Utilidad del dímero D en el diagnóstico de tromboembolismo pulmonar en la Fundación Santa Fé de Bogotá

INTRODUCCIÓN: El diagnóstico de Tromboembolismo Pulmonar (TEP) ha sido un reto clínico a pesar de los avances en modalidades diagnósticas y opciones terapéuticas, el TEP permanece como una entidad sub diagnosticada y letal. La medición en sangre del Dímero D, con punto de corte de 500 mcg/L, por lo tanto es una excelente prueba de tamizaje para los pacientes en el departamento de urgencias . Esta evaluación inicial debe ser complementada con la realización de angioTAC de tórax, decisión que debe ser tomada precozmente con el fin de evitar complicaciones que amenacen la vida METODOLOGIA: Se realizo un estudio de prueba diagnóstica retrospectivo donde se revisaron las historias clínicas de 109 pacientes adultos de la Fundación Santa Fe de Bogotá en quienes se realizo angioTAC de tórax con protocolo para TEP, con probabilidad diagnóstica de Tromboembolismo Pulmonar Baja o Intermedia por criterios de Wells y que además tengan Dímero D. Se calculo la sensibilidad y especificidad del Dímero D teniendo en cuenta la probabilidad clínica pre test calculada por criterios de Wells, y se calcularon likelihood ratio positivo y negativo para cada punto de corte de Dímero D. RESULTADOS: El estudio mostro una sensibilidad del 100% para valores de Dímero D menores de 1100 mcg/L, en pacientes con baja probabilidad, y sensibilidad de 100% para valores menores de 700 mcg/L en pacientes con probabilidad intermedia. DISCUSIÓN: Pacientes con baja probabilidad pre test por criterios de Wells con valores de Dímero D menores de 1100 mcg/L y de probabilidad intermedia con valores menores de 700 mcg/L no requieren estudios adicionales, lo cual disminuye de manera importante la toma de angioTAC y reduce costos de atención.

Eficacia diagnostica del ácido láctico en liquido cefalorraquídeo en meningitis postclipaje de aneurisma cerebral y hemorragia subaracnoidea

La concentración de ácido láctico en LCR en pacientes con sospecha de meningitis postquirúrgica luego de clipaje de aneurisma cerebral y hemorragia subaracnoidea espontánea se midió prospectivamente por un período de tres años. Se analizaron un total de 32 muestras de líquido cefalorraquídeo, se midió la concentración de ácido láctico y se comparó con el cultivo de LCR. Los cultivos fueron positivos en cinco pacientes, con una prevalencia de infección del 15%. Se utilizó un valor umbral de ácido láctico de 4 mmol/L. y se encontró una sensibilidad del 80%, especificidad del 52%, VPP del 23%, VPN del 93%, y likelihood ratio (LHR) positivo de 1,66 con una probabilidad post test de 15% de la concentración del ácido láctico en el diagnóstico de meningitis postquirúrgica en pacientes con hemorragia subaracnoidea aneurismática. La concentración de ácido láctico en LCR tiene un desempeño limitado en el diagnóstico de meningitis postquirúrgica en pacientes con hemorragia subaracnoidea aneurismática.

Validación diagnóstica del test neural 1 para el síndrome de túnel del carpo

El objetivo de este estudio fue realizar una prueba de validez diagnostica del test neural 1 para el diagnóstico del Síndrome de Túnel del Carpo (STC) utilizando como prueba de referencia o de oro el test de conducción nerviosa. En este estudio participaron 115 sujetos, 230 manos con sospecha clínica de STC quienes fueron evaluados con el test de conducción nerviosa y el test neural 1. Se encontró una sensibilidad del 93.0% (IC 95%:88,21-96,79) y una especificidad del 6,67% (IC 95%:0,0-33,59), razón de verosimilitud positiva fue de 1,00 y razón de verosimilitud negativa de 1,05. Valor predictivo positivo de 86,9% y un valor predictivo negativo de 12,5%. Se concluye que el test neural 1 es una prueba clínica de alta sensibilidad y baja especificidad de gran utilidad para el monitoreo e identificación del STC. Es un procedimiento para el diagnóstico clínico de bajo costo que puede incluirse en los exámenes de rutina de los trabajadores como complemento a las pruebas clínicas sugeridas por las Gatiso para dar mayor precisión a la identificación temprana del STC. Se sugiere combinarla con otros test de mayor especificidad para ser aplicada en trabajadores en condiciones de riesgo o que presenten síntomas en miembros superiores y realizar otros estudios en donde participen sujetos sin diagnóstico clínico del STC.

Factores asociados a la asistencia al control prenatal en gestantes del municipio de Yopal Casanare, Colombia – 2011

Introducción: Según OMS en 2011, 536.000 mujeres murieron en el mundo por causas relacionadas al embarazo y el parto; obteniendo Colombia índices altos de mortalidad materna (Fondo de Población de las Naciones Unidas, 2010); mientras Casanare reportó cuatro casos en 2009, y Yopal en 2010 alcanzó una tasa de 66,5 por 100.000 NV (Plan de desarrollo municipio de Yopal); por tanto se busca identificar factores que afectan la adherencia al control prenatal. Metodología: Estudio observacional de prevalencia analítica realizado con datos de gestantes de Yopal (Casanare) canalizadas por Intervenciones Colectivas 2011, con una muestra de 621 gestantes en las semanas de gestación 8,12,16,20,24,28,32,36,38 y 40.. Resultados: La adherencia al control prenatal fue del 15% y los factores que mostraron asociación estadísticamente significativa con adherencia al control prenatal fueron: régimen de salud (P=0.010); semana de gestación (p=0.000); trimestre del embarazo, antecedentes de abortos, apoyo económico (OR=1.738; IC=95%; 1.026-2.945); embarazo planeado, soporte familiar, satisfacción de compartir tiempo y espacio con el cónyuge (p=0.009, 0.001, 0.006); convivencia con familia materna (P=0.032), razón de verosimilitud 0.046, y valor OR=0.444; IC=95%; 0.208 – 0.948; y se identificaron barreras como inoportunidad de citas e insatisfacción por los servicios, donde el 98,9% de gestantes que no las encontraron tuvieron adherencia al control prenatal. Conclusión: Es necesario fortalecer programas de promoción de salud materna, control prenatal, prevención del embarazo adolescente y derechos de la mujer; reforzando acciones de vigilancia para disminuir las barreras de aseguramiento y calidad de los servicios.

Seasonal adjustment and cointegration

El documento examina el efecto de filtros de ajuste en el tamaño y poder de prueba de cointegración que usan los residuales como pruebas ADF y PP, mediante procedimientos MonteCarlo y una aplicación empírica. Nuestros resultados indican que el uso de filtros distorsiona el tamaño y reduce el poder de estas pruebas.

Hábitos alimentarios en la primera infancia : educación y prevención.

Aproximación a los hábitos de consumo de la población infantil escolarizada de 0-6 años, con atención preferente sobre los productos de baja calidad nutricional (BACAN), más conocidos como golosinas.Elaborar un programa de intervención dirigido a los distintos sectores de la comunidad educativa: centros, familias y niños, cuyo objetivo es reducir el consumo abusivo de productos de baja calidad nutricional. Muestra de 492 padres de niños matriculados en primer ciclo de los Centros de Educación Infantil, dependientes de la CARM y de segundo ciclo de EI de centros dependientes del MEC. Recogida de información mediante la aplicación de un cuestionario a los padres-madres. Análisis de datos. Elaboración de un programa de intervención en centros escolares. Cuestionario sobre consumo, de elaboración propia. Correlación entre variables. Estadísticos: Chi cuadrado de Pearson y de Likelihood Ratio. El consumo de productos BACAN no es homogéneo. Se diversifica y aumenta con la edad, excepción hecha con los fritos industriales cuyo consumo aparece a las edades más tempranas. La mayoría de las familias sitúan el consumo de sus hijos entre una y tres unidades de estos productos. Se ha constatado que los padres proporcionan estos productos a los hijos a pesar de estar informados de su perjuicio sobre la salud.

Periodic Reordering

For many networks in nature, science and technology, it is possible to order the nodes so that most links are short-range, connecting near-neighbours, and relatively few long-range links, or shortcuts, are present. Given a network as a set of observed links (interactions), the task of finding an ordering of the nodes that reveals such a range-dependent structure is closely related to some sparse matrix reordering problems arising in scientific computation. The spectral, or Fiedler vector, approach for sparse matrix reordering has successfully been applied to biological data sets, revealing useful structures and subpatterns. In this work we argue that a periodic analogue of the standard reordering task is also highly relevant. Here, rather than encouraging nonzeros only to lie close to the diagonal of a suitably ordered adjacency matrix, we also allow them to inhabit the off-diagonal corners. Indeed, for the classic small-world model of Watts & Strogatz (1998, Collective dynamics of ‘small-world’ networks. Nature, 393, 440–442) this type of periodic structure is inherent. We therefore devise and test a new spectral algorithm for periodic reordering. By generalizing the range-dependent random graph class of Grindrod (2002, Range-dependent random graphs and their application to modeling large small-world proteome datasets. Phys. Rev. E, 66, 066702-1–066702-7) to the periodic case, we can also construct a computable likelihood ratio that suggests whether a given network is inherently linear or periodic. Tests on synthetic data show that the new algorithm can detect periodic structure, even in the presence of noise. Further experiments on real biological data sets then show that some networks are better regarded as periodic than linear. Hence, we find both qualitative (reordered networks plots) and quantitative (likelihood ratios) evidence of periodicity in biological networks.

An application of the GLUE methodology for estimating the parameters of the INCA-N model

The conceptual and parameter uncertainty of the semi-distributed INCA-N (Integrated Nutrients in Catchments-Nitrogen) model was studied using the GLUE (Generalized Likelihood Uncertainty Estimation) methodology combined with quantitative experimental knowledge, the concept known as 'soft data'. Cumulative inorganic N leaching, annual plant N uptake and annual mineralization proved to be useful soft data to constrain the parameter space. The INCA-N model was able to simulate the seasonal and inter-annual variations in the stream-water nitrate concentrations, although the lowest concentrations during the growing season were not reproduced. This suggested that there were some retention processes or losses either in peatland/wetland areas or in the river which were not included in the INCA-N model. The results of the study suggested that soft data was a way to reduce parameter equifinality, and that the calibration and testing of distributed hydrological and nutrient leaching models should be based both on runoff and/or nutrient concentration data and the qualitative knowledge of experimentalist. (c) 2006 Elsevier B.V. All rights reserved.

Fixed point dual carrier modulation performance for wireless USB

Dual Carrier Modulation (DCM) is currently used as the higher data rate modulation scheme for Multiband Orthogonal Frequency Division Multiplexing (MB-OFDM) in the ECMA-368 defined Ultra-Wideband (UWB) radio platform. ECMA-368 has been chosen as the physical radio platform for many systems including Wireless USB (W-USB), Bluetooth 3.0 and Wireless HDMI; hence ECMA-368 is an important issue to consumer electronics and the user’s experience of these products. In this paper, Log Likelihood Ratio (LLR) demapping method is used for the DCM demaper implemented in fixed point model. Channel State Information (CSI) aided scheme coupled with the band hopping information is used as the further technique to improve the DCM demapping performance. The receiver performance for the fixed point DCM is simulated in realistic multi-path environments.

A score test for binary data with patient non-compliance

A score test is developed for binary clinical trial data, which incorporates patient non-compliance while respecting randomization. It is assumed in this paper that compliance is all-or-nothing, in the sense that a patient either accepts all of the treatment assigned as specified in the protocol, or none of it. Direct analytic comparisons of the adjusted test statistic for both the score test and the likelihood ratio test are made with the corresponding test statistics that adhere to the intention-to-treat principle. It is shown that no gain in power is possible over the intention-to-treat analysis, by adjusting for patient non-compliance. Sample size formulae are derived and simulation studies are used to demonstrate that the sample size approximation holds. Copyright © 2003 John Wiley & Sons, Ltd.

A parametric model for the interval censored survival times of Acacia mangium plantation in a spacing trial

Survival times for the Acacia mangium plantation in the Segaliud Lokan Project, Sabah, East Malaysia were analysed based on 20 permanent sample plots (PSPs) established in 1988 as a spacing experiment. The PSPs were established following a complete randomized block design with five levels of spacing randomly assigned to units within four blocks at different sites. The survival times of trees in years are of interest. Since the inventories were only conducted annually, the actual survival time for each tree was not observed. Hence, the data set comprises censored survival times. Initial analysis of the survival of the Acacia mangium plantation suggested there is block by spacing interaction; a Weibull model gives a reasonable fit to the replicate survival times within each PSP; but a standard Weibull regression model is inappropriate because the shape parameter differs between PSPs. In this paper we investigate the form of the non-constant Weibull shape parameter. Parsimonious models for the Weibull survival times have been derived using maximum likelihood methods. The factor selection for the parameters is based on a backward elimination procedure. The models are compared using likelihood ratio statistics. The results suggest that both Weibull parameters depend on spacing and block.

Dual carrier modulation demapping methods and performances for wireless USB

Dual Carrier Modulation (DCM) was chosen as the higher data rate modulation scheme for MB-OFDM (Multiband Orthogonal Frequency Division Multiplexing) in the UWB (Ultra-Wide Band) radio platform ECMA-368. ECMA-368 has been chosen as the physical implementation for high data rate Wireless USB (W-USB) and Bluetooth 3.0. In this paper, different demapping methods for the DCM demapper are presented, being Soft Bit, Maximum Likely (ML) Soft Bit and Log Likelihood Ratio (LLR). Frequency diversity and Channel State Information (CSI) are further techniques to enhance demapping methods. The system performance for those DCM demapping methods simulated in realistic multi-path environments are provided and compared.

A comparison between feature-based and EM-based contour tracking

Most active-contour methods are based either on maximizing the image contrast under the contour or on minimizing the sum of squared distances between contour and image 'features'. The Marginalized Likelihood Ratio (MLR) contour model uses a contrast-based measure of goodness-of-fit for the contour and thus falls into the first class. The point of departure from previous models consists in marginalizing this contrast measure over unmodelled shape variations. The MLR model naturally leads to the EM Contour algorithm, in which pose optimization is carried out by iterated least-squares, as in feature-based contour methods. The difference with respect to other feature-based algorithms is that the EM Contour algorithm minimizes squared distances from Bayes least-squares (marginalized) estimates of contour locations, rather than from 'strongest features' in the neighborhood of the contour. Within the framework of the MLR model, alternatives to the EM algorithm can also be derived: one of these alternatives is the empirical-information method. Tracking experiments demonstrate the robustness of pose estimates given by the MLR model, and support the theoretical expectation that the EM Contour algorithm is more robust than either feature-based methods or the empirical-information method. (c) 2005 Elsevier B.V. All rights reserved.

Relatedness testing in subdivided populations

Assigning probabilities to alleged relationships, given DNA profiles, requires, among other things, calculation of a likelihood ratio (LR). Such calculations usually assume independence of genes: this assumption is not appropriate when the tested individuals share recent ancestry due to population substructure. Adjusted LR formulae, incorporating the coancestry coefficient F(ST), are presented here for various two-person relationships, and the issue of mutations in parentage testing is also addressed.

Multiband OFDM modulation and demodulation for ultra wideband communications

This chapter considers the Multiband Orthogonal Frequency Division Multiplexing (MB- OFDM) modulation and demodulation with the intention to optimize the Ultra-Wideband (UWB) system performance. OFDM is a type of multicarrier modulation and becomes the most important aspect for the MB-OFDM system performance. It is also a low cost digital signal component efficiently using Fast Fourier Transform (FFT) algorithm to implement the multicarrier orthogonality. Within the MB-OFDM approach, the OFDM modulation is employed in each 528 MHz wide band to transmit the data across the different bands while also using the frequency hopping technique across different bands. Each parallel bit stream can be mapped onto one of the OFDM subcarriers. Quadrature Phase Shift Keying (QPSK) and Dual Carrier Modulation (DCM) are currently used as the modulation schemes for MB-OFDM in the ECMA-368 defined UWB radio platform. A dual QPSK soft-demapper is suitable for ECMA-368 that exploits the inherent Time-Domain Spreading (TDS) and guard symbol subcarrier diversity to improve the receiver performance, yet merges decoding operations together to minimize hardware and power requirements. There are several methods to demap the DCM, which are soft bit demapping, Maximum Likelihood (ML) soft bit demapping, and Log Likelihood Ratio (LLR) demapping. The Channel State Information (CSI) aided scheme coupled with the band hopping information is used as a further technique to improve the DCM demapping performance. ECMA-368 offers up to 480 Mb/s instantaneous bit rate to the Medium Access Control (MAC) layer, but depending on radio channel conditions dropped packets unfortunately result in a lower throughput. An alternative high data rate modulation scheme termed Dual Circular 32-QAM that fits within the configuration of the current standard increasing system throughput thus maintaining the high rate throughput even with a moderate level of dropped packets.