Análisis comparativo de la huella hídrica en agroecosistemas de la microcuenca Alto Rio Ubaté

Con el fin de visibilizar y analizar los vínculos entre el agua y la agricultura desde la perspectiva ambiental (relaciones entre cultura y ecosistemas), se identificaron y describieron dos grupos de agroecosistemas de la micro cuenca Alto Río Ubaté (MARU) en función de la tenencia de la tierra y el consumo del agua en monocultivos de papa (Solanum tuberosum L.) y pasto kikuyo (Pennisetum clandestinum Hochst. ex Chiov.). Se estimó la huella hídrica de los cultivos de papa y pastos para el periodo 2009 – 2014 para los dos grupos de agroecosistemas analizados. Esto se complementó con el análisis cualitativo de los aspectos culturales que determinan el consumo de agua en los cultivos y la estimación de la Estructura Agroecológica Principal (EAP) en fincas ubicadas en la MARU. Los agricultores arrendatarios sólo siembran papa y su principal objetivo es lograr que el cultivo sea rentable. Obtienen dos cosechas de papa al año y el valor promedio estimado de huella hídrica para este cultivo es de 430,2 m3/t. El valor estimado de huella hídrica para los cultivos manejados por arrendatarios es superior con respecto a los propietarios, quienes destinan parte de la cosecha para el autoconsumo y se preocupan por la protección del suelo y el agua en el territorio. Los propietarios obtienen una cosecha de papa al año y el valor promedio estimado de huella hídrica por ciclo de cultivo de papa es de 422,2 m3/t. Para el cultivo de pasto se estimó un valor 103,3 m3/t por ciclo. Aunque ambos grupos utilizan un paquete tecnológico similar para el cultivo de la papa, hay diferencias en los valores estimados de huella hídrica que pueden ser explicadas desde el volumen de insumos utilizados, los rendimientos obtenidos, la intensidad en las siembras y las percepciones del agricultor frente al agua y su relación con el agroecosistema.Abstract. In order to visualize and analyze the links between water and agriculture from an environmental perspective (relationships between culture and ecosystems), were identified and described two groups of agro-ecosystems of the Alto Ubaté River Basin (AURB) in function of landownership and the water consumption in potato (Solanum tuberosum L.) and kikuyu crops (Pennisetum clandestinum Hochst. ex Chiov.). The water footprint of potato crops and kikuyu was estimated for the period 2009 – 2014 by the identified agro-ecosystems. This was supplemented with an analysis of cultural aspects links to crop water consumption and the Agro-ecosystem Main Structure (AMS). The main objective of tenants is to make the potato crop profitable and have the largest potato crop water footprint (430,2 m3 /t). The owners, who spend part of the harvest for subsistence and care about the protection of soil and water in the river basin report a potato crop water footprint of 422,2 m3 /t, and kikuyu crop water footprint of 103,3 m3 /t. Despite both groups have a similar technology for potato cropping, they have different values on their crops water footprint that can be explained from the volume of inputs used, yields, crop intensity, farmer perceptions and his relationship with the agro ecosystem.Maestrí

Diseño de un modelo de preparación de la defensa y exposición pública del Trabajo Final de Máster

Memoria ID-0014. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2015-2016

Iniciativas para el impulso de la participación de los estudiantes en los procesos de garantía y evaluación de la calidad de los títulos de la Facultad de Comercio y Turismo

La Facultad de Comercio y Turismo plantea la propuesta de un conjunto de iniciativas encaminadas a incrementar la participación de los estudiantes y, que las respuestas reflejen un uso responsable del mecanismo, así como un conocimiento del sistema

pilotSTRATEGY project 2021-2026: “CO2 Geological Pilots in Strategic Territories”

[EN] The pilotSTRATEGY (2021-2026) is investigating geological CO2 storage sites in industrial regions to support development of large-scale carbon capture and storage (CCS). It is focused on deep saline aquifers–porous rock formations filled with brine several kilometres below ground – which promise a large capacity for storing captured CO2. The goal of the characterisation is to assess the site’s containment, injectivity, capacity, integrity, hydrodynamics, and monitorability in order to ensure safe and permanent storage of CO2. PilotSTRATEGY covers the initial stages of project development up to the pre-final investment decision (pre-FID), regulatory approval and permitting of storage, and applied on selected structures of Paris Basin in France, the Lusitanian Basin in Portugal and the Ebro Basin in Spain, and in lower detail, in West Macedonia in Greece and Upper Silesia in Poland.The project has received funding from the European Union’s Horizon 2020 programme (10.1 million Euros, No. 101022664).Peer reviewe

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

Aprendizaje de las prácticas de laboratorio de Química Farmacéutica del Grado en Farmacia y Doble Grado en Farmacia y Nutrición a través del aula virtual

Depto. de Química en Ciencias FarmacéuticasFac. de FarmaciaFALSEsubmitte

Using Interpretable Machine Learning to Identify Baseline Predictive Factors of Remission and Drug Durability in Crohn’s Disease Patients on Ustekinumab

Ustekinumab has shown efficacy in Crohn's Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients' data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index <= 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission

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

Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic : a matched analysis

The primary aim of our study was to investigate the association between intubation timing and hospital mortality in critically ill patients with COVID-19-associated respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic waves and the influence of prior non-invasive respiratory support on outcomes. This is a secondary analysis of a multicentre, observational and prospective cohort study that included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across 58 Spanish intensive care units (ICU) participating in the CIBERESUCICOVID project. The study period was between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring within the first 24 h of intensive care unit (ICU) admission. Propensity score (PS) matching was used to achieve balance across baseline variables between the early intubation cohort and those patients who were intubated after the first 24 h of ICU admission. Differences in outcomes between early and delayed intubation were also assessed. We performed sensitivity analyses to consider a different timepoint (48 h from ICU admission) for early and delayed intubation. Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patients were included in the analysis (307 for each group). In the unmatched population, there were no differences in mortality between the early and delayed groups. After PS matching, patients with delayed intubation presented higher hospital mortality (27.3% versus 37.1%, p =0.01), ICU mortality (25.7% versus 36.1%, p=0.007) and 90-day mortality (30.9% versus 40.2%, p=0.02) when compared to the early intubation group. Very similar findings were observed when we used a 48-hour timepoint for early or delayed intubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and 45% in the first, second, third and fourth wave, respectively; first versus second, third and fourth waves p<0.001). In both the main and sensitivity analyses, hospital mortality was lower in patients receiving high-flow nasal cannula (n=294) who were intubated earlier. The subgroup of patients undergoing NIV (n=214) before intubation showed higher mortality when delayed intubation was set as that occurring after 48 h from ICU admission, but not when after 24 h. In patients with COVID-19 requiring invasive mechanical ventilation, delayed intubation was associated with a higher risk of hospital mortality. The use of early intubation significantly decreased throughout the course of the pandemic. Benefits of such an approach occurred more notably in patients who had received high-flow nasal cannul