Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures.

Objective: To analyse whether bone mineral density (BMD) assessment is required in postmenopausal women presenting with low trauma vertebral fracture. Methods: Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients with high energy trauma; (b) patients with malignancies; (c) patients with a metabolic bone disease other than osteoporosis. All postmenopausal women were included in whom BMD had been evaluated at both the lumbar spine and femoral neck by dual energy x ray absorptiometry during the six months after the diagnosis. Patients with a potential cause of osteoporosis other than age and menopause were not considered. A total of 215 patients were identified. Results: The mean (SD) age of the patients was 65.9 (6.9) years. BMD at the lumbar spine was 0.725 (0.128) g/cm2 and the T score was ¿2.94 (1.22); BMD at the femoral neck was 0.598 (0.095) g/cm2 and the T score was ¿2.22 (0.89). The BMD of the patients was significantly lower than that of the general population at both the lumbar spine and femoral neck. When the lowest value of the two analysed zones was considered, six patients (3%) showed a normal BMD, 51 (23.5%) osteopenia, and 158 (73.5%) osteoporosis. The prevalence of osteoporosis at the femoral neck increased with age; it was 25% in patients under 60, 35% in patients aged 60¿70, and 60% in patients over 70. Conclusion: These results indicate that bone densitometry is not required in postmenopausal women with clinically diagnosed vertebral fractures if it is performed only to confirm the existence of a low BMD.

Clinical usefulness of temporal artery biopsy.

To assess the diagnostic usefulness of temporal artery biopsy in temporal arteritis (TA) and establish clinical features capable of predicting its positivity we have retrospectively studied the biopsy specimens and the clinical features of 103 patients who had undergone temporal artery biopsy. Temporal artery biopsy reached a positive predictive value of 90.2% with respect to the final diagnosis based on the criteria proposed by Ellis and Ralston and the clinical course. The simultaneous presence of recent onset headache, jaw claudication, and abnormalities of the temporal arteries on physical examination had a specificity of 94.8% with respect to the histological diagnosis and of 100% with respect to final diagnosis. The presence of any of these clinical features, though of little specificity (34.4%), had a sensitivity of 100% with respect to histological diagnosis, selecting a group of patients in whom temporal artery biopsy has more discriminative value.

Pro-adrenomedullin usefulness in the management of children with community-acquired pneumonia, a preliminary prospective observational study

BackgroundIn adult population with community acquired pneumonia high levels of pro-adrenomedullin (pro-ADM) have been shown to be predictors of worse prognosis. The role of this biomarker in pediatric patients had not been analyzed to date. The objective of this study is to know the levels of pro-ADM in children with community acquired pneumonia (CAP) and analyze the relation between these levels and the patients¿ prognosis.FindingsProspective observational study including patients attended in the emergency service (January to October 2009) admitted to hospital with CAP and no complications at admission. The values for pro-ADM were analyzed in relation to: need for oxygen therapy, duration of oxygen therapy, fever and antibiotic therapy, complications, admission to the intensive care unit, and length of hospital stay. Fifty patients were included. Ten presented complications (7 pleural effusion). The median level of pro-ADM was 1.0065¿nmol/L (range 0.3715 to 7.2840¿nmol/L). The patients presenting complications had higher levels of pro-ADM (2.3190 vs. 1.1758¿nmol/L, p¿=¿0.013). Specifically, the presence of pleural effusion was associated with higher levels of pro-ADM (2.9440 vs. 1.1373¿nmol/L, p¿<¿0.001).ConclusionsIn our sample of patients admitted to hospital with CAP, pro-ADM levels are related to the development of complications during hospitalization.

Usefulness of betalactam therapy for community-acquired pneumonia in the era of drug-resistant Streptococcus pneumoniae: a randomized study of amoxicillin-clavulanate and ceftriaxone

Empirical antibiotic therapy of community-acquired pneumonia (CAP) has been complicated by the worldwide emergence of penicillin resistance among Streptococcus pneumoniae. The impact of this resistance on the outcome of patients hospitalized for CAP, empirically treated with betalactams, has not been evaluated in a randomized study. We conducted a prospective, randomized trial to assess the efficacy of amoxicillin-clavulanate (2 g/200 mg/8 hr) and ceftriaxone (1 g/24 hr) in a cohort of patients hospitalized for moderate-to-severe CAP. Three-hundred seventy-eight patients were randomized to receive amoxicillin-clavulanate (184 patients) or ceftriaxone (194 patients). Efficacy was assessed on Day 2, after completion of therapy and at long term follow-up. There were no significant differences in outcomes between treatment groups, both in intention-to-treat and per-protocol analysis. Overall mortality was 10.3% for amoxicillin-clavulanate and 8.8% for ceftriaxone (NS). There were 116 evaluable patients with proven pneumococcal pneumonia. Rates of high-level penicillin resistance (MIC of penicillin ≥2 µg/mL) were similar in the two groups (8.2 and 10.2%). Clinical efficacy at the end of therapy was 90.6% for amoxicillin-clavulanate and 88.9% for ceftriaxone (95% C.I. of the difference: -9.3 to +12.7%). No differences in outcomes were attributable to differences in penicillin susceptibility of pneumococcal strains. Sequential i.v./oral amoxicillin-clavulanate and parenteral ceftriaxone were equally safe and effective for the empirical treatment of acute bacterial pneumonia, including penicillin and cephalosporin-resistant pneumococcal pneumonia. The use of appropriate betalactams in patients with penumococcal pneumonia and in the overall CAP population, is reliable at the current level of resistance

Scientific evidence on the usefulness of intraarticular hyaluronic acid injection in the management of temporomandibular dysfunction

Hyaluronic acid (HA) is found in high concentrations in cartilage and synovial fluid, and is an important component of the extracellular matrixes- exerting joint lubrication and buffering actions thanks to its viscoelastic properties. The present study examines the scientific evidence found in the current literature on the usefulness of the intraarticular injection of HA in patients with temporomandibular dysfunction. A literature search was made up until May 2008 in the following databases: PubMed / MEDLINE. Of the articles found in the literature, the present review included 18 relevant studies on the application of HA in the temporomandibular joint (TMJ). The quality, level of evidence and strength of recommendation of the articles was evaluated based on the"Strength of Recommendation Taxonomy" criteria. It is concluded that type A level of recommendation exists in favor of the intraarticular injection of HA in dysfunction of the TMJ. However, further studies are needed to establish the true therapeutic effects and to identify the best dosing regimen.

Clinical usefulness of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) scale in patients with type I bipolar disorder

Background: The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results: Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations: The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion: With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

Clinical usefulness of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) scale in patients with type I bipolar disorder

Background: The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results: Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations: The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion: With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

The usefulness of phonological information for the acquisition of grammatical structure in child language development

During the process of language development, one of the most important tasks that children must face is that of identifying the grammatical category to which words in their language belong. This is essential in order to be able to form grammatically correct utterances. How do children proceed in order to classify words in their language and assign them to their corresponding grammatical category? The present study investigates the usefulness of phonological information for the categorization of nouns in English, given the fact that it is phonology the first source of information that might be available to prelinguistic infants who lack access to semantic information or complex morphosyntactic information. We analyse four different corpora containing linguistic samples of English speaking mothers addressing their children in order to explore the reliability with which words are represented in mothers’ speech based on several phonological criteria. The results of the analysis confirm the prediction that most of the words to which English learning infants are exposed during the first two years of life can be accounted for in terms of their phonological resemblance

Multivariate contemporaneous-threshold autoregressive models

This paper proposes a contemporaneous-threshold multivariate smooth transition autoregressive (C-MSTAR) model in which the regime weights depend on the ex ante probabilities that latent regime-specific variables exceed certain threshold values. A key feature of the model is that the transition function depends on all the parameters of the model as well as on the data. Since the mixing weights are also a function of the regime-specific innovation covariance matrix, the model can account for contemporaneous regime-specific co-movements of the variables. The stability and distributional properties of the proposed model are discussed, as well as issues of estimation, testing and forecasting. The practical usefulness of the C-MSTAR model is illustrated by examining the relationship between US stock prices and interest rates.

Banning Obsolete Weapons or Reshaping Perceptions of Military Utility: Discursive Dynamics in Weapons Prohibitions

The paper focuses on the argumentative process through which new international norms prohibiting the use of weapons causing severe civilian harm emerge. It examines the debate surrounding the use and usefulness of landmines and cluster munitions and traces the process through which NGOs change conceptions of military utility and effectiveness of certain weapons by highlighting their humanitarian problems and questioning their military value. By challenging military thinking on these issues, NGOs redefine the terms of the debate – from a commonplace practice, the use of such weapons becomes controversial and military decisions need to be justified. The argument-counterargument dynamic shifts the burden of proof of the necessity and safety of the weapons to the users. The process witnesses the ability of NGOs to influence debates on military issues despite their disadvantaged position in hard security issue areas. It also challenges realist assumptions that only weapons that are obsolete or low-cost force equalizers for weak actors can be banned. To the contrary, the paper shows that in the case of landmines and cluster munitions, defining the military (in)effectiveness of the weapons is part and parcel of the struggle for their prohibition.

Human biology: cibernética y biología humana en el nuevo discurso expositivo de la década de 1970

En este trabajo se explica cuáles fueron las estrategias utilizadas y los resultados obtenidos en la primera exposición del nuevo esquema museográfico del Museo de Historia Natural de Londres, concebido por Roger Miles, Jefe del Departamento de Servicios Públicos de esa prestigiada institución. Esta iniciativa pretendía atraer a un mayor número de visitantes a partir de exposiciones basadas en modelos y módulos interactivos que relegaban a los objetos de las colecciones a un segundo plano. La exposición se tituló Human Biology y fue inaugurada el 24 de mayo de 1977. El tema de la exposición fue la biología humana, pero como se argumenta en este trabajo, Human Biology sirvió también como medio para legitimar el discurso modernizador de la biología humana, en tanto disciplina más rigurosa por las herramientas y técnicas más precisas que las utilizadas por la antropología física tradicional. Se buscaba también generar una audiencia para reforzar el campo interdisciplinario de la ciencia cognitiva y en particular la inteligencia artificial. El equipo de asesores científicos de la exposición contó entre sus miembros con personalidades que jugaron un papel protagónico en el desarrollo de esas disciplinas, y necesitaban demostrar su validez y utilidad ante los no especialistas y el público en general.

Desenvolupament de problemes virtuals i interactius per a l’aprenentatge de la Microbiologia

La finalitat del projecte ha estat desenvolupar un espai virtual teòric-pràctic per a l’aprenentatge de la Microbiologia. Aquest espai virtual, basat en l'aprenentatge a través de problemes, s’ha anomenat “Microbiologia Interactiva” i proposa a l’alumne les següents àrees temàtiques: Introducció a les tècniques de la Microbiologia; Estructura i funció de la cèl.lula microbiana; Creixement i control microbià; Microbiologia molecular; Fisiologia i metabolisme microbians; Virologia; Ecologia Microbiana; Diversitat microbiana. Per a cada temàtica s’han definit unes competències a assolir a través de la resolució de problemes teòrics o pràctics. En aquest darrer cas, se li proposa a l’alumne que entri en el laboratori virtual per a la resolució dels casos pràctics plantejats. A més, per a la resolució dels problemes, l’alumne disposa d’un seguit de recursos per a cada temàtica. Finalment, també s’inclouen activitats de relació i d’ampliació per tal d’estimular la discussió, l’esperit crìtic, el treball en grup i la recerca bibliogràfica. A més, per tal de facilitar el seu ús, el web disposa també d'un tutorial. El web “Microbiologia Interactiva” es va introduir de forma pilat en l’ensenyament de l'assignatura de Microbiologia de la Llicenciatura de Biologia i de la de Microbiologia I de la llicenciatura de Biotecnologia de la Universitat Autònoma de Barcelona (UAB) durant el curs 2007-08. Al llarg d'aquest curs es va valorar la seva utilitat i acceptació per part dels alumnes mitjançant enquestes. Els bons resultats obtinguts van aconsellar que aquesta eina fora ja utilitzada en totes les assignatures generals de Microbiologia de les llicenciatures de Biologia, Biotecnologia, Bioquímica, Química, Enginyeria Química, Ciències Ambientals i Ciència i Tecnologia dels Aliments de la UAB. Actualment el web s’està també utilitzant amb molt bons resultats a les assignatures de Microbiologia dels nous graus que ofereix la Facultat de Biociències de la UAB. Així doncs, en aquest projecte s’han assolit amb escreix els objectius previstos. Es pot consultar el web desenvolupat a l’adreça http://microbiologia.uab.cat//Microbiologia_Interactiva_Web/.

Diseño y desarrollo de un equipo de caracterización de ISFET para la medida de analitos iónicos

En este proyecto se desarrolla una unidad de medida para investigar la cuantificación de la concentración de analitos iónicos en análisis clínico mediante sensores ISFET. Para su desarrollo se precisa de un elemento que simule el comportamiento de un ISFET por lo que también se desarrolla un simulador de ISFET. Para realizar la unidad de medida se diseñan unos circuitos SMU que permiten polarizar en tensión y medir la corriente de cada terminal de un ISFET y del electrodo de referencia que actúa de puerta. El simulador se realiza con un MOSFET de la misma geometría que el ISFET y dos generadores de tensión programables. Desarrollados y validados los circuitos correspondientes, obtenemos unos excelentes resultados en el simulador que se revela de gran utilidad para la puesta en marcha de la unidad de medida, la cual ofrece unos resultados bastante buenos, si bien se aprecian ciertas corrientes de fuga que no permiten alcanzar toda la exactitud que se pretendía. Ello es debido a los circuitos impresos que deberán ser mejorados hasta conseguir la exactitud deseada. Sin embargo pueden darse por válidos los circuitos de medida diseñados.

Re-opening the black box in societal metabolism: the application of MuSIASEM to water

In this paper we address the complexity of the analysis of water use in relation to the issue of sustainability. In fact, the flows of water in our planet represent a complex reality which can be studied using many different perceptions and narratives referring to different scales and dimensions of analysis. For this reason, a quantitative analysis of water use has to be based on analytical methods that are semantically open: they must be able to define what we mean with the term “water” when crossing different scales of analysis. We propose here a definition of water as a resource that deal with the many services it provides to humans and ecosystems. WE argue that water can fulfil so many of them since the element has many characteristics that allow for the resource to be labelled with different attributes, depending on the end use –such as drinkable. Since the services for humans and the functions for ecosystems associated with water flows are defined on different scales but still interconnected it is necessary to organize our assessment of water use across different hierarchical levels. In order to do so we define how to approach the study of water use in the Societal Metabolism, by proposing the Water Metabolism, tganized in three levels: societal level, ecosystem level and global level. The possible end uses we distinguish for the society are: personal/physiological use, household use, economic use. Organizing the study of “water use” across all these levels increases the usefulness of the quantitative analysis and the possibilities of finding relevant and comparable results. To achieve this result, we adapted a method developed to deal with multi-level, multi-scale analysis - the Multi-Scale Integrated Analysis of Societal and Ecosystem Metabolism (MuSIASEM) approach - to the analysis of water metabolism. In this paper, we discuss the peculiar analytical identity that “water” shows within multi-scale metabolic studies: water represents a flow-element when considering the metabolism of social systems (at a small scale, when describing the water metabolism inside the society) and a fund-element when considering the metabolism o ecosystems (at a larger scale when describing the water metabolism outside the society). The theoretical analysis is illustrated using two case which characterize the metabolic patterns regarding water use of a productive system in Catalonia and a water management policy in Andarax River Basin in Andalusia.

Mètodes algebraics i de teoria de la prova per a la formalització del raonament vague

Projecte de recerca elaborat a partir d’una estada a la Università degli studi di Siena, Italy , entre 2007 i 2009. El projecte ha consistit en un estudi de la formalització lògica del raonament en presència de vaguetat amb els mètodes de la Lògica Algebraica i de la Teoria de la Prova. S'ha treballat fonamental en quatre direccions complementàries. En primer lloc, s'ha proposat un nou plantejament, més abstracte que el paradigma dominant fins ara, per l'estudi dels sistemes de lògica borrosa. Fins ara en l'estudi d'aquests sistemes l'atenció havia recaigut essencialment en l'obtenció de semàntiques basades en tnormes contínues (o almenys contínues per l'esquerra). En primer nivell de major abstracció hem estudiat les propietats de completesa de les lògiques borroses (tant proposicionals com de primer ordre) respecte de semàntiques definides sobre qualsevol cadena de valors de veritat, no necessàriament només sobre l'interval unitat dels nombres reals. A continuació, en un nivell encara més abstracte, s’ha pres l'anomenada jerarquia de Leibniz de la Lògica Algebraica Abstracta que classifica tots els sistemes lògics amb un bon comportament algebraic i s'ha expandit a una nova jerarquia (que anomenem implicacional) que permet definir noves classes de lògiques borroses que contenen quasi totes les conegudes fins ara. En segon lloc, s’ha continuat una línia d'investigació iniciada els darrers anys consistent en l'estudi de la veritat parcial com a noció sintàctica (és a dir, com a constants de veritat explícites en els sistemes de prova de les lògiques borroses). Per primer cop, s’ha considerat la semàntica racional per les lògiques proposicionals i la semàntica real i racional per les lògiques de primer ordre expandides amb constants. En tercer lloc, s’ha tractat el problema més fonamental del significat i la utilitat de les lògiques borroses com a modelitzadores de (part de) els fenòmens de la vaguetat en un darrer article de caràcter més filosòfic i divulgatiu, i en un altre més tècnic en què defensem la necessitat i presentem l'estat de l'art de l'estudi de les estructures algèbriques associades a les lògiques borroses. Finalment, s’ha dedicat la darrera part del projecte a l'estudi de la complexitat aritmètica de les lògiques borroses de primer ordre.