Eficacia del aceite de oliva en la prevención de úlceras por presión en pacientes inmovilizados en atención primaria. Ensayo clínico aleatorizado, multicéntrico, paralelo, triple ciego, de no inferioridad

Las úlceras por presión representan un importante problema de salud pública y tienen un importante impacto económico en los sistemas de salud. La mayoría de los estudios para prevenir las úlceras por presión se han llevado a cabo en contextos hospitalarios, usando ácidos grasos hiperoxigenados (AGHO) y hasta la fecha, no se ha realizado ningún estudio específico con aceite de oliva virgen extra (AOVE) en el entorno domiciliario. Material y método Objetivo principal: evaluar si la utilización de AOVE no es inferior a los AGHO en la prevención de úlceras por presión (UPP) en pacientes inmovilizados en el entorno domiciliario. Diseño: Ensayo clínico aleatorizado multicéntrico, paralelo, a triple ciego, de no inferioridad. Ámbito: Población consultante de centros de salud andaluces. Muestra: 831 pacientes inmovilizados en riesgo de padecer UPP. Resultados El período de seguimiento fue de 16 semanas. En el análisis por protocolo, ninguna de las zonas evaluadas presentó diferencias de riesgo de incidencia de las úlceras por presión que superasen el valor delta establecido (10%). Sacro: AOVE 8 (2,55%) vs AGHO 8 (3,08%), RAR 0,53 (-2,2 a 3,26). Talón derecho: AOVE 4 (1,27%) vs AGHO 5 (1,92)%, RAR 0,65 (-1,43 a 2,73). Talón izquierdo: AOVE 3 (0,96%) vs AGHO 3 (1,15%), RAR 0.2 (-1,49 a 1,88). Trocánter Derecho: AOVE 0 (0%) vs AGHO 4 (1,54%), RAR 1,54 (0,04-3,03). Trocánter izquierdo: AOVE 1 (0,32%) vs AGHO 1 (0,38%), RAR 0.07 (-0,91 a 1,04). Discusión Este ensayo clínico pretendía evaluar si la prevención de las UPP usando una fórmula de AOVE no era inferior a la prevención de UPP con el uso AGHO, en el entorno domiciliario y con pacientes inmovilizados de alto riesgo. Los resultados han mostrado esta no inferioridad al no observarse diferencias que hayan superado el límite inferior del intervalo de confianza y convierte al aceite de oliva en un producto eficaz para la prevención de UPP en este tipo de pacientes. Se necesitan más estudios para investigar el mecanismo de acción del AOVE en la prevención de las UPP y relacionarlo con la etiopatogenia de éstas. Bibliografía 1. Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009 Jul;57(7):1175–83. 2. Yamamoto Y, Hayashino Y, Higashi T, Matsui M, Yamazaki S, Takegami M, et al. Keeping vulnerable elderly patients free from pressure ulcer is associated with high caregiver burden in informal caregivers. J Eval Clin Pract. 2010 Jun;16(3):585–9. 3. Hanson D, Langemo DK, Anderson J, Thompson P, Hunter S. Friction and shear considerations in pressure ulcer development. Adv Skin Wound Care. 2010 Jan;23(1):21–4. 4. Soldevilla Agreda JJ, Torra i Bou J-E, Verdú Soriano J, López Casanova P. 3.er Estudio Nacional de Prevalencia de Úlceras por Presión en España, 2009: Epidemiología y variables definitorias de las lesiones y pacientes. Gerokomos. 2011 Jun;22(2):77–90. 5. Kottner J, Lahmann N, Dassen T. [Pressure ulcer prevalence: comparison between nursing homes and hospitals]. Pflege Z. 2010 Apr;63(4):228–31. 6. Wilborn D, Halfens R, Dassen T, Tannen A. [Pressure ulcer prevalence in German nursing homes and hospitals: what role does the National Nursing Expert Standard Prevention of Pressure Ulcer play?]. Gesundheitswesen Bundesverb Ärzte Öffentl Gesundheitsdienstes Ger. 2010 Apr;72(4):240–5. 7. Tubaishat A, Anthony D, Saleh M. Pressure ulcers in Jordan: a point prevalence study. J Tissue Viability. 2011 Feb;20(1):14–9. 8. James J, Evans JA, Young T, Clark M. Pressure ulcer prevalence across Welsh orthopaedic units and community hospitals: surveys based on the European Pressure Ulcer Advisory Panel minimum data set. Int Wound J. 2010 Jun;7(3):147–52. 9. Defloor T, Schoonhoven L, Katrien V, Weststrate J, Myny D. Reliability of the European Pressure Ulcer Advisory Panel classification system. J Adv Nurs. 2006 Apr;54(2):189–98

Computational analysis and physico-chemical characterization of an inclusion compound between praziquantel and methyl-beta-cyclodextrin for use as an alternative in the treatment of schistosomiasis

Schistosomiasis is still an endemic disease in many regions, with 250 million people infected with Schistosoma and about 500,000 deaths per year. Praziquantel (PZQ) is the drug of choice for schistosomiasis treatment, however it is classified as Class II in the Biopharmaceutics Classification System, as its low solubility hinders its performance in biological systems. The use of cyclodextrins is a useful tool to increase the solubility and bioavailability of drugs. The aim of this work was to prepare an inclusion compound of PZQ and methyl-beta-cyclodextrin (MeCD), perform its physico-chemical characterization, and explore its in vitro cytotoxicity. SEM showed a change of the morphological characteristics of PZQ:MeCD crystals, and IR data supported this finding, with changes after interaction with MeCD including effects on the C-H of the aromatic ring, observed at 758 cm(-1). Differential scanning calorimetry measurements revealed that complexation occurred in a 1:1 molar ratio, as evidenced by the lack of a PZQ transition temperature after inclusion into the MeCD cavity. In solution, the PZQ UV spectrum profile in the presence of MeCD was comparable to the PZQ spectrum in a hydrophobic solvent. Phase solubility diagrams showed that there was a 5.5-fold increase in PZQ solubility, and were indicative of a type A(L) isotherm, that was used to determine an association constant (K(a)) of 140.8 M(-1). No cytotoxicity of the PZQ:MeCD inclusion compound was observed in tests using 3T3 cells. The results suggest that the association of PZQ with MeCD could be a good alternative for the treatment of schistosomiasis.

Elaboración de un plan de gestión de residuos sólidos y estudio de los factores que inciden en la eficiencia y eficacia del plan en las Mecánicas-talleres MAGL y J. J. & Hijos

La generación de residuos sólidos dentro de las mecánicas automotrices en la actualidad, se ha convertido en unos de los principales problemas difíciles de manejar y solucionar, debido al incremento y demanda de vehículos, generando un impacto ambiental negativo tanto en el área de trabajo como en la ciudad. Por tal razón, en varias ciudades del Ecuador y del mundo se ha propuesto la implementación de diferentes planes para el manejo de Residuos Sólidos en este sector. El presente estudio está enfocado a la elaboración de un plan de gestión de Residuos Sólidos, aplicado a dos mecánicas automotrices de la ciudad de Cuenca: J.J. & HIJO y MAGL, realizando de esta manera un análisis a los factores que inciden en la eficiencia y eficacia del mismo. El diseño y aplicación del plan de gestión permitirá estimar el grado de impacto ambiental producido por la generación de los residuos en mecánicas automotrices, por otro lado permitirá la optimización de recursos, disminución de impactos y contaminaciones ambientales, mejoras en el sistema de clasificación, recolección, transporte y disposición final de los desechos e impulsar la conservación de ambiente que nos rodea.

Image summarisation: human action description from static images

Dissertação de Mestrado, Processamento de Linguagem Natural e Indústrias da Língua, Faculdade de Ciências Humanas e Sociais, Universidade do Algarve, 2014

Caracterização da estruturação espacial dos povoamentos da epifauna do litoral rochoso do distrito de Mercúfi. província de Cabo Delgado (Norte de Moçambique), com uso de Sistema de Informação Geográfica: distribuição, abundância, diversidade e conservação

Dissertação de mest. em Estudos Marinhos e Costeiros, Faculdade de Ciências do Mar e do Ambiente, Univ. do Algarve, 2002

The medico-legal importance of establishing human identity by palatal rugoscopy: evaluation of the immutability and individuality of palatal rugae under the influence of ante mortem orthodontic treatment

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Trends in child and adolescent obesity prevalence according to socioeconomic position: protocol for a systematic review

BACKGROUND: Obesity is a significant public health issue and is socially patterned, with greater prevalence of obesity observed in the most socioeconomically disadvantaged groups. Recent evidence suggests that the prevalence of childhood obesity is levelling off in some countries. However, this may not be the case across all socioeconomic strata. The aim of this review is to examine whether trends in child and adolescent obesity prevalence since 1990 differ according to socioeconomic position in developed countries.

METHODS: An electronic search will be conducted via Ovid Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Collaboration to identify articles that report trends in obesity prevalence in children and adolescents according to socioeconomic position. We will also search grey literature databases including the Virtual Library for Public Health and the System for Information on Grey Literature, as well as websites from relevant organisations. Articles that report on a series of cross sectional studies; describe one or more measure of obesity with data recorded at two or more time points since 1990; and report trends by at least one indicator of socioeconomic position will be included. Quality of included studies will be evaluated according to criteria that consider both internal and external validity. Descriptive analysis will be performed to examine trends since 1990 in childhood obesity prevalence according to socioeconomic position.

DISCUSSION: The review will provide a picture of change over time in developed countries of childhood obesity prevalence across socioeconomic strata and identify whether changes in childhood obesity prevalence are experienced equally across socioeconomic groups.

Interobserver agreement of Neer and AO classifications for proximal humeral fractures

BACKGROUND:The classification of proximal humeral fractures remains challenging. The two main classification systems used, the Neer and the AO classification, have both been shown to have less than ideal interobserver agreement. Agreement in classification is required, however, to guide fracture management.

METHOD:Data from the Victorian Orthopaedic Trauma Outcomes Registry were collected and the X-rays of 104 proximal humeral fractures were reviewed by three orthopaedic consultants. They classified the fractures according to the Neer and AO classifications, as well as their simplified versions. Interobserver agreement was then assessed using kappa statistics.

RESULTS:Interobserver agreement was better overall in the Neer classification, which was moderate (kappa = 0.40-0.58), than the AO classification, which was fair to moderate (kappa = 0.31-0.54). When simplified, the Neer and AO classification interobserver agreement remained similar.

CONCLUSION:The classification of proximal humeral fractures with both the Neer and the AO systems remains difficult with minimal improvements seen when reducing the number of categories in each classification system. From these results, the Neer classification system would appear slightly more useful in clinical practice to guide treatment.

Robust real-time bio-kinematic movement tracking using multiple kinects for tele-rehabilitation

This paper investigates the robust and accurate capture of human joint poses and bio-kinematic movements for exercise monitoring in real-time tele-rehabilitation applications. Recently developed model-based estimation ideas are used to improve the accuracy, robustness, and real-time characteristics considered vital for applications, where affordability and domestic use are the primary focus. We use the spatial diversity of the arbitrarily positioned Microsoft Kinect receivers to improve the reliability and promote the uptake of the concept. The skeleton-based information is fused to enhance accuracy and robustness, critical for biomedical applications. A specific version of a robust Kalman filter (KF) in a linear framework is employed to ensure superior estimator convergence and real-time use, compared to other commonly used filters. The algorithmic development was conducted in a generic form and computer simulations were conducted to verify our assertions. Hardware implementations were carried out to test the viability of the proposed state estimator in terms of the core requirements of reliability, accuracy, and real-time use. Performance of the overall system implemented in an information fusion context was evaluated against the commercially available and industry standard Vicon system for different exercise routines, producing comparable results with much less infrastructure and financial investment.

Occupational therapy in forensic psychiatry: Recent developments in our understandings (2007-2013)

Introduction: Occupational therapy in forensic settings has developed in recent decades, leading to an increasing amount of research being conducted in this field. There have been two previous attempts to provide overviews of this body of evidence and future directions for research; however, the rate of research has accelerated in recent years. This critical review addresses the following question: what evidence has been published about occupational therapy in forensic psychiatry over the past 7 years? Method: A mixed methods approach was adopted, with four databases and a search engine consulted (OTDBase, CINAHL, AMED, PSYCHInfo, Google Scholar). The inclusion criteria were: (a) articles published in peer reviewed journals since 2007 and (b) authored by at least one occupational therapist. Twenty-five studies were identified for review, and the four dimensions of occupation - doing, being, becoming and belonging - were used to provide a theoretical context for the subsequent discussion. Findings: The recent evidence base in forensic psychiatry focuses on doing and being, with fewer articles addressing becoming and belonging. Conclusion: This review has identified increasing numbers of studies about forensic occupational therapy, which may reflect growth in both interest and the worldwide workforce.

Minimising impairment: protocol for a multicentre randomised controlled trial of upper limb orthoses for children with cerebral palsy

BACKGROUND: Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone.

METHODS/DESIGN: This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score ≥1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed.

DISCUSSION: This study will provide evidence to inform clinicians, services, funding agencies and parents/carers of children with CP whether the provision of a rigid WHO to reduce upper limb impairment, in combination with usual multidisciplinary care, is worth the effort and costs.

Studies of CMS data access patterns with machine learning techniques

This thesis presents a study of the Grid data access patterns in distributed analysis in the CMS experiment at the LHC accelerator. This study ranges from the deep analysis of the historical patterns of access to the most relevant data types in CMS, to the exploitation of a supervised Machine Learning classification system to set-up a machinery able to eventually predict future data access patterns - i.e. the so-called dataset “popularity” of the CMS datasets on the Grid - with focus on specific data types. All the CMS workflows run on the Worldwide LHC Computing Grid (WCG) computing centers (Tiers), and in particular the distributed analysis systems sustains hundreds of users and applications submitted every day. These applications (or “jobs”) access different data types hosted on disk storage systems at a large set of WLCG Tiers. The detailed study of how this data is accessed, in terms of data types, hosting Tiers, and different time periods, allows to gain precious insight on storage occupancy over time and different access patterns, and ultimately to extract suggested actions based on this information (e.g. targetted disk clean-up and/or data replication). In this sense, the application of Machine Learning techniques allows to learn from past data and to gain predictability potential for the future CMS data access patterns. Chapter 1 provides an introduction to High Energy Physics at the LHC. Chapter 2 describes the CMS Computing Model, with special focus on the data management sector, also discussing the concept of dataset popularity. Chapter 3 describes the study of CMS data access patterns with different depth levels. Chapter 4 offers a brief introduction to basic machine learning concepts and gives an introduction to its application in CMS and discuss the results obtained by using this approach in the context of this thesis.

Non-invasive winding fault detection for induction machines based on stray flux magnetic sensors

Non-intrusive monitoring of health state of induction machines within industrial process and harsh environments poses a technical challenge. In the field, winding failures are a major fault accounting for over 45% of total machine failures. In the literature, many condition monitoring techniques based on different failure mechanisms and fault indicators have been developed where the machine current signature analysis (MCSA) is a very popular and effective method at this stage. However, it is extremely difficult to distinguish different types of failures and hard to obtain local information if a non-intrusive method is adopted. Typically, some sensors need to be installed inside the machines for collecting key information, which leads to disruption to the machine operation and additional costs. This paper presents a new non-invasive monitoring method based on GMRs to measure stray flux leaked from the machines. It is focused on the influence of potential winding failures on the stray magnetic flux in induction machines. Finite element analysis and experimental tests on a 1.5-kW machine are presented to validate the proposed method. With time-frequency spectrogram analysis, it is proven to be effective to detect several winding faults by referencing stray flux information. The novelty lies in the implement of GMR sensing and analysis of machine faults.

Probabilistic Security Constrained Fuzzy Power Flow Models

In restructured power systems, generation and commercialization activities became market activities, while transmission and distribution activities continue as regulated monopolies. As a result, the adequacy of transmission network should be evaluated independent of generation system. After introducing the constrained fuzzy power flow (CFPF) as a suitable tool to quantify the adequacy of transmission network to satisfy 'reasonable demands for the transmission of electricity' (as stated, for instance, at European Directive 2009/72/EC), the aim is now showing how this approach can be used in conjunction with probabilistic criteria in security analysis. In classical security analysis models of power systems are considered the composite system (generation plus transmission). The state of system components is usually modeled with probabilities and loads (and generation) are modeled by crisp numbers, probability distributions or fuzzy numbers. In the case of CFPF the component’s failure of the transmission network have been investigated. In this framework, probabilistic methods are used for failures modeling of the transmission system components and possibility models are used to deal with 'reasonable demands'. The enhanced version of the CFPF model is applied to an illustrative case.

Undergraduate sports students' perceptions of a change to game sense pedagogy

This paper contributes to research in the scholarship of teaching by reporting on undergraduate sports students perceptions of their own learning when exposed to a Game Sense learning approach and reflections on my experience of teaching it. A multiple methods approach was utilised to gather data from a four-week games component of a 10-week unit of study with all participants (n = 20; aged 18-21) in their first year of a three-year sports-related undergraduate degree. The games classification system was used to plan session content over the four weeks with each week focusing on a different games classification. Data were organised and coded via inductive coding procedures with analysis conducted concurrently to identify three prominent themes: 1) positive experiences of competition and game play, 2) the range of cognitive and emotional learning opportunities provided by Game Sense pedagogy facilitated improved student engagement and learning, and 3) the challenge of effective teacher questioning to stimulate game play knowledge construction.