Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

El cultivo de garbanzo (Cicer arietinum L.) en Argentina

El Programa Transferencia de Resultados de Investigación y Comunicación Pública de la Ciencia (PROTRI), de la Secretaría de Ciencia y Tecnología del Gobierno de la Provincia de Córdoba, financió la realización del libro El cultivo de garbanzo en Argentina con el objeto de promover la transferencia de resultados, experiencias o saberes entre las áreas del sector social y productivo para una mejor calidad de vida. Para la ejecución de esta obra han sido convocados técnicos e investigadores de las Ciencias Agropecuarias, Biológicas y Económicas, quienes en una forma clara y sencilla, aunque no menos consistente, ponen a disposición del lector sus experiencias adquiridas a lo largo de varios años de trabajo. El desarrollo de los diferentes temas se realiza a través de dieciséis Capítulos que abarcan desde la domesticación de Cicer y su llegada a la Argentina (Capítulo 1), pasando por el estudio morfológico de las diferentes partes de la planta en relación a los cultivares locales (Capítulo 2), además del manejo del suelo y sus nutrientes, en cuanto a requerimientos edáficos en los sistemas productivos (Capítulo 3). También se contempla el análisis de la influencia de los diversos factores ambientales para la determinación de zonas productivas (Capítulo 4). En el Capítulo 5 se hace referencia a la ecofisiología del cultivo, sus requerimientos en las diferentes etapas fenológicas, y cuándo y cómo se expresan en los cultivares. Un tema de indudable importancia para las leguminosas en general, y para el garbanzo en particular, es la simbiosis con las bacterias fijadoras de nitrógeno y su influencia en la productividad, el cual se desarrolla en el Capítulo 6. La mejora genética en el país es abordada en el Capítulo 7, donde se exponen sus inicios, desarrollo, disponibilidad de recursos, bondades y potencial del germoplasma disponible. A lo largo del ciclo biológico de la planta, el cultivo es visitado por insectos e infectado por hongos. Identificarlos y conocer sus ciclos biológicos y comportamientos es un aspecto importante para seleccionar las medidas de manejo y control más adecuadas (Capítulos 8 y 9). Quizás pocos sepan que el volumen de semilla genética de un cultivar, alcanza sólo unos pocos gramos (alrededor de 20). Para llevar este pequeño volumen a toneladas, se requiere del trabajo y tesón de investigadores, fitomejoradores y productores. Resultado de ese esfuerzo es la difusión de los seis cultivares obtenidos en el país, y se sigue trabajando para lograr nuevos materiales que se adapten a las diversas áreas y sistemas de producción (Capítulo 10). El desarrollo de los diferentes cultivares, que dan lugar a diversas arquitecturas de plantas, sumado a la adopción de diversos sistemas de producción, hace que el tema de la mecanización ocupe un lugar importante. Maquinas pequeñas y grandes intervienen en las etapas de siembra y de cosecha tratando de lograr la mayor eficiencia posible y un producto de calidad (Capítulo 11). Un cuello de botella para la expansión del cultivo es su comercialización, tanto para consumo interno como externo. En el Capítulo 12 se analizan los diferentes mercados y la necesidad de lograr un producto rentable de alta calidad, para mercados muy diversos. En el Capítulo 13 se hace un recorrido por las diferentes Provincias que actualmente producen garbanzo. Sus autores comentan como se incorporó el cultivo a los sistemas productivos de la región, sobre posibilidades y limitaciones, manejos y potencial de rendimiento, entre otros aportes. Los Capítulos 14 y 15 presentan dos temas de relevancia actual: la composición química del grano y las posibilidades de brindar valor agregado a éste, aspectos reforzados en la última década por el auge de las tendencias que promueven un nuevo estilo de vida y una alimentación sana, con alimentos naturales, bajos en grasa y con un buen balance nutricional. En el último Capítulo (16) se presentan experiencias de investigación en las que se utilizó al garbanzo como materia prima o como sustrato para diversas experimentaciones. La interacción docente-investigador-alumno permitió que vieran la luz diversos trabajos que, además de la formación de recursos humanos, brindan una información útil y novedosa al incursionar en temas tales como manejo de fechas de siembra, riego, alimento para pollos, cerdos y abejas. Estimado lector, tiene en sus manos un libro que es una invitación a un viaje con dieciséis estaciones. En cada una de ellas encontrará información sobre el cultivo del garbanzo en la Argentina. Estos datos fueron obtenidos por docentes, investigadores, productores, estudiantes que trabajaron y siguen trabajando para aportar al conocimiento del cultivo en nuestro país, bajo la realidad local y el contexto regional, ya que la mayoría de los trabajos y publicaciones son de origen extranjero y la aplicación de muchas de las tecnologías de manejo requieren una correcta adaptación y validación. Esperamos que este libro, además de serle útil, pueda ser disfrutado, sintiendo la pasión y el entusiasmo de cada uno de los autores por brindar y compartir sus conocimientos y logros

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Measurement of the top quark forward-backward production asymmetry and the anomalous chromoelectric and chromomagnetic moments in pp collisions at √s = 13 TeV

Abstract The parton-level top quark (t) forward-backward asymmetry and the anomalous chromoelectric (d̂ t) and chromomagnetic (μ̂ t) moments have been measured using LHC pp collisions at a center-of-mass energy of 13 TeV, collected in the CMS detector in a data sample corresponding to an integrated luminosity of 35.9 fb−1. The linearized variable AFB(1) is used to approximate the asymmetry. Candidate t t ¯ events decaying to a muon or electron and jets in final states with low and high Lorentz boosts are selected and reconstructed using a fit of the kinematic distributions of the decay products to those expected for t t ¯ final states. The values found for the parameters are AFB(1)=0.048−0.087+0.095(stat)−0.029+0.020(syst),μ̂t=−0.024−0.009+0.013(stat)−0.011+0.016(syst), and a limit is placed on the magnitude of | d̂ t| < 0.03 at 95% confidence level. [Figure not available: see fulltext.

Measurement of b jet shapes in proton-proton collisions at root s=5.02 TeV

We present the first study of charged-hadron production associated with jets originating from b quarks in proton-proton collisions at a center-of-mass energy of 5.02 TeV. The data sample used in this study was collected with the CMS detector at the CERN LHC and corresponds to an integrated luminosity of 27.4 pb(-1). To characterize the jet substructure, the differential jet shapes, defined as the normalized transverse momentum distribution of charged hadrons as a function of angular distance from the jet axis, are measured for b jets. In addition to the jet shapes, the per-jet yields of charged particles associated with b jets are also quantified, again as a function of the angular distance with respect to the jet axis. Extracted jet shape and particle yield distributions for b jets are compared with results for inclusive jets, as well as with the predictions from the pythia and herwig++ event generators.Peer reviewe

MUSiC : a model-unspecific search for new physics in proton-proton collisions at root s=13TeV

Results of the Model Unspecific Search in CMS (MUSiC), using proton-proton collision data recorded at the LHC at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9 fb(-1), are presented. The MUSiC analysis searches for anomalies that could be signatures of physics beyond the standard model. The analysis is based on the comparison of observed data with the standard model prediction, as determined from simulation, in several hundred final states and multiple kinematic distributions. Events containing at least one electron or muon are classified based on their final state topology, and an automated search algorithm surveys the observed data for deviations from the prediction. The sensitivity of the search is validated using multiple methods. No significant deviations from the predictions have been observed. For a wide range of final state topologies, agreement is found between the data and the standard model simulation. This analysis complements dedicated search analyses by significantly expanding the range of final states covered using a model independent approach with the largest data set to date to probe phase space regions beyond the reach of previous general searches.Peer reviewe

Measurement of prompt open-charm production cross sections in proton-proton collisions at root s=13 TeV

The production cross sections for prompt open-charm mesons in proton-proton collisions at a center-of-mass energy of 13TeV are reported. The measurement is performed using a data sample collected by the CMS experiment corresponding to an integrated luminosity of 29 nb(-1). The differential production cross sections of the D*(+/-), D-+/-, and D-0 ((D) over bar (0)) mesons are presented in ranges of transverse momentum and pseudorapidity 4 < p(T) < 100 GeV and vertical bar eta vertical bar < 2.1, respectively. The results are compared to several theoretical calculations and to previous measurements.Peer reviewe

Measurement of the azimuthal anisotropy of Y(1S) and Y(2S) mesons in PbPb collisions at root s(NN)=5.02 TeV

The second-order Fourier coefficients (v(2)) characterizing the azimuthal distributions of Y(1S) and Y(2S) mesons produced in PbPb collisions at root s(NN) = 5.02 TeV are studied. The Y mesons are reconstructed in their dimuon decay channel, as measured by the CMS detector. The collected data set corresponds to an integrated luminosity of 1.7 nb(-1). The scalar product method is used to extract the v2 coefficients of the azimuthal distributions. Results are reported for the rapidity range vertical bar y vertical bar < 2.4, in the transverse momentum interval 0 < pT < 50 GeV/c, and in three centrality ranges of 10-30%, 30-50% and 50-90%. In contrast to the J/psi mesons, the measured v(2) values for the Y mesons are found to be consistent with zero. (C) 2021 The Author(s). Published by Elsevier B.V.Peer reviewe

Measurement of B-c(2S)(+) and B-c*(2S)(+) cross section ratios in proton-proton collisions at root s=13 TeV

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