Clinical prediction of occupational and non-specific low back pain

Non-specific Occupational Low Back Pain (NOLBP) is a health condition that generates a high absenteeism and disability. Due to multifactorial causes is difficult to determine accurate diagnosis and prognosis. The clinical prediction of NOLBP is identified as a series of models that integrate a multivariate analysis to determine early diagnosis, course, and occupational impact of this health condition. Objective: to identify predictor factors of NOLBP, and the type of material referred to in the scientific evidence and establish the scopes of the prediction. Materials and method: the title search was conducted in the databases PubMed, Science Direct, and Ebsco Springer, between1985 and 2012. The selected articles were classified through a bibliometric analysis allowing to define the most relevant ones. Results: 101 titles met the established criteria, but only 43 metthe purpose of the review. As for NOLBP prediction, the studies varied in relation to the factors for example: diagnosis, transition of lumbar pain from acute to chronic, absenteeism from work, disability and return to work. Conclusion: clinical prediction is considered as a strategic to determine course and prognostic of NOLBP, and to determine the characteristics that increase the risk of chronicity in workers with this health condition. Likewise, clinical prediction rules are tools that aim to facilitate decision making about the evaluation, diagnosis, prognosis and intervention for low back pain, which should incorporate risk factors of physical, psychological and social.

Análisis del gen adra2a receptor alfa 2a adrenergico en pacientes con trastorno de hiperactividad y déficit de atención

El trastorno de hiperactividad y déficit de atención (THDA), es definido clínicamente como una alteración en el comportamiento, caracterizada por inatención, hiperactividad e impulsividad. Estos aspectos son clasificados en tres subtipos, que son: Inatento, hiperactivo impulsivo y mixto. Clínicamente se describe un espectro amplio que incluye desordenes académicos, trastornos de aprendizaje, déficit cognitivo, trastornos de conducta, personalidad antisocial, pobres relaciones interpersonales y aumento de la ansiedad, que pueden continuar hasta la adultez. A nivel global se ha estimado una prevalencia entre el 1% y el 22%, con amplias variaciones, dadas por la edad, procedencia y características sociales. En Colombia, se han realizado estudios en Bogotá y Antioquia, que han permitido establecer una prevalencia del 5% y 15%, respectivamente. La causa específica no ha sido totalmente esclarecida, sin embargo se ha calculado una heredabilidad cercana al 80% en algunas poblaciones, demostrando el papel fundamental de la genética en la etiología de la enfermedad. Los factores genéticos involucrados se relacionan con cambios neuroquímicos de los sistemas dopaminérgicos, serotoninérgicos y noradrenérgicos, particularmente en los sistemas frontales subcorticales, corteza cerebral prefrontal, en las regiones ventral, medial, dorsolateral y la porción anterior del cíngulo. Basados en los datos de estudios previos que sugieren una herencia poligénica multifactorial, se han realizado esfuerzos continuos en la búsqueda de genes candidatos, a través de diferentes estrategias. Particularmente los receptores Alfa 2 adrenérgicos, se encuentran en la corteza cerebral, cumpliendo funciones de asociación, memoria y es el sitio de acción de fármacos utilizados comúnmente en el tratamiento de este trastorno, siendo esta la principal evidencia de la asociación de este receptor con el desarrollo del THDA. Hasta la fecha se han descrito más de 80 polimorfismos en el gen (ADRA2A), algunos de los cuales se han asociado con la entidad. Sin embargo, los resultados son controversiales y varían según la metodología diagnóstica empleada y la población estudiada, antecedentes y comorbilidades. Este trabajo pretende establecer si las variaciones en la secuencia codificante del gen ADRA2A, podrían relacionarse con el fenotipo del Trastorno de Hiperactividad y el Déficit de Atención.

Apoyo social e ideación suicida en pacientes con cáncer

El diagnóstico de cáncer ha sido asociado con un alto riesgo de presentar ideación suicida en comparación con la población no oncológica, sin embargo se ha considerado al apoyo social como un factor protector para la ocurrencia de esta conducta. La presente investigación tuvo como objetivo identificar la relación entre el apoyo social percibido y la ideación suicida en 90 pacientes oncológicos adultos en Bogotá, bajo la hipótesis de que a mayor apoyo social percibido, menor presencia de ideación suicida. Se midió la variable de apoyo social a través del cuestionario Duke UNC y la ideación suicida a través de cuatro instrumentos: Escala de Ideación Suicida (SSI), Escala de Desesperanza de Beck (BHS), el ítem 9 del Inventario de Depresión de Beck (BDI-IA) y una entrevista semiestructurada. Los resultados mostraron que no existe relación entre el apoyo social percibido y la ideación suicida. Por otro lado se identificó una prevalencia de suicidio entre 5,6% y 22,77%, confirmando que el paciente con cáncer considera el suicidio y es fundamental evaluar esta variable en esta población. Se considera importante continuar con la realización de investigaciones que permitan generalizar los resultados a la población oncológica colombiana.

Prediction of postprandial blood glucose under intra-patient variability and uncertainty and its use in the design of insulin dosing strategies for type 1 diabetic patients

In this thesis I propose a novel method to estimate the dose and injection-to-meal time for low-risk intensive insulin therapy. This dosage-aid system uses an optimization algorithm to determine the insulin dose and injection-to-meal time that minimizes the risk of postprandial hyper- and hypoglycaemia in type 1 diabetic patients. To this end, the algorithm applies a methodology that quantifies the risk of experiencing different grades of hypo- or hyperglycaemia in the postprandial state induced by insulin therapy according to an individual patient’s parameters. This methodology is based on modal interval analysis (MIA). Applying MIA, the postprandial glucose level is predicted with consideration of intra-patient variability and other sources of uncertainty. A worst-case approach is then used to calculate the risk index. In this way, a safer prediction of possible hyper- and hypoglycaemic episodes induced by the insulin therapy tested can be calculated in terms of these uncertainties.

Visual efficiency detection index : a new composite measure of visual search

Visual search is an important component of our interaction with our surroundings, allowing us to successfully identify external cues that impact our spatial navigation. Previous research has established fixation duration, fixation count, saccade velocity, and saccade amplitude as important indices of visual search. We examined the Visual Efficiency Detection Index (VEDI) comprising multiple aspects of visual search performance into a single measure of global visual performance. Forty participants, 10 adults ages 22-48, and children ages 6, 8, and 10, completed tests of working memory and visual search in response to stimuli relevant to pedestrian decision making. Results indicated VEDI statistically relates to established indices of visual search in relation to their interpretability for human performance. The VEDI was also sensitive to developmental differences in visual search performance, suggesting insight to its utility in the developmental psychological literature.

The effect of doubled CO2 and model basic state biases on the monsoon-ENSO system. I: Mean response and interannual variability

The impact of doubled CO2 concentration on the Asian summer monsoon is studied using a coupled ocean-atmosphere model. Both the mean seasonal precipitation and interannual monsoon variability are found to increase in the future climate scenario presented. Systematic biases in current climate simulations of the coupled system prevent accurate representation of the monsoon-ENSO teleconnection, of prime importance for seasonal prediction and for determining monsoon interannual variability. By applying seasonally varying heat flux adjustments to the tropical Pacific and Indian Ocean surface in the future climate simulation, some assessment can be made of the impact of systematic model biases on future climate predictions. In simulations where the flux adjustments are implemented, the response to climate change is magnified, with the suggestion that systematic biases may be masking the true impact of increased greenhouse gas forcing. The teleconnection between ENSO and the Asian summer monsoon remains robust in the future climate, although the Indo-Pacific takes on more of a biennial character for long periods of the flux-adjusted simulation. Assessing the teleconnection across interdecadal timescales shows wide variations in its amplitude, despite the absence of external forcing. This suggests that recent changes in the observed record cannot be distinguished from internal variations and as such are not necessarily related to climate change.

Stratospheric circulation in seasonal forecasting models: implications for seasonal prediction

Accurate seasonal forecasts rely on the presence of low frequency, predictable signals in the climate system which have a sufficiently well understood and significant impact on the atmospheric circulation. In the Northern European region, signals associated with seasonal scale variability such as ENSO, North Atlantic SST anomalies and the North Atlantic Oscillation have not yet proven sufficient to enable satisfactorily skilful dynamical seasonal forecasts. The winter-time circulations of the stratosphere and troposphere are highly coupled. It is therefore possible that additional seasonal forecasting skill may be gained by including a realistic stratosphere in models. In this study we assess the ability of five seasonal forecasting models to simulate the Northern Hemisphere extra-tropical winter-time stratospheric circulation. Our results show that all of the models have a polar night jet which is too weak and displaced southward compared to re-analysis data. It is shown that the models underestimate the number, magnitude and duration of periods of anomalous stratospheric circulation. Despite the poor representation of the general circulation of the stratosphere, the results indicate that there may be a detectable tropospheric response following anomalous circulation events in the stratosphere. However, the models fail to exhibit any predictability in their forecasts. These results highlight some of the deficiencies of current seasonal forecasting models with a poorly resolved stratosphere. The combination of these results with other recent studies which show a tropospheric response to stratospheric variability, demonstrates a real prospect for improving the skill of seasonal forecasts.

Overview and response to reviewers of The Singing Neanderthals

Why are humans musical? Why do people in all cultures sing or play instruments? Why do we appear to have specialized neurological apparatus for hearing and interpreting music as distinct from other sounds? And how does our musicality relate to language and to our evolutionary history? Anthropologists and archaeologists have paid little attention to the origin of music and musicality — far less than for either language or ‘art’. While art has been seen as an index of cognitive complexity and language as an essential tool of communication, music has suffered from our perception that it is an epiphenomenal ‘leisure activity’, and archaeologically inaccessible to boot. Nothing could be further from the truth, according to Steven Mithen; music is integral to human social life, he argues, and we can investigate its ancestry with the same rich range of analyses — neurological, physiological, ethnographic, linguistic, ethological and even archaeological — which have been deployed to study language. In The Singing Neanderthals Steven Mithen poses these questions and proposes a bold hypothesis to answer them. Mithen argues that musicality is a fundamental part of being human, that this capacity is of great antiquity, and that a holistic protolanguage of musical emotive expression predates language and was an essential precursor to it. This is an argument with implications which extend far beyond the mere origins of music itself into the very motives of human origins. Any argument of such range is bound to attract discussion and critique; we here present commentaries by archaeologists Clive Gamble and Iain Morley and linguists Alison Wray and Maggie Tallerman, along with Mithen's response to them. Whether right or wrong, Mithen has raised fascinating and important issues. And it adds a great deal of charm to the time-honoured, perhaps shopworn image of the Neanderthals shambling ineffectively through the pages of Pleistocene prehistory to imagine them humming, crooning or belting out a cappella harmonies as they went.

A GIS-based empirical model for vegetation prediction in Lefka Ori, Crete

The aim of the study was to establish and verify a predictive vegetation model for plant community distribution in the alti-Mediterranean zone of the Lefka Ori massif, western Crete. Based on previous work three variables were identified as significant determinants of plant community distribution, namely altitude, slope angle and geomorphic landform. The response of four community types against these variables was tested using classification trees analysis in order to model community type occurrence. V-fold cross-validation plots were used to determine the length of the best fitting tree. The final 9node tree selected, classified correctly 92.5% of the samples. The results were used to provide decision rules for the construction of a spatial model for each community type. The model was implemented within a Geographical Information System (GIS) to predict the distribution of each community type in the study site. The evaluation of the model in the field using an error matrix gave an overall accuracy of 71%. The user's accuracy was higher for the Crepis-Cirsium (100%) and Telephium-Herniaria community type (66.7%) and relatively lower for the Peucedanum-Alyssum and Dianthus-Lomelosia community types (63.2% and 62.5%, respectively). Misclassification and field validation points to the need for improved geomorphological mapping and suggests the presence of transitional communities between existing community types.

The role of eddies in driving the tropospheric response to stratospheric heating perturbations

A simplified general circulation model has been used to investigate the chain of causality whereby changes in tropospheric circulation and temperature are produced in response to stratospheric heating perturbations. Spinup ensemble experiments have been performed to examine the evolution of the tropospheric circulation in response to such perturbations. The primary aim of these experiments is to investigate the possible mechanisms whereby a tropospheric response to changing solar activity over the 11-yr solar cycle could be produced in response to heating of the equatorial lower stratosphere. This study therefore focuses on a stratospheric heating perturbation in which the heating is largest in the tropics. For comparison, experiments are also performed in which the stratosphere is heated uniformly at all latitudes and in which it is heated preferentially in the polar region. Thus, the mechanisms discussed have a wider relevance for the impact of stratospheric perturbations on the troposphere. The results demonstrate the importance of changing eddy momentum fluxes in driving the tropospheric response. This is confirmed by the lack of a similar response in a zonally symmetric model with fixed eddy forcing. Furthermore, it is apparent that feedback between the tropospheric eddy fluxes and tropospheric circulation changes is required to produce the full model response. The quasigeostrophic index of refraction is used to diagnose the cause of the changes in eddy behavior. It is demonstrated that the latitudinal extent of stratospheric heating is important in determining the direction of displacement of the tropospheric jet and storm track.

The global response to tropical heating in the Madden-Julian oscillation during the northern winter

A life cycle of the Madden–Julian oscillation (MJO) was constructed, based on 21 years of outgoing long-wave radiation data. Regression maps of NCEP–NCAR reanalysis data for the northern winter show statistically significant upper-tropospheric equatorial wave patterns linked to the tropical convection anomalies, and extratropical wave patterns over the North Pacific, North America, the Atlantic, the Southern Ocean and South America. To assess the cause of the circulation anomalies, a global primitive-equation model was initialized with the observed three-dimensional (3D) winter climatological mean flow and forced with a time-dependent heat source derived from the observed MJO anomalies. A model MJO cycle was constructed from the global response to the heating, and both the tropical and extratropical circulation anomalies generally matched the observations well. The equatorial wave patterns are established in a few days, while it takes approximately two weeks for the extratropical patterns to appear. The model response is robust and insensitive to realistic changes in damping and basic state. The model tropical anomalies are consistent with a forced equatorial Rossby–Kelvin wave response to the tropical MJO heating, although it is shifted westward by approximately 20° longitude relative to observations. This may be due to a lack of damping processes (cumulus friction) in the regions of convective heating. Once this shift is accounted for, the extratropical response is consistent with theories of Rossby wave forcing and dispersion on the climatological flow, and the pattern correlation between the observed and modelled extratropical flow is up to 0.85. The observed tropical and extratropical wave patterns account for a significant fraction of the intraseasonal circulation variance, and this reproducibility as a response to tropical MJO convection has implications for global medium-range weather prediction. Copyright © 2004 Royal Meteorological Society

How well does the ECMWF Ensemble Prediction System predict blocking?

Forecasting atmospheric blocking is one of the main problems facing medium-range weather forecasters in the extratropics. The European Centre for Medium-Range Weather Forecasts (ECMWF) Ensemble Prediction System (EPS) provides an excellent basis for medium-range forecasting as it provides a number of different possible realizations of the meteorological future. This ensemble of forecasts attempts to account for uncertainties in both the initial conditions and the model formulation. Since 18 July 2000, routine output from the EPS has included the field of potential temperature on the potential vorticity (PV) D 2 PV units (PVU) surface, the dynamical tropopause. This has enabled the objective identification of blocking using an index based on the reversal of the meridional potential-temperature gradient. A year of EPS probability forecasts of Euro-Atlantic and Pacific blocking have been produced and are assessed in this paper, concentrating on the Euro-Atlantic sector. Standard verification techniques such as Brier scores, Relative Operating Characteristic (ROC) curves and reliability diagrams are used. It is shown that Euro-Atlantic sector-blocking forecasts are skilful relative to climatology out to 10 days, and are more skilful than the deterministic control forecast at all lead times. The EPS is also more skilful than a probabilistic version of this deterministic forecast, though the difference is smaller. In addition, it is shown that the onset of a sector-blocking episode is less well predicted than its decay. As the lead time increases, the probability forecasts tend towards a model climatology with slightly less blocking than is seen in the real atmosphere. This small under-forecasting bias in the blocking forecasts is possibly related to a westerly bias in the ECMWF model. Copyright © 2003 Royal Meteorological Society

North Atlantic Oscillation response to transient greenhouse gas forcing and the impact on European winter climate: a CMIP2 multi-model assessment

This study investigates the response of wintertime North Atlantic Oscillation (NAO) to increasing concentrations of atmospheric carbon dioxide (CO2) as simulated by 18 global coupled general circulation models that participated in phase 2 of the Coupled Model Intercomparison Project (CMIP2). NAO has been assessed in control and transient 80-year simulations produced by each model under constant forcing, and 1% per year increasing concentrations of CO2, respectively. Although generally able to simulate the main features of NAO, the majority of models overestimate the observed mean wintertime NAO index of 8 hPa by 5-10 hPa. Furthermore, none of the models, in either the control or perturbed simulations, are able to reproduce decadal trends as strong as that seen in the observed NAO index from 1970-1995. Of the 15 models able to simulate the NAO pressure dipole, 13 predict a positive increase in NAO with increasing CO2 concentrations. The magnitude of the response is generally small and highly model-dependent, which leads to large uncertainty in multi-model estimates such as the median estimate of 0.0061 +/- 0.0036 hPa per %CO2. Although an increase of 0.61 hPa in NAO for a doubling in CO2 represents only a relatively small shift of 0.18 standard deviations in the probability distribution of winter mean NAO, this can cause large relative increases in the probabilities of extreme values of NAO associated with damaging impacts. Despite the large differences in NAO responses, the models robustly predict similar statistically significant changes in winter mean temperature (warmer over most of Europe) and precipitation (an increase over Northern Europe). Although these changes present a pattern similar to that expected due to an increase in the NAO index, linear regression is used to show that the response is much greater than can be attributed to small increases in NAO. NAO trends are not the key contributor to model-predicted climate change in wintertime mean temperature and precipitation over Europe and the Mediterranean region. However, the models' inability to capture the observed decadal variability in NAO might also signify a major deficiency in their ability to simulate the NAO-related responses to climate change.

A regime view of the North Atlantic Oscillation and its response to anthropogenic forcing

The distribution of the daily wintertime North Atlantic Oscillation (NAO) index in the 40-yr ECMWF Re-Analysis (ERA-40) is significantly negatively skewed. Dynamical and statistical analyses both suggest that this skewness reflects the presence of two distinct regimes—referred to as “Greenland blocking” and “subpolar jet.” Changes in both the relative occurrence and in the structure of the regimes are shown to contribute to the long-term NAO trend over the ERA-40 period. This is contrasted with the simulation of the NAO in 100-yr control and doubled CO2 integrations of the third climate configuration of the Met Office Unified Model (HadCM3). The model has clear deficiencies in its simulation of the NAO in the control run, so its predictions of future behavior must be treated with caution. However, the subpolar jet regime does become more dominant under anthropogenic forcing and, while this change is small it is clearly statistically significant and does represent a real change in the nature of NAO variability in the model.

Predicting the profile of nutrients available for absorption: from nutrient requirement to animal response and environmental impact

Current feed evaluation systems for dairy cattle aim to match nutrient requirements with nutrient intake at pre-defined production levels. These systems were not developed to address, and are not suitable to predict, the responses to dietary changes in terms of production level and product composition, excretion of nutrients to the environment, and nutrition related disorders. The change from a requirement to a response system to meet the needs of various stakeholders requires prediction of the profile of absorbed nutrients and its subsequent utilisation for various purposes. This contribution examines the challenges to predicting the profile of nutrients available for absorption in dairy cattle and provides guidelines for further improved prediction with regard to animal production responses and environmental pollution. The profile of nutrients available for absorption comprises volatile fatty acids, long-chain fatty acids, amino acids and glucose. Thus the importance of processes in the reticulo-rumen is obvious. Much research into rumen fermentation is aimed at determination of substrate degradation rates. Quantitative knowledge on rates of passage of nutrients out of the rumen is rather limited compared with that on degradation rates, and thus should be an important theme in future research. Current systems largely ignore microbial metabolic variation, and extant mechanistic models of rumen fermentation give only limited attention to explicit representation of microbial metabolic activity. Recent molecular techniques indicate that knowledge on the presence and activity of various microbial species is far from complete. Such techniques may give a wealth of information, but to include such findings in systems predicting the nutrient profile requires close collaboration between molecular scientists and mathematical modellers on interpreting and evaluating quantitative data. Protozoal metabolism is of particular interest here given the paucity of quantitative data. Empirical models lack the biological basis necessary to evaluate mitigation strategies to reduce excretion of waste, including nitrogen, phosphorus and methane. Such models may have little predictive value when comparing various feeding strategies. Examples include the Intergovernmental Panel on Climate Change (IPCC) Tier II models to quantify methane emissions and current protein evaluation systems to evaluate low protein diets to reduce nitrogen losses to the environment. Nutrient based mechanistic models can address such issues. Since environmental issues generally attract more funding from governmental offices, further development of nutrient based models may well take place within an environmental framework.