Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

Improving Information Problem Solving skills in Secondary Education through embedded instruction

This empirical study consists in an investigation of the effects, on the development of Information Problem Solving (IPS) skills, of a long-term embedded, structured and supported instruction in Secondary Education. Forty secondary students of 7th and 8th grades (13–15 years old) participated in the 2-year IPS instruction designed in this study. Twenty of them participated in the IPS instruction, and the remaining twenty were the control group. All the students were pre- and post-tested in their regular classrooms, and their IPS process and performance were logged by means of screen capture software, to warrant their ecological validity. The IPS constituent skills, the web search sub-skills and the answers given by each participant were analyzed. The main findings of our study suggested that experimental students showed a more expert pattern than the control students regarding the constituent skill ‘defining the problem’ and the following two web search sub-skills: ‘search terms’ typed in a search engine, and ‘selected results’ from a SERP. In addition, scores of task performance were statistically better in experimental students than in control group students. The paper contributes to the discussion of how well-designed and well-embedded scaffolds could be designed in instructional programs in order to guarantee the development and efficiency of the students’ IPS skills by using net information better and participating fully in the global knowledge society.

Time and space: genetic structure of the common sea urchin paracentrotus lividus in the south-eastern iberian coast

Spatio-temporal variability in settlement and recruitment, high mortality during the first life-history stages, and selection may determine the genetic structure of cohorts of long-lived marine invertebrates at small scales. We conducted a spatial and temporal analysis of the common Mediterranean Sea urchin Paracentrotus lividus to determine the genetic structure of cohorts at different scales. In Tossa de Mar (NW Mediterranean), recruitment was followed over 5 consecutive springs (2006-2010). In spring 2008, recruits and two-year-old individuals were collected at 6 locations along East and South Iberian coasts separated from 200 to over 1,100 km. All cohorts presented a high genetic diversity based on a fragment of mtCOI. Our results showed a marked genetic homogeneity in the temporal monitoring and a low degree of spatial structure in 2006. In 2008, coupled with an abnormality in the usual circulation patterns in the area, the genetic structure of the southern populations studied changed markedly, with arrival of many private haplotypes. This fact highlights the importance of point events in renewing the genetic makeup of populations, which can only be detected through analysis of the cohort structure coupling temporal and spatial perspectives.

All-sky search algorithms for monochromatic signals in bar gravitational wave detector data

In this paper we design and develop several filtering strategies for the analysis of data generated by a resonant bar gravitational wave (GW) antenna, with the goal of assessing the presence (or absence) therein of long-duration monochromatic GW signals, as well as the eventual amplitude and frequency of the signals, within the sensitivity band of the detector. Such signals are most likely generated in the fast rotation of slightly asymmetric spinning stars. We develop practical procedures, together with a study of their statistical properties, which will provide us with useful information on the performance of each technique. The selection of candidate events will then be established according to threshold-crossing probabilities, based on the Neyman-Pearson criterion. In particular, it will be shown that our approach, based on phase estimation, presents a better signal-to-noise ratio than does pure spectral analysis, the most common approach.

Systems Medicine and Integrated Care to Combat Chronic Noncommunicable Diseases.

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

Organización de la reanimación cardiopulmonar intrahospitalaria. Situación actual en España.

La parada cardiorrespiratoria (PCR) dentro del hospital es considerada una emergencia vital y está demostrado que existe una relación directa entre la respuesta asistencial y la mortalidad asociada a este evento. Los resultados del tratamiento de la PCR son un indicador de calidad de los centros sanitarios. En el caso en concreto de España, la mayoría de hospitales no disponen de un sistema organizado e integral de atención a la PCR. A pesar de los avances en medicina y tecnológicos, la tasa de supervivencia no ha variado significativamente en los últimos 30 años por lo que se ha de considerar como un problema social, económico y sanitario de gran magnitud que cabe abordar con todas las herramientas disponibles. Objetivos: Conocer cómo se organiza la reanimación cardiopulmonar (RCP) dentro del hospital y conocer los planes integrales de RCP publicados por los hospitales españoles. Metodología: Se realiza una revisión de la literatura a través de las bibliotecas indexadas Pubmed y Web of Science mediante criterios de inclusión/exclusión, uso de operadores booleanos y búsqueda bibliográfica manual. Además se realiza una entrevista a un médico referente nacional en la investigación sobre RCP. Resultados: Se han encontrado 7 planes integrales para la atención a la PCR y solo 2 de ellos están avalados por el Plan Nacional de RCP (PNRCP), miembro del Consejo Español de RCP (CERCP). Conclusiones: Existe una falta de publicaciones por parte de los hospitales españoles sobre planes integrales para la organización de la RCP que cumplan los criterios de calidad necesarios. Si bien todos los hospitales disponen de protocolos propios dirigidos a sus profesionales para la actuación en caso de PCR, estos son de uso interno y solo tienen en común entre ellos el hecho de seguir las recomendaciones de las guías del European Resuscitation Council (ERC). III Es necesario que los centros sanitarios fomenten y compartan su actividad investigadora sobre el tema. Palabras clave: parada cardíaca hospitalaria, resucitación cardiopulmonar, Plan hospitalario de resucitación.

El poblament tardoantic al sector meridional de la Tarraconensis (sud de Catalunya i nord del País Valencià). Concomitàncies i diferències

Les darreres recerques dutes a terme en el Projecte Ager Tarraconensis (PAT) han permès augmentar considerablement els coneixements existents sobre l’antiguitat tardana al territorium de Tarraco, tema que ja havíem estudiat parcialment en la nostra tesi doctoral (1992), que inclou també altres àrees del Camp de Tarragona no incloses al PAT. D’altra banda, en els darrers anys hem tingut també ocasió d’estudiar parcialment el poblament antic a la zona de les terres de l’Ebre i al nord del País Valencià, molt especialment a les comarques de l’Alt Palància i la Plana de Castelló. El conjunt d’aquests estudis ens permet plantejar una visió general sobre el poblament tardoantic en una zona determinada que correspon a la part costanera meridional de l’antiga provincia Tarraconensis, amb els límits i la denominació que rep a partir de la divisió de Dioclecià. L’estudi comparatiu del poblament tardoantic d’aquestes àrees permet contrastar, a més de punts en comú, també algunes diferències, tant en el diferent grau de pervivència dels hàbitats després de la crisi del segle III com en l’aparició de nous tipus d’hàbitats (poblats en altura) que no apareixen en totes les àrees, sinó només en les més meridionals. S’aborda també la problemàtica de l’existència d’unes poques vil·les luxoses durant el segle IV (especialment la controvertida de Centcelles), en contrast amb altres hàbitats més modestos, així com el pas de la vil·la a un altre tipus de poblament dispers.

Net Neutrality: Measuring the Problem, Assessing the Legal Risks

Network neutrality is a growing policy controversy. Traffic management techniques affect not only high-speed, high-money content, but by extension all other content too. Internet regulators and users may tolerate much more discrimination in the interests of innovation. For instance, in the absence of regulatory oversight, ISPs could use Deep Packet Inspection (DPI) to block some content altogether, if they decide it is not to the benefit of ISPs, copyright holders, parents or the government. ISP blocking is currently widespread in controlling spam email, and in some countries in blocking sexually graphic illegal images. In 1999 this led to scrutiny of foreclosure of Instant Messaging and video and cable-telephony horizontal merger. Fourteen years later, there were in 2013 net neutrality laws implemented in Slovenia, the Netherlands, Chile and Finland, regulation in the United States and Canada , co-regulation in Norway, and self-regulation in Japan, the United Kingdom and many other European countries . Both Germany and France in mid-2013 debated new net neutrality legislation, and the European Commission announced on 11 September 2013 that it would aim to introduce legislation in early 2014. This paper analyses these legal developments, and in particular the difficulty in assessing reasonable traffic management and ‘specialized’ (i.e. unregulated) faster services in both EU and US law. It also assesses net neutrality law against the international legal norms for user privacy and freedom of expression

A common cognitive, psychiatric, and dysmorphic phenotype in carriers of NRXN1 deletion

Deletions in the 2p16.3 region that includes the neurexin (NRXN1) gene are associated with intellectual disability and various psychiatric disorders, in particular, autism and schizophrenia. We present three unrelated patients, two adults and one child, in whom we identified an intragenic 2p16.3 deletion within the NRXN1 gene using an oligonucleotide comparative genomic hybridization array. The three patients presented dual diagnosis that consisted of mild intellectual disability and autism and bipolar disorder. Also, they all shared a dysmorphic phenotype characterized by a long face, deep set eyes, and prominent premaxilla. Genetic analysis of family members showed two inherited deletions. A comprehensive neuropsychological examination of the 2p16.3 deletion carriers revealed the same phenotype, characterized by anxiety disorder, borderline intelligence, and dysexecutive syndrome. The cognitive pattern of dysexecutive syndrome with poor working memory and reduced attention switching, mental flexibility, and verbal fluency was the same than those of the adult probands. We suggest that in addition to intellectual disability and psychiatric disease, NRXN1 deletion is a risk factor for a characteristic cognitive and dysmorphic profile. The new cognitive phenotype found in the 2p16.3 deletion carriers suggests that 2p16.3 deletions might have a wide variable expressivity instead of incomplete penetrance

Spermiogenesis and spermatozoon ultrastructure of the diphyllidean cestode Echinobothrium euterpes (Neifar, Tyler and Euzet 2001) Tyler 2006, a parasite of the common guitarfish Rhinobatos rhinobatos

Spermiogenesis and the ultrastructural characters of the spermatozoon of Echinobothrium euterpes are described by means of transmission electron microscopy, including cytochemical analysis for glycogen. Materials were obtained from a common guitarfish Rhinobatos rhinobatos caught in the Gulf of Gabès (Tunisia). Spermiogenesis in E. euterpes is characterized by the orthogonal development of two unequal flagella followed by the flagellar rotation and the proximodistal fusion of these flagella with the median cytoplasmic process. The most interesting pattern characterizing the diphyllidean cestodes is the presence of a triangular body constituted by fines and dense granules without visible striation and assimilated at the striated rootlets. This pattern, only related in the Diphyllidea cestodes may be a synapomorphy of this order. Spermiogenesis is also characterized by the presence of a very short flagellum (around 1 μm long), observed in all the stages of spermiogenesis. This type of flagellum has never been commented in the diphyllidean cestodes and should be considered as an evolved character in this group. In the latest stage of spermiogenesis, this short axoneme probably degenerates. Thus, the mature spermatozoon of E. euterpes possesses only one axoneme of 9 + '1' trepaxonematan pattern. It also exhibits a single helical electron-dense crested body, a spiraled nucleus, few parallel cortical microtubules, and α-glycogen granules. Similitudes and differences between spermatozoa of diphyllideans are discussed.

Spermiogenesis and spermatozoon ultrastructure of the diphyllidean cestode Echinobothrium euterpes (Neifar, Tyler and Euzet 2001) Tyler 2006, a parasite of the common guitarfish Rhinobatos rhinobatos

Spermiogenesis and the ultrastructural characters of the spermatozoon of Echinobothrium euterpes are described by means of transmission electron microscopy, including cytochemical analysis for glycogen. Materials were obtained from a common guitarfish Rhinobatos rhinobatos caught in the Gulf of Gabès (Tunisia). Spermiogenesis in E. euterpes is characterized by the orthogonal development of two unequal flagella followed by the flagellar rotation and the proximodistal fusion of these flagella with the median cytoplasmic process. The most interesting pattern characterizing the diphyllidean cestodes is the presence of a triangular body constituted by fines and dense granules without visible striation and assimilated at the striated rootlets. This pattern, only related in the Diphyllidea cestodes may be a synapomorphy of this order. Spermiogenesis is also characterized by the presence of a very short flagellum (around 1 μm long), observed in all the stages of spermiogenesis. This type of flagellum has never been commented in the diphyllidean cestodes and should be considered as an evolved character in this group. In the latest stage of spermiogenesis, this short axoneme probably degenerates. Thus, the mature spermatozoon of E. euterpes possesses only one axoneme of 9 + '1' trepaxonematan pattern. It also exhibits a single helical electron-dense crested body, a spiraled nucleus, few parallel cortical microtubules, and α-glycogen granules. Similitudes and differences between spermatozoa of diphyllideans are discussed.