Implementing technology in healthcare : insights from physicians

Technology has significantly changed the way health organizations operate. However, the role it plays in healthcare systems remains unclear. This aim of this study was to evaluate the opinion of physicians regarding e-health and determine what factors influence their opinion and describe the advantages, inconveniences and threats they may perceive by its use. A cross-sectional questionnaire-based study. A questionnaire which had been previously designed and validated by the authors was used to interview physicians from the Barcelona Medical Association. 930 physicians were contacted by phone to participate in the study. Seven hundred sixty physicians responded to the questionnaire (response rate: 82%). The usefulness of telemedicine scored 7.4 (SD 1.8) on a scale from 1-10 (from the lowest to the highest) and the importance of the Internet in the workplace was 8.2 points (SD 1.8). Therapeutic compliance (7.0 -SD 1.8-) and patient health (7.0 -SD 1.7-) showed the best scores, and there were differences between professionals who had and had not previously participated in a telemedicine project (p < 0.05). The multivariate regression model explained the 41% of the variance for 7 factors: participation in telemedicine project (p < 0.001), quality of clinical practice (p < 0.001), patient health (p < 0.001), professional workload (p = 0.005), ease-of-use of electronic device (p = 0.007), presence of incentives for telemedicine (p = 0.011) and patient preference for in-person visits (p = 0.05). Physicians believe in the usefulness of e-health. Professionals with previous experience with it are more open to its implementation and consider that the benefits of technology outweigh its possible difficulties and shortcomings. Physicians demanded projects with appropriate funding and technology, as well as specific training to improve their technological abilities. The relationship of users with technology differs according to their personal or professional life. Although a 2.0 philosophy has been incorporated into many aspects of our lives, healthcare systems still have a long way to go in order to adapt to this new understanding of the relationship between patients and their health. The online version of this article (doi:10.1186/s12911-017-0489-2) contains supplementary material, which is available to authorized users

Prediction of Major Bleeding in Anticoagulated Patients for Venous Thromboembolism : Comparison of the RIETE and the VTE-BLEED Scores

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).The performance of validated bleeding risk scores in patients with venous thromboembolism (VTE) could be different depending on the time after index event or the site of bleeding. In this study we compared the "classic" Registro Informatizado de Enfermedad TromboEmbólica (RIETE) score and the more recently developed VTE-BLEED score for the prediction of major bleeding in patients under anticoagulant therapy in different time intervals after VTE diagnosis. Out of 82,239 patients with acute VTE, the proportion of high-risk patients according to the RIETE and VTE-BLEED scores was 7.1 and 62.3%, respectively. The performance of both scores across the different study periods (first 30 days after VTE diagnosis, days 31-90, days 91-180, and days 181-360) was similar, with areas under the receiving operating characteristics (ROC) curve (AUC) ranging between 0.69 and 0.72. However, the positive predictive values were low, ranging between 0.6 and 3.9 (better for early major bleeding than for later periods). A sensitivity analysis limited to patients with unprovoked VTE showed comparable results. Both scores showed a trend toward a better prediction of extracranial than intracranial major bleeding, the RIETE score resulting more useful for early extracranial bleeding and the VTE-BLEED for late intracranial hemorrhages. Our study reveals that the usefulness of available bleeding scores may vary depending on the characteristics of the patient population and the time frame evaluated. Dynamic scores could be more useful for this purpose.publishersversionPeer reviewe

Medicina y producción científica en MútuaTerrassa: la contribución de las mujeres

Objetivo: Analizar la evolución de la productividad científica del grupo MútuaTerrassa diferenciando las autorías por sexo y contrastando con los datos sobre los profesionales sanitarios contratados, en 2001, 2010, 2011 y 2015. Método: El estudio se ha realizado en MútuaTerrassa, entidad centenaria que gestiona entre otros recursos un hospital universitario de la Universidad de Barcelona, 10 centros de atención primaria y 20 centros sociosanitarios y residenciales. Se realizó un análisis bibliométrico de la producción científica a partir de las memorias científicas. El número de profesionales contratados por sexos y categorías fue proporcionado por recursos humanos. Se consideró autoría preferente firmar en primera o última posición o ser autor de la correspondencia, el resto de posiciones se consideraron correspondientes a autorías de colaboradores. Resultados: El 77% de los profesionales sanitarios fueron mujeres, sin variaciones en el período 2001-2015. Entre los médicos de atención primaria, el 64% fueron mujeres, proporción que se mantuvo también estable. Entre los médicos de hospital se incrementó el porcentaje de mujeres, desde el 46% en 2001 hasta el 58% en 2015. En los 4 años analizados se publicaron 394 artículos que contenían 1749 autorías: 33% de mujeres (n=585) y 67% de hombres (n=1164). Las mujeres firmaron el 18% de las autorías preferentes y el 19% de las autorías de colaboradores, en 2001, vs el 29% y el 37%, respectivamente, en 2015. Conclusiones: La brecha de género en las autorías de publicaciones científicas de los profesionales sanitarios asistenciales es considerable pero está disminuyend

Quantitative description of metal center organization and interactions in single-atom catalysts

Ultra-high-density single-atom catalysts (UHD-SACs) present unique opportunities for harnessing cooperative effects between neighboring metal centers. However, the lack of tools to establish correlations between the density, type, and arrangement of the isolated metal atoms with the support surface properties hinders efforts to engineer advanced material architectures. Here, we precisely describe the metal center organization in various mono- and multimetallic UHD-SACs based on nitrogen-doped carbon (NC) supports by coupling transmission electron microscopy with tailored machine-learning methods (released as a user-friendly web app) and density functional theory simulations. Our approach quantifies the non-negligible presence of multimers with increasing atom density, characterizes the size and shape of these low-nuclearity clusters, and identifies surface atom density criteria to ensure isolation. Further, it provides previously inaccessible experimental insights into coordination site arrangements in the NC host, uncovering a repulsive interaction that influences the disordered distribution of metal centers in UHD-SACs. This observation holds in multimetallic systems, where chemically-specific analysis quantifies the degree of intermixing. These fundamental insights into the materials chemistry of single-atom catalysts are crucial for designing catalytic systems with superior reactivity.This publication was created as part of NCCR Catalysis (grant number 180544), a National Centre of Competence in Research funded by the Swiss National Science Foundation. A. R.-F. acknowledges funding from the Generalitat de Catalunya and the European Union under Grant 2023 FI-3 00027. N.L. acknowledges support from the Ministerio de Ciencia e Innovación, ref. no. RTI2018-101394-B-100, and the Severo Ochoa Grant, MCIN/AEI/10.13039/501100011033-CEX2019-000925-S. The authors thank BSC-RES for generously providing computational resources.Peer ReviewedPostprint (published version

Dopaminergic control of ADAMTS2 expression through cAMP/CREB and ERK: molecular effects of antipsychotics

A better understanding of the molecular mechanisms that participate in the development and clinical manifestations of schizophrenia can lead to improve our ability to diagnose and treat this disease. Previous data strongly associated the levels of deregulated ADAMTS2 expression in peripheral blood mononuclear cells (PBMCs) from patients at first episode of psychosis (up) as well as in clinical responders to treatment with antipsychotic drugs (down). In this current work, we performed an independent validation of such data and studied the mechanisms implicated in the control of ADAMTS2 gene expression. Using a new cohort of drug-naïve schizophrenia patients with clinical follow-up, we confirmed that the expression of ADAMTS2 was highly upregulated in PBMCs at the onset (drug-naïve patients) and downregulated, in clinical responders, after treatment with antipsychotics. Mechanistically, ADAMTS2 expression was activated by dopaminergic signalling (D1-class receptors) and downstream by cAMP/CREB and mitogen-activated protein kinase (MAPK)/ERK signalling. Incubation with antipsychotic drugs and selective PKA and MEK inhibitors abrogated D1-mediated activation of ADAMTS2 in neuronal-like cells. Thus, D1 receptors signalling towards CREB activation might participate in the onset and clinical responses to therapy in schizophrenia patients, by controlling ADAMTS2 expression and activity. The unbiased investigation of molecular mechanisms triggered by antipsychotic drugs may provide a new landscape of novel targets potentially associated with clinical efficacy.Acknowledgements: We are highly indebted to the participants and their families for their cooperation in this study. We also thank IDIVAL biobank (Inés Santiuste and Jana Arozamena) for clinical samples and data as well as the PAFIP members (Marga Corredera) for the data collection. This work was supported by: SAF2016-76046-R and SAF2013-46292-R (MINECO and FEDER) to B.C.F., PI16/00156 (isciii and FEDER) to J.P.V., LUCHAMOS POR LA VIDA project to F.R.J. and J.P.V., SAF2017-83702-R (MINECO and FEDER), Red TERCEL RD12/0019/0024 (ISCIII) and GVA-PROMETEO 2018/041 (Generalitat Valenciana) to S.M. J.P.V. is supported by the RyC research programme (RYC-2013-14097) and F.R.J. by the predoctoral research programme (BES-2014-070615), from MINECO and FEDER

Exploring APOE genotype effects on Alzheimer's disease risk and amyloid β burden in individuals with subjective cognitive decline: The FundacioACE Healthy Brain Initiative (FACEHBI) study baseline results

Introduction: Subjective cognitive decline (SCD) has been proposed as a potential preclinical stage of Alzheimer's disease (AD). Nevertheless, the genetic and biomarker profiles of SCD individuals remain mostly unexplored. Methods: We evaluated apolipoprotein E (APOE) ε4's effect in the risk of presenting SCD, using the Fundacio ACE Healthy Brain Initiative (FACEHBI) SCD cohort and Spanish controls, and performed a meta-analysis addressing the same question. We assessed the relationship between APOE dosage and brain amyloid burden in the FACEHBI SCD and Alzheimer's Disease Neuroimaging Initiative cohorts. Results: Analysis of the FACEHBI cohort and the meta-analysis demonstrated SCD individuals presented higher allelic frequencies of APOE ε4 with respect to controls. APOE dosage explained 9% (FACEHBI cohort) and 11% (FACEHBI and Alzheimer's Disease Neuroimaging Initiative cohorts) of the variance of cerebral amyloid levels. Discussion: The FACEHBI sample presents APOE ε4 enrichment, suggesting that a pool of AD patients is nested in our sample. Cerebral amyloid levels are partially explained by the APOE allele dosage, suggesting that other genetic or epigenetic factors are involved in this AD endophenotype

Dopaminergic control of ADAMTS2 expression through cAMP/CREB and ERK: molecular effects of antipsychotics

© The Author(s) 2019.A better understanding of the molecular mechanisms that participate in the development and clinical manifestations of schizophrenia can lead to improve our ability to diagnose and treat this disease. Previous data strongly associated the levels of deregulated ADAMTS2 expression in peripheral blood mononuclear cells (PBMCs) from patients at first episode of psychosis (up) as well as in clinical responders to treatment with antipsychotic drugs (down). In this current work, we performed an independent validation of such data and studied the mechanisms implicated in the control of ADAMTS2 gene expression. Using a new cohort of drug-naïve schizophrenia patients with clinical follow-up, we confirmed that the expression of ADAMTS2 was highly upregulated in PBMCs at the onset (drug-naïve patients) and downregulated, in clinical responders, after treatment with antipsychotics. Mechanistically, ADAMTS2 expression was activated by dopaminergic signalling (D1-class receptors) and downstream by cAMP/CREB and mitogen-activated protein kinase (MAPK)/ERK signalling. Incubation with antipsychotic drugs and selective PKA and MEK inhibitors abrogated D1-mediated activation of ADAMTS2 in neuronal-like cells. Thus, D1 receptors signalling towards CREB activation might participate in the onset and clinical responses to therapy in schizophrenia patients, by controlling ADAMTS2 expression and activity. The unbiased investigation of molecular mechanisms triggered by antipsychotic drugs may provide a new landscape of novel targets potentially associated with clinical efficacy.This work was supported by: SAF2016-76046-R and SAF2013-46292-R (MINECO and FEDER) to B.C.F., PI16/00156 (isciii and FEDER) to J.P.V., LUCHAMOS POR LA VIDA project to F.R.J. and J.P.V., SAF2017-83702-R (MINECO and FEDER), Red TERCEL RD12/0019/0024 (ISCIII) and GVA-PROMETEO 2018/041 (Generalitat Valenciana) to S.M. J.P.V. is supported by the RyC research programme (RYC-2013-14097) and F.R.J. by the predoctoral research programme (BES-2014-070615), from MINECO and FEDER

Resource recovery from sulphate-rich sewage through an innovative anaerobic-based water resource recovery facility (WRRF)

[EN] This research work proposes an innovative water resource recovery facility (WRRF) for the recovery of energy, nutrients and reclaimed water from sewage, which represents a promising approach towards enhanced circular economy scenarios. To this aim, anaerobic technology, microalgae cultivation, and membrane technology were combined in a dedicated platform. The proposed platform produces a high-quality solid- and coliform-free effluent that can be directly discharged to receiving water bodies identified as sensitive areas. Specifically, the content of organic matter, nitrogen and phosphorus in the effluent was 45 mg COD.L-1 , 14.9 mg N.L-1 and 0.5 mg P.L-1 , respectively. Harvested solar energy and carbon dioxide biofixation in the form of microalgae biomass allowed remarkable methane yields (399 STP L CH 4.kg(-1) CODinf ) to be achieved, equivalent to theoretical electricity productions of around 0.52 kWh per m 3 of wastewater entering the WRRF. Furthermore, 26.6% of total nitrogen influent load was recovered as ammonium sulphate, while nitrogen and phosphorus were recovered in the biosolids produced (650 +/- 77 mg N.L-1 and 121.0 +/- 7.2 mg P.L-1).This research was supported by the Spanish Ministry of Economy and Competitiveness (MINECO, Projects CTM2014-54980-C2-1-R and CTM2014-54980-C2-2-R) jointly with the European Regional Development Fund (ERDF), which are gratefully acknowledged. This research was also supported by the Spanish Ministry of Education, Culture and Sport via two pre-doctoral FPU fellowships (FPU14/05082 and FPU15/02595) and by the Spanish Ministry of Economy and Competitiveness via two pre-doctoral FPI fellowships (BES-2015-071884, BES-2015-073403) and one Juan de la Cierva contract (FJCI-2014-21616). The authors would also like to acknowledge the support received from Generalitat Valenciana via two VALithornd post-doctoral grants (APOSTD/2014/049 and APOSTD/2016/104) and via the fellowships APOTI/2016/059 and CPI-16-155, as well as the financial aid received from the European Climate KIC association for the 'MAB 2.0' Project (APIN0057_ 2015-3.6-230_ P066-05) and Universitat Politecnica de Valencia via a pre-doctoral FPI fellowship to the seventh author.Seco Torrecillas, A.; Aparicio Antón, SE.; Gonzalez-Camejo, J.; Jiménez Benítez, AL.; Mateo-Llosa, O.; Mora-Sánchez, JF.; Noriega-Hevia, G.... (2018). Resource recovery from sulphate-rich sewage through an innovative anaerobic-based water resource recovery facility (WRRF). Water Science & Technology. 78(9):1925-1936. https://doi.org/10.2166/wst.2018.492S19251936789Bair, R. A., Ozcan, O. O., Calabria, J. L., Dick, G. H., & Yeh, D. H. (2015). Feasibility of anaerobic membrane bioreactors (AnMBR) for onsite sanitation and resource recovery (nutrients, energy and water) in urban slums. Water Science and Technology, 72(9), 1543-1551. doi:10.2166/wst.2015.349Barat, R., Serralta, J., Ruano, M. V., Jiménez, E., Ribes, J., Seco, A., & Ferrer, J. (2013). Biological Nutrient Removal Model No. 2 (BNRM2): a general model for wastewater treatment plants. Water Science and Technology, 67(7), 1481-1489. doi:10.2166/wst.2013.004Batstone, D. J., Hülsen, T., Mehta, C. M., & Keller, J. (2015). Platforms for energy and nutrient recovery from domestic wastewater: A review. Chemosphere, 140, 2-11. doi:10.1016/j.chemosphere.2014.10.021Bilad, M. R., Arafat, H. A., & Vankelecom, I. F. J. (2014). Membrane technology in microalgae cultivation and harvesting: A review. Biotechnology Advances, 32(7), 1283-1300. doi:10.1016/j.biotechadv.2014.07.008Carrington E.-G. 2001 Evaluation of Sludge Treatments for Pathogen Reduction. http://europa.eu.int/comm/environment/pubs/home.htm.Cookney, J., Mcleod, A., Mathioudakis, V., Ncube, P., Soares, A., Jefferson, B., & McAdam, E. J. (2016). Dissolved methane recovery from anaerobic effluents using hollow fibre membrane contactors. Journal of Membrane Science, 502, 141-150. doi:10.1016/j.memsci.2015.12.037De Morais, M. G., & Costa, J. A. V. (2007). Biofixation of carbon dioxide by Spirulina sp. and Scenedesmus obliquus cultivated in a three-stage serial tubular photobioreactor. Journal of Biotechnology, 129(3), 439-445. doi:10.1016/j.jbiotec.2007.01.009Giménez, J. B., Robles, A., Carretero, L., Durán, F., Ruano, M. V., Gatti, M. N., … Seco, A. (2011). Experimental study of the anaerobic urban wastewater treatment in a submerged hollow-fibre membrane bioreactor at pilot scale. Bioresource Technology, 102(19), 8799-8806. doi:10.1016/j.biortech.2011.07.014Giménez, J. B., Martí, N., Ferrer, J., & Seco, A. (2012). Methane recovery efficiency in a submerged anaerobic membrane bioreactor (SAnMBR) treating sulphate-rich urban wastewater: Evaluation of methane losses with the effluent. Bioresource Technology, 118, 67-72. doi:10.1016/j.biortech.2012.05.019Giménez, J. B., Bouzas, A., Carrere, H., Steyer, J.-P., Ferrer, J., & Seco, A. (2018). Assessment of cross-flow filtration as microalgae harvesting technique prior to anaerobic digestion: Evaluation of biomass integrity and energy demand. Bioresource Technology, 269, 188-194. doi:10.1016/j.biortech.2018.08.052González-Camejo, J., Serna-García, R., Viruela, A., Pachés, M., Durán, F., Robles, A., … Seco, A. (2017). Short and long-term experiments on the effect of sulphide on microalgae cultivation in tertiary sewage treatment. Bioresource Technology, 244, 15-22. doi:10.1016/j.biortech.2017.07.126Martí, N., Barat, R., Seco, A., Pastor, L., & Bouzas, A. (2017). Sludge management modeling to enhance P-recovery as struvite in wastewater treatment plants. Journal of Environmental Management, 196, 340-346. doi:10.1016/j.jenvman.2016.12.074Moosbrugger R. , WentzelM. & EkamaG.1992Simple Titration Procedures to Determine H2CO3 Alkalinity and Short-chain Fatty Acids in Aqueous Solutions Containing Known Concentrations of Ammonium, Phosphate and Sulphide Weak Acid/Bases. Water. Res. Commission, Report, No. TT 57/92.Morales, N., Boehler, M., Buettner, S., Liebi, C., & Siegrist, H. (2013). Recovery of N and P from Urine by Struvite Precipitation Followed by Combined Stripping with Digester Sludge Liquid at Full Scale. Water, 5(3), 1262-1278. doi:10.3390/w5031262Pretel, R., Durán, F., Robles, A., Ruano, M. V., Ribes, J., Serralta, J., & Ferrer, J. (2015). Designing an AnMBR-based WWTP for energy recovery from urban wastewater: The role of primary settling and anaerobic digestion. Separation and Purification Technology, 156, 132-139. doi:10.1016/j.seppur.2015.09.047Pretel, R., Robles, A., Ruano, M. V., Seco, A., & Ferrer, J. (2016). Economic and environmental sustainability of submerged anaerobic MBR-based (AnMBR-based) technology as compared to aerobic-based technologies for moderate-/high-loaded urban wastewater treatment. Journal of Environmental Management, 166, 45-54. doi:10.1016/j.jenvman.2015.10.004Sharma, B., Sarkar, A., Singh, P., & Singh, R. P. (2017). Agricultural utilization of biosolids: A review on potential effects on soil and plant grown. Waste Management, 64, 117-132. doi:10.1016/j.wasman.2017.03.002Sialve, B., Bernet, N., & Bernard, O. (2009). Anaerobic digestion of microalgae as a necessary step to make microalgal biodiesel sustainable. 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Maximizing resource recovery from urban wastewater through an innovative facility layout

[EN] This research work proposes an innovative layout for urban wastewater treatment based on anaerobic technology, microalgal cultivation and membrane technology. The proposed Water Resource Recovery Facility (WRRF) system can treat urban wastewater efficiently, complying with legal discharge limits and allowing for resource recovery, i.e. energy, nutrients and reclaimed water. In addition, the proposed layout produces less solid wastes than a conventional wastewater treatment plant (WWTP) and it is possible to recover energy as biogas, not only from the original wastewater sources but also from the biomass generated in the WRRF system