Overcoming failure in infrastructure risk governance implementation: large dams journey

[EN] There is ample recognition of the risk inherent in our very existence and modes of social organization, with a reasonable expectation that implementing risk governance will result in enhanced resilience as a society. Despite this, risk governance is not a mainstream approach in the infrastructure sector, regardless of the increasing number of peer-reviewed published conceptualizations, mature procedures to support its application, or public calls to cope with systemic risks in our modern societies. This paper aims to offer a different view on the issue of risk governance, with focus in the analysis of the root causes of its relatively low degree of implementation in the infrastructure sector. We later analyze the impact of such essential causes, which we have grouped and labeled as the ontology, the concerns, the anathemas, and the forgotten, in the specific field of large dams. Finally, we describe the journey toward risk governance in the specific field of large dams, thus supporting the ultimate objective of this paper to facilitate an evidence-based approach to successful risk governance implementation within and outside the dam sector.This work was supported by Spanish Ministry of Economy and Competitiveness (Ministerio de Economía y Competitividad (España) [grant number BIA2013-48157-C2-1-R].Escuder Bueno, I.; Halpin, E. (2016). Overcoming failure in infrastructure risk governance implementation: large dams journey. Journal of Risk Research. https://doi.org/10.1080/13669877.2016.1215345SAbrahamsen, E. B., & Aven, T. (2012). Why risk acceptance criteria need to be defined by the authorities and not the industry? Reliability Engineering & System Safety, 105, 47-50. doi:10.1016/j.ress.2011.11.004Ardiles, L. D. Sanz, P. Moreno, E. Jenaro, J. Fleitz, and I. 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Performance of artificial intelligence for detection of subtle and advanced colorectal neoplasia

OBJECTIVES: There is uncertainty regarding the efficacy of artificial intelligence (AI) software to detect advanced subtle neoplasia, particularly flat lesions and sessile serrated lesions (SSLs), due to low prevalence in testing datasets and prospective trials. This has been highlighted as a top research priority for the field. METHODS: An AI algorithm was evaluated on 4 video test datasets containing 173 polyps (35,114 polyp positive frames and 634,988 polyp-negative frames) specifically enriched with flat lesions and SSLs, including a challenging dataset containing subtle advanced neoplasia. The challenging dataset was also evaluated by 8 endoscopists (4 independent, 4 trainees, according to Joint Advisory Group on GI endoscopy (JAG) standards in United Kingdom). RESULTS: In the first 2 video datasets, the algorithm achieved per-polyp sensitivities of 100% and 98.9%. Per-frame sensitivities were 84.1% and 85.2% . In the subtle dataset, the algorithm detected a significantly higher number of polyps (P<0.0001), compared to JAG-independent and trainee endoscopists, achieving per-polyp sensitivities of 79.5%, 37.2% and 11.5% respectively. Furthermore, when considering subtle polyps detected by both the algorithm and at least one endoscopist, the AI detected polyps significantly faster on average. CONCLUSIONS: The AI based algorithm achieved high per-polyp sensitivities for advanced colorectal neoplasia, including flat lesions and SSLs, outperforming both JAG independent and trainees on a very challenging dataset containing subtle lesions that could have been overlooked easily and contribute to interval colorectal cancer. Further prospective trials should evaluate AI to detect subtle advanced neoplasia in higher risk populations for colorectal cancer

Assessing motivational stages and processes of change for weight management around bariatric surgery: A multicenter study

Introduction/Purpose: The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre- contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change. Materials/Methods: A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study. Results: A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/ m2 in maintenance versus 1.4 ± 1.4 kg/m2 in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change. Conclusion: Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge

Long-acting beta2-agonists for chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a respiratory disease that causes progressive symptoms of breathlessness, cough and mucus build-up. It is the fourth or fifth most common cause of death worldwide and is associated with significant healthcare costs.Inhaled long-acting beta2-agonists (LABAs) are widely prescribed to manage the symptoms of COPD when short-acting agents alone are no longer sufficient. Twice-daily treatment with an inhaled LABA is aimed at relieving symptoms, improving exercise tolerance and quality of life, slowing decline and even improving lung function and preventing and treating exacerbations. OBJECTIVES: To assess the effects of twice-daily long-acting beta2-agonists compared with placebo for patients with COPD on the basis of clinically important endpoints, primarily quality of life and COPD exacerbations. SEARCH METHODS: We searched the Cochrane Airways Group trials register, ClinicalTrials.gov and manufacturers' websites in June 2013. SELECTION CRITERIA: Parallel, randomised controlled trials (RCTs) recruiting populations of patients with chronic obstructive pulmonary disease. Studies were required to be at least 12 weeks in duration and designed to assess the safety and efficacy of a long-acting beta2-agonist against placebo. DATA COLLECTION AND ANALYSIS: Data and characteristics were extracted independently by two review authors, and each study was assessed for potential sources of bias. Data for all outcomes were pooled and subgrouped by LABA agent (formoterol 12 μg, formoterol 24 μg and salmeterol 50 μg) and then were separately analysed by LABA agent and subgrouped by trial duration. Sensitivity analyses were conducted for the proportion of participants taking inhaled corticosteroids and for studies with high or uneven rates of attrition. MAIN RESULTS: Twenty-six RCTs met the inclusion criteria, randomly assigning 14,939 people with COPD to receive twice-daily LABA or placebo. Study duration ranged from three months to three years; the median duration was six months. Participants were more often male with moderate to severe symptoms at randomisation; mean forced expiratory volume in 1 second (FEV1) was between 33% and 55% predicted normal in the studies, and mean St George's Respiratory Questionnaire score (SGRQ) ranged from 44 to 55 when reported.Moderate-quality evidence showed that LABA treatment improved quality of life on the SGRQ (mean difference (MD) -2.32, 95% confidence interval (CI) -3.09 to -1.54; I(2) = 50%; 17 trials including 11,397 people) and reduced the number of exacerbations requiring hospitalisation (odds ratio (OR) 0.73, 95% CI 0.56 to 0.95; I(2) = 10%; seven trials including 3804 people). In absolute terms, 18 fewer people per 1000 were hospitalised as the result of an exacerbation while receiving LABA therapy over a weighted mean of 7 months (95% CI 3 to 31 fewer). Scores were also improved on the Chronic Respiratory Disease Questionnaire (CRQ), and more people receiving LABA treatment showed clinically important improvement of at least four points on the SGRQ.The number of people who had exacerbations requiring a course of oral steroids or antibiotics was also lower among those taking LABA (52 fewer per 1000 treated over 8 months; 95% CI 24 to 78 fewer, moderate quality evidence).Mortality was low, and combined findings of all studies showed that LABA therapy did not significantly affect mortality (OR 0.90, 95% CI 0.75 to 1.08; I(2) = 21%; 23 trials including 14,079 people, moderate quality evidence). LABA therapy did not affect the rate of serious adverse events (OR 0.97, 95% CI 0.83 to 1.14; I(2) = 34%, moderate quality evidence), although there was significant unexplained heterogeneity, especially between the two formoterol doses.LABA therapy improved predose FEV1 by 73 mL more than placebo (95% CI 48 to 98; I(2) = 71%, low quality evidence), and people were more likely to withdraw from placebo than from LABA therapy (OR 0.74, 95% CI 0.69 to 0.80; I(2) = 0%). Higher rates of withdrawal in the placebo arm may reduce our confidence in some results, but the disparity is more likely to reduce the magnitude of difference between LABA and placebo than inflate the true effect; removing studies at highest risk of bias on the basis of high and unbalanced attrition did not change conclusions for the primary outcomes. AUTHORS' CONCLUSIONS: Moderate-quality evidence from 26 studies showed that inhaled long-acting beta2-agonists are effective over the medium and long term for patients with moderate to severe COPD. Their use is associated with improved quality of life and reduced exacerbations, including those requiring hospitalisation. Overall, findings showed that inhaled LABAs did not significantly reduce mortality or serious adverse events

Experiencia colaborativa entre el CAAC y la facultad de BB.AA. de Sevilla para la producción de la obra del colectivo Usco Strobe Room

El contenido de esta comunicación recoge la experiencia derivada de la colaboración entre dos instituciones públicas, universidad y museo, que persiguen desde ámbitos distintos la educación en arte contemporáneo. Su desarrollo se centra en la memoria de producción de una de las piezas conceptuales del programa expositivo del Centro Andaluz de Arte Contemporáneo, en el que participaron alumnos en prácticas formativas de la Facultad de Bellas Artes de Sevilla. Paradójicamente abordamos la producción de una obra y no su intervención conservadora o restauradora

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Peer reviewe

A combined risk analysis approach for complex dam-levee systems

[EN] In many areas of the world, dams and levees are built to reduce the likelihood of flooding. However, if they fail, the result can be catastrophic flooding beyond what would happen if they did not exist. Therefore, understanding the risk reduced by the dam or levee, as well as any risk imposed by these flood defences is of high importance when determining the appropriate risk reduction investment strategy. This paper describes an approach for quantifying and analysing risk for complex dam-levee systems, and its application to a real case study. The basis behind such approach rely on the potential of event tree modelling to analyse risk from multiple combinations of load-system response-consequence' events, tested by the authors for a real case study. The combined approach shows how the contribution to system risk of each sub-system can be assessed. It also describes how decisions on risk mitigation measures, at the individual asset scale, can and should be informed in terms of how they impact the overall system risk.This work was supported by Spanish Ministry of Economy and Competitiveness (MINECO) [BIA 2013-48157-C2-1-R].Castillo-Rodríguez, J.; Needham, J.; Morales Torres, A.; Escuder Bueno, I. (2017). A combined risk analysis approach for complex dam-levee systems. Structure and Infrastructure Engineering. 13(12):1624-1638. https://doi.org/10.1080/15732479.2017.1314514S16241638131

Prevalence of severe/morbid obesity and other weight status and anthropometric reference standards in Spanish preschool children: The PREFIT project

BACKGROUND: Childhood obesity has become a major health problem in children under the age of 5 years. Providing reference standards would help paediatricians to detect and/or prevent health problems related to both low and high levels of body mass and to central adiposity later in life. Therefore, the aim of this study was to examine the prevalence of different weight status categories and to provide sex- and age-specific anthropometry reference standards for Spanish preschool children. METHODS: A total of 3178 preschool children (4.59±0.87 years old) participated in this study. Prevalence of different degrees of obesity (mild, severe, and morbid) and other weight status categories were determined. RESULTS: Reference standards were obtained. Prevalence of overweight and obese preschool children in the Spanish population ranged from 21.4 to 34.8%. Specifically, the obesity prevalence was 3.5, 1.2, and 1.3% of these subjects were categorized as mild, severe, and morbid obese. Sex- and age-specific reference standards for anthropometric parameters are provided for every 0.25 years (i.e. every trimester of life). CONCLUSION: Our results show a high prevalence of overweight/obese preschoolers. The provided sex- and age-specific anthropometric reference standards could help paediatricians to track and monitor anthropometric changes at this early stage in order to prevent overweight/obesity.We thank the participation of the preschoolers, parents, and teachers in this study. We are grateful to Ms. Carmen Sainz-Quinn for assistance with the English language. This work is part of a Ph.D. Thesis conducted in the Biomedicine Doctoral Studies of the University of Granada, Spain. The PREFIT project takes place owing to the funding of the Ramón y Cajal grant held by FBO (RYC-2011-09011). C.C.-S. is supported by a grant from the Spanish Ministry of Economy and Competitiveness (BES-2014-068829). E.G.A. and F.B.O. are supported by a grant from the Spanish Ministry of Science and Innovation (RYC-2014-16390 and RYC-2011-09011, respectively). C.A.-B., A.P.-B., and G.S.-D. are supported by the Spanish Ministry of Education (FPU13/03137, FPU15/ 05337, and FPU13/04365, respectively). Additional funding was obtained from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES) and by the Junta de Andalucia, Consejería de Conocimiento, Investigación y Universidades. In addition, funding was provided by the SAMID III network, RETICS, the PN I+D+I 2017-2021 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion, the European Regional Development Fund (ERDF) (RD16/0022, SOMM17/6107/UGR), the EXERNET Research Network on Exercise and Health in Special Populations (DEP2005- 00046/ACTI), the University of the Basque Country (GIU14/21), and the University of Zaragoza (JIUZ-2014-BIO-08)

Performance of hospitals according to the ESC ACCA quality indicators and 30-day mortality for acute myocardial infarction: national cohort study using the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) register

Aims To investigate the application of the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QI) for acute myocardial infarction for the study of hospital performance and 30-day mortality. Methods and results National cohort study (n = 118,075 patients, n = 211 hospitals, MINAP registry), 2012-13. Overall, 16 of the 20 QIs could be calculated. Eleven QIs had a significant inverse association with GRACE risk adjusted 30-day mortality (all P < 0.005). The association with the greatest magnitude was high attainment of the composite opportunity-based QI (80-100%) vs. zero attainment (odds ratio 0.04, 95% confidence interval 0.04-0.05, P < 0.001), increasing attainment from low (0.42, 0.37- 0.49, P < 0.001) to intermediate (0.15, 0.13-0.16, P < 0.001) was significantly associated with a reduced risk of 30-day mortality. A 1% increase in attainment of this QI was associated with a 3% reduction in 30-day mortality (0.97, 0.97-0.97, P < 0.001). The QI with the widest hospital variation was ′fondaparinux received among NSTEMI′ (interquartile range 84.7%) and least variation ′centre organisation′ (0.0%), with seven QIs depicting minimal variation (<11%). GRACE risk score adjusted 30-day mortality varied by hospital (median 6.7%, interquartile range 5.4-7.9%). Conclusions Eleven QIs were significantly inversely associated with 30-day mortality. Increasing patient attainment of the composite quality indicator was the most powerful predictor; a 1% increase in attainment represented a 3% decrease in 30-day standardised mortality. The ESC QIs for acute myocardial infarction are applicable in a large health system and have the potential to improve care and reduce unwarranted variation in death from acute myocardial infarction