Prescripción inducida en atención primaria de la Comarca Bilbao

ObjetivosPrincipales: conocer la proporción de prescripción inducida (PI) en Comarca Bilbao y su procedencia, la proporción de gasto correspondiente a la PI, la proporción de PI en los principales grupos terapéuticos, la actitud del médico de atención primaria ante la prescripción solicitada y su influencia en el gasto, la proporción de desacuerdo con dicha prescripción y los motivos de desacuerdo, y la proporción con informe del especialista. Secundarios: conocer la proporción de PI en los demás grupos terapéuticos, en fármacos VINE, EFG y en los de nula o baja mejora terapéutica.Diseño.Estudio transversal, descriptivoEmplazamientoAtención primariaParticipantesFármacos financiables prescritos por y/o solicitados a los médicos de familia de EAP.Resultados principalesSe estudiaron 7.922 fármacos. Tipo de prescripción: PI, 48,3% (IC del 95%, 47,2–49,4); del médico de atención primaria (PRO), 50,6% (IC del 95%, 49,5–51,7); desconocida, 1,1% (IC del 95%, 0,9–1,3). Procedencia principal: especialista público (72,2%), especialista privado (16,6%). Un 62,5% del gasto correspondió a la PI. En el grupo terapéutico más prescrito, sistema nervioso central (24,2%), PI, 39,8%; PRO, 58,9%; en aparato cardiovascular (19,1%), PI, 56,2%, PRO, 43,1%. Se prescribió el fármaco solicitado en un 98,4% de los casos, se cambio en el 1,2% y se suprimió en un 0,4%. Proporción de desacuerdo, 11%; motivos de desacuerdo, no hay necesidad de tratar (23,9%), grupo terapéutico (34,4%), principio activo (13,2%), marca comercial (28,5%). Hubo informe de especialista en un 62,4% de los casos.ConclusionesSe detecta una proporción considerable de prescripción no atribuible a atención primaria y una proporción importante de fármacos que el médico de primaria prescribe sin estar de acuerdo. Sería necesario un sistema que permitiera separar el gasto por niveles, así como mejorar la comunicación entre éstos.ObjectivesMain objetives: to know the proportion of induced prescription (IP) in Area Bilbao and its source, the proportion of cost IP accounts for, the proportion of IP in the main therapeutic groups, the attitude of GP when requested for prescription and its influence on cost, the proportion of disagreement with requested prescription, the reasons for disagreement, and the proportion with letter from specialist. Secondary objectives: to know the proportion of IP in the remaining therapeutic groups, in drugs of low clinical value, in generic drugs and in new drugs with low or no therapeutic improvement.DesignA descriptive cross-sectional study.SettingPrimary health care.ParticipantsDrugs prescribable under National Health Service prescribed by and/or requested to GPs.Main results7.922 drugs were analysed. Type of prescription: IP, 48.3% (95% CI, 47.2–49.4); GP prescription (GPP), 50.6% (95% CI, 49.5–51.7); unknown source, 1,1% (95% CI, 0.9–1.3). Main source, public specialist (72.2%), private specialist (16.6%). IP accounted for 62.5% of cost. In the most prescribed therapeutic group, central nervous system (24.2%), IP, 39.8%; GPP, 58.9%; in cardiovascular system (19.1%), IP, 56.2%; GPP, 43.1%. 98.4% of requested prescription was actually prescribed, 1.2% was changed and 0.4%, suppressed. Proportion of disagreement, 11%; reasons for disagreement, no need for medical treatment (23.9%), therapeutic group (34.4%), active ingredient (13.2%), brand name (28.5%). There was a 62.4% with letter from specialist.ConclusionsPrimary care is not accountable for a substantial proportion of prescription. GP prescribes a considerable proportion of drugs without agreement. It would be necessary a system that allows to separate the cost by care levels and also improve their communication

Testing abstract behavioral specifications

We present a range of testing techniques for the Abstract Behavioral Specification (ABS) language and apply them to an industrial case study. ABS is a formal modeling language for highly variable, concurrent, component-based systems. The nature of these systems makes them susceptible to the introduction of subtle bugs that are hard to detect in the presence of steady adaptation. While static analysis techniques are available for an abstract language such as ABS, testing is still indispensable and complements analytic methods. We focus on fully automated testing techniques including black-box and glass-box test generation as well as runtime assertion checking, which are shown to be effective in an industrial setting

The Delphi technique in ecology and biological conservation: Applications and guidelines

1. Many areas of science, including conservation and environmental management, regularly require engaging stakeholders or experts to produce consensus or technical inputs. The Delphi technique is an iterative and anonymous participatory method used for gathering and evaluating such expert-based knowledge. 2. We outline the methodology of the Delphi technique and provide a taxonomy of its main variants. In addition, we refine the technique by providing suggestions to address common limitations (e.g. time consumption, attrition rate) in order tomake the method more suitable for application in ecology and conservation. 3. A comprehensive search for studies that have applied the Delphi technique in conservation and environmental management resulted in 36 papers. The Delphi technique has been applied to a range of issues, including developing decision support systems and predicting ecological impacts of climate change. 4. The papers reviewed suggest that the Delphi technique is an efficient, inclusive, systematic and structured approach that can be used to address complex issues. A major strength compared to other group-based techniques is the reduced influence of social pressures among respondents. 5. The Delphi technique is relatively little used and seems undervalued. Given its wide range of possible applications, it could be applied more widely in evaluating evidence and providing expert judgments.The authors would like to thank Pinaki Bhattacharya, Maria Voigt, Francisco Benitez-Capistros and the three anonymous reviewers for their significant contributions in improving the earlier manuscript. WJS is funded by Arcadia. NM and JH were funded by the Belgian National Science Foundation (FNRS), MIS ID 1765914 project. NM was also funded by the Fondation Weiner Anspach (FWA) postdoctoral fellowship.This is the author accepted manuscript. The final version is available from Wiley at http://dx.doi.org/10.1111/2041-210X.1238

Proposal of a water-quality index for high andean basins: application to the Chumbao river, Andahuaylas, Peru

Thewater fromthe high Andean rivers is peculiar due to its composition and the geomorphology of its sources, and naturally or anthropogenically contamination is not discarded along its course. This water is used for agriculture and human consumption, therefore knowing its quality is important. This research aimed to proposing and formulate a water-quality index for high Andean basins through the Delphimethod, and its application in the Chumbao River located in Andahuaylas-Peru. Forty-three water-quality parameters were evaluated through the Delphi method, and the water-quality index (WQIHA) was formulated with a weighted average of the weights of the selected parameters, it was compared with the WQI Dinius. For this purpose, ten sampling points were considered along the Chumbao River located between 4274 and 2572 m of altitude and theWQIHA was applied. In addition, field and laboratory analyses were carried out in 2018, 2019, and 2021, in dry and rainy seasons. Twenty parameters were grouped in the physicochemical sub-index (SIPC), heavy metals sub-index (SIHM), and organic matter sub-index (SIOM). Each group contributed with weights of 0.30, 0.30, and 0.40, respectively, for theWQIHA formulation. The SIPC and SIOM showed that the areas near the head of the basin presented excellent and good quality, while the urbanized areas were qualified as marginal to poor; SIHM reported good quality in all points and seasons. Regarding the WQIHA, the index shows good quality in the zones above 3184 m of altitude, contrasting with poor quality downstream, decreasing notably in both seasons, suggesting continuous degradation of the water body

The Large Aperture GRB Observatory

The Large Aperture GRB Observatory (LAGO) is aiming at the detection of the high energy (around 100 GeV) component of Gamma Ray Bursts, using the single particle technique in arrays of Water Cherenkov Detectors (WCD) in high mountain sites (Chacaltaya, Bolivia, 5300 m a.s.l., Pico Espejo, Venezuela, 4750 m a.s.l., Sierra Negra, Mexico, 4650 m a.s.l). WCD at high altitude offer a unique possibility of detecting low gamma fluxes in the 10 GeV - 1 TeV range. The status of the Observatory and data collected from 2007 to date will be presented.Comment: 4 pages, proceeding of 31st ICRC 200

Water Cherenkov Detectors response to a Gamma Ray Burst in the Large Aperture GRB Observatory

In order to characterise the behaviour of Water Cherenkov Detectors (WCD) under a sudden increase of 1 GeV - 1 TeV background photons from a Gamma Ray Burst (GRB), simulations were conducted and compared to data acquired by the WCD of the Large Aperture GRB Observatory (LAGO). The LAGO operates arrays of WCD at high altitude to detect GRBs using the single particle technique. The LAGO sensitivity to GRBs is derived from the reported simulations of the gamma initiated particle showers in the atmosphere and the WCD response to secondaries.Comment: 5 pages, proceeding of the 31st ICRC 200

Insights from Water Quality of High Andean Springs for Human Consumption in Perú

The headwaters of the high Andean basin in Peru accumulate water from the mist, rain, snow, and hail, and it is transported superficially and underground to low-lying areas, mostly used for drinkable purposes. The natural water in these areas might be altered due to legal and illegal mining extraction. The aim of the study was to evaluate the water quality for human consumption. Seventeen water samples were examined from Andahuaylas (A), San Jerónimo (S), Talavera (T), and Chiara (CH) districts located between 2813 and 4004 m altitude in the Andes. We used physic ochemical, microbiological, and metal parameters, and the results were compared to permissible levels established by the WHO and ECA-Peru to examine samples collected in the dry and rainy seasons in 2019. Application of principal component analysis (PCA) identified areas and conditioning parameters. Extractive mining activity influences the quality of springs due to the presence of metals, especially antimony (Sb), arsenic (As), cadmium (Cd), and lead (Pb), values of which are higher than values permissible for human consumption, being higher in the dry season (p < 0.05). In addition, the presence of cations and particulate matter affects physico-chemical parameters, for example turbidity. PCA showed that parameters for water characterization are season-independent, and water quality in the springs would be conditioned by the presence of metals, especially in Andahuaylas and Talavera zones, as well as the parameters that are associated with dissolved solids in the water (turbidity and fluorides). A frequent monitoring program of springs and groundwater is recommended, with the purpose to protect water from contamination and guarantee safe water availability in low-lying and urbanized areas

Diagnostic Accuracy of Adenosine Deaminase and Lymphocyte Proportion in Pleural Fluid for Tuberculous Pleurisy in Different Prevalence Scenarios

BACKGROUND: Tuberculous pleural effusion (TPE) is a paucibacillary manifestation of tuberculosis, so isolation of Mycobacterium tuberculosis is difficult, biomarkers being an alternative for diagnosis. Adenosine deaminase (ADA) is the most cost-effective pleural fluid marker and is routinely used in high prevalence settings, whereas its value is questioned in areas with low prevalence. The lymphocyte proportion (LP) is known to increase the specificity of ADA for this diagnosis. We analyse the diagnostic usefulness of ADA alone and the combination of ADA ≥ 40 U/l (ADA(40)) and LP ≥ 50% (LP(50)) in three different prevalence scenarios over 11 years in our area. MATERIALS AND METHODS: Biochemistry, cytology and microbiology studies from 472 consecutive pleural fluid samples were retrospectively analyzed. ADA and differential cell count were determined in all samples. We established three different prevalence periods, based on percentage of pleural effusion cases diagnosed as tuberculosis: 1998-2000 (31.3%), 2001-2004 (11.8%), and 2005-2008 (7.4%). ROC curves, dispersion diagrams and pre/post-test probability graphs were produced. TPE accounted for 73 episodes (mean prevalence: 15.5%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for ADA(40) were 89%, 92.7%, 69.2% and 97.9%, respectively. For ADA(40)+LP(50) the specificity and PPV increased (98.3% and 90%) with hardly any decrease in the sensitivity or NPV (86.3% and 97.5%). No relevant differences were observed between the three study periods. CONCLUSIONS/SIGNIFICANCE: ADA remains useful for the diagnosis of TPE even in low-to-intermediate prevalence scenarios when combined with the lymphocyte proportion