Patient-reported outcomes in meta-analyses - part 2: methods for improving interpretability for decision-makers

Systematic reviews and meta-analyses of randomized trials that include patient-reported outcomes (PROs) often provide crucial information for patients, clinicians and policy-makers facing challenging health care decisions. Based on emerging methods, guidance on improving the interpretability of meta-analysis of patient-reported outcomes, typically continuous in nature, is likely to enhance decision-making. The objective of this paper is to summarize approaches to enhancing the interpretability of pooled estimates of PROs in meta-analyses. When differences in PROs between groups are statistically significant, decision-makers must be able to interpret the magnitude of effect. This is challenging when, as is often the case, clinical trial investigators use different measurement instruments for the same construct within and between individual randomized trials. For such cases, in addition to pooling results as a standardized mean difference, we recommend that systematic review authors use other methods to present results such as relative (relative risk, odds ratio) or absolute (risk difference) dichotomized treatment effects, complimented by presentation in either: natural units (e.g. overall depression reduced by 2.4 points when measured on a 50-point Hamilton Rating Scale for Depression); minimal important difference units (e.g. where 1.0 unit represents the smallest difference in depression that patients, on average, perceive as important the depression score was 0.38 (95%CI 0.30 to 0.47) units less than the control group); or a ratio of means (e.g. where the mean in the treatment group is divided by the mean in the control group, the ratio of means is 1.27, representing a 27%relative reduction in the mean depression score).

The effects of thoracic epidurally administered drugs on urethral sphincter function in women: a pooled analysis

OBJECTIVES Thoracic epidural analgesia (TEA) has been shown to inhibit detrusor activity in patients undergoing open renal surgery, resulting in clinically relevant post-void residuals. However, the impact of different epidural drug mixtures on urethral sphincter function is not completely elucidated. DESIGN Pooled analysis of an open observational study and a double-blind randomized trial. SETTING Single tertiary centre. SUBJECTS Twenty-eight women without lower urinary tract symptoms and post-void residual <100 mL, who underwent open renal surgery with TEA. METHODS Pooling results in three groups with different epidural regimens (7 with bupivacaine 0.125%, 8 with bupivacaine 0.125% and fentanyl 2 μg/mL, and 13 with bupivacaine 0.1% plus fentanyl 2 μg/mL and epinephrine 2 μg/mL). All women underwent urethral pressure measurements before TEA and during TEA 2-3 days postoperatively. All patients received a TEA placed at the insertion site interspace T 8-9. RESULTS Maximum urethral closure pressure at rest decreased significantly during TEA with bupivacaine alone (median 70 cm H2 O [interquartile range 66-76] to 43 [43-65], P = 0.031) and with bupivacaine/fentanyl/epinephrine (75 cm H2 O [68-78] to 56 [52-75], P = 0.028), whereas with bupivacaine/fentanyl, no significant change could be detected (74 [51-88] vs 67 [46-70], P = 0.156). In all groups, functional profile length at rest was not influenced during TEA. CONCLUSION TEA with bupivacaine and the addition of fentanyl and epinephrine appears to decrease maximum urethral closure pressure at rest in women. The addition of fentanyl alone to bupivacaine may reduce this effect. Thus, the TEA effect on urethral sphincter function seems to depend on the drug mixture administered.

Exercise for osteoarthritis of the hip.

BACKGROUND Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip osteoarthritis (OA) report are based on limited evidence. OBJECTIVES To determine whether land-based therapeutic exercise is beneficial for people with hip OA in terms of reduced joint pain and improved physical function and quality of life. SEARCH METHODS We searched five databases from inception up to February 2013. SELECTION CRITERIA All randomised controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in water) with a non-exercise group. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. We resolved disagreements through consensus. Two review authors independently extracted data, assessed risk of bias and the quality of the body of evidence for each outcome using the GRADE approach. We conducted analyses on continuous outcomes (pain, physical function and quality of life) and dichotomous outcomes (proportion of study withdrawals). MAIN RESULTS We considered that seven of the 10 included RCTs had a low risk of bias. However, the results may be vulnerable to performance and detection bias as none of the RCTs were able to blind participants to treatment allocation and, while most RCTs reported blinded outcome assessment, pain, physical function and quality of life were participant self reported. One of the 10 RCTs was only reported as a conference abstract and did not provide sufficient data for the evaluation of bias risk.High-quality evidence from nine trials (549 participants) indicated that exercise reduced pain (standardised mean difference (SMD) -0.38, 95% confidence interval (CI) -0.55 to -0.20) and improved physical function (SMD -0.38, 95% CI -0.54 to -0.05) immediately after treatment. Pain and physical function were estimated to be 29 points on a 0- to 100-point scale (0 was no pain or loss of physical function) in the control group; exercise reduced pain by an equivalent of 8 points (95% CI 4 to 11 points; number needed to treat for an additional beneficial outcome (NNTB) 6) and improved physical function by an equivalent of 7 points (95% CI 1 to 12 points; NNTB 6). Only three small studies (183 participants) evaluated quality of life, with overall low quality evidence, with no benefit of exercise demonstrated (SMD -0.07, 95% CI -0.23 to 0.36). Quality of life was estimated to be 50 points on a norm-based mean (standard deviation (SD)) score of 50 (10) in the general population in the control group; exercise improved quality of life by 0 points. Moderate-quality evidence from seven trials (715 participants) indicated an increased likelihood of withdrawal from the exercise allocation (event rate 6%) compared with the control group (event rate 3%), but this difference was not significant (risk difference 1%; 95% CI -1% to 4%). Of the five studies reporting adverse events, each study reported only one or two events and all were related to increased pain attributed to the exercise programme.The reduction in pain was sustained at least three to six months after ceasing monitored treatment (five RCTs, 391 participants): pain (SMD -0.38, 95% CI -0.58 to -0.18). Pain was estimated to be 29 points on a 0- to 100-point scale (0 was no pain) in the control group, the improvement in pain translated to a sustained reduction in pain intensity of 8 points (95% CI 4 to 12 points) compared with the control group (0 to 100 scale). The improvement in physical function was also sustained (five RCTs, 367 participants): physical function (SMD -0.37, 95% CI -0.57 to -0.16). Physical function was estimated to be 24 points on a 0- to 100-point scale (0 was no loss of physical function) in the control group, the improvement translated to a mean of 7 points (95% CI 4 to 13) compared with the control group.Only five of the 10 RCTs exclusively recruited people with symptomatic hip OA (419 participants). There was no significant difference in pain or physical function outcomes compared with five studies recruiting participants with hip or knee OA (130 participants). AUTHORS' CONCLUSIONS Pooling the results of these 10 RCTs demonstrated that land-based therapeutic exercise programmes can reduce pain and improve physical function among people with symptomatic hip OA.

Systematic reviews and meta-analyses of randomized trials: principles and pitfalls

Systematic reviews and meta-analyses allow for a more transparent and objective appraisal of the evidence. They may decrease the number of false-negative results and prevent delays in the introduction of effective interventions into clinical practice. However, as for any other tool, their misuse can result in severely misleading results. In this article, we discuss the main steps that should be taken when conducting systematic reviews and meta-analyses, namely the preparation of a review protocol, identification of eligible trials, and data extraction, pooling of treatment effects across trials, investigation of potential reasons for differences in treatment effects across trials, and complete reporting of the review methods and findings. We also discuss common pitfalls that should be avoided, including the use of quality assessment tools to derive summary quality scores, pooling of data across trials as if they belonged to a single large trial, and inappropriate uses of meta-regression that could result in misleading estimates of treatment effects because of regression to the mean or the ecological fallacy. If conducted and reported properly, systematic reviews and meta-analyses will increase our understanding of the strengths and weaknesses of the available evidence, which may eventually facilitate clinical decision making.

Pelvic floor muscle activation and strength components influencing female urinary continence and stress incontinence: A systematic review

AIMS A better understanding of pelvic floor muscle (PFM) activation and strength components is a prerequisite to get better insight in PFM contraction mechanisms and develop more specific PFM-training regimens for female stress urinary incontinence (SUI) patients. The aim of this systematic review (2012:CRD42012002547) was to evaluate and summarize existing studies investigating PFM activation and strength components influencing female continence and SUI. METHODS PubMed, EMBASE, and Cochrane databases were systematically searched for literature from January 1980 to November 2013 for cross-sectional studies comparing female SUI patients with healthy controls and intervention studies with SUI patients reporting on the association between PFM activation and strength components and urine loss. Trial characteristics, evaluated PFM components, their definitions, measurement methods, study outcomes, as well as quality measures, based on the Cochrane risk of bias tool, were independently extracted. The high heterogeneity of the retrieved data made pooling of results impossible and therefore restricted the analysis to a systematic review. RESULTS Cross-sectional studies showed group differences in favor of the continent women compared to SUI patients for PFM activation or PFM maximal strength, mean strength or sustained contraction. All intervention studies showed an improvement of PFM strength and decrease in urine loss in SUI patients after physical therapy. CONCLUSIONS Higher PFM activation and strength components influence female continence positively. This systematic review underscored the need for a standardized PFM components' terminology (similar to rehabilitation and training science), standardized test procedures and well matched diagnostic instruments. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.

What is the influence of randomisation sequence generation and allocation concealment on treatment effects of physical therapy trials? A meta-epidemiological study.

OBJECTIVE To determine if adequacy of randomisation and allocation concealment is associated with changes in effect sizes (ES) when comparing physical therapy (PT) trials with and without these methodological characteristics. DESIGN Meta-epidemiological study. PARTICIPANTS A random sample of randomised controlled trials (RCTs) included in meta-analyses in the PT discipline were identified. INTERVENTION Data extraction including assessments of random sequence generation and allocation concealment was conducted independently by two reviewers. To determine the association between sequence generation, and allocation concealment and ES, a two-level analysis was conducted using a meta-meta-analytic approach. PRIMARY AND SECONDARY OUTCOME MEASURES association between random sequence generation and allocation concealment and ES in PT trials. RESULTS 393 trials included in 43 meta-analyses, analysing 44 622 patients contributed to this study. Adequate random sequence generation and appropriate allocation concealment were accomplished in only 39.7% and 11.5% of PT trials, respectively. Although trials with inappropriate allocation concealment tended to have an overestimate treatment effect when compared with trials with adequate concealment of allocation, the difference was non-statistically significant (ES=0.12; 95% CI -0.06 to 0.30). When pooling our results with those of Nuesch et al, we obtained a pooled statistically significant value (ES=0.14; 95% CI 0.02 to 0.26). There was no difference in ES in trials with appropriate or inappropriate random sequence generation (ES=0.02; 95% CI -0.12 to 0.15). CONCLUSIONS Our results suggest that when evaluating risk of bias of primary RCTs in PT area, systematic reviewers and clinicians implementing research into practice should pay attention to these biases since they could exaggerate treatment effects. Systematic reviewers should perform sensitivity analysis including trials with low risk of bias in these domains as primary analysis and/or in combination with less restrictive analyses. Authors and editors should make sure that allocation concealment and random sequence generation are properly reported in trial reports.

Sutureless Aortic Valve Replacement International Registry (SU-AVR-IR): design and rationale from the International Valvular Surgery Study Group (IVSSG).

BACKGROUND Sutureless aortic valve replacement (SU-AVR) is an innovative approach which shortens cardiopulmonary bypass and cross-clamp durations and may facilitate minimally invasive approach. Evidence outlining its safety, efficacy, hemodynamic profile and potential complications is replete with small-volume observational studies and few comparative publications. METHODS Minimally invasive aortic valve surgery and high-volume SU-AVR replacement centers were contacted for recruitment into a global collaborative coalition dedicated to sutureless valve research. A Research Steering Committee was formulated to direct research and support the mission of providing registry evidence warranted for SU-AVR. RESULTS The International Valvular Surgery Study Group (IVSSG) was formed under the auspices of the Research Steering Committee, comprised of 36 expert valvular surgeons from 27 major centers across the globe. IVSSG Sutureless Projects currently proceeding include the Retrospective and Prospective Phases of the SU-AVR International Registry (SU-AVR-IR). CONCLUSIONS The global pooling of data by the IVSSG Sutureless Projects will provide required robust clinical evidence on the safety, efficacy and hemodynamic outcomes of SU-AVR.

The timing of extraction of non-restorable first permanent molars: a systematic review.

AIM To identify the ideal timing of first permanent molar extraction to reduce the future need for orthodontic treatment. MATERIALS AND METHODS A computerised database and subsequent manual search was performed using Medline database, Embase and Ovid, covering the period from January 1946 to February 2013. Two reviewers (JE and ME) extracted the data independently and evaluated if the studies matched the inclusion criteria. Inclusion criteria were specification of the follow-up with clinical examination or analysis of models, specification of the chronological age or dental developmental stage at the time of extraction, no treatment in between, classification of the treatment result into perfect, good, average and poor. The search was limited to human studies and no language limitations were set. RESULTS The search strategy resulted in 18 full-text articles, of which 6 met the inclusion criteria. By pooling the data from maxillary sites, good to perfect clinical outcome was estimated in 72% (95% confidence interval 63%-82%). Extractions at the age of 8-10.5 years tended to show better spontaneous clinical outcomes compared to the other age groups. By pooling the data from mandibular sites, extractions performed at the age of 8-10.5 and 10.5-11.5 years showed significantly superior spontaneous clinical outcome with a probability of 50% and 59% likelihood, respectively, to achieve good to perfect clinical result (p<0.05) compared to the other age groups (<8 years of age: 34%, >11.5 years of age: 44%). CONCLUSION Prevention of complications after first permanent molars extractions is an important issue. The overall success rate of spontaneous clinical outcome for maxillary extraction of first permanent molars was superior to mandibular extraction. Extractions of mandibular first permanent molars should be performed between 8 and 11.5 years of age in order to achieve a good spontaneous clinical outcome. For the extraction in the maxilla, no firm conclusions concerning the ideal extraction timing could be drawn.

Lung Pattern Classification for Interstitial Lung Diseases Using a Deep Convolutional Neural Network

Automated tissue characterization is one of the most crucial components of a computer aided diagnosis (CAD) system for interstitial lung diseases (ILDs). Although much research has been conducted in this field, the problem remains challenging. Deep learning techniques have recently achieved impressive results in a variety of computer vision problems, raising expectations that they might be applied in other domains, such as medical image analysis. In this paper, we propose and evaluate a convolutional neural network (CNN), designed for the classification of ILD patterns. The proposed network consists of 5 convolutional layers with 2×2 kernels and LeakyReLU activations, followed by average pooling with size equal to the size of the final feature maps and three dense layers. The last dense layer has 7 outputs, equivalent to the classes considered: healthy, ground glass opacity (GGO), micronodules, consolidation, reticulation, honeycombing and a combination of GGO/reticulation. To train and evaluate the CNN, we used a dataset of 14696 image patches, derived by 120 CT scans from different scanners and hospitals. To the best of our knowledge, this is the first deep CNN designed for the specific problem. A comparative analysis proved the effectiveness of the proposed CNN against previous methods in a challenging dataset. The classification performance (~85.5%) demonstrated the potential of CNNs in analyzing lung patterns. Future work includes, extending the CNN to three-dimensional data provided by CT volume scans and integrating the proposed method into a CAD system that aims to provide differential diagnosis for ILDs as a supportive tool for radiologists.

Effects of exercise with oxygen prebreathe for decompression risk reduction

Astronauts performing extravehicular activities (EVA) are at risk for occupational hazards due to a hypobaric environment, in particular Decompression Sickness (DCS). DCS results from nitrogen gas bubble formation in body tissues and venous blood. Denitrogenation achieved through lengthy staged decompression protocols has been the mainstay of prevention of DCS in space. Due to the greater number and duration of EVAs scheduled for construction and maintenance of the International Space Station, more efficient alternatives to accomplish missions without compromising astronaut safety are desirable. ^ This multi-center, multi-phase study (NASA-Prebreathe Reduction Protocol study, or PRP) was designed to identify a shorter denitrogenation protocol that can be implemented before an EVA, based on the combination of adynamia and exercise enhanced oxygen prebreathe. Human volunteers recruited at three sites (Texas, North Carolina and Canada) underwent three different combinations (“PRP phases”) of intense and light exercise prior to decompression in an altitude chamber. The outcome variables were detection of venous gas embolism (VGE) by precordial Doppler ultrasound, and clinical manifestations of DCS. Independent variables included age, gender, body mass index, oxygen consumption peak, peak heart rate, and PRP phase. Data analysis was performed both by pooling results from all study sites, and by examining each site separately. ^ Ten percent of the subjects developed DCS and 20% showed evidence of high grade VGE. No cases of DCS occurred in one particular PRP phase with use of the combination of dual-cycle ergometry (10 minutes at 75% of VO2 peak) plus 24 minutes of light EVA exercise (p = 0.04). No significant effects were found for the remaining independent variables on the occurrence of DCS. High grade VGE showed a strong correlation with subsequent development of DCS (sensitivity, 88.2%; specificity, 87.2%). In the presence of high grade VGE, the relative risk for DCS ranged from 7.52 to 35.0. ^ In summary, a good safety level can be achieved with exercise-enhanced oxygen denitrogenation that can be generalized to the astronaut population. Exercise is beneficial in preventing DCS if a specific schedule is followed, with an individualized VO2 prescription that provides a safety level that can then be applied to space operations. Furthermore, VGE Doppler detection is a useful clinical tool for prediction of altitude DCS. Because of the small number of high grade VGE episodes, the identification of a high probability DCS situation based on the presence of high grade VGE seems justified in astronauts. ^

Extreme temperature events analyzed with Fast Fourier Transform

Extreme weather and climate events have received increased attention in the last few years, due to the often large loss of agriculture business and exponentially increasing costs associated with them and insurance planning. This increased attention raises the question as to whether extreme weather and climate events are truly increasing, whether this is only a perceived increase exacerbated by enhanced media coverage, or both. There are a number of ways extreme climate events can be defined, such as extreme daily temperatures, extreme daily rainfall amounts, and large areas experiencing unusually warm monthly temperatures, among others. In this study, we will focus our attention in frost and heatstroke events measuring it as the number of days under 0 ºC and number of days with daily maximum over 30ºC monthly respectively. We have studied the trends in these extreme events applying a Fast Fourier Transform to the series to clarify the tendency. Lack of long-term climate data suitable for analysis of extremes is the single biggest obstacle to quantifying whether extreme events have changed over the twentieth century, including high temporal and spatial resolution observations of temperatures. However, several series have been grouped in different ways: chosen the longest series independently, by provinces, by main watersheds and altitude. On the other hand, synthetic series generated by Luna and Balairón (AEMet) were also analyzed. The results obtained by different pooling data are discussed concluding the difficulties to assess the extreme events tendencies and high regional variation in the trends.

High definition video quality assessment metric built upon full reference ratios

Métrica de calidad de video de alta definición construida a partir de ratios de referencia completa. La medida de calidad de video, en inglés Visual Quality Assessment (VQA), es uno de los mayores retos por solucionar en el entorno multimedia. La calidad de vídeo tiene un impacto altísimo en la percepción del usuario final (consumidor) de los servicios sustentados en la provisión de contenidos multimedia y, por tanto, factor clave en la valoración del nuevo paradigma denominado Calidad de la Experiencia, en inglés Quality of Experience (QoE). Los modelos de medida de calidad de vídeo se pueden agrupar en varias ramas según la base técnica que sustenta el sistema de medida, destacando en importancia los que emplean modelos psicovisuales orientados a reproducir las características del sistema visual humano, en inglés Human Visual System, del que toman sus siglas HVS, y los que, por el contrario, optan por una aproximación ingenieril en la que el cálculo de calidad está basado en la extracción de parámetros intrínsecos de la imagen y su comparación. A pesar de los avances recogidos en este campo en los últimos años, la investigación en métricas de calidad de vídeo, tanto en presencia de referencia (los modelos denominados de referencia completa), como en presencia de parte de ella (modelos de referencia reducida) e incluso los que trabajan en ausencia de la misma (denominados sin referencia), tiene un amplio camino de mejora y objetivos por alcanzar. Dentro de ellos, la medida de señales de alta definición, especialmente las utilizadas en las primeras etapas de la cadena de valor que son de muy alta calidad, son de especial interés por su influencia en la calidad final del servicio y no existen modelos fiables de medida en la actualidad. Esta tesis doctoral presenta un modelo de medida de calidad de referencia completa que hemos llamado PARMENIA (PArallel Ratios MEtric from iNtrInsic features Analysis), basado en la ponderación de cuatro ratios de calidad calculados a partir de características intrínsecas de la imagen. Son: El Ratio de Fidelidad, calculado mediante el gradiente morfológico o gradiente de Beucher. El Ratio de Similitud Visual, calculado mediante los puntos visualmente significativos de la imagen a través de filtrados locales de contraste. El Ratio de Nitidez, que procede de la extracción del estadístico de textura de Haralick contraste. El Ratio de Complejidad, obtenido de la definición de homogeneidad del conjunto de estadísticos de textura de Haralick PARMENIA presenta como novedad la utilización de la morfología matemática y estadísticos de Haralick como base de una métrica de medida de calidad, pues esas técnicas han estado tradicionalmente más ligadas a la teledetección y la segmentación de objetos. Además, la aproximación de la métrica como un conjunto ponderado de ratios es igualmente novedosa debido a que se alimenta de modelos de similitud estructural y otros más clásicos, basados en la perceptibilidad del error generado por la degradación de la señal asociada a la compresión. PARMENIA presenta resultados con una altísima correlación con las valoraciones MOS procedentes de las pruebas subjetivas a usuarios que se han realizado para la validación de la misma. El corpus de trabajo seleccionado procede de conjuntos de secuencias validados internacionalmente, de modo que los resultados aportados sean de la máxima calidad y el máximo rigor posible. La metodología de trabajo seguida ha consistido en la generación de un conjunto de secuencias de prueba de distintas calidades a través de la codificación con distintos escalones de cuantificación, la obtención de las valoraciones subjetivas de las mismas a través de pruebas subjetivas de calidad (basadas en la recomendación de la Unión Internacional de Telecomunicaciones BT.500), y la validación mediante el cálculo de la correlación de PARMENIA con estos valores subjetivos, cuantificada a través del coeficiente de correlación de Pearson. Una vez realizada la validación de los ratios y optimizada su influencia en la medida final y su alta correlación con la percepción, se ha realizado una segunda revisión sobre secuencias del hdtv test dataset 1 del Grupo de Expertos de Calidad de Vídeo (VQEG, Video Quality Expert Group) mostrando los resultados obtenidos sus claras ventajas. Abstract Visual Quality Assessment has been so far one of the most intriguing challenges on the media environment. Progressive evolution towards higher resolutions while increasing the quality needed (e.g. high definition and better image quality) aims to redefine models for quality measuring. Given the growing interest in multimedia services delivery, perceptual quality measurement has become a very active area of research. First, in this work, a classification of objective video quality metrics based on their underlying methodologies and approaches for measuring video quality has been introduced to sum up the state of the art. Then, this doctoral thesis describes an enhanced solution for full reference objective quality measurement based on mathematical morphology, texture features and visual similarity information that provides a normalized metric that we have called PARMENIA (PArallel Ratios MEtric from iNtrInsic features Analysis), with a high correlated MOS score. The PARMENIA metric is based on the pooling of different quality ratios that are obtained from three different approaches: Beucher’s gradient, local contrast filtering, and contrast and homogeneity Haralick’s texture features. The metric performance is excellent, and improves the current state of the art by providing a wide dynamic range that make easier to discriminate between very close quality coded sequences, especially for very high bit rates whose quality, currently, is transparent for quality metrics. PARMENIA introduces a degree of novelty against other working metrics: on the one hand, exploits the structural information variation to build the metric’s kernel, but complements the measure with texture information and a ratio of visual meaningful points that is closer to typical error sensitivity based approaches. We would like to point out that PARMENIA approach is the only metric built upon full reference ratios, and using mathematical morphology and texture features (typically used in segmentation) for quality assessment. On the other hand, it gets results with a wide dynamic range that allows measuring the quality of high definition sequences from bit rates of hundreds of Megabits (Mbps) down to typical distribution rates (5-6 Mbps), even streaming rates (1- 2 Mbps). Thus, a direct correlation between PARMENIA and MOS scores are easily constructed. PARMENIA may further enhance the number of available choices in objective quality measurement, especially for very high quality HD materials. All this results come from validation that has been achieved through internationally validated datasets on which subjective tests based on ITU-T BT.500 methodology have been carried out. Pearson correlation coefficient has been calculated to verify the accuracy of PARMENIA and its reliability.

Arquitectura Petite: Charlotte Perriand & Kazuyo Sejima. Una historia transnacional

La tesis revela paralelismos y conexiones entre las arquitectas/diseñadoras Charlotte Perriand (1903-1999) y Kazuyo Sejima (n. 1956), reflejados en una serie de proyectos de pequeña escala que denomino arquitectura petite—mobiliario tecnológico habitable—, resultado de momentos semejantes de cambio social, cultural, económico, industrial y transnacional en Francia en la década de 1920 y en Japón en la década de 1980. Este trabajo dirige su atención a la arquitectura doméstica concebida desde el interior por arquitectos con una formación complementaria en diseño de mobiliario. A su vez, profundiza en la relación que se establece entre el diseño de una casa y el diseño de un mueble, una máquina o un vestido. Los pequeños proyectos, próximos al mobiliario, diseñados por Sejima, no han sido suficientemente estudiados, al igual que los proyectos de arquitectura experimental proyectados por Perriand. Ambas trayectorias analizadas desde estos renovados puntos de vista se encuentran en lo que denominamos arquitectura petite. Surge así un nuevo paradigma espacial en un contexto de poder de lo femenino—en los medios de comunicación—y de intercambio cultural transnacional. Cuando el mobiliario crece y se equipa tecnológicamente para hacerse habitable por un grupo de personas, con cualidades suficientes de confort sensorial, es arquitectura petite. En 2009, Toyo Ito mostró en una conferencia en Madrid, una imagen de Sejima posando en su proyecto Pao I. Justo ochenta años antes, en 1929, Le Corbusier presentó en Buenos Aires la imagen de Perriand posando para su Chaise Longue. La coincidencia de ambas fotografías, junto con la lectura de dos inspiradores artículos de Toyo Ito, “Adèle’s dream” (1984)—cuyo enigmático título utiliza un nombre francés femenino para describir una casa japonesa—y “Simple lines for Le Corbusier” (1994), dieron origen a la hipótesis central de una investigación: la comparación de dos arquitectas, sus maestros y dos objetos pertenecientes a dos momentos y lugares distantes. Perriand y Sejima fueron emblemas del concepto de Nueva Feminidad, ambas tenían éxito en la prensa generalista del momento antes de ser contratadas por Le Corbusier y Toyo Ito respectivamente. Junto a sus maestros de entonces, concibieron dos iconos de la era de la maquina y de la electrónica respectivamente, la Chaise Longue (1928) y Pao I (1985), diseñados para ellas mismas. Perriand y Sejima usaron su propio cuerpo como unidad de medida y su imagen como reclamo publicitario para la promoción de los dos objetos respectivamente. La precisión técnica, materiales de lujo y enfoque de la relajación que compartieron la Chaise Longue y Pao I sugirió un nomadismo lúdico que anticipó el desarrollo posterior de lo que denominamos de arquitectura petite por parte de Perriand y Sejima. Ambos prototipos son los antecedentes de una arquitectura de talla precisa o petite (objetos híbridos entre casa, mueble y máquina con la sensualidad como característica distintiva) que ambas arquitectas han proyectado a lo largo de su carrera, y que aúnan su interés mutuo por las propiedades físicas de los materiales, así como su formación en diseño de mobiliario y su fascinación por la moda. La tesis concluye que la arquitectura petite es la depositaria de los manifiestos de una época, la que sigue a la era de la máquina enunciada por Le Corbusier y a la era de la electrónica descrita por Toyo Ito. En este sentido, la tesis evidencia la forma en la que importantes arquitectos han concentrado ideas ambiciosas en pequeños proyectos. Las características de petite se resumen en el hecho de ser una arquitectura de límites precisos, desmontable y por tanto temporal, que explora el potencial técnico y formal de nuevos materiales importados de otras industrias, incorpora condiciones sensuales propias de su escala antropométrica, y está destinada al ocio de un grupo de personas. A modo de colofón, la tesis descubre la existencia de una historia de ficción que vincula a Charlotte Perriand y Kazuyo Sejima a través de Toyo Ito: “El diario de Adèle”. ABSTRACT This dissertation reveals parallels between the architects/designers Charlotte Perriand (1903- 1999) and Kazuyo Sejima (b. 1956), reflected in a series of small projects I call petite architecture—habitable technological furniture—, which formed during similar periods of social, cultural, economic, industrial and transnational change in France in the 1920s and in Japan in the 1980s. This research focuses on domestic architecture conceived from the inside by architects with additional training in furniture design. At the same time, it explores the relationships established between the design of a house, a piece of furniture, a machine, or a dress. Small architectural projects, close to the furniture, designed by Sejima have not been sufficiently studied, as well as the experimental architectural projects designed by Perriand. Both of their experimental trajectories analyzed from this renovated point of view converge on what we call petite architecture. Thus, it raises a new spatial paradigm in the context of feminine power within the media, as direct consumers, and transnational cultural exchange. When furniture expands and is technologically equipped to the point where it becomes habitable by a group, or groups of people, providing its occupants with sensorial comfort, it is petite architecture. In 2009, at a conference in Madrid, Ito showed a picture of Sejima posing at his Pao I (1985). Just eighty years earlier, in 1929, Le Corbusier exhibited in a conference in Buenos Aires an image of Perriand posing for his Chaise Longue (1928). The coincidence of the two photographs, along with two inspiring articles by Toyo Ito "Adèle's dream" (1984) — whose enigmatic title uses a French female name to describe a Japanese house — and "Simple lines for Le Corbusier" (1994) led to a hypothesis and an investigation comparing the two architects, their mentors, and two objects, each belonging to two distant times and places. Perriand and Sejima were emblems of the concept of New Femininity, both had success in the media of their time before being hired by Le Corbusier and Toyo Ito respectively. Together with their mentors they designed two objects that became icons of the Machine Age and the Electronic Age respectively: the Chaise Longue (1928) and Pao I (1985). Designed "for themselves," Perriand and Sejima used their own bodies as a measuring unit and their image as a publicity stunt to promote the two objects respectively. Both objects are the embryonic capsules of the architecture that pampers the scale or petite (objects that conflate residence, machine and furniture, and have sensuality as a distinctive feature). From the technical precision, luxurious materials, and approach towards relaxation, emerged a playful nomadism, which anticipated the further development of what we call petite architecture. Perriand and Sejima would develop these ideas throughout their career, pooling their interests on the physical properties of materials, formation in furniture design, and their intense interest in fashion. The dissertation concludes that petite architecture is the manifestation of an age, which follows the Machine Age defined by Le Corbusier and the Electronic Age described by Toyo Ito. In this sense, the dissertation demonstrates the way in which important architects have focused their ambitious ideas on small projects. petite characteristics are summarized as being: architecture that pampers the scale, is (de)mountable and therefore temporary, explores the formal and technical potential of novel materials and techniques imported from other industries, incorporates sensual conditions according with its anthropometric scale, and is conceived for the leisure of a group of people. In addition, by way of colophon, the dissertation discovers the existence of a fictional story that links Charlotte Perriand and Kazuyo Sejima through Toyo Ito: "Adèle's Diary".

Alternativas de centralización de la función de tesorería en holdings de compañías internacionales

A través del proyecto se pretende buscar diferentes alternativas de centralización de la función de tesorería y el continuum de madurez para un holding internacional de compañías, lo que implica desde modelos de cash pooling, a modelos de centros de servicios compartidos (factorías de cobros y pagos), a modelos avanzados de bancos internos, analizando en qué casos puede ser aplicable cada uno. En términos generales, el proyecto se divide en cuatro bloques: -Repaso a los roles, responsabilidades y evolución de la función de tesorería, a nivel general -Repaso a las alternativas de centralización de la función de tesorería -Caso sobre un diseño de un modelo de centralización para un grupo internacional -Conclusiones---ABSTRACT---Through the project aims to find different alternatives of centralized treasury function and the continuum of maturity for an international holding company, which means from models of cash pooling, models of shared service centers (factories collections and payments ), to advanced models of domestic banks, analyzing in which cases may be applicable each. Overall, the project is divided into four main parts: -Review of the roles, responsibilities and evolution of the treasury function, in general --Review of the alternatives of centralization of the treasury function -Case study on a design of a centralized model for an international group -Conclusions

Potenciación de la respuesta productiva en rumiantes mediante el empleo de proteínas protegidas

El principal objetivo de esta tesis fue incrementar la eficiencia proteica en las dietas de rumiantes mediante el uso de proteínas protegidas (harina de girasol y guisante de primavera), así como mejorar la predicción de los aportes de proteína microbiana. Una partida de harinas comerciales de girasol (HG) y de guisante de primavera (GP) fueron tratadas con soluciones 4 N de ácido málico (268,2 g/L) o ácido ortofosfórico (130,6 g/L). Para cada harina, ácido y día de tratamiento, dos fracciones de 12,5 kg fueron pulverizadas sucesivamente en una hormigonera con la solución de ácido correspondiente mediante un pulverizador de campo. Las dos fracciones fueron mezcladas posteriormente y se dejaron reposar durante 1 h a temperatura ambiente. La mezcla fue luego secada en una estufa de aire forzado a 120 ºC durante 1 h. La estufa fue apagada inmediatamente después y el material tratado se mantuvo dentro de ésta hasta la mañana siguiente. El material fue removido durante el proceso de secado cada 30 min durante las primeras 2 h y cada 60 min durante las 5 h posteriores. Este proceso se repitió hasta conseguir las cantidades de harinas tratadas necesarias en los distintos ensayos. En el primer experimento (capitulo 3) se llevaron a cabo estudios de digestión ruminal e intestinal para evaluar los efectos de la aplicación de las soluciones ácidas indicadas y calor a fin de proteger las proteínas de HG y GP contra la degradación ruminal. Estos estudios se realizaron con tres corderos canulados en el rumen y en el duodeno. El estudio de digestión ruminal fue realizado en tres periodos experimentales en los que los corderos fueron alimentados sucesivamente con tres dietas isoproteicas que incluían HG y GP, sin tratar o tratadas con ácidos málico u ortofosfórico. Cada periodo experimental de 21 días incluyó sucesivamente: 10 días de adaptación a las dietas, un estudio del tránsito ruminal de las partículas de HG y GP (días 11 a 14), y la incubación de las muestras de ambos alimentos en bolsas de nailon (días 15–21). Las harinas incubadas en cada periodo experimental correspondieron a las que fueron incluidas en las dietas. Las bacterias ruminales fueron marcadas desde el día 11 hasta el día 21 del periodo experimental mediante infusión intra-ruminal continua con una fuente de 15N. Tras finalizar las incubaciones in situ el día 21 el rumen fue vaciado en cada periodo para aislar las bacterias asociadas a la fase sólida y liquida del rumen. El estudio de digestión intestinal fue realizado veinte días después del final del estudio ruminal a fin de eliminar el enriquecimiento en 15N de la digesta. En este estudio se incubaron muestras compuestas obtenidas mediante la combinación de los diferentes residuos no degradados en el rumen de forma que fuesen representativas de la composición química de la fracción no degradada en el rumen (RU). En esta fase los corderos fueron alimentados con la dieta sin tratar para determinar la digestibilidad de las harinas tanto tratadas como sin tratar mediante la técnica de las bolsas móviles. Además, las proteínas contenidas en las harinas tratadas y sin tratar, así como en las muestras correspondientes a los residuos a 0 h, las muestras compuestas anteriormente indicadas y las muestras no digeridas intestinalmente fueron extraídas y sometidas a electroforesis para determinar el sitio de digestión de las diferentes fracciones proteicas. Las estimaciones de la RU y la digestibilidad intestinal de la materia seca, la materia orgánica (solamente para RU), la proteína bruta (PB) y el almidón (solamente en GP) fueron obtenidos considerando la contaminación microbiana y las tasas de conminución y salida de partículas. Las estimaciones de RU y de la digestibilidad intestinal disminuyeron en todas las fracciones evaluadas de ambos alimentos al corregir por la contaminación microbiana acaecida en el rumen. Todas las estimaciones de RU aumentaron con los tratamientos de protección, incrementándose también la digestibilidad intestinal de la materia seca en la HG. Los bajos valores de la digestibilidad de la proteína de GP tratado y sin tratar sugieren la presencia de algún factor antitripsico no termolábil es esta harina. Los tratamientos de protección incrementaron consistentemente la fracción de materia seca y PB digerida intestinalmente en los dos alimentos, mientras que la fracción de almidón en la muestra de GP solamente aumentó numéricamente (60,5% de media). Sin embargo, los tratamientos también redujeron la fermentación de la materia orgánica, lo cual podría disminuir la síntesis de proteína microbiana. Los estudios de electroforesis muestran la práctica desaparición de la albumina por la degradación ruminal en ambos alimentos, así como que los cambios en otras proteínas de la muestra RU fueron más pronunciados en GP que en HG. La composición de las bacterias asociadas con las fases de digesta ruminal sólida (BAS) y líquida (BAL) fue estudiada para revisar la precisión de un sistema de predicción previo que determinaba la infravaloración del aporte de nutrientes correspondiente a las BAS cuando de usa 15N como marcador y las BAL como referencia microbiana (capitulo 4). Al comparar con BAS, BAL mostraron menores contenidos en materia orgánica, polisacáridos de glucosa y lípidos totales y un mayor contenido en PB, así como un mayor enriquecimiento en 15N. Los datos obtenidos en el estudio actual se ajustan bien a la ecuación previa que predice el enriquecimiento en 15N de las BAS a partir del mismo valor en BAL. Esta nueva ecuación permite establecer que se produce una infravaloración de un 22% en el aporte de PB al animal a partir de las BAS sintetizadas si las BAL son usadas como muestras de referencia. Una segunda relación calculada utilizando los valores medios por dieta expuestos en numerosos trabajos encontrados en la literatura confirma la magnitud de este error. Esta infravaloración asociada al uso de BAL como referencia fue mayor para el aporte de glucosa (43,1%) y todavía mayor para el aporte de lípidos (59,9%), como consecuencia de los menores contenidos de ambas fracciones en BAL frente a SAB. Estos errores deberían ser considerados para obtener mayor precisión en la estimación del aporte de nutrientes microbianos y mejorar la nutrición de los rumiantes. En el experimento 2 se realizó un estudio de producción (capitulo 5) para evaluar los efectos del tratamiento de las harinas HG y GP con soluciones de ácido málico o ácido ortofosfórico sobre el crecimiento, el consumo de concentrado y el rendimiento y engrasamiento de las canales de corderos de engorde. Noventa corderos machos de cruce entrefino procedentes de tres granjas comerciales (peso inicial medio = 14,6, 15,3 y 13,3 kg, respectivamente) fueron asignados aleatoriamente a cinco dietas con diferentes niveles de proteína y diferentes tratamientos con ácidos y engordados hasta un peso medio al sacrificio de 25 kg. Las fuentes de proteína en el pienso control (C; PB=18,0%) fueron harina de soja, HG y GP sin tratar. En tres de los piensos experimentales, las harinas tratadas con ácido ortofosfórico sustituyeron a las de HG y GP sin tratar (Control Ortofosfórico, PC; PB=18,0% sobre materia seca), sustituyéndose, además, la harina de soja parcialmente (Sustitución Media Ortofosfórico, MSP; PB=16,7%) o totalmente (Sustitución Total Ortofosfórico, TSP; PB=15,6%). Finalmente, en uno de los piensos el ácido ortofosfórico fue reemplazo por acido málico para proteger ambas harinas (Sustitución Media Málico, MSM; PB= 16,7%). La paja de trigo (fuente de forraje) y el concentrado fueron ofrecidos ad libitum. Dieciocho corderos fueron distribuidos en seis cubículos con tres animales para cada dieta. Los datos fueron analizados según un análisis factorial considerando el peso inicial como covariable y la granja de procedencia como bloque. Los datos de consumo de concentrado y eficiencia de conversión fueron analizados usando el cubículo como unidad experimental, mientras que los datos sobre ganancia media diaria, rendimiento a la canal, grasa dorsal y grasa pélvico renal fueron analizados usando el cordero como unidad experimental. No se encontró ningún efecto asociado con el nivel de PB sobre ninguna variable estudiada. Esto sugiere que usando proteínas protegidas es posible utilizar concentrados con 15,6% de PB (sobre materia seca) disminuyendo así la cantidad de concentrados de proteína vegetal a incluir en los piensos y la calidad de los concentrados proteicos. Los corderos alimentados con la dieta MSM tuvieron mayores ganancias medias diarias (15,2%; P= 0,042), y mejores rendimiento a la canal en caliente (1,3 unidades porcentuales; P= 0,037) que los corderos alimentados con el concentrado MSP. Esto podría ser explicado por los efectos benéficos ruminales del malato o por el mayor efecto de protección conseguido con el ácido málico. ABSTRACT The main objective of this thesis project was to increase the protein efficiency in ruminant diets by using protected protein (sunflower meal and spring pea), and improving the prediction of microbial protein supply. Commercial sunflower meal (SFM) and spring pea (SP) were treated with 4 N solutions (200 mL/kg) of malic acid (268.2 g/L) or orthophosphoric acid (130.6 g/L). Daily, two fractions of 12.5 kg of one of these meals were successively sprayed with the tested acid solution in a concrete mixer using a sprayer. Both fractions were then mixed and allowed to rest for 1 h at room temperature. The blend was then dried in a forced air oven at 120 ºC for 1 h. Then the oven was turned off and the treated material was left in the oven overnight. During the drying process, the material was stirred every 30 min during the first 2 h and then every 60 min for the subsequent 5 h. This process was repeated until the amounts of treated flour needed for the different trials performed. In the first experiment (chapter 3), ruminal and intestinal digestion trials were conducted to study the effects of the application of these acid solutions and heat to protect proteins of SFM and SP against ruminal degradation using three wethers fitted with rumen and duodenum cannulae. The ruminal digestion study was carried out in three experimental periods in which the wethers were successively fed three isoproteic diets including SFM and SP, untreated or treated with malic or orthophosphoric acids. The experimental periods of 21 days included successively: 10 days of diet adaptation, SFM and SP particle ruminal transit study (days 11–14) and ruminal nylon-bag incubations (days 15–21). The meals incubated in each experimental period were those corresponding to the associated diet. Rumen bacteria were labelled from days 11 to 21 by continuous intra-ruminal infusion of a 15N source and the rumen was emptied at the end of in situ incubations in each period to isolate solid adherent bacteria and liquid associate bacteria. The intestinal digestion trial was conducted twenty days after the end of the ruminal studies to eliminate the 15N enrichment in the digesta. The tested samples were composite samples obtained pooling the different ruminally undegraded residues to be representative of the chemical composition of the ruminally undegraded fraction (RU). Wethers were fed the untreated diet to determine the intestinal digestibility of untreated and treated meals using the mobile nylon bag technique. In addition, protein in untreated and treated meals and their 0 h, composite and intestinally undigested samples were extracted and subjected to electrophoresis to determine the digestion site of the different protein fractions. Estimates of the RU and its intestinal digestibility of dry matter, organic matter (only for RU), crude protein (CP) and starch (only in SP) were obtained considering ruminal microbial contamination and particle comminution and outflow rates. When corrected for the microbial contamination taking place in the rumen, estimates of RU and intestinal digestibility decreased in all tested fractions for both feeds. All RU estimates increased with the protective treatments, whereas intestinal digestibility-dry matter also increased in SFM. Low intestinal digestibility-CP values in untreated and treated samples suggested the presence of non-heat labile antitrypsin factors in SP. Protective treatments of both feeds led to consistent increases in the intestinal digested fraction of dry matter and CP, being only numerically different for SP-starch (60.5% as average). However, treatments also reduced the organic matter fermentation, which may decrease ruminal microbial protein synthesis. Electrophoretic studies showed albumin disappearance in both SFM and SP, whereas changes in other RU proteins were more pronounced in SP than SFM. The chemical composition of bacteria associated with solid (SAB) and liquid (LAB) rumen-digesta phases was studied to examine the accuracy of a previous regression system determining the underevaluation of SAB-nutrient supply using 15N as marker and LAB as microbial reference (chapter 4). Compared with SAB, LAB showed lower contents of organic matter, polysaccharide-glucose and total lipids and the opposite for the CP content and the 15N enrichment. Present data fitted well to the previous relationship predicting the 15N enrichment of SAB from the same value in LAB. This new equation allows establishing an underevaluation in the supply of CP from the synthesized SAB in 22.0% if LAB is used as reference. Another relationship calculated using mean diet values from the literature confirmed the magnitude of this error. This underevaluation was higher for the supply of glucose (43.1%) and still higher for the lipid supply (59.9%) as a consequence of the lower contents of these both fractions in LAB than in SAB. These errors should be considered to obtain more accurate estimates of the microbial nutrient supply and to improve ruminant nutrition. A production study was performed in experiment 2 (chapter 5) to examine the effects of treating SFM and SP meals with orthophosphoric or malic acid solutions on growth performance, concentrate intake, and carcass yield and fatness of growing-fattening lambs. Ninety "Entrefino" cross male lambs from three commercial farms (average initial body weights (BW) = 14.6, 15.3 and 13.3 kg) were randomly assigned to five diets with different acid treatment and protein levels, and fattened to an average slaughter weight of 25 kg. Protein sources in the control concentrate (C; CP=18%) were soybean meal and untreated SFM and SP. In three of the experimental concentrates, orthophosphoric acid-treated meals substituted untreated SFM and SP (Orthophosphoric Control, PC; CP=18% dry matter basis), and soybean meal was partially (Medium Substitution Orthophosphoric, MSP; CP=16.7%) or totally removed (Total Substitution Orthophosphoric, TSP; CP=15.6%). In addition, in one concentrate orthophosphoric acid was replaced by malic acid to protect these meals (Medium Substitution Malic, MSM; CP= 16.7%). Wheat straw (roughage source) and concentrate were offered ad libitum. Eighteen lambs were allocated to six pens of three animals on each diet. Data were analyzed using a factorial analysis with initial body weight BW as covariate and farm of origin as block. Data on concentrate intake and feed conversion efficiency were analyzed using pen as experimental unit, while data on average daily gain, carcass yield, dorsal fat, and kidney-pelvic-fat were analyzed with lamb as experimental unit. No effect associated with the CP level was observed on any parameter. This suggests that with protected proteins it is possible to feed concentrates with 15.6% CP (dry matter basis) reducing the quantity of vegetable protein meals to include in the concentrate as well as the quality of the protein concentrates. Lambs feed MSM had higher average daily gains (15.2%; P= 0.042), and better hot carcass yields (1.3 percentage points; P= 0.037) than lambs feed MSP. This probably can be explained by ruminal malate actions and by greater protection effects obtained with malic acid.