Total disc arthroplasty versus anterior cervical interbody fusion: use of the Spine Tango registry to supplement the evidence from randomized control trials.

BACKGROUND CONTEXT Several randomized controlled trials (RCTs) have compared patient outcomes of anterior (cervical) interbody fusion (AIF) with those of total disc arthroplasty (TDA). Because RCTs have known limitations with regard to their external validity, the comparative effectiveness of the two therapies in daily practice remains unknown. PURPOSE This study aimed to compare patient-reported outcomes after TDA versus AIF based on data from an international spine registry. STUDY DESIGN AND SETTING A retrospective analysis of registry data was carried out. PATIENT SAMPLE Inclusion criteria were degenerative disc or disc herniation of the cervical spine treated by single-level TDA or AIF, no previous surgery, and a Core Outcome Measures Index (COMI) completed at baseline and at least 3 months' follow-up. Overall, 987 patients were identified. OUTCOME MEASURES Neck and arm pain relief and COMI score improvement were the outcome measures. METHODS Three separate analyses were performed to compare TDA and AIF surgical outcomes: (1) mimicking an RCT setting, with admission criteria typical of those in published RCTs, a 1:1 matched analysis was carried out in 739 patients; (2) an analysis was performed on 248 patients outside the classic RCT spectrum, that is, with one or more typical RCT exclusion criteria; (3) a subgroup analysis of all patients with additional follow-up longer than 2 years (n=149). RESULTS Matching resulted in 190 pairs with an average follow-up of 17 months that had no residual significant differences for any patient characteristics. Small but statistically significant differences in outcome were observed in favor of TDA, which are potentially clinically relevant. Subgroup analyses of atypical patients and of patients with longer-term follow-up showed no significant differences in outcome between the treatments. CONCLUSIONS The results of this observational study were in accordance with those of the published RCTs, suggesting substantial pain reduction both after AIF and TDA, with slightly greater benefit after arthroplasty. The analysis of atypical patients suggested that, in patients outside the spectrum of clinical trials, both surgical interventions appeared to work to a similar extent to that shown for the cohort in the matched study. Also, in the longer-term perspective, both therapies resulted in similar benefits to the patients.

RELATIONS AMONG REMEMBERED PARENTAL ACCEPTANCE AND BEHAVIORAL CONTROL IN CHILDHOOD, ADULTS' CURRENT PSYCHOLOGICAL ADJUSTMENT, AND CAREER INDECISIVENESS

This study tested the hypothesis that career indecisiveness among men tends to be associated with different levels of self-reported psychological adjustment and with different remembrances of parental (maternal and paternal) acceptance and behavioral control in childhood from those of women. One hundred twenty-six respondents ages 17 through 54 (M = 23.7 years, SD = 8.21 years) participated in this study. Thirty-seven where males; 90 were females. Measures used in this study included the Career Decision Scale, the Adult version of the Parental Acceptance-Rejection/Control Questionnaire for mothers and for fathers, and the Adult version of the Personality Assessment Questionnaire. Both men and women remembered their mothers as well as their fathers as being loving in childhood. Additionally, men and women remembered both parents as being moderately behaviorally controlling in childhood. Finally, both men and women reported a fair level of psychological maladjustment. And on average, both men and women were fairly indecisive about their careers. Results of analyses supported the hypothesis in that career indecisiveness among women but not men was significantly correlated with remembered maternal and paternal acceptance in childhood, as well as with self-reported psychological adjustment and age. However, only women’s self-reported psychological adjustment made a significant and unique contribution to variations in their reports of career indecisiveness. None of the predictor variables were significantly associated with career indecisiveness among men.

Patient-centered medical home technology effects on hypertension and diabetes control

Background: Hypertension and Diabetes is a public health and economic concern in the United States. The utilization of medical home concepts increases the receipt of preventive services, however, do they also increase adherence to treatments? This study examined the effect of patient-centered medical home technologies such as the electronic health record, clinical support system, and web-based care management in improving health outcomes related to hypertension and diabetes. Methods: A systematic review of the literature used a best evidence synthesis approach to address the general question " Do patient-centered medical home technologies have an effect of diabetes and hypertension treatment?" This was followed by an evaluation of specific examples of the technologies utilized such as computer-assisted recommendations and web-based care management provided by the patient's electronic health record. Ebsco host, Ovid host, and Google Scholar were the databases used to conduct the literature search. Results: The initial search identified over 25 studies based on content and quality that implemented technology interventions to improve communication between provider and patient. After further assessing the articles for risk of bias and study design, 13 randomized controlled studies were chosen. All of the studies chosen were conducted in various primary care settings in both private practices and hospitals between the years 2000 and 2007. The sample sizes of the studies ranged from 42 to 2924 participants. The mean age for all of the studies ranged from 56 to 71 years. The percent women in the studies ranged from one to 78 percent. Over one-third of the studies did not provide the racial composition of the participants. For the seven studies that did provide information about the ethnic composition, 64% of the intervention participants were White. All of the studies utilized some type of web-based or computer-based communication to manage hypertension or diabetes care. Findings on outcomes were mixed, with nine out of 13 studies showing no significant effect on outcomes examined, and four of the studies showing significant and positive impact on health outcomes related to hypertension or diabetes Conclusion: Although the technologies improved patient and provider satisfaction, the outcomes measures such as blood pressure control and glucose control were inconclusive. Further research is needed with diverse ethnic and SES population to investigate the role of patient-centered technologies on hypertension and diabetes control. Also, further research is needed to investigate the effects of innovative medical home technologies that can be used by both patients and providers to increase quality of communication concerning adherence to treatments.^

Cost-effectiveness of intensified interventions to control healthcare-associated MRSA infections -- A systematic literature review

Methicillin Resistant Staphylococcus aureus healthcare-associated infections (MRSA HAIs) are a major cause of morbidity in hospitalized patients. They pose great economic burden to hospitals caring for these patients. Intensified Interventions aim to control MRSA HAIs. Cost-effectiveness of Intensified Interventions is largely unclear. We performed a review of cost-effectiveness literature on Intensified Interventions , and provide a summary of study findings, the status of economic research in the area, and information that will help decision-makers at regional level and guide future research.^ We conducted literature search using electronic database PubMed, EBSCO, and The Cochrane Library. We limited our search to English articles published after 1999. We reviewed a total of 1,356 titles, and after applying our inclusion and exclusion criteria selected seven articles for our final review. We modified the Economic Evaluation Abstraction Form provided by CDC, and used this form to abstract data from studies.^ Of the seven selected articles two were cohort studies and the remaining five were modeling studies. They were done in various countries, in different study settings, and with different variations of the Intensified Intervention . Overall, six of the seven studies reported that Intensified Interventions were dominant or at least cost-effective in their study setting. This effect persisted on sensitivity testing.^ We identified many gaps in research in this field. The cost-effectiveness research in the field is mostly composed of modeling studies. The studies do not always clearly describe the intervention. The intervention and infection costs and the sources for these costs are not always explicit or are missing. In modeling studies, there is uncertainty associated with some key model inputs, but these inputs are not always identified. The models utilized in the modeling studies are not always tested for internal consistency or validity. Studies usually test the short term cost-effectiveness of Intensified Interventions but not the long results.^ Our study limitation was the inability to adjust for differences in study settings, intervention costs, disease costs, or effectiveness measures. Our study strength is the presentation of a focused literature review of Intensified Interventions in hospital settings. Through this study we provide information that will help decision makers at regional level, help guide future research, and might change clinical care and policies. ^

La política demográfica del tercer gobierno peronista: justificaciones, repercusiones y resistencias a las restricciones al control de la natalidad (1973-1976)

Desde mediados de la década del '50, el tamaño de la población comenzó a ser considerado en relación a necesidades geopolíticas y proyectos de desarrollo, mientras proliferaban organismos internacionales decididos a influir sobre las conductas reproductivas de los países del Tercer Mundo. En este contexto, Argentina defendió su autonomía e intentó diseñar una política de población que atendiera a su particular situación de caída demográfica. El tercer gobierno peronista incluyó esta problemática en su plan de gobierno y fue más allá de lo discursivo al implementar, por primera vez en el país, medidas coercitivas sobre el libre acceso a la anticoncepción. Estas disposiciones generaron importantes debates sociales que se expresaron en los medios de prensa escrita, al interior de la corporación médica y en las calles, a través del accionar del movimiento feminista y el Frente de Liberación Homosexual. En este artículo nos proponemos iluminar este aspecto poco estudiado por la historiografía, reconstruyendo la cosmovisión de la época sobre el problema demográfico, las contradicciones al interior del gobierno respecto a las medidas a seguir, sus repercusiones y las resistencias que generaron. Consideramos necesario conocer con mayor profundidad este tema y sus perdurables consecuencias negativas en la 'cultura anticonceptiva' del país.

La política demográfica del tercer gobierno peronista: justificaciones, repercusiones y resistencias a las restricciones al control de la natalidad (1973-1976)

Desde mediados de la década del '50, el tamaño de la población comenzó a ser considerado en relación a necesidades geopolíticas y proyectos de desarrollo, mientras proliferaban organismos internacionales decididos a influir sobre las conductas reproductivas de los países del Tercer Mundo. En este contexto, Argentina defendió su autonomía e intentó diseñar una política de población que atendiera a su particular situación de caída demográfica. El tercer gobierno peronista incluyó esta problemática en su plan de gobierno y fue más allá de lo discursivo al implementar, por primera vez en el país, medidas coercitivas sobre el libre acceso a la anticoncepción. Estas disposiciones generaron importantes debates sociales que se expresaron en los medios de prensa escrita, al interior de la corporación médica y en las calles, a través del accionar del movimiento feminista y el Frente de Liberación Homosexual. En este artículo nos proponemos iluminar este aspecto poco estudiado por la historiografía, reconstruyendo la cosmovisión de la época sobre el problema demográfico, las contradicciones al interior del gobierno respecto a las medidas a seguir, sus repercusiones y las resistencias que generaron. Consideramos necesario conocer con mayor profundidad este tema y sus perdurables consecuencias negativas en la 'cultura anticonceptiva' del país.

La política demográfica del tercer gobierno peronista: justificaciones, repercusiones y resistencias a las restricciones al control de la natalidad (1973-1976)

Desde mediados de la década del '50, el tamaño de la población comenzó a ser considerado en relación a necesidades geopolíticas y proyectos de desarrollo, mientras proliferaban organismos internacionales decididos a influir sobre las conductas reproductivas de los países del Tercer Mundo. En este contexto, Argentina defendió su autonomía e intentó diseñar una política de población que atendiera a su particular situación de caída demográfica. El tercer gobierno peronista incluyó esta problemática en su plan de gobierno y fue más allá de lo discursivo al implementar, por primera vez en el país, medidas coercitivas sobre el libre acceso a la anticoncepción. Estas disposiciones generaron importantes debates sociales que se expresaron en los medios de prensa escrita, al interior de la corporación médica y en las calles, a través del accionar del movimiento feminista y el Frente de Liberación Homosexual. En este artículo nos proponemos iluminar este aspecto poco estudiado por la historiografía, reconstruyendo la cosmovisión de la época sobre el problema demográfico, las contradicciones al interior del gobierno respecto a las medidas a seguir, sus repercusiones y las resistencias que generaron. Consideramos necesario conocer con mayor profundidad este tema y sus perdurables consecuencias negativas en la 'cultura anticonceptiva' del país.

Political economy of low sulfurization and air pollution control policy in Japan : SOx emission reduction by fuel conversion

In the early stages of the development of Japan’s environmental policy, sulfur oxide (SOx) emissions, which seriously damage health, was the most important air pollution problem. In the second half of the 1960s and the first half of the 1970s, the measures against SOx emissions progressed quickly, and these emissions were reduced drastically. The most important factor of the reduction was the conversion to a low-sulfur fuel for large-scale fuel users, such as the electric power industry. However, industries started conversion to low-sulfur fuel not due to environmental concerns, but simply to reduce costs. Furthermore, the interaction among the various interests of the electric power industry, oil refineries, the central government, local governments, and citizens over the energy and environmental policies led to the measures against SOx emissions by fuel conversion.

Management of Urban Mobility to Control Climate Change in Cities

The need of decarbonization of urban mobility is one of the main priorities for all countries to achieve greenhouse gas (GHG) emissions reduction targets. In general, the transport modes which have experienced the most growth in recent years tend to be the most polluting. Most efforts have been focused on the vehicle efficiency improvements and vehicle fleet renewal; nevertheless more emphasis should be placed on strategies related to the management of urban mobility and modal share. Research of individual travel which analyzes CO2 emissions and car and public transport share in daily mobility will enable better assessments of the potential of urban mobility measures introduced to limit GHG emissions produced by transport in cities. This paper explores the sustainability impacts of daily mobility in Spain using data from two National Travel Surveys (NTSs) (2000 and 2006) and includes a method by which to estimate the CO2 emissions associated with each journey and each surveyed individual. The results demonstrate that in the 2000 to 2006 period, there has been an increase in daily mobility which has led to a 17% increase in CO2 emissions. When separated by transport mode, cars prove to be the main contributor to that increase, followed by public transport. More focus should be directed toward modal shift strategies which not only take the number of journeys into account but also consider distance. The contributions of this paper have potential applications in the assessment of current and future urban transport policies.

Development of a methodology and tool to evaluate the impact of ICT measures on road transport emissions

The paper presents the main elements of a project entitled ICT-Emissions that aims at developing a novel methodology to evaluate the impact of ICT-related measures on mobility, vehicle energy consumption and CO2 emissions of vehicle fleets at the local scale, in order to promote the wider application of the most appropriate ICT measures. The proposed methodology combines traffic and emission modelling at micro and macro scales. These will be linked with interfaces and submodules which will be specifically designed and developed. A number of sources are available to the consortium to obtain the necessary input data. Also, experimental campaigns are offered to fill in gaps of information in traffic and emission patterns. The application of the methodology will be demonstrated using commercially available software. However, the methodology is developed in such a way as to enable its implementation by a variety of emission and traffic models. Particular emphasis is given to (a) the correct estimation of driver behaviour, as a result of traffic-related ICT measures, (b) the coverage of a large number of current vehicle technologies, including ICT systems, and (c) near future technologies such as hybrid, plug-in hybrids, and electric vehicles. The innovative combination of traffic, driver, and emission models produces a versatile toolbox that can simulate the impact on energy and CO2 of infrastructure measures (traffic management, dynamic traffic signs, etc.), driver assistance systems and ecosolutions (speed/cruise control, start/stop systems, etc.) or a combination of measures (cooperative systems).The methodology is validated by application in the Turin area and its capacity is further demonstrated by application in real world conditions in Madrid and Rome.

Excitación y control de IGBTs de un inversor trifásico sinusoidal

El origen del proyecto se encuentra en la mejora de un inversor trifásico sinusoidal comercial sobre la base del estudio de las técnicas de excitación óptimas para los IGBTs que lo componen en su etapa de potencia. En las primeras fases de planteamiento del proyecto se propone una idea mucho más ambiciosa, la realización de un nuevo convertidor de emergencia, destinado al sector ferroviario, para dar servicio de climatización. Este convertidor está formado por la asociación en cascada de un bloque DC/DC elevador y un bloque inversor DC/AC trifásico controlado mediante PWM con modulación sinusoidal. Se pretendía así dar solución a las siguientes problemáticas detectadas en los convertidores comercializados hasta el momento: un bloque elevador excesivamente sobredimensionado, subsistemas de control independientes para los dos bloques que configuran el convertidor, adicionalmente, la tarjeta driver se rediseña con cada cambio de especificaciones por parte de un nuevo cliente y finalmente, las comunicaciones tanto de diagnosis como de mantenimiento necesitaban una importante actualización. Inicialmente, se ha realizado un estudio teórico de los bloques elevador e inversor para poder realizar el diseño y dimensionamiento de sus componentes tanto semiconductores como electromagnéticos. Una vez completada la parte de potencia, se estudia el control que se realiza mediante medidas directas y simulación tanto de la estrategia de control del elevador como del inversor. Así se obtiene una información completa de la funcionalidad de las tarjetas existentes. Se desea realizar el diseño de una única tarjeta controladora y una única tarjeta de drivers para ambos bloques. Por problemas ajenos, en el transcurso de este proyecto se cancela su realización comercial, con lo que se decide al menos crear la placa de control y poder gobernar un convertidor ya existente, sustituyendo la tarjeta de control del bloque elevador. Para poder fabricar la placa de control se divide en dos tarjetas que irán conectadas en modo sándwich. En una tarjeta está el microcontrolador y en otra está todo el interface necesario para operar con el sistema: entradas y salidas digitales, entradas y salidas analógicas, comunicación CAN, y un pequeño DC/DC comercial que proporciona alimentación al prototipo. Se realiza un pequeño programa funcional para poder manejar el convertidor, el cual con una tensión de 110V DC, proporciona a la salida una tensión de 380V AC. Como ya se ha expuesto, debido a la cancelación del proyecto industrial no se profundiza más en su mejora y se decide proponerlo para su evaluación en su fase actual. ABSTRACT. The beginning of the project is found in the improvement of a commercial sine wave three phase inverter which is based in a study about optimal excitation techniques to IGBTs which compose in the power stage. In the early phases of project it is proposed a much more ambitious idea, the fact of a new emergency converter, proposed for the rail sector to work in an air condition unit. This converter is formed by an association of a block cascaded DC/DC booster and a block DC/AC inverter three-phase controlled by a sine wave modulation PWM. The purposed was to give a solution to following problems detected in commercial converters nowadays: an excessively oversized block boost, independent control subsystems for two blocks that configure the converter. In addition, driver board is redesigned with each specifications change demand it a new customer, and finally, the communications, diagnostic and maintenance that needed a important upgrade. Initially, it has been performed a theoretical study of boost and the inverter blocks to be able to perform the component’s design and the size (semiconductor and electromagnetic fields). Once finished power study, it is analysed the control performed using direct measures and simulation of boost control strategy and inverter. With this it is obtained complete information about existing cards functionality. The project is looking for the design of just one controller card and one drivers´ card for both blocks. By unrelated problems, during the course of this project a commercial realization. So at least its decided to create control board to be able to existing converter, replacing boost block’s control board. To be able to manufacture control board it is divided in two cards connected in sandwiching mode. In a card is microcontroller and in another is all needed interface to operate with the system: digital inputs and outputs, analogical inputs and outputs, CAN communication, and a small DC / DC business that provide power supply to the prototype. It is performed a small functional program to handle the converter, which with an input voltage 110V DC provides an output voltage 380V AC. As already has been exposed, due to industrial project cancellation it is decided no to continue with all improvements and directly to evaluate it in the current phase.

Management of urban mobility to control climate change in cities in Spain

The need to decarbonize urban mobility is one of the main motivations for all countries to achieve reduction targets for greenhouse gas (GHG) emissions. In general, the transport modes that have experienced the most growth in recent years tend to be the most polluting. Most efforts have focused on improvements in vehicle efficiency and on the renewal of vehicle fleets; more emphasis should be placed on strategies related to the management of urban mobility and modal share. Research of individual travel that analyzes carbon dioxide (CO2) emissions and car and public transport share in daily mobility will enable better assessments of the potential of urban mobility measures introduced to limit GHG emissions produced by transport in cities. The climate change impacts of daily mobility in Spain are explored with data from two national travel surveys in 2000 and 2006, and a method for estimating the CO2 emissions associated with each journey and each surveyed individual is provided. The results demonstrate that from 2000 to 2006, daily mobility has increased and has led to a 17% increase in CO2 emissions. When these results are separated by transport mode, cars prove to be the main contributor to that increase, followed by public transport. More focus should be directed toward modal shift strategies, which take into account not only the number of journeys but also the distance traveled. These contributions have potential applications in the assessment of current and future urban transport policies related to low-carbon urban transportation.

Desarrollo de software de control y medida para goniofotómetro de tipo B

El proyecto trata del desarrollo de un software para realizar el control de la medida de la distribución de intensidad luminosa en luminarias LED. En el trascurso del proyecto se expondrán fundamentos teóricos sobre fotometría básica, de los cuales se extraen las condiciones básicas para realizar dicha medida. Además se realiza una breve descripción del hardware utilizado en el desarrollo de la máquina, el cual se basa en una placa de desarrollo Arduino Mega 2560, que, gracias al paquete de Labview “LIFA” (Labview Interface For Arduino”), será posible utilizarla como tarjeta de adquisición de datos mediante la cual poder manejar tanto sensores como actuadores, para las tareas de control. El instrumento de medida utilizado en este proyecto es el BTS256 de la casa GigaHerzt-Optik, del cual se dispone de un kit de desarrollo tanto en lenguaje C++ como en Labview, haciendo posible programar aplicaciones basadas en este software para realizar cualquier tipo de adaptación a las necesidades del proyecto. El software está desarrollado en la plataforma Labview 2013, esto es gracias a que se dispone del kit de desarrollo del instrumento de medida, y del paquete LIFA. El objetivo global del proyecto es realizar la caracterización de luminarias LED, de forma que se obtengan medidas suficientes de la distribución de intensidad luminosa. Los datos se recogerán en un archivo fotométrico específico, siguiendo la normativa IESNA 2002 sobre formato de archivos fotométricos, que posteriormente será utilizado en la simulación y estudio de instalaciones reales de la luminaria. El sistema propuesto en este proyecto, es un sistema basado en fotometría tipo B, utilizando coordenadas VH, desarrollando un algoritmo de medida que la luminaria describa un ángulo de 180º en ambos ejes, con una resolución de 5º para el eje Vertical y 22.5º para el eje Horizontal, almacenando los datos en un array que será escrito en el formato exigido por la normativa. Una vez obtenidos los datos con el instrumento desarrollado, el fichero generado por la medida, es simulado con el software DIALux, obteniendo unas medidas de iluminación en la simulación que serán comparadas con las medidas reales, intentando reproducir en la simulación las condiciones reales de medida. ABSTRACT. The project involves the development of software for controlling the measurement of light intensity distribution in LEDs. In the course of the project theoretical foundations on basic photometry, of which the basic conditions for such action are extracted will be presented. Besides a brief description of the hardware used in the development of the machine, which is based on a Mega Arduino plate 2560 is made, that through the package Labview "LIFA" (Interface For Arduino Labview "), it is possible to use as data acquisition card by which to handle both sensors and actuators for control tasks. The instrument used in this project is the BTS256 of GigaHerzt-Optik house, which is available a development kit in both C ++ language as LabView, making it possible to program based on this software applications for any kind of adaptation to project needs. The software is developed in Labview 2013 platform, this is thanks to the availability of the SDK of the measuring instrument and the LIFA package. The overall objective of the project is the characterization of LED lights, so that sufficient measures the light intensity distribution are obtained. Data will be collected on a specific photometric file, following the rules IESNA 2002 on photometric format files, which will then be used in the simulation and study of actual installations of the luminaire. The proposed in this project is a system based on photometry type B system using VH coordinates, developing an algorithm as the fixture describe an angle of 180 ° in both axes, with a resolution of 5 ° to the vertical axis and 22.5º for the Horizontal axis, storing data in an array to be written in the format required by the regulations. After obtaining the data with the instrument developed, the file generated by the measure, is simulated with DIALux software, obtaining measures of lighting in the simulation will be compared with the actual measurements, trying to play in the simulation the actual measurement conditions .

Salud comunitaria y acción social en el control epidemiológico del tracoma infantil, España (1932-1939)

En el contexto de la endemia tracomatosa que afectó a diversas regiones españolas hasta la década de 1960, se analizan los determinantes epidemiológicos del tracoma infantil y su abordaje desde el modelo de asistencia preventiva que encerraba el concepto de salud comunitaria que se perfiló en el período de entreguerras. La detección precoz de casos, unida a actividades preventivas, educativas, terapéuticas y de inspección, como las que llevaron a cabo las enfermeras visitadoras, contribuyeron al control de la enfermedad. Los resultados reafirman la validez de las estrategias de intervención horizontal de mejora de las condiciones higiénicas y de los factores medioambientales que explicaban la prevalencia del tracoma.

La aplicación de las medidas correctivas de control de la estabilidad presupuestaria y sostenibilidad financiera a las subvenciones

A través del presente trabajo se pretende analizar algunas de las medidas correctivas que sobre la Administración pública impone la LOEPSF. En concreto, la contenida en el art. 20.3 de la citada Ley, que obliga a recabar un informe del Ministerio de Hacienda para la percepción de subvenciones públicas a los entes del sector público integrados en Comunidades Autónomas que no hayan cumplido los objetivos de déficit. El trabajo defiende una interpretación restrictiva del citado precepto sobre la base del análisis del presupuesto de hecho de la norma y su naturaleza de norma sancionadora.