Strain longitudinal global para la detecci��n de estenosis coronaria significativa en pacientes con infarto agudo del miocardio

Introducci��n: La evaluaci��n de la funci��n mioc��rdica global y regional juega una papel cr��tico en el diagn��stico y manejo de los pacientes con enfermedad coronaria con importantes implicaciones pronosticas, las nuevas t��cnicas ecocardiogr��ficas como la evaluaci��n del STRAIN han sido validadas como una herramienta objetiva, comprehensiva y precisa para evaluar dichos par��metros. Objetivo: Determinar la capacidad del strain global longitudinal para la detecci��n de estenosis coronaria significativa, n��mero de territorios comprometidos y territorio anat��mico del vaso culpable; en pacientes sin antecedentes de enfermedad coronaria previa con infarto agudo del miocardio. Dise��o: estudio de pruebas diagn��sticas retrospectivo en el que se utiliz�� como gold est��ndar la angiograf��a coronaria, se seleccionaron 64 pacientes con ecocardiograma transtor��cico previo a la angiograf��a coronaria. Resultados: Se demostr�� una exactitud intermedia del strain global longitudinal para detectar estenosis coronaria por an��lisis de curvas ROC, con un ��rea bajo la curva de 0,78 p= 0,000 (IC 0,6; 1,0), Una sensibilidad de 96.5% (91.7%, 101.3%), especificidad 40.0% (9.6%, 70.4%) y una prevalencia real del enfermedad coronaria de 85.1% (76.5%, 93.6%) Conclusiones: La medici��n de la funci��n global y regional por medio del strain global longitudinal identifica pacientes con infarto agudo del miocardio que tienen estenosis coronaria significativa, n��mero de territorios afectados, y la distribuci��n anat��mica de los posibles vasos culpables, sin embargo hay que tener precauci��n en su uso que s��lo se limite a escenarios en donde pueda ser interpretado adecuadamente. Palabras clave: strain global bidimensional, detecci��n de estenosis coronaria significativa, infarto del miocardio.

Percepci��n de calidad de vida relacionada con la salud en pacientes con s��ndrome de apnea e hipoapnea obstructiva del sue��o

El objetivo de esta investigaci��n es describir la calidad de vida y la calidad del sue��o en los pacientes con diagn��stico de S��ndrome de Apnea Hipoapnea del sue��o, mediante el uso de un grupo de cuestionarios para obtener datos demogr��ficos, la evaluaci��n del grado de somnolencia diurna percibida, la percepci��n de la calidad del sue��o y la percepci��n de la calidad de vida relacionada con la salud con encuestas en sus respectivas versiones validadas para Colombia.

��ndice de adiposidad corporal como predictor de obesidad y de s��ndrome metab��lico en adultos de Bogot��, Colombia

Recientemente, Bergman et al. desarrollaron el ��ndice de adiposidad corporal (IAC), como un marcador de obesidad por exceso de grasa corporal en la pr��ctica cl��nica. En este estudio se evalu�� la validez del IAC como marcador de obesidad por exceso de adiposidad, adem��s de examinar la capacidad predictiva del IAC con componentes e ��ndices metab��licos asociados al SM en adultos de Bogot��, Colombia.

Perfil epidemiol��gico de la prevalencia de hipoacusia en un grupo de empleados que trabaja en el ambiente urbano, 2015

El prop��sito de este estudio es determinar la relaci��n entre la exposici��n ocupacional y los niveles de audici��n en trabajadores urbanos en espacio abierto (aseo urbano en general). Se realiz�� un estudio de corte transversal con 491 personas que incluyen hombres y mujeres, cuyo ambiente laboral es el espacio abierto de la ciudad. Los datos se obtuvieron durante los ex��menes m��dicos peri��dicos realizados en el a��o 2014 a los empleados de una empresa cuya actividad econ��mica es el aseo urbano, que incluye recolecci��n de basuras, cuidado forestal y de prados de uso com��n, y limpieza del borde de los andenes. Se realiz�� estad��stica descriptiva para las caracter��sticas demogr��ficas y raz��n de disparidad u Odds Ratio (OR) para buscar la relaci��n de antecedentes y h��bitos personales con el riesgo de desarrollar p��rdida auditiva. De las 491 personas expuestas a niveles altos de ruido ocupacional, 62% present�� p��rdida auditiva, de los cuales la mayor��a se desempe��a como guada��adores y cortadores de c��sped, y son personas que llevan trabajando entre 1-5 a��os en la empresa. Se encontr�� un aumento estad��sticamente significativo entre la baja escolaridad y el riesgo de sufrir hipoacusia (p=0.0001) y un efecto protector del uso de motocicleta y aud��fonos. La enfermedad vascular perif��rica, la pr��ctica de tejo y la diabetes mostraron una fuerte tendencia a aumentar el riesgo. La p��rdida auditiva encontrada en este grupo no se puede relacionar directamente con la exposici��n ocupacional a ruido, a pesar de ser trabajos que se llevan a cabo en el espacio urbano. Sin embargo, la baja escolaridad favorece la lesi��n auditiva y puede verse acelerada por enfermedades de alta prevalencia como diabetes y practicas recreacionales locales.

Eficacia y seguridad de la melatonina para el manejo de los trastornos del sue��o en el autismo: meta-an��lisis

INTRODUCCI��N: El 80% de los ni��os y adolescentes con trastornos del espectro autista (TEA) presenta alg��n trastorno del sue��o, en cuya g��nesis al parecer intervienen alteraciones en la regulaci��n de la melatonina. El objetivo de este metaan��lisis fue determinar la eficacia y seguridad de la melatonina para el manejo de ciertos trastornos del sue��o en ni��os con TEA. M��TODOS: Tres revisores extrajeron los datos relevantes de los ensayos cl��nicos aleatorizados doble ciego de alta calidad publicados en bases de datos primarias, de ensayos cl��nicos, de revisiones sistem��ticas y de literatura gris; adem��s se realiz�� b��squeda en bola de nieve. Se analizaron los datos con RevMan 5.3. Se realiz�� un an��lisis del inverso de la varianza por un modelo de efectos aleatorios para las diferencias de medias de los desenlaces propuestos: duraci��n del tiempo total, latencia de sue��o y n��mero de despertares nocturnos. Se evalu�� la heterogeneidad interestudios con el par��metro I2 RESULTADOS: La b��squeda inicial arroj�� 355 resultados, de los cuales tres cumplieron los criterios de selecci��n. La melatonina result�� ser un medicamento seguro y eficaz para aumentar la duraci��n total del sue��o y disminuir la latencia de sue��o en ni��os y adolescentes con TEA; hasta el momento la evidencia sobre el n��mero de despertares nocturnos no es estad��sticamente significativa. DISCUSI��N: A la luz de la evidencia disponible, la melatonina es una elecci��n segura y eficaz para el manejo de ciertos problemas del sue��o en ni��os y adolescentes con TEA. Es necesario realizar estudios con mayores tama��os muestrales y comparados con otros medicamentos disponibles en el mercado.

Assessment of the usability of the 'alpha' version of the prototype 'Octopus'-application of the heuristic evaluation model of user's graphic interfaces. 'Evaluaci��n de la utilidad de la versi��n 'alfa' del prototipo 'Octopus'-uso del modelo de evaluaci��n heur��stico de los interfaces gr��ficos del usuario'.

Resumen basado en el de la publicaci��n

Development, implementation and evaluation of an activated sludge supervisory system for the Granollers WWTP

La present tesi pret��n recollir l'experi��ncia viscuda en desenvolupar un sistema supervisor intel��ligent per a la millora de la gesti�� de plantes depuradores d'aig��es residuals., implementar-lo en planta real (EDAR Granollers) i avaluar-ne el funcionament dia a dia amb situacions t��piques de la planta. Aquest sistema supervisor combina i integra eines de control cl��ssic de les plantes depuradores (controlador autom��tic del nivell d'oxigen dissolt al reactor biol��gic, ��s de models descriptius del proc��s...) amb l'aplicaci�� d'eines del camp de la intel��lig��ncia artificial (sistemes basats en el coneixement, concretament sistemes experts i sistemes basats en casos, i xarxes neuronals). Aquest document s'estructura en 9 cap��tols diferents. Hi ha una primera part introduct��ria on es fa una revisi�� de l'estat actual del control de les EDARs i s'explica el perqu�� de la complexitat de la gesti�� d'aquests processos (cap��tol 1). Aquest cap��tol introductori juntament amb el cap��tol 2, on es pret��n explicar els antecedents d'aquesta tesi, serveixen per establir els objectius d'aquest treball (cap��tol 3). A continuaci��, el cap��tol 4 descriu les peculiaritats i especificitats de la planta que s'ha escollit per implementar el sistema supervisor. Els cap��tols 5 i 6 del present document exposen el treball fet per a desenvolupar el sistema basat en regles o sistema expert (cap��tol 6) i el sistema basat en casos (cap��tol 7). El cap��tol 8 descriu la integraci�� d'aquestes dues eines de raonament en una arquitectura multi nivell distribu��da. Finalment, hi ha una darrer cap��tol que correspon a la avaluaci�� (verificaci�� i validaci��), en primer lloc, de cadascuna de les eines per separat i, posteriorment, del sistema global en front de situacions reals que es donin a la depuradora

Valores de trabalho, satisfa����o global com o trabalho e satisfa����o com a vida : um estudo explorat��rio das diferen��as s��cio-demogr��ficas em institutos de sa��de

Foram objetivos do presente estudo proceder �� an��lise das rela����es entre Valores de trabalho, Satisfa����o no trabalho e Satisfa����o com a vida em profissionais do sector da sa��de e perceber se dimens��es como antiguidade na empresa, os anos de experi��ncia e o n��mero de organiza����es, fun����o, defini����o de objetivos, avalia����o do desempenho, idade, escolaridade, sexo e estado civil tinham um papel nas dimens��es principais do estudo. Foi recolhida uma amostra de 214 profissionais da sa��de, sendo 24% do sexo masculino e com idades entre 21 e 71 anos (M=40.06; DP=10.93). Foram utilizados os instrumentos WVS (Schwartz, 1994), QSGT (Hackman & Oldham, 1975) e SWLS (Diener, 1984). Os resultados mostraram que existe uma rela����o positiva entre a satisfa����o na vida e a satisfa����o no trabalho; que quanto mais elevados eram os valores de trabalho Poder, Realiza����o, Hedonismo, Estimula����o, Auto dire����o, Benevol��ncia, Conformismo e Seguran��a, maior era a Satisfa����o no trabalho; que quanto mais elevados s��o os valores de trabalho Poder, Realiza����o, Hedonismo, Estimula����o, Auto dire����o, Universalismo, Benevol��ncia, Tradi����o, Conformismo e Seguran��a maior era a Satisfa����o com a vida; e que existem diferen��as entre sexos, idade, estado civil e escolaridade ao n��vel dos valores de trabalho. Contudo, apesar da satisfa����o com a vida ser influenciada pela satisfa����o no trabalho e pelos valores de trabalho, estas dimens��es, por si s��, n��o explicam fortemente a satisfa����o com a vida.

Evaluation of suitable spectral intervals for near-IR laboratory detection of water vapour continuum absorption

The water vapour continuum absorption is an important component of molecular absorption of radiation in atmosphere. However, uncertainty in knowledge of the value of the continuum absorption at present can achieve 100% in different spectral regions leading to an error in flux calculation up to 3-5 W/m2 global mean. This work uses line-by-line calculations to reveal the best spectral intervals for experimental verification of the CKD water vapour continuum models in the currently least studied near-infrared spectral region. Possible sources of errors in continuum retrieval taken into account in the simulation include the sensitivity of laboratory spectrometers and uncertainties in the spectral line parameters in HITRAN-2004 and Schwenke-Partridge database. It is shown that a number of micro-windows in near-IR can be used at present for laboratory detection of the water vapour continuum with estimated accuracy from 30 to 5%.

Efficient evaluation of highly oscillatory acoustic scattering surface integrals

We consider the approximation of some highly oscillatory weakly singular surface integrals, arising from boundary integral methods with smooth global basis functions for solving problems of high frequency acoustic scattering by three-dimensional convex obstacles, described globally in spherical coordinates. As the frequency of the incident wave increases, the performance of standard quadrature schemes deteriorates. Naive application of asymptotic schemes also fails due to the weak singularity. We propose here a new scheme based on a combination of an asymptotic approach and exact treatment of singularities in an appropriate coordinate system. For the case of a spherical scatterer we demonstrate via error analysis and numerical results that, provided the observation point is sufficiently far from the shadow boundary, a high level of accuracy can be achieved with a minimal computational cost.

Isolating the signal of ocean global warming

Identifying the signature of global warming in the world's oceans is challenging because low frequency circulation changes can dominate local temperature changes. The IPCC fourth assessment reported an average ocean heating rate of 0.21 �� 0.04 Wm���2 over the period 1961���2003, with considerable spatial, interannual and inter-decadal variability. We present a new analysis of millions of ocean temperature profiles designed to filter out local dynamical changes to give a more consistent view of the underlying warming. Time series of temperature anomaly for all waters warmer than 14��C show large reductions in interannual to inter-decadal variability and a more spatially uniform upper ocean warming trend (0.12 Wm���2 on average) than previous results. This new measure of ocean warming is also more robust to some sources of error in the ocean observing system. Our new analysis provides a useful addition for evaluation of coupled climate models, to the traditional fixed depth analyses.

Evaluation of ozone and water vapor fields from the ECMWF reanalysis ERA-40 during 1991-1999 in comparison with UARS satellite and MOZAIC aircraft observations

[ 1] The European Centre for Medium-Range Weather Forecasts (ECMWF) 40-year Reanalysis (ERA-40) ozone and water vapor reanalysis fields during the 1990s have been compared with independent satellite data from the Halogen Occultation Experiment (HALOE) and Microwave Limb Sounder (MLS) instruments on board the Upper Atmosphere Research Satellite (UARS). In addition, ERA-40 has been compared with aircraft data from the Measurements of Ozone and Water Vapour by Airbus In-Service Aircraft (MOZAIC) program. Overall, in comparison with the values derived from the independent observations, the upper stratosphere in ERA-40 has about 5 - 10% more ozone and 15 - 20% less water vapor. This dry bias in the reanalysis appears to be global and extends into the middle stratosphere down to 40 hPa. Most of the discrepancies and seasonal variations between ERA-40 and the independent observations occur within the upper troposphere over the tropics and the lower stratosphere over the high latitudes. ERA-40 reproduces a weaker Antarctic ozone hole, and of less vertical extent, than the independent observations; values in the ozone maximum in the tropical stratosphere are lower for the reanalysis. ERA-40 mixing ratios of water vapor are considerably larger than those for MOZAIC, typically by 20% in the tropical upper troposphere, and they may exceed 60% in the lower stratosphere over high latitudes. The results imply that the Brewer-Dobson circulation in the ECMWF reanalysis system is too fast, as is also evidenced by deficiencies in the way ERA-40 reproduces the water vapor "tape recorder'' signal in the tropical stratosphere. Finally, the paper examines the biases and their temporal variation during the 1990s in the way ERA-40 compares to the independent observations. We also discuss how the evaluation results depend on the instrument used, as well as on the version of the data.

Evaluation of the sea ice simulation in a new coupled atmosphere-ocean climate model (HadGEM1)

[ 1] A rapid increase in the variety, quality, and quantity of observations in polar regions is leading to a significant improvement in the understanding of sea ice dynamic and thermodynamic processes and their representation in global climate models. We assess the simulation of sea ice in the new Hadley Centre Global Environmental Model (HadGEM1) against the latest available observations. The HadGEM1 sea ice component uses elastic-viscous-plastic dynamics, multiple ice thickness categories, and zero-layer thermodynamics. The model evaluation is focused on the mean state of the key variables of ice concentration, thickness, velocity, and albedo. The model shows good agreement with observational data sets. The variability of the ice forced by the North Atlantic Oscillation is also found to agree with observations.

Global scale water stages from SAR imagery (GlosSARi) to support global flood forecasting

Despite the success of studies attempting to integrate remotely sensed data and flood modelling and the need to provide near-real time data routinely on a global scale as well as setting up online data archives, there is to date a lack of spatially and temporally distributed hydraulic parameters to support ongoing efforts in modelling. Therefore, the objective of this project is to provide a global evaluation and benchmark data set of floodplain water stages with uncertainties and assimilation in a large scale flood model using space-borne radar imagery. An algorithm is developed for automated retrieval of water stages with uncertainties from a sequence of radar imagery and data are assimilated in a flood model using the Tewkesbury 2007 flood event as a feasibility study. The retrieval method that we employ is based on possibility theory which is an extension of fuzzy sets and that encompasses probability theory. In our case we first attempt to identify main sources of uncertainty in the retrieval of water stages from radar imagery for which we define physically meaningful ranges of parameter values. Possibilities of values are then computed for each parameter using a triangular ���membership��� function. This procedure allows the computation of possible values of water stages at maximum flood extents along a river at many different locations. At a later stage in the project these data are then used in assimilation, calibration or validation of a flood model. The application is subsequently extended to a global scale using wide swath radar imagery and a simple global flood forecasting model thereby providing improved river discharge estimates to update the latter.

Evaluation of the S(T) assimilation method with the Argo dataset

Recent observations from the Argo dataset of temperature and salinity profiles are used to evaluate a series of 3-year data assimilation experiments in a global ice���ocean general circulation model. The experiments are designed to evaluate a new data assimilation system whereby salinity is assimilated along isotherms, S(T ). In addition, the role of a balancing salinity increment to maintain water mass properties is investigated. This balancing increment is found to effectively prevent spurious mixing in tropical regions induced by univariate temperature assimilation, allowing the correction of isotherm geometries without adversely influencing temperature���salinity relationships. In addition, the balancing increment is able to correct a fresh bias associated with a weak subtropical gyre in the North Atlantic using only temperature observations. The S(T ) assimilation method is found to provide an important improvement over conventional depth level assimilation, with lower root-mean-squared forecast errors over the upper 500 m in the tropical Atlantic and Pacific Oceans. An additional set of experiments is performed whereby Argo data are withheld and used for independent evaluation. The most significant improvements from Argo assimilation are found in less well-observed regions (Indian, South Atlantic and South Pacific Oceans). When Argo salinity data are assimilated in addition to temperature, improvements to modelled temperature fields are obtained due to corrections to model density gradients and the resulting circulation. It is found that observations from the Argo array provide an invaluable tool for both correcting modelled water mass properties through data assimilation and for evaluating the assimilation methods themselves.