BackgroundLymphoedema is a common and troublesome condition that develops following breast cancer treatment. The aim of this study is to analyze the effectiveness of Manual Lymphatic Drainage in the treatment of postmastectomy lymphoedema in order to reduce the volume of lymphoedema and evaluate the improvement of the concomitant symptomatology.MethodsA randomized, controlled clinical trial in 58 women with post-mastectomy lymphoedema. The control group includes 29 patients with standard treatment (skin care, exercise and compression measures, bandages for one month and, subsequently, compression garnments). The experimental group includes 29 patients with standard treatment plus Manual Lymphatic Drainage. The therapy will be administered daily for four weeks and the patient's condition will be assessed one, three and six months after treatment.The primary outcome parameter is volume reduction of the affected arm after treatment, expressed as a percentage. Secondary outcome parameters include: duration of lymphoedema reduction and improvement of the concomitant symptomatology (degree of pain, sensation of swelling and functional limitation in the affected extremity, subjective feeling of being physically less atractive and less feminine, difficulty looking at oneself naked and dissatisfaction with the corporal image).DiscussionThe results of this study will provide information on the effectiveness of Manual Lymphatic Drainage and its impact on the quality of life and physical limitations of these patients.Trial registrationClinicalTrials (NCT): NCT01152099

Objective-To compare the value and limitations of exercise testing, dipyridamole echocardiography, dobutamineatropine echocardiography, and MIBI-SPECT (technetium-99m methoxyisobutyl nitrile single photon emission computed tomography) during dobutamine infusion in the diagnosis of coronary artery disease. Design-The performance of these four tests was assessed in random order on a consecutive cohort of patients. The presence or absence of coronary artery disease was confirmed by coronary angiography. Setting-Two tertiary care and university centres. Patients-102 consecutive patients with chest pain and no previous history of coronary artery disease. Ten patients with left bundle branch block were excluded for further analysis of exercise testing and scintigraphy results. Results-MIBI-SPECT was the most sensitive (87%) but the least specific test (70%). Exercise stress testing had a sensitivity of 66%, which increased to 80% when patients with inconclusive results were excluded. Dipyridamole and dobutamine echocardiography had similar sensitivity (81%, 78%) and specificity (94%, 88%). All four tests had similar accuracy and positive and negative predictive values. Agreement between the echocardiographic techniques was excellent (detection of coronary artery disease 87%, = 0.72; regional analysis 93%, = 0.72; diagnosis of the "culprit" vessel 95%, = 0.92), and it was good between echocardiographic techniques and MIBI-SPECT (diagnosis of the culprit vessel 90%, = 0.84 with dobutamine and 92%, = 0.85 with dipyridamole). Conclusions-Exercise stress testing has a sensitivity comparable to other tests in patients capable of exercising and with no basal electrical abnormalities. The greatest sensitivity is oVered by MIBI-SPECT and the greatest specificity is obtained with stress echocardiography. Redundant information is obtained with dipyridamole echocardiography, dobutamine echocardiography, and MIBI-SPECT.

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Next-generation computing solutions, such as cyber-physical systems or Industry 4.0, are focused on increasing efficiency in process execution as much as possible. Removing unproductive delays or keeping infrastructures operating at their total capacity are typical objectives in these future systems. Decoupling infrastructure providers and service providers using Anything-as-a-Service (XaaS) paradigms is one of the most common approaches to address this challenge. However, many real scenarios not only include machines or controllers but also people and workers. In this case, deploying process execution algorithms and XaaS solutions degenerates in a People-as-a-Service scenario, which poses a critical dilemma: Can highly efficient production scenarios guarantee people’s wellbeing? In this paper, we address this problem and propose a new process execution algorithm based on a novel understanding of efficiency. In this case, a humanized efficiency definition combining traditional efficiency ratios and wellbeing indicators is used to allocate tasks and assign them to different existing workers. In order to evaluate the proposed solution, a simulation scenario including social and physical elements was built. Using this scenario, a first experimental validation was carried out.

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