Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus

Background: Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre-frail participants aged >= 70 years with type 2 diabetes mellitus. Methods: The MID-Frail study was a cluster-randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre-frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator-linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost-effectiveness of the intervention was undertaken using the incremental cost-effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost-effectiveness of the intervention. Results: After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes. Conclusions: We have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost-effective improvement in the functional status of older frail and pre-frail participants with type 2 diabetes mellitus

R-Allyl Nickel(II) Complexes with Chelating N-Heterocyclic Carbenes: Synthesis, Structural Characterization, and Catalytic Activity

The N-heterocyclic carbene (NHC) nickel complexes [(L)Ni(NHC)][BArF4] (ArF = 3,5-bis(trifluoromethyl)- phenyl; L = allyl (1), methylallyl (2); NHC = 1-(2-picolyl)-3-methylimidazol-2-ylidene (a), 1-(2-picolyl)-3-isopropylimidazol-2-ylidene (b), 1-(2-picolyl)-3-n-butylimidazol-2-ylidene (c), 1-(2-picolyl)-3-phenylimidazol-2-ylidene (d), 1-(2-picolyl)-3- methylbenzoimidazol-2-ylidene (e), 1-(2-picolyl)-4,5-dichloro-3-methylimidazol-2-ylidene (f)) have been obtained in high yields and characterized by NMR spectroscopy. Furthermore, 1d was unambiguously characterized by single-crystal X-ray crystallography. Complexes 1a−f/2a−f have shown catalytic activity toward dimerization and hydrosilylation of styrenes. In particular, 1a proved to be the most efficient catalyst in the dimerization of styrene derivatives in the absence of cocatalyst. Also, complexes 1a,d showed high selectivity and moderate to good yields in hydrosilylation reactions

The Effect of Tuberculosis on Mortality in HIV Positive People: A Meta-Analysis

Tuberculosis is a leading cause of death in people living with HIV (PLWH). We conducted a meta analysis to assess the effect of tuberculosis on mortality in people living with HIV. Meta-analysis of cohort studies assessing the effect of tuberculosis on mortality in PLWH. To identify eligible studies we systematically searched electronic databases (until December 2008), performed manual searches of citations from relevant articles, and reviewed conference proceedings. Multivariate hazard ratios (HR) of mortality in PLWH with and without tuberculosis, estimated in individual cohort studies, were pooled using random effect weighting according to "Der Simonian Laird method" if the p-value of the heterogeneity test was <0.05. Fifteen cohort studies were systematically retrieved. Pooled overall analysis of these 15 studies estimating the effect of tuberculosis on mortality in PLWH showed a Hazard Ratio (HR) of 1.8 (95% confidence interval (CI): 1.4-2.3). Subanalysis of 8 studies in which the cohort was not exposed to highly active antiretroviral therapy (HAART) showed an HR of 2.6 (95% CI: 1.8-3.6). Subanalysis of 6 studies showed that tuberculosis did not show an effect on mortality in PLWH exposed to HAART: HR 1.1 (95% CI: 0.9-1.3). These results provide an indication of the magnitude of benefit to an individual that could have been expected if tuberculosis had been prevented. It emphasizes the need for additional studies assessing the effect of preventing tuberculosis or early diagnosis and treatment of tuberculosis in PLWH on reducing mortality. Furthermore, the results of the subgroup analyses in cohorts largely exposed to HAART provide additional support to WHO's revised guidelines, which include promoting the initiation of HAART for PLWH co-infected with tuberculosis. The causal effect of tuberculosis on mortality in PLWH exposed to HAART needs to be further evaluated once the results of more cohort studies become availabl

Gamificación en Iberoamérica. Experiencias desde la comunicación y la educación

La presente obra capitular es el resultado de las investigaciones sobre las aplicaciones de la gamificación en contextos múltiples, emergentes provenientes de las comunicaciones presentadas en el Simposio 06 del III Congreso Internacional Comunicación y Pensamiento (Sevilla, España), así como de aquellas presentadas por los miembros del Gamelab UPS, del Proyecto I+D+i Coordinado “Competencias mediáticas de la ciudadanía en medios digitales emergentes (smartphones y tablets): Prácticas innovadoras y estrategias educomunicativas en contextos múltiples” (EDU2015-64015-C3-1-R) (MINECO/FEDER), de la “Red de Educación Mediática” del Programa Estatal de Investigación Científica-Técnica de Excelencia, Subprograma Estatal de Generación de Conocimiento (EDU2016-81772-REDT), financiados por el Fondo Europeo de Desarrollo Regional (FEDER) y Ministerio de Economía y Competitividad de España. En este sentido se busca construir, desde una mirada dual desde Europa y América Latina el primer libro iberoamericano de gamificación, avalado por el Gamelab de la Universidad Politécnica Salesiana (Ecuador), el Proyecto I+D+i EDU2015-64015-C3-1-R, la Red Interuniversitaria Euroamericana de Investigación sobre Competencias Mediáticas para la Ciudadanía (Alfamed), el Laboratorio de Estudios en Comunicación (Ladecom) y el Grupo de Investigación Ágora (PAI-HUM-648) de la Universidad de Huelva (España) y el Grupo de Investigación Estructura, Historia y Contenidos de la Comunicación GREHCCO

Palladium(0) nanoparticles stabilized by phosphorus dendrimers containing coordinating 15-membered triolefinic macrocycles in periphery

A new family of phosphorus dendrimers containing on their surfaces 3, 6,12, and 96 15-membered azamacrocycles has been synthesized. The coordinating ability of these macrocycles to palladium(0) atoms allowed the preparation of new dendrimers of several generations containing the corresponding metal complexes and several new nanoparticulated materials, where nanoparticles are stabilized mainly by the complexed dendrimers of the zero, first, and fourth generations. No reduction process of palladium(II) salts was needed to prepare nanoparticles of 2.5-7.9 nm diameter. All the new compounds and materials have been characterized by NMR, IR, elemental analysis and/or matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) spectrometry, high-resolution transmission electron microscopy, and electron diffraction. Also UV-vis spectra were obtained. The Mizoroki-Heck reaction has been catalyzed in a homogeneous and heterogeneous manner by using four different materials; in all cases, the catalyst could be recovered and reused several times. © 2008 American Chemical Society

Nucleophilic aromatic substitution on 4-fluorophenylsulfonamides: Nitrogen, oxygen, and sulfur nucleophiles

Improved conditions are reported for the stoichiometric reaction of nitrogen, oxygen, and sulfur nucleophiles with weakly activated 4-fluorophenylsulfonamides. © Georg Thieme Verlag Stuttgart

Wide temperature range mesomorphic behaviour of highly fluorinated 15-membered macrocycles and their open trisulphonamide precursor

The mesomorphic properties of 15-membered azamacrocycles containing long hydrocarbon or highly fluorinated long chains have been explored along with those of their open precursors. The liquid crystalline behaviour is determined by the presence of different heteroatoms or long fluorinated chains and the substitution pattern of the aryl units of the sulphonamides. The presence of highly fluorinated long chains in the para position with regard to the sulphonamide group was found to favour the formation of smectic mesophases with wide temperature ranges. All of the mesophases were studied by polarizing optical microscopy and differential scanning calorimetry. © 2007 Taylor & Francis

Structure of chiral pyrazoles in the solid state and in solution

The X-ray molecular structures of three chiral pyrazoles bearing (4S)-4-benzyloxazolidin-2-ones or (2R)-bornane- 10,2-sultams at position 3(5) have been studied by single crystal X-ray di raction and by NMR. In the solid state, the same pyrazole tautomer a has been found for the three compounds, that with the chiral group in the 3-position. Their crystal structures consist of inÐnite chains (catemers) formed by NÈHÉÉÉO2X (X : C, S) hydrogen bonds. The use of solid-state 13C NMR spectroscopy demonstrated that the pyrazole is also an a tautomer. 13C NMR spectra in methanol solution yield average signals even at [80 ¡C ; nevertheless, interpolation allows one to estimate that in solution tautomer a also predominates.We are indebted to MEC of Spain (Projects PB93-0896 and PB98-0902) and Generalitat de Catalunya (Project 1998SGR- 0056 and a scholarship to R. M. S.) for Ðnancial support, and to URQUIMA, S. A. (Dr Joan for a generous gift of Blade) oxazolidinone. We thank the Departamento de Química y (UNED) for recording the CPMASOrgánica Biología spectra of compounds 1 and 2.Peer reviewe