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Cervical ultrasound (CE) has emerged as a promising tool in recent years for vocal cord (VC) assessment in patients undergoing thyroid surgery. Our aim is to assess the reliability of CE once implemented in an endocrine surgery unit and performed by the surgeons themselves.86 participants with no history of laryngeal pathology or cervical surgery underwent CE by three independent endocrine surgeons. Laryngeal structures and specifically the VCs were analysed. To consider the examination as diagnostic, the VCs had to be visualised statically and during phonation. The time taken to perform the technique and the interobserver variability were also analysed.Of the 86 participants, 51.2% were male with a mean age of 43 years. The range of diagnostic examinations between surgeons was 60-68%, with substantial agreement between the 3 explorers (Fleiss's K-value = .714). Male sex and advanced age were factors associated with non-assessability of the technique. The mean procedure time was 72 s.CE is a fast, non-invasive, feasible bedside tool useful for the assessment of VCs prior to thyroid surgery, mainly in young women.

Rapid and unplanned urbanisation can lead to altered local climate by increasing land surface temperature (LST), particularly in summer months. This study investigates the Urban Heat Island (UHI) in Greater Cairo, Egypt, using remote sensing techniques to estimate LST of summer months over 45 years (1986, 2000, 2017, and predicted year 2030). The research objectives and steps were, 1- mapped land use/ land cover (LULC), 2- conducted spatiotemporal analysis of LST, with a comparison of change in LST across different land cover types, 3- predicted future LST for 2030, and 4- examined this temporal change for a hot-spot area (ring road) and a cool-spot area (the River Nile). The results showed that urban areas have increased over the last 30 years by 179.9 km2 (13 %), while agriculture areas decreased by 148 km2 (12 %) and water bodies decreased by 6 km2 (0.5 %). The mean LST over Greater Cairo increased over time, from 31.3 °C (1986) to 36.0 °C (2017) and is predicted to reach 37.9 °C in 2030. While a notable rise of mean LST in the Cairo ring road buffer zone (88 km2), where it was 31.1 °C (1986), and 37 °C (2017) due to the triple increase of urban areas on account of agriculture areas, and the LST it may reach 38.9 °C by 2030. The mean LST increased slightly more in urban hot-spot areas than in cooler cultivated areas. UHI may induce a modification in the local climate that can negatively affect agricultural land, and human thermal comfort and unfortunately lead to a less sustainable environment.

Resumen Antecedentes y objetivo En este estudio presentamos los resultados del subgrupo de pacientes espanoles del estudio VERIFIE, primer estudio postautorizacion prospectivo que evalua la seguridad y efectividad a largo plazo del oxihidroxido sucroferrico (OHS) en pacientes en dialisis con hiperfosfatemia durante la practica clinica habitual. Pacientes y metodos Se incluyeron pacientes en hemodialisis y dialisis peritoneal con indicacion de tratamiento con OHS. La duracion del seguimiento fue de 12 a 36 meses desde el inicio del tratamiento con OHS. Las variables primarias de seguridad fueron la incidencia de reacciones adversas a medicamentos, eventos medicos de interes especial y variaciones en los parametros del hierro. La efectividad del OHS se evaluo mediante el cambio en los niveles de fosforo serico. Resultados Se reclutaron 286 pacientes y se analizaron los datos de 282. De estos 282 pacientes, 161 (57,1%) abandonaron el estudio de manera prematura y un 52,5% recibieron tratamiento concomitante con otros captores de fosforo. Un 35,1% reportaron reacciones adversas a medicamentos y la mayoria fueron de tipo gastrointestinal (77,1%) y de intensidad leve/moderada (83,7%). Un 14,2% de los pacientes presentaron eventos medicos de interes especial, de los que el 93,7% fueron leves/moderados. Se observo un incremento de la ferritina (386,66 vs. 447,55 ng/mL; p = 0,0013) y saturacion de la transferrina (28,07 vs. 30,34%; p = 0,043) desde el inicio hasta la ultima visita. Los niveles de fosforo serico disminuyeron progresivamente desde 5,69 mg/dL al inicio hasta 4,84 mg/dL en la ultima visita (p Conclusiones El OHS presento un perfil de efectividad favorable, un perfil de seguridad similar al observado en el estudio internacional con una mayoria de efectos adversos de severidad leve/moderada, y un numero reducido de comprimidos diarios en pacientes espanoles en dialisis.

Hypertension is one of the main cardiovascular risk factors. An educational intervention, aimed at increasing or reinforcing the patient's knowledge, can contribute to better control of their blood pressure. Our goal was to evaluate the efficacy of a continuing therapeutic education versus an initial intervention in hypertensive patients.Experimental study of multicenter community intervention, through the application of a therapeutic education program in hypertension.980 patients on antihypertensive treatment were included, 490 in each group, with a mean age of 65 years, and 50% women, baseline mean SBP in both groups was136 mmHg. Regarding knowledge about hypertension, although a similar initial improvement was observed in both groups, at the end of the study, in the continuous intervention group (CIG) an average of 23.06 correct answers was observed, while in the Initial intervention group (IIG) the mean was 20.91, being the difference statistically significant (p0.001). At the end of the study, the mean SBP was 127.5 mmHg in the CIG and 136.57 mmHg in the IIG group. Likewise, a lower percentage of patients with a BMI ≥25 was observed in the CIG (78.2%) than in the IIG 82.6%, this difference being statistically significant (p0.001). This same effect was observed on the abdominal perimeter, observing an increased abdominal perimeter in 46.3% of the CIG compared to 68.8% in the IIG (p0.001). CONCLUSIóN: A continuous educational intervention increases the degree of knowledge about hypertension compared to an initial intervention. Likewise, this intervention is associated with an improvement in blood pressure, weight, body mass index and abdominal girth figures.

Resumen Introduccion y objetivos La hipertension es uno de los principales factores de riesgo cardiovascular. Una intervencion educativa, destinada a aumentar o reforzar los conocimientos del paciente, puede contribuir a un mejor control de su presion arterial. Nuestro objetivo fue evaluar la eficacia de una educacion terapeutica continuada frente a una intervencion inicial en hipertensos. Metodos Estudio experimental, de intervencion comunitaria multicentrica, mediante la aplicacion de un programa de educacion terapeutica en hipertension arterial (HTA). Resultados Se incluyeron 980 pacientes en tratamiento antihipertensivo, 490 en cada grupo, con edad media de 65 anos, y un 50% mujeres siendo la presion arterial sistolica (PAS) media inicial en ambos grupos de 136 mmHg. Respecto a los conocimientos sobre la hipertension, aunque se observo una mejoria inicial similar en ambos grupos, al finalizar el estudio, en el grupo de intervencion continuado (GIC) se observo una media de 23,06 respuestas acertadas, mientras que en el grupo de intervencion inicial (GII) la media fue de 20,91, siendo la diferencia estadisticamente significativa (p Conclusion Una intervencion educativa continuada aumenta el grado de conocimiento sobre la hipertension respecto a una intervencion inicial. Asimismo, esta intervencion se asocia a una mejoria en las cifras de presion arterial, peso, indice de masa corporal y perimetro abdominal.

Current traffic congestion and the resulting carbon emissions are two of the main problems threatening the sustainability of modern cities. The challenges facing today's cities focus primarily on the optimization of traffic ow and the transition to electric vehicles. The latter aspect implies the need for an adequate deployment of the infrastructure of charging stations. The inherent complexity in today's cities and the difficulty in implementing new policies whose benefits are difficult to measure and predict has led in recent years to consider the enormous potential of simulation tools and in particular of the agent-based simulation (ABS). ABS allows the speciffication of complex models that reect the complexity and dynamism of urban mobility. Current technology in ABS has evolved and matured sufficiently to provide very sophisticated tools but lacking facilities for a exible and realistic generation of input data in the execution of the experiments. In line with this, this paper introduces two configurable generators that automatize the creation of experiments in agent-based simulations. The generators have been developed with the SimFleet simulation tool enhancing the simulation of realistic movements and location of vehicles, passengers and other users of the urban traffic system within a city. The generators proved to be useful for comparing different distributions of locations as well as different agent movement behaviors based on real city data.