14 resultados para Double burden of malnutrition
em Universidad Politécnica de Madrid
Resumo:
inor actinides (MAs) transmutation is a main design objective of advanced nuclear systems such as generation IV Sodium Fast Reactors (SFRs). In advanced fuel cycles, MA contents in final high level waste packages are main contributors to short term heat production as well as to long-term radiotoxicity. Therefore, MA transmutation would have an impact on repository designs and would reduce the environment burden of nuclear energy. In order to predict such consequences Monte Carlo (MC) transport codes are used in reactor design tasks and they are important complements and references for routinely used deterministic computational tools. In this paper two promising Monte Carlo transport-coupled depletion codes, EVOLCODE and SERPENT, are used to examine the impact of MA burning strategies in a SFR core, 3600 MWth. The core concept proposal for MA loading in two configurations is the result of an optimization effort upon a preliminary reference design to reduce the reactivity insertion as a consequence of sodium voiding, one of the main concerns of this technology. The objective of this paper is double. Firstly, efficiencies of the two core configurations for MA transmutation are addressed and evaluated in terms of actinides mass changes and reactivity coefficients. Results are compared with those without MA loading. Secondly, a comparison of the two codes is provided. The discrepancies in the results are quantified and discussed.
Resumo:
The paper identifies the potential spatial and social impacts of a proposed road-pricing scheme for different social groups in the Madrid Metropolitan Area (MMA). We appraise the accessibility of different districts within the MMA in terms of the actual and perceived cost of using the road infrastructure ‘before’ and ‘after’ implementation of the scheme. The appraisal framework was developed using quantitative survey data and qualitative focus group discussions with residents. We then simulated user behaviours (mode and route choice) based on the empirical evidence from a travel demand model for the MMA. The results from our simulation model demonstrated that implementation of the toll on the orbital metropolitan motorways (M40, M30, for example) decreases accessibility mostly in the districts where there are no viable public transport alternatives. Our specific study finding is that the economic burden of the road-pricing scheme particularly affects unskilled and lower income individuals living in the south of the MMA. The focus groups confirmed that low income drivers in the south part of the MMA would reduce their use of tolled roads and have to find new arrangements for these trips: i.e. switch to public transport, spend double the time travelling or stay at home. More generally, our research finds that European transport planners are still a long way from recognising the social equity implications of their policy decisions and that more thorough social appraisals are needed to avoid the social exclusion of low income populations when road tolling is proposed.
Resumo:
The paper explores the spatial and social impacts arising from implementation of a road-pricing scheme in the Madrid Metropolitan Area (MMA). Our analytical focus is on understanding the effects of the scheme on the transport accessibility of different social groups within the MMA. We define an evaluation framework to appraise the accessibility of different districts within the MMA in terms of the actual and perceived cost of using the road infrastructure "before" and "after" the implementation of the scheme. The framework was developed using quantitative survey data and qualitative data from focus group discussions with residents. We then simulated user behaviors (mode and route choice) based on the empirical evidence from a travel demand model for the MMA. The results from our simulation model demonstrated that implementation of the toll on the orbital metropolitan motorways (M40, M30, for example) decreases accessibility, mostly in the districts where there are no viable public transport alternatives. Our key finding is that the economic burden of the road-pricing scheme particularly affects unskilled and lower income individuals living in the south of the MMA. Consequently lower income people reduce their use of tolled roads and have to find new arrangements for these trips: i.e. switch to the public transport, spend double the time for their commuter trips or stay at home. The results of our research could be applicable more widely for anyone wishing to better understand the important relationship between increased transport cost and social equity, especially where there is an intention to introduce similar road-pricing schemes within the urban context.
Resumo:
As a result of the variscan collision, several allochtonous complexes were emplaced on the Iberian margin in Devonian times, among them the Cabo Ortegal Complex comprising the Moeche ophiolitic sequence. Copper has been won from several mines (Piquitos I & II, Barqueira, Maruxa) from disseminated ores and thin massive sulphide layers in the Moeche Unit, a strongly deformed meta-volcanic sequence comprising mainly quartz-chlorite schists and mylonites, which defines the top of the ophiolite. The ores were metamorphosed and strongly deformed under brittle conditions (for pyrite), but their textures are often apparently post-deformational, due to very common solution-transfer processes; they are composed mostly of pyrite and chalcopyrite, with minor sphalerite, pyrrhotite, etc., and with traces of native gold and PGE. The geology, mineralogy, and geochemistry of the orebodies relate closely to VMS of the Cu-Zn (Cyprus) type. Fluid inclusion studies allowed an estimation of metamorphic conditions at pressures of 2/2’5 kb and T 325/350ºC. New determinations using the chlorite geothermometer yield temperatures around 320 ºC, corresponding to pressures near 2 kb according to the isochores deduced from the fluid inclusion study, although in the Barqueira mine higher temperatures, up to 350 ºC, are found, corresponding to presssures up to 2’5 kb. Pb isotopic compositions of pyrite point to a double source of Pb, i.e. a main mantle and a subordinate crustal source. The values for 87SR/86Sr in pyrite support this interpretation, but some results suggest later mobilization in an open system, corresponding to solution-transfer. Age determinations of pyrite deduced from the Pb isotope uranogenic graph, ≈ 480 Ma, do not fit with the metamorphic ages published for the Moeche Unit, and might point to the age of Pb extraction from the mantle.
Resumo:
A total of 32 samples of surficial soil were collected from 16 playground areas in Madrid (Spain), in order to investigate the importance of the geochemistry of the soil on subsequent bioaccessibility of trace elements. The in vitro bioaccessibility of As, Co, Cr, Cu, Ni, Pb and Zn was evaluated by means of two extraction processes that simulate the gastric environment and one that reproduces a gastric + intestinal digestion sequence. The results of the in vitro bioaccessibility were compared against aqua regia extractions (“total” concentration), and it was found that total concentrations of As, Cu, Pb and Zn were double those of bioaccessible values, whilst that of Cr was ten times higher. Whereas the results of the gastric + intestinal extraction were affected by a high uncertainty, both gastric methods offered very similar and consistent results, with bioaccessibilities following the order: As = Cu = Pb = Zn > Co > Ni > Cr, and ranging from 63 to 7 %. Selected soil properties including pH, organic matter, Fe and CaCO3 content were determined to assess their influence on trace element bioaccessibility, and it was found that Cu, Pb and Zn were predominantly bound to organic matter and, to a lesser extent, Fe oxides. The former fraction was readily accessible in the gastric solution, whereas Fe oxides seemed to recapture negatively charged chloride complexes of these elements in the gastric solution, lowering their bioaccessibility. The homogeneous pH of the playground soils included in the study does not influence trace element bioaccessibility to any significant extent except for Cr, where the very low gastric accessibility seems to be related to the strongly pH-dependent formation of complexes with organic matter. The results for As, which have been previously described and discussed in detail in Mingot et al. (Chemosphere 84: 1386–1391, 2011), indicate a high gastric bioaccessibility for this element as a consequence of its strong association with calcium carbonate and the ease with which these bonds are broken in the gastric solution. The calculation of risk assessments are therefore dependant on the methodology used and the specific environment they address. This has impacts on management strategies formulated to ensure that the most vulnerable of society, children, can live and play without adverse consequences to their health.
Resumo:
This paper investigates the propagation of airblast or pressure waves in air produced by bench blasting (i.e. detonation of the explosive in a row of blastholes, breaking the burden of rock towards the free vertical face of the block). Peak overpressure is calculated as a function of blasting parameters (explosive mass per delay and velocity at which the detonation sequence proceeds along the bench) and the polar coordinates of the position of interest (distance to the source and azimuth with respect to the free face). The model has been fitted to empirical data using linear least squares. The data set is composed of 122 airblast records monitored at distances less than 400 m in 41 production blasts carried out in two quarries. The model is statistically significant and has a determination coefficient of 0.87. The formula is validated from 12 airblast measurements gathered in five additional blasts.
Resumo:
New forms of natural interactions between human operators and UAVs (Unmanned Aerial Vehicle) are demanded by the military industry to achieve a better balance of the UAV control and the burden of the human operator. In this work, a human machine interface (HMI) based on a novel gesture recognition system using depth imagery is proposed for the control of UAVs. Hand gesture recognition based on depth imagery is a promising approach for HMIs because it is more intuitive, natural, and non-intrusive than other alternatives using complex controllers. The proposed system is based on a Support Vector Machine (SVM) classifier that uses spatio-temporal depth descriptors as input features. The designed descriptor is based on a variation of the Local Binary Pattern (LBP) technique to efficiently work with depth video sequences. Other major consideration is the especial hand sign language used for the UAV control. A tradeoff between the use of natural hand signs and the minimization of the inter-sign interference has been established. Promising results have been achieved in a depth based database of hand gestures especially developed for the validation of the proposed system.
Resumo:
Spider silks combine a significant number of desirable characteristics in one material, including large tensile strength and strain at breaking, biocompatibility, and the possibility of tailoring their properties. Major ampullate gland silk (MAS) is the most studied silk and their properties are explained by a double lattice of hydrogen bonds and elastomeric protein chains linked to polyalanine β-nanocrystals. However, many basic details regarding the relationship between composition, microstructure and properties in silks are still lacking. Here we show that this relationship can be traced in flagelliform silk (Flag) spun by Argiope trifasciata spiders after identifying a phase consisting of polyglycine II nanocrystals. The presence of this phase is consistent with the dominant presence of the –GGX– and –GPG– motifs in its sequence. In contrast to the passive role assigned to polyalanine nanocrystals in MAS, polyglycine II nanocrystals can undergo growing/collapse processes that contribute to increase toughness and justify the ability of Flag to supercontract.
Resumo:
El interés por los sistemas fotovoltaicos de concentración (CPV) ha resurgido en los últimos años amparado por el desarrollo de células multiunión de muy alta eficiencia basadas en semiconductores de los grupos III-V. Estas células han permitido obtener módulos de concentración con eficiencias que prácticamente duplican las del panel plano y que llegan al 35% en los módulos récord. Esta tesis está dedicada al diseño y la implementación experimental de nuevos conceptos que permitan obtener módulos CPV que no sólo alcancen una eficiencia alta en condiciones estándar sino que, además, sean lo suficientemente tolerantes a errores de montaje, seguimiento, temperatura y variaciones espectrales para que la energía que producen a lo largo del año sea máxima. Una de las primeras cuestiones que se abordan es el diseño de elementos ópticos secundarios para sistemas cuyo primario es una lente de Fresnel y que permiten, para una concentración fija, aumentar el ángulo de aceptancia y la tolerancia del sistema. Varios secundarios reflexivos y refractivos han sido diseñados y analizados mediante trazado de rayos. En particular, utilizando óptica anidólica y basándose en el diseño de una sola etapa conocido como ‘concentrador dieléctrico que funciona por reflexión total interna‘, se ha diseñado, fabricado y caracterizado un secundario con salida cuadrada que, usado junto con una lente de Fresnel, permite alcanzar simultáneamente una elevada eficiencia, concentración y aceptancia. Además, se ha propuesto y prototipado un método alternativo de fabricación para otro de los secundarios, denominado domo, consistente en el sobremoldeo de silicona sobre células solares. Una de las características que impregna todo el trabajo realizado en esta tesis es la aproximación holística en el diseño de módulos CPV, es decir, se ha prestado especial atención al diseño conjunto de la célula y la óptica para garantizar que el sistema total alcance la mayor eficiencia posible. En este sentido muchos sistemas ópticos desarrollados en esta tesis han sido diseñados, caracterizados y optimizados teniendo en cuenta que el ajuste de corriente entre las distintas subcélulas que comprenden la célula multiunión bajo el concentrador sea muy próximo a uno. La capa antirreflectante sobre la célula funciona, en cierto modo, como interfaz entre la óptica y la célula, por lo que se ha diseñado un método de optimización de capas antirreflectantes que considera no sólo el amplio rango de longitudes de onda para el que las células multiunión son sensibles sino también la distribución angular de intensidad sobre la célula creada por la óptica de concentración. Además, la cuestión de la falta de uniformidad también se ha abordado mediante la comparación de las distribuciones espectrales y espaciales de irradiancia que crean diferentes ópticas (simuladas mediante trazado de rayos y fotografiadas) y las pérdidas de eficiencia que experimentan las células iluminadas por dichas ópticas de concentración medidas experimentalmente. El efecto de la temperatura en la óptica de concentración también ha sido objeto de estudio de esta tesis. En particular, mediante simulaciones de elementos finitos se han dado los primeros pasos para el análisis de las deformaciones que sufren los dientes de las lentes de Fresnel híbridas (vidrio-silicona), así como el cambio de índice de refracción con la temperatura y la influencia de ambos efectos sobre el funcionamiento de los sistemas. Se ha implementado un modelo que tiene por objeto considerar las variaciones ambientales, principalmente temperatura y contenido espectral de la radiación directa, así como las sensibilidades térmica y espectral de los sistemas CPV, con el fin de maximizar la energía producida por un módulo de concentración a lo largo de un año en un emplazamiento determinado. Los capítulos 5 y 6 de este libro están dedicados al diseño, fabricación y caracterización de un nuevo concepto de módulo fotovoltaico denominado FluidReflex y basado en una única etapa reflexiva con dieléctrico fluido. En este nuevo concepto la presencia del fluido aporta algunas ventajas significativas como son: un aumento del producto concentración por aceptancia (CAP, en sus siglas en inglés) alcanzable al rodear la célula con un medio cuyo índice de refracción es mayor que uno, una mejora de la eficiencia óptica al disminuir las pérdidas por reflexión de Fresnel en varias interfaces, una mejora de la disipación térmica ya que el calor que se concentra junto a la célula se trasmite por convección natural y conducción en el fluido y un aislamiento eléctrico mejorado. Mediante la construcción y medida de varios prototipos de unidad elemental se ha demostrado que no existe ninguna razón fundamental que impida la implementación práctica del concepto teórico alcanzando una elevada eficiencia. Se ha realizado un análisis de fluidos candidatos probando la existencia de al menos dos de ellos que cumplen todos los requisitos (en particular el de estabilidad bajo condiciones de luz concentrada) para formar parte del sistema de concentración FluidReflex. Por ´ultimo, se han diseñado, fabricado y caracterizado varios prototipos preindustriales de módulos FluidReflex para lo cual ha sido necesario optimizar el proceso de fabricación de la óptica multicavidad a fin de mantener el buen comportamiento óptico obtenido en la fabricación de la unidad elemental. Los distintos prototipos han sido medidos, tanto en el laboratorio como bajo el sol real, analizando el ajuste de corriente de la célula iluminada por el concentrador FluidReflex bajo diferentes distribuciones espectrales de la radiación incidente así como el excelente comportamiento térmico del módulo. ABSTRACT A renewed interest in concentrating photovoltaic (CPV) systems has emerged in recent years encouraged by the development of high-efficiency multijunction solar cells based in IIIV semiconductors that have led to CPV module efficiencies which practically double that of flat panel PV and which reach 35% for record modules. This thesis is devoted to the design and experimental implementation of new concepts for obtaining CPV modules that not only achieve high efficiency under standard conditions but also have such a wide tolerance to assembly errors, tracking, temperature and spectral variations, that the energy generated by them throughout the year is maximized. One of the first addressed issues is the design of secondary optical elements whose primary optics is a Fresnel lens and which, for a fixed concentration, allow an increased acceptance angle and tolerance of the system. Several reflective and refractive secondaries have been designed and analyzed using ray tracing. In particular, using nonimaging optics and based on the single-stage design known as ‘dielectric totally internally reflecting concentrator’, a secondary with square output has been designed, fabricated and characterized. Used together with a Fresnel lens, the secondary can simultaneously achieve high efficiency, concentration and acceptance. Furthermore, an alternative method has been proposed and prototyped for the fabrication of the secondary named dome. The optics is manufactured by direct overmolding of silicone over the solar cells. One characteristic that permeates all the work done in this thesis is the holistic approach in the design of CPV modules, meaning that special attention has been paid to the joint design of the solar cell and the optics to ensure that the total system achieves the highest attainable efficiency. In this regard, many optical systems developed in the thesis have been designed, characterized and optimized considering that the current matching among the subcells within the multijunction solar cell beneath the optics must be close to one. Antireflective coating over the cell acts, somehow, as an interface between the optics and the cell. Consequently, a method has been designed to optimize antireflective coatings that takes into account not only the broad wavelength range that multijunction solar cells are sensitive to but also the angular intensity distribution created by the concentrating optics. In addition, the issue of non-uniformity has also been addressed by comparing the spectral and spatial distributions of irradiance created by different optics (simulated by ray tracing and photographed) and the efficiency losses experienced by cells illuminated by those concentrating optics experimentally determined. The effect of temperature on the concentrating optics has also been studied in this thesis. In particular, finite element simulations have been use to analyze the deformations experienced by the facets of hybrid (silicon-glass) Fresnel lenses, the change of refractive index with temperature and the influence of both effects on the system performance. A model has been implemented which take into consideration atmospheric variations, mainly temperature and spectral content of the direct normal irradiance, as well as thermal and spectral sensitivities of systems, with the aim of maximizing the energy harvested by a CPV module throughout the year in a particular location. Chapters 5 and 6 of this book are devoted to the design, fabrication, and characterization of a new concentrator concept named FluidReflex and based on a single-stage reflective optics with fluid dielectric. In this new concept, the presence of the fluid provides some significant advantages such as: an increased concentration acceptance angle product (CAP) achievable by surrounding the cell with a medium whose refractive index is greater than one, an improvement of the optical efficiency by reducing losses due to Fresnel reflection at several interfaces, an improvement in heat dissipation as the heat concentrated near the cell is transmitted by natural convection and conduction in the fluid, and an improved electrical insulation. By fabricating and characterizing several elementary-unit prototypes it was shown that there is no fundamental reason that prevents the practical implementation of this theoretical concept reaching high efficiency. Several fluid candidates were investigated proving the existence of at least to fluids that meet all the requirements (including the stability under concentrated light) to become part of the FluidReflex concentrator. Finally, several pre-industrial FluidReflex module prototypes have been designed and fabricated. An optimization process for the manufacturing of the multicavity optics was necessary to attain such an optics quality as the one achieved by the single unit. The module prototypes have been measured, both indoors and outdoors, analyzing the current matching of the solar cells beneath the concentrator for different spectral distribution of the incident irradiance. Additionally, the module showed an excellent thermal performance.
Resumo:
Blended-wing-body (BWB) aircraft are being studied with interest and effort to improve economic efficiency and to overcome operational and infrastructure related problems associated to the increasing size of conventional transport airplanes. The objective of the research reported here is to assess the aerodynamic feasibility and operational efficiency of a great size, blended wing body layout, a configuration which has many advantages. To this end, the conceptual aerodynamic design process of an 800 seat BWB has been done completed with a comparison of performance and operational issues with last generation of conventional very large aircraft. The results are greatly encouraging and predict about 20 percent increase in transport productivity efficiency, without the burden of new or aggravated safety or operational problems.
Resumo:
With the growing body of research on traumatic brain injury and spinal cord injury, computational neuroscience has recently focused its modeling efforts on neuronal functional deficits following mechanical loading. However, in most of these efforts, cell damage is generally only characterized by purely mechanistic criteria, function of quantities such as stress, strain or their corresponding rates. The modeling of functional deficits in neurites as a consequence of macroscopic mechanical insults has been rarely explored. In particular, a quantitative mechanically based model of electrophysiological impairment in neuronal cells has only very recently been proposed (Jerusalem et al., 2013). In this paper, we present the implementation details of Neurite: the finite difference parallel program used in this reference. Following the application of a macroscopic strain at a given strain rate produced by a mechanical insult, Neurite is able to simulate the resulting neuronal electrical signal propagation, and thus the corresponding functional deficits. The simulation of the coupled mechanical and electrophysiological behaviors requires computational expensive calculations that increase in complexity as the network of the simulated cells grows. The solvers implemented in Neurite-explicit and implicit-were therefore parallelized using graphics processing units in order to reduce the burden of the simulation costs of large scale scenarios. Cable Theory and Hodgkin-Huxley models were implemented to account for the electrophysiological passive and active regions of a neurite, respectively, whereas a coupled mechanical model accounting for the neurite mechanical behavior within its surrounding medium was adopted as a link between lectrophysiology and mechanics (Jerusalem et al., 2013). This paper provides the details of the parallel implementation of Neurite, along with three different application examples: a long myelinated axon, a segmented dendritic tree, and a damaged axon. The capabilities of the program to deal with large scale scenarios, segmented neuronal structures, and functional deficits under mechanical loading are specifically highlighted.
Resumo:
Background: In recent years, Spain has implemented a number of air quality control measures that are expected to lead to a future reduction in fine particle concentrations and an ensuing positive impact on public health. Objectives: We aimed to assess the impact on mortality attributable to a reduction in fine particle levels in Spain in 2014 in relation to the estimated level for 2007. Methods: To estimate exposure, we constructed fine particle distribution models for Spain for 2007 (reference scenario) and 2014 (projected scenario) with a spatial resolution of 16x16 km2. In a second step, we used the concentration-response functions proposed by cohort studies carried out in Europe (European Study of Cohorts for Air Pollution Effects and Rome longitudinal cohort) and North America (American Cancer Society cohort, Harvard Six Cities study and Canadian national cohort) to calculate the number of attributable annual deaths corresponding to all causes, all non-accidental causes, ischemic heart disease and lung cancer among persons aged over 25 years (2005-2007 mortality rate data). We examined the effect of the Spanish demographic shift in our analysis using 2007 and 2012 population figures. Results: Our model suggested that there would be a mean overall reduction in fine particle levels of 1mg/m3 by 2014. Taking into account 2007 population data, between 8 and 15 all-cause deaths per 100,000 population could be postponed annually by the expected reduction in fine particle levels. For specific subgroups, estimates varied from 10 to 30 deaths for all non-accidental causes, from 1 to 5 for lung cancer, and from 2 to 6 for ischemic heart disease. The expected burden of preventable mortality would be even higher in the future due to the Spanish population growth. Taking into account the population older than 30 years in 2012, the absolute mortality impact estimate would increase approximately by 18%. Conclusions: Effective implementation of air quality measures in Spain, in a scenario with a short-term projection, would amount to an appreciable decline infine particle concentrations, and this, in turn, would lead to notable health-related benefits. Recent European cohort studies strengthen the evidence of an association between long-term exposure to fine particles and health effects, and could enhance the health impact quantification in Europe. Air quality models can contribute to improved assessment of air pollution health impact estimates, particularly in study areas without air pollution monitoring data.
Resumo:
Hoy en día, por primera vez en la historia, la mayor parte de la población podrá vivir hasta los sesenta años y más (United Nations, 2015). Sin embargo, todavía existe poca evidencia que demuestre que las personas mayores, estén viviendo con mejor salud que sus padres, a la misma edad, ya que la mayoría de los problemas de salud en edades avanzadas están asociados a las enfermedades crónicas (WHO, 2015). Los sistemas sanitarios de los países desarrollados funcionan adecuadamente cuando se trata del cuidado de enfermedades agudas, pero no son lo suficientemente eficaces en la gestión de las enfermedades crónicas. Durante la última década, se han realizado esfuerzos para mejorar esta gestión, por medio de la utilización de estrategias de prevención y de reenfoque de la provisión de los servicios de atención para la salud (Kane et al. 2005). Según una revisión sistemática de modelos de cuidado de salud, comisionada por el sistema nacional de salud Británico, pocos modelos han conceptualizado cuáles son los componentes que hay que utilizar para proporcionar un cuidado crónico efectivo, y estos componentes no han sido suficientemente estructurados y articulados. Por lo tanto, no hay suficiente evidencia sobre el impacto real de cualquier modelo existente en la actualidad (Ham, 2006). Las innovaciones podrían ayudar a conseguir mejores diagnósticos, tratamientos y gestión de pacientes crónicos, así como a dar soporte a los profesionales y a los pacientes en el cuidado. Sin embargo, la forma en las que estas innovaciones se proporcionan no es lo suficientemente eficiente, efectiva y amigable para el usuario. Para mejorar esto, hace falta crear equipos de trabajo y estrategias multidisciplinares. En conclusión, hacen falta actividades que permitan conseguir que las innovaciones sean utilizadas en los sistemas de salud que quieren mejorar la gestión del cuidado crónico, para que sea posible: 1) traducir la “atención sanitaria basada en la evidencia” en “conocimiento factible”; 2) hacer frente a la complejidad de la atención sanitaria a través de una investigación multidisciplinaria; 3) identificar una aproximación sistemática para que se establezcan intervenciones innovadoras en el cuidado de salud. El marco de referencia desarrollado en este trabajo de investigación es un intento de aportar estas mejoras. Las siguientes hipótesis han sido propuestas: Hipótesis 1: es posible definir un proceso de traducción que convierta un modelo de cuidado crónico en una descripción estructurada de objetivos, requisitos e indicadores clave de rendimiento. Hipótesis 2: el proceso de traducción, si se ejecuta a través de elementos basados en la evidencia, multidisciplinares y de orientación económica, puede convertir un modelo de cuidado crónico en un marco descriptivo, que define el ciclo de vida de soluciones innovadoras para el cuidado de enfermedades crónicas. Hipótesis 3: es posible definir un método para evaluar procesos, resultados y capacidad de desarrollar habilidades, y asistir equipos multidisciplinares en la creación de soluciones innovadoras para el cuidado crónico. Hipótesis 4: es posible dar soporte al desarrollo de soluciones innovadoras para el cuidado crónico a través de un marco de referencia y conseguir efectos positivos, medidos en indicadores clave de rendimiento. Para verificar las hipótesis, se ha definido una aproximación metodológica compuesta de cuatro Fases, cada una asociada a una hipótesis. Antes de esto, se ha llevado a cabo una “Fase 0”, donde se han analizado los antecedentes sobre el problema (i.e. adopción sistemática de la innovación en el cuidado crónico) desde una perspectiva multi-dominio y multi-disciplinar. Durante la fase 1, se ha desarrollado un Proceso de Traducción del Conocimiento, elaborado a partir del JBI Joanna Briggs Institute (JBI) model of evidence-based healthcare (Pearson, 2005), y sobre el cual se han definido cuatro Bloques de Innovación. Estos bloques consisten en una descripción de elementos innovadores, definidos en la fase 0, que han sido añadidos a los cuatros elementos que componen el modelo JBI. El trabajo llevado a cabo en esta fase ha servido también para definir los materiales que el proceso de traducción tiene que ejecutar. La traducción que se ha llevado a cabo en la fase 2, y que traduce la mejor evidencia disponible de cuidado crónico en acción: resultado de este proceso de traducción es la parte descriptiva del marco de referencia, que consiste en una descripción de un modelo de cuidado crónico (se ha elegido el Chronic Care Model, Wagner, 1996) en términos de objetivos, especificaciones e indicadores clave de rendimiento y organizada en tres ciclos de innovación (diseño, implementación y evaluación). Este resultado ha permitido verificar la segunda hipótesis. Durante la fase 3, para demostrar la tercera hipótesis, se ha desarrollado un método-mixto de evaluación de equipos multidisciplinares que trabajan en innovaciones para el cuidado crónico. Este método se ha creado a partir del método mixto usado para la evaluación de equipo multidisciplinares translacionales (Wooden, 2013). El método creado añade una dimensión procedural al marco. El resultado de esta fase consiste, por lo tanto, en una primera versión del marco de referencia, lista para ser experimentada. En la fase 4, se ha validado el marco a través de un caso de estudio multinivel y con técnicas de observación-participante como método de recolección de datos. Como caso de estudio se han elegido las actividades de investigación que el grupo de investigación LifeStech ha desarrollado desde el 2008 para mejorar la gestión de la diabetes, actividades realizadas en un contexto internacional. Los resultados demuestran que el marco ha permitido mejorar las actividades de trabajo en distintos niveles: 1) la calidad y cantidad de las publicaciones; 2) se han conseguido dos contratos de investigación sobre diabetes: el primero es un proyecto de investigación aplicada, el segundo es un proyecto financiado para acelerar las innovaciones en el mercado; 3) a través de los indicadores claves de rendimiento propuestos en el marco, una prueba de concepto de un prototipo desarrollado en un proyecto de investigación ha sido transformada en una evaluación temprana de una intervención eHealth para el manejo de la diabetes, que ha sido recientemente incluida en Repositorio de prácticas innovadoras del Partenariado de Innovación Europeo en Envejecimiento saludable y activo. La verificación de las 4 hipótesis ha permitido demonstrar la hipótesis principal de este trabajo de investigación: es posible contribuir a crear un puente entre la atención sanitaria y la innovación y, por lo tanto, mejorar la manera en que el cuidado crónico sea procurado en los sistemas sanitarios. ABSTRACT Nowadays, for the first time in history, most people can expect to live into their sixties and beyond (United Nations, 2015). However, little evidence suggests that older people are experiencing better health than their parents, and most of the health problems of older age are linked to Chronic Diseases (WHO, 2015). The established health care systems in developed countries are well suited to the treatment of acute diseases but are mostly inadequate for dealing with CDs. Healthcare systems are challenging the burden of chronic diseases by putting more emphasis on the prevention of disease and by looking for new ways to reorient the provision of care (Kane et al., 2005). According to an evidence-based review commissioned by the British NHS Institute, few models have conceptualized effective components of care for CDs and these components have been not structured and articulated. “Consequently, there is limited evidence about the real impact of any of the existing models” (Ham, 2006). Innovations could support to achieve better diagnosis, treatment and management for patients across the continuum of care, by supporting health professionals and empowering patients to take responsibility. However, the way they are delivered is not sufficiently efficient, effective and consumer friendly. The improvement of innovation delivery, involves the creation of multidisciplinary research teams and taskforces, rather than just working teams. There are several actions to improve the adoption of innovations from healthcare systems that are tackling the epidemics of CDs: 1) Translate Evidence-Based Healthcare (EBH) into actionable knowledge; 2) Face the complexity of healthcare through multidisciplinary research; 3) Identify a systematic approach to support effective implementation of healthcare interventions through innovation. The framework proposed in this research work is an attempt to provide these improvements. The following hypotheses have been drafted: Hypothesis 1: it is possible to define a translation process to convert a model of chronic care into a structured description of goals, requirements and key performance indicators. Hypothesis 2: a translation process, if executed through evidence-based, multidisciplinary, holistic and business-oriented elements, can convert a model of chronic care in a descriptive framework, which defines the whole development cycle of innovative solutions for chronic disease management. Hypothesis 3: it is possible to design a method to evaluate processes, outcomes and skill acquisition capacities, and assist multidisciplinary research teams in the creation of innovative solutions for chronic disease management. Hypothesis 4: it is possible to assist the development of innovative solutions for chronic disease management through a reference framework and produce positive effects, measured through key performance indicators. In order to verify the hypotheses, a methodological approach, composed of four Phases that correspond to each one of the stated hypothesis, was defined. Prior to this, a “Phase 0”, consisting in a multi-domain and multi-disciplinary background analysis of the problem (i.e.: systematic adoption of innovation to chronic care), was carried out. During phase 1, in order to verify the first hypothesis, a Knowledge Translation Process (KTP) was developed, starting from the JBI Joanna Briggs Institute (JBI) model of evidence-based healthcare was used (Pearson, 2005) and adding Four Innovation Blocks. These blocks represent an enriched description, added to the JBI model, to accelerate the transformation of evidence-healthcare through innovation; the innovation blocks are built on top of the conclusions drawn after Phase 0. The background analysis gave also indication on the materials and methods to be used for the execution of the KTP, carried out during phase 2, that translates the actual best available evidence for chronic care into action: this resulted in a descriptive Framework, which is a description of a model of chronic care (the Chronic Care Model was chosen, Wagner, 1996) in terms of goals, specified requirements and Key Performance Indicators, and articulated in the three development cycles of innovation (i.e. design, implementation and evaluation). Thanks to this result the second hypothesis was verified. During phase 3, in order to verify the third hypothesis, a mixed-method to evaluate multidisciplinary teams working on innovations for chronic care, was created, based on a mixed-method used for the evaluation of Multidisciplinary Translational Teams (Wooden, 2013). This method adds a procedural dimension to the descriptive component of the Framework, The result of this phase consisted in a draft version of the framework, ready to be tested in a real scenario. During phase 4, a single and multilevel case study, with participant-observation data collection, was carried out, in order to have a complete but at the same time multi-sectorial evaluation of the framework. The activities that the LifeStech research group carried out since 2008 to improve the management of diabetes have been selected as case study. The results achieved showed that the framework allowed to improve the research activities in different directions: the quality and quantity of the research publications that LifeStech has issued, have increased substantially; 2 project grants to improve the management of diabetes, have been assigned: the first is a grant funding applied research while the second is about accelerating innovations into the market; by using the assessment KPIs of the framework, the proof of concept validation of a prototype developed in a research project was transformed into an early stage assessment of innovative eHealth intervention for Diabetes Management, which has been recently included in the repository of innovative practice of the European Innovation Partnership on Active and Health Ageing initiative. The verification of the 4 hypotheses lead to verify the main hypothesis of this research work: it is possible to contribute to bridge the gap between healthcare and innovation and, in turn, improve the way chronic care is delivered by healthcare systems.
Resumo:
La aparición y avance de la enfermedad del marchitamiento del pino (Pine Wilt Desease, PWD), causada por Bursaphelenchus xylophilus (Nematoda; Aphelenchoididae), el nematodo de la madera del pino (NMP), en el suroeste de Europa, ha puesto de manifiesto la necesidad de estudiar la fenología y la dispersión de su único vector conocido en Europa, Monochamus galloprovincialis (Col., Cerambycidae). El análisis de 12 series de emergencias entre 2010 y 2014, registradas en Palencia, València y Teruel, con material procedente de diversos puntos de la península ibérica, demostró una alta variabilidad en la fenología de M. galloprovincialis y la divergencia térmica respecto de las poblaciones portuguesas. Para éstas, el establecimiento de los umbrales térmicos de desarrollo de las larvas post-dormantes del vector (12,2 y 33,5ºC) permitió la predicción de la emergencia mediana para la fecha en la que se acumulaban de 822 grados-día. Ninguna de las series analizadas en este trabajo necesitó de dichos grados-día estimados para la emergencia mediana. Asimismo, la emergencia se adelantó en las regiones más calurosas, mientras que se retrasó en las zonas más templadas. Más allá de la posible variabilidad entre poblaciones locales peninsulares, se detectaron indicios de que la diferencia en la acumulación de calor durante el otoño puede afectar el grado de maduración de las larvas invernantes, y su posterior patrón temporal de emergencia. Por último, también fueron observados comportamientos de protandria en las emergencias. Respecto a la fenología de su vuelo, entre los años 2010 y 2015, fueron ejecutados un total de 8 experimentos de captura de M. galloprovincialis mediante trampas cebadas con atrayentes en diferentes regiones (Castellón, Teruel, Segovia y Alicante) permitiendo el seguimiento del periodo de vuelo. Su análisis permitió constatar la disminución de las capturas y el acortamiento del periodo de vuelo con la altitud, el inicio del vuelo en el mes de mayo/junio a partir de los 14ºC de temperatura media diaria, la influencia de las altas temperaturas en la disminución de las capturas estivales (potencial causante de perfiles bimodales en las curvas de vuelo en las zonas menos frías), la evolución de la proporción de sexos a lo largo del periodo de vuelo (que muestra una mayor captura de hembras al inicio y de machos al final) y el comportamiento diurno y ligado a las altas temperaturas del vuelo circadiano del insecto. Dos redes de muestreo sistemático de insectos saproxílicos instaladas en la Comunitat Valencia (Red MUFFET, 15 parcelas, año 2013) y en Murcia (Red ESFP, 20 parcelas, años 2008-2010) permitieron el estudio de la comunidad de insectos relacionada con M. galloprovincialis. Cada una de las parcelas contaba con una trampa cebada con atrayentes y una estación meteorológica. El registro de más de 250 especies de coleópteros saproxílicos demostró el potencial que tiene el empleo de redes de trampas vigía para la detección temprana de organismos exóticos, además de permitir la caracterización y evaluación de las comunidades de entomofauna útil, representando una de las mejores herramientas de la gestión integrada de plagas. En este caso, la comunidad de saproxílicos estudiada mostró ser muy homogénea respecto a la variación ambiental de las zonas de muestreo, y que pese a las pequeñas variaciones entre las comunidades de los diferentes ecosistemas, el rol que M. galloprovincialis desempeña en ellas a lo largo de todo el gradiente estudiado es el mismo. Con todo, el análisis mediante redes de interacción mostró su relevancia ecológica al actuar de conector entre los diferentes niveles tróficos. Por último, un total de 12 experimentos de marcaje-liberación-recaptura desarrollados entre 2009 y 2012 en Castellón, Teruel, Valencia y Murcia permitieron evaluar el comportamiento dispersivo de M. galloprovincialis. Las detecciones mediante trampas cebadas de los insectos liberados se dieron por lo menos 8 días después de la emergencia. La abundancia de población pareció relacionada con la continuidad, la naturalización de la masa, y con la afección previa de incendios. La dispersión no estuvo influida por la dirección ni la intensidad de los vientos dominantes. La abundancia de material hospedante (en lo referente a las variables de masa y a los índices de competencia) influyó en la captura del insecto en paisajes fragmentados, aunque la ubicación de las trampas optimizó el número de capturas cuando se ubicaron en el límite de la masa y en zonas visibles. Por último también se constató que M. galloprovincialis posee suficiente capacidad de dispersión como para recorrer hasta 1500 m/día, llegando a alcanzar distancias máximas de 13600m o de 22100 m. ABSTRACT The detection and expansion of the Pine Wilt Desease (PWD), caused by Bursaphelenchus xylophilus (Nematoda; Aphelenchoididae), Pine Wood Nematode (PWN), in southwestern Europe since 1999, has triggered off the study of the phenology and the dispersion of its unique vector in the continent, Monochamus galloprovincialis (Coleoptera, Cerambycidae). The analysis of 12 emergence series between 2010 and 2014 registered in Palencia, Teruel and Valencia (Spain), registered from field colonized material collected at several locations of the Iberian Peninsula, showed a high variability in the emergence phenology of M. galloprovincialis. In addition, these patterns showed a very acute thermal divergence regarding a development model fitted earlier in Portugal. Such model forecasted the emergence of 50% of M. galloprovincialis individuals in the Setúbal Peninsula (Portugal) when an average of 822 degree-days (DD) were reached, based on the accumulation of heat from the 1st of March until emergence and lower and upper thresholds of 12.2 ºC and 33,5 °C respectively. In our results, all analyzed series needed less than 822 DD to complete the 50% of the emergence. Also, emergency occurred earlier in the hottest regions, while it was delayed in more temperate areas. Beyond the possible variability between local populations, the difference in the heat accumulation during the fall season may have affected the degree of maturation of overwintering larvae, and subsequently, the temporal pattern of M. galloprovincialis emergences. Therefore these results suggest the need to differentiate local management strategies for the PWN vector, depending on the location, and the climatic variables of each region. Finally, protandrous emergence patterns were observed for M. galloprovincialis in most of the studied data-sets. Regarding the flight phenology of M. galloprovincialis, a total of 8 trapping experiments were carried out in different regions of the Iberian Peninsula (Castellón, Teruel, Segovia and Alicante) between 2010 and 2015. The use of commercial lures and traps allowed monitoring of the flight period of M. galloprovincialis. The analyses of such curves, helped confirming different aspects. First, a decline in the number of catches and a shortening of the flight period was observed as the altitude increased. Flight period was recorded to start in May / June when the daily average temperature went over 14 ° C. A significant influence of high temperatures on the decrease of catches in the summer was found in many occasions, which frequently lead to a bimodal profile of the flight curves in warm areas. The evolution of sex ratio along the flight period shows a greater capture of females at the beginning of the period, and of males at the end. In addition, the circadian response of M. galloprovincialis to lured traps was described for the first time, concluding that the insect is diurnal and that such response is linked to high temperatures. Two networks of systematic sampling of saproxylic insects were installed in the Region of Valencia (Red MUFFET, 15 plots, 2013) and Murcia (Red ICPF, 20 plots, 2008-2010). These networks, intended to serve the double purpose of early-detection and long term monitoring of the saproxylic beetle assemblies, allowed the study of insect communities related to M. galloprovincialis. Each of the plots had a trap baited with attractants and a weather station. The registration of almost 300 species of saproxylic beetles demonstrated the potential use of such trapping networks for the early detection of exotic organisms, while at the same time allows the characterization and evaluation of useful entomological fauna communities, representing one of the best tools for the integrated pest management. In this particular case, the studied community of saproxylic beetles was very homogeneous with respect to environmental variation of the sampling areas, and despite small variations between communities of different ecosystems, the role that M. galloprovincialis apparently plays in them across the studied gradient seems to be the same. However, the analysis through food-webs showed the ecological significance of M. galloprovincialis as a connector between different trophic levels. Finally, 12 mark-release-recapture experiments were carried out between 2009 and 2012 in Castellón, Teruel, Valencia and Murcia (Spain) with the aim to describe the dispersive behavior of M. galloprovincialis as well as the stand and landscape characteristics that could influence its abundance and dispersal. No insects younger than 8 days were caught in lured traps. Population abundance estimates from mark-release-recapture data, seemed related to forest continuity, naturalization, and to prior presence of forest fires. On the other hand, M. galloprovincialis dispersal was not found to be significantly influenced by the direction and intensity of prevailing winds. The abundance of host material, very related to stand characteristics and spacing indexes, influenced the insect abundance in fragmented landscapes. In addition, the location of the traps optimized the number of catches when they were placed in the edge of the forest stands and in visible positions. Finally it was also found that M. galloprovincialis is able to fly up to 1500 m / day, reaching maximum distances of up to 13600 m or 22100 m.