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Abstract Background Detecting, treating and monitoring anaemia has a functional, social and economic impact on patients’ quality of life and the health system, since inadequate monitoring can lead to more accident & emergency visits and hospitalizations. The aim of this study is to evaluate the impact in the patient clinical outcomes of using haemoglobinometry to early detect anaemia in patients with chronic anaemia in primary care. Methods Randomized controlled trial Capillary haemoglobin will be measured using a haemoglobinometer on a monthly basis in the intervention group. In the control group, the protocol currently in force at the primary care centre will be followed and venous haemoglobin will be measured. Any cases of anaemia detected in either group will be referred to the transfusion circuit of the reference hospital. Discusion The results will shed light on the impact of the intervention on the volume of hospitalizations and accident & emergency (A&E) visits due to anaemia, as well as patients’ quality of life. Chronic and repeated bouts of anaemia are detected late, thus leading to decompensation in chronic diseases and, in turn, more A&E visits and hospitalizations. The intervention should improve these outcomes since treatment could be performed without delay. Improving response times would decrease decompensation in chronic diseases, as well as A&E visits and hospitalizations, and improve quality of life. The primary care nurse case manager will perform the intervention, which should improve existing fragmentation between different care levels. Trial registration NCT04757909. Registered 17 February 2021. Retrospectively registered.

Resumen: La visión multidimensional de la enfermedad es fundamental en la atención de patologías complejas como la enfermedad renal crónica (ERC). Es oportuno definir y unificar conceptos que permitan que los diferentes profesionales encargados de la atención ofrezcan una atención multidisciplinar, alineados a las necesidades de cada persona.Debido al creciente aumento de la incidencia de ERC en el mundo y teniendo en cuenta que pueden existir diferentes trayectorias en el curso de la enfermedad, es necesario establecer abordajes integrales personalizados para cada paciente y sus familias de manera más temprana. Este planteamiento va más allá del simple control de los síntomas urémicos o de la congestión y consiste en abordar tempranamente los problemas no solo sintomáticos sino también funcionales, sociales y de afrontamiento de la enfermedad, facilitando la toma de decisiones tanto en el escenario de la ERC como en situaciones agudas, potencialmente irreversibles o en intervenciones que no mejoren el pronóstico vital.Para asegurar la excelencia en la atención es relevante evaluar indicadores para la atención paliativa y de soporte renal, como la presencia de la planificación anticipada y compartida de la atención, la inclusión de atención psicosocial, ética, espiritual y la atención al duelo. Esto permite ofrecer una atención integral, humanizada y de calidad para el paciente y sus familiares.Los cuidados paliativos y de soporte renal no se orientan únicamente a los pacientes en los últimos días de vida. Definir, unificar y evaluar los conceptos permitirá aplicarlos de manera oportuna en cada momento específico de la trayectoria de la ERC. Abstract: The multidimensional view of the disease is fundamental in the care of complex diseases such as chronic kidney disease (CKD). It is appropriate to define and unify concepts that allow the different professionals involved in care to provide multidisciplinary care tailored to the needs of each individual.Given the increasing incidence of CKD worldwide and the fact that the disease may progress at different rates, there is a need to establish personalized, comprehensive approaches for each patient and their families at an earlier stage. This approach goes beyond the simple control of uremic symptoms or congestion and consists of addressing not only symptomatic but also functional, social and coping problems at an early stage, facilitating decision making both in the CKD and in acute settings, potentially irreversible situations or interventions that do not improve life expectancy.To ensure excellence in care, it is important to assess indicators of palliative care and renal support, such as the presence of advance and shared care planning, the inclusion of psychosocial, ethical, spiritual and bereavement care. This enables the provision of comprehensive, humanized, and high-quality care for patients and their families.Palliative and renal care is not just about patients in the last days of life. Defining, unifying, and evaluating the concepts will allow them to be applied in a timely manner at each specific moment of the CKD trajectory.

Introduction: The evaluation of integrated care programmes for high-need high-cost older people is a challenge. We aim to share the early implementation results of the ProPCC programme in the North-Barcelona metropolitan area, in Catalonia, Spain. Methods: We analysed the intervention with retrospective data from May 2018 to December 2021 by describing the cohort complexity and by showing its 6-months pre-post impact on time spent at home and resources used: primary care visits, emergency department visits, hospital admissions and hospital stay. Findings: 264 cases were included (91% at home; 9% in nursing homes). 6-month pre vs. 6-months post results were (mean, p-value): primary care visits 8.2 vs. 11.5 (p < 0.05); emergency department visits 1.4 vs. 0.9 (p < 0.05); hospital admissions 0.7 vs. 0.5 (p < 0.05); hospital stay 12.8 vs. 7.9 days (p < 0.05). Time spent at home was 169.2 vs.174.2 days (p < 0.05). Conclusion: Early implementation of the ProPCC programme results in an increase in time spent at home (up to 3%) and significant reductions in emergency department attendance (–37.2%) and hospital stays (–38.3%). The increased use of primary care resources is compensated by the hospital resources savings, with a result in the average total cost of –46.3%.

Abstract Background Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. Methods We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. Results A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P

Objectives: To explore the association between drug exposure and SARS-CoV-2 prognosis among elderly people living in long-term care facilities (LTC) Design: We carried out a cross-sectional study among old people living in LTC that had a proven SARS-CoV-2 infection, including socio-demographic data, comorbidities and drug intake at the moment of the diagnosis. The study was focused on ACE2 inhibitors, ARA-II blockers, inhaled bronchodilators, oral corticoids, platelet antiaggregants, oral anti-coagulants, statins and Vitamin D. Results: 1 306 individuals were included, with a mean age of 86.7 years, and 72.3% were females. The case fatality rate was 24.4%. Among the studied exposures platelet antiaggregants were the most prevalent (24.7%). After adjusting for propensity score, the intake of inhaled corticoids (OR 0.73; p=0.03) and statins (OR 0.65; p=0.03) were found to be protective factors of death, whereas ACE2 inhibitor showed an almost significant association (OR 0.73, p=0.07). Conclusions: Considering the high prevalence of drug intake among elderly people, drug exposure may be an important Covid-19 disease modifier in LTC residents and should be considered when exploring prognostic risk factors associated to Covid-19.

Underwater noise is a significant pollutant produced by anthropogenic activities carried out in the sea. Several types of acoustic sources can potentially have adverse impacts on marine fauna, especially on cetaceans. The vocalization response of cetaceans to underwater noise varies depending on noise characteristics such as duration, bandwidth, and intensity, as well as the species being insonified. Some studies report changes in vocalization properties due to continuous noise, but there is a lack of knowledge regarding impulsive noise sources, especially those related to explosive events. It is known that underwater explosions represent a serious threat to marine fauna because it produces one of the highest sound pressure levels introduced by anthropogenic activities. In this communication, an opportunistic study related to changes in the dolphin vocalizations was performed by considering two scenarios (i.e., before and after a detonation event). The acoustic raw data were recorded by a passive acoustic device installed in a mooring line deployed in the Mediterranean coast of Spain. The objective of the experimental installation was to monitor the underwater sound pressure level in the framework of the development of the Marine Strategy Framework Directive (MSFD) in Spain. A detonation event of unknown origin was recorded during the monitoring period while Delphinids were vocalizing, allowing for the observation of their acoustic reaction to the explosion. The study considers the number of vocalizations, morphology of whistles, and spectral characteristics before and after the explosion. The results obtained indicate that the number of whistles, their complexity in terms of morphology, and spectral components vary due to the explosive event, showing significant differences that will be presented and discussed in this communication.

Introduction: The prevalence of people with complex chronic conditions is increasing. This population’s high social and health needs require person-centred integrated approaches to care. Methods: To collect data about experiences with the health system and identify priorities for care, we conducted 2 focus groups and 15 semi-structured interviews involving patients with multimorbidity and advanced conditions, caregivers, and representatives of patients’ associations. To design the programme, we combined this information with evidence-based recommendations from local healthcare and social care professionals. Results: Patients’ and caregivers’ main priorities were to ensure (a) comprehension of information provided by healthcare professionals; (b) coordination between patients, caregivers, and professionals; (c) access to social services; (d) support to caregivers in managing situations; (e) perceived support throughout the healthcare process; (f) home care, when available; and (d) a patient-centred approach. These dimensions were included in 37 of 63 clinical actions of the programme to cover the whole care trajectory: identifying high needs, defining, and providing care plans, managing crises, and providing transitional care and end-of-life care. Conclusion: We developed an evidence-based integrated care programme tailored to high-need patients combining input from patients, caregivers, and healthcare and social care professionals.

Abstract Background Use of the video digital format in the classroom is a common way to present clinical cases to stimulate discussion and increase learning. A simulated live performance with actors, also in the classroom, could be an alternative way to present cases that may be more attractive to arouse students’ interest and attention. The aim of the present study was to compare the learning process between a group of students who saw a clinical case as a simulated live scene in the classroom and others seeing the same clinical case projected by video. Method One hundred and thirty-one students (69 from physiotherapy and 62 from medicine) attended an interactive seminar on delirium in older people. Each group was subdivided into two groups: one saw the clinical case as a theatrical performance in the classroom (scene group; n = 68), while the other saw the same case projected on video (video group; n = 63). Before and after attending the seminar, students answered a questionnaire [four questions on theoretical knowledge of delirium (score 0–7) and two on subjective learning perception (linear scale: 0–10) (score 0–20)]. At the end, a further question was included on the usefulness of the scene or a video in the learning process (linear scale: 0–10). Results Students in both groups (live scene and video) significantly improved in all questionnaire scores after the seminar (p = 0.001) with a large Effect Size (ES > 0.80). Students of the scene group obtained higher scores on theoretical delirium knowledge [6.41 ± 0.73 vs 5.93 ± 1.31 (p = 0.05)], subjective learning perception questions (what they thought they knew about delirium) (16.28 ± 3.51 versus 15.92 ± 2.47 (p = 0.072)], and the overall questionnaire (22.45 ± 4.15 versus 21.48 ± 2.94 (p = 0.027)] than the video group. Students of the scene group opined that live scene was very useful for learning with a mean score of 9.04 ± 1.16 (range 0–10), and opinion in the student’s video group scored 8.21 ± 1.22 (p = 0.001). Conclusions All students improved significantly their knowledge but those who saw the theatrical performance obtained slightly better results, which suggest that this form of clinical case presentation in the classroom may be an alternative at least as effective as traditional video projections.

Over the last decade, national authorities and European administrations have made great efforts to establish methodological standards for the assessment of underwater continuous noise, especially under the requirements set by the Marine Strategy Framework Directive (MSFD). Through the MSFD implementation across EU Member States Marine Reporting Units (MRUs), it is intended to establish the Good Environmental Status (GES) whether it is achieved or not. The evaluation of the Sound Pressure Level (SPL) at the local or regional scale for 1/3 octave band of 63 Hz and 125 Hz and the identification of long temporary trends were considered to be a priority due to the valuable information they can offer in relation to continuous low-frequency noise. Nevertheless, the methodology to determine threshold values from which to evaluate the GES has become difficult to define, and new approaches and considerations are currently being discussed by groups of experts, such as the technical subgroup on underwater acoustics (TGnoise) and regional commissions (e.g., OSPAR). This work presents a methodology to perform the assessment of a given area, providing a risk index that is related to potential appearance of masking effect due to the underwater noise produced by marine traffic. The risk index is hinged on the calculation of area under curves defined by the density of animals and a variable related to underwater noise SPL, defined as percentage of communication distance reduction. At this stage, the methodology presented does not consider physiological or behavioral mechanisms to overcome the masking by animals. The methodology presented has been applied to the bottlenose dolphin (Tursiops truncatus) inhabiting the ABIES—NOR marine demarcation to illustrate the possible use of risk-based models to manage marine areas related to human pressures, such as marine traffic, with the potential adverse impact on a given species (e.g., masking effect).

Anthropogenic impulsive sound sources with high intensity are a threat to marine life and it is crucial to keep them under control to preserve the biodiversity of marine ecosystems. Underwater explosions are one of the representatives of these impulsive sound sources, and existing detection techniques are generally based on monitoring the pressure level as well as some frequency-related features. In this paper, we propose a complementary approach to the underwater explosion detection problem through assessing the arrow of time. The arrow of time of the pressure waves coming from underwater explosions conveys information about the complex characteristics of the nonlinear physical processes taking place as a consequence of the explosion to some extent. We present a thorough review of the characterization of arrows of time in time-series, and then provide specific details regarding their applications in passive acoustic monitoring. Visibility graph-based metrics, specifically the direct horizontal visibility graph of the instantaneous phase, have the best performance when assessing the arrow of time in real explosions compared to similar acoustic events of different kinds. The proposed technique has been validated in both simulations and real underwater explosions.

Introduction: The growing numbers of People with Complex Chronic Conditions (PCCC) has been leading to a challenge of adaptation of the care providers’ response to the high needs presented by individuals. Short description of practice change implemented: The creation of a Chronic Care Management Team (CCMT) supported an innovative strategy focused on reaching a more integrated model of care. A community-based care programme was developed based on: a. International evidence (reviewed by two CCMT experts); b. A consensus reached by clinical leaders involved on care (in a local task force group with 60 members from primary and secondary care); c. The inclusion of people experience (by two focus groups with patients, and home interviews to carers and members of community institutions). It led to a new organisational and governance model for the whole territory. An IT tools adaptation was required to support the CCMT task on monitoring the care process and outcome indicators. Aim and theory of change: In order to improve the quality of the care process and to obtain patient-centred outcomes in an efficient way, it was urged to change the usual model, to a new multidisciplinary, multidimensional, patient-centred provision of integrated care focused in the community, with the central role of expert Primary Care teams. Targeted population and stakeholders: PCCC including those with advanced illnesses. Stakeholders: several units from the Catalan Health Institute in Badalona area, North of Barcelona, as a territorial public provider of primary care and hospital care, which collaborate with other social care and intermediate care providers in the area. Timeline: Phase 1: development of theory for change (2018); Phase 2: implementation of the new model of care (2018-2019); Phase 3: evaluation of the model (2019). Highlights (innovation, Impact and outcomes) People-centred integrated care ongoing project at meso level as a response to high needs of PCCC in an urban territory in the Catalan public health system. Definition of the care model by people involved on care (patients, carers and staff). Functional integration of clinicians from the institution. CCMT led the integration by: defining and monitoring the quality of the care process, planning the adaptation of resources, and evaluating people-centred outcomes. Comments on sustainability: High sustainability expected due to the pragmatic approach. Comments on transferability: High transferability expected due to the position of our institution in the health system. Conclusions (comprising key findings): Our project was created based on a need to deepen on integrated care provision. Preliminary results on the quality of the care process have been evaluated. Preliminary results centred on people have been evaluated. Discussion: It is a huge opportunity for our system to develop and evaluate an integrated care strategy at a meso level, following the Catalan Government integrated care strategy. Lessons learned: Adapting the theoretical model to real world required a strong leadership, clear governance, time for change and the alignment of all the actors. The consensus reached, based on people experience and views, was a strong element for change.

Passive acoustic monitoring systems allow for non-invasive monitoring of underwater species and anthropogenic noise. One of these systems has been developed keeping in mind the need to create a user-friendly tool to obtain the ambient noise indicators, while at the same time providing a powerful tool for marine scientists and biologists to progress in studying the effect of human activities on species and ecosystems. The device is based on a low-power processor with ad-hoc electronics, ensuring that the system has efficient energy management, and that the storage capacity is large enough to allow deployments for long periods. An application is presented using data from an acoustic campaign done in 2018 at El Gorguel (Cartagena, Spain). The results show a good agreement between theoretical maps created using AIS data and the ambient noise level indicators measured in the frequency bands of 63 Hz and 125 Hz specified in the directive 11 of the EU Marine Strategy Framework Directive. Using a 2D representation, these ambient noise indicators have enabled repetitive events and daily variations in boat traffic to be identified. The ship noise registered can also be used to track ships by using the acoustic signatures of the engine propellers’ noise.

La informàtica en núvol (cloud computing) és una arquitectura de prestació o aprovisionament de serveis de tecnologies de la informació i la comunicació que està agafant força protagonisme, i que segons els analistes en els propers anys es consolidarà tant pel que fa als usuaris individuals de la Xarxa i de serveis en línia, com a les empreses, que afectarà la seva manera d'utilitzar les TIC. En relació amb els usuaris de la Xarxa, la informàtica en núvol té molts punts de connexió amb el Web 2.0, i en relació amb les empreses, està estretament lligada als processos d'externalització (o outsourcing) dels serveis TIC. En aquest article s'identifiquen i analitzen les qüestions més rellevants del binomi informàtica en núvol i protecció de dades de caràcter personal.

Signal processing is an essential tool in nondestructive material characterization. Pulse-echo inspection with ultrasonic energy provides signals (A-scans) that can be processed in order to obtain parameters which are related to physical properties of inspected materials. Conventional techniques are based on the use of a short-term frequency analysis of the A-scan, obtaining a time-frequency response (TFR), to isolate the evolution of the different frequency-dependent parameters. The application of geometrical estimators to TFRs provides an innovative way to complement conventional techniques based on the one-dimensional evolution of an A-scan extracted parameter (central or centroid frequency, bandwidth, etc.). This technique also provides an alternative method of obtaining similar meaning and less variance estimators. A comparative study of conventional versus new proposed techniques is presented in this paper. The comparative study shows that working with binarized TFRs and the use of shape descriptors provide estimates with lower bias and variance than conventional techniques. Real scattering materials, with different scatterer sizes, have been measured in order to demonstrate the usefulness of the proposed estimators to distinguish among scattering soft tissues. Superior results, using the proposed estimators in real measures, were obtained when classifying according to mean scatterer size.