Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments

Background: Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit. Methods: This was a prospective cohort study of patients with eCOPD attending the EDs of 16 participating hospitals. Recruitment started in June 2008 and ended in September 2010. Information on possible predictor variables was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up. Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED, as well as at death within 1 month of the index ED visit. Multivariate logistic regression models were developed in a derivation sample and validated in a validation sample. The score was compared with other published prediction rules for patients with stable COPD. Results: In total, 2,487 patients were included in the study. Predictors of death during hospital admission, or within 1 week of discharge to home from the ED were patient age, baseline dyspnea, previous need for long-term home oxygen therapy or non-invasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival (area under the curve (AUC) = 0.85). Addition of arterial blood gas parameters (oxygen and carbon dioxide partial pressures (PO2 and PCO2)) and pH) did not improve the model. The same variables were predictors of death at 1 month (AUC = 0.85). Compared with other commonly used tools for predicting the severity of COPD in stable patients, our rule was significantly better. Conclusions: Five clinical predictors easily available in the ED, and also in the primary care setting, can be used to create a simple and easily obtained score that allows clinicians to stratify patients with eCOPD upon ED arrival and guide the medical decision-making process.

La secuencia del Neolítico en La Rioja Alavesa desde su origen hasta las primeras edades del metal

Homenaje a Ignacio Barandiarán Maestu / coord. por Javier Fernández Eraso, Juan Santos Yanguas

Phenotypic variation in Calandrinia galapagosa (Portulacaceae)

Calandrinia galapagosa St. John is found only on San Cristóbal Island in the Galápagos archipelago, where it is severely threatened by feral goats. A population at Cerro Colorado is protected by an exclosure constructed for this purpose in 1993. Individuals of this population have white or pinkish white flowers with a green stem, whereas the population at La Galapaguera, has pinkish white flowers with a purple stem.

Multi-fidelity simulation modelling in optimization of a hybrid submarine propulsion system

Multi-objective Genetic Algorithms have become a popular choice to aid in optimising the size of the whole hybrid power train. Within these optimisation processes, other optimisation techniques for the control strategy are implemented. This optimisation within an optimisation requires many simulations to be run, so reducing the computational cost is highly desired. This paper presents an optimisation framework consisting of a series hybrid optimisation algorithm, in which a global search optimizes a submarine propulsion system using low-fidelity models and, in order to refine the results, a local search is used with high-fidelity models. The effectiveness of the Hybrid optimisation algorithm is demonstrated with the optimisation of a submarine propulsion system. © 2011 EPE Association - European Power Electr.

Coherent design methodology using modelling, simulation and optimisation

There is an increasing demand for optimising complete systems and the devices within that system, including capturing the interactions between the various multi-disciplinary (MD) components involved. Furthermore confidence in robust solutions is esential. As a consequence the computational cost rapidly increases and in many cases becomes infeasible to perform such conceptual designs. A coherent design methodology is proposed, where the aim is to improve the design process by effectively exploiting the potential of computational synthesis, search and optimisation and conventional simulation, with a reduction of the computational cost. This optimization framework consists of a hybrid optimization algorithm to handles multi-fidelity simulations. Simultaneously and in order to handles uncertainty without recasting the model and at affordable computational cost, a stochastic modelling method known as non-intrusive polynomial chaos is introduced. The effectiveness of the design methodology is demonstrated with the optimisation of a submarine propulsion system.

Clarin sonoro, que haze gente para el cielo, o Tratado de las penas, qve padecen los condenados

Signaturas: [¶]4, A-Q8, R4.

Un indicador de la comprensión del esquema derivada: el uso de las relaciones lógicas

Desde distintos planteamientos las investigaciones han proporcionado información sobre las características de la comprensión del concepto de derivada en los estudiantes. Sin embargo, falta más información sistemática sobre indicadores que ayuden a describir el desarrollo de la comprensión de dicho concepto. En este trabajo, desde la teoría piagetiana del desarrollo de un esquema a través de los niveles intra, inter, trans, caracterizamos una evidencia empírica de cómo el uso que se hace de las “relaciones lógicas” entre diferentes elementos matemáticos del concepto derivada por parte de los estudiantes cuando resuelven un problema, aporta información para explicar el fenómeno de paso de un nivel de desarrollo del esquema derivada al siguiente.

Desafios para o trabalho colaborativo nas aulas de estatística

Hoje encontramos estatística nos currículos de matemática da maioria dos países. Em Portugal, a estatística é ensinada nas aulas de matemática por um professor de matemática até ao ensino universitário. As orientações curriculares para o ensino da Estatística referem a necessidade de os alunos colocarem questões, recolherem, organizarem e representarem dados através de uma investigação. Uma forma de o fazer é implementando estratégias de trabalho colaborativo na sala de aula. Esta forma de trabalho cria oportunidades de enriquecer o poder estatístico dos alunos pois discutem e explicam ideias, expõem, avaliam e refutam argumentos e resoluções. Nesta comunicação procura-se reflectir sobre as vantagens do trabalho colaborativo nas aulas de estatística, incluindo a nossa própria investigação sobre o tema.

Patrones, generalización y estrategias inductivas de estudiantes de 3º y 4º de la ESO en el problema de baldosas

En este trabajo describimos los patrones y la generalización que llevan a cabo 359 estudiantes de 3o y 4o de la ESO en la resolución del “problema de las baldosas”. Prestamos especial atención a los tipos de patrones identificados, a la forma en que los estudiantes expresan la generalización y, mediante la descripción de las estrategias inductivas, presentamos algunas características de la generalización referentes a los elementos y a los sistemas de representación utilizados.

Problemas geométricos de variación y el uso de software dinámico

En este artículo se presentan dos problemas geométricos que involucran la noción de variación, analizados desde la perspectiva de la resolución de problemas y la incorporación del software dinámico como un medio que puede potenciar el aprendizaje de los estudiantes. Los objetivos al presentar un análisis desde diferentes procedimientos de solución a estos problemas son: exhibir distintos acercamientos a situaciones, los cuales puede ir desarrollando el estudiante y el grupo al abordarlas, proporcionar al profesor elementos que le permitan proponer trayectorias hipotéticas del aprendizaje vinculadas con los conceptos y habilidades matemáticas que se requieren para abordar el problema y para comprenderlo, así como proveer de elementos al docente para identificar los momentos en los cuales puede intervenir en el proceso de solución para encauzar o enfatizar conceptos o habilidades matemáticas.

Unraveling EU Policies: the ““Common Basic Principles”” and the ““European Integration Fund”” as a technology of government

this paper is about EU “soft policies” on immigrant integration. It analyzes the “Common Basic Principles” (CBPs) and the “European Integration Fund” (EIF), two devices that have been recently established within this framework. It adopts the theoretical perspective of the “anthropology of policy” and “governmentality studies”. It shows the context of birth of the aforementioned devices, as well as their functioning and the assessment done by the actors implied in the elaboration/implementation/evaluation of the related policies. It is based both on documentary research as well as direct observation and interviews done to the actors implied. It concludes that the PBC and the EIF should be considered as a “technology of government”, that strives to align the conduct of the actors with the governmental aims, as well as it produces specific practices and knowledge. It also underlines an intrinsic feature of many policies: their “congenital failure”, since they are (often) disputed and resignified by situated actors, who are embedded in asymmetrical power relations.

The sector of olive-oil cooperatives and the use of ICT: A comparative study regarding othe legal forms

The current global environment and the general increase in the spread and use of Information Technology and Communication (ICT) by companies and consumers, make the use of these technologies as essential to confront the growing competition in the market. Focused on this sector, in this research we analyze the use of electronic commerce, as through websites as through electronic markets, and the use of social networking tools as enablers of business. For this aim, we conducted a comparative analysis between the Andalusian olive oil cooperatives and other legal forms which are present in the sector.

Factores determinantes del uso de Internet en la comercialización del aceite de oliva. Análisis del sector en Cataluña

Las cooperativas son entidades con una gran presencia económica y social en España, y tienen una gran influencia en la economía rural de las zonas donde están ubicadas. El principal objetivo del presente trabajo es el análisis del uso de las nuevas tecnologías por parte de las cooperativas agroalimentarias, centrándose en las productoras de aceite de oliva para determinar los principales factores que condicionan su comportamiento en la Red. En el presente estudio se analizan sus sitios web y se determina qué tipo de información aporta, tanto datos generales como datos de comercialización. A partir de los resultados obtenidos, se busca la relación que pueda existir entre el tamaño de la cooperativa, su actividad exportadora o la actividad de comercio electrónico con la presencia online, mediante una regresión logística. De esta manera podremos conocer si realmente la implantación de nuevas tecnologías en las cooperativas permite desarrollar una óptima actividad económica.

Dogs in the paradise: The influence of the cynical philosophy in the construction of the myth of the good savage

This paper studies the influence of cynic philosophy in the construction of the myth of the good savage. In the first part it studies the importance of cynicism in the XVI century and how the cynic influence of Erasmus, More and Montaigne was fundamental to the way that Europe approached the American indigenous. In the second part it studies the cynic motives that could have influenced in the construction of the myth of the good savage.

The conflict between realism and abstraction in the field of spanish art as an iteration of la "Querelle des Anciens et des Modernes"

Based on the analysis model favored by the study of the conditions in which the seventeenth century Querelle des Anciens et des Modernes took place, we examine the case of confrontation between realism and abstraction, which occurred in the context of Spanish art in the nineties of the twentieth century. Connections are established with other aesthetic conflicts which are considered part of a genealogy whose most explicit antecedent could be placed in the before mentioned complaint, such as the confrontation between realism and abstraction in the American art scene, which occurred in the fifties of the last century, and the more recent controversy on pluralism and the end of art.