The hotel industry is an important energy consumer that needs efficient energy management methods to guarantee its performance and sustainability. The new role of hotels as prosumers increases the ...difficulty in the design of these methods. Also, the scenery is more complex as renewable energy systems are present in the hotel energy mix. The performance of energy management systems greatly depends on the use of reliable predictions for energy load. This paper presents a new methodology to predict energy load in a hotel based on intelligent techniques. The model proposed is based on a hybrid intelligent topology implemented with a combination of clustering techniques and intelligent regression methods (Artificial Neural Network and Support Vector Regression). The model includes its own energy demand information, occupancy rate, and temperature as inputs. The validation was done using real hotel data and compared with time-series models. Forecasts obtained were satisfactory, showing a promising potential for its use in energy management systems in hotel resorts.
Aim
To evaluate the relationship between the pressure exerted on the heel of one foot resting directly on a mattress, versus that exerted on the other heel, protected by a pillow beneath the Achilles ...tendon area and the changes thus produced in perfusion, oxygenation and temperature in the skin of heels of healthy volunteers lying in a supine position.
Design
Experimental study in a pre‐clinical phase, with healthy volunteer participants and intrapeople control.
Methods
The study was carried out from November 2017 – May 2018. A pressure measurement surface was placed between the participant and the constant low‐pressure support surface. Doppler laser devices were used to measure local temperature and perfusion. The degree of oxygenation was determined using an infrared beam close to the pressure zone in each heel. Both feet rested immobile on the bed, in a natural position, for 2 hr. To ensure intrapeople control, in every case the left heel was raised slightly, compared with the right.
Results
Eighteen participants took part in this study. Analysis of the results obtained showed that capillary blood flow was significantly reduced in the heel subjected to pressure, compared with the other heel, while no significant effects on oxygen saturation or temperature were observed. The variables associated with greater oxygen saturation were capillary blood flow, local temperature and pressure exerted. Fat‐free mass, fat mass and duration of exposure to pressure were all significantly associated with reduced oxygen saturation.
Conclusions
In healthy participants, when the heel is subjected to constant pressure against a constant low‐pressure support surface, there is a significant reduction in blood flow, compared with the heel where pressure is relieved. However, there are no significant differences in temperature or tissue oxygenation.
Impact
Significant reductions in vascular flow were observed; however, the oxygenation and temperature of the heel tissues remained unchanged. These findings, corroborated in real patients, would advance our understanding and facilitate decision‐making on measures to prevent pressure ulcers, such as repositioning or tissue protection.
Trial registration: The protocol is registered in ClinicalTrials.gov (NCT02736838).
目的
评价健康参与者仰卧位时足跟部皮肤的灌注、氧合和温度变化与单足直接躺在床垫上和另一足跟部在跟腱区下枕头保护下所受压力的关系。
设计
临床前阶段的实验研究,有健康志愿者参与者和患者内对照。
方法
本研究于2017年11月‐2018年5月进行。压力测量表面被放置在参与者和恒定低压支撑表面之间。用多普勒激光装置测量局部温度和灌注。氧合程度是用靠近每个脚跟压力区的红外线光束来测定的。两只脚在床上静止,保持自然姿势,持续2小时。为了确保足内控制,在每种情况下,与右脚跟相比,左脚跟略有抬高。
结果
18名参与者参加了这项研究。对所得结果的分析表明,与另一只脚跟相比,受压脚跟的毛细血管血流量明显减少,而对氧饱和度或温度没有明显影响。与更高的氧饱和度相关的变量是毛细血管血流量、局部温度和施加的压力。无脂肪量、脂肪量和压力持续时间均与氧饱和度降低显着相关。
结论
在健康参与者中,当脚后跟承受恒定的压力,与压力减轻的脚后跟相比,脚后跟承受恒定的低压支撑表面时,血流量明显减少。但温度和组织氧合无显著差异。
影响
观察到血管流量显著减少;而足跟组织的氧合和温度则保持不变。这些在真实病人中得到证实的发现,将促进我们对压疮预防措施的理解,并有助于决策,如重新定位或组织保护。
试验注册
该协议已在ClinicalTrials.gov (NCT02736838)注册。
Aims and Objectives
To evaluate the effectiveness of self‐care programmes in type 2 diabetes mellitus (T2DM) population in primary health care.
Background
The impact of educational interventions on ...T2DM has been evaluated in various contexts, but there is uncertainty about their impact in that of primary care.
Design
Systematic review and meta‐analysis.
Methods
A search was conducted in PubMed, CINAHL, WOS and Cochrane databases for randomised controlled trials carried out in the period January 2005‐December 2017, including studies with at least one face‐to‐face educational interventions. The quality of the evidence for the primary outcome was evaluated using the GRADE System. A meta‐analysis was used to determine the effect achieved although only the results classified as critical or important were taken into consideration. Checklist of Preferred Reporting Items for Systematic Reviews and Meta‐analyses has been followed. PROSPERO registration Number: CRD42016038833.
Results
In total, 21 papers (20 studies) were analysed, representing a population of 12,018 persons with T2DM. For the primary outcome, HbA1c, the overall reduction obtained was −0.29%, decreasing the effect in long‐term follow‐up. The quality of the evidence was low/very low due to very serious risk of bias, inconsistency and indirectness of results. Better results were obtained for individual randomised trials versus cluster designs and in those programmes in which nurses leaded the interventions. The findings for other cardiovascular risk factors were inconsistent.
Conclusions
Educational interventions in primary care addressing T2DM could be effective for metabolic control, but the low quality of the evidence and the lack of measurement of critical results generates uncertainty and highlights the need for high‐quality trials.
Relevance to clinical practice
Most of self‐care programmes for T2DM in primary care are focused on metabolic control, while other cardiovascular profile variables with greater impact on mortality or patient‐reported outcomes are less intensely addressed.
Multiple ecosystem functions need to be considered simultaneously to manage and protect the several ecosystem services that are essential to people and their environments. Despite this, cost ...effective, tangible, relatively simple and globally relevant methodologies to monitor in situ soil multifunctionality, that is, the provision of multiple ecosystem functions by soils, have not been tested at the global scale.
We combined correlation analysis and structural equation modelling to explore whether we could find easily measured, field‐based indicators of soil multifunctionality (measured using functions linked to the cycling and storage of soil carbon, nitrogen and phosphorus). To do this, we gathered soil data from 120 dryland ecosystems from five continents.
Two soil surface attributes measured in situ (litter incorporation and surface aggregate stability) were the most strongly associated with soil multifunctionality, even after accounting for geographic location and other drivers such as climate, woody cover, soil pH and soil electric conductivity. The positive relationships between surface stability and litter incorporation on soil multifunctionality were greater beneath the canopy of perennial vegetation than in adjacent, open areas devoid of vascular plants. The positive associations between surface aggregate stability and soil functions increased with increasing mean annual temperature.
Synthesis and applications. Our findings demonstrate that a reduced suite of easily measured in situ soil surface attributes can be used as potential indicators of soil multifunctionality in drylands world‐wide. These attributes, which relate to plant litter (origin, incorporation, cover), and surface stability, are relatively cheap and easy to assess with minimal training, allowing operators to sample many sites across widely varying climatic areas and soil types. The correlations of these variables are comparable to the influence of climate or soil, and would allow cost‐effective monitoring of soil multifunctionality under changing land‐use and environmental conditions. This would provide important information for evaluating the ecological impacts of land degradation, desertification and climate change in drylands world‐wide.
Our findings demonstrate that a reduced suite of easily measured in situ soil surface attributes can be used as potential indicators of soil multifunctionality in drylands world‐wide. These attributes, which relate to plant litter (origin, incorporation, cover), and surface stability, are relatively cheap and easy to assess with minimal training, allowing operators to sample many sites across widely varying climatic areas and soil types. The correlations of these variables are comparable to the influence of climate or soil, and would allow cost‐effective monitoring of soil multifunctionality under changing land‐use and environmental conditions. This would provide important information for evaluating the ecological impacts of land degradation, desertification and climate change in drylands world‐wide.
Aim
To measure the Effectiveness of a Diabetes Education Program for people with T2DM, based on Tailored interventions and the Theory of Planned Behaviour.
Design
Cluster randomized controlled ...clinical trial.
Methods
This multicentre study will be carried out at 30 primary healthcare centres, where 436 persons with Type 2 Diabetes Mellitus (T2DM), aged between 18–75 years, will be recruited. The experimental educational program to be applied is modelled using components obtained from a systematic review and prior qualitative analysis. In addition, a taxonomy of nursing practice is used to standardize the program, based on the Theory of Planned Behaviour as a conceptual model. The intervention will be carried out by community nurses, using ADAPP‐Ti®, an application developed with FileMaker Pro v.18. The control group will receive usual care and data will be collected at 6, 12, and 18 months, for both groups. The primary outcome considered will be glycosylated haemoglobin and cardiovascular factors, while the secondary ones will be tobacco consumption, body mass index, barriers to self‐care, health‐related quality of life, and lifestyle modification. The protocol was approved by the Ethics Committee of the Province of Malaga (Spain) in November 2014.
Discussion
The degree of metabolic control in T2DM is not always associated with healthy lifestyles and significant levels of medication are often prescribed to achieve clinical objectives. An intervention focused on needs, based on the best available evidence and a solid conceptual framework, might successfully consolidate appropriate self‐care behaviour in this population.
Impact
The study will result in the publication of an educational program featuring well‐defined interventions and activities that will enable clinicians to tailor health care to the individual's needs and to combat treatment inertia in attending this population.
摘要
目标
以定制干预措施和计划行为理论为基础,对2型糖尿病患者的糖尿病教育计划的有效性进行评估。
设计
群随机对照临床试验。
方法
这项多中心研究将在30个初级医疗中心进行,将招募436名年龄在18‐75岁之间的2型糖尿病(T2DM)患者。将采用的实验教育方案是使用从系统回顾和先前的定性分析中获得的内容进行建模。此外,以计划行为理论为概念模型,采用护理实践分类法来规范程序。干预将由社区护士使用由FileMaker Pro v.18开发的ADAPP‐Ti®进行。对照组将接受常规护理,并在6个月、12个月和18个月收集数据。考虑的主要结果是糖化血红蛋白和心血管因素,次要结果是烟草消费、体重指数、自我保健障碍、健康相关生活质量和生活方式改变。2014年11月,马拉加省(西班牙)伦理委员会批准了该方案。
讨论
2型糖尿病患者的代谢控制程度并不总是与健康的生活方式相关,为了达到临床目标,通常会开出大量药物。以现有的最佳证据和坚实的概念框架为基础,以需求为重点的干预措施可能会成功地巩固这一群体适当的自我保健行为。
影响
这项研究将导致一项教育计划的出版,其特点是明确的干预措施和活动,使临床医生能够根据个人需求量身定制医疗保健,并克服治疗惯性。
The modulation of the A2B adenosine receptor is a promising strategy in cancer (immuno) therapy, with A2BAR antagonists emerging as immune checkpoint inhibitors. Herein, we report a systematic ...assessment of the impact of (di- and mono-)halogenation at positions 7 and/or 8 on both A2BAR affinity and pharmacokinetic properties of a collection of A2BAR antagonists and its study with structure-based free energy perturbation simulations. Monohalogenation at position 8 produced potent A2BAR ligands irrespective of the nature of the halogen. In contrast, halogenation at position 7 and dihalogenation produced a halogen-size-dependent decay in affinity. Eight novel A2BAR ligands exhibited remarkable affinity (K i < 10 nM), exquisite subtype selectivity, and enantioselective recognition, with some eutomers eliciting sub-nanomolar affinity. The pharmacokinetic profile of representative derivatives showed enhanced solubility and microsomal stability. Finally, two compounds showed the capacity of reversing the antiproliferative effect of adenosine in activated primary human peripheral blood mononuclear cells.
Abstract
Aims
Severe tricuspid regurgitation (TR) has adverse effects on outcomes, with limited therapeutic options. We report the outcomes of patients undergoing percutaneous annuloplasty as a ...treatment of ≥severe functional TR in a single centre.
Methods and results
Prospective, single-arm, single-centre study that enrolled 24 consecutive patients with at least severe functional TR undergoing percutaneous annuloplasty with Cardioband system between 2019 and 2021. Clinical and echocardiographic data were prospectively collected, with a mean follow-up of 279 ± 246 days. At baseline, 66.6% were in New York Heart Association (NYHA) Classes III and IV and 100% had significant oedema. Technical success was 91.6%. At the end of follow-up, there was one death. Echocardiography showed a significant reduction in septolateral annular diameter of 10.4 mm (P < 0.001) that remained stable at the end of follow-up. The severity of the TR was also reduced. About 81.8% of patients were in NYHA Classes I and II. The number of patients with significant oedema decreased to 46% (P = 0.01). Six-minute walk distance improved by 68.8 m (P = 0.12).
Conclusion
Percutaneous annuloplasty with Cardioband system is an effective and safe treatment for patients with symptomatic, ≥severe functional TR. Annular reduction and TR severity reduction remained significant and sustained for 1 year. Patients experienced improvements in quality of life and exercise capacity.
Graphical Abstract
Graphical Abstract
Effects of Cardioband implantation for the treatment of tricuspid regurgitation. TR, tricuspid regurgitation; NYHA, New York Heart Association; SVC, superior vein cava; IVC, inferior vein cava; IAS, interatrial septum.
Hutchinson–Gilford progeria syndrome (HGPS) is a rare genetic disease caused by defective prelamin A processing, leading to nuclear lamina alterations, severe cardiovascular pathology, and premature ...death. Prelamin A alterations also occur in physiological aging. It remains unknown how defective prelamin A processing affects the cardiac rhythm. We show age-dependent cardiac repolarization abnormalities in HGPS patients that are also present in the Zmpste24
−/− mouse model of HGPS. Challenge of Zmpste24
−/− mice with the β-adrenergic agonist isoproterenol did not trigger ventricular arrhythmia but caused bradycardia-related premature ventricular complexes and slow-rate polymorphic ventricular rhythms during recovery. Patch-clamping in Zmpste24
−/− cardiomyocytes revealed prolonged calcium-transient duration and reduced sarcoplasmic reticulum calcium loading and release, consistent with the absence of isoproterenol-induced ventricular arrhythmia. Zmpste24
−/− progeroid mice also developed severe fibrosis-unrelated bradycardia and PQ interval and QRS complex prolongation. These conduction defects were accompanied by overt mislocalization of the gap junction protein connexin43 (Cx43). Remarkably, Cx43 mislocalization was also evident in autopsied left ventricle tissue from HGPS patients, suggesting intercellular connectivity alterations at late stages of the disease. The similarities between HGPS patients and progeroid mice reported here strongly suggest that defective cardiac repolarization and cardiomyocyte connectivity are important abnormalities in the HGPS pathogenesis that increase the risk of arrhythmia and premature death.
Kaposi sarcoma (KS) is an angioproliferative lesion in which two main KS cell sources are currently sustained: endothelial cells (ECs) and mesenchymal/stromal cells. Our objective is to establish the ...tissue location, characteristics and transdifferentiation steps to the KS cells of the latter. For this purpose, we studied specimens of 49 cases of cutaneous KS using immunochemistry and confocal and electron microscopy. The results showed that delimiting CD34+ stromal cells/Telocytes (CD34+SCs/TCs) in the external layer of the pre-existing blood vessels and around skin appendages form small convergent lumens, express markers for ECs of blood and lymphatic vessels, share ultrastructural characteristics with ECs and participate in the origin of two main types of neovessels, the evolution of which gives rise to lymphangiomatous or spindle-cell patterns-the substrate of the main KS histopathological variants. Intraluminal folds and pillars (papillae) are formed in the neovessels, which suggests they increase by vessel splitting (intussusceptive angiogenesis and intussusceptive lymphangiogenesis). In conclusion, delimiting CD34+SCs/TCs are mesenchymal/stromal cells that can transdifferentiate into KS ECs, participating in the formation of two types of neovessels. The subsequent growth of the latter involves intussusceptive mechanisms, originating several KS variants. These findings are of histogenic, clinical and therapeutic interest.
Perivascular cells in the pericytic microvasculature, pericytes and CD34+ stromal cells/telocytes (CD34+SCs/TCs), have an important role in angiogenesis. We compare the behavior of these cells ...depending on whether the growth of endothelial cells (ECs) from the pre-existing microvasculature is toward the interstitium with vascular bud and neovessel formation (sprouting angiogenesis) or toward the vascular lumen with intravascular pillar development and vessel division (intussusceptive angiogenesis). Detachment from the vascular wall, mobilization, proliferation, recruitment, and differentiation of pericytes and CD34+SCs/TCs, as well as associated changes in vessel permeability and functionality, and modifications of the extracellular matrix are more intense, longer lasting over time, and with a greater energy cost in sprouting angiogenesis than in intussusceptive angiogenesis, in which some of the aforementioned events do not occur or are compensated for by others (e.g., sparse EC and pericyte proliferation by cell elongation and thinning). The governing mechanisms involve cell–cell contacts (e.g., peg-and-socket junctions between pericytes and ECs), multiple autocrine and paracrine signaling molecules and pathways (e.g., vascular endothelial growth factor, platelet-derived growth factor, angiopoietins, transforming growth factor B, ephrins, semaphorins, and metalloproteinases), and other factors (e.g., hypoxia, vascular patency, and blood flow). Pericytes participate in vessel development, stabilization, maturation and regression in sprouting angiogenesis, and in interstitial tissue structure formation of the pillar core in intussusceptive angiogenesis. In sprouting angiogenesis, proliferating perivascular CD34+SCs/TCs are an important source of stromal cells during repair through granulation tissue formation and of cancer-associated fibroblasts (CAFs) in tumors. Conversely, CD34+SCs/TCs have less participation as precursor cells in intussusceptive angiogenesis. The dysfunction of these mechanisms is involved in several diseases, including neoplasms, with therapeutic implications.
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