Análisis del envío de unidades SEM para accidentes en el distrito de l’Eixample

Son muchas las propuestas que se introducen anualmente para mejorar la seguridad en el automóvil, tanto en la seguridad primaria y secundaria, que hacen referencia a la actuación del conductor y a los elementos que actúan automáticamente en el siniestro, como en la terciaria, referida a las intervenciones que se llevan a cabo después del accidente. En esta última destaca la importancia de una respuesta rápida y eficiente de los equipos de emergencia y recursos disponibles. El objetivo del proyecto es realizar un análisis sobre el envío de los equipos médicos de emergencia para los siniestros de tráfico en el Eixample de Barcelona. Este distrito está situado en la parte central de la ciudad y se distingue por su alta congestión vial, por lo que su accidentalidad es elevada. Se examina la actuación del Sistema d’Emergències Mèdiques (SEM) mediante la simulación de secuencias de accidentes que requieren su intervención. Inicialmente, se realiza un estudio estadístico sobre la evolución de las cifras de accidentalidad en el territorio español y, más detalladamente, en Cataluña y Barcelona. Seguidamente se desarrolla un análisis de los recursos disponibles en la ciudad, como se distribuyen y en qué momentos intervienen, además de representar la estructura y las dimensiones de la zona de estudio, L’Eixample. Finalmente, se crea un programa de simulación de accidentes, que se intenta aproximar a la realidad de la zona, para posteriormente analizar resultados y buscar posibles puntos de mejora en el sistema

Editorial EJKM Volume 18 Issue 3: Advances in Health Knowledge Management: New Perspectives

Editorial EJKM Volume 18 Issue 3: Advances in Health Knowledge Management: New Perspectives by Maria Jose Sousa, Francesca Dal Mas and Renato Lopes Da Cost

Malaria resurgence risk in southern Europe: climate assessment in an historically endemic area of rice fields at the Mediterranean shore of Spain

<p>Abstract</p> <p>Background</p> <p>International travel and immigration have been related with an increase of imported malaria cases. This fact and climate change, prolonging the period favouring vector development, require an analysis of the malaria transmission resurgence risk in areas of southern Europe. Such a study is made for the first time in Spain. The Ebro Delta historically endemic area was selected due to its rice field landscape, the presence of only one vector, <it>Anopheles atroparvus</it>, with densities similar to those it presented when malaria was present, in a situation which pronouncedly differs from already assessed potential resurgence areas in other Mediterranean countries, such as France and Italy, where many different <it>Anopheles </it>species coexist and a different vector species dominates.</p> <p>Methods</p> <p>The transmission risk was assessed analysing: 1) climate diagrams including the minimum temperature for <it>Plasmodium falciparum </it>and <it>Plasmodium vivax </it>development; 2) monthly evolution of the Gradient Model Risk (GMR) index, specifying transmission risk period and number of potential <it>Plasmodium </it>generations; 3) ecological characteristics using remote sensing images with the Eurasia Land Cover characteristics database and the monthly evolution of the Normalized Difference Vegetation Index (NDVI); 4) evaluation of <it>A. atroparvus </it>population dynamics.</p> <p>Results</p> <p>Climatological analyses and GMR index show that a transmission risk presently exists, lasting from May until September for <it>P. falciparum</it>, and from May until October for <it>P. vivax</it>. The GMR index shows that the temperature increase does not actually mean a transmission risk increase if accompanied by a precipitation decrease reducing the number of parasite generations and transmission period. Nevertheless, this limitation is offset by the artificial flooding of the rice fields. Maximum NDVI values and <it>A. atroparvus </it>maximum abundance correspond to months with maximum growth of the rice fields.</p> <p>Conclusions</p> <p>The Ebro Delta presents the ecological characteristics that favour transmission. The temperature increase has favoured a widening of the monthly potential transmission window with respect to when malaria was endemic. The combined application of modified climate diagrams and GMR index, together with spatial characterization conforms a useful tool for assessing potential areas at risk of malaria resurgence. NDVI is a good marker when dealing with a rice field area.</p

Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real-world efficacy from the EoE CONNECT registry

Eosinophilic esophagitis; Swallowed topical corticosteroids; Cross-sectional studyEsofagitis eosinofílica; Corticosteroides tópicos ingeridos; Estudio transversalEsofagitis eosinofílica; Corticoides tòpics ingerits; Estudi transversalBackground: Swallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses. Objective: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice. Methods: Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations. Results: Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness. Conclusion: Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.Instituto de Salud Carlos III, Grant/Award Number: JR19/0000

Accurate and timely diagnosis of Eosinophilic Esophagitis improves over time in Europe. An analysis of the EoE CONNECT Registry.

Diagnostic delay; Endoscopy; Eosinophilic esophagitisRetraso en el diagnóstico; Endoscopia; Esofagitis eosinofílicaRetard diagnòstic; Endoscòpia; Esofagitis eosinofílicaBackground: Poor adherence to clinical practice guidelines for eosinophilic esophagitis (EoE) has been described and the diagnostic delay of the disease continues to be unacceptable in many settings. Objective: To analyze the impact of improved knowledge provided by the successive international clinical practice guidelines on reducing diagnostic delay and improving the diagnostic process for European patients with EoE. Methods: Cross-sectional analysis of the EoE CONNECT registry based on clinical practice. Time periods defined by the publication dates of four major sets of guidelines over 10 years were considered. Patients were grouped per time period according to date of symptom onset. Results: Data from 1,132 patients was analyzed and median (IQR) diagnostic delay in the whole series was 2.1 (0.7-6.2) years. This gradually decreased over time with subsequent release of new guidelines (p < 0.001), from 12.7 years up to 2007 to 0.7 years after 2017. The proportion of patients with stricturing of mixed phenotypes at the point of EoE diagnosis also decreased over time (41.3% vs. 16%; p < 0.001), as did EREFS scores. The fibrotic sub-score decreased from a median (IQR) of 2 (1-2) to 0 (0-1) when patients whose symptoms started up to 2007 and after 2017 were compared (p < 0.001). In parallel, symptoms measured with the Dysphagia Symptoms Score reduced significantly when patients with symptoms starting before 2007 and after 2012 were compared. A reduction in the number of endoscopies patients underwent before the one that achieved an EoE diagnosis, and the use of allergy testing as part of the diagnostic workout of EoE, also reduced significantly over time (p = 0.010 and p < 0.001, respectively). Conclusion: The diagnostic work-up of EoE patients improved substantially over time at the European sites contributing to EoE CONNECT, with a dramatic reduction in diagnostic delay

Stream flow regime, temperature and climate change: the loss of fish habitat

This study is aimed at forecasting the changes in the suitability of brown trout habitat (Salmo trutta L.), caused by alterations in the stream temperature and the flow regime under climate change scenarios. The stream temperature and instantaneous flow in several streams in Central Spain were modelled from daily temperature and precipitation data. Logistic models were used for stream temperature modelling whereas M5? model trees were used to develop the precipitation-runoff models. These models were utilized to simulate the running flows under the climate change scenarios RCP4.5 and RCP8.5 (5thIPCC). The resulting forecasts suggested a different response of the stream temperature to the atmospheric warming in accordance with the geologic nature of basins. At the same time, significant decreases in summer flow and increases in the frequency of zero-flow events were predicted. In the future, significant declines in summer flow could exacerbate the negative impact on trout populations of increased water temperature by reducing both the suitable spatial habitat and the warming resistance of the water mass

Microbiological contamination of conventional and reclaimed irrigation water: evaluation and management measures

The wide diversity of irrigation water sources (i.e., drinking water, groundwater, reservoir water, river water) includes reclaimed water as a requested measure for increasing water availability, but it is also a challenge as pathogen exposure may increase. This study evaluates the level of microbial contamination in different irrigation waters to improve the knowledge and analyses management measures for safety irrigation. Over a one-year period, the occurrence of a set of viruses, bacteria and protozoa, was quantified and the performance of a wetland system, producing reclaimed water intended for irrigation, was characterized. Human fecal pollution (HAdV) was found in most of the irrigation water types analysed. Hepatitis E virus (HEV), an emerging zoonotic pathogen, was present in groundwater where porcine contamination was identified (PAdV). The skin-carcinoma associated Merkel cell polyomavirus (MCPyV), was found occasionally in river water. Noroviruses were detected, as expected, in winter, in river water and reclaimed water. Groundwater, river water and reservoir water also harboured potential bacterial pathogens, like Helicobacter pylori, Legionella spp. and Aeromonas spp. that could be internalized and viable inside amoebas like Acanthamoeba castellanii, which was also detected. Neither Giardia cysts, nor any Cryptosporidium oocysts were detected. The wetland system removed 3 Log10 of viruses and 5 Log10 of bacteria, which resembled the river water quality. Irrigation waters were prone to variable contamination levels and according to the European guidance documents, the E. coli (EC) levels were not always acceptable. Sporadic detection of viral pathogens as NoV GII and HAdV was identified in water samples presenting lower EC than the established limit (100MNP/100 mL). When dealing with reclaimed water as a source of irrigation the analysis of some viral parameters, like HAdV during the peak irrigation period (summer and spring) or NoV during the coldest months, could complement existing water management tools based on bacterial indicators

Compósito cimentício com elevado teor de fibra de coco tratada: propriedades físicas e durabilidade

O aproveitamento da fibra de coco na construção civil pode diminuir o consumo de agregados minerais comoareia e brita, e melhorar propriedades físicas e mecânicas de um compósito cimentício. No entanto, um dospontos mais precários está relacionado à degradação acelerada da fibra vegetal pela ação química da matrizcimentícia. Então, avaliou-se a incorporação da fibra de coco com um novo tratamento, e sua influência naspropriedades físicas e durabilidade do compósito cimentício. O tratamento utilizou látex natural, sílica ativa efibra de coco na proporção de 10%, em relação à massa de cimento, para a produção de corpos de prova. Foramdeterminadas as capacidades de atenuação térmica e acústica, massa específica e executados ensaiosmecânicos e de durabilidade. Os dados experimentais indicaram melhora do desempenho termoacústico donovo compósito em até 20% por comparação com o desempenho do compósito cimentício sem a sua presença.Os resultados preliminares obtidos permitem concluir que o compósito pode ser aproveitado na construçãocivil para produção de tijolos de alvenaria para vedação.Palavras-chave: Materiais alternativos de construção, Fibras vegetais, Durabilidade, Sustentabilidade

Effects of integrase inhibitor-based antiretroviral therapy on brain outcomes according to time since acquisition of HIV-1 infection

Integrase strand transfer inhibitors (INSTI) are a main component of the current antiretroviral regimens recommended for treatment of HIV infection. However, little is known about the impact of INSTI on neurocognition and neuroimaging. We developed a prospective observational trial to evaluate the effects of INSTI-based antiretroviral therapy on comprehensive brain outcomes (cognitive, functional, and imaging) according to the time since HIV-1 acquisition. We recruited men living with HIV who initiated antiretroviral therapy with INSTI 6 months since estimated date of HIV-1 acquisition (n = 15). We also recruited a group of matched seronegative individuals (n = 15). Assessments were performed at baseline (before initiation of therapy in HIV arms) and at weeks 4 and 48. Baseline cognitive functioning was comparable between the arms. At week 48, we did not find cognitive differences between starting therapy with INSTI earlier than 3 months or later than 6 months after acquisition of HIV-1 infection. Functional status was poorer in individuals diagnosed earlier. This effect recovered 48 weeks after initiation of therapy. Regarding brain imaging, we found that men living with HIV initiating antiretroviral therapy later experienced a greater decrease in medial orbitofrontal cortex over time, with expected negative repercussions for decision-making tasks

Characterization of an enhanced antigenic change in the pandemic 2009 H1N1 influenza virus haemagglutinin

Murine hybridomas producing neutralizing mAbs specific to the pandemic influenza virus A/California/07/2009 haemagglutinin (HA) were isolated. These antibodies recognized at least two different but overlapping new epitopes that were conserved in the HA of most Spanish pandemic isolates. However, one of these isolates (A/Extremadura/RR6530/2010) lacked reactivity with the mAbs and carried two unique mutations in the HA head (S88Y and K136N) that were required simultaneously to eliminate reactivity with the murine antibodies. This unusual requirement directly illustrates the phenomenon of enhanced antigenic change proposed previously for the accumulation of simultaneous amino acid substitutions at antigenic sites of the influenza A virus HA during virus evolution (Shih et al., Proc Natl Acad Sci USA, 104 , 6283-6288, 2007). The changes found in the A/Extremadura/RR6530/2010 HA were not found in escape mutants selected in vitro with one of the mAbs, which contained instead nearby single amino acid changes in the HA head. Thus, either single or double point mutations may similarly alter epitopes of the new antigenic site identified in this work in the 2009 H1N1 pandemic virus HA. Moreover, this site is relevant for the human antibody response, as shown by competition of mAbs and human post-infection sera for virus binding. The results are discussed in the context of the HA antigenic structure and challenges posed for identification of sequence changes with possible antigenic impact during virus surveillance.This work was supported in part by grants GR09/0023 (A. N.), GR09/0039 (J. A. M.) and GR09/0040 (I. C.) from Instituto de Salud Carlos III under a special research programme on pandemic flu. Additionally, the Biología Viral Unit is supported currently by grant SAF2012-31217 from Plan Nacional I+D+i.S