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.

Strukturbildung durch Selbstorganisation von Oligonukleotiden

Die DNA-Doppelhelix ist eine relativ dicke (Ø ≈ 2 nm), kompakte und dadurch auf kurzen Längenskalen relativ steife Verbindung (lp[dsDNA] ≈ 50-60 nm), mit einer klar definierten Struktur, die durch biologische Methoden sehr präzise manipuliert werden kann. Die Auswirkungen der primären Sequenz auf die dreidimensionale Strukturbildung ist gut verstanden und exakt vorhersagbar. Des Weiteren kann DNA an verschiedenen Stellen mit anderen Molekülen verknüpft werden, ohne dass ihre Selbsterkennung gestört wird. Durch die helikale Struktur besteht außerdem ein Zusammenhang zwischen der Lage und der räumlichen Orientierung von eingeführten Modifikationen. Durch moderne Syntheseverfahren lassen sich beliebige Oligonukleotidsequenzen im Bereich bis etwa 150-200 Basen relativ preiswert im Milligrammmaßstab herstellen. Diese Eigenschaften machen die DNA zu einem idealen Kandidaten zur Erzeugung komplexer Strukturen, die durch Selbsterkennung der entsprechenden Sequenzen gebildet werden. In der hier vorgelegten Arbeit wurden einzelsträngige DNA-Abschnitte (ssDNA) als adressierbare Verknüpfungsstellen eingesetzt, um verschiedene molekulare Bausteine zu diskreten nicht periodischen Strukturen zu verbinden. Als Bausteine dienten flexible synthetische Polymerblöcke und semiflexible Doppelstrang-DNA-Abschnitte (dsDNA), die an beiden Enden mit unterschiedlichen Oligonukleotidsequenzen „funktionalisiert“ sind. Die zur Verknüpfung genutzten Oligonukleotidabschnitte wurden so gewählt (n > 20 Basen), dass ihre Hybridisierung zu einer bei Raumtemperatur stabilen Doppelstrangbildung führt. Durch Kombination der Phosphoramiditsynthese von DNA mit einer festkörpergestützten Blockkopplungsreaktion konnte am Beispiel von Polyethylenoxiden ein sehr effektiver Syntheseweg zur Herstellung von ssDNA1-PEO-ssDNA2-Triblockcopolymeren entwickelt werden, der sich problemlos auf andere Polymere übertragen lassen sollte. Die Längen und Basenabfolgen der beiden Oligonukleotidsequenzen können dabei unabhängig voneinander frei gewählt werden. Somit wurden die Voraussetzungen geschaffen, um die Selbsterkennung von Oligonukleotiden durch Kombination verschiedener Triblockcopolymere zur Erzeugung von Multiblockcopolymeren zu nutzen, die mit klassischen Synthesetechniken nicht zugänglich sind. Semiflexible Strukturelemente lassen sich durch die Synthese von Doppelstrangfragmenten mit langen überstehenden Enden (sticky-ends) realisieren. Die klassischen Ansätze der molekularen Genetik zur Erzeugung von sticky-ends sind in diesem Fall nicht praktikabel, da sie zu Einschränkungen im Bezug auf Länge und Sequenz der überhängenden Enden führen. Als Methode der Wahl haben sich zwei verschiedene Varianten der Polymerase Kettenreaktion (PCR) erwiesen, die auf der Verwendung von teilkomplementären Primern beruhen. Die eigentlichen Primersequenzen wurden am 5´-Ende entweder über ein 2´-Desoxyuridin oder über einen kurzen Polyethylenoxid-Spacer (n = 6) mit einer frei wählbaren „sticky-end-Sequenz“ verknüpft. Mit diesen Methoden sind sowohl 3´- als auch 5´-Überhänge zugänglich und die Länge der Doppelstrangabschnitte kann über einen breiten Molmassenbereich sehr exakt eingestellt werden. Durch Kombination derartiger Doppelstrangfragmente mit den biosynthetischen Triblockcopolymeren lassen sich Strukturen erzeugen, die als Modellsysteme zur Untersuchung verschiedener Biomoleküle genutzt werden können, die in Form eines mehrfach gebrochenen Stäbchens vorliegen. Im letzten Abschnitt wurde gezeigt, dass durch geeignete Wahl der überstehenden Enden bzw. durch Hybridisierung der Doppelstrangfragmente mit passenden Oligonukleotiden verzweigte DNA-Strukturen mit Armlängen von einigen hundert Nanometern zugänglich sind. Im Vergleich zu den bisher veröffentlichten Methoden bietet diese Herangehensweise zwei entscheidende Vorteile: Zum einen konnte der Syntheseaufwand auf ein Minimum reduziert werden, zum anderen ist es auf diesem Weg möglich die Längen der einzelnen Arme, unabhängig voneinander, über einen breiten Molmassenbereich zu variieren.

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.

Operating System Contribution to Composable Timing Behaviour in High-Integrity Real-Time Systems

The development of High-Integrity Real-Time Systems has a high footprint in terms of human, material and schedule costs. Factoring functional, reusable logic in the application favors incremental development and contains costs. Yet, achieving incrementality in the timing behavior is a much harder problem. Complex features at all levels of the execution stack, aimed to boost average-case performance, exhibit timing behavior highly dependent on execution history, which wrecks time composability and incrementaility with it. Our goal here is to restitute time composability to the execution stack, working bottom up across it. We first characterize time composability without making assumptions on the system architecture or the software deployment to it. Later, we focus on the role played by the real-time operating system in our pursuit. Initially we consider single-core processors and, becoming less permissive on the admissible hardware features, we devise solutions that restore a convincing degree of time composability. To show what can be done for real, we developed TiCOS, an ARINC-compliant kernel, and re-designed ORK+, a kernel for Ada Ravenscar runtimes. In that work, we added support for limited-preemption to ORK+, an absolute premiere in the landscape of real-word kernels. Our implementation allows resource sharing to co-exist with limited-preemptive scheduling, which extends state of the art. We then turn our attention to multicore architectures, first considering partitioned systems, for which we achieve results close to those obtained for single-core processors. Subsequently, we shy away from the over-provision of those systems and consider less restrictive uses of homogeneous multiprocessors, where the scheduling algorithm is key to high schedulable utilization. To that end we single out RUN, a promising baseline, and extend it to SPRINT, which supports sporadic task sets, hence matches real-world industrial needs better. To corroborate our results we present findings from real-world case studies from avionic industry.

Transport Properties and Novel Sensing Applications of Organic Semiconducting Crystals

The present thesis is focused on the study of Organic Semiconducting Single Crystals (OSSCs) and crystalline thin films. In particular solution-grown OSSC, e.g. 4-hdroxycyanobenzene (4HCB) have been characterized in view of their applications as novel sensors of X-rays, gamma-rays, alpha particles radiations and chemical sensors. In the field of ionizing radiation detection, organic semiconductors have been proposed so far mainly as indirect detectors, i.e. as scintillators or as photodiodes. I first study the performance of 4HCB single crystals as direct X-ray detector i.e. the direct photon conversion into an electrical signal, assessing that they can operate at room temperature and in atmosphere, showing a stable and linear response with increasing dose rate. A dedicated study of the collecting electrodes geometry, crystal thickness and interaction volume allowed us to maximize the charge collection efficiency and sensitivity, thus assessing how OSSCs perform at low operating voltages and offer a great potential in the development of novel ionizing radiation sensors. To better understand the processes generating the observed X-ray signal, a comparative study is presented on OSSCs based on several small-molecules: 1,5-dinitronaphthalene (DNN), 1,8-naphthaleneimide (NTI), Rubrene and TIPS-pentacene. In addition, the proof of principle of gamma-rays and alpha particles has been assessed for 4HCB single crystals. I have also carried out an investigation of the electrical response of OSSCs exposed to vapour of volatile molecules, polar and non-polar. The last chapter deals with rubrene, the highest performing molecular crystals for electronic applications. We present an investigation on high quality, millimeter-sized, crystalline thin films (10 – 100 nm thick) realized by exploiting organic molecular beam epitaxy on water-soluble substrates. Space-Charge-Limited Current (SCLC) and photocurrent spectroscopy measurements have been carried out. A thin film transistor was fabricated onto a Cytop® dielectric layer. The FET mobility exceeding 2 cm2/Vs, definitely assess the quality of RUB films.

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.

Synthesis, properties and application of polyphenylene phosphonium salts

The central objective of this work was to generate weakly coordinating cations of unprecedented molecular size providing an inherently stable hydrophobic shell around a central charge. It was hypothesized that divergent dendritic growth by means of thermal [4+2] Diels-Alder cycloaddition might represent a feasible synthetic method to circumvent steric constraints and enable a drastic increase in cation size.rnThis initial proposition could be verified: applying the divergent dendrimer synthesis to an ethynyl-functionalized tetraphenylphosphonium derivative afforded monodisperse cations with precisely nanoscopic dimensions for the first time. Furthermore, the versatile nature of the applied cascade reactions enabled a throughout flexible design and structural tuning of the desired target cations. The specific surface functionalization as well as the implementation of triazolyl-moieties within the dendrimer scaffold could be addressed by sophisticated variation of the employed building block units (see chapter 3). rnDue to the steric screening provided by their large, hydrophobic and shape-persistent polyphenylene shells, rigidly dendronized cations proved more weakly coordinating compared to their non-dendronized analogues. This hypothesis has been experimentally confirmed by means of dielectric spectroscopy (see chapter 4). It was demonstrated for a series of dendronized borate salts that the degree of ion dissociation increased with the size of the cations. The utilization of the very large phosphonium cations developed within this work almost achieved to separate the charge carriers about the Bjerrum length in solvents of low polarity, which was reflected by approaching near quantitative ion dissociation even at room temperature. In addition to effect the electrolyte behavior in solution, the steric enlargement of ions could be visualized by means of several crystal structure analyses. Thus an insight into lattice packing under the effect of extraordinary large cations could be gathered. rnAn essential theme of this work focused on the application of benzylphosphonium salts in the classical Wittig reaction, where the concept of dendronization served as synthetic means to introduce an exceptionally large polyphenylene substituent at the -position. The straightforward influence of this unprecedented bulky group on the Wittig stereochemistry was investigated by NMR-analysis of the resulting alkenes. Based on the obtained data a valuable explanation for the origin of the observed selectivity was brought in line with the up-to-date operating [2+2] cycloaddition mechanism. Furthermore, a reliable synthesis protocol for unsymmetrically substituted polyphenylene alkenes and stilbenes was established by the design of custom-built polyphenylene precursors (see chapter 5).rnFinally, fundamental experiments to functionalize a polymer chain with sterically shielded ionic groups either in the pending or internal position were outlined within this work. Thus, inherently hydrophobic polysalts shall be formed so that future research can invesigate their physical properties with regard to counter ion condensation and charge carrier mobility.rnIn summary, this work demonstrates how the principles of dendrimer chemistry can be applied to modify and specifically tailor the properties of salts. The numerously synthesized dendrimer-ions shown herein represent a versatile interface between classic organic and inorganic electrolytes, and defined macromolecular structures in the nanometer-scale. Furthermore the particular value of polyphenylene dendrimers in terms of a broad applicability was illustrated. This work accomplished in an interdisciplinary manner to give answer to various questions such as structural modification of ions, the resulting influence on the electrolyte behavior, as well as the stereochemical control of organic syntheses via polyphenylene phosphonium salts. rn

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.

Valutazione delle funzioni obiettivo nell'operating theatre scheduling

il ruolo della tesi è stato di valorizzare attraverso la valutazione di un peso l'urgenza e la necessità di cure dei pazienti processati da un modello di ottimizzazione. Essa si inserisce all'interno di un progetto di creazione di tale modello per la schedulazione di interventi in un reparto chirurgico di un generico ospedale.si è fatto uso del software ibm opl optimization suite.

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.

Adverse effect of noise in the operating theatre on surgical-site infection

The aim of this pilot study was to evaluate the noise level in an operating theatre as a possible surrogate marker for intraoperative behaviour, and to detect any correlation between sound level and subsequent surgical-site infection (SSI).

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.