Is photoelectrocatalysis an efficient process to degrade endocrine disruptors chemicals?

Endocrine disruptors chemicals (EDCs) pose significant health risks, including cancer, behavioral disorders, and infertility. In this study, we employed the photoelectrocatalysis (PEC) technique with optimized tungsten oxide (WO3) nanostructures as a photoanode to degrade three diverse EDCs: methiocarb, dimethyl phthalate, and 4-tert-butylphenol. PEC degradation tests were carried out for individual contaminants and a mixture of them, assessing efficiency across different EDC families. Ultra High-Performance Liquid Chromatography and Mass Spectrometry was used to control the course of the experiments. For individual solutions, 4-tert-butylphenol and methiocarb were 100% degraded at 1 hour of PEC degradation. Among the tested EDCs, dimethyl phthalate showed the highest resistance to degradation when treated individually. However, when assessed in a mixture with the other EDCs, the degradation efficiency of dimethyl phthalate increased compared to its individual treatment. Furthermore, four degradation intermediates were identified for each contaminant. Finally, toxicity tests revealed that the initial solution was more toxic than the samples treated for all the contaminants tested, except for the phthalate.

Boosting the Oxygen Evolution Activity of FeNi Oxides/Hydroxides by Molecular and Atomic Engineering.

FeNi oxides/hydroxides are the best performing catalysts for oxidizing water at basic pH. Consequently, their improvement is the cornerstone to develop more efficient artificial photosynthetic systems. During the last 5 years different reports have demonstrated an enhancement of their activity by engineering their structures via: (1) modulation of the number of oxygen, iron and nickel vacancies; (2) single atoms (SAs) doping with metals such as Au, Ir, Ru and Pt; and (3) modification of their surface using organic ligands. All these strategies have led to more active and stable electrocatalysts for oxygen evolution rection (OER). In this Concept, we critically analyze these strategies using the most relevant examples.

Characterization and Comparison of WO3/WO3-MoO3 and TiO2/TiO2-ZnO Nanostructures for Photoelectrocatalytic Degradation of the Pesticide Imazalil.

Tungsten oxide (WO3) and zinc oxide (ZnO) are n-type semiconductors with numerous applications in photocatalysis. The objective of this study was to synthesize and characterize different types of nanostructures (WO3, WO3-Mo, TiO2, and TiO2-ZnO) for a comparison of hybrid and pure nanostructures to use them as a photoanodes for photoelectrocatalytic degradation of emerging contaminants. With the aim of comparing the properties of both samples, field emission scanning electron microscopy (FE-SEM) and confocal laser-Raman spectroscopy were used to study the morphology, composition, and crystallinity, respectively. Electrochemical impedances, Mott-Schottky, and water splitting measurements were performed to compare the photoelectrochemical properties of photoanodes. Finally, the photoelectrocatalytic degradation of the pesticide Imazalil was carried out with the best optimized nanostructure (TiO2-ZnO).

Livelihood Capitals and Opportunity Cost for Grazing Areas' Restoration: A Sustainable Intensification Strategy in the Ecuadorian Amazon.

Land use change in pastures is considered one of the leading drivers of tropical deforestation in the Ecuadorian Amazon Region (EAR). To halt and reverse this process, it is necessary to understand, among other factors, the local livelihoods, income from grazing area and the appropriate options to foster sustainable production, incorporating the land-sparing and land-sharing approach. This work was conducted using 167 household surveys along an altitudinal gradient within the buffer and transition zone of the Sumaco Biosphere Reserve (SBR) in the EAR. The results of a comparative analysis of the main capital variables (human, social, natural, financial, and physical), and the opportunity cost of grazing area assessment provides the following key findings: (a) the concepts of land sparing and land sharing should be considered as complementary local strategies, including household livelihoods and the opportunity cost of the grazing area; (b) we should encourage markets with differentiated restoration rights, based on households engaged in low grazing areas' opportunity costs, and making less impact on capitals' livelihood a key element of economic and conservation initiatives; and (c) sectoral policy implications, including moderate intensification and technological improvements to strengthen the pastureland-sparing and -sharing approach, are discussed.

Experimental and Theoretical Tests on the Corrosion Protection of Mild Steel in Hydrochloric Acid Environment by the Use of Pyrazole Derivative.

In this study, 1,5-diallyl-1H-pyrazolo [3,4-d] pyrimidin-4 (5H)-one (PPD) was evaluated as an anticorrosion agent for mild steel (MS) in 1 M HCl. The analysis was performed by weight loss (WL), potentiodynamic polarization measurement, and electrochemical impedance spectroscopy (EIS). The Tafel polarization showed that PPD is a mixed-type inhibitor and reaches 94% of the protective efficiency at 10-3 M. EIS results indicated that the resistance to charge transfer increases with increasing inhibitor concentration and the corrosion of MS is controlled by a charge transfer process. The inhibitor adsorption on the MS surface obeyed the Langmuir's adsorption isotherm. Thermodynamic parameters were calculated to elaborate the corrosion inhibition mechanism. The micrographic analysis revealed the existence of a barrier layer on the electrode surface with the presence of PPD. Theoretical examinations performed by electronic/atomic computer simulations confirmed that the obtained results were found to be consistent with experimental findings.

Degradation of Methylparaben Using Optimal WO3 Nanostructures: Influence of the Annealing Conditions and Complexing Agent.

In this work, WO3 nanostructures were synthesized with different complexing agents (0.05 M H2O2 and 0.1 M citric acid) and annealing conditions (400 °C, 500 °C and 600 °C) to obtain optimal WO3 nanostructures to use them as a photoanode in the photoelectrochemical (PEC) degradation of an endocrine disruptor chemical. These nanostructures were studied morphologically by a field emission scanning electron microscope. X-ray photoelectron spectroscopy was performed to provide information of the electronic states of the nanostructures. The crystallinity of the samples was observed by a confocal Raman laser microscope and X-ray diffraction. Furthermore, photoelectrochemical measurements (photostability, photoelectrochemical impedance spectroscopy, Mott-Schottky and water-splitting test) were also performed using a solar simulator with AM 1.5 conditions at 100 mW·cm-2. Once the optimal nanostructure was obtained (citric acid 0.01 M at an annealing temperature of 600 °C), the PEC degradation of methylparaben (CO 10 ppm) was carried out. It was followed by ultra-high-performance liquid chromatography and mass spectrometry, which allowed to obtain the concentration of the contaminant during degradation and the identification of degradation intermediates. The optimized nanostructure was proved to be an efficient photocatalyst since the degradation of methylparaben was performed in less than 4 h and the kinetic coefficient of degradation was 0.02 min-1.

Influence of Cocatalysts (Ni, Co, and Cu) and Synthesis Method on the Photocatalytic Activity of Exfoliated Graphitic Carbon Nitride for Hydrogen Production.

Exfoliated graphitic carbon nitride (ex-g-CN) was synthesized and loaded with non-noble metals (Ni, Cu, and Co). The synthesized catalysts were tested for hydrogen production using a 300-W Xe lamp equipped with a 395 nm cutoff filter. A noncommercial double-walled quartz-glass reactor irradiated from the side was used with a 1 g/L catalyst in 20 mL of a 10 vol% triethanolamine aqueous solution. For preliminary screening, the metal-loaded ex-g-CN was synthesized using the incipient wetness impregnation method. The highest hydrogen production was observed on the Ni-loaded ex-g-CN, which was selected to assess the impact of the synthesis method on hydrogen production. Ni-loaded ex-g-CN was synthesized using different synthesis methods: incipient wetness impregnation, colloidal deposition, and precipitation deposition. The catalysts were characterized by X-ray powder diffraction, X-ray photoelectron spectroscopy, nitrogen adsorption using the Brunauer-Emmett-Teller method, and transmission electron microscopy. The Ni-loaded ex-g-CN synthesized using the colloidal method performed best with a hydrogen production rate of 43.6 µmol h-1 g-1. By contrast, the catalysts synthesized using the impregnation and precipitation methods were less active, with 28.2 and 10.1 µmol h-1 g-1, respectively. The hydrogen production performance of the suspended catalyst (440 µmol m-2 g-1) showed to be superior to that of the corresponding immobilized catalyst (236 µmol m-2 g-1).

Does Gender Impact Technology Adoption in Dual-Purpose Cattle in Mexico?

This paper examines the role of women in the dual-purpose livestock system (DP) in Mexico through their technological adoption patterns and aims to evaluate whether there are significant differences between the technology adoption networks of men and women farmers. The sample was composed of 383 DP small farms with 20 or fewer cows and a high level of vulnerability. Social Network Analysis (SNA) was applied, and the centrality measures were calculated for the technological areas of management, feeding, genetics, reproduction, and animal health. Significant differences were found in reproduction levels between men and women farmers. Therefore, SNA was developed in this technological area where men mainly occupied central positions (brokers) while women were just close to the leaders in the network. The results have shown that farms run by women were smaller and presented higher levels of specialization and milk productivity (20% higher), and women prioritized those technologies linked to female reproductive efficiency. Moreover, women were deeply embedded in men's networks through numerous ties and were capable of building connections with groups of farmers outside of their own group.

Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study.

BACKGROUND: Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing hemoglobin A1c (HbA1c) levels to recommended targets is associated with a marked decrease in the risk of type 2 diabetes mellitus (T2DM)-related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empower people with T2DM, leading to improved metabolic control of the disease. OBJECTIVE: This study aimed to analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately controlled T2DM. METHODS: The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA1c levels ≥7.5% to ≤9.5%, receiving treatment with noninsulin antihyperglycemic agents, and able to use a smartphone app. Individuals were randomly assigned (2:1) to the DeMpower app-empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA1c≤7.5% with a ≥0.5% reduction in HbA1c at week 24. RESULTS: Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 in the DeMpower app-empowered group and 17 in the control group) were analyzed. There was a trend toward a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=.07) in the DeMpower app group that was statistically significant when the target was HbA1c≤7.5% (64% vs 24%; P=.02) or HbA1c≤8% (85% vs 53%; P=.02). The mean HbA1c was significantly reduced at week 24 (-0.81, SD 0.89 vs -0.15, SD 1.03; P=.03); trends for improvement in other cardiovascular risk factors, medication adherence, and satisfaction were observed. CONCLUSIONS: The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario.

Unravelling the Mechanistic Pathway of the Hydrogen Evolution Reaction Driven by a Cobalt Catalyst.

A cobalt complex bearing a κ-N3 P2 ligand is presented (1+ or CoI (L), where L is (1E,1'E)-1,1'-(pyridine-2,6-diyl)bis(N-(3-(diphenylphosphanyl)propyl)ethan-1-imine). Complex 1+ is stable under air at oxidation state CoI thanks to the π-acceptor character of the phosphine groups. Electrochemical behavior of 1+ reveals a two-electron CoI /CoIII oxidation process and an additional one-electron reduction, which leads to an enhancement in the current due to hydrogen evolution reaction (HER) at Eonset =-1.6 V vs Fc/Fc+ . In the presence of 1 equiv of bis(trifluoromethane)sulfonimide, 1+ forms the cobalt hydride derivative CoIII (L)-H (22+ ), which has been fully characterized. Further addition of 1 equiv of CoCp*2 (Cp* is pentamethylcyclopentadienyl) affords the reduced CoII (L)-H (2+ ) species, which rapidly forms hydrogen and regenerates the initial CoI (L) (1+ ). The spectroscopic characterization of catalytic intermediates together with DFT calculations support an unusual bimolecular homolytic mechanism in the catalytic HER with 1+ .

Integrated rearing system proposal for Cantareus aspersus in experimental orchards: Growth models.

An integrated rearing system for Cantareus aspersus under environmental conditions in an experimental orchard is proposed. In this study, the natural behaviour, circadian rhythms and suitable rearing conditions of the edible snail were optimised to produce homogeneous growth and low variability. The growth was standardised, and growth pattern fit was assessed with various models. One thousand fry were cultured in the orchard, and a random sample of 100 snails were measured weekly for 23 weeks. The rearing system had the following characteristics: snails and earthworms were included in the experimental rearing orchard; a homogeneous group of juvenile snails of the same age and size and high rearing density (500 snails/m2) was used; snails were fed with layers mash ad libitum; and mixed and fringes vegetation was planted in the orchard. A commercial size of 60% of snails was achieved in 21 weeks and 95% in 23 weeks. The different models showed a good fit, and the quadratic model obtained the best fit. This experimental snail orchard proposal can be extended to other areas, although it must be corrected according to different environmental conditions and fit to other species of interest. This experimental model could constitute a viable alternative to traditional models of animal experimentation with mammals, and given its high adaptability, it could be applied in different fields of science.

Insights into the light-driven hydrogen evolution reaction of mesoporous graphitic carbon nitride decorated with Pt or Ru nanoparticles.

Ru or Pt nanoparticles have been prepared following the organometallic approach and deposited onto the surface of mesoporous graphitic carbon nitride (mpg-CN). Three different Ru-based samples have also been compared to investigate the effect of 4-phenylpyridine as a stabilizing agent. The photocatalytic performance towards the hydrogen evolution reaction (HER) has been tested showing that all hybrid systems clearly outperform the photocatalytic activity of bare mpg-CN. In particular, Pt-decorated mpg-CN yields the largest H2 production upon visible-light irradiation (870 µmol h-1 g-1, TOF = 14.1 h-1, TON = 339 after 24 h) when compared with the Ru-based samples (137-155 µmol h-1 g-1, TOFs between 2.3-2.7 h-1, TONs between 54-57 after 24 h). Long-term photochemical tests (up to 65 h irradiation) show also an improved stability of the Pt-based samples over the Ru counterpart. Photophysical experiments aimed at rationalizing the photocatalytic performance of the different hybrid systems elucidate that the enhanced activity of the Pt-decorated mpg-CN over the Ru-based analogues arises from improved electron transfer kinetics from mpg-CN to the metal nanoparticles.

Adherence, control of cardiometabolic factors and therapeutic inertia in patients with type 2 diabetes in the primary care setting.

INTRODUCTION: Studies on treatment adherence to glucose-lowering drugs among patients with type 2 diabetes (T2D) including concomitant treatment for other cardiovascular risk factors are scarce. We aimed to estimate the prevalence of good adherence to all medications used to control diabetes, hypertension and dyslipidemia and to analyse cardiometabolic control and its associated factors in T2D patients in the primary care (PC) setting. METHODS: Observational, retrospective study conducted in adult patients with T2D who were followed in the PC setting in Spain. Patients were classified as adherent in a particular category if the summary of the proportion of days covered (PDC) for a particular medication category was ≥80% and were considered globally adherent if the PDC was ≥80% for each of the 3 medication categories. RESULTS: A total of 457 evaluable patients were recruited, among which 321 patients (70.3%, 95% CI 65.8 to 74.4) were adherent to the three drug categories. The proportion of patients controlled for the 3 cardiometabolic risk factors was 31% according to the contemporary clinical practice guideline criteria, 58% according to investigator judgment and 36% when the objective for HbA1c was individualized. In a multivariate analysis, presenting comorbidities was associated with a lower likelihood of showing adequate control of dyslipidemia (odds ratio [OR] 0.25, 95% CI, 0.16-0.40) and the three cardiometabolic factors as a whole (OR 0.43, 95% CI 0.26-0.70). In a post hoc analysis, therapeutic inertia was found to be greater for dyslipidemia and hypertension than for T2D. CONCLUSIONS: Despite a relatively high adherence to all medications for treating diabetes, hypertension and dyslipidemia in patients with T2D in the PC setting in Spain, the control of cardiometabolic risk factors as a whole is far from optimal. This could be related, at least in part, to the high frequency of comorbidity of these patients.

Impact of Advanced Diabetes Centers on the healthcare experience of patients with type 2 diabetes using the IEXPAC tool.

AIMS: To determine the experience with healthcare among patients with type 2 diabetes according to the assistance model provided in their primary care centers, and to determine factors related with their experience. METHODS: This was a cross-sectional study performed in patients with type 2 diabetes with cardiovascular or renal complications. The patients were divided in two groups according to whether they had been attended in Advanced Diabetes centers (ADC) or the traditional assistance centers. Patient's healthcare experience was assessed with the "Instrument for Evaluation of the Experience of Chronic Patients" (IEXPAC) questionnaire, with possible scores ranging from 0 (worst experience) to 10 (best experience). RESULTS: A total of 451 patients (215 from ADC and 236 from traditional assistance centers) were included. The mean overall IEXPAC scores were 5.9 ±â€¯1.7 (ADC) and 6.0 ±â€¯1.9 (traditional assistance centers; p = 0.82). In the multivariant analyses, in ADC, the regular follow-up by the same physician (p = 0.01) and follow-up by a nurse (p = 0.01), were associated with a better patient experience, whereas receiving a higher number of medications with a worse patient experience (p = 0.04). In the traditional assistance centers, only the regular follow-up by the same physician was associated with a better experience (p = 0.02). Patients from ADC centers reported a higher score in the quality of life scale (69.1 ±â€¯16.5 vs 64.6 ±â€¯17.5; p = 0.008). CONCLUSIONS: In general, the healthcare experience of type 2 diabetic patients with their sanitary assistance can be improved. Patients from ADC centers report a higher score in the quality of life scale.

Original Approach to Synthesize TiO2/ZnO Hybrid Nanosponges Used as Photoanodes for Photoelectrochemical Applications.

In the present work, TiO2/ZnO hybrid nanosponges have been synthesized for the first time. First, TiO2 nanosponges were obtained by anodization under hydrodynamic conditions in a glycerol/water/NH4F electrolyte. Next, in order to achieve the anatase phase of TiO2 and improve its photocatalytic behaviour, the samples were annealed at 450 °C for 1 h. Once the TiO2 nanosponges were synthesized, TiO2/ZnO hybrid nanosponges were obtained by electrodeposition of ZnO on TiO2 nanosponges using different temperatures, times, and concentrations of zinc nitrate (Zn(NO3)2). TiO2/ZnO hybrid nanosponges were used as photoanodes in photoelectrochemical water splitting tests. The results indicate that the photoelectrochemical response improves, in the studied range, by increasing the temperature and the Zn(NO3)2 concentration during the electrodeposition process, obtaining an increase in the photoelectrochemical response of 141% for the TiO2/ZnO hybrid nanosponges electrodeposited at 75 °C with 10 mM Zn(NO3)2 for 15 min. Furthermore, morphological, chemical, and structural characterization was performed by Field Emission Scanning Electron Microscopy (FE-SEM) with Energy Dispersive X-Ray spectroscopy (EDX), Raman Confocal Laser Spectroscopy, X-Ray Photoelectron Spectroscopy (XPS), and Grazing Incidence X-Ray Diffraction (GIXRD).

Population viability analysis of the endangered Dupont's Lark Chersophilus duponti in Spain.

Steppe lands in Europe are critically affected by habitat loss and fragmentation, and hold over 50% of IUCN Red List bird species in Europe. Dupont's Lark is a threatened steppe-specialist passerine whose European geographic range is restricted to Spain, with less than 2000 pairs and an annual population decline of - 3.9%. Its strongly fragmented habitat leads to a metapopulation structure in the Iberian Peninsula that includes 24 populations and 100 subpopulations. We present an updated Population Viability Analysis based on the latest scientific knowledge regarding distribution, population trends, breeding biology and connectivity. Our results predict metapopulation extinction in 2-3 decades, through a centripetal contraction process from the periphery to the core. The probability of extinction in 20 years was 84.2%, which supports its relisting to Endangered in Spain following IUCN criteria. We carried out a sensitivity analysis showing that some parameters, especially productivity and survival of adults and juveniles, help to increase metapopulation viability. Simulation of management scenarios showed that habitat restoration in a subset of key subpopulations had a positive effect on the overall metapopulation persistence. Translocations of a limited number of individuals from source to recipient locations may help to rescue the most endangered subpopulations without reducing the global time to extinction of the metapopulation. In addition, we identified the most critical areas for action, where local populations of the species are prone to extinction. This work suggests that the viability of the Dupont's Lark metapopulation could be improved and its risk of extinction reduced if urgent and localized conservation measures are applied. In the short-term, habitat loss and fragmentation due to ploughing, reforestation and infrastructures implementation in Dupont's Lark habitat must be avoided. Habitat restoration and translocations could help to avoid imminent extinction of critical subpopulations. Restoration of extensive grazing is recommended as the most effective way to achieve the long-term conservation of Dupont's Lark in Spain.

Connectivity in Spanish metapopulation of Dupont's lark may be maintained by dispersal over medium-distance range and stepping stones.

BACKGROUND: Dupont's Lark is an endangered bird, whose fragmented distribution in Europe is entirely restricted to Spain. This lark, suffering pronounced population decline and range contraction, inhabits steppes that have long been used for grazing sheep and are now threatened by rural abandonment and land use changes. Thus, for conservation of the lark, increasing knowledge about the connectivity of the Spanish metapopulation and identifying the most important connectivity nodes are crucial. METHODS: The study was carried out in Spain, using over 16,000 Dupont's Lark georeferenced observations. We used distance buffers to define populations and subpopulations, based on the available scientific information. We identified potential stepping stones using a MaxEnt probability of presence model. Connectivity was assessed using Conefor software, using the centroid of each subpopulation and stepping stone as nodes. Each node was assigned a quantitative attribute based on total habitat area, within-node habitat quality and internal fragmentation. We evaluated different connectivity scenarios by potential movement thresholds (5-20-100 km) and presence or absence of stepping stones in the network. RESULTS: Dupont's Lark Iberian metapopulation comprises 24 populations and 100 subpopulations, plus 294 potential stepping stones. Movement thresholds and stepping stones had a strong influence in the potential network connectivity. The most important nodes are located in the core of the metapopulation, which shows connectivity among subpopulations in the different indices and scenarios evaluated. Peripheral populations are more isolated and require stepping stones or medium (20 km) or long (100 km) potential movement thresholds to join the network. DISCUSSION: Metapopulation connectivity may be greater than expected, thanks to stepping stones and potential medium-distance movements. Connectivity is crucial for conservation and can be increased by preserving or improving adequate habitat in the most important nodes. Given the current species decline, steppe habitat should be urgently protected from land use changes and agriculture intensification, at least in the critical subpopulations and stepping stones. Long-term conservation of steppe lands and Dupont's Lark in Spain requires the recovery of traditional grazing and more research on juvenile dispersion. Meanwhile, the conservation of potentially critical stepping stones should be incorporated to management plans.

Morphological Variations of Wild Populations of Brycon dentex (Characidae, Teleostei) in the Guayas Hydrographic Basin (Ecuador). The Impact of Fishing Policies and Environmental Conditions.

The Guayas, located in Ecuador, is the largest basin in the Pacific Ocean and has an inventory of 123 native freshwater species. Most of these are endemic species that are threatened or at-risk due to anthropogenic activity and the modification, fragmentation, and destruction of habitats. The aim of this study was to determine the morphometric variation in three wild populations of Brycon dentex in the Guayas basin rivers and their connections to fishing management and environmental conditions. A total of 200 mature fish were captured, and 26 morphometric parameters were measured. The fishing policies (Hypothesis 1) and environmental conditions (Hypothesis 2) were considered fixed factors and were validated by t-tests. The morphological variation among the three populations (Hypothesis 3) was validated through a discriminant analysis. Fishing policies and resource management were found to generate morphological differences associated with body development. In addition, the environmental conditions were found to influence the size and structure of Brycon dentex populations. The analyzed populations were discriminated by the generated morphometric models, which differentiated Cluster 1 (Quevedo and Mocache rivers) with high fishing pressure from Cluster 2 (Pintado river) with medium-low fishing pressure. Morphometric differentiation by discriminant analysis is a direct and economic methodology that can be applied as an indicator of diversity maintenance.

Experience of Patients with Diabetes and Other Cardiovascular Risk Factors with Health Professionals and Healthcare in Spain.

We aimed to evaluate the experience of patients with type 2 diabetes (T2DM) with healthcare received in Spain. This was a retrospective, observational study in patients with T2DM cared for in primary healthcare (PHC) centers. A cross-sectional analysis of the patients' experience data was performed using the Instrument for the Evaluation of the Experience of Chronic Patients (IEXPAC). A total of 475 patients with T2DM were recruited from 36 PHC centers, of which 248 (52.2%) completed the IEXPAC questionnaire. The IEXPAC total mean score (range 0-10) was 7 points, with an average "new relational model" score of 2.5 points. The mean continuity of care score after hospital discharge was 6.2 points. The results showed that 8% of the patients always or almost always used the internet to check their medical history, appointments or other data from their healthcare service, and 15% responded that healthcare professionals always or almost always informed them of forums or other reliable internet sites to obtain information about their illness. The study results show that there is a wide margin for improvement in the experience of patients with T2DM with healthcare in Spain, especially regarding the information patients receive or can obtain.

Incidence and Characteristics of Kidney Stones in Patients on Ketogenic Diet: A Systematic Review and Meta-Analysis.

Very-low-carbohydrate diets or ketogenic diets are frequently used for weight loss in adults and as a therapy for epilepsy in children. The incidence and characteristics of kidney stones in patients on ketogenic diets are not well studied. Methods: A systematic literature search was performed, using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the databases' inception through April 2020. Observational studies or clinical trials that provide data on the incidence and/or types of kidney stones in patients on ketogenic diets were included. We applied a random-effects model to estimate the incidence of kidney stones. Results: A total of 36 studies with 2795 patients on ketogenic diets were enrolled. The estimated pooled incidence of kidney stones was 5.9% (95% CI, 4.6-7.6%, I2 = 47%) in patients on ketogenic diets at a mean follow-up time of 3.7 +/- 2.9 years. Subgroup analyses demonstrated the estimated pooled incidence of kidney stones of 5.8% (95% CI, 4.4-7.5%, I2 = 49%) in children and 7.9% (95% CI, 2.8-20.1%, I2 = 29%) in adults, respectively. Within reported studies, 48.7% (95% CI, 33.2-64.6%) of kidney stones were uric stones, 36.5% (95% CI, 10.6-73.6%) were calcium-based (CaOx/CaP) stones, and 27.8% (95% CI, 12.1-51.9%) were mixed uric acid and calcium-based stones, respectively. Conclusions: The estimated incidence of kidney stones in patients on ketogenic diets is 5.9%. Its incidence is approximately 5.8% in children and 7.9% in adults. Uric acid stones are the most prevalent kidney stones in patients on ketogenic diets followed by calcium-based stones. These findings may impact the prevention and clinical management of kidney stones in patients on ketogenic diets.