Preliminary Water Assessment Reports of The Test Basins of The Watch Project

This report presents the initial plans of the case studies how they link to rest of the Watch project and on which water resources they will focus. This report will function as the basis for further discussions on how to improve the integration of the case studies within the project and to develop a more general protocol for each of the case studies. Currently 5 catchments are used within the Watch project, they differ in climatic and hydro-geological features and expected climate changes: the Glomma River basin (Eastern Norway), the upper Guadiana basin (Central Spanish Plateau), the Nitra River basin (central Slovakia), the Upper-Elbe basin (part of the Elbe River) and the island of Crete. Also the water resources issues vary over these cases. Agricultural (and domestic) water use is under pressure in the Mediterranean catchments probably aggravating with the expected increase in drought frequency under future climate. The Norwegian catchment provides hydropower services under threat of precipitation increase rather than decrease. The central European catchments are threatened mainly by increased variability, i.e. increased frequencies of extremes in a densely populated environment, and river flow may need additional buffers (reservoirs) to reduce floodrisk and store water for dry period

Green's Matrix for a Second Order Self-Adjoint Matrix Differential Operator

A systematic construction of the Green's matrix for a second order, self-adjoint matrix differential operator from the linearly independent solutions of the corresponding homogeneous differential equation set is carried out. We follow the general approach of extracting the Green's matrix from the Green's matrix of the corresponding first order system. This construction is required in the cases where the differential equation set cannot be turned to an algebraic equation set via transform techniques.Comment: 19 page

Development and characterization of a hydrogel containing silver sulfadiazine for antimicrobial topical applications

Development and optimization of a hydrogel with impregnated silver sulfadiazine was pursued, for antimicrobial topical applications. The selected hydrogel exhibited a homogeneous appearance, with whitish colloration and devoid of any fractures or cracks. The content in impregnated silver sulfadiazine was within established limits (1%, w/w) with a standard deviation of up to 1.28%. The hydrogel presented a good characteristic in relation to release of the active antimicrobial principle, verified through swelling tests and antimicrobial activity. The swelling tests indicated a higher increase in weight during the first 6 h of contact with a moist environment, with a maximum value of 266.00 ± 0.81, and with maintenance of the original shape of the hydrogel. The impregnated silver sulfadiazine presented antimicrobial activity, as expected, indicating a prolonged release of the drug. The infrared spectra of the hydrogel with impregnated silver sulfadiazine indicated that the drug did not engage in any bonds with the polymeric matrix, which otherwise could have reduced its antimicrobial activity. The mechanical resistance tests produced good results, indicating that the hydrogels may be utilized in different locations of the human body with skin lesions.Project funding by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, São Paulo, Brazil) (FAPESP Ref. Nos. 2012/15651-4, 2013/03181-6, and 2014/21122-0) is hereby gratefully acknowledged. This work also received support from CNPq in the form of a Research Productivity (PQ) fellowshi

From Epidemic Meningitis Vaccines for Africa to the Meningitis Vaccine Project

Background. Polysaccharide vaccines had been used to control African meningitis epidemics for >30 years but with little or modest success, largely because of logistical problems in the implementation of reactive vaccination campaigns that are begun after epidemics are under way. After the major group A meningococcal meningitis epidemics in 1996–1997 (250 000 cases and 25 000 deaths), African ministers of health declared the prevention of meningitis a high priority and asked the World Health Organization (WHO) for help in developing better immunization strategies to eliminate meningitis epidemics in Africa. Methods. WHO accepted the challenge and created a project called Epidemic Meningitis Vaccines for Africa (EVA) that served as an organizational framework for external consultants, PATH, the US Centers for Disease Control and Prevention (CDC), and the Bill & Melinda Gates Foundation (BMGF). Consultations were initiated with major vaccine manufacturers. EVA commissioned a costing study/business plan for the development of new group A or A/C conjugate vaccines and explored the feasibility of developing these products as a public–private partnership. Representatives from African countries were consulted. They confirmed that the development of conjugate vaccines was a priority and provided information on preferred product characteristics. In parallel, a strategy for successful introduction was also anticipated and discussed. Results. The expert consultations recommended that a group A meningococcal conjugate vaccine be developed and introduced into the African meningitis belt. The results of the costing study indicated that the “cost of goods” to develop a group A – containing conjugate vaccine in the United States would be in the range of US$0.35–$1.35 per dose, depending on composition (A vs A/C), number of doses/vials, and presentation. Following an invitation from BMGF, a proposal was submitted in the spring of 2001. Conclusions. In June 2001, BMGF awarded a grant of US$70 million to create the Meningitis Vaccine Project (MVP) as a partnership between PATH and WHO, with the specific goal of developing an affordable MenA conjugate vaccine to eliminate MenA meningitis epidemics in Africa. EVA is an example of the use of WHO as an important convening instrument to facilitate new approaches to address major public health problems

Effect of an early neurocognitive rehabilitation on autonomic nervous system in critically ill patients

Introduction Recent clinical and electrophysiological studies reveal a high incidence of autonomic nervous system (ANS) dys- function in patients treated in ICU [1]. ANS disturbances may produce diverse and unexpected consequences. For instance, critically ill patients are at risk of neurocognitive impairments that may persist after hospital discharge. Among various pathophysiological mechanisms proposed, ANS dysfunction leading cholinergic deficiency seems one of the most viable to explain the development of long-term sequelae. Heart rate variability (HRV) has been related to the activity of the prefrontal cortex [2] hence, prefrontal activation could help to strengthen the auto- nomic nervous system integrity. We are interested in assessing the improvement of the ANS dysfunction through neural circuits’ activation. Thus, we propose a novel therapy that could allow the reinforcing of ANS through an early neurocognitive intervention targeted to improve prefrontal activation. Objectives The aim of this study was to explore if the integrity of the ANS, via cardiac vagal tone, measured by the HRV can be modified after early neurocognitive rehabilitation in ICU patients. Methods A total of 17 critically ill patients received a 20-minute Early Neurocognitive Rehabilitation (ENR) session in their own bed in the ICU. HRV was derived from the recorded ECG signal during pre-session, session and post-session. Power in the specific frequency bands related to sympathetic and parasympathetic systems was computed (PLF and PHF for low and high frequency bands, respectively). PLF was computed within the clas- sic band, while PHF was computed within a band cen- tered at respiratory rate. Changes in the HRV parameters from pre-session to session, and from pre- session to post-session were studied using Wilcoxon signed-rank test. Results Clinical data of the sample are summarized in table 1. Comparing with baseline values, 9 patients (53%) showed a decreased PLF in post-session, while 8 patients (47%) presented a higher PLF (p = .759). In 12 patients (71%), PHF increased after the ENR session, suggesting an increase of parasympathetic activity (p = .836). Conclusions Diagnosis, severity of illness or medication could explain the differential effect in the evolution of the HRV para- meters among different patients. Despite differences, an early neurocognitive rehabilitation seems to increase parasympathetic activity after the session in the majority of the patients. Clinical characteristics of the critical ill patients should be further studied to determinate which patients could be the best candidates for early neurocog- nitive intervention

Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

© 2015, Springer International Publishing Switzerland. Background: The concept of pharmaceutical care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. Objective: The objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of a medication review with follow-up (MRF) service for older adults with polypharmacy in Spanish community pharmacies against the alternative of having their medication dispensed normally. Methods: The study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of 6 months. The target population was older adults with polypharmacy, defined as individuals taking five or more medicines per day. The study was conducted in 178 community pharmacies in Spain. Cost-utility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as quality-adjusted life-years (QALYs). In order to analyze the uncertainty of ICER results, we performed a non-parametric bootstrapping with 5000 replications. Results: A total of 1403 older adults, aged between 65 and 94 years, were enrolled in the study: 688 in the intervention group (IG) and 715 in the control group (CG). By the end of the follow-up, both groups had reduced the mean number of prescribed medications they took, although this reduction was greater in the IG (0.28 ± 1.25 drugs; p < 0.001) than in the CG (0.07 ± 0.95 drugs; p = 0.063). Older adults in the IG saw their quality of life improved by 0.0528 ± 0.20 (p < 0.001). In contrast, the CG experienced a slight reduction in their quality of life: 0.0022 ± 0.24 (p = 0.815). The mean total cost was €977.57 ± 1455.88 for the IG and €1173.44 ± 3671.65 for the CG. In order to estimate the ICER, we used the costs adjusted for baseline medications and QALYs adjusted for baseline utility score, resulting in a mean incremental total cost of −€250.51 ± 148.61 (95 % CI −541.79 to 40.76) and a mean incremental QALY of 0.0156 ± 0.004 (95 % CI 0.008–0.023). Regarding the results from the cost-utility analysis, the MRF service emerged as the dominant strategy. Conclusion: The MRF service is an effective intervention for optimizing prescribed medication and improving quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that the MRF service is cost effective

Factores de control de la dinámica sedimentaria en el frente litoral de la Bahía de Cádiz

En la bahía de Cádiz, al SO de la Península Ibérica, se diferencian dos sectores: una bahía externa de carácter arenoso, bien conectada con mar abierto y la plataforma, donde la fracción fina está restringida a zonas frente a desembocaduras de ríos y caños mareales o bajo la influencia de flujos de turbidez. Otra es la bahía interna, más abrigada que la anterior y caracterizada por la presencia de ambientes mareales y fondo fangoso. Los dos sectores están comunicados por el estrecho de Puntales, que es esencial para la renovación del agua de la bahía interna y para el suministro de materia en suspensión a la externa. El régimen de mareas es mesomareal, con amplitud máxima de 3.7 m y media de 2.18 m. El oleaje tipo sea presenta enfrentamiento levante-poniente con dominio de la componente Este, mientras que el de tipo swell está por la componente Oeste. Las corrientes litorales están controladas por el oleaje y fisiografía de la costa y el fondo. La orientación dominante de la costa de NNO a SSE, hace que se reciba de cara el oleaje del SO. Esta dirección está interceptada por segmentos ENE a OSO, que le dan un aspecto escalonado que condiciona la dinámica sedimentaria y la ubicación de la desembocadura de ríos y ambientes de depósito

Manejo del neonato con coartación de aorta e hipoplasia de arco

ResumenIntroducciónLa coartación aórtica del neonato puede asociar en un porcentaje importante hipoplasia del arco aórtico, llegando en algunas series al 60%.Cuando existe hipoplasia del arco aórtico distal el tratamiento estándar consiste en la resección de la zona de coartación y anastomosis termino-terminal extendida.En casos de hipoplasia severa del arco aórtico distal y arco distal largo, podría no ser suficiente con la resección y anastomosis termino-terminal extendida, por lo que sería razonable realizar alguna técnica adicional para ampliar el arco aórtico distal, evitando así un abordaje anterior, el uso de parada circulatoria con o sin perfusión cerebral selectiva y el aumento de la morbimortalidad perioperatoria.MétodosPresentamos los resultados de 4 neonatos, a los que se les realizó una ampliación del arco aórtico distal, según técnica de Amato (anastomosis latero-lateral entre las arterias carótida y subclavia izquierdas), para posteriormente resecar la zona de coartación y anastomosar la aorta descendente al arco aórtico previamente ampliado.ResultadosEn todos los casos el ecocardiograma postoperatorio mostró arco reconstruido con flujo laminar. No se ha presentado ningún caso de recoartación durante un período de seguimiento medio de 12 meses.ConclusiónConsideramos que la técnica de elección en la coartación con hipoplasia de arco distal es la resección y anastomosis termino-terminal extendida.En casos seleccionados, con arco aórtico distal muy largo y severamente hipoplásico, la técnica de Amato es una alternativa atractiva, con el objeto de evitar un abordaje anterior y el uso de CEC. Además, puede realizarse en un primer tiempo, manteniendo perfusión sistémica ductus-dependiente.AbstractIntroductionNeonatal aortic coarctation can be combined with a significant percentage of aortic arch hypoplasia, reaching 60% in some series.When there is hypoplasia of the distal aortic arch, the standard treatment consists of resection of the coarctation zone and extended end-to-end anastomosis.In cases of severe distal aortic arch hypoplasia and a long distal arch, resection and extended end-to-end anastomosis would not be sufficient, making it reasonable to perform an additional technique to widen the distal aortic arch, thus avoiding an anterior approach and interrupting the blood circulation with or without selective cerebral infusion, with the resulting risk of an increase in perioperative morbidity and mortality.MethodsThe results are presented on 4 neonates on whom a widening of the distal aortic arch was performed using the Amato technique (side-to-side anastomosis between the left carotid and subclavian arteries), in order to subsequently resect the coarctation zone and perform an anastomosis of the descending aorta to the previously widened aortic arch.ResultsThe post-operative echocardiogram showed a reconstructed arch with laminar flow in all cases. There has been no recurrence of coarctation in any of the cases during a mean follow-up of 12 months.ConclusionWe believe that resection with extended end-to-end anastomosis is the technique of choice in coarctation with distal arch hypoplasia.The Amato technique is an attractive alternative in selected cases with a very long and severely hypoplastic distal arch, with the aim of avoiding an anterior approach and the use of extracorporeal circulation. This could also be performed initially, maintaining ductal-dependent systemic perfusion

Prescripció infermera: posicionament i opinió dels professionals de salut a Catalunya sobre els seus beneficis

Prescripció infermera; Professionals de la salut; ConsensPrescripción enfermera; Profesionales de la salud; ConsensoNursing prescription; Health professionals; ConsensusLa publicació d'aquest informe té l'objectiu de mesurar el grau de consens entre els professionals de la salut implicats en el futur desplegament de la prescripció infermera a Catalunya. El document recull els resultats de la investigació en què van participar infermeres i infermers, metges i metgesses i farmacèutics i farmacèutiques en una enquesta basada en la metodologia Health Consensus