Assessment of soil surface roughness decay at semiarid field conditions using the shadow analysis method

Soil surface roughness (SSR) is an excellent parameter to assess soil vulnerability to wind and water erosion. Several methods are used to measure SSR depending on specific field and climate conditions. The method based on the shadow analysis has shown to be the most convenient technique to characterize SSR in the field than existing procedures when used in arid and semi-arid regions of Spain. This convenience is due to climate and soil conditions prevailing and low development and maintenance costs and adaptability. Therefore, the present study aimed to assess the SSR decay using the shadow analysis method at field in eight controlled plots of 1 m2. The data were collected from beginning of fall 2009 to spring 2010. Half of the experimental plots were covered to be used as control, to avoid influence from wind and water erosion. The rest of the plots were uncovered to assure SSR decay and to evaluate the parameter as the result of the produced erosion. The results showed marked differences among the cover an uncover plots. The parameters demonstrated that the method can be used to study the influence of wind and water erosion on soil at field conditions, although some adjustments must be done on method since it presents some limitations, mainly related to weather conditions when used continuously at field condition

Evaluation of the impact of training in the health sector

The impact of training refers to the effects generated by training in the organization. In this paper we present a research on the impact of several training programs framed in a Training Plan on Rational Use of Medicines in the region of Catalonia (in the northeast of Spain), where almost 3000 health professionals participated. The aim is to evaluate if the training of doctors and nurses decreases the public expenditure on drugs. The results show that training has not the impact expected on the prescription of medicines, because there are other factors of health organizations that seriously limit the impact of training. These results lead us to carry out proposals for the improvement of the effectiveness of the training programs evaluated, and in parallel to reflect upon the methodological implications and techniques of the evaluation of the impact of trainingEl impacto de la formación se refiere a los efectos que genera la formación en la organización. En este artículo se presenta una investigación sobre el impacto de varios programas de formación enmarcados en un Plan de Formación sobre el Uso Racional del Medicamento en Cataluña, en el que participaron casi 3.000 profesionales de la sanidad. El objetivo es evaluar si la formación de médicos y personal de enfermería disminuye el gasto público en medicamentos. Los resultados muestran que la formación no tiene el impacto esperado en la prescripción de medicamentos, debido a que hay otros factores en las organizaciones de la salud que limitan seriamente el impacto de la formación. Estos resultados nos llevan a realizar propuestas para la mejora de la eficacia de los programas de formación evaluados, y en paralelo, a reflexionar sobre las implicaciones metodológicas y técnicas de la evaluación del impacto de la formació

Association between a SLC23A2 gene variation, plasma vitamin C levels, and risk of glaucoma in a Mediterranean population

PurposeSeveral dietary factors have been associated with glaucoma. Among them, dietary antioxidant intake (i.e., vitamin C and vitamin A) in association with glaucoma has been analyzed, but with mixed results. Genetic factors may play a role in modulating the effect of dietary antioxidant intake on glaucoma; however, nutrigenetic studies in this field are scarce. Our aim was to study the association between selected polymorphisms in key proteins related to vitamin C and vitamin A concentrations and primary open-angle glaucoma (POAG).MethodsWe performed a case-control study matched for age, sex, and bodyweight. We recruited 300 subjects (150 POAG cases and 150 controls) from a Mediterranean population and determined the plasma concentrations of vitamin C and vitamin A for each subject. We selected the following single-nucleotide polymorphisms (SNPs) in genes related to vitamin A and vitamin C concentrations: rs176990 and rs190910 in the retinol-binding protein 1 (RBP1) gene; and rs10063949 and rs1279683 in the Na+-dependent L-ascorbic acid transporters 1 and 2, respectively (encoded by the SLC23A1 and SLC23A2 genes).ResultsWe found a statistically significant association between the rs1279386 (A>G) SNP in SLC23A2 and POAG risk. In the crude analysis, homozygous subjects for the G allele (GG subjects) had higher risk of POAG than other genotypes (OR: 1.67; 95% CI: 1.03–2.71). This association remained statistically significant (p=0.010) after multivariate adjustment for potential confounders. We also found that POAG patients had lower plasma vitamin C concentrations than control subjects (9.9±1.7 µg/ml versus 11.7±1.8 µg/ml, p<0.001). Moreover, we consistently detected a significant association between the rs1279386 SNP in SLC23A2 and plasma vitamin C concentrations: GG subjects had significantly lower plasma vitamin C concentrations than the other genotypes (9.0±1.4 µg/ml versus 10.5±1.6 µg/ml, p<0.001 in POAG cases and 10.9±1.6 µg/ml versus 12.1±1.8 µg/ml, p<0.001 in controls). The rs10063949 SNP in SLC23A1 was not associated with either plasma vitamin C concentrations or POAG risk. Similarly, SNPs in RBP1 were not associated with vitamin A concentrations or POAG risk.ConclusionsThe rs1279683 SNP in SLC23A2 was significantly associated with lower plasma concentrations of vitamin C and with higher risk of POAG in GG subjects

Longitudinal analysis of blood DNA methylation identifies mechanisms of response to tumor necrosis factor inhibitor therapy in rheumatoid arthritis

Epigenetics; Rheumatoid arthritis; Treatment responseEpigenètica; Artritis reumatoide; Resposta al tractamentEpigenética; Artritis reumatoide; Respuesta al tratamientoBackground Rheumatoid arthritis (RA) is a chronic, immune-mediated inflammatory disease of the joints that has been associated with variation in the peripheral blood methylome. In this study, we aim to identify epigenetic variation that is associated with the response to tumor necrosis factor inhibitor (TNFi) therapy. Methods Peripheral blood genome-wide DNA methylation profiles were analyzed in a discovery cohort of 62 RA patients at baseline and at week 12 of TNFi therapy. DNA methylation of individual CpG sites and enrichment of biological pathways were evaluated for their association with drug response. Using a novel cell deconvolution approach, altered DNA methylation associated with TNFi response was also tested in the six main immune cell types in blood. Validation of the results was performed in an independent longitudinal cohort of 60 RA patients. Findings Treatment with TNFi was associated with significant longitudinal peripheral blood methylation changes in biological pathways related to RA (FDR<0.05). 139 biological functions were modified by therapy, with methylation levels changing systematically towards a signature similar to that of healthy controls. Differences in the methylation profile of T cell activation and differentiation, GTPase-mediated signaling, and actin filament organization pathways were associated with the clinical response to therapy. Cell type deconvolution analysis identified CpG sites in CD4+T, NK, neutrophils and monocytes that were significantly associated with the response to TNFi. Interpretation Our results show that treatment with TNFi restores homeostatic blood methylation in RA. The clinical response to TNFi is associated to methylation variation in specific biological pathways, and it involves cells from both the innate and adaptive immune systems.This study was funded by the Instituto de Salud Carlos III

Usefulness of the hemogram as a measure of clinical and serological activity in systemic lupus erythematosus

Background and objectives: Systemic Lupus Erythematosus (SLE) follow-up is based on clinical, and analytical parameters. We aimed to determine the differences between the Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR) and Red blood cell distribution width (RDW) between SLE patients and healthy controls and to assess their association with anemia status, classical inflammatory biomarkers and cytokines, disease activity, SLE related factors and treatment received for SLE. Methods: Seventy-seven patients with SLE according to 2012 SLICC criteria and 80 healthy controls were included. Patients with SLE were classified in SLE with anemia (SLE-a) and SLE without anemia (SLE-na). Statistical analysis between SLE patients and controls and the association of serological and clinical activity markers with proposed hematological indices among SLE patients were performed. Results: RDW, NLR and PLR, were significantly higher in SLE patients than in healthy control group (p < 0.001), in SLE-a patients as compared to SLE-na (p < 0.0001) and were significantly associated with hypocomplementemia (p < 0.05). PLR was higher in active patients measured by SLEDAI-2K score and with longer disease duration (p < 0.05). RDW was associated with serological activity of the patients (p < 0.05) and was correlated with SLEDAI-2K and SLICC/ACR scores, hsCRP, D-dimer, fibrinogen, IL-6 and TNF as well as with corticosteroids intake (p = 0.05). A logistic regression analysis confirmed that after adjustment by age and hemoglobin values, RDW presented linear correlation with IL-6 levels (Beta-coefficient = 0.369, p = 0.003). Conclusion: NLR, PLR and RDW values suggest SLE serological and clinical activity. Given their availability, these markers not only could be useful tools to identify and monitor active SLE patients but whose application should be considered in inflammatory pathologies orchestrated by IL-6 and TNFThis work has been supported by a grant from Instituto de Salud Carlos III (Expedient number PI16-01480): VMT has a grant from Instituto de Salud Carlos III (CM19/00223)

Describing Complexity in Palliative Home Care Through HexCom : A Cross-Sectional, Multicenter Study

Complexity has become a core issue in caring for patients with advanced disease and/or at the end-of-life. The Hexagon of Complexity (HexCom) is a complexity assessment model in the process of validation in health-care settings. Our objective is to use the instrument to describe differences in complexity across disease groups in specific home care for advanced disease and/or at the end-of-life patients, both in general and as relates to each domain and subdomain. Cross-sectional study of home care was conducted in Catalonia. The instrument includes 6 domains of needs (clinical, psychological/emotional, social/family, spiritual, ethical, and death-related), 4 domains of resources (intrapersonal, interpersonal, transpersonal, and practical), and 3 levels of complexity (High (H), Moderate (M), and Low (L)). Interdisciplinary home care teams assessed and agreed on the level of complexity for each patient. Forty-three teams participated (74.1% of those invited). A total of 832 patients were assessed, 61.4% of which were cancer patients. Moderate complexity was observed in 385 (47.0%) cases and high complexity in 347 (42.4%). The median complexity score was 51 for cancer patients and 23 for patients with dementia (p<0.001). We observed the highest level of complexity in the social/family domain. Patients/families most frequently used interpersonal resources (80.5%). This study sheds light on the high-intensity work of support teams, the importance of the social/family domain and planning the place of death, substantial differences in needs and resources across disease groups, and the importance of relationship wellbeing at the end-of-life

Conceptualizacion y generalidades de farmacovigilancia en colombia

La farmacovigilancia permite a todos los profesionales de la salud conocer los PRM (Problemas Relacionados con Medicamentos), detectar, evaluar, comprender y prevenir los eventos adversos que pudiera causar cualquier fármaco destinado para una terapia especifica. La estructura del diplomado de profundización en farmacovigilancia nos permite indagar sobre las generalidades, métodos y programas de la farmacovigilancia, además de comprender lo que significa un evento adverso y como se clasifican estos eventos. Para que el programa nacional de farmacovigilancia funcione correctamente se necesita entender las interacciones medicamentosas, la relación entre el quehacer farmacéutico y dicho programa, como se debe hacer una promoción del uso adecuado de los medicamentos y/o dispositivos médicos, todo esto con el fin de realizar una buena evaluación de seguridad y efectividad en la farmacoterapia.Pharmacovigilance allows all health professionals to know the MRPs (Medicine Related Problems), detect, evaluate, understand and prevent adverse events that could be caused by any drug intended for a specific therapy. The structure of the diploma of deepening pharmacovigilance allows us to investigate the generalities, methods and programs of pharmacovigilance, in addition to understanding what an adverse event means and how these events are classified. For the national pharmacovigilance program to function properly, the relationship between pharmaceutical work and the pharmacovigilance program needs to be understood, as appropriate use of medicinal products and/or medical devices should be promoted, all in order to perform a good safety and effectiveness assessment in pharmacotherapy

Early Pliocene climatic optimum, cooling and early glaciation deduced by terrestrial and marine environmental changes in SW Spain

The Pliocene is a key period in Earth's climate evolution, as it records the transition from warm and stable conditions to the colder and more variable glaciated climate of the Pleistocene. Simultaneously, climate became more seasonal in the Mediterranean area, and Mediterranean-type seasonal precipitation rhythm with summer drought established. These climatic changes presumably had significant impacts on terrestrial environments. However, the response of terrestrial environments to such climate changes is still not fully understood due to the lack of detailed studies dealing with this period of time. In this study, multiproxy analyses of continuous core sampling from La Matilla (SW Spain) shows detailed and continuous record of pollen, sand content and abundance of benthic foraminifer Bolivina spathulata to describe paleoenvironmental and paleoclimate trends during the early Pliocene. This record shows warmest, most humid climate conditions and highest riverine nutrient supply at ~ 4.35 Ma, coinciding with the Pliocene climatic optimum and high global sea level. A climate cooling and aridity trend occurred subsequently and a significant glaciation occurred at ~ 4.1–4.0 Ma, during a period known by very little terrestrial evidence of glaciation. Our multiproxy data thus indicate that terrestrial and marine environments were significantly variable during the early Pliocene and that major glaciation-like cooling occurred before the intensification of northern hemisphere glaciation at the beginning of the Pleistocene (~2.7 Ma). This major climate cooling and aridity maxima between 4.1 and 4.0 Ma is independently validated by a coeval sea-level drop (third order Za2 sequence boundary). This sea level drawdown is supported by enhanced coarse sedimentation and minima in riverine nutrient supply, showing paired vegetation and sea-level changes and thus a strong land-ocean relationship. This study also shows that long-term climatic trends were interrupted by orbital-scale cyclic climatic variability, with eccentricity, obliquity and precession acting as the main triggers controlling climate and environmental change in the area.Peer ReviewedPostprint (author's final draft

Assessing Face Validity of the HexCom Model for Capturing Complexity in Clinical Practice : a Delphi study

Funding: This research was funded by INSTITUT CATALÀ DE LA SALUT, grant number 7Z19/008.Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and to be valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centred care at a practical level, a methodological study was carried out to assess the face validity of the model. In particular, a Delphi method involving a group of 14 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a content validity index-item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic, and the HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing complexity in healthcare practice