The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation

Background: Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. METHODS: To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. CONCLUSIONS: In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields.

Optical imaging and two-photon microscopy study of hemodynamic changes contralateral to ictal focus during epileptiform discharges

Il est relativement bien établi que les crises focales entraînent une augmentation régionale du flot sanguin dans le but de soutenir la demande énergétique en hémoglobine oxygénée des neurones épileptiques. Des changements hémodynamiques précoces ont également été rapportés dans la région homologue controlatérale, bien que ceci ait été moins bien caractérisé. Dans cette étude, notre objectif est de mieux caractériser, lors de crises focales, la nature des changements hémodynamiques précoces dans la région homologue controlatérale au foyer épileptique. L'imagerie optique intrinsèque (IOI) et la microscopie deux-photons sont utilisées pour étudier les changements hémodynamiques dans la région homologue controlatérale au site de crises focales induites par l’injection de 4-aminopyridine (4-AP) dans le cortex somatosensitif ipsilatéral de souris. Dans l'étude d'IOI, des changements de l’oxyhémoglobine (HbO), de la désoxyhémoglobine (HbR) et du débit sanguin cérébral ont été observées dans la région homologue controlatérale au site de crises focales lors de toutes les crises. Toutefois, ces changements étaient hétérogènes, sans patron cohérent et reproduisible. Nos expériences avec la microscopie deux-photons n’ont pas révélé de changements hémodynamiques significatifs dans la région homotopique controlatérale lors de trains de pointes épileptiques. Nos résultats doivent être interprétés avec prudence compte tenu de plusieurs limitations: d’une part absence de mesures électrophysiologiques dans la région d’intérêt controlatérale au foyer simultanément à l’imagerie deux-photons et à l'IOI; d’autre part, lors des expériences avec le deux-photons, incapacité à générer de longues décharges ictales mais plutôt des trains de pointes, couverture spatiale limitée de la région d’intérêt controlatérale, et faible puissance suite au décès prématuré de plusieurs souris pour diverses raisons techniques. Nous terminons en discutant de divers moyens pour améliorer les expériences futures.

Applying scanning electron microscopy for the ultrastructural and clinical analysis of periprosthetic capsules in implant-based breast reconstruction

La reconstruction en deux étapes par expanseur et implant est la technique la plus répandue pour la reconstruction mammmaire post mastectomie. La formation d’une capsule périprothétique est une réponse physiologique universelle à tout corps étranger présent dans le corps humain; par contre, la formation d’une capsule pathologique mène souvent à des complications et par conséquent à des résultats esthétiques sous-optimaux. Le microscope électronique à balayage (MEB) est un outil puissant qui permet d’effectuer une évaluation sans pareille de la topographie ultrastructurelle de spécimens. Le premier objectif de cette thèse est de comparer le MEB conventionnel (Hi-Vac) à une technologie plus récente, soit le MEB environnemental (ESEM), afin de déterminer si cette dernière mène à une évaluation supérieure des tissus capsulaires du sein. Le deuxième objectif est d‘appliquer la modalité de MEB supérieure et d’étudier les modifications ultrastructurelles des capsules périprothétiques chez les femmes subissant différents protocoles d’expansion de tissus dans le contexte de reconstruction mammaire prothétique. Deux études prospectives ont été réalisées afin de répondre à nos objectifs de recherche. Dix patientes ont été incluses dans la première, et 48 dans la seconde. La modalité Hi-Vac s’est avérée supérieure pour l’analyse compréhensive de tissus capsulaires mammaires. En employant le mode Hi-Vac dans notre protocole de recherche établi, un relief 3-D plus prononcé à été observé autour des expanseurs BIOCELL® dans le groupe d’approche d’intervention retardée (6 semaines). Des changements significatifs n’ont pas été observés au niveau des capsules SILTEX® dans les groupes d’approche d’intervention précoce (2 semaines) ni retardée.

Scanning Electron Microscopy Studies on Tear and Wear Failure of Short Kevlar Fiber-Thermoplastic- Polyurethane Composite

Tear and wear properties of short kevlar fiber, thermoplastic polcurethane (TPU) composite with respect to fiber loading-and fiber onentation has been studied and the fracture surfaces were examined under scanning electron microscope (SEM). Tear strength first decreased up to 20 phr fiber loading and then gradually increased with increasing fiber loading. Anisotropy in tear strength was evident beyond a fiber loading of 20 phr. Tear fracture surface of unfilled TPU showed sinusoidal folding characteristics of high strength matrix. At low fiber loading the tear failure was mainly due to fibermatrix failure whereas at higher fiber loading the failure occurred by fiber breakage. Abrasion loss shows a continuous rise with increasing fiber loading, the loss in the transverse orientation of fibers being higher than that in the longitudinal orientation. The abraded surface showed lone cracks and ridges parallel to the direction of abrasion indicating an abrasive wear mechanism. In the presence of fber the abrasion loss was mainly due to fiber low.

Influence of the buffer environment on the Relative Biological Effectiveness of carbon ion radiation, investigated by Scanning Force Microscopy and gel electrophoresis

This work focuses on the analysis of the influence of environment on the relative biological effectiveness (RBE) of carbon ions on molecular level. Due to the high relevance of RBE for medical applications, such as tumor therapy, and radiation protection in space, DNA damages have been investigated in order to understand the biological efficiency of heavy ion radiation. The contribution of this study to the radiobiology research consists in the analysis of plasmid DNA damages induced by carbon ion radiation in biochemical buffer environments, as well as in the calculation of the RBE of carbon ions on DNA level by mean of scanning force microscopy (SFM). In order to study the DNA damages, besides the common electrophoresis method, a new approach has been developed by using SFM. The latter method allows direct visualisation and measurement of individual DNA fragments with an accuracy of several nanometres. In addition, comparison of the results obtained by SFM and agarose gel electrophoresis methods has been performed in the present study. Sparsely ionising radiation, such as X-rays, and densely ionising radiation, such as carbon ions, have been used to irradiate plasmid DNA in trishydroxymethylaminomethane (Tris buffer) and 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid (HEPES buffer) environments. These buffer environments exhibit different scavenging capacities for hydroxyl radical (HO0), which is produced by ionisation of water and plays the major role in the indirect DNA damage processes. Fragment distributions have been measured by SFM over a large length range, and as expected, a significantly higher degree of DNA damages was observed for increasing dose. Also a higher amount of double-strand breaks (DSBs) was observed after irradiation with carbon ions compared to X-ray irradiation. The results obtained from SFM measurements show that both types of radiation induce multiple fragmentation of the plasmid DNA in the dose range from D = 250 Gy to D = 1500 Gy. Using Tris environments at two different concentrations, a decrease of the relative biological effectiveness with the rise of Tris concentration was observed. This demonstrates the radioprotective behavior of the Tris buffer solution. In contrast, a lower scavenging capacity for all other free radicals and ions, produced by the ionisation of water, was registered in the case of HEPES buffer compared to Tris solution. This is reflected in the higher RBE values deduced from SFM and gel electrophoresis measurements after irradiation of the plasmid DNA in 20 mM HEPES environment compared to 92 mM Tris solution. These results show that HEPES and Tris environments play a major role on preventing the indirect DNA damages induced by ionising radiation and on the relative biological effectiveness of heavy ion radiation. In general, the RBE calculated from the SFM measurements presents higher values compared to gel electrophoresis data, for plasmids irradiated in all environments. Using a large set of data, obtained from the SFM measurements, it was possible to calculate the survive rate over a larger range, from 88% to 98%, while for gel electrophoresis measurements the survive rates have been calculated only for values between 96% and 99%. While the gel electrophoresis measurements provide information only about the percentage of plasmids DNA that suffered a single DSB, SFM can count the small plasmid fragments produced by multiple DSBs induced in a single plasmid. Consequently, SFM generates more detailed information regarding the amount of the induced DSBs compared to gel electrophoresis, and therefore, RBE can be calculated with more accuracy. Thus, SFM has been proven to be a more precise method to characterize on molecular level the DNA damage induced by ionizing radiations.

Acquiring expert knowledge for the design of conceptual information systems

Conceptual Information Systems unfold the conceptual structure of data stored in relational databases. In the design phase of the system, conceptual hierarchies have to be created which describe different aspects of the data. In this paper, we describe two principal ways of designing such conceptual hierarchies, data driven design and theory driven design and discuss advantages and drawbacks. The central part of the paper shows how Attribute Exploration, a knowledge acquisition tool developped by B. Ganter can be applied for narrowing the gap between both approaches.

Interacting software-agents to support a kind of expert supervision systems

Expert supervision systems are software applications specially designed to automate process monitoring. The goal is to reduce the dependency on human operators to assure the correct operation of a process including faulty situations. Construction of this kind of application involves an important task of design and development in order to represent and to manipulate process data and behaviour at different degrees of abstraction for interfacing with data acquisition systems connected to the process. This is an open problem that becomes more complex with the number of variables, parameters and relations to account for the complexity of the process. Multiple specialised modules tuned to solve simpler tasks that operate under a co-ordination provide a solution. A modular architecture based on concepts of software agents, taking advantage of the integration of diverse knowledge-based techniques, is proposed for this purpose. The components (software agents, communication mechanisms and perception/action mechanisms) are based on ICa (Intelligent Control architecture), software middleware supporting the build-up of applications with software agent features

Expert supervision based on cases

The paper focuses on taking advantage of large amounts of data that are systematically stored in plants (by means of SCADA systems), but not exploited enough in order to achieve supervisory goals (fault detection, diagnosis and reconfiguration). The methodology of case base reasoning (CBR) is proposed to perform supervisory tasks in industrial processes by re-using the stored data. The goal is to take advantage of experiences, registered in a suitable structure as cam, avoiding the tedious task of knowledge acquisition and representation needed by other reasoning techniques as expert systems. An outlook of CBR terminology and basic concepts are presented. The adaptation of CBR in performing expert supervisory tasks, taking into account the particularities and difficulties derived from dynamic systems, is discussed. A special interest is focused in proposing a general case definition suitable for supervisory tasks. Finally, this structure and the whole methodology is tested in a application example for monitoring a real drier chamber

Efectos del consumo de cigarrillo en la presentación y severidad de la dismenorrea

Introducción: La dismenorrea se presenta como una patología cada vez más frecuente en mujeres de 16-30 años. Dentro de los factores asociados a su presentación, el consumo de tabaco ha revelado resultados contradictorios. El objetivo del presente estudio es explorar la asociación entre el consumo de cigarrillo y la presentación de dismenorrea, y determinar si los trastornos del ánimo y la depresión, alteran dicha asociación. Materiales y métodos: Se realizó un estudio de prevalencia analítica en mujeres de la Universidad del Rosario matriculadas en pregrado durante el primer semestre de 2013, para determinar la asociación entre el consumo de tabaco y la presentación de dismenorrea. En el estudio se tuvieron en cuenta variables tradicionalmente relacionadas con dismenorrea, incluyendo las variables ansiedad y depresión como potenciales variables de confusión. Los registros fueron analizados en el programa Estadístico IBM SPSS Statistics Versión 20.0. Resultados: Se realizaron 538 cuestionarios en total. La edad promedio fue 19.92±2.0 años. La prevalencia de dismenorrea se estimó en 89.3%, la prevalencia de tabaquismo 11.7%. No se encontró una asociación entre dismenorrea y tabaquismo (OR 3.197; IC95% 0.694-14.724). Dentro de las variables analizadas, la depresión y la ansiedad constituyen factores de riesgo independientes para la presentación de dismenorrea con una asociación estadísticamente significativa p=0.026 y p=0.024 respectivamente. El análisis multivariado encuentra como factor determinante en la presentación de dismenorrea, la interacción de depresión y ansiedad controlando por las variables tradicionales p<0.0001. Sin embargo, esta asociación se pierde cuando se analiza en la categoría de dismenorrea severa y gana relevancia el uso de métodos de anticoncepción diferentes a los hormonales, mientras que el hecho de haber iniciado la vida sexual presenta una tendencia limítrofe de riesgo. Conclusiones: No se puede demostrar que el tabaco es un factor asociado a la presentación de dismenorrea. Los trastornos del ánimo y la ansiedad constituyen factores determinantes a la presentación de dismenorrea independientemente de la presencia de otros concomitantes. Las variables de asociación se modifican cuando la variable dependiente se categoriza en su estado más severo. Se necesitan estudios más amplios y detallados para establecer dicha asociación.

Escala para valoración cliníca de fotoenvejecimiento cutáneo en la cara

Introducción: el fotoenvejecimiento cutáneo es causado principalmente por la exposición crónica y acumulativa a los rayos ultravioleta. Las clasificaciones y escalas existentes evalúan el envejecimiento cutáneo de forma global y no existe un instrumento que valore exclusivamente el fotoenvejecimiento cutáneo. Objetivo: Construir y realizar la validación de contenido, de una escala para valoración clínica del fotoenvejecimiento cutáneo en la cara. Materiales y métodos: Estudio de validez de contenido, de una escala para valoración clínica del fotoenvejecimiento cutáneo en cara, construida a partir del marco conceptual, y evaluada por 15 expertos con especialidades médicas que manejan el fotoenvejecimiento. Los datos obtenidos se analizaron así: porcentaje de la pertinencia; la media; coeficiente de variación (CV) e índice de validez de contenido por ítem (CVIi) de cada ítem incluido en la escala. Resultados: Para el grupo de 15 expertos evaluadores, la pertinencia de los 6 ítems incluidos en los criterios clínicos, arrojo una media de 4,2/5 con CVIi entre 73,3% y 100% y con CV por debajo del 20%; el ítem de surcos tuvo un CV de 26,93%; la pertinencia de los 5 ítems incluidos en los antecedentes, arrojo una media de 3,9/5, un CVIi entre 73,3% y 80% y un CV entre 33,67% y 39,84%. Discusión y conclusiones: La validez de contenido de los criterios clínicos de la escala cumplió en un nivel alto con la pertinencia, lo que indica que miden adecuada y exclusivamente las dimensiones del grado clínico de fotoenvejecimiento cutáneo en cara evaluado por los expertos.

Expert. 'Experto'.

Expert, y su programa asociado Gestor, está dirigido a alumnos de ESO a partir de 12 años. Se trata de un software educativo pensado para ayudar en el planteamiento y resolución de problemas: Expert permite ejercitarse (al alumno) a través de la resolución de problemas e incluye un sistema experto de ayuda. Por su parte, Gestor permite añadir nuevos problemas al profesor o alumno a través de una base de datos. Este programa pretende emular al profesor en el planteamiento, ayuda y resolución de actividades, siendo muy apropiado para matemáticas, física, química, cálculo mercantil y otros temas. Incluye un breve manual de instalación y utilización.

Desenvolupament d'un sistema expert com a eina per a una millor gestió de la qualitat de les aigües fluvials

Avui en dia no es pot negar el fet que els humans són un component més de les conques fluvials i que la seva activitat afecta enormement la qualitat de les aigües. A nivell europeu, l'elevada densitat de població situada en les conques fluvials ha comportat un increment de la mala qualitat de les seves aigües fluvials. En les darreres dècades l'increment de les càrregues de nutrients en els sistemes aquàtics ha esdevingut un problema prioritari a solucionar per les administracions competents en matèria d'aigua. La gestió dels ecosistemes fluvials no és una tasca fàcil. Els gestors es troben amb què són sistemes molt complexos, donada l'estreta relació existent entre els ecosistemes fluvials i els ecosistemes terrestres que drenen. Addicionalment a la complexitat d'aquests sistemes es troba la dificultat associada de la gestió o control de les entrades de substàncies contaminants tant de fonts puntuals com difoses. Per totes aquestes raons la gestió de la qualitat de les aigües fluvials esdevé una tasca complexa que requereix un enfocament multidisciplinar. Per tal d'assolir aquest enfocament diverses eines han estat utilitzades, des de models matemàtics fins a sistemes experts i sistemes de suport a la decisió. Però, la major part dels esforços han estat encarats cap a la resolució de problemes de reduïda complexitat, fent que molts dels problemes ambientals complexos, com ara la gestió dels ecosistemes fluvials, no hagin estat vertaderament tractats. Per tant, es requereix l'aplicació d'eines que siguin de gran ajuda en els processos de presa de decisions i que incorporin un ampli coneixement heurístic i empíric: sistemes experts i sistemes de suport a la decisió. L'òptima gestió de la qualitat de l'aigua fluvial requereix una aproximació integrada i multidisciplinar, que pot ésser aconseguida amb una eina intel·ligent construïda sobre els conceptes i mètodes del raonament humà. La present tesi descriu la metodologia desenvolupada i aplicada per a la creació i construcció d'un Sistema Expert, així com el procés de desenvolupament d'aquest Sistema Expert, com el principal mòdul de raonament d'un Sistema de Suport a la Decisió Ambiental. L'objectiu principal de la present tesi ha estat el desenvolupament d'una eina d'ajuda en el procés de presa de decisions dels gestors de l'aigua en la gestió de trams fluvials alterats antròpicament per tal de millorar la qualitat de la seva aigua fluvial. Alhora, es mostra el funcionament de l'eina desenvolupada a través de dos casos d'estudi. Els resultats derivats del Sistema Expert desenvolupat, implementat i presentat en la present tesi mostren que aquests sistemes poden ésser eines útils per a millorar la gestió dels ecosistemes fluvials.

The new professional: underdog or expert? New Museology in the 21th century

For a long time, museum’s form and function were impregnated with social exclusion, only accessible for a prosperous and educated minority. It held the monopoly on the past and therefore in a way on the present and the future. However times have changed and different perspectives on museum practices have been taken. In 1989 the British Peter Vergo mentioned as quoted below, a number of possible museologies, including a ‘new’, and therefore presumably an ‘old’ type of museology: “At the simplest level I would define it, as a state of widespread dissatisfaction with the ‘old’ museology, both within and outside the museum profession; and though the reader may object that such a definition is not merely negative, but circular, I would retort that what is wrong with the ‘old’ museology is that it is too much about museum methods, and too little about purposes of museums; that museology has in the past only frequently been seen, if it has been seen at all, as a theoretical and humanistic discipline.” (Vergo, 1989)