El atrio como estrategia estructural en nuevos rascacielos que renuncian a la verticalidad: casos de estudio

In the last decade, a new type of high rise building has been emerging. They are leaning or undulating skyscrapers which become real architectural icons by defying the building logic that the preservation of the vertical line implies. The acceptance of this last aspect is making emerge several works of this kind signed by some of the most influential architectural firms in the world. But, do these new involve works new structural concepts or strategies that answer to their singular characters? Here, the structural solution of two examples is analyzed to identify those contributions with a structural/architectural nature that could became a base for the development of this type. The use of the atrium is recognized as one of them. An assessment based on models of its influence on the structural behavior of leaning towers is carried out.En la última década, ha venido emergiendo un nuevo tipo de edificio en altura. Se trata de rascacielos inclinados u ondulados que, desafiando toda la lógica edificatoria que supone la conservación de la verticalidad, se convierten en auténticos hitos e iconos arquitectónicos. El reconocimiento de este último aspecto está conduciendo a la emergencia de varias representaciones de este tipo respaldadas por algunos de los estudios de arquitectura más influyentes del panorama internacional. Pero, ¿vienen estas actuaciones acompañadas de nuevos conceptos o estrategias estructurales o de diseño que respondan a la singularidad que las caracteriza? Se analiza aquí la solución estructural de dos ejemplos para identificar aquellas aportaciones de carácter estructural/arquitectónico que apuntan a servir de base para el desarrollo del tipo. Reconociéndose la utilización del atrio como una de ellas, se lleva a cabo una evaluación basada en modelos de su influencia en el comportamiento estructural de torres inclinadas

Análisis estructural de la torre del homenaje de la Alhambra de Granada (España)

This paper aim, on one hand, to describe the structural response of “Homenaje Tower”, one of the towers of the Historical Complex of the Alhambra, in Granada (Spain) and, on the other hand, to look over the different techniques used in the structural analysis of historical buildings, applying them to the tower to assess the scope of each of them. The tower is analyzed from three methods that count on different levels of complexity. First, an analysis using graphical method for limit analysis is carried out to assess the different safety coefficients from a stability point of view. Secondly, a finite element linear elastic analysis is applied in order to identify possible stress concentration zones, in particular zones with tensile stresses. Finally, a nonlinear static pushover analysis has been carried out over five different numerical models to assess the structural response to horizontal loads of perimeter walls and interior porticos.Este artículo pretende describir la respuesta estructural de la Torre del Homenaje, una de las torres del complejo de la Alhambra (Granada), y por otro lado revisar las distintas técnicas utilizadas en el análisis estructural de edificios históricos aplicándolas a dicho objeto para valorar el alcance de cada una de ellas. La torre se analiza mediante tres procedimientos con diferentes niveles de complejidad. En primer lugar, se utiliza el método de líneas de empuje para valorar los diferentes coeficientes de seguridad desde un punto de vista de la estabilidad. En segundo lugar, se lleva a cabo un análisis elástico y lineal aplicando el método de los elementos finitos para identificar posibles concentraciones de tensiones de tracción. Por último, se ha realizado un análisis estático no lineal tipo pushover sobre cinco modelos numéricos diferentes para valorar la respuesta estructural ante acciones horizontales de los muros perimetrales y de los pórticos interiores

El atrio como estrategia estructural en nuevos rascacielos que renuncian a la verticalidad: casos de estudio

In the last decade, a new type of high rise building has been emerging. They are leaning or undulating skyscrapers which become real architectural icons by defying the building logic that the preservation of the vertical line implies. The acceptance of this last aspect is making emerge several works of this kind signed by some of the most influential architectural firms in the world. But, do these new involve works new structural concepts or strategies that answer to their singular characters? Here, the structural solution of two examples is analyzed to identify those contributions with a structural/architectural nature that could became a base for the development of this type. The use of the atrium is recognized as one of them. An assessment based on models of its influence on the structural behavior of leaning towers is carried out.<br><br>En la última década, ha venido emergiendo un nuevo tipo de edificio en altura. Se trata de rascacielos inclinados u ondulados que, desafiando toda la lógica edificatoria que supone la conservación de la verticalidad, se convierten en auténticos hitos e iconos arquitectónicos. El reconocimiento de este último aspecto está conduciendo a la emergencia de varias representaciones de este tipo respaldadas por algunos de los estudios de arquitectura más influyentes del panorama internacional. Pero, ¿vienen estas actuaciones acompañadas de nuevos conceptos o estrategias estructurales o de diseño que respondan a la singularidad que las caracteriza? Se analiza aquí la solución estructural de dos ejemplos para identificar aquellas aportaciones de carácter estructural/arquitectónico que apuntan a servir de base para el desarrollo del tipo. Reconociéndose la utilización del atrio como una de ellas, se lleva a cabo una evaluación basada en modelos de su influencia en el comportamiento estructural de torres inclinadas

Biochemical algorithm to identify individuals with ALPL variants among subjects with persistent hypophosphatasaemia

Hypophosphatasia (HPP) is a rare and underdiagnosed condition characterized by deficient bone and teeth mineralization. The aim of this study was first, to evaluate the diagnostic utility of employing alkaline phosphatase (ALP) threshold levels to identify adults with variants in ALPL among individuals with persistently low ALP levels and second, to determine the value of also including its substrates (serum pyridoxal-5′-phosphate—PLP—and urinary phosphoetanolamine-PEA) for this purpose in order to create a biochemical algorithm that could facilitate the diagnostic work-up of HPP. Results: The study population comprised 77 subjects with persistent hypophosphatasaemia. They were divided into two groups according to the presence (+GT) or absence (−GT) of pathogenic ALPL variants: 40 +GT and 37 −GT. Diagnostic utility measures were calculated for different ALP thresholds and Receiver Operating Characteristic (ROC) curves were employed to determine PLP and PEA optimal cut-off levels to predict the presence of variants. The optimal threshold for ALP was 25 IU/L; for PLP, 180 nmol/L and for PEA, 30 µmol/g creatinine. Biochemical predictive models were assessed using binary logistic regression analysis and bootstrapping machine learning technique and results were then validated. For ALP 180 nmol/L) that when combined, seem to be very useful to identify individuals with ALPL variant

Can we identify individuals with an ALPL variant in adults with persistent hypophosphatasaemia?

Hypophosphatasia (HPP) is an inborn error of metabolism characterized by low levels of serum alkaline phosphatase (ALP). Scarce evidence exists about features that should signal the potential association between hypophosphatasaemia and HPP in adults. The aim of this study is to estimate the prevalence of ALPL variants in subjects with persistent hypophosphatasaemia and determine the associated clinical and laboratory features. For this cross-sectional study, laboratory records of 386,353 subjects were screened by measurement of ALP activity. A total of 85 (0.18%) subjects with persistent hypophosphatasaemia (≥2 serum alkaline phosphatase-ALP-measurements ≤35 IU/L and none &gt; 45 IU/L) were included (secondary causes previously discarded). ALPL genetic testing and a systematized questionnaire to retrieve demographic, clinical and laboratory data were performed. Descriptive analysis and logistic regression models were employed to identify the clinical and laboratory characteristics associated with ALPL variants. Results: Forty subjects (47%) had a variant(s) in ALPL. With regard to clinical characteristics, the presence of an ALPL variant was significantly associated only with musculoskeletal pain (OR: 7.6; 95% IC: 1.9-30.9). Nevertheless, a trend to present more dental abnormalities (OR: 3.6; 95% IC: 0.9-13.4) was observed. Metatarsal stress fractures were also more frequent (4 vs 0; p &lt; 0.05) in this group. Regarding laboratory features, median ALP levels were lower in subjects with ALPL variants (26 vs 29 IU/L; p &lt; 0.005). Interestingly, the threshold of ALP levels &lt; 25 IU/L showed a specificity, positive predictive value and positive likelihood ratio of 97.8, 94.4% and 19.8 to detect a positive ALPL test, respectively. Conclusions: In subjects with persistent hypophosphatasaemia -secondary causes excluded- one out of two presented ALPL variants. Musculoskeletal pain and ALP levels &lt; 25 IU/L are associated with this variant(s). In this scenario, ALP levels &lt; 25 IU/L seem to be very useful to identify individuals with the presence of an ALPL variantGenetic testing was supported by a grant from Alexion Pharmaceuticals Inc., which had no role in the study design or data analysi

Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set : translation and cross-cultural adaptation into 15 languages

Introduction: The Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English version of the ASAS HI, including the EF Item Set, cross-culturally into 15 languages. Methods: Translation and cross-cultural adaptation has been carried out following the forward-backward procedure. In the cognitive debriefing, 10 patients/country across a broad spectrum of sociodemographic background, were included. Results: The ASAS HI and the EF Item Set were translated into Arabic, Chinese, Croatian, Dutch, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish, Thai and Turkish. Some difficulties were experienced with translation of the contextual factors indicating that these concepts may be more culturally-dependent. A total of 215 patients with axial SpA across 23 countries (62.3% men, mean (SD) age 42.4 (13.9) years) participated in the field test. Cognitive debriefing showed that items of the ASAS HI and EF Item Set are clear, relevant and comprehensive. All versions were accepted with minor modifications with respect to item wording and response option. The wording of three items had to be adapted to improve clarity. As a result of cognitive debriefing, a new response option 'not applicable' was added to two items of the ASAS HI to improve appropriateness. Discussion: This study showed that the items of the ASAS HI including the EFs were readily adaptable throughout all countries, indicating that the concepts covered were comprehensive, clear and meaningful in different cultures

2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice.

To formulate evidence-based recommendations and overarching principles on the use of imaging in the clinical management of crystal-induced arthropathies (CiAs). An international task force of 25 rheumatologists, radiologists, methodologists, healthcare professionals and patient research partners from 11 countries was formed according to the EULAR standard operating procedures. Fourteen key questions on the role of imaging in the most common forms of CiA were generated. The CiA assessed included gout, calcium pyrophosphate deposition disease and basic calcium phosphate deposition disease. Imaging modalities included conventional radiography, ultrasound, CT and MRI. Experts applied research evidence obtained from four systematic literature reviews using MEDLINE, EMBASE and CENTRAL. Task force members provided level of agreement (LoA) anonymously by using a Numerical Rating Scale from 0 to 10. Five overarching principles and 10 recommendations were developed encompassing the role of imaging in various aspects of patient management: making a diagnosis of CiA, monitoring inflammation and damage, predicting outcome, response to treatment, guided interventions and patient education. Overall, the LoA for the recommendations was high (8.46-9.92). These are the first recommendations that encompass the major forms of CiA and guide the use of common imaging modalities in this disease group in clinical practice

Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis

Objectives The Assessment of SpondyloArthritis International Society (ASAS) aimed to develop a set of quality standards (QS) to help improve the quality of healthcare provided to adult patients affected by axial spondyloarthritis (axSpA) worldwide. Methods An ASAS task force developed a set of QS using a stepwise approach. First, key areas for quality improvement were identified, discussed, rated and agreed on. Thereafter, areas were prioritised and statements for the most important key areas were phrased on consensus. Appropriate quality measures were defined to allow quantification of the QS at the community level. Results The ASAS task force, consisting of 20 rheumatologists, two physiotherapists and two patients, selected and proposed 34 potential key areas for quality improvement which were then commented by 140 ASAS members and patients. Within that process three new key areas came up, which led to a re-evaluation of all 37 key areas by 120 ASAS members and patients. Five key areas were identified as most important to determine quality of care: referral including rapid access, rheumatology assessment, treatment, education/self-management and comorbidities. Finally, nine QS were agreed on and endorsed by the whole ASAS membership. Conclusions ASAS successfully developed the first set of QS to help improving healthcare for adult patients with axSpA. Even though it may currently not be realistic to achieve the QS in all healthcare systems, they provide high-quality of care framework for patients with axSpA that should be aimed for

MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group

OBJECTIVES: The Assessment of SpondyloArthritis international Society (ASAS) MRI working group (WG) was convened to generate a consensus update on standardised definitions for MRI lesions in the sacroiliac joint (SIJ) of patients with spondyloarthritis (SpA), and to conduct preliminary validation. // METHODS: The literature pertaining to these MRI lesion definitions was discussed at three meetings of the group. 25 investigators (20 rheumatologists, 5 radiologists) determined which definitions should be retained or required revision, and which required a new definition. Lesion definitions were assessed in a multi-reader validation exercise using 278 MRI scans from the ASAS classification cohort by global assessment (lesion present/absent) and detailed scoring (inflammation and structural). Reliability of detection of lesions was analysed using kappa statistics and the intraclass correlation coefficient (ICC). // RESULTS: No revisions were made to the current ASAS definition of a positive SIJ MRI or definitions for subchondral inflammation and sclerosis. The following definitions were revised: capsulitis, enthesitis, fat lesion and erosion. New definitions were developed for joint space enhancement, joint space fluid, fat metaplasia in an erosion cavity, ankylosis and bone bud. The most frequently detected structural lesion, erosion, was detected almost as reliably as subchondral inflammation (κappa/ICC:0.61/0.54 and 0.60/0.83) . Fat metaplasia in an erosion cavity and ankylosis were also reliably detected despite their low frequency (κappa/ICC:0.50/0.37 and 0.58/0.97). // CONCLUSION: The ASAS-MRI WG concluded that several definitions required revision and some new definitions were necessary. Multi-reader validation demonstrated substantial reliability for the most frequently detected lesions and comparable reliability between active and structural lesions

Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis

Objectives: The Assessment of SpondyloArthritis International Society (ASAS) aimed to develop a set of quality standards (QS) to help improve the quality of healthcare provided to adult patients affected by axial spondyloarthritis (axSpA) worldwide. Methods: An ASAS task force developed a set of QS using a stepwise approach. First, key areas for quality improvement were identified, discussed, rated and agreed on. Thereafter, areas were prioritised and statements for the most important key areas were phrased on consensus. Appropriate quality measures were defined to allow quantification of the QS at the community level. Results: The ASAS task force, consisting of 20 rheumatologists, two physiotherapists and two patients, selected and proposed 34 potential key areas for quality improvement which were then commented by 140 ASAS members and patients. Within that process three new key areas came up, which led to a re-evaluation of all 37 key areas by 120 ASAS members and patients. Five key areas were identified as most important to determine quality of care: referral including rapid access, rheumatology assessment, treatment, education/self-management and comorbidities. Finally, nine QS were agreed on and endorsed by the whole ASAS membership. Conclusions: ASAS successfully developed the first set of QS to help improving healthcare for adult patients with axSpA. Even though it may currently not be realistic to achieve the QS in all healthcare systems, they provide high-quality of care framework for patients with axSpA that should be aimed for