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The development of new building elements, such as concrete and mortar with sustainable materials, which produce a lower carbon footprint, is an achievable milestone in the short term. The need to reduce the environmental impact of the production of cement-based materials is of vital importance. This work focuses on the evaluation of the life-cycle assessment, production costs, mechanical performance, and durability of three mortars and three concrete mixtures in which mixed recycled aggregates (MRAs) and biomass bottom ash from olive waste (oBBA) were included to replace cement and aggregates. Powdered MRA and oBBA were also applied as complementary cementitious materials with a reduced environmental footprint. Chemical and physical tests were performed on the materials, and mechanical performance properties, life-cycle assessment, and life-cycle cost analysis were applied to demonstrate the technical and environmental benefits of using these materials in mortar and concrete mixtures. This research showed that the application of MRA and oBBA produced a small reduction in mechanical strength but a significant benefit in terms of life-cycle population and environmental costs. The results demonstrated that finding long-term mechanical strength decreases between 2.7% and 14% for mortar mixes and between 1.7% and 10.4% for concrete mixes. Although there were small reductions in mechanical performance, the savings in environmental and monetary terms make the feasibility of manufacturing these cement-based materials feasible and interesting for both society and the business world. CO2 emissions are reduced by 25% for mortar mixes and 12% for concrete mixes with recycled materials, and it is possible to reduce the cost per cubic meter of mortar production by 20%, and the savings in the cost of production of a cubic meter of concrete is 13.8%.

IntroductionPediatric post-thyroidectomy hypocalcemia management varies significantly from hospital to hospital. The current study has two aims: first, we evaluate demographic data in all pediatric patients submitted to thyroid surgery in our Spanish tertiary hospital over 20 years; secondly, we describe the way that hypocalcemia was diagnosed and treated in that period and present a multidisciplinary protocol for perioperative management of this condition.MethodsThis is a retrospective and observational study of all patients from 0 to 16 years old who underwent thyroid surgery from 2000 to 2020 at our institution. Demographic, surgical and electrolyte data were recorded from the electronic database.ResultsFrom 2000 to 2016, pediatric thyroid surgery at our institution was performed on 33 patients without a consistent approach or standard electrolyte management. A protocol for perioperative management of these patients was introduced in 2017, and applied to 13 patients. In 2019, the protocol was assessed and updated following a case of symptomatic hypocalcemia. From 2000 to 2016, 47 pediatric patients in all underwent thyroid surgery. We registered eight asymptomatic hypocalcemias. One child developed symptomatic hypocalcemia. Two patients have permanent hypoparathyroidism.DiscussionOur incidence of general complications following thyroidectomy was low; hypocalcemia was the most prevalent. All the cases of hypocalcemia submitted to the protocol were identified early by iPTH measurements. Intraoperative iPTH levels and percentage drop from baseline could help stratify patients according to their risk of hypocalcemia. High risk patients require immediate postoperative supplementation, including calcitriol and calcium carbonate.

Anaerobic soil disinfestation (ASD) is proposed as an alternative to the use of chemical fumigants against Fusarium wilt in strawberry crops. Different residual wastes (rice bran, fishmeal, and residual strawberry extrudate) were assessed as amendments for ASD. Two different concentrations and two incubation durations were tested in growth chamber trials. The abundance of several microbial groups was noted before and after the treatments. Strawberry plants were grown in the treated soils to record Fusarium wilt disease severity. The population density of F. oxysporum increased after ASD in most amendments with rice bran and residual strawberry extrudate. Changes in Trichoderma spp., copiotrophic bacteria, and Streptomyces spp. populations were observed after anaerobiosis treatments and plant trials. A reduction in the disease severity was achieved in ASD-treated soils with 20 t/ha of rice bran at both 25 and 60 days of incubation, but not when using a 13.5 t/ha dose. Similarly, treatments using 19.3 t/ha of fishmeal for both incubation durations were able to reduce disease severity. In contrast, a severity reduction was only obtained in soils treated with 25.02 t/ha of the residual strawberry extrudate and incubated for 60 days in anaerobic conditions. Two of the three by-products tested were able to reduce Fusarium wilt symptoms in strawberry plants after an ASD-treatment period of only 25 days. Accordingly, the technique seems promising for strawberry growers in Huelva, Spain, and highly sustainable by giving value to residues produced in surrounding areas.

Abstract Rationale and Aim Advanced Practice Nurse (APN) is a specialist who has acquired clinical skills to make complex decisions for a better professional practice. In the United States, this figure has been developed in different ways, but in some European countries, it is not yet fully developed, although it may imply a significant advance in terms of continuity and quality of care in patients with chronic or multiple pathologies, including cardiac ones and, more specifically, heart failure (HF). The follow‐up of HF patients in many countries has focused on the medical management of the process, neglecting all the other comprehensive health aspects that contribute to decompensation of HF, worsening quality indicators or patient satisfaction, and there are not updated reviews to clarify the relevance of APN in HF, comparing the results of APN interventions with doctors clinical practice, since the complexity of care that HF patients need makes it difficult to control the disease through regular treatment. For this reason, this systematic review was proposed in order to update the available knowledge on the effectiveness of APN interventions in HF patients, analysing four PICO questions (Patients, Interventions, Comparison and Outcomes): whether APN implies a reduction in the number of hospital readmissions, if it reduces mortality, if it has a positive cost‐benefit relationship and if it implies any improvement in the quality of life of HF patients. Design and Methods A systematic review was performed based on the PRISMA statement, searching at four databases: PubMed, CINAHL, Scopus and Cuiden. Articles were selected based on the following criteria: English/Spanish language, up to 6 years since publication, and original quantitative studies of experimental, quasi‐experimental or observational character. Papers were excluded if they do not comply with CONSORT or STROBE checklists, and if they had not been published in journals indexed in JCR and/or SJR. For the analysis, two separate researchers used the Cochrane Handbook form for systematic reviews of intervention, collecting authorship variables, study methods, risks of bias, intervention and comparison groups, results obtained, PICO question or questions answered, and the main conclusions. Results A total of 43,754 patients participated in the 11 included studies for the development of this review, mostly from United States and non‐European countries, with a clearly visible lack of European publications. Regarding the results related to first PICO question, researches reviewed proved that APN implied a reduction in the number of hospital readmissions in patients with heart failure (up to 33%). Regarding the second question, mortality was always lower in groups assisted by APN versus in control groups (up to 7.8% vs. 17.7%). Regarding the third question, APN was cost‐effective in this type of patient as the cost reduction was eventually calculated in 1.9 million euros. Regarding the last question, quality of life of patients who have been cared for by an APN had notoriously improved, although one of the papers concluded that no significant differences were found. All the questions addressed obtained a positive answer; therefore, APN is a practice that reduced hospital readmissions and mortality in HF patients. The cost‐effectiveness is much better with APN than with usual care, and although the quality of life of HF patients seems to improve with APN, more studies are needed to support this focused on this.

PurposeTo analyze the effectiveness, complications and long-term outcome of the patients with ureteropelvic junction obstruction (UPJO) treated by endoscopic retrograde balloon dilatation (ERBD) in the largest series reported.Materials and MethodsBetween years 2004 and 2018, 112 patients with primary unilateral UPJO were treated by ERBD. Endoscopic treatment consisted on a retrograde balloon dilatation of the ureteropelvic junction (UPJ), through cystoscopy and under fluoroscopic guidance, using high-pressure balloon catheters. In case of persistence in the balloon notch, a Cutting Balloon™ catheter was used. Double-J stent was placed after dilatation.ResultsMean age at surgery was 13.1 ± 21.3 months, 92 cases being younger than 18 months. Mean operative time was 24.4 ± 10.3 min; hospital stay was 1 day in 82% of patients. No intraoperative complications occurred. UPJ was calibrated at time of stent removal with cystoscopy 39.1 ± 13.7 days after dilatation. ERBD was not possible in 11 cases. An additional procedure was needed in 24 cases: second ERBD (n = 11, seven during the stent withdrawal), a third dilatation (n = 3) due to persistent hydronephrosis, and percutaneous endopyelotomy (n = 3) or open pyeloplasty (n = 7) in cases of technical failure. Significant improvement in postoperative ultrasound measures were observed (p < 0.05, T-test). Long-term success rate was 76.8% after one dilatation, and 86.6% in those who required up to 2 dilatations. Mean follow-up was 66.7 ± 37.5 months.ConclusionsERBD is a feasible and safe option for the minimally invasive treatment of UPJ obstruction in infants. Long-term outcome is acceptable with a very low complication rate.

Partial splenectomy allows preserving immune function in benign splenic lesions such as epidermoid cysts. Determining the plane of resection and perfusion of the spleen remnant can be difficult, especially in centrally located lesions. We present a 13-year-old girl with a symptomatic splenic cyst of 6 cm in diameter located next to the splenic hilum. Laparoscopic partial splenectomy was performed through a 10-mm umbilical approach and three accessory 5-mm ports. Intraoperative intravenous injection of indocyanine green (ICG) at 0.2 mg/kg guided the careful dissection of the splenic hilum and checked the spleen perfusion once the upper arterial branch was clamped. The subsequent wash-out of the ICG allowed inspection of the peripheral vascular return of the splenic remnant through polar veins. Surgery was uneventful with minimal blood loss. Follow-up ultrasound scan revealed a well-perfused small splenic remnant with no signs of recurrence. Laparoscopic partial splenectomy is feasible in benign splenic tumors, especially in those cases of peripheral location. Fluorescence facilitates the safe dissection of the splenic hilum, the visualization of the transection plane of the spleen and the perfusion of the remnant in cases of anatomically and technically complicated partial splenectomies.

To accomplish the 1.5 °C and 2 °C climate change targets, the European Union (EU) has set up several policy initiatives. Within the EU, the carbon emissions of the road transport sector from the consumption of diesel and gasoline are constantly rising. (1) Background: due to road transport policies, diesel and gasoline use within the EU is increasing the amount of carbon in the atmosphere and adding to climate risks. (2) Methods: sustainability analysis used was based on the method recommended by the Intergovernmental Panel on Climate Change. (3) Results: to meet its road transport requirements, the EU produces an estimated 0.237–0.245 billion tonnes of carbon per year from its total consumption of diesel and gasoline. (4) Conclusion: if there is no significant reduction in diesel and gasoline carbon emissions, there is a real risk that the EU’s carbon budget commitment could lapse and that climate change targets will not be met. Sustainability analysis of energy consumption in road transport sector shows the optimum solution is the direct electrification of road transport.

Objetivo: hacer una revisión de los principales tractos cerebrales y sus aplicaciones en las neurociencias a partir de la experiencia en la Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá D.C., Colombia. Materiales y métodos: revisión bibliográfica y utilización de imágenes con resonadores de 1.5 T o 3 T para describir las imágenes de tractografía en enfermedades del sistema nervioso central. Resultados: se muestran las características principales de la tractografía basados en casos de nuestra institución. Discusión: en la gran mayoría de patologías cerebrales no hay estudios sobre la utilidad de la tractografía. Aunque es un estudio disponible en la actualidad, es poca la información que suele obtenerse a nivel clínico, pues toma bastante tiempo el posproceso de las imágenes y en la mayoría de centros no está protocolizada la secuencia de obtención de la reconstrucción de cada uno de los tractos por separado. Conclusiones: es posible reconstruir los principales tractos cerebrales con escáneres de 1.5 T y 3 T, identificando las vías clave del cerebro y su relación con tumores cerebrales, trauma craneoencefálico, abuso de sustancias y otras afecciones.

In civil engineering and construction, in the selection of the most adequate and sustainable alternative, all of the alternatives and selection criteria, such as the requirements of the construction process (which are often overlooked) and the preferences of designers, clients, or contractors, are not always taken into account. The purpose of this article is to suggest a methodology that may allow studying all of the possible alternatives to find the most ideal solution among all of the existing possibilities for the selection of retaining walls to be built in infrastructures in different environments. For this purpose, all typologies of retaining walls and selection criteria (external requirements, construction requirements, characteristics of the natural land and economic criteria) are first identified. Subsequently, a simple methodological method is proposed, allowing the relative importance of each criterion to be established and allowing us to select the most suitable solution for each situation by successively applying different multicriteria decision-making methods. Finally, the methodology developed is applied to two projects in different locations with different constraints. The results obtained provide a set of compromise solutions that remain as best-rank alternatives when the weights of the criteria change. Therefore, the methodology developed can be applied to the selection of typologies of other structures in future projects.

Recycled concrete aggregates and mixed recycled aggregates are specified as types of aggregates with lower densities, higher water absorption capacities, and lower mechanical strength than natural aggregates. In this paper, the mechanical behaviour and microstructural properties of natural aggregates, recycled concrete aggregates and mixed recycled aggregates were compared. Different specimens of unbound recycled mixtures demonstrated increased resistance properties. The formation of new cement hydrated particles was observed, and pozzolanic reactions were discovered by electronon microscopy in these novel materials. The properties of recycled concrete aggregates and mixed recycled aggregates suggest that these recycled materials can be used in unbound road layers to improve their mechanical behaviour in the long term.

Boron and tin complexes have been a versatile and very interesting scaffold for the design of nonlinear optical (NLO) chromophores. In this paper we present a wide range of reports since the 1990s to date, which include second-order (e.g., second harmonic generation) and third-order (e.g., two-photon absorption) NLO properties. After a short introduction on the origin of the NLO response in molecules, the different features associated with the introduction of these inorganic motifs in the organic-based NLO materials are discussed: Their effect on the accepting/donating capabilities of the substituents, on the efficiency of the π-conjugated linkage, and on the topology of the chromophores which can be tuned from the first generation of “push-pull„ chromophores to more sophisticated two- or three-dimensional architectures.

La actividad del arte es posible por la aptitud humana para experimentar sentimientos y comienza cuando se utilizan signos exteriores para comunicar las emociones por medio de líneas, colores, imágenes verbales, etc. La teoría del arte, es respecto a la historia del arte lo que la poética y la retórica significan para la historia de la literatura. El artista ofrece imágenes concretas de fuerzas mucho menos tangibles que nosotros conocemos como esperanzas, aspiraciones, miedos, etc, que traducidas a modelos de formas y colores, se presentan como reflejos de la naturaleza humana, en ese sentido, la educación artística tiene un papel importante en la educación. La historiografía del arte se inicia con la «Historia del Arte de la Antiguedad», a mediados del siglo XVIII y un siglo después, «La Civilización del Renacimiento». En el siglo XX, se produce un concepto más amplio de las diversas tradiciones estéticas al integrar todas las tradiciones. El concepto de historia del arte según Adorno, es «la historia del progreso de su autonomía» y la tesis explícita por Platón, hace ya muchos siglos, es que el arte debería ser la base de la educación.

Se prepararon óxidos mixtos de SiO2-TiO2 de diferente composición por el método sol-gel combinado con tratamiento hidrotérmico (TH), utilizando como precursores tetraetilortosilicato y tetraisopropóxido de titanio como fuente de silicio y titanio respectivamente. Los híbridos obtenidos usando el tensoactivo no iónico Triton X100, fueron sometidos a TH por 48 horas a 120 °C, a lavado, secado a 70 °C/24 h y calcinación a 550 °C/2 h (rampa de 1°C/min.). Los óxidos mixtos que se caracterizaron por fisisorción de nitrógeno, SEM, TEM, FTIR, DRX y TGA, presentan área específica alta, en el intervalo de 190-805 m²/g y diámetro promedio de poro de 4,0-6,5 nm además muestran la presencia de la fase anatasa deseable en reacciones fotocatalíticas.

Background and aimsMany improvements have been made in the treatment of human immunodeficiency virus (HIV) in pediatric patients; however, challenges remain in terms of achieving normal growth, body composition, and metabolism during treatment, etc. Current nutritional recommendations are based on studies performed in adults, with limited data on the HIV-infected pediatric population. Therefore, this study aimed to compare the resting energy expenditure (REE) of asymptomatic HIV-infected pediatric patients with healthy counterparts and to compare body composition, dietary intake, and physical activity between the two groups.MethodsThis was a cross-sectional study of asymptomatic HIV-infected children who were receiving antiretroviral therapy; the infected group was compared with the uninfected group, matched by age (± 6 months), sex, and body mass index (± 0.5 z-score). Participants were recruited between 2021 and 2022, as outpatients. In both groups, REE was determined by indirect calorimetry and body composition by bioelectrical impedance analysis and hand strength, measured using a hydraulic hand dynamometer.ResultsSeventy-eight participants were enrolled, where n = 39 HIV-infected children and n = 39 controls, with a mean age of 11.6 ± 3.4 years old. REE was significantly higher in the HIV group (1254.4 ± 334.7 kcal/day vs. 1124.7 ± 321 kcal/day, p = 0.013) than in the control group. Fat-free mass (FFM) was lower in the HIV group (28.2 ± 10.5 kg vs. 32 ± 11.2 kg, p = 0.001); this trend continued when the index skeletal muscle was evaluated (7.2 ± 1.2 vs. 7.6 ± 1.5, p = 0.04). The strength of the dominant hand was also lower in the HIV group (12 (8–18) kg vs. 20 (10.5–26) kg, p < 0.0001).ConclusionsChildren with asymptomatic HIV infection have higher REE than their uninfected peers. They also present decreased FFM, skeletal muscle mass index, and muscle strength. These parameters should be considered during nutritional assessment in this population to have a favorable impact on nutritional status and growth.

Blockchain (BC) represents a disruptive technology that has been extensively used to ensure immutability of digital transactions. Starting as an underlying mechanism in the digital currency sector, it has been applicable in a wide range of sectors and application domains. Agriculture represents a sector of significance for overall sustainability challenges that is benefiting from digitalisation and technological evolution and the enforcement of Industry 4.0 paradigm shift towards precision agriculture. Introduction of Internet of Things, and Cyber-Physical Systems increase overall complexity, with Big Data analysis and Machine Learning technologies paving the way for innovative applications. BC appears to be a promising technology for agriculture introducing new mechanisms for tracing of products and overall agricultural Supply Chain management from the farm to the fork. The authors perform a review of 152 scientific works, providing a concise summary for each and extracting current challenges and open issues for the application of BC in agriculture. By synthesizing their findings, they perform a state of the art analysis along the PESTELS framework. A large number of challenges including technological ones, create big research potential for the evolution of the area.

Here we present two cases of entomophthoramycosis in young children, these were the first cases ever diagnosed at our center. Both cases represented a diagnostic and treatment challenge. Surgical treatment was key in the management of both patients. Even though atypical disease was encountered, clinical response was obtained after surgical excision and antifungal treatment for a few months.

Vulvar masses in children are an unusual finding but their differential diagnosis is extensive. In case of solid masses, rhabdomyosarcoma (RMS) must always be considered due to the fact that it is the most common tumor in external genitals during childhood. However, RMS has a radiological appearance very similar to juvenile xanthogranuloma (JXG). We present a 16-month-old girl with a 2 cm solid mass on her left labia majora, with four overlying cutaneous papules. After imaging tests, an excisional biopsy was programmed due to high malignancy suspicion. Histopathology of the mass and one of the papules was diagnostic for JXG. After a 12-month follow-up, the patient shows no signs of relapse or complication. Deep JXG is an uncommon entity in childhood and exceptional in the genital area. Therefore, it must be included in the differential diagnosis of a solid vulvar mass, especially if accompanying yellowish xanthomatous cutaneous lesions are present.

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