Acute leukaemia in children, adolescents and young adults in California: trends and inequalities in early death and survival during 1988-2011

Survival after acute paediatric (014 years), adolescent (15-19 years) and young adult (20-39 years) leukaemia has improved substantially over the last five decades, particularly for acute lymphoblastic leukaemia (ALL) and acute promyelocytic leukaemia, a subtype of acute myeloid leukaemia. This progress represents one of the most successful achievements in the history of medicine and has been attributed to the development of effective chemotherapy regimens, improvement in supportive care, better risk stratification, use of targeted therapies, and advances in haematopoietic stem cell transplantation. Currently, long-term survival for children diagnosed with acute lymphoblastic leukaemia is 80%-90% in developed countries. Strikingly, survival among adolescents and young adults with this disease is about 60% and 40% respectively. In addition, in these countries, 5-year survival for young patients with acute myeloid leukaemia (excluding acute promyelocytic leukaemia) remains approximately 60% in the modern era of treatment. This project aimed to evaluate how survival and, when appropriate, early death (death occurring within 30 days of diagnosis) after acute leukaemia varied during almost 25 years in California, the most populous and racially/ethnically diverse state in the United States (US). A second aim was to investigate the association between sociodemographic and selected clinical factors and outcomes. Using high-quality data from the California Cancer Registry, I evaluated survival trends from acute lymphoblastic leukaemia among patients aged 0-19 years, and survival and early death trends after acute myeloid leukaemia among patients aged 0-39 years. I also investigated whether early death has decreased among young patients after the approval by the US Food and Drug Administration of all-trans retinoic acid (ATRA) for the treatment of acute promyelocytic leukaemia. The overall results of this thesis showed improvement in survival over time for all age groups and subtypes of leukaemia. Early death after acute promyelocytic and myeloid leukaemias declined during the study period. However, these outcomes varied widely by age at diagnosis and were associated with sociodemographic and clinical factors. Racial/ethnical survival inequalities were identified and found to persist even after adjustment for other covariates. These inequalities were more marked among patients of Hispanic (acute lymphoblastic leukaemia) and black race/ethnicity (for acute lymphoblastic and myeloid leukaemias). Patients living in lower socioeconomic neighbourhoods had worse survival than those living in higher socioeconomic neighbourhoods (for acute lymphoblastic and myeloid leukaemias). Early death and worse survival were associated with initial care at hospitals not affiliated with National Cancer Institute-designated cancer centres (for acute myeloid leukaemia) and lack of health insurance (for acute myeloid and promyelocytic leukaemias). Intriguingly, over the 25-year study period, adolescents and young adults with acute leukaemia continued to have worse survival than children. These results suggest that lack of timely access to treatment and suboptimal care have influenced outcome among vulnerable patients. In conclusion, survival and early death after acute leukaemia has greatly improved among young patients in California. However, inequalities in outcomes remain and are likely a result of multiple factors. My studies highlight the importance of population-based data to reveal the actual burden of the disease in this population and help clinicians, policy makers, government, and researchers better understand the predictors of outcomes. I expect my work to contribute to the development of strategies aimed at improving survival from acute leukaemia, especially amon

Efeito de operadores, dia de observação e tamanho de amostra e de grânulos na determinação do arredondamento de grânulos da fração areia de solos

Using Krumbein's visual comparison chart, a study is made of the effect of day of observation, observer and sample size on the roundness of quartz grains, using medium, fine and very fine sand as obtained from the "arenito Botucatu" soils in the region of Piracicaba, SP, Brazil. As to sample si ze, 25 grains proved to be sufficient. No significant statistical effect was observed for day of observation. The effect of observer was verified for medium and fine fractions only.Estudam-se, através da carta de comparação visual de Krumbein, os efeitos do dia de observação, observadores e tamanho de amostra na determinação do arredondamento de granulos de quartzo, nas frações areia media, areia fina e areia muito fina de solos do arenito Botucatu, no Município de Piracicaba. Conclui-se que amostras de 25 granulos sao suficientes. Não foi observado efeito estatisticamente significativo do dia de observação. Efeito de observadores foi verificado apenas para as frações media e fina

An Update on Effort Estimation in Agile Software Development: A Systematic Literature Review

[EN] Software developers require effective effort estimation models to facilitate project planning. Although Usman et al. systematically reviewed and synthesized the effort estimation models and practices for Agile Software Development (ASD) in 2014, new evidence may provide new perspectives for researchers and practitioners. This article presents a systematic literature review that updates the Usman et al. study from 2014 to 2020 by analyzing the data extracted from 73 new papers. This analysis allowed us to identify six agile methods: Scrum, Xtreme Programming and four others, in all of which expert-based estimation methods continue to play an important role. This is particularly the case of Planning Poker, which is very closely related to the most frequently used size metric (story points) and the way in which software requirements are specified in ASD. There is also a remarkable trend toward studying techniques based on the intensive use of data. In this respect, although most of the data originate from single-company datasets, there is a significant increase in the use of cross-company data. With regard to cost factors, we applied the thematic analysis method. The use of team and project factors appears to be more frequent than the consideration of more technical factors, in accordance with agile principles. Finally, although accuracy is still a challenge, we identified that improvements have been made. On the one hand, an increasing number of papers showed acceptable accuracy values, although many continued to report inadequate results. On the other, almost 29% of the papers that reported the accuracy metric used reflected aspects concerning the validation of the models and 18% reported the effect size when comparing models.This work was supported by the Spanish Ministry of Science, Innovation and Universities through the Adapt@Cloud Project under Grant TIN2017-84550-R.Fernández-Diego, M.; Méndez, ER.; González-Ladrón-De-Guevara, F.; Abrahao Gonzales, SM.; Insfran, E. (2020). An Update on Effort Estimation in Agile Software Development: A Systematic Literature Review. IEEE Access. 8:166768-166800. https://doi.org/10.1109/ACCESS.2020.3021664S166768166800

EVALUACIÓN DE UN NUEVO REGADÍO A LO LARGO DE 10 AÑOS: BALANCES HÍDRICOS, CALIDAD DEL RIEGO Y CONTAMINACIÓN POR SALES Y NITRATOS

[ES] La transformación al regadío es frecuente en zonas semiáridas a lo largo del mundo por sus numerosas ventajas, pero el regadío también es considerado como el principal consumidor de recursos hídricos y la principal fuente de contaminación difusa. En este trabajo se presenta una evaluación de la calidad del riego y del lixiviado de sales y nitratos en una cuenca hidrológica (7,38 km2 ) representativa de los regadíos presurizados de la cuenca del Ebro. El estudio abarca 10 años hidrológicos: antes (2004-2005), durante (2006- 2008) y después (2009-2013) de la transformación de secano a regadío. Para este periodo, se realizaron balances hídricos y se obtuvieron indicadores de la calidad del riego a partir de éstos. Con la medida de la concentración de sales y nitratos en los diferentes componentes, se estimó la masa de estos contaminantes procedentes de la zona regable (352 ha), y se obtuvieron índices de contaminación. La eficiencia de riego alcanzó un 76,1%, mientras que las pérdidas de eficiencia se debieron a la evaporación y arrastre del riego por aspersión (13,5%) y al drenaje del riego (10,4%). La eficiencia de riego aumentó (1,05% año-1 ) y la fracción de drenaje disminuyó (0,95% año-1 ). Sin embargo, no se garantizó un incremento en la calidad del riego ya que el déficit hídrico también se incrementó (0,95% año-1 ) situándose en 17,8% al final del periodo de estudio. Tanto las masas exportadas como los índices de contaminación se incrementaron significativamente con la transformación al riego. Sin embargo, los valores obtenidos se encuentran por debajo del umbral de los regadíos considerados como más sostenibles. Mejoras en el manejo del riego, que tengan en cuenta la humedad del suelo y la velocidad del viento podrían incrementar de forma considerable la calidad del riego y disminuir el lixiviado y los índices de contaminación.Merchán, D.; Causapé, J.; Abrahao, R.; García-Garizabal, I. (2015). EVALUACIÓN DE UN NUEVO REGADÍO A LO LARGO DE 10 AÑOS: BALANCES HÍDRICOS, CALIDAD DEL RIEGO Y CONTAMINACIÓN POR SALES Y NITRATOS. En XXXIII CONGRESO NACIONAL DE RIEGOS. Valencia 16-18 junio de 2015. Editorial Universitat Politècnica de València. https://doi.org/10.4995/CNRiegos.2015.1440OC

Influence of irrigation on the occurrence of organic and inorganic pollutants in soil, water and sediments of a Spanish agrarian basin (Lerma)

Para comprender los diversos posibles impactos ambientales producidos por el riego, el estudio de una cuenca en transformación de zona en secano a condiciones de regadío supone una gran ventaja. Este trabajo investiga la presencia de 44 plaguicidas y metabolitos, 11 compuestos organoclorados, 17 PAHs, 13 PCBs, y varios metales como Cd, Cr, Cu, Ni, Pb, Zn, As, Se y Hg, en los suelos, aguas y sedimentos de una cuenca agrícola del nordeste de España. La zona de estudio se encontraba en condiciones de secano hasta el año 2006, cuando comenzó a regarse. Los muestreos del presente trabajo se realizaron en 2008, y el principal objetivo ha sido comprobar si estos primeros años bajo riego tienen influencia en las concentraciones de las sustancias y elementos analizados. Los principales contaminantes detectados fueron compuestos organoclorados, PAHs y metales en los suelos; atrazina, desetilatrazina, terbutilazina, dicofol y pp’-DDT en las aguas; y PAHs, 1,2,4 triclorobenceno y metales en los sedimentos. Se ha demostrado que, hasta la finalización del estudio, no existen graves problemas de contaminación relacionados con las sustancias analizadas, y que por el momento, el riego no ha influido prácticamente en las concentraciones de dichas sustancias en la cuenca. Sin embargo, se han descubierto puntualmente valores ligeramente elevados de endrín en el suelo, pp’-DDT en el agua y Ni y Zn en los sedimentos In order to understand the several possible environmental impacts caused by irrigation, the existence of a study area under transition from unirrigated to irrigated land is a great advantage. This work investigates the presence of 44 pesticides and metabolites, 11 organochlorinated compounds, 17 polycyclic aromatic hydrocarbons (PAHs), 13 polychlorinated biphenyls (PCBs), and several metals and metalloids such as Cd, Cr, Cu, Ni, Pb, Zn, As, Se and Hg, in the soil, water and sediments of an agrarian basin in Northeast Spain. The study area was unirrigated until 2006, when irrigation began. The objective of this work was to verify if the first irrigation years influenced the concentrations of the substances and elements analyzed. The main contaminants detected were organochlorinated compounds, PAHs and metals in the soil; atrazine, desethylatrazine, terbuthylazine, dicofol and pp’-DDT in the water; and PAHs, 1,2,4 trichlorobenzene and metals in the sediments. Until the conclusion of this study, no serious contamination issues existed related to the analyzed substances, and for the moment, irrigation has not significantly influenced the concentrations of such substances in the basin. Nevertheless, slightly elevated punctual values were observed for endrin in the soil, pp’-DDT in the water, and Ni and Zn in the sediments

Gathering patients and rheumatologists' perceptions to improve outcomes in idiopathic inflammatory myopathies

Objective: Therapeutic targets in Idiopathic Inflammatory Myopathies (IIM) are based on the opinions of physicians/specialists, which may not reflect the main concerns of patients. The authors, therefore, assessed the outcome concerns of patients with IIM and compared them with the concerns of rheumatologists in order to develop an IIM outcome standard set. Methods: Ninety-three IIM patients, 51 rheumatologists, and one physiotherapist were invited to participate. An open questionnaire was initially applied. The top 10 answers were selected and applied in a multiple-choice questionnaire, inquiring about the top 3 major concerns. Answers were compared, and the agreement rate was calculated. Concerns were gathered in an IIM outcome standard set with validated measures. Results: The top three outcome concerns raised by patients were medication side effects/muscle weakness/prevention functionality loss. The top three concerns among rheumatologists were to prevent loss of functionality/to ensure the quality of life/to achieve disease remission. Other's outcomes concerns only pointed out by patients were muscle pain/diffuse pain/skin lesions/fatigue. The agreement rate between both groups was 41%. Assessment of these parameters guided the development of an IIM standard set which included Myositis Disease Activity Assessment Visual Analogue Scale/Manual Muscle Testing/fatigue and pain Global Visual Analogue Scale/Health Assessment Questionnaire/level of physical activity. Conclusion: The authors propose a novel standard set to be pursued in IIM routine follow-up, which includes not only the main patients/rheumatologist outcome concerns but also additional important outcomes only indicated by patients. Future studies are necessary to confirm if this comprehensive approach will result in improved adherence and ultimately in better assistance

Normal Values Determination for High Resolution Esophageal Manometry Using Sitting Viscous Solution Swallows. Results of a Multicenter Study in Healthy Volunteers

Q1Q1Introduction: It has been suggested that a more physiologic esophageal manometry study protocol, including non-liquid solutions and a sitting position, could improve the test performance. For the specificity determination of putative findings it is necessary to determine normal values Aim: To determine normal values for sitting viscous solution swallows in healthy volunteers using high-resolution esophageal manometry.https://orcid.org/0000-0002-9219-4548Revista Nacional - Indexad

Face and content validation of the amyotrophic lateral sclerosis—Bulbar dysfunction index (ALS-BDI)

PurposeEarly detection and tracking of bulbar dysfunction in amyotrophic lateral sclerosis (ALS) are critical for directing management of the disease. Existing physiological assessments of bulbar dysfunction are often inaccessible and cost-prohibitive for clinical application. Existing clinical assessments are limited. The overall goal of our research is to develop a brief and reliable, clinician-administered assessment tool, the ALS Bulbar Dysfunction Index (ALS-BDI) to evaluate bulbar dysfunction. The aim of this study was to establish content and face validity of the ALS-BDI through item generation and reduction, including item scoring.MethodsThe design of the ALS-BDI followed guidelines outlined by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The design stage of the ALS-BDI involved two steps: (Step 1) the generation of candidate items from a literature review of commonly used clinical tools, and selection of items following a review of item reliability and item relevance and expert consensus; (Step 2) the assessment of their content and face validity via online survey feedback from experts (n = 35). The initial design was followed by a semi-structured cognitive interview with Speech-Language Pathologists (n = 5) to finalize a testable draft of the instrument.ResultsTwo drafts of the ALS-BDI were developed. The first draft contained 48 items, after a review of existing clinical tools for their relevance to bulbar dysfunction in ALS. Of the 48 items, 35 items were retained after surveying experts and clinician users for their relevance, feasibility, interpretability, and appropriateness. The second draft of the ALS-BDI contained 37 items, due to one item splitting, based on users cognitive interviews.ConclusionsThe ALS-BDI described in this study aims to provide a brief and reliable, clinician-administered assessment tool to evaluate bulbar dysfunction in patients with ALS. Future research will evaluate the psychometric properties of this tool including its reliability, validity, and responsiveness to change over time

Contraction amplitude is a relevant predictor of bolus transit during sitting viscous solution swallows in healthy individuals : preliminary results of a multicenter study using high resolution impedance manometry (HRIM)

Q1Q1https://orcid.org/0000-0002-9219-4548https://orcid.org/0000-0003-1222-0636https://orcid.org/0000-0002-4523-7947Revista Internacional - Indexad