Antibiotic lock technique combined with systemic antimicrobial therapy for management of port-related bloodstream infections in onco-haematological patients without catheter removal

Background : Port-related bloodstream infection (PRBSI) is a common complication associated with long-term use of ports systems. Systemic antimicrobial therapy (ST) and removal of the device is the standard management of PRBSI. However, a conservative management combining ST with antibiotic lock therapy (ALT) without port removal has been suggested as an alternative management option for infections due to gram-positive skin colonizers with low virulence.¦Objectives : i) to assess the frequency of management of PRBSI in onco-hematological patients by combining the ALT with ST, without catheter removal and ii) to analyze the efficacy of such an approach.¦Methods : Retrospective observational study over a 6-year period between 2005 and 2010, including patients who where diagnosed with PRBSI and who were treated with ST and ALT. PRBSI diagnosis consisted in clinical signs of bacteremia with blood cultures positive for gram-positive skin colonizers. The primary endpoint was failure to cure the PRBSI.¦Results : 61 port infections were analysed, of which 23 PRBSI met the inclusion criteria. All the patients were suffering from haematological conditions and 75% were neutropenic at the time of PRBSI diagnosis. S. epidermidis was responsible for 91% of PRBSI (21/23). The median duration of ST was 14 days (range 7-35) and the median duration of ALT was 15 days (range 8-41). Failure to cure the PRBSI requiring port removal was observed in 4 patients, but was not associated with severe infectious complications. Kaplan-Meier analysis showed a success rate in port salvage at day 180 (6 months) of 78% (95%CI 59-97%).¦Conclusion : The success rate observed in the present study suggests that combining ST and ALT is an effective option to conservatively treat PRBSI caused by pathogens of low virulence such as S. epidermidis.

Earnings management and audit adjustments: An empirical study of IBEX 35 constituents

Doubts about the reliability of a company's qualitative financial disclosure increase market participant expectations from the auditor's report. The auditing process is supposed to serve as a monitoring device that reduces management incentives to manipulate reported earnings. Empirical research confirms that it could be an efficient device under some circumstancesand recognizes that our estimates of the informativeness of audit reports are unavoidably biased (e.g., because of a client's anticipation of the auditing process). This empirical study supports the significant role of auditors in the financial market, in particular in the prevention of earnings management practice. We focus on earnings misstatements, which auditors correct with anadjustment, using a sample of past and current constituents of the benchmark market index in Spain, IBEX 35, and manually collected audit adjustments reported over the 1997-2004 period (42 companies, 336 annual reports, 75 earnings misstatements). Our findings confirm that companies more often overstate than understate their earnings. An investor may foresee earningsmisreporting, as manipulators have a similar profile (e.g., more leveraged and with lower sales). However, he may receive valuable information from the audit adjustment on the size of earnings misstatement, which can be significantly large (i.e., material in almost all cases). We suggest that the magnitude of an audit adjustment depends, other things constant, on annual revenues and free cash levels. We also examine how the audit adjustment relates to the observed market price, trading volume and stock returns. Our findings are that earnings manipulators have a lower price and larger trading volume compared to their rivals. Their returns are positively associated with the magnitude of earnings misreporting, which is not consistent with the possible pricing of audit information.

Thermal modeling and management in ultrathin chip stack technology

This paper presents a thermal modeling for power management of a new three-dimensional (3-D) thinned dies stacking process. Besides the high concentration of power dissipating sources, which is the direct consequence of the very interesting integration efficiency increase, this new ultra-compact packaging technology can suffer of the poor thermal conductivity (about 700 times smaller than silicon one) of the benzocyclobutene (BCB) used as both adhesive and planarization layers in each level of the stack. Thermal simulation was conducted using three-dimensional (3-D) FEM tool to analyze the specific behaviors in such stacked structure and to optimize the design rules. This study first describes the heat transfer limitation through the vertical path by examining particularly the case of the high dissipating sources under small area. First results of characterization in transient regime by means of dedicated test device mounted in single level structure are presented. For the design optimization, the thermal draining capabilities of a copper grid or full copper plate embedded in the intermediate layer of stacked structure are evaluated as a function of the technological parameters and the physical properties. It is shown an interest for the transverse heat extraction under the buffer devices dissipating most the power and generally localized in the peripheral zone, and for the temperature uniformization, by heat spreading mechanism, in the localized regions where the attachment of the thin die is altered. Finally, all conclusions of this analysis are used for the quantitative projections of the thermal performance of a first demonstrator based on a three-levels stacking structure for space application.

Assessment of Channelizing Device Effectiveness on High Speed/High Volume Roadways, 2007

Part 6 of the Manual on Uniform Traffic Control Devices (MUTCD) describes several types of channelizing devices that can be used to warn road users and guide them through work zones; these devices include cones, tubular markers, vertical panels, drums, barricades, and temporary raised islands. On higher speed/volume roadways, drums and/or vertical panels have been popular choices in many states, due to their formidable appearance and the enhanced visibility they provide when compared to standard cones. However, due to their larger size, drums also require more effort and storage space to transport, deploy and retrieve. Recent editions of the MUTCD have introduced new devices for channelizing; specifically of interest for this study is a taller (>36 inches) but thinner cone. While this new device does not offer a comparable target value to that of drums, the new devices are significantly larger than standard cones and they offer improved stability as well. In addition, these devices are more easily deployed and stored than drums and they cost less. Further, for applications previously using both drums and tall cones, the use of tall cones only provides the ability for delivery and setup by a single vehicle. An investigation of the effectiveness of the new channelizing devices provides a reference for states to use in selecting appropriate traffic control for high speed, high volume applications, especially for short term or limited duration exposures. This study includes a synthesis of common practices by state DOTs, as well as daytime and nighttime field observations of driver reactions using video detection equipment. The results of this study are promising for the day and night performance of the new tall cones, comparing favorably to the performance of drums when used for channelizing in tapers. The evaluation showed no statistical difference in merge distance and location, shy distance, or operating speed in either daytime or nighttime conditions. The study should provide a valuable resource for state DOTs to utilize in selecting the most effective channelizing device for use on high speed/high volume roadways where timely merging by drivers is critical to safety and mobility.

Legal Issues for FOSS-based Supply Chain Management ¿ Black Duck Software

Open source is typically outside of normal commercial software procurement processes.The Challenges.Increasingly diverse and distributed set of development resources.Little/no visibility into the origins of the software.Supply Chain Comparison: Hardware vs Software.Open source has revolutionized the mobile and device landscape, other industries will follow.Supply chain management techniques from hardware are useful for managing software.SPDX A standard format for communicating a software Bill of Materials across the supply chain.Effective management and control requires training, tools, processes and standards.

Distraction osteogenesis in the management of severe maxillary hypoplasia in cleft lip and palate patients.

The aim of this study was to systematically review literature reporting on the use of external distraction osteogenesis (DO) and internal DO in the treatment of severe maxillary hypoplasia in cleft and palate patients. Literature research has been performed using the PubMed database of the National Library of Medicine and National Institutes of Health from 1966 to August 2007. We used cleft lip and palate and distraction osteogenesis as key words. Of the 104 articles found, we only considered the Anglo-Saxon literature, which reported on the correction of the maxillary hypoplasia with DO techniques. A total of 32 studies reported on anteroposterior external DO (27 studies on rigid external device and 5 on face mask), 17 studies reported on anteroposterior internal DO, and 3 studies reported on transverse internal DO have been retained for this review. Despite the heterogeneity and methodological limitations of most of the studies, results showed that external DO with rigid external device and internal DO resulted to be a more reliable and accurate technique than the face mask in the management of severe maxillary hypoplasia in patients with cleft lip and palate. The current review demonstrated that external and internal DO in the treatment of severe maxillary hypoplasia in cleft and palate patients (1) is a reproducible and valuable alternative to standard orthognathic surgery procedures, (2) allows for a global improvement in facial aesthetic, (3) allows a maxillary correction in patients during the period of mixed dentition, and (4) allows either for an unchanged or better velopharyngeal function.

Low cost driver device for microclimate maintenance in the pre-milking of dairy cattle

Due to the importance of the environment on animal production and thus environmental control, the study aims to build a system for monitoring and control the meteorological variables, temperature and relative humidity, low cost, which can be associated with an evaporative cooling system (ECS). The system development included all the stages of assembly, test and laboratory calibration, and later the validation of the equipment carried in the field. The validation step showed results which allowed concluding that the system can be safely used in the monitoring of these variables. The controller was efficient in management of the microclimate in the waiting corral and allowed the maintenance of the air temperature within the comfort range for dairy cattle in pre-milking with averaged 25.09 ºC during the afternoon. The equipment showed the lower cost (R$ 325.76) when compared to other middle market (R$ 450.00).

The Design and Implementation of a Power Management Feature to a Configuration Management System

Green IT is a term that covers various tasks and concepts that are related to reducing the environmental impact of IT. At enterprise level, Green IT has significant potential to generate sustainable cost savings: the total amount of devices is growing and electricity prices are rising. The lifecycle of a computer can be made more environmentally sustainable using Green IT, e.g. by using energy efficient components and by implementing device power management. The challenge using power management at enterprise level is how to measure and follow-up the impact of power management policies? During the thesis a power management feature was developed to a configuration management system. The feature can be used to automatically power down and power on PCs using a pre-defined schedule and to estimate the total power usage of devices. Measurements indicate that using the feature the device power consumption can be monitored quite precisely and the power consumption can be reduced, which generates electricity cost savings and reduces the environmental impact of IT.

Integrated Management of Interface Power (IMIP) Framework

La présence importante de plusieurs réseaux sans-fils de différentes portées a encouragée le développement d’une nouvelle génération d’équipements portables sans-fils avec plusieurs interfaces radio. Ainsi, les utilisateurs peuvent bénéficier d’une large possibilité de connectivité aux réseaux sans-fils (e.g. Wi-Fi [1], WiMAX [2], 3G [3]) disponibles autour. Cependant, la batterie d’un nœud mobile à plusieurs interfaces sera rapidement épuisée et le temps d’utilisation de l’équipement sera réduit aussi. Pour prolonger l’utilisation du mobile les standards, des réseaux sans-fils, on définie (individuellement) plusieurs états (émission, réception, sleep, idle, etc.); quand une interface radio n’est pas en mode émission/réception il est en mode sleep/idle où la consommation est très faible, comparée aux modes émission/réception. Pourtant, en cas d’équipement portable à multi-interfaces radio, l’énergie totale consommée par les interfaces en mode idle est très importante. Autrement, un équipement portable équipé de plusieurs interfaces radio augmente sa capacité de connectivité mais réduit sa longévité d’utilisation. Pour surpasser cet inconvénient on propose une plate-forme, qu'on appelle IMIP (Integrated Management of Interface Power), basée sur l’extension du standard MIH (Media Independent Handover) IEEE 802.21 [4]. IMIP permet une meilleure gestion d’énergie des interfaces radio, d’un équipement mobile à multi-radio, lorsque celles-ci entrent en mode idle. Les expérimentations que nous avons exécutées montrent que l’utilisation de IMIP permet d'économiser jusqu'a 80% de l'énergie consommée en comparaison avec les standards existants. En effet, IMIP permet de prolonger la durée d'utilisation d'équipements à plusieurs interfaces grâce à sa gestion efficace de l'énergie.

Management of Traffic Control — A Computer Oriented Approach

Traffic Management system (TMS) comprises four major sub systems: The Network Database Management system for information to the passengers, Transit Facility Management System for service, planning, and scheduling vehicle and crews, Congestion Management System for traffic forecasting and planning, Safety Management System concerned with safety aspects of passengers and Environment. This work has opened a rather wide frame work of model structures for application on traffic. The facets of these theories are so wide that it seems impossible to present all necessary models in this work. However it could be deduced from the study that the best Traffic Management System is that whichis realistic in all aspects is easy to understand is easy to apply As it is practically difficult to device an ideal fool—proof model, the attempt here has been to make some progress-in that direction.

A Reinforcement-Learning Approach to Power Management

We describe an adaptive, mid-level approach to the wireless device power management problem. Our approach is based on reinforcement learning, a machine learning framework for autonomous agents. We describe how our framework can be applied to the power management problem in both infrastructure and ad~hoc wireless networks. From this thesis we conclude that mid-level power management policies can outperform low-level policies and are more convenient to implement than high-level policies. We also conclude that power management policies need to adapt to the user and network, and that a mid-level power management framework based on reinforcement learning fulfills these requirements.

Profiling management for personalised multimedia delivery on-demand within the AXMEDIS framework

Media content distribution on-demand becomes more complex when performed on a mass scale involving various channels with distinct and dynamic network characteristics, and, deploying a variety of terminal devices offering a wide range of capabilities. It is practically impossible to create and prepackage various static versions of the same content to match all the varying demand parameters of clients for various contexts. In this paper we present a profiling management approach for dynamically personalised media content delivery on-demand integrated with the AXMEDIS Framework. The client profiles comprise the representation of User, Device, Network and Context of content delivery based on MPEG-21:DIA. Although the most challenging proving ground for this personalised content delivery has been the mobile testbed i.e. the distribution to mobile handsets, the framework described here can be deployed for disribution, by the AXMEDIS PnP module, through other channels e.g. satellite, Internet to a range of client terminals e.g. desktops, kiosks, IPtv and other terrminals whose baseline terminal capabilities can be made availabe by the manufacturers as is normal.

A methodology to measure the environmental impact of ICT operating systems across different device platforms

Abstract: A new methodology was created to measure the energy consumption and related green house gas (GHG) emissions of a computer operating system (OS) across different device platforms. The methodology involved the direct power measurement of devices under different activity states. In order to include all aspects of an OS, the methodology included measurements in various OS modes, whilst uniquely, also incorporating measurements when running an array of defined software activities, so as to include OS application management features. The methodology was demonstrated on a laptop and phone that could each run multiple OSs, results confirmed that OS can significantly impact the energy consumption of devices. In particular, the new versions of the Microsoft Windows OS were tested and highlighted significant differences between the OS versions on the same hardware. The developed methodology could enable a greater awareness of energy consumption, during both the software development and software marketing processes.

Power Management Controls

In an office building in the US the office equipment uses about 7% of the total electricity use. Eventhough this is a low number, there is still a reason to save more energy, especially since one third of theenergy savings are lost when power management is not enabled.The core in the project ”Power Management Controls” is to develop a voluntary standard, The UserInterface Standard, that manufacturers of office equipment can use as a reference when they developnew equipment and design new interfaces. The interface is an important part of the use of powermanagement and doing this should increase the use of power management and save more energy. Theinterfaces are ofter hidden or inconsistent and confusing, which makes it harder for the user tounderstand power management. A more consistent interface makes it easier for the user to understandthe meaning of an interface and power management itselfThe standard consists of six different parts, which describe what can be done to achieve a consistentinterface. The standard also describes the part of the project called Dynamic Behavior. This part isconcentrating on the interfaces and the behavior of the device over time, which is important for the userto understand.The purpose of this degree project is to study and participate in the project ”Power ManagementControls”, and to understand what is being done to save more energy.

Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation

The aim of this research was to test the hypothesis that treatment with intra-oral appliances with different occlusal designs was beneficial in the management of pain of masticatory muscles compared with a control group. A total of 51 patients were analysed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) to obtain the diagnosis of masticatory myofascial pain (MMP). The sample was then randomly divided into three groups: group I (n = 21) wore a full coverage acrylic stabilisation occlusal splint; group II (n = 16) wore an anterior device nociceptive trigeminal inhibitory (NTI) system; and group III (n = 14) only received counselling for behavioural changes and self-care (the control group). The first two groups also received counselling. Follow-ups were performed after 2 and 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale (VAS) and pressure pain threshold (PPT) of the masticatory muscles. Possible adverse effects were also recorded, such as discomfort while using the appliance and occlusal changes. The results were analysed with KruskalWallis, anova, Tukeys and Friedman tests, with a significance level of 5%. Group I showed improvement in the reported pain at the first follow-up (2 weeks), whereas for groups II and III, this progress was detected only after 6 weeks and 3 months, respectively. The PPT values did not change significantly. It was concluded that behavioural changes are effective in the management of pain in MMP patients. However, the simultaneous use of occlusal devices appears to produce an earlier improvement.