Person-centred care provided by a multidisciplinary primary care team to improve therapeutic adequacy in polymedicated elderly patients (PCMR): randomised controlled trial protocol.

INTRODUCTION: The increase in elderly population has led to an associated increase in multiple pathologies, frailty, polypharmacy, healthcare costs, decreased quality of life and mortality. We designed an intervention based on person-centred care model. This article outlines a study protocol, which aims to explore the effects of the intervention to improve therapeutic adequacy in polymedicated elderly patients. METHODS AND ANALYSIS: An open, randomised, multicentre, controlled clinical trial. The study population includes polymedicated (≥8 prescription medications) patients ≥75 years old. In the intervention group, the multidisciplinary team (primary care pharmacist, family doctor and nurse) will meet to carry out multidimensional reviews (frailty, clinical complexity, morbidity and therapeutic adequacy) of the study subjects. If changes are proposed to the treatment plan, a clinical interview will be conducted with the patient to agree on changes in accordance with their preferences. Follow-up visits will be scheduled at 6 and 12 months. In the control group, where the usual clinical practice will be followed, the necessary data will be collected to compare the results.The key variables are the variation in the mean number of incidents (potentially inappropriate prescription) per patient, the number of medications, the number of changes implemented to the treatment plan and the variation in the number of hospital admissions. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of the IDIAPJGol and by the University of Barcelona's Bioethics Commission. The results are expected to be published in peer reviewed open-access journals, and as part of a doctoral thesis. TRIAL REGISTRATION NUMBER: NCT04188470. Pre-results.

Distribution of dissolved organic matter in freshwaters using excitation emission fluorescence and Multivariate Curve Resolution.

Multivariate Curve Resolution Alternating Least Squares (MCR-ALS) method with the trilinearity constraint is proposed for the analysis of excitation-emission fluorescence data from Dissolved Organic Matter (DOM) in fresh water natural systems, and the results obtained are compared with those obtained with PARAFAC. The effects of different number of components and constraints on the stability of the proposed models are compared. MCR-ALS is shown to be an effective way to characterize and resolve DOM sources in natural fresh water systems from EEM data, with good correlation with experimentally measured DOM concentration values. MATLAB georeferenced mapping is used to illustrate the geographical distribution of resolved DOM contributions. MCR-ALS resolved EEM spectra are used to recognize the corresponding chemical groups assigned to possible DOM sources. Relationships between human activities and the environmental situation of the river system are discussed from these possible DOM sources.

Exploring the links between antibiotic occurrence, antibiotic resistance, and bacterial communities in water supply reservoirs.

Antibiotic resistance represents a growing global health concern due to the overuse and misuse of antibiotics. There is, however, little information about how the selective pressure of clinical antibiotic usage can affect environmental communities in aquatic ecosystems and which bacterial groups might be responsible for dissemination of antibiotic resistance genes (ARGs) into the environment. In this study, chemical and biological characterization of water and sediments from three water supply reservoirs subjected to a wide pollution gradient allowed to draw an accurate picture of the concentration of antibiotics and prevalence of ARGs, in order to evaluate the potential role of ARGs in shaping bacterial communities, and to identify the bacterial groups most probably carrying and disseminating ARGs. Results showed significant correlation between the presence of ARG conferring resistance to macrolides and the composition of bacterial communities, suggesting that antibiotic pollution and the spreading of ARG might play a role in the conformation of bacterial communities in reservoirs. Results also pointed out the bacterial groups Actinobacteria and Firmicutes as the ones probably carrying and disseminating ARGs. The potential effect of antibiotic pollution and the presence of ARGs on the composition of bacterial communities in lacustrine ecosystems prompt the fundamental question about potential effects on bacterial-related ecosystem services supplied by lakes and reservoirs.

Fibroelastoma dorsi: un tumor infrecuente e infradiagnosticado / Elastofibroma Dorsi: An Uncommon and Under-Diagnosed Tumour

El elastofibroma dorsi es un tumor poco frecuente de los tejidos blandos localizados a nivel infraescapulary/o subescapular. Su incidencia es variable, produciéndose entre la cuarta y la séptima década de la vida,y es más común en las mujeres. Se han revisado 16 casos de elastofibroma diagnosticados en 12 pacientes(7 mujeres, 58,3%), de las cuales 4 pacientes presentaron fibroelastomas bilaterales. El síntoma másfrecuente fue el dolor. El diagnóstico se realizó mediante exploración física, tomografía computarizaday/o resonancia magnética nuclear para confirmar el diagnóstico en casos dudosos. La cirugía de exéresisse realizó bajo anestesia general sin observarse complicaciones mayores. El elastofibroma es un tumorde la pared torácica infrecuente y/o infradiagnosticado con un impacto incierto que requiere su exéresissolo en pacientes sintomáticos(AU)

Elastofibroma dorsi is a relatively rare soft-tissue tumour localized at the infra-scapular level and/orsubscapular regions. It usually occurs between the fourth and seventh decade of life, and is morecommon in females. We reviewed sixteen elastofibromas diagnosed in 12 patients (7 females, 58.3%).Four patients had bilateral elastofibromas. The most common symptom was pain. Presumptive diagnosiswas made by physical examination. Chest ultrasound, computed tomography and/or magnetic resonanceimaging were performed to confirm the diagnosis. Surgery was performed under general anaesthesia.No major complications were observed. Elastofibromas are tumours of the chest wall with an uncertainimpact. Surgical resection is indicated only in symptomatic patients(AU)

Elastofibroma dorsi: an uncommon and under-diagnosed tumour.

Elastofibroma dorsi is a relatively rare soft-tissue tumour localized at the infra-scapular level and/or subscapular regions. It usually occurs between the fourth and seventh decade of life, and is more common in females. We reviewed sixteen elastofibromas diagnosed in 12 patients (7 females, 58.3%). Four patients had bilateral elastofibromas. The most common symptom was pain. Presumptive diagnosis was made by physical examination. Chest ultrasound, computed tomography and/or magnetic resonance imaging were performed to confirm the diagnosis. Surgery was performed under general anaesthesia. No major complications were observed. Elastofibromas are tumours of the chest wall with an uncertain impact. Surgical resection is indicated only in symptomatic patients.

Driving factors of the phytoplankton functional groups in a deep Mediterranean reservoir.

The control of phytoplankton growth is mainly related to the availability of light and nutrients. Both may select phytoplankton species, but only if they occur in limiting amounts. During the last decade, the functional groups approach, based on the physiological, morphological and ecological attributes of the species, has proved to be a more efficient way to analyze seasonal changes in phytoplankton biomass. We analysed the dynamics of the phytoplankton functional groups sensu Reynolds, recognising the driving forces (light, mixing regime, and nutrients) in the Sau Reservoir, based on a one-year cycle (monthly surface-water sampling). The Sau Reservoir is a Mediterranean water-supply reservoir with a canyon-shaped basin and a clear and mixed epilimnion layer. The long stratification period and high light availability led to high phytoplankton biomass (110.8 fresh-weight mg L(-1)) in the epilimnion during summer. The reservoir showed P-limitation for phytoplankton growth in this period. All functional groups included one or more species (X2-Rhodomonas spp.; Y-Cryptomonas spp.; F-Oocystis lacustris; K-Aphanocapsa spp.) selected by resources, especially phosphorus. Species of Cryptomonas (group Y) dominated during the mixing period (winter season) in conditions of low light and relatively high availability of dissolved nutrients. Increases in water-column stability during spring stratification led to phytoplankton biomass increases due to the dominance of small flagellate functional groups (X2 and X3, chrysophyceans). The colonial chlorophycean O. lacustris (group F) peaked during the mid-summer stratification, when the mixed epilimnion was clearly depleted in nutrients, especially SRP. High temperature and increases in nutrient concentration during the end-summer and mid-autumn resulted in a decrease of green algae (group F) and increase of Aphanocapsa spp. (cyanobacteria, group K) and dinoflagellates (group L(o)). The study also revealed the important role of physical processes in the seasonal gradient, in selecting phytoplankton functional groups, and consequently in the assessment of ecological status. The Q index (assemblage index) based on functional groups indicated the overall good ecological status of the Sau Reservoir, which varied as a function of the mixing regime. This is the first application of the Assemblage Index to a European water-supply reservoir.

Tailoring dam structures to water quality predictions in new reservoir projects: assisting decision-making using numerical modeling.

Selection of reservoir location, the floodable basin forest handling, and the design of dam structures devoted to water supply (e.g. water outlets) constitute relevant features which strongly determine water quality and frequently demand management strategies to be adopted. Although these crucial aspects should be carefully examined during dam design before construction, currently the development of ad hoc limnological studies tailoring dam location and dam structures to the water quality characteristics expected in the future reservoir is not typical practice. In this study, we use numerical simulation to assist on the design of a new dam project in Spain with the aim of maximizing the quality of the water supplied by the future reservoir. First, we ran a well-known coupled hydrodynamic and biogeochemical dynamic numerical model (DYRESM-CAEDYM) to simulate the potential development of anoxic layers in the future reservoir. Then, we generated several scenarios corresponding to different potential hydraulic conditions and outlet configurations. Second, we built a simplified numerical model to simulate the development of the hypolimnetic oxygen content during the maturation stage after the first reservoir filling, taking into consideration the degradation of the terrestrial organic matter flooded and the adoption of different forest handling scenarios. Results are discussed in terms of reservoir design and water quality management. The combination of hypolimnetic withdrawal from two deep outlets and the removal of all the valuable terrestrial vegetal biomass before flooding resulted in the best water quality scenario.