Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a Pediatric emergency room

OBJECTIVE: To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children. METHODS: This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. RESULTS: 650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value. CONCLUSIONS: The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.

Assessing the effectiveness of ISO 3382 for evaluating the acoustical quality of italian historical theatres: the case study of the Bonci Theatre

The present study concerns the acoustical characterisation of Italian historical theatres. It moved from the ISO 3382 which provides the guidelines for the measurement of a well established set of room acoustic parameters inside performance spaces. Nevertheless, the peculiarity of Italian historical theatres needs a more specific approach. The Charter of Ferrara goes in this direction, aiming at qualifying the sound field in this kind of halls and the present work pursues the way forward. Trying to understand how the acoustical qualification should be done, the Bonci Theatre in Cesena has been taken as a case study. In September 2012 acoustical measurements were carried out in the theatre, recording monaural e binaural impulse responses at each seat in the hall. The values of the time criteria, energy criteria and psycho-acoustical and spatial criteria have been extracted according to ISO 3382. Statistics were performed and a 3D model of the theatre was realised and tuned. Statistical investigations were carried out on the whole set of measurement positions and on carefully chosen reduced subsets; it turned out that these subsets are representative only of the “average” acoustics of the hall. Normality tests were carried out to verify whether EDT, T30 and C80 could be described with some degree of reliability with a theoretical distribution. Different results, according to the varying assumptions underlying each test, were found. Finally, an attempt was made to correlate the numerical results emerged from the statistical analysis to the perceptual sphere. Looking for “acoustical equivalent areas”, relative difference limens were considered as threshold values. No rule of thumb emerged. Finally, the significance of the usual representation through mean values and standard deviation, which may be meaningful for normal distributed data, was investigated.

High frequency acoustics in colloid-based meso- and nanostructures by spontaneous Brillouin light scattering

Materials that can mold the flow of elastic waves of certain energy in certain directions are called phononic materials. The present thesis deals essentially with such phononic systems, which are structured in the mesoscale (<1 µm), and with their individual components. Such systems show interesting phononic properties in the hypersonic region, i.e., at frequencies in the GHz range. It is shown that colloidal systems are excellent model systems for the realization of such phononic materials. Therefore, different structures and particle architectures are investigated by Brillouin light scattering, the inelastic scattering of light by phonons.rnThe experimental part of this work is divided into three chapters: Chapter 4 is concerned with the localized mechanical waves in the individual spherical colloidal particles, i.e., with their resonance- or eigenvibrations. The investigation of these vibrations with regard to the environment of the particles, their chemical composition, and the influence of temperature on nanoscopically structured colloids allows novel insights into the physical properties of colloids at small length scales. Furthermore, some general questions concerning light scattering on such systems, in dispute so far, are convincingly addressed.rnChapter 5 is a study of the traveling of mechanical waves in colloidal systems, consisting of ordered and disordered colloids in liquid or elastic matrix. Such systems show acoustic band gaps, which can be explained geometrically (Bragg gap) or by the interaction of the acoustic band with the eigenvibrations of the individual spheres (hybridization gap).rnWhile the latter has no analogue in photonics, the presence of strong phonon scatterers, when a large elastic mismatch between the composite components exists, can largely impact phonon propagation in analogy to strong multiple light scattering systems. The former is exemplified in silica based phononic structures that opens the door to new ways of sound propagation manipulation.rnChapter 6 describes the first measurement of the elastic moduli in newly fabricated by physical vapor deposition so-called ‘stable organic glasses’. rnIn brief, this thesis explores novel phenomena in colloid-based hypersonic phononic structures, utilizing a versatile microfabrication technique along with different colloid architectures provided by material science, and applying a non-destructive optical experimental tool to record dispersion diagrams.rn

A new method for the estimation of the reverberation time from measured room impulse responses with application to Italian opera houses

The Schroeder's backward integration method is the most used method to extract the decay curve of an acoustic impulse response and to calculate the reverberation time from this curve. In the literature the limits and the possible improvements of this method are widely discussed. In this work a new method is proposed for the evaluation of the energy decay curve. The new method has been implemented in a Matlab toolbox. Its performance has been tested versus the most accredited literature method. The values of EDT and reverberation time extracted from the energy decay curves calculated with both methods have been compared in terms of the values themselves and in terms of their statistical representativeness. The main case study consists of nine Italian historical theatres in which acoustical measurements were performed. The comparison of the two extraction methods has also been applied to a critical case, i.e. the structural impulse responses of some building elements. The comparison underlines that both methods return a comparable value of the T30. Decreasing the range of evaluation, they reveal increasing differences; in particular, the main differences are in the first part of the decay, where the EDT is evaluated. This is a consequence of the fact that the new method returns a “locally" defined energy decay curve, whereas the Schroeder's method accumulates energy from the tail to the beginning of the impulse response. Another characteristic of the new method for the energy decay extraction curve is its independence on the background noise estimation. Finally, a statistical analysis is performed on the T30 and EDT values calculated from the impulse responses measurements in the Italian historical theatres. The aim of this evaluation is to know whether a subset of measurements could be considered representative for a complete characterization of these opera houses.

Design and acoustic characterization of a new listening room

Il presente lavoro tratta la progettazione e caratterizzazione di una nuova "listening room" ad acustica controllata partendo dai requisiti dettati dalle norme tecniche ITU-R BS 1116-1 e EBU/UER Tech. doc. 3276. Ad oggi è presente un'ampia letteratura, che tratta approcci per valutazione acustica delle sale di ascolto. Essa inizialmente era volta a trovare proporzioni ideali tra le dimensioni della camera, poi la ricerca si è spostata sull'elaborazione di modelli previsionali. Purtroppo tali metodi spesso non riescono a garantire le prestazioni desiderate, mentre le prove sperimentali dettate dalle norme risultano essere di comprovata validità. L'ambiente oggetto di studio è stato progettato all'interno dello spazio dei laboratori CIRI. La tecnologia costruttiva è frutto di uno studio approfondito, in particolare la scelta di fibre di poliestere termolegate, per il rivestimento delle pareti interne, è stata valutata attraverso misure in camera riverberante secondo UNI-EN-ISO 354. Si è poi seguita una metodologia iterativa che coinvolgesse messa in opera, misurazioni in situ e valutazione tramite confronto con i parametri consigliati dalle normative tecniche sopra citate. In quest'ottica sono state effettuate acquisizioni di risposte all'impulso monoaurali e dei livelli di pressione sonora per verificare la qualità di isolamento e il comportamento alle basse frequenze. La validazione restituisce indicazioni positive per gli utilizzi dell'ambiente ipotizzati e risulta compatibile con le stringenti richieste delle norme tecniche.

Sviluppo dell'ingegneria di cantiere per la realizzazione di moduli "local equipment room"

Sviluppo dell'ingegneria di cantiere per la realizzazione di due strutture per il settore oil & gas e offshore. Definizione di layout di cantiere, supportazione, roll-up di sottoassiemi, sollevamenti tramite tiri piramidali e bilancini, movimentazione tramite carrelli semoventi o SPMT.

Progettazione e realizzazione di un'applicazione Android per il Virtual Dressing Room

Il lavoro svolto per la tesi consiste nella realizzazione di un'applicazione Android che permetta all’utente di scattare o caricare dalla gallery una foto personale e prelevare da una ListView fotografie di abiti da provare mediante trascinamento di quest’ultimi sulla foto dell’utente. Le fasi di lavoro sono state principalmente quattro: - Ricerca sullo stato dell’arte della tecnologia legata al Virtual Dressing Room (storia, elenco e descrizione dei metodi utilizzati da piattaforme esistenti, esempi reali di queste metodologie) - Progettazione con individuazione degli obiettivi e featuring dell’applicazione - Implementazione dell'applicazione (creazione dei layout e codice java delle activity:inserimento taglie e scelta uomo/donna, scatto/caricamento foto, creazione del database e utilizzo mediante ListView, visualizzazione e gestione del carrello). Scrittura del volume di tesi (introduzione e descrizione della tecnologia, progettazione, implementazione con descrizione su Android SDK, Android Studio e implementazione con descrizione dei layout e classi).

Measuring attitudes, behaviours, and influences in inner city victims of interpersonal violence (VIVs) - a Swiss emergency room pilot study

Background Switzerland is confronted with the problem of interpersonal violence. Violence is in the increase and the potential for aggression seems to be rising. Observations by hospitals discern an appalling increase of the severity of the injuries. The aim of this study is to collect accurate information about the social environment, the motivation and possible reasons for violence. We also intend to investigate whether sociocultural, or ethnic differences among male victims exist. Materials and methods For the first time in Switzerland, this survey employed a validated questionnaire from the division of violence prevention, Atlanta, Georgia. The first part of the questionnaire addressed social and demographic factors which could influence the risk of violence: age, gender, duration of stay in Switzerland, nationality and educational level. Beside these social structural factors, the questionnaire included questions on experience of violent offences in the past, information about the most recent violent offence and intra and interpersonal facts. The questionnaire itself consists of 27 questions, translated into German and French. In a pilot study, the questionnaire was checked with adolescents for feasibility and comprehensibility. Results 69 male VIVs were interviewed at two hospitals in the Canton of Bern. Most of the adolescents emphasised that weapons were not used during their confrontations. It is astonishing that all of the young men considered themselves to be victims. Most of the brawls were incited after an exchange of verbal abuse and provocations with unfamiliar individuals. The rivals could neither be classified with the help of ethnic categories nor identifiable groups of the youth scenes. The incidents took place in scenes, where violence was more likely to happen. Interestingly and contrary to a general perception the offenders are well integrated into sport and leisure clubs. A further surprising result of our research is that the attitude towards religion differs between young men with experience of violence and non-violent men. Discussion Youth violence is a health issue, which concerns us globally. The human and economic toll of violence on victims and offenders, their families, and on society in general is high. The economic costs associated with violence-related illness and disability is estimated to be millions of Swiss francs each year. Physicians and psychologists are compelled to identify the factors, which cause young people to be violent, to find out which interventions prove to be successful, and to design effective prevention programs. The identification of effective programs depends on the availability of reliable and valid measures to assess changes in violence-related attitudes. In our efforts to create healthier communities, we need to investigate; document and do research on the causes and circumstances of youth violence.

Delivery room management of very low birth weight infants in Germany, Austria and Switzerland--a comparison of protocols

Surveys from the USA, Australia and Spain have shown significant inter-institutional variation in delivery room (DR) management of very low birth weight infants (VLBWI, <1500g) at birth, despite regularly updated international guidelines.

Dysnatraemias in the emergency room: Undetected, untreated, unknown?

Hypo- and hypernatraemia are the most common electrolyte disorders in hospitalized patients and have been associated with increased mortality. However, data on the prevalence of dysnatraemias in the emergency room and the characteristics of patients presenting with them are rare.

Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room

To identify reasons for ordering computed tomography pulmonary angiography (CTPA), to identify the frequency of reasons for CTPA reflecting defensive behavior and evidence-based behavior, and to identify the impact of defensive medicine and of training about diagnosing pulmonary embolism (PE) on positive results of CTPA.