Partner-developed electronic health record tools to facilitate social risk-informed care planning.

OBJECTIVE: Increased social risk data collection in health care settings presents new opportunities to apply this information to improve patient outcomes. Clinical decision support (CDS) tools can support these applications. We conducted a participatory engagement process to develop electronic health record (EHR)-based CDS tools to facilitate social risk-informed care plan adjustments in community health centers (CHCs). MATERIALS AND METHODS: We identified potential care plan adaptations through systematic reviews of hypertension and diabetes clinical guidelines. The results were used to inform an engagement process in which CHC staff and patients provided feedback on potential adjustments identified in the guideline reviews and on tool form and functions that could help CHC teams implement these suggested adjustments for patients with social risks. RESULTS: Partners universally prioritized tools for social risk screening and documentation. Additional high-priority content included adjusting medication costs and changing follow-up plans based on reported social risks. Most content recommendations reflected partners' interests in encouraging provider-patient dialogue about care plan adaptations specific to patients' social needs. Partners recommended CDS tool functions such as alerts and shortcuts to facilitate and efficiently document social risk-informed care plan adjustments. DISCUSSION AND CONCLUSION: CDS tools were designed to support CHC providers and staff to more consistently tailor care based on information about patients' social context and thereby enhance patients' ability to adhere to care plans. While such adjustments occur on an ad hoc basis in many care settings, these are among the first tools designed both to systematize and document these activities.

[Los determinantes sociales de la salud en España (2010-2021): una revisión exploratoria de la literatura.] / The social determinants of health in Spain (2010-2021): an exploratory review of the literature.

OBJECTIVE: Los determinantes sociales de la salud (DSS) son los ejes en torno a los cuales se articulan las desigualdades sociales en salud. El estudio de dichas diferencias entre grupos sociales resulta fundamental para el abordaje de las inequidades. El objetivo de esta revisión fue estudiar las aportaciones realizadas en la investigación sobre el efecto de los DSS en la salud o sus factores intermedios en la población española desde el año 2010 hasta 2021. METHODS: Se realizó una revisión exploratoria de la literatura. Dos revisores ciegos realizaron la búsqueda, cribado e inclusión de los artículos (50). RESULTS: La mayoría de los artículos incluidos fueron estudios transversales (70%) y revisiones (12%). La información extraída se agrupó en cada uno de los DSS: lugar de residencia (5 artículos), raza/etnia/origen (9), ocupación (3), sexo/género (4), nivel educativo (7), estatus socioeconómico (15), capital social/apoyo social (1) y diversidad afectivo-sexual y de género (6). Los desenlaces en salud más reportados fueron la salud mental (40%) y el estado autopercibido de salud (30%). CONCLUSIONS: Los resultados coinciden con la literatura publicada: a mayor desventaja social en cualquiera de los DSS se hallaron peores resultados en salud, siendo estos peores cuando se superponían varios ejes de desigualdad. Esta revisión puede haber incurrido en varios sesgos, entre los que están el de publicación y el de selección. La investigación futura sobre los DSS debe adoptar un enfoque interseccional que permita una mejor comprensión de los ejes sobre los que actúan las desigualdades.

OBJETIVO: Social determinants of health (SDH) are the axes of social inequalities in health. Studying these differences between social groups is essential for addressing inequities. The objective of this review was to study the contributions made by the research on the effect of the SDH on health or its intermediate factors in the Spanish population from 2010 to 2021. METODOS: An scoping review of the literature was carried out. Two blind reviewers performed the search, screening and selection of articles (50). RESULTADOS: Most of articles included were cross-sectional studies (70%) and reviews (12%). Extracted information was grouped into each of the DSS: place of residence (5 items), race/ethnicity/origin (9), occupation (3), sex/gender (4), educational level (7), socioeconomic status (15), social capital/social support (1) and affective-sexual and gender diversity (6). Most reported health outcomes were mental health (40%) and self-perceived health status (30%). CONCLUSIONES: Results are in line with the published literature. The greater the social disadvantage in any of the DSS, the worse the health results, which were even worse when several axes of inequality overlapped. This review may have had some biases, including publication and selection bias. Future research on the SDH must adopt an intersectional approach that will allow a better understanding of the axes on which inequalities take place.

Monte Carlo simulation of neutron scattering by a textured polycrystal.

A method of simulating the neutron scattering by a textured polycrystal is presented. It is based on an expansion of the scattering cross sections in terms of the spherical harmonics of the incident and scattering directions, which is derived from the generalized Fourier expansion of the polycrystal orientation distribution function. The method has been implemented in a Monte Carlo code as a component of the McStas software package, and it has been validated by computing some pole figures of a Zircaloy-4 plate and a Zr-2.5Nb pressure tube, and by simulating an ideal transmission experiment. The code can be used to estimate the background generated by components of neutron instruments such as pressure cells, whose walls are made of alloys with significant crystallographic texture. As a first application, the effect of texture on the signal-to-noise ratio was studied in a simple model of a diffraction experiment, in which a sample is placed inside a pressure cell made of a zirconium alloy. With this setting, the results of two simulations were compared: one in which the pressure-cell wall has a uniform distribution of grain orientations, and another in which the pressure cell has the texture of a Zr-2.5Nb pressure tube. The results showed that the effect of the texture of the pressure cell on the noise of a diffractogram is very important. Thus, the signal-to-noise ratio can be controlled by appropriate choice of the texture of the pressure-cell walls.

Remote mapping of foodscapes using sUAS and a low cost BG-NIR sensor.

The assessment of landscape condition for large herbivores, also known as foodscapes, is fast gaining interest in conservation and landscape management programs worldwide. Although traditional approaches are now being replaced by satellite imagery, several technical issues still need to be addressed before full standardization of remote sensing methods for these purposes. We present a low-cost method, based on the use of a modified blue/green/near-infrared (BG-NIR) camera housed on a small-Unmanned Aircraft System (sUAS), to create foodscapes for a generalist Mediterranean ungulate: the Iberian Ibex (Capra pyrenaica) in Northeast Spain. Faecal cuticle micro-histological analyses were used to assess the dietary preferences of ibexes and then individuals of the most common plant species (n = 19) were georeferenced to use as test samples. Because of the seasonal pattern in vegetation activity, based on the NDVI (Smooth term Month = 21.5, p-value < .01, R2 = 43%, from a GAM), images were recorded in winter and spring to represent contrasting vegetation phenology using two flight heights above ground level (30 and 60 m). Additionally, the range of image pixel sizes was 3.5-30 cm with the smallest pixel size representing the highest resolution. Boosted Trees were used to classify plant taxa based on spectral reflectance and create a foodscape of the study area. The number of target species, the sampling season, the height of flight and the image resolution were analysed to determine the accuracy of mapping the foodscape. The highest classification error (70.66%) was present when classifying all plant species using a 30 cm pixel size from acquisitions at 30 m height. The lowest error (18.7%), however, was present when predicting plants preferred by ibexes, at 3.5 cm pixel size acquired at 60 m height. This methodology can help to successfully monitor food availability and seasonality and to identify individual species.

Clinical and economic impact of the taurolidine lock on home parenteral nutrition.

INTRODUCTION: catheter-related bloodstream infections (CRBSI) are one of the most serious concerns in patients on home parenteral nutrition (HPN) which involve high morbidity and cost for the healthcare system. In the last years, taurolidine lock has proven to be beneficial in the prevention of CRBSI; however, the evidence of its efficiency is limited. OBJECTIVE: to determine if taurolidine lock is a cost-effective intervention in patients on HPN. MATERIALS AND METHODS: retrospective study in patients on HPN with taurolidine lock. We compared the CRBSI rate and cost of its complications before and during taurolidine lock. RESULTS: thirteen patients, six (46%) males and seven (54%) females, with a mean age of 61.08 (SD = 14.18) years received taurolidine lock. The total days of catheterization pre and per-taurolidine were 12,186 and 5,293, respectively. The underlying disease was benign in five patients (38.5%) and malignant in eight (61.5%). The CRBSI rate pre vs per-taurolidine was 3.12 vs 0.76 episodes per 1,000 catheter days (p = 0.0058). When the indication was a high CRBSI rate, this was 9.72 vs 0.39 (p < 0.001) in pre and per-taurolidine period respectively. No differences have been observed in the occlusion rates. None of the patients reported any adverse effects. The total cost of CRBSI in the pre-taurolidine period was 151,264.14 euros vs 24,331.19 euros in the per-taurolidine period. CONCLUSIONS: our study shows that taurolidine lock is a cost-effective intervention in patients on HPN with high risk of CRBSI.

Implicaciones para el desarrollo de las personas a través de la formación del profesorado en entornos donde existen procesos universales de desarrollo, mediada por interacciones virtuales / Implications for the development of people through teacher training in settings in which there are universal developmental processes, mediated by virtual interaction

El presente texto, recoge las discusiones y reflexiones derivadas de variasinvestigaciones en las que se describe, analiza y evidencia la participación de los actores que conforman la actual sociedad de la información como constantes de la educación superior en México, los paliativos que de ella se emanan, la transmisión de información y los procesos de formación actuales, el desafío de construir signos y símbolos cuando las señales ya no son controladas por el dispositivo pedagógico tradicional lo que exige, en un contexto cambiante, que la educación superior no sea más un interior autosuficiente, posibilitando la producción de subjetividades por las clases disciplinares y de control, legitimadas por medio de viejas y nuevas tecnologías.

The present text, includes discussions and reflections derived from several studies in which the participation of the actors that make up the current information society as constants of higher education in Mexico are described, analyzed, and madeevident, as well as the palliatives emanating from it, transmission of information and the current training processes, the challenge of building signs and symbols when the signals are no longer controlled by the traditional pedagogical device, which requires, in a changing context, that higher education is no longer a selfsufficient interior, making the production of subjectivity possible by the disciplinary and control classes, legitimized by means of old and new technologies.

Comportamiento del programa de erradicación del stegomyia aegypti en el municipio de guáimaro durante el año 2002 / An assessment of the Task Force on Stegomyia aegypti at the Municipality of Guaimaro during the year 2002

Se realizó un estudio descriptivo del Programa de Erradicación del Stegomyia aegypti durante el año 2002 en Guáimaro, Camagüey. Durante el período de estudio se produjeron cuatro eventos, para un promedio de un local positivo/introducción. El área de salud de Guáimaro reportó tres focos (75 por ciento) y uno en Cascorro (25 por ciento), estos se produjeron en el primer semestre del año, a razón de un foco/mes. Dos tipos de depósitos fueron afectados, tres tanques bajos (75 por ciento) y una larvitrampa (25 por ciento). En las radiobatidas el 100 por ciento de las viviendas y locales fueron inspeccionados y tratados. Se impeccionaron 59165 depósitos, de los cuales el 77.5 por ciento recibieron algún tipo de tratamiento (24.5 por ciento destruidos y el 43.0 por ciento flameados). Con Abate se trató al 37.25 por ciento. Los índices aédicos estuvieron por debajo de lo normado hasta el 1 por ciento, índice Casa de 0.0024, Recipiente de 0.00023 y el Breteau de 0.0024. La principal vía de entrada de los focos al municipio fue la carretera

Costo del Programa Nacional de Control de la Tuberculosis. Centro Provincial de Higiene y Epidemiología de Ciudad de La Habana, 2002* / Cost of the National Tuberculosis Control Program. Provincial Hygiene and Epidemiology Center of Havana City, 2002

Se realizó un estudio descriptivo retrospectivo de estimación de costos del Programa Nacional de Control de la Tuberculosis en Ciudad de La Habana, desde una perspectiva institucional. Las variables estudiadas fueron: personal, reactivos, equipos y edificación. Se estimaron costos directos e indirectos, que fueron expresados en pesos (1 peso= 1 USD). La ejecución del programa en el Centro Provincial de Higiene y Epidemiología generó costos por más de 80 000 pesos; 52,2 % recayó en los recursos humanos. El costo promedio en pesos por caso de tuberculosis fue de 378,08; el tratamiento alcanzó 175,88; la realización de la tuberculina 6,65; un cultivo 2,59; la quimioprofilaxis 2,12; el control de calidad del diagnóstico BAAR fue de 1,64 y 1,02 la baciloscopia. El costo de la detección de un caso, una investigación completa y la quimioprofilaxis de sus contactos resultaron respectivamente 38, 26 y 82 veces menos costosas que el tratamiento de uno. Los salarios aportaron más de la mitad de los costos del programa a este nivel, a pesar de que la institución garantizó en el período, un volumen importante de recursos para la ejecución del programa en la provincia. La vigilancia epidemiológica de la tuberculosis y la prevención con quimioprofilaxis resultaron actividades menos costosas que el tratamiento de un enfermo.

A retrospective descriptive study of cost estimation of the National Tuberculosis Control Program (NTCP) in the City of Havana was carried out from an institutional point of view. Salary, reagents, buildings and equipment were the studied variables. Direct and indirect costs were estimated and expressed in equivalent Cuban pesos to American dollars (1 Peso = 1 USD). The implementation of the NTCP in the Provincial Hygiene and Epidemiology Center generated costs for more than 80 000 pesos, from which 52.2% was in human resources. The average cost for every TB case in Cuban pesos was 378.08; the treatment cost was 175.88 per TB case; tuberculin skin performance reached 6.65 per contact; 2.59 for one culture; chemoprophylaxis treatment was 2.12 per contact; the quality control of sputum smear microscopies was 1.64 and 1.02 for a sputum smear microscopy. The costs of a case detection, a complete investigation and the chemoprophylaxis of its contacts were 38, 26 and 82 times lower than that of a case treatment. The salaries represented more than half of the program costs at this level, although this institution guaranteed an important volume of resources for the program implementation in the province. Tuberculosis epidemiological surveillance and chemoprophylaxis prevention were less costly than a case treatment.