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INTRODUCTION Analgesics are widely used, but evidence regarding whether their use increases the risk of inflammatory bowel disease (IBD) flares or complications is unclear. Therefore, self-medication with analgesics in IBD is usually not recommended. The aim of this study was to explore the prevalence of self-medication with analgesics in a cohort of ulcerative colitis (UC) patients and to identify reasons and factors associated with self-medication. METHODS This cross-sectional study included consecutive unselected adult patients with UC. Participants were asked to complete an anonymous web-based survey with multiple-choice questions and closed responses. No clinical data were collected. RESULTS A total of 546 patients (61.2% women, mean age 39.9 years) completed the survey. The prevalence of self-medication with analgesics was 49.8% (272/546). Paracetamol (45.2%) and metamizole (21.2%) were the most frequently used drugs; frequencies of self-medication were

Measuring quality of care (QoC) from a patient’s perspective is becoming increasingly important in inflammatory bowel disease. The objective of this study was to determine whether patients’ evaluations of QoC correlate with better inflammatory bowel disease outcomes. A survey including patients’ characteristics, a decalogue of QoC indicators, and self-reported disease outcomes was completed by Spanish patients with inflammatory bowel disease. A QoC index (QoCI) was constructed with the sum of the “yes” answers in the decalogue. We evaluated the correlation of QoCI with outcomes. A sub-analysis comparing patients with high QoCI vs those with low QoCI was performed (QoCI = 10 or ≤ 7). Seven hundred and eighty-eight questionnaires were analyzed. Mean age of participants was 43.4 years (63% women). Mean QoCI was 8.1 (± 2.4). The QoCI correlated significantly with activity of the disease, number of flares, emergency/unscheduled visits, and disease control. Patients scoring in the first QoCI quartile reported a decreased rate of moderate/severe disease (34.8% vs 55.3%, p < 0.001), fewer numbers of flares (p < 0.001), and fewer emergency/unscheduled visits (p < 0.001) compared with those in the lower QoCI quartile. The high QoC group also reported better disease control. Patient-evaluated QoC correlates with better outcomes. Evaluation of QoC by patients may be useful to detect inadequate care and improve inflammatory bowel disease outcomes.

Background There is a growing consensus across stakeholders on the value of patient preference (PP) studies, as recognized by the European Medicines Agency and the European Network for Health Technology Assessment. This study aimed to develop a PP survey to quantitatively evaluate which characteristics are most important to inflammatory bowel disease (IBD) patients, so that the results can inform the medicinal product life cycle (MPLC). Methods Following the PREFER recommendations, a four-step approach was followed to develop the PP survey: 1) stated preference method selection, 2) attribute and level development, 3) survey implementation, and 4) survey piloting. Throughout the different steps of the survey development, an advisory board (AB) consisting out of patients, patient organizations, gastroenterologists, IBD nurses, and statisticians were consulted. Results First, a discrete choice experiment (DCE) was chosen as the preferred elicitation method because it allows to reach the objectives of the survey, namely to: 1) quantify the relative importance of different attributes, 2) elicit the trade-offs patients make, and 3) measure preference heterogeneity. Second, a scoping literature review of IBD clinical trials, available IBD treatments, and previously published preference studies was performed. Discussions on these characteristics with patients (n=11) during focus group discussions (FGDs) using the nominal group technique revealed the following patient prioritized characteristics: prevent surgery, long-term clinical remission, improved quality of life, occurrence of urgency, and improved labor rate. Based upon the results of the FGDs, a preliminary list of possible attributes for inclusion in the DCE was refined during AB meetings. This list was iteratively adapted until consensus was found on 14 attributes, their levels, and corresponding explanations (Figure 1). Third, the DCE survey was designed to include these 14 attributes using partial profiles next to measures about sociodemographic variables, health literacy, and treatment experience. Fourth, piloting the study with IBD patients (n=4) revealed that the survey was comprehensible, had a good flow, and contained graphics that supported the content. Only minor text edits were needed. Conclusion It is key to develop a PP survey in partnership with patients and other members of the AB. This survey will be rolled out across Europe in 11 different languages and will increase understanding of which treatment aspects are most important to IBD patients. These aspects should be included in drug development and evaluation so that the MPLC can be more patient-centered and future treatments will target aspects that are most important to IBD patients themselves.

BACKGROUND Few studies have examined self-medication with corticosteroids among patients with ulcerative colitis (UC). AIMS To assess the frequency of self-medication with oral corticosteroids in UC patients, and associated factors and reasons. METHODS An anonymous, voluntary, web-based survey was administered to adults with UC recruited via a Spanish patient association (ACCU) and hospital gastroenterology departments. Information was provided by patients; no clinical data were collected. Descriptive statistics and comparisons of frequencies are displayed. RESULTS Among 546 respondents (mean age 39.9 years, median duration of UC since diagnosis 7 years,) 36 (6.6%) reported self-medication with oral corticosteroids during the past year (once: 23 patients; 2-3 times: 10 patients; >3 times: 3 patients). Self-medication was more common among patients managed in general gastroenterology vs. inflammatory bowel disease clinics [23 (9.0%) vs. 11 (2.9%), P = 0.019], patients with no regular follow-up [4 (22.2%) vs. 32 (6.1%), P = 0.026] and patients with more flares (P < 0.001). Patients who stored steroids from previous flares (17.9% vs. 6.0%, P < 0.001) or who lived with a partner taking steroids (9.3% vs. 1.1%, P = 0.038) were more likely to self-medicate than other patients. Common reasons for self-medicating included the need for quick symptom relief (55.6%), fear of worsening (47.2%) and difficulty in getting an appointment (25.0%). Only seven patients (19.4%) informed their physician when they started self-medicating and only four (11.1%) declared they would not start corticosteroids again. CONCLUSION Self-medication with oral corticosteroids is not a common practice among patients with UC in Spain, but several areas of improvement exist.

Purpose Information regarding patients' needs, fears and experiences/perceptions in the perioperative setting is limited. Through two focus groups, we explored the needs, fears and experiences of patients who had recently undergone, or were scheduled for, surgery under general anaesthesia, with regard to the entire perioperative process. Materials and Methods Adults were invited to participate in a focus group if they had (a) undergone abdominal or gynaecological surgery with general anaesthesia in the past 4 months (focus group 1) or (b) been indicated for abdominal or gynaecological surgery and were waiting for the assigned surgery date (focus group 2). Discussions were audio recorded and, through thematic analysis, patients' needs and experiences/perceptions regarding perioperative surgical stages were obtained/coded. Analysis of code co-occurrence was performed using a codes matrix. Results Focus groups consisted of 13 females, 1 male (50% aged >45 years). The immediate postoperative period generated the highest number of co-occurrences, followed by the indication of surgery. The most frequent code was the need for information, especially at the indication of surgery, the pre-anaesthesia clinic and in the postoperative period. Fears were described particularly at the indication of surgery, the waiting period, the surgical room, anaesthesia induction and the postoperative period, particularly after hospital discharge; pain was cited most commonly in the postoperative period. Stress/anxiety and emotional impact were also cited in the postoperative period including home arrival. Conclusion Information collected in these patients' focus groups should inform future research and healthcare planning. Patients demand receiving more comprehensive and understandable information and more involvement in several steps; this could reduce fears and stress/anxiety described across the perioperative process. Importantly, findings also extend to the postoperative period and home arrival.

Background Quality of care (QoC) is a highly important topic in inflammatory bowel disease (IBD). We recently elaborated a decalogue of QoC indicators (IQCARO-QoC) developed by IBD patients. The aim of the present study was to assess the factors associated with patients’ evaluation of QoC in Spain using the IQCARO-QoC Decalogue recently developed by IBD patients. Methods A survey including patients’ socio-demographic and clinical characteristics, and the IQCARO-QoC Decalogue, was completed by IBD patients. We described patients’ assessment of QoC across Spanish patients. A univariable and multivariable analysis was performed to explore the associations between patients’ characteristics and QoC. Results Questionnaires from 788 participant patients were analysed. Participants’ mean age was 43.4 years, 63% were females and 58% had Crohn’s disease. The mean QoC score was 8.1 (± 2.4 SD) points out of a maximum of 10. Items with the lowest score were related to the provision of information and the implication of the medical team throughout the entire patient care. Factors associated with better QoC scores included: being employed better disease control, fewer numbers of unscheduled visits, and being followed by a gastroenterologist specialized in IBD. Conclusions Spanish patients’ reported QoC seems to be globally good although there is room for improvement, especially in providing adequate information to patients. Care provided by specialized IBD gastroenterologists seems to be related with higher QoC scores.

Background Quality improvement is a major topic in inflammatory bowel disease (IBD) care, and measuring quality of care (QoC) is necessary for QoC improvement. Most QoC projects or consensus statements are designed from the health care professional point of view. Having QoC indicators designed for and fully evaluable by patients may provide a key tool for external evaluation of QoC improvement measures. The aim of the IQCARO project was to identify indicators to measure QoC from the IBD patient’s point of view. Methods An extensive review of the literature to identify indicators of QoC was performed; first the identified indicators were reviewed by a steering committee including patients, nurses, IBD specialists, and methodologists. Then 2 focus groups of IBD patients analyzed the QoC indicators to determine whether they could be understood and evaluated by patients. The final QoC indicators were selected by a group of IBD patients using a Delphi consensus methodology. Results An initial list of 54 QoC indicators was selected by the steering committee. The QoC indicators were evaluated by 16 patients who participated in 2 focus groups. They identified 21 indicators that fulfilled the understandability and evaluability requirements. The 10 most relevant QoC indicators were selected by 26 patients with IBD using a Delphi consensus. The selected items covered important aspects of QoC, including professionalism, patients’ autonomy, information, accessibility, and continuity of care. Conclusions The present Delphi consensus identified QoC indicators that are useful for developing and measuring improvement strategies in the management of IBD.

Metabolic syndrome (MS), a conglomeration of several conditions including obesity, type 2 diabetes mellitus (T2DM), insulin resistance, elevated blood pressure, and dyslipidemia is reaching epidemic proportions. Anemia is caused by iron deficiency or dysregulation of iron homeostasis, leading to tissue hypoxia. Coexistence of anemia and MS or its components has been reported in the literature. The term "rubrometabolic syndrome" acts as a unifying entity linking the importance of blood in health and anemia in MS; it justifies two principles-redness of blood and low-grade inflammation. Chronic low-grade inflammation in MSaffects iron metabolism leading to anemia. Tissue hypoxia that results from the anemic condition seems to be a major causative factor for the exacerbation of several microvascular and macrovascular components of T2DM, which include diabetic neuropathy, nephropathy, retinopathy, and cardiovascular complications. In obesity, anemia leads to malabsorption of micronutrients and can complicate the management of the condition by bariatric surgery. Anemia interferes with the diagnosis and management of T2DM, obesity, dyslipidemia, or hypertension due to its effect on pathological tests as well as medications. Since anemia in MS is multifaceted, the management of anemia is challenging as overcorrection of anemia with erythropoietin-stimulating agents can cause detrimental effects. These limitations necessitate availability of an effective and safe therapy that can maintain and elevate the hemoglobin levels along with maintaining the physiological balance of other systems. This review discusses the physiological links between anemia and MS along with diagnosis and management strategies in patients with coexistence of anemia and MS.

Background Despite the existence of specific recommendations, patients with inflammatory bowel disease (IBD) have shown low immunization rates. The aim of this study was to evaluate the adherence to vaccination recommendations by physicians to their IBD patients. Methods An online anonymous survey was sent to 8000 patients from a national patient association (ACCU-Spain). Three invitations were sent between October-December 2020. Questions were jointly designed by ACCU and GETECCU. Potential reasons for vaccination compliance were evaluated and analysed for different vaccines: age, gender, type of IBD, type of healthcare and treatments. Descriptive analyses and logistic regression were performed to identify factors associated with adherence to vaccination recommendations. Results 1302 patients with IBD responded to the survey (mean age 43 years [SD 12], 72% women). Forty percent of patients had ulcerative colitis, 58% Crohn’s disease and 2% indeterminate colitis. 91% of patients were treated in public facilities, 5% in a private setting and 4% in both. 41% of patients were treated with 5ASA, 35% with azathioprine/methotrexate, 50% with biologics and 8% with corticosteroids. Although [IRL1] [YZ2] physicians recommended vaccination, 45% were not adherent to papilloma virus vaccine, 18% to pneumococcus, 18% to hepatitis B vaccine, 16% to influenza and 12% to tetanus. The main reason for non-compliance to physician recommendation was considering that is not necessary (Table 1). Some factors associated to vaccine compliance are shown in Table 2. Conclusion Non-adherence to vaccination recommendations in IBD patients is frequent. Patients with immunosuppressive therapy show less compliance to the vaccination recommendations. The importance and benefits of vaccination needs to be explained to improve the adherence in IBD patients.

In the present investigation, AA7075-T6 alloys and AZ31B-H24 were joined by the FSW process using the following range of parameters: rotational speed between 200 and 800 rpm, welding speed from 30 to 60 mm/min and a tilt angle from 1° to 3°. In some cases, a tool offset of 1 mm was used into Mg-based alloy. The experimental results show that sound and good joints can be obtained by positioning the tool in the middle of the joint-line using a rotational speed of 200 rpm, a welding speed of 30 mm/min and a tool tilt angle of 1°. The hardness and ultimate tensile strength in the stir zone were 122 Hv and 61.35 MPa, respectively. Also, it is important to mention that the Al3Mg2 and Al12Mg17 intermetallics compounds were observed in the this zone besides some defects like cavities and tunnel.

Background and aims Our objective was to define, describe and organize (on the basis of consensus) the patient's preferences in the management of ulcerative colitis (UC), in order to further incorporate them in daily practice and improve patients satisfaction, adherence to the treatment and quality of care. Methods Qualitative study. A narrative literature review in Medline using Mesh and free-text terms was conducted to identify articles on UC patient preferences as well as clinical scenarios that may influence the preferences. The results were presented and discussed in a multidisciplinary nominal group meeting composed of six gastroenterologists, one primary care physician, one nurse practitioner and one expert patient. Key clinical scenarios and patient preferences were then defined, generating a series of points to consider and recommendations. The level of agreement with the final selection of preferences was established following a Delphi process. Results The narrative review retrieved 69 articles of qualitative design and moderate quality. The following key clinical scenarios were identified: diagnosis, follow-up, surgery, and special situations/patients profiles such as adolescents or women. Patient preferences were classified into information, treatment (pharmacological and non-pharmacological), follow-up, relations with health professionals, relations with the health system and administration. Finally, 11 recommendations on patient preferences for UC in relation to its management reached the level of agreement established. Conclusion The consensual description of patient's preferences contribute to identify different areas for improvement in healthcare practice.

Background Despite the existence of specific recommendations, patients with Inflammatory Bowel Disease (IBD) have shown low immunization rates. The aim of this study was to evaluate the management of vaccines in clinical practice in IBD from the perspective of physicians and patients. Methods An online anonymous survey was sent to 8000 patients from a national patient association (ACCU-Spain) and 1000 members of the Spanish IBD Working Group (GETECCU). Three invitations were sent between October-December 2020. Forty questions were jointly designed by ACCU and GETECCU in two different surveys for physicians and patients. Descriptive analyses were performed, comparing physician’s and patient’s responses by standard statistical analyses Results 144 physicians and 1302 patients responded to the surveys (overall mean age of 43 years (SD 9.5). 65% of physicians managed more than 200 patients and 80% had >5 years of experience. Most physicians (99%) were concerned about vaccines in IBD patients in their clinical practice, and 63% of them considered vaccines very important. Only 3.5% of physicians recommended live vaccines for their IBD patients with immunosuppressive treatments. One third of physicians did not recommend HPV vaccine. In spite of 69% of physicians recommending influenza vaccine during pregnancy, only 7.2% of pregnant patients indicated that they had received advice on influenza vaccination on their pregnancy (p Conclusion Deficiencies in knowledge regarding vaccination of IBD patients can be frequent. The perspective of physicians and patients is different, with physicians perceiving more recommendations related to vaccines than patients were recommended.

The Wixárika route was declared by the Government of the State of San Luis Potosí with a first proposal for a polygon as a state reserve area on 27th of October, 2000, and in 2001 the category of Natural Sacred Site is awarded. Initially, this region had an original area of 138,750 ha. Subsequently, the Federal Government of Mexico, through the National Commission of Protected Natural Areas (CONANP), creates the “Preliminary Justification Study”, where a larger polygon is proposed, including the Sacred Natural Sites for the Wixárika within the reserve. On the 3rd of November 2012, a group formed by scientists and researchers discussed the study carried out, in which they argued that the limits of the Reserve should respond to natural criteria defined by the watersheds of the basins, rather than linear geometric criteria, thus protecting hydrogeological, eco-systematic and social dynamics. So it is proposed adding to the previous polygon the water area of the basin, which represented an increase of 65,437.41 ha to the previously recognized within the PNA, decreeing a total area of 256,946.32 ha, according to the basin limit. However, after analyzing the zone, it was observed that other important elements were not analyzed in-depth and must be considered, such as; physiological, hydrological and topographical elements, meteorological and climatological phenomena, hydrogeology of the area as an adequate element of the basin delimitation, establishment and location of mining concessions. Also, fauna, flora and vegetation of the area were not studied. Thus, an evaluation of the soil was considered recognizing its relationship with toxic elements that could persist in the area. Similarly, an attempt was contemplated, including economic and social elements of the place. Consequently, it was proposed to expand the polygon, covering a new area of 293,388.42 ha. This expansion included all the elements described.

Inflammatory bowel disease; Patients experience; Chronic disease Malaltia intestinal inflamatòria; Experiència dels pacients; Malalties cròniques Enfermedad intestinal inflamatoria; Experiencia de los pacientes; Enfermedades crónicas To assess inflammatory bowel disease (IBD) patients' experience of chronic illness care and the relationship with demographic and healthcare-related characteristics.This cross-sectional survey used the Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC) questionnaire to identify parameters associated with a better healthcare experience for IBD patients. IEXPAC questionnaire responses are grouped into 3 factors - productive interactions, new relational model, and patient self-management, scoring from 0 (worst) to 10 (best experience). Scores were analyzed by bivariate comparisons and multiple linear regression models.Surveys were returned by 341 of 575 patients (59.3%, mean age 46.8 (12.9) years, 48.2% women). Mean (SD) IEXPAC score was 5.9 (2.0); scores were higher for the productive interactions (7.7) and patient self-management factors (6.7) and much lower for the new relational model factor (2.2). Follow-up by a nurse, being seen by the same physician, and being treated with a lower number of medicines were associated with higher (better) overall patient experience score, and higher productive interactions and self-management factor scores. A higher productive interactions score was also associated with patients receiving medication subcutaneously or intravenously. Higher new relational model scores were associated with follow-up by a nurse, affiliation to a patients' association, receiving help from others for healthcare, a lower number of medicines and a higher educational level.In patients with IBD, a better overall patient experience was associated with follow-up by a nurse, being seen by the same physician, and being treated with a lower number of medicines.

Background Ulcerative colitis (UC) is a debilitating chronic condition that affects the large intestine and courses with episodes of flare and remission, being steroid-free remission the main treatment goal. Our aim was to assess the prevalence of self-medication with analgesics, and its associated factors in a Spanish cohort of UC patients. Methods An anonymous cross-sectional survey was developed by 3 IBD experts from the Spanish working group on Crohn’s disease (CD) and Ulcerative Colitis (GETECCU), one nurse of the Spanish nursing working group on inflammatory bowel disease (GETEII) and two patients from the Spanish confederation of associations of patients with CD and UC (ACCU). A link to the online survey was distributed to the ACCU affiliates and to other adult patients with UC through 50 inflammatory bowel disease (IBD) units from Spain. Participants voluntarily answered to the survey based on their own experiences during the last year. Results We collected data from 546 patients, 61% women, mean age 40 years old. Of these, 51% patients were followed-up by IBD specialists and 47% by a general gastroenterologist. Patients’ self-reported disease activity during the last year was: 125 (23%) inactive, 188 (34%) mild, 170 (31%) moderate and 63 (12%) severe. Visits to the emergency room (24%), urgent telephone calls (43%) and hospital admissions (10%) were reported by patients during the last year. A total of 320 (59%) patients declared to have self-medicated with analgesics during the past year, mostly with paracetamol [n = 247 (45%)] and metamizole [118 (22%)], followed by ibuprofen [26 (5%)] and codeine [23 (4%)]. The frequency of self-medication was higher in those patients who declared having a moderate (57%) to severe (65%) disease activity, compared with those who felt their disease was mild (45%) or inactive (39%), (p < 0.001). In addition, patients who needed urgent telephone assistance showed a higher frequency of self-medication (n = 139, 59%) [OR 2 (95% CI:1–3), p < 0.001]. Multivariate analysis revealed that self-medication with analgesics was associated to female gender [OR 2 (95% CI: 1–3), p < 0.001], intravenous (IV) biological therapy [OR 3 (95% CI: 2–5), p < 0.001] and visits to the emergency room [OR 3 (95% CI: 2–4), p < 0.001]. Conclusion Self-medication with analgesics is a common practice in patients with UC from Spain. Factors like being a woman, treatment with IV biological drugs, needing urgent telephone assistance and attending to the emergency room, were associated with self-medication with analgesics. This project was endorsed by GETECCU, GETEII, ACCU and funded by MSD Spain.

Background Medical treatment of mild-to-moderate flares of ulcerative colitis (UC) is based on topical and oral mesalazine, steroids or a combination of both. Sometimes self-medication with any of them can occur during a flare and it could interfere with clinical practice. Our aim was to assess the prevalence of self-medication with steroids in UC-patients and the reasons for this behaviour. Methods An anonymous cross-sectional survey was developed by representatives of the Spanish working group on Crohn’s disease and UC (GETECCU), the Spanish nursing working group on Inflammatory bowel disease (IBD) (GETEII) and the Spanish associations of patients with CD and UC (ACCU). A link to the online survey was distributed to adult UC patients through 50 Spanish IBD units as well as in the ACCU webpage. Participants voluntarily answered to the survey based on their own experiences. Results A total of 546 patients were included, 61% women, mean age 40 years old. Half of them (51%) were followed-up by IBD specialists, while 47% by general gastroenterologists. Thirty-six (6.6%) patients self-medicated with steroids. The main reasons to self-medicate with steroids were the need for quick relief of symptoms (n = 20, 56%), fear of worsening (n = 17, 47%) and difficulty for getting a medical appointment or being previously prescribed by the doctor (n = 9, 25%, both). Sixty-four per cent of them self-medicate once per year, while 8% self-medicate more than three times per year. Of these patients, 175 (32%) reported that self-medication lasted less than one month, while in 9 (18%) lasted for more than 3 months. Factors related to self-medication with steroids were the increased number of flares (p < 0.001), living with someone who uses oral steroids (p = 0.04), keeping the steroids left after finishing the treatment (p < 0.001), and prescription of corticosteroids in case of worsening by the primary care doctor (p = 0.02). Self-medication was less frequent in those patients who were attended by an IBD specialist (11, 3%), compared of those followed by an internal medicine physician (2, 33%), (p = 0.007), or by a general gastroenterologist (n = 23, 9%), (p = 0.02). Multivariate analysis showed that a higher number of flares [OR 7 (95% CI: 1–32), p < 0.001] and being attended by a general gastroenterologist [OR 0.08 (95% CI=0.01–0.5), p = 0.007] were both associated with a greater frequency of self-medication. Conclusion Self-medication with steroids is not a common practice in patients with UC from Spain. However, there is still room for improvement in clinical practice. Characteristics of the healthcare system and the disease may influence the rate of self-medication in UC patients. This project was endorsed by GETECCU, GETEII, ACCU and funded by MSD Spain.

Management of Diaphorina citri Kuwayama (Hemiptera: Liviidae) populations is one of the major strategies for reducing the spread and incidence of huanglongbing (HLB). HLB is putatively caused by Candidatus Liberibacter spp. (Rhizobiales: Phyllopbacteriaceae) that are transmitted to citrus by psyllid vectors. Diaphorina citri population monitoring is done to detect its presence and inform on management decisions. Various methods are used for detecting and estimating D. citri densities but trapping with yellow or lime-green sticky cards has proven to be the most effective method. These sticky cards rely on the color preference of adult D. citri, but many flying organisms are attracted to the same color spectrum as psyllids. Hence, in field situations, sticky traps are hampered by large numbers of bycatches of nontarget organisms and debris. Here, we described a method using a mesh laid on the surface of traps as a sift to catch mainly psyllids, while reducing bycatches. By filtering D. citri through this mesh, they can be counted more rapidly and accurately. Although mesh-covered traps captured 5-15% less D. citri relative to uncovered ACP traps, both types of traps statistically agreed on D. citri detection and population densities. The effectiveness of mesh-covered traps did not vary with season. In addition, mesh-covered traps eliminated >90% of nontarget organisms and allowed for quicker enumeration of D. citri. We expect this method will become an important component of redesigning integrated pest management programs in citrus groves by reducing unintended impacts of beneficial arthropods during large scale D. citri monitoring.

The development of renewable energy has increased over the past few years due to the high cost of fossil fuels and our great dependence on them. Solar energy has been evaluated in the majority of developed countries. Mexico is known to possess large quantities of renewable energy resources, for example, approximately 6000 MW of wind energy resources. Nevertheless, solar energy is not sufficiently developed in Mexico. In this work, the global solar resources in Mexican states along the Gulf of Mexico were assessed. The data used in the analysis were obtained from the Automatic Meteorological Stations (AMEs) of the National Meteorological Service of Mexico (NMS) every 10 min over a period of 10 years, as well as from the Surface Meteorology and Solar Energy (SMSE) of the National Aeronautics and Space Administration (NASA) every month over 22 years. AMEs and SMSE validation data were compared to calculate their determination coefficient, R2, which was above 90%. A total of 13 maps generated by a Geographic Information System (GIS), one per month, and annually averaged global solar resources were used to determine the areas and the periods of the year with the greatest global solar energy resources. According to the results obtained in this study, the highest amount of solar energy, i.e., greater than 6.22 kWh/m2/day, was registered on July in the state of Tamaulipas. Based on the average annual energy map, the southern region of Veracruz State registered the largest resource, i.e., greater than 5.03 kWh/m2/day. From the foregoing analysis, the primary conclusion arrived at in the present work is that solar energy has significant potential for complementing energetic requirements in Mexican states along the Gulf of Mexico. It is recommended that the government adopt policies supporting and promoting the utilization of solar energy to maintain fossil fuel reserves and to reduce greenhouse gases.

Background Self-medication, when agreed with the treating physician, is an essential component of self-care. We describe the associated factors and the reasons related to the practice of self-medication with steroids, aminosalcylates (AS) or analgesics in patients with ulcerative colitis (UC) in Spain. Methods Information was anonymoulsy provided by patients through a web-based cross-sectional survey developed by 3 inflammatory bowel disease (IBD) experts from the Spanish working group on IBD (GETECCU), one nurse from the Spanish nursing working group on IBD (GETEII) and two patients from the Spanish confederation of associations of patients with IBD (ACCU). Participants voluntarily answered to the survey based on their own experiences from February to April 2019. Reasons for self-medication are described as frequencies and associated factors through logistic regression models. Results A total of 546 patients (61% women, mean age 40 years old) responded. Of these, 36 (7%) patients self-medicated with corticosteroids, and was associated with higher number of UC self-reported flares during the past year [OR 7 (95% CI: 1–32), p < 0.001] and follow-up by a general gastroenterologist instead of in an IBD unit [OR 0.08 (0.01–0.5), p = 0.007]. Self-medication with AS was reported by 90 patients (16%) [oral 20 (22%) and topic 70 (78%)], and was associated with treatment with topical AS [OR 3 (95% CI: 2–4), p < 0.001]. Finally, 320 patients (59%) self-medicated with analgesics and this was associated with female gender [OR 2 (95% CI: 1–3), p < 0.001], need of intravenous (IV) biological therapy [OR 3 (95% CI: 2–5) p < 0.001] and emergency room visits within the past year [OR 3 (95% CI: 2–4), p < 0.001]. The main reasons for self-medication were ‘need for quick relief of symptoms’, ‘fear of worsening’ and, for AS, ‘agreed with the doctor’ (Table 1). Conclusion Self-medication in UC is not a common practice, but most of the times it is not agreed with the treating physician. Self-medication with analgesics was more frequent, probably reflecting a need of self-care. Female sex, number of flares, IV treatment, and need of emergency room care were factors associated to self-medication. This project was endorsed by GETECCU, GETEII, ACCU and funded by MSD Spain.

Most of information regarding the construction of continuous cooling transformation (CCT) diagrams considers the decomposition of austenite above the critical transformation temperature Ac3. The development of new grades of multiphase advanced high-strength steels (AHSS) usually involves an intercritical annealing stage, making it necessary the construction of CCT diagrams from the intercritical range. The availability of CCT diagrams constructed from the intercritical austenite is practically non-existent in the open literature. The present research reports an approach for the design of AHSS based on the behavior of CCT diagrams calculated from the intercritical temperature range as a function of chemical composition. Changes in chemical composition were conducted to promote the fabrication of multiphase AHSS steels under conditions that simulate continuous annealing and galvanizing lines (CAGL). To validate the results obtained from computer simulations, the steel was then fabricated, processed at laboratory scale and subjected to thermal cycles that simulate CAGL. Although there is a good approximation between theoretical and experimental results, it was observed that the software presents some limitations regarding the effects of plastic deformation and carbon partitioning during the isothermal bainitic treatment (IBT) on the final microstructures.

The effects of five differently-colored sticky traps in capturing adult Diaphorina citri were evaluated in citrus orchards. Trap catches of D. citri were monitored fortnightly on blue, green, red, white and yellow sticky cards placed on three citrus varieties during D. citri active flight period from April to July in south Texas. Evaluation of mean trap catches of each color by repeated measures analysis of variance produced three separate groups: yellow traps caught significantly more D. citri adults than the other four traps; red and green traps caught significantly more D. citri than blue and white traps, which were not significantly different. Although the number of adult psyllid captured on all trap types significantly increased with time during the trapping period, the performance of traps did not change with time. Trap catches were also significantly influenced by the citrus species; traps placed on lemon trees captured more D. citri than those placed on sweet orange and grapefruit, suggesting that plant preference exhibited by D. citri may influence the performance of traps. The ratio of trap reflectance between the 680 to 700 nm and the 450 nm was significantly correlated with total trap catches in all host species studied. Thus, this index was a good indicator of the attractiveness of adult D. citri to colored traps. Additionally, we compared the reflectance values of young versus mature flush shoots of the three host plants used in this study as related to densities of D. citri recorded in colored traps. We discussed the importance of visual cues in the host finding behavior of adult D. citri.

Mexico has installed less wind power compared to the other North American countries. Renewable energy sources only account for 3% of the energy mix in Mexico. The U.S. states bordering Mexico, namely Texas, New Mexico, Arizona, and California, have good wind power resources. Among them, Texas has the highest installed wind power capacity of 10.34 GW. The wind resources in these bordering states indicate that the wind energy resource in Northern Mexico must be assessed; thus, the spatial and temporal information about the wind energy resource was studied. The daily pattern of the wind speed, one per state studied, was obtained. The wind speed was found to exhibit a pattern; it increases from 4 pm until 6 am the following day. The main conclusions are that the state of Tamaulipas has the highest Wind Power Density (WPD) of 1000 W/m2 during September and October, but the north of Nuevo Leon has, in a large part of its territory, an annual WPD greater than 103 W/m2; each state has 1700 useful hours of wind speed above 3 m/s. Northern Mexico has some zones with excellent wind speed as well; the states of Chihuahua, Coahuila, Nuevo Leon and Tamaulipas have a wind speed of over 4.51 m/s across nearly their entire territories. Because Mexico in recent years has been starting to exploit renewable energy sources, the government has mandated energy reform, which improves the conditions for investment in wind energy in Mexico.

Heat input during welding metal fusion generates different transformations, such as grain growth, hydrogen cracking, and the formation of brittle structures, generally associated with the heat-affected zone (HAZ). For this reason, it is very important to know the behavior of this area before welding. This paper presents a study of the thermal behavior and its effect on phase transformations in the HAZ, depending on cooling rates (0.1–200 ∘C/s) to obtain continuous cooling transformation (CCT) curves for an high-strength low-alloy (HSLA) steel. In order to determine the formed phases, optical microscopy and Vickers microhardness measurement were used. The experimental CCT curve was obtained from an HSLA steel, and the results showed that, with the used cooling conditions, the steel did not provide formation of brittle structures. Therefore, it is unlikely that welds made by submerged arc welding (SAW) may lead to hydrogen embrittlement in the HAZ, which is one of the biggest problems of cracking in gas conduction pipelines. In addition, with these results, it will be possible to control the microstructure to optimize the pipe fabrication with SAW process in industrial plants.

The synthesis of strontium aluminates of the SrAl2O4 and Sr3Al2O6 type using SrCO3–Al2O3 blends was investigated. Blends 3:1 molar ratio of Al2O3 and mechanically activated SrCO3 were prepared and conformed into pellets by uniaxial compression at 100 MPa. In an experimental stage, thermogravimetric analysis was used to investigate the isothermal decomposition of mechanically activated SrCO3 powders in the blend, in the range of temperatures from 900 to 1100 °C. Then, samples were sintered at 1450 °C for several periods of time (4–36 h), and the products obtained were analyzed by X-ray diffraction and scanning electron microscopy. The results obtained showed that the formation of Sr3Al2O6 starts after 4 h of heat treatment, and it is completed at 36 h. Moreover, other phase such as SrAl2O4 formed in small amounts in the samples sintered for 12 h. Kinetic measurements showed that the conversion of SrCO3 into Sr3Al2O6 follow two different reaction mechanisms, with different controlling steps. The first mechanism relates to the order of reaction model for the Sr3Al2O6 phase formation, whereas the second mechanism relates to the nucleation and growth of these phase particles. The activation energy measured for both processes was 88.59 kJ and 54.06 kJ, respectively.

The systemic neonicotinoid insecticide imidacloprid, Admire Pro, was applied to 3- and 4-yr-old nonbearing ‘Rio Red’ grapefruit, Citrus × paradisi Macfad., trees in 2006 and 2007, respectively, to determine its effects in the control of two major citrus pests, the Asian citrus psyllid, Diaphorina citri Kuwayama (Hemiptera: Psyllidae), and a citrus leafminer Phyllocnistis citrella Stainton (Lepidoptera: Gracillariidae). Young flush shoots were randomly collected weekly for 13 and 11 wk in 2006 and 2007, respectively, to determine the infestation levels and densities of immature stages of both Asian citrus psyllid and P. citrella. Additional flush shoot samples were collected in 2007 and titers of imidacloprid in leaf tissue were determined using an enzyme-linked immunosorbent assay. Soil application of imidacloprid significantly reduced the infestation levels and densities of both pests on flush shoots, starting from the second week post application. The effects of the neonicotinoid insecticide were similar in both years. Analysis of imidacloprid concentration in leaf tissue showed a gradual increase during the first 3 wk, and titers remained well above 200 ppb for 11 wk postapplication. Significant positive correlations were obtained between imidacloprid titers in leaf tissue and the percentage of control levels achieved for both pests. A high level of suppression of both P. citrella and Asian citrus psyllid populations on citrus trees was associated with imidacloprid titer in leaf tissue >200 ppb, which was reached 2 wk after soil treatment. Although soil application of imidacloprid did not provide rapid knockdown of Asian citrus psyllid and P. citrella populations, it resulted in chronic residues in leaf tissue and long-term suppression of both pests.

This work is an analysis of wind characteristics of Baja California Sur (BCS), Mexico, during the period from February 1997 to February 1998. Fifteen wind stations located in the eastern coastal area recorded the wind speed and wind direction for this region. The wind resources of BCS were recorded and the annual average wind speed, power density, and annual energy density at 10 m above ground level are presented here. We considered the wind data from El Cardon, BCS, as a case study. This location can be considered to be representative of the 15 wind stations that were installed in BCS. Using the Weibull probability density function, we estimated the wind energy output and the capacity factor for two different wind turbines during the year. The capacity factors for both wind turbines were estimated at close to 25%. Considering the wind energy output and the capacity factor, we estimated the levelized production costs for both wind turbines. Taking into account two different discount rates of 7% and 10%, we developed data for the levelized production cost of both wind turbines.

Laboratory studies were conducted to determine the effects of parasitoid age and number of hosts available on selected attributes of parasitoid reproduction. Newly emerged mated females of the gregarious parasitoid Allorhogas pyralophagus Marsh were divided into groups ranging in age from 5 to 12 d. For each age class, individual females were exposed to one, two, four, and eight hosts of the Mexican rice borer, Eoreuma loftini (Dyar), over a 24-h period. For each age class, number of eggs laid and hosts attacked were fitted to nonlinear oviposition models and type II functional response curves, respectively. Numbers of eggs laid per female per day were highest at ≈20 eggs per day in 6-d-old females, declining to ≈5 per day in 12-d-old females. The functional response curves showed declining attack rates with time, from ≈2.0 hosts per day in 5-d-old females, to ≈1.0 in 12-d-old parasitoids. Percentage of progeny emergence was not affected by either parasitoid age or number of hosts available. Perc...

The virulency of an endemic nematode, Steinernema riobravis Cabanillas, Poinar and Raulston (Nematoda: Steinernematidae), was tested against the Mexican rice borer, Eoreuma loftini(Dyar) (Lepidoptera: Pyralidae), in the laboratory and field. Steinernema riobravis caused 100% mortality in E. loftini larvae at all concentrations of 20 to 240 nematodes per larva 2 d post treatment. Numbers of juvenile progeny increased significantly with inoculum dosage of nematodes. Average juvenile progeny ranged from 2,000 per borer larva at 10 nematodes per larva to over 4,000 per larva at 120 per larva. A field experiment on sugarcane (Saccharum spp. cv ‘NCo 310’) was performed using three treatments: (1) control (no nematodes); (2) low application rate (1.24 × 109 nematodes/ha); and, (3) high application rate (2.47 × 109 nematodes/ha). At weekly intervals, the field was sampled for numbers of internodes per stalk, numbers of internodes damaged by borer larvae, and parasitoids reared from larvae collected. The field results showed the nematode treatments were ineffective in reducing borer incidence or damage. Percentage of bored internodes and numbers of borers collected significantly increased with time, but treatment effects were not significant. Numbers of parasitoids emerging from the larvae collected were too low to be analyzed statistically. Plant height, aboveground biomass, and juice quality were not significantly affected by treatment. The ineffectiveness of the nematode applications may be due to desiccation caused by exposure to sunlight and inadequate humidity, as well as poor contact with the target insect.

We compared laboratory and field efficacies of pyrethroid insecticides (Baythroid, ‘FCR 4545’ [both cyfluthrin], Karate [lambda cyhalothrin]) and insect growth regulators (Confirm [tebufenozide], ‘RH-2485’ [methoxyfenozide]) against the Mexican rice borer, Eoreuma loftini (Dyar), a key pest of sugarcane in south Texas. We also studied treatment effects on longevity and survivorship of its braconid parasitoid, Allorhogas pyralophagus Marsh. In the 1996 field season, Baythroid resulted in lower percentages of bored internodes compared with the other treatments. In the 1997 season, less borer damage was found in ‘FCR 4545’ (an isomer of Baythroid), relative to the other treatments. The differences may be partially attributed to the different application methods (tractor sprayer versus aerial). In both field seasons, no significant treatment effects could be found in any of the yield or juice quality measurements, suggesting that improvements must be made in application technology, or the biorational insecticides must be used in conjunction with other control agents, such as biological controls. Efficacy may be improved if applications can be timed to windows of susceptibility based on either plant phenology or pest lifecycle. Baythroid and FCR 4545 were generally most effective in reducing damage caused by E. loftini, although residual toxicity of Baythroid was higher than FCR 4545 against both E. loftini and A. pyralophagus. Comparisons between similar bioassays showed that Baythroid and tebufenozide were more toxic to E. loftini than to A. pyralophagus. Therefore, if A. pyralophagus or a similar parasitoid were to be used in conjunction with an insecticide, an effective approach may be to use a less toxic biorational, such as the insect growth regulator tebufenozide, or to time the release of the parasitoids after residual toxicity has declined in a biorational such as FCR 4545.

Today, stainless steel is widely used in automotive industry due to its high impact resistance, corrosion resistance and light weight. This paper present the research carried out to study the differences between microstructure and mechanical properties of 409 and 308 stainless steel sheets, each joints by gas tungsten arc welding (GTAW). For each of weldments, detailed analysis was conducted on the chemical composition, microstructure characteristics and mechanical properties of base metal (BM), heat affected zone (HAZ) and fusion zone (FZ). Scanning electron microscopy (SEM) and optical microscopy were used to analyze microstructural changes and mechanical properties, including microhardness and tensile test. This study can be a practical guide in the selection of other materials in order to determine the important to use in structural automotive industry.

Adult acute myeloid leukemia (AML) is a highly heterogeneous stem cell malignancy characterized by the clonal expansion of immature myeloid precursors. AML may emerge de novo, following other hematopoietic malignancies or after cytotoxic therapy for other disorders. Here, we investigated the clonal vs reactive nature of residual maturing bone marrow cells in 59 newly diagnosed adult AML and mixed phenotype acute leukemia (MPAL) patients as assessed by interphase fluorescence in situ hybridization analysis of AML and myelodysplastic syndrome-associated cytogenetic alterations and/or the pattern of chromosome X inactivation, in females. In addition, we investigated the potential association between the degree of molecular/genetic involvement of hematopoiesis and coexistence of altered immunophenotypes by flow cytometry. Our results indicate that residual maturing neutrophils, monocytes and nucleated red cell precursors from the great majority of newly diagnosed AML and MPAL cases show a clonal pattern of involvement of residual maturing hematopoietic cells, in association with a greater number of altered immunophenotypes. These findings are consistent with the replacement of normal/reactive hematopoiesis by clonal myelopoiesis and/or erythropoiesis in most newly diagnosed AML and MPAL cases, supporting the notion that in most adults presenting with de novo AML, accumulation of blast cells could occur over a pre-existing clonal hematopoiesis.

This paper describes the capability of near infra-reflectance (NIRS) to predict the nutritional quality of pastures from southern Chile (39°-40°S). A Fourier transformed near-infrared (FT-NIR) method for rapid determination of dry matter (DM), crude protein (CP), in vitro digestibility (IVD) and metabolizable energy (ME) was used. Calibration models were developed between chemical and NIRS spectral data using partial least squares (PLS) regression and external validation. The coefficients of determination in calibration (R2c) were high varying between 0.89-0.99 and the root mean square errors of calibration (RMSEC) were low, ranging between 0.46-2.55 for the parameters analysed. The Residual Prediction Deviation (RPD) was higher than 2.5. Our results confirmed the convenience of using a wide range of samples applicability in the calibration set. Data also showed that the use of an independent set of samples for external validation increases the robustness of the models to predict unknown samples. Our results indicated RPD values higher than 2.5 which is the minimum recommended for this type of prediction. Thus, the result showed that NIRS was useful to estimate the nutritional quality of permanent pastures, and has a great potential to be used as a rapid decision tool for the studied analysis. Thanks the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT) post-doc grant n°3120069. info:eu-repo/semantics/publishedVersion

Background Several new drugs for the treatment of hepatitis C virus (HCV) have been released in the past years. Clinical trials have demonstrated good efficacy. These clinical trials of regimens to treat chronic infection with HCV used as their primary efficacy endpoint HCV RNA levels 24 weeks after the end of treatment (SVR24). More recently, regulatory authorities have begun to accept SVR at 12 weeks post-treatment (SVR12) as a valid efficacy endpoint. Purpose To evaluate the efficacy of 5 of the newest treatments for HCV, analysing HCV RNA levels after 4 (HCVRNA4), 12 (HCVRNA12) and 24 (HCVRNA24) weeks. Material and methods Retrospective observational study conducted from September 2014 to September 2015. We searched for recommendations in HCV guidelines and drug data sheets. We obtained patient information from the electronic prescription software (PRISMA-APD) and clinical data from the medical history database (DIRAYA). Results 63 patients were included (47 males and 16 females), with an average age of 53 years. The genotype of the virus was 1A in 14 patients, 1B in 33, 3A in 8 and genotype 4 in 7. 30 (47.62%) were previously treated with another drug and 10 (15.87%) were coinfected with HIV. 13 were treated with ledipasvir/sofosbuvir, 15 with simeprevir, 3 with sofosbuvir, 17 with sofosbuvir/simeprevir and 15 with sofosbuvir/daclatasvir. 48 (81%) presented HCVRNA4 undetectable levels. After 12 weeks of treatment, only 2 patients presented with detectable levels of HCVRNA (1 with genotype 4 with level 4 liver fibrosis, treated with sofosbuvir plus simeprevir, who suffered a relapse). Another patient, genotype 3A with level 4 liver fibrosis, treated with sofosbuvir plus daclatasvir, also suffered a relapse after 24 weeks. The rest of the patients remain with undetectable levels waiting for the next analysis. Conclusion The results confirm the expectations proved in clinical trials, with an early response. Coinfection with HIV does not seem to modify treatment response. The 2 relapsers in this study were previously treated patients. Future studies including more patients are needed in order to ensure the effectiveness of the new treatments in the long term. No conflict of interest.

Congenital or developmental deformities of the chest rarely cause severe functional problems in the manner of larger anomalies of the limbs. Poland syndrome is known as a variety of associated anomalies centered on the trunk and upper limbs. The authors report the case of a 28-year-old female with absence of the pectoralis major muscle and depression of the left anterior thoracic wall (sunken chest). She presented with hypoplasia of the papillary–areolar complex; her upper left limb was normal. Seven years after undergoing placement of a left-side breast prosthesis, she requested replacement of the implant because she was dissatisfied with its shape. Chest radiographs showed a chest deformity and deviation of the mediastinum to the right. After surgically removing the prosthesis, an area of costal reabsorption on the left side was seen at its site, with exposure of the parietal pericardium. The prosthesis was replaced with another of greater volume and the patient was referred to the thoracic surgery service. No cases of regional bone resorption secondary to the presence of a breast prosthesis are reported in the literature. However, it is known that compression results in bone absorption and subsequent bone remodeling. The authors therefore believe that greater attention to this possibility is needed in cases of breast prosthesis replacement among patients with Poland syndrome, by means of specific imaging studies such as computed tomography.

Background Tolvaptan is the first oral antagonist of the vasopressin V2 receptor. It is indicated in adult patients with hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH). Purpose To evaluate the use of tolvaptan in a tertiary hospital. Materials and Methods An observational study was conducted on patients treated with tolvaptan from January 2012 to September 2012. Data was collected from the review of medical histories, lab tests and dispensing records. A data collection sheet was designed on which were recorded: diagnosis related to hyponatraemia, age, gender, dose, clinical department that prescribed it, serum sodium when the treatment with tolvaptan was initiated, evolution and possible side effects. Results 6 patients (50% male) received tolvaptan in the study period. Average age was 72.53 years. The clinical department that wrote the prescription was Internal Medicine in five cases and Oncology in the other one. The background pathology was lung cancer in two cases, heart failure in two cases, idiopathic SIADH in one case and only one case of SIADH. The average serum sodium concentration pre-treatment was 113 (101–120) mg/dl. The dose usually used was 15 mg/day, although one patient took 30 mg/day. The average length of treatment was 123 (30–270) days. Only one patient discontinued treatment due to gastrointestinal side effects. One terminal cancer patient and an 85-year-old patient died. The average cost-day per patient was €65.75. Conclusions Our results agree with the tolvaptan clinical trials, that it appears to be safe and effective in the treatment of hyponatraemia refractory to other treatments. The high cost of the treatment and the limited experience in its use required strict control over its administration. No conflict of interest.