El límite en la ciudad ilustrada: la ordenación de un espacio urbano

Al aproximarnos al estudio de las ciudades españolas de la segunda mitad del XVIII, nos enfrentamos a un material que resulta ser de muy distinta naturaleza: referencias cartográficas, memorias de proyección, información facilitada por los censos, descripciones en libros de viajes o guías para forasteros, grabados, perspectivas o vistas a vuelo de pájaro de núcleos urbanos... ; aparentemente su conjunto ofrece una imagen global de la ciudad: existe, sin embargo, un problema debido al carácter contradictorio de los documentos citados; a menudo los planos tan sólo son siluetas de población, donde no se detalla la configuración de la trama ni se define cual fue la ocupación real de manzanas; en otras, el autor decídió integrar en su diseño proyectos que no llegaron a realizarse; en los grabados o perspectivas se cambia, a menudo, la escala o se incluyen fantásticos equipamíentos, con los que la referencia aparece distorsíonada; si leemos las guias de forasteros o almanaques veremos como, en su mayoría, se concibieron como largas listas donde se enumeraban calles, se daba referencia de palacios e iglesias más importantes, fíjándose a continuación posibles recorridos que permitiesen ver, comodamente, los hitos mencionados, pero nada se decía sobre la cíudad. Por último, tampoco los libros de viajeros son referencia fidedigna puesto que, a menudo, sus opiniones sobre una misma ciudad eran contradictorias, bien por valorar distintos aspectos, o, caso de coincidir, por expresar opiniones diferentes

Interrater agreement of two adverse drug reaction causality assessment methods: A randomised comparison of the Liverpool Adverse Drug Reaction Causality Assessment Tool and the World Health Organization-Uppsala Monitoring Centre system

<div><p>Introduction</p><p>A new method to assess causality of suspected adverse drug reactions, the Liverpool Adverse Drug Reaction Causality Assessment Tool (LCAT), showed high interrater agreement when used by its developers. Our aim was to compare the interrater agreement achieved by LCAT to that achieved by another causality assessment method, the World Health Organization-Uppsala Monitoring Centre system for standardised case causality assessment (WHO-UMC system), in our setting.</p><p>Methods</p><p>Four raters independently assessed adverse drug reaction causality of 48 drug-event pairs, identified during a hospital-based survey. A randomised design ensured that no washout period was required between assessments with the two methods. We compared the methods’ interrater agreement by calculating agreement proportions, kappa statistics, and the intraclass correlation coefficient. We identified potentially problematic questions in the LCAT by comparing raters’ responses to individual questions.</p><p>Results</p><p>Overall unweighted kappa was 0.61 (95% CI 0.43 to 0.80) on the WHO-UMC system and 0.27 (95% CI 0.074 to 0.46) on the LCAT. Pairwise unweighted Cohen kappa ranged from 0.33 to 1.0 on the WHO-UMC system and from 0.094 to 0.71 on the LCAT. The intraclass correlation coefficient was 0.86 (95% CI 0.74 to 0.92) on the WHO-UMC system and 0.61 (95% CI 0.39 to 0.77) on the LCAT. Two LCAT questions were identified as significant points of disagreement.</p><p>Discussion</p><p>We were unable to replicate the high interrater agreement achieved by the LCAT developers and instead found its interrater agreement to be lower than that achieved when using the WHO-UMC system. We identified potential reasons for this and recommend priority areas for improving the LCAT.</p></div

The Liverpool ADR Causality Assessment Tool (LCAT), with numbering of questions as used in this manuscript.

<p>* Yes or unassessable. Unassessable refers to situations where the medicine is administered on one occasion (e.g. vaccine), the patient receives intermittent therapy (e.g. chemotherapy), or is on medication which cannot be stopped (e.g. immunosuppressants). †Examples of objective evidence: positive laboratory investigations of the causal ADR mechanism (not those merely confirming the adverse reaction), supra-therapeutic drug levels, good evidence of dose-dependent relationship with toxicity in the patient. LCAT reproduced under a Creative Commons Attribution License. Source: Gallagher [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0172830#pone.0172830.ref004" target="_blank">4</a>].</p

Distribution of raters’ responses to LCAT questions.

<p>Distribution of raters’ responses to LCAT questions.</p

Pairwise distribution of outcomes, when using the WHO-UMC system.

<p>Pairwise distribution of outcomes, when using the WHO-UMC system.</p

Pairwise distribution of outcomes, when using the LCAT.

<p>Pairwise distribution of outcomes, when using the LCAT.</p

Bone mineral density parameters by sex and ART exposure.

<p>Bone mineral density parameters by sex and ART exposure.</p

Multivariate linear regression model of associations with lumbar spine BMD (g/cm²), n = 423^*.

<p>Multivariate linear regression model of associations with lumbar spine BMD (g/cm²), n = 423^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0144286#t005fn002" target="_blank">*</a>}.</p

Multivariate linear regression model of associations with total hip BMD (g/cm²) n = 412^*.

<p>Multivariate linear regression model of associations with total hip BMD (g/cm²) n = 412^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0144286#t003fn002" target="_blank">*</a>}.</p

Participant characteristics (n = 444).

<p>Participant characteristics (n = 444).</p