Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loos of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study

Aims: To assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED). Methods and results: A multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were 14 years old and were admitted to the ED because of an episode of T-LOC. Questionnaires and corresponding electrocardiograms (ECGs) were reviewed by a Steering Committee (SC) to unify diagnostic criteria, evaluate adherence to guidelines, and diagnose correctly the ECGs. We included 1419 patients (prevalence, 1.14%).ECG was performed in 1335 patients (94%) in the ED: 498 (37.3%) ECGs were classified as abnormal. The positive diagnostic yield ranged from 0% for the chest X-ray to 12% for the orthostatic test. In the ED, 1217 (86%) patients received a final diagnosis of syncope, whereas the remaining 202 (14%) were diagnosed of non-syncopal transient lossof consciousness (NST-LOC). After final review by the SC, 1080 patients (76%) were diagnosed of syncope, whereas 339 (24%) were diagnosed of NST-LOC (P , 0.001). Syncope was diagnosed correctly in 84% of patients. Only 25% of patients with T-LOC were admitted to hospitals. Conclusion Adherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.

A model of the mammalian retina and the visual cortex. Disorders of vision

A model of the mammalian retina and the behavior of the first layers in the visual cortex is reported. The building blocks are optically programmable logic cells. A model of the retina, similar to the one reported by Dowling (1987) is presented. From the model of the visual cortex obtained, some types of symmetries and asymmetries are possible to be detected

An approach to a model of the visual cortex: disorders of vision

One of the most challenging problems that must be solved by any theoretical model purporting to explain the competence of the human brain for relational tasks is the one related with the analysis and representation of the internal structure in an extended spatial layout of múltiple objects. In this way, some of the problems are related with specific aims as how can we extract and represent spatial relationships among objects, how can we represent the movement of a selected object and so on. The main objective of this paper is the study of some plausible brain structures that can provide answers in these problems. Moreover, in order to achieve a more concrete knowledge, our study will be focused on the response of the retinal layers for optical information processing and how this information can be processed in the first cortex layers. The model to be reported is just a first trial and some major additions are needed to complete the whole vision process.

Consciousness, Meaning and the Future Phenomenology

Phenomenological states are generally considered sources of intrinsic motivation for autonomous biological agents. In this paper we will address the issue of exploiting these states for robust goal-directed systems. We will provide an analysis of consciousness in terms of a precise definition of how an agent “understands” the informational flows entering the agent. This model of consciousness and understanding is based in the analysis and evaluation of phenomenological states along potential trajectories in the phase space of the agents. This implies that a possible strategy to follow in order to build autonomous but useful systems is to embed them with the particular, ad-hoc phenomenology that captures the requirements that define the system usefulness from a requirements-strict engineering viewpoint.

Consciousness, Action Selection, Meaning and Phenomenic Anticipation

Phenomenal states are generally considered the ultimate sources of intrinsic motivation for autonomous biological agents. In this article, we will address the issue of the necessity of exploiting these states for the design and implementation of robust goal-directed artificial systems. We will provide an analysis of consciousness in terms of a precise definition of how an agent "understands" the informational flows entering the agent and its very own action possibilities. This abstract model of consciousness and understanding will be based in the analysis and evaluation of phenomenal states along potential future trajectories in the state space of the agents. This implies that a potential strategy to follow in order to build autonomous but still customer-useful systems is to embed them with the particular, ad hoc phenomenality that captures the system-external requirements that define the system usefulness from a customer-based, requirements-strict engineering viewpoint.

Novel system for bite-force sensing and monitoring based on magnetic eear field communication

Intraoral devices for bite-force sensing have several applications in odontology and maxillofacial surgery, as bite-force measurements provide additional information to help understand the characteristics of bruxism disorders and can also be of help for the evaluation of post-surgical evolution and for comparison of alternative treatments. A new system for measuring human bite forces is proposed in this work. This system has future applications for the monitoring of bruxism events and as a complement for its conventional diagnosis. Bruxism is a pathology consisting of grinding or tight clenching of the upper and lower teeth, which leads to several problems such as lesions to the teeth, headaches, orofacial pain and important disorders of the temporomandibular joint. The prototype uses a magnetic field communication scheme similar to low-frequency radio frequency identification (RFID) technology (NFC). The reader generates a low-frequency magnetic field that is used as the information carrier and powers the sensor. The system is notable because it uses an intra-mouth passive sensor and an external interrogator, which remotely records and processes information regarding a patient?s dental activity. This permits a quantitative assessment of bite-force, without requiring intra-mouth batteries, and can provide supplementary information to polysomnographic recordings, current most adequate early diagnostic method, so as to initiate corrective actions before irreversible dental wear appears. In addition to describing the system?s operational principles and the manufacture of personalized prototypes, this report will also demonstrate the feasibility of the system and results from the first in vitro and in vivo trials.

Aphasic seizures in patients with temporopolar and anterior temporobasal lesions: a video-EEG study

Studies of patients with temporal lobe epilepsy provide few descriptions of seizures that arise in the temporopolar and the anterior temporobasal brain region. Based on connectivity, it might be assumed that the semiology of these seizures is similar to that of medial temporal lobe epilepsy. However, accumulating evidence suggests that the anterior temporobasal cortex may play an important role in the language system, which could account for particular features of seizures arising here. We studied the electroclinical features of seizures in patients with circumscribed temporopolar and temporobasal lesions in order to identify specific features that might differentiate them from seizures that originate in other temporal areas. Among 172 patients with temporal lobe seizures registered in our epilepsy unit in the last 15 years, 15 (8.7%) patients had seizures caused by temporopolar or anterior temporobasal lesions (11 left-sided lesions). The main finding in our study is that patients with left-sided lesions had aphasia during their seizures as the most prominent feature. In addition, while all patients showed normal to high intellectual functioning in standard neuropsychological testing, semantic impairment was found in a subset of 9 patients with left-sided lesions. This case series demonstrates that aphasic seizures without impairment of consciousness can result from small, circumscribed left anterior temporobasal and temporopolar lesions. Thus, the presence of speech manifestation during seizures should prompt detailed assessment of the structural integrity of the basal surface of the temporal lobe in addition to the evaluation of primary language areas.

Composición florística y etnobotánica de las diferentes formaciones vegetales de la provincia de Loja, Ecuador

Pese a que Loja (Ecuador) presenta una gran riqueza ecológica y cultural, ni su patrimonio etnobotánico, ni cómo afecta el uso de las plantas al estado de conservación de los ecosistemas es bien conocido. Por ello se ha realizado un estudio etnobotánico y ecológico para conocer el papel que han jugado las plantas en la cultura tradicional de la provincia y comprender qué factores influyen en su uso. Durante 2006 y 2008 se entrevistó a 770 informantes (196 de ellos vendedores en mercados locales) y se realizaron 373 transectos en 118 remanentes boscosos, 51% indicados por la gente como lugares de recolección. Se ha registrado el saber etnobotánico de 717 especies pertenecientes a 143 familias, la mayoría nativas del Ecuador, 31 de ellas endémicas. Ello supone un 15% de la flora total de Loja. Sin embargo especies introducidas como Matricaria recutita o Eucalyptus globulus están entre las más citadas. La mayor riqueza se obtuvo para las plantas medicinales (509 especies), que se usan sobre todo para tratar las llamadas “inflamaciones internas” (210 especies, Matricaria recutita y Melissa officinalis principalmente) y trastornos del sistema digestivo (188, Matricaria recutita y Mentha pulegium). En los mercados se venden 169 especies, la mayoría para elaborar la bebida típica llamada horchata (65) y para curar “inflamaciones internas” (36). Además se emplean 414 con otros fines (161 para leña, 142 para alimentación humana, 133 para construcción de viviendas y muebles, 98 para artesanías, 89 ornamentales, 27 tintóreas y 72 para otros usos). En los remanentes se inventariaron 19.156 individuos correspondientes a 1440 especies de 153 familias, de las cuales 437 son empleadas por la población. La riqueza media de especies y de plantas útiles fue significativamente mayor en los remanentes recolectados lo cual parece demostrar que la explotación no afecta negativamente a la diversidad de especies al generar variabilidad de hábitats. También se vio que la proporción de especies útiles disminuye en los remanentes más diversos. También se observó que la probabilidad de uso de una especie aumenta con la frecuencia y la abundancia y disminuye con la distancia a los remanentes en los que aparece. Este patrón general no se cumple para las especies medicinales y ornamentales. Estos datos demuestran una gran riqueza de conocimientos tradicionales y una gran vitalidad del uso de muchas especies y corroboran la hipótesis de que los recursos vegetales más accesibles y abundantes son, salvo excepciones, los más empleados por la gente. ABSTRACT Although the Loja province (Ecuador) has a great ecological and cultural richness, neither the ethnobotanical heritage nor the incidence of plant use on ecosystems conservation it is well known. We have made an ethnobotanical and ecological study to determine the role played by plants in the traditional culture of the province and to understand what factors influence their use. Between 2006 and 2008 we interviewed 770 informants (196 of them vendors in local markets) and inventoried 373 transects in 118 forest remnants (51% of them indicated by people as collection sites). We recorded the ethnobotanical knowledge for 717 species belonging to 143 families, mostly native of Ecuador, 31 of which are endemic. This represents about a 15% of the total flora of Loja. However introduced species such as Matricaria recutita and Eucalyptus globulus are among the most cited. Medicinal plants (509 species) were the most abundant, and are used primarily to treat so‐called "internal inflammation" (210 species, with Matricaria recutita and Melissa officinalis as the most valued) and disorders of the digestive system (188, Matricaria recutita and Mentha pulegium). We recorded 169 species sold in markets, most of them (65) employed to elaborate a typical drink called horchata and to heal "internal inflammation" (36). In addition 414 are used for other purposes: 161 for firewood, 142 for human consumption, 133 for construction and furniture, 98 for handicrafts, 89 as ornamental, 27 for dye and 72 for other uses. In the forest remnants, 19,156 individuals corresponding to 1440 species of 153 families, 437 of which are used by the population were inventoried. The average species richness (both total and of useful plants) was significantly higher in exploited remnants, which suggest that exploitation does not adversely affect species diversity and instead increases habitat diversity. We also found that the proportion of useful species decreases in decreased in the most diverse remnants. It was also observed that the probability of use of a species increases with its frequency and abundance and decreases as the distance form localities to remnants where it appears increases. This general pattern however does not hold for medicinal and ornamental species. These results show the extraordinary wealth of traditional knowledge and the great vitality in the use of many species and support the hypothesis that most accessible and abundant plant resources are the most used by people.

La construcción de la transparencia : Museo de Arte Contemporáneo del siglo 21 de Kanazawa - SANAA

La tesis doctoral “La construcción de la transparencia. Museo de Arte Contemporáneo del Siglo 21 de Kanazawa / SANAA” estudia, desde diferentes perspectivas, esta obra de los arquitectos japoneses Kazuyo Sejima + Ryue Nishizawa / SANAA. El museo, proyectado y construido entre 1999 y 2004, supone un referente arquitectónico de gran relevancia en el cambio de siglo, y está considerado un manifiesto construido en el que resuenan ecos culturales y sociales de su época. La investigación toma como constante el Museo del Siglo 21 de Kanazawa y a través de él se realizan una serie de miradas transversales a modo de narrativas interconectadas. Estas visiones múltiples colaboran, a través de las relaciones que se producen entre ellas, a generar un entendimiento global de esta obra y sus efectos sobre la cultura arquitectónica contemporánea. La tesis se estructura en dos partes: la primera estudia de manera analítica la obra en su contexto cultural, el proceso de proyecto y el edificio construido. La segunda parte propone una triple lectura interpretativa del edificio en relación a temas de especial relevancia para el proyecto y al modelo de espacio que constituye, tomando de nuevo como constante la noción de transparencia. La tesis partirá de la interpretación que hace del museo su directora artística Yuko Hasegawa, cuya colaboración activa durante el proceso de diseño resultó de gran relevancia para el resultado final. Hasegawa define la obra como la materialización de una situación cultural característica del nuevo siglo basada en tres conceptos: La Coexistencia, la Consciencia y la Inteligencia Colectiva. A partir de dichas ideas entenderemos la transparencia no sólo desde el punto de vista de las cualidades físicas y materiales del espacio sino también, desde una perspectiva más amplia: como estrategia utilizada para clarificar la organización funcional del edificio y las relaciones entre sus partes como posición política, catalizadora del espacio público; la producción de consciencia a través de la experiencia del arte y la arquitectura; y como medio de representación y generación de una identidad colectiva basada en la visibilidad mediática. Las conclusiones de esta investigación, extraídas de las confluencias y puntos de intersección de las diferentes miradas transversales proyectadas sobre la obra, determinan una clara voluntad por parte de los arquitectos de construir un espacio donde lo público se entiende como el ensamblaje de diferentes individualidades. De manera similar al proceso de proyecto, la multiplicidad y las relaciones entre elementos autónomos generan un consciencia colectiva del espacio donde, a través de la organización programática, la construcción y el uso de los materiales y la luz, la arquitectura tiene la voluntad de desvanecerse para ofrecer protagonismo a sus usuarios y a las relaciones y encuentros que se producen entre ellos y con el espacio que habitan. ABSTRACT The PhD thesis “The construction of transparency. 21st Century Museum of Contemporary Art in Kanazawa / SANAA” studies, from different perspectives, this work, realized by Japanese architects Kazuyo Sejima + Ryue Nishizawa / SANAA. The museum, designed and built between 1999 and 2004, had a huge relevance as an architectural referent in the swift of the century, being considered a built manifesto that echoes the culture and society of its time. The research takes as a constant the 21st Century Museum in Kanazawa and it is studied throughout a series of transversal readings as interconnected narratives. These multiple approaches and the relations among them, help to generate a global understanding of the building and its effects on contemporary architectural culture. The dissertation is structured in two parts: the first one studies from an analytical perspective the project in its cultural context, the process of design and the built work. The second part proposes a triple interpretative reading of the building in relation to topics that are especially relevant for the project and the spatial model that it constitutes, taking again the notion of transparency as a constant concept. The thesis departs from the interpretation expressed by the artistic director of the museum, Yuko Hasegawa, whose active collaboration during the design process had special relevance for the final result. She defines the work as the materialization of the cultural context of the new century based in three concepts: Co-existence, Consciousness and Collective Intelligence. From these concepts we will understand transparency, not only from the point of view of the physical and material qualities of the space, but also from a broader perspective: as an strategy used to clarify the functional organization of the building and the relation of its parts as political stand that catalyzes the public space; the production of consciousness based on the experience of art and architecture; and as a method of representation and construction of a collective identity based in the media visibility. The conclusions of this research -extracted from the confluences and intersections of the different transversal readings projected on the work- determine a clear intention by the architects to build a space where the public is understood as an assembly of different individualities. In a similar way as it happens in the design process, the multiplicity of relations between autonomous elements generate a collective consciousness of the space. Throughout the programmatic organization, the construction and the use of light and materials, the architecture has the will of disappearance to yield protagonist the users and the relations and encounters that happen among them and the space they inhabit.

El tiempo como sustancia de la forma : una aproximación al Museo de Arte Romano de Mérida desde los presupuestos del vitalismo

El modelo dominante durante la Era Moderna asume la presencia del hombre como sujeto dentro del gran engranaje mecánico del Cosmos. Asimismo, recoge una idea acerca del ser natural dentro de la tradición ontológica iniciada por el eleatismo presocrático que concibe a éste como lo inmutable y estático frente al cambio y al movimiento, los cuales se constituyen como meras apariencias. Durante el periodo anterior a la aparición de los grandes filósofos griegos se produce una transformación en donde, de la inicial cosmología vinculada a un tiempo primordial, se pasará a una visión del Universo como ente indestructible, atemporal, inmutable, perfecto, geométrico y espacial. Si en Demócrito se admite un universo sometido al azar y a la necesidad, en Platón el Universo sólo atiende a la necesidad. Este modelo ontológico se pone en entredicho cuando el hombre ya no es concebido como pieza de un sistema más amplio, sino como centro radical del pensamiento. La condición radical del hombre es entonces su propia vida, siendo éste el concepto troncal del denominado vitalismo cuyo más influyente representante en España es José Ortega y Gasset. El estatismo del ser –del hombre- pierde sentido; en palabras del propio Ortega, “no es un ser sino un estar siendo” lo que caracteriza a la vida humana. La razón cartesiana es ahora la razón vital y su objeto de estudio no es la naturaleza sino el propio devenir, es decir, el tiempo, la historia. Este planteamiento es fundamental para comprender el edificio que es objeto de este estudio, el Museo de Arte Romano de Mérida (1980-1985) de Rafael Moneo. Por ello el concepto de tiempo es utilizado como marco y estructura de la presente tesis, a sabiendas del notorio y muy significativo papel que este edificio desempeñó en la carrera de su autor y en el panorama nacional e internacional de la arquitectura y de la museología. Este proyecto nos permite acercarnos al pensamiento de su autor a través de un edificio que, aun habiendo sido ampliamente reconocido, no cuenta con un estudio suficientemente exhaustivo que recoja la amplitud y riqueza que encierra. Esta tesis no es un compendio de lo que ya se ha investigado sobre Mérida; es una aproximación global e interpretativa cuyo sentido sólo puede concebirse al vislumbrar la estructura completa de la misma en sintonía con el "lógos" vital, histórico y narrativo que el proyecto encierra. Se revisará la concepción histórica según la cual, la configuración espacial de la forma habría tenido primacía respecto a su configuración temporal, al remitir esta última a una condición espacializada y circunstancial. La componente vicaria de la circunstancia será elevada por Ortega a la categoría de esencial, visualizando así una paradoja cuya reformulación nos lleva a la concepción de un tiempo sustancial. El diccionario de la RAE, en su tercera acepción, define la sustancia como “aquello que permanece en algo que cambia”, lo cual nos remite al pensamiento antiguo. Se mostrará que lo que permanece no necesariamente implica una concepción estática y eleática de la forma, que la arquitectura esencial no es unívocamente la arquitectura atemporal del platonismo y que cabe concebir la "firmitas" desde la atención a la "durée" bergsoniana. Al asociar tradicionalmente la sustancia con el referido estatismo, se margina al tiempo y a la duración a lo no sustancial; por ello, se tratará de aproximar los términos de tiempo y sustancia para definir la forma. Ello conllevará al estudio de las notables patologías derivadas de la asunción de un tiempo cronológico en nuestra contemporaneidad frente a las cuales, las intuiciones contenidas en Mérida, se alinearán con la actual actitud revisionista en el ámbito del pensamiento filosófico y científico. En Mérida, la memoria recogerá los aspectos de la conciencia así como los aspectos vinculados a la experiencia íntima y colectiva como soporte para la consecución de un discurso. La dualidad entre intuición e inteligencia será recogida por Moneo con idea de trascender su incomunicabilidad, mediante una operación que consistirá en la reivindicación de una memoria irreductible, cuya morada estaría incardinada en el propio tiempo de la duración y de la vida y no en la espacialidad coextensiva del presente y de la acción funcional sobre la materia. Moneo asumirá el papel de la memoria como condición central de una forma que se encarnará al concebirse como un teatro. En la respuesta a la contradicción entre el hecho físico y el efecto psíquico de la experiencia humana residirá la pertinencia de un tiempo narrativo. Será entonces el lenguaje el encargado de aportar sentido a la obra mediante el recurso fundado en la dramatización de la experiencia, es decir, a través de una conexión entre la conciencia íntima y el carácter social y colectivo intrínseco en la arquitectura. ABSTRACT TIME AS A SUBSTANCE OF FORM. AN APPROACH TO THE ROMAN ART MUSEUM OF MÉRIDA FROM THE VIEWPOINT OF VITALISM. The dominant model during the Modern Era placed man as a subject inside the great mechanism of the cosmos. It is also based in an idea about natural being within the ontological tradition initiated by the pre-Socratic Eleatism that conceives it as something immutable and static in respect with change and movement, which are considered as mere appearances. Prior to the emergence of the great Greek philosophers occurred a transformation where concepts of cosmology linked to a primordial time, changed to a view of the universe as indestructible, timeless, unchanging, perfect, geometric and spatial. If Democritus accepted a universe subjected to randomness and necessity, Plato thought that the universe only worked by necessity. This ontological model is called into question when man is not conceived as a piece of a broader system, but as a radical center of thinking. The radical condition of man then is his own life. This is the core concept of so-called Vitalism, whose most influential representative in Spain was José Ortega y Gasset. The stillness of being – of man - loses its meaning; in the words of Ortega, “it is not being but being in progress” that characterizes human life. The Cartesian reason is now the vital reason and its subject of study is no longer nature but its own evolution, in other words, time and history. This approach is fundamental to understand the building which is the subject of this study, the Museum of Roman Art in Mérida (1980-1985) by Rafael Moneo. The concept of time is used as a framework and structure of this thesis, demonstrating the notorious and very significant role this building has implied in the career of its author and in the national and international panorama of architecture and museology. This project allow us to approach the thought of its author through a building that, even whilst widely recognized, does not yet have a sufficiently comprehensive study covering its breadth and richness. This thesis is not a compendium of what already has been researched on Merida; it is a global and interpretative approach whose meaning can only be conceived as a study of its complete structure in line with the vital, historical and narrative logos the project implies. We will review the historical idea where spatial configuration of the form would have had primacy with respect to temporary configuration, because the latter refers to a spatial and circumstantial condition. The vicarious nature of the circumstance will be elevated by Ortega to the category of essential, thus showing a paradox which reformulation leads us to the conception of a substantial time. The dictionary of the Spanish Royal Academy, in its third meaning, defines substance as "that which remains in something that changes". This is a reference to ancient thought. It will be shown that what remains does not necessarily imply a static and Eleatic conception of form. It will also be shown that the essential architecture is not uniquely the timeless architecture of Platonism and that it is possible to conceive the "firmitas" parallel to the "durée" of Henri Bergson. As a result of this traditional association between substance and stillness, it marginalizes the time and the duration to the non-substantial; for this reason, we will try to approach terms of time and substance to define the shape. This will involve studying significant pathologies resulting from an assumption of chronological time in our contemporary world against which, the insights contained in Merida, will be aligned with the current revisionist attitude in the fields of philosophical and scientific thought. In Merida, memory includes aspects of consciousness as well as aspects linked to the intimate and collective experience as a foundation for the achievement of discourse. The duality between intuition and intelligence is put forward by Moneo with the idea of transcending its lack of communication, by means of a resource consisting of the vindication of an irreducible memory, whose home would be embodied in the time of duration and life and not in the coextensive spatiality of the present and in the functional action on the matter. Moneo demonstrates the role of memory as a central condition of form as a theatre. In response to the contradiction between the physical fact and the psychological effect of human experience lies the relevance of narrative time. Language then assumes the responsibility of giving meaning to the work through the dramatization of experience, i.e., through a connection between the intimate consciousness and the intrinsic social and collective character of architecture.