Ejercicio y resultados clínicos en pacientes con enfermedad de Parkinson: una revisión sistemática y metaanálisis

Antecedentes. La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa más común en el mundo, la cual afecta el componente físico, psicológico y social de los individuos que la padecen. Numerosos estudios han abordado los beneficios de diferentes programas de ejercicio, llegando a ser una estrategia no-farmacológica efectiva para aminorar el deterioro funcional de los pacientes con EP. Objetivo. Determinar los efectos de las diferentes modalidades de ejercicio físico en los principales desenlaces clínicos en pacientes con EP. Métodos. Se consultaron las bases de datos MEDLINE, EMBASE, Scopus, CENTRAL y PEDro desde febrero de 1990 hasta febrero de 2014 para identificar Ensayos Clínicos Aleatorizados (ECA) publicados. Además, se examinaron las listas de referencias de otras revisiones y de estudios identificados. La extracción de datos se realizó por dos autores independientes. Se empleó un modelo de efectos aleatorios en presencia de heterogeneidad estadística (I2>50%). El sesgo de publicación fue evaluado mediante el gráfico de embudo. Resultados: Un total de 18 estudios fueron incluidos. Se encontraron diferencias estadísticamente significativas en las intervenciones con ejercicio y las siguientes medidas de resultado, severidad de los síntomas motores (MDS-UPDRS) DME 1.44, IC 95% [-2.09 a -0.78] (p<0.001) I2= 87,9% y el equilibrio DME 0,52 IC 95% [0,30 a 0,74] (p<0.001) I2= 85,6%. En el análisis de subgrupos en la modalidad de ejercicio aeróbico, en MDS-UPDRS DME -1,28, IC 95% [-1,98 a -0,59] (p<0.001), 3 calidad de vida DME -1,91 IC 95% [-2,76 a -1,07] (p<0.001), equilibrio DME 0,54 IC 95% [0,31 a 0,77] (p<0.001), 10-m WT DME 0,15 IC 95% [0,06 a 0,25] (p<0.001) y Vo2 máximo DME -1,09 IC 95% [-1,31 a -0,88] (p=0.001), 6MWT DME 40,46 IC 95% [11,28 a 69,65] (p=0.007). Conclusiones: El ejercicio aeróbico produjo mejoras significativas en MDS UPDRS, equilibrio, calidad de vida, 10-m WT y y Vo2 máximo; mientras que el ejercicio combinado mejoró la fuerza.

Resultados de la cirugía laparoscópica comparada con la cirugía abierta en el cáncer colorrectal. Revisión sistemática

Determinar el efecto de la cirugía laparoscópica versus cirugía abierta sobre la supervivencia en el manejo de pacientes del cáncer colorectal.

Gradient-based reinforcement learning techniques for underwater robotics behavior learning

Darrerament, l'interès pel desenvolupament d'aplicacions amb robots submarins autònoms (AUV) ha crescut de forma considerable. Els AUVs són atractius gràcies al seu tamany i el fet que no necessiten un operador humà per pilotar-los. Tot i això, és impossible comparar, en termes d'eficiència i flexibilitat, l'habilitat d'un pilot humà amb les escasses capacitats operatives que ofereixen els AUVs actuals. L'utilització de AUVs per cobrir grans àrees implica resoldre problemes complexos, especialment si es desitja que el nostre robot reaccioni en temps real a canvis sobtats en les condicions de treball. Per aquestes raons, el desenvolupament de sistemes de control autònom amb l'objectiu de millorar aquestes capacitats ha esdevingut una prioritat. Aquesta tesi tracta sobre el problema de la presa de decisions utilizant AUVs. El treball presentat es centra en l'estudi, disseny i aplicació de comportaments per a AUVs utilitzant tècniques d'aprenentatge per reforç (RL). La contribució principal d'aquesta tesi consisteix en l'aplicació de diverses tècniques de RL per tal de millorar l'autonomia dels robots submarins, amb l'objectiu final de demostrar la viabilitat d'aquests algoritmes per aprendre tasques submarines autònomes en temps real. En RL, el robot intenta maximitzar un reforç escalar obtingut com a conseqüència de la seva interacció amb l'entorn. L'objectiu és trobar una política òptima que relaciona tots els estats possibles amb les accions a executar per a cada estat que maximitzen la suma de reforços totals. Així, aquesta tesi investiga principalment dues tipologies d'algoritmes basats en RL: mètodes basats en funcions de valor (VF) i mètodes basats en el gradient (PG). Els resultats experimentals finals mostren el robot submarí Ictineu en una tasca autònoma real de seguiment de cables submarins. Per portar-la a terme, s'ha dissenyat un algoritme anomenat mètode d'Actor i Crític (AC), fruit de la fusió de mètodes VF amb tècniques de PG.

Dispositivos Médicos na farmácia comunitária e hospitalar : o contributo e o papel dos farmacêuticos na garantia da utilização segura dos dispositivos

Actualmente, os dispositivos médicos são cada vez mais uma base em que assenta a qualidade de vida na área da saúde, sendo desta forma importante garantir que estes se ajustam à sua função e sejam seguros. Não apresentando qualquer acção a nível farmacológico, metabólico ou imunológico, mecanismo de acção atribuído aos medicamentos, auxiliam directa ou indirectamente o homem no tratamento ou prevenção de doenças e estados de saúde actuando por meios físicos ou mecânicos. Estes podem ser importantes no diagnóstico, prevenção, monitorização, tratamento ou alívio de uma doença ou ferimento; em investigação, substituição, modificação de um processo fisiológico e no controlo da concepção. Tendo um papel tão relevante na saúde dos doentes, é essencial que haja uma supervisão directa por parte dos profissionais de saúde, nomeadamente os farmacêuticos. Hoje em dia, devido ao facto de cada vez mais doentes quererem diagnosticar e controlar as suas próprias condições médicas, o papel do farmacêutico é cada vez mais importante porque está envolvido directamente na sua supervisão e dispensa. Para além disso, o farmacêutico está ligado à aquisição, selecção e fornecimento de numerosos dispositivos médicos que considera mais adequado a cada situação, sendo estes para uso por iniciativa própria ou por outros profissionais de saúde.

Current Trends in Hearing Assistance Technology

A survey was distributed to practicing audiologists regarding the dispensing trends of Hearing Assistance Technology. Sixty-one responses were collected and analyzed revealing significant trends in HAT dispensing.

A Newton method for pose refinement of 3D models

Different optimization methods can be employed to optimize a numerical estimate for the match between an instantiated object model and an image. In order to take advantage of gradient-based optimization methods, perspective inversion must be used in this context. We show that convergence can be very fast by extrapolating to maximum goodness-of-fit with Newton's method. This approach is related to methods which either maximize a similar goodness-of-fit measure without use of gradient information, or else minimize distances between projected model lines and image features. Newton's method combines the accuracy of the former approach with the speed of convergence of the latter.

Quality of medicines stored together in multi-compartment compliance aids

Background and Objective: Dispensing medicines into compliance aids is a common practice in pharmacy contrary to manufacturers’ advice and studies have shown the appearance of light-sensitive tablets is compromised by such storage; we previously found evidence of reduced bioavailability at elevated temperature and humidity. Our objective was to examine the physicochemical stability of two generic atenolol tablets in different compliance aids and with aspirin co-storage at room temperature and at 40 °C/75% relative humidity. Methods: The physicochemical stability of atenolol tablets was evaluated after 28 days of storage and compared with controls by examining visual appearance, weight, disintegration, dissolution, friability and hardness to accepted standards and using a previously validated HPLC method for chemical assay. Results and Discussion: The response to storage was brand-dependent and not straightforward. With one make of atenolol (Alpharma), storage in compliance aids even at room temperature impacted on physical stability, reducing tablet hardness, with storage in Dosett® exerting a greater impact than storage in Medidos® (t-test P < 0·001). Co-storage at elevated temperature and humidity also impacted on the appearance of non-coated aspirin tablets (Angette™). The chemical stability of atenolol was not affected and we did not find evidence of changes to bioavailability with either make. Certainly data for one atenolol make (CP Pharmaceuticals) co-stored with aspirin (Angette™ and Nu-Seals) in both compliance aids at room temperature provided evidence of short-term stability. But medicines are dispensed into compliance aids in multi-factorial ways so our study highlights not only the lack of evidence but also a realization that evidence to support real practice may not be accomplished through research. Conclusion: Reassuring practitioners of the continued stability of medicines in compliance aids under the countless condition in which they are dispensed in practice may requires a different approach involving medical device regulators and more definitive professional guidance.

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

Stress-induced changes in the Schizosaccharomyces pombe proteome using two-dimensional difference gel electrophoresis, mass spectrometry and a novel integrated robotics platform

Robotic and manual methods have been used to obtain identification of significantly changing proteins regulated when Schizosaccharomyces pombe is exposed to oxidative stress. Differently treated S. pombe cells were lysed, labelled with CyDye and analysed by two-dimensional difference gel electrophoresis. Gel images analysed off-line, using the DeCyder image analysis software [GE Healthcare, Amersham, UK] allowed selection of significantly regulated proteins. Proteins displaying differential expression were excised robotically for manual digestion and identified by matrix-assisted laser desorption/ionisation - mass spectrometry (MALDI-MS). Additionally the same set of proteins displaying differential expression were automatically cut and digested using a prototype robotic platform. Automated MALDI-MS, peak label assignment and database searching were utilised to identify as many proteins as possible. The results achieved by the robotic system were compared to manual methods. The identification of all significantly altered proteins provides an annotated peroxide stress-related proteome that can be used as a base resource against which other stress-induced proteomic changes can be compared.

Stress-induced changes in the Schizosaccharomyces pombe proteome using two-dimensional difference gel electrophoresis, mass spectrometry and a novel integrated robotics platform

Robotic and manual methods have been used to obtain identification of significantly changing proteins regulated when Schizosaccharomyces pombe is exposed to oxidative stress. Differently treated S. pombe cells were lysed, labelled with CyDye (TM) and analysed by two-dimensional difference gel. electrophoresis. Gel images analysed off-line, using the DeCyder (TM) image analysis software [GE Healthcare, Amersham, UK] allowed selection of significantly regulated proteins. Proteins displaying differential expression were excised robotically for manual digestion and identified by matrix-assisted laser desorption/ionisation - mass spectrometry (MALDI-MS). Additionally the same set of proteins displaying differential expression were automatically cut and digested using a prototype robotic platform. Automated MALDI-MS, peak label assignment and database searching were utilised to identify as many proteins as possible. The results achieved by the robotic system were compared to manual methods. The identification of all significantly altered proteins provides an annotated peroxide stress-related proteome that can be used as a base resource against which other stress-induced proteomic changes can be compared.

Causes of preventable drug-related hospital admissions: a qualitative study

Objective: To explore the causes of preventable drug-related admissions (PDRAs) to hospital. Design: Qualitative case studies using semi-structured interviews and medical record review; data analysed using a framework derived from Reason's model of organisational accidents and cascade analysis. Participants: 62 participants, including 18 patients, 8 informal carers, 17 general practitioners, 12 community pharmacists, 3 practice nurses and 4 other members of healthcare staff, involved in events leading up to the patients' hospital admissions. Setting: Nottingham, UK. Results: PDRAs are associated with problems at multiple stages in the medication use process, including prescribing, dispensing, administration, monitoring and help seeking. The main causes of these problems are communication failures ( between patients and healthcare professionals and different groups of healthcare professionals) and knowledge gaps ( about drugs and patients' medical and medication histories). The causes of PDRAs are similar irrespective of whether the hospital admission is associated with a prescribing, monitoring or patient adherence problem. Conclusions: The causes of PDRAs are multifaceted and complex. Technical solutions to PDRAs will need to take account of this complexity and are unlikely to be sufficient on their own. Interventions targeting the human causes of PDRAs are also necessary - for example, improving methods of communication.

Cooperative transport of extended payloads

In this paper we present experimental results for the dual robot transport of an extended payload. Two robotic rovers that were designed specifically for the extended payload transport task are described. Each rover incorporates a 4-DOF robot arm incorporating three active joints (one of which is a gripper), a passive wrist, and a mobile base which employs a rocker-bogie design. A set of behaviours has been developed to support the performance of the task, integrating simple sensing with controls. We describe the behaviours and their integration within the overall task structure. The experimental results presented focus on the manipulation elements of the task, but incorporate a complete cycle of pick-up, traversal, and putdown.

Design and development of a dextrous manipulator

This paper develops a novel method of actuation for robotic hands. The solution employs Bowden cable routed to each joint as the means by which the finger is actuated. The use of Bowden cable is shown to be feasible for this purpose, even with the changing frictional forces associated with it's use. This method greatly simplifies the control of the hand by removing the coupling between joints, and allows for direct and accurate translation between the joints and the motors driving the Bowden wires. The design also allows for two degrees of freedom (with the same centre of rotation) to be realised in the largest knuckle of each finger, meaning biological finger kinematics are more accurately emulated.

Design of redundant drive joint with adjustable stiffness and damping mechanism to improve joint admittance

Improving admittance of robotic joints is the key issue for making rehabilitation robots safe. This paper describes a design of Redundant Drive Joint (RD-Joint) which allows greater flexibility in the design of robotic mechanisms. The design strategy of the RD-Joint employs a systematic approach which consists of 1) adopting a redundant joint mechanism with internal kinematical redundancy to reduce effective joint inertia, and 2) adopting an adjustable admittance mechanism with a novel Cross link Reduction Mechanism and mechanical springs and dampers as a passive second actuator. First, the basic concepts used to construct the redundant drive joint mechanism are explained, in particular the method that allows a reduction in effective inertia at the output joint. The basic structure of the RD-Joint is introduced based on the idea of reduced inertia along with a method to include effective stiffness and damping. Then, the basic design of the adjustable admittance mechanism is described. Finally, a prototype of RD-joint is described and its expected characteristics are discussed.

Building reliable systems for space applications using swarm-array computing

Space applications demand the need for building reliable systems. Autonomic computing defines such reliable systems as self-managing systems. The work reported in this paper combines agent-based and swarm robotic approaches leading to swarm-array computing, a novel technique to achieve self-managing distributed parallel computing systems. Two swarm-array computing approaches based on swarms of computational resources and swarms of tasks are explored. FPGA is considered as the computing system. The feasibility of the two proposed approaches that binds the computing system and the task together is simulated on the SeSAm multi-agent simulator.