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

Controles locales y regionales del metabolismo en ríos de cabecera: aportaciones del primer proyecto colaborativo de la AIL

Streams play a key role in the global biogeochemical cycles, processing material from adjacent terrestrial systems and transporting it downstream. However, the drivers of stream metabolism, especially those acting at broad spatial scales, are still not well understood. Moreover, stream metabolism can be affected by hydrological changes associated with seasonality, and thus, assessing the temporality of metabolic rates is a key question to understand stream function. This study aims to analyse the geographical and temporal patterns in stream metabolism and to identify the main drivers regulating the wholeecosystem metabolic rates at local and regional scales. Using a coordinated distributed experiment, we studied ten headwaters streams located across five European ecoregions during summer and fall 2014.We characterized the magnitude and variability of gross primary production (GPP) and ecosystem respiration (ER) with the open-channel method. Moreover, we examined several climatic, geographical, hydrological, morphological, and physicochemical variables that can potentially control stream metabolic rates. Daily rates of stream metabolism varied considerately across streams, with GPP and ER ranging from 0.06 to 4.33 g O2 m?2 d?1 and from 0.72 to 14.20 g O2 m?2 d?1, respectively. All streams were highly heterotrophic (P/R < 1), except the southernmost one. We found that the drier climates tended to have the highest GPP, while humid regions presented the highest ER. Between the sampling periods no statistical differences were found. Partial-least squares models (PLS) explained ?80% of the variance in GPP and ER rates across headwater streams and included both local and regional variables. Rates of GPP varied primarily in response to the local variables, such as streambed substrate and stream water temperature. In contrast, regional variables, such as the mean annual temperature or the land use of the catchment, had more relevance to explain ER. Overall, our results highlight that stream metabolism depends on both local and regional drivers and show the positive experience of a young network of researchers to assess scientific challenges across large-scale geographic areas.Los ecosistemas fluviales tienen un papel relevante en los ciclos biogeoquímicos globales, ya que procesan el material de la cuenca y lo transportan río abajo. Sin embargo, los factores que afectan al metabolismo, especialmente aquellos que actúan en una escala espacial más amplia, todavía no se conocen completamente. Además, el metabolismo fluvial puede variar a causa de cambios hidrológicos relacionados con la estacionalidad; lo que también hace importante incluir la variabilidad temporal para entender el funcionamiento de los ríos. Mediante el uso de un experimento distribuido y coordinado, estudiamos diez ríos de cabecera localizados a lo largo de cinco ecoregiones europeas durante verano y otoño del 2014. Se midió la magnitud y la variabilidad de la producción primaria bruta (PPB) y la respiración ecosistémica (RE) mediante el método de canal abierto. Así mismo, se examinaron los factores climáticos, hidrológicos y físico-químicos que potencialmente pueden afectar las tasas metabólicas fluviales. Las tasas diarias de metabolismo fluvial variaron considerablemente entre ríos, con valores de PPB de entre 0.06 a 4.33 g O2 m-2 día-1, y de RE de entre 0.72 a 14.20 g O2 m-2 día-1. Todos los ríos fueron altamente heterotróficos (P/R < 1), excepto el río más meridional. Se observó que los climas secos tendían a tener mayor PPB y las regiones húmedas tendían a tener una mayor RE. No se encontraron diferencias estadísticas entre los períodos de estudio. Los modelos de regresión de mínimos cuadrados parciales (PLS) explicaron --80% de la varianza de PPB y RE para los ríos estudiados. Las tasas de PPB variaron principalmente con factores locales como el sustrato del lecho del río y la temperatura del agua. En cambio, las tasas de RE estuvieron estrechamente relacionadas con factores regionales, como la temperatura media anual y los impactos en la cuenca. En conjunto, nuestros resultados resaltan la necesidad de incluir la escala local y regional en el estudio del metabolismo fluvial y muestran la experiencia positiva de una red coordinada de jóvenes investigadores para lograr retos científicos de amplia escala geográfica.We thank the support of the AIL board throughout the development of the project and all the affiliated institutions for the accessibility of laboratory premises, especially the Limnology Department of Uppsala University and the Department d’Ecologia of the Universitat de Barcelona. We greatly thank all the extended team of participants for their valuable contribution in DOMIPEX project. The authors were supported by the following founding: NC by Wenner-Gren foundation stipend (Sweden, 2014-2016) and a Juan de la Cierva grant (FJCI-2014-23064), EE by a pre-doctoral grant from the Basque Government (2014-2017), AGB by a Swedish Research Council grant (SMAREF 2014-2016), PRL by a Ramón Areces Foundation Postdoctoral Scholarship AM by the Univ. of the Basque Country, AMGF and SP by pre-doctoral research grants from the Spanish Ministry of Economy and Competitiveness (Ref: BES-2013-065770, Ref: BES-2012-059743, respectively), and RR by the IMDEA-Water Institute. DOMIPEX project was founded by the First Call of Collaborative Projects among Young Researchers of the Iberian Association of Limnology (AIL; 2013-2015)

Behind the scenes: mechanisms regulating climatic patterns of dissolved organic carbon uptake in headwater streams

Large variability in dissolved organic carbon (DOC) uptake rates has been reported for headwater streams, but the causes of this variability are still not well understood. Here we assessed acetate uptake rates across 11 European streams comprising different ecoregions by using whole-reach pulse acetate additions. We evaluated the main climatic and biogeochemical drivers of acetate uptake during two seasonal periods. Our results show a minor influence of sampling periods but a strong effect of climate and dissolved organic matter (DOM) composition on acetate uptake. In particular, mean annual precipitation explained half of the variability of the acetate uptake velocities (VfAcetate) across streams. Temperate streams presented the lowest VfAcetate, together with humic-like DOM and the highest stream respiration rates. In contrast, higher VfAcetate were found in semiarid streams, with protein-like DOM, indicating a dominance of reactive, labile compounds. This, together with lower stream respiration rates and molar ratios of DOC to nitrate, suggests a strong C limitation in semiarid streams, likely due to reduced inputs from the catchment. Overall, this study highlights the interplay of climate and DOM composition and its relevance to understand the biogeochemical mechanisms controlling DOC uptake in streams.Theauthors were supported by the following funding: N. C. by a Generalitat de Catalunya-Beatriu de Pinós grant (BP2016–00215), E. E. by a predoctoral grant from the Basque Government, A. G. B. by a Generalitat de Catalunya-Beatriu de Pinós (BP-00385-2016), A. M. G. F. by a predoctoral research grant (BES-2013-065770) from the Spanish Ministry of Economy and Competitiveness, P. R. L. by a Ramón Areces Foundation Postdoctoral Scholarship, and A. L. by a Kempe Foundation stipend. DOMIPEX project was funded by the First Call of Collaborative Projects among Young Researchers of the Iberian Association of Limnology (AIL; 2013–2015)

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