Performance recovery from exercise: A review from a statistical point of view

Background. Research into methods for recovery from fatigue due to exercise is a popular topic among sport medicine, kinesiology and physical therapy. However, both the quantity and quality of studies and a clear solution of recovery are lacking. An analysis of the statistical methods in the existing literature of performance recovery can enhance the quality of research and provide some guidance for future studies. Methods: A literature review was performed using SCOPUS, SPORTDiscus, MEDLINE, CINAHL, Cochrane Library and Science Citation Index Expanded databases to extract the studies related to performance recovery from exercise of human beings. Original studies and their statistical analysis for recovery methods including Active Recovery, Cryotherapy/Contrast Therapy, Massage Therapy, Diet/Ergogenics, and Rehydration were examined. Results: The review produces a Research Design and Statistical Method Analysis Summary. Conclusion: Research design and statistical methods can be improved by using the guideline from the Research Design and Statistical Method Analysis Summary. This summary table lists the potential issues and suggested solutions, such as, sample size calculation, sports specific and research design issues consideration, population and measure markers selection, statistical methods for different analytical requirements, equality of variance and normality of data, post hoc analyses and effect size calculation.^

Adherence to adjuvant chemotherapy and post-treatment surveillance in a large community-based cohort of patients with colon cancer

The objective of this dissertation was to determine the initiation and completion rates of adjuvant chemotherapy, its toxicity and the compliance rates of post-treatment surveillance for elderly patients with colon cancer using the linked Surveillance, Epidemiology, and End Results – Medicare database.^ The first study assessed the initiation and completion rate of 5-fluorouracil-based adjuvant chemotherapy and its relationship with patient characteristics. Of the 12,265 patients diagnosed with stage III colon adenocarcinoma in 1991-2005, 64.4% received adjuvant chemotherapy within 3-months after tumor resection and 40% of them completed the treatment. Age, marital status, and comorbidity score were significant predictors for chemotherapy initiation and completion.^ The second study estimated the incidence rate of toxicity-related endpoints among stage III colon adenocarcinoma patients treated with chemotherapy in 1991-2005. Of the 12,099 patients, 63.9% underwent chemotherapy and had volume depletion disorder (3-month cumulative incidence rate [CIR]=9.1%), agranulocytosis (CIR=3.4%), diarrhea (CIR=2.4%), nausea and vomiting (CIR=2.3%). Cox regression analysis confirmed such association (HR=2.76; 95% CI=2.42-3.15). The risk of ischemic heart diseases was slightly associated with chemotherapy (HR=1.08), but significantly among patients aged <75 with no comorbidity (HR=1.70). ^ The third study determined the adherence rate of follow-up cares among patients diagnosed with stage I-III colon adenocarcinoma in 2000 - June 2002. We identified 7,348 patients with a median follow-up of 59 months. The adherence rate was 83.9% for office visits, 29.4% for CEA tests, and 74.3% for colonoscopy. Overall, 25.2% met the recommended post-treatment care. Younger age at diagnosis, white race, married, advanced stage, fewer comorbidities, and chemotherapy use were significantly associated with guideline adherence.^ In conclusions, not all colon cancer patients received chemotherapy. Receiving chemotherapy was associated with increased risk of developing gastrointestinal, hematological and cardiac toxicities. Patients were more likely to comply with the schedule for office visits and colonoscopy but failed in CEA tests. ^

Detecting genetic and nutritional lung cancer risk factors related to folate metabolism using Bayesian generalized linear models

Complex diseases, such as cancer, are caused by various genetic and environmental factors, and their interactions. Joint analysis of these factors and their interactions would increase the power to detect risk factors but is statistically. Bayesian generalized linear models using student-t prior distributions on coefficients, is a novel method to simultaneously analyze genetic factors, environmental factors, and interactions. I performed simulation studies using three different disease models and demonstrated that the variable selection performance of Bayesian generalized linear models is comparable to that of Bayesian stochastic search variable selection, an improved method for variable selection when compared to standard methods. I further evaluated the variable selection performance of Bayesian generalized linear models using different numbers of candidate covariates and different sample sizes, and provided a guideline for required sample size to achieve a high power of variable selection using Bayesian generalize linear models, considering different scales of number of candidate covariates. ^ Polymorphisms in folate metabolism genes and nutritional factors have been previously associated with lung cancer risk. In this study, I simultaneously analyzed 115 tag SNPs in folate metabolism genes, 14 nutritional factors, and all possible genetic-nutritional interactions from 1239 lung cancer cases and 1692 controls using Bayesian generalized linear models stratified by never, former, and current smoking status. SNPs in MTRR were significantly associated with lung cancer risk across never, former, and current smokers. In never smokers, three SNPs in TYMS and three gene-nutrient interactions, including an interaction between SHMT1 and vitamin B12, an interaction between MTRR and total fat intake, and an interaction between MTR and alcohol use, were also identified as associated with lung cancer risk. These lung cancer risk factors are worthy of further investigation.^

Social and economically influenced factors associated with breast cancer treatment among blacks and whites. A qualitative study

Background: Despite the fact breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. A part of these disparities may be due to either inadequately following guideline recommended treatment or treatment delays. Although racial/ethnic disparities in breast cancer treatment and mortality have been extensively documented, the mechanisms by which these disparities occur remain largely unknown. Social and economically influenced factors such as choice of providers, distance of treatment facility, transportation, health insurance, and job related factors may also contribute to racial differences in breast cancer treatment; however, these have not been explored sufficiently in previous research. ^ Aim: The purpose of this study was to evaluate the role of social and economically influenced factors that may contribute to racial disparities in the receipt of guideline recommended treatment using the Health Disparities Model. ^ Methods: In this qualitative comparative case study, data from medical records, structured telephone interviews, and in-depth patient interviews explored the relationship between social and economically influenced factors and breast cancer treatment. Transcripts were analyzed using standard iterative process followed by immersion/crystallization approach. Participants were identified through rapid ascertainment from the New Jersey Cancer Registry and this study included 8 African-American and 8 white women aged 20-85 years old diagnosed with early stage breast cancer between 2003-2007, matched on age, race, and physician recommended treatment. ^ Results: We did not identify differences by race in factors that influenced the receipt of breast cancer treatment among the individual matched pairs. Four prominent themes emerged among women from both groups who experienced similar difficulties influenced by socioeconomic factors. Choice of providers, distance of facility, health insurance, and job related factors all contributed to breast cancer treatment experience among these women. Conclusions: We identified common issues influenced by socioeconomic factors and its relation with the receipt of breast cancer treatment, regardless of race. However, more research is needed to study the additional factors conveying racial differences affecting breast cancer treatment. ^

Assessing the patterns of colorectal cancer treatment, adherence to treatment guidelines and survival in Texas

Colorectal cancer (CRC) is the third leading cancer in both incidence and mortality in Texas. This study investigated the adherence of CRC treatment to standard treatment guidelines and the association between standard treatment and CRC survival in Texas. The author used Texas Cancer Registry (TCR) and Medicare linked data to study the CRC treatment patterns and factors associated with standard treatment in patients who were more than 65 years old and were diagnosed in 2001 through 2007. We also determined whether adherence to standard treatment affect patients' survival. Multiple logistic regression and Cox regression analysis were used to analyze our data. Both regression models are adjusted for demographic characteristics and tumor characteristics. We found that for the 3977 regional colon cancer patients 80 years old or younger, 60.2% of them received chemotherapy, in adherence to the recommended treatment guidelines. People with younger age, female gender, higher education and lower comorbidity score are more likely adherent to this surgery guideline. Patients' adherence to chemotherapy in this cohort have better survival compared to those who are not (HR: 0.76, 95% CI: 0.68-0.84). For the 12709 colon cancer patients treated with surgery, 49.3% have more than 12 lymph nodes removed, in adherence to the treatment guidelines. People with younger age, female gender, higher education, regional stage, lager tumor size and lower comorbidity score are more likely to adherent to this surgery guideline. Patients with more than 12 lymph nodes removed in this cohort have better survival (HR: 0.86, 95% CI: 0.82-0.91). For the 1211 regional rectal cancer patients 80 years old or younger, 63.2% of them were adherent to radiation treatment. People with smaller tumor size and lower comorbidity score are more likely to adherent to this radiation guideline. There is no significant survival difference between radiation adherent patients and non-adherent patients (HR: 1.03, 95% CI: 0.82-1.29). For the 1122 regional rectal cancer patients 80 years old or younger who were treated with surgery, 76.0% of them received postoperative chemotherapy, in adherence to the treatment guidelines. People with younger age and smaller comorbidity score are related with higher adherence rate. Patients adherent with adjuvant chemotherapy in this cohort have better survival than those were not adherent (HR: 0.60, 95% CI: 0.45-0.79).^

Dieta de verano de bovinos pastoreando en bosques de lenga (Nothofagus pumilio) y mallines de Chubut, Argentina

Se determinó la composición de la dieta de verano de bovinos pastoreando en sistemas formados por bosques de Nothofagus pumilio (lenga) y mallines, del noroeste del Chubut. Se estimó la disponibilidad forrajera de los mallines y del sotobosque mediante cortes de biomasa aérea, y se determinó la composición dietaria mediante análisis microhistológico de heces. La dieta está integrada principalmente por especies de gramíneas y graminoides, que disminuyeron su frecuencia al final del verano, mientras que los renovales de lenga y otras especies leñosas la aumentaron. El ganado selecciona gramíneas en ambos períodos, y al final del verano también los renovales de lenga. La ganadería constituye una importante y creciente forma de subsistencia para los pobladores rurales del noroeste del Chubut. Este trabajo aporta elementos para avanzar en la búsqueda de herramientas que permitan la sustentabilidad de los bosques de lenga.

Historiografía didáctica brasileña en el siglo XIX : Joaquim Manuel de Macedo y sus Lecciones

El Proceso de Independencia brasileño ocurrido en 1822 ha impuesto a la intelectualidad de la Nación recién Formada la Necesidad de Pensar y Construir su Historia Relación pecado con los designios de Portugal. Dos Espacios concibieron e irradiaron los Conocimientos Acerca de la Historia brasileña: el Colegio de Pedro II (1837) y el Instituto Histórico y Geográfico Brasileño (1838). En ESE contexto Joaquim Manuel de Macedo escribio la obra "Liçoes de Historia do Brasil" (1861) Presentando ONU Método para Enseñar y estudiar la Historia Nacional. Propongo En Esta Reflexión ONU Diálogo con la historiografía didáctica brasileña en el siglo XIX desde la Obra "Liçoes" de Macedo y Tomando Como directriz los Contenidos Relacionados a la Guerra del Paraguay.

Historiografía didáctica brasileña en el siglo XIX : Joaquim Manuel de Macedo y sus Lecciones

El Proceso de Independencia brasileño ocurrido en 1822 ha impuesto a la intelectualidad de la Nación recién Formada la Necesidad de Pensar y Construir su Historia Relación pecado con los designios de Portugal. Dos Espacios concibieron e irradiaron los Conocimientos Acerca de la Historia brasileña: el Colegio de Pedro II (1837) y el Instituto Histórico y Geográfico Brasileño (1838). En ESE contexto Joaquim Manuel de Macedo escribio la obra "Liçoes de Historia do Brasil" (1861) Presentando ONU Método para Enseñar y estudiar la Historia Nacional. Propongo En Esta Reflexión ONU Diálogo con la historiografía didáctica brasileña en el siglo XIX desde la Obra "Liçoes" de Macedo y Tomando Como directriz los Contenidos Relacionados a la Guerra del Paraguay.

Historiografía didáctica brasileña en el siglo XIX : Joaquim Manuel de Macedo y sus Lecciones

El Proceso de Independencia brasileño ocurrido en 1822 ha impuesto a la intelectualidad de la Nación recién Formada la Necesidad de Pensar y Construir su Historia Relación pecado con los designios de Portugal. Dos Espacios concibieron e irradiaron los Conocimientos Acerca de la Historia brasileña: el Colegio de Pedro II (1837) y el Instituto Histórico y Geográfico Brasileño (1838). En ESE contexto Joaquim Manuel de Macedo escribio la obra "Liçoes de Historia do Brasil" (1861) Presentando ONU Método para Enseñar y estudiar la Historia Nacional. Propongo En Esta Reflexión ONU Diálogo con la historiografía didáctica brasileña en el siglo XIX desde la Obra "Liçoes" de Macedo y Tomando Como directriz los Contenidos Relacionados a la Guerra del Paraguay.

Durabilidad de los bloques de tierra comprimida : Evaluación y recomendaciones para la normalización de los ensayos de erosión y absorción

La presente tesis continúa una línea de investigación iniciada en el 2006, centrada en el estudio de nuevas soluciones constructivas que toman la tierra cruda como base. Se pretende la difusión de los resultados obtenidos con el fin de fomentar estas técnicas constructivas, como por ejemplo, los sistemas de eco-construcción. El empleo de tierra cruda como sistema constructivo presenta grandes ventajas; entre ellas, un bajo impacto medioambiental, la capacidad de integración en el paisaje y un menor consumo energético. Con el fin de superar los inconvenientes que presenta el empleo de la tierra como elemento constructivo y afianzar su valor como posible material para la edificación, se estudian las propiedades de durabilidad de la misma y se dan pautas para una posible normativa futura. Se ha llevado a cabo un análisis exhaustivo de las normativas internacionales, estudiando los ensayos propuestos por los diferentes Organismos Internacionales de Normalización para caracterizar la durabilidad de los materiales de tierra. Ante la gran diversidad y heterogeneidad de las especificaciones encontradas en los ensayos que se aplican para un mismo fin, se han desarrollado dispositivos lo suficientemente versátiles para la ejecución de los ensayos propuestos. El conjunto de ensayos desarrollados en esta tesis, ha permitido elaborar una guía de recomendaciones para ensayos aplicados a materiales de tierra cruda. Además, se han estudiado las diferencias de comportamiento de los bloques de tierra comprimidos (BTC) fabricados en España, evaluando su viabilidad como material de construcción. Esta tesis ayuda a consolidar el papel de la tierra cruda en el panorama de edificación actual, solventando las dudas de los técnicos en cuanto a la durabilidad frente al agua y ausencia de normativa. Por tanto, las conclusiones sobre ensayos de durabilidad en materiales de tierra y las mejoras propuestas en algunos ensayos, sirven de referencia para la determinación de la durabilidad en los materiales basados en tierra cruda. De igual manera, es también un objetivo de la tesis que los resultados obtenidos aporten una visión general del estado normativo de los materiales a base de tierra cruda e información útil a aportar para la elaboración de documentos reconocidos sobre tierra en nuestro país, concretamente, apoyando la labor de normalización llevada a cabo en el subcomité de AENOR. This thesis continues a research line begun in 2006, focused on the study of new building solutions based on unbaked earth. With the aim to promote these construction techniques, it seeks the diffusion of the result obtained, for example eco-building systems. The use of unbaked earth as building system has great advantages such as low environmental impact, integrate ability into the landscape and lower energy consumption. In order to overcome the disadvantages of the use of earth as a building element and consolidate its value as possible building material, it is studied the properties of its durability and it is given guidelines for possible future standard. It has carried out an exhaustive analysis of international standards, studying the tests proposed by several International Organizations of Standards in order to characterize the durability of earth materials. Because of the great diversity and heterogeneity of the specifications found in the tests that are applied for the same purpose, we have developed devices versatile enough for the implementation of the proposed tests. The set of developed tests in this thesis has allowed developing a recommendation guideline for tests applied to unbaked earth materials. In addition, we have studied the differences of behavior of compressed earth blocks (CEB) manufactured in Spain, evaluating its viability as building material. This thesis helps to consolidate the role of unbaked earth in the scene of current building, solving the doubts of technicians about durability against rain and lack of standard. Therefore, the conclusions of durability tests in earth materials and the proposed improvements in some tests, serve as a reference for determining the durability of the materials based on raw earth. In the same way, it is also an objective of the thesis that the obtained results provide an overview of standards status of materials based on unbaked earth and useful information for the development documents recognized on earth in our country, supporting the standardization that is taking place at the subcommittee AENOR.

The use of the ESS Bilbao installations for laser fusion studies

In this work the use of ESS-Bilbao fast neutron lines for irradiation of materials for nuclear fusion is studied. For the comparison of ESS-Bilbao with an inertial fusion facility a simplified model of HiPER chamber has been used. Several positions for irradiation at ESS-Bilbao have been also compared. The material chosen for the damage analysis is silica due to its importance on IFC optics. In this work a detailed comparison between the two facilities for silica irradiation is given. The comparison covers the neutron fluxes, doses, defect production and PKA spectra. This study is also intended as a methodological approach or guideline for future works on other materials.

Vulnerabilidad sísmica en Puerto Príncipe, Haití. Escala Macrosísmica Haitiana.

Haití, es un país claramente prioritario como receptor de cooperación para el desarrollo. Tras el terremoto del 12 de enero de 2010, se ha desarrollado un Proyecto de Cooperación Interuniversitaria entre la Universidad del Estado de Haití y la Universidad Politécnica de Madrid, financiado por la Agencia Española de Cooperación Internacional para el Desarrollo.El proyecto consiste en la formación y capacitación de los técnicos Haitianos para reconstruir su país. Se está trabajando en la creación de una escala macrosísmica Haitiana, partiendo como base de la Escala Macrosísmica Europea 1998. En este sentido, se hace un análisis exhaustivo de toda la documentación técnica y científica existente hasta la fecha sobre tipos de edificios, clases de vulnerabilidad y grados de daños dependiendo del tipo de edificio. Como caso de estudio se aplica en la ciudad de Puerto Príncipe.En primer lugar se ha clasificado el parque inmobiliario de Puerto Príncipe en diferentes tipologías constructivas, tras un trabajo de campo y teniendo en cuenta las guías de auto-construcción y reparación de edificios publicadas por el Ministerio de Obras Públicas, Transporte y Comunicaciones de Haití. (MTPTC).En el estudio de la vulnerabilidad, además del tipo de estructura de los edificios, se tiene en cuenta la habitabilidad básica que debe tener todo asentamiento humano, analizando no sólo el edificio, sino todo el entorno externo de espacios públicos, infraestructuras, dotaciones y servicios que, en conjunto,conforman el núcleo de cada población y permiten el funcionamiento eficiente del sistema de asentamientos del territorio habitado; pues, en última instancia, dicho territorio construido es el que mejor acota los riesgos ante la vulnerabilidad material y más garantiza la vida saludable de las personas. Los parámetros estudiados son: urbanísticos (anchos de vías, dimensiones de manzanas, trazado, infraestructuras,...), geológicos (estudios del efecto local e identificación de las fallas activas respecto a la edificación) y topográficos (implantación del edificio en zonas llanas, en laderas...). En último lugar, con todos estos datos y los daños registrados en el terremoto de enero de 2010, se hace una escala de intensidades macrosísmica y un plano de ordenación de la vulnerabilidad en Puerto Príncipe, que sirva de base a las autoridades haitianas para la planificación urbanística y la reconstrucción, mitigando de esta manera el riesgo símico. SUMMARY Haiti is a clear priority country as a recipient of development cooperation. After the earthquake of January 12, 2010, an Inter-University Cooperation Project has been developed between the State University of Haiti and the Polytechnic University of Madrid, funded by the Spanish Agency for International Development.The project consists of training and qualifying Haitian technicians to rebuild their country. We are currently working on the creation of a Haitian Macroseismic Scale,based on the European Macroseismic Scale 1998.For the accomplishment of this goal, a comprehensive (deep) analysis is being held, going through all the scientific and technical documentation to date, related to building types, kinds of vulnerability and degrees/ levels of damage depending on the type of building. As a case study, this has been applied to the city of Port-au-Prince.First of all, we have classified the housing typology of Port-au-Prince in different construction types, after carrying on field work in this area and keeping in mind the guidelines for self-construction and repairment of buildings published by the Ministry of Work, Transport and Communications of Haiti. (MTPTC).Regarding the study of vulnerability, besides the type of structure of the buildings, we take into account the basic habitability every human settlement should have, analyzing not only the building, but all the external environment of public spaces,infrastructures, amenities and services, which, as a whole, shape the core of each population and allow the efficient functioning of the settlement system on the inhabited territory. It is this territory,ultimately, the one that better narrows the risks when facing material vulnerability and that better ensures a healthy life for people. The studied parameters are: urban (lane width, block dimensions, layout, infrastructure...), geological (studies focusing on local effects and identification of the active faults in relation to the building) and topographical (implementation of the building on flat areas, slopes...)Finally, with all this data (information) and the registered damages related to the earthquake occurred in 2010, we create a Macroseismic Intensity Scale and a Management Plan of the vulnerability in Port-au-Prince. They will serve as a guideline for Haitians authorities in the urban planning and reconstruction, thus reducing seismic risk.

Parallel workflows to personalize clinical guidelines recommendations: application to gestational diabetes mellitus

The MobiGuide system provides patients with personalized decision support tools, based on computerized clinical guidelines, in a mobile environment. The generic capabilities of the system will be demonstrated applied to the clinical domain of Gestational Diabetes (GD). This paper presents a methodology to identify personalized recommendations, obtained from the analysis of the GD guideline. We added a conceptual parallel part to the formalization of the GD guideline called "parallel workflow" that allows considering patient?s personal context and preferences. As a result of analysing the GD guideline and eliciting medical knowledge, we identified three different types of personalized advices (therapy, measurements and upcoming events) that will be implemented to perform patients? guiding at home, supported by the MobiGuide system. These results will be essential to determine the distribution of functionalities between mobile and server decision support capabilities.

Predicción del remonte extremo en playas : aplicación a los sectores litorales de la costa española

El remonte extremo o remonte del 2% es un parámetro clave en la ingeniería costera dado que permite acometer actuaciones en las playas bajo criterios de sostenibilidad económico y socioambiental. Estas actuaciones van desde el diseño de estructuras en el trasdós de la playa a planes de actuación urbanística en la costa tal que se determine adecuadamente los límites de dominio público. El adecuado diseño de estas actuaciones adquiere más relevancia hoy en día debido a las nuevas amenazas que se ponen de relieve debido al cambio climático, y que en el caso concreto de la costa se materializa en inundaciones que provocan pérdidas económicas. Estudios precedentes han realizado ensayos in situ o en modelo físico para la determinación del remonte extremo en playas. Al comparar estas formulaciones la dispersión es alta lo que implica que la precisión en la obtención del remonte no sea suficiente. Esta dispersión se justifica debido al amplio espectro de playas existentes y la alta variabilidad del clima marítimo. Este problema cobra más relevancia debido a las actuaciones preventivas o correctivas a acometer frente al cambio climático bajo un criterio de sostenibilidad. Con el fin de realizar actuaciones sostenibles bajo el contexto actual del probable aumento de inundaciones costeras por cambio climático no deben obtenerse ni magnitudes sobredimensionadas con el consecuente consumo de recursos y afección a las actividades económicas, ni magnitudes subestimadas que pongan en riesgo la estabilidad y/o la funcionalidad de las actuaciones para un periodo de diseño. El principal objetivo de esta tesis es proponer una formulación de aplicación en la obtención del remonte extremo tal que se cumplan los criterios de seguridad para el servicio y funcionalidad de la obra y los criterios de sostenibilidad económico y socio-ambiental que se requieren hoy en día. Es decir, una fórmula que no sobredimensione el cálculo de este valor pero que pueda cubrir la casuística que acontece en las distintas tipologías de playas. Complementariamente a este objetivo se ejemplifica la aplicación de estas formulaciones en casos reales tal que se reduzca la incertidumbre y ambigüedad en la obtención de las variables independientes de las formulaciones. Para la consecución de estos objetivos se realiza un estado del arte en el que se estudia tanto los estudios estadísticos en la obtención de este parámetro como los modelos numéricos propuestos para ello, tal que se deduzca la mejor línea de investigación en la consecución del fin de esta tesis. Tras este estudio del arte se concluye que la mejor línea de investigación sigue la vía estadística y se diseña un modelo físico con fondo de arena en contraste con modelos físicos con fondo impermeable fijo. Los resultados de dicho modelo se han comparado con las formulaciones precedentes y se proponen las fórmulas de aplicación más convenientes para la obtención del remonte extremo. Complementariamente a la propuesta de formulaciones se desarrolla una metodología de aplicación de dichas formulaciones a casos de la costa española que ejemplifican convenientemente su uso para una adecuada predicción de este valor en las playas. The extreme runup is a key parameter in coastal management. This parameter allows to develop sustainability actions at the coast that meet economical and environmental criteria. At the coast the actions can be either design of structures at the shore or actions plans delimiting reclamation areas. The climate change has given more relevance to accomplish an appropriate design for the coastal management actions. At the coast the threaten are mainly focused on more frequent floods that cause economic losses. Previous studies have carried out field or physical model experiments to accomplish an equation for the extreme runup prediction. Although dispersion remains high when comparing the different proposals so the accuracy in the prediction might be risky. This scattering comes from the wide sort of beaches and the high variability of the maritime climate. The new actions that are needed to develop to counteract the effects of the climate change need a more efficient criteria. Hence formulations should not overestimate or underestimate the values of the extreme runup. The overestimation implies to consume resources that are not needed and the underestimation means in a structure risk to support safely the loads. The main goal of this thesis is to propose a formulation for the extreme runup prediction so the safety of the structure can be accomplished but at the same time the sustainability of the action is ensured under economical and environmental criteria that are demanded nowadays. So the formulation does not overestimate the extreme value but cover with enough confidence the different sort of beaches. The application of the formulation is also explained in order to reduce uncertainty when the input values are obtained. In order to accomplish the goal of this research firstly a literature review is done. Statistical and numerical models are studied. The statistical model is selected as the most convenient research guideline. In order to obtain runup results a physical model with sand bed is carried out. The bed differs from those that used impermeable slope in previous experiments. Once the results are obtained they are compared with the previous equations and a final formulation is proposed. Finally a methodology to apply the deduced formulation to the Spanish beaches is addressed.

Patient-oriented computerized clinical guidelines for mobile decision support in gestational diabetes

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients’ self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient’s access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients’ personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients’ acceptance of the whole system.