The Experience With Health Care of Patients With Inflammatory Arthritis: A Cross-sectional Survey Using the Instrument to Evaluate the Experience of Patients With Chronic Diseases

[Abstract] Background: Patients' experience with health care is becoming a key component for the provision of a patient-centered health care model. The aim of this study was to assess the experience with health care of patients with inflammatory arthritis and patient- and health care-related factors. Methods: Patients responded to an anonymous survey provided by their treating clinical teams. The survey comprised the validated 12-item IEXPAC (Instrument to Evaluate the EXperience of PAtients with Chronic diseases) tool and demographic variables and health care-related characteristics that may affect patients' experience. Results: A total of 359 of 625 surveys were returned (response rate, 57.4%). Overall, patient responses were positive (>60% gave "always/mostly" answers) for statements assessing the interaction between patients and health care professionals or patient self-management following health care professional guidance. However, positive patient responses for items regarding patient interaction with the health care system via the internet or with other patients were less than 13%. Only 25.6% of patients who had been hospitalized reported receiving a follow-up call or visit following discharge. In the bivariate analysis, experience scores were higher (better experience) in men, those seen by fewer specialists or by the same physician, and in patients treated with a fewer number of drugs or with subcutaneous/intravenous drugs. Multivariate analyses identified regular follow-up by the same physician and treatment with subcutaneous/intravenous drugs as variables associated with a better patient experience. Conclusions: This study identifies areas of care for patients with inflammatory arthritis with the potential to improve patients' experience and highlights the importance of patient-physician relationships and comprehensive patient care

Estudio experimental sobre la influencia de la temperatura ambiental en la resistencia del hormigón preparado. Bases teóricas

The present article discusses the effects of temperature on the performance of both fresh and hardened concrete and on the properties of its constituent materials, from an industrial perspective. The primary aim of the study was to optimize concrete in very warm environments. Certain industrial procedures are proposed to minimize the adverse effects of climate on ready-mixed concrete performance. A number of experiments were conducted to determine the effect of extreme temperatures on the thermal behaviour, workability and mechanical properties of concrete, cement mortars, cement pastes, and aggregates. The results showed that aggregates, the predominant component of concrete, are especially temperature-labile. Basic measures for optimizing concrete performance in very warm weather were also developed. This procedure was successfully applied on an industrial scale in readymixed concrete production plants, where it yielded significant savings in summertime cement consumption.En este artículo se presenta un estudio sobre los efectos de la temperatura ambiental sobre las prestaciones del hormigón, en estado fresco y endurecido, y sobre las propiedades de los materiales constituyentes del mismo, desde una perspectiva industrial. El objetivo principal es el de optimizar la dosificación del hormigón en climas cálidos y al mismo tiempo, establecer medidas de actuación a nivel industrial para minimizar los efectos adversos en plantas de producción de hormigón preparado. En la primera parte del artículo, se muestran los resultados de varias campañas experimentales cuyo propósito ha sido determinar la influencia de las temperaturas ambientales extremas sobre las propiedades térmicas, de trabajabilidad y mecánicas del hormigón, así como de morteros, pastas de cemento y áridos. Las conclusiones apuntan al árido como un factor de gran importancia, no sólo por las características específicas de su comportamiento con la temperatura, sino también, porque es el componente presente en mayor contenido en el hormigón. En la segunda parte del artículo, se presentan las bases de una formulación metodológica para llevar a cabo la optimización del hormigón en climas cálidos

Healthcare experience and their relationship with demographic, disease and healthcare-related variables: a cross-sectional survey of patients with chronic diseases using the IEXPAC scale.

[Abstract] BACKGROUND: Patient experience is acknowledged as a principal aspect of quality healthcare delivery, and it has implications with regard to outcomes. OBJECTIVES: Our objective was to evaluate the healthcare experience of patients with chronic diseases to identify patient-perceived healthcare gaps and to assess the influence of demographic and healthcare-related variables on patient experiences. METHODS: A cross-sectional survey was delivered to adult patients with chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases. Patient experiences were assessed with the Instrument for Evaluation of the Experience of Chronic Patients (IEXPAC) questionnaire, with possible scores ranging from 0 (worst) to 10 (best experience). RESULTS: Of the 2474 patients handed the survey, 1618 returned it (response rate 65.4%). Patients identified gaps in healthcare related mainly to access to reliable information and services, interaction with other patients and continuity of healthcare after hospital discharge. The mean ± standard deviation (SD) IEXPAC score was 6.0 ± 1.9 and was higher for patients with HIV (6.6 ± 1.7) than for those with rheumatic disease (5.5 ± 2.0), IBD (5.9 ± 2.0) or DM (5.9 ± 1.9) (p < 0.001). In multivariate models, better overall IEXPAC experience was associated with follow-up by the same physician, follow-up by a nurse, receiving healthcare support from others and treatment with subcutaneous or intravenous drugs. The multivariate model that confirmed patients with HIV or DM had better experience than did those with rheumatic diseases. CONCLUSIONS: Through IEXPAC, patients identified aspects for healthcare quality improvements and circumstances associated with better experience, which may permit greater redirection of healthcare toward patient-centered goals while facilitating improvements in social care and long-term healthcare quality

Functional traits determine plant co-occurrence more than environment or evolutionary relatedness in global drylands

Plant–plant interactions are driven by environmental conditions, evolutionary relationships (ER) and the functional traits of the plants involved. However, studies addressing the relative importance of these drivers are rare, but crucial to improve our predictions of the effects of plant–plant interactions on plant communities and of how they respond to differing environmental conditions. To analyze the relative importance of – and interrelationships among – these factors as drivers of plant–plant interactions, we analyzed perennial plant co-occurrence at 106 dryland plant communities established across rainfall gradients in nine countries. We used structural equation modelling to disentangle the relationships between environmental conditions (aridity and soil fertility), functional traits extracted from the literature, and ER, and to assess their relative importance as drivers of the 929 pairwise plant–plant co-occurrence levels measured. Functional traits, specifically facilitated plants’ height and nurse growth form, were of primary importance, and modulated the effect of the environment and ER on plant–plant interactions. Environmental conditions and ER were important mainly for those interactions involving woody and graminoid nurses, respectively. The relative importance of different plant–plant interaction drivers (ER, functional traits, and the environment) varied depending on the region considered, illustrating the difficulty of predicting the outcome of plant–plant interactions at broader spatial scales. In our global-scale study on drylands, plant–plant interactions were more strongly related to functional traits of the species involved than to the environmental variables considered. Thus, moving to a trait-based facilitation/competition approach help to predict that: (1) positive plant–plant interactions are more likely to occur for taller facilitated species in drylands, and (2) plant–plant interactions within woody-dominated ecosystems might be more sensitive to changing environmental conditions than those within grasslands. By providing insights on which species are likely to better perform beneath a given neighbour, our results will also help to succeed in restoration practices involving the use of nurse plants

MAGIC Upper Limits for two Milagro-detected, Bright Fermi Sources in the Region of SNR G65.1+0.6

We report on the observation of the region around supernova remnant G65.1+0.6 with the stand-alone MAGIC-I telescope. This region hosts the two bright GeV gamma-ray sources 1FGL J1954.3+2836 and 1FGL J1958.6+2845. They are identified as GeV pulsars and both have a possible counterpart detected at about 35 TeV by the Milagro observatory. MAGIC collected 25.5 hours of good quality data, and found no significant emission in the range around 1 TeV. We therefore report differential flux upper limits, assuming the emission to be point-like (<0.1 deg) or within a radius of 0.3 deg. In the point-like scenario, the flux limits around 1 TeV are at the level of 3 % and 2 % of the Crab Nebula flux, for the two sources respectively. This implies that the Milagro emission is either extended over a much larger area than our point spread function, or it must be peaked at energies beyond 1 TeV, resulting in a photon index harder than 2.2 in the TeV band.Comment: 8 pages, 3 figures, 1 tabl

First bounds on the high-energy emission from isolated Wolf-Rayet binary systems

High-energy gamma-ray emission is theoretically expected to arise in tight binary star systems (with high mass loss and high velocity winds), although the evidence of this relationship has proven to be elusive so far. Here we present the first bounds on this putative emission from isolated Wolf-Rayet (WR) star binaries, WR 147 and WR 146, obtained from observations with the MAGIC telescope.Comment: (Authors are the MAGIC Collaboration.) Manuscript in press at The Astrophysical Journal Letter

Simultaneous multi-frequency observation of the unknown redshift blazar PG 1553+113 in March-April 2008

The blazar PG 1553+113 is a well known TeV gamma-ray emitter. In this paper, we determine its spectral energy distribution using simultaneous multi-frequency data in order to study its emission processes. An extensive campaign was carried out between March and April 2008, where optical, X-ray, high-energy (HE) gamma-ray, and very-high-energy (VHE) gamma-ray data were obtained with the KVA, Abastumani, REM, RossiXTE/ASM, AGILE and MAGIC telescopes, respectively. This is the first simultaneous broad-band (i.e., HE+VHE) gamma-ray observation, though AGILE did not detect the source. We combine data to derive source's spectral energy distribution and interpret its double peaked shape within the framework of a synchrotron self compton modelComment: 5 pages, 2 figures, publishe

Surface indicators are correlated with soil multifunctionality in global drylands

Multiple ecosystem functions need to be considered simultaneously to manage and protect the several ecosystem services that are essential to people and their environments. Despite this, cost effective, tangible, relatively simple and globally relevant methodologies to monitor in situ soil multifunctionality, that is, the provision of multiple ecosystem functions by soils, have not been tested at the global scale. We combined correlation analysis and structural equation modelling to explore whether we could find easily measured, field-based indicators of soil multifunctionality (measured using functions linked to the cycling and storage of soil carbon, nitrogen and phosphorus). To do this, we gathered soil data from 120 dryland ecosystems from five continents. Two soil surface attributes measured in situ (litter incorporation and surface aggregate stability) were the most strongly associated with soil multifunctionality, even after accounting for geographic location and other drivers such as climate, woody cover, soil pH and soil electric conductivity. The positive relationships between surface stability and litter incorporation on soil multifunctionality were greater beneath the canopy of perennial vegetation than in adjacent, open areas devoid of vascular plants. The positive associations between surface aggregate stability and soil functions increased with increasing mean annual temperature. Synthesis and applications. Our findings demonstrate that a reduced suite of easily measured in situ soil surface attributes can be used as potential indicators of soil multifunctionality in drylands world-wide. These attributes, which relate to plant litter (origin, incorporation, cover), and surface stability, are relatively cheap and easy to assess with minimal training, allowing operators to sample many sites across widely varying climatic areas and soil types. The correlations of these variables are comparable to the influence of climate or soil, and would allow cost-effective monitoring of soil multifunctionality under changing land-use and environmental conditions. This would provide important information for evaluating the ecological impacts of land degradation, desertification and climate change in drylands world-wide.Fil: Eldridge, David J.. University of New South Wales; AustraliaFil: Delgado Baquerizo, Manuel. Universidad Rey Juan Carlos; EspañaFil: Quero, José L.. Universidad de Córdoba; EspañaFil: Ochoa, Victoria. Universidad Rey Juan Carlos; España. Universidad de Alicante; EspañaFil: Gozalo, Beatriz. Universidad Rey Juan Carlos; España. Universidad de Alicante; EspañaFil: García Palacios, Pablo. Universidad Rey Juan Carlos; EspañaFil: Escolar, Cristina. Universidad Rey Juan Carlos; EspañaFil: García Gómez, Miguel. Universidad Politécnica de Madrid; EspañaFil: Prina, Aníbal. Universidad Nacional de La Pampa; ArgentinaFil: Bowker, Mathew A.. Northern Arizona University; Estados UnidosFil: Bran, Donaldo Eduardo. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche; ArgentinaFil: Castro, Ignacio. Universidad Experimental Simón Rodríguez; VenezuelaFil: Cea, Alex. Universidad de La Serena; ChileFil: Derak, Mchich. No especifíca;Fil: Espinosa, Carlos I.. Universidad Técnica Particular de Loja; EcuadorFil: Florentino, Adriana. Universidad Central de Venezuela; VenezuelaFil: Gaitán, Juan José. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación de Recursos Naturales. Instituto de Suelos; Argentina. Universidad Nacional de Luján. Departamento de Tecnología; ArgentinaFil: Gatica, Mario Gabriel. Universidad Nacional de San Juan. Facultad de Ciencias Exactas Físicas y Naturales. Departamento de Biología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan. Centro de Investigaciones de la Geosfera y Biosfera. Universidad Nacional de San Juan. Facultad de Ciencias Exactas Físicas y Naturales. Centro de Investigaciones de la Geosfera y Biosfera; ArgentinaFil: Gómez González, Susana. Universidad de Cádiz; EspañaFil: Ghiloufi, Wahida. Université de Sfax; TúnezFil: Gutierrez, Julio R.. Universidad de La Serena; ChileFil: Guzman, Elizabeth. Universidad Técnica Particular de Loja; EcuadorFil: Hernández, Rosa M.. Universidad Experimental Simón Rodríguez; VenezuelaFil: Hughes, Frederic M.. Universidade Estadual de Feira de Santana; BrasilFil: Muiño, Walter. Universidad Nacional de La Pampa; ArgentinaFil: Monerris, Jorge. No especifíca;Fil: Ospina, Abelardo. Universidad Central de Venezuela; VenezuelaFil: Ramírez, David A.. International Potato Centre; PerúFil: Ribas Fernandez, Yanina Antonia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan. Centro de Investigaciones de la Geosfera y Biosfera. Universidad Nacional de San Juan. Facultad de Ciencias Exactas Físicas y Naturales. Centro de Investigaciones de la Geosfera y Biosfera; ArgentinaFil: Romão, Roberto L.. Universidade Estadual de Feira de Santana; BrasilFil: Torres Díaz, Cristian. Universidad del Bio Bio; ChileFil: Koen, Terrance B.. No especifíca;Fil: Maestre, Fernando T.. Universidad Rey Juan Carlos; España. Universidad de Alicante; Españ

Probing quantum gravity using photons from a flare of the active galactic nucleus Markarian 501 observed by the MAGIC telescope

We analyze the timing of photons observed by the MAGIC telescope during a flare of the active galactic nucleus Mkn 501 for a possible correlation with energy, as suggested by some models of quantum gravity (QG), which predict a vacuum refractive index \simeq 1 + (E/M_{QGn})^n, n = 1,2. Parametrizing the delay between gamma-rays of different energies as \Delta t =\pm\tau_l E or \Delta t =\pm\tau_q E^2, we find \tau_l=(0.030\pm0.012) s/GeV at the 2.5-sigma level, and \tau_q=(3.71\pm2.57)x10^{-6} s/GeV^2, respectively. We use these results to establish lower limits M_{QG1} > 0.21x10^{18} GeV and M_{QG2} > 0.26x10^{11} GeV at the 95% C.L. Monte Carlo studies confirm the MAGIC sensitivity to propagation effects at these levels. Thermal plasma effects in the source are negligible, but we cannot exclude the importance of some other source effect.Comment: 12 pages, 3 figures, Phys. Lett. B, reflects published versio

Soil fungal abundance and plant functional traits drive fertile island formation in global drylands

Dryland vegetation is characterized by discrete plant patches that accumulate and capture soil resources under their canopies. These “fertile islands” are major drivers of dryland ecosystem structure and functioning, yet we lack an integrated understanding of the factors controlling their magnitude and variability at the global scale.EEA BarilocheFil: Ochoa-Hueso, Raúl. Universidad Autónoma de Madrid. Department of Ecology; EspañaFil: Eldridge, David J. University of New South Wales. School of Biological, Earth and Environmental Sciences; AustraliaFil: Delgado-Baquerizo, Manuel. University of Colorado. Cooperative Institute for Research in Environmental Sciences; Estados Unidos. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; EspañaFil: Soliveres, Santiago. University of Bern. Institute of Plant Sciences; SuizaFil: Bowker, Matthew A. Northern Arizona University. School of Forestry; Estados UnidosFil: Gross, Nicolás. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; España. Institut Nationale de la Recherche Agronomique; Francia. Université La Rochelle. Centre d’étude biologique de Chizé; FranciaFil: Le Bagousse-Pinguet, Yoann. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; EspañaFil: Quero, José L. Universidad de Córdoba. Escuela Técnica Superior de Ingeniería Agronómica y de Montes. Departamento de Ingeniería Forestal: EspañaFil: García-Gómez, Miguel. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; EspañaFil: Valencia, Enrique. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; EspañaFil: Arredondo, Tulio. Instituto Potosino de Investigación Científica y Tecnológica. División de Ciencias Ambientales; MéxicoFil: Beinticinco, Laura. Universidad Nacional de La Pampa. Facultad de Agronomía; ArgentinaFil: Bran, Donaldo Eduardo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Bariloche; ArgentinaFil: Cea, Alex. Universidad de La Serena. Departamento de Biología; ChileFil: Coaguila, Daniel. Instituto de Ensino Superior de Rio Verde; BrasilFil: Dougill, Andrew J. University of Leeds. School of Earth and Environment; Gran BretañaFil: Espinosa, Carlos I. Universidad Técnica Particular de Loja. Departamento de Ciencias Naturales; EcuadorFil: Gaitan, Juan Jose. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Suelos; ArgentinaFil: Guuroh, Reginald T. University of Cologne. Botanical Institute. Range Ecology and Range Management Group; Alemania. CSIR-Forestry Research Institute of Ghana; GhanaFil: Guzmán, Elizabeth. Universidad Técnica Particular de Loja. Departamento de Ciencias Naturales; EcuadorFil: Gutiérrez, Julio R.. Universidad de La Serena. Departamento de Biología; Chile. Centro de Estudios Avanzados en Zonas Áridas (CEAZA); Chile. Instituto de Ecología y Biodiversidad; ChileFil: Hernández, Rosa M. Universidad Experimental Simón Rodríguez. Centro de Agroecología Tropical. Laboratorio de Biogeoquímica; VenezuelaFil: Huber-Sannwald, Elisabeth. Instituto Potosino de Investigación Científica y Tecnológica. División de Ciencias Ambientales; MéxicoFil: Jeffries, Thomas. Western Sydney University. Hawkesbury Institute for the Environment; AustraliaFil: Linstädter, Anja. University of Cologne. Botanical Institute. Range Ecology and Range Management Group; AlemaniaFil: Mau, Rebecca L. Northern Arizona University. Center for Ecosystem Science and Society: Estados UnidosFil: Monerris, Jorge. Université du Québec à Montréal. Pavillon des Sciences Biologiques. Département des Sciences Biologiques; CanadáFil: Prina, Anibal. Universidad Nacional de La Pampa. Facultad de Agronomía; ArgentinaFil: Pucheta, Eduardo. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales. Departamento de Biología; ArgentinaFil: Stavi, Ilan. Dead Sea and Arava Science Center, IsraelFil: Thomas, Andrew. Aberystwyth University. Department of Geography and Earth Sciences; Gran BretañaFil: Zaady, Eli. Agricultural Research Organization. Gilat Research Center. Natural Resources; IsraelFil: Singh, Brajesh K. Western Sydney University. Hawkesbury Institute for the Environment; Australia. Western Sydney University. Global Centre for Land-Based Innovation; AustraliaFil: Maestre, Fernando T. Universidad Rey Juan Carlos. Escuela Superior de Ciencias Experimentales y Tecnología. Departamento de Biología y Geología, Física y Química Inorgánica; Españ