Quality analysis and categorisation of public space

Public spaces are considered areas that promote users' physical and mental health. The role of these people in public spaces makes it necessary to evaluate such areas. In this study, 12 urban parks on the island of Tenerife were evaluated, combining the assessment of a trained observer and the perception of users, to analyse and categorise the environmental quality of the parks. The findings of this study conclude that users are good evaluators of public spaces; that the Public Space Characteristics Observation Questionnaire (PSCOQ) tool allows the classification of public spaces and that physical order is capable of predicting the environmental quality and the restorative capacity of spaces, as perceived by users. The PSCOQ observation tool makes it possible to detect the strengths and weaknesses of public spaces so they can be improved and adapted to the needs of users.

Impact of socioeconomic inequalities on dental caries in deprived children: a multilevel analysis

OBJECTIVES

Inequalities have been reported between high, middle and low socioeconomic position (SEP) children. However, the effect of contextual and individual SEP on existing inequalities among socioeconomically deprived children varies between local contexts. The aim of this study was to assess the impact of contextual and individual SEP on individual caries experience among socioeconomically deprived children in Chile.

METHODS

Cross-sectional multilevel analysis of data from the 2015 electronic register of the National Board of School Aid and Scholarships (JUNAEB) of Chile. The contextual variables were the municipality Human Development Index (HDI) and rurality index. Individual variables included gender, living in extreme poverty and school grade. Multilevel negative binomial models assessed their impact on DMFT/dmft.

RESULTS

112,429 children in 255 municipalities were included. Overall, contextual SEP (HDI) was not associated with caries experience in the primary or permanent dentition. Individual SEP (living in extreme poverty) was associated with caries experience in both dentitions. The proportion of children living in extreme poverty with caries experience in the primary teeth was 17% higher than children not living in extreme poverty (PR 1.17; 95% CI 1.15-1.19), while for children with permanent teeth it was 9% higher (PR 1.09; 95% CI 1.08-1.11).

CONCLUSION

These findings could support the development of health strategies focused on individual SEP to efficiently reduce oral health inequalities among socioeconomically deprived children.

Experimental study of the potential for thermal energy recovery with thermoelectric devices in low displacement diesel engines

Improving the thermal efficiency of internal combustion engines is essential to reduce the operating costs and complaints with the increasing environmental requirements. Thermoelectric generators came up as an opportunity to reuse part of the heat loss with the exhausts. This paper evaluates the performance of a thermoelectric generator to improve the efficiency of a stationary diesel engine under different rotational speeds and torques. The data was obtained through CFD simulations and validated with experiments. The proposed solution uses a cooling system to control the temperature of the thermoelectric modules. The results show that the torque and the rotational speed of the engine are the most significant performance parameters of the thermoelectric generator, while the influence of the cooling water temperature has a minor but still significant influence. Additionally, the results show a change from 1.3% to 6.2% in the thermoelectric generator efficiency, while the exergy efficiency varies between 1.8% and 7.9%. The exergy balance indicates that most of the exergy is loss because of the irreversibilities in the thermoelectric generator and of the exergy loss with the exhausts. The exergy loss can be reduced by optimizing the design of the heat exchanger. Since the thermoelectric generator improved the engine efficiency by a marginal 0.2%-0.8%. Therefore, it is important to further research how to improve the design of heat exchangers for thermoelectric generators to increase their energy conversion efficiency and their impact on the energy efficiency of internal combustion engines.

Context-Dependence in parasite effects on keyhole limpets

Parasites alter the reproductive performance of their hosts, limit their growth, and thereby modify the energy budget of these hosts. Experimental studies and theoretical models suggest that the outcome of the host-parasite interactions could be determined by ecological factors such as food availability levels in the local habitats. Nutrient inputs may affect the host's food resource availability with positive or negative effects on parasite infection rates and tolerance of infection, however this has not been specifically evaluated in natural systems. In this study, we evaluate the effects of parasitism by Proctoeces humboldti on body size, gonadosomatic index (GSI), and metabolic rate (oxygen consumption) of their second intermediate host Fissurella crassa limpets, under contrasting natural conditions of productivity (upwelling center vs upwelling shadow sites). Our results evidenced that parasitized limpets collected from the intertidal habitat influenced by coastal upwelling site showed greater shell length, muscular foot biomass and GSI as compared to non-parasitized limpets collected in the same site, and compared to parasitized and non-parasitized limpets collected from the sites under the influence of upwelling shadow conditions. Oxygen consumption was lower in parasitized limpets collected from the upwelling-influenced site than in the other groups, independent of age, suggesting reduced metabolic stress in infected individuals inhabiting these productive sites. Our results suggest that increased productivity in upwelling sites could mitigate the conflict for resources in the P. humboldti - F. crassa system, influencing where such interaction is found in the continuum between parasitism and mutualism. Since parasitism is ubiquitous in natural systems, and play important roles in ecological and evolutionary processes, it is important to analyze host-parasite interaction across a variety of ecological conditions, especially in biological conservation.

Results after implementation of a sedoanalgesia protocol for procedures in hospital environment

INTRODUCTION

We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure.

PATIENTS AND METHOD

Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction.

RESULTS

279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe.

CONCLUSIONS

The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Determination of Nitrogen Solubility in Dilute Pepsin Hydrochloric Acid Solution of Fishmeal: Interlaboratory Study

A revised method to determine solubility of nitrogen in dilute pepsin, using 0.0002% pepsin in place of 0.2% in AOAC Official Method 971.09, was tested in 16 laboratories with 12 samples of fishmeal. Results were calculated according to 2 procedures: AOAC Official Method 971.09 and a method described in 1964 by researchers at the Torry Research Station (Aberdeen, Scotland), and generally referred to as the modified Torry method. Variations in the method of shaking and source of pepsin were also investigated. Pepsin solubility values were lower and more variable when calculated by the Torry procedure. The method of shaking apparently affected the result when calculated according to the Torry but not the AOAC method. The source of pepsin had no significant effect on between-laboratory variability, but a comparison of the 2 main sources within one laboratory resulted in highly significant differences. Based on this study, the International Fishmeal and Fish Oil Organization has adopted this new method, using 0.0002% pepsin but keeping the AOAC method of calculation. The type of shaker and source of pepsin are recommended but are not mandatory. The repeatability and reproducibility limits of this new method are 1.6 and 3.3% units of solubility, respectively.

The cAMP/PKA Pathway Inhibits Beta-amyloid Peptide Release from Human Platelets

The main component of Alzheimer's disease (AD) is the amyloid-beta peptide (Aβ), the brain of these patients is characterized by deposits in the parenchyma and cerebral blood vessels known as cerebral amyloid angiopathy (CAA). On the other hand, the platelets are the major source of the Aβ peptide in circulation and once secreted can activate the platelets and endothelial cells producing the secretion of several inflammatory mediators that finally end up unchaining the CAA and later AD. In the present study we demonstrate that cAMP/PKA pathway plays key roles in the regulation of calpain activation and secretion of Aβ in human platelets. We confirmed that inhibition of platelet functionality occurred when platelets were incubated with forskolin (molecule that rapidly increased cAMP levels). In this sense we found that platelets pre-incubated with forskolin (20 μM) present a complete inhibition of calpain activity and this effect is reversed using an inhibitor of protein kinase A. Consequentially, when platelets were inhibited by forskolin a reduction in the processing of the APP with the consequent decrease in the Aβ peptide secretion was observed. Therefore our study provides novel insight in relation to the mechanism of processing and release of the Aβ peptide from human platelets.

ZrO2-SBA-15 catalysts for the one-pot cascade synthesis of GVL from furfural

Controlling the zirconia coating thickness in ZrO₂-SBA-15 materials allows tuning their catalytic performance in the one-pot transformation of furfural into GVL.

A composite indicator to assess the quality of care in the management of patients with rheumatoid arthritis in outpatient rheumatology clinics

OBJECTIVE

The current guidelines in the treatment of rheumatoid arthritis (RA) include the early diagnosis and early use of disease modifying drugs to achieve remission or low disease activity level, known as "Treat to Target" (T2T). The objective of this study is to develop a composite indicator (CI) to evaluate the quality of care in the management of patients with RA, according to the T2T strategy and other general recommendations concerning the management of these patients.

MATERIAL AND METHOD

The phases of the construction of the CI were: 1) selection of quality criteria through expert judgment; 2) prioritization of the criteria, according to relevance and feasibility, applying the Delphi methodology (two rounds) involving 20 experts; 3) design of quality indicators; and 4) calculation of the weighted CI, using the mean value in relevance and feasibility granted by the experts. The source of information for the calculation of the CI are the medical records of patients with RA.

RESULTS

Twelve criteria out of 37 required a second Delphi round. Thirty-one criteria were prioritized. These criteria presented a median in relevance and feasibility greater than or equal to 7.5, with an interquartile range of less than 3.5, and a level of agreement (score greater than or equal to 8) greater than or equal to 80%.

CONCLUSIONS

The constructed CI allows us to evaluate the quality of care of patients with RA following the T2T strategy in the rheumatology units of Spanish hospitals, offering a valid and easily interpretable summary measure.

CIELAB color coordinates versus relative proportions of myoglobin redox forms in the description of fresh meat appearance

This work examined changes in color that can be explained solely on the basis of the total myoglobin content and the relative proportions of deoxymyoglobin, oxymyoglobin (OMb) and metmyoglobin (MMb) during storage of meat. Meat color was evaluated for L*, a*, b*, C* and h_ab. Total pigment content was measured from the reflex attenuance at 525 nm (A₅₂₅). The relative proportions of each pigment was determined using two different methods: the Krzywicki method based on the reflex attenuance values at 473, 525, 572 and 700 nm and the KS method based on K/S ratios of the absorption and scattering coefficients (K/S)₄₇₄ ÷ (K/S)₅₂₅, (K/S)₅₇₂ ÷ (K/S)₅₂₅ and (K/S)₆₁₀ ÷ (K/S)₅₂₅. The study was performed on beef (Longissimus lumborum) samples measured after 1, 4 and 7 days of exposure to air. Result revealed that L* values can be fully explained by A₅₂₅ alone. C* and a* were well explained by those parameters related to OMb content. The other color parameters depended on pigment forms. The KS method gave better results. The parameters related to MMb content were relevant to classify samples according to the time of exposure to air. In any case, information provided by color and pigment parameters were complementary to each other.

A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study

Objective

To generate a global reference for caesarean section (CS) rates at health facilities.

Design

Cross‐sectional study.

Setting

Health facilities from 43 countries.

Population/Sample

Thirty eight thousand three hundred and twenty‐four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing.

Methods

We hypothesised that mathematical models could determine the relationship between clinical‐obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three‐step approach to generate the global benchmark of CS rates at health facilities: creation of a multi‐country reference population, building mathematical models, and testing these models.

Main outcome measures

Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate.

Results

According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C‐Model, with summary estimates ranging from 0.832 to 0.844. The C‐Model was able to generate expected CS rates adjusted for the case‐mix of the obstetric population. We have also prepared an e‐calculator to facilitate use of C‐Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/).

Conclusions

This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C‐Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS.

Tweetable abstract

The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems.

The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems.

General expressions for the refractive indices of absorbing biaxial media as a function of the angle of incidence

In this work we obtain general expressions for the complex refractive indices of refracted waves as a function of the angle of incidence in the case of an electromagnetic wave propagating in a transparent isotropic medium that reaches an interface with a biaxial absorbing medium. The biaxial absorbing medium is only required to have a diagonalizable complex dielectric tensor. Obtained expressions can be applied to any orientation of the principal axes and can be specialized for isotropic, uniaxial or biaxial, or transparent or absorbing media. By using these expressions we have also obtained the surface of indices and the surface of absorption coefficients for an example of a biaxial absorbing medium.

Diagnostic utility of oxidative damage markers for early rheumatoid arthritis in non-smokers and negative anti-CCP patients

BACKGROUND

Besides the development of new markers and diagnostic criteria for rheumatoid arthritis (RA), many patients are still diagnosed after several years of symptoms. Oxidative stress markers are already increased at an early stage of RA. Our aim was to evaluate the additional diagnostic value of these markers.

METHODS

A case-control study was performed. Patients met the 1987 RA ACR criteria, less than 2 years of symptoms and no previous treatment with disease-modifying anti-rheumatic drugs (DMARD), steroids or vitamin E. Controls were selected from patient's relatives and matched (1:1) by gender, age, and current smoking habit. Oxidative damage markers were malonyldialdehyde (MDA), Lipid hydroperoxides (LOOH) and Carbonyl proteins (CP). Statistical analysis was performed in agreement with the STARD initiative.

RESULTS

Sixty-five RA patients without treatment and 65 healthy controls were included. LOOH, CP, antibodies against citrullinated peptides (anti-CCP) and rheumatoid factor (RF) were significantly higher in patients, and MDA higher in controls. The same results were obtained in the subgroups of patients who smoke or not, and in anti-CCP positive or negative. The diagnosis performance of traditional markers showed good specificity but low sensitivity. The addition of LOOH and CP increased the sensitivity and the area under the receiving operating characteristic (ROC) curve especially in non-smoking (66%) and negative anti-CCP (51%) patients.

CONCLUSIONS

The separate or combined addition of LOOH or CP to the traditional disease markers improved the diagnosis of RA, especially in non-smoking or negative anti-CCP patients.

Protein Quantification by MRM for Biomarker Validation

In this chapter we describe how mass spectrometry-based quantitative protein measurements by multiple reaction monitoring (MRM) have opened up the opportunity for the assembly of large panels of candidate protein biomarkers that can be simultaneously validated in large clinical cohorts to identify diagnostic protein biomarker signatures. We outline a workflow in which candidate protein biomarker panels are initially assembled from multiple diverse sources of discovery data, including proteomics and transcriptomics experiments, as well as from candidates found in the literature. Subsequently, the individual candidates in these large panels may be prioritised by application of a range of bioinformatics tools to generate a refined panel for which MRM assays may be developed. We describe a process for MRM assay design and implementation, and illustrate how the data generated from these multiplexed MRM measurements of prioritised candidates may be subjected to a range of statistical tools to create robust biomarker signatures for further clinical validation in large patient sample cohorts. Through this overall approach MRM has the potential to not only support individual biomarker validation but also facilitate the development of clinically useful protein biomarker signatures.

Conformal sulfated zirconia monolayer catalysts for the one-pot synthesis of ethyl levulinate from glucose

Here we describe a simple route to creating conformal sulphated zirconia monolayers throughout an SBA-15 architecture that confers efficient acid-catalysed one-pot conversion of glucose to ethyl levulinate.

From high doses of oral rivastigmine to transdermal rivastigmine patches: user experience and satisfaction among caregivers of patients with mild to moderate Alzheimer disease

INTRODUCTION

Rivastigmine, a treatment for mild to moderate Alzheimer disease (AD), is the first cholinesterase inhibitor to be available in the transdermal format. We aim to describe user experience and satisfaction with the rivastigmine patch, as well as any clinical changes perceived in patients.

METHODS

Observational, cross-sectional, multicentre study with 239 investigators and 1851 informal caregivers of patients with mild to moderate AD. Patients were treated with transdermal rivastigmine patches for ≥ 6 months and had previously received high doses of oral rivastigmine.

RESULTS

Mean caregiver age was 59.8±14.4 years and 70.9% were women. They spent 10.0±7.1hours per day providing care and 79.8% lived with the patient. Patch instructions were described as easy to follow by 97.1% of the caregivers and 92.1% of them rated patch application as easy or very easy. The most commonly cited disadvantage was adhesion problems (26.8%). Discontinuation of treatment was due to cutaneous reactions in most cases. Overall, 76.5% of the caregivers were satisfied or very satisfied with transdermal treatment and 77.4% considered that its interference with daily activities was minimal or null. The patch was preferred to oral treatment by 94.3% of caregivers. Clinical Global Impression of Change ratings improved according to 61.3% of the caregivers and 53% of the investigators. Few caregivers reported medication forgetfulness.

CONCLUSIONS

Most caregivers of patients with mild to moderate AD preferred the transdermal format of rivastigmine to the oral format. Caregivers also reported overall satisfaction, ease of use, and reduced impact on daily activities for transdermal rivastigmine format, in addition to patient improvement compared to their condition under the previous treatment.

[Rivastigmine as treatment for patients with mild to moderately severe Alzheimer disease under normal clinical practice conditions. The ENTERPRISE study]

INTRODUCTION

Alzheimer disease (AD) causes progressive cognitive decline leading to loss of independence for activities of daily living; rivastigmine is one of the drugs used for symptomatic management.

OBJECTIVE

To assess the therapeutic use of different pharmaceutical forms of rivastigmine in patients with AD in normal clinical practice.

PATIENTS AND METHODS

Cross-sectional, observational, multi-centre study conducted on patients with mild to moderate AD treated with rivastigmine in Spanish outpatient clinics specialising in Geriatrics, Psychiatry, and Neurology. Data regarding use of oral (OR) and transdermal (TDR) rivastigmine, compliance (degree of adherence), and caregiver satisfaction with treatment were evaluated.

RESULTS

In total, 2252 patients with a mean age of 77.2 years were included; 60.2% were women. AD was moderate to moderately severe in 58.4%. Rivastigmine treatment was started orally in 54.4% of the patients and transdermally in 45.6%; 35.6% of those who started treatment by the OR route switched to TDR. A single dose adjustment was sufficient for 77.5% of patients on TDR treatment vs 11.8% of patients receiving OR treatment. More patients on TDR treatment (80.8% vs. 57.1% on OR treatment) reached the maximum therapeutic dose of rivastigmine and did so in a shorter period of time (51.6 vs 205.8 days). Compliance rates (60.5% vs 47.2%) and caregivers' satisfaction with treatment (89.4% vs 81.9%) were also higher for TDR.

CONCLUSIONS

In normal clinical practice, using the TDR route of administration improves dose titration and drug compliance, allowing more patients to reach the maximum recommended dose of rivastigmine in a shorter time period.

Factors determining when to start levodopa/carbidopa/entacapone treatment in Spanish patients with Parkinson's disease

INTRODUCTION

Several therapeutic options are available for the symptomatic treatment of Parkinson's disease (PD).There is no reliable information about which factors are involved in the choice of treatment.

OBJECTIVE

To identify factors contributing to the decision to start treatment with levodopa/carbidopa/entacapone (LCE) in patients with PD.

PATIENTS AND METHODS

We completed a descriptive cross-sectional retrospective multicentre study of patients with idiopathic PD receiving LCE. Clinical data were collected with special attention to factors that could potentially determine when to initiate treatment with LCE in normal clinical practice.

RESULTS

We studied 1050 patients with a mean age of 71.3±8.7 years (58.2% men). Average time from onset of symptoms to diagnosis was 13.8±12.9 months, with a latency time of 74.5±53.6 months before starting LCE treatment. The most common initial symptoms were tremor (70.6%), reduced dexterity (43.2%) and slowness of movement (41.5%). At the start of LCE treatment, most patients were in Hoehn and Yahr stage 2 (57.5%), with an average rating of 73.4% on the Schwab & England scale. Eight hundred twenty two patients (78.3%) received treatment with other drugs before starting LCE (mean time between starting any PD treatment and starting LCE was 40.5±47.2 months). Clinical factors with a moderate, marked, or crucial effect on the decision to start LCE treatment were bradykinesia (84.7%), daytime rigidity (72.2%), general decline (72.2%), difficulty walking (66.4%), tremor (62.7%), nocturnal rigidity (56.1%), and postural instability (53%). Difficulty performing activities of daily living was the only psychosocial factor identified as having an influence on the decision (84.3%).

CONCLUSIONS

The decision to start patients with idiopathic PD on LCE treatment is mainly determined by motor deficits and disabilities associated with disease progression.

Uniaxial absorbing media: conditions for refraction in the direction of the optical axis

When a plane wave is incident from an isotropic medium into a uniaxial transparent medium so that the ordinary wave propagates in the direction of the optical axis, the extraordinary wave will also propagate in the same direction and with the same refractive index. We will show that this is not the case when the second medium is a uniaxial absorbing material. In this work, we will state a clear and precise interpretation of the meaning of propagation in the direction of the optical axis in the case of uniaxial absorbing media. Assuming that the ordinary wave is refracted in the direction of the optical axis we will analyze the refraction of the extraordinary wave and we will compare it with the case of transparent media. The necessary conditions to have both ordinary and extraordinary waves refracted in the direction of the optical axis will be obtained.

Effect of normobaric hypoxia on the testis in a murine model

High-altitude hypoxia generates spermiogram impairment due to germinal epithelium, Leydig cells, sperm and seminal plasma alterations, but precise mechanisms involved are unknown. The objective of this work was to analyse the effect of normobaric hypoxia on the morphology of testicular interstitium and some associated molecular and hormonal factors. Twenty-four mice were exposed to normobaric hypoxia (8.1% inspired oxygen fraction) during 20 days. The effects on body weight, testicular weight, vascularisation, testosterone, HIF1-α and VEGF were analysed at different periods of exposure and compared to controls. Hypoxic mice had lower body weight than mice kept in normoxia. Testicular weight raised significantly the 1st day, but remained normal during the rest of experiment. Number of blood vessels per field and mean diameter of vessels were higher in hypoxic mice. Plasmatic and testicular testosterone raised during first 24 h of hypoxia, but decreased on the 5th day. Vascular/interstitial ratio (proportion of interstice occupied by blood vessels) duplicated at the end of the experiment. Most substantial early effects of hypoxia were testicular oedema, increase in number and diameter of blood vessels and elevation of plasmatic and testicular testosterone. Normobaric hypoxia generates similar effects to those induced by hypobaric hypoxia.

[Peri-operative management of disease modifying anti-rheumatic drugs: recommendations based on a meta-analysis]

The objective of this paper is make recommendations for the perioperative management of antirheumatic treatment based on the best available evidence. A systematic review was performed including studies in which patients with rheumatic diseases treated with biological and non-biological disease-modifying antirheumatic drugs (DMARDs) had undergone surgery. A total of 5,285 studies were recorded, of which 27 were finally included. These contained information on 5,268 patients and 7,933 surgeries. The majority were women (mean age 55 years) were diagnosed with rheumatoid arthritis, and the most studied drug was methotrexate (MTX). The final recommendations include: maintaining treatment with MTX or leflunomide in the perioperative period in the absence of other risk factors for postoperative complications (Level of Evidence 1c, Grade D recommendation). Biological DMARDs should be temporarily suspended, or the surgery scheduled as far as possible from the last dose, and, if there were other risk factors a space at least two doses (Level of Evidence 2c; Grade D recommendation).

[Consensus on the Use of Rituximab in Rheumatoid Arthritis. A document with evidence-based recommendations. Grupo de Expertos en Rituximab. ]

INTRODUCTION

Rituximab has been employed successfully for the treatment of Rheumatoid Arthritis (RA). However, its particular mechanism of action, as well as a lack of concrete guidelines for its management have generated doubts on its use.

OBJECTIVE

To establish recommendations that facilitates the use of rituximab in common clinical practice.

METHODS

In a first Delphi round, 9 expert rheumatologists got together to develop questions on those subjects generating most doubts on the efficacy and safety of the drug. These were adapted to perform a systematic review of the evidence, which was presented in a second meeting. Nominal groups were formed to respond to each question and give a recommendation. These recommendations were presented in a second Delphi round to a larger group of experts in rheumatology. Once again recommendations were discussed, modified and voted upon. Once approved, a vote on the degree of agreement for each recommendation was carried out.

RESULTS

17 recommendations were established, 10 regarding efficacy and 7 safety. All of the efficacy recommendations except 3 presented a good or moderate degree of evidence. Among the safety recommendations, 3 had a good or moderate degree of evidence while in the rest it was indirect, scarce or non-existent and a product of expert recommendation. The degree of agreement between experts was elevated for most of the recommendations.

CONCLUSIONS

These recommendations attempt to clear doubts on the use of rituximab and establish guidelines for its use in daily practice. Efficacy recommendations have a high degree of evidence, allowing the clinician to be guided in therapeutic decisions. Safety recommendations have a lower degree of evidence.

Influence of absorption on the anomalous negative refraction in right-handed uniaxial absorbing dielectric media

In this work we study the anomalous negative refraction when a plane wave is incident from an isotropic medium to a uniaxial absorbing medium. We study the influence of the anisotropy on the refractive indices and the anisotropy on the absorption coefficients in the negative refraction of these materials. Negative refraction can occur for the ordinary and extraordinary waves for a wide range of values of the angle of incidence. The allowed values of the angle of incidence that lead to negative refraction are analyzed in detail as a function of the orientation of the optic axis and the values of the refractive indices and absorption coefficients.

Interface between transparent isotropic and uniaxial absorbing dielectric media: equations for ray tracing and for the direction of propagation

In this work we analyze the propagation of a plane wave that passes from an isotropic transparent medium to a uniaxial absorbing medium. Detailed expressions that give the real directions of propagation of the wave and the energy of the reflected and refracted ordinary and extraordinary waves are obtained. These expressions are valid for every orientation of the optic axis of the uniaxial medium and for every direction of propagation of the incident wave. Expressions are tested in the case of an interface between a transparent and an absorbing isotropic media and for the air-rutile (TiO2) interface. The effect of absorption has been evaluated by comparing the results obtained in rutile with the results obtained in a transparent uniaxial medium with the same real refractive indices. Results are presented for different values of the angle of incidence and the orientation of the plane of incidence.

Should levodopa dose be reduced when switched to stalevo?

The addition of entacapone to levodopa-carbidopa (LC) or the switch from LC to a tablet containing levodopa-carbidopa-entacapone (LCE) improves the wearing-off phenomenon, increases the 'on' time and decreases the 'off' time, but the appearance or exacerbation of dyskinesias is the more frequent side-effect. Thus, a reduction of the total levodopa dosage would be recommended. However, this could result in a lack of efficacy against the wearing-off. We report on the results of a clinical trial conducted to determine the best way in terms of efficacy, tolerability and safety of switching from LC to LCE in patients with Parkinson's disease (PD) and end of dose wearing-off. 39 patients with PD and wearing-off without or with mild dyskinesias were randomly assigned to either a group receiving the same LC dosage or to a group in which the total LC amount was reduced by 15-25%. Four weeks after the change, both groups showed an increase in daily 'on' time and a reduction in the daily time spent in 'off'. Two patients in each group experienced an increase in basal dyskinesias. No differences in clinical assessment between groups were found. Tolerance was excellent. This study suggests that switching from LC to LCE in patients with mild-to-moderate wearing-off can be done safely with or without reducing the total LD amount, but in the clinical setting it would be more practical to keep the dosage of LC unchanged unless severe dyskinesias are present.

Complex unitary vectors for the direction of propagation and for the polarization of electromagnetic waves in uniaxial and absorbing dielectric media

The propagation of inhomogeneous and elliptically polarized plane waves in absorbing uniaxial anisotropic media is described using complex unitary vectors to represent the direction of propagation and the direction of polarization. Detailed expressions for electric displacement, electric field, and magnetic field vectors are obtained for the ordinary and extraordinary waves, and their geometry is discussed. According to the complex direction of propagation, three particular cases are studied: the real case (homogeneous wave), the case perpendicular to the optical axis, and the case coplanar with the optic axis. The case of isotropic media is also analyzed.

[Anesthesia in urology: notes on its history and development in Spain, 1847 to 1950]

This review of the historical course of anesthesia performed in the context of urology in Spain relies on primary sources: doctoral theses, dissertations, published articles, inaugural addresses, conference proceedings, and books belonging to various archives and libraries. We collected a large number of documents relating to urology and of particular interest regarding anesthesia, classified them, and subjected them to critical analysis. This allowed us to carefully follow the development of anesthesia and urology itself, both of which attained notable clinical and scientific importance in Spain. Anesthesia with chloroform and incomplete anesthesia were the norm during the second half of the 19th century. However, during the first half of the 20th century, the most widely used techniques were the application of ether or spinal or local infusions, although epidural and intravenous techniques were also mentioned.

Long-term effectiveness and quality of life improvement in entacapone-treated Parkinson's disease patients: the effects of an early therapeutic intervention

To evaluate the long-term effects of entacapone on both mean daily 'on' time and health-related quality of life (QoL) in patients with Parkinson's disease (PD) experiencing 'end-of-dose' motor fluctuations and the benefits of an early therapeutic intervention. A prospective, multicenter, observational, 12-month study was performed with an initial 3-month intervention phase, consisting of a phone call to half of the patients from randomly selected investigators to assess if dose adjustment was necessary. Effectiveness was determined by home diaries ('on' time), subscales II and III of the Unified Parkinson's Disease Rating Scale (UPDRS), and the Parkinson's Disease Questionnaire (PDQ-8). After 3 months of treatment, 4.0% of the intervention group patients discontinued the study, versus 18.4% in the control group (P < 0.01). The improvement in 'on' time was significantly increased since the 3-month visit (21%, P < 0.0001) until the end of the study (23% at 12 months, P < 0.0001). Entacapone also induced significant reductions in the UPDRS scores for subscales II and III and in the PDQ-8 score. 11.2% of patients experienced at least one adverse reaction. This study confirms the effectiveness of entacapone in reducing motor fluctuations by increasing 'on' time, and in improving QoL of PD patients. An early adjustment of entacapone and levodopa doses reduces the number of treatment discontinuations during the first months of treatment.