474 resultados para EMS


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In this paper a novel rank estimation technique for trajectories motion segmentation within the Local Subspace Affinity (LSA) framework is presented. This technique, called Enhanced Model Selection (EMS), is based on the relationship between the estimated rank of the trajectory matrix and the affinity matrix built by LSA. The results on synthetic and real data show that without any a priori knowledge, EMS automatically provides an accurate and robust rank estimation, improving the accuracy of the final motion segmentation

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Plasma concentrations of the enantiomers of fluoxetine (FLX) and norfluoxetine (NFLX) were measured at days 7, 14, and 23 of oral administration of 20 mg of racemic fluoxetine in 11 patients who were comedicated with risperidone. Eight patients were genotyped as being cytochrome P4502D6 extensive metabolizers (EMs) and three as cytochrome P4502D6 poor metabolizers (PMs). No statistically significant differences were calculated between EMs and PMs in the concentrations of (R)-FLX and (R)-NFLX for all days examined (day 23, mean +/- SD for (R)-FLX and (R)-NFLX in EMs, 16 +/- 5 and 29 +/- 20 ng/mL, respectively; in PMs, 16 +/- 1 and 20 +/- 2 ng/mL, respectively). However, concentrations of (S)-FLX and (S)-NFLX were higher and lower, respectively, in PMs as compared with EMs (day 7, p = 0.037 and p = 0.036; day 14, p = 0.014 and p = 0.014; day 23, p = 0.068 and p = 0.038). On day 23, mean (S)-FLX and (S)-NFLX in EMs were (mean +/- SD) 39 +/- 26 and 63 +/- 26 ng/mL, and in PMs they were 88 +/- 7 and 19 +/- 2 ng/mL. This study confirms the results of the single-dose studies showing that CYP2D6 is involved in the demethylation of FLX to NFLX, with a stereoselectivity toward the (S)-enantiomer. The data also clearly show that the CYP2D6 genotype has an important influence on the concentrations of the (S)- but not of the (R)-enantiomer of FLX and NFLX after multiple doses.

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L'objectiu del treball és dissenyar i implementar un sistema de simulació de votació electrònica, emprant una adaptació sobre corbes el·líptiques del criptosistema ElGamal, per tal d'estudiar-ne la viabilitat, centrant l'atenció en temes de seguretat, especialment en el procés de mescla de vots per tal de desvincular un vot de la persona que l'ha emès.

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El programa de Televisió de Catalunya Tot un Món, emès des de l'any 2004, té per objectiu explicar la immigració i la diversitat cultural a partir de les experiències personals dels immigrants. La finalitat d'aquest estudi és esbrinar fins a quin punt els programes divulgatius que tenen per objectiu donar a conèixer la imatge de la comunitat romanesa representen una imatge que s'adiu amb la realitat d'aquesta comunitat. El present projecte de recerca s'articula a partir de l'exploració de tres camps de treball diferents: l'anàlisi del contingut dels capítols del programa Tot un Món protagonitzats per romanesos, l'anàlisi de les dues carpetes de material didàctic elaborades amb l'objectiu d'explicar la immigració a les escoles i, per últim, la realització i anàlisi d'entrevistes a immigrants romanesos amb diferents perfils per comprovar-ne el seu grau d'identificació. La culminació d'aquest estudi relacionarà tres àmbits disciplinaris: l'audiovisual, l'educatiu i el sociològic.

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Aquest projecte, s’ha desenvolupat en un marc empresarial, concretament al departamentR+D+i de l’empresa Wonesys S.L. de Sant Cugat del Vallès. L’empresa es dedica aldesenvolupament d’equipament per transmissions òptiques.Les eines de gestió dels equips existents, no satisfan els requeriments de l’empresa i amb aquest projecte es busca la implementació d’una eina per fer-ho. Entre les aplicacions actuals es pot trobar, per una banda, un sistema EMS (Element Management System) que ofereix interfíciegràfica d’usuari, però que requereix una infrastructura complexa per ser executada. Per l’altra banda, fins a tres interfícies diferents per connectar directament amb els equips, dues d’elles basades en protocols estàndard i una tercera que implementa un protocol propietari. Es tractad’interfícies d’intercanvi de text, per tant, la gestió mitjançant les mateixes es fa molt poc pràctica tot i no requerir cap infrastructura complexa com en el cas anterior. Una combinació de les virtuts de les anteriors són, a grans trets, els requeriments de la nova aplicació. Es volconstruir, doncs, una aplicació amb interfície gràfica d’usuari complerta que pugui ser accessible de forma senzilla utilitzant, tan sols, un terminal com a maquinari de suport.Un anàlisi del mercat il·lustra que hi ha molta disparitat en aplicacions similars. Hi ha grans diferències entre aplicacions de fabricants d’equipament i altres que només fan aplicacions per tercers.De les diverses possibilitats presentades per dur a terme la implementació, després d’un detingut anàlisi, es considera que la millor opció és el desenvolupament d’una aplicació web. Com l’aplicació ha de residir en un sistema Linux encastat, es fa un repàs del concepte ‘encastat’. Es defineix el terme i es dóna una mirada al mercat. Es descriuen i es comparen les arquitecturesARM i x86 i es relacionen amb el món encastat.Al tractar-se d’un sistema encastat amb arquitectura diferent a la d’un entorn web habitual, l’elecció de les eines representa un paper molt important, així com el procés de compilació i configuració d’eines que tradicionalment s’obtenen compilades.S’han escollit eines de programari lliure i dissenyades especialment per a entorns encastats. El patró de disseny usat pel desenvolupament de l’aplicació web és el Model View Controller, que facilita l’estructuració i un correcte manteniment de l’aplicació.La utilització de la tecnologia web resulta en una aplicació senzilla d’utilitzar, sense necessitat d’instal·lació de cap tipus per part de l’usuari i amb una interfície gràfica molt versàtil. La valoració per part dels usuaris de l’aplicació, tant treballadors de l’empresa en tasques dedesenvolupament i depuració, com clients en equips en explotació, és molt positiva. Tant és així, que sorgeixen opcions per reformular el sistema EMS per unificar interfícies i reaprofitar codi.

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OBJECTIVES: The aim of this study was to evaluate the rate and reason for refusal of telephone-based cardiopulmonary resuscitation (CPR) instruction by bystanders after the implementation of the dispatch center's systematic telephone CPR protocol. METHODS: Over a 15-month period the authors prospectively collected all case records from the emergency medical services (EMS) dispatch center when CPR had been proposed to the bystander calling in and recorded the reason for declining or not performing that the bystander spontaneously mentioned. All pediatric and adult traumatic and nontraumatic cases were included. Situations when resuscitation had been spontaneously initiated by bystanders were excluded. RESULTS: During the study period, dispatchers proposed CPR on 264 occasions: 232 adult nontraumatic cases, 17 adult traumatic cases, and 15 pediatric (traumatic and nontraumatic) cases. The proposal was accepted in 163 cases (61.7%, 95% confidence interval [CI] = 54.6% to 66.5%), and CPR was eventually performed in 134 cases (51%, 95% CI = 43.2% to 55.3%). In 35 of the cases where resuscitation was not carried out, the condition of the patient or conditions at the scene made this decision medically appropriate. Of the remaining 95 cases, 55 were due to physical limitations of the caller, and 33 were due to emotional distress. CONCLUSIONS: The telephone CPR acceptance rate of 62% in this study is comparable to those of other similar studies. Because bystanders' physical condition is one of the keys to success, the rate may not improve as the population ages.

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OBJECTIVE: In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. METHODS: This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. RESULTS: During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. CONCLUSIONS: This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery rate and false positive are similar to those found in previous studies. We found our results satisfying the given short time frame of this study. Our results demonstrate that it is possible to improve the quality of emergency services at moderate or even no additional costs and this should be of interest to all EMS that do not presently benefit from using T-CPR procedures. EMS that currently do not offer T-CPR should consider implementing this technique as soon as possible, and we expect our experience may provide answers to those planning to incorporate T-CPR in their daily practice.

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Acute organophosphate (OP) intoxication is associated with many symptoms and clinical signs, including potentially life-threatening seizures and status epilepticus. Instead of being linked to the direct cholinergic toxidrome, OP-related seizures are more probably linked to the interaction of OPs with acetylcholineindependent neuromodulation pathways, such as GABA and NMDA. The importance of preventing, or recognizing and treating OP-related seizures lies in that, the central nervous system (CNS) damage from OP poisoning is thought to be due to the excitotoxicity of the seizure activity itself rather than a direct toxic effect. Muscular weakness and paralysis occurring 1-4 days after the resolution of an acute cholinergic toxidrome, the intermediate syndrome is usually not diagnosed until significant respiratory insufficiency has occurred; it is nevertheless a major cause of OP-induced morbidity and mortality and requires aggressive supportive treatment. The condition usually resolves spontaneously in 1-2 weeks.Treatment of OP intoxication relies on prompt diagnosis, and specific and immediate treatment of the lifethreatening symptoms. Since patients suffering from OP poisoning can secondarily expose care providers via contaminated skin, clothing, hair, or body fluids. EMS and hospital caregivers should be prepared to protect themselves with appropriate protective equipment, isolate such patients, and decontaminate them. After prompt decontamination, the initial priority of patient management is an immediate ABCDE (A : airway, B : breathing, C : circulation, D : dysfunction or disability of the central nervous system, and E : exposure) resuscitation approach, including aggressive respiratory support, since respiratory failure is the usual ultimate cause of death. The subsequent priority is initiating atropine therapy to oppose the muscarinic symptoms and diazepam to prevent or control seizures, with oximes added to enhance acetylcholinesterase (AChE) activity recovery. Large doses of atropine and oximes may be necessary for poisoning due to suicidal ingestions of OP pesticides.

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When dealing with the design of service networks, such as healthand EMS services, banking or distributed ticket selling services, thelocation of service centers has a strong influence on the congestion ateach of them, and consequently, on the quality of service. In this paper,several models are presented to consider service congestion. The firstmodel addresses the issue of the location of the least number of single--servercenters such that all the population is served within a standard distance,and nobody stands in line for a time longer than a given time--limit, or withmore than a predetermined number of other clients. We then formulateseveral maximal coverage models, with one or more servers per service center.A new heuristic is developed to solve the models and tested in a 30--nodesnetwork.

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Treball de recerca realitzat per alumnes d’ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l’any 2010. Prenent com a punt de partença l'estudi del mite grec de Memnó s’ha realitzat un estudi teòric i aplicat sobre l’efecte termoacústic. La metodologia del treball passa per l'estudi del mite grec de Memnó i dels fets històrics documentats, així com de la teoria dels modes de vibració en tubs sonors i de l'efecte termoacústic, que permeten explicar el fenomen i entendre el fonament del làser acústic. Posats els fonaments, es tracta de dissenyar i construir un instrument que permeti reproduir el fenomen observat fa 2000 anys i que funcioni com un làser acústic. Finalment, amb l'instrument construït, es poden realitzar diverses anàlisis experimentals per comprovar les característiques del so emès i en quines condicions s'emet. El fenòmen del Memnònium, produït per l'efecte termoacústic, té el mateix fonament que els dispositius anomenats làsers acústics. El so emès pels dos làsers acústics que hem construït és una ona harmònica. Funcionen com tubs sonors oberts per un extrem i ressonant en el primer mode de vibració, amb un comportament equivalent al d'un diapasó. El so emès és de gran intensitat. La freqüència depèn de la longitud del tub, d'acord amb la teoria dels tubs sonors. L’efecte s'aconsegueix de la mateixa manera amb recipients de formes diverses.

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L’estudi de les situacions comunicatives sempre m’ha atret de manera significativa. El món de la publicitat, també. L’assignatura de Semiòtica audiovisual ha estat el vincle que ha inspirat el tema d’aquest treball. L’idea inicial era la d’analitzar des d’una perspectiva semiòtica un document audiovisual, concretament, Beauty is nothing without brains, un espot televisiu de Mercedes-Benz emès als Estats Units l’any 2007. Es pretenia identificar i analitzar cadascun dels elements que configuren la comunicació audiovisual i presentar possibles versions traductològiques del mateix. La dificultat de crear un esquema d’anàlisi que em permetés estructurar-ne l’estudi va conduir-me a Frederic Chaume. És llavors quan aconsegueixo concretar el tema del treball: es pretén analitzar aquest document audiovisual seguint el model proposat per Chaume, responent a un hipotètic encàrrec de traducció el qual demana la seva adaptació al mercat català.

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Televisió Espanyola va començar la producció de programes a Catalunya amb la inauguració del estudis de Miramar el dia 14 de juliol de1959. El primer programa emès des d’aquest centre va ser realitzat als jardins de l’edifici i presentat per José Luis Barcelona. Era l’inici d’una història que ha superat ja el cinquantè aniversari i de la qual encara queden moltes coses per conèixer i per explicar. Tota la programació dels primers anys era en llengua castellana, fins la primera emissió de televisió en català, el 27 d'octubre de 1964. Va ser el punt de partida de molts anys de programes en català. Un dels valors que aporta TVE a Catalunya és la contribució als informatius d’àmbit estatal. És en aquesta especialitat dels programes d’informació que tant Miramar com Sant Cugat tenen una llarga experiència. Un indicador per estudiar aquest camí llarg i no sempre fàcil de les emissions de TVE des de Catalunya i en llengua catalana pot ser l’anàlisi de l’evolució dels informatius al llarg del temps. Aspectes com l’hora d’emissió, la durada, el nombre de notícies, la forma de presentar-les, els recursos utilitzats i en definitiva tot allò relacionat amb l’estructura d’aquests programes. Ens proposem descobrir els canvis que han tingut aquests informatius en català en diferents èpoques. En la mesura que sigui possible, quantificar les variacions que s’hagin produït en diversos aspectes del seu contingut i característiques . En especial els relatius al text llegit i a la imatge. Aquest treball pretén ser una primera aproximació a l’estudi de les estructures dels programes informatius diaris, que certifiqui l’existència d’una línia d’investigació que es pugui seguir en el futur.

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In this open, 30-day trial, the pharmacokinetics, safety and tolerability of a combination therapy of risperidone (4 or 6 mg/day)and fluoxetine (20mg/day from day 6) were evaluated in 11 psychotic inpatients. CYP2D6 genotyping revealed that 3 and 8 patients were poor metabolizers (PMs) and extensive metabolizers (EMs) of debrisoquine, respectively. The mean (+/- SD) AUC of risperidone increased from 83.1 +/- 46.8 ng.h/ml and 398.3 +/- 33.2 ng.h/ml (monotherapy) to 345.1 +/- 158.0 ng.h/ml (p < 0.05) and 514.0 +/- 144.2 ng.h/ml (p < 0.001) when coadministered with fluoxetine in EMs and PMs, respectively. The AUC of the active moiety (risperidone plus 9-hydroxy-risperidone) increased from 470.0 +/- 170.0 ng.h/ml to 663.0 +/- 243.3 ng.h/ml (p < 0.05)and from 576.3 +/- 19.6 ng.h/ml to 788.0 +/- 89.1 ng.h/ml (ns) in EMs and PMs, respectively. In EMs, the AUC of 9-hydroxy-risperidone remained similar (monotherapy vs. combination therapy: 386.8 +/- 153.0 ng.h/ml vs. 317.7 +/- 125.2 ng.h/ml, ns),whereas it increased in PMs (178.3 +/- 23.5 ng.h/ml vs. 274.0 +/- 55.1 ng.h/ml (p < 0.05)). Ten of the 11 patients showed a clinical improvement (reduction of 20% or more in total PANSS score and 70% on the mean MADRS score compared to baseline). The severity and incidence of extrapyramidal symptoms and adverse events did not significantly increase when fluoxetine was added.

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Steady-state blood concentrations of (R)- methadone (i.e., the active form), (S)-methadone, and (R,S)-methadone were measured before and after introduction of paroxetine 20 mg/day during a mean period of 12 days in 10 addict patients in methadone maintenance treatment. Eight patients were genotyped as CYP2D6 homozygous extensive metabolizers (EMs) and two patients as poor metabolizers (PMs). Paroxetine significantly increased concentrations of both enantiomers of methadone in the whole group (mean increase for (R)-methadone +/- SD, 26 +/- 32%; range, -14% to +83%, p = 0.032; for (S)-methadone, 49 +/- 51%; range, -29% to +137%, p = 0.028; for (R,S)-methadone, 35 +/- 41%; range, -20% to +112%, p = 0.032) and in the group of eight EMs (mean increase, 32%, p = 0.036; 53%, p = 0.028; and 42%, p = 0.036, for (R)-methadone, (S)-methadone, and (R,S)-methadone, respectively). On the other hand, in the two PMs, (S)-methadone but not (R)-methadone concentrations were increased by paroxetine (mean increases of 36% and 3%, respectively). Paroxetine is a strong CYP2D6 inhibitor, and these results confirm previous studies showing an involvement of CYP2D6 in methadone metabolism with a stereoselectivity toward the (R)-enantiomer. Because paroxetine is a mild inhibitor of CYP1A2, CYP2C9, CYP2C19, and CYP3A4, increase of (S)-methadone concentrations in both EMs and PMs could be mediated by inhibition of any of these isozymes.

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CYP2D6 is involved in the O-demethylation metabolic pathway of venlafaxine in humans. In this study, we investigated whether this isozyme is stereoselective. Plasma samples from seven CYP2D6 extensive metabolizers (EMs) and five CYP2D6 poor metabolizers (PMs), collected during a period without and with coadministration of quinidine, were analysed. Subjects were administered venlafaxine hydrochloride 18.75 mg orally every 12 h for 48 h on two occasions (1 week apart); once alone and once during the concomitant administration of quinidine sulphate every 12 h. Blood and urine samples were collected under steady-state conditions over one dosing interval (12 h). The present results show that, although CYP2D6 catalyses the O-demethylation of both enantiomers of venlafaxine, it displays a marked stereoselectivity towards the (R)-enantiomer. The oral clearance of (R)-venlafaxine was found to be nine-fold higher in EMs compared to PMs [median (range) 173 (29-611) l/h versus 20 (16-24) l/h, P < 0.005], while it was two-fold higher for (S)-venlafaxine [73 (32-130) l/h versus 37 (21-44) l/h, P < 0.05]. In EMs, quinidine decreased (R)- and (S)-venlafaxine oral clearance by 12-fold ( 0.05) and four-fold ( 0.05), respectively. In contrast, quinidine did not have any effects on renal clearance of (R)-venlafaxine [4 (2-10) l/h for venlafaxine alone versus 5 (0.6-7) l/h for venlafaxine + quinidine] and of (S)-venlafaxine [4 (1-7) l/h for venlafaxine alone versus 3 (0.4-6) l/h for venlafaxine + quinidine]. The coadministration of quinidine to EMs resulted in an almost complete inhibition of the partial metabolic clearance of (R)-venlafaxine to O-demethylated metabolites [127 (10-493) l/h down to 1 (0.1-3) l/h, 0.05], while a seven-fold reduction was measured for (S)-venlafaxine [47 (14-94) l/h versus 7 (1-19) l/h, 0.05]. In PMs, coadministration of quinidine did not significantly change oral clearance and partial metabolic clearance of (R)- and (S)-venlafaxine to its various metabolites. In contrast, data obtained on the partial metabolic clearance of (R)- and (S)-venlafaxine to N-demethylated metabolites, a reaction which is mediated by CYP3A4, suggest a lack of stereoselectivity of this enzyme.