Efficacy and safety of autologous platelet rich plasma for the treatment of vascular ulcers in primary care: Phase III study

Background: Vascular ulcers are commonly seen in daily practice at all levels of care and have great impact at personal, professional and social levels with a high cost in terms of human and material resources. Given that the application of autologous platelet rich plasma has been shown to decrease healing times in various different studies in the hospital setting, we considered that it would be interesting to assess the efficacy and feasibility of this treatment in primary care. The objectives of this study are to assess the potential efficacy and safety of autologous platelet rich plasma for the treatment of venous ulcers compared to the conventional treatment (moist wound care) in primary care patients with chronic venous insufficiency (C, clinical class, E, aetiology, A, anatomy and P, pathophysiology classification C6). Design: We will conduct a phase III, open-label, parallel-group, multicentre, randomized study. The subjects will be 150 patients aged between 40 and 100 years of age with an at least 2-month history of a vascular venous ulcer assigned to ten primary care centres. For the treatment with autologous platelet rich plasma, all the following tasks will be performed in the primary care setting: blood collection, centrifugation, separation of platelet rich plasma, activation of coagulation adding calcium chloride and application of the PRP topically after gelification. The control group will receive standard moist wound care. The outcome variables to be measured at baseline, and at weeks 5 and 9 later include: reduction in the ulcer area, Chronic Venous Insufficiency Quality of Life Questionnaire score, and percentage of patients who require wound care only once a week. Discussion: The results of this study will be useful to improve the protocol for using platelet rich plasma in chronic vascular ulcers and to favour wider use of this treatment in primary care.

In Vitro Surfactant and Perfluorocarbon Aerosol Deposition in a Neonatal Physical Model of the Upper Conducting Airways

Objective: Aerosol delivery holds potential to release surfactant or perfluorocarbon (PFC) to the lungs of neonates with respiratory distress syndrome with minimal airway manipulation. Nevertheless, lung deposition in neonates tends to be very low due to extremely low lung volumes, narrow airways and high respiratory rates. In the present study, the feasibility of enhancing lung deposition by intracorporeal delivery of aerosols was investigated using a physical model of neonatal conducting airways. Methods: The main characteristics of the surfactant and PFC aerosols produced by a nebulization system, including the distal air pressure and air flow rate, liquid flow rate and mass median aerodynamic diameter (MMAD), were measured at different driving pressures (4-7 bar). Then, a three-dimensional model of the upper conducting airways of a neonate was manufactured by rapid prototyping and a deposition study was conducted. Results: The nebulization system produced relatively large amounts of aerosol ranging between 0.3 +/- 0.0 ml/min for surfactant at a driving pressure of 4 bar, and 2.0 +/- 0.1 ml/min for distilled water (H(2)Od) at 6 bar, with MMADs between 2.61 +/- 0.1 mu m for PFD at 7 bar and 10.18 +/- 0.4 mu m for FC-75 at 6 bar. The deposition study showed that for surfactant and H(2)Od aerosols, the highest percentage of the aerosolized mass (similar to 65%) was collected beyond the third generation of branching in the airway model. The use of this delivery system in combination with continuous positive airway pressure set at 5 cmH(2)O only increased total airway pressure by 1.59 cmH(2)O at the highest driving pressure (7 bar). Conclusion: This aerosol generating system has the potential to deliver relatively large amounts of surfactant and PFC beyond the third generation of branching in a neonatal airway model with minimal alteration of pre-set respiratory support.

Effectiveness of a Multi-Component Smoking Cessation Support Programme (McSCSP) for Patients with Severe Mental Disorders: Study Design

Only a few studies have examined the efficacy and safety of smoking cessation programmes in patients with mental disorders. The aim of this paper is to describe in detail the methodology used in the study as well as the Multi-component Smoking Cessation Support Programme in terms of pharmacological treatments and psychological interventions. An open-label 9-month follow-up study was conducted in Spain. A total of 82 clinically stable outpatients with schizophrenia, schizoaffective or bipolar disorder were enrolled. Treatment consisted of a programme specifically developed by the research team for individuals with severe mental disorders. The programme consisted of two phases: (1) weekly individual motivational therapy for 4-12 weeks, and (2) a 12-week active treatment phase. During this phase, at each study visit patients received a one- or two-week supply of medication (transdermal nicotine patches, varenicline or bupropion) with instructions on how to take it, in addition to group psychotherapy for smoking cessation. Evaluations were performed: (1) at the time of enrolment in the study, (2) during the 12-week active treatment phase of the study (weekly for the first 4 weeks and then biweekly), and (3) after the end of this phase (two follow-up assessments at weeks 12 and 24). Evaluations included: (1) smoking history, (2) substance use, (3) psychopathology, (4) adverse events, and (5) laboratory tests. The importance of this study lies in addressing a topical issue often ignored by psychiatrists: the unacceptably high rates of tobacco use in patients with severe mental disorders.

Efficacy of a cognitive and behavioural psychotherapy applied by primary care psychologists in patients with mixed anxiety-depressive disorder: a research protocol

Background: In contrast with the recommendations of clinical practice guidelines, the most common treatment for anxiety and depressive disorders in primary care is pharmacological. The aim of this study is to assess the efficacy of a cognitive-behavioural psychological intervention, delivered by primary care psychologists in patients with mixed anxiety-depressive disorder compared to usual care. Methods/Design: This is an open-label, multicentre, randomized, and controlled study with two parallel groups. A random sample of 246 patients will be recruited with mild-to-moderate mixed anxiety-depressive disorder, from the target population on the lists of 41 primary care doctors. Patients will be randomly assigned to the intervention group, who will receive standardised cognitive-behavioural therapy delivered by psychologists together with usual care, or to a control group, who will receive usual care alone. The cognitive-behavioural therapy intervention is composed of eight individual 60-minute face-to face sessions conducted in eight consecutive weeks. A follow-up session will be conducted over the telephone, for reinforcement or referral as appropriate, 6 months after the intervention, as required. The primary outcome variable will be the change in scores on the Short Form-36 General Health Survey. We will also measure the change in the frequency and intensity of anxiety symptoms (State-Trait Anxiety Inventory) and depression (Beck Depression Inventory) at baseline, and 3, 6 and 12 months later. Additionally, we will collect information on the use of drugs and health care services. Discussion: The aim of this study is to assess the efficacy of a primary care-based cognitive-behavioural psychological intervention in patients with mixed anxiety-depressive disorder. The international scientific evidence has demonstrated the need for psychologists in primary care. However, given the differences between health policies and health services, it is important to test the effect of these psychological interventions in our geographical setting.

An Open and Social Spaced Repetition System for Language Learning

In the last decades big improvements have been done in the field of computer aided learning, based on improvements done in computer science and computer systems. Although the field has been always a bit lagged, without using the latest solutions, it has constantly gone forward taking profit of the innovations as they show up. As long as the train of the computer science does not stop (and it won’t at least in the near future) the systems that take profit of those improvements will not either, because we humans will always need to study; Sometimes for pleasure and some other many times out of need. Not all the attempts in the field of computer aided learning have been in the same direction. Most of them address one or some few of the problems that show while studying and don’t take into account solutions proposed for some other problems. The reasons for this can be varied. Sometimes the solutions simply are not compatible. Some other times, because the project is an investigation it’s interesting to isolate the problem. And, in commercial products, licenses and patents often prevent the new projects to use previous work. The world moved forward and this is an attempt to use some of the options offered by technology, mixing some old ideas with new ones.

Open Personalization: Involving Third Parties in Improving the User Experience of Websites

Traditional software development captures the user needs during the requirement analysis. The Web makes this endeavour even harder due to the difficulty to determine who these users are. In an attempt to tackle the heterogeneity of the user base, Web Personalization techniques are proposed to guide the users’ experience. In addition, Open Innovation allows organisations to look beyond their internal resources to develop new products or improve existing processes. This thesis sits in between by introducing Open Personalization as a means to incorporate actors other than webmasters in the personalization of web applications. The aim is to provide the technological basis that builds up a trusty environment for webmasters and companion actors to collaborate, i.e. "an architecture of participation". Such architecture very much depends on these actors’ profile. This work tackles three profiles (i.e. software partners, hobby programmers and end users), and proposes three "architectures of participation" tuned for each profile. Each architecture rests on different technologies: a .NET annotation library based on Inversion of Control for software partners, a Modding Interface in JavaScript for hobby programmers, and finally, a domain specific language for end-users. Proof-of-concept implementations are available for the three cases while a quantitative evaluation is conducted for the domain specific language.

The basque ecological debt: global socioecological impacts of a small open economy

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Evaluation of Fentanyl Disposition and Effects in Newborn Piglets as an Experimental Model for Human Neonates

Background: Fentanyl is widely used off-label in NICU. Our aim was to investigate its cerebral, cardiovascular and pulmonary effects as well as pharmacokinetics in an experimental model for neonates. Methods: Fentanyl (5 mu g/kg bolus immediately followed by a 90 minute infusion of 3 mu g/kg/h) was administered to six mechanically ventilated newborn piglets. Cardiovascular, ventilation, pulmonary and oxygenation indexes as well as brain activity were monitored from T = 0 up to the end of experiments (T = 225-300 min). Also plasma samples for quantification of fentanyl were drawn. Results: A "reliable degree of sedation" was observed up to T = 210-240 min, consistent with the selected dosing regimen and the observed fentanyl plasma levels. Unlike cardiovascular parameters, which were unmodified except for an increasing trend in heart rate, some of the ventilation and oxygenation indexes as well as brain activity were significantly altered. The pulmonary and brain effects of fentanyl were mostly recovered from T = 210 min to the end of experiment. Conclusion: The newborn piglet was shown to be a suitable experimental model for studying fentanyl disposition as well as respiratory and cardiovascular effects in human neonates. Therefore, it could be extremely useful for further investigating the drug behaviour under pathophysiological conditions.

Anisotropic expansion and SNIa: An open issue

We review the appropriateness of using SNIa observations to detect potential signatures of anisotropic expansion in the Universe. We focus on Union2 and SNLS3 SNIa datasets and use the hemispherical comparison method to detect possible anisotropic features. Unlike some previous works where nondiagonal elements of the covariance matrix were neglected, we use the full covariance matrix of the SNIa data, thus obtaining more realistic and not underestimated errors. As a matter of fact, the significance of previously claimed detections of a preferred direction in the Union2 dataset completely disappears once we include the effects of using the full covariance matrix. Moreover, we also find that such apreferred direction is aligned with the orthogonal direction of the SDSS observational plane and this suggests a clear indication that the SDSS subsample of the Union2 dataset introduces a significant bias, making the detected preferred direction unphysical. We thus find that current SNIa surveys are inappropriate to test anisotropic features due to their highly non-homogeneous angular distribution in the sky. In addition, after removal of the highest in homogeneous sub-samples, the number of SNIa is too low. Finally, we take advantage of the particular distribution of SNLS SNIa sub- sample in the SNLS3 data set, in which the observations were taken along four different directions. We fit each direction independently and find consistent results at the 1 sigma level. Although the likelihoods peak at relatively different values of Omega(m), the low number of data along each direction gives rise to large errors so that the likelihoods are sufficiently broad as to overlap within 1 sigma. (C) 2014 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http:// creativecommons. org/licenses/by/4.0/).