Designing a Person-Centred Integrated Care Programme for People with Complex Chronic Conditions: A Case Study from Catalonia

INTRODUCTION

The prevalence of people with complex chronic conditions is increasing. This population's high social and health needs require person-centred integrated approaches to care.

METHODS

To collect data about experiences with the health system and identify priorities for care, we conducted 2 focus groups and 15 semi-structured interviews involving patients with multimorbidity and advanced conditions, caregivers, and representatives of patients' associations. To design the programme, we combined this information with evidence-based recommendations from local healthcare and social care professionals.

RESULTS

Patients' and caregivers' main priorities were to ensure (a) comprehension of information provided by healthcare professionals; (b) coordination between patients, caregivers, and professionals; (c) access to social services; (d) support to caregivers in managing situations; (e) perceived support throughout the healthcare process; (f) home care, when available; and (d) a patient-centred approach. These dimensions were included in 37 of 63 clinical actions of the programme to cover the whole care trajectory: identifying high needs, defining, and providing care plans, managing crises, and providing transitional care and end-of-life care.

CONCLUSION

We developed an evidence-based integrated care programme tailored to high-need patients combining input from patients, caregivers, and healthcare and social care professionals.

ZnO-mesoporous glass scaffolds loaded with osteostatin and mesenchymal cells improve bone healing in a rabbit bone defect

The use of 3D scaffolds based on mesoporous bioactive glasses (MBG) enhanced with therapeutic ions, biomolecules and cells is emerging as a strategy to improve bone healing. In this paper, the osteogenic capability of ZnO-enriched MBG scaffolds loaded or not with osteostatin (OST) and human mesenchymal stem cells (MSC) was evaluated after implantation in New Zealand rabbits. Cylindrical meso-macroporous scaffolds with composition (mol %) 82.2SiO₂-10.3CaO-3.3P₂O₅-4.2ZnO (4ZN) were obtained by rapid prototyping and then, coated with gelatin for easy handling and potentiating the release of inorganic ions and OST. Bone defects (7.5 mm diameter, 12 mm depth) were drilled in the distal femoral epiphysis and filled with 4ZN, 4ZN + MSC, 4ZN + OST or 4ZN + MSC + OST materials to evaluate and compare their osteogenic features. Rabbits were sacrificed at 3 months extracting the distal third of bone specimens for necropsy, histological, and microtomography (µCT) evaluations. Systems investigated exhibited bone regeneration capability. Thus, trabecular bone volume density (BV/TV) values obtained from µCT showed that the good bone healing capability of 4ZN was significantly improved by the scaffolds coated with OST and MSC. Our findings in vivo suggest the interest of these MBG complete systems to improve bone repair in the clinical practice.

Multifunctional antibiotic- and zinc-containing mesoporous bioactive glass scaffolds to fight bone infection

Bone regeneration is a clinical challenge which requires multiple approaches. Sometimes, it also includes the development of osteogenic and antibacterial biomaterials to treat the emergence of possible infection processes arising from surgery. This study evaluates the antibacterial properties of gelatin-coated meso-macroporous scaffolds based on the bioactive glass 80%SiO₂-15%CaO-5%P₂O₅ (mol-%) before (BL-GE) and after being doped with 4% of ZnO (4ZN-GE) and loaded with both saturated and the minimal inhibitory concentrations of one of the antibiotics: levofloxacin (LEVO), vancomycin (VANCO), rifampicin (RIFAM) or gentamicin (GENTA). After physical-chemical characterization of materials, release studies of inorganic ions and antibiotics from the scaffolds were carried out. Moreover, molecular modelling allowed determining the electrostatic potential density maps and the hydrogen bonds of antibiotics and the glass matrix. Antibacterial in vitro studies (in planktonic, inhibition halos and biofilm destruction) with S. aureus and E. coli as bacteria models showed a synergistic effect of zinc ions and antibiotics. The effect was especially noticeable in planktonic cultures of S. aureus with 4ZN-GE scaffolds loaded with VANCO, LEVO or RIFAM and in E. coli cultures with LEVO or GENTA. Moreover, S. aureus biofilms were completely destroyed by 4ZN-GE scaffolds loaded with VANCO, LEVO or RIFAM and the E. coli biofilm total destruction was accomplished with 4ZN-GE scaffolds loaded with GENTA or LEVO. This approach could be an important step in the fight against microbial resistance and provide needed options for bone infection treatment. STATEMENT OF SIGNIFICANCE: Antibacterial capabilities of scaffolds based on mesoporous bioactive glasses before and after adding a 4% ZnO and loading with saturated and minimal inhibitory concentrations of levofloxacin, vancomycin, gentamicin or rifampicin were evaluated. Staphylococcus aureus and Escherichia coli were the infection model strains for the performed assays of inhibition zone, planktonic growth and biofilm. Good inhibition results and a synergistic effect of zinc ions released from scaffolds and antibiotics were observed. Thus, the amount of antibiotic required to inhibit the bacterial planktonic growth was substantially reduced with the ZnO inclusion in the scaffold. This study shows that the ZnO-MBG osteogenic scaffolds are multifunctional tools in bone tissue engineering because they are able to fight bacterial infections with lower antibiotic dosage.

Osteostatin potentiates the bioactivity of mesoporous glass scaffolds containing Zn2+ ions in human mesenchymal stem cells

There is an urgent need of biosynthetic bone grafts with enhanced osteogenic capacity. In this study, we describe the design of hierarchical meso-macroporous 3D-scaffolds based on mesoporous bioactive glasses (MBGs), enriched with the peptide osteostatin and Zn2+ ions, and their osteogenic effect on human mesenchymal stem cells (hMSCs) as a preclinical strategy in bone regeneration. The MBG compositions investigated were 80%SiO2-15%CaO-5%P2O5 (in mol-%) Blank (BL), and two analogous glasses containing 4% ZnO (4ZN) and 5% ZnO (5ZN). By using additive fabrication techniques, scaffolds exhibiting hierarchical porosity: mesopores (around 4 nm), macropores (1-600 μm) and big channels (∼1000 μm), were prepared. These MBG scaffolds with or without osteostatin were evaluated in hMCSs cultures. Zinc promoted hMSCs colonization (both the surface and inside) of MBG scaffolds. Moreover, Zn2+ ions and osteostatin together, but not independently, in the scaffolds were found to induce the osteoblast differentiation genes runt related transcription factor-2 (RUNX2) and alkaline phosphatase (ALP) in hMSCs after 7 d of culture in the absence of an osteogenic differentiation-promoting medium. These results add credence to the combined use of zinc and osteostatin as an effective strategy for bone regeneration applications. STATEMENT OF SIGNIFICANCE: Mesoporous bioactive glasses (MBGs) are bioceramics whose unique properties make them excellent materials for bone tissue engineering. Physico-chemical characterization of MBGs as scaffolds made by rapid prototyping, doped with zinc (potential osteogenic, angiogenic and bactericidal ion) and loaded with osteostatin (osteogenic peptide) are described. These Zn-MBGs scaffolds showed 3D hierarchical meso-macroporous structure that enables to host and release osteostatin. When decorated with human mesenchymal stem cells (hMSCs), MBGs scaffoldsenriched with both zinc and osteostatin exhibited a synergistic effect to enhance hMSCs growth, and also hMSCs osteogenic differentiationwithout addition of other osteoblastic differentiation factors to the culture medium. This novel strategy has a great potential for use in bone tissue engineering.

Evaluation and measurement of heliostat misalignment in solar power plant using vector model

Heliostat alignment evaluation is among the main issues in solar tower concentration plant operation and maintenance. This paper describes a novel method used to evaluate heliostat misalignment and its experimental verification. This method provides a different way of visualizing beam centroid pointing errors by generating the complete deviation curve for each axis. This, for example, would be useful for verifying a heliostat's correct alignment by using a measurement performed out of the receiver target, using these traces to calculate its reflection's expected location, given a known misalignment. This measurement could be performed during operation simply by including a reflective element in the heliostat and two detector arrays on the tower's surface. This model has been tested for various types of misalignments of a heliostat at different hours, dates, and heliostat locations. The simulation results have been validated by using an experimental setup at a scale of 1:100.

Mutation status and immunoglobulin gene rearrangements in patients from northwest and central region of Spain with chronic lymphocytic leukemia

The aim of this study was to investigate the frequency and mutation status of the immunoglobulin heavy variable chain (IGHV) in a cohort of 224 patients from northwest and central region of Spain diagnosed with chronic lymphocytic leukemia (CLL), and to correlate it with cytogenetic abnormalities, overall survival (OS) and time to first treatment (TTFT). 125 patients had mutated IGHV, while 99 had unmutated IGHV. The most frequently used IGHV family was IGHV3, followed by IGHV1 and IGHV4. The regions IGHV3-30, IGHV1-69, IGHV3-23, and IGHV4-34 were the most commonly used. Only 3.1% of the patients belonged to the subfamily IGHV3-21 and we failed to demonstrate a worse clinical outcome in this subgroup. The IGHV4 family appeared more frequently with mutated pattern, similar to IGHV3-23 and IGHV3-74. By contrast, IGHV1-69 was expressed at a higher frequency in unmutated CLL patients. All the cases from IGHV3-11 and almost all from IGHV5-51 subfamily belonged to the group of unmutated CLL.

Brillouin induced self-heterodyne technique for narrow line width measurement

A novel technique is introduced for jitter-insensitive sub-KHz resolution linewidth characterization technique in ultra-narrow lasers for optical communication applications. The technique is based on self-heterodyne detection induced by Stimulated Brillouin Scattering (SBS). Non linear SBS drives the heterodyne mixing through optical frequency locking of a narrow tunable laser source and the signal under test, which is modulated in the low frequency range. Due to SBS nature, jitter variations in the optical frequency do not affect the correlation spectra measured with resolution figures up to 300 Hz, without the need for optical delay line as in conventional homodyne correlation techniques.

All in fiber optical frequency metrology by selective Brillouin amplification of single peak in an optical comb

Suitable use of stimulated Brillouin amplification (SBA) effect for selective single peak amplification in an optical frequency comb is demonstrated to provide high accuracy in optical frequency metrology. A pump wave generated by a tunable laser source (TLS) is used to stimulate SBA of such optical comb along an optical fiber and selectively amplify only one single peak of the comb. Nature of SBA preserves both linewidth and absolute wavelength position of the selected comb peak. All of these features result in a simple, robust and compact all in fiber system. Relative optical frequency accuracy in the order of Hz is confirmed.

[Cerebrotendinous xanthomatosis: report of 4 patients]

Cerebrotendinous xanthomatosis (CTX) is an uncommon autosomal recessive disease caused by mutation of the CYP27A1 gene. It is characterized by the presence of xanthomas in different tissues, principally brain and tendon, due to the accumulation of beta-cholestanol. Diagnosis is confirmed by measurement of serum beta-cholestanol and urinary bile alcohol levels. Therapy with chenodeoxycholic acid has been shown to be the most effective treatment and can halt progression of the disease. We present 4 patients with a history of neurological disorders since childhood and who were diagnosed with CTX after developing tendon xanthomas. Although diagnostic suspicion depends to a large extent on recognition of tendon xanthomas, these are not an early sign of the disease, which can present with neurological disorders, cataracts, and chronic diarrhea. Early diagnosis of CTX therefore rests on measurement of serum beta-cholestanol levels, even in absence of tendon xanthomas.

Subpicometer wavelength accuracy with gain-switched laser diode in high-resolution optical spectrometry

We present a method to generate an optical reference comb signal with subpicometer wavelength accuracy. XPM nonlinear effect in a fiber is used to get an optical frequency comb signal, free of frequency chirp and wavelength instabilities, from a pulsed gain-switched laser diode. Principles of such comb generation are presented as well as the application of this comb as a ruler to measure frequency differences in high resolution optical spectrum measurements. To confirm this method, Brillouin filtering optical spectrometric technique is used to characterize a modulated optical source. Typical resolution of this technique allows 0.08 pm wavelength accuracy.

High resolution light intensity spectrum analyzer (LISA) based on Brillouin optical filter

A high-resolution light intensity spectrum analyzer technique to derive the RF modulation spectrum of optical signals is presented and experimentally confirmed. It uses the XPM nonlinear effect in a dispersion shifted fiber to obtain the light intensity spectrum, and a Brillouin optical filtering method to implement the high resolution spectrometric analysis. Measured RF spectra of PRBS modulated optical signals at 2.5 Gb/s and 10 Gb/s are presented and compared with their corresponding ones obtained in the electrical detection domain to confirm the capabilities of the method.Influence of fiber electrostriction effect is measured and analyzed.

Direct measurement of frequency and polarization dependences of cross-phase modulation in fibers from high-resolution optical spectra

We present the results of an experiment for frequency and polarization dependence characterization of non-linear cross-phase-modulation (XPM) effects in optical fibers. The measurement technique is based on the direct analysis of high-resolution optical spectra of a signal wave that is phase modulated by an intensity-modulated pump wave. Measurement results provide experimental confirmation of the scalar character, over the whole resonant frequency range, of the electrostrictive contribution to the nonlinear refractive index. Also, the results confirm experimentally the relation describing the polarization dependence of the Kerr contribution to XPM in non-polarization-maintaining fibers.