Resumen Dada la importancia del conocimiento de la estenosis mitral, se desarrollan simulaciones para el entrenamiento de su diagnóstico durante el grado. Se preparan varios supuestos clínicos de ...alta fidelidad y diferentes niveles de dificultad y se adaptan a maniquí SimMan, incluyendo información de anamnesis, signos e imágenes reales anonimizadas. Una vez probados los casos, son utilizados en sesiones teórico-prácticas para reforzar lo aprendido en clase. Los alumnos presentan dificultades para reconocer la patología basándose en la clínica y la información recabada durante la anamnesis. No obstante, mantienen alto grado de sospecha clínica que no confirman hasta la visualización de las imágenes. El alumnado es capaz de reconocer el cuadro gracias a las imágenes complementarias, pero no de elaborar un juicio clínico previo. Creemos que se debe reforzar el reconocimiento de signos, haciendo hincapié en que las pruebas complementarias sirven para confirmar una presunción clínica que previamente han debido de elaborar ellos mismos.
Lesions to ventral occipital cortex can produce severe deficits in color vision, a syndrome known as cerebral achromatopsia. Because most studies examine relatively few cases, however, uncertainty ...remains about precisely which cortical loci, when damaged, produce the syndrome. In addition, the extents of the associated perceptual deficits remain unclear. To address these issues, we performed a meta-analysis of 92 case reports from the literature. The severity of color vision deficits of the cases varied greatly, although nearly all showed some deficit in color discrimination. Almost all cases tested also showed some loss of spatial vision. Lesion overlap analyses revealed a relatively small region of high overlap in ventral occipital cortex. The region of high overlap was located near areas identified by neuroimaging studies as important for color perception. For comparison, we performed a similar analysis of prosopagnosia, a disorder of face perception, and found several regions of high lesion overlap adjacent to the region associated with achromatopsia. Because the behavioral deficits in achromatopsia are often incomplete and never restricted to color vision, the region of high lesion overlap may be one critical stage within a stream of many visual areas that participate nonexclusively in color perception.
Resumen Introducción La simulación como herramienta docente se está estableciendo como una prioridad en los currículos de nuestra especialidad en determinados países, principalmente anglosajones, y ...cada vez se están desarrollando escenarios más sofisticados y completos. Métodos Se ha fomentado la creación de un equipo multidisciplinar con profesores de universidad, estudiantes de Medicina y médicos con el objetivo de mejorar la docencia del Grado en Medicina y valorar su potencial exportación a la formación especializada en Cirugía Cardiovascular. Resultados Los alumnos de Medicina participantes demostraron una clara mejoría en la asimilación de información, así como en sus habilidades clínico-prácticas, conforme se fueron estableciendo escenarios de simulación. Del mismo modo, esta herramienta permitió una evaluación objetiva tanto de los resultados in situ como de la evolución temporal de los mismos. Conclusiones Dado el rendimiento positivo en estudiantes de Medicina, y debido a la cada vez mayor dificultad en la formación de residentes en nuestros hospitales (cuestiones ético-legales, escasez de tiempo de formación, complejidad de casos), se debería plantear la creación de un grupo de Simulación a nivel nacional para valorar la inclusión de la misma en el currículo de la especialidad.
The efficient use of the photovoltaic power requires a good estimation of the PV generation. That is why the use of good techniques for forecast is necessary. In this research paper, Long Short-Term ...Memory, Bidirectional Long Short-Term Memory and the Temporal convolutional network are studied in depth to forecast the photovoltaic power, voltage and efficiency of a 1320 Wp amorphous plant installed in the Technology Support Centre in the University Rey Juan Carlos, Madrid (Spain). The accuracy of these techniques are compared using experimental data along one year, applying 1 timestep or 15 min and 96 step times or 24 h, showing that TCN exhibits outstanding performance, compared with the two other techniques. For instance, it presents better results in all forecast variables and both forecast horizons, achieving an overall Mean Squared Error (MSE) of 0.0024 for 15 min forecasts and 0.0058 for 24 h forecasts. In addition, the sensitivity analyses for the TCN technique is performed and shows that the accuracy is reduced as the forecast horizon increases and that the 6 months of dataset is sufficient to obtain an adequate result with an MSE value of 0.0080 and a coefficient of determination of 0.90 in the worst scenarios (24 h of forecast).
Automated guided vehicles (AGV) or mobile robots (MR) are being used more and more in modern factories, logistics, etc. To extend the work-time of the robot, kinetic energy recovery systems are ...implemented to store the braking or lifting energy. In most applications, the energy storage system is a Li-ion battery, which is therefore subjected to increased stress and is also oversized. Super-Capacitors can be used in combination to solve this issue. In this paper, different power distribution systems are analysed and compared, using both single or hybrid storage systems (battery and super-capacitor combined). The comparison is both qualitative, using general system characteristics, and quantitative, using an efficiency/power density Pareto front analysis.
Certain modern power electronics systems require active regulation of the split DC bus capacitor voltages. The series resonant converter is suitable to be utilized as an active voltage regulator, due ...to its ability to operate with soft switching, and hence, with high efficiency. In discontinuous conduction mode, the series resonant converter operates with a constant unity voltage gain, thus achieving balancing of the DC link. However, discontinuous conduction mode does not provide means for achieving a different voltage distribution, which is important in many scenarios. On the other hand, by operating in quantum mode (i.e. type 2 discontinuous conduction mode), the voltages across DC bus capacitor can be regulated. Therefore, the modeling of the quantum mode series resonant converter connected across split DC bus is presented in this paper. The steady-state operation as well as transient behavior are discussed and experimentally verified on a laboratory prototype.
Liver toxicity caused by high-dose myeloablative therapy leads to significant morbidity after hematopoietic cell transplantation. We examined the hypothesis that liver toxicity after cyclophosphamide ...and total body irradiation is related to cyclophosphamide through its metabolism to toxins. Cyclophosphamide was infused at 60 mg/kg over 1 to 2 hours on each of 2 consecutive days, followed by total body irradiation. Plasma was analyzed for cyclophosphamide and its major metabolites. Liver toxicity was scored by the development of sinusoidal obstruction syndrome (veno-occlusive disease) and by total serum bilirubin levels. The hazards of liver toxicity, nonrelapse mortality, tumor relapse, and survival were calculated using regression analysis that included exposure to cyclophosphamide metabolites (as the area under the curve). Of 147 patients, 23 (16%) developed moderate or severe sinusoidal obstruction syndrome. The median peak serum bilirubin level through day 20 was 2.6 mg/dL (range, 0.5-41.1 mg/dL). Metabolism of cyclophosphamide was highly variable, particularly for the metaboliteo-carboxyethyl-phosphoramide mustard, whose area under the curve varied 16-fold. Exposure to this metabolite was statistically significantly related to sinusoidal obstruction syndrome, bilirubin elevation, nonrelapse mortality, and survival, after adjusting for age and irradiation dose. Patients in the highest quartile ofo-carboxyethyl-phosphoramide mustard exposure had a 5.9-fold higher risk for nonrelapse mortality than did patients in the lowest quartile. Engraftment and tumor relapse were not statistically significantly related to cyclophosphamide metabolite exposure. Increased exposure to toxic metabolites of cyclophosphamide leads to increased liver toxicity and nonrelapse mortality and lower overall survival after hematopoietic cell transplantation.
In modern aircraft designs, following the More Electrical Aircraft (MEA) philosophy, there is a growing need for new high-power converters. In this context, innovative solutions to provide high ...efficiency and power density are required. This paper proposes an unregulated LLC full-bridge operating at resonant frequency to obtain a constant gain at all loads. The first harmonic approximation (FHA) model is not accurate enough to estimate the voltage gain in converters with high parasitic resistance. A modified FHA model is proposed for voltage gain analysis, and time-based models are used to calculate the instantaneous current required for the ZVS transition analysis. A method using charge instead of current is proposed and used for this ZVS analysis. Using this method, an auxiliary circuit is proposed to achieve complete ZVS within the whole load range, avoiding a gapped transformer design and increasing the efficiency and power density. A 28 Vdc output voltage prototype, with 10 kW peak output power, has been developed to validate the theoretical analysis and the proposed auxiliary circuit. The maximum efficiency (96.3%) is achieved at the nominal power of 5 kW.
Summary
Patients with relapsed diffuse large B‐cell lymphoma (DLBCL) who have failed or are ineligible for autologous haematopoietic cell transplantation (HCT) have a poor prognosis. We examined the ...outcomes of non‐myeloablative allogeneic HCT in this setting. Thirty‐one patients with DLBCL and one patient with Burkitt lymphoma received allogeneic HCT following 2 Gy total body irradiation with or without fludarabine. Median age was 52 years. Twenty‐four patients (75%) had undergone prior autologous HCT. Disease status at HCT was complete response (14/32, 44%), partial response (9/32, 28%), or refractory (9/32, 28%). Cumulative incidences of acute graft‐versus‐host disease (GVHD) grades II–IV, grades III–IV, and chronic GVHD were 53%, 19%, and 47% respectively. With a median follow‐up of 45 months, 3‐year estimated overall (OS) and progression‐free survival (PFS) was 45% and 35% respectively. Three‐year cumulative incidences of relapse and non‐relapse mortality were 41% and 25% respectively. In multivariate models, chemosensitive disease and receipt of ≥4 lines of treatment before HCT were associated with better OS. Patients with chemosensitive disease had 3‐year OS and PFS of 56% and 43% respectively. Non‐myeloablative allogeneic HCT can produce long‐term disease‐free survival in patients with chemosensitive relapsed DLBCL who have failed or are ineligible for autologous HCT.
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