Multiple vertebral fractures after suspension of denosumab. A series of 56 cases

Background: Denosumab is a monoclonal antibody approved for the treatment of postmenopausal osteoporosis. The withdrawal of denosumab produces an abrupt loss of bone mineral density and may cause multiple vertebral fractures (MVF). Objective: The objective of this study is to study the clinical, biochemical, and densitometric characteristics in a large series of postmenopausal women who suffered MVF after denosumab withdrawal. Likewise, we try to identify those factors related to the presence of a greater number of vertebral fractures (VF). Patients and methods: Fifty-six patients (54 women) who suffered MVF after receiving denosumab at least for three consecutive years and abruptly suspended it. A clinical examination was carried out. Biochemical bone remodelling markers (BBRM) and bone densitometry at the lumbar spine and proximal femur were measured. VF were diagnosed by magnetic resonance imaging MRI, X-ray, or both at dorsal and lumbar spine. Results: Fifty-six patients presented a total of 192 VF. 41 patients (73.2%) had not previously suffered VF. After discontinuation of the drug, a statistically significant increase in the BBRM was observed. In the multivariate analysis, only the time that denosumab was previously received was associated with the presence of a greater number of VF (P = .04). Conclusions: We present the series with the largest number of patients collected to date. 56 patients accumulated 192 new VF. After the suspension of denosumab and the production of MVF, there was an increase in the serum values of the BBRM. The time of denosumab use was the only parameter associated with a greater number of fractures

Measuring efficiency in the Summer Olympic Games disciplines: the case of the Spanish athletes

This paper estimates the technical efficiency of Olympic disciplines in which Spanish athletes participate, taking into account the results obtained in the last three Olympic Games. A stochastic production frontier model (normal-exponential), using two control variables linked to economic factors such as budget and sports scholarships, is estimated in order to obtain different Olympic sports’ efficiencies distinguished by gender, using data from 2005 to 2016. The results detect some differences among the considered disciplines. In all the cases, athletics, canoeing, cycling, swimming, and tennis, depending on the gender, reach better values. This paper’s novelty lies in the efficiency analysis carried out on the Olympic disciplines and athletes of a country and not on the country’s efficiency, which allows managers and stakeholders to decide about investments concerning disciplines and athletes.Ministerio Ciencia e Innovación | Ref. PID2019-105428RB-I00Ministerio de Economía, Industria y Competitividad | Ref. ECO2017-85577-

Sitúate : revista digital de situaciones de aprendizaje

Los textos discontinuos están presentes en todos los contextos de la vida pero han ocupado muy poco lugar en el contexto escolar. Concretamente, dentro del área de Lengua y Literatura tradicionalmente han predominado los textos continuos (literarios, periodísticos, etc.). Dada su importancia, se hace necesario enseñar estrategias que faciliten su comprensión. Para ello, se le indica al alumnado que forma parte de un grupo de aspirantes al departamento de comunicación técnica de una gran empresa. Dicha empresa considera muy importante el trabajo en equipo y, por tanto, es necesario que conforme grupos para realizar dicho trabajo. Esta empresa fabrica una amplia variedad de artículos y valora a los aspirantes a su departamento técnico a través de la presentación de un manual de instrucciones o guía de uso de un prototipo de producto. Dicho manual se muestra en una presentación que valora una comisión técnica que decide qué equipos de trabajo han cumplido todos los requisitos. Para ello, previamente, se ha enviado uno de sus manuales de ejemplo. Se trabaja con este texto para su total comprensión y utilización de modelo para el producto final. El contenido de esta actividad está vinculado con el Plan lector del centro y el aprendizaje de estrategias lectoras, la integración de las TIC y con la Educación para el consumo, ya que los textos utilizados pueden hacer reflexionar sobre nuestra responsabilidad y nuestros derechos como consumidores.ES

Breast density classification to reduce false positives in CADe systems

[Abstract] This paper describes a novel weighted voting tree classification scheme for breast density classification. Breast parenchymal density is an important risk factor in breast cancer. Moreover, it is known that mammogram interpretation is more difficult when dense tissue is involved. Therefore, automated breast density classification may aid in breast lesion detection and analysis. Several classification methods have been compared and a novel hierarchical classification procedure of combined classifiers with linear discriminant analysis (LDA) is proposed as the best solution to classify the mammograms into the four BIRADS tissue classes. The classification scheme is based on 298 texture features. Statistical analysis to test the normality and homoscedasticity of the data was carried out for feature selection. Thus, only features that are influenced by the tissue type were considered. The novel classification techniques have been incorporated into a CADe system to drive the detection algorithms and tested with 1459 images. The results obtained on the 322 screen-film mammograms (SFM) of the mini-MIAS dataset show that 99.75% of samples were correctly classified. On the 1137 full-field digital mammograms (FFDM) dataset results show 91.58% agreement. The results of the lesion detection algorithms were obtained from modules integrated within the CADe system developed by the authors and show that using breast tissue classification prior to lesion detection leads to an improvement of the detection results. The tools enhance the detectability of lesions and they are able to distinguish their local attenuation without local tissue density constraints

Inventory of Water–Energy–Waste Resources in Rural Houses in Gran Canaria Island: Application and Potential of Renewable Resources and Mitigation of Carbon Footprint and GHG

The potential application of renewable energies is diverse, and they have demonstrated their suitability in their application to the size and operation of activities. Rural tourism is one of the products with the greatest potential for growth within the tourist offer of the island of Gran Canaria, as it combines sustainable development and respect for the natural environment. Among the renewable energies with high applicability in rural environments, we highlight photovoltaic solar, low-temperature solar thermal and the methanation of waste and wastewater generated in tourism. This article shows a methodology adapted and developed for the study of the water-energy-waste nexus, considering parameters of waste generation, water and energy consumption, the occupied area and potential renewable energy generation in rural houses in Gran Canaria and evaluates their environmental profitability. It has been concluded that applying these renewable technologies can significantly reduce the carbon and ecological footprint of the activity of rural houses based on the available surface. This contributes to achieving the energy and environmental objectives proposed by the EU to achieve decarbonization by 2050

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research