Retrospective assesment of the levonorgestrel intrauterine device to treat complex atypical hyperplasia and early endometrioid endometrial cancer

Objective: The primary objective of this project was to describe the efficacy of the Levonorgestrel Intrauterine Device (LIUD) for treatment of Complex Endometrial Cancer (CAH) and Grade 1 Endometrial Cancer (G1EEC) in terms of rate of Complete Response (CR) and Partial Response (PR) after 6 months of therapy. Finally, we assessed if any clinical or pathologic features were associated with response to the LIUD. ^ Methods: This study was a retrospective case series designed to report the response rate of patients with CAH or G1EEC treated with LIUD therapy. In addition, this study has a laboratory component to assess molecular predictors of response to LIUD therapy. Retrospective data already collected from patients diagnosed with CAH or EEC grade 1 and treated with LIUD therapy at MD Anderson Cancer Center (MDACC) were used for this study. Patients from all ethnic and race groups were included. A Complete Response (CR) was defined in patients diagnosed with CAH if pathologic report at 6 months demonstrated either no evidence of hyperplasia or no atypia in the setting of simple or complex hyperplasia. Partial Response (PR) was recorded if disease downgraded to only CAH from G1EEC. No Response (NR) was recorded if pathologic report demonstrates no change (Stable Disease, SD) or progression to cancer (Progressive Disease, PD). We calculated the proportion of patients with complete response to LIUD therapy with 95% confidence interval. We compared the response rates (CR/PR vs NR) by obesity status (Obese if BMI > 40 kg/m2 vs non-obese if BMI <= 40 kg/m2) as well as other clinical and pathologic factors, such as age, uterine size (median size), and presence of exogenous progesterone effect. ^ Results: There were 39 patients diagnosed with either CAH or G1EEC treated with the LIUD. Of 39 patients, 12 did not have pathological results of biopsy at 6months time period. Of 27 evaluable patients, 17 were diagnosed with CAH and 10 with G1EEC. Overall response rate (RR) was 78% (95% CI = 62-94%) at 6 months, 18 patients had CR (4 in G1EEC; 14 in CAH), 3 patients had PR (3 in G1EEC), 3 had SD (1 in CAH; 2 in G1EEC), 3 had PD (2 in CAH; 1 in G1EEC). After histology stratification, RR at 6 months was 82.35% (14/17; 95%CI = 67.4-97.3%) in CAH and 70% (7/10; 95% CI = 41-98.4%) in G1EEC. ^ There was no difference in response (R) and no response (NR) based on BMI (p=0.56). He observed a trend showing association between age with response (p=0.1). There was no association between uterine size and response to therapy (p=0.17). We recorded strong association between exogenous progesterone effect and response. ^ Conclusion: LIUD therapy for the treatment of CAH and G1EEC may be effective and safe. Presence of exogenous progesterone effect may predict the response to LIUD therapy at earlier time points. There is need of further studies with larger sample size to explore the relationship of response with other clinical and pathologic factors^

El amor mas allá del narcisismo

El trabajo trata sobre un recorrido por la teorización psicoanalítica del amor tomando como referencia a Sigmund Freud y Jacques Lacan. Ello lleva desde la consideración freudiana del amor bajo los pliegues del narcisismo hasta la definición lacaniana del amor como dispositivo para sostener la diferencia heterónima del otro. Se refiere una antigua discusión que en el ámbito de la iglesia católica, llevó a la cuestión del amor puro y como, de alguna manera, el psicoanálisis la retoma. Esto realiza un camino por los distintos seminarios concluyendo en el seminario XX y la tesis central del no hay relación-proporción sexual. Y ello apunta a establecer las coordenadas necesarias para el desarrollo de una clínica de la des-pareja en los avatares de la vida contemporánea

El amor mas allá del narcisismo

El trabajo trata sobre un recorrido por la teorización psicoanalítica del amor tomando como referencia a Sigmund Freud y Jacques Lacan. Ello lleva desde la consideración freudiana del amor bajo los pliegues del narcisismo hasta la definición lacaniana del amor como dispositivo para sostener la diferencia heterónima del otro. Se refiere una antigua discusión que en el ámbito de la iglesia católica, llevó a la cuestión del amor puro y como, de alguna manera, el psicoanálisis la retoma. Esto realiza un camino por los distintos seminarios concluyendo en el seminario XX y la tesis central del no hay relación-proporción sexual. Y ello apunta a establecer las coordenadas necesarias para el desarrollo de una clínica de la des-pareja en los avatares de la vida contemporánea

El amor mas allá del narcisismo

El trabajo trata sobre un recorrido por la teorización psicoanalítica del amor tomando como referencia a Sigmund Freud y Jacques Lacan. Ello lleva desde la consideración freudiana del amor bajo los pliegues del narcisismo hasta la definición lacaniana del amor como dispositivo para sostener la diferencia heterónima del otro. Se refiere una antigua discusión que en el ámbito de la iglesia católica, llevó a la cuestión del amor puro y como, de alguna manera, el psicoanálisis la retoma. Esto realiza un camino por los distintos seminarios concluyendo en el seminario XX y la tesis central del no hay relación-proporción sexual. Y ello apunta a establecer las coordenadas necesarias para el desarrollo de una clínica de la des-pareja en los avatares de la vida contemporánea

Biodiversity context of all samples from the Tara Oceans Expedition (2009-2013)

The Tara Oceans Expedition (2009-2013) sampled the world oceans on board a 36 m long schooner, collecting environmental data and organisms from viruses to planktonic metazoans for later analyses using modern sequencing and state-of-the-art imaging technologies. Tara Oceans Data are particularly suited to study the genetic, morphological and functional diversity of plankton. The present data set provides biodiversity context to all samples from the Tara Oceans Expedition (2009-2013), including various diversity indexes calculated for the sampling location using satellite and model climatologies (Darwin project, Physat) and results from the sequencing of Tara Oceans samples.

Registry of all samples from the Tara Oceans Expedition (2009-2013)

The Tara Oceans Expedition (2009-2013) sampled the world oceans on board a 36 m long schooner, collecting environmental data and organisms from viruses to planktonic metazoans for later analyses using modern sequencing and state-of-the-art imaging technologies. Tara Oceans Data are particularly suited to study the genetic, morphological and functional diversity of plankton. Data sets in this collection provide methodological and environmental context to all samples collected during the Tara Oceans Expedition (2009-2013).

Environmental context of all samples from the Tara Oceans Expedition (2009-2013), about mesoscale features

The Tara Oceans Expedition (2009-2013) sampled the world oceans on board a 36 m long schooner, collecting environmental data and organisms from viruses to planktonic metazoans for later analyses using modern sequencing and state-of-the-art imaging technologies. Tara Oceans Data are particularly suited to study the genetic, morphological and functional diversity of plankton. The present data set provides environmental context to all samples from the Tara Oceans Expedition (2009-2013), about mesoscale features related to the sampling date, time and location. Includes calculated averages of mesaurements made concurrently at the sampling location and depth, and calculated averages from climatologies (AMODIS, VGPM) and satellite products.

Analysis and design of a thrombectomy device by using simulation techniques

Purpose: In this work, we present the analysis, design and optimization of one experimental device recently developed in the UK, called the 'GP' Thrombus Aspiration Device (GPTAD). This device has been designed to remove blood clots without the need to make contact with the clot itself thereby potentially reducing the risk of problems such as downstream embolisation. Method: To obtain the minimum pressure necessary to extract the clot and to optimize the device, we have simulated the performance of the GPTAD analysing the resistances, compliances and inertances effects. We model a range of diameters for the GPTAD considering different forces of adhesion of the blood clot to the artery wall, and different lengths of blood clot. In each case we determine the optimum pressure required to extract the blood clot from the artery using the GPTAD, which is attached at its proximal end to a suction pump. Result: We then compare the results of our mathematical modelling to measurements made in laboratory using plastic tube models of arteries of comparable diameter. We use abattoir porcine blood clots that are extracted using the GPTAD. The suction pressures required for such clot extraction in the plastic tube models compare favourably with those predicted by the mathematical modelling. Discussion & Conclusion: We conclude therefore that the mathematical modelling is a useful technique in predicting the performance of the GPTAD and may potentially be used in optimising the design of the device.

DIMETER: a haptic master device for tremor diagnosis in neurodegenerative diseases

In this study, a device based on patient motion capture is developed for the reliable and non-invasive diagnosis of neurodegenerative diseases. The primary objective of this study is the classification of differential diagnosis between Parkinson's disease (PD) and essential tremor (ET). The DIMETER system has been used in the diagnoses of a significant number of patients at two medical centers in Spain. Research studies on classification have primarily focused on the use of well-known and reliable diagnosis criteria developed by qualified personnel. Here, we first present a literature review of the methods used to detect and evaluate tremor; then, we describe the DIMETER device in terms of the software and hardware used and the battery of tests developed to obtain the best diagnoses. All of the tests are classified and described in terms of the characteristics of the data obtained. A list of parameters obtained from the tests is provided, and the results obtained using multilayer perceptron (MLP) neural networks are presented and analyzed.

Boolean logic device done with DFB laser diode

We present simulation results on how power output-input characteristic Instability in Distributed FeedBack -DFB semiconductor laser diode SLA can be employed to implemented Boolean logic device. Two configurations of DFB Laser diode under external optical injection, either in the transmission or in the reflective mode of operation, is used to implement different Optical Logic Cells (OLCs), called the Q- and the P-Device OLCs. The external optical injection correspond to two inputs data plus a cw control signal that allows to choose the Boolean logic function to be implement. DFB laser diode parameters are choosing to obtain an output-input characteristic with the values desired. The desired values are mainly the on-off contrast and switching power, conforming shape of hysteretic cycle. Two DFB lasers in cascade, one working in transmission operation and the other one in reflective operation, allows designing an inputoutput characteristic based on the same respond of a self-electrooptic effect device is obtained. Input power for a bit'T' is 35 uW(70uW) and a bit "0" is zero for all the Boolean function to be execute. Device control signal range to choose the logic function is 0-140 uW (280 uW). Q-device (P-device)

Monitorización y optimización de terapias de tele-neurorrehabilitación cognitiva

El Daño Cerebral Adquirido (DCA) se define como una lesión cerebral que ocurre después del nacimiento y que no guarda relación con defectos congénitos o enfermedades degenerativas. En el cerebro, se llevan a cabo las funciones mentales superiores como la atención, la memoria, las funciones ejecutivas y el lenguaje, consideradas pre-requisitos básicos de la inteligencia. Sea cual sea su causa, todo daño cerebral puede afectar a una o varias de estas funciones, de ahí la gravedad del problema. A pesar de los avances en nuevas técnicas de intervención precoz y el desarrollo de los cuidados intensivos, las afectaciones cerebrales aún no tienen tratamiento ni quirúrgico ni farmacológico que permita una restitución de las funciones perdidas. Los tratamientos de neurorrehabilitación cognitiva y funcional pretenden, por tanto, la minimización o compensación de las alteraciones ocasionadas por una lesión en el sistema nervioso. En concreto, la rehabilitación cognitiva se define como el proceso en el que personas que han sufrido un daño cerebral trabajan de manera conjunta con profesionales de la salud para remediar o aliviar los déficits cognitivos surgidos como consecuencia de un episodio neurológico. Esto se consigue gracias a la naturaleza plástica del sistema nervioso, donde el cerebro es capaz de reconfigurar sus conexiones neuronales, tanto creando nuevas como modificando las ya existentes. Durante los últimos años hemos visto una transformación de la sociedad, en lo que se ha denominado "sociedad de la información", cuyo pilar básico son las Tecnologías de la Información y las Comunicaciones (TIC). La aplicación de estas tecnologías en medicina ha revolucionado la manera en que se proveen los servicios sanitarios. Así, donde tecnología y medicina se mezclan, la telerrehabilitación se define como la rehabilitación a distancia, ayudando a extender los servicios de rehabilitación más allá de los centros hospitalarios, rompiendo las barreras geográficas, mejorando la eficiencia de los procesos y monitorizando en todo momento el estado y evolución del paciente. En este contexto, el objetivo general de la presente tesis es mejorar la rehabilitación neuropsicológica de pacientes que sufren alteraciones cognitivas, mediante el diseño, desarrollo y validación de un sistema de telemedicina que incorpora las TIC para avanzar hacia un nuevo paradigma personalizado, ubicuo y ecológico. Para conseguirlo, se han definido los siguientes objetivos específicos: • Analizar y modelar un sistema de telerrehabilitación, mediante la definición de objetivos y requisitos de usuario para diseñar las diferentes funcionalidades necesarias. • Definir una arquitectura de telerrehabilitación escalable para la prestación de diferentes servicios que agrupe las funcionalidades necesarias en módulos. • Diseñar y desarrollar la plataforma de telerrehabilitación, incluida la interfaz de usuario, creando diferentes roles de usuario con sus propias funcionalidades. • Desarrollar de un módulo de análisis de datos para extraer conocimiento basado en los resultados históricos de las sesiones de rehabilitación almacenadas en el sistema. • Evaluación de los resultados obtenidos por los pacientes después del programa de rehabilitación, obteniendo conclusiones sobre los beneficios del servicio implementado. • Evaluación técnica de la plataforma de telerrehabilitación, así como su usabilidad y la relación coste/beneficio. • Integración de un dispositivo de eye-tracking que permita la monitorización de la atención visual mientras los pacientes ejecutan tareas de neurorrehabilitación. •Diseño y desarrollo de un entorno de monitorización que permita obtener patrones de atención visual. Como resumen de los resultados obtenidos, se ha desarrollado y validado técnicamente la plataforma de telerrehabilitación cognitiva, demostrando la mejora en la eficiencia de los procesos, sin que esto resulte en una reducción de la eficacia del tratamiento. Además, se ha llevado a cabo una evaluación de la usabilidad del sistema, con muy buenos resultados. Respecto al módulo de análisis de datos, se ha diseñado y desarrollado un algoritmo que configura y planifica sesiones de rehabilitación para los pacientes, de manera automática, teniendo en cuenta las características específicas de cada paciente. Este algoritmo se ha denominado Intelligent Therapy Assistant (ITA). Los resultados obtenidos por el asistente muestran una mejora tanto en la eficiencia como en la eficacia de los procesos, comparado los resultados obtenidos con los de la planificación manual llevada a cabo por los terapeutas. Por último, se ha integrado con éxito el dispositivo de eye-tracking en la plataforma de telerrehabilitación, llevando a cabo una prueba con pacientes y sujetos control que ha demostrado la viabilidad técnica de la solución, así como la existencia de diferencias en los patrones de atención visual en pacientes con daño cerebral. ABSTRACT Acquired Brain Injury (ABI) is defined as brain damage that suddenly and unexpectedly appears in people’s life, being the main cause of disability in developed countries. The brain is responsible of the higher cognitive functions such as attention, memory, executive functions or language, which are considered basic requirements of the intelligence. Whatever its cause is, every ABI may affects one or several functions, highlighting the severity of the problem. New techniques of early intervention and the development of intensive ABI care have noticeably improved the survival rate. However, despite these advances, brain injuries still have no surgical or pharmacological treatment to re-establish lost functions. Cognitive rehabilitation is defined as a process whereby people with brain injury work together with health service professionals and others to remediate or alleviate cognitive deficits arising from a neurological insult. This is achieved by taking advantage of the plastic nature of the nervous system, where the brain can reconfigure its connections, both creating new ones, and modifying the previously existing. Neuro-rehabilitation aims to optimize the plastic nature by inducing a reorganization of the neural network, based on specific experiences. Personalized interventions from individual impairment profile will be necessary to optimize the remaining resources by potentiating adaptive responses and inhibiting maladaptive changes. In the last years, some applications and software programs have been developed to train or stimulate cognitive functions of different neuropsychological disorders, such as ABI, Alzheimer, psychiatric disorders, attention deficit or hyperactivity disorder (ADHD). The application of technologies into medicine has changed the paradigm. Telemedicine allows improving the quality of clinical services, providing better access to them and helping to break geographical barriers. Moreover, one of the main advantages of telemedicine is the possibility to extend the therapeutic processes beyond the hospital (e.g. patient's home). As a consequence, a reduction of unnecessary costs and a better costs/benefits ratio are achieved, making possible a more efficient use of the available resources In this context, the main objective of this work is to improve neuro-rehabilitation of patients suffering cognitive deficits, by designing, developing and validating a telemedicine system that incorporates ICTs to change this paradigm, making it more personalized, ubiquitous and ecologic. The following specific objectives have been defined: • To analyse and model a tele-rehabilitation system, defining objectives and user requirements to design the different needed functionalities. • To define a scalable tele-rehabilitation architecture to offer different services grouping functionalities into modules. • To design and develop the tele-rehabilitation platform, including the graphic user interface, creating different user roles and permissions. • To develop a data analysis module to extract knowledge based on the historic results from the rehabilitation sessions stored in the system. • To evaluate the obtained results by patients after the rehabilitation program, arising conclusions about the benefits of the implemented service. • To technically evaluate the tele-rehabilitation platform, and its usability and the costs/benefit ratio. • To integrate an eye-tracking device allowing the monitoring of the visual attention while patients execute rehabilitation tasks. •To design and develop a monitoring environment that allows to obtain visual attention patterns. Summarizing the obtained results, the cognitive tele-rehabilitation platform has been developed and evaluated technically, demonstrating the improvements on the efficiency without worsening the efficacy of the process. Besides, a usability evaluation has been carried out, with very good results. Regarding the data analysis module, an algorithm has been designed and developed to automatically select and configure rehabilitation sessions, taking into account the specific characteristics of each patient. This algorithm is called Intelligent Therapy Assistant (ITA). The obtained results show an improvement both in the efficiency and the efficacy of the process, comparing the results obtained by patients when they receive treatments scheduled manually by therapists. Finally, an eye-tracking device has been integrated in the tele-rehabilitation platform, carrying out a study with patients and control subjects demonstrating the technical viability of the developed monitoring environment. First results also show that there are differences between the visual attention patterns between ABI patients and control subjects.

Grasp Mapping Between a 3-Finger Haptic Device and a Robotic Hand

This paper presents the implementation of a robust grasp mapping between a 3-finger haptic device (master) and a robotic hand (slave). Mapping is based on a grasp equivalence defined considering the manipulation capabilities of the master and slave devices. The metrics that translate the human hand gesture to the robotic hand workspace are obtained through an analytical user study. This allows a natural control of the robotic hand. The grasp mapping is accomplished defining 4 control modes that encapsulate all the grasps gestures considered.

Facilitating the creation of interactive multi-device Learning Objects using an online authoring tool

Learning Objects facilitate reuse leading to cost and time savings as well as to the enhancement of the quality of educational resources. However, teachers find it difficult to create or to find high quality Learning Objects, and the ones they find need to be customized. Teachers can overcome this problem using suitable authoring systems that enable them to create high quality Learning Objects with little effort. This paper presents an open source online e-Learning authoring tool called ViSH Editor together with four novel interactive Learning Objects that can be created with it: Flashcards, Virtual Tours, Enriched Videos and Interactive Presentations. All these Learning Objects are created as web applications, which can be accessed via mobile devices. Besides, they can be exported to SCORM including their metadata in IEEE LOM format. All of them are described in the paper including an example of each. This approach for creating Learning Objects was validated through two evaluations: a survey among authors and a formal quality evaluation of 209 Learning Objects created with the tool. The results show that ViSH Editor facilitates educators the creation of high quality Learning Objects.

A micromachined device provides a new bend on fibroblast traction forces

We have measured the traction forces generated by fibroblasts using a novel micromachined device that is capable of determining the subcellular forces generated by individual adhesive contacts. The front of migrating fibroblasts produced intermittent rearward forces whereas the tail produced larger forward directed forces. None of the forces were steady; they all had periodic fluctuations. The transition between forward and rearward traction forces occurred at the nucleus, not at the rear of the cell or the border between the endoplasm and the ectoplasm. We propose that the coupling of lamella extensions to fluctuating rearward tractions in front of the nuclear region move the front of a fibroblast forward, while force-facilitated release of rear adhesive contacts and anterior-directed tractions allow the region behind the nucleus to advance.