Practical scores for the detection of malnutrition

Malnutrition occurs in 30 - 60 % of hospitalized medical or surgical patients, as well as out-patients. Serious consequences at various levels were observed. Malnutrition influences negatively the quality of life, the immune system, muscle strength and worsens the prognosis of the patient. Interventions for a rapid and simple identification and effective treatment of this condition are essential and cost saving. Screening tools for the identification of patients at nutritional risk are very useful in daily practice. The systematic identification of patients with potential or apparent malnutrition is very important allowing an effective nutritional treatment at an early time. The medical team in charge should perform the nutritional risk screening and the following assessment to recognize the nutritional problems and to solve them in an interdisciplinary and -professional team.

Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened?

BACKGROUND While multi-drug resistant organisms (MDRO) are a global phenomenon, there are significant regional differences in terms of prevalence. Traveling to countries with a high MDRO prevalence increases the risk of acquiring such an organism. In this study we determined risk factors for MDRO colonization among patients who returned from a healthcare system in a high-prevalence area (so-called transfer patients). Factors predicting colonization could serve as screening criteria to better target those at highest risk. METHODS This screening study included adult patients who had been exposed to a healthcare system abroad or in a high-prevalence region in Switzerland over the past six months and presented to our 950-bed tertiary care hospital between January 1, 2012 and December 31, 2013, a 24-month period. Laboratory screening tests focused on Gram-negative MDROs and methicillin-resistant Staphylococcus aureus (MRSA). RESULTS A total of 235 transfer patients were screened and analyzed, of which 43 (18 %) were positive for an MDRO. Most of them yielded Gram-negative bacteria (42; 98 %), with only a single screening revealing MRSA (2 %); three screenings showed a combination of Gram-negative bacteria and MRSA. For the risk factor analysis we focused on the 42 Gram-negative MDROs. Most of them were ESBL-producing Escherichia coli and Klebsiella pneumoniae while only two were carbapenemase producers. In univariate analysis, factors associated with screening positivity were hospitalization outside of Europe (p < 0.001), surgical procedure in a hospital abroad (p = 0.007), and - on admission to our hospital - active infection (p = 0.002), antibiotic treatment (p = 0.014) and presence of skin lesions (p = 0.001). Only hospitalization outside of Europe (Odds Ratio, OR 3.2 (95 % CI 1.5- 6.8)) and active infection on admission (OR 2.7 (95 % CI 1.07- 6.6)) remained as independent predictors of Gram-negative MDRO colonization. CONCLUSION Our data suggest that a large proportion of patients (i.e., 82 %) transferred to Switzerland from hospitals in high MDRO prevalence areas are unnecessarily screened for MDRO colonization. Basing our screening strategy on certain criteria (such as presence of skin lesions, active infection, antibiotic treatment, history of a surgical procedure abroad and hospitalization outside of Europe) promises to be a better targeted and more cost-effective strategy.

Imputation of sequence level genotypes in the Franches-Montagnes horse breed

BACKGROUND A cost-effective strategy to increase the density of available markers within a population is to sequence a small proportion of the population and impute whole-genome sequence data for the remaining population. Increased densities of typed markers are advantageous for genome-wide association studies (GWAS) and genomic predictions. METHODS We obtained genotypes for 54 602 SNPs (single nucleotide polymorphisms) in 1077 Franches-Montagnes (FM) horses and Illumina paired-end whole-genome sequencing data for 30 FM horses and 14 Warmblood horses. After variant calling, the sequence-derived SNP genotypes (~13 million SNPs) were used for genotype imputation with the software programs Beagle, Impute2 and FImpute. RESULTS The mean imputation accuracy of FM horses using Impute2 was 92.0%. Imputation accuracy using Beagle and FImpute was 74.3% and 77.2%, respectively. In addition, for Impute2 we determined the imputation accuracy of all individual horses in the validation population, which ranged from 85.7% to 99.8%. The subsequent inclusion of Warmblood sequence data further increased the correlation between true and imputed genotypes for most horses, especially for horses with a high level of admixture. The final imputation accuracy of the horses ranged from 91.2% to 99.5%. CONCLUSIONS Using Impute2, the imputation accuracy was higher than 91% for all horses in the validation population, which indicates that direct imputation of 50k SNP-chip data to sequence level genotypes is feasible in the FM population. The individual imputation accuracy depended mainly on the applied software and the level of admixture.

Evaluating the impact of vertical integration on health system peformance

Vertical integration is grounded in economic theory as a corporate strategy for reducing cost and enhancing efficiency. There were three purposes for this dissertation. The first was to describe and understand vertical integration theory. The review of the economic theory established vertical integration as a corporate cost reduction strategy in response to environmental, structural and performance dimensions of the market. The second purpose was to examine vertical integration in the context of the health care industry, which has greater complexity, higher instability, and more unstable demand than other industries, although many of the same dimensions of the market supported a vertical integration strategy. Evidence on the performance of health systems after integration revealed mixed results. Because the market continues to be turbulent, hybrid non-owned integration in the form of alliances have increased to over 40% of urban hospitals. The third purpose of the study was to examine the application of vertical integration in health care and evaluate the effects. The case studied was an alliance formed between a community hospital and a tertiary medical center to facilitate vertical integration of oncology services while maintaining effectiveness and preserving access. The economic benefits for 1934 patients were evaluated in the delivery system before and after integration with a more detailed economic analysis of breast, lung, colon/rectal, and non-malignant cases. A regression analysis confirmed the relationship between the independent variables of age, sex, location of services, race, stage of disease, and diagnosis, and the dependent variable, cost. The results of the basic regression model, as well as the regression with first-order interaction terms, were statistically significant. The study shows that vertical integration at an intermediate health care system level has economic benefits. If the pre-integration oncology group had been treated in the post-integration model, the expected cost savings from integration would be 31.5%. Quality indicators used were access to health care services and research treatment protocols, and access was preserved in the integrated model. Using survival as a direct quality outcome measure, the survival of lung cancer patients was statistically the same before and after integration. ^

Evaluation of the city of Houston HIV/STD prevention program in Houston Independent School District (HISD) high schools

This cross-sectional study was undertaken to evaluate the impact in terms of HIV/STD knowledge and sexual behavior that the City of Houston HIV/STD prevention program in HISD high schools has had on students who have participated in it by comparing them with their peers who have not, based on self reports. The study further evaluated the program cost-effectiveness for averting future HIV infections by computing Cost-Utility Ratios based on reported sexual behavior. ^ Mixed results were obtained, indicating a statistically significant difference in knowledge with the intervention group having scored higher (p-value 0.001) but not for any of the behaviors assessed. The knowledge score outcome's overall p-value after adjusting for each stratifying variable (age, grade, gender and ethnicity) was statistically significant. The Odds Ratio of intervention group participants aged 15 years or more scoring 70% or higher was 1.86 times; that of intervention group female participants was 2.29 times; and that of intervention group Black/African American participants was 2.47 times relative to their comparison group counterparts. The knowledge score results remained statistically significant in the logistic regression model, which controlled for age, grade level, gender and ethnicity. The Odds Ratio in this case was 1.74. ^ Three scenarios based on the difference in the risk of HIV infection between the intervention and comparison group were used for computation of Cost-Utility Ratios: Base, worst and best-case scenario. The best-case scenario yielded cost-effective results for male participants and cost-saving results for female participants when using ethnicity-adjusted HIV prevalence. The scenario remained cost-effective for female participants when using the unadjusted HIV prevalence. ^ The challenge to the program is to devise approaches that can enhance benefits for male participants. If it is a threshold problem implying that male participants require more intensive programs for behavioral change, then programs should first be piloted among boys before being implemented across the board. If it is a reflection of gender differences, then we might have to go back to the drawing board and engage boys in focus group discussions that will help formulate more effective programs. Gender-blind approaches currently in vogue do not seem to be working. ^

Should Texas use public funding for bariatric surgery?

Background. Obesity in America has increased exponentially since the 1970s with no sign of slowing down. It is a major public health problem, and is currently the second leading cause of preventable deaths in America (Flegal et al., 2010). Bariatric surgery is currently the only approved therapy that has shown to have a lasting impact on obese patients. While the initial cost of the surgery remains high, numerous cost-benefit analyses have demonstrated an overall cost saving within two to five years (McEwen et al., 2010). Only three states, including Texas, do not currently fund bariatric surgery through Medicare and Medicaid. ^ Objectives. To determine whether the current data on the cost-benefit analysis of bariatric surgery supports Texas' decision to not publicly fund bariatric surgery through its Medicare and Medicaid programs. ^ Methods. We conducted literature reviews to determine the current cost of obesity in Texas as well as the methods being employed to treat obesity currently. We then analyzed the history of bariatric surgery and its current implementation, looking at safety and the future benefits of bariatric surgery. We then looked at key cost-benefit analyses and meta-analyses to determine the cost effectiveness of bariatric surgery. We then analyzed both direct medical expenditures and indirect benefits of bariatric surgery. ^ Conclusions. If the obesity epidemic continues unabated, it will become one of the leading health expenditures in Texas within decades. Given that surgery is currently the only approved therapy for obesity that has been shown to be effective in the majority of patients, Texas' decision not to publicly fund bariatric surgery is short sighted.^

Evaluating the Utility of Clinical Criteria for the Identification of Lynch Syndrome among Endometrial Cancer Patients

Background: Lynch Syndrome (LS) is a familial cancer syndrome with a high prevalence of colorectal and endometrial carcinomas among affected family members. Clinical criteria, developed from information obtained from familial colorectal cancer registries, have been generated to identify individuals at elevated risk for having LS. In 2007, the Society of Gynecologic Oncology (SGO) codified criteria to assist in identifying women presenting with gynecologic cancers at elevated risk for having LS. These criteria have not been validated in a population-based setting. Materials and Methods: We retrospectively identified 412, unselected endometrial cancer cases. Clinical and pathologic information were obtained from the electronic medical record, and all tumors were tested for expression of the DNA mismatch repair proteins through immunohistochemistry. Tumors exhibiting loss of MSH2, MSH6 and PMS2 were designated as probable Lynch Syndrome (PLS). For tumors exhibiting immunohistochemical loss of MLH1, we used the PCR-based MLH1 methylation assay to delineate PLS tumors from sporadic tumors. Samples lacking methylation of the MLH1 promoter were also designated as PLS. The sensitivity and specificity for SGO criteria for detecting PLS tumors was calculated. We compared clinical and pathologic features of sporadic tumors and PLS tumors. A simplified cost-effectiveness analysis was also performed comparing the direct costs of utilizing SGO criteria vs. universal tumor testing. Results: In our cohort, 43/408 (10.5%) of endometrial carcinomas were designated as PLS. The sensitivity and specificity of SGO criteria to identify PLS cases were 32.7 and 77%, respectively. Multivariate analysis of clinical and pathologic parameters failed to identify statistically significant differences between sporadic and PLS tumors with the exception of tumors arising from the lower uterine segment. These tumors were more likely to occur in PLS tumors. Cost-effectiveness analysis showed clinical criteria and universal testing strategies cost $6,235.27/PLS case identified and $5,970.38/PLS case identified, respectively. Conclusions: SGO 5-10% criteria successfully identify PLS cases among women who are young or have significant family history of LS related tumors. However, a larger proportion of PLS cases occurring at older ages with less significant family history are not detected by this screening strategy. Compared to SGO clinical criteria, universal tumor testing is a cost effective strategy to identify women presenting with endometrial cancer who are at elevated risk for having LS.

Proceedings of the 23rd Annual Biochemical Engineering Symposium

The 23rd Annual Biochemical Engineering Symposium was held at the University of Oklahoma on April 17, 1993. The objectives of the symposium were to provide 1) a forum for informal discussion of biochemical engineering research being carried at the participating universities and 2) an opportunity for students to present and publish their work. Thirteen papers presented at the symposium are included in the proceedings. Because final publication usually takes place in refereed journals, the articles included here are typically brief and often cover work in progress. The program of the symposium and a list of participants are included in the proceedings. ContentsA Low-Cost Bioreactor Strategy for RNA Synthesis, H. Anthony Marble, Eleni Chrisikos, and Robert H. Davis Development of a CELSS Bioreactor: Oxygen Transfer and Micromixing in Parabolic Flight, P.E. Villeneuve, K.S. Wenger, B.G. Thompson, T. Kedar, and E.H. Dunlop Scale-up of Dexter Murine Bone Marrow Cultures Utilizing a Three-Dimensional Fiberglass Support Matrix, John G. Highfill, Paul Todd, Steve Haley, and Dhinaker Kompala Modeling and Estimation of States of Recombinant Fermentations Using Nonlinear Input/Output Models, Vicotr M. Saucedo and M. Nazmul Karim Deadent Microfiltration of Bovine Serum Albumin Suspension Through Yeast Cake Layers and Assymetric Polymeric Membranes, Naveen Arora and Robert H. Davis Monitoring the Fate of Toluene and Phenol in the Rhizosphere, N. Muralidharan, Lawrence C. Davis, and Larry E. Erickson Hydrodynamic Motions Associated with Bubble Coalescence and Breakup, T.Y. Yiin, L.A. Glasgow, and L.E. Erickson Expression and Purification of a-Human Atrial Natriuretic Peptide in Escherichia coli by Fusion with L-Asparaginase, Nien-Tung Ma and Roger G. Harrison High Pressure Crystallization of Proteins, Mungara V. Saikumar, Charles E. Glatz, and Maurice A. Larson Structure/Function Relationships in the Catalytic and Starch Binding Domains of Glucoamylase, Pedro M. Coutinho, Clark Ford, Peter J. Reilly Cellular Responses of Insect Cell Spodoptera frugiperda to Environmental Stresses, Paul Yeh, Grace Y. Sun, Gary A. Weisman, Rakesh Bajpai A Novel Approach to Understanding the Antimicrobial Activity of Peptides, Naveen Pathak, Marie-Helene Janna, Gael Ruche, David McCarthy, and Roger Harrison Mass Transfer in the Bioremediation of Soils Contaminated with Trapped Non-Aqueous Phase Liquids, Xiaoqing Yang, Larry E. Jacobson, and L.T. Fan

Is FTA/EPA effective for a developing country to attract FDI? : simulation analysis based on an extended knowledge-capital model

To prepare an answer to the question of how a developing country can attract FDI, this paper explored the factors and policies that may help bring FDI into a developing country by utilizing an extended version of the knowledge-capital model. With a special focus on the effects of FTAs/EPAs between market countries and developing countries, simulations with the model revealed the following: (1) Although FTA/EPA generally ends to increase FDI to a developing country, the possibility of improving welfare through increased demand for skilled and unskilled labor becomes higher as the size of the country declines; (2) Because the additional implementation of cost-saving policies to reduce firm-type/trade-link specific fixed costs ends to depreciate the price of skilled labor by saving its input, a developing country, which is extremely scarce in skilled labor, is better off avoiding the additional option; (3) If a country hopes to enjoy larger welfare gains with EPA, efforts to increase skilled labor in the country, such as investing in education, may be beneficial.

Mixing Snapshots and Fast Time Integration of PDEs

A local proper orthogonal decomposition (POD) plus Galerkin projection method was recently developed to accelerate time dependent numerical solvers of PDEs. This method is based on the combined use of a numerical code (NC) and a Galerkin sys- tem (GS) in a sequence of interspersed time intervals, INC and IGS, respectively. POD is performed on some sets of snapshots calculated by the numerical solver in the INC inter- vals. The governing equations are Galerkin projected onto the most energetic POD modes and the resulting GS is time integrated in the next IGS interval. The major computa- tional e®ort is associated with the snapshots calculation in the ¯rst INC interval, where the POD manifold needs to be completely constructed (it is only updated in subsequent INC intervals, which can thus be quite small). As the POD manifold depends only weakly on the particular values of the parameters of the problem, a suitable library can be con- structed adapting the snapshots calculated in other runs to drastically reduce the size of the ¯rst INC interval and thus the involved computational cost. The strategy is success- fully tested in (i) the one-dimensional complex Ginzburg-Landau equation, including the case in which it exhibits transient chaos, and (ii) the two-dimensional unsteady lid-driven cavity problem

Capacidad y comportamiento de la adsorción de fenol en caolines naturales y modificados

En la actualidad las industrias químicas, farmacéuticas y clínicas, originan contaminantes en aguas superficiales, aguas subterráneas y suelos de nuestro país, como es el caso del fenol, contaminante orgánico común y altamente dañino para los organismos, incluso a bajas concentraciones. Existen en el mercado diferentes metodologías para minimizar la contaminación pero muchos de estos procesos tienen un alto coste, generación de contaminantes, etc. La adsorción de contaminantes por medio de arcillas es un método ampliamente utilizado, encontrándose eficaz y económico. Pero la dificultad de adsorber un contaminante orgánico como el fenol motiva la creación de un material llamado organoarcillas. Las organoarcillas son arcillas modificadas con un surfactante, a su vez, los surfactantes son moléculas orgánicas que confieren a la superficie de la arcilla carga catiónica en lugar de aniónica, haciendo más fácil la adsorción de fenol. Para esta tesis se ha elegido el caolín como material adsorbente, fácilmente disponible y relativamente de bajo coste. Se ha trabajado con: arenas de caolín, material directo de la extracción, y caolín lavado, originado del proceso de lavado de las arenas de caolín. Ambos grupos se diferencian fundamentalmente por su contenido en cuarzo, ampliamente mayor en las arenas de caolín. Con el objetivo de desarrollar un material a partir del caolín y arenas de éste con capacidad de retención de contaminates, en concreto, fenol, se procedió a modificar los materiales de partida mediante tratamientos térmicos, mecánicos y/o químicos, dando lugar a compuestos con mayor superficie química reactiva. Para ello se sometió el caolín y las arenas caoliníferas a temperaturas de 750ºC durante 3h, a moliendas hasta alcanzar su amorfización, y/o a activaciones con HCl 6M o con NaOH 5M durante 3h a 90ºC. En total se obtuvieron 18 muestras, en las que se estudiaron las características físico-químicas, mineralógicas y morfológicas de cada una de ellas con el fin de caracterizarlas después de haber sufrido los tratamientos y/o activaciones químicas. Los cambios producidos fueron estudiados mediante pH, capacidad de intercambio catiónico (CEC), capacidad de adsorción de agua (WCU y CWC), distribución de tamaño de partícula (PSD), área de superficie específica (SBET), difracción de rayos X (XRD), espectroscopía infrarroja por transformada de Fourier (FTIR), métodos térmicos (TG, DTG y DTA), y microscopía electrónica de transmisión y barrido (SEM y TEM). Además se analizó los cambios producidos por los tratamientos en función de las pérdidas de Al y Si que acontece en las 18 muestras. Los resultados para los materiales derivados de la arenas caoliníferas fueron similares a los obtenidos para los caolines lavados, la diferencia radica en la cantidad de contenido de caolinita en los diferente grupos de muestras. Apoyándonos en las técnicas de caracterización se puede observar que los tratamientos térmico y molienda produce materiales amorfos, este cambio en la estructura inicial sumado a las activaciones ácida y alcalina dan lugar a pérdidas de Si y Al, ocasionando que sus propiedades físico-químicas, mineralógicas y morfológicas se vean alteradas. Un fuerte aumento es observado en las áreas superficiales y en la CEC en determinadas muestras, además entre los cambios producidos se encuentra la producción de diferentes zeolitas en porcentajes distintos con el tratamiento alcalino. Para la obtención de las organoarcillas, las 18 muestras se sometieron a la surfactación con hexadeciltrimetil amonio (HDTMA) 20 mM durante 24h a 60ºC, esta concentración de tensioactivo fue más alta que la CEC de cada muestra. Los camext bios anteriormente producidos por los tratamientos y activaciones, afectan de forma diferente en la adsorción de HDTMA, variando por tanto la adsorción del surfactante en la superficie de las muestras. Se determinó el tensioactivo en superficie por FTIR, además se realizó un análisis de componentes principales (PCA) para examinar la dependencia entre las relaciones Si/Al de las muestras en la capacidad de adsorción de tensioactivo, y para el estudio de la adsorción de HDTMA en las muestras se realizaron además del análisis termogravimétrico, aproximaciones con los modelos de Freundllich y Langmuir. Se persigue conocer las diferentes formas y maneras que tiene el tensioactivo de fijarse en la superficie de las muestras. En las organoarcillas resultantes se cuantificó el fenol adsorbido cuando éstas fueron puestas en contacto con diferentes concentraciones de fenol: 50, 500, 1000, 2000, y 2500 mg/l durante 24h. El contaminante sorbido se calculó por medio de cromatografía de gases, y se realizaron aproximaciones con los modelos de Freundllich y Langmuir. El comportamiento de adsorción de fenol en arcillas orgánicas es regido por las características de las muestras. De forma general se puede decir que las muestras de caolines lavados tienen más capacidad de adsorción de fenol que las muestras de arenas de caolín y que la activación alcalina ha proporcionado una mejora en la adsorción de fenol en los dos grupos. En consecuencia se han obtenido materiales adsorbentes heterogéneos y por tanto, con propiedades diferentes. Se ha evaluado el comportamiento global de las arenas de caolín por un lado y del caolín lavado por otro. Las arenas de caolín presentan altos niveles de cuarzo y su uso para ciertos tipos de industrias no son recomendados en ocasiones por el alto costo que el proceso de limpieza y purificación implicaría. Por ello es importante reseñar en este proyecto las aplicaciones que ofrecen algunas muestras de este grupo. Los ensayos acontecidos en esta tesis han dado lugar a las siguientes publicaciones: • Pérdida de Al y Si en caolines modificados térmica- o mecánicamente y activados por tratamientos químicos. A. G. San Cristóbal, C Vizcayno, R. Castelló. Macla 9, 113-114. (2008). • Acid activation of mechanically and thermally modfied kaolins. A. G. San Cristóbal, R. Castelló, M. A. Martín Luengo, C Vizcayno. Mater. Res. Bull. 44 (2009) 2103-2111. • Zeolites prepared from calcined and mechanically modified kaolins. A comparative study. A. G San Cristóbal, R. Castelló, M. A. Martín Luengo, C Vizcayno. Applied Clay Science 49 (2010) 239-246. • Study comparative of the sorption of HDTMA on natural and modified kaolin. A. G San Cristóbal, R. Castelló, J. M. Castillejo, C Vizcayno. Aceptada en Clays and Clay minerals. • Capacity of modified kaolin sand and washed kaolin to adsorb phenol. A. G San Cristóbal, R. Castelló, C Vizcayno. Envío a revista sujeto a la publicación del artículo anterior. ABSTRACT Today’s chemical, pharmaceutical and clinical industries generate pollutants that affect the soils and surface and ground waters of our country. Among these, phenol is a common organic pollutant that is extremely harmful to living organisms, even at low concentrations. Several protocols exist to minimize the effects of pollutants, but most are costly procedures or even generate other pollutants. The adsorption of hazardous materials onto clays is perhaps the most used, efficient and cost-saving method available. However, organic compounds such as phenol are difficult to adsorb and this has led to the development of materials known as organoclays, which are much better at remediating organic compounds. Organoclays are clays that have been modified using a surfactant. In turn, surfactants are organic molecules that confer a cationic rather than anionic charge to the clay surface, improving it’s capacity to adsorb phenol. For this doctorate project, kaolin was selected as an adsorbent material for the removal of phenol given its easy sourcing and relatively low cost. The materials investigated were kaolin sand, a directly extracted material, and washed kaolin, which is the byproduct of the kaolin sand washing process. The main difference between the materials is their quartz content, which is much higher in the kaolin sands. To generate a product from kaolin or kaolin sand capable of retaining organic pollutants such as phenol, both materials were subjected to several heat, chemical and/or mechanical treatments to give rise to compounds with a greater reactive surface area. To this end the two starting materials underwent heating at 750ºC for 3 h, grinding to the point of amorphization and/or activation with HCl 6M or NaOH 5M for 3 h at 90ºC. These treatments gave rise to 18 processed samples, which were characterized in terms of their morphological, mineralogical, and physical-chemical properties. The behaviour of these new materials was examined in terms of their pH, cation exchange capacity (CEC), water adsorption capacity (WCU and WCC), particle size distribution (PSD), specific surface area (SBET), and their X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), thermal (DTG, DTA) and scanning and transmission electron microscopy (SEM and TEM) properties. The changes conferred by the different treatments were also examined in terms of Al and Si losses. Results for the materials derived from kaolin sands and washed kaolin were similar, with differences attributable to the kaolinite contents of the samples. The treatments heat and grinding produced amorphous materials, which when subjected to acid or alkali activation gave rise to Si and Al losses. This in turn led to a change in physico- chemical, mineralogical and morphological properties. Some samples showed a highly increased surface area and CEC. Further, among the changes produced, alkali treatment led to the generation of zeolites in different proportions depending on the sample. To produce the organoclays, the 18 samples were surfacted with hexadecyltrimethylammonium (HDTMA) 20 mM for 24 h at 60ºC. This surfactant concentration is higher than the CEC of each sample. The amount of HDTMA adsorbed onto the surface of each sample determined by FTIR varied according to treatment. A principle components analysis (PCA) was performed to examine correlations between sample Si/Al ratios and surfactant adsorption capacity. In addition, to explore HDTMA adsorption by the samples, DTG and DTA data were fitted to Freundllich and Langmuir models. The mechanisms of surfactant attachment to the sample surface were also addressed. The amount of phenol adsorbed by the resultant organoclays was determined when exposed to different phenol concentrations: 50, 500, 1000, 2000, and 2500 mg/l for 24 h. The quantity of adsorbed pollutant was estimated by gas chromatography and the data fitted to the models of Freundllich and Langmuir. Results indicate that the phenol adsorption capacity of the surfacted samples is dependent on the sample’s characteristics. In general, the washed kaolin samples showed a greater phenol adsorption capacity than the kaolon sands and alkali activation improved this capacity in the two types of sample. In conclusion, the treatments used gave rise to adsorbent materials with varying properties. Kaolin sands showed high quartz levels and their use in some industries is not recommended due to the costs involved in their washing and purification. The applications suggested by the data obtained for some of the kaolin sand samples indicate the added value of this industrial by-product. The results of this research project have led to the following publications: • Pérdida de Al y Si en caolines modificados térmica- o mecánicamente y activados por tratamientos químicos. A. G. San Cristóbal, C Vizcayno, R. Castelló. Macla 9, 113-114. (2008). • Acid activation of mechanically and thermally modfied kaolins. A. G. San Cristóbal, R. Castelló, M. A. Martín Luengo, C Vizcayno. Mater. Res. Bull. 44 (2009) 2103-2111. • Zeolites prepared from calcined and mechanically modified kaolins. A comparative study. A. G. San Cristóbal, R. Castelló, M. A. Martín Luengo, C Vizcayno. Applied Clay Science 49 (2010) 239-246. • Study comparative of the sorption of HDTMA on natural and modified kaolin. A. G. San Cristóbal, R. Castelló, J. M. Castillejo, C Vizcayno Accepted in Clays and Clay minerals. • Capacity of modified kaolin sand and washed kaolin to adsorb phenol. A. G San Cristóbal, R. Castelló, C Vizcayno. Shipment postponed, subject to the publication of the previous article.

Persuasive system design methods to deliver a cardio-rehabilitation program of post mi outpatients

Las enfermedades no transmisibles provocan cada ano 38 millones de fallecimientos en el mundo. Entre ellas, tan solo cuatro enfermedades son responsables del 82% de estas muertes: las enfermedades cardiovasculares, las enfermedades crónicas respiratorias, la diabetes, y el cáncer. Se prevé que estas cifras aumenten en los próximos anos, ya que las tendencias indican que en el año 2030 las muertes por esta causa ascenderán a 53 millones de personas. La Organización Mundial de la Salud (OMS) considera importante buscar soluciones para afrontar esta situación y ha solicitado a los gobiernos del mundo la implementación de intervenciones para mejorar los hábitos de vida de las personas y reducir así el riesgo de desarrollo de enfermedades no trasmisibles. Cada año se producen 32 millones de infartos de miocardio y derrames celebrales, de los cuales 12.5 son mortales. En el mundo entre el 40% y 75% de la víctimas de un infarto de miocardio mueren antes de su ingreso en el hospital. En los casos que sobreviven, la adopción de un estilo de vida saludable puede evitar infartos sucesivo, y supone un ahorro potencial de 6 billones de euros al año. La rehabilitación cardiaca es un programa individualizado que aplica un método multidisciplinar para ayudar al paciente a recuperar su condición física, a gestionar la enfermedad cardiovascular y sus comorbilidades, a adoptar hábitos de vida saludables, y a promover su salud mental. La rehabilitación cardiaca requiere la total involucración y motivación del paciente, solo de esta manera se podrán promover hábitos saludables y mejorar la gestión y prevención de su enfermedad. Aunque la participación en los programas de rehabilitación cardiaca es baja, hoy en día existen programas de rehabilitación cardiaca que el paciente puede realizar en su casa. Estos suponen una solución prometedora para aumentar la participación. La rehabilitación cardiaca se considera una intervención integral donde los modelos de psicología de la salud son aplicados para promover un cambio en el estilo de vida de las personas así como para ayudarles a afrontar su propia enfermedad. Existen métodos para implementar cambios de hábitos y de aptitud, y también se considera muy relevante promover no solo el bienestar físico sino también el mental. Existen tecnologías que promueven los cambios de comportamientos en los seres humanos. En concreto, las tecnologías persuasivas y los sistemas de apoyo al cambio de comportamientos modelan las características, las estrategias y los métodos de diseño para promover cambios usando la tecnología. Pero estos modelos tienen algunas limitaciones: todavía no se ha definido que rol tienen las emociones en el cambio de comportamientos y como traducir los métodos de la psicología de la salud en la tecnología. Esta tesis se centra en tres elementos que tienen un rol clave en los cambios de hábitos y actitud: el estado físico, el estado mental, y la tecnología. -Estado de salud: un estado de salud critico puede modificar la actitud del ser humano respecto al cambio. A la vez un buen estado de salud hace que la necesidad del cambio sea menos percibida. -Estado emocional: la actitud tiene un componente afectivo. Los estados emocionales negativos pueden reducir la habilidad de una persona para adoptar nuevos comportamientos. La salud mental es la situación ideal donde los individuos tienen predisposición a los cambios. La tecnología puede ayudar a las personas a adoptar nuevos hábitos, así como a mantener una salud física y mental. Este trabajo de investigación se centra en el diseño de tecnologías para la mejora del estado físico y emocional de las personas. Se ha propuesto un marco de diseño llamado “Well.Be.Sign”. El marco se basa en tres aspectos: El marco teórico: representa los elementos que se tienen que definir para diseñar tecnologías para promover el bienestar de las personas. -El diagrama de influencia: presenta las fuerzas de ‘persuasión’ en el contexto de la salud. El rol de las tecnologías persuasivas ha sido contextualizado en una dimensión donde otros elementos influencian el usuario.  El proceso de diseño: describe el proceso de diseño utilizando una metodología iterativa e incremental que aplica una combinación de métodos de diseño existentes (Diseño Orientado a Objetivos, Diseño de Sistemas Persuasivos) así como elementos originales de este trabajo de investigación. Los métodos se han aplicados para diseñar un sistema que ofrezca un programa de tele-rehabilitación cardiaca. Inicialmente se ha diseñado un prototipo de acuerdo con las necesidades del usuario. En segundo lugar, el prototipo se ha extendido especificando la intervención requerida para al programa de rehabilitación cardiaca. Finalmente el sistema se ha desarrollado y validado en un ensayo clínico con grupo control, donde se observaron las variaciones del estado cardiovascular, el nivel de conocimiento acerca de la enfermedad, la percepción de la enfermedad, la persistencia de hábitos saludables, y la aceptabilidad del sistema. Los resultados muestran que el grupo de intervención tiene una superior capacidad cardiovascular, mejor conocimiento acerca de la enfermedad, y más percepción de control de la enfermedad. Asimismo, en algunos casos se ha registrado persistencia de los hábitos de ejercicios 6 meses después del uso del sistema. Otros dos estudios se han presentado para demonstrar la relevancia del estado emocional del usuario en el diseño de aplicaciones para la promoción del bienestar.  En personas con una grave enfermedad crónica como la insuficiencia cardiaca, donde se ha presentado las conexiones entre estado de salud y estado emocional. En el estudio se ensena la relaciones que tienen los síntomas y las emociones negativas y como un estado negativo emocional puede empeorar la condición física del paciente. -Personas con trastornos del humor: el estudio muestra como las emociones pueden tener un impacto en la percepción de la tecnología por parte del usuario. ABSTRACT Noncommunicable diseases (NCDs) cause the death of 38 million people every year. Four major NCDs are responsible for 82% of these deaths: cardio vascular disease, chronic respiratory disease, diabetes and cancer. These pandemic numbers are projected to raise to 53 million deaths in 2030, and for this reason the assembly of the World Health Organization (WHO) considers communicable diseases as an urgent need to be addressed. It is also a trend to advocate the adoption of mobile technology to deliver health services and to promote healthy behaviours among citizens, but adopting healthS promoting lifestyle is still a difficult task facing human tendencies. Within this context, there is a promising opportunity: persuasive technologies. These technologies are intentionally designed to change a person’s attitudes or behaviours; when applied in this context, than can be used to change health-related attitudes, beliefs, and behaviours. Each year there are 32 million heart attacks and strokes globally, of which about 12.5 million are fatal. Worldwide between 40 and 75% of all heart-attack victims die before reaching hospital. Avoiding a second heart attack by improving adherence to lifestyle and medication regimens has a cost saving potential of around €6 billion per year. In most of the cases the cardiovascular event has been provoked by unhealthy lifestyle. Furthermore, after an MI event the patient's decision to adopt or not healthier behaviour will influence the progress of the disease. Cardio-rehabilitation is an individualized program that follows a multidisciplinary approach to support the user to recover from the Myocardial Infarction, manage the Cardio Vascular Disease and the comorbidities, adopt healthy habits, and cope with any emotional distress. Cardio- rehabilitation requires patient participation and willingness to perform behavioral modifications and change the attitude toward the management and prevention of the disease. Participation in the Cardio Rehabilitation program is not high; the home-based rehabilitation program is a promising solution to increase participation. Nowadays cardio rehabilitation is considered a comprehensive intervention in which models of health psychology are applied to promote the behaviour change of the individuals. Relevant methods that have been successfully applied to foster healthy habits include the Health Belief Model and the Trans Theoretical Model. Studies also demonstrate the importance to promote not only the physical but also the mental well being of the individuals. The idea of also promoting behaviour change using technologies has been defined by the literature as persuasive technologies or behaviour change support systems, in which the features, the strategies and the design method have been modelled to foster the behaviour change using technology. Limitations have been found in this model: there is still research to be done on the role of the emotions and how psychological health intervention can be translated into computer methods. This research focuses on three elements that could foster behaviour change in individuals: the physical and emotional status of the person, and the technology. Every component can influence the user's attitude and behaviour in the following ways: ' Physical status: bad physical status could change human attitude toward the necessity to adopt health behaviours; at the same time, good health status reduces the need to adopt healthy habits. ' Emotional status: the attitude has an affective component, negative emotional state can reduce the ability of a person to adopt new behaviours, and mental well being is the ideal situation in which individuals have a predisposition to adopt healthy behaviours. ' Technology: it can help users to adopt new behaviours and can also be support to promote physical and emotional status. Following this approach the idea driven in this research is that technology that is designed to improve the physical status and the emotional status of the individual could better foster behaviour change. According to this principle, the Well.Be.Sign framework has been proposed. The framework is based on three views: ' The theoretical framework: it represents the patterns that have to be defined to design the technologies to promote well being. ' The influence diagram: it shows the persuasive forces in the context of health care. The role of the persuasive technologies is contextualized in a wider universe where other factors and persuasive forces influence a patient. ' The design process: it shows the process of design using an iterative, incremental methodology that applies a combination of existing methodologies (Goal Directed Design and Persuasive System Design) and others that are original to this research. The methods have been applied to design a system to deliver cardio rehabilitation at home: first a prototype has been defined according to the user’s needs, then it has been extended with the specific intervention required for the cardio–rehabilitation, finally the system has been developed and validated in a controlled clinical study in which the cardiovascular fitness, the level of knowledge, the perception of the illness, the persistence of healthy habits and the system acceptance (only the intervention group) were measured. The results show that the intervention group increased cardiovascular capacity, knowledge, feeling of control of illness and perceived benefits of exercise at the end of the study. After six months of the study, a followSup of the exercise habits was performed. Some individuals of the intervention group continued to be engaged in the running exercise sessions promoted in the designed system. Two other cases have been presented to demonstrate the foundations of the Well.Be.Sign’s approach to promote both physical and emotional status: ' People affected by Heart Failure, in which a bidirectional connection between health status and emotions has been discussed with patients. Two correlations were demonstrated: the relationship between symptoms and negative emotional response, and that negative emotional status is correlated with worsening of chronic conditions. ' People with mood disorders: the study shows that emotions could also impact how the user perceives the technology.

The Big BIM battle: BIM adoption in the UK for large and small companies

As BIM adoption continues, the goal of a totally collaborative model with multiple contributors is attainable. Many initiatives such as the 2016 UK government level 2 BIM deadline are putting pressure on the construction industry to speed up the changeover. Clients and collaborators have higher expectations of using digital 3D models to communicate design ideas and solve practical problems. Contractors and clients are benefitting from cost saving scheduling and clash detection offered by BIM. Effective collaboration on the project will also give speed and efficiency gains. Despite this, many businesses of varying sizes are still having problems. The cost of the software and the training provides an obvious barrier for micro-enterprises and could explain a delay in adoption. Many studies have looked at these problems faced by SME and micro-enterprises. Larger companies have different problems. The efforts made by government to encourage them are quite comprehensive, but is anything being done to help smaller sectors and keep the industry cohesive? This limited study examines several companies of varying size and varying project type: architectural design businesses, main contractor, structural engineer and building consultancy. The study examines the barriers to a truly collaborative BIM workflow facing different specialities on a larger project and a contrasting small/medium project. The findings will establish that different barriers for each sector are actually pushing further apart, thus potentially creating a BIM-only construction elite, leaving the small companies remaining on 2D based drawing.

Multidisciplinary strategies for the management of heart failure patients at high risk for admission - A systematic review of randomized trials

OBJECTIVES The aim of this study was to determine whether multidisciplinary strategies improve outcomes for heart failure (HF) patients. BACKGROUND Because the prognosis of HF remains poor despite pharmacotherapy, there is increasing interest in alternative models of care delivery for these patients. METHODS Randomized trials of multidisciplinary management programs in HF were identified by searching electronic databases and bibliographies and via contact with experts. RESULTS Twenty-nine trials (5,039 patients) were identified but were not pooled, because of considerable heterogeneity. A priori, we divided the interventions into homogeneous groups that were suitable for pooling. Strategies that incorporated follow-up by a specialized multidisciplinary team (either in a clinic or a non-clinic setting) reduced mortality (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.59 to 0.96), HF hospitalizations (RR 0.74, 95% CI 0.63 to 0.87), and all-cause hospitalizations (RR 0.81, 95% CI 0.71 to 0.92). Programs that focused on enhancing patient self-care activities reduced HF hospitalizations (RR 0.66, 95% CI 0.52 to 0.83) and all-cause hospitalizations (RR 0.73, 95% CI 0.57 to 0.93) but had no effect on mortality (RR 1.14, 95% CI 0.67 to 1.94). Strategies that employed telephone contact and advised patients to attend their primary care physician in the event of deterioration reduced HF hospitalizations (RR 0.75, 95% CI 0.57 to 0.99) but not mortality (RR 0.91, 95% CI 0.67 to 1.29) or all-cause hospitalizations (RR 0.98, 95% CI 0.80 to 1.20). In 15 of 18 trials that evaluated cost, multidisciplinary strategies were cost-saving. CONCLUSIONS Multidisciplinary strategies for the management of patients with HF reduce HF hospitalizations. Those programs that involve specialized follow-up by a multidisciplinary team also reduce mortality and all-cause hospitalizations. (C) 2004 by the American College of Cardiology Foundation.

The evolving role of research consortia in East Asia

Research consortia have played an important role in the economic success of several East Asian countries. This paper looks at the ways these consortia - which are created for strategic rather than cost-saving purposes - have evolved over time. Three models for institutional learning are suggested, and three case studies are presented of research consortia in each model. The cases demonstrate the centrality of learning in facilitating the development then transition from innovation diffusion capabilities to innovation generation capabilities in East Asian firms. Cases are provided of the Samsung Electronics in Korea, the clusters of firms that are associated with ITRI in Taiwan, and the technological development of Ericsson China. Reference is made to the use of institutional innovations in the East Asian context such as patent pools that supplement more conventional forms of R&D collaboration.