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Alfonso Palma

Publications and source records attributed to Alfonso Palma.

10 recordsLinked to original sources

Perceptual bias in speech error data collection: insights from Spanish speech errors.

This paper studies the reliability and validity of naturalistic speech errors as a tool for language production research. Possible biases when collecting naturalistic speech errors are identified and specific predictions derived. These patterns are then contrasted with published reports from Germanic languages (English, German and Dutch) and one Romance language (Spanish). Unlike findings in the Germanic languages, Spanish speech errors show many patterns which run contrary to those expected from bias: (1) more phonological errors occur between words than within word; (2) word-initial consonants are less likely to participate in errors than word-medial consonants, (3) errors are equally likely in stressed and in unstressed syllables, (4) perseverations are more frequent than anticipations, and (5) there is no trace of a lexical bias. We present a new corpus of Spanish speech errors collected by many theoretically naïve observers (whereas the only corpus available so far was collected by two highly trained theoretically informed observers), give a general overview of it, and use it to replicate previous reports. In spite of the different susceptibility of these methods to bias, results were remarkably similar in both corpora and again contrary to predictions from bias. As a result, collecting speech errors "in the wild" seems to be free of bias to a reasonable extent even when using a multiple-collector method. The observed contrasting patterns between Spanish and Germanic languages arise as true cross-linguistic differences.

Adult↗

Improving hollow fiber dialyzer efficiency with a recirculating dialysate system. I: Theory and applicability.

The mathematical theory that underlies a novel non-regenerated recirculating dialysate system (RDS) for improving diffusive clearance in hemodialyzers is presented. The theory states the conditions that hemodialyzers must meet to be suitable in RDS optimization. We have verified the applicability of the RDS for several Cuprophan and polysulfone (PS) commercial dialyzers, showing that PS (synthetic) membranes achieve the highest increments of diffusive clearance. A numerical simulation analysis over more general conditions defined by the dimensionless groups of the system demonstrated that the highest diffusive clearance improvements are achieved in dialyzers operating with a low value of the diffusive mass-transfer area/blood flow rate ratio. This study has provided the base for the assessment of the performance of the RDS as compared to several high-efficiency systems, presented in Part II of this work [M. Prado, L. M. Roa, A. Palma, and J. A. Milan, Ann. Biomed. Eng. (2004) submitted].

Blood Chemical Analysis↗

Improving hollow fiber dialyzer efficiency with a recirculating dialysate system II: comparison against two-chamber dialysis systems.

The theoretical basis of the nonregenerated recirculating dialysate system (RDS) was derived in Part I of this work [M. Prado, L. M. Roa, A. Palma, and J. A. Milán, Ann. Biomed. Eng. (2005)]. This system pursues the maximization of the clearance of hollow fiber dialyzers whose performance is controlled by diffusion, as occurred in standard hemodialysis. In this second part we perform a comparison by digital simulation of the RDS against three well-known two-chamber dialysis systems. As a major outcome, the efficiency of the RDS increased by a factor of five-eight with respect to the efficiency of a single dialyzer operating with a number of transfer units equal to 0.1, that is when the diffusive mass-transfer of the dialyzer is exhausted. Present low-flux dialyzers do not take advantage of the full potential of this technique, but the functional domain where high-flux and high-area dialyzers operate could be more suitable to exploit this technique. We conclude that RDS can be a competitive efficient technique for optimizing the dialysis efficiency.

Animals↗

Double target comparison of blood-side methods for measuring the hemodialysis dose.

BACKGROUND: Despite the fact that urea kinetic modelling has been successfully applied to quantify the hemodialysis since the beginning of the 1980s, there is not a consensus yet concerning which is the most proper dialysis dose index and the method for calculating it. In this work, we propose that a combined measurement of the dialysis dose from two complementary perspectives of the removal process should provide a more complete description of dialysis than a measurement alone. This hypothesis is reviewed and the measuring methods are compared. METHODS: A cross-sectional randomized clinical study over 98 stable ESRD patients submitted to thrice-weekly hemodialysis was carried out with the aim of comparing 16 blood-side methods for measuring the hemodialysis dose from patient and dialyzer perspectives. The availability of urea rebound measurements and computational resources have been taken into account. RESULTS: The outcomes point to four novel blood-side methods as the most accurate for measuring the effective dialysis system Kt/V (mKt/V) in clinical conditions. Their limits of agreement (mean +/- 2.SD) range from 1.93 +/- 2.09% for a non-iterative method without the urea rebound measurement (BUN3) to -0.08 +/- 0.58% for an iterative method with BUN3. The best non-iterative blood-side method for measuring the equilibrated Kt/V (eKt/V) is the second generation formula of Daugirdas (-2.42 +/- 1.05%) when BUN3 is available and the rate equation of Daugirdas and Schneditz (-1.74 +/- 7.91%) when BUN3 is not available. The difference mKt/V-eKt/V is significant and positive, and increases with the dialysis dose in a personalized manner. CONCLUSION: We have confirmed the arguments that support the hypothesis of the study. The best blood-side methods for the combined measurement of dialysis dose as a function of the available resources have been determined.

Adult↗

A novel mathematical method based on urea kinetic modeling for computing the dialysis dose.

A novel normalized single pool urea kinetic model (nspUKM) for the quantification of the urea removal, dialyzer urea clearance and urea generation rate during a dialysis session, is presented. Its major goal is the computation of an accurate estimate of the fractional dialyzer urea clearance (dKt/V), which is denoted nKt/V, in contrast to the equilibrated Kt/V (eKt/V). This work clarifies the significance of dKt/V as a complement to eKt/V in hemodialysis (HD) prescription and quantification. This new model emerges from a generalization of the standard single pool urea kinetic model (spUKM) of the US National Cooperative Dialysis Study (NCDS), identified as gspUKM. Due to their significance, the standard single pool Kt/V (spKt/V) and the eKt/V are also analyzed from gspUKM in this work, with the aim of achieving a better interpretation of the results. Indices nKt/V, eKt/V and spKt/V have been compared with the dKt/V computed from a published and validated two-pool urea kinetic model (2pUKM). We present the results obtained from a clinical study carried out on a group of 30 end stage renal disease (ESRD) patients. The limits of agreement (mean+/-2S.D. (standard deviation) of the difference) between nKt/V and 2pKt/V were -0.077+/-0.72% (percentage of the dKt/V mean), while between eKt/V and 2pKt/V were -13.75+/-17.39% and between spKt/V and 2pKt/V were -1.61+/-6.54%. These scores prove that the nspUKM model is able to provide a very accurate estimate of 2pKt/V and thus dKt/V, even with high flux (HF) HD. The presented method joins the simplicity of single-pool models to the accuracy of double-pool models, when the target is the identification of the dialyzer urea clearance, urea removal and urea generation rate, although it does not provide a good prediction of the urea dynamics. Finally, we think that our analytical and experimental findings throw light on the behavior and applicability of the different Kt/V indices analyzed.

Blood Urea Nitrogen↗

Proliferation in hyperplastic human and normal rat parathyroid glands: role of phosphate, calcitriol, and gender.

BACKGROUND: Parathyroid gland hyperplasia develops in azotemic patients. A phosphate excess and calcitriol deficiency play critical roles in its development. Our goals were to determine whether differences in serum phosphate values at parathyroidectomy (PTX) in hemodialysis patients with refractory hyperparathyroidism: (1) correlated with parathyroid cell proliferation; and (2) affected the antiproliferative response to in vitro calcitriol. Studies were also performed to determine whether the phosphate concentration in the medium affected the antiproliferative response to calcitriol, and whether a high phosphate diet and calcitriol treatment affected parathyroid cell proliferation and parathyroid hormone (PTH) levels in normal rats. METHODS: Forty-seven parathyroid glands from 19 hemodialysis patients were obtained at PTX. Flow cytometry was used to determine cell proliferation (percent cells in S phase) in excised parathyroid glands. Similarly, cell proliferation was determined in parathyroid tissue incubated for 24 hours in medium with or without 10(-7) mol/L calcitriol and with 1 or 4 mmol/L phosphate. In normal rats, the effect of 3 days of a high phosphate diet (1.2% P) and calcitriol treatment (100 pmol/kg) on PTH values and cell proliferation was evaluated. RESULTS: In cells from freshly removed parathyroid glands obtained at PTX from hemodialysis patients, there were no significant correlations between the percent cells in S phase and age, gender, and serum phosphate, calcium, and PTH. While incubation of parathyroid tissue with 10(-7) mol/L calcitriol did reduce cell proliferation (P < 0.001), both the pre-PTX serum phosphate value (P= 0.003) and female gender (P=0.003) were associated with a decreased response to calcitriol. Incubation of parathyroid tissue in medium containing 4 mmol/L phosphate did not increase cell proliferation. In normal rats, a high phosphate diet for 3 days increased cell proliferation (P < 0.05) and PTH levels (P < 0.05), and calcitriol treatment was without effect. CONCLUSION: Our findings suggest a high phosphate burden, as well as female gender, favor parathyroid cell proliferation and both may reduce the inhibition of parathyroid function by calcitriol.

Adult↗

Vascular calcification in the uremic patient: a cardiovascular risk?

BACKGROUND: Several factors suggest that the presence of vascular calcification (VC) is associated with a high risk of cardiac events in uremic patients. The aim of this study was to analyze the influence of VC on cardiac morbidity and mortality in our hemodialysis (HD) patients. METHODS: We studied 79 patients on HD: 43 males, mean age 48 +/- 15 years old, mean time on HD 83 +/- 63 months. The presence of VC was evaluated by radiologic series. Other cardiovascular risk factors analyzed were arterial hypertension, diabetes mellitus, obesity, cigarette smoking, anemia, and dyslipidemia. All patients underwent M-mode, two-dimensional, Doppler echocardiography. Patients were followed for two years. During this time, clinical information collected included predialysis blood pressure, incidence of ischemic heart disease, episodes of congestive heart failure, and mortality due to cardiovascular event. RESULTS: VC was observed in 55.7% of patients. Left ventricular hypertrophy, diastolic dysfunction, and cardiac valve calcification were significantly associated with VC. Ischemic heart disease (71.4% vs. 28.6%) and episodes of cardiac failure (0.41 vs. 0.18 per year; P < 0.05) appeared more frequently in the patient group with VC. VC was present in 80.6% of patients who developed episodes of heart failure. Eight patients died from cardiac disease; each of them had VC. CONCLUSION: The presence of VC can help to identify those HD patients with a higher cardiovascular risk.

Aged↗

Renal telehealthcare system based on a patient physiological image: a novel hybrid approach in telemedicine.

This paper presents a novel renal telemedicine system, Virtual Center for Renal Support (VCRS), focused on the end-stage renal disease (ESRD) population. The VCRS design modifies the telemedicine paradigm, currently centered on communication technologies and monitoring devices, by emphasizing the way that biosignals are used to extract on-line knowledge to be used by physicians to solve current needs of this population. We begin with an ESRD review, from which a summary of major limitations of current renal health assistance programs is obtained. This is used to form the basis for the VCRS. This work is focused on a theoretical description of the technological architecture of VCRS, followed by a simulation experiment showing some preliminary results from a prototype of a patient physiologic image (PPI) computer component, the major knowledge creator of VCRS. Preliminary results show that PPI technology provides the ability to supervise internal variables representing the patient's dynamic behavior. The demonstrated relation between adequate control of extracellular volume and blood pressure suggests that VCRS is able to generate hypovolemia warnings before their occurrence during a hemodyalysis session delivered remotely. However, PPI is not restricted to kinetic models, which were initially chosen because of their successful results in the provision of dialysis. Preliminary results suggest the ability of this telemedicine system to enhance remote patient supervision and care.

Adult↗

Virtual center for renal support: technological approach to patient physiological image.

The patient physiological image (PPI) is a novel concept which manages the knowledge of the virtual center for renal support (VCRS), currently being developed by the Biomedical Engineering Group of the University of Seville. PPI is a virtual "replica" of the patient, built by means of a mathematical model, which represents several physiological subsystems of a renal patient. From a technical point of view, PPI is a component-oriented software module based on cutting-edge modeling and simulation technology. This paper provides a methodological and technological approach to the PPI. Computational architecture of PPI-based VCRS is also described. This is a multi-tier and multi-protocol system. Data are managed by several ORDBMS instances. Communications design is based on the virtual private network (VPN) concept. Renal patients have a minimum reliable access to the VCRS through a public switch telephone network--X.25 gateway. Design complies with the universal access requirement, allowing an efficient and inexpensive connection even in rural environments and reducing computational requirements in the patient's remote access unit. VCRS provides support for renal patients' healthcare, increasing the quality and quantity of monitored biomedical signals, predicting events as hypotension or low dialysis dose, assisting further to avoid them by an online therapy modification and easing diagnostic tasks. An online therapy adjustment experiment simulation is presented. Finally, the presented system serves as a computational aid for research in renal physiology. This is achieved by an open and reusable modeling and simulation architecture which allows the interaction among models and data from different scales and computer platforms, and a faster transference of investigation models toward clinical applications.

Aged↗