Validation of a Virtual Assistant for Improving Medication Adherence in Patients with Comorbid Type 2 Diabetes Mellitus and Depressive Disorder

Virtual assistants are programs that interact with users through text or voice messages simulating a human-based conversation. The development of healthcare virtual assistants that use messaging platforms is rapidly increasing. Still, there is a lack of validation of these assistants. In particular, this work aimed to validate the effectiveness of a healthcare virtual assistant, integrated within messaging platforms, with the aim of improving medication adherence in patients with comorbid type 2 diabetes mellitus and depressive disorder. For this purpose, a nine-month pilot study was designed and subsequently conducted. The virtual assistant reminds patients about their medication and provides healthcare professionals with the ability to monitor their patients. We analyzed the medication possession ratio (MPR), measured the level of glycosylated hemoglobin (HbA1c), and obtained the patient health questionnaire (PHQ-9) score in the patients before and after the study. We also conducted interviews with all participants. A total of thirteen patients and five nurses used and evaluated the proposed virtual assistant using the messaging platform Signal. Results showed that on average, the medication adherence improved. In the final interview, 69% of the patients agreed with the idea of continuing to use the virtual assistant after the study

Distributional and Ecological Notes on the Halfbeaks of Eastern Gulf of Mexico, with a Provisional Key for Their Identification

Several fishes of the halfbeak genus Hyporhamphus occurring in the Mexican Gulf of Mexico and Caribbean Sea have been misidentified or confused in the literature. Most of it has centered around the taxonomic status of H. unifasciatus (including its synonym H. roberti), which is shown to comprise a complex of three species, H. unifasciatus, the recently described H. meeki, from the western Atlantic region, and an undescribed species from the eastern Pacific Ocean. Another eastern Mexico halfbeak is the freshwater form H. mexicanus. Using Banford and Collette (1993), we examined specimens from collections at UANL, UNAM, IPN, and ECOCH and have clarified the Mexican distribution of these species. We here report additional Mexican records of H. meeki, previously known only from United States waters and from the coast of Yucatán, clarify the distribution of H. unifasciatus, and provide the first marine record of the freshwater species H. mexicanus. A distribution map and keys for identification of the eastern Mexican species are provided

Evaluation of optical techniques for characterising soil organic matter quality in agricultural soils

Soil organic matter (SOM) is one of the main global carbon pools. It is a measure of soil quality as its presence increases carbon sequestration and improves physical and chemical soil properties. The determination and characterisation of humic substances gives essential information of the maturity and stresses of soils as well as of their health. However, the determination of the exact nature and molecular structure of these substances has been proven difficult. Several complex techniques exist to characterise SOM and mineralisation and humification processes. One of the more widely accepted for its accuracy is nuclear magnetic resonance (NMR) spectroscopy. Despite its efficacy, NMR needs significant economic resources, equipment, material and time. Proxy measures like the fluorescence index (FI), cold and hot-water extractable carbon (CWC and HWC) and SUVA-254 have the potential to characterise SOM and, in combination, provide qualitative and quantitative data of SOM and its processes. Spanish and British agricultural cambisols were used to measure SOM quality and determine whether similarities were found between optical techniques and 1H NMR results in these two regions with contrasting climatic conditions. High correlations (p < 0.001) were found between the specific aromatic fraction measured with 1H NMR and SUVA-254 (Rs = 0.95) and HWC (Rs = 0.90), which could be described using a linear model. A high correlation between FI and the aromatics fraction measured with 1H NMR (Rs = −0.976) was also observed. In view of our results, optical measures have a potential, in combination, to predict the aromatic fraction of SOM without the need of expensive and time consuming techniques

Analytical characterization of secondary phases and void distributions in an ultrafine-grained ODS Fe─14Cr model alloy

Proceedings of the: The 14th International Conference on Fusion Reactor Materials (ICFRM-14) was held at the Sapporo Convention Center in Sapporo, Japan from 7 to 12 September 2009.Two model Fe─14Cr alloys, one containing 0.3 wt.% of Y₂O₃ particles, were fabricated by mechanical alloying of Fe and Cr elemental powders under a He atmosphere. They were subsequently consolidated and thermomechanically treated to produce ultra-fine grained materials. Cr-carbides and oxides were found in both alloys. The oxide dispersion-strengthened (ODS) alloy also contained a fine dispersion of nanoparticles, some of them having a Y─O rich core and a Cr-rich shell. Nanometric sized voids were found in both materials, often attached to secondary phases, dislocations and grain boundaries. Their sizes were significantly smaller in the ODS alloy.This research has been supported by the Fusion Energy Materials Science (FEMaS) FP7 coordination action and the IP3 FP6 ESTEEM project under Contract No. 026019. The financial support from European Fusion Development Agreement (Contract No. 09-240), the Ministerio de Innovacion y Ciencia (Project No. ENE 2008-06403-C06-04 and Juan de la Cierva programme) and the Comunidad de Madrid, through the program ESTRUMAT-CM, Grant S-0505/MAT/0077Publicad

Problemas de salud y factores determinantes del número de visitas a demanda en pacientes hiperutilizadores de un centro de salud

ObjetivosDescribir las características sociodemográficas y problemas de salud que presentan los pacientes hiperconsultadores de un centro de salud y determinar los factores que explican el número de visitas solicitadas en consulta demanda del médico de familia.DiseñoDescriptivo, retrospectivo. Análisis multivariante: regresión lineal múltiple.EmplazamientoCentro de salud urbano.PacientesPacientes que han solicitado cita para consulta demanda en el centro de salud en al menos nueve ocasiones durante 1999 (n = 7.852). Muestra aleatoria de 386 pacientes (alfa, 0,05; precisión, 95%).Mediciones y resultados principalesVariable dependiente: número de consultas demanda solicitadas en 1999. Variables independientes: edad, tamaño familiar, zona residencia, activo o pensionista, inclusión en programas, problemas de salud (CIAP-2), número de fármacos en prescripción repetida (clasificación anatómica), incapacidad laboral temporal (IT). Los hiperconsultadores son un 57,8% (IC, 52,9-62,7%) mujeres; edad media, 55 años (DE, 18,5); tamaño familiar, 2,7 miembros (DE, 1,457); 58,8% pensionistas; número medio de citas, 15 (DE, 6,7); consumo medio, 1,58 (DE, 2,46) fármacos de forma habitual; inclusión en programas: 37,7%, hipertensión; 16%, diabetes; 17%, dislipemia; 16%, consulta de enfermería. Patologías más prevalentes: cardiocirculatorias (43,8%), endocrinometabólicas (32%), traumatológicas (26,7%) y salud mental (21%). El modelo de regresión incluye las variables edad, número de fármacos y haber estado en IT.ConclusionesLos hiperconsultadores de nuestro centro de salud son mujeres de edad media con problemas de salud física de evolución crónica y problemas de salud mental. El número de visitas está relacionado con la edad y las necesidades administrativas: medicación y bajas.ObjectivesTo describe the social and demographic characteristics and health problems of over-users of a health centre and to determine the number of attendances requested on demand at the general medical clinic.DesignRetrospective and descriptive. Multivariate analysis: multiple linear regression.SettingUrban health centre.PatientsPatients who requested a consultation at the health centre on at least nine occasions in 1999 (N = 7852). Random sample of 386 patients (alpha 0.05, 95% accuracy).Measurements and main resultsDependent variable: number of on-demand consultations requested in 1999. Independent variables: age, family size, area of residence, active or pensioner, inclusion in programmes, health problems (CIAP-2), number of drugs on repeat prescription (Anatomical Classification), short-term time off work. 57% of over-users were women (CI, 52.9-62.7%); mean age 55 (SD 18.5); family size 2.7 members (SD 1.457); 58.8% pensioners. Mean number of appointments 15 (SD 6.7). Mean habitual consumption of 1.58 medicines (SD 2.46). Inclusion in programmes: 37.7% hypertension, 16% diabetes, 17% dyslipaemia, 16% nursing clinic. Most prevalent pathologies: cardiocirculatory (43.8%), endocrino-metabolic (32%), traumatology (26.7%) and mental health (21%). The regression model included the variables of age, number of medicines and having had short-term time off.ConclusionsOver-users of our health centre are middle-aged women with chronic physical health problems and with mental health problems. The number of attendances is related to age and administrative requirements: medication and sick notes

Nasal spray formulations based on combined hyalurosomes and glycerosomes loading zingiber officinalis extract as green and natural strategy for the treatment of rhinitis and rhinosinusitis

A total green nanotechnological nasal spray has been manufactured and proposed as an alternative treatment of rhinitis and rhinosinusitis. It was obtained by combining the strengthening effect of liposomes on barrier function, the hydrating and lubricating properties of sodium hyaluro-nan and the anti-inflammatory and antioxidant activities of the extract of Zingiber officinalis. To this purpose, the extract was loaded in special phospholipid vesicles immobilized with hyaluronic acid (hyalurosomes), which were further enriched with glycerol in the water phase. Liposomes and glycerosomes were prepared as well and used as reference. Vesicles were oligolamellar and multi-compartment, as confirmed by cryogenic transmission electron microscopy (cryo-TEM) observation, small in size (~140 nm) and negatively charged (~-23 mV). Spray characteristics were evaluated by using the Spraytec® and instant images, from which the plume angle was measured. The range of the droplet size distribution and the narrow spray angle obtained suggest a good nebulization and a possible local deposition in the nasal cavity. In vitro studies performed by using human keratinocytes confirmed the high biocompatibility of vesicles and their ability to effectively counteract oxidative damage on cells induced by hydrogen peroxide. The overall collected data suggest that our vesicles are suitable as nasal spray. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Inestabilidad lateral crónica de tobillo: hallazgos artroscópicos y resultados tras reparación mediante técnica de Karlsson

ObjetivoRecoger los resultados obtenidos asociando la artroscopia diagnóstico-terapéutica a la técnica propuesta por Karlsson.Material y métodoSe revisaron retrospectivamente 11 casos tratados entre diciembre de 2004 y julio de 2009 mediante cirugía artroscópica de tobillo asociada a la técnica de Karlsson. La media de edad fue de 25 años (rango 13-45). Primero se realizó la artroscopia y posteriormente el abordaje lateral para la reparación ligamentosa. El ligamento peroneo-calcáneo se reparó en los 4 casos en que se objetivó su lesión. Se valoró la funcionalidad según la escala de la American Orthopaedic Foot and Ankle Society (AOFAS) y el grado de satisfacción subjetiva. Se recogieron las complicaciones.ResultadosTras un seguimiento medio de 11 meses, valoramos 11 pacientes cuya puntuación media según la AOFAS fue de 84 puntos. La valoración subjetiva fue excelente en 7 casos, buena en 2 y mala en 2. Como complicaciones, hubo 2 casos de síndrome de dolor regional complejo (SDRC) y un paciente tuvo que ser reintervenido con técnica de Castaing II.ConclusionesConsideramos que la asociación de la artroscopia previa a la realización de la reconstrucción para el tratamiento de la inestabilidad crónica constituye una maniobra útil para el diagnóstico de patologías articulares asociadas, aportando información importante para el pronóstico funcional de la articulación.AimsThe purpose of this study is to evaluate the result of diagnostic and therapeutic arthroscopy in association with Karlsson technique.Material And MethodsBetween 2004 and 2009, 11 patients were operated by ankle arthroscopic surgery associated with Karlsson technique. The mean age was 25 years (range 13-45). Arthroscopy was performed first and secondly the lateral approach to ligament repair. Peroneal-calcaneal ligament wasn injuried and repaired in 4 cases. AOFAS scale was used for clinical and functional evaluation, and patients were asked about subjective satisfaction. Complications were recorded.ResultsAt a mean follow-up of 11 months the mean final score was 84 points on the AOFAS scale. The subjective assessment was excellent in 7 cases, good in 2 and poor in 2. There were 2 cases of CRPS and one patient was reoperated by Castaing II technique.ConclusionsWe believe that the association of arthroscopy prior to the reconstruction is useful for associated joint lesion diagnosis, providing important information for the functional prognosis of the joint