Colaboración internacional y buenas prácticas en la gestión de enfermedades crónicas complejas a través de herramientas web 2.0: Observatorio de prácticas innovadoras en el manejo de enfermedades crónicas complejas OPIMEC

Ponencias de la Segunda Conferencia internacional sobre brecha digital e inclusión social, celebrada del 28 al 30 de octubre de 2009 en la Universidad Carlos III de MadridLas enfermedades crónicas (EC) constituyen un reto de salud mundial en el siglo XXI. La OMS las define como enfermedades de larga duración por lo general de progresión lenta y prevé que en 2020 serán responsables del 73% de las muertes y del 60% de la carga global de enfermedad (World Health Organization, 2002). Es primordial que la comunidad internacional de salud pública y de gestión sanitaria conozca y comparta información sobre los avances en las prácticas tecnológicas y organizativas más innovadoras en gestión de EC, con énfasis en las EC Complejas (ECC) asociadas a una mayor pérdida de autonomía y grado de dependencia y discapacidad. Con este propósito, a mediados de 2006, la Dirección General de Innovación Sanitaria, Sistemas y Tecnología de la Consejería de Salud de la Junta de Andalucía crea el «Observatorio de Prácticas Innovadoras para el Manejo de Enfermedades Crónicas Complejas» (OPIMEC) que impulsa la participación y generación de conocimiento en información sanitaria para profesionales y una Plataforma de Red en el ámbito de la gestión de ECC para el fomento de alianzas y colaboraciones desde Andalucía basadas en dar y recibir conocimiento abierto entre personas, equipos y organizaciones (Jadad AR, 1999, p. 761-764; Jadad AR, 2000, p.362-365). La Web del Observatorio de Prácticas Innovadoras en el Manejo de Enfermedades Crónicas Complejas (OPIMEC), http://www.opimec.org, va centrada en la creación de una plataforma basada en la Web 2.0. que permite el acceso y la edición colaborativa de contenidos para profesionales. El objetivo fundamental de esta plataforma es compartir y colaborar en la generación y difusión de conocimiento, todo ello facilitado con herramientas innovadoras de la Web 2.0. como son la publicación de contenidos, la votación, comentarios sobre los contenidos, la sindicación de contenidos y la creación de comunidades abiertas de trabajo colaborativo. El proyecto OPIMEC cuenta con una cadena de procesos de gestión de la información de los que podemos destacar su forma colaborativa de crear conocimiento por todas las personas usuarias de la plataforma, un equipo editorial encargado de asegurar la calidad de los contenidos y una evaluación por pares de las prácticas y organizaciones propuestas en la Web. Desde la edición, hasta la publicación y su distribución final el conocimiento es examinado metódicamente. Este proceso es automatizado a través de herramientas de software libre creadas para OPIMEC y asesorado por su Consejo Asesor Internacional. Así pues, la plataforma Web 2.0 que da soporte al observatorio OPIMEC está construida sobre tecnologías libres como: Framework Web Django (impulsado por Google Inc. entre otros), MySQL y GNU/Linux. La elección de esta combinación tecnológica se ha realizado tras un análisis exhaustivo sobre las tecnologías abiertas disponibles, en base a criterios de eficiencia, productividad y adaptabilidad a las necesidades actuales y futuras de OPIMEC. La Web OPIMEC tiene intención y vocación de convertirse en un destacado proyecto a nivel mundial con clara vertiente de cooperación internacional e innovación, mejorando la calidad de vida de la ciudadanía, aprovechando las herramientas que ofrece la difundida red global de Internet y promocionando la participación e iniciativa de los y las profesionales. Nuestra Web OPIMEC está estructurada en espacios que facilitan y propician la participación y consecución de los objetivos del proyecto, con el fin de que la asimilación de sus contenidos por parte de las personas usuarias sea eficiente y efectiva. Podemos encontrar en ella, herramientas existentes en las redes sociales así como algunas nuevas desarrolladas específicamente para OPIMEC, como son los “documentos colaborativos”, que facilitarán el trabajo, la conexión y la participación de profesionales desde cualquier parte del mundo, pudiendo así aprovechar los recursos al máximo, Se dispone por tanto de destacadas herramientas como una base de datos actualizada de eventos, noticias, recursos y documentos, directorios y mapas de organizaciones, prácticas y personas innovadoras, espacios de comunidad en las que los equipos de trabajo pueden desarrollarse, comunicarse y complementarse con otras personas usuarias, compartiendo buenas prácticas, innovación y contenidos novedosos en el manejo de enfermedades crónicas complejas. El aspecto importante de la plataforma es que las personas usuarias son de forma democrática, creadores, evaluadores y consumidores de los contenidos publicados, siendo así una herramienta de trabajo construida, ampliada, valorada y seguida por toda la comunidad de profesionales; facilitando la difusión del conocimiento construido por y para todos y todas los profesionales sanitarios, personal investigador, ciudadanos y ciudadanas en general en el manejo de enfermedades crónicas complejas. Un conocimiento ampliamente compartido es la clave para aumentar y mejorar el bienestar social y la calidad de vida

Stochastic simulation of the spatial heterogeneity of deltaic hydrofacies accounting for the uncertainty of facies proportions

The spatial geological heterogeneity of an aquifer significantly affects groundwater storage, flow and the transport of solutes. In the particular case of coastal aquifers, spatial geological heterogeneity is also a major determining factor of the spatio-temporal patterns of water quality (salinity) due to seawater intrusion. While the hydraulics of coastal hydrogeology can be modeled effectively by various density flow equations, the aquifer geology is highly uncertain. A stochastic solution to the problem is to generate numerical realisations of the geology using sequential stratigraphy, geophysical models or geostatistical approaches. The geostatistical methods (two-point geostatistics, Markov chain models and multiple-point geostatistics) have the advantage of minimal data requirements, e.g., when the only data available are from cores from a few sparsely located boreholes. We provide an extension of sequential indicator simulation by including the uncertainty of the hydrofacies proportions in the simulation approach. We also deal with the problem of variogram estimation from sparse boreholes and we discuss the implicit transition probabilities and the connectivity of simulated realisations of a number of categorical variables. The variogram model used in the simulation of hydrofacies significantly influences the degree of connectivity of the hydrofacies in the simulated model. The choice of model is critical as connectivity determines the amount and extent of seawater intrusion and hence the environmental risk. The methodology is illustrated with a case study of the Andarax river delta, a coastal aquifer in south-eastern Spain. This is a semi-arid Mediterranean region in which the increasing use of, and demand for, groundwater is exacerbated by a transient tourist population that reaches its peak in the summer when the demand for the permanent population is at its highest. The work reported here provides a sound basis for designing flow simulation models for the optimal management of groundwater resources. This paper is an extended version of a presentation given at the 2012 GeoENV Conference held in Valencia, Spain.S. Jorreto-Zaguirre, P.A. Dowd, E. Pardo-Igúzquiza, A. Pulido-Bosch and F. Sánchez-Marto

Soluble RAGE in COPD, with or without coexisting obstructive sleep apnoea

Background: Hypoxia can reduce the levels of soluble receptor for advanced glycation end-products (sRAGE), a new anti-inflammatory biomarker of COPD. We assessed sRAGE in patients with hypoxia-related diseases such as COPD, OSA and OSA-COPD overlap. Methods: Plasma levels of sRAGE were measured in 317 subjects at baseline (57 heathy nonsmokers HNS], 84 healthy smokers HS], 79 OSA, 62 COPD and 35 OSA-COPD overlap patients) and in 294 subjects after one year of follow-up (50 HNS, 74 HS, 77 OSA, 60 COPD and 33 overlap). Results: After adjusting for age, sex, smoking status and body mass index, sRAGE levels showed a reduction in OSA (- 12.5%, p = 0.005), COPD (- 14.8%, p < 0.001) and OSA-COPD overlap (- 12.3%, p = 0.02) compared with HNS. There were no differences when comparing sRAGE plasma levels between overlap patients and those with OSA or COPD alone. At follow-up, sRAGE levels did not change significantly in healthy subjects, COPD and OSA or OSA-COPD overlap nontreated with continuous positive airway pressure (CPAP). Moreover, in patients with OSA and OSA-COPD overlap who were treated with CPAP, sRAGE increased significantly. Conclusions: The levels of sRAGE are reduced in COPD and OSA. Treatment with CPAP appears to improve sRAGE levels in patients with OSA who also had COPD

Serum metabolomics tells the story of disease degree in a fish enteritis model

Comunicación presentada en la 19th International Conference on Diseases of Fish and Shellfish, celebrada en Oporto (Portugal) del 9 al 12 de septiembre de 2019.[Introduction]: In animal production, enteritis is responsible for serious economic losses, being intestinal parasitism a major stress factor leading to malnutrition and lowered performance and production efficiency. The intestinal myxozoan parasite Enteromyxum leei dwells between gut epithelial cells and causes severe desquamative enteritis in gilthead sea bream (Sparus aurata) that impairs nutrient absorption causing anorexia, cachexia, growth impairment, reduced marketability and increased mortality. This study aimed to outline the gut failure produced in this fish-parasite model using a multifaceted approach and to find and validate serum non-lethal markers of gut barrier dysfunction.[Methodology]: Intestinal integrity was studied in parasitized and non-parasitized fish by immunohistochemistry with specific markers for cellular adhesion (E-cadherin) and tight junctions (Tjp-1 and Cldn3) and by functional studies of permeability (oral administration of FITC-dextran) and electrophysiology (Ussing chambers). Serum samples from parasitized and non-parasitized fish were analyzed using non-targeted metabolomics and some significantly altered metabolites were selected to be validated using commercial kits.[Results]: The expression of the tight junction proteins Tjp-1 and Cldn3 was significantly lower in parasitized fish along all the intestine, while no differences were found in E-cadherin labeling. Some parasitized fish showed a significant increase in paracellular uptake measured by FITC-dextran detection in serum. Electrophysiology studies showed a decrease in transepithelial resistance in infected animals, which showed a diarrheic profile when compared to the normal absorptive profile of the control animals. Serum metabolomics revealed 3702 ions, from which the differential expression of 20 identified compounds significantly separated control from infected groups in multivariate analyses (PLS-DA), and even separated groups by intensity of infection. Of these compounds, inosine and creatine were identified as relevant and tested with commercial kits in serum samples.[Conclusion]: This study demonstrates the loss of barrier function induced by the enteric parasite E. leei and underlines key markers to differentiate control and infected fish. The untargeted serum metabolomics approach did not reveal specific effects by the parasite, but more a profile typical of absorption dysfunction and anorexia, which are, of course, part of the disease signs.Funding: ParaFishControl H2020 project (634429), Aquaexcel2020 (652831, TNA AE10004-INTEBREAM), AGL2013-48560-R

Time of flight measurements based on FPGA using a breast dedicated PET

In this work the implementation of a Time-to-Digital Converter (TDC) using a Nutt delay line FPGA-based and applied on a Positron Emission Tomography (PET) device is going to be presented in order to check the system’s suitability for Time of Flight (TOF) measurements. In recent years, FPGAs have shown great advantages for precise time measurements in PET. The architecture employed for these measurements is described in detail. The system developed was tested on a dedicated breast PET prototype, composed of LYSO crystals and Positive Sensitive Photomultipliers (PSPMTs). Two distinct experiments were carried out for this purpose. In the first test, system linearity was evaluated in order to calibrate the time measurements, providing a linearity error of less than 2% and an average time resolution of 1.4 ns FWHM. The second set of measurements tested system resolution, resulting in a FWHM as good as 1.35 ns. The results suggest that the coincidence window for the current PET can be reduced in order to minimize the random events and thus, achieve better image qualityAguilar, A.; García Olcina, R.; Martos, J.; Soret, J.; Torres-Pais, J.; Benlloch Baviera, JM.; González Martínez, AJ.... (2014). Time of flight measurements based on FPGA using a breast dedicated PET. Journal of Instrumentation. 9:0-8. doi:10.1088/1748-0221/9/05/C05012S08

Predictive factors and early biomarkers of response in multiple sclerosis patients treated with natalizumab

There are an increasing number of treatments available for multiple sclerosis (MS). The early identification of optimal responders to individual treatments is important to achieve individualized therapy. With this aim, we performed a multicenter retrospective longitudinal study including 186 MS patients treated with natalizumab who were followed for 2 years. We analyzed the following variables at recruitment: sex, current age, age at disease onset, disease duration, EDSS, number of T2 and Gd + lesions, IgG and IgM oligoclonal bands, HLA class II (DR, DRB, DQA, DQB, and DRB1*15:01), IgG and IgM antibody titers against human herpesvirus 6 (HHV-6) and the antibody response to Epstein–Barr virus (EBV) through the measurement of the anti-EBNA-1 and anti-VCA IgG titers, in relation to clinical response (no relapses or disability progression), and to NEDA-3 (no evidence of disease activity in terms of clinical response and no changes in MRI scans either) after 2-years follow-up. Baseline EDSS score, baseline EBNA-1 IgG titers and percentage change of HHV6 IgG titers between baseline and 6 month visits were significantly different in clinical responders and in NEDA-3 status (all of them remained significant in the multivariate analysis). We identified three variables for the early identification of natalizumab optimal responders in a rapid and cost-effective approach

Seasonal and spatial variability in condition of age-0+ Argentine hake Merluccius hubbsi Marini, 1933, in the San Jorge Gulf (Argentina): A bottom-up perspective

In the north Patagonian region of the Argentinean Continental Shelf, the San Jorge Gulf (SJG; 45°‐47°S, 65°30ʹ‐67°30ʹW) is the main nursery ground of age‐0+ Argentine hake Merluccius hubbsi Marini, 1933, one of the most important fishery resources in Argentina. The gulf exhibits strong seasonal and spatial fluctuations in environmental features, which might affect survival of age‐0+ individuals and recruitment to the adult population. Our main goal was to evaluate the seasonal and spatial dynamics of their nutritional status within the SJG in winter 2016, spring 2016 and summer 2017. Condition indices (relative condition factor Kn, hepatosomatic index HSI and liver lipid content %L) and diet information (feeding incidence and relative importance of prey) were combined with physical (temperature and salinity) and biological (satellite chlorophyll‐a concentration; chl‐a) data. Age‐0+ condition indices and prey intake showed significant seasonal variations, with minimum values in winter, intermediate in summer and maximum in spring, strongly coupled to the mean chl‐a concentration in each season. Herbivorous euphausiids Euphausia spp. were the preferred prey along the study period. A bottom‐up effect on condition of age‐0+ hake is suggested, manifested as lower condition values in winter, the less productive season. Spatially, better conditioned individuals matched sectors of the gulf where chl‐a concentrations were higher, coupled to the presence of frontal systems. Monitoring age‐0+ hake nutritional status is relevant in the current global change scenario, which might modify phytoplankton biomass and composition and, consequently, the herbivorous zooplankton abundances.Fil: Temperoni, Brenda. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Subsede Instituto Nacional de Investigación y Desarrollo Pesquero; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Massa, Agueda Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Subsede Instituto Nacional de Investigación y Desarrollo Pesquero; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Martos, Patricia. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Departamento de Ciencias Marinas; ArgentinaFil: Marrari, Marina. Ministerio de Defensa. Armada Argentina. Servicio de Hidrografía Naval. Departamento Oceanografía; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Selection for growth is associated in gilthead sea bream (Sparus aurata) with diet flexibility, changes in growth patterns and higher intestine plasticity

Farmed gilthead sea bream (Sparus aurata) is able to grow efficiently with new feed formulations based on plant ingredients. Here, two experimental diets with standard and high inclusion levels of plant ingredients were formulated to assess the suited use of plant-based diets in fish with different growth genetic backgrounds. To pursue this issue, a long-term feeding trial (12-months) was conducted with fish (17 g initial body weight) of 16 families coming from the broodstock of PROGENSA project, that were grown communally in the IATS-CSIC experimental facilities. All fish in the study (2545) were PIT-tagged, and their pedigree was re-constructed with 96% success by using a SMsa1 multiplex of 11 microsatellites, which revealed the main parents contributions of 5 females and 6 males. Each diet was randomly assigned to replicate 3000 L tanks, gathering each replicate a similar family composition through all the feeding trial. Data on growth performance highlighted a strong ge- netic effect on growth trajectories, associated with enhanced growth during winter in fish selected for faster growth. No main dietary effects were found on growth rates or condition factor, and regression-correlation analyses of growth rates across families on both diets suggest that genome by diet interaction was weak, while genetic variation accounted for most of the growth phenotypic variation. Hepatosomatic index (HSI) and me- senteric fat index (MSI) of five families, covering the growth variability of the population, were regulated nu- tritionally and genetically, but without statistically significant genome by diet interactions. Fish from faster growing families showed shorter intestines after being fed the control diet, but this phenotype was masked by the enriched plant-based diet. Collectively, the results demonstrate that selection for faster growth is associated in gilthead sea bream with different growth trajectories and a high diet flexibility and intestine plasticity.Versión del editor2,04