Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Numerical schemes for quasi-1D steady nozzle flows

[EN] In this work we construct high-resolution numerical schemes for the calculation of the quasi-1D unsteady flow in pipes with variable cross-sectional area. This is an example of non-homogeneous hyperbolic systems of conservation laws that admit stationary solutions. We use the strategy developed by the authors in [1] which is to transform the non-homogeneous system into homogeneous writing the source term in divergence form, so that it can be incorporated into the flux vector of the homogeneous system and discretized in the same way. As a result, the source terms are automatically discretized to achieve perfect balance with flux terms, obtaining well-balanced schemes that produce very robust and accurate solutions. Concretely, the mentioned strategy will be used to extend the flux limiter technique [2] and the Harten, Lax and van Leer (HLL) Riemann solver [3] to the quasi-1D flow in ducts of variable cross-section. The numerical results confirm the capacity of these methods to construct well-balanced schemes. (C) 2021 Elsevier Inc. All rights reserved.Gascón Martínez, ML.; Corberán, JM.; García Manrique, JA. (2021). Numerical schemes for quasi-1D steady nozzle flows. Applied Mathematics and Computation. 400:1-14. https://doi.org/10.1016/j.amc.2021.126072S11440

A numerical simulation of woven/anionic polyamide 6 composite part manufacturing using structural reactive injection moulding process

In this work, a structural reactive injection moulding process using reactive anionic polyamide 6 (APA-6) is studied. Semi-empirical equations for the prediction of the APA-6 reaction kinetics and an advection equation for void transport are used in the numerical scheme. A complex numerical simulation of reactive injection of ε-caprolactam was developed for a three-dimensional industrial part. The validity of the approach is demonstrated for determining an effective injection strategy, including the position of vents and gates and the most effective parameter values for minimum mould filling time without the formation of voids.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research work is supported by the Spanish Ministry of Science and Innovation, project DPI2010-20333 and the Generalitat Valenciana through programme PROMETEO/2009/063.García Manrique, JA.; Hoto, R.; Gascón Martínez, ML.; Andrés De La Esperanza, FJ. (2014). A numerical simulation of woven/anionic polyamide 6 composite part manufacturing using structural reactive injection moulding process. Journal of Thermoplastic Composite Materials. 1-15. https://doi.org/10.1177/0892705714530746S115Van Rijswijk, K., Bersee, H. E. N., Jager, W. F., & Picken, S. J. (2006). Optimisation of anionic polyamide-6 for vacuum infusion of thermoplastic composites: choice of activator and initiator. Composites Part A: Applied Science and Manufacturing, 37(6), 949-956. doi:10.1016/j.compositesa.2005.01.023Van Rijswijk, K., van Geenen, A. A., & Bersee, H. E. N. (2009). Textile fiber-reinforced anionic polyamide-6 composites. Part II: Investigation on interfacial bond formation by short beam shear test. Composites Part A: Applied Science and Manufacturing, 40(8), 1033-1043. doi:10.1016/j.compositesa.2009.02.018Van Rijswijk, K., Lindstedt, S., Vlasveld, D. P. N., Bersee, H. E. N., & Beukers, A. (2006). Reactive processing of anionic polyamide-6 for application in fiber composites: A comparitive study with melt processed polyamides and nanocomposites. Polymer Testing, 25(7), 873-887. doi:10.1016/j.polymertesting.2006.05.006Van Rijswijk, K., & Bersee, H. E. N. (2007). Reactive processing of textile fiber-reinforced thermoplastic composites – An overview. Composites Part A: Applied Science and Manufacturing, 38(3), 666-681. doi:10.1016/j.compositesa.2006.05.007Pillay, S., Vaidya, U. K., & Janowski, G. M. (2005). Liquid Molding of Carbon Fabric-reinforced Nylon Matrix Composite Laminates. Journal of Thermoplastic Composite Materials, 18(6), 509-527. doi:10.1177/0892705705054412Garcı́a, J. A., Gascón, L., & Chinesta, F. (2003). A fixed mesh numerical method for modelling the flow in liquid composites moulding processes using a volume of fluid technique. Computer Methods in Applied Mechanics and Engineering, 192(7-8), 877-893. doi:10.1016/s0045-7825(02)00604-7Davé, R. S., & Loos, A. C. (Eds.). (2000). Processing of Composites. doi:10.3139/9783446401778Woo Il Lee, Loos, A. C., & Springer, G. S. (1982). Heat of Reaction, Degree of Cure, and Viscosity of Hercules 3501-6 Resin. Journal of Composite Materials, 16(6), 510-520. doi:10.1177/002199838201600605Gupta, A., Kelly, P. A., Bickerton, S., & Walbran, W. A. (2012). Simulating the effect of temperature elevation on clamping force requirements during rigid-tool Liquid Composite Moulding processes. Composites Part A: Applied Science and Manufacturing, 43(12), 2221-2229. doi:10.1016/j.compositesa.2012.08.003Kabo, G. J., Kozyro, A. A., Krouk, V. S., Sevruk, V. M., Yursha, I. A., Simirsky, V. V., & Gogolinsky, V. I. (1992). Thermodynamic properties of 6-aminohexanoic lactam (ɛ-caprolactam). The Journal of Chemical Thermodynamics, 24(1), 1-13. doi:10.1016/s0021-9614(05)80249-6Marx, P., Smith, C. W., Worthington, A. E., & Dole, M. (1955). Specific Heat of Synthetic High Polymers. IV. Polycaprolactam. The Journal of Physical Chemistry, 59(10), 1015-1019. doi:10.1021/j150532a005Dole, M., & Wunderlich, B. (1959). Die Makromolekulare Chemie, 34(1), 29-49. doi:10.1002/macp.1959.020340102Kim, K. J., Kim, Y. Y., Yoon, B. S., & Yoon, K. J. (1995). Mechanism and kinetics of adiabatic anionic polymerization of ε-caprolactam in the presence of various activators. Journal of Applied Polymer Science, 57(11), 1347-1358. doi:10.1002/app.1995.070571111Malkin, A. Y., Ivanova, S. L., Frolov, V. G., Ivanova, A. N., & Andrianova, Z. S. (1982). Kinetics of anionic polymerization of lactams. (Solution of non-isothermal kinetic problems by the inverse method). Polymer, 23(12), 1791-1800. doi:10.1016/0032-3861(82)90124-0Camargo, R. E., Gonzalez, V. M., Macosko, C. W., & Tirrell, M. (1983). Bulk Polymerization Kinetics by the Adiabatic Reactor Method. Rubber Chemistry and Technology, 56(4), 774-783. doi:10.5254/1.3538154Teuwen, J. J. E., van Geenen, A. A., & Bersee, H. E. N. (2012). Novel Reaction Kinetic Model for Anionic Polyamide-6. Macromolecular Materials and Engineering, 298(2), 163-173. doi:10.1002/mame.201100457RUIZ, E., ACHIM, V., SOUKANE, S., TROCHU, F., & BREARD, J. (2006). Optimization of injection flow rate to minimize micro/macro-voids formation in resin transfer molded composites. Composites Science and Technology, 66(3-4), 475-486. doi:10.1016/j.compscitech.2005.06.013García, J. A., Gascón, L., Chinesta, F., Ruiz, E., & Trochu, F. (2010). An efficient solver of the saturation equation in liquid composite molding processes. International Journal of Material Forming, 3(S2), 1295-1302. doi:10.1007/s12289-010-0681-8Chui, W. K., Glimm, J., Tangerman, F. M., Jardine, A. P., Madsen, J. S., Donnellan, T. M., & Leek, R. (1997). Case Study from Industry:Process Modeling in Resin Transfer Molding as a Method to Enhance Product Quality. SIAM Review, 39(4), 714-727. doi:10.1137/s0036144596308546Gascón LL, García JA, Ruiz E, Modelling and prediction of saturation in liquid composite molding, submitted to publication, 2013[Please update Ref 21.]