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

Pathologic and Risk Analysis of the Lojuela Castle (Granada-Spain): Methodology and Preventive Conservation for Medieval Earthen Fortifications

This study presents a methodology generated for the preventive conservation of defensive earthen architecture, applied to the case of the Lojuela Castle (Lecrin Valley, Granada, Spain). In the application of the designed protocol, a multidisciplinary analysis of its patrimonial characteristics and multidimensional evaluation was developed, applying the technique of qualitative consultation to a group of experts—the Delphi method. This methodology allowed us to relate the hazard factors and the vulnerability of the asset for each group of risks that a ect it. The support of the method in with geographic information systems (GIS) has favored the production of predictive cartography and risk analysis—including the territorial dimensions and spatial interactions of the asset with the physical environment. This has facilitated the obtention of micro-zoning maps of each of the risks examined. The risk mapping in micro-zoning and the knowledge of the structure’s vulnerability represents an important contribution to the future conservation and management of this heritage. They favor strategies that minimize the incidence of risks and allow the prioritization of the conservation actions with a minimum economic investment, creating an e cient maintenance program. This will facilitate the protection, conservation and valorization decisions by the administration and the competent bodies involved in the protection of these sites.State Research Agency (SRA) BIA2015 69938-REuropean Union (EU

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