Users' Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study

[EN] Background: Despite a large number of clinical trials aiming at evaluating the digital self-management of chronic diseases, there is little discussion about users¿ experiences with digital approaches. However, a good user experience is a critical factor for technology adoption. Understanding users¿ experiences can inform the design of approaches toward increased motivation for digital self-management. Objective: This study aimed to evaluate the self-management of cystic fibrosis (CF) with a focus on gastrointestinal concerns and the care of young patients. Following a user-centered design approach, we developed a self-management app for patients and parents and a web tool for health care professionals (HCPs). To evaluate the proposed solutions, a 6-month clinical trial was conducted in 6 European CF competence centers. This paper analyzes the user acceptance of the technology and the benefits and disadvantages perceived by the trial participants. Methods: A mixed methods approach was applied. Data were collected through 41 semistructured qualitative interviews of patients, parents, and HCPs involved in the clinical trial. In addition, data were collected through questionnaires embedded in the self-management app. Results: Support for enzyme dose calculation and nutrition management was found to be particularly useful. Patients and parents rapidly strengthened their knowledge about the treatment and increased their self-efficacy. Reported benefits include reduced occurrence of symptoms and enhanced quality of life. Patients and parents had different skills, requiring follow-up by HCPs in an introductory phase. HCPs valued obtaining precise information about the patients, allowing for more personalized advice. However, the tight follow-up of several patients led to an increased workload. Over time, as patient self-efficacy increased, patient motivation for using the app decreased and the quality of the reported data was reduced. Conclusions: Self-management enfolds a collaboration between patients and HCPs. To be successful, a self-management approach should be accepted by both parties. Through understanding behaviors and experiences, this study defines recommendations for a complex case¿the demanding treatment of CF. We identify target patient groups and situations for which the app is most beneficial and suggest focusing on these rather than motivating for regular app usage over a long time. We also advise the personalized supervision of patients during the introduction of the approach. Finally, we propose to develop guidance for HCPs to facilitate changes in practice. As personalization and technology literacy are factors found to influence the acceptance of digital self-management of other chronic diseases, it is relevant to consider the proposed recommendations beyond the case of CF.The authors of this paper, on behalf of the MyCyFAPP consortium, acknowledge the European Union and the Horizon 2020 Research and Innovation Framework Programme for funding the project (ref. 643806). The authors would like to thank all project partners for their collaboration during participant recruitment and project management. Without the dedication of participants in terms of time, effort, and valuable input, this publication would not have been possible. The authors would like to thank all the participants who contributed to this work.Floch, J.; Vilarinho, T.; Zettl, A.; Ibáñez Sánchez, G.; Calvo-Lerma, J.; Stav, E.; Halland Haro, P.... (2020). Users' Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study. JMIR mHealth and uHealth. 8(7):1-19. https://doi.org/10.2196/15896S11987Webb, T. L., Joseph, J., Yardley, L., & Michie, S. (2010). Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy. Journal of Medical Internet Research, 12(1), e4. doi:10.2196/jmir.1376Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., … Haines, A. (2013). The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review. PLoS Medicine, 10(1), e1001362. doi:10.1371/journal.pmed.1001362Marcolino, M. S., Oliveira, J. A. Q., D’Agostino, M., Ribeiro, A. L., Alkmim, M. B. M., & Novillo-Ortiz, D. (2018). The Impact of mHealth Interventions: Systematic Review of Systematic Reviews. JMIR mHealth and uHealth, 6(1), e23. doi:10.2196/mhealth.8873Venkatesh, Morris, Davis, & Davis. (2003). User Acceptance of Information Technology: Toward a Unified View. MIS Quarterly, 27(3), 425. doi:10.2307/30036540Cystic Fibrosis Europe2020-05-27https://www.cf-europe.eu/Conway, S., Balfour-Lynn, I. M., De Rijcke, K., Drevinek, P., Foweraker, J., Havermans, T., … Peckham, D. (2014). European Cystic Fibrosis Society Standards of Care: Framework for the Cystic Fibrosis Centre. Journal of Cystic Fibrosis, 13, S3-S22. doi:10.1016/j.jcf.2014.03.009Floch, J., Zettl, A., Fricke, L., Weisser, T., Grut, L., Vilarinho, T., … Schauber, C. (2018). User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development Approach. JMIR mHealth and uHealth, 6(5), e113. doi:10.2196/mhealth.8236Calvo-Lerma, J., Martinez-Jimenez, C. P., Lázaro-Ramos, J.-P., Andrés, A., Crespo-Escobar, P., Stav, E., … Ribes-Koninckx, C. (2017). Innovative approach for self-management and social welfare of children with cystic fibrosis in Europe: development, validation and implementation of an mHealth tool (MyCyFAPP). BMJ Open, 7(3), e014931. doi:10.1136/bmjopen-2016-014931Borowitz, D., Gelfond, D., Maguiness, K., Heubi, J. E., & Ramsey, B. (2013). Maximal daily dose of pancreatic enzyme replacement therapy in infants with cystic fibrosis: A reconsideration. Journal of Cystic Fibrosis, 12(6), 784-785. doi:10.1016/j.jcf.2013.05.011Calvo-Lerma, J., Fornés-Ferrer, V., Peinado, I., Heredia, A., Ribes-Koninckx, C., & Andrés, A. (2019). A first approach for an evidence-based in vitro digestion method to adjust pancreatic enzyme replacement therapy in cystic fibrosis. PLOS ONE, 14(2), e0212459. doi:10.1371/journal.pone.0212459Calvo-Lerma, J., Hulst, J., Boon, M., Martins, T., Ruperto, M., Colombo, C., … Ribes-Koninckx, C. (2019). The Relative Contribution of Food Groups to Macronutrient Intake in Children with Cystic Fibrosis: A European Multicenter Assessment. Journal of the Academy of Nutrition and Dietetics, 119(8), 1305-1319. doi:10.1016/j.jand.2019.01.003Turck, D., Braegger, C. P., Colombo, C., Declercq, D., Morton, A., Pancheva, R., … Wilschanski, M. (2016). ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clinical Nutrition, 35(3), 557-577. doi:10.1016/j.clnu.2016.03.004Vo, V., Auroy, L., & Sarradon-Eck, A. (2019). Patients’ Perceptions of mHealth Apps: Meta-Ethnographic Review of Qualitative Studies. JMIR mHealth and uHealth, 7(7), e13817. doi:10.2196/13817Anderson, K., Burford, O., & Emmerton, L. (2016). Mobile Health Apps to Facilitate Self-Care: A Qualitative Study of User Experiences. PLOS ONE, 11(5), e0156164. doi:10.1371/journal.pone.0156164Boon, M., Calvo-Lerma, J., Claes, I., Havermans, T., Asseiceira, I., Bulfamante, A., … Ribes-Koninckx, C. (2020). Use of a mobile application for self-management of pancreatic enzyme replacement therapy is associated with improved gastro-intestinal related quality of life in children with Cystic Fibrosis. Journal of Cystic Fibrosis, 19(4), 562-568. doi:10.1016/j.jcf.2020.04.001Hevner, March, Park, & Ram. (2004). Design Science in Information Systems Research. MIS Quarterly, 28(1), 75. doi:10.2307/25148625-ISO 9241-210:2010 Ergonomics of Human-System Interaction — Part 210: Human-Centred Design for Interactive SystemsInternational Organization for Standardization20102020-06-05https://www.iso.org/standard/52075.htmlVilarinho, T., Floch, J., & Stav, E. (2017). Co-designing a mHealth Application for Self-management of Cystic Fibrosis. Lecture Notes in Computer Science, 3-22. doi:10.1007/978-3-319-67687-6_1Kristensen, G. K., & Ravn, M. N. (2015). The voices heard and the voices silenced: recruitment processes in qualitative interview studies. Qualitative Research, 15(6), 722-737. doi:10.1177/1468794114567496Etikan, I. (2016). Comparison of Convenience Sampling and Purposive Sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1. doi:10.11648/j.ajtas.20160501.11Bryman, A. (2006). Integrating quantitative and qualitative research: how is it done? Qualitative Research, 6(1), 97-113. doi:10.1177/1468794106058877Klein, H. K., & Myers, M. D. (1999). A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems. MIS Quarterly, 23(1), 67. doi:10.2307/249410Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi:10.1191/1478088706qp063oaLee, Y., Kozar, K. A., & Larsen, K. R. T. (2003). The Technology Acceptance Model: Past, Present, and Future. Communications of the Association for Information Systems, 12. doi:10.17705/1cais.01250Calvo-Lerma, J., Hulst, J. M., Asseiceira, I., Claes, I., Garriga, M., Colombo, C., … Ribes-Koninckx, C. (2017). Nutritional status, nutrient intake and use of enzyme supplements in paediatric patients with Cystic Fibrosis; a European multicentre study with reference to current guidelines. Journal of Cystic Fibrosis, 16(4), 510-518. doi:10.1016/j.jcf.2017.03.005Johnson, K. B., Patterson, B. L., Ho, Y.-X., Chen, Q., Nian, H., Davison, C. L., … Mulvaney, S. A. (2015). The feasibility of text reminders to improve medication adherence in adolescents with asthma. Journal of the American Medical Informatics Association, 23(3), 449-455. doi:10.1093/jamia/ocv158Granger, D., Vandelanotte, C., Duncan, M. J., Alley, S., Schoeppe, S., Short, C., & Rebar, A. (2016). Is preference for mHealth intervention delivery platform associated with delivery platform familiarity? BMC Public Health, 16(1). doi:10.1186/s12889-016-3316-2Cook, K. A., Modena, B. D., & Simon, R. A. (2016). Improvement in Asthma Control Using a Minimally Burdensome and Proactive Smartphone Application. The Journal of Allergy and Clinical Immunology: In Practice, 4(4), 730-737.e1. doi:10.1016/j.jaip.2016.03.005Cafazzo, J. A., Casselman, M., Hamming, N., Katzman, D. K., & Palmert, M. R. (2012). Design of an mHealth App for the Self-management of Adolescent Type 1 Diabetes: A Pilot Study. Journal of Medical Internet Research, 14(3), e70. doi:10.2196/jmir.2058Riis, A., Hjelmager, D. M., Vinther, L. D., Rathleff, M. S., Hartvigsen, J., & Jensen, M. B. (2018). Preferences for Web-Based Information Material for Low Back Pain: Qualitative Interview Study on People Consulting a General Practitioner. JMIR Rehabilitation and Assistive Technologies, 5(1), e7. doi:10.2196/rehab.8841Goetz, M., Müller, M., Matthies, L. M., Hansen, J., Doster, A., Szabo, A., … Wallwiener, S. (2017). Perceptions of Patient Engagement Applications During Pregnancy: A Qualitative Assessment of the Patient’s Perspective. JMIR mHealth and uHealth, 5(5), e73. doi:10.2196/mhealth.7040Giunti, G., Kool, J., Rivera Romero, O., & Dorronzoro Zubiete, E. (2018). Exploring the Specific Needs of Persons with Multiple Sclerosis for mHealth Solutions for Physical Activity: Mixed-Methods Study. JMIR mHealth and uHealth, 6(2), e37. doi:10.2196/mhealth.8996Aujoulat, I., d’ Hoore, W., & Deccache, A. (2007). Patient empowerment in theory and practice: Polysemy or cacophony? Patient Education and Counseling, 66(1), 13-20. doi:10.1016/j.pec.2006.09.008Waite-Jones, J. M., Majeed-Ariss, R., Smith, J., Stones, S. R., Van Rooyen, V., & Swallow, V. (2018). Young People’s, Parents’, and Professionals’ Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study. JMIR mHealth and uHealth, 6(1), e25. doi:10.2196/mhealth.9179Lubberding, S., van Uden-Kraan, C. F., Te Velde, E. A., Cuijpers, P., Leemans, C. R., & Verdonck-de Leeuw, I. M. (2015). Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors. Journal of Clinical Nursing, 24(9-10), 1367-1379. doi:10.1111/jocn.12753Simons, L., Valentine, A. Z., Falconer, C. J., Groom, M., Daley, D., Craven, M. P., … Hollis, C. (2016). Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs. JMIR mHealth and uHealth, 4(1), e31. doi:10.2196/mhealth.5009Velu, A. V., van Beukering, M. D., Schaafsma, F. G., Frings-Dresen, M. H., Mol, B. W., van der Post, J. A., & Kok, M. (2017). Barriers and Facilitators for the Use of a Medical Mobile App to Prevent Work-Related Risks in Pregnancy: A Qualitative Analysis. JMIR Research Protocols, 6(8), e163. doi:10.2196/resprot.7224Switsers, L., Dauwe, A., Vanhoudt, A., Van Dyck, H., Lombaerts, K., & Oldenburg, J. (2018). Users’ Perspectives on mHealth Self-Management of Bipolar Disorder: Qualitative Focus Group Study. JMIR mHealth and uHealth, 6(5), e108. doi:10.2196/mhealth.9529Al Dahdah, M. (2017). Health at her fingertips: development, gender and empowering mobile technologies. Gender, Technology and Development, 21(1-2), 135-151. doi:10.1080/09718524.2017.1385701Consolvo, S. (2012). Designing for Healthy Lifestyles: Design Considerations for Mobile Technologies to Encourage Consumer Health and Wellness. Foundations and Trends® in Human–Computer Interaction, 6(3–4), 167-315. doi:10.1561/110000004

Toward Value-Based Healthcare through Interactive Process Mining in Emergency Rooms: The Stroke Case

[EN] The application of Value-based Healthcare requires not only the identification of key processes in the clinical domain but also an adequate analysis of the value chain delivered to the patient. Data Science and Big Data approaches are technologies that enable the creation of accurate systems that model reality. However, classical Data Mining techniques are presented by professionals as black boxes. This evokes a lack of trust in those techniques in the medical domain. Process Mining technologies are human-understandable Data Science tools that can fill this gap to support the application of Value-Based Healthcare in real domains. The aim of this paper is to perform an analysis of the ways in which Process Mining techniques can support health professionals in the application of Value-Based Technologies. For this purpose, we explored these techniques by analyzing emergency processes and applying the critical timing of Stroke treatment and a Question-Driven methodology. To demonstrate the possibilities of Process Mining in the characterization of the emergency process, we used a real log with 9046 emergency episodes from 2145 stroke patients that occurred from January 2010 to June 2017. Our results demonstrate how Process Mining technology can highlight the differences between the flow of stroke patients compared with that of other patients in an emergency. Further, we show that support for health professionals can be provided by improving their understanding of these techniques and enhancing the quality of care.This research was funded by Hospital General de Valencia thanks to the LOPEZ TRIGO 2017 AWARD and by the CONICYT grant REDI 170136 Project. The APC was funded by the APE/2019/007 (D.O.G.V. 8355/06.08.2018 Annex XIII).Ibáñez Sánchez, G.; Fernández Llatas, C.; Martinez-Millana, A.; Celda, A.; Mandingorra, J.; Aparici-Tortajada, L.; Valero Ramon, Z.... (2019). Toward Value-Based Healthcare through Interactive Process Mining in Emergency Rooms: The Stroke Case. International Journal of Environmental research and Public Health. 16(10):1-22. https://doi.org/10.3390/ijerph16101783S1221610Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, Health, And Cost. Health Affairs, 27(3), 759-769. doi:10.1377/hlthaff.27.3.759Porter, M. E. (2010). What Is Value in Health Care? New England Journal of Medicine, 363(26), 2477-2481. doi:10.1056/nejmp1011024Mamlin, B. W., & Tierney, W. M. (2016). The Promise of Information and Communication Technology in Healthcare: Extracting Value From the Chaos. The American Journal of the Medical Sciences, 351(1), 59-68. doi:10.1016/j.amjms.2015.10.015Murdoch, T. B., & Detsky, A. S. (2013). The Inevitable Application of Big Data to Health Care. JAMA, 309(13), 1351. doi:10.1001/jama.2013.393Bates, D. W., Saria, S., Ohno-Machado, L., Shah, A., & Escobar, G. (2014). Big Data In Health Care: Using Analytics To Identify And Manage High-Risk And High-Cost Patients. Health Affairs, 33(7), 1123-1131. doi:10.1377/hlthaff.2014.0041Fernández-Llatas, C., Meneu, T., Traver, V., & Benedi, J.-M. (2013). Applying Evidence-Based Medicine in Telehealth: An Interactive Pattern Recognition Approximation. International Journal of Environmental Research and Public Health, 10(11), 5671-5682. doi:10.3390/ijerph10115671Rojas, E., Sepúlveda, M., Munoz-Gama, J., Capurro, D., Traver, V., & Fernandez-Llatas, C. (2017). Question-Driven Methodology for Analyzing Emergency Room Processes Using Process Mining. Applied Sciences, 7(3), 302. doi:10.3390/app7030302Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn’t. BMJ, 312(7023), 71-72. doi:10.1136/bmj.312.7023.71Is Evidence-Based Medicine Patient-Centered and Is Patient-Centered Care Evidence-Based? (2006). Health Services Research, 41(1), 1-8. doi:10.1111/j.1475-6773.2006.00504.xGoldberger, J. J., & Buxton, A. E. (2013). Personalized Medicine vs Guideline-Based Medicine. JAMA, 309(24), 2559. doi:10.1001/jama.2013.6629Kelly, M. P., Heath, I., Howick, J., & Greenhalgh, T. (2015). The importance of values in evidence-based medicine. BMC Medical Ethics, 16(1). doi:10.1186/s12910-015-0063-3Gonzalez-Ferrer, A., Seara, G., Cháfer, J., & Mayol, J. (2018). Generating Big Data Sets from Knowledge-based Decision Support Systems to Pursue Value-based Healthcare. International Journal of Interactive Multimedia and Artificial Intelligence, 4(7), 42. doi:10.9781/ijimai.2017.03.006Lazer, D., Kennedy, R., King, G., & Vespignani, A. (2014). The Parable of Google Flu: Traps in Big Data Analysis. Science, 343(6176), 1203-1205. doi:10.1126/science.1248506Rojas, E., Munoz-Gama, J., Sepúlveda, M., & Capurro, D. (2016). Process mining in healthcare: A literature review. Journal of Biomedical Informatics, 61, 224-236. doi:10.1016/j.jbi.2016.04.007Fernandez-Llatas, C., Lizondo, A., Monton, E., Benedi, J.-M., & Traver, V. (2015). Process Mining Methodology for Health Process Tracking Using Real-Time Indoor Location Systems. Sensors, 15(12), 29821-29840. doi:10.3390/s151229769Baker, K., Dunwoodie, E., Jones, R. G., Newsham, A., Johnson, O., Price, C. P., … Hall, G. (2017). Process mining routinely collected electronic health records to define real-life clinical pathways during chemotherapy. International Journal of Medical Informatics, 103, 32-41. doi:10.1016/j.ijmedinf.2017.03.011Rebuge, Á., & Ferreira, D. R. (2012). Business process analysis in healthcare environments: A methodology based on process mining. Information Systems, 37(2), 99-116. doi:10.1016/j.is.2011.01.003Partington, A., Wynn, M., Suriadi, S., Ouyang, C., & Karnon, J. (2015). Process Mining for Clinical Processes. ACM Transactions on Management Information Systems, 5(4), 1-18. doi:10.1145/2629446Storm-Versloot, M. N., Ubbink, D. T., Kappelhof, J., & Luitse, J. S. K. (2011). Comparison of an Informally Structured Triage System, the Emergency Severity Index, and the Manchester Triage System to Distinguish Patient Priority in the Emergency Department. Academic Emergency Medicine, 18(8), 822-829. doi:10.1111/j.1553-2712.2011.01122.xFeigin, V. L., Roth, G. A., Naghavi, M., Parmar, P., Krishnamurthi, R., Chugh, S., … Forouzanfar, M. H. (2016). Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet Neurology, 15(9), 913-924. doi:10.1016/s1474-4422(16)30073-4Howard, G., & Goff, D. C. (2012). Population shifts and the future of stroke: forecasts of the future burden of stroke. Annals of the New York Academy of Sciences, 1268(1), 14-20. doi:10.1111/j.1749-6632.2012.06665.xGustavsson, A., Svensson, M., Jacobi, F., Allgulander, C., Alonso, J., Beghi, E., … Olesen, J. (2011). Cost of disorders of the brain in Europe 2010. European Neuropsychopharmacology, 21(10), 718-779. doi:10.1016/j.euroneuro.2011.08.008Alberts, M. J. (2000). Recommendations for the Establishment of Primary Stroke Centers. JAMA, 283(23), 3102. doi:10.1001/jama.283.23.3102Conca, T., Saint-Pierre, C., Herskovic, V., Sepúlveda, M., Capurro, D., Prieto, F., & Fernandez-Llatas, C. (2018). Multidisciplinary Collaboration in the Treatment of Patients With Type 2 Diabetes in Primary Care: Analysis Using Process Mining. Journal of Medical Internet Research, 20(4), e127. doi:10.2196/jmir.8884Chavalarias, D., Wallach, J. D., Li, A. H. T., & Ioannidis, J. P. A. (2016). Evolution of ReportingPValues in the Biomedical Literature, 1990-2015. JAMA, 315(11), 1141. doi:10.1001/jama.2016.195

Process mining for healthcare: Characteristics and challenges

[EN] Process mining techniques can be used to analyse business processes using the data logged during their execution. These techniques are leveraged in a wide range of domains, including healthcare, where it focuses mainly on the analysis of diagnostic, treatment, and organisational processes. Despite the huge amount of data generated in hospitals by staff and machinery involved in healthcare processes, there is no evidence of a systematic uptake of process mining beyond targeted case studies in a research context. When developing and using process mining in healthcare, distinguishing characteristics of healthcare processes such as their variability and patient-centred focus require targeted attention. Against this background, the Process-Oriented Data Science in Healthcare Alliance has been established to propagate the research and application of techniques targeting the data-driven improvement of healthcare processes. This paper, an initiative of the alliance, presents the distinguishing characteristics of the healthcare domain that need to be considered to successfully use process mining, as well as open challenges that need to be addressed by the community in the future.This work is partially supported by ANID FONDECYT 1220202, Direccion de Investigacion de la Vicerrectoria de Investigacion de la Pontificia Universidad Catolica de Chile-PUENTE [Grant No. 026/2021] ; and Agencia Nacional de Investigacion y Desarrollo [Grant Nos. ANID-PFCHA/Doctorado Nacional/2019-21190116, ANID-PFCHA/Doctorado Nacional/2020-21201411] . With regard to the co-author Hilda Klasky, this manuscript has been authored by UT-Battelle, LLC, under contract DE-AC05-00OR22725 with the US Department of Energy (DOE) . The US government retains and the publisher, by accepting the article for publication, acknowledges that the US government retains a nonexclusive, paid-up, irrevocable, worldwide license to publish or reproduce the published form of this manuscript, or allow others to do so, for US government purposes. DOE will provide public access to these results of federally sponsored research in accordance with the DOE Public Access Plan (http://energy.gov/downloads/doe-public-access-plan)Munoz Gama, J.; Martin, N.; Fernández Llatas, C.; Johnson, OA.; Sepúlveda, M.; Helm, E.; Galvez-Yanjari, V.... (2022). Process mining for healthcare: Characteristics and challenges. Journal of Biomedical Informatics. 127:1-15. https://doi.org/10.1016/j.jbi.2022.10399411512

Multiproxy approach to reconstruct fossil primate feeding behavior: Case study for macaque from the Plio-Pleistocene site Guefaït-4.2 (eastern Morocco)

The genus Macaca belongs to Cercopithecidae (Old World monkeys), Cercopithecinae, Papionini. The presence of Macaca in North Africa is well known from the Late Miocene to the Late Pleistocene. However, the diet of fossil Macaca has been poorly described in the literature. In this study, we investigated the feeding habits of Macaca cf. sylvanus (n = 4) from the Plio-Pleistocene site Guefaït-4.2 in eastern Morocco through multiproxy analysis combining analyses of stable carbon and oxygen isotopes from tooth enamel, buccal microtexture, and low-magnification occlusal dental microwear. For both microwear analyses, we compared the macaques with a new reference collection of extant members of Cercopithecoidea. Our occlusal microwear results show for the fossil macaque a pattern similar to the extant Cercocebus atys and Lophocebus albigena, African forest-dwelling species that are characterized by a durophagous diet based mainly on hard fruit and seed intake. Buccal microtexture results also suggest the consumption of some grasses and the exploitation of more open habitats, similar to that observed in Theropithecus gelada. The δ13C of M. cf. sylvanus indicates a C3 based-diet without the presence of C4 plants typical of the savanna grassland in eastern Africa during this period. The high δ18O values of M. cf. sylvanus, compared with the contemporary ungulates recovered from Guefaït-4.2, could be associated with the consumption of a different resource by the primate such as leaves or fresh fruits from the upper part of trees. The complementarity of these methods allows for a dietary reconstruction covering a large part of the individual’s life.This work has been funded by Palarq Foundation, Spanish Ministry of Culture and Sport (Ref: 42-T002018N0000042853 and 170-T002019N0000038589), Direction of Cultural Heritage (Ministry of Culture and Communication, Morocco), Faculty of Sciences (Mohamed 1r University of Oujda, Morocco), INSAP (Institut National des Sciences de l’Archéologie et du Patrimoine), Spanish Ministry of Science, Innovation and Universities (Ref: CGL2016-80975-P, CGL2016-80000-P, PGC2018-095489-B-I00, and PID2021- 122355NB-C33), Research Groups Support of the Generalitat de Catalunya (2017 SGR 836, 2017 SGR 1040, 2017 SGR 102, and 2017 SGR 859) and PDC2021-121613-I00 and PID2020-112963GB-I00 by ERDF A way of making Europe, by the European Union. RS-R, MC, AR-H, and CT research was funded by CERCA Programme Generalitat de Catalunya. IR-P is beneficiary of predoctoral fellowship (2020-FI-B-00731) funded by AGAUR and the Fons Social Europeu (FSE). AA and is beneficiary of a fellowship from the Erasmus Mundus Program to do the Master in Quaternary and Prehistory at the Universitat Rovira i Virgili (Tarragona, Spain). CT was supported by the Spanish Ministry of Science and Innovation through the “Ramón y Cajal” program (RYC2020-029404-I). The Institut Català de Paleoecologia Humana i Evolució Social (IPHES-CERCA) has received financial support from the Spanish Ministry of Science and Innovation through the “María de Maeztu” program for Units of Excellence (CEX2019-000945-M), including the postdoctoral fellowships of AR-H.With funding from the Spanish government through the "Severo Ochoa Center of Excellence" accreditation CEX2019-000945-M.Peer reviewe

Hydroxychloroquine is associated with a lower risk of polyautoimmunity: data from the RELESSER Registry

Objectives. This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE. Methods. RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity. Results. Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)]. Conclusion. Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies

Comprehensive description of clinical characteristics of a large systemic Lupus Erythematosus Cohort from the Spanish Rheumatology Society Lupus Registry (RELESSER) with emphasis on complete versus incomplete lupus differences

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple organ involvement and pronounced racial and ethnic heterogeneity. The aims of the present work were (1) to describe the cumulative clinical characteristics of those patients included in the Spanish Rheumatology Society SLE Registry (RELESSER), focusing on the differences between patients who fulfilled the 1997 ACR-SLE criteria versus those with less than 4 criteria (hereafter designated as incomplete SLE (iSLE)) and (2) to compare SLE patient characteristics with those documented in other multicentric SLE registries. RELESSER is a multicenter hospital-based registry, with a collection of data from a large, representative sample of adult patients with SLE (1997 ACR criteria) seen at Spanish rheumatology departments. The registry includes demographic data, comprehensive descriptions of clinical manifestations, as well as information about disease activity and severity, cumulative damage, comorbidities, treatments and mortality, using variables with highly standardized definitions. A total of 4.024 SLE patients (91% with ≥4 ACR criteria) were included. Ninety percent were women with a mean age at diagnosis of 35.4 years and a median duration of disease of 11.0 years. As expected, most SLE manifestations were more frequent in SLE patients than in iSLE ones and every one of the ACR criteria was also associated with SLE condition; this was particularly true of malar rash, oral ulcers and renal disorder. The analysis-adjusted by gender, age at diagnosis, and disease duration-revealed that higher disease activity, damage and SLE severity index are associated with SLE [OR: 1.14; 95% CI: 1.08-1.20 (P < 0.001); 1.29; 95% CI: 1.15-1.44 (P < 0.001); and 2.10; 95% CI: 1.83-2.42 (P < 0.001), respectively]. These results support the hypothesis that iSLE behaves as a relative stable and mild disease. SLE patients from the RELESSER register do not appear to differ substantially from other Caucasian populations and although activity [median SELENA-SLEDA: 2 (IQ: 0-4)], damage [median SLICC/ACR/DI: 1 (IQ: 0-2)], and severity [median KATZ index: 2 (IQ: 1-3)] scores were low, 1 of every 4 deaths was due to SLE activity. RELESSER represents the largest European SLE registry established to date, providing comprehensive, reliable and updated information on SLE in the southern European population

Diagnóstico Territorial del Litoral de Cantabria. Volumen I: Informe.

Estudios de base para la redacción del Plan de Ordenación del Litoral (POL) de Cantabria.Este proyecto de investigación aplicada se ha realizado gracias al Convenio de Colaboración entre el Gobierno de Cantabria y la Universidad de Cantabria titulado “Diagnóstico Territorial del Litoral de Cantabria”

Análisis Socio-Urbanístico de Cantabria. Volumen II: Análisis del Planeamiento.

Estudios de base para la redacción de las Normas Urbanísticas Regionales (NUR) de Cantabria.Este proyecto de investigación aplicada se ha realizado gracias al Convenio de Colaboración entre el Gobierno de Cantabria y la Universidad de Cantabria titulado “Análisis Socio-Urbanístico de Cantabria”

Sin / Sense

Sexto desafío por la erradicación de la violencia contra las mujeres del Institut Universitari d’Estudis Feministes i de Gènere «Purificación Escribano» de la Universitat Jaume

Adelante / Endavant

Séptimo desafío por la erradicación de la violencia contra las mujeres del Institut Universitari d’Estudis Feministes i de Gènere "Purificación Escribano" de la Universitat Jaume