Factores determinantes de mortalidad, deterioro cognitivo, recuperación de la independencia y capacidad de marcha previas, a los seis meses de padecer fractura de cadera en personas de 65 años o más, en un hospital español

La fractura de cadera osteoporótica es un evento con alta y creciente incidencia a nivel mundial. En España se producen más de 50.000 fracturas en el anciano y por baja energía al año, el 75% son mujeres, que siempre requieren hospitalización, e intervención quirúrgica el 95% de los casos, con una estancia hospitalaria media de 10.9 DE = 6.9 días. Tienen una gran importancia en cuanto a la mortalidad, que es del 2 al 7% durante el ingreso, 7.1% en 30 días y 30% al año. Entre los factores incrementan su mortalidad, el mayor acuerdo está en la espera quirúrgica de más de 48 horas. El porcentaje de personas ancianas con fractura de cadera que no recuperan la función previa oscila entre el 23 y el 50%, dependiendo de varios factores, entre ellos complicaciones como el delirio, más frecuente en personas con deterioro cognitivo previo. El momento de mayor mortalidad, deterioro funcional y mental se produce al sexto mes. En nuestro país, el coste medio por este proceso es de unos 9.000 euros. A fin de conocer qué mortalidad y disfunción al sexto mes, y a qué factores se asocian, en los fracturados de cadera de 65 años o más, atendidos en nuestro Hospital se ha realizado un estudio longitudinal retrospectivo de 665 pacientes registrando características sociodemográficas, comorbilidades al ingreso, complicaciones durante el mismo, fármacos al ingreso y alta; además del deterioro cognitivo, evaluación de la dependencia y de la capacidad de marcha al ingreso, al alta y sexto mes; así como la mortalidad al sexto mes. Hemos realizado tanto un análisis bivariante como multivariante entre todas las variables que pueden influir en la mortalidad al sexto mes; deterioro cognitivo, y en la falta de recuperación de la marcha y de la independencia al sexto mes de la fractura de cadera, respecto a las previas al ingreso. Además se ha implementado un modelo predictivo mediante regresión lineal múltiple que identifica los factores que explican la disfunción mental (nº de errores en la EP) y física: valores cuantitativos del IB (0-100) y FAC (0-5) al sexto mes. Los principales factores asociados a la mayor mortalidad son la mayor dependencia, peor marcha y deterioro cognitivo, institucionalización, policomorbilidad al ingreso, fármacos al ingreso como anticoagulantes y broncodilatatores, y complicaciones durante el ingreso como la insuficiencia cardiaca aguda e infección respiratoria. El delirium se identifica en el análisis bivariante, pero no el ajuste multivarible. Los factores que explican el deterioro cognitivo moderado y severo al sexto mes son la dependencia sobre todo la previa al ingreso, el deterioro cognitivo durante el ingreso, mala marcha al alta hospitalaria, la institucionalización, todos ellos más que la edad avanzada. Según el modelo predictivo el deterioro inicial es el que fundamentalmente determina el que tiene el paciente al sexto mes (el ΔR2=83.2% de la varianza de la EP al 6º mes), interviniendo mínimamente los otros factores comentados. En cuanto a la falta de recuperación funcional, tanto de la marcha como la independencia previa, el factor más importante es sobre todo el hecho de pérdida cualitativa de tales funciones, durante el ingreso. Factores con menor intensidad de efecto en esta falta de recuperación son el riesgo quirúrgico, el deterioro cognitivo previo, y la edad avanzada. La hemoglobinemia < 8.5 mg/dl durante el ingreso se asocia a la falta de recuperación funcional global, y el tipo extraarticular de fractura, la no recuperación de la marcha.Osteoporotic hip fracture is an event with a high and growing incidence worldwide. In Spain, more than 50,000 fractures occur in the elderly and due to low energy per year, 75% women who always require hospitalization, 95% surgical intervention, with a mean hospital stay of 10.9 SD = 6.9 days. They are of great importance in terms of mortality, which is 2-7% on admission, 7.1% in 30 days and 30% per year, and among the factors that increase it, the greatest agreement is in waiting longer for surgery more than 48 hours. The percentage of elderly people with hip fracture who do not recover their previous function ranges between 23 and 50%, depending on several factors, including complications such as delirium, which is more frequent in people with previous cognitive impairment. The highest mortality moment, functional and mental deterioration occurs at the sixth month. In our country, the average cost for this process is 9000 euros. In order to know what mortality and dysfunction at the sixth month, and to what factors are associated, in hip fracture patients aged 65 years or older, treated at our Hospital, a retrospective longitudinal study of 665 patients was carried out, recording sociodemographic characteristics, comorbidities at admission , complications during the same, drugs on admission and discharge, cognitive impairment, assessment of dependence and walking ability on admission, discharge and sixth month; as well as mortality. We have performed both a bivariate and multivariate analysis between all the variables that can influence mortality, cognitive impairment, and the lack of recovery of gait and independence prior to admission at the sixth month of the hip fracture. In addition, a predictive model has been implemented using multiple linear regression that identifies the factors that explain the mental (number of errors in the SPMSQ) and physical dysfunction: quantitative values of the BI (0-100) and FAC (0-5) at the sixth month. The main factors associated with higher mortality are greater dependency, poorer gait and cognitive impairment, institutionalization, polycomorbidity on admission, admission drugs such as anticoagulants and bronchodilators, and complications during admission such as acute heart failure and respiratory infection. Delirium is identified on bivariate analysis but not multivariable adjustment. The factors that explain moderate and severe cognitive impairment at the sixth month are dependency especially prior to admission, cognitive impairment during admission, poor walking at hospital discharge, and institutionalization, all of them more than advanced age. According to the predictive model, the initial deterioration is what fundamentally determines what the patient has at the sixth month (ΔR2=83.2% of the variance PE to 6th month), intervening minimally with the other factors mentioned. Regarding the lack of functional recovery, both of walking and previous independence, the most important factor is the qualitative loss of both functions during admission. Factors with less intensity of effect on this lack recovery of functions are surgical risk, prior cognitive impairment, and advanced age. Hemoglobinemia < 8.5 mg/dl during admission is associated with the lack of global functional recovery, and the extra-articular type of fracture, the non-recovery of walking

Determinants of Higher Mortality at Six Months in Patients with Hip Fracture: A Retrospective Study

Hip fracture is a pathology with high mortality, but the lack of a universal adaptation of the factors associated with death makes it difficult to predict risk and implement prevention in this group. This study aimed to identify the factors that determine a higher mortality at six months following hip fracture

Project Management Learning in a Collaborative Distant Learning Context - An Actual On-going Experience

The goal of this paper is to show the results of an on-going experience on teaching project management to grade students by following a development scheme of management related competencies on an individual basis. In order to achieve that goal, the students are organized in teams that must solve a problem and manage the development of a feasible solution to satisfy the needs of a client. The innovative component advocated in this paper is the formal introduction of negotiating and virtual team management aspects, as different teams from different universities at different locations and comprising students with different backgrounds must collaborate and compete amongst them. The different learning aspects are identified and the improvement levels are reflected in a rubric that has been designed ad hoc for this experience. Finally, the effort frameworks for the student and instructor have been established according to the requirements of the Bologna paradigms. This experience is developed through a software-based support system allowing blended learning for the theoretical and individual?s work aspects, blogs, wikis, etc., as well as project management tools based on WWW that allow the monitoring of not only the expected deliverables and the achievement of the goals but also the progress made on learning as established in the defined rubri

Radial derivatives as a test of pre-big bang events on the Planck data

Although the search for azimuthal patterns in cosmological surveys is useful to characterize some effects depending exclusively on an angular distance within the standard model, they are considered as a key distinguishing feature of some exotic scenarios, such as bubble collisions or conformal cyclic cosmology (CCC). In particular, the CCC is a non-stardard framework that predicts circular patterns on the cosmic microwave background intensity fluctuations. Motivated by some previous works that explore the presence of radial gradients, we apply a methodology based on the radial derivatives to the latest release of Planck data. The new approach allows exhaustive studies to be performed at all-sky directions at a HEALPIX resolution of Nside = 1024. Specifically, two different analyses are performed focusing on weight functions in both small (up to a 5-deg radius) and large scales. We present a comparison between our results and those shown by An, Meissner & Nurowski (2017) and An et al. (2018). In addition, a possible polarization counterpart of these circular patterns is also analysed for the most promising case. Taking into account the limitations to characterize the significance of the results, including the possibility of suffering a look-elsewhere effect, no strong evidence of the kind of circular patterns expected from CCC is found in the Planck data for either the small or the large scales.The authors would like to thank Spanish Agencia Estatal de Investigacion (AEI, MICIU) for the financial support provided under ´the projects with references ESP2017-83921-C2-1-R and AYA2017-90675-REDC, co-funded with European Union ‘Fondo Europeo de Desarrollo Regional’ (EU FEDER) funds, and also acknowledge the funding from Unidad de Excelencia Mar´ıa de Maeztu (MDM 2017-0765). AM-C acknowledges the postdoctoral contract from the University of the Basque Country UPV/EHU ‘Especializacion´ de personal investigador doctor’ program, and the financial Support from the Spanish Ministry MINECO, MCIU/AEI/FEDER grant (PGC2018-094626-B-C21), the Basque Government grant (IT979-16). This research used resources of the National Energy Research Scientific Computing Center (NERSC), a U.S. Department of Energy Office of Science User Facility operated under Contract No. DEAC02-05CH11231

Land privatization and deforestation in a commodity production frontier

Conservation policies often promote land privatization to reduce incentives for deforestation. However, empirical evidence on the relationship between land-tenure form and forest conservation outcomes is inconclusive. We combined key informant mapping and geospatial analyses to test the association between the area under tenure and the area deforested by extra-local private and local nonprivate agents in the Argentine Dry Chaco over four decades (1976–2016). The study area is a typical commodity production frontier within a global deforestation hotspot. We found a strong spatial and temporal coupling between the area under tenure and the area deforested by extra-local private agents from 1987 to 2006, when a 59% increase in the former was accompanied by a 508% increase in the latter. Local private agents maintained high levels of forest cover, similarly to local nonprivate agents. Our findings have implications for the adaptive design of the Forest Law in the Argentine Dry Chaco.Fil: Faingerch, Melina. Universidad Nacional de Mar del Plata. Facultad de Ciencias Agrarias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Vallejos, María. Universidad de Buenos Aires; ArgentinaFil: Texeira González, Marcos Alexis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Métodos Cuantitativos y Sistemas de Información; ArgentinaFil: Mastrangelo, Matias Enrique. Universidad Nacional de Mar del Plata. Facultad de Ciencias Agrarias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Using CMB polarization to constrain the anomalous nature of the Cold Spot with an incomplete-sky coverage

Recent results of the ESA Planck satellite have confirmed the existence of some anomalies in the statistical distribution of the cosmic microwave background (CMB) anisotropies. One of the most intriguing anomalies is the cold spot, first detected in the Wilkinson Microwave Anisotropy Probe (WMAP) data by Vielva et al. In a later paper, Vielva et al. (2011) developed a method to probe the anomalous nature of the cold spot by using the cross-correlation of temperature and polarization of the CMB fluctuations. Whereas this work was built under the assumption of analysing full-sky data, in this paper we extend such approach to deal with realistic data sets with a partial-sky coverage. In particular, we exploit the radial and tangential polarization patterns around temperature spots. We explore the capacity of the method to distinguish between a standard Gaussian CMB scenario and an alternative one, in which the cold spot arises from a physical process that does not present correlated polarization features (e.g. topological defects), as a function of the instrumental-noise level. Moreover, we consider more in detail the case of an ideal noise-free experiment and the ones with the expected instrumental-noise levels in QUIJOTE and Planck experiments. We also present an application to the 9-year WMAP data, without being able to obtain firm conclusions, with a significance level of 32 per cent. In the ideal case, the alternative scenario could be rejected at a significance level of around 1 per cent, whereas for expected noise levels of QUIJOTE and Planck experiments the corresponding significance levels are 1.5 and 7.4 per cent, respectively

Environmental and anthropogenic drivers affect the abundance of anchovy and mysids in the Guadalquivir Estuary (SW Spain)

Natural drivers, acting at various spatio-temporal scales firstly determine the distribution and abundance of species. On top of this natural forcing we usually find anthropogenic effects. Disentangling the relative influence of these two sources of variability has always been a challenge in ecology, and particularly in fisheries science. The Guadalquivir Estuary (SW Spain) serves as nursery ground for several commercial species in the Gulf of Cadiz. This study aims at quantifying the relative influence of biological (predator-prey effects), environmental (e.g. temperature, winds) and anthropogenic (dam discharges) effects on this nursery function with the focus on an important species, anchovy. We used data from a monitoring programme consisting of monthly records since 1997 at two sites: Tarfia (32 km) and Bonanza (8 km) (distance from the river mouth). Nonparametric models (GAM) were fit to the data to estimate the partial effects of the various covariates. We found positive and linear effects of temperature and mysids on anchovy abundance in both stations, while turbidity, winds and freshwater input had a negative effect, reducing fish abundance. A dam, 110 km upstream from the Guadalquivir mouth regulates freshwater discharges, directly influencing the estuarine habitat quality and extent, as captured by our models. In order to separate the anthropogenic effects from natural variability we further ran the models on a number of scenarios combining a range of dam discharges and environmental conditions. Water management stands out as a key node where potentially conflicting interests (irrigators, electric power, shipping, aquaculture, fisheries) converge. By focussing on the consequences that the effects of these activities ultimately have on the anchovy fishery, through this nursery function, our study aims to contribute to the process of making the ecosystem approach operational in the Gulf of Cadiz

PLK1 regulates centrosome migration and spindle dynamics in male mouse meiosis

Cell division requires the regulation of karyokinesis and cytokinesis, which includes an essential role of the achromatic spindle. Although the functions of centrosomes are well characterised in somatic cells, their role during vertebrate spermatogenesis remains elusive. We have studied the dynamics of the meiotic centrosomes in male mouse during both meiotic divisions. Results show that meiotic centrosomes duplicate twice: first duplication occurs in the leptotene/zygotene transition, while the second occurs in interkinesis. The maturation of duplicated centrosomes during the early stages of prophase I and II are followed by their separation and migration to opposite poles to form bipolar spindles I and II. The study of the genetic mouse model Plk1(Δ/Δ) indicates a central role of Polo-like kinase 1 in pericentriolar matrix assembly, in centrosome maturation and migration, and in the formation of the bipolar spindles during spermatogenesis. In addition, in vitro inhibition of Polo-like kinase 1 and Aurora A in organotypic cultures of seminiferous tubules points out to a prominent role of both kinases in the regulation of the formation of meiotic bipolar spindlesThis work was supported by funding from Ministerio de Economía, Industria y Competitividad, Gobierno de España (MINECO) (Spain) [grant number BFU2014-53681-P and MEIONET (BFU2015-71786-REDT) to J. A. S. and grant number RTI2018-095582-B-I00 to M. M.]

Modelling Multimodal Dialogues for Social Robots Using Communicative Acts

Social Robots need to communicate in a way that feels natural to humans if they are to effectively bond with the users and provide an engaging interaction. Inline with this natural, effective communication, robots need to perceive and manage multimodal information, both as input and output, and respond accordingly. Consequently, dialogue design is a key factor in creating an engaging multimodal interaction. These dialogues need to be flexible enough to adapt to unforeseen circumstances that arise during the conversation but should also be easy to create, so the development of new applications gets simpler. In this work, we present our approach to dialogue modelling based on basic atomic interaction units called Communicative Acts. They manage basic interactions considering who has the initiative (the robot or the user), and what is his/her intention. The two possible intentions are either ask for information or give information. In addition, because we focus on one-to-one interactions, the initiative can only be taken by the robot or the user. Communicative Acts can be parametrised and combined in a hierarchical manner to fulfil the needs of the robot’s applications, and they have been equipped with built-in functionalities that are in charge of low-level communication tasks. These tasks include communication error handling, turn-taking or user disengagement. This system has been integrated in Mini, a social robot that has been created to assist older adults with cognitive impairment. In a case of use, we demonstrate the operation of our system as well as its performance in real human–robot interactions.The research leading to these results has received funding from the projects Development of social robots to help seniors with cognitive impairment (ROBSEN), funded by the Ministerio de Economia y Competitividad; RoboCity2030-DIH-CM, Madrid Robotics Digital Innovation Hub, S2018/NMT-4331, funded by “Programas de Actividades I+D en la Comunidad de Madrid” and cofunded by Structural Funds of the EU; and Robots sociales para estimulación física, cognitiva y afectiva de mayores (ROSES) RTI2018-096338-B-I00 funded by Agencia Estatal de Investigación (AEI), Ministerio de Ciencia, Innovación y Universidade