Severity in biliary peritonitis

Objective. To analyze clinical and laboratory findings in order to find variables predictive of severity of Biliary Peritonitis (BP). Patients and methods. Physical findings, course of illness, imaging and laboratory data were evaluated in 42 patients with BP, and statistically analysed to assess their prognostic significance. Results. Serious illness and worse outcome were associated with: age ≥ 60 years (P=0.034), long time between onset of symptoms and treatment (P=0.025), fever > 38°C (P=0.009), WBC count > 17,000 cell/mm³ (P=0.043), diffuse abdominal pain (P=0.034), and infected bile (P=0.048). Conclusions. Most patients become severely ill due to supervening infection, while early bile drainage avoids serious complications. In addition, abdominal pain, fever and WBC count are also predictive of severity of BP.

A Periodic State Space Model to Monthly Long-term Temperature Data

This work presents a periodic state space model to model monthly temperature data. Additionally, some issues are discussed, as the parameter estimation or the Kalman filter recursions adapted to a periodic model. This framework is applied to monthly long-term temperature time series of Lisbon.

Nonlinear periodic problems with a jumping reaction

We consider a periodic problem driven by the scalar $p-$Laplacian and with a jumping (asymmetric) reaction. We prove two multiplicity theorems. The first concerns the nonlinear problem ($1

Managing and utilizing information flow for new products’ periodic account sales process

The goal was to understand, document and module how information is currently flown internally in the largest dairy organization in Finland. The organization has undergone radical changes in the past years due to economic sanctions between European Union and Russia. Therefore, organization’s ultimate goal would be to continue its growth through managing its sales process more efficiently. The thesis consists of a literature review and an empirical part. The literature review consists of knowledge management and process modeling theories. First, the knowledge management discusses how data, information and knowledge are exchanged in the process. Knowledge management models and processes are describing how knowledge is created, exchanged and can be managed in an organization. Secondly, the process modeling is responsible for visualizing information flow through discussion of modeling approaches and presenting different methods and techniques. Finally, process’ documentation procedure was presented. In the end, a constructive research approach was used in order to identify process’ related problems and bottlenecks. Therefore, possible solutions were presented based on this approach. The empirical part of the study is based on 37 interviews, organization’s internal data sources and theoretical framework. The acquired data and information were used to document and to module the sales process in question with a flowchart diagram. Results are conducted through construction of the flowchart diagram and analysis of the documentation. In fact, answers to research questions are derived from empirical and theoretical parts. In the end, 14 problems and two bottlenecks were identified in the process. The most important problems are related to approach and/or standardization for information sharing, insufficient information technology tool utilization and lack of systematization of documentation. The bottlenecks are caused by the alarming amount of changes to files after their deadlines.

Efficient split eld FDTD analysis of third-order nonlinear materials in two-dimensionally periodic media

In this work the split-field finite-difference time-domain method (SF-FDTD) has been extended for the analysis of two-dimensionally periodic structures with third-order nonlinear media. The accuracy of the method is verified by comparisons with the nonlinear Fourier Modal Method (FMM). Once the formalism has been validated, examples of one- and two-dimensional nonlinear gratings are analysed. Regarding the 2D case, the shifting in resonant waveguides is corroborated. Here, not only the scalar Kerr effect is considered, the tensorial nature of the third-order nonlinear susceptibility is also included. The consideration of nonlinear materials in this kind of devices permits to design tunable devices such as variable band filters. However, the third-order nonlinear susceptibility is usually small and high intensities are needed in order to trigger the nonlinear effect. Here, a one-dimensional CBG is analysed in both linear and nonlinear regime and the shifting of the resonance peaks in both TE and TM are achieved numerically. The application of a numerical method based on the finite- difference time-domain method permits to analyse this issue from the time domain, thus bistability curves are also computed by means of the numerical method. These curves show how the nonlinear effect modifies the properties of the structure as a function of variable input pump field. When taking the nonlinear behaviour into account, the estimation of the electric field components becomes more challenging. In this paper, we present a set of acceleration strategies based on parallel software and hardware solutions.

Principales agentes causales de peritonitis asociada a diálisis peritoneal de catéter blando y rígido y su sensibilidad antimicrobiana, en pacientes de nefrología del Hospital Nacional Rosales, de Mayo a Octubre de 2013

La falla renal crónica definitiva ocasiona la acumulación de productos metabólicos de desecho, alteraciones en el volúmen y en la concentración de electrólitos, así como diversos trastornos endocrinos. La diálisis peritoneal es una forma efectiva de terapia sustitutiva de la función renal. El Hospital Nacional Rosales, es la institución que más demanda tiene de servicios, y como en todo centro de salud es necesario conocer los patrones de susceptibilidad y las posibles terapias empíricas para las diferentes infeccines nosocomiales asociadas a la diálisis peritoneal. El objetivo del presente estudio es el de determinar cuáles son los microorganismos más comunes y su sensibilidad antimicrobiana en pacientes con peritonitis asociada a diálisis peritoneal en el programa de nefrología, de mayo a octubre de 2013. Materiales y método: observacional descriptivo y transversal. Periodo de investigación: mayo a octubre de 2013. Universo: cultivos de líquido peritoneal de pacientes de nefrología con diálisis peritoneal con catéter rígido o blando en el periodo mayo a octubre de 2013. Muestra: cultivos de líquido peritoneal positivos, de pacientes de nefrología con diálisis peritoneal con catéter rígido o blando en el periodo mayo a octubre de 2013. Tipo de muestreo: muestreo por cuotas. Resultados: el estudio mostró al igual que lo descrito en la literatura, que los microorganismos Gram positivos son los más frecuentemente identificados en las infecciones relacionadas a diálisis peritoneal, en catéter blando, y aunque a nivel internacional no está descrito el uso también en catéter rígido. Y que cada hospital, dependiendo de sus estudios de susceptibilidad, debe implementar su terapia empírica. Nosotros recomendamos iniciar el tratamiento con Vancomicina y Cefalosporina de cuarta generación o Amikacina, mientras se obtiene el reporte del cultivo del Líquido Ascítico.

Unfolding Operator Method for Thin Domains with a Locally Periodic Highly Oscillatory Boundary

We analyze the behavior of solutions of the Poisson equation with homogeneous Neumann boundary conditions in a two-dimensional thin domain which presents locally periodic oscillations at the boundary. The oscillations are such that both the amplitude and period of the oscillations may vary in space. We obtain the homogenized limit problem and a corrector result by extending the unfolding operator method to the case of locally periodic media.

Diez años del Registro Uruguayo de Peritonitis en Diálisis Peritoneal

La peritonitis es una complicación grave de la diálisis peritoneal (DP), por lo que interesa conocer la incidencia y sensibilidad antibiótica de los gérmenes causantes. En Uruguay, desde el 1° de enero de 2004, se realiza un registro nacional de las peritonitis en DP, gérmenes, sensibilidad y evolución. Método: se analizaron los registros desde el 1° de enero de 2004 al 31 de diciembre de 2013. El registro fue aprobado por comités de ética institucionales. Resultados: en el período se registraron 850 peritonitis, con una incidencia que descendió de 0,49/paciente-año (2004-2005) a 0,37/paciente-año (2013). La incidencia de Staphylococcus aureus y Staphylococcus coagulasa negativo (SCoN) fue menor en 2009-2013 vs 2004-2005 (0,2 vs 0,12 peritonitis/paciente-año, test Poisson p<0,05). En 2009-2013: 14/54 S. aureus y 26/71 SCoN fueron meticilinorresistente, similar al período previo. El 98% de los gérmenes gramnegativos fueron sensibles a amikacina. En 145/467 (31%) episodios no se identificó germen. Se logró cura primaria en 71% de las peritonitis por grampositivos y en 45% por gramnegativos (chi2 p<0,05). En 2013 se observó mayor incidencia de peritonitis en los centros en los que no se controló el estado de portador nasal. Comentarios y conclusiones: se justifica implementar el control de portador de Staphylococcus aureus. La incidencia de peritonitis por S. aureus y SCoN meticilinorresistentes, la incidencia sostenida de gérmenes gramnegativos (con peor evolución), y el elevado porcentaje de cultivos sin desarrollo justifica mantener el protocolo antibiótico empírico inicial con vancomicina y amikacina. El descenso de la incidencia de S. aureus + SCoN podría ser atribuido a una mejor educación de los pacientes en DP.

Periodic emission of droplets from an oscillating electrified meniscus of a low-viscosity, highly conductive liquid

The generation of identical droplets of controllable size in the micrometer range is a problem of much interest owing to the numerous technological applications of such droplets. This work reports an investigation of the regime of periodic emission of droplets from an electrified oscillating meniscus of a liquid of low viscosity and high electrical conductivity attached to the end of a capillary tube, which may be used to produce droplets more than ten times smaller than the diameter of the tube. To attain this periodic microdripping regime, termed axial spray mode II by Juraschek and Röllgen [R. Juraschek and F. W. Röllgen, Int. J. Mass Spectrom. 177, 1 (1998)], liquid is continuously supplied through the tube at a given constant flow rate, while a dc voltage is applied between the tube and a nearby counter electrode. The resulting electric field induces a stress at the surface of the liquid that stretches the meniscus until, in certain ranges of voltage and flow rate, it develops a ligament that eventually detaches, forming a single droplet, in a process that repeats itself periodically. While it is being stretched, the ligament develops a conical tip that emits ultrafine droplets, but the total mass emitted is practically contained in the main droplet. In the parametrical domain studied, we find that the process depends on two main dimensionless parameters, the flow rate nondimensionalized with the diameter of the tube and the capillary time, q, and the electric Bond number BE, which is a nondimensional measure of the square of the applied voltage. The meniscus oscillation frequency made nondimensional with the capillary time, f, is of order unity for very small flow rates and tends to decrease as the inverse of the square root of q for larger values of this parameter. The product of the meniscus mean volume times the oscillation frequency is nearly constant. The characteristic length and width of the liquid ligament immediately before its detachment approximately scale as powers of the flow rate and depend only weakly on the applied voltage. The diameter of the main droplets nondimensionalized with the diameter of the tube satisfies dd≈(6/π)1/3(q/f)1/3, from mass conservation, while the electric charge of these droplets is about 1/4 of the Rayleigh charge. At the minimum flow rate compatible with the periodic regimen, the dimensionless diameter of the droplets is smaller than one-tenth, which presents a way to use electrohydrodynamic atomization to generate droplets of highly conducting liquids in the micron-size range, in marked contrast with the cone-jet electrospray whose typical droplet size is in the nanometric regime for these liquids. In contrast with other microdripping regimes where the mass is emitted upon the periodic formation of a narrow capillary jet, the present regime gives one single droplet per oscillation, except for the almost massless fine aerosol emitted in the form of an electrospray.

Report on the Status of Findings and Recommendations from the City of Bertram’s Periodic Examination Report dated August 27, 2014 for the period August 1, 2015 through July 31, 2016

Report on the Status of Findings and Recommendations from the City of Bertram’s Periodic Examination Report dated August 27, 2014 for the period August 1, 2015 through July 31, 2016

Report on the Status of Findings and Recommendations from the City of Olin’s Periodic Examination Report dated November 17, 2014 for the period June 1, 2015 through April 30, 2016

Report on the Status of Findings and Recommendations from the City of Olin’s Periodic Examination Report dated November 17, 2014 for the period June 1, 2015 through April 30, 2016

Report on the Status of Findings and Recommendations from the City of Kelley’s Periodic Examination Report dated December 11, 2014 for the period April 1, 2015 through March 31, 2016

Report on the Status of Findings and Recommendations from the City of Kelley’s Periodic Examination Report dated December 11, 2014 for the period April 1, 2015 through March 31, 2016