Enhancing the quality of international orthopedic medical mission trips using the blue distinction criteria for knee and hip replacement centers

Background: Several organizations seek to address the growing burden of arthritis in developing countries by providing total joint replacements (TJR) to patients with advanced arthritis who otherwise would not have access to these procedures. Because these mission trips operate in resource poor environments, some of the features typically associated with high quality care may be difficult to implement. In the U.S., many hospitals that perform TJRs use the Blue Cross/Shield’s Blue Distinction criteria as benchmarks of high quality care. Although these criteria were designed for use in the U.S., we applied them to Operation Walk (Op-Walk) Boston’s medical mission trip to the Dominican Republic. Evaluating the program using these criteria illustrated that the program provides high quality care and, more importantly, helped the program to find areas of improvement. Methods: We used the Blue Distinction criteria to determine if Op-Walk Boston achieves Blue Distinction. Each criterion was grouped according to the four categories included in the Blue Distinction criteria— “general and administrative”, “structure”, “process”, or “outcomes and volume”. Full points were given for criteria that the program replicates entirely and zero points were given for criteria that are not replicated entirely. Of the non-replicated criteria, Op-Walk Boston’s clinical and administrative teams were asked if they compensate for failure to meet the criterion, and they were also asked to identify barriers that prevent them from meeting the criterion. Results: Out of 100 possible points, the program received 71, exceeding the 60-point threshold needed to qualify as a Blue Distinction center. The program met five out of eight “required” criteria and 11 out of 19 “informational” criteria. It scored 14/27 in the “general” category, 30/36 in the “structure” category, 17/20 in the “process” category, and 10/17 in the “outcomes and volume” category. Conclusion: Op-Walk Boston qualified for Blue Distinction. Our analysis highlights areas of programmatic improvement and identifies targets for future quality improvement initiatives. Additionally, we note that many criteria can only be met by hospitals operating in the U.S. Future work should therefore focus on creating criteria that are applicable to TJR mission trips in the context of developing countries

Modelización numérica del hormigón reforzado con fibras poliméricas.

El hormigón reforzado con fibras es una tecnología en desarrollo y objeto de estudio para profundizar en la comprensión de su comportamiento tenso-deformacional. En particular, si el material de las fibras de refuerzo es polipropileno, su comportamiento mecánico puede diferir substancialmente en estados de plasticidad o de propagación de daño. Se propone el desarrollo de un estudio de sensibilidad del comportamiento tenso-deformacional de los sistemas de refuerzo del hormigón con fibras de base polimérica mediante la generación de modelos numéricos previamente calibrados

Modelización numérica del hormigón reforzado con fibras poliméricas.

El hormigón reforzado con fibras es una tecnología en desarrollo y objeto de estudio para profundizar en la comprensión de su comportamiento tenso-deformacional. En particular, si el material de las fibras de refuerzo es polipropileno, su comportamiento mecánico puede diferir substancialmente en estados de plasticidad o de propagación de daño. Se propone el desarrollo de un estudio de sensibilidad del comportamiento tenso-deformacional de los sistemas de refuerzo del hormigón con fibras de base polimérica mediante la generación de modelos numéricos previamente calibrados

. 54 (2017) Segunda época. Arqueología

Estimados lectores, en el número 54 de la revista Arqueología presentamos once contribuciones sobre los recientes trabajos de investigación realizados en el oc-cidente, el altiplano central y el sureste de México, los cuales son una muestra de la variedad de enfoques con que nos acercamos a la arqueología mexicana, tanto a escala regional como de sitio.- Presentación por Laura Adriana Castañeda Cerecero. -Patrón de asentamientos prehispánicos en la cuenca baja del río Baluarte, Sinaloa por Luis Alfonso Grave Tirado. - Siguiendo el camino del sol. Pensamientos cosmogónicos compartidos entre la costa sinaloense y el valle de Guadiana por Cinthya Isabel Vidal Aldana y Emmanuel Alejandro Gómez Ambriz. - Elementos rituales en el paisaje del valle de Unión de Tula, Jalisco por Eduardo Ladrón de Guevara Ureña. - De la lámina delgada al agente humano: una revisión de la interacción Aztatlán-Chalchihuites por Cinthya Isabel Vidal Aldana. - Arqueología y paisaje sagrado en las comunidades de Atla y Xolotla, en Pahuatlán, Sierra Norte de Puebla por Alberto Diez Barroso Repizo. - Los popoloca: ¿un solo pueblo? por José de Jesús Alberto Cravioto Rubí. - El Museo Comunitario de Tenochtitlán: aciertos y retos por Nelly Zoé Núñez Rendón. - Representaciones zoomorfas en la cerámica Yestla-Naranjo de Guerrero por Eliseo F. Padilla Gutiérrez y Paul Schmidt Schoenberg. - Un minero en la Sierra Gorda: caso de contaminación ocupacional multielemental de metales pesados a finales del periodo Clásico por Alberto Juan Herrera Muñoz, Elizabeth Mejía Pérez Campos. - Resolución acústica en edificaciones en Yucatán y Chiapas por J.J. Hurtak, Desiree Hurtak, Alan Howarth y Beatriz Silva Torres. - Los estudios arqueoastronómicos de El Castillo de Chichén Itzá: nuevas propuestas para su interpretación por Orlando J. Casares Contreras. - El Proyecto Arqueológico Teteles de Ávila Castillo, investigaciones en la Sierra Norte de Puebla por Alberto Diez Barroso Repizo. - Comentarios al informe de Jorge Ruffier Acosta acerca de la cerámica de Cholula por Denisse Gómez Santiago. - Reseña. Walter R.T. Witschey (ed.), Encyclopedia of the Ancient Maya, Nueva York, Rowman and Littlefield, 2016 por Antonio Benavides Castillo

RENACER study: Assessment of 12-month efficacy and safety of 168 certolizumab PEGol rheumatoid arthritis-treated patients from a Spanish multicenter national database

Objective: To assess effectiveness and safety of certolizumab PEGol (CZP) in rheumatoid arthritis (RA) patients after 12 months of treatment and to detect predictors of response.Methods: Observational longitudinal prospective study of RA patients from 35 sites in Spain. Variables (baseline, 3- and 12-month assessment): sociodemographics, previous Disease Modifying Anti-Rheumatic Drug (DMARD) and previous Biological Therapies (BT) use; TJC, SJC, ESR, CRP, DAS28, SDAI. Response variables: TJC, SJC, CRP, ESR, and steroids dose reductions, EULAR Moderate/Good Response, SDAI response and remission, DAS28 remission. Safety variables: discontinuation due to side-effects. Descriptive, comparative and Logistic regression analyses were performed.Results: We included 168 patients: 79.2% women, mean age 54.5 years (+/- 13.2 SD), mean disease duration 7.5 years (+/- 7.3 SD). Mean number of prior DMARD: 1.4 (+/- 1.2 SD), mean number of prior BT was 0.8 (+/- 1.1). Mean time on CZP was 9.8 months (+/- 3.4 SD). A total of 71.4% were receiving CZP at 12-month assessment. Baseline predictors of response: lower prior number DMARD; low number prior BT; higher CRP, ESR, TJC, SJC, DAS28 and SDAI (

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used