Tool for the identification and implementation of Environmental Indicators in Ports (TEIP)

In this paper, the concept of environmental indicator is reviewed as a relevant element used in the environmental management of any organisation. The importance of this element within an Environmental Management System (EMS) is also justified. Although EMS standards recognise the relevance of using indicators, they do not specify any methodology to identify which indicators have to be implemented. In addition, the present research demonstrates that although there is a high percentage of European ports that have already implemented performance indicators, most of them do not mention the method applied to obtain the indicators. This suggests that some of the procedures used by ports to identify indicators may not necessarily be science-based or systematic in approach. For these reasons, the need to develop a new methodology able to identify the ports' most adequate indicators was detected. Therefore, a Tool for the identification and implementation of Environmental Indicators in Ports (TEIP) was developed. It aims at identifying performance indicators in ports and providing guidelines for their proper implementation. This is a computer and science-based tool (www.eports.cat/teip) that provides a quick calculation and outputs, and it is designed to be as user-friendly and practical as possible in order to facilitate its completion by the user. This new methodology is applicable to all types of ports no matter the size, geographical location or its commercial profile; it provides targeted and specific results for each one. TEIP aims at helping port managers at easily determining their significant port indicators, which provides valuable elements for the decision-making processes.Peer ReviewedPostprint (author's final draft

Evaluación de la equidad del servicio de transporte público: El caso de Palma de Mallorca

The practice of sustainable transport planning must take into account the level of territorial and social equity of service. The equity analysis requires a deep understanding of the service and the territorial and social characteristics where it is implanted. We propose a simplified method to analyze the equity of the public bus system that has been used in the city of Palma de Mallorca. The bus service level was calculated from the spatial analysis of the offer and was contrasted with the population and with a multidimensional index of social need for public transportation leading to horizontal and vertical equity respectively. Next the overall equity of the service was tested with the support of the Lorenz curve and Gini coefficient. Finally, a sensitivity analysis of bus routes depending on the role they play in the equity of the service was performed.La planificación sostenible del transporte público requiere la consideración de la equidad territorial y social. El análisis de la equidad precisa de un profundo conocimiento del servicio así como de las características territoriales y sociales dónde se implanta. En este artículo se propone un método simplificado para el análisis de la equidad del sistema de autobuses públicos, aplicado a la ciudad de Palma. El nivel de servicio se calcula a partir del análisis territorial de la oferta, y se contrasta con la población existente y con un índice multidimensional de necesidad social de transporte público, dando lugar a la equidad horizontal y vertical, respectivamente. Posteriormente, se verifica la equidad global del servicio con el apoyo de la curva de Lorenz y del coeficiente GINI. Finalmente, se realiza un análisis de sensibilidad a través de la frecuencia de las rutas de autobús en relación a la equidad social del servicio

Los sistemas de bicicleta pública y la movilidad urbana sostenible. Un análisis en la ciudad de Palma (Mallorca, Islas Baleares)

El artículo analiza los sistemas de bicicleta pública como instrumento de incentivación de los desplazamientos en bicicleta en el marco de las políticas de movilidad sostenible. Se centra en su implantación en la ciudad de Palma y se valoran tres componentes: la evolución del reparto modal en la ciudad desde su instalación en 2011 y su relación con el tráfico ciclista; la cobertura territorial del sistema y su funcionamiento; y, por último, las características, el perfil y las motivaciones de los usuarios. Del análisis se deduce una baja aceptación del sistema, a pesar del incremento más que notable del número de ciclistas en la ciudad

Grey Level and Noise Evaluation of a Foveon X3 Image Sensor: A Statistical and Experimental Approach

Radiometric values on digital imagery are affected by several sources of uncertainty. A practical, comprehensive and flexible procedure to analyze the radiometric values and the uncertainty effects due to the camera sensor system is described in this paper. The procedure is performed on the grey level output signal using image raw units with digital numbers ranging from 0 to 212-1. The procedure is entirely based on statistical and experimental techniques. Design of Experiments (DoE) for Linear Models (LM) are derived to analyze the radiometric values and estimate the uncertainty. The presented linear model integrates all the individual sensor noise sources in one global component and characterizes the radiometric values and the uncertainty effects according to the influential factors such as the scene reflectance, wavelength range and time. The experiments are carried out under laboratory conditions to minimize the rest of uncertainty sources that might affect the radiometric values. It is confirmed the flexibility of the procedure to model and characterize the radiometric values, as well as to determine the behaviour of two phenomena when dealing with image sensors: the noise of a single image and the stability (trend and noise) of a sequence of images.The authors would like to thank the support provided by the Spanish Ministry of Science and Innovation to the project HAR2010-18620. The authors also acknowledge the chance to take pictures with the lighting equipment in the Soils Laboratory at the Universitat Politecnica de Valencia.Riutort Mayol, G.; Marqués Mateu, Á.; Seguí Gil, AE.; Lerma García, JL. (2012). Grey Level and Noise Evaluation of a Foveon X3 Image Sensor: A Statistical and Experimental Approach. Sensors. 12(8):10339-10368. https://doi.org/10.3390/s120810339S103391036812

Intrinsic Subtypes and Therapeutic Decision-Making in Hormone Receptor-Positive/HER2-Negative Metastatic Breast Cancer with Visceral Crisis: A Case Report

Background: CDK4/6 inhibitors (CDKi), namely, palbociclib, ribociclib, and abemaciclib, combined with either an aromatase inhibitor (AI) or fulvestrant are the standard first/second line for hormone receptor-positive(HR+)/HER2-negative(neg) metastatic breast cancer (MBC). However, the choice of one specific CDKi is arbitrary and based on the physician's experience with the drug, toxicity profile, and patient's preferences, whereas biomarkers for optimal patient selection have not been established so far. Moreover, upfront chemotherapy is still recommended in case of clinical presentation with visceral crisis, despite no evidence of superior benefit for chemotherapy regimens against CDKi-based regimens. Recent correlative biomarker analyses from pivotal trials of palbociclib and ribociclib showed that HR+/HER2-neg MBC might respond differently according to the molecular intrinsic subtype, with Luminal A and B tumors being sensitive to both CDKi, Basal-like being insensitive to endocrine therapy, irrespective of CDKi, and HER2-enriched tumors showing a benefit only with ribociclib-based therapy. Clinical case: We hereby present a paradigmatic clinical case of a woman affected by a relapsed HR+/HER2-neg MBC with bone and nodal lesions, presenting with a visceral crisis in the form of lymphangitis carcinomatosis and diagnosed with a molecularly HER2-enriched tumor, successfully treated with upfront ribociclib + fulvestrant. The patient experienced a complete symptomatic and radiologic remission of the lymphangitis with a partial response as best response, according to RECIST 1.1 criteria. The progression-free survival (PFS) was of 20 months, in line with the median PFS observed in the ribociclib + fulvestrant pivotal trial, where, however, patients with visceral crisis had been excluded. Conclusions: This clinical case confirms in the real-world setting that non-luminal subtypes can be found in HR+/HER2-neg disease and may have potential therapeutic implications in the metastatic setting. It also questions the recommendation of upfront chemotherapy in the case of a visceral crisis in the era of CDKi-based regimens. These issues merit further evaluation in prospective and larger studies

Cardiometabolic Risk Profiles in Patients With Impaired Fasting Glucose and/or Hemoglobin A1c 5.7% to 6.4%: Evidence for a Gradient According to Diagnostic Criteria. The PREDAPS Study

It has been suggested that the early detection of individuals with prediabetes can help prevent cardiovascular diseases. The purpose of the current study was to examine the cardiometabolic risk profile in patients with prediabetes according to fasting plasma glucose (FPG) and/or hemoglobin A1c (HbA1c) criteria. Cross-sectional analysis from the 2022 patients in the Cohort study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS Study) was developed. Four glycemic status groups were defined based on American Diabetes Association criteria. Information about cardiovascular risk factors-body mass index, waist circumference, blood pressure, cholesterol, triglycerides, uric acid, gamma-glutamyltransferase, glomerular filtration-and metabolic syndrome components were analyzed. Mean values of clinical and biochemical characteristics and frequencies of metabolic syndrome were estimated adjusting by age, sex, educational level, and family history of diabetes. A linear trend (P < 0.001) was observed in most of the cardiovascular risk factors and in all components of metabolic syndrome. Normoglycemic individuals had the best values, individuals with both criteria of prediabetes had the worst, and individuals with only one-HbA1c or FPG-criterion had an intermediate position. Metabolic syndrome was present in 15.0% (95% confidence interval: 12.6-17.4), 59.5% (54.0-64.9), 62.0% (56.0-68.0), and 76.2% (72.8-79.6) of individuals classified in normoglycemia, isolated HbA1c, isolated FPG, and both criteria groups, respectively. In conclusion, individuals with prediabetes, especially those with both criteria, have worse cardiometabolic risk profile than normoglycemic individuals. These results suggest the need to use both criteria in the clinical practice to identify those individuals with the highest cardiovascular risk, in order to offer them special attention with intensive lifestyle intervention programs

Evolución de pacientes con prediabetes en Atención Primaria de Salud (PREDAPS): resultados del primer año de seguimiento

En 2012, la Red de Grupos de Estudio de la Diabetes en Atención Primaria de la Salud (redGDPS) inició el Estudio PREDAPS con la finalidad de determinar la incidencia de diabetes en individuos con prediabetes e identificar los factores asociados al desarrollo de la enfermedad y de sus complicaciones. En la etapa basal se incluyeron 2022 participantes, formando dos cohortes: una cohorte de 838 sujetos sin alteraciones del metabolismo de la glucosa y otra cohorte de 1184 sujetos con prediabetes. Durante el año 2013 se realizó la primera visita de seguimiento. El objetivo del presente trabajo es mostrar los principales resultados obtenidos en este primer año de seguimiento y evaluar la relación entre diversos factores registrados en la etapa basal y la incidencia de diabetes en la cohorte de sujetos con prediabetes

Modifiable risk factors associated with prediabetes in men and women: a cross-sectional analysis of the cohort study in primary health care on the evolution of patients with prediabetes (PREDAPS-Study)

Background: Prediabetes is a high-risk state for diabetes development, but little is known about the factors associated with this state. The aim of the study was to identify modifiable risk factors associated with the presence of prediabetes in men and women. Methods: Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS-Study) is a prospective study on a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects without glucose metabolism disorders. It is being conducted by 125 general practitioners in Spain. Data for this analysis were collected during the baseline stage in 2012. The modifiable risk factors included were: smoking habit, alcohol consumption, low physical activity, inadequate diet, hypertension, dyslipidemia, and obesity. To assess independent association between each factor and prediabetes, odds ratios (ORs) were estimated using logistic regression models. Results: Abdominal obesity, low plasma levels of high-density lipoprotein cholesterol (HDL-cholesterol), and hypertension were independently associated with the presence of prediabetes in both men and women. After adjusting for all factors, the respective ORs (95% Confidence Intervals) were 1.98 (1.41-2.79), 1.88 (1.23-2.88) and 1.86 (1.39-2.51) for men, and 1.89 (1.36-2.62), 1.58 (1.12-2.23) and 1.44 (1.07-1.92) for women. Also, general obesity was a risk factor in both sexes but did not reach statistical significance among men, after adjusting for all factors. Risky alcohol consumption was a risk factor for prediabetes in men, OR 1.49 (1.00-2.24). Conclusions: Obesity, low HDL-cholesterol levels, and hypertension were modifiable risk factors independently related to the presence of prediabetes in both sexes. The magnitudes of the associations were stronger for men than women. Abdominal obesity in both men and women displayed the strongest association with prediabetes. The findings suggest that there are some differences between men and women, which should be taken into account when implementing specific recommendations to prevent or delay the onset of diabetes in adult population. Keywords: Prediabetes, Modifiable risk factors, Primary health care, Men, Women, Spai

Telecos Sense Fronteres: Pla de telecomunicacions pera la regió del Kukra River. Fase III

Des de Telecos Sense Fronteres en aquest treball es pretén donar una solució tècnica al problema de la incomunicació de diferents entitats mèdiques del país de Nicaragua. A la conca del Kukra River, riu de la regió de la RAAS de Nicaragua, hi viuen diverses comunitats en situació molt precària. Una d'elles és La Aurora, l'única que disposa d'un Puesto de Salud molt rudimentari per atendre les necessitatsde totes les comunitats. El personal sanitari d'aquesta comunitat ha de fer viatges de fins a deu hores a peu, a cavall o en barca per arribar a les altres comunitats o a un hospital amb recursos. L'hospital més proper es troba a la ciutat de Bluefields, capital de la RAAS, a unes vuit hores de navegació en barca. Existeix un pla per al desenvolupament de la zona. L'objectiu d'aquest TFC és la tercera fase del projecte, consistent en la instal·lació d'infrastructures de comunicacions a l'Hospital Regional Ernesto Sequeira, incloen cablejat estructurat, intranet, extensions telefóniques i un software de gestió hospitalària. Addicionalment, es recollirà la informació necessària per a les següents campanyes del projecte