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In this paper, we present a multi-tiered network-based optimization model describing the provision of services by network slices of 5G-Service providers (e.g. through Unmanned Aerial Vehicles (UAVs) organized as Flying Ad hoc Networks (FANET)), taking into account the security levels of each provider. The three levels of the network consist of the infrastructure layers, which contain resources needed to execute a service, the slices layer, where services are served for the services layer, which represents the upper layer of the network and consists of services or applications required by users or devices. The objective of the proposed model is to establish the optimal flows between network layers and the optimal security levels in order to maximize the providers’ profits, given by the difference between the revenues obtained by the sale of services and the rental of their resources and the costs. Numerical experiments are performed and solved with a new nature-inspired genetic algorithm adapted to the optimization 5G network problem.

Background The advent of low-cost adalimumab (ADA) biosimilars is expected to increase access to biologics. Whether ADA biosimilars influence the use of conventional immunomodulators, especially azathioprine (AZA), which should be the alternative in steroid-dependant IBD, has not been investigated and comparative data on efficacy and safety are scanty. The aim of this study is to compare ADA biosimilars and Azathioprine (AZA) in patients with IBD naive to biologics and/or immunosuppressive agents. Methods A retrospective-prospective observational study was conducted on 55 consecutive IBD-patients (30 CD, 25 UC), in follow up in our tertiary referral center, who started ADA biosimilars or AZA between 11/2018 and 11/2021. Drug choice was upon clinical judgement. Primary outcomes, clinical response and steroid-free clinical remission, were evaluated at 12 and 84 weeks, using HBI for CD and p-Mayo score for UC. Active disease was defined HBI>5 for CD e p-Mayo>2 for UC. Secondary outcomes were persistence and retention rate. Results The two treatment groups showed similar baseline characteristics regarding age, sex, familial predisposition, smoking, type of IBD and previous surgery, except the use of systemic steroids (42,85% of patients treated with ADA and 18,5% of patients with AZA; p= 0,029) and presence of active disease (60,71 % of ADA and 37,03% of AZA; p=0,082). At week 12 clinical response was obtained in 22/28 (78,6%) treated with ADA and in 22/27 (81,5%) with AZA (p=0.789), at week 84 response rate was obtained in 10/10 (100%) of ADA e 10/13 (76,9%) of AZA (p= 0,155). Clinical remission at week 12 was achieved by 19/28 (67,9%) of ADA patients and by 24/27 (88,9%) AZA (p=0,061), at week 84 by 10/10 (100%) of ADA and by 12/13 (92,3%) of AZA (p=0,380). No adverse events were registered in the ADA group, 5 AE leading to discontinuation occurred in the AZA group (0% VS 18,52% , p=0,018). The retention rate was 85,7% for ADA and 74,1% and AZA (p= 0,285). According to IBD type, treatment persistence of ADA was higher in patients with CD (Log-rank test p=0,004); in CD the persistence rate is significantly better for ADA as compared to AZA. (Log-rank test p=0,008), in UC the difference was not significant (p=0,41). Conclusion Our results suggest that ADA biosimilars are an effective therapy in steroid-dependent IBD, with a better safety profile compared to AZA, thus resulting in a higher probability of treament persistence especially in CD. The use of AZA is expected to decline in the next years.

Background Self-imposed food restrictions are common in patients with inflammatory bowel disease (IBD) because oftheir erroneous belief of the role of food in disease worsening and, recently, eating disorders have alsobeen described. Orthorexia nervosa is characterized by the obsession of eating healthy and natural foods.Only a few studies have assessed orthorexia in patients with digestive disease and there are no studies inIBD. The aim of this study is to assess the risk of orthorexia in patients with IBD. Methods 158 consecutive subjects were prospectively recruited from February to October 2022 in a tertiary referralcenter: 113 patients with IBD and 45 healthy controls. The cohort of IBD patients consisted of 74 patientson biologic drugs, 28 patients on conventional therapy, and 12 patients admitted to the ward for diseaseflares. Demographic and clinical data were collected, and the ORTO-15 questionnaire, validated by Doniniet al., was used to assess the risk of orthorexia. Results Patients with IBD had a prevalence of orthorexia of 77%, significantly higher than the 47% observed in thecontrol group (p Conclusion Our study showed that most patients with IBD has a risk of orthorexia and that this is associated with alower BMI and a history of previous surgery for IBD. Further research is warranted to evaluate the clinicalimpact of orthorexia in patients with IBD and its relationship with the avoidant restrictive food intakedisorder (ARFID) or other eating disorder. Evidence based counselling by a qualified dietician is stronglywarranted in IBD clinics.

Background The use of ustekinumab (UST) and vedolizumab (VDZ) as second line therapy in Crohn’s disease (CD) patients failing tumour necrosis factor alpha inhibitors is still debated. The aim of the study was to compare in a large multicentre observational retrospective cohort, the effectiveness of UST and VDZ as second line therapy as assessed by clinical and objective outcomes including endoscopy and gastro intestinal (GI)-imaging. Methods Clinical response, remission and steroid-free remission at week 26 and 52 were evaluated in a retrospective cohort of CD patients previously experienced TNF-alpha inhibitors (primary or secondary failure, and intolerant). Objective response and remission were evaluated by one or more techniques including ileocolonoscopy, magnetic resonance (MR)/computer tomography (CT) enteroclysis and small bowel ultrasound (US) performed within 3 months before the beginning of the treatment and after one year of therapy. Inverse propensity of treatment weighting (IPTW) and propensity score matching (PMS) methods were used for statistical analysis. Results 470 CD patients (239 UST and 231 VDZ) were included in the study. At week 26 clinical response, clinical remission and steroid free remission were similar between the two groups (Figure 1) At week 52, clinical remission and steroid-free remission rates were significantly higher in VDZ-treated patients (clinical remission: UST 42.5% vs VDZ 55.5%, p=0.01; steroid-free clinical remission UST 40.6% vs VDZ 51.1%, p=0.038; Figure 1). 302 patients (135 UST and 167 VDZ) had objective evaluation of disease activity at baseline and week 52. At week 52 objective response and remission rates were similar between the groups. (Figure 2). Clinical response at week 26 predicted steroid-free remission at week 52 in both UST- and VDZ-treated patients. Safety profiles were similar between the two groups. Conclusion One-year treatment with VDZ was associated with higher rate of clinical remission as compared to UST, but no difference was observed between the two groups when objective outcomes were investigated

Background There is no head-to-head trial comparing ustekinumab (UST) and vedolizumab (VDZ) in Crohn’s disease (CD). Recently, real-world studies evaluated the two biologics in patients refractory to anti-TNF therapy, i.e. as second-line agents. Conversely, no study specifically focused on the effectiveness of UST and VDZ as third-line agents, i.e. after failure with at least one TNF-α inhibitor plus failure with VDZ or UST. We performed a multicentre, real-world assessment of the effectiveness of UST and VDZ in these highly-refractory patients with CD. Methods Data of consecutive patients with CD treated with UST and VDZ as third-line therapy until October, 2021 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD). The effectiveness was evaluated at, 8, 26, and, 52 weeks, and as treatment persistence at the end of follow up. The clinical outcomes were steroid-free clinical remission (SFCR - Harvey-Bradshaw Index Results 143 patients (UST: n=113; VDZ: n=30) were included. After, 8 weeks, SFCR was reported in, 38.1% of patients treated with UST and in, 43.3% of patients treated with VDZ (p=0.75), while CR was reported in, 61.9% of patients treated with UST and in, 60.0% patients treated with VDZ (p=1.00). After, 26 weeks, the rates of SFCR and CR were, 41.6% for UST and, 50.0% for VDZ (p=0.60), and, 61.4% for UST and, 66.7% for VDZ (p=0.81), respectively. After, 52 weeks, the rates of SFCR and CR were, 51.8% for UST and, 57.1% for VDZ (p=0.78), and, 65.9% for UST and, 71.4% for VDZ (p=0.77), respectively. Lack of difference in effectiveness between the two drugs at any time point was confirmed by multiple logistic regression models. After, 26 weeks, 88.7% of patients treated with UST and, 81.4% of patients treated with VDZ were still on treatment. Univariable Cox survival analysis showed a higher probability of treatment discontinuation for VDZ compared with UST (HR for VDZ:, 2.66; p=0.008), even if such difference was not confirmed at the multiple Cox proportional hazard regression model (HR for VDZ:, 1.94; p=0.08), where only age (HR, 0.98; p=0.04) and use of systemic steroids at baseline (HR, 3.29; p=0.003) were found to be independent predictors of treatment discontinuation. Conclusion This is the first real-world study assessing VDZ and UST as third-line therapy in patients with CD. Both drugs showed surprisingly high effectiveness, without significant differences between them.

Background Coronavirus disease 2019 (COVID-19), had two pandemic waves in 2020, respectively in April and November. In the general population, the first wave has been characterized by a higher prevalence in Northern Italy and a higher mortality rate compared to the second one. The aim of this study was to compare the characteristics of IBD patients and negative outcomes of COVID-19 (pneumonia, hospitalization, ventilatory support, death) between the two pandemic waves in Italy. Methods Prospective observational cohort study. Patients with diagnosis of IBD and confirmed SARS-CoV-2 infection were enrolled. Differences between first and second wave were tested for significance using the Student’s t test and Fisher’s test, as appropriate. A two-tailed p value Results We enrolled 937 IBD patients from 47 participating IBD centres across Italy (219 in the first wave, 718 in the second wave). There were no significant differences between the first and the second wave in terms of age (46.3 ± 16.0 vs. 44.1 ± 15.5 years, p=0.06) and gender (female 45.7% vs. 48.2%, p= 0.54). In the first wave, a lower percentage of patients was affected by Crohn’s disease (CD): 92 (42.0%) vs. 399 (55.6%) (p Conclusion IBD patients had higher number of COVID-19 negative outcomes in the first wave than in second wave. In the first wave, a significantly higher percentage of patients were from Northern Italy, but no significant differences in negative outcomes were observed in comparison with those from Central- Southern Italy. Overall, findings in IBD population are coherent with those observed in the general population.

Objective We conducted a national survey to understand the impact of state-level density reporting laws on women’s level of density risk awareness and their engagement in conversations with providers regarding supplemental screening. Methods In all, 1,500 US women aged 40 to 74 years who obtained a mammogram within 2 years were surveyed in February 2018. The sampling design yielded 300 respondents in each of five groups categorized based on density reporting law features. Women were asked about their breast density-related knowledge, importance of being notified, and sources of information and if conversations with providers regarding density and supplemental screening occurred. Survey results were compared across groups and between women residing in states with versus without density laws. Results The majority of respondents in all groups felt that it is important for women to know their breast density type (range, 85%-90%). Women were most likely informed of breast density type by a health care provider (range, 68%-72%), followed by the mammography result letter (range, 48%-68%), and then a radiologist (range, 46%-61%). Women from states with a density law were significantly more likely to have learned of their breast tissue type from a mammogram results letter (60% versus 48%, P = .011) and discuss supplemental screening (67% versus 53%, respectively; P = .008) than women from states without a law. Conclusion State-level density reporting laws are associated with increased breast density awareness and increased likelihood of conversations between women and their providers regarding supplemental screening.

Background Cross-sectional studies have assessed the prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with inflammatory bowel disease (IBD). However, longitudinal studies are more suitable to capture dynamic changes. Our aim was to investigate the prevalence and progression of NAFLD in a cohort of IBD patients using validated non-invasive tools. The role of metabolic, disease-related and genetic factors as predictors of NAFLD was also assessed. Methods IBD patients without known chronic liver disease were enrolled between 2019 and 2021. NAFLD was defined as Hepatic Steatosis Index (HSI) ≥ 36 or controlled attenuation parameter (CAP) ≥288 dB/m. Demographic data, traditional risk factors for NAFLD, biochemical tests and disease features were retrospectively collected in a dedicated database at the time of IBD diagnosis (defined as baseline) and at the last follow-up visit. PNPLA3 rs738409 C>G and TM6F2 E167K C>T polymorphisms were also investigated. Univariate and multivariate logistic regression analysis were performed to identify risk factors for NAFLD at baseline and at the end of follow-up. Results 227 consecutive patients (mean age 46.1 ± 13.4 years, 48.7% males, 57% Crohn’s disease, mean disease duration 9.4 ±7.5 years) were enrolled. Laboratory data at the time of diagnosis were available for 64 patients. The mean HSI was 30.9 ± 4.9 and 8/64 eligible patients (12.5%) had NAFLD at baseline. Male sex (odds ratio [OR]: 5.6; 95% confidence interval [CI] 3.1–8.9; P = 0.02) and body mass index (BMI) (OR: 1.4, 95% CI 1.1–2.9; P = 0.0008) were significantly associated with NAFLD at baseline. 11/64 (17.1%) patients developed NAFLD, accounting for an incidence rate of 4.0/100 PY; this was predicted only by changes in BMI over time (OR: 13.6, 95% CI 4.8–19.5; P = 0.001). At the last follow-up visit, NAFLD was diagnosed in 31.2% (71/227) according to HSI and in 21.1% (48/227) according to CAP. Among 8 patients with NAFLD at baseline, HSI worsened in 6 patients (41.0 ± 3.3 vs 44.0 ± 5.2), while two patients had steatosis regression. At the end of follow-up, age (P = 0.01), BMI (P = 0.002) and previous surgery (P = 0.01) were independently associated with NAFLD. Conclusion Our study confirms that NAFLD is common in patients with IBD. Variables related to IBD were not associated with incident NAFLD. Age, BMI and previous surgery were independently associated with NAFLD progression, suggesting a pathogenetic role of gut microbiota and impairment in bile acids metabolism. Our results suggest the need for active surveillance for NAFLD in patients with IBD.

Background Refractory ulcerative proctitis significantly affects patients’ quality of life, because of disabling symptoms such as tenesmus, fecal urgency and rectal bleeding. Immunosuppressive drugs, such as thiopurines and biologics, are recommended by clinical guidelines. Recently, a few studies have suggested that topical tacrolimus can be an effective and safe therapy in inducing clinical remission in these patients. However, there are no comparative data with biologics. The aim of our study was to compare the efficacy and safety of topical tacrolimus versus biological therapy in a retrospective cohort of refractory ulcerative proctitis patients’ followed up in two tertiary IBD clinics. Methods Consecutive patients with refractory ulcerative proctitis who started rectal tacrolimus 2 mg o.d. or biologics were enrolled between 2018 and 2020. Ulcerative refractory proctitis was defined as active disease up to 20 cm beyond the anal verge and endoscopic Mayo score ≥2 failure to both topical and oral mesalamine and corticosteroids. Primary endpoints were clinical response and remission after 8 and 54 weeks of treatment. Secondary endpoints were endoscopic remission after 54 weeks and the rate of adverse events. Clinical response was defined as a decrease in partial Mayo score of ≥3 points, plus either a decrease in rectal bleeding subscore of ≥1 or an absolute rectal bleeding score of ≤1. Clinical remission was defined as a partial Mayo score ≤2, while endoscopic remission as a Mayo endoscopic subscore ≤1. Results 25 patients were enrolled (17 males, mean age 52.0±17.2 years, mean disease duration 11.6±9.0 years, mean partial Mayo score 6.7±1.3; mean endoscopic Mayo score 2.6±0.2). 10 patients were treated with rectal tacrolimus, 15 with biologics (antiTNFs=12; vedolizumab=3). There were no differences at baseline between the two groups. At week 8, 64.0% of patients had a clinical response, while 32.0% obtained clinical remission. At week 54, 80.0% were on clinical response and almost half of the patients were on clinical and endoscopic remission. No significant difference in clinical and endoscopic response and remission rates was observed in the two groups except for a trend toward significance in favour of biologics in the rate of concomitant topical corticosteroid use at 8 weeks (p = 0.06). Two patients experienced biologics related-side effects, while no one had tacrolimus related-ones. Conclusion In this real-world two centers experience, both rectal tacrolimus and systemic biological therapy seem to have comparable efficacy in inducing and maintaining remission in refractory ulcerative proctitis patients. Topical tacrolimus can be a safer and cheaper therapeutic option. Our results need confirmation in prospective and larger studies.

The paper focuses on Carlo Levi’s reportages from India (1957), in order to outline how the peculiar mixture of narrative and essay writing conveys these texts into the genre of Travel literature, as well as to reconsider a work so easily forgotten by field studies. A first recognition on the topic shows how little literature has considered the timeframe of this journey up to recent times: due to the uncertain date marked on the only Indian letter sent by Levi to his wife, critics have agreed to range it between several months and a year. The bias is subsequently taken into account as the prism to approach these texts through: in fact, despite the deliberate attempt at sketching achrony for poetical purposes, micro and macrotextual features – with an emphasis on the descriptions of wintertime – allow to place these texts in time, thus confirming the hybrid features of these proses. Through rhetorical and textual analysis, then, the paper discusses the reportages from a theoretical perspective.

Background The efficacy of Ustekinumab (UST) on Crohn’s disease (CD) associated spondyloarthropathy (SpA) was evaluated neither in randomized controlled trials nor in real-world studies. Web-based data from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD) were extracted to perform a multicentre, real-world assessment of the effectiveness of UST on CD-associated SpA Methods All consecutive CD patients with active SpA at the initiation of the treatment with UST from January 2019 (the date on which the drug became available for clinical practice in Sicily) to August 2019 were extracted from the SN-IBD cohort. The study outcomes were evaluated at 8 and 24 weeks. The primary outcome was the articular response, defined as the disappearance of objective signs of arthritis (swelling and/or articular stiffness) and resolution of pain. As ancillary end-points, the clinical response (reduction of Harvey-Bradshaw Index ≥ 3 compared with baseline with a concomitant reduction of at least ≥ 50% of steroid dosage compared with baseline) and the steroid-free remission (Harvey-Bradshaw Index < 5 without steroids use) were assessed. Results Out of 131 total patients treated with UST, 30 consecutive patients (22.9%) had active SpA at baseline (axial SpA: 3/30; peripheral SpA: 18/30; axial plus peripheral SpA: 9/30). After 8 weeks, 10 patients (33.3%) reported an articular response [0/3 patients with axial SpA, 7/18 patients (38.9%) with peripheral SpA, and 3/9 patients (33.3%) with axial and peripheral SpA]. After 24 weeks, 13 patients (43.3%) had an articular response [0/3 patients with axial SpA, 10/18 patients (55.5%) with peripheral SpA, and 3/9 patients (33.3%) with axial and peripheral SpA]. None of these 13 responders was taking systemic steroids at 24 weeks. The concomitant presence of a clinical response on intestinal symptoms was associated with the articular response at 24 weeks at univariable analysis (OR 5.14, CI 1.09-32.70, p=0.038). Conclusion UST obtained a response on articular symptoms in nearly half of the patients with CD and active SpA at baseline after 24 weeks. The rate of response was higher in case of peripheral arthropathy. The articular response was associated with the clinical response on intestinal symptoms.

Background Efficacy and safety of ustekinumab for the treatment of Ulcerative colitis (UC) has been demonstrated in phase III clinical trials, but real world data are scarce. The aim of this study was to assess effectiveness and safety of ustekinumab in an Italian cohort of UC patients. Methods Data of patients with UC who started using ustekinumab were collected. Primary endpoint was steroid-free clinical remission at 24 and 52 weeks of therapy. Secondary endpoints were: treatment response, endoscopic remission, treatment persistence at 12 months and safety. Results A total of 68 patients (males 63.2 %; mean age (SD) 31 years (14.5)) were included. All patients were biologics experienced. At 24 and 52 weeks, 32 % and 50 % of patients achieved steroid-free clinical remission, 85% and 81% had clinical response, respectively. (Table 1) At the end of follow-up there were a significant reduction of pMS from baseline (p Conclusion Data from our small real-life cohort of treatment-refractory UC patients suggest satisfactory effectiveness of ustekinumab and an excellent safety. More data assessing mucosal healing after one year of treatment are needed

Background Homeostatic turnover of the extracellular matrix conditions the structure and function of the healthy lung. In lung transplantation, long-term management remains limited by chronic lung allograft dysfunction, an umbrella term used for a heterogeneous entity ultimately associated with pathological airway and/or parenchyma remodeling. Objective This study assessed whether the local cross-talk between the pulmonary microbiota and host cells is a key determinant in the control of lower airway remodeling posttransplantation. Methods Microbiota DNA and host total RNA were isolated from 189 bronchoalveolar lavages obtained from 116 patients post lung transplantation. Expression of a set of 11 genes encoding either matrix components or factors involved in matrix synthesis or degradation (anabolic and catabolic remodeling, respectively) was quantified by real-time quantitative PCR. Microbiota composition was characterized using 16S ribosomal RNA gene sequencing and culture. Results We identified 4 host gene expression profiles, among which catabolic remodeling, associated with high expression of metallopeptidase-7, -9, and -12, diverged from anabolic remodeling linked to maximal thrombospondin and platelet-derived growth factor D expression. While catabolic remodeling aligned with a microbiota dominated by proinflammatory bacteria (eg, Staphylococcus, Pseudomonas, and Corynebacterium), anabolic remodeling was linked to typical members of the healthy steady state (eg, Prevotella, Streptococcus, and Veillonella). Mechanistic assays provided direct evidence that these bacteria can impact host macrophage-fibroblast activation and matrix deposition. Conclusions Host-microbes interplay potentially determines remodeling activities in the transplanted lung, highlighting new therapeutic opportunities to ultimately improve long-term lung transplant outcome., Graphical abstract

"La forma tradicional de investigar en psicología en México ha hecho que sea una réplica de la psicología norteamericana y de algunas corrientes teóricas europeas. Aquí se hace un análisis crítico de esta situación y se propone construir una psicología mexicana, partiendo de nuevos paradigmas que reflejen la influencia de situaciones estructurales y colectivas propias del acontecer mexicano. Se muestra como ejemplo la investigación realizada de un estudio sobre la identidad nacional en México. Con los datos obtenidos se observa una situación crítica de la identidad nacional, así como un proceso de caída institucional del Estado-Nación mexicano."

Background Multicenter studies were conducted to evaluate the DPP ® HIV 1/2 Assay using oral fluid (OF) and fingerstick (FS) specimens in two different countries at the point of care (POC). Objective To evaluate the DPP ® HIV 1/2 Assay using OF and FS specimens when compared to various worldwide algorithms for the detection of HIV. Methods At each testing center, each participant was tested using the DPP HIV 1/2 Assay using OF and FS specimens. Each sample was dispersed into a premeasured buffer in a dropper bottle (DPP ® SampleTainer™ bottle) and added to the sample well of the device followed by the addition of running buffer to the buffer well of the device. Reference testing was performed according to the National testing algorithm of each Country. Results Assay sensitivity resulted in ranges of 98.9–100% for OF specimens and 99.8–100% for FS specimens. Assay specificity resulted in ranges of 99.9–100% for OF specimens and 99.5–100% for FS specimens. Conclusions Assay sensitivity and specificity obtained for both FS and OF were similar. The DPP HIV 1/2 Assay is highly accurate in detecting antibodies to HIV-1/2 with OF and FS specimens when compared to nationally accepted algorithms. The assay is especially advantageous in that the original sample is collected in a closed vial, eliminating the need for recollection of samples at the POC in the event of an invalid result or assay error upon testing.

On rend compte, dans cet article, d’une recherche, portant sur l’identite nationale et le profil civique, dans laquelle sont comparees plusieurs regions du Mexique et une ville europeenne (Seville, Espagne). On a selectionne des echantillons representatifs de toutes les regions etudiees, auxquels a ete appliquee une echelle d’evaluation standardisee, explorant la perception de vingt institutions, qui representent l’Etat-nation. On observe l’influence du degre d’integration dans le processus de mondialisation sur la baisse d’intensite de l’identite nationale et du profil civique des regions. Seville est celle qui presente les indices les plus faibles, tant pour l’identite nationale que pour le profil civique, relativement a toutes les regions mexicaines etudiees.

Social and cultural conditions (including U.S. border and inland influence, role models within the family, and educational background) which affect locus of control and achievement motivation among Mexican entrepreneurs were explored among 64 selected entrepreneurs in two Mexican towns, one on the Mexico-U.S. border, the other located inland. Analyses showed that the border subsample scored higher on External locus of control; however, in both subsamples the father was an important element in the locus of control variable and the entrepreneur status. No statistically significant mean difference was noted for achievement motivation. Practical applications and limitations are discussed.

"Este artículo hace un análisis de distintas aproximaciones de la psicosociología y la psicología política que permiten explicar los componentes de la “identidad universitaria”. Consideramos con Rosa, Bellelli y Backhurst que la identidad no puede desarrollarse sin la intervención de la memoria (en cierta manera histórica), en tanto que implica el desarrollo mismo de la conciencia sobre los eventos episó- dicos que dan forma a la identidad social y personal."