Impacto de la rigidez de las uniones en el coste global de pórticos a dos aguas de acero

This paper studies the influence of joint stiffness value combinations in gabled steel frames. Twelve different joint stiffness values were combined for the column base, knee joint and ridge joint. Ten different geometries were combined for gabled steel frames (8-20 m span, 3.5-10 m column height and 10-20% roof slope). Finally, three different load levels for snow and wind were considered, with constant values of permanent and maintenance loads. A total of 46656 cases were analyzed using specific software for steel structure design, obtaining in each case the total cost. Graphical cost representation was obtained for each joint stiffness value combination. Joints represent an average of 17% of the total cost of gabled steel frame structures. In general, lower cost structures were obtained with low joint rigidity values. It is possible to reduce the total cost by around 18% on average, with appropriate selection of joint stiffness combinations.En este artículo se presenta un estudio sobre la influencia de la rigidez de las uniones en pórticos a dos aguas de acero. Se combinan doce valores diferentes de rigidez de placa de anclaje, hombro y cumbrera. Se combinan diez geometrías (8- 20 m de luz, 3.5-10 m de altura de pilares y 10-20% de pendiente de cubierta). Se consideran tres niveles de carga de nieve y viento con valores constantes de carga de mantenimiento. Se analizan un total de 46656 supuestos utilizando un programa informático de cálculo de estructuras para obtener en cada caso su coste total. Se obtiene la representación gráfica del coste para cada combinación de rigideces. En general, los costes más bajos de las estructuras se corresponden con valores bajos de rigidez. Es posible reducir el coste total un 18% de media, con la selección apropiada de la combinación de valores de rigidez de las uniones

A New European Bauhaus for a Culture of Transversality and Sustainability

This article provides a critical study of a New European Bauhaus initiative in the context of transversality, relational nature and sustainability of construction, architecture and civil engineering. Social and environmental factors in this ecosystem of innovation are highlighted, as well as the perspectives of actors within it. The relationships between art, technology and science of historical Bauhaus are assessed. The investigation of transversality was carried out using a visual tool developed by the authors, CATI, considering sustainability as the backbone. The New European Bauhaus is a pool of innovation that is supported by governments, academia, industry, society and the (natural) environment. It aims at social, environmental and cultural sustainability and includes ideas of social transformation. It is necessary to absorb the impact and overwhelming cultural consequences of previous and current Industrial Revolutions, principally relying on cyber–physical systems to generate spaces and collective intelligence. The climate crisis and the COVID-19 pandemic have increased the need for new approaches, expanding the concept of smart cities to smart territories, taking into account participation in society and general inclusivity

La ocupación tardoantigua de la Cueva de Guantes (Palencia): contexto y materiales

Cave of Guantes, located in Palencia, near the village called Guardo, is a site known for its Middle Paleolithic deposits, as well as for indefinite subsequent occupations. The present study discloses a set of Late Antiquity material, highlighting, among them, a “tremís” that belonged to Visigothic King Égica, which was recovered on the surface levels of the cave, during the last archeological interventions. Because the coins from the Visigothic period are not too numerous, it seems interesting to make them known within this archeological context. As it has been mentioned, along with the coin, some other material appeared which allowed us to make some assumptions about the characteristics of the finding and the deposit. The work includes an extensive analysis on the occupation of the cave during the late times of the Roman Empire and Late Antiquity, as well as on the possible role played by the Roman communication channels during the late occupation of the Cave of Guantes. Our conclusion, after the study, is that the cave must have been the result of exceptional occupations, although continuous over the time, due to its fine location and accessibility, and also probably in relation to agricultural work. The discovery of the “tremís” could be by chance, but also due to an occultation caused by a violent event, in which case we propose, as the reason, the military operations carried out by the Muslims, between year 712 and 713, to get control over the North of the Península.La Cueva de Guantes (Palencia), ubicada en las proximidades de Guardo, es un yacimiento conocido por sus depósitos del Paleolítico Medio e indefinidas ocupaciones posteriores. Este estudio da a conocer un conjunto de materiales tardoantiguos entre los que destaca un tremís del rey visigodo Égica, recuperado en los niveles superficiales de la cueva durante las últimas intervenciones arqueológicas. El monetario de época visigoda no es demasiado numeroso y, por ello, siempre resulta de interés darlo a conocer en este contexto arqueológico. Como indicamos, junto a la moneda aparecieron otros materiales que permiten realizar algunas consideraciones sobre las características del hallazgo y del yacimiento. El trabajo realiza un extenso análisis sobre las ocupaciones en cuevas durante los momentos tardíos del Imperio romano y la tardoantigüedad, y sobre el papel que las vías de comunicación romanas pueden haber desempeñado en la ocupación tardía de la Cueva de Guantes. Tras este estudio, se concluye que la cueva debió de ser fruto de ocupaciones puntuales, pero continuadas en el tiempo, debido a su buena ubicación y accesibilidad, y posiblemente en relación con labores agropecuarias. El hallazgo del tremís pudiera ser fruto de una pérdida casual, pero también de una ocultación ante un evento violento, en cuyo caso proponemos el contexto de las cercanas operaciones militares realizadas por los musulmanes entre el 712 y el 713 para el control del norte peninsular

Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry

Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

Using Interpretable Machine Learning to Identify Baseline Predictive Factors of Remission and Drug Durability in Crohn’s Disease Patients on Ustekinumab

Ustekinumab has shown efficacy in Crohn's Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients' data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index <= 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 +/- 20.6% vs 93.6 +/- 20.6%, P < 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 +/- 5.2 mm vs 19.9 +/- 6.7 mm, P < 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P < 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P < 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 ± 20.6% vs 93.6 ± 20.6%, P &lt; 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 ± 5.2 mm vs 19.9 ± 6.7 mm, P &lt; 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P &lt; 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P &lt; 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case–Control Study (COVID-19-EII)

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case-control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March-July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3-5.9), occupational risk (OR: 2.9; 95%CI: 1.8-4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2-2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09-0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution