RESUMEN
Bioeconomy is becoming the main driver transforming European agri-food value chains towards global sustainability in the food supply chain. Intensive horticultural production systems based on medium and low-tech greenhouses are suitable scenarios implementing bioeconomy strategies to achieve sustainability targets. Since the publication of the European Strategy of Bioeconomy in 2012, policy measures intended to boost bioeconomy are responsible for changing what are now considered outdated production systems to more high-tech models capable of responding to climate-change challenges. This article describes the potential for the agri-food supply chain to drive the transition of medium and low-tech intensive greenhouse systems to biobased, circular economy value-chains. Key areas of impact relate to waste valorisation and management, new inputs based on biotechnological innovations, building clusters of innovative delivery partners within the sector, and the increase in public awareness of the impact of the bioeconomy through socio-economic analysis.
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Biotecnología/economía , Conservación de los Recursos Naturales/economía , Horticultura/economía , Desarrollo Económico , EspañaRESUMEN
BACKGROUND: In the present study, the rate of dermal transfer of pesticides to agricultural workers occurring via contact with sprayed hard surfaces was investigated. Cotton gloves were used as dosimeters to collect residues from hard surfaces contaminated by pesticides in greenhouses. Dosimeters, either dry or moistened, were in contact with wood, metal and plastic surfaces that had previously been sprayed. The experimental approach applied mimicked typical hand contact. Moistened cotton gloves were used to simulate hand moisture from dew/condensation or rainfall. The effect of total duration of contact on the final hand exposure via transfer was investigated. RESULTS: The higher duration contact tested (50 s) resulted in higher transfer rates for metal and plastic surfaces; no such effect was noted in the case of the wood surface. The pesticide amount transferred from the metal and plastic surfaces to wet gloves was greater than that transferred to dry gloves. Such a trend was not observed for the wood surface. Transfer rates varied from 0.46 to 77.62% and from 0.17 to 16.90% for wet and dry samples, respectively. CONCLUSION: The current study has generated new data to quantify the proportion of pesticide deposits dislodged from three different non-crop surfaces when in contact with dry or wet gloves. © 2018 Crown copyright. Pest Management Science © 2018 Society of Chemical Industry.
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Agricultores , Exposición Profesional/análisis , Residuos de Plaguicidas/metabolismo , Piel/metabolismo , Humanos , Presión , Propiedades de SuperficieRESUMEN
A dislodgeable foliar residue study was conducted in greenhouse pepper and tomato on the island of Crete, Greece, following the spray application of an SC insecticide (with active substance (a.s.) tebufenozide) and an EC fungicide (a.s. bupirimate). Furthermore, for the assessment of worker exposure to pesticides - as a result of re-entering the treated crops - a worker dermal exposure study was carried out during the tasks of tying or pruning, which allowed the transfer coefficient values for the specific tasks to be determined. Pesticide residues were analysed with an in house developed and fully validated HPLC-ESI/MS analytical method. The results from the study resulted in transfer coefficient values which were in agreement with current EFSA guideline values in most of the cases with the exception of bupirimate in a tomato greenhouse. In that case, high potential dermal exposure and low dislodgeable foliar residue values were observed, which is thought to be due to the moist leaves collected during sampling and monitoring, which led to greater than expected transfer coefficient values.
RESUMEN
Risk assessments for human exposures to plant protection products (PPPs) have traditionally focussed on single routes of exposure and single compounds. Extensions to estimate aggregate (multi-source) and cumulative (multi-compound) exposure from PPPs present many new challenges and additional uncertainties that should be addressed as part of risk analysis and decision-making. A general approach is outlined for identifying and classifying the relevant uncertainties and variabilities. The implementation of uncertainty analysis within the MCRA software, developed as part of the EU-funded ACROPOLIS project to address some of these uncertainties, is demonstrated. An example is presented for dietary and non-dietary exposures to the triazole class of compounds. This demonstrates the chaining of models, linking variability and uncertainty generated from an external model for bystander exposure with variability and uncertainty in MCRA dietary exposure assessments. A new method is also presented for combining pesticide usage survey information with limited residue monitoring data, to address non-detect uncertainty. The results show that incorporating usage information reduces uncertainty in parameters of the residue distribution but that in this case quantifying uncertainty is not a priority, at least for UK grown crops. A general discussion of alternative approaches to treat uncertainty, either quantitatively or qualitatively, is included.
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Dieta/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Contaminación de Alimentos , Modelos Estadísticos , Residuos de Plaguicidas/toxicidad , Plaguicidas/toxicidad , Triazoles/toxicidad , Adulto , Contaminantes Ocupacionales del Aire/toxicidad , Productos Agrícolas/crecimiento & desarrollo , Daucus carota/crecimiento & desarrollo , Encuestas sobre Dietas , Monitoreo del Ambiente , Agricultores , Femenino , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional/efectos adversos , Raíces de Plantas/crecimiento & desarrollo , Medición de Riesgo , Incertidumbre , Reino Unido , Adulto JovenRESUMEN
The need for improved tools to estimate the cumulative and aggregate exposure to compounds such as plant protection products (PPPs) is recognised in the EU Regulation 1107/2009. A new model has been developed to estimate the exposure within a population to single compounds or compounds within a Cumulative Action Group, considering dietary and non-dietary sources and multiple exposure routes. To test the model a field study was carried out in Italy with operators applying tebuconazole fungicides, with measurements of dermal exposure collected. Whole urine samples were collected and analysed to provide values for the absorbed dose of tebuconazole, with duplicate diet samples collected and analysed as a measure of dietary exposures. The model provided predicted values of exposure for combined dietary and non-dietary routes of exposures which were compared to the measured absorbed dose values based on urinary analysis. The model outputs provided mean daily exposure values of 1.77 (± 1.96) µg a.s./kg BW which are comparable to measured mean values from the biomonitoring field study of 1.73 (± 1.31) µg a.s./kg BW. To supplement the limited measurement data available, comparisons against other models were also made and found to be comparable.
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Dieta/efectos adversos , Contaminación de Alimentos , Modelos Estadísticos , Exposición Profesional/efectos adversos , Residuos de Plaguicidas/toxicidad , Plaguicidas/toxicidad , Adolescente , Adulto , Anciano , Contaminantes Ocupacionales del Aire/toxicidad , Contaminantes Ocupacionales del Aire/orina , Productos Agrícolas/crecimiento & desarrollo , Registros de Dieta , Monitoreo del Ambiente , Agricultores , Frutas/crecimiento & desarrollo , Fungicidas Industriales/toxicidad , Fungicidas Industriales/orina , Humanos , Italia , Masculino , Persona de Mediana Edad , Residuos de Plaguicidas/orina , Plaguicidas/orina , Triazoles/toxicidad , Triazoles/orina , Vitis/crecimiento & desarrollo , Adulto JovenRESUMEN
Exposures to plant protection products (PPPs) are assessed using risk analysis methods to protect public health. Traditionally, single sources, such as food or individual occupational sources, have been addressed. In reality, individuals can be exposed simultaneously to multiple sources. Improved regulation therefore requires the development of new tools for estimating the population distribution of exposures aggregated within an individual. A new aggregate model is described, which allows individual users to include as much, or as little, information as is available or relevant for their particular scenario. Depending on the inputs provided by the user, the outputs can range from simple deterministic values through to probabilistic analyses including characterisations of variability and uncertainty. Exposures can be calculated for multiple compounds, routes and sources of exposure. The aggregate model links to the cumulative dietary exposure model developed in parallel and is implemented in the web-based software tool MCRA. Case studies are presented to illustrate the potential of this model, with inputs drawn from existing European data sources and models. These cover exposures to UK arable spray operators, Italian vineyard spray operators, Netherlands users of a consumer spray and UK bystanders/residents. The model could also be adapted to handle non-PPP compounds.
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Dieta/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Contaminación de Alimentos , Implementación de Plan de Salud , Modelos Estadísticos , Residuos de Plaguicidas/toxicidad , Plaguicidas/toxicidad , Adulto , Niño , Preescolar , Ecotoxicología/métodos , Unión Europea , Femenino , Guías como Asunto , Encuestas Epidemiológicas , Humanos , Internet , Masculino , Persona de Mediana Edad , Método de Montecarlo , Exposición Profesional/efectos adversos , Medición de Riesgo/normas , Programas Informáticos , Adulto JovenRESUMEN
The objective of this work was to generate spray drift data from pesticide application in the field comparing spray drift from traditional equipment with emerging, anti-drift technologies. The applications were carried out in the Kopais area in central Greece. Currently few data exist as regards to pesticide spray drift in Southern European conditions. This work details the data for ground and airborne deposition of spray drift using the methodology developed in the UK by the Food and Environment Research Agency (FERA). Three trials were performed in two days using sunset yellow dye which deposited on dosimeters placed at specific distances from the edge of the sprayer boom. The application was carried out with a tractor mounted boom sprayer, which was of local manufacture, as were the nozzles of Trial I, being flat fan brass nozzles. For Trials II and III anti-drift nozzles were used. The boom sprayers were used with the settings as employed by the farmers for the routine pesticide applications. The results of this work indicate that drift was significantly reduced when anti-drift nozzles were utilized.
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Agricultura/métodos , Contaminantes Atmosféricos/análisis , Contaminación del Aire/prevención & control , Modelos Químicos , Plaguicidas/análisis , Monitoreo del Ambiente , Grecia , Proyectos PilotoRESUMEN
The mechanisms by which genetic variation affects transcription regulation and phenotypes at the nucleotide level are incompletely understood. Here we use natural genetic variation as an in vivo mutagenesis screen to assess the genome-wide effects of sequence variation on lineage-determining and signal-specific transcription factor binding, epigenomics and transcriptional outcomes in primary macrophages from different mouse strains. We find substantial genetic evidence to support the concept that lineage-determining transcription factors define epigenetic and transcriptomic states by selecting enhancer-like regions in the genome in a collaborative fashion and facilitating binding of signal-dependent factors. This hierarchical model of transcription factor function suggests that limited sets of genomic data for lineage-determining transcription factors and informative histone modifications can be used for the prioritization of disease-associated regulatory variants.
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Elementos de Facilitación Genéticos/genética , Regulación de la Expresión Génica/genética , Variación Genética/genética , Selección Genética/genética , Factores de Transcripción/metabolismo , Secuencias de Aminoácidos/genética , Animales , Secuencia de Bases , Linaje de la Célula/genética , Proteínas de Unión al ADN/metabolismo , Histonas/química , Histonas/metabolismo , Macrófagos/metabolismo , Masculino , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Modelos Biológicos , Mutación/genética , FN-kappa B/metabolismo , Unión Proteica , Reproducibilidad de los Resultados , Factor de Transcripción ReIA/metabolismoRESUMEN
Little objective information exists about musculoskeletal bleeding patterns in haemophilic arthropathy. Bleeding is assumed to be the cause of painful joints or muscles. Clotting factor treatment is provided empirically, but often does not alleviate pain. We hypothesized that perception of pain aetiology is unreliable, and introduced point-of-care high-resolution musculoskeletal ultrasound (MSKUS) to differentiate intra-articular bleeds vs. joint inflammation, and intra-muscle bleeds vs. other regional pain syndromes. To assess painful musculoskeletal episodes in adult haemophiliacs, we used rapid MSKUS, employing grey scale and power Doppler examination. Forty episodes in 30 adult haemophiliacs were evaluated. Thirty three of the 40 episodes were patient-reported as 'bleeding', five as 'arthritis-type' pain and two as 'undecided'. Of the 33 bleeding reports, only 12 were confirmed by MSKUS; the other episodes revealed other pathology. In contrast, three of five perceived arthritis flares were reclassified as bleeds. Similarly, physician assessment was incorrect in 18 of 40 instances. Swelling and warmth were present in approximately half of confirmed bleeding and non-bleeding episodes, and therefore not useful clinically. Few of the painful episodes were symptom controlled at the time of MSKUS. Management changed based on objective imaging findings in >70% of episodes, which resulted in symptom improvement >60% of the time. Significant discrepancies exist between MSKUS findings and patient/physician-perceived pain classification as bleeding or other musculoskeletal symptoms. Current practice of prescribing clotting factor or conservative measures based on pain perception seems inadequate and suggests that point-of-care imaging should be included into modern haemophilia care.
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Hemofilia A/diagnóstico por imagen , Hemofilia B/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Dolor/diagnóstico por imagen , Adulto , Artritis/diagnóstico por imagen , Femenino , Hemorragia/diagnóstico por imagen , Humanos , Masculino , Calidad de Vida , Sinovitis/diagnóstico por imagen , Ultrasonografía , Adulto JovenRESUMEN
BACKGROUND: Disability scales do not enable the transmission of concise, meaningful and daily function description for clinical purposes. STUDY DESIGN: Cross-sectional statistical analysis of 328 patients' Spinal Cord Independence Measure (SCIM) III item scores (SIS). OBJECTIVE: To develop a concise and clinically interpretable data-based characterization of daily task accomplishment for patients with spinal cord lesions (SCLs). SETTING: Multi-center study at 13 spinal units in 6 countries. METHODS: Patients were grouped into clusters characterized by smaller differences between the patients' SIS within the clusters than between their centers, using the k-medoides algorithm. The number of clusters (k) was chosen according to the percent of SIS variation they explained and the clinical distinction between them. RESULTS: Analysis showed that k=8 SIS clusters offer a good description of the patient population. The eight functional clusters were designated as A-H, each cluster (grade) representing a combination of task accomplishments. Higher grades were usually (but not always) associated with patients implementing more difficult tasks. Throughout rehabilitation, the patients' functional grade improved and the distribution of patients with similar functional grades within the total SCIM III score deciles remained stable. CONCLUSIONS: A new classification based on SIS clusters enables a concise description of overall functioning and task accomplishment distribution in patients with SCL. A software tool is used to identify the patients' functional grade. Findings support the stability and utility of the grades for characterizing the patients' functional status.
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Actividades Cotidianas/clasificación , Evaluación de la Discapacidad , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Anciano , Algoritmos , Estudios Transversales , Incontinencia Fecal/etiología , Incontinencia Fecal/rehabilitación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuadriplejía/etiología , Cuadriplejía/rehabilitación , Reproducibilidad de los Resultados , Estudios Retrospectivos , Traumatismos de la Médula Espinal/complicacionesRESUMEN
STUDY DESIGN: Multicenter international cohort study. OBJECTIVE: The objective of this study was to establish target values for Spinal Cord Independence Measure (SCIM) III scoring in rehabilitation for clinically complete spinal cord lesion (SCL) neurological levels. SETTING: In total, 13 spinal cord units in six countries from North America, Europe and the Middle East were taken. METHODS: Total SCIM III scores and gain at discharge from rehabilitation were calculated for SCL levels in 128 patients with American Spinal Injury Association Impairment Scale (AIS) grade A on admission to rehabilitation. RESULTS: Median, quartiles, mean and s.d., values of discharge SCIM III scores and SCIM III gain for the various SCL levels are presented. Total SCIM III scores and gain were significantly correlated with the SCL level (r=0.730, r=0.579, P<0.001). CONCLUSIONS: Calculated discharge SCIM III scores can be used as target values for functional achievements at various neurological levels in patients after AIS A SCL. They are generally, but not always, inversely correlated with SCL level.
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Evaluación de la Discapacidad , Evaluación de Resultado en la Atención de Salud/métodos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/diagnóstico , Adulto , Europa (Continente) , Humanos , Cooperación Internacional , Persona de Mediana Edad , Medio Oriente , Examen Neurológico , América del Norte , Recuperación de la Función/fisiología , Reproducibilidad de los Resultados , Traumatismos de la Médula Espinal/rehabilitación , Adulto JovenRESUMEN
In this study the operator exposure levels during bait applications of an insecticide in olive groves were determined using a whole body dosimetry method for dermal exposure. The study design allowed the roles of application task duration and coverall type to be evaluated as factors influencing operator exposure. Twenty applications were carried out with knapsack sprayers in the Tanagra region of Viotia, Greece, ten of which were for a 1h and ten for a 3h duration. An in-house GC-NPD analytical method was developed and validated for the determination of malathion, the active substance (a.s.) of the insecticide formulation used in field trials. The mean recovery of field-fortified samples was 84% (%RSD=3.0). Field trial results generally indicated lower operator exposure levels than indicated by the most relevant operator exposure predictive model. Residues of malathion on internal dosimeters were compared to those measured on the respective outer coveralls (potential dermal exposure) to evaluate the protective factor of each one of the two coverall types used. Both coverall types provided satisfactory levels of protection and can be considered as suitable protection for the conditions of the application scenario studied. Furthermore, the results indicated that there is not a strong correlation between exposure levels and duration of application.
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Insecticidas/análisis , Malatión/análisis , Exposición Profesional , Ropa de Protección/normas , Adulto , Cromatografía de Gases , Grecia , Humanos , Exposición por Inhalación , Control de Insectos , Olea , Piel , Factores de Tiempo , Adulto JovenRESUMEN
STUDY DESIGN: A multi-center international cohort study. OBJECTIVE: To evaluate the reliability and validity of the third version of the Spinal Cord Independence Measure (SCIM III), separately for patients with traumatic spinal cord lesions (SCLs). SETTING: A total of 13 spinal cord units in six countries from North America, Europe and the Middle-East. METHODS: SCIM III and Functional Independence Measure (FIM) were assessed for 261 patients with traumatic SCLs, on admission to rehabilitation and before discharge, by two raters. Conventional statistical measures were used to evaluate the SCIM III reliability and validity. RESULTS: In almost all SCIM III tasks, the total agreement between the paired raters was >80%. The κ coefficients were all >0.6 and statistically significant. Pearson's coefficients of the correlations between the paired raters were >0.9, the mean differences between raters were nonsignificant and the intraclass correlation coefficients (ICCs) were ≥ 0.95. Cronbach's α values for the entire SCIM III scale were 0.833-0.835. FIM and SCIM III total scores were correlated (r=0.84, P<0.001). SCIM III was more responsive to changes than FIM. In all subscales, SCIM III identified more changes in function than FIM, and in 3 of the 4 subscales, differences in responsiveness were statistically significant (P<0.02). CONCLUSION: The results confirm the reliability and validity of SCIM III for patients with traumatic SCLs in a number of countries.
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Evaluación de la Discapacidad , Evaluación de Resultado en la Atención de Salud/métodos , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/rehabilitación , Encuestas y Cuestionarios/normas , Actividades Cotidianas/clasificación , Adulto , Estudios de Cohortes , Femenino , Humanos , Vida Independiente/normas , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVE: To assess the opinions of vascular surgery trainees on the new Accreditation Council for Graduate Medical Education (ACGME) guidelines. METHODS: A questionnaire was developed and electronically distributed to trainee members of the Society for Vascular Surgery. RESULTS: Of 238 eligible vascular trainees, 38 (16%) participated. Respondents were predominantly 30 to 35 years of age (47%), male (69%), in 2-year fellowship (73%), and at large academic centers (61%). Trainees report occasionally working while fatigued (63%). Fellows were more likely to report for duty while fatigued (P = .012) than integrated vascular residents. Respondents thought further work-hour restrictions would not improve patient care or training (P < .05) and may not lead to more sleep or improved quality of life. Respondents reported that duty hours should vary by specialty (81%) and allow flexibility in the last years of training (P < .05). CONCLUSIONS: Vascular surgery trainees are concerned about further duty-hour restrictions on patient care, education, and training and fatigue mitigation has to be balanced against the need to adequately train vascular surgeons.
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Educación de Postgrado en Medicina/normas , Fatiga/prevención & control , Internado y Residencia/normas , Seguridad del Paciente/normas , Admisión y Programación de Personal/normas , Sociedades Médicas/normas , Procedimientos Quirúrgicos Vasculares/educación , Procedimientos Quirúrgicos Vasculares/normas , Carga de Trabajo/normas , Acreditación , Adulto , Distribución de Chi-Cuadrado , Curriculum/normas , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Guías de Práctica Clínica como Asunto , Calidad de Vida , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Estados Unidos , Procedimientos Quirúrgicos Vasculares/efectos adversosRESUMEN
Increasing societal and governmental concern about the worldwide use of chemical pesticides is now providing strong drivers towards maximising the efficiency of pesticide utilisation and the development of alternative control techniques. There is growing recognition that the ultimate goal of achieving efficient and sustainable pesticide usage will require greater understanding of the fluid mechanical mechanisms governing the delivery to, and spreading of, pesticide droplets on target surfaces such as leaves. This has led to increasing use of computational fluid dynamics (CFD) as an important component of efficient process design with regard to pesticide delivery to the leaf surface. This perspective highlights recent advances in CFD methods for droplet spreading and film flows, which have the potential to provide accurate, predictive models for pesticide flow on leaf surfaces, and which can take account of each of the key influences of surface topography and chemistry, initial spray deposition conditions, evaporation and multiple droplet spreading interactions. The mathematical framework of these CFD methods is described briefly, and a series of new flow simulation results relevant to pesticide flows over foliage is provided. The potential benefits of employing CFD for practical process design are also discussed briefly.
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Modelos Químicos , Plaguicidas/química , Hojas de la PlantaRESUMEN
In this study, the field performance of two coverall designs used by pesticide applicators was determined. Two coverall types were selected based on data from previously conducted comfort testing under field conditions in southern Europe. Dermal exposure was measured during 22 applications conducted with 11 operators using similar hand-held spray guns in greenhouse pepper crops in the Ierapetra region of Crete, Greece. One of the coverall designs studied was made from a cotton/polyester material treated with a water-repellent Resist Spills(R) finish, which was compared in the field study to a coverall of similar design, but using a woven, untreated cotton material. An in-house analytical method was developed and validated for determining residues of the active substance (a.s.) malathion on the dosimeters. The derived levels of dermal exposure were used as a measure of the protection provided by the two types of coveralls. In addition, by comparing the total amount of the a.s. recovered from outer and inner dosimeters (potential dermal exposure = 238.8 mg kg(-1) a.s. for the cotton coverall and 160.44 mg kg(-1) a.s. for the Resist Spills coverall), a value could be determined for the degree of coverall penetration. The mean penetration (milligrams per kilogram a.s.) of the outer coveralls, calculated as a percentage of the total contamination, was 0.4% for the water-repellent coverall and 2.3% for the cotton coverall. The mean recovery from the laboratory and field-fortified samples was >91 and 74%, respectively and used as the main criterion for quality control of the analytical data. Under the field trial conditions evaluated, both the coverall designs gave better protection than the default values used in the most relevant predictive exposure model. Therefore, they could be considered as appropriate tools of personal protection when both comfort and field performance is taken into account under the specific application scenario.
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Agricultura , Exposición Profesional/análisis , Plaguicidas/análisis , Ropa de Protección/normas , Absorción Cutánea , Monitoreo del Ambiente/métodos , Grecia , HumanosRESUMEN
A comparison of the Potential Dermal Exposure (PDE) of workers to the insecticide deltamethrin was made as a function of crop type, in small agricultural production units in Argentina. Seven experiments were done with two different crops (maize and broccoli, treated area between 600 and 1000 m(2)) with three different operators under typical field conditions using a lever operated knapsack. The methodology is based on the whole body dosimetry technique, presenting separately the data for mixing/loading and application activities. These results indicate a higher concentration of pesticide in lower body sections for broccoli and a wider distribution for maize. The risk inherent in these agricultural procedures is estimated through Margin of Safety (MOS) values and was found to be generally safe. Preliminary results of a mass balance distribution of the pesticide between crop, soil and operator are also presented.
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Agricultura , Insecticidas/análisis , Nitrilos/análisis , Exposición Profesional/análisis , Piretrinas/análisis , Argentina , Brassica , Productos Agrícolas , Mano , Humanos , Ropa de Protección , Medición de Riesgo , Piel , Zea maysRESUMEN
PURPOSE: To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. METHOD: Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge. RESULTS: Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors. CONCLUSIONS: The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.
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Evaluación de la Discapacidad , Enfermedades de la Médula Espinal/rehabilitación , Actividades Cotidianas , Estudios de Cohortes , Defecación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Paraplejía/rehabilitación , Cuadriplejía/rehabilitación , Reproducibilidad de los Resultados , Respiración , Autocuidado , MicciónRESUMEN
Nuclear receptors form a large family of ligand-dependent transcription factors that regulate diverse aspects of development and homeostasis. Several of these receptors have been demonstrated to play important roles in controlling biological processes that influence the development and clinical consequences of atherosclerosis. Because nuclear receptors are regulated by small molecules, they are potential targets for anti-atherogenic drugs. In this chapter, we review the use of mouse models to evaluate roles of nuclear receptors and their ligands in the pathogenesis and treatment of atherosclerosis.
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Aterosclerosis/fisiopatología , Receptores Citoplasmáticos y Nucleares/metabolismo , Factores de Transcripción/metabolismo , Animales , Modelos Animales de Enfermedad , Sistemas de Liberación de Medicamentos , Regulación de la Expresión Génica/fisiología , Humanos , Ligandos , RatonesRESUMEN
BACKGROUND: A third version of the Spinal Cord Independence Measure (SCIM III), made up of three subscales, was formulated following comments by experts from several countries and Rasch analysis performed on the previous version. OBJECTIVE: To examine the validity, reliability, and usefulness of SCIM III using Rasch analysis. DESIGN: Multicenter cohort study. SETTING: Thirteen spinal cord units in six countries from North America, Europe, and the Middle-East. SUBJECTS: 425 patients with spinal cord lesions (SCL). INTERVENTIONS: SCIM III assessments by professional staff members. Rasch analysis of admission scores. MAIN OUTCOME MEASURES: SCIM III subscale match between the distribution of item difficulty grades and the patient ability measurements; reliability of patient ability measures; fit of data to Rasch model requirements; unidimensionality of each subscale; hierarchical ordering of categories within items; differential item functioning across classes of patients and across countries. RESULTS: Results supported the compatibility of the SCIM subscales with the stringent Rasch requirements. Average infit mean-square indices were 0.79-1.06; statistically distinct strata of abilities were 3 to 4; most thresholds between adjacent categories were properly ordered; item hierarchy was stable across most of the clinical subgroups and across countries. In a few items, however, misfit or category threshold disordering were found. CONCLUSIONS: The scores of each SCIM III subscale appear as a reliable and useful quantitative representation of a specific construct of independence after SCL. This justifies the use of SCIM in clinical research, including cross-cultural trials. The results also suggest that there is merit in further refining the scale.