Comparison of soil quality indexes calculated by network and principal component analysis for carbonated soils under different uses

There is an urgent need to conserve and improve the quality of agricultural soils in the coming decades. Decision tools capable of providing reliable information about soil quality are needed, and soil quality index (SQI) is one of the most used. Principal component analysis (PCA) is the common methodology to calculate it, however in some cases fails to differentiate soil quality properly. Therefore, the aim of this work is to assess a SQI through a different methodology as network analysis (NTA) and compare it with PCA, assuming that soil uses affect soil qualities differently. From soils with different uses (rainfed, olive grove and forest) network analysis and principal component analysis have been used to select a minimum dataset (MDS) to generate SQI from 36 physical, chemical and biological soil variables. Using NTA, geometric mean of the enzyme activities (GMEAN), bulk density (BD) and phosphatase activity (phos) where selected as indicators, while PCA selected total organic carbon (TOC), free Fe oxides (FeF), crystalline Mn oxides (MnX), pH, electrical conductivity (EC) and percentage of coarse sand (CS). Four SQI were calculated from each MDS through linear and non-linear scoring equations and by additive integration and weights. The SQI generated by NTA were more useful than those generated by PCA, as in addition to having fewer indicators they were able to better differentiate the uses in the study. This greater resolution capacity of the NTA would be the consequence of a better selection of indicators using this method than using PCA

Estudio de los suelos del entorno del Balneario de San Nicolás (Almería)

Las propiedades físico-químicas de los suelos que se encuentran en la parte superficial de las capas freáticas, juegan un papel muy importante en las características hidroquímicas de las aguas subyacentes, pues fenómenos como disolución, hidrolisis y procesos de óxido-reducción de fracciones minerales y orgánicas de los suelos influyen de forma significativa en la composición de las mismas. Además, textura, estructura y materia orgánica del suelo son factores claves en la regulación del régimen hidrodinámico. En este trabajo analizamos las características edáficas de cuatro suelos muy significativos de los alrededores del Balneario de San Nicolás, ubicado en Alhama de Almería, Alpujarra Almeriense, situada a 450 msnm en la ladera norte de la Sierra de Gádor. Son suelos con escaso desarrollo, tipo AC, formados a partir de materiales sedimentarios constituidos por margas arenosas, calcarenitas, dolomías y yeso, los situados en las proximidades del Valle del Andarax, y por materiales de derrubios de ladera y pie de monte, con predominio de cuarcita, dolomías, calizas y calizas margosas, los situados en la Sierra de Gádor. Los suelos son carbonatados y están saturados, siendo el calcio el catión mayoritario. Presentan pHs básicos, bajo contenido en materia orgánica y texturas gruesas. Cuarzo, calcita, dolomita y yeso son los minerales más abundantes entre los no laminares, y son las micas los filosilicatos presentes en mayor proporción. El predominio de texturas gruesas y la perdida de estructura en los horizontes profundos son determinantes en el grado de infiltración. Se han incluido en las unidades Regosoles y Calcisoles

Estudio de los suelos de los alrededores del balneario de Paracuellos de Jiloca (Zaragoza)

El aprovechamiento de las aguas mineromedicinales como medio para sanar de forma natural se conoce desde épocas ancestrales. Sus acciones terapéuticas están condicionadas con los gases y las fases sólidas que contengan, y estos dependen del equilibrio y la composición de la atmosfera, los suelos y las rocas.Estos equilibrios están relacionados con la temperatura y la presión del sistema, y cualquier cambio puede producir una variación que afecte a los procesos de disolución y precipitación de los minerales, y por tanto, a la concentración de elementos químicos en las aguas.La composición del suelo juega un papel determinante ya que en su interior se producen reacciones de sorción-desorción, complejación-disociación, disolución-precipitación, que determinan la movilidad de los constituyentes orgánicos e inorgánicos que forman el suelo. En función del resultado de estas reacciones los elementos y compuestos pude quedarse, o alcanzar las aguas subyacentes. En este trabajo analizamos las características edáficas de cuatro suelos muy representativos de los alrededores de la localidad de Paracuellos de Jiloca, localidad donde se encuentra la casa balneario. Pertenece la zona al Sistema Ibérico, en el Valle del Jiloca, situado a una altitud de 586 msnm y se encuentra a 4,6 km de Calatayud. Son suelos con escaso desarrollo, tipo AC, formados a partir de materiales sedimentarios constituidos por conglomerados, calizas margosas y yesos. Presentan pHs básicos, poca materia orgánica, texturas gruesas, son carbonatados y están saturados, siendo el calcio el catión mayoritario. La alta pedregosidad, el predominio de las texturas gruesas,y estructuras débiles, condiciona una porosidad elevada lo que hace que estos suelos tengan un alto grado de infiltración

Suelos del entorno del balneario

Soil characteristics are decisive in groundwater quality. The impact of human activities, especially in areas subject to agricultural pressure, involves potential risks which may be critical to the viability of the water resource. This work gathers together the study of three representative soils located in the thermal environment of “Villa Olmedo”, Valladolid. All of them have developed from arkoses and found around 750 m elevation in a zone of flat topography. Morphological, physical, chemical and mineralogical properties of these soils were analyzed. They are poorly developed, coarse textured, with pH close to neutrality and antric features in the surface horizons. El conocimiento del suelo es imprescindible para comprender el riesgo de la posible afectación de las aguas subterráneas, especialmente en áreas sometidas a una fuerte presión de actividad agrícola. Se presenta el estudio de tres suelos localizados en los alrededores del Balneario “Villa de Olmedo”, provincia de Valladolid. Se han desarrollado a partir de arcosas, situados en topografía llana, con una altitud entorno a los 750 m y bajo clima Mediterráneo templado. Se analizaron las propiedades morfológicas, físicas, químicas y mineralógicas de los suelos. En general, son suelos poco evolucionados, con textura gruesa, pH próximos a la neutralidad y horizontes superficiales con características ántricas.

Estudio de los suelos de los alrededores del Balneario de Villavieja de Nules (Castellón de la Plana)

Soil is the first natural barrier that has to be crossed by the compounds deposited on the Earth's surface to reach aquifers. Knowing about the physicochemical properties involved in the infiltration processes, as well as the soil type, are essential parameters which allows us to analyze the risk of contamination affecting the composition of groundwater. In this work, the environmental factors of the area around the Balneario de Villavieja Nules (Castellón de la Plana) are described, and some of the chemical, physical, and mineralogical characteristics of four soils are analyzed. Most particularly C, N, pH, CE, CIC y CO3 2‐, as well as texture, bulk density, particle density, porosity, hydraulic parameters and clay fraction mineralogy were determined. The results showed that the environmental characteristics of the area, together with the types of soil analyzed slow down the water flow processes.El  suelo  es  la  primera  barrera  natural  que  han  de  atravesar  los  compuestos  depositados  en  la  superficie  terrestre  para  llegar  a  los  acuíferos.  Conocer  las  propiedades  fisicoquímicas  que  intervienen  en  los  procesos  de  infiltración,  así  como  saber  el  tipo  de  suelo,  son  parámetros  esenciales  que  nos  permite  analizar  el  riesgo  de  contaminación  que  afecta  la  composición  del  agua  subterránea.  En  este  trabajo  se  describen  los factores ambientales de la zona, y se analizan  algunas  de  las  propiedades  químicas,  físicas  y  mineralógicas  de  cuatro  suelos  característicos  de los alrededores del Balneario de Villavieja de  Nules  (Castellón  de  la  Plana).  Para  ello  se  ha  obtenido el contenido en: C, N, pH, CE, CIC y CO3  2‐,  así  como  se  ha  determinado:  textura,  densidad  aparente,  densidad  real,  porosidad,  parámetros  hidráulicos  y  la  mineralogía  de  la  fracción  arcilla.  De  los  resultados  se  desprende  que  las  características  ambientales  de  la  zona,  junto  a  los  tipos  de  suelos  analizados  ralentizan  los procesos de flujos descendentes

Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts

Gastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood cell (RBC) transfusion has long been the cornerstone of treatment for anemia due to GI bleeding. However, blood is not devoid of potential adverse effects, and it is also a precious resource, with limited supplies in blood banks. Nowadays, all patients should benefit from a patient blood management (PBM) program that aims to minimize blood loss, optimize hematopoiesis (mainly by using iron replacement therapy), maximize tolerance of anemia, and avoid unnecessary transfusions. Integration of PBM into healthcare management reduces patient mortality and morbidity and supports a restrictive RBC transfusion approach by reducing transfusion rates. The European Commission has outlined strategies to support hospitals with the implementation of PBM, but it is vital that these initiatives are translated into clinical practice. To help optimize management of anemia and iron deficiency in adults with acute or chronic GI bleeding, we developed a protocol under the auspices of the Spanish Association of Gastroenterology, in collaboration with healthcare professionals from 16 hospitals across Spain, including expert advice from different specialties involved in PBM strategies, such as internal medicine physicians, intensive care specialists, and hematologists. Recommendations include how to identify patients who have anemia (or iron deficiency) requiring oral/intravenous iron replacement therapy and/or RBC transfusion (using a restrictive approach to transfusion), and transfusing RBC units 1 unit at a time, with assessment of patients after each given unit (i.e., “don’t give two without review”). The advantages and limitations of oral versus intravenous iron and guidance on the safe and effective use of intravenous iron are also described. Implementation of a PBM strategy and clinical decision-making support, including early treatment of anemia with iron supplementation in patients with GI bleeding, may improve patient outcomes and lower hospital costs

2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla

La transfusión de sangre alogénica (TSA) no es inocua, y como consecuencia han surgido múltiples alternativas a la misma (ATSA). Existe variabilidad respecto a las indicaciones y buen uso de las ATSA. Dependiendo de la especialidad de los médicos que tratan a los pacientes, el grado de anemia, la política transfusional, la disponibilidad de las ATSA y el criterio personal, estas se usan de forma variable. Puesto que las ATSA tampoco son inocuas y pueden no cumplir criterios de coste-efectividad, la variabilidad en su uso es inaceptable. Las sociedades españolas de Anestesiología y Reanimación (SEDAR), Hematología y Hemoterapia (SEHH), Farmacia Hospitalaria (SEFH), Medicina Intensiva y Unidades Coronarias (SEMICYUC), Trombosis y Hemostasia (SETH) y Transfusiones Sanguíneas (SETS) han elaborado un documento de consenso para el buen uso de la ATSA. Un panel de expertos de las 6 sociedades ha llevado a cabo una revisión sistemática de la literatura médica y elaborado el 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Solo se contempla las ATSA dirigidas a disminuir la transfusión de concentrado de hematíes. Se definen las ATSA como toda medida farmacológica y no farmacológica encaminada a disminuir la transfusión de concentrado de hematíes, preservando siempre la seguridad del paciente. La cuestión principal que se plantea en cada ítem se formula, en forma positiva o negativa, como: «La ATSA en cuestión reduce/no reduce la tasa transfusional». Para formular el grado de recomendación se ha usado la metodología Grades of Recommendation Assessment, Development and Evaluation (GRADE)

Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] 15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activityS

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

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group