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Objective: To determine the association between psychotic experiences and nonpsychotic mental disorders in the general population. Methodology: Analytical prevalence study with secondary information source applied in the general population aged 15 to 65 years old, randomly selected by probabilistic sampling. The instrument for collecting the information was the Composite International Diagnosis Interview (CIDI), which diagnoses 23 mental disorders according to the DSM-IV criteria (Diagnostic and Statistical Manual of Mental Disorders). Sociodemographic and psychiatric clinical variables were assessed, but the main variable evaluated consisted in six psychotic experiences (hallucinations and delusions). The primary study was approved by the University Research and Ethics Committee. The p-value

Traumatic events and violence are widespread public health problems. They do not have limits related to age, sex or socioeconomic level. The prevalence of mental disorders and sociodemographic characteristics were compared in the context of traumatic events and types of violence in the general population.Observational prevalence study with a secondary information source, in the general population aged 13 to 65 years, selected at random. The interview was conducted using the Compositum International Diagnosis Interview which generates psychiatric diagnoses according to the DSM-IV. The variables included were traumatic events grouped into five categories: related to armed conflict, sexual violence, interfamily violence, other types of violence, traumas and some mental disorders. The prevalence of mental disorders was compared in the five categories of traumatic events. Statistical significance was defined as a p value of0.05.Sexual and interfamily violence were more prevalent in women (p0.05). In those under age 13, major depression related to armed conflict had a prevalence of 48.3%, with a significant difference from the other trauma groups (p=0.015). All prevalences for childhood-onset disorders showed significantly different prevalences compared with the group for violence related to armed conflict (p0.05) and suicidal ideation was higher in the sexual violence group (p=0.006).High prevalences of mental disorders were found in people who had been exposed to traumatic events and violence. In those who experienced traumatic events related to armed conflict and sexual violence, higher prevalences of certain mental disorders were detected.

Small-scale PV generation is particularly affected by the irradiance variability produced by cloud shadows. Accurate predictions of the clouds passing over the PV field are thus necessary for the optimized management and integration of this renewable power source. Two main elements are required to perform these predictions: the local irradiance field and the cloud motion vector. Irradiance sensor networks are positioning as a promising data source at the spatial and temporal scales of the problem, avoiding the irradiance inference problems and costs of image-based instrumentation. This paper proposes a method to infer the cloud shadow motion vector from small-scale irradiance sensor networks data. The method does not require specific network configuration or layout, and the algorithm is computationally simple: graphical solutions are obtained by aggregating mean absolute errors in a diagram/matrix with each element representing a possible displacement of the cloud shadows. The validation is conducted with a fractal cloud model that allows the generation of irradiance time series according to an arbitrary cloud motion vector. The most correlated pair and the linear cloud edge methods are used for benchmarking purposes. Gridded and non-gridded sensors layouts are tested with number of sensors ranging from 9 to 100, monitored areas from 100 to 10000 m2, and sampling periods from 0.3 to 3.3 s. The results show the superiority of the proposed method with a reduction of 50–90% of the root mean square errors respect to the benchmark methods in 75% of the tests. Additionally, the proposed method maintains similar performance as sampling rate decreases, while the benchmark methods exhibit worsening results.

A case study was conducted to explore public secondary school teachers’ perspectives, practices, and experiences concerning the design and implementation of the English curriculum, as well as the professional development offered by the government in order to implement language policies and curriculum guidelines in the city of Medellin, Colombia. The study lasted one year and included a survey, the analysis of curriculum documents from five selected institutions, and focus group interviews as data collection instruments. Results indicate that the initiatives provided by the government have not been effective in supporting teachers in this endeavor as they have been very limited in terms of curriculum design, and reflect a technical view of teacher learning. In addition, several contextual and social factors have tremendously affected the implementation of language policies and curriculum guidelines in schools. Besides, teachers point to several needs, including that they have more time to appropriate and implement reforms, that they be included in policy-making as affected parties, that professional development initiatives be freed from political and economic interests and that they be offered a preparation that combines improving their language proficiency, English teaching methodologies and curriculum design. RESUMEN: El presente estudio de caso se propuso explorar las perspectivas, prácticas y ex-periencias de maestros en instituciones públicas de educación básica secundaria sobre el diseño y la implementación del currículo de inglés, así como el desarrollo profesional ofrecido por el gobierno para implementar políticas lingüísticas y directrices curriculares en la ciudad de Medellín, Colombia. El estudio se realizó a lo largo de un año, en el cual se aplicó una encuesta, se analizaron documentos curriculares de cinco instituciones seleccionadas, y entrevistas en grupos focales como instrumentos de recolección de datos. Los resultados indican que las ini-ciativas dadas por el gobierno no han sido efectivas para apoyar a los maestros en su labor, pues han sido muy limitadas en términos de diseño curricular, y reflejan una visión técnica de la formación docente. Además, varios factores sociales y contextuales han afectado la implementación de las políticas lingüísticas y de pautas curriculares en las instituciones. Por otro lado, los docentes señalan varias necesidades, como el tener más tiempo para apropiar e implementar las reformas, que se les incluya en la formulación de políticas como partes afectadas, que se liberen las iniciativas de desarrollo profesional de intereses políticos y económicos y que se les ofrezca una preparación que combine el mejoramiento de su competencia lingüística, las metodologías de enseñanza del inglés y el diseño curricular. RÉSUMÉ: Cette étude de cas a été menée afin d’explorer les perspectives, les pratiques et les expériences d ́enseignants d ́écoles secondaires publiques de Medellín suite à l ́implémentation du curriculum d’anglais langue étrangère et au développement professionnel offert par le gouvernement comme faisant partie des politiques linguistiques et des directrices curriculaires. Cette étude s ́est déroulée sur un an au cours de laquelle nous avons collecté les données suivantes: un questionnaire auprès des acteurs, l ́analyse des documents curriculaires de cinq institutions scolaires et des entretiens de groupe. Les résultats montrent que les initiatives du gouvernement pour appuyer les enseignants n ́ont guère été probantes. En effet, quant à la conception curriculaire, celles-ci sont très restreintes et traduisent une vision technique de la formation des enseignants. De plus, plusieurs facteurs sociaux et propres au contexte affectent énormément la mise en place des poli-tiques linguistiques et des orientations curriculaires. Par ailleurs, les enseignants invoquent différents besoins: celui de disposer de plus de temps pour élaborer les réformes et les mettre en place; celui d’être inclus dans la prise de décision sur les politiques qui influencent leurs pratiques ; celui de séparer les initiatives de formation professionnelle des intérêts politiques et économiques, et celui d ́ une formation qui leur permette d ́actualiser leur compétence linguistique en anglais, leurs méthodologies d’enseignement et la conception curriculaire.

Smoking can play a key role in SARS-CoV-2 infection and in the course of the disease. Previous studies have conflicting or inconclusive results on the prevalence of smoking and the severity of the coronavirus disease (COVID-19).Observational, multicenter, retrospective cohort study of 14,260 patients admitted for COVID-19 in Spanish hospitals between February and September 2020. Their clinical characteristics were recorded and the patients were classified into a smoking group (active or former smokers) or a non-smoking group (never smokers). The patients were followed up to one month after discharge. Differences between groups were analysed. A multivariate logistic regression and Kapplan Meier curves analysed the relationship between smoking and in-hospital mortality.The median age was 68.6 (55.8-79.1) years, with 57.7% of males. Smoking patients were older (69.9 (59.6-78.0 years)), more frequently male (80.3%) and with higher Charlson index (4 (2-6)) than non-smoking patients. Smoking patients presented a worse evolution, with a higher rate of admission to the intensive care unit (ICU) (10.4 vs. 8.1%), higher in-hospital mortality (22.5 vs. 16.4%) and readmission at one month (5.8 vs. 4.0%) than in non-smoking patients. After multivariate analysis, smoking remained associated with these events.Active or past smoking is an independent predictor of poor prognosis in patients with COVID-19. It is associated with higher ICU admissions and in-hospital mortality.El tabaquismo puede tener un papel importante en la infección por SARS-CoV-2 y en el curso de la enfermedad. Los estudios previos muestran resultados contradictorios o no concluyentes sobre la prevalencia de fumar y la severidad en la enfermedad por coronavirus (COVID-19).Estudio de cohortes observacional, multicéntrico y retrospectivo de 14.260 pacientes que ingresaron por COVID-19 en hospitales españoles desde febrero a septiembre de 2020. Se registraron sus características clínicas y se clasificaron en el grupo con tabaquismo si tabaquismo activo o previo o en el grupo sin tabaquismo si nunca habían fumado. Se realizó un seguimiento hasta un mes después del alta. Se analizaron las diferencias entre grupos. La relación entre tabaquismo y mortalidad intrahospitalaria se valoró mediante una regresión logística multivariante y curvas de Kapplan Meier.La mediana de edad fue 68,6 (55,8–79,1) años, con un 57,7% de varones. El grupo con tabaquismo presentó mayor edad (69,9 (59,6–78,0 años)), predominio masculino (80,3%) y mayor índice de Charlson (4 (2−6)). La evolución fue peor en estos pacientes, con una mayor tasa de ingreso en UCI (10,4 vs 8,1%), mayor mortalidad intrahospitalaria (22,5 vs 16,4%) y reingreso al mes (5,8 vs 4,0%) que el grupo sin tabaquismo. Tras el análisis multivariante, el tabaquismo permanecía asociado a estos eventos.El tabaquismo de forma activa o pasada es un factor predictor independiente de mal pronóstico en los pacientes con COVID-19, estando asociada a mayor probabilidad de ingreso en UCI y a mayor mortalidad intrahospitalaria.

The most representative indicator of vitamin D status in clinical practice is 25(OH)D3, but new biomarkers could improve the assessment of vitamin D status and metabolism. The objective of this study is to investigate the association of serum vitamin D metabolites and vitamin D metabolite ratios (VMRs) with potentially influential factors in premenopausal women. This is a cross-sectional study based on 1422 women, aged 39-50, recruited from a Madrid Medical Diagnostic Center. Participants answered an epidemiological and a food frequency questionnaire. Serum vitamin D metabolites were determined using an SPE-LC-MS/MS platform. The association between participant's characteristics, vitamin D metabolites, and VMRs was quantified by multiple linear regression models. Mean 25(OH)D3 concentration was 49.2 + 18.9 nmol/L, with greater deficits among obese, nulliparous, dark-skinned women, and with less sun exposure. A lower R2 ratio (1,25(OH)2D3/25(OH)D3) and a higher R4 (24,25(OH)2D3/1,25(OH)2D3) were observed in nulliparous women, with high sun exposure, and those with low caloric intake or high consumption of calcium, vitamin D supplements, or alcohol. Nulliparous women had lower R1 (25(OH)D3/Vit D3) and R3 (24,25(OH)2D3/25(OH)D3), and older women showed lower R3 and R4. Vitamin D status modified the association of the VMRs with seasons. VMRs can be complementary indicators of vitamin D status and its endogenous metabolism, and reveal the influence of certain individual characteristics on the expression of hydroxylase enzymes. This study was funded by the Spanish Ministry of Health (EC11–273) and by the Carlos III Institute of Health (PI15CIII/0029). The article presents independent research. The views expressed are those of the authors and not necessarily those of the Carlos III Institute of Health. Sí

This article proposes a measurement solution designed to monitor instantaneous frequency in power systems. It uses a data acquisition module and a GPS receiver for time stamping. A program in Python takes care of receiving the data, calculating the frequency, and finally transferring the measurement results to a database. The frequency is calculated with two different methods, which are compared in the article. The stored data is visualized using the Grafana platform, thus demonstrating its potential for comparing scientific data. The system as a whole constitutes an efficient low cost solution as a data acquisition system.

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90‐day and 1‐year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90‐day all‐cause (odds ratio [OR], 2.81; 95% CI, 2.33–3.38) and PE‐related mortality (OR, 2.38; 95% CI, 1.37–4.14) and increased 1‐year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10–9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all‐cause mortality (OR, 1.91; 95% CI, 1.57–2.32) but not PE‐related mortality (OR, 1.50; 95% CI, 0.85–2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90‐day all‐cause (OR, 2.28; 95% CI, 1.75–2.97) and PE‐related (OR, 3.64; 95% CI, 2.01–6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.

Background: Carriers of the G2019S mutation of LRRK2 provide a great opportunity to investigate the premotor stages of Parkinson's disease (PD). We have studied by serial clinical and dopamine transporter single photon emission computed tomography (DaT-SPECT) evaluations a cohort of asymptomatic carriers of the LRRK2-G2019S mutation in order to evaluate the usefulness of these tools as biomarkers. Here we report the results of the extended follow-up of this cohort at 8 years. Methods: Seventeen participants, of the 25 available from the 4-year evaluation, completed the 8-year assessment. UPDRS-III, UPSIT test and DaT-SPECT imaging (123I-ioflupane) were performed. We used repeated-measures linear mixed effects models to examine the changes in DaT binding over time. Results: Three carriers had converted to PD at 4 years. One additional carrier converted at 8 years. PD-converters had lower striatal DaT binding at baseline than non-converters. There was a significant decline of DaT binding over time, with a mean annual rate of 3.5%, with somewhat inter-individual and intra-individual variability and comparable between PD-converters and non-converters. No carrier with DAT binding ratio above an undefined threshold between 0.5 and 0.8 developed PD symptoms. The age-adjusted UPSIT score did not change significantly over time. Conclusions: The rate of conversion to PD at 8 years in this cohort aged ~58 years at baseline was 16%. The observed decline of DaT binding over time and its association with the phenotype render DaT-SPECT a potentially useful tool for monitoring the premotor stage of the disease, although at the individual level its ability to predict phenoconversion is limited.

In Europe, gastric adenocarcinoma (GADC) is commonly regarded as a disease of the elderly. This study aims to assess the proportion, characteristics, and survival of patients diagnosed with GADC under the age of 60.This is a retrospective, multicentric, and analytical study conducted at four tertiary Spanish hospitals. All patients diagnosed with GADC between 2008 and 2015 were included. Demographic, clinical, endoscopic, histologic, and survival data were retrieved. A multivariate analysis was performed to compare GADC in young (age≤60 years) and elderly patients.A total of 1374 patients with GADC were included. The mean age was 74 years (SD:11.1); 62.2% were males. There were 177 patients under the age of 60 (12.9%, 95% CI: 11.2-14.8%). GADC was frequently encountered as a metastatic disease in both young and elderly patients (Stage IV: 45.7% and 41%, respectively). In the multivariate analysis, alcohol abuse, ASA functional status I-II, diffuse subtype, neoadjuvant, and palliative therapy were independently associated (P0.05) with age ≤60 years. No differences were found in 2-year survival (GADC ≤60: 39% vs. 35%, P=0.45). Curative-intent surgery, TNM stage I-II, body mass index30kg/mOne out of eight cases of GADC were diagnosed under the age of 60. Metastatic disease was frequent at diagnosis and overall survival was poor regardless of age. Factors associated with localized disease correlated with improved survival in younger patients. Our results underline the need for early diagnosis strategies in our country.

Missed gastric cancer (MGC) is poorly documented in Mediterranean populations.(1) To assess the rate, predictors and survival of MGC. (2) To compare MGC and non-MGC tumors.This is a retrospective-cohort study conducted at four centers. MGC was defined as cancer detected within three years after negative esophagogastroduodenoscopy. Gastric adenocarcinomas diagnosed between 2008-2015 were included. Patients with no follow-up were excluded.During the study period 123,395 esophagogastroduodenoscopies were performed, with 1374 gastric cancers being diagnosed (1.1%). A total of 1289 gastric cancers were finally included. The overall rate of MGC was 4.7% (61/1289, 3.7-6%). A negative esophagogastroduodenoscopy in MGC patients was independently associated with PPI therapy (p 0.001), previous Billroth II anastomosis (p = 0.002), and lack of alarm symptoms (p 0.001). The most frequent location for MGC was the gastric body(52.4%). MGCs were smaller than non-MGCs (31 vs 41 mm, p = 0.047), more often flat or depressed (p = 0.003) and less likely to be encountered as advanced disease. Overall 2-year survival was similar between MGC (34.1%) and Non-MGC (35.3 %) (p = 0.59).MGC accounted for nearly five percent of newly-diagnosed gastric adenocarcinomas. Overall survival was poor and not different between MGC and non-MGC.

The role of vitamin D in mammographic density is still unclear. This study examines the association between serum 25-hydroxyvitamin D (25(OH)D) and mammographic density, overall and by specific women characteristics. DDM-Madrid is a cross-sectional study that recruited 1403 premenopausal women in a breast radiodiagnosis unit of Madrid City Council. Information was collected with a questionnaire and plasma 25(OH)D was measured by solid-phase extraction on-line coupled to liquid chromatography–tandem mass spectrometry. Percent mammographic density was assessed using a semi-automated computer tool (DM-Scan). Multivariable linear regression models were used to quantify the associations, categorizing 25(OH)D levels (nmol/L) into 3 groups according to the cut-offs established by the US Endocrine Society. Models were adjusted for age, education, body mass index, age at menarche, parity, previous breast biopsies, family history of breast cancer, physical activity, energy intake, use of corticoids, hypercholesterolemia and day of sample extraction. Mean serum 25(OH)D level was 49.4 + 18.9 nmol/L. Women with sufficient concentrations of 25(OH)D showed a slight decrease in mammographic density (β >75nmol/L=-3.40; p = 0.037). No differences were observed according to women characteristics except for parity, where the protective effect of 25(OH)D was only seen among nulliparous (β >75nmol/L=-13.00; p-heterogeneity = 0.006). In light of the protective effect of vitamin D on mammographic density and the high prevalence of vitamin D insufficiency in our population, improving these levels could be an effective measure for the prevention of health problems related to the lack of this essential vitamin.

espanolIntroduccion El trasplante autologo de precursores hematopoyeticos (TPHA) es una modalidad de tratamiento aceptada para la enfermedad de Crohn (EC) refractaria. Material y metodos Se recogen los pacientes con EC refractaria sometidos a TPHA en el hospital Universitario Ramon y Cajal de Madrid y se describen de forma retrospectiva los resultados obtenidos. Resultados Un total de 7 pacientes han recibido TPHA debido a EC refractaria en nuestro centro. Tres pacientes (43%) presentaron remision clinica y endoscopica; un paciente (14%) mejoria clinica sin remision y 3 pacientes (43%) permanecian activos con necesidad de reinicio del tratamiento en la valoracion de la respuesta inicial al TPHA (a 6 meses). Los sintomas recurrieron en 5 de los 7 pacientes (71%), y todos ellos requirieron reinicio de tratamiento medico a una media de 13,8 meses (rango: 3-30 meses). Solo un paciente requirio cirugia tras el TPHA. Al final del seguimiento a una media de 48 meses (rango: 17-78 meses) 5/7 (71%) de los pacientes estaban en remision clinica con o sin tratamiento. Conclusion El TPHA puede ser una opcion terapeutica prometedora para pacientes con EC refractaria. Su utilidad radica en que puede producir la remision clinica sin tratamiento en algunos pacientes, pero tambien en que puede hacer la enfermedad tratable, consiguiendo respuesta a determinados tratamientos en pacientes que la habian perdido previamente. EnglishAbstract Introduction Autologous haematopoietic stem cell transplantation (AHSCT) is an accepted treatment in refractory Crohn's disease (CD). Material and methods Data on patients with refractory CD subjected to AHSCT are collected at the Hospital Universitario Ramon y Cajal in Madrid and the results obtained are described retrospectively. Results Seven patients in total have received AHSCT due to refractory CD in our centre. Three patients (43%) presented with clinical and endoscopic remission; one patient (14%) clinical improvement without remission and three patients (43%) remained active with the need to restart treatment in the assessment of the initial response to the AHSCT (after six months). Symptoms recurred in five of the seven patients (71%) and all of them had to restart medical treatment after an average of 13.8 months (range: 3–30 months). Only one patient needed surgery after the AHSCT. At the end of the follow-up, after a mean of 48 months (range: 17–78 months), 5/7 (71%) of the patients were in clinical remission with or without treatment. Conclusion AHSCT may be a promising therapeutic option for patients with refractory CD. Its usefulness lies in the fact that it can produce clinical remission without treatment in some patients, but also that it can make the disease treatable, obtaining a response to certain treatments in patients who had previously lost it.

Introduction Autologous haematopoietic stem cell transplantation (AHSCT) is an accepted treatment in refractory Crohn's disease (CD). Material and methods Data on patients with refractory CD subjected to AHSCT are collected at the Hospital Universitario Ramon y Cajal in Madrid and the results obtained are described retrospectively. Results Seven patients in total have received AHSCT due to refractory CD in our centre. Three patients (43%) presented with clinical and endoscopic remission; one patient (14%) clinical improvement without remission and three patients (43%) remained active with the need to restart treatment in the assessment of the initial response to the AHSCT (after six months). Symptoms recurred in five of the seven patients (71%) and all of them had to restart medical treatment after an average of 13.8 months (range: 3–30 months). Only one patient needed surgery after the AHSCT. At the end of the follow-up, after a mean of 48 months (range: 17–78 months), 5/7 (71%) of the patients were in clinical remission with or without treatment. Conclusion AHSCT may be a promising therapeutic option for patients with refractory CD. Its usefulness lies in the fact that it can produce clinical remission without treatment in some patients, but also that it can make the disease treatable, obtaining a response to certain treatments in patients who had previously lost it.

[EN] Introduction: Mammographic density (MD), the proportion of radiologically dense breast tissue, is a strong risk factor for breast cancer. Our objective is to investigate the influence of occupations and occupational exposure to physical, chemical, and microbiological agents on MD in Spanish premenopausal women. Methods: This is a cross-sectional study based on 1362 premenopausal workers, aged 39-50, who attended a gynecological screening in a breast radiodiagnosis unit of Madrid City Council. The work history was compiled through a personal interview. Exposure to occupational agents was evaluated using the Spanish job-exposure matrix MatEmESp. MD percentage was assessed using the validated semi-automated computer tool DM-Scan. The association between occupation, occupational exposures, and MD was quantified using multiple linear regression models, adjusted for age, educational level, body mass index, parity, previous breast biopsies, family history of breast cancer, energy intake, use of oral contraceptives, smoking, and alcohol consumption. Results: Although no occupation was statistically significantly associated with MD, a borderline significant inverse association was mainly observed in orchard, greenhouse, nursery, and garden workers (beta = -6.60; 95% confidence interval (95%CI) = -14.27; 1.07) and information and communication technology technicians (beta = -7.27; 95%CI = -15.37; 0.84). On the contrary, a positive association was found among technicians in art galleries, museums, and libraries (beta = 8.47; 95%CI = -0.65; 17.60). Women occupationally exposed to fungicides, herbicides, and insecticides tended to have lower MD. The percentage of density decreased by almost 2% for every 5 years spent in occupations exposed to the mentioned agents. Conclusions: Although our findings point to a lack of association with the occupations and exposures analyzed, this study supports a deeper exploration of the role of certain occupational agents in MD, such as pesticides., This work was supported by the Carlos III Institute of Health (AESI PI15CIII/00029 and AESI PI15CIII/00013). The article presents independent research. The views expressed are those of the authors and not necessarily those of the Carlos III Institute of Health.

Introduction In recent years, multiple studies have aimed to develop and validate portable technological devices capable of monitoring the motor complications of Parkinson’s disease patients (Parkinson’s Holter). The effectiveness of these monitoring devices for improving clinical control is not known. Methods and analysis This is a single-blind, cluster-randomised controlled clinical trial. Neurologists from Spanish health centres will be randomly assigned to one of three study arms (1:1:1): (a) therapeutic adjustment using information from a Parkinson’s Holter that will be worn by their patients for 7 days, (b) therapeutic adjustment using information from a diary of motor fluctuations that will be completed by their patients for 7 days and (c) therapeutic adjustment using clinical information collected during consultation. It is expected that 162 consecutive patients will be included over a period of 6 months. The primary outcome is the efficiency of the Parkinson’s Holter compared with traditional clinical practice in terms of Off time reduction with respect to the baseline (recorded through a diary of motor fluctuations, which will be completed by all patients). As secondary outcomes, changes in variables related to other motor complications (dyskinesia and freezing of gait), quality of life, autonomy in activities of daily living, adherence to the monitoring system and number of doctor–patient contacts will be analysed. The noninferiority of the Parkinson’s Holter against the diary of motor fluctuations in terms of Off time reduction will be studied as the exploratory objective. Ethics and dissemination approval for this study has been obtained from the Hospital Universitari de Bellvitge Ethics Committee. The results of this study will inform the practical utility of the objective information provided by a Parkinson’s Holter and, therefore, the convenience of adopting this technology in clinical practice and in future clinical trials. We expect public dissemination of the results in 2022. Trial registration NCT04176302;https://clinicaltrials.gov/show/NCT04176302

Introduction: Single nucleotide polymorphisms (SNPs) in the BDNF, COMT, CBR1 and CCK genes have been associated with the process of fear extinction in humans. Since fear extinction plays a key role in recovering from psychological trauma, there is a possibility that these genes modulate the risk of developing post-traumatic stress disorder (PTSD). Objective: To assess unilocus and multilocus associations between SNPs in the BDNF, COMT, CBR1 and CCK genes and the risk of developing PTSD. Materials and methods: 129 inhabitants of the municipality of Itagüí, Colombia, who had experienced psychological trauma at least once, were genotyped for these polymorphisms (38 cases of PTSD and 91 controls). Logistic regression was used to perform unilocus and multilocus association tests for single SNPs and existing SNP-SNP genotypic combinations. Results: No unilocus associations were found, but interactions between the BDNF and CBR1 genes and between the COMT and CCK genes were observed. Of these interactions, the genotypic combinations that behaved as risk factors were AG-AA (OR=13.52, p

Objective: To identify the causes of breastfeeding abandonment and the success factors associated with relactation in mothers with children attended in a specialised health institution. Methodology: Descriptive transversal design through non-probabilistic convenience sampling, with 100 mothers and their children. A structured survey was used and central tendency measurements and frequencies were analysed. The study was approved by the Ethics committee of the School of Health Sciences at the University Pontificia Bolivariana. Results: The average age was 26.8 years; 73 % had a low socioeconomic level; 59 % were cohabitating; 46 % were housewives; 32 % had a high school degree; 57 % were first-time mothers; 74 % had a high obstetric risk; and 59 % had children by caesarean section. Causes of breastfeeding abandonment were newborn hospitalization (79 %) and low birth weight (52 %). Health professionals suggested substitutes for hypogalactia in 18 % of the mothers. Incorrect maternal posture: 66.1 and 61 % with no previous experience. Relactation success factors were: chronological age under one month (48 %); effective newborn breast sucking (89 %); good newborn breast grasping (71 %). During the non-breastfeeding period, 72 % received mixed milk, 82 % did not breastfeed between 8 and 30 days, 98 % of the mothers were willing to relactate, 91 % considered the support of their families and health professionals as good. Conclusion: Children hospitalization was the main cause of breastfeeding abandonment and the main success factors for relactation were effective breast sucking, mothers’ readiness and support. RESUMEN Objetivo: identificar las causas de abandono de la lactancia materna y los factores de éxito para la relactación en madres con hijos atendidos en una institución de salud. Metodología: descriptivo, transversal. Muestreo no probabilístico a conveniencia, con una muestra de cien madres y sus hijos. Se utilizó una encuesta estructurada y se analizaron las medidas de tendencia central y las frecuencias. El estudio fue aprobado por el comité de ética de la Escuela de Ciencias de la Salud de la Universidad Pontificia Bolivariana. Resultados: las participantes tenían una media de edad de 26,8 años; el 73 % era de estrato socioeconómico bajo; el 59 % se encontraba en unión libre; el 46 % eran amas de casa; el 32 % contaba con bachillerato completo; el 57 % eran primigestantes; el 74 % tenía un alto riesgo obstétrico; y el 59 % tuvieron a su hijo por cesárea. Causas de abandono de la lactancia: hospitalización de los neonatos (79 %) y bajo peso al nacer (52 %). El personal de salud sugirió sucedáneos por hipogalactia en el 18 % de las madres. Postura incorrecta de la madre: 66,1 y 61 %, sin experiencias previas. Factores de éxito para relactar: edad cronológica menor de un mes (48 %); el bebé succionó al ponerlo al pecho (89 %); buen agarre (71 %). Durante el periodo de no lactancia, el 72 % recibió leche mixta, el 82 % no lactó entre 8 y 30 días, el 98 % de las madres estuvieron dispuestas a relactar, el 91 % consideró bueno el apoyo de sus familias y del personal de salud. Conclusión: la hospitalización del hijo fue la principal causa de abandono de la lactancia, y los principales factores de éxito para la relactación fueron la succión efectiva, la disposición de las madres y el apoyo. RESUMO Objetivo: identificar as causas de abandono do aleitamento materno e os fatores de sucesso para a relactação em mães de filhos atendidos em uma unidade de saúde. Metodologia: descritiva e transversal. Amostragem não probabilística por conveniência, com 100 mães e seus filhos. Um questionário estruturado foi utilizado e as medidas de tendência central e as frequências foram analisadas. O estudo foi aprovado pelo comitê de ética da Escola de Ciências da Saúde da Universidad Pontificia Bolivariana, Colômbia. Resultados: as participantes tinham em média 26,8 anos de idade; 73 % eram de classe social baixa; 59 % estavam em união estável; 46 % eram donas de casa; 32 % contavam com ensino médio completo; 57 % eram primigestas; 74 % tinham alto risco obstétrico, e 59 % tiveram seu filho por cesariana. Causas de abandono do aleitamento: hospitalização dos recém-nascidos (79 %) e baixo peso ao nascer (52 %). A equipe de saúde sugeriu a hipogalactia como causa da substituição do leite materno em 18 % das mães; postura incorreta da mãe em 66,1 % e 61 % devido à falta de experiência. Fatores de sucesso para relactar: idade cronológica menor de um mês (48 %); sucção do peito por parte bebê (89 %); pega correta (71 %). Durante o período de não aleitamento materno, 72 % receberam aleitamento misto; 82 % não lactaram entre 8 e 30 dias; 98 % das mães estiveram dispostas a relactar; 91 % consideraram o apoio de suas famílias e da equipe de saúde como bom. Conclusões: o internamento do filho foi a principal causa do abandono do aleitamento materno, e os principais fatores de relactação foram a sucção efetiva, a disposição das mães e o apoio.

In recent years, power quality (PQ) has become a major concern due to the increasing complexity of modern power systems within the integration of distributed energy resources. This paper presents the design and implementation of a learning platform for their PQ surveillance. The proposed design consists of two independent but also complementary modules. With time-compression capabilities, the first one is a signal processing module; it is based on higher-order statistics (HOS) and it is thought to monitor and characterize the voltage; its counterpart is oriented to statistical learning, and it detects and classifies PQ events. The aim of this platform is to enable both undergraduate and graduate engineering students to analyze modelling techniques for event analysis via different lessons with the underlying goal of approaching to real-life practice.

Backgound: Traditional anthropometrics such as body mass index (BMI) or waist circumference (WC) do not fully capture the complex biology of body fat (BF) in the elderly. The Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index, based on BMI, is proposed as a better indicator of BF. However, its relation with BMI is not clear. The aim was to compare the agreement between CUN-BAE, BMI, and WC in those aged &ge, 50 years. Methods: A cross-sectional sample of 3153 Caucasian healthy adults was taken from the MCC-Spain study. The Pearson&rsquo, s correlation and its 95% confidence interval (CI), adiposity distribution, and Kappa Index (95%CI) were calculated. Results: The correlation of CUN-BAE with WC is 0.18 (95%CI 0.14&ndash, 0.21) and that with BMI is moderate (r 0.58, 95%CI 0.55&ndash, 0.60), but both increased strongly by sex. Agreement (normal weight/overweight/obesity) of CUN-BAE with BMI is 7% and with WC is 18%. Conclusions: The correlation and the degree of agreement of CUN-BAE with BMI and WC are low in individuals aged over 50, but it is higher by sex. Thus, this different criterion of obesity may have clinical applications. More studies with a gold standard are needed to evaluate the CUN-BAE in elderly adults.

BACKGROUND Multimodal MRI approach is based on a combination of MRI parameters sensitive to different tissue characteristics (eg, volume atrophy, iron deposition, and microstructural damage). The main objective of the present study was to use a multimodal MRI approach to identify brain differences that could discriminate between matched groups of patients with multiple system atrophy, Parkinson's disease, and healthy controls. We assessed the 2 different MSA variants, namely, MSA-P, with predominant parkinsonism, and MSA-C, with more prominent cerebellar symptoms. METHODS Twenty-six PD patients, 29 MSA patients (16 MSA-P, 13 MSA-C), and 26 controls underwent 3-T MRI comprising T2*-weighted, T1-weighted, and diffusion tensor imaging scans. Using whole-brain voxel-based MRI, we combined gray-matter density, T2* relaxation rates, and diffusion tensor imaging scalars to compare and discriminate PD, MSA-P, MSA-C, and healthy controls. RESULTS Our main results showed that this approach reveals multiparametric modifications within the cerebellum and putamen in both MSA-C and MSA-P patients, compared with PD patients. Furthermore, our findings revealed that specific single multimodal MRI markers were sufficient to discriminate MSA-P and MSA-C patients from PD patients. Moreover, the unsupervised analysis based on multimodal MRI data could regroup individuals according to their clinical diagnosis, in most cases. CONCLUSIONS This study demonstrates that multimodal MRI is able to discriminate patients with PD from those with MSA with high accuracy. The combination of different MR biomarkers could be a great tool in early stage of disease to help diagnosis. © 2018 International Parkinson and Movement Disorder Society.

Context Lack of coordination may create significant problems between work teams, this problem is even most critical when team workers are geographically distributed as it results in cost increases and delays in the projects. There exists a technique called Socio-Technical Congruence (STC) that aims at helping to measure and control the coordination level existing in an organization at their different levels. Objective The objective of this paper is to carry out a systematic mapping of the field of socio-technical congruence. The aspects of particular interest for this article are: Socio-Technical Congruence definition, different ways to measure it, available tools to measure or that can help to measure it, the areas of application, its benefits and the case studies that analyze the effects Socio-Technical Congruence has on the organization as regards the products quality and the improvements in performance in the long term development, in an attempt to characterize the state of the art of this field identifying gaps and opportunities for further research. Therefore, companies could use this work as a starting point to apply STC measures in their work teams. Results This paper presents the results of a systematic mapping of Literature about Socio-Technical Congruence (STC) in order to investigate and classify the existing articles and conferences about the subject, as well as summarizing the most important aspects in regards to provide a general overview about the existing studies. Conclusions After analyzing the 40 papers found, we can conclude that there is no one standard measure of socio-technical congruence, although most take the proposal by Kwan et al. applying adaptations and improvements on it as regards the environment that it will be focused on. In general, most case studies talk about the benefits of STC control in organizations. However, only one paper focus on global software development where the problems of communication, coordination and control are an important risk. Moreover, there are only a few papers that explore the risks of excessively overloading users with coordination iterations when controlling STC. In fact, no case study to examine these risks and their effect on developers’ productivity has been found. The small number of studies found on STC, together with the research gaps we have pointed out, suggest that further investigation on socio-technical congruence is required.

Introduction. Among patients with mental illness, dual disorders patients are characterized by a heterogeneous and more severe clinical presentation that is difficult to treat. Therefore, knowledge about the distribution of this disorder and the characteristics of these patients can be helpful to optimize and organize health resources. Objective. To explore the prevalence and socio-demographic and clinical factors associated with dual disorders patients who were hospitalized due to mental illness at a psychiatric unit in Colombia between January and June 2013; this data was collected and analyzed on the basis of the medical records of each patient. Method. Observational, quantitative, cross-sectional study of a secondary source. It included the analysis of 201 patients aged 18 to 65. Results. There were 201 patients analyzed; 45.3% had dual disorders, with a ratio of 2.24 men:women; there was a high frequency of single marital status (69.2%) and more than 90% had a low socioeconomic level. The factors significantly associated with dual disorders in order of importance were: age from 18 to 35 years (OR = 11.03; CI 95% [4.43, 27.46]), male (OR = 5.10, CI 95% [2.26, 11.50]), history of aggression (OR = 3.35; CI 95% [1.63, 6.91]), and readmission in the year after hospital discharge (OR = 2.23; CI 95% [1.08, 4.61]). Discussion and conclusion. Dual disorders prevalence in this study is similar to that found by other authors. The high prevalence of dual disorders requires specialized therapeutic programs for treatment. The more hospitals know about the associated variables in this study, the more they will be able to improve their approach to patients.

Background and Aim The need for endoscopic investigation in patients with iron deficiency without anemia (ID) is not established. Methods Data from patients with ID (serum ferritin ≤20 ng/mL, normal hemoglobin) studied with upper and lower endoscopy were retrospectively analyzed. Patients evaluated for iron deficiency anemia (IDA) served as controls, matched by sex and age in a proportion 2:1. Presence, type, location and age distribution of endoscopic findings were compared. Results 109 patients (55% females; mean age 59.6 ± 13.5 years; age distribution

Biomarkers will have an important role in the diagnosis, prognosis and response to treatment in bronchiectasis during the transition towards precision medicinehttp://bit.ly/30swlUK

Autonomous measurement units are indispensable for the development of the smart grid in order to get faster processing responses, stability, and to provide the user with information regarding power quality (losses, harmonics, outages, steady-state and transient events). In this paper, the development of a novel FPGA-based real-time analyzer is presented. The signal processing nucleus is based on higher-order statistics, introducing the Spectral Kurtosis as an online assessment. Indeed, this fourth-order spectrum enhances non-Gaussian behavior in very unfavorable noise conditions. In the Power Quality assessment frame, the outline of this spectrum can be used to reveal the presence of underlying electrical perturbations. In this paper it is presented an autonomous analyzer that uses the Spectral Kurtosis to detect the presence of low level harmonics. These harmonics are difficult to detect using conventional techniques and can generate problems in power distribution when they are associated to a resonant response in the powered load. The proposed system has been described in synthesizable VHDL and performs an indirect estimator of a poly-spectrum slide, based on the FFT. This synthesizable description has been implemented using a low cost FPGA, enabling a continuous monitoring of the power signal (without dead times) with a high oversampling rate. The proposed solution has been conceived to be introduced in smart grids with high penetration of Distributed Energy Resources (DER).

The aim of this study is to analyse the percentage of hypovitaminosis D, as well as its relationship with the various parameters of calcium-phosphate metabolism. A case control study was conducted on 366 patients, divided into two groups: Group 1: 127 non-stone-forming patients, and Group 2: 239 calcium stone forming. A study was performed on calcium-phosphate metabolism and urinary lithogenic factors. The percentage of vitamin D deficiency (25-OH-vitamin D levels

This paper presents a Wireless Sensor Network (WSN) design, using the Application Programming Interface (API) mode for accessing to the communication modules built-in functions. In these conditions, the use of an external microcontroller can be avoided with the subsequent reduction in the global network cost, but also increasing the reliability and the flexibility while maintaining the essential features of typical WSN. To show the system performance, two variables have been monitored: light and temperature.

Idarucizumab is a monoclonal antibody that rapidly reverses the anticoagulant effect of dabigatran. The experience with this drug in the setting of gastrointestinal bleeding is scarce. We present the case of an 84-year-old male with known history of non-valvular atrial fibrillation anticoagulated with dabigatran who presented to the emergency room with melena. During his stay in the emergency department he suddenly worsened with hemodynamic derangement and massive melena so idarucizumab was administered. Gastroscopy and colonoscopy were performed without identifying a bleeding source. After the administration of idarucizumab, the patient did not presented signs of ongoing bleeding. Anticoagulation was resumed on the sixth day and no rebleeding or thromboembolic events have been recorded after six months of follow-up. This case and the limited information available in the literature suggest that idarucizumab can be useful and safe in cases of severe gastrointestinal bleeding with recent intake of dabigatran.

This paper presents a novel non-destructive method for termite detection that uses the entropy of the continuous wavelet transform of the acoustic emission signals as an uncertainty measurement, to achieve selective frequency separation in complex impulsive-like noisy scenarios, with the aid of the spectral kurtosis as a validating tool. The goal consists of detecting relevant frequencies, by looking up the minima in the curve associated to the entropy of the difference between the raw data and the wavelet-based reconstructed version. By measuring the signal’s uncertainty, the scales corresponding to the entropy minima, or pseudo-frequencies, manage to target three main types of emissions generated by termites: the modulating components (enveloping curve), the carrier signals (activity, feeding and excavating), and the communicating impulses bursts (alarms). The spectral kurtosis corroborates the location of the entropy minima (optimum uncertainty) matching them to its maxima, associated to frequencies with the highest amplitude variability, and consequently minimizing the measurement uncertainty. The method is primarily conceived to cover the acoustic-range, in order to acquire signals via standard sound cards; a broaden high-frequency study is developed for the assessment, and with the added value of discovering new and higher frequency components of the species emissions. The potential of the method makes it useful for myriads of applications in the frame of nondestructive transient detection.

The blooming an integration of these data sources would impulse and consolidate the use of energy nowcasting. As said, the development of nowcasting techniques based on big data or crowdsourcing, could benefit wind energy integration. But they also could represent an important tool for emerging configurations of power systems, as micro-grids and nano-grids. These grids range in a scale between one building to a small community of neighbours. The integration of wind energy in this context demands low-cost and easy-to-implement wind power forecasting products, and the developments in nowcasting could provide satisfactory solutions.

This paper proposes a technique based in the graphical cluster analysis to be implemented in Smart Power Quality Analyzers (SPQA), a proposal Instrument Class S, according to the standard UNE-EN 61000-4-30, with the goal of monitoring electrical grids where new events arise as a consequence of the penetration of new energy resources. In the presence of an electrical fault the instrument triggers the measurement procedure, according to a settled threshold of the PQ, and calculates the higher-order statistics (HOS) features in the time domain that enable the classification. Performance results over a battery of 160 signals show two clusters (sags and transients), with an acceptable accuracy of 80%. The work also presents the concept of the uncertainty inter-cluster area. The analysis of the intensity cluster disturbances helps the grid operator characterizing better the database and introducing some qualitative criteria for monitoring the smart grid.

Resumen Introduccion El trastorno por deficit de atencion e hiperactividad es un problema del neurodesarrollo de alta prevalencia que se asocia con grave disfuncion personal, familiar y social. Objetivo Explorar la posible asociacion entre trastorno por deficit de atencion e hiperactividad y comportamiento suicida en una poblacion de adolescentes. Metodos Estudio observacional analitico de corte a partir de fuente secundaria. Se analizaron variables sociodemograficas, clinicas, de crianza y eventos vitales de 447 adolescentes a quienes se aplico la Compositum International Diagnosis Interview . Se realizo analisis descriptivo y bivariable a traves de odds ratio (OR) y sis intervalos de confianza del 95% (IC95%); las variables con significacion estadistica (p software SPSS ® version 21.0. Resultados El 59,1% eran mujeres, con una mediana [intervalo intercuartilico] de edad de 16 [14-18] anos. El comportamiento suicida se presento en el 31% de las mujeres y el 23% de los varones. Mostraban deficit de atencion el 6,3% de los adolescentes. El analisis de regresion logistica mostro que las variables que mejor explicaban el comportamiento suicida de los adolescentes fueron: el sexo femenino, el trastorno de estres postraumatico, el trastorno de panico y el consumo de cocaina con trastorno por estres postraumatico. Conclusiones El diagnostico y la intervencion temprana del deficit de atencion e hiperactividad en ninos puede ser una estrategia util en la prevencion del comportamiento suicida en la adolescencia.

The availability of updated information of regional wind fields is fundamental for an efficient management and prediction of wind power production. The present paper proposes a regional wind monitoring system based on the integration of different meteorological nets as a direct way to obtain this information. Concretely, we describe a monitoring system for the region of Andalusia supported by 198 stations, able to provide near surface wind field estimations with updating period of 10 min. Each of these stations has different characteristics since they are focused on measuring different environmental parameters, and most of them are below the quality level required by the World Meteorological Organization for wind measurement. Despite this drawback, the proposed monitoring system takes advantage of the high density of measurement points to produce valuable descriptions of the regional wind field. A basic geostatistical model coupled to the system achieves better results than Numerical Weather Prediction models, obtaining RMSE values of 1.52 m/s and 64.9° for speed and directional series respectively. The test confirms the tolerance of this massive monitoring system to data without quality assurance, being an interesting platform to implement crowdsourcing methodologies.

El presente artículo tiene como objetivo presentar un panorama ambiental, técnico y económico de la producción de bioalcohol, a partir de la Fracción Orgánica de Residuos Sólidos Urbanos (FORSU), tema que ha sido trabajado en investigaciones conjuntas con la Universidad de Castilla La Mancha (UCLM-España) y complementado con otros desarrollos realizados a través de la línea de investigación en Residuos Sólidos de la Universidad EAN, con el apoyo de estudiantes de especialización tanto en gestión de residuos sólidos, como en finanzas y negocios internacionales. El aprovechamiento no convencional de los Residuos Sólidos Urbanos (RSU), y en particular, para las condiciones de América Latina en donde más del 50% de los RSU corresponden a residuos de características orgánicas, termina siendo una posibilidad para agregar valor, generar crecimiento económico y crear condiciones de trabajo dignas para las personas vinculadas al aprovechamiento informal de residuos. Por ello, aprovechando el potencial de la biotecnología que ofrece diversas opciones para la generación de energías renovables, se busca abordar la producción de bioetanol a partir de procesos biológicos de metabolización de la materia orgánica mediante fermentación. En este artículo se presentará inicialmente, el contexto global de la producción de biocombustibles en Colombia, para posteriormente presentar el desarrollo de una fase preliminar a escala de laboratorio para la obtención de bioalcohol mediante una unidad de fermentación anaerobia experimental. Posteriormente se mencionarán los elementos económicos y financieros relativos a la implementación de este tipo de tecnologías y que por consiguiente podrían afectar el desarrollo a escala industrial de dicho proceso. Los resultados permitirán evaluar la viabilidad técnica y económica, al menos en una etapa preliminar, de implementación de este tipo de procesos en Colombia. In this research a computational simulation of the process of anaerobic digestion was carried out, using a homogenous mixture of bovine manure and citric residuals to assess the viability of renewable energy generation from the co- digestion of these residuals. In accordance with the former outcomes, an experimental stage was carried out in which periodic measurements of the control variables of anaerobic biodegradability were taken such as pH, alkalinity, oxygen chemical demand (total and soluble), among others. Also, process performance parameters were established and comparative values between experimental outcomes and computational results were determined. Additionally, a simulation of the anaerobic digestion process was carried out under similar conditions formerly established in a previous research through different experiments using the ADM-1 model. Based on the expected outcomes and as a result of experiments and simulations, the model precision was evaluated taking into account the values obtained from experimental measurements. Finally, a simplified model was implemented to evaluate energy production by a pilot- scale installation which performs the anaerobic treatment of organic residuals under observation. This model showed that there was an energetic deficit at the beginning; however, once the biogas production started the process, it became autosustainable and the system provided an increasing amount of available energy. Nesta pesquisa foi feita a simulação computacional do processo de digestão anaeróbica da mistura homogeneizada de esterco bovino e resíduos cítricos com o propósito de avaliar a viabilidade da geração de energia renovável a partir da co-digestão destes resíduos. Baseados nos resultados obtidos anteriormente, e mediante o desenvolvimento da etapa experimental na qual foram realizadas medições periódicas das variáveis de controle do processo de biodegradabilidade anaeróbica tais como pH, alcalinidade, demanda química de oxigênio (total e solúvel), entre outras, estabeleceram-se os parâmetros de desempenho do processo e foram determinados os valores de comparação entre os resultados experimentais e os resultados computacionais. Adicionalmente, realizou-se a simulação do processo de digestão anaeróbica em condições semelhantes às estabelecidas previamente em outra investigação a partir de ensaios experimentais, através da implementação do modelo ADM-1. Baseados nos resultados obtidos através das medições experimentais e as simulações, a precisão do modelo foi avaliada com respeito aos valores das medições experimentais. Finalmente, implementou-se um modelo simplificado para a avaliação da energia produzida por uma instalação a escala piloto que realiza o tratamento anaeróbico do resíduo orgânico em estudo. O modelo mostrou que inicialmente existe um déficit energético para que o processo ocorra; contudo, uma vez a produção de biogás começa, o processo se torna autosustentável e o sistema entrega uma quantidade crescente de energia disponível.

Background: Mycophenolate (MF) is effective as induction and maintenance treatment in patients with lupus nephritis (LN). This study evaluates the efficacy and safety of MF in patients with refractory and relapsing LN. Methods: Data were retrospectively obtained for 85 patients (35 refractory and 50 relapsing) from 11 nephrology departments in Spain. The primary endpoints were the incidence and cumulative number of renal responses and relapses and their relationship with baseline clinical and analytical data. The secondary endpoint was the appearance of side effects. Results: The main clinical and analytical variables were similar both in refractory and relapsing LN. Most of the patients had received cyclophosphamide, and all of them switched to MF. 74 patients (87%) achieved a response (69% partial, 31% complete). Age at starting MF, gender, pathological classification, body mass index, blood pressure, baseline renal function, and proteinuria were not associated with achieving response. After stopping MF, 3 of 19 patients (15.7%) relapsed, all at 6 months of follow-up. No differences were found between clinical and analytical variables and number of relapses. Side effects were unremarkable, except for 1 patient, who died of thrombocytopenia and ovarian hemorrhage. Conclusions: Switching to MF from other immunosuppressive treatments is effective and safe in refractory and relapsing LN.

Background/Purpose: Psoriasis is a multisystem disease which has been related to vitamin-D deficiency through chronic inflammation. This psoriasis-related inflammatory state and vitamin-D deficiency may induce bone mineral density loss. The purpose of this study is to assess the relationship of psoriasis with bone mineral density, by comparing psoriatic patients with healthy controls and patients with osteopenia/osteoporosis. Methods: A total of 185 subjects were studied; 58 psoriatic patients who had not been under systemic or biological treatment were included. Age, gender, body mass index, phosphocalcic metabolic parameters and hip and lumbar (L4) bone mineral density data were collected. These variables were compared with those collected in 61 healthy controls and 67 patients with osteopenia/osteoporosis. Results: Psoriatic patients showed worse hip and lumbar spine bone mineral density levels than healthy controls (P = 0.001) and better levels than osteoporotic patients (P < 0.001). Multivariate analysis demonstrated a negative association of age and a positive association of body mass index in hip bone mineral density in psoriatic patients. Limitations: The main limitations are those of cross-sectional studies, such as a lack of follow up period, and a male predominance in the psoriatic group, which is corrected employing a multivariate analysis with an adjusted model for confounding factors. Conclusions: Bone mineral density levels in psoriatic patients are situated halfway between healthy controls and patients with osteopenia/osteoporosis. In addition, the higher body mass index in patients with psoriasis appears to confer a protective effect against further development of lower bone mineral density.

This research presents a comparative analysis of wind speed forecasting methods applied to perform 1 h-ahead forecasting. The main significant development has been the introduction of low-quality measurements as exogenous information to improve these predictions. Eight prediction models have been assessed, three of these models [persistence, autoregressive integrated moving average (ARIMA) and multiple linear regression] are used as references, and the remaining five, based on neural networks, are evaluated on the basis of two procedures. Firstly, four quality indices are assessed (the Pearson’s correlation coefficient, the index of agreement, the mean absolute error and the mean squared error). Secondly, an analysis of variance test and multiple comparison procedure are conducted. The findings indicate that a backpropagation network with five neurons in the hidden layer is the best model obtained with respect to the reference models. The pair of improvements (mean absolute-mean squared error) obtained are 29.10%–56.54%, 28.15%–53.99% and 4.93%–14.38%, for the persistence, ARIMA and multiple linear regression models, respectively. The experimental results reported in this paper show that traditional agricultural measurements enhance the predictions.

This paper deals with a novel application of the Spectral Kurtosis (SK) in power-quality modeling and analysis. The two major advantages of this three-spectral analysis are: robustness to noise and the capability to detect nonlinearities, as impulsive-like signals. The first aim is to study some of the theoretical aspects of the SK estimation, performing a connection to the power-quality event analysis. Then, real-life situations’ performances are presented to correlate results with synthetics. Despite the fact the limited resolution in the frequency domain (to gain computation speed), the method presents an accuracy of 84% over real-life registers.

Objective: To ascertain in a cross-sectional study whether substantia nigra (SN) echogenicity, olfaction, and dopamine transporter (DaT)-SPECT are reliable premotor biomarkers in a cohort of asymptomatic carriers of the LRRK2 G2019S mutation (AsG2019S+). Methods: These biomarkers were evaluated in 49 AsG2019S+ patients, and we also studied olfaction and SN echogenicity in 29 patients with G2019S-associated Parkinson disease (PD-G2019S), 47 relatives who were noncarriers of the LRRK2 G2019S mutation (AsG2019S−), 50 patients with idiopathic Parkinson disease (iPD), and 50 community controls. Results: Eighty-five percent of unaffected mutation carriers (AsG2019S+) showed pathologic SN hyperechogenicity, with a similar proportion observed among both PD-G2019S and iPD cases, and 41% of AsG2019S− also showing increased SN echogenicity. The proportion of hyposmic individuals was not statistically different in patients with PD-G2019S (50%) and iPD (82%), but hyposmia was significantly less common in both AsG2019S+ (26%) and AsG2019S− (28%). In AsG2019S+ cases, reduced striatal uptake in DaT-SPECT was observed in 43.7%. Conclusions: Independently of age at examination, the most frequently altered premotor biomarker in LRRK2 G2019S-associated PD was SN hyperechogenicity, whereas abnormal DaT-SPECT predominated in older, unaffected mutation carriers.

Introduction At least 10% of patients with Obsessive-compulsive Disorder (OCD) are refractory to psychopharmacological treatment. The emergence of new technologies for the modulation of altered neuronal activity in Neurosurgery, deep brain stimulation (DBS), has enabled its use in severe and refractory OCD cases. The objective of this article is to review the current scientific evidence on the effectiveness and applicability of this technique to refractory OCD. Method We systematically reviewed the literature to identify the main characteristics of deep brain stimulation, its use and applicability as treatment for obsessive-compulsive disorder. Therefore, we reviewed PubMed/Medline, Embase and PsycINFO databases, combining the key-words ‘Deep brain stimulation’, ‘DBS’ and ‘Obsessive-compulsive disorder’ ‘OCS’. The articles were selected by two of the authors independently, based on the abstracts, and if they described any of the main characteristics of the therapy referring to OCD: applicability; mechanism of action; brain therapeutic targets; efficacy; side-effects; co-therapies. All the information was subsequently extracted and analysed. Results The critical analysis of the evidence shows that the use of DBS in treatment-resistant OCD is providing satisfactory results regarding efficacy, with assumable side-effects. However, there is insufficient evidence to support the use of any single brain target over another. Patient selection has to be done following analyses of risks/benefits, being advisable to individualise the decision of continuing with concomitant psychopharmacological and psychological treatments. Conclusions The use of DBS is still considered to be in the field of research, although it is increasingly used in refractory-OCD, producing in the majority of studies significant improvements in symptomatology, and in functionality and quality of life. It is essential to implement random and controlled studies regarding its long-term efficacy, cost-risk analyses and cost/benefit.

The aim of this study was to analyze the presence of lithogenic metabolic factors in the blood and urine of patients with osteopenia versus osteoporosis. This is a cross-sectional study including 67 patients who were divided into two groups according to the presence of either osteopenia or osteoporosis as measured by bone densitometry: group 1—40 patients with osteopenia (22 men and 18 women) and group 2—27 patients with osteoporosis (13 men and 14 women). Metabolic studies were performed on the blood and urine; statistical analysis was performed comparing means and conducting linear correlation and multivariate analyses with SPSS. Statistical significance was considered to be p ≤ 0.05. The mean age of patients in group 1 was 52.9 ± 12.8 years versus 50.3 ± 11.4 in group 2; the difference was not statistically significant. In group 2, higher levels of osteocalcin, β-crosslaps, urinary calcium, fasting urine calcium/creatinine, 24 h urine calcium/creatinine and 24 h oxaluria were observed compared to group 1. In the multivariate analysis, only the β-crosslaps and urinary calcium were independently associated with osteoporosis. It would be advisable to determine the urinary calcium levels in patients with osteoporosis since altered levels may necessitate modifying the diagnostic and therapeutic approach to osteoporosis.

To analyze the presence of phosphocalcic metabolism disorders in patients with osteopenia-osteoporosis without nephrolithiasis with respect to a control group.A cross-sectional study was conducted in patients with osteopenia-osteoporosis without nephrolithiasis (n = 67) in lumbar spine or femur and in a control group (n = 61) with no lithiasis or bone disorders. Blood bone markers, phosphocalcic metabolism, fasting urine, 24-h urine lithogenic risk factors, and densitometry were recorded in both groups. SPSS 20.0 was used for statistical analysis.In comparison with the controls, significantly higher blood calcium (9.27 ± 0.36 vs. 9.57 ± 0.38, p = 0.0001), intact parathormone (45.6 ± 14.9 vs. 53.8 ± 18.9, p = 0.008), and alkaline phosphatase (61.9 ± 20.9 vs. 70.74 ± 18.9, p = 0.014) levels were found in patients with osteopenia-osteoporosis. In the 24-h urine test, citrate (1010.7 ± 647.8 vs. 617.6 ± 315.8, p = 0.0001) and oxalate (28.21 ± 17.65 vs. 22.11 ± 16.49, p = 0.045) levels were significantly lower in osteopenia-osteoporosis patients than in controls, with no significant difference in calcium (187.3 ± 106.9 vs. 207.06 ± 98.12, p = 0.27) or uric acid (540.7 ± 186.2 vs. 511.9 ± 167.06, p = 0.35) levels. Patients with osteopenia-osteoporosis had significantly higher levels of lithogenic risk factors associated with bone remodeling, including significantly increased β-crosslaps and osteocalcin values and higher β-crosslaps/osteocalcin ratios.Patients with osteopenia-osteoporosis without nephrolithiasis showed phosphocalcic metabolism disorders as well as lower urinary citrate and higher β-crosslaps/osteocalcin and fasting calcium/creatinine ratios, which would increase the risk of nephrolithiasis. Hence, prospective studies are warranted to evaluate the long-term risks.

Higher-order statistics demonstrate their innovative features to characterize power quality events, beyond the traditional and limited Gaussian perspective, integrating time-frequency features and within the frame of a Higher-Order Neural Network (HONN). With the massive advent of smart measurement equipment in the electrical grid (Smart Grid), and in the frame of high penetration scenarios of renewable energy resources, the necessity dynamic power quality monitoring is gaining even more importance in order to identify the suspicious sources of the perturbation, which are nonlinear and unpredictable in nature. This eventually would satisfy the demand of intelligent instruments, capable not only of detecting the type of perturbation, but also the source of its origin in a scenario of distributed energy resources.