Ensimmäiset päivät sairaalassa : viiden iäkkään potilaan havainnointi vuodeosastolla

English summary: First 72 hours in hospital : observation of five older patients on a ward

Incidence, complications and risk factors for severe falls in patients on maintenance haemodialysis.

BACKGROUND: Falls have been insufficiently studied in patients on maintenance haemodialysis (MHD). This study assessed the incidence and complications of severe falls and the ability of risk factors, including the Performance-Oriented Mobility Assessment (POMA) test, to predict them in this population. METHODS: All patients on MHD from our centre were asked to participate in this survey. POMA test and a record of risk factors for falls were obtained at baseline. Severe falls, as defined by an admission in an emergency ward, were documented prospectively. RESULTS: Eighty-four patients (median age 69.5 years, minimum 26 years, maximum 85 years) were enrolled. Predialytic POMA scores were low (median 20, minimum 5, maximum 26). After a mean follow-up of 20.6 months (142.2 patient-years), 31 severe falls were recorded in 24 patients (28.6%; incidence 0.22 per patient-year) and complicated by fractures in 54.8% of severe falls. In univariate analysis, age, a past history of falls, malnutrition, depression, but not POMA score, were associated with severe falls. A POMA score of >21 had a negative predictive value of 82%. CONCLUSIONS: Severe falls were common in MHD patients in this study and resulted in fractures in >50% of the cases. They were associated with ageing, a past history of falls, malnutrition and depression. Although there was a trend towards a lower POMA score in fallers as compared to non-fallers, the POMA score was not an independent predictor of severe falls in this study. These data may help to stratify the patient's risk of falling in order to target programmes to prevent falls in this population.

La investigación cooperativa

La "Collaborative Research" (Investigación cooperativa) se presenta como una alternativa del diseño "R and D" en Educación y una de las modalidades de la "Action Research". Puede considerarse a E. E. U. U. como país pionero de sus más importantes realizaciones. El artículo intenta presentar una síntesis de la evolución histórica de este tipo de investigación, deteniéndose especialmente en sus orígenes, vinculados a la "Action Research"; la crisis de esta ultima; la creación de los diseños interactivos IR and DT de Tikunoff, Ward y Griffin en 1975 (Interactive Research and Development on teaching) en un contexto internacional favorable al resurgimiento de la Action Research y explicitado en diversidad de corrientes y movimientos orientados a potenciar el cambio educativo y social a través de la investigación; finalmente, su expansión actual. Del estudio de las obras de sus representantes principales (Griffin, Oja, Pine, Smulyan, Tikunoff, Ward, etc. ), se extraen los elementos que podemos considerar claves para una definición de la Collaborative Research, los procesos y diseños de investigación empleados y las condiciones requeridas para que pueda llevarse a cabo. A partir de este análisis se ofrece una reflexión sobre los problemas concretos vinculados a este tipo de investigación: los que surgen al inicio de la misma; los que se dan en torno al proceso de comunicación y, sobre todo los relacionados con la producción real de conocimiento científico, señalando en cada uno de estos apartados posibles vías de soluci6n, apuntadas desde los nuevos enfoques de la investigación educativa. * Profesora Catedrática del Departamento de Métodos de Investigación y Diagnóstico en Educación.

Looking for Validity or Testing It? The Perils of Stepwise Regression, Extreme-Scores Analysis, Heteroscedasticity, and Measurement Error

When researchers introduce a new test they have to demonstrate that it is valid, using unbiased designs and suitable statistical procedures. In this article we use Monte Carlo analyses to highlight how incorrect statistical procedures (i.e., stepwise regression, extreme scores analyses) or ignoring regression assumptions (e.g., heteroscedasticity) contribute to wrong validity estimates. Beyond these demonstrations, and as an example, we re-examined the results reported by Warwick, Nettelbeck, and Ward (2010) concerning the validity of the Ability Emotional Intelligence Measure (AEIM). Warwick et al. used the wrong statistical procedures to conclude that the AEIM was incrementally valid beyond intelligence and personality traits in predicting various outcomes. In our re-analysis, we found that the reliability-corrected multiple correlation of their measures with personality and intelligence was up to .69. Using robust statistical procedures and appropriate controls, we also found that the AEIM did not predict incremental variance in GPA, stress, loneliness, or well-being, demonstrating the importance for testing validity instead of looking for it.

Health technology assessment in evolution - focal therapy in localised prostate cancer.

Focal therapy in prostate cancer aims to treat only the part of the gland harboring clinically significant disease while preserving the rest of the tissue. This approach may substantially reduce treatment-related toxicity without compromising disease control outcomes. Short- to medium-term functional and oncological results in prospective interventional studies are promising, but comparative effectiveness research against standard of care is required to incorporate focal therapy among standard options. In this review, we discuss the actual stage of assessment and results of sources of energy commonly used to deliver focal therapy. We also provide our viewpoint on how the field will evolve in the near future.

Comparison of short-wood forwarding systems used in Iberia

Abstract

Tolerância ao alumínio em porta-enxertos somaclonais de macieira cultivados em solução nutritiva

A macieira (Malus sp.) cultivada em solos ácidos com pH inferior a 5,0 pode apresentar distúrbios nutricionais e inibição de crescimento causados por níveis tóxicos de Al que podem afetar a absorção do Ca, o qual apresenta estreita correlação com a produção de frutos de melhor qualidade. O objetivo deste trabalho foi verificar a tolerância ao Al em 18 somaclones e três cultivares porta-enxertos provenientes da seleção in vitro. As plântulas foram cultivadas durante 45 dias em copos de plástico de 300 mL contendo solução nutritiva e utilizando-se sílica lavada como substrato. Os valores obtidos foram submetidos à análise multivariada pelos componentes principais e agrupamento hierárquico baseado no método de Ward, o qual revelou ser mais adequado na classificação dos clones quanto à tolerância ao Al do que os testes de médias. O porcentual de redução na matéria seca da parte aérea e no número de folhas foram características que melhor possibilitaram a discriminação dos clones. Os clones foram classificados em três grupos: bem sensível ou não tolerante, moderadamente tolerante e tolerante.

Tire traces: discrimination and classification of pyrolysis-GC/MS profiles

Tire traces can be observed on several crime scenes as vehicles are often used by criminals. The tread abrasion on the road, while braking or skidding, leads to the production of small rubber particles which can be collected for comparison purposes. This research focused on the statistical comparison of Py-GC/MS profiles of tire traces and tire treads. The optimisation of the analytical method was carried out using experimental designs. The aim was to determine the best pyrolysis parameters regarding the repeatability of the results. Thus, the pyrolysis factor effect could also be calculated. The pyrolysis temperature was found to be five time more important than time. Finally, a pyrolysis at 650 °C during 15 s was selected. Ten tires of different manufacturers and models were used for this study. Several samples were collected on each tire, and several replicates were carried out to study the variability within each tire (intravariability). More than eighty compounds were integrated for each analysis and the variability study showed that more than 75% presented a relative standard deviation (RSD) below 5% for the ten tires, thus supporting a low intravariability. The variability between the ten tires (intervariability) presented higher values and the ten most variant compounds had a RSD value above 13%, supporting their high potential of discrimination between the tires tested. Principal Component Analysis (PCA) was able to fully discriminate the ten tires with the help of the first three principal components. The ten tires were finally used to perform braking tests on a racetrack with a vehicle equipped with an anti-lock braking system. The resulting tire traces were adequately collected using sheets of white gelatine. As for tires, the intravariability for the traces was found to be lower than the intervariability. Clustering methods were carried out and the Ward's method based on the squared Euclidean distance was able to correctly group all of the tire traces replicates in the same cluster than the replicates of their corresponding tire. Blind tests on traces were performed and were correctly assigned to their tire source. These results support the hypothesis that the tested tires, of different manufacturers and models, can be discriminated by a statistical comparison of their chemical profiles. The traces were found to be not differentiable from their source but differentiable from all the other tires present in the subset. The results are promising and will be extended on a larger sample set.

Assessment of the capacity to consent to treatment in patients admitted to acute medical wards.

BACKGROUND: Assessment of capacity to consent to treatment is an important legal and ethical issue in daily medical practice. In this study we carefully evaluated the capacity to consent to treatment in patients admitted to an acute medical ward using an assessment by members of the medical team, the specific Silberfeld's score, the MMSE and an assessment by a senior psychiatrist. METHODS: Over a 3 month period, 195 consecutive patients of an internal medicine ward in a university hospital were included and their capacity to consent was evaluated within 72 hours of admission. RESULTS: Among the 195 patients, 38 were incapable of consenting to treatment (unconscious patients or severe cognitive impairment) and 14 were considered as incapable of consenting by the psychiatrist (prevalence of incapacity to consent of 26.7%). Agreement between the psychiatrist's evaluation and the Silberfeld questionnaire was poor (sensitivity 35.7%, specificity 91.6%). Experienced clinicians showed a higher agreement (sensitivity 57.1%, specificity 96.5%). A decision shared by residents, chief residents and nurses was the best predictor for agreement with the psychiatric assessment (sensitivity 78.6%, specificity 94.3%). CONCLUSION: Prevalence of incapacity to consent to treatment in patients admitted to an acute internal medicine ward is high. While the standardized Silberfeld questionnaire and the MMSE are not appropriate for the evaluation of the capacity to consent in this setting, an assessment by the multidisciplinary medical team concurs with the evaluation by a senior psychiatrist.

Fallers in postacute rehabilitation have worse functional recovery and increased health services use.

OBJECTIVES: To determine characteristics associated with single and multiple fallers during postacute rehabilitation and to investigate the relationship among falls, rehabilitation outcomes, and health services use. DESIGN: Retrospective cohort study. SETTING: Geriatric postacute rehabilitation hospital. PARTICIPANTS: Patients (n = 4026) consecutively admitted over a 5-year period (2003-2007). MEASUREMENTS: All falls during hospitalization were prospectively recorded. Collected patients' characteristics included health, functional, cognitive, and affective status data. Length of stay and discharge destination were retrieved from the administrative database. RESULTS: During rehabilitation stay, 11.4% (458/4026) of patients fell once and an additional 6.3% (253/4026) fell several times. Compared with nonfallers, fallers were older and more frequently men. They were globally frailer, with lower Barthel score and more comorbidities, cognitive impairment, and depressive symptoms. In multivariate analyses, compared with 1-time fallers, multiple fallers were more likely to have lower Barthel score (adjOR: 2.45, 95% CI: 1.48-4.07; P = .001), cognitive impairment (adjOR: 1.43, 95% CI: 1.04-1.96; P = .026), and to have been admitted from a medicine ward (adjOR: 1.55, 95% CI: 1.03-2.32; P = .035). Odds of poor functional recovery and institutionalization at discharge, as well as length of stay, increased incrementally from nonfallers to 1-time and to multiple fallers. CONCLUSION: In these patients admitted to postacute rehabilitation, the proportion of fallers and multiple fallers was high. Multiple fallers were particularly at risk of poor functional recovery and increased health services use. Specific fall prevention programs targeting high-risk patients with cognitive impairment and low functional status should be developed in further studies.

Els Itineraris educatius dels joves extutelats a Europa

Dins del 7è Programa marc de la Unió Europea, s'ha endegat un estudi, que va del 2008 al 2010 a cinc països –Regne Unit, Dinamarca, Hongria, Suècia i Espanya (centrat a Catalunya)– que té per objectiu explorar els factors que afavoreixen i ajuden els joves tutelats i extutelats a continuar els seus estudis després de l'escolaritat obligatòria. Cada equip de recerca esta duent a terme un estudi de casos que consisteixen a fer, d'una banda, entrevistes amb responsables de serveis socials i de protecció a la infància, i, d'altra banda, entrevistes en profunditat amb joves d'entre 19 i 21 anys que han estat tutelats almenys un any de la seva vida i que ho estaven a l'edat de 16 anys, i, finalment, entrevistes amb educadors, acollidors o persones que han estat claus a les seves vides. Els joves seleccionats seran entrevistats de nou un any més tard per veure en quina mesura s'han pogut fer els seus plans. L'objectiu del present article és doble: d'una banda, aportar algunes de les dades que s'han obtingut de la primera fase ja conclosa sobre revisió dels estudis existents en aquest àmbit i, de l'altra, obrir un debat, poc present encara al nostre país, que pot culminar el proper març del 2010 amb motiu d'unes jornades a Catalunya on es podran presentar, compartir i debatre els primers resultats de la investigació

Consumer acceptance of high pressure processed beef-based chilled ready meals: The mediating role of food-related lifestyle factors

The aim of this research was to investigate the effects of high pressure processing (HPP) on consumer acceptance for chilled ready meals manufactured using a low-value beef cut. Three hundred consumers evaluated chilled ready meals subjected to 4 pressure treatments and a non-treated control monadically on a 9-point scale for liking for beef tenderness and juiciness, overall flavour, overall liking, and purchase intent. Data were also collected on consumers' food consumption patterns, their attitudes towards food by means of the reduced food-related lifestyle (FRL) instrument, and socio-demographics. The results indicated that a pressure treatment of 200 MPa was acceptable to most consumers. K-means cluster analysis identified 4 consumer groups with similar preferences, and the optimal pressure treatments acceptable to specific consumer groups were identified for those firms that would wish to target attitudinally differentiated consumer segments

Survival in soil and detection of co-transformed Trichoderma harzianum by nested PCR

The objective of this work was to evaluate the survival of two Trichoderma harzianum co-transformants, TE 10 and TE 41, carrying genes for green fluorescent protein (egfp) and for resistance to benomyl, during four weeks in a contained soil microcosm. Selective culture media were used to detect viable fungal material, whose identity was confirmed by the observation of the fluorescent phenotype by direct epifluorence microscopy. PCR using two nested primer pairs specific to the egfp gene was also used to detect the transformed fungi. Although it was not possible to reliably detect the egfp gene directly from soil extracts, an enrichment step involving selective culture of soil samples in liquid medium prior to DNA extraction enabled the consistent detection of the T. harzianum co-transformants by nested PCR for the duration of the incubation period.

Indicadores de produção de soja no Rio Grande do Sul comparados ao zoneamento agrícola

O Estado do Rio Grande do Sul é responsável por aproximadamente 20% da produção nacional de soja, o que torna necessário um conhecimento mais amplo de indicadores da produção desta cultura neste Estado. O objetivo deste trabalho foi analisar, em comparação ao zoneamento agrícola, alguns indicadores de produção da soja nos municípios que compõem a região de produção significativa da cultura da soja no Rio Grande do Sul. A análise de agrupamento foi realizada pelo método de Ward. Os municípios foram agrupados em função do rendimento, da produção e da razão entre a área colhida de soja e a área total do Município. O resultado da análise de agrupamento quanto ao rendimento foi comparado ao zoneamento agroclimático da soja para o Estado. Existe uma estreita relação entre os grupos formados pela análise das três variáveis. O zoneamento agrícola da soja no Estado do Rio Grande do Sul apresenta uma possível inconsistência no agrupamento dos municípios por rendimento. Nos outros agrupamentos, esta inconsistência não é observada.