Valoración funcional en la demencia grave

Severe dementia is currently one of the main causes of dependence and is defined as cognitive impairment that interferes with the performance of basic activities of daily living. However, in clinical practice severe dementia is difficult to define.Assessment of the ability to perform activities of daily living is a key factor in patients with severe dementia, since functional impairment is a defining feature. Assessment allows an accurate prognosis to be made and a care plan to be established, as well as the effectiveness of the intervention to be evaluated, when necessary.Functional assessment in dementia is complex, since functional status is the expression of multiple interactions, especially in geriatric patients. Functional status is measured by functional scales. In severe dementia, these scales must evaluate basic activities of daily living in the different types of dementia with high sensitivity to changes and strong discriminatory capacity. They should also be culturally adapted and validated in the community and institutional settings. Consensus should be established on the use of these instruments to allow them to be standardized and their results to be compared.     

Disease

This paper examines what it is for a condition to be a disease. It falls into two sections. In the first I examine the best existing account of disease (as proposed by Christopher Boorse) and argue that it must be rejected. In the second I outline a more acceptable account of disease. According to this account, by disease we mean a condition that it is a bad thing to have, that is such that we consider the afflicted person to have been unlucky, and that can potentially be medically treated. All three criteria must be fulfilled for a condition to be a disease. The criterion that for a condition to be a disease it must be a bad thing is required to distinguish the biologically different from the diseased. The claim that the sufferer must be unlucky is needed to distinguish diseases from conditions that are unpleasant but normal, for example teething. Finally, the claim that for a condition to be a disease it must be potentially medically treatable is needed to distinguish diseases from other types of misfortune, for example economic problems and legal problems.     

Note on a mechanism of the distribution of wealth

A population of individuals is considered to be characterized by a distribution of wealth which is the result of gain and loss from the outside as well as a result of exchange. The population is assumed to be uniform except for the variation in a parameter determining the manner of partition during exchange. The parameter is assumed to be normally distributed over the population. The resulting distribution of wealth is calculated for some special cases and it is found to be very asymmetric.     

POSTURAL VERTIGO AND POSITIONAL NYSTAGMUS

Oscillation of the eyes of a patient when the head is placed in a certain position is objective evidence to support a complaint of postural vertigo—dizziness when the head is tilted forward or upward or turned to one side or the other. Since positional nystagmus may be difficult to evoke and may be elicited at one time and not at another, it is important to make repeated tests, lest a causative lesion be overlooked.Vertigo in such cases may be caused by pathologic change in the eighth peripheral nerve or in the central vestibular pathways. Sometimes no organic disease is observable even though positional nystagmus validates a complaint of vertigo. In such instances the patient should be assured that he does not have a progressive disease and be advised against activity in which dizziness would be hazardous.     

A proposal on metrics for identification using nucleic acid sequences

Abstract The need is stressed for attempts to be made to permit diagnostic nucleic acid sequences to be used in a quantitative manner. Sequence differences or binding values should be converted to a distance measure and from this an ultrametric tree should be constructed. A single quantitative determination can yield considerable information about the likely identity of an unknown microorganism when the distance obtained from the sequence is compared with the tree. The concept is illustrated by hypothetical species and genus subsequences, and it is suitable both for successive use of hierarchical subsequences and for automated identification. It is pointed out that entirely specific subsequences for higher taxa may be difficult to discover. These principles will be useful for the future design of diagnostic sequences, including possible application to DNA-DNA pairing.     

Asthma in children--problems in diagnosis

Bronchial asthma in children may be difficult to diagnose. Education of the parents regarding allergic conditions, specifically bronchial asthma, is exceedingly important in order to assure satisfactory treatment and clinical results. Chest symptoms of unexplained origin in early life should immediately arouse suspicion of allergic disease. Other causes of asthmatic symptoms must be borne in mind and excluded before a positive diagnosis of bronchial asthma is established. Of the many factors to be considered in investigating a child with asthma, a comprehensive history is most essential. The climate to which the patient is exposed and the psychic influences must be taken into account. Physical examination, x-ray films and laboratory procedures should be carefully executed. Skin testing, especially with food allergens, should not be relied upon to give all the information in allergic disease. Some form of diet trial, such as elimination diets, should be used if sensitivity to food is suspected.     

Assessment of the potential germ cell mutagenicity of industrial and plant protection chemicals as part of an integrated study of genotoxicity in vitro and in vivo

An approach is described that enables the germ cell mutagenicity of chemicals to be assessed as part of an integrated assessment of genotoxic potential. It is recommended, first, that the genotoxicity of a chemical be defined by appropriate studies in vitro. This should involve use of the Salmonella mutation assay and an assay for the induction of chromosomal aberrations, but supplementary assays may be indicated in specific instances. If negative results are obtained from these 2 tests there is no need for the conduct of additional tests. Agents considered to be genotoxic in vitro should then be assessed for genotoxicity to rodents. This will usually involve the conduct of a bone marrow cytogenetic assay, and in the case of negative results, a genotoxicity test in an independent tissue. Agents found to be non-genotoxic in vivo are regarded as having no potential for germ cell mutagenicity. Agents found to be genotoxic in vivo may either be assumed to have potential as germ cell mutagens, or their status in this respect may be defined by appropriate germ cell mutagenicity studies. The basis of the approach, which is supported by the available experimental data, is that germ cell mutagens will be evident as somatic cell genotoxins in vivo, and that these will be detected as genotoxins in vitro given appropriate experimentation. The conduct of appropriate and adequate studies is suggested to be of more value than the conduct of a rigid set of prescribed tests.     

On the limitations of life cycle assessment and environmental systems analysis tools in general

The potential and limitations of life cycle assessment and environmental systems analysis tools in general are evaluated. More specifically this is done by exploring the limits of what can be shown by LCA and other tools. This is done from several perspectives. First, experiences from current LCAs and methodology discussions are used including a discussion on the type of impacts typically included, quality of inventory data, methodological choices in relation to time aspects, allocation, characterisation and weighting methods and uncertainties in describing the real world. Second, conclusions from the theory of science are practised. It is concluded that it can in general not be shown that one product is environmentally preferable to another one, even if this happens to be the case. This conclusion has important policy implications. If policy changes require that it must be shown that one product is more (or less) environmentally preferable before any action can be taken, then it is likely that no action is ever going to take place. If we want changes to be made, decisions must be taken on a less rigid basis. It is expected that in this decision making process, LCA can be a useful input. Since it is the only tool that can be used for product comparisons over the whole life cycle, it can not be replaced by any other tool and should be used. Increased harmonisation of LCA methodology may increase the acceptability of chosen methods and increase the usefulness of the tool.     

Equipoise, knowledge and ethics in clinical research and practice

It is widely maintained that a clinical trial is ethical only if some form of equipoise between the treatments being compared obtains. To be in equipoise between two treatments A and B is to be cognitively indifferent between the statement 'A is strictly more effective than B' and its negation. It is natural to claim that equipoise regarding A and B is necessary for randomised assignment to treatments A and B to be beneficent and non-maleficent and is sufficient for such an assignment to be fair. Cashing this out precisely is difficult, and various forms of equipoise have been discussed which consider whose equipoise is relevant to the decision. This is to make judgement of equipoise something to be managed socially, while its prima facie significance is supposedly cognitive. Recent reconstructions of equipoise-like concepts in epistemology give clues about how to understand equipoise cognitively. In this paper I examine some of this work and discuss how successful it has been. I suggest that while this work is promising, it still has far to go, and that while equipoise remains the best theory we have of the cognitive justification for clinical trials, it is nonetheless incoherent.     

What is this stuff called fitness?

This paper considers a variety of attempts to define fitness in such a way as to defend the theory of evolution by natural selection from the criticism that it is a circular argument. Each of the definitions is shown to be inconsistent with the others. The paper argues that the environment in which an animal evolves can be defined only with respect to the properties of the phenotype of the animal and that it is therefore not illuminating to try to explain the phenotypic properties of the animal in terms of adaptation to an environment that is defined by those very properties. Furthermore, since there is no way that the environment can be defined independently of the presence of the animal there is no way that the quality of an animal can be assessed; and there can be no objective criteria by whichany form of selection can be carried out, therefore there can be no criteria by whichnatural selection can be carried out. It is proposed that fitness is nothing more than the production of offspring, that this is a phenotypic property like all the others, and if it is heritable then the offspring of the parents that produce the most offspring will themselves produce the most offspring, and that in principle it is impossible to account for this in terms of the other phenotypic properties of the fittest animals except by circular argument. Differential rates of reproduction are the causes of evolution and the phenotypic causes are strictly inexplicable.     

SEEDLING BLIGHT OF SUGAR-CANE-A NEW DISEASE CAUSED BY HELMINTHOSPORIUM SACCHARI BUTLER

The fungus Helminthosporium sacchari Butler, known to be the cause of eye spot, a common air-borne disease of sugar-cane leaves, is now shown to be the cause of an undescribed seed-borne disease of sugar-cane seedlings. It is therefore suggested that the disease should be renamed eye spot and seedling blight of sugarcane.
The symptoms of seedling blight are described, and the pathogenicity of the fungus to sugar-cane seedlings is confirmed. Incidence of seedling blight is shown to be markedly affected by the growing conditions, and disease-escape is common. The two most important factors predisposing seedlings to attack appear to be (i) the relative humidity of the atmosphere, and (ii) the occurrence of a check to the continuous growth of the seedlings.
With the discovery of the existence of seedling blight, eye spot assumes a particular significance in plant-breeding plots, because it may be responsible for the loss of sugar-cane seedlings, any one of which is potentially a desirable new variety.     

The role of microorganisms in mediating and facilitating the uptake of plant nutrients from soil

Summary No root systems in nature are without a microbial population. These may be freeliving or symbiotic.The incidence and nutrition of the freeliving microorganisms is discussed. Shortage of substrate makes it unlikely that the N-fixers in the population can fix useful amounts of N. There is a possibility that P supply is improved, but an analysis of possible processes shows them to be rather unlikely, and evidence for them to be poor. Manganese and iron uptake can be altered by microbial activity. Growth of plants can be affected by non-nutritional bacterial effects.The ecology of Rhizobium in the soil is briefly discussed, and the varying needs of different identified strains is stressed.Mycorrhizal infection of plants leads to large growth increases in appropriate conditions. This is almost always linked to increased P uptake, but zinc and copper nutrition can also be improved. The processes involved are briefly discussed. Rapid and extensive infection is important; it is very sensitive to temperature. New modelling methods are now becoming available to measure the behaviour of the fungal infections. The microorganisms require C compounds from the plant, and new measurements of this cost are discussed. The possibility of practical use of mycorrhizal fungi seem to be improving.Keynote address     

The importance of the prediction model in the validation of alternative tests

An overview is presented of the validation process adopted by the European Centre for the Validation of Alternative Methods, with particular emphasis on the central role of the prediction model (PM). The development of an adequate PM is considered to be just as important as the development of an adequate test system, since the validity of an alternative test can only be established when both components (the test system and the PM) have successfully undergone validation. It is argued, however, that alternative tests and their associated PMs do not necessarily need to undergo validation at the same time, and that retrospective validation may be appropriate when a test system is found to be reliable, but the case for its relevance remains to be demonstrated. For an alternative test to be considered "scientifically valid", it is necessary for three conditions to be fulfilled, referred to here as the criteria for scientific relevance, predictive relevance, and reliability. A minimal set of criteria for the acceptance of any PM is defined, but it should be noted that required levels of predictive ability need to be established on a case-by-case basis, taking into account the inherent variability of the alternative and in vivo test data. Finally, in view of the growing shift in emphasis from the use of stand-alone alternative tests to alternative testing strategies, the importance of making the PM an integral part of the testing strategy is discussed.     

ASTHMA IN CHILDREN—PROBLEMS IN DIAGNOSIS

Bronchial asthma in children may be difficult to diagnose. Education of the parents regarding allergic conditions, specifically bronchial asthma, is exceedingly important in order to assure satisfactory treatment and clinical results.Chest symptoms of unexplained origin in early life should immediately arouse suspicion of allergic disease. Other causes of asthmatic symptoms must be borne in mind and excluded before a positive diagnosis of bronchial asthma is established.Of the many factors to be considered in investigating a child with asthma, a comprehensive history is most essential. The climate to which the patient is exposed and the psychic influences must be taken into account. Physical examination, x-ray films and laboratory procedures should be carefully executed. Skin testing, especially with food allergens, should not be relied upon to give all the information in allergic disease. Some form of diet trial, such as elimination diets, should be used if sensitivity to food is suspected.     

Opinion: the species problem, can we achieve a universal concept?

One of the so called 'species problems' is that no universal concept exists. There is a tendency among microbiologists to criticize the hitherto devised concept. It is considered by some researchers as being too conservative and not suitable to be compared with those for eukaryotes. However, such problem is not only restricted to prokaryotes, but among other taxonomies comparisons seem to be impossible. As it is argued, the underlying cause to this problem is the reductionistic and monistic use of taxonomy. Analyzing the more than 22 devised concepts it seems possible to achieve a universal species concept. However, this might not be pragmatic. For the time being, a pluralistic sense of the species concept might be accepted, and one will have to recognize that any comparison among different taxonomies will be difficult.     

S-methyl glutathione synthesis is catalyzed by the cheR methyltransferase in Escherichia coli.

The cheR methyltransferase, known to be necessary for the methyl esterification of receptors involved in chemotaxis, is shown to be essential to the synthesis of S-methyl glutathione from glutathione and S-adenosylmethionine in intact Escherichia coli. S-Methyl glutathione is not, however, found to be essential for chemotaxis. It is suggested that the synthesis of S-methyl glutathione may be due to a "parasitic" reaction of glutathione with S-adenosylmethionine bound to the methyltransferase.     

A model to describe the pattern of availability of broadcast phosphorus fertilizer during the growth of a crop

A model is described which compares the rate of phosphorus demand of a field grown lettuce crop with the rate at which the crop can obtain phosphorus from broadcast fertilizer. Early root growth of lettuce is so slow that on average it takes about 21 days for the first granule of fertilizer to be exploited by a plant, whereas seed reserves of phosphorus are depleted within about 8 days of sowing. This is likely to result in a reduction in yield which cannot be overcome by simply applying more broadcast fertilizer. Some placement of fertilizer near to each plant is required if phosphorus deficiency is to be avoided. The model can also be applied to other crops, and the delay before the first fertilizer granule is exploited is shown to be slightly shorter in cabbage and very short in wheat.     

A new species of the genus Paracryptops from India, with remarks on the generic and specific characters (Chilopoda: Scolopendromorpha: Cryptopidae)

Paracryptops spinosus , a new centipede species from Delhi, is described. The species is unique in the genus in that its anal legs have their femora and tibiae beset distally with extraordinary spines. It is pointed out that the exceedingly short poison claws supposed to be incapable of meeting in the middle cannot be depended upon to identify the genus Paracryptops . This character is apparent, not real and should be discarded. It is also pointed out that the number of tibial teeth used as a key character at species level, being subject to age variation, can be of limited taxonomic value and should be used with caution.     

Large-volume liposuction complicated by retroperitoneal hemorrhage: management principles and implications for the quality improvement process

Large-volume liposuction can be associated rarely with major medical complications and death. The case of exsanguinating retroperitoneal hemorrhage that led to cardiopulmonary arrest in an obese 47-year-old woman who underwent large-volume liposuction is described. Extensive liposuction is not a minor procedure. Performance in an ambulatory setting should be monitored carefully, if it is performed at all. Reporting of adverse events associated with outpatient procedures performed by plastic surgeons should be mandated. Hemodynamic instability in the early postoperative period in an otherwise healthy patient may be due to fluid overload, lidocaine toxicity, or to hemorrhagic shock and must be recognized and treated aggressively. Guidelines for the safe practice of large-volume liposuction need to be established.     

Demonstration of the facts and research of the causes in environmental epidemiology: methodological aspects

There are usually three major steps in the study of the possible impact of environmental factors on health: 1) to demonstrate that there is an association between exposure to the factor and the disease under study; 2) to demonstrate that this association is causal; 3) to evaluate the health benefit that could be obtained by removing the source of exposure. Statistical methods are commonly assumed to provide an objective way of achieving these three steps. This paper reviews some of the conditions that have to be met to allow proper interpretations and to avoid some of the controversies that are often found in health-environment studies. First, it should be remembered that the so-called P value which is used to qualify 'statistically significant' associations between risk factors and diseases does not give any indication of the probability that this association is actual, while far too often it is believed that it does. The probability that an association between an environmental factor and a disease is real could, however, be estimated by using Bayesian methods. These methods require that the a priori probabilities be stated, which is difficult to do in practice. Some directions to overcome this difficulty are presented. Second, the analysis of causality cannot be carried out on statistical grounds alone and the so-called 'causality criteria' are of limited practical interest. Definition of what is a cause, and upon which conditions a candidate factor of a disease can be considered as a cause, deserves much research effort, and careful consideration of the huge literature (mostly outside of the epidemiological field, for example in logic) which is devoted to this subject. Finally, the measurement of the role of a factor in a disease is very often assessed through the use of 'attributable fraction' or 'attributable mortality'. This should be done only when it is demonstrated that the considered factor is causal. Moreover, the interpretation of attributable fractions to a specific factor may be difficult in the (general) case where there are multiple causal factors implied in the development of the disease. Demographic measures of 'potential years (or days, etc.) of life lost' should in general be used, rather than 'numbers of deaths' to quantify the possible impact of environmental factors. Also, as the personal factors are generally extremely important in the determinism of the causes of death associated to environmental factors, and as they cannot be controlled through ecological studies, epidemiological designs where these cofactors can be evaluated individually on cases and controls should be preferred.