Search

Introduction HaemoassistTM 2 is an electronic system designed for people with bleeding disorders and their physicians to record prophylactic infusions and treatment of bleeds. It aims to improve adherence by permitting reminders and accuracy of documentation by facilitating real-time reporting. Aim To assess documentation quality and adherence to prophylactic regimens in patients with haemophilia A, haemophilia B or von Willebrand disease who are using HaemoassistTM 2. Methods Ten centres enrolled consecutive patients, who had been using HaemoassistTM 2 for ≥ 3 months (Cohort 1, 'quality of documentation'). Of these, patients who had a specified prophylactic regimen in HaemoassistTM 2 for ≥ 3 months were eligible for inclusion in Cohort 2 ('adherence to prophylaxis'). Results Cohort 1 comprised 796 patients (71% with severe haemophilia A; median 20.5 months of HaemoassistTM 2 use). The most common method of documentation for patients was using the mobile app; the median time between infusion and documentation was 4 hours using the app, compared with 85 hours using a web portal on a stationery device. The median total annualised number of infusions was consistent in the first and last 3 months of documentation (128; IQR: 70-184 and 120; IQR 64-176, respectively). Cohort 2 comprised 202 patients (79% severe haemophilia A; median of 13 months on prophylactic regimen in HaemoassistTM 2). The rate of adherence to prophylaxis was 83%; median deviation between planned and actual infusion time was ± 2 hours. Conclusion HaemoassistTM 2 was used consistently over prolonged periods of time and allowed for precise analysis of adherence to prophylaxis.

In many cities, sectorization projects of the drinking water distribution network have been implemented. This study provides a methodology to evaluate the efficiency of the sectors of a water distribution network by applying a data envelopment analysis weighted Russell directional distance (DEA-WRDD) model. This non-radial DEA model gives the overall efficiency of each unit of analysis, as well as each input, output, and undesirable output considered in the evaluation. The variables used in the analysis provide a multidisciplinary view: economic factors (covering costs), water quality parameters, and technical aspects. The empirical analysis was performed for the sectors of the water distribution network of the city of Valencia (Spain) for the year 2016. In this particular case, the results showed that approximately half of the sectors were efficient. The efficiency values of each variable indicate that the main challenges (faced by the water distribution company) were the optimization of maintenance costs and the reduction of leaks, both of which have an impact on the quality of the distributed water. So, the purpose of this article is to highlight the usefulness of efficiency analysis to help the decision making of managers of sectorized water distribution networks so that they can optimize the management.

Water is essential for our lives and activities. Everyone can drink good quality water, the question is whether they have access to it in the first place. Water quality and its treatment depend on the water source. This treatment has costs that users have to pay in the water tariff. It is very important to establish a water tariff that permits the best water treatment and has a low impact on the users. Cost functions are a useful tool to predict costs before an implementation or improvement. This article, using three easy steps (analysis, obtaining costs and modification of the water tariff) proposes improving water purification treatment using cost functions in order to find the best solution for providing the best quality water with the least cost impact on the water tariff. This methodology aims to help supply managers justify their decisions in order to optimise the available economic resources.

Gastrointestinal parasites with direct and/or indirect life cycles, namely Eimeria spp., Ascaridia galli, Heterakis gallinarum and Capillaria spp., are responsible for the most frequent and heavy economic losses in aviculture. The current review aimed to collect information about gastrointestinal parasites affecting poultry, as well as, research studies regarding parasitic diseases in free-range chicken production. From the references used in this review, 20% highlight research studies correlating prevalence of gastrointestinal parasites in free-range chickens and factors such as the production system, age and animal density, hygienic conditions and weather. Coccidiosis is responsible for the major economic losses in poultry farms. Diseases have different clinical signs and result in variable impacts on animals. Control programs include mainly vaccination, anti-coccidia and anthelminthic drugs, as well as, house cleaning and disinfection. This review concluded that coccidia and helminths are a global threat to free-range poultry production. More research in this area is necessary in order to understand the major factors influencing the prevalence of parasitic diseases in this type of poultry production. Also the search for new control strategies must be a priority, mainly using natural antiparasitic compounds and biological control approaches. info:eu-repo/semantics/publishedVersion

Resumen Comunicamos la puesta en marcha de un programa intensivo y multidisciplinar de perdida de peso en pacientes con obesidad morbida (OM). Este ensayo clinico se basa en la educacion para la salud, el apoyo en el proceso de cambio, los medicamentos y las sesiones de terapia de grupo. Nuestra intencion es demostrar que los resultados obtenidos con este programa de perdida de peso a 2 anos son, cuando menos, comparables a los resultados que se obtienen con la cirugia bariatrica en estos pacientes con OM. Es nuestra intencion igualmente demostrar que este tratamiento multidisciplinar induce una mejoria de las comorbilidades y esta asociado a un menor gasto en el presupuesto de nuestro Sistema Nacional de Salud.

INTRODUCTION Prophylaxis with factor VIII (FVIII) is considered the gold standard for managing hemophilia A (HA) patients without inhibitors to prevent bleedings and to preserve normal musculoskeletal function. Classically, the prophylaxis with a standard half-life FVIII is 20 to 40 IU/kg administered every other day. In practice this "one-size-fits-all" way of dosing does not work in many patients due to the interindividual variability on the concentration-time profile of FVIII, body weight, age, blood group and level of Von Willebrand factor. Pharmacokinetic (PK)-guided regimens have been proposed as an effective way to optimize prophylaxis efficacy. Different online PK tools have been developed to estimate patients' PK with only 2 blood samples. The integration of PK and clinical data can help physicians to adjust dosing. Since 2014 we have been using an online tool to perform PK estimation in patients using the FVIII product Advate® (myPKFiT®, www.mypkfit.com; Baxter Healthcare Corporation; Haemophilia 2014, 20 (Suppl.2):15). In June 2018 a new version has been launch, the version 3.0. This v3.0 includes a dose calculation update based on the ability to modify an individual dose or trough level of an individual prophylaxis regimen providing an accurate adjustment of prophylaxis dosing in comparison with version 2.0 (v2.0). This report describes the impact of the PK estimation in the infusion frequency and factor consumption, comparing both versions, in a cohort of people with HA. METHODS This is an observational case series from a single hemophilia treatment Spanish center. The inclusion criteria were: patients receiving prophylaxis with octocog alfa who accepted to participate in the PK study. Two blood samples have been collected for the estimation of FVIII PK (3-4 hours and 24-28 hours after administration of their usual dose of FVIII) in real world practice. We measured FVIII using one-stage assay. The FVIII trough levels were adjusted between 1% and 3% according to patients characteristics. Demographic data, PK parameters, infusion frequency, dosage and consumption after PK adjustment of prophylaxis using the v2.0 and v3.0 tool were analyzed. RESULTS Eleven patients were evaluated (7 severe, 3 moderate, 1 mild HA) aged 2-43 years (median 14 years). There were no differences in PK parameters between v2.0 and v3.0 as the applied algorithm for both versions is the same. PK results are shown in the Panel A of the table below. The elected trough level was between 1-3% depending of the physical activity and joint health of every individual patient. Prophylaxis regimen was modified in 6/11 patients after PK analysis with both versions of the App: 2 pediatric patients increased their FVIII dose and 3 adults increased their treatment frequency. We have only observed differences in 3 patients comparing the two versions: Patient 1 started a new infusion regimen (every 48h to 48-48-72h) with a mild increase in consumption, and patient 2 and 5 maintained the regimen every 48h with slight reductions in consumption. Results are shown in the Panel B of the table below. CONCLUSIONS Both versions of myPKFit™ are a helpful tool to adjust FVIII dosing regimens. This latest version allows to individualize even more the treatment regimen and to achieve a more efficient consumption. Prospective evaluation of the use of PK‐tailored prophylaxis in routine care and its impact on patient outcomes is needed. Table. Table. Disclosures No relevant conflicts of interest to declare.

Objective: To evaluate the effect of the implementation of a smart-phone based therapy management application over the monitoring of the hemophilia A (HA) and B (HB) patients in home-care setting. Setting: Since 2016 our hospital is using a mobile app and real time therapy management system for hemophilia patients (Haemoassist™, StatConsult) as a new tool of hemophilia patients care management complementing the existing health charts. Methods: A retrospective research conducted at one hemophilia treatment center covering four islands. HA and HB patients using the mobile app with at least 6-month follow-up period were included. Data on socio-demographics, clinical and therapy were collected before and after 6-month period of the app introduction. Sources of information were the electronic medical history (Millenium-Cerner™), pharmacy outpatient delivery program (Hospiwin™) and the above mentioned smart-phone app. The adherence was estimated calculating real factor consumption divided by the theoretical factor consumption according to prescribed prophylactic regimen for each study period. The extra doses for bleeding episodes were collected only after the intervention, due to unavailable reliable reports for mild and moderate bleeding events before the incorporation of the app. Results: A total of 28 patients with severe and moderate HA and HB on prophylactic treatment were included. The median age was 25 years (range 3-57). The median of the first period adherence was 72.7 % (range 30.77-100%) and of the second was 100% (range 51.88-100%). The median of the difference between periods was 15% (see chart 1 for more detailed information). In the post-intervention period, 12 (43 %) patients had a median of 3 bleeding events (range 1 -7) and needed extra-infusions with a median of 7 doses (range 3-17). Conclusions: The adherence to prophylactic treatment is crucial to reduce joint bleedings (Manco-Johnson MJ et al. NEJM. 2007). The use of therapy management mobile app has contributed to increase adherence in our patients allowing a precise monitoring of the administered factor and bleeding events in real time. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

El siglo XIX se caracteriza por numerosos cambios tanto a nivel social como estructural de la población: se produce un acelerado desarrollo urbano sin planificación y carente de servicios que da lugar a una mala calidad de vida y numerosas epidemias. Estos cambios tienen como resultado un nuevo movimiento, el Higienismo, que pretende mejorar las condiciones de vida de la población. En España, todas las reformas higiénicas se desarrollaron mediante los planes de Ensanche. Uno de los puntos clave de este pensamiento es el abastecimiento de agua potable como medio para evitar enfermedades. La ciudad de Valencia es un claro ejemplo de la importancia de este movimiento y cómo el abastecimiento de agua es un elemento clave en la mejora de la calidad de vida de las personas. The nineteenth century is characterized by social and structural changes to the population: quick, unplanned urban development took place together with a lack of services that resulted in poor quality of life and numerous epidemics. These changes gave rise to a new movement, Hygienics, which aimed to improve the living conditions of the population. In Spain, all hygienic reforms were developed through Ensanche (urban expansion) Plans. One of the key points of this movement is a supply of clean water as a means to prevent diseases. Valencia is an example of the importance of this movement and how water supply is a key element in improving the quality of life.

The long term potentiation (LTP) of synaptic transmission constitutes a remarkable example of synaptic plasticity, and represents a learning model. The LTP has been described by several authors in the hippocampus through high frequency stimulation.In the present paper we have used conventional EMG biofeedback techniques which aims at investigating the rehabilitation of myopathies and the electrophysiological mechanism of neuromuscular learning at marrow level. Three experimental patients of progressive muscular dystrophy, aged between 11 and 15, were systematically treated with EMG biofeedback in several muscular groups. Special attention is given to the records corresponding to rest post maximum effort (RPME).For the principal muscular groups rehabilitated it has been verified that the motor unit potentials corresponding to RPME show intense activity, with average amplitudes of 600 700 mV and duration close to 15 ms, against a practically nonexistent activity before rehabilitation. The descent of the alkaline phosphatase (from 200 U/l to 50 U/l) and the lactic deshydrogenase (from 320 U/l to 210 U/l) are specially significant.The EMG biofeedback techniques allow us to improve physical efficiency in patients of progressive muscular dystrophy. The analysis of post biofeedback motor unit potentials, and the strong descent of the enzymes in the last phase of treatment, allows us to deduce the establishment of LTP between the alpha motoneurons and the axonic terminals of the microneurons of Renshaw. The mechanism of the LTP at marrow level is interpreted through two physiological hypotheses concerning the circuit of Renshaw.

Se aborda experimentalmente el tratamiento de la distrofia muscular progresiva (D.M.P.)en un enfermo de 14 años, con tecnicas de biofeedback-EMG, como alternativa a las terapeuticas habituales (farmacologia, ortopedica y rehabilitadores). En la fase previa al traamiento y a los 6 meses de finalizar el mismo se realizan examenes clinicos, bioquimicos y electrofisiologicos, para evaluar los respectivos restulados. Considerando la favorable evolucion de los mismos, se analiza el fenomeno EMG de Reposo Post-Maximo Esfuerzo (RPME), que presenta el enfermo en la fase final del periodo de aprendiazaje neuromscular, contemplandolo desde una triple perspectiva: a) Electromiografica; b) Fisica y c) Bioquimica-Fisiologica. Sobre esta base se propone una hipotesis fisiologica, con el estudio de un mecanismo regulador de la accion "feedback-feedforward

Introduction The long term potentiation (LTP) of synaptic transmission constitutes a remarkable example of synaptic plasticity, and represents a learning model. The LTP has been described by several authors in the hippocampus through high frequency stimulation. Objectives, patients and methods In the present paper we have used conventional EMG biofeedback techniques which aims at investigating the rehabilitation of myopathies and the electrophysiological mechanism of neuromuscular learning at marrow level. Three experimental patients of progressive muscular dystrophy, aged between 11 and 15, were systematically treated with EMG biofeedback in several muscular groups. Special attention is given to the records corresponding to rest post maximum effort (RPME). Results For the principal muscular groups rehabilitated it has been verified that the motor unit potentials corresponding to RPME show intense activity, with average amplitudes of 600 700 mV and duration close to 15 ms, against a practically nonexistent activity before rehabilitation. The descent of the alkaline phosphatase (from 200 U/l to 50 U/l) and the lactic deshydrogenase (from 320 U/l to 210 U/l) are specially significant. Conclusions The EMG biofeedback techniques allow us to improve physical efficiency in patients of progressive muscular dystrophy. The analysis of post biofeedback motor unit potentials, and the strong descent of the enzymes in the last phase of treatment, allows us to deduce the establishment of LTP between the alpha motoneurons and the axonic terminals of the microneurons of Renshaw. The mechanism of the LTP at marrow level is interpreted through two physiological hypotheses concerning the circuit of Renshaw.