Confronting a Paradox: A New Perspective of the Impact of Uncertainty in Suspense

Suspense is a key narrative issue in terms of emotional gratifications. Reactions in response to this type of entertainment are positively related to enjoyment, having a significant impact on the audience's immersion and suspension of disbelief. Related to computational modeling of this feature, some automatic storytelling systems include limited implementations of suspense management system in their core. In this way, the interest of this subject in the area of creativity has resorted to different definitions from fields as narratology and the film industry, as much as several proposals of its constituent features. Among their characteristics, uncertainty is one of the most discussed in terms of impact and need: while many authors affirm that uncertainty is essential to evoke suspense, others limit or reject its influence. Furthermore, the paradox of suspense reflects the problem of including uncertainty as a component required in suspense creation systems. Due to this need to contrast the effects of the uncertainty in order to compute a general model for automatic storytelling systems, we conducted an experiment measuring suspense experienced by a group of subjects that read a story. While a group of them were told the ending of the story in advance, the members of the other group experimented the same story in chronological order. Both the subjects' reported suspense and their physiological responses are gathered and analyzed. Results provide evidence to conclude that uncertainty affects the emotional response of readers, but independently and in a different form than suspense does. It will help to propose a model in which uncertainty is processed separately as management of the amount of knowledge about the outcome available to the spectator, which acts as a control signal to modulate the input features, but not directly in suspense computing.

The role of posttraumatic stress and posttraumatic growth on online information use in breast cancer survivors

OBJECTIVE

Changes perceived as both positive (eg, posttraumatic growth [PTG]) and negative (eg, posttraumatic stress symptoms [PTSS]) have been associated with intensive Internet use among breast cancer survivors. In this multicenter study, we analyzed the role of PTG and PTSS on the amount of time spent looking for online cancer information, its content, and its psychological impact.

METHODS

Posttraumatic stress symptoms and PTG were assessed in 182 breast cancer survivors by using the Post-traumatic Stress Disorder Checklist and Post-traumatic Growth Inventory questionnaires. Subjects also completed a questionnaire about their behavior when looking for online illness-related information (ie, time spent, type of contents, and psychological impact).

RESULTS

Posttraumatic stress symptoms positively correlated with the amount of time spent looking for cancer-related information, including both medical and psychosocial content. By contrast, PTG showed no relationships with the amount of time, but with a predominant search for cancer-related psychosocial information. The psychological impact of online information was associated with participants' levels of PTG and/or PTSS. Whereas PTG was related to a decrease of women's hope, PTSS was linked to the perception of being less conscious or inadequately informed about the illness, thereby increasing feelings of distress.

CONCLUSIONS

Posttraumatic stress symptoms and PTG show relationships with the amount of time spent online, the type of information accessed online, and the psychological impact of Internet use. Health professionals should prescribe online information according to the psychological response to cancer. There is a need for professional-led online resources to provide patients with timely information as well as support sites to facilitate psychological adjustment.

[Dislocation of the proximal hallux interphalangeal joint with interposition of a sesamoid bone: a blibliographic review]

The irreducible dislocation of the hallux interphalangeal joint is an infrequent condition and only a few cases have been described. It presents as dorsal dislocation with interposition of the sesamoid bone, which has the possibility of being radiologically undetectable. We present the case of a 29 year-old patient who, after a sports trauma sustained a hallux interphalangeal dislocation that went unnoticed for eight days. Since, closed reduction was not possible, as occurred in several cases reported in the literature, open reduction was performed through a dorsal incision. Based on a bibliographic review, it is possible to state that there are several treatment options and multiple approaches, and that these lesions usually have a good prognosis.

A consensus statement on the gender perspective in lung cancer

Lung cancer is the most common cancer globally and has the highest mortality. Although this disease is not associated with a particular gender, its incidence is rising among women, who are diagnosed at an increasingly younger age compared with men. One of the main reasons for this rise is women taking up smoking. However, many non-smoking women also develop this disease. Other risk factors implicated in the differential development of lung cancer in women are genetic predisposition, tumour histology and molecular profile. Proportionally more women than men with lung cancer have a mutation in the EGFR gene. This consensus statement reviews the available evidence about the epidemiological, biological, diagnostic, therapeutic, social and psychological aspects of lung cancer in women.

[Reliability of a chronic obstructive pulmonary disease diagnosis register in Primary Care]

INTRODUCTION/OBJECTIVE

One of main limitations in studies of COPD in health databases could be the low quality of the information. Our first aim was evaluate reliability of the registry of COPD diagnosis register in Primary Care. A description and comparison is also presented of the characteristics of the patients according to the diagnostic confirmation.

MATERIAL AND METHODS

A cross-sectional study using healthcare databases of Cantabria. A pre-selected sample of 1,457 patients was obtained in which COPD diagnosis was specifically registered. COPD confirmation was classified into confirmed COPD, not confirmed-not rejected COPD, and diagnostic error (over-diagnosis). Descriptive and clinical characteristics, comorbidities, and treatments were collected in each group.

RESULTS

COPD was confirmed in 766 patients: 52.6% (95%CI: 49.9-55.2). Prevalence of over-diagnosis was 7.2% (95%CI: 5.9-8.6). There were statistically significant gender differences. In the COPD confirmed group age, tobacco consumption and severity according to FEV1 was higher. An average of 1.95 bronchial exacerbations during the last 4years was observed among diagnostic errors. Inhaled corticosteroids were prescribed in 74.9% of COPD confirmed patients, and in 41.9% of over-diagnosed patients.

CONCLUSIONS

The reliability of the COPD register was deficient, with only 52.6% with a confirmed diagnosis. Stable treatment for COPD was prescribed in all groups, highlighting the use of inhaled corticosteroids.

Independent effect of prior exacerbation frequency and disease severity on the risk of future exacerbations of COPD: a retrospective cohort study

Few studies have researched the independent effect of COPD severity on the risk of future exacerbations adjusted by previous exacerbation frequency. We aimed to analyse the independent effect of COPD severity on the risk of exacerbations in the following year, and whether this effect was stronger or not than the effect of a previous history of exacerbations. We conducted a retrospective population-based cohort study including 900 patients with confirmed COPD. Exacerbation frequency was observed for the previous year and for the following year. Patients were defined as ‘Frequent Exacerbator’ (FE) phenotype if they suffered ⩾2 exacerbations in a year, and were categorised according to the severity of COPD (GOLD Grades 1–4). Odds ratios (ORs) were estimated by logistic regression adjusting for age, gender, smoking status, severity of COPD and being FE in the previous year. The main predictor of being FE among all grades of COPD severity was a history of frequent exacerbations in the previous year: adjusted OR 4.97; 95% confidence interval (CI) (3.54–6.97). COPD severity was associated with a higher risk of being FE: Crude OR GOLD Grade 4 3.86; 95% CI (1.50–9.93). However, this association diminished after adjusting for being FE in the previous year: adjusted OR 2.08; 95% CI (0.75–5.82). Our results support that a history of frequent exacerbations in the previous year is the most important independent predictor of exacerbations in the following year, also among the most severe COPD patients. Severity of COPD would be associated with a higher risk of exacerbations, but this effect would be partly determined by the exacerbations suffered in the previous year.

Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease

BACKGROUND AND AIM

Exacerbations of chronic obstructive pulmonary disease (COPD) carry significant consequences for patients and are responsible for considerable health-care costs-particularly if hospitalization is required. Despite the importance of hospitalized exacerbations, relatively little is known about their determinants. This study aimed to analyze predictors of hospitalized exacerbations and mortality in COPD patients.

METHODS

This was a retrospective population-based cohort study. We selected 900 patients with confirmed COPD aged ≥35 years by simple random sampling among all COPD patients in Cantabria (northern Spain) on December 31, 2011. We defined moderate exacerbations as events that led a care provider to prescribe antibiotics or corticosteroids and severe exacerbations as exacerbations requiring hospital admission. We observed exacerbation frequency over the previous year (2011) and following year (2012). We categorized patients according to COPD severity based on forced expiratory volume in 1 second (Global Initiative for Chronic Obstructive Lung Disease [GOLD] grades 1-4). We estimated the odds ratios (ORs) by logistic regression, adjusting for age, sex, smoking status, COPD severity, and frequent exacerbator phenotype the previous year.

RESULTS

Of the patients, 16.4% had ≥1 severe exacerbations, varying from 9.3% in mild GOLD grade 1 to 44% in very severe COPD patients. A history of at least two prior severe exacerbations was positively associated with new severe exacerbations (adjusted OR, 6.73; 95% confidence interval [CI], 3.53-12.83) and mortality (adjusted OR, 7.63; 95%CI, 3.41-17.05). Older age and several comorbidities, such as heart failure and diabetes, were similarly associated.

CONCLUSIONS

Hospitalized exacerbations occurred with all grades of airflow limitation. A history of severe exacerbations was associated with new hospitalized exacerbations and mortality.

Evaluation of MPEG-7-Based Audio Descriptors for Animal Voice Recognition over Wireless Acoustic Sensor Networks

Environmental audio monitoring is a huge area of interest for biologists all over the world. This is why some audio monitoring system have been proposed in the literature, which can be classified into two different approaches: acquirement and compression of all audio patterns in order to send them as raw data to a main server; or specific recognition systems based on audio patterns. The first approach presents the drawback of a high amount of information to be stored in a main server. Moreover, this information requires a considerable amount of effort to be analyzed. The second approach has the drawback of its lack of scalability when new patterns need to be detected. To overcome these limitations, this paper proposes an environmental Wireless Acoustic Sensor Network architecture focused on use of generic descriptors based on an MPEG-7 standard. These descriptors demonstrate it to be suitable to be used in the recognition of different patterns, allowing a high scalability. The proposed parameters have been tested to recognize different behaviors of two anuran species that live in Spanish natural parks; the Epidalea calamita and the Alytes obstetricans toads, demonstrating to have a high classification performance.

Prevalence of Influenza Vaccination in Chronic Obstructive Pulmonary Disease Patients and Impact on the Risk of Severe Exacerbations

OBJECTIVE

To determine the prevalence of influenza vaccination in chronic obstructive pulmonary disease (COPD) patients, and the effectiveness of the procedure.

METHODS

Retrospective population-based cohort study. On 31 December 2011, influenza vaccination history was retrieved from 899 patients with confirmed COPD selected by simple random sampling from all COPD patients in Cantabria (northern Spain). Severe exacerbations (hospitalization due to COPD exacerbation) and overall mortality during 2012 were treated as dependent variables. Odds ratios (OR) were estimated by logistic regression, adjusting for age, sex, smoking status, severity of COPD, and frequency of exacerbations during the previous year. Prevented fraction among the exposed (PFe-adjusted) was determined as a measure of impact.

RESULTS

Overall prevalence of influenza vaccination was 62.7%, but this rate fell in patients classified as more severe according to FEV1 (52.0%). Influenza vaccination showed a statistically significant protective effect against severe exacerbations in the following year: Ora: 0.54 (95%CI: 0.35-0.84); FPe-adjusted: 0.46 (95%CI: 0.16-0.65). A non-significant protective effect for overall mortality was observed: Ora: 0.76 (95%CI: 0.41-1.40). When stratified according to COPD severity (FEV1), the protective effect against risk of hospitalization was higher in more severe COPD patients: Ora: 0.23 (95%CI: 0.11-0.48); FPe-adjusted: 0.77 (95%CI: 0.52-0.89).

CONCLUSIONS

We found that influenza vaccination has a protective effect and reduces the risk of hospitalization due to exacerbations in the following year. Despite the evidence for protection, prevalence of vaccination was not optimal, especially in more severe COPD patients.

Mesenteric tumor due to chronic anisakiasis

Intestinal anisakiasis is a rare parasitic disease and difficult to diagnose due to symptoms are not specific, so it is considered an underdiagnosed disease. The clinical suspicion with a correct diagnosis of anisakiasis allows the establishment of a correct treatment; in most cases, the resolution is possible with conservative treatment, avoiding unnecessary surgery to the preoperative differential diagnosis of acute abdomen. We report the case of apatient who required urgent surgery secondary to an exacerbation of chronic anisakiasis.

Signatures of a two-dimensional ferromagnetic electron gas at the La0.7Sr0.3MnO3/SrTiO3 interface arising from orbital reconstruction

The magnetoresistance of La0.7Sr0.3MnO3/SrTiO3 superlattices with magnetic field rotating out-of-plane shows unexpected peaks for in-plane fields. Resistivity calculations with spin-orbit coupling reveal that orbital reconstruction at the manganite interface leads to a 2D ferromagnetic electron gas coupled antiparallel to the manganite "bulk". These orbital and magnetic reconstructions are supported by X-ray linear dichroism and ab initio calculations.

Burden of serious fungal infections in Spain

Estimates of the incidence and prevalence of serious fungal infections, based on epidemiological data, are essential in order to inform public health priorities given the lack of resources dedicated to the diagnosis and treatment of these serious fungal diseases. However, epidemiology of these infections is largely unknown, except for candidaemia and cryptococcosis. The aim of this work is to calculate the burden of serious fungal infections in Spain. All published epidemiology papers reporting fungal infection rates from Spain were identified. Where no data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence, depending on the condition. Around 8.1 million people suffer a fungal infection every year. Most of them are skin or mucosal infections causing no deaths. Candidaemia is more common than in other European countries and has risen by 1.88-fold in frequency in the last decade (8.1 cases × 100,000). Good estimates of invasive aspergillosis (2.75 cases × 100,000) and mucormycosis (0.04 × 100,000) are available. Fungal infections with a high mortality such as invasive aspergillosis, candidaemia, Pneumocystis pneumonia and mucormycosis are not numerous in Spain, but they affect those with severe underlying diseases and are therefore linked to poor outcomes. Additional studies are required, especially for high burden diseases such as recurrent thrush in women (∼9000 cases × 100,000 women), allergic bronchopulmonary aspergillosis (126 cases × 100,000) and severe asthma with fungal sensitisation (198 cases × 100,000).

Competition between covalent bonding and charge transfer at complex-oxide interfaces

Here we study the electronic properties of cuprate-manganite interfaces. By means of atomic resolution electron microscopy and spectroscopy, we produce a subnanometer scale map of the transition metal oxidation state profile across the interface between the high Tc superconductor YBa2Cu3O7-δ and the colossal magnetoresistance compound (La,Ca)MnO3. A net transfer of electrons from manganite to cuprate with a peculiar nonmonotonic charge profile is observed. Model calculations rationalize the profile in terms of the competition between standard charge transfer tendencies (due to band mismatch), strong chemical bonding effects across the interface, and Cu substitution into the Mn lattice, with different characteristic length scales.

[Intensive care services resources in Spain]

OBJECTIVES

To identify the resources related to the care of critically ill patients in Spain, which are available in the units dependent of the Services of Intensive Care Medicine (ICM) or other services/specialties, analyzing their distribution according to characteristics of the hospitals and by autonomous communities.

DESIGN

Prospective observational study.

SETTING

Spanish hospitals.

PARTICIPANTS

Heads of the Services of ICM.

MAIN OUTCOME VARIABLES

Number of units and beds for critically ill patients and functional dependence.

RESULTS

The total number of registries obtained with at least one Service of ICM was 237, with a total of 100,198 hospital beds. Level iii (43.5%) and level ii (35%) hospitals predominated. A total of 73% were public hospitals and 55.3% were non-university centers. The total number of beds for adult critically ill patients, was 4,738 (10.3/100,000 inhabitants). The services of ICM registered had available 258 intensive are units (ICUs), with 3,363 beds, mainly polyvalent ICUs (81%) and 43 intermediate care units. The number of patients attended in the Services of ICM in 2008 was 174,904, with a percentage of occupation of 79.5% A total of 228 units attending critically ill patients, which are dependent of other services with 2,233 beds, 772 for pediatric patients or neonates, were registered. When these last specialized units are excluded, there was a marked predominance of postsurgical units followed by coronary and cardiac units.

CONCLUSIONS

Seventy one per cent of beds available in the Critical Care Units in Spain are characterized by attending severe adult patients, are dependent of the services of ICM, and most of them are polyvalent.

[Recommendations of the Infectious Diseases Work Group (GTEI) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Infections in Critically Ill Patients Study Group (GEIPC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) for the diagnosis and treatment of influenza A/H1N1 in seriously ill adults admitted to the Intensive Care Unit]

The diagnosis of influenza A/H1N1 is mainly clinical, particularly during peak or seasonal flu outbreaks. A diagnostic test should be performed in all patients with fever and flu symptoms that require hospitalization. The respiratory sample (nasal or pharyngeal exudate or deeper sample in intubated patients) should be obtained as soon as possible, with the immediate start of empirical antiviral treatment. Molecular methods based on nucleic acid amplification techniques (RT-PCR) are the gold standard for the diagnosis of influenza A/H1N1. Immunochromatographic methods have low sensitivity; a negative result therefore does not rule out active infection. Classical culture is slow and has low sensitivity. Direct immunofluorescence offers a sensitivity of 90%, but requires a sample of high quality. Indirect methods for detecting antibodies are only of epidemiological interest. Patients with A/H1N1 flu may have relative leukopenia and elevated serum levels of LDH, CPK and CRP, but none of these variables are independently associated to the prognosis. However, plasma LDH> 1500 IU/L, and the presence of thrombocytopenia <150 x 10(9)/L, could define a patient population at risk of suffering serious complications. Antiviral administration (oseltamivir) should start early (<48 h from the onset of symptoms), with a dose of 75 mg every 12h, and with a duration of at least 7 days or until clinical improvement is observed. Early antiviral administration is associated to improved survival in critically ill patients. New antiviral drugs, especially those formulated for intravenous administration, may be the best choice in future epidemics. Patients with a high suspicion of influenza A/H1N1 infection must continue with antiviral treatment, regardless of the negative results of initial tests, unless an alternative diagnosis can be established or clinical criteria suggest a low probability of influenza. In patients with influenza A/H1N1 pneumonia, empirical antibiotic therapy should be provided due to the possibility of bacterial coinfection. A beta-lactam plus a macrolide should be administered as soon as possible. The microbiological findings and clinical or laboratory test variables may decide withdrawal or not of antibiotic treatment. Pneumococcal vaccination is recommended as a preventive measure in the population at risk of suffering severe complications. Although the use of moderate- or low-dose corticosteroids has been proposed for the treatment of influenza A/H1N1 pneumonia, the existing scientific evidence is not sufficient to recommend the use of corticosteroids in these patients. The treatment of acute respiratory distress syndrome in patients with influenza A/H1N1 must be based on the use of a protective ventilatory strategy (tidal volume <10 ml / kg and plateau pressure <35 mmHg) and positive end-expiratory pressure set to high patient lung mechanics, combined with the use of prone ventilation, muscle relaxation and recruitment maneuvers. Noninvasive mechanical ventilation cannot be considered a technique of choice in patients with acute respiratory distress syndrome, though it may be useful in experienced centers and in cases of respiratory failure associated with chronic obstructive pulmonary disease exacerbation or heart failure. Extracorporeal membrane oxygenation is a rescue technique in refractory acute respiratory distress syndrome due to influenza A/H1N1 infection. The scientific evidence is weak, however, and extracorporeal membrane oxygenation is not the technique of choice. Extracorporeal membrane oxygenation will be advisable if all other options have failed to improve oxygenation. The centralization of extracorporeal membrane oxygenation in referral hospitals is recommended. Clinical findings show 50-60% survival rates in patients treated with this technique. Cardiovascular complications of influenza A/H1N1 are common. Such problems may appear due to the deterioration of pre-existing cardiomyopathy, myocarditis, ischemic heart disease and right ventricular dysfunction. Early diagnosis and adequate monitoring allow the start of effective treatment, and in severe cases help decide the use of circulatory support systems. Influenza vaccination is recommended for all patients at risk. This indication in turn could be extended to all subjects over 6 months of age, unless contraindicated. Children should receive two doses (one per month). Immunocompromised patients and the population at risk should receive one dose and another dose annually. The frequency of adverse effects of the vaccine against A/H1N1 flu is similar to that of seasonal flu. Chemoprophylaxis must always be considered a supplement to vaccination, and is indicated in people at high risk of complications, as well in healthcare personnel who have been exposed.

Anaerobic monodigestion of poultry manure: determination of operational parameters for CSTR

In this work the anaerobic monodigestion for the treatment of turkey manure was evaluated, without its codigestion with another substrate. The effect of the organic loading rate (OLR) and the substrate concentration (high total solids (TS) concentration) or product concentration (high volatile fatty acids (VFA) and/or ammonia (NH(3)-N) concentrations) was studied. The results show that for a continuous stirred tank reactor (CSTR) operation, a maximum of 40 g/L of TS and 4.0 g/L of ammonium (NH(4)(+)) was required. In addition, the maximum organic loading rate (OLR) will not exceed 1.5 kg VS/m(3)d. Higher TS and NH(4)(+) concentrations and OLR lead to a reduction on the methane productivity and volatile solids (VS) removal. During the CSTR operation, a high alkalinity concentration (above 10 g/L CaCO(3)) was found; this situation allowed maintaining a constant and appropriate pH (close to 7.8), despite the VFA accumulation. In this sense, the alkalinity ratio (α) is a more appropriate control and monitoring parameter of the reactor operation compared to pH. Additionally, with this parameter a VS removal of 80% with a methane productivity of 0.50 m(3)(CH4)/m(3)(R)d is achieved.

Arsenic mobilization by epilithic bacterial communities associated with volcanic rocks from Camarones River, Atacama Desert, northern Chile

The arsenic biogeochemical cycle is greatly dependent on microbial transformations that affect both the distribution and mobility of arsenic species in the environment. In this study, a microbial biofilm from volcanic rocks was characterized on the basis of its bacterial composition and ability to mobilize arsenic under circumneutral pH. Biofilm microstructure was analyzed by scanning electron microscopy (SEM)-energy-dispersive spectroscopy (EDS). Strains were isolated from biofilms and identified by 16S rDNA sequences analysis. Arsenic oxidation and reduction capacity was assayed with high-performance liquid chromatography coupled to gaseous formation performing the detection by atomic absortion in a quartz bucket (HPLC/HG/QAAS), and polymerase chain reaction was used to detect aox and ars genes. Bacterial communities associated with volcanic rocks were studied by denaturing gradient gel electrophoresis (DGGE). The SEM-EDS studies showed the presence of biofilm after 45 days of incubation. The relative closest GenBank matches of the DNA sequences, of isolated arsenic-resistant strains, showed the existence of four different genus: Burkholderia, Pseudomonas, Erwinia, and Pantoea. Four arsenite-resistant strains were isolates, and only three strains were able to oxidize >97% of the As(III) present (500 uM). All arsenate-resistant isolates were able to reduce between 69 and 86% of total As(V) (1000 uM). Analysis of 16S rDNA sequences obtained by DGGE showed the presence of four bacterial groups (∝-proteobacteria, γ-proteobacteria, Firmicutes, and Actinobacteria). Experiments demonstrate that epilithic bacterial communities play a key role in the mobilization of arsenic and metalloids speciation.