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Describir la sobrecarga del cuidador de pacientes sobrevivientes a un accidente cerebrovascular isquémico (ACVi) en una población en Colombia.

Bayesian optimization is a popular technique in optimization of functions which are expensive to evaluate (e.g. in experimental optimization of complex and slow processes). Bayesian optimizers select the points in which the cost function is evaluated via optimizing a surrogate acquisition function. Such acquisition function is usually fixed, based on intuition, from several choices available in the literature. However, for a given problem, it is sometimes difficult to know which is the right one and, perhaps, a strategy combining them along the experiments sequence might provides better results. This paper explores a scenario-based optimization to estimate the best sequence of acquisition function choices in finite-horizon optimization problems under uncertainty, cast as a Partially Observable Markov Decision Process. Improvements over standard Bayesian optimization and a recent rollout strategy are illustrated in simulation.

To assess the degree of compliance with the European ESC/EAS 2016 and 2019 dyslipidaemia guidelines in patients with type 2 diabetes mellitus (T2DM).

To assess the degree of compliance with the European ESC/EAS 2016 and 2019 dyslipidaemia guidelines in patients with type 2 diabetes mellitus (T2DM).

The antimicrobial activity of a commercial Lippia citriodoraextract (LCE) at 2,500 μg mL−1(maximum sensory acceptable level) and vanillin (MIC and 2 MIC) alone and in combination were analyzed in four strains of Escherichia coli(two nonverotoxigenic and two verotoxigenic) in cation-adjusted Mueller-Hinton medium and in Piel de Sapo melon juice (MJ) stored under refrigeration (4°C) for 7 days. The bacterial counts of the four strains together in untreated samples were higher (≈4 log CFU/mL) in cation-adjusted Mueller-Hinton medium than in stored MJ. LCE showed higher antimicrobial activity in MJ than in standard culture broth, but vanillin showed a higher effect in broth. The verotoxigenic strain E. coliO146:H stx2was the most sensitive to LCE in refrigerated MJ. Combinations of vanillin (at MIC and 2 MIC) with LCE were very effective in reducing E. colicounts either in broth or in refrigerated MJ to undetectable levels. Bactericidal effects were observed for the combinations in all strains in broth and in MJ. Also, these combinations showed an antimicrobial synergistic effect after day 3 of storage in MJ in three of the bacterial strains tested. These results indicate that the combination of LCE (at maximum sensory acceptable levels) and vanillin (at low concentrations) could be considered as a promising natural antimicrobial agent to inhibit verotoxigenic E. coligrowth in refrigerated MJ and improve its quality.

An output-feedback decentralised formation control strategy is pursued under pole-region constraints, assuming that the agents have access to relative position measurements with respect to a set of neighbors in a graph describing the sensing topology. No communication between the agents is assumed; however, a shared one-way communication channel with a pilot is needed for steering tasks. Each agent has a separate copy of the same controller. A virtual structure approach is presented for the formation steering as a whole; actual formation control is established via cone-complementarity linearization algorithms for the appropriate matrix inequalities. In contrast to other research where only stable consensus is pursued, the proposed method allows us to specify settling-time, damping and bandwidth limitations via pole regions. In addition, a full methodology for the decoupled handling of steering and formation control is provided. Simulation results in the example section illustrate the approach.

La creación de un centro estatal de salud pública, con una dotación adecuada de recursos, permitirá afrontar los desafíos de la salud pública del presente y del futuro en España. Para ello, las funciones de esta futura institución, que se propone como Agencia Estatal, deben abordar, además de las necesidades habituales de organización de la salud pública, la conexión de estas con los Objetivos de Desarrollo Sostenible,coordinando una estrategia estatal que integre distintos actores de salud en una red generosa y cooperativa, y desarrollando una estrategia de comunicación en salud pública innovadora, referente y priorizada, entre otros aspectos. La falta de recursos, la relativa desconexión actual de las funciones esenciales de salud pública en el ámbito estatal y la inequidad en el desarrollo autonómico y municipal de estas propician el desarrollo del proyecto de la Agencia como una red de redes, tal como se defiende en este trabajo. Aportamos ideas para un proceso que confiamos en que será decisivo para la salud pública española del siglo xxi.

ABSTRACTThis paper develops the application of the Dual Rate Dual Sampling Reference Filtering Control Strategy to 2D and 3D visual feedback control. This strategy allows to overcome the problem of sensor latency and to address the problem of control task failure due to visual features leaving the camera field of view. In particular, a Dual Rate Kalman Filter is used to generate inter-sample estimations of the visual features to deal with the problem of vision sensor latency, whereas a Dual Rate Extended Kalman Filter Smoother is used to generate more convenient visual features trajectories in the image plane. Both 2D and 3D visual feedback control approaches are widely analyzed throughout the paper, as well as the overall system performance using different visual feedback controllers, providing a set of results that highlight the improvements in terms of solution reachability, robustness, and time domain response. The proposed control strategy has been validated on an industrial system with hard real-time limitations, consisting of a 6 DOF industrial manipulator, a 5 MP camera, and a PLC as controller.

To develop evidence- and experience-based recommendations for the management of psoriasis during preconception, pregnancy, postpartum, and breastfeeding.

Desarrollar recomendaciones basadas en la mejor evidencia y experiencia sobre el manejo de pacientes con psoriasis durante la edad fértil, el embarazo, el posparto y la lactancia.

There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn’s disease. The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn’s disease complicated with symptomatic strictures. In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn’s disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up. Overall, 262 patients with Crohn’s disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab (N?=?141, 54%) or adalimumab (N?=?121, 46%). The treatment was effective in 87% and 73% of patients after 6 and 12 months, respectively, and continued to be effective in 26% after a median follow-up of 40 months (IQR, 19–85). Nonetheless, 15% and 21% of individuals required surgery after 1 and 2 years, respectively, with an overall surgery rate of 32%. Postoperative complications were identified in 15% of patients, with surgical site infection as the most common. Starting anti-TNF therapy in the first 18 months after the diagnosis of Crohn’s disease or the identification of stricturing complications was associated with a higher effectiveness (HR 1.62, 95% CI 1.18–2.22; and HR 1.55, 95% CI 1.1–2.23; respectively). Younger age, lower albumin levels, strictures located in the descending colon, concomitant aminosalicylates use or presence of lymphadenopathy were associated with lower effectiveness. Anti-TNF agents are effective in approximately a quarter of patients with Crohn’s disease and symptomatic intestinal strictures, and 68% of patients are free of surgery after a median of 40 months of follow-up. Early treatment and some potential predictors of response were associated with treatment success in this setting.

Evaluar si la telemedicina con telemonitorización es una herramienta clínicamente útil y segura para el seguimiento de pacientes con COVID-19.

Background There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn’s disease.Aim The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn’s disease complicated with symptomatic strictures.Methods In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn’s disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up.Results Overall, 262 patients with Crohn’s disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab (N= 141, 54%) or adalimumab (N= 121, 46%). The treatment was effective in 87% and 73% of patients after 6 and 12 months, respectively, and continued to be effective in 26% after a median follow-up of 40 months (IQR, 19–85). Nonetheless, 15% and 21% of individuals required surgery after 1 and 2 years, respectively, with an overall surgery rate of 32%. Postoperative complications were identified in 15% of patients, with surgical site infection as the most common. Starting anti-TNF therapy in the first 18 months after the diagnosis of Crohn’s disease or the identification of stricturing complications was associated with a higher effectiveness (HR 1.62, 95% CI 1.18–2.22; and HR 1.55, 95% CI 1.1–2.23; respectively). Younger age, lower albumin levels, strictures located in the descending colon, concomitant aminosalicylates use or presence of lymphadenopathy were associated with lower effectiveness.Conclusions Anti-TNF agents are effective in approximately a quarter of patients with Crohn’s disease and symptomatic intestinal strictures, and 68% of patients are free of surgery after a median of 40 months of follow-up. Early treatment and some potential predictors of response were associated with treatment success in this setting.

The linear programming (LP) approach to solve the Bellman equation in dynamic programming is a well-known option for finite state and input spaces to obtain an exact solution. However, with function approximation or continuous state spaces, refinements are necessary. This paper presents a methodology to make approximate dynamic programming via LP work in practical control applications with continuous state and input spaces. There are some guidelines on data and regressor choices needed to obtain meaningful and well-conditioned value function estimates. The work discusses the introduction of terminal ingredients and computation of lower and upper bounds of the value function. An experimental inverted-pendulum application will be used to illustrate the proposal and carry out a suitable comparative analysis with alternative options in the literature.

A laboratory experiment to study the effect of soil amendments in the bioremediation of polluted soils is described. Students extracted and measured 0.01 M CaCl2-soluble Cd, EDTA-soluble Cd, and DTPA-soluble Cd concentrations in contaminated soils, treated with a liming material (mussel shell), and/or with an organic amendment (pine bark). The results of the laboratory experiment show that it is easy to perform and reproduce, and it gives results that can be interpreted from the point of view of bioremediation and immobilization of Cd, whereas the postlab work by the students shows that the learning objectives of the laboratory phase were met, with students being able to identify the relevance of two of the main parameters affecting metal bioavailability in soils: pH and organic matter content.

Objective.Because the addition of carotid ultrasound (US) into composite cardiovascular (CV) risk scores has been found effective for identifying patients with inflammatory arthritis and high CV risk, we aimed to determine whether its use would facilitate the reclassification of patients with psoriatic arthritis (PsA) into the very high Systematic Coronary Risk Evaluation (SCORE) risk category and whether this might be related to disease features.Methods.This was a cross-sectional study involving 206 patients who fulfilled ClASsification for Psoriatic ARthritis criteria for PsA, and 179 controls. We assessed lipid profile, SCORE, disease activity measurements, and the presence of carotid plaques and carotid intima-media thickness by ultrasonography. A multivariable regression analysis, adjusted for classic CV risk factors, was performed to evaluate whether the risk of reclassification could be explained by disease-related features and to assess the most parsimonious combination of risk reclassification predictors.Results.Forty-seven percent of patients were reclassified into a very high SCORE risk category after carotid US compared to 26% of controls (p < 0.001). Patients included in the low SCORE risk category were those who were more commonly reclassified (30% vs 14%, p = 0.002). The Disease Activity Index for PsA (DAPSA) score was associated with reclassification (β 1.10, 95% CI 1.02–1.19; p = 0.019) after adjusting for age and traditional CV risk factors. A model containing SCORE plus age, statin use, and DAPSA score yielded the highest discriminatory accuracy compared to the SCORE-alone model (area under the receiver-operating characteristic curve 0.863, 95% CI 0.789–0.936 vs 0.716, 95% CI 0.668–0.764; p < 0.001).Conclusion.Patients with PsA are more frequently reclassified into the very high SCORE risk category following carotid US assessment than controls. This was independently explained by the disease activity.

AbstractPlant and essential oil extracts have been used for some time as antimicrobials and antioxidants, although little is known about the interactions between the main components of these plant materials. This knowledge could help to design more potent antimicrobial and antioxidant mixtures. Carvacrol and thymol, the main components of the essential oils of the Lamiaceae family of plants, were assessed in combination to evaluate their antioxidant activity and antimicrobial effect against 19 strains of Staphylococcus aureus(S. aureus) of different origins (clinical, meat, milk, and other) and mostly (12) enterotoxin producers. The microdilution test assay was used to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the two phenolics alone and in combination. Based on the fractional inhibitory concentration index (FICI), no antimicrobial interaction (0.5 < FICI <4) between carvacrol and thymol was observed against 42% of the S. aureusstrains and an antagonistic interaction (FICI >4) was observed in the rest, which indicates different behavior among strains in relation to this antimicrobial combination. Particularly, an antagonistic effect was observed in 29% of the meat origin strains and 57% of the dairy origin strains. Combinations of carvacrol and thymol were bactericidal (differences in MIC and MBC values not more than twofold) for 60% of the tested strains. At low concentrations of both components, the antioxidant effect is additive. However, at high concentrations (2.50 or 2.66 mM) of at least one of the components of the combination, it is antagonistic. The different types of interactions of the components in the combination can depend on many factors (ratio, structural characteristics, and the establishment of intermolecular complexes). The results could be used as reference to apply this combination in foods to control S. aureus, to maintain the organoleptic properties and to extend the shelf-life of them.

Understanding the origin and referral routes of patients seen in teledermatology and in-person dermatology consultations in Spain is of interest from the perspective of health care management. The objective of this study was to describe the referral routes and the frequency and characteristics of teledermatology consultations in Spain.

El conocimiento de las rutas de origen y derivación de los pacientes atendidos en consulta dermatológica presencial y de teledermatología en España tiene interés desde el punto de vista de la gestión sanitaria. El objetivo de este estudio es describir las rutas de derivación y la frecuencia y características de la teledermatología en España.

Helicobacter pyloriresistance to antimicrobial agents is on the rise and it is thus imperative to be aware of local resistance rates. The main objective of the present study was to describe the evolution of primary antimicrobial resistance in H. pylori, analysing its antibiotic susceptibility over a 13-year period in a region of northern Spain, as well as host-related factors.

Papillary renal neoplasm with reversed polarity (PRNRP) is a recently described rare renal neoplasm. Traditionally, it was considered a variant of papillary renal cell carcinoma (PRCC). However, several studies reported significant differences between PRNRP and PRCC in terms of clinical, morphological, immunohistochemical and molecular features. Nonetheless, PRNRP remains a poorly understood entity. We used microarray analysis to elucidate the non-coding RNA (ncRNA) and gene expression profiles of 10 PRNRP cases and compared them with other renal neoplasms. Unsupervised cluster analysis showed that PRNRP had distinct expression profiles from either clear cell renal cell carcinoma (ccRCC) or PRCC cases at the level of ncRNA but were less distinct at the level of gene expression. An integrated omic approach determined miRNA:gene interactions that distinguished PRNRP from PRCC and we validated 10 differentially expressed miRNAs and six genes by quantitative RT-PCR. We found that levels of the miRNAs, miR-148a, miR-375and miR-429, were up-regulated in PRNRP cases compared to ccRCC and PRCC. MiRNA target genes, including KRAS and VEGFA oncogenes, and CXCL8, which regulates VEGFA, were also differentially expressed between renal neoplasms. Gene set enrichment analysis (GSEA) determined different activation of metabolic pathways between PRNRP and PRCC cases. Overall, this study is by far the largest molecular study of PRNRP cases and the first to investigate either ncRNA expression or their gene expression by microarray assays.

Ecosystems provide a variety of benefits to human society and humanity’s utilization of ecosystems affects their composition, structure, and functions. Global change drivers demand us to study the interactions between ecological and social systems, and advise strategies to protect the large fraction of Chilean unique ecosystems. Long-term research and monitoring are vital for meaningful understanding of human impacts and socio-ecological feedback, which occur over multiple spatial and time-scales and can be invisible to traditional grant-sponsored short-term studies.