Risk charts to guide targeted HIV-1 viral load monitoring of ART: development and validation in patients from resource-limited settings.

BACKGROUND HIV-1 RNA viral load (VL) testing is recommended to monitor antiretroviral therapy (ART) but not available in many resource-limited settings. We developed and validated CD4-based risk charts to guide targeted VL testing. METHODS We modeled the probability of virologic failure up to 5 years of ART based on current and baseline CD4 counts, developed decision rules for targeted VL testing of 10%, 20% or 40% of patients in seven cohorts of patients starting ART in South Africa, and plotted cut-offs for VL testing on colour-coded risk charts. We assessed the accuracy of risk chart-guided VL testing to detect virologic failure in validation cohorts from South Africa, Zambia and the Asia-Pacific. FINDINGS 31,450 adult patients were included in the derivation and 25,294 patients in the validation cohorts. Positive predictive values increased with the percentage of patients tested: from 79% (10% tested) to 98% (40% tested) in the South African, from 64% to 93% in the Zambian and from 73% to 96% in the Asia-Pacific cohorts. Corresponding increases in sensitivity were from 35% to 68% in South Africa, from 55% to 82% in Zambia and from 37% to 71% in Asia-Pacific. The area under the receiver-operating curve increased from 0.75 to 0.91 in South Africa, from 0.76 to 0.91 in Zambia and from 0.77 to 0.92 in Asia Pacific. INTERPRETATION CD4-based risk charts with optimal cut-offs for targeted VL testing may be useful to monitor ART in settings where VL capacity is limited.

Capitalisation of Experiences of the Swiss Support to Sustainable Management of Natural Resources (SMNR) in Bulgaria

Following the collapse of the communist regime in 1989, Bulgaria has undergone dramatic political, economic and social transformations. The transition process of the past two decades was characterized by several reforms to support democratisation of the political system and the functioning of a free-market economy. Since 1992, Switzerland has been active in Bulgaria providing assistance to the transition process, with support to Sustainable Management of Natural Resources (SMNR) starting in 1995. The SMNR Capitalisation of Experiences (CapEx) took place between March and September 2007, in the context of SDC phasing out its programmes in Bulgaria by the end of 2007 due to the country’s accession to the European Union. The CapEx exercise has culminated in the identification of 17 lessons learned. In the view of the CapEx team, many of these lessons are relevant for countries that are in the process of joining the EU, facing similar democratisation challenges as Bulgaria. Overall, the Swiss SMNR projects have been effective entry points to support areas that are crucial to democratic transitions, namely participation in public goods management, decentralisation, human capacity development in research and management, and preparation for EU membership. The specificity of the Swiss support stems from an approach that combines a long-term commitment with a clear thematic focus (forestry, biodiversity conservation and organic agriculture). The multistakeholder approach and diversification of support between local, regional and national levels are also important elements that contributed to make a difference in relation to other donors supporting the Bulgarian transition. At the institutional level, there are a number of challenges where the contribution of SMNR activities was only modest, namely improving the legal framework and creating more transparency and accountability, both of which are time and resource-consuming processes. In addition, the emergence of competent and sustainable non-government organisations (NGOs) is a complex process that requires support to membership based organisations, a challenge that was hardly met in the case of SMNR. Finally, reform of government institutions involved in management of natural resources is difficult to achieve via project support only, as it requires leverage and commitment at the level of policy dialogue. At the programme management level, the CapEx team notes that corruption was not systematically addressed in SMNR projects, indicating that more attention should be given to this issue at the outset of any new project.

Capacity Building in the Use of Geospatial Tools for Natural Resource Management in Tajikistan: Inception report

The sustainable management of natural resources is a key issue for sustainable development of a poor, mountainous country such as Tajikistan. In order to strengthen its agricultural and infrastructural development efforts and alleviate poverty in rural areas, spatial information and analysis are of crucial importance to improve priority setting and decision making efficiency. However, poor access to geospatial data and tools, and limited capacity in their use has greatly constrained the ability of governmental institutions to effectively assess, plan, and monitor natural resources management. The Centre for Development and Environment (CDE) has thus been mandated by the World Bank Group to provide adequate technical support to the Community Agriculture and Watershed Management Project (CAWMP). This support consists of a spatial database on soil degradation trends in 4 watersheds, capacity development in and awareness creation about geographic information technology and a spatial data exchange hub for natural resources management in Tajikistan. CDE’s support has started in July 2007 and will last until December 2007 with a possible extension in 2008.

Implementation and Operational Research: Risk Charts to Guide Targeted HIV-1 Viral Load Monitoring of ART: Development and Validation in Patients From Resource-Limited Settings.

BACKGROUND HIV-1 RNA viral load (VL) testing is recommended to monitor antiretroviral therapy (ART) but not available in many resource-limited settings. We developed and validated CD4-based risk charts to guide targeted VL testing. METHODS We modeled the probability of virologic failure up to 5 years of ART based on current and baseline CD4 counts, developed decision rules for targeted VL testing of 10%, 20%, or 40% of patients in 7 cohorts of patients starting ART in South Africa, and plotted cutoffs for VL testing on colour-coded risk charts. We assessed the accuracy of risk chart-guided VL testing to detect virologic failure in validation cohorts from South Africa, Zambia, and the Asia-Pacific. RESULTS In total, 31,450 adult patients were included in the derivation and 25,294 patients in the validation cohorts. Positive predictive values increased with the percentage of patients tested: from 79% (10% tested) to 98% (40% tested) in the South African cohort, from 64% to 93% in the Zambian cohort, and from 73% to 96% in the Asia-Pacific cohort. Corresponding increases in sensitivity were from 35% to 68% in South Africa, from 55% to 82% in Zambia, and from 37% to 71% in Asia-Pacific. The area under the receiver operating curve increased from 0.75 to 0.91 in South Africa, from 0.76 to 0.91 in Zambia, and from 0.77 to 0.92 in Asia-Pacific. CONCLUSIONS CD4-based risk charts with optimal cutoffs for targeted VL testing maybe useful to monitor ART in settings where VL capacity is limited.

Brain-borne IL-1 adjusts glucoregulation and provides fuel support to astrocytes and neurons in an autocrine/paracrine manner.

It is still controversial which mediators regulate energy provision to activated neural cells, as insulin does in peripheral tissues. Interleukin-1β (IL-1β) may mediate this effect as it can affect glucoregulation, it is overexpressed in the 'healthy' brain during increased neuronal activity, and it supports high-energy demanding processes such as long-term potentiation, memory and learning. Furthermore, the absence of sustained neuroendocrine and behavioral counterregulation suggests that brain glucose-sensing neurons do not perceive IL-1β-induced hypoglycemia. Here, we show that IL-1β adjusts glucoregulation by inducing its own production in the brain, and that IL-1β-induced hypoglycemia is myeloid differentiation primary response 88 protein (MyD88)-dependent and only partially counteracted by Kir6.2-mediated sensing signaling. Furthermore, we found that, opposite to insulin, IL-1β stimulates brain metabolism. This effect is absent in MyD88-deficient mice, which have neurobehavioral alterations associated to disorders in glucose homeostasis, as during several psychiatric diseases. IL-1β effects on brain metabolism are most likely maintained by IL-1β auto-induction and may reflect a compensatory increase in fuel supply to neural cells. We explore this possibility by directly blocking IL-1 receptors in neural cells. The results showed that, in an activity-dependent and paracrine/autocrine manner, endogenous IL-1 produced by neurons and astrocytes facilitates glucose uptake by these cells. This effect is exacerbated following glutamatergic stimulation and can be passively transferred between cell types. We conclude that the capacity of IL-1β to provide fuel to neural cells underlies its physiological effects on glucoregulation, synaptic plasticity, learning and memory. However, deregulation of IL-1β production could contribute to the alterations in brain glucose metabolism that are detected in several neurologic and psychiatric diseases.Molecular Psychiatry advance online publication, 8 December 2015; doi:10.1038/mp.2015.174.

Governance and the Capacity to Manage Resilience in Regional Social-Ecological Systems

The sustainability of regional development can be usefully explored through several different lenses. In situations in which uncertainties and change are key features of the ecological landscape and social organization, critical factors for sustainability are resilience, the capacity to cope and adapt, and the conservation of sources of innovation and renewal. However, interventions in social-ecological systems with the aim of altering resilience immediately confront issues of governance. Who decides what should be made resilient to what? For whom is resilience to be managed, and for what purpose? In this paper we draw on the insights from a diverse set of case studies from around the world in which members of the Resilience Alliance have observed or engaged with sustainability problems at regional scales. Our central question is: How do certain attributes of governance function in society to enhance the capacity to manage resilience? Three specific propositions were explored: ( 1) participation builds trust, and deliberation leads to the shared understanding needed to mobilize and self-organize; ( 2) polycentric and multilayered institutions improve the fit between knowledge, action, and social-ecological contexts in ways that allow societies to respond more adaptively at appropriate levels; and ( 3) accountable authorities that also pursue just distributions of benefits and involuntary risks enhance the adaptive capacity of vulnerable groups and society as a whole. Some support was found for parts of all three propositions. In exploring the sustainability of regional social-ecological systems, we are usually faced with a set of ecosystem goods and services that interact with a collection of users with different technologies, interests, and levels of power. In this situation in our roles as analysts, facilitators, change agents, or stakeholders, we not only need to ask: The resilience of what, to what? We must also ask: For whom?

Perceptions of institutional support of community -based participatory research within prevention research centers

The Institute of Medicine (IOM) report on the future of health care states that the focus on health needs to shift to the management and prevention of chronic illnesses and that academic health centers (AHCs) should play an active role in this process through community partnerships (IOM, 2002). Grant funding from the National Institutes of Health and the creation of the Centers for Disease Control and Prevention (CDC) Prevention Research Centers (PRC) across the county represent a transition toward more proactively seeking out community partnerships to better design and disseminate health promotion programs (Green, 2001). ^ The focus of the PRCs is to conduct rigorous, community-based, prevention research, to seek outcomes applicable to public health programs and policies. The PRCs work is to create and foster partnerships among public health and community organizations, to address health promotion and disease prevention issues (CDC, 2003). ^ The W.K. Kellogg Foundation defines CBPR as "a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health." ^ In 1995, CDC asked the IOM to review the PRC program to examine the extent to which the program is providing the public health community with strategies to address public health problems in disease prevention and health promotion (IOM, 1997). No comprehensive evaluation n of the individual PRCs had ever been done (IOM, 1997). ^ The CDC was interested in understanding how it could better support the PRC program through improved management and oversight to influence the program's success. The CDC only represents one of the entities that influence the success of a PRC. Another key entity to consider is the support of and influence of the Schools of Public Health in which the PRCs reside. Using evaluation criteria similar to those that were developed by the IOM, this study examined how aspects of structural capacity of the Schools of Public Health in which the PRCs reside are perceived to influence PRC community-based research activities. ^

Seawater carbonate chemistry and dark respiration and photosynthetic capacity during experiments with coral Acropora formosa, 2010

Ocean acidification is expected to lower the net accretion of coral reefs yet little is known about its effect on coral photophysiology. This study investigated the effect of increasing CO2 on photosynthetic capacity and photoprotection in Acropora formosa. The photoprotective role of photorespiration within dinoflagellates (genus Symbiodinium) has largely been overlooked due to focus on the presence of a carbon-concentrating mechanism despite the evolutionary persistence of a Form II Rubisco. The photorespiratory fixation of oxygen produces phosphoglycolate that would otherwise inhibit carbon fixation though the Calvin cycle if it were not converted to glycolate by phosphoglycolate phosphatase (PGPase). Glycolate is then either excreted or dealt with by enzymes in the photorespiratory glycolate and/or glycerate pathways adding to the pool of carbon fixed in photosynthesis. We found that CO2 enrichment led to enhanced photoacclimation (increased chlorophyll a per cell) to the subsaturating light levels. Light-enhanced dark respiration per cell and xanthophyll de-epoxidation increased, with resultant decreases in photosynthetic capacity (Pnmax) per chlorophyll. The conservative CO2 emission scenario (A1B; 600-790 ppm) led to a 38% increase in the Pnmax per cell whereas the 'business-as-usual' scenario (A1F1; 1160-1500 ppm) led to a 45% reduction in PGPase expression and no change in Pnmax per cell. These findings support an important functional role for PGPase in dinoflagellates that is potentially compromised under CO2 enrichment.

Analysis of the geometric altimetry to support aircraft optimal profiles within future 4D trajectory management

The use of barometric altimetry is to some extent a limiting factor on safety, predictability and efficiency of aircraft operations, and reduces the potential of the trajectory based operations capabilities. However, geometric altimetry could be used to improve all of these aspects. Nowadays aircraft altitude is estimated by applying the International Standard Atmosphere which differs from real altitude. At different temperatures for an assigned barometric altitude, aerodynamic forces are different and this has a direct relationship with time, fuel consumption and range of the flight. The study explores the feasibility of using sensors providing geometric reference altitude, in particular, to supply capabilities for the optimization of vertical profiles and also, their impact on the vertical Air Traffic Management separation assurance processes. One of the aims of the thesis is to assess if geometric altitude fulfils the aeronautical requirements through existing sensors. Also the thesis will elaborate on the advantages of geometric altitude over the barometric altitude in terms of efficiency for vertical navigation. The evidence that geometric altitude is the best choice to improve the efficiency in vertical profile and aircraft capacity by reducing vertical uncertainties will also be shown. In this paper, an atmospheric study is presented, as well as the impact of temperature deviation from International Standard Atmosphere model is analyzed in order to obtain relationship between geometric and barometric altitude. Furthermore, an aircraft model to study aircraft vertical profile is provided to analyse trajectories based on geometric altitudes.

Comportamiento estructural de elementos de fábrica reforzados con materiales compuestos avanzados solicitados a flexión y flexocompresión

El refuerzo de estructuras existentes mediante el encolado exterior de láminas de polímeros reforzados con fibras (FRP) se ha convertido en la aplicación más común de los materiales compuestos avanzados en construcción. Estos materiales presentan muchas ventajas frente a los materiales convencionales (sin corrosión, ligeros, de fácil aplicación, etc.). Pero a pesar de las numerosas investigaciones realizadas, aún persisten ciertas dudas sobre algunos aspectos de su comportamiento y las aplicaciones prácticas se llevan a cabo sólo con la ayuda de guías, sin que haya una normativa oficial. El objetivo de este trabajo es incrementar el conocimiento sobre esta técnica de refuerzo, y más concretamente, sobre el refuerzo a flexión de estructuras de fábrica. Con frecuencia el elemento reforzado es de hormigón armado y las láminas de FRP encoladas al exterior sirven para mejorar su resistencia a flexión, cortante o compresión (encamisados). Sin embargo su empleo en otros materiales como las estructuras de fábrica resulta muy prometedor. Las fábricas se caracterizan por soportar muy bien los esfuerzos de compresión pero bastante mal los de tracción. Adherir láminas de materiales compuestos puede servir para mejorar la capacidad resistente de elementos de fábrica sometidos a esfuerzos de flexión. Pero para ello, debe quedar garantizada una correcta adherencia entre el FRP y la fábrica, especialmente en edificios antiguos cuya superficie puede estar deteriorada por encontrarse a la intemperie o por el propio paso del tiempo. En el capítulo II se describen los objetivos fundamentales del trabajo y el método seguido. En el capítulo III se hace una amplia revisión del estado de conocimiento sobre el tema. En el apartado III.1 se detallan las principales características y propiedades mecánicas de fibras, matrices y materiales compuestos así como sus principales aplicaciones, haciendo especial hincapié en aspectos relativos a su durabilidad. En el apartado III.2 se incluye una revisión histórica de las líneas de investigación, tanto teóricas como empíricas, publicadas sobre estructuras de hormigón reforzadas a flexión encolando materiales compuestos. El apartado III.3 se centra en el aspecto fundamental de la adherencia refuerzo-soporte. Se hace un repaso a distintos modelos propuestos para prevenir el despegue distinguiendo si éste se inicia en la zona de anclaje o si está inducido por fisuras en la zona interior del elemento. Se observa falta de consenso en las propuestas. Además en este punto se relatan las campañas experimentales publicadas acerca de la adherencia entre materiales compuestos y fábricas. En el apartado III.4 se analizan las particularidades de las estructuras de fábrica. Además, se revisan algunas de las investigaciones relativas a la mejora de su comportamiento a flexión mediante láminas de FRP. El comportamiento mecánico de muros reforzados solicitados a flexión pura (sin compresión) ha sido documentado por varios autores, si bien es una situación poco frecuente en fábricas reales. Ni el comportamiento mecánico de muros reforzados solicitados a flexocompresión ni la incidencia que el nivel de compresión soportado por la fábrica tiene sobre la capacidad resistente del elemento reforzado han sido suficientemente tratados. En cuanto a los trabajos teóricos, las diferentes propuestas se basan en los métodos utilizados para hormigón armado y comparten los principios habituales de cálculo. Sin embargo, presentan diferencias relativas, sobre todo, a tres aspectos: 1) la forma de modelar el comportamiento de la fábrica, 2) el valor de deformación de cálculo del refuerzo, y 3) el modo de fallo que se considera recomendable buscar con el diseño. A pesar de ello, el ajuste con la parte experimental de cada trabajo suele ser bueno debido a una enorme disparidad en las variables consideradas. Cada campaña presenta un modo de fallo característico y la formulación que se propone resulta apropiada para él. Parece necesario desarrollar un método de cálculo para fábricas flexocomprimidas reforzadas con FRP que pueda ser utilizado para todos los posibles fallos, tanto atribuibles a la lámina como a la fábrica. En el apartado III.4 se repasan algunas lesiones habituales en fábricas solicitadas a flexión y se recogen ejemplos de refuerzos con FRP para reparar o prevenir estos daños. Para mejorar el conocimiento sobre el tema, se llevan a cabo dos pequeñas campañas experimentales realizadas en el Instituto de Ciencias de la Construcción Eduardo Torroja. La primera acerca de la adherencia de materiales compuestos encolados a fábricas deterioradas (apartado IV.1) y la segunda sobre el comportamiento estructural a flexocompresión de probetas de fábrica reforzadas con estos materiales (apartado IV.2). En el capítulo V se analizan algunos de los modelos de adherencia propuestos para prevenir el despegue del extremo del refuerzo. Se confirma que las predicciones obtenidas con ellos resultan muy dispares. Se recopila una base de datos con los resultados experimentales de campañas sobre adherencia de FRP a fábricas extraídas de la literatura y de los resultados propios de la campaña descrita en el punto IV.1. Esta base de datos permite conocer cual de los métodos analizados resulta más adecuado para dimensionar el anclaje de láminas de FRP adheridas a fábricas. En el capítulo VI se propone un método para la comprobación en agotamiento de secciones de fábrica reforzadas con materiales compuestos sometidas a esfuerzos combinados de flexión y compresión. Está basado en el procedimiento de cálculo de la capacidad resistente de secciones de hormigón armado pero adaptado a las fábricas reforzadas. Para ello, se utiliza un diagrama de cálculo tensión deformación de la fábrica de tipo bilineal (acorde con el CTE DB SE-F) cuya simplicidad facilita el desarrollo de toda la formulación al tiempo que resulta adecuado para predecir la capacidad resistente a flexión tanto para fallos debidos al refuerzo como a la fábrica. Además se limita la deformación de cálculo del refuerzo teniendo en consideración ciertos aspectos que provocan que la lámina adherida no pueda desarrollar toda su resistencia, como el desprendimiento inducido por fisuras en el interior del elemento o el deterioro medioambiental. En concreto, se propone un “coeficiente reductor por adherencia” que se determina a partir de una base de datos con 68 resultados experimentales procedentes de publicaciones de varios autores y de los ensayos propios de la campaña descrita en el punto IV.2. También se revisa la formulación propuesta con ayuda de la base de datos. En el capítulo VII se estudia la incidencia de las principales variables, como el axil, la deformación de cálculo del refuerzo o su rigidez, en la capacidad final del elemento. Las conclusiones del trabajo realizado y las posibles líneas futuras de investigación se exponen en el capítulo VIII. ABSTRACT Strengthening of existing structures with externally bonded fiber reinforced polymers (FRP) has become the most common application of advanced composite materials in construction. These materials exhibit many advantages in comparison with traditional ones (corrosion resistance, light weight, easy to apply, etc.). But despite countless researches have been done, there are still doubts about some aspects of their behaviour and applications are carried out only with the help of guidelines, without official regulations. The aim of this work is to improve the knowledge on this retrofitting technique, particularly in regard to flexural strengthening of masonry structures. Reinforced concrete is often the strengthened material and external glued FRP plates are used to improve its flexural, shear or compressive (by wrapping) capacity. However the use of this technique on other materials like masonry structures looks promising. Unreinforced masonry is characterized for being a good material to support compressive stresses but really bad to withstand tensile ones. Glue composite plates can improve the flexural capacity of masonry elements subject to bending. But a proper bond between FRP sheet and masonry must be ensured to do that, especially in old buildings whose surface can be damaged due to being outside or ageing. The main objectives of the work and the methodology carried out are described In Chapter II. An extensive overview of the state of art is done in Chapter III. In Section III.1 physical and mechanical properties of fibers, matrix and composites and their main applications are related. Durability aspects are especially emphasized. Section III.2 includes an historical overview of theoretical and empirical researches on concrete structures strengthened gluing FRP plates to improve their flexural behaviour. Section III.3 focuses on the critical point of bonding between FRP and substrate. Some theoretical models to prevent debonding of FRP laminate are reviewed, it has made a distinction between models for detachment at the end of the plate or debonding in the intermediate zones due to the effects of cracks. It is observed a lack of agreement in the proposals. Some experimental studies on bonding between masonry and FRP are also related in this chapter. The particular characteristics of masonry structures are analyzed in Section III.4. Besides some empirical and theoretical investigations relative to improve their flexural capacity with FRP sheets are reviewed. The mechanical behaviour of strengthened walls subject to pure bending (without compression) has been established by several authors, but this is an unusual situation for real masonry. Neither mechanical behaviour of walls subject to bending and compression nor influence of axial load in the final capacity of the strengthened element are adequately studied. In regard to theoretical studies, the different proposals are based on reinforced concrete analytical methods and share common design principles. However, they present differences, especially, about three aspects: 1) the constitutive law of masonry, 2) the value of ultimate FRP strain and 3) the desirable failure mode that must be looked for. In spite of them, a good agreement between each experimental program and its theoretical study is often exhibited due to enormous disparity in considered test parameters. Each experimental program usually presents a characteristic failure mode and the proposed formulation results appropriate for this one. It seems necessary to develop a method for FRP strengthened walls subject to bending and compression enable for all failure modes (due to FRP or masonry). Some common damages in masonry subject to bending are explained in Section III.4. Examples of FRP strengthening to repair or prevent these damages are also written. Two small experimental programs are carried out in Eduardo Torroja Institute to improve the knowledge on this topic. The first one is concerned about the bond between FRP plates and damaged masonry (section IV.1) and the second one is related to the mechanical behaviour of the strengthened masonry specimens subject to out of plane bending combined with axial force (section IV.2). In the Chapter V some bond models to prevent the debonding at the FRP plate end are checked. It is confirmed that their predictions are so different. A pure-shear test database is compiled with results from the existing literature and others from the experimental program described in section IV.1. This database lets know which of the considered model is more suitable to design anchorage lengths of glued FRP to masonry. In the Chapter VI a method to check unreinforced masonry sections with external FRP strengthening subject to bending and compression to the ultimate limit state is proposed. This method is based on concrete reinforced one, but it is adapted to strengthened masonry. A bilinear constitutive law is used for masonry (according to CTE DB SE-F). Its simplicity helps to develop the model formulation and it has proven to be suitable to predict bending capacity either for FRP failures or masonry crushing. With regard to FRP, the design strain is limited. It is taken into account different aspects which cause the plate can’t reach its ultimate strength, like intermediate FRP debonding induced by opening cracking or environmental damage. A “bond factor” is proposed. It is obtained by means of an experimental bending test database that includes 68 results from the existing literature and from the experimental program described in section IV.2. The proposed formulation has also been checked with the help of bending database. The effects of the main parameters, like axial load, FRP design effective strain or FRP stiffness, on the bending capacity of the strengthened element are studied in Chapter VII. Finally, the main conclusions from the work carried out are summarized in Chapter VIII. Future lines of research to be explored are suggested as well.

Evaluating a web-based clinical decision support system for language disorders screening in a nursery school

Background: Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective: This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. Methods: This paper details the evaluation results of the ?Gades? CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child?s language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. Results: The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development. Conclusions: This research demonstrated the benefit of a Web-based CDSS to monitor children?s neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.

Analytical bearing capacity of strip footing in weightless materials with power-law failure criteria

Sokolovskii’s method of characteristics is extended to provide analytical solutions for the ultimate load at the moment of plastic failure under plane-strain conditions of shallow strip foundations on weightless rigid-plastic media with a noncohesive power-law failure envelope. The formulation is made parametrically in terms of the instantaneous friction angle, and the key idea to obtain the bearing capacity is that information can be transmitted from the free surface (where external loads are known) to the contact plane of the foundation. The methodology can consider foundations adjacent to a slope, external surcharges at the free surface, and inclined loads (both on the slope and on the foundation). Sensitivity analyses illustrate the influence on bearing capacity of changes in the different geometrical parameters involved. An application example is presented and design plots are provided, and model predictions are compared with results of bearing capacity tests under low gravity.

Enhancing Guideline-based decision support with distributed computation through local mobile application

We introduce the need for a distributed guideline-based decision sup-port (DSS) process, describe its characteristics, and explain how we implement-ed this process within the European Union?s MobiGuide project. In particular, we have developed a mechanism of sequential, piecemeal projection, i.e., 'downloading' small portions of the guideline from the central DSS server, to the local DSS in the patient's mobile device, which then applies that portion, us-ing the mobile device's local resources. The mobile device sends a callback to the central DSS when it encounters a triggering pattern predefined in the pro-jected module, which leads to an appropriate predefined action by the central DSS, including sending a new projected module, or directly controlling the rest of the workflow. We suggest that such a distributed architecture that explicitly defines a dialog between a central DSS server and a local DSS module, better balances the computational load and exploits the relative advantages of the cen-tral server and of the local mobile device.

Service capacity reserve under uncertainty by hospital's ER's analogies: a practical model for car services

El objetivo de esta investigación consiste en definir un modelo de reserva de capacidad, por analogías con emergencias hospitalarias, que pueda ser implementado en el sector de servicios. Este está específicamente enfocado a su aplicación en talleres de servicio de automóviles. Nuestra investigación incorpora la incertidumbre de la demanda en un modelo singular diseñado en etapas que agrupa técnicas ARIMA, teoría de colas y simulación Monte Carlo para definir los conceptos de capacidad y ocupación de servicio, que serán utilizados para minimizar el coste implícito de la reserva capacidad necesaria para atender a clientes que carecen de cita previa. Habitualmente, las compañías automovilísticas estiman la capacidad de sus instalaciones de servicio empíricamente, pero los clientes pueden llegar bajo condiciones de incertidumbre que no se tienen en cuenta en dichas estimaciones, por lo que existe una diferencia entre lo que el cliente realmente demanda y la capacidad que ofrece el servicio. Nuestro enfoque define una metodología válida para el sector automovilístico que cubre la ausencia genérica de investigaciones recientes y la habitual falta de aplicación de técnicas estadísticas en el sector. La equivalencia con la gestión de urgencias hospitalarias se ha validado a lo largo de la investigación en la se definen nuevos indicadores de proceso (KPIs) Tal y como hacen los hospitales, aplicamos modelos estocásticos para dimensionar las instalaciones de servicio de acuerdo con la distribución demográfica del área de influencia. El modelo final propuesto integra la predicción del coste implícito en la reserva de capacidad para atender la demanda no prevista. Asimismo, se ha desarrollado un código en Matlab que puede integrarse como un módulo adicional a los sistemas de información (DMS) que se usan actualmente en el sector, con el fin de emplear los nuevos indicadores de proceso definidos en el modelo. Los resultados principales del modelo son nuevos indicadores de servicio, tales como la capacidad, ocupación y coste de reserva de capacidad, que nunca antes han sido objeto de estudio en la industria automovilística, y que están orientados a gestionar la operativa del servicio. ABSTRACT Our aim is to define a Capacity Reserve model to be implemented in the service sector by hospital's emergency room (ER) analogies, with a practical approach to passenger car services. A stochastic model has been implemented using R and a Monte Carlo simulation code written in Matlab and has proved a very useful tool for optimal decision making under uncertainty. The research integrates demand uncertainty in a unique model which is built in stages by implementing ARIMA forecasting, Queuing Theory and a Monte Carlo simulation to define the concepts of service capacity and occupancy, minimizing the implicit cost of the capacity that must be reserved to service unexpected customers. Usually, passenger car companies estimate their service facilities capacity using empirical methods, but customers arrive under uncertain conditions not included in the estimations. Thus, there is a gap between customer’s real demand and the dealer’s capacity. This research sets a valid methodology for the passenger car industry to cover the generic absence of recent researches and the generic lack of statistical techniques implementation. The hospital’s emergency room (ER) equalization has been confirmed to be valid for the passenger car industry and new process indicators have been defined to support the study. As hospitals do, we aim to apply stochastic models to dimension installations according to the demographic distribution of the area to be serviced. The proposed model integrates the prediction of the cost implicit in the reserve capacity to serve unexpected demand. The Matlab code could be implemented as part of the existing information technology systems (ITs) to support the existing service management tools, creating a set of new process indicators. Main model outputs are new indicators, such us Capacity, Occupancy and Cost of Capacity Reserve, never studied in the passenger car service industry before, and intended to manage the service operation.

El modelo constructivo: la influencia de la técnica en la teoría de la arquitectura (1840-1899)

La hipótesis de partida de esta tesis es que existe una influencia directa entre la técnica que se desarrolla durante el segundo período del s. XIX y el cambio sustancial de los conceptos y de la teoría arquitectónica que se da en esos mismos años. Dicha influencia genera nuevos modelos constructivos que serán la base de la arquitectura moderna. Para llegar a la confirmación de la hipótesis, se han planteado tres objetivos principales que responden a los tres capítulos principales de la misma. En primera instancia, se establecen las condiciones teóricas del debate arquitectónico entre las fechas estudiadas. Se analiza el concepto de modelo y «estilo» para evaluar si, efectivamente, hubo cambio o no. También se analizará si los arquitectos eran conscientes de la necesidad de una nueva arquitectura que respondiese a la funcionalidad que el progreso requería. Para comprobar que dicho cambio se ha producido a todos los niveles hasta el punto de redefinir el modelo constructivo se escoge un ejemplo práctico que cumpla las condiciones necesarias para sustentar o no la tesis y se investiga sobre si sucede o no el cambio. A continuación, se analizará la situación de la técnica y de los avances tecnológicos en el período estudiado. Es importante contrastar que realmente hay un conocimiento y una conciencia verdadera de cambio entre los teóricos y los arquitectos que están construyendo en ese momento. Confirmar que dicha conexión existe es vital para la investigación; para eso, se analizará y se profundizará en las conexiones entre la arquitectura y la ingeniería (o los avances tecnológicos) para entender la implicación de uno con el otro. Con este fin, se han estudiado las distintas publicaciones periódicas de la época; sobre todo la más relevante y la que primero se editó, que fue La revue générale de l’architecture; me he apoyado en ella. Es un documento que mensualmente recoge cambios, avances y debates. Tuvo una grandísima divulgación; todo docente, arquitecto e ingeniero de la época tenía un acceso fácil y directo a dicha publicación. Por último, a raíz de una construcción ideal proyectada por uno de los grandes arquitectos teóricos de la época, se reflexiona sobre si esa arquitectura supone realmente una comprensión y una conciencia de los nuevos modelos arquitectónicos, definidos por una técnica en progreso, o si responde exclusivamente a una utopía arquitectónica como tantas otras se habían esbozado con anterioridad por grandes teóricos. Para poder definir la geometría de este elemento estructural, se ha realizado un modelado tridimensional que permite calcular la estructura a través de un proceso de elementos finitos. El propósito de este cálculo no es exclusivamente saber si la estructura era viable o no en aquella época, sino también comprender si la definición de estos originales elementos estructurales implicaba una concepción nueva de las estructuras tridimensionales y eso significa que empezaba a germinar un cambio sustancial en la teoría de la arquitectura, con la búsqueda de un nuevo modelo constructivo derivado de los avances técnicos. De este modo queda demostrado que el modelo constructivo ha cambiado definitivamente por un modelo mucho más versátil y sobre todo con una gran capacidad de adaptación, esto combinado a su vez con una proliferación de patentes que intentan y buscan una estandarización del modelo constructivo y que no son, en ningún caso, un modelo en sí. Como última conclusión, queda argumentado que en aquella época ya se tenía una gran intuición estructural; a pesar de que el cálculo matemático era todavía algo relativamente nuevo, se manejaban de forma instintiva líneas de cargas, combinación de materiales y nuevas formas, que ayudarán a crear los modelos de los próximos años y que serán la base del cálculo numérico posterior. ABSTRACT The hypothesis of this thesis is that there is a direct influence between the technique developed during the second period of the XIX century and the substantial change in the concepts and in the architectural theory that occurs in those years. This influence develops new building models that will be the basis of modern architecture. To confirm this hypothesis, we present three principal objectives that corresponds to the three principals chapsters of the text. First, we establish the theoretical conditions of the architectural debate between the dates studied. We analyze the concepts of model and “style” to assess whether there was a change or not. We consider as well if architects were aware of the need for a new architecture to respond to the functionality needs that progress demanded. To verify that the change occurred at all levels to the extent of redefining the building model we choose a practical example that fulfills the necessary conditions to support or not the thesis and we investigate whether or not the change happens. Next, we analyze the status of technical and technological advances in the study period of study. It is important to contrast that there is a real knowledge and awareness of change between the theorists and architects who are building at the time. Confirming that that connection exists is vital for the research; for that, we will analyze and deepen into the connections between architecture and engineering (or technological progress) to understand the implication of one into the other. To this end, we have studied various publications of the time; especially the most relevant and the first published, La Revue générale de l’architecture; I have relied on it. This is a monthly document that includes changes, developments and debates. It had a very great disclosure; every teacher, architect and engineer of the time had a direct and easy access to this publication. Finally, following theoretical ideal construction projected by one of the great architects of the time, we reflect on whether that architecture really represents an understanding and awareness of the new architectural models defined by a technique in progress, or if it only responds to an architectural utopia as the ones outlined earlier by the great theorists. To be able to define the geometry of this structural item, we have carried out a three-dimensional modeling that enables us to calculate the structure through a process of finite elements. The purpose of this calculation is not exclusively understanding whether the structure was viable or not at the time, but also understanding if the definition of these original structural elements involved a new concept of three-dimensional structures and if that involved the beginning of a substantial change in theory of architecture, with the search for a new construction model derived from technical advances. In this way it is demonstrated that the building model has definitely changed for a much more versatile one and above all with a high adaptation capacity, this combined in turn with a proliferation of patents that try and seek a standardization of the building model and are not, in any case, a model in itself. As a final conclusion, it is argued that at the time a major structural intuition was present; even though the math calculation was still relatively new, in an instinctively way load lines, combination of materials and new forms were taken into account, that will help to create models in the coming years and which will form the basis of subsequent numerical calculation.