Cambio climático, aridez y sequías en Canarias

Ponencia presentada en: XII Congreso de la Asociación Española de Climatología celebrado en Santiago de Compostela entre el 19 y el 21 de octubre de 2022.[ES]El cambio climático supone un factor de gran incertidumbre en cuanto a la posible evolución de los niveles de aridez y de sequía. Por una parte, se prevé un aumento de la evapotranspiración y por otra, el comportamiento de la precipitación presenta importantes diferencias regionales. En este trabajo se han analizado las proyecciones de la aridez y de las futuras sequías en las Islas Canarias, en términos de frecuencia, duración y severidad, utilizando el modelo Weather Research and Forecasting (WRF) para el periodo 2070-2099, y para los escenarios Representative Concentration Pathways (RCPs) 4.5 y 8.5. Las condiciones iniciales y de contorno se definieron mediante tres modelos incluidos en el Coupled Model Intercomparison Project 5 (CMIP5): GFDL-ESM2M, MIROC-ESM e IPSL-CM5. Los cambios futuros de la aridez se obtuvieron empleando el cambio en el índice de aridez (ACI), basado en la relación entre el cambio fraccional de la evaporación potencial y de la precipitación respecto al periodo de referencia 1981-2009. En el caso de la sequía, se utilizó el índice estandarizado de precipitación (SPI) para las escalas de tiempo de 3 y 12 meses. Asimismo, se consideraron eventos de sequía extrema (eventos extremos húmedos) cuando el SPI toma valores por debajo (por encima) de -2 (2). A partir de los resultados obtenidos, podemos destacar que la aridez y los eventos de sequía extrema aumentarán a finales de siglo respecto al periodo de referencia, para ambos escenarios.[EN]Climate change is a great relevance factor in the evolution of aridity and droughts due to increase of evapotranspiration and the behavior of precipitation. In this work, we analyses climate change projections in terms of frequency, duration, and severity of future aridity and drought in the Canary Island with the Weather Research and Forecasting (WRF) model driven by some Coupled Models Intercomparison Project phase 5 (CMIP5) simulations, for the period 2070-2099 and for two Representative Concentration Pathways (RCP) scenarios (RCP4.5 and RCP8.5). Initial and boundary conditions were defined using three models of the Coupled Model Intercomparison Project 5 (CMIP5): GFDL-ESM2M, MIROC-ESM and IPSL-CM5. Aridity change index was obtained to assessment future changes of aridity, which is based on the fractional change of potential evapotranspiration and precipitation with respect to the reference period (1981-2009). To evaluate droughts, the Standardized Precipitation Index (SPI) was applied at the 3 and 12-month time scales. In addition, extreme drought (wet) events are considered when SPI is lower (higher) than -2 (2). The results show an increase of extreme aridity and drought events by the end of this century with respect to the reference period for both emission scenarios.Este estudio se ha realizado en el marco del proyecto VidDATA (RTC2019-006948-7), cofinanciado por el Programa Estatal de I+D+i Orientada a los Retos de la Sociedad del Ministerio de Ciencia e Innovación, España. Agradecemos el apoyo del Proyecto PLANCLIMAC (MAC / 3.5b / 244), el cual está financiado por el Programa INTERREG MAC 2014-2020 de la Unión Europea, cofinanciado por el Fondo Europeo de Desarrollo Regional (FEDER-FEDER)

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Mutations in TP53 and JAK2 are independent prognostic biomarkers in B-cell precursor acute lymphoblastic leukaemia

[Background]: In B-cell precursor acute lymphoblastic leukaemia (B-ALL), the identification of additional genetic alterations associated with poor prognosis is still of importance. We determined the frequency and prognostic impact of somatic mutations in children and adult cases with B-ALL treated with Spanish PETHEMA and SEHOP protocols. [Methods]: Mutational status of hotspot regions of TP53, JAK2, PAX5, LEF1, CRLF2 and IL7R genes was determined by next-generation deep sequencing in 340 B-ALL patients (211 children and 129 adults). The associations between mutation status and clinicopathological features at the time of diagnosis, treatment outcome and survival were assessed. Univariate and multivariate survival analyses were performed to identify independent prognostic factors associated with overall survival (OS), event-free survival (EFS) and relapse rate (RR). [Results]: A mutation rate of 12.4% was identified. The frequency of adult mutations was higher (20.2% vs 7.6%, P=0.001). TP53 was the most frequently mutated gene (4.1%), followed by JAK2 (3.8%), CRLF2 (2.9%), PAX5 (2.4%), LEF1 (0.6%) and IL7R (0.3%). All mutations were observed in B-ALL without ETV6-RUNX1 (P=0.047) or BCR-ABL1 fusions (P<0.0001). In children, TP53mut was associated with lower OS (5-year OS: 50% vs 86%, P=0.002) and EFS rates (5-year EFS: 50% vs 78.3%, P=0.009) and higher RR (5-year RR: 33.3% vs 18.6% P=0.037), and was independently associated with higher RR (hazard ratio (HR)=4.5; P=0.04). In adults, TP53mut was associated with a lower OS (5-year OS: 0% vs 43.3%, P=0.019) and a higher RR (5-year RR: 100% vs 61.4%, P=0.029), whereas JAK2mut was associated with a lower EFS (5-year EFS: 0% vs 30.6%, P=0.035) and a higher RR (5-year RR: 100% vs 60.4%, P=0.002). TP53mut was an independent risk factor for shorter OS (HR=2.3; P=0.035) and, together with JAK2mut, also were independent markers of poor prognosis for RR (TP53mut: HR=5.9; P=0.027 and JAK2mut: HR=5.6; P=0.036). [Conclusions]: TP53mut and JAK2mut are potential biomarkers associated with poor prognosis in B-ALL patients.This work was supported in part by a grant from the European Union’s Seventh Framework Programme (FP7/2007–2013) under Grant Agreement 306242-NGS-PTL, the Consejeria de Educacion, Junta de Castilla y León (HUS272U13, SA085U16 to JMHR and JCYL-EDU/346/2013 PhD scholarship to MHS), Fundación Castellano Leonesa de Hematología y Hemoterapia (FUCALHH 2013) to JMHR, Proyectos de Investigacion del SACYL, Spain (BIO/SA31/13 and BIO/SA10/14) to RB; The Instituto de Salud Carlos III from Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund (ISCIII-FEDER) ‘‘Una manera de hacer Europa’’ Spanish Cancer Network (RD12/0036/0069 and RD12/0036/0061 to JM) and FIS grants PI15/01471 to JMHR and PI15/00032 to EFR. Universidad Pedagogica y Tecnologica de Colombia—Vicerrectoría de Investigacion y Extension (Grupo de Investigacion en Ciencias Biomedicas UPTC—GICBUPTC, Escuela de Ciencias Biologicas) to MFC.Peer Reviewe