Tornillos expansivos: Un recurso en la artrodesis lumbosacra

En los últimos años han aparecido numerosos sistemas de fijación transpedicular que han hecho evolucionar a esta técnica. En 1991 se diseñó el sistema OMEGA 21 que permite la posibilidad de utilización de tornillos expansivos en artrodesis lumbosacra: un caso de fractura estallido, una fractura patológica en el seno de una columna osteoporótica, una cirugía de revisión en una fractura vertebral y un caso de desmontaje de un sistema de fijación transpedicular. En total fueron colocados 11 tornillos expansivos apareciendo la rotura de uno de ellos a los 15 meses. El tornillo expansivo permite la utilización de la fijación transpedicular en situaciones especiales, teniendo dos indicaciones precisas: casos con osteoporosis grave y cirugía de revisión.In recent years numerous pedicular fixation systems have appeared, revolutionizing the technique. In 1991, the OMEGA-21 system was designed to allow the use of expansive screws in lumbosacral arthrodesis: one burst fracture, one pathologic fracture in an osteoporotic spine, one revision surgery of a vertebral fracture and one disassembly of a pedicular fixation system. In total, 11 expansive screws were placed, one of them appearing broken 15 months after implantation. Expansive screws allows the use of pedicular fixation in special situations, having two precise indications: severe osteoporosis and revision surgery

The body grid as an assessment tool for body image

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Constructivist Psychology on 19 May 2017 available online: http://www.tandfonline.com/10.1080/10720537.2017.1320244The aim of this study was to analyze the body grid (BG) as an assessment tool for body image in a sample of patients with breast cancer, after surgery. We explored two measures of cognitive structure, percentage of variance accounted for by the first factor (PVAFF) and polarization, and we compared measures of body image and body self-esteem obtained by means of the BG with those obtained via a validated body image questionnaire. Our sample was composed of 23 patients (12 subjected to radical mastectomy, 11 subjected to conserving surgery) and 24 healthy controls. Participants were administered the BG and the Multidimensional Body Self Relations Questionnaire (MBSRQ). We analyzed the similarities between instruments using correlations and nonparametric tests. We have also provided two case studies to exemplify the use of the BG.  We found statistical differences in cognitive structure between patients and healthy controls. There were no differences between women subjected to mastectomy and women with breast conserving surgery in the level of PVAFF, but there were significant differences between them in the level of polarization. We found significant correlations between body image indices of both instruments, especially self-evaluated attractiveness (MBSRQ) and distance between real and ideal body (BG). We found similar distributions of these indices in all of the samples. We concluded that the BG provides useful information about body image. The results show that both instruments assess similar constructs. This suggests that the BG is a valid instrument for body image assessmen

Content categories system for body constructs applied to patients with mastectomy

Body image is a predictor of psychological adjustment to cancer and a risk factor for depression. Questionnaires to assess body image in cancer patients assume a preconceived concept of body image and do not reflect the patient's subjective experience. This study aims to develop a content categories system for analyzing body constructs in breast cancer patients from their own experience. Methods The sample comprised 542 constructs, from 23 patients subjected to surgery (12 mastectomy/11 breast-conserving surgery) and 24 controls. Participants were assessed with the Body Grid. Three independent judges coded the constructs elicited following a tentative categories system. Result Six categories appeared: Objective Appearance, Esthetics, Function, Strength, Energy and Emotions, with similar distribution in the samples. Objective Appearance, Esthetics and Emotions were the most used. The inter-rater agreement was very good. Conclusions These findings highlight the importance of knowing which thematic areas concern the most to each patient and the absent ones in their constructions, in order to focus psychotherapy on the developing of new meanings that allow a more integrated body imag

Generation of human computational models with machine learning

Services in smart environments pursue to increase the quality of people?s lives. The most important issues when developing this kind of environments is testing and validating such services. These tasks usually imply high costs and annoying or unfeasible real-world testing. In such cases, artificial societies may be used to simulate the smart environment (i.e. physical environment, equipment and humans). With this aim, the CHROMUBE methodology guides test engineers when modeling human beings. Such models reproduce behaviors which are highly similar to the real ones. Originally, these models are based on automata whose transitions are governed by random variables. Automaton?s structure and the probability distribution functions of each random variable are determined by a manual test and error process. In this paper, it is presented an alternative extension of this methodology which avoids the said manual process. It is based on learning human behavior patterns automatically from sensor data by using machine learning techniques. The presented approach has been tested on a real scenario, where this extension has given highly accurate human behavior models

Cultural dynamism and business vitality in medium-sized cities—evidence and proposals for sustainable development

This work uses tools recently designed to conduct analyses and proposals around the cultural development of medium-sized cities. The Cultural and Creative Cities Monitor model, or CCCM, is first applied to the 81 cities in Spain with between 50, 000 and 100, 000 inhabitants. We also refer to the UNESCO Culture/2030 Indicators, specifically indicator 8 (Cultural companies), to in-vestigate whether cultural dynamism is related to business vitality in those cities. Our observation of the 29 CCCM indicators and the C3 index, which synthesizes cultural performance, is explained, and these data are complemented with cultural business data (on assets, benefits, and jobs) from a sample of 13, 204 firms. The C3 index values reveal significant differences in the cultural and creative performance of the selected cities according to their location (metropolitan or non-metropolitan) and their administrative rank. Moreover, when comparing the C3 index with the indicators on business activity, evidence indicates a clear positive relationship between cultural dynamism and firm vitality. These results support the contribution of culture to the sustainable development of me-dium-sized Spanish cities and further establish the suitability of the tools used to assist cities in designing appropriate cultural policies

De la evaluación continua al aprendizaje continuo

Ponencia presentada en: VIII Jornadas de Innovación Docente de la UBU, Burgos, 5 de abril de 2016, organizadas por el Instituto de Formación e Innovación Educativa-IFIE de la Universidad de Burgo

Numerical study of interface cracking in composite structures using a novel geometrically nonlinear Linear Elastic Brittle Interface Model: Mixed-mode fracture conditions and application to structured interfaces

Interface cracking is one of the most prominent failure modes in fibre reinforced polymer (FRP) composites. Recent trends in high-tech applications of FRP composites exploit the limits of the load bearing capacity, generally encompassing the development of notable nonlinear effects from geometrical and material signatures. In this investigation, we present a comprehensive assessment of the new Linear Elastic Brittle Interface Model (LEBIM) in geometrically nonlinear applications undergoing mixed-mode fracture conditions. This interface model for triggering fracture events is formulated through the advocation of continuum-like assumptions (for initial non-zero interface thickness) and allows the incorporation of the potential role of the in-plane deformation effects. The performance of the present interface model is demonstrated through the simulation of specimens with mixed-mode delamination, with special attention for its application in samples equipped with structured interfaces. Current predictions exhibit an excellent agreement with respect to experimental data, validating the proposed methodology

Rotura del núcleo de polietileno en cotilo no cementado

La rotura del componente de polietileno de los cotilos en la prótesis total de cadera, es una complicación raramente descrita, sobre todo en artroplastias no cementadas. Presentamos un caso de rotura del polietileno en una prótesis total de cadera no cementada, revisando los 15 casos previamente publicados. Nuestro propósito es alertar sobre la posibilidad de esta infrecuente complicación.Fracture of the polyethylene liner of uncemented acetabular components is rarely mentioned in the literature. One case of fracture of the polyethylene liner is uncementeed his arthroplasty is described and we review 15 cases previously reported. The purpose of the report is to alert about this rare complication

La opinión de los usuarios como oportunidad de mejora en atención primaria

ObjetivosDeterminar los aspectos del centro de atención primaria (CAP) que desagradan más a los clientes/usuarios, investigar sus determinantes y aplicar la intervención o intervenciones correspondientes.DiseñoEvaluación orientada hacia los resultados. Detección de los motivos de insatisfacción a través de un estudio observacional transversal a partir de una encuesta autocumplimentada en 200 individuos seleccionados mediante muestreo aleatorio por conglomerados. Constitución de un grupo de mejora continua para investigar los factores determinantes de los problemas detectados y sus posibles soluciones.EmplazamientoCAP Rambla, Sant Feliu de Llobregat, del Instituto Catalán de la Salud.Participantes y contextoUsuarios/clientes de la sala de espera del CAP. Grupo de mejora: profesionales del Equipo de Atención Primaria Sant Feliu y del Servicio de Atención Primaria Baix Llobregat Nord.IntervencionesReorganización de las agendas de los médicos de cabecera y disminución de las tareas burocráticas en las consultas.Mediciones principalesVariables sociodemográficas de los encuestados y motivos de insatisfacción de éstos. Se procedió a analizar los determinantes del problema. La variable principal fue la demora de la cita previa.ResultadosEntre los motivos de insatisfacción expresados por los usuarios, el más frecuente fue el tiempo de demora, con un 16% (intervalo de confianza [IC] del 95%, 10,9-21,1). Esta queja se refería tanto a la espera para obtener un visita como al tiempo en la sala de espera. Como determinantes de la demora se identificaron el número elevado de pacientes, la duplicación de visitas, las visitas burocráticas, el número elevado de visitas urgentes y la cita previa insuficiente.ConclusionesLa opinión de los usuarios nos ayuda a conocer en qué medida los servicios públicos de salud están cumpliendo sus expectativas. La mejora de los procesos es un paso fundamental para la mejora continua, pero debe ir acompañada de recursos adecuados a las necesidades de la población.ObjectivesTo determine those aspects of Primary Care Center (PCC) that displeases more the clients/users, to investigate its determinants, and to apply the intervention or corresponding interventions.DesignResults evaluation oriented. Detection of dissatisfaction reasons through cross observational study from survey self-fulfilled on 200 individuals selected through random cluster sampling. A continuous improvement group was implemented in order to the factors causing detected problems and their possible solutions were analyzed.LocationRambla PCC, Sant Feliu de Llobregat. Catalonian Health Institute.Participants and contextUsers/clients of the PCC who were in the waiting room. Improvement Group: Professionals of Sant Feliu Primary Care Team and Baix Llobregat Nord Primary Care Service.InterventionsReorganization of the family doctors’ agendas and reduction of bureaucratic tasks in the physicians’ offices.Principal measurementsRespondents sociodemographic data, and reasons for their dissatisfaction. Determinants of the problem were analyzed. The principal cause of discomfort was the delay of previous appointment.ResultsAmong reasons for discomfort expressed by the users, the most frequent was lag time with 16% (95% CI, 10.9-21.1). This complaint referred both to wait for obtaining visit and to be in the waiting room before being visited. As determinants of delay there were identified a high number of patients, visits duplicity, bureaucratic visits, high number of urgent visits and an insufficient previous appointment visits.ConclusionsPatient's opinions help us to know how public health services are accomplishing their expectations. Process improvement is indispensable in order to provide a quality product, but it must be endowed with resources adequacy to population needs