What Matters Most to Patients and Rheumatologists? A Discrete Choice Experiment in Rheumatoid Arthritis

Introduction: To determine patient and rheumatologist preferences for rheumatoid arthritis (RA) treatment attributes in Spain and to evaluate their attitude towards shared decision-making (SDM). Methods: Observational, descriptive, exploratory and cross-sectional study based on a discrete choice experiment (DCE). To identify the attributes and their levels, a literature review and two focus groups (patients [P] = 5; rheumatologists [R] = 4) were undertaken. Seven attributes with 2–4 levels were presented in eight scenarios. Attribute utility and relative importance (RI) were assessed using a conditional logit model. Patient preferences for SDM were assessed using an ad hoc questionnaire. Results: Ninety rheumatologists [52.2% women; mean years of experience 18.1 (SD: 9.0); seeing an average of 24.4 RA patients/week (SD: 15.3)] and 137 RA patients [mean age: 47.5 years (SD: 10.7); 84.0% women; mean time since diagnosis of RA: 14.2 years (SD: 11.8) and time in treatment: 13.2 years (SD: 11.2), mean HAQ score 1.2 (SD: 0.7)] participated in the study. In terms of RI, rheumatologists and RA patients viewed: time with optimal QoL: R: 23.41%/P: 35.05%; substantial symptom improvement: R: 13.15%/P: 3.62%; time to onset of treatment action: R: 16.24%/P: 13.56%; severe adverse events: R: 10.89%/P: 11.20%; mild adverse events: R: 4.16%/P: 0.91%; mode of administration: R: 25.23%/P: 25.00%; and added cost: R: 6.93%/P: 10.66%. Nearly 73% of RA patients were involved in treatment decision-making to a greater or lesser extent; however, 27.4% did not participate at all. Conclusion: Both for rheumatologists and patients, the top three decision-making drivers are time with optimal quality, treatment mode of administration and time to onset of action, although in different ranking order. Patients were willing to be more involved in the treatment decision-making process

The domestication syndrome in Phoenix dactylifera seeds : toward the identification of wild date palm populations

Investigating crop origins is a priority to understand the evolution of plants under domestication, develop strategies for conservation and valorization of agrobiodiversity and acquire fundamental knowledge for cultivar improvement. The date palm(Phoenix dactylifera L.) belongs to the genus Phoenix, which comprises 14 species morphologically very close, sometimes hardly distinguishable. It has been cultivated for millennia in the Middle East and in North Africa and constitutes the keystone of oasis agriculture. Yet, its origins remain poorly understood as no wild populations are identified. Uncultivated populations have been described but they might represent feral, i.e. formerly cultivated, abandoned forms rather than truly wild populations. In this context, this study based on morphometrics applied to 1625 Phoenix seeds aims to (1) differentiate Phoenix species and (2) depict the domestication syndrome observed in cultivated date palm seeds using other Phoenix species as a "wild" reference. This will help discriminate truly wild from feral forms, thus providing new insights into the evolutionary history of this species. Seed size was evaluated using four parameters: length, width, thickness and dorsal view surface. Seed shape was quantified using outline analyses based on the Elliptic Fourier Transform method. The size and shape of seeds allowed an accurate differentiation of Phoenix species. The cultivated date palm shows distinctive size and shape features, compared to other Phoenix species: seeds are longer and elongated. This morphological shift may be interpreted as a domestication syndrome, resulting from the long-term history of cultivation, selection and human-mediated dispersion. Based on seed attributes, some uncultivated date palms from Oman may be identified as wild. This opens new prospects regarding the possible existence and characterization of relict wild populations and consequently for the understanding of the date palm origins. Finally, we here describe a pipeline for the identification of the domestication syndrome in seeds that could be used in other crops

Construcción de esculturas de hormigón con elementos procedentes del reciclado

This paper shows the conceptual development, project, constructive and execution processes of a group of seven sculptures designed to act as containers of other art works carried out by the Spanish artist Jesús Soler. This sculptural group bases its message on the sustainability and the recycling of materials. Its fundamental boundary conditions are the capacity to be mounted and dismounted without any anchorage to the soil, durability and protection of the art work in front of meteorological agents. The sculptural group transmits by itself an environmental message. This paper describes the geometry and proportions, based on the “Le Corbusier Modulor” and the golden section, as well as all the constructive techniques applied for the correct design of each sculpture: formwork systems, concrete with recycled arid, corten steel frames, anchorages, etc. Finally the first assembly process of this itinerant sculptural work is described; it is mounted in the Parque del Retiro in the city of Madrid (Spain).Este trabajo recoge el desarrollo conceptual, de proyecto, construcción y de ejecución de un conjunto de siete esculturas disenadas para actuar como contenedores de otras obras de arte (17 cuadros) realizadas por el artista Jesús Soler. Este conjunto escultórico basa su mensaje en la sostenibidad y el reciclaje. Presenta, como condiciones de contorno fundamentales, la capacidad de ser montado y desmontado sin necesidad de anclar al terreno, durabilidad y protección de las obras frente a agentes meteorológicos y todo ello transmitiendo por sí mismas un mensaje medioambiental. Se describe en el documento la geometría y proporciones basadas en el “Modulor” de Le Corbusier y, por consiguiente, en la sección áurea, así como todas las técnicas constructivas aplicadas para el correcto diseno de cada obra: sistemas de encofrado, hormigones con áridos reciclados, marcos de acero corten, anclajes, etc. Finalmente se describe el primer proceso de montaje de esta obra itinerante, en el Parque del Retiro de Madrid

Inverse problems in high pressure processes and food engineering

Depto. de Análisis Matemático y Matemática AplicadaInstituto de Matemática Interdisciplinar (IMI)Fac. de Ciencias MatemáticasTRUEpu

Estudio de la fluencia de una calcarenita: la Piedra de San Julián (Alicante)

Rocks creep has a great importance in the evaluation of the long-term behaviour of elements built with or within these materials. In this work, a porous well-known limestone locally named as San Julián stone has been physically and mechanically characterized. Uniaxial compressive tests for 96 h. at constant stress are carried out. Long-term behaviour has been modelled by means of a well-known creep model, the CEB-FIP Model code 2010, used for modelling other stony-material (i.e. concrete). Furthermore, a rheological model has been proposed. The main aim of this work is to investigate the possibility of exploiting the vast experience accumulated in the study of concrete deformational long-term behaviour in order to obtaining a reasonable approach to the behaviour of the rock, for too long testing times difficult to implement in laboratory. A creep function adapted to the studied rock only dependent on its elastic and mechanical characteristics is also proposed in this work.La fluencia de las rocas tiene gran importancia en la evaluación del comportamiento a largo plazo de elementos construidos con estos materiales. En este trabajo, se ha caracterizado física y mecánicamente una calcarenita porosa bien conocida localmente como Piedra de San Julián. Se han realizado ensayos de compresión uniaxial de 96 h. a carga constante. Se ha utilizado un modelo de fluencia bien conocido, el Código-modelo CEB-FIP 2010, usado para modelizar otro material pétreo (hormigón). Además, se ha propuesto un modelo reológico. El objetivo principal de este trabajo es investigar la posibilidad de aprovechar la gran experiencia acumulada en el estudio del hormigón, con el fin de obtener un enfoque para el comportamiento de la roca, para tiempos de prueba muy largos difíciles de implementar en laboratorio. Se propone una función de fluencia adaptada a la roca estudiada dependiente sólo de sus características elásticas y mecánicas

Dynamic Identification of Damage in Brick Masonry Walls

This paper shows the experimental and numerical analysis developed on a brick masonry wall of 3x2.5x0.2 m to understand the changes on its dynamic behaviour with different stiffness situations: (i) original, (ii) loaded with different load levels, (iii) damaged by horizontal in plane loads, (iv) retrofitted with Textile Reinforced Mortars (TRM) and (v) retrofitted and damaged by horizontal in plane loads. This analysis has been developed at the Civil Engineering Lab at the University of Alicante. On this masonry wall a matrix of 8 seismic accelerometers have been installed to evaluate, in plane and out of plane, changes in the main frequencies, modal damping ratios and modal shapes. By the use of Operational Modal Analysis techniques the results shows that the changes on the stiffness have important influence on the main frequencies and in the modal damping ratios. Very low influence have been detected on the modal shapes due to the low level of external vibrations generated during the tests. Due to the low level of vibrations inside the lab,the classical application of ambient vibrations for OMA has been not possible and an external white noise force has been introduced on the top the wall by the use of a shaker to generate a general level of vibrations on the specimen

Detección de interacciones y duplicidades en 2 farmacias comunitarias de Alicante mediante revisiones de la medicación a mayores crónicos

Introducción: El envejecimiento es un proceso en el que se producen importantes cambios fisiológicos y aumenta la incidencia de múltiples patologías. Estos cambios pueden producir alteraciones farmacocinéticas y farmacodinámicas, con importantes implicaciones en los regímenes de dosificación de fármacos. Objetivos: Analizar la farmacoterapia del paciente anciano desde la farmacia comunitaria para conocer y clasificar los medicamentos prescritos, analizar las interacciones y buscar duplicidades. Material y métodos: Estudio descriptivo y observacional, en el que se incluyeron pacientes de atención primaria mayores de 65 años con, al menos, un tratamiento crónico. Se clasificaron los fármacos, se analizaron las interacciones y se buscaron duplicidades con Bot Plus. Resultados: El grupo terapéutico más prescrito fue el C (aparato cardiovascular). El subgrupo terapéutico de mayor consumo fue el de los IBP (inhibidores de la bomba de protones). El principio activo más prescrito fue omeprazol. Se detectaron 299 interacciones y 17 duplicidades con Bot Plus. Conclusiones: El 66,8% de los pacientes mayores de 65 años eran polimedicados, con una media de 7 medicamentos/paciente. El grupo terapéutico más prescrito fue el de los fármacos para el aparato cardiovascular, y los subgrupos terapéuticos más prescritos fueron los IBP y las estatinas; omeprazol fue el principio activo más prescrito. Se han detectado 299 interacciones, de las cuales las clasificadas como «espaciar administración» pueden ser evitadas con una adecuada dispensación del farmacéutico. Por último, un 8% de los pacientes presentaba duplicidades

Dynamic behaviour of a novel transition wedge composed by prefabricated reinforced concrete slabs

Abrupt variations of track stiffness in transitions from conventional to slab track, e.g., over bridges and tunnels, usually lead to passenger discomfort, vehicle and track damage and even safety issues. Therefore, to minimize this negative effect, it is very convenient to smooth the stiffness changes in such transitions; and wedges arise as a very effective technique. Although granular wedges are commonly suggested by railroad managers as a solution, this typology presents some disadvantages, e.g., high construction time and costs, that should be addressed. In this paper, a new solution based on prefabricated, reinforced concrete slabs is presented and its dynamical performance is assessed by means of a 3D FEM model. Results indicate that track vibrations both on the rail and over a sleeper are considerably reduced when the new slab-based wedge is considered instead of a traditional granular wedge

Fatigue Assessment of Old Riveted Railway Bridges: Laboratory Testing of a Real Bridge

The bridge over the Quisi Ravine in Alicante Province (Spain), built between 1913 and 1915, consists of six 22-22-42-42-22-22 m long steel Pratt truss spans, the lateral spans being isostatic and the central spans continuous. All the joints between the steel elements are riveted. As the bridge has been carrying railway traffic for more than 100 years, its condition needed to be assessed before carrying out the necessary repairs reinforcement to extend its service life. One of the most interesting tasks on the bridge involved a study of its fatigue behaviour to estimate its remaining useful life. Only a few kilometres away there happened to be another bridge with identical geometry over the Ferrandet Ravine, which had recently been dismantled and taken out of service and had carried the same railway traffic as the one over the Quisi Ravine. Advantage was therefore taken of this unique opportunity to test one of its isostatic spans in order to extrapolate the results to the Quisi Bridge. These tests were carried out at the ICITECH laboratories at the Universitat Politècnica de València in two different scenarios: 1) one test on a 22 m span, and 2) another on one of its girders, in both of which simulated railway traffic cyclical loads were applied. The results allowed us to estimate the number of trains that could pass over the bridge and its remaining service life, and also to define a monitoring method to help in decision making in case of possible failures of its component parts. The study also included an analysis of the bridge’s robustness in local failures of some of its elements, which led to a further bridge cyclical loading test with a deliberately damaged component. Even though other researchers had previously carried out fatigue tests on full-scale riveted bridge elements, the ICITECH study is unique in that it is the first time a full-scale bridge has been subjected to fatigue tests. This work was accompanied by advanced numerical modelling studies considering the fracture mechanics theory