Evaluating destinations' efforts to improve sustainability in tourism using the inter-temporal decomposition of a composite indicator

This work was supported by grants from the Ministry of Economy and Competitiveness [PID2019-104263RB-C41 and PGC2018-095786-B-IOO], from the European Regional Development Fund (FEDER) and from the Ministry of Economy, Knowledge, Business and University, of the Andalusian Government, within the framework of the FEDER Andalusia 2014-2020 operational program. Specific objective 1.2.3. «Promotion and generation of frontier knowledge and knowledge oriented to the challenges of society, development of emerging technologies») within the framework of the reference research project (UPO-1380624). FEDER co-financing percentage 80%. Funding for open access publishing: Universidad Pablo de Olavide/CBUA.UPO-1380624, PID2019-104263RB-C41 and PGC2018-095786-B-IOOSustainable tourism indicators are instruments for measuring tourism sustainability, widely used in the planning and decision-making processes. For this measurement, in recent decades composite indicators have been proposed that provide dynamic evaluations to assess the progress that each destination registers towards more sustainable situations. However, the measures proposed so far do not allow the evaluation of each destination's own effort or the effectiveness of the measures put in place, because the evaluation they provide depends on the decisions made when adding information (weighting, reference situations...). In this study, a dynamic measure of sustainable tourism is proposed, which, through the intertemporal decomposition of a global indicator with multiplicative aggregation, assesses the effort that each destination makes to improve its sustainability situation. The aggregation procedure is carried out in two stages. In the first one, a compensatory synthetic indicator is obtained for each aspect using a weighting scheme determined from information and dispersion criteria. In a second phase, the global composite indicator is obtained with a multiplicative aggregation, setting unique and common weights for all destinations through DEA models and using different benchmarks for each type of destination, in order to take into account their different starting situations.Departmento de Economía, Métodos Cuantitativos e Historia Económica, Universidad Pablo de Olavid

Elucidating the Effect of Nutritional Imbalances of N and K on the Infection of Verticillium dahliae in Olive

The effect of mineral nutrition on wilt diseases has been previously reported in many herbaceous hosts, though such an effect on Verticillium wilt in olive (Olea europaea L.; VWO), caused by Verticillium dahliae, is still uncertain. Field observations reveal that nitrogen (N) excess or imbalances of N-potassium (K) favour VWO epidemics. However, this has yet to be demonstrated. Thus, the aim of this study was to evaluate the influences of nutritional imbalances of N and K in V. dahliae infection of olive. To this end, adjusted treatments with N excess (↑N+↑Na), K deficiency (↓K) and their combination (↑N+↑Na+↓K) were evaluated on the viability of V. dahliae microsclerotia (MS), as well as on disease development in olive plants. In parallel, the potential indirect effect of the treatments on the viability of conidia and MS of V. dahliae was evaluated through the stimuli of root exudates. Treatments ↑N+↑Na and ↑N+↑Na+↓K decreased MS germination and disease progress, whereas ↓K significantly increased both parameters. Root exudates from treated plants increased the conidia germination of V. dahliae but reduced the MS germination. The results of this study will be the basis for planning further research towards a better understanding of the effect of mineral nutrition on VWO

Real-world data of fulvestrant as first-line treatment of postmenopausal women with estrogen receptor-positive metastatic breast cancer

Goals of endocrine therapy for advanced breast cancer (ABC) include prolonging survival rates, maintaining the quality of life, and delaying the initiation of chemotherapy. We evaluated the effectiveness of fulvestrant as first-line in patients with estrogen receptor (ER)-positive ABC with relapse during or after adjuvant anti-estrogenic therapy in real-world settings. Retrospective, observational study involving 171 postmenopausal women with ER-positive ABC who received fulvestrant as first-line between January 2011 and May 2018 in Spanish hospitals. With a median follow-up of 31.4 months, the progression-free survival (PFS) with fulvestrant was 14.6 months. No differences were seen in the visceral metastatic (14.3 months) versus non-visceral (14.6 months) metastatic subgroup for PFS. Overall response rate and clinical benefit rate were 35.2% and 82.8%. Overall survival was 43.1 months. The duration of the clinical benefit was 19.2 months. Patients with ECOG performance status 0 at the start of treatment showed a significant greater clinical benefit rate and overall survival than with ECOG 1-2. Results in real-world settings are in concordance with randomized clinical trials. Fulvestrant continues to demonstrate clinical benefits in real-world settings and appears be well tolerated as first-line for the treatment of postmenopausal women with ER-positive ABC

Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are considered a single entity with variability in the extent of the lesions, characterized by erythema multiforme that may involve mucosa. Severe cutaneous reactions secondary to medications are classified according to the area of epidermal detachment. The activation of cytotoxic T cells and macrophages is mediated mainly by IL-2 and interferon gamma secreted by Th1 lymphocytes, and the activation of eosinophils and B lymphocytes in IgE is mediated by secreted IL-4, IL-5, IL-10 and IL13 by B lymphocytes. The topography of SJS is predominantly central, affecting the trunk and sometimes a generalized dissemination is shown that affects a body surface area of less than 10%, characterized by irregular violaceous erythematous macules of target shooting, which can form confluent blisters. TEN is characterized by a skin detachment greater than 30% of the body surface, whose predominant lesion is diffuse erythema with individual macules, which give rise to detachment surfaces greater than 5 cm. The treatment is symptomatic, nonspecific, and aimed at avoiding complications, carried out in specialized intensive care units, due to ignorance of the pathogenesis. Integral management with different therapeutic alternatives can represent a crucial part in the multisystemic management of SJS and TEN

Long term measurement of the 222Rn concentration in the Canfranc Underground Laboratory

We report the results of 6 years (2013–2018) of measurements of 222Rn air concentration, relative humidity, atmospheric pressure and temperature in the halls A, B and C of the Canfranc Underground Laboratory (LSC). We have calculated all the Pearson correlation coefficients among these parameters and we have found a positive correlation between the 222Rn concentration and the relative humidity. Both correlated variables show a seasonal periodicity. The joint analysis of laboratory data and 4 years (2015– 2018) of the meteorological variables outside the laboratory shows the correlation between the 222Rn concentration and the outside temperature. The collected information stresses the relevance of designing good Rn-mitigation strategies in current and future experiments at LSC; in particular, we have checked for two years (2017–2018) the good performance of the mitigation procedure of the ANAIS-112 experiment. Finally, we have monitored (2019–2021) for 2 years of live time, the radon-free air provided by the radon abatement system installed in the laboratory.This research was funded by MCIN/AEI/10.13039/501100011033 under Grant PID2019-104374GB-I00; by MINECO-FEDER under Grants FPA2017-83133-P, and FPA2014-55986-P; by MICINN-FEDER under Grants FPA2011-23749; by CONSOLIDER-Ingenio 2010 Programme under Grants MultiDark CSD2009-00064 and CPAN CSD2007-00042; by the University of Zaragoza under Grant UZ2017-CIE-09; by the Spanish Meteorological Agency (AEMET), the Gobierno de Aragón (Group in Nuclear and Astroparticle Physics, ARAID Foundation and I. Coarasa predoctoral grant), the European Social Fund and by the LSC consortium

Use of rivaroxaban and acetylsalicylic acid as a combined treatment for peripheral arterial disease in Central Military Hospital

Background: The objective of this research was to evaluate the behavior of 3 risk indicators for peripheral arterial disease in patients under oral treatment with rivaroxaban 2.5 mg every 12 hours plus, acetylsalicylic acid 100 mg every 24 hours. It was hypothesized that the oral combination of rivaroxaban and acetylsalicylic acid presents a therapeutic advantage over other treatments.Methods: A prospective longitudinal and non-randomized study of a single center was performed. 59 patients with peripheral arterial disease were included and treated with acetylsalicylic acid + rivaroxaban. Peak systolic velocity, ankle-brachial index and C reactive protein index were evaluated.Results: Significant changes were found at month 1 and 3 of follow-up in maximum systolic velocity, ankle-arm index and C-reactive protein index. The baseline peak systolic velocity (PSV) in the anterior tibial artery had significant differences after one month of treatment (p=0.001) and after 3 months (p=0.001). The baseline PSV in the posterior tibial artery had significant differences compared to the values found at the month of treatment (p=0.001) and 3 months (p=0.001). In the ankle-brachial index a baseline median of 0.790 was found, one month after the treatment of 0.795 (p=0.147) and 3 months after 0.800 (p=0.019). The mean baseline C-reactive protein obtained was 73.142 mg/l, at one month 87.233 mg/l (p=0.001) and at 3 months at 79.009 mg/l (p=0.294) with a standard deviation of 67.18, 74.78 and 69.69 respectively.Conclusions: The combined use of acetylsalicylic acid and rivaroxaban allows a clinical improvement in patients with peripheral arterial disease

Antebrachial microvascular flap for reconstruction of the pelvic limb: case report

Complex defects in the soft tissues of the foot and ankle caused by high-energy trauma, infection, cancer or diabetes require rapid and effective treatment which decreases the risk of infection, bone healing time, hospital stay and number total of surgical approaches. Authors report a clinical case of a 23-year-old female patient who suffers high-energy trauma due to a motorcycle accident which causes exposure of the distal third of the tibia, loss of the tibial joint face, and loss of tissue throughout the region of the malleolus medial of the right pelvic extremity. Tissue transfer to the pelvic limb is performed using left contralateral radial antebrachial free flap as donor area. This case report aims to emphasize the key aspects of the high energy trauma approach by using microvascular flaps, as well as the satisfactory evolution of the patient that directly affects the prognosis for life and function

Intrinsic Subtypes and Gene Expression Profiles in Primary and Metastatic Breast Cancer

Biological changes that occur during metastatic progression of breast cancer are still incompletely characterized. In this study, we compared intrinsic molecular subtypes and gene expression in 123 paired primary and metastatic tissues from breast cancer patients. Intrinsic subtype was identified using a PAM50 classifier and χ 2 tests determined the differences in variable distribution. The rate of subtype conversion was 0% in basal-like tumors, 23.1% in HER2-enriched (HER2-E) tumors, 30.0% in luminal B tumors, and 55.3% in luminal A tumors. In 40.2% of cases, luminal A tumors converted to luminal B tumors, whereas in 14.3% of cases luminal A and B tumors converted to HER2-E tumors. We identified 47 genes that were expressed differentially in metastatic versus primary disease. Metastatic tumors were enriched for proliferation-related and migration-related genes and diminished for luminal-related genes. Expression of proliferation-related genes were better at predicting overall survival in metastatic disease (OSmet) when analyzed in metastatic tissue rather than primary tissue. In contrast, a basal-like gene expression signature was better at predicting OSmet in primary disease compared with metastatic tissue. We observed correlations between time to tumor relapse and the magnitude of changes of proliferation, luminal B, or HER2-E signatures in metastatic versus primary disease. Although the intrinsic subtype was largely maintained during metastatic progression, luminal/HER2-negative tumors acquired a luminal B or HER2-E profile during metastatic progression, likely reflecting tumor evolution or acquisition of estrogen independence. Overall, our analysis revealed the value of stratifying gene expression by both cancer subtype and tissue type, providing clinicians more refined tools to evaluate prognosis and treatment. Cancer Res; 77(9); 1-9. ©2017 AACR

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Imbalances in endoplasmic reticulum (ER) proteostasis are associated with etiologically-diverse degenerative diseases linked to excessive extracellular protein misfolding and aggregation. Reprogramming of the ER proteostasis environment through genetic activation of the Unfolded Protein Response (UPR)-associated transcription factor ATF6 attenuates secretion and extracellular aggregation of amyloidogenic proteins. Here, we employed a screening approach that included complementary arm-specific UPR reporters and medium-throughput transcriptional profiling to identify non-toxic small molecules that phenocopy the ATF6-mediated reprogramming of the ER proteostasis environment. The ER reprogramming afforded by our molecules requires activation of endogenous ATF6 and occurs independent of global ER stress. Furthermore, our molecules phenocopy the ability of genetic ATF6 activation to selectively reduce secretion and extracellular aggregation of amyloidogenic proteins. These results show that small molecule-dependent ER reprogramming, achieved through preferential activation of the ATF6 transcriptional program, is a promising strategy to ameliorate imbalances in ER function associated with degenerative protein aggregation diseases