Efectividad comparativa del seguimiento remoto a personas con marcapasos cardíacos frente al convencional: calidad de vida a los 6 meses.

BACKGROUND The use of remote follow-up (RF) of people with pacemakers (PM) is limited in comparison to the hospital modality (HS), being still poor the scientific evidence that shows their comparative effectiveness. The aim of this study was to compare the quality of life in individuals with different modalities of follow-up. METHODS Controlled, not randomized nor masked clinical trial, with data collection at pre and post-implantation of pacemakers during the 6 months follow-up. All patients over 18 years-old who were implanted a PM during the study period were selected (n = 83), and they were assigned to RF (n = 30) or HF (n = 53) groups according to their personal characteristics and patient's preferences. Baseline characteristics and number of visits to the hospital were analysed, the EuroQol-5D (EQ5D) questionnaire was administered to evaluate the health-related quality of life, and Duke Activity Status Index (DASI) to assess the functional capacity. RESULTS There were no significant differences between both groups in relation to the baseline analysis, EQ5D (RF:0.7299; HF:0.6769) and DASI (RF:21.41; HF:19.99). At 6 months the quality of life was improved in both groups (EQ5D RF:0.8613; HF:0.8175; p = 0,439) still without significant differences between them. DASI score was similar to baseline (20.51 vs 21.80). RF group performed less transmissions/visits per patient (1.57) than hospital group (1.96; relative reduction 31%; p = 0.015). CONCLUSIONS Remote follow-up of people with pacemakers might be considered as an equivalent option to the hospital follow-up in relation to the quality of life and it reduces the number of hospital visits.

Cuestiones controvertidas en evaluación económica (I): perspectiva y costes de intervenciones sanitarias.

Economic evaluation of health care interventions has experienced a strong growth over the past decade and is increasingly present as a support tool in the decisions making process on public funding of health services and pricing in European countries. A necessary element using them is that agents that perform economic evaluations have minimum rules with agreement on methodological aspects. Although there are methodological issues in which there is a high degree of consensus, there are others in which there is no such degree of agreement being closest to the normative field or have experienced significant methodological advances in recent years. In this first article of a series of three, we will discuss on the perspective of analysis and assessment of costs in economic evaluation of health interventions using the technique Metaplan. Finally, research lines are proposed to overcome the identified discrepancies.

Cuestiones controvertidas en evaluación económica (II): medidas de resultado en salud de las intervenciones sanitarias

In this second article of a series of three, we will discuss using the Metaplan technique on controversial issues of health outcomes in economic evaluation of health care interventions. The four-discussion areas focus on: choice of health outcomes measures, where any outcome measure is superior to another; extrapolation and transferability of health outcomes measures, which should not be assumed the results of an EEIS of one country to another without making certain adjustments; appropriate instruments to measure quality of life in Spain, where the EQ-5D was indicated as convenient due to its widespread international use; and, indirect comparisons, where the combination of both comparisons, direct and indirect, it would be advisable if the test for indirect estimates is consistent and has been validated. Finally, research lines to try to overcome the identified discrepancies were identified in each of these areas, some of those are: doing studies of correlation between scores of specific and generic instruments measuring quality of life; update or create a database of economic evaluations in Spain; estimating utilities for the Spanish population by existing generic and specific instruments; or, establish a common way to show the results of a meta-analysis network.

Immigració, cohesió social i convivéncia al espai públic

L'assentament de població immigrada ha repercutit en el paisatge social de les ciutats que s'ha diversificat i s’ha tornat més complex, la qual cosa ha originat profunds canvis demogràfics i socioeconòmics. L'objectiu principal de aquesta investigació és analitzar la convivència a l'espai públic entre població autòctona i migrant, i elaborar possibles propostes d'actuació. L'espai públic és un espai fonamental per la socialització i la convivència entre diferents grups de població, però també és un espai de conflicte. Per analitzar aquesta relació entre convivència i espai públic s'ha estudiat la quotidianitat de la població immigrada als espais públics i la interacció a l'espai físic entre població autòctona i immigrada a través del treball de camp a tres barris de tres municipis de la província de Barcelona. La metodologia de la recerca s'ha concretat a través de l'estudi de casos, utilitzant en cadascun d'ells diferents tècniques que pertanyen a metodologies qualitatives i quantitatives. A través del treball de camp s'ha determinat que els usos que fa la població immigrant de l'espai públic són molt variats: socialització, feina, cura, oci, pràctica d'esports, celebracions i, en alguns casos, dormir, entre d’altres. També s'ha pogut establir una relació entre la intensitat i el tipus d'ús que es fa de l'espai públic i diferents variables com gènere, origen o tipus de projecte migratori. El projecte ha permès identificar elements que poden millorar la convivència en l'espai públic i a partir d'aquí s'han generat algunes línies d'actuació.

Evalution of Hot Mix Asphalt Moisture Sensitivity Using the Nottingham Asphalt Test Equipment, July 2005

Moisture sensitivity of Hot Mix Asphalt (HMA) mixtures, generally called stripping, is a major form of distress in asphalt concrete pavement. It is characterized by the loss of adhesive bond between the asphalt binder and the aggregate (a failure of the bonding of the binder to the aggregate) or by a softening of the cohesive bonds within the asphalt binder (a failure within the binder itself), both of which are due to the action of loading under traffic in the presence of moisture. The evaluation of HMA moisture sensitivity has been divided into two categories: visual inspection test and mechanical test. However, most of them have been developed in pre-Superpave mix design. This research was undertaken to develop a protocol for evaluating the moisture sensitivity potential of HMA mixtures using the Nottingham Asphalt Tester (NAT). The mechanisms of HMA moisture sensitivity were reviewed and the test protocols using the NAT were developed. Different types of blends as moisture-sensitive groups and non-moisture-sensitive groups were used to evaluate the potential of the proposed test. The test results were analyzed with three parameters based on performance character: the retained flow number depending on critical permanent deformation failure (RFNP), the retained flow number depending on cohesion failure (RFNC), and energy ratio (ER). Analysis based on energy ratio of elastic strain (EREE ) at flow number of cohesion failure (FNC) has higher potential to evaluate the HMA moisture sensitivity than other parameters. If the measurement error in data-acquisition process is removed, analyses based on RFNP and RFNC would also have high potential to evaluate the HMA moisture sensitivity. The vacuum pressure saturation used in AASHTO T 283 and proposed test has a risk to damage specimen before the load applying.

Avaliação de necessidades de formação em professores do ensino secundário em Cabo Verde

II Resumo Cabo Verde é um país que tem acompanhado as grandes mudanças políticas, sociais, económicas e educativas, atribuindo um papel preponderante aos professores na educação/formação dos indivíduos. Neste sentido a formação inicial não pode constituir um acto “acabado” que não tem em linha de conta as mudanças que decorrem no seu seio. A formação contínua aparece com um processo de construção da mudança, apoiado no desenvolvimento profissional dos professores. A avaliação de necessidade de formação em professores do ensino secundário em Cabo Verde é o tema do trabalho de investigação, realizado nas escolas secundárias da ilha de Santo Antão, em Cabo Verde, no sentido de identificar questões problemáticas na formação inicial e contínua de professores e as suas implicações na qualidade educativa. Neste sentido, ao longo de 5 capítulos apresentamos os pontos desta investigação, estruturados de forma a se poder acompanhar a sua evolução. No 1º capítulo, apresenta-se a Problemática de Investigação, que constitui a parte inicial da dissertação, pela exposição do quadro conceptual do ensino secundário em Cabo Verde através da contextualização e identificação do problema, da formulação dos objectivos e questões de investigação. No 2º capítulo faz-se o percurso histórico/educativo de Cabo Verde, desde a época colonial, passando pela educação após a independência em 1975, à constituição da Lei de Bases do Sistema Educativo e a Reforma Educativa dos anos 90. No 3º capítulo, intitulado “A Formação Inicial e Continua de Professores em Cabo Verde”, é abordado o enquadramento teórico desta investigação, com referência à contextualização geral da formação e modelos de formação de professores, evoluindo para a realidade Cabo-verdiana, tendo em consideração as instituições de formação de professores e o contexto actual do ensino secundário em Cabo Verde. No 4º capítulo faz-se a apresentação da Metodologia de Investigação, adoptada num estudo extensivo, do qual abordamos a natureza da investigação e caracterizamos a amostra e respondentes. Como técnicas de recolha de dados, são utilizados: o inquérito por questionário (n=77), a professores do ensino secundário e o inquérito por entrevista (n=9), aos directores das escolas secundárias da ilha de Santo Antão e a formadores de professores em São Vicente. Como técnica de análise de dados, são utilizados diversos procedimentos estatísticos e a análise de conteúdo. O 5º capítulo corresponde a apresentação e discussão dos resultados da investigação desses três públicos analisados. Para finalizar, apresenta-se uma conclusão que corresponde a síntese dos resultados obtidos, propostas de sugestões de melhoria e limitações do estudo. Cabo Verde is a country willing to follow the great political, social, economic and educational changes. This important role have attributed to teachers to educate and train individuals. In this sense the initial training cannot be considered as a “finished” task without taking into consideration those changes. The in service training appears as a scientific and pedagogic autonomization towards the growing change. The Evaluation of Secondary School teacher training Needs in Cabo Verde constitutes an investigation work, carried out in Santo Antão's island Secondary schools, aiming to identify problems in initial and continuous teachers' training and their implications in the educational quality. In this sense, along five chapters we will present the points of this investigation, structured to facilitate the understanding of its evolution. In the first chapter we present the Problem of Investigation which is an introductory part of the dissertation, the conceptual theory of the Cabo Verde secondary education through the contextualization and identification of the problem, the formulation of the objectives and investigation issues. In the second chapter we present the Cabo Verde historical/educational background, from the colonial time, going through after independence in 1975, to the constitution of the Basic Educational Law of the System and the nineties Educational Reform. In the third chapter entitled “The Initial and in-service Teacher´s Training in Cabo Verde” brings the theoretical framework of this investigation, where we present a general contextualization of teachers' training and models, developed from the reality of Cabo Verde. In this regard we will consider the teachers' training institutions and the current secondary education context in Cabo Verde. In the fourth chapter we present the Research Methodology, adopted in an extensive study, of which we draw the nature of the investigation and we characterized the sample. We carried out questionnaire (n=77) to teachers, interviews (n=9) to headmasters from Santo Antão's island secondary schools and trainers from São Vicente. We used statistical analyses and content analyses as data analyse techniques. The fifth chapter deals with presentation the discussion of results of those three analyzed publics' investigation. Finally, we present a summary of the obtained results, suggestions for improvement and limitations of study.

Driver scheduling problem modelling

The Drivers Scheduling Problem (DSP) consists of selecting a set of duties for vehicle drivers, for example buses, trains, plane or boat drivers or pilots, for the transportation of passengers or goods. This is a complex problem because it involves several constraints related to labour and company rules and can also present different evaluation criteria and objectives. Being able to develop an adequate model for this problem that can represent the real problem as close as possible is an important research area.The main objective of this research work is to present new mathematical models to the DSP problem that represent all the complexity of the drivers scheduling problem, and also demonstrate that the solutions of these models can be easily implemented in real situations. This issue has been recognized by several authors and as important problem in Public Transportation. The most well-known and general formulation for the DSP is a Set Partition/Set Covering Model (SPP/SCP). However, to a large extend these models simplify some of the specific business aspects and issues of real problems. This makes it difficult to use these models as automatic planning systems because the schedules obtained must be modified manually to be implemented in real situations. Based on extensive passenger transportation experience in bus companies in Portugal, we propose new alternative models to formulate the DSP problem. These models are also based on Set Partitioning/Covering Models; however, they take into account the bus operator issues and the perspective opinions and environment of the user.We follow the steps of the Operations Research Methodology which consist of: Identify the Problem; Understand the System; Formulate a Mathematical Model; Verify the Model; Select the Best Alternative; Present the Results of theAnalysis and Implement and Evaluate. All the processes are done with close participation and involvement of the final users from different transportation companies. The planner s opinion and main criticisms are used to improve the proposed model in a continuous enrichment process. The final objective is to have a model that can be incorporated into an information system to be used as an automatic tool to produce driver schedules. Therefore, the criteria for evaluating the models is the capacity to generate real and useful schedules that can be implemented without many manual adjustments or modifications. We have considered the following as measures of the quality of the model: simplicity, solution quality and applicability. We tested the alternative models with a set of real data obtained from several different transportation companies and analyzed the optimal schedules obtained with respect to the applicability of the solution to the real situation. To do this, the schedules were analyzed by the planners to determine their quality and applicability. The main result of this work is the proposition of new mathematical models for the DSP that better represent the realities of the passenger transportation operators and lead to better schedules that can be implemented directly in real situations.

Estimating uncertainty of alcohol-attributable fractions for infectious and chronic diseases.

Background: Alcohol is a major risk factor for burden of disease and injuries globally. This paper presents a systematic method to compute the 95% confidence intervals of alcohol-attributable fractions (AAFs) with exposure and risk relations stemming from different sources.Methods: The computation was based on previous work done on modelling drinking prevalence using the gamma distribution and the inherent properties of this distribution. The Monte Carlo approach was applied to derive the variance for each AAF by generating random sets of all the parameters. A large number of random samples were thus created for each AAF to estimate variances. The derivation of the distributions of the different parameters is presented as well as sensitivity analyses which give an estimation of the number of samples required to determine the variance with predetermined precision, and to determine which parameter had the most impact on the variance of the AAFs.Results: The analysis of the five Asian regions showed that 150 000 samples gave a sufficiently accurate estimation of the 95% confidence intervals for each disease. The relative risk functions accounted for most of the variance in the majority of cases.Conclusions: Within reasonable computation time, the method yielded very accurate values for variances of AAFs.

Processus et fonctions psychiques de l'écriture : de la création littéraire au groupe à médiation

Ce travail porte sur l'étude des processus et fonctions psychiques de la création littéraire et de l'écriture dans une perspective psychanalytique, à partir d'une méthodologie de recherche qualitative exploratoire. Un premier volet de la recherche s'attache à étudier les processus et fonctions psychiques dans la création littéraire à partir de six entretiens semi-structurés avec des écrivains romands publiés. Les entretiens sont analysés en profondeur à partir de la méthodologie qualitative Interpretative Phenomenological Analysis (Smith, Flowers & Larkin, 2009). Un second volet de la recherche étudie les processus et fonctions psychiques de l'écriture dans un atelier de groupe à médiation écriture prenant place dans un Centre de Jour pour adultes, à partir de l'élaboration de deux cas. L'articulation des analyses de ces expériences d'écriture dans les deux contextes étudiés permet de mettre en évidence des enjeux de continuité/discontinuité dans le passage du premier mouvement créateur de l'écriture - le « miroir-papier » - vers le mouvement de la publication/lecture - le « miroir-lecteur ». Ces enjeux de partage invitent à penser le travail créateur de l'écriture à partir de la notion de « Moi- peau » (Anzieu, 1995) et à préciser cinq fonctions psychiques de l'écriture : transformation ; protection ; échange ; réassurance narcissique ; partage. Un accent particulier est porté sur la fonction de protection, dans la tension qu'elle entretient avec celle de transformation, au travers de la mise en évidence de six formes d'enveloppes d'écriture protectrice. Finalement, les analyses mettent en évidence la manière dont cette tension entre un investissement défensif de l'écriture et un investissement de transformation se déploie par des voies singulières en vue d'une tentative de résolution du conflit subjectif interne entre les exigences du « public intérieur » (De M'Uzan, 1964) et la rencontre avec l'objet réel. Ces pistes d'analyses permettent de préciser les modalités de contribution de l'écriture aux processus de symbolisation et d'enrichir la pratique du champ des médiations thérapeutiques de repères d'appréciation clinique. - Based on an exploratory qualitative research methodology, this work focuses on the psychical processes and functions of literary creation and writing from a psychoanalytic perspective. The first part of the research investigates psychical processes and functions in creative writing through the analysis of six semi-structured interviews with published Swiss writers. The interviews are analyzed according to the exploratory qualitative methodology Interpretative Phenomenological Analysis (Smith, Flowers & Larkin, 2009). The second area of research examines the processes of writing in the context of an art-therapy writing group that took place in an adult day center. The observations lead to the elaboration of two case studies. The joint analysis of these writing experiences highlights issues of continuity/discontinuity in passing from the first creative writing movement - the « mirror-paper » - to the final publication/reading of the work - the «mirror-reader». These issues enable us to understand the creative writing processes from the concept of the « skin-ego » (Anzieu, 1995). Five functions of writing are proposed: transformation, protection, exchange, narcissistic reassurance, and sharing. An emphasis on the tension between the protection and the transformation functions is highlighted through the identification of six forms of protective writing psychical envelopes. Finally, the analysis shows how this tension between a defensive and a transformative investment in writing takes place in an attempt to resolve the internal conflict between the « inner audience » (De M'Uzan, 1964) and the encounter with the real object. This study clarifies the way creative writing can contribute to symbolization and can enrich clinical assessment in the field of art-therapy.

Whose DNA is this? How relevant a question? (a note for forensic scientists).

This communication seeks to draw the attention of researchers and practitioners dealing with forensic DNA profiling analyses to the following question: is a scientist's report, offering support to a hypothesis according to which a particular individual is the source of DNA detected during the analysis of a stain, relevant from the point of view of a Court of Justice? This question relates to skeptical views previously voiced by commentators mainly in the judicial area, but is avoided by a large majority of forensic scientists. Notwithstanding, the pivotal role of this question has recently been evoked during the international conference "The hidden side of DNA profiles. Artifacts, errors and uncertain evidence" held in Rome (April 27th to 28th, 2012). Indeed, despite the fact that this conference brought together some of the world's leading forensic DNA specialists, it appeared clearly that a huge gap still exists between questions lawyers are actually interested in, and the answers that scientists deliver to Courts in written reports or during oral testimony. Participants in the justice system, namely lawyers and jurors on the one hand and forensic geneticists on the other, unfortunately talk considerably different languages. It thus is fundamental to address this issue of communication about results of forensic DNA analyses, and open a dialogue with practicing non-scientists at large who need to make meaningful use of scientific results to approach and help solve judicial cases. This paper intends to emphasize the actuality of this topic and suggest beneficial ways ahead towards a more reasoned use of forensic DNA in criminal proceedings.

La investigacion cualitativa y sus aplicaciones en Biblioteconomia y Documentacion

Se intenta determinar cuáles son las técnicas cualitativas concretas que pueden ser útiles en el desarrollo de investigaciones en Biblioteconomía y Documentación, qué temas son más susceptibles de ser abordados desde una óptica cualitativa, y si existe una correlación entre la técnica empleada y el tema tratado. Se analiza la temática y técnicas empleadas en los artículos de investigación publicados en Journal of the American Society for Information Science entre 1995 y 1997, y en los aparecidos en Journal of Documentation y Library and Information Science Research desde 1993 hasta 1997. La mayor parte de los artículos que emplean técnicas cualitativas estudian el comportamiento del usuario en la recuperación de la información, bien sea explorando su conducta al utilizar un sistema automatizado, o bien centrándose en las tácticas que diversos grupos de usuarios emplean al resolver sus necesidades informativas. Finalmente se exponen las principales características que definen este tipo de investigaciones.

Biofilm formation on bone grafts and bone graft substitutes: comparison of different materials by a standard in vitro test and microcalorimetry.

We analyzed the initial adhesion and biofilm formation of Staphylococcus aureus (ATCC 29213) and S. epidermidis RP62A (ATCC 35984) on various bone grafts and bone graft substitutes under standardized in vitro conditions. In parallel, microcalorimetry was evaluated as a real-time microbiological assay in the investigation of biofilm formation and material science research. The materials beta-tricalcium phosphate (beta-TCP), processed human spongiosa (Tutoplast) and poly(methyl methacrylate) (PMMA) were investigated and compared with polyethylene (PE). Bacterial counts (log(10) cfu per sample) were highest on beta-TCP (S. aureus 7.67 +/- 0.17; S. epidermidis 8.14 +/- 0.05) while bacterial density (log(10) cfu per surface) was highest on PMMA (S. aureus 6.12 +/- 0.2, S. epidermidis 7.65 +/- 0.13). Detection time for S. aureus biofilms was shorter for the porous materials (beta-TCP and processed human spongiosa, p < 0.001) compared to the smooth materials (PMMA and PE), with no differences between beta-TCP and processed human spongiosa (p > 0.05) or PMMA and PE (p > 0.05). In contrast, for S. epidermidis biofilms the detection time was different (p < 0.001) between all materials except between processed human spongiosa and PE (p > 0.05). The quantitative analysis by quantitative culture after washing and sonication of the material demonstrated the importance of monitoring factors like specific surface or porosity of the test materials. Isothermal microcalorimetry proved to be a suitable tool for an accurate, non-invasive and real-time microbiological assay, allowing the detection of bacterial biomass without removing the biofilm from the surface.

Evaluation of Hot Mix Asphalt Moisture Sensitivity Using the Nottingham Asphalt Test Equipment, July 2005

Moisture sensitivity of Hot Mix Asphalt (HMA) mixtures, generally called stripping, is a major form of distress in asphalt concrete pavement. It is characterized by the loss of adhesive bond between the asphalt binder and the aggregate (a failure of the bonding of the binder to the aggregate) or by a softening of the cohesive bonds within the asphalt binder (a failure within the binder itself), both of which are due to the action of loading under traffic in the presence of moisture. The evaluation of HMA moisture sensitivity has been divided into two categories: visual inspection test and mechanical test. However, most of them have been developed in pre-Superpave mix design. This research was undertaken to develop a protocol for evaluating the moisture sensitivity potential of HMA mixtures using the Nottingham Asphalt Tester (NAT). The mechanisms of HMA moisture sensitivity were reviewed and the test protocols using the NAT were developed. Different types of blends as moisture-sensitive groups and non-moisture-sensitive groups were used to evaluate the potential of the proposed test. The test results were analyzed with three parameters based on performance character: the retained flow number depending on critical permanent deformation failure (RFNP), the retained flow number depending on cohesion failure (RFNC), and energy ratio (ER). Analysis based on energy ratio of elastic strain (EREE ) at flow number of cohesion failure (FNC) has higher potential to evaluate the HMA moisture sensitivity than other parameters. If the measurement error in data-acquisition process is removed, analyses based on RFNP and RFNC would also have high potential to evaluate the HMA moisture sensitivity. The vacuum pressure saturation used in AASHTO T 283 and proposed test has a risk to damage specimen before the load applying.

Tutkimusmetodologia ja sen kehittäminen opettajan käyttöteorian ja opetuksen välisen suhteen tutkimuksessa

Summary: Research methodology and its development in the study of the relationship between a teacher's practical theory and teaching practices