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En el contexto de un ensayo clínico que se diseñó para comparar la funcionalidad de los catéteres arteriales mantenidos con suero heparinizado vs salino se detectó una tasa de reclutamiento de casos muy lenta. En un intento de buscar posibles soluciones para mejorar la tasa de inclusión de sujetos en el estudio se planteó analizar las posibles causas relacionadas. En función de los resultados obtenidos, se debían plantear enmiendas al protocolo que permitieran facilitar una más rápida selección de casos sin mermar la calidad del estudio. Metodología: De cada catéter insertado no incluido en el ensayo se recogía, de manera prospectiva, el motivo de no inclusión para su posterior análisis. Resultados: Los motivos más frecuentes para no incluir un caso en el estudio fueron la inserción del catéter arterial fuera de la UCI, incidencias relacionadas con el consentimiento informado (CI) y más de 5 intentos para canalizar la arteria. El resto se relacionaba con causas hematológicas o competición con otros ensayos. Conclusiones: Las causas de no inclusión de pacientes más importantes fueron susceptibles de corregirse mediante la presentación de enmiendas al protocolo sin que éste se resintiese en su calidad o en la consecución de sus objetivos. Así, se presentaron cuatro enmiendas al Comité Ético de Investigación Clínica (CEIC) del centro, dos de las cuales fueron aceptadas y posteriormente comunicadas a la Agencia Española del Medicamento. Actualmente se está acabando la fase de inclusión de casos con menor retraso que si no se hubieran presentado las enmiendas. Abstract Regarding a clinical trial designed to compare the functionality of arterial catheters kept with heparin vs saline solution, a slow rate of case recruiting was detected. In order to improve this rate an analysis of the reasons for non-inclusion was set up. According to the results, amendments to the protocol had to be proposed to improve case inclusion without reducing the quality of the study. Methodology: All not included catheter insertions were registered and analysed regarding the reason of non-inclusion. Results: The more frequent reasons for non including a case in the study were the insertion of the catheter in other ward or department, the issues related with the informed consent (IC) and the need of more than 5 attempts to insert the catheter. The remaining reasons were related to hematological issues as well as competition with other trials. Conclusions: The main reasons for not including cases in the trial were subject to be changed by including amendments to the protocol, without affecting neither the trial quality nor the proposed goals. So, four amendments were proposed to the local ethical commission, two of which were accepted and subsequently notified to the Spanish Drug Agency. The phase of cases inclusion is now ending with less delay had the amendments not been presented. Centro de Trabajo: Hospital Mútua de Terrassa. Terrassa, Barcelona Fecha del Trabajo: 07/09/2005 Palabra Clave: Enfermería, ensayo clínico, catéter, criterios de inclusión, enmiendas Key Words: Nursing, clinical trial, catheter, selection criteria, amendments to protocol

Auxin is an essential hormone for plant growth and development. Auxin influx carriers AUX1/LAX transport auxin into the cell, while auxin efflux carriers PIN pump it out of the cell. It is well established that efflux carriers play an important role in the shoot vascular patterning, yet the contribution of influx carriers to the shoot vasculature remains unknown. Here, we combined theoretical and experimental approaches to decipher the role of auxin influx carriers in the patterning and differentiation of vascular tissues in the Arabidopsis inflorescence stem. Our theoretical analysis predicts that influx carriers facilitate periodic patterning and modulate the periodicity of auxin maxima. In agreement, we observed fewer and more spaced vascular bundles in quadruple mutants plants of the auxin influx carriers aux1lax1lax2lax3. Furthermore, we show AUX1/LAX carriers promote xylem differentiation in both the shoot and the root tissues. Influx carriers increase cytoplasmic auxin signaling, and thereby differentiation. In addition to this cytoplasmic role of auxin, our computational simulations propose a role for extracellular auxin as an inhibitor of xylem differentiation. Altogether, our study shows that auxin influx carriers AUX1/LAX regulate vascular patterning and differentiation in plants.

We evaluated the hypothesis that the number of circulating EPC could be associated with the risk of stroke recurrence (SR) or vascular events (VE) after an ischemic stroke.We studied prospectively consecutive patients with cerebral infarction within the first 48 hours after the onset. We recorded demographic factors, vascular risk factors, previous Rankin scale (RS) score, and etiology. We analyzed EPC counts by flow cytometry in blood collected at day 7 and defined EPC as CD34+/CD133+/KDR+ cells. Mean follow-up was 29.3 ± 16 months. We evaluated SR as well as VE. Patients were classified as to the presence or absence of EPC in the circulation (either EPC+ or EPC-). Bivariate analyses, Kaplan-Meier survival curves and Cox regression models were used.We included 121 patients (mean age 70.1±12.6 years; 65% were men). The percentage of EPC+ patients was 47.1%. SR occurred in 12 (9.9%) and VE in 18 (14.9%) patients. SR was associated significantly with a worse prior RS score, previous stroke and etiology, but not with EPC count. VE were associated significantly with EPC-, worse prior RS score, previous stroke, high age, peripheral artery disease and etiology. Cox regression model showed that EPC- (HR 7.07, p=0.003), age (HR 1.08, p=0.004) and a worse prior RS score (HR 5.8, p=0.004) were associated significantly with an increased risk of VE.The absence of circulating EPC is not associated with the risk of stroke recurrence, but is associated with an increased risk of future vascular events.

Investigación en base a una programa matemático basado en la aplicación de seis principios psicopedagógicos escogidos a partir de un proceso cualitativo de análisis bibliográfico y curricular de las matemáticas de la Educación Primaria. El artículo justifica la aplicación de estos principios con el objetivo de dotar a los futuros maestros y maestras de instrumentos aplicables y de reflexión para que, en su tarea como docentes, ayuden a disminuir el fracaso escolar en matemáticas y aproximar estos contenidos a la vida cotidiana del alumnado.

El presente artículo presenta una propuesta experimental sobre cómo gestionar las demandas de los problemas matemáticos en la enseñanza primaria. En primer lugar, se describe el estado de la cuestión, poniendo énfasis en los aspectos atencionales y de motivación en el aula. En, segundo lugar, se presentan los resultados de una investigación en la que se implementó una metodología de enseñanza y aprendizaje de las matemáticas, fundamentado en un tratamiento estratégico de la lectura de las demandas de los problemas.

BACKGROUND: Although non-specific pain in the upper limb muscles of workers engaged in mild repetitive tasks is a common occupational health problem, much is unknown about the associated structural and biochemical changes. In this study, we compared the muscle energy metabolism of the extrinsic finger extensor musculature in instrumentalists suffering from work-related pain with that of healthy control instrumentalists using non-invasive phosphorus magnetic resonance spectroscopy ((31)P-MRS). We hypothesize that the affected muscles will show alterations related with an impaired energy metabolism. METHODOLOGY/PRINCIPAL FINDINGS: We studied 19 volunteer instrumentalists (11 subjects with work-related pain affecting the extrinsic finger extensor musculature and 8 healthy controls). We used (31)P-MRS to find deviations from the expected metabolic response to exercise in phosphocreatine (PCr), inorganic phosphate (Pi), Pi/PCr ratio and intracellular pH kinetics. We observed a reduced finger extensor exercise tolerance in instrumentalists with myalgia, an intracellular pH compartmentation in the form of neutral and acid compartments, as detected by Pi peak splitting in (31)P-MRS spectra, predominantly in myalgic muscles, and a strong association of this pattern with the condition. CONCLUSIONS/SIGNIFICANCE: Work-related pain in the finger extrinsic extensor muscles is associated with intracellular pH compartmentation during exercise, non-invasively detectable by (31)P-MRS and consistent with the simultaneous energy production by oxidative metabolism and glycolysis. We speculate that a deficit in energy production by oxidative pathways may exist in the affected muscles. Two possible explanations for this would be the partial and/or local reduction of blood supply and the reduction of the muscle oxidative capacity itself.

Regarding a clinical trial designed to compare the functionality of arterial catheters kept with heparin vs saline solution, a slow rate of case recruiting was detected. In order to improve this rate an analysis of the reasons for non-inclusion was set up. According to the results, amendments to the protocol had to be proposed to improve case inclusion without reducing the quality of the study.Methodology: All not included catheter insertions were registered and analysed regarding the reason of non-inclusion.Results: The more frequent reasons for non including a case in the study were the insertion of the catheter in other ward or department, the issues related with the informed consent (IC) and the need of more than 5 attempts to insert the catheter. The remaining reasons were related to hematological issues as well as competition with other trials.Conclusions: The main reasons for not including cases in the trial were subject to be changed by including amendments to the protocol, without affecting neither the trial quality nor the proposed goals. So, four amendments were proposed to the local ethical commission, two of which were accepted and subsequently notified to the Spanish Drug Agency. The phase of cases inclusion is now ending with less delay had the amendments not been presented.

Abstract Background Female Genital Mutilation (FGM) is a traditional practice which is harmful to health and is profoundly rooted in many Sub-Saharan African countries. It is estimated that between 100 and 140 million women around the world have been victims of some form of FGM and that each year 3 million girls are at risk of being submitted to these practices. As a consequence of the migratory phenomena, the problems associated with FGM have extended to the Western countries receiving the immigrants. The practice of FGM has repercussions on the physical, psychic, sexual and reproductive health of women, severely deteriorating their current and future quality of life. Primary healthcare professionals are in a privileged position to detect and prevent these situations of risk which will be increasingly more present in Spain. Methods/Design The objective of the study is to describe the knowledge, attitudes and practices of the primary healthcare professionals, working in 25 health care centres in Barcelona and Girona regions, regarding FGM, as well as to investigate the perception of this subject among the migrant communities from countries with strong roots in these practices. A transversal descriptive study will be performed with a questionnaire to primary healthcare professionals and migrant healthcare users. Using a questionnaire specifically designed for this study, we will evaluate the knowledge, attitudes and skills of the healthcare professionals to approach this problem. In a sub-study, performed with a similar methodology but with the participation of cultural mediators, the perceptions of the migrant families in relation to their position and expectancies in view of the result of preventive interventions will be determined. Variables related to the socio-demographic aspects, knowledge of FGM (types, cultural origin, geographic distribution and ethnicity), evaluation of attitudes and beliefs towards FGM and previous contact or experience with cases or risk situations will be obtained. Discussion Knowledge of these harmful practices and a preventive approach from a transcultural perspective may represent a positive intervention model for integrative care of immigrants, respecting their values and culture while also being effective in eliminating the physical and psychic consequences of FGM.

Abstract Background The practice of Female Genital Mutilation (FGM), a deeply-rooted tradition in 28 countries in Sub-Saharan Africa, carries important negative consequences for the health and quality of life of women and children. Migratory movements have brought this harmful traditional practice to our medical offices, with the subsequent conflicts related to how to approach this healthcare problem, involving not only a purely healthcare-related event but also questions of an ethical, cultural identity and human rights nature. Methods The aim of this study was to analyse the perceptions, degree of knowledge, attitudes and practices of the primary healthcare professionals in relation to FGM. A transversal, descriptive study was performed with a self-administered questionnaire to family physicians, paediatricians, nurses, midwives and gynaecologists. Trends towards changes in the two periods studied (2001 and 2004) were analysed. Results A total of 225 (80%) professionals answered the questionnaire in 2001 and 184 (62%) in 2004. Sixteen percent declared detection of some case in 2004, rising three-fold from the number reported in 2001. Eighteen percent stated that they had no interest in FGM. Less than 40% correctly identified the typology, while less than 30% knew the countries in which the practice is carried out and 82% normally attended patients from these countries. Conclusion Female genital mutilations are present in primary healthcare medical offices with paediatricians and gynaecologists having the closest contact with the problem. Preventive measures should be designed as should sensitization to promote stands against these practices.

We describe the design steps and final implementation of a MIMO OFDM prototype platform developed to enhance the performance of wireless LAN standards such as HiperLAN/2 and 802.11, using multiple transmit and multiple receive antennas. We first describe the channel measurement campaign used to characterize the indoor operational propagation environment, and analyze the influence of the channel on code design through a ray-tracing channel simulator. We also comment on some antenna and RF issues which are of importance for the final realization of the testbed. Multiple coding, decoding, and channel estimation strategies are discussed and their respective performance-complexity trade-offs are evaluated over the realistic channel obtained from the propagation studies. Finally, we present the design methodology, including cross-validation of the Matlab, C++, and VHDL components, and the final demonstrator architecture. We highlight the increased measured performance of the MIMO testbed over the single-antenna system.

One of the main problems of SAR imagery is the presence of speckle noise, originated by the inherent coherent nature of this type of systems. For one-dimensional SAR systems it has been demonstrated that speckle can be considered as a multiplicative noise term. Nevertheless, this simple model cannot be exported when multidimensional SAR imagery is addressed. This paper is devoted to present the latest advances into the definition of a multidimensional speckle noise model which does not depend on the data dimensionality. Speckle noise may be modeled by multiplicative and additive noise sources, whose combination is determined by the data's correlation structure. The validity of the proposed model is demonstrated by its application to a real L-band multidimensional SAR dataset acquired by the German ESAR sensor.