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ObjectiveTo evaluate the association between neuroimaging and outcome in infants with congenital cytomegalovirus (cCMV), focusing on qualitative MRI and quantitative diffusion-weighted imaging of white matter abnormalities (WMAs).MethodsMulticentre retrospective cohort study of 160 infants with cCMV (103 symptomatic). A four-grade neuroimaging scoring system was applied to cranial ultrasonography and MRI acquired at ≤3 months. WMAs were categorised as multifocal or diffuse. Temporal-pole WMAs (TPWMAs) consisted of swollen or cystic appearance. Apparent diffusion coefficient (ADC) values were obtained from frontal, parieto-occipital and temporal white matter regions. Available follow-up MRI at ≥6 months (N=14) was additionally reviewed. Neurodevelopmental assessment included motor function, cognition, behaviour, hearing, vision and epilepsy. Adverse outcome was defined as death or moderate/severe disability.ResultsNeuroimaging scoring was associated with outcome (p<0.001, area under the curve 0.89±0.03). Isolated WMAs (IWMAs) were present in 61 infants, and WMAs associated with other lesions in 30. Although TPWMAs and diffuse pattern often coexisted in infants with IWMAs (p<0.001), only TPWMAs were associated with adverse outcomes (OR 7.8; 95% CI 1.4 to 42.8), including severe hearing loss in 20% and hearing loss combined with other moderate/severe disabilities in 15%. Increased ADC values were associated with higher neuroimaging scores, WMAs based on visual assessment and IWMAs with TPWMAs. ADC values were not associated with outcome in infants with IWMAs. Findings suggestive of progression of WMAs on follow-up MRI included gliosis and malacia.ConclusionsCategorisation of neuroimaging severity correlates with outcome in cCMV. In infants with IWMAs, TPWMAs provide a guide to prognosis.

La enfermedad biliopancreática aguda comprende la pancreatitis aguda de cualquier causa, el cólico biliar, la colecistitis aguda, la colangitis y la coledocolitiasis. Se trata de patologías frecuentes con una morbimortalidad elevada en casos graves, por lo que será importante la clasificación de gravedad desde el servicio de urgencias (SU) para un mejor manejo. En su mayor parte, estas entidades nosológicas están causadas por cálculos biliares que son cada vez más frecuentes (5%-15% de la población occidental) en una población con un porcentaje de obesidad y sobrepeso crecientes. Son más frecuentes a partir de los 65 años y en mujeres. A pesar de lo frecuentes que son, las litiasis biliares solamente producen síntomas en el 15%-20% de los pacientes. En su mayor parte, estas patologías cursan con dolor abdominal, generalmente en el hemiabdomen superior, por lo que es importante saber diferenciar unas de otras, para iniciar el tratamiento necesario lo más precozmente posible y mejorar el pronóstico. La historia clínica y la exploración física, la analítica con perfil hepático y pancreático y la ecografía abdominal o la tomografía computarizada abdominal serán necesarias para el diagnóstico diferencial de la mayoría de estos pacientes. De inicio, estos pacientes precisarán en prácticamente todos los casos una dieta absoluta, sueroterapia, analgesia y, solamente en algunos casos, antibioterapia empírica. Aquí resumiremos los aspectos más importantes de cada patología, centrándonos sobre todo en el enfoque en el SU.

La urgencia hipertensiva y la emergencia hipertensiva (EH) se engloban como crisis hipertensiva y se diferencian en que, en la primera, hay una elevación significativa de presión arterial (PA) sin daño en órganos diana (corazón, cerebro, riñón, retina y arterias), y en la segunda sí la hay. El riesgo cardiovascular en la urgencia hipertensiva no es particularmente alto, mientras que la EH supone un riesgo vital y precisa un descenso más agresivo de las cifras de PA, un manejo hospitalario y medicación intravenosa.

El síncope es un motivo de consulta muy frecuente en los servicios de urgencias (SU), por lo que identificar a aquellos pacientes que presentan criterios para considerarlo de alto riesgo es fundamental para un correcto manejo. La mayoría de las causas son benignas, constituyendo el síncope neuromediado y la hipotensión ortostática la mayor proporción de casos vistos en los SU. El síncope de causa cardíaca generalmente secundario a arritmias o estenosis aórtica es más común en la población mayor. En la valoración se debe confirmar si ha existido una pérdida transitoria del conocimiento, si es de origen sincopal o no y plantear si existe un diagnóstico etiológico. Se debe realizar un examen físico y ECG a todos los pacientes. En función de los resultados y de la anamnesis se plantean otras pruebas complementarias como analítica de sangre, ecocardiograma, masaje del seno carotídeo o monitorización prolongada.

Joven de 15 años, previamente sana, se presentó con dolor abdominal, vómitos, diarrea, eritema malar, edema palpebral y en miembros inferiores, artralgias, rigidez matinal y visión borrosa bilateral. Estudios de laboratorio y por imágenes junto con la clínica permitieron realizar el diagnóstico de síndrome nefrótico secundario a lupus eritematoso sistémico. Al examen oftalmológico se constató 8/10 de visión en ambos ojos y edema de papila bilateral con estrella macular parcial, hallazgos compatibles con una neurorretinitis bilateral. La biopsia renal estableció el diagnóstico de nefritis lúpica membranosa. Se inició tratamiento inmunosupresor, con mejoría clínica gradual.

AbstractFrom the point of view of institutional communication, the Second Vatican Council can be considered the most significant media event of the 20th century organized by an institution. This was so because of its duration, impact on millions of people, and the media interest it generated. For the Catholic Church, the management of the official information of this Assembly was an undertaking of enormous proportions, involving complex challenges. This article provides an overview of how the Vatican II information services dealt with such challenges.

Public transport systems are undergoing a significant change in most cities thanks to the advances in technology. The focus is not only on sustainability but also on efficiency and the experience of the passenger. In this work, we propose a complete redesign of the public transportation that considers a heterogeneous fleet of electric buses that dynamically changes in terms of the needs of each bus line at different hours, as well as a new bus schedule that minimizes passenger waiting time at bus stops by synchronizing different bus lines. In order to get optimal solutions, two optimization steps are needed. Preliminary results suggest that it is possible to implement an electrical bus fleet with different passenger and battery capacities that addresses the passenger demand, including the transfers on extensive trips where the users reduce travel times due to the synchronized schedule.

Background: A high consumption of fruit and vegetables is possibly associated with a decreased risk of colorectal cancer (CRC). However, the findings to date are inconsistent. Objective: We examined the relation between self-reported usual consumption of fruit and vegetables and the incidence of CRC. Design: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 452,755 subjects (131,985 men and 320,770 women) completed a dietary questionnaire in 1992-2000 and were followed up for cancer incidence and mortality until 2006. A multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HRs) and 95% CIs. Results: After an average follow-up of 8.8 y, 2,819 incident CRC cases were reported. Consumption of fruit and vegetables was inversely associated with CRC in a comparison of the highest with the lowest EPIC-wide quintile of consumption (HR: 0.86; 95% CI: 0.75, 1.00; P for trend = 0.04), particularly with colon cancer risk (HR: 0.76; 95% CI: 0.63, 0.91; P for trend < 0.0l). Only after exclusion of the first 2 y of follow-up were these findings corroborated by calibrated continuous analyses for a 100-g increase in consumption: HRs of 0.95 (95% CI: 0.91, 1.00; P = 0.04) and 0.94 (95% CI: 0.89, 0.99; P = 0.02), respectively. The association between fruit and vegetable consumption and CRC risk was inverse in never and former smokers, but positive in current smokers. This modifying effect was found for fruit and vegetables combined and for vegetables alone (P for interaction < 0.01 for both). Conclusions: These findings suggest that a high consumption of fruit and vegetables is associated with a reduced risk of CRC, especially of colon cancer. This effect may depend on smoking status.

Background: Consumption of fried food has been suggested to promote obesity, but this association has seldom been studied. Objective: We aimed to assess the association of energy intake from fried food with general and central obesity in Spain, a Mediterranean country where frying with oil is a traditional cooking procedure. Design: This was a cross-sectional study of 33 542 Spanish persons aged 29-69 y who were participating in the European Prospective Investigation into Cancer and Nutrition between 1992 and 1996. Dietary intake was assessed by a diet history questionnaire. Height, weight, and waist circumference were measured by trained interviewers. Analyses were performed with logistic regression and were adjusted for total energy intake and other confounders. Results: The prevalence of general obesity [body mass index (in kg/[m.sup.2]) [greater than or equal to] 30] was 27.6% in men and 27.7% in women. Respective figures for central obesity (waist circumference [greater than or equal to] 102 cm in men and [greater than or equal to] 88 cm in women) were 34.5% and 42.6%. The average proportion of energy intake from fried food was 15.6% in men and 12.6% in women. The adjusted odds ratios for general obesity in the highest versus the lowest quintile of fried food intake were 1.26 (95% CI: 1.09, 1.45; P for trend < 0.001) in men and 1.25 (1.11, 1.41; P for trend < 0.001) in women. The corresponding values for central obesity were 1.17 (1.02, 1.34; P for trend < 0.003) in men and 1.27 (1.13, 1.42; P for trend < 0.001) in women. Conclusion: Fried food was positively associated with general and central obesity only among subjects in the highest quintile of energy intake from fried food. KEY WORDS Fried food, general obesity, central obesity, olive oil, Spain

Background: Epidemiologic data suggest that persons with diets rich in fruit and vegetables are at a lower risk of several chronic diseases and mortality than are persons with diets poor in fruit and vegetables. Often, this effect is attributed to antioxidant micronutrients found in plant foods. Objective: We aimed to assess the relation of mortality to the consumption of fruit, vegetables, and other plant foods and to the dietary intake of vitamin C, vitamin E, and carotenoids. Design: The study was a prospective study in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition. During 6.5 y of follow-up, 562 deaths occurred in 41 358 subjects aged 30-69 y. Proportional hazards regression analysis was used to assess the relation between dietary factors and total mortality. Results: After adjustment for age, sex, and several potential confounders, the hazard ratio for the highest versus the lowest quartile of consumption was 0.79 (95% CI: 0.62, 1.00; P for trend = 0.029) for fresh fruit, 0.72 (0.56, 0.91 ; P for trend = 0.006) for root vegetables, and 0.77 (0.60, 0.98; P for trend = 0.015) for fruiting vegetables (ie, vegetables that contain the 'fruit' part of the plant, the seeds). The corresponding figures for antioxidant nutrients were 0.74 (0.58, 0.94; P for trend = 0.009) for vitamin C, 0.68 (0.53, 0.87, P for trend = 0.006) for provitamin A carotenoids, and 0.65 (0.51,0.84; P for trend 0.001) for lycopene. The effect of vitamin C and provitamin A disappeared after adjustment for total antioxidant capacity in plant foods. Conclusions: A high intake of fresh fruit, root vegetables, and fruiting vegetables is associated with reduced mortality, probably as a result of their high content of vitamin C, provitamin A carotenoids, and lycopene. Antioxidant capacity could partly explain the effect of ascorbic acid and provitamin A but not the association with lycopene. Am J Clin Nutr 2007:85:1634-42. KEY WORDS Mortality, fruit, vegetables, antioxidants, cohort studies

Background: Body weight and body mass index (BMI) are positively related to risk of colon cancer in men, whereas weak or no associations exist in women. This discrepancy may be related to differences in fat distribution between sexes or to the use of hormone replacement therapy (HRT) in women. Methods: We used multivariable adjusted Cox proportional hazards models to examine the association between anthropometric measures and risks of colon and rectal cancer among 368 277 men and women who were free of cancer at baseline from nine countries of the European Prospective Investigation Into Cancer and Nutrition. All statistical tests were two-sided. Results: During 6.1 years of follow-up, we identified 984 and 586 patients with colon and rectal cancer, respectively. Body weight and BMI were statistically significantly associated with colon cancer risk in men (highest versus lowest quintile of BMI, relative risk [RR] = 1.55, 95% confidence interval [CI] = 1.12 to 2.15; [P.sub.trend] = .006) but not in women. In contrast, comparisons of the highest to the lowest quintile showed that several anthropometric measures, including waist circumference (men, RR = 1.39, 95% CI = 1.01 to 1.93; [P.sub.trend] = .001; women, RR = 1.48, 95% CI = 1.08 to 2.03; [P.sub.trend] = .008), waist-to-hip ratio (WHR; men, RR = 1.51, 95% CI = 1.06 to 2.15; [P.sub.trend] = .006; women, RR = 1.52, 95% CI = 1.12 to 2.05; [P.sub.trend] = .002), and height (men, RR = 1.40, 95% CI = 0.99 to 1.98; [P.sub.trend] = .04; women, RR = 1.79, 95% CI = 1.30 to 2.46; [P.sub.trend]

Background: Dietary factors are thought to have an important role in gastric and esophageal carcinogenesis, but evidence from cohort studies for such a role is lacking. We examined the risks of gastric cancer and esophageal adenocarcinoma associated with meat consumption within the European Prospective investigation Into Cancer and Nutrition (EPIC) cohort. Methods: A total of 521 457 men and women aged 35-70 years in 10 European countries participated in the EPIC cohort. Dietary and lifestyle information was collected at recruitment. Cox proportional hazard models were used to examine associations between meat intake and risks of cardia and gastric noncardia cancers and esophageal adenocarcinoma. Data from a calibration substudy were used to correct hazard ratios (HRs) and 95% confidence intervals (CIs) for diet measurement errors. In a nested case-control study, we examined interactions between Helicobacter pylori infection status (i.e., plasma H. pylori antibodies) and meat intakes. All statistical tests were two-sided. Results: During a mean follow-up of 6.5 years, 330 gastric adenocarcinoma and 65 esophageal adenocarcinomas were diagnosed. Gastric noncardia cancer risk was statistically significantly associated with intakes of total meat (calibrated HR per 100-g/ day increase = 3.52; 95% CI = 1.96 to 6.34), red meat (calibrated HR per 50-g/day increase = 1.73; 95% CI = 1.03 to 2.88), and processed meat (calibrated HR per 50-g/day increase = 2.45; 95% CI = 1.43 to 4.21). The association between the risk of gastric noncardia cancer and total meat intake was especially large in H. pylori-infected subjects (odds ratio per 100-g/day increase = 5.32; 95% CI = 2.10 to 13.4). Intakes of total, red, or processed meat were not associated with the risk of gastric cardia cancer. A positive but non-statistically significant association was observed between esophageal adenocarcinoma cancer risk and total and processed meat intake in the calibrated model. In this study population, the absolute risk of development of gastric adenocarcinoma within 10 years for a study subject aged 60 years was 0.26% for the lowest quartile of total meat intake and 0.33% for the highest quartile of total meat intake. Conclusion: Total, red, and processed meat intakes were associated with an increased risk of gastric noncardia cancer, especially in H. pylori antibody-positive subjects, but not with cardia gastric cancer.

Visual simulators aim at evaluating vision with ophthalmic corrections prior to prescription or implantation of intraocular lenses (IOLs) in the patient’s eye. In the present study, we present the design, implementation, and validation of a new IOL-in-cuvette channel in an Adaptive Optics visual simulator, which provides an alternative channel for pre-operative simulation of vision with IOLs. The IOL is projected on the pupil’s plane of the subject by using a Rassow system. A second lens, the Rassow lens, compensates for an IOL of 20 D while other powers can be corrected with a Badal system within a 5 D range. The new channel was evaluated by through-focus (TF) optical quality in an artificial eye on bench, and by TF visual acuity in patients, with various IOL designs (monofocal, diffractive trifocal, and refractive extended depth of focus).

The article highlights the epistemological privilege of observation in social contexts marked by armed violence and disorder. Faced with these situations, researchers have sometimes considered that their work begins once the conflicts have stabilized, thus favouring archives (written or oral) and secondary sources over observation and interviews collected in context. Despite the difficulties it poses, however, investigation in context offers the researcher, through a sometimes-brutal confrontation with exceptional situations, the possibility of greater theoretical creativity by opening to new objects and new research questions. In return, such research requires a more reactive modality of theoretical elaboration, with a constant reciprocal interaction between hypotheses and data production. Rather than developing these themes in an abstract way, we return to the investigation we conducted on the Syrian conflict. We analyse in particular the difficulties of access, the risks of selection bias, the problems associated with remote research and subcontracting of data production, and the advantages of conducting collective fieldwork.

We report on the fabrication of efficient antibacterial substrates selective for bacteria, i.e., noncytotoxic against mammalian cells. The strategy proposed is based on the different size of bacteria (1–4 μm) in comparison with mammalian cells (above 20 μm) that permit the bacteria to enter in contact with the inner part of micrometer-sized pores where the antimicrobial functionality are placed. On the contrary, mammalian cells, larger in terms of size, remain at the top surface, thus reducing adverse cytotoxic effects and improving the biocompatibility of the substrates. For this purpose, we fabricated well-ordered functional microporous substrates (3–5 μm) using the breath figures approach that enabled the selective functionalization of the pore cavity, whereas the rest of the surface remained unaffected. Microporous surfaces were prepared from polymer blends comprising a homopolymer (i.e., polystyrene) and a block copolymer (either polystyrene-b-poly(dimethylaminoethyl methacrylate) (PDMAEMA) or a quaternized polystyrene-b-poly(dimethylaminoethyl methacrylate)). As a result, porous surfaces with a narrow size distribution and a clear enrichment of the PDMAEMA or the quaternized PDMAEMA block inside the pores were obtained that, in the case of the quaternized PDMAEMA, provided an excellent antimicrobial activity to the films.

Caso clínico Niña de 10 años con dismorfia facial, escoliosis, baja talla, hipotonía muscular, foramen oval permeable y retraso madurativo, acude a consulta para corrección de ectropión congénito bilateral. Al examen oftalmológico se constató ectropión palpebral inferior, euribléfaron y lagoftalmos bilaterales, con fenómeno de Bell positivo. Se realizaron injertos cutáneos autólogos de espesor completo en párpados inferiores con cantoplastia lateral bilateral, resolviendo el ectropión y mejorando la oclusión palpebral. Posteriormente, se hizo un estudio genético que reveló una mutación en el gen PTPN11y permitió, junto a la clínica, hacer el diagnóstico de síndrome de Noonan (SN).

PURPOSE:To measure the in vivo longitudinal chromatic aberration (LCA) from the chromatic difference of focus (480 to 700 nm) using psychophysical methods in patients bilaterally implanted with a hydrophobic trifocal intraocular lens (IOL).METHODS:Psychophysical best focus was measured in both eyes at different wavelengths (480 to 700 nm) and at three different viewing distances (0.00, +1.75, and +3.50 diopters [D]) using a custom-developed polychromatic adaptive optics set-up provided with a supercontinuum laser, a Hartmann-Shack wavefront sensor, a deformable mirror, a motorized Badal system, a pupil monitoring system, and a psychophysical channel with monochromatically illuminated stimuli. Measurements were performed on 10 patients (20 eyes) bilaterally implanted with hydrophobic trifocal diffractive IOLs (FineVisionHP POD F GF; PhysIOL). LCA was computed from the chromatic difference of focus curves as the difference between 480 and 700 nm at near, intermediate, and far.RESULTS:The LCA from psychophysical measurements was significantly higher for far vision (0.99 ± 0.06 diopters [D]), than for intermediate (0.67 ± 0.10 D) and near (0.23 ± 0.08 D) vision (one-way analysis of variance, The LCA from psychophysical measurements was significantly higher for far vision (0.99 ± 0.06 diopters [D]), than for intermediate (0.67 ± 0.10 D) and near (0.23 ± 0.08 D) vision (one-way analysis of variance, P< .05).CONCLUSIONS:LCA for far vision was significantly higher than for intermediate and near vision in hydrophobic trifocal diffractive IOLs, in agreement with a previous study with the same optical design but hydrophilic material IOLs. The LCA for the hydro-phobic IOL is slightly higher than for the hydrophilic IOL at far. Different combinations of refractive and diffractive LCA will allow optimizing IOL designs to improve polychromatic image quality.[[J Refract Surg. 2020;36(12):804–810.]

While being one of the first and most elegant tools for dimensionality reduction, Fisher linear discriminant analysis (FLDA) is not currently considered among the top methods for feature extraction or classification. In this paper, we will review two recent approaches to FLDA, namely, least squares Fisher discriminant analysis (LSFDA) and regularized kernel FDA (RKFDA) and propose deep FDA (DFDA), a straightforward nonlinear extension of LSFDA that takes advantage of the recent advances on deep neural networks. We will compare the performance of RKFDA and DFDA on a large number of two-class and multiclass problems, many of them involving class-imbalanced data sets and some having quite large sample sizes; we will use, for this, the areas under the receiver operating characteristics (ROCs) curve of the classifiers considered. As we shall see, the classification performance of both methods is often very similar and particularly good on imbalanced problems, but building DFDA models is considerably much faster than doing so for RKFDA, particularly in problems with quite large sample sizes. [ABSTRACT FROM AUTHOR]

Aunque las guías de práctica clínica recomiendan un ajuste continuado del tratamiento del asma, reduciendo la medicación de mantenimiento cuando se alcanza el control (step-down), existen pocos estudios de práctica clínica habitual orientados a recabar información de los factores que condicionan su fracaso.

While multifocal intraocular lenses (MIOLs) are increasingly implanted to correct for presbyopia, how one sees with a multifocal correction is hard to explain and imagine. The current study evaluates the quality of various visual simulating technologies by comparing vision with simulated MIOLs pre-operatively and the implanted MIOLs post-operatively in the same patients. Two simulation platforms were used: (1) a custom-developed adaptiveoptics (AO) system, with two visual simulator devices: a spatial light modulator (SLM) and an optotunable lens operating under temporal multiplexing (SimVis); and (2) a wearable, binocular, large field of view SimVis2Eyes clinical simulator (SimVis Gekko, 2Eyes Vision, Madrid, Spain). All devices were programmed to simulate a trifocal diffractive MIOL (POD F, FineVision, PhysIOL). Eight patients were measured pre-operatively simulating the trifocal lens and post-operatively with implantation of the same MIOL. Through-focus decimal visual acuity (TF VA) was measured (1) monocularly in monochromatic light using a four-alternative-forced-choice procedure in the AO system; and (2) binocularly using a clinical optotype in white light. Visual simulations pre-operatively predict well the TF VA performance found post-operatively in patients implanted with the real IOL. The average RMS difference between TF curves with the different visual simulators was 0.05 ± 0.01. The average RMS difference between the TF VA curves with the SimVis pre-operatively and the real MIOL post-operatively was 0.06 ± 0.01 in both platforms, and it was higher in cataract eyes (0.08 ± 0.01, on average across simulators) than in eyes with clear lens. In either group the shape of the TF curves is similar across simulators and pre- and post-operatively. TF curves cross-correlated significantly between simulators (lag k = 0, rho = 0.889), as well as with results with the real MIOL implanted (lag k = 0, rho = 0.853). Visual simulations are useful programmable tools to predict visual performance with MIOLs, both in an AO environment and in a clinical simulator. Pre-operative visual simulations and post-operative data are in good agreement.

El adenoma hipofisario ectópico es una entidad poco frecuente que se localiza más frecuentemente en el seno esfenoidal. Presentamos el caso de un paciente con adenoma hipofisario ectópico sin expresión funcional asociado a silla turca vacía, lo cual plantea un amplio diagnóstico diferencial. Es un tumor de naturaleza benigna a pesar de que se describe la presencia de necrosis en un porcentaje de casos. La resonancia es el método diagnóstico que permite estudiar los trastornos endocrinos relacionados con el eje hipotálamo-hipofisario y la biopsia endoscópica, su confirmación histológica. Es importante incluir marcadores hipofisarios en el panel de técnicas inmunohistoquímicas.

Presbyopia, the age-related loss of the crystalline lens’s ability to dynamically focus, occurs primarily because of stiffening of lens material, making the ciliary muscle forces insufficient to reshape the lens. Despite its prevalence, there is no satisfactory solution to presbyopia. Here we present a novel accommodating intraocular lens (AIOL) able to reshape upon equatorial forces in compliance with the eye’s accommodating mechanism. The concept and design parameters are demonstrated through finite element model simulations and measurements in a manufactured AIOL prototype, using custom quantitative 3D OCT (geometrical changes) and laser ray tracing (power changes), with forces radially applied using a custom eight-arm mechanical stretcher. There was an excellent agreement between simulations and measurements (1% for the focal length and 11.4% for geometrical parameters, on average) for radial load up to 0.6 N. The developed design is expected to achieve ∼2.5D of effective power change with a polymer material with 0.10–0.25 MPa Young’s modulus and n=1.43−1.46.

Highlights • A new density estimator for multi-objective optimization the first of polynomial complexity capable of deal with three-objective problems. • An adaptive mechanism of evolutionary operators selection for multi-objective optimization based on a fuzzy inference system. • A new metaheuristic for hard multi-objective optimization problems. Abstract We propose a new method for multi-objective optimization, called Fuzzy Adaptive Multi-objective Evolutionary algorithm (FAME). It makes use of a smart operator controller that dynamically chooses the most promising variation operator to apply in the different stages of the search. This choice is guided by a fuzzy logic engine, according to the contributions of the different operators in the past. FAME also includes a novel effective density estimator with polynomial complexity, called Spatial Spread Deviation (SSD). Our proposal follows a steady-state selection scheme and includes an external archive implementing SSD to identify the candidate solutions to be removed when it becomes full. To assess the performance of our proposal, we compare FAME with a number of state of the art algorithms (MOEA/D-DE, SMEA, SMPSOhv, SMS-EMOA, and BORG) on a set of difficult problems. The results show that FAME achieves the best overall performance. [ABSTRACT FROM AUTHOR]

The Simultaneous Vision simulator (SimVis) is a visual demonstrator of multifocal lens designs for prospective intraocular lens replacement surgery patients and contact lens wearers. This programmable device employs a fast tunable lens and works on the principle of temporal multiplexing. The SimVis input signal is tailored to mimic the optical quality of the multifocal lens using the theoretical SimVis temporal profile, which is evaluated from the through-focus Visual Strehl ratio metric of the multifocal lens. In this paper, for the first time, focimeter-verified on-bench validations of multifocal simulations using SimVis are presented. Two steps are identified as being critical to accurate SimVis simulations. Firstly, a new iterative approach is presented that improves the accuracy of the theoretical SimVis temporal profile for three different multifocal intraocular lens designs – diffractive trifocal, refractive segmented bifocal, and refractive extended depth of focus, while retaining a low sampling. Secondly, a fast focimeter is used to measure the step response of the tunable lens, and the input signal is corrected to include the effects of the transient behavior of the tunable lens. It was found that the root-mean-square of the difference between the estimated through-focus Visual Strehl ratio of the multifocal lens and SimVis is not greater than 0.02 for all the tested multifocal designs.

We present a novel method to automatically generate new parallel solvers for optimization problems, called the Virtual Savant. It applies machine learning to model a reference algorithm (which is treated as a black box) from its solutions to a given problem, and after, it is able to efficiently and accurately reproduce its solutions on new unseen problem instances. Additionally, the generated parallel algorithm is scalable to a different problem dimension. We analyze the performance and accuracy of our novel technique on a scheduling problem, and we use instances of different features and sizes. Virtual Savant was used to learn from an exact algorithm, a well-known heuristic, and a specialized parallel metaheuristic. During our experiments, our method solved to optimality up to 95.5% of the 200 unseen instances tested. For larger instances, it is not only highly competitive with the reference algorithms, but it is even able to outperform them in some cases. Another outstanding result is that Virtual Savant improved its accuracy when scaling the problem size (without additional training), with respect to the original algorithm. [ABSTRACT FROM AUTHOR]

General noise cost functions have been recently proposed for support vector regression (SVR). When applied to tasks whose underlying noise distribution is similar to the one assumed for the cost function, these models should perform better than classical $$\epsilon$$ ϵ -SVR. On the other hand, uncertainty estimates for SVR have received a somewhat limited attention in the literature until now and still have unaddressed problems. Keeping this in mind, three main goals are addressed here. First, we propose a framework that uses a combination of general noise SVR models with naive online R minimization algorithm (NORMA) as optimization method, and then gives non-constant error intervals dependent upon input data aided by the use of clustering techniques. We give theoretical details required to implement this framework for Laplace, Gaussian, Beta, Weibull and Marshall–Olkin generalized exponential distributions. Second, we test the proposed framework in two real-world regression problems using data of two public competitions about solar energy. Results show the validity of our models and an improvement over classical $$\epsilon$$ ϵ -SVR. Finally, in accordance with the principle of reproducible research, we make sure that data and model implementations used for the experiments are easily and publicly accessible.

We describe herein a novel strategy for the fabrication of efficient 3D printed antibacterial scaffolds. For this purpose, both the surface topography as well as the chemical composition of 3D scaffolds fabricated by additive manufacturing were modified. The scaffolds were fabricated by fused deposition modeling (FDM) using high-impact polystyrene (HIPS) filaments. The surface of the objects was then topographically modified providing materials with porous surfaces by means of the Breath Figures approach. The strategy involves the immersion of the scaffold in a polymer solution during a precise period of time. This approach permitted the modification of the pore size varying the immersion time as well as the solution concentration. Moreover, by using polymer blend solutions of polystyrene and polystyrene-b-poly(acrylic acid) (PS23-b-PAA18) and a quaternized polystyrene-b-poly(dimethylaminoethyl methacrylate) (PS42-b-PDMAEMAQ17), the scaffolds were simultaneously chemically modified. The surfaces were characterized by scanning electron microscopy and infrared spectroscopy. Finally, the biological response toward bacteria was explored. Porous surfaces prepared using quaternized PDMAEMA as well as those prepared using PAA confer antimicrobial activity to the films, i.e., were able to kill on contact Staphylococcus aureusemployed as model bacteria.

BackgroundThe impact of intrauterine and extrauterine growth on later insulin resistance and fat mass (FM) in very low birth weight (VLBW) infants is not well established. The aim of our study was to evaluate the effects of intrauterine and early/late extrauterine growth on later insulin resistance and body composition in VLBW infants from 6 months’ corrected age (CA) to 36 months.MethodsProspective measurements of body composition by dual-energy X-ray absorptiometry and insulin resistance by homeostasis model assessment insulin resistance (HOMA-IR) along with other fasting plasma biochemistries were made in 95 VLBW infants at 6, 12, 18, and 24 months’ CA and 36 months’ postnatal age. Mixed-effect models were used to evaluate the effects of age, sex, maturation status, and Δweight SD score on percentage FM (PFM), FM index (FMI), fat-free mass index (FFMI), and HOMA-IR.ResultsPFM and FMI were negatively associated with a decrease in weight–SD scores from birth to 36 weeks’ postmenstrual age (PMA; P=0.001) and from 36 weeks’ PMA to 6 months’ CA (P=0.003). PFM and FMI were higher in AGA than in small for gestational age (SGA) infants. HOMA-IR was not associated with the Δweight–SD scores in either period.ConclusionsCatch-down growth in terms of weight is associated with persistently lower adiposity but not insulin resistance up to 36 months of age.

Fast tunable lenses allow an effective design of a portable simultaneous vision simulator (SimVis) of multifocal corrections. A novel method of evaluating the temporal profile of a tunable lens in simulating different multifocal intraocular lenses (M-IOLs) is presented. The proposed method involves the characteristic fitting of the through-focus (TF) optical quality of the multifocal component of a given M-IOL to a linear combination of TF optical quality of monofocal lenses viable with a tunable lens. Three different types of M-IOL designs are tested, namely: segmented refractive, diffractive and refractive extended depth of focus. The metric used for the optical evaluation of the temporal profile is the visual Strehl (VS) ratio. It is shown that the time profiles generated with the VS ratio as a metric in SimVis resulted in TF VS ratio and TF simulated images that closely matched the TF VS ratio and TF simulated images predicted with the M-IOL. The effects of temporal sampling, varying pupil size, monochromatic aberrations, longitudinal chromatic aberrations and temporal dynamics on SimVis are discussed.

PURPOSE:Standard evaluation of aberrations from wavefront slope measurements in patients implanted with a rotationally asymmetric multifocal intraocular lens (IOL), the Lentis Mplus (Oculentis GmbH, Berlin, Germany), results in large magnitude primary vertical coma, which is attributed to the intrinsic IOL design. The new proposed method analyzes aberrometry data, allowing disentangling the IOL power pupillary distribution from the true higher order aberrations of the eye.METHODS:The new method of wavefront reconstruction uses retinal spots obtained at both the near and far foci. The method was tested using ray tracing optical simulations in a computer eye model virtually implanted with the Lentis Mplus IOL, with a generic cornea or with anterior segment geometry obtained from custom quantitative spectral-domain optical coherence tomography in a real patient. The method was applied to laser ray tracing aberrometry data at near and far fixation obtained in a patient implanted with the Lentis Mplus IOL.RESULTS:Higher order aberrations evaluated from simulated and real retinal spot diagrams following the new reconstruction approach matched the nominal aberrations (approximately 98%). Previously reported primary vertical coma in patients implanted with this IOL lost significance with the application of the proposed reconstruction.CONCLUSIONS:Custom analysis of ray tracing–based retinal spot diagrams allowed decoupling of the true higher order aberrations of the patient's eye from the power pupillary distribution of a rotationally asymmetric multifocal IOL, therefore providing the appropriate phase map to accurately evaluate through-focus optical quality.[[J Refract Surg.2017;33(4):257–265.]

Spatial-light-modulators (SLM) are increasingly used as active elements in adaptive optics (AO) systems to simulate optical corrections, in particular multifocal presbyopic corrections. In this study, we compared vision with lathe-manufactured multi-zone (2-4) multifocal, angularly and radially, segmented surfaces and through the same corrections simulated with a SLM in a custom-developed two-active-element AO visual simulator. We found that perceived visual quality measured through real manufactured surfaces and SLM-simulated phase maps corresponded highly. Optical simulations predicted differences in perceived visual quality across different designs at Far distance, but showed some discrepancies at intermediate and near.

Los pólipos serrados (PS) grandes, PS proximales, PS con displasia y la presencia de múltiples adenomas sésiles serrados (P/ASS), que englobamos bajo el término PS con riesgo aumentado de lesiones metacrónicas (PSRALM), se asocian a un mayor riesgo de presentar dichas lesiones, pero desconocemos si también se asocian a un mayor riesgo de neoplasia avanzada de colon (NA) sincrónica.

Bifocal contact or intraocular lenses use the principle of simultaneous vision to correct for presbyopia. A modified two-channel simultaneous vision simulator provided with an amplitude transmission spatial light modulator was used to optically simulate 14 segmented bifocal patterns (+ 3 diopters addition) with different far/near pupillary distributions of equal energy. Five subjects with paralyzed accommodation evaluated image quality and subjective preference through the segmented bifocal corrections. There are strong and systematic perceptual differences across the patterns, subjects and observation distances: 48% of the conditions evaluated were significantly preferred or rejected. Optical simulations (in terms of through-focus Strehl ratio from Hartmann-Shack aberrometry) accurately predicted the pattern producing the highest perceived quality in 4 out of 5 patients, both for far and near vision. These perceptual differences found arise primarily from optical grounds, but have an important neural component.

Traditional battery energy storage systems (BESS) are based on the series/parallel connections of big amounts of cells. However, as the cell to cell imbalances tend to rise over time, the cycle life of the battery-pack is shorter than the life of individual cells. New design proposals focused on modular systems could help to overcome this problem, increasing the access to each cell measurements and management. During the design of a modular battery system many factors influence the lifespan calculation. This work is centred on carrying out a factor importance analysis to identify the most relevant variables and their interactions. The analysis models used to calculate the reliability of the batteries are the state of health (SoH) and the Multi-State System (MSS) analysis with the Universal Generating Function (UGF), while electronic devices reliability is approximated using constant failure rate achieved with FIDES guide. Thus, it is determined numerically that module redundancy, cell capacity, module voltage and their interactions are the most determinant design characteristics.

Multifocal lenses are increasingly used solutions for presbyopia, the age-related loss of crystalline lens focus ability. These lenses work by the principle of simultaneous vision, superimposing focused and defocused images on the retina. Providing the experience of simultaneous vision to a patient before permanent implantation of a multifocal lens is a recognized unmet need to increase the patient’s confidence and optimize the lens selection. We developed a hand-held, see-through multifocal vision simulator based on temporal multiplexing of a tunable lens. The device was calibrated and validated using focimetry and Hartmann–Shack aberrometry revealing high reproducibility of the through-focus multifocal energy distribution and high optical quality. We measured visual acuity and perceptual quality on nine cyclopeged patients with three monofocal, two bifocal, and two trifocal corrections with different far/intermediate/near energy distributions simulated using the device. Visual performance and perceptual quality with multifocal corrections varied across patients, although they were more uniform across distances than monofocal corrections. Among the bifocal and trifocal designs, a trifocal with more energy at far was the most frequently identified as providing better quality. The simultaneous vision simulator proved a promising compact tool to study visual performance with multifocal corrections and to select the lens design best suited for each patient, alternative to costly and bulky adaptive optics based devices.

Background/Objectives:: High intakes of unprocessed red or processed meat may increase the risk of stroke. We aimed to examine the association between unprocessed red meat, processed meat and total red meat consumption and risk of total stroke and ischaemic stroke. Subjects/Methods:: Cox proportional hazards regression analyses were conducted based on the data for 41 020 men and women aged 29–69 years at baseline. Results:: During a mean follow-up of 13.8 years, 674 incident cases of stroke (531 ischaemic strokes, 79 haemorrhagic strokes, 42 subarachnoid haemorrhages and 22 mixed or unspecified events) were identified. After multiple adjustment, unprocessed red meat, processed meat and total red meat consumption were not correlated with incidence of total stroke or ischaemic stroke in either men or women. The hazard ratios (HRs) for unprocessed red meat and processed meat and risk of total stroke comparing the highest with the lowest quintiles were, respectively, 0.81 (95% confidence interval (CI) 0.54–1.21; P-trend=0.15) and 0.92 (95% CI 0.64–1.32; P-trend=0.82) in men and 1.21 (95% CI 0.79–1.85; P-trend=0.10) and 0.81 (95% CI 0.51–1.27; P-trend=0.17) in women. The HRs for unprocessed red meat and processed meat and risk of ischaemic stroke were, respectively, 0.80 (95% CI 0.51–1.25; P-trend=0.51) and 0.86 (95% CI 0.57–1.29; P-trend=0.77) in men and 1.24 (95% CI 0.74–2.05; P-trend=0.13) and 0.82 (95% CI 0.47–1.42; P-trend=0.31) in women. Conclusions:: In the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, unprocessed red meat and processed meat consumption were not associated with risk of stroke in men or women.

Analizar las dimensiones estudiadas en la investigación sobre las condiciones de vida y salud de las personas mayores no institucionalizadas en la literatura científica en el medio español.

Cardiac rehabilitation (CR) is very effective for secondary prevention of cardiovascular disorders. The objective of this study was to analyze population factors associated with nonenrollment of cardiac patients in these programs.

Abstract Advances in the care of patients with metastatic colorectal cancer arise from well-designed clinical trials. In the present document we address specific challenges in the design of clinical trials for metastatic colorectal cancer regarding staging and standard of care according to prognosis, as well as some relevant methodological issues.