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Resumen Introduccion y objetivos Los nodulos tiroideos requieren con frecuencia evaluacion mediante ecografia y puncion aspiracion con aguja fina (PAAF). No obstante, la PAAF no permite la diferenciacion entre adenoma y carcinoma folicular en lesiones de tipo IV segun la clasificacion de Bethesda. Esto provoca numerosas intervenciones quirurgicas innecesarias porque no es posible garantizar el caracter benigno de las lesiones, ni siquiera cuando la mayoria de las muestras corresponden a adenomas o incluso a otras lesiones benignas. El objetivo de este estudio es establecer si hay caracteristicas ecograficas que nos ayudarian a pronosticar el riesgo de malignidad de los nodulos con un diagnostico anatomopatologico de neoplasia folicular para conseguir un abordaje mas conservador de los nodulos sin sospecha de malignidad. Material y metodos Estudiamos 61 nodulos en 61 pacientes (51 mujeres y 10 varones) que se habian sometido a intervencion quirurgica de la glandula tiroides y tenian resultados histopatologicos de adenoma o carcinoma folicular. Se analizaron diversas caracteristicas ecograficas de los nodulos (composicion, ecogenicidad, borde, estado de calcificacion, presencia de halo y sospecha general de malignidad segun el observador) y se establecio su correlacion con el analisis histopatologico. Resultados Observamos una relacion estadisticamente significativa entre el carcinoma folicular y la presencia de calcificaciones, bordes mal definidos y la sospecha o impresion general del observador (definida por sospecha clara de signos ecograficos de malignidad, como calcificacion, borde mal definido y un nodulo solido marcadamente hipoecoico; y signos ecograficos de benignidad, como composicion ecogenica predominantemente quistica y presencia de halo hipoecogenico perinodular). Sin embargo, todas estas caracteristicas han mostrado una sensibilidad baja en el estudio que nos ocupa (30%, 30% y 50%, respectivamente). En cambio, la ausencia del signo de halo ha demostrado una sensibilidad del 100% y un valor predictivo negativo del 100% en nuestro estudio. Conclusiones La presencia de calcificaciones, los bordes mal definidos y la impresion o sospecha general de malignidad se asocian con un riesgo mayor de carcinoma folicular en nodulos tiroideos de tipo IV segun la clasificacion de Bethesda, pero su ausencia no permite pronosticar el caracter benigno de estos nodulos. En cambio, cuando se observa una lesion con signo de halo, deberia considerarse una neoplasia folicular benigna.

Trace elements play an important role in the fine-tuning of complex material properties. This study focuses on the correlation of microstructure, lattice misfit and creep properties. The compositionally complex alloy Al10Co25Cr8Fe15Ni36Ti6 (in at. %) was tuned with high melting trace elements Hf and W. The microstructure consists of a γ matrix, γ' precipitates and the Heusler phase and it is accompanied by good mechanical properties for high temperature applications. The addition of 0.5 at.% Hf to the Al10Co25Cr8Fe15Ni36Ti6 alloy resulted in more sharp-edged cubic γ′ precipitates and an increase in the Heusler phase amount. The addition of 1 at.% W led to more rounded γ′ precipitates and the dissolution of the Heusler phase. The shapes of the γ' precipitates of the alloys Al9.25Co25Cr8Fe15Ni36Ti6Hf0.25W0.5 and Al9.25Co25Cr8Fe15Ni36Ti6Hf0.5W0.25, that are the alloys of interest in this paper, create a transition from the well-rounded precipitates in the alloy with 1% W containing alloy to the sharp angular particles in the alloy with 0.5% Hf. While the lattice misfit has a direct correlation to the γ' precipitates shape, the creep rate is also related to the amount of the Heusler phase. The lattice misfit increases with decreasing corner radius of the γ' precipitates. So does the creep rate, but it also increases with the amount of Heusler phase. The microstructures were investigated by SEM and TEM, the lattice misfit was calculated from the lattice parameters obtained by synchrotron radiation measurements.

Resumen Objetivo Evaluar la relacion de la inteligencia emocional (IE) con el sindrome de burnout (BO) en los medicos de Atencion Primaria. Material y metodos Estudio descriptivo transversal. Emplazamiento todos los centros de salud y consultorios del Principado de Asturias. Participantes medicos de Atencion Primaria que esten en activo. Intervencion: en abril de 2018 se envio un cuestionario anonimo autoadministrado con variables sociodemograficas, laborales y las escalas validadas TMMS-24 (IE) y MBI (BO). Variables la variable dependiente fue el BO. Como variables independientes se tomaron las 3 dimensiones de la IE, la edad, el sexo, el estado civil, el numero de hijos, el tipo de formacion, el tipo de contrato, el tiempo trabajado, las horas de guardia, los pacientes al dia, el cupo, el ambito rural o urbano, el area sanitaria, la relacion con enfermeria/hospital y la docencia. Analisis estadistico: inferencia bayesiana. Resultados Se enviaron 647 encuestas, participando 374 sujetos (tasa de respuesta del 57,8%). La distribucion posterior de la prevalencia de BO fue del 64,5% [indice de credibilidad 95%: 59,7 a 69,2]. Encontramos asociacion del BO con las 3 dimensiones de la IE; tener mas habilidades emocionales disminuye el riesgo de presentar BO. Mostraron, ademas, incrementar la odds de prevalencia de BO la edad, el tipo de contrato, el ambito urbano y la media de pacientes/dia. Mostraron disminuir la odds de prevalencia tener hijos y ser tutor. Conclusiones Cabe destacar el elevado BO de los medicos de Atencion Primaria, mas de uno de cada 2 medicos estan quemados. Por tanto, segun resultados obtenidos, proponemos profundizar en la adquisicion de habilidades relacionadas con la IE y mejorar las condiciones laborales en Atencion Primaria.

Background and aimNo marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity.MethodsAt baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as 3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI).ResultsFifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN 1 L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN >3 L/day).ConclusionsThe type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.

Resumen Vasa previa ocurre cuando los vasos umbilicales no protegidos por el tejido placentario o cordon umbilical se situan en el segmento uterino inferior, delante de la presentacion fetal a menos de 2 cm del orificio cervical interno. Los factores de riesgo son insercion velamentosa de cordon, placenta previa, placenta succenturiata y tecnicas de reproduccion asistida. El diagnostico mediante ecografia transvaginal y Doppler color permite objetivar la presencia de vasos fetales por delante de la presentacion fetal. El manejo incluye la maduracion fetal con corticoides y cesarea electiva antes del parto. Describimos un caso clinico ocurrido en nuestro hospital.

Background The novelty of using telemedicine systems with inflammatory bowel disease (IBD) patients represents a new point of view of care delivery. However, different factors such as the acceptance and access to telematic means, the digital literacy of the population and health professionals, as well as other objective and subjective factors in their use must be weighed in order to implement this type of programs. Thus, we propose a multicenter study in different IBD units of Spanish centers with availability of telemedicine programs for clinical follow-up and/or determination of fecal calprotectin at home. Methods Cross-sectional observational study. IBD monographic units around national territory with available telemedicine programs were contacted. They were requested to answer to specific questionnaires by professionals (10 questions) and by patients (18 questions), all of them compound by closed-ended questions with a 5-item Likert scale and short answer questions. The closed-ended questions underwent quantitative analysis, while the short answer questions underwent qualitative analysis using the SWOT method. Results To abstract date, 18 IBD units joined to the study, including 21 health professionals and 44 patients. The mean score for the closed-ended questions was 26.45 ± 7.32 out of 40 points for health professionals (6.6/10) and 52.67 ± 23.54 out of 72 points for patients (7.3/10). The SWOT analysis identified as weaknesses: lack of integration with the computer system of the centers; threats: low perceived usefulness, flaws in the design of the application; and strengths: free telematic system and fecal calprotectin collection kits, reduction of visits to the healthcare center, simple collection method and analysis of fecal calprotectin at home. Conclusion The development of telemedicine systems in IBD units in our country is still limited. Users, patients and professionals, perceive some problems in its use that lead to its underuse and abandonment. Implementing improvement measures represents an opportunity to increase their acceptance and to incorporate this kind of programs into daily practice.

Introduction Patients with Schizophrenia Spectrum Disorders (SSD) often lead unhealthy lifestyles with higher prevalence of obesity and unfavourable cardiometabolic parameters with less life expectancy and often worse quality of life compared with general population. Objectives Evaluate the effectiveness of a combined intervention of exercise and psychoeducation in 48 SSD outpatients with metabolic syndrome (MetS), treated with second-generation antipsychotics and also aimed to explore if the effect persisted in a long-term follow-up of 24 months. Methods The intervention included a 12-week aerobic exercise program and a session of lifestyle psychoeducation. Effectiveness was measured in terms a wide range of outcomes involving physical and psychological health, functioning, quality of life, physical activity and changes in motivation to exercise in the context of the self-determination theory. Results The active intervention group showed benefits after Bonferroni correction over clinical global impression, identified motivation to exercise and changes of physical activity pattern. Maintenance of effects after 24 months of follow-up was observed for identified regulation to exercise and also for negative symptoms of psychosis (Table). Table. Effects assigned-group/time-over *p≤0.05 **p≤0.01. Variables 12weeks 24months Time Groupxtime Groupx timex gender p p p p p HDL (mg/dl) 0.021* Negative Syndrome Scale 0.044* 0.004** BREQ-2- Extrinsic regulation 0.008** 0.004** -External 0.026* -Introyected 0.038* -Identified 0.018* 0.015* 0.003** 0.002** BREQ-2-Intrinsic regulation 0.005** 0.004** Pedometer (steps/day) 0.001** 0.006** Conclusions A combined intervention on SSD outpatients with MetS showed effectiveness over several clinical parameters and functioning. Therefore, should be considered an essential part of the integral treatment in mental health services for SSD patients. Disclosure No significant relationships.

Resumen Objetivo El objetivo principal de este estudio es analizar el manejo de las urgencias pediatricas en atencion primaria por parte de los medicos de familia. El objetivo secundario es estimar el grado de adecuacion de las derivaciones hospitalarias. Material y metodos Se realizo un estudio observacional descriptivo retrospectivo. Se analizaron las visitas realizadas por los menores de 14 anos atendidos a lo largo de un ano en horario de atencion continuada en una zona basica de salud, tras un muestreo aleatorio por conglomerados monoetapico de 45 dias. Resultados Se atendieron un total de 447 consultas urgentes por pacientes en edad pediatrica, con una media de edad de 6,83 anos (DE = 3,82). Se resolvieron in situ el 92,8% de las consultas urgentes realizadas por menores de 14 anos. El porcentaje de derivaciones al servicio hospitalario fue del 7,2% (IC 95%: 4,9-10). Al 56% (IC 95%: 37,7-73,6) de los ninos derivados se les realizo algun tipo de intervencion hospitalaria (pruebas, tratamientos, valoracion por otros especialistas no pediatras, observacion y/o ingreso). Conclusiones La tasa de derivacion fue del 7,2%, que situa en el limite alto de lo encontrado en otros estudios. La mitad de los pacientes derivados requirieron algun tipo de intervencion, por lo que podrian considerarse derivaciones justificadas. Ademas, se ha encontrado una buena concordancia (indice kappa = 0,778) entre los diagnosticos desde atencion primaria y el diagnostico final de pediatria, por lo que se puede inferir que los diagnosticos realizados en edad pediatrica por medicos de familia son acertados.

As the electric companies need to assure the reliability of their services, power line management gains importance during the last years. Many of them rely on LiDAR scanning of their assets to obtain the status of their power line corridors and determine possible risks. In this paper, a novel sevenfold staged pipeline is introduced to classify pylon and wire points and model the conductors. Wire points are subdivided into three categories: shield, common conductor and chain. Pylons of two different types are taken into account: suspension and anchor. For the first case, insulator strains are also identified and separated. Wire points are segmented as individual conductors and a 3D-wise model based on the catenary equation is generated for each conductor using particle swarm optimization. Tests have been conducted on a set with 25 point cloud files to assess the accuracy and correctness of the results given by the proposed pipeline.

Resumen Objetivo Estimar la efectividad del cribado selectivo frente al universal en la deteccion de disfuncion tiroidea (DT) en el embarazo en condiciones de practica clinica. Material y metodos Estudio de diseno transversal basado en la identificacion de gestantes con factores de riesgo (FR) de DT en una cohorte de 220 mujeres con cribado poblacional positivo. El estudio se desarrollo en el Area Sanitaria de Oviedo entre abril del 2010 y marzo del 2011. Resultados Se identificaron FR en el 83,6% de las gestantes con DT. Los FR mas prevalentes fueron la edad ≥ 30 anos (70,5%), la historia de abortos previos (21,8%) y la historia familiar de patologia tiroidea (20,9%). Sin tener en cuenta la edad, solo el 51,8% de las gestantes presentaba FR. Conclusiones El cribado selectivo logra identificar una elevada proporcion de gestantes con DT pero a expensas de incluir en el cribado a un gran numero de mujeres, por lo que no parece una estrategia efectiva.

The linear non-threshold model (LNTM) is a theoretical dose-response function as a result of extrapolating the late effects of high-dose exposure to ionizing radiation to the low-dose range, but there is great uncertainty about its validity. The acceptance of LNTM as the dominant probabilistic model have survived to the present day and it is actually the cornerstone of current radiation protection policies. In the last decades, advances in molecular and evolutive biology, cancer immunology, and many epidemiological and animal studies have cast serious doubts about the reliability of the NLTM, as well as suggesting alternative models, like the hormetic theory. Considering the given evidences, a discussion between the involved scientific societies and the regulatory commissions is promtly required in order to to reach a redefiniton of theradiation protection basis, as it would be specially crucial in the medical field.

Thyroid nodules frequently require ultrasound and Fine Needle Aspiration Cytology (FNAC) evaluation. However, FNA cytology does not allow differentiation between follicular adenoma and carcinoma on Bethesda type IV lesions. This situation leads to many unnecessary surgical procedures because it is not possible to assure the benignity of the lesions, even when most of the specimens correspond to adenomas or even other benign lesions. The objective in this study is to establish if there are any US characteristics that would help us to predict the risk of malignancy of nodules with a pathological diagnosis of follicular neoplasm in order to achieve a more conservative management for non-suspicious nodules.We studied 61 nodules in 61 patients (51 women and 10 men) that underwent thyroid surgery and had histopathological results of either follicular adenoma or carcinoma. Different US characteristics of the nodules were analysed (composition, echogenicity, margin, calcification status, the presence of halo and overall observer suspicion of malignancy) and were correlated with the histopathological analysis.We have found a statistically significant association between the presence of calcifications, ill-defined borders and overall observer suspicion or impression (defined by well-known suspicious for malignancy ultrasonographic features, such as calcification, poorly defined margin, and a markedly hypoechoic solid nodule; and benign ultrasonographic features, such as predominantly cystic echogenic composition and the presence of a perinodular hypoechogenic halo) with follicular carcinoma. However all those features have shown low sensitivities in the present study (30%, 30% and 50%, respectively). On the other hand, the absence of halo sign has shown a sensitivity of 100% and a negative predictive value (NPV) of 100% in our study.The presence of calcifications, ill-defined borders and the overall impression or suspicion of malignancy are associated with a higher risk for follicular carcinoma in Bethesda type IV thyroid nodules but their absence does not allow to predict benignity in these nodules. Inversely, when a halo sign lesion is observed, benign follicular neoplasm should be considered.

This paper analyses the antioxidant enzymes response of Mytilus galloprovincialis exposed to a tar mixture during a laboratory assay. These tar mixtures are generally used in the cleaning and waterproofing of the wooden rafts used in mussel culture, and are characterized by their high content in PAHs and transition metals. The punctual spillage of these mixtures around the rafts could cause mussel stress, affecting culture sustainability and product quality for human consumption. The analysis of kinetic parameters and specific activity of the enzymes analysed revealed important tissue differences, which can be summarized as high affinity for reactive species in gills, and high antioxidant efficiency in digestive gland and mantle tissue. Furthermore, the analysis of variance demonstrates dose- and time-dependent response of most enzymes to tar exposure, as well as influence of the dose-time interaction. Antioxidative metabolism of gills constitutes an early response against pollution-stimulated ROS production and is mainly mediated by SOD and CAT activities. While antioxidant defence of digestive gland and mantle is carried out mainly by peroxidases and glyoxalases. These results suggest the necessity of taking into account the integrated antioxidant response of different organs from bioindicator species in toxicological studies. Multivariate analysis of all data obtained corroborates the antioxidant tissular differences, and highlights the activities SOD of gills, GST of digestive gland and Se-GPX of mantle from mussels as suitable biomarkers of PAHs pollution. In the natural environment, the relationship of these enzyme activities, independently of their seasonal or physiologic variation, discriminates between different PAHs and Pb concentrations accumulated in mussels, validating their utility in the assessment of aquaculture areas quality. Financiado para publicación en acceso aberto: Universidade de Vigo/CISUG

Traditionally the study of chemical elements has been limited to well-known concepts like the periodic properties and chemical families. However, current information shows a new and rich language that allows us to observe relations in the elements that are not limited to their positions in the table. These relations are evident when reactions are represented through networks, as in the case of similar reactivity of organic compounds sharing functional groups. For the past two decades, it has been argued that network reactions may be considered the core of chemistry. This network, which constitutes the basic set of chemical knowledge, provides the basis for classification and delivers routes to obtain new and known substances. In order to provide an example, we constructed and analyzed a network of chemical elements from the formation of stoichiometric binary compounds, providing to the chemistry, a formal structure of extracting the chemical knowledge. Thus, we explored all possible presence of relationships among elements. Concepts like degree centrality and centralization, the relationships among metals, semimetal and nonmetal classes, blocks, and chemical families were analyzed. We observed that the network structure had a small core set of elements of high reactivity and also a peripheral set of elements of low reactivity. The classes, blocks and families show the following increasing order of reactivity: nonmetals > semimetals > metals; p > s > d > f; and families: boron, carbon, pnictogens, chalcogens, halogens, lanthanoids > other families. This example shows, from the network perspective, that the elements and their classifications exhibit properties such as the reactivity, order, and similarity.

In this paper, a novel approach to the on-screen reordering of geolocated marks for geographical information system is proposed. This self-organizing set of marks, called Non-Overlapping Marks , relies on a real-time simulation of a physical model of point masses. This work presents the challenges of displaying a high number of such georeferenced features on 2D and 3D maps, and the goals that the final mark distribution should achieve. It is described how the proposed model uses electrostatic and elastic forces, among others, to improve the marks readability. Moreover, the proposed system has been fully implemented on a virtual globe framework. The final part of this work addresses experimentally the margins of usability of the proposed system.

Many organizations of all kinds are using new technologies to assist the acquisition and analysis of data. Seaports are a good example of this trend. Seaports generate data regarding the management of marine traffic and other elements, as well as environmental conditions given by meteorological sensors and buoys. However, this enormous amount of data, also known as Big Data, is useless without a proper system to organize, analyze and visualize it. SmartPort is an online platform for the visualization and management of a seaport data that has been built as a GIS application. This work offers a Rich Internet Application that allows the user to visualize and manage the different sources of information produced in a port environment. The Big Data management is based on the FIWARE platform, as well as “The Internet of Things” solutions for the data acquisition. At the same time, Glob3 Mobile (G3M) framework has been used for the development of map requirements. In this way, SmartPort supports 3D visualization of the ports scenery and its data sources.

Resumen La especie Bifidobacterium scardovii esta constituida por bacilos gram positivos anaerobios facultativos, cuyo desarrollo es estimulado por el CO 2 y la anaerobiosis. Excepcionalmente se la ha asociado a infecciones humanas. Se presenta el caso de un paciente anoso con infeccion urinaria por B. scardovii y Enterococcus faecalis , ambos microorganismos aislados en 2 urocultivos consecutivos . El bacilo no desarrollo en los medios de cultivo habituales, pero si en agar chocolate en CO 2 y en agar Brucella suplementado, incubados durante 72 h a 35 °C. La coloracion de Gram alerto acerca de su presencia al observarse abundantes bacilos gram positivos irregulares con extremos bifurcados en forma de Y, y escasos cocos gram positivos. Es importante la coloracion de Gram en orinas con piuria y la siembra en medios enriquecidos por tiempos prolongados. En este caso, sin el resultado del Gram y con el desarrollo de E. faecalis , no hubiesemos advertido la presencia del agente mayoritario.

The stress response of turbot Scophthalmus maximus was evaluated in fish maintained 8 days under different water depths, normal (NWD, 30 cm depth, total water volume 40 l) or low (LWD, 5 cm depth, total water volume 10 l), in the additional presence of infection–infestation of two pathogens of this species. This was caused by intraperitoneal injection of sublethal doses of the bacterium Aeromonas salmonicida subsp. salmonicida or the parasite Philasterides dicentrarchi (Ciliophora:Scuticociliatida). The LWD conditions were stressful for fish, causing increased levels of cortisol in plasma, decreased levels of glycogen in liver and nicotinamide adenine dinucleotide phosphate (NADP) and increased activities of G6Pase and GSase. The presence of bacteria or parasites in fish under NWD resulted in increased cortisol levels in plasma whereas in liver, changes were of minor importance including decreased levels of lactate and GSase activity. The simultaneous presence of bacteria and parasites in fish under NWD resulted a sharp increase in the levels of cortisol in plasma and decreased levels of glucose. Decreased levels of glycogen and lactate and activities of GSase and glutathione reductase (GR), as well as increased activities of glucose-6-phosphate dehydrogenase (G6PDH), 6-phosphogluconate dehydrogenase (6PGDH) and levels of nicotinamide adenine dinucleotide phosphate (NADPH) occurred in the same fish in liver. Finally, the presence of pathogens in S. maximus under stressful conditions elicited by LWD resulted in synergistic actions of both type of stressors in cortisol levels. In liver, the presence of bacteria or parasites induced a synergistic action on several variables such as decreased activities of G6Pase and GSase as well as increased levels of NADP and NADPH and increased activities of GPase, G6PDH and 6PGDH.

Two cases of insidious bacteremia by uncommon curve and spiral-shaped, motile anaerobic gram-negative rods are presented. Both of them were of an unclear origin and occurred in immunosuppressed patients with simultaneous diseases. The key tests for the identification of Anaerobiospirillum were its micromorphology, a strictly anaerobic condition, negative catalase activity, the special-potency disk profile, glucose fermentation, and β-NAG production. Desulfovibrio species was identified by all the above preliminary tests but with a different disk profile, as well as for being asaccharolytic and desulfoviridin and H2S producer. We here alert about the resistance or intermediate susceptibility of Anaerobiospirillum succiniciproducens against antimicrobial agents, such as metronidazole, one of the first-line drugs used for the treatment of anaerobic gram-negative infections. Aminopenicillins with β-lactamase-inhibitor combinations and imipenem were active for this agent. Desulfovibrio desulfuricans was β-lactamase producer and resistant to cephalosporins, while metronidazole, imipenem and levofloxacin were active. A reliable identification of these microorganisms is important for establishing the best therapeutic scheme.

The influence of visitors on the welfare of captive animals, known as the visitor effect, may in some instances be stressful, adversely affecting animal health. Although the survival of many felid species depends on captive breeding programmes, little is known about this effect. A better understanding of the visitor effect is required to ensure the well-being of felids and the success of breeding programmes. We sought to determine whether the presence of visitors affects behaviour patterns and space use in five feline species in two Spanish zoos: Eurasian lynx (Lynx lynx), jaguar (Panthera onca), bobcat (Lynx rufus),ocelot (Leopardus pardalis) and Asiatic lion (Panthera leo persica) and, if so, whether the effect on animal welfare is positive or negative. To our knowledge, no previous research has addressed the visitor effect in these species, with the exception of the jaguar. Data on animal behaviour, enclosure use, and visitor density were collected during the spring and summer of 2011 and 2012. Changes were observed for all studied species when the zoo was open to the public: four species devoted less time to complex behaviour (ie play, walk) and spent more time resting; ocelots and bobcats made more use of hidden spaces and less use of areas closer to visitors, while the jaguar tended to do the opposite. No correlation was found between visitor density and animal activity, indicating that animals are affected by the mere presence of visitors, regardless of their number. Our findings are in line with those reported by other authors, who have suggested that these behavioural changes are linked to chronic stress. Visitor effect was classed as negative for the welfare of all studied species apart from the jaguar. We advocate the need for future research into potential solutions to mitigate the adverse effect of visitors on felids.

Background Inflammatory Bowel Disease patients (IBD) are in a higher risk of colorectal cancer (CRC) than the general population. Studies show that surveillance with chromoendoscopy (CE) is useful for prevention as it detects a higher number of dysplastic lesions, allowing their endoscopic resection and therefore preventing CRC. We aimed to assess our endoscopic results in IBD patients with previous diagnose of dysplasia. Methods We performed a retrospective data collection from IBD patients who have had dysplastic lesions in screening chromoendoscopy, performed in our hospital from January 2013 to June 2019. Demographic and clinical data at basal time were collected, as well as endoscopic and histological findings in basal chromoendoscopy and in the first follow-up Results 353 chromoendoscopies were performed in our Endoscopy Unit in this period and 50 patients showed dysplastic lesions. 14 (28%) of them had already had dysplasia in previous colonoscopies, which were performed with white light and aleatory biopsies. Basal characteristics are shown in the following table. In the initial chromoendoscopy, an average of 2.57 dysplastic lesions with an average size of 7.59 mm was detected. 70.8% were flat lesions (0-IIa/0-IIb Paris classification) and 53% were located distal to the splenic flexure. 85.7% were tubular adenomas low-grade dysplasia (LGD), 2 cases of high-grade dysplasia (HGD), one serrated polyp and one adenocarcinoma. Twenty-nine follow-up chromoendoscopy have been performed and new dysplasia lesions were found in 41.37% (average of 1.86 lesions, median 8 mm). 55.6% of the lesions were tubular adenomas LGD and 11.1% serrated adenomas LGD. Our analysis shows that patients with new lesions in the second chromoendoscopy had had worse bowel preparation on the first one (7.5 vs. 8.9, p = 0,006). We also found that these patients with new lesions had more flat lesions than sessile ones (70.6% Paris IIa, 23.5% IIb, 5.9% Is, p < 0,005). Conclusion Surveillance with chromoendoscopy in IBD patients with previous dysplastic lesions detects new dysplasia in 28% of them and LGD is the most frequent histology. In our sample, finding flat lesions or worse bowel cleaning in the first chromoendoscopy predicts having a higher number of lesions on the follow-up.

Background Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer. Dye-based chromoendoscopy (CE) is the currently recommended method for the detection of dysplasia in IBD surveillance colonoscopy; the role of virtual chromoendoscopy (VCE) is not yet well defined. To compare CE with VCE using iSCAN1 digital image enhanced colonoscopy in the detection of colonic neoplastic lesions in IBD patients. Methods Randomised, single-centre trial to assess the detection rate of colonic neoplastic lesions in patients with long-standing IBD. Patients were randomised in two arms: dye-spraying CE using indigo carmine and electronic VCE using iSCAN1 digital image. Detection rates of dysplasia or any neoplastic lesion were compared by the two endoscopic techniques. Results A total of 129 patients were studied (67 by CE and 62 by VCE). Demographic and clinical characteristics were homogeneous in the two groups; 26 Crohn′s disease and 103 ulcerative colitis, 52% women, mean age 50 years, median duration of IBD 204 months, family history of colorectal cancer in 10 (8%), associated primary sclerosing cholangitis in 8 (6%), personal history of colorectal dysplastic lesions in 12 (9%), and more than 50% colonic involvement in 72 (56%). In total, 27 lesions (9 hyperplastic, 8 adenomatous and 10 low-grade dysplasia) were detected in 23 patients, without differences between CE and VCE arms (15 [22%] and 12 [19%] lesions, respectively; p = 0.98); on the other hand, neoplastic lesion (dysplasia or adenoma) detection rates was similar (12 [18%] in CE and 6 [10%] in VCE arms, p = 0.2). The duration of the withdrawal time of colonoscopy in minutes for patients in the CE group was median 14 min and in the VCE group was median 10 min (p < 0.001). Conclusion There is no statistical difference between CE and VCE using iSCAN1 in the detection rate of colonic neoplastic lesions in IBD patients. Surveillance colonoscopy with VCE (iSCAN1) spends less time than conventional CE.

The purpose of this study is to analyse the relationship between emotional intelligence (EI) and burnout syndrome (BOS) in doctors in Primary Health Care.Cross-sectional descriptive study.All healthcare centres and clinics in Asturias.Doctors of Primary Health Care who are active.In April 2018, an anonymous self-administered questionnaire was sent to all concerned. It included sociodemographic data, employment data, and TMMS-24 (EI) and MBI (BOS) validated scales.BOS as a dependent variable. Three dimensions of EI, age, sex, marital status, number of children, form of training, contract type, time worked, on-call hours, number of patients per day, quota, rural or urban setting, healthcare area, relationship with nursing/hospital, and teaching as independent variables.Bayesian inference.A total of 647 questionnaires were sent, and 374 subjects took part in the study (response rate: 57.8%). The subsequent distribution of BOS prevalence was 64.5% [95% credibility index: 59.7-69.2]. BOS was associated with 3 dimensions of the EI, and to have higher social skills decreased the risk of presenting with BOS. Age, contract type, urban setting, and number of patients per day tended to increase the odds of prevalence of BOS. Having children or being a guardian tended to decrease the odds of prevalence.The high level of BOS in Primary Health Care doctors should be pointed out, with more than one out of 2 doctors having burnout. Therefore, we suggest looking into how emotional skills are achieved, and also how to improve working conditions in Primary Health Care.

Infection of large vessel prostheses is a rare but critical complication. The aim of this work is to assess the impact of PET/CT with 18F-Fluordesoxyglucose (PET-FDG) on the diagnosis of infection in our environment.Thirty-five patients (38 scans) were evaluated for suspected prosthetic infection. A qualitative analysis was performed taking into account the distribution of the radiopharmaceutical, categorizing the studies as positive or negative for infection. Those with focal or multifocal deposits along the vascular prosthesis were considered positive, and negative if a homogeneous and diffuse distribution over the whole prosthesis was observed, or a total absence of uptake. A semi-quantitative analysis was performed using SUVmax and average SUV values, and a metabolic index was calculated (SUVmax of the graft / average SUV of the normal vascular pool).The PET-FDG study was positive in 20 patients, with a diagnostic accuracy of 84%. The 38 PET-FDG scans performed showed positive capture patterns (focal in 6, multifocal in 15, diffuse in 4) and negative pattern in the remaining 13. The sensitivity, specificity, positive and negative predictive values obtained for the PET-FDG were 95%, 89%, 90% and 94%, and for the AngioTC study 50%, 73%, 73% and 50%, respectively. The area values under the ROC curve were as follows: for the AngioTC 0.642 (not significant), and for the SUVmax values of 0.925 (p0.005), average SUV of 0.922 (p0.005) and for the metabolic index of 0.917 (p0.005).The PET-FDG proves to be a tool with high diagnostic accuracy in the infection of vascular prosthesis, both visual analysis according to patterns and semi-quantitative.

The main objective of this study is to analyse the management of paediatric emergencies by Family Doctors in Primary Care. The secondary objective is to determine the appropriateness of hospital referrals.A retrospective, observational, and descriptive study was performed. An analysis was carried out on the visits made by children less than 14years-old during one year in continued care opening hours in a basic health area, after single-stage cluster random sampling of 45days.A total of 447 emergency consultations were made by paediatric patients with a mean age of 6.83years (SD=3.82). Almost all (92.8%) the emergency consultations made by children less than 14years were resolved in situ. The referral rate to hospitals was 7.2% (95%CI: 4.9-10). Just over half (56%: 95%CI: 37.7-73.6) of the children referred had some type of hospital intervention (tests, treatments, assessments by other non-paediatric specialists, observation and or admission).The referral rate was 7.2%, which is in the upper limit of that found in other studies. Just over half of the children required some type of intervention, which could be considered as justified referrals. Furthermore, good agreement was found (Kappa index=0.778) between the diagnosis from Primary Care and the final diagnosis by paediatricians, inferring that the diagnosis made on paediatric patients by Family Doctors are correct.

We have introduced here the concept of Hamiltonian triangular refinement. For any Hamiltonian triangulation it is shown that there is a refinement which is also a Hamiltonian triangulation and the corresponding Hamiltonian path preserves the nesting condition of the corresponding space-filling curve. We have proved that the number of such Hamiltonian triangular refinements is bounded from below and from above. The relation between Hamiltonian triangular refinements and space-filling curves is also explored and explained.

In this note we analyse the classical longest-edge n-section algorithm applied to the simplicial partition in Rd, and prove that an infinite sequence of simplices violating the Zlamal minimum angle condition, often required in finite element analysis and computer graphics, is unavoidably produced if n ≥ 4. This result implies the fact that the number of different simplicial shapes produced by this version of n-section algorithms is always infinite for any n ≥ 4.

Showing whether the longest-edge (LE) bisection of tetrahedra meshes degenerates the stability condition or not is still an open problem. Some reasons, in part, are due to the cost for achieving the computation of similarity classes of millions of tetrahedra. We prove the existence of tetrahedra where the LE bisection introduces, at most, 37 similarity classes. This family of new tetrahedra was roughly pointed out by Adler in 1983. However, as far as we know, there has been no evidence confirming its existence. We also introduce a new data structure and algorithm for computing the number of similarity tetrahedral classes based on integer arithmetic, storing only the square of edges. The algorithm lets us perform compact and efficient high-level similarity class computations with a cost that is only dependent on the number of similarity classes.

Resumen Objetivo Valorar la concordancia diagnostica en la interpretacion de retinografias entre el medico de atencion primaria y el oftalmologo, asi como presentar los indices de validez de un programa de cribado de retinopatia diabetica durante su fase de implantacion. Material y metodos Estudio descriptivo observacional de una muestra de 243 pacientes diabeticos (tipo 1 y 2) mayores de 14 anos, de 2 centros de salud urbanos, captada de manera oportunista cuando acudian a consulta entre el 21/07/2011 y el 26/01/2012. Se les realizo retinografia digital bilateral de campo unico a 45°, toma de presion intraocular y agudeza visual. Los medicos de atencion primaria elaboraban un informe que se remitia junto con las retinografias telematicamente al oftalmologo, quien revisaba las imagenes y generaba un nuevo informe con su diagnostico. La ausencia de retinografia y/o informe valorables se consideraron como perdidas. Se estimaron la concordancia diagnostica entre los observadores y los indices de validez del programa de cribado. Resultados Se obtuvo un indice kappa de 0,62 (IC 95% 0,42-0,82) y un indice PABAK de 0,89 tras ajustar por prevalencia y sesgos. Se obtuvieron los siguientes indices de validez: sensibilidad 68,8%, especificidad 96,5%, valores predictivos positivo y negativo del 61,1 y 97,5%, respectivamente. El 57,2% de los pacientes no presento enfermedad que requiriera derivacion al oftalmologo. Conclusiones El grado de concordancia obtenido varia entre considerable/casi perfecto dependiendo del indice usado en el analisis (kappa/PABAK, respectivamente). La realizacion de retinografias en los centros de salud mejora la capacidad resolutiva del medico de atencion primaria y la accesibilidad de los pacientes al cribado.

This report describes a two-month-old Ouessant ram lamb with hind limb ataxia, knuckling and falling attributable to an abscess in the thoracic vertebral region. A swelling palpated adjacent to the spinous processes of the 9th to 12th thoracic vertebrae was identified via ultrasonography as an abscess located on the transverse processes of these vertebrae. Magnetic resonance imaging of the lamb postmortem revealed that the abscess had invaded the vertebral canal through a channel at the level of the 9th thoracic vertebra causing extradural spinal cord compression. Postmortem examination confirmed these findings, and histological examination showed acute spinal cord degeneration.Es wird ein 2 Monate altes, männliches Ouessant-Schaf mit Abszess im Bereich der thorakalen Wirbelsäule beschrieben. Die wichtigsten klinische Befunde waren Nachhandataxie, Überköten hinten beidseits, Schwanken der Nachhand und Umfallen. Bei der Adspektion und Palpation wurde neben den Dornfortsätzen der Brustwirbel 9 bis 12 eine Umfangsvermehrung festgestellt. Diese stellte sich bei der Ultraschalluntersuchung als kavitäre Läsion dar (Verdacht auf Abszessbildung), welche seitlich auf den Querfortsätzen der Brustwirbel lag. Das Schaf wurde euthanasiert. Bei der postmortem durchgeführten MRT-Untersuchung (Magnetresonanztomographie) konnten Ausmass und Lage des Abszesses genau charakterisiert werden. Auf Höhe von T9 war ein Kanal zu sehen, der vom Abszess ausging und sich in den Wirbelkanal erstreckte und das Rückenmark komprimierte. Die Sektion bestätigte die MRI-Befunde. Histologisch war an der Kompressionsstelle eine akute Degeneration des Rückenmarks zu sehen, welche für die klinischen Symptome verantwortlich war.

In this paper we survey all known (including own recent results) properties of the longest-edge n -section algorithms. These algorithms (in classical and recently designed conforming form) are nowadays used in many applications, including finite element simulations, computer graphics, etc. as a reliable tool for controllable mesh generation. In addition, we present a list of open problems arising in and around this topic.

The incidence of prosthetic shoulder replacements has increased considerably in recent years, as well as the complications derived from the procedure. The correct diagnosis of each type of complication is essential for therapeutic decision making, which is currently based on the information provided by radiological and nuclear medicine imaging. Nevertheless, both techniques have intrinsic limitations that could be mostly overcome with the advent of the hybrid SPECT/CT imaging, which is set to play a fundamental role in the evaluation of shoulder prostheses.

Neurological symptoms in patients with cat-scratch disease (CSD) have been rarely reported. The aim of this study is to analyze the frequency of neurological CSD (NCSD) and describe the disease clinical presentation, management and outcome. We retrospectively selected patients with a CSD syndrome and Bartonella IgG titers > 1:256. Data regarding epidemiological, clinical, management, and follow-up features were analyzed and discussed. A comparison between NCSD and non-neurological CSD (NNCSD) was established. Thirty-nine CSD patients were selected. NCSD frequency was 10.25%. No children were found affected in the NCSD group. A 65.7% of NNCSD and the entirety of the NCSD group had a history of cat exposure. Immunosuppression was only present in the NNCSD group (8.6%). NCSD presentations were as follows: isolated aseptic meningitis (25%), neuroretinitis (50%), and isolated optic neuritis (25%). A greater proportion of patients in the NCSD group had fever and raised levels of acute phase reactants and white blood cells. 85.7% of NNCSD had a complete recovery, whereas only 50% of the NCSD patients experienced a full recovery. NCSD may be a distinctive group compared to NNCSD due to its later age of presentation, the more intense systemic response, and the poorer outcome.

The aim of this study is to determine the risk factors involved in the development of these fractures and analyze the treatments used as well as their influence on the clinical and functional prognosis of patients.We made an observational, retrospective case-control study, with a sample of 38 patients (40 femoral bones) operated in our hospital, who had two femoral ipsilateral implants, proximal and distal. We found 10 cases of interimplant fracture and 28 patients who had not suffered a fracture (2 of them had bilateral implants). We analyzed the influence of different variables, such as age, gender, comorbidities, radiological variables, type of treatments employed, clinical evolution, etc. RESULTS: the female sex was predominant in both groups, 80.7 was the average age. Osteoporosis was statistically significant (P=.007) for the development of these fractures. We did not find statistical significance in the radiological variables. Surgical treatment was the most frequent, and the plate of osteosynthesis the most employed option. We found a death rate of 40% at 4 years. Although all fractures healed, the survivors' ambulation ability was reduced.interimplant fractures are predominant in elderly women. Osteoporosis is a statistically significant risk factor. Despite optimal treatment and fracture healing, functional outcomes were decreased. Specific classification systems and therapeutic algorithms are necessary to improve the management and prognosis of these patients.

On the basis of traditional Terrain Quadtree algorithms this paper introduces a new Level Of Detail (LoD) criteria which allows the visualization of a virtual earth on many kinds of mobile devices with a suitable accuracy. The earth rendering system is intended to run beneath the threshold that resources of current devices impose, regarding especially the graphics hardware capabilities and the memory usage. At the same time, the system deals flawless with typical screen-based user interaction allowing smooth flying and rapid orientation changes of the camera. The present work analyses the memory and graphics requirements from a theoretical perspective. Finally, we give a useful performance study that compares the globe on some mobile and desktop devices, focusing on LoD techniques, visibility test, creation of texture tiles, uploading tiles to GPU, and rendering.

We prove that both, the repeated interior point based subdivision and the LE m -section ( m ? 4 ) of an initial n -simplex in R n ( n ? 2 ) , produce a sequence of simplicial meshes with minimum interior solid angles converging to zero.

In this note we introduce the conforming longest-edge n-section algorithm and show that for n ? 4 it produces a family of triangulations which does not satisfy the maximum angle condition.

Social media can be an excellent tool in the training of future doctors, but also in their future work. For this, future health professionals should know basic concepts such as "personal brand" or know how to manage the privacy settings when sharing certain information in their personal profiles. The aim of this study was to evaluate the changes in the perception and knowledge of medical students comparing the results of a survey before and after receiving a specialized training course. Issues such as whether they would be willing to put their personal accounts on their curriculum vitae or to hire erasure services in the network that minimize their fingerprint. During the 2016-17 academic year a 2-hour course was taught by a sixth-year student and social networking expert. One week before the course and one month later an online survey of 16 questions was conducted and the results compared. The previous (pre) survey was answered by 107 students, while the post (post) survey was answered by 72. After the course, one of the first results was an increase in the number of students who knew social networks specialized in Medicine. There are no significant changes in the way networks use, but there is an increase in the concern to publish reliable and proven medical information. An undesirable effect of the course is that there was an increase in the concern about a possible negative effect on their future of the information they share in social networks, which can be positive because, despite this, there is an increase in the Number of students who would add their user on social networks in their curriculum. There is also an increase in the number of students who affirm that social networks can be useful in their current training and in their future work, also in the knowledge of basic concepts as personal brand. In conclusion, a brief course on basic concepts of social media and their applications in Medicine improves the students' concern about the related knowledge and about the potential positive in both their training and their future work. For this reason, social media should be included in curriculum design in Medicine and, probably, in other university degrees.

A new edge-based partition for triangle meshes is presented, the Seven Triangle Quasi-Delaunay partition (7T-QD). The proposed partition joins together ideas of the Seven Triangle Longest-Edge partition (7T-LE), and the classical criteria for constructing Delaunay meshes. The new partition performs similarly compared to the Delaunay triangulation (7T-D) with the benefit of being more robust and with a cheaper cost in computation. It will be proved that in most of the cases the 7T-QD is equal to the 7T-D. In addition, numerical tests will show that the difference on the minimum angle obtained by the 7T-QD and by the 7T-D is negligible.

The Longest-Edge (LE) trisection of a triangle is obtained by joining the two points which divide the longest edge in three with the opposite vertex. If LE-trisection is iteratively applied to an initial triangle, then the maximum diameter of the resulting triangles is between two sharpened decreasing functions. This paper mathematically answers the question of how fast the diameters of a triangle mesh tend to zero as repeated trisection is performed, and completes the previous empirical studies presented in the MASCOT 2010 Meeting (Perdomo et al., 2010).