Valoración del daño corporal en pie y tobillo: aportaciones desde el ámbito del podólogo

En la Valoración del Daño Corporal se utilizan baremos ya que la cuantificación es primordial dentro de la labor pericial médica. Estos baremos en la mayoría de los casos no son de obligado cumplimiento y el hecho de que existan distintos baremos produce una falta de uniformidad. Revisados los baremos actuales en relación a la valoración del daño en tobillo y pie obtenemos las siguientes conclusiones: Cuando los baremos valoran los grados de limitación articular es preciso que se especifique cómo se realiza la medición. Sería necesario homogeneizar los criterios para reducir la variabilidad interobservador y favorecen la reproductibilidad de las mediciones. Se otorga mucha importancia a las mediciones clínicas que son muy variables y poca a las valoraciones funcionales. Es preciso valorar la necesidad de utilizar elementos ortoprotésicos para mejorar la función.In the Evaluation of damage corporal scales are used since the quantification is essential inside the medical expert work. These scales in most cases are not of forced fulfillment and the fact that different scales exist it produces an absence of uniformity. Checked the current scales as regards the evaluation of the damage in ankle and foot we obtain the following conclusions: When the scales value the limitation grades articulating is necessary that is specified how the measurement is realized. It would be necessary to homogenize the criteria to reduce the changeability interobserver and they favor the reproduce of the measurements. A lot of importance is granted to the clinical measurements that they are very variable and small to the functional evaluations. It is necessary to value the need to use elements ortoprotesics to improve the function

Propuesta de una guia para la valoración del daño corporal en tobillo y pie

En los baremos de valoración del daño utilizados en España existen diversas deficiencias en la valoración del tobillo y del pie. Se presenta una propuesta de guía para la valoración del daño corporal del tobillo y del pie y que recoge los efectos de las lesiones en sus articulaciones. Se determina que es necesario valorar el aparato locomotor desde el punto de vista funcional, así como el calzado y el desgaste del mismo. Por tratarse el tobillo y el pie de estructuras de carga deberían recibir una mayor puntuación en los baremos como se propone en la guía.In the scales of evaluation of the damage used in Spain diverse shortcomings exist in the evaluation of the ankle and of the foot. A guide proposal appears for the evaluation of the bodily harm of the ankle and of the foot and who gathers the effects of the injuries in its joints. One determines that it is necessary to value the locomotive device from the functional point of view, as well as the footwear and the wear of the same one. For there talk each other the ankle and the foot of structures of load they should receive a major punctuation in the scales as he proposes in the guide

Clustering Groundwater Level Time Series of the Exploited Almonte-Marismas Aquifer in Southwest Spain

Groundwater resources are regularly the principal water supply in semiarid and arid climate areas. However, groundwater levels (GWL) in semiarid aquifers are suffering a general decrease because of anthropic exploitation of aquifers and the repercussions of climate change. Effective groundwater management strategies require a deep characterization of GWL fluctuations, in order to identify individual behaviors and triggering factors. In September 2019, the Guadalquivir River Basin Authority (CHG) declared that there was over-exploitation in three of the five groundwater bodies of the Almonte-Marismas aquifer, Southwest Spain. For that reason, it is critical to understand GWL dynamics in this aquifer before the new Spanish Water Resources Management Plans (2021–2027) are developed. The application of GWL series clustering in hydrogeology has grown over the past few years, as it is an extraordinary tool that promptly provides a GWL classification; each group can be related to different responses of a complex aquifer under any external change. In this work, GWL time series from 160 piezometers were analyzed for the period 1975 to 2016 and, after data pre-processing, 24 piezometers were selected for clustering with k-means (static) and time series (dynamic) clustering techniques. Six and seven groups (k) were chosen to apply k-means. Six characterized types of hydrodynamic behaviors were obtained with time series clustering (TSC). Number of clusters were related to diverse affections of water exploitation depending on soil uses and hydrogeological spatial distribution parameters. TSC enabled us to distinguish local areas with high hydrodynamic disturbance and to highlight a quantitative drop of GWL during the studied period

Footprint Curvature in Spanish Women: Implications for Footwear Fit

The incorrect adjustment of footwear produces alterations in the foot that affect quality of life. The usual measurements for shoe design are lengths, widths and girths, but these measures are insufficient. The foot presents an angle between the forefoot and the rearfoot in the transverse plane, which is associated with foot pronation, hallux valgus and metatarsus adductus. Here, we aimed at identifying the groups formed by the angulations between the forefoot and rearfoot using a sample of footprints from 102 Spanish women. The angle between the forefoot and rearfoot was measured according to the method described by Bunch. A cluster analysis was performed using the K-means algorithm. Footprints were grouped into three types: curved, semi-curved and straight, according to the degrees of angulation between the forefoot and rearfoot. There is great variability in the morphology of the foot. Based on our findings, to achieve a better footwear fit, we propose the manufacture of three types of lasts with different curvatures

Los resultados de aprendizaje en la mejora de la formación de los alumnos. Profundización a partir de la concreción y formulación inicial para el Máster en Educación Especial de la Facultad de Educación

El proyecto, a partir de la formación del profesorado, durante el curso anterior, en la formulación y concreción de resultados de aprendizaje, tiene el objetivo de analizar las posibles lagunas de resultados de aprendizaje del Máster en Educación Especial de la UCM en relación con las competencias del título, así como estudiar la valoración por parte de los alumnos del Máster del fomento de los resultados de aprendizaje propuestos para cada asignatura, así como profundizar en las posibles mejoras en la metodología que podrían favorecer una mejora de la formación en términos de los citados resultados de aprendizaje

Rarity of monodominance in hyperdiverse Amazonian forests.

Tropical forests are known for their high diversity. Yet, forest patches do occur in the tropics where a single tree species is dominant. Such "monodominant" forests are known from all of the main tropical regions. For Amazonia, we sampled the occurrence of monodominance in a massive, basin-wide database of forest-inventory plots from the Amazon Tree Diversity Network (ATDN). Utilizing a simple defining metric of at least half of the trees ≥ 10 cm diameter belonging to one species, we found only a few occurrences of monodominance in Amazonia, and the phenomenon was not significantly linked to previously hypothesized life history traits such wood density, seed mass, ectomycorrhizal associations, or Rhizobium nodulation. In our analysis, coppicing (the formation of sprouts at the base of the tree or on roots) was the only trait significantly linked to monodominance. While at specific locales coppicing or ectomycorrhizal associations may confer a considerable advantage to a tree species and lead to its monodominance, very few species have these traits. Mining of the ATDN dataset suggests that monodominance is quite rare in Amazonia, and may be linked primarily to edaphic factors

Estimating the global conservation status of more than 15,000 Amazonian tree species

Estimates of extinction risk for Amazonian plant and animal species are rare and not often incorporated into land-use policy and conservation planning. We overlay spatial distribution models with historical and projected deforestation to show that at least 36% and up to 57% of all Amazonian tree species are likely to qualify as globally threatened under International Union for Conservation of Nature (IUCN) Red List criteria. If confirmed, these results would increase the number of threatened plant species on Earth by 22%. We show that the trends observed in Amazonia apply to trees throughout the tropics, and we predict thatmost of the world’s >40,000 tropical tree species now qualify as globally threatened. A gap analysis suggests that existing Amazonian protected areas and indigenous territories will protect viable populations of most threatened species if these areas suffer no further degradation, highlighting the key roles that protected areas, indigenous peoples, and improved governance can play in preventing large-scale extinctions in the tropics in this century

Local hydrological conditions influence tree diversity and composition across the Amazon basin

Tree diversity and composition in Amazonia are known to be strongly determined by the water supplied by precipitation. Nevertheless, within the same climatic regime, water availability is modulated by local topography and soil characteristics (hereafter referred to as local hydrological conditions), varying from saturated and poorly drained to well-drained and potentially dry areas. While these conditions may be expected to influence species distribution, the impacts of local hydrological conditions on tree diversity and composition remain poorly understood at the whole Amazon basin scale. Using a dataset of 443 1-ha non-flooded forest plots distributed across the basin, we investigate how local hydrological conditions influence 1) tree alpha diversity, 2) the community-weighted wood density mean (CWM-wd) – a proxy for hydraulic resistance and 3) tree species composition. We find that the effect of local hydrological conditions on tree diversity depends on climate, being more evident in wetter forests, where diversity increases towards locations with well-drained soils. CWM-wd increased towards better drained soils in Southern and Western Amazonia. Tree species composition changed along local soil hydrological gradients in Central-Eastern, Western and Southern Amazonia, and those changes were correlated with changes in the mean wood density of plots. Our results suggest that local hydrological gradients filter species, influencing the diversity and composition of Amazonian forests. Overall, this study shows that the effect of local hydrological conditions is pervasive, extending over wide Amazonian regions, and reinforces the importance of accounting for local topography and hydrology to better understand the likely response and resilience of forests to increased frequency of extreme climate events and rising temperatures

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group