Search

Background To assess mortality rate (MR) and standardized mortality rate (SMR) of rheumatoid arthritis-related interstitial lung disease (RA-ILD) patients and to evaluate the role of radiographic patterns in mortality. Methods A longitudinal multicentric study was conducted in RA-ILD patients from 2005 to 2015 and followed-up until October 2018 in Madrid. Patients were included in the Neumologia-Reumatología y Enfermedades Autoinmunes Registry, from diagnosis of ILD. The main outcome was all-cause mortality. The radiographic pattern at baseline [usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), or others] was the independent variable. Covariables included sociodemographic and clinical data. Survival techniques were used to estimate MR, expressed per 1000 persons-year with their 95% confidence intervals [CI]. Cox multiple regression model was run to examine the influence of radiographic patterns on survival. SMR [CI] was calculated comparing MR obtained with MR expected in the general population of Madrid by indirect age-gender standardization. Results 47 patients were included with a follow-up 242 patients-year. There were 16 (34%) deaths, and most frequent causes were acute ILD exacerbation and pneumonia. MR was 64.3 [39.4–104.9], and 50% of the patients died at 8.3 years from ILD diagnosis. After adjusting for confounders, (UIP compared to NSIP was associated with higher mortality risk. The overall SMR was 2.57 [1.4–4.17]. Women of 60–75 years of age were the group with the highest SMR. Conclusions RA-ILD is associated with an excess of mortality compared to general population. Our results support that UIP increases the risk of mortality in RA-ILD, regardless other factors.

ObjectivesTo describe patients with autoimmune inflammatory rheumatic diseases (AIRD) who had COVID-19 disease; to compare patients who required hospital admission with those who did not and assess risk factors for hospital admission related to COVID-19.MethodsAn observational longitudinal study was conducted during the pandemic peak of severe acute respiratory syndrome coronavirus 2 (1 March 2020 to 24 April). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid, Spain with a medical diagnosis of AIRD and with symptomatic COVID-19 were included. The main outcome was hospital admission related to COVID-19. The covariates were sociodemographic, clinical and treatments. We ran a multivariable logistic regression model to assess risk factors for the hospital admission.ResultsThe study population included 123 patients with AIRD and COVID-19. Of these, 54 patients required hospital admission related to COVID-19. The mean age on admission was 69.7 (15.7) years, and the median time from onset of symptoms to hospital admission was 5 (3–10) days. The median length of stay was 9 (6–14) days. A total of 12 patients died (22%) during admission. Compared with outpatients, the factors independently associated with hospital admission were older age (OR: 1.08; p=0.00) and autoimmune systemic condition (vs chronic inflammatory arthritis) (OR: 3.55; p=0.01). No statistically significant findings for exposure to disease-modifying antirheumatic drugs were found in the final model.ConclusionOur results suggest that age and having a systemic autoimmune condition increased the risk of hospital admission, whereas disease-modifying antirheumatic drugs were not associated with hospital admission.

The empty substrate-integrated waveguide (SIW) (ESIW) is an evolution of the SIW. Just as the SIW, the ESIW is of low cost and low profile, and can be integrated into a printed circuit board, but the losses in the ESIW are lower than in those in the SIW thanks to the removal of the dielectric material, which results in ESIW devices with performances close to those implemented with standard rectangular waveguides. In order to increase the operational (monomode) bandwidth of the rectangular waveguides, a metal ridge can be inserted (leading to the ridge waveguide). Extrapolating this idea to the ESIW, in this letter, a study of possible ridge ESIW (RESIW) geometries has been performed, and a novel transition from microstrip line to RESIW is proposed. In order to validate the performance of transition, a back-to-back prototype has been manufactured and measured.

ObjectivesTo asses the clinical course in RA-related interstitial lung disease (RA-ILD) patients with and without rituximab (RTX). The influence of other variables was also evaluated.MethodsA longitudinal multicentre study was conducted in RA diagnosed with ILD from 2007 until 2018 in Madrid. Patients were included in a registry [pNEumology RhEumatology Autoinmune diseases (NEREA)] from the time of ILD diagnosis. The main endpoint was functional respiratory impairment (FI), when there was a decline ≥5% in the predicted forced vital capacity compared with the previous one. Pulmonary function was measured at baseline and in follow-up visits every 6–12 months. The independent variable was therapy with RTX. Covariables included sociodemographic, clinical, radiological and other therapies. Survival techniques were used to estimate the incidence rate (IR) and 95% CI of functional impairment, expressed per 100 patient-semesters. Cox multivariate regression models were run to examine the influence of RTX and other covariates on FI. Results were expressed as the hazard ratio (HR) and CI.ResultsA total of 68 patients were included. FI occurred in 42 patients [IR 23.5 (95% CI 19, 29.1)] and 50% of them had FI within 1.75 years of an ILD diagnosis. A multivariate analysis showed that RTX exposure resulted in a lower risk of FI compared with non-exposure [HR 0.51 (95% CI 0.31, 0.85)]. Interstitial pneumonia, glucocorticoids, disease activity and duration also influenced FI.ConclusionRA-ILD patients deteriorate over time, with the median time free of impairment being

Substrate Integrated (SI) technologies, either completely or partially filled with dielectric, as well as completely empty (i.e. without any dielectric material), have been object of intense research in the last years. Their performance in terms of losses, cost and size are mid-way between those of classical planar lines and rectangular waveguides. Many communication devices have already been successfully designed, manufactured and measured in all these SI technologies. But these measurements are mostly done at room temperature under atmospheric pressure conditions. However, the good results (in terms of low loss, profile and cost) of these novel technologies, especially the completely empty versions, close to the performance of the rectangular waveguide, make them a very good alternative for being used in small satellite payloads. Up to now, few attention has been given to the thermal analysis of these SI technologies, still missing a complete comparative study of these effects under both, atmospheric pressure and vacuum conditions. In this work the same filter is implemented on four different SI technologies (including completely and partially filled with dielectric, as well as empty -no dielectric- versions). The four filters are designed, manufactured, and measured at different temperatures according to the thermal testing standards for space applications. The thermal study is performed under atmospheric pressure conditions and, for the first time, under high vacuum conditions. Finally, a comparison with all previous available thermal studies (all of them performed at atmospheric pressure levels) is included.

Resumen: En atención primaria solo el dolor crónico supera a la depresión y la ansiedad en la pérdida de años de vida ajustados por calidad. Más del 70% de las personas que sufrían enfermedades mentales comunes consultaron por ello a su médico/a de familia. Sin embargo, «la regla de las mitades decrecientes» es una realidad: menos del 50% de las personas consultantes de atención primaria con enfermedades mentales comunes fueron diagnosticadas correctamente, y de ellas, menos del 50% recibieron un tratamiento (farmacológico o psicológico) adecuado, y de estas, menos del 50% fueron adherentes. Los modelos colaborativos de atención a las enfermedades mentales comunes en atención primaria han demostrado su efectividad en ensayos clínicos, pero su implementación en un contexto más general y real es difícil y su efectividad todavía es poco conocida. Se han desarrollado y validado algoritmos de riesgo para predecir el inicio y el pronóstico de las enfermedades mentales comunes en atención primaria que son útiles para su tratamiento y prevención. Existen evidencias de que las intervenciones psicológicas, psicoeducativas y de ejercicio físico son efectivas en prevención primaria, incluso en atención primaria, aunque su efecto es pequeño o moderado. Estas intervenciones tienen un gran potencial para ser escalables en las escuelas, el ámbito laboral y la atención primaria; además, cuando se administran mediante tecnologías de la información y la comunicación (p. ej., App), en programas autoguiados o mínimamente guiados, han demostrado su efectividad para el tratamiento y la prevención de las enfermedades mentales comunes. También son muy accesibles y de bajo coste, y contribuyen a la implementación masiva de estas intervenciones en diferentes contextos. Abstract: In primary health care only chronic pain surpass depression and anxiety in loss of quality-adjusted life years. More than 70% of people suffering from common mental disorders consulted their GPs for this reason. However, ‘the declining halves rule’ is a reality: less than 50% of primary care attendees with common mental disorders were correctly diagnosed, of these less than 50% received adequate treatment (pharmacological or psychological) and of these less than 50% patients were adherent. Collaborative models of common mental disorders care in primary health care have demonstrated their effectiveness through clinical trials; however, its implementation in a more general and real context is difficult and its effectiveness remains unclear. Risk algorithms have been developed and validated in primary health care to predict the onset and prognosis of common mental disorders; which are useful for their treatment and prevention. There is evidence that psychological and psychoeducational interventions (and possibly those of physical exercise) are effective for the primary prevention of common mental disorders, even in primary health care; although their effects are small or moderate. These interventions have a high potential to be scalable in schools, workplace and primary health care; in addition, when they are administered through information and communication technologies (e.g. by App), in self-guided or minimally guided programs, they have demonstrated their effectiveness for the treatment and prevention of common mental disorders. They are also very accessible, have low cost and contribute to the massive implementation of these interventions in different settings.

The automotive industry is undergoing major transformation, with the emergence of vehicular networks, intelligent transportation systems, and autonomous cars over the last decade. These technologies are made possible by recent advances of software, hardware, and communication systems, along with the development of various applications and standards. Today, new technologies are incorporated into cars that detect potential road hazards and improve the driving experience. There are three key components being integrated into cars: sensors, information systems, and communication technologies to create connected vehicle networks. Vehicle-to-vehicle (V2V) communication is being used in connected networks to reduce traffic congestion, improve passengers’ safety, and enable the efficient management of vehicles on roads. Here, we present recent research developments and current trends in V2V communications. We discuss architectural issues and wireless technologies that support V2V. We also present recently proposed security solutions for V2V. Finally, we discuss outstanding challenges for enabling the deployment and adoption of V2V technology.

Guarantees for traffic traversing the public Internet are hard to come by, as service-level agreements are typically only available for traffic within a single autonomous system or towards direct neighbors. This deficiency leads to unpredictable performance already under normal conditions and can cause outages in the face of networklevel distributed-denial-of-service (DDoS) attacks. In this paper, we present an architecture achieving guaranteed bandwidth properties for global inter-domain network traffic. The control plane of our architecture is based on a distributed server infrastructure, while the data plane enables efficient packet forwarding on per-flow stateless routers. Our implementation demonstrates the technical feasibility and scalability of the design.

Urban analysis at different spatial scales (micro- and mesoscale) of local climate conditions is required to test typical artificial urban boundaries and related climate hazards such as high temperatures in built environments. The multitude of finishing materials and sheltering objects within built environments produce distinct patterns of different climate conditions, particularly during the daytime. The combination of high temperatures and intense solar radiation strongly perturb the environment by increasing the thermal heat stress at the pedestrian level. Therefore, it is becoming common practice to use numerical models and tools that enable multiple design and planning alternatives to be quantitatively and qualitatively tested to inform urban planners and decision-makers. These models and tools can be used to compare the relationships between the micro-climatic environment, the subjective thermal assessment, and the social behaviour, which can reveal the attractiveness and effectiveness of new urban spaces and lead to more sustainable and liveable public spaces. This review article presents the applications of selected environmental numerical models and tools to predict human thermal stress at the mesoscale (e.g., satellite thermal images and UrbClim) and the microscale (e.g., mobile measurements, ENVI-met, and UrbClim HR) focusing on case study cities in mid-latitude climate regions framed in two European research projects. The work leading to these results has received funding from the European Community’s Seventh Framework Programme under Grant Agreement No. 308497, Project RAMSES—Reconciling Adaptation, Mitigation, and Sustainable Development for Cities (2012–2017) and from the European Union’s H2020 Research and Innovation Programme under Grant Agreement No. 73004 (PUCS/Climate-fit.city). The APC was funded by the Research Group of Building and Technology, De partment of Civil and Environmental Engineering, Norwegian University of Science and Technology

The 2021 sales volume in the market of service robots is attractive. Expert reports from the International Federation of Robotics confirm 27 billion USD in total market share. Moreover, the number of new startups with the denomination of service robots nowadays constitutes 29% of the total amount of robotic companies recorded in the United States. Those data, among other similar figures, remark the need for formal development in the service robots area, including knowledge transfer and literature reviews. Furthermore, the COVID-19 spread accelerated business units and some research groups to invest time and effort into the field of service robotics. Therefore, this research work intends to contribute to the formalization of service robots as an area of robotics, presenting a systematic review of scientific literature. First, a definition of service robots according to fundamental ontology is provided, followed by a detailed review covering technological applications; state-of-the-art, commercial technology; and application cases indexed on the consulted databases.

This article shows the result of the research carried out during the 2020/21 academic year, in the subject of Information Security, taught in Higher Education, in the fourth year of the Degree in Telematics Engineering in Telecommunications and also in the Degree in Computer Engineering in Information Technology, at the University Center of Merida of the University of Extremadura. The motivation of the research was to monitor the teaching, in a non-invasive way that helps in the teaching / learning process, while the students do not feel that they are being evaluated, minimizing the stress produced by the exams, and trying to automate the learning assessment process so that the teacher has a quick and easy-to-use tool that provides information on the evolution of the students' mental structure, online. The bases of the study that we present are different investigations on pathfinder associative networks and nuclear concepts. The research process developed in several stages. The first step consisted in obtaining the prior knowledge of the students with the help of software created for this purpose. With the data obtained, the associative pathfinder networks of each student were created to know their mental structure. Data were collected at various moments of the teaching course, to verify the evolution of the teaching-learning process and through associative pathfinder networks, the mental structures of the students were graphically represented, being able to observe the evolution of learning during the teaching period.

Introduction: Rheumatic and musculoskeletal diseases (RMDs) have a significant impact on patients’ health-related quality of life (HRQoL) exacerbating disability, reducing independence and work capacity, among others. Predictors’ identification affecting HRQoL could help to place efforts that minimize the deleterious impact of these conditions on patients’ wellbeing. This study evaluates the influence of demographic and clinical predictors on the HRQoL of a cohort of RMD patients, measured using the Rosser classification index (RCI). Methods: We included patients attending the Hospital Clínico San Carlos (HCSC) rheumatology outpatient clinic from 1 April 2007 to 30 November 2017. The primary outcome was the HRQoL assessed in each of the patient’s visits using the RCI. Demographic and clinical variables extracted from a departmental electronic health record (EHR) were used as predictors: RMD diagnoses, treatments, comorbidities, and averaged HRQoL values from previous periods (for this last variable, values were imputed if no information was available). Association between predictors and HRQoL was analyzed using penalized generalized estimating equations (PGEEs). To account for imputation bias, the PGEE model was repeated excluding averaged HRQoL predictors, and common predictors were considered. Discussion: A total of 18,187 outpatients with 95,960 visits were included. From 410 initial predictors, 19 were independently associated with patients’ HRQoL in both PGEE models. Chronic kidney disease (CKD), an episode of prescription of third level analgesics, monoarthritis, and fibromyalgia diagnoses were associated with worse HRQoL. Conversely, the prescription in the previous visit of acid-lowering medication, colchicine, and third level analgesics was associated with better HRQoL. Conclusion: We have identified several diagnoses, treatments, and comorbidities independently associated with HRQoL in a cohort of outpatients attending a rheumatology clinic.

Background: Mesenchymal stem cells (MSCs) are a promising treatment of different musculoskeletal diseases including osteoarthritis and rheumatoid arthritis (RA). Results from different approaches in this treatment have been not conclusive. Aim: To analyze factors related to interactions between peripheral blood mononuclear cells (PBMCs) and MSCs and the influence of cellular activation. Materials & methods: PBMCs from RA patients and healthy controls (HC) were obtained. MSCs from bone marrow (BM-MSCs) were obtained from six donors. CD4, CD25, CD69 and CD127 expression was measured by flow cytometry. Repeated measures analysis of variance (ANOVA) models were performed using activation, co-culture with BM-MSCs and time of culture (24 h, 72 h, 6 days) as within-subject variables. Results: PBMCs activated and co-cultured with BM-MSCs showed a lower proportion of CD25-positive and CD25high/CD127low-negative cells in both RA and HC. Additionally, a maintained expression of CD69 was also observed in RA and HC when PBMCs were activated and co-cultured with BM-MSCs. Conclusion: Both PBMC activation grade and RA disease activity influence the immunomodulatory effect of BM-MSCs on T-cell activation.

At the beginning of the 21st century, increasing amount of greenery in urban areas has been a priority for many urban planners following a social and environmental demand of the population. Many sustainability benefits can be attributed to urban green infrastructures. In this study we focus on analyzing the impact of vertical green systems (VGSs) on outdoor climate variables and thermal comfort by means of modelling techniques (ENVI-met v.4.3). The study is carried out in a courtyard surrounded by high-rise buildings in the hot and humid tropical climate of Singapore. Results show that weather conditions have a significant influence on the outdoor thermal performance of VGSs. Thermal comfort perception can be reduced by one category (e.g. from hot to warm) close to the facade depending on the geographic orientation of the VGS. Finally, this study shows that thermal benefits for pedestrians are provided mainly by the lowest meters of the VGS. Green elements above 6 meters in the facade reduce significantly the impact at pedestrian level. Results provide an insight to the implementation and dimensions of VGSs as urban infrastructure to improve the outdoor thermal environment, particularly in the tropical urban environment.

Noble metals such as Au, Ag, and Cu supported over semiconducting ZnO are well-known heterogeneous oxidation catalysts. All of them have been utilized for the oxidation of diesel soot with varied success. However, Au-supported ZnO is seen to be superior among them. Here, we present a comparative study of all these three catalysts for diesel soot oxidation to explain why Au/ZnO is the best among them, demonstrating the contribution of electronic states of metals in composite catalysts. The electronic states of Cu, Ag, and Au determined by X-ray photoelectron spectroscopy on 1 wt % Cu/ZnO, 1 wt % Ag/ZnO, and 1 wt % Au/ZnO catalysts were correlated with their diesel soot oxidation activities. Although all three catalysts present reasonable diesel soot oxidation activities at relatively low temperature, 1% Cu/ZnO and 1% Ag/ZnO oxidize only about 60% of the deposited diesel soot around 250 °C and 1% Au/ZnO oxidizes 100% of the deposited diesel soot, at a temperature as low as 230 °C. The activity of the catalysts is attributed to the formation of stable M0–Mδ+ bifunctional catalytic sites at the metal–ZnO interface, which enhances the contact efficiency of solid diesel soot on Mδ+ and generates the superoxide species on M0 moieties. The stability of the bifunctional M0–Mδ+ sites is controlled by the electronic interactions between the metal (M) and n-type semiconductor ZnO at their interface. Very high activity of 1% Au/ZnO is attributed to the presence of Au3+ at the catalyst surface, which generates a stronger Coulombic force with diesel soot electrons. We demonstrate a direct relation between the diesel soot oxidation activity of these three metals and their electronic states at the catalyst surface.

Aims: To analyze the association between colchicine prescription and COVID-19-related hospital admissions in patients with rheumatic and musculoskeletal diseases (RMDs). Methods: Patients attending a rheumatology outpatient clinic from a tertiary care center in Madrid, Spain, from 1 September 2019 to 29 February 2020 were included. Patients were assigned as exposed or unexposed based on whether they were prescribed with colchicine in their last visit to the clinic during the 6 months before the start of the observation period. Treatment changes during the observation period were also considered. The primary outcome was COVID-19-related hospital admissions between 1 March and 20 May 2020. Secondary outcome included COVID-19-related mortality. Several weighting techniques for data balancing, based and non-based on the propensity score, followed by Cox regressions were performed to estimate the association of colchicine prescription on both outcomes. Discussion: The number of patients entered in the study was 9379, with 406 and 9002 exposed and unexposed follow-up periods, respectively. Generalized Boosted Models (GBMs) and Empirical Balancing Calibration Weighting (EBCW) methods showed the best balance for COVID-19-related hospital admissions. Colchicine prescription did not show a statistically significant association after covariable balancing ( p-value = 0.195 and 0.059 for GBM and EBCW, respectively). Regarding mortality, the low number of events prevented a success variable balancing and analysis. Conclusion: Colchicine prescription does not play a significant protective or risk role in RMD patients regarding COVID-19-related hospital admissions. Our observations could support the maintenance of colchicine prescription in those patients already being treated, as it is not associated with a worse prognosis. Plain language title: Colchicine influence in COVID-19-related hospital admissions

[EN] Hot air drying (HAD) at temperatures below the spontaneous evaporation temperature could be combined with microwave (MW) radiation as a thermal energy source in order to reduce the drying time. A photon flux in the microwave range interacts with dipolar molecules (water) through orientation and induction, producing electrical energy storage and thermal energy accumulation and generating an increase in the internal energy of food. The different mechanisms involved in water transport could change when the microwave penetration depth exceeds the sample characteristic dimension of mass transport. The aim of this paper is to determine the effect of MW in the combined HAD-MW drying of raw potato in order to obtain the real driving forces and mechanisms involved in the water transport, with the purpose of optimizing the MW power used. For this purpose, combined drying was carried out on potato samples (0, 4 and 6 W/g). The sample surface temperature was monitored by infrared thermography, and the sample mass was measured continuously through a precision balance. In parallel with continuous drying, another drying treatment was performed at different times (20, 40, 60, 90, 120, 180, 420 min) and conditions (0, 4 and 6 W/g) to analyze the dielectric properties, mass, moisture, volume and water activity. The results show that it is possible to monitor combined drying by infrared thermography, and it can be concluded that the convection heating is mostly transformed into surface water evaporation, with negligible thermal conduction from the surface, and microwave radiation is mostly transformed into an increase in the potato's internal energy., The authors acknowledge the financial support from THE SPANISH MINISTERIO DE ECONOMÍA, INDUSTRIA Y COMPETITIVIDAD, Programa Estatal de I+D+i orientada a los Retos de la Sociedad AGL2016-80643-R, Agencia Estatal de Investigación (AEI) and Fondo Europeo de Desarrollo Regional (FEDER). Juan Ángel Tomás-Egea wants to thank the FPI Predoctoral Program of the Universitat Politècnica de València for its support.

Aims: In this pandemic, it is essential for rheumatologists and patients to know the relationship between COVID-19 and inflammatory rheumatic diseases (IRDs). We wanted to assess the role of targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARDs) and other variables in the development of moderate-severe COVID-19 disease in IRD. Methods: An observational longitudinal study was conducted during the epidemic peak in Madrid (1 March to 15 April 2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid with a medical diagnosis of IRD were included. Main outcome: hospital admission related to COVID-19. Independent variable: ts/bDMARDs. Covariates: sociodemographic, comorbidities, type of IRD diagnosis, glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Incidence rate (IR) of hospital admission related to COVID-19 was expressed per 1000 patient-months. Cox multiple regression analysis was run to examine the influence of ts/bDMARDs and other covariates on IR of hospital admission related to COVID-19. Results: A total of 3951 IRD patients were included (5896 patient-months). Methotrexate was the csDMARD most used. Eight hundred and two patients were on ts/bDMARDs, mainly anti-TNF agents, and Rtx. Hospital admissions related to COVID-19 occurred in 54 patients (1.36%) with an IR of 9.15 (95% confidence interval: 7–11.9). In the multivariate analysis, older, male, comorbidities, and specific systemic autoimmune conditions (Sjögren, polychondritis, Raynaud, and mixed connective tissue disease) had more risk of hospital admissions. Exposition to ts/bDMARDs did not achieve statistical significance. Use of glucocorticoids, NSAIDs, and csDMARDs dropped from the final model. Conclusion: This study provides additional evidence in IRD patients regarding susceptibility to moderate–severe infection related to COVID-19.

Hidradenitis suppurativa (HS) is a chronic, recurrent and debilitating inflammatory skin disease of the hair follicle that usually presents as painful, deep-seated inflamed lesions in the apocrine gland-bearing areas of the body. HS patients suffer from uncomfortable signs and symptoms, such as pain, pruritus, malodour and suppuration, which may impair patients’ quality of life (QoL). Although HS patients frequently experience these signs and symptoms, they are only occasionally assessed by clinicians and, unexpectedly, the scientific evidence available is limited and heterogeneous. The aim of this study is to summarize the evidence regarding the impact of HS signs and symptoms on QoL to serve as a basis for future research and help clinicians to consider them in the daily care of HS patients. A systematic review and meta-analysis were conducted following PRISMA Guidelines. The following search algorithm was used: (hidradenitis or “acne inversa”) and (pain or itch or odour or malodour or suppuration or oozing or drainage) and (“quality of life”). The literature search identified 836 references, 17 of them met the eligible criteria and were included for analysis, representing 4929 HS patients. Mean age of the participants was 36.28 years and there was a predominance of female sex among study participants. The BMI of the population was in the range of over-weight and about two out five patients were active smokers. Studies included patients with mild to moderate HS, with a mean disease duration of 13.69 years. The HS signs and symptoms assessed were pain, pruritus, malodour and suppuration. Overall, the higher intensity of a sign or symptom correlated with poorer general QoL or specific QoL dimensions including sexual distress, anxiety, depression and sleep. The most frequently employed tool to assess QoL was the Dermatology Life Quality Index (DLQI). DLQI was used in 52.9% of the studies (9/17) with a mean value of 10.70 (2.16 SD). The scores employed to assess signs and symptoms severity were subjective and varied between studies, being the numerical rating scale (NRS) for each of the most used symptoms. The mean NRS value for pain was 3.99 and the mean NRS for pruritus was 4.99. In conclusion, we have summarized, categorized and analyzed the scientific evidence regarding signs and symptoms in HS patients and their impairment in QoL. Their assessment should be thorough and included during routine evaluation of HS patients to motivate therapeutic modifications and increase patients’ health.

On Mar. 19, 2020, Argentina’s government decided to close academic institutions for an indefinite time in an attempt to contain the spread of the COVID-19 pandemic. Since the University established that, when the quarantine ends, 5 weeks will be reserved for face-to-face activities that could not be carried out virtually (laboratory lessons and final exams), the main focus on the online activities was in the theoretical lessons. For the Instrumental Analytical Chemistry course both synchronous strategy such as questions and answer sessions and asynchronous communication such as Microsoft PowerPoint presentations with explicative audios, simulated assays, and assignments were adopted. A survey conducted with our students indicated that although synchronous lessons provided face-to-face interaction, the lack of good Internet connectivity was the main weakness of this strategy. On the other hand, asynchronous lessons did not require very high bandwidth networks and had the possibility of stopping the lesson and continuing it later. However, students’ lack of interaction with their teachers was the main drawback of this type of communication. Most of the students pointed out that a blend of synchronous and asynchronous communication is more desirable for Instrumental Analytical Chemistry lessons than asynchronous or synchronous communication separately. Fil: Villanueva, María Emilia. Universidad Nacional de Luján; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Metabolismo del Fármaco. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Metabolismo del Fármaco; Argentina Fil: Camilli, Emiliano. Universidad Nacional de Luján; Argentina Fil: Chirillano, Ana Clara. Universidad Nacional de Luján; Argentina Fil: Cufré, Juan Angel. Universidad Nacional de Luján; Argentina Fil: de Landeta, María Cristina. Universidad Nacional de Luján; Argentina Fil: Rigacci, Laura Natalia. Universidad Nacional de Luján; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Velazco, Viviana Miriam. Universidad Nacional de Luján; Argentina Fil: Pighin, Andrés Fabián. Universidad Nacional de Luján; Argentina

Background: In this pandemia, it is essential for rheumatologist and patients to know the relationship between COVID-19 and inflammatory rheumatic diseases (IRD). We want to assess the role of targeted synthetic or biologic disease modifying antirheumatic drugs (ts/bDMARDs) and other variables in the development of moderate-severe COVID-19 disease in IRD. Methods: An observational longitudinal study was conducted (1stMar to 15thApr 2020). All patients from the rheumatology outpatient clinic from a hospital in Madrid with a medical diagnosis of IRD were included. Main outcome: hospital admission related to COVID-19. Independent variable: ts/bDMARDs. Covariates: sociodemographic, comorbidities, type of IRD diagnosis, glucocorticoids, NSAIDs and conventional synthetic DMARDs (csDMARDs). Incidence rate (IR) of hospital admission related to COVID-19, was expressed per 1,000 patients-month. Cox multivariate regression analysis was run to examine the influence of ts/bDMARDs and other covariates on IR. Results: 3,591 IRD patients were included (5,896 patients-month). Concerning csDMARDs, methotrexate was the most used followed by antimalarials. 802 patients were on ts/bDMARDs, mainly anti-TNF agents, and rituximab. Hospital admissions related to COVID-19 occurred in 54 patients (1.36%) with an IR of 9.15 [95%CI: 7-11.9]. In the multivariate analysis, older, male gender, presence of comorbidities and specific systemic autoimmune conditions (Sjoegren, polychondritis, Raynaud and mixed connective tissue disease) had more risk of hospital admissions regardless other factors. Exposition to ts/bDMARDs did not achieve statistical signification. Use of glucocorticoids, NSAIDs, and csDMARDs dropped from the final model. Conclusion: This study provides additional evidence in IRD patients regarding susceptibility to moderate-severe infection related to COVID-19.

OBJECTIVES: To describe patients with inflammatory rheumatic diseases (IRD) who had COVID-19; to compare patients who need hospital admission versus those that did not and assess risk factors of hospital admission related to COVID-19. METHODS: We performed a prospective observational study, from 1st March 2020 until the 24th of April. All patients being attended at the rheumatology outpatient clinic of a tertiary hospital of Madrid, with medical diagnosis of inflammatory rheumatic disease, and with symptomatic COVID-19 disease were included. Main variable was the hospital admission related to COVID-19. Covariates: sociodemographic, clinical and treatments. We performed a multivariate logistic regression model to assess risk factors of hospital admission. RESULTS: 123 patients with IRD and COVID-19 disease were identified and included. We found 54 patients that need hospital admission, 59.2% were women, with a mean age at hospital admission of 69.7 (15.7) years, and a median lag time from symptoms onset to hospital admission of 5 (3-10) days. The median length of stay was 9 (6-14) days. A total of 12 patients died (22%) during their hospital admission. Factors independently associated with hospital admission were being older (OR 1.08; p=0.00), and type of diagnosis (OR 3.55; p=0.01), compared to those who were ambulatory. DMARDs dropped from the model. Male sex, associated comorbidities and glucocorticoids use showed a tendency risk (p

We developed and independently validated a rheumatoid arthritis (RA) mortality prediction model using the machine learning method Random Survival Forests (RSF). Two independent cohorts from Madrid (Spain) were used: the Hospital Clínico San Carlos RA Cohort (HCSC-RAC; training; 1,461 patients), and the Hospital Universitario de La Princesa Early Arthritis Register Longitudinal study (PEARL; validation; 280 patients). Demographic and clinical-related variables collected during the first two years after disease diagnosis were used. 148 and 21 patients from HCSC-RAC and PEARL died during a median follow-up time of 4.3 and 5.0 years, respectively. Age at diagnosis, median erythrocyte sedimentation rate, and number of hospital admissions showed the higher predictive capacity. Prediction errors in the training and validation cohorts were 0.187 and 0.233, respectively. A survival tree identified five mortality risk groups using the predicted ensemble mortality. After 1 and 7 years of follow-up, time-dependent specificity and sensitivity in the validation cohort were 0.79–0.80 and 0.43–0.48, respectively, using the cut-off value dividing the two lower risk categories. Calibration curves showed overestimation of the mortality risk in the validation cohort. In conclusion, we were able to develop a clinical prediction model for RA mortality using RSF, providing evidence for further work on external validation.

Network testbeds have empowered networking research and facilitated scientific progress. However, current testbeds focus mainly on experiments involving the current Internet. In this paper, we propose SCIONLAB, a novel global network testbed that enables exciting research opportunities and experimentation with the SCION next-generation Internet architecture. New users can join SCIONLAB as a full-fledged autonomous system with minimal effort and administrative overhead, and directly gain unfettered access to its inter-domain routing system. Based on a well-connected network topology consisting of globally distributed nodes, SCIONLAB enables new experiments, such as inter-domain multipath communication, path-aware networking, exploration of novel routing policies, and new approaches for DDoS defense. SCIONLAB has been operational since 2016 and has supported diverse research projects. We describe the design and implementation of SCIONLAB, and present use cases that illustrate exciting research opportunities., 2020 IEEE 28th International Conference on Network Protocols (ICNP), ISBN:978-1-7281-6992-7, ISBN:978-1-7281-6993-4

Background: This research describes the incidence and factors associated with opportunistic infections in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs). Methods: A retrospective longitudinal study was carried out from 2007 to 2018. We included RA patients treated with a tumor necrosis factor (TNF)-targeted bDMARD or non-TNF-targeted bDMARD from the start of bDMARDs. An independent variable was the development of an indicator of opportunistic infection after biological (IOIb) treatment. Secondary variables included sociodemographic, clinical, and treatments. We used survival techniques to estimate the incidence of IOIb, per 1000 patient-years (95% CI). We performed a Cox multivariate regression analysis model to compare the risk of IOIb. Results were expressed as a hazard ratio (HR). Results: A total of 441 RA patients were included, that started 761 different courses of bDMARDs. A total of 81% were women with a mean age at first bDMARD of 57.3 ± 14 years. A total of 71.3% of the courses were TNF-targeted bDMARDs and 28.7% were non-TNF-targeted bDMARDs. There were 37 IOIb (25 viral, 6 fungal, 5 bacterial, 1 parasitic). Nine of these required hospitalization and one died. The global incidence of IOIb was 23.2 (16.8–32). TNF-targeted bDMARDs had 25 IOIb, incidence 20.5 (13.9–30.4), and non-TNF-targeted bDMARDs had 12 IOIb, incidence 31.7 (18–55.9). In the multivariate analysis, glucocorticosteroids (HR 2.17, p = 0.004) and lower lymphocyte count increased the risk for IOIb (HR 0.99, p = 0.005). Conclusions: The incidence of IOIb due to bDMARDs was 23 cases per 1000 patient-years. Close monitoring should be taken in the RA patients treated with bDMARDs and glucocorticosteroids, mainly in elderly patients and those with a low total lymphocyte count at the beginning of bDMARD treatment.

La aldea de Cedeño es altamente vulnerable al embate de los fenómenos hidro meteorológicos que periódicamente ocurren en sus playas (Marejadas), a esto se le debe sumar los efectos que producirá el cambio climático. Todo lo anterior ocasionara daños irreversibles como retroceso de la línea de costa, inundaciones debido al aumento del océano, perdida de humedales, intrusión de agua salina, y desplazamiento de personas. Los impactos negativos en el sistema territorial y por ende en la calidad de vida de sus pobladores serán grandes. El objetivo general, consistió en elaborar una línea base sobre los patrones de variabilidad de la costa de la Aldea de Cedeño (tasas de erosión/acreción), además de la cartografía de amenazas ante fenómenos naturales (Mapas de inundación marejadas/ inundación ante el ascenso del mar), que sirva de apoyo para proponer políticas de planificación y gestión del territorio adecuadas. La metodología empleada se basó en análisis geoespacial, usando herramientas de sistemas de información geográfica, teledetección, participación ciudadana y herramientas estadísticas. Los resultados evidenciaron un comportamiento erosivo en las playas de la aldea de Cedeño, así como también una gran área vulnerable a inundación ante las marejadas y escenarios de ascenso del nivel del mar.

Objective To analyze the resource utilization in rheumatoid arthritis (RA) patients and predictive factors in and patients treated with biological drugs and biologic-naive. Methods A cross-sectional study was performed in a sample including all regions and hospitals throughout the country. Sociodemographic data, disease activity parameters and treatment data were obtained. Resource utilization for two years of study was recorded and we made costs imputation. Correlation analyzes were performed on all RA patients and those treated with biological and biological naive, to estimate the differences in resource utilization. Factors associated with increased resources utilization (costs) attending to treatment was analyzed by linear regression models. Results We included 1.095 RA patients, 26% male, mean age of 62 ± 14 years. Mean of direct medical costs per patient was €24,291 ± €45,382. Excluding biological drugs, the average cost per patient was €3742 ± €3711. After adjustment, factors associated with direct medical costs for all RA patients were biologic drugs (P = .02) and disease activity (P = .004). In the biologic-naive group, the predictor of direct medical costs was comorbidity (P Conclusion Our data show a remarkable economic impact of RA. It is important to identify and estimate the economic impact of the disease, compare data from other geographic samples and to develop improvement strategies to reduce these costs and increase the quality of care.

The health of the global population has undergone rapid transformation. Life expectancy and chronic conditions are increasing, and persons aged 65 years or older have become the fastest growing segment of population. The worldwide picture of disease burden is increasingly defined by disability instead of premature mortality. Population growth, ageing and sedentary lifestyles, particularly in developing countries, will result in a crisis for the population health that requires a multi-system response. The growing awareness of the diseases burden increases the need for accurate measurement and assessment of the burden and measurement of the impact of any public health action. Musculoskeletal (MSK) diseases are increasingly recognised as a major and important group of diseases, which requires more attention from society and health care systems. The epidemiological evidence confirms the dramatic increase in the majority of MSK disorders with age, a phenomenon that is occurring in all parts of the world, particularly among females. There is a necessity to ensure global health policies to recognise the importance of disability burden for overall health, well-being and economic prosperity for the individual and society. It is important to promote a common goal between public health, primary care, specialised health and social services to reduce disability; to encourage health programs or models of care addressing chronic conditions, including the importance of primary and secondary prevention, early intervention, care coordination, access to a multidisciplinary team to address the bio-psychosocial aspects of chronic conditions. There is an identified need to develop a Health Care Systems response to enable the implementation of early intervention as an effective strategy to reduce the burden of MSK disorders with particular importance and potential gains for the target population of older people who have shown an acute loss of function due to MSK diseases. It will contribute to meeting the ‘triple aim' goals in health systems of improving patient's care experience (satisfaction, confidence and trust), improving the health of people and populations (mortality, disability and quality of life) and improving the societal costs of diseases.

AIM To investigate the rates and determinants of success of repeat percutaneous coronary intervention (PCI) following an initial failed attempt at recanalising the chronic total occlusions (CTO) percutaneously. METHODS In 445 consecutive first attempt CTO-PCI procedures in our institution, procedural failure occurred in 149 (33.5%). Sixty-four re-PCI procedures were performed in 58 patients (39%) all had a single CTO. Procedural and outcome data in the re-PCI population was entered into the institutional database. A retrospective analysis of clinical, angiographic and procedural data was performed. RESULTS Procedural success was achieved in 41 (64%) procedures. Univariate analysis of clinical and angiographic characteristics showed that re-PCI success was associated with intravascular ultrasound (IVUS) guidance (19.5% vs 0%, P = 0.042), while failure was associated with severe calcification (30.4% vs 9.7%, P = 0.047) and a JCTO score > 3 (56.5% vs 17.1% P = 0.003). Following multiple regression analysis the degree of lesion complexity (J-CTO score > 3), IVUS use, involvement of an experienced CTO operator and LAD CTO location were significant predictors of successful re-PCI. Overall the complication rate was low, with the only MACCE two periprocedural MI’s neither of which required intervention. CONCLUSION Re-PCI substantially increases the overall success rate of CTO revascularization. Predictors of re-PCI success included the use of IVUS, the involvement of an experienced CTO operator in the repeat attempt and the location of the CTO.

Objectives The aim of this study was to develop and assess the effectiveness of a patient decision aid (PDA) to support treatment decision making in Spanish patients with moderate-to-severe rheumatoid arthritis (RA) who fail to achieve the therapeutic goal with the current disease-modifying antirheumatic treatment strategy. Methods The PDA was developed in accordance with the International Patient Decision Aids Standards recommendations. A steering group led the project. Three literature reviews and two focus groups were performed to develop the PDA prototype. To check its comprehensibility, acceptability, and feasibility, alpha-testing was performed using the Decision Support Acceptability Scale (DSAS). Beta-testing was conducted to assess preliminary evidence of PDA efficacy using the Decisional Conflict Scale (DCS) before and after PDA use. Readiness was evaluated using the Preparation for Decision Making Scale (PDMS). Results The PDA included (1) a brief description of RA, (2) treatment information, and (3) a values clarification section. Alpha-testing revealed that most patients considered that the information was presented in a good or excellent way and it could help clarify their values and facilitate treatment decision making. Most rheumatologists agreed that the PDA was easy to understand, to use, and allowed them to reach a shared decision. Beta-testing showed that PDA significantly reduced overall patients’ decisional conflict [33.2 (DE: 21.4) vs 24.6 (23.5); p

Our objective is to develop and validate a predictive model based on the random forest algorithm to estimate the readmission risk to an outpatient rheumatology clinic after discharge. We included patients from the Hospital Cl&iacute, nico San Carlos rheumatology outpatient clinic, from 1 April 2007 to 30 November 2016, and followed-up until 30 November 2017. Only readmissions between 2 and 12 months after the discharge were analyzed. Discharge episodes were chronologically split into training, validation, and test datasets. Clinical and demographic variables (diagnoses, treatments, quality of life (QoL), and comorbidities) were used as predictors. Models were developed in the training dataset, using a grid search approach, and performance was compared using the area under the receiver operating characteristic curve (AUC-ROC). A total of 18,662 discharge episodes were analyzed, out of which 2528 (13.5%) were followed by outpatient readmissions. Overall, 38,059 models were developed. AUC-ROC, sensitivity, and specificity of the reduced final model were 0.653, 0.385, and 0.794, respectively. The most important variables were related to follow-up duration, being prescribed with disease-modifying anti-rheumatic drugs and corticosteroids, being diagnosed with chronic polyarthritis, occupation, and QoL. We have developed a predictive model for outpatient readmission in a rheumatology setting. Identification of patients with higher risk can optimize the allocation of healthcare resources.

The new digital communication ecosystem has brought about a reconfiguration of its uses as a result of adapting the new media and electronic devices to the existing ones. Hypermediality, facilitated by the Internet and the media’s conversion to multiplatform media, has redefined content. This has led to the emergence of new formats exclusive to electronic media, due to the synergistic merging of written press narrative strategies integrated into audiovisual reports. This study aims to analyze the electronic media’s audiovisual content and to determine different formats. For that purpose, a methodology is developed based on the description of the formal elements of these types of items from a reading of the narrative and audiovisual language, identifying the elements founded on conventional television journalism formats. The methodology is based on the analysis of a representative sample of the audiovisual contents from El País’, El Español’s and Playground’s digital portals from June and July 2018. The analysis concludes by categorizing the audiovisual contents into four formats, which are grouped according to their structure, coverage, and production complexity. Audiovisual content in cybermedia is not only articulated as an extension of the news text by illustrating facts and the main figure’s statements, but it can also be integrated into the text autonomously, and even makes up independent sections in the medium.

Cities are drivers of economic development, providing infrastructure to support countless activities and services. Today, the world's 750 biggest cities account for more than 57% of the global gross domestic product (GDP) and this number is expected to increase to 61% by 2030. More than half of the world's population lives in cities, or urban areas, and this share will continue to grow. Rapid urban growth has posed both challenges and opportunities for city planners, not least when it comes to the design of transportation and logistics systems for freight. But urbanization also fosters innovation and sharing, which have led to new models for organizing movement of goods within the city. In this chapter, we highlight one of these new models: crowd logistics. We define the characterizing features of crowd logistics, review applications of crowd-based services within urban environments, and discuss research opportunities in the area of crowd logistics.

Aims: The aim of this study was to assess the effect of “outpatient readmissions” on the health-related quality of life (HR-QoL) of outpatients from a rheumatology clinic, meaning the effect of the patient’s return to the outpatient clinic after having received care and been discharged. Methods: We conducted an observational longitudinal retrospective study, with patients selected from the Hospital Clínico San Carlos Musculoskeletal cohort, based on having received at least one discharge from the outpatient clinic and having returned (readmission) at least once after the discharge. The main outcomes were the patients’ baseline HR-QoL (measured on the first visit of each episode) and the ΔHR-QoL (difference between the HR-QoL in the last and the first visit of each episode). Successive episodes of admission and readmission were chronologically ordered, paired and analyzed using nested linear mixed models, nested by patients and by admission–readmission tandem. We carried out bivariable and multivariable analyses to assess the effect of demographic, clinical, treatment and comorbidity-related variables in both main outcomes. Results: For the first main outcome, 5887 patients (13,772 episodes) were analyzed. Based on the multivariable level, readmission showed no significant marginal effect on the baseline HR-QoL ( p-value = 0.17). Conversely, when analyzing the ΔHR-QoL, we did observe a negative and significant marginal effect ( p-value = 0.028), meaning that readmission was associated with a lower gain in the HR-QoL during the follow-up, compared with the previous episode. Conclusion: In the outpatient setting, readmission exerts a deleterious effect in patients undergoing this process. Identification of outpatients more likely to be readmitted could increase the value of the care provided.

We appreciate the interest of Aydin et al 1 in our study about risk factors for hospital admissions related to COVID-19 in patients with inflammatory rheumatic diseases (IRD).2 COVID-19 pandemic is a matter in constant update and certainly an enormous challenge for researchers, clinicians, healthcare workers and epidemiologists. In this sense, all together are making enormous efforts in their fields to overcome this global crisis. In relation to research advances, there has been an explosion in the publication of articles related to COVID-19. In this pandemic situation, it is true that it has been a challenge and a race against the clock for researchers and some publications could be less rigorous than expected.3 For this reason, and according to Aydin et al ,1 the critical reading it is important to interpret the results, paying special attention to the limitations of each study. The role of IRD, their therapies and other potential factors in the risk of SARS-CoV-2 infection and …

Individualized treatment of rheumatoid arthritis (RA) based on genetic/serologic factors is increasingly accepted. Moreover, patients are more actively involved in the management of their disease. However, personality has received little attention with respect to perception of the need and adherence to treatment. Our objective was to evaluate whether patient personality was associated with the acceptance or rejection of more aggressive early treatment. We performed a cross-sectional study in two hospitals with early arthritis clinics where sociodemographic, clinical, and therapeutic variables are systematically recorded. Patients completed Eysenck Personality Questionnaire, Multidimensional Health Locus of Control, Pain-Related Self-Statement Scale and Pain-Related Control Scale. Aggressive treatment was considered if patients received more than two DMARDs or biological agents during the first year of follow-up. Multivariate logistic regression analysis was performed to determine predictors of aggressive treatment. One hundred seventy-six RA patients were included (80 % women, disease begin median age 55 years). Treatment was considered aggressive in 57.9 % of the sample. Scores were high in extraversion in 50.8 % of patients, neuroticism in 29.5 % and psychoticism in 14.7 %. Neuroticism was the only factor associated with aggressive treatment, which was less probable (p = 0.04, OR = 0.40). Neuroticism also decreased the possibility of receiving a combination of biologics and DMARDs (p = 0.04, OR = 0.28). Patients with high scores on neuroticism are more worried, obsessive and hypochondriac, leading them to reject more aggressive therapy. It is important to educate about their disease so that they will accept more aggressive approaches in clear cases of poor outcome.

Objectives Newborn (NB) auditory deficit has a prevalence of 1–2% in the world. Since the 1990s different screening programs have been put into practice. The Newborn Hearing Screening Program has been in operation since 2002 in our hospital (HCUVA) in Murcia (Spain) and two years later it was introduced into the whole of the Autonomous Community of the Region of Murcia as part of universal healthcare. The objective of this study was to analyze and assess its results. Method The newborn (NB) population is divided into two groups: not-at-risk NBs and at-risk NBs. In the first case we carry out acoustic otoemissions (AOEs) 48 h after birth and depending on the result the child is either discharged or, in negative cases, the infant undergoes a series of tests in a period of 30–45 days to confirm or rule out the existence of hearing anomalies. In the at-risk group we combine AOEs with brain trunk potentials (BERA) following the stages in a decision tree diagram similar to the ones for not-at-risk children in order to provide a clinical diagnosis in the first three months of life. Results The screening performance was assessed for the 156,122 children studied, of which 151,258 belonged to the group of not-at-risk children; and 4864 to the group at risk of hypoacusia. As a result of the screening only 410 (0.26%) were sent to consultation, 213 in the not-at-risk group (0.14%) and 197 (24.7%) in the at-risk group. A total of 7452 false positives were identified (4.7%), 6951 (4.5%) in the not-at-risk group; and 501 (10.3%) in the group with risk factors; and there were 53 false negatives (0.03%). Sensitivity in the screening program was 88.5%, with a specificity of 95%. Conclusions The Region of Murcia has a Newborn Hearing Screening Program with tests that provide a high level of sensitivity and specificity in accordance with the findings of the literature. Our results endorse the program and the patients were treated in a way that met the objective of providing a correct diagnosis and the appropriate therapeutic action.

The study aims to analyze the association between the bone and cartilage/periarticular components of the radiographic joint damage and disability over the course of disease, in a cohort of rheumatoid arthritis (RA) patients from a day-to-day clinical practice. The secondary aim is to study the role of demographic and disease-related variables in this association. We performed a retrospective longitudinal study including 736 RA patients. Disability was assessed with the health assessment questionnaire (HAQ), and radiographic joint damage of hands and wrists with the Sharp van-der-Heijde score (total (SHS), erosion (ES), and narrowing/(sub)luxation (NSLS) components]. Generalized estimating equations models, adjusted by disease activity, demographic and disease-related variables, were used to test the relationship between SHS and medium-term (median value of the HAQs performed in the following year after each radiograph) and long-term (set of HAQ measures performed during follow-up, at least 1 year apart from the first x-ray) disability. Interaction terms between the SHS and demographic and disease-related variables were introduced in the models. To account for multiple testing, Bonferroni correction was applied. NSLS was independently associated with medium-term disability, even after Bonferroni correction. We observed significant and positive interactions between NSLS and age at x-ray, and with the ES. SHS showed no association with long-term disability. The cartilage/soft tissue component of the radiographic joint damage seems to exert a much more important role in medium-term disability than the erosive component. This association could be modulated by the age at the x-ray and by the magnitude of the erosive damage.

Objective The aim of this study was to assess the reliability and validity of the Spanish version of the Rosser classification system for disease states in patients with musculoskeletal disorders. Methods Our study was based on a questionnaire validation design. Patients were attended at an outpatient rheumatology clinic at Hospital Clinico San Carlos, Madrid, Spain. The Rosser classification system was completed by the physician from the research team (PMQ) and by the patient (HMQ). Criterion standards: The EuroQol-5D for the HMQ and the physician global estimate (DOCGL) for the PMQ. Internal consistency reliability was assessed using Cronbach α. Test-retest reliability and interobserver reliability were analyzed using the intraclass correlation coefficient. The criterion validity between HMQ and EuroQol-5D and between PMQ and DOCGL was assessed using the Spearman correlation coefficient. Results The full analysis was based on 4 samples of patients (104 to 266 patients), most of whom were middle-aged women. For HMQ, Cronbach α was 0.70. Test-retest reproducibility was 0.7. With respect to criterion validity, significant correlations in the expected direction were observed. For PMQ, Cronbach α was 0.70, indicating excellent intraobserver and interobserver reliability. With respect to criterion validity, strong correlations were observed between the PMQ and the DOCGL. Conclusions The Rosser classification system showed satisfactory reliability and suitable criterion validity for patients with musculoskeletal disorders. The instrument seems to be suitable for clinical decision making and research.

T1 colorectal polyps with at least 1 risk factor for metastasis to lymph node should be treated surgically and are considered endoscopically unresectable. Optical analysis, based on the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification system, is used to identify neoplasias with invasion of the submucosa that require endoscopic treatment. We assessed the accuracy of the NICE classification, along with other morphologic characteristics, in identifying invasive polyps that are endoscopically unresectable (have at least 1 risk factor for metastasis to lymph node).We performed a multicenter, prospective study of data collected by 58 endoscopists, from 1634 consecutive patients (examining 2123 lesions) at 17 university and community hospitals in Spain from July 2014 through June 2016. All consecutive lesions10 mm assessed with narrow-band imaging were included. The primary end point was the accuracy of the NICE classification for identifying lesions with deep invasion, using findings from histology analysis as the reference standard. Conditional inference trees were fitted for the analysis of diagnostic accuracy.Of the 2123 lesions analyzed, 89 (4.2%) had features of deep invasion and 91 (4.3%) were endoscopically unresectable. The NICE classification system identified lesions with deep invasion with 58.4% sensitivity (95% CI, 47.5-68.8), 96.4% specificity (95% CI, 95.5-97.2), a positive-predictive value of 41.6% (95% CI, 32.9-50.8), and a negative-predictive value of 98.1% (95% CI, 97.5-98.7). A conditional inference tree that included all variables found the NICE classification to most accurately identify lesions with deep invasion (P.001). However, pedunculated morphology (P.007), ulceration (P = .026), depressed areas (P.001), or nodular mixed type (P.001) affected accuracy of identification. Results were comparable for identifying lesions that were endoscopically unresectable.In an analysis of 2123 colon lesions10 mm, we found the NICE classification and morphologic features identify those with deep lesions with96% specificity-even in non-expert hands and without magnification. ClinicalTrials.gov number NCT02328066.

[EN] Substrate integrated waveguides are increasingly being used due to their capability of combining the advantages of planar circuits and traditional waveguides. The development of empty substrate integrated waveguides has substantially reduced the related insertion losses, since waves propagate through air instead of propagating through a lossy dielectric medium. Recently, a new empty coaxial structure, completely built with printed circuit boards and integrated in a substrate, has been proposed. It has been named empty substrate integrated coaxial Line (ESICL). The resulting coaxial line has low cost, easy manufacturing, low radiation, low losses, high-quality factor, and is non dispersive. A transition from grounded coplanar waveguide to ESICL already exists. In this work, a transition from microstrip to ESICL is presented for the first time. In order to demonstrate its feasibility, a back-to-back structure and a bandpass filter have been manufactured and measured., This work was supported by the Ministerio de Economia y Competitividad, Spanish Government, under Research Project TEC2016-75934-C4-3-R and Research Project TEC2016-75934-C4-1-R.

[EN] We report a joint experimental and theoretical study of the structural, vibrational, elastic, optical, and electronic properties of the layered high-mobility semiconductor Bi2O2Se at high pressure. A good agreement between experiments and ab initio calculations is observed for the equation of state, the pressure coefficients of the Raman-active modes and the bandgap of the material. In particular, a detailed description of the vibrational properties is provided. Unlike other Sillen-type compounds which undergo a tetragonal to collapsed tetragonal pressure-induced phase transition at relatively low pressures, Bi2O2Se shows a remarkable structural stability up to 30 GPa; however, our results indicate that this compound exhibits considerable electronic changes around 4 GPa, likely related to the progressive shortening and hardening of the long and weak Bi-Se bonds linking the Bi2O2 and Se atomic layers. Variations of the structural, vibrational, and electronic properties induced by these electronic changes are discussed., This work was supported by Brazilian Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) under project 201050/2012-9, by Spanish MINECO projects MAT2015-71070-REDC, MAT2016-75586-C4-1/2/3-P and CTQ2015-65207-P and by the Grant Agency of the Czech Republic (GA CR) under project 16-07711S. Supercomputer time has been provided by the Red Espanola de Supercomputacion (RES) and the MALTA cluster. D.S.-P. and J.A.S. acknowledge the "Ramon y Cajal" fellowship program (RYC-2015-17482) and Spanish Mineco Projects (2014-15643 and 2017-83295-P). J.R.-F. acknowledge the "Juan de la Cierva" program (IJCI-2014-20513) for financial support.

INTRODUCTION: Retroperitoneal sarcoma (RPS) is a rare disease accounting for 0.1%–0.2% of all malignancies. Management of RPS is complex and requires multidisciplinary, tailored treatment strategies at all stages, but especially in the context of metastatic or multifocal recurrent disease. Due to the rarity and heterogeneity of this family of diseases, the literature to guide management is limited. METHODS: The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaboration of sarcoma experts from all disciplines convened in an effort to overcome these limitations. The TARPSWG has compiled the available evidence surrounding metastatic and multifocally recurrent RPS along with expert opinion in an iterative process to generate a consensus document regarding the complex management of this disease. The objective of this document is to guide sarcoma specialists from all disciplines in the diagnosis and treatment of multifocal recurrent or metastatic RPS. RESULTS: All aspects of patient assessment, diagnostic processes, local and systemic treatments, and palliation are reviewed in this document, and consensus recommendations provided accordingly. Recommendations were guided by available evidence, in conjunction with expert opinion where evidence was lacking. CONCLUSIONS: This consensus document combines the available literature regarding the management of multifocally recurrent or metastastic RPS with the practical expertise of high-volume sarcoma centers from multiple countries. It is designed as a tool for decision making in the complex multidisciplinary management of this condition and is expected to standardize management across centers, thereby ensuring that patients receive the highest quality care.

New learning strategies try to extend the use of common devices among students in physics lab practices. In particular, there is a recent trend to explore the possibilities of using smartphone sensors to describe physics phenomena. On the other hand, the study of the moment of inertia by the use of the torsion pendulum is a typical example in the first courses of fundamentals of physics. This example allows the exploration of harmonic motion, Newton’s second law, the moment of inertia theory, and the parallel axis theorem all in one. Here, we report the use of the accelerometer sensor of a smartphone to visualize and demonstrate the parallel axis theorem in a torsion pendulum.

El patrón de dolor crónico implica altos niveles de emociones negativas, dolor y discapacidad percibida. Pocos estudios han evaluado el patrón de aparición del dolor crónico y éste era nuestro objetivo. Método: fueron evaluados 146 participantes con 4 semanas la Baja Laboral por enfermedades musculoesqueléticas (DsMS) y 95 con artritis reumatoide (AR) mediante los siguientes instrumentos: el Cuestionario de Tristeza y Depresión (CTD), el Inventario de Situaciones y Respuestas de Ansiedad–forma breve-. (ISRA-B), Cuestionario de Evaluación de Salud (HAQ), una escala analógica visual para la intensidad del dolor y una escala tipo Likert para la frecuencia del dolor. Los análisis (descriptivos y bivariados) incluyeron una comparación de las puntuaciones de las pruebas entre los pacientes con baja laboral por EM en comparación con los pacientes con AR. Resultados: Los pacientes con Baja Laboral por enfermedades musculoesqueléticas y los pacientes con AR informaron de una percepción similarde su discapacidad, según el HAQ. Pacientes con Baja Laboral por enfermedades musculoesqueléticas informaron mayor frecuencia percibida y más intensidad de dolor que los pacientes con AR. En relación a las emociones negativas, ambos grupos presentaron niveles altos y similares, con algunos niveles más pobres de los pacientes con AR en comparación con Pacientes con Baja Laboral por enfermedades musculoesqueléticas para la ansiedad cognitiva, la ansiedad de evaluación y la de la vida cotidiana (en ISRA-B). Las puntuaciones en depresión presentan los mismos niveles en ambos grupos de pacientes.Conclusión. Nuestro estudio muestra que los pacientes con dolor subagudo/discapacidad y dolor crónico/discapacidad reportan un patrón muy similar para las emociones negativas y la percepción del dolor y la discapacidad, lo que sugiere que estos factores aparecen en una etapa temprana y favorecen, por tanto, la transición de dolor agudo a crónico/discapacidad.

The objective of the study was to develop evidence-based and practical recommendations for the detection and management of comorbidity in patients with rheumatoid arthritis (RA) in daily practice. We used a modified RAND/UCLA methodology and systematic review (SR). The process map and specific recommendations, based on the SR, were established in discussion groups. A two round Delphi survey permitted (1) to prioritize the recommendations, (2) to refine them, and (3) to evaluate their agreement by a large group of users. The recommendations cover: (1) which comorbidities should be investigated in clinical practice at the first and following visits (including treatments, risk factors and patient's features that might interfere with RA management); (2) how and when should comorbidities and risk factors be investigated; (3) how to manage specific comorbidities, related or non-related to RA, including major adverse events of RA treatment, and to promote health (general and musculoskeletal health); and (4) specific recommendations to assure an integral care approach for RA patients with any comorbidity, such as health care models for chronic inflammatory patients, early arthritis units, relationships with primary care, specialized nursing care, and self-management. These recommendations are intended to guide rheumatologists, patients, and other stakeholders, on the early diagnosis and management of comorbidity in RA, in order to improve disease outcomes.

Objective To estimate the incidence of musculoskeletal-related acute physical disability in the elderly (APDE). Methods A primary care–based registry was established in Madrid's Health Area 7 from October 1, 2005 to September 31, 2006. We included all persons age ≥65 years, who were non-institutionalized and covered by the health cards assigned to the participating general practitioners (GPs). A case of APDE was defined as a moderate mobility alteration in the disability level within the Rosser's Classification System, in the last 3 months, related to a musculoskeletal cause. Incidence rates (IRs) were estimated per 10,000 person-years by direct standardization with a 95% confidence interval (95% CI). Results Eight primary care centers and 23 GPs participated in the registry, covering 8,546 elderly patients. In the inclusion year, the GPs identified 147 new APDE cases in 106 patients. The annual estimated incidence of APDE was 331 cases per 10,000 person-years (95% CI 280–389) and the IR of new patients with an APDE episode was 239 (95% CI 196–288); the IR was higher in women (344 cases; 95% CI 279.8–423.0) than in men (207 cases; 95% CI 127.0–338.2). Conclusion The incidence estimate of acute physical disability related to musculoskeletal disorders in the elderly should help us to determine the magnitude of this health problem, as well as the first step to establishing a specific practice for the recovery of cases and for the prevention of loss of functioning, mobility, and independence.