Modelos de gestión en nutrición clínica. Puntos débiles y puntos fuertes

En el VIº Foro de Debate Abbott-SENPE se establece una discusión multidisciplinar y multiprofesional para buscar el o los modelos de gestión clínica que consideramos más adecuados para la Unidades de Nutrición Clínica y Dietética (UNCyD) en España. Se valoran los puntos débiles y fuertes así como las oportunidades de los actuales sistemas y se concluye en la observación de una cierta disparidad vinculada no solo a las comunidades autónomas sino también a los diferentes tipos de hospital. Se propone, desde SENPE, la creación de un grupo de trabajo que ayude a la normalización de los modelos y a potenciar la cultura del Cuadro de Mandos Integral y de Gestión del Cambio.At the 6th Abbott-SENPE Debate Forum a multidisciplinary and multiprofessional discussion was established in order to seek for the model or the models of clinical management most appropriate for Clinical Nutrition and Dietetics Units (CNAD) in Spain. The weaknesses and strengths as well as opportunities for the current systems were assessed concluding that a certain degree of disparity was observed not only due to regional differences but also to different hospital types. It was proposed, from SENPE, the creation of a working group helping to standardize the models and promote the culture of Integral Control and Change Management

Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery

In order to develop evidence-based recommendations and expert consensus for nutrition management of patients undergoing bariatric surgery and postoperative follow-up, we conducted a systematic literature search using PRISMA methodology plus critical appraisal following the SIGN and AGREE-II procedures. The results were discussed among all members of the GARIN group, and all members answered a Likert scale questionnaire to assess the degree of support for every recommendation. Patients undergoing bariatric surgery should be screened preoperatively for some micronutrient deficiencies and treated accordingly. A VLCD (Very Low-Calorie Diet) should be used for 4–8 weeks prior to surgery. Postoperatively, a liquid diet should be maintained for a month, followed by a semi-solid diet also for one month. Protein requirements (1–1.5 g/kg) should be estimated using adjusted weight. Systematic use of specific multivitamin supplements is encouraged. Calcium citrate and vitamin D supplements should be used at higher doses than are currently recommended. The use of proton-pump inhibitors should be individualised, and vitamin B12 and iron should be supplemented in case of deficit. All patients, especially pregnant women, teenagers, and elderly patients require a multidisciplinary approach and specialised follow-up. These recommendations and suggestions regarding nutrition management when undergoing bariatric surgery and postoperative follow-up have direct clinical applicability.Nestle Healthcar

Recomendaciones del Grupo GARIN para el manejo de pacientes no críticos con diabetes o hiperglucemia de estrés y nutrición artificial

Background & aims: By means of this update, the GARIN working group aims to define its position regarding the treatment of patients with diabetes or stress hyperglycaemia and artificial nutrition. In this area there are many aspects of uncertainty, especially in non-critically ill patients. Methods: Bibliographical review, and specific questions in advance were discussed and answered at a meeting in the form of conclusions. Results: We propose a definition of stress hyperglycaemia. The indications and access routes for artificial nutrition are no different in patients with diabetes/stress hyperglycaemia than in non-diabetics. The objective must be to keep pre-prandial blood glucose levels between 100 and 140 mg/dl and post-prandial levels between 140 and 180 mg/dl. Hyperglycemia can be prevented through systematic monitoring of capillary glycaemias and adequately calculate energy-protein needs. We recommend using enteral formulas designed for patients with diabetes (high monounsaturated fat) to facilitate metabolic control. The best drug treatment for treating hyperglycaemia/diabetes in hospitalised patients is insulin and we make recommendations for adapt the theoretical insulin action to the nutrition infusion regimen. We also addressed recommendations for future investigation. Conclusions: This recommendations about artificial nutrition in patients with diabetes or stress hyperglycaemia can add value to clinical work.Introducción y objetivos: En el tratamiento de los pacientes con diabetes o hiperglucemia de estrés y la nutrición artificial existen muchas áreas de incertidumbre, sobre todo en pacientes no críticos. El grupo de trabajo GARIN tiene como objetivo definir su posición en este campo. Material y métodos: Revisión bibliográfica previa y reunión presencial en la que se discutieron y contestaron preguntas específicas sobre el tema. Resultados: Proponemos una definición de hiperglucemia de estrés. Las indicaciones y las rutas de acceso a la nutrición artificial no difieren en los pacientes con hiperglucemia de estrés o diabetes respecto a los no diabéticos. El objetivo debe ser mantener los niveles de glucemia preprandial entre 100 y 140 mg/dl y postprandial entre 140 y 180 mg/dl. La hiperglucemia puede prevenirse a través de una monitorización sistemática de las glucemias capilares y un cálculo adecuado de las necesidades energético-proteicas. Recomendamos el uso de fórmulas enterales diseñadas para pacientes con diabetes (alto contenido en grasas monoinsaturadas) para facilitar el control metabólico. El mejor tratamiento farmacológico para tratar la hiperglucemia/diabetes en pacientes hospitalizados es la insulina, aconsejando adaptar la acción teórica de la insulina al régimen de infusión de la nutrición. También realizamos recomendaciones para investigaciones futuras. Conclusiones: Estas recomendaciones aportan respuestas concretas sobre cuestiones comunes en la asistencia a pacientes con diabetes o hiperglucemia de estrés y nutrición artificial

The striped soldier shrimp Plesionika edwardsii (Crustacea:Decapoda:Pandalidae) from the cape Verde Islands

This study is part of the PROACTIVA 1-2 (2009-2012) and MARPROF-CV (2010-2014) projects, in the framework of the Canary Islands Government and UE PCT MAC 2007-2013 programmes respectively. Research has mainly focused on the stock assessment of the striped soldier shrimp, Plesionika edwardsii (Brandt, 1851), because it has shown moderate to high levels of fishing yield and abundances compatible with the development of a new sustainable fishery in the Cape Verde Islands. Cruises took place on board the R/V Prof. Ignacio Lozano. Four 15-day surveys have been conducted to date: Cabo Verde 2010-04 (April 2010), Camar˜ao-1 (November 2011), Camar˜ao-2 (Mars 2012) and Camar ˜ao-3 (July 2012). An innovative fishing gear so-called multiple semi-floating shrimp trap (MSFST) was used. Each fishing line was composed by 40-65 traps operating around 2.4 m above the seafloor, using Decapterus macarellus (Carangidae) as unique bait of the traps. Fishing depth was 66-458 m, and efective fishing time was 16-18 h. Each trap was attached to the main bottom line every 15 m, and the maximum attraction of this bait was established to be 100 or 150 m, according to the experience gained from the local fishery for deep-sea lobsters. So density by area was calculated assuming two different areas of attraction of the fishing gear. Initial biomass was estimated from depletion experiments at different abundance stations by applying the Leslie & Davis (1939) method, modified by Ricker (1975). Each fishing operation was classified according to its yield (CPUE in g/trap/night). The potential fishing planar area was estimated between the isobathymetric lines between 90 and 220 m. Total biomasses (Bt) were calculated from areas (km2) and mean minimum/maximum densities (kg/km2). Maximum sustainable yield (MSY) was estimated from Bt using the Beddington and Cooke (1983) model by entering natural mortality (0.6), growth rate (0.53 year�1) and recruitment age (1.32 year), which are the parameters for this target species published for the Canaries. These parameters estimate a biological exploitation rate ( ) of 0.262. Interpolations were applied to estimate MSY for insular stocks representing lesser than 5% of the total fishing grounds for this species in the archipelago. The MSY estimated by depletion were 30.5 tons/year for the stock of S˜ao Vicente, Santa Luzia, Ilheus and S˜ao Nicolau, 10 tons/year for the stock of Santiago, 138.8 tons/year for the stock of Boa Vista and Maio, and 5.6 tons/year for the stock of Sal. The small stocks estimated by interpolation were: 4.5 tons/year for the stock of Santo Ant˜ao, 1.3 tons/year for the stock of Fogo, and 1.8 tons/year for the stock of Brava and Ilheus. In total, 192.5 tons per year was the total MSY for the striped soldier shrimp around the islands of the Cape Verde archipelago, occupying a total area of 1,918 km2 of new fishing grounds at between 90 and 220 m of depth. In comparison with the traditional bottom trap used in the Canary Islands, the innovative fishing gear MSFST were proved to be more selective for pandalid shrimps, minimizing the gear impact on the seafloor as well as the by-catch by reducing the discards. Depletion methods are based on the assumption of a closed system, that is with minimum or zero immigration between neighbouring areas. The straight forward decline of CPUEs obtained during the depletion experiments seems to confirm that P. edwardsii is a low mobility species, making this assumption valid at least during short-time periods. Because of the bathymetry profile of these islands,the depth range is from very close (few nautical miles in Santiago) to far away (10-12 n.m. in Boa Vista) to the coastline. Fishing effort should be controlled on the basis of quotas, number of fishing vessels and a precautionary approach in order to ensure that catching is commensurate with sustainable levels of exploitation. MSY estimates suggest that this new Capeverdean fishery should be carried out by specialized medium-sized fishing vessels. During the last decades a combination of shrimp trawling and industrial trapping activity has threatened over-exploitation in the Mediterranean fisheries targeting on P. edwardsii; currently the shrimp collapse has conducted to the decline of these fisheries. Can the Cape Verde regulatory bodies and all the stakeholders involved learn the lessons this teaches us about this resource management

By-catch composition of the striped soldier shrimp Plesionika edwardsii (Crustace: Decapoda: Pandalidae) experimental fishery in the Cape Verde Islands

This work focuses on the by-catch composition of Plesionika edwardsii experimental fishery in the Cape Verde Islands. Obtaining information on abundance, composition and lifecycle of species involved in this potential fishery is useful, in order to ensure its sustainable development under an ecosystem approach. The first step towards this goal is the description of catches. Four 15-day research surveys were conducted on board the R/V Prof. Ignacio Lozano: April 2010 (S˜ao Vicente and Santa Luzia islands), November 2011 (Santiago island), March 2012 (Boa Vista island,) and July 2012 (Sal and S˜ao Nicolau islands). The working depths were between 66 and 458 m depth. A standardized innovative fishing gear was used, so-called multiple semi-floating shrimp traps. Each fishing line was composed by 40-65 traps operating around 2.4 m above the seafloor, using Decapterus macarellus (Carangidae) as unique bait of the traps. Multiple semi-floating shrimp traps is a passive fishing system that allows catch and release sea significant part of the unwanted catches, as in the case of Chondrichthyes or Anguilliformes, reducing the fishing impact on non-target species. The main by-catch was composed of 53 species belonging to three groups including Chondrichthyes (three families and three species), Crustacea (11 families and 19 species) and Osteichthyes (15 families and 29 species). Plesionika edwardsii, the target species of this fishery, represented 97.8% of the catch in terms of abundance and 40.1% in biomass. By-catch represented 59.9% of total catch in terms of biomass. Osteichthyes (87.5%) were the dominant group and was represented by the following main families; Sparidae (33.9%), Moridae (32.5%), Muraenidae (32.5%), Scorpaenidae (9.9%) and Tetraodontidae (9.8%). Chondrichthyes (11.6%) were composed by Centrophoridae (65.3%) and Triakidae (34.1%). Finally, Crustacea (1.9%) were chiefly composed by Pandalidae (79.1%). However, different families represented by specific species were found to be dominant around each island. Sparidae were the dominant family represented by Pagellus acarne (46.2% of total by-catch) at S˜ao Vicente, and by Dentex macrophthalmus (42.6%) at Boa Vista. Tetraodontidae with Sphoeroides pachygaster (25.9%) and Sparidae with P. acarne (25.1%) were the co-dominant families in the by-catch around Santa Luzia. Muraenidae were the dominant family represented by Gymnothorax polygonius (69.4%) at Sal, and by Muraena helena (63.4%) at S˜ao Nicolau. Finally, Scorpaenidae with Pontinus kuhlii (22.3%) and Moridae with Physiculus cyanostrophus (22.1%) were the co-dominant families of the bycatch around Santiago. Acknowledgements: This study is part of the PROACTIVA 1-2 (2009-2012) and MARPROF-CV (2010-2014) projects, in the framework of the Canary Islands Government and UE PCT MAC 2007- 2013 programmes respectively

The starburst-active galactic nucleus connection in the merger galaxy Mrk 938: An infrared and X-ray view

Mrk 938 is a luminous infrared (IR) galaxy in the local Universe believed to be the remnant of a galaxy merger. It shows a Seyfert 2 nucleus and intense star formation according to optical spectroscopic observations. We have studied this galaxy using new Herschel far-IR imaging data in addition to archival X-ray, UV, optical, near-IR and mid-IR data. Mid- and far-IR data are crucial to characterize the starburst contribution, allowing us to shed new light on its nature and to study the coexistence of active galactic nuclei (AGN) and starburst activity in the local Universe. The decomposition of the mid-IR Spitzer spectrum shows that the AGN bolometric contribution to the mid-IR and total IR luminosity is small [Lbol(AGN)/LIR ? 0.02], which agrees with previous estimations. We have characterized the physical nature of its strong IR emission and constrained it to a relatively compact emitting region of ?2 kpc. It is in this obscured region where most of the current star formation activity is taking place as expected for luminous IR galaxies. We have used Herschel imaging data for the first time to constrain the cold dust emission with unprecedented accuracy. We have fitted the integrated far-IR spectral energy distribution and derived the properties of the dust, obtaining a dust mass of 3 × 107 M . The far-IR is dominated by emission at 35 K, consistent with dust heated by the ongoing star formation activityThanks to F. Schweizer for kindly providing the optical image of Mrk 938, to J. Gallimore for providing the MIPS SED data, and to H. Krimm and W. Baumgartner for the analysis of the BAT ob- servations. PE, AA-H and MP-S acknowledge support from the Spanish Plan Nacional de Astronom ́ıa y Astrof ́ısica under grant AYA2009-05705-E. AA-H and MP-S acknowledge support under grant AYA2010-21161-C02-01. MP-S acknowledges support from the CSIC under grant JAE-Predoc-2007. AMP-G acknowledges support by the Spanish Plan Nacional de Astronom ́ıa y Astrof ́ısica under the grant AYA2008-06311-CO2-01. CRA acknowledges fi- nancial support from STFC (ST/G001758/1) and from the Span- ish Ministry of Science and Innovation (MICINN) through project Consolider-Ingenio 2010 Programme grant CSD2006-00070: First Science with the GTC. MP acknowledges Junta de Andaluc ́ıa and Spanish Ministry of Science and Innovation through projects PO8- TIC-03531 and AYA2010-15169. PACS has been developed by a consortium of institutes led by MPE (Germany) and including UVIE (Austria); KU Leuven, CSL, IMEC (Belgium); CEA, LAM (France); MPIA (Germany); INAF- IFSI/OAA/OAP/OAT, LENS, SISSA (Italy) and IAC (Spain). This development has been supported by the funding agencies BMVIT (Austria), ESA-PRODEX (Belgium), CEA/CNES (France), DLR (Germany), ASI/INAF (Italy) and CICYT/MCYT (Spain). SPIRE has been developed by a consortium of institutes led by Cardiff University (UK) and including University of Lethbridge (Canada); NAOC (China); CEA, LAM (France); IFSI, University of Padua (Italy); IAC (Spain); Stockholm Observatory (Sweden); Imperial College London, RAL, UCL-MSSL, UKATC, University of Sus- sex (UK) and Caltech, JPL, NHSC, University of Colorado (USA). This development has been supported by national funding agencies: CSA (Canada); NAOC (China); CEA, CNES, CNRS (France); ASI (Italy); MCINN (Spain); SNSB (Sweden); STFC (UK) and NASA (USA). This work is based on observations made with the Spitzer Space Telescope, which is operated by the Jet Propulsion Labo- ratory, California Institute of Technology, under NASA contract 1407

By-catch composition of the striped soldier shrimp Plesionika edwardsii (Crustace: Decapoda: Pandalidae) experimental fishery in the Cape Verde Islands

This work focuses on the by-catch composition of Plesionika edwardsii experimental fishery in the Cape Verde Islands. Obtaining information on abundance, composition and lifecycle of species involved in this potential fishery is useful, in order to ensure its sustainable development under an ecosystem approach. The first step towards this goal is the description of catches. Four 15-day research surveys were conducted on board the R/V Prof. Ignacio Lozano: April 2010 (S˜ao Vicente and Santa Luzia islands), November 2011 (Santiago island), March 2012 (Boa Vista island,) and July 2012 (Sal and S˜ao Nicolau islands). The working depths were between 66 and 458 m depth. A standardized innovative fishing gear was used, so-called multiple semi-floating shrimp traps. Each fishing line was composed by 40-65 traps operating around 2.4 m above the seafloor, using Decapterus macarellus (Carangidae) as unique bait of the traps. Multiple semi-floating shrimp traps is a passive fishing system that allows catch and release sea significant part of the unwanted catches, as in the case of Chondrichthyes or Anguilliformes, reducing the fishing impact on non-target species. The main by-catch was composed of 53 species belonging to three groups including Chondrichthyes (three families and three species), Crustacea (11 families and 19 species) and Osteichthyes (15 families and 29 species). Plesionika edwardsii, the target species of this fishery, represented 97.8% of the catch in terms of abundance and 40.1% in biomass. By-catch represented 59.9% of total catch in terms of biomass. Osteichthyes (87.5%) were the dominant group and was represented by the following main families; Sparidae (33.9%), Moridae (32.5%), Muraenidae (32.5%), Scorpaenidae (9.9%) and Tetraodontidae (9.8%). Chondrichthyes (11.6%) were composed by Centrophoridae (65.3%) and Triakidae (34.1%). Finally, Crustacea (1.9%) were chiefly composed by Pandalidae (79.1%). However, different families represented by specific species were found to be dominant around each island. Sparidae were the dominant family represented by Pagellus acarne (46.2% of total by-catch) at S˜ao Vicente, and by Dentex macrophthalmus (42.6%) at Boa Vista. Tetraodontidae with Sphoeroides pachygaster (25.9%) and Sparidae with P. acarne (25.1%) were the co-dominant families in the by-catch around Santa Luzia. Muraenidae were the dominant family represented by Gymnothorax polygonius (69.4%) at Sal, and by Muraena helena (63.4%) at S˜ao Nicolau. Finally, Scorpaenidae with Pontinus kuhlii (22.3%) and Moridae with Physiculus cyanostrophus (22.1%) were the co-dominant families of the bycatch around Santiago. Acknowledgements: This study is part of the PROACTIVA 1-2 (2009-2012) and MARPROF-CV (2010-2014) projects, in the framework of the Canary Islands Government and UE PCT MAC 2007- 2013 programmes respectively

The striped soldier shrimp Plesionika edwardsii (Crustacea:Decapoda:Pandalidae) from the cape Verde Islands

This study is part of the PROACTIVA 1-2 (2009-2012) and MARPROF-CV (2010-2014) projects, in the framework of the Canary Islands Government and UE PCT MAC 2007-2013 programmes respectively. Research has mainly focused on the stock assessment of the striped soldier shrimp, Plesionika edwardsii (Brandt, 1851), because it has shown moderate to high levels of fishing yield and abundances compatible with the development of a new sustainable fishery in the Cape Verde Islands. Cruises took place on board the R/V Prof. Ignacio Lozano. Four 15-day surveys have been conducted to date: Cabo Verde 2010-04 (April 2010), Camar˜ao-1 (November 2011), Camar˜ao-2 (Mars 2012) and Camar ˜ao-3 (July 2012). An innovative fishing gear so-called multiple semi-floating shrimp trap (MSFST) was used. Each fishing line was composed by 40-65 traps operating around 2.4 m above the seafloor, using Decapterus macarellus (Carangidae) as unique bait of the traps. Fishing depth was 66-458 m, and efective fishing time was 16-18 h. Each trap was attached to the main bottom line every 15 m, and the maximum attraction of this bait was established to be 100 or 150 m, according to the experience gained from the local fishery for deep-sea lobsters. So density by area was calculated assuming two different areas of attraction of the fishing gear. Initial biomass was estimated from depletion experiments at different abundance stations by applying the Leslie & Davis (1939) method, modified by Ricker (1975). Each fishing operation was classified according to its yield (CPUE in g/trap/night). The potential fishing planar area was estimated between the isobathymetric lines between 90 and 220 m. Total biomasses (Bt) were calculated from areas (km2) and mean minimum/maximum densities (kg/km2). Maximum sustainable yield (MSY) was estimated from Bt using the Beddington and Cooke (1983) model by entering natural mortality (0.6), growth rate (0.53 year�1) and recruitment age (1.32 year), which are the parameters for this target species published for the Canaries. These parameters estimate a biological exploitation rate ( ) of 0.262. Interpolations were applied to estimate MSY for insular stocks representing lesser than 5% of the total fishing grounds for this species in the archipelago. The MSY estimated by depletion were 30.5 tons/year for the stock of S˜ao Vicente, Santa Luzia, Ilheus and S˜ao Nicolau, 10 tons/year for the stock of Santiago, 138.8 tons/year for the stock of Boa Vista and Maio, and 5.6 tons/year for the stock of Sal. The small stocks estimated by interpolation were: 4.5 tons/year for the stock of Santo Ant˜ao, 1.3 tons/year for the stock of Fogo, and 1.8 tons/year for the stock of Brava and Ilheus. In total, 192.5 tons per year was the total MSY for the striped soldier shrimp around the islands of the Cape Verde archipelago, occupying a total area of 1,918 km2 of new fishing grounds at between 90 and 220 m of depth. In comparison with the traditional bottom trap used in the Canary Islands, the innovative fishing gear MSFST were proved to be more selective for pandalid shrimps, minimizing the gear impact on the seafloor as well as the by-catch by reducing the discards. Depletion methods are based on the assumption of a closed system, that is with minimum or zero immigration between neighbouring areas. The straight forward decline of CPUEs obtained during the depletion experiments seems to confirm that P. edwardsii is a low mobility species, making this assumption valid at least during short-time periods. Because of the bathymetry profile of these islands,the depth range is from very close (few nautical miles in Santiago) to far away (10-12 n.m. in Boa Vista) to the coastline. Fishing effort should be controlled on the basis of quotas, number of fishing vessels and a precautionary approach in order to ensure that catching is commensurate with sustainable levels of exploitation. MSY estimates suggest that this new Capeverdean fishery should be carried out by specialized medium-sized fishing vessels. During the last decades a combination of shrimp trawling and industrial trapping activity has threatened over-exploitation in the Mediterranean fisheries targeting on P. edwardsii; currently the shrimp collapse has conducted to the decline of these fisheries. Can the Cape Verde regulatory bodies and all the stakeholders involved learn the lessons this teaches us about this resource management

Anisotropy studies around the galactic centre at EeV energies with the Auger Observatory

Data from the Pierre Auger Observatory are analyzed to search for anisotropies near the direction of the Galactic Centre at EeV energies. The exposure of the surface array in this part of the sky is already significantly larger than that of the fore-runner experiments. Our results do not support previous findings of localized excesses in the AGASA and SUGAR data. We set an upper bound on a point-like flux of cosmic rays arriving from the Galactic Centre which excludes several scenarios predicting sources of EeV neutrons from Sagittarius $A$. Also the events detected simultaneously by the surface and fluorescence detectors (the `hybrid' data set), which have better pointing accuracy but are less numerous than those of the surface array alone, do not show any significant localized excess from this direction.Comment: Matches published versio