Configuración smart para el patrimonio Euro-Mediterráneo: el dibujo smart para el Rabàto de Agrigento

Research on the rehabilitation of a district of the suburbs of the historic Italian city of Agrigento, from reinterpreting historical frame in a new key to space utilization invites reflection on the concept of urban regeneration in historic areas medium cities of Euro-Mediterranean context, at a time when the growth of cities seems to enter a phase of stagnation in which the tourism component of these areas reveals a possibility of urban transformation. The article proposes a methodology for analysis and intervention Rabato district in which energy efficiency, implementation of smart technologies and citizen participation are complemented by the incorporation of economic, cultural and social values, to build an expanded concept of smart city. In addition, we propose the creation of a mapping system and visualization of urban data, which may constitute a network of historic smart cities, which serve to transfer and share knowledge and intervention methodologies.La investigación sobre la rehabilitación de un barrio de los arrabales de la ciudad histórica italiana de Agrigento a partir de la reinterpretación de su trama histórica en una nueva clave de aprovechamiento del espacio, invita a reflexionar sobre el concepto de regeneración urbana en áreas históricas de ciudades medias del contexto euro mediterráneo, en un momento en el que el crecimiento de las ciudades parece entrar en una fase de estancamiento y en el que la componente turística de estos ámbitos se revela como una posibilidad de transformación urbana. El artículo propone una metodología sobre el análisis y la intervención en el barrio del Rabato en el que la eficiencia energética, la implementación de tecnologías smart y la participación ciudadana, se complementan con la incorporación de los valores patrimoniales, culturales y sociales para construir un concepto expandido de ciudad inteligente. Además, se propone la creación de un sistema de mapeo y visibilización de datos urbanos, que pudieran constituir una red de ciudades históricas smart, que sirviese para transferir y compartir conocimiento y metodologías de intervención

Training Habits of Eumenorrheic Active Women during the Different Phases of Their Menstrual Cycle: A Descriptive Study

This research was supported by the Pre-competitive Projects for Early Stage Researchers Program from the University of Granada (ref: PPJIA2020.03). The authors would like to thank all the participants.This study meets the ethical standards of theWorld Medical Association’s Declaration of Helsinki (2013), and it was approved by the Institutional Review Board (Universidad de La Frontera, Temucho, Chile, 005_19).Informed consent was obtained from all subjects involved in the study.The purpose of this study was to examine the training habits of eumenorrheic active women during their menstrual cycle (MC), and its perceived influence on physical performance regarding their athletic level. A group of 1250 sportswomen filled in a questionnaire referring to demographic information, athletic performance and MC-related training habits. Of the participants, 81% reported having a stable duration of MC, with most of them (57%) lasting 26-30 days. Concerning MC-related training habits, 79% indicated that their MC affects athletic performance, although 71% did not consider their MC in their training program, with no differences or modifications in training volume or in training intensity for low-level athletes (LLA) and high-level athletes (HLA) with hormonal contraceptive (HC) use. However, LLA with a normal MC adapted their training habits more, compared with HLA, also stopping their training (47.1% vs. 16.1%, respectively). Thus, different training strategies should be designed for HLA and LLA with a normal MC, but this is not so necessary for HLA and LLA who use HC. To sum up, training adaptations should be individually designed according to the training level and use or non-use of HC, always taking into account the pain suffered during the menstrual phase in most of the athletes.Pre-competitive Projects for Early Stage Researchers Program from the University of Granada PPJIA2020.0

Imported Plasmodium falciparum malaria in HIV-infected patients: a report of two cases

As HIV becomes a chronic infection, an increasing number of HIV-infected patients are travelling to malaria-endemic areas. Association of malaria with HIV/AIDS can be clinically severe. Severe falciparum malaria is a medical emergency that is associated with a high mortality, even when treated in an Intensive Care Unit. This article describes two cases of HIV-positive patients, who returned from malaria-endemic areas and presented a parasitaemia > 5% of erythrocytes and clinical signs of severe falciparum malaria, both with > 350 CD4 cell count/μl, absence of chemoprophylaxis and successful response. Factors like drug interactions and the possible implication of anti-malarial therapy bioavailability are all especially interesting in HIV-malaria co-infections

Assessment of Darkling Beetle Fauna after Implementation of an Environmental Restoration Program in the Southern Iberian Peninsula Affected by the Aznalcóllar Toxic Spill

This study is part of the Follow up Restoration Program of animal communities that colonize the Guadiamar River Basin. In 1998, the area was affected by a release of toxic sludge after the retention walls of the Aznalcóllar Mines (southern Iberian Peninsula) broke. The main objective of this study was to assess the current state of the population of Tenebrionidae, one of the most representative groups of edaphic Coleoptera inhabiting the Guadiamar River Basin. This paper analyses the progress made by the darkling beetle community six years after the disaster occurred and the Restoration Program was implemented. The study is based on faunistic data from systematic sampling carried out for six years to monitor plots distributed across the damaged area. To make an overall assessment of the tenebrionid fauna in relation to adjacent areas qualitative and quantitative ecological indices were applied, and temporal follow up and biogeographical comparisons were also made. The results indicate that, on the whole, tenebrionid fauna was somewhat affected by the Aznalcóllar Mine spill, and that a greater loss of fauna was detected closer to the accident site. The analysis of the temporal population dynamic suggests that the most affected zones are undergoing a process of re-colonization. However, this process varies widely by species and has not yet reached the expected levels of a non-affected river basin in the southern Iberian Peninsula

Characteristics of hepatitis C virus resistance in an international cohort after a decade of direct-acting antivirals

Background & Aims: Direct-acting antiviral (DAA) regimens provide a cure in >95% of patients with chronic HCV infection. However, in some patients in whom therapy fails, resistance-associated substitutions (RASs) can develop, limiting retreatment options and risking onward resistant virus transmission. In this study, we evaluated RAS prevalence and distribution, including novel NS5A RASs and clinical factors associated with RAS selection, among patients who experienced DAA treatment failure. Methods: SHARED is an international consortium of clinicians and scientists studying HCV drug resistance. HCV sequence linked metadata from 3,355 patients were collected from 22 countries. NS3, NS5A, and NS5B RASs in virologic failures, including novel NS5A substitutions, were examined. Associations of clinical and demographic characteristics with RAS selection were investigated. Results: The frequency of RASs increased from its natural prevalence following DAA exposure: 37% to 60% in NS3, 29% to 80% in NS5A, 15% to 22% in NS5B for sofosbuvir, and 24% to 37% in NS5B for dasabuvir. Among 730 virologic failures, most were treated with first-generation DAAs, 94% had drug resistance in ≥1 DAA class: 31% single-class resistance, 42% dual-class resistance (predominantly against protease and NS5A inhibitors), and 21% triple-class resistance. Distinct patterns containing ≥2 highly resistant RASs were common. New potential NS5A RASs and adaptive changes were identified in genotypes 1a, 3, and 4. Following DAA failure, RAS selection was more frequent in older people with cirrhosis and those infected with genotypes 1b and 4. Conclusions: Drug resistance in HCV is frequent after DAA treatment failure. Previously unrecognized substitutions continue to emerge and remain uncharacterized. Lay summary: Although direct-acting antiviral medications effectively cure hepatitis C in most patients, sometimes treatment selects for resistant viruses, causing antiviral drugs to be either ineffective or only partially effective. Multidrug resistance is common in patients for whom DAA treatment fails. Older patients and patients with advanced liver diseases are more likely to select drug-resistant viruses. Collective efforts from international communities and governments are needed to develop an optimal approach to managing drug resistance and preventing the transmission of resistant viruses

Identification of factors involved in medication compliance: incorrect inhaler technique of asthma treatment leads to poor compliance

Josep Darbà,1 Gabriela Ramírez,2 Antoni Sicras,3 Laura García-Bujalance,4 Saku Torvinen,5 Rainel Sánchez-de la Rosa6 1Department of Economics, Universitat de Barcelona, 2BCN Health Economics & Outcomes Research S.L., 3Department of Planning, Badalona Serveis Assistencials S.A., Barcelona, 4Market Access Department, Teva Pharmaceutical, Madrid, Spain; 5Market Access Department, Teva Pharmaceuticals Europe BV, Amsterdam, the Netherlands; 6Medical Department, Teva Pharmaceutical, Madrid, Spain Objective: To identify the impact of delivery device of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA) on asthma medication compliance, and investigate other factors associated with compliance. Materials and methods: We conducted a retrospective and multicenter study based on a review of medical registries of asthmatic patients treated with ICS/LABA combinations (n=2,213) whose medical devices were either dry powder inhalers (DPIs, such as Accuhaler®, Turbuhaler®, and NEXThaler®) or pressurized metered-dose inhalers (pMDI). Medication compliance included persistence outcomes through 18 months and medication possession ratios. Data on potential confounders of treatment compliance such as asthma exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also explored. Results: The probability of asthma medication compliance in case of DPIs was lower compared to pMDIs, which suggests that inhaler devices influence inhalation therapies. There were additional confounding factors that were considered as explanatory variables of compliance. A worse measure of airflow obstruction (forced expiration volume in 1 second), comorbidities and general practitioner (GP) consultations more than once per month decreased the probability of compliance. Within comorbidities, alcoholism was positively associated with compliance. Patients of 29–39, 40–50, and 51–61 age groups or suffering from more than two exacerbations during the study period were more likely to comply with their medication regime. The effects of DPIs toward compliance varied with the different DPIs. For instance, Accuhaler® had a greater negative effect on compliance compared to Turbuhaler® and Nexthaler® in cases of patients who suffered exacerbations. We found that GP consultations reduced the probability of medication compliance for patients treated with formoterol/budesonide combination. For retired patients, visiting the GP increased the probability of medication compliance. Conclusion: We concluded that inhaler devices influence patients’ compliance for long-term asthma medication. The impact of Accuhaler®, Turbuhaler®, and NEXThaler® on medication compliance was negative. We also identified some confounders of medication compliance such as patient’s age, severity of asthma, comorbidities, and health care costs. Keywords: adherence, inhaler devices, medication possession ratio, dry powder inhalers, pressurized metered-dose inhalers, persistenc

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups