Memòria Practicum II : Gestió de Serveis Sanitaris, Hospital de Sta Maria de Lleida, Unitat d'Aguts, Servei de Psiquiatria

Memòria del Practicum II realitzat a la Unitat d'aguts del Servei de Psiquiatria de l'Hospital de Santa Maria a Lleida.

Presència, traducció i recepció de la literatura del Quebec a Catalunya

Les literatures francòfones, relegades durant molts anys a una quasi total indiferència per part de la literatura francesa, han pres en els últims quinze anys una importància considerable. L'esforç per part de molts professors d'incloure aquestes literatures en els programes d'ensenyament està donant els seus fruits. L'interès suscitat per l'estudi de la literatura quebequesa i l'apogeu que està prenent a Catalunya –a més de les bones relacions Catalunya-Quebec– van ser el motor d’una recerca sobre la presència, la traducció i la recepció de la literatura de Quebec a Catalunya. Per tal de conèixer l’estat de la qüestió, es va procedir, en un primer temps, a un seguiment de tot el que s’havia publicat a Catalunya referent a la literatura del Quebec. Igualment, es va sondejar els treballs sobre aquesta matèria que no havien estat objecte de publicació i es va recopilar la diversa informació sobre les manifestacions culturals relacionades amb aquesta matèria. En un segon temps, es va procedir a l’estudi dels materials obtinguts i a la seva avaluació. Malgrat la presència recent de la literatura del Quebec a Catalunya i la manca de planificació institucional per dur a terme una traducció sistemàtica que permeti mostrar l’estat actual d’aquesta literatura, es troba, cada vegada més, una voluntat manifesta de donar a conèixer aquesta cultura provinent de Quebec ja sigui per afinitats o voluntats individuals o per respondre a les tendències de mercat.

Automated Segmentation of Cerebral Vasculature with Aneurysms in 3DRA and TOF-MRA using Geodesic Active Regions: an Evaluation Study

Purpose: To evaluate the suitability of an improved version of an automatic segmentation method based on geodesic active regions (GAR) for segmenting cerebral vasculature with aneurysms from 3D X-ray reconstruc-tion angiography (3DRA) and time of °ight magnetic resonance angiography (TOF-MRA) images available in the clinical routine.Methods: Three aspects of the GAR method have been improved: execution time, robustness to variability in imaging protocols and robustness to variability in image spatial resolutions. The improved GAR was retrospectively evaluated on images from patients containing intracranial aneurysms in the area of the Circle of Willis and imaged with two modalities: 3DRA and TOF-MRA. Images were obtained from two clinical centers, each using di®erent imaging equipment. Evaluation included qualitative and quantitative analyses ofthe segmentation results on 20 images from 10 patients. The gold standard was built from 660 cross-sections (33 per image) of vessels and aneurysms, manually measured by interventional neuroradiologists. GAR has also been compared to an interactive segmentation method: iso-intensity surface extraction (ISE). In addition, since patients had been imaged with the two modalities, we performed an inter-modality agreement analysis with respect to both the manual measurements and each of the two segmentation methods. Results: Both GAR and ISE di®ered from the gold standard within acceptable limits compared to the imaging resolution. GAR (ISE, respectively) had an average accuracy of 0.20 (0.24) mm for 3DRA and 0.27 (0.30) mm for TOF-MRA, and had a repeatability of 0.05 (0.20) mm. Compared to ISE, GAR had a lower qualitative error in the vessel region and a lower quantitative error in the aneurysm region. The repeatabilityof GAR was superior to manual measurements and ISE. The inter-modality agreement was similar between GAR and the manual measurements. Conclusions: The improved GAR method outperformed ISE qualitatively as well as quantitatively and is suitable for segmenting 3DRA and TOF-MRA images from clinical routine.

Dynamic estimation of three-dimensional cerebrovascular deformation from rotational angiography

Purpose: The objective of this study is to investigate the feasibility of detecting and quantifying 3D cerebrovascular wall motion from a single 3D rotational x-ray angiography (3DRA) acquisition within a clinically acceptable time and computing from the estimated motion field for the further biomechanical modeling of the cerebrovascular wall. Methods: The whole motion cycle of the cerebral vasculature is modeled using a 4D B-spline transformation, which is estimated from a 4D to 2D + t image registration framework. The registration is performed by optimizing a single similarity metric between the entire 2D + t measured projection sequence and the corresponding forward projections of the deformed volume at their exact time instants. The joint use of two acceleration strategies, together with their implementation on graphics processing units, is also proposed so as to reach computation times close to clinical requirements. For further characterizing vessel wall properties, an approximation of the wall thickness changes is obtained through a strain calculation. Results: Evaluation on in silico and in vitro pulsating phantom aneurysms demonstrated an accurate estimation of wall motion curves. In general, the error was below 10% of the maximum pulsation, even in the situation when substantial inhomogeneous intensity pattern was present. Experiments on in vivo data provided realistic aneurysm and vessel wall motion estimates, whereas in regions where motion was neither visible nor anatomically possible, no motion was detected. The use of the acceleration strategies enabled completing the estimation process for one entire cycle in 5-10 min without degrading the overall performance. The strain map extracted from our motion estimation provided a realistic deformation measure of the vessel wall. Conclusions: The authors' technique has demonstrated that it can provide accurate and robust 4D estimates of cerebrovascular wall motion within a clinically acceptable time, although it has to be applied to a larger patient population prior to possible wide application to routine endovascular procedures. In particular, for the first time, this feasibility study has shown that in vivo cerebrovascular motion can be obtained intraprocedurally from a 3DRA acquisition. Results have also shown the potential of performing strain analysis using this imaging modality, thus making possible for the future modeling of biomechanical properties of the vascular wall.

Three-dimensional morphological analysis of intracranial aneurysms: a fully automated method for aneurysm sac isolation and quantification

Morphological descriptors are practical and essential biomarkers for diagnosis andtreatment selection for intracranial aneurysm management according to the current guidelinesin use. Nevertheless, relatively little work has been dedicated to improve the three-dimensionalquanti cation of aneurysmal morphology, automate the analysis, and hence reduce the inherentintra- and inter-observer variability of manual analysis. In this paper we propose a methodologyfor the automated isolation and morphological quanti cation of saccular intracranial aneurysmsbased on a 3D representation of the vascular anatomy.

8-month non-use of a language. A case tudy. A longitudinal study of the effects on non use of one of the languages (Spanish) of a German L1 multilingual

Under the Dynamic Model of Multilingualism multilinguals are especially vulnerable to language attrition. It was the aim of the present study to verify if this was the case and to observe whether the different linguistic skills (receptive vs. descriptive) and the different linguistic levels (syntactic, lexical, morphological, etc.) would be affected equally.Data were gathered longitudinally by means of a language test for the subject’s reading, writing, listening and speaking skills as well as her knowledge of grammar and vocabulary. Although the overall accuracy remained intact and no proof for attrition in the receptive skills was found, the productive skills - mainly fluency - were shown to have suffered from language attrition. This was demonstrated by an increase in the number of pauses, hesitations, repetitions and self-corrections among others and decrease in the percentage of error-free clauses and decrease in the clause length, in oral and written fluency respectively.

Characterizing major avalanche episodes in space and time in the twentieth and early twentyfirst centuries in the Catalan Pyrenees

With the aim of better understanding avalanche risk in the Catalan Pyrenees, the present work focuses on the analysis of major (or destructive) avalanches. For such purpose major avalanche cartography was made by an exhaustive photointerpretation of several flights, winter and summer field surveys and inquiries to local population. Major avalanche events were used to quantify the magnitude of the episodes during which they occurred, and a Major Avalanche Activity Magnitude Index (MAAMI) was developed. This index is based on the number of major avalanches registered and its estimated frequency in a given time period, hence it quantifies the magnitude of a major avalanche episode or winter. Furthermore, it permits a comparison of the magnitude between major avalanche episodes in a given mountain range, or between mountain ranges, and for a long enough period, it should allow analysis of temporal trends. Major episodes from winter 1995/96 to 2013/14 were reconstructed. Their magnitude, frequency and extent were also assessed. During the last 19 winters, the episodes of January 22-23 and February 6-8 in 1996 were those with highest MAAMI values,followed by January 30-31, 2003, January 29, 2006, and January 24-25, 2014. To analyze the whole twentieth century, a simplified MAAMI was defined in order to attain the same purpose with a less complete dataset. With less accuracy, the same parameters were obtained at winter time resolution throughout the twentieth century. Again, 1995/96 winter had the highest MAAMI value followed by 1971/72, 1974/75 and 1937/38 winter seasons. The analysis of the spatial extent of the different episodes allowed refining the demarcation of nivological regions, and improving our knowledge about the atmospheric patterns that cause major episodes and their climatic interpretation. In some cases, the importance of considering a major avalanche episode as the result of a previous preparatory period, followed by a triggering one was revealed.