Structural behaviour and design criteria of under-deck cable-stayed bridges subjected to seismic action

Under-deck cable-stayed bridges are very effective structural systems for which the strong contribution of the stay cables under live loading allows for the design of very slender decks for persistent and transient loading scenarios. Their behaviour when subjected to seismic excitation is investigated herein and a set of design criteria are presented that relate to the type and arrangement of bearings, the number and configuration of struts, and the transverse distribution of stay cables. The nonlinear behaviour of these bridges when subject to both near-field and far-field accelerograms has been thoroughly investigated through the use of incremental dynamic analyses. An intensity measure that reflects the pertinent contributions to response when several vibration modes are activated was proposed and is shown to be effective for the analysis of this structural type. The under-deck cable-stay system contributes in a very positive manner to reducing the response when the bridges are subject to very strong seismic excitation. For such scenarios, the reduction in the stiffness of the deck because of crack formation, when prestressed concrete decks are used, mobilises the cable system and enhances the overall performance of the system. Sets of natural accelerograms that are compliant with the prescriptions of Eurocode 8 were also applied to propose a set of design criteria for this bridge type in areas prone to earthquakes. Particular attention is given to outlining the optimal strategies for the deployment of bearings

Identifying the semantics of eligibility criteria of clinical trials based on relevant medical ontologies

An important objective of the INTEGRATE project1 is to build tools that support the efficient execution of post-genomic multi-centric clinical trials in breast cancer, which includes the automatic assessment of the eligibility of patients for available trials. The population suited to be enrolled in a trial is described by a set of free-text eligibility criteria that are both syntactically and semantically complex. At the same time, the assessment of the eligibility of a patient for a trial requires the (machineprocessable) understanding of the semantics of the eligibility criteria in order to further evaluate if the patient data available for example in the hospital EHR satisfies these criteria. This paper presents an analysis of the semantics of the clinical trial eligibility criteria based on relevant medical ontologies in the clinical research domain: SNOMED-CT, LOINC, MedDRA. We detect subsets of these widely-adopted ontologies that characterize the semantics of the eligibility criteria of trials in various clinical domains and compare these sets. Next, we evaluate the occurrence frequency of the concepts in the concrete case of breast cancer (which is our first application domain) in order to provide meaningful priorities for the task of binding/mapping these ontology concepts to the actual patient data. We further assess the effort required to extend our approach to new domains in terms of additional semantic mappings that need to be developed.

A multi-criteria optimization and decision-making approach for improvement of food engineering processes.

The objective of this study was to propose a multi-criteria optimization and decision-making technique to solve food engineering problems. This technique was demostrated using experimental data obtained on osmotic dehydratation of carrot cubes in a sodium chloride solution. The Aggregating Functions Approach, the Adaptive Random Search Algorithm, and the Penalty Functions Approach were used in this study to compute the initial set of non-dominated or Pareto-optimal solutions. Multiple non-linear regression analysis was performed on a set of experimental data in order to obtain particular multi-objective functions (responses), namely water loss, solute gain, rehydration ratio, three different colour criteria of rehydrated product, and sensory evaluation (organoleptic quality). Two multi-criteria decision-making approaches, the Analytic Hierarchy Process (AHP) and the Tabular Method (TM), were used simultaneously to choose the best alternative among the set of non-dominated solutions. The multi-criteria optimization and decision-making technique proposed in this study can facilitate the assessment of criteria weights, giving rise to a fairer, more consistent, and adequate final compromised solution or food process. This technique can be useful to food scientists in research and education, as well as to engineers involved in the improvement of a variety of food engineering processes.

Berth Management in Container Terminals: Quality of Service

This paper empirically evaluates container terminal service attributes. The methodology proposed focuses on statistical control. Based on the concept of service segmentation, the authors employed control charts to classify container terminal services. The purpose of control charts is to allow simple detection of events that are indicative of actual process change. This simple decision can be difficult where the process characteristic is continuously varying, the control chart provides statistically objective criteria of change. When change is detected and considered good its cause should be identified and possibly become the new way of working, where the change is bad then its cause should be identified and eliminated. Both theoretical and practical implications of the research findings are discussed in this paper.

Berth management in container terminals: quality of service

This paper empirically evaluates container terminal service attributes. The methodology proposed focuses on statistical control. Based on the concept of service segmentation, we employed control charts to classify container terminal services. The purpose of control charts is to allow simple detection of events that are indicative of actual process change. This simple decision can be difficult where the process characteristic is continuously varying; the control chart provides statistically objective criteria of change. When change is detected and considered good its cause should be identified and possibly become the new way of working, where the change is bad then its cause should be identified and eliminated. This paper is organized as follows: Section 1 is the introduction, Section 2 provides a brief note on other studies that inspired this research, section 3 focuses on the methodology used, and develops the results obtained and finally conclusions are shown in Section 4. Theoretical and practical implications of the research findings are discussed.

Development of mathematical models to elaborate strategies, select alternatives and development of plans for adaptation of communities to climate change in different geographical areas including costs to implement it.

There is evidence that the climate changes and that now, the change is influenced and accelerated by the CO2 augmentation in atmosphere due to combustion by humans. Such ?Climate change? is on the policy agenda at the global level, with the aim of understanding and reducing its causes and to mitigate its consequences. In most countries and international organisms UNO (e.g. Rio de Janeiro 1992), OECD, EC, etc . . . the efforts and debates have been directed to know the possible causes, to predict the future evolution of some variable conditioners, and trying to make studies to fight against the effects or to delay the negative evolution of such. The Protocol of Kyoto 1997 set international efforts about CO2 emissions, but it was partial and not followed e.g. by USA and China . . . , and in Durban 2011 the ineffectiveness of humanity on such global real challenges was set as evident. Among all that, the elaboration of a global model was not boarded that can help to choose the best alternative between the feasible ones, to elaborate the strategies and to evaluate the costs, and the authors propose to enter in that frame for study. As in all natural, technological and social changes, the best-prepared countries will have the best bear and the more rapid recover. In all the geographic areas the alternative will not be the same one, but the model must help us to make the appropriated decision. It is essential to know those areas that are more sensitive to the negative effects of climate change, the parameters to take into account for its evaluation, and comprehensive plans to deal with it. The objective of this paper is to elaborate a mathematical model support of decisions, which will allow to develop and to evaluate alternatives of adaptation to the climatic change of different communities in Europe and Latin-America, mainly in especially vulnerable areas to the climatic change, considering in them all the intervening factors. The models will consider criteria of physical type (meteorological, edaphic, water resources), of use of the ground (agriculturist, forest, mining, industrial, urban, tourist, cattle dealer), economic (income, costs, benefits, infrastructures), social (population), politician (implementation, legislation), educative (Educational programs, diffusion) and environmental, at the present moment and the future. The intention is to obtain tools for aiding to get a realistic position for these challenges, which are an important part of the future problems of humanity in next decades.

Development of mathematical models to elaborate strategies, to select alternatives and the development of plans for the adaptation of communities to climate change in different geographical areas including costs to implement it

Climate change is on the policy agenda at the global level, with the aim of understanding and reducing its causes and to mitigate its consequences. In most of the countries and international organisms UNO, OECD, EC, etc … the efforts and debates have been directed to know the possible causes, to predict the future evolution of some variable conditioners, and trying to make studies to fight against the effects or to delay the negative evolution of such. Nevertheless, the elaboration of a global model was not boarded that can help to choose the best alternative between the feasible ones, to elaborate the strategies and to evaluate the costs. As in all natural, technological and social changes, the best-prepared countries will have the best bear and the more rapid recover. In all the geographic areas the alternative will not be the same one, but the model should help us to make the appropriated decision. It is essential to know those areas that are more sensitive to the negative effects of climate change, the parameters to take into account for its evaluation, and comprehensive plans to deal with it. The objective of this paper is to elaborate a mathematical model support of decisions, that will allow to develop and to evaluate alternatives of adaptation to the climatic change of different communities in Europe and Latin-America, mainly, in vulnerable areas to the climatic change, considering in them all the intervening factors. The models will take into consideration criteria of physical type (meteorological, edaphic, water resources), of use of the ground (agriculturist, forest, mining, industrial, urban, tourist, cattle dealer), economic (income, costs, benefits, infrastructures), social (population), politician (implementation, legislation), educative (Educational programs, diffusion), sanitary and environmental, at the present moment and the future.

Domestic hot water consumption vs. solar thermal energy storage: the optimum size of the storage tank

Many efforts have been made in order to adequate the production of a solar thermal collector field to the consumption of domestic hot water of the inhabitants of a building. In that sense, much has been achieved in different domains: research agencies, government policies and manufacturers. However, most of the design rules of the solar plants are based on steady state models, whereas solar irradiance, consumption and thermal accumulation are inherently transient processes. As a result of this lack of physical accuracy, thermal storage tanks are sometimes left to be as large as the designer decides without any aforementioned precise recommendation. This can be a problem if solar thermal systems are meant to be implemented in nowadays buildings, where there is a shortage of space. In addition to that, an excessive storage volume could not result more efficient in many residential applications, but costly, extreme in space consumption and in some cases too heavy. A proprietary transient simulation program has been developed and validated with a detailed measurement campaign in an experimental facility. In situ environmental data have been obtained through a whole year of operation. They have been gathered at intervals of 10 min for a solar plant of 50 m2 with a storage tank of 3 m3, including the equipment for domestic hot water production of a typical apartment building. This program has been used to obtain the design and dimensioning criteria of DHW solar plants under daily transient conditions throughout a year and more specifically the size of the storage tank for a multi storey apartment building. Comparison of the simulation results with the current Spanish regulation applicable, “Código Técnico de la Edificación” (CTE 2006), offers fruitful details and establishes solar facilities dimensioning criteria.

Building resilience to water scarcity in Southern Spain: A case study of rice farming in Doñana protected wetlands

Agricultural water management needs to evolve in view of increased water scarcity, especially when farming and natural protected areas are closely linked. In the study site of Don?ana (southern Spain), water is shared by rice producers and a world heritage biodiversity ecosystem. Our aim is to contribute to defining adaptation strategies that may build resilience to increasing water scarcity and minimize water conflicts among agricultural and natural systems. The analytical framework links a participatory process with quantitative methods to prioritize the adaptation options. Bottom-up proposed adaptation measures are evaluated by a multi-criteria analysis (MCA) that includes both socioeconomic criteria and criteria of the ecosystem services affected by the adaptation options. Criteria weights are estimated by three different methods?analytic hierarchy process, Likert scale and equal weights?that are then compared. Finally, scores from an MCA are input into an optimization model used to determine the optimal land-use distribution in order to maximize utility and land-use diversification according to different scenarios of funds and water availability. While our results show a spectrum of perceptions of priorities among stakeholders, there is one overriding theme that is to define a way to restore part of the rice fields to natural wetlands. These results hold true under the current climate scenario and evenmore so under an increased water scarcity scenario.

Analysis of the suitability of existing medical ontologies for building a scalable semantic interoperability solution supporting multi-site collaboration in oncology

Semantic interoperability is essential to facilitate efficient collaboration in heterogeneous multi-site healthcare environments. The deployment of a semantic interoperability solution has the potential to enable a wide range of informatics supported applications in clinical care and research both within as ingle healthcare organization and in a network of organizations. At the same time, building and deploying a semantic interoperability solution may require significant effort to carryout data transformation and to harmonize the semantics of the information in the different systems. Our approach to semantic interoperability leverages existing healthcare standards and ontologies, focusing first on specific clinical domains and key applications, and gradually expanding the solution when needed. An important objective of this work is to create a semantic link between clinical research and care environments to enable applications such as streamlining the execution of multi-centric clinical trials, including the identification of eligible patients for the trials. This paper presents an analysis of the suitability of several widely-used medical ontologies in the clinical domain: SNOMED-CT, LOINC, MedDRA, to capture the semantics of the clinical trial eligibility criteria, of the clinical trial data (e.g., Clinical Report Forms), and of the corresponding patient record data that would enable the automatic identification of eligible patients. Next to the coverage provided by the ontologies we evaluate and compare the sizes of the sets of relevant concepts and their relative frequency to estimate the cost of data transformation, of building the necessary semantic mappings, and of extending the solution to new domains. This analysis shows that our approach is both feasible and scalable.

Changes in the governance system for higher education in Peru to meet the challenges of the 21st century

The competition in markets, the distribution of limited resources based on productivity and performance, and the efficient management of universities are changing the criteria of trust and legitimacy of the educational system in Peru. Universities are perceived more as institutions of the public sector, while the services they offer must rather contribute to the modernization of the emerging society and the knowledge economy. Higher Educations reforms - initiated in the 1980s - have been inspired by the successful university organizations that have managed to change their governance and addressed to transform certain bureaucratic institutions into organizations capable of playing active role in this global competition for resources and best talent. Within this context, Peruvian universities are facing two major challenges: adapting themselves to new global perspectives and being able to develop a better response to society demands, needs and expectations. This article proposes a model of governance system for higher education in Peru that gives a comprehensive solution to these challenges, allowing dealing with the problems of universities for their development and inclusion within the global trends. For this purpose, a holistic and qualitative methodologic approach was developed, considering an integrated method which considered educational reality as a whole, understanding its facts, components and elements that affects its outcomes. It is proposed to define a policy for university education in Peru that permeates society, by changing the planning model from a social reform model to a policy analysis model, where the Peruvian State acts as sole responsible for responding to the demanding society as its legal representative complemented with some external and independent bodies that define the basis of best practice, as it is being done in many university models worldwide.

Virtual 3D Support Contents Oriented to Interactive Self-Learning

In the educational project described in this paper, new virtual 3D didactical contents have been developed to achieve specific outcomes, within the frame of a new methodology oriented to objectives of the European Higher Education Area directives. The motivation of the project was to serve as a new assessment method, to create a link between new programs of study with the older ones. In this project, new rubrics have been developed to be employed as an objective method of evaluation of specific and transversal outcomes, to accomplish the certification criteria of institutions like ABET (Accreditation Board for Engineering and Technology).

Diseño de un modelo de riesgo integral de incendios forestales mediante técnicas multicriterio y su automatización en sistemas de información geográfica : una aplicación en la Comunidad Valenciana

Los incendios forestales son la principal causa de mortalidad de árboles en la Europa mediterránea y constituyen la amenaza más seria para los ecosistemas forestales españoles. En la Comunidad Valenciana, diariamente se despliega cerca de un centenar de vehículos de vigilancia, cuya distribución se apoya, fundamentalmente, en un índice de riesgo de incendios calculado en función de las condiciones meteorológicas. La tesis se centra en el diseño y validación de un nuevo índice de riesgo integrado de incendios, especialmente adaptado a la región mediterránea y que facilite el proceso de toma de decisiones en la distribución diaria de los medios de vigilancia contra incendios forestales. El índice adopta el enfoque de riesgo integrado introducido en la última década y que incluye dos componentes de riesgo: el peligro de ignición y la vulnerabilidad. El primero representa la probabilidad de que se inicie un fuego y el peligro potencial para que se propague, mientras que la vulnerabilidad tiene en cuenta las características del territorio y los efectos potenciales del fuego sobre el mismo. Para el cálculo del peligro potencial se han identificado indicadores relativos a los agentes naturales y humanos causantes de incendios, la ocurrencia histórica y el estado de los combustibles, extremo muy relacionado con la meteorología y las especies. En cuanto a la vulnerabilidad se han empleado indicadores representativos de los efectos potenciales del incendio (comportamiento del fuego, infraestructuras de defensa), como de las características del terreno (valor, capacidad de regeneración…). Todos estos indicadores constituyen una estructura jerárquica en la que, siguiendo las recomendaciones de la Comisión europea para índices de riesgo de incendios, se han incluido indicadores representativos del riesgo a corto plazo y a largo plazo. El cálculo del valor final del índice se ha llevado a cabo mediante la progresiva agregación de los componentes que forman cada uno de los niveles de la estructura jerárquica del índice y su integración final. Puesto que las técnicas de decisión multicriterio están especialmente orientadas a tratar con problemas basados en estructuras jerárquicas, se ha aplicado el método TOPSIS para obtener la integración final del modelo. Se ha introducido en el modelo la opinión de los expertos, mediante la ponderación de cada uno de los componentes del índice. Se ha utilizado el método AHP, para obtener las ponderaciones de cada experto y su integración en un único peso por cada indicador. Para la validación del índice se han empleado los modelos de Ecuaciones de Estimación Generalizadas, que tienen en cuenta posibles respuestas correlacionadas. Para llevarla a cabo se emplearon los datos de oficiales de incendios ocurridos durante el período 1994 al 2003, referenciados a una cuadrícula de 10x10 km empleando la ocurrencia de incendios y su superficie, como variables dependientes. Los resultados de la validación muestran un buen funcionamiento del subíndice de peligro de ocurrencia con un alto grado de correlación entre el subíndice y la ocurrencia, un buen ajuste del modelo logístico y un buen poder discriminante. Por su parte, el subíndice de vulnerabilidad no ha presentado una correlación significativa entre sus valores y la superficie de los incendios, lo que no descarta su validez, ya que algunos de sus componentes tienen un carácter subjetivo, independiente de la superficie incendiada. En general el índice presenta un buen funcionamiento para la distribución de los medios de vigilancia en función del peligro de inicio. No obstante, se identifican y discuten nuevas líneas de investigación que podrían conducir a una mejora del ajuste global del índice. En concreto se plantea la necesidad de estudiar más profundamente la aparente correlación que existe en la provincia de Valencia entre la superficie forestal que ocupa cada cuadrícula de 10 km del territorio y su riesgo de incendios y que parece que a menor superficie forestal, mayor riesgo de incendio. Otros aspectos a investigar son la sensibilidad de los pesos de cada componente o la introducción de factores relativos a los medios potenciales de extinción en el subíndice de vulnerabilidad. Summary Forest fires are the main cause of tree mortality in Mediterranean Europe and the most serious threat to the Spanisf forest. In the Spanish autonomous region of Valencia, forest administration deploys a mobile fleet of 100 surveillance vehicles in forest land whose allocation is based on meteorological index of wildlandfire risk. This thesis is focused on the design and validation of a new Integrated Wildland Fire Risk Index proposed to efficient allocation of vehicles and specially adapted to the Mediterranean conditions. Following the approaches of integrated risk developed last decade, the index includes two risk components: Wildland Fire Danger and Vulnerability. The former represents the probability a fire ignites and the potential hazard of fire propagation or spread danger, while vulnerability accounts for characteristics of the land and potential effects of fire. To calculate the Wildland Fire Danger, indicators of ignition and spread danger have been identified, including human and natural occurrence agents, fuel conditions, historical occurrence and spread rate. Regarding vulnerability se han empleado indicadores representativos de los efectos potenciales del incendio (comportamiento del fuego, infraestructurasd de defensa), como de las características del terreno (valor, capacidad de regeneración…). These indicators make up the hierarchical structure for the index, which, following the criteria of the European Commission both short and long-term indicators have been included. Integration consists of the progressive aggregation of the components that make up every level in risk the index and, after that, the integration of these levels to obtain a unique value for the index. As Munticriteria methods are oriented to deal with hierarchically structured problems and with situations in which conflicting goals prevail, TOPSIS method is used in the integration of components. Multicriteria methods were also used to incorporate expert opinion in weighting of indicators and to carry out the aggregation process into the final index. The Analytic Hierarchy Process method was used to aggregate experts' opinions on each component into a single value. Generalized Estimation Equations, which account for possible correlated responses, were used to validate the index. Historical records of daily occurrence for the period from 1994 to 2003, referred to a 10x10-km-grid cell, as well as the extent of the fires were the dependant variables. The results of validation showed good Wildland Fire Danger component performance, with high correlation degree between Danger and occurrence, a good fit of the logistic model used and a good discrimination power. The vulnerability component has not showed a significant correlation between their values and surface fires, which does not mean the index is not valid, because of the subjective character of some of its components, independent of the surface of the fires. Overall, the index could be used to optimize the preventing resources allocation. Nevertheless, new researching lines are identified and discussed to improve the overall performance of the index. More specifically the need of study the inverse relationship between the value of the wildfire Fire Danger component and the forested surface of each 10 - km cell is set out. Other points to be researched are the sensitivity of the index component´s weight and the possibility of taking into account indicators related to fire fighting resources to make up the vulnerability component.

Zonificación del espacio por agrupación de unidades superficiales. Aplicación a la gestión de sistemas extensivos del tipo cereal-ovino

RESUMEN Los procesos de diseño de zonas o diseño del territorio implican la partición de un espacio geográfico, organizado en un conjunto de unidades de área, en diferentes regiones o zonas según un conjunto especifico de criterios que varían en función del campo de aplicación. En la mayoría de los casos, el objetivo fundamental consiste en crear zonas de tamaño aproximadamente igual respecto a uno o varios atributos de medida -de carácter cuantitativo- (zonas con igual número de habitantes, igual promedio de ventas...). Sin embargo, están apareciendo nuevas aplicaciones, algunas en el contexto de las políticas de desarrollo sostenible, cuya finalidad es la definición de regiones con un tamaño predeterminado, no necesariamente similar. Además, en estos casos las zonas han de formarse en torno a un conjunto específico de posiciones, semillas o generadores. Este tipo de particiones no han sido lo suficientemente investigadas, de manera que no se conocen modelos de solución para la delimitación automática de las zonas. En esta tesis se ha diseñado un nuevo método basado en una versión discreta del diagrama de Voronoi con peso aditivo adaptativo (DVPAA), que permite la partición de un espacio bidimensional en zonas de un tamaño específico, considerando tanto la posición como el peso de cada uno de los generadores. El método consiste en resolver repetidamente un tradicional diagrama de Voronoi con peso aditivo, de forma que los pesos de cada generador se actualizan en cada iteración. En el proceso de cálculo de distancias se usa una métrica basada en el camino más corto, lo que garantiza que la partición obtenida esté formada por un conjunto de zonas conexas. La heurística diseñada se integra en una aplicación prototipo, desarrollada en un entorno SIG (Sistemas de Información Geográfica), que permite el trazado automático de zonas según los criterios anteriormente expuestos. Para analizar la viabilidad del método se ha utilizado como caso de estudio la gestión de los recursos pastorales para la ganadería extensiva en tres municipios de Castilla-La Mancha. Las pruebas realizadas ponen de manifiesto que la heurística diseñada, adaptada a los criterios que se plantean en el contexto de la gestión de sistemas extensivos agropecuarios, es válida para resolver este tipo de problemas de partición. El método propuesto se caracteriza por su eficacia en el tratamiento de un gran número de unidades superficiales en formato vectorial, generando soluciones que convergen con relativa rapidez y verifican los criterios establecidos. En el caso estudiado, aunque la posición prefijada de los generadores reduce considerablemente la complejidad del problema, existen algunas configuraciones espaciales de estos elementos para las que el algoritmo no encuentra una solución satisfactoria, poniéndose de manifiesto una de las limitaciones de este modelo. Tal y como se ha podido comprobar, la localización de los generadores puede tener un considerable impacto en la zonificación resultante, por lo que, de acuerdo con Kalcsics et al. (2005), una selección "inadecuada" difícilmente puede generar regiones válidas que verifiquen los criterios establecidos. ABSTRACT Tenitory or zone design processes entail partitioning a geographic space, organized as a set of basic areal units, into different regions or zones according to a specific set of entena that are dependent on the application context. In most cases the aim is to create zones that have approximately equal sizes with respect to one or several measure attributes (zones with equal numbers of inhabitants, same average sales, etc). However, some of the new applications that have emerged, particularly in the context of sustainable development policies, are aimed at defining zones of a predetermined, though not necessarily similar, size. In addition, the zones should be built around a given set of positions, seeds or generators. This type of partitioning has not been sufñciently researched; therefore there are no known approaches for automated zone delimitation. This thesis proposes a new method based on a discrete versión of the Adaptive Additively Weighted Voronoi Diagram (AAWVD) that makes it possible to partition a 2D space into zones of specific sizes, taking both the position and the weight of each (seed) generator into account. The method consists of repeatedly solving a traditional additively weighted Voronoi diagram, so that the weights of each generator are updated at every iteration. The partition s zones are geographically connected nsing a metric based 011 the shortest path. The proposed heuristic lias been included in an application, developed in a GIS environment that allows the automated zone delimitation according to the mentioned criteria. The management of the extensive farming system of three municipalities of Castilla-La Mancha (Spain) has been used as study case to analyze the viability of the method. The tests carried out have established that the proposed method, adapted to the criteria of this application field, is valid for solving this type of partition problem. The applied algorithm is capable of handling a high number of vector areal units, generating solutions that converge in a reasonable CPU time and comply with the imposed constraints. Although the complexity of this problem is greatly reduced when the generator's positions are fixed, in many cases, these positions impose a spatial confignration that the algorithm proposed is unable to solve, thus revealing one of the limitations of this method. It has been shown that the location of the generators has a considerable impact on the final solution, so that, as Kalcsics et al. (2005) observed, an "inadequate" selection can hardly generate valid zones that comply with the established criteria.

Diabetes gestacional : el rol del ejercicio físico en su prevención

Introducción. La prevalencia de la Diabetes Gestacional (DG) varía en todo el mundo, así como entre los grupos raciales y étnicos del mismo país. Hasta la fecha actual, no se ha llegado a un consenso en el criterio diagnóstico, y eso dificulta una estimación veraz de prevalencia entre países. A pesar de ello, es ineludible obviar el incremento en la incidencia de esta complicación en todo el mundo, y la trascendencia de sus riesgos a la salud pública. En España, según los criterios clásicos –del National Diabetes Data Group- existe una alta prevalencia en un 8,8 % de DG en gestantes. Es importante encontrar la mejor vía para la prevención de la DG y, uno de los factores de riesgo parece ser el aumento excesivo de peso durante el embarazo. El ejercicio es un elemento fundamental para el control del metabolismo de la glucosa y para reducir los niveles de hiperlipidemia. Sin embargo, existe controversia para definir el tipo de sesiones, duración e intensidad que puedan contribuir a su prevención. Objetivo. Conocer en qué medida el ejercicio físico programado durante el embarazo, combinado en agua y tierra, con ejercicios aeróbicos y de tonificación muscular, puede actuar como un factor de prevención de la DG. Al mismo tiempo, valorar si exceder las recomendaciones de peso puede influir el diagnóstico de la DG. Material y Métodos. Este estudio se desarrolló mediante una colaboración entre la Universidad Politécnica de Madrid y los Servicios de Ginecología y Obstetricia del Hospital Universitario de Puerta de Hierro, el Hospital Universitario de Torrelodones y el Centro de Salud de Torrelodones. Se obtuvo la aprobación del Comité Ético de Investigación Clínica (CEIC). Se realizó un ensayo clínico, aleatorizado, controlado, no enmascarado. 272 mujeres gestantes sanas dieron su consentimiento informado para la inclusión en el estudio. De las cuáles, finalmente 257 (edad= 33,2±4,4 años) fueron analizadas, 101 de ellas correspondientes al grupo intervención (GI, n=101) y 156 al grupo control (GC, n=156). El inicio del programa correspondió a la semana 10-14 del embarazo hasta el final, la 38-40. Con una frecuencia de 3 sesiones semanales y una duración de 60 y 50 minutos, en tierra y agua, respectivamente. Resultados. Se halló diferencias significativas en los valores en los 180 min del test de tolerancia oral a la glucosa [GI: 98,00±29,48 mg/dl vs. GC: 116,25±29,90 mg/dl (t64= 2,37; p= 0,021)] y, de igual modo, el GI mostró menor prevalencia de la DG [GI: 1 %, Ejercicio y DG n= 1 vs. GC: 8,8 %, n= 13 (2 1= 6,84; p= 0,009)] y una estimación de riesgo significativa (OR= 9,604; 95 % CI: 1,23-74,66). La excesiva ganancia de peso fue menor en el GI [GI: 22,8 %, n= 23 vs. GC: 34,9 %, n= 53 (2 1= 4,22; p= 0,040)], pero no existió una correlación con la incidencia de DG (ϕ= -0,007; p= 0,910). Conclusiones. El programa de ejercicio desarrollado durante el embarazo mostró efectividad en la reducción de la prevalencia de la DG, preservó la tolerancia a la glucosa y redujo la excesiva ganancia de peso materno. Background. The prevalence of Gestational Diabetes (GD) varies around the world, as well as between racial and ethnic groups within the same country. Currently, there is not a consensus about the diagnostic criteria, and that makes it difficult to obtain accurate estimates of prevalence between countries. The increased trend in the prevalence across the globe and the risks for public health cannot be ignored. In Spain, according to the diagnostic criteria of National Diabetes Data Group, there is a prevalence of 8.8 % for GD in pregnant women. It is important to look for the best way to prevent GD and one of the risk factors seems to be excessive weight gained during pregnancy. Exercise is an essential element for glucose metabolic control and reducing hyperlipidemia levels. However, there is controversy to define the type of activity, duration and intensity to prevent GD. Objective. To assess the effectiveness of an exercise programme carried out during pregnancy (land/aquatic activities), both aerobic and muscular conditioning can help to the prevent GD. Also, to assess if excessive maternal weight gain influences the GD diagnosis. Material and methods. Collaboration between the Technical University of Madrid and the Gynecology and Obstetrics Department of Puerta de Hierro University Hospital, Torrelodones University Hospital and Health Center of Torrelodones supported the study. It was approved by the Clinical Research Ethics Committee (CEIC). A clinical, randomized controlled trial recruited 272 pregnant women without obstetric contraindications and gave informed consent for inclusion in the study. Of these women, 257 were studied (age= 33,2±4,4 years), 101 in intervention group (IG, n= 101) and 156 in control group (CG, n= 156). A physical exercise program three times per week during pregnancy was developed. The duration of the sessions was 60 minutes and 50 minutes in land and water, respectively. Results. The IG showed lower maternal values in the Oral Glucose Tolerance Test (OGTT) at 180 minutes [IG: 98,00±29,48 mg/dl vs. CG: 116,25±29,90 mg/dl (t64= 2,37; p= 0,021)] and the IG reduced the prevalence of GD [IG: 1%, n= 1 vs. CG: 8,8 %, n= 13 (2 1= 6,84; p= 0,009)] with a significance risk estimate (OR= 9,604; 95 % CI: 1,23- 74,66). Excessive maternal weight gain was less in the IG [IG: 22,8 %, n= 23 vs. CG: Exercise and GD 34,9 %, n= 53 (2 1= 4,22; p= 0,040)] but there was no correlation with the prevalence of GD (ϕ= -0,007; p= 0,910). Conclusions. The exercise programme performed during pregnancy reduced the prevalence of GD, preserved glucose tolerance and reduced excessive maternal weight gain.