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Background and objective: Mode of delivery is one of the issues that most concerns obstetricians. The caesarean section rate has increased progressively in recent years, exceeding the limit recommended by health institutions. Obstetricians generally lack the necessary technology to help them decide whether a caesarean delivery is appropriate based on antepartum and intrapartum conditions. Methods: In this study, we have tested the suitability of using three popular artificial intelligence algorithms, Support Vector Machines, Multilayer Perceptron and, Random Forest, to develop a clinical decision support system for the prediction of the mode of delivery according to three categories: caesarean section, euthocic vaginal delivery and, instrumental vaginal delivery. For this purpose, we used a comprehensive clinical database consisting of 25038 records with 48 attributes of women who attended to give birth at the Service of Obstetrics and Gynaecology of the University Clinical Hospital "Virgen de la Arrixaca" in the Murcia Region (Spain) from January of 2016 to January 2019. Women involved were patients with singleton pregnancies who attended to the emergency room on active labour or undergoing a planned induction of labour for medical reasons. Results: The three implemented algorithms showed a similar performance, all of them reaching an accuracy equal to or above 90% in the classification between caesarean and vaginal deliveries and somewhat lower, around 87% between instrumental and euthocic. Conclusions: The results validate the use of these algorithms to build a clinical decision system to help gynaecologists to predict the mode of delivery.

Microbial fuel cell (MFC) power performance strongly depends on the biofilm growth, which in turn is affected by the feed flow rate. In this work, an artificial neural network (ANN) approach has been used to simulate the effect of the flow rate on the power output by ceramic MFCs fed with neat human urine. To this aim, three different second-order algorithms were used to train our network and then compared in terms of prediction accuracy and convergence time: Quasi-Newton, Levenberg-Marquardt, and Conjugate Gradient. The results showed that the three training algorithms were able to accurately simulate power production. Amongst all of them, the Levenberg-Marquardt was the one that presented the highest accuracy (R = 95%) and the fastest convergence (7.8 s). These results show that ANNs are useful and reliable tools for predicting energy harvesting from ceramic-MFCs under changeable flow rate conditions, which will facilitate the practical deployment of this technology., Highlights • ANNs are reliable tools for predicting the power performance of ceramic-MFCs. • QN, LM and CG algorithms were able to accurately simulate the power output by MFCs. • LM algorithm showed the highest accuracy (R = 95%) and the fastest convergence (7.8s).

Resumen: Introducción: La displasia del desarrollo de la cadera (DDC) engloba un espectro de anomalías que afecta a la maduración y desarrollo de la cadera. La presentación podálica es uno de los factores de riesgo asociado a esta patología y puede ser modificada en las últimas semanas de gestación mediante la versión cefálica externa (VCE). El objetivo de nuestro trabajo es determinar la incidencia de DDC en pacientes sometidos a una VCE exitosa, así como valorar la necesidad de incluir a estos niños (podálicos durante gran parte de la gestación) en el protocolo de cribado de DDC. Material y métodos: Estudio de cohortes prospectivo realizado en el Hospital Universitario de Vigo entre el 1 de enero y el 31 de diciembre del 2015. Participaron niños sometidos a VCE y niños podálicos no sometidos a VCE. A todos ellos se les realizó una ecografía de cadera para estudiar la incidencia de DDC en ambos grupos. Resultados: Se incluyeron un total de 122 pacientes. Se intentó realizar VCE en 67 (54,9%) siendo exitosa en 35 (52,2%). De los 122 niños: 14 fueron diagnosticados de DDC mediante ecografía. Tres (8,5%) de los niños con DDC nacieron en presentación cefálica tras VCE exitosa con exploración física de caderas normal al nacimiento. Conclusiones: La VCE reduce el riesgo de DDC con respecto a la presentación podálica pero de no incluir a los niños versionados con éxito en el protocolo de cribado de DDC, corremos el riesgo de no detectar precozmente esta patología. Abstract: Introduction: Developmental dysplasia of the hip (DDH) refers to the spectrum of abnormalities of maturation and development of the hip. Breech presentation is associated with DDH. This risk factor can be modified by external cephalic version (ECV). The aim of this study is to evaluate the incidence of DDH in patients who successfully underwent ECV, as well as to evaluate need for these children (breech for a period during gestation) to be included in the DDH screening protocol. Material and methods: A prospective cohort study was conducted in the Hospital Universitario de Vigo from January 1, 2015 to December 31, 2015. It included children born in cephalic presentation after a successful ECV, as well as children born in breech presentation. They all were screened for DDH by ultrasound examination of the hip. Results: Out of a total of 122 newborns included in the study, ECV was attempted on 67 (54.9%), of which 35 (52.2%) were successful. Out of the 14 children diagnosed with DDH, 3 of those born in cephalic presentation after a successful ECV were found to be normal on physical examination. Conclusions: Successful ECV is associated with a lower incidence of DDH as regards breech presentation. However, these patients should be included in the DDH screening protocol for the early detection of this disorder.

Resumen: Objetivos: El objetivo de este estudio fue evaluar el impacto de un conjunto de 5 intervenciones sobre la incidencia de infecciones relacionadas con la asistencia sanitaria en una unidad de Neonatología de nivel iii. Material y métodos: Estudio cuasiexperimental pre-postintervención. Se incluyó a aquellos prematuros con peso al nacimiento

Objectives: An evaluation is made of the impact of a series of five interventions on the incidence of hospital-related infections in a level iii neonatal unit. Material and methods: Quasi-experimental, pre-post intervention study, which included preterm infants weighing 1500 g at birth or delivered at

A new and simple method to estimate the concentration of solids in a binary solids mixture is proposed and experimentally tested in a small fluidized bed set up. In the proposed method, it is necessary to measure the pressure drop in different sections of the bed at different gas velocities so as to be able to determine local minimum fluidization velocities using the Ergun equation. Because the minimum fluidization velocity of a solids mixture is known to be dependent on its weight fraction, a calibration curve can be derived by means of the Cheung equation and this is shown to be sufficient to obtain reasonably good estimates of the axial solids concentration profiles inside the bed. This methodology has been applied to three different mixtures of iron oxide ore of varying size with limestone or glass spheres. Satisfactory agreement between the experimental and calculated concentrations as well as pooled relative standard deviations lower than ±7%, are obtained in all three cases. This technique could facilitate future experimental research on solids mixing and segregation phenomena in fluidized beds, as it is a very low-cost, non-destructive and very fast method to determine solids concentration bed profiles., The authors acknowledge the financial support received from the Spanish Ministry of Economy, Industry and Competitivity (ENE2015-68885-C2-1-R).

Resumen: Introducción: El uso de catéteres centrales (CC) está asociado a complicaciones mecánicas (CM). Nuestro objetivo fue conocer si la posición incorrecta de la punta se asociaba con mayor incidencia de CM. Material: Estudio descriptivo de 6 años en la UCIN del Hospital Universitario Santa Lucía de Cartagena. Se recogieron los CC, la indicación, el motivo de retirada, la posición en las pruebas de imagen, las CM y el tratamiento derivado. Resultados: Se estudiaron 604 CC, la mayoría (347) de vena umbilical, epicutáneos (193) y de vena femoral (34). El 14,2% tuvo CM. La posición incorrecta de la punta se asoció a mayores CM (21,1 vs. 8,2%; p

The reduction reaction of copper oxide with CH4 is highly exothermic and can be arranged to generate sufficient heat to in-situ calcine calcium carbonate and produce a highly concentrated stream of CO2. This concept is tested at TRL4 in a packed-bed reactor operated close to adiabatic conditions. The impact of the initial solids temperature and the inlet flowrate of the gases is evaluated. A 50/50 (vol.%) mixture of methane and hydrogen (i.e., a possible composition of the PSA-off gas generated in a reforming process) has also been used as reducing gas. The presence of H2 reduces the CuO/CaCO3 proportion required in the bed and promotes the calcination at temperatures lower than 870 °C. The experimental measurements are well predicted by a one-dimensional fixed-bed reactor model, in which the steam methane reforming, water–gas-shift, carbon deposition and carbon gasification reactions are also considered. Different characterization techniques (i.e., SEM, XRD, N2 adsorption, TPR) demonstrate that both commercial CuO- and CaO-based materials show good stability after successive cyclic experiments., The authors acknowledge the contribution of J.M Alarcon during the experimental campaign. This research was funded by the EU-FP7 ASCENT Project (Grant agreement number 608512).

The attrition of CaO-based solids operating in calcium looping (CaL) post-combustion CO2 capture systems is an important factor to consider when limestones are selected as sorbent precursors. In this work, four commercial natural limestones with similar chemical compositions but with very different mechanical properties were tested in a 30kWth calcium looping pilot plant. The main attrition mechanisms that act upon the limestones (i.e. fragmentation, decrepitation and abrasion) were identified on the basis of the evolution of their particle size distributions during the start-up and the first calcination of each batch. Great differences in the performance of the selected limestones were observed, which confirms the suitability of the experimental procedure employed for sorbent screening purposes in these high-velocity, high-temperature pilot plants. Several attrition indexes reported in the literature were tested to conclude that the Total Particle Generated Index (TPGI) and the Maximum Diameter of Particles Generated (MDPG) indexes are the most useful for quantifying attrition phenomena and rank limestones., This research was partially funded by the European Community Research Fund for Coal and Steel (CaO2 project: RFC-PR-13006) and from the Spanish Ministry of Economy and Competitivity ENE2015-68885-C2-1-R.

La impulsividad ha sido relacionada con multitud de trastornos psiquiátricos como el abuso de sustancias. La Escala de Impulsividad de Barratt (BIS-11) es uno de los autoinformes más comúnmente administrados para la evaluación de la impulsividad, tanto en el ámbito clínico como de investigación. Hay una versión para adolescentes llamada BIS- 11-A, que aún no ha sido convenientemente adaptada a población española. El objetivo de este estudio es ofrecer una versión española alternativa y más adecuada del BIS-11-A, así como la evaluación de sus características psicométricas tales como estructura factorial, fiabilidad y validez predictiva sobre el uso de sustancias (uso en el último mes de alcohol, tabaco y cánnabis, presencia de borracheras en el último mes, consumo intensivo y problemático de alcohol). El BIS-11-A e ítems de la Encuesta Escolar Europea sobre Alcohol y otras Drogas (ESPAD) fueron aplicados a 1.183 estudiantes (edad 12-14 años) en 16 institutos españoles de educación secundaria. El BIS-11-A ha mostrado una estructura bidimensional, alta fiabilidad (alfa de Cronbach = 0,87) y buena capacidad para identificar el uso de sustancias, consumo intensivo y problemático de alcohol (sensibilidad = 67,3-75%; especificidad = 83,4-85,4%). La versión española del BIS-11-A es un instrumento fiable y válido para su uso con adolescentes tempranos.

[Resumen] El objetivo de este estudio es identificar los diferentes perfiles de regulación emocional presentes en una muestra de estudiantes universitarios y analizar si entre los perfiles identificados existen diferencias en la percepción de estresores académicos y en las respuestas psicofisiológicas de estrés. Participaron 504 estudiantes de fisioterapia de diferentes universidades españolas, el 74% de sexo femenino y con una edad promedio de 21.06 ± 3.74 años a los que se les administró la Escala de Dificultades en la Regulación Emocional (DERS) y el Cuestionario de Estrés Académico (escala de estresores [ECEA] y escala de respuesta [RCEA]). El análisis de conglomerados identificó tres perfiles de regulación: alta regulación emocional, baja regulación emocional y baja regulación emocional con alta atención. Se obtuvieron diferencias estadísticamente significativas entre los diferentes perfiles tanto para la percepción de estresores como para las respuestas psicofisiológicas de estrés. Los estudiantes con un perfil de alta regulación emocional percibieron en menor medida el entorno académico como amenazante y experimentaron con menor frecuencia manifestaciones psicofisiológicas de estrés. Los estudiantes con perfiles de baja regulación y baja regulación con alta atención emocional mostraron resultados similares, a excepción de las alteraciones del sueño. En conclusión, los estudiantes de fisioterapia con elevadas puntuaciones en control y aceptación de sus estados emocionales perciben las circunstancias académicas de forma más adaptativa y experimentan menores respuestas de estrés. [Abstract] A study was designed with the aim of identifying different profiles of emotional regulation in a sample of university students, and analysing the differences among the identified profiles in relation to stressors perception and psychophysiological stress responses. The participants were 504 Spanish physiotherapy students (74% women), with a mean age of 21.06 ± 3.74 years old, which answered the Difficulty Emotion Regulation Scale (DERS) and the Academic Stress Questionnaire (stressors scale [ECEA] and response scale [RCEA]). Based on Cluster analysis, three emotional regulation profiles were identified: students with high emotional regulation profile, students with low emotional regulation profile and students with low emotional regulation but high scores in emotional attention profile. The results indicated statistically significant differences between the emotional regulation profiles in stress appraisals and psychophysiological responses. Succinctly, students with high emotional regulation profile perceived academic environment as less threatening and showed lesser scores in stress responses. Students with low emotional regulation profile and low emo- tional regulation but high emotional attention profile showed similar scores, with the exception of sleep disorders. Briefly, physiotherapy students who had higher scores on emotional control and acceptance, perceived the academic setting in a more adaptive way and reported fewer stress responses.

This work describes the performance of an improved Casingle bondCu looping process designed to produce H2 and/or power from natural gas while generating CO2 suitable for reuse and/or permanent storage. The core of the process relies on an arrangement whereby fixed-bed reactors perform adiabatically. A sequence of five stages: sorption enhanced reforming (SER), Cu oxidation, solid/gas heat exchange, CuO reduction/CaCO3 calcination and steam methane reforming (SMR) is used. A continuous flow rate of O2-depleted gas is produced at a sufficiently high pressure and high temperature to drive a gas turbine for the generation of power. The new process design allows the number of reactors to be reduced from the 15 originally proposed in the original scheme to only five. The energy requirements for the reduction/calcination step can be reduced by using the PSA off-gas from the H2 purification step and the syngas generated in a SMR stage. This also allows a reduction of the Cu/Ca molar ratio in the bed to a value of around 2. A dynamic reactor model partially validated in a previous work was used to simulate in detail a complete cycle of the Casingle bondCu loping process under large-scale conditions. The simulations show that the progression of the reaction and heat exchange fronts can be regulated by the partial recirculation of the product gases. A process design for a base case with a reference output of 30,000 N m3/h of pure H2 (88.5 MWth), which is the typical production of fired tubular reformers installed in refineries, shows that reactors 6 m long with an inner diameter of 3 m would be sufficient to carry out the entire process, assuming a cycle duration of 15 min and a maximum drop in inlet pressure of 10% per stage. A hydrogen production efficiency of 77% is achievable, which is 6 net points above the efficiency of benchmarks based on fired tubular reformers that use amines (MDEA) to remove the CO2. A CO2 capture efficiency of about 95% is obtained, which is 10 net points higher than the values typically estimated for reference H2 plants that use MDEA absorption., The authors acknowledge the financial support from ASCENT (Advanced solid cycles with efficient novel technologies) Project funded by the European Union Seventh Framework Programme FP7 under Grant agreement no. 608512.

El objetivo de este estudio era describir la implementación de dos programas basados en la evidencia (PBE) para adolescentes con trastornos por consumo de cannabis en el Sistema Público de Salud, y sus principales resultados. La Aproximación de Reforzamiento Comunitario para Adolescentes (A-CRA) y el Control de Contingencias (MC) fueron elegidos como los programas de intervención más eficaces para esta población. Un total de 26 adolescentes participaron en el estudio (91,7% chicos; edad media = 16,5 años) en dos centros de carácter ambulatorio en España. Se utilizó un diseño cuasi-experimental, donde un grupo recibió A-CRA y el otro A-CRA+MC. La implementación de ambos programas resultó factible, con resultados clínicos positivos. El A-CRA ofreció buenas tasas de retención (81,3%) y abstinencia (68,6%). Los resultados del grupo A-CRA+MC no fueron significativamente mejores que los del A-CRA en retención (100%) o abstinencia (75,5%), aunque el limitado tamaño muestral no permite establecer conclusiones firmes. Los problemas asociados al cannabis y la sintomatología depresiva se redujeron durante el tratamiento. Varias limitaciones nos impiden determinar la eficacia clínica del A-CRA en este estudio. El proceso de traslación de los PBE al contexto clínico presentó múltiples dificultades que deben ser abordadas. Se discuten recomendaciones para futuros intentos de implementación de PBE en estos contextos.

Resumen

Background/aims: The Parkinson's Disease Cognitive Functional Rating Scale (PD-CFRS) was designed to avoid motor biases in capturing the functional impact of cognitive impairment in Parkinson's disease (PD). Its performance capturing functional impairment in other conditions leading to cognitive dysfunction is unknown. We compare it with non-specific Instrumental Activities of Daily Living scales. Methods: Two hundred consecutive patients diagnosed in a community hospital with mild cognitive impairment (MCI) [31 MCI-amnestic; 33 MCI-multi-domain; 33 PD-MCI] and dementia [35 Alzheimer's disease; 34 vascular dementia; 34 PD with dementia] were assessed on the PD-CFRS, the Blessed Dementia Scale (BDS), the Clinical Dementia Rating Sum of Boxes (CDR-SOB), and given a comprehensive cognitive assessment. Diagnostic accuracy and optimal cut-off scores were calculated for the PD-CFRS and compared with each functional measure. Results: The PD-CFRS presented high concurrent validity and significant correlation with both BDS and CDR-SOB, and cognitive scores offering a similar discrimination accuracy to non-specific scales [PD-CFRS >= 9 (sensitivity = 0.94; specificity = 0.95)]. No changes appear in cut-off scores when excluding PD patients. Effect size analysis indicated no relevant interference with PD-CFRS scores between the principal cognitive subgroups. Discussion: The findings extend the clinimetric properties of the PD-CFRS and indicate it as an adequate instrument to capture the full spectrum of functional consequences of cognitive decline in the community. (C) 2015 Elsevier B.V. All rights reserved.

b e d g s c r l t e p Actualmente, se recomienda que inmediatamente despues del parto el recien nacido vigoroso se coloque en contacto piel con piel sobre el pecho y el abdomen materno. Esta recomendacion ha sido apoyada por la Sociedad Espanola de Neonatologia1, la Iniciativa para la Humanizacion de la Asistencia al Nacimiento y la Lactancia2 de UNICEF y el Ministerio de Sanidad, Servicios Sociales e Igualdad de Espana3. Tambien queda recogida en las recomendaciones de la Academia Americana de Pediatria4 y en las guias clinicas australiana5, canadiense6 y britanica7. Son numerosas las razones que sustentan esta recomendacion. El vinculo afectivo entre padres e hijo es crucial para la supervivencia y el desarrollo del recien nacido, y para que aparezca es preciso el contacto fisico y la interaccion entre los padres y el recien nacido. El establecimiento del vinculo y el apego van a condicionar las respuestas emocionales de los ninos durante sus primeros anos. El contacto piel con piel precoz entre la madre y el nino mejora las percepciones de

Resumen: El Comité de Estándares de la Sociedad Española de Neonatología (SENeo) considera que el nuevo documento de la Academia Americana de Pediatría respecto a las recomendaciones del palivizumab para prevenir las infecciones graves por el virus respiratorio sincitial (VRS) no aporta nuevas evidencias científicas que justifiquen la modificación de las recomendaciones actuales de la SENeo. No obstante, se proponen unos ajustes en los criterios de las recomendaciones vigentes para reducir el coste del fármaco mediante su administración correcta y juiciosa. Abstract: The Standards Committee of the Spanish Neonatology Society (SENeo) considers that the new document from the American Academy of Pediatrics, including recommendations for palivizumab use to prevent serious infections produced by the Respiratory Syncytial Virus (RSV), provides no new scientific evidence which would justify the modification of the current recommendations of the SENeo. However, some adjustments to the criteria of the existing recommendations are proposed to reduce the cost of the drug by its correct and judicious management.

[Resumen] Objetivo: Determinar la frecuencia y los factores asociados al consumo farmacológico y a consultas al médico de familia por dolor musculoesquelético en mariscadoras. Métodos: Estudio transversal (n = 929) considerando variables sociodemográficas, frecuencia de dolor musculoesquelético, consumo de recursos sanitarios, incapacidad funcional (Roland-Morris) y calidad de vida relacionada con la salud (SF-36). Resultados: El 98,7% eran mujeres de 50,6 años (media) de edad, el 66,5% refirieron dolor musculoesquelético, el 43% toma fármacos y el 64% ha consultado al médico de familia por dolor musculoesquelético. Tras realizar modelos de regresión logística, las variables asociadas al consumo farmacológico son los años trabajados, el dolor en cadera-rodilla, el dolor lumbar, el dolor corporal y la función física; las asociadas a la consulta al médico de familia son el dolor en cadera-rodilla, el dolor cervical-dorsal-hombros, el dolor corporal y la función social. Conclusiones: Las variables que más afectan al consumo de recursos sanitarios son el dolor localizado en cadera-rodilla y la dimensión física de calidad de vida relacionada con la salud, especialmente el dolor corporal. [Abstract] Objective: To determine the frequency and factors associated with medicine consumption and consultations with family physicians due to musculoskeletal pain in fishery workers. Methods: We performed a cross-sectional study (n = 929). The variables analyzed consisted of sociodemographic factors, the frequency of musculoskeletal pain, healthcare resource consumption, back pain disability (Roland-Morris) and health-related quality of life (SF-36). Results: A total of 98.7% of the sample were women, with a mean age of 50.6 years. Musculoskeletal pain was reported by 66.5%, 43% were taking medication, and 64% had consulted their family physician due to musculoskeletal pain. The factors associated with medication intake in the logistic regression analysis were the number of years worked in the sector, hip-knee pain, bodily pain and physical functioning. The variables associated with physician visits were the presence of hip-knee pain, neck-back-shoulder pain, bodily pain, and social functioning. Conclusions: The variables most closely associated with resource utilization were hip-knee pain and the physical dimension of health-related quality of life, especially bodily pain.

P. 1661-1672 Using Iberian red deer as a model, this study presents a supervised learning method, the Support Vector Machines (SVM), to characterize sperm population structure related with freezability. Male freezability was assessed by evaluating motility, membrane status and mitochondrial membrane potential of sperm after a freezing-thawing procedure. The SVM model was generated using sperm motility information captured by computer-assisted sperm analysis (CASA) from thawed semen, belonging to six stags with marked differences on their freezability. A total of 1369 sperm tracks were recorded for seven kinematic parameters and assigned to four motility patterns based on them: weak motile, progressive, transitional and hyperactivated-like. Then, these data were split in two sets: the training set, used to train the SVM model, and the testing set, used to examine how the SVM method and three other unsupervised methods, a non-hierarchical, a hierarchical and a multistep clustering procedures, performed the sperm classification into subpopulations. The SVM was revealed as the most accurate method in the characterization of sperm subpopulations, showing all the sperm subpopulations obtained in this way high significant correlations with those sperm parameters used to characterize freezability of males. Given its superiority, the SVM method was used to characterize the sperm motile subpopulations in Iberian red deer. Sperm motile data from frozen–thawed semen belonging to 25 stags were recorded and loaded into the SVM model. The sperm population structure revealed that those males showing poor freezability were characterized by high percentages of sperm with a weak motility pattern. In opposite, males showing good freezability were characterized by higher percentages of sperm with a progressive and hyperactivated-like motility pattern and lower percentages of sperm with a weak motile pattern. We also identified a sperm subpopulation with a transitional motility pattern. This subpopulation increased as the freezability of males improved, and may be used as indicative of overall sperm motility. SI