Una experiencia didáctica para la enseñanza-aprendizaje de la conservación del patrimonio histórico

This article introduce the objectives, methodology and results of a teaching innovation project implemented in technical schools whose aim is to bring students to real experiences within the intervention on the Historical Heritage. This proposal has sought the promotion of cooperative and interdisciplinary work through the creation of a virtual tool that eases an integral to the restorative experience.El presente artículo recoge los objetivos, metodología y resultados de un proyecto de innovación docente implementado en las escuelas técnicas cuyo fin es acercar al estudiantado a experiencias reales de intervención sobre el Patrimonio Histórico. Dicha propuesta ha buscado el fomento del trabajo cooperativo e interdisciplinar a través de la creación de una herramienta virtual que facilitara el conocimiento integral de la experiencia restauradora

Hereditary primary lateral sclerosis and progressive nonfluent aphasia

Objective: to report a kindred with an association between hereditary primary lateral sclerosis (PLS) and progressive nonfluent aphasia. Patients and methods: six members from a kindred with 15 affected individuals spanning three generations, suffered from spasticity without muscle atrophy or fasciculation, starting in the lower limbs and spreading to the upper limbs and bulbar musculature, followed by effortful speech, nonfluent language and dementia, in 5 deceased members. Disease onset was during the sixth decade of life, or later. Cerebellar ataxia was the inaugural manifestation in two patients, and parkinsonism, in another. Results: neuropathological examination in two patients demonstrated degeneration of lateral corticospinal tracts in the spinal cord, without loss of spinal, brainstem, or cerebral motor neurons. Greater loss of corticospinal fibers at sacral and lumbar, rather than at cervical or medullary levels was demonstrated, supporting a central axonal dying-back pathogenic mechanism. Marked reduction of myelin and nerve fibers in the frontal lobes was also present. Argyrophilic grain disease and primary age-related tauopathy were found in one case each, and considered incidental findings. Genetic testing, including exome sequencing aimed at PLS, ataxia, hereditary spastic paraplegia, and frontotemporal lobe dementia, triplet-repeated primed polymerase chain reaction aimed at dominant spinocerebellar ataxias, and massive sequencing of the human genome, yielded negative results. Conclusion: a central distal axonopathy affecting the corticospinal tract, exerted a pathogenic role in the dominantly inherited PLS-progressive nonfluent aphasia association, described herein. Further molecular studies are needed to identify the causative mutation in this disease

Programa de Atención al Ictus en Aragón (PAIA). Estrategia del cambio y resultados en el periodo 2009-2014

Introducción En 2008, Aragón tenía tasas de morbimortalidad y discapacidad por ictus superiores a las del conjunto de España. Se estableció la necesidad de desarrollar un Programa de Atención al Ictus (PAIA). Material y métodos Damos a conocer la dinámica de planificación, implantación, evaluación y mejora que se ha desarrollado entre los años 2009-2014 y sus resultados a 5 años. Resultados Se ha mejorado en la estructura, en los procesos y en los resultados, con mejoría en los indicadores clave de la asistencia (audit 2008-2010-2012) y otros: tasa ictus 2013: 2, 07 (2008: 2, 36); 78% ictus atendidos en áreas/unidades en 2014 (30%, 2008); tasa fibrinólisis 8, 3% en 2014 (4, 4%, 2010); fibrinólisis hospitales secundarios (30% total); fibrinólisis con teleictus 9%; descenso de la mortalidad por ictus, 38%; años de vida prematura perdidos 67, 7 (2013)/144 (2008); capacitación de enfermería, desarrollo de la neurosonología, trabajo en red, con protocolos y buenas prácticas compartidos entre sectores sanitarios, etc. Conclusiones La gestión por procesos y equipos multidisciplinares desplegados en una distribución territorial integral, con protocolos y referencias establecidas y una dinámica de evaluación y mejora continua, ha demostrado ser una herramienta potente para garantizar la calidad y la equidad. El PAIA, por su dinámica de mejora sostenida y la implicación de los clínicos, es un buen ejemplo de gestión clínica y trabajo en red. Introduction: In 2008, stroke mortality, morbidity, and disability rates in Aragon were higher than the average in Spain. These data underscored the need to develop a stroke care programme (PAIA). Material and methods: We present the dynamics of planning, implementation, evaluation, and improvement developed between 2009 and 2014 as well as the results of the PAIA after that 5-year period. Results: Structure, processes, and outcomes have improved with reference to the key indicators of healthcare (audit: 2008, 2010, 2012) among others: stroke rate in 2013 was 2.07 (2.36 in 2008); 78% of strokes were managed in stroke units in 2014 (30% in 2008); rate of fibrinolysis was 8.3% in 2014 (4.4% in 2010); fibrinolysis was administered in secondary hospitals (30% of the total); fibrinolysis was administered by Telestroke in 9%; stroke mortality decreased (38%); 67.7 years of potential life lost (YPLL) in 2013 (144 in 2008); nurse training; development of neurosonology; networking; sharing protocols and best practices between health sectors, etc. Conclusions: Integrated process management and multidisciplinary teams distributed and deployed over an entire territory with established protocols, references, evaluations, and continuous development, have been proven powerful tools to ensure both quality and equality. The PAIA is a good example of clinical governance and networking due to its dynamic and sustained improvement and cooperation between clinicians

Aproximación a los criterios y técnicas de recuperación de las fábricas de ladrillo

El modo de intervenir sobre bienes patrimoniales en lo que al uso de materiales y técnicas se refiere ha corrido paralelo a la evolución del pensamiento doctrinal en esta materia, orientándose desde el uso aquellos más propios de la obra nueva hasta la actual reversión hacia una tecnología tradicional. Junto a la recuperación de la funcionalidad de las estructuras hemos de considerar que el principio de autenticidad debe ser regente en la elección de los criterios de actuación entendida no sólo como preservación de la materialidad sino también desde la perspectiva de mantener y/o recuperar un determinado modo de "hacer". Este hecho va a abrir el debate hacia la posibilidad o no de integración de materiales y tecnología de otra naturaleza como fórmula de recuperación de forma, estética y función, sin comprometer los valores patrimoniales del conjunto. Tomando como muestra las actuaciones de restauración de unidades ejecutadas total o en parte con ladrillo en el mudéjar granadino, el estudio expone los que han sido criterios adoptados y las fórmulas ejecutadas mostrando los principales resultados según el modo de intervención. Además comprobaremos como la recuperación de la función no siempre ha sido compatible con el respeto de los valores del bien.Consejo General de la Arquitectura Técnica de Españ

Mitigating damage on heritage structures by continuous conservation using thermal real-time monitoring. Case study of Ziri Wall, city of Granada, Spain

Climate change and anthropogenic causes represent a multidisciplinary problem in urban environments, specifically in the destruction of historical elements of enormous value. Although conventional preservation methods are based on comprehensive conservation measures and periodic inspection, these urban elements sometimes lie in a state of neglect due to lack of means to carry out continuous monitoring. The present work develops a replicable and easy-to-apply multi-analytical methodology, which proposes the use of standard monitoring to automatically diagnose the elements of heritage buildings. Similar approaches are becoming popular in the setting of Structural Health Monitoring, and their application in the field of environmental monitoring is one of the valuable outputs of this work. Diagnosis is based on the development of an inverse characterisation model of the thermal response in a known state of conservation through standard monitoring. This model is calibrated using real measurements. The methodology involves characterising energy response to environmental excitations measured against what is deemed to be a baseline state of conservation. Also, the monitoring system and data processing required is defined and explained in detail. Anomalies detected in the comparison of the baseline to subsequent real-time measurements would highlight the need to bring scheduled on-site inspections forward with an affordable cost. This benchmarking using the estimation of baseline and real measurements is the main result of the methodology. Finally, the methodology developed was validated with an exhaustive study conducted on the Ziri Wall at Granada, Spain, in both summer and winter. The findings revealed a good fit between calculated and experimental data, with mean absolute errors of under 1 °C in both seasons. The proposal can be applied in other fields such as preventive maintenance. © 2021 Elsevier Lt

Hereditary primary lateral sclerosis and progressive nonfluent aphasia

Objective: to report a kindred with an association between hereditary primary lateral sclerosis (PLS) and progressive nonfluent aphasia. Patients and methods: six members from a kindred with 15 affected individuals spanning three generations, suffered from spasticity without muscle atrophy or fasciculation, starting in the lower limbs and spreading to the upper limbs and bulbar musculature, followed by effortful speech, nonfluent language and dementia, in 5 deceased members. Disease onset was during the sixth decade of life, or later. Cerebellar ataxia was the inaugural manifestation in two patients, and parkinsonism, in another. Results: neuropathological examination in two patients demonstrated degeneration of lateral corticospinal tracts in the spinal cord, without loss of spinal, brainstem, or cerebral motor neurons. Greater loss of corticospinal fibers at sacral and lumbar, rather than at cervical or medullary levels was demonstrated, supporting a central axonal dying-back pathogenic mechanism. Marked reduction of myelin and nerve fibers in the frontal lobes was also present. Argyrophilic grain disease and primary age-related tauopathy were found in one case each, and considered incidental findings. Genetic testing, including exome sequencing aimed at PLS, ataxia, hereditary spastic paraplegia, and frontotemporal lobe dementia, triplet-repeated primed polymerase chain reaction aimed at dominant spinocerebellar ataxias, and massive sequencing of the human genome, yielded negative results. Conclusion: a central distal axonopathy affecting the corticospinal tract, exerted a pathogenic role in the dominantly inherited PLS-progressive nonfluent aphasia association, described herein. Further molecular studies are needed to identify the causative mutation in this disease

A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS

Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis-"strengths, weaknesses, opportunities, threats" (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings