Search

Frailty is associated with increased mortality and hospitalizations in patients with heart failure (HF). However, there is little evidence regarding the burden of morbidity. In this study, we aimed to assess the association between frailty and recurrent all-cause HF hospitalizations in patients with stable chronic HF. This was an observational and prospective study that enrolled HF outpatients followed in a specialized HF unit of a single tertiary care center from 2017 to 2019. Frailty was assessed by Fried criteria. Robustness, prefrailty, and frailty were defined as 0, 1 to 2, and ≥3, respectively. The independent association between frailty status and recurrent hospitalizations was assessed through Famoye's bivariate Poisson regression model, and risk estimates were expressed as incidence rate ratios (IRR). A total of 277 patients were included. The mean age was 74 ± 10 years, 118 were women (42.6%), and 131 patients (47.3%) had left ventricular ejection fraction ≥50. According to Fried's score 61 patients (22%) were robust, 95 patients (34%) were prefrail, and 121 patients (44%) were frail. After a median follow-up of 2.21 (1.6 to 2.8) years, 52 patients (19%) died. We registered 348 all-cause hospitalizations in 144 patients (52%) and 178 HF hospitalizations in 108 patients (39%). Compared with robust patients, frailty was associated with a higher risk of all-cause and HF recurrent hospitalizations in multivariable analysis (IRR 2.01, 95% confidence interval 1.14 to 3.57, p = 0.017 and IRR 2.25, 95% confidence interval 1.16-4.36, p = 0.016, respectively). In conclusion, in patients with chronic HF, frailty identifies patients with an increased risk of total and recurrent all-cause and HF hospitalizations.

Complex decision-making problems can be conveniently decomposed in more manageable sub-problems through a hierarchical approach. Often, there are interaction effects between sub-criteria or elementary criteria in the hierarchy. In this paper, we propose a generalization of the recently published interval outranking approach to deal with this kind of problems. This new method allows an easy setting of weights (including interaction weights), and other model parameters as interval numbers. The proposal also allows to set outranking relations associated with each non-elementary criterion. On this background, the INTERCLASS-nB and INTERCLASS-nC multi-criteria ordinal classification (multi-criteria sorting) methods are generalized to cope with interacting and hierarchical criteria; these methods can suggest assignments of actions to ordered classes for each non-elementary criterion. Finally, an application of the classification methods is illustrated by evaluating research and development projects.

This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. The consensus has been developed by a multidisciplinary team made up of members of the Cardiovascular Risk Group of the Spanish Diabetes Society (SED). The work is a necessary update as, since the last review three years ago, there have been many clinical trials that have studied the cardiovascular outcomes of numerous drugs in the diabetic population. We believe that this guideline update may be of interest to all clinicians treating patients with diabetes.

The signature of a system is a probability vector that depends only on the system structure. Under the classic IID (independent and identically distributed) assumption on the component lifetimes, the system lifetime distribution is the convex combination of consecutive component failure times, and the signature coordinates constitute the mixture coefficients. In this case the signature representations are very useful in determining the system lifetime distributions and for stochastic comparisons of them. This first representation was obtained in 1985 by Samaniego. Then it was extended to the more general case of exchangeable component lifetimes. In 2011 Marichal, Mathonet and Waldhauser presented necessary and sufficient conditions assuring the Samaniego representation. There were expressed in terms of distributional properties of families of auxiliary indicator random vectors parametrized by positive numbers. In the paper we obtain other necessary and sufficient conditions represented in terms of the marginal distributions of component lifetimes and the dependence copula of them. Moreover, we study symmetry conditions for the equality of structural and probabilistic signatures.

Resumen Antecedentes y objetivo La prescripcion potencialmente inadecuada de un farmaco por omision se define como la no utilizacion de farmacos que si estan clinicamente indicados. El objetivo de este articulo es analizar y describir la evolucion de las prescripciones inadecuadas por omision en los residentes de los centros sociosanitarios de un departamento de salud. Material y metodos Estudio descriptivo observacional retrospectivo realizado en los centros sociosanitarios del departamento de salud Valencia-Clinico-Malvarrosa durante el periodo 2016-2018. Se incluyeron todos los pacientes institucionalizados durante este periodo. Se evaluo la prevalencia de prescripciones potencialmente inadecuadas por omision en base a la version 2 de los criterios START. Las variables provienen de las historias clinicas electronicas de atencion ambulatoria de la Conselleria de Sanitat (Abucasis). Resultados Un total de 2.251 pacientes diferentes formaron parte del estudio en el periodo seleccionado, edad media de 79,53 anos, 69% mujeres, y consumo medio de farmacos cronicos de 4,60 farmacos/residente. Se identificaron un total de 2.647 prescripciones potencialmente inadecuadas por omision en el periodo de estudio, obteniendo datos similares durante los tres anos. Los criterios START mas prevalentes fueron los vinculados al sistema musculoesqueletico y al sistema cardiovascular, y los relacionados con el consumo de analgesicos. El valor medio de prevalencia de prescripciones inadecuadas por omision en el periodo estudiado fue del 39,54%. Conclusion Los resultados de nuestro estudio confirman una elevada prevalencia de prescripciones potencialmente inadecuadas por omision en los residentes de centros sociosanitarios, y el mantenimiento de dicha prevalencia durante los tres anos de estudio.

We study different redundancy mechanisms in coherent systems with possibly dependent heterogeneous components. The dependence is modelled through copulas. We use distortion functions to obtain general results for different redundancy procedures. This model includes the popular active redundancy and minimal repair procedures. The purpose is to determine where these redundant components should be located in the system, according to its structure. We study series and parallel systems in detail. In the first case (series systems), it is well known that active and minimal repair redundancies should be assigned to the weakest component. However, we show that, surprisingly, this is not always the case for all the redundancy mechanisms. Moreover, we give a condition on the redundancy mechanism to get this expected property. Similar results are obtained for parallel systems. In these systems one can think that the best option is to assign the redundancy to the strongest component. However, we prove that this is not always the case. We include results for other system structures as well and we show that these properties also depend on the copula (dependence structure).

SummaryBackgroundA SARS-CoV-2 protein-based heterodimer vaccine, PHH-1V, has been shown to be safe and welltolerated in healthy young adults in a first-in-human, Phase I/IIa study dose-escalation trial. Here, we report the interim results of the Phase IIb HH-2, where the immunogenicity and safety of a heterologous booster with PHH-1V is assessed versus a homologous booster with BNT162b2 at 14, 28 and 98 days after vaccine administration.MethodsThe HH-2 study is an ongoing multicentre, randomised, active-controlled, double-blind, non-inferiority Phase IIb trial, where participants 18 years or older who had received two doses of BNT162b2 were randomly assigned in a 2:1 ratio to receive a booster dose of vaccine —either heterologous (PHH-1V group) or homologous (BNT162b2 group)— in 10 centres in Spain. Eligible subjects were allocated to treatment stratified by age group (18-64 versus ≥65 years) with approximately 10% of the sample enrolled in the older age group. The primary endpoints were humoral immunogenicity measured by changes in levels of neutralizing antibodies (PBNA) against the ancestral Wuhan-Hu-1 strain after the PHH-1V or the BNT162b2 boost, and the safety and tolerability of PHH-1V as a boost. The secondary endpoints were to compare changes in levels of neutralizing antibodies against different variants of SARS-CoV-2 and the T-cell responses towards the SARS-CoV-2 spike glycoprotein peptides. The exploratory endpoint was to assess the number of subjects with SARS-CoV-2 infections ≥14 days after PHH-1V booster. This study is ongoing and is registered withClinicalTrials.gov,NCT05142553.FindingsFrom 15 November 2021, 782 adults were randomly assigned to PHH-1V (n=522) or BNT162b2 (n=260) boost vaccine groups. The geometric mean titre (GMT) ratio of neutralizing antibodies on days 14, 28 and 98, shown as BNT162b2 active control versus PHH-1V, was, respectively, 1·68 (p+and CD8+T-cells expressing IFN-γ on day 14. There were 458 participants who experienced at least one adverse event (89·3%) in the PHH-1V and 238 (94·4%) in the BNT162b2 group. The most frequent adverse events were injection site pain (79·7% and 89·3%), fatigue (27·5% and 42·1%) and headache (31·2 and 40·1%) for the PHH-1V and the BNT162b2 groups, respectively. A total of 52 COVID-19 cases occurred from day 14 post-vaccination (10·14%) for the PHH-1V group and 30 (11·90%) for the BNT162b2 group (p=0·45), and none of the subjects developed severe COVID-19.InterpretationOur interim results from the Phase IIb HH-2 trial show that PHH-1V as a heterologous booster vaccine, when compared to BNT162b2, although it does not reach a non-inferior neutralizing antibody response against the Wuhan-Hu-1 strain at days 14 and 28 after vaccination, it does so at day 98. PHH-1V as a heterologous booster elicits a superior neutralizing antibody response against the previous circulating Beta and the currently circulating Omicron BA.1 SARS-CoV-2 variants in all time points assessed, and for the Delta variant on day 98 as well. Moreover, the PHH-1V boost also induces a strong and balanced T-cell response. Concerning the safety profile, subjects in the PHH-1V group report significantly fewer adverse events than those in the BNT162b2 group, most of mild intensity, and both vaccine groups present comparable COVID-19 breakthrough cases, none of them severe.FundingHIPRA SCIENTIFIC, S.L.U.

Aims To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes. Methods A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008–2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated. Results Mean follow-up was 3.2 years and 506 deaths and 1720 hospitalizations were recorded. The cumulative risk for the individual events increased as eGFR levels decreased. The PAR associated with having an eGFR of 60 mL/min/1.73 m2 or less was 11.4% (95% CI 4.8–18.3) for all-cause mortality, 9.2% (95% CI 5.3–13.4) for coronary heart disease, and 2.6% (95% CI −1.8 to 7.4) for stroke. Conclusions Reduced eGFR levels were associated with a larger proportion of avoidable deaths and cardiovascular hospitalizations in people with diabetes compared to previously reported results in people with other cardiovascular risk factors.

Aim Glycated hemoglobin A1c (HbA1c) is a reliable risk factor of cardiovascular diseases in diabetic patients, but information about this relationship in elderly patients is scarce. The aim of this study is to analyze, the relationship between HbA1c levels and the risk of mayor adverse cardiovascular events (MACE) in patients with diabetes over 70 years. Methods Prospective study of subjects with diabetes using electronic health records from the universal public health system in the Valencian Community, Spain, 2008–2012. We included men and women aged ≥ 70 years with diabetes who underwent routine health examinations in primary care. Primary endpoint was the incidence of MACE: all-cause mortality and/or hospital admission due to coronary heart disease or stroke. A standard Cox and Cox-Aalen models were adjusted. Results 5016 subjects were included whit a mean age of 75.1 years (46.7% men). During an average follow-up of 49 months (4.1 years), 807 (16.1%) MACE were recorded. The incidence of MACE was 20.6 per 1000-person-years. Variables significantly associated to the incidence of MACE were male gender (HR: 1.61), heart failure (HR: 2.26), antiplatelet therapy (HR: 1.39), oral antidiabetic treatment (HR: 0.74), antithrombotics (HR: 1.79), while age, creatinine, HbA1c and peripheral arterial disease were time-depend associated variables. Conclusion These results highlights the importance of HbA1c level in the incidence of cardiovascular events in older diabetic patients.

In the reliability literature, several results have been presented to compare binary (two states) systems. Often, such results are obtained from copula-based extensions of fuzzy measures, where a fuzzy measure describes the structure of a system and a copula describes the stochastic dependence among the lifetimes of its components. Other similar results have been obtained in terms of the concept of signature. Here, we extend all those results to multi-state systems made up from binary components by suitably constructing corresponding mixed binary systems. For such a construction, we show how any fuzzy measure can be decomposed as a convex combination of { 0 , 1 } -valued fuzzy measures and how such a decomposition extends to the corresponding aggregation function. For a mixed system we can furthermore consider its signature and so we can also define a signature for the multi-state system. For mixed systems associated to different multi-state systems, we can thus obtain different comparison results, which can be translated into the corresponding comparisons for the parent multi-state systems. Stochastic comparisons are obtained for the discrete random variables which represent the states of two systems at time t, as well. The arguments in the paper will be illustrated by means of examples and related remarks.

Technological and mathematical advances have provided opportunities to investigate new approaches for the holistic quantification of complex biological systems. One objective of these approaches, including the multi-inverse deterministic approach proposed in this paper, is to deepen the understanding of biological systems through the structural development of a useful, best-fitted inverse mechanistic model. The objective of the present work was to evaluate the capacity of a deterministic approach, that is, the multi-inverse approach (MIA), to yield meaningful quantitative nutritional information. To this end, a case study addressing the effect of diet composition on sheep weight was performed using data from a previous experiment on saccharina (a sugarcane byproduct), and an inverse deterministic model (named Paracoa) was developed. The MIA successfully revealed an increase in the final weight of sheep with an increase in the percentage of corn in the diet. Although the soluble fraction also increased with increasing corn percentage, the effective nonsoluble degradation increased fourfold, indicating that the increased weight gain resulted from the nonsoluble substrate. A profile likelihood analysis showed that the potential best-fitted model had identifiable parameters, and that the parameter relationships were affected by the type of data, number of parameters and model structure. It is necessary to apply the MIA to larger and/or more complex datasets to obtain a clearer understanding of its potential.

The minimal repair replacement is a reasonable assumption in many practical systems. Under this assumption a failed component is replaced by another one whose reliability is the same as that of the component just before the failure, i.e., a used component with the same age. In this paper we study the minimal repair in coherent systems. We consider both the cases of independent and dependent components. Three replacement policies are studied. In the first one, the first failed component in the system is minimally repaired while, in the second one, we repair the component which causes the system failure. A new technique based on the relevation transform is used to compute the reliability of the systems obtained under these replacement policies. In the third case, we consider the replacement policy which assigns the minimal repair to a fixed component in the system. We compare these three options under different stochastic criteria and for different system structures. In particular, we provide the optimal strategies for all the coherent systems with 1–4 independent and identically distributed components.

Feeding behavior is a multifactorial process with pivotal relevance for the maintenance and survival of ruminants. This study evaluated the effect of gastrointestinal nematodes (GIN), condensed tannin (CT) content of plants, and their possible interaction on the intake and selection of feed resources by Criollo goats in a heterogeneous vegetation. An 8-wk field experiment was conducted in the tropical deciduous forest (TDF) during the rainy season with adult Criollo goats (35.1 ± 6.7 kg body weight [BW]). Goats were assigned to four groups (n = 6): 1) MOX: suppressive treatment with moxidectin (Cydectin 0.4 mg/kg BW subcutaneous every 4 wk), 2) INF: with natural GIN infection, 3) MOX + PEG: treated with moxidectin and dosed with a CT-neutralizing agent (50 g of polyethylene glycol [PEG] diluted in 50 mL of water, per os), and 4) INF + PEG: with natural GIN infection and PEG dosage. Intake was measured using a direct observation method in a 2.2-ha TDF plot. Plant availability was obtained from 30 exclusion quadrants (2 × 2 m). Selection was estimated with the Cheeson index using the ratio of consumed plants and their availability by grouping plant species as shrubs and herbs (with high CT [> 10%], medium CT [> 3% to

The challenges of Portfolio Optimization have led to an increasing interest from the multi-objective evolutionary algorithms research community; however, little attention has been paid to the particular preferences of the investor in order to select the most preferred portfolio from a set of mathematically equivalent alternatives in presence of many criteria. The main goal of this work is thus modeling the preferences of the investor in order to find the most satisfactory portfolio from the investor's perspective when many objective functions are considered. Here, the investor's behavior facing risk, the estimations of the portfolios' future returns, and the risk of not attaining those returns are all represented by means of probabilistic confidence intervals. The imperfect knowledge related to the subjectivity of the investor is modeled on the basis of Interval Theory and the outranking method. The proposed approach aggregates the many criteria on the basis of the investor's particular system of preferences producing a selective pressure towards the most preferred portfolio while the investor's cognitive effort in the final selection is reduced. An illustrative example in the context of stock portfolio optimization is provided, where several investors interested in many criteria are simulated. The considered criteria are confidence intervals around the portfolios' expected returns, and indicators from the so-called fundamental and technical analyses. Our approach is compared, using real historical data, with an outstanding multi-objective evolutionary algorithm, MOEA/D, and some well-known benchmarks in Modern Portfolio Theory and Finance Theory, namely, the Mean-Variance approach and the Dow Jones Industrial Average index. The results show an evident superiority of the proposed approach in both the context of the underlying criteria (confidence intervals and financial indicators) and the context of the actual returns. Thus, we conclude that the proposed approach was able to find satisfactory portfolios in the context of the experiments.

This paper presents a new outranking method whose main feature is its capacity to handle imperfect knowledge. This research is interested in two important sources of imperfect knowledge: 1) poorly known model parameters, and 2) imperfectly known (even missing) criterion values characterizing the actions. The use of interval numbers to model imperfect knowledge is suggested, and a new interval-based outranking method is proposed as an extension of the outranking approach to the interval framework. This method handles different sources of imperfect knowledge coming from model parameters (weights, veto thresholds, majority threshold) and from ill-determined, imprecise, uncertain, arbitrary (even missing) criterion values. The index of likelihood of the interval outranking is interpreted from a logical perspective, and could be used for choice, ranking and ordinal classification. Specifically, this paper proposes the method INTERCLASS for ordinal classification, which is inspired by ELECTRE TRI-B. Their assignment rules and structural properties are similar, but INTERCLASS is able to handle imprecisions in weights, veto thresholds, cutting level, and even in criteria defining limiting profiles.

Indirect approaches for eliciting preference model parameters for multiple criteria decision aiding are of growing interest because they imply relatively less cognitive effort from the decision-maker (DM). Direct approaches are particularly hard in the case of the new ELECTRE TRI-nB method, because the task involves eliciting a number of limiting profiles for each category boundary. However, in ELECTRE methods, the simultaneous inference of the whole set of parameters needs the construction and resolution of a non-linear non-convex programming problem, which is typically very hard to solve. Therefore, an evolutionary-based method to infer the parameters of the ELECTRE TRI-nB model is proposed in this paper. The quality of the solutions is tested by measuring the capacity to restore the assignment examples and the capacity to make consistent assignments of new actions. In extensive computer experiments, using the pseudo-conjunctive assignment procedure, some main conclusions arise: (i) the capacity of the method to restore the training examples reaches high values, mainly with three and five limiting profiles per category; and (ii) the capacity to make appropriate assignments of new actions (not belonging to the training information) can be greatly improved by increasing the number of limiting profiles.

The approach proposed here uses evolutionary algorithms combined with interval analysis to optimize the allocation of resources in portfolio optimization. The proposal uses probabilistic confidence intervals to characterize the solutions. Such characterization allows the investor to consider not only the expected impact of the portfolios but also the risk of not obtaining that expected impact. This approach identifies the behavior of the investor in the face of risk and gives her/him support depending on her/his own preferences. Portfolio optimization is performed through one of the most outstanding evolutionary multi-objective approaches, the so-called Multiobjective Evolutionary Algorithm Based on Decomposition (MOEA/D). To the best of our knowledge, this algorithm has not been used in the context of interval analysis. In this work, MOEA/D has been enhanced so that it can deal with chromosomes and fitness values described as interval numbers. In order to evaluate the proposed approach, an illustrative application in stock portfolio selection is included. We use as our dataset 13 years of historical monthly prices of stocks in the Dow Jones Industrial Average index (DJIA), including those of the 2008 crisis. Besides, we have carried out an extensive evaluation comparing the performance of the proposed approach with respect to the DJIA index, the Markowitz's mean-variance approach, and other more recent approaches. The results show that the proposed approach outperforms the other ones and allow us to conclude that, within the context of our experiments, i) the proposal was effective in the allocation of resources in most of the periods considered (156 scenarios), ii) the approach is appropriate to find portfolios by explicitly considering the DM's attitude facing risk, and iii) interval analysis was a robust measure of risk even for the 2008 crisis.

Eco-efficiency and building optimization potential of prefabricated structures to be used in new buildings are studied, focusing on the analysis of a novel dry precast beam-column connection under different durability and re-using scenarios. The analyses include structural response (via numerical models), optimization potential (material take off, building schedule and economic cost) and environmental impact (via Life Cycle Assessment, LCA). The connection is applied to a case study which is representative of common buildings: a seven-story concrete structure with frames and deck slabs. The structural response of the connection accomplishes the Eurocode safety prescriptions. Man-hours and task duration decrease around 80%, and the global schedule undergoes 60% diminution. Focusing on economic issues, when the prefabricated structural elements are reused the accumulated economic cost significantly decreases. LCA shows that durability, in terms of service life, is directly related to the environmental impact. However, other design options, such us re-using, have less repercussion in the impact categories (i.e. Global Warming Potential and Embodied Energy), and in the global cost. Results from this research could contribute to the implementation of prefabricated elements in the building stock promoting eco-efficiency.

Traditionally ignored in comparison with the energy flow, the interest on the information flow and in general on the informational perspective is nowadays manifest in biological fields. Herein we will revisit classical ideas on biomolecular information processing, basically from Efim Liberman and Michael Conrad, weaving them together with new views on the information flow as captured by cellular signaling systems and with the development of biological complexity. A consistent new explanatory framework looms-potentially contributing to a new cell theory. It would incorporate fundamental conceptualizations on the mechanisms of molecular recognition and informational architectures, the life cycle and the characterization of meaning, and finally the emergence of biological complexity. Concerning the evolutionary process, this informational approach depicts an indefinite series of recursion processes performed in the open-ended environment of the real world, potentially affected by multiple contingencies modifying the informational architectures involved in recursion. Consequently, a large variety of molecular tools and systems would have been incorporated speeding up the variability of genomes and facilitating their displacement in sequence space. To the extent to which the comparison with human mobility in physical space may hold, a power law could be hypothesized interconnecting the variability outcomes of the different evolutionary 'vehicles' or variation modes. Contributing to a renewed discussion on the evolutionary process is another essential goal of the present work.

Within material test reactor calculations, energy dependent flux and reaction rate uncertainties are typically not quantified when performing as-run analyses to determine the neutron field experienced by the experiment. When high fidelity Monte-Carlo codes are used in such analyses, straight forward methods to calculate output uncertainties are not available, instead expert opinion is used to postulate computational uncertainties. New methods to propagate uncertainties through these high fidelity simulations are available when sufficient computational power is available. A tool is developed here for sampling any part of an MCNP input from random distributions to determine output uncertainties based on those inputs. Another tool is developed to sample nuclear data cross-section in ACE format using multi-group nuclear data covariances. The Total Monte-Carlo Method and Gesellschaft fur Anlagen-und Reaktorsicherheit method (GRS) are implemented and compared to one another as well as MCNP sensitivity and uncertainty calculations. The methods were applied to the Godiva critical sphere k-eigenvalue, the UAM pin-cell benchmark energy dependent flux and reaction rates, and the Advanced Test Reactor energy dependent flux within an experimental location. The two methods agree well, with GRS allowing for an order of magnitude speedup for reaction rate uncertainty calculations and several orders of magnitude for eigenvalue uncertainty calculations.

Resumen: Es objetivo de este artículo mostrar una experiencia de práctica novedosa implementada por la dirección de un departamento de salud. Se expone un modelo organizativo de coordinación sociosanitaria entre los diferentes niveles asistenciales y sectores, estableciendo sinergias de los recursos sociales y sanitarios comunes del Departamento de Salud Clínico-Malvarrosa (Valencia). Tras un año, se han constituido cinco consejos de salud de zona básica en atención primaria y una comisión de coordinación sociosanitaria integrada por tres subcomisiones: 1) de atención asistencial social y sanitaria, 2) de asociacionismo y voluntariado hospitalario, y 3) de acción comunitaria y participación ciudadana. La estructura organizativa propuesta se ha consolidado y las acciones realizadas se han valorado de manera positiva por las diferentes personas implicadas. Se ha generado una red de comunicación social y sanitaria: interdepartamental, extradepartamental y extrahospitalaria. Abstract: The objective of this article is to show an experience of new practice as implemented by the management of a Department of Health. An organisational model is shown of sociosanitary coordination between the different levels of care and sectors, establishing synergies of the common social and health resources of the Clínico-Malvarrosa Department of Health (Valencia, Spain). After one year, five basic health councils have been set up in Primary Care and a Sociosanitary Coordination Commission composed of three subcommittees: 1) socio and health care, 2) associationism and hospital volunteering, and 3) community action and citizen participation. The proposed organisational structure has been consolidated, the actions carried out have been valued positively by the different agents involved. It has generated a network of social and health communication: interdepartmental, extra-departmental and out-of-hospital. Palabras clave: Coordinación sociosanitaria, Vulnerabilidad, Acción comunitaria, Keywords: Sociosanitary coordination, Vulnerability, Community action

If the random variable X represents the lifetime of a unit, the mean residual life (MRL) function m ( t ) = E ( X − t | X > t ) is a basic tool to study the aging process. The decreasing/increasing mean residual life (DMRL/IMRL) aging classes are defined by the corresponding monotonicity properties of function m . In this paper, sufficient properties are provided for the preservation of these aging classes under the formation of order statistics and coherent systems with identically distributed (ID) components. We consider both the cases of independent and dependent components. In the last case, the sufficient conditions are based on properties of the copula which determines the dependence structure.

This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors in diabetes mellitus. The consensus is made by members of the Cardiovascular Risk Group of the Spanish Diabetes Society. We have proposed and updated interventions on lifestyle, pharmacological treatment indicated to achieve therapeutic objectives according to the levels of HbA1c, degree of obesity, hypertension, hyperlipidemia, heart failure, platelet antiagregation, renal insufficiency, and diabetes in the elderly, as well as new biomarkers of interest in the evaluation of cardiovascular risk in individuals with diabetes mellitus. The work is an update of the interventions and therapeutic objectives in addition, it is noted the need for the inclusion of specialists in Endocrinology, Metabolism and Nutrition in Cardiac Rehabilitation Units for the control and monitoring of this population.

An important issue related to code biology concerns the cell’s informational relationships with the environment. As an open self-producing system, a great variety of inputs and outputs are necessary for the living cell, not only consisting of matter and energy but also involving information flows. The analysis here of the simplest cells will involve two basic aspects. On the one side, the molecular apparatuses of the prokaryotic signaling system, with all its variety of environmental signals and component pathways (which have been called 1–2-3 Component Systems), including the role of a few second messengers which have been pointed out in bacteria too. And in the other side, the gene transcription system as depending not only on signaling inputs but also on a diversity of factors. Amidst the continuum of energy, matter, and information flows, there seems to be evidence for signaling codes, mostly established around the arrangement of life-cycle stages, in large metabolic changes, or in the relationships with conspecifics (quorum sensing) and within microbial ecosystems. Additionally, and considering the complexity growth of signaling systems from prokaryotes to eukaryotes, four avenues or “roots” for the advancement of such complexity would come out. A comparative will be established in between the signaling strategies and organization of both kinds of cellular systems. Finally, a new characterization of “informational architectures” will be proposed in order to explain the coding spectrum of both prokaryotic and eukaryotic signaling systems. Among other evolutionary aspects, cellular strategies for the construction of novel functional codes via the intermixing of informational architectures could be related to the persistence of retro-elements with obvious viral ancestry.

Based on novel topological considerations, we postulate a gauge symmetry for living cells and proceed to interpret it from a consistent Eastern perspective: the li organization principle. In our framework, the reference system is the living cell, equipped with general symmetries and energetic constraints standing for the intertwined biochemical, metabolic and signaling pathways that allow the global homeostasis of the system. Environmental stimuli stand for forces able to locally break the symmetry of metabolic/signaling pathways, while the species-specific DNA is the gauge field that restores the global homeostasis after external perturbations. We apply the Borsuk-Ulam Theorem (BUT) to operationalize a methodology in terms of topology/gauge fields and subsequently inquire about the evolution from inorganic to organic structures and to the prokaryotic and eukaryotic modes of organization. We converge on the strategic role that second messengers have played regarding the emergence of a unitary gauge field with profound evolutionary implications. A new avenue for a deeper investigation of biological complexity looms. Philosophically, we might be reminded of the duality between two essential concepts proposed by the great Chinese synthesizer Zhu Xi (in the XIII Century). On the one side the li organization principle, equivalent to the dynamic interplay between symmetry and information; and on the other side the qi principle, equivalent to the energy participating in the process-both always interlinked with each other. In contemporary terms, it would mean the required interconnection between information and energy, and the necessity to revise essential principles of information philosophy.

ACL; International audience; The structure signature of a system made up of n components having continuous and i.i.d. lifetimes was defined in the eighties by Samaniego as the n-tuple whose kth coordinate is the probability that the kth component failure causes the system to fail. More recently, a bivariate version of this concept was considered as follows. The joint structure signature of a pair of systems built on a common set of components having continuous and i.i.d. lifetimes is a square matrix of order n whose (k, l)-entry is the probability that the kth failure causes the first system to fail and the lth failure causes the second system to fail. This concept was successfully used to derive a signature-based decomposition of the joint reliability of the two systems. In the first part of this paper we provide an explicit formula to compute the joint structure signature of two or more systems and extend this formula to the general non-i.i.d. case, assuming only that the distribution of the component lifetimes has no ties. We also provide and discuss a necessary and sufficient condition on this distribution for the joint reliability of the systems to have a signature-based decomposition. In the second part of this paper we show how our results can be efficiently applied to the investigation of the reliability and signature of multistate systems made up of two-state components. The key observation is that the structure function of such a multistate system can always be additively decomposed into a sum of classical structure functions. Considering a multistate system then reduces to considering simultaneously several two-state systems

Optimised ZnO nanorod characteristics are essential for novel devices to operate efficiently, especially shifting the n-type nature towards intrinsic or p-type. The effects of argon bombardment for varying amounts of time on the surface chemistry and Fermi level of ZnO nanorods have been studied using XPS. Bombardment at 5 keV removed surface contamination caused by amorphous carbon and OH−, H2O and C-O groups. The bombardment also causes the O1s, Zn2p and valence band to shift to lower binding energies, indicating a shift towards intrinsic behaviour. Bombardment time can be used to effect a shift of up to 0.8 eV, and this shift remains after the nanorods were re-contaminated by exposure to ambient conditions for 28 days. These results indicate that argon bombardment can permanently shift the n-type nature of ZnO to intrinsic for use in novel devices.

The present work studies the effect of redundancies on the reliability of coherent systems formed by modules. Different redundancies at components’ level versus redundancies at modules’ level are investigated, including active and standby redundancies. For that, a new model is presented. This model takes into account the dependence among the components, as well as, the dependence among the modules of the system. In both cases, the dependence structure is modeled by copula functions. Several results are provided to compare systems consisting of heterogeneous components. The comparisons are distribution-free with respect to the components. In particular, we consider the cases when the components in the modules are independent and connected (or not) in series, and when the components are dependent within the modules. In both cases, it is assumed that the modules can be dependent. Furthermore, the case in which the components in each module are identically distributed (dependent or independent) is also considered. We illustrate the theoretical results with several examples, NT is partially supported by Ministerio de Ciencia e Innovación of Spain under grant PID2019-108079GB-C22/AEI/10.13039/501100011033. AA was supported by Ministerio de Economía y Competitividad of Spain under grant MTM2017-89577-P. Finally, JN is partially supported by Ministerio de Ciencia e Innovación of Spain under grant PID2019-103971GBI00/ AEI/10.13039/501100011033

This paper presents a new method for multiple criteria ordinal classification (sorting) problems. In an ordinal classification problem, the categories (also called classes in related literature) are pre-defined and ordered, from the best to the worst or from the worst to the best. The actions (not necessarily known a priori ) are assigned to the different ordered categories. Several ELECTRE type methods were designed to deal with this kind of problem. However, none of them proposes a characterization of the categories through a set of limiting profiles. This is the novelty of the current method, which may be considered as an extension of ELECTRE TRI-B. It fulfills a set of structural requirements: uniqueness of the assignments, independence, monotonicity, homogeneity, conformity, and stability with respect to merging and splitting operations. All these features will be presented in the current paper and illustrated through three examples.

Background Patients with spinal cord injury (SCI) who carry indwelling urinary catheters have an increased risk of urinary tract infection (UTI). Antiseptic silver alloy-coated (SAC) silicone urinary catheters prove to be a promising intervention to reduce UTIs; however, current evidence cannot be extrapolated to patients with SCI. Purpose This study aimed to assess the efficacy of SAC urinary catheters for preventing catheter-associated urinary tract infections. Design/Setting This is an open-label, multicenter (developed in Spain, Portugal, Chile, Turkey, and Italy), randomized clinical trial conducted in 14 hospitals from November 2012 to December 2015. Patient Sample Eligible patients were men or women with traumatic or medical SCI, aged ≥18 years, requiring an indwelling urinary catheter for at least 7 days. Outcome Measures The primary outcome was the incidence of symptomatic UTIs. The secondary outcome included bacteremia in the urinary tract and adverse events. Materials and Methods Patients were randomized to receive a SAC urinary catheter (experimental group) or a standard catheter (control group) for at least 7 days. Data were compared using chi-squared test and also calculating the absolute risk difference with a 95% confidence interval. An adjusted analysis including different risk factors of UTI was performed. This study was mainly funded by La Marato de TV3 Foundation (grant number # 112210) and the European Clinical Research Infrastructures Network organization. The funders had no role in the interpretation or reporting of results. Results A total of 489 patients were included in the study, aged 55 years in the experimental group and aged 57 in the control group (p=.870); 72% were men; 43% were hospitalized patients, and 57% were outpatients (p=1.0). The most frequent cause of SCI was traumatic (73.75%), and the localization was mainly the cervical spine (42.74%). Most of the patients had an A score (complete spinal injury and no motor and sensory is preserved) on the ASIA scale (62.37%). The median time of urethral catheterization was 27 days in the experimental group and 28 days in the control group (p=.202). Eighteen patients (7.41%) in the experimental group and 19 in the control (7.72%) group had a symptomatic UTI (odds ratio [OR] 0.96 [0.49–1.87]). The adjusted analysis revealed no change in the results. Only three patients in the experimental group had bacteremia within the urinary tract. The experimental group presented more adverse events related to the use of a catheter than the control group (OR 0.03 [0.00–0.06]). Conclusions The results of this study do not support the routine use of indwelling antiseptic SAC silicone urinary catheters in patients with SCI. However, UTIs associated to long-term urinary catheter use remain a challenge and further investigations are still needed.

Domestic production of high specific activity 60Co was halted after a target rupture in 2012 at the Advanced Test Reactor (ATR). The Isotope Program (IP) within the US Department of Energy (DOE) Office of Science tasked a multilaboratory team of researchers and managers from Oak Ridge and Idaho National Laboratories with the redesign the radioisotope capsule. The objective of this effort was to create a more robust and reliable design, compared to the pre-2012 target. The team successfully completed this task to produce the DOE-IP cobalt (Co) production capsule design. Furthermore, 66 capsules were successfully fabricated by Oak Ridge National Laboratory (ORNL) and delivered to Idaho National Laboratory (INL) for irradiation in the ATR between January 2014 and October 2016. This paper describes the efforts of the team to prepare and disposition the two initial DOE-IP Co production capsules that were processed in March 2020. These efforts include performing accurate production predictions, experimentally validating predictions with assay measurements, shipping with the Orano-furnished Battelle Energy Alliance Research Reactor shipping package, and disassembling capsules at the isotope vendor site.

Urban wind energy exploitation is an important topic for smart sustainable cities. The present investigation is a step in this direction, considering the latest advances in building aerodynamics, identifying and analyzing the optimum building-roof shape for the urban wind energy exploitation. This investigation focusses in two aspects: the isolated building shape optimization and the analysis of this building in an urban environment. The optimization includes an analysis of the roof-wall transition geometry by testing different variations of a spherical roof, a roof-width sensitivity analysis of the optimum geometry and an exploration of the building aspect ratio effect on the flow. A comparison of velocity, turbulent kinetic energy and turbulence intensity is carried out. The wind turbine positioning on the roof is analyzed in detail. An exactly spherical roof connected to a cylindrical wall is identified as the most advantageous option. Additionally, the effect of the neighboring buildings is investigated considering different heights for the surroundings. The wind flow on the roof is strongly affected by the presence of surrounding buildings, increasing the turbulence intensity close to the roof surface. Slender shapes are identified as the most interesting building shapes for wind energy exploitation, leading to a higher speed-up and to a lower turbulence intensity.

Understanding the nature of life has always been a fundamental objective of human knowledge. It is no wonder that biology, as the science of life, together with physics, has traditionally been the discipline that has generated the deepest philosophical and social repercussions. In our time, the major achievements in bioinformatics, systems biology, and "omic" fields (genomics, proteomics, metabolomics, etc.) have not only spurred a new biotechnological and biomedical 'postindustrial revolution', but they have also disclosed an intriguing molecular panorama of biological organization that invites us to reinterpret central themes of philosophy in the light of the new knowledge. Essential tenets of phenomenology may take an intriguing new turn when contemplated from these new biological perspectives: Does the living cell instantiate a unique biomolecular way of being in the world? How is life self-produced in continuous communication with the surrounding world? How can the incessant flows of mass, energy and information inherent of embodiment be coherently harnessed across billions of cellular individuals? In this paper, based on the latest developments in cellular signaling, we will discuss the dynamic intertwining between self-production and communication that characterizes life at the prokaryotic, eukaryotic, organismic, and social levels of organization. An in-depth analysis of the particular transcriptional responses of a bacterium (Escherichia coli K-12 strain), taking as a model system, will follow. It is the creation, transmission and reception of signals which, in all instances, provides guidance and orientation to the inner self-production activities of the living agent and connects it with the world. Transitions to new levels of organization are marked by the emergence of new forms of communication, embedded in the correspondingly augmented life-cycles of the more complex entities. As will be argued here, the ascending complexity of life is always information-based and recapitulates level after level, a successful "informational formula" for being in the world. The phenomenological basis for the naturalization of cognition has moved from the biological to a new scientific arena: informational. The philosophical notion of being-in-the-world (Dasein; Heidegger) is shown to be completely compatible with the latest advances in biology and information science.

The study of social entrepreneurship has rapidly evolved in the last years, with a significant number of articles published. Based on a review of the existing literature in the theoretical framework of social entrepreneurship, this article attempts to clarify this phenomenon in the empirical framework of gastronomy. Gastronomy has emerged as a useful tool in social change at all levels, revolutionizing certain theoretical precepts in social entrepreneurship. A term so used in recent years that forces to rethink its meaning; what is and what is not social entrepreneurship; and the profile and the role of the social entrepreneur when detecting the social opportunity. In the preparation of this paper, several examples have been used to help understand this phenomenon. Likewise, thanks to this paper, doors are opened to future research areas in the field of social entrepreneurship in gastronomy.

We present two new interval-based extensions of ELECTRE TRI-nB and ELECTRE TRI-nC, in which the preference relations are built by using the interval outranking approach. The boundaries between adjacent classes (or categories) are described by a set of limiting profiles, whose criteria could take on values which are interval numbers. Compared to INTERCLASS (a recently proposed interval-based ordinal classification method), the assignments suggested by our first extension come from enhanced preference relations between the actions and limiting boundaries and are likely to be more appropriate. In addition, it can suggest assignments from a pseudo-conjunctive logic. In our second extension, each class is characterized by a set of representative actions, again allowing interval numbers as criterion scores. The outranking relations between actions and classes are enhanced by having several representative actions in each category. Both new extensions can handle imperfect knowledge of the model parameters (weights, veto thresholds, credibility threshold), even missing criterion scores. Some fundamental properties and results are proved to guarantee the consistency of the methods, which are also illustrated with some numerical examples.

The present work explores, from the vantage point of the sociotype, the dramatic acceleration of cultural change alongside the successive industrial revolutions, particularly in the ongoing information era. Developed within the genotype-phenotype-sociotype conceptual triad, the sociotype means the average social environment that is adaptively demanded by the “social brain” of each individual. For there is a regularity of social interaction, centered on social bonding and talking time, which has been developed as an adaptive trait, evolutionarily rooted, related to the substantial size increase of human groups. A quantitative approach to the sociotype basic traits shows fundamental competitive interrelationships taking place within an overall “attention economy.” Approaching these figures via the Planckian Distribution Equation, they can be connected with many other competitive processes taking place in the biological, economic, and cultural realms. Concerning culture, the cognitive limits of the individual, which we consider commensurate with the sociotype general limitations, impose by themselves a strict boundary on the cultural items effectively handled by each individual, fostering the overall competition and decay. Further, the emergence of differentiated generations with ample discrepancy in styles of life, social aspirations, and dominant technologies would represent a systematic bias in the competition and replacement of cultural items. Intriguingly, the cultural acceleration detected in modern societies alongside the successive industrial revolutions, with an ostensible climax in the ongoing fourth industrial revolution –the information era– might be itself a paradoxical consequence of the sociotype''s dynamic constancy.

It is usually very difficult to elicit the parameter values of models representing decision makers’ preferences. Consequently, some imprecision, ill-determination and arbitrariness are unavoidable. Moreover, such elicitation cannot be performed by traditional optimization techniques in a reasonable time. Therefore, we present here a novel elicitation method guided by a genetic algorithm whose main contribution is coping with imperfect knowledge. The latter is done by using interval numbers representing all the possible values that the parameters can attain. The assessment of the method showed its high ability to reproduce the decision maker’s preferences. Finally, as the method proposed in this paper is the complement of the authors’ previous work regarding the optimization of stock portfolios, we provide a case study in such a field. We use differential evolution to obtain the most satisfactory portfolio. The results reported here show that the best portfolio returns are obtained when the elicitation method is exploited, and we conclude that the new overall approach might be an interesting alternative to the already-existing methods.

The main goal of this work is to study the role played by the helicity in the two-dimensional Klein tunneling for massive Dirac fermions. To this end, we consider the cases in which massive Dirac fermions with a defined helicity are scattered by step and barrier electrostatic potentials. For each potential, we first calculate the contributions of fermion states with conserved and inverted helicity to the reflection and transmission coefficients, analyzing how the potential ( V 0 ), fermion’s mass, energy ( E ) and angle of incidence affect them. In the step potential case, we find that the transmission probability for fermion states with inverted helicity is small when V 0 E , but becomes dominant when V 0 > E . In the barrier potential case, this probability is always null. This behavior is explained by the breaking of the helicity conservation by the mass term, allowing the reflection of states with inverted helicity in both potentials, and transmission of inverted helicity states only in the step potential. Finally, we give some insights on the consequences of our results in materials with Dirac-like quasiparticles, such as graphene, topological insulators and Weyl semimetals.

The analysis of the wind flow around buildings is of great interest in the field of renewable energies. This work presents an investigation of the effects of roof-mounted solar panels on the wind flow on building roofs, from the point of view of the wind energy exploitation. CFD simulations of the wind flow around an isolated building are performed with OpenFOAM. The simulations are compared with two wind tunnel experiments for validation: an isolated building and an array of solar panels. The wind flow on an empty roof is compared with roof-mounted solar panels cases. The solar panels are tested with tilt angles of 10 degrees and 30 degrees, the most adequate inclination for solar panels in the Mediterranean region. The analysis is carried out both quantitatively and qualitatively. The full-scale building results are compared with a reduced-scale model and scaling issues are reported. The most adequate wind turbine for each roof region is suggested.

The analysis of the wind flow around buildings has a great interest from the point of view of the wind energy assessment, pollutant dispersion control, natural ventilation and pedestrians wind comfort and safety. Since LES turbulence models are computationally time consuming when applied to real geometries, RANS models are still widely used. However, RANS models are very sensitive to the chosen turbulence parametrisation and the results can vary according to the application. In this investigation, the simulation of the wind flow around an isolated building is performed using various types of RANS turbulence models in the open source code OpenFOAM, and the results are compared with benchmark experimental data. In order to confirm the numerical accuracy of the simulations, a grid dependency analysis is performed and the convergence index and rate are calculated. Hit rates are calculated for all the cases and the models that successfully pass a validation criterion are analysed at different regions of the building roof, and the most accurate RANS models for the modelling of the flow at each region are identified. The characteristics of the wind flow at each region are also analysed from the point of view of the wind energy generation, and the most adequate wind turbine model for the wind energy exploitation at each region of the building roof is chosen.