Blind intubation of anaesthetised children with supraglottic airway devices AmbuAura-i and Air-Q cannot be recommended: A randomised controlled trial.

BACKGROUND Paediatric supraglottic airway devices AmbuAura-i and Air-Q were designed as conduits for tracheal intubation. Although fibreoptic-guided intubation has proved successful, blind intubation as a rescue technique has never been evaluated. OBJECTIVE Evaluation of blind intubation through AmbuAura-i and Air-Q. On the basis of fibreoptic view data, we hypothesised that the success rate with the AmbuAura-i would be higher than with the Air-Q. DESIGN A prospective, randomised controlled trial with institutional review board (IRB) approval and written informed consent. SETTING University Childrens' Hospital; September 2012 to July 2014. PATIENTS Eighty children, American Society of Anesthesiologists (ASA) class I to III, weight 5 to 50 kg. INTERVENTIONS Tracheal intubation was performed through the randomised device with the tip of a fibrescope placed inside and proximal to the tip of the tracheal tube. This permitted sight of tube advancement, but without fibreoptic guidance (visualised blind intubation). MAIN OUTCOME MEASURES Primary outcome was successfully visualised blind intubation; secondary outcomes included supraglottic airway device success, insertion times, airway leak pressure, fibreoptic view and adverse events. RESULTS Personal data did not differ between groups. In contrast to our hypothesis, blind intubation was possible in 15% with the Air-Q and in 3% with the AmbuAura-i [95% confidence interval (95% CI) 6 to 31 vs. 0 to 13%; P = 0.057]. First attempt supraglottic airway device insertion success rates were 95% (Air-Q) and 100% (AmbuAura-i; 95% CI 83 to 99 vs. 91 to 100; P = 0.49). Median leak pressures were 18 cmH2O (Air-Q) and 17 cmH2O [AmbuAura-i; interquartile range (IQR) 14 to 18 vs. 14 to 19 cmH2O; P = 0.66]. Air-Q insertion was slower (27 vs. 19 s, P < 0.001). There was no difference in fibreoptic view, or adverse events (P > 0.05). In one child (Air-Q size 1.5, tube size 3.5), the tube dislocated during device removal. CONCLUSION Ventilation with both devices is reliable, but success of blind intubation is unacceptably low and cannot be recommended for elective or rescue purposes. If intubation through a paediatric supraglottic airway device is desired, we suggest that fibreoptic guidance is used. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01692522.

Strategies of Active Dissemination of Workplace Health Promotion

Purpose – A growing body of literature provides evidence for the efficacy of workplace health promotion (WHP). However, little is known about effective dissemination strategies for WHP interventions. The purpose of this paper is to describe how a WHP agency in Zurich, Switzerland, used bulk mailings, information events, telephone marketing and free initial consultations for the large-scale geographic marketing of WHP services, with a focus on tobacco prevention (TP). Design/methodology/approach – To analyze the number of companies responding positively to solicitation, examine the predictors of positive responses and explore the reasons for negative responses, the authors used both quantitative (e.g. a standardized questionnaire) and qualitative (telephone interviews) methods. Findings – The results show that except for telephone marketing (69 percent), the success rates of dissemination activities were very low (3-9 percent). Predictors for a positive response were institutionalization of WHP, the representative’s personal concern about TP, and problems with environmental tobacco smoke within the company. The most prominent reason for a negative Response was that the companies had already implemented TP measures by themselves and needed no further external support. Practical implications – It is suggested that TP was the wrong emphasis for a WHP program to be disseminated at that particular time, because a law on protection from passive smoking was introduced in Switzerland shortly afterwards. Originality/value – The study examines dissemination strategies under real-life Consulting conditions. It builds on on a large sample of companies and uses both quantitative and qualitative research methods. It reports specific numbers and success rates of marketing activities and thereby contributes to the knowledge about an important issue for intervention planning in the field of WHP.

Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial

BACKGROUND Long-term success rates using ablation for persistent atrial fibrillation (AF) are disappointing and usually do not exceed 60%. OBJECTIVES This study sought to compare arrhythmia-free survival between pulmonary vein isolation (PVI) and a stepwise approach (full defrag) consisting of PVI, ablation of complex fractionated electrograms, and additional linear ablation lines in the setting of atrial tachycardias (AT) in patients with persistent AF after PVI. METHODS From November 2010 to February 2013, 205 patients (151 men; 61.7 ± 10.2 years of age) underwent de novo ablation for persistent AF. Subsequently, patients were prospectively randomized to either PVI alone (n = 78) or full defrag (n = 75), with 52 patients not randomized due to AF termination with the original PVI. The primary endpoint was recurrence of any AT after a blanking period of 3 months. RESULTS During the entire study, 241 ablations were performed (mean: 1.59 in the PVI-alone group, 1.55 in the full-defrag group). With the stepwise approach, termination of AF occurred in 45 (60%) patients. However, arrhythmia-free survival did not differ whether patients underwent single or multiple procedures (p = 0.468). Procedure duration, fluoroscopy time, and radiofrequency duration were significantly longer in the full-defrag group (all p < 0.001). CONCLUSIONS A stepwise approach aimed at AF termination does not seem to provide additional benefit over PVI alone in patients with persistent AF, but it is associated with significantly longer procedural and fluoroscopic duration as well as radiofrequency application time. (The Randomized Catheter Ablation of Persist End Atrial Fibrillation Study [CHASE-AF]; NCT01580124).

Three-year outcomes of Straumann Bone Level SLActive dental implants in daily dental practice: a prospective non-interventional study

OBJECTIVE The aim of this investigation was to evaluate the performance of Straumann Bone Level SLActive implants in various clinical situations in daily dental practice for up to 3 years. METHOD AND MATERIALS This was a prospective, multicenter, non-interventional study in which implants were placed within approved indications in any situation deemed suitable by the treating clinician. No implant placement or loading protocol was specified, and implants were placed according to the routine treatment protocols at each participating center. RESULTS In this analysis, data were available from 342 implants in 233 patients in three countries (USA, Canada, and Switzerland). One or two implants were placed in the majority of patients (70.8% and 19.3%, respectively), mostly in the maxilla (71.3%); almost half (47.7%) were placed in the esthetic zone. Implant placement after 4 to > 16 weeks of healing was preferred in Switzerland (92.0%), while 42.0% of implants were placed immediately in the USA and Canada. A flapless procedure was performed in 25.2% of cases in the USA and Canada, compared to 0.5% in Switzerland. Cumulative implant survival and success rates after 3 years were 97.5% and 93.5%, respectively. CONCLUSION Straumann Bone Level Implants can achieve favorable outcomes and high survival rates after 3 years in daily dental practice. The survival and success rates were comparable with those achieved in formal controlled clinical trials.

Antibody-Drug Conjugates for Tumor Targeting-Novel Conjugation Chemistries and the Promise of non-IgG Binding Proteins

Antibody-drug conjugates (ADCs) have emerged as a promising class of anticancer agents, combining the specificity of antibodies for tumor targeting and the destructive potential of highly potent drugs as payload. An essential component of these immunoconjugates is a bifunctional linker capable of reacting with the antibody and the payload to assemble a functional entity. Linker design is fundamental, as it must provide high stability in the circulation to prevent premature drug release, but be capable of releasing the active drug inside the target cell upon receptor-mediated endocytosis. Although ADCs have demonstrated an increased therapeutic window, compared to conventional chemotherapy in recent clinical trials, therapeutic success rates are still far from optimal. To explore other regimes of half-life variation and drug conjugation stoichiometries, it is necessary to investigate additional binding proteins which offer access to a wide range of formats, all with molecularly defined drug conjugation. Here, we delineate recent progress with site-specific and biorthogonal conjugation chemistries, and discuss alternative, biophysically more stable protein scaffolds like Designed Ankyrin Repeat Proteins (DARPins), which may provide such additional engineering opportunities for drug conjugates with improved pharmacological performance.

Long-term results of endoscopic third ventriculostomy: an outcome analysis.

OBJECT Endoscopic third ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series. The authors present a large case series of 113 patients who underwent 126 ETVs, and they highlight the initial postoperative outcome after 3 months and long-term follow-up with an average of 7 years. METHODS All patients who underwent ETV at the Department of Neurosurgery, Mainz University Hospital, between 1993 and 1999 were evaluated. Obstructive hydrocephalus was the causative pathology in all cases. RESULTS The initial clinical success rate was 82% and decreased slightly to 78% during long-term follow-up. Long-term success was analyzed using Kaplan-Meier curves. Overall, ETV failed in 31 patients. These patients underwent a second ETV or shunt treatment. A positive impact on long-term success was seen for age older than 6 months, and for obstruction due to cysts or benign aqueductal stenosis. The complication rate was 9% with 5 intraoperative and 5 postoperative events. CONCLUSIONS The high clinical success rate in short-term and long-term follow-up confirms ETV's status as the gold standard for the treatment of obstructive hydrocephalus, especially for distinct pathologies. The patient's age and underlying pathology may influence the outcome. These factors should be considered carefully preoperatively by the surgeon.

Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: five-year results from a double-blind, randomized controlled trial.

BACKGROUND The aim of this study was to compare the 5-year survival and success rates of 3.3 mm dental implants either made from titanium-zirconium (TiZr) alloy or from Grade IV titanium (Ti Grade IV) in mandibular implant-based removable overdentures. METHODS The core study had a follow-up period of 36 months and was designed as a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann Bone Level implants (diameter 3.3 mm, SLActive®), one of TiZr (test) and one of Ti Grade IV (control), in the interforaminal region. This follow-up study recruited patients from the core study and evaluated the plaque and sulcus bleeding indices, radiographic crestal bone level, as well as implant survival and success 60 months after implant placement. RESULTS Of the 91 patients who initially received implants, 75 completed the 36 month follow-up and 49 were available for the 60 month examination. Two patients were excluded so that a total of 47 patients with an average age of 72 ± 8 years were analysed. The characteristics and 36-month performance of the present study cohort did not differ from the non-included initial participants (p > 0.05). In the period since the 36-month follow-up examination, no implant was lost. The cumulative implant survival rate was 98.9 % for the TiZr group and 97.8 % for the Ti Grade IV group. Crestal bone level changes at 60 months were not different in the test and control group (TiZr -0.60 ± 0.69 mm and Ti Grade IV -0.61 ± 0.83 mm; p = 0.96). The cumulative implant success rate after 60 months was 95.8 and 92.6 % for TiZr and Ti Grade IV, respectively. CONCLUSIONS After 60 months, the positive outcomes of the 36 month results for TiZr and Ti Grade IV implants were confirmed, with no significant differences with regard to crestal bone level change, clinical parameters and survival or success rates. TiZr implants performed equally well compared to conventional Ti Grade IV 3.3 mm diameter-reduced implants for mandibular removable overdentures. TRIAL REGISTRATION Registered on www.clinicaltrials.gov: NCT01878331.

Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days

BACKGROUND: From 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the United States provided medical abortions principally by a regimen of oral mifepristone, followed 24-48 h later by vaginal misoprostol. In late March 2006, analyses of serious uterine infections following medical abortions led Planned Parenthood to change the route of misoprostol administration and to employ additional measures to minimize subsequent serious uterine infections. In August 2006, we conducted an extensive audit of medical abortions with the new buccal misoprostol regimen so that patients could be given accurate information about the success rate of the new regimen. OBJECTIVES: We sought to evaluate the effectiveness of the buccal medical abortion regimen and to examine correlates of its success during routine service delivery. METHODS: In 2006, audits were conducted in 10 large urban service points to estimate the success rates of the buccal regimen. Success was defined as medical abortion without vacuum aspiration. These audits also permitted estimates of success rates with oral misoprostol following mifepristone in a subset in which 98% of the subjects stemmed from two sites. RESULTS: The effectiveness of the buccal misoprostol-mifepristone regimen was 98.3% for women with gestational ages below 60 days. The oral misoprostol-mifepristone regimen, used by 278 women with a gestational age below 50 days, had a success rate of 96.8%. CONCLUSION: In conjunction with 200 mg of mifepristone, use of 800 mcg of buccal misoprostol up to 59 days of gestation is as effective as the use of 800 mcg of vaginal misoprostol up to 63 days of gestation.

Control by ATR-FTIR of surface treatment of cork stoppers and its effect on their mechanical performance

Fourier transform infrared (FTIR) spectroscopy was applied to determine the type of surface treatment and dose used on cork stoppers and to predict the friction between stopper and bottleneck. Agglomerated cork stoppers were finished with two different doses and using two surface treatments: P (paraffin and silicone), 15 and 25 mg/stopper, and S (only silicone), 10 and 15 mg/stopper. FTIR spectra were recorded at five points for each stopper by attenuated total reflectance (ATR). Absorbances at 1,010, 2,916, and 2,963 cm -1 were obtained in each spectrum. Discriminant analysis techniques allowed the treatment, and dose applied to each stopper to be identified from the absorbance values. 91.2% success rates were obtained from individual values and 96.0% from the mean values of each stopper. Spectrometric data also allowed treatment homogeneity to be determined on the stopper surface, and a multiple regression model was used to predict the friction index (If = Fe/Fc) (R 2 = 0.93)

Discriminación del estado de la carretera mediante procesado acústico en vehículo

La rápida adopción de dispositivos electrónicos en el automóvil, ha contribuido a mejorar en gran medida la seguridad y el confort. Desde principios del siglo 20, la investigación en sistemas de seguridad activa ha originado el desarrollo de tecnologías como ABS (Antilock Brake System), TCS (Traction Control System) y ESP (Electronic Stability Program). El coste de despliegue de estos sistemas es crítico: históricamente, sólo han sido ampliamente adoptados cuando el precio de los sensores y la electrónica necesarios para su construcción ha caído hasta un valor marginal. Hoy en día, los vehículos a motor incluyen un amplio rango de sensores para implementar las funciones de seguridad. La incorporación de sistemas que detecten la presencia de agua, hielo o nieve en la vía es un factor adicional que podría ayudar a evitar situaciones de riesgo. Existen algunas implementaciones prácticas capaces de detectar carreteras mojadas, heladas y nevadas, aunque con limitaciones importantes. En esta tesis doctoral, se propone una aproximación novedosa al problema, basada en el análisis del ruido de rodadura generado durante la conducción. El ruido de rodadura es capturado y preprocesado. Después es analizado utilizando un clasificador basado en máquinas de vectores soporte (SVM), con el fin de generar una estimación del estado del firme. Todas estas operaciones se realizan en el propio vehículo. El sistema propuesto se ha desarrollado y evaluado utilizando Matlabr, mostrando tasas de aciertos de más del 90%. Se ha realizado una implementación en tiempo real, utilizando un prototipo basado en DSP. Después se han introducido varias optimizaciones para permitir que el sistema sea realizable usando un microcontrolador de propósito general. Finalmente se ha realizado una implementación hardware basada en un microcontrolador, integrándola estrechamente con las ECU del vehículo, pudiendo obtener datos capturados por los sensores del mismo y enviar las estimaciones del estado del firme. El sistema resultante ha sido patentado, y destaca por su elevada tasa de aciertos con un tamaño, consumo y coste reducidos. ABSTRACT Proliferation of automotive electronics, has greatly improved driving safety and comfort. Since the beginning of the 20th century, investigation in active safety systems has resulted in the development of technologies such as ABS (Antilock Brake System), TCS (Traction Control System) and ESP (Electronic Stability Program). Deployment cost of these systems is critical: historically, they have been widely adopted only when the price of the sensors and electronics needed to build them has been cut to a marginal value. Nowadays, motor vehicles include a wide range of sensors to implement the safety functions. Incorporation of systems capable of detecting water, ice or snow on the road is an additional factor that could help avoiding risky situations. There are some implementations capable of detecting wet, icy and snowy roads, although with important limitations. In this PhD Thesis, a novel approach is proposed, based on the analysis of the tyre/road noise radiated during driving. Tyre/road noise is captured and pre-processed. Then it is analysed using a Support Vector Machine (SVM) based classifier, to output an estimation of the road status. All these operations are performed on-board. Proposed system is developed and evaluated using Matlabr, showing success rates greater than 90%. A real time implementation is carried out using a DSP based prototype. Several optimizations are introduced enabling the system to work using a low-cost general purpose microcontroller. Finally a microcontroller based hardware implementation is developed. This implementation is tightly integrated with the vehicle ECUs, allowing it to obtain data captured by its sensors, and to send the road status estimations. Resulting system has been patented, and is notable because of its high hit rate, small size, low power consumption and low cost.

Descripción de parámetros glóticos basados en el modelado de los pliegues vocales para la detección de patología de la voz

Las patologías de la voz se han transformado en los últimos tiempos en una problemática social con cierto calado. La contaminación de las ciudades, hábitos como el de fumar, el uso de aparatos de aire acondicionado, etcétera, contribuyen a ello. Esto alcanza más relevancia en profesionales que utilizan su voz de manera frecuente, como, por ejemplo, locutores, cantantes, profesores o teleoperadores. Por todo ello resultan de especial interés las técnicas de ayuda al diagnóstico que son capaces de extraer conclusiones clínicas a partir de una muestra de la voz grabada con un micrófono, frente a otras invasivas que implican la exploración utilizando laringoscopios, fibroscopios o videoendoscopios, técnicas en cualquier caso mucho más molestas para los pacientes al exigir la introducción parcial del instrumental citado por la garganta, en actuaciones consideradas de tipo quirúrgico. Dentro de aquellas técnicas se ha avanzado mucho en un período de tiempo relativamente corto. En lo que se refiere al diagnóstico de patologías, hemos pasado en los últimos quince años de trabajar principalmente con parámetros extraídos de la señal de voz –tanto en el dominio del tiempo como en el de la frecuencia– y con escalas elaboradas con valoraciones subjetivas realizadas por expertos a hacerlo también con parámetros procedentes de estimaciones de la fuente glótica. La importancia de utilizar la fuente glótica reside, a grandes rasgos, en que se trata de una señal vinculada directamente al estado de la estructura laríngea del locutor y también en que está generalmente menos influida por el tracto vocal que la señal de voz. Es conocido que el tracto vocal guarda más relación con el mensaje hablado, y su presencia dificulta el proceso de detección de patología vocal. Estas estimaciones de la fuente glótica han sido obtenidas a través de técnicas de filtrado inverso desarrolladas por nuestro grupo de investigación. Hemos conseguido, además, profundizar en la naturaleza de la señal glótica: somos capaces de descomponerla y relacionarla con parámetros biomecánicos de los propios pliegues vocales, obteniendo estimaciones de elementos como la masa, la pérdida de energía o la elasticidad del cuerpo y de la cubierta del pliegue, entre otros. De las componentes de la fuente glótica surgen también los denominados parámetros biométricos, relacionados con la forma de la señal, que constituyen por sí mismos una firma biométrica del individuo. También trabajaremos con parámetros temporales, relacionados con las diferentes etapas que se observan dentro de la señal glótica durante un ciclo de fonación. Por último, consideraremos parámetros clásicos de perturbación y energía de la señal. En definitiva, contamos ahora con una considerable cantidad de parámetros glóticos que conforman una base estadística multidimensional, destinada a ser capaz de discriminar personas con voces patológicas o disfónicas de aquellas que no presentan patología en la voz o con voces sanas o normofónicas. Esta tesis doctoral se ocupa de varias cuestiones: en primer lugar, es necesario analizar cuidadosamente estos nuevos parámetros, por lo que ofreceremos una completa descripción estadística de los mismos. También estudiaremos cuestiones como la distribución de los parámetros atendiendo a criterios como el de normalidad estadística de los mismos, ocupándonos especialmente de la diferencia entre las distribuciones que presentan sujetos sanos y sujetos con patología vocal. Para todo ello emplearemos diferentes técnicas estadísticas: generación de elementos y diagramas descriptivos, pruebas de normalidad y diversos contrastes de hipótesis, tanto paramétricos como no paramétricos, que considerarán la diferencia entre los grupos de personas sanas y los grupos de personas con alguna patología relacionada con la voz. Además, nos interesa encontrar relaciones estadísticas entre los parámetros, de cara a eliminar posibles redundancias presentes en el modelo, a reducir la dimensionalidad del problema y a establecer un criterio de importancia relativa en los parámetros en cuanto a su capacidad discriminante para el criterio patológico/sano. Para ello se aplicarán técnicas estadísticas como la Correlación Lineal Bivariada y el Análisis Factorial basado en Componentes Principales. Por último, utilizaremos la conocida técnica de clasificación Análisis Discriminante, aplicada a diferentes combinaciones de parámetros y de factores, para determinar cuáles de ellas son las que ofrecen tasas de acierto más prometedoras. Para llevar a cabo la experimentación se ha utilizado una base de datos equilibrada y robusta formada por doscientos sujetos, cien de ellos pertenecientes al género femenino y los restantes cien al género masculino, con una proporción también equilibrada entre los sujetos que presentan patología vocal y aquellos que no la presentan. Una de las aplicaciones informáticas diseñada para llevar a cabo la recogida de muestras también es presentada en esta tesis. Los distintos estudios estadísticos realizados nos permitirán identificar aquellos parámetros que tienen una mayor contribución a la hora de detectar la presencia de patología vocal. Alguno de los estudios, además, nos permitirá presentar una ordenación de los parámetros en base a su importancia para realizar la detección. Por otra parte, también concluiremos que en ocasiones es conveniente realizar una reducción de la dimensionalidad de los parámetros para mejorar las tasas de detección. Por fin, las propias tasas de detección constituyen quizá la conclusión más importante del trabajo. Todos los análisis presentes en el trabajo serán realizados para cada uno de los dos géneros, de acuerdo con diversos estudios previos que demuestran que los géneros masculino y femenino deben tratarse de forma independiente debido a las diferencias orgánicas observadas entre ambos. Sin embargo, en lo referente a la detección de patología vocal contemplaremos también la posibilidad de trabajar con la base de datos unificada, comprobando que las tasas de acierto son también elevadas. Abstract Voice pathologies have become recently in a social problem that has reached a certain concern. Pollution in cities, smoking habits, air conditioning, etc. contributes to it. This problem is more relevant for professionals who use their voice frequently: speakers, singers, teachers, actors, telemarketers, etc. Therefore techniques that are capable of drawing conclusions from a sample of the recorded voice are of particular interest for the diagnosis as opposed to other invasive ones, involving exploration by laryngoscopes, fiber scopes or video endoscopes, which are techniques much less comfortable for patients. Voice quality analysis has come a long way in a relatively short period of time. In regard to the diagnosis of diseases, we have gone in the last fifteen years from working primarily with parameters extracted from the voice signal (both in time and frequency domains) and with scales drawn from subjective assessments by experts to produce more accurate evaluations with estimates derived from the glottal source. The importance of using the glottal source resides broadly in that this signal is linked to the state of the speaker's laryngeal structure. Unlike the voice signal (phonated speech) the glottal source, if conveniently reconstructed using adaptive lattices, may be less influenced by the vocal tract. As it is well known the vocal tract is related to the articulation of the spoken message and its influence complicates the process of voice pathology detection, unlike when using the reconstructed glottal source, where vocal tract influence has been almost completely removed. The estimates of the glottal source have been obtained through inverse filtering techniques developed by our research group. We have also deepened into the nature of the glottal signal, dissecting it and relating it to the biomechanical parameters of the vocal folds, obtaining several estimates of items such as mass, loss or elasticity of cover and body of the vocal fold, among others. From the components of the glottal source also arise the so-called biometric parameters, related to the shape of the signal, which are themselves a biometric signature of the individual. We will also work with temporal parameters related to the different stages that are observed in the glottal signal during a cycle of phonation. Finally, we will take into consideration classical perturbation and energy parameters. In short, we have now a considerable amount of glottal parameters in a multidimensional statistical basis, designed to be able to discriminate people with pathologic or dysphonic voices from those who do not show pathology. This thesis addresses several issues: first, a careful analysis of these new parameters is required, so we will offer a complete statistical description of them. We will also discuss issues such as distribution of the parameters, considering criteria such as their statistical normality. We will take special care in the analysis of the difference between distributions from healthy subjects and the distributions from pathological subjects. To reach these goals we will use different statistical techniques such as: generation of descriptive items and diagramas, tests for normality and hypothesis testing, both parametric and nonparametric. These latter techniques consider the difference between the groups of healthy subjects and groups of people with an illness related to voice. In addition, we are interested in finding statistical relationships between parameters. There are various reasons behind that: eliminate possible redundancies in the model, reduce the dimensionality of the problem and establish a criterion of relative importance in the parameters. The latter reason will be done in terms of discriminatory power for the criterion pathological/healthy. To this end, statistical techniques such as Bivariate Linear Correlation and Factor Analysis based on Principal Components will be applied. Finally, we will use the well-known technique of Discriminant Analysis classification applied to different combinations of parameters and factors to determine which of these combinations offers more promising success rates. To perform the experiments we have used a balanced and robust database, consisting of two hundred speakers, one hundred of them males and one hundred females. We have also used a well-balanced proportion where subjects with vocal pathology as well as subjects who don´t have a vocal pathology are equally represented. A computer application designed to carry out the collection of samples is also presented in this thesis. The different statistical analyses performed will allow us to determine which parameters contribute in a more decisive way in the detection of vocal pathology. Therefore, some of the analyses will even allow us to present a ranking of the parameters based on their importance for the detection of vocal pathology. On the other hand, we will also conclude that it is sometimes desirable to perform a dimensionality reduction in order to improve the detection rates. Finally, detection rates themselves are perhaps the most important conclusion of the work. All the analyses presented in this work have been performed for each of the two genders in agreement with previous studies showing that male and female genders should be treated independently, due to the observed functional differences between them. However, with regard to the detection of vocal pathology we will consider the possibility of working with the unified database, ensuring that the success rates obtained are also high.

Modelo multidimensional de los factores que afectan la interacción entre marketing y ventas en el lanzamiento de nuevos productos en Latino América

Esta tesis se centra en la identificación y análisis de los factores que pueden favorecer o actuar como barreras del éxito de la implementación de la innovación y las relaciones entre sí, desde el enfoque de la interface marketing-ventas. El trabajo empírico se enmarca en el vacío de investigación existente en el campo del proceso de lanzamiento de nuevos productos en los mercados donde operan subsidiarias de empresas multinacionales de consumo masivo (FMCG). Las empresas FMCG son altamente dependientes de la innovación como proceso clave determinante del crecimiento competitivo de mediano y largo plazo. En un contexto de acortamiento del ciclo de vida de los productos, como resultado del desarrollo tecnológico y científico que impactan en el comportamiento de los consumidores, las empresas invierten un mayor nivel de recursos en el desarrollo de nuevos productos, reingeniería y programas de innovación (Mundra, Gulati y Gupta, 2013). Sin embargo, a pesar del aumento en la inversión, las tasas de éxito de la innovación reportadas son inferiores al 25% (Evanschitzky, Eisend, Calantone y Jiang, 2012). Aumentar las tasas de éxito de los proyectos de innovación es reconocida en la literatura como un elemento clave para la supervivencia y competitividad de las empresas, para ser superiores a su competencia y desarrollar nuevos modelos de negocios. A pesar de la existencia de estudios que intentan comprender el proceso de lanzamiento de nuevos productos, no se ha identificado un claro prototipo de gestión de la innovación (Gupta et al, 2007). Profundizando en los factores de éxito, los autores Keupp, Palmié y Gassman (2012) reconocen que la innovación exitosa no depende solamente de la estrategia de selección de los proyectos de innovación, sino también la forma en que los mismos son implementados (Klein and Sorra, 1996; Repenning, 2002; Keupp, Palmié y Gassmann, 2012). Al analizar la implementación de los proyectos de lanzamiento de nuevos productos al mercado, en empresas FMCG, dicho proceso es responsabilidad principalmente de las funciones de marketing y ventas a través de la comunicación con los consumidores y los clientes respectivamente (Ernst, Hoyer y Rubsaamen, 2010). Es decir que el éxito en la implementación de la innovación requiere la gestión efectiva de la relación inter-funcional entre marketing y ventas (Ernst, Hoyer y Rubsaamen, 2010; Hughes, Le Bon y Malshe, 2012). A pesar de la importancia de la integración entre marketing y ventas en la conceptualización e implementación de la innovación, este tema no ha sido estudiado en profundidad (Hughes, Le Bon y Malshe, 2012; Keupp, Palmié y Gassmann, 2012). En las empresas multinacionales, está demostrado que el desempeño de las subsidiarias determinan el éxito competitivo de la empresa a nivel global. El desafío de dichas subsidiarias es conjugar el desarrollo global de innovación y comunicación con las características locales de comportamiento del consumidor y el mercado. Por lo tanto, esta investigación empírica responde a la pregunta académica y de gestión acerca de cómo mejorar las tasas de éxito de lanzamiento de nuevos productos al mercado en subsidiarias de empresas de consumo masivo, desde la perspectiva de la relación entre marketing y ventas. En particular analiza cómo afectan la formalización de los procesos y los mecanismos de comunicación a la confianza interpersonal y a la efectividad de la interface marketing-ventas y dichos factores a su vez sobre la planificación integrada de la implementación de la innovación. La determinación de los factores o ítems que conforman cada uno de los constructos del proceso de ejecución de la innovación, se llevó a cabo a partir de una revisión exhaustiva del estado del arte de la literatura sobre las interfaces funcionales y el proceso de innovación. Posteriormente, los ítems seleccionados (más de 50 en total) fueron validados por referentes de marketing y ventas de Argentina y Uruguay a través de entrevistas en profundidad. A partir de los factores identificados se construyeron dos modelos teóricos: • (1) relativo a la influencia de las dimensiones de confianza interpersonal sobre la efectividad de las uniones inter-funcionales y como los mecanismos organizacionales, tales como la frecuencia y la calidad de la comunicación entre las áreas, afectan la confianza y la relación entre ellas; • (2) relativo a la dimensión planificación integrada de la implementación de la innovación, ya que durante el lanzamiento de nuevos productos al mercado, marketing y ventas utilizan procesos formales que facilitan la comunicación frecuente y efectiva, desarrollando confianza inter-personal que no solamente afecta la efectividad de su relación sino también el desarrollo de planes integrados entre ambas áreas. El estudio fue llevado a cabo en una empresa multinacional de consumo masivo que integra la lista Global 500 (Fortune, 2015), presente en todo el mundo con más de 25 marcas participantes en más de 15 categorías, implementando 150 proyectos de innovación en el último año. El grupo de subsidiarias en estudio fue reconocido a nivel mundial por su desempeño en crecimiento competitivo y su alta contribución al crecimiento total. El modelo analizado en esta tesis fue expandido al resto de América Latina, tratándose entonces de un caso ejemplar que representa una práctica de excelencia en la implementación de la innovación en subsidiarias de una empresa multinacional. La recolección de los datos fue llevado a cabo a través de un cuestionario estructurado y confidencial, enviado a la base de datos de todo el universo de directores y gerentes de marketing y ventas. El nivel de respuesta fue muy elevado (70%), logrando 152 casos válidos. El análisis de datos comprendió el análisis descriptivo de los mismos, estimación de fiabilidad y análisis factorial exploratorio a través del software SPSS v.20. El análisis factorial confirmatorio y el análisis de senderos para examinar las relaciones entre los factores se estudiaron mediante el software R (Package 2.15.1., R Core Team, 2012) (Fox, 2006). Finalmente se llevaron a cabo entrevistas en profundidad a gerentes de marketing y ventas de cada uno de los seis países con el fin de profundizar en los constructos y sus relaciones. Los resultados de los modelos demuestran que la frecuencia de comunicación impacta positivamente en la calidad de la misma, que a su vez afecta directamente la relación entre marketing y ventas. Adicionalmente, la calidad de la comunicación impacta sobre la confianza cognitiva, que a su vez se relaciona no solamente con la confianza afectiva sino también con la relación entre ambas áreas. Esto significa que para mejorar la implementación de la innovación, los gerentes deberían orientarse a reforzar la relación entre marketing y ventas facilitando la construcción de confianza interpersonal primero cognitiva y luego afectiva, incrementando la frecuencia de la comunicación que alimenta la calidad de la comunicación entre ambas áreas. A través del segundo modelo se demuestra que durante el lanzamiento de nuevos productos al mercado, marketing y ventas necesitan emplear procesos formales que faciliten la comunicación frecuente y efectiva. De esta forma se contrarresta el efecto negativo de la formalización sobre la planificación integrada entre ambas áreas. Adicionalmente, los gerentes de ambos departamentos deberían promover la construcción de confianza interpersonal, no solamente para mejorar la efectividad de la relación, sino también para desarrollar planes integrados de implementación de nuevos productos. Finalmente, se valida que la frecuencia de la comunicación, la confianza afectiva y la relación marketing-ventas, se relacionan positivamente con la planificación integrada en la implementación de la innovación. El estudio contribuye a la comprensión de los factores que las empresas pueden emplear para mejorar la relación inter-funcional entre marketing y ventas y la implementación de la innovación en empresas de consumo masivo. El aporte de esta investigación puede ser valorado de dos maneras, los aportes a la gestión y a la academia. Desde el punto de vista empresarial, provee a los líderes al frente de empresas de consumo masivo, del conocimiento sobre los factores que afectan la implementación de la innovación y en definitiva el éxito del negocio a mediano y largo plazo. Desde el punto de vista académico aporta al conocimiento del proceso de implementación de la innovación y en la efectividad de la interface marketing y ventas en un caso de buenas prácticas en el mercado de consumo masivo. A su vez incorpora por primera vez un estudio empírico en geografías emergentes capaces de recuperar el camino de crecimiento posterior a una profunda crisis económica a través de la exitosa implementación de la innovación en sus mercados. ABSTRACT This thesis is focused on the identification, analysis and relationship study of factors which may benefit or hinder the successful deployment of innovation, from a marketing-sales interface perspective. Considering the non-existent investigation dedicated to the study of new products launches into markets in which Fast Moving Consumer Goods (FMCG) companies’ subsidiaries operate, it is that this investigation has been carried out. FMCG companies rely on innovation as their key process for a competitive growth on a medium and long term basis. Nowadays, the life-cycle of products is getting shorter as a result of new technological and scientific development, having impact on consumer behavior, and therefore companies are forced to dedicating more resources to the development of new products, reengineering and innovation programs (Mundra, Gulati and Gupta, 2013). However, in spite of the investment increase, the innovation success rates have been reported to be lower than 25% (Evanschitzky, Eisend, Calantone y Jiang, 2012). Increasing success rates on innovation processes has been considered as a key element on the survival and competitiveness of companies, outperforming competitors and developing new business models. Despite new studies which try to comprehend the process of new products launch, a prototype of innovation management has not yet been identified (Gupta et al, 2007). Emphasizing on success factors, authors Keupp, Palmié and Gassman (2012) recognize that successful innovation does not solely depend on innovation processes’ selection strategy, but it is also based on the way in which these are implemented (Klein and Sorra, 1996; Repenning, 2002; Keupp, Palmié y Gassmann, 2012). While analyzing the implementation of projects for new products releases on massive consumption companies, the two departments in charge of taking this forward are marketing and sales, by focusing on communication strategies with consumers and clients respectively (Ernst, Hoyer y Rubsaamen, 2010). This means that having success on innovation implementation requires an effective management of inter-functional relationship among marketing and sales (Ernst, Hoyer y Rubsaamen, 2010; Hughes, Le Bon y Malshe, 2012). In spite of the importance on the integration between marketing and sales on the conceptualization and implementation of innovation, this subject has not been studied in depth (Hughes, Le Bon y Malshe, 2012; Keupp, Palmié y Gassmann, 2012). In multinational companies, previous research has confirmed that the performance of their subsidiaries determine the competitive success of the company on a global scale. The challenge of said subsidiaries is to conjugate the global innovation development and communication with the local consumer and market behavior. Therefore, this empirical study aims to respond to the academic and management question of how to improve the success rates of new product launches into MNE subsidiary’ markets, from a marketing-sales relationship perspective. Particularly, this investigation analyses how the formalization of products and communication mechanisms affect interpersonal trust and marketing-sales interface effectiveness and also on how these factors affect the overall planning of the implementation of innovation. The determination of which factors build the hypothesis of the innovation execution process was taken forward through an extensive research on the extant literature on functional interfaces and innovation processes. More than 50 items were selected which were in turn validated by marketing and sales referents on Uruguay and Argentina through in depth interviews. Based on the identified factors, two theoretical models were proposed: (1) Relative to the influence that interpersonal trust dimensions have on inter functional linkages effectiveness and how organizational mechanisms such as frequency and quality of communication between departments affect trust and their relationship. (2) Relative to the integrated planning and innovation implementation dimensions. Marketing and sales department use formal process thus allowing inter-personal trust, which affects positively their relationship and also enables the development of integrated planning between them. The study was performed within a massive consumption company which is part of the “Global 500” (Fortune, 2015), with subsidiaries all over the world and more than 25 participant brands in 15 categories, having implemented over 150 innovation projects in the year under study. The analyzed subsidiary group has been awarded worldwide for their performance in competitive growth and their high contribution to the total growth. The model being analyzed in this thesis was implemented throughout Latin America, representing a remarkable case of innovation implementation excellence for subsidiaries of multinational companies. Data recollection was carried out through a structured and confidential questionnaire, sent to the universe of marketing-sales directors and managers’ database available with a high level of responsiveness of 70%, resulting in 152 valid cases. Data exploration involved a descriptive analysis, followed by a reliability estimation and an exploratory factorial analysis carried out through SPSS v.20. Confirmatory factorial analysis and path analysis (to examine relations between the different study factors) were studied using “R” software (Package 2.15.1., R Core Team, 2012) (Fox, 2006). Finally, in depth interviews were carried out to several marketing and sales managers in each of the six countries so as to further confirm the hypothesis and their relations. The models results prove that communication frequency has a positive impact on the quality of the same, which in turn has direct effects on the marketing-sales relations. Additionally, communication quality has an impact on the cognitive trust, which also relates not only to affective trust, but also to the relation between both areas. This means that in order to improve the implementation of innovation, managers should strive to enforce marketing-sales relations, facilitating the interpersonal trust construction (firstly cognitive, followed by affective trust), increasing the communication frequency, and therefore nurturing the communication quality among both areas. Through the second model, the results confirm the importance of creating effective relationships between sales and marketing to facilitate planning integrated new product implementations. While formalized new product development processes provide opportunities for sales and marketing to communicate, this does not directly influence the planning of integrated new product implementations. By using these formal opportunities to communicate to create information quality, it is possible to improve sales and marketing’s ability to integrate information during the planning process. Further, communication quality creates inter-personal trust in the other party’s competences (cognitive-based trust), leading to affect-based trust. Affect-based inter-personal trust, not only to improve the overall effectiveness of the sales and marketing relationship, but also helps in planning integrated new product implementations. This study contributes to the understanding of factors which enterprises can use to improve the inter-functional relations between marketing and sales, and the implementation of innovation in FMCG companies. The contribution of this investigation can be measured in two ways: enrichment of management and contribution to the academic area. From a business perspective, it provides massive consumption businesses leaders with knowledge on which factors affect innovation implementation, which results on mid and long-term success for the company. From an academic point of view, it provides knowledge on a prototype of successful innovation implementation management based on the marketing-sales interface effectiveness through a case study in the FMCG consumption market. Last but not least, it incorporates for the first time an empiric study on emerging geographies capable of recovery post a deep economic crisis through successful innovation implementation on their markets.

From cell death to embryo arrest: Mathematical models of human preimplantation embryo development

Human preimplantation embryos exhibit high levels of apoptotic cells and high rates of developmental arrest during the first week in vitro. The relation between the two is unclear and difficult to determine by conventional experimental approaches, partly because of limited numbers of embryos. We apply a mixture of experiment and mathematical modeling to show that observed levels of cell death can be reconciled with the high levels of embryo arrest seen in the human only if the developmental competence of embryos is already established at the zygote stage, and environmental factors merely modulate this. This suggests that research on improving in vitro fertilization success rates should move from its current concentration on optimizing culture media to focus more on the generation of a healthy zygote and on understanding the mechanisms that cause chromosomal and other abnormalities during early cleavage stages.

Self-reported difficulty in conceiving as a measure of infertility

BACKGROUND: This study aimed to explore the meaning and potential use of women's self-reported difficulties in conceiving as a measure of infertility in epidemiological studies, and to compare women's stated reasons for infertility with information in their medical records. METHODS: Data were available from a population-based case-control study of ovarian cancer involving 1638 women. The sensitivity and specificity of women's self-reported infertility were calculated against their estimated fertility status based on detailed reproductive histories. Self-reported reasons for infertility were compared with diagnoses documented in women's medical records. RESULTS: The sensitivity of women's self-reported difficulty in conceiving was 66 and 69% respectively when compared with calendar-derived and self-reported times taken trying to conceive; its specificity was 95%. Forty-one (23%) of the 179 women for whom medical records were available had their self-reported fertility problem confirmed. Self-reported infertility causes could be compared with diagnoses in medical records for only 22 of these women. CONCLUSIONS: Self-reported difficulty conceiving is a useful measure of infertility for quantifying the burden of fertility problems experienced in the community. Validation of reasons for infertility is unlikely to be feasible through examination of medical records. Improved education of the public regarding the availability and success rates of infertility treatments is proposed.

Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation

OBJECTIVE: To estimate the efficacy of midline fascial plication of the posterior vaginal wall in women with rectoceles and obstructed defecation. METHODS: Prospective evaluation of 38 consecutive women with symptomatic rectoceles (stage II or greater) and obstructed defecation included pre- and postoperative standardized pelvic floor questions, pelvic organ prolapse quantification measurements, validated bowel function questionnaires, defecating proctogram, and patient satisfaction. Reviews were conducted by nonsurgical coauthors. RESULTS: The median follow-up was 12.5 months (range 2.5-26 months). The subjective success rates were 97% (95% confidence interval [CI] 0.83-1.00%) at 12 months and 89% (95% CI 0.55-0.98%) at 24 months. The objective success rates were 87% (95% CI 0.64-0.96%) at 12 months and 79% (95% CI 0.51-0.92%) at 24 months. The average points, Ap and Bp, were significantly reduced from -0.1 (range -2 to 3) and 1.1 (range -1 to 8), preoperatively, to -2.6 (range -3 to -1) and -2.5 (range -3 to 0), postoperatively, respectively (P