed by the space holder method and solid-state sintering. The volume fraction of Ta ranged between 20 and 30 wt.%. The sintering kinetics was evaluated by dilatometry tests. Sintered materials were characterized by SEM, XRD and computed tomography. Porosity features and permeability were determined from 3D images, and their mechanical properties were evaluated from microhardness and compression tests. The sintering behavior and the final microstructure are driven by the Ta diffusion into the Ti, slowing down the densification and modifying the transition temperature of α-to-ß. Due to ß-stabilization, martensite α' was obtained after sintering. Mechanical properties are reduced because of the ß-stabilization and pore addition, being predominantly the pore effect. Permeability depended on the pore characteristics, finding values close to the human bones. It was concluded that powder metallurgy generates highly TixTa alloys with a combination of α, ß and α' Ti phases as well as remaining Ta particles that are beneficial to improve the biocompatibility and osseointegration of such materials. Being the Ti25Ta40salt alloy the most suitable for orthopedic implants because of its characteristics and properties.

Ti64/20Ag Porous Composites Fabricated by Powder Metallurgy for Biomedical Applications.

We present a novel Ti64/20Ag highly porous composite fabricated by powder metallurgy for biomedical applications and provide an insight into its microstructure and mechanical proprieties. In this work, the Ti64/20Ag highly porous composites were successfully fabricated by the space holder technique and consolidated by liquid phase sintering, at lower temperatures than the ones used for Ti64 materials. The sintering densification was evaluated by dilatometry tests and the microstructural characterization and porosity features were determined by scanning electron microscopy and computed microtomography. Permeability was estimated by numerical simulations on the 3D real microstructure. Mechanical properties were evaluated by simple compression tests. Densification was achieved by interparticle pore filling with liquid Ag that does not drain to the large pores, with additional densification due to the macroscopical deformation of large pores. Pore characteristics are closely linked to the pore formers and the permeability was highly increased by increasing the pore volume fraction, mainly because the connectivity was improved. As expected, with the increase in porosity, the mechanical properties decreased. These results permitted us to gain a greater understanding of the microstructure and to confirm that we developed a promising Ti64/20Ag composite, showing E of 7.4 GPa, σy of 123 MPa and permeability of 3.93 × 10-11 m2. Enhanced adaptability and antibacterial proprieties due to Ag were obtained for bone implant applications.

Usefulness of the optic nerve sheath ultrasound in patients with cessation of cerebral flow.

Optic nerve sheath diameter (ONSD) ultrasound has proven to be a useful tool for the detection of intracranial hypertension (IH). The DVNO values, in patients with cessation of cerebral blood flow (CCBF), has not been clarified yet. OBJECTIVE: Establish an association between DVNO and CFSC in neurocritical patients admitted to an ICU. PATIENTS AND METHODS: Cross-sectional study of patients admitted in a third level ICU, between April 2017 and April 2018, with neurological pathology. ONSD ultrasound was performed in the first 24 h and as the patient was diagnosed of CCBF. The ONSD values of patients with and without diagnosis of CCBF were compared. RESULTS: 99 patients were included, 29 of whom showed CCBF in transcranial Doppler. The ONSD measurement did not demonstrate significant differences between both groups, 65.94 ±â€¯7.55 in the group with CCBF and 63.88 ±â€¯5.56 in the group without CCBF, p = 0.14. CONCLUSION: In our study, ONSD values capable of recognizing CCBF were not identified.

Electronic properties and reactivity of oxidized graphene nanoribbons and their interaction with phenol.

The effect of the oxidized functional groups on the structural, electronic, and reactivity properties of armchair graphene nanoribbons has been investigated in the framework of the density functional theory. The presence of functional groups near the edges stabilizes the oxidized graphene nanoribbons (OGNRs) more than substituting near the center. Overall, we found slight differences in the electronic properties of OGNRs concerning the pristine ones. The oxygen contribution of functional groups to the DOS is found in the conducting energy bands far from the Fermi level. Consequently, the semiconducting behavior is maintained after doping. Based on the reactivity of OGNRs, the most promising nanostructures were proposed as adsorbents studying the interaction and complexation with phenol, a critical pollutant removed mainly by hydrotreating processes (HDO) to produce bio-oil. Parallel and perpendicular phenol conformations were found towards the OGNRs in the optimized complexes driven by a physisorption process. These results provide significant insights for catalytic processes that use biomass derivatives containing phenolic compounds. The physisorption of streams containing pollutants on OGNRs could be adapted to new technological applications for the remotion of aromatic compounds under environmentally friendly operational conditions.

Deconstructing laws of accessibility and facility distribution in cities.

The era of the automobile has seriously degraded the quality of urban life through costly travel and visible environmental effects. A new urban planning paradigm must be at the heart of our road map for the years to come, the one where, within minutes, inhabitants can access their basic living needs by bike or by foot. In this work, we present novel insights of the interplay between the distributions of facilities and population that maximize accessibility over the existing road networks. Results in six cities reveal that travel costs could be reduced in half through redistributing facilities. In the optimal scenario, the average travel distance can be modeled as a functional form of the number of facilities and the population density. As an application of this finding, it is possible to estimate the number of facilities needed for reaching a desired average travel distance given the population distribution in a city.

Usefulness of the optic nerve sheath ultrasound in patients with cessation of cerebral flow. / Utilidad de la ecografía de la vaina del nervio óptico en pacientes con cese de flujo cerebral.

Optic nerve sheath diameter (ONSD) ultrasound has proven to be a useful tool for the detection of intracranial hypertension (IH). The ONSD values, in patients with cessation of cerebral blood flow (CCBF), has not been clarified yet. OBJECTIVE: Establish an association between ONSD and CCBF in neurocritical patients admitted to an ICU. PATIENTS AND METHODS: Cross-sectional study of patients admitted in a third level ICU, between April 2017 and April 2018, with neurological pathology. ONSD ultrasound was performed in the first 24 hours and as the patient was diagnosed of CCBF. The ONSD values of patients with and without diagnosis of CCBF were compared. RESULTS: 99 patients were included, 29 of whom showed CCBF in transcranial Doppler. The ONSD measurement did not demonstrate significant differences between both groups, 6,59 ± 0,75 in the group with CCBF and 6,39 ± 0,56 in the group without CCBF p=0.141. CONCLUSION: In our study, ONSD values capable of recognizing CCBF were not identified.

Development of a predictive model of hospitalization in primary care patients with heart failure.

BACKGROUND: Heart failure (HF) is the leading cause of hospitalization in people over age 65. Predictive hospital admission models have been developed to help reduce the number of these patients. AIM: To develop and internally validate a model to predict hospital admission in one-year for any non-programmed cause in heart failure patients receiving primary care treatment. DESIGN AND SETTING: Cohort study, prospective. Patients treated in family medicine clinics. METHODS: Logistic regression analysis was used to estimate the association between the predictors and the outcome, i.e. unplanned hospitalization over a 12-month period. The predictive model was built in several steps. The initial examination included a set of 31 predictors. Bootstrapping was used for internal validation. RESULTS: The study included 251 patients, 64 (25.5%) of whom were admitted to hospital for some unplanned cause over the 12 months following their date of inclusion in the study. Four predictive variables of hospitalization were identified: NYHA class III-IV, OR (95% CI) 2.46 (1.23-4.91); diabetes OR (95% CI) 1.94 (1.05-3.58); COPD OR (95% CI) 3.17 (1.45-6.94); MLHFQ Emotional OR (95% CI) 1.07 (1.02-1.12). AUC 0.723; R2N 0.17; Hosmer-Lemeshow 0.815. Internal validation AUC 0.706.; R2N 0.134. CONCLUSION: This is a simple model to predict hospitalization over a 12-month period based on four variables: NYHA functional class, diabetes, COPD and the emotional dimension of the MLHFQ scale. It has an acceptable discriminative capacity enabling the identification of patients at risk of hospitalization.

Disability and quality of life in heart failure patients: a cross-sectional study.

BACKGROUND: Although both hospitalization and mortality due to heart failure (HF) have been widely studied, less is known about the impact of HF on disability and quality of life. AIM: To assess the degree of disability and quality of life in HF patients attended at family medicine centres. DESIGN AND SETTING: Cross-sectional study of a cohort of HF patients attended at family medicine centres. METHODS: Disability was assessed with the WHODAS 2 questionnaire, which provides a global and six domain scores that is understanding and communication, getting around, self-care, getting along with people, life activities and participation in society. Quality of life was assessed with the Minnesota Living with Heart Failure Questionnaire, which furnishes a global and two domain scores, physical and emotional. RESULTS: A breakdown of the results showed that 28% of patients had moderate disability and 16.7% had severe disability, with the most important areas affected being: life activities, 8.9% extreme disability and 30.3% severe disability; getting around, 34.6% severe disability and 2% extreme disability; and participation in society, 53.3% moderate-severe disability. Quality of life was mildly affected. New York Heart Association (NYHA) Functional Classification and sex were the major determinants of disability and quality of life. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists were associated with better scores in the "getting around" and "life activity" domains. CONCLUSION: HF patients in primary care show an important degree of disability and an acceptable quality of life.

Macroscopic dynamics and the collapse of urban traffic.

Stories of mega-jams that last tens of hours or even days appear not only in fiction but also in reality. In this context, it is important to characterize the collapse of the network, defined as the transition from a characteristic travel time to orders of magnitude longer for the same distance traveled. In this multicity study, we unravel this complex phenomenon under various conditions of demand and translate it to the travel time of the individual drivers. First, we start with the current conditions, showing that there is a characteristic time τ that takes a representative group of commuters to arrive at their destinations once their maximum density has been reached. While this time differs from city to city, it can be explained by Γ, defined as the ratio of the vehicle miles traveled to the total vehicle distance the road network can support per hour. Modifying Γ can improve τ and directly inform planning and infrastructure interventions. In this study we focus on measuring the vulnerability of the system by increasing the volume of cars in the network, keeping the road capacity and the empirical spatial dynamics from origins to destinations unchanged. We identify three states of urban traffic, separated by two distinctive transitions. The first one describes the appearance of the first bottlenecks and the second one the collapse of the system. This collapse is marked by a given number of commuters in each city and it is formally characterized by a nonequilibrium phase transition.

Development and validation of a risk stratification model for prediction of disability and hospitalisation in patients with heart failure: a study protocol.

BACKGROUND: Chronic heart failure (CHF) reduces quality of life and causes hospitalisation and death. Identifying predictive factors of such events may help change the natural history of this condition. AIM: To develop and validate a stratification system for classifying patients with CHF, according to their degree of disability and need for hospitalisation due to any unscheduled cause, over a period of 1 year. METHODS AND ANALYSIS: Prospective, concurrent, cohort-type study in two towns in the Madrid autonomous region having a combined population of 1 32 851. The study will include patients aged over 18 years who meet the following diagnostic criteria: symptoms and typical signs of CHF (Framingham criteria) and left ventricular ejection fraction (EF)<50% or structural cardiac lesion and/or diastolic dysfunction in the presence of preserved EF (EF>50%).Outcome variables will be(a) Disability, as measured by the WHO Disability Assessment Schedule V.2.0 Questionnaire, and (b) unscheduled hospitalisations. The estimated sample size is 557 patients, 371 for predictive model development (development cohort) and 186 for validation purposes (validation cohort). Predictive models of disability or hospitalisation will be constructed using logistic regression techniques. The resulting model(s) will be validated by estimating the probability of outcomes of interest for each individual included in the validation cohort. ETHICS AND DISSEMINATION: The study protocol has been approved by the Clinical Research Ethics Committee of La Princesa University Teaching Hospital (PI-705). All results will be published in a peer-reviewed journal and shared with the medical community at conferences and scientific meetings.

Postdural puncture headache: impact of needle type, a randomized trial.

BACKGROUND CONTEXT: The most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times. PURPOSE: The purpose of this study was to define the impact of needle type, atraumatic (Sprotte [S]) versus traumatic (Quincke [Q]) on postdural puncture headache (PDPH) incidence. STUDY DESIGN: The study is based on a prospective, randomized, and simple-blinded clinical trial. PATIENT SAMPLE: Patients older than 14 years were scheduled for a diagnostic or therapeutic LP. OUTCOME MEASURES: The outcome measure included the development of PDPH according to the International Headache Association criteria. METHODS: Patients fulfilling eligibility criteria were randomly allocated to one of two kinds of spinal needle: atraumatic or S-type or traumatic or Q-type. They were interviewed on days 2 and 7 about the development of PDPH. RESULTS: The incidence of PDPH was 22.43% with Q-type needle and 8.51% with S-type needle, p=.04. The duration of PDPH in patients in the S-type was 1 day or less, compared with a median of 4.14 days in the Q-type (p=.00). In the logistic regression model, the S-type needle together with the age of the patient were the only two statistically significant factors in the development of postlumbar puncture headache (PLPH), both of them being protective. CONCLUSIONS: We found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.

Natural History of Parkinson's Disease in the Province of Segovia: Disability in a 20 Years Longitudinal Study.

BACKGROUND: Parkinson's disease mainly affects the elderly population causing a progressive functional disability with motor, psychic, and cognitive deterioration. OBJECTIVE: This study was carried out to evaluate disability caused by Parkinson's disease by analyzing the median time to reach Hoehn and Yahr stage III and to investigate predictor variables based on a 20-year longitudinal follow-up study. METHODS: We examined 273 patients with Parkinson's disease recruited between 1978 and 1998. We performed a survival analysis using the Kaplan-Meier method to determine the time to disability and we used a Cox regression model to adjust prognosis factors. RESULTS: The median time to reach Hoehn and Yahr stage III was 7.73 years (95% CI: 5.95-8.05). Independent predictors of disability were: age at onset, the hazard ratio (HR) = 1.10, 95% CI: 1.08-1.12; UPDRS II (activities of daily living) HR = 1.08, 95% CI: 1.03-1.14; and akinesia and rigidity at onset HR = 1.55, 95% CI: 1.07-2.24. CONCLUSIONS: Patients with Parkinson's disease evolve gradually toward disability, and prognostic factors of this evolution were identified.

Contrasting effects of hardwood and softwood organosolv lignins on enzymatic hydrolysis of lignocellulose.

Identifying an appropriate parameter to elucidate effects of lignin on enzymatic hydrolysis is essential to understand the interactions between enzymes and lignin. Contrasting effects of hardwood organosolv lignin (EOL-SG) and softwood organosolv lignin (EOL-LP) on enzymatic hydrolysis were observed. The addition of EOL-SG (8 g/L) significantly improved the 72 h hydrolysis yields of organosolv pretreated sweetgum (OPSG) and loblolly pine (OPLP) from 49.3% to 68.6% and from 41.2% to 60.8%, respectively. In contrast, the addition of EOL-LP decreased the 72 h hydrolysis yields of OPSG and OPLP to 42.0% and 38.1%, respectively. A strong correlation between the distribution coefficients of cellulase enzymes on lignins and the changes of hydrolysis yields indicated that the inhibitory or stimulatory effects of organosolv lignins on enzymatic hydrolysis were governed by the distribution coefficients (R). The different R values probably were related to the electrostatic interactions, hydrophobic interactions and hydrogen bondings between enzymes and lignin.

Heart failure in primary care: co-morbidity and utilization of health care resources.

BACKGROUND: In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. OBJECTIVE: To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. METHODS: Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. RESULTS: One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). CONCLUSIONS: Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity.

Collagenous sprue: don´t forget connective tissue in chronic diarrhea evaluation.

Collagenous sprue is a rare disease of the small bowel characterized by mucosal atrophy and excessive subepithelial collagen deposition. The etiology remains unclear and the diagnosis is based upon patient´s clinical picture and anatomopathological findings. Clinically, collagenous sprue is characterized by persistent diarrhoea, severe malabsorption, multiple nutrient deficiencies and progressive weight loss. Differential diagnosis includes celiac disease, which is mandatory to rule out because of their frequent association. Glutenfree diet is the first therapeutic step, but it usually is not effective. However, recent studies show high success rates with immunomodulators, mainly corticosteroids. We report the case of a patient presenting with chronic diarrhea and severe malabsorption who was diagnosed with collagenous sprue, with no response to gluten free diet, but with excellent response to budesonida.

Esprúe colágeno: no olvidemos el tejido conectivo en la evaluación de la diarrea crónica / Collagenous sprue: don’t forget connective tissue in chronic diarrhea evaluation

El esprúe colágeno es una patología infrecuente del intestino delgado caracterizada por atrofia de la mucosa y depósito excesivo de colágeno a nivel subepitelial. Su etiología es desconocida y su diagnóstico se realiza en base a la presencia tanto de un cuadro clínico compatible como de hallazgos anatomopatógicos sugestivos. Los pacientes suelen presentar diarrea crónica, malabsorción, deficiencias nutricionales graves y una marcada pérdida ponderal. Dentro del diagnóstico diferencial es mandatorio descartar enfermedad celiaca por su frecuente asociación a la misma. La dieta sin gluten es el primer escalón terapéutico, pero generalmente no es efectiva. Sin embargo, estudios recientes señalan altas tasas de éxito mediante el uso de inmunomoduladores. Presentamos el caso de un paciente con diarrea crónica y malabsorción grave diagnosticado de esprúe colágeno, sin respuesta a la dieta sin gluten, en el que el tratamiento con budesonida ha conseguido una excelente respuesta(AU)

Collagenous sprue is a rare disease of the small bowel characterized by mucosal atrophy and excessive subepithelial collagen deposition. The etiology remains unclear and the diagnosis is based upon patient’s clinical picture and anatomopathological findings. Clinically, collagenous sprue is characterized by persistent diarrhoea, severe malabsorption, multiple nutrient deficiencies and progressive weight loss. Differential diagnosis includes celiac disease, which is mandatory to rule out because of their frequent association. Gluten-free diet is the first therapeutic step, but it usually is not effective. However, recent studies show high success rates with immunomodulators, mainly corticosteroids. We report the case of a patient presenting with chronic diarrhea and severe malabsorption who was diagnosed with collagenous sprue, with no response to gluten free diet, but with excellent response to budesonida(AU)

Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is frequent and often coexists with other diseases. The aim of this study was to quantify the prevalence of COPD and related chronic comorbidity among patients aged over 40 years visiting family practices in an area of Madrid. METHODS: An observational, descriptive, cross-sectional study was conducted in a health area of the Madrid Autonomous Region (Comunidad Autónoma de Madrid). The practice population totalled 198,670 persons attended by 129 Family Physicians (FPs), and the study population was made up of persons over the age of 40 years drawn from this practice population. Patients were deemed to have COPD if this diagnosis appeared on their clinical histories. Prevalence of COPD; prevalence of a further 25 chronic diseases in patients with COPD; and standardised prevalence ratios, were calculated. RESULTS: Prevalence of COPD in family medicine was 3.2% (95% CI 3.0-3.3) overall, 5.3% among men and 1.4% among women; 90% of patients presented with comorbidity, with a mean of 4 ± 2.04 chronic diseases per patient, with the most prevalent related diseases being arterial hypertension (52%), disorders of lipid metabolism (34%), obesity (25%), diabetes (20%) and arrhythmia (15%). After controlling for age and sex, the observed prevalence of the following ten chronic diseases was higher than expected: heart failure; chronic liver disease; asthma; generalised artherosclerosis; osteoporosis; ischaemic heart disease; thyroid disease; anxiety/depression; arrhythmia; and obesity. CONCLUSIONS: Patients with COPD, who are frequent in family practice, have a complex profile and pose a clinical and organisational challenge to FPs.