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Virginia Bellido,1 Natalia Duque,2 Rachel S Newson,3 Esther Artime,2 Erik Spaepen,4 Miriam Rubio de Santos,2 Jennifer Redondo-Antón,2 Silvia Díaz-Cerezo,2 Jorge Navarro5 1Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; 2Medical Department, Medical Affairs, Eli Lilly and Company, Madrid, Spain; 3NAPAC Real World Evidence, Medical Affairs, Eli Lilly and Company, Sydney, NSW, Australia; 4Statistics, HaaPACS GmbH, Schriesheim, Germany; 5Department of Medicine, University of Valencia, Valencia, SpainCorrespondence: Natalia Duque, Eli Lilly and Company, Alcobendas, Madrid, Spain, Email duque_natalia@lilly.comBackground: This study aimed to determine physicians’ perceptions of the extent of suboptimal insulin dosing and the barriers and solutions to optimal dosing in people with diabetes (PwD) treated with insulin.Methods: A cross-sectional online survey was conducted in four countries with primary care physicians and endocrinologists treating PwD using insulin pens, which included 53 questions on physicians’ characteristics and their perceptions of the behaviors of PwD in relation to insulin dosing routines, unmet needs and potential solutions. Analyses were descriptive.Results: Of the 160 physicians (80 primary care physicians, 80 specialists) surveyed in Spain, 58.1% were male and 88.8% had been qualified to practice for more than five years. Most physicians (> 65%) indicated that 0– 30% of PwD missed or skipped, mistimed, or miscalculated an insulin dose in the last 30 days. Common reasons for these actions were that PwD forgot, were out of their normal routine, were too busy or distracted, or were unsure of how much insulin to take. To optimize insulin dosing, over 75% of physicians considered it very helpful for PwD to have real-time insulin dosing calculation guidance, mobile app reminders, a device automatically recording glucose measurements and/or insulin, having insulin and glucose data in one place, and having the time for more meaningful conversations about insulin dosing routines.Conclusion: According to physicians’ perspectives, suboptimal insulin dosing remains common among PwD. This survey highlights the need for integrated and automated insulin dosing support to manage the complexity of insulin treatment, improve communications between PwD and physicians, and ultimately improve outcomes for PwD.Plain Language Summary: In Spain, more than 50% of people with diabetes (PwD) do not reach glycemic targets (glycated hemoglobin [HbA1C] under 7%). While there are many innovations in insulin therapy and device technology, treatment adherence is often poor.This study presents results from an online survey of physicians’ perceptions of insulin dosing and the barriers and solutions to optimal insulin dosing in Spain. Most physicians indicated that PwD missed or skipped, mistimed, or miscalculated an insulin dose. Common reasons included PwD being out of their normal routine, being too busy or distracted, or being unsure of how much insulin to take. To improve insulin dosing, physicians suggested real-time insulin dosing calculation guidance, mobile app reminders, and a device that automatically records glucose measurements and insulin. Furthermore, having time for more meaningful conversations about insulin dosing routines was found as a solution to improve insulin dosing.There is a need for integrated and automated insulin dosing support to manage insulin treatment, improve communications between PwD and physicians, and improve outcomes for PwD.Keywords: diabetes mellitus, type 1 diabetes mellitus, type 2 diabetes mellitus, insulin dosing, physicians, Spain, barriers, solutions

Ángel Luis Guerrero-Peral,1 Jesús Porta-Etessam,2 Jaime Rodríguez-Vico,3 Mercedes Núñez,4 Antonio Ciudad,4 Silvia Díaz-Cerezo,4 Carla Garí-Peris,5 Francisco Javier Pérez-Sádaba,5 Luis Lizán,5 Sonia Santos-Lasaosa6 1Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; 2Neurology Department, Hospital Clínico San Carlos, Madrid, Spain; 3Neurology Department, Fundación Jimenez Diaz, Madrid, Spain; 4Medical Department, Eli Lilly, Madrid, Spain; 5Outcomes’ 10, Castellón, Spain; 6Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, SpainCorrespondence: Mercedes Núñez, Eli Lilly, Av. de la Industria, 30, Alcobendas, Madrid, 28108, Spain, Tel +34 647447827, Email nunez_mercedes@lilly.comPurpose: We aimed to validate the Spanish version of the Decisional Conflict Scale (DCS) and analyze its psychometric properties in people with migraine.Patients and Methods: The DCS validation comprised two phases. First, a translation and cross-cultural adaptation following the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Practices: 1-preparation, 2-independent forward translation, 3-reconciliation, 4-back-translation, 5-harmonization, 6-clinical review, and 7-content validation in a group of migraine patients. Second, the analysis of the psychometric properties. The reliability or internal consistency of the DCS scale and subscales was assessed using Cronbach’s α value. The item-subscale correlation was also evaluated. A floor and ceiling effects for DCS score was considered when at least 15% of respondents obtained DCS > 90 (ceiling) or < 10 (floor). The construct validity was studied through the correlation between the DCS subscales and by the correlation between the DCS and other questionnaires (Decision Self-Efficacy Scale [DSES] and 9-item Shared Decision-Making [SDM-Q-9]). Spearman’s coefficients were estimated for the correlations.Results: The cross-cultural adaptation was conducted on 17 patients who completed the questionnaire in a mean of 2.4 ± 1.1 minutes. Generally, more than 75% of them considered that DCS items were adequate, easy to understand, and relevant. The psychometric properties were evaluated in a sample of n=128 patients. Accordingly, the internal consistency of DCS was high, with a Cronbach’s α of 0.97 for the scale and between 0.87 to 0.96 for subscales. Also, a slight floor effect was observed, with 24.2% of patients having DCS scores < 10. The correlation between subscales exceeded Spearman’s coefficient of 0.7. Whereas the correlation between the DCS and the other questionnaires was generally moderate (Spearman’s coefficient > 0.4).Conclusion: The Spanish version (Spain) of the DCS has very acceptable psychometric properties (reliability and construct validity) and good potential for assessing decisional conflicts among migraine patients.Keywords: migraine, decision-making, decisional conflict scale, psychometric properties, adaptation, Spanish

Antoni Sicras-Mainar,1 Silvia Díaz-Cerezo,2 Verónica Sanz de Burgoa,3 Ruth Navarro-Artieda41Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Spain; 2Health Economics and Outcomes Research Department, Pfizer, SLU, Alcobendas, Spain; 3Medical Department, Pfizer, SLU, Alcobendas, Spain; 4Medical Documentation Unit, Hospital Germans Trias i Pujol, Badalona, SpainAbstract: This cohort retrospective study explored the cost and clinical consequences of smoking cessation in outpatients after cardiovascular events (CVEs), in Spain. A total of 2,540 patients (68.1 years; 60.7% male; 8.4% smokers, 52.9% ex-smokers, and 38.7% never smokers) fulfilling the selection criteria and followed up throughout a period of 36 months after the event were considered eligible for analysis. Total costs were higher among current smokers in comparison with ex-smokers and never smokers (€7,981 versus [vs] €7,322 and €5,619, respectively) (P < 0.001). Both health care costs (€6,273 vs €5,673 and €4,823, respectively) (P < 0.001) and loss of productivity at work costs (€1,708 vs €1,650 and €796, respectively) (P < 0.001) accounted for such differences. There was also a difference in CVE recurrence rates (18.6% vs 16.5% and 9.6%, respectively) (P < 0.01). Smoking cessation in CVE outpatients was associated with lower cost and risk of CVE recurrence compared with smokers, and their health status was similar to that of never smokers, in routine clinical practice in Spain.Keywords: mortality, health resources, health care costs

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Giardia intestinalis is a pathogen associated with foodborne outbreaks and Escherichia coli is commonly used as a marker of faecal contamination. Implementation of routine identification methods of G. intestinalis is difficult for the analysis of vegetables and the microbiological detection of E. coli requires several days. This study proposes a PCR-based assay for the detection of E. coli and G. intestinalis cysts using crude DNA isolated from artificially contaminated lettuce. The G. intestinalis and E. coli PCR assays targeted the β-giardin and uidA genes, respectively, and were 100% specific. Forty lettuces from local markets were analysed by both PCR and light microscopy and no cysts were detected, the calculated detection limit was 20 cysts per gram of lettuce; however, by PCR, E. coli was detected in eight of ten randomly selected samples of lettuce. These data highlight the need to validate procedures for routine quality assurance. These PCR-based assays can be employed as alternative methods for the detection of G. intestinalis and E. coli and have the potential to allow for the automation and simultaneous detection of protozoa and bacterial pathogens in multiple samples. Significance and Impact of the Study There are few studies for Giardia intestinalis detection in food because methods for its identification are difficult for routine implementation. Here, we developed a PCR-based method as an alternative to the direct observation of cysts in lettuce by light microscopy. Additionally, Escherichia coli was detected by PCR and the sanitary quality of lettuce was evaluated using molecular and standard microbiological methods. Using PCR, the detection probability of Giardia cysts inoculated onto samples of lettuce was improved compared to light microscopy, with the advantage of easy automation. These methods may be employed to perform timely and affordable detection of foodborne pathogens. [ABSTRACT FROM AUTHOR]

We present the analysis of the first 18 months of data obtained with the COSMOSOMAS (COSMOlogical Structures On Medium Angular Scales) experiment at the Teide Observatory (Tenerife). Three maps have been obtained at 12.7, 14.7 and 16.3 GHz covering 9000 deg2 each with a resolution of ∼1° and with sensitivities 49, 59 and 115 μK beam−1, respectively. These data in conjunction with the Wilkinson Microwave Anisotropy Probe ( WMAP) first year maps have revealed that the cosmic microwave background (CMB) is the dominant astronomical signal at high galactic latitude in the three COSMOSOMAS channels with an average amplitude of (68 per cent c.l. not including calibration errors). This value is in agreement with the predicted CMB signal in the COSMOSOMAS maps using the best-fitting Λ-CDM model to the WMAP power spectrum. Cross-correlation analysis of the 408-MHz map and the COSMOSOMAS data at high galactic latitudes give values in the range from 12.7 to 16.3 GHz. Removing detected point sources in this template, reduces the amplitude of the correlated signal to 8–9 μK. The mean spectral index of the correlated signal between the 408 MHz desourced and the COSMOSOMAS maps is between −3.20 and −2.94 at which indicates that this signal is due to synchrotron emission. Cross-correlation of COSMOSOMAS data with the Diffuse Infrared Background Experiment (DIRBE) map at 100 μm shows the existence of a common signal with amplitude and in the 12.7, 14.7 and 16.3 GHz COSMOSOMAS maps at . Using the WMAP data, we find this DIRBE correlated signal rises from high to low frequencies flattening below ∼20 GHz. At higher galactic latitudes the average amplitude of the correlated signal with the DIRBE maps decreases slightly. The frequency behaviour of the COSMOSOMAS/ WMAP correlated signal with DIRBE is not compatible with the expected tendency for thermal dust. A study of the Hα emission maps do not support free–free as a major contributor to that signal. Our results provide new evidence of a Galactic foreground with properties compatible with predictions by spinning dust models. [ABSTRACT FROM AUTHOR]

Abstract: Consumers (n =265) tasted semitendinosus (ST), semimembranosus (SM) and gluteo biceps (GB) (right and left) from 180 entire male lambs. Muscles were from three Spanish breeds: Rasa Aragonesa (local meat breed), Churra (local dairy breed) and Spanish Merino. Within breed, three slaughter live weights were considered (10–12, 20–22 or 30–32 kg). Isolated muscles were aged under vacuum package for 1, 2, 4, 8 or 16 days. Consumers evaluated tenderness, flavour quality and overall acceptability. Globally, the three attributes were significantly influenced by breed, slaughter live weight and ageing. Considering breed effect, Churra had the lowest scores for tenderness in the heaviest lambs while Spanish Merino was the most tender at 20–22 kg but there were no differences between either for 10–12 kg lambs. Muscles from the heaviest lambs were considered the toughest and those from the 10–12 kg lambs the most tender. Tenderness improved with ageing, but more for SM and GB. Flavour was better in the lightest lambs and, in general, it was not affected negatively by ageing. Consumers preferred meat from the 10–12 kg lambs in all breeds (the most tender and with the best flavour) and aged for intermediate to long periods (4–16 days). For the three attributes, the ST muscle had the best ratings at short ageing times and GB at long ageing times. [Copyright &y& Elsevier]

Abstract: The longissimus lumborum (right and left) from 180 entire male lambs were tasted by a nine-member trained taste panel. The samples were from lambs from three Spanish breeds; Rasa Aragonesa (local meat breed), Churra (local dairy breed) and Spanish Merino. Within breed, three slaughter live weights were considered (10–12, 20–22 or 30–32 kg) and meat was aged in a vacuum package for 1, 2, 4, 8 or 16 days. Panellists assessed a total of eight descriptors. Lamb odour and lamb flavour intensities increased with slaughter weight. However, fat flavour intensity was significantly influenced by breed, with the highest score for Rasa Aragonesa. Off-flavour intensity was influenced by breed and ageing, with higher scores for Rasa Aragonesa and longer ageing times. Tenderness and juiciness were influenced by all three effects (P ⩽0.001, each) and there was a significant interaction between breed and slaughter live weight. Meat was juicier and more tender in the lightest Churra lambs, and in the Spanish Merino lambs for the heavier weight animals. Tenderness and juiciness increased with ageing. The best quality flavour was for the Spanish Merino and the intermediate and heavier lambs. [Copyright &y& Elsevier]

The effects of breed, slaughter weight and ageing time on the meat quality of the three most important Spanish breeds were considered. Two hundred and twenty-five lambs of Rasa Aragonesa-local meat breed-, Churra-local dairy breed- and Spanish Merino were used. Animals (75 of each breed) were slaughtered at three different live weights (10–12, 20–22 or 30–32 kg), and the meat was aged for 1, 2, 4, 8 or 16 days. The meat pH, colour, amount of haem pigments, intramuscular fat, moisture, hydroxyproline content and sarcomere length were measured at 24 h post-mortem. Meat texture was measured by compression after each ageing time. The pH of the samples ranged from 5.50 to 5.58. Meat colour varied with breed and slaughter weight (P⩽0.01), the M. longissimus thoracis was lighter in the youngest animals and in the Churra breed and redder in Merinos. Intramuscular fat increased and moisture decreased for heavier lambs. Differences in collagen were associated with breed (P⩽0.01); total and insoluble collagen contents were higher in the Churra breed. Sarcomere length was only slightly affected by slaughter weight. Meat from the Churra breed had the highest values at high levels of compression. Suckling lambs (10–12 kg) had greater myofibrillar toughness than heavier lambs and ageing strongly influenced myofibrillar tenderness. [Copyright &y& Elsevier]

We describe the first instrument of a cosmic microwave background experiment for mapping cosmological structures on medium angular scales (the COSMOSOMAS experiment) and diffuse Galactic emission. The instrument is located at Teide Observatory (Tenerife) and is based on a circular scanning sky strategy. It consists of a 1-Hz spinning flat mirror directing the sky radiation into a 1.8-m off-axis paraboloidal antenna, which focuses it on to a cryogenically cooled HEMT-based receiver operating in the frequency range 12–18 GHz. The signal is split by a set of three filters, allowing simultaneous observations at 13, 15 and 17 GHz, each with a 1-GHz bandpass. A 1°–5° resolution sky map complete in right ascension and covering 20° in declination is obtained each day at these frequencies. The observations presented here correspond to the first months of operation, which have provided a map of 9000 deg[sup 2] on the sky centred at Dec.=+31° with sensitivities of 140, 150 and 250 μK per beam area in the channels at 13, 15 and 17 GHz, respectively. We discuss the design and performance of the instrument, the atmospheric effects, the reliability of the data obtained and prospects of achieving a sensitivity of 30 μK per beam in 2 years of operation. [ABSTRACT FROM AUTHOR]

Objective: Leukocytes arriving to choriodecidua during labor are capable to secrete cytokines and collagenases that may play a role in extracellular matrix degradation leading to the rupture of amniochorion. The aim of this work was to study the role of amniochorion in the active recruitment of leukocytes through production of specific chemokines during labor. Methods: Amniochorion explants were obtained from women at term with spontaneous labor ( n = 4) and subjected to cesarean section without labor ( n = 4). Explant cultures were carried out during 24 hr and a homogenate including the culture media was made after this period. Cell free extracts were tested in Boyden chambers for chemotaxis using leukocytes from maternal blood obtained from women with ( n = 2) and without labor ( n = 2). Attracted cells were analyzed by flow cytometry for count and immunophenotype. Chemokines were identified in the extracts using a commercial chemiarray. Results: All tested amniochorion extracts induced chemotaxis for leukocytes; however, those from labor tissues induced a higher chemotactic activity than the correspondent non-in-labor tissues ( P = 0.003). Chemotactic effect was higher over leukocytes from labor women ( P = 0.001). More than 80% of the attracted cells were polymorphonuclear cells in all cases. IL-8 was the main chemokine found in all extracts; however its concentration was increased in extracts from labor. Conclusions: Fetal membranes induced chemotaxis for leukocytes and this condition is enhanced by the presence of labor. Amniochorion under active labor secretes IL-8 which induces a preferential chemotaxis for polymorphonuclears. Infiltration of these cells in choriodecidua during labor may play a role in the amniochorion degradation associated to rupture. [ABSTRACT FROM AUTHOR]

The objective was to understand treatment patterns and persistence, and associated costs among type 2 diabetes (T2DM) patients starting glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in routine clinical practice in Spain. T2DM patients >=18 years initiating a new treatment with the most widely used GLP-1 RAs, either once-weekly exenatide-QW, once-weekly dulaglutide, or once-daily liraglutide (index therapy) between 01/11/2015 and 30/06/2017 (index date) were included. The proportion of patients persistent at one year was highest among dulaglutide patients and lowest among exenatide-QW patients. [Extracted from the article]