Monte Carlo N-Particle forward modeling for density reconstruction of double shell capsule radiographs.

In the Double Shell Inertial Confinement Fusion concept, characterizing the shape asymmetry of imploding metal shells is vital for understanding energy-efficient compression and radiative losses of the thermonuclear fuel. The Monte Carlo N-Particle MCNP® code forward models radiography of Double Shell capsule implosions using the Advanced Radiographic Capability at the National Ignition Facility. A procedure is developed for using MCNP to reconstruct density profiles from the radiograph image intensity. For a given Double Shell imploding target geometry, MCNP radiographs predict image contrast, which can help guide experimental design. In future work, the calculated MCNP synthetic radiographs will be compared with experimental radiographs to determine the radial and azimuthal density profiles of the Double Shell capsules.

Assessment of clinical and hemodynamic congestion as predictors of mortality in elderly outpatients with heart failure.

INTRODUCTION: This work aims to evaluate whether a clinical examination and measurement of N-terminal pro-brain natriuretic peptide can predict poor prognosis in outpatients with heart failure. PATIENTS AND METHODS: We carried out a retrospective study from 2010 to 2018 in 238 patients diagnosed with heart failure. At baseline, we evaluated the presence of pulmonary rales and bilateral leg edema (clinical congestion) together with N-terminal pro-brain natriuretic peptide ≥ 1500 pg/mL (hemodynamic congestion). Patients were classified into 4 groups depending on their congestion pattern: no congestion (G1) (n = 50); clinical congestion (G2) (n = 43); hemodynamic congestion (G3) (n = 73); and clinical and hemodynamic congestion (G4) (n = 72). The primary outcome was all-cause mortality at one year of follow-up. RESULTS: A total of 238 patients were included. The mean age was 82 years, 61.8% were women, and 20.7% had reduced left ventricular ejection fraction. Thirty patients died in the first year of follow-up (12.6%). After controlling for confounding variables (sex, recent discharge for heart failure, estimated glomerular filtration rate, and left ventricular ejection fraction), the independent risk of death in each group compared to G1 as the reference group was: G2: HR 4.121 (95%CI 1.131-15.019); G3: HR 2.511 (95%CI 1.007-6.263); and G4: HR 7.418 (95%CI 1.630-33.763). CONCLUSION: Congestion in outpatients with heart failure correlates with prognosis. Patients with both clinical and hemodynamic congestion had the highest risk of all-cause death at one year.

[Mild behavioural impairment as an antecedent of dementia: presentation of the diagnostic criteria and the Spanish version of the MBI-C scale for its evaluation]. / Deterioro comportamental leve como antecedente de la demencia: presentacion de los criterios diagnosticos y de la version española de la escala MBI-C para su valoracion.

INTRODUCTION: Neuropsychiatric symptoms are common in dementia and also in previous stages such as mild cognitive impairment. Their presence is related to greater conversion to dementia in cognitively healthy people or with mild cognitive impairment compared to those who do not suffer them. AIM: An international working group pertaining to the Alzheimer Association has proposed the concept of 'mild behavioral impairment' (MBI) to identify patients with mild neuropsychiatric symptoms and normal cognition or mild cognitive impairment and to study the further risk of developing dementia from any cause. A new scale, the Mild Behavioral Impairment-Checklist (MBI-C), has been developed for the assessment of MBI in clinical and research settings. DEVELOPMENT: Data on the greater risk of dementia in the presence of neuropsychiatric symptoms are shown to justify the development of the new concept of MBI, improving the previous attempts of categorization of these states. Diagnostic criteria of MBI and the process of creation of the MBI-C scale are described. The Spanish version is presented in this article. Finally, the next steps in the investigation of the concept and measurement of MBI and its future prospects are suggested. CONCLUSIONS: The new MBI criteria and their measurement using the MBI-C scale are promising for a better and earlier identification of patients at risk of developing dementia and as an aid to investigate the underlying neurodegenerative processes.

TITLE: Deterioro comportamental leve como antecedente de la demencia: presentacion de los criterios diagnosticos y de la version española de la escala MBI-C para su valoracion.Introduccion. Los sintomas neuropsiquiatricos son frecuentes en la demencia y tambien en estadios previos, como el deterioro cognitivo leve. Su aparicion se relaciona con mayor conversion a demencia en personas cognitivamente sanas o con deterioro cognitivo leve, en comparacion con las personas que no los presentan. Objetivo. Dar a conocer la importancia en las fases previas a la demencia del concepto 'deterioro comportamental leve' (DCoL) y mostrar los criterios consensuados de DCoL de la International Society to Advance Alzheimer's Research and Treatment. Estos criterios permitiran identificar a pacientes con sintomas neuropsiquiatricos leves y cognicion normal o deterioro cognitivo leve, y estudiar el riesgo ulterior de desarrollar demencia por cualquier causa. A su vez, se presenta una nueva escala, la Mild Behavioral Impairment-Checklist (MBI-C), para la valoracion clinica y en investigacion del DCoL. Desarrollo. Se muestran datos del mayor riesgo de demencia en presencia de sintomas neuropsiquiatricos para justificar el desarrollo del nuevo concepto de DCoL, que perfecciona los intentos previos de categorizacion de estos estados. Se describen los criterios diagnosticos de DCoL y el proceso de creacion de la MBI-C, y se presenta su version española. Finalmente, se plantean los proximos pasos en la investigacion del concepto y medicion del DCoL y sus perspectivas de futuro. Conclusiones. Los nuevos criterios de DCoL y su medicion mediante la MBI-C resultan prometedores de cara a una mejor y mas temprana identificacion de los pacientes con riesgo de desarrollar demencia y una ayuda para la investigacion de los procesos neurodegenerativos subyacentes.

Pseudoautosomal abnormalities in terminal AZFb+c deletions are associated with isochromosomes Yp and may lead to abnormal growth and neuropsychiatric function.

STUDY QUESTION: Are copy number variations (CNVs) in the pseudoautosomal regions (PARs) frequent in subjects with Y-chromosome microdeletions and can they lead to abnormal stature and/or neuropsychiatric disorders? SUMMARY ANSWER: Only subjects diagnosed with azoospermia factor (AZF)b+c deletions spanning to the end of the Y chromosome (i.e. terminal deletions) harbor Y isochromosomes and/or cells 45,X that lead to pseudoautosomal gene CNVs, which were associated with abnormal stature and/or neuropsychiatric disorders. WHAT IS KNOWN ALREADY: The microdeletions in the long arm of the Y chromosome (Yq) that include the loss of one to three AZF regions, referred to as Yq microdeletions, constitute the most important known etiological factor for primary spermatogenic failure. Recently, controversy has arisen about whether Yq microdeletions are associated with gain or loss of PAR genes, which are implicated in skeletal development and neuropsychiatric function. STUDY DESIGN, SIZE, DURATION: We studied a cohort of 42 Chilean patients with complete AZF deletions (4 AZFa, 4 AZFb, 23 AZFc, 11 AZFb+c) from a university medical center, diagnosed over a period of 15 years. The subjects underwent complete medical examinations with special attention to their stature and neuropsychiatric function. PARTICIPANTS/MATERIALS, SETTING, METHODS: All subjects were characterized for Yq breakpoints by PCR, and for CNVs in PARs by multiplex ligation-dependent probe amplification (MLPA), followed by qPCR analysis for genes in PAR1 (SHOX and ZBED1), PAR2 (IL9R) and two single copy genes (SRY and DDX3Y, respectively located in Yp11.3 and AZFa). In addition, karyotypes revision and fluorescence in situ hybridization (FISH) for SRY and centromeric probes for X (DXZ1) and Y (DYZ3) chromosomes were performed in males affected with CNVs. MAIN RESULTS AND THE ROLE OF CHANCE: We did not detect CNVs in any of the 35 AZF-deleted men with interstitial deletions (AZFa, AZFb, AZFc or AZFb+c). However, six of the seven patients with terminal AZFb+c deletions showed CNVs: two patients showed a loss and four patients showed a gain of PAR1 genes, with the expected loss of VAMP-7 in PAR2. In these patients, the Yq breakpoints localized to the palindromes P8, P5 or P4. In the four cases with gain of PAR1, qPCR analysis showed duplicated signals for SRY and DDX3Y and one copy of IL9R, indicating isodicentric Yp chromosomes [idic(Y)] with breakpoint in Yq11.22. The two patients who had loss of PAR1, as shown by MLPA, had an additional reduction for SRY and DDX3Y, as shown by qPCR, associated with a high proportion of 45,X cells, as determined by FISH and karyotype. In agreement with the karyotype analysis, we detected DYZ3++ and DYZ3+ cells by FISH in the six patients, confirming idic(Y) and revealing additional monocentric Y chromosome [i(Y)]. Five patients had a history of major depressive disorders or bipolar disorder, and three had language impairment, whereas two patients showed severe short stature (Z score: -2.75 and -2.62), while a man with bipolar disorder was very tall (Z score: +2.56). LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: The number of males studied with Y-chromosome microdeletions and normozoospermic controls with normal karyotypes may not be enough to rule out an association between AZF deletions and PAR abnormalities. The prevalence of Y isochromosomes and/or 45,X cells detected in peripheral blood does not necessarily reflect the variations of PAR genes in target tissues. WIDER IMPLICATIONS OF THE FINDINGS: This study shows that CNVs in PARs were present exclusively in patients with terminal AZFb+c deletions associated with the presence of Y isochromosomes and 45,X cells, and may lead to neuropsychiatric and growth disorders. In contrast, we show that men with interstitial Yq microdeletions with normal karyotypes do not have an increased risk of PAR abnormalities and of phenotypical consequences. Moreover, our results highlight the importance of performing molecular studies, which are not considered in the usual screening for patients with Yq microdeletions. STUDY FUNDING/COMPETING INTERESTS: This work was supported by the National Fund for Scientific and Technological Development of Chile (FONDECYT), grant no. 1120176 (A.C.). The authors declare that no conflicting interests exist.

Uncovering Hospitalists' Information Needs from Outside Healthcare Facilities in the Context of Health Information Exchange Using Association Rule Learning.

BACKGROUND: Important barriers to health information exchange (HIE) adoption are clinical workflow disruptions and troubles with the system interface. Prior research suggests that HIE interfaces providing faster access to useful information may stimulate use and reduce barriers for adoption; however, little is known about informational needs of hospitalists. OBJECTIVE: To study the association between patient health problems and the type of information requested from outside healthcare providers by hospitalists of a tertiary care hospital. METHODS: We searched operational data associated with fax-based exchange of patient information (previous HIE implementation) between hospitalists of an internal medicine department in a large urban tertiary care hospital in Florida, and any other affiliated and unaffiliated healthcare provider. All hospitalizations from October 2011 to March 2014 were included in the search. Strong association rules between health problems and types of information requested during each hospitalization were discovered using Apriori algorithm, which were then validated by a team of hospitalists of the same department. RESULTS: Only 13.7% (2 089 out of 15 230) of the hospitalizations generated at least one request of patient information to other providers. The transactional data showed 20 strong association rules between specific health problems and types of information exist. Among the 20 rules, for example, abdominal pain, chest pain, and anaemia patients are highly likely to have medical records and outside imaging results requested. Other health conditions, prone to have records requested, were lower urinary tract infection and back pain patients. CONCLUSIONS: The presented list of strong co-occurrence of health problems and types of information requested by hospitalists from outside healthcare providers not only informs the implementation and design of HIE, but also helps to target future research on the impact of having access to outside information for specific patient cohorts. Our data-driven approach helps to reduce the typical biases of qualitative research.

The carbon budget of a large catchment in the Argentine Pampa plain through hydrochemical modeling.

Mar Chiquita is a coastal lagoon located in the Argentine Buenos Aires province in South America. The aim of this study is to estimate the annual contribution of inland waters to the carbon cycle in this lagoon's catchment by estimating the corresponding local carbon budget. Fifteen pairs of water samples were chosen to carry out hydrogeochemical modeling using PHREEQC software. Groundwater samples were considered as recharge water (initial solutions), while streamwater samples were taken as groundwater discharge (final solutions for inverse modeling/reference solutions for direct modeling). Fifteen direct models were performed, where each groundwater sample was constrained to calcite equilibrium under two different carbon dioxide partial pressure (PCO2) conditions: atmospheric conditions (log PCO2 (atm) = -3.5) and a PCO2 value of log PCO2 (atm) = -3. Groundwater samples are close to calcite equilibrium conditions. The calcite precipitation process is kinetically slower than gas diffusion, causing oversaturation of this reactant phase in streamwater samples. This was accompanied by a pH increase of approximately two units due to a PCO2 decrease. From the fifteen inverse models it was estimated that, of the total carbon that enters per year in the hydrological cycle of the study area, about 11.9% is delivered to the atmosphere as CO2 and around 6.7% is buried in sediments. This would indicate that 81.4% of the remaining carbon is retained in equilibrium within the system or discharged into the Mar Chiquita lagoon and/or directly to the ocean through regional flows.

The impact of parent socio-economic status on executive functioning and cortical morphology in individuals with schizophrenia and healthy controls.

BACKGROUND: Relatively lower executive functioning is characteristic of individuals with schizophrenia. As low socio-economic status (SES) early in life (i.e. parent SES) has been linked with lower executive skills in healthy children, we hypothesized that parental SES (pSES) would be more strongly related to executive functioning in individuals with schizophrenia than in controls and have a greater impact on prefrontal cortical morphology. METHOD: Healthy controls (n = 125) and individuals with schizophrenia (n = 102) completed tests assessing executive functioning and intelligence. The groups were matched on pSES, which was evaluated with the Hollingshead-Redlich scale. A principal components analysis (PCA) was conducted on 10 variables from six executive tests, yielding three specific components (fluency, planning and response inhibition). Voxel-based morphometry (VBM) was used to evaluate effects of pSES on gray matter (GM) concentration. RESULTS: Lower pSES was associated with lower scores across the three executive functioning components, and a significant group by pSES interaction was observed such that low pSES, in particular, affected individuals with schizophrenia. These effects remained significant when intellectual ability, education and self-SES (sSES) were added as covariates. VBM revealed that lower pSES was associated with reduced GM volume in several anterior brain regions, especially the superior frontal gyrus, in patients but not in controls. CONCLUSIONS: These findings suggest that individuals with schizophrenia may be particularly vulnerable to the adverse impact of low pSES, in terms of both lower executive skills and reduced anterior GM volumes.

Epilepsy training needs for Spanish neurologists: ARPE study results.

INTRODUCTION: This study was designed to create an updated training program on epilepsy to solve whatever problems that general neurologists may detect in patients during consults. OBJECTIVES: To understand general neurologists' training needs in order to plan a specific program that may improve/standardize the clinical management of patients with epilepsy. MATERIAL AND METHODS: 122 general neurologists non-subspecialized on epilepsy were surveyed in all regions of Spain regarding the following issues: initial diagnosis, treatment, special situations by population group and/or comorbidity, prognosis and follow-up as well as whatever other topics the training program should cover. RESULTS: Neurologists agreed that treatment was the most interesting topic for them (100%), followed by diagnosis (46.67%), special situations by population group and/or comorbidity (30%), and prognosis/follow-up (7.14%). There were insignificant differences attributable to age and sex. CONCLUSIONS: Training ensures success, provided that it takes into account pedagogical considerations and professional targets to be trained, as well as technological and formal issues.

[Prevalence of childhood obesity in the Murcia Region; an assessment of different references for body mass index]. / Prevalencia de obesidad infantil en la Región de Murcia, valorando distintas referencias para el índice de masa corporal.

INTRODUCTION: Childhood obesity is a problem of high magnitude with serious repercussions on health, which justifies estimating its prevalence at local level to identify conditioning factors and to take preventive actions. The main objective of the present work is to estimate the prevalence of overweight and obesity in the children in the general population of the Murcia Region, using the body mass index (BMI) and applying the International Obesity Task Force (IOTF) criteria, and to compare these results with the ones obtained from other frequently used references in Spain. MATERIAL AND METHODS: The BMI of 178,894 children aged from 2 to 14 years was determined. The prevalence of overweight and obesity was compared to the IOTF, to the studies of the World Health Organization, as well as those of the Orbergozo Foundation (FO), and the Cross-sectional Spanish Growth Study (ETEC) references. The agreement between the different results was evaluated using the kappa index. RESULTS: The evaluation using the IOTF cut-off points gave an overweight prevalence of 20.6% (95% CI: 20.4-20.8), an obesity prevalence of 11.4% (95% CI: 11.2-11.5) and an overweight plus obesity prevalence of 32% (95% CI: 31.8-32.2), with this last one being higher in girls (33.2%) than in boys (30.9%). The highest agreement is between IOTF and FO-2011 (kappa=.795) and between FO-2011 and ETEC (kappa=.794). CONCLUSION: A high prevalence of overweight and obesity in children in the Region of Murcia was found. The ETEC and the FO-2011 study showed the highest agreement with the results obtained using the IOTF criteria.

Nonlinear analysis of actigraphic signals for the assessment of the attention-deficit/hyperactivity disorder (ADHD).

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children and adolescents; however, its etiology is still unknown, which hinders the existence of reliable, fast and inexpensive standard diagnostic methods. In this paper, we propose a novel methodology for automatic diagnosis of the combined type of ADHD based on nonlinear signal processing of 24h-long actigraphic registries. Since it relies on actigraphy measurements, it constitutes an inexpensive and non-invasive objective diagnostic method. Our results on real data reach 96.77% sensitivity and 84.38% specificity by means of multidimensional classifiers driven by combined features from different time intervals. Our analysis also reveals that, if features from a single time interval are used, the whole 24-h interval is the only one that yields classification figures with practical diagnostic capabilities. Overall, our figures overcome those obtained by actigraphy-based methods reported and are comparable with others based on more expensive (and not so convenient) adquisition methods.

[Clinical safety plan in a university hospital complex. Initial diagnosis: study of adverse events]. / Plan de seguridad clínica del Complejo Hospitalario Universitario de Albacete (CHUA). Diagnóstico inicial: estudio de eventos adversos.

OBJECTIVES: To establish the incidence of adverse events (AEs) and incidence of patients with AEs in the University Hospital Complex of Albacete (CHUA); to identify and define the AEs which are linked to health care; to analyse avoidable AE and determine their impact; to plan improvement actions. METHOD: . DESIGN: Retrospective cohort study. SAMPLE: Patients registered from 5 November to 19 November, 2007. CASE DEFINITION: Any accident or incident reported in the medical record which injured or may have injured the patient. MATERIAL: Adverse Events Screening Guide, adapted from the Harvard study. Spanish version of the Modular Review Form (MRF2) for retrospective case record review. STATISTICAL ANALYSIS: Univariate and bivariate analysis and logistic regression model. RESULTS: The incidence of patients with AEs linked to hospital care was 6.8%. The incidence was significantly different depending on: age, presence of intrinsic or extrinsic risk factors (excluding peripheral venous catheter); 8.2% of AE was linked to care; 14.3% to medication; 26.5% to nosocomial infections; 35.7% to technical problems in procedures; 11.2% to diagnosis, and the remaining 4.1% to other types of AEs. In these incidences, 12.2% were considered mild, 78.6% moderate and 8.2% serious. Half (50%) of AEs caused an increase in hospital stay, and in 34.7% cases determined hospitalisation. A total of 63.3% of AEs were considered avoidable. CONCLUSIONS: The study of AEs in the CHUA represents an improvement within the hospital quality program. Incidences of patients with AEs and those related to health care fall within the range of those found in the studies where the objective was quality improvement.

Socioeconomic status, race, and bone turnover in the Midlife in the US Study.

UNLABELLED: Among a group of 940 US adults, economic adversity and minority race status were associated with higher serum levels of markers of bone turnover. These results suggest that higher levels of social stress may increase bone turnover. INTRODUCTION: To determine socioeconomic status (SES) and race differences in levels of bone turnover. METHODS: Using data from the Biomarker Substudy of the Midlife in the US (MIDUS) study (491 men, 449 women), we examined cross-sectional associations of SES and race with serum levels of bone turnover markers (bone-specific alkaline phosphatase [BSAP], procollagen type I N-terminal propeptide [PINP], and N-telopeptide [Ntx]) separately in men and women. Linear multivariable regression was used to control for body weight, menopausal transition stage, and age. RESULTS: Among men, low family poverty-to-income ratio (FPIR) was associated with higher turnover, but neither education nor race was associated with turnover. Men with FPIR <3 had 1.808 nM BCE higher Ntx (P = 0.05), 3.366 U/L higher BSAP (P = 0.02), and 7.066 higher PINP (P = 0.02). Among women, neither education nor FPIR was associated with bone turnover, but Black women had 3.688 nM BCE higher Ntx (P = 0.001), 5.267 U/L higher BSAP (P = 0.005), and 11.906 µg/L higher PINP (P = 0.008) compared with non-Black women. CONCLUSIONS: Economic adversity was associated with higher bone turnover in men, and minority race status was associated with higher bone turnover in women, consistent with the hypothesis that higher levels of social stresses cause increased bone turnover. The magnitude of these associations was comparable to the effects of some osteoporosis medications on levels of turnover.

[Critical study of spanish adult consumer profile of antibiotics on the basis of National Surveys of Health in 1993, 1995, 1997, 2001 and 2003]. / Estudio crítico del perfil del consumidor español adulto de antibióticos, en base a las Encuestas Nacionales de Salud de 1993, 1995, 1997, 2001 y 2003.

OBJECTIVE: The objective of this study has been to examine antibiotic consumption in Spain through the use of the National Surveys of Health (NSH) . MATERIAL AND METHODS: Taking the NSH, between 1993 and 2003, certain variables regarding the consumption of antibiotics have been analyzed; putting these into groups according to their typology, habits, comorbidity and the utilization of health resources. This information has been compared with published data by other authors. RESULTS: The consumption of antibiotics was approximately 3%, and 9-19% of this was not prescribed. Significant statistical associations have been observed between the consumption of antibiotics and other aspects such as academic and income levels, habits such as smoking, general health, certain chronic diseases, being bed-ridden due to disease; and also the use of certain medicines and the anti-influenza vaccine. CONCLUSIONS: Consumption of antibiotics coincides with described data by other authors, and this was always higher than prescribed. The association with other variables may be limited by the inadequate NSH design in order to know the exact consumption of antibiotics.

[Usefulness of digestive ultrasonography in the assessment of ulcerative colitis extent]. / Utilidad de la ecografía en la valoración de la extensión de la colitis ulcerosa.

INTRODUCTION: A full examination of the colon should be avoided upon finding severe endoscopic lesions in patients with ulcerative colitis. However, knowledge of the precise extent of disease is quite important for disease prognosis and the making of therapeutic decisions. Therefore, any validation of a non-invasive technique to assess the extent of ulcerative colitis gains a lot of interest and importance. MATERIAL AND METHOD: The study included patients that were previously diagnosed of having ulcerative colitis or were beginning to suffer from the disease. A prospective and blind evaluation was carried out to determine the precision of digestive ultrasonography in assessment of ulcerative colitis extent. All ultrasonography was carried out by the same person and was always performed prior to carrying out a full endoscopic study, which is used as the gold standard. The hydrocolonic ultrasonograpy technique was not used in any of the cases. RESULTS: A total of 20 patients -13 males (65%) and 7 females (35%), with an average age of 51.7 years (aged between 24-82 years)- were included in the study. Endoscopic studies revealed severe disease in 5 cases (25%), moderate disease in 12 patients (60%), and mild lesions in the 3 remaining cases (15%). A colonic ultrasonogram was considered satisfactory in 18 cases (90%), and the extent of disease as established by ultrasonography was in all cases consistent with that established through colonoscopy: 3 patients (16.6%) had ulcerative proctitis, 9 patients (50%) had left-sided ulcerative colitis, and 6 (33.3%) had extensive colitis. CONCLUSIONS: Digestive ultrasonography allows to study the colon in most patients, especially when inflammatory activity is present, and provides a greater accuracy in assessing ulcerative colitis extent, which is independent of its activity level.

[An analysis of avoidable admissions to a neurology service]. / Análisis de los ingresos evitables en un servicio de neurología.

INTRODUCTION: Inappropriate admissions to a hospital service generate unnecessary costs for our health care service. Most admissions to a hospital service come from the emergency department. The presence of a neurologist to attend hospital emergencies would be an important factor allowing admission criteria to be streamlined. AIMS: To determine the number of avoidable admissions (AA) in a neurology service, and to define their characteristics. PATIENTS AND METHODS: We conducted a prospective, descriptive study of the admissions that took place in the Neurology Service of the Hospital General Universitario de Elche (Alicante) over a period of three months. The neurologist determines whether admission is indicated or not. We collected demographic data concerning the patient, the admission diagnosis, neurological diagnosis, the reason for appropriateness and the reason for AA. RESULTS: A total of 250 admissions were attended; 65 were considered to be AA (26%). The most frequent diagnoses in the cases of AA were non-neurological (32.3%), clinical findings (15.4%), neuropathies (10.8%) and epilepsy (10.8%). The reasons leading to AA were non-neurological and transfer to another service (30.8%), follow-up by neurology outpatient department (NOD) (29.2%), NOD study (21.5%), non-neurological and discharge (16.9%) and not specified (1.5%). The mean length of stay in the case of AA was 4.3 days. CONCLUSIONS: The number of AA in our service is higher than that found in other studies. On-duty neurologists, streamlining outpatient diagnostic testing and the design of flexible schedules for outpatient care would reduce the amount of resources that are used, while at the same time increasing the quality of the health service.

[Impact of a clinical pathway for the diabetic foot in a general hospital]. / Impacto de una vía clínica para el pie diabético en un hospital general.

OBJECTIVE: The ulcers, infections and isquemia of the foot are the main causes of hospitalisation of the diabetic patient and, very frequently, they are reason for the amputation of the limb. The objective of this investigation consists of evaluating the results of a multidisciplinary clinical pathway designed by the set of specialists of different departments from our hospital, as well as of the associated personnel of infirmary, implied in the management of this pathology. PATIENTS AND METHODS: We have analysed the evolution of a series of clinical and socio-economic indicators comparing, in the patients admitted with diagnose of complicated diabetic foot, the previous period to the implantation of the clinical pathway years 1998, 1999 and 2000) with the later period to this implantation (years 2001 and 2002). It is evaluated in each group: the percentage of greater and smaller amputations, mortality, the average stay, the percentage of readmitances in 30 days, the percentage of arteriographies, the percentage of patients controlled by rehabilitation, and the economic cost of the individual processes, as well as the global cost. In the group including in the clinical pathway it was carried out, in addition, a satisfaction survey. The statistical comparison was made by means of the Chi square test. RESULTS: We did not find differences as far as the average stay, nor to intrahospitable mortality. If we found a clear increase in the percentage of arteriographies (of the 3.5% passage to 13%), and in the percentage of patients controlled by rehabilitation (of the 19.8% passage to the 84.3%). The rate of greater amputations of the patients not including in the clinical pathway change from 17.4% to 9.7% after the implantation of this route. The rate of readmitances to 30 days diminished from 9.3 to 6,5%. The global economic cost and the average cost by patient have been inferior after the implantation of the clinical route. The survey of satisfaction of this last group offered a global satisfaction of 95%. CONCLUSIONS: The results suggest that the approach to the diagnose and treatment on the complicated diabetic foot by means of this multidisciplinary clinical pathway improves the evolution of the hospitalised patient, diminishing the number of greater amputations, without extending the average stay and maintaining, or even diminishing, the global economic cost.

Validación de una escala para adolescentes (EBHAD): un estudio piloto en Puerto Rico / Validation of a scale for adolescents (EBHAD): a pilot study in Puerto Rico

This investigation presents the development and validation process of a scale whose principal purpose is to identify those areas in which one is required to achieve improved functioning and adequate emotional health resulting in improved sports performance with adolescent athletes. The "Hechavarria Wellness Scale for Adolescent Athletes" (HWSAA) was developed. The concept of wellness was measured utilizing the following 4 sub-scales measuring; depressive symptomatology, trait anxiety, self-esteem and social relations. A pilot study was undertaken with a universe of 149 adolescent athletes from both sexes with an average of 15.6 years old and residing within the different municipalities of Puerto Rico. The alpha coefficient reliability of the HWSAA and its' subscales fluctuated between 0.71 and 0.82. The results suggest that the HWSAA and its' subscales possess a psychometrically adequate internal consistency. This means that the instrument is valid and reliable for the sample utilized. We suggest further research with the HWSAA

Cerebral maturation in premature infants: quantitative assessment using MR imaging.

BACKGROUND AND PURPOSE: The assessment of whether brain development is at an appropriate level for age has become an integral part of clinical MR reporting, although few studies have quantitatively defined the developmental changes occurring in premature infants. We have developed a simple scoring system to assess four parameters of cerebral maturation--myelination, cortical folding, glial cell migration, and germinal matrix distribution--to determine the total maturation score (TMS). The aim of this study was to validate this scoring system in a large population of preterm infants across a range of gestational ages. METHODS: A retrospective analysis was conducted of MR images acquired over a 3-year period with an identical imaging protocol. Infants born more than 14 days before the imaging examination and those with a clinical or radiologic history suggestive of neuroabnormality were excluded from the study. The TMS was derived by consensus. Interobserver agreement was evaluated by using the Bland-Altman plot. RESULTS: Images from 134 infants (23-41 weeks' gestational age) were evaluated. The TMS was significantly related to the postmenstrual age of the infant, with the mean TMS for each age group increasing with advancing postmenstrual age. Interobserver agreement was found to be high (mean difference in score = 0.07, SD = 0.56). CONCLUSION: This scoring system provides a standardized method for assessing cerebral maturation in the premature infant. The TMS is easy to calculate from standard MR images, is reproducible, and can help detect changes occurring within a postnatal age of a few weeks.