Measurement and correlates of physical activity behavior among older minority women

Research has shown that physical activity serves a preventive function against the development of several major chronic diseases. However, studying physical activity and its health benefits is difficult due to the complexity of measuring physical activity. The overall aim of this research is to contribute to the knowledge of both correlates and measurement of physical activity. Data from the Women On The Move study were used for this study (n = 260), and the results are presented in three papers. The first paper focuses on the measurement of physical activity and compares an alternate coding method with the standard coding method for calculating energy expenditure from a 7-day activity diary. Results indicate that the alternative coding scheme could produce similar results to the standard coding in terms of total activity expenditure. Even though agreement could not be achieved by dimension, the study lays the groundwork for a coding system that saves considerable amount of time in coding activity and has the ability to estimate expenditure more accurately for activities that can be performed at varying intensity levels. The second paper investigates intra-day variability in physical activity by estimating the variation in energy expenditure for workers and non-workers and identifying the number of days of diary self-report necessary to reliably estimate activity. The results indicate that 8 days of activity are needed to reliably estimate total activity for individuals who don't work and 12 days of activity are needed to reliably estimate total activity for those who work. Days of diary self-report required by dimension for those who don't work range from 6 to 16 and for those who work from 6 to 113. The final paper presents findings on the relationship between daily living activity and Type A behavior pattern. Significant findings are observed for total activity and leisure activity with the Temperament Scale summary score. Significant findings are also observed for total activity, household chores, work, leisure activity, exercise, and inactivity with one or more of the individual items on the Temperament Scale. However, even though some significant findings were observed, the overall models did not reveal meaningful associations. ^

Interrelationships between the structural and functional aspects of social relationships, comorbidity and health related quality of life in breast cancer survivors

It is widely acknowledged in theoretical and empirical literature that social relationships, comprising of structural measures (social networks) and functional measures (perceived social support) have an undeniable effect on health outcomes. However, the actual mechanism of this effect has yet to be clearly understood or explicated. In addition, comorbidity is found to adversely affect social relationships and health related quality of life (a valued outcome measure in cancer patients and survivors). ^ This cross sectional study uses selected baseline data (N=3088) from the Women's Healthy Eating and Living (WHEL) study. Lisrel 8.72 was used for the latent variable structural equation modeling. Due to the ordinal nature of the data, Weighted Least Squares (WLS) method of estimation using Asymptotic Distribution Free covariance matrices was chosen for this analysis. The primary exogenous predictor variables are Social Networks and Comorbidity; Perceived Social Support is the endogenous predictor variable. Three dimensions of HRQoL, physical, mental and satisfaction with current quality of life were the outcome variables. ^ This study hypothesizes and tests the mechanism and pathways between comorbidity, social relationships and HRQoL using latent variable structural equation modeling. After testing the measurement models of social networks and perceived social support, a structural model hypothesizing associations between the latent exogenous and endogenous variables was tested. The results of the study after listwise deletion (N=2131) mostly confirmed the hypothesized relationships (TLI, CFI >0.95, RMSEA = 0.05, p=0.15). Comorbidity was adversely associated with all three HRQoL outcomes. Strong ties were negatively associated with perceived social support; social network had a strong positive association with perceived social support, which served as a mediator between social networks and HRQoL. Mental health quality of life was the most adversely affected by the predictor variables. ^ This study is a preliminary look at the integration of structural and functional measures of social relationships, comorbidity and three HRQoL indicators using LVSEM. Developing stronger social networks and forming supportive relationships is beneficial for health outcomes such as HRQoL of cancer survivors. Thus, the medical community treating cancer survivors as well as the survivor's social networks need to be informed and cognizant of these possible relationships. ^

Quality in healthcare organizations: Its meaning and measurement

This dissertation explores two important aspects of quality in healthcare: its meaning and its measurement. For a better understanding of what quality means, the history of quality in the manufacturing and service industries is reviewed. Concepts that are similar are pointed out as are concepts that are different. The definition introduced by the Institute of Medicine (IOM) for quality in healthcare and the six IOM aims of safety, timeliness, patient-centeredness, effectiveness, efficiency, and equitableness for a high quality healthcare system are adopted. The current activities by various organizations that proclaim improvement in quality or measurement of quality as their goal are reviewed. This is followed by examining what is offered by these organizations in terms of how many of IOM aims they address.^ This dissertation ends by offering a quality measurement framework that satisfies all IOM aims. Operational aspects of the measurement framework are discussed. Future areas of research are also discussed.^

Spatial and temporal aspects of synaptic plasticity

The notion that changes in synaptic efficacy underlie learning and memory processes is now widely accepted even if definitive proof of the synaptic plasticity and memory hypothesis is still lacking. When learning occurs, patterns of neural activity representing the occurrence of events cause changes in the strength of synaptic connections within the brain. Reactivation of these altered connections constitutes the experience of memory for these events and for other events with which they may be associated. These statements summarize a long-standing theory of memory formation that we refer to as the synaptic plasticity and memory hypothesis. Since activity-dependent synaptic plasticity is induced at appropriate synapses during memory formation, and is both necessary and sufficient for the information storage, we can speculate that a methodological study of the synapse will help us understand the mechanism of learning. Random events underlie a wide range of biological processes as diverse as genetic drift and molecular diffusion, regulation of gene expression and neural network function. Additionally spatial variability may be important especially in systems with nonlinear behavior. Since synapse is a complex biological system we expect that stochasticity as well as spatial gradients of different enzymes may be significant for induction of plasticity. ^ In that study we address the question "how important spatial and temporal aspects of synaptic plasticity may be". We developed methods to justify our basic assumptions and examined the main sources of variability of calcium dynamics. Among them, a physiological method to estimate the number of postsynaptic receptors as well as a hybrid algorithm for simulating postsynaptic calcium dynamics. Additionally we studied how synaptic geometry may enhance any possible spatial gradient of calcium dynamics and how that spatial variability affect plasticity curves. Finally, we explored the potential of structural synaptic plasticity to provide a metaplasticity mechanism specific for the synapse. ^

AN INVESTIGATION OF THE POSSIBLE RELATIONSHIP BETWEEN CERTAIN PHYSIOLOGICAL AND PSYCHOLOGICAL MEASURES AND SMOKING CESSATION IN A SELF - SELECTED POPULATION

This study focused on the possible relationship between certain physiological and psychological variables and the cessation of smoking. The population studied was employees enrolled in a multimodality smoking cessation program at the local offices of a major American corporation. In order to be eligible to participate, each individual must have become a non-smoker by the end of the smoking cessation program.^ Three physiological measures were taken on each individual while performing a relaxation exercise; (1) Electromyogram (EMG), (2) Galvanic Skin Response (GSR), and (3) Skin Temperature. The psychological measure consisted of the variable "anxiety" in the Cattell 16-PF personality inventory. Individual's self report of their smoking status was verified through a test for expired carbon monoxide levels.^ For the total population (N-31) no significant relationships were found between the physiological and psychological variable measured and cessation; however, with the removal of two cases discovered during the post-test interview to be influenced by external factors of high caffeine level and a severe family crisis, the measure of EMG, attained significance in discriminating between the successful and unsuccessful in Smoking Cessation. ^

The heart challenge: The effect of regular aerobic exercise on body fat distribution in third and fourth grade school children: A randomized clinical trial

The pattern of body fat distribution known as "centralized", and characterized by a predominance of subcutaneous fat on the trunk and a "pot belly", has been associated with an increased risk of chronic disease. These patterns of fat distribution, as well as the lifestyle habit variables associated with adult fatness and chronic morbidity clearly begin to develop during childhood, indicating the need for intervention and primary prevention of obesity, particularly the centralized form, during childhood or adolescence. The purpose of this study was to determine whether regular aerobic exercise could beneficially alter the distribution of body fat in 8 and 9 year old children. One hundred and eighty-eight participants were randomized into either a regular aerobic exercise treatment group or a standard physical education program control group. A variety of aerobic activities was used for intervention 5 days per week during physical education class for a period of 12 weeks. Fat distribution was measured by a number of the most commonly used indices, including ratios of body circumferences and skinfolds and indices derived from a principal components analysis. Change over time in average pulse rate was used to determine if intervention actually occurred. Approximately 10% of the students were remeasured, allowing the calculation of intra- and interexaminer measurement reliability estimates for all indices.^ This study group was comparable to the U.S. population, though the study children were slightly larger for certain measures. No effect of the exercise intervention was found. The most likely explanation for this was inadequacy of the intervention, as indicated by the lack of any change in average pulse rate with treatment. The results of the measurement reliability analysis are reported and indicate that body circumference ratios are more precise than skinfold ratios, particularly when multiple observers are used. Reliability estimates for the principal component indices were also high.^ It remains unclear whether the distribution of body fat can be altered with exercise. It is likely that this issue will remain undecided until one highly reliable, valid, and sensitive measure of fat distribution can be found. ^

Gene expression and physiological changes of the Antarctic krill Euphausia superba under different hypoxia intensities

Antarctic krill (Euphausia superba) from South Georgia comprise one of the most northern and abundant krill stocks. South Georgia waters are undergoing rapid warming, as a result of climate change, which in turn could alter the oxygen concentration of the water. We investigated gene expression in Antarctic krill related to aerobic metabolism, antioxidant defence, and heat-shock response under severe (2.5% O2 saturation or 0.6 kPa) and threshold (20% O2 saturation or 4 kPa) hypoxia exposure compared to in situ levels (normoxic; 100% O2 saturation or 21 kPa). Biochemical metabolic and oxidative stress indicators complemented the genic expression analysis to detect in vivo signs of stress during the hypoxia treatments. Expression levels of the genes citrate synthase (CS), mitochondrial manganese superoxide dismutase (SODMn-m) and one heat-shock protein isoform (E) were higher in euphausiids incubated 6 h at 20% O2 saturation than in animals exposed to control (normoxic) conditions. All biochemical antioxidant defence parameters remained unchanged among treatments. Levels of lipid peroxidation were raised after 6 h of severe hypoxia. Overall, short-term exposure to hypoxia altered mitochondrial metabolic and antioxidant capacity, but did not induce anaerobic metabolism. Antarctic krill are swarming organisms and may experience short periods of hypoxia when present in dense swarms. A future, warmer Southern ocean, where oxygen saturation levels are decreased, may result in smaller, less dense swarms as they act to avoid greater levels of hypoxia.

Influence of loudspeaker directivity on the measurement uncertainty

One of the most significant aspects of a building’s acoustic behavior is the airborne sound insulation of the room façades, since this determines the protection of its inhabitants against environmental noise. For this reason, authorities in most countries have established in their acoustic regulations for buildings the minimum value of sound insulation that must be respected for façades. In order to verify compliance with legal requirements it is usual to perform acoustic measurements in the finished buildings and then compare the measurement results with the established limits. Since there is always a certain measurement uncertainty, this uncertainty must be calculated and taken into account in order to ensure compliance with specifications. The most commonly used method for measuring sound insulation on façades is the so-called Global Loudspeaker Method, specified in ISO 140-5:1998. This method uses a loudspeaker placed outside the building as a sound source. The loudspeaker directivity has a significant influence on the measurement results, and these results may change noticeably by choosing different loudspeakers, even though they all fulfill the directivity requirements of ISO 140-5. This work analyzes the influence of the loudspeaker directivity on the results of façade sound insulation measurement, and determines its contribution to measurement uncertainty. The theoretical analysis is experimentally validated by means of an intermediate precision test according to ISO 5725-3:1994, which compares the values of sound insulation obtained for a façade using various loudspeakers with different directivities

Contribution to the quality improvement of the antenna measurement using post-processing techniques = Contribución a la mejora de la calidad de medida de antena usando técnicas de post-procesado

One important task in the design of an antenna is to carry out an analysis to find out the characteristics of the antenna that best fulfills the specifications fixed by the application. After that, a prototype is manufactured and the next stage in design process is to check if the radiation pattern differs from the designed one. Besides the radiation pattern, other radiation parameters like directivity, gain, impedance, beamwidth, efficiency, polarization, etc. must be also evaluated. For this purpose, accurate antenna measurement techniques are needed in order to know exactly the actual electromagnetic behavior of the antenna under test. Due to this fact, most of the measurements are performed in anechoic chambers, which are closed areas, normally shielded, covered by electromagnetic absorbing material, that simulate free space propagation conditions, due to the absorption of the radiation absorbing material. Moreover, these facilities can be employed independently of the weather conditions and allow measurements free from interferences. Despite all the advantages of the anechoic chambers, the results obtained both from far-field measurements and near-field measurements are inevitably affected by errors. Thus, the main objective of this Thesis is to propose algorithms to improve the quality of the results obtained in antenna measurements by using post-processing techniques and without requiring additional measurements. First, a deep revision work of the state of the art has been made in order to give a general vision of the possibilities to characterize or to reduce the effects of errors in antenna measurements. Later, new methods to reduce the unwanted effects of four of the most commons errors in antenna measurements are described and theoretical and numerically validated. The basis of all them is the same, to perform a transformation from the measurement surface to another domain where there is enough information to easily remove the contribution of the errors. The four errors analyzed are noise, reflections, truncation errors and leakage and the tools used to suppress them are mainly source reconstruction techniques, spatial and modal filtering and iterative algorithms to extrapolate functions. Therefore, the main idea of all the methods is to modify the classical near-field-to-far-field transformations by including additional steps with which errors can be greatly suppressed. Moreover, the proposed methods are not computationally complex and, because they are applied in post-processing, additional measurements are not required. The noise is the most widely studied error in this Thesis, proposing a total of three alternatives to filter out an important noise contribution before obtaining the far-field pattern. The first one is based on a modal filtering. The second alternative uses a source reconstruction technique to obtain the extreme near-field where it is possible to apply a spatial filtering. The last one is to back-propagate the measured field to a surface with the same geometry than the measurement surface but closer to the AUT and then to apply also a spatial filtering. All the alternatives are analyzed in the three most common near-field systems, including comprehensive noise statistical analyses in order to deduce the signal-to-noise ratio improvement achieved in each case. The method to suppress reflections in antenna measurements is also based on a source reconstruction technique and the main idea is to reconstruct the field over a surface larger than the antenna aperture in order to be able to identify and later suppress the virtual sources related to the reflective waves. The truncation error presents in the results obtained from planar, cylindrical and partial spherical near-field measurements is the third error analyzed in this Thesis. The method to reduce this error is based on an iterative algorithm to extrapolate the reliable region of the far-field pattern from the knowledge of the field distribution on the AUT plane. The proper termination point of this iterative algorithm as well as other critical aspects of the method are also studied. The last part of this work is dedicated to the detection and suppression of the two most common leakage sources in antenna measurements. A first method tries to estimate the leakage bias constant added by the receiver’s quadrature detector to every near-field data and then suppress its effect on the far-field pattern. The second method can be divided into two parts; the first one to find the position of the faulty component that radiates or receives unwanted radiation, making easier its identification within the measurement environment and its later substitution; and the second part of this method is able to computationally remove the leakage effect without requiring the substitution of the faulty component. Resumen Una tarea importante en el diseño de una antena es llevar a cabo un análisis para averiguar las características de la antena que mejor cumple las especificaciones fijadas por la aplicación. Después de esto, se fabrica un prototipo de la antena y el siguiente paso en el proceso de diseño es comprobar si el patrón de radiación difiere del diseñado. Además del patrón de radiación, otros parámetros de radiación como la directividad, la ganancia, impedancia, ancho de haz, eficiencia, polarización, etc. deben ser también evaluados. Para lograr este propósito, se necesitan técnicas de medida de antenas muy precisas con el fin de saber exactamente el comportamiento electromagnético real de la antena bajo prueba. Debido a esto, la mayoría de las medidas se realizan en cámaras anecoicas, que son áreas cerradas, normalmente revestidas, cubiertas con material absorbente electromagnético. Además, estas instalaciones se pueden emplear independientemente de las condiciones climatológicas y permiten realizar medidas libres de interferencias. A pesar de todas las ventajas de las cámaras anecoicas, los resultados obtenidos tanto en medidas en campo lejano como en medidas en campo próximo están inevitablemente afectados por errores. Así, el principal objetivo de esta Tesis es proponer algoritmos para mejorar la calidad de los resultados obtenidos en medida de antenas mediante el uso de técnicas de post-procesado. Primeramente, se ha realizado un profundo trabajo de revisión del estado del arte con el fin de dar una visión general de las posibilidades para caracterizar o reducir los efectos de errores en medida de antenas. Después, se han descrito y validado tanto teórica como numéricamente nuevos métodos para reducir el efecto indeseado de cuatro de los errores más comunes en medida de antenas. La base de todos ellos es la misma, realizar una transformación de la superficie de medida a otro dominio donde hay suficiente información para eliminar fácilmente la contribución de los errores. Los cuatro errores analizados son ruido, reflexiones, errores de truncamiento y leakage y las herramientas usadas para suprimirlos son principalmente técnicas de reconstrucción de fuentes, filtrado espacial y modal y algoritmos iterativos para extrapolar funciones. Por lo tanto, la principal idea de todos los métodos es modificar las transformaciones clásicas de campo cercano a campo lejano incluyendo pasos adicionales con los que los errores pueden ser enormemente suprimidos. Además, los métodos propuestos no son computacionalmente complejos y dado que se aplican en post-procesado, no se necesitan medidas adicionales. El ruido es el error más ampliamente estudiado en esta Tesis, proponiéndose un total de tres alternativas para filtrar una importante contribución de ruido antes de obtener el patrón de campo lejano. La primera está basada en un filtrado modal. La segunda alternativa usa una técnica de reconstrucción de fuentes para obtener el campo sobre el plano de la antena donde es posible aplicar un filtrado espacial. La última es propagar el campo medido a una superficie con la misma geometría que la superficie de medida pero más próxima a la antena y luego aplicar también un filtrado espacial. Todas las alternativas han sido analizadas en los sistemas de campo próximos más comunes, incluyendo detallados análisis estadísticos del ruido con el fin de deducir la mejora de la relación señal a ruido lograda en cada caso. El método para suprimir reflexiones en medida de antenas está también basado en una técnica de reconstrucción de fuentes y la principal idea es reconstruir el campo sobre una superficie mayor que la apertura de la antena con el fin de ser capaces de identificar y después suprimir fuentes virtuales relacionadas con las ondas reflejadas. El error de truncamiento que aparece en los resultados obtenidos a partir de medidas en un plano, cilindro o en la porción de una esfera es el tercer error analizado en esta Tesis. El método para reducir este error está basado en un algoritmo iterativo para extrapolar la región fiable del patrón de campo lejano a partir de información de la distribución del campo sobre el plano de la antena. Además, se ha estudiado el punto apropiado de terminación de este algoritmo iterativo así como otros aspectos críticos del método. La última parte de este trabajo está dedicado a la detección y supresión de dos de las fuentes de leakage más comunes en medida de antenas. El primer método intenta realizar una estimación de la constante de fuga del leakage añadido por el detector en cuadratura del receptor a todos los datos en campo próximo y después suprimir su efecto en el patrón de campo lejano. El segundo método se puede dividir en dos partes; la primera de ellas para encontrar la posición de elementos defectuosos que radian o reciben radiación indeseada, haciendo más fácil su identificación dentro del entorno de medida y su posterior substitución. La segunda parte del método es capaz de eliminar computacionalmente el efector del leakage sin necesidad de la substitución del elemento defectuoso.

Influence of loudspeaker directivity on the measurement uncertainty of the acoustic testing of facades.

One of the most significant aspects of a building?s acoustic behavior is the airborne sound insulation of the room façades, since this determines the protection of its inhabitants against environmental noise. For this reason, authorities in most countries have established in their acoustic regulations for buildings the minimum value of sound insulation that must be respected for façades. In order to verify compliance with legal requirements it is usual to perform acoustic measurements in the finished buildings and then compare the measurement results with the established limits. Since there is always a certain measurement uncertainty, this uncertainty must be calculated and taken into account in order to ensure compliance with specifications. The most commonly used method for measuring sound insulation on façades is the so-called Global Loudspeaker Method, specified in ISO 140-5:1998. This method uses a loudspeaker placed outside the building as a sound source. The loudspeaker directivity has a significant influence on the measurement results, and these results may change noticeably by choosing different loudspeakers, even though they all fulfill the directivity requirements of ISO 140-5. This work analyzes the influence of the loudspeaker directivity on the results of façade sound insulation measurement, and determines its contribution to measurement uncertainty. The theoretical analysis is experimentally validated by means of an intermediate precision test according to ISO 5725-3:1994, which compares the values of sound insulation obtained for a façade using various loudspeakers with different directivities. Keywords: Uncertainty, Façade, Insulation

Running away from side effects: physical exercise as a complementary intervention for breast cancer patients

The number of breast cancer survivors increases every year, thanks to the development of new treatments and screening techniques. However, patients present with numerous side effects that may affect their quality of life. Exercise has been demostrated to reduce some of these side effects, but in spite of this, few breast cancer patientes know and follow the exercise recommendations needed to remain healthy. In this review, we describe the differente breast cancer treatments and the related side effects and implications of exercise in relation to these. We propose that exercise could be and integrative complementary intervention to improve physiological, physical and psychological factors that affect survival and quality of life of these patients. For that reason, the main objective of this review is to provide a general overview of exercise benefits in breast cancer patients and recommendations of how to design exercise interventions in patients with different side effects.

Lidar uncertainty in complex terrain development of a bias correction methodology

El autor ha trabajado como parte del equipo de investigación en mediciones de viento en el Centro Nacional de Energías Renovables (CENER), España, en cooperación con la Universidad Politécnica de Madrid y la Universidad Técnica de Dinamarca. El presente reporte recapitula el trabajo de investigación realizado durante los últimos 4.5 años en el estudio de las fuentes de error de los sistemas de medición remota de viento, basados en la tecnología lidar, enfocado al error causado por los efectos del terreno complejo. Este trabajo corresponde a una tarea del paquete de trabajo dedicado al estudio de sistemas remotos de medición de viento, perteneciente al proyecto de intestigación europeo del 7mo programa marco WAUDIT. Adicionalmente, los datos de viento reales han sido obtenidos durante las campañas de medición en terreno llano y terreno complejo, pertenecientes al también proyecto de intestigación europeo del 7mo programa marco SAFEWIND. El principal objetivo de este trabajo de investigación es determinar los efectos del terreno complejo en el error de medición de la velocidad del viento obtenida con los sistemas de medición remota lidar. Con este conocimiento, es posible proponer una metodología de corrección del error de las mediciones del lidar. Esta metodología está basada en la estimación de las variaciones del campo de viento no uniforme dentro del volumen de medición del lidar. Las variaciones promedio del campo de viento son predichas a partir de los resultados de las simulaciones computacionales de viento RANS, realizadas para el parque experimental de Alaiz. La metodología de corrección es verificada con los resultados de las simulaciones RANS y validadas con las mediciones reales adquiridas en la campaña de medición en terreno complejo. Al inicio de este reporte, el marco teórico describiendo el principio de medición de la tecnología lidar utilizada, es presentado con el fin de familiarizar al lector con los principales conceptos a utilizar a lo largo de este trabajo. Posteriormente, el estado del arte es presentado en donde se describe los avances realizados en el desarrollo de la la tecnología lidar aplicados al sector de la energía eólica. En la parte experimental de este trabajo de investigación se ha estudiado los datos adquiridos durante las dos campañas de medición realizadas. Estas campañas has sido realizadas en terreno llano y complejo, con el fin de complementar los conocimiento adquiridos en casa una de ellas y poder comparar los efectos del terreno en las mediciones de viento realizadas con sistemas remotos lidar. La primer campaña experimental se desarrollo en terreno llano, en el parque de ensayos de aerogeneradores H0vs0re, propiedad de DTU Wind Energy (anteriormente Ris0). La segunda campaña experimental se llevó a cabo en el parque de ensayos de aerogeneradores Alaiz, propiedad de CENER. Exactamente los mismos dos equipos lidar fueron utilizados en estas campañas, haciendo de estos experimentos altamente relevantes en el contexto de evaluación del recurso eólico. Un equipo lidar está basado en tecnología de onda continua, mientras que el otro está basado en tecnología de onda pulsada. La velocidad del viento fue medida, además de con los equipos lidar, con anemómetros de cazoletas, veletas y anemómetros verticales, instalados en mástiles meteorológicos. Los sensores del mástil meteorológico son considerados como las mediciones de referencia en el presente estudio. En primera instancia, se han analizado los promedios diez minútales de las medidas de viento. El objetivo es identificar las principales fuentes de error en las mediciones de los equipos lidar causadas por diferentes condiciones atmosféricas y por el flujo no uniforme de viento causado por el terreno complejo. El error del lidar ha sido estudiado como función de varias propiedades estadísticas del viento, como lo son el ángulo vertical de inclinación, la intensidad de turbulencia, la velocidad vertical, la estabilidad atmosférica y las características del terreno. El propósito es usar este conocimiento con el fin de definir criterios de filtrado de datos. Seguidamente, se propone una metodología para corregir el error del lidar causado por el campo de viento no uniforme, producido por la presencia de terreno complejo. Esta metodología está basada en el análisis matemático inicial sobre el proceso de cálculo de la velocidad de viento por los equipos lidar de onda continua. La metodología de corrección propuesta hace uso de las variaciones de viento calculadas a partir de las simulaciones RANS realizadas para el parque experimental de Alaiz. Una ventaja importante que presenta esta metodología es que las propiedades el campo de viento real, presentes en las mediciones instantáneas del lidar de onda continua, puede dar paso a análisis adicionales como parte del trabajo a futuro. Dentro del marco del proyecto, el trabajo diario se realizó en las instalaciones de CENER, con supervisión cercana de la UPM, incluyendo una estancia de 1.5 meses en la universidad. Durante esta estancia, se definió el análisis matemático de las mediciones de viento realizadas por el equipo lidar de onda continua. Adicionalmente, los efectos del campo de viento no uniforme sobre el error de medición del lidar fueron analíticamente definidos, después de asumir algunas simplificaciones. Adicionalmente, durante la etapa inicial de este proyecto se desarrollo una importante trabajo de cooperación con DTU Wind Energy. Gracias a esto, el autor realizó una estancia de 1.5 meses en Dinamarca. Durante esta estancia, el autor realizó una visita a la campaña de medición en terreno llano con el fin de aprender los aspectos básicos del diseño de campañas de medidas experimentales, el estudio del terreno y los alrededores y familiarizarse con la instrumentación del mástil meteorológico, el sistema de adquisición y almacenamiento de datos, así como de el estudio y reporte del análisis de mediciones. ABSTRACT The present report summarizes the research work performed during last 4.5 years of investigation on the sources of lidar bias due to complex terrain. This work corresponds to one task of the remote sensing work package, belonging to the FP7 WAUDIT project. Furthermore, the field data from the wind velocity measurement campaigns of the FP7 SafeWind project have been used in this report. The main objective of this research work is to determine the terrain effects on the lidar bias in the measured wind velocity. With this knowledge, it is possible to propose a lidar bias correction methodology. This methodology is based on an estimation of the wind field variations within the lidar scan volume. The wind field variations are calculated from RANS simulations performed from the Alaiz test site. The methodology is validated against real scale measurements recorded during an eight month measurement campaign at the Alaiz test site. Firstly, the mathematical framework of the lidar sensing principle is introduced and an overview of the state of the art is presented. The experimental part includes the study of two different, but complementary experiments. The first experiment was a measurement campaign performed in flat terrain, at DTU Wind Energy H0vs0re test site, while the second experiment was performed in complex terrain at CENER Alaiz test site. Exactly the same two lidar devices, based on continuous wave and pulsed wave systems, have been used in the two consecutive measurement campaigns, making this a relevant experiment in the context of wind resource assessment. The wind velocity was sensed by the lidars and standard cup anemometry and wind vanes (installed on a met mast). The met mast sensors are considered as the reference wind velocity measurements. The first analysis of the experimental data is dedicated to identify the main sources of lidar bias present in the 10 minute average values. The purpose is to identify the bias magnitude introduced by different atmospheric conditions and by the non-uniform wind flow resultant of the terrain irregularities. The lidar bias as function of several statistical properties of the wind flow like the tilt angle, turbulence intensity, vertical velocity, atmospheric stability and the terrain characteristics have been studied. The aim of this exercise is to use this knowledge in order to define useful lidar bias data filters. Then, a methodology to correct the lidar bias caused by non-uniform wind flow is proposed, based on the initial mathematical analysis of the lidar measurements. The proposed lidar bias correction methodology has been developed focusing on the the continuous wave lidar system. In a last step, the proposed lidar bias correction methodology is validated with the data of the complex terrain measurement campaign. The methodology makes use of the wind field variations obtained from the RANS analysis. The results are presented and discussed. The advantage of this methodology is that the wind field properties at the Alaiz test site can be studied with more detail, based on the instantaneous measurements of the CW lidar. Within the project framework, the daily basis work has been done at CENER, with close guidance and support from the UPM, including an exchange period of 1.5 months. During this exchange period, the mathematical analysis of the lidar sensing of the wind velocity was defined. Furthermore, the effects of non-uniform wind fields on the lidar bias were analytically defined, after making some assumptions for the sake of simplification. Moreover, there has been an important cooperation with DTU Wind Energy, where a secondment period of 1.5 months has been done as well. During the secondment period at DTU Wind Energy, an important introductory learning has taken place. The learned aspects include the design of an experimental measurement campaign in flat terrain, the site assessment study of obstacles and terrain conditions, the data acquisition and processing, as well as the study and reporting of the measurement analysis.

Automatic physical activity pattern recognition and meal intake modelling in type 1 diabetes for their inclusion in artificial pancreas systems

La diabetes comprende un conjunto de enfermedades metabólicas que se caracterizan por concentraciones de glucosa en sangre anormalmente altas. En el caso de la diabetes tipo 1 (T1D, por sus siglas en inglés), esta situación es debida a una ausencia total de secreción endógena de insulina, lo que impide a la mayoría de tejidos usar la glucosa. En tales circunstancias, se hace necesario el suministro exógeno de insulina para preservar la vida del paciente; no obstante, siempre con la precaución de evitar caídas agudas de la glucemia por debajo de los niveles recomendados de seguridad. Además de la administración de insulina, las ingestas y la actividad física son factores fundamentales que influyen en la homeostasis de la glucosa. En consecuencia, una gestión apropiada de la T1D debería incorporar estos dos fenómenos fisiológicos, en base a una identificación y un modelado apropiado de los mismos y de sus sorrespondientes efectos en el balance glucosa-insulina. En particular, los sistemas de páncreas artificial –ideados para llevar a cabo un control automático de los niveles de glucemia del paciente– podrían beneficiarse de la integración de esta clase de información. La primera parte de esta tesis doctoral cubre la caracterización del efecto agudo de la actividad física en los perfiles de glucosa. Con este objetivo se ha llevado a cabo una revisión sistemática de la literatura y meta-análisis que determinen las respuestas ante varias modalidades de ejercicio para pacientes con T1D, abordando esta caracterización mediante unas magnitudes que cuantifican las tasas de cambio en la glucemia a lo largo del tiempo. Por otro lado, una identificación fiable de los periodos con actividad física es un requisito imprescindible para poder proveer de esa información a los sistemas de páncreas artificial en condiciones libres y ambulatorias. Por esta razón, la segunda parte de esta tesis está enfocada a la propuesta y evaluación de un sistema automático diseñado para reconocer periodos de actividad física, clasificando su nivel de intensidad (ligera, moderada o vigorosa); así como, en el caso de periodos vigorosos, identificando también la modalidad de ejercicio (aeróbica, mixta o de fuerza). En este sentido, ambos aspectos tienen una influencia específica en el mecanismo metabólico que suministra la energía para llevar a cabo el ejercicio y, por tanto, en las respuestas glucémicas en T1D. En este trabajo se aplican varias combinaciones de técnicas de aprendizaje máquina y reconocimiento de patrones sobre la fusión multimodal de señales de acelerometría y ritmo cardíaco, las cuales describen tanto aspectos mecánicos del movimiento como la respuesta fisiológica del sistema cardiovascular ante el ejercicio. Después del reconocimiento de patrones se incorpora también un módulo de filtrado temporal para sacar partido a la considerable coherencia temporal presente en los datos, una redundancia que se origina en el hecho de que en la práctica, las tendencias en cuanto a actividad física suelen mantenerse estables a lo largo de cierto tiempo, sin fluctuaciones rápidas y repetitivas. El tercer bloque de esta tesis doctoral aborda el tema de las ingestas en el ámbito de la T1D. En concreto, se propone una serie de modelos compartimentales y se evalúan éstos en función de su capacidad para describir matemáticamente el efecto remoto de las concetraciones plasmáticas de insulina exógena sobre las tasas de eleiminación de la glucosa atribuible a la ingesta; un aspecto hasta ahora no incorporado en los principales modelos de paciente para T1D existentes en la literatura. Los datos aquí utilizados se obtuvieron gracias a un experimento realizado por el Institute of Metabolic Science (Universidad de Cambridge, Reino Unido) con 16 pacientes jóvenes. En el experimento, de tipo ‘clamp’ con objetivo variable, se replicaron los perfiles individuales de glucosa, según lo observado durante una visita preliminar tras la ingesta de una cena con o bien alta carga glucémica, o bien baja. Los seis modelos mecanísticos evaluados constaban de: a) submodelos de doble compartimento para las masas de trazadores de glucosa, b) un submodelo de único compartimento para reflejar el efecto remoto de la insulina, c) dos tipos de activación de este mismo efecto remoto (bien lineal, bien con un punto de corte), y d) diversas condiciones iniciales. ABSTRACT Diabetes encompasses a series of metabolic diseases characterized by abnormally high blood glucose concentrations. In the case of type 1 diabetes (T1D), this situation is caused by a total absence of endogenous insulin secretion, which impedes the use of glucose by most tissues. In these circumstances, exogenous insulin supplies are necessary to maintain patient’s life; although caution is always needed to avoid acute decays in glycaemia below safe levels. In addition to insulin administrations, meal intakes and physical activity are fundamental factors influencing glucose homoeostasis. Consequently, a successful management of T1D should incorporate these two physiological phenomena, based on an appropriate identification and modelling of these events and their corresponding effect on the glucose-insulin balance. In particular, artificial pancreas systems –designed to perform an automated control of patient’s glycaemia levels– may benefit from the integration of this type of information. The first part of this PhD thesis covers the characterization of the acute effect of physical activity on glucose profiles. With this aim, a systematic review of literature and metaanalyses are conduced to determine responses to various exercise modalities in patients with T1D, assessed via rates-of-change magnitudes to quantify temporal variations in glycaemia. On the other hand, a reliable identification of physical activity periods is an essential prerequisite to feed artificial pancreas systems with information concerning exercise in ambulatory, free-living conditions. For this reason, the second part of this thesis focuses on the proposal and evaluation of an automatic system devised to recognize physical activity, classifying its intensity level (light, moderate or vigorous) and for vigorous periods, identifying also its exercise modality (aerobic, mixed or resistance); since both aspects have a distinctive influence on the predominant metabolic pathway involved in fuelling exercise, and therefore, in the glycaemic responses in T1D. Various combinations of machine learning and pattern recognition techniques are applied on the fusion of multi-modal signal sources, namely: accelerometry and heart rate measurements, which describe both mechanical aspects of movement and the physiological response of the cardiovascular system to exercise. An additional temporal filtering module is incorporated after recognition in order to exploit the considerable temporal coherence (i.e. redundancy) present in data, which stems from the fact that in practice, physical activity trends are often maintained stable along time, instead of fluctuating rapid and repeatedly. The third block of this PhD thesis addresses meal intakes in the context of T1D. In particular, a number of compartmental models are proposed and compared in terms of their ability to describe mathematically the remote effect of exogenous plasma insulin concentrations on the disposal rates of meal-attributable glucose, an aspect which had not yet been incorporated to the prevailing T1D patient models in literature. Data were acquired in an experiment conduced at the Institute of Metabolic Science (University of Cambridge, UK) on 16 young patients. A variable-target glucose clamp replicated their individual glucose profiles, observed during a preliminary visit after ingesting either a high glycaemic-load or a low glycaemic-load evening meal. The six mechanistic models under evaluation here comprised: a) two-compartmental submodels for glucose tracer masses, b) a single-compartmental submodel for insulin’s remote effect, c) two types of activations for this remote effect (either linear or with a ‘cut-off’ point), and d) diverse forms of initial conditions.

Efectos de una intervención nutricional personalizada a largo plazo sobre los hábitos alimentarios de jugadores profesionales de baloncesto y su influencia en la percepción del esfuerzo y la fatiga

El presente trabajo consistió en el desarrollo de una intervención nutricional a largo plazo llevada a cabo con jugadores profesionales de baloncesto, en función al cumplimiento de las recomendaciones nutricionales, con los siguientes dos objetivos: 1) valorar los cambios que dicha intervención produce sobre las prácticas nutricionales diarias de estos deportistas y 2) conocer la influencia de las modificaciones nutricionales producidas sobre la tasa de percepción del esfuerzo por sesión (RPE-Sesión) y la fatiga, a lo largo de una temporada competitiva, tanto para entrenamientos como partidos oficiales. Los objetivos del estudio se fundamentan en: 1) la numerosa evidencia científica que muestra la inadecuación de los hábitos nutricionales de los jugadores de baloncesto y otros deportistas respecto a las recomendaciones nutricionales; 2) el hecho ampliamente reconocido en la literatura especializada de que una ingesta nutricional óptima permite maximizar el rendimiento deportivo (a nivel físico y cognitivo), promoviendo una rápida recuperación y disminuyendo el riesgo de enfermedades y lesiones deportivas. No obstante, pocos estudios han llevado a cabo una intervención nutricional a largo plazo para mejorar los hábitos alimentarios de los deportistas y ninguno de ellos fue realizado con jugadores de baloncesto; 3) la elevada correlación entre la percepción del esfuerzo (RPE) y variables fisiológicas relacionadas al desarrollo de un ejercicio (por ej.: frecuencia cardíaca, consumo máximo de oxígeno o lactato sanguíneo) y los múltiples estudios que muestran la atenuación de la RPE durante la realización del ejercicio mediante una ingesta puntual de nutrientes, (especialmente de hidratos de carbono) aunque ninguno fue desarrollado en baloncesto; 4) el estudio incipiente de la relación entre la ingesta nutricional y la RPE-Sesión, siendo éste un método validado en baloncesto y otros deportes de equipo como indicador de la carga de trabajo interna, el rendimiento deportivo y la intensidad del ejercicio realizado; 5) el hecho de que la fatiga constituye uno de los principales factores influyentes en la percepción del esfuerzo y puede ser retrasada y/o atenuada mediante la ingesta de carbohidratos, pudiendo disminuir consecuentemente la RPE-Sesión y la carga interna del esfuerzo físico, potenciando el rendimiento deportivo y las adaptaciones inducidas por el entrenamiento; 6) la reducida evidencia acerca del comportamiento de la RPE-Sesión ante la modificación de la ingesta de nutrientes, encontrándose sólo un estudio llevado a cabo en baloncesto y 7) la ausencia de investigaciones acerca de la influencia que puede tener la mejora del patrón nutricional de los jugadores sobre la RPE-Sesión y la fatiga, desconociéndose si la adecuación de los hábitos nutricionales conduce a una disminución de estas variables en el largo plazo para todos los entrenamientos y partidos oficiales a nivel profesional. Por todo esto, este trabajo comienza con una introducción que presenta el marco teórico de la importancia y función de la nutrición en el deporte, así como de las recomendaciones nutricionales actuales a nivel general y para baloncesto. Además, se describen las intervenciones nutricionales llevadas a cabo previamente con otros deportistas y las consecuentes modificaciones sobre el patrón alimentario, coincidiendo este aspecto con el primer objetivo del presente estudio. Posteriormente, se analiza la RPE, la RPE-Sesión y la fatiga, focalizando el estudio en la relación de dichas variables con la carga de trabajo físico, la intensidad del entrenamiento, el rendimiento deportivo y la recuperación post ejercicio. Finalmente, se combinan todos los aspectos mencionados: ingesta nutricional, RPE percepción del esfuerzo y fatiga, con el fin de conocer la situación actual del estudio de la relación entre dichas variables, conformando la base del segundo objetivo de este estudio. Seguidamente, se exponen y fundamentan los objetivos antes mencionados, para dar lugar después a la explicación de la metodología utilizada en el presente estudio. Ésta consistió en un diseño de estudios de caso, aplicándose una intervención nutricional personalizada a tres jugadores de baloncesto profesional (cada jugador = un estudio de caso; n = 1), con el objetivo de adecuar su ingesta nutricional en el largo plazo a las recomendaciones nutricionales. A su vez, se analizó la respuesta individual de cada uno de los casos a dicha intervención para los dos objetivos del estudio. Para ello, cada jugador completó un registro diario de alimentos (7 días; pesada de alimentos) antes, durante y al final de la intervención. Además, los sujetos registraron diariamente a lo largo del estudio la RPE-Sesión y la fatiga en entrenamientos físicos y de balón y en partidos oficiales de liga, controlándose además en forma cuantitativa otras variables influyentes como el estado de ánimo y el sueño. El análisis de los datos consistió en el cálculo de los estadísticos descriptivos para todas las variables, la comparación de la ingesta en los diferentes momentos evaluados con las recomendaciones nutricionales y una comparación de medias no paramétrica entre el período pre intervención y durante la intervención con el test de Wilcoxon (medidas repetidas) para todas las variables. Finalmente, se relacionaron los cambios obtenidos en la ingesta nutricional con la percepción del esfuerzo y la fatiga y la posible influencia del estado de ánimo y el sueño, a través de un estudio correlacional (Tau_b de Kendall). Posteriormente, se presentan los resultados obtenidos y la discusión de los mismos, haciendo referencia a la evidencia científica relacionada que se encuentra publicada hasta el momento, la cual facilitó el análisis de la relación entre RPE-Sesión, fatiga y nutrición a lo largo de una temporada. Los principales hallazgos y su correspondiente análisis, por lo tanto, pueden resumirse en los siguientes: 1) los tres jugadores de baloncesto profesional presentaron inicialmente hábitos nutricionales inadecuados, haciendo evidente la necesidad de un nutricionista deportivo dentro del cuerpo técnico de los equipos profesionales; 2) las principales deficiencias correspondieron a un déficit pronunciado de energía e hidratos de carbono, que fueron reducidas con la intervención nutricional; 3) la ingesta excesiva de grasa total, ácidos grasos saturados, etanol y proteínas que se halló en alguno/s de los casos, también se adecuó a las recomendaciones después de la intervención; 4) la media obtenida durante un período de la temporada para la RPE-Sesión y la fatiga de entrenamientos, podría ser disminuida en un jugador individual mediante el incremento de su ingesta de carbohidratos a largo plazo, siempre que no existan alteraciones psico-emocionales relevantes; 5) el comportamiento de la RPE-Sesión de partidos oficiales no parece estar influido por los factores nutricionales modificados en este estudio, dependiendo más de la variación de elementos externos no controlables, intrínsecos a los partidos de baloncesto profesional. Ante estos resultados, se pudo observar que las diferentes características de los jugadores y las distintas respuestas obtenidas después de la intervención, reforzaron la importancia de utilizar un diseño de estudio de casos para el análisis de los deportistas de élite y, asimismo, de realizar un asesoramiento nutricional personalizado. Del mismo modo, la percepción del esfuerzo y la fatiga de cada jugador evolucionaron de manera diferente después de la intervención nutricional, lo cual podría depender de las diferentes características de los sujetos, a nivel físico, psico-social, emocional y contextual. Por ello, se propone que el control riguroso de las variables cualitativas que parecen influir sobre la RPE y la fatiga a largo plazo, facilitaría la comprensión de los datos y la determinación de factores desconocidos que influyen sobre estas variables. Finalmente, al ser la RPE-Sesión un indicador directo de la carga interna del entrenamiento, es decir, del estrés psico-fisiológico experimentado por el deportista, la posible atenuación de esta variable mediante la adecuación de los hábitos nutricionales, permitiría aplicar las cargas externas de entrenamiento planificadas, con menor estrés interno y mejor recuperación entre sesiones, disminuyendo también la sensación de fatiga, a pesar del avance de la temporada. ABSTRACT This study consisted in a long-term nutritional intervention carried out with professional basketball players according to nutritional recommendations, with the following two main objectives: 1) to evaluate the changes produced by the intervention on daily nutritional practices of these athletes and 2) to determine the influence of long term nutritional intake modifications on the rate of perceived exertion per session (Session-RPE) and fatigue, throughout a competitive season for training as well as competition games. These objectives are based on: 1) much scientific evidence that shows an inadequacy of the nutritional habits of basketball players and other athletes regarding nutritional recommendations; 2) the fact widely recognized in the scientific literature that an optimal nutrition allows to achieve the maximum performance of an athlete (both physically and cognitively), promoting fast recovery and decreasing risks of sports injuries and illnesses. However, only few studies carried out a long term nutritional intervention to improve nutritional practices of athletes and it could not be found any research with basketball players; 3) the high correlation between the rate of perceived exertion (RPE) and physiological variables related to the performance of physical exercise (e.g.: heart rate, maximum consumption of oxygen or blood lactate) and multiple studies showing the attenuation of RPE during exercise due to the intake of certain nutrients (especially carbohydrates), while none of them was developed in basketball; 4) correlation between nutritional intake and Session-RPE has been recently studied for the first time. Session-RPE method has been validated in basketball players and other team sports as an indicator of internal workload, sports performance and exercise intensity; 5) fatigue is considered one of the main influential factor on RPE and sport performance. It has also been observed that carbohydrates intake may delay or mitigate the onset of fatigue and, thus, decrease the perceived exertion and the internal training load, which could improve sports performance and training-induced adaptations; 6) there are few studies evaluating the influence of nutrient intake on Session-RPE and only one of them has been carried out with basketball players. Moreover, it has not been analyzed the possible effects of the adequacy of players’ nutritional habits through a nutritional intervention on Session-RPE and fatigue, variables that could be decreased for all training session and competition games because of an improvement of daily nutritional intake. Therefore, this work begins with an introduction that provides the conceptual framework of this research focused on the key role of nutrition in sport, as well as on the current nutritional recommendations for athletes and specifically for basketball players. In addition, previous nutritional interventions carried out with other athletes are described, as well as consequential modifications on their food pattern, coinciding with the first objective of the present study. Subsequently, RPE, Session-RPE and fatigue are analyzed, with focus on their correlation with physical workload, training intensity, sports performance and recovery. Finally, all the aforementioned aspects (nutritional intake, RPE and fatigue) were combined in order to know the current status of the relation between each other, this being the base for the second objective of this study. Subsequently, the objectives mentioned above are explained, continuing with the explanation of the methodology used in the study. The methodology consisted of a case-study design, carrying out a long term nutritional intervention with three professional basketball players (each player = one case study; n = 1), in order to adapt their nutritional intake to nutritional recommendations. At the same time, the individual response of each player to the intervention was analyzed for the two main objectives of the study. Each player completed a food diary (7 days; weighing food) in three moments: before, during and at the end of the intervention. In addition, the Session-RPE and fatigue were daily recorded throughout the study for all trainings (training with ball and resistance training) and competition games. At the same time, other potentially influential variables such as mood state and sleeping were daily controlled throughout the study. Data analysis consisted in descriptive statistics calculation for all the variables of the study, the comparison between nutritional intake (evaluated at different times) and nutritional recommendations and a non-parametric mean comparison between pre intervention and during intervention periods was made by Wilcoxon test (repeated measurements) for all variables too. Finally, the changes in nutritional intake, mood state and sleeping were correlated with the perceived exertion and fatigue through correctional study (Tau_b de Kendall). After the methodology, the study results and the associated discussion are presented. The discussion is based on the current scientific evidence that contributes to understand the relation between Session-RPE, fatigue and nutrition throughout the competitive season. The main findings and results analysis can be summarized as follows: 1) the three professional basketball players initially had inadequate nutritional habits and this clearly shows the need of a sports nutritionist in the coaching staff of professional teams; (2) the major deficiencies of the three players’ diet corresponded to a pronounced deficit of energy intake and carbohydrates consumption which were reduced with nutritional intervention; (3) the excessive intake of total fat, saturated fatty acids, ethanol and protein found in some cases were also adapted to the recommendations after the intervention; (4) Session-RPE mean and fatigue of a certain period of the competition season, could be decreased in an individual player by increasing his carbohydrates intake in the long term, if there are no relevant psycho-emotional disorders; (5) the behavior of the Session-RPE in competition games does not seem to be influenced by the nutritional factors modified in this study. They seem to depend much more on the variation of external non-controllable factors associated with the professional basketball games. Given these results, the different characteristics of each player and the diverse responses observed after the intervention in each individual for all the variables, reinforced the importance of the use of a case study design for research with elite athletes as well as personalized nutritional counselling. In the same way, the different responses obtained for RPE and fatigue in the long term for each player due to modification of nutritional habits, show that there is a dependence of such variables on the physical, psychosocial, emotional and contextual characteristics of each player. Therefore it is proposed that the rigorous control of the qualitative variables that seem to influence the RPE and fatigue in the long term, may facilitate the understanding of data and the determination of unknown factors that could influence these variables. Finally, because Session-RPE is a direct indicator of the internal load of training (psycho-physiological stress experienced by the athlete), the possible attenuation of Session-RPE through the improvement in nutritional habits, would allow to apply the planned external loads of training with less internal stress and better recovery between sessions, with a decrease in fatigue, despite of the advance of the season.

Infrared thermography and shoulder pain in wheelchair users = Termografía infrarroja y dolor de hombro en usuarios de sillas de ruedas

Las personas que usan la silla de ruedas como su forma de movilidad prioritaria presentan una elevada incidencia (73%) de dolor de hombro debido al sobreuso y al movimiento repetitivo de la propulsión. Existen numerosos métodos de diagnóstico para la detección de las patologías del hombro, sin embargo la literatura reclama la necesidad de un test no invasivo y fiable, y sugiere la termografía como una técnica adecuada para evaluar el dolor articular. La termografía infrarroja (IRT) proporciona información acerca de los procesos fisiológicos a través del estudio de las distribuciones de la temperatura de la piel. Debido a la alta correlación entre ambos lados corporales, las asimetrías térmicas entre flancos contralaterales son una buena indicación de patologías o disfunciones físicas subyacentes. La fiabilidad de la IRT ha sido estudiada con anterioridad en sujetos sanos, pero nunca en usuarios de sillas de ruedas. Las características especiales de la población con discapacidad (problemas de sudoración y termorregulación, distribución sanguínea o medicación), hacen necesario estudiar los factores que afectan a la aplicación de la IRT en usuarios de sillas de ruedas. La bibliografía discrepa en cuanto a los beneficios o daños resultantes de la práctica de la actividad física en las lesiones de hombro por sobreuso en usuarios de sillas de ruedas. Recientes resultados apuntan a un aumento del riesgo de rotura del manguito rotador en personas con paraplejia que practican deportes con elevación del brazo por encima de la cabeza. Debido a esta falta de acuerdo en la literatura, surge la necesidad de analizar el perfil termográfico en usuarios de sillas de ruedas sedentarios y deportistas y su relación con el dolor de hombro. Hasta la fecha sólo se han publicado estudios termográficos durante el ejercicio en sujetos sanos. Un mayor entendimiento de la respuesta termográfica al ejercicio en silla de ruedas en relación al dolor de hombro clarificará su aparición y desarrollo y permitirá una apropiada intervención. El primer estudio demuestra que la fiabilidad de la IRT en usuarios de sillas de ruedas varía dependiendo de las zonas analizadas, y corrobora que la IRT es una técnica no invasiva, de no contacto, que permite medir la temperatura de la piel, y con la cual avanzar en la investigación en usuarios de sillas de ruedas. El segundo estudio proporciona un perfil de temperatura para usuarios de sillas de ruedas. Los sujetos no deportistas presentaron mayores asimetrías entre lados corporales que los sedentarios, y ambos obtuvieron superiores asimetrías que los sujetos sin discapacidad reportados en la literatura. Los no deportistas también presentaron resultados más elevados en el cuestionario de dolor de hombro. El área con mayores asimetrías térmicas fue hombro. En deportistas, algunas regiones de interés (ROIs) se relacionaron con el dolor de hombro. Estos resultados ayudan a entender el mapa térmico en usuarios de sillas de ruedas. El último estudio referente a la evaluación de la temperatura de la piel en usuarios de sillas de ruedas en ejercicio, reportó diferencias significativas entre la temperatura de la piel antes del test y 10 minutos después del test de propulsión de silla de ruedas, en 12 ROIs; y entre el post-test y 10 minutos después del test en la mayoría de las ROIs. Estas diferencias se vieron atenuadas cuando se compararon las asimetrías antes y después del test. La temperatura de la piel tendió a disminuir inmediatamente después completar el ejercicio, e incrementar significativamente 10 minutos después. El análisis de las asimetrías vs dolor de hombro reveló relaciones significativas negativas en 5 de las 26 ROIs. No se encontraron correlaciones significativas entre las variables de propulsión y el cuestionario de dolor de hombro. Todas las variables cinemáticas correlacionaron significativamente con las asimetrías en múltiples ROIs. Estos resultados indican que los deportistas en sillas de ruedas exhiben una capacidad similar de producir calor que los deportistas sin discapacidad; no obstante, su patrón térmico es más característico de ejercicios prolongados que de esfuerzos breves. Este trabajo contribuye al conocimiento de la termorregulación en usuarios de sillas de ruedas durante el ejercicio, y aporta información relevante para programas deportivos y de rehabilitación. ABSTRACT Individuals who use wheelchairs as their main means of mobility have a high incidence (73%) of shoulder pain (SP) owing to overuse and repetitive propulsion movement. There are numerous diagnostic methods for the detection of shoulder pathologies, however the literature claims that a noninvasive accurate test to properly assess shoulder pain would be necessary, and suggests thermography as a suitable technique for joint pain evaluation. Infrared thermography (IRT) provides information about physiological processes by studying the skin temperature (Tsk) distributions. Due to the high correlation of skin temperature between both sides of the body, thermal asymmetries between contralateral flanks are an indicator of underlying pathologies or physical dysfunctions. The reliability of infrared thermography has been studied in healthy subjects but there are no studies that have analyzed the reliability of IRT in wheelchair users (WCUs). The special characteristics of people with disabilities (sweating and thermoregulation problems, or blood distribution) make it necessary to study the factors affecting the application of IRT in WCUs. Discrepant reports exist on the benefits of, or damage resulting from, physical exercise and the relationship to shoulder overuse injuries in WCUs. Recent findings have found that overhead sports increase the risk of rotator cuff tears in wheelchair patients with paraplegia. Since there is no agreement in the literature, the thermographic profile of wheelchair athletes and nonathletes and its relation with shoulder pain should also be analysed. Infrared thermographic studies during exercise have been carried out only with able-bodied population at present. The understanding of the thermographic response to wheelchair exercise in relation to shoulder pain will offer an insight into the development of shoulder pain, which is necessary for appropriate interventions. The first study presented in this thesis demonstrates that the reliability of IRT in WCUs varies depending on the areas of the body that are analyzed. Moreover, it corroborates that IRT is a noninvasive and noncontact technique that allows the measurement of Tsk, which will allow for advances to be made in research concerned with WCUs. The second study provides a thermal profile of WCUs. Nonathletic subjects presented higher side-to-side skin temperature differences (ΔTsk) than athletes, and both had greater ΔTsk than the able-bodied results that have been published in the literature. Nonathletes also revealed larger Wheelchair Users Shoulder Pain Index (WUSPI) score than athletes. The shoulder region of interest (ROI) was the area with the highest ΔTsk of the regions measured. The analysis of the athletes’ Tsk showed that some ROIs are related to shoulder pain. These findings help to understand the thermal map in WCUs. Finally, the third study evaluated the thermal response of WCUs in exercise. There were significant differences in Tsk between the pre-test and the post-10 min in 12 ROIs, and between the post-test and the post-10 in most of the ROIs. These differences were attenuated when the ΔTsk was compared before and after exercise. Skin temperature tended to initially decrease immediately after the test, followed by a significant increase at 10 minutes after completing the exercise. The ΔTsk versus shoulder pain analysis yielded significant inverse relationships in 5 of the 26 ROIs. No significant correlations between propulsion variables and the results of the WUSPI questionnaire were found. All kinematic variables were significantly correlated with the temperature asymmetries in multiple ROIs. These results present indications that high performance wheelchair athletes exhibit similar capacity of heat production to able-bodied population; however, they presented a thermal pattern more characteristic of a prolonged exercise rather than brief exercise. This work contributes to improve the understanding about temperature changes in wheelchair athletes during exercise and provides implications to the sports and rehabilitation programs.