Comparación de cuatro escalas de riesgo en pacientes que consultaron por síncope al servicio de urgencias

Introducción: El síncope es un motivo frecuente de consulta en Urgencias, definir el estudio y el destino de estos pacientes es motivo de controversia. Se han diseñado varias escalas para estratificación del riesgo en pacientes con esta entidad. En este estudio se comparan las características operativas de 4 escalas para la decisión de hospitalizar pacientes con síncope que consultan a un servicio de urgencias de una institución de III y IV Nivel Métodos. Estudio analítico transversal, en el que se aplicaron las 4 escalas de riesgo a pacientes que consultaron por síncope al servicio de Urgencias durante un período de 6 meses y que fueron hospitalizados en la institución donde se realizó. Se evaluaron los resultados aplicando el programa Epidat 3.1 para sensibilidad y especificidad, índice de Youden. Resultados. Se incluyeron en total 91 pacientes. La sensibilidad de las escalas San Francisco, OESIL, EGSYS y la institucional para el requerimiento de hospitalización fue de 79%, 87%. 63% y 95% respectivamente y la especificidad fue de 52%, 40%, 64% y 14%. EL riesgo de mortalidad no fue adecuadamente detectado por la escala de San Francisco.. Conclusiones. Ninguna de las escalas aplicadas a los pacientes hospitalizados que consultaron por síncope a urgencias superó el juicio clínico para definir la hospitalización. Sin embargo, la escala OESIL y la institucional pueden ayudar a corroborar la decisión clínica de hospitalizar en esta población.

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.

Robustness against large-scale failures in communications networks

This thesis studies robustness against large-scale failures in communications networks. If failures are isolated, they usually go unnoticed by users thanks to recovery mechanisms. However, such mechanisms are not effective against large-scale multiple failures. Large-scale failures may cause huge economic loss. A key requirement towards devising mechanisms to lessen their impact is the ability to evaluate network robustness. This thesis focuses on multilayer networks featuring separated control and data planes. The majority of the existing measures of robustness are unable to capture the true service degradation in such a setting, because they rely on purely topological features. One of the major contributions of this thesis is a new measure of functional robustness. The failure dynamics is modeled from the perspective of epidemic spreading, for which a new epidemic model is proposed. Another contribution is a taxonomy of multiple, large-scale failures, adapted to the needs and usage of the field of networking.

Methodology to obtain the user's Human Values Scale from Smart User Models

En años recientes,la Inteligencia Artificial ha contribuido a resolver problemas encontrados en el desempeño de las tareas de unidades informáticas, tanto si las computadoras están distribuidas para interactuar entre ellas o en cualquier entorno (Inteligencia Artificial Distribuida). Las Tecnologías de la Información permiten la creación de soluciones novedosas para problemas específicos mediante la aplicación de los hallazgos en diversas áreas de investigación. Nuestro trabajo está dirigido a la creación de modelos de usuario mediante un enfoque multidisciplinario en los cuales se emplean los principios de la psicología, inteligencia artificial distribuida, y el aprendizaje automático para crear modelos de usuario en entornos abiertos; uno de estos es la Inteligencia Ambiental basada en Modelos de Usuario con funciones de aprendizaje incremental y distribuido (conocidos como Smart User Model). Basándonos en estos modelos de usuario, dirigimos esta investigación a la adquisición de características del usuario importantes y que determinan la escala de valores dominantes de este en aquellos temas en los cuales está más interesado, desarrollando una metodología para obtener la Escala de Valores Humanos del usuario con respecto a sus características objetivas, subjetivas y emocionales (particularmente en Sistemas de Recomendación).Una de las áreas que ha sido poco investigada es la inclusión de la escala de valores humanos en los sistemas de información. Un Sistema de Recomendación, Modelo de usuario o Sistemas de Información, solo toman en cuenta las preferencias y emociones del usuario [Velásquez, 1996, 1997; Goldspink, 2000; Conte and Paolucci, 2001; Urban and Schmidt, 2001; Dal Forno and Merlone, 2001, 2002; Berkovsky et al., 2007c]. Por lo tanto, el principal enfoque de nuestra investigación está basado en la creación de una metodología que permita la generación de una escala de valores humanos para el usuario desde el modelo de usuario. Presentamos resultados obtenidos de un estudio de casos utilizando las características objetivas, subjetivas y emocionales en las áreas de servicios bancarios y de restaurantes donde la metodología propuesta en esta investigación fue puesta a prueba.En esta tesis, las principales contribuciones son: El desarrollo de una metodología que, dado un modelo de usuario con atributos objetivos, subjetivos y emocionales, se obtenga la Escala de Valores Humanos del usuario. La metodología propuesta está basada en el uso de aplicaciones ya existentes, donde todas las conexiones entre usuarios, agentes y dominios que se caracterizan por estas particularidades y atributos; por lo tanto, no se requiere de un esfuerzo extra por parte del usuario.

Nest Boxes Facilitate Local-Scale Conservation of Common Goldeneye (Bucephala clangula) and Bufflehead (Bucephala albeola) in Alberta, Canada

We tested the general predictions of increased use of nest boxes and positive trends in local populations of Common Goldeneye (Bucephala clangula) and Bufflehead (Bucephala albeola) following the large-scale provision of nest boxes in a study area of central Alberta over a 16-year period. Nest boxes were rapidly occupied, primarily by Common Goldeneye and Bufflehead, but also by European Starling (Sturnus vulgaris). After 5 years of deployment, occupancy of large boxes by Common Goldeneye was 82% to 90% and occupancy of small boxes by Bufflehead was 37% to 58%. Based on a single-stage cluster design, experimental closure of nest boxes resulted in significant reductions in numbers of broods and brood sizes produced by Common Goldeneye and Bufflehead. Occurrence and densities of Common Goldeneye and Bufflehead increased significantly across years following nest box deployment at the local scale, but not at the larger regional scale. Provision of nest boxes may represent a viable strategy for increasing breeding populations of these two waterfowl species on landscapes where large trees and natural cavities are uncommon but wetland density is high.

Patch Scale Nest-Site Selection by Marbled Murrelets (Brachyramphus marmoratus)

The Marbled Murrelet (Brachyramphus marmoratus) is a threatened alcid that nests almost exclusively in old-growth forests along the Pacific coast of North America. Nesting habitat has significant economic importance. Murrelet nests are extremely difficult and costly to find, which adds uncertainty to management and conservation planning. Models based on air photo interpretation of forest cover maps or assessments by low-level helicopter flights are currently used to rank presumed Marbled Murrelet nesting habitat quality in British Columbia. These rankings are assumed to correlate with nest usage and murrelet breeding productivity. Our goal was to find the models that best predict Marbled Murrelet nesting habitat in the ground-accessible portion of the two regions studied. We generated Resource Selection Functions (RSF) using logistic regression models of ground-based forest stand variables gathered at plots around 64 nests, located using radio-telemetry, versus 82 random habitat plots. The RSF scores are proportional to the probability of nests occurring in a forest patch. The best models differed somewhat between the two regions, but include both ground variables at the patch scale (0.2-2.0 ha), such as platform tree density, height and trunk diameter of canopy trees and canopy complexity, and landscape scale variables such as elevation, aspect, and slope. Collecting ground-based habitat selection data would not be cost-effective for widespread use in forestry management; air photo interpretation and low-level aerial surveys are much more efficient methods for ranking habitat suitability on a landscape scale. This study provides one method for ground-truthing the remote methods, an essential step made possible using the numerical RSF scores generated herein.

Short-eared Owl (Asio flammeus) surveys in the North American Intermountain West: utilizing citizen scientists to conduct monitoring across a broad geographic scale

The Short-eared Owl (Asio flammeus) is an open-country species breeding in the northern United States and Canada, and has likely experienced a long-term, range-wide, and substantial decline. However, the cause and magnitude of the decline is not well understood. We set forth to address the first two of six previously proposed conservation priorities to be addressed for this species: (1) better define habitat use and (2) improve population monitoring. We recruited 131 volunteers to survey over 6.2 million ha within the state of Idaho for Short-eared Owls during the 2015 breeding season. We surveyed 75 transects, 71 of which were surveyed twice, and detected Short-eared Owls on 27 transects. We performed multiscale occupancy modeling to identify habitat associations, and performed multiscale abundance modeling to generate a state-wide population estimate. Our results suggest that within the state of Idaho, Short-eared Owls are more often found in areas with marshland or riparian habitat or areas with greater amounts of sagebrush habitat at the 1750 ha transect scale. At the 50 ha point scale, Short-eared Owls tend to associate positively with fallow and bare dirt agricultural land and negatively with grassland. Cropland was not chosen at the broader transect scale suggesting that Short-eared Owls may prefer more heterogeneous landscapes. On the surface our results may seem contradictory to the presumed land use by a “grassland” species; however, the grasslands of the Intermountain West, consisting largely of invasive cheatgrass (Bromus tectorum), lack the complex structure shown to be preferred by these owls. We suggest the local adaptation to agriculture represents the next best habitat to their historical native habitat preferences. Regardless, we have confirmed regional differences that should be considered in conservation planning for this species. Last, our results demonstrate the feasibility, efficiency, and effectiveness of utilizing public participation in scientific research to achieve a robust sampling methodology across the broad geography of the Intermountain West.

Sensitivity of large-scale atmospheric analyses to humidity observations and its impact on the global water cycle and tropical and extratropical weather systems in ERA40

Reanalysis data obtained from data assimilation are increasingly used for diagnostic studies of the general circulation of the atmosphere, for the validation of modelling experiments and for estimating energy and water fluxes between the Earth surface and the atmosphere. Because fluxes are not specifically observed, but determined by the data assimilation system, they are not only influenced by the utilized observations but also by model physics and dynamics and by the assimilation method. In order to better understand the relative importance of humidity observations for the determination of the hydrological cycle, in this paper we describe an assimilation experiment using the ERA40 reanalysis system where all humidity data have been excluded from the observational data base. The surprising result is that the model, driven by the time evolution of wind, temperature and surface pressure, is able to almost completely reconstitute the large-scale hydrological cycle of the control assimilation without the use of any humidity data. In addition, analysis of the individual weather systems in the extratropics and tropics using an objective feature tracking analysis indicates that the humidity data have very little impact on these systems. We include a discussion of these results and possible consequences for the way moisture information is assimilated, as well as the potential consequences for the design of observing systems for climate monitoring. It is further suggested, with support from a simple assimilation study with another model, that model physics and dynamics play a decisive role for the hydrological cycle, stressing the need to better understand these aspects of model parametrization. .

Climate response to basin-scale warming and cooling of the North Atlantic Ocean

Using experiments with an atmospheric general circulation model, the climate impacts of a basin-scale warming or cooling of the North Atlantic Ocean are investigated. Multidecadal fluctuations with this pattern were observed during the twentieth century, and similar variations--but with larger amplitude--are believed to have occurred in the more distant past. It is found that in all seasons the response to warming the North Atlantic is strongest, in the sense of highest signal-to-noise ratio, in the Tropics. However there is a large seasonal cycle in the climate impacts. The strongest response is found in boreal summer and is associated with suppressed precipitation and elevated temperatures over the lower-latitude parts of North and South America. In August­-September-­October there is a significant reduction in the vertical shear in the main development region for Atlantic hurricanes. In winter and spring, temperature anomalies over land in the extratropics are governed by dynamical changes in circulation rather than simply reflecting a thermodynamic response to the warming or cooling of the ocean. The tropical climate response is primarily forced by the tropical SST anomalies, and the major features are in line with simple models of the tropical circulation response to diabatic heating anomalies. The extratropical climate response is influenced both by tropical and higher-latitude SST anomalies and exhibits nonlinear sensitivity to the sign of the SST forcing. Comparisons with multidecadal changes in sea level pressure observed in the twentieth century support the conclusion that the impact of North Atlantic SST change is most important in summer, but also suggest a significant influence in lower latitudes in autumn and winter. Significant climate impacts are not restricted to the Atlantic basin, implying that the Atlantic Ocean could be an important driver of global decadal variability. The strongest remote impacts are found to occur in the tropical Pacific region in June­-August and September­-November. Surface anomalies in this region have the potential to excite coupled ocean­atmosphere feedbacks, which are likely to play an important role in shaping the ultimate climate response.

The relationship between diffuse spectral reflectance of the soil and its cation exchange capacity is scale-dependent

Diffuse reflectance spectroscopy (DRS) is increasingly being used to predict numerous soil physical, chemical and biochemical properties. However, soil properties and processes vary at different scales and, as a result, relationships between soil properties often depend on scale. In this paper we report on how the relationship between one such property, cation exchange capacity (CEC), and the DRS of the soil depends on spatial scale. We show this by means of a nested analysis of covariance of soils sampled on a balanced nested design in a 16 km × 16 km area in eastern England. We used principal components analysis on the DRS to obtain a reduced number of variables while retaining key variation. The first principal component accounted for 99.8% of the total variance, the second for 0.14%. Nested analysis of the variation in the CEC and the two principal components showed that the substantial variance components are at the > 2000-m scale. This is probably the result of differences in soil composition due to parent material. We then developed a model to predict CEC from the DRS and used partial least squares (PLS) regression do to so. Leave-one-out cross-validation results suggested a reasonable predictive capability (R2 = 0.71 and RMSE = 0.048 molc kg− 1). However, the results from the independent validation were not as good, with R2 = 0.27, RMSE = 0.056 molc kg− 1 and an overall correlation of 0.52. This would indicate that DRS may not be useful for predictions of CEC. When we applied the analysis of covariance between predicted and observed we found significant scale-dependent correlations at scales of 50 and 500 m (0.82 and 0.73 respectively). DRS measurements can therefore be useful to predict CEC if predictions are required, for example, at the field scale (50 m). This study illustrates that the relationship between DRS and soil properties is scale-dependent and that this scale dependency has important consequences for prediction of soil properties from DRS data

Exploring the spatial relations between soil physical properties and apparent electrical conductivity

Relations between the apparent electrical conductivity of the soil (ECa) and top- and sub-soil physical properties were examined for two arable fields in southern England (Crowmarsh Battle Farms and the Yattendon Estate). The spatial variation of ECa and the soil properties was explored geostatistically. The variogram ranges showed that ECa varied on a similar spatial scale to many of the soil physical properties in both fields. Several features in the map of kriged predictions of ECa were also evident in maps of the soil properties. In addition, the correlation coefficients showed a strong relation between ECa and several soil properties. A moving correlation analysis enabled differences in the relations between ECa and the soil properties to be examined within the fields. The results indicated that relations were inconsistent; they were stronger in some areas than others. A regression of ECa on the principal component scores of the leading components for both fields showed that the first two components accounted for a large proportion of the variance in ECa, whereas the others accounted for little or none. For Crowmarsh topsoil sand and clay, loss on ignition and volumetric water measured in the autumn had large correlations on the first component, and for Yattendon they were large for topsoil sand and clay, and autumn and spring volumetric water. The cross-variograms suggested strong coregionalization between ECa and several soil physical properties; in particular subsoil sand and silt at Crowmarsh, and subsoil sand and clay at Yattendon. The structural correlations from the linear model of coregionalization confirmed the strength of the relations between ECa and the subsoil properties. Nevertheless, no one property was consistently important for both fields. Although a map of ECa can indicate the general patterns of spatial variation in the soil, it is not a substitute for information on soil properties obtained by sampling and analysing the soil. Nevertheless, it could be used to guide further sampling. (c) 2005 Elsevier B.V. All rights reserved.

Problems with determining the particle size distribution of chalk soil and some of their implications

Particle size distribution (psd) is one of the most important features of the soil because it affects many of its other properties, and it determines how soil should be managed. To understand the properties of chalk soil, psd analyses should be based on the original material (including carbonates), and not just the acid-resistant fraction. Laser-based methods rather than traditional sedimentation methods are being used increasingly to determine particle size to reduce the cost of analysis. We give an overview of both approaches and the problems associated with them for analyzing the psd of chalk soil. In particular, we show that it is not appropriate to use the widely adopted 8 pm boundary between the clay and silt size fractions for samples determined by laser to estimate proportions of these size fractions that are equivalent to those based on sedimentation. We present data from field and national-scale surveys of soil derived from chalk in England. Results from both types of survey showed that laser methods tend to over-estimate the clay-size fraction compared to sedimentation for the 8 mu m clay/silt boundary, and we suggest reasons for this. For soil derived from chalk, either the sedimentation methods need to be modified or it would be more appropriate to use a 4 pm threshold as an interim solution for laser methods. Correlations between the proportions of sand- and clay-sized fractions, and other properties such as organic matter and volumetric water content, were the opposite of what one would expect for soil dominated by silicate minerals. For water content, this appeared to be due to the predominance of porous, chalk fragments in the sand-sized fraction rather than quartz grains, and the abundance of fine (<2 mu m) calcite crystals rather than phyllosilicates in the clay-sized fraction. This was confirmed by scanning electron microscope (SEM) analyses. "Of all the rocks with which 1 am acquainted, there is none whose formation seems to tax the ingenuity of theorists so severely, as the chalk, in whatever respect we may think fit to consider it". Thomas Allan, FRS Edinburgh 1823, Transactions of the Royal Society of Edinburgh. (C) 2009 Natural Environment Research Council (NERC) Published by Elsevier B.V. All rights reserved.

Sensitivity analysis of a catchment-scale nitrogen model

There are now considerable expectations that semi-distributed models are useful tools for supporting catchment water quality management. However, insufficient attention has been given to evaluating the uncertainties inherent to this type of model, especially those associated with the spatial disaggregation of the catchment. The Integrated Nitrogen in Catchments model (INCA) is subjected to an extensive regionalised sensitivity analysis in application to the River Kennet, part of the groundwater-dominated upper Thames catchment, UK The main results are: (1) model output was generally insensitive to land-phase parameters, very sensitive to groundwater parameters, including initial conditions, and significantly sensitive to in-river parameters; (2) INCA was able to produce good fits simultaneously to the available flow, nitrate and ammonium in-river data sets; (3) representing parameters as heterogeneous over the catchment (206 calibrated parameters) rather than homogeneous (24 calibrated parameters) produced a significant improvement in fit to nitrate but no significant improvement to flow and caused a deterioration in ammonium performance; (4) the analysis indicated that calibrating the flow-related parameters first, then calibrating the remaining parameters (as opposed to calibrating all parameters together) was not a sensible strategy in this case; (5) even the parameters to which the model output was most sensitive suffered from high uncertainty due to spatial inconsistencies in the estimated optimum values, parameter equifinality and the sampling error associated with the calibration method; (6) soil and groundwater nutrient and flow data are needed to reduce. uncertainty in initial conditions, residence times and nitrogen transformation parameters, and long-term historic data are needed so that key responses to changes in land-use management can be assimilated. The results indicate the general, difficulty of reconciling the questions which catchment nutrient models are expected to answer with typically limited data sets and limited knowledge about suitable model structures. The results demonstrate the importance of analysing semi-distributed model uncertainties prior to model application, and illustrate the value and limitations of using Monte Carlo-based methods for doing so. (c) 2005 Elsevier B.V. All rights reserved.

Estimating the spatial scale of herbicide and soil interactions by nested sampling, hierarchical analysis of variance and residual maximum likelihood

An unbalanced nested sampling design was used to investigate the spatial scale of soil and herbicide interactions at the field scale. A hierarchical analysis of variance based on residual maximum likelihood (REML) was used to analyse the data and provide a first estimate of the variogram. Soil samples were taken at 108 locations at a range of separating distances in a 9 ha field to explore small and medium scale spatial variation. Soil organic matter content, pH, particle size distribution, microbial biomass and the degradation and sorption of the herbicide, isoproturon, were determined for each soil sample. A large proportion of the spatial variation in isoproturon degradation and sorption occurred at sampling intervals less than 60 m, however, the sampling design did not resolve the variation present at scales greater than this. A sampling interval of 20-25 m should ensure that the main spatial structures are identified for isoproturon degradation rate and sorption without too great a loss of information in this field.

Boundary layer structure and decoupling from synoptic scale flow during NAMBLEX

This paper presents an overview of the meteorology and planetary boundary layer structure observed during the NAMBLEX field campaign to aid interpretation of the chemical and aerosol measurements. The campaign has been separated into five periods corresponding to the prevailing synoptic condition. Comparisons between meteorological measurements ( UHF wind profiler, Doppler sodar, sonic aneometers mounted on a tower at varying heights and a standard anemometer) and the ECMWF analysis at 10 m and 1100 m identified days when the internal boundary layer was decoupled from the synoptic flow aloft. Generally the agreement was remarkably good apart from during period one and on a few days during period four when the diurnal swing in wind direction implies a sea/land breeze circulation near the surface. During these periods the origin of air sampled at Mace Head would not be accurately represented by back trajectories following the winds resolved in ECMWF analyses. The wind profiler observations give a detailed record of boundary layer structure including an indication of its depth, average wind speed and direction. Turbulence statistics have been used to assess the height to which the developing internal boundary layer, caused by the increased surface drag at the coast, reaches the sampling location under a wide range of marine conditions. Sampling conducted below 10 m will be impacted by emission sources at the shoreline in all wind directions and tidal conditions, whereas sampling above 15 m is unlikely to be affected in any of the wind directions and tidal heights sampled during the experiment.