909 resultados para Lead-time and set-up optimization


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Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

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Published opinions regarding the outcomes and complications in older patients have a broad spectrum and there is a disagreement whether surgery in older patients entails a higher risk. Therefore this study examines the risk of surgery for lumbar spinal stenosis relative to age in the pooled data set of the Spine Tango registry.

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The Environmental Health (EH) program of Peace Corps (PC) Panama and a non-governmental organization (NGO) Waterlines have been assisting rural communities in Panama gain access to improved water sources through the practice of community management (CM) model and participatory development. Unfortunately, there is little information available on how a water system is functioning once the construction is complete and the volunteer leaves the community. This is a concern when the recent literature suggests that most communities are not able to indefinitely maintain a rural water system (RWS) without some form of external assistance (Sara and Katz, 1997; Newman et al, 2002; Lockwood, 2002, 2003, 2004; IRC, 2003; Schweitzer, 2009). Recognizing this concern, the EH program director encouraged the author to complete a postproject assessment of the past EH water projects. In order to carry out the investigation, an easy to use monitoring and evaluation tool was developed based on literature review and the author’s three years of field experience in rural Panama. The study methodology consists of benchmark scoring systems to rate the following ten indicators: watershed, source capture, transmission line, storage tank, distribution system, system reliability, willingness to pay, accounting/transparency, maintenance, and active water committee members. The assessment of 28 communities across the country revealed that the current state of physical infrastructure, as well as the financial, managerial and technical capabilities of water committees varied significantly depending on the community. While some communities are enjoying continued service and their water committee completing all of its responsibilities, others have seen their water systems fall apart and be abandoned. Overall, the higher score were more prevalent for all ten indicators. However, even the communities with the highest scores requested some form of additional assistance. The conclusion from the assessment suggests that the EH program should incorporate an institutional support mechanism (ISM) to its sector policy in order to systematically provide follow-up support to rural communities in Panama. A full-time circuit rider with flexible funding would be able to provide additional technical support, training and encouragement to those communities in need.

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This dissertation discusses structural-electrostatic modeling techniques, genetic algorithm based optimization and control design for electrostatic micro devices. First, an alternative modeling technique, the interpolated force model, for electrostatic micro devices is discussed. The method provides improved computational efficiency relative to a benchmark model, as well as improved accuracy for irregular electrode configurations relative to a common approximate model, the parallel plate approximation model. For the configuration most similar to two parallel plates, expected to be the best case scenario for the approximate model, both the parallel plate approximation model and the interpolated force model maintained less than 2.2% error in static deflection compared to the benchmark model. For the configuration expected to be the worst case scenario for the parallel plate approximation model, the interpolated force model maintained less than 2.9% error in static deflection while the parallel plate approximation model is incapable of handling the configuration. Second, genetic algorithm based optimization is shown to improve the design of an electrostatic micro sensor. The design space is enlarged from published design spaces to include the configuration of both sensing and actuation electrodes, material distribution, actuation voltage and other geometric dimensions. For a small population, the design was improved by approximately a factor of 6 over 15 generations to a fitness value of 3.2 fF. For a larger population seeded with the best configurations of the previous optimization, the design was improved by another 7% in 5 generations to a fitness value of 3.0 fF. Third, a learning control algorithm is presented that reduces the closing time of a radiofrequency microelectromechanical systems switch by minimizing bounce while maintaining robustness to fabrication variability. Electrostatic actuation of the plate causes pull-in with high impact velocities, which are difficult to control due to parameter variations from part to part. A single degree-of-freedom model was utilized to design a learning control algorithm that shapes the actuation voltage based on the open/closed state of the switch. Experiments on 3 test switches show that after 5-10 iterations, the learning algorithm lands the switch with an impact velocity not exceeding 0.2 m/s, eliminating bounce.

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Ein auf Basis von Prozessdaten kalibriertes Viskositätsmodell wird vorgeschlagen und zur Vorhersage der Viskosität einer Polyamid 12 (PA12) Kunststoffschmelze als Funktion von Zeit, Temperatur und Schergeschwindigkeit angewandt. Im ersten Schritt wurde das Viskositätsmodell aus experimentellen Daten abgeleitet. Es beruht hauptsächlich auf dem drei-parametrigen Ansatz von Carreau, wobei zwei zusätzliche Verschiebungsfaktoren eingesetzt werden. Die Temperaturabhängigkeit der Viskosität wird mithilfe des Verschiebungsfaktors aT von Arrhenius berücksichtigt. Ein weiterer Verschiebungsfaktor aSC (Structural Change) wird eingeführt, der die Strukturänderung von PA12 als Folge der Prozessbedingungen beim Lasersintern beschreibt. Beobachtet wurde die Strukturänderung in Form einer signifikanten Viskositätserhöhung. Es wurde geschlussfolgert, dass diese Viskositätserhöhung auf einen Molmassenaufbau zurückzuführen ist und als Nachkondensation verstanden werden kann. Abhängig von den Zeit- und Temperaturbedingungen wurde festgestellt, dass die Viskosität als Folge des Molmassenaufbaus exponentiell gegen eine irreversible Grenze strebt. Die Geschwindigkeit dieser Nachkondensation ist zeit- und temperaturabhängig. Es wird angenommen, dass die Pulverbetttemperatur einen Molmassenaufbau verursacht und es damit zur Kettenverlängerung kommt. Dieser fortschreitende Prozess der zunehmenden Kettenlängen setzt molekulare Beweglichkeit herab und unterbindet die weitere Nachkondensation. Der Verschiebungsfaktor aSC drückt diese physikalisch-chemische Modellvorstellung aus und beinhaltet zwei zusätzliche Parameter. Der Parameter aSC,UL entspricht der oberen Viskositätsgrenze, wohingegen k0 die Strukturänderungsrate angibt. Es wurde weiterhin festgestellt, dass es folglich nützlich ist zwischen einer Fließaktivierungsenergie und einer Strukturänderungsaktivierungsenergie für die Berechnung von aT und aSC zu unterscheiden. Die Optimierung der Modellparameter erfolgte mithilfe eines genetischen Algorithmus. Zwischen berechneten und gemessenen Viskositäten wurde eine gute Übereinstimmung gefunden, so dass das Viskositätsmodell in der Lage ist die Viskosität einer PA12 Kunststoffschmelze als Folge eines kombinierten Lasersinter Zeit- und Temperatureinflusses vorherzusagen. Das Modell wurde im zweiten Schritt angewandt, um die Viskosität während des Lasersinter-Prozesses in Abhängigkeit von der Energiedichte zu berechnen. Hierzu wurden Prozessdaten, wie Schmelzetemperatur und Belichtungszeit benutzt, die mithilfe einer High-Speed Thermografiekamera on-line gemessen wurden. Abschließend wurde der Einfluss der Strukturänderung auf das Viskositätsniveau im Prozess aufgezeigt.

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Contaminant metals bound to sediments are subject to considerable solubilization during passage of the sediments through the digestive systems of deposit feeders. We examined the kinetics of this process, using digestive fluids extracted from deposit feeders Arenicola marina and Parastichopus californicus and then incubated with contaminated sediments. Kinetics are complex, with solubilization followed occasionally by readsorption onto the sediment. In general, solubilization kinetics are biphasic, with an initial rapid step followed by a slower reaction. For many sediment-organism combinations, the reaction will not reach a steady state or equilibrium within the gut retention time (GRT) of the organisms, suggesting that metal bioavailability in sediments is a time-dependent parameter. Experiments with commercial protein solutions mimic the kinetic patterns observed with digestive fluids, which corroborates our previous study that complexation by dissolved amino acids (AA) in digestive fluids leads to metal solubilization (Chen & Mayer 1998b; Environ Sci Technol 32:770-778). The relative importance of the fast and slow reactions appears to depend on the ratio of ligands in gut fluids to the amount of bound metal in sediments. High ligand to solid metal ratios result in more metals released in fast reactions and thus higher lability of sedimentary metals. Multiple extractions of a sediment with digestive fluid of A. marina confirm the potential importance of incomplete reactions within a single deposit-feeding event, and make clear that bioavailability to a single animal is Likely different from that to a community of organisms. The complex kinetic patterns lead to the counterintuitive prediction that toxification of digestive enzymes by solubilized metals will occur more readily in species that dissolve less metals.

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Genetically encoded, ratiometric biosensors based on fluorescence resonance energy transfer (FRET) are powerful tools to study the spatiotemporal dynamics of cell signaling. However, many biosensors lack sensitivity. We present a biosensor library that contains circularly permutated mutants for both the donor and acceptor fluorophores, which alter the orientation of the dipoles and thus better accommodate structural constraints imposed by different signaling molecules while maintaining FRET efficiency. Our strategy improved the brightness and dynamic range of preexisting RhoA and extracellular signal-regulated protein kinase (ERK) biosensors. Using the improved RhoA biosensor, we found micrometer-sized zones of RhoA activity at the tip of F-actin bundles in growth cone filopodia during neurite extension, whereas RhoA was globally activated throughout collapsing growth cones. RhoA was also activated in filopodia and protruding membranes at the leading edge of motile fibroblasts. Using the improved ERK biosensor, we simultaneously measured ERK activation dynamics in multiple cells using low-magnification microscopy and performed in vivo FRET imaging in zebrafish. Thus, we provide a construction toolkit consisting of a vector set, which enables facile generation of sensitive biosensors.

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The relationship between serum cholesterol and cancer incidence was investigated in the population of the Hypertension Detection and Follow-up Program (HDFP). The HDFP was a multi-center trial designed to test the effectiveness of a stepped program of medication in reducing mortality associated with hypertension. Over 10,000 participants, ages 30-69, were followed with clinic and home visits for a minimum of five years. Cancer incidence was ascertained from existing study documents, which included hospitalization records, autopsy reports and death certificates. During the five years of follow-up, 286 new cancer cases were documented. The distribution of sites and total number of cases were similar to those predicted using rates from the Third National Cancer Survey. A non-fasting baseline serum cholesterol level was available for most participants. Age, sex, and race specific five-year cancer incidence rates were computed for each cholesterol quartile. Rates were also computed by smoking status, education status, and percent ideal weight quartiles. In addition, these and other factors were investigated with the use of the multiple logistic model.^ For all cancers combined, a significant inverse relationship existed between baseline serum cholesterol levels and cancer incidence. Previously documented associations between smoking, education and cancer were also demonstrated but did not account for the relationship between serum cholesterol and cancer. The relationship was more evident in males than females but this was felt to represent the different distribution of occurrence of specific cancer sites in the two sexes. The inverse relationship existed for all specific sites investigated (except breast) although a level of statistical significance was reached only for prostate carcinoma. Analyses after exclusion of cases diagnosed during the first two years of follow-up still yielded an inverse relationship. Life table analysis indicated that competing risks during the period of follow-up did not account for the existence of an inverse relationship. It is concluded that a weak inverse relationship does exist between serum cholesterol for many but not all cancer sites. This relationship is not due to confounding by other known cancer risk factors, competing risks or persons entering the study with undiagnosed cancer. Not enough information is available at the present time to determine whether this relationship is causal and further research is suggested. ^

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The relationship between degree of diastolic blood pressure (DBP) reduction and mortality was examined among hypertensives, ages 30-69, in the Hypertension Detection and Follow-up Program (HDFP). The HDFP was a multi-center community-based trial, which followed 10,940 hypertensive participants for five years. One-year survival was required for inclusion in this investigation since the one-year annual visit was the first occasion where change in blood pressure could be measured on all participants. During the subsequent four years of follow-up on 10,052 participants, 568 deaths occurred. For levels of change in DBP and for categories of variables related to mortality, the crude mortality rate was calculated. Time-dependent life tables were also calculated so as to utilize available blood pressure data over time. In addition, the Cox life table regression model, extended to take into account both time-constant and time-dependent covariates, was used to examine the relationship change in blood pressure over time and mortality.^ The results of the time-dependent life table and time-dependent Cox life table regression analyses supported the existence of a quadratic function which modeled the relationship between DBP reduction and mortality, even after adjusting for other risk factors. The minimum mortality hazard ratio, based on a particular model, occurred at a DBP reduction of 22.6 mm Hg (standard error = 10.6) in the whole population and 8.5 mm Hg (standard error = 4.6) in the baseline DBP stratum 90-104. After this reduction, there was a small increase in the risk of death. There was not evidence of the quadratic function after fitting the same model using systolic blood pressure. Methodologic issues involved in studying a particular degree of blood pressure reduction were considered. The confidence interval around the change corresponding to the minimum hazard ratio was wide and the obtained blood pressure level should not be interpreted as a goal for treatment. Blood pressure reduction was attributed, not only to pharmacologic therapy, but also to regression to the mean, and to other unknown factors unrelated to treatment. Therefore, the surprising results of this study do not provide direct implications for treatment, but strongly suggest replication in other populations. ^

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With most clinical trials, missing data presents a statistical problem in evaluating a treatment's efficacy. There are many methods commonly used to assess missing data; however, these methods leave room for bias to enter the study. This thesis was a secondary analysis on data taken from TIME, a phase 2 randomized clinical trial conducted to evaluate the safety and effect of the administration timing of bone marrow mononuclear cells (BMMNC) for subjects with acute myocardial infarction (AMI).^ We evaluated the effect of missing data by comparing the variance inflation factor (VIF) of the effect of therapy between all subjects and only subjects with complete data. Through the general linear model, an unbiased solution was made for the VIF of the treatment's efficacy using the weighted least squares method to incorporate missing data. Two groups were identified from the TIME data: 1) all subjects and 2) subjects with complete data (baseline and follow-up measurements). After the general solution was found for the VIF, it was migrated Excel 2010 to evaluate data from TIME. The resulting numerical value from the two groups was compared to assess the effect of missing data.^ The VIF values from the TIME study were considerably less in the group with missing data. By design, we varied the correlation factor in order to evaluate the VIFs of both groups. As the correlation factor increased, the VIF values increased at a faster rate in the group with only complete data. Furthermore, while varying the correlation factor, the number of subjects with missing data was also varied to see how missing data affects the VIF. When subjects with only baseline data was increased, we saw a significant rate increase in VIF values in the group with only complete data while the group with missing data saw a steady and consistent increase in the VIF. The same was seen when we varied the group with follow-up only data. This essentially showed that the VIFs steadily increased when missing data is not ignored. When missing data is ignored as with our comparison group, the VIF values sharply increase as correlation increases.^

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Particle mixing rates have been determined for 5 South Atlantic/Antarctic and 3 equatorial Pacific deep-sea cores using excess 210Pb and 32Si measurements. Radionuclide profiles from these siliceous, calcareous, and clay-rich sediments have been evaluated using a steady state vertical advection diffusion model. In Antarctic siliceous sediments210Pb mixing coefficients (0.04-0.16 cm**2/y) are in reasonable agreement with the 32Si mixing coefficient (0.2 or 0.4 cm**2/y, depending on 32Si half-life). In an equatorial Pacific sediment core, however, the 210Pb mixing coefficient (0.22 cm**2/y) is 3-7 times greater than the 32Si mixing coefficient (0.03 or 0.07 cm**2/y). The difference in 210Pb and 32Si mixing rates in the Pacific sediments results from: (1) non-steady state mixing and differences in characteristic time and depth scales of the two radionuclides, (2) preferential mixing of fine-grained clay particles containing most of the 210Pb activity relative to coarser particles (large radiolaria) containing the 32Si activity, or (3) the supply of 222Rn from the bottom of manganese nodules which increases the measured excess 210Pb activity (relative to 226Ra) at depth and artificially increases the 210Pb mixing coefficient. Based on 32Si data and pore water silica profiles, dissolution of biogenic silica in the sediment column appears to have a minor effect on the 32Si profile in the mixed layer. Deep-sea particle mixing rates reported in this study and the literature do not correlate with sediment type, sediment accumulation rate, or surface productivity. Based on differences in mixing rate among three Antarctic cores collected within 50 km of each other, local variability in the intensity of deep-sea mixing appears to be as important as regional differences in sediment properties.

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The purpose of this study was to evaluate summer and fall residency and habitat selection by gray whales, Eschrichtius robustus, together with the biomass of benthic amphipod prey on the coastal feeding grounds along the Chukotka Peninsula. Thirteen gray whales were instrumented with satellite transmitters in September 2006 near the Chukotka Peninsula, Russia. Nine transmitters provided positions from whales for up to 81 days. The whales travelled within 5 km of the Chukotka coast for most of the period they were tracked with only occasional movements offshore. The average daily travel speeds were 23 km/day (range 9-53 km/day). Four of the whales had daily average travel speeds <1 km/day suggesting strong fidelity to the study area. The area containing 95% of the locations for individual whales during biweekly periods was on average 13,027 km**2 (range 7,097-15,896 km**2). More than 65% of all locations were in water <30 m, and between 45 and 70% of biweekly kernel home ranges were located in depths between 31 and 50 m. Benthic density of amphipods within the Bering Strait at depths <50 m was on average ~54 g wet wt/m**2 in 2006. It is likely that the abundant benthic biomass is more than sufficient forage to support the current gray whale population. The use of satellite telemetry in this study quantifies space use and movement patterns of gray whales along the Chukotka coast and identifies key feeding areas.

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The characteristics of a global set-up of the Finite-Element Sea-Ice Ocean Model under forcing of the period 1958-2004 are presented. The model set-up is designed to study the variability in the deep-water mass formation areas and was therefore regionally better resolved in the deep-water formation areas in the Labrador Sea, Greenland Sea, Weddell Sea and Ross Sea. The sea-ice model reproduces realistic sea-ice distributions and variabilities in the sea-ice extent of both hemispheres as well as sea-ice transport that compares well with observational data. Based on a comparison between model and ocean weather ship data in the North Atlantic, we observe that the vertical structure is well captured in areas with a high resolution. In our model set-up, we are able to simulate decadal ocean variability including several salinity anomaly events and corresponding fingerprint in the vertical hydrography. The ocean state of the model set-up features pronounced variability in the Atlantic Meridional Overturning Circulation as well as the associated mixed layer depth pattern in the North Atlantic deep-water formation areas.

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Reconstruction of the geologic history of the Yenisey Ridge, which developed as an accretionary collision orogen on the western margin of the Siberian craton is essential to understanding the evolution of mobile belts surrounding older cratons, as well as to resolving the recently much debated problem of whether Siberia was part of the supercontinent Rodinia. Available paleotectonic models suggest that this supercontinent was assembled at the Middle-Late Riphean boundary (1100-900 Ma) as a result of the Grenville orogeny, the first long-lived mountain building event which occurred in geosynclinal areas during the Neogaea. However, the character of crustal evolution at that stage is still speculative due to the lack of reliable and conclusive isotope data. In many current geodynamic models, a common underlying assumption is that the Yenisey Ridge showed very little endogenic activity for 1 Gyr, from the time of Tarak granite emplacement (1900-1840 Ma) to the Middle Neoproterozoic (~750 Ma). On the basis of this assumption, several recent studies suggested the absence of Grenvillian collisional events within the Yenisey Ridge. The results of the SHRIMP II U-Pb analysis of rift-related plagiogranites of the Nemtikha Complex, Yenisey Ridge (1380-1360 Ma) suggest an increase in magmatic activity in the Mesoproterozoic. Interpretation of these results in terms of a supercontinent cycle may help find evidence for possible occurrence of the Grenville orogeny on the western margin of the Siberian craton. With this in mind, we attempted to reconstruct using recent geochronological constraints the evolution of metapelitic rocks from the Teya polymetamorphic complex (TPMC), which is a good example of superimposed zoning of low and medium-pressure facies series. High precision age determinations from rock complexes formed in different geodynamic settings under different thermodynamic conditions and geothermal gradients were used to distinguish several major metamorphic events and unravel their time relations with tectonic and magmatic activity in the region.