Influence of Service Conditions and Mix Design on the Physical-Mechanical Properties of Roller-Compacted Concrete for Pavement.

This research focuses on the behavior of roller-compacted concrete (RCC) used in pavements, which are prone to deterioration affecting their performance. These deteriorations result from various causes, including traffic load, errors during construction, mix design, and ambient conditions. Among these, ambient conditions could lead to a marked variable impact on material behavior and durability depending on the conditions associated with each region. Accordingly, this study aims to deepen the understanding of the effect, which a broader range of ambient conditions and different mix designs have on the physical and mechanical properties of RCC. Measurements such as the amount of water vapor per kilogram of air were used to apply the findings comprehensively. The RCC analysis encompassed experimentation with different compositions, altering the cement water ratio amount, and adding a superplasticizer. The impact of curing on the materials was evaluated before subjecting them to various humidity and temperature conditions. Laboratory tests were conducted to measure performance, including moisture, shrinkage, compressive strength, and the progression of flexural fracture resistance over curing periods of up to 90 days. The results revealed a logarithmic correlation between shrinkage and ambient humidity, which is the most determining factor in performance. Mix optimization through increased cement and reduced water enhanced the tensile strength of the material. Furthermore, the curing process was confirmed to increase resistance to shrinkage, especially in the long term, establishing it as a crucial element for the structural stability of RCC, which is relatively insensitive to variations in ambient conditions.

Prediction of the Physical-Mechanical Properties of Roller-Compacted Concrete Pavements under Different Service and Mix Conditions Based on Cement and Water Content.

Roller-compacted concrete (RCC) for pavements has experienced problems with its physical-mechanical performance over extended periods due to ambient and in situ curing conditions. Accordingly, this study aimed to present multiple regression equations for calculating the physical-mechanical properties of RCC for pavements under different service and mix conditions. For this purpose, the research included two cement and two water contents, one reduced with admixture, and four combinations of temperature and relative humidity. For model calibration and definition of the equations, cubic and beam samples were fabricated to carry out physical-mechanical tests, such as moisture content, shrinkage, and modulus of rupture. Laboratory-obtained data were studied with the Response Surface Methodology (RSM) to determine the best regression equations. The main findings determined that the behavior of a mixture of RCC at a prolonged ambient exposure time is possible because the surface models and the RSM were consistent with the different service and mix conditions. The models showed an accuracy of 98.99% in detecting shrinkage changes from 12 to 16% cement with 5.65% water in dry to wet ambient conditions. Similarly, moisture content and modulus of rupture had a 98.27 to 98.88% fit. Finally, the drying shrinkage, with mixes of 12% cement and water content variations with water-reducing admixture and superplasticizer effects, had an adjustment of 94.87%.

Seguridad alimentaria y nutricional de niños menores de 5 años: de la dimensión alimentaria a la nutricional / Food and Nutrition Security of Children under 5 Years: From Food to Nutritional Dimension / Segurança alimentar e nutricional de crianças menores de 5 anos: da dimensão alimentar à nutricional

Objetivo: analizar la asociación de características biológicas y sociales con la seguridad alimentaria y nutricional (san) de niños menores de 5 años con base en indicadores de percepción del hambre y antro-pométricos.Materiales y métodos: estudio transversal realizado en municipios brasileños que fueron priorizados para el desarrollo de acciones de prevención de la obesidad infantil en 2017/2018. La san se midió usando la Escala Brasileña de Inseguridad Alimentaria y se utilizaron los índices antropométricos Talla/Edad (T/E), Peso/Edad (P/E) y Peso/Talla (P/T). Las asociaciones se testaron por regresión de Poisson con varianza robusta.Resultados: de los 868 niños, el 24.3 % vivía en familias con inseguridad alimenta-ria y nutricional moderada-severa (ianm-s), el 7.0 % tenía T/E baja; el 7.8 % P/E alto, y el 14.4 %, P/T alto. Si bien la ianm-s se asoció con una amplia gama de factores negativos del contexto social, las prevalencias de las desviaciones antropométricas fueron mayores en menores de 2 años y cuando las madres tenían el mismo diagnóstico nutricional que el niño.Conclusión: a pesar de las prevalencias expresivas de ianm-sy desviaciones antropométricas, la ianm-s fue más pronunciada, especialmente en contextos sociales des-favorables. La san mostró un comportamiento diferente en sus dimensiones alimentaria y nutricional, tanto en términos de frecuencia como de determinación

Objective: To analyze the association between biological and social characteristics with the food and nutritional security (fns) of children aged <5 years based on hunger perception and anthropometric indicators. Materials and methods: This cross-sectional study was performed at Brazilian municipali-ties that have been prioritized for the development of actions aimed at preventing childhood obesity in 2017­2018. The fns aspect was analyzed with reference to the Brazilian Food Insecurity Scale and the anthropometric indices Height/Age (H/A), Weight/Age (P/A), and Weight/Height (P/H) were used. The associations were tested by the Poisson Regression with robust variance. Results: Of the 868 children, 24.3 % lived in families with moderate­severe food and nutritional insecurity, 7.0 % had low H/A, 7.8 % had high P/A, and 14.4% had high P/E. The moderate­severe food and nutritional insecurity was associ-ated with a wide range of negative factors in the social context, but the prevalence of anthropometric deviations was higher in children <2 years and when their mothers had the same nutritional diagno-sis. Conclusion: Despite the expressive prevalence of moderate­severe food and nutritional insecurity and anthropometric deviations, the former was more pronounced, especially under unfavorable social contexts. san displayed different behaviors in its food and nutritional dimensions, both in the terms of frequency and determination.

Objetivo: analisar a associação de características biológicas e sociais com a Segurança Alimentar e Nutricional (san) de crianças menores de 5 anos com base em indicadores de percepção da fome e antropométricos. Materiais e métodos: estudo transversal realizado em municípios brasileiros que foram priorizados para o desenvolvimento de ações de prevenção da obesidade infantil em 2017/2018. A san foi medida usando a Escala Brasileira de Insegurança Alimentar e utilizaram-se os índices antropométricos Estatura/Idade (E/I), Peso/Idade (P/I) e Peso/Estatura (P/E). As associações se testaram por Regressão de Poisson com variância robusta. Resultados: das 868 crianças, 24.3 % residiam em famílias com Insegurança Alimentar e Nutricional Moderada-Grave (ianm-g), 7.0 % tinham E/I baixa, 7.8 % P/I elevado e 14.4 % P/E elevado. Enquanto a ianm-gassociou-se a uma ampla gama de fatores negativos do contexto social, as prevalências dos desvios antropo-métricos foram maiores em menores de 2 anos e quando as mães tiveram o mesmo diagnóstico nutricional que a criança. Conclusão: apesar das prevalências expressivas de ianm-g e de desvios antropométricos, a ianm-gfoi mais acentuada, sobretudo em contextos sociais desfavoráveis. A san manifestou comportamento dife-rente nas suas dimensões alimentar e nutricional, tanto em termos de frequência quanto de determinação.

La cosmovisión indígena en políticas públicas medioambientales para reducir la contaminación durante la pandemia del coronavirus / coronavirusIndigenous Worldview in Environmental Public Policies to Reduce Pollution during the Coronavirus Pandemic / A cosmovisão indígena nas políticas públicas ambientais de redução da poluição durante a pandemia do coronavírus

Introducción: consecuencia de la pandemia a causa del coronavirus (SARS-CoV-2), desde el 2020 ha aumen-tado la generación de los residuos con riesgo biológico o infeccioso, usados en los protocolos de biosegu-ridad por parte de la ciudadanía en general y el talento humano en salud. Ello generó un alto riesgo para salud y un aumento en el índice de contaminación ambiental y degradación de los recursos naturales, que hasta el momento ha superado las expectativas para su mitigación. Desarrollo: para contrarrestar el impacto del aumento en el índice de contaminación ambiental, se reflexiona sobre la necesidad de buscar acciones medioambientales para mitigar el daño y ampliar el concepto sobre el medio ambiente y la importancia de la interacción y codependencia del ser humano con la naturaleza. Se plantea la idea de retomar elementos conceptuales del conocimiento de las culturas indígenas sobre la visión holística del ambiente, partiendo de una cosmovisión indígena del buen vivir, donde el ambiente y el ser humano se encuentran en constante equilibrio y armonía. Conclusión: se pretende encontrar, desde la cosmovisión indígena, posibles abordajes conceptuales que mitiguen el impacto de la contaminación ambiental a causa del coronavirus, así como la formulación de acciones estratégicas para la adecuada gestión de estos residuos

Introduction: Since 2020, due to the the Coronavirus (SARS-CoV-2) pandemic, there has been an increase in generation of waste with biological or infectious risk used in biosafety protocols by the community and human resources in health, which, in turn, generates a high rate of pollution and environmental degradation of natural resources that has so far exceeded expectations for mitigation.Development: To reduce the impact of this problematic situation, a reflection was made to strengthen the current public policies and implement environmental actions that seek to mitigate the damage, but, above all, to change the concept of the environment and increase awareness about the importance of interac-tion and codependency of human beings with nature. The idea of retaking conceptual elements of the knowledge of indigenous cultures regarding the holistic vision of the environment is proposed, starting from a Quechua worldview of good living, where the environment and the human being are in constant balance and harmony. Conclusions:This study is intended to determine, from the indigenous worldview, the possible conceptual approaches that mitigate the environmental impact, as well as to formulate strategic actions for the adequate management of the resultant waste.

Introdução: como consequência da pandemia causada pelo Coronavírus (SARS-CoV-2), desde 2020 houve um aumento na geração de resíduos com risco biológico ou infeccioso utilizados em protocolos de bios-segurança pelo público em geral e talentos humanos em saúde; o que gerou um alto risco à saúde e um aumento no índice de contaminação ambiental e degradação dos recursos naturais que até agora tem superado as expectativas para sua mitigação. Desenvolvimento: para neutralizar o impacto do aumento do índice de contaminação ambiental, é feita uma reflexão sobre a necessidade de buscar ações ambien-tais para mitigar os danos, e ampliar o conceito de meio ambiente e a importância da interação e code-pendência do ser humano com a natureza. Propõe-se a ideia de retomar elementos conceituais do conhe-cimento das culturas indígenas sobre a visão holística do meio ambiente, partindo de uma cosmovisão indígena do bem viver, onde o meio ambiente e o ser humano estão em constante equilíbrio e harmonia. Conclusão: pretende-se encontrar a partir da visão de mundo indígena, possíveis abordagens conceituais que mitiguem o impacto da contaminação ambiental devido ao coronavírus, bem como a formulação de ações estratégicas para o gerenciamento adequado desses resíduos

Spatiotemporal analysis of the surface urban heat island (SUHI), air pollution and disease pattern: an applied study on the city of Granada (Spain).

There is worldwide concern about how climate change -which involves rising temperatures- may increase the risk of contracting and developing diseases, reducing the quality of life. This study provides new research that takes into account parameters such as land surface temperature (LST), surface urban heat island (SUHI), urban hotspot (UHS), air pollution (SO2, NO2, CO, O3 and aerosols), the normalized difference vegetation index (NDVI), the normalized difference building index (NDBI) and the proportion of vegetation (PV) that allows evaluating environmental quality and establishes mitigation measures in future urban developments that could improve the quality of life of a given population. With the help of Sentinel 3 and 5P satellite images, we studied these variables in the context of Granada (Spain) during the year 2021 to assess how they may affect the risk of developing diseases (stomach, colorectal, lung, prostate and bladder cancer, dementia, cerebrovascular disease, liver disease and suicide). The results, corroborated by the statistical analysis using the Data Panel technique, indicate that the variables LST, SUHI and daytime UHS, NO2, SO2 and NDBI have important positive correlations above 99% (p value: 0.000) with an excess risk of developing these diseases. Hence, the importance of this study for the formulation of healthy policies in cities and future research that minimizes the excess risk of diseases.

Orientadores de la decision de inversion: una conceptualización desde el estilo de liderazgo del emprendedor de impacto / Drivers of the decision-making process for investing: an impact entrepreneur's leadership style conceptualization / Orientadores de decisão de investimento: uma conceituação a partir do estilo de liderança do empresário de impacto

RESUMEN En un contexto de búsqueda de oportunidades de inversion, la impresión inicial que sobre un emprendedor se forme un inversionista influye de manera directa en su propio proceso decisional. En ese sentido, el presente trabajo busca estudiar las implicaciones que subyacen a este panorama inicial, puntualmente en un escenario de decisiones de inversion sobre iniciativas que apuestan por el desarrollo sostenible (i.e., inversiones de impacto). Para ello, haciendo uso de un caso de estudio, se despliega un proceso de análisis cualitativo que permite identificar las especificidades del estilo de liderazgo de un emprendedor de impacto determinado, así como la forma en que este mismo estilo podr'a afectar la eventual decision de un potencial inversionista. En ese orden de ideas, el presente trabajo contribuye a la transferibilidad y profundización del tópico en cuestión, en diversas áreas del conocimiento. СLASIFICACIÓN JEL: 126, Q56

AВSTRАСT In a context of seeking investment opportunities, the initial impression that an investor forms on an entrepreneur influences their own decision-making process. In this sense, the present work seeks to study the implications underlying this initial panorama, specifically in a scenario of investment decisions on initiatives that are committed to reach a sustainable development (i.e., impact investments). For this purpose, and using a case study a qualitative analysis process is deployed, allowing the identification of the corresponding leadership style of a given impact entrepreneur; as well as the way in which this same style could affect the eventual decision of a potential investor In that order of ideas, the present work contributes to the transferability and deepening of the topic at issue in various areas of knowledge. JEL CLASSIFICATION: 126, Q56

RESUMO No contexto da busca de oportunidades de investimento, a impressão inicial que um investidor tem de um empresário tem uma influência direta em seu próprio processo de tomada de decisão. Neste sentido, este documento procura estudar as implicações que estão na base deste panorama inicial, especificamente em um cenário de decisões de investimento em iniciativas comprometidas com o desenvolvimento sustentável (ou seja, investimentos de impacto). Para este fim, utilizando um estudo de caso, é implantado um processo de análise qualitativa para identificar as especificidades do estilo de liderança de um determinado empreendedor de impacto, bem como a forma como este mesmo estilo poderia afetar a eventual decisão de um investidor potencial. Neste sentido, este trabalho contribui para a transferibilidade e aprofundamento do tema em questão, em várias áreas do conhecimento. CLASSIFICAÇÃO JEL: 126, Q56

Caracterización de pacientes con prescripción de losartán en dosis superior a la dosis máxima diaria, su problemática e intervención

Introducción: La hipertensión arterial es una de las enfermedades con mayor preva-lencia en nuestro país. La prescripción de antagonistas del receptor de angiotensina tipo II, es uno los tratamientos más comunes; sin embargo, su dosis máxima efectiva es controversial. Objetivo: El objetivo del estudio fue caracterizar una población de una entidad promotora de salud en Colombia, que recibía para el manejo de la hipertensión arterial, una dosis de losartán mayor a 100 mg/día. Metodología: Se incluyó una base de prescripción de 3816 casos con hipertensión arterial, en manejo con losartán potásico a dosis superiores a 100 mg/día, con una muestra proporcional de 300 casos; en quienes se aplicó una alerta de dosis máxima (100 mg/día) en la prescripción. Se describió el perfil farmacoterapéutico, interacciones farmacológicas, cambios de dosificación y en las cifras de presión arterial. Para confirmar el efecto terapéutico de losartán potásico en control de cifras de presión arterial, se realizaron pruebas estadísticas (Tukey, Bonferroni). Resultados: De los 300 pacientes, 224 (74,6%) contaban con registro de presión arterial al inicio de la prescripción de losartán potásico a 100 mg/día; después de la intervención se logró reducción de dosis en 70 casos (23,3%). 76 casos (25,3%) no contaban con ningún paraclínico de seguimiento. Conclusión: No se encontró evidencia clínica o científica que justifique la prescripción de losartán con dosis mayores a 100 mg/día para el manejo de la hipertensión arterial esencial en nuestra población descrita.

SUMMARY Introduction: Hypertension is one of the most prevalent diseases in our country. Type II angiotensin receptor antagonists are one of the most common treatments; however, its maximum effective dose is controversial. Aim: The objective of study to characterize a population of a health promoting entity in Colombia, which received a dose of losartan greater than 100 mg/day for management of arterial hypertension. Methodology: The study included a prescription base of 3816 cases with arterial hypertension, in management with losartan potassium at doses higher than 100 mg/day, with a proportional sample of 300 cases; in whom a maximum dose alert (100 mg/day) was applied in prescription. Pharmacotherapeutic profile, drug interactions, dosage changes, and changes in blood pressure figures were described. To confirm therapeutic effect of losartan potassium in controlling blood pressure figures, statistical tests were performed (Tukey, Bonferroni). Results: Of the 300 patients, 224 (74.6%) had a blood pressure record at beginning of prescription of losartan potassium at 100 mg/day; after the intervention, a dose reduction was achieved in 70 cases (23.3%). 76 cases (25.3%) did not have any follow-up paraclinical. Conclusion: It was concluded that losartan potassium at doses greater than 100 mg/day did not show statistically significant differences for blood pressure control. We found insufficient clinical and scientific evidence to support the treatment with losartan more than 100 mg/day for hypertension in our population.

Introdução: A hipertensão arterial é uma das doenças mais prevalentes em nosso país. Os antagonistas do receptor de angiotensina tipo II são um dos tratamentos mais comuns; entretanto, sua dose máxima efetiva é controversa. Objetivo: Caracterizar uma população de uma entidade promotora de saúde na Colômbia, que receberam uma dose de losartana superior a 100 mg/dia para tratamento de hipertensão. Metodologia: O estudo incluiu uma base de prescrição de 3816 casos com hipertensão arterial, em manejo com losartana potássica em doses maiores superior a 100 mg/ dia, com amostra proporcional de 300 casos; em quem um máximo alerta de dose (100 mg/dia) foi aplicado na prescrição. Perfil farmacoterapêutico, interações medicamentosas, alterações de dosagem e alterações nos valores da pressão arterial foram descrito. Para confirmar o efeito terapêutico da losartana potássica no controle do sangue valores pressóricos, foram realizados testes estatísticos (Tukey, Bonferroni). Resultados: De dos 300 pacientes, 224 (74,6 %) tinham registro de pressão arterial no início da prescrição de losartana potássica a 100 mg/dia; após a intervenção, uma redução da dose foi alcançada em 70 casos (23,3 %). 76 casos (25,3 %) não tiveram seguimento paraclínico. Conclusão: Concluiuse que a losartana potássica em doses maiores superior a 100 mg/dia não apresentou diferenças estatisticamente significativas para a pressão arterial ao controle. Encontramos evidências clínicas e científicas insuficientes para apoiar o tratamento com losartana mais de 100 mg/dia para hipertensão em nossa população.

Effect of Ethanol Consumption on the Accuracy of a Glucose Oxidase-Based Subcutaneous Glucose Sensor in Subjects with Type 1 Diabetes.

Continuous glucose monitors (CGM) have improved the management of patients with type 1 diabetes (T1D), with glucose oxidase (GOx)-based sensors being the most used. However, they are potentially subject to both electrochemical and enzymatic interferences, including those related to changes of pH. The objective of this study is to investigate the effect of ethanol, given as beer along with a mixed meal, on the accuracy of a commercial GOx-CGM. Data from 12 T1D participants in a randomized crossover trial to evaluate the effect of meal composition and alcohol consumption on postprandial glucose concentration were used. Absolute error (AE) and mean absolute relative difference (MARD) were calculated. The differences between the alcohol and nonalcohol scenarios were assessed using the Mann−Whitney U and Wilcoxon signed-rank tests. The AE in the alcohol study was low, but significantly greater as compared to the study without alcohol (p-value = 0.0418). The MARD was numerically but not significantly greater. However, both variables were greater at pH < 7.36 and significantly affected by time only in the alcohol arm. In T1D, alcohol consumption affects the accuracy of a GOx-CGM. This effect could be at least partially related to the ethanol-induced changes in pH.

Impacts of the COVID-19 confinement on air quality, the Land Surface Temperature and the urban heat island in eight cities of Andalusia (Spain).

The COVID-19 outbreak and ensuing global lockdown situation have generated a very negative impact on the world economy, but they have also lent us a unique opportunity to research and better grasp the impacts of human activity on environmental pollution and urban climates. Such studies will be of vital importance for decision-making on measures needed to mitigate the effects of climate change in urban areas, in order to turn them into resilient environments. This study looks at eight cities in the region of Andalusia (southern Spain) to comprehensively assess their environmental quality with parameters (Pm10, So2, No2, Co and O3) obtained from meteorological stations. The aim was to determine how these parameters affect the Land Surface Temperature (LST) and the Surface Urban Heat Island (SUHI), on the basis of Sentinel 3 satellite thermal images. Knowing to what extent improved air quality can reduce the LST and SUHI of cities will be essential in the context of future environmental studies on which to base sustainable decisions. The geographic situation of cities in the Mediterranean Sea basin, highly vulnerable to climate change, and the high pollution rates and high daily temperature variations of these urban areas make them particularly attractive for analyses of this sort. During the confinement period, average reductions of some environmental pollutants were achieved: So2 (-33.5%), Pm10 (-38.3%), No2 (-44.0%) and Co (-26.5%). However, the environmental variable O3 underwent an average growth of 5.9%. The LST showed an average reduction of -4.6 °C (-19.3%), while the SUHI decreased by 1.02 °C (-59.8%). These values exhibit high spatio-temporal variations between day and night, and between inland and coastal cities.

Linfedema: de la fisiopatología al tratamiento actual / Lymphedema: from pathophysiology to current treatment

Resumen El linfedema es la acumulación de líquido rico en proteínas en el intersticio debido a una incompetencia de los canales linfáticos. Se clasifica en primario cuando es ocasionado por anormalidades estructurales congénitas en los canales linfáticos, mientras que el secundario está causado por disrupciones en la integridad anatómica, que pueden acontecer después de trauma, infecciones (filariasis linfática), posterior a vaciamientos ganglionares, o iatrogénica. Objetivo: Describir los aspectos más importantes del tratamiento del linfedema entendiéndose este desde la fisiopatología. Metodología: Se incluyeron artículos publicados en idiomas español e inglés, la mayoría entre 2011 y 2021 que tuvieran contenido relacionado con el objetivo del presente manuscrito. Conclusiones: El linfedema se ha convertido en un reto para los profesionales de la salud debido a su complejo tratamiento multidisciplinario, pero gracias al avance de la microcirugía, el manejo quirúrgico se convertido en una creciente alternativa efectiva, especialmente gracias a su enfoque fisiopatológico de la enfermedad. MÉD. UIS.2021;34(3): 61-70.

Abstract Lymphedema is the accumulation of protein-rich fluid in the interstitium due to an incompetence of the lymphatic channels. It is classified as primary when it occurs due to lymphatic channels abnormalities, and secondary lymphedema when it is caused by trauma, infection, venous thrombosis, oncological diseases and iatrogenia, especially after lymph node dissection. Objective: To describe the most important aspects in the treatment of lymphedema, understanding it from a pathophysiological perspective. Methodology: Articles published in Spanish and English were included, the majority between 2011 and 2021 that have content related to the objective of this manuscript. Conclusions: Lymphedema has become a challenge to physicians due to the complex and multidisciplinary treatment that it requires, but, owing to the advance from microsurgery, the surgical management has become an increasingly effective alternative, especially because of its disease pathophysiological approach. MÉD.UIS.2021;34(3): 61-70.

Effect of meal composition and alcohol consumption on postprandial glucose concentration in subjects with type 1 diabetes: a randomized crossover trial.

INTRODUCTION: Meal composition is known to affect glycemic variability and glucose control in type 1 diabetes. The objective of this work was to evaluate the effect of high carbohydrate meals of different nutritional composition and alcohol on the postprandial glucose response in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: Twelve participants were recruited to this randomized crossover trial. Following a 4-week run-in period, participants received a mixed meal on three occasions with the same carbohydrate content but different macronutrient composition: high protein-high fat with alcohol (0.7g/kg body weight, beer), high protein-high fat without alcohol, and low protein-low fat without alcohol at 2-week intervals. Plasma and interstitial glucose, insulin, glucagon, growth hormone, cortisol, alcohol, free fatty acids, lactate, and pH concentrations were measured during 6 hours. A statistical analysis was then carried out to determine significant differences between studies. RESULTS: Significantly higher late postprandial glucose was observed in studies with higher content of fats and proteins (p=0.0088). This was associated with lower time in hypoglycemia as compared with the low protein and fat study (p=0.0179), at least partially due to greater glucagon concentration in the same period (p=0.04). Alcohol significantly increased lactate, decreased pH and growth hormone, and maintained free fatty acids suppressed during the late postprandial phase (p<0.001), without significant changes in plasma glucose. CONCLUSIONS: Our data suggest that the addition of proteins and fats to carbohydrates increases late postprandial blood glucose. Moreover, alcohol consumption together with a mixed meal has relevant metabolic effects without any increase in the risk of hypoglycemia, at least 6 hours postprandially. TRIAL REGISTRATION NUMBER: NCT03320993.

Determination of the Real Cracking Moment of Two Reinforced Concrete Beams Through the Use of Embedded Fiber Optic Sensors.

This article investigates the possibility of applying weldable optic fiber sensors to the corrugated rebar in reinforced concrete structures to detect cracks and measure the deformation of the steel. Arrays have initially been designed comprised of two weldable optic fiber sensors, and one temperature sensor to compensate its effect in measuring deformations. A series of tests were performed on the structures to evaluate functioning of the sensors, and the results obtained from the deformation measures shown by the sensors have been stored using specific software. Two reinforced concrete beams simply resting on the support have been designed to perform the tests, and they have been monitored in the zones with maximum flexion moment. Different loading steps have been applied to the beams at the center of the span, using a loading cylinder, and the measurement of the load applied has been determined using a loading cell. The analysis of the deformation measurements of the corrugated rebar obtained by the optic fiber sensors has allowed us to determine the moment at which the concrete has cracked due to the effect of the loads applied and the deformation it has suffered by the effect of the different loading steps applied to the beams. This means that this method of measuring deformations in the corrugated rebar by weldable optic fiber sensors provides very precise results. Future lines of research will concentrate on determining an expression that indicates the real cracking moment of the concrete.

Sharpening the thermal release of DNA from nanoparticles: towards a sequential release strategy.

Unlike the sharp melting behavior of DNA-linked nanoparticle aggregates, the melting of DNA strands from individual gold nanoparticles is broad despite the high surface density of bound DNA. Here, it is demonstrated how sharpened melting can be achieved in colloidal nanoparticle systems using branched DNA-doubler structures hybridized with complementary DNA-doublers bound to the gold nanoparticle. Moreover, sharpened transitions are observed when DNA-doublers are hybridized with linear DNA-modified gold nanoparticles. This result suggests that the DNA density on nanoparticles is intrinsically great enough to form cooperative structures with the DNA-doublers. Finally, by introducing abasic destabilizing groups, the melting temperature of these DNA-doublers decreases without decreasing the sharpness. Consequently, by varying the temperature, two DNA-doublers with different stabilities dissociate sequentially from the gold nanoparticle surface, without overlapping and within a narrow temperature window. Owing to the excellent thermal selectivities exhibited by this system, the implementation of DNA-doublers in sequential photothermal therapies and with other nanomedicine delivery agents that rely on DNA dissociation as the mechanism of selective release is anticipated.

Tuning ratios, densities, and supramolecular spacing in bifunctional DNA-modified gold nanoparticles.

Methods for combining multiple functions into well-defined nanomaterials are still lacking, despite their need in nanomedicine and within the broader field of nanotechnology. Here several strategies for controlling the amount and the ratio of combinations of labeled DNA on 13-nm gold nanoparticles using self-assembly of thiolated DNA and/or DNA-directed assembly are explored. It is found that the self-assembly of mixtures of fluorescently labeled DNA can lead to a higher amount of labeled DNA per particle; however, the ratio of fluorophores on the nanoparticles differs greatly from that in the self-assembly solution. In contrast, when fluorescently labeled DNA are hybridized to DNA-modified gold nanoparticles, the fluorophore ratio on the nanoparticles is much closer to their ratio in solution. The use of bifunctional DNA-doublers in self-assembly and DNA-directed assembly is also explored to increase the complexity of these materials and control their composition. Finally, tuning the distance between the labels from 2.9 to 5.4 nm was achieved using different hybridized DNA clamp complexes. Fluorescent results suggest that assembling these clamps on nanoparticle surfaces may be possible, although the resulting label spacing could not be quantified.

Regional variations in test requiring patterns of general practitioners in Spain.

OBJECTIVE: To analyze the requesting patterns for a range of laboratory tests ordered in 2009 from eight laboratories providing services to eight health areas, using appropriate indicators. DESIGN: Indicators measured every test request per 1,000 inhabitants, and indicators that measured the number of tests per related test requested by general practitioners were calculated. The savings generated, if each Health Care Department achieved the appropriate indicator standard, were also calculated. Laboratory Information System registers were collected, and indicators were calculated automatically in each laboratory using a data warehouse application. RESULTS: There was a large difference in demand for tests by health areas. The ratio of related tests also showed a great variability. The savings generated if each Health Care Department had achieved the appropriate indicator standard were €172,116 for free thyroxine, €18,289 for aspartate aminotransferase, and €62,678 for urea. CONCLUSIONS: Considerable variability exists in general practitioners' demand for laboratory tests.

Evaluation of PSA testing by general practitioners: regional study in the autonomic Community of Valencia.

OBJECTIVES: The aim of the study is to compare the use of PSA testing among general practitioners (GPs). METHODS: The number of PSA tests ordered by general practitioners in the years 2008-2009 was examined in a cross-sectional study of nine health districts of Spain. The percentage of PSA ordered to men younger than 50 (PSA<50/PSAtotal) and 40 years (PSA<40/PSAtotal) was calculated. The percentage of men over 50 years who were attended was also calculated and this data was compared with the number of PSA ordered to this population. For two of the departments, these data were also compared between GPs and urologists. RESULTS: PSA testing in 2009 is higher than 2008 in seven health districts. PSA testing in men younger than 50 years was increased along the period of the study and in men younger than 40 years remained steady. The differences between the values of the indicators for urologists and GPs are significant. CONCLUSIONS: The number of PSA tests and the percentage performed to men younger 50 years has been increasing and the variability is high. These data are suggestive for interventions focused on PSA testing and prostate cancer screening in primary care settings.

Evaluación de la solicitud de antígeno prostático específico por atención primaria: estudio piloto regional en la comunidad valenciana / Evaluation of psa testing by general practitioners: regional study in the autonomic community of valencia

OBJETIVO: El objetivo del estudio es la valoración del patrón de solicitud de PSA por los médicos de Atención Primaria (AP).MÉTODOS: Estudio transversal de la solicitud de PSA por médicos de AP en nueve Departamentos de Salud. Se evaluó el número de solicitudes de PSA y el porcentaje de PSA solicitados a menores de 50 años (PSA<50/PSAtotal) y también a menores de 40 años respecto del total de PSA solicitados (PSA<40/PSAtotal).También se calculó el porcentaje de varones mayores de 50 años atendidos y se comparó con el número de PSA solicitados a esa población. Para dos de los Departamentos, también se compararon estos datos con los mismos para médicos especialistas en Urología.RESULTADOS: En siete de los Departamentos la demanda en 2009 es superior a la del año 2008. La demanda a varones menores de 40 años se mantiene estable y a varones menores de 50 años aumenta progresivamente a lo largo del periodo del estudio. Las diferencias entre los valores de los indicadores para urólogos y médicos de AP son significativas.CONCLUSIONES: El número de solicitudes de PSA y el porcentaje realizado a varones menores de 50 años ha ido incrementándose y la variabilidad en la solicitud es elevada, lo que indica la necesidad de establecer estrategias orientadas a la adecuación de la demanda mediante la comunicación entre profesionales(AU)

OBJECTIVES: The aim of the study is to compare the use of PSA testing among general practitioners (GPs).METHODS: The number of PSA tests ordered by general practitioners in the years 2008-2009 was examined in a cross-sectional study of nine health districts of Spain. The percentage of PSA ordered to men younger than 50 (PSA<50/PSAtotal) and 40 years (PSA<40/PSAtotal) was calculated. The percentage of men over 50 years who were attended was also calculated and this data was compared with the number of PSA ordered to this population. For two of the departments, these data were also compared between GPs and urologists.RESULTS: PSA testing in 2009 is higher than 2008 in seven health districts. PSA testing in men younger than 50 years was increased along the period of the study and in men younger than 40 years remained steady. The differences between the values of the indicators for urologists and GPs are significant.CONCLUSIONS: The number of PSA tests and the percentage performed to men younger 50 years has been increasing and the variability is high. These data are suggestive for interventions focused on PSA testing and prostate cancer screening in primary care settings(AU)

Estudio piloto regional de evaluación de las solicitudes de pruebas urgentes al laboratorio en la Comunidad Valenciana / No disponible

Objetivo: Comparar las solicitudes de pruebas urgentes en catorce Laboratorios de la Comunidad Valenciana. Material y Métodos: Se utilizaron los datos de actividad del Sistema de Información Económico del año 2008 del Catálogo oficial de pruebas de Bioquímica Clínica y Biología Molecular de la Agencia Valenciana de Salud, para comparar la demanda mediante indicadores de adecuación. Resultados: Existe una gran dispersión entre los resultados de los indicadores. Conclusiones: La considerable variabilidad en la utilización de las pruebas de laboratorio urgentes en 14 Departamentos de Salud sugiere la necesidad de establecer estrategias para su homogeneización (AU)

No disponible

Evaluación del patrón de solicitud de hemoglobina glucosilada por Atención Primaria: estudio piloto regional en la Comunidad Valenciana / An evaluation of glycosylated hemoglobin requesting patterns in a primary care setting: a pilot experience in the Valencian Community (Spain)

Objetivo Mostrar el patrón de solicitud de hemoglobina glucosilada (HbA1c) en ocho departamentos de salud mediante el cálculo de indicadores de adecuación de la demanda. Métodos Estudio transversal en el que se recogen el número de HbA1c solicitadas desde Atención Primaria durante los años 2008 y 2009. Como indicador de adecuación se calculó el porcentaje de valores de HbA1c con resultado inferior a 6,5%. Las variables y los indicadores se recogieron y calcularon de forma automatizada. También se calculó en cada departamento de salud el número de determinaciones de HbA1c teóricas que deberían haber sido solicitadas según datos de prevalencia conocida. Resultados se observó un incremento progresivo de la demanda de determinaciones de HbA1c y, aproximadamente el 54% de los valores de HbA1c en siete de estos ocho departamentos fueron inferiores a 6,5%. El número de HbA1c teóricas que deberían haber sido solicitadas según la prevalencia de diabetes fue mayor que el número solicitado en todos los departamentos. Conclusión Los resultados parecen indicar la inadecuación en la solicitud de la HbA1c en los departamentos de salud estudiados, no sólo por la probable sobreutilización en pacientes no diabéticos sino por la infrautilización en pacientes que sí lo son (AU)

Objective To assess the pattern of glycosylated hemoglobin (HbA1c) requests by clinicians from eight health departments by calculating indicators of demand appropriateness. Methods A cross-sectional study of the number of HbA1c requests by primary care clinics in 2008 and 2009. The indicator of demand appropriateness was the proportion of HbA1c values lower than 6.5%. Variables were collected and indicators were automatically calculated. The number of HbA1c measurements that should theoretically have been requested according to known diabetes prevalence data was also calculated. Results A progressive increase was seen in demand for HbA1c measurements. Approximately 54% of HbA1c values obtained in seven of the eight departments studied were lower than 6.5%. The number of theoretical HbA1c requests that would have been expected based on the known prevalence of diabetes was higher than the number of HbA1c requests in all departments. Conclusion The results appear to suggest that HbA1c requests by the health departments studied were not always appropriate. HbA1c measurements were probably overused in patients without diabetes and underused in patients with diabetes (AU)