Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial

BACKGROUND Symptoms associated with pes planovalgus or flatfeet occur frequently, even though some people with a flatfoot deformity remain asymptomatic. Pes planovalgus is proposed to be associated with foot/ankle pain and poor function. Concurrently, the multifactorial weakness of the tibialis posterior muscle and its tendon can lead to a flattening of the longitudinal arch of the foot. Those affected can experience functional impairment and pain. Less severe cases at an early stage are eligible for non-surgical treatment and foot orthoses are considered to be the first line approach. Furthermore, strengthening of arch and ankle stabilising muscles are thought to contribute to active compensation of the deformity leading to stress relief of soft tissue structures. There is only limited evidence concerning the numerous therapy approaches, and so far, no data are available showing functional benefits that accompany these interventions. METHODS After clinical diagnosis and clarification of inclusion criteria (e.g., age 40-70, current complaint of foot and ankle pain more than three months, posterior tibial tendon dysfunction stage I & II, longitudinal arch flattening verified by radiography), sixty participants with posterior tibial tendon dysfunction associated complaints will be included in the study and will be randomly assigned to one of three different intervention groups: (i) foot orthoses only (FOO), (ii) foot orthoses and eccentric exercise (FOE), or (iii) sham foot orthoses only (FOS). Participants in the FOO and FOE groups will be allocated individualised foot orthoses, the latter combined with eccentric exercise for ankle stabilisation and strengthening of the tibialis posterior muscle. Participants in the FOS group will be allocated sham foot orthoses only. During the intervention period of 12 weeks, all participants will be encouraged to follow an educational program for dosed foot load management (e.g., to stop activity if they experience increasing pain). Functional impairment will be evaluated pre- and post-intervention by the Foot Function Index. Further outcome measures include the Pain Disability Index, Visual Analogue Scale for pain, SF-12, kinematic data from 3D-movement analysis and neuromuscular activity during level and downstairs walking. Measuring outcomes pre- and post-intervention will allow the calculation of intervention effects by 3×3 Analysis of Variance (ANOVA) with repeated measures. DISCUSSION The purpose of this randomised trial is to evaluate the therapeutic benefit of three different non-surgical treatment regimens in participants with posterior tibial tendon dysfunction and accompanying pes planovalgus. Furthermore, the analysis of changes in gait mechanics and neuromuscular control will contribute to an enhanced understanding of functional changes and eventually optimise conservative management strategies for these patients. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT01839669.

Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.

BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are the backbone of osteoarthritis pain management. We aimed to assess the effectiveness of different preparations and doses of NSAIDs on osteoarthritis pain in a network meta-analysis. METHODS For this network meta-analysis, we considered randomised trials comparing any of the following interventions: NSAIDs, paracetamol, or placebo, for the treatment of osteoarthritis pain. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the reference lists of relevant articles for trials published between Jan 1, 1980, and Feb 24, 2015, with at least 100 patients per group. The prespecified primary and secondary outcomes were pain and physical function, and were extracted in duplicate for up to seven timepoints after the start of treatment. We used an extension of multivariable Bayesian random effects models for mixed multiple treatment comparisons with a random effect at the level of trials. For the primary analysis, a random walk of first order was used to account for multiple follow-up outcome data within a trial. Preparations that used different total daily dose were considered separately in the analysis. To assess a potential dose-response relation, we used preparation-specific covariates assuming linearity on log relative dose. FINDINGS We identified 8973 manuscripts from our search, of which 74 randomised trials with a total of 58 556 patients were included in this analysis. 23 nodes concerning seven different NSAIDs or paracetamol with specific daily dose of administration or placebo were considered. All preparations, irrespective of dose, improved point estimates of pain symptoms when compared with placebo. For six interventions (diclofenac 150 mg/day, etoricoxib 30 mg/day, 60 mg/day, and 90 mg/day, and rofecoxib 25 mg/day and 50 mg/day), the probability that the difference to placebo is at or below a prespecified minimum clinically important effect for pain reduction (effect size [ES] -0·37) was at least 95%. Among maximally approved daily doses, diclofenac 150 mg/day (ES -0·57, 95% credibility interval [CrI] -0·69 to -0·46) and etoricoxib 60 mg/day (ES -0·58, -0·73 to -0·43) had the highest probability to be the best intervention, both with 100% probability to reach the minimum clinically important difference. Treatment effects increased as drug dose increased, but corresponding tests for a linear dose effect were significant only for celecoxib (p=0·030), diclofenac (p=0·031), and naproxen (p=0·026). We found no evidence that treatment effects varied over the duration of treatment. Model fit was good, and between-trial heterogeneity and inconsistency were low in all analyses. All trials were deemed to have a low risk of bias for blinding of patients. Effect estimates did not change in sensitivity analyses with two additional statistical models and accounting for methodological quality criteria in meta-regression analysis. INTERPRETATION On the basis of the available data, we see no role for single-agent paracetamol for the treatment of patients with osteoarthritis irrespective of dose. We provide sound evidence that diclofenac 150 mg/day is the most effective NSAID available at present, in terms of improving both pain and function. Nevertheless, in view of the safety profile of these drugs, physicians need to consider our results together with all known safety information when selecting the preparation and dose for individual patients. FUNDING Swiss National Science Foundation (grant number 405340-104762) and Arco Foundation, Switzerland.

Prevalence and determinants of type 2 diabetes among Filipino Americans in Houston metropolitan statistical area, Texas

Diabetes in adults (type 2) has emerged as a world health problem. Prevalence and risk factors have been found to vary in different populations. The wide range of prevalence rates worldwide indicates the importance of genetic and environmental factors in the etiology of the disease. The few available studies suggest that Filipinos are among the higher-risk groups for developing diabetes. This cross-sectional study estimated the overall prevalence rate of type 2 diabetes among Filipino Americans, ages 20–74 years and residents of Houston Metropolitan Statistical Area, Texas, to be 16.1%. The observed high prevalence was associated with age, sex, family history of diabetes, obesity, region of birth; and, in women, gestational diabetes and income. The diabetic Filipino Americans had a higher proportion of parental history of diabetes, medical history of hypertension, and history of smoking; were physically less active, but generally non-obese, compared with the United States diabetic population. ^

The socioeconomic status of families of hyperglycemic versus non-hyperglycemic children: A descriptive analysis

The proportion of children and adolescents living with type 2 diabetes mellitus (DM) is rising at an alarming rate. Studies have shown that poor dietary choices and sedentary behaviors account for progression of some of the most prevalent diseases in America, including obesity, heart disease and diabetes. Other studies have shown that genetics plays a role in the diabetic determination of an individual, although not very common. What are some of the differentiating factors between elevated and non-elevated fasting capillary glucose (FCG) levels in children of similar ages, knowing they spend a majority of their lives at home or at school? Why are some children acquiring diabetes while others are not? This study utilized an IRB-approved Family Demographic Survey to determine gender, family income, parent education levels, sedentary practices, and household size. Only those families who gave consent to take part in the study received a questionnaire. The statistical results were used to test the hypothesis that children living with elevated FCG levels are more likely to descend from families with lower incomes, and lower levels of education.^ With regard to household income and FCG status of non-hyperglycemic and hyperglycemic children (Table 4b), there are 10.4% more hyperglycemic children in the lower income bracket than non-hyperglycemic children in the same income bracket.^ With regard to maternal education and FCG status (Table 5b), there are 7.0% more hyperglycemic children in the high school or less maternal educational attainment level than non-hyperglycemic children in the same maternal educational level. The Pearson correlation of maternal education and FCG status showed a negative correlation value of -.035 (Table 5d). The higher the occurrence of hyperglycemia in a child, the lower the maternal educational status is. Household size ranges and averages are nearly identical in families of both hyperglycemic and non-hyperglycemic children. ^

Assessment of US Air Force student pilots with intermittent monofixation syndrome on a non-stereoptic dependent flight maneuver in pilot training

The United States Air Force School of Aerospace Medicine (USAFSAM) and Aeromedical Consult Service (ACS) have developed waiver criteria for pilots with subtle substandard depth perception. This is to allow United States Air Force (USAF) pilots with mild depth perception deficiency to continue flying duties while limiting the risk to flight safety and ensuring the availability of costly human resources. From 1999 to 2005, 166 aviators were given waivers for intermittent monofixation syndrome (IMFS). Of these, 96 were student pilots who performed slightly worse at stereoptic dependent flight maneuvers than student pilots (8,907) with normal depth perception (Lowry, 2006).^ This study's purpose is to evaluate the performance of the extended-trail maneuver, a non-stereoptic dependent flying maneuver, as executed by a cohort of 12 United States Air Force student pilots with intermittent monofixation syndrome versus the cohort of 100 student pilots with normal depth perception. These subjects are extracted from the cohorts examined by Lowry (2006) and the null hypothesis predicts no statistical difference in the performance of the non-stereoptic dependant flight maneuver extended-trail between student pilots with intermittent monofixation syndrome and those without the condition. ^

Exposure to nonsteroidal anti-inflammatory drugs and weight loss and hospitalization in non-small cell lung cancer patients

Background. Cancer cachexia is a common syndrome complex in cancer, occurring in nearly 80% of patients with advanced cancer and responsible for at least 20% of all cancer deaths. Cachexia is due to increased resting energy expenditure, increased production of inflammatory mediators, and changes in lipid and protein metabolism. Non-steroidal anti-inflammatory drugs (NSAIDs), by virtue of their anti-inflammatory properties, are possibly protective against cancer-related cachexia. Since cachexia is also associated with increased hospitalizations, this outcome may also show improvement with NSAID exposure. ^ Design. In this retrospective study, computerized records from 700 non-small cell lung cancer patients (NSCLC) were reviewed, and 487 (69.57%) were included in the final analyses. Exclusion criteria were severe chronic obstructive pulmonary disease, significant peripheral edema, class III or IV congestive heart failure, liver failure, other reasons for weight loss, or use of research or anabolic medications. Information on medication history, body weight and hospitalizations was collected from one year pre-diagnosis until three years post-diagnosis. Exposure to NSAIDs was defined if a patient had a history of being treated with NSAIDs for at least 50% of any given year in the observation period. We used t-test and chi-square tests for statistical analyses. ^ Results. Neither the proportion of patients with cachexia (p=0.27) nor the number of hospitalizations (p=0.74) differed among those with a history of NSAID use (n=92) and those without (n=395). ^ Conclusions. In this study, NSAID exposure was not significantly associated with weight loss or hospital admissions in patients with NSCLC. Further studies may be needed to confirm these observations.^

BAYESIAN STATISTICAL METHODS IN GENE-ENVIRONMENT AND GENE-GENE INTERACTION STUDIES

Complex diseases such as cancer result from multiple genetic changes and environmental exposures. Due to the rapid development of genotyping and sequencing technologies, we are now able to more accurately assess causal effects of many genetic and environmental factors. Genome-wide association studies have been able to localize many causal genetic variants predisposing to certain diseases. However, these studies only explain a small portion of variations in the heritability of diseases. More advanced statistical models are urgently needed to identify and characterize some additional genetic and environmental factors and their interactions, which will enable us to better understand the causes of complex diseases. In the past decade, thanks to the increasing computational capabilities and novel statistical developments, Bayesian methods have been widely applied in the genetics/genomics researches and demonstrating superiority over some regular approaches in certain research areas. Gene-environment and gene-gene interaction studies are among the areas where Bayesian methods may fully exert its functionalities and advantages. This dissertation focuses on developing new Bayesian statistical methods for data analysis with complex gene-environment and gene-gene interactions, as well as extending some existing methods for gene-environment interactions to other related areas. It includes three sections: (1) Deriving the Bayesian variable selection framework for the hierarchical gene-environment and gene-gene interactions; (2) Developing the Bayesian Natural and Orthogonal Interaction (NOIA) models for gene-environment interactions; and (3) extending the applications of two Bayesian statistical methods which were developed for gene-environment interaction studies, to other related types of studies such as adaptive borrowing historical data. We propose a Bayesian hierarchical mixture model framework that allows us to investigate the genetic and environmental effects, gene by gene interactions (epistasis) and gene by environment interactions in the same model. It is well known that, in many practical situations, there exists a natural hierarchical structure between the main effects and interactions in the linear model. Here we propose a model that incorporates this hierarchical structure into the Bayesian mixture model, such that the irrelevant interaction effects can be removed more efficiently, resulting in more robust, parsimonious and powerful models. We evaluate both of the 'strong hierarchical' and 'weak hierarchical' models, which specify that both or one of the main effects between interacting factors must be present for the interactions to be included in the model. The extensive simulation results show that the proposed strong and weak hierarchical mixture models control the proportion of false positive discoveries and yield a powerful approach to identify the predisposing main effects and interactions in the studies with complex gene-environment and gene-gene interactions. We also compare these two models with the 'independent' model that does not impose this hierarchical constraint and observe their superior performances in most of the considered situations. The proposed models are implemented in the real data analysis of gene and environment interactions in the cases of lung cancer and cutaneous melanoma case-control studies. The Bayesian statistical models enjoy the properties of being allowed to incorporate useful prior information in the modeling process. Moreover, the Bayesian mixture model outperforms the multivariate logistic model in terms of the performances on the parameter estimation and variable selection in most cases. Our proposed models hold the hierarchical constraints, that further improve the Bayesian mixture model by reducing the proportion of false positive findings among the identified interactions and successfully identifying the reported associations. This is practically appealing for the study of investigating the causal factors from a moderate number of candidate genetic and environmental factors along with a relatively large number of interactions. The natural and orthogonal interaction (NOIA) models of genetic effects have previously been developed to provide an analysis framework, by which the estimates of effects for a quantitative trait are statistically orthogonal regardless of the existence of Hardy-Weinberg Equilibrium (HWE) within loci. Ma et al. (2012) recently developed a NOIA model for the gene-environment interaction studies and have shown the advantages of using the model for detecting the true main effects and interactions, compared with the usual functional model. In this project, we propose a novel Bayesian statistical model that combines the Bayesian hierarchical mixture model with the NOIA statistical model and the usual functional model. The proposed Bayesian NOIA model demonstrates more power at detecting the non-null effects with higher marginal posterior probabilities. Also, we review two Bayesian statistical models (Bayesian empirical shrinkage-type estimator and Bayesian model averaging), which were developed for the gene-environment interaction studies. Inspired by these Bayesian models, we develop two novel statistical methods that are able to handle the related problems such as borrowing data from historical studies. The proposed methods are analogous to the methods for the gene-environment interactions on behalf of the success on balancing the statistical efficiency and bias in a unified model. By extensive simulation studies, we compare the operating characteristics of the proposed models with the existing models including the hierarchical meta-analysis model. The results show that the proposed approaches adaptively borrow the historical data in a data-driven way. These novel models may have a broad range of statistical applications in both of genetic/genomic and clinical studies.

Geotechnical Analysis of Contaminated Sand by Light Non-Aquous Phase Liquids

Contaminated soil reuse was investigated, with higher profusion, throughout the early 90’s, coinciding with the 1991 Gulf War, when efforts to amend large crude oil releases began in geotechnical assessment of contaminated soils. Isolated works referring to geotechnical testing with hydrocarbon ground contaminants are described in the state-of-the-art, which have been extended to other type of contaminated soil references. Contaminated soils by light non-aquous phase liquids (LNAPL) bearing capacity reduction has been previously investigated from a forensic point of view. To date, all the research works have been published based on the assumption of constant contaminant saturation for the entire soil mass. In contrast, the actual LNAPLs distribution plumes exhibit complex flow patterns which are subject to physical and chemical changes with time and distance travelled from the release source. This aspect has been considered along the present text. A typical Madrid arkosic soil formation is commonly known as Miga sand. Geotechnical tests have been carried out, with Miga sand specimens, in incremental series of LNAPL concentrations in order to observe the soil engineering properties variation due to a contamination increase. Results are discussed in relation with previous studies and as a matter of fact, soil mechanics parameters change in the presence of LNAPL, showing different tendencies according to each test and depending on the LNAPL content, as well as to the specimen’s initially planned relative density, dense or loose. Geotechnical practical implications are also commented on and analyzed. Variation on geotechnical properties may occur only within the external contour of contamination distribution plume. This scope has motivated the author to develop a physical model based on transparent soil technology. The model aims to reproduce the distribution of LNAPL into the ground due to an accidental release from a storage facility. Preliminary results indicate that the model is a potentially complementary tool for hydrogeological applications, site-characterization and remediation treatment testing within the framework of soil pollution events. A description of the test setup of an innovative three dimensional physical model for the flow of two or more phases, in porous media, is presented herein, along with a summary of the advantages, limitations and future applications for modeling with transparent material. En los primeros años de la década de los años 90, del siglo pasado, coincidiendo con la Guerra del Golfo en 1991, se investigó intensamente sobre la reutilización de suelos afectados por grandes volúmenes de vertidos de crudo, fomentándose la evaluación geotécnica de los suelos contaminados. Se describen, en el estado del arte de esta tésis, una serie de trabajos aislados en relación con la caracterización geotécnica de suelos contaminados con hidrocarburos, descripción ampliada mediante referencias relacionadas con otros tipos de contaminación de suelos. Existen estudios previos de patología de cimentaciones que analizan la reducción de la capacidad portante de suelos contaminados por hidrocarburos líquidos ligeros en fase no acuosa (acrónimo en inglés: LNAPL de “Liquid Non-Aquous Phase Liquid”). A fecha de redacción de la tesis, todas las publicaciones anteriores estaban basadas en la consideración de una saturación del contaminante constante en toda la extensión del terreno de cimentación. La distribución real de las plumas de contaminante muestra, por el contrario, complejas trayectorias de flujo que están sujetas a cambios físico-químicos en función del tiempo y la distancia recorrida desde su origen de vertido. Éste aspecto ha sido considerado y tratado en el presente texto. La arena de Miga es una formación geológica típica de Madrid. En el ámbito de esta tesis se han desarrollado ensayos geotécnicos con series de muestras de arena de Miga contaminadas con distintas concentraciones de LNAPL con el objeto de estimar la variación de sus propiedades geotécnicas debido a un incremento de contaminación. Se ha realizado una evaluación de resultados de los ensayos en comparación con otros estudios previamente analizados, resultando que las propiedades mecánicas del suelo, efectivamente, varían en función del contenido de LNAPL y de la densidad relativa con la que se prepare la muestra, densa o floja. Se analizan y comentan las implicaciones de carácter práctico que supone la mencionada variación de propiedades geotécnicas. El autor ha desarrollado un modelo físico basado en la tecnología de suelos transparentes, considerando que las variaciones de propiedades geotécnicas únicamente deben producirse en el ámbito interior del contorno de la pluma contaminante. El objeto del modelo es el de reproducir la distribución de un LNAPL en un terreno dado, causada por el vertido accidental de una instalación de almecenamiento de combustible. Los resultados preliminares indican que el modelo podría emplearse como una herramienta complementaria para el estudio de eventos contaminantes, permitiendo el desarrollo de aplicaciones de carácter hidrogeológico, caracterización de suelos contaminados y experimentación de tratamientos de remediación. Como aportación de carácter innovadora, se presenta y describe un modelo físico tridimensional de flujo de dos o más fases a través de un medio poroso transparente, analizándose sus ventajas e inconvenientes así como sus limitaciones y futuras aplicaciones.

Non-destructive methods to estimate physical aging of plywood

This paper studies the relationship between aging, physical changes and the results of non-destructive testing of plywood. 176 pieces of plywood were tested to analyze their actual and estimated density using non-destructive methods (screw withdrawal force and ultrasound wave velocity) during a laboratory aging test. From the results of statistical analysis it can be concluded that there is a strong relationship between the non-destructive measurements carried out, and the decline in the physical properties of the panels due to aging. The authors propose several models to estimate board density. The best results are obtained with ultrasound. A reliable prediction of the degree of deterioration (aging) of board is presented.

Linear global instability of non-orthogonal incompressible swept attachment-line boundary layer flow

Instability of the orthogonal swept attachment line boundary layer has received attention by local1, 2 and global3–5 analysis methods over several decades, owing to the significance of this model to transition to turbulence on the surface of swept wings. However, substantially less attention has been paid to the problem of laminar flow instability in the non-orthogonal swept attachment-line boundary layer; only a local analysis framework has been employed to-date.6 The present contribution addresses this issue from a linear global (BiGlobal) instability analysis point of view in the incompressible regime. Direct numerical simulations have also been performed in order to verify the analysis results and unravel the limits of validity of the Dorrepaal basic flow7 model analyzed. Cross-validated results document the effect of the angle _ on the critical conditions identified by Hall et al.1 and show linear destabilization of the flow with decreasing AoA, up to a limit at which the assumptions of the Dorrepaal model become questionable. Finally, a simple extension of the extended G¨ortler-H¨ammerlin ODE-based polynomial model proposed by Theofilis et al.4 is presented for the non-orthogonal flow. In this model, the symmetries of the three-dimensional disturbances are broken by the non-orthogonal flow conditions. Temporal and spatial one-dimensional linear eigenvalue codes were developed, obtaining consistent results with BiGlobal stability analysis and DNS. Beyond the computational advantages presented by the ODE-based model, it allows us to understand the functional dependence of the three-dimensional disturbances in the non-orthogonal case as well as their connections with the disturbances of the orthogonal stability problem.

An Intercomparison of Modelling Approaches for Simulating the Atmospheric Dispersion of Ammonia Emitted by Agricultural Sources

RESUMEN La dispersión del amoniaco (NH3) emitido por fuentes agrícolas en medias distancias, y su posterior deposición en el suelo y la vegetación, pueden llevar a la degradación de ecosistemas vulnerables y a la acidificación de los suelos. La deposición de NH3 suele ser mayor junto a la fuente emisora, por lo que los impactos negativos de dichas emisiones son generalmente mayores en esas zonas. Bajo la legislación comunitaria, varios estados miembros emplean modelos de dispersión inversa para estimar los impactos de las emisiones en las proximidades de las zonas naturales de especial conservación. Una revisión reciente de métodos para evaluar impactos de NH3 en distancias medias recomendaba la comparación de diferentes modelos para identificar diferencias importantes entre los métodos empleados por los distintos países de la UE. En base a esta recomendación, esta tesis doctoral compara y evalúa las predicciones de las concentraciones atmosféricas de NH3 de varios modelos bajo condiciones, tanto reales como hipotéticas, que plantean un potencial impacto sobre ecosistemas (incluidos aquellos bajo condiciones de clima Mediterráneo). En este sentido, se procedió además a la comparación y evaluación de varias técnicas de modelización inversa para inferir emisiones de NH3. Finalmente, se ha desarrollado un modelo matemático simple para calcular las concentraciones de NH3 y la velocidad de deposición de NH3 en ecosistemas vulnerables cercanos a una fuente emisora. La comparativa de modelos supuso la evaluación de cuatro modelos de dispersión (ADMS 4.1; AERMOD v07026; OPS-st v3.0.3 y LADD v2010) en un amplio rango de casos hipotéticos (dispersión de NH3 procedente de distintos tipos de fuentes agrícolas de emisión). La menor diferencia entre las concentraciones medias estimadas por los distintos modelos se obtuvo para escenarios simples. La convergencia entre las predicciones de los modelos fue mínima para el escenario relativo a la dispersión de NH3 procedente de un establo ventilado mecánicamente. En este caso, el modelo ADMS predijo concentraciones significativamente menores que los otros modelos. Una explicación de estas diferencias podríamos encontrarla en la interacción de diferentes “penachos” y “capas límite” durante el proceso de parametrización. Los cuatro modelos de dispersión fueron empleados para dos casos reales de dispersión de NH3: una granja de cerdos en Falster (Dinamarca) y otra en Carolina del Norte (EEUU). Las concentraciones medias anuales estimadas por los modelos fueron similares para el caso americano (emisión de granjas ventiladas de forma natural y balsa de purines). La comparación de las predicciones de los modelos con concentraciones medias anuales medidas in situ, así como la aplicación de los criterios establecidos para la aceptación estadística de los modelos, permitió concluir que los cuatro modelos se comportaron aceptablemente para este escenario. No ocurrió lo mismo en el caso danés (nave ventilada mecánicamente), en donde el modelo LADD no dio buenos resultados debido a la ausencia de procesos de “sobreelevacion de penacho” (plume-rise). Los modelos de dispersión dan a menudo pobres resultados en condiciones de baja velocidad de viento debido a que la teoría de dispersión en la que se basan no es aplicable en estas condiciones. En situaciones de frecuente descenso en la velocidad del viento, la actual guía de modelización propone usar un modelo que sea eficaz bajo dichas condiciones, máxime cuando se realice una valoración que tenga como objeto establecer una política de regularización. Esto puede no ser siempre posible debido a datos meteorológicos insuficientes, en cuyo caso la única opción sería utilizar un modelo más común, como la versión avanzada de los modelos Gausianos ADMS o AERMOD. Con el objetivo de evaluar la idoneidad de estos modelos para condiciones de bajas velocidades de viento, ambos modelos fueron utilizados en un caso con condiciones Mediterráneas. Lo que supone sucesivos periodos de baja velocidad del viento. El estudio se centró en la dispersión de NH3 procedente de una granja de cerdos en Segovia (España central). Para ello la concentración de NH3 media mensual fue medida en 21 localizaciones en torno a la granja. Se realizaron también medidas de concentración de alta resolución en una única localización durante una campaña de una semana. En este caso, se evaluaron dos estrategias para mejorar la respuesta del modelo ante bajas velocidades del viento. La primera se basó en “no zero wind” (NZW), que sustituyó periodos de calma con el mínimo límite de velocidad del viento y “accumulated calm emissions” (ACE), que forzaban al modelo a calcular las emisiones totales en un periodo de calma y la siguiente hora de no-calma. Debido a las importantes incertidumbres en los datos de entrada del modelo (inputs) (tasa de emisión de NH3, velocidad de salida de la fuente, parámetros de la capa límite, etc.), se utilizó el mismo caso para evaluar la incertidumbre en la predicción del modelo y valorar como dicha incertidumbre puede ser considerada en evaluaciones del modelo. Un modelo dinámico de emisión, modificado para el caso de clima Mediterráneo, fue empleado para estimar la variabilidad temporal en las emisiones de NH3. Así mismo, se realizó una comparativa utilizando las emisiones dinámicas y la tasa constante de emisión. La incertidumbre predicha asociada a la incertidumbre de los inputs fue de 67-98% del valor medio para el modelo ADMS y entre 53-83% del valor medio para AERMOD. La mayoría de esta incertidumbre se debió a la incertidumbre del ratio de emisión en la fuente (50%), seguida por la de las condiciones meteorológicas (10-20%) y aquella asociada a las velocidades de salida (5-10%). El modelo AERMOD predijo mayores concentraciones que ADMS y existieron más simulaciones que alcanzaron los criterios de aceptabilidad cuando se compararon las predicciones con las concentraciones medias anuales medidas. Sin embargo, las predicciones del modelo ADMS se correlacionaron espacialmente mejor con las mediciones. El uso de valores dinámicos de emisión estimados mejoró el comportamiento de ADMS, haciendo empeorar el de AERMOD. La aplicación de estrategias destinadas a mejorar el comportamiento de este último tuvo efectos contradictorios similares. Con el objeto de comparar distintas técnicas de modelización inversa, varios modelos (ADMS, LADD y WindTrax) fueron empleados para un caso no agrícola, una colonia de pingüinos en la Antártida. Este caso fue empleado para el estudio debido a que suponía la oportunidad de obtener el primer factor de emisión experimental para una colonia de pingüinos antárticos. Además las condiciones eran propicias desde el punto de vista de la casi total ausencia de concentraciones ambiente (background). Tras el trabajo de modelización existió una concordancia suficiente entre las estimaciones obtenidas por los tres modelos. De este modo se pudo definir un factor de emisión de para la colonia de 1.23 g NH3 por pareja criadora por día (con un rango de incertidumbre de 0.8-2.54 g NH3 por pareja criadora por día). Posteriores aplicaciones de técnicas de modelización inversa para casos agrícolas mostraron también un buen compromiso estadístico entre las emisiones estimadas por los distintos modelos. Con todo ello, es posible concluir que la modelización inversa es una técnica robusta para estimar tasas de emisión de NH3. Modelos de selección (screening) permiten obtener una rápida y aproximada estimación de los impactos medioambientales, siendo una herramienta útil para evaluaciones de impactos en tanto que permite eliminar casos que presentan un riesgo potencial de daño bajo. De esta forma, lo recursos del modelo pueden Resumen (Castellano) destinarse a casos en donde la posibilidad de daño es mayor. El modelo de Cálculo Simple de los Límites de Impacto de Amoniaco (SCAIL) se desarrolló para obtener una estimación de la concentración media de NH3 y de la tasa de deposición seca asociadas a una fuente agrícola. Está técnica de selección, basada en el modelo LADD, fue evaluada y calibrada con diferentes bases de datos y, finalmente, validada utilizando medidas independientes de concentraciones realizadas cerca de las fuentes. En general SCAIL dio buenos resultados de acuerdo a los criterios estadísticos establecidos. Este trabajo ha permitido definir situaciones en las que las concentraciones predichas por modelos de dispersión son similares, frente a otras en las que las predicciones difieren notablemente entre modelos. Algunos modelos nos están diseñados para simular determinados escenarios en tanto que no incluyen procesos relevantes o están más allá de los límites de su aplicabilidad. Un ejemplo es el modelo LADD que no es aplicable en fuentes con velocidad de salida significativa debido a que no incluye una parametrización de sobreelevacion del penacho. La evaluación de un esquema simple combinando la sobreelevacion del penacho y una turbulencia aumentada en la fuente mejoró el comportamiento del modelo. Sin embargo más pruebas son necesarias para avanzar en este sentido. Incluso modelos que son aplicables y que incluyen los procesos relevantes no siempre dan similares predicciones. Siendo las razones de esto aún desconocidas. Por ejemplo, AERMOD predice mayores concentraciones que ADMS para dispersión de NH3 procedente de naves de ganado ventiladas mecánicamente. Existe evidencia que sugiere que el modelo ADMS infraestima concentraciones en estas situaciones debido a un elevado límite de velocidad de viento. Por el contrario, existen evidencias de que AERMOD sobreestima concentraciones debido a sobreestimaciones a bajas Resumen (Castellano) velocidades de viento. Sin embrago, una modificación simple del pre-procesador meteorológico parece mejorar notablemente el comportamiento del modelo. Es de gran importancia que estas diferencias entre las predicciones de los modelos sean consideradas en los procesos de evaluación regulada por los organismos competentes. Esto puede ser realizado mediante la aplicación del modelo más útil para cada caso o, mejor aún, mediante modelos múltiples o híbridos. ABSTRACT Short-range atmospheric dispersion of ammonia (NH3) emitted by agricultural sources and its subsequent deposition to soil and vegetation can lead to the degradation of sensitive ecosystems and acidification of the soil. Atmospheric concentrations and dry deposition rates of NH3 are generally highest near the emission source and so environmental impacts to sensitive ecosystems are often largest at these locations. Under European legislation, several member states use short-range atmospheric dispersion models to estimate the impact of ammonia emissions on nearby designated nature conservation sites. A recent review of assessment methods for short-range impacts of NH3 recommended an intercomparison of the different models to identify whether there are notable differences to the assessment approaches used in different European countries. Based on this recommendation, this thesis compares and evaluates the atmospheric concentration predictions of several models used in these impact assessments for various real and hypothetical scenarios, including Mediterranean meteorological conditions. In addition, various inverse dispersion modelling techniques for the estimation of NH3 emissions rates are also compared and evaluated and a simple screening model to calculate the NH3 concentration and dry deposition rate at a sensitive ecosystem located close to an NH3 source was developed. The model intercomparison evaluated four atmospheric dispersion models (ADMS 4.1; AERMOD v07026; OPS-st v3.0.3 and LADD v2010) for a range of hypothetical case studies representing the atmospheric dispersion from several agricultural NH3 source types. The best agreement between the mean annual concentration predictions of the models was found for simple scenarios with area and volume sources. The agreement between the predictions of the models was worst for the scenario representing the dispersion from a mechanically ventilated livestock house, for which ADMS predicted significantly smaller concentrations than the other models. The reason for these differences appears to be due to the interaction of different plume-rise and boundary layer parameterisations. All four dispersion models were applied to two real case studies of dispersion of NH3 from pig farms in Falster (Denmark) and North Carolina (USA). The mean annual concentration predictions of the models were similar for the USA case study (emissions from naturally ventilated pig houses and a slurry lagoon). The comparison of model predictions with mean annual measured concentrations and the application of established statistical model acceptability criteria concluded that all four models performed acceptably for this case study. This was not the case for the Danish case study (mechanically ventilated pig house) for which the LADD model did not perform acceptably due to the lack of plume-rise processes in the model. Regulatory dispersion models often perform poorly in low wind speed conditions due to the model dispersion theory being inapplicable at low wind speeds. For situations with frequent low wind speed periods, current modelling guidance for regulatory assessments is to use a model that can handle these conditions in an acceptable way. This may not always be possible due to insufficient meteorological data and so the only option may be to carry out the assessment using a more common regulatory model, such as the advanced Gaussian models ADMS or AERMOD. In order to assess the suitability of these models for low wind conditions, they were applied to a Mediterranean case study that included many periods of low wind speed. The case study was the dispersion of NH3 emitted by a pig farm in Segovia, Central Spain, for which mean monthly atmospheric NH3 concentration measurements were made at 21 locations surrounding the farm as well as high-temporal-resolution concentration measurements at one location during a one-week campaign. Two strategies to improve the model performance for low wind speed conditions were tested. These were ‘no zero wind’ (NZW), which replaced calm periods with the minimum threshold wind speed of the model and ‘accumulated calm emissions’ (ACE), which forced the model to emit the total emissions during a calm period during the first subsequent non-calm hour. Due to large uncertainties in the model input data (NH3 emission rates, source exit velocities, boundary layer parameters), the case study was also used to assess model prediction uncertainty and assess how this uncertainty can be taken into account in model evaluations. A dynamic emission model modified for the Mediterranean climate was used to estimate the temporal variability in NH3 emission rates and a comparison was made between the simulations using the dynamic emissions and a constant emission rate. Prediction uncertainty due to model input uncertainty was 67-98% of the mean value for ADMS and between 53-83% of the mean value for AERMOD. Most of this uncertainty was due to source emission rate uncertainty (~50%), followed by uncertainty in the meteorological conditions (~10-20%) and uncertainty in exit velocities (~5-10%). AERMOD predicted higher concentrations than ADMS and more of the simulations met the model acceptability criteria when compared with the annual mean measured concentrations. However, the ADMS predictions were better correlated spatially with the measurements. The use of dynamic emission estimates improved the performance of ADMS but worsened the performance of AERMOD and the application of strategies to improved model performance had similar contradictory effects. In order to compare different inverse modelling techniques, several models (ADMS, LADD and WindTrax) were applied to a non-agricultural case study of a penguin colony in Antarctica. This case study was used since it gave the opportunity to provide the first experimentally-derived emission factor for an Antarctic penguin colony and also had the advantage of negligible background concentrations. There was sufficient agreement between the emission estimates obtained from the three models to define an emission factor for the penguin colony (1.23 g NH3 per breeding pair per day with an uncertainty range of 0.8-2.54 g NH3 per breeding pair per day). This emission estimate compared favourably to the value obtained using a simple micrometeorological technique (aerodynamic gradient) of 0.98 g ammonia per breeding pair per day (95% confidence interval: 0.2-2.4 g ammonia per breeding pair per day). Further application of the inverse modelling techniques for a range of agricultural case studies also demonstrated good agreement between the emission estimates. It is concluded, therefore, that inverse dispersion modelling is a robust technique for estimating NH3 emission rates. Screening models that can provide a quick and approximate estimate of environmental impacts are a useful tool for impact assessments because they can be used to filter out cases that potentially have a minimal environmental impact allowing resources to be focussed on more potentially damaging cases. The Simple Calculation of Ammonia Impact Limits (SCAIL) model was developed as a screening model to provide an estimate of the mean NH3 concentration and dry deposition rate downwind of an agricultural source. This screening tool, based on the LADD model, was evaluated and calibrated with several experimental datasets and then validated using independent concentration measurements made near sources. Overall SCAIL performed acceptably according to established statistical criteria. This work has identified situations where the concentration predictions of dispersion models are similar and other situations where the predictions are significantly different. Some models are simply not designed to simulate certain scenarios since they do not include the relevant processes or are beyond the limits of their applicability. An example is the LADD model that is not applicable to sources with significant exit velocity since the model does not include a plume-rise parameterisation. The testing of a simple scheme combining a momentum-driven plume rise and increased turbulence at the source improved model performance, but more testing is required. Even models that are applicable and include the relevant process do not always give similar predictions and the reasons for this need to be investigated. AERMOD for example predicts higher concentrations than ADMS for dispersion from mechanically ventilated livestock housing. There is evidence to suggest that ADMS underestimates concentrations in these situations due to a high wind speed threshold. Conversely, there is also evidence that AERMOD overestimates concentrations in these situations due to overestimation at low wind speeds. However, a simple modification to the meteorological pre-processor appears to improve the performance of the model. It is important that these differences between the predictions of these models are taken into account in regulatory assessments. This can be done by applying the most suitable model for the assessment in question or, better still, using multiple or hybrid models.

Statistical Machine Learning for Automatic Assessment of Physical Activity Intensity Using Multi-axial Accelerometry and Heart Rate

This work explores the automatic recognition of physical activity intensity patterns from multi-axial accelerometry and heart rate signals. Data collection was carried out in free-living conditions and in three controlled gymnasium circuits, for a total amount of 179.80 h of data divided into: sedentary situations (65.5%), light-to-moderate activity (17.6%) and vigorous exercise (16.9%). The proposed machine learning algorithms comprise the following steps: time-domain feature definition, standardization and PCA projection, unsupervised clustering (by k-means and GMM) and a HMM to account for long-term temporal trends. Performance was evaluated by 30 runs of a 10-fold cross-validation. Both k-means and GMM-based approaches yielded high overall accuracy (86.97% and 85.03%, respectively) and, given the imbalance of the dataset, meritorious F-measures (up to 77.88%) for non-sedentary cases. Classification errors tended to be concentrated around transients, what constrains their practical impact. Hence, we consider our proposal to be suitable for 24 h-based monitoring of physical activity in ambulatory scenarios and a first step towards intensity-specific energy expenditure estimators

Multimodal non-rigid image registration methods for therapy and surgery planning

La planificación pre-operatoria se ha convertido en una tarea esencial en cirugías y terapias de marcada complejidad, especialmente aquellas relacionadas con órgano blando. Un ejemplo donde la planificación preoperatoria tiene gran interés es la cirugía hepática. Dicha planificación comprende la detección e identificación precisa de las lesiones individuales y vasos así como la correcta segmentación y estimación volumétrica del hígado funcional. Este proceso es muy importante porque determina tanto si el paciente es un candidato adecuado para terapia quirúrgica como la definición del abordaje a seguir en el procedimiento. La radioterapia de órgano blando es un segundo ejemplo donde la planificación se requiere tanto para la radioterapia externa convencional como para la radioterapia intraoperatoria. La planificación comprende la segmentación de tumor y órganos vulnerables y la estimación de la dosimetría. La segmentación de hígado funcional y la estimación volumétrica para planificación de la cirugía se estiman habitualmente a partir de imágenes de tomografía computarizada (TC). De igual modo, en la planificación de radioterapia, los objetivos de la radiación se delinean normalmente sobre TC. Sin embargo, los avances en las tecnologías de imagen de resonancia magnética (RM) están ofreciendo progresivamente ventajas adicionales. Por ejemplo, se ha visto que el ratio de detección de metástasis hepáticas es significativamente superior en RM con contraste Gd–EOB–DTPA que en TC. Por tanto, recientes estudios han destacado la importancia de combinar la información de TC y RM para conseguir el mayor nivel posible de precisión en radioterapia y para facilitar una descripción precisa de las lesiones del hígado. Con el objetivo de mejorar la planificación preoperatoria en ambos escenarios se precisa claramente de un algoritmo de registro no rígido de imagen. Sin embargo, la gran mayoría de sistemas comerciales solo proporcionan métodos de registro rígido. Las medidas de intensidad de voxel han demostrado ser criterios de similitud de imágenes robustos, y, entre ellas, la Información Mutua (IM) es siempre la primera elegida en registros multimodales. Sin embargo, uno de los principales problemas de la IM es la ausencia de información espacial y la asunción de que las relaciones estadísticas entre las imágenes son homogéneas a lo largo de su domino completo. La hipótesis de esta tesis es que la incorporación de información espacial de órganos al proceso de registro puede mejorar la robustez y calidad del mismo, beneficiándose de la disponibilidad de las segmentaciones clínicas. En este trabajo, se propone y valida un esquema de registro multimodal no rígido 3D usando una nueva métrica llamada Información Mutua Centrada en el Órgano (Organ-Focused Mutual Information metric (OF-MI)) y se compara con la formulación clásica de la Información Mutua. Esto permite mejorar los resultados del registro en áreas problemáticas incorporando información regional al criterio de similitud, beneficiándose de la disponibilidad real de segmentaciones en protocolos estándares clínicos, y permitiendo que la dependencia estadística entre las dos modalidades de imagen difiera entre órganos o regiones. El método propuesto se ha aplicado al registro de TC y RM con contraste Gd–EOB–DTPA así como al registro de imágenes de TC y MR para planificación de radioterapia intraoperatoria rectal. Adicionalmente, se ha desarrollado un algoritmo de apoyo de segmentación 3D basado en Level-Sets para la incorporación de la información de órgano en el registro. El algoritmo de segmentación se ha diseñado específicamente para la estimación volumétrica de hígado sano funcional y ha demostrado un buen funcionamiento en un conjunto de imágenes de TC abdominales. Los resultados muestran una mejora estadísticamente significativa de OF-MI comparada con la Información Mutua clásica en las medidas de calidad de los registros; tanto con datos simulados (p<0.001) como con datos reales en registro hepático de TC y RM con contraste Gd– EOB–DTPA y en registro para planificación de radioterapia rectal usando OF-MI multi-órgano (p<0.05). Adicionalmente, OF-MI presenta resultados más estables con menor dispersión que la Información Mutua y un comportamiento más robusto con respecto a cambios en la relación señal-ruido y a la variación de parámetros. La métrica OF-MI propuesta en esta tesis presenta siempre igual o mayor precisión que la clásica Información Mutua y consecuentemente puede ser una muy buena alternativa en aplicaciones donde la robustez del método y la facilidad en la elección de parámetros sean particularmente importantes. Abstract Pre-operative planning has become an essential task in complex surgeries and therapies, especially for those affecting soft tissue. One example where soft tissue preoperative planning is of high interest is liver surgery. It involves the accurate detection and identification of individual liver lesions and vessels as well as the proper functional liver segmentation and volume estimation. This process is very important because it determines whether the patient is a suitable candidate for surgical therapy and the type of procedure. Soft tissue radiation therapy is a second example where planning is required for both conventional external and intraoperative radiotherapy. It involves the segmentation of the tumor target and vulnerable organs and the estimation of the planned dose. Functional liver segmentations and volume estimations for surgery planning are commonly estimated from computed tomography (CT) images. Similarly, in radiation therapy planning, targets to be irradiated and healthy and vulnerable tissues to be protected from irradiation are commonly delineated on CT scans. However, developments in magnetic resonance imaging (MRI) technology are progressively offering advantages. For instance, the hepatic metastasis detection rate has been found to be significantly higher in Gd–EOB–DTPAenhanced MRI than in CT. Therefore, recent studies highlight the importance of combining the information from CT and MRI to achieve the highest level of accuracy in radiotherapy and to facilitate accurate liver lesion description. In order to improve those two soft tissue pre operative planning scenarios, an accurate nonrigid image registration algorithm is clearly required. However, the vast majority of commercial systems only provide rigid registration. Voxel intensity measures have been shown to be robust measures of image similarity, and among them, Mutual Information (MI) is always the first candidate in multimodal registrations. However, one of the main drawbacks of Mutual Information is the absence of spatial information and the assumption that statistical relationships between images are the same over the whole domain of the image. The hypothesis of the present thesis is that incorporating spatial organ information into the registration process may improve the registration robustness and quality, taking advantage of the clinical segmentations availability. In this work, a multimodal nonrigid 3D registration framework using a new Organ- Focused Mutual Information metric (OF-MI) is proposed, validated and compared to the classical formulation of the Mutual Information (MI). It allows improving registration results in problematic areas by adding regional information into the similitude criterion taking advantage of actual segmentations availability in standard clinical protocols and allowing the statistical dependence between the two modalities differ among organs or regions. The proposed method is applied to CT and T1 weighted delayed Gd–EOB–DTPA-enhanced MRI registration as well as to register CT and MRI images in rectal intraoperative radiotherapy planning. Additionally, a 3D support segmentation algorithm based on Level-Sets has been developed for the incorporation of the organ information into the registration. The segmentation algorithm has been specifically designed for the healthy and functional liver volume estimation demonstrating good performance in a set of abdominal CT studies. Results show a statistical significant improvement of registration quality measures with OF-MI compared to MI with both simulated data (p<0.001) and real data in liver applications registering CT and Gd–EOB–DTPA-enhanced MRI and in registration for rectal radiotherapy planning using multi-organ OF-MI (p<0.05). Additionally, OF-MI presents more stable results with smaller dispersion than MI and a more robust behavior with respect to SNR changes and parameters variation. The proposed OF-MI always presents equal or better accuracy than the classical MI and consequently can be a very convenient alternative within applications where the robustness of the method and the facility to choose the parameters are particularly important.

Reliability analysis based on non-dimensional parameters

A reliability analysis method is proposed that starts with the identification of all variables involved. These are divided in three groups: (a) variables fixed by codes, as loads and strength project values, and their corresponding partial safety coefficients, (b) geometric variables defining the dimension of the main elements involved, (c) the cost variables, including the possible damages caused by failure, (d) the random variables as loads, strength, etc., and (e)the variables defining the statistical model, as the family of distribution and its corresponding parameters. Once the variables are known, the II-theorem is used to obtain a minimum equivalent set of non-dimensional variables, which is used to define the limit states. This allows a reduction in the number of variables involved and a better understanding of their coupling effects. Two minimum cost criteria are used for selecting the project dimensions. One is based on a bounded-probability of failure, and the other on a total cost, including the damages of the possible failure. Finally, the method is illustrated by means of an application.

A derivation of thermodynamic principles

A detailed macroscopic description as in continuum mechanics, and just the concept of microstate,have been used to derive thermodynamics from mechanics. In opposition to statistical physics, the derivation lays emphasis on a definite prescription for macrostates (and non-equilibrium entropy), and uses basic features of the macrostate concept: complementary descriptions, involving either conservative and additive quantities or densities;scale-free character; reference to finite velocities and regions distant in space, thus introducing time indirectly. On the other hand, the derivation keeps the particle substratum (limit of number of particles N taken at fixed densities), and makes no ergodic-type considerations.