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Background: Rheumatoid arthritis (RA) in elderly population represents a challenge for physicians in terms of therapeutic management. Methotrexate (MTX) is the first-line treatment among conventional synthetic-disease-modifying anti-rheumatic drugs (cs-DMARDs); however, it is often associated with adverse events (AEs). Therefore, the objective of this study was to identify the incidence and risk factors of MTX discontinuation due to AEs in elderly patients with RA in a long-term retrospective cohort study. Methods: Clinical sheets from elderly RA patients taking MTX from an outpatient rheumatology consult in a university centre were reviewed. To assess MTX persistence, we used Kaplan–Meir curves and Cox regression models to identify the risk of withdrawing MTX due to adverse events. Results: In total, 198 elderly RA patients who reported using MTX were included. Of them, the rates of definitive suspension of MTX due to AEs were 23.0% at 5 years, 35.6% at 10 years and 51.7% at 15 years. The main organs and system involved were gastrointestinal (15.7%) and mucocutaneous (3.0%). Factors associated with withdrawing MTX due to AEs were MTX dose ≥ 15 mg/wk (adjusted HR: 2.46, 95% CI: 1.22–4.96, p = 0.012); instead, the folic acid supplementation was protective for withdrawal (adjusted HR: 0.28, 95% CI: 0.16–0.49, p < 0.001). Conclusions: Higher doses of MTX increase the risk of withdrawals in elderly RA, while folic acid supplementation reduces the risk. Therefore, physicians working in therapeutic management for elderly patients using MTX must focus on using lower MTX doses together with the concomitant prescription of folic acid. [ABSTRACT FROM AUTHOR]

Background and Objectives: According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection". The increased presence of free radicals causes an increase in oxidative stress. Vitamin C is an essential water-soluble vitamin with antioxidant activity and immunoregulatory effects that plays a potential role in the treatment of bacterial infections. Our aim was to evaluate the effectiveness of adding vitamin C to the conventional treatment of sepsis to decrease its mortality rate. Materials and Methods: In a prospective cohort study, we included patients with a diagnosis of sepsis and a SOFA score ≥ 9 who were evaluated in an Intensive Care Unit at a secondary-care hospital. According to the intensive care specialist, they were treated using two different strategies: Group 1—patients with sepsis treated with conventional treatment without vitamin C; Group 2—patients with sepsis with the addition of vitamin C to conventional treatment. Results: We included 34 patients with sepsis. The incidence of mortality was 38%, and 47% of patients used vitamin C as an adjuvant to the basic treatment of sepsis. In the basal analyses, patients treated with use of vitamin C compared to patients treated without vitamin C required less use of glucocorticoids (75% vs. 100%, p = 0.039). At follow-up, patients treated without vitamin C had higher mortality than patients treated with vitamin C as an adjuvant for the treatment of sepsis (55.6% vs. 18.8%, p = 0.03). We observed that the use of vitamin C was a protective factor for mortality in patients with sepsis (RR: 0.54, 95% CI: 0.31–0.96, p = 0.03). Conclusions: The use of vitamin C as an adjuvant to treatment decreases the risk of mortality by 46% in patients with sepsis and SOFA ≥ 9 compared to patients treated without vitamin C as an adjuvant to sepsis. [ABSTRACT FROM AUTHOR]

The use of complementary therapies is highly prevalent among patients with rheumatoid arthritis (RA). Nevertheless, the use of complementary medicine could involve problems in the following of scientifically accepted treatments. To date, there is limited information regarding the association of nonconventional therapies with problems regarding compliance with the treatment. Therefore, the objective of this study was to identify whether the utilization of complementary therapies is associated with a high risk of problems regarding therapeutic adherence to conventional synthetic disease-modifying anti-rheumatic drugs (cs-DMARDs) in RA patients. A survey was performed with RA patients in an outpatient rheumatology clinic in a university hospital; the use of complementary therapies, as well as their type, was identified. To assess problems with therapeutic adherence, we used the four-item Morisky–Green scale. A comprehensive assessment of clinical and therapeutic characteristics was performed. Univariable and multivariable models were performed to identify the risk of problems with therapeutic adherence in users of complementary therapies. In total, 250 RA patients were included; 92% used complementary therapies. Of them, the most frequently used were herbal medicine (65%), homeopathy (64%), and cannabis and its derivatives (51%). In the univariable logistic regression analysis, the factors associated with problems in the therapeutic adherence to cs-DMARDs were age (p = 0.019), the presence of other comorbidities (p = 0.047), and the use of complementary therapies (p = 0.042). After controlling for potential confounders, the use of complementary therapies increased the risk of problems with therapeutic adherence to cs-DMARDs (adjusted OR = 2.84, 95% CI = 1.06–7.63, p = 0.037). We concluded that the use of complementary therapies increases the risk of problems with therapeutic adherence. Therefore, for physicians and healthcare professionals, the early identification of the use of nonconventional therapies in their RA patients is required, followed by a directed discussion with their patients about the risks and benefits to which they could be exposed to complementary therapies. [ABSTRACT FROM AUTHOR]

Recent research indicates that information and communication technologies (ICTs) can support social participation in the planning, design and maintenance of public spaces (PDMPS), specifically to create comprehensive knowledge among different stakeholders. However, critics point out that the use of ICTs by planners and decision-makers often ignores the needs of local residents. For this research, we inquired how ICTs can support social participation in PDMPS. Our case study combines a literature review and 21 semi-structured interviews with government officials, non-governmental organisations, academics and architecture/urban planning consultancy companies in Mexico to understand how different stakeholders use ICTs to improve the quality of public spaces. We developed an approach that facilitates the analysis of ICT aspects related to hardware and software supporting social participation in PDMPS. The findings show that Mexico has a base of digital tools requiring technical capacities and spatial literacy at various stages of PDMPS, and ICTs are seen as an opportunity to engage with residents. However, in practice, our interviewees mentioned that ICTs are rarely implemented to support participatory processes due to high costs, a lack of political support and the insufficient technical expertise of technical staff to engage with residents using ICTs. The paper closes with recommendations and suggestions for future research on how ICTs can better support participatory processes in PDMPS. [ABSTRACT FROM AUTHOR]

The coronavirus SARS-CoV-2 generated an alert that became a state of emergency in health issues worldwide, a situation that affected the entire population, including pregnant women. The present study aims to understand the effect of the psychopathological profile of a sample of pregnant women at the time of the COVID-19 pandemic on themselves during childbirth (Phase 1) and after childbirth and the anthropometric measures of the neonate at birth (Phase 2). The total sample comprises 81 pregnant women aged 32.07 years (SD = 5.45) and their neonates. Sociodemographic and obstetric data of the sample were collected. During pregnancy, psychopathology was measured by means of the SCL-90, as well as other psychological measures on stress and social support. Cluster k-means techniques were used to uncover the heterogeneous profiles of psychopathology in Phase 1. Two main psychopathological profiles were found (Cluster 1: High psychopathological symptoms; Cluster 2: Low psychopathological symptoms). The clusters generated show significant differences in all the SCL-90-R subscales used and in the general index at Phase 1. After childbirth, high psychopathology profile membership was associated with a greater probability of having a non-eutocic delivery. On the other hand, the low psychopathological symptoms cluster shows higher levels of depressive symptoms, hostility, paranoid ideation, and psychotic symptoms in Phase 2. In conclusion, there seemed to exist two heterogeneous profiles of psychopathology in pregnant women during the pandemic; the stress related to the pandemic seemed uninfluential on the development of a profile of high psychopathological symptoms and the psychopathology profile may influence delivery and postpartum outcomes. [ABSTRACT FROM AUTHOR]

Promoting neglected and underutilized crop species is a possible solution to deal with the complex challenges of global food security. Chayote is a Neglected and Underutilized Cucurbit Species (NUCuS), which is recognized as a fruit vegetable in Latin America and is widely grown in Asia and Africa. However, basic biological knowledge about the crop is insufficient in scientific sources, especially outside of its center of origin. In this study, limited observations on reproductive characters were conducted, differentiating accessions from Mexico, Japan, and Myanmar. Cytological evaluation among Mexican and Japanese accessions showed that the relative nuclear DNA content is 1.55 ± 0.05 pg, the estimated genome size is 1511 at 2C/Mbp, and the observed mitotic chromosomal number is 2n = 28. The genetic diversity of 21 chayote accessions was also examined using six microsatellite markers. A global low genetic heterozygosity (Ho = 0.286 and He = 0.408) and three genetic groups were detected. The results established the basis to provide insights into chayote arrival history in Asia by looking at the crop's reproductive morphology, cytology, and genetic diversity status outside its origin center. This could help in developing sustainable utilization and conservation programs for chayote. [ABSTRACT FROM AUTHOR]

Electric variable speed drives (VSD) have been replacing mechanic and hydraulic systems in many sectors of industry and transportation because of their better performance and reduced cost. However, the electric systems still face the issue of being considered less reliable than the mechanical ones. For this reason, researchers have been actively investigating effective ways to increase the reliability of such systems. This paper is focused on the analysis of the common-mode voltage (CMV) generated by the operation of the VSDs which directly affects to the lifetime and reliability of the complete system. The method is based on the mathematical description of the harmonic spectrum of the CMV depending on the PWM method implementation. A generalized PWM method where the carriers present a variable phase-displacement is developed. As a result of the presented analysis, the CMV reduction is achieved by applying the PWM method with optimal carrier phase-displacement angles without any external component and/or passive filtering technique. The optimal values of the carrier phase-displacement angles are obtained considering the minimization of the CMV total harmonic distortion. The resulting method is easily implementable on mostly off-the-shelf mid-range micro-controller control platforms. The strategy has been evaluated in a scaled-down experimental setup proving its good performance. [ABSTRACT FROM AUTHOR]

Postpartum post-traumatic stress disorder (PTSD) is not a specific process but can last for months and may manifest itself during any subsequent pregnancies or even become chronic. This study aimed to determine the factors associated with long-term PTSD symptoms one year after delivery. A cross-sectional study was conducted on 1301 Spanish puerperal women. Data were collected on sociodemographic, obstetric, and neonatal variables. The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was administered online through midwives' associations across Spain. Crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals were calculated. A PPQ score ≥ 19 (high-risk) was recorded for 13.1% (171) of the participants. Identified risk factors were not respecting a birth plan (aOR = 1.89 (95% CI 1.21–2.94)), formula-feeding of the baby at discharge (aOR = 2.50 (95% CI 1.20–5.17)), postpartum surgical intervention (aOR = 2.23 (95% CI 1.02–4.85)), hospital readmission (aOR = 3.45 (95% CI 1.21–9.84)), as well as verbal obstetric violence (aOR = 3.73 (95% CI 2.52–5.53)) and psycho-affective obstetric violence (aOR = 3.98 (95% CI 2.48–6.39)). During childbirth, some clinical practices, such as formula-feeding of the newborn at discharge or types of obstetric violence towards the mother, were associated with a higher risk of PTSD symptoms one year after delivery. [ABSTRACT FROM AUTHOR]

In electric power systems, any deviation with respect to the theoretical sinusoidal waveform is considered to be a disturbance in the power quality of the electrical grid. The deviation can alter any of the parameters of the waveform: frequency, amplitude, and symmetry among phases. Microgrid, as a part of the electric power system, has to contribute providing an adequate current waveform in grid connected-mode, as well as to guarantee similar voltage features than the standard requirement given for public distribution grids under normal exploitation conditions in islanded mode. Adequate power quality supply is necessary for the correct compatibility between all the devices connected to the same grid. In this paper, the power quality of microgrids is managed using a Model Predictive Control (MPC) methodology which regulates the power converters of the microgrids in order to achieve the requirements. The control algorithm is developed for the following microgrids working modes: grid-connected, islanded, and interconnected. The simulation results demonstrate that the proposed methodology improves the transient response in comparison with classical methods in all the working modes, minimizing the harmonic content in the current and the voltage even with the presence of non-balanced and non-harmonic-free three-phase voltage and current systems. [ABSTRACT FROM AUTHOR]

Hand-in-hand with the smart-grid paradigm development, power converters used in high-power applications are facing important challenges related to efficiency and power quality. To overcome these issues, the pre-programmed Pulse-Width Modulation (PWM) methods have been extensively applied to reduce the harmonic distortion with very low power switching losses for high-power converters. Among the pre-programmed PWM techniques, Selective Harmonic Elimination (SHE) has been the prevailing solution, but recently, Selective Harmonic Mitigation (SHM) stands as a superior alternative to provide further control of the harmonic spectrum with similar losses. However, the large computational burden required by the SHM method to find a solution confines it as an off-line application, where the switching set valid solutions are pre-computed and stored in a memory. In this paper, for the first time, a real-time implementation of SHM using an off-the-shelf mid-range microcontroller is presented and tested. The Exchange Market Algorithm (EMA), initially focused on optimizing financial transactions, is considered and executed to achieve the SHM targets. The performance of the EMA-based SHM is presented showing experimental results considering a reduced number of switching angles applied to a specific three-level converter, but the method can be extrapolated to any other three-level converter topology. [ABSTRACT FROM AUTHOR]

This work describes an efficient implementation in terms of computation time and resource usage in a Field-Programmable System-On-Chip (FPSoC) of a Finite Control Set Model Predictive Control (FCS-MPC) algorithm. As an example, the FCS-MPC implementation is used for the current reference tracking of a two-level three-phase power converter. The proposed solution is an enabler for using both complex control algorithms and digital controllers for high switching frequency semiconductor technologies. An original HW/SW (hardware and software) system architecture for an FPSoC is designed to take advantage of a modern operating system, while removing time uncertainty in real-time software tasks, and exploiting dedicated FPGA fabric for the most complex computations. In addition, two different architectures for the FPGA-implemented functionality are proposed and compared in order to study the area-speed trade-off. Experimental results show the feasibility of the proposed implementation, which achieves a speed hundreds of times faster than the conventional Digital Signal Processor (DSP)-based control platform. [ABSTRACT FROM AUTHOR]

Acting as an interface between the grid and many energy systems, the active front-end (AFE) has been widely used in a large variety of industrial applications. In this paper, in order to ensure the fast dynamic performance and good disturbance rejection ability of the AFE, a high-gain observer (HGO) plus adaptive super-twisting algorithm (STA) for the three-level neutral-point-clamped (NPC) converter is proposed. Comparing with the conventional PI control strategy, the proposed controller implements the adaptive STA in the voltage regulator to provide a faster transient response. The gains of the adaptive STA keep varying according to the rules being reduced in steady state but increasing in transient conditions. Therefore, the chattering phenomenon is mitigated and the dynamic response is guaranteed. Additionally, to undermine the impact of external disturbances on the dc-link voltage, a high-efficiency HGO is designed in the voltage regulation loop to reject it. Experimental results based on a three-level NPC prototype are given and compared with the conventional PI method to validate the fast dynamic performance and high disturbance rejection ability of the proposed approach. [ABSTRACT FROM AUTHOR]

Three-level neutral-point-clamped (NPC) converter is widely used in energy conversion systems due to its good properties for high-power systems presenting output waveforms with reduced harmonic distortion. To obtain better system performance, an integral sliding-mode control (ISMC)-based direct power control (DPC) strategy is proposed for NPC converters. The controller achieves three objectives. First, an extended state observer (ESO)-based ISMC strategy, to enforce the active and reactive power to their reference values, is applied in the power tracking loop. ESO is used to reduce the influence of parameter uncertainties. Next, in the voltage regulation loop, a radial basis function neural network (RBFNN)-based adaptive ISMC strategy is applied to regulate the DC-link voltage. RBFNN is used to estimate the load variation, which is considered as a disturbance, to improve the system disturbance rejection ability. An adaptive law is used in the controller to reduce the chattering of reference active power which can reduce the current harmonic distortion. Finally, a proportional-integral (PI) control strategy is applied in the voltage balancing loop to achieve voltage balance between two DC-link capacitors. Experimental results show the effectiveness and superiority of the proposed control strategy for the NPC power converter compared with PI-based DPC strategy. [ABSTRACT FROM AUTHOR]

This study aimed to develop and validate two predictive models of postpartum post-traumatic stress disorder (PTSD) risk using a retrospective cohort study of women who gave birth between 2018 and 2019 in Spain. The predictive models were developed using a referral cohort of 1752 women (2/3) and were validated on a cohort of 875 women (1/3). The predictive factors in model A were delivery type, skin-to-skin contact, admission of newborn to care unit, presence of a severe tear, type of infant feeding at discharge, postpartum hospital readmission. The area under curve (AUC) of the receiver operating characteristic (ROC) in the referral cohort was 0.70 (95% CI: 0.67-0.74), while in the validation cohort, it was 0.69 (95% CI: 0.63-0.75). The predictive factors in model B were delivery type, admission of newborn to care unit, type of infant feeding at discharge, postpartum hospital readmission, partner support, and the perception of adequate respect from health professionals. The predictive capacity of model B in both the referral cohort and the validation cohort was superior to model A with an AUC-ROC of 0.82 (95% CI: 0.79-0.85) and 0.83 (95% CI: 0.78-0.87), respectively. A predictive model (model B) formed by clinical variables and the perception of partner support and appropriate treatment by health professionals had a good predictive capacity in both the referral and validation cohorts. This model is preferred over the model (model A) that was formed exclusively by clinical variables.