Ratcheting of granular materials

We investigate the quasi-static mechanical response of soils under cyclic loading using a discrete model of randomly generated convex polygons. This response exhibits a sequence of regimes, each one characterized by a linear accumulation of plastic deformation with the number of cycles. At the grain level, a quasi-periodic ratchet-like behavior is observed at the contacts, which excludes the existence of an elastic regime. The study of this slow dynamics allows to explore the role of friction in the permanent deformation of unbound granular materials supporting railroads and streets.Comment: Changed content Submitted to Physical Review Letter

Social campaigns to encourage responsible fashion consumption: qualitative study with university students

A fruitful line of research on responsible consumption has recently emerged due to a concern for and interest in environmental issues and the growing resource depletion, providing an opportunity for communications to influence human behavior toward environmental protection. This paper shows the design, implementation, and impact assessment of two social campaigns aimed to inform the public of the effects of an overconsumption of clothing and encourage responsible consumption. We designed a non-experimental, descriptive, qualitative study based on 30 semi-structured interviews with university students in Bogotá, Colombia, from variables such as campaigns’ message, behavioral intentions, and relationship with the social and environmental context. The results show the students’ unawareness of overconsumption but suggest a positive impact on their intentions to increase responsible apparel consumption. This study contributes to empirical knowledge of better alternatives for effective messages that favor responsible consumption.En los últimos años se ha desarrollado una fructífera línea de investigación en consumo responsable debido a la preocupación y el interés por el problema ambiental y el creciente deterioro de los recursos naturales, lo que representa un campo de trabajo para la comunicación en su posibilidad de influir en el comportamiento humano a favor del cuidado y protección del ambiente. Este trabajo presenta el diseño, desarrollo y evaluación de impacto de dos campañas sociales orientadas a informar sobre los efectos del consumo desmedido de prendas de vestir y fortalecer el consumo responsable de este tipo de productos. Se diseñó un estudio no experimental, descriptivo y de carácter cualitativo, basado en 30 entrevistas semiestructuradas a estudiantes universitarios en Bogotá (Colombia), a partir de variables como el mensaje de las campañas, las intenciones conductuales y la relación con el contexto social y ambiental. Los hallazgos evidencian desconocimiento acerca del problema derivado del consumo excesivo de prendas de vestir, aunque sugieren un impacto positivo respecto a las posibles intenciones comportamentales a favor del consumo responsable de ropa. Esta investigación aporta al conocimiento empírico sobre alternativas en la construcción de mensajes efectivos para coadyuvar al consumo responsable

Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care: A systematic review

BACKGROUND: Shared decision making (SDM) is a process within the physician-patient relationship applicable to any clinical action, whether diagnostic, therapeutic, or preventive in nature. It has been defined as a process of mutual respect and participation between the doctor and the patient. The aim of this study is to determine the effectiveness of decision aids (DA) in primary care based on changes in adherence to treatments, knowledge, and awareness of the disease, conflict with decisions, and patients'' and health professionals'' satisfaction with the intervention. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database. The inclusion criteria were randomized clinical trials as study design; use of SDM with DA as an intervention; primary care as clinical context; written in English, Spanish, and Portuguese; and published between January 2007 and January 2019. The risk of bias of the included studies in this review was assessed according to the Cochrane Collaboration''s tool. RESULTS: Twenty four studies were selected out of the 201 references initially identified. With the use of DA, the use of antibiotics was reduced in cases of acute respiratory infection and decisional conflict was decreased when dealing with the treatment choice for atrial fibrillation and osteoporosis. The rate of determination of prostate-specific antigen (PSA) in the prostate cancer screening decreased and colorectal cancer screening increased. Both professionals and patients increased their knowledge about depression, type 2 diabetes, and the perception of risk of acute myocardial infarction at 10 years without statins and with statins. The satisfaction was greater with the use of DA in choosing the treatment for depression, in cardiovascular risk management, in the treatment of low back pain, and in the use of statin therapy in diabetes. Blinding of outcomes assessment was the most common bias. CONCLUSIONS: DA used in primary care are effective to reduce decisional conflict and improve knowledge on the disease and treatment options, awareness of risk, and satisfaction with the decisions made. More studies are needed to assess the impact of shared decision making in primary care

Conflictos de interés en la profesión médica

En las últimas décadas el mundo de la medicina se ha familiarizado con la valoración de los conflictos de interés (CDI). En las revista científicas se ha generalizado el requisito de que los autores declaren sus CDI en relación con los artículos que proponen publicar; otros aspectos sensibles que merecen atención son los CDI en la toma de decisiones sobre prescripción y los CDI de quienes ocupan puestos de responsabilidad en instituciones científicas, asistenciales o de representación profesional. Estos debates son coherentes con la preocupación de las sociedades democráticas por la justicia y la ética social que exigen juego limpio en la toma de decisiones que afectan a terceros, particularmente a los pacientes. En el presente trabajo se analiza el concepto de los CDI, los tipos de conflictos que pueden abarcar y se reflexiona sobre propuestas para la gestión de los mismos en la profesión médica. In the last decades the world of medicine has become familiar with the disclosure of conflicts of interest (CDI). The requirement for authors to declare their CDIs concerning their publications is a common issue. Another topic for CDI is related to the medical decision making on prescription. Finally, professionals being in positions of responsibility in professional societies or associations and healthcare institutions are asked to show their disclosure of CDI. These debates show up the interest of democratic societies for justice and social ethics that demand fair play in making decisions that may affect third parties, particularly patients. In the present work, the concept and types of CDIs are analyzed, and authors make proposals for the management of CDI in the medical profession

Vocación y profesionalismo: reflexiones de los estudiantes catalizadas por el cine de Spielberg

La profesión médica tiene un marcado sentido vocacional que está estrechamente vinculado a su dimensión ética; sin embargo, existen dudas sobre el papel que los estudios de grado están ejerciendo en su desarrollo. Con la finalidad de favorecer la reflexión al respecto, se celebró un seminario con estudiantes y profesores desarrollado en 3 fases: a) libre exposición de los alumnos sobre lo que consideraban que es la vocación médica; b) presentación por parte de los profesores del marco teórico de la educación médica, seguido del visionado de varias escenas de películas dirigidas por Steven Spielberg que facilitan la reflexión sobre el significado de los componentes éticos y humanos de la medicina, y c) discusión abierta entre alumnos y profesores. Se analizan las principales conclusiones: conviene crear espacios para la reflexión sobre la dimensión vocacional de la medicina a lo largo de los estudios del grado, lo cual, de algún modo, ya se debería considerar en los procedimientos de selección y acceso; en la tarea docente es fundamental el ejemplo de los formadores, así como una tutorización individualizada que «cuide» el desarrollo vocacional; es necesario promover una formación que vaya más allá de la adquisición de conocimientos y habilidades, prestando atención a la gestión de las emociones, el acompañamiento ante los problemas éticos y la educación de las actitudes; el contacto precoz con la actividad clínica, ya desde el comienzo de los estudios se valora como un factor decisivo para motivar a los alumnos ante la inmensa carga teórica que deben afrontar. The medical profession has a marked vocational sense that is closely linked to its ethical dimension. However, there are doubts about the role that undergraduate studies are playing in their development. In order to encourage reflection on this issue, a seminar was held with students and teachers, developed in 3 phases: a) free presentation by students about what they considered to be the medical vocation; b) presentation by professors of the theoretical framework of medical education, followed by the viewing of several scenes of films directed by Steven Spielberg that facilitate reflection on the meaning of the ethical and human components of medicine, and c) open discussion between students and teachers. The main conclusions were analysed: it is worth creating spaces for reflection on the vocational dimension of medicine throughout undergraduate studies. This, in some way, should already be considered in the selection and access procedures to medical school. In the teaching task it is essential that the lecturers are seen as role models, as well as providing individualised tutoring that includes vocational development. Thus, it is necessary to promote training that goes beyond the acquisition of knowledge and skills, paying attention to the management of emotions, the approach to the ethical problems, and the education of attitudes. Early contact with clinical activity, from the beginning of studies is considered a decisive factor to motivate students before the immense theoretical burden they have to face