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Earlier activities on health technology assessment (HTA) started in Spain around 1984, with the creation of a National Advisory Board on HTA, and the development of national and regional HTA organizations in the early 1990s. In 2012, the Spanish Health Ministry established the Spanish Network for Health Technology Assessment of the National Health System (RedETS); funded at national level and including all public HTA organizations at national and regional levels. RedETSis focused on the assessment of nondrug health technologies to inform the revision (approval and funding or disinvestment) of the Benefit Portfolio of the Spanish NHS. In parallel with European Network for Health Technology Assessment (EUnetHTA), RedETS has been setting-up and sharing common procedures and methodological guidelines to ensure effective cooperation and mutual recognition of the scientific and technical production in HTA. The output of RedETS is fifty to sixty annual reports, including the production of full HTA reports, Clinical Practice Guidelines, methodological guidance reports, relative effectiveness assessments, tools to support shared decision making between patients and healthcare professionals, and monitoring studies. The HTA assessments requested by the Regional Health Authorities are the biggest component of the annual RedETS working plan. These assessment needs are identified according to a yearly process and prioritized by a Commission composed of representatives from all Spanish regions with the aid of the PRITEC tool. The objectives of this study are to report and update the normative and organizational state of HTA in Spain; describing noteworthy advances witnessed over the past 10 years, as well as discussing existing challenges.
With the aim of performing perimeter surveillance of high-speed railway networks, this paper presents the design of a passive multistatic radar system based on the use of Long-Term Evolution (LTE) downlink signals as the illumination of opportunity. Taking into account the specifications and standard of the LTE system, the ambiguity function of measured downlink signals is analyzed in terms of range and Doppler resolution, ambiguities, and sidelobe level. The deployment of the proposed passive radar is flexible and scalable, and it is based on multichannel software defined radio receivers that obtain the reference and surveillance signals by means of digital beamforming. The signal processing and data fusion are based, respectively, on the delay-Doppler cross-correlation with the reconstructed reference signals and a two-stage tracking at sensor and central level. Finally, the performance of the proposed system is estimated in terms of its maximum detection range and simulation results of the detection of moving targets are presented, demonstrating its technical feasibility for the short-range detection of pedestrians, vehicles, and small drones.
The design of mixed-technology quasi-reflectionless planar bandpass filters (BPFs), bandstop filters (BSFs), and multi-band filters is reported. The proposed quasi-reflectionless filter architectures comprise a main filtering section that determines the power transmission response (bandpass, bandstop, or multi-band type) of the overall circuit network and auxiliary sections that absorb the reflected radio-frequency (RF) signal energy. By loading the input and output ports of the main filtering section with auxiliary filtering sections that exhibit a complementary transfer function with regard to the main one, a symmetric quasi-reflectionless behavior can be obtained at both accesses of the overall filter. The operating principles of the proposed filter concept are shown through synthesized first-order BPF and BSF designs. Selectivity-increase techniques are also described. They are based on: (i) cascading in-series multiple first-order stages and (ii) increasing the order of the filtering sections. Moreover, the RF design of quasi-reflectionless multi-band BPFs and BSFs is discussed. A hybrid integration scheme in which microstrip-type and lumped-elements are effectively combined within the filter volume is investigated for size miniaturization purposes. For experimental validation purposes, two quasi-reflectionless BPF prototypes (one- and two-stage architectures) centered at 2 GHz and a second-order BSF prototype centered at 1 GHz were designed, manufactured, and measured.
Three sizes of beads 1, 2 and 3 mm of chitosan and poly (vinyl alcohol) were generated and crosslinked with ethylene glycol diglycidyl ether. The modification was carried out using a glass reactor, in which the beads were exposed to the glow discharge plasma (GDP). The adsorption experiments were carried out in triplicate at 30 °C, 200 rpm, 72 h at different pH values in the range between 2 and 7. The concentrations of the dye in the supernatants were determined by UV-vis spectrophotometry. The 1 mm beads with and without modification, as well as those adsorbed and without adsorbing were characterized by FTIR and SEM. A higher and constant adsorption capacity was observed using modified beads (814, 857 and 1509 mg/g for the 3, 2 and 1 mm beads, respectively). For unmodified beads the adsorption capacity decreased when the initial pH value was increased. This makes the beads modified by GDP a robust material with respect to pH variation and a good candidate to be used in the removal of synthetic dyes.
Mechanized dredging impact on discards was assessed along the northern Alboran Sea (W Mediterranean Sea). Data from 101 dredging operations were analysed for contrasting spatial and seasonal variability of damage, with the use of a three-level damage scale. 4.5% of discarded individuals displayed intermediate damage, whereas 11.3% displayed severe damage. Echinoderms displayed the highest level of damage (~75% of total collected individuals) and Echinocardium cf. mediterraneum was the most susceptible discarded species (85% with severe damage), followed by bivalves (7.3%) and crustaceans (3.3%). The target Chamelea gallina showed a low proportion of damaged individuals, probably due to their thick protective shell, which promotes the survival of discarded undersized target individuals. Spatial differences in damage level on discards were linked to some gear characteristics, to the higher amount of gravels and to longer tow durations, whereas damage was generally higher in cold months and partly related to higher quantities of hard shelled molluscs, in both cases increasing the abrasion and damage to retained organisms. Data suggest that dredges with a lower number of narrower iron teeth and towed for a shorter time could decrease the damage rate in discards of this fishery. A spatial management plan based on the type of grounds would be useful in order to improve efficiency of these fisheries and minimize their impact to soft bottoms with different commercial catches and biological communities.
Research on innovation management has pointed out that the capitalization of collaborative innovation practices is influenced by firms’ internal context. This paper aims to answer the following question: which organizational factors help to overcome the challenges that firms face in the different phases of the collaborative innovation process? For this purpose, previous literature is revised and three case studies are analyzed by means of applying a framework that structures the collaborative innovation process in three areas of relevance (i.e., development, integration and commercialization of the innovation). The results of the analysis inform the proposal of a theoretical framework that identifies the organizational context factors that determine the success or failure of collaborative innovation practices in each of the stages of the process.
Surgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.
To examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRS
American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011–2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.
Of 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes.
The primary outcome of interest was 30-day SSI rate.
A total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23–2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09–1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06–2.53; P=.02), and longer duration of procedure were associated with development of SSI.
Patients with disseminated cancer are at a higher risk for developing SSI. ASA score >3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.
To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017.
This prospective, pre–post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate.
During the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34–0.6; P<.001).
Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina.
The Spanish National Network (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. The necessity of considering a Quality Management System has been detected and, consequently, a common tool for all the members needs to be developed. We describe in this study the process to achieve that goal.
Based on both a review of previous literature and the proposal for a self-evaluating tool, a group of experts from each agency through consensus have developed a tool for self-evaluation in Health Technology Assessment (HTA) agencies. Through the structure described in the handbook of the Andalusian Agency for Healthcare Quality (ACSA), each standard should have a statement or proposal that needs to also include evidence or good practices, and the corresponding evaluation questions. In separate workgroups, the definition of these proposals, evidence and evaluation questions were developed. One face-to-face meeting and two meetings via teleconference were necessary to achieve a final document with all the quality standards.
From a proposed structure of sixty-six standards, the titles, definitions, statements and evidence as well as good practices and evaluation questions were established in workgroups with consensus among all of the members (1 - 3). The final version of the self-assessment tool was composed of sixty-eight standards, grouped in twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process, and IV Resources.
Quality management requires an evaluation tool and this version, based on a systematic review and consensus, is a useful and practical instrument for developing a handbook by each member of REDETS. An online version of the tool is in process of development.
The synthesis and antiprotozoal activity of some simple dialkyl pyrazole-3,5-dicarboxylates (compounds 2–6) and their sodium salts (pyrazolates) (compounds 7–9) against Trypanosoma cruzi, Leishmania infantum and Leishmania braziliensis are reported. In most cases the studied compounds showed, especially against the clinically significant amastigote forms, in vitro activities higher than those of the reference drugs (benznidazole for T. cruzi and glucantime for Leishmania spp.); furthermore, the low non-specific cytotoxicities against Vero cells and macrophages shown by these compounds led to good selectivity indexes, which are 8–72 times higher for T. cruzi amastigotes and 15–113 times higher for Leishmania spp. amastigotes than those of the respective reference drugs. The high efficiency of diethyl ester 3 and its sodium salt 8 against the mentioned protozoa was confirmed by further in vitro assays on infection rates and by an additional in vivo study in a murine model of acute and chronic Chagas disease. The inhibitory capacity of compounds 3 and 8 on the essential iron superoxide dismutase of the aforementioned parasites may be related to the observed anti-trypanosomatid activity. The low acute toxicity of compounds 3 and 8 in mice is also reported in this article.
Both maternal Fe deficiency (ID) and being overweight or obese (Ow/Ob, BMI≥25 kg/m2) may negatively affect offspring brain development. However, the two risk factors correlate and their independent effects on infant neurodevelopment are unclear. PREOBE is a prospective observational study that included 331 pregnant Spanish women, of whom 166 had pre-gestational Ow/Ob. Fe status was analysed at 34 weeks and at delivery, and babies were assessed using Bayley III scales of neurodevelopment at 18 months. In confounder-adjusted analyses, maternal ID at 34 weeks was associated with lower composite motor scores at 18 months (mean 113·3 (sd 9·9) v. 117·1 (sd 9·2), P=0·039). Further, the offspring of mothers with ID at delivery had lower cognitive scores (114·0 (sd 9·7) v. 121·5 (sd 10·9), P=0·039) and lower receptive, expressive and composite (99·5 (sd 8·6) v. 107·6 (sd 8·3), P=0·004) language scores. The negative associations between maternal ID at delivery and Bayley scores remained even when adjusting for maternal Ow/Ob and gestational diabetes. Similarly, maternal Ow/Ob correlated with lower gross motor scores in the offspring (12·3 (sd 2·0) v. 13·0 (sd 2·1), P=0·037), a correlation that remained when adjusting for maternal ID. In conclusion, maternal ID and pre-gestational Ow/Ob are both negatively associated with Bayley scores at 18 months, but independently and on different subscales. These results should be taken into account when considering Fe supplementation for pregnant women.
Art libraries have a vital role to play in documenting and disseminating the dynamic cultural identities of Latin American and Caribbean peoples. In Havana, some eight libraries and information centres share the task of documenting the art of Cuba itself, and of other Latin American and Caribbean countries. However, their collections are under-resourced and, in most cases, out-of-date; automation is overdue, and there is an urgent need to create a union catalogue and to develop a network of cooperation. (The text of a paper presented to the IFLA Section of Art Libraries at the IFLA General Conference at Havana, August 1994).
Objectives: Behavioral variant frontotemporal dementia (bvFTD) is characterized by early atrophy in the frontotemporoinsular regions. These regions overlap with networks that are engaged in social cognition-executive functions, two hallmarks deficits of bvFTD. We examine (i) whether Network Centrality (a graph theory metric that measures how important a node is in a brain network) in the frontotemporoinsular network is disrupted in bvFTD, and (ii) the level of involvement of this network in social-executive performance. Methods: Patients with probable bvFTD, healthy controls, and frontoinsular stroke patients underwent functional MRI resting-state recordings and completed social-executive behavioral measures. Results: Relative to the controls and the stroke group, the bvFTD patients presented decreased Network Centrality. In addition, this measure was associated with social cognition and executive functions. To test the specificity of these results for the Network Centrality of the frontotemporoinsular network, we assessed the main areas from six resting-state networks. No group differences or behavioral associations were found in these networks. Finally, Network Centrality and behavior distinguished bvFTD patients from the other groups with a high classification rate. Conclusions: bvFTD selectively affects Network Centrality in the frontotemporoinsular network, which is associated with high-level social and executive profile. (JINS, 2016, 22, 250–262)
In this work, Na- and K-doped β-Li5AlO4 samples were synthesized, characterized and analyzed thermogravimetrically (dynamically and isothermally), under different CO2 conditions. Additionally, chemisorption/desorption cycles were performed for the best chemical compositions and thermal conditions determined. While the CO2 chemisorption of the Na- and K-doped β-Li5AlO4 samples was improved at high temperatures (450 -700 °C), the opposite effect was observed at lower temperatures as well as in the presence of water vapor.
This article focuses on one of the most suggestive proposals within the sound domain of the twentieth century: the concerts for bells and bell towers devised by the Spanish musician Llorenç Barber. His original idea of transforming the city into a monumental instrument provides the starting point for the analysis. In order to access the competing claims of sound art versus music, the text approaches Barber’s creative thinking as if it were a sound grammar devised specifically for the city: materials and performance techniques become a ‘phonetics’, structural elements as a ‘morphology’, the ‘syntax’ of sound-handling strategies, and the formal structure of the score as a ‘narrative’ of the concert. Within each dimension, the text shows how the ‘city instrument’ has extended Barber’s creative horizon by transforming musical problems into unclassifiable strategies of dealing with sound, which are capable of producing a sonic experience deeply rooted in the historical and cultural development of the city. Finally, this research shows how uncertainty, indeterminacy, ambiguity, accident or change (unacceptable concepts for the traditional musical domain) become an essential part of these works. Inevitably, such aspects require from the ‘composer’ a kind of pragmatism that seems to be inherent in the outdoor sound design.
We present a simple and robust method to acquire quantitative maps of compositional fluctuations in nanostructures from low magnification high-angle annular dark field (HAADF) micrographs calibrated by energy-dispersive X-ray (EDX) spectroscopy in scanning transmission electron microscopy (STEM) mode. We show that a nonuniform background in HAADF-STEM micrographs can be eliminated, to a first approximation, by use of a suitable analytic function. The uncertainty in probe position when collecting an EDX spectrum renders the calibration of HAADF-STEM micrographs indirect, and a statistical approach has been developed to determine the position with confidence. Our analysis procedure, presented in a flowchart to facilitate the successful implementation of the method by users, was applied to discontinuous InGaN/GaN quantum wells in order to obtain quantitative determinations of compositional fluctuations on the nanoscale.
The composition and structure of sublittoral faunal assemblages inhabiting soft bottoms (15–72 m depth) within the Marine Protected Area ‘Acantilados y Fondos Marinos de Calahonda-Castell de Ferro’ in southern Spain (North Alboran Sea, Mediterranean) have been studied in relation to sediment and water column variables. Three assemblages were identified and corresponded to mixed bottom, unstable bottom and coastal detritic bottom assemblages, based on Pérès & Picard's (1964) benthic classification. A total of 14,318 individuals were collected and 218 species identified, molluscs being the best represented group (141 species). Species richness displayed significant differences with depth and transect, with the highest values observed in the medium to very fine sand and muddy bottoms with bioclasts located at the shallowest sampling stations. The presence of some rare and poorly known invertebrates that are scarce in other areas of the Mediterranean Sea is remarkable, such as the crustacean decapods Bythocaris cosmetops and Pagurus mbizi, Atlantic species with no records in the Mediterranean Sea, and the bathyal molluscs Poromya granulata and Alvania testae, collected at shallow depths. The spatial distribution of faunal assemblages was mainly related to depth and percentage of gravel and clay according to the canonical correspondence analysis. The geographic location of the area, the heterogeneity of soft bottoms and the presence of upwellings in the area may favour the high biodiversity found in the studied soft bottoms. This study increases the scarce knowledge of the circalittoral fauna of sedimentary habitats of the Alboran Sea, providing a baseline for the management of this interesting SCI and for the EU Marine Strategy Framework Directive.
The purpose of this work was to study the relationship between self-focused
attention and mindfulness in participants prone to hallucinations and others who
were not. A sample of 318 healthy participants, students at the universities of
Sevilla and Almería, was given the Launay-Slade Hallucinations
Scale-revised (LSHS-R, Bentall & Slade, 1985). Based on this sample, two groups were formed:
participants with high (n = 55) and low proneness
(n = 28) to hallucinations. Participants with a
score higher than a standard deviation from the mean in the LSHS-R were included
in the high proneness group, participants with a score lower than a standard
deviation from the mean in the LSHR-R were included in the second one. All
participants were also given the Self-Absorption Scale (SAS, McKenzie
& Hoyle, 2008) and the
Southampton Mindfulness Questionnaire (SMQ, Chadwick et al., 2008). The results showed that
participants with high hallucination proneness had significantly higher levels
of public (t(80) = 6.81, p
< .001) and private (t(77) = 7.39,
p < .001) self-focused attention and lower levels
of mindfulness (t(81) = -4.56, p
< .001) than participants in the group with low hallucination
proneness. A correlational analysis showed a negative association between
self-focused attention (private and public) and mindfulness (r
= -0.23, p < .001; r
= -0.38, p < .001 respectively). Finally,
mindfulness was found to partly mediate between self-focused attention and
hallucination proneness. The importance of self-focused attention and
mindfulness in understanding the etiology of hallucinations discussed and
suggest some approaches to their treatment.
A combination of transmission electron microscopy techniques and spatially resolved microanalysis is used to investigate the nanostructure, constituting phases, and chemical elemental distribution in CrAlYN multilayered coatings. The location of the metallic elements and their chemical state are needed to understand their functional properties. Samples were prepared with variable Al (4–12 at%) and Y (2–5 at%) contents by direct current reactive magnetron sputtering on silicon substrates using metallic targets and Ar/N2 mixtures under different deposition parameters (power applied to the target and rotation speed of the sample holder). The changes produced in the nanostructure and chemical distribution were investigated. Nanoscale resolution electron microscopy analysis has shown that these coatings present a singular nanostructure formed by multilayers containing at a certain periodicity nanovoids filled with molecular nitrogen. Spatially resolved energy dispersive spectroscopy and electron energy loss elemental mappings and profiles showed that the chromium, aluminum, and yttrium atoms are distributed in a sequential way following the position of the targets inside the deposition chamber. Analysis of the different atomic distribution and phases formed at the nanoscale is discussed depending on the deposition parameters.