Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loos of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study

Aims: To assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED). Methods and results: A multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were 14 years old and were admitted to the ED because of an episode of T-LOC. Questionnaires and corresponding electrocardiograms (ECGs) were reviewed by a Steering Committee (SC) to unify diagnostic criteria, evaluate adherence to guidelines, and diagnose correctly the ECGs. We included 1419 patients (prevalence, 1.14%).ECG was performed in 1335 patients (94%) in the ED: 498 (37.3%) ECGs were classified as abnormal. The positive diagnostic yield ranged from 0% for the chest X-ray to 12% for the orthostatic test. In the ED, 1217 (86%) patients received a final diagnosis of syncope, whereas the remaining 202 (14%) were diagnosed of non-syncopal transient lossof consciousness (NST-LOC). After final review by the SC, 1080 patients (76%) were diagnosed of syncope, whereas 339 (24%) were diagnosed of NST-LOC (P , 0.001). Syncope was diagnosed correctly in 84% of patients. Only 25% of patients with T-LOC were admitted to hospitals. Conclusion Adherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.

Ion-temperature-sensitive effect in transient langmuir probe response

A theory is presented for a method, recently proposed by Hester and Sonin, of determining the ion temperature in a plasma by measuring the transient current to a cylindrical Langmuir probe after applying a potential Vp{ — eVpy>KTe) under conditions where collection is collision free and the ratio of probe radius to Debye length is small. The ion component of the current does not approach its final steady-state value monotonicalfy, but exhibits a strong, ion-temperature-dependent overshoot in the first few ion-plasma periods following the biasing of the probe. Analytical formulas are derived for the case of a Maxwellian plasma, and convenient graphical results are presented. The possible masking of the overshoot by a transient displacement current is discussed; it is shown how to avoid such displacement effects. For the overshoot to be sensitive to the ion temperature T the probe must be near plasma (zero) potential before applying V1,(eVp~<0.lKTe, VP~ being that initial potential); this is not a drawback of the method, but, on the contrary, it can be used to accurately determine plasma potential along with T.

The influence of economic incentives linked to road safety indicators on accidents: The case of toll concessions in Spain

The goal of this paper is to evaluate whether the incentives incorporated in toll highway concession contracts in order to encourage private operators to adopt measures to reduce accidents are actually effective at improving safety. To this end, we implemented negative binomial regression models using information about highway characteristics and accident data from toll highway concessions in Spain from 2007 to 2009. Our results show that even though road safety is highly influenced by variables that are not managed by the contractor, such as the annual average daily traffic (AADT), the percentage of heavy vehicles on the highway, number of lanes, number of intersections and average speed; the implementation of these incentives has a positive influence on the reduction of accidents and injuries. Consequently, this measure seems to be an effective way of improving safety performance in road networks.

Transient acoustic response in car cabins with localization of reflections

Due to its small size and the restrictions on source and listener positions, the design of sound reproduction systems for car cabins is particularly cumbersome. In the present project the measurement of the impulse response between a single loudspeaker and a listener position, with special emphasis on the directional characteristics, will be examined. The propagation paths inside a car are very short, meaning that it is very difficult for the existing commercial measurement systems to resolve the different reflections arriving to the listener. This paper propose a first approach of an algorithm based on time difference of arrival along a measurement technique aiming at finding the reflections and their direction of arrival to the listener. To this end a circular microphone array at a known position is employed, along with Maximum-Length Sequences (MLS) measurement technique. The results are processed so as to extract the directional properties, demonstrate the physical limitations that can influence or prevent this detection in practice. Measurements were carried out in a free-field environment (anechoic chamber) making use of different panels closer around the microphone array. RESUMEN. El diseño de sistemas de reproducción de audio para cabinas de coche es especialmente complicado debido al reducido tamaño del espacio y las restricciones de los altavoces y posiciones de escucha de los ocupantes. En el presente proyecto, se examinan mediciones de la respuesta al impulso entre un altavoz y una posición de escucha con especial énfasis en las características direccionales. Los caminos de propagación de las ondas sonoras dentro de un coche son muy cortos, lo que hace difícil para los instrumentos de medida existentes en el mercado determinar las direcciones de llegada de las diferentes reflexiones que llegan a una posición de escucha. Este trabajo propone una primera aproximación de un algoritmo, basado en las diferencias temporales de llegada de una onda a diferentes puntos de medida, y una particular técnica de medida de la respuesta al impulso para obtener las direcciones de llegada de reflexiones a una posición de escucha. Para ello, se emplea una matriz circular de micrófonos en una posición conocida junto con la técnica de medida MLS (Maximum Length Sequence). Los resultados obtenidos son procesados para extraer la dirección de llegada de las reflexiones acústicas y encontrar las limitaciones que influyan en la detección de dichas reflexiones. Las mediciones se llevan a cabo en un entorno de campo libre y utilizando diferentes superficies reflectantes alrededor de la matriz de micrófonos.

Impedance-based stability and transient-performance assessment applying maximum peak criteria

The impedance-based stability-assessment method has turned out to be a very effective tool and its usage is rapidly growing in different applications ranging from the conventional interconnected dc/dc systems to the grid-connected renewable energy systems. The results are sometime given as a certain forbidden region in the complex plane out of which the impedance ratio--known as minor-loop gain--shall stay for ensuring robust stability. This letter discusses the circle-like forbidden region occupying minimum area in the complex plane, defined by applying maximum peak criteria, which is well-known theory in control engineering. The investigation shows that the circle-like forbidden region will ensure robust stability only if the impedance-based minor-loop gain is determined at the very input or output of each subsystem within the interconnected system. Experimental evidence is provided based on a small-scale dc/dc distributed system.

Safety and operability of small fishing vessels: study of a series of stability-related accidents

The intact stability of five small Spanish fishing vessels with ages between 3 and 8 years old which sunk in stability related accidents between 2004 and 2007 is compared to the stability of the fishing vessels which were retired from service to build those. The seakeeping performance of both sets of vessels is also compared. The differences found between the results obtained by the two methods have been analyzed. The suitability of seakeeping methods to assess stability performance is discussed.

Fishing effort control regulations influence on stability, safety and operability of small fishing vessels: study of a series of stability related accidents occurred in Spain between 2004 and 2007

Entre los años 2004 y 2007 se hundieron por problemas de estabilidad cinco pesqueros españoles de pequeña eslora, de características parecidas, de relativamente poca edad, que habían sido construidos en un intervalo de pocos años. La mayoría de los tripulantes de esos pesqueros fallecieron o desaparecieron en esos accidentes. Este conjunto de accidentes tuvo bastante repercusión social y mediática. Entre ingenieros navales y marinos del sector de la pesca se relacionó estos accidentes con los condicionantes a los diseños de los pesqueros impuestos por la normativa de control de esfuerzo pesquero. Los accidentes fueron investigados y publicados sus correspondientes informes; en ellos no se exploró esta supuesta relación. Esta tesis pretende investigar la relación entre esos accidentes y los cambios de la normativa de esfuerzo pesquero. En la introducción se expone la normativa de control de esfuerzo pesquero analizada, se presentan datos sobre la estructura de la flota pesquera en España y su accidentalidad, y se detallan los criterios de estabilidad manejados durante el trabajo, explicando su relación con la seguridad de los pesqueros. Seguidamente se realiza un análisis estadístico de la siniestralidad en el sector de la pesca para establecer si el conjunto de accidentes estudiados supone una anomalía, o si por el contrario el conjunto de estos accidentes no es relevante desde el punto de vista estadístico. Se analiza la siniestralidad a partir de diversas bases de datos de buques pesqueros en España y se concluye que el conjunto de accidentes estudiados supone una anomalía estadística, ya que la probabilidad de ocurrencia de los cinco sucesos es muy baja considerando la frecuencia estimada de pérdidas de buques por estabilidad en el subsector de la flota pesquera en el que se encuadran los cinco buques perdidos. A continuación el trabajo se centra en la comparación de los buques accidentados con los buques pesqueros dados de baja para construir aquellos, según exige la normativa de control de esfuerzo pesquero; a estos últimos buques nos referiremos como “predecesores” de los buques accidentados. Se comparan las dimensiones principales de cada buque y de su predecesor, resultando que los buques accidentados comparten características de diseño comunes que son sensiblemente diferentes en los buques predecesores, y enlazando dichas características de diseño con los requisitos de la nueva normativa de control del esfuerzo pesquero bajo la que se construyeron estos barcos. Ello permite establecer una relación entre los accidentes y el mencionado cambio normativo. A continuación se compara el margen con que se cumplían los criterios reglamentarios de estabilidad entre los buques accidentados y los predecesores, encontrándose que en cuatro de los cinco casos los predecesores cumplían los criterios de estabilidad con mayor holgura que los buques accidentados. Los resultados obtenidos en este punto permiten establecer una relación entre el cambio de normativa de esfuerzo pesquero y la estabilidad de los buques. Los cinco buques accidentados cumplían con los criterios reglamentarios de estabilidad en vigor, lo que cuestiona la relación entre esos criterios y la seguridad. Por ello se extiende la comparativa entre pesqueros a dos nuevos campos relacionados con la estabilidad y la seguridad delos buques: • Movimientos a bordo (operatividad del buque), y • Criterios de estabilidad en condiciones meteorológicas adversas El estudio de la operatividad muestra que los buques accidentados tenían, en general, una mayor operatividad que sus predecesores, contrariamente a lo que sucedía con el cumplimiento de los criterios reglamentarios de estabilidad. Por último, se comprueba el desempeño de los diez buques en dos criterios específicos de estabilidad en caso de mal tiempo: el criterio IMO de viento y balance intenso, y un criterio de estabilidad de nueva generación, incluyendo la contribución original del autor de considerar agua en cubierta. Las tendencias observadas en estas dos comparativas son opuestas, lo que permite cuestionar la validez del último criterio sin un control exhaustivo de los parámetros de su formulación, poniendo de manifiesto la necesidad de más investigaciones sobre ese criterio antes de su adopción para uso regulatorio. El conjunto de estos resultados permite obtener una serie de conclusiones en la comparativa entre ambos conjuntos de buques pesqueros. Si bien los resultados de este trabajo no muestran que la aprobación de la nueva normativa de esfuerzo pesquero haya significado una merma general de seguridad en sectores enteros de la flota pesquera, sí se concluye que permitió que algunos diseños de buques pesqueros, posiblemente en busca de la mayor eficiencia compatible con dicha normativa, quedaran con una estabilidad precaria, poniendo de manifiesto que la relación entre seguridad y criterios de estabilidad no es unívoca, y la necesidad de que éstos evolucionen y se adapten a los nuevos diseños de buques pesqueros para continuar garantizando su seguridad. También se concluye que la estabilidad es un aspecto transversal del diseño de los buques, por lo que cualquier reforma normativa que afecte al diseño de los pesqueros o su forma de operar debería estar sujeta a evaluación por parte de las autoridades responsables de la seguridad marítima con carácter previo a su aprobación. ABSTRACT Between 2004 and 2007 five small Spanish fishing vessels sank in stability related accidents. These vessels had similar characteristics, had relatively short age, and had been built in a period of a few years. Most crewmembers of these five vessels died or disappeared in those accidents. This set of accidents had significant social and media impact. Among naval architects and seamen of the fishing sector these accidents were related to the design constraints imposed by the fishing control effort regulations. The accidents were investigated and the official reports issued; this alleged relationship was not explored. This thesis aims to investigate the relationship between those accidents and changes in fishing effort control regulations. In the introduction, the fishing effort control regulation is exposed, data of the Spanish fishing fleet structure and its accident rates are presented, and stability criteria dealt with in this work are explained, detailing its relationship with fishing vessel safety. A statistical analysis of the accident rates in the fishing sector in Spain is performed afterwards. The objective is determining whether the set of accidents studied constitute an anomaly or, on the contrary, they are not statistically relevant. Fishing vessels accident rates is analyzed from several fishing vessel databases in Spain. It is concluded that the set of studied accidents is statistically relevant, as the probability of occurrence of the five happenings is extremely low, considering the loss rates in the subsector of the Spanish fishing fleet where the studied vessels are fitted within. From this point the thesis focuses in comparing the vessels lost and the vessels that were decommissioned to build them as required by the fishing effort control regulation; these vessels will be referred to as “predecessors” of the sunk vessels. The main dimensions between each lost vessel and her predecessor are compared, leading to the conclusion that the lost vessels share design characteristics which are sensibly different from the predecessors, and linking these design characteristics with the requirements imposed by the new fishing control effort regulations. This allows establishing a relationship between the accidents and this regulation change. Then the margin in fulfilling the regulatory stability criteria among the vessels is compared, resulting, in four of the five cases, that predecessors meet the stability criteria with greater clearance than the sunk vessels. The results obtained at this point would establish a relationship between the change of fishing effort control regulation and the stability of vessels. The five lost vessels complied with the stability criteria in force, so the relation between these criteria and safety is put in question. Consequently, the comparison among vessels is extended to other fields related to safety and stability: • Motions onboard (operability), and • Specific stability criteria in rough weather The operability study shows that the lost vessels had in general greater operability than their predecessors, just the opposite as when comparing stability criteria. Finally, performance under specific rough weather stability criteria is checked. The criteria studied are the IMO Weather Criterion, and one of the 2nd generation stability criteria under development by IMO considering in this last case the presence of water on deck, which is an original contribution by the author. The observed trends in these two cases are opposite, allowing to put into question the last criterion validity without an exhaustive control of its formulation parameters; indicating that further research might be necessary before using it for regulatory purposes. The analysis of this set of results leads to some conclusions when comparing both groups of fishing vessels. While the results obtained are not conclusive in the sense that the entry into force of a new fishing effort control in 1998 caused a generalized safety reduction in whole sectors of the Spanish fishing fleet, it can be concluded that it opened the door for some vessel designs resulting with precarious stability. This evidences that the relation between safety and stability criteria is not univocal, so stability criteria needs to evolve for adapting to new fishing vessels designs so their safety is still guaranteed. It is also concluded that stability is a transversal aspect to ship design and operability, implying that any legislative reform affecting ship design or operating modes should be subjected to assessing by the authorities responsible for marine safety before being adopted.

Effects of cross sections tables generation and optimization on rod ejection transient analyses

Best estimate analysis of rod ejection transients requires 3D kinetics core simulators. If they use cross sections libraries compiled in multidimensional tables,interpolation errors – originated when the core simulator computes the cross sections from the table values – are a source of uncertainty in k-effective calculations that should be accounted for. Those errors depend on the grid covering the domain of state variables and can be easily reduced, in contrast with other sources of uncertainties such as the ones due to nuclear data, by choosing an optimized grid distribution. The present paper assesses the impact of the grid structure on a PWR rod ejection transient analysis using the coupled neutron-kinetics/thermal-hydraulicsCOBAYA3/COBRA-TF system. Forthispurpose, the OECD/NEA PWR MOX/UO2 core transient benchmark has been chosen, as material compositions and geometries are available, allowing the use of lattice codes to generate libraries with different grid structures. Since a complete nodal cross-section library is also provided as part of the benchmark specifications, the effects of the library generation on transient behavior are also analyzed.Results showed large discrepancies when using the benchmark library and own-generated libraries when compared with benchmark participants’ solutions. The origin of the discrepancies was found to lie in the nodal cross sections provided in the benchmark.

Transient behavior of a system composed of conductive thin wire structures excited by harmonic and lightning type signals

The transient response of a system of independent electrodes buried in a semi-infinite conducting medium is studied. Using a simple and versatile numerical scheme written by the authors and based on the Electric Field Integral Equation (EFIE), the effect caused by harmonic signals ranging on frequency from Hz to hundred of MHz, and also by lightning type driving signal striking at a remote point far from the conductors, is extensively studied. The value of the scalar potential appearing on the electrodes as a function of the frequency of the applied signal is one of the variables investigated. Other features such as the input impedance at the injection point of the signal and the Ground Potential Rise (GPR) over the electrode system are also discussed

Poisson dynamic models. An application to interurban accidents in Spain

In this study we apply count data models to four integer–valued time series related to accidentality in Spanish roads applying both the frequentist and Bayesian approaches. The time series are: number of fatalities, number of fatal accidents, number of killed or seriously injured (KSI) and number of accidents with KSI. The model structure is Poisson regression with first order autoregressive errors. The purpose of the paper is first to sort out the explanatory variables by relevance and second to carry out a prediction exercise for validation.

Transient thermal analysis during the ascent phase of a balloon-borne payload. Comparison with SUNRISE test flight measurements

The thermal design of stratospheric balloon payloads usually focuses on the cruise phase of the missions, that is, the floating altitude conditions. The ascent phase usually takes between 2 and 4 h, a very small period compared to the duration of the whole mission, which can last up to 4 weeks. However, during this phase payloads are subjected to very harsh conditions due mainly to the convective cooling that occurs as the balloon passes through the cold atmosphere, with minimum temperatures in the tropopause. The aim of this work is to study the thermal behaviour of a payload carried by a long duration balloon during the ascent phase. Its temperature has been calculated as a function of the altitude from sea level to floating conditions. To perform this analysis it has been assumed that the thermal interactions (convection and radiation) depend on the altitude, on the environmental conditions (which in turn depend also on the altitude) and on the temperature of the system itself. The results have been compared with the measurements taken during the SUNRISE test flight, launched in October 2007 by CSBF from Fort Sumner (New Mexico).

Transient excess of MYC activity can elicit genomic instability and tumorigenesis

Overexpression of the MYC protooncogene has been implicated in the genesis of diverse human tumors. Tumorigenesis induced by MYC has been attributed to sustained effects on proliferation and differentiation. Here we report that MYC may also contribute to tumorigenesis by destabilizing the cellular genome. A transient excess of MYC activity increased tumorigenicity of Rat1A cells by at least 50-fold. The increase persisted for >30 days after the return of MYC activity to normal levels. The brief surfeit of MYC activity was accompanied by evidence of genomic instability, including karyotypic abnormalities, gene amplification, and hypersensitivity to DNA-damaging agents. MYC also induced genomic destabilization in normal human fibroblasts, although these cells did not become tumorigenic. Stimulation of Rat1A cells with MYC accelerated their passage through G1/S. Moreover, MYC could force normal human fibroblasts to transit G1 and S after treatment with N-(phosphonoacetyl)-l-aspartate (PALA) at concentrations that normally lead to arrest in S phase by checkpoint mechanisms. Instead, the cells subsequently appeared to arrest in G2. We suggest that the accelerated passage through G1 was mutagenic but that the effect of MYC permitted a checkpoint response only after G2 had been reached. Thus, MYC may contribute to tumorigenesis through a dominant mutator effect.

Immunologic tolerance to myelin basic protein decreases stroke size after transient focal cerebral ischemia

Immune mechanisms contribute to cerebral ischemic injury. Therapeutic immunosuppressive options are limited due to systemic side effects. We attempted to achieve immunosuppression in the brain through oral tolerance to myelin basic protein (MBP). Lewis rats were fed low-dose bovine MBP or ovalbumin (1 mg, five times) before 3 h of middle cerebral artery occlusion (MCAO). A third group of animals was sensitized to MBP but did not survive the post-stroke period. Infarct size at 24 and 96 h after ischemia was significantly less in tolerized animals. Tolerance to MBP was confirmed in vivo by a decrease in delayed-type hypersensitivity to MBP. Systemic immune responses, characterized in vitro by spleen cell proliferation to Con A, lipopolysaccharide, and MBP, again confirmed antigen-specific immunologic tolerance. Immunohistochemistry revealed transforming growth factor β1 production by T cells in the brains of tolerized but not control animals. Systemic transforming growth factor β1 levels were equivalent in both groups. Corticosterone levels 24 h after surgery were elevated in all sham-operated animals and ischemic control animals but not in ischemic tolerized animals. These results demonstrate that antigen-specific modulation of the immune response decreases infarct size after focal cerebral ischemia and that sensitization to the same antigen may actually worsen outcome.

INAF, a protein required for transient receptor potential Ca2+ channel function

The trp gene of Drosophila encodes a subunit of a class of Ca2+-selective light-activated channels that carry the bulk of the phototransduction current. Transient receptor potential (TRP) homologs have been identified throughout animal phylogeny. In vertebrates, TRP-related channels have been suggested to mediate “store-operated Ca2+ entry,” which is important in Ca2+ homeostasis in a wide variety of cell types. However, the mechanisms of activation and regulation of the TRP channel are not known. Here, we report on the Drosophila inaF gene, which encodes a highly eye-enriched protein, INAF, that appears to be required for TRP channel function. A null mutation in this gene significantly reduces the amount of the TRP protein and, in addition, specifically affects the TRP channel function so as to nearly shut down its activity. The inaF mutation also dramatically suppresses the severe degeneration caused by a constitutively active mutation in the trp gene. Although the reduction in the amount of the TRP protein may contribute to these phenotypes, several lines of evidence support the view that inaF mutations also more directly affect the TRP channel function, suggesting that the INAF protein may have a regulatory role in the channel function.

Stimulation of the blue light phototropic receptor NPH1 causes a transient increase in cytosolic Ca2+

Blue light regulates plant growth and development, and three photoreceptors, CRY1, CRY2, and NPH1, have been identified. The transduction pathways of these receptors are poorly understood. Transgenic plants containing aequorin have been used to dissect the involvement of these three receptors in the regulation of intracellular Ca2+. Pulses of blue light induce cytosolic Ca2+ transients lasting about 80 s in Arabidopsis and tobacco seedlings. Use of organelle-targeted aequorins shows that Ca2+ increases are limited to the cytoplasm. Blue light treatment of cry1, cry2, and nph1 mutants showed that NPH1, which regulates phototropism, is largely responsible for the Ca2+ transient. The spectral response of the Ca2+ transient is similar to that of phototropism, supporting NPH1 involvement. Furthermore, known interactions between red and blue light and between successive blue light pulses on phototropic sensitivity are mirrored in the blue light control of cytosolic Ca2+ in these seedlings. Our observations raise the possibility that physiological responses regulated by NPH1, such as phototropism, may be transduced through cytosolic Ca2+.